急性ST段抬高型心肌梗死患者入院早期中性粒细胞/淋巴细胞比值与院内主要不良心血管事件的相关性

目的:探讨急性ST段抬高型心肌梗死(STEMI)患者入院早期中性粒细胞/淋巴细胞比值(NLR)与院内主要不良心血管事件(MACE)的相关性。方法:回顾分析2010-01至2014-12我院接受急诊经皮冠状动脉介入治疗(PCI)的STEMI患者420例,分为发生院内MACE组(n=47)和正常出院组(n=273)。应用单因素及多因素Logistic回归分析评价NLR是否可以作为STEMI患者发生院内MACE的独立危险因素。结果:单因素Logistic回归分析提示:高NLR患者院内MACE发生率明显高于低NLR患者(比值比=3.19,95%可信区间:1.55~2.65,P=0.012)。多因素Logistic回归分析提示:高NLR是STEMI患者发生院内MACE的独立危险因素(比值比=3.05,95%可信区间:1.59~10.54,P=0.015)。结论:入院早期高NLR与STEMI患者发生院内MACE相关,是STEMI患者发生院内MACE的独立危险因素。     

中性粒细胞/淋巴细胞比值对ST段抬高型心肌梗死患者PCI术后心血管不良事件的预测价值

目的探讨中性粒细胞与淋巴细胞比值(NLR)对ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入治疗(PCI)术后7 d内发生主要不良心血管事件(MACE)的预测价值。方法选择2014年1月~2016年1月于四川省乐山市人民医院心内科行PCI的STEMI患者136例,其中男性71例,女性65例,平均年龄(64.58±11.72)岁。依据NLR水平分为高NLR组(2.43,69例)和低NLR组(≤2.43,67例)。根据整体风险分层(GRC)评分将患者分为:低危组(41例)、中危组(67例)、高危组(28例)。收集所有患者病史、吸烟史、家族史等资料。入院后检测C反应蛋白(CRP)等指标,术后检测白细胞计数、淋巴细胞计数和N末端脑钠肽前体(NT-pro BNP)水平,并计算出NLR。PCI术后观察7 d,记录MACE及其发生时间。结果与低NLR组比较,高NLR组糖尿病病史比例、NT-pro BNP、CRP、中性粒细胞、NLR、MACE发生率升高,淋巴细胞减少,差异有统计学意义(P均0.05)。低危组NLR为(1.52±0.48),中危组为(2.41±0.52),高危组为(4.28±0.87),MACE发生率分别9.76%、19.4%、53.57%,随着GRC风险分层的上升MACE发生率增加,NLR升高,差异有统计学意义(P均0.05)。ROC曲线分析NLR、GRC评分、GRC评分+NLR对发生MACE的预测价值,曲线下面积(AUC)分别为:0.862(95%CI:0.791~0.974)、0.907(95%CI:0.855~0.967)、0.938(95%CI:0.886~0.989)。多因素分析结果提示,NLR(OR=2.794,95%CI:1.655~5.404)、年龄(OR=1.451,95%CI:1.602~1.842)、NT-pro BNP(OR=1.326,95%CI:1.063~1.814)、糖尿病病史(OR=2.473,95%CI:1.571~3.679)、高血压病史(OR=1.305,95%CI:1.041~3.816)均是STEMI患者PCI术后7 d内发生MACE的独立危险因素。结论中性粒细胞/淋巴细胞比值与年龄、NT-pro BNP、糖尿病病史、高血压病史是STEMI患者PCI术后7 d内发生MACE的独立危险因素,同时联合GRC评分可高效预测STEMI患者PCI术后7 d内MACE的发生,可辅助细化此类患者危险分层管理。     

