目的:探讨心脏磁共振在评价微创心外膜左心室重建对室壁瘤患者心室功能和形态影响中的作用.方法:2018年1月至2020年5月,连续纳入因心肌梗死后室壁瘤接受微创心外膜左心室重建的10例患者.术前和术后1个月患者接受心脏磁共振常规扫描、长轴和短轴电影及延迟增强序列扫描,使用CVI42软件进行左室节段性心功能测量和几何形态参数测量.结果:MRI检查均顺利完成并获得了具有诊断价值的图像.术后1个月患者的左室射血分数较术前明显增加,左室舒张末期容积和容积指数、左室收缩末期容积和容积指数均较术前明显减小;静息状态心输出量和心输出指数明显增加;术后患者收缩期和舒张期的左心室长轴、短轴、心尖轴均明显减小;左心室球形指数和心尖锥形指数明显减小.相关性分析提示,左心室重建术后,左室射血分数与收缩期和舒张期的心尖锥形指数均呈负相关.结论:微创心外膜左心室重建可改善患者左心室形态和功能,心脏磁共振可用于评价手术前后的心室形态和功能,预测患者术后心功能.

GPBAR1, a transmembrane G protein-coupled receptor for bile acids, is widely expressed in multiple tissues in humans and rodents. In recent years, GPBAR1 has been thought to play an important role in bile homeostasis, metabolism and inflammation. This review specifically focuses on the function of GPBAR1 in cholestatic liver disease and summarizes the various pathways through which GPBAR1 acts in cholestatic models. GPBAR1 mainly regulates cholestasis in a holistic system of liver-gallbladder-gut formation. In the state of cholestasis, the activation of GPBAR1 could regulate liver inflammation, induce cholangiocyte regeneration to maintain the integrity of the biliary tree, control the hydrophobicity of the bile acid pool and promote the secretion of bile HCO 3 − . All these functions of GPBAR1 might be clear ways to protect against cholestatic diseases and liver injury. However, the characteristic of GPBAR1-mediated proliferation increases the risk of proliferation of cholangiocarcinoma in malignant transformed cholangiocytes. This dichotomous function of GPBAR1 limits its use in cholestasis. During disease treatment, simultaneous activation of GPBAR1 and FXR receptors often results in improved outcomes, and this strategy may become a crucial direction in the development of bile acid-activated receptors in the future.

Astragali Radix (AR), the dried root of Astragali Radix membranaceus (Fisch.) Bge. or Astragali Radix membranaceus (Fisch.) Bge. var. mongholicus (Bge) Hsiao, is a commonly used traditional Chinese medicine for the treatment of liver diseases. This study aimed to comprehensively evaluate the pharmacological action and explore the potential mechanism of AR on liver fibrosis. Rats were administered with carbon tetrachloride for eight weeks, followed by oral treatment with AR for six weeks. The efficacy was confirmed by measuring liver function and liver fibrosis levels. The underlying mechanisms were explored by detecting the expression of related proteins. AR significantly decreased the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), collagen IV (COL-IV), hyaluronic acid (HA), laminin (LN), and precollagen type III (PCIII). In addition, AR inhibited the deposition of collagen and the activation of hepatic stellate cells. Those data strongly demonstrated that AR alleviated liver fibrosis by CCl4. In order to illustrate the potential inflammatory, the mRNA levels of IL-6, TNF-α, and IL-1β were detected. Subsequently, immunohistochemistry analysis was performed to further verify the expression of type I collagen. Finally, the expression of key proteins in the inflammatory signaling pathway was detected. AR significantly reduced the expression of high-mobility group box 1 (HMGB1), TLR4, Myd88, RAGE, and NF-κ B p65 genes and proteins. In addition, western blotting showed AR decreased the protein expression of RAGE, p-MEK1/2, p-ERK1/2, and p-c-Jun. Taken together, our data reveal that AR significantly inhibits liver fibrosis by intervening in the HMGB1-mediated inflammatory signaling pathway and secretion signaling pathway. This study will provide valuable references for the in-depth research and development of Astragali Radix against liver fibrosis.

