Biomechanical rationale of coronary artery bypass grafting of multivessel disease

The biomechanical model of human coronary arteries was modified for improving the quality of diagnosis and surgical treatment for coronary heart disease. The problem of hemodynamics in the left coronary artery with multivessel bed disease – 45% stenosis of the anterior descending branch and 75% stenosis of the circumflex branch – was particularly considered. Numerical simulation of the coronary arterial bypass of the main trunk was carried out to estimate the functional condition of the coronary arteries after restoring myocardial blood supply by surgery.     

Uric acid modulates vascular endothelial function through the down regulation of nitric oxide production

Abstract

Endothelial dysfunction characterized by decreased nitric oxide (NO) bioavailability is the first stage of coronary artery disease. It is known that one of the factors associated with an increased risk of coronary artery disease is a high plasma level of uric acid. However, causative associations between hyperuricaemia and cardiovascular risk have not been definitely proved. In this work, we tested the effect of uric acid on endothelial NO bioavailability. Electrochemical measurement of NO production in acetylcholine-stimulated human umbilical endothelial cells (HUVECs) revealed that uric acid markedly decreases NO release. This finding was confirmed by organ bath experiments on mouse aortic segments. Uric acid dose-dependently reduced endothelium-dependent vasorelaxation. To reveal the mechanism of decreasing NO bioavailability we tested the effect of uric acid on reactive oxygen species production by HUVECs, on arginase activity, and on acetylcholine-induced endothelial NO synthase phosphorylation. It was found that uric acid increases arginase activity and reduces endothelial NO synthase phosphorylation. Interestingly, uric acid significantly increased intracellular superoxide formation. In conclusion, uric acid decreases NO bioavailability by means of multiple mechanisms. This finding supports the idea of a causal association between hyperuricaemia and cardiovascular risk.     

清醒狗短暂缺血心肌复灌注时舒缩功能的变化

在狗的心脏上装入微超声探头和高精度微压力传感器,手术后两星期,在清醒状态下给予左冠状动脉旋支阻断三分钟。在复灌注过程中,观察到血液动力学指标与收缩期心室壁厚度(WT)迅速恢复正常;但在 dWT/dt—WT 环形图上出现舒张早期异常相,其形状与缺血过程不同。低氧和急遽冠状动脉过度充盈可以产生此种异常图形。我们推测,心肌缺血可能促使一些产物的形成,复灌注时它使冠脉过度舒张,冠脉灌注增加,从而造成舒张早期急遽充盈而形成了此种异常的形图。     

Disturbed lipid metabolism in diabetic coronary vessels

The aim of this study was to clarify whether or not arachidonic acid metabolic disorders are caused by a substrate inavailability and whether such disorders might contribute to circulatory disturbances in the diabetic myocardium. Norepinephrine induced a decrease in the conductivity of both coronary arterial bed and myocardial microcirculation in alloxan-diabetic dogs. It was markedly (p < 0.05) attenuated both by indomethacin and acetylsalicylic acid pretreatments indicating an imbalance among the vasoactive prostanoids in diabetes. TXA₂ release from the diabetic coronary rings was found to be elevated and could be normalized after the blockade of vascular adrenoceptors by phentolamine (p < 0.05). PGIZ synthesis was also enhanced by adrenergic blockade in the diabetic arterial rings. After pretreatment with ^l4C arachidonic acid, in order to measure substrate availability, the arachidonic acid metabolic rate was less in the diabetic coronary arteries than in healthy vessels (p < 0.05). Ten µmol/1 norepinephrine decreased arachidonic acid metabolism in the presence of prelabelled substrate in the diabetic animals, compared to an increase observed in metabolically healthy dogs. Therefore diabetes appears to diminish arachidonic acid metabolism and uptake independent of adrenoceptors and to induce an imbalance between vasoconstrictor and vasodilator cyclooxygenase products, resulting in elevated TXA₂ release controlled by adrenergic mechanisms which may contribute to an impairment in myocardial microcirculation.Abbreviations 6-oxo-PGF₁ 6-oxo prostaglandin F₁ - HPLC High Pressure Liquid Chromatograph - LAD Left Anterior Descending (coronary artery) - PGI₂ Prostacyclin - TXA₂ Thromboxane     

犬冠状动脉阻力的胆碱能调节

本实验在麻醉开胸犬,采用冠状动脉左旋支恒流灌注,于搏动的和心室纤颤(VF)的心脏,研究了电刺激迷走神经(VNS)及冠状动脉内注入乙酰胆碱(ACh)对冠状动脉阻力的影响。当 VNS 和冠脉内给 ACh 时,(1)心肌内小冠状动脉阻力显著减低,而心外膜大冠状动脉阻力并无明显变化;(2)冠状动脉左旋支总阻力的减低幅度在 VF 的心脏比在搏动的心脏显著减小。以上结果表明,迷走-ACh 扩张冠脉的作用主要是舒张心肌内小冠状动脉,并可通过减低心肌收缩力而间接降低冠状动脉阻力。     

