血浆NT-ProBNP及D-Dimer检测在老年慢性肺源性心脏病患者中的应用价值

目的探讨血浆氨基末端脑钠肽前体（NT—ProBNP）、D-二聚体（D-Dimer）在老年慢性肺源性心脏病患者中的应用价值。方法选取25例老年慢性肺源性心脏病急性加重期患者，分别检测治疗前（A组）、治疗后2周（B组）血浆NT—ProBNP、D—Dimer水平、动脉血二氧化碳分压及氧分压。并以30例老年单纯COPD急性加重患者（c组）做对照。结果A组较B组及C组比较，血浆NT-Pro BNP及D-Dimer水平显著增高，差异具有统计学意义（P〈0．05）。结论血浆NT-ProBNP及D-Dimer可作为评估老年慢性肺源性心脏病患者右心室功能不全严重程度的敏感指标。     

Flow cytometric assessment of circulating platelet and erythrocytes microparticles in young thalassemia major patients: relation to pulmonary hypertension and aortic wall stiffness

Heart disease is the leading cause of mortality and morbidity in β‐thalassemia major (β‐TM). Aggregability of abnormal red cells and membrane‐derived microparticles (MPs) stemming from activated platelets and erythrocytes are responsible for thrombotic risk. We measured platelet and erythrocyte MPs (PMPs and ErMPs) in 60 young β‐TM patients compared with 40 age‐ and sex‐matched healthy controls and assessed their relation to clinicopathological characteristics and aortic elastic properties. Patients were studied stressing on transfusion history, splenectomy, thrombotic events, chelation therapy, hematological and coagulation profiles, flow cytometric measurement of PMPs (CD41b⁺) and ErMPs (glycophorin A⁺) as well as echocardiographic assessment of aortic elastic properties. Aortic stiffness index and pulmonary artery pressure were significantly higher, whereas aortic strain and distensibility were lower in TM patients than controls (P < 0.001). Both PMPs and ErMPs were significantly elevated in TM patients compared with controls, particularly patients with risk of pulmonary hypertension, history of thrombosis, splenectomy or serum ferritin >2500 μg/L (P < 0.001). Compliant patients on chelation therapy had lower MPs levels than non‐compliant patients (P < 0.001). PMPs and ErMPs were positively correlated to markers of hemolysis, serum ferritin, D‐dimer, vWF Ag, and aortic stiffness, whereas negatively correlated to hemoglobin level and aortic distensibility (P < 0.05). We suggest that increased MPs may be implicated in vascular dysfunction, pulmonary hypertension risk, and aortic wall stiffness observed in thalassemia patients. Their quantification could provide utility for early detection of cardiovascular abnormalities and monitoring the biological efficacy of chelation therapy.     

There's plenty of room at the forum: Potential risks and safety assessment of engineered nanomaterials

The celebrated physicist and Nobel laureate Richard Feynman was the first to predict the opportunities presented by the manipulation of matter at the level of individual atoms and molecules. Today, almost 50 years after his classic lecture on the wonders of the small world, the evolving nanotechnologies have the potential to bring about major changes in the lives of citizens. However, the very same properties that make engineered nanomaterials so promising from a technological perspective, such as their high degree of reactivity and the ability to cross biological barriers, could also make these novel materials harmful to human health and the environment. Therefore, exploitation of the full potential of the nanotechnologies requires close attention to safety issues. The 1st Nobel Forum mini-symposium on nanotoxicology was recently held in Stockholm, Sweden, and the program was devoted to the topic of definitions and standardization in nanotoxicological research, as well as nano-specific risk assessment and regulatory/legislative issues. Examples of recent and ongoing studies of carbon-based nanomaterials, including single-walled carbon nanotubes, using a wide range of in vitro and in vivo model systems were also presented. The current review will provide some highlights and conclusions from this exciting meeting.     

Targeting RhoA/ROCK pathway in pulmonary arterial hypertension

Introduction: Pulmonary arterial hypertension (PAH) is a rare disease with a complex pathogenesis. It is often associated with an increased vascular resistance, whilst in the more advanced stages there is a remodelling of the vascular walls. PAH has an intricate involvement of various signaling pathways, including the ras homolog family member A (RhoA)–Rho kinase (ROCK) axis. Currently, available therapies are not always able to significantly slow PAH progression. Therefore, newer approaches are needed.

Areas covered: In this review, areas covered include the role of the RhoA/ROCK in PAH pathogenesis and the plausibility of its therapeutic targeting. Furthermore, various inhibitory compounds are discussed, including Fasudil and SB-772077-B.

Expert opinion: Currently, specific RhoA/ROCK inhibition is the most promising therapeutic approach for PAH. Research has shown that it suppresses both the components of this axis and the upstream upregulating mediators. An inhaled RhoA/ROCK inhibitor may be a successful future therapy; however, further clinical trials are needed to support this approach.     

Impaired pulmonary function is a risk predictor for sudden cardiac death in men

Abstract

Objectives. Little is known about the association of reduced pulmonary function and the risk of sudden cardiac death (SCD). Our aim was to examine the relation of forced expiratory volume (FEV₁), forced vital capacity (FVC), and the ratio of FEV₁ to FVC with SCD in a population-based sample of men.

Methods. This study was based on 1250 men 42–60 years of age without chronic obstructive pulmonary disease, asthma, and lung cancer. During the 20-year follow-up, 95 SCDs occurred. FEV₁, FVC, and ratio of FEV₁ to FVC were used as lung function tests.

Results. As a continuous variable, each 10% increase in the percentage predicted FEV₁ was associated with 18% (adjusted risk 0.82, 95% CI 0.73–0.93, P < 0.002) reduced risk for SCD. Subjects with most reduced (lowest quintile) FEV₁ had a 3.5-fold increased risk for SCD (95% CI 1.42–8.41, P = 0.006), after adjustment for conventional risk factors. Similar results were observed with FVC. The results remained statistically significant among non-smokers and smokers respectively.

Conclusion. Our study shows that reduced lung function is a robust predictor of SCD in middle-aged men. Lung function test may be useful in risk stratification for SCD in general population.     

营养支持对慢性阻塞性肺疾病患者营养状况及疗效影响的研究

目的:探求营养支持对慢性阻塞性肺疾病患者营养状况及疗效影响。方法:将100例慢性阻塞性肺疾病患者随机分成两组,各50例,即营养组口服整蛋白营养液;对照组患者营养膳食由家属自行配制。在营养支持的治疗前及治疗后分别检测两组患者的淋巴细胞计数(TLC)、血清白蛋白(ALB)、血红蛋白(Hb)。结果:TLC、ALB、Hb在两组得到改善(P<0.05),与对照组相比,营养组TLC、ALB、Hb改善更明显,差异有统计学意义(P<0.05);治疗后两组PaO2均升高,PaCO2均降低,营养组改善更明显,差异有统计学意义(P<0.05);治疗后营养组临床总显效率高于对照组,差异有统计学意义(P<0.05)。结论:合理营养可以有效改善COPD患者高能量分解状态,保证充足的营养供给,缓解发热、感染、应激反应对能量的需求,促进疾病的转归,从而达到理想的治疗效果。