Ethnopharmacological relevance: Benzoinum (Styraceae) is a traditional Chinese medicine used to treat stroke and other cardio-cerebrovascular diseases for thousands of years. Benzoinum has also proven to have diverse pharmacological activity, but the neuroprotection mechanism of apoptosis in ischaemic stroke was not determined. Aim of this study: To investigate the protective effect of a neurovascular unit (NVU) and the mechanisms of benzoinum on cerebral ischaemic rats. Materials and methods: The neuroprotective activity of benzoinum against middle cerebral artery occlusion (MCAO)-induced cerebral ischaemic injury. Neurological scores, 2,3,5-Triphenyltetrazolium chloride (TTC) staining, and hematoxylin-eosin staining (HE) staining were conducted to evaluate the neurological damage. Infarction rate and denatured cell index (DCI) were also calculated. The ultrastructure of neuron and blood-brain-barrier (BBB) was observed by transmission electron microscopy (TEM). Immunohistochemistry and reverse transcription-polymerase chain reaction (RT-PCR) were used to detect Bax, Bcl-2 and Caspase 3 expression. Furthermore, Claudin 5 also was detected through immunohistochemistry. Results: Benzoinum could significantly improve neurological function score and reduce cerebral infarction rate and DCI. In addition, benzoinum alleviated pathomorphological change and apoptosis in the brain tissue of MCAO rats. The results of TEM and claudin 5 expression of immunohistochemistry showed that benzoinum could play a neuroprotective effect in NVU. Also, benzoinum-enhanced Bcl2, and reduced Bax and Bax/Bcl-2 and Caspase 3, suggest that benzoinum provided a neuroprotective effect by inhibited cell apoptosis. Conclusion: Benzoinum could play a neuroprotective role and regulate apoptosis for repair and stabilisation of NVU. This anti-apoptosis activity might be associated with the downregulation of Bax and Caspase 3, and the upregulation of Bcl2. Our present findings provide a promising medication for the treatment of ischaemic stroke.

1 临床资料 患者 男,61岁.主因"上呼吸道感染5 d后出现胸闷,位于心前区,呈压迫感,伴大汗,持续1 h左右自行缓解"2019年12月2日就诊于厦门大学附属心血管病医院心内科.既往长期吸烟史30年,每日20支;高血压病10余年,服用缬沙坦,未规律监测.入院查体未见异常,生命体征正常.心电图示:V2～V6导联ST段轻度弓背抬高,高敏肌钙蛋白T升高 3015 ng/L.急诊床旁超声心动图示:各房室正常,左心室射血分数(left ventricular ejection fraction,LVEF) 69％.结合既往病史及辅助检查拟入院诊断:胸闷(待查)、急性心肌炎(acute myocarditis,AM)、急性心肌梗死(acute myocardium infarction,AMI)、高血压病.予以营养心肌、激素、抗病毒、抗栓、调脂、降压、护胃及对症支持治疗.12月3日增强心脏磁共振成像(cardiovascular magnetic resonance,CMR)示:T2WI示左心室心尖段侧壁见心外膜下条片状高信号影,心肌静息灌注成像示左心室壁下未见灌注低信号影;心肌延迟强化成像示:左心室基底段间隔壁、中央段间隔壁、前壁心肌中层见弧形延迟强化影(图1).为进一步明确诊断,入院第3天(12月4日)行冠状动脉造影示:左前降支近段50％狭窄,D1近段50％～60％狭窄,右冠状动脉中段50％狭窄,未见严重狭窄病变.血清病毒抗体检测提示抗EB病毒抗体阳性,住院期间复查心电图提示ST段逐步恢复至正常,高敏肌钙蛋白T降幅较大且于第5天降至正常.第8天(12月10日)复查CMR示:T2WI示左心室未见异常信号灶,心肌静息灌注成像无异常;心肌延迟强化示左心室基底段间隔壁、中央段间隔壁及前壁心肌中层的弧形延迟强化较前(12月3日)明显减轻(图2).综上考虑急性病毒性心肌炎诊断基本明确.随访4个月患者无不适,门诊复查心电图、超声心动图均未见异常.

