Pharmacological induced target temperature management after cardiac arrest： the capsaicinoids

Cardiac or respiratory arrest lasting only a few minutes can inflict grave harm on numerous bodily organs, not least of all, the brain. Neurocognitive deficits, which are often severe and profoundly life altering, remain a major source of morbidity among survivors.

Disease modeling of desmosome-related cardiomyopathy using induced pluripotent stem cell-derived cardiomyocytes

Cardiomyopathy is a pathological condition characterized by cardiac pump failure due to myocardial dysfunction and the major cause of advanced heart failure requiring heart transplantation.Although optimized medical therapies have been developed for heart failure during the last few decades,some patients with cardiomyopathy exhibit advanced heart failure and are refractory to medical therapies.Desmosome,which is a dynamic cell-to-cell junctional component,maintains the structural integrity of heart tissues.Genetic mutations in desmo-somal genes cause arrhythmogenic cardiomyopathy(AC),a rare inheritable disease,and predispose patients to sudden cardiac death and heart failure.Recent advances in sequencing technologies have elucidated the genetic basis of cardiomyopathies and revealed that desmosome-related cardiomyopathy is concealed in broad cardiomyopathies.Among desmosomal genes,mutations in PKP2(which encodes PKP2)are most frequently identified in patients with AC.PKP2 deficiency causes various pathological cardiac phenotypes.Human cardiomyocytes differentiated from patient-derived induced pluripotent stem cells(iPSCs)in combination with genome editing,which allows the precise arrangement of the targeted genome,are powerful experimental tools for studying disease.This review summarizes the current issues associated with practical medicine for advanced heart failure and the recent advances in disease modeling using iPSC-derived cardiomyocytes targeting desmosome-related cardiomyopathy caused by PKP2 deficiency.

Cardiac arrest, stony heart, and cardiopulmonary resuscitation: An updated revisit

The post-resuscitation period is recognized as the main predictor of cardiopul-monary resuscitation(CPR)outcomes.The first description of post-resuscitation syndrome and stony heart was published over 50 years ago.Major manifestations may include but are not limited to,persistent precipitating pathology,systemic ischemia/reperfusion response,post-cardiac arrest brain injury,and finally,post-cardiac arrest myocardial dysfunction(PAMD)after successful resuscitation.Why do some patients initially survive successful resuscitation,and others do not?Also,why does the myocardium response vary after resuscitation?These ques-tions have kept scientists busy for several decades since the first successful resuscitation was described.By modifying the conventional modalities of resu-scitation together with new promising agents,rescuers will be able to salvage the jeopardized post-resuscitation myocardium and prevent its progression to a dismal,stony heart.Community awareness and staff education are crucial for shortening the resuscitation time and improving short-and long-term outcomes.Awareness of these components before and early after the restoration of circulation will enhance the resuscitation outcomes.This review extensively addresses the underlying pathophysiology,management,and outcomes of post-resuscitation syndrome.The pattern,management,and outcome of PAMD and post-cardiac arrest shock are different based on many factors,including in-hospital cardiac arrest vs out-of-hospital cardiac arrest(OHCA),witnessed vs unwitnessed cardiac arrest,the underlying cause of arrest,the duration,and protocol used for CPR.Although restoring spontaneous circulation is a vital sign,it should not be the end of the game or lone primary outcome;it calls for better understanding and aggressive multi-disciplinary interventions and care.The development of stony heart post-CPR and OHCA remain the main challenges in emergency and critical care medicine.

