冠状动脉内支架再狭窄的多因素回归分析

目的分析与冠状动脉内支架再狭窄有关的临床和血管造影及其处理因素。方法回顾性分析了在我院成功冠状动脉内支架置入和６个月后有冠状动脉造影随访的７４例病人的临床和血管造影及处理资料。用单因素和多因素回归分析方法分析了病人年龄、冠心病易患因素、靶病变形态学、及术后最小管腔开放直径（ＭＬＤ）等３２个变量与再狭窄的关系。结果在单因素分析中发现：术前血管参照直径和术后ＭＬＤ在再狭窄组明显低于非再狭窄组（３．１±０．３ｍｍｖｓ３．３±０．４ｍｍ和２．９±０．４ｖｓ３．２±０．４ｍｍ（Ｐ＜０．０５和０．０１）。支架直径小于３．５ｍｍ组的再狭窄率明显高于支架直径大于３．５ｍｍ组的再狭窄率（４１．７％ｖｓ１０．８％，Ｐ＜０．０５）。多元Ｌｏｇｉｓｔｉｃ回归分析发现：术后支架管腔ＭＬＤ、支架直径＜３．５ｍｍ、吸烟和高龄是再狭窄的独立危险因素。结论术后支架管腔ＭＬＤ、支架直径＜３．５ｍｍ、吸烟和高龄是最重要的支架再狭窄的独立危险因素     

经皮腔内冠状动脉成形术后再狭窄的临床多因素分析

目的:通过对再狭窄和临床易患因素关系的分析,希望找出再狭窄的独立预测因素.方法;本研究回顾性分析了50例(共61支血管)在我院成功进行了PTCA术,并于术后6个月有完整冠状动脉造影随访资料的病人,通过单因素及多因素方法分析再狭窄与临床因素的关系.结果:再狭窄率为49.2%(30/61).单因素分析中发现病变AHA/ACC分型B和C型、长病变、术前直径狭窄百分比较大、术前最小管腔直径较小组的再狭窄率高,以上4个因素和再狭窄的关系有显著统计学意义(P<0.01).球囊最大充气压较大和梗塞相关血管的再狭窄率较高,以上2因素和再狭窄的关系有统计学意义(P<0.05).多元Logistic回归分析结果显示病变分型为B和C型、梗塞相关血管、最大球囊充气压较大可使再狭窄率增高.结论:病变分型、梗塞相关血管、球囊最大充气压力再狭窄的独立预测因素.     

运动训练对大管径冠状动脉支架再狭窄率的影响

目的：探讨运动训练对接受直径≥3．0mm的冠状动脉药物支架患者再狭窄率的影响。方法：回顾性分析接受管径≥3．0mm药物支架,并获得6个月临床和冠状动脉造影随访的90例患者（95个病变）的资料（心肌梗死、慢性完全闭塞病变、再狭窄及桥血管病变除外）。根据是否进行运动训练患者被分为运动训练组（42例）和非运动训练组（48例）,对其6个月支架内再狭窄率进行对比研究。结果：运动训练组的再狭窄率明显低于非运动训练组（9．5％比18．8％,P〈0．05）。结论：对于接受管径≥3．0mm的冠状动脉支架患者,运动训练也是减少再狭窄率的有效方法。     

旋磨术与切割球囊在冠状动脉支架再狭窄治疗中的作用

目的比较旋磨术与切割球囊及常规球囊对冠状动脉支架内再狭窄的疗效。方法将416例单支冠状动脉病变支架内再狭窄患者分别用旋磨术、切割球囊与常规球囊进行扩张治疗,在治疗即刻及6个月时再次行冠状动脉造影并进行定量分析。结果(1)介入治疗前各组间支架内再狭窄情况无明显区别。(2)旋磨后即刻所获得的冠状动脉支架内最小血管直径(MLD)最大(2.67±0.55mm,P<0.05),切割球囊与常规球囊治疗组差异无统计学意义(2.51±0.65mm比2.53±0.65mm,P>0.05)。(3)6个月后旋磨治疗组的冠状动脉支架内MLD最小(1.52±0.91mm,P<0.05),切割球囊组大于常规球囊治疗组,但差异无统计学意义(1.96±0.74mm比1.75±0.83mm,P>0.05)。旋磨术与切割球囊及常规球囊治疗组支架内血管直径狭窄率分别为54.78%,38.31%及46.50%。(4)旋磨治疗组后期血管丢失量最大(P<0.05),切割球囊组明显低于常规球囊治疗组(P<0.05)。结论旋磨术对冠状动脉支架内再狭窄即刻疗效显著,但远期疗效仍以经皮腔内冠状动脉成形术(PTCA)最佳。     

