静脉溶栓时机对急性ST段抬高型心肌梗死患者溶栓效果及主要不良心脏事件发生率的影响

目的:探讨静脉溶栓时机对急性ST段抬高型心肌梗死患者溶栓效果及主要不良心脏事件发生率的影响。方法:将2016年1月至2017年12月我院接诊的314例急性ST段抬高型心肌梗死患者纳入本研究,按照溶栓治疗时间不同分为A组(发病至溶栓时间6 h)172例、B组(发病至溶栓时间为6～12 h)102例和C组(发病至溶栓时间12 h)40例,比较三组患者溶栓效果、溶栓后ST段回落情况以及住院期间主要不良心脏事件发生情况。结果:A组患者梗死冠脉溶通率、溶栓后ST段回落幅度高于B组和C组,且B组高于C组,差异均有统计学意义(P0.05)。A组患者治疗后ST段回落最大幅度所需时间、住院期间主要不良心脏事件总发生率低于B组和C组,且B组低于C组,差异均有统计学意义(P0.05)。结论:急性ST段抬高型心肌梗死患者发病后6 h内静脉溶栓治疗梗死冠脉溶通率更高、ST段回落效果更好,可降低住院期间主要不良心脏事件发生风险。     

持续颅内压监测对大面积脑梗死外科治疗预后的应用价值

目的:探讨持续颅内压(ICP)监测对大面积脑梗死外科治疗预后的应用价值。方法:选取2013年3月至2018年3月期间在我院接受治疗的大面积脑梗死患者100例作为研究对象,所有患者经去骨瓣减压术后行ICP监测和生命体征监测,通过结果分为:低压组62例(2.70kPa≤ICP5.30kPa),高压组38例(ICP≥5.30 kPa)。记录患者ICP监测数值,接收者操作特征(ROC)曲线分析患者预后情况,对患者进行术后3个月内随访,了解患者平常活动能力进行判断预后的状况。观察ICP与预后的相关性。结果:两组患者性别、年龄、室速、室性早搏、糖尿病、高血压病、脑卒中、高脂血症、风心病、冠心病、扩张性心肌病、既往心肌梗死、肥厚性心肌病、甲亢性心脏病等资料比较差异无统计学意义(P0.05)。低压组患者中预后良好的ICP监测值显著低于预后不良者(P0.05),高压组中预后良好的ICP监测值显著低于预后不良者(P0.05)。ICP预测大面积脑梗死外科治疗预后的ROC曲线面积0.704,采用最大约等指数计算得出ICP预测大面积脑梗死外科治疗预后的最大AUC面积相应参数截止值为4.89,其中敏感度为0.435,特异性为0.896。结论:持续ICP监测结果显示ICP值越小,患者的预后就越好,ICP值越高,患者的预后越差。ICP监测对大面积脑梗死外科治疗的预后具有预测价值,对判断和改善预后能起到有效帮助,值得在临床推广应用。     

血栓通注射液对暂时性和永久性大鼠脑缺血模型的神经保护作用

血栓通注射液(冻干)(XST)是一种从三七中提取的中草药标准化产品,广泛用于临床治疗急性脑梗塞等脑血管疾病。本研究评估了XST在不同大鼠脑缺血模型中的急性和延长保护作用,并探讨了其对过氧化物酶(Prx) 6-toll样受体(TLR) 4信号通路的影响。用XST处理抑制过氧化物酶(Prx) 6-toll样受体(TLR) 4的蛋白质表达和p38的磷酸化水平,并且上调STAT3的磷酸化水平。XST治疗3 d可显著降低暂时性大脑中动脉阻塞(MCAO)诱导的梗死体积和肿胀百分比,并调节白细胞介素-1β(IL-1β)、IL-17、IL-23p19、肿瘤坏死因子-α(TNFα)和诱导型一氧化氮合酶(iNOS)。在永久MCAO大鼠中,XST可以减少梗死体积和肿胀百分比。XST治疗还可以增加大鼠的体重并改善一批功能结果。XST可以保护暂时性和永久性MCAO大鼠的缺血性损伤可能与Prx6-TLR4途径有关。     

Hyaluronate supports hESC‐cardiomyocyte cell therapy for cardiac regeneration after acute myocardial infarction