Role of induced pluripotent stem cells in diagnostic cardiology

Ethical concerns about stem cell-based research have delayed important advances in many areas of medicine,including cardiology.The introduction of induced pluripotent stem cells(iPSCs)has supplanted the need to use human stem cells for most purposes,thus eliminating all ethical controversies.Since then,many new avenues have been opened in cardiology research,not only in approaches to tissue replacement but also in the design and testing of antiarrhythmic drugs.This methodology has advanced to the point where induced human cardiomyocyte cell lines can now also be obtained from commercial sources or tissue banks.Initial studies with readily available iPSCs have generally confirmed that their behavioral characteristics accurately predict the behavior of beating cardiomyocytes in vivo.As a result,iPSCs can provide new ways to study arrhythmias and heart disease in general,accelerating the development of new,more effective antiarrhythmic drugs,clinical diagnoses,and personalized medical care.The focus on producing cardiomyocytes that can be used to replace damaged heart tissue has somewhat diverted interest in a host of other applications.This manuscript is intended to provide non-specialists with a brief introduction and overview of the research carried out in the field of heart rhythm disorders.

Alcohol-Induced Cardiomyopathy Presenting with Left Ventricular Apical Thrombus

Background: Chronic excessive alcohol consumption has been strongly associated with alcohol-induced cardiomyopathy (AC) in patients with no evidence of coronary artery disease (CAD). AC may cause cardiovascular complications and significant impact on the quality of life. We discuss an interesting case of dilated cardiomyopathy, associated complication, diagnostic work-up and management. Case Report: A young male presented to our service with worsening dyspnea, orthopnea, and scrotal and lower extremity edema. On average, he consumed a pack of 12 beers every day and had a 30-pack-years smoking history. He was found to be in acute heart failure with evidence of pulmonary edema and cardiomegaly on chest imaging. He had biventricular dilatation and severely reduced left ventricular ejection fraction (LVEF) 15% in addition to a thrombus in the LV apex. The cardiac catheterization was unremarkable for CAD. He was diuresed appropriately resulting in significant weight loss and resolution of symptoms. LV thrombus was treated with unfractionated heparin infusion that was transitioned to warfarin. He was maintained on guidelines-directed medical therapy for heart failure. Extensive counseling was provided regarding alcohol and tobacco cessation. On follow-up echocardiogram, his LVEF improved and there was no evidence of LV thrombus. We think, the readership will benefit from our experience of treating a case of AC, and the importance of clinical history. Conclusion: Chronic excessive alcohol use is detrimental to cardiac function leading to alcohol-induced cardiomyopathy. A careful approach to clinical history of alcohol consumption and prompt diagnostic workup negative for ischemic causes may confirm the diagnosis. Cardiac function improves with guidelines-directed medical therapy for heart failure and abstinence from alcohol.

Senescence-like changes induced by expression of p21^(Waf1/Cipl)in NIH3T3 cell line

P21Waf1/Cip1 is a potent cyclin-dependent kinase inhibitor. As a downstream mediator of p53, p21Waf1/Cip1 involves in cell cycle arrest, differentiation and apoptosis. Previous studies in human cells provided evidence for a link between p21Waf1/Cip1 and cellular senescence. While in murine cells, the role of p21Waf1/Cip1 is indefinite. We explored this issue using NIH3T3 cells with inducible p21Waf1/Cip1 expression. Induction of p21Waf1/Cip1 triggered G1 growth arrest, and NIH3T3-p21 cells exhibited morphologic features, such as enlarged and flattened cellular shape, specific to the senescence phenotype. We also showed that p21Waf1/Cip1-transduced NIH3T3 cells expressed β-galactosidase activity at pH 6.0, which is known to be a marker of senescence. Our results suggest that p21Waf1/Cip1 can also induce senescence-like changes in murine cells.

Senescence—like changes induced by expression of p21^Waf1／Cip1 in NIH3T3 cell line

P21Waf1/Cip1 is a potent cyclin-dependent kinase inhibitor. As a downstream mediator of p53, p21Waf1/Cip1 involves in cell cycle arrest, differentiation and apoptosis. Previous studies in human cells provided evidence for a link between p21Waf1/Cip1 and cellular senescence. While in murine cells, the role of p21Waf1/Cip1 is indefinite. We explored this issue using NIH3T3 cells with inducible p21Waf1/Cip1 expression. Induction of p21Waf1/Cip1 triggered G1 growth arrest, and NIH3T3-p21 cells exhibited morphologic features, such as enlarged and flattened cellular shape, specific to the senescence phenotype. We also showed that p21Waf1/Cip1-transduced NIH3T3 cells expressed β-galactosidase activity at pH 6.0, which is known to be a marker of senescence. Our results suggest that p21Waf1/Cip1 can also induce senescence-like changes in murine cells.

