Hepatocyte growth factor gene-modified bone marrow-derived mesenchymal stem cells transplantation promotes angiogenesis in a rat model of hindlimb ischemia

Angiogenic gene therapy and cell-based therapy for peripheral arterial disease (PAD) have been studied intensively currently.This study aimed to investigate whether combining mesenchymal stem cells (MSCs) transplantation with ex vivo human hepatocyte growth factor (HGF) gene transfer was more therapeutically efficient than the MSCs therapy alone in a rat model of hindlimb ischemia.One week after establishing hindlimb ischemia models,Sprague-Dawley (SD) rats were randomized to receive HGF gene-modified MSCs transplantation (HGF-MSC group),untreated MSCs transplantation (MSC group),or PBS injection (PBS group),respectively.Three weeks after injection,angiogenesis was significantly induced by both MSCs and HGF-MSCs transplantation,and capillary density was the highest in the HGF-MSC group.The number of transplanted cell-derived endothelial cells was greater in HGF-MSC group than in MSC group after one week treatment.The expression of angiogenic cytokines such as HGF and VEGF in local ischemic muscles was more abundant in HGF-MSC group than in the other two groups.In vitro,the conditioned media obtained from HGF-MSCs cultures exerted proproliferative and promigratory effects on endothelial cells.It is concluded that HGF gene-modified MSCs transplantation therapy may induce more potent angiogenesis than the MSCs therapy alone.Engraftment of MSCs combined with angiogenic gene delivery may be a promising therapeutic strategy for the treatment of severe PAD.     

二维斑点追踪技术评价舒张性心力衰竭患者左室心内膜和心外膜下心肌功能

目的 应用二维斑点追踪成像技术评价射血分数正常的舒张性心力衰竭(diastolic heart failure,DHF)患者左室心内、外膜下心肌功能.方法 临床确诊的DHF患者36例、收缩性心力衰竭(systolic heart failure,SHF)患者20例及正常对照组41例.二维超声心动图分别存储胸骨旁左室短轴基底水平、心尖水平连续3个心动周期的二维灰阶图像.使用Qlab 7.0工作站进行脱机分析,记录左室上述两短轴切面心内、外膜下心肌旋转角度.结果 ①所有受检者左室同一水平心内、外膜下心肌旋转运动呈相同方向运动,心尖水平呈逆时针方向旋转,基底水平呈顺时针方向旋转.②心尖水平及基底水平心内膜下心肌旋转角度均大于心外膜下心肌旋转角度.③与正常对照组相比,DHF及SHF患者心尖水平心内膜下心肌旋转角度减低;DHF患者心尖水平心外膜下心肌旋转角度与正常组比较未见明显减低,SHF组较正常组及DHF组明显减低.④DHF组基底水平心内、外膜下心肌旋转角度较正常对照组相应心肌层旋转角度值减低,但差异无统计学意义.SHF患者基底水平心内、外膜下心肌旋转角度显著减低.结论 SHF患者左室心内膜下心肌和心外膜下心肌旋转运动减低;DHF患者左室心尖水平心内膜下心肌旋转运动减弱,射血分数正常的DHF患者存在收缩功能异常.

Abstract：

Objective To observe the rotation of subendocardium and subepidium by two-dimensional speckle tracking imaging(2D-STI),and to evaluate its performance in diastolic heart failure patients(DHF)with a normal left ventricular ejection fraction. Methods Ninety-seven consecutive clinically stable patients were enrolled in this study [41 healthy controls,36 with diastolic heart failure,20 with systolic heart failure (SHF)]. High frame rate dynamic two-dimensional images were recorded at the left ventricular short-axis view,including basal, papillary muscle and apical planes. Subendocardial and subepicardial global rotation were measured using Q-lab 7.0 software offline. Results ① In all the subjects, the rotation of the subendocardium was obviously greater than that of subepicardium. ②As seen from the apex,left ventricular subendocardium and subepicardium performed a wringing motion with a clockwise rotation at the base and countclockwise rotation at the apex. ③In the apical plane, subendocardial rotation was significantly lower in both heart failure groups than in controls,and was depressed to a larger extent in SHF patients than in those with DHF. Subepicardial rotation was no significant difference between the DHF group and the control group, though it was significantly lower in patients with SHF. ④At the base, the rotation of subendocardium and subepicardium were not different between DHF and control groups, but it was significantly reduced in patients with SHF. Conclusions The subendocardial rotation is reduced, but subepicardial rotation is normal in DHF patients. On the other hand, in patients with SHF, subendocardial and subepicardial rotation are both reduced. The left ventricular systolic properties are impaired in DHF patients.     

