血清透明质酸水平与急性自发性脑出血患者转归的相关性

目的 探讨脑出血患者血清透明质酸水平与临床转归的相关性.方法 纳入明确诊断为急性自发性脑出血的患者,记录基线临床资料,在入院24 h内检测血清透明质酸水平,在发病3个月后采用改良Rankin量表评价临床转归,分为转归良好组(0～2分)和转归不良组(＞2分),对2组临床资料进行比较和分析.结果 共纳入321例患者,转归良好组184例,转归不良组137例.转归良好组年龄[(46.3±8.6)岁对(62.4± 10.5)岁;t=3.761,P=0.025]、体质指数[(24.1±5.3)kg/m2对(27.8±6.1)kg/m2;t=6.193,P=0.013]、血肿体积[(59.7±9.7)ml对(89.2±14.9)ml;=6.278,P＜0.001]、基线格拉斯哥昏迷量表(Glasgow Coma Scale,GCS)评分[(6.3±1.5)分对(3.9±0.7)分;t=9.121,P＜0.001]、基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分[(9.6±1.5)分对(16.3±4.5)分;=9.989,P＜0.001]和血清透明质酸水平[(376.2 ±22.9)ng/ml对(876.1±19.6)ng/ml;t=19.681,P＜0.001]与转归不良组存在显著统计学差异.多变量logistic回归分析显示,透明质酸[优势比(odds ratio,OR)4.396,95％可信区间(confidence interval,CI)1.912～6.897;P ＜0.001]、血肿体积(OR2.328,95％ CI 1.912 ～3.843;P=0.013)、NIHSS评分(OR2.662,95％ CI 1.127 ～2.976;P=0.023)和GCS评分(OR 0.879,95％ CI 0.097～0.969;P =0.046)是影响脑出血患者转归的独立因素.结论 基线血清透明质酸水平增高是急性自发性脑出血患者转归不良的独立预测因素.     

血清尿酸浓度对急性缺血性卒中患者短期转归的影响:回顾性病例系列研究

目的 探讨血清尿酸浓度对急性缺血性卒中患者短期转归的影响.方法 选取就诊的缺血性卒中患者,根据出院时改良Rankin量表(modified Rankin Scale,mRS)评分将患者分为转归良好组(mRS评分0～2分)和转归不良组(mRS评分3～6分),比较两组基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分、血清尿酸(serum uric acid,SUA)水平以及其他人口统计学和临床资料.结果 共纳入311例急性缺血性卒中患者,转归良好组185例,转归不良组126例.转归不良组基线NIHSS评分(中位数,四分位间距)[7(4 ～11)分对3(2 ～4)分;Z=9.858,P=0.001]、既往2型糖尿病(29.4％对14.1％;x2=10.877,P=0.001)和TIA史(27.8％对17.8％;x2=4.335,P=0.037)患者构成比显著性高于转归良好组,而SUA水平[(331.984±118.995) mmol/L对(363.276±100.743) mmol/L;t=2.497,P=0.013]和NIHSS评分＜9分的患者构成比(63.5％对96.8％;x2 =59.562,P=0.000)显著性低于转归良好组.SUA较低四分位数组基线NIHSS评分和出院mRS评分更高(P均＜0.01).多变量logistic回归分析显示,SUA增高为急性缺血性卒中患者短期转归的独立保护因素(优势比0.997,95％可信区间0.995 ～0.999;P =0.016).结论 SUA增高是急性缺血性卒中患者短期转归的独立保护因素.     

