急性缺血心肌炎症与再灌注

近20年来,随着经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的发展,相关的研究日益增多,许多研究显示炎症反应在行PCI治疗的患者的预后中发挥着很大的作用。PCI术后患者心肌再灌注的疗效日益引起人们的关注,尤其是再灌注无复流的危害和重要性,如何控制炎症因子(如hs-CRP,IL-6,TNF-α等)的水平,以有益于行PCI术的患者,需要更多一些前瞻性研究去观察。     

不稳定心绞痛患者超敏C 反应蛋白水平与病变血管支数的关系

目的:探讨超敏c反应蛋白(hs-CRP)水平对于不稳定心绞痛(UA)患者多支血管病变的诊断价值。方法:回顾性选取不稳定心绞痛患者据其动脉造影结果分为单支病变组、多支病变组均行超敏c反应蛋白检测并比较两组的差异,在阳性结果基础上行ROC曲线分析。结果:1.单支病变组、多支病变组hs-CRP存在显著差异;2.ROC曲线下面积>0.5。结论:针对于不稳定心绞痛患者其超敏c反应蛋白水平与病变血管支数关系密切,对于临床诊断有一定价值。     

参元益气活血胶囊联合心痛贴穴位贴敷对不稳定性心绞痛气虚血瘀证患者脂代谢和氧化应激的影响

摘要 目的：观察参元益气活血胶囊联合心痛贴穴位贴敷对不稳定性心绞痛（UA）气虚血瘀证患者脂代谢和氧化应激的影响。方法：按照随机数字表法将2020年3月~2022年9月期间首都医科大学附属北京中医医院收治的100例UA患者分为对照组（常规西医治疗和心痛贴穴位贴敷）和研究组（对照组的基础上接受参元益气活血胶囊治疗），各为50例。对比两组中医证候积分、心绞痛发作次数和持续时间、脂代谢指标[总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）]、氧化应激指标[超氧化物歧化酶（SOD）、丙二醛（MDA）]、心功能指标[左心室射血分数（LVEF）、心输出量（CO）、左心室舒张末期内径（LVEDD）]。结果：两组治疗4周后胸痛、胸闷、气短、心悸、神倦乏力、自汗、不寐评分均下降，且研究组均低于对照组（P<0.05）。两组治疗4周后心绞痛发作次数减少，持续时间缩短，且研究组改善幅度大于对照组（P<0.05）。两组治疗4周后TG、TC、LDL-C下降，HDL-C升高，且研究组改善幅度大于对照组（P<0.05）。两组治疗4周后SOD升高，MDA下降，且研究组改善幅度大于对照组（P<0.05）。两组治疗4周后LVEF、CO升高，LVEDD下降，且研究组改善幅度大于对照组（P<0.05）。结论：参元益气活血胶囊联合心痛贴穴位贴敷治疗UA气虚血瘀证患者，可减少心绞痛发作次数，缩短持续时间，促进临床症状改善，改善心功能、脂代谢和氧化应激水平。     

3D打印技术辅助前侧微创入路手术治疗不稳定型骨盆骨折的临床疗效分析

目的:探讨3D打印技术辅助前侧微创入路手术治疗不稳定型骨盆骨折的临床疗效及安全性。方法:选择2014年8月到2017年2月在我院诊治的骨盆骨折患者78例作为研究对象,按照随机信封抽签原则分为观察组与对照组,每组各39例。对照组采用常规X线与CT进行手术设计,观察组采用3D打印技术进行手术设计,两组都给予前侧微创入路手术治疗,比较两组的手术时间、切口长度、骨折愈合时间、术中出血量、术中和术后并发症的发生情况及术后3个月的骨盆功能优良率。结果:所有患者都完成手术,无术中严重并发症发生,两组手术时间及切口长度对比差异无统计学意义(P0.05)。对照组的骨折愈合时间、术中出血量显著高于观察组(P0.05)。观察组术后并发症的发生率(5.1%)显著低于对照组(25.6%)(P0.05),术后3个月的骨盆功能优良率(97.4%)显著高于对照组(74.4%)(P0.05)。结论:与常规X线与CT前侧微创入路手术治疗比较,3D打印技术辅助前侧微创入路手术治疗不稳定型骨盆骨折可为患者提供安全、有效、个性化的治疗,减少术后并发症的发生,改善患者的骨盆功能。     

