北京协和医院外科老年患者术后静脉血栓栓塞症流行病学调查

目的 调查北京协和医院外科老年患者术后静脉血栓栓塞症(VTE)的流行病学资料,寻找老年患者术后发生VTE的危险因素。方法 回顾性分析2016年5月至7月在北京协和医院接受手术的4 819例患者的临床资料,收集患者的基本信息、术后及出院后3个月内症状性VTE的发生及预防情况。根据年龄将患者分为老年组(≥65岁,925例)和中青年组(<65岁,3894例),比较2组的VTE发生、预防情况以及发生VTE相关危险因素的差异。采用SPSS 26.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、U检验、χ²检验及方差分析。结果 老年组和中青年组患者术后VTE的发病率分别为2.59%(24/925)、0.33%(13/3894),老年组VTE的发病风险约为中青年组的8倍(RR=7.952,95％CI 4.033~15.678;P<0.001)。神经外科老年患者的VTE发病率最高(16.67%,4/24),且显著高于其他科室(P=0.003)。老年组有19项危险因素占比显著高于中青年组(P<0.01),其中占比最多的前3项危险因素分别为大手术(>45min)、恶性肿瘤和肥胖(体质量指数＞25kg/m²)。多因素logistic回归分析显示下肢肿胀、当前吸烟和手术时间>2h是老年患者术后发生VTE的独立危险因素(P<0.05)。老年高危人群使用机械预防和药物预防的比例均高于中青年高危人群[51.42%(399/776)和39.21%(567/1446),P<0.001;31.44%(244/776)和20.95%(303/1446),P<0.001]。老年VTE患者中,有70.83%(17/24)发病前未接受药物预防,58.33%(14/24)仅接受机械预防仍发生症状性VTE。结论 老年外科手术患者术后VTE发病率高于中青年患者,对于合并下肢肿胀、当前吸烟和手术时间>2h的老年患者应加强围手术期VTE药物预防。     

江苏省苏北县级城镇29 167例体检人群的肾功能随增龄变化情况

目的 探讨江苏省苏北县级城镇大样本量体检人群肾功能增龄变化。方法 回顾性、横断面研究调查2018年2月至2019年12月于江苏省射阳县人民医院体检的31593名成年人的资料。根据年龄不同分为18~29岁、30~39岁、40~49岁、50~59岁、60~69岁及70岁+组。使用基于肌酐的慢性肾脏病流行病学协作公式估算肾小球滤过率(eGFR),采用线性回归法计算eGFR随增龄下降速度,以χ²检验比较组间年均下降率,线性趋势χ²检验比较不同年龄组eGFR< 90ml/(min·1.73m²)发生率差异。采用SPSS 26.0软件进行数据分析。结果 共29167名体检者纳入本研究。eGFR随增龄下降,年平均下降速度为(0.82±0.00) ml/(min·1.73m²),各年龄组年平均下降速度分别(0.64±0.07)、(0.69±0.04)、(0.78±0.03)、(0.78±0.03)、(0.87±0.06)、(1.03±0.06) ml/(min·1.73m²),在70岁+组下降速度显著增快(P<0.05)。肌酐、尿素氮在正常参考值范围时,eGFR< 90ml/(min·1.73m²)的发生率分别为14.73%和12.27%。体检人群eGFR< 90ml/(min·1.73m²)的发生率随增龄而增加,总发生率为13.00%,各年龄组发生率分别为0.27%,0.86%,5.43%,13.28%,32.30%,86.45%,线性趋势χ²检验显示趋势变化差异有统计学意义(P<0.05)。70岁以上老年人eGFR< 60ml/(min·1.73m²)的发生率为10.84%。结论 体检人群eGFR随增龄显著降低,低eGFR在老年人中发生率高,建议综合使用肌酐、尿素氮及eGFR评估体检人群肾功能。     