在小冠状动脉中置入支架的安全性与有效性研究

目的：随着经皮冠状动脉腔内成形术（ＰＴＣＡ）操作者经验的积累,支架置入技术的提高和术前、术后药物治疗方案的改进,已使大的冠状动脉（直径≥３．０ ｍ ｍ ）置入支架后支架内血栓形成和闭塞的危险性明显降低,但是在小血管中（直径＜ ３．０ ｍ ｍ ）置入支架是否也有同样好的结果尚不十分清楚,本文旨在检验在小血管中置入支架的安全性与有效性。　　方法：我们在７９ 例病人的８３ 支小冠状动脉中置入了８４ 个支架,采用的支架置入技术为支架置入后用稍大一点或相同大小的非顺应性球囊高压扩张,术前、术后予以阿司匹林和噻氯匹定（抵克力得）联合治疗。　　结果：成功的支架置入使病变直径狭窄从（７９．０７±１５．５９）％ 降至（－ ０．３８±７．１７）％ ,无支架内血栓形成,使并发症发生率降低,６６ 例病人在６ 个月的临床随访中,大部分病人（８９．０％ ）仍保持无症状;在冠状动脉造影随访中,支架内再狭窄率为２９．６％ 。　　结论：在直径＜ ３．０ ｍ ｍ 的小冠状动脉中置入支架手术成功率高,有明显的即刻血管腔扩大,支架内血栓形成和术后出血并发症发生率低,并有可接受的再狭窄率,是安全有效的     

血浆 IP10水平与冠心病患者 PCI 术后支架内再狭窄的关系

目的：探讨血浆IP10水平与冠心病患者经皮冠状动脉介入治疗（PCI）术后支架内再狭窄的关系。方法选取行PCI的冠心病患者（均植入冠状动脉支架）, PCI术后半年复查冠状动脉造影,结果示支架内再狭窄且狭窄程度≥参照血管50％患者17例为支架内再狭窄组（ ISR组）;造影提示支架内再狭窄＜50％或无再狭窄患者95例为支架内无再狭窄组（ NSR组）;另选冠状动脉造影示冠状动脉狭窄程度＜50％的胸痛患者106例作为对照组。比较三组血浆IP10水平。结果 NSR组血浆IP10水平高于对照组,但两组比较P＞0．05;ISR组血浆IP10水平明显高于NSR组（P＜0．05）。结论支架内再狭窄患者血浆IP10水平明显高于支架内无再狭窄者;IP10有可能作为评价PCI术后支架内再狭窄发生风险的一项独立预测指标。     

经皮冠状动脉腔内切割球囊成形术治疗小血管病变的临床评价

冠状动脉支架置人术（Stenting）治疗直径大于3mm的冠脉m管病变可明确降低再狭窄发生率，但对于小血管（直径〈3mm）的冠脉病变介入治疗方式仍有争论。本文旨在通过应用经皮冠状动脉腔内切割球囊成形术（Cutting Balloon Angioplasty，CBA）和普通球囊血管成形术（Plain Old Balloon Angioplasty．POBA）的比较，探讨CBA对冠心病小血管病变的疗效。     

双源CT对冠状动脉支架内再狭窄诊断价值的Meta分析

目的评价双源CT在经皮冠状动脉支架置入术后支架内再狭窄的诊断价值。方法计算机检索2005年12月1日～2011年12月30日Pubmed,Embase,Cochrane library,CNKI,CBMdisc数据库,查询双源CT在诊断冠状动脉支架内再狭窄研究的中、英文文献。对纳入文献进行质量评估,计算双源CT诊断冠状动脉支架内再狭窄灵敏度（SE）、特异度（SP）及其95%可信区间（CI）,绘制及计算受试者工作特征曲线（SROC）和曲线下面积（AUC）。结果共纳入9篇文献。基于支架分析,双源CT诊断冠状动脉支架内再狭窄的合并灵敏度为0.91（95%CI：0.86～0.95）,特异度为0.92（95%CI：0.90～0.94）,AUC为0.97。双源CT对诊断冠状动脉内大支架（直径≥3mm）再狭窄的准确度高于小支架（直径〈3mm）,差异有统计学意义（P〈0.05）。不可评价支架的合并构成比为0.066（95%CI：0.05～0.09）。结论双源CT诊断冠状动脉支架内再狭窄的准确度高,适用于直径≥3mm的支架,是冠状动脉支架随访和评价的一种有效且无创的检测方法。     

