白鲜皮水提物对大鼠心肌缺血再灌注损伤的保护作用

目的研究白鲜皮水提物对大鼠心肌缺血再灌注损伤的保护作用。方法 Wistar大鼠随机分为假手术组,模型组,阳性药组(地奥心血康)及白鲜皮低、中、高剂量组(白鲜皮水提物0.128、0.64、1.28 g/kg),每组6只。结扎冠状动脉左前降支制备大鼠心肌缺血再灌注损伤模型,观察给药后大鼠心电图ST段的改变,测量心肌梗死面积,观察大鼠心肌组织病理形态,检测大鼠血清CK,SOD活性、MDA含量。结果白鲜皮中、高剂量组给药后能明显减少心肌梗死面积,明显降低缺血30 min和再灌注120 min时ST段的抬高,并能降低大鼠血清中MDA含量,升高SOD活性,减少因缺血导致的心肌组织病理损害。结论白鲜皮水提物对大鼠心肌缺血再灌注损伤具有保护作用,其作用机制可能与保护心肌细胞功能、提高心肌抗氧化能力、清除氧自由基有关。     

大鼠自主呼吸下建立急性心肌梗死模型

目的大鼠自主呼吸情况下,快捷、简便地建立大鼠急性心肌梗死模型。方法 180～220gSD大鼠60只,于胸骨左缘第4-5肋间隙切开皮层作荷包缝合,逐层钝性分离肌肉,挤出心脏,快速结扎左冠状动脉前降支(LAD)后,送回心脏同时挤压胸廓,拉紧荷包以建立心肌梗死模型。记录结扎前、结扎后3h心电图;结扎3h后取出心脏,冰冻切片TTC染色。结果 50只大鼠成功建立心肌梗死模型,模型成功率为83.33%。心电图显示结扎冠脉后出现R波峰降低,ST段拱背抬高及ST-T融合,TTC染色后左心室出现明显灰白色梗死区。结论本方法可在大鼠自主呼吸情况下,较短的时间内以简便的手术、较小的创伤建立大鼠急性心肌梗死模型。     

骨内单次注射小剂量辛伐他汀对大鼠心梗后血管新生的影响

目的研究骨内局部单次注射小剂量辛伐他汀对大鼠心梗后血管新生和心功能的影响。方法Wistar大鼠随机分为假手术组、心肌梗死模型组和骨内注射辛伐他汀组(n=12)。冠状动脉左前降支结扎建立大鼠心肌梗死模型。24 h后实验组左胫骨内单次注射辛伐他汀0.5 mg,4周后分别通过小动物超声心动图评价左室功能,三苯基氯化四氮唑(TTC)染色计算心肌梗死面积,免疫荧光染色检测局部血管新生情况。结果超声心动图结果表明心肌梗死4周后左心室收缩功能明显下降,骨内注射辛伐他汀对大鼠心肌梗死后左心室功能未见明显改善;TTC染色发现骨内注射辛伐他汀组心肌梗死面积未见明显减少;免疫荧光染色显示,骨内注射辛伐他汀组心肌血管密度没有显著增加。结论大鼠心梗24 h后骨内单次注射小剂量辛伐他汀(0.5 mg),心肌梗死面积、血管新生及心脏功能无显著改善。     

大鼠急性心肌梗死模型的制备及对肌钙蛋白T的影响

目的探讨建立大鼠急性心肌梗死（AMI）模型的方法,研究心肌梗死大鼠血浆中肌钙蛋白T（cTn-T）的动态变化。方法大鼠经结扎左冠状动脉前降支造成心肌梗死,建立稳定的心肌梗死模型;分别在结扎后31 h、48 h、69 h、168 h检测cTn-T含量和计算心肌梗死重量指数。结果成功制备心肌梗死大鼠模型,并对常规技术进行改进,降低动物死亡率。大鼠左冠状动脉结扎31 h、48 h模型组与假手术组cTn-T含量差异极显著（P〈0.001）;各时间点心肌梗死重量指数比较,差异极显著（P〈0.001）。cTn-T值与梗死重量指数呈显著性正相关（r=0.90,P〈0.01）。结论结合大鼠心肌梗死程度进一步佐证了模型制备较成功。cTn-T表现出特异性和敏感性,并在31 h最接近达峰时间,有早期诊断心肌梗死的价值,也可作为判断AMI时心肌梗死程度和预后的参考指标。     

