乙醛脱氢酶2在法舒地尔心肌保护作用中的机制

目的 探讨乙醛脱氢酶2(ALDH2)是否参与Rho激酶抑制剂法舒地尔的心肌保护作用,并分析其可能机制.方法 采用离体大鼠心脏,结扎冠状动脉左前降支30 min模拟局部心肌缺血,松开结扎线恢复灌流120 min复制心肌缺血/再灌注(I/R)模型.实验分4组:I/R组、法舒地尔组、ALDH2抑制剂氨基氰(CYA)组和法舒地尔+CYA(联合组)组.连续记录左心室动力学变化,再灌注期间收集冠脉流出液测定乳酸脱氢酶(LDH)含量;RT-PCR检测ALDH2mRNA表达以及Bcl-2/Bax比值的变化.结果 与I/R组比,法舒地尔组明显促进了左室发展压、左心室内压最大上升和下降速率、左心室做功的恢复,降低复灌期冠脉流出液中LDH的释放,ALDH2 mRNA表达增加,Bcl-2/Bax比值增高.ALDH2抑制剂CYA明显减弱法舒地尔的作用,抑制了心室动力学指标的恢复,LDH释放增多,ALDH2mRNA表达降低,Bcl-2/Bax比值降低.结论 法舒地尔抑制Rho激酶信号通路发挥心肌保护作用,其机制可能与激动ALDH2、抑制凋亡发生有关.     

葡萄糖酸镁对离体大鼠心肌缺血/再灌注细胞凋亡的影响及机制

目的:观察葡萄糖酸镁对离体大鼠心肌缺血/再灌注(I/R)损伤的保护作用及可能机制。方法:将48只大鼠等分为对照组、I/R组、葡萄糖酸镁组。实验1:每组取8只大鼠,对照组用改良的K-H液持续灌注110min;I/R组用改良的K-H液灌流20min后,停灌30min,再灌注60min;葡萄糖酸镁组在改良的K-H液中加入葡萄糖酸镁2.4mmol/L,余同I/R组。检测心肌灌流液中肌酸激酶(CK),乳酸脱氢酶(LDH)含量,心肌组织中总超氧化物歧化酶(T-SOD)、丙二醛(MDA)含量。实验2:每组8只大鼠,实验过程基本与实验1相同,仅将再灌注时间改为120min,检测心肌细胞凋亡指数(AI)。观察实验1、2合组再灌注心律失常发生情况。结果:葡萄糖酸镁组与I/R组相比,室性心律失常发生率显著下降(VT:43.8%对100.0%,VF:12.5%对75.0%,P<0.01);再灌流出液中CK、LDH含量显著降低[CK:(121.76±0.75)U/L对(132.33±1.73)U/L,LDH:(51.94±1.93)U/L对(62.73±2.18)U/L,P<0.01];心肌组织T-SOD活性显著升高[(49.12±0.54)NU/mg对(40.09±1.64)NU/mg,P<0.01];MDA含量、细胞凋亡指数显著降低[MDA:(3.05±0.19)μmol/g对(3.94±0.16)μmol/g,AI:(27.79±1.59)%对(33.61±2.10)%,P<0.01]。结论:葡萄糖酸镁对离体大鼠心肌I/R损伤具有保护作用,其机制可能与清除氧自由基、抗细胞凋亡有关。     

辛伐他汀缺血后处理对大鼠心肌缺血再灌注损伤的保护作用

目的探讨辛伐他汀缺血后处理对大鼠心肌缺血再灌注（I/R）损伤的保护作用及机制。方法采用Langendorff离体心脏灌流模型,将32只大鼠随机分为四组各8只。对照组用改良K-H缓冲液持续灌流;I/R组用改良K-H缓冲液稳定灌注、停灌、再灌;治疗组用改良K-H缓冲液稳定灌注、停灌后,在K-H缓冲液中加入辛伐他汀20μmol/L再灌;K-H缓冲液再灌;N-硝基-L-精氨酸甲酯（L-NAME）组用改良K-H缓冲液稳定灌注、停灌后,在K-H缓冲液中加入辛伐他汀20μmol/L、L-NAME 100μmol/L再灌,K-H缓冲液再灌。观察各组再灌注心律失常发生情况,检测其冠脉流出液中的肌酸激酶（CK）、乳酸脱氢酶（LDH）、NO,心肌组织总超氧化物歧化酶（T-SOD）活性、丙二醛（MDA）及细胞凋亡指数（AI）。结果与I/R组比较,治疗组心律失常发生率下降,CK、LDH、MDA及细胞AI降低,T-SOD活性、NO升高（P均〈0.01）;与治疗组比较,L-NAME组心律失常发生率升高,CK、LDH、MDA及细胞AI升高,T-SOD活性、NO降低（P均〈0.01）。结论辛伐他汀缺血后处理能减轻大鼠心肌I/R损伤,其作用机制与清除氧自由基、增加NO含量、减少心肌细胞凋亡有关。     