冠心病PCI术后再狭窄的临床分析

目的：了解冠心病冠状动脉介入治疗（PCI）术后再狭窄的原因,为预防再狭窄发生提供根据。方法：回顾性分析我院冠脉支架置入300例中冠脉造影随访的74例的临床、血管造影及处理资料。并根据随访结果有、无再狭窄分为再狭窄组（42例）,无再狭窄组（32例）,分析病人年龄、性别、冠心病易患因素,靶病变形态学及术后最小管腔开放直径（MLD）等因素与再狭窄的关系。结果：与无再狭窄组比较,再狭窄组的男性（34.4%比76.2%）、吸烟（46.9%比71.4%）、PCI术后管腔直径〈3.5mm（40.0%比62.2%）显著增加。结论：男性、吸烟、支架直径〈3.5mm与PCI后冠状动脉再狭窄有关。     

冠状动脉支架置入后再狭窄危险因素的Logistic回归分析

目的　探讨冠状动脉支架置入术后再狭窄的相关危险因素。方法　对我院行冠状动脉支架置入并行冠状动脉造影随访患者171例的临床资料进行回顾性分析。根据造影随访结果其中术后48例患者中的56支靶血管发生再狭窄作为病例组,未发生再狭窄患者123例,133支血管作为对照组。先采用Pearson卡方单因素分析,将单因素分析存在统计学差异的临床变量纳入Logistic回归方程,计算冠状动脉支架置入术后再狭窄的独立危险因素。结果　单因素分析显示：术前狭窄程度＞90%（χ²4.71,P0.03）、支架直径≤3　mm　（χ²27.92,P0.00）、病变长度＞15　mm（χ²4.67,P0.03）、残余狭窄＞5%（χ²10.05,P0.00）、吸烟患者（χ²4.78,P0.03）、糖尿病患者（χ²4.72,P0.03）和术后不规范抗凝（χ²6.70,P0.01）与术后支架内再狭窄有关;Logistic回归分析显示支架直径≤3　mm　（OR4.34,　95%CI:　2.01～8.38,P0.02）、残余狭窄＞5%（OR2.2,　95%CI:　1.56～4.88,P0.03）和术后不规范抗凝（OR1.88,　95%CI:1.21～3.68,P0.04）是影响冠状动脉术后再狭窄的独立危险因素。风险比例模型显示,置入支架直径≤3　mm患者随访期间发生再狭窄的风险显著高于支架直径＞3　mm患者（HR3.53,　95%CI:2.08～5.99,　P0.00）。结论　置入支架直径较小、残余狭窄较重且术后抗凝不规范的患者是支架植入术后再狭窄的危险人群,应加强监测,规范抗凝,降低其再狭窄的发生风险。     

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.     

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.     

High prevalence of distal sensory polyneuropathy in antiretroviral-treated and untreated people with HIV in Tanzania

Objectives To describe the prevalence of distal sensory polyneuropathy (DSP), a complication of both advanced HIV disease and of antiretroviral therapy (ART), amongst Tanzanians with HIV, on and off ART (including stavudine) with CD4 counts above and below 200 cells/μl. Methods We recruited participants attending ART clinic into four groups: >6 months ART exposure and (i) CD4 < 200 cells/μl or (ii) CD4 > 200 cells/μl (ART/CD4 < 200 and ART/CD4 > 200, respectively); ART‐naïve and (iii) CD4 < 200 cells/μl or iv)CD4 > 200 cells/μl (noART/CD4 < 200 and noART/CD4 > 200, respectively). Primary outcome was DSP, as defined by presence of at least one symptom and one sign. Results Of 326 evaluable participants, 81 (32 men, median age 38 years, median CD4 142 cells/μl) were enrolled in the ART/CD4 < 200 group, 78 (17 men, median age 37 years, median CD4 345 cells/μl) in ART/CD4 > 200, 81 (30 men, median age 37 years, median CD4 128 cells/μl) in noART/CD4 < 200 and 86 (22 men, median age 33 years, median CD4 446 cells/μl) in noART/CD4 > 200. Numbness was the most commonly reported symptom. DSP prevalence ranged from 43.2% in ART/CD4 < 200 to 20.9% in noART/CD4 > 200. DSP was more common among men (adjusted odds ratio [aOR] 1.9, 95% confidence interval [CI] 1.2–3.3) and older participants (aOR 2.7, 95% CI 1.1–6.2 for age 40 + vs. <30 years). Conclusion Distal sensory polyneuropathy is common amongst those attending this clinic, even those with no ART exposure and a CD4 count above 200 cells/μl. Stavudine and didanosine expose HIV‐infected patients to an additional avoidable risk of DSP. Access to non‐neurotoxic ART regimes as well as earlier HIV diagnosis and initiation of ART is needed.