二维与三维超声心动图斑点追踪技术检测乳腺癌蒽环类药物心脏毒性的可行性研究北大核心

目的:探讨二维与三维斑点追踪技术以及实时三维超声心动图在早期检测蒽环类药物所致心脏毒性中的价值,并评估其可行性。方法:对乳腺癌患者于蒽环类药物化疗前、化疗第3周期及化疗结束后行超声心动图检查,以3D LVEF结果为评价标准,统计分析各参数在评估心脏毒性中的临床价值。结果:共92例乳腺癌患者纳入研究。常规超声心动图以及2D GLS的可行性均较好,而RT-3DE及3D-STI在化疗前时可行性欠佳,在化疗中以及结束后可行性进一步降低;2D LVEF在不同化疗周期间差异均无统计学意义;2D GLS、3D GLS、3D GRS以及3D GAS自第3周期结束后明显降低,并持续到化疗结束后;E/A、3D LVEF以及3D GCS在化疗结束后明显降低;ROC曲线显示3D GAS对蒽环类药物心脏毒性的诊断效能最高,截断值为-30.8%,敏感度、特异度分别为79%、92%。结论:3D-STI可以早期识别蒽环类药物所致的亚临床心功能不全,然而在部分乳腺癌患者中其可行性欠佳,临床应用受到了限制。对于这类患者,2D GLS可以作为可靠的补充数据,能够提供比2D LVEF更准确的信息。     

Cardioprotective effects of rutin in rats exposed to pirarubicin toxicity

We established both an acute and chronic cardiac toxicity rat model, which showed pretreatment with rutin attenuated pirarubicin-induced myocardial histopathological injury, electrocardiogram abnormalities, and cardiac dysfunction. Rutin also significantly reduced serum levels of MDA, BNP, CK-MB, CTnT, and LDH and increased serum SOD levels. Treatment with rutin and dexrazoxane resulted in an increase in Bcl-2/Bax ratio (p < 0.05) and reduction in JNK and Caspase-3 protein levels, compared to the pirarubicin group (all p < 0.05). Furthermore, rutin at a dose of 50 mg/kg significantly attenuated the above-mentioned alterations. Our study suggests the antioxidant and anti-apoptotic properties of rutin may be responsible for the cardioprotective effects observed.     

Advances in nano-delivery systems for doxorubicin: an updated insight

Doxorubicin (DOX) is the most effective chemotherapeutic drug developed against broad range of cancers such as solid tumours, transplantable leukemias and lymphomas. Conventional DOX-induced cardiotoxicity has limited its use. FDA approved drugs i.e. non-pegylated liposomal (Myocet^®) and pegylated liposomal (Doxil^®) formulations have no doubt shown comparatively reduced cardiotoxicity, but has raised new toxicity issues. The entrapment of DOX in biocompatible, biodegradable and safe nano delivery systems can prevent its degradation in circulation minimising its toxicity with increased half-life, enhanced pharmacokinetic profile leading to improved patient compliance. In addition, nano delivery systems can actively and passively target the tumour resulting increase in therapeutic index and decreased side effects of drug. Foreseeing the need of a comprehensive review on DOX nanoformulations, in this article we for the first time have given an updated insight on DOX nano delivery systems.     

Treatment of poisoning induced cardiac impairment using cardiopulmonary bypass: a review

Severe poisoning can cause potentially fatal cardiac depression. Cardiopulmonary bypass (CPB) can support the depressed myocardium, but there are no clear indications or guidelines available on its use in severe poisoning. A review was conducted of relevant papers in the available literature (seven single case reports of both deliberate and accidental ingestion of cardiotoxic drugs and two animal studies). Although CPB is rarely used in the management of poisoning, it may have potential benefits for haemodynamic instability not responding to conventional measures. At present there is insufficient evidence concerning the use of CPB as a treatment for severe cardiac impairment due to poisoning (grade C). This review suggests that in patients with severe and potentially prolonged reversible cardiotoxicity there is potential for full survival with CPB, provided that the patient has not already sustained hypoxic cerebral damage due to resistant hypotension prior to its use.     

