Application of non-invasive ventilator in acute heart failure with preserved ejection fraction / 中华急诊医学杂志

Objective To investigate the clinical features of patients with heart failure and the safety and efficacy of noninvasive ventilator in patients with heart failure.Methods Sequentially enrolled 65 patients who were diagnosed with decompensated heart failure in Tianjin Chest Hospital Heart Center from October 2016 to October 2017 and who had acute heart failure during hospitalization requiring noninvasive ventilator,were divided into the HF-PEF group (n=19) and HF-REF group (n=46).The clinical data of the two groups and the observation indexes before and after the application of the non-invasive ventilator were compared.Results Comparing the admission data of the two groups,the proportion of patients with hypertension (57.9％ vs 21.7％,P=0.005) and LVEF(％) (53.00±4.85 vs 33.07±7.24,P＜0.01)were significantly higher in the HF-PEF group than those in the HF-REF group;LVEDD (mm) in the HFPEF group was significantly lower than that in the HF-REF group (50.00±5.23 vs 63.82±8.95,P＜0.01).In the two groups of patients with acute left heart failure,blood lactate levels (mmol/L) in the HF-PEF group (4.20±1.06 vs 2.02±0.88,P＜0.05) and systolic blood pressure (mmHg) (151.32±43.40 vs 117.90± 19.55,P＜0.05) were significantly higher than those in the HF-REF group.After the application of non-invasive ventilator,systolic blood pressure (mmHg) (34.38±9.36 vs 16.94±5.19,P=0.038) and PaCO2 (mmHg)(2.49±0.98 vs-0.06±0.00,P=0.025),and lactic acid (mmol/L) (2.06±0.67 vs 0.04±0.01,P=0.001) were significantly lower in the HF-PEF group than those in the HF-REF group.While the NT-proBNP level (ng/L) (13 064.90±1 963.83 vs 11 687.13±1 028.03,P=0.848) did not decrease significantly,and the time of non-invasive ventilator application (h)was significantly longer than that in the HF-REF group (152.74±10.61 vs 71.03±10.41,P=0.013).Conclusions Hypertension is the main cause of HF-PEF group.The systolic blood pressure and blood lactate level in HF-PEF patients with acute left heart failure are significantly higher than HF-REF patients.Non-invasive ventilator is also safe and effective for the treatment of acute left heart failure in HF-PEF patients,but HF-PEF patients with acute left heart failure have a longer clinical remission time.

Association of MMP3 promoter 5A/6A polymorphism with stability of extracellular matrix of atherosclerotic plaque / 中华医学遗传学杂志

OBJECTIVE@#To assess the association of 5A/6A polymorphism in the promoter region of MMP3 gene with the stability of extracellular matrix of atherosclerotic plaque.@*METHODS@#Clinical data of 776 consecutive patients undergoing percutaneous coronary intervention (PCI) was reviewed. MMP3 gene polymorphisms and serum level of MMP3 for the second admission were collected. The target gene fragment containing MMP3 promoter region was transfected into HepG2 vector cells. The influence of the polymorphism on the expression of the MMP3 gene was determined in vitro.@*RESULTS@#Compared with the first admission data, the proportion of mutant MMP3 genotypes (5A/5A+5A/6A) was significantly higher in patients with acute myocardial infarction (AMI) compared with the control group (37.6% vs. 24.9%, P<0.01). 64.1% of the patients carrying the 5A allele had AMI, whereas only 50.11% of those carrying the 6A allele had AMI (P<0.01). The proportion of wild-type MMP3 genotype (6A/6A) was significantly higher in the stenotic group compared with the non-restenosis group (79.5% vs. 66.5%, P<0.01). Restenosis has occurred in 9.5% of patients harboring the 5A allele compared with 16.2% in those carrying the 6A allele (P<0.01). In addition, serum level of MMP3 in the restenosis group was significantly lower than that of the non-restenosis group (P<0.01). In vitro studies confirmed that the expression of pGL2-Basic/6A was significantly lower than that of pGL2-Basic/5A.@*CONCLUSION@#The 5A/6A polymorphism in the promoter region of the MMP3 gene may influence its transcriptional activity and impact on the degradation or push-up of extracellular matrix, resulting in a difference in the stability of atherosclerosis plaques, which in turn may induce different pathological processes in AMI or restenosis after stenting.