Recent advances have shown that immune checkpoint inhibitors are emerging as promising therapeutic targets to improve the quality of life in cancer patients. This meta-analysis was conducted to evaluate the influence of Kanglaite injection (KLTi) combined with chemotherapy versus chemotherapy alone on clinical efficacy, immune function, and safety for the treatment of advanced non-small-cell lung cancer (NSCLC). Several electronic databases, including PubMed, Web of Science, Wan-Fang, VMIS, EMBASE, Cochrane Library, CNKI, CBM, and MEDLINE, as well as grey literatures, were comprehensively searched from January 2000 to November 2019. Randomized controlled trials (RCTs) reporting outcomes of clinical efficacy and immune function were collected according to their inclusion and exclusion criteria. Cochrane Reviewers' Handbook 5.2 was applied to assess the risk of bias of included trials. STATA 13.0 and Review Manager 5.3 software were used for meta-analysis. Twenty-five RCTs comprising 2151 patients meeting the inclusion criteria were identified. Meta-analysis showed that compared with chemotherapy alone, KLTi plus the same chemotherapy significantly improved clinical efficacy, including complete response, partial response, stable disease, and progressive disease, as well as immune function, including CD3+, CD4+, CD8+, and CD4+/CD8+. There was a significant reduction in nausea and vomiting, thrombocytopenia, and leukopenia in combination treatments. However, the outcomes were limited because of the low quality and small sample size of the included studies. In conclusion, this work might provide beneficial evidence of KLTi combined with chemotherapy for improving clinical efficacy and immune function, as well as reducing the incidence of adverse events in advanced NSCLC patients. KLTi might be a beneficial therapeutic method for the treatment of advanced NSCLC. Due to the quality of the data, more rigorous and well-designed RCTs are needed to confirm these findings.

The combination of Aconiti Lateralis Radix Praeparata (ALRP) and Zingiberis Rhizoma (ZR) is one of the most typical representatives reflecting the very essence of the theory of Chinese material medica compatibility, which has been used to treat cardiovascular disease for many years. Previously, we demonstrated that ALRP-ZR prevented doxorubicin (DOX)-induced chronic heart failure (CHF) in vivo. However, its active components are still unclear. This study was aimed to investigate the therapeutic effect and potential mechanism of higenamine combined with [6]-gingerol (HG/[6]-GR) against doxorubicin (DOX) - induced chronic heart failure (CHF) in rats. Therapeutic effects of HG/[6]-GR on hemodynamics indices, serum biochemical indicators, histopathology and TUNEL staining of rats were assessed. Moreover, a UHPLC-Q-TOF/MS-based serum metabonomic approach coupled with biochemical assay has been performed to identify the potential mechanisms of HG/[6]-GR on DOX-induced CHF. HG/[6]-GR had effects on promoting of hemodynamic indices, decreasing serum biochemical indicators, and alleviating histological damage of heart tissue. Serum metabonomics analyses indicated that the therapeutic effects of HG and [6]-GR were mainly associated with the regulation of eight metabolites and twelve pathways, which may be responsible for the therapeutic efficacy of HG/[6]-GR. Moreover, the results showed that HG/[6]-GR could substantially regulate the expression level of energy metabolism-related metabolites and pathways. Multivariate statistical analysis has provided new insights for understanding CHF and investigating the therapeutic effects and mechanisms of HG/[6]-GR, which influencing the metabolites related to energy metabolism pathway.

1 病例 患者男性,73岁,主因"胸闷伴活动后气促8年余,近10月晕厥3次"入院.患者8年前反复出现胸闷不适,伴活动后气促,多于环境改变、情绪激动时出现,持续时间长,休息后可缓解,无胸痛、心悸,无头晕、头痛,无恶心、呕吐,无呼吸困难等不适,未曾诊治.10月前患者行走中突发晕厥,晕厥前无特殊不适,持续4～5 min后意识恢复,无胸闷、头痛、心悸等不适,未重视.4月前在爬楼中突发胸闷、心悸、气促不适,随即晕厥,持续5 min后清醒,未诊治.2月前患者夜间休息,起夜时突发晕厥,持续5 min后意识恢复,无胸闷痛、呼吸困难,无恶心呕吐,无头晕头痛等不适.

