Myocardial infarction (MI) is a leading cause of high global cardiovascular mortality and disability. Platelet-rich plasma (PRP), as a widely available autologous biological product rich in various growth factors, holds significant potential for promoting tissue healing and regeneration. However, its clinical application is limited by short in vivo retention time and transient therapeutic effects, necessitating the development of novel drug delivery systems to enhance its clinical value. In this study, a novel injectable PRP-Gel composite was developed. Based on the Schiff base reaction, the composite gel exhibits excellent biocompatibility, biodegradability, appropriate mechanical properties and enables controlled release of multiple growth factors from PRP. Results at 28 days post-intramyocardial injection demonstrated that, compared with the control group, the PRP-Gel composite effectively promoted angiogenesis, inhibited cardiac cell apoptosis and injury, significantly reduced infarct size, decreased myocardial fibrosis and preserved ventricular wall thickness, ultimately leading to a marked improvement in cardiac function. In summary, the composite gel developed in this study provides an optimized strategy for the clinical application of PRP and represents a promising therapeutic approach for myocardial regeneration following MI.

慢性血栓栓塞性肺高血压(chronic thromboembolic pulmonary hypertension,CTEPH)是未溶解的血栓发生机化、内膜纤维性增生,近端肺血管腔狭窄甚至闭塞、远端肺血管重构,引起肺动脉压力及肺血管阻力进行性升高,右心负荷逐渐增加,最终导致右心衰竭甚至死亡的一组病理生理学复杂的临床综合征[1].其主要临床表现为呼吸困难、乏力、活动耐力减低.依照我国2021 年肺高血压指南的临床分类,CTEPH属于第四类肺动脉阻塞性疾病导致的肺高血压;按照血流动力学分类,CTEPH属于毛细血管前性肺动脉高压.

摘要：慢性血栓栓塞性肺高血压 (CTEPH) 属于第四类肺动脉阻塞性疾病导致的肺高血压，它是多种原因共同作用，引起近端肺血管阻塞、远端肺血管重构，最终导致右心衰竭，甚至死亡的一种病理生理学复杂、预后不良的严重疾病。该病的发病机制仍不完全清楚，多种因素可能共同作用于该病的发生、发展的全过程，包括炎症、原位血栓和内皮功能障碍等多种因素。其中炎症在该疾病中的作用已越来越多的受到关注，了解炎症在CTEPH中的作用不仅有助于确定最佳的治疗方案，还可能有助于未来预防策略的制定。本文将对炎症在CTEPH中的作用进行综述，以期能够为更好的制定CTEPH的治疗策略提供更多的帮助。

主动脉夹层(aortic dissection,AD)指主动脉腔内的血液从主动脉内膜撕裂处进入主动脉中膜,使中膜分离,沿主动脉长轴方向扩展形成主动脉壁的真假两腔分离状态[1],血液可在真假腔间流动或形成血栓,真、假腔可相通或不通.是主动脉病变最常见死亡原因,发病率为(2.6～6.0)/10万[2],由于检查技术提升,近年来有文献报道发病率可达16.3/10万.

Objective To investigate the effect of PLGA-PEG scaffold incorporating angiopoietin 1(Ang1) loaded nanoparticle that was injected into the infarcted area of rat heart to protect the heart from infarction and explore potential mechanisms. Methods Rat models of myocardial infarction were replicated,and one week later SD rats were randomly divided into 3 groups:Ang1-PLGA-PEG injection group [injected with 100 μL nanoparticle suspension, about (1.61±0.05)μg Ang1](n=9),Ang1 injection group[injected with PBS solution of angiopoietin1(100 μL, 25 ng/μL)](n=8),the model control group(injected with 100 μL PBS solution)(n=8). Four weeks after injection,cardiac function was examined by echocardiography,scar tissue hyperplasia was measured by Masson staining, cardiomyocyte apoptosis and angiogenesis were detected by immunofluorescence. Results In comparison with other two groups,Ang1-PLGA-PEG injection group showed an increased blood vessel density in the infarcted area and maturity(P＜0.05),which prevented cardiomyocyte apoptosis (P＜0.05) The area of myocardial infarction was significantly decreased(P＜0.05), the remodeling of cardiomyopathy was reduced and these changes improved cardiac function (P＜0.05). Compared with the model control group, pure Ang1 injected into the surrounding area did not show curative effect (P＜0.05). Conclusions Injection of Ang1-PLGA-PEG nanoparticles into the infarcted area of left ventricle may promote vascular proliferation and facilitate the survival of cardiomyocytes,It provides an experimental basis for clinical application.