外科围手术期去氨加压素对出血和血栓形成的影响

目的 评价血管外科静脉曲张手术、泌尿外科手术以及骨科手术围术期应用去氨加压素对围术期出血及术后相关血液检测指标的影响。 方法 选择2018年1月至2019年7月于中国医学科学院北京协和医院、北京大学肿瘤医院、中国医科大学附属盛京医院、山东省立医院、临沂市人民医院接受大隐静脉曲张手术、泌尿外科手术以及骨科手术患者182例,本研究为前瞻性研究,采用随机数表法将患者分为药物组(n=98)和对照组(n=84)。每组患者按照手术方式不同又分为静脉曲张手术组、骨科手术组及泌尿外科手术组。比较2组血红蛋白、血小板、血清钠、丙氨酸氨基转移酶、血肌酐、凝血酶原时间(PT)、活化部分凝血酶原时间(APTT)、D-二聚体、纤维蛋白原(Fb)、术后是否发生出血、术中出血量以及术后瘀斑面积变化。采用SPSS 26.0软件进行数据分析。根据数据类型,组间比较分别采用χ²检验、U检验、t检验或Fisher确切概率法。结果 术后第1天,药物组患者中静脉曲张手术组及骨科手术组血清钠、静脉曲张手术组APTT及骨科手术组PT,均明显低于对照组,差异均有统计学意义(均P<0.05)。术后第2天,药物组患者中静脉曲张手术组及骨科手术组血清钠、Fb,均明显低于对照组,差异均有统计学意义(均P<0.05)。对照组术后第1,2天血肌酐均比术前降低,差异均有统计学意义(均P<0.05)。其余指标差异无统计学意义。药物组中的静脉曲张手术组术后瘀斑发生率[16(32.7%)]低于对照组[16(41.0%)],且药物组单侧患肢瘀斑面积[0.220cm²(0.155cm²,0.580cm²)]较对照组[0.315cm²(0.163cm²,1.475cm²)]小,差异均有统计学意义(均P<0.05)。结论 围术期应用去氨加压素可影响相应血液检测指标,有效减少大隐静脉曲张术后瘀斑面积,减少出血和下肢深静脉血栓发生率。     

血红蛋白水平对老年男性住院患者预后影响的回顾性队列研究

目的 探讨不同血红蛋白(Hb)水平对老年男性住院患者预后的影响,并分析老年男性肾功能不全患者的最佳Hb区间。方法 回顾性分析2008年1月至2010年12月于中国人民解放军总医院国家老年疾病临床医学研究中心住院的1623例老年男性患者的临床资料。根据Hb水平将患者分成4个组:Hb≤110g/L组413例、110g/L＜Hb≤120g/L组139例、120g/L＜Hb≤130g/L组241例以及Hb＞130g/L组830例。根据入院时基线肾功能水平,将患者分为肾功能不全组[eGFR＜60ml/(min·1.73m²)]357例和肾功能正常组[eGFR≥60ml/(min·1.73m²)]1266例。应用SPSS 25.0统计软件进行数据分析。不同Hb水平患者累计生存率及急性心肌梗死发生率差异采用Kaplan-Meier生存曲线分析。相关性分析采用Cox比例风险回归模型。结果 在5年随访期内,共有617例(38.0%)患者发生全因死亡,254例(15.7%)患者发生急性心肌梗死。Kaplan-Meier生存曲线分析显示,Hb＞130g/L组累计全因死亡率及急性心肌梗死发生率最低,Hb≤110g/L组累计全因死亡率及急性心肌梗死发生率最高,组间两两比较log-rank检验差异均有统计学意义(均P＜0.05)。对肾功能不全患者进行Cox比例风险回归分析发现,与Hb≤110g/L组比较,120g/L＜Hb≤130g/L组(HR＝0.43,95％CI 0.25～0.73;P＝0.002)和Hb＞130g/L组(HR＝0.46,95％CI 0.24～0.87;P＝0.017)患者的全因死亡风险显著降低,120g/L＜Hb≤130g/L组患者的急性心肌梗死发生风险显著降低(HR＝0.31,95％CI 0.14～0.69;P＝0.004)。结论 老年男性住院患者较高的Hb水平可降低全因死亡率及急性心肌梗死发生率。当患有肾功能不全时,存在最佳Hb水平区间。Hb＞120g/L和全因死亡低风险相关,120g/L＜Hb≤130g/L和急性心肌梗死低风险相关。     