大鼠心肌梗死模型的建立及梗死后心电生理和左室功能的变化

目的建立具有稳定性高,重复性强,存活时间长的大鼠心肌梗死模型,探讨采用心电图（ECG）和心脏超声心动图（UCG）监测心梗后心电生理和左室功能变化的可行性。方法Wistar大鼠经10%水合氯醛麻醉后,气管切开插管及连通呼吸机,开胸后结扎冠状动脉左前降支。于手术后4、8和12周行ECG检测和UCG检查,术后12周取出心脏行病理检查。结果采用本法建立大鼠心肌梗死模型,术后72h内大鼠存活率为83.3%,术后12周以上大鼠存活率为73.3%。术后48、和12周ECG监测示心梗后PR间期,QRS时限,QT间期和QTc间期均较假手术组延长,同期行UCG监测示心梗后左室舒张末期内径和左室收缩末期内径显著增加,左室射血分数值和左室短轴缩短率值显著降低,12周后组织病理HE染色符合慢性心肌梗死的病理改变。结论本技术操作简单、创伤轻、成功率高,术后采用ECG和UCG可有效监测心梗后不同时期心电变化和左室功能变化。     

大鼠慢性心肌梗死模型制备的改进

目的 改进制备大鼠心肌梗死模型的方法,提高术后大鼠存活率.方法 采用戊巴比妥钠腹腔注射麻醉,开胸行冠状动脉前降支结扎法,术后给予呼吸道管理.结果 术后存活率达到76%,4周存活率达到67.5%.结论 准确结扎前降支才能保证造模成功,加强呼吸道管理是提高术后大鼠存活率的重要措施.     

结扎大鼠左冠状动脉不同时间制备心肌梗死模型的比较

目的探索大鼠左冠状动脉前降支不同结扎处理后,对心肌形态学及心功能的影响,以建立适合移植干细胞再生修复心肌梗死研究的稳定、可靠和更合乎发病机制的动物模型。方法雄性SD大鼠70只,随机分为五组。即:结扎(15、30、456、0 min)再灌、结扎非再灌。于处理后1 d、1周2、周或4周动态观察心肌梗死变化,并于处理一月后测量动脉收缩压(ASP)、动脉舒张压(ADP),左室收缩压(LVSP),左室舒张末压(LVEDP)及左室压力上升及下降最大速度(±dp/dtmax)。结果引起明显的心肌梗死至少需要结扎30 min。结扎(456、0 min)再灌、结扎非再灌的心肌梗死明显,并观察到梗死区域心肌已绝大部分纤维化,且梗死面积变化较恒定。同时测定不同结扎时间心功能的变化发现,结扎(456、0 min)再灌或结扎非再灌各组ASP、DAP、LVSP、±dp/dtmax显著下降,LVEDP明显升高。并见不同结扎时间处理后,大鼠心功能的变化与心肌梗死后的梗死面积变化密切相关。结论建立了实验大鼠左冠状动脉前降支中上1/3处结扎45 min以上的大鼠心肌梗死模型。不仅合乎临床心肌梗死的发病机制,而且梗死部位、梗死区域面积稳定,适合于移植细胞再生修复心肌梗死的研究。     

大鼠心肌梗死动物模型的制备

目的建立一种稳定可重复的大鼠急性心肌梗死动物模型。方法SD大鼠经口气管插管,呼吸机辅助呼吸,开胸结扎冠脉左前降支。术后28 d行心脏超声,血流动力学及组织病理学检查。结果大鼠术后存活率60%;手术组LVEF较假手术组显著降低（P〈0.01）;与假手术组比,手术组的LVSP明显下降（P〈0.05）,±dp/dt显著降低（P〈0.01）,而LVEDP明显升高（P〈0.01）;病理组织学检查可见瘢痕形成,纤维组织增生。结论本文建立心肌梗死动物模型的方法操作简便、重复性好。     

