Therapy of the Failing Heart

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Cell-sheet Therapy With Omentopexy Promotes Arteriogenesis and Improves Coronary Circulation Physiology in Failing Heart

Cell-sheet transplantation induces angiogenesis for chronic myocardial infarction (MI), though insufficient capillary maturation and paucity of arteriogenesis may limit its therapeutic effects. Omentum has been used clinically to promote revascularization and healing of ischemic tissues. We hypothesized that cell-sheet transplantation covered with an omentum-flap would effectively establish mature blood vessels and improve coronary microcirculation physiology, enhancing the therapeutic effects of cell-sheet therapy. Rats were divided into four groups after coronary ligation; skeletal myoblast cell-sheet plus omentum-flap (combined), cell-sheet only, omentum-flap only, and sham operation. At 4 weeks after the treatment, the combined group showed attenuated cardiac hypertrophy and fibrosis, and a greater amount of functionally (CD31⁺/lectin⁺) and structurally (CD31⁺/α-SMA⁺) mature blood vessels, along with myocardial upregulation of relevant genes. Synchrotron-based microangiography revealed that the combined procedure increased vascularization in resistance arterial vessels with better dilatory responses to endothelium-dependent agents. Serial ¹³N-ammonia PET showed better global coronary flow reserve in the combined group, mainly attributed to improvement in the basal left ventricle. Consequently, the combined group had sustained improvements in cardiac function parameters and better functional capacity. Cell-sheet transplantation with an omentum-flap better promoted arteriogenesis and improved coronary microcirculation physiology in ischemic myocardium, leading to potent functional recovery in the failing heart.     

受磷蛋白在心力衰竭中的作用

Ca^2＋从胞质中的快速转移,是心肌细胞有效舒缩所必需的生理过程,由心肌肌浆网钙泵（sarco—plasmicreticulum Ca^2＋ATPase,SERCA2a）完成这一生理变化,而受磷蛋白（phospholamban,PLB）是对SERCA2a直接发挥调节作用的钙调节蛋白。     

Urocortin 2 Gene Transfer Improves Heart Function in Aged Mice

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Cardiac I-1c Overexpression With Reengineered AAV Improves Cardiac Function in Swine Ischemic Heart Failure

Cardiac gene therapy has emerged as a promising option to treat advanced heart failure (HF). Advances in molecular biology and gene targeting approaches are offering further novel options for genetic manipulation of the cardiovascular system. The aim of this study was to improve cardiac function in chronic HF by overexpressing constitutively active inhibitor-1 (I-1c) using a novel cardiotropic vector generated by capsid reengineering of adeno-associated virus (BNP116). One month after a large anterior myocardial infarction, 20 Yorkshire pigs randomly received intracoronary injection of either high-dose BNP116.I-1c (1.0 × 10¹³ vector genomes (vg), n = 7), low-dose BNP116.I-1c (3.0 × 10¹² vg, n = 7), or saline (n = 6). Compared to baseline, mean left ventricular ejection fraction increased by 5.7% in the high-dose group, and by 5.2% in the low-dose group, whereas it decreased by 7% in the saline group. Additionally, preload-recruitable stroke work obtained from pressure–volume analysis demonstrated significantly higher cardiac performance in the high-dose group. Likewise, other hemodynamic parameters, including stroke volume and contractility index indicated improved cardiac function after the I-1c gene transfer. Furthermore, BNP116 showed a favorable gene expression pattern for targeting the heart. In summary, I-1c overexpression using BNP116 improves cardiac function in a clinically relevant model of ischemic HF.     