心血管疾病高居城乡居民总死因之首,据统计全球心血管疾病死亡率在过去的20余年里增加了近40％[1].传统的心脏生物标志物,如肌钙蛋白、脑钠肽、肌酸激酶等在心血管疾病的诊断、危险分层及预后中起着关键作用,血清胱抑素C (cystatin C, CysC)作为一种新型心血管疾病生物标志物,近年来越来越受到关注.本文就CysC与常规心血管疾病的关系作一综述.

心尖部室壁瘤是临床上常见的疾病,发病早期如果得不到及时有效的治疗,将会引起心力衰竭、心脏破裂、缺血性心肌病及栓塞等并发症,主要是由于冠状动脉粥样硬化引起的心肌梗死造成[1]. 文献[2,3]报道显示:部分冠状动脉正常患者也可以引发心肌梗死后室壁瘤. 数据报道显示[4,5]:每年全球约有1700万人死于心血管疾病,并且一半以上死于急性心肌梗死,对于存活患者液容易演变为慢性心力衰竭.目前,临床上对于心尖部室壁瘤成形缺血性心肌病患者以经皮左室分区术治疗为主,该手术包括:入路系统、输送系统和心室分隔装置三部分,该手术能实现室壁瘤与左心室正常心肌的分离.但是,部分患者治疗过程中由于缺乏理想的评价方法,导致术后效果较差,对患者心功能影响较大,不利于患者术后恢复[6,7]. 文献[8]报道显示:将CT用于经皮左室分区术治疗心尖部室壁瘤成形缺血性心肌病患者中效果理想,有助于评估患者心功能,促进患者恢复,但是该结论有待验证. 因此,本研究以2015年6月至2017年6月医院收治的心尖部室壁瘤成形缺血性心肌病患者25例作为研究对象,探讨CT在经皮左室分区术治疗心尖部室壁瘤成形缺血性心肌病患者中的应用及对心功能射血分数(EF)的影响,报告如下.

Objective: To assess the clinical application of percutaneous balloon aortic valvuloplasty (PBAV) in patients with calcified severe aortic stenosis (AS) combining heart failure (HF). Methods: A total of 15 relevant patients treated by PBAV in our hospital from 2014-12 to 2017-05 were studied. The baseline information, echocardiography parameters, peri-operative situation and follow-up condition were summarized. Results: All 15 AS patients were combined with severe HF including 3 with NYHA III and 12 with NYHA IV; 2 cases had cardiac shock. 6/15 patients received palliative PBAV for symptom relieving and 9 for bridging step (1 case pre-operative step for non-cardiogenic surgery). PBAV was successful in all patients; the average operative dilation was (2.60±1.3) times; 2 patients suffered from complete left bundle block at immediate post-operation, 1 had ventricular tachycardia during the operation and 1 had ischemic stroke 3 days after operation, no other complications occurred. Catheter measured immediate post-operative peak trans-valvular pressure gradient was decreased from (75.0±24.0) mmHg to (39.8±14.2) mmHg, P<0.01. Echocardiography showed that before discharge, the max flow velocity was reduced from (4.98±0.76) m/s to (4.20±0.75) m/s, P<0.01, max-PG reduced from(101.3±30.4) mmHg to (72.9.0±23.3) mmHg, P<0.01, mean-PG reduced from (62.4±19.0) mmHg to (44.9±15.1) mmHg, P<0.01;while left ventricular diastolic dimension and LVEF were similar at per- and post-operation, P>0.05. NT-proBNP was decreased from (13 889±12 303) pg/ml to (5 412±4 923) pg/ml, P<0.01. The average post-operative follow-up time was (3-27) months and the median NYHA grade improved from IV to II. Conclusion: Palliative and bridging PBAV was reliable and safe in severe AS-HF patients for short time, it had less complication and could be used as an optional treatment.