Protection of ±500 kV HVDC Double-circuit Converter Station from Lightning Induced Overvoltage

In order to obtain reasonable schemes of arrester in converter stations, the arrester scheme of "Xiluodu-Guangdong HVDC ± 500 kV double circuit transmission" project against lighting induced overvoltage, which was designed according to the main principle of lightning protection in converter station, is discussed. A calculation of the lighting induced overvoltage in Zhaotong converter station un- der various operation modes is performed with ATP-EMTP software, then the surge arrester configuration of the converter station is decided, and the arrester protection schemes of smoothing reactor and neutral line are studied. It is concluded that additional protection is necessary because of the relatively large gap between protected disconnecting switch and arrester of metallic return transfer bus. Plus, the smoothing reactor (SR) arrester near the valve hall could be removed to improve the scheme’s economic performance.

Yinchenhao decoction attenuates obstructive jaundice-induced liver injury and hepatocyte apoptosis by suppressing protein kinase RNA-like endoplasmic reticulum kinase-induced pathway

BACKGROUND Chronic biliary obstruction results in ischemia and hypoxia of hepatocytes,and leads to apoptosis.Apoptosis is very important in regulating the homeostasis of the hepatobiliary system.Endoplasmic reticulum(ER)stress is one of the signaling pathways that induce apoptosis.Moreover,the protein kinase RNA-like endoplasmic reticulum kinase(PERK)-induced apoptotic pathway is the main way;but its role in liver injury remains unclear.Yinchenhao decoction(YCHD)is a traditional Chinese medicine formula that alleviates liver injury and apoptosis,yet its mechanism is unknown.We undertook this study to investigate the effects of YCHD on the expression of ER stress proteins and hepatocyte apoptosis in rats with obstructive jaundice(OJ).AIM To investigate whether YCHD can attenuate OJ-induced liver injury and hepatocyte apoptosis by inhibiting the PERK-CCAAT/enhancer-binding protein homologous protein(CHOP)-growth arrest and DNA damage-inducible protein 34(GADD34)pathway and B cell lymphoma/leukemia-2 related X protein(Bax)/B cell lymphoma/leukemia-2(Bcl-2)ratio.METHODS For in vivo experiments,30 rats were divided into three groups:control group,OJ model group,and YCHD-treated group.Blood was collected to detect the indicators of liver function,and liver tissues were used for histological analysis.For in vitro experiments,30 rats were divided into three groups:G1,G2,and G3.The rats in group G1 had their bile duct exposed without ligation,the rats in group G2 underwent total bile duct ligation,and the rats in group G3 were given a gavage of YCHD.According to the serum pharmacology,serum was extracted and centrifuged from the rat blood to cultivate the BRL-3A cells.Terminal deoxynucleotidyl transferase mediated dUTP nick end-labelling(TUNEL)assay was used to detect BRL-3A hepatocyte apoptosis.Alanine aminotransferase(ALT)and aspartate transaminase(AST)levels in the medium were detected.Western blot and quantitative real-time polymerase chain reaction(qRT-PCR)analyses were used to detect protein and gene expression levels of PERK,CHOP,GADD34,Bax,and Bcl-2 in the liver tissues and BRL-3A cells.RESULTS Biochemical assays and haematoxylin and eosin staining suggested severe liver function injury and liver tissue structure damage in the OJ model group.The TUNEL assay showed that massive BRL-3A rat hepatocyte apoptosis was induced by OJ.Elevated ALT and AST levels in the medium also demonstrated that hepatocytes could be destroyed by OJ.Western blot or qRT-PCR analyses showed that the protein and mRNA expression levels of PERK,CHOP,and GADD34 were significantly increased both in the rat liver tissue and BRL-3A rat hepatocytes by OJ.The Bax and Bcl-2 levels were increased,and the Bax/Bcl-2 ratio was also increased.When YCHD was used,the PERK,CHOP,GADD34,and Bax levels quickly decreased,while the Bcl-2 levels increased,and the Bax/Bcl-2 ratio decreased.CONCLUSION OJ-induced liver injury and hepatocyte apoptosis are associated with the activation of the PERK-CHOP-GADD34 pathway and increased Bax/Bcl-2 ratio.YCHD can attenuate these changes.

