多平面经食道超声心动图对心血管疾病的诊断价值

为了评价多平面经食道超声心动图（ＴＥＥ）的临床应用价值，对３６例临床经胸超声心动图（ＴＴＥ）检查尚未完全明确诊断的心血管疾病患者进行了ＴＥＥ检查。结果显示：①２６例（７２％）患者ＴＥＥ补充或纠正了ＴＴＥ诊断；②９例手术患者ＴＥＥ诊断符合率１００％；③对感染性心内膜炎小赘生物的检出、间隔缺损部位、数目、合并畸型、心腔内血栓、大动脉瘤等ＴＥＥ的诊断价值明显高于ＴＴＥ。     

EFFECTS OF LOSARTAN ON THE CARDIOVASCULAR SYSTEM, RENAL HAEMODYNAMICS AND FUNCTION AND LUNG LIQUID FLOW IN FETAL SHEEP

1. The angiotensin type 1 (AT₁) receptor antagonist, losartan (10 mg/kg) was infused intravenously into nine chronically catheterized fetal sheep (125–132 days gestation). Losartan reduced the fetal systolic (P < 0.01) and diastolic (P < 0.01) pressor response to 5 μg angiotensin II (AngII) i.v. from 27.4 ± 1.5 to 7.4 ± 0.9 and from 17.5 ± 1.3 to 5.4 ± 0.6 mmHg, respectively, after 1h and to 6.1 ± 0.5 and 4.4 ± 0.5 mmHg, respectively, after 2h. Maternal pressor responses to 5 μg AngII i.v. were unchanged. Fetal mean arterial pressure decreased (P < 0.05) after losartan administration, but fetal heart rate did not change. 2. Fetal haematocrit increased (P < 0.05), fetal PO₂ decreased (P < 0.01), PCO₂ did not change and pH decreased (P < 0.01), as did plasma bicarbonate levels (P < 0.01) following administration of losartan. Thus, losartan induced a fetal metabolic acidosis. 3. Fetal placental blood flow did not change following administration of losartan. In the fetal kidney, losartan caused a decrease in vascular resistance (P < 0.01) and an increase in blood flow (P < 0.05). Glomerular filtration rate decreased (P < 0.05); thus, filtration fraction decreased (P < 0.01). There was no change in the fractional reabsorption of sodium and glomerulotubular balance was maintained. Free water clearance decreased (P < 0.01) and became negative. Urine flow decreased (P < 0.01), the excretion rates of sodium, potassium and chloride did not change, but the urinary sodium:potassium ratio decreased (P < 0.05). There was a decrease in lung liquid flow (P < 0.05) following losartan. 4. It is concluded that the fetal renin-angiotensin system (RAS) is important in the maintenance of fetal arterial pressure, the regulation of fetal renal blood flow and is essential in the maintenance of fetal glomerular function. Further, these actions of AngII are mediated via functional AT₁ receptors. These effects of losartan on the fetal cardiovascular system, renal blood flow and function are similar to those observed following captopril administration. Thus, the effects of angiotensin converting enzyme (ACE) inhibition in the foetus are due to the blockade of the fetal RAS and are independent of any direct effects on bradykinin or prostaglandin levels.     

巨噬细胞功能M1/M2极性化在心血管疾病中的研究进展

巨噬细胞是先天免疫系统的主要细胞,具有可塑性和异质性,在机体的免疫应答、组织稳态、重塑等多方面发挥重要功能。根据功能极性可分为M1(促炎)和M2(抗炎)2个亚型。M1/M2巨噬细胞在响应局部微环境的刺激反应过程中,通过改变其功能极化,获得特定的功能表型并分泌不同的细胞因子。巨噬细胞通过改变代谢重编程以适应其功能变化。M2巨噬细胞以氧化磷酸化和脂肪酸为能量代谢的主要方式,而M1巨噬细胞为无氧糖酵解。目前研究发现在心血管疾病中,巨噬细胞可能通过其功能极性变化引起巨噬细胞激活、组织浸润、释放促炎性细胞因子而参与心血管疾病的发生。本文对巨噬细胞功能极化、代谢重编程在心血管疾病中的作用进行综述。     

An Extension of the Regression of Offspring on Mid-Parent to Test for Association and Estimate Locus-Specific Heritability: The Revised ROMP Method