Mechanism of thermosensitive moxibustion on knee osteoarthritis in rabbit models / 中国针灸

<p><b>OBJECTIVE</b>To observe the impacts of thermosensitive moxibustion (TSM) on the expressions of nitric oxide (NO), typeⅠdisintegrin and metalloproteinase with thrombospondin motifs-4 (ADAMTS-4), typeⅡcollagen and proteoglycan (PG) in the rabbit models of knee osteoarthritis (KOA) and explore the mechanism of TSM on KOA.</p><p><b>METHODS</b>A total of 42 Japanese long-eared male rabbits were divided into a blank group (6 rabbits), a model group (6 rabbits), a moxibustion group (24 rabbits) and a sham-operation group (6 rabbits) according to the random number table. In the blank group, the rabbits were fed normally. In the model and moxibustion groups, the papain injection was given to establish KOA models. The rabbits in the sham-operation group were treated with the intracavity injection of 0.9% NaCl solution. The rabbits were forced to move for 30 min every day, continuously for 15 days during modeling. At the end of modeling, in the moxibustion group, moxibusiton was applied at "Dubi" (ST 35), once a day, 40 min each time, for 14 days totally. According to the temperature changes during moxibustion, the rabbits were divided into a TSM group and a non-TSM group. 6 rabbits were collected randomly from the two groups. The usual feeding was given in the blank group, the model group and the sham-operation group, without any intervention. The body mass and behavioristics changes were observed in each group. At the end of treatment, the nitrate reduction method was adopted to determine NO expression in the serum. The real-time PCR was adopted to determine the expressions of ADAMTS-4, typeⅡcollagen and PG in the cartilage.</p><p><b>RESULTS</b>① After modeling, compared with the blank group, the body mass was all reduced and the Lequesne MG score was increased in the model group, TSM group, non-TSM group and sham-operation group (<0.05, <0.01). After intervention, compared with the blank group, the body mass was decreased and the Lequesne MG score was increased in the model and sham-operation groups (<0.05, <0.01). Compared with the model group, the body mass was increased and the lequesne MG score was decreased in the TSM, non-TSM, and sham-operation groups (<0.05, <0.01). Compared with the non-TSM group, the body mass in the TSM group was increased remarkably (<0.05), but the difference in Lequesne MG score was not statistically significant (>0.05). ② After intervention, compared with the blank group, the expressions of NO and ADAMTS-4 were all increased and the expressions of typeⅡcollagen and PG were decreased in the model group, TSM group, non-TSM group and sham-operation group (<0.05, <0.01). Compared with the model group, the expressions of NO and ADAMTS-4 were all remarkably lower and the expressions of typeⅡcollagen and PG were increased in the TSM group, non-TSM group and sham-operation group (<0.05, <0.01). Compared with the non-TSM group, the expressions of NO and ADAMTS-4 were all remarkably lower and the expressions of typeⅡcollagen and PG were increased in the TSM group after intervention (all <0.05).</p><p><b>CONCLUSION</b>The thermosensitive moxibustion alleviates the inflammatory reactions and protects the joint cartilage through inhibiting the expressions of NO and ADAMTS-4 to achieve the effects in the treatment of KOA.</p>

Effects of heat-sensitive moxibustion on HPA axis in rats with irritable bowel syndrome / 中国针灸