Objective To evaluate the preliminary experience and mid-term outcome of transcatheter aortic valve replacement(TAVR)in patients with calcifi ed severe aortic stenosis.Methods From December 2014 to February 2016, 10 TAVR cases were admitted in the Cardiovascular Hospital, Xiamen University. The baseline characteristics, echocardiography parameters and clinical follow-up data were analyzed. Results All cases were complicated with impaired heart function(NYHAⅢ in 4 cases, NYHA Ⅳ in 6 cases). The mean age was (75.1±6.2) years and 4(4/10) of them were men. The mean logistic EuroSCORE was (27.2±23.6) % and the mean society of thoracic surgery (STS) mortality score was (9.1±4.8) %. Five cases had bicuspid aortic valve. TAVR was successfully performed in all 10 patients, and valve-in-valve implantation was done in 1 (10%) case. Immediately after procedure, the peak trans-aortic valve pressure gradient decreases from (85.9±22.7) mmHg to (23.2±5.4) mmHg. One case had marginal moderate periprosthetic leak and one case received stent implantation for femoral artery complication during the procedure. During hospitalization, 1 case had blood transfusion for gastrointestinal bleeding and permanent pacemakers were implanted in 2 (2/10) cases. The survival rate was 10/10 at 30 days after TAVR. One case with end-stage renal disease died for gastrointestinal bleeding 36 days after TAVR. For the other 9 patients, 12 months echocardiography data showed that the peak and mean trans-aortic valve gradient was (20.0±5.2) mmHg and (10.6±3.1) mmHg respectively. The lef t ventricular diastolic diameter(LVDD)decreased[(56.5±9.4)mm vs.(51.8±7.6)mm,P=0.035] and left ventricular ejection fraction(LVEF)increased significantly[(46.9±22.2)% vs.(63.7±9.4)%, P=0.029].To date,median follow-up period was(22.0±4.8)month.Clinical symptoms improved in all the 9 cases. The patient with periprosthetic leak had record of hospitalization for several times due to heart failure. Conclusions From the initial TAVR experience of our hospital, TAVR can be done safely and smoothly after strictly TAVR candidate cases selection.

Objective: Borneol has been used to treat stroke in China since ancient times. In our previous research, we demonstrated the effect of borneol on cerebral ischaemia injury via meta-analysis. The neurovascular unit (NVU) is the structural basis of the preservation of the brain microenvironment and is believed to be a promising target in treating stroke. In this research, we explored the roles of three kinds of borneol, namely, L-borneolum (B1), D-borneolum (B2) and synthetic borneol (B3), in the NVU with permanent middle cerebral artery occluded (pMCAO) rats. Methods: The Longa scoring method was used to evaluate nerve function deficits in the pMCAO rats. Awakening time, brain water content, brain index and brain edema rate were also measured. TTC staining was used to calculate the cerebral infarction rate. The morphology of the ischaemia penumbra brain tissue was observed via HE staining, and the neuronal denatured cell index (DCI) was calculated. An enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of vascular endothelial growth factor VEGF and TNF-alpha in the serum. Moreover, the ultrastructures of the neurons and of the blood-brain barrier (BBB) were observed using transmission electron microscopy. The expression levels of Claudin-5, Bcl-2 and Bax in the ischaemia penumbra of pMCAO rats were detected using real-time PCR and immunohistochemistry. Results: Pretreatment with B1, B2 and B3 delayed the recovery time (P < 0.01). B1 remarkably ameliorated neurological deficits 24 h after cerebral ischaemia (P < 0.05). Moreover, B1 and B3 were both able to ameliorate brain edema and the area of cerebral infarction. In addition, B1, B2 and B3 all increased serum VEGF levels and decreased serum TNF-a levels (P < 0.01). For the ultrastructure determination, the BBB and the nerve centre were significantly improved by B1, B2 and B3. The mechanistic exploration revealed that B2 and B3 protected the brain by reducing the Bax/Bcl-2 ratio (P < 0.05, P < 0.01, respectively). Immunohistochemistry suggested that B1, B2 and B3 could also enhance the expression of Claudin-5 (P < 0.01). Conclusion: The three kinds of borneol demonstrated different protective effects on cerebral ischaemia injury. L-Borneolum displayed the most prominent anti-cerebral ischaemia effect among them. The mechanism was most likely executed via anti-apoptosis and anti-inflammation effects and maintenance of the stability of the BBB and TJs to comprehensively improve NVU function.

