3D打印是指通过数字图像数据转换为具有三维物理模型的技术.随着3D打印技术的不断成熟并与医学领域的结合,3D生物打印为心血管疾病治疗康复提供新思路.本文就3D生物打印技术在心血管领域研究的进展作一综述.

"微创"是现代心脏外科的重要发展趋势,胸腔镜下的心脏外科手术虽然近年来刚刚起步,但却是心脏外科领域一次非常重要的"微创"技术飞跃,也是微创心脏手术未来发展的重要方向.胸腔镜下的心脏外科手术与传统手术相比较具有损伤小、恢复快、美观等特点,但对心脏外科医师所需要掌握的心脏外科胸腔镜技术要求较高.

BACKGROUND:Gastric variceal bleeding is often more serious and can be fatal. Currently, international consensus recommendations for the treatment of gastric variceal bleeding vary according to endoscopic classification. Few studies have investigated ligation versus gastric variceal obturation (GVO) for the treatment of gastric varices. METHODS:The study included 79 patients with cirrhosis-induced bleeding from esophageal and fundal varices who were treated at the Second Hospital of Hebei Medical University between January 2016 and December 2020 and who met the inclusion criteria. Among them, 42 patients were included in the intensive gastric varices ligation (IGVL) group, and 37 were included in the GVO group. We conducted a retrospective cohort study to analyze the effectiveness and safety of these 2 treatments. RESULTS:The rebleeding rate after initial treatment was significantly lower in the IGVL group than in the GVO group (23.8% vs. 48.6%, P<0.05). No significant between-group difference was observed in overall mortality (14.3% vs. 32.4%), 6-week mortality (0.0% vs. 2.7%), or 1-year mortality (11.9% vs. 13.5%, all P>0.05). The >1-year mortality and bleeding-related mortality rates were significantly higher in the GVO group than in the IGVL group (23.3% vs. 2.7%, P<0.05; 27.0% vs. 9.5%, P<0.05). The incidence of adverse events was 57.1% in the IGVL group and 48.6% in the GVO group, with no significant difference (P>0.05). Independent predictors for rebleeding after initial treatment were the use of GVO as endoscopic treatment, total bilirubin >17.1 µmol/L, liver cancer, and diabetes. For mortality, the independent predictors were male sex, liver cancer, ascites, and rebleeding after initial treatment. CONCLUSIONS:Rebleeding after initial treatment was lower after IGVL than GVO. Independent predictors for rebleeding after initial treatment were endoscopic treatment method, total bilirubin >17.1 µmol/L, liver cancer, and diabetes. For mortality, the independent predictors were male sex, liver cancer, ascites, and rebleeding after initial treatment.

胃食管反流病(gastroesophageal reflux disease,GERD)是消化内科的常见疾病,临床表现容易反复发作,同时胃食管反流病被认为是食管腺癌(esophageal adenocarcinoma,EAC)发生的危险因素.家族研究显示GERD遗传率约为30％,COL3A1、ABAT基因与遗传风险显著相关;多种基因如IL-1基因簇、GNB3、GSTP1与GERD发生风险密切相关.TP53基因突变及EGF、MMP、CCND1、CDX2、COX-2的单核苷酸多态性会导致基因组不稳定,进而促使部分个体向Barrett食管及食管腺癌发展.本文就胃食管反流病发生及发展为食管腺癌过程中分子生物学的作用作一综述.

