AMI 患者血浆NT-proBNP 水平与心肌缺血及预后关系的研究

目的:探讨急性心肌梗死(AMI)患者血浆N末端B型尿钠肽前体(NT-proBNP)的水平与心肌缺血及预后的关系。方法:98例急性心肌梗死患者根据患者是否行直接PCI手术治疗,分为PCI手术治疗组和非PCI治疗组,观察缺血改善情况与NT-proBNP水平的关系,同时根据治疗后NT-proBNP的水平分为三组,A组NT-proBNP<125pg/ml、B组125pg/ml≤NT-proBNP<450pg/ml、C组NT-proBNP≥450pg/ml,观察NT-proBNP的水平与预后的关系。结果:行PCI组NT-proBNP的水平下降程度(438.3±134.5)明显高于未行PCI组者(158.6±146.1,P<0.05),MACE的发生情况C组明显高于A组(P=0.006<0.01),也高于B组(P=0.028<0.05),A组与B组相比,B组的MACE发生率有上升的趋势,但是无统计学意义(P=0.432>0.05)。结论:急性心肌梗死患者早期血浆NT-proBNP的水平在一定程度上可以反应心肌的缺血程度,且与患者的预后成明显的负相关。     

In vivo characterization of tumor and tumor vascular network using multi‐modal imaging approach

We present a multi‐modal optical diagnostic approach utilizing a combined use of Fluorescence Intravital Microscopy (FIM), Dynamic Light Scattering (DLS) and Spectrally Enhanced Microscopy (SEM) modalities for in vivo imaging of tumor vascular network and blood microcirculation. FIM is used for imaging of tumor surroundings and microenvironment, SEM provides information regarding blood vessels topography, whereas DLS is applied for functional imaging of vascular network and blood microcirculation. This complementary combination of the imaging approaches is extremely useful for functional in vivo imaging of blood vasculature and tumor microenvironment. The technique has also a great potential in vascular biology and can significantly expand the capabilities of tumor angiogenesis studies and notably contribute to the development of cancer treatment. (© 2011 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Static magnetic fields alter arteriolar tone in vivo

This study was designed to directly quantify the effect of localized static magnetic field (SMF) exposure on the diameter of microvessels in adult rat skeletal muscle in vivo. Microvascular networks in the exteriorized rat spinotrapezius microvasculature were exposed to a localized, uniform 70 mT SMF for 15 min. Arteriolar vessel diameters were measured; and the extent of vessel contraction, microvascular tone, was calculated before exposure, immediately after exposure, and 15 and 30 min after removal of the field. A calculated value of high tone corresponds to vessels that are vasoconstricted and a calculated value of low tone refers to vessels that are vasodilated. Vessels with initial tone <15% showed an increasing trend in tone and, conversely, vessels with initial tone >15% showed a significant (P < 0.05) decrease in tone 15 and 30 min following application, respectively. Further classification of the data with regards to the initial vessel diameter demonstrated that vessels with initial diameters <30 microm and initial tone <15%, smaller diameter vessels that are initially vasodilated, showed significant (P < 0.05) increase in tone immediately, 15 and 30 min following SMF exposure. Additionally, <30 microm vessels with >15% initial tone, smaller diameter vessels that are initially vasoconstricted, demonstrated a significant (P < 0.05) decrease in tone 30 min after SMF exposure. Vessels with initial diameters >30 microm had no significant response to the SMF. These results imply that SMF exposure influences arteriolar diameters, and therefore microvascular tone, in a restorative fashion acting to normalize the tone to the median tone value of 15% following exposure. Because this response occurs primarily in the resistance arterioles, which significantly influence tissue perfusion, SMF application could be efficacious for the treatment of both ischemic and edematous tissue disorders involving compromised microvascular function.     