Objectives Cerebral ischemia can cause severe harm to people's health with the characteristics of high incidence, high disability, and high mortality. Xingnaojing injection (XNJI) is widely used in the treatment of cerebral ischemia. The aim of this review is to evaluate the efficacy and mechanism of XNJI in animal models of cerebral ischemia. Methods Total seven electronic databases in English or Chinese (CNKI, Wanfang, VMIS, PubMed, MEDLINE, Embase, and the Cochrane Library) about most experiments and studies which came out before June 2018 of XNJI for cerebral ischemia have been searched. Data extraction, quality assessment, and meta-analysis are conducted according to the Cochrane standards and RevMan 5.3 software. Results We have identified 23 eligible studies and made a meta-analysis based on these studies. Meta-analysis shows that XNJI contributes significantly to reduction in neurological deficit score (P = 0.0002, MD = -1.25, 95% CI: -1.92, -0.58) compared with the control group of cerebral ischemia. Subgroup analytic results demonstrate that XNJI has been more effective in animal model of cerebral ischemia-reperfusion injury (P = 0.009, MD = -1.35, 95%CI: -2.36, -0.34) than that of permanent cerebral ischemia (P = 0.0002, MD = -1.08, 95%CI: -1.66, -0.51). Compared with control group, XNJI could remarkably reduce cerebral infarction area (P < 0.00001, MD = -14.98, 95%CI: -21.36, -8.59), brain edema (P < 0.00001, MD = -4.64, 95%CI: -5.38, -3.90), and neuronal cell apoptosis (P < 0.0001, MD = -12.21, 95%CI: 18.05, -6.37). Meanwhile, the meta-analysis shows that XNJI has a significant anti-inflammatory effect, and the levels of TNF-α, IL-6, and IL-1β are significantly reduced by XNJI (P = 0.001, MD = -4.13, 95%CI:-6.68, -1.58; P < 0.00001, MD = -119.23, 95%CI: -138.04, -100.43; P = 0.21, MD = -228.69, 95% CI: -586.20, 128.83). Additionally, XNJI could raise the body's antioxidant function and the level of SOD and GSH-Px (P = 0.002, MD = 53.02, 95% CI: -20.52, 85.78; P = 0.01, MD = 8.65, 95% CI: 1.77, 15.48) and decrease the level of MDA (P < 0.00001, MD = -4.16, 95% CI: -5.50, -2.82). Conclusion XNJI might be effective in cerebral ischemia by regulating oxidative stress and inflammatory reaction.

Objective To evaluate the safety and efficacy of epicardial ventricular restoration (EVR) using REVIVENT system in patients with antero-septal scar and dilated ischemic cardiomyopathy. Methods Ten ischemic heart patients with antero-septal scar underwent the operation. The scarred lateral left ventricular wall was apposed to the septal scar with serial paired anchors placed through epicardial transmural excluding the non-viable portions of the chamber. Left ventricular hemodynamic assessments as well as left ventricular ejection fraction, left ventricular end-systolic/diastolic volume (LVEDV/LVESV) and their indexes (LVEDVI/LVESVI) were measured by cardiac magnetic resonance (CMR). Results Ten ischemic heart failure patients with antero-septal scar, aged(55.2±13.9)years, received a hybrid epicardial ventricular restoration. Cardiac MR done at one a month after the procedure showed an elevation of LVEF from(27.8±4.6%)to(37.5±11.4)% (+35%, P<0.01). LVESV was significantly reduced from(149.9±61.6) ml to(109.9±58.0)ml (–26.7%, P<0.01), LVESVI was reduced from(84.8±36.7)ml/m2to(63.0±34.2) ml/m2(reduced by 25.7%, P<0.01); LVEDV was reduced from(203.0±64.0)ml to(167.9±58.2)ml (reduced by 17.3%, P<0.01), and LVESV was reduced from(114.5±37.8)ml/m2to(96.2±35.2)ml/m2(reduced by 16.0%, P<0.01). Cardiac output (CO) increased from(4.0±1.5)L/min to(4.8±1.2)L/min(increased by 20.0%, P=0.034) and cardiac index (CI) increased from(2.2±0.7)L/(min ? m2) to(2.7±0.7)L/(min ? m2) (increased by 22.4%, P=0.023). Conclusions Our preliminary experience on EVR using the REVIVENT system demonstrated signifi cant increase in LVEF, CO and CI, with decreases in LVEDV/LVESV at 1 month following the procedure. Its feasibility and safety need further evaluation in the future.

