血府逐瘀口服液联合阿司匹林对右心导管射频消融所致血栓前状态的影响

目的探讨血府逐瘀口服液联合阿司匹林对右心导管射频消融(RFCA)所致血栓前状态的预防作用。方法选择150例行导管射频消融的右侧旁路折返型室上性心动过速(AVRT)病人将其随机分成3组,每组50例,对照组(Ⅰ组)术前不使用血府逐瘀口服液或肠溶阿司匹林;血府逐瘀口服液组(Ⅱ组)术前第7天开始服血府逐瘀口服液10mL,每日3次,术前1d停服;血府逐瘀口服液加阿司匹林组(Ⅲ组)术前第7天开始服血府逐瘀口服液10mL,每日3次,肠溶阿司匹林100mg,每日1次,术前1d停服。每例病人于术前(T0)、电生理检查后即刻(T1)、射频放电全部结束后即刻(T2)、术后24h(T3)检测血浆血小板α颗粒膜糖蛋白(GMP-140)、内皮素(ET)、血管性假血友病因子(vWF)、D-二聚体(DD),并将组内T1,T2,T3时刻与T0时刻比较,组间T1,T2,T3时刻作对比,观察各项指标的变化。结果①组内T1,T2,T3时刻与T0时刻比较,vWF,ET差异均无统计学意义(P>0.05);GMP-140,DD3组均升高,以T2时刻升高最显著,其中Ⅰ组差异有统计学意义(P<0.01),Ⅱ组、Ⅲ组差异无统计学意义(P>0.05)。②组间T1,T2,T3时刻比较,Ⅱ组、Ⅲ组,DD均较Ⅰ组明显降低(P<0.01),Ⅲ组降低幅度较Ⅱ组大但无统计学意义(P>0.05)。结论血府逐瘀口服液加阿司匹林对右心导管射频消融所致血栓前状态有预防作用。     

射频导管消融术对血栓前状态的影响及阿司匹林的作用

目的探讨射频导管消融术(RFCA)对血栓前状态的影响,评价阿司匹林(Asp)的干预作用。方法选择58例行RFCA的阵发性室上性心动过速患者将其随机分成两组:Asp组(n=28):术前3天口服Asp;对照组(n=30):术前不用药。分别于术前(T0)、电生理检查(EPS)后(T1)、射频放电后即刻(T2)、术后24 h(T3)测定血浆血管性假血友病因子(VWF)、内皮素(ET)、血小板α颗粒膜糖蛋白140(GMP-140)和D-二聚体(DD),比较两组内不同时间点各项指标的变化及两组间的差异。并作RFCA的程序变量与血栓前状态的分子标志物变化的相关性分析。结果①两组患者VWF和ET在不同时间点较术前无显著差异(P>0.05);②对照组GMP-140和DD在T1时刻即有显著升高(P<0.05),T2时刻进一步升高达峰值,T3较T0有所下降,但仍明显高于术前(P(0.05);Asp组GMP-140在T1、T2、T3时刻与T0时刻比较无明显升高(P>0.05),而DD仍有显著升高(P<0.05或P<0.01),但与对照组同一时间点比较升高的幅度明显降低(P<0.05);④GMP-140和DD升高的幅度与手术持续时间呈正相关(r=0.48,r=0.41,P<0.05)。结论尽管术中应用肝素RFCA仍可导致血栓前状态。RFCA致血栓前状态与手术持续时间呈正相关。Asp可减轻RFCA引起的血栓前状态。     

射频消融术对凝血系统的影响

目的：探讨射频消融术（RFCA）后外周血管栓塞的发生机制及防治对策。方法：将90例室上性心动过速患者分为3组：A组术前不用抗凝药,B组术前使用阿司匹林,C组术前使用钙通道阻滞剂－氨氯地平。在术前、插管完成心内电生理检测后、RFCA后即刻及术后2d,抽静脉血观察血小板α－颗粒膜糖蛋白（Gmp-140)、血栓烷B2（TXB2）、蛋白C、蛋白S的变化。结果：A组病人,与术前比较,其他3个时段血浆Gmp-140、TXB2含量明显增加,蛋白C及蛋白S血浆含量无明显变化,且发现左右心导管操作对Gmp-140、TXB2变化无明显影响;B、C组病人与A组相比,相同时段的血浆Gmp-140、TXB2含量减小。结论：RFCA可引起血小板的激活,抗凝系统无明显变化,可能致血栓形成,服用阿司匹林及氨氯地平可阻止血小板的激活,有阻止血栓形成的作用。     

