不同剂量舒芬太尼对心脏瓣膜置换术患者应激反应、炎性因子及心肌损伤的影响

目的:探讨不同剂量舒芬太尼对心脏瓣膜置换术患者应激反应、炎性因子及心肌损伤的影响。方法:根据随机数字表法将100例行心脏瓣膜置换术的患者分为低剂量组(n=33,舒芬太尼剂量为1.0μg/kg)、中剂量组(n=33,舒芬太尼剂量为1.5μg/kg)以及高剂量组(n=34,舒芬太尼剂量为2.0μg/kg),比较三组患者应激反应、炎性因子、心肌损伤等指标的变化以及围术期指标情况。结果:中剂量组、高剂量组麻醉诱导后(T1)、插管后1 min(T2)、插管后5 min(T3)、插管后10 min(T4)时间点心率(HR)、平均动脉压(MAP)均低于低剂量组同时间点,且高剂量组低于中剂量组(P<0.05)。与低剂量组比较,中剂量组、高剂量组阻断后30 min(T6)、开主动脉后2h(T7)以及术后1d(T8)时间点白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)均降低(P<0.05)。与低剂量组比较,中剂量组、高剂量组体外循环停机2h(T9)、体外循环停机8h(T10)、体外循环停机24h(T11)、体外循环停机48h(T12)时间点心肌肌钙蛋白I(cTnI)、肌酸磷酸激酶同工酶(CK-MB)均降低(P<0.05)。低剂量组、中剂量组重症监护室(ICU)滞留时间、拔管时间显著短于高剂量组(P<0.05),而三组心血管不良事件发生率比较差异无统计学意义(P>0.05)。结论:给予1.0μg/kg舒芬太尼麻醉的患者应激反应小,1.5μg/kg、2.0μg/kg舒芬太尼可更好地控制心脏瓣膜置换术患者炎性反应,同时对患者心肌损伤有一定的保护作用,但2.0μg/kg舒芬太尼会延长患者ICU滞留时间、拔管时间。     

压力-应激对大鼠心肌细胞Cx43蛋白表达及心肌纤维化的影响

目的:探讨压力-应激对大鼠心肌细胞间隙连接蛋白-43(Cx43)蛋白表达及心肌纤维化的影响。方法:将20只雄性SD大鼠随机分为正常对照组(n=10)和模型组(n=10),对照组正常饲养,模型组给予不可预测性复合应激结合孤养建立压力-应激大鼠模型。监测两组大鼠的体重变化,并通过组织形态学方法,探讨压力-应激对大鼠心肌细胞Cx43蛋白表达及心肌纤维化的影响。结果:在为期42天的造模过程中,从应激第7天开始,模型组大鼠体重明显低于对照组,差异有统计学意义(P<0.001)。且模型组体重增长缓慢,体重增长百分比明显低于对照组,差异有统计学意义(P<0.001)。与对照组相比,模型组大鼠组织HE染色可见心肌细胞排列紊乱,横纹消失,细胞间隙增大,部分肌纤维断裂、溶解,Masson染色可见心肌间质纤维化,胶原纤维增生、排列紊乱。心肌细胞免疫组化染色可见模型组Cx43蛋白表达明显下降(平均光密度值为0.0110±0.0028),与对照组相比(平均光密度值为0.0268±0.0025),差异具有统计学意义(t=-13.081,P<0.001)。结论:过度疲劳导致猝死的发生可能与Cx43蛋白表达水平的下降引起的恶性心律失常有关。     

特发性膜性肾病患者外周血中性粒细胞-淋巴细胞比值的临床与病理价值分析

摘要 目的：探讨外周血中性粒细胞与淋巴细胞比值（NLR）在特发性膜性肾病（IMN）中的临床及病理价值。方法：收集2017年1月至2019年12月确诊为IMN患者221例作为IMN组,将2019年7月至2019年9月体检且尿常规和肾功能指标正常的87例健康体检者作为正常对照组,计算每个研究对象的NLR值,比较两组间NLR值的差异。记录IMN患者的血生化指标及患者的肾脏病理分期及纤维化程度,并且根据MDRD公式计算肾小球滤过率(eGFR),分析NLR与IMN患者的血生化指标及病理特征的相关性。ROC曲线分析外周血NLR评估IMN患者肾间质纤维化的敏感性和特异性。结果：IMN组外周血NLR值高于对照组,差异有统计学意义（P<0.05）。外周血NLR值与IMN患者年龄和肾间质纤维化有关联（P均<0.05）,但与IMN患者性别及肾脏病理分期无关联（P均>0.05）。IMN外周血NLR值与IMN患者hs-CRP、SCr、BUN呈正相关（P<0.05）,与eGFR呈负相关（P<0.05）,与ESR、UA、TP、Alb、24小时蛋白尿定量均无相关性（P均>0.05）。不同程度肾间质纤维化的IMN患者外周血NLR值不同,差异有统计学意义（P<0.05）,且肾间质纤维化程度在1、2、3级时,纤维化程度越重,NLR值越大;3个级别间两两比较,差异均有统计学意义（P均<0.05）。外周血NLR值预测IMN患者肾间质纤维化的ROC曲线下面积为0.715[95%CI(0.626,0.803)],其截断值为1.858时,灵敏度为68.6%,特异度为66.7%。结论：外周血NLR可作为IMN肾脏功能水平的一个有效评价指标,且与IMN患者肾间质纤维化有关,可作为判断肾间质纤维化的参考指标。     

