Abstract: Objective To investigate the effect of autologous bone marrow mesenchymal stem cells (MSCs) transplantation on cardiac function and their proliferation and differentiation in the post-infarct myocardium in rabbits. Methods Twenty New Zealand rabbits were randomly divided into two groups, the autologous bone marrow mesenchymal stem cells group (MSCs group,n=10) and control group (n=10). Myocardial infarct model was set up by ligation of the left anterior descending (LAD), two weeks after establishment of the infarct model,either 400μl of cell suspension (total cells 1×106) labled by 1,1’-dioctadecyl3,3,3’,3’-tetramethyl indocarbocyanine perchlorate (Dil) or a comparable volume of L-DMEM medium were autologously transplanted into several different points of the periphery of the scar respectively. To evaluate the heart function, echocardiography were performed before modeling,two weeks after modeling, 2 and 4 weeks after the cells transplantation for asurements of left ventricular end systolic diameter (LVESD) and left ventricular end diastolic diameter (LVEDD), tocalculate left ventricular eject fraction(LVEF) and left ventricular fractional shortening (LVFS). Meanwhile the myocardial contrast echocardiography (MCE) were performed for evaluating the blood perfusion of the post-infarct myocardium. Eight weeks after the transplantation, the animalswere undergoing euthanasia, specimens were acquired for pathology. Results Echocardiography indicated that:The LVEF and LVFS between two groups were fundamentally the same before modeling,two weeks after modeling respectively (0.72±0.08 vs. 0.71±0.04,0.56±0.11 vs. 0.55±0.09; 0.35±0.06 vs. 0.35±0.04, 0.24±0.08 vs. 0.23±0.03, Pgt;0.05), but those were improved significantly in group MSCs when compared with control group at two weeks and four weeks after the cells transplantation(0.71±0.05 vs. 0.60±0.05，0.72±0.07 vs. 0.62±0.08 and 0.34±0.03 vs. 0.29±0.01， 0.35±0.06 vs. 0.27±0.05 respectively,Plt;0.05). There were no differences in LVESD and LVEDD between two groups in any time points(Pgt;0.05). MCE showed the blood perfusion of the infarct myocardium were improved two and four weeks after the cell transplantation. Pathology indicated that Dil positive cells were survived in MSCs transplanted hearts, stained positively for αsarcomeric actin and desmin eight weeks after cell transplantation, HE slides indicated that the capillary density in all the cells transplanted hearts were much higher when compared with control group (38.6±7.6/mm2 vs. 21.4±3.9/mm2，Plt;0.05). ConclusionMSCs can differentiate into cardiomyocytes, improve myocardial perfusion and cardiac function when transplanted into ischemic myocardium.
A 55-year-old male patient was admitted to the hospital due to "recurrent chest pain for 8 months, with worsening symptoms for 2 weeks". After admission, comprehensive relevant examinations led to the consideration of a giant chronic left ventricular pseudoaneurysm caused by myocardial infarction with non-obstructive coronary arteries. Surgical treatment was performed at our hospital. We discuss the diagnosis and treatment of this patient.
Objective To investigate the effect and prognosis of patients with ventricular septal rupture after myocardial infarction treated by surgical repair combining an occluder and a patch. Methods Clinical data of 42 patients with myocardial infarction complicated with ventricular septal rupture admitted to the First Affiliated Hospital of Zhengzhou University from January 2010 to September 2021 were retrospectively analyzed. According to the surgical methods, 27 patients were divided into a traditional group, including 17 males and 10 females, with an average age of 62.81±6.81 years, who were repaired by patch only, and 15 patients were divided into a modified group, including 11 males and 4 females, with an average age of 64.27±9.24 years, who were repaired by surgery combining an occluder and a patch. Perioperative and follow-up data of the two groups were compared and analyzed.Results There were statistical differences between the two groups in preoperative Killip grading, rate of intra-aortic balloon pump use, interval from myocardial infarction to operation, and the number of culprit artery (P<0.05). There was no statistical difference in other preoperative data, the cardiopulmonary bypass time, aortic cross-clamping time, postoperative hospital stay or in-hospital death rate between the two groups (P＞0.05). No residual shunt occurred in the modified group, and the difference was statistically significant compared with the traditional group (P=0.038). There was no statistical difference in other complications between the two groups (P＞0.05). The median follow-up time was 4 years. Two patients in the traditional group and one in the modified group died during follow-up. The follow-up cardiac function grading of patients in the modified group was statistically different from that in the traditional group (P=0.023). Conclusion The perioperative mortality of ventricular septal rupture after myocardial infarction is high, but the long-term effect is satisfactory. Surgical repair combining an occluder and a patch is a safe and effective treatment for ventricular septal rupture, which can effectively reduce postoperative residual shunt.