改良衰弱指数预测老年全髋关节置换术后并发症的临床应用

目的 探讨改良衰弱指数(mFI-5)预测老年全髋关节置换术后并发症的临床应用价值,为患者围手术期综合干预提供参考依据。方法 回顾性分析2014年1月至2019年8月于中国人民解放军总医院第一医学中心骨科收治的年龄≥65岁的老年全髋关节置换手术639例患者的临床资料。收集患者人口统计学资料、手术相关信息、mFI-5评分变量及术后并发症信息,构建mFI-5。根据mFI-5评分分为衰弱组(mFI-5≥2分)与非衰弱组(mFI-5<2分)。术后并发症包括术后谵妄、脑卒中、肺炎、深静脉血栓及肺不张。比较2组患者术后并发症的发生情况。采用SPSS 26.0软件进行数据分析。根据数据类型,组间比较分别采用t检验及χ²检验。采用二分类多因素logistic回归分析探讨衰弱对全髋关节置换患者术后并发症的预测作用。结果 衰弱组190例(29.73%),非衰弱组449例(70.27%)。2组患者性别、美国麻醉医师协会分级及麻醉方式比较,差异均有统计学意义(均P<0.05)。衰弱组在慢性阻塞性肺疾病或慢性肺炎病史、非独立功能状态、2型糖尿病史、术前30d内充血性心力衰竭史以及需要药物治疗的高血压病史五个方面的发生情况均明显高于非衰弱组,差异均有统计学意义[27例(14.21%)和9例(2.00%),132例(69.47%)和43例(9.58%),92例(48.42%)和23例(5.12%),2例(1.05%)和0(0.00),176例(92.63%)和177例(39.42%);均P<0.001]。衰弱组患者总并发症发生率明显高于非衰弱组,差异有统计学意义[94例(49.47%)和20例(4.45%);P<0.001]。多因素logistic回归分析显示,衰弱组患者出现术后并发症的风险是非衰弱组倍12.23倍(OR=12.23,95%CI 6.51~23.98;P=0.002),差异有统计学意义(P<0.05)。衰弱是术后谵妄(OR=10.32,95%CI 5.63~23.79;P=0.022)、脑卒中(OR=12.24,95%CI 5.09~69.01;P<0.001)、肺部感染(OR=5.88,95%CI 2.31~23.91;P<0.001)和DVT(OR=27.61,95%CI 3.02~78.24;P=0.034)的独立危险因素。结论 mFI-5是预测老年全髋关节置换患者术后并发症的有效评估工具,mFI-5≥2分可作为预测术后并发症的有效指标。     