银杏达莫联合通痹胶囊治疗冠心病心绞痛的临床疗效及对血清IL-1β、TNF-α、ET-1、MMP-9水平的影响

目的:研究银杏达莫联合通痹胶囊治疗冠心病心绞痛的临床疗效及对血清白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)、内皮素-1(ET-1)、基质金属蛋白酶-9(MMP-9)水平的影响。方法:选取2015年8月至2016年7月我院收治的84例冠心病心绞痛患者,根据患者入院顺序分为观察组和对照组,42例每组。对照组使用通痹胶囊完成治疗,观察组在此基础上联合银杏达莫完成治疗。比较两组患者临床疗效、心绞痛发作次数、持续时间、ST段下移程度、血清IL-1β、TNF-α、ET-1、MMP-9水平的变化。结果:治疗后,观察组临床总有效率显著高于对照组[92.86%(39/42)比66.67%(28/42)](P0.05);两组患者心绞痛发作次数、持续时间、ST段下移程度、血清IL-1β、TNF-α、ET-1、MMP-9水平均较治疗前显著降低(P0.05),且观察组以上指标均明显低于对照组(P0.05)。观察组和对照组的不良反应发生率比较差异无统计学意义(P0.05)。结论:银杏达莫联合通痹胶囊治疗冠心病心绞痛能有效改善患者临床症状并提高临床疗效,可能与其显著降低患者血清IL-1β、TNF-α、ET-1、MMP-9水平有关。     

Carvedilol modifies antioxidant status of patients with stable angina

The aim of this study was to evaluate the effect of carvedilol on the enzymatic antioxidative defence and plasma antioxidative activity in patients with stable angina. The study comprised 30 patients, aged 37–49 years with stable angina. Patients received carvedilol in escalating doses of 12.5 mg/24 h, 25 mg/24 h, and 50 mg/24 h for 4 weeks each. The control group was matched for age and gender, and consisted of 12 healthy volunteers, aged 39-49 years. Blood samples were collected from the cubital vein before and 4, 8 and 12 weeks after the therapy from the patients and once from the control group. For all the subjects, the superoxide dismutase (SOD-1), glutathione peroxidase (GSH-Px), catalase (CAT) activities in the erythrocytes and the antioxidant activity of the blood plasma were determined. The enzymatic antioxidative defence was significantly decreased in patients with stable angina in comparison to the healthy subjects. During the carvedilol therapy, an increase in the SOD-1, GSH-Px and CAT activities was observed. Moreover, 8 and 12 weeks after carvedilol therapy, the GSH-Px activity did not differ significantly from that observed in the group of healthy subjects. Carvedilol also increased the plasma antioxidative activity in patients with stable angina, but its level remained significantly lower than in the control group. In conclusion, carvedilol enhances antioxidant defense mechanisms in patients with chronic stable angina pectoris.     

Cardiac remodelling: concentric versus eccentric hypertrophy in strength and endurance athletes

Cardiac remodelling is commonly defined as a physiological or pathological state that may occur after conditions such as myocardial infarction, pressure overload, idiopathic dilated cardiomyopathy or volume overload. When training excessively, the heart develops several myocardial adaptations causing a physiological state of cardiac remodelling. These morphological changes depend on the kind of training and are clinically characterised by modifications in cardiac size and shape due to increased load. Several studies have investigated morphological differences in the athlete’s heart between athletes performing strength training and athletes performing endurance training. Endurance training is associated with an increased cardiac output and volume load on the left and right ventricles, causing the endurance-trained heart to generate a mild to moderate dilatation of the left ventricle combined with a mild to moderate increase in left ventricular wall thickness. Strength training is characterised by an elevation of both systolic and diastolic blood pressure. This pressure overload causes an increase in left ventricular wall thickness. This may or may not be accompanied by a slight raise in the left ventricular volume. However, the development of an endurancetrained heart and a strength-trained heart should not be considered an absolute concept. Both forms of training cause specific morphological changes in the heart, dependent on the type of sport. (Neth Heart J 2008;16:129-33.)     

Symptomatic relief precedes improvement of myocardial blood flow in patients under spinal cord stimulation

Background

Spinal cord electrical stimulation (SCS) has shown to be a treatment option for patients suffering from angina pectoris CCS III-IV although being on optimal medication and not suitable for conventional treatment strategies, e.g. CABG or PTCA. Although many studies demonstrated a clear symptomatic relief under SCS therapy, there are only a few short-term studies that investigated alterations in cardiac ischemia. Therefore doubts remain whether SCS has a direct effect on myocardial perfusion.

Methods

A prospective study to investigate the short- and long-term effect of spinal cord stimulation (SCS) on myocardial ischemia in patients with refractory angina pectoris and coronary multivessel disease was designed. Myocardial ischemia was measured by MIBI-SPECT scintigraphy 3 months and 12 months after the beginning of neurostimulation. To further examine the relation between cardiac perfusion and functional status of the patients we measured exercise capacity (bicycle ergometry and 6-minute walk test), symptoms and quality of life (Seattle Angina Questionnaire [SAQ]), as well.

