Interventional electrophysiology represents a relatively recent subspecialty within the field of cardiology.In the past half-century,there has been significant advan-cement in the development and implementation of inn...Interventional electrophysiology represents a relatively recent subspecialty within the field of cardiology.In the past half-century,there has been significant advan-cement in the development and implementation of innovative ablation treatments and approaches.However,the treatment of arrhythmias continues to be inade-quate.Several arrhythmias,such as ventricular tachycardia and atrial fibrillation,pose significant challenges in terms of therapeutic efficacy,whether through interventional procedures or the administration of antiarrhythmic drugs.Cardio-logists are engaged in ongoing research to explore innovative methodologies,such as genome editing,with the purpose of effectively managing arrhythmias and meeting the growing needs of patients afflicted with rhythm disturbances.The field of genome editing has significant promise and has the potential to serve as a highly effective personalized therapy for rhythm disorders in patients.However,several ethical issues must be considered.展开更多
BACKGROUND The development of fully functional small diameter vascular grafts requires both a properly defined vessel conduit and tissue-specific cellular populations.Mesenchymal stromal cells(MSCs) derived from the W...BACKGROUND The development of fully functional small diameter vascular grafts requires both a properly defined vessel conduit and tissue-specific cellular populations.Mesenchymal stromal cells(MSCs) derived from the Wharton's Jelly(WJ) tissue can be used as a source for obtaining vascular smooth muscle cells(VSMCs),while the human umbilical arteries(h UAs) can serve as a scaffold for blood vessel engineering.AIM To develop VSMCs from WJ-MSCs utilizing umbilical cord blood platelet lysate.METHODS WJ-MSCs were isolated and expanded until passage(P) 4. WJ-MSCs were properly defined according to the criteria of the International Society for Cell and Gene Therapy. Then, these cells were differentiated into VSMCs with the use of platelet lysate from umbilical cord blood in combination with ascorbic acid,followed by evaluation at the gene and protein levels. Specifically, gene expression profile analysis of VSMCs for ACTA2, MYH11, TGLN, MYOCD, SOX9,NANOG homeobox, OCT4 and GAPDH, was performed. In addition,immunofluorescence against ACTA2 and MYH11 in combination with DAPI staining was also performed in VSMCs. HUAs were decellularized and served as scaffolds for possible repopulation by VSMCs. Histological and biochemical analyses were performed in repopulated h UAs.RESULTS WJ-MSCs exhibited fibroblastic morphology, successfully differentiating into"osteocytes", "adipocytes" and "chondrocytes", and were characterized by positive expression(> 90%) of CD90, CD73 and CD105. In addition, WJ-MSCs were successfully differentiated into VSMCs with the proposed differentiation protocol. VSMCs successfully expressed ACTA2, MYH11, MYOCD, TGLN and SOX9. Immunofluorescence results indicated the expression of ACTA2 and MYH11 in VSMCs. In order to determine the functionality of VSMCs, h UAs were isolated and decellularized. Based on histological analysis, decellularized h UAs were free of any cellular or nuclear materials, while their extracellular matrix retained intact. Then, repopulation of decellularized h UAs with VSMCs was performed for 3 wk. Decellularized h UAs were repopulated efficiently by the VSMCs. Biochemical analysis revealed the increase of total hydroyproline and s GAG contents in repopulated h UAs with VSMCs. Specifically, total hydroxyproline and s GAG content after the 1 st, 2 nd and 3 rd wk was 71 ± 10, 74 ± 9 and 86 ± 8 μg hydroxyproline/mg of dry tissue weight and 2 ± 1, 3 ± 1 and 3 ± 1μg s GAG/mg of dry tissue weight, respectively. Statistically significant differences were observed between all study groups(P<0.05).CONCLUSION VSMCs were successfully obtained from WJ-MSCs with the proposed differentiation protocol. Furthermore, h UAs were efficiently repopulated by VSMCs. Differentiated VSMCs from WJ-MSCs could provide an alternative source of cells for vascular tissue engineering.展开更多