孤立性脑桥梗死的临床和影像学特征:脑桥旁正中梗死与脑桥腔隙性梗死的比较

目的 探讨孤立性脑桥梗死的临床和影像学特征以及早期运动障碍进展(progessive motor deficits,PMD)和短期预后的影响因素.方法 对初次发病24 h内入院的86例孤立性脑桥梗死患者进行回顾性分析,根据梗死灶最大直径和部位分为脑桥旁正中梗死(paramedian pontine infarction,PPI)和脑桥腔隙性梗死(lacunar pontine infarction,LPI),根据早期PMD情况分为PMD组和无PMD组,根据出院时改良Rankin量表(modified Rankin Scale,mRS)评分分为转归不良组(mRS评分＞2分)和转归良好组(mRS评分≤2分),对不同病例组的临床和影像学特征进行比较.结果 PPI组(n=35)高脂血症(57.14％对33.33％;x2=4.80,P=0.028)、偏瘫(97.14％对72.55％;x2=8.718,P=0.003)、基底动脉狭窄(45.71％对17.65％;x2=7.930,P=0.005)和出院时转归不良(54.29％对31.37％;x2=4.515,P=0.034)患者构成比以及基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分[(6.00 ±2.39)分对(4.61 ±3.41)分;t=2.087,P=0.040]均显著性高于LPI组(n＝ 51).PMD组(n=22)基线舒张压水平[(97.82±15.61)mm Hg对(89.55±12.23)mm Hg,1 mm Hg=0.133 kPa;t =2.258,P=0.031]以及PPI(63.64％对32.81％;x2=6.445,P＝0.011)和基底动脉狭窄(59.10％对18.75％;x2=12.922,P=0.000)的构成比均显著性高于无PMD组(n＝64).转归不良组(n＝ 35)基线NIHSS评分[(6.80±2.63)分对(3.73 ±2.55)分;t＝5.426,P＝0.000]和空腹血糖水平[(9.40±5.15) mmol/L对(6.56 ±2.69) mmol/L;t =2.985,P=0.004]以及PPI患者构成比(54.29％对31.37％;x2 =4.515,P＝0.034)均显著性高于转归良好组(n=51).多变量logistic回归分析显示,基底动脉狭窄是PPI发病[优势比(odds ratio,OR)3.801,95％可信区间(confidence interval,CI)1.357～10.646;P=0.011]和孤立性脑桥梗死早期PMD(OR 4.571,95％ CI1.214～17.214;P=0.025)的独立危险因素,基线NIHSS评分≥5分是其短期转归不良的独立预测因素(OR4.277,95％ CI 1.505 ～ 12.151;P=0.006).结论 PPI主要与基底动脉分支病变有关,基线NIHSS评分≥5分可能是孤立性脑桥梗死短期转归不良的独立预测因素,其早期PMD和短期转归不良均可能与基底动脉病变有关.     

轻型缺血性卒中患者转归不良的预测因素：前瞻性队列研究

目的 探讨轻型缺血性卒中患者的功能转归并明确其转归不良的危险因素.方法 前瞻性纳入发病后72 h内就诊的轻型缺血性卒中患者,根据发病后90 d时改良Rankin量表（modified Rankin Scale,mRS）评分将患者分为转归不良组（mRS评分＞2分）和转归良好组（mRS评分0～2分）.采用单变量分析和多变量logistic回归分析对人口统计学资料、血管危险因素、临床资料、实验室检查资料、影像学资料和随访资料进行比较和分析,明确轻型缺血性卒中转归不良的危险因素.结果 共纳入253例轻型缺血性卒中患者,其中71例（28.1％）转归不良.单变量分析显示,转归不良组年龄（=2.037,P=0.043）、基线美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分（U=4 610.000,P=0.000）、基线mRS评分（U=5 723.000,P=0.000）以及既往缺血性卒中史（x2 =4.950,P=0.026）、有症状大血管重度狭窄或闭塞（x2=49.037,P=0.000）、大动脉粥样硬化型卒中（x2=34.359,P=0.000）、早期神经功能恶化（x2=45.804,P=0.000）、并发肺炎（x2=12.121,P=0.000）以及缺血性卒中复发（x2=14.305,P=0.000）的患者比例显著性高于转归良好组.多变量logistic回归分析显示,高龄[优势比（odds ratio,OR）1.049,95％可信区间（confidence interval,CI）1.012 ～1.086;P=0.008]、基线mRS评分较高（OR 2.130,95％ CI 1.212～3.743;P=0.009）、基线NIHSS评分较高（OR 1.532,95％ CI 1.064 ～2.206;P=0.022）、有症状大血管重度狭窄或闭塞（OR 7.569,95％ CI 3.497～ 16.380;P=0.000）、早期神经功能恶化（OR 7.369,95％ CI2.648～20.510;P =0.000）和缺血性卒中复发（OR 10.450,95％ CI 3.071 ～35.564;P=0.000）是转归不良的独立危险因素.结论 超过1/4的轻型缺血性卒中患者转归不良,高龄、基线mRS评分较高、基线NIHSS评分较高、有症状大血管重度狭窄或闭塞、早期神经功能恶化以及缺血性卒中复发是其?     