For the purposes of promoting the effect of secondary prevention of myocardial infarction, and improving the compliance with myocardial infarction (MI) secondary prevention, a guideline for strengthening patients self-management on non-pharmacological secondary prevention was produced by an multidiscipline team leaded by Chinese Association of Integrative Medicine clinical cardiovascular branch, Lanzhou University Evidence-Based Medicine Center, Peking University School of Nursing, Tianjin University of Traditional Chinese Medicine and Beijing University of Chinese Medicine. This is the first version of patient guideline in China. This paper introduces the main methods, processes and characteristics of the patient guideline development. It will provide reference to future researchers to the development of the patient guideline.
Objective To evaluate the cardiac protection function of high thoracic epidural anesthesia (HTEA) for patients with acute coronary syndrome or heart failure. Methods A literature search was conducted with computerized database on PubMed, EBSCO, Springer, Ovid, and CNKI from 1990 to May 2010. Further searches for articles were conducted by checking all references describing cardiac protection studies with HTEA. All included articles were assessed and data were extracted according to the standard of Cochrane review. The homogeneous studies were pooled using RevMan 4.2.10 software. Results A total of 28 articles involving 1 041 patients were included. The results of meta-analyses showed that, a) cardiac function: HTEA could significantly improve ejection fraction of left ventricle (WMD= –?10.28, 95%CI –?14.14 to –?6.43) and cardiac output (WMD= –?1.26, 95%CI –?1.63 to –?0.89), contract left ventricular diastolic dimension (WMD= 5.02, 95%CI 3.72 to 6.32), increase E peak (WMD= –?17.50, 95%CI –?29.40 to –?5.59) and decrease A peak (WMD= 27.36, 95%CI 24.46 to 30.26); b) ischemic degree for patients with heart failure: the change of NST-T (WMD= 1.45, 95%CI 1.12 to 1.78) and ∑ST-T (WMD= 1.02, 95%CI 0.78 to 1.26) got significantly decreased after HTEA; c) ischemic degree for patients with acute coronary syndrome: HTEA could obviously lessen the times (WMD= 4.24, 95%CI 0.48 to 8.00) and duration (WMD= 23.29, 95%CI 4.66 to 42.11) of myocardial ischemia, decrease the times of heart attack (WMD= 3.44, 95%CI 0.92 to 5.97), and decrease the change of NST-T (WMD= 1.10, 95%CI 0.84 to 1.36) and ∑ST-T (WMD= 1.33, 95%CI 1.01 to 1.65); d) hemodynamic change for patients with acute coronary syndrome: HTEA could obviously decrease heart beat (WMD= 8.44, 95%CI 3.81 to 13.07) and systolic arterial pressure (WMD= 2.07, 95%CI 0.81 to 3.34), but not decrease the diastolic blood pressure (WMD= 2.06, 95%CI –?0.52 to 4.64) so as to avoid influencing the infusion of coronary artery; and e) influence on Q-T interval dispersion: HTEA could significantly decrease Q-Td (WMD= 9.51, 95%CI 4.74 to 14.27), Q-Tcd (WMD= 11.82, 95%CI 5.55 to 18.09), and J-Td (WMD= 9.04, 95%CI 2.30 to 15.79). Conclusions High thoracic epidural anesthesia can obviously improve the systolic and diastolic function of left ventricle, decrease the heart beat and stabilize hemodynamic change, lessen the times and duration for myocardial ischemia, reserve the ST segment change, contract Q-T interval dispersion, which has to be further proved with more high quality studies.
The study aimed to evaluate the therapeutic effect of nilotinib-loaded biocompatible gelatin methacryloyl (GelMA) microneedles patch on cardiac dysfunction after myocardial infarction(MI), and provide a new clinical perspective of myocardial fibrosis therapies. The GelMA microneedles patches were attached to the epicardial surface of the infarct and peri-infarct zone in order to deliver the anti-fibrosis drug nilotinib on the 10th day after MI, when the scar had matured. Cardiac function and left ventricular remodeling were assessed by such as echocardiography, BNP (brain natriuretic peptide) and the heart weight/body weight ratio (HW/BW). Myocardial hypertrophy and fibrosis were examined by WGA (wheat germ agglutinin) staining, HE (hematoxylin-eosin staining) staining and Sirius Red staining. The results showed that the nilotinib-loaded microneedles patch could effectively attenuate fibrosis expansion in the peri-infarct zone and myocardial hypertrophy, prevent adverse ventricular remodeling and finally improve cardiac function. This treatment strategy is a beneficial attempt to correct the cardiac dysfunction after myocardial infarction, which is expected to become a new strategy to correct the cardiac dysfunction after MI. This is of great clinical significance for improving the long-term prognosis of MI patients.