液氮冷冻大鼠左冠状动脉前降支中上1／3所支配区域建立心肌梗死模型

目的探讨大鼠左冠状动脉前降支中上1／3所支配的区域液氮冷冻处理后对心肌形态学及心功能的影响,以建立适合移植干细胞再生修复心肌梗死研究的一种新的大鼠心肌梗死模型制作方法。方法80只雄性SD大鼠,随机分为3组即：冷冻组、结扎组、对照组。大鼠麻醉后,行气管插管连通动物呼吸机,打开胸廓暴露心脏,用特制的直径为0．6cm冷冻头置入液氮中冷冻降温后迅速冷冻大鼠左冠状动脉前降支中上1／3所支配的区域,或结扎左冠状动脉前降支中上1／3处。分别于处理后1d、3d、7d、14d、28d观察心脏病理组织学变化,并于处理28d后检测心功能的变化。结果在液氮冷冻大鼠心脏后,大鼠心肌组织出现凝固性坏死,继而有肉芽组织长人梗死灶内,最后形成疤痕。用液氮冷冻法可成功复制心肌梗死大鼠动物模型。与冠状动脉结扎法相比较,操作简单,手术时间短,死亡率低．心肌梗死面积变异小。结论液氮冷冻法作为一种复制心肌梗死模型的方法,有其自身的优势．可用于心肌梗死发生机制和干细胞治疗等方面的研究。     

大鼠心肌梗死对c-kit、CD34干细胞及炎症反应的影响

探索大鼠心肌梗死发生后,梗死区域c-kit心肌干细胞、CD34标记的具有多向分化潜能干细胞、炎症细胞以及影响心率功能的CX43连接蛋白的动态变化过程。通过左前降支结扎建立大鼠心肌梗死模型,利用HE染色观察梗死模型建立情况;运用免疫组织化学方法检测c-kit、CD34、ED1以及CX43标记物的含量及分布。研究表明,通过左前降支结扎成功构建大鼠心肌梗死模型,在心肌梗死发生后,梗死区域c-kit阳性细胞的比例逐渐增加,高于假手术组(p0.01);CD34阳性细胞数随着时间的变化先升高后降低,也高于假手术组(p0.01);与炎症相关ED1阳性细胞在梗死初期含量较高,随着时间推移而降低,高于假手术组(p0.01);CX43蛋白的含量梗死组低于假手术组(p0.05)。本研究对临床研究和治疗心肌梗死有一定参考价值。     

Haemodynamics in the first seconds after coronary artery occlusion.

The changes in cardiac and in total haemodynamics, occurring during the first seconds of occlusion and the subsequent desocclusion of coronary arteries were studied on 28 dogs. The most intensive changes were observed after the trunk occlusion of the left coronary artery. Simultaneously with decreasing blood inflow into the myocardium its contractility and the systolic pressure in the left ventricle and the outflow from the coronary sinus began to fall rapidly. The systolic pressure in the left ventricle decreased within the first 10 s from 24 to 13-15 kPa (180 to 100-110 mm Hg), which means that the systolic pressure fell about 1 kPa (7-8 mm Hg) per second, or 0.5-0.6 kPa (4-5 mm Hg) per systole. At the same time the end-diastolic pressure in the left ventricle also increased from zero to 3-4 kPa (25-30 mm Hg). After the trunk desocclusion of the left coronary artery the systolic pressure in the left ventricle proceeded to fall by about 2-3 kPa (15-22 mm Hg). Only then, 20-25 s after the desocclusion, blood flow in the left coronary artery began to rise intensively and 4-6 s later the myocardial contractility and the systolic pressure in the left ventricle also increased. After unclamping (50-60 s), there was an overshoot of haemodynamic values above preocclusive values and then followed the compensatory phase. This phase lasted 80-90 s and on its peak the pressure and flow parameters increased by about 50-60% above preocclusive values. During the occlusion of ramus interventricularis anterior or ramus circumflexus for 30-60 s the haemodynamic parameters changed only slightly. The same was observed during trunk occlusion of the right coronary artery (30-60 s), but in that case many extrasystoles occurred.     