Background To investigate the current state of knowledge and practice of Helicobacter pylori (H. pylori) infection management in China. Materials and Methods This nationwide, multicenter, cross-sectional questionnaire survey was conducted between March and April 2021 with respect to the diagnosis and treatment of H. pylori infection in 31 provinces, encompassing over 1000 hospitals in mainland China. General physician information, diagnostic and detection status, eradication treatment, reexamination and follow-up after treatment, and basic knowledge of physicians were collected and compared with the Fifth Chinese National Consensus Report on Management of H. pylori infection and the 2016 Maastricht V/Florence guidelines. The subgroup analysis was also performed. Results Of the 6873 questionnaire respondents, 48.8% were males, and 51.2% were females. Approximately, 26.5% of respondents indicated that their hospitals had dedicated clinics for managing H. pylori infection. Moreover, 88.0% of respondents prescribed a bismuth-containing quadruple regimen as the initial eradication treatment, and 92.7% deemed the gastric acid suppression critical. Furthermore, 91.0% of respondents routinely recommended a reexamination 1-2 months after eradication therapy, and 95.1% advised patients to stop PPI treatment at least 2 weeks before reexamination. The detail of following (the choice of target population/methods; the choice/availability of drugs/regimens, indications for eradication, factors influencing eradication efficacy/improvement methods and factors influencing adherence, management options/factors influencing relapse; the timing and methods, awareness of reinfection rates/prevention measures, and the approach to continuing education, awareness of guidelines, and acceptance of current core concepts of management) was also described. Subgroup analysis further revealed that significant differences were existed in being gastroenterologist or not, different education level, professional title, years of working, and provincial administrative regions. Conclusions Chinese physicians' skills and knowledge about the diagnosis and treatment of H. pylori infection could be improved. More works on education are needed in future.

遗传因素是华法林存在个体差异的最重要因素,与药代动力学、药效学及药物转运相关的基因都能够影响华法林的抗凝治疗.近年研究发现,载脂蛋白E(ApoE)基因多态性与华法林个体剂量差异相关.本文就ApoE基因多态性对华法林稳定剂量的影响以及华法林个体化给药方案的研究进展作一综述.

Lung aging alters the intrinsic structure of the lung and pulmonary surfactant system and increases the mortality and morbidity due to respiratory diseases in elderly individuals. We hypothesized that lung aging results from an insufficiency of type II alveolar epithelial cells (AECIIs) in the lung tissue. Sirtuin 3 (SIRT3) is a member of the sirtuin family of proteins that promote longevity in many organisms. Increased SIRT3 expression has been linked to an extended life span in humans. Hence, we speculated that the overexpression of SIRT3 may help to ameliorate lung senescence and improve AECII function. AECIIs were isolated from young and old patients with pneumothorax caused by pulmonary bullae. The expression of SIRT3, manganese superoxide dismutase, and catalase, as well as cell function and senescence indicators of young and old AECIIs, was measured before and after SIRT3 overexpression. After SIRT3 overexpression, the aged state of old AECIIs improved, and antiapoptotic activity, proliferation, and secretion were dramatically enhanced. Surfactant protein C (SPC), which is secreted by AECIIs, reduces alveolar surface tension, repairs the alveolar structure, and regulates inflammation. SPC deficiency in patients is associated with increased inflammation and delayed repair. SIRT3 deacetylated forkhead box O3a, thereby protecting mitochondria from oxidative stress and improving cell function and the senescent state of old AECIIs. These findings provide a possible direction for aging-delaying therapies and interventions for diseases of the respiratory system.

目的:比较HTK液与冷血停搏液在心脏瓣膜手术中应用效果,为临床心肌保护灌注策略提供依据.方法:采用单中心数据回顾性分析,选取2015年5月-2018年8月在体外循环下(CPB,Cardiopulmonary Bypass)应用灌注停跳液停跳的瓣膜手术患者529例,分为冷停液组(n=326)及HTK液组(n=203),采用倾向得分匹配方法将上述两组资料进行匹配,确定选取73对可匹配病例进行比较.采集的临床结果主要为CPB时间,阻断时间,ICU停留时间(intensive care unit length of stay,ICU LOS)以及血清钠术中术后浓度变化等参数.其次为,术后呼吸机辅助时间,IABP(Intra aortic ballon pump)的使用及新发透析,30天死亡率与术后主要并发症情况.结果:匹配后两组中冷停液组较HTK液组的主动脉平均阻断时间及CPB时间长,差异具有统计学意义(P＜0.05),HTK液组存在短暂性低血钠血症(P＜0.05),ICU LOS以及其余各临床结果无显著差异.结论:心脏瓣膜手术中应用HTK液与冷血停搏液临床早期结果一致,可根据手术操作流程及病人经济水平进行合理选择.

