静电纺丝血管外支架抑制静脉移植物内膜增生

目的 探讨聚-3-羟基丁酸与聚-4-羟基丁酸聚酯[P(3HB-co-4HB)]静电纺丝血管外支架预防静脉移植物内膜增生的机制.方法 静电纺丝技术制备P(3HB-co-4HB)血管外支架.SD大鼠随机分成2组,每组24只,建立颈外静脉-颈总动脉血管移植模型:无支架(Ns)组和非限制支架(PS)组.分别于术后3、7、14、28 d取静脉移植物标本,计算机图像系统分析内膜、中膜厚度和面积,免疫组织化学检测静脉移植物增殖细胞核抗原(PCNA)表达.逆转录-聚合酶链反应(RT.PCR)检测静脉移植物血小板源性生长因子.BB(PDGF-BB)和组织因子(TF)mRNA表达.结果 术后7、14、28 d支架组静脉移植物内膜与中膜的厚度和面积明显低于无支架组(P<0.05).两组PCNA表达均增加并在术后14 d最高,而支架组在术后7、14 d PCNA表达低于无支架组(P<0.05).术后3、7d支架组PDGF.BB和TFmRNA表达明显低于无支架组(P<0.01).结论 静电纺丝P(3HB-co-4HB)血管外非限制性支架能抑制静脉移植物内膜增生,并通过降低静脉移植物管壁早期组织因子表达发挥作用.     

人脐带血内皮祖细胞与血管内皮生长因子和碱性成纤维细胞生长因子共培养及其增殖和迁移能力

背景：目前组织工程心脏瓣膜再内皮化种子细胞主要来源于成熟内皮细胞,内皮祖细胞作为内皮细胞的前体细胞越来越受到人们的关注。目的：分离和扩增人脐带血内皮祖细胞,观测其体外生物学特性。方法：密度梯度离心法分离新鲜的脐血中单个核细胞,在含血管内皮生长因子和碱性成纤维细胞生长因子的培养液中培养扩增,通过形态学、免疫荧光和流式细胞仪等对贴壁细胞进行鉴定;并与脐静脉内皮细胞进行增殖和迁移能力比较。结果与结论：随着培养和诱导时间延长,贴壁细胞形态发生明显的改变,从小圆形变成梭形,逐渐分化成典型成熟内皮细胞的鹅卵石样形态,并可形成特征性的克隆;体外诱导7d后90%以上贴壁细胞呈Dil-ac-LDL和FITC-UEA-I双阳性;贴壁细胞流式细胞仪分析显示：培养7d的细胞VEGFR-2、CD34和CD133表达分别占（77.4±4.9）%、（52.4±6.6）%和（19.4±2.1）%,培养28d的细胞VEGFR-2和CD34表达分别占（81.1±7.4）%和（7.6±3.1）%,而未检测到CD133表达;人内皮祖细胞增殖和迁移能力明显高于人脐静脉内皮细胞（P〈0.05）,并且细胞数量可扩增达109L-1。结果显示用密度梯度离心法和贴壁筛选法,可从人脐带血分离、纯化内皮祖细胞;内皮祖细胞可诱导分化为内皮细胞,增殖和迁移能力都很强。     

去端肽胶原介导小干扰RNA抑制大鼠静脉移植物内膜增生

Objective To evaluate the efficacy of using small interfering RNA targeting TF as a therapy for vein graft failure. Methods External jugular vein to carotid artery interposition vein grafts, which were applied to a low flow condition, were made in 120 Sprague-Dawley rats weighing 260 to 300 g. These rats were randomly divided into 4 groups, 30 rats each group. Group A was atelocollagen-TF Stealth<'TM> Select RNAi group. Group B was atelocollagen-TF Stealth<'TM> RNAi group. Group C was atelocollagen group. Group D was control group. Small interfering RNA mixed with atelocollagen was administrated to the external wall of grafted veins. The TF protein expression of vein gratis was analyzed by Western blot at 1, 3, 7, 14, and 28 d postoperatively, and by immunochemistry at 3 d postoperatively. The proliferation index was determined at 14 d postoperatively. Neointimal hyperplasia was evaluated at 28 d postoperatively. BLOCK-iTTM fluorescent oligo was used to confirm its stability and successful transfer into the vein graft wall at 3 and 7 d postoperatively for another group (n = 12). Results Fluorescence of BLOCK-iT<'TM> fluorescent align could be detected in the graft wall even at 7 d postoperatively. Knockdown of the TF expression was achieved by perivascular application of siRNA using atelocollagen. Compared with control group, the intima thickness at 28 d after grafting was significantly reduced (P ＜ 0.05). This phenomenon was preceded by significant reduction of cell proliferation in siRNA-treated grafts at 14 d postoperatively (P ＜0.05). Conclusion The expression of TF in vein grafts can be effectively inhibited by specific siRNAs using a atelocoilagen-based nonviral delivery approach/n vivo, so that the neointimal thickening can be prevented.     