虎杖苷通过PKC对大鼠离体缺血再灌注心肌的保护作用

目的:研究虎杖苷(polydatin,PD)对大鼠离体缺血/再灌注(I/R)心肌的保护作用。方法:将40只SD大鼠随机分为4组,包括I/R组,PD(I/R+PD)组,虎杖苷+蛋白激酶C(PKC)阻断剂(I/R+PD+chelerythrine)组和PKC阻断剂(I/R+chelerythrine)组。采用Langendorff灌流法建立离体心肌I/R模型,缺血40 min,再灌注共40 min,分别测量再灌20 min以及再灌40 min时心功能和酶学指标包括:心率、左室收缩压(LVDP)、左室舒张末压(LVEDP)、心室内压最大变化速率(±dp/dtmax)及磷酸激酶(PK)、乳酸脱氢酶(LDH)浓度。结果:心肌I/R可引起心脏功能I/R+PD组±dp/dtmax的恢复率明显回升(P0.05),同时,LVEDP、LVDP等指标也有明显改善(P0.05),LDH、PK浓度在复灌20和40 min时明显低于I/R组(P0.05)。说明PD能部分抑制再灌注期PK和LDH的漏出。PD还能够显著提高I/R心肌的超氧化物歧化酶(SOD)水平,并且降低丙二醛(MDA)水平,发挥心肌保护作用。应用PKC抑制剂chelerythrine则可以消除PD的上述作用。结论:PD可能通过PKC蛋白信号转导通路对I/R心肌发挥保护作用。     

激活乙醛脱氢酶2抑制硝酸甘油耐受大鼠缺血再灌注心肌损伤

目的:探讨乙醛脱氢酶2（ALDH2）激动剂（Alda-1）对硝酸甘油耐受(NT)大鼠心肌缺血/再灌注损伤(MI/RI)的影响。方法: 24只成年雄性SD大鼠随机分为4组:Con组、Alda-1组、NT组和NT+Alda-1治疗组，每组6只(n=6)。经静脉给予硝酸甘油10 mg/(kg·day)处理7 d，建立NT大鼠模型，治疗组在硝酸甘油给药的第5天起，同时输注Alda-110 mg/(kg·day) 3 d。模型建立后，采用冠脉左前降支结扎缺血30 min再灌注4 h建立在体大鼠急性心肌缺血/再灌注(MI/R)模型。术中监测血流动力学指标，再灌结束后检测血清乳酸脱氢酶(LDH)并取心肌组织检测心肌梗死面积、蛋白质羰基化程度和心肌内活性氧簇(ROS)的水平。结果: 离体血管灌流显示，硝酸甘油连续处理7 d，可导致大鼠血管内皮依赖性和内皮非依赖性舒张能力显著降低，提示出现NT。定量检测心肌ALDH2的活性发现Alda-1可显著改善NT导致的心肌ALDH2活性抑制。在NT情况下，MI/RI较对照组显著加重，表现为心肌收缩舒张速率显著降低，血清LDH的水平显著增加，心肌梗死面积扩大（均P<0.05）。与NT组相比，采用Alda-1治疗，可显著改善NT组大鼠的MI/RI（均P<0.05）。并且，Alda-1治疗可显著抑制NT情况下缺血/再灌注心肌中蛋白质羰基化程度和ROS的含量。结论: 激活ALDH2可显著抑制NT导致的MI/RI加重，其机制可能与减轻心肌蛋白质氧化损伤有关。     

