高血压病患者细胞环核苷酸与循环血管活性物质的关系

目的：探讨环核苷酸与血管活性物质与高血压病的关系。方法：观察１０７例高血压病患者和３０ 例正常人淋巴细胞环核苷酸和血浆多种血管活性物质变化,其中３１ 例高血压病患者服依那普利２４ 周后复查各项指标。结果：高血压病患者淋巴细胞环磷酸腺苷（ｃＡＭＰ）和环磷酸鸟苷（ｃＧＭＰ）高于对照组（Ｐ＜ ０．０１）;血浆内皮素（ＥＴ）、血管紧张素Ⅱ（ＡｎｇⅡ）、去甲肾上腺素（ＮＥ）、内源性洋地黄物质（ＥＤＬＳ）和心钠素（ＡＮＰ）增高并与ｃＡＭＰ呈正相关,ＡＮＰ与ｃＧＭＰ呈正相关（Ｐ＜ ０．０５～Ｐ＜ ０．０１）;依那普利干预后,上述指标均低于治疗前（Ｐ＜ ０．０５～Ｐ＜ ０．０１））。结论：细胞环核苷酸含量升高可能部分与循环多种血管活性物质水平增高有关,其相互作用改变可能参与高血压病的发病过程     

高血压病左室重量与血管紧张素Ⅱ、醛固酮的相互关系及培哚普利、美托洛尔对其影响

研究６２例高血压病（ＥＨ）血浆血管紧张素Ⅱ（ＡＴⅡ）、醛固酮（ＡＬＤ）水平及其与左室肥厚（ＬＶＨ）的关系，并与２０例正常人进行对照。根据左室重量指数（ＬＶＭＩ）将ＥＨ伴ＬＶＨ者４７例随机分为两组，投以培哚普利或美托洛尔治疗８周。结果显示，ＥＨ患者血浆ＡＴⅡ及ＡＬＤ浓度明显高于对照组（Ｐ＜０．００１），ＬＶＨ组高于非ＬＶＨ组（Ｐ＜０．００５），ＬＶＨ组的ＬＶＭＩ与ＡＴⅡ和ＡＬＤ正相关（ｒ分别为０．３４２和０．３５６，Ｐ＜０．０１），用药后两组ＬＶＭＩ、ＡＴⅡ和ＡＬＤ水平均显著降低，且８周后两组ＬＶＭＩ差异有显著性（Ｐ＜０．０５），ＬＶＭＩ下降值与血浆ＡＴⅡ、ＡＬＤ浓度下降值呈正相关（ｒ分别为０．６１２和０．６４７，Ｐ＜０．００１），提示ＡＴⅡ、ＡＬＤ是引起ＥＨ心肌肥厚重要的体液因素，培哚普利及美托洛尔短期治疗均可使ＬＶＨ逆转，培哚普利对ＬＶＨ的逆转可能优于美托洛尔。     

高血压患者血浆和淋巴细胞中血管紧张素Ⅱ、内皮素和一氧化氮的变化及关系

分析一组高血压病患者血浆和淋巴细胞中血管紧张素Ⅱ（ＡｎｇⅡ）、内皮素（ＥＴ）和一氧化氮（ＮＯ）含量的变化及它们间的相互关系。方法高血压（ＥＨ）组３９例，正常对照（ＮＣ）组４１例，放射免疫分析法测定ＡｎｇⅡ、ＥＴ，高效液相色谱分析法测定ＮＯ。结果ＥＨ患者血浆和淋巴细胞中ＥＴ均高于ＮＣ组（Ｐ分别＜０．０５和＜０．０１），ＮＯ低于ＮＣ组（Ｐ分别＜０．０５和＜０．０１）。除血浆ＥＴ和ＮＯ外，各指标改变ＥＨⅡ期较Ⅰ期明显（Ｐ分别＜０．０５和＜０．０１）。逐步回归分析表明，ＥＨ组平均动脉压（ＭＡＰ）与血浆及淋巴细胞中ＡｎｇⅡ、ＥＴ呈正相关，与ＮＯ负相关（ｒ分别＝０．６７，０．８１，Ｐ均＜０．０１）；ＥＨ组血浆和淋巴细胞中ＮＯ与ＡｎｇⅡ、ＥＴ均呈负相关（ｒ分别＝－０．６５１，－０．７２５，Ｐ均＜０．０１）。结论淋巴细胞反映血管内皮细胞内分泌功能比血浆更为敏感，与ＭＡＰ相关性更好，ＡｎｇⅡ、ＥＴ和ＮＯ三者分泌失平衡，是ＥＨ发病的重要原因之一。     

牛磺酸对体外循环手术患者心肌保护作用的基础与临床初步研究

本研究在离体大鼠心肌缺血－再灌注模型上和体外循环心内直视手术病人应用牛磺酸后，观察牛磺酸对体外循环手术病人的血浆内皮素、血管紧张素Ⅱ和脂质过氧化代谢产物丙二醛变化的影响。提示：①动物模型上用牛磺酸组较对照组心律失常发生机会少，ＬＶＥＣ和±ＬＶｄｐ／ｄｔｍａｘ较对照组升高，ＬＶＰＤＰ和ＣＰＰ显著降低，心肌组织内蛋白漏出和丙二醛含量均明显减少；②用牛磺酸组内皮素含量较对照组低（Ｐ＜０．０１）。在体外循环前４个阶段，血管紧张素Ⅱ在两组中的变化规律相似，但术后２４小时，用牛磺酸组血管紧张素Ⅱ较对照组为低；③在用牛磺酸组的各个阶段，丙二醛含量明显较对照组低（Ｐ＜０．０５或Ｐ＜０．０１）。证明牛磺酸对心肌细胞具有保护作用，指出体外循环前后应用牛磺酸是有益处的。     