右室流出道起搏对心功能影响的Meta分析

目的 系统评价右室流出道起搏对心功能的影响。 方法 计算机检索Cochrane 图书馆（2008 年第4 期）、PubMed、EMbase,同时检索CBM、CNKI、VIP 和万方数据库,检索时间截至2010 年1 月,收集右室流出道（RVOT）起搏与右室心尖部（RVA）起搏比较对心功能影响的随机对照试验（RCT）,并按Cochrane 协作网推荐的方法进行质量评价、资料提取和Meta 分析。 结果 共纳入16 个RCT,包括926 例患者。Meta 分析结果显示：①左室射血分数：RVOT 组在3 个月和18 个月的左室射血分数均高于RVA 组,差异有统计学意义［WMD= 3.53,95%CI（1.02,6.04）;WMD= 8.94,95%CI（7.35,10.52）］。② QRS 波时限：术后即时RVOT 组和RVA 组相比,QRS波时限有所减小,差异有统计学意义［WMD= –22.42,95%CI（–31.05,–13.80）］,然而3 个月后差异无统计学意义［WMD= –13.88,95%CI（–29.75,2.00）］。③ 起搏参数：RVOT 组在术后即时的起搏阈值（V）高于RVA 组,而3 个月后,与RVA 组无差别。在感知阈值和阻抗方面,即时和术后3 个月时两者之间均无差异。 结论 相对于心尖部起搏,虽然短期内右室流出道起搏可以提高心脏功能,但长期结果仍有待于观察。限于目前研究对右室流出道起搏的长期结果报道不足,仍然需要大样本、多中心随机对照试验进一步证实右室流出道起搏的优越性。     

风湿性瓣膜病的右室舒张功能研究

本文采用2—DE和彩色多普勒超声心动图(CDFI)对30例风湿性瓣膜病患者与30例正常人的三尖瓣血流频谱参数进行估测及对照。其中二尖瓣狭窄(MS)行气囊扩张术11例,未行气囊扩张术19例,有三尖瓣返流(TR)16例,无TR14例。结果显示:风心病组三尖瓣血流参数VA、VE、VA/VE、Aanea、Earea、Aarea/Earea均高于正常组;MS行二尖瓣气囊扩张术后右室舒张功能有一定改善;三尖瓣的VA、VE和左房内径、病程长短、瓣口面积相关。     

氯沙坦对充血性心力衰竭心功能及部分神经内分泌激素的影响

目的 :探讨血管紧张素Ⅱ受体拮抗剂氯沙坦 (Losartan ,商品名 :科素亚 )抗心力衰竭疗效 ,及对充血性心力衰竭患者血浆部分神经内分泌激素的影响。方法 :33例患者 ,服用氯沙坦 2 5～ 5 0mg/d ,治疗 12周 ,观察其治疗前后神经内分泌激素的影响和治疗前后血浆肾素活性 (PRA)、血管紧张素Ⅱ (AngⅡ )、去甲肾上腺素 (NE)、肾上腺素(E)、内皮素 (ET)、一氧化氮 (NO)水平及心功能改变情况。结果 :3例患者心功能得到明显改善 ,血浆PRA、AngⅡ、NE、ET水平均显著下降 ,NO水平升高。结论 :血管紧张素Ⅱ拮抗剂不仅能抑制肾素 血管紧张素系统 (RAS)和交感神经活性 ,还能调节内皮细胞舒缩功能 ,改善心功能     

Robotic Resistance/Assistance Training Improves Locomotor Function in Individuals Poststroke: A Randomized Controlled Study

Objective

To determine whether providing a controlled resistance versus assistance to the paretic leg at the ankle during treadmill training will improve walking function in individuals poststroke.

Design

Repeated assessment of the same patients with parallel design and randomized controlled study between 2 groups.

Setting

Research units of rehabilitation hospitals.

Participants

Patients (N=30) with chronic stroke.

Intervention

Subjects were stratified based on self-selected walking speed and were randomly assigned to the resistance or assistance training group. For the resistance group, a controlled resistance load was applied to the paretic leg at the ankle to resist leg swing during treadmill walking. For the assistance group, a load that assists swing was applied.

Main Outcome Measures

Primary outcome measures were walking speed and 6-minute walking distance. Secondary measures included clinical assessments of balance, muscle tone, and quality of life. Outcome measures were evaluated before and after 6 weeks of training and at 8 weeks' follow-up, and compared within group and between the 2 groups.