Increased expression of myocardial semaphorin 3A in isoproterenol-induced heart failure rats

Background Maintenance of normal cardiac function is controlled by the autonomic nervous system. In congestive heart failure （CHF）, sympathetic nerve denervation is increasingly recognized. The sympathetic fiber density depends on the balance between neurotrophins and neural guidance molecules. Semaphorin 3A （sema3a）, a secreted neural guidance factor, is a well characterized member of the newly found semaphorin family. It can induce sympathetic growth cone collapse and axon repulsion. We conducted this study to investigate cell sources of sema3a in the heart, the expression level of sema3a in CHF and discuss the possible role of sema3a in CHF.Methods Rats were divided into four groups： 30 days control group rats, 30 days CHF rats, 60 days control group rats,60 days CHF rats. The heart failure model was induced by injection of isoproterenol （ISO） 340 mg/kg continuously two days. All animals underwent echocardiography and haemodynamics measurements. Cardiac expression of sema3a was determined by real time polymerase chain reaction （RT-PCR） and Western blotting analysis. Immunohistochemical analysis was used to determine the cell source of sema3a in the heart.Results Isoproterenol induced 30 days and 60 days CHF rats displayed left ventricular dilation, systolic and diastolic function decrease. Sema3a was secreted by the cardiocytes and increased significantly in 30 days and 60 days CHF rats compared with the controls （RT-PCR： 30 days group： 0.32±0.05 vs. 0.58±0.06, P ＜0.01; 60 days group： 0.34±0.08 vs.0.71±0.07, P＜0.01. Western blotting： 30 days group： 0.25±0.10 vs. 0.46±0.10, P＜0.05; 60 days group： 0.29±0.10 vs.0.55±0.16, P＜0.01. Immunohistochemical analysis： 30 days group： 2.91±0.20 vs. 5.31±0.30, P＜0.01; 60 days group：2.94±0.30 vs. 5.80±0.30, P＜0.01）.Conclusions Sema3a was expressed in the heart by cardiocytes. Increased expression of sema3a may partly account for sympathetic denervation in CHF; modulation of this pathway may prove beneficial in heart failure sympathetic remodeling.

Intramural Hematoma versus Thrombus： Radiation-induced Heart Disease Results in Mass Formation after Radiofrequency Ablation

Radiofrequency catheter ablation （RFCA）,albeit an effective therapy for drug-refractory atrial fibrillation （AF）,can be associated with complications in 3.9-22.0% of cases, of which cerebrovascular embolization,cardiac tamponade,and pulmonary vein stenosis are more common,and atrial hematoma is more rare.Here,we presented a case describing an elderly woman diagnosed with an intramural left atrial hematoma after AF ablation.

Pulmonary arterial hypertension confirmed by right heart catheterization following COVID-19 pneumonia: A case report and review of literature

BACKGROUND Pulmonary arterial hypertension(PAH)is a disease of the arterioles resulting in an increased resistance in pulmonary circulation with associated high pressures in the pulmonary arteries,causing irreversible remodeling of the pulmonary arterial walls.Coronavirus disease 2019(COVID-19)has been associated with development of new onset PAH in the literature leading to symptoms of dyspnea,cough and fatigue that persist in spite of resolution of acute COVID-19 infection.However,the majority of these cases of COVID related PAH were diagnosed using echocardiographic data or via right heart catheterization in mechanically ventilated patients.CASE SUMMARY Our case is the first reported case of COVID related PAH diagnosed by right heart catheterization in a non-mechanically ventilated patient.Right heart catheterization has been the gold standard for diagnosis of pulmonary hypertension.Our patient had right heart catheterization four months after her initial COVID-19 infection due to persistent dyspnea.CONCLUSION This revealed new onset PAH that developed following her infection with COVID-19,an emerging sequela of the infection.

