用于心室辅助装置血流动力学性能评价的体外模拟循环系统技术进展

体外模拟循环系统(mock circulatory systems,MCS)是一个模拟人体循环系统血流动力学状态的试验平台,被广泛用于心室辅助装置和人工瓣膜等心血管人工器官的体外性能评价和生机电系统中的血流动力学响应研究。通过调整模拟心脏的驱动元件和模拟血管系统的集中参数元件,MCS可以模拟人体健康、运动、心力衰竭等不同生理状态的血流动力学特性。自1960年代至今,MCS研发目标从满足最基本的心室辅助装置或机械瓣膜的系统性能评价要求,已发展到能够复现局部重要器官的血流动力学状态。总结MCS目前的设计原则、系统搭建以及研究进展和未来展望。     

完全磁悬浮心室辅助装置的体外模拟循环系统实验研究

目的研究我国自主研发的第3代完全磁悬浮心室辅助装置(CH-VAD)对于心衰患者的循环辅助效果。方法建立一套体外模拟循环系统(mock circulatory system,MCS)。该系统能够模拟人体健康休息状态以及心力衰竭状态,并与CH-VAD协同工作,测试CH-VAD在连续流状态下的辅助效果。另外,对CH-VAD的搏动流控制方法进行测试,该模式采用正弦波速度波形,使CH-VAD的运行与MCS心室周期同步。结果 CH-VAD在正常连续流状态下能够使心衰状态的血流动力学参数(动脉压、心排量)恢复到正常范围。初步的搏动流测试结果显示,当前的速度搏动幅值对血流动力学影响较小,搏动流状态下与连续流状态所对应的平均动脉压、动脉脉压、平均心排量与心排量波形等差异不大。结论 CH-VAD能够通过搏动控制器产生一定程度的速度搏动,提供足够的心室辅助,并可以进一步改良优化,提供符合生理条件的搏动血流。所研制的MCS能够提供心室辅助装置以及其他机械循环辅助装置一个有效、可控的体外测试平台,是机械循环辅助装置设计、优化和验证的重要工具。     

听力辅助装置技术的最新进展和展望

听力辅助装置的技术近年来发展很快.本文简要地介绍了目前听力辅助装置的原理及其分类,之后从语音信号处理、自激噪声抵消、语音增强技术等几个方面较为详细的介绍了近年来在该领域取得的主要技术进展,最后对听力辅助装置今后的发展进行了展望.     

心室辅助装置的内皮化

由于供心的短缺及心脏移植的长期生存率并不理想，长期心室辅助成为终末期心衰病人的最好选择。然而，血栓栓塞仍然是长期心室辅助最主要的并发症之一。如何控制长期辅助循环过程中血液的激活，提高辅助循环装置的生物相容性是辅助循环装置发展需要解决的重要课题。本对心室辅助装置内皮化的提出、目前进展、理论基础、方法及其存在的问题作一综述。     

心室辅助装置的现状及问题

心室辅助装置是用来部分或全部替代心脏的泵血功能，维持良好全身循环状态的机械装置，在近３０年间得到了巨大的发展。本文简介了心室辅助装置的发展历史，主要介绍了心室辅助装置设计中的问题，现有装置的结构和类型及存在的溶血和血栓形成问题。     

心室辅助装置的内皮化

由于供心的短缺及心脏移植的长期生存率并不理想 ,长期心室辅助成为终末期心衰病人的最好选择。然而 ,血栓栓塞仍然是长期心室辅助最主要的并发症之一。如何控制长期辅助循环过程中血液的激活 ,提高辅助循环装置的生物相容性是辅助循环装置发展需要解决的重要课题。本文对心室辅助装置内皮化的提出、目前进展、理论基础、方法及其存在的问题作一综述     

轴流式心脏辅助装置及其发展现状

心脏移植术中心脏供体的供需矛盾很突出,解决这个问题的主要手段是采用心室辅助装置做移植桥梁过渡.现在国际上应用最广的心室辅助装置是轴流式心室辅助装置,本文主要介绍目前国际上应用于临床的轴流式心脏辅助装置的临床效果和处于开发阶段的轴流式心脏辅助装置的实验结果.     

