BIS监测下右美托咪定联合七氟醚对颅内动脉瘤介入栓塞术患者苏醒质量、血清氧化应激指标和神经损伤标志物的影响

摘要 目的：探讨脑电双频指数（BIS）监测下右美托咪定联合七氟醚对颅内动脉瘤介入栓塞术患者苏醒质量、血清氧化应激指标和神经损伤标志物的影响。方法：采用随机数字表法,将我院2019年3月-2021年6月期间收治的80例颅内动脉瘤介入栓塞术患者分为研究组（BIS监测下右美托咪定联合七氟醚,n=40）和对照组（BIS监测下七氟醚,n=40）,观察两组血流动力学、苏醒质量、血清氧化应激指标和神经损伤标志物水平变化。记录两组围术期间不良反应发生状况。结果：气管插管后1 min（T1）~拔管后10 min（T4）时点,两组平均动脉压（MAP）、心率（HR）升高后下降,但研究组低于对照组同时点（P<0.05）。与对照组比较,研究组苏醒时间、恢复呼吸时间、拔管时间较短（P<0.05）。T1~T4时点,两组超氧化物歧化酶（SOD）、过氧化氢酶（CAT）水平下降后升高,但研究组较对照组同时点高（P<0.05）。术后1 d,两组人脑髓鞘碱性蛋白（MBP）、神经元特异性烯醇化酶（NSE）、S100?茁水平升高,但研究组低于对照组同时点（P<0.05）。对照组、研究组的不良反应发生率组间对比无显著性差异（P>0.05）。结论：BIS监测下七氟醚联合右美托咪定应用于颅内动脉瘤介入栓塞术患者中,可提高苏醒质量,减轻氧化应激水平和神经损伤程度,稳定血流动力学波动。     

高血压前期患者颈动脉血管弹性超声参数与左室舒张功能的关系研究

摘要 目的：研究高血压前期患者颈动脉血管弹性超声参数与左室舒张功能的关系。方法：选取2019年12月-2020年12月因血压异常于河北北方学院附属第一医院接受诊断与治疗的161例患者,根据血压水平分为高血压前期组（82例）与高血压组（79例）;另选取同期于我院体检的80例健康志愿者作为对照组。收集三组临床资料,检测生化指标与血压;通过超声诊断仪中超声射频信号血管内中膜定量分析（QIMT）与动脉僵硬度定量分析（QAS）软件测量颈动脉血管弹性超声参数[颈动脉内中膜厚度（IMT）、顺应性系数（CC）、扩张性系数（DC）、血管弹性指数（α、β）、脉搏波传导速度（PWV）];超声心动图检查左室功能指标[左室射血分数（LVEF）、左室质量指数（LVMI）、舒张早期血流速度峰值（E）/舒张晚期血流速度峰值（A）、等容舒张时间（IVRT）、舒张期减速时间（DT）];采用Pearson相关性法分析颈动脉血管弹性超声参数与心室指标的相关性。结果：三组收缩压与舒张压水平存在统计学意义（P＜0.05）。高血压前期组与高血压组IMT、α、β、PWV高于对照组,DC、CC低于对照组（P＜0.05）,且高血压前期组IMT、α、β、PWV低于高血压组,DC、CC高于高血压组（P＜0.05）。高血压前期与高血压组E/A低于对照组,IVRT、DT高于对照组（P＜0.05）,且高血压前期组E/A高于高血压组,IVRT、DT低于高血压组（P＜0.05）。经Peason相关性分析显示,IMT、α、β、PWV与E/A呈负相关,与IVRT、DT呈正相关（P＜0.05）;DC、CC与E/A呈正相关,与IVRT、DT呈负相关（P＜0.05）。结论：高血压前期患者颈动脉血管弹性功能下降,且伴有左室舒张功能受损,颈动脉血管弹性超声参数与左室舒张功能密切相关。     