Results

31 patients (65 ± 11 SEM years; 25 male, 6 female) were included into the study. The average consumption of short acting nitrates (SAN) decreased rapidly from 12 ± 1.6 times to 3 ± 1 times per week. The walking distance and the maximum workload increased from 143 ± 22 to 225 ± 24 meters and 68 ± 7 to 96 ± 12 watt after 3 months. Quality of life increased (SAQ) significantly after 3 month compared to baseline, as well. No further improvement was observed after one year of treament. Despite the symptomatic relief and the improvement in maximal workload computer based analysis (Emory Cardiac Toolbox) of the MIBI-SPECT studies after 3 months of treatment did not show significant alterations of myocardial ischemia compared to baseline (16 patients idem, 7 with increase and 6 with decrease of ischemia, 2 patients dropped out during initial test phase). Interestingly, in the long-term follow up after one year 16 patients (of 27 who completed the one year follow up) showed a clear decrease of myocardial ischemia and only one patient still had an increase of ischemia compared to baseline.

Conclusion

Thus, spinal cord stimulation not only relieves symptoms, but reduces myocardial ischemia as well. However, since improvement in symptoms and exercise capacity starts much earlier, decreased myocardial ischemia might not be a direct effect of neurostimulation but rather be due to a better coronary collateralisation because of an enhanced physical activity of the patients.     

Instability of (GATA)<Subscript> n</Subscript> microsatellite loci in the parthenogenetic Caucasian rock lizard<Emphasis Type="Italic"> Darevskia unisexualis</Emphasis> (Lacertidae)

Mini- and microsatellites, comprising tandemly repeated short nucleotide sequences, are abundant dispersed repetitive elements that are ubiquitous in eukaryotic genomes. In humans and other bisexual species hypervariable mini- and microsatellite loci provide highly informative systems for monitoring of germline and somatic instability. However, little is known about the mechanisms by which these loci mutate in species that lack effective genetic recombination. Here, multilocus DNA fingerprinting was used to study M13 minisatellite and (GATA) _n microsatellite instability in the parthenogenetic Caucasian rock lizard Darevskia unisexualis (Lacertidae). DNA fingerprinting of 25 parthenogenetic families, from six isolated populations in Armenia (comprising a total of 84 siblings), using the oligonucleotide (GATA)₄ as a hybridization probe, revealed mutant fingerprinting phenotypes in 13 siblings that differed from their mothers in several restriction DNA fragments. In three families (8 siblings), the mutations were present in the germline. Moreover, the mutant fingerprint phenotypes detected in siblings were also present in population DNA samples. No intrafamily variations in DNA fingerprint patterns were observed with the M13 minisatellite probe. Estimates of the mutation rate for (GATA) _n microsatellite loci in D. unisexualis showed that it was as high as that seen in some bisexual species, reaching 15% per sibling or 0.95% per microsatellite band. Furthermore, in one case, a somatic (GATA) _n microsatellite mutation was observed in an adult lizard. These findings directly demonstrate that mutations in (GATA) _n microsatellite loci comprise an important source of genetic variation in parthenogenetic populations of D. unisexualis.Communicated by G. P. Georgiev     

A gene controlling rate of anthocyanin synthesis and mutation frequency of the gene An1 in Petunia hybrida

Summary The difference in colour intensity between flowers of sporogenic revertants of the white flowering lines W17 and W28 is caused by an incompletely dominant gene Inl. This gene is not linked to the anthocyanin gene Anl. In the dominant state Inl causes a 50% decrease in colour intensity of selfcoloured red flowers.Chromatographic analysis of anthocyanins of plants homozygous recessive or dominant for Inl showed that the same anthocyanins are produced in both genotypes (cyanidin-3-glucoside and cyanidin-3-diglucoside). Anthocyanin synthesis starts at the same stage of development of the flower in both genotypes. When the bud reaches a length of approximately 45 mm, however, anthocyanin synthesis in the Inl Inl line slows down.No influence of the gene Inl on the concentration of dihydroquercetin-7-glucoside in buds and flowers could be observed, which indicates that the influence of Inl on flower colour development is restricted to the last part of the biosynthesis of anthocyanins, i.e. the conversion of dihydroflavonols into anthocyanins.In addition to Inl having a decreasing effect on flower colour intensity, evidence is produced that the gene Inl also influences the reversion frequency of unstable alleles of the gene Anl.