RESUMO
BACKGROUND: Bone marrow-derived stem cells are under investigation as a treatment for ischemic heart disease. Mesenchymal stem cells (MSCs) have been used preferentially in the acute ischemia model; data in the chronic ischemia model are lacking. METHODS AND RESULTS: Twelve dogs underwent ameroid constrictor placement. Thirty days later, they received intramyocardial injections of either MSCs (100x10(6) MSCs/10 mL saline) (n=6) or saline only (10 mL) (controls) (n=6). All were euthanized at 60 days. Resting and stress 2D echocardiography was performed at 30 and 60 days after ameroid placement. White blood cell count (WBC), C-reactive protein (CRP), creatine kinase MB (CK-MB), and troponin I levels were measured. Histopathological and immunohistochemical analyses were performed. Mean left ventricular ejection fraction was similar in both groups at baseline but significantly higher in treated dogs at 60 days. WBC and CRP levels were similar over time in both groups. CK-MB and troponin I increased from baseline to 48 hours, eventually returning to baseline. There was a trend toward reduced fibrosis and greater vascular density in the treated group. MSCs colocalized with endothelial and smooth muscle cells but not with myocytes. CONCLUSIONS: In a canine chronic ischemia model, MSCs differentiated into smooth muscle cells and endothelial cells, resulting in increased vascularity and improved cardiac function.
Assuntos
Células Endoteliais/citologia , Endotélio Vascular/citologia , Transplante de Células-Tronco Mesenquimais , Músculo Liso Vascular/citologia , Isquemia Miocárdica/cirurgia , Miócitos de Músculo Liso/citologia , Animais , Proteína C-Reativa/análise , Diferenciação Celular , Linhagem da Célula , Vasos Coronários/citologia , Vasos Coronários/patologia , Creatina Quinase/sangue , Creatina Quinase Forma MB , Cães , Feminino , Fibrose , Injeções Intralesionais , Isoenzimas/sangue , Contagem de Leucócitos , Masculino , Isquemia Miocárdica/sangue , Isquemia Miocárdica/diagnóstico por imagem , Isquemia Miocárdica/patologia , Isquemia Miocárdica/fisiopatologia , Miócitos Cardíacos/patologia , Neovascularização Fisiológica , Especificidade de Órgãos , Fenótipo , Volume Sistólico , Troponina I/sangue , UltrassonografiaAssuntos
Recursos Humanos de Enfermagem Hospitalar/educação , Recursos Humanos de Enfermagem Hospitalar/provisão & distribuição , Seleção de Pessoal , Desenvolvimento de Pessoal , Adulto , Educação Técnica em Enfermagem , Necessidades e Demandas de Serviços de Saúde , Hospitais Religiosos , Humanos , Judaísmo , Kentucky , Pessoa de Meia-Idade , Afiliação Institucional , Desenvolvimento de Programas , Estados Unidos , Recursos HumanosRESUMO
Key nursing representatives from Jewish Hospital of Louisville, Ky., share techniques for garnering a successful Magnet appraisal.
Assuntos
Credenciamento/organização & administração , Enfermeiros Administradores/organização & administração , Serviço Hospitalar de Enfermagem/normas , Distinções e Prêmios , Benchmarking/organização & administração , Hospitais Religiosos , Humanos , Kentucky , Liderança , Marketing de Serviços de Saúde , Papel do Profissional de Enfermagem , Objetivos Organizacionais , Técnicas de PlanejamentoRESUMO
BACKGROUND: In working rat hearts, metabolic support of injured tissue enhances recovery after acute myocardial infarction. Clinical experience with a systemic "polarizing solution" supports this claim. OBJECTIVES: In a dog model of ischemia/reperfusion, we tested the feasibility of subselectively supplying adapted metabolic substrates before instituting blood reperfusion. METHODS: Thirty-five dogs underwent ligation of the proximal left anterior descending artery and collaterals for 90 minutes. The animals were randomly assigned to receive direct blood reperfusion (Group I), intracoronary glucose, insulin, and potassium (Group II), or intracoronary glucose, insulin, and potassium plus propionyl-L-carnitine (PLC) (Group III). After 30 minutes of artificial reperfusion, prograde blood flow was resumed in groups II and III. A routine necropsy was performed 3 to 5 days later. Primary endpoints were severe arrhythmias, death, markers of infarct size, and specific histologic features. RESULTS: We excluded 4 dogs for technical reasons and 2 others for preexisting cardiomyopathy. In the remaining 29 animals, large apical infarctions were documented ventriculographically during arterial ligation. One dog died of irreversible ventricular fibrillation during the initial ischemic period, and 9/28 dogs (32.1%) died during early reperfusion. Ventricular fibrillation was more common with 10% (versus 5%) dextrose concentrations and was eliminated by PLC. Irreversibly injured (versus jeopardized) areas of myocardium were more common in Group III (85.9 19.3%) than in Groups I and II (16.9 10.8%). CONCLUSION: Subselective infusion of metabolically supportive solutions during acute myocardial infarction is technically feasible. To prevent osmotic endothelial damage, the perfusate must have a low (< 5%) dextrose content.