糖尿病合并缺血性心脏病患者的心率变异分析

为探讨Ⅱ型糖尿病合并缺血性心脏病患者的心率变异性及其临床意义，应用２４小时动态心电图监测７８例Ⅱ型糖尿病患者，并与４８例年龄、性别配对的正常人比较。结果显示Ⅱ型糖尿病患者１０项时域分析指标及心率变异指数均比正常人明显减低，最小心率比正常人增快；合并缺血性心脏病患者心率变异指数减低的阳性率明显高于同组其它Ⅱ型糖尿病患者。提示Ⅱ型糖尿病患者植物神经损害，迷走神经张力减低，心率变异性减低，而且其心率变异性减低程度与心脏损害程度有关。     

2型糖尿病患者无症状心肌缺血心率变异性的研究

目的冠心病是2型糖尿病主要心血管并发症,且经常表现为无症状心肌缺血（SMI）,本研究观察2型糖尿病患者SMI发作与心率变异性的相关性。方法在我院行运动负荷心肌灌注显像检查的患者中,选取1个月内做过动态心电图监测的157名无冠心病临床症状的2型糖尿病患者,其中34例为SMI患者;123例为无心肌缺血发作患者,并在其中随机选37例为对照组。结果SMI的发生率为21．6％;SMI组除24小时平均心率高于无心肌缺血组外。心率变异性各参数中：总体标准差、均值标准差、标准差均值、差值的均方根和差值〉50ms的百分比与无心肌缺血组相比较均明显下降。结论心率变异性减低与2型糖尿病合并SMI明显相关,而心率变异性减低作为评价心脏神经自主病变的早期信号,说明2型糖尿病合并SMI的发病与心脏自主神经病变密切相关,心率变异性或可作为无症状的2型糖尿病患者SMI筛查的指标之一。     

糖尿病合并无痛性心肌缺血患者心率变异分析

目的 探讨2型糖尿病合并无痛性心肌缺血患者及2型糖尿病合并冠心病心绞痛患者的心率变异性的差异。方法 应用24h动态心电图监测57例2型糖尿病患者，进行时域分析。结果 2型糖尿病合并无痛性心肌缺血患者比2型糖尿病合并冠心病心绞痛患者的心率变异性减低更明显。结论 2型糖尿病合并无痛性心肌缺血患者更应该引起临床的足够重视。     

糖尿病合并无痛性心肌缺血患者心率变异性临床分析

目的 探讨2 型糖尿病合并无痛性心肌缺血患者及2型糖尿病合并冠心病心绞痛患者的心率变异性(HRV)的差异.方法 应用24 h 动态心电图监测57例2型糖尿病患者,进行HRV时域分析.结果 2型糖尿病合并无痛性心肌缺血患者比2 型糖尿病合并冠心病心绞痛患者的心率变异性明显减低(P<0.05).结论 2型糖尿病合并无痛性心肌缺血患者更应该引起临床的足够重视.     

2型糖尿病合并冠心病的心率变异性分析

目的探讨2型糖尿病合并冠心病病人的心率变异性(HRV)及其临床意义。方法应用Holter监测123例2型糖尿病病人(其中合并冠心病45例),并与50名正常人对照,比较两组24h正常R-R间期标准差(SD),24h每5min正常R-R间期均值的标准差(SDA),24h相邻正常R-R间期差值均方根(RMSSD),相邻正常R-R间期差值大于50ms的个数占心跳总数百分比(PNN50),24h最大心率、最小心率、平均心率。结果2型糖尿病4项时域分析指标及心率变异指数均比正常人明显降低(P<0.01),最小心率及平均心率均比正常人增快(P<0.01),最大心率无统计学意义;2型糖尿病合并冠心病病人的心率变异指数降低的阳性率明显高于同组单纯2型糖尿病病人(P<0.01)。结论2型糖尿病病人自主神经损害,迷走神经张力减低,心率变异性降低,而且其心率变异性降低程度与心脏损害程度有关。     