The Regression of Offspring on Mid-Parent (ROMP) method is a test of association between a quantitative trait and a candidate locus. ROMP estimates the trait heritability and the heritability attributable to a locus and requires genotyping the offspring only. In this study, the theory underlying ROMP was revised (ROMP_rev) and extended. Computer simulations were used to determine the type I error and power of the test of association, and the accuracy of the locus-specific heritability estimate. The ROMP_rev test had good power at the 5% significance level with properly controlled type I error. Locus-specific heritability estimates were, on average, close to simulated values. For non-zero locus-specific heritability, the proposed standard error was downwardly biased, yielding reduced coverage of 95% confidence intervals. A bootstrap approach with proper coverage is suggested as a second step for loci of interest.
ROMP_rev was applied to a study of cardiovascular-related traits to illustrate its use. An association between polymorphisms within the fibrinogen gene cluster and plasma fibrinogen was detected (p < 0.005) that accounted for 29% of the estimated fibrinogen heritability. The ROMP_rev method provides a computationally fast and simple way of testing for association and obtaining accurate estimates of locus-specific heritability while minimizing the genotyping required.     

Family history of hypertension,gender, and cardiovascular reactivity and stereotypy during stress

Thirty subjects with a family history of hypertension and 28 subjects without such a history performed a Stroop Color-Word Interference task, a mental arithmetic task (serial subtraction of sevens), and a shock avoidance task (repeating digits backward while expecting to be shocked for mistakes). Systolic and diastolic blood pressure and pulse rate were recorded while subjects anticipated, undertook, and recovered from the shock avoidance task and undertook and recovered from the Stroop and mental arithmetic tasks. It was found that compared to nonfamily history subjects, family history subjects manifested reliably greater cardiovascular reactivity during each task and in anticipation of the shock avoidance task. These results are congruent with the notion that excessive sympathetic nervous system reactivity—possibly genetically determined—is involved in the development of some form(s) of essential hypertension. Further, the results indicated that family history subjects manifested greater consistency, or stereotypy, of cardiovascular response across the experimental tasks than nonfamily history subjects. The possible role of cardiovascular stereotypy in the development of essential hypertension is also discussed.This investigation was supported by University of Kansas General Research Allocation 3115-xO-0038 to B. Kent Houston.     

Fine structure of the carotid body of the midterm human fetus

Summary The human fetal carotid body was studied using both histochemical and electron microscopic methods. The glomus cells of a mid term fetal carotid body evidently contain catecholamines. This was demonstrated both by formaldehyder-induced fluorescence of the cells and by the presence of typical dense-cored vesicles (diameter 1430–3200 Å) in the cytoplasm of the chief cells. The glomus cells were densely innervated and the synapses found on their surface were probably cholinergic in type, containing agranular synaptic vesicles measuring 400–700 Å in diameter with a few dense-cored vesicles measuring 900 to 1300 Å. Synapses were not found in any other cell type within the glomus caroticum. The prominent feature of the glomus cell cytoplasm was the presence of the dense-cored vesicles. The density of the vesicular core varied only slightly from cell to cell. There were no perceptible differences in vesicular size between the different cells. The glomus cells were mostly surrounded by the processes of the sustentacular cells, which usually also surrounded the capillary walls. No glomus cells were ever found in direct contact with the capillary wall. The capillaries were wide and very numerous over the restricted area of the organ. They formed sinusoidal loops, probably anastomosing with each other. Finally, the features of the fine structure are discussed, correlating the present findings with our knowledge about the adult functional carotic body.     

Diagnostic performance of aPS/PT antibodies in neuropsychiatric lupus and cardiovascular complications of systemic lupus erythematosus

Abstract

Background: Systemic lupus erythematosus (SLE) is associated with a constellation of complications affecting multiple organs, including neuropsychiatric manifestations (NPSLE) and ischaemic events, leading to increased long-term morbidity. Antiphospholipid antibodies (aPL) are a major determinant of vascular inflammation and thromboembolic risk. The diagnostic role of anti-phosphatidylserine/prothrombin (aPS/PT) antibodies in this setting is incompletely defined.

Aim: To verify whether aPS/PT add to diagnostics and disease stratification in patients with SLE with or without other aPL.