急性缺血性卒中机械取栓后出血性转化和临床转归的影响因素

目的 探讨急性缺血性卒中患者机械取栓治疗后出血性转化(hemorrhagic transformation,HT)和转归不良的危险因素.方法 回顾性纳入接受机械取栓治疗的急性缺血性卒中患者,收集患者的人口统计学、血管危险因素和其他临床资料,应用改良Rankin量表(modified Rankin Scale,mRS)评价发病90d时临床转归,转归良好定义为mRS评分0～2分.根据HT情况将患者分为HT组和非HT组,根据mRS评分将患者分为转归良好组和转归不良组.应用多变量logistic回归分析确定HT和转归不良的独立危险因素.结果 共纳入48例接受机械取栓治疗的急性缺血性卒中患者,男性25例(52.1％),平均年龄(64.77 ±9.14)岁,平均美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(17.70 ±3.77)分.22例(45.8％)发生HT,其中9例为有症状HT;24例(50.0％)转归良好.HT组男性比例显著低于非HT组(30.4％对72.0％;x2=8.293,P=0.004),而糖尿病(65.2％对36.0％;x2=4.090,P=0.043)和心房颤动(78.3％对44.0％;x2=5.880,P=0.015)的患者比例以及基线空腹血糖水平[(8.514±4.400) mmol/L对(6.354±1.472) mmol/L;t =2.319,P=0.025]则显著高于非HT组.多变量logistic回归分析显示,心房颤动[优势比(odds ratio,OR)6.136,95％可信区间(confidence interval,CI)1.617～23.291;P=0.042]是机械取栓后发生HT的危险因素.转归良好组基线NIHSS评分[(16.050±4.865)分对(19.210±4.423)分;=2.354,P =0.023]以及糖尿病(29.2％对70.8％;x2=8.333,P=0.004)、前循环卒中(62.5％对87.5％;x2 =4.000,P =0.046)、大脑中动脉闭塞(29.2％对75.0％;x2=10.101,P=0.002)和脑实质血肿(4.1％对33.3％;P=0.011)患者比例显著低于转归不良组,而心房颤动(75.0％对45.8％;x2=4.269,P=0.039)和椎基底动脉闭塞(37.5％对12.5％;x2=10.113,P=0.006)患者比例显著高于转归不良组.多变量logistic回归分析显示,糖尿病(OR5.898,95％ CI 1.699～20.479;P=0.005)、基线NIHSS评分(OR1.167,95％ CI 1.011 ～1.347;P=0.035)和脑实质血肿(OR 1.295,95％ CI 1.099 ～ 1.875;P =0.028)是转归不良的独立危险因素.结论 心房颤动是急性缺血性卒中患者机械取栓治疗后HT风险的独立预测因素.糖尿病、基线NIHSS评分较高和并发脑实质血肿是转归不良的独立预测因素.因此,在对急性缺血性卒中患者开展机械取栓治疗前应充分评估其HT和转归不良风险.     

