金华市婺城区社区居民高血压干预效果分析

目的探讨高血压社区综合干预的可行性及有效性。方法 2008年3月至2009年9月金华市婺城区选择4个社区265名高血压病患者进行健康教育、生活方式干预和根据高血压防治指南进行个体化药物治疗综合干预,随访观察18个月。结果干预前社区高血压病病人对高血压知识知晓率、服药率和控制率分别为65.1%、41.9%、29.1%,干预后分别为87.7%、83.4%、71.3%(P0.01);干预前社区高血压病病人不吸烟、低盐膳食、规律运动人数比率分别为61.9%、12.1%、17.7%,干预后分别为81.5%、49.4%、66.8%(P0.01))。结论社区高血压综合防治方法能有效提高高血压患者的知识知晓率、服药率和控制率,在社区实行是切实可行的。     

北京东四社区中老年高血压患者社区健康教育指导的效果

目的：分析北京东四社区中老年人高血压综合干预效果,探讨社区中老年高血压综合管理方法。方法：2007年1月～12月调查北京东四社区4个居委会,共计2235名≥50岁中老年人的生活方式、高血压患病、服药及血压控制情况。对该群体进行每月1次的健康大课堂教育、每周1次的入户血压监测及个体化用药指导,比较干预前后社区居民生活方式的改善、高血压患者服药及血压控制情况。结果：确诊高血压514例（23．00％）,其中,男224例（10．02％）,女290例（12．98％）;80．71％高血压患者知道患有高血压病,19．3％否认或不知道有高血压病,是在人户服务中首次诊断的;514例高血压患者中服降压药治疗者354例（68．87％）,正确规律服药者仅135名（26．27％）;血压控制达标者仅260例〈50．58％）。干预后高血压患者服药者482例（93．77％）,正确服药者395例（76．85％）,血压达标人数450例（87．55％）,P均〈0．001;居民生活方式明显改善,参加运动人数显著增加,吸烟人数、饮食钠超标人数显著减少（P〈0．001）。结论：高血压的社区发病率高,治疗依从性差,控制率低,健康教育结合入户个体化定期监测、指导可明显提高其服药依从性和血压控制率。     

老少边县社区高血压病综合干预效果分析

目的探讨老少边县社区高血压病综合干预的效果。方法将广西龙州县城东社区386例高血压患者按随机数字表法随机分为干预组和对照组,每组193例。对照组给予健康教育和药物治疗;干预组患者在对照组基础上进行合理饮食指导、戒烟限酒、适宜运动、心理干预等"四位一体"的综合性干预。比较两组患者干预前后高血压知晓率、服药依从性、血压水平、生活方式以及血脂异常情况和肥胖发生率。结果干预后干预组患者高血压知晓率、服药完全依从性显著高于对照组(P0.01),生活方式改善情况优于对照组(P0.01),收缩压和舒张压低于对照组(P0.01),血脂异常和肥胖发生率低于对照组(P0.05)。结论 "四位一体"的综合干预,能大幅度提高高血压患者的高血压知晓率和服药依从性,显著改善患者生活方式,有效降低血压、血脂水平和肥胖发生率。     

高血压患者3733例综合干预效果分析

目的分析社区高血压综合干预有效性。方法 2008年3月至2011年6月,对义乌市北苑社区3733名高血压病患者进行健康教育、生活方式干预和根据高血压防治指南进行个体化药物治疗综合干预,随访观察3年。结果干预前社区高血压病患者对高血压知晓率、服药率和控制率分别为23.01%、36.72%、33.94%,干预后分别为高血压病知晓率92.03%,服药率82.26%,控制率74.63%,急性心脑血管病事件发生率由干预前的1.15%降为干预后的0.54%,死亡率为零。结论社区责任医生团队工作的到位与否,是对高血压患者进行健康管理的关键。     

食物血糖生成指数对肥胖患者营养干预作用的影响

将80例肥胖患者随机分为自主择食组（对照组）、以食物交换份择食组（FEL组），以FEL和食物血糖生成指数（GI）择食组（FEL＋GI组），根据其年龄、体格测量和减肥标准确定干预对象的营养素摄人量，干预时间为6个月。结果显示，与对照组比较，FEL＋GI组干预后体质量指数（BMI）、脂肪百分比（％Fat）、低密度脂蛋白胆固醇（LDL—C）、腰臀比（wHR）、空腹血糖（FBG）、甘油三酯（TG）明显降低（P〈0．01，〈0．05），高密度脂蛋白胆固醇（HDL—C）明显升高（P〈0．01）；FEL组BMI、％Fat和FBG明显降低（P〈0．01，〈0．05），HDL—C明显升高（P〈0．05）。提示肥胖患者在健康饮食原则基础上利用食物GI选择食物，建立合理的膳食结构，对控制体重有良好效果。     

医院-社区一体化高血压管理模式干预效果评价

目的：探讨医院-社区一体化高血压管理模式效果。方法：2010年6月～2011年7月,抽取苏州市盛泽镇1 786例高血压患者,进行为期1年医院-社区一体化高血压综合干预,进行效果评价。结果：与干预前比较,干预后高血压相关知识知晓率、行为方式改善率均明显提高（P均〈0.001）,高血压患者规范管理率（51.96%比80.33%）、规律服药率（42.22%比74.36%）、血压控制率（40.93%比64.93%）亦明显提高（P均〈0.001）。结论：医院-社区一体化高血压管理模式干预效果显著,具有重要示范和推广意义。     

