Impact of repaired aortic coarctation in left ventricular myocardial work

AimsMyocardial strain analysis enables more precise assessment of cardiac performance but is relatively load dependent. New tools have been developed with afterload adjustment. Our objective was to assess myocardial work (MW) in patients with repaired aortic coarctation (rACo).MethodsProspective study of consecutive patients with rACo who underwent a routine transthoracic echocardiogram in 2018 and 2019 at our center. Patients with significant aortic valve disease, pacemaker, or other congenital heart diseases (except for mild bicuspid aortic valve disease) were excluded. Global longitudinal strain with two dimensional speckle tracking analysis and MW were obtained (GWI:Global Work Index; GCW: Global Constructive Work; GWW: Global Wasted Work; GWE: Global Work Efficiency). Blood pressure was measured in the patient's right arm.ResultsWe included 42 patients in the analysis, mean age of 37±10 years, 38% males. In this group, 52% had hypertension and 64% had a concomitant bicuspid aortic valve. In comparison to previously published reference values, patients with rACo had significantly lower GWI (1807 vs. 1896 mmHg%) and GCW (2173 vs. 2232 mmHg%) (p<0.001), particularly in males. Systolic blood pressure is an independent predictor for GWI (β=0.432) and for GCW (β=0.534) and GLS an independent predictor of all MW parameters (β>0.594). Neither age nor gender were independent predictors.ConclusionsIn patients with rACo, there are some signs of left ventricular dysfunction with a reduction in GCW and GWI and with preserved GWE, despite normal ejection fraction and strain.     

Baicalin-loaded PEGylated lipid nanoparticles: characterization,pharmacokinetics, and protective effects on acute myocardial ischemia in rats

Context: Baicalin has many pharmacological activities, including protective function against myocardial ischemia by antioxidant effects and free radical scavenging activity. However, its rapid elimination half-life in plasma and poor water solubility limits its clinical efficacy.

Objective: Novel baicalin-loaded PEGylated nanostructured lipid carriers (BN-PEG-NLC) were developed to improve bioavailability of BN, to prolong retention time in vivo and to enhance its protective effect.

Methods: In this study, BN-PEG-NLC were prepared by the emulsion-evaporation and low temperature-solidification method using a mixture of glycerol monostearate and polyethylene glycol monostearate as solid lipids, and oleic acid as the liquid lipid. The physicochemical properties of NLC were characterized. The pharmacokinetic and pharmacodynamic behaviors of BN-PEG-NLC or BN-NLC were evaluated in acute MI rats.

Results and discussion: The particle size, zeta potential, and entrapment efficiency for BN-PEG-NLC were observed as 83.9?nm, ?32.1?mV, and 83.5%, respectively. The release profiles of BN from both BN-PEG-NLC and BN-NLC were fitted to the Ritger–Peppas modal, which presented burst release initially and prolonged release afterwards. Pharmacokinetics results indicated that BN-PEG-NLC exhibited a 7.2-fold increase in AUC in comparison to BN solution, while a 3-fold increase in comparison to BN-NLC. Biodistribution results revealed that BN-PEG-NLC exhibited higher heart drug concentration compared with BN-NLC as well as BN solution. In the present study, BN-PEG-NLC significantly ameliorated infarct size.

Conclusion: The results of the present study imply that PEG-NLC could be the biocompatible carriers for heart-targeted drug delivery to improve myocardial ischemia.     

缺血修饰性白蛋白在急性缺血性胸痛中的诊断价值

目的 评价缺血修饰性白蛋白（ischemia modified albumin，IMA）对急性缺血性胸痛（ICP）的早期诊断价值。方法 时206例发病〈12h、表现为急性胸痛的患者立即行12导联心电图（ECG）检查，并抽血进行IMA、肌钙蛋白I（cTnI）、肌酸激酶同工酶MB（CK-MB）测定。将ECG、IMA、cTnI、CK-MB的结果单独或结合与最终诊断为非缺血性胸痛（NICP）及ICP的相互关系进行比较。结果 最后诊断为ICP98例，NICP108例，ICP发病〈3h和3-6h组IMA水平明显升高，与NICP组比较差异有统计学意义（P〈0．001）；ICP发病〉6h组IMA水平与NICP组比较差异无统计学意义（P〉0．05）。IMA诊断发病〈3hICP的敏感性和阴性预测值（NPV）为89．1％和88．8％，明显高于ECG、cTnI和CK-MB，四者结合为97．6％和96．9％；IMA诊断发病3～6hICP的敏感性和NPV为71．7％和74．5％，也高于ECG、cTnI、CK-MB，四者结合为95．5％和94．2％；但IMA对于发病〉6h的ICP则无诊断作用。结论 IMA是诊断ICP的早期敏感生化指标，对于发病〈6h（尤其是〈3h）的ICP诊断具有较高的敏感性和NPV，优于ECG、CK-MB、cTnI；将IMA与其他指标结合，可进一步提高对ICP的诊断价值。     

急性心肌梗死急诊介入治疗的临床评价

目的探讨急诊经皮冠状动脉介入治疗术(PCI)对ST段抬高型急性心肌梗死(STAMI)的治疗价值。方法STAMI46例,在发病12h内行急诊冠状动脉造影及直接冠脉支架置入术(DS)或预扩张后支架置入术(PS),观察术中心律失常发生情况,术后TIMI分级、心电图,出院前左室射血分数(LVEF)和住院期间主要不良心脏事件(MACE)等。结果DS组与PS组各项指标无差异,44例达TIMI3级,成功率达95.7%,ST段回落率67.4%,平均LVEF(49.4±9.46)%,术中心律失常发生率21.7%,无MACE发生。结论对于发病12h的STAMI患者,行急诊PCI,可开通梗塞相关动脉(IRA),改善心肌再灌注和近期预后。     

Observations on the efficacy of combined acupuncture and medicine in Treating 50 cases of pseudobulbar paralysis

目的：观察针药结合治疗假性延髓麻痹的疗效。方法：采用完全随机抽样法分为针刺组50例，对照组48例。针刺组在西医治疗的同时，应用针刺进行综合治疗；对照组单纯接受西医药物治疗。结果：针刺组有效率为92．0％，对照组为62．5％。两组疗效差异具有非常显著性意义（P〈0．01）。结论：针药结合治疗假性延髓麻痹效果明显优于单纯西药治疗。     

急性肺栓塞时心肌血流灌注的变化

目的观察急性肺栓塞（APE）后冠状动脉血流量及心脏肌钙蛋白T（cTnT）与肌红蛋白（Mb）含量变化，探讨心肌血流灌注在急性肺栓塞继发心肌损伤机制中的作用。方法通过介入方法经导管注入自体血栓选择性栓塞肺动脉，建立不同栓塞面积的急性肺栓塞动物模型。监测栓前、栓后5、30min，1、2h冠状动脉血流量变化及栓后4h血清cTnT与Mb含量。结果急性肺栓塞后血清cTnT与Mb含量升高。急性肺栓塞导致冠状动脉血流量显著下降，肺血管栓塞后15～30min降至最低值，30min后趋于平稳。右冠血流量下降程度与肺栓塞面积有显著相关性。结论冠状动脉血流量减少及血清心肌结构蛋白含量升高为急性肺栓塞继发心肌缺血改变提供了直接证据。急性心肌缺血严重影响急性肺栓塞的预后。