Relationships between perioperative vascular endothelial function and cardiovascular changes

Background Perioperative cardiovascular complications occurred frequently,especially coronary heart disease,as atherosclerosis risk factors in patients.To explore the perioperative arterial vascular endothelial function and carotid intima-media thickness(IMT) as atherosclerosis early pathological changes of alternative indicators forecast the possibility of cardiovascular complications.Methods We selected surgery patients 150 cases:including atherosclerosis risk factors group(ASF group):73 cases,among them,22 cases had carotid artery atherosclerosis plaque(ASF:IMT Plaque) and 51 cases had no plaque(ASF:NO-IMT Plaque);and non-risk factors group(NO-ASF group):77 cases,among them,18 cases had carotid artery atherosclerosis plaque(NO-ASF:IMT Plaque) and 59 cases had no plaque(NO-ASF:NO-IMT Plaque).Arterial vascular endothelial function was measured as flow-mediated dilation(FMD) of the brachial artery using high-resolution B-mode ultrasonic device,for one day before operation(the baseline of value),on two hours from recovery after general anesthesia,the first day after operation,the fifth days after operation.Results FMD of two groups on two hours was reduced,compared with the baseline,but FMD of ASF group was decreased significantly(P = 0.032);FMD of ones further was increased on Day 1 and Day 5,but NO-ASF group was increased significantly(P < 0.05);FMD of the baseline and atherosclerosis risk factors was negatively correlated(R =-0.216,P = 0.023).FMD of ASF:IMTP group was decreased significantly respectively in four times,compared with the ASF:NO-IMTP group(P = 0.034,P = 0.009,P = 0.001 and P = 0.017).FMD of NO-ASF:IMTP group was decreased significantly respectively in four times,compared with the NO-ASF:NO-IMTP group(P = 0.006,P = 0.005,P = 0.000 and P = 0.000).Pulse pressure(PP) was not different on Day 1(P = 0.26),and was different between the two groups in the remaining three periods(P = 0.035,P = 0.040 and P = 0.014);SBP was not different between the basic value(P > 0.05),there were differences in the other three times(P < 0.05).While Nitroglycerin-induced dilation(NTG) was stable throughout.Conclusions Arterial endothelial function was correlative with atherosclerosis risk factors,and that EDD and IMT as atherosclerosis alternative indicators forecast cardiovascular and cerebrovascular events after surgery is feasible.     

血管内皮功能与偏头痛的研究进展

本文综述了偏头痛的发病机制,发病原因主要是脑内外血管内皮功能紊乱致血管收缩和舒张功能障碍;采用高分辨B型超声扫描肱动脉内皮功能的方法对血管内皮细胞功能的评定有较高的相关性。     

急诊科内应用重组组织型纤溶酶原激活剂治疗急性心肌梗死44例临床分析

目的评价急诊科内应用重组组织型纤溶酶原激活剂（ｒｔ－ＰＡ）静脉溶栓治疗急性心肌梗死（ＡＭＩ）的疗效及安全性。方法４４例ＡＭＩ患者在急诊科内接受ｒｔ－ＰＡ静脉溶栓治疗。ｒｔ－ＰＡ总量原则为“三级剂量,开通则停”。即当临床显示血管再通时将剂量限制在５０ｍｇ、７５ｍｇ及１００ｍｇ,特殊情况适当加量。负荷量及余量输注速率视梗死部位而异。结果药物总量达５０ｍｇ、７５ｍｇ及１００ｍｇ时血管再通率分别为５９％、７７％及８４％。３例并发心源性休克患者剂量达１００ｍｇ后无再通且病情恶化,分别追加５０ｍｇ、５０ｍｇ及１００ｍｇ后血管再通且存活。总再通率为９１％。轻度出血率为２７％,无严重及颅内出血。结论提示在急诊科内应用ｒｔ－ＰＡ静脉溶栓治疗ＡＭＩ安全有效。     

