年龄对于复杂性急性Stanford B型主动脉夹层患者预后的影响

目的:探讨年龄对于复杂性急性Stanford B型主动脉夹层(Complicated acute type B aortic dissection,cABAD)患者预后的影响。方法:回顾性分析2010年1月至2017年6月急诊收治入院的156例cABAD患者的住院病例资料,将其根据不同的年龄、治疗方式(药物保守治疗、血管内介入治疗、传统手术治疗)及治疗结果进行分组,并在不同的年龄组进行分析。结果:本研究的患者平均年龄为52.46±11.72岁,45%的患者(n=70)大于65岁,55%的患者(n=86)小于65岁。小于65岁的患者有22.2%的患者(n=19)接受药物保守治疗、19.8%的患者(n=17)接受传统手术治疗、58%的患者(n=50)接受血管内介入治疗,大于65岁的患者有48.6%的患者(n=34)接受药物保守治疗、11.4%的患者(n=8)接受传统手术治疗、40%的患者(n=28)接受血管内介入治疗。小于65岁与大于65岁患者院内死亡率分别为12.8%与35.7%(P0.001),接受血管内治疗分别为2%与28.6%(P=0.001),常规手术治疗分别为21%与37.5%(P=0.468),药物保守治疗分别为31.5%与41.7%(P=0.489)。年龄65岁或以上是多因素分析中住院死亡率的预测因子(OR=2.72;95%CI 1.343-4.674; P=0.012)。结论:年龄≥65岁对于cABAD患者的预后具有显著的影响,血管内介入治疗可有效降低院内死亡率,但死亡率随着年龄的增长而升高。     

Regulatory T cells protected against abdominal aortic aneurysm by suppression of the COX‐2 expression

CD4⁺CD25⁺ regulatory T cells (Tregs) have been shown to protect against the development of abdominal aortic aneurysm (AAA). Cyclooxygenase‐2 (COX‐2), a pro‐inflammatory protein, can convert arachidonic acid into prostaglandins (PGs). The present study was aimed to investigate the effect of Tregs on COX‐2 expression in angiotension II (Ang II)‐induced AAA in ApoE^?/? mice. Tregs were injected via tail vein in every 2 weeks. Ang II was continuously infused by a micropump for 28 days to induce AAA. In vivo, compared with the control group, adoptive transfer of Tregs significantly reduced the incidence of AAA, maximal diameter, and the mRNA and protein expression of COX‐2 in mice. Immunofluorescence showed that Tregs treatment reduced COX‐2 expression both in smooth muscle cells (SMCs) and macrophages in AAA. In vitro, the Western blot analysis showed that Tregs reduced Ang II‐induced COX‐2 expression in macrophages and SMCs. Meanwhile, ELISA showed that Tregs reduced Ang II‐induced prostaglandin E₂ (PGE₂) secretion. Moreover, Tregs increased SMC viability and induced transition of macrophages phenotype from M1 to M2. In conclusion, Tregs treatment dramatically decreased the expression of COX‐2 in vivo and in vitro, suggesting that Tregs could protect against AAA through inhibition of COX‐2. The study may shed light on the immune treatment of AAA.     

LncRNA TNK2‐AS1 regulated ox‐LDL‐stimulated HASMC proliferation and migration via modulating VEGFA and FGF1 expression by sponging miR‐150‐5p