介入栓塞术在急诊难治性医源性肾出血中的临床应用价值

摘要 目的：探讨介入栓塞术在急诊难治性医源性肾出血中的临床应用价值。方法：收集2012年6月至2021年6月南京医院大学第一附属医院收治的72例急诊难治性医源性肾出血的患者。所有患者在保守治疗无效的情况下,行介入下肾动脉血管造影,根据造影表现确定出血责任动脉,并行栓塞治疗,术后观察临床止血的有效性及安全性。结果：72例患者,介入血管造影呈阳性结果64例,包括血管出现单纯造影剂外溢12例,单纯假性动脉瘤19例,单纯动静脉瘘8例,9例患者合并两种造影表现,以及16例患者呈现动脉出血的一些间接征象。阳性出血患者介入栓塞技术成功率及临床止血率为100%。72例患者介入术后3 d血白细胞、血中性粒细胞比率、血红蛋白、血细胞比容及血小板较术前明显升高（均P＜0.05）,血肌酐及尿素氮较介入术前轻度升高（均P＞0.05）;其中30例患者介入术后7 d再次检测血肌酐及尿素氮,较介入术前基本恢复正常（均P＞0.05）。住院期间所有患者未出现肾衰等严重的术后并发症。结论：介入栓塞术治疗急诊难治性医源性肾出血患者,具有安全、高效、并发症少等优点,临床上值得推广应用。     

大鼠基底动脉和尾动脉平滑肌G蛋白的异质性

用离体血管收缩功能实验法分析了大鼠基底动脉（ＢＡ）和尾动脉（ＣＡ）平滑肌细胞Ｇ蛋白的异质性。结果显示,当ＢＡ和ＣＡ平滑肌被精氨酸血管加压素（ＡＶＰ）激动后,该两种血管对Ｇ蛋白非选择性激活剂ＧＴＰγＳ的收缩反应发生了相反的变化：ＢＡ对ＧＴＰγＳ的收缩增强,并且这种收缩增强不受百日咳毒素（ＰＴ,Ｇｉ和Ｇｏ抑制剂）的影响。而霍乱毒素（ＣＴ,Ｇｓ激活剂）则完全抑制这种收缩,呈单相反应。与ＢＡ相反,ＣＡ对ＧＴＰγＳ的收缩减弱,后者可被ＰＴ预温育反转为收缩增强,而且ＣＴ对这种收缩的抑制作用短暂,呈双相反应。结果提示,ＢＡ和ＣＡ平滑肌细胞介导激动剂收缩反应的Ｇ蚕白存在异质性。     

Ultrastructural localization of nitric oxide synthase and endothelin in coronary and pulmonary arteries of newborn rats

This is the first report on the ultrastructural distribution of nitric oxide synthase and endothelin immunoreactivities in the coronary and pulmonary arteries of newborn Wistar rats. The distribution of nitric oxide synthase and endothelin was investigated using pre-embedding peroxidase-antiperoxidase immunocytochemistry. In both arteries examined, positive labelling for nitric oxide synthase was localized both in the endothelium and smooth muscle, whereas positive labelling for endothelin was localized in the endothelium exclusively. In the coronary artery, approximately 80% and 55% of the endothelial cells examined were positive for nitric oxide synthase and endothelin, respectively, whereas in the pulmonary artery, 77% and 60% of the endothelial cells were positive for nitric oxide synthase and endothelin, respectively. These findings indicate that nitric oxide synthase and endothelin are colocalized in some of the endothelial cells of the newborn rat. In the endothelium, nitric oxide synthase and endothelin immunoreactivities were distributed throughout the cell cytoplasm and in association with the membranes of intracellular organelles. In smooth muscle, a relationship of nitric oxide synthase immunoreactivity to endoplasmic reticulum was observed in the pulmonary artery. In summary, in the newborn rat, endothelial cells of the coronary and pulmonary artery are rich in nitric oxide synthase (neuronal isoform) and endothelin, and it is suggested therefore that they may be substantially involved in vasomotor control of the cardiac and pulmonary circulation during early stages of postnatal development.     

缺氧促进热休克蛋白70在肺动脉平滑肌细胞中的表达

缺氧性肺动脉高压中肺动脉结构重组,中膜平滑肌细胞增殖并迁移,但机制不明。本研究观察缺氧对肺动脉平滑肌细胞（ＰＡＳＭＣ）细胞周期、ＤＮＡ合成及细胞增殖的影响,并通过观察缺氧对ＰＡＳＭＣ热休克蛋白７０（ＨＳＰ７０）表达的影响,初步探讨缺氧的作用是如何介导的。结果表明缺氧可直接或协同内皮质－１促进ＰＡＳＭＣ ＤＮＡ合成及细胞增殖,并可增加ＨＳＰ７０在ＰＡＳＭＣ中的表达。     