<p><b>OBJECTIVE</b>To observe the effects of heat-sensitive moxibustion on corticotropin releasing hormone (CRH), adrenocorticotrophic hormone (ACTH) and corticosterone (CORT) in rats with irritable bowel syndrome (IBS), and to explore the possible mechanism of heat-sensitive moxibustion on IBS.</p><p><b>METHODS</b>According to random number table, 56 SD male rats were randomly divided into a blank group (=8), a model group (=8), a moxibustion group (=32), and a mifepristone group (RU-486 group,=8). The rats in the blank group were treated with normal feeding; the rats in the model group, RU-486 group and moxibustion group were treated with chronic non-predictable stimulation for 21 days to establish IBS model. After model establishment, the rats in the moxibustion group were treated with moxibustion at "Mingmen" (GV 4) for 40 min, once a day for 14 days; the tail temperature was recorded every 5 min; according to the change of tail temperature, the rats were divided into a heat-sensitive moxibustion group and a non-heat-sensitive moxibustion group, and 8 rats were randomly selected in the two groups. The rats in the RU-486 group were treated with gastric administration of RU-486 for 14 days, while the rats in the blank group, model group and moxibustion groups were treated with identical volume of 0.9% NaCl. The rat general condition, body mass, behavioristics, intestinal propulsive rate and visceral sensitivity were observed in each group; ELISA method was used to detect serum CRH, ACTH and CORT; optical microscope was applied to observe the morphological changes of colon.</p><p><b>RESULTS</b>(1) After model establishment, rats were in rest state, fatigued, with withered hair and dim ear; the stool was dry or watery; the body mass were slowly increased; the number of crossed grid and standing frequency were significantly reduced; visceral sensitivity was increased and intestinal propulsion rate was decreased; no obvious inflammatory cell infiltration was observed under microscope. (2) After intervention, compared with the blank group, the body mass and visceral sensitivity in the RU-486 group were not significantly different (both>0.05), but the intestinal propulsion rate was decreased significantly (<0.01). Compared with the blank group, the body mass of heat-sensitive moxibustion group and non-heat-sensitive moxibustion group was lower (both<0.01), but the visceral sensitivity and intestinal propulsion rate were similar (both>0.05). Compared with the model group, the body mass and visceral sensitivity were improved in the RU-486 group (<0.05,<0.01), but the intestinal propulsion rate was similar (>0.05). The body mass, visceral sensitivity and intestinal propulsion rate of the heat-sensitive moxibustion group and the non-heat-sensitive moxibustion group were superior to those of the model group (<0.05,<0.01), and the body mass and intestinal propulsion rate of heat-sensitive moxibustion group were superior to those of non-heat-sensitive moxibustion group (both<0.05). (3) After intervention, compared with the blank group, the contents of CRH, ACTH and CORT in the model group were significantly increased (<0.05,<0.01). Compared with the model group, the contents of CRH, ACTH and CORT of the heat-sensitive moxibustion group were statistically reduced (<0.05,<0.01), and the contents of CRH and ACTH in the non-heat-sensitive moxibustion group were statistically reduced (<0.05,<0.01); the content of CRH in the RU-486 group was reduced (<0.05), but the contents of ACTH and CORT were increased (<0.05,<0.01). Compared with the non-heat-sensitive moxibustion group, the heat-sensitive moxibustion group was better in the improvement of CRH (<0.05), but there was no significant difference of ACTH and CORT between the two groups (both>0.05).</p><p><b>CONCLUSION</b>Heat-sensitive moxibustion could reduce the contents of CRH, ACTH and CORT through the HPA axis, and improve the function of gastrointestinal motility to treat IBS.</p>

Correlation of B-type natriuretic peptide with blood lipids and renal function in elderly patients with coronary heart disease / 中华老年医学杂志

