利用平滑指数评价替米沙坦的平稳降压作用

目的 利用平滑指教评价替米沙坦治疗轻中度原发性高血压的降压平稳性.方法 采用自身对照的方法,对40例轻中度高血压患者,口服替米沙坦80mg,1次/d,疗程8周,于治疗前后进行24h动态血压监测并计算平滑指数.结果 治疗8周后,24h平均收缩压和舒张压、日问平均收缩压和舒张压、夜间平均舒张压和收缩压与治疗前比较明显下降,差异有统计学意义(P<0.01)收缩压平滑指数为(1.11±0.32),舒张压平滑指数为(1.01±0.12).结论 替米沙坦治疗原发性轻中度高血压平稳、有效并具有良好的平滑指数.     

依普利酮治疗轻中度高血压疗效和安全性的临床研究

比较依普利酮50 mg或100 mg与氯沙坦50 mg或100 mg每天一次治疗轻中度高血压的疗效和安全性。随机、双盲、双模拟平行对照设计,将84例轻中度高血压(90 mm Hg≤舒张压<110 mm Hg)患者分为依普利酮组和氯沙坦组。依普利酮50mg或100 mg每天一次口服治疗轻中度高血压安全有效,其降压疗效与氯沙坦相似。     

依普利酮治疗轻中度高血压疗效和安全性的临床研究

比较依普利酮50 mg或100 mg与氯沙坦50 mg或100 mg每天一次治疗轻中度高血压的疗效和安全性。随机、双盲、双模拟平行对照设计,将84例轻中度高血压(90 mm Hg≤舒张压<110 mm Hg)患者分为依普利酮组和氯沙坦组。依普利酮50mg或100 mg每天一次口服治疗轻中度高血压安全有效,其降压疗效与氯沙坦相似。     

依普利酮与氯沙坦对轻中度原发性高血压患者动脉僵硬度及中心动脉压的影响

目的探讨依普利酮与氯沙坦对收缩压及舒张压均增高的双期轻中度原发性高血压患者动脉僵硬度及中心动脉压(CAP)的影响。方法随机、双盲、双模拟、阳性药物平行对照设计,将84例轻中度原发性高血压患者[舒张压90～<110mm Hg(1mm Hg=0.133kPa)且收缩压140～<180mm Hg]分为依普利酮组和氯沙坦组,每组各42例,经服用安慰剂2周后进入12周的试验期,分别给予依普利酮50mg或氯沙坦50mg,口服1次/d,复诊1次/2周,4周后如舒张压≥90mm Hg,则改为依普利酮100mg分2次口服或氯沙坦100mg,口服1次/d。安慰剂治疗2周后及12周试验期结束前分别进行肝肾功能、电解质、血糖、血脂、血常规、尿常规、动态血压监测、臂踝脉搏波传导速度(baPWV)和CAP的测定。结果依普利酮组高血压患者完成试验37例,失访5例,氯沙坦组完成试验40例,失访2例;与治疗前相比,依普利酮组及氯沙坦组患者坐位收缩压及舒张压、动态血压参数、baPWV及CAP均明显降低;治疗12周末,两组患者的坐位收缩压及舒张压下降幅度差异无统计学意义[(18.3±8.6)比(21.4±9.4),(14.0±5.3)比(15.1±6.6)mm Hg,均P>0.05];依普利酮组的24h平均收缩压及平均舒张压、昼平均收缩压及平均舒张压、夜平均收缩压及平均舒张压、baPWV、CAP及总的不良事件发生率,与氯沙坦组相比差异无统计学意义(均P>0.05)。结论依普利酮与氯沙坦均能明显降低轻中度收缩压及舒张压均增高的双期原发性高血压患者的动脉僵硬度及中心动脉压。     

替米沙坦对老年高血压病患者脉压的影响

目的：探讨血管紧张素Ⅱ的Ⅰ型受体拮抗剂（ARB1）替米沙坦对老年高血压病患者脉压的影响。方法：符合WHO／ISH高血压病诊断标准的高血压病Ⅰ、Ⅱ级患者90例，治疗组56例。口服替米沙坦40～80mg，1次／d；对照组34例，口服赖诺普利5～10mg，1次／d。结果：用药半年后替米沙坦组，赖诺普利组收缩压（SBP）、舒张压（DBP）均显著下降（P分别〈0．001，〈0．01）、替米沙坦组脉压（PP）亦有明显缩小（P〈0．01）。结论：替米沙坦不仅是安全可靠的降压药，而且还可以缩小脉压，具有器官保护作用，可作为老年高血压一线用药。     