Proteomics of ischemia/reperfusion injury in rabbit myocardium reveals alterations to proteins of essential functional systems

Brief periods of myocardial ischemia prior to timely reperfusion result in prolonged, yet reversible, contractile dysfunction of the myocardium, or "myocardial stunning". It has been hypothesized that the delayed recovery of contractile function in stunned myocardium reflects damage to one or a few key sarcomeric proteins. However, damage to such proteins does not explain observed physiological alterations to myocardial oxygen consumption and ATP requirements observed following myocardial stunning, and therefore the impact of alterations to additional functional groups is unresolved. We utilized two-dimensional gel electrophoresis and mass spectrometry to identify changes to the protein profiles in whole cell, cytosolic- and myofilament-enriched subcellular fractions from isolated, perfused rabbit hearts following 15 min or 60 min low-flow (1 mL/min) ischemia. Comparative gel analysis revealed 53 protein spot differences (> 1.5-fold difference in visible abundance) in reperfused myocardium. The majority of changes were observed to proteins from four functional groups: (i) the sarcomere and cytoskeleton, notably myosin light chain-2 and troponin C; (ii) redox regulation, in particular several components of the NADH ubiquinone oxidoreductase complex; (iii) energy metabolism, encompassing creatine kinase; and (iv) the stress response. Protein differences appeared to be the result of isoelectric point shifts most probably resulting from chemical modifications, and molecular mass shifts resulting from proteolytic or physical fragmentation. This is consistent with our hypothesis that the time course for the onset of injury associated with myocardial stunning is too brief to be mediated by large changes to gene/protein expression, but rather that more subtle, rapid and potentially transient changes are occurring to the proteome. The physical manifestation of stunned myocardium is therefore the likely result of the summed functional impairment resulting from these multiple changes, rather than a result of damage to a single key protein.     

Molecular and cellular events at the site of myocardial infarction: from the perspective of rebuilding myocardial tissue

The potential for bone marrow-derived progenitor cells (BMDPC) to regenerate myocardial tissue following infarction depends on homing, migration, nourishment, and spatially appropriate growth of BMDPC. Requisite to these objectives is the expression of adhesion molecules (ICAM-1) and chemoattractant cytokines (MCP-1), matrix metalloproteinase (MMP) activity, a neovasculature, and fibrillar collagen scaffolding. We found that enhanced ICAM-l and MCP-1, as well as MMP activity on day 3 and 7 postMI, are present to facilitate the homing, chemotaxis, and migration of circulating cells into the infarct site. The vascular network formed at the infarct site contains a ratio of conduit to exchange vessels that is greater than that for control tissue and therefore its ability to nourish BMDPC for their growth appears to be tenuous. These findings, together with the dense formation of a fibrillar collagen scar beyond week 2, suggest the optimal time to rebuild myocardium from BMDPC resides within 2 week postMI.     

Effect of desflurane-induced preconditioning following ischemia-reperfusion on nitric oxide release in rabbits

Nitric oxide (NO) is the mediator of ischemic preconditioning against myocardial infarction. Desflurane produces anesthetic preconditioning to protect the myocardium against infarction. In the model of myocardial ischemia-reperfusion injury in rabbits, we evaluated desflurane-induced ischemic preconditioning and studied its mechanism of NO synthesis. Thirty-two male adult New Zealand white rabbits were anesthetized with intravenous (IV) 30 mg/kg pentobarbital followed by 5 mg/kg/hr infusion. All rabbits were subjected to 30 minutes (min) long lasting left anterior descending coronary artery (LAD) occlusion and three hours (hr) of subsequent reperfusion. Before LAD occlusion, the rabbits were randomly allocated into four groups for preconditioning treatment (eight for each group). The control group did not receive any preconditioning treatment. The desflurane group received inhaled desflurane 1.0 MAC (minimal end-tidal alveolar concentration) for 30 min that was followed by a 15 min washout period. The L-NAME-desflurane group received L-NAME (NG-nitro-L-arginine methyl ester; non-selective Nitric Oxide Synthetase (NOS) inhibitor) 1 mg/kg IV 15 min before 1.0 MAC inhaled desflurane for 30 min. The L-NAME group received L-NAME 1 mg/kg IV. Infarct volume, ventricular arrhythmia, plasma lactate dehydrogenase (LDH), creatine kinase (CK) activity and myocardial perfusion were recorded simultaneously. We have found that hemodynamic values of the coronary blood flow before, during, and after LAD occlusion were not significantly different among these four groups. For the myocardial ischemia-reperfusion injury animals, the infarction size (mean +/- SEM) in the desflurane group was significantly reduced to 18 +/- 3% in the area at risk as compared with 42 +/- 7% in the control group, 35 +/- 6 in the L-NAME group, and 34 +/- 4% in the L-NAME-desflurane group. The plasma LDH, CK levels, and duration of ventricular arrhythmia were also significantly decreased in the desflurane group during ischemia-reperfusion injury. Our results indicate that desflurane is an anesthetic preconditioning agent, which could protect the myocardium against the ischemia-reperfusion injury. This beneficial effect of desflurane on the ischemic preconditioning is probably through NO release since L-NAME abrogates the desflurane preconditioning effect.     

