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Injury mechanism of COVID-19-induced cardiac complications. 新型冠状病毒感染心脏并发症的损伤机制
Q4 Medicine Pub Date : 2023-07-01 Epub Date: 2023-06-23 DOI: 10.1097/CP9.0000000000000055
Ling Leng, Xiu-Wu Bian

Heart dysfunction is one of the most life-threatening organ dysfunctions caused by coronavirus disease 2019 (COVID-19). Myocardial or cardiovascular damage is the most common extrapulmonary organ complication in critically ill patients. Understanding the pathogenesis and pathological characteristics of myocardial and vascular injury is important for improving clinical diagnosis and treatment approach. Herein, the mechanism of direct damage caused by severe acute respiratory syndrome coronavirus 2 to the heart and secondary damage caused by virus-driven inflammation was reviewed. The pathological mechanism of ischemia and hypoxia due to microthrombosis and inflammatory injury as well as the injury mechanism of tissue inflammation and single myocardial cell necrosis triggered by the viral infection of pericytes or macrophages, hypoxia, and energy metabolism disorders were described. The latter can provide a novel diagnosis, treatment, and investigation strategy for heart dysfunctions caused by COVID-19 or the Omicron variant.

心脏功能障碍是2019冠状病毒病(新冠肺炎)引起的最危及生命的器官功能障碍之一。心肌或心血管损伤是危重患者最常见的肺外器官并发症。了解心肌和血管损伤的发病机制和病理特征对于改进临床诊断和治疗方法具有重要意义。本文综述了严重急性呼吸综合征冠状病毒2型对心脏的直接损伤和病毒驱动的炎症引起的继发性损伤的机制。介绍了微血栓和炎症损伤引起的缺血缺氧的病理机制,以及由周细胞或巨噬细胞的病毒感染、缺氧和能量代谢紊乱引发的组织炎症和单个心肌细胞坏死的损伤机制。后者可以为新冠肺炎或奥密克戎变异株引起的心脏功能障碍提供新的诊断、治疗和调查策略。
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引用次数: 0
Diabetes and associated cardiovascular complications: The role of microRNAs 糖尿病和相关心血管并发症:microrna的作用
Q4 Medicine Pub Date : 2023-07-01 DOI: 10.1097/cp9.0000000000000062
Mirjana T. Macvanin, Esma R. Isenovic
Diabetes mellitus (DM