IL-21R expression on CD8+ T cells promotes CD8+ T cell activation in coxsackievirus B3 induced myocarditis

IL-21 is a multi-functional cytokine which can promote survival, proliferation and activation of T and B lymphocytes including CD8 T cells. Previous studies have shown that autoimmune CD8+ T cells are the primary pathogenic effector cell in coxsackievirus B3 (CVB3) induced myocarditis in C57Bl/6 mice. To evaluate the role of IL-21 in promoting CD8+ T cell mediated cardiac injury in myocarditis, C57Bl/6 and IL-21RKO mice were infected with CVB3. IL-21RKO mice developed significantly less myocarditis than C57Bl/6 animals although cardiac virus titers were equivalent between the mouse strains. Numbers of CD8+IFNγ+ cells were decreased in IL-21RKO mice but numbers of either CD4+IFNγ+ or CD4+IL-4+ cells were not significantly different from C57Bl/6 animals indicating a selective effect of IL-21 signaling on the CD8+ T cell response. To confirm that IL-21 signaling exclusively functions at the level of the CD8+ T cell in CVB3 induced myocarditis, purified CD8+ cells were isolated from either C57Bl/6 or IL-21RKO donors and adoptively transferred into CD8KO recipients prior to CVB3 infection. CD8KO recipients given either C57Bl/6 or IL-21RKO CD8+ cells showed equivalent reconstitution of the CD8+ cells in the spleen but the recipients given C57Bl/6 CD8+ cells showed significantly greater myocarditis than recipients of IL-21RKO CD8+ cells. These data demonstrate that IL-21 signaling directly in the CD8+ cell population is required for CVB3-induced myocarditis.     

Distribution of biventricular disease in arrhythmogenic cardiomyopathy: an autopsy study

Arrhythmogenic cardiomyopathy is a rare cardiomyopathy characterized by fibrofatty replacement primarily of the right ventricular myocardium. It is a major cause of sudden death in the young and in athletes. There are few autopsy studies of the ventricular distribution of the disease. Fifty cases of sudden cardiac death with fibrofatty replacement in either ventricle from a single medical examiner's office were studied. Distribution of disease as determined grossly and microscopically was correlated with activity at time of death, race, and presence of inflammation. Extent of disease was right ventricular in 6 cases (12%; age, 25 ± 5 years), biventricular in 25 (50%; age, 36 ± 3 years), and left ventricular in 19 (38%; age, 37 ± 3 years) (P = .13). Inflammation was present in 44% of biventricular arrhythmogenic cardiomyopathy versus 74% of left ventricular arrhythmogenic cardiomyopathy and 83% of right ventricular arrhythmogenic cardiomyopathy (P = .06). Arrhythmogenic cardiomyopathy, when presenting with sudden death, is usually biventricular. There is a trend that univentricular involvement occurs at an earlier age and that right ventricular involvement shows more inflammation, suggesting different stages of disease.     

自身免疫性心肌炎模型的研究进展

自身免疫性心肌炎是病毒性心肌炎的第2阶段,即自身免疫反应阶段。它在心肌炎发生及进展过程中起着不容忽视的作用,因此受到广泛的关注。实验性自身免疫性心肌炎(EAM)动物模型的诱导成功,更好地了解心肌炎的发病机理。现就近年建立的EAM模型的研究进展予以综述,为建立适合的动物模型,进一步阐明其机制并为该病的药物治疗提供参考。     

非心源性病变心律失常146例临床分析

目的:探讨非心源性病变心律失常的临床特点及治疗,提高对此类心律失常的认识,以减少误诊。方法:回顾性分析146例非心源性病变心律失常患者的临床表现、导致心律失常的原发疾病,以及针对性治疗原发疾病后心律失常的转归。结果:146例非心源性疾患分别为颈椎病38例(26.0%)、隐性甲亢31例(21.2%)、恶性肿瘤18例(12.3%)、心脏神经官能症16例(11.0%)、胆道疾病15例(10.3%)等;心律失常以早搏及心动过速为主,患者常伴有心悸、胸闷、焦虑、多汗及心前区疼痛等症状;≥60岁患者容易误诊为冠心病,<60岁的患者容易误诊为心肌炎,差异有统计学意义(P<0.05)。针对性治疗原发疾病后,心律失常绝大多数都能很快缓解、消失,尤其是恶性肿瘤切除后心律失常可迅速缓解。结论:很多非心源性疾患可致心律失常,此类患者常伴有原发疾病的临床表现,对原发疾病的治疗可使心律失常很快缓解、消失。     

Idioventricular rhythm induced by therapeutic hypothermia

We report the case of a 11-year-old girl with fulminant myocarditis and cardiogenic shock who received cardiopulmonary resuscitation and extracorporeal membrane oxygenation support. During the induction of hypothermia, her rhythm degenerated into idioventricular rhythm with extremely prolonged QRS duration. The hypothermia-induced bradycardia caused a drop of mixed venous oxygenation saturation and which was resolved by re-warming to normothermia. This finding suggested that hypothermia may compromise cardiac performance and physicians should be cautious about its application in patients with fulminant myocarditis.     

