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Objective:To evaluate the relationship between sleep arousal, ambulatory blood pressure and new-onset heart failure(NOHF)in elderly patients with obstructive sleep apnea(OSA).Methods:A total of 584 elderly patients with OSA who were diagnosed and treated in our hospital between March 2015 and March 2019 were prospectively and consecutively selected, with a mean age of(70.1±7.2)years.Polysomnography(PSG)results were obtained at baseline, and the arousal index(AI)was calculated.Based on the quartiles of AI, patients were divided into 4 groups: a low-level group(AI<18.4/h, 186 cases), a low-medium level group(18.4-29.1/h, 177 cases), a medium-high level group(29.2-41.2/h, 137 cases)and a high-level group(>41.2 /h, 84 cases). Participants were followed up for 18 months, the results of ambulatory blood pressure were recorded and compared, and the relationship between AI and the risk of NOHF was analyzed.Results:Compared with the low-level group, patients in the low-medium, medium-high, and high-level groups were older(70.1, 70.3, 73.3 vs.68.7 years, F=2.726, P=0.043)and had more smokers(43.8%, 49.6%, 54.8% vs.38.2%, χ2=8.809, P=0.032), a larger body mass index(26.3, 26.7, 27.6 vs.25.4 kg/m 2, F=2.731, P=0.042), a higher Epworth sleepiness scale score(7.83, 8.50, 9.91 vs.7.64, F=5.124, P=0.018), a higher apnea hypopnea index(23.5, 34.8, 52.7 vs.17.6, F=5.632, P=0.007), lower nocturnal oxygen saturation(80.2, 75.3, 72.1 vs.83.7 mmHg, F=4.811, P=0.024), and higher N-terminal pro-B-type natriuretic peptide(NT-proBNP)levels(317.5, 337.5, 359.2 vs.267.5 pg/L, F=4.307, P=0.033). At the median follow-up(18 months, 14-24 months), the results of ambulatory blood pressure monitoring showed that 24-hour systolic blood pressure(24 h SBP)(147.3, 148.6, 156.2 vs.143.8 mmHg, F=5.4311, P=0.013), 24-hour diastolic blood pressure(24 h DBP)(80.1, 79.5, 83.7 vs.76.5 mmHg, F=5.679, P=0.011)in the low-medium, medium-high and high-level groups were higher than those in the low-level group.The results of survival analysis showed that there were 75(12.8%)cases of NOHF, mostly with preserved ejection fraction(47 cases)or mid-range ejection fraction heart failure(20 cases). The incidences of NOHF were 6.5%, 12.4%, 16.1% and 22.4%, respectively for the low level, low-medium, medium-high and high-level groups, and the risk of NOHF in the low-medium, medium-high and high-level groups was significantly higher than in the low level group(log-rank χ2=11.624, P=0.007). Variables with P<0.2 in the univariate analysis, age and sex were included in the multivariate Cox regression analysis.The results showed that age( HR=1.724, 95% CI: 1.216-3.135), diabetes( HR=1.514, 95% CI: 1.127-3.058), NT proBNP( HR=1.517, 95% CI: 1.232-2.366), nocturnal diastolic blood pressure( HR=2.004, 95% CI: 1.332-4.638), and middle-high AI level( HR=1.611, 95% CI: 1.204-2.967)and high AI level( HR=1.863, 95% CI: 1.272-3.538)were independent factors of NOHF in elderly OSA patients. Conclusions:Sleep arousal in elderly patients with OSA increases blood pressure levels and the risk of NOHF.
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Objective To investigate any therapeutic effect of combining hyperbaric oxygen with mesenchymal stem cells (MSCs) in treating traumatic brain injury (TBI).Methods Eighty healthy adult rats were randomly divided into a control group,a hyperbaric oxygen group,a stem cell group and a combination group,each of 20.TBI was introduced into the rats of all 4 groups.Twenty-four hours after the modelling,the hyperbaric oxygen group received hyperbaric oxygen therapy,the stem cell group received MSCs transplantation,the combination group was given the hyperbaric oxygen therapy an hour after the MSCs transplantation,while the control group was not given any treatment.All of the rats were evaluated using neurological severity scores (NSSs) after the modeling and again after the treatment.They were then sacrificed for HE staining and the expression of nuclear factor kappa B (NF-kB) and brain-derived neurotrophic factor (BDNF) were observed.Results On the 3rd,5th,10th and 20th day after the modeling,the average NSS of the combination group was significantly lower than those of the other three groups.However,the average NSS of the combination group on the 20th day was significantly superior to that on the 3rd and the 5th days.Compared with the control group,the edema of brain cells was less severe in the other 3 groups.The average expression of NF-kB and BDNF in the combination group was significantly higher than in the other 3 groups on the 3rd,5th,10th and 20th day after the modeling.Conclusion Hyperbaric oxygen,especially long term treatment combined with stem cell transplantation,can significantly improve nerve function in the brain after trauma,relieve inflammation and edema in and around the damaged area,and promote the expression of the NF-kB and BDNF.