复方替米沙坦对单药控制不良高血压患者的有效性和安全性

目的 评价复方替米沙坦在替米沙坦单药治疗无充分反应时中国高血压患者中的有效性和安全性.方法 多中心、随机、双盲、双模拟临床试验.经1周安慰剂筛选期,699例符合入选标准的轻、中度高血压患者进入80 mg替米沙坦单药开放治疗期.345例对替米沙坦单药开放治疗8周无充分反应[平均坐位舒张压≥90 mm Hg(1 mm Hg=0.133 kPa)]的患者进入为期8周的随机双盲治疗期.175例患者进入复方替米沙坦治疗组(80 mg替米沙坦加12.5 mg氢氯噻嗪),170例进入80 mg替米沙坦单药治疗组.每次随访测量坐位和立位的收缩压和舒张压谷值,记录不良事件.筛选期以及开放和随机双盲治疗期结束时进行实验室和心电图检查.结果 (1)与开放治疗期结束(基线)比较,随机双盲治疗8周后,复方替米沙坦组坐位舒张压谷值平均下降10.1 mm Hg,替米沙坦单药组平均下降7.7 mm Hg,两组间比较P=0.0017.复方替米沙坦组坐位收缩压谷值平均下降14.2 mm Hg,替米沙坦单药组平均下降7.4 mm Hg,两组间比较P＜0.0001.(2)与基线比较,随机双盲治疗8周后,复方替米沙坦组立位舒张压和收缩压谷值平均下降幅度大于替米沙坦单药组,两组间比较P=0.0350和P＜0.0001.(3)按照平均坐位舒张压谷值＜90 mm Hg和(或)与基线值相比降低≥10 mm Hg评价,随机双盲治疗8周后,复方替米沙坦组有效率为74.6%(129例患者),替米沙坦单药组为59.2%(100例患者),两组间比较P=0.0016.(4)在随机双盲期,两组与试验药物有关的不良事件发生率分别为3.5%和3.6%,两组间比较P＞0.05.结论 替米沙坦单药治疗无充分反应的中国高血压患者,复方替米沙坦每日口服一次能够进一步降低血压,且安全性良好.     

小剂量左旋氨氯地平、替米沙坦和氢氯噻嗪同时或不同时给药对杓型高血压的影响

目的 探讨小剂量左旋氨氯地平、替米沙坦及氢氯噻嗪同时或不同时给药对杓型高血压的影响.方法 选择我院门诊及住院杓型高血压患者272例（收缩压＜ 180 mm Hg,舒张压91～109 mm Hg）,年龄＞45岁,男性179例,女性93例.随机分为两组：Ⅰ组（不同时给药组,135例）晨服替米沙坦40 mg和氢氯噻嗪10 mg,晚服左旋氨氯地平2.5 mg;Ⅱ组（同时给药组,137例）以上三种药物均晨服（剂量同Ⅰ组）.两组基线资料均衡可比.所有病例治疗前及治疗8周后进行动态血压监测.结果 治疗8周后,Ⅰ组和Ⅱ组的24h收缩压/舒张压均较治疗前降低[（128.64± 12.76）mm Hg/（82.46±7.18）mm Hg比（144.36±15.86）mm Hg/（92.34±7.86）mm Hg,P＜0.01,（127.54±13.06）mm Hg/（81.92±7.28）mm Hg比（143.68±15.58）mm Hg/（92.52±7.64）mm Hg,P＜0.01],两组间降低幅度差异无统计学意义（P＞0.05）;夜间收缩压/舒张压较治疗前降低[（134.28 ±13.36）mm Hg/（82.76±6.84）mm Hg比（116.42±12.14）mm Hg/（70.18±6.28）mm Hg,P＜0.01,（134.46±13.58）mm Hg/（82.48±6.72）mm Hg比（118.18±12.18）mm Hg/（71.82±6.86）mm Hg,P＜0.01],降低幅度差异无统计学意义（P＞0.05）.Ⅰ组治疗后收缩压昼夜差值高于治疗前[（21.10±4.88）mm Hg比（17.32±4.26）mm Hg,P＜0.05];Ⅱ组差异无统计学意义（P＞0.05）.治疗后Ⅰ组收缩压昼夜差值高于Ⅱ组[（21.10±4.88）mm Hg和（18.04±4.26）mm Hg,两组比较差异有统计学意义（P＜0.05）].结论 对于杓型高血压患者,小剂量左旋氨氯地平、替米沙坦和氢氯噻嗪无论同时或不同时给药均能有效地控制24h、日间和夜间血压,而同时一次给药患者的依从性会更好,还能减少深杓型血压的发生.     