综合治疗高血压伴焦虑抑郁症效果观察

目的观察高血压病伴焦虑抑郁症患者在降压药基础上联用黛力新并进行生活心理干预的治疗效果。方法将86例高血压病伴焦虑抑郁症患者随机分为观察组与对照组各43例,观察组在应用降压药基础上加用黛力新并进行生活心理干预,对照组用降压药物治疗及生活心理干预,疗程12周。结果观察组患者血压及焦虑自评量表、抑郁自评量表评分在治疗后均显著下降（P均〈0．01）,且优于对照组（P均〈0．01）,而对照组治疗前后无显著性变化（P〉0．05）。结论高血压伴焦虑抑郁症患者在应用降压药基础上,联合黛力新与生活心理干预的综合治疗可提高降压效果,明显降低高血压患者焦虑抑郁症状。     

北京丰台城区、山东曲阜农村老年高血压病现状调查

目的了解目前中国北方部分地区城市及乡村老年人群高血压病的流行现状。方法以问卷调查形式，采取整群抽样的方法，分别调查北京丰台城区老年人（年龄≥60岁）2038人，山东曲阜乡村老年人2026人。问卷内容主要包括：高血压病史，高血压的治疗、控制情况以及与高血压有关的行为因素。结果在老年高血压的患病率，知晓率，治疗率及控制率方面，城市组（56．1％，85．9％，81．3％，32．8％）与乡村组（39．0％，65．0％，62．3％，4．0％）之间存在着显著差异（P〈0．001，P〈0．01，P〈0．001，P〈0．001）。高血压患者脑卒中的发生率乡村组（44．9％）较城市组（22．0％）高（P〈0．001）。结论目前中国北方城乡部分地区老年高血压病的患病率及并发症的发生率较高，控制率仍较低。老年高血压及其并发症的防治水平有待进一步提高。     

社区护理干预对高血压患者生活质量的影响

目的 研究护理干预对本社区高血压患者生活质量的影响及其血压控制效果评价。方法 对172例原发性高血压患者采用答卷方式调查其生活质量指标，并检测其动态血压指标。实施社区综合防治管理后复查并比较实施前、后动态血压变化及生活质量的变化。结果 实施社区干预后其动态血压各指标，患者的健康感觉、躯体症状、工作能力、性生活状况、认识功能、社会参与能力、生活满足感等均有显著改善并有统计学意义（P均〈0．01），唯睡眠状态变化不明显（P〉0．05）。结论 社区护理干预对高血压患者无论在改善高血压患者行为变化即生活方式、提高生活质量、降低其血压水平、提高其血压控制率等方面有积极作用。     

农村社区高血压综合干预效果评价

目的评价社区综合干预对农村社区高血压病的效果。方法通过对3968例高血压患者建立健康档康、定期随访、健康教育、规范药物治疗等社区卫生综合干预,2年后进行干预效果评价。结果干预后,高血压患者的高血压知晓率、治疗率、控制率、规范服药率明显提高,高盐饮食和体育锻炼、饮酒情况有改善,但吸烟情况无显著变化。结论社区综合干预可以显著控制农村社区高血压患者的血压,改善高血压患者的不良生活习惯,提高患者的生活质量。     

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.     

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.     

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.     

Variabilité des concentrations plasmatiques de l’angiotensinogène et risque d’hypertension artérielle chez le rat transgénique

Aim

Genetic polymorphisms of the human angiotensinogen gene are frequent and may induce up to 30% increase of plasma angiotensinogen concentrations with a blood pressure increase of up to 5 mmHg. Their role for the pathogenesis of human arterial hypertension remains unclear. High plasma angiotensinogen levels could increase the sensitivity to other blood pressure stressors.

Methods

Male transgenic rats with a 9-fold increase of plasma angiotensinogen concentrations and male non-transgenic rats aged 10 weeks were treated or not with NG-Nitro-L-arginine-methyl ester for 3 weeks in their drinking water (n = 3/group). Systolic blood pressure and body weight were measured at baseline and at the end of the study when left ventricular weight and ventricular expression of angiotensin I-converting enzyme and procollagen Iα1 were determined (polymerase chain reaction).

Results

At baseline, transgenic rats had +18 mmHg higher bood pressure and –8% lower body weight compared to non-transgenic rats (P < 0.05) without significant changes for the vehicle groups throughout the study (P > 0.05). NG-Nitro-L-arginine-methyl ester increased blood pressure, left ventricular weight and left ventricular weight indexed for body weight by +41%, +17.6% and +18.6% (P < 0.05) in transgenic and +25%, +5.3% and +6.7% (P > 0.05) in non-transgenic rats compared to untreated animals, respectively. Cardiac gene expression showed no differences between groups (P > 0.05).

Conclusion

Increased plasma angiotensinogen levels may sensitize to additional blood pressure stressors. Our preliminary results point towards an independent role of angiotensinogen in the pathogenesis of human hypertension and associated end-organ damage.