B-type natriuretic peptide in children with atrial or ventricular septal defect: a cardiac catheterization study

In this study, we investigated the relationship between plasma B-type natriuretic peptide (BNP) levels and hemodynamics from cardiac catheterization in pediatric patients with atrial or ventricular septal defect. A total of 59 patients were studied including 80% of patients had Qp/Qs > 1.5 and 25% of patients had pulmonary hypertension. The mean BNP value and BNP z-score were 10.9?±?11.2 pg/mL and ?0.28?±?1.7 (?2.85 to 3.29), respectively. There was a statistically significant linear correlation between BNP value and the size of defects (r?=?0.303, p?=?0.002) and a trend toward to positive correlation between BNP value and Qp/Qs ratio (r?=?0.183, p?=?0.166) among all patients. To identify patients with a Qp/Qs ratio >1.5, the sensitivity and specificity were 28%, 100% in all patients at a plasma BNP cut-off point of 15 pg/mL. We concluded that a BNP > 15 pg/mL would help identify patients who need further intervention.     

Increasing Pulmonary Artery Pulsatile Flow Improves Hypoxic Pulmonary Hypertension in Piglets

Pulmonary arterial hypertension (PAH) is a disease affecting distal pulmonary arteries (PA). These arteries are deformed, leading to right ventricular failure. Current treatments are limited. Physiologically, pulsatile blood flow is detrimental to the vasculature. In response to sustained pulsatile stress, vessels release nitric oxide (NO) to induce vasodilation for self-protection. Based on this observation, this study developed a protocol to assess whether an artificial pulmonary pulsatile blood flow could induce an NO-dependent decrease in pulmonary artery pressure. One group of piglets was exposed to chronic hypoxia for 3 weeks and compared to a control group of piglets. Once a week, the piglets underwent echocardiography to assess PAH severity. At the end of hypoxia exposure, the piglets were subjected to a pulsatile protocol using a pulsatile catheter. After being anesthetized and prepared for surgery, the jugular vein of the piglet was isolated and the catheter was introduced through the right atrium, the right ventricle and the pulmonary artery, under radioscopic control. Pulmonary artery pressure (PAP) was measured before (T0), immediately after (T1) and 30 min after (T2) the pulsatile protocol. It was demonstrated that this pulsatile protocol is a safe and efficient method of inducing a significant reduction in mean PAP via an NO-dependent mechanism. These data open up new avenues for the clinical management of PAH.     

Right Ventricular Systolic Pressure Measurements in Combination with Harvest of Lung and Immune Tissue Samples in Mice

The function of the right heart is to pump blood through the lungs, thus linking right heart physiology and pulmonary vascular physiology. Inflammation is a common modifier of heart and lung function, by elaborating cellular infiltration, production of cytokines and growth factors, and by initiating remodeling processes ¹.Compared to the left ventricle, the right ventricle is a low-pressure pump that operates in a relatively narrow zone of pressure changes. Increased pulmonary artery pressures are associated with increased pressure in the lung vascular bed and pulmonary hypertension ². Pulmonary hypertension is often associated with inflammatory lung diseases, for example chronic obstructive pulmonary disease, or autoimmune diseases ³. Because pulmonary hypertension confers a bad prognosis for quality of life and life expectancy, much research is directed towards understanding the mechanisms that might be targets for pharmaceutical intervention ⁴. The main challenge for the development of effective management tools for pulmonary hypertension remains the complexity of the simultaneous understanding of molecular and cellular changes in the right heart, the lungs and the immune system.Here, we present a procedural workflow for the rapid and precise measurement of pressure changes in the right heart of mice and the simultaneous harvest of samples from heart, lungs and immune tissues. The method is based on the direct catheterization of the right ventricle via the jugular vein in close-chested mice, first developed in the late 1990s as surrogate measure of pressures in the pulmonary artery^5-13. The organized team-approach facilitates a very rapid right heart catheterization technique. This makes it possible to perform the measurements in mice that spontaneously breathe room air. The organization of the work-flow in distinct work-areas reduces time delay and opens the possibility to simultaneously perform physiology experiments and harvest immune, heart and lung tissues.The procedural workflow outlined here can be adapted for a wide variety of laboratory settings and study designs, from small, targeted experiments, to large drug screening assays. The simultaneous acquisition of cardiac physiology data that can be expanded to include echocardiography^5,14-17 and harvest of heart, lung and immune tissues reduces the number of animals needed to obtain data that move the scientific knowledge basis forward. The procedural workflow presented here also provides an ideal basis for gaining knowledge of the networks that link immune, lung and heart function. The same principles outlined here can be adapted to study other or additional organs as needed.     

