Coronary blood flow reserve measured by contrast media injection depends on myocardial viability

Coronary blood flow reserve may be affected by several physiological variables besides hydraulic impediment to flow. A hyperaemic response induced by hyperosmolar radiopaque contrast medium was recorded in the left anterior descending and left circumflex arteries with a steerable pulsed Doppler system in four patients with Q wave anterior myocardial infarction chronic scar and non-stenotic coronary arteries. Resting flow velocities were similar in both arteries. The magnitude of the hyperaemic response induced by contrast media in the circumflex artery (mean flow velocity increase from 5.9 +/- 2.5 baseline to 12.2 +/- 0.6 cm s-1 at peak flow, P less than 0.05) was almost twice that induced in the left anterior descending artery (mean flow velocity increase from 6.1 +/- 2.2 baseline to 7.4 +/- 2.6 cm s-1 at peak flow, P = N.S.). The peak flow to baseline flow velocities ratios were 1.22 +/- 0.15 in the left anterior descending artery vs 2.23 +/- 0.75 in the circumflex artery. Thus when a post-myocardial infarction chronic scar is supplied by a non-stenotic coronary artery, the coronary blood flow hyperaemic response to contrast media-induced transient ischaemia is decreased, suggesting that coronary blood flow reserve depends on a myocardial metabolic stimulus which is impaired by ischaemic cell death.     

Closure of extracardiac Fontan fenestration by using the covered Cheatham Platinum stent.

OBJECTIVE: The purpose of this study was to describe our experience concerning the use of covered Cheatham Platinum (CP) stent in patients with fenestrated total cavopulmonary connection (TCPC). BACKGROUND: Closure of TCPC fenestrations has been achieved by utilizing different devices designed to close intra-cardiac or aorto-pulmonary communications. METHODS: We used the covered CP stent in 6 patients with fenestrated TCPC. Median age and weight were 11 years and 38 Kg, respectively. Femoral approach was used in all but 1 patient having bilateral thrombosis of femoral veins. The CP stent was crimped on a BiB balloon in 5 patients and on a simple balloon in 1 patient. The balloon's diameter was the same size or 1-2 mm larger than the TCPT conduit, according to angiographic diameter. RESULTS: Mean procedural and fluoroscopy time were 41 +/- 8 and 8 +/- 2 min, respectively. Immediate full occlusion of fenestration was obtained in all patients. Mean central venous pressure was not significantly increased from 10.8 +/- 2.5 to 11.8 +/- 2.8 mm Hg and oxygen saturation significantly increased from (91.5 +/- 4.4)% to (98.5 +/- 1.9)% (P = 0.003). No procedural or intra-hospital complications occurred. In particular, no arrhythmias, systemic embolism, or acute venous thrombosis were observed. At a median follow-up of 2.8 months all patients have normal oxygen saturation and are symptom-free. CONCLUSIONS: The covered CP stent can be easily and effectively used for closure of TCPC fenestrations. This method has the advantage to avoid protrusion of prosthetic material into the left atrium and to prevent early or late embolism.     

降纤酶对脑梗死病人血液流变学及脑循环动力学指标的影响

目的观察急性脑梗死病人应用国产降纤酶后血液流变学及脑循环动力学指标的变化。方法入选59例病人,其中治疗组32例,对照组27例,检测两组病人用药后的血液流变学及脑循环动力学等指标。结果治疗组用药后全血低切黏度为9.55mPa.s±1.74mPa.s、全血高切黏度为4.05mPa.s±0.81mPa.s、血浆黏度为1.79mPa.s±0.07mPa.s、红细胞聚集指数为2.09±0.22、红细胞变形指数为0.47±0.05、平均血流速度为3.33cm/s±2.69cm/s、最低血流速度为2.19cm/s±1.87cm/s。对照组全血低切黏度为10.91mPa.s±2.28mPa.s、全血高切黏度为4.67mPa.s±1.02mPa.s、血浆黏度为1.89mPa.s±0.09mPa.s、红细胞聚集指数2.23±0.21、红细胞变形指数0.42±0.06、平均血流速度为0.53cm/s±1.66cm/s、最低血流速度0.45cm/s±1.10cm/s,两组比较均有统计学意义（P〈0.05）。结论降纤酶具有改善血液流变学及脑循环动力学等指标的作用。     