动态血压监测评价复方厄贝沙坦的降压作用

目的：评价厄贝沙坦／氢氯噻嗪(复方厄贝沙坦，商品名安博诺)降压谷／峰比值及降压效果。方法：开放试验。28例轻中度高血压患者日服一次复方厄贝沙坦(厄贝沙坦150mg／氢氯噻嗪12、5mg)、共8周，治疗前后行24h动态血压监测。结果：收缩压、舒张压谷／峰比值分别为56．1％、55．3％，24h、昼、夜平均血压分别下降22．2／13．3mmHg、23．8／14．1mmHg、15．0／9．1mmHg。结论：复方厄贝沙坦日服一次，降压作用可维持24h。     

替米沙坦降压疗效的临床研究

目的前瞻性评估替米沙坦治疗原发性高血压的降压疗效和安全性. 方法 139例轻中度原发性高血压病人随机服用替米沙坦40～80 mg或福辛普利10～20 mg共26周,服药前、后行动态血压监测(ABPM),观察24 h SBP和DBP、谷峰比值、给药末6 h血压变化、降压有效率和不良反应.结果替米沙坦和福辛普利均能有效降低血压,26周治疗有效率分别为75%和72%(P>0.05),替米沙坦谷峰比值较福辛普利高(SBP72% vs 62%,P<0.05;DBP75% vs 63% P<0.05),且较福辛普利具有更强的降低清晨200-800血压的作用(P<0.05).替米沙坦不良反应发生率较少.结论替米沙坦治疗轻中度原发性高血压安全有效,耐受性好,可持续24 h理想的控制血压.     

小剂量左旋氨氯地平、替米沙坦及氢氯噻嗪同时和不同时给药对血压晨峰的影响

目的 探讨小剂量左旋氨氯地平、替米沙坦及氢氯噻嗪同时与不同时给药对轻中度高血压患者血压晨峰（MBPS）的影响.方法 选择我院2011年5月至2014年5月门诊及住院的高血压患者138例,男性86例,女性52例.入选者收缩压（SBP）＜180 mm Hg,舒张压（DBP）91～109 mm Hg,年龄＞45岁,24 h动态血压监测（ABDM）具有MBPS现象.随机分为2组：Ⅰ组（不同时给药组,70例）晨服替米沙坦40 mg和氢氯噻嗪10 mg,晚服左旋氨氯地平2.5 mg;Ⅱ组（同时给药组,68例）以上三种药物均晨服.所有病例治疗前及治疗8周后进行ABPM监测.结果 治疗8周后,Ⅰ组和Ⅱ组的24h SBP/DBP均较治疗前分别降低17.34/10.26 mm Hg和16.64/10.42 mm Hg,日间SBP/DBP分别降低15.48/9.86 mm Hg和17.36/10.28 mm Hg,均较治疗前明显降低（P＜0.01）,两组间降低幅度未见统计学差异（P＞0.05）.两组夜间SBP/DBP分别降低21.52/11.22 mm Hg和15.82/10.14 mm Hg,均较治疗前明显降低（P＜0.01）;Ⅰ组治疗后降低幅度较Ⅱ组明显,两组比较差异有统计学意义（P＜0.05）.治疗前与治疗8周后清晨收缩压差值（MSBPD）Ⅰ组分别为（37.26±10.34）mm Hg和（23.14±7.82）mm Hg,治疗后显著降低（P＜0.01）;Ⅱ组分别为（37.48±10.32）mm Hg和（29.34±8.46）mmHg,治疗后明显降低（P＜0.05）,两组治疗后比较,差异有统计学意义（P＜0.05）.结论 对于晨峰高血压患者,小剂量左旋氨氯地平、替米沙坦及氢氯噻嗪无论同时还是不同时给药均能有效控制24h、日间和夜间血压;而不同时给药治疗夜间血压优于同时给药,尤其控制MBPS现象更明显.     

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.     

MUTATION FREQUENCY IN NURSES AND PHARMACISTS WORKING WITH CYTOTOXIC DRUGS

Individuals occupationally exposed to cytotoxic drugs may be at risk owing to the effects of these agents on DNA. As an index of DNA damage, in vivo mutations were measured in lymphocytes from 24 oncology nurses or pharmacists and 24 matched controls. Mutation frequency was significantly increased in exposed individuals and appeared to be related to duration of exposure. However, the overall magnitude of the increase was small and its biological significance remains to be determined.     

A single injection of adrenergic agonists enhances pineal melatonin production in Turkish hamsters

Abstract: The purpose of this study was to determine whether the pineal gland of Turkish hamsters (Mesocricetus brandti) responds to adrenergic agonists with an increase in melatonin production, and, if it does, whether the sensitivity of the pineal gland to agonists would differ throughout the dark phase. Adult Turkish hamsters weighing 110–210 g received a subcutaneous injection of isoproterenol (ISO, 1 mg/kg B.W.) or norepinephrine (NE, 1 mg/kg B.W.) at different times of night. Animals exposed to LD 16:8 responded to ISO or NE with increased pineal melatonin content only when injected at dawn, when endogenous melatonin is at basal or near-basal levels. When the 8 hr scotophase was entirely replaced with light, the responsiveness to ISO injections at dawn disappeared. In animals exposed to light from 30 min prior to injection to the time of sacrifice, ISO injections increased pineal melatonin content (P < 0.005, three-way ANOVA), which varied, depending on the specific time of injection (effect of time of night, P < 0.05, three-way ANOVA). These results demonstrate that (1) adrenergic agonists enhance the production of pineal melatonin in Turkish hamsters, (2) this stimulatory effect takes place late, but not early in the 8 hr scotophase, and (3) the adrenergic induction of pineal melatonin production in Turkish hamsters requires priming by darkness during the appropriate circadian phase.     