目的 探讨内镜下密集套扎结合硬化剂治疗肝硬化食管胃重度静脉曲张对患者肝合成功能的影响.方法 选取河北医科大学第二医院消化内科自2014年1月至2018年12月收治的76例肝硬化食管胃重度静脉曲张患者为研究对象.所有患者均进行了密集套扎结合小剂量聚桂醇血管内注射治疗,分别在套扎前、密集套扎、补充套扎、第1次硬化、第2次硬化治疗日当天早晨空腹于肘正中采取少量静脉血,并检测血清前白蛋白、凝血酶原活动度、胆碱酯酶及其余生化指标.观察治疗前后患者各指标及Child-Pugh分级的变化情况.结果 随着治疗方式的推进,患者的凝血酶原活动度、前白蛋白及胆碱酯酶指标逐渐升高,与前1次治疗比较,差异均有统计学意义(P<0.05).治疗后,Child-Pugh分级A级患者比例高于治疗前,B级、C级患者比例低于治疗前,差异均有统计学意义(P<0.05).结论 对于肝硬化食管胃重度静脉曲张患者采取血管内注射小剂量聚桂醇并联合密集套扎的治疗方法,在治疗食管胃重度静脉曲张的同时,并随序贯治疗的完成,肝合成功能逐步恢复.

1例30岁Turner综合征女患者,合并DeBakeyⅡ型主动脉夹层、主动脉瓣关闭不全(轻-中度)、主动脉缩窄.完善相关检查后,于2016年10月20日在深低温停循环下行主动脉瓣成形+升主动脉及半弓人工血管置换+升主动脉-胸降主动脉人工血管分流术.术后患者恢复良好.目前随访2年余,患者高血压消失,已恢复正常工作、生活.Turner综合征合并多种高危因素导致DeBakeyⅡ型主动脉夹层、胸降主动脉缩窄,一期手术治疗可取得良好效果,诊疗过程中应注意加强对患者的心理呵护,使患者生理与心理均健康.

Engineered heart tissues (EHTs) are regarded as being the most promising alternative to synthetic materials, and autologous mesenchymal stem cells (MSCs) are widely used as seeding cells. However, few studies have evaluated the feasibility of using MSCs from patients with cyanotic congenital heart disease (C-CHD) as seeding cells for EHTs, in comparison with cells from patients of acyanotic congenital heart disease (A-CHD). In the present study, we cultured MSCs from A-CHD and C-CHD patients in normoxia or hypoxia conditions, and compared their pro-angiogenic, anti-apoptotic and inflammation-modulatory potentials. In vivo, we seeded the cells into collagen patches conjugated with, or without, proangiogenic cytokines, which were used to repair the right ventricular outflow tract (RVOT) of rats. The in vitro results showed that C-CHD MSCs expressed higher levels of VEGFA and VEGFR2, and secreted more pro-angiogenic and anti-inflammatory cytokines under hypoxic conditions. On the other hand, apoptosis-related genes from C-CHD MSCs were modulated adaptably, converting these cells into an anti-apoptotic phenotype. In vivo studies demonstrated that in 4 weeks after RVOT reconstruction, cytokine-immobilized patches seeded with C-CHD MSCs exhibited preserved morphology, prolonged cell survival and enhanced angiogenesis compared to A-CHD MSCs. C-CHD MSCs that undergo “naturally hypoxic precondition” present a better cell source for EHTs, which would provide a promising individualized biomaterial for C-CHD patients.

目的 探讨建立大鼠右室流出道重建术动物模型的可行性.方法 对15只成年雌性Sprague-Dawley (SD)大鼠实施右室流出道重建术.将胶原海绵补片经过碳化二亚胺法处理,并种植人骨髓间充质干细胞(紫绀型先心病患者来源,年龄＜5岁),利用新构建的工程化心肌补片修补大鼠的右心室流出道.3d后,随机取3只大鼠处死,取出心脏,对心脏正面、内面及剖面摄片,以确定透壁切除心肌组织.4周后,将大鼠心脏取出,作抗人线粒体抗体染色确定补片是否仍有种子细胞存活(n=4).此外,在1个月、3个月时,各处死大鼠3只,直视摄影观察并行马洪染色(Masson's trichrome)观察补片降解情况(n=3).结果 2只大鼠于术后24 h内死亡,建模总体死亡率为13.3％(2/15).直视摄片证明右心室流出道为透壁切除,补片完全替代了右室流出道心肌组织.4周后补片上仍有种子细胞存活.结论 大鼠右室流出道重建术模型可作为组织工程心肌补片(EHT)实验研究中一种稳定、可靠且经济的初筛模型.