注射用地尔硫卓联合前列地尔注射液对射血分数保留型心衰患者心功能、血清炎症因子和氧化应激的影响

摘要 目的：注射用地尔硫卓联合前列地尔注射液对射血分数保留型心衰（HFpEF）患者心功能、血清炎症因子和氧化应激的影响。方法：选取2016年3月至2020年3月期间于齐都医院接受治疗的HFpEF患者108例,根据奇偶排序法分为对照组54例、研究组54例,对照组患者给予注射用地尔硫卓治疗,研究组患者给予注射用地尔硫卓联合前列地尔注射液治疗,疗程为2周。对比两组治疗2周后的疗效,记录两组治疗期间不良反应发生情况。对比两组治疗前、治疗2周后的二尖瓣舒张早期血流峰速度/心房收缩期二尖瓣口最大血流流速（E/A）以及二尖瓣舒张早期血流峰速度/二尖瓣环舒张早期运动峰速度（E/E''）、B型尿钠肽（BNP）、C反应蛋白（CRP）、白细胞介素（IL）-6、巨噬细胞移动抑制因子（MIF）、鸟嘌呤（8-OHdG）、超氧化物歧化酶（SOD）、丙二醛（MDA）。结果：与对照组的总有效率75.93%（41/54）相比,研究组的总有效率92.59%（50/54）更高（P<0.05）。研究组治疗2周后BNP、E/E''低于对照组,E/A高于对照组（P<0.05）。研究组治疗2周后IL-6、CRP、MIF低于对照组（P<0.05）。研究组治疗2周后8-OhdG、MDA低于对照组,SOD高于对照组（P<0.05）。两组均未见明显不良反应发生。结论：注射用地尔硫卓联合前列地尔注射液能显著改善HFpEF患者心功能,改善机体血清炎症因子和氧化应激,安全有效。     

Detection of radiation induced cardiotoxicity: Role of echocardiography and biomarkers

We review the role of echocardiography and biomarkers in detection of radiation-induced cardiac toxicity (RICT). RICT is related to micro- and macrovascular damage which induce inflammation, endothelial dysfunction, accelerated atherosclerosis, myocyte degeneration and fibrosis. The process is cumulative dose to the heart and target volume dependent. Furthermore, the damage of the heart is frequently potentiated by the adjunctive chemotherapy. The clinical manifestations of RICT may acutely develop but most often become clinically apparent several years after irradiation. RICT clinical manifestation covers a wide spectrum of pathologies including pericarditis, coronary artery disease (CAD), myocardial infarction, valvular heart disease, rhythm abnormalities, and non-ischemic myocardial and conduction system damages. Echocardiography and cardiac markers are important diagnostic tools for the detection of RICT.     

Dimethyl fumarate protects thioacetamide‐induced liver damage in rats: Studies on Nrf2, NLRP3, and NF‐κB

The present study was designed to investigate the hepatoprotective potential of dimethyl fumarate (DMF) against thioacetamide (TAA)‐induced liver damage. Wistar rats were treated with DMF (12.5, 25, and 50 mg/kg/day, orally) and TAA (200 mg/kg intraperitoneally, every third day) for 6 consecutive weeks. TAA exposure significantly reduced body weight, increased liver weight and index, and intervention with DMF did not ameliorate these parameters. DMF treatment significantly restored TAA‐induced increase in the levels of aspartate aminotransferase, alanine aminotransferase, γ‐glutamyl transferase, total bilirubin, uric acid, malondialdehyde, reduced glutathione, and histopathological findings such as inflammatory cell infiltration, deposition of collagen, necrosis, and bridging fibrosis. DMF treatment significantly ameliorated TAA‐induced hepatic stellate cell activation, increase in inflammatory cascade markers (NACHT, LRR, and PYD domains‐containing protein 3; NLRP3, apoptosis‐associated speck like protein containing a caspase recruitment domain; ASC, caspase‐1, nuclear factor‐kappa B; NF‐κB, interleukin‐6), fibrogenic makers (α‐smooth muscle actin; ɑ‐SMA, transforming growth factor; TGF‐β1, fibronectin, collagen 1) and antioxidant markers (nuclear factor (erythroid‐derived 2)‐like factor 2; Nrf2, superoxide dismutase‐1; SOD‐1, catalase). The present findings concluded that DMF protects against TAA‐induced hepatic damage mediated through the downregulation of inflammatory cascades and upregulation of antioxidant status.     