Immune effector mechanisms in malaria: An update focusing on human immunity

The past decade has witnessed dramatic decreases in malaria‐associated mortality and morbidity around the world. This progress has largely been due to intensified malaria control measures, implementation of rapid diagnostics and establishing a network to anticipate and mitigate antimalarial drug resistance. However, the ultimate tool for malaria prevention is the development and implementation of an effective vaccine. To date, malaria vaccine efforts have focused on determining which of the thousands of antigens expressed by Plasmodium falciparum are instrumental targets of protective immunity. The antigenic variation and antigenic polymorphisms arising in parasite genes under immune selection present a daunting challenge for target antigen selection and prioritization, and is a given caveat when interpreting immune recall responses or results from monovalent vaccine trials. Other immune evasion strategies executed by the parasite highlight the myriad of ways in which it can become a recurrent infection. This review provides an update on immune effector mechanisms in malaria and focuses on our improved ability to interrogate the complexity of human immune system, accelerated by recent methodological advances. Appreciating how the human immune landscape influences the effectiveness and longevity of antimalarial immunity will help explain which conditions are necessary for immune effector mechanisms to prevail.     

Secondary aortoduodenal fistula

Aorto-duodenal fistulae （ADF） are the most frequent aorto-enteric fistulae （80%）, presenting with upper gastrointestinal bleeding. We report the first case of a man with a secondary aorto-duodenal fistula presenting with a history of persistent occlusive syndrome. A 59-year old man who underwent an aortic-bi-femoral bypass 5 years ago, presented with dyspepsia and biliary vomiting. Computed tomography scan showed in the third duodenal segment the presence of inflammatory tissue with air bubbles between the duodenum and prosthesis, adherent to the duodenum. The patient was submitted to surgery, during which the prosthesis was detached from the duodenum, the intestine failed to close and a gastro-jejunal anastomosis was performed. The post-operative course was simple, secondary ADF was a complication （0.3%-2%） of aortic surgery. Mechanical erosion of the prosthetic material into the bowel was due to the lack of interposed retroperitoneal tissue or the excessive pulsation of redundantly placed grafts or septic procedures. The third or fourth duodenal segment was most frequently involved. Diagnosis of ADF was difficult. Surgical treatment is always recommended by explorative laparotomy. ADF must be suspected whenever a patient with aortic prosthesis has digestive bleeding or unexplained obstructive syndrome. Rarely the clinical picture of ADF is subtle presenting as an obstructive syndrome and in these cases the principal goal is to effectively relieve the mechanical bowel obstruction.     

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.     

Married to M. tuberculosis: risk of infection and disease in spouses of smear-positive tuberculosis patients

Objectives To quantify the risk of infection and disease in spouses of tuberculosis patients and the extent to which intervention could reduce the risk in this highly exposed group. Methods We compared HIV prevalence, TB prevalence and incidence and tuberculin skin test (TST) results in spouses of TB patients and community controls. HIV‐positive spouses were offered isoniazid preventive therapy (IPT), and TST was repeated at 6, 12 and 24 months. Results We recruited 148 spouses of smear‐positive patients ascertained prospectively and 3% had active TB. We identified 203 spouses of previously diagnosed smear‐positive patients, 11 had already had TB, and the rate of TB was 2.4 per 100 person years(py) over 2 years (95% CI 1.15–5.09). 116 were found alive and recruited. HIV prevalence was 37% and 39% in the prospective and retrospective spouse groups and 17% in controls. TST was ≥10 mm in 80% of HIV negative and in 57% of HIV‐positive spouses ascertained retrospectively; 74% HIV negative and 62% HIV‐positive spouses ascertained prospectively, and 48% HIV negative and 26% HIV‐positive community controls. Of 54 HIV‐positive spouses, 18 completed 6‐month IPT. At 2 year follow‐up, 87% of surviving spouses had TST ≥10 mm and the rate of TB was 1.1 per 100 py (95% CI 0.34–3.29). Conclusions Spouses are a high‐risk group who should be screened for HIV and active TB. TST prevalence was already high by the time the spouses were approached but further infections were seen to occur. Uptake and adherence to IPT was disappointing, lessening the impact of short‐duration therapy.