基于智能穿戴设备探讨睡眠时长与高血压关系的真实世界研究

目的 基于智能穿戴设备测量睡眠时长与家庭血压,明确睡眠时长与高血压的关联性。方法 本研究数据资料来自由中国医疗保健国际交流促进会发起的“血压健康研究”,由中国人民解放军总医院执行。本研究采用在线招募方式,招募来自全国34个省、自治区、直辖市的受试者。根据纳入与排除标准,2021年12月至2023年1月共纳入1706例既往无高血压病史的成年受试者,采用华为智能血压手表测量睡眠数据及家庭血压数据,通过填写电子问卷收集受试者人口学资料和病史等信息。按照基线时血压测量数值将受试者分为高血压组[收缩压(SBP)≥135mmHg(1mmHg=0.133kPa),和(或)舒张压(DBP)≥85mmHg,n=851]和非高血压组(SBP＜135mmHg,且DBP＜85mmHg,n=855)。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用t检验或χ²检验进行组间比较。采用多因素logistic回归分析睡眠时长与高血压之间的横断面关系。结果 1706例受试者中男性1519例(89.04%),女性187例(10.96%);年龄(44.87±11.52)岁;体质量指数(BMI)为(24.99±3.33)kg/m²;睡眠时长(7.35±1.10)h;收缩压(125.97±11.75)mmHg,舒张压(84.66±8.45)mmHg;心率(77.43±9.63)次/min。在不同睡眠时长(≥9h、7~<9h、5~<7h、<5h)受试者中,高血压患病率比较(45.26%、48.16%、52.63%和67.65%),差异有统计学意义(P=0.046)。随着睡眠时长缩短,高血压患病率有增高趋势。未校正混杂因素的多因素logistic回归分析结果显示,与睡眠时长7~<9h组比较,睡眠时长≥9h组(OR=0.890,95%CI 0.583~1.358;P=0.589)及睡眠时长5~<7h组(OR=1.196,95%CI 0.974~1.469;P=0.088)高血压风险无统计学差异;睡眠时长<5h组(OR=2.250,95%CI 1.086~4.665;P=0.029)的受试者高血压风险增加。校正了所有可获取混杂因素(年龄、性别、BMI、高盐饮食习惯、吸烟/饮酒史、呼吸睡眠暂停综合征史、糖尿病史、慢性肾脏病史等)后,与睡眠时长7~<9h组的受试者比较,睡眠时长≥9h组(OR=0.952,95%CI 0.606~1.495;P=0.831)及睡眠时长5~<7h组(OR=1.056,95%CI 0.848~1.315;P=0.625)高血压风险无统计学差异;睡眠时长<5h组(OR=2.238,95%CI 1.026~4.884;P=0.043)受试者的高血压风险依然增加。结论 睡眠时长过长及睡眠时长轻度不足与高血压风险无显著关联,睡眠时长过短与高血压风险增加显著关联。     

老年前列腺癌患者前列腺根治术后影响尿控恢复状况的相关因素

目的 分析老年前列腺癌患者前列腺根治术后尿控恢复状况的相关因素。方法 选择2021年1月至2022年9月中部战区总医院行前列腺根治术治疗的老年前列腺癌患者131例为观察对象,根据术后尿控恢复状况分为尿失禁组(n=46)和尿控组(n=85)。比较两组临床资料及围手术期指标,采用多因素logistic回归分析患者前列腺根治术后尿控恢复状况的相关因素。采用SPSS 20.0统计软件进行数据分析。组间比较采用χ²检验。结果 尿失禁组患者年龄≥75岁、体质量指数(BMI)≥24kg/m2、既往经尿道前列腺电切术(TURP)史、合并高血压史、合并糖尿病史比例明显高于尿控组,差异均有统计学意义(P＜0.05)。尿失禁组患者术前前列腺体积30~75ml、肿瘤分期≥T3a期、术中出血量≥600ml比例明显高于尿控组,保留最长尿道长度(MULP)、保留神经血管束(NVB)、完全保留膀胱颈、术后规律提肛训练比例明显低于尿控组,差异均有统计学意义(P＜0.05)。年龄≥75岁、既往TURP史、肿瘤分期≥T3a期、术中出血量≥600ml均为前列腺根治术后尿失控的危险因素(OR=2.451、3.015、2.156、3.074;P＜0.05);保留MULP、保留NVB、完全保留膀胱颈、术后规律提肛训练为前列腺根治术后失控的保护因素(OR=0.674、0.845、0.874、0.912;P＜0.05)。结论 影响前列腺根治术后患者尿控恢复情况的因素多样,其中年龄、既往TURP史、肿瘤分期、术中出血量均为前列腺根治术后尿失控危险因素,对存在术后尿失禁高危因素患者进行早期干预有助于降低尿失禁发生率。     

