经皮切割球囊成形术治疗支架内再狭窄的研究

目的　研究切割球囊成形术对治疗支架内再狭窄的即刻和 6个月内随访效果。方法　 6 9例支架内再狭窄患者随机分配到切割球囊组 (38例 )和普通球囊治疗组 (31例 )。球囊扩张前及扩张后即刻在定量冠状动脉造影和冠状动脉内超声下 ,测定相关参数。观察随访 6个月内临床改善及冠状动脉造影结果。研究终点包括出现心肌梗死 ,需要冠状动脉搭桥或再介入治疗。结果　两组的手术成功率均为 10 0 %。切割球囊组 1例患者扩张后在支架的远端出现夹层。平均随访 (6 .7± 2 .3)个月。切割球囊组于术后 3和 6个月时的再狭窄率显著低于普通球囊组(15 %∶38%及 18%∶4 2 % ,P <0 .0 0 1)。扩张后即刻血管直径获得值在切割球囊组和普通球囊组分别为 (1.72±0 .5 2 )mm和 (1.15± 0 .5 4 )mm ,随访 3个月及随访终点时切割球囊组的血管直径晚期丢失分别为 (0 .2 6± 0 .0 5 )mm(3个月 )及 (0 .38± 0 .0 6 )mm ,同时的普通球囊组丢失值分别为 (0 .78± 0 .19)mm(3个月 )及 (0 .89± 0 .16 )mm。结论　切割球囊成形术治疗老年冠心病患者支架内狭窄效果可靠 ,安全 ,容易操作 ,再狭窄率低     

应用切割球囊预扩张后置入金属裸支架治疗冠状动脉开口病变的4年临床随访

目的探讨应用切割球囊预扩张后置入金属裸支架治疗冠状动脉开口病变的远期临床疗效.方法对66例有冠状动脉开口病变的患者行切割球囊预扩张后置入金属裸支架,并对上述患者进行了6～8个月的冠状动脉造影随访和4年的临床随访.66例中冠状动脉主干开口病变9例,前降支开口病变50例,回旋支和右冠脉动脉开口病变各为3例和4例.按照切割球囊与血管直径1∶1的原则,选择切割球囊的大小.结果66例患者中完成经皮冠状动脉介入治疗(PCI)术后6～8个月冠状动脉造影随访者38例,造影随访率为57.6%,其中9例发生支架内再狭窄.66例中完成4年临床随访55例,其中死亡2例,1例于冠状动脉旁路移植(CABG)术后死亡,1例死于肺癌,发生非Q波心肌梗死2例,均由支架内严重再狭窄所致,经再次PCI治疗成功.4年间行血管重建术8例,其中再次PCI 4例,行CABG 4例,总计心脏事件发生率为16.4%(9/55).结论本研究显示切割球囊预扩张后置入金属裸支架有良好的近远期效果,未发现有晚期血栓形成致心脏事件的证据.     

经皮切割球囊成形术治疗老年冠心病患者冠状动脉支架内再狭窄69例分析

目的　观察切割球囊对老年冠心病患者支架内再狭窄的即刻和 6个月时治疗效果。　方法　 6 9例支架内再狭窄患者分配到切割球囊 (38例 )和普通球囊 (31例 )治疗组。球囊扩张前及扩张后即刻 ,用定量冠状动脉造影和冠状动脉内超声测定相关参数。随访 6个月时临床改善及冠状动脉造影结果。研究终点包括出现心肌梗死、需要冠状动脉旁路移植或再介入治疗。　结果　两组的手术成功率为 10 0 %。切割球囊组 1例患者扩张后在支架的远端出现夹层。平均随访 (6 7± 0 3)个月。切割球囊组于术后 3和 6个月时的再狭窄率显著低于普通球囊组 (分别为 15 %对 38%及 18%对4 3% ,均为P <0 0 0 1)。扩张后即刻血管直径获得值在切割球囊组和普通球囊组分别为 (1 72± 0 5 2 )mm和 (1 15± 0 5 4 )mm ,而 3和 6个月后切割球囊组的血管直径晚期丢失值为 (0 2 6± 0 0 5 )mm及(0 38± 0 0 6 )mm ,普通球囊组丢失值为 (0 78± 0 19)mm及 (0 89± 0 16 )mm(均为P <0 0 0 1)。　结论　切割球囊治疗老年冠心病患者支架内再狭窄效果可靠、安全 ,容易操作 ,再狭窄率低 ,易于被患者接受 ,是一个较有前途的治疗手段。     