内皮素－1对缺氧肺动脉平滑肌细胞的增殖作用

内皮素（ＥＴ）是至今所发现的最强的内源性血管收缩肽,近年来发现ＥＴ－１能促进血管平滑肌细胞增殖。本研究表明ＥＴ－１对缺氧培养的肺动脉平滑肌细胞（ＰＡＳＭＣ）有剂量依赖的增殖作用,缺氧可促进ＰＡＳＭＣ的ＤＮＡ合成且增加ＥＴ－１的丝裂原作用。ＥＴ－１的丝裂原作用主要由其Ａ型受体（ＥＴＲ＿Ａ）所介导,ＥＴＲ＿Ａ的特异拮抗剂ＢＱ１２３可显著抑制缺氧以及缺氧与ＥＴ－１协同所产生的增殖作用,而且发现ＥＴＲ＿Ａ在缺氧培养的ＰＡＳＭＣ中的表达显著高于常氧对照组ＰＡＳＭＣ。本研究表明ＥＴ－１参与了缺氧性肺动脉结构重组,而缺氧可增强ＰＡＳＭＣ对ＥＴ－１的增殖反应性。     

Filaments and rod-shaped tubulated bodies in the endothelia of anterior cerebral arteries in young rats

Summary Endothelia of the anterior cerebral arteries in rats aged 1 to 3 days were studied. Thin (about 50–90 Å) and thick (about 100–110 Å) filaments are present in the endothelia. Numerous spherical- or rod-shaped bodies, measuring approximately 0.07 to 0.3 m in diameter and up to 0.6 m in length occur in the endothelial cells. These bodies contain a tubular structure. The diameter of the individual tubules is about 200 Å. The present observations suggest that spherical- or rod-shaped inclusions are first synthesized in the rough endoplasmic reticulum and thereafter these materials are transported into the Golgi complex for maturation. A small number of the inclusions, however, may originate directly from the rough endoplasmic reticulum and not pass through the Golgi apparatus.A part of this study was demonstrated at the 70th Versammlung der Anatomischen Gesellschaft in Düsseldorf, April, 1–5, 1975The author thanks Mr. Tatsuro Fukushima for preparation of photographs     

Clinical significance of circulating microRNAs as diagnostic biomarkers for coronary artery disease

Coronary artery disease (CAD) is one of the biggest threats to human life. Circulating microRNAs (miRNAs) have been reported to be linked to the pathogenesis of CAD, indicating the possible role in CAD diagnosis. The present study aimed to explore the expression profile of plasma miRNAs and estimate their value in diagnosis for CAD. 67 Non‐CAD control subjects and 88 CAD patients were enrolled. We conducted careful evaluation by RT‐PCR analysis, Spearman rank correlation coefficients analysis, Receiver Operating Characteristic (ROC) curves analysis and so on. The plasma levels of six miRNAs known to be related to CAD were measured and three of them showed obvious expression change. Circulating miR‐29a‐3p, miR‐574‐3p and miR‐574‐5p were all significantly increased. ROC analysis revealed the probability of the three miRNAs as biomarkers with AUCs (areas under the ROC curve) of 0.830, 0.792 and 0.789, respectively. They were significantly correlated with each other in CAD patients, suggesting the possibility of joint diagnosis. The combined AUC was 0.915, much higher than each single miRNA. Therefore, our study revealed three promising biomarkers for early diagnosis of CAD. The combination of these miRNAs may act more effectively than individual ones for CAD diagnosis.     

An extracellular vesicle epitope profile is associated with acute myocardial infarction

The current standard biomarker for myocardial infarction (MI) is high‐sensitive troponin. Although powerful in clinical setting, search for new markers is warranted as early diagnosis of MI is associated with improved outcomes. Extracellular vesicles (EVs) attracted considerable interest as new blood biomarkers. A training cohort used for diagnostic modelling included 30 patients with STEMI, 38 with stable angina (SA) and 30 matched‐controls. Extracellular vesicle concentration was assessed by nanoparticle tracking analysis. Extracellular vesicle surface‐epitopes were measured by flow cytometry. Diagnostic models were developed using machine learning algorithms and validated on an independent cohort of 80 patients. Serum EV concentration from STEMI patients was increased as compared to controls and SA. EV levels of CD62P, CD42a, CD41b, CD31 and CD40 increased in STEMI, and to a lesser extent in SA patients. An aggregate marker including EV concentration and CD62P/CD42a levels achieved non‐inferiority to troponin, discriminating STEMI from controls (AUC = 0.969). A random forest model based on EV biomarkers discriminated the two groups with 100% accuracy. EV markers and RF model confirmed high diagnostic performance at validation. In conclusion, patients with acute MI or SA exhibit characteristic EV biomarker profiles. EV biomarkers hold great potential as early markers for the management of patients with MI.