急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后炎性因子的变化对院内主要不良心血管事件的预测价值

目的 探讨急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入（PCI）术后炎性因子的变化对院内主要不良心血管事件（MACE）的预测价值。 方法 选取2015年6月～2019年6月于邢台市第三医院院就诊的500例STEMI患者为研究对象,收集患者临床资料,于PCI手术次日抽取空腹静脉血进行炎性因子检测,根据院内是否发生MACE分为MACE组（85例）和无MACE组（415例）。采用单因素分析和多因素Logistic回归分析STEMI患者PCI术后发生院内MACE的独立影响因素,采用ROC曲线评价炎症指标对STEMI患者院内MACE的预测价值,构建STEMI患者行PCI术后院内发生MACE的列线图预测模型,采用受试者工作特征（ROC）曲线、Hosmer-Lemeshow goodness-of-fit检验、Calibration曲线评价模型的区分度、准确度和一致性。 结果 MACE组年龄、糖尿病患病率、D-二聚体（DD）指标明显高于无MACE组（均P<0.05）,LVEF指标明显低于无MACE组（P<0.05）,吸烟率、血清肌酐（Scr）、肌酸激酶同工酶（CK-MB）、心肌钙蛋白I（cTnI）、白细胞计数（WBC）、超敏C反应蛋白（hs-CRP）、中性粒细胞淋巴细胞比值（NLR）、血小板淋巴细胞比值（PLR）、降钙素原（PCT）、白介素-6（IL-6）指标显著高于无MACE组（均P<0.01）。多因素回归分析结果显示年龄（P<0.05）、糖尿病（P<0.05）、Scr（P<0.05）、CK-MB（P<0.05）以及炎性因子hs-CRP、NLR、PLR、PCT和IL-6（均P<0.01）是STEMI患者PCI术后院内发生MACE的独立危险因素,LVEF（P<0.05）是院内发生MACE的保护因素。炎症因子hs-CRP、NLR、PLR、PCT、IL-6均具有一定的预测价值。基于预后独立影响因素构建的列线图模型拟合效果良好,ROC曲线下面积为0.761（95% CI为0.680～0.839）,表明模型预测能力较好。 结论 炎性因子hs-CRP、NLR、PLR、PCT、IL-6均为STEMI患者PCI术后发生院内MACE的独立危险因素,对患者近期预后具有较好的预测价值,该研究构建的列线图模型可作为预测STEMI患者PCI术后院内MACE风险的量化工具,有助于为STEMI患者制定术后护理,帮助患者降低并发症风险。     

单核细胞/高密度脂蛋白比值与行急诊PCI的STEMI患者院内主要不良心血管事件的相关分析

目的探讨单核细胞/高密度脂蛋白比值(MHR)与行急诊经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者院内主要不良心血管事件(MACE)发生风险的关系。方法入选2015年10月~2016年6月于哈尔滨医科大学附属第一医院CCU病房行急诊PCI的286例STEMI患者,其中男性193例,女性93例,年龄40~80岁。根据住院1周内是否发生MACE将患者分为MACE组(131例)和非MACE组(155例)。由心血管介入医师行急诊冠状动脉造影检查,并行PCI。入院时测定总胆固醇、三酰甘油、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、C反应蛋白、肌酸激酶同工酶(CK-MB)、MHR、左室射血分数等。结果与非MACE组比较,MACE组左室射血分数降低,CK-MB和MHR升高,差异有统计学意义(P均0.05)。多因素Logistic回归分析,结果显示C反应蛋白(OR=1.009,95%CI:1.001~1.016)、左室射血分数(OR=0.934,95%CI:0.905~0.963)、CK-MB(OR=1.003,95%CI:1.001~1.004)是STEMI患者院内发生MACE的影响因素。MHR升高是STEMI患者院内发生MACE的危险因素。结论 MHR与行急诊PCI的STEMI患者发生主要不良心血管事件有关,MHR越大,主要不良心血管事件发生的风险越高。     

单体C反应蛋白、整体面积应变与行急诊经皮冠状动脉介入的STEMI患者短期预后的相关性

目的探讨急性ST段抬高型心肌梗死(STEMI)血浆单体C反应蛋白(mCRP)水平、整体面积应变(GAS)与急诊经皮冠状动脉介入(PCI)治疗后短期预后的相关性。方法接受急诊PCI治疗STEMI患者142例,并对患者住院期间及出院后3个月进行随访,以主要心血管事件(MACE)作为终点事件,分为MACE组及无MACE组,分析血浆mCRP水平及左心室射血分数(LVEF)、GAS在两组间的差异。单因素、多因素COX回归分析mCRP及GAS是否是行急诊PCI治疗STEMI患者将来发生MACE的独立危险因素。结果 (1)MACE组mCRP水平明显高于无MACE组,MACE组GAS值明显低于无MACE组,MACE组LVEF明显低于无MACE组,差异均有统计学意义(P0.05)。(2)血浆mCRP水平及GAS是STEMI并接受急诊PCI治疗的患者是否发生MACE的危险因素,而血浆mCRP水平是独立的危险因素[RR=1.06,95%CI(1.004～1.125),P=0.035]。结论患者血浆mCRP水平、GAS与STEMI冠状动脉病变严重程度密切相关,提示mCRP水平联合GAS可早期、无创评估STEMI病情严重程度,并可预测接受急诊PCI治疗的STEMI患者短期预后。     