微型移动导管手术室的民用模式研究

微型移动导管手术室是为适应野战条件下心血管急重伤病的快速诊治而研制的新型医疗设备。本文主要研究探讨该微型移动导管手术室的民用模式,包括针对STEMI病人的人机一体化反送救治模式,突发事件中伤员的现场救治模式,重要活动的卫生安全保障模式以及对三线以下城市乡镇的医疗巡诊模式。     

改良颈静脉置管术在自身给药成瘾模型优化中的作用研究

目的:探讨技术和方法的改进,提高动物颈静脉置管以及药物成瘾自身给药模型构建的成功率,为成瘾研究提供更稳定和高效的建模方法。方法:对建立自身给药模型的传统颈静脉置管术进行改良,选取成年雄性SD大鼠60只,按照随机数字表法分为传统手术组(n=30)和改良手术组(n=30),分别完成颈静脉置管术后,按照随机数字表法,再将每组分为对照训练组(n=15)和成瘾训练组(n=15),构建大鼠自身给药模型,观察两组大鼠自身给药模型成功率。结果:大鼠的颈静脉置管手术可能出现的手术并发症主要包括堵管、漏管、感染甚至死亡等,最主要的并发症是漏管,占比最大。颈静脉置管传统手术组手术成功率为43.33%±3.333,颈静脉置管改良手术组手术成功率为90.00%±3.333,显著高于颈静脉置管传统手术组(P0.05)。两组成瘾训练组有效鼻触次数均分别明显高于其对照训练组(P0.05)。结论:大鼠改良后的颈静脉置管手术效果明显优于传统手术,颈静脉置管手术成功率明显提高。     

Evaluation of the Efficacy of the H. pylori Protein HP-NAP as a Therapeutic Tool for Treatment of Bladder Cancer in an Orthotopic Murine Model

Bladder cancer is one of the most common malignancies of the urogenital tract. Intravesical injection of Bacillus Calmette-Guérin (BCG) is the gold standard treatment for the high-grade non-muscle invasive bladder cancer (NMIBC). However, since the treatment-related side effects are relevant, newer biological response modifiers with a better benefit/side effects ratio are needed.The tumour microenvironment can influence both tumour development and therapy efficacy. In order to obtain a good model, it is desirable to implant tumour cells in the organ from which the cancer originates.In this protocol, we describe a method for establishing a tumour in the bladder cavity of female mice and subsequent delivery of therapeutic agents; the latter are exemplified by our use of Helicobacter pylori neutrophil activating protein (HP-NAP). A preliminary chemical burn of the mucosa, followed by the injection of mouse urothelial carcinoma cell line MB49 via urethral catheterization, enables the cells to attach to the bladder mucosa. After a period, required to allow an initial proliferation of the cells, mice are treated with HP-NAP, administrated again via catheterization. The anti-tumour activity of HP-NAP is evaluated comparing the tumour volume, the extent of necrosis and the degree of vascularization between vehicle- and HP-NAP-treated animals.     

