Effects of integrated disease management program on the outcome of patients with heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the feasibility and efficacy on the outcome of patients with heart failure of integrated disease management program with heart failure clinic, patient education and telephone follow-up.</p><p><b>METHODS</b>A total of 145 hospitalized patients with chronic heart failure and LVEF ≤ 45% or patients with LVEF > 45% and NT-proBNP > 1500 ng/L were divided into conventional group (n = 71) and interventional group (n = 74). Patients were followed for 10 to 12 months.</p><p><b>RESULTS</b>Baseline clinical characteristics, LVEF and dose of evidence-based medicine were similar between the 2 groups. During follow-up, the NYHA functional class was higher in conventional group than interventional group (3.2 ± 0.5 vs 1.4 ± 0.5, P < 0.05), and the LVEF deteriorated in the conventional group and improved from 34% to 40%in the interventional group. The proportions of self-monitoring of weight, blood pressure and pulse rate in the interventional group were significantly higher than those of conventional group (P < 0.05). Among patients with systolic heart failure, 40% patients in the interventional group and 11% patients in the conventional group achieved the target doses of β-blockers (P < 0.05). Cardiovascular event rate of conventional group and interventional group is 91.5% and 27.0% respectively (P < 0.05).</p><p><b>CONCLUSION</b>Integrated disease management program with heart failure clinic, patient education and telephone follow-up can improve patient compliance to heart failure treatment, improve cardiac function and reduce cardiovascular event rate.</p>

Role of ICAM-1 in stem cell up-regulation after acute myocardial infarction / 上海第二医科大学学报

Objective To investigate the role of intercellular adhesion molecule-1 (ICAM-1) in the up-regulation of peripheral blood somatic stem cells after acute myocardial infarction in rats. Methods The models of acute myocardial infarction were established in 16 rata by ligation of left anterior descending branch of left coronary artery through chest incision, and the animal were divided into control group(n=8) and experiment group (n=8). The hearts of another 2 rats were obtained for normal myocardial tissue sections as controls. Monoclonal antibody of ICAM-1 was infused from the caudal vein in experimental group, and no invervention was conducted for control group. Blood samples were obtained from caudal vein on the first, third, seventh and fourteenth day after operation in these two groups. Serum concentration of ICAM-1 was measured by ELISA, positive rate of CD34 cells in peripheral blood was detected by flow cytometry, and the parameters of concentration of ICAM-1 and positive rate of CD34 cells at each time point were compared between groups. Results The concentration of ICAM-1 in peripheral blood of experiment group reached the lowest of (59.01±2.22) pg/mL on the seventh day. The concentrations of ICAM-1 in peripheral blood of experiment group were lower than those in control group, and there were significant differences between these two groups on the seventh and fourteenth day(P < 0.01). The positive rate of CD34 cells in peripheral blood of experiment group reached the highest of (12±2.11)% on the seventh day. The positive rates of CD34 cells in peripheral blood of experiment group were higher than those in control group, and there were significant differences between these two groups on the third, seventh and fourteenth day(P<0.05 or P<0.01). Conclusion ICAM-1 can inhibit the up-regulation of peripheral blood somatic stem cells after acute myocardial infarction in rats.

Endothelial progenitor cells related gene expression changes before and early after revascularization in patients with acute myocardial infarction / 中华心血管病杂志

<p><b>OBJECTIVE</b>The purpose of this study was to observe the endothelial progenitor cells (EPCs) related gene expression changes before and early after revascularization in patients with acute myocardial infarction.</p><p><b>METHODS</b>Peripheral blood samples were taken from patients with acute anterior myocardial infarction 6 hours and 7 days after PCI and stenting. Mononuclear cells (MNCs) were isolated by Ficoll-density centrifugation and cultured in M-199 medium. After 14 days culture, attaching cells incorporated DiI-acetylated low-density lipoprotein (EPCs) were collected and RNA was isolated by Trizol for microarray analysis on 24 genes associated with permissibility/vessel tone (angiotensin system: ACE, AGTR-1, AGTR-2; NO system: eNOS; prostacyclin system: COX-2; endothelin system: ET-1, ETA, ETB; superoxide anions system: SOD-1), angiogenesis (adhesion molecule: CDH5; growth factors and receptors: VEGFR1, VEGFR2, VEGF) and endothelial cell activation (adhesion molecules expression: ICAM1, ICAM2, ICAM3, PECAM-1, E-Selectin, L-Selection, VCAM1; change phenotype from antithrombotic to prothrombotic: tPA, uPA, PAI, vWF). VEGFR2, PECAM-1 and VE-cadherin positive cells were identified by flow cytometry.</p><p><b>RESULT</b>Eight gene expressions (AGTR-1, AGTR-2, COX-2, eNOS, ET-1, ETA, VEGF) were significantly downregulated 7 days post PCI compared to pre-PCI (P < 0.05). Flow cytometry results showed that VEGFR2 positive cells were also significantly reduced post PCI than that of before PCI (P < 0.05).</p><p><b>CONCLUSION</b>PCI down-regulated endothelial progenitor cells related gene expressions in patients with acute myocardial infarction.</p>

In vitro differentiaion of peripheral blood mononuclear cells into smooth muscle progenitor cells / 上海第二医科大学学报

Objective To optimize methods of culturing smooth muscle progenitor cells(SPCs) from mononuclear cells(MNCs) of peripheral blood. Methods Human MNCs isolated from buffy coat were seeded on M-199 with bovine pituitary extraction.On the eighth day outgrowth cells were stimulated with platelet-derived growth factor-BB(PDGF-BB).Fifteen days later,immunofluorescence,Western blot or RT-PCR was used to analyzed the expression of smooth muscle cell specific ?-actin(?-SMA),smooth muscle myosin heavy chain(SM MHC),Calponin,CD34,Tie-2 and Flk-1,and fluorescence activated cell sorter was employed to examine ?-SMA positive cells ratio. Results The cells stimulated by PDGF-BB for 15 d were positive for ?-SMA,SM MHC,Calponin,CD34 and Flk-1,but negative for Tie-2.The ?-SMA positive cells ratio was(90.57?5.63)%,significantly different from that of the control(P