血浆miR-577水平对急性ST段抬高心肌梗死预后评估的价值分析

目的探究血浆微小核糖核酸-577(miR-577)水平对急性ST段抬高心肌梗死(STEMI)长期预后评估的价值。方法选取2014年6月～2016年6月于海军安庆医院收治的急性STEMI患者67例作为研究对象。将入组患者根据有无心血管不良事件(MACE)发生分为:有MACE组32例和无MACE组35例。采用实时荧光定量(qRT-PCR)法检测血浆miR-577表达水平,分析与心肌功能、脂代谢、氧化应激等指标相关性,探究其对STEMI患者预后评估价值。结果有MACE组急性STEMI患者心率、血肌酐、肌钙蛋白(cTnI)、高敏C反应蛋白(hs-CRP)、丙二醛(MDA)水平均明显高于无MACE组患者(P0.05),血浆miR-577、谷胱甘肽(GSH)、高密度脂蛋白胆固醇(HDL-C)水平明显低于无MACE组患者(P0.05)。有MACE组STEMI患者血浆miR-577水平与心率、血肌酐、cTnI、hs-CRP与MDA水平呈负相关(P0.05),与HDL-C、GSH水平呈正相关(P0.05)。低HDL-C、高MDA、低miR-577水平是影响急性STEMI患者MACE发生的独立危险因素(P0.05)。血浆miR-577表达水平预测急性STEMI患者发生MACE的曲线下面积为0.883(95%CI:0.638～0.833,P0.05),取miR-577的最佳临界值为0.82时,其预测急性STEMI患者发生MACE的敏感度为87.50%,特异度为88.60%。结论有MACE组急性STEMI患者血浆miR-577表达水平明显降低,与心肌功能、脂代谢、氧化应激等相关指标变化有关,可能用于急性STEMI预后评估。     

老年急性ST段抬高型心肌梗死患者PCI术后不良心血管事件影响因素分析及列线图预测模型建立

目的]分析老年急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后不良心血管事件影响因素,并建立列线图预测模型。 [方法]选取2021年2月—2023年1月在辽宁省金秋医院接受PCI术的老年急性STEMI患者216例,依照术后院内不良心血管事件发生情况划分为发生组(n＝33)和未发生组(n＝183)。收集所有患者一般资料、实验室指标、影像学检查资料、术后用药资料,采用单因素与多因素Logistic回归分析探究不良心血管事件独立危险因素,根据独立危险因素中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)、C反应蛋白/白蛋白比值(CAR)、C反应蛋白与高密度脂蛋白胆固醇比值(CHR)构建列线图预测模型,绘制校准曲线对列线图模型进行验证,并绘制受试者工作特征(ROC)曲线,分析列线图模型的预测效能。 [结果]发生组NLR、PLR、CAR、CHR水平及Gensini评分、血小板聚集率(PAR)明显较未发生组高,左心室射血分数(LVEF)明显较未发生组低(P＜0.05);Logistic回归分析结果显示,Gensini评分、LVEF、PAR、NLR、PLR、CAR、CHR是老年急性STEMI患者PCI术后发生不良心血管事件的独立危险因素(P＜0.05);根据独立危险因素构建预测老年急性STEMI患者PCI术后发生不良心血管事件风险的列线图模型,模型校准曲线与理想模型较为接近,ROC曲线显示,列线图预测不良心血管事件发生风险的ROC曲线下面积为0.914。 [结论]NLR、PLR、CAR、CHR是影响老年急性STEMI患者PCI术后发生不良心血管事件的独立危险因素,基于以上因素构建的列线图模型能有效预测老年急性STEMI患者PCI术后发生不良心血管事件的风险。     

