老年非瓣膜性心房纤颤的伴随疾病和节律控制的状况分析

目的：研究因非瓣膜性心房纤颤（房颤）住院的老年患者的伴随疾病及心律和心室率控制的状况。方法：回顾性分析12余年住院患者的240例资料，分析其房颤病程和伴随的疾病，药物治疗和起搏治疗的情况，心率和心律的变化。结果：合并心力衰竭、传导系统病变和脑卒中者分别为57．1％、31．7％和20．4％。对房颤病程不清楚者在阵发性房颤中占13．9％、在持续性房颤中占20．1％。在阵发性房颤中单独应用普罗帕酮（心律平）、B受体阻滞剂、胺碘酮治疗者分别占37．6％、25．7％和21．8％，用两种以上药物治疗者占14．9％，有7．9％的患者自行转复为窦性心律。在持续性房颤中单用地高辛、β受体阻滞剂、非二氢吡啶类钙拮抗剂治疗者分别占57．6％、23．7％和7．2％，用两种以上药物治疗者占10．8％，有20．1％的患者无需用药物控制心室率。有10．9％的阵发性房颤患者和14．4％的持续性房颤患者均行VVI起搏，主要原因分别为病态窦房结综合征和Ⅱ度以上房室传导阻滞。结论：老年非瓣膜性房颤常伴随心力衰竭、传导系统疾病和脑卒中，部分患者未及时发现和治疗房颤，大部分阵发性房颤单用普罗帕酮、β受体阻滞剂或胺碘酮可转复为窦性心律，在持续性房颤患者中，有57．6％用地高辛、20．1％不用控制心率的药物就可维持心室率。阵发性房颤和持续性房颤的起搏指征和方式均有待商榷。     

Gonadotropin-releasing hormone exhibits circadian rhythm in phase with arginine-vasopressin in co-cultures of the female rat preoptic area and suprachiasmatic nucleus

To determine whether the suprachiasmatic nucleus can drive a circadian release of gonadotropin-releasing hormone (GnRH) in the preoptic area, we measured the release of GnRH, arginine-vasopressin and vasoactive intestinal polypeptide (VIP) in cocultures of the preoptic area and the suprachiasmatic nucleus at 2-h intervals over a period of 120 h. The release of GnRH in cocultures exhibited a significant circadian rhythm in the presence of oestrogen but not in the absence of oestrogen. The period of the GnRH circadian rhythm was the same as that of the arginine-vasopressin circadian rhythm, and different from the VIP circadian rhythm in each coculture. Furthermore, the peak phase of the GnRH rhythm occurred at the time same as that of the arginine-vasopressin rhythm in each coculture. However, the peak phase of the GnRH rhythm was not always the same as that of the VIP rhythm. Administration of arginine-vasopressin significantly increased GnRH release in single preoptic area cultures in the presence of oestrogen, but VIP did not. The result suggests that, in cocultures of the suprachiasmatic nucleus and the preoptic area, arginine-vasopressin neurones drive the circadian release of GnRH in the presence of oestrogen. We suggest that arginine-vasopressin neurones in the suprachiasmatic nucleus mediate the clock information to GnRH neurones in vivo as well.     

高血压合并阻塞性睡眠呼吸暂停的动态血压特点

目的：观察高血压合并阻塞性睡眠呼吸暂停（OSA）患者的动态血压特点。方法：126例高血压研究对象均进行24h动态血乐和多导睡眠图监测，并根据睡眠呼吸暂停低通气指数分为3组：单纯高血压组（EH）、高血压合并轻度睡眠呼吸暂停组（EH＋轻度OSA组）、高血压合并中、重度睡眠呼吸暂停组（EH＋中重度OSA组），比较3组的血压、血压昼夜节律及晨峰出现的频率。结果：高血压合并OSA组与EH组相比各期血压水平均显著升高，血压昼夜节律明显下降，晨峰现象明显增加，差异均有统计学意义。且中重度组与轻度组比差异亦有统计学意义（P〈0．05或P〈0．01）。结论：高血压合并OSA患者各期血压水平、晨峰现象增加。昼夜节律明显下降，且OSA病情越重，这种变化越明显。     