人口老龄化和各种心脏疾病终末期导致慢性心力衰竭(心衰)的患病率逐年增加,沉重的医疗负担和预后差是患者及家庭面临的严峻问题.缺血性心肌病患者通常无法在心肌梗死(心梗)时间窗内开通罪犯血管,导致大面积心肌坏死后形成疤痕[1].心脏外科既往在冠状动脉(冠脉)旁路移植的同时切除梗死区域的疤痕,进行左心室重建,在部分患者中能够改善预后[2].但外科手术创伤大、费用多,手术风险高,因此未能在临床上广泛开展.目前,通过经导管途径的左心室重建术或左心室分区术,旨在减小左心室容积,改善或消除大面积左心室疤痕患者的室壁活动异常,增加患者心输出量并降低血栓栓塞和疤痕相关的恶性心律失常的发生,是缺血性心衰介入器械治疗领域的热点.我院于2015年初开展经导管途径使用PARACHUTE装置进行左心室重建,目前已成功完成25例.2017年初我院心脏团队使用REVIVENT系统完成8例心外膜左心室重建.早期临床研究[3-6]结果显示,该方法有较高的手术成功率和短期安全性,术后患者的有创心排量、超声心动图以及包括NYHA心功能分级、6分钟步行试验在内的心功能指标均较术前有所改善.多模式心脏影像学检查在左心室重建的患者筛选、介入器械选择、手术方案及心功能评估、远期预后判断等方面,与以往外科左心室重建有较大不同.本文将通过介绍介入左心室重建的器械治疗进展,重点阐述多模式心脏影像学评估在伴有左心室严重重构的缺血性心力衰竭患者中的应用.

目的 比较正常血压年轻人低、中、高强度运动前后血压、心率的变化,观察缓步行走对高血压患者血压、心率的影响,探讨真实世界研究中低代谢当量(MET,＜3 METs)的温和运动之辅助降压作用及其神经内分泌机制.方法 本试验分两部分:第一部分共入选正常血压年轻人32名,分别进行低强度[缓步行走3 km,耗时(49±4)min]、中等强度[快步行走3 km,耗时(32±2)min]和高强度(健身房综合锻炼1 h)运动,其中32人全部参加缓步行走,自我评估体力可耐受中等强度运动的24人参加快步行走,平素有健身房锻炼习惯的9人参加高强度运动,于运动前、运动后即刻,5及10 min分别测静息血压、心率,并计算简易心肌耗氧量(收缩压×心率),检测尿常规、白蛋白、尿β内啡肽;第二部分共入选20～86岁高血压患者30例及年龄相似的正常血压对照24人,均进行缓步行走3 km,步行前后测静息血压、心率、尿白蛋白、尿β内啡肽及生长激素.结果 ①正常血压年轻人一次性缓步行走3 km可显著降低运动后10 min内的静息血压、心率与简易心肌耗氧量[运动后10 min比运动前:收缩压(108±8)比(115±8)mm Hg,心率(70±11)比(76±12)次/min,简易心肌耗氧量(7225±1189)比(8690±1633) mm Hg·次/min,均P＜0.01],而快步行走显著增加运动后即刻静息收缩压、心率与心肌耗氧量[运动后即刻比运动前:收缩压(115±11)比(110±10) mm Hg,心率(89±18)比(73±10)次/min,简易心肌耗氧量(9151±2374)比(7230±1368) mm Hg·次/min,均P＜0.01];高强度运动1h显著增加运动后10 min内的静息心率(P＜0.01)及心肌耗氧(P＜0.05),增加血尿和(或)尿白蛋白阳性率(P＜0.05).②高血压患者缓步行走3 km可显著降低步行后10 min内的静息收缩压、舒张压、心率与简易心肌耗氧量[运动后10 min比运动前:收缩压(125±11)比(133±9)mm Hg,心率(73±10)比(78±12)次/min,简易心肌耗氧量(8469±2075)比(9523±2216) mm Hg·次/min,均P＜0.01];缓步行走过程中立位心率及心肌耗氧量变化不显著.③缓步行走3 km可显著增加正常血压人群及高血压患者运动开始后1h尿β内啡肽排出量(P＜0.05),而尿生长激素及白蛋白排出量无显著变化.结论 真实世界研究中高血压患者缓步行走3 km,可在不显著增加心血管负荷的情况下,降低运动后短期内的静息血压及心率,其辅助降压机制可能部分与运动增加β内啡肽释放有关.