Influence of serotonin on myocardial blood flow in the presence and absence of a coronary arterial stenosis: observations in domestic swine

This study tested the hypothesis that 5-HT may impair coronary flow regulation by inappropriately increasing arteriolar tone in the coronary circulation. Ten closed chest, domestic swine were studied both in the presence and in the absence of a severe artificial intraluminal coronary stenosis. A 5-French micromanometer catheter with fluid lumen was placed in the left anterior descending coronary artery and used to record pressure and infuse 5-HT (40 and 100 micrograms/min) into the coronary circulation. For the stenosis phase of the protocol the catheter was embedded in the artificial stenosis. Hemodynamics, regional myocardial blood flow (microsphere technique), coronary vascular resistance, lactate consumption, and oxygen metabolism were measured at control and at 5 min of each 5-HT dose. In the absence of coronary artery stenosis (i.e., full vasodilatory reserve), there was no change in regional myocardial blood flow or coronary vascular resistance during 5-HT infusion. In the presence of a severe coronary stenosis (i.e., limited vasodilator reserve) 5-HT produced a significant (P less than 0.05) decrease versus control in the distal left anterior descending: circumflex zone endocardial blood flow ratio (0.63 +/- 0.19, mean +/- 1 SD, to 0.55 +/- 0.15) and a significant (P less than 0.05) increase versus control in endocardial (50.6 +/- 16.6 to 61.2 +/- 19.8 mm Hg/ml/min/g) and transmural (49.9 +/- 9.5 to 57.2 +/- 12.8) coronary vascular resistance. Thus, 5-HT does not impair coronary flow regulation when full vasodilatory reserve is present. When coronary vasodilatory reserve is impaired by the presence of a severe proximal stenosis, 5-HT causes modest impairment of endocardial flow regulation.     

Effect of passive myocardium on the compliance of porcine coronary arteries

The objective of this study was to determine the effect of passive myocardium on the coronary arteries under distension and compression. To simulate distension and compression, we placed a diastolic-arrested heart in a Lucite box, where both the intravascular pressure and external (box) pressure were varied independently and expressed as a pressure difference (DeltaP = intravascular pressure - box pressure). The DeltaP-cross-sectional area relationship of the first several generations of porcine coronary arteries and the DeltaP-volume relationship of the coronary arterial tree (vessels >0.5 mm in diameter) were determined using a video densitometric technique in the range of +150 to -150 mmHg. The vasodilated left anterior descending (LAD) coronary artery of six KCl-arrested hearts were perfused with iodine and 3% Cab-O-Sil. The intravascular pressure was varied in a triangular pattern, whereas the absolute cross-sectional area of each vessel and the total arterial volume were calculated using video densitometry under different box pressures (0, 50, 100, and 150 mmHg). In the range of positive DeltaP, we found that the compliance of the proximal LAD artery in situ (4.85 +/- 3.8 x 10-3 mm2/mmHg) is smaller than that of the same artery in vitro (16.5 +/- 6 x 10-3 mm2/mmHg; P = 0.009). Hence, the myocardium restricts the compliance of the epicardial artery under distension. In the negative DeltaP range, the LAD artery does not collapse, whereas the same vessel readily collapses when tested in vitro. Hence, we conclude that myocardial tethering prevents collapse of large blood vessel under compression.     

Impact of plaques in the left coronary artery on wall shear stress and pressure gradient in coronary side branches

In this study, we investigate plaques located at the left coronary bifurcation. We focus on the effect that the resulting changes in wall shear stress (WSS) and wall pressure stress gradient (WPSG) have on atherosclerotic progress in coronary artery disease. Coronary plaques were simulated and placed at the left main stem and the left anterior descending to produce >50% narrowing of the coronary lumen. Computational fluid dynamics analysis was carried out, simulating realistic physiological conditions that show the in vivo cardiac haemodynamic. WSS and WPSG in the left coronary artery were calculated and compared in the left coronary models, with and without the presence of plaques during cardiac cycles. Our results showed that WSS decreased while WPSG was increased in coronary side branches due to the presence of plaques. There is a direct correlation between coronary plaques and subsequent WSS and WPSG variations based on the bifurcation plaques simulated in the realistic coronary models.     