Long non‐coding RNAs (lncRNAs) have been indicated for the regulatory roles in cardiovascular diseases. This study determined the expression of lncRNA TNK2 antisense RNA 1 (TNK2‐AS1) in oxidized low‐density lipoprotein (ox‐LDL)‐stimulated human aortic smooth muscle cells (HASMCs) and examined the mechanistic role of TNK2‐AS1 in the proliferation and migration of HASMCs. Our results demonstrated that ox‐LDL promoted HASMC proliferation and migration, and the enhanced proliferation and migration in ox‐LDL‐treated HASMCs were accompanied by the up‐regulation of TNK2‐AS1. In vitro functional studies showed that TNK2‐AS1 knockdown suppressed cell proliferation and migration of ox‐LDL‐stimulated HASMCs, while TNK2‐AS1 overexpression enhanced HASMC proliferation and migration. Additionally, TNK2‐AS1 inversely regulated miR‐150‐5p expression via acting as a competing endogenous RNA (ceRNA), and the enhanced effects of TNK2‐AS1 overexpression on HASMC proliferation and migration were attenuated by miR‐150‐5p overexpression. Moreover, miR‐150‐5p could target the 3’ untranslated regions of vascular endothelial growth factor A (VEGFA) and fibroblast growth factor 1 (FGF1) to regulate FGF1 and VEGFA expression in HASMCs, and the inhibitory effects of miR‐150‐5p overexpression in ox‐LDL‐stimulated HASMCs were attenuated by enforced expression of VEGFA and FGF1. Enforced expression of VEGFA and FGF1 also partially restored the suppressed cell proliferation and migration induced by TNK2‐AS1 knockdown in ox‐LDL‐stimulated HASMCs, while the enhanced effects of TNK2‐AS1 overexpression on HASMC proliferation and migration were attenuated by the knockdown of VEGFA and FGF1. Collectively, our findings showed that TNK2‐AS1 exerted its action in ox‐LDL‐stimulated HASMCs via regulating VEGFA and FGF1 expression by acting as a ceRNA for miR‐150‐5p.     

BMP7基因沉默抑制钙盐诱导猪主动脉瓣膜间质细胞成骨分化

目的:探究小干扰RNA(small interference RNA,siRNA)介导的骨形态发生蛋白7(bone morphogenetic protein7,BMP7)基因沉默对钙盐诱导猪主动脉瓣膜间质细胞成骨分化的影响及机制,为钙化性主动脉瓣膜病(calcific aortic valve disease,CAVD)的干预及治疗提供理论依据。方法:非CAVD瓣膜组织(non-CAVD组)取自手术治疗的主动脉夹层患者,CAVD瓣膜组织(CAVD组)取自因钙化性主动脉瓣狭窄而进行主动脉瓣膜置换术的患者,采用免疫组化和Western blot法检测non-CAVD组和CAVD组中BMP7、Runt相关转录因子2(Runx2)的蛋白质表达水平。选取健康家猪处死后即刻于无菌条件下取主动脉瓣叶,采用胶原酶连续消化法分离主动脉瓣膜间质细胞,观察其形态特征,并用免疫荧光染色行表型鉴定。采用脂质体转染法将BMP7-siRNA转染猪主动脉瓣膜间质细胞,采用qPCR和Western blot法验证BMP7表达的变化;利用钙盐培养基诱导细胞成骨分化,建立体外主动脉瓣膜间质细胞钙化模型后,采用ALP染色和茜素红S染色实验分别检测细胞早期及晚期成骨分化能力;采用qPCR和Western blot法分别检测细胞成骨相关基因及蛋白质Runx2、OCN和OPN的表达情况。并用Western blot法检测BMP7下游信号通路中Smad1/5/8的磷酸化水平。结果:BMP7和Runx2蛋白在CAVD组中表达明显高于non-CAVD组。成功分离出原代猪主动脉瓣膜间质细胞,α-平滑肌肌动蛋白(α-SMA)及波形蛋白(vimentin)染色阳性,血管性血友病因子(von willebrand factor,vWF)染色阴性。转染BMP7-siRNA后猪主动脉瓣膜间质细胞中BMP7的mRNA和蛋白质水平均明显下调,早期及晚期成骨分化能力均明显降低。沉默BMP7基因的表达,可下调Runx2、OCN和OPN的基因及蛋白质表达,且磷酸化的Smad1/5/8(p-Smad1/5/8)蛋白水平明显降低。结论:BMP7基因沉默抑制钙盐诱导的主动脉瓣膜间质细胞的成骨分化能力,BMP7/Smads信号通路可能在该过程中发挥重要作用。     