Objective To investigate the effects of granulocyto-colony stimulating factor (G-CSF) on the mobil ization of endothel ial progenitor cells (EPCs) in the rats with myocardial infarction (MI), to observe the density of neovascularization and the mRNA expressions of vascular endothel ial growth factor (VEGF) and its receptor (Flk-1) in the border area of MI. Methods Thirty-six adult male rats (weighing 250-280 g) were divided randomly into control group, MI group, and G-CSF group. In MI group and G-CSF group, the models of MI were establ ished by left anterior descenting coronary artery l igation and were treated with intraperitoneal injection of sal ine (0.3 mL/d) or G-CSF [30 μg/(kg?d)] for 5 days. In control group, after open chest operation, chest was closed without treatment. The level of EPCs was surveyed and the plasma concentrations of VEGF and C-reaction protein (CRP) were measured at 7 days. The mRNA expressions of VEGFand its receptor Flk-1 in the border area of infarct myocardium were determined through RT-PCR. Results Compared withcontrol group, the number of circulating white blood cell (WBC) and EPCs levels, and the serum concentrations of VEGF and CRP were all significantly increased in MI group and G-CSF group (P lt; 0.05); when compared with MI group, the number of circulating WBC and EPCs levels, and the serum concentrations of VEGF were increased and the concentration of CRP was decreased in G-CSF group (P lt; 0.05). Compared with control group, the mRNA expressions of VEGF and Flk-1, and the density of neovascularization in the border area of infarct myocardium were increased in MI group and G-CSF group, whereas those in G-CSF group were significantly augmented compared with MI group (P lt; 0.05). Conclusion In the rats with MI, G-CSF could promote EPCs mobil ization, increase the mRNA expressions of VEGF and Flk-1, and augment the density of neovascularization in the border area of infarct myocardium.
Objective To investigate the extent intravenously transplantation of mesenchymal stem cells (MSCs) mediated by magnetic targeting material arrive in the myocardial infarction region and its effects on the recovery of myocardial infarction. Methods Identify the phenotype of the fourth genet of ex vivo expanded MSCs, stain with DAPI after inducing with 10μmol/L 5-aza, then preserve the MSCs for transplantation. 28 SD rats were divided into three groups: group A (n=10), delivered MSCs combined with magnetic targeting material for 30 minutes to rats through tail vein,and kept on raising after placing magnets on the corresponding skin region to myocardial infarction area for 30min; group B (n=9), administration MSCs not conjuncted with magnetic targeting material through tail vein; group C (n=9), direct intramyocardial transplantation of MSCs. Two days after transplantation, evaluate the aggregation state of MSCs in the area of myocardial infarction; 30d later, estimate the functional and morphological changes in myocardial infarction region. Results We observed that each MSCs had 3-5 molecules of magnetic targeting material attached to its membrane under transmission electron microscope. The homing rates of MSCs respectively were group A 38%, group B 6%, group C 53%.The number of aggregating MSCs of group A and group C was apparently more than that of group B（Plt;0.01）. After transplantation, the contraction indices of left ventricle in group A and group C had significant improvement as compared with that of pretransplantation (LVEF 46%±6% vs. 38%±8%, 51%±5% vs. 35%±4%; LVFS 28%±6% vs. 20%±7%, 32%±4% vs. 20%±5%, Plt;0.05) and administrated cells stained with DAPI could be detected in infarction region under optical microscope. After transplantation, the contraction indices of left ventricle in group B hadn’t conspicuous improvement, and the transplanted cells labeled with DAPI could not be identified in infarction region under optical microscope (homing rate of MSCs 38%). There was no statistically difference of results between group A and group C, but in experiment process, there was a high mortality in group C. Conclusion The method that intravenously delivery of MSCs mediated by magnetic targeting material could accumulate much more MSCs in infarction region, reduce infarction size, and effectively improve the cardiac function after infarction.