婴幼儿先天性心脏病外科治疗现状和进展

先天性心脏病(congenital heart disease, CHD)居我国人口出生缺陷首位,发病率占新生活产婴儿6.87‰～14.39‰,每年新增病例12～15万.简单CHD如房间隔缺损(ASD)、室间隔缺损(VSD)、动脉导管未闭(PDA)、肺动脉瓣狭窄(PS)等占CHD总数60.0%～70.0%,若不能及时治疗,相当一部分在婴幼儿期(≤3岁)因为严重肺动脉高压、肺部感染、缺氧伴心力衰竭等夭折;复杂CHD主要包括法洛四联症(TOF)、肺动脉闭锁(PA)、右室双出口(DORV)、大动脉错位(TGA)、左室发育不良(HLHS)、完全性肺静脉异位连接(TAPVC)、完全型房室隔缺损(CAVSD)、主动脉弓离断(IAA)、主动脉缩窄(CoA)等,1周内自然死亡率约30.0%,1个月内约50.0%.     

急性主动脉夹层合并新型冠状病毒感染管理策略建议

自2019年12月新型冠状病毒(2019 novel coronavirus,SARS-Co V-2)感染病例在武汉市被发现,近期SARS-Co V-2肺炎肆虐,湖北省等地疫情严重。SARS-Co V-2感染患者大多以发热、乏力、干咳、头疼等症状起病,部分以恶心、呕吐、腹泻为首发症状。外周血检验提示白细胞总数正常或降低,淋巴细胞计数减少.     

SOCS1/SOCS3在冠心病患者外周血单个核细胞中的表达及意义

目的探讨SOCS1和SOCS3在冠心病发病中的作用,进一步了解冠心病的发病机制。方法应用real time-PCR及Western blot法检测正常健康人(对照组,n=10)和冠心病患者(冠心病组,n=30)外周血单个核细胞中SOCS1/SOCS3的mRNA和蛋白表达水平,同时用ELISA法检测血浆中IL-1β、IL-4、IL-6、IL-10、IL-12、IL-17、TNF-α、IFN-γ和TGF-β1水平。结果 SOCS1、SOCS3的mRNA和蛋白在冠心病组[SOCS1:(1.95±0.77),(1.19±0.43);SOCS3:(3.60±1.35),(1.35±0.59)]的表达水平明显高于对照组[SOCS1:(1.18±0.43),(0.58±0.33);SOCS3:(1.16±0.67),(0.87±0.35)],差异均有统计学意义(均P<0.05)。与对照组比较,冠心病患者血浆IL-1β[(22.2±8.1)vs.(13.6±5.9)],IL-6[(33.1±14.2)vs.(19.1±9.1)],IL-12[(25.0±5.5)vs.(11.5±2.9)],IL-17[(25.0±10.4)vs.(13.4±5.6)],TNF-α[(29.5±12.0)vs.(17.8±6.4)],IFN-γ[(20.3±10.7)vs.(10.4±3.8)]水平显著上升,而IL-4[(8.3±3.4)vs.(16.4±7.4)],IL-10[(14.9±7.2)vs.(38.7±16.9)]和TGF-β1[(122±52)vs.(361±117)]水平明显下降(单位均为pg/mL),两组间的差异均有统计学意义(均P<0.01)。结论 SOCS1和SOCS3的高表达可能参与冠心病的发病,其机制可能与冠心病患者体内促炎细胞因子水平升高有关。     