激活乙醛脱氢酶2抑制老年大鼠心肌缺血再灌注损伤

目的 衰老心肌对缺血/再灌注（I/R）损伤的耐受能力显著降低,导致老年心肌缺血易损性。本研究旨在探讨乙醛脱氢酶2（ALDH2）激动剂Alda-1对老年大鼠心肌I/R损伤的影响。方法 成年（3～4月龄,40只）和老年（22～24月龄,40只）雄性SD大鼠随机分为I/R组和I/R+Alda-1治疗组。采用冠状动脉左前降支结扎缺血30min再灌注4h建立在体大鼠急性心肌I/R模型,于再灌注前5min经静脉分别以2ml/（kg·h）速度分别输注生理盐水（0.9% NaCl）和Alda-1（16mg/kg）并持续到再灌注结束。于术中监测血流动力学指标,再灌注结束后取心肌组织检测ALDH2活性、蛋白质羰基化程度和心肌内活性氧簇（ROS）水平,抽取血样检测LDH水平。结果 检测心肌ALDH2活性显示,老年心肌ALDH2活性较成年组显著降低。与成年组相比,老年心肌缺血再灌注损伤显著加重,表现为心肌收缩舒张速率显著降低,血清乳酸脱氢酶（LDH）水平显著增加（均P＜0.05）。再灌注期Alda-1治疗可有效提高老年I/R心肌ALDH2活性（P＜0.05）,并显著抑制老年大鼠的上述心肌缺血再灌注损伤（均P＜0.05）。老年组I/R心肌中蛋白质羰基化程度和ROS生成较成年I/R心肌显著增加（均P＜0.05）。Alda-1治疗可有效改善老年I/R心肌中的蛋白质羰基化和ROS水平。结论 激活心肌ALDH2可显著改善衰老心肌抗I/R损伤能力,其机制可能与减轻I/R导致的蛋白质氧化损伤有关。     

不同浓度硝酸甘油对心脏缺血/再灌注的作用及ALDH2的作用

目的 探讨不同浓度硝酸甘油(GTN)对离体大鼠心脏缺血/再灌注损伤的作用,进一步分析线粒体乙醛脱氢酶2(ALDH2)在其中的作用.方法 采用离体大鼠心脏Langendorff灌流方法,局部结扎冠状动脉左前降支30 min,复灌30 min复制缺血/再灌注模型.实验分五组,正常对照组,单纯缺血/再灌注组,GTN低浓度组(10 -8 mol/L GTN),中浓度组(10-7 mol/L GTN)及高浓度组(2×10 -6 mol/L GTN).测定心室动力学指标和复灌期间冠脉流出液中乳酸脱氢酶( lactate dehydrogenase,LDH)含量,RT-PCR测定左心室前壁心尖组织线粒体ALDH2基因mRNA表达水平.结果 与单纯缺血/再灌注组相比,GTN低浓度组左心室发展压(LVDP)、室内压最大上升/下降速率(±dp/dtmax)均增高,左心室舒张末压(LVEDP)降低,中浓度组无明显差异,高浓度组LVDP和±dp/dtmax均降低;LVEDP增高.与缺血/再灌注组相比,正常对照组和低浓度GTN组心肌组织ALDH2 mRNA表达增高,中浓度无明显差异,高浓度组大鼠心肌ALDH2 mRNA表达降低.结论 低浓度GTN可对抗心肌缺血/再灌注损伤,高浓度GTN加重损伤,中浓度GTN对损伤影响不大,此现象可能与不同浓度GTN引起心肌ALDH2的释放量不同有关.     