Transcatheter aortic valve implantation （TAVI） carries a significant thromboembolic and concomitant bleeding risk, not only during the procedure but also during the periprocedural period. Many issues concerning opti...Transcatheter aortic valve implantation （TAVI） carries a significant thromboembolic and concomitant bleeding risk, not only during the procedure but also during the periprocedural period. Many issues concerning optimal antithrombotic therapy after TAVI are still under debate. In the present review, we aimed to identify all relevant studies evaluating antithrombotic therapeutic strategies in relation to clinical outcomes after the procedure. Four randomized control trials （RCT） were identified analyzing the post-TAVI antithrombotic strategy with all of them utilizing aspirin lifelong plus clopidogrel for 3-6 months. Seventeen registries have been identified, with a wide variance among them regarding baseline characteristics, while concerning antiplatelet therapy, clopidogrel duration was ranging from 3-12 months. Four non-randomized trials were identified, comparing single vs. dual antiplatelet therapy after TAVI, in respect of investigating thromboembolic outcome events over bleeding complications. Finally, limited data from a single RCT and a retrospective study exist with regards to anticoagulant treatment during the procedure and the optimal antithrombotic therapy when concomitant atrial fibrillation. In conclusion, due to the high risk and frailty of the treated population, antithrombotic therapy after TAVI should be carefully evaluated. Diminishing ischaemic and bleeding complications remains the main challenge in these patients with further studies to be needed in this field.展开更多
Coronavirus disease 2019(COVID-19)is associated with poor cardiovascular outcomes in patients with heart failure(HF)of all categories of ejection fraction(EF),but mainly in patients with HF with reduced EF.Moreover,ca...Coronavirus disease 2019(COVID-19)is associated with poor cardiovascular outcomes in patients with heart failure(HF)of all categories of ejection fraction(EF),but mainly in patients with HF with reduced EF.Moreover,cardiac transplant patients exhibit worse cardiovascular prognosis,high mortality,and more admissions to the intensive care unit.In general,COVID-19 seems to deteriorate the clinical status of HF and favors the development of acute respiratory distress syndrome and multiorgan failure,especially in the presence of cardiovascular comorbidities such as diabetes mellitus,kidney dysfunction,and older age.COVID-19 may induce new-onset HF with complex mechanisms that involve myocardial injury.Indeed,myocardial injury comprises a large category of detrimental effects for the myocardium,such as myocardial infarction type 1 or type 2,Takotsubo cardiomyopathy,microvascular dysfunction and myocarditis,which are not easily distinguished by HF.The pathophysiologic mechanisms mainly involve direct myocardial damage by severe acute respiratory syndrome coronavirus 2,cytokine storm,hypercoagulation,inflammation,and endothelial dysfunction.The proper management of patients with COVID-19 involves careful patient evaluation and ongoing monitoring for complications such as HF.展开更多
文摘Interventional electrophysiology represents a relatively recent subspecialty within the field of cardiology.In the past half-century,there has been significant advan-cement in the development and implementation of innovative ablation treatments and approaches.However,the treatment of arrhythmias continues to be inade-quate.Several arrhythmias,such as ventricular tachycardia and atrial fibrillation,pose significant challenges in terms of therapeutic efficacy,whether through interventional procedures or the administration of antiarrhythmic drugs.Cardio-logists are engaged in ongoing research to explore innovative methodologies,such as genome editing,with the purpose of effectively managing arrhythmias and meeting the growing needs of patients afflicted with rhythm disturbances.The field of genome editing has significant promise and has the potential to serve as a highly effective personalized therapy for rhythm disorders in patients.However,several ethical issues must be considered.