Left ventricular endocardial pacing in cardiac resynchronisation therapy: Moving from bench to bedside

In cardiac resynchronisation therapy, failure to implant a left ventricular lead in a coronary sinus branch has been reported in up to 10% of cases. Although surgical insertion of epicardial leads is considered the standard alternative, this is not without morbidity and technical limitations. Endocardial left ventricular pacing can be an alternative as it has been associated with a favourable acute haemodynamic response compared with epicardial pacing in both animal and human studies. In this paper, we discuss left ventricular endocardial pacing and compare it with epicardial surgical implantation. Ease of application and procedural complications and morbidity compare favourably with epicardial surgical techniques. However, with limited experience, the most important concern is the still unknown long-term risk of thromboembolic complications. Therefore, for now endovascular implants should remain reserved for severely symptomatic heart failure patients and patients at high surgical risk of failed coronary sinus implantation.     

小型猪生物可降解支架置入术中不同麻醉方法的研究

目的比较两种不同麻醉方法对小型猪的麻醉效果。方法将12头小型猪随机分成两组,每组6头,一组是戊巴比妥钠复合氯胺酮静脉麻醉（Ⅰ组）,另一组是丙泊酚复合氯胺酮静脉麻醉（Ⅱ组）。麻醉后对动物实施心脏生物可降解支架置入术,观察动物麻醉起效时间、苏醒时间、麻醉效果、呼吸频率（RR）、心率（HR）、血氧饱和度（SpO2）及术后苏醒情况。结果两种方法麻醉后,动物分别在7.6±2.4 min（Ⅰ组）、2.4±1.4 min（Ⅱ组）进入麻醉状态（P〈0.05）。术后苏醒时间分别为30.8±8.8 min（Ⅰ组）、16.5±2.8min（Ⅱ组）（P〈0.05）,Ⅱ组动物比Ⅰ组动物苏醒平稳（P〈0.05）。两组心率及呼吸频率变化无明显差别,而氧饱和度在第10 min（Ⅰ组87%,Ⅱ组92%）和30 min（Ⅰ组94%,Ⅱ组89%）由于追加麻醉药后,两组值差异较大,但很快恢复正常。Ⅱ组麻醉效果较Ⅰ组麻醉效果好。结论两种麻醉方法均能达到良好的麻醉效果,丙泊酚复合氯胺酮麻醉较戊巴比妥钠复合氯胺酮麻醉的效果强且术后苏醒快,是一种比较理想的麻醉方法。     

右心导管法测大鼠肺动脉压力的改良

目的:目前常用的测量大鼠肺动脉压力的右心导管法存在一定的缺陷,且很难得到典型的压力曲线图。本实验对大鼠经颈外静脉插管与测压的方法进行改良,同时与已有报道的实验结果进行比较,并提供正常SD大鼠右心房、右心室及肺动脉的压力参考值及典型的压力曲线图,以协助研究人员判断导管位置,及时调整导管的深度和方向,快速测出肺动脉压力。方法:雌雄不分的清洁级SD大鼠共30只,体重180~230 g,6~7周龄。应用自制的末端呈一弧形的PE-10管,采用改良后的右心导管法,经颈外静脉插入大鼠心腔及肺动脉,检测并计算大鼠右心房、右心室和肺动脉的收缩压、舒张压及肺动脉平均压。结果:右心房压力波动较平缓,呈小波浪形;右心室压力曲线波动大,骤升骤降;肺动脉压力曲线有重搏波。正常SD大鼠右心房舒张压为(2.03±2.56)mmHg,收缩压为(2.82±1.85)mmHg;右心室舒张压为(5.72±3.99)mmHg,收缩压为(18.73±4.80)mmHg;肺动脉舒张压为(15.27±2.64)mmHg,收缩压为(18.49±2.53)mmHg,肺动脉平均压为(16.34±2.32)mmHg。右心室收缩压与肺动脉收缩压无明显差异(P0.05)。结论:改良后的方法可准确到达大鼠肺动脉,提供的压力参考值及曲线图有助于研究人员顺利完成测压实验。