Hydrangenol suppresses VEGF-stimulated angiogenesis by targeting p27KIP1-dependent G1-cell cycle arrest,VEGFR-2-mediated signaling,and MMP-2 expression*

We previously reported that hydrangenol has potent antitumor activity against human bladder cancer EJ cells. Here, we investigated the antiangiogenic activity of hydrangenol using in vitro and ex vivo models. Treatment with hydrangenol significantly inhibited the proliferation of vascular endothelial growth factor (VEGF)-induced HUVECs in a concentration-dependent manner (EC_50?=?10?μM). Flow cytometry analysis revealed that hydrangenol suppressed the VEGF-induced inhibition of G1-cell cycle phase and also decreased cyclin D1, cyclin E, CDK2, and CDK4 levels. Hydrangenol-mediated arrest in the G1-cell cycle phase was associated with p27KIP1 level, but not p21WAF1 or p53 level. Hydrangenol also significantly inhibited VEGFR-2-mediated signaling pathways including ERK1/2, AKT, and endothelial nitric oxide synthase. Interestingly, immunoprecipitation assay demonstrated that the inhibition of VEGFR-2 activation was independent of VEGF binding, thereby suggesting an allosteric regulation of hydrangenol against VEGFR-2. Additionally, hydrangenol inhibited migration, invasion, and capillary-like tubular formation in VEGF-stimulated HUVECs. Zymography and immunoblot analyses revealed that these inhibitory activities were partially owing to the VEGF-induced inhibition of matrix metalloproteinase-2 activity. Finally, VEGF-mediated microvessel sprouting was inhibited in the presence of hydrangenol in ex vivo aortic ring assay. Taken together, hydrangenol possesses a potent antiangiogenesis potential; thus we believe that hydrangenol may be developed as a therapeutic reagent to treat angiogenesis-mediated diseases.     

Three-Dimensional Computational Modeling of an Extra-Descending Aortic Assist Device Using Fluid-Structure Interaction

BackgroundThe incidence of heart failure is anticipated to rise by 2030, resulting in more than 8 million adults with this condition in US. Despite the advancement in pharmacological and surgical treatments, some patients progress to severe forms of cardiac dysfunction requiring cardiac transplantation as a last-resort treatment. Cardiac assist devices play an essential role in the recovery of normal cardiac performance through reversible remodeling or in assisting the weak organ to prolong survival rate. However, these devices need to be monitored carefully, as prolonged use may lead to physiological maladaptation and further cardiac complications. The optimization of such devices has done through the development and use of numerical simulations that allow the analysis of in-vivo hemodynamic patterns of blood flow. This study aims to investigate the performance of a model of extra-aortic assist device surrounding the descending aorta through three-dimensional patient-specific modeling.MethodsA three-dimensional model of the aorta was constructed from patient-specific cardiac CT images of a 60-year-old male diagnosed with left ventricular failure at the Tehran Heart Center (THC). Numerical simulation was conducted for two complete cardiac cycles using fluid-structure interaction (FSI) analysis under the assumption that the balloon and the aortic vessel behave as linear elastic materials, and that blood is a Newtonian and incompressible fluid.ResultsThe numerical simulation demonstrated a high correlation between the FSI analysis and clinical data of the patient-specific anatomical and physiological conditions. Blood velocity, pressure, deformation, and strain contours were simulated and analyzed through three-dimensional modeling. Compared to the unassisted aorta, the device provided an increase in blood flow displacement of an additional 15 ml of blood in the descending aorta, brachiocephalic, carotid, and subclavian arteries. The maximum von Mises stress distribution across the aortic vessel was higher than the stress imposed on the system in the unassisted heart, with values of 3.3 MPa and 0.28 MPa, respectively. Numerical investigation of structural responses revealed that no remarkable force was exerted on the aortic valve by the device at the descending aorta.ConclusionWe present the numerical investigation of a counterpulsation device around the descending aorta that has not previously been tested on human or animal models. While this extra-aortic balloon pump (EABP) did not show a significant improvement in coronary perfusion, there is room for improvement in further studies to optimize the geometry of the balloon. Additional investigations are required to determine the efficacy of this device and its safety before in-vivo experimental studies are pursued. This simulation has clinical relevance when choosing an appropriate cardiac assist device to address patient-specific physiological and pathological conditions.     