血清尿酸、胆红素水平与急性缺血性卒中患者近期转归的相关性

目的：探讨基线尿酸水平及胆红素水平与急性缺血性卒中患者短期转归的关系。方法收集缺血性卒中患者的临床资料,包括入院时血清尿酸和胆红素水平、美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)评分、出院时或第14天时改良 Rankin 量表(modified Rankin Scale, mRS)评分(0~2分定义为转归良好,>2分定义为转归不良)。结果共纳入急性缺血性卒中患者162例,转归良好组114例,转归不良组48例。2组之间糖尿病(51．75%对75．00%;χ2=7．526,P =0．006)、既往卒中或短暂性脑缺血发作( transient ischemic attack, TIA)史(18．42%对50．00%;χ2=17．790, P <0．001)的患者构成比以及基线舒张压[(87．061±12．245)mmHg 对(82．375±10．949)mmHg,1 mmHg =0．133 kPa;t =2．293,P =0．023]、高密度脂蛋白胆固醇[(1．604±0．299)mmol/L 对(1．265±0．206)mmol/L; t =3．227, P =0．002]、空腹血糖[(2．875±0．438)mmol/L 对(8．160±0．592)mmol/L; t =-4．761, P <0．001)]、尿酸[(289．365±77．168)μmol/L 对(248．206±66．206)μmol/L; t =3．111, P =0．002]、总胆红素[(14．673±2．213)μmol/L 对(10．395±2．714)μmol/L; t =3．779, P <0．001]、直接胆红素[(6．036±1．392)μmol/L 对(4．956±1．379)μmol/L; t =2．088, P =0．038]、间接胆红素[(8．634±2．307)μmol/L 对(5．439±1．223)μmol/L;t =4．219,P <0．001]水平存在显著差异。多变量 logistic回归分析显示,既往卒中或 TIA 史[优势比(odds ratio, OR)3．751,95%可信区间(confidence interval, CI)1．395~10．091;P =0．009]和基线 NIHSS 评分(OR 2．723,95% CI 1．093~6．783;P =0．031)是缺血性卒中转归不良的独立危险因素,而尿酸(OR 0．357,95% CI 0．141~0．900;P =0．029)、高密度脂蛋白胆固醇(OR 0．262,95% CI 0．079~0．870;P =0．029)和间接胆红素(OR 0．117,95% CI 0．025~0．539;P =0．006)与转归良好独立相关。结论基线尿酸和间接胆红素水平增高是急性缺血性卒中患者转归良好的有利因素。     

微量白蛋白尿与急性缺血性卒中的严重程度和转归的关系

目的 探讨微量白蛋白尿(microalbuminuria,MAU)与急性缺血性卒中的危险因素、病情严重程度及转归的关系.方法 前瞻性纳入连续的急性缺血性卒中患者,根据尿白蛋白/肌酐比率(urine albumin/creatinine ratio,UACR)分为MAU阳性组(≥30 mg/g)和MAU阴性组(＜30 mg/g),根据改良Rankin量表(modified Rankin Scale,mRS)评分分为转归良好组(0～2分)和转归不良组(＞2分),对各项人口统计学和临床资料进行比较,并分析急性缺血性卒中转归不良和MAU阳性的独立因素.结果 共纳入156例急性缺血性卒中患者,其中男性84例,女性72例;年龄53～ 78岁,平均(65.4±6.2)岁;发病至入院时间为1.5～28 h;94例转归良好,62例转归不良,无死亡病例;76例MAU阳性,80例MAU阴性.多变量logistic回归分析显示,高龄[优势比(odds ratio,OR)1.992,95％可信区间(c onfidence interval,CI)1.108～2.374;P=0.015]、合并糖尿病(OR 2.497,95％ CI1.177～5.298;P =0.017)和心房颤动(OR 2.338,95％ CI1.062 ～5.148;P=0.035)、高血清高半胱氨酸(homocysteine,Hcy)水平(OR 2.541,95％ CI 1.073～6.02;P=0.047)和UACR(OR 2.130,95％ CI1.396 ～3.017;P =0.001)、MAU阳性(OR 3.291,95％ CI1.681 ～6.444;P=0.001)、高基线美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分(OR9.196,95％ CI2.828～19.815;P ＜0.001)是急性缺血性卒中患者转归不良的独立危险因素.MAU阳性组合并糖尿病的患者比例(P=0.038)以及空腹血糖水平(P=0.025)、血清Hcy水平(P=0.022)和颈动脉内膜-中膜厚度(intima-media thickness,IMT)(P=0.019)与MAU阴性组存在显著性差异.MAU阳性组前循环梗死比例较低(P=0.033),基线NIHSS评分(P=0.003)和转归不良率较高(P＜0.001).多变量logistic回归分析显示,合并糖尿病(OR 2.237,95％ CI1.036 ～4.829;P =0.040)以及空腹血糖(OR 1.223,95％ CI1.145 ～1.673;P=0.027)和Hcy水平(OR 2.542,95％ CI 1.047～6.612;P=0.025)、颈动脉IMT(OR1.295,95％ CI1.106 ～1.362;P=0.023)和基线NIHSS评分(OR1.206,95％ CI1.044 ～1.219;P =0.023)增高与急性缺血性卒中患者MAU阳性独立相关.结论 MAU阳性是急性缺血性卒中转归不良的独立危险因素之一,且与急性缺血性卒中的部分危险因素密切相关,并对急性缺血性卒中病情严重程度和转归有着显著的影响.     