葡萄糖酸镁对离体大鼠心肌缺血／再灌注细胞凋亡的影响及机制

目的:观察葡萄糖酸镁对离体大鼠心肌缺血/再灌注(I/R)损伤的保护作用及可能机制.方法:将48只大鼠等分为对照组、I/R组、葡萄糖酸镁组.实验1:每组取8只大鼠,对照组用改良的K-H液持续灌注110 min;I/R组用改良的K-H液灌流20 min后,停灌30 min,再灌注60 min;葡萄糖酸镁组在改良的K-H液中加入葡萄糖酸镁2.4 mmol/L,余同I/R组.检测心肌灌流液中肌酸激酶(CK),乳酸脱氢酶(LDH)含量,心肌组织中总超氧化物歧化酶(T-SOD)、丙二醛(MDA)含量.实验2:每组8只大鼠,实验过程基本与实验1相同,仅将再灌注时间改为120 min,检测心肌细胞凋亡指数(AI).观察实验1、2合组再灌注心律失常发生情况.结果:葡萄糖酸镁组与I/R组相比,室性心律失常发生率显著下降(VT:43.8%对100.0%,VF:12.5 %对75.0%,P<0.01);再灌流出液中CK、LDH含量显著降低[CK:(121.76±0.75)U/L对(132.33±1.73)U/L,LDH:(51.94±1.93)U/L对(62.73±2.18)U/L,P<0.01];心肌组织T-SOD活性显著升高[(49.12±0.54)NU/mg对(40.09±1.64)NU/mg,P<0.01];MDA含量、细胞凋亡指数显著降低[MDA:(3.05±0.19)μmol/g对(3.94±0.16)μmol/g,AI:(27.79±1.59)%对(33.61±2.10)%,P<0.01].结论:葡萄糖酸镁对离体大鼠心肌I/R损伤具有保护作用,其机制可能与清除氧自由基、抗细胞凋亡有关.     

激活乙醛脱氢酶2抑制糖尿病小鼠心肌羰基应激和缺血/再灌注损伤

目的:观察乙醛脱氢酶2(ALDH2)激动剂Alda-1对Ⅰ型糖尿病(DM)小鼠心肌缺血/再灌注(I/R)损伤的影响,探讨羰基应激在DM心脏缺血性损伤易感性增高中的作用。方法:以C57BL/6雄性小鼠为实验对象,腹腔注射链脲佐菌素(STZ)制备Ⅰ型DM小鼠模型。将正常C57BL/6小鼠(20只)和DM小鼠(20只)随机分为I/R组和I/R+Alda-1治疗组,每组10只。采用冠状动脉左前降支结扎缺血30 min再灌注4 h建立在体小鼠急性心肌I/R模型,于再灌注前5 min经静脉以2 ml/(kg·h)速度分别输注生理盐水(NS)或Alda-1(16 mg/kg)并持续到再灌注结束。再灌注结束后取血检测血清乳酸脱氢酶(LDH)水平,取心肌组织检测ALDH2活性、心肌内活性氧簇(ROS)水平,蛋白羰基化程度和心肌梗死(MI)面积。结果:检测心肌ALDH2活性显示,DM小鼠心肌ALDH2活性较对照组显著降低。与对照组相比,DM小鼠心肌I/R损伤显著加重,表现为MI面积增大,血清LDH水平显著增加(均P0.05)。再灌注期Alda-1治疗可有效提高DM小鼠I/R心肌ALDH2活性(P0.05),并显著抑制DM小鼠的上述心肌I/R损伤(均P0.05)。DM组I/R心肌中蛋白质羰基化程度和ROS生成较对照组I/R心肌显著增加(均P0.05)。Alda-1治疗可有效改善DM小鼠I/R心肌中的蛋白质羰基化和ROS水平。结论:激活心肌ALDH2可显著改善DM小鼠心肌抗I/R损伤能力,其机制可能与减轻DM小鼠在I/R过程中导致的蛋白质氧化损伤有关。     

酸性复灌液对再灌注未成熟心肌细胞线粒体功能的影响

目的:观察酸性复灌液对未成熟心肌细胞线粒体功能的作用。方法:采用兔Langendorff离体心脏灌注模型,分为缺血/再灌组(I/R组,8只)和酸性灌注组(E组,8只)。I/R组灌流20min后缺血60min,用pH7.4HEPES-KH液恢复灌注100min;E组pH 7.4HEPES-KH液灌流20min后缺血60min,用pH 6.8、pH 7.1和pH 7.4HEPES-KH液依次灌注5min、5min和90min。测定心肌组织ATP含量、心肌细胞内和心肌线粒体Ca2+含量、心肌线粒体Ca2+-ATPase活性、心肌线粒体合成ATP能力[ATP]m、心肌线粒体超微结构。结果:与I/R组相比,E组ATP含量、心肌线粒体Ca2+-ATPase活性和[ATP]m均优于I/R组(均P0.01),心肌细胞内和心肌线粒体Ca2+含量均低于I/R组(均P0.01),E组线粒体结构损伤较I/R组明显减轻。结论:梯度酸性复灌液对离体未成熟心肌细胞线粒体功能具有明显保护作用。     

Pulmonary injury from transfusion-related acute lung injury

Transfusion-related acute lung injury (TRALI) can be a life-threatening complication of transfusion. In its severe form, it is clinically indistinguishable from acute respiratory distress syndrome. Symptoms typically begin within 4 hours of transfusion. TRALI has been reported after transfusion of all plasma-containing blood components. TRALI is associated with antibodies to white blood cells and biologically active lipids in trans-fused blood components.     