苦瓜蛋白对载脂蛋白E基因敲除小鼠动脉粥样硬化形成及小肠胆固醇转运相关基因表达的影响

目的 探讨苦瓜蛋白对载脂蛋白E基因敲除小鼠小肠胆固醇转运相关基因表达的影响,阐明苦瓜蛋白在动脉粥样硬化发生中的作用机制.方法 选用36只6周龄的雄性载脂蛋白E基因敲除小鼠,随机分为普食组(对照组)、高脂高胆固醇饲料组(高脂组)、高脂高胆固醇+苦瓜蛋白组(苦瓜蛋白组).喂养12周后处死,比较各组血脂水平,苏丹Ⅳ染色观察全主动脉粥样硬化病变程度,主动脉窦冰冻切片油红O染色检测脂质沉积,逆转录聚合酶链反应和Western Blot分别检测ATP结合盒转运体G5和G8的mRNA和蛋白表达.结果 高脂组总胆固醇、甘油三酯、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇的水平比对照组明显升高(P＜0.05),而苦瓜蛋白组总胆固醇(14.52±1.06 mmol/L比18.21±1.95 mmol/L)、甘油三酯(0.51±0.11 mmol/L比0.92±0.07 mmol/L)和低密度脂蛋白胆固醇(4.12 mmol/L±0.95比7.16±0.98 mmol/L)水平显著低于高脂组(P＜0.05),高密度脂蛋白胆固醇的水平与高脂组比差异无显著性(P＞0.05).苦瓜蛋白组主动脉斑块面积(31.2%±3.6%比69.6%±4.8%)和主动脉窦脂质面积(26.02±3.07 μ m2/比45.23±11.2 μm2)比高脂组显著减少.苦瓜蛋白组小肠中ATP结合盒转运体G5和G8的mRNA和蛋白表达都比高脂组明显升高(P＜0.05).结论 苦瓜蛋白可通过增加载脂蛋白E基因敲除小鼠小肠中ATP结合盒转运体G5和G8的表达,降低血脂水平,减少主动脉斑块及主动脉窦脂质沉积.     

miR-626下调HepG2细胞载脂蛋白(a)的表达

目的筛选高效调控LPA基因表达的miRNA。方法用在线预测工具预测作用于LPA基因3'UTR的miRNA,RT-PCR和Western blot检测转染预测所得miRNA mimic后HepG2细胞载脂蛋白(a)[Apo(a)]mRNA和蛋白表达水平。实验分为对照组、miR-626 mimic组、miR-626 mimic+miR-626 inhibitor组和miR-626 inhibitor组共4组。使用荧光素酶报告系统进行miR-626靶标验证实验。结果可作用于LPA基因3'UTR的miRNA有9个。mimic转染组与对照组相比,Apo(a)的mRNA表达水平差异不显著,但miR-626能显著下调Apo(a)蛋白的表达。使用miR-626 inhibitor后,miR-626对Apo(a)蛋白的下调作用减弱。转染miR-626后细胞裂解液的荧光强度显著下降。结论miR-626能显著下调Apo(a)蛋白表达水平,其通过与LPA mRNA 3'UTR序列结合,抑制LPA mRNA翻译实现的。     

成纤维细胞生长因子21通过诱导自噬促进泡沫细胞胆固醇流出

目的探讨成纤维细胞生长因子21(FGF21)促进泡沫细胞胆固醇流出的机制。方法在建立THP-1巨噬细胞源性泡沫细胞模型的基础上,以不同浓度(0、50、100、200、400μg/L)FGF21处理泡沫细胞24 h,以200μg/L FGF21处理泡沫细胞不同时间(0、6、12、24、48 h),Western blot、激光共聚焦检测LC3,MDC染色分析自噬小体,HPLC、油红O染色测定细胞内胆固醇蓄积,液体闪烁计数分析胆固醇流出。结果 200、400μg/L的FGF21,以及200μg/L的FGF21作用24 h和48 h,泡沫细胞总胆固醇(TC)、游离胆固醇(FC)和胆固醇酯(CE)水平均显著降低,而其胆固醇流出显著增强。机制研究发现,FGF21可诱导泡沫细胞自噬体形成,且微管相关蛋白Ⅰ轻链3(LC3-Ⅰ)至微管相关蛋白Ⅱ轻链3(LC3-Ⅱ)转化率显著增加,但自噬相关基因5(ATG5)siRNA或3-甲基腺嘌呤(3-MA)或巴弗洛霉素A1(BafA1)干预自噬后,FGF21对TC、FC和CE的降低作用减弱,同时胆固醇流出减少,泡沫细胞脂质蓄积加重。结论 FGF21通过上调自噬促进泡沫细胞胆固醇流出。     

潍坊市2660名放射工作人员职业健康检查结果分析

对2020年12月—2022年11月在潍坊市人民医院进行职业健康检查的2 660名放射工作人员的体检结果进行分析。放射作业人员外周血WBC计数降低、淋巴细胞染色体异常、眼晶状体混浊、心电图及胸片异常检出率增高，工业企业及三级医院更应加强对放射工作人员的健康监护。