活血解毒中药有效部位对ApoE基因敲除小鼠动脉粥样硬化斑块炎症反应的影响

目的观察活血(三七总皂苷)、解毒(黄连提取物)、活血解毒中药有效部位(虎杖提取物、大黄醇提物)对ApoE基因敲除小鼠动脉粥样硬化(AS)斑块炎症反应的影响。方法70只(6~8)周龄小鼠ApoE基因敲除小鼠予高脂饮食喂养13周后,待其形成成熟的AS斑块后,随机分为活血解毒组(虎杖提取物组、大黄醇提物组)、活血对照组(三七总皂苷组)、解毒对照组(黄连提取物组)、模型组、阳性对照组(辛伐他汀组)。继续高脂喂养并按体重比折算的临床推荐剂量给予相应药物治疗13周后,处死动物,检测血清超敏C反应蛋白(hs-CRP)及可溶性白细胞分化抗原40配体(sCD40L)水平,并取主动脉根部4个切面,分别行HE染色和Movat染色,用免疫组化染色法观察小鼠主动脉根部斑块内过氧化物酶体增殖物激活受体γ(PPAR-γ)的蛋白表达,实时荧光定量PCR法检测主动脉内PPAR-γ及核转录因子κB(NF-κB)mRNA的表达。结果与模型组比较,大黄醇提物组及虎杖提取物组血清hs-CRP和sCD40L水平均明显降低(P<0.01或P<0.05)。解毒对照组黄连提取物主动脉斑块内PPAR-γ蛋白及基因表达均明显增多(P<0.01),而中药各组小鼠主动脉斑块内NF-κBmRNA的表达与模型组比较均无统计学意义(P<0.05)。结论采用临床推荐剂量治疗的活血解毒中药有效部位中,虎杖提取物和大黄醇提物可明显降低ApoE基因敲除小鼠血清炎症标志物hs-CRP及sCD40L水平,其效果优于单纯活血或解毒组,但对PPAR-γ和NF-κB的作用并不明显。而黄连提取物却可明显增加具有抗AS炎症作用的保护性受体PPAR-γ的蛋白和基因表达,提示其作用环节有所不同,值得深入研究。     

Effect of anaemia on haemodynamics in patients with cirrhosis

BACKGROUND: It has been suggested that increased blood haemoglobin attenuates splanchnic vasodilatation in portal-hypertensive rats by nitric oxide inactivation. However, the haemodynamic effect of anaemia in cirrhotic patients of varying severity has been rarely discussed. The aim of this study was to evaluate the influence of anaemia on systemic and splanchnic haemodynamics in cirrhotic patients of differing severity. METHODS: Two hundred and twenty-five cirrhotic patients were included in this study. All biochemical and haemodynamic results were utilized for analysis. Anaemia was defined as a haemoglobin level below the cut-off value of 12 g/dL, which might best predict low systemic vascular resistance. RESULTS: Compared with non-anaemic patients, anaemic patients had decreased mean arterial pressure (90 +/- 1 vs 95 +/- 1 mmHg, P = 0.002), and decreased systemic vascular resistance (1022 +/- 25 vs 1227 +/- 30, P < 0.0001), and increased cardiac index (4.3 +/- 0.1 vs 3.8 +/- 0.1 L/min per m2, P < 0.0001) and increased hepatic venous pressure gradient (16.7 +/- 0.5 vs 14.4 +/- 0.6 mmHg, P = 0.006). Haemoglobin concentration exerted an influence on the degree of vasodilatation in cirrhotic patients, with Child-Pugh's A class (but not in Child-Pugh's B and C classes), and in patients without ascites (but not in patients with ascites). CONCLUSIONS: It was concluded that anaemia has a negative effect on hyperdynamic circulation in patients with early cirrhosis which is not observed in patients with advanced cirrhosis.     

慢性心肌缺血中侧支循环作用的研究

目的:运用冠脉造影和非介入性方法研究冠状动脉慢性闭塞多支病变(Chronic Occlusive Multivessle Disease)中侧支循环与临床状况及表示侧支循环状况的临床指标。方法:选择既往无心肌梗塞、有稳定型和不稳定型心绞痛病史,冠脉造影示至少一支冠脉完全闭塞并有多支病变的病人,根据CAG判断侧支循环的分级情况,病人被分为侧支良好组(A组:侧支循环2．3级)和侧支不良组(B组:侧支循环0,1级),对两组患者临床特征进行对比分析。结果:40例冠脉慢性闭塞多支病变患者中侧支良好的有28例(A组),侧支不良的有12例(B组)。心绞痛病程(>3个月)在A组中占96．4％,在B组中占66．6％,B组明显少于A组(P<0．05)。异常Q波的出现率两组分别为28．5％(A组),66．6％(B组),B组明显高于A组(P<0．05)。室壁运动正常者A组占39．2％,明显高于B组的10％(P<0．01)。左室射血分数(LVEF)A组明显高于B组(50±8．0:44．8±5．5,P<0．05)。结论:病程较短,有异常Q波,室壁运动异常,左室射血分数<50％者提示侧支循环不佳。     

大脑中动脉狭窄患者侧枝循环开放相关因素分析及其对预后的影响

目的 评估大脑中动脉患者的侧枝循环状况,进一步探讨大脑中动脉狭窄患者的相关影响因素及其对预后的影响.方法 选择住院患者经头颅磁共振成像（MRI）及磁共振血管成像（MRA）确诊的单侧大脑中动脉中-重度狭窄（其为责任血管）的急性脑梗死患者60例,采用经颅多普勒（TCD）评估侧枝循环,分为侧枝循环开放组及未开放组各30例,对患者的相关影响因素及NIHSS评分进行相关性分析.结果 大脑中动脉狭窄的急性脑梗死患者侧枝循环开放组与未开放组卒中量表（NIHSS）评分差异有统计学意义（P＜0.05）;其侧枝循环开放情况与冠心病、年龄、糖尿病、吸烟、饮酒无相关性（P＞0.05）,而与高血压病、高脂血症、高同型半胱氨酸血症及性别有相关性（OR =0.145、0.226、6.507、4.164,P＜0.05）.结论 大脑中动脉狭窄患者侧枝循环的建立与开放及多种缺血性脑血管病的危险因素有一定相关性.     