脑梗死合并代谢综合征的老年人群发病特点及其危险因素分析

目的 分析脑梗死合并代谢综合征老年人群发病特点及危险因素。方法 收集2015年3月至2019年10月于江苏省扬州友好医院就诊的临床诊断为脑梗死的老年患者154例,其中合并代谢综合征患者80例(观察组),单纯脑梗死患者74例(对照组),对2组患者一般临床资料、血浆胆固醇(TC)、甘油三酯(TG)及高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、收缩压、舒张压、餐后2h血糖、空腹胰岛素、神经功能和并发症发生情况进行比较,并对脑梗死合并代谢综合征相关因素进行多因素logistic回归分析。采用SPSS 21.0软件进行数据分析。根据数据类型,组间比较分别采用χ²检验或者t检验。结果 观察组患者BMI(28.3±3.5)kg/m²、腰围(94.6±10.2)cm、吸烟史[35例(43.8%)]、饮酒史[33例(41.3%)]、高血压[57例(71.3%)]、高血糖[64例(80.0%)]和高血脂[49例(61.3%)]均高于对照组[25.7±2.9)kg/m²、(89.3±9.4)cm、20例(27.0%)、18例(24.3%)、36例(48.6%)、39例(52.7%)、30例(40.5%)],差异均有统计学意义(均P<0.05)。观察组患者TC(5.25±1.13)mmol/L、TG(2.36±0.85)mmol/L、FPG(7.83±0.87)mmol/L、收缩压(149.32±12.41)mmHg (1mmHg=0.133kPa)、舒张压(89.34±9.12)mmHg、餐后2h血糖(10.81±3.45)mmol/L和空腹胰岛素(10.86±2.75)mmol/L均高于对照组[(4.89±0.94)mmol/L、(1.82±0.64)mmol/L、(6.28±0.57)mmol/L、(141.71±11.52)mmHg、(82.31±7.61)mmHg、(7.87±3.14)mmol/L和(8.49±2.53)mmol/L],观察组HDL-C(0.94±0.24)mmol/L低于对照组(1.08±0.36)mmol/L,差异均有统计学意义(均P<0.05)。观察组患者神经功能评分(24.62±6.74)分、神经功能评分等级为重型的比例41.3%(33/80)、肺部感染11.3%(9/80)、心力衰竭28.8%(23/80)、肝肾衰竭的发生率16.3%(13/80),均高于对照组[(17.21±6.25)分、21.6%(16/74)、2.7%(2/74)、9.5%(7/74)、4.1%(3/74)],差异均有统计学意义(均P<0.05);观察组与对照组脑梗死的复发率比较,差异无统计学意义(P>0.05)。通过logistic回归分析发现高血压、FPG≥6.1mmol/L、TG≥1.7mmol/L、肺部感染及肥胖均为脑梗死合并代谢综合征的危险因素。结论 脑梗死合并代谢综合征的老年患者的病情重,预后差,且高血压、FPG≥6.1mmol/L、TG≥1.7mmol/L、肺部感染及肥胖为脑梗死合并代谢综合征老年患者的危险因素。     