Objective To explore the correlation of B-type natriuretic peptide (BNP) with blood lipids and renal function in elderly patients with coronary heart disease (CHD).Methods According to the four quantiles of BNP level,325 subjects aged 65 years and over were divided into four groups:group A (≤32.4 ng/L),group B (32.5 ng/L),group C (62.4 ng/L),group D (＞ 162.5 ng/L).The left ventricular ejection fraction (LVEF),left ventricular end-diastole dimension (LVEDD),levels of blood lipids and renal function were compared among the groups.Results With the increase of BNP level,the LVEF was gradually decreased [(63.3±8.2) ％,(59.6±7.4) ％,(57.9±9.7)％,(55.2±10.6)％,respectively,F=11.54,P＜0.01] and the LVEDD was gradually increased (F=6.76,P＜0.01),the level of triglyceride (TG) was gradually decreased (F=2.73,P ＜0.05) in group A,B,C and D.Creatinine clearance was gradually decreased [(1.24±0.31) ml ·s-1 · 1.73 m-2,(1.21±0.31) ml· s-1 · 1.73 m-2,(1.24±0.29) ml · s-1 · 1.73 m 2,(1.09± 0.33) ml · s-1 · 1.73 m-2,respectively,F=3.62,P＜0.05],and blood urea nitrogen was gradually increased (F=4.43,P＜0.05) in group A,B,C and D.Multi-linear regression analysis showed that levels of total cholesterol,triglyceride,low density lipoprotein-cholesterol,high density lipoproteincholesterol,very low density lipoprotein-cholesterol,creatinine clearance and blood urea nitrogen were influencing factors for BNP (all P＜0.05).Conclusions BNP level can be used as a sensitive indicator for the diagnosis of heart failure and the assessment of its severity.The levels of blood lipids and renal function are associated with BNP.

The Preliminary Study of the Relationship between IL-6,IL-10,TNF-αand Coronary Artery Disease / 天津医药

Objective To study the relationship between coronary artery disease (CHD ) and interleukin-6 (IL-6), TNF-α and IL-10. Methods Patients with CHD were included in CHD group (n=628) and patients without CHD con?firmed by coronary angiography were selected in control group (n=540) . The recorded data included age, body mass index (BMI) and serum levels of glucose (GLU), total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C). Meanwhile serum levels of IL-6, TNF-α, IL-10 were determined by ELISA. Results Serum levels of BMI, LDL-C, TG were higher in CHD group than those in control group(P<0.01). The serum level of HDL-C was significantly lower in CHD group than that in control group(P<0.01). Serum levels of IL-6(P<0.05)and TNF-α(P<0.01)were higher in CHD group than those in control group. The serum level of IL-10 was significant?ly lower in CHD group than that in control group(P<0.01). Conclusion IL-6 and TNF-αare involved in the develop?ment of CHD. IL-10 can inhibit inflammation and protect vessel integrity.

Effects of MMP-3 Gene Polymorphism in Restenosis after Percutaneous Coronary Interventions / 天津医药

Objective To investigate the relationship between matrix metalloproteinase-3 (MMP-3) gene promoter polymorphisms 5A/6A and the restenosis after percutaneous coronary intervention (PCI). Methods A total of 437 patients with PCI were selected in this study. Patients were divided into mutant genotype group (5A/5A+5A/6A, n=136) and wild genotype group (6A/6A, n=301) according to MMP-3 polymorphism. The angiography and clinic data were collected before and after coronary angiography in two groups of patients. The serum level MMP-3 and genotype analysis were compared be-tween two groups. Results There was no significant difference in the restenosis rate between two groups (42.2%vs 33.1%, P>0.05). The restenosis degree was significantly higher in wild genotype group than that in mutant genotype group (56.28%± 11.10%vs 36.00%±10.17%, P＜0.01). There was no significant difference in the serum level of MMP-3 between two groups (13.38μg/L ± 3.00μg/L vs 12.33μg/L ± 2.96μg/L, P>0.05). There was a higher restenosis rate in patients carrying 6A al-lele than that of patients carrying 5A allele (P＜0.05). Carrying wild genotypes are risk factors for restenosis after PCI. Con-clusion Patients carrying 6A allele have significantly higher risk of resteonsis than patients carrying 5A allele.