心室辅助装置的现状及问题

心室辅助装置是用来部分或全部替代心脏的泵血功能、维持良好全身循环状态的机械装置，在近３０年间得到了巨大的发展。本文简介了心室辅助装置的发展历史，主要介绍了心室辅助装置设计中的问题、现有装置的结构和类型及存在的溶血和血栓形成问题     

植入式左心辅助装置

到九十年代以后，非植入式左心辅助装置已逐渐发展成为植入式，且气能驱动已由电能驱动所代替。本文简介了左心辅助装置的发展状况，主要介绍了植入式左心辅助装置的结构及特点、材料及其处理、植入方式和目前存在的问题。     

植入式左心辅助装置

到九十年代以后，非植入式左心辅助装置已逐渐发展成为植入式，且气能驱动已由电能驱动所代替。本文简介了左心辅助装置的发展状况，主要介绍了植入式左心辅助装置的结构及特点、材料及其处理、植入方式和目前存在的问题。     

心脏建模仿真研究进展

本文综述了近年来国际上在不同层次上心脏建模仿真的研究成果和进展 ,分别介绍了亚细胞和细胞层次、组织和器官层次上的心脏电生理模型、机械力学模型和生物化学模型。最后 ,简要地分析了心脏建模存在的问题并展望了心脏建模仿真领域今后的发展趋势     

The developing heart and congenital heart defects: a make or break situation

Congenital heart defects are common in humans, but the underlying basis for these defects is not well understood. It has been clear that abnormal heart development is at the root of these diseases, but the genes involved have remained elusive until recently. This review focuses on recent advances in our understanding of mammalian heart formation, and how some of these processes, when disrupted, lead to congenital heart defects.     

Recent progress in the molecular genetics of congenital heart defects

Congenital heart defects (CHD) constitute the single most common anatomic class of birth defects and are a major cause of infant mortality. Correlation of normal and pathological embryology/anatomy has led to the formulation of mechanistic models, but there is limited understanding of the genetic basis for the inferred embryological processes. Most evidence points to extensive etiologic heterogeneity and a re-evaluation of simple multifactorial models is required. The recent identification of several genes responsible for congenital heart defects in the context of more complex clinical disorders provides significant entry points for the genetic analysis of human heart development. The association of aneusomies (particularly microdeletion syndromes) with specific cardiac lesions provides further strong support for mechanistic classification. Studies in the mouse are laying the groundwork for a comprehensive genetic model of cardiac organogenesis. Nevertheless, the basis for the large majority of CHD, especially isolated defects, remains obscure. Dissection of the genetic components of CHD is one of the greatest challenges in medical genetics for the coming decades.     

硫化氢在心力衰竭干预中的作用

目前临床上对心力衰竭的防治还没有较好的策略。H2S是一种具有多种生理学功能的内源性气体信号分子,且具有心肌保护功能。H2S对动脉粥样硬化、心肌肥大、氧化应激和同型半胱氨酸的影响,以及它在心力衰竭中的作用越来越受到人们的关注。     

先心病中microRNA对DNA甲基化的调控及其应用前景

正先天性心脏病是最常见的出生缺陷,在活产婴儿中的总体发病率为0.8%~[1],居非感染原因死亡率第1位。先心病发病机制至今仍未完全阐明,目前认为主要是由于遗产因素、环境因素单独或者共同作用导致的。近年来,表观遗传学在先心病中的作用越来越被人们所认识。表观遗传学是指在DNA序列不变的情况下,可决定基因表达与否并可稳定遗传下去的调控方式,包括DNA甲基化、非编码RNA、基因组印记、染色质组蛋白修饰等。DNA甲基     

组织工程心脏瓣膜细胞生物学研究进展

由于现有的机械瓣和生物瓣仍存在种种不足，如不具备生长性、需抗凝、易感染、不能生长和自我修复等。组织工程心脏瓣膜是一新兴的研究领域，涉及多门学科。构建组织工程心脏瓣膜应包括支架的制作、细胞的种植、瓣膜的体外培养和最终移植人人体。其中种植的细胞是组织工程心脏瓣膜的基本要素。就组织工程心脏瓣膜的细胞生物学研究进展做一综述。     