目的:探讨延伸至心脏的静脉内平滑肌瘤病发病机制、临床特点、手术治疗方式;提高对延伸至心脏的静脉内平滑肌瘤病的认识.方法:回顾性分析兰州大学第一医院收治的3例延伸至心脏内的静脉内平滑肌瘤病患者临床资料、诊治过程,并复习相关文献.结果:3例患者均成功行手术治疗,其中2例一期一站式经胸腹联合切口行"子宫、附件、盆腔肿物切除+心脏、下腔静脉肿物取出术",另1例患者手术分2期进行,一期先行"右心房肿物切除+三尖瓣成形术",术后1周二期行"全子宫切除+双侧附件切除+下腔静脉肿物取出+右侧输尿管支架植入术".3例患者均手术成功,术后康复出院.结论:延伸至心脏的静脉内平滑肌瘤病临床少见,彻底切除瘤体是治疗本病的关键.手术需多学科联合,可一期一站式完成,也可分期分站式完成,2种手术方式临床治疗效果满意.

Background: Patients with myocardial bridging (MB) are associated with adverse cardiovascular events, but a decision to perform surgical intervention, especially for patients with systolic intermediate stenosis, is a difficult clinical issue. Fractional flow reserve (FFR) represents a novel method for the functional evaluation of coronary stenosis, but the relationship between FFR and MB remains controversial because of the cyclic dynamic stenosis of MB. Quantitative flow ratio (QFR) is a novel index allowing fast assessment of FFR from a diagnostic coronary angiography. This study aimed to investigate the relationship between QFR and MB patients and to further develop a prediction model of QFR-guided surgical intervention for these patients. Methods: Forty-five symptomatic lone MB patients who had undergone coronary angiography were consecutively enrolled in this study. MB was located in the middle of left anterior descending artery with intermediate stenosis during systole. The patients were retrospectively divided into a medical therapy group or a surgical therapy group. Systolic geometry based QFR (SG-QFR) and diastolic geometry based QFR (DG-QFR) were calculated based on three-dimensional quantitative coronary angiography and patient-specific flow velocity. Subsequently, time-averaged QFR (TA-QFR) is defined as the average of SG-QFR and DG-QFR. Results: Receiver operating characteristic curve analysis revealed that TA-QFR (AUC = 0.91; 95% CI: 0.79-0.98) was found to be the best pre-operative index for surgical intervention to MB, when compared with DG-QFR (AUC = 0.69; 95% CI: 0.53-0.82; difference: 0.22; 95% CI: 0.04-0.41; p = 0.02) and SG-QFR (AUC = 0.87; 95% CI: 0.74-0.95; difference: 0.04; 95% CI: 0.00-0.08; p = 0.03). Conclusions: TA-QFR improved the performance of functional evaluation in MB patients with intermediate stenosis during systole and is useful for guiding surgical intervention.

心力衰竭(heart failure,HF)是以一系列症状(呼吸困难、端坐呼吸、下肢肿胀)和体征(颈静脉压升高、肺充血)为特征的临床综合征,常由心脏结构或功能异常引起.流行病学研究表明,HF是心肌梗死(myocardial infarction,MI)后常见并发症,发生率约为25％[1].Kapur等[2]试验表明:早期血管再通作为MI后HF有效的快速治疗方法.但在冠状动脉旁路移植术后,心肌的不完全血运重建仍高达37％,而在经皮冠状动脉介入治疗后高达43％[3].目前,神经激素阻滞作为MI后HF的长期治疗方法,已经证明了β受体阻滞剂,血管紧张素转换酶抑制剂和血管紧张素II受体阻滞剂可降低MI后死亡率,但不适用于全部患者.缺血事件发生后,心肌细胞凋亡、胶原瘢痕形成以及心室扩张、肥大导致心脏重构.尽管这种重构可以暂时保留心输出量,但不完全血运重建导致心脏重构进行性发展,最终会发展为不可逆转的心力衰竭.目前,治疗终末期心力衰竭的唯一方式是全心移植.然而,由于器官数量有限、患者与供者的匹配困难等多种问题,严重限制了器官移植的发展.