Methods: 131 consecutive patients were studied, including 20 patients with SLE and secondary antiphospholipid syndrome (APS). aPS/PT IgG and IgM were assessed through ELISA and patients were stratified based on the presence of other aPL, on their clinical and laboratory features at time of blood sampling and on their clinical history. Synthetic indices of disease activity, chronic damage and cardiovascular risk were calculated at time of venipuncture.

Results: Fifty-one (38.9%) patients with SLE had aPS/PT and 15 (11.5%) patients had aPS/PT as the only aPL (aPS/PT-only). aPS/PT-only patients had a significantly higher prevalence of NPSLE than quadruple aPL-negative patients (p?=?.007). Patients with aPS/PT were more likely to have a history of ischaemia, thrombocytopenia and Libman–Sacks’ endocarditis. The presence of aPS/PT also associated with previous accrual of at least one damage item (p?=?.043), but had limited predictive values for damage progression in the short term.

Conclusion: aPS/PT antibodies provide non-redundant information that could contribute to risk assessment and stratification of patients with SLE.     

心血管疾病患者血浆CF 6的含量变化

目的:研究常见心血管疾病中血浆内线粒体偶联因子6(mitochondrial coupling factor 6,CF6)含量的变化,以探讨CF6在其发病中的意义.方法:放射免疫分析检测血浆CF6的含量(pg/ml).结果:正常健康人群血浆CF6含量为210.5±33.7pg/ml.原发性高血压患者为307.5±95.5pg/ml,急性心肌梗塞患者为364.5±105.1,心力衰竭患者为351.2±104.6;睡眠呼吸暂停综合征患者为351.9±87.1,原发性高血压伴糖尿病患者为466.4±136.3,p＜0.01,与正常人比较均明显升高(均p＜0.01或p＜0.05);稳定性心绞痛患者为266.3±69.3,心律失常患者为258.8±80.1,有上升趋势,但无统计学明显差异(p＞0.05),肺动脉高压患者降低(159.3±122.8,p＞0.05).结论:原发性高血压、急性心肌梗塞、心力衰竭、睡眠呼吸暂停综合征患者血浆CF6含量明显升高,并与病情严重程度有关,提示CF6可能在其病理生理过程中发挥着重要的作用,对于变化的机制及其意义有待于深入研究.     

Relationship quality moderates the effect of social support given by close friends on cardiovascular reactivity in women

We examined the role of the type of support provided, gender of support provider, and relationship quality in predicting how social support might influence cardiovascular reactivity during acute stress in women. A group of 88 women received either emotional, instrumental, or no support from a close female or male friend while performing a series of speech tasks. Results suggest that the effectiveness of social support for women depended primarily on the quality of the friendship (i.e., purely positive, or ambivalent). More specifically, women who interacted with a female, ambivalent friend had the largest changes in diastolic blood pressure, total peripheral resistance (TPR), and pre-ejection period compared to the other conditions. Furthermore, receiving emotional support from a purely positive friend was related to lower increases in cardiac output (CO) compared to a no-support condition. In contrast, receiving emotional support from an ambivalent friend was related to larger increases in CO and only small changes in TPR when compared to individuals in the no-support condition. These data are discussed in light of the psychosocial processes underlying social support effects in women, and the importance of a more comprehensive view of how close relationships influence cardiovascular function. This research was generously supported by Grant1 R01 MH58690-01 from the National Institute of Mental Health awarded to Bert N. Uchino.     

Anger Cognitions and Cardiovascular Recovery Following Provocation

The current study describes the creation and validation of the Anger Cognitions Inventory (ACI) to assess the cognitive appraisals associated with resentful and reflective anger. The ACI was created based on a content analysis of self-reports of participants' thoughts and feelings following anger provocation in the laboratory. Exploratory and confirmatory factor analyses on two separate college student samples (N = 267 and N = 276, respectively) revealed five subscales which could validly be grouped into resentful and reflective anger. Convergent and divergent validity data showed that resentful anger correlated positively with anger-out/trait anger and reflective anger correlated positively with anger-in/brooding. A second study showed positive correlations between rumination and delayed cardiovascular recovery following anger provocation. Limitations of both studies include restricted samples which limit generalizability of results and cardiovascular recovery data collected in Study II which does not include assessment of autonomic balance between vagal and sympathetic responsivity.