冠脉内切割球囊术67例使用体会

目的　观察冠脉内切割球囊术对支架内再狭窄、分叉处病变、起始部病变、多支病变及小血管病变的疗效及并发症。方法　从 2 0 0 0 - 0 9～ 2 0 0 1- 0 7共完成冠脉内切割球囊术 6 7例 ,其中支架内再狭窄 9例 ,分叉处病变13例 ,起始部病变 11例 ,小血管病变 2 2例 ,较大血管 (≥ 3 0mm)单纯行切割球囊 6例 ,多支病变切割球囊 6例 ,用切割球囊作扩张后植入支架的患者 12例。结果　手术全部成功 ,1例患者出现第 2对角支起始部严重撕裂 ,经支架植入后无不良后果。支架内再狭窄者随访 1～ 8个月 ,平均 5 6个月 ,3例复发心绞痛 ,其中 2例为切割球囊术后再狭窄 ,另 1例为回旋支病变明显加重 ,而支架内无明显再狭窄 ,经单纯切割球囊术后已 3月余 ,无心绞痛发作 ,其余病人随访 3～ 8个月 ,平均 5个月 ,无心绞痛发生。结论　冠脉内切割球囊术是一种比较安全、有效的冠脉内介入手术     

冠状动脉内放射治疗对支架内再狭窄的作用

目的　研究应用β射线 (90 Sr/90 y)进行冠状动脉内放射治疗对国人支架内再狭窄的作用。方法　自 1 999年 1 2月至 2 0 0 2年 1月 ,我院对 5 3例患者 [男 4 9例 ,女 4例 ,平均年龄 (5 3 2± 9 8)岁 ]5 5处支架内再狭窄病变 (支架直径≥ 2 5mm ,1 0mm≤病变长度≤ 30mm) ,在球囊 (1 0处病变用普通球囊 ,4 5处病变用切割球囊 )满意扩张后 ,应用Beta Cath系统 (Novoste)进行冠状动脉内放射治疗。放射源长度 4 0mm。术后 8个月随访冠状动脉造影 ,用MEDCONViewer软件包进行定量冠状动脉造影 (QCA)分析。结果　 5 3例患者 5 5处支架内再狭窄病变均被满意扩张 ,冠状动脉内放射治疗全部成功 ,术中并发冠状动脉痉挛 1例 (1 8%) ,无其他并发症。全部患者随访期中无死亡 ,随访≥ 8个月 33例患者中 1例 (3 0 %)发生非Q波心肌梗死 ,6例 (1 8 2 %)进行靶血管重建术。该 33例患者中 2 9例(87 9%) 30处病变进行了随访冠状动脉造影 ,再狭窄率在支架段为 1 0 0 %(3/30 ) ,分析段为 2 3 3 %(7/30 )。最小管径直径术前为 (0 41± 0 2 2 )mm ,术后即刻为 (1 99± 0 42 )mm ,8个月随访时为 (1 73± 0 82 )mm ,平均病变长度为 (2 3 3± 5 4)mm。全部患者无晚期血栓形成、假性动脉瘤及冠状动脉瘤发生。结论　应用90 Sr     

不稳定型心绞痛无保护左主干病变支架术后随访研究

目的　探讨冠状动脉内支架治疗无保护左主干病变 (LMD)的安全性及有效性。方法　2 7例LMD经球囊预扩张后置入支架。术后 6和 12个月行冠状动脉造影随访。结果　左主干开口病变 12例、体部 4例、末端 6例 (累及分叉开口 6例、单纯末端 1例 ) ,自开口到体部均狭窄者 5例 (含自开口处就完全闭塞 1例 )。术后 12个月时 ,左心室射血分数从 4 9 8%增加到 5 6 3% (P <0 0 5 )。球囊扩张时 2 0例 ( 6 2 % )出现显著心率减慢和血压下降。共置入 2 8枚支架 ,其中左主干内 2 7枚 ,主干内支架直径 ( 3 90± 0 4 7)mm、长度 ( 12 5 4± 3 95 )mm。全部患者均完成 12个月的临床随访 ,19例 ( 70 % )患者接受 6个月时冠状动脉造影 ,3例支架内再狭窄 ( 15 % ) ,其中 2例接受冠状动脉旁路术 ,1例行血管内放射治疗 ;术后 12个月时 15例 ( 5 5 % )行冠状动脉造影随访 ,1例再狭窄行冠状动脉旁路术 ,因此术后 12个月内累积再狭窄率为 2 1%。 4例再狭窄患者中 ,3例为末端病变 ( 75 % ) ,1例为开口病变( 2 5 % )。结论　冠状动脉内支架治疗LMD疗效可靠 ,冠状动脉造影随访可及时发现再狭窄。左主干末端病变再狭窄率显著。     