心脏移植是治疗终末期心脏病的一种有效方法,但由于供体的缺乏使其开展受到限制.近年来异种心脏移植(CXTx)的研究取得了显著的进展,为心脏移植供体短缺提供了一个可行的方案.但由于存在跨物种免疫排斥反应、移植术后无法长期维持心脏生理功能及移植物状态监测欠佳等问题,CXTx仍面临着许多挑战.本文就CXTx在免疫排斥反应、移植方法、异种移植物状态监测等方面的研究进展做一综述并讨论CXTx的临床应用前景及面临的挑战.

目的:通过转染Bcl-2基因增强老年人骨髓间充质干细胞(hMSCs)的Bcl-2表达,尝试改善老年hMSCs在缺氧环境下的抗凋亡、抗损伤能力,为基因联合细胞移植改善老年hMSCs自体移植治疗缺血性心脏病的提供依据.方法:分离培养老年hMSCs并进行鉴定.构建Bcl-2基因质粒并对老年入hMSCs进行Bcl-2基因的转染.应用CO2和N2的混合气体建立稳定的缺氧培养环境模拟心肌梗死时的缺氧环境,分别对老年hMSCs及Bcl-2转染后老年hMSCs进行缺氧培养,比较各组细胞的细胞凋亡及损伤情况.通过冠状动脉结扎建立稳定的大鼠心肌梗死模型,分别应用老年hMSCs及Bcl-2转染后的老年hMSCs进行细胞移植,比较各组细胞在心肌梗死区域缺氧环境下的存活情况,同时应用超声心动图对比两组细胞移植后心肌梗死大鼠心脏功能的改善情况.结果:转染Bcl-2的老年hMSCs能够稳定表达Bcl-2的基因及蛋白.转染Bcl-2后的老年hMSCs在缺氧环境下较未转染的老年细胞其凋亡数量明显下降、生存率明显提高,表达的Bcl-2基因及蛋白也多于未转染的老年细胞.各组细胞移植至大鼠梗死心脏后可见转染Bcl-2的老年hMSCs组的细胞存活数量明显高于未转染组,梗死心脏的Bcl-2的基因含量和蛋白表达量也高于未转染老年细胞移植组,心肌梗死大鼠在移植了转染Bcl-2的老年hMSCs组后其心脏的射血分数和左心室短轴缩短率好于未行细胞移植组和移植未转染细胞组.结论:增加老年hMSCs中Bcl-2基因的含量能够增加其Bcl-2蛋白表达量、增强其在缺氧环境中的抗凋亡能力.应用Bcl-2转染的方法能够增强老年hMSCs移植治疗心肌梗死时的移植后细胞存活能力、提高梗死区域的Bcl-2蛋白表达量并增强了老年hMSCs移植改善心肌梗死后心脏功能的效果.

Recent evidence highlights that microRNAs serve as crucial regulators of tumorigenesis, including non-small cell lung cancer (NSCLC). The present study was designed to investigate the expression profile, clinical significance and biological role of miR-421 in NSCLC. The results showed that miR-421 expression was markedly increased in NSCLC tissues and cell lines. Further experimental data indicated that knockdown of miR-421 significantly inhibited NSCLC cell proliferation and induced cell cycle arrest in vitro. The migratory and invasive abilities of NSCLC cells were also attenuated following miR-421 knockdown. Furthermore, PDCD4 was identified as a direct target of miR-421, and its expression was inversely correlated with miR-421 expression in NSCLC tissues. PDCD4 also abrogated the oncogenic role of miR-421 in NSCLC cells. Collectively, our study revealed that miR-421 is significantly upregulated in NSCLC and might represent a potential therapeutic target for NSCLC patients.