老年高血压患者血压昼夜节律对左室肥厚的影响

【摘要】 目的 研究老年高血压患者的血压昼夜节律变化对左室肥厚的影响。方法 选取我院126例高血压患者,根据心脏彩超提示左室肥厚情况分为肥厚组（n=52例）和非肥厚组（n=74例）。比较两组动态血压指标及血压变异性,进行多因素分析探讨血压变异性对左室肥厚的影响。 结果 高血压肥厚组24h平均收缩压（24hSBP）、白天平均收缩压（dSBP）、夜间平均收缩压（nSBP）、24h收缩压标准差（24hSSD）、24h舒张压标准差（24hDSD）、白天收缩压标准差（dSSD）、夜间收缩压标准差（nSSD）均高于非肥厚组,差异有统计学意义（P＜005）。Logistic回归分析显示,24h SBP 与dSSD、nSSD为左室肥厚的独立危险因素（P＜005）。结论 老年高血压患者的24h SBP 与dSSD、nSSD是影响左室肥厚的独立危险因素,平稳控制血压对防止左室肥厚的发生有一定影响。     

Chronobiological Analysis of a New Clock Mutant,Toki, in Drosophila Melanogaster

We have isolated a new semidominant clock mutant Toki on the second chromosome in Drosophila melanogaster. This mutant differs from the wild-type Canton-S in several properties as follows. Larger values are obtained in the phase angle difference (ψ, the time from lights-off in a 24-hr light-dark cycle to an activity offset), the ratio of activity time to rest time (α/ρ) and the activity level. The free-running period (τ) is 25.3 hr, one hour longer than in the wild-type. In the phase response curve (PRC), the ratio between the delay and the advance portion is larger and the cross-over point occurs later, although there is no difference in amplitude of the mutant's PRC (Type I). The rhythm is more sensitive to the light intensity, becoming obscure in darker condition. Toki interacts with other clock mutations, per^S, per^L and And, in such a way that τ s associated with these three X-linked mutations are lengthened and ψ values become smaller.     

Circadian control of human cardiovascular function

Endogenous circadian rhythms prepare the cardiovascular (CV) system for optimal function to match the daily anticipated behavioral and environmental cycles, including variable activities when awake during the day and recuperation when sleeping at night. The overall day-night patterns in most CV variables result from the summation of predictable circadian effects with variable behavioral and environmental effects on the CV system. The circadian system has also been implicated in the morning peak in the incidence of adverse CV events, including myocardial infarction, stroke, and sudden cardiac death. We discuss the resting and stress-reactive circadian control of CV physiology in humans and suggest future research opportunities, including improving CV therapy by optimally timing therapy relative to a person’s internal body clock time.     

Impact of Temporal Lobe Epilepsy on Phonological Processing and Reading: A Case Study of Identical Twins

In order to evaluate the possible consequences of temporal lobe epilepsy on reading acquisition, we first compared the reading skills and phonological awareness abilities in a set of 13-year-old identical twins, one of whom is affected by temporal lobe epilepsy (LB). We then compared their performances to those of an age- and IQ-matched control group. Both siblings have an intellectual quotient above average as well as normal memory and linguistic abilities. Results showed that the reading age of LB (assessed by the Lefabvrais French reading test) was more than two years behind expectations whereas that of her sister was above average. Further, in contrast to her sister and healthy control subjects, LB exhibited specific deficits in elaborate metaphonological awareness abilities (non-word repetition, rhyme production, phonemic segmentation and syllabic inversion). These could be linked to temporal lobe dysfunction, thus confirming the important role of the temporal lobes in reading acquisition.     

24-h activity rhythm and sleep in depressed outpatients

Disturbances in sleep and circadian rest-activity rhythms are key features of depression. Actigraphy, a non-invasive method for monitoring motor activity, can be used to objectively assess circadian rest-activity rhythms and sleep patterns. While recent studies have measured sleep and daytime activity of depressed patients using wrist-worn actigraphy, the actigraphic 24-h rest-activity rhythm in depression has not been well documented. We aimed to examine actigraphically measured sleep and circadian rest-activity rhythms in depressed outpatients. Twenty patients with DSM-IV major depressive episode and 20 age- and sex-matched healthy controls participated in this study. Participants completed 7 consecutive days of all-day actigraphic activity monitoring while engaging in usual activities. For sleep parameters, total sleep time, wake after sleep onset, and sleep fragmentation index were determined. Circadian rhythms were estimated by fitting individual actigraphy data to a cosine curve of a 24-h activity rhythm using the cosinor method, which generated three circadian activity rhythm parameters, i.e., MESOR (rhythm-adjusted mean), amplitude, and acrophase. Subjective sleep was also assessed using a sleep diary and the Pittsburgh Sleep Quality Index. Patients showed significantly lower MESOR and more dampened amplitude along with significant sleep disturbances. Logistic regression analysis revealed that lower MESOR and more fragmented sleep emerged as the significant predictors of depression. Correlations between subjectively and actigraphically measured parameters demonstrated the validity of actigraphic measurements. These results indicate marked disturbances in sleep and circadian rest-activity rhythms of depression. By simultaneously measuring sleep and rest-activity rhythm parameters, actigraphy might serve as an objective diagnostic aid for depression.