小冠状动脉狭窄性病变的介入治疗

目的 :探讨小冠状动脉 （直径 <3 mm）狭窄性病变实施普通球囊、切割球囊或小支架介入治疗的疗效和并发症。方法 :小冠脉狭窄性病变介入治疗 （PCI）患者 13 6（男 87,女 49）例 ,年龄 3 2～ 85（54± 17）岁。根据手术方法分为普通球囊组、切割球囊组和小支架组。残余狭窄率 <3 0 %且无动脉夹层、撕裂等并发症者为手术成功 ,术后 6个月复查冠脉造影。结果 :普通球囊组 3 2例 ,手术成功 2 6例 （81% ） ,出现动脉夹层或扩张不满意改支架术 6例 （2 4% ）。切割球囊组 48例 ,手术成功 43例 （90 % ） ,出现动脉夹层或扩张不满意改支架术 3例 ,出现造影剂血管外漏 2例。支架组 56例 ,手术成功 53例 （95% ） ,出现造影剂血管外漏 2例 ,出现心包填塞抢救成功 1例。3组均未出现血管急性闭塞。术后 6个月 ,切割球囊组、小支架组、普通球囊组冠脉造影狭窄率分别为 2 3 % （11例 ）、16% （9例 ）、3 8% （12例 ）。结论 :小冠脉狭窄性病变实施介入治疗能取得显著效果 ,小支架术优于普通球囊扩张术 ,切割球囊扩张与普通球囊扩张具有近似疗效     

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。     

切割球囊冠状动脉腔内成形术102例

目的　应用切割球囊行冠状动脉腔内成形术并对其疗效进行评价。方法　对 10 2例冠心病患者的 116处病变行切割球囊扩张治疗 ,对其进行分析 ,并短期随访。结果　 116处病变血管直接切割球囊扩张治疗 ,成功率 94 %,结合普通小球囊预扩张后其成功率为 97%。 16例支架内再狭窄均扩张成功。 116处病变切割球囊扩张后安放支架 72个 (支架安放率 6 2 %) ,4 4例单纯行切割球囊扩张术者残余狭窄为 0～ 2 0 %[平均为 (11 6± 5 9) %]。 1例患者术后出现心包填塞 ,1例发生严重内膜撕裂。无急性闭塞、急诊冠状动脉旁路移植手术及急性心肌梗死发生。随访 1～ 2 0月 (平均 11 2月 ) ,10 (9 8%)例患者于术后出现心绞痛。其他患者随访期间无心脏事件发生。 12例病人复查冠脉造影 ,其中 3例发生再狭窄。结论　切割球囊行冠状动脉腔内成形术安全、有效 ,短期疗效良好。     

切割球囊冠状动脉腔内成形术52例临床分析

目的　应用切割球囊行冠状动脉腔内成形术并对其疗效进行评价。方法　对 5 2例冠心病患者的 63处病变行切割球囊扩张治疗 ,对其进行分析 ,并短期随访。结果　 63处血管直接切割球囊扩张治疗 ,成功率92 1% ,其中 9例完全闭塞性病变中 7例获得成功。 2例支架内再狭窄均扩张成功。 63处病变切割球囊扩张后安放支架 43个 (支架安放率 68 3 % ) ,2 0例单纯行切割球囊扩张术者残余狭窄为 0～ 2 0 % [平均为 ( 7 2±5 6) % ]。 1例患者术后出现心包填塞 ,无严重内膜撕裂、急性闭塞、急诊冠脉架桥术及急性心肌梗死发生。随访6～ 12个月 ,1例单纯行切割球囊扩张术患者于术后 1月出现心绞痛 ,经冠脉造影证实为再狭窄。其他患者随访期间无心脏事件发生。结论　切割球囊行冠状动脉腔内成形术安全、有效 ,短期疗效良好     

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.