老年高血压病患者血浆内皮素,心房肽的变化及依那普利对其影响

以健康老年人３０例，单纯高血压病（ＥＨ）患者２０例，高血压伴左室肥厚（ＬＶＨ）患者１５例为研究对象，并给予高血压患者依那普利治疗８ｗ，检测其治疗前后血浆内皮素（ＥＴ）、心房肽（ＡＮＰ）水平。结果表明，高血压病患者血浆中ＥＴ、ＡＮＰ明显高于正常对照组（Ｐ＜０．０１），ＬＶＨ组ＥＴ水平高于ＥＨ组（Ｐ＜０．０１），ＡＮＰ水平两组间无明显差异。依那普利治疗后，高血压患者血浆ＥＴ水平及血压明显下降（Ｐ＜０．０１），ＡＮＰ水平无明显变化。提示ＥＴ可能参与高血压和高血压性左室肥厚的发生，依那普利在降血压的同时也可以降低血浆ＥＴ水平     

依那普利对充血性心力衰竭患者肾上腺素能通路作用的探讨

３０例充血性心力衰竭患者，应用依那普利口服治疗。３～４周后血淋巴细胞β受体密度上调（Ｐ＜０．０１）；血浆去甲肾上腺素、肾上腺素均下降（Ｐ＜０．０１和Ｐ＜０．０５）；血淋巴细胞内环磷酸腺苷含量下降（Ｐ＜０．０１）。表明依那普利对肾上腺素能通路起良好的调控作用。     

心功能障碍患者心肌组织及血浆肾素－血管紧张素系统、心钠素改变的临床意义

１９例心功能障碍患者的血浆、心肌血管紧张素Ⅱ（ＡｎｇⅡ）、心钠素（ＡＮＦ）含量高于正常对照组；血浆ＡｎｇⅡ和ＡＮＦ含量增高与心脏指数（ＣＩ）呈显著负相关（ｒ＝－０．５９６８，Ｐ＜０．０５；ｒ＝－０．８９９６，Ｐ＜０．０１），心肌ＡｎｇⅡ含量变化与左室心肌重量（ＬＶＭ）呈显著正相关（ｒ＝０．５７２３，Ｐ＜０．０５）；提示心脏局部肾素－血管紧张素系统（ＲＡＳ）活性增高和ＡＮＦ变化参与心肌细胞增殖及心室重塑的意义较为突出。     

多种血管活性物质与细胞膜离子转运与高血压的相互关系

目的探讨血管活性物质与细胞膜离子转运的关系及其在高血压病（ＥＨ）发病中的作用。方法观察１０７例ＥＨ患者和３０例正常人血浆多种血管活性物质、淋巴细胞离子泵和阳离子变化，并对血压与１３个相关预选因子进行逐步回归分析。结果ＥＨ患者血浆内皮素、血管紧张素Ⅱ、内源性洋地黄物质、去甲肾上腺素和心钠素增高，它们彼此相关并与淋巴细胞钠泵和钙泵活性下降、Ｎａ＋和Ｃａ２＋浓度升高相关，其中血管紧张素Ⅱ、去甲肾上腺素、心钠素、细胞钠泵和Ｎａ＋与血压之间有独立的相关关系。结论体循环中多种血管活性物质含量改变和相互作用与细胞膜离子转运缺陷有密切的内在关系，并可能在ＥＨ的发病过程中起协同和促进作用。     

颅脑疾患术后肾缺血引起尿中表皮生长因子变化的临床意义

观察了垂体瘤和小脑幕下肿瘤及脑外伤术后病人尿中表皮生长因子（ＥＧＦ）的变化，以及肾素活性、血管紧张素Ⅰ和Ⅱ的变化。结果脑疾患术后尿ＥＧＦ排出量与正常对照比较明显降低（Ｐ＜０．０１）。肾素活性、血管紧张素Ⅰ和Ⅱ的变化与正常对照比较明显升高（Ｐ＜０．０１或Ｐ＜０．０５）。     

QT间期离散度与左心室肥厚的关系及依那普利对其影响

目的：探讨ＱＴ间期离散度（ＱＴｄ）与左心室肥厚的关系及依那普利治疗对其的影响。方法：选择高血压病（ＥＨ）患者５７例，其中合并左心室肥厚（ＬＶＨ）者（ＥＨ＋ＬＶＨ组）３０例，无合并左心室肥厚者（ＥＨ－ＬＶＨ组）２７例；正常对照者（正常对照组）２４例。用超声心动图仪检测法求得左心室重量，同时从心电图上测得ＱＴｄ与校正后ＱＴｄ（ＱＴｃｄ）。ＥＨ＋ＬＶＨ组患者用依那普利治疗６个月。结果：①ＥＨ＋ＬＶＨ组患者ＱＴｄ与ＱＴｃｄ明显大于ＥＨ－ＬＶＨ组和正常对照组，而ＥＨ－ＬＶＨ组和正常对照组间无显著性差异；②ＱＴｄ和ＱＴｃｄ与左心室重量呈显著正相关（ｒ＝０．７５，Ｐ＜０．０５及ｒ＝０．６１，Ｐ＜０．０５）；③治疗６个月后，ＱＴｄ和ＱＴｃｄ、左心室重量均降低，且ＱＴｄ缩小程度（ΔＱＴｄ）、ＱＴｃｄ缩小程度（ΔＱＴｃｄ）与左心室重量减轻程度（ΔＬＶＭ）亦呈显著正相关。结论：左心室肥厚是高血压病患者ＱＴｄ增大的主要原因；ＱＴｄ可作为左心室肥厚程度的评估指标；依那普利能有效逆转左心室肥厚，减小ＱＴｄ。     

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.