糖尿病合并缺血性心脏病患者的心率变异分析

目的：糖尿病患者大部分死于心血管系统并发症，近来证明心率变异性是反映心脏自主神经活动的一项无创性指标，本文旨在研究ＩＩ型糖尿病合并缺血性心脏病患者的心率变异性。方法：应用２４小时动态心电图测定了７２例ＩＩ型糖尿病患者心率变异指数和心率，并与５０例年龄、性别配对的正常人比较。结果：ＩＩ型糖尿病患者心率变异指数比正常人明显减低（２３．４４±７．８７比３８．７３±１０．６８，Ｐ＜０．０１）。且２４小时平均心率和最慢心率比正常人增快（７８．６±８．５比７０．３±６．２，Ｐ＜０．０１；５７．０±８．９比４８．６±５．２，Ｐ＜０．０１）。其中２２例合并缺血性心脏病患者心率变异指数减低的阳性率明显高于其它ＩＩ型糖尿病患者（８２％比４８％，Ｐ＜０．０５）。结论：ＩＩ型糖尿病患者交感神经张力升高，迷走神经张力减低，伴有缺血性心脏病患者更显著，这可能意味着患者日后发生心性猝死的危险性增加。     

2型糖尿病合并充血性心力衰竭患者心率变异性分析

目的:探讨2型糖尿病(T2DM)合并慢性充血性心力衰竭(CHF)患者的心脏自主神经损害情况。方法:应用24 h动态心电图监测分析T2DM合并CHF患者的心率变异性,并和单纯T2DM患者及健康体检者对照。结果: T2DM合并CHF患者的心率变异性多种时域指标(SDNN、SDANN、SDNN-index、rMSSSD、PNN50)均较单纯T2DM 患者及健康体检者显著减低(P<0．01)。结论:T2DM合并CHF患者的心脏自主神经损害明显加重,应尽早进行检测和干预。     

2型糖尿病患者心率变异性分析

目的:分析2型糖尿病对心率变异性的影响。方法:对31例2型糖尿病患者和健康对照组进行24 h动态心电图监测,并测定心率变异性时域指标SDNN、SDNNIndex、SDANN、rMSSD、PNN50和频域指标TF、LF、HF、LF/HF和24h平均心率。结果:2型糖尿病患者心率变异性指标较对照组显著降低（P<0.05或P<0.01）。结论:2型糖尿病患者心率变异性减低,提示心脏自主神经功能受损。     

老年2型糖尿病合并冠心病患者的心率变异性分析

目的探讨老年2型糖尿病（T2DM）合并冠心病（CHD）患者心率变异性（HRV）分析的临床意义。方法对44例老年T2DM患者按照有无合并CHD分为2组，20例健康人为对照组，进行HRV时域分析。结果单纯T2DM组和合并CHD组的HRV时域各项指标均低于对照组（P〈0．05，P〈0．01）；合并CHD组的大部分参数值亦低于单纯T2DM组（P〈0．05）。结论老年T2DM合并CHD会显著加重心脏自主神经功能损害，使心率变异性降低。HRV能较直观地评价老年T2DM患者的心血管功能状态，有助于早期筛选高危患者，预防心血管事件的发生。     

冠心病合并高血压病患者的心率变异性分析

目的探讨冠心病合并高血压病患者心脏自主神经功能的变化规律。方法对42例冠心病合并高血压病患者进行24h心率变异时域分析,并与年龄匹配的单纯性冠心病患者(37例)及健康成人(30名)比较,观察心率变化规律。结果单纯性冠心病组心率变异时域分析指标比对照组减低(P0.05),而冠心病合并高血压病组心率变异性指标进一步减低(P0.01)。结论冠心病患者自主神经功能受损,伴高血压病患者自主神经功能进一步受损。     