Phenotyping of hypertensive heart disease and hypertrophic cardiomyopathy using personalized 3D modelling and cardiac cine MRI

Differential diagnosis of hypertensive heart disease (HHD) and hypertrophic cardiomyopathy (HCM) is clinically challenging but important for treatment management. This study aims to phenotype HHD and HCM in 3D + time domain by using a multiparametric motion-corrected personalized modeling algorithm and cardiac magnetic resonance (CMR). 44 CMR data, including 12 healthy, 16 HHD and 16 HCM cases, were examined. Multiple CMR phenotype data consisting of geometric and dynamic variables were extracted globally and regionally from the models over a full cardiac cycle for comparison against healthy models and clinical reports. Statistical classifications were used to identify the distinctive characteristics and disease subtypes with overlapping functional data, providing insights into the challenges for differential diagnosis of both types of disease. While HCM is characterized by localized extreme hypertrophy of the LV, wall thickening/contraction/strain was found to be normal and in sync, though it was occasionally exaggerated at normotrophic/less severely hypertrophic regions during systole to preserve the overall ejection fraction (EF) and systolic functionality. Additionally, we observed that hypertrophy in HHD could also be localized, although at less extreme conditions (i.e. more concentric). While fibrosis occurs mostly in those HCM cases with aortic obstruction, only minority of HHD patients were found affected by fibrosis. We demonstrate that subgroups of HHD (i.e. preserved and reduced EF: HHDpEF & HHDrEF) have different 3D + time CMR characteristics. While HHDpEF has cardiac functions in normal range, dilation and heart failure are indicated in HHDrEF as reflected by low LV wall thickening/contraction/strain and synchrony, as well as much reduced EF.     

Tripartite motif protein 52 (TRIM52) promoted fibrosis in LX‐2 cells through PPM1A‐mediated Smad2/3 pathway

To investigate the roles of tripartite motif containing 52 (TRIM52) in human hepatic fibrosis in vitro, human hepatic stellate cell line LX‐2 cells were transfected with hepatitis B virus (HBV) replicon to establish HBV‐induced fibrosis in LX‐2 cells, and then treated with small interfering RNA‐mediated knockdown of TRIM52 (siTRIM52). LX‐2 cells without HBV replicon transfection were treated with lentiviruses‐mediated overexpression of TRIM52 and phosphatase magnesium dependent 1A (PPM1A). Fibrosis response of LX‐2 cells were assessed by the production of hydroxyproline (Hyp) and collagen I/III, as well as protein levels of α‐smooth muscle actin (α‐SMA). PPM1A and phosphorylated (p)‐Smad2/3 were measured to assess the mechanism. The correlation between TRIM52 and PPM1A was determined using co‐immunoprecipitation, and whether and how TRIM52 regulated the degradation of PPM1A were determined by ubiquitination assay. Our data confirmed HBV‐induced fibrogenesis of LX‐2 cells, as evidenced by significant increase in Hyp and collagen I/III and α‐SMA, which was associated with reduction of PPM1A and elevation of transforming growth factor‐β (TGF‐β), p‐Smad2/3, and p‐Smad3L. However, those changes induced by HBV were significantly attenuated with additional siTRIM52 treatment. Similar to HBV, overexpression of TRIM52 exerted promoted effect in the fibrosis of LX‐2 cells. Interestingly, TRIM52 induced the fibrogenesis of LX‐2 cells and the activation of TGF‐β/Smad pathway were significantly reversed by PPM1A overexpression. Furthermore, our data confirmed TRIM52 as a deubiquitinase that influenced the accumulation of PPM1A protein, and subsequently regulated the fibrogenesis of LX‐2 cells. TRIM52 was a fibrosis promoter in hepatic fibrosis in vitro, likely through PPM1A‐mediated TGF‐β/Smad pathway.     

Psoralen attenuates bleomycin‐induced pulmonary fibrosis in mice through inhibiting myofibroblast activation and collagen deposition

Idiopathic pulmonary fibrosis (IPF) is a progressive disease characterized by excessive deposition of extracellular matrix (ECM) and chronic inflammation with limited therapeutic options. Psoralen, a major active component extracted from Psoralea corylifolia L. seed, has several biological effects. However, the role of psoralen in IPF is still unclear. Here, we hypothesized that psoralen played an essential role in IPF in the inhibition of fibroblast proliferation and inflammatory response. A murine model of IPF was established by injecting bleomycin (BLM) intratracheally, and psoralen was administered for 14 days from the 7^th to 21^st day after BLM injection. Our results demonstrated that psoralen treatment reduced body weight loss and improved the survival rate of mice with IPF. Histological and immunofluorescent examination showed that psoralen alleviated BLM‐induced lung parenchymal inflammatory and fibrotic alteration. Furthermore, psoralen inhibited proliferation and collagen synthesis of mouse fibroblasts and partially reversed BLM‐induced expression of α‐smooth muscle actin at both the tissue and cell level. Moreover, psoralen decreased the expression of transforming growth factor‐β1, interleukin‐1β, and tumor necrosis factor‐α in the lungs of BLM‐stimulated mice. Our results reveale for the first time that psoralen exerts therapeutic effects against IPF in a BLM‐induced murine model.