The MORC2 p.S87L mutation reduces proliferation of pluripotent stem cells derived from a patient with the spinal muscular atrophy-like phenotype by inhibiting proliferation-related signaling pathways

Mutations in the microrchidia CW-type zinc finger protein 2(MORC2)gene are the causative agent of Charcot-Marie-Tooth disease type 2Z(CMT2Z),and the hotspot mutation p.S87L is associated with a more seve re spinal muscular atrophy-like clinical phenotype.The aims of this study were to determine the mechanism of the severe phenotype caused by the MORC2 p.S87L mutation and to explore potential treatment strategies.Epithelial cells were isolated from urine samples from a spinal muscular atrophy(SMA)-like patient[MORC2 p.S87L),a CMT2Z patient[MORC2 p.Q400R),and a healthy control and induced to generate pluripotent stem cells,which were then differentiated into motor neuron precursor cells.Next-generation RNA sequencing followed by KEGG pathway enrichment analysis revealed that differentially expressed genes involved in the PI3K/Akt and MAP K/ERK signaling pathways were enriched in the p.S87L SMA-like patient group and were significantly downregulated in induced pluripotent stem cells.Reduced proliferation was observed in the induced pluripotent stem cells and motor neuron precursor cells derived from the p.S87L SMA-like patient group compared with the CMT2Z patient group and the healthy control.G0/G1 phase cell cycle arrest was observed in induced pluripotent stem cells derived from the p.S87L SMA-like patient.MORC2 p.S87Lspecific antisense oligonucleotides(p.S87L-ASO-targeting)showed significant efficacy in improving cell prolife ration and activating the PI3K/Akt and MAP K/ERK pathways in induced pluripotent stem cells.Howeve r,p.S87L-ASO-ta rgeting did not rescue prolife ration of motor neuron precursor cells.These findings suggest that downregulation of the PI3K/Akt and MAP K/ERK signaling pathways leading to reduced cell proliferation and G0/G1 phase cell cycle arrest in induced pluripotent stem cells might be the underlying mechanism of the severe p.S87L SMA-like phenotype.p.S87L-ASO-targeting treatment can alleviate disordered cell proliferation in the early stage of pluripotent stem cell induction.

目标体温管理对体外心肺复苏患者神经功能结局和出院生存率影响的系统评价

目的系统评价目标体温管理对体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)患者神经功能结局和出院生存率的影响。方法计算机检索PubMed、Cochrane Library、Elsevier、Web of Science、Ovid、中国知网、万方、SinoMed、中华医学期刊全文数据库中关于目标体温管理对ECPR患者结局指标影响的文献,检索时限均从建库至2023年6月1日。严格按照纳入排除标准进行筛选,提取资料,评价文献质量,采用RevMan 5.3软件对纳入研究进行Meta分析。结果共纳入8篇研究,包括3687例ECPR患者。与非目标体温管理组比较,目标体温管理未能显著改善患者神经功能结局(OR=1.37,95%CI 0.89~2.13,P=0.16)和出院生存率(OR=0.98,95%CI 0.82~1.15,P=0.77),且两组出血、下肢缺血、肾损伤和感染等ECMO相关并发症发生率差异无统计学意义(OR=1.24,95%CI 0.91~1.68,P=0.17)。结论目标体温管理对ECPR患者的神经结局和出院生存率无显著改善作用,但不会加重ECMO相关并发症的发生。

Dual-chamber pacing confers better myocardial performance and improves clinical outcomes compared to single-chamber pacing