腹主动脉缩窄小鼠心脏结构和功能的动态变化*

目的: 探讨腹主动脉缩窄小鼠在向心衰发展的过程中心脏结构和功能的动态变化。方法: 健康雄性昆明小鼠,随机分为模型组、假手术组和对照组。模型组采用腹主动脉缩窄的方法制备慢性心力衰竭小鼠模型,假手术组只分离出腹主动脉但不结扎,对照组不做任何处理。模型组组内分为2周组、4周组、6周组和8周组,每组10只。观察各组小鼠行为学表现、心电图、超声心动图和心肌组织病理学的变化。结果: 模型组与对照组相比:模型组小鼠术后2周开始出现行为学改变并且仅有2周组小鼠出现IVSS降低(P＜0.05);术后4周开始出现病理性J波、EF降低(P＜0.05)、IVSD增加(P＜0.05)和心肌损伤;术后6周开始出现LVPWD和LVPWS增加(P＜0.05);术后8周开始出现LV mass corrected增加(P＜0.05)。各组小鼠心率、R幅值、T幅值、ST段、PR间期、QT间期、QTc等数据差异均无显著性。结论: 腹主动脉缩窄导致小鼠出现心衰的过程中出现了EF降低、室间隔肥厚、病理性J波、左室后壁肥厚以及左室质量增加等变化。     

LncRNA H19 regulates smooth muscle cell functions and participates in the development of aortic dissection through sponging miR-193b-3p

Background: Multiple studies showed that long-chain noncoding RNA H19 (LncRNA H19) is high-expressed in human and mouse abdominal aortic aneurysms (AAAs). We speculated that it plays an important role in arterial disease, and therefore studied the role and mechanism of H19 in aortic dissection (AD).Methods: The expressions of related genes in human aortic smooth muscle cells (HASMCs) induced by platelet-derived growth factor BB (PDGF-BB) or in the aortic tissue of AD patients/mice were identified by Western blot and quantitative real-time polymerase chain reaction. The targeting relationship between H19 and miR-193b-3p was predicted and verified by bioinformatics analysis, dual luciferase assay, RNA pull-down assay, RNA immunoprecipitation (RIP), and Pearson correlation coefficient. The H19 and miR-193b-3p effects on the biological functions of tissues and cells were examined by MTT (3-(4,5-dimethyl-2-thiazolyl)-2,5-diphenyl-2-H-tetrazolium bromide, thiazolyl blue tetrazolium bromide) assay, wound-healing assay, and Hematoxylin–Eosin (HE) staining.Results: LncRNA H19 was abnormally high-expressed in thoracic aorta tissues of AD patients, and it could competitively bind to and inhibit miR-193b-3p. In the PDGF-BB group, the expressions of H19, matrix metallopeptidase (MMP) 2 (MMP-2) and MMP-9 were up-regulated and the expressions of miR-193b-3p, α-SMA, and SM22α were down-regulated; moreover, the proliferation and migration rate of HASMCs were increased. However, H19 silencing reversed the regulation of PDGF-BB on HASMCs. More interestingly, miR-193b-3p inhibitor could partially reverse the effect of H19 silencing. In addition, the above results were verified by animal experiments, showing that shH19 and up-regulated miR-193b-3p could significantly reduce the thoracic aorta pathological damage in AD mice.Conclusion: LncRNA H19 regulated smooth muscle cell function by sponging miR-193b-3p and it participated in the development of AD.     

Surgical treatment of transcatheter aortic valve infective endocarditis

Netherlands Heart Journal - There is growing interest in infections occurring after transcatheter aortic valve implantation (TAVI). The incidence, and clinical and anatomical features suggest many...