Correlation between B-type natriuretic peptide and fibrinogen in the elderly patients with coronary heart disease / 中华老年医学杂志

Objective To explore the relationship between B-type natriuretic peptide (BNP) and fibrinogen (Fib) in the elderly patients with coronary heart disease (CHD). Methods According to the level of BNP,325 subjects aged more than 65 years were divided into four groups,BNP:≤32.4ng/Lgroup,32.5～62.3 ng/Lgroup,62.4～162.5 ng/Lgroup,＞162.5 ng/L group.The levels of left ventricular ejection fraction (LVEF),left ventricular end-diastole dimension (LVEDD) and Fib were compared among the groups. Results With increasing BNP level,the LVEF was gradually decreased [(63.3±8.2)％,(59.6±7.4)％,(57.9±9.7)％,(55.2±10.6)％] and the level of LVEDD was increased[(50.5±4.7)mm,(51.4±5.4)mm,(52.8±5.7)mm,(54.2±5.9)mm ;F=11.54,6.76,both P＜0.01],the level of Fib was enhanced [(3.4±0.7)g/L,(3.7±0.8)g/L,(3.8±1.1)g/L,(4.2±1.0)g/L; F=8.02,P＜0.01].The level of BNP had positive correlation with Fib (r=0.25,P＜0.01). Multi-linear regression analysis showed that Fib and LVEF were influencing factors of BNP (t =2.92, - 3.15, both P ＜ 0.01 ). Conclusions The BNP level is helpful to diagnose heart failure and assess heart function.There is an association between BNP and Fib level.

Correlation between blood lipids and creatinine clearance in the elderly patients with coronary heart disease / 中华老年医学杂志

Objective To explore the relationship between blood lipids and creatinine clearance (Ccr)in aged patients with coronary heart disease(CHD).Methods According to coronary artery angiography(CAG)and Ccr,784 subjects aged 65 years and over were divided into groups and Their lipid levels were compared.Results With increasing lesion of coronary branches,the level of Ccr was obviously decreased(F=5.35,P＜0.01).The level of apolipoprotein A1(ApoA1)was reduced and apolipoprotein B(ApoB)enhanced in renal function of moderate-severe injury(CCr＜0.83 ml ·s-1 · 1.73m-2)(F=5.31,F=4.91,both P＜0.01).The level of ApoA1 was decreased(F=3.52,P＜0.05)and Apo B increased(F=5.65,P＜0.01)in male renal function of moderate-severe injury.The levels of ApoA1 decreased(F=5.79,P＜0.01),ApoB increased(F=4.56,P＜0.05)and high density lipoprotein-cholesterol reduced(F=3.39,P＜0.05)in CHD with renal group of moderatesevere injury.Multi-logistic regression analysis showed that Ccr,HDL-C,ApoA1 and ApoB were influencing factors of CHD.Conclusions Abnormal blood lipid and renal dysfunction are risk factors of CHD,dyslipidemia may induce renal dysfunction.It is important to control lipids and improve other organ functions in the aged patients with CHD.

The Effects of Recombinant Adeno-Associated Virus Vector Delivery of Angiotensin Ⅱ Type 1 Receptor shRNA on Blood Pressure and Angiotensin Ⅱ Type 1 Receptor mRNA Expression in Renal Hypertensive Rats / 中华高血压杂志

Background Hypertension is a multigenetic inheritable disease.Gene therapy by regulating gene expression showed long term effects and less side effects,and has been emerged to be a potential and prospective treatment.Objective To investigate the effects of retroviraladeno-associated virus vector containing shRNA targeted on the AT1R gene (rAAV-AT1R-shRNA) on blood preesure(BP) in renal hypertensive rats,and the inhibitory effect of RNA interference (RNAi) on AT1R mRNA expression in renal hypertensive rats.Methods Two-kideny one-clip (2K1C) renal hypertension (RH) were established in SD rats and randomly to receive rAAV-AT1R-shRNA,1.5?109 particles/mL(n=12,ip),as treated group or retroviral vector (rAAV-EGFP),2.9?109 particles/mL,ip,as vehicle group,normal SD rats served as controls (n=12).SBP was measured before and after treatment.Animals were euthanized and blood,brain,heart,liver,kidney,aorta and adrenal gland were collected to identify the sites of rAAV-AT1R-shRNA expression by fluorescence microscope.Angiotensin Ⅱwas assessed by radioimmunology.Results 24 hours after single injection of rAAV-AT1R-shRNA,SBP was reduced by (22.3?5.5)mmHg compared to before intervention (P