Adipose‑derived stem cells (ADSCs) and bone marrow‑derived stem cells (BMSCs) are considered to be prospective sources of mesenchymal stromal cells (MSCs), that can be used in cell therapy for atherosclerosis. The present study investigated whether ADSCs co‑cultured with M1 foam macrophages via treatment with oxidized low‑density lipoprotein (ox‑LDL) would lead to similar or improved anti‑inflammatory effects compared with BMSCs. ADSCs, peripheral blood monocytes, BMSCs and ox‑LDL were isolated from ten coronary heart disease (CHD) patients. After three passages, the supernatants of the ADSCs and BMSCs were collected and systematically analysed by liquid chromatography‑quadrupole time‑of‑flight‑mass spectrometry (6530; Agilent Technologies, Inc., Santa Clara, CA, USA). Cis‑9, trans‑11 was deemed to be responsible for the potential differences in the metabolic characteristics of ADSCs and BMSCs. These peripheral blood monocytes were characterized using flow cytometry. Following peripheral blood monocytes differentiation into M1 macrophages, the formation of M1 foam macrophages was achieved through treatment with ox‑LDL. Overall, 2x106 ADSCs, BMSCs or BMSCs+cis‑9, trans‑11 were co‑cultured with M1 foam macrophages. Anti‑inflammatory capability, phagocytic activity, anti‑apoptotic capability and cell viability assays were compared among these groups. It was demonstrated that the accumulation of lipid droplets decreased following ADSCs, BMSCs or BMSCs+cis‑9, trans‑11 treatment in M1 macrophages derived from foam cells. Consistently, ADSCs exhibited great advantageous anti‑inflammatory capabilities, phagocytic activity, anti‑apoptotic capability activity and cell viability over BMSCs or BMSCs+cis‑9, trans‑11. Additionally, BMSCs+cis‑9, trans‑11 also demonstrated marked improvement in anti‑inflammatory capability, phagocytic activity, anti‑apoptotic capability activity and cell viability in comparison with BMSCs. The present results indicated that ADSCs would be more appropriate for transplantation to treat atherosclerosis than BMSCs alone or BMSCs+cis‑9, trans‑11. This may be an important mechanism to regulate macrophage immune function.

目的 寻找到一种与人类心肌细胞衰老及缺血再灌注损伤相关的基因或蛋白,为增强老年人心肌细胞抗缺血再灌注损伤能力、提高心外科治疗效果提供依据.方法 经我院伦理委员会批准、术前签订知情同意书,对心脏外科术中需心脏停跳的年轻(5～10岁)及老年(60岁以上)患者,分别切取停跳前后废弃的心房肌组织约1 cm×1 cm,应用Real time PCR及Western blot技术检测和比较年轻与老年人心肌细胞中氧化物酶增殖激活的受体 α(PPARα)的表达水平差异,并进一步分析缺血再灌注前后PPARα 含量在不同年龄患者心肌中的变化情况.结果 通过对比年轻及老年人的心肌细胞中PPARα在mRNA和蛋白表达水平上的差异,可见老年人心肌细胞中PPARα 的mRNA和蛋白表达水平明显低于年轻人(P<0.05);年轻和老年人心肌组织中PPARα 的mRNA表达水平在经历缺血再灌注损伤后均明显增加,并且年轻人心肌组织中PPARα 的mRNA表达增加的比例明显高于老年人(P<0.05);年轻和老年人心肌组织中PPARα 蛋白含量在经历缺血再灌注损伤后均明显增加,但本次研究中年轻人心肌组织中PPARα 蛋白含量的增加比例与老年人相比并未发现明显差异.结论 随着年龄的增加,人心肌细胞中PPARα 基因含量及蛋白表达明显减少,而当年轻人及老年人心肌细胞在遭到缺血再灌注损伤时,PPARα 基因含量及蛋白表达均明显增加,其中年轻人心脏中的PPARα 在损伤时增加的较老年人可能更为明显.