Objective: Xingnaojing injection (XNJ) is derived from An-Gong-Niu-Huang pill, a well-known traditional Chinese patent medicine, which is widely used for stroke. To evaluate the therapeutic effect of XNJ on cerebral infarction, an extensive meta-analysis was used. Methods: Six major electronic databases including the Chinese Biomedical Database (CBM), Wanfang, the VIP medicine information system (VMIS) and the China National Knowledge Infrastructure (CNKI), PubMed, Embase, and the Cochrane Library were examined to retrieve randomized controlled trials designed to evaluate the clinical efficacy of XNJ in treating CI before November 26, 2016. Results: There were 53 randomized controlled trials with 4915 participants in this study. The results reflected that compared with the conventional therapy (CT) alone, XNJ could significantly improve the overall response rate (OR = 3.56, 95% CI [2.94, 4.32], P < 0.00001), and clinical symptom (including increasing activities of daily living (ADL, MD = 10.23, 95% CI [9.47, 10.99], P < 0.00001), and reduce infarction size (MD = -1.83, 95% CI [-2.49, -1.16], P < 0.00001)). However, there was no significant difference between the XNJ treatment and conventional therapy in Glasgow Coma Scale (GCS, P = 0.32). Neurological deficit score demonstrated that XNJ could significantly reduce the score in two different evaluation criterions as National Institutes of Health Stroke Scale (NIHSS, MD = -3.44, 95% CI [-4.52, -2.36], P < 0.00001), and the Chinese Stroke Scale (CSS, MD = -5.72, 95% CI [-6.94, -4.50], P < 0.00001). Additionally, serum MMPs, including MMP-2 and MMP-9 were significantly reduced by XNJ treatment compared with conventional therapy (MD = -11.24, 95% CI [-20.83, -1.65], P = 0.02; MD = -25.08, 95% CI [-35.49, -14.67], P < 0.00001, respectively). Moreover, XNJ was able to improve hemorrheology in reducing whole blood viscosity, plasma viscosity, and hematocrit (MD = -1.44, 95% CI [-2.18, 0.70], P = 0.001; MD = -0.22, 95% CI [-0.37, -0.07], P = 0.003; MD = -3.63, 95% CI [-6.23, -1.03], P = 0.006, respectively). The therapeutic efficacy of XNJ was found associated with improving hemodynamics (increasing peak-flow rate, and average velocity) (MD = 12.66, 95% CI [10.50, 14.81], P < 0.00001; MD = 9.90, 95% CI [8.63, 11.17], P < 0.00001). XNJ was also related to reducing cholesterol and triglyceride (MD = -1.06, 95% CI [-1.21, -0.92], P < 0.00001; MD = -1.05, 95% CI [-1.12, -0.97], P < 0.00001). Conclusion: Despite the sample size and the poor quality of the included studies of this review, the results of the research showed that XNJ might be a beneficial therapeutic method for the treatment of cerebral infarction.

Objective To evaluate the immediate effect of percutaneous ventricular restoration (PVR) using the PARACHUTE system in ischemic cardiomyopathy patients with apical aneurysm.Methods The study included 25 patients who received PARACHUTE partitioning device (PVD) implantation in the Xiamen Cardiovascular Hospital between January 2015 to December 2016.Invasive left ventricular hemodynamic assessments as well as cardiac output and cardiac output index were analyzed.Results Twenty-five patients [mean age (65.4±11.9) years] suffered from left ventricular aneurysm and heart failure patients after anterior myocardial infarction were enrolled.Ventricular partitioning device implantation was successful in 24/25 (96.0%) patients.PVR was failed in 1 patient due to unable to land the PVD in a satisfactory location.After implantation, a significant increase in cardiac output [(3.83±0.72) L/min vs.(4.85±0.93) L/min, P<0.01] and cardiac index [(2.32±0.74) L/(min·m2) vs.(2.90±0.82) L/(min·m2), P<0.01] was found.Conclusions Our preliminary experience on percutaneous ventricular restoration using PARACHUTE system demonstrates its feasibility and safety with increase in cardiac output and cardiac index immediately following the device implantation.