Accumulation of Calcium and Phosphorus in the Coronary Arteries of Thai Subjects

To clarify the manner of accumulation of Ca and P in the coronary arteries, the authors divided the coronary arteries into many segments based on arterial ramification and investigated the element contents of the segments by direct chemical analysis. After ordinary dissection at Chiang Mai University was finished, the left coronary (LC) and the right coronary (RC) arteries were removed successively from the hearts of Thai subjects. The Thai subjects consisted of seven men and five women, ranging in age from 42 to 87 years (average age = 73.9 ± 13.5 years). The LC and the RC arteries were divided into 19 segments based on arterial ramification. After incineration with nitric acid and perchloric acid, element contents of the segments were analyzed by inductively coupled plasma–atomic emission spectrometry. In two cases, a significant content of Ca and P was contained only in the left anterior descending (LAD) artery (type I). In four cases, a significant content of Ca and P was contained in both the LAD and the RC arteries (type II). In five cases, a significant content of Ca and P was contained in all the LAD, the RC, and the circumflex (CF) arteries (type III). In the other one case, no significant content of Ca and P was contained in the coronary arteries. The manner of accumulation of Ca and P in the coronary arteries was classified into the three types, I, II, and III. Regarding the average content of elements in 12 cases, the average content of Ca was the highest in the segment of the LAD artery ramifying the first left diagonal artery and was higher in the proximal and distal adjacent segments of the LAD artery ramifying the first left diagonal artery, the proximal segment of the RC artery, and the proximal segment of the CF artery. To examine an effect of arterial ramification on accumulation of Ca and P, the differences in the Ca and P content between artery-ramifying and non-ramified proximal or distal segments of the coronary arteries were analyzed with Student’s t test. It was found that there were no significant differences in the Ca and P content between the artery-ramifying and non-ramified proximal or distal segments of the coronary arteries.     

Electrocardiography as a tool for validating myocardial ischemia-reperfusion procedures in mice

This paper evaluates the modifications induced by ischemia and ischemia-reperfusion in mice after permanent or transient, respectively, ligation of the left coronary artery and establishes a correlation among the extent of ischemia, electrocardiograph features, and infarct size. The left coronary artery was ligated 1 mm distal from the tip of the left auricle. Histologic analysis revealed that 30-min ischemia (n = 9) led to infarction involving 9.7% ± 0.5% of the left ventricle, whereas 1-h ischemia (n = 9) resulted in transmural infarction of 16.1% ± 4.6% of the left ventricle. In contrast, 24-h ischemia (n = 8) and permanent ischemia (n = 8) induced similarly sized infarcts (33% ± 2% and 31.8% ± 0.7%, respectively), suggesting ineffective reperfusion after 24-h ischemia. Electrocardiography revealed that ligation of the left coronary artery led to ST height elevation (204 compared with 14 μV) and QTc prolongation (136 compared with 76 ms). Both parameters rapidly normalized on reperfusion, demonstrating that electrocardiography was important for validating correct ligation and reperfusion. In addition, electrocardiography predicted the severity of the myocardial damage induced by ischemia. Our results show that electrocardiographic changes present after 30-min ischemia were reversed on reperfusion; however, prolonged ischemia induced pathologic electrocardiographic patterns that remained even after reperfusion. The mouse model of myocardial ischemia-reperfusion can be improved by using electrocardiography to validate ligation and reperfusion during surgery and to predict the severity of infarction.     

Hemodynamic impacts of various types of stenosis in the left coronary artery bifurcation: A patient-specific analysis

This study investigates the hemodynamic changes to various types of coronary stenosis in the left coronary artery bifurcation, based on a patient-specific analysis. Twenty two patients with left coronary artery disease were included in this study. All stenoses involving the left coronary artery bifurcation were classified into four types, according to their locations: A) left circumflex (LCx) and left anterior descending (LAD), B) LCx only, C) left main stem only, and D) LAD only. Computational fluid dynamics (CFD) was performed to analyze the flow and wall shear stress (WSS) changes in all reconstructed left coronary geometries. Our results showed that the flow velocity and WSS were significantly increased at stenotic locations. High WSS was found at >70% lumen stenosis, which ranged from 2.5 Pa to 3.5 Pa. This study demonstrates that in patients with more than 50% stenosis in the left coronary artery bifurcation, WSS plays an important role in providing information about the extent of coronary atherosclerosis in the left coronary artery branch.     