反复发热、消瘦伴脑损害并表现为感染性心内膜炎可能的艾滋病一例

患者女,26岁,农民.因"反复咳嗽、咳痰伴乏力、间断发热2个月余"入院.起病初在当地按"感冒"治疗可缓解,约1个月后突然出现头昏、吐词不清、右侧肢体乏力,右侧颜面感觉迟钝,在当地医院行头颅CT检查提示左基底节、丘脑、内囊及顶叶多发性梗塞,给予脱水治疗.2天后出现咳嗽、咳痰伴每日午后发热,最高达41℃,持续1周.胸片检查提示右下肺感染,直背综合征.反复使用青霉素、先锋霉素等治疗约半个月,体温仍有波动.患者自发病以来,体重下降约5 kg.体格检查:体温36.3℃,心率72次/分,律齐,胸骨左缘第3肋间可闻及舒张期叹气样杂音,右下肺可闻及少许细湿哕音,肝脾肋下未触及,双下肢不肿.     

急性心肌梗死合并慢性肾脏病患者的临床特点分析

目的:探讨急性心肌梗死(AMI)合并慢性肾脏病(CKD)患者的临床特点。方法:回顾性分析华中科技大学同济医学院附属协和医院心内科收治的792例AMI患者,分为合并CKD组(263例)和非CKD组(529例),收集患者的临床基线资料、实验室检查、心电图、心脏超声、冠状动脉(冠脉)造影资料进行比较分析。结果:AMI合并CKD患者组高龄、女性、主诉"喘气"、高血压史、陈旧性心肌梗死、心力衰竭、心源性休克、室性心动过速、心室颤动、院内死亡发生率均显著高于非CKD组(P0.01);而非CKD组合并血脂异常、吸烟史的比例更高(P0.01)。AMI合并CKD≥3期的患者中老年人更常见(P0.01),AMI合并CKD4-5期患者心力衰竭及心源性休克的发生率显著增加(P0.05);合并CKD组的N-末端B型脑钠肽前体(NT-proBNP)水平、糖化血红蛋白、血肌酐、血清白蛋白、血尿酸、胱抑素水平、左房内径明显高于非CKD组(P0.01);左室射血分数(LVEF)显著低于非CKD组(P0.01);右束支传导阻滞、冠脉三支病变、钙化病变、左主干病变比例显著高于非CKD组(P0.05)。结论:AMI合并CKD患者的临床症状常不典型,合并高血压者比例较高,更易出现心源性休克,冠脉病变更为严重,左心功能降低更为明显,预后更差。     

犬骨骼肌成肌细胞体外分离、纯化及培养方法改良探索

目的:探讨犬骨骼肌成肌细胞(SkMs)体外分离、纯化及培养方法的改良并研究其生物学特性.方法:采用机械分离结合Ⅱ型胶原酶、中性蛋白酶双酶一步消化法分离犬骨骼肌成肌细胞,经差速贴壁法纯化后,在骨骼肌细胞生长培养基(SKGM)中进行原代和传代培养,免疫细胞化学染色鉴定.结果:改良后的培养方法适于获取犬骨骼肌成肌细胞,SKGM培养基适于犬骨骼肌成肌细胞的体外培养.SkMs在细胞密集或低血清分化培养基作用下可融合成肌管.结蛋白(desmin)单克隆抗体(mAb)细胞化学染色鉴定SkMs呈阳性,纯度在90%以上.结论:通过改良后的双酶一步消化法获得的SkMs在合适的培养条件下能够增殖、分化并保持其生物学特性,为其在基因治疗和组织工程中的应用奠定了基础.     

急性心肌梗死合并心房颤动患者的临床特点分析

目的 探讨急性心肌梗死(AMI)合并心房颤动(AF)患者的临床特点。方法 纳入2014年1月至2017年12月华中科技大学同济医学院附属协和医院心内科收治的AMI住院患者777例。根据患者既往史及住院期间心电图诊断是否合并AF,将其分为AMI并AF组(78例)和AMI无AF组(699例)。收集2组患者的基本情况、心血管危险因素、生物化学指标、心脏超声、冠状动脉造影等资料,进行统计分析,比较2组患者临床特点的差异。结果 AMI并AF组患者的年龄、吸烟史、卒中史、慢性肾脏病史、室性心律失常的发生率均显著高于AMI无AF组(P＜0.05)。AMI并AF组血红蛋白、红细胞计数、甘油三酯、估算的肾小球滤过率显著低于AMI无AF组,而血尿酸、尿素氮、肌酐、胱抑素C、脑钠尿肽、高敏C反应蛋白水平均显著高于AMI无AF组(P＜0.05)。心脏超声结果显示,与AMI无AF组相比,AMI并AF组左心房内径和右心房内径明显增大(P＜0.01),左心室射血分数显著降低(P＜0.05)。2组冠状动脉造影检查结果无显著差异(P＞0.05)。结论 AMI合并AF患者室性心律失常、心力衰竭发生率高,易合并贫血及慢性肾脏病。     