IntroductionEnormous progress has been made in cardiac regeneration using human embryonic stem cell‐derived cardiomyocyte (hESC‐CM) grafts in pre‐clinical trials. However, the rate of cell survival has remained very low due to anoikis after transplantation into the heart as single cells. Numerous solutions have been proposed to improve cell survival, and one of these strategies is to co‐transplant biocompatible materials or hydrogels with the hESC‐CMs.MethodsIn our study, we screened various combinations of biomaterials that could promote anoikis resistance and improve hESC‐CM survival upon co‐transplantation and promote cardiac functional recovery. We injected different combinations of Matrigel, alginate and hyaluronate with hESC‐CM suspensions into the myocardium of rat models with myocardial infarction (MI).ResultsOur results showed that the group treated with a combination of hyaluronate and hESC‐CMs had the lowest arrhythmia rates when stimulated with programmed electrical stimulation. While all three combinations of hydrogel‐hESC‐CM treatments improved rat cardiac function compared with the saline control group, the combination with hyaluronate most significantly reduced pathological changes from left ventricular remodelling and improved both left ventricular function and left ventricular ejection fraction by 28 days post‐infarction.ConclusionHence, we concluded that hyaluronate‐hESC‐CM is a superior combination therapy for promoting cardiac regeneration after myocardial infarction.     

急性脑梗死并发肺部感染患者预后及危险因素分析

目的分析急性脑梗死并发肺部感染患者病原菌分布、病原菌耐药性、患者用药特征及其危险因素。方法选取2015年3月至2017年3月在我院急诊科进行住院治疗,且年龄60岁的急性脑梗死并发肺部感染患者60例为研究对象,对患者的一般资料及病原菌分布情况、耐药情况和患者用药情况进行分析。结果 60例患者中有30例出现肺部感染,感染率为50.00%。肺部感染患者中死亡4例。肺部感染患者痰液中共培养出28株病原菌,其中革兰阴性菌21株,革兰阳性菌5株,真菌2株。30例肺部感染患者共使用6种抗感染药物,其中哌拉西林/舒巴坦的使用频率最高,其次为依替米星及美罗培南。Logistic回归分析显示,病原菌分布、耐药情况和患者用药情况与患者的预后存在相关性。结论急性脑梗死并发肺部感染患者的病原菌分布、耐药情况及患者用药情况与患者的预后密切相关,应针对上述因素给予患者合理的治疗。     

Role of B lymphocytes in the infarcted mass in patients with acute myocardial infarction

Despite early reperfusion, patients with ST segment elevation myocardial infarction (STEMI) may present large myocardial necrosis and significant impairment of ventricular function. The present study aimed to evaluate the role of subtypes of B lymphocytes and related cytokines in the infarcted mass and left ventricular ejection fraction obtained by cardiac magnetic resonance imaging performed after 30 days of STEMI. This prospective study included 120 subjects with STEMI submitted to pharmacoinvasive strategy. Blood samples were collected in subjects in the first (D1) and 30th (D30) days post STEMI. The amount of CD11b+ B1 lymphocytes (cells/ml) at D1 were related to the infarcted mass (rho = 0.43; P=0.033), measured by cardiac MRI at D30. These B1 cells were associated with CD4+ T lymphocytes at D1 and D30, while B2 classic lymphocytes at day 30 were related to left ventricular ejection fraction (LVEF). Higher titers of circulating IL-4 and IL-10 were observed at D30 versus D1 (P=0.013 and P<0.001, respectively). Titers of IL-6 at D1 were associated with infarcted mass (rho = 0.41, P<0.001) and inversely related to LVEF (rho = −0.38, P<0.001). After multiple linear regression analysis, high-sensitivity troponin T and IL-6 collected at day 1 were independent predictors of infarcted mass and, at day 30, only HDL-C. Regarding LVEF, high-sensitivity troponin T and high-sensitivity C-reactive protein were independent predictors at day 1, and B2 classic lymphocytes, at day 30. In subjects with STEMI, despite early reperfusion, the amount of infarcted mass and ventricular performance were related to inflammatory responses triggered by circulating B lymphocytes.     