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Objective To preliminarily discuss the effect of thrombectomy with the TREVO device in patients with acute ischemic stroke.Methods Six patients with acute ischemic stroke treated with TREVO device at the Department of Neurointervention,Beijing Fengtai You′anmen Hospital from April to June 2016 were analyzed retrospectively,including 2 patients with middle cerebral artery (MCA)occlusion (time window from 2. 7 to 5. 5 h),4 with basilar artery occlusion (time window from 4. 0 to 7. 0 h). The effect of thrombectomy was evaluated by the modified thrombolysis in cerebral infarction (mTICI ) scores. The National Institutes of Health Stroke Scale (NIHSS)scores were used to evaluate the neurological status of patients before and after treatment. The prognosis was evaluated by the modified Rankin scale. Results (1 )After 1 to 2 embolectomies,the occlusive arteries of 5 patients achieved recanalization (mTICI gradeⅡb-Ⅲ;posterior circulation in 4 cases,MCA in 1 case). (2)Compared with at admission,the NIHSS score in 1 of 2 patients with MCA occlusion was reduced by 8 points at discharge,and 1 was not any improvement;compared with at admission,the NIHSS scores in 3 of 4 patients with basilar artery occlusion were decreased by 8-26 points at discharge,and 1 was not any improvement;in 2 patients with MCA occlusion,the modified Rankin scale scores were 0 to 1 at 3 months after discharge (0 in 1 case,4 in 1 case);the Rankin scale scores in 4 patients with basilar artery occlusion at 3 months after discharge were 0 in 1 case,1 in 2 cases,and 5 in 1 case.Conclusion The preliminary experience of using TREVO device embolectomy for patients with acute ischemic stroke shows that it is more safe and effective.
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Objective:To explore interleukin (IL)-8 and C reactive protein (CRP) levels change after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD) .Methods :A total of 90 CHD patients , who hospitalized in our hospital from Mar 2010 to Dec 2012 ,were selected .According to their therapeutic methods , they were divided into PCI group (n=70) and conservative treatment group (n=20) .Another 20 healthy people were regarded as healthy control group .Changes of IL-8 and C reactive protein (CRP ) concentrations before and within 20d after treatment were compared among three groups .Results :Compared with before treatment ,on 1d af-ter treatment ,there were significant reductions in levels of IL-8 [ (63.22 ± 13.10) pg/ml vs .(31.58 ± 9.10) pg/ml] and CRP [ (14.59 ± 6.13) mg/L vs .(9.61 ± 2.35) mg/L] in PCI group ,IL-8 was significantly lower than that of conservative treatment group [(50.18 ± 19.31) pg/ml] ,P0.05. Conclusion:IL-8 and C reactive protein levels significantly reduce after PCI ,which can be treated as indexes evaluating PCI postoperative prognosis in CHD patients .
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Objective To observe the influence of different doses of atorvastatin on the hyperlipidemia and cardiac ischemic events after percutaneous coronary intervention (PCI) in patients with coronary heart disease (CHD).Methods 132 cases with CHD in our hospital were randomly divided into group A,group B and group C,and they were given different doses of atorvastatin after the PCI surgery,.The changes of lipid levels and cardiac ischemic events were compared.Results TC,TG and LDL-C levels in the three groups were significantly decreased after treatment,and the HDL-C level significantly increased (P ＜ 0.05),TC and LDL-C of group B and group C were significantly lower(P ＜ 0.05).The cardiac ischemic events and the incidence rate of a variety of adverse reactions of group C were less than group A and group B,but the differences were not significant (P ＞ 0.05).Conclusion Highdose atorvastatin (40mg) can effectively decrease blood lipid levels in CHD patients after PCI,reduce the incidence rate of cardiac ischemic events,and it is safe,effective,which is worth to be promoted and applicated in clinical.
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Objeetive To investigate the relationship between 24-hour blood pressure rhythm and carotid scleratheroma in elderly patients with hypertension.Methods 193 elderly patients with hypertension were enrolled in the study and divided into study group (91 cases with carotid atherosclerosis) and control group (102 cases).All the patients were given 24h blood pressure rhythm examination.The characteristics of 24hour blood pressure rhythm was compared between the two groups.Results The 24h average systolic blood pressure(24h-SBP),24h average diastolic blood pressure (24h-DBP),24h average pulse pressure (24h-MBP) between the study group and the control group had no significant differences(P ＞ 0.05).The daytime average systolic blood pressure(d-SBP),diurnal mean diastolic blood pressure (d-DBP),diurnal average pulse pressure (d-MBP),nocturnal mean systolic blood pressure (n-SBP),nocturnal mean diastolic blood pressure(n-DBP),nocturnal mean pulse pressure(n-MBP) of the study group were significantly higher than those of the control group (t =16.92,24.68,6.16,12.87,11.59,6.35,all P ＜0.05).In study group,d-SBP,d-DBP,d-MBP were higher than n-SBP,n-DBP,n-MBP,the differences were statistically significant(F =73.61,P ＜ 0.01).The circadian blood pressure variability of the study group was more than 10％,the 24h ambulatory blood pressure curve graph of the study group was non-dipper curve.The circadian blood pressure variability of the control group was less than 5％,the 24h ambulatory blood pressure curve was dipper type curve.Conclusion The MBPS is strongly associated with carotid scleratheroma,and clinical treatment and study could derive from ABPM data analysis.