基底动脉狭窄程度与孤立性脑桥梗死短期转归的相关性

目的探讨基底动脉狭窄程度与急性孤立性脑桥梗死短期转归的相关关系.方法连续纳入2016年4月至2018年4月在开封市中心医院神经内科入住的急性孤立性脑桥梗死患者共137例.根据1月改良Rankin量表(mRS)评分将患者分为转归良好组(mRS≤2分)和转归不良组(mRS评分>2分),入院当天或第2天采集空腹静脉血进行血液生化指标检查,详细记录美国国立卫生研究院卒中量表(NIHSS)评分及其他人口统计学资料进行比较.应用磁共振血管成像评估患者的基底动脉狭窄程度,并根据血管狭窄程度分为无狭窄、轻度狭窄、中度狭窄和重度狭窄.结果转归良好组108例,转归不良组29例.转归良好组基线NIHSS评分[(2.71±0.22)分比(7.10±0.59)分,t=6.99,P<0.01]和总胆固醇水平[(4.29±0.10)mmol/L比(4.76±0.17)mmol/L,t=2.21,P=0.03]低于转归不良组.转归良好组中基底动脉无狭窄的患者发病比例高于转归不良组[76(70.4%)比5(17.2%),χ²=26.70,P<0.01],而基底动脉重度狭窄患者比例低于转归不良组[4(3.7%)比7(24.1%),P=0.002].二变量Logistics回归分析结果表明,NIHSS评分及基底动脉血管的狭窄程度是患者短期转归的危险因素(OR=1.658,95%CI:1.327~2.071;P=0.000和OR=2.071,95%CI:1.159~3.701;P=0.014).结论基底动脉血管狭窄程度是急性脑桥梗死患者短期转归的危险因素,基底动脉狭窄愈严重,脑桥梗死患者的预后愈差.     

血浆低密度脂蛋白水平与脑出血患者血肿增大和转归的相关性:回顾性队列研究

目的 探讨血浆低密度脂蛋白(low-density lipoprotein,LDL)水平与脑出血早期血肿增大以及3个月时临床转归和死亡的关系.方法 纳入原发性脑出血患者316例,记录其一般资料,在起病6h内及24 h行CT扫描,同时检测血脂、血糖、血压以及美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分.随访3个月,记录其改良Rankin量表(modified RankinScale, mRS)评分及死亡例数.结果 血浆LDL水平降低[优势比(odds ratio,OR)0.323,95％可信区间(confidence interval,CL)0.128～0.819;P=0.017]和收缩压增高(OR l.015,95％ CI 1.000～1.029;P =0.043)与脑出血早期血肿增大独立相关.血浆LDL水平降低(OR 0.253,95％CI 0.102～0.629;P=0.003)和血糖水平增高(OR 1.458,95％ CI 1.257～1.693;P＜0.001)是发病3个月时的临床转归不良的独立因素.血浆LDL水平降低(OR 0.211,95％ CI 0.075～0.597;P=0.003)、血糖水平增高(OR 1.406,95％ CI 1.212～1.632;P=0.001)和收缩压增高(OR 1.026,95％ CI 1.009～1.043;P=0.002)是3个月内死亡的独立危险因素.受试者工作特征曲线显示,LDL水平＜2.58 mmol/L是血肿增大的独立预测因素(敏感性71.79％,特异性64.71％,阳性预测值40.00％,阴性预测值87.50％).结论 血浆LDL水平降低是原发性脑出血患者早期血肿增大、3个月时转归不良和死亡的独立预测因素.     