不同途径应用低分子肝素对血小板活性的影响及阿司匹林的干预作用

目的:探讨不同途径应用低分子肝素(LMWH)对血小板活性的影响,并观察联用常规剂量100 ms/d的阿司匹林对该影响的干预作用.方法:107例患者依据用药途径不同分为静脉达肝素钠组(n=29)、皮下达肝素钠组(n=27)、静脉达肝素钠加阿司匹林组(n=25)和皮下达肝素钠加阿司匹林组(n=26).分别采用酶联免疫双抗体夹心法(ELISA)和流式细胞技术检测静脉及皮下应用低分子肝素后血小板活化指标:血小板α颗粒膜糖蛋白-140(GMP-140)、血管性假血友病因子相关抗原(vWF:Ag)及血小板膜糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)受体复合物的变化,并观察联用常规剂量阿司匹林干预后上述指标的变化.结果:不同途径应用低分子肝素对血小板激活的影响:血小板膜糖蛋白Ⅱb/Ⅲa水平:静脉达肝素钠组注射0.5 h后和皮下达肝素钠组注射2天后均较其注射前升高,差异均有统计学意义(P<0.05).血小板α颗粒膜糖蛋白-140水平:静脉达肝素钠组注射0.5 h后较其注射前升高,差异有统计学意义(P<0.05).阿司匹林对不同途径应用低分子肝素激活血小板的干预作用:静脉达肝素钠加阿司匹林组和皮下达肝素钠加阿司匹林组,血小板膜糖蛋白Ⅱb/Ⅲa水平、血小板α颗粒膜糖蛋白-140水平,2组各时间点较注射前差异无统计学意义(P>0.05);而血管性假血友病因子相关抗原水平,静脉达肝素钠加阿司匹林组注射0.5 h后较其注射前下降,差异有统计学意义(P<0.05).结论:静脉或皮下应用低分子肝素均可以激活血小板,且联用常规剂量100 mg/d的阿司匹林能够有效抑制由低分子肝素引起的血小板活性增高.     

射频消融术对凝血的影响及氨氯地平对其防治效果

目的 :探讨射频消融 (RFCA)术后外周血管栓塞的发生机制及防治对策。方法 :将 6 0例室上性心动过速患者分为 2组 (A组术前不用抗凝药 ,B组术前使用钙通道阻滞剂——氨氯地平 ) ,在术前、插管完成心内电生理检测后 ,消融完成后即刻及术后 2 d,采静脉血观察血小板 α-颗粒膜糖蛋白 (Gm p- 140 )、血栓烷 B2 (Tx B2 )、蛋白C(PC)、蛋白 S(PS)的变化。结果 :A组患者与术前比较 ,其他三个时点血浆 Gmp- 140、Tx B2 含量明显增加 ,PC及PS血浆含量无变化 ,且发现年龄、血压、血脂 ,左右心系统操作对 Gmp- 140、Tx B2 变化无影响 ;B组患者与术前相比 ,其他三个时点的血浆 Gmp- 140、Tx B2 含量无明显变化。结论 :RFCA术可引起血小板的激活 ,抗凝系统无明显变化 ,可能致血栓形成 ,服用氨氯地平可阻止血小板的激活 ,有阻止血栓形成的效果。     

射频消融术对凝血、抗凝系统的影响及阿斯匹林的作用

为探讨射频消融术 (RFCA)后外周血管栓塞的发生机制 ,将 6 0例室上性心动过速患者分为两组 (A组术前不用抗凝药 ,B组术前使用阿斯匹林 (ASA) ,在术前、插管完成心内电生理检测后、RFCA后即刻及术后两天 4个时段抽静脉血观察血小板α 颗粒膜糖蛋白 (Gmp 140 )、血栓烷B2 (TXB2 )、蛋白C(PC)、蛋白S(PS)的变化。结果 :A组病人 ,与术前比较 ,其他 3个时段血浆Gmp 140、TXB2 含量明显增加 (分别为 7.32± 0 .49,12 .87± 1.99,13.6 4± 1.47pg/mlvs 6 .2 6± 0 .75pg/ml,P <0 .0 5或 0 .0 1;80 .0 6± 2 .18,10 0 .42± 1.41,90 .0 8± 4.82pg/mlvs 70 .45± 2 .2 7pg/ml,P <0 .0 5或 0 .0 1) ,PC及PS血浆含量无变化 ,但左右心系统操作对Gmp 140、TXB2 变化无影响 ;B组与A组相比 ,术后相同时段的血浆Gmp 140、TXB2 含量减小 ,P <0 .0 5或 0 .0 1。提示RFCA可引起血小板的激活 ,对抗凝系统无明显影响 ,可致血栓形成 ;服用ASA可阻止血小板的激活 ,从而阻止血栓形成的作用     