Heart failure (HF) is a common and serious manifestation after myocardial infarction (MI). Despite their clinical importance, current treatments for MI still have several limitations. Revascularization has been proven to have positive effects on MI-induced damage. Currently biomaterial-based angiogenesis strategies represent potential candidates for MI treatment. Bioglass (BG) is a commercially available family of bioactive glasses. BG has angiogenic properties and thus might be an attractive alternative for MI treatments. Here, we loaded BG in sodium alginate (BGSA), locally injected it into peri-infarct myocardial tissue and examined its suitability for inducing cardiac angiogenesis and eventually improving cardiac function following MI. Cardiac function was evaluated via echocardiography. Infarct morphometry, angiogenesis, apoptosis and angiogenic protein expression were all analysed 4 weeks after BGSA injection. Compared with the control treatment, BGSA was sufficient to prompt angiogenesis, suppress apoptosis, up-regulate the expression of angiogenic proteins, attenuate infarct size, preserve wall thickness and eventually improve cardiac function. Our results demonstrate the feasibility and effectiveness of BGSA in myocardial regeneration via angiogenesis, suggesting that BGSA is a potential therapeutic strategy for post-infarct myocardial regeneration.

目的:比较接受孙氏手术与去分支化杂交手术治疗的急性Ⅰ型主动脉夹层患者的围术期及术后短期预后. 方法:纳入2015年3月至2017年5月在兰州大学第一医院心血管外科行Ⅰ型主动脉夹层广泛修复手术患者85例,其中行孙氏手术患者(孙氏组)64例,行去分支化杂交手术患者(去分支化组)21例,比较两组患者围术期及术后短期生存状况. 结果:与孙氏组相比,去分支化组患者年龄大,肥胖、术前合并肝功不全者比例高,主动脉阻断及体外循环时间短,术后呼吸机辅助呼吸时间短,围术期红细胞及冷沉淀使用量少,ICU住院时间及术后住院时间短,肺部感染率低(P均＜0.05).两组的在院死亡率和术后1年生存率无统计学差异. 结论:去分支化杂交手术是治疗急性Ⅰ型主动脉夹层的新方法,适用于高龄、高危人群,短期预后良好.

目的:对比分站式杂交冠状动脉血运重建(HCR)与常规不停跳冠状动脉旁路移植术(CABG)治疗多支病变的疗效. 方法:收集同一时期内冠状动脉粥样硬化性心脏病(冠心病)多支病变患者61例,经心内科、心外科联合会诊评估病情后,分为行分站式HCR患者27例(HCR组)和行CABG患者34例(CABG组).收集并比较2组患者的基线资料、术前检查结果、术前SYNTAX评分和欧洲心血管手术危险因素评分系统(EuroSCORE)评分、手术资料、术后情况、住院时间和花费、术后院内并发症.所有患者随访1年,记录主要不良心脑血管事件(MACCE)和次要不良事件. 结果:2组患者的基线特征基本一致.HCR组的手术时间、切口大小、出血量均明显小于CABG组(P＜0.05),2组最终再血管化的血管数量差异无统计学意义(P＞0.05).HCR组的24 h和48 h胸腔引流量、胸腔引流带管时间、红细胞及血浆用量、呼吸机辅助呼吸时间、ICU时间和总住院时间均明显低于CABG组(P＜0.05).CABG组术后各类并发症的发生率高于HCR组(P＜0.05),2组均无院内死亡.所有患者术后最长随访1年,两组MACCE和次要不良事件发生率的差异无统计学意义(P＞0.05). 结论:对于冠心病多支病变患者,分站式HCR有更好的围术期表现,以及不劣于CABG的花费及早期随访结果.