急性心肌梗死患者PCI术后主要不良心血管事件发生的影响因素

目的:探讨急性心肌梗死患者经皮冠状动脉介入治疗(PCI)术后近期主要不良心血管事件(MACE)发生的影响因素。方法:回顾性分析2013年1月至2017年3月在我院接受PCI治疗的459例急性ST段抬高型心肌梗死(STEMI)患者的临床资料。根据PCI术后近期是否发生MACE,患者被分为MACE组(96例)和非MACE组(363例)。分析此类患者近期MACE发生的影响因素。结果:459例患者中MACE发生率为20.92%(96/459)。与非MACE组比较,MACE组男性、高血压、高脂血症、糖尿病、吸烟、穿刺桡动脉和术后ST段回落不良比例、年龄、NYHA分级、发病至再灌注时间、cTnI、NT-proBNP、TG、LDL-C、Hcy、hsCRP水平、冠脉病变支数显著升高和增加,LVEF、HDL-C和术前强化他汀治疗比例显著降低(除性别P0.05,其他P均0.01)。多因素Logistic分析显示,年龄≥68岁、糖尿病、LDL-C≥2.83mmol/L、NT-proBNP≥3874pg/ml、hsCRP≥23.91mg/L和术后ST段回落不良是STEMI患者PCI术后近期MACE发生的独立危险因素(OR=1.683～6.890,P均0.01),术前强化他汀治疗是其独立保护因素(OR=0.543,P=0.001)。结论:急性心肌梗死患者PCI术后近期MACE发生受多种因素影响,应根据患者的危险因素进行干预和治疗,以减少PCI术后MACE的发生率,改善患者预后。     

血清CD147水平对经皮冠状动脉介入术干预非梗死相关动脉预后评估的价值

目的探讨血清CD147水平对经皮冠状动脉介入术(PCI)干预非梗死相关动脉(non-IRA)预后评估的价值。方法选取本院2017年3月—2019年3月收治的103例合并多支血管病变的ST段抬高型心肌梗死(STEMI)患者103例,患者均在PCI成功开通IRA后的3～7天行non-IRA PCI治疗。根据术后6个月患者是否发生主要不良心血管事件(MACE)分为两组:非MACE组75例,MACE组28例。依据Killip心功能分级标准进行分级;检查超声心动图并记录左心室射血分数(LVEF);采用Judkins法行冠状动脉造影检查,并记录血管狭窄情况。比较两组一般资料、血清生物化学指标差异;绘制ROC曲线,评估血清CD147水平对STEMI患者行多支血管PCI后发生MACE的诊断价值;采用COX回归模型分析STEMI患者行多支血管PCI后发生MACE的危险因素。结果与非MACE组相比,MACE组高脂血症比例、KillipⅡ～Ⅲ级比例、低密度脂蛋白胆固醇和CD147水平均较高(P0.05),LVEF较低(P0.05)。ROC结果显示,血清CD147诊断STEMI患者行多支血管PCI后发生MACE的曲线下面积为0.834,截断值为625.58 ng/L,对应的灵敏度、特异度分别为78.60%、81.30%,约登指数为0.599。COX回归模型结果显示,KillipⅡ～Ⅲ级、LVEF45%、高水平CD147均是STEMI患者行多支血管PCI后发生MACE的独立危险因素(P0.05)。结论 CD147与STEMI患者行多支血管PCI预后密切相关,对STEMI患者PCI后发生MACE有一定诊断价值,可为行多支血管PCI的STEMI患者的预后评估提供参考依据。     

血清微小RNA-20a和自噬相关基因7对急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后主要不良心血管事件的预测

目的 探讨血清微小RNA(miR)-20a和自噬相关基因7（ATG7）对急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后主要不良心血管事件（MACE）的预测价值。方法 纳入行PCI的初发急性STEMI患者233例，根据院内预后情况分为MACE组64例和非MACE组169例。比较两组患者血清氨基末端脑钠肽前体（NT-proBNP）、Ⅲ型前胶原氨端肽（PⅢNP）、ATG7及miR-20a水平并分析其相关性。结果 MACE组患者年龄、NT-proBNP、PⅢNP、ATG7水平及Killip心功能Ⅳ级患者比例均高于非MACE组，血清miR-20a水平低于非MACE组（P<0.05）。多因素logistic回归分析结果显示，高龄、Killip心功能Ⅳ级、NT-proBNP、PⅢNP及ATG7水平升高是急性STEMI患者PCI后发生院内MACE的独立危险因素，而血清miR-20a水平升高是其独立保护因素（P<0.05）。Pearson相关分析结果显示，血清miR-20a与ATG7、NT-proBNP、PⅢNP均呈负相关（P<0.05），而血清ATG7与NT-proBNP、PⅢNP均呈正相关（P<0.05）。受试者工作特征(ROC)曲线分析结果显示，血清miR-20a联合ATG7预测急性STEMI患者PCI后发生院内MACE的价值高于血清miR-20a和ATG7。结论 血清miR-20a和ATG7均与NT-proBNP、PⅢNP密切相关，是急性STEMI患者PCI后发生院内MACE的独立预测因素。     

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.