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。     

Microwave-Accelerated and Metal-Enhanced Fluorescence Myoglobin Detection on Silvered Surfaces: Potential Application to Myocardial Infarction Diagnosis

In this short paper, we describe a novel approach to both significantly accelerate and optically amplify fluorescence-based immunoassays. Our approach utilizes metal-enhanced fluorescence (MEF) to intrinsically optically amplify fluorescence signatures, which, when combined with the use of low-power microwaves to kinetically accelerate assays, provides for both ultrafast and ultrabright immunoassays. Surprisingly, the use of low-power microwaves and silver nanostructures provides for localized heating, concentrating the effect to the particles themselves as compared to the generic heating of the high dielectric assay fluid. We have subsequently applied our microwave-accelerated MEF approach to the detection of myoglobin, where its rapid quantification is paramount for the clinical assessment of an acute myocardial infarction.     

兔实验性动脉粥样硬化和急性心肌梗死双模型的建立

目的建立兔实验性动脉粥样硬化和心肌梗死双模型,比较血管新生在动脉粥样硬化和缺血心肌中发生机制的差异。方法选择20只雄性新西兰兔,随机分为两组,A组10只为普通饮食对照组,B组10只为高脂饮食组,共喂养9周。第3周末心导管封堵冠状动脉血管致急性心肌梗死。测定不同时期血脂水平。实验终点,苏丹Ⅲ染色测定主动脉斑块阳性面积;免疫组化染色测定不同心肌区域和主动脉血管壁CD34阳性反应强度,测定不同心肌区域新生血管密度;Western blot检测hypoxia-inducible factor1α(HIF-1α)在动脉粥样硬化和缺血心肌中的表达。结果高脂组血脂水平进行性增高。高脂组主动脉斑块阳性面积高于对照组,差异有显著性。在心肌正常区、梗死区和梗死边缘区:CD34阳性反应强度和新生血管密度各组间差异有显著性,HIF-1α的表达各组间差异有显著性;均为梗死边缘区最高,梗死区次之,正常区最低。在高脂组和对照组主动脉:CD34阳性反应强度两组间差异有显著性,HIF-1α的表达两组间差异有显著性;高脂组强于对照组。结论成功建立兔实验性动脉粥样硬化和心肌梗死双模型,提示动脉粥样硬化和缺血心肌中均有血管新生的参与。     

二维斑点追踪技术评价犬心梗后自体骨髓CD34＋干细胞移植对心肌功能的影响

目的应用二维斑点追踪成像超声心动图（2D-STE）,评价犬心梗后自体骨髓CD34＋干细胞移植对心肌功能的影响。方法 12只杂种犬行冠脉左前降支结扎术,导致前壁心肌梗死,随机分为两组,A组为对照组,结扎术后两周二次开胸手术,经心肌注射磷酸盐缓冲液（PBS）1 mL;B组为治疗组,结扎术后两周二次开胸手术,经心肌注射含自体骨髓CD34＋干细胞的磷酸盐缓冲液1 mL。应用STE对12只犬结扎术前、术后左室短轴基底段及心尖段心室节段径向应变（RS）、圆周方向应变（CS）以及局部心肌旋转（Rot）进行分析,并对对照组和治疗组治疗后的RS、CS及Rot变化进行比较。结果心肌梗死后梗死节段的RS、CS以及Rot均下降,治疗后治疗组梗死段RS及Rot较对照组好转。结论 STE能够评价左室短轴局部心肌的收缩功能,心肌梗死后梗死段短轴各方向应变减低,自体骨髓CD34＋干细胞移植能够提高局部心肌的收缩功能。