Three layer functional model and energy exchange concept of aging process

Relying on a certain degree of abstraction, we can propose that no particular distinction exists between animate or living matter and inanimate matter. While focusing attention on some specifics, the dividing line between the two can be drawn. The most apparent distinction is in the level of structural and functional organization with the dissimilar streams of ‘energy flow’ between the observed entity and the surrounding environment. In essence, living matter is created from inanimate matter which is organized to contain internal intense energy processes and maintain lower intensity energy exchange processes with the environment. Taking internal and external energy processes into account, we contend in this paper that living matter can be referred to as matter of dissipative structure, with this structure assumed to be a common quality of all living creatures and living matter in general. Interruption of internal energy conversion processes and terminating the controlled energy exchange with the environment leads to degeneration of dissipative structure and reduction of the same to inanimate matter, (gas, liquid and/or solid inanimate substances), and ultimately what can be called ‘death.’ This concept of what we call dissipative nature can be extended from living organisms to social groups of animals, to mankind. An analogy based on the organization of matter provides a basis for a functional model of living entities. The models relies on the parallels among the three central structures of any cell (nucleus, cytoplasm and outer membrane) and the human body (central organs, body fluids along with the connective tissues, and external skin integument). This three-part structural organization may be observed almost universally in nature. It can be observed from the atomic structure to the planetary and intergalactic organizations. This similarity is corroborated by the membrane theory applied to living organisms. According to the energy nature of living matter and the proposed functional model, the decreased integrity of a human body's external envelope membrane is a first cause of the structural degradation and aging of the entire organism. The aging process than progresses externally to internally, as in single cell organisms, suggesting that much of the efforts towards the restoration and maintenance of the mechanisms responsible for structural development should be focused accordingly, on the membrane, i.e., the skin. Numerous reports indicate that all parts of the human body, like: bones, blood with blood vessels, muscles, skin, and so on, have some ability for restoration. Therefore, actual revival of not only aging tissue of the human body's membrane, but the entire human body enclosed within, with all internal organs, might be expected. We assess several aging theories within the context of our model and provide suggestions on how to activate the body's own anti-aging mechanisms and increase longevity. This paper presents some analogies and some distinctions that exist between the living dissipative structure matter and inanimate matter, discusses the aging process and proposes certain aging reversal solutions.     

Unusual responses of nocturnal pineal melatonin synthesis and secretion to swimming: Attempts to define mechanisms

Abstract: The effect of swimming at night on rat pineal melatonin synthesis was compared with that of light exposure at night. Rats were forced to swim at 0030 hr (lights out at 2000 hr) and sacrificed by decapitation 15 and 30 min later, immediately after swimming. Other groups of animals were exposed to white light (650μW/cm²) for 15 and 30 min at same time. Swimming caused a rapid and highly significant drop in the melatonin content in the pineal gland; however, the activity of N-acetyltransferase (NAT), the supposed rate limiting enzyme in the melatonin production, was not changed. Despite the drop in pineal melatonin levels, serum concentrations of the indole remained elevated in the rats that swam. In contrast, melatonin levels in the pineal and serum of light exposed rats fell precipitously, accompanied by a significant suppression of NAT activity. Since we anticipated that the strenuous exercise associated with swimming may induce release of artrial natriuretic peptide (ANP) from the heart, which in turn could cause the release of pineal melatonin, in a second study we injected physiological saline intravenously to stretch the cardiac muscle and release ANP. Three milliliters of normal saline was injected during the day into the jugular vein of anesthetized rats that were pretreated with isoproterenol to stimulate pineal melatonin production. Animals were killed 15 min after the saline injection, and pineal NAT activity and pineal melatonin levels were measured. The saline injections caused no alteration in the elevated levels of either NAT or melatonin. These data suggest that the disparity in pineal NAT activity (which was high) and pineal melatonin (which was low), in animals swum at night, may not be caused by ANP which is released during strenuous exercise such as swimming.     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Melatonin and photoperiodic time measurement: Seasonal breeding in the sheep

Abstract: Well-established circadian physiology supports the view that photoperiodic time measurement utilizes the coincidence between the presence of light and a photosensitive phase of a 'biological clock' to alter reproductive status—the so-called external coincidence model of seasonal breeding. In this review, we examine the mechanism whereby photoperiod interacts with presumed suprachiasmatic nuclei activity to allow endogenous melatonin to normally synchronize reproductive activity to the optimal time of year. The Romney Marsh sheep is particularly explored as an experimental model. It is suggested that the on/off activity of seasonal reproduction may be a robust mechanism able to be predictably manipulated by the judicious use of the light/dark cycle and exogenous melatonin, but firmly based on circadian principles.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Language of CTO interventions – Focus on hardware

The knowledge of variety of chronic total occlusion (CTO) hardware and the ability to use them represents the key to success of any CTO interventions. However, the multiplicity of CTO hardware and their physical character and the terminology used by experts create confusion in the mind of an average interventional cardiologist, particularly a beginner in this field. This knowledge is available but is scattered. We aim to classify and compare the currently used devices based on their properties focusing on how physical character of each device can be utilized in a specific situation, thus clarifying and simplifying the technical discourse.