OBJECTIVE:The purpose of this study was to determine the predictors of early left ventricular (LV) dysfunction in patients with rheumatic heart disease (RHD) after mitral valve replacement (MVR). We examined echocardiographic and nonechocardiographic predictors. METHODS:This study included 571 patients receiving MVR for RHD from 2012 to 2017. Their baseline characters, preoperative examination, operation data, and postoperative echocardiography were collected retrospectively. Univariate and multivariate logistic regression were used to evaluate the predictors of early LV dysfunction after MVR. The LV dysfunction was defined as left ventricular end-ejection fraction (LVEF) <50%. The interaction model was further performed to calculate interaction effects between predictors selected by logistic regression. RESULTS:In the 571 patients, 164 (28.7%) had early LV dysfunction after the operation, but only 94 (16.5%) had a preoperative LVEF <50%. Significant differences between two groups (LVEF ≥50% or LVEF <50%) were finally revealed in LV end-diastolic dimension, preoperative atrial fibrillation (AF), preoperative LVEF <50%, and the white blood cell (WBC) count measured after admission (>10 × 109 L -1 ) in the multivariate logistic regression. Corresponding odds ratios (ORs) were 1.06, 1.82, 3.63, and 2.64, respectively. Diabetes, lesion type, LV end-systolic dimension, aspartate transaminase, alanine transaminase, and serum creatinine were statistically significant (P < .05) in univariate logistic regression, with matched ORs 2.45, 1.66/0.65, 1.07, 2.50, 1.83, and 2.90, respectively. However, these variables were not significant anymore in the multivariate logistic model. Besides, the OR of early postoperative LV dysfunction increased to 7.00 when preoperative AF, preoperative LVEF <50%, and WBC >10 × 109 L-1 were all present. CONCLUSIONS:The preoperative LV dysfunction, a large LV volume, AF and over-normal WBC could independently predict postoperative LV dysfunction.

临床资料 患者,男,66岁,主因“间断胸闷气促25年,加重8月”收住入院.体检示:一般可,血压118/78 mm Hg,颈静脉不充盈,右胸下部听诊呼吸音减低,可闻及湿罗音,心界左下扩大,心率89次/min,心律齐,主动脉瓣区有粗糙喷射性收缩期杂音,腹部(—),四肢脉搏细弱,双下肢轻度水肿.辅助检查:心脏超声示主动脉瓣环钙化,瓣叶增厚、钙化、粘连,二叶式主动脉瓣,瓣口开放面积0.65 cm2,最大跨瓣压差110 mm Hg,主动脉瓣环内径为19 mm,左心房内径34 mm,左心室舒张期末内径71 mm,左心室射血分数(LVEF) 29％.主动脉及冠状动脉(冠脉)计算机断层扫描血管造影(CTA)示患者主动脉瓣Type 0型二叶瓣,中度钙化,钙化集中在左瓣窦,左右冠脉均发自左瓣窦.

RATIONALE:Pulmonary artery sarcomas (PAS) are easily misdiagnosed as thromboembolic disease of pulmonary arteries, because of rarity and presenting with nonspecific signs, symptoms, or imaging findings. PATIENT CONCERNS:A 26-year-old man was admitted to the department of invasive technology with fever and dyspnea. Blood tests showed inflammatory activity, a slight increase of D-dimer and Fibrin Degradation Product. A chest enhanced computed tomography (CT) scanning revealed multiple filling defects occurred in the main trunk of both pulmonary arteries and branches of the left pulmonary artery DIAGNOSES:: It was initially diagnosed with pulmonary embolism (PE) and deep vein thrombosis (DVT), but was eventually diagnosed with pulmonary artery sarcoma that was confirmed by biopsy. INTERVENTIONS:The transcatheter thrombolysis therapy, inferior vena cava filter implantation, and operation were performed. OUTCOMES:The Organized mass was removed by the operation and was pathologically diagnosed as pulmonary artery sarcoma, the patient received postoperative chemotherapy according to the recommendation of oncology department. LESSONS:Coagulation markers have been reported to differentiate PAS from PE, but this case suggested that PAS can be associated with DVT and abnormal coagulation-fibrinolysis system.