早期血清白蛋白水平对重型颅脑损伤术后患者预后的预测价值

目的 评估早期血清白蛋白(ALB)水平用于预测重型颅脑损伤(STBI)术后患者预后的价值。方法 采用回顾性研究方法,选取2015年9月至2020年6月徐州医科大学附属医院重症医学科收治的年龄≥18岁、ICU住院时间＞7d的149例STBI术后患者为研究对象,根据28d生存情况将其分为存活组和死亡组。收集患者一般资料,入ICU 1、3、5、7d的血清ALB水平,1~3、4~5、6~7d ALB补充量。采用多因素logistic回归分析影响预后的独立危险因素。通过动态ALB水平及急性生理和慢性健康状况Ⅱ(APACHEⅡ)评分绘制受试者工作特征曲线(ROC),评估其预测28d预后的价值;基于相应时间点ALB临界值分组,通过Kaplan-Meier生存曲线分析累积生存率。结果 149例患者中,28d内死亡41例,病死率为27.5%。治疗时间延长情况下,存活组血清ALB水平呈逐渐上升趋势,死亡组呈先下降后升高趋势,死亡组3d血清ALB水平最低。相较存活组,死亡组入ICU 3、5、7d血清ALB水平皆明显偏低[(35.22±0.54)和(25.99±0.60),(36.58±0.54)和(32.29±4.25),(36.70±0.49)和(34.66±0.79)mmol/L,均P＜0.05)]。分析ROC曲线可知,在预测STBI术后患者28d死亡方面,入ICU 3d与5d血清ALB具有较高的价值,ROC曲线下面积(AUC)依次是0.928和0.892(均P＜0.001);APACHEⅡ评分及入ICU 7d血清ALB水平次之,两者AUC依次是0.801和0.616(均P＜0.05)。以3d血清ALB 31.2g/L当作预测28d死亡的临界值时,其灵敏度为95.12%,特异度为81.48%,阳性似然比为3.02,阴性似然比为0.07。分析Kaplan-Meier生存曲线可知,入ICU不同时间点,高于血清ALB临界值者28d存活率明显比低于临界值者高,且生存期更长。3d时血清ALB＞31.2g/L者28d存活率明显高于血清ALB≤31.2g/L者,且生存期显著延长[28d存活率:96.7%(89/92)和 32.8%(19/57), χ²=68.068,P＜0.001;生存期(d):26.46(23.96,30.11)和24.26(19.93,28.46),Z=3.423,P=0.001〕。 结论 血清ALB水平下降代表STBI术后患者预后不佳;入ICU 3 d血清ALB水平对STBI术后患者预后预测价值最高。     

老年髋膝关节置换术患者术后自我康复现状及生活质量的影响因素

目的 探讨老年髋膝关节置换术(THA/TKA)患者术后自我康复现状,并分析患者生活质量的影响因素。方法 选择2020年1月至2022年1月琼海市人民医院收治的190例老年THA/TKA手术患者为研究对象,使用问卷调查的方式,统计老年THA/TKA治疗者出院后家庭康复6个月时的自我康复现状。采用SPSS 20.0统计软件进行数据分析。根据数据类型,分别采用单因素方差分析、t检验或χ²检验进行组间比较。采用多元线性回归分析老年THA/TKA治疗者术后生活质量的影响因素。结果 190份调查问卷中,回收有效问卷179份。179例患者简明健康调查量表(SF-36)各维度平均得分为(54.41±8.77)分;患者术后髋、膝关节优良率分别为40.00%(36/90)和42.70%(38/89);患者整体自护能力分级及社会支持水平多处于中低水平[85.47%(153/179)和88.83%(159/179)];焦虑、抑郁发生率分别为25.14%(45/179)和27.37%(49/179);自我康复训练依从性多处于良或差水平[33.52%(60/179)和46.37%(83/179)]。多元线性回归分析结果提示,术后并发症(β=-3.854,P<0.001)及抑郁(β=-0.277,P<0.001)对老年THA/TKA治疗者生活质量有负向预测作用;自护能力(β=0.236,P<0.001)、社会支持水平(β=0.611,P<0.001)及自我康复训练依从性(β=0.213,P<0.001)对其生活质量有正向预测作用,回归方程差异显著(F=13.115,P<0.001),这些变量共同解释生活质量的50.60%的变异。结论 老年THA/TKA患者术后6个月自我康复整体现状不佳,术后并发症、自护能力、社会支持水平、抑郁及自我康复训练依从性是老年THA/TKA治疗者生活质量的独立影响因素,建议临床从这些方面入手,改善患者术后生活质量。     

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.