迷走神经与乙酰胆碱对缩窄的犬冠状动脉节段阻力的影响

在麻醉开胸犬,用电起搏维持心率恒定,研究了电刺激颈迷走神经(VNS)及冠状动脉内注入乙酰胆碱(ACh)对缩窄的冠状动脉的节段阻力及血流量的影响。在左旋支主干造成不同程度的冠状动脉缩窄。分别测定左旋支血流量(CBF_(cx))、主动脉压和主旋支远端冠状动脉压,记录心电图。实验发现,在冠状动脉临界狭窄和重度狭窄时,VNS 或冠脉给ACh 引起心外膜大冠状动脉阻力及冠状动脉主旋支总阻力增大,CBF_(cx)减少;随着缩窄程度加重,这些改变也愈明显,然而,心肌内小冠状动脉阻力却无显著改变。     

Interstitial noradrenaline concentration of rat hearts as influenced by cellular catecholamine uptake mechanisms

Marked concentration differences of noradrenaline (NA) between the vascular and the interstitial compartment were detected by sampling interstitial transudate from isolated perfused rat hearts. The ratios of vascular/interstitial concentration amounted to 7.4 to 1.3 depending on the concentration of NA administered (3 × 10^–9 to 10^–6 M). These concentration differences were abolished by inhibitors of uptake₁ desipramine (DMI) I and uptake, (O-methyl-isoprenaline (OMI)). Neuronal uptake, was characterized by a K_m of 0.22 mol/l and a V_max of 370 pmol × min^–1 × gWWT^–1, extraneuronal uptake₂ by a K_UPTAKE of = 0.313 min^–4.The apparent permeability surface area (P×S)-product calculated from uptake rate and transcapillary concentration difference was significantly decreased by administrating 100 mol/l (NA) in presence of DMI. A presumed endothelial uptake mechanism contributing to catecholamine translocation was investigated in endothelial cells in culture. These cells showed a specific noradrenaline uptake with a K_m of 4.35 mol/l and a V_max of about 75 pmol × min^–1 x gWWT^–1. Any inhibiton by inhibitors of both of the two noradrenaline uptakes was lacking. The uptake rate of this mechanism is insufficient to contribute to the diffusive conductivity of the capillary wall (P × S-product). We conclude from our investigations on interstitial concentrations of catecholamines and transcapillary concentration differences, that the capillary wall, owing to its metabolic and diffusional characteristics, influences the exchange of catecholamines to a substantial and physiologically relevant extent.     

Changes in drinking water selenium and mortality for coronary disease in a residential cohort

In a part of the municipal territory of Reggio Emilia, northern Italy, selenium in drinking water decreased from 7 μg/L to less than 1 μg/L. In a cohort of 4419 individuals, previously exposed for at least 5 yr to the drinking water with higher selenium content, the 7-yr temporal distribution of deaths for coronary disease and for stroke was analyzed to examine a possible relationship with changes in drinking water selenium. From January 1986 until August 1988, when tap water selenium was 7 μg/L, deaths for coronary disease were one in males and two in females. After the decrease in drinking water selenium, 21 and 10 coronary deaths were observed, respectively, in males and in females from September 1988 to December 1992. No significant difference in the temporal distribution of stroke deaths was observed both in males and in females. Even if an effect of chance and aging in the temporal distribution of coronary deaths may not be excluded, findings of the study seem to be consistent with the hypothesis of a beneficial effect of selenium on coronary disease mortality.     

The medical utility of genomics data in neuropsychiatry: mutational genetics versus association genetics

The long anticipated ‘genetic revolution’ in neuropsychiatry has yet to have an impact on the practice of clinical medicine. Excitement in the 1980s over major genetic breakthroughs in schizophrenia and manic depression, for example, has been replaced in the late 1990s by the sobering realization that most common neuropsychiatric disorders are multifactorial. Despite considerable effort and resources, no ‘causative’ genetic variation has been identified that plays a definitive major role in any common neuropsychiatric disorder.     

蝮蛇抗栓酶治疗冠心病

应用蝮蛇抗栓酶治疗15例冠心病患者,其中12例为慢性冠心病患者,3例为急性心肌梗塞患者.治疗结果表明:治疗后心电图示心肌缺血改善者达72.7%,心脏 B 超示室壁运动改善者达80%,心阻抗血流图示 PEP/LVET 明显下降,P<0.01,CI 明显增高.P<0.05,说明蝮蛇抗栓酶具有明显的改善心肌缺血和左心室功能的作用。