依那普利叶酸对伴有H型高血压的急性缺血性卒中患者转归的影响

目的 探讨依那普利叶酸片对伴有H型高血压的急性缺血性卒中患者转归的影响.方法 前瞻性连续纳入伴有H型高血压的急性缺血性卒中患者,随机分为依那普利叶酸治疗组和依那普利治疗组.依那普利叶酸治疗组给予马来酸依那普利叶酸片(10 mg/0.8 mg,1次/d);依那普利治疗组给予马来酸依那普利片(10 mg,1次/d).收集所有患者的人口学特征以及基线临床资料.应用改良Rankin量表(modified Rankin Sacle,mRS)评估患者出院和90 d时的转归情况,转归良好定义为mRS评分0～2分,转归不良定义为mRS评分＞2分.结果 共纳入248例患者,其中男性占66.5％,平均高半胱氨酸(homocysteine,Hcy)水平为(18.513±9.700) μmol/L.依那普利叶酸组和依那普利组分别为123例和125例,2组人口统计学、基线临床资料均无显著差异,转归不良的患者比例亦无显著差异(16.3％对18.4％;x2=0.198,P=0.738).将2组所有病例分为转归良好组和转归不良组,其中转归良好组205例(82.7％),转归不良组43例(17.3％).转归良好组平均年龄显著小于转归不良组[(69.22±11.12)岁对(75.88±9.26)岁;t=-4.826,P＜ 0.001],基线收缩压[(139.88±19.23)mmHg对(144.28±17.92) mmHg,l mmHg =0.133 kPa;t =2.138,P=0.033]和美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分[(2.454±2.340)分对(13.605±6.415)分;t=-27.081,P＜0.001]以及大动脉粥样硬化性卒中的患者构成比(58.50％对74.4％;x2=5.901,P=0.015)均显著低于转归不良组,但Hcy水平[(18.524±10.339) μmol/L对(18.298±6.105) μmol/L;t=0.013,P=0.989]和接受依那普利叶酸治疗的患者比例(50.2％对46.5％;x2 =0.198,P=0.738)无显著差异.多变量logistic回归分析显示,大动脉粥样硬化性卒中(优势比1.025,95％可信区间1.002～1.049;P =0.006)和基线NIHSS评分(优势比2.4,95％可信区间1.734 ～3.322;P ＜0.001)是转归不良的独立危险因素.结论 Hcy水平不是伴有H型高血压的急性缺血性卒中患者转归不良的独立危险因素.与依那普利比较,依那普利叶酸不能显著改善伴有H型高血压的急性缺血性卒中患者的转归.     

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.     

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.     

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.     

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.     

Serological survey of HIV and syphilis in pregnant women in Madagascar

Objectives Peripartal transmission of human immunodeficiency virus (HIV) and Treponema pallidum, the causative agent of syphilis, leads to severe consequences for newborns. Preventive measures require awareness of the maternal infection. Although HIV and syphilis testing in Madagascar could be theoretically carried out within the framework of the national pregnancy follow‐up scheme, the required test kits are rarely available at peripheral health centres. In this study, we screened blood samples of pregnant Madagascan women for HIV and syphilis seroprevalence to estimate the demand for systemic screening in pregnancy. Methods Retrospective anonymous serological analysis for HIV and syphilis was performed in plasma samples from 1232 pregnant women that were taken between May and July 2010 in Ambositra, Ifanadiana, Manakara, Mananjary, Moramanga and Tsiroanomandidy (Madagascar) during pregnancy follow‐up. Screening was based on Treponema pallidum haemagglutination tests for syphilis and rapid tests for HIV, with confirmation of positive screening results on line assays. Results Out of 1232 pregnant women, none were seropositive for HIV and 37 (3%) were seropositive for Treponema pallidum. Conclusions Our findings are in line with previous studies that describe considerable syphilis prevalence in the rural Madagascan population. The results suggest a need for screening to prevent peripartal Treponema pallidum transmission, while HIV is still rare. If they are known, Treponema pallidum infections can be easily, safely and inexpensively treated even in pregnancy to reduce the risk of transmission.