血清miR-146a／b实时荧光定量分析及其作为分子标志物的初步评价

目的：以特异性调节Toll样受体信号通路的miR-146a／b为检测靶标,建立血清miRNAs分子荧光定量检测方法,并对其作为血清炎症分子标志物的潜在价值进行初步评价。方法：采集正常体质量儿童血清20例（对照组）、超重儿童血清20例（超重组）、肥胖儿童血清20例（肥胖组）及健康成年人血清50例（健康成人组）,酚-氯仿法提取血清总RNAs,SYBRGreen实时荧光定量技术定量检测血清中miR-146a／b拷贝数,GraphpadPrism5．0软件进行统计分析并绘图。结果：对照组血清中miR-146a的拷贝数显著低于超重组（P=-0．0061）和肥胖组（P=-0．0262）,超重组和肥胖组之间差异无统计学意义（P=0．0656）。miR-146a表达量的受试者工作特征曲线下面积（AUC）分析显示：对照组vs超重组AUC=O．8475,P=-0．0002;对照组vs肥胖组AUC=0．6050,P=-0．2560;超重组vs肥胖组AUC=0．5475,P=0．6073。miR-146b与miR-146a呈不同表达趋势,超重组儿童血清miR-146b拷贝数显著高于对照组（P=-0．0090）和肥胖组儿童（P=0．0023）,肥胖组儿童血清中miR-146b的拷贝数均值虽略低于对照组,但差异无统计学意义（P=-0．1556）。miR-146b表达量的AUC分析显示：正常组vs超重组AUC=0．7425,P=O．0087;正常组vs肥胖组AUC=0．6325,P=0．1517;超重组vs肥胖组AUC=0．7825,P=0．0023。miR．146a／b拷贝数值变异系数（CV）大：对照组、超重组和肥胖组儿童血清中miR。146a拷贝数的cv值分别为80．94％、110．94％、175．88％;miR-146b拷贝数的cV值分别为164．11％、189．72％、152．00％。在健康成人血清中miR-146a／b呈现相近表达模式,miR-146a和miR-146b的cV值分别是37．86％、74．82％。结论：miR-146a在对照组、超重组和肥胖组的表达量变化显示其与儿童肥胖具有-定相关性,可以从整体水平说明miR-146a与体内炎症水平呈正相关关系,但是由于其在血清中拷贝数值变异较大且各组问无明确分界,不能确定其参考值范围。因此,血清miR-146a／b拷贝数差异不足以用于临床个体化诊断,血清miR-146a／b作为炎症相关分子标志物的价值尚需进一步探讨。     

益气活血法治疗气虚血瘀型糖尿病肾病临床观察

目的观察益气活血法对气虚血瘀型糖尿病肾病早、中期患者肾脏的保护作用。方法将60例患者随机分为治疗组和对照组,每组30例。对照组给予常规糖尿病健康教育、控制血压、血糖以及对症支持治疗,治疗组在对照组治疗的基础上加用当归补血汤治疗。治疗3月后观察2组患者肾功能、血脂、血糖、24 h尿蛋白定量的变化,同时比较治疗前后患者生存质量积分的变化。结果治疗组在降低血脂、尿蛋白,稳定血糖及肾功能,改善生存质量等方面作用明显,与对照组比较差异有统计意义（P〈0.05）。结论益气活血法可以有效地改善早、中期糖尿病肾病患者的生存质量,保护肾脏功能,延缓病情进展。     

急诊体外循环在心血管外科中的应用

目的:研究并讨论在心血管外科中应用急诊体外循环的经验和临床疗效,并对急诊体外循环在临床中应用指征的作用进行探讨。方法:选取进行急诊体外循环术救治的50例患者,其中包括5例心脏肿瘤,12例心瓣膜功能不全,14例冠状动脉的旁路移植手术,7例大血管手术,2例外伤性的心脏破裂,4例患者实施法洛四联症的急性缺氧的矫治手术和6例先天性的心脏病介入治疗失败急诊术。结果:进行急诊体外循环手术的50例患者中,在手术后有45例存活,其手术的成功率是90%。结论:急诊体外循环术是心外科中救治急危重患者的一种重要有效措施,也是临床上救治心外科患者的唯一有效方案,但在治疗过程中需要多科室进行协作,并及时掌握手术中的各项指征,及时建立体外循环,减少术后并发症的发生,从而提高手术的成功率。