自动心肌运动定量技术评价蒽环类药物致白血病儿童心脏毒性的价值

目的：探讨自动心肌运动定量（aCMQ）技术评价急性淋巴细胞白血病（ALL）儿童使用蒽环类药物化疗后亚临床左室功能损害的价值。方法：选取2021年11月至2022年1月在温州医科大学附属第二医院育英儿童医院采用DVLD方案诱导化疗的30例ALL患儿作为白血病组,在化疗前和化疗3个月后行超声心动图检查。同期选取性别匹配的26例健康者作为对照组。运用常规超声心动图获取左室射血分数（LVEF）、左室短轴缩短率（LVFS）、二尖瓣口舒张早期峰值流速（E）与晚期最大峰值流速（A）比值（E/A）、E与二尖瓣环舒张早期血流峰值（e’）比值（E/e’）、e’与二尖瓣环舒张晚期血流峰值（a’）比值e’/a’。运用aCMQ技术获得两腔心纵向应变（AP2LS）、三腔心纵向应变（AP3LS）、四腔心纵向应变（AP4LS）及整体纵向应变（LVGLS）,左室短轴基底段环向应变（SAXBCS）、左室短轴中间段环向应变（SAXMCS）、左室短轴心尖段环向应变（SAXACS）及整体环向应变（LVGCS）,并进行比较分析。结果：白血病组与对照组年龄差异无统计学意义（P ＞0.05）;对照组、化疗前组及化疗后组LVEF、LVFS、E/A、E/e’、e’/a’差异无统计学意义（P ＞0.05）,化疗前组AP4LS、AP3LS、AP2LS、GLS、SAXBCS、SAXMCS、SAXACS及GCS值与对照组比较,差异无统计学意义（均P ＞0.05）;化疗后组SAXBCS、SAXMCS值与化疗前和对照组比较,差异无统计学意义（P ＞0.05）;化疗后组AP4LS、AP3LS、AP2LS、GLS、SAXACS及GCS参数绝对值低于对照组和化疗前组,差异有统计学意义（P ＜0.05）。结论：aCMQ技术能早期发现儿童ALL蒽环类药物化疗所致亚临床左室功能损害,可作为一种评估左室收缩功能相对准确的方法。     

附子水提物单次给药对小鼠心脏“量-时-毒”关系研究

目的: 通过心电图变化和血清生化指标的改变,研究附子水提物单次给药对正常小鼠心脏“量-毒”和“时-毒”关系的影响。 方法: 根据给药剂量和药后不同时间点对小鼠分组,单次灌胃给予一定剂量的附子水提物,观察给药前后小鼠ECG的变化,计算心、肝、肾的脏器指数,并检测血清中肌酸激酶(CK)、乳酸脱氢酶(LDH)、B-型脑钠肽(BNP)和肌钙蛋白(CTn-I)的水平。 结果: “时-毒”关系研究表明:给小鼠灌胃一定剂量附子水提物5 min后,小鼠心率开始升高,60 min达到峰值后逐渐降低;QRS间期、R波幅度、T波时间和幅度、QT间期从药后5 min开始降低,60 min达到最低值后逐渐升高;血中CK,LDH,BNP和CTn-I从药后5 min开始升高,60 min达到峰值;各时间点小鼠脏体比值无显著变化。“量-毒”关系研究表明:随着单次给药剂量的逐渐增大,小鼠的心率逐渐升高,心电图QRS间期、T波时间和幅度、QT间期逐渐减小,小鼠血清CK,LDH,BNP和CTn-I水平也逐渐升高,均呈现一定的剂量依赖性;各剂量组小鼠脏体比值无显著变化。 结论: 小鼠于不同剂量和不同时间点单次灌胃给予一定剂量的附子水提物可造成不同程度的心脏损伤,并呈现一定的“量-时-毒”关系,其毒性峰效应时间点出现在药后60 min。     

Establishing Normal Values

In acute epiglottitis, x-ray examination may circumvent any difficulty in visualizing the airway by direct inspection because of gross obstruction or an uncooperative patient. A lateral film of the soft tissues of the neck is diagnostically useful in evaluating the severity of obstruction and the indication for tracheotomy. Simultaneous cineradiography or video tape recording enhances its diagnostic value.