Aerobic training prevents cardiometabolic changes triggered by myocardial infarction in ovariectomized rats

This study aimed to evaluate the impact of aerobic training (AT) on autonomic, cardiometabolic, ubiquitin‐proteasome activity, and inflammatory changes evoked by myocardial infarction (MI) in ovariectomized rats. Female Wistar rats were ovariectomized and divided into four groups: sedentary + sham (SS), sedentary + MI (SI), AT + sham surgery (TS), AT + MI (TI). AT was performed on a treadmill for 8 weeks before MI. Infarcted rats previously subjected to AT presented improved physical capacity, increased interleukin‐10, and decreased pro‐inflammatory cytokines. Metabolomic analysis identified and quantified 62 metabolites, 9 were considered significant by the Vip Score. SS, SI, and TS groups presented distinct metabolic profiles; however, TI could not be distinguished from the SS group. MI dramatically increased levels of dimethylamine, and AT prevented this response. Our findings suggest that AT may be useful in preventing the negative changes in functional, inflammatory, and metabolic parameters related to MI in ovariectomized rats.     

精氨酸及其代谢产物对缺血性脑卒中的作用

摘要：缺血性脑卒中是成年人群致残、致死的重要原因之一,有效治疗手段和药物的匮乏是脑卒中致残的主要原因。精氨酸既是一种营养物质,又具有多种独特的生理与药理作用,在早产儿和严重应激状态下精氨酸在维持正氮平衡与正常生理功能方面发挥重要作用,常将精氨酸称为条件必需氨基酸。精氨酸是生物体合成多胺的前体物质,同时精氨酸代谢也产生高活性自由基一氧化氮。精氨酸代谢及其代谢产物的改变可对脑卒中产生多种影响,如线粒体功能破坏、钙离子通道紊乱、血脑屏障损伤等。本文综述了精氨酸及其代谢产物在缺血性脑卒中病理过程中的作用。深入的研究和探讨其损伤和保护的双重作用机制将为缺血性脑卒中的防御和治疗提供新的策略。     

Exosomes from neuronal stem cells may protect the heart from ischaemia/reperfusion injury via JAK1/2 and gp130

Myocardial infarction requires urgent reperfusion to salvage viable heart tissue. However, reperfusion increases infarct size further by promoting mitochondrial damage in cardiomyocytes. Exosomes from a wide range of different cell sources have been shown to activate cardioprotective pathways in cardiomyocytes, thereby reducing infarct size. Yet, it is currently challenging to obtain highly pure exosomes in quantities enough for clinical studies. To overcome this problem, we used exosomes isolated from CTX0E03 neuronal stem cells, which are genetically stable, conditionally inducible and can be produced on an industrial scale. However, it is unknown whether exosomes from neuronal stem cells may reduce cardiac ischaemia/reperfusion injury. In this study, we demonstrate that exosomes from differentiating CTX0E03 cells can reduce infarct size in mice. In an in vitro assay, these exosomes delayed cardiomyocyte mitochondrial permeability transition pore opening, which is responsible for cardiomyocyte death after reperfusion. The mechanism of MPTP inhibition was via gp130 signalling and the downstream JAK/STAT pathway. Our results support previous findings that exosomes from non-cardiomyocyte-related cells produce exosomes capable of protecting cardiomyocytes from myocardial infarction. We anticipate our findings may encourage scientists to use exosomes obtained from reproducible clinical-grade stocks of cells for their ischaemia/reperfusion studies.     

Sonothrombolysis in the ambulance for ST-elevation myocardial infarction: rationale and protocol

BackgroundTreatment of ST-elevation myocardial infarction (STEMI) has improved over the years. Current challenges in the management of STEMI are achievement of early reperfusion and the prevention of microvascular injury. Sonothrombolysis has emerged as a potential treatment for acute myocardial infarction, both for epicardial recanalisation as well as improving microvascular perfusion. This study aims to determine safety and feasibility of sonothrombolysis application in STEMI patients in the ambulance.MethodsTen patients with STEMI will be included and treated with sonothrombolysis in the ambulance during transfer to the PCI centre. Safety will be assessed by the occurrence of ventricular arrhythmias and shock during sonothrombolysis intervention. Feasibility will be assessed by the extent of protocol completion and myocardial visibility. Efficacy will be determined by angiographic patency rate, ST-elevation resolution, infarct size and left ventricular volumes, and function measured with cardiovascular magnetic resonance imaging, and contrast and strain echocardiography. A comparison will be made with matched controls using an existing STEMI database.DiscussionSonothrombolysis is a novel technique for the treatment of cardiovascular thromboembolic disease. The first clinical trials on its use for STEMI have demonstrated promising results. This study will be the first to examine the feasibility of in-ambulance sonothrombolysis for STEMI.Trial registrationEU Clinical Trials Register (identifier: 2019-001883-31), registered 2020-02-25.