The deleterious effects of long term right ventricular pacing are increasingly being recognized today.Current clinical practice favors the implantation of dual-chamber permanent pacemaker which maintains atrioventricular synchrony and is associated with better quality of life.However,despite the popular belief and common sense surrounding the superiority of dual-chamber pacing over single chamber pacing,the same has never been conclusively verified in clinical trials.Some observational evidence however,does exists which supports the improved cardiac hemodynamics,lower the rate of atrial fibrillation,heart failure and stroke in dual-chamber pacing compared to single-chamber pacing.In the index study by Haque et al,right ventricular pacing,particularly in ventricular paced,ven-tricular sensed,inhibited response and rate responsive pacemaker adversely im-pacted the left ventricular functions over 9-months compared to dual pacing,dual sensing,dual responsive and rate responsive pacemaker.Although there are key limitations of this study,these findings does support a growing body of evidence reinstating the superiority of dual chamber pacing compared to single chamber pacing.

基于血糖优化的早期间断肠内营养在心脏瓣膜置换术后应激性高血糖患者中的应用

目的探讨基于血糖优化干预的早期间断肠内营养方案在心脏瓣膜置换术后合并应激性高血糖患者中的应用效果。方法构建血糖优化干预后的早期间断肠内营养方案,前瞻性分析2022年5月—2023年5月上海市某三级甲等医院心胸外科重症监护室心脏瓣膜置换术后合并应激性高血糖患者158例,按时间先后顺序分为对照组(n=78)和观察组(n=80),对照组采用常规肠内营养与血糖管理方案,观察组采用基于血糖优化干预的早期间断肠内营养方案。比较2组患者血糖管理质量指标及营养相关结局指标。结果实施基于血糖优化管理的早期间断肠内营养方案后,观察组最大血糖波动幅度、胰岛素使用时间及低血糖发生率明显低于对照组(P<0.05),葡萄糖目标范围内时间明显高于对照组,差异具有统计学意义(P<0.05);观察组患者营养相关指标(血清前清蛋白、血红蛋白、7 d热卡达标率)均高于对照组,差异均有统计学意义(P<0.05)。结论基于血糖优化干预的早期间断肠内营养方案可有效改善心脏瓣膜置换术后合并应激性高血糖患者的营养状态,减少血糖波动,提升血糖管理质量,具有一定的科学性和实用性。