Objective To construct a cationic microbubble (CMB), and investigate the enhancement of gene transfection efficiency and therapeutic effect of ultrasound-targeted microbubble destruction (UTMD) in vivo with CMB compared to definity MB (DMB). Methods In vitro, the CMB was prepared by the method of thin film hydration. The morphology, size, zeta potential, and gene-carrying capacity of CMB were compared with the DMB. In vivo, the firefly luciferase gene which was used as a reporter gene was targeted transfected into myocardium of 16 rats with CMB and DMB, respectively. The gene transfection efficiency and targeting were observed dynamically. Then, ischemia-reperfusion (I/R) model was performed on 64 rats. The models of 60 rats were successfully confirmed by using ultrasonography at 5 days after I/R. The rats were divided into 3 groups ( n=20) randomly. The control group received DMB carrying empty plasmid for transfection; DMB group received DMB carrying AKT plasmid for transfection; and CMB group received CMB carrying AKT plasmid for transfection. The cardiac perfusion, cardiac function, infarct size, and infarct thickness were measured by ultrasonography and histological observations after treatment. In addition, the capillary and arteriolar densities were measured with immunohistochemical staining. The myocyte apoptosis was measured with TUNEL staining. The protein expressions of AKT, phospho-AKT (P-AKT), Survivin, and phospho-BAD (P-BAD) were measured by Western blot. Results The size of CMB was uniformly. The zeta potential of CMB was significantly higher than that of DMB ( t=28.680, P=0.000). The CMB bound more plasmid DNA than the DMB ( P<0.05). The luciferase activity of myocardium were higher in CMB group than in DMB group both in vitro and in vivo measurements ( P<0.05). There was no significant difference between groups in the ratio of signal intensity in anterior wall to posterior wall, ejection fraction (EF), and fractional shortening (FS) at 5 days after I/R ( P>0.05), but the above indexes were significant higher in CMB and DMB groups than in control group at 21 days after I/R ( P<0.05). Besides, the above indexes were significant higher in CMB group than in DMB group at 21 days after I/R ( P<0.05). The infarct size was the smallest and infarct thickness was the thickest in the CMB group, followed by DMB group, control group at 21 days after I/R. The capillary and arteriolar densities of CMB and DMB groups were significant higher than those of control group at 21 days after I/R ( P<0.05). Besides, the capillary and arteriolar densities of CMB group were significant higher than those of DMB group ( P<0.05). The apoptotic cells were the most in the control group, followed by DMB group, CMB group at 3 days after gene transfection, showing significant differences between groups ( P<0.05). The protein expressions of AKT, P-AKT, Survivin, and P-BAD were significant higher in CMB and DMB groups than those in control group at 3 days after gene transfection ( P<0.05). Besides, these protein expressions were significant higher in CMB group than those in DMB group ( P<0.05). Conclusion The DNA-carrying capacity and gene transfection efficiency are elevated by CMB, although its physicochemical property is the same as DMB. When ultrasound-targeted AKT gene transfection is used to treat myocardial I/R injury in rats, delivery of AKT with the CMB can result in higher transfection efficiency and greater cardiac functional improvements compared to the DMB.

Left ventricular aneurysm (LVA) is a common complication of myocardial infarction. However, the optimal treatment for LVA remains controversial. In this retrospective study, we analyzed the early and long-term clinical consequences of surgical ventricular restoration on 102 patients who had undergone repair between January, 2005 and January, 2015. The LVA repair approaches comprised of patch plasty (n=28), linear repair (n=40), and plication repair (n=34). Patient demographics were 60.8% male, and the mean age was 60.5 +/- 7.2 years. The in-hospital mortality rate was 7.8% (8/102), including 6 patients who died from low cardiac output and 2 from multiorgan failure. During the early postoperative period, left ventricular sizes significantly decreased in the patch plasty and linear repair groups compared with the plication group. In addition, all 3 repair techniques greatly ameliorated left ventricular ejection fraction (P<.05), and there was no significant difference in survival rate between groups (P=.25). Surgical ventricular restoration (linear repair, plication repair, and patch plasty) obtained equivalently appreciable outcomes for cardiac function improvement, perioperative mortality, and survival. Selection of a surgical technique for LVA patients should be optimized to individual patient conditions including the morphological characteristics of the aneurysm and ischemic scar.

目的 探讨体验式教学法对住培学生各方面能力的提升作用,探索提高心血管外科住培教学效果的方法 .方法将我院心血管外科住培基地的59名学生随机分为实验组和对照组,对照组按住培大纲进行各项教学内容,实验组按大纲要求进行教学的同时融入体验式教学法,通过考核成绩及问卷调查综合比较分析各组教学效果.结果 实验组理论考试、病例分析、体格检查的评分均高于对照组,差异有统计学意义(P<0.05),而病历书写、诊疗技术、手术操作的评分虽略高于对照组,但差异无统计学意义(P>0.05).90％ 以上实验组学生通过问卷调查反馈体验式教学法对提高学习能力、增强表达能力等方面有较大帮助.结论 体验式教学法有助于提高心血管外科住院医师规范化培训的教学效果.