射频消融术对血栓前状态的影响及氨氯地平防治的研究

目的探讨射频消融术（radiofrequency catheter ablation,RFCA）对血栓前状态的影响及氨氯地平的防治效果。方法 60例拟行射频消融术治疗的患者,随机分为对照组（n=30）和氨氯地平干预组（n=30,干预组）,对照组术前服用安慰剂（淀粉片剂1片,术前2h口服）;干预组术前一周服用氨氯地平（5mg,qd）。采用双抗体夹心酶联免疫吸附法（ELISA）、发色底物法及Born比浊法等检测两组患者RFCA前后血浆中血管内假血友病因子（vWF）、血小板α颗粒膜糖蛋白-140（GMP-140）、D-二聚体（D-Dimer）、纤溶酶原激活物抑制物（PAI）以及血小板聚集率（PAG）的变化。结果对照组vWF、GMP-140、D-Dimer、PAI及PAG在RFCA术后均明显升高,其差别有统计学意义（P〈0.05）;试验组术后以上指标较术前也有所增高,但其差别无统计学意义（P〉0.05）。结论射频消融术可促进血栓前状态的形成,氨氯地平有一定预防作用。     

氯吡格雷对射频导管消融术血栓前状态的临床干预

将60例行射频导管消融术（RFCA）的阵发性室上性心动过速患者随机分成两组，治疗组术前3d口服氯毗格雷150mg／d；对照组术前不用药。分别于术前、电生理检查（EPS）后、术后即刻、术后2d测定血浆内皮素（ET）、血小板a颗粒膜糖蛋白140（GMP-140）、血栓烷（TXB：）和D-二聚体（DD），比较两组各项指标变化。结果显示，两组ET各时间点比较均无统计学差异（P〉0．05）；与术前比较，对照组其他时间点血浆GMP-140、TXB：和DD明显增加（P〈0．05，〈0．01），治疗组无明显变化，与对照组比较P〈0．05，〈0．01；左、右心导管操作对各项指标无明显影响。提示氯吡格雷可减轻RFCA引起的血栓前状态。     

射频消融术对血凝状态及肌钙蛋白I含量的影响

目的研究射频消融术(RFCA)对血凝状态及肌钙蛋白I(cTnI)含量的影响.方法60例行RFCA的病人分别测定电生理检查术(EPS)术前、后,消融术前,消融术后即刻,4、12、24小时D-二聚体(DD),血小板α颗粒膜糖蛋白(GMP-140),cTnI含量.结果血清DD,GMP-140水平在EPS及RFCA后升高,而cTnI水平仅在RFCA后升高.峰值cTnI与峰值DD,GMP-140呈直线正相关(r=0.48,0.39,P<0.001,<0.005).结论RFCA可损伤心肌并改变血凝状态,心肌损伤可诱发血小板聚集,促进血栓形成.     

射频消融术对凝血、抗凝系统的影响及阿司匹林的防治效果

目的探讨射频消融(RFCA)术后外周血管栓塞的发生机制及防治对策。方法将60例室上性心动过速患者分为2组(A组术前不用抗凝药,B组术前使用阿司匹林),在术前、插管完成心内电生理检测后,消融完成后即刻及术后2 d,采静脉血观察血小板活化因子(PAF)、血栓烷B2 (TXB_2)、蛋白C(PC)、蛋白S(PS)的变化。结果A组患者与术前比较,其他三个时点血浆PAF、TXB_2含量明显增加,PC及PS血浆含量无变化,且发现年龄、左右心系统操作对PAF、TXB_2变化无影响；B组患者与术前相比,其他三个时点的血浆PAF、TXB_2含量无明显变化。结论RFCA术可引起血小板的激活,抗凝系统无明显变化,可致血栓形成。服用阿司匹林可阻止血小板的激活,从而阻止血栓的形成。     

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.     

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.     

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.     

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.