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The mechanisms of increased expression of toll-like receptor 4 (TLR-4) during the formation of foam cells were explored. Low density lipoprotein (LDL) was prepared by density gradient ultracentrifugation and oxidized by incubation with CuCl2. The human monocytic leukemia cell line (THP-1) was cultured in RPMI1640. The differentiation of THP-1 cells into macrophages (MPs) was induced by using myristate acetate (PMA) for 48 h. The macrophages were then incubated with oxidized LDL (ox-LDL) to generate foam cells (FCs). The mRNA and protein expression levels of human TLR-4 were detected by immunocytochemistry, Western blotting and reverse transcription polymerase chain reaction (RT-PCR). The results showed that the TLR-4 mRNA and the protein expression levels were significantly increased during the differentiation of monocytes into macrophages (P＜0.05) as well as during the formation of lipid-laden foam cells (P＜0. 05). It was concluded that the upregulation of human TLR-4 gene expression during the differentiation of monocytes into macrophages and the differentiation of macrophages into foam cells could increase TLR-4 protein synthesis dramatically, which may enhance the ability of foam cells inflammation reaction in atherosclerosis.
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To investigate the effects of leptin on expression of acyl-coenzymeA: cholesterol acyl-transferases-1 (ACAT-1) in monocyte-macrophage differentiation, human monocytic cells (THP-1) were cultured in RPMI 1640 and made to differentiate into macrophages under the incubation with phorbol myristate acetate (PMA) for 48 h. The cells were divided into 4 groups according to different intervention factors as follows: MCs cultured in RPM11640 medium with 10% FBS for 48 h served as MC group (control group), MCs cultured in medium with serum-free RPM11640 containing 5% BSA, 100 nmol/L PMA for 48 h as MP group, MCs cultured in RPMI1640 medium with 10% FBS, 10 micromol/ml leptin for 48 h as leptin-MC group, and MCs cultured in medium with serum-free RPMI1640 containing 5% BSA. 100 nmol/L PMA, and 10 micromol/ml leptin for 48 h as leptin-MP group. Immunocytochemistry, reverse transcription polymerase chain reaction (RT-PCR) and Western blot were performed, respectively, to observe the effects of leptin on expression of ACAT-1 in the monocyte-macrophage differentiation. Our results showed that expression of ACAT-1 protein and mRNA in MP-group is two times that in MC-group (P<0.05), and the expression of ACAT-1 protein and mRNA increased by up to 4 folds in leptin-MP group-as compared with that of MC group (P<0.01). Thus, our results support the idea that expression of ACAT-1 increases more in cultured human macrophages than in monocytes, and leptin can significantly promote ACAT-1 expression. It was concluded that high expression of ACAT-1 may accelerate the development of human atherogenesis, and leptin might participate in atherogenesis by increasing expression of ACAT-1.
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Humanos , Aterosclerose , Diferenciação Celular , Células Cultivadas , Leptina , Farmacologia , Macrófagos , Biologia Celular , Monócitos , Biologia Celular , Esterol O-Aciltransferase , Genética , Acetato de TetradecanoilforbolRESUMO
To study the angiogenic potency of hypoxia-prestimulated bone marrow stromal cells (BMSCs) when transplanted into acute myocardial infarction models of rats. BMSCs were cultured under hypoxia condition for 24 h. Their expression of VEGF was investigated. The rat acute myocardial infarction models were made by coronary artery ligation and divided into 3 groups at random. In normoxia group, twice-passaged BMSCs were labeled with Bromodeoxyuridine (BrdU) and then implanted into the infarction regions and ischemic border of the recipients in 4 weeks. The rats in hypoxia group were implanted with hypoxia-prestimulated BMSCs. In control group, the model rats received only DMEM medium injection. Six-weeks after AMI, the infarction regions were examined to identify the angiogenesis and the expression of the VEGF. Our results showed that viable cells labeled with BrdU could be identified in the host hearts. The infarction regions in normoxia and hypoxia groups had a greater capillary density and increased VEGF expression than the regions in control group. The capillary density and VEGF expression in hypoxia group were higher than in normoxia group. It is concluded that the enhanced expression of VEGF in BMSCs could be induced by ex vivo hypoxia stimulation. BMSCs implantation promoted the angiogenesis in myocardial infarction tissue via supplying exogenic VEGF. Angiogenic potency of bone marrow stromal cells was improved by ex vivo hypoxia prestimulation though the enhanced VEGF expression.