jpi@wiley.com ; Tan@uthscsa.edu ; cs-journals@wiley.com  

6 June, 2011

Pineal Research Editors,

I have read a lot of fascinating articles on the beneficial effects of Melatonin on coronary artery disorder, published on Pineal Research.

I think that the more important effects of Melatonin, whose action mechanisms are more complex than generally admitted (1-15), are overlooked, because Authors ignore CAD Inherited Real Risk, and Newborn-Pathological, type I, subtype b) aspecific, Endoarteriolar Blocking Devices.

As a matter of fact, physicians all around the world must know exactly both the real quantum-biophysical-semeiotic constitutions and related inherited real risk of all individuals enrolled in whatever study (www.semeioticabiofisica.it).  Notoriously, coronary inherited real risk, as well as subclinical, and consequently very dangerous, coronary heart disease are very prevalent among older individuals, independently associated with atually known risk of CAD , and substantially increases the risk (presence of newborn, pathological, type I, subtype b)  aspecific, Endoarteriolar Blocking Devices in coronary small arteries, according to Hammersen), among individuals with hypertension or diabetes mellitus. Melatonin, ameliorating the underlying mitochondrial cytopathy, I descovered 35 years ago and termed Congenital Acidosic Enzyme-Metabolic Histngiopathy (1-6), influences positively such a pathological condition, tranforming it in its "residual" variant.

In following, I suggest - once again - an useful, reliable and easy clinical manoeuvre, that allows doctor to recognize both CAD Inherited Real Risk and silent CAD (1-3). This manoeuvre proved to be really useful in my 55-year-long clinical experience, also in order to the bed-side recognizing heart ischaemic disease before cardiac pathology occurs. Moreover, it is well known that patients with coronary artery disease (CAD) may have no symptoms at all for many years or decades and that the electrocardiographic features of ischaemia may be induced by exercise without accompaning angina (1). (For further information: See web site http://www.semeioticabiofisica.it, Practical Applications). In other words, we need a clinical tool reliable in rapid detecting CAD, even clinically silent, initiating from CAD “real risk”, doctor can now utilize in his day-to-day practice (1). I think surely that one method is "Myocardial Ischaemic Biophysical- Semeiotic Preconditioning", described elsewhere(1-3). >From the tehnical viewpoint, doctor has to know, at least, the auscultatory percussion of the stomach, described even in old acàdemic books of two last centuries (Rasario IX edition). Briefly, in healthy individuals, digital pressure of mean intensity, applied upon heart cutaneous projection area, brings about the so-called gastric aspecific reflex (= in the stomach, fundus and body are dilated; on the contrary, antral-pyloric region contracts) after an age-dependent latency time of 8 sec., that lasts less than 4 sec. (= parameter value of paramount significance since it parallels the efficicacy of coronary microvessel Microcirculatory Funcional Reserve).

A second, successive evaluation after an interval of 5 sec. exactly, provokes the identical reflex, but after lt. of 12 sec. or more: physiological myocardial preconditioning, typeI.

On the contrary, in patients involved by CAD, even silent, i.e. subclinical,latency time persists identical in both evaluations, or results clearly lower in the second one, in relation with disease seriousness: type II and respectively type III precosnditioning. Of course, biophysical semeiotic preconditioning evaluation, really more complex than it appears in the above brief description, can be applied to all others biological systems, with favourable influences on primary prevention and diagnosis (1-12).