双源CT 冠状动脉血管成像诊断心肌桥的价值探讨

目的：研究双源CT 冠状动脉血管成像诊断心肌桥的临床价值。方法：选择260 例具有典型心前区不适的患者进行双源CT 冠脉血管成像检查,观察其发生部位,测量其长度和深度并进行分析。结果：260 例受检患者中,62例共70 段存在心肌桥,检出率 达20.76%,高于文献报道的检出率18.2%。所有心肌桥均发生于左前降支,其中近段17 段(24.4%),中段43 段(61.4%),远段10 段 (14.2%)。心肌桥平均长度为15.8± 6.4mm,深度为1.4± 0.85mm。结论：双源CT 冠状动脉血管成像因其便捷无创,不受心率严格 限制且价格低廉可作为心肌桥筛查的理想检查手段。     

正常小鼠冠状动脉的超声成像技术分析

目的探讨利用高频小动物心脏超声对C57BL／6小鼠冠状动脉进行评价的可行性,为小鼠冠状动脉相关疾病动物模型的制备及其功能评价提供依据。方法采用Vevo770型高分辨小动物超声仪,频率30mHz的宽频探头,对20只健康C57BL／6小鼠于4、8和12周龄时冠状动脉的情况进行观察。测定和分析不同周龄小鼠冠状动脉内径值的变化。结果全部20只小鼠超声均成功检测到冠状动脉。超声心动图显示小鼠4周龄时左冠状动脉主干内径检测值为0．36±0．02mm,右冠状动脉主干内径值为0．29±0．03mm;8周龄时左冠状动脉主干内径值为0．38±0．06mm,右冠状动脉主干内径值为0．37±0．02（mm）;12周龄时左冠状动脉主干内径值为0．38±0．02mm,右冠状动脉主干内径值为0．39±0．03mm。结论利用高频小动物心脏超声可获取正常小鼠清晰的冠状动脉图像,并能准确反映小鼠冠状动脉内径值动态变化。为小鼠冠状动脉疾病模型的制备及其功能评价提供依据。     

Definition of the margin of major coronary artery bifurcations during radiotherapy with electrocardiograph-gated 4D-CT

PurposeThe aim was to measure the cardiac motion-induced displacements of major coronary artery bifurcations utilizing electrocardiography (ECG)-gated four-dimensional computed tomography (4D-CT) and to determine the margin of coronary artery bifurcations.MethodsThirty-seven female patients who underwent retrospective ECG-gated 4D-CT in inspiratory breath hold (IBH) were enrolled. The left main coronary artery bifurcation (LM), the obtuse marginal branch bifurcation (OM), the first diagonal branch bifurcation (D₁), the second diagonal branch bifurcation (D₂), the caudal portion of the left anterior descending branch (APX), the first right ventricular artery bifurcation (V) and the acute marginal branch bifurcation (AM) were contoured. The center of the contour of the coronary arterial bifurcations at end systole was defined as the standard, and the margin were then calculated.ResultsThe margin in the left–right (LR), cranio-caudal (CC), and anterior-posterior (AP) coordinates were as follows: LM 3, 3, and 3 mm; D₁ 6, 3, and 3 mm; D₂ 3, 3, and 3 mm; APX 4, 4, and 4 mm; OM 4, 6, and 5 mm; V 6, 8, and 7 mm; and AM 6, 8, and 7 mm, respectively.ConclusionCoronary artery bifurcations should be considered a separate organ at risk (OAR), and different margin should be provided due to the differences resulting from motion displacement. The maximum margin in the LR, CC, and AP coordinates of left coronary artery bifurcations were 6, 6, and 5 mm, and those of the right coronary artery bifurcations were 6, 8, and 7 mm, respectively.