Results

After 6 weeks of robotic training, walking speed significantly increased for both groups, with no significant differences in walking speed gains observed between the 2 groups. In addition, 6-minute walking distance and balance significantly improved for the assistance group but not for the resistance group.

Conclusions

Applying a controlled resistance or an assistance load to the paretic leg during treadmill training may induce improvements in walking speed in individuals poststroke. Resistance training was not superior to assistance training in improving locomotor function in individuals poststroke.     

早期干预促进大鼠神经生长因子表达与脑功能的关系

目的　研究早期干预对宫内缺氧缺血性脑损伤 (HIBD)大鼠脑内神经生长因子 (NGF)表达及脑功能状态的影响。方法　制备宫内 HIBD大鼠模型 33只 ,随机选择 18只通过早期触摸和丰富环境刺激进行早期干预 ,其余为非干预组 ,同时设正常对照组 18只。干预 2 8d后 ,进行感觉运动功能 (行走试验 )测试 ,并采用 EL ISA法检测各组大鼠海马与额皮质区 NGF的含量。结果　 HIBD非干预组大鼠感觉运动功能 (10 .47± 3.46 ) s较正常对照组 (8.17± 2 .48) s减退(P<0 .0 5 ) ,HIBD干预组的感觉运动功能 (8.11± 2 .89) s好于 HIBD非干预组 (P<0 .0 5 ) ,与正常对照组无显著性差异(P>0 .0 5 ) ;HIBD干预组大鼠海马与额皮质区 NGF含量 (2 0 5 2 .0 3± 133.2 5 ;1481.0 9± 80 .95 ) pg/ g高于非干预组(1919.5 5± 137.5 1;1370 .89± 12 8.86 ) pg/ g(P<0 .0 5 ) ,略低于正常对照组海马区 NGF(2 174.18± 172 .14) pg/ g(P<0 .0 5 ) ;而与正常额皮质区 NGF (15 19.90± 83.2 8) pg/ g无显著性差异 (P>0 .0 5 ) ,而且大鼠行走试验结果与其海马、额皮质 NGF的含量成正相关 (r海 =0 .32 3,r皮 =0 .317,P<0 .0 5 )。结论　早期干预可促进缺氧缺血脑损伤大鼠脑内神经生长因子表达与脑功能恢复。     

曲美他嗪治疗缺血性心肌病心衰的疗效及对心功能和心率变异性的影响

目的探讨曲美他嗪治疗缺血性心肌病心衰的临床疗效及对患者心功能和心率变异性的影响。方法将124例缺血性心肌病心衰患者按照就诊顺序随机分为对照组和观察组各62例。两组均采用常规抗心衰治疗,观察组在此基础上加用曲美他嗪,观察两组治疗前后心功能及心率变异性差异,并对两组的临床疗效进行评价。结果观察组总有效率为93.55%,显著高于对照组(P<0.05);两组治疗后心功能和心率变异性均明显改善,观察组变化更为显著,两组间差异具有统计学意义(P<0.05)。结论曲美他嗪治疗缺血性心肌病心衰疗效确切,能够有效改善患者心功能及心率变异性,值得大力推广。     

Disturbances of Pulmonary Function in Rheumatic Heart Disease

The main therapeutic approach to toxoplasmosis is a combination of pyrimethamine and sulfonamides.

Wilson's disease (hepatolenticular degeneration) responds to a copper-poor diet and agents that remove copper from the tissues. Two new anticholinesterases used to treat glaucoma are Phospholine iodide and demecarium bromide. Compounds to reverse the action of anticholinesterases also are being studied, e.g., 2-pyridine aldoxime methiodide.

Neostigmine administered locally may help control the ocular manifestations of myasthenia gravis and aid in diagnosis.

Steroids given for systemic diseases may produce unusual ocular side effects, and some drugs that may be instilled in the eye may produce serious systemic disorders. Tranquilizers also have produced some unusual complications.