BlueScreen HC在食品接触材料多组分迁移物遗传毒性检测中的适用性

目的探讨基于人生长阻滞和DNA损伤诱导45α(GADD45α)基因的遗传毒性高通量筛选体系BlueScreen HC(BSHC)在食品接触材料多组分迁移物遗传毒性检测中的适用性。方法将人GADD45α基因开放阅读框上游2000 bp序列作为启动子,采用分子克隆构建入嘌呤霉素和高斯荧光素酶(Gluc)双标记的慢病毒质粒pEZX-LvPG04中,并用慢病毒感染人淋巴母细胞TK6,获得稳转细胞系TK6-Gluc。以甲基磺酸甲酯(MMS,终浓度0,1.56,3.13,6.25,12.5,25.0和50.0 mg·L^(-1))为非代谢活化条件下的阳性物质,环磷酰胺(CTX,终浓度0,0.78,1.56,3.13,6.25,12.5和25.0 mg·L^(-1))为代谢活化条件下的阳性物质,二甲基亚砜(DMSO,终浓度0,0.35,0.69,1.38,2.75,5.5和11.0 g·L^(-1))为阴性物质,分别在非活化和活化条件下验证构建的BSHC。将改性淀粉/聚对苯二甲酸-己二酸丁二醇酯(MS/PBAT)作为研究对象,采用体积分数4%乙酸及10%,20%,50%和95%乙醇作为食品模拟物,40℃、浸泡24 h获得5份MS/PBAT多组分迁移物,并用DMSO作为溶剂复溶得到5份多组分迁移溶液作为受试物。以终浓度为0,0.38,0.76,1.53,3.05,6.10和12.20 g·L^(-1)的不同受试物在活化和非活化2种条件下处理TK6-Gluc细胞。非活化条件下作用48 h;活化条件下,在添加体积分数1%大鼠肝S9代谢活化系统的同时,作用3 h后更换新鲜培养基,继续培养至48 h。处理结束后,采用CCK-8法检测细胞活性,同时采用Secrete-Pair^(TM)Gaussia Luciferase Assay试剂盒检测培养基中Gluc化学发光强度。另外,采用终浓度为3.05和12.20 g·L^(-1)的不同受试物对鼠伤寒沙门氏菌TA98和TA100进行微量波动Ames试验以及对体外培养的中国仓鼠肺细胞CHL进行体外哺乳细胞染色体畸变试验,检测受试物的致突变和染色体畸变作用,与BSHC遗传毒性结果进行对比分析。结果采用BSHC法,将相对细胞活性80%定义为生长抑制的最低有效浓度阈值,实验组相对细胞活性低于溶剂对照组的80%提示化合物引起细胞生长抑制。将实验组相对细胞活性低于溶剂对照组的30%定义为出现细胞毒性,此时将不考虑遗传毒性。在无细胞毒性前提下,活化条件下实验组Gluc化学发光强度大于溶剂对照组的1.8倍时,非活化条件下实验组Gluc化学发光强度大于溶剂对照组的1.5倍时,判定为遗传毒性阳性;反之认为无遗传毒性。与溶剂对照组相比,阴性物质DMSO所有浓度均未产生遗传毒性。非活化条件下,MMS 12.5,25.0和50.0 mg·L^(-1)产生遗传毒性;活化条件下,CTX 6.25,12.5和25.0 mg·L^(-1)产生遗传毒性。非活化条件下,MS/PBAT的95%乙醇迁移物6.10和12.20 g·L^(-1)和MS/PBAT的50%乙醇迁移物12.20 g·L^(-1)组细胞生长抑制,所有处理组均未观察到相对细胞活性低于30%的细胞毒性,且未观察到Gluc高表达,表明5种MS/PBAT多组分迁移物在非活化条件下均未产生遗传毒性。活化条件下,MS/PBAT的95%乙醇迁移物12.20 g·L^(-1)和MS/PBAT的4%乙酸迁移物6.10,12.20 g·L^(-1)组细胞表现出显著的生长抑制,所有处理组均未观察到相对细胞活性低于30%的细胞毒性,且未观察到Gluc高表达,表明5种MS/PBAT多组分迁移物在活化条件下均未产生遗传毒性。微量波动Ames试验结果表明,在活化和非活化条件下,MS/PBAT的5种多组分迁移物3.05和12.20 g·L^(-1)作用于TA98和TA1002种菌株,致突变阳性孔的数量均不超过溶剂对照组的2倍,即均未产生致突变作用;作用于CHL细胞后的细胞染色体畸变率亦均无显著变化。结论初步建立了基于GADD45α基因的遗传毒性高通量筛选方法BSHC,提示可用于食品接触材料多组分迁移物的体外遗传毒性评价,但仍需进一步探索其最低有效浓度,并应用更多种类混合物进行进一步验证。