Immunological Aspects of the Statins＇ Function in Patients with Heart Failure： A Report from the Annual Conference of ESC Heart Failure 2005

The annual meeting of the Heart Failure Association of ESC in Lisbon, in June 2005, was exceptionally successful. There were many very interesting presentations and workshops with the unique rifle： Statins in heart failureCholesterol-lowering is not the only goal. Heart failure （HF） is a progressive disease with coronary artery disease （CAD） as the most often underlying etiology. Treatment to prevent progression of heart failure has been targeted to reverse the consequences of HF and to a less extent the cause - the atherosclerotic plaque itself. On the average 50% of patients with heart failure are treated with lipid intervention. Lipid-lowering treatment with statins clearly reduces morbidity and mortality of patients with documented CAD. Since the prevalent etiology of heart failure is CAD, its prevention may reduce heart failure progression. However, recent studies suggest that pleiotropic effects of statins are more important than the influence related to their cholesterol lowering mechanism. Furthermore it is suggested that low levels of circulating lipoproteins and cholesterol may be independent predictors of impaired outcome in patients with heart failure. There are some possible explanations for this finding. High levels of cholesterol can be beneficial to heart failure patients; cholesterol-rich serum lipoproteins are able to modulate inflammatory immune function because they bind and detoxify bacterial lipopolysaccharide, a very strong stimulator of the release of proinflammatory cytokines that promote heart failure progression and death. So current recommendations strongly emphasize that the aim of treatment of HF is not to lower cholesterol. Cellular ＆ Molecular Immunology. 2005;2（6）：433-437.     

Plasmalemmal fatty acid transport is regulated in heart and skeletal muscle by contraction,insulin and leptin,and in obesity and diabetes

It has been assumed that the uptake of long chain fatty acids (LCFAs) into skeletal muscle and the heart muscle, as well as other tissues, occurred via passive diffusion. In recent years our work has shown that the LCFA uptake into skeletal muscle is a highly regulated process. The use of giant sarcolemmal vesicles obtained from skeletal muscle and heart has been used to demonstrate that LCFA uptake into these tissues occurs via a protein‐mediated mechanism involving the 40 kDa plasma membrane associated fatty acid binding protein (FABPpm) and the 88 kDa fatty acid translocase, the homologue of human CD36 (FAT/CD36). Both are ubiquitously expressed proteins and correlate with LCFA uptake into heart and muscle, consistent with the known differences in LCFA metabolism in these tissues. It has recently been found that FAT/CD36 is present in an intracellular (endosomal) compartment from which it can be translocated to the plasma membrane within minutes by muscle contraction and by insulin, to stimulate LCFA uptake. In rodent models of obesity and type 1 diabetes LCFA uptake into heart and muscle is also increased, either by permanently relocating FAT/CD36 to the plasma membrane without altering its expression (obesity) or by increasing the expression of both FAT/CD36 and FABPpm (type 1 diabetes). Chronic leptin treatment decreases LCFA transporters and transport in muscle. Clearly, recent evidence has established that LCFA uptake into heart and muscle is regulated acutely and chronically.     

机械瓣的空化研究进展

综述了近年来机械瓣空化的研究状况，讨论了有关研究方法，总结了机械瓣空化的研究成果，指出了机械瓣空化研究趋势。     

高血压性心脏病与心室晚电位关系探讨

近年研究结果表明心室晚电位能预测心脏病患者的恶性心律失常的发生,对预防心脏性猝死有重要价值。高血压性心脏病患者易发生恶性心律失常及心脏性猝死。我们用体表信号平均心电图对140例高血压性心脏病患者进行测定,38例患者阳性,阳性率27.14％。40例单纯高血压患者阳性率5％。30例正常健康人阳性率3.33％。表明只有高血压性心脏病患者阳性率显著增加(P<0.01)。这部分患者应视为高危人群,给予医学的干预,延长患者寿命。