Reperfusion injury

This article reviews the early and late morphologic changes associated with reperfusion of ischemic myocardium. If instituted within minutes of coronary artery occlusion, all reversibly injured myocardium is salvaged. Once some irreversibly injured myocardium is present, the usually bland region of coagulation necrosis is transformed into an edematous, hemorrhagic zone with "contraction-band" necrosis and vascular obstruction (no-reflow phenomenon). Whether or not these changes occur in otherwise salvageable myocardium is controversial. Data from studies with conflicting results are presented. Popular proposed mechanisms of reperfusion injury include the no-reflow phenomenon and free radical-mediated injury. No reflow has been related to direct vascular injury, compression of capillaries by edema fluid, and obstruction of vascular channels by leukocytes. Free radicals, which inactivate enzymes and destroy membranes, are primarily oxygen derived, and produced by neutrophils, endothelial cells, and myocardial cells. Whether or not reperfusion injury exists is still debated; if it does, the mechanism of injury remains to be proven. Ongoing research in this field will augment our knowledge of cell death and interventions to delay or prevent it.     

Ballistic injury

Wound profiles made under controlled conditions in the wound ballistics laboratory at the Letterman Army Institute of Research showed the location along their tissue path at which projectiles cause tissue disruption and the type of disruption (crush from direct contact with the projectile or stretch from temporary cavitation). Comparison of wound profiles showed the fallacy in attempting to judge wound severity using velocity alone, and laid to rest the common belief that in treating a wound caused by a high-velocity missile, one needs to excise tissue far in excess of that which appears damaged. All penetrating projectile wounds, whether civilian or military, therefore should be treated the same regardless of projectile velocity. Diagnosis of the approximate amount and location of tissue disruption is made by physical examination and appropriate radiographic studies. These wounds are contaminated, and coverage with a penicillin-type antibiotic should be provided.     

Spinal-cord injury

More than a decade ago, spinal-cord injury meant confinement to a wheelchair and a lifetime of medical comorbidity. The physician's armamentarium of treatments was very limited, and provision of care for individuals with spinal-cord injury was usually met with frustration. Advances in the neurosciences have drawn attention to research into spinal-cord injury. Nowadays, advanced interventions provide high hope for regeneration and functional restoration. As scientific advances become more frequent, scepticism is giving way to the ideas that spinal-cord injury will eventually be repairable and that strategies to restore function are within our grasp. We address the present understanding of spinal-cord injury, its cause, pathophysiology, diagnosis, and treatment, and look at promising research avenues. We also discuss new treatment options, including functional electric stimulation and part-weight-supported walking.     

Near-hanging injury

Near-hanging injury results in multisystem insult and injury. Acute or delayed respiratory complications can result in death. A survivor can suffer neuropsychiatric sequelae ranging from amnesia to a prolonged vegetative state. Treatment is directed toward ensuring cerebral oxygenation, lowering increased intracranial pressure, and treating respiratory distress. Psychiatric consultation will be necessary in long-term survivors. Patients should be observed for at least 24 hours after a near-hanging injury.     

Mild head injury, anticoagulants, and risk of intracranial injury

We studied intracranial damage in patients with mild head injuries who were taking warfarin. Of the 215,785 individuals who visited the Mount Auburn and Beth Israel accident and emergency departments during our study, we identified records for 144 patients by anticoagulation status and computed tomography (CT) imaging. We retrospectively reviewed these patients and ten (7%, 95% CI 3-11) with clinically important injuries on cranial CT. Our findings suggest that patients with head injuries who receive anticoagulants have a similar or greater risk of intracranlal injury to those falling into a previously defined moderate-risk category, invalidating a previous conclusion that CT scanning is unnecessary in such patients.