去端肽胶原介导小干扰RNA抑制大鼠静脉移植物内膜增生

Objective To evaluate the efficacy of using small interfering RNA targeting TF as a therapy for vein graft failure. Methods External jugular vein to carotid artery interposition vein grafts, which were applied to a low flow condition, were made in 120 Sprague-Dawley rats weighing 260 to 300 g. These rats were randomly divided into 4 groups, 30 rats each group. Group A was atelocollagen-TF Stealth<'TM> Select RNAi group. Group B was atelocollagen-TF Stealth<'TM> RNAi group. Group C was atelocollagen group. Group D was control group. Small interfering RNA mixed with atelocollagen was administrated to the external wall of grafted veins. The TF protein expression of vein gratis was analyzed by Western blot at 1, 3, 7, 14, and 28 d postoperatively, and by immunochemistry at 3 d postoperatively. The proliferation index was determined at 14 d postoperatively. Neointimal hyperplasia was evaluated at 28 d postoperatively. BLOCK-iTTM fluorescent oligo was used to confirm its stability and successful transfer into the vein graft wall at 3 and 7 d postoperatively for another group (n = 12). Results Fluorescence of BLOCK-iT<'TM> fluorescent align could be detected in the graft wall even at 7 d postoperatively. Knockdown of the TF expression was achieved by perivascular application of siRNA using atelocollagen. Compared with control group, the intima thickness at 28 d after grafting was significantly reduced (P ＜ 0.05). This phenomenon was preceded by significant reduction of cell proliferation in siRNA-treated grafts at 14 d postoperatively (P ＜0.05). Conclusion The expression of TF in vein grafts can be effectively inhibited by specific siRNAs using a atelocoilagen-based nonviral delivery approach/n vivo, so that the neointimal thickening can be prevented.     

心、肺联合移植一例报告

目的对1例心、肺联合移植术进行总结分析。方法对1例患先天性心脏病、室间隔缺损合并艾森曼格综合征者施行同种异体原位心、肺联合移植术,手术在中低温、体外循环下进行。术后对受者进行密切监护,积极防治排斥反应和感染。结果术中体外循环时间240min,升主动脉阻断时间125min;患者术后第7、203d发生移植肺急性排斥反应,第177、228d发生移植心急性排斥反应,均经治疗逆转;第9d发生肺部及胸腔感染,经抗感染治疗痊愈;第265d发生肺部毛霉菌感染,经两性霉素B治疗后症状控制;目前受者的心功能为Ⅰ级,超声心动图提示心脏结构及瓣膜功能基本正常,肺部感染的临床表现基本消失,生活自理。结论良好的心肺保护、细致的外科操作和正确的围手术期处理是心、肺联合移植成功的关键。     

RGD肽在组织工程领域的应用

种子细胞、生物材料和组织器官再生构成组织工程三大要素，其中细胞和材料间相互作用是主要研究内容。将某些生物活性分子固定在高分子或生物源性材料的表面，修饰其结构特征，提高材料的生物相容性和细胞亲和力，为种子细胞黏附、增殖、扩展和分化提供良好界面，促进细胞外基质（ECM）产生，是构建组织工程产品的重要措施。生物活性分子以生长因子和多肽最常用。后者又以ROD肽研究最为深入。本文就RGD肽的生物学效应、种类、检测、固定方法等作一综述。     

Rastelli术后右心衰竭的临床分析

目的 :回顾性分析 8例Rastelli术后右心衰竭的可能原因以及防治措施。方法 :从 1997年 8月至2 0 0 0年 8月 ,我科行Rastelli术 8例 ,全组患者均用Dacron补片修补室间隔缺损 ,同种带瓣管道重建右室肺动脉通道。结果 :术后早期死亡 1例 ,生存 7例 ,围术期右心衰竭 5例。随访 6个月～ 3年 ,除 1例顽固性心力衰竭外 ,4例生长发育良好。结论 :Rastelli术后右心衰竭发生率高 ,其原因可能与外管道置入位置和方向不恰当、室间隔缺损修补后左、右心腔大小失衡、室间隔缺损修补不严密妨碍三尖瓣隔瓣功能以及心肌缺血时间长等有关。针对这些因素 ,手术中应采取相应措施 ,术后合理的内科治疗也能较好地改善预后。