Manifestation of acute peritonitis and pneumonedema in scrub typhus without eschar: A case report

BACKGROUNDScrub typhus is an acute infectious disease caused by rickettsia infection. The diagnosis is based on eschar, and clinical manifestations can range from asymptomatic to multiorgan dysfunction. CASE SUMMARYWe report the case of a 35-year-old man living in Zhuhai, Guangdong, China, who had repeated high fever with a maximum body temperature of 40.2 °C and elevated white blood cells and procalcitonin levels. After 7 d of persistent high fever, the patient developed rash, abdominal pain, and symptoms of peritonitis. Within 24 h after admission, the patient developed diffuse peritonitis and pneumonedema, requiring ventilator support in the intensive care unit. However, there was no eschar on the body, and the first Weil-Felix test was negative. Taking into account that the patient had a history of jungle activities, doxycycline combined with meropenem was selected. The patient improved, healed, and was discharged after a week. The diagnosis of scrub typhus was confirmed by a repeat Weil-Felix test (Oxk 1:640), and pathology of the appendix resected by laparotomy suggests vasculitis.CONCLUSIONThis rare presentation of peritonitis, pulmonary edema, and pancreatitis caused by scrub typhus reminds physicians to be alert to the possibility of scrub typhus.     

Effect of astragaloside on cardiomyocyte apoptosis in murine coxsackievirus B3 myocarditis

Astragaloside is the major component of Astragalus membranaceus, one of the Chinese medical herbs, and has several pharmacological actions on cardiovascular system, including positive inotropic, anti-arrhythmia and anti-oxidant activities. We have investigated the effect of astragaloside on cardiomyocyte apoptosis and expression of apoptosis-associated genes in mice with coxsackievirus B₃ (CVB₃)-induced myocarditis, the former of which has been detected by terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end-labeling (TUNEL) assay and the latter determined by using a focused microarray. Results showed that cardiomyocyte apoptosis and expression of various apoptosis associated genes are inhibited after treatment with astragaloside. The anti-apoptotic activity of astragaloside may contribute to the improvement of clinical outcomes in treating myocarditis with pharmaceutics of Astragalus membranaceus.     

灯盏花素对病毒性心肌炎心肌细胞凋亡的作用

目的:研究灯盏花素从细胞凋亡方面对病毒性心肌炎的治疗作用。方法:建立病毒性心肌炎的模型。40只Balb/c雄性小鼠随机分为正常对照组(n=10)、病毒感染组(n=15)和灯盏花素组(n=15),在感染后第9天处死小鼠,取其心脏进行检测。用HE染色法观察其心肌病理变化,免疫组化法观察Caspase-3情况,用TUNEL法观察心肌细胞凋亡情况。结果:①治疗组心肌病理变化改变减轻(P<0.01);②治疗组Caspase-3的表达较感染组低(P<0.05);③治疗组心肌细胞凋亡少于感染组(P<0.01)。结论:细胞凋亡在病毒性心肌炎中发挥重要作用,灯盏花素对病毒性心肌炎有治疗作用。     

儿童病毒性心肌炎心电图分析

[目的]研究儿童病毒性心肌炎的心电图特点。[方法]选择180例资料完整的儿童病毒性心肌炎患者,对其心电图结果进行分析。[结果]①180例儿童病毒性心肌炎患者中心电图异常率76.67%,多表现为窦性心动过速、各类早搏、ST-T改变和多种类型房室传导阻滞。②异常心电图中,快速性心律失常171例次,缓慢性心律失常14例次。[结论]心电图检查对儿童病毒性心肌炎诊断、治疗、预后有重要作用,是儿童病毒性心肌炎必不可少的检查方法。     

中药治疗柯萨奇B病毒性心肌炎的研究进展

综述了近年关于中医药治疗柯萨奇B病毒性心肌炎的实验及临床研究。研究包括单味中药(以黄芪、西洋参、人参等为主)、中药复方(中药传统方剂及自拟方)治疗本病的情况。实验研究方面从保护心肌、抑制病毒复制和免疫治疗三方面进行较深入的研究,临床研究方面从该病的分期入手论述了中药的显著疗效,同时也指出了存在的问题及今后研究方向。