武汉市社会福利院老年人群高血压现状调查

目的 调查武汉市社会福利院老年人群高血压患病率、知晓率、治疗率和控制率及相关危险因素,为特殊弱势人群中的高血压防治提供新思路.方法 采用问卷调查法对武汉市社会福利院某小区年龄≥60岁68名常住老年人进行调查,由培训过的医师对调查对象进行血压测量、资料收集和健康教育,并按不同年龄段分为3组进行对比分析.结果 武汉市社会福利院老年人群高血压患病率达76.47%,其中单纯收缩期高血压占69.23%.高血压患者的知晓率、治疗率和控制率分别为46.15%、53.85%、15.38%.≥80岁的老年组高血压的治疗率和控制率显著低于其他年龄组(P＜0.05),合并多器官疾病的比例高于其他年龄组(P＜0.05).应用最为广泛的口服降压药物为钙通道阻滞剂和国产复方制剂.Logistic回归分析显示,年龄、肥胖、饮酒、吸烟、心血管病家族史、高盐饮食等危险因素与高血压的发病密切相关.结论 武汉市社会福利院老年人群高血压患病率较高,高血压知晓率、治疗率和控制率仍处于较差水平.社会心理因素在福利院特殊人群高血压的发病和控制中可能起重要作用.社区高血压患者的规范化管理、经常性的健康教育、积极的社会援助和不良生活方式的纠正是福利院老年人群高血压防治的有效措施和手段.     

新型冠状病毒肺炎疫情防控期间急性ST段抬高型心肌梗死患者溶栓治疗七例分析

目的评估在新型冠状病毒肺炎疫情防控期间急性ST段抬高型心肌梗死(STEMI)溶栓疗效及风险,在兼顾疫情防控、确保防护的条件下为急性STEMI溶栓治疗最优化提供参考。方法回顾性分析2020年2月29日至4月3日在华中科技大学同济医学院附属协和医院本部确诊为急性STEMI并行溶栓治疗的7例患者,评估其溶栓疗效及风险;在保障疫情防控、确保防护的前提下优化溶栓流程,成立专职溶栓小组,启动三级防护,定人、定岗、定位,就地隔离溶栓,开放溶栓绿色通道,溶栓前送检血常规、新型冠状病毒肺炎(2019-nCoV)抗体检测、2019-nCoV核酸检测,待溶栓治疗结束后完善肺部CT;通过流程改进前后首次心电图至溶栓时间的比较来评估流程优化效果。结果急性STEMI并行溶栓治疗患者共7例,6例再通,无出血并发症。溶栓后7例患者中有5例住院,平均住院天数19.6 d。随访至2020年4月14日,7例患者无1例死亡。最初的2例患者按常规医疗流程诊治,后5例患者按照优化后流程进行诊治。首次心电图至溶栓时间优化前分别为201、106 min,优化后分别为42、46、51、43、54 min,时间明显缩短。结论在新型冠状病...     

二维斑点追踪成像评价舒张性心功能衰竭患者左心室局部收缩功能

目的 探讨二维斑点追踪成像(speckle tissue imaging,STI)评价射血分数正常的舒张性心功能衰竭(diastolic heart failure,DHF)患者的左心室心肌局部收缩功能.方法 临床确诊的DHF患者与正常对照组各32例.分别存储胸骨旁左心室短轴基底水平、乳头肌水平及心尖水平连续3个心动周期的二维灰阶图像,使用Qlab7.0工作站进行脱机分析,记录上述三个短轴切面共18个节段径向收缩期峰值应变率;记录基底水平、心尖水平旋转角度峰值,计算左心室扭转峰值(Twist).结果 DHF组的各节段径向应变率曲线形态与正常对照组相似,两组内同一水平不同节段间的径向应变率峰值差异均无统计学意义(P>0.05).与正常对照组相比,DHF组左心室心尖水平前间隔、侧壁、后壁、下壁,乳头肌水平后壁、后间隔,基底水平后壁、下壁及后间壁的收缩期峰值应变率低于正常对照组(P<0.05).DHF组左心室心尖、基底水平旋转角度峰值及左心室整体扭转角度峰值均较正常组减低,但差异无统计学意义(P>0.05).结论 二维斑点追踪成像显示左心室射血分数正常的DHF患者早期存在局部心肌收缩功能异常.