文摘BACKGROUND The development of fully functional small diameter vascular grafts requires both a properly defined vessel conduit and tissue-specific cellular populations.Mesenchymal stromal cells(MSCs) derived from the Wharton's Jelly(WJ) tissue can be used as a source for obtaining vascular smooth muscle cells(VSMCs),while the human umbilical arteries(h UAs) can serve as a scaffold for blood vessel engineering.AIM To develop VSMCs from WJ-MSCs utilizing umbilical cord blood platelet lysate.METHODS WJ-MSCs were isolated and expanded until passage(P) 4. WJ-MSCs were properly defined according to the criteria of the International Society for Cell and Gene Therapy. Then, these cells were differentiated into VSMCs with the use of platelet lysate from umbilical cord blood in combination with ascorbic acid,followed by evaluation at the gene and protein levels. Specifically, gene expression profile analysis of VSMCs for ACTA2, MYH11, TGLN, MYOCD, SOX9,NANOG homeobox, OCT4 and GAPDH, was performed. In addition,immunofluorescence against ACTA2 and MYH11 in combination with DAPI staining was also performed in VSMCs. HUAs were decellularized and served as scaffolds for possible repopulation by VSMCs. Histological and biochemical analyses were performed in repopulated h UAs.RESULTS WJ-MSCs exhibited fibroblastic morphology, successfully differentiating into"osteocytes", "adipocytes" and "chondrocytes", and were characterized by positive expression(> 90%) of CD90, CD73 and CD105. In addition, WJ-MSCs were successfully differentiated into VSMCs with the proposed differentiation protocol. VSMCs successfully expressed ACTA2, MYH11, MYOCD, TGLN and SOX9. Immunofluorescence results indicated the expression of ACTA2 and MYH11 in VSMCs. In order to determine the functionality of VSMCs, h UAs were isolated and decellularized. Based on histological analysis, decellularized h UAs were free of any cellular or nuclear materials, while their extracellular matrix retained intact. Then, repopulation of decellularized h UAs with VSMCs was performed for 3 wk. Decellularized h UAs were repopulated efficiently by the VSMCs. Biochemical analysis revealed the increase of total hydroyproline and s GAG contents in repopulated h UAs with VSMCs. Specifically, total hydroxyproline and s GAG content after the 1 st, 2 nd and 3 rd wk was 71 ± 10, 74 ± 9 and 86 ± 8 μg hydroxyproline/mg of dry tissue weight and 2 ± 1, 3 ± 1 and 3 ± 1μg s GAG/mg of dry tissue weight, respectively. Statistically significant differences were observed between all study groups(P<0.05).CONCLUSION VSMCs were successfully obtained from WJ-MSCs with the proposed differentiation protocol. Furthermore, h UAs were efficiently repopulated by VSMCs. Differentiated VSMCs from WJ-MSCs could provide an alternative source of cells for vascular tissue engineering.
文摘Transcatheter aortic valve implantation （TAVI） carries a significant thromboembolic and concomitant bleeding risk, not only during the procedure but also during the periprocedural period. Many issues concerning optimal antithrombotic therapy after TAVI are still under debate. In the present review, we aimed to identify all relevant studies evaluating antithrombotic therapeutic strategies in relation to clinical outcomes after the procedure. Four randomized control trials （RCT） were identified analyzing the post-TAVI antithrombotic strategy with all of them utilizing aspirin lifelong plus clopidogrel for 3-6 months. Seventeen registries have been identified, with a wide variance among them regarding baseline characteristics, while concerning antiplatelet therapy, clopidogrel duration was ranging from 3-12 months. Four non-randomized trials were identified, comparing single vs. dual antiplatelet therapy after TAVI, in respect of investigating thromboembolic outcome events over bleeding complications. Finally, limited data from a single RCT and a retrospective study exist with regards to anticoagulant treatment during the procedure and the optimal antithrombotic therapy when concomitant atrial fibrillation. In conclusion, due to the high risk and frailty of the treated population, antithrombotic therapy after TAVI should be carefully evaluated. Diminishing ischaemic and bleeding complications remains the main challenge in these patients with further studies to be needed in this field.
文摘Coronavirus disease 2019(COVID-19)is associated with poor cardiovascular outcomes in patients with heart failure(HF)of all categories of ejection fraction(EF),but mainly in patients with HF with reduced EF.Moreover,cardiac transplant patients exhibit worse cardiovascular prognosis,high mortality,and more admissions to the intensive care unit.In general,COVID-19 seems to deteriorate the clinical status of HF and favors the development of acute respiratory distress syndrome and multiorgan failure,especially in the presence of cardiovascular comorbidities such as diabetes mellitus,kidney dysfunction,and older age.COVID-19 may induce new-onset HF with complex mechanisms that involve myocardial injury.Indeed,myocardial injury comprises a large category of detrimental effects for the myocardium,such as myocardial infarction type 1 or type 2,Takotsubo cardiomyopathy,microvascular dysfunction and myocarditis,which are not easily distinguished by HF.The pathophysiologic mechanisms mainly involve direct myocardial damage by severe acute respiratory syndrome coronavirus 2,cytokine storm,hypercoagulation,inflammation,and endothelial dysfunction.The proper management of patients with COVID-19 involves careful patient evaluation and ongoing monitoring for complications such as HF.