TNIP1基因单核苷酸多态性及其mRNA表达水平与老年慢性心力衰竭患者肺部感染的相关性分析

目的探讨肿瘤坏死因子诱导蛋白3相互作用蛋白1(TNFAIP3-interacting protein 1,TNIP1)基因单核苷酸多态性及其mRNA表达水平与老年慢性心力衰竭患者肺部感染的相关性。方法选择2019年10月至2022年10月于上海建工医院重症医学科就诊的130例老年慢性心力衰竭患者作为研究对象,根据是否于院内发生肺部感染分为感染组(32例)和未感染组(98例)。对TNIP1基因的两个SNP位点rs6889239(T>C)、rs17728338(A>G)进行基因分型,并检测外周血TNIP1基因的mRNA表达水平。结果TNIP1基因rs6889239位点在感染组和非感染组之间的基因型分布以及等位基因频率的差异均无统计学意义(P>0.05);两组的rs17728338位点AA、AG、GG基因型分布比较差异有统计学意义(P<0.05),且感染组等位基因G的频率显著高于未感染组(P<0.05)。相较于未感染组,感染组患者的外周血TNIP1基因mRNA表达水平显著增加,差异有统计学意义(P<0.001)。受试者工作特征(Receiver operating characteristic,ROC)曲线分析结果显示外周血TNIP1基因表达水平预测慢性心力衰竭患者发生肺部感染的灵敏度和特异度分别为71.9%和95.9%。感染组和非感染组TNIP1基因rs6889239位点不同基因型患者的外周血TNIP1基因的表达水平比较差异均无统计学意义(P>0.05),而rs17728338位点不同基因型患者的外周血TNIP1基因表达水平比较差异有统计学意义(P<0.05)。结论TNIP1基因rs17728338表达水平与老年慢性心力衰竭患者发生肺部感染有关。

李宜瑞辨治注意缺陷多动障碍经验

注意缺陷多动障碍是儿童时期常见的以注意力不集中、多动和冲动为特征的精神-心理-行为障碍疾病之一。李宜瑞教授认为,本病系脏腑阴阳失调所致,心脾肾不足乃病机之本,常兼肝亢、痰湿等标证。临证时宜审慎辨证,用药以四君子汤为基础方,重视健脾,合用龙骨、首乌藤、白芍、石菖蒲、远志、益智、合欢皮、连翘等以增智养神、祛痰开窍,心脾肾同治;同时根据伴随症状进行加减用药,标本兼顾,以调和脏腑阴阳,从而改善注意缺陷多动障碍患儿的注意力、记忆力。

血清sTWEAK、sLOX-1与H型高血压合并HFpEF患者颈动脉粥样硬化的关系

目的研究血清可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)、可溶性凝集素样氧化型低密度脂蛋白受体-1(sLOX-1)与H型高血压合并射血分数保留的心力衰竭(HFpEF)患者颈动脉粥样硬化的关系。方法选取2021年2月至2023年3月沧州中西医结合医院收治的161例H型高血压合并HFpEF患者,按是否发生颈动脉粥样硬化分为硬化组与非硬化组。同期选取80例于我院体检的健康的志愿者作为对照组。收集受试者的临床资料,采用酶联免疫吸附法检测血清sTWEAK、sLOX-1水平,比较H型高血压合并HFpEF患者与对照组血清sTWEAK、sLOX-1水平,采用多因素logistic回归分析患者发生颈动脉粥样硬化的影响因素,受试者工作特征(ROC)曲线分析血清sTWEAK、sLOX-1对患者发生颈动脉粥样硬化的预测价值。结果161例患者中65例发生颈动脉粥样硬化,发生率为40.37%(65/161),未发生颈动脉粥样硬化者96例。两组在年龄、吸烟、血脂四项等方面比较,差异有统计学意义(P<0.05)。硬化组与非硬化组血清sTWEAK水平低于对照组,sLOX-1水平高于对照组(P<0.05);且硬化组sTWEAK水平低于非硬化组,sLOX-1水平高于非硬化组(P<0.05)。多因素logistic回归分析显示,HDL-C、sTWEAK、年龄、LDL-C、sLOX-1水平是患者发生颈动脉粥样硬化的影响因素(P<0.05)。ROC曲线显示,血清sTWEAK、sLOX-1联合检测对发生颈动脉粥样硬化的预测曲线下面积(AUC)为0.842,预测效能高于两指标单独检测。结论H型高血压合并HFpEF患者的血清sTWEAK水平下降、sLOX-1水平上升,与颈动脉粥样硬化发生有关,两者联合检测对颈动脉粥样硬化的发生具有一定预测价值。