临床资料患者男性,26岁,1个月前无明显诱因出现胸闷、气短,吸气时胸部疼痛,呼吸困难,未予诊治.2周前以上症状明显加重,伴有咳嗽、咳痰、咯血.就诊与当地医院,测得纤维蛋白原(FIB)6.37 g/L,D-dimer 4.68 μg/mL,血沉(ESR) 55 mm/h.胸部增强CT提示,肺动脉主干及左肺动脉分叉多发充盈缺损,下肢静脉彩超提示,右下肢静脉局部中低回声块附壁.诊断为:肺栓塞(pulmonary thromboembolism,PTE),深静脉血栓(deep vein thrombosis,DVT).行“下腔静脉滤器置入术+左肺动脉置管溶栓术”,给予抗凝、溶栓治疗后复查CT病变未见减小.考虑是血栓时间长,溶栓效果差,遂转我科进一步诊治.

Three-dimensional (3D) printing thermosets offers great potential to customize sophisticated constructs for a myriad of applications.

心脏作为终末分化器官,其再生能力十分有限.动物实验表明干细胞移植可以促进心肌细胞再生,有效改善左室功能.近年来,干细胞移植与非细胞策略结合为心肌梗死的治疗提供了新思路.该文主要介绍干细胞移植治疗心肌梗死的现状、遇到的障碍和非细胞策略.

Advanced glycation end products of BSA (AGE-BSA) contribute to the pathogenesis of diabetic vascular diseases. However, the roles and underlying mechanisms of AGE-BSA in diabetic vascular diseases remain largely unclear. Long non-coding RNAs (lncRNAs) are widely identified and known as gene regulators. However, the roles of lncRNAs in diabetic vascular disease are still vague. In this study, we sought to investigate the contributions of lncRNAs in human umbilical vein endothelial cells (HUVECs) treated with AGE-BSA. We first demonstrated that AGE-BSA reduced the cell viability and inhibited the cell proliferation of HUVECs. Then, we found that lncRNA MEG3 was up-regulated in HUVECs treated with AGE-BSA. Furthermore, inhibition of MEG3 restored the AGE-BSA-induced repression of cell viability and proliferation. In addition, our results revealed that MEG3 played its role via modulation of miR-93 expression in HUVECs treated with AGE-BSA. Furthermore, we illustrated that miR-93 played its role via regulation of p21 in HUVECs treated with AGE-BSA. Ultimately, our study displayed that AGE-BSA exerted its function via modulation of MEG3/miR-93/p21 pathway in HUVECs. Thus, for the first time, we identified the MEG3/miR-93/p21 axis in HUVECs treated with AGE-BSA, which might be a novel regulatory network in diabetic vascular cells, and possess the potential therapeutic value for diabetes mellitus.

BACKGROUND Matrix metalloproteinase 9 (MMP9) has recently emerged as a risk predictor in patients with cardiovascular diseases. However, little is known about the significance of increased plasma MMP9 in patients with perioperative myocardial injury. We aimed to investigate the role of MMP9 in the occurrence of myocardial injury during off-pump coronary artery bypass grafting (OPCAB). METHODS A total of 34 consecutive patients with coronary artery diseases (CAD) were recruited in this prospective, observational study. All patients were operated for OPCAB surgery. Serial blood samples were collected preoperatively and 12 hours after surgery. MMP9, together with cardiac troponin I (cTnI), creatinine kinase myocardial b fraction (CK-MB), C-reactive protein (CRP), and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels in plasma were measured at each time-point. RESULTS MMP9 levels increased significantly at 12 hours after surgery, attaining nearly 2 times the baseline levels (P=0.0001). There was a significant correlation between preoperative (pre-OP) circulating levels of MMP9 and the left ventricular ejection fraction (LVEF) (r=0.48; P=0.004) as well as European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (r=0.43; P=0.012). Patients were in New York Heart Association (NYHA) functional class III or IV heart failure showed a significantly higher MMP9 levels (1,348.0±337.2 vs. 630.4±93.0 ng/L, P=0.012) as compared to the patients in NYHA functional class I and II. No significant correlation was observed between MMP9 and age (P=0.612), serum creatinine (P=0.185), CRP (P=0.207), NT-proBNP (P=0.058). A significant correlation was observed in these data between the post-OP MMP9 and cTnI (r=0.35; P=0.003). CONCLUSIONS Our study first established a connection between MMP9 and OPCAB procedure, suggesting that MMP9 could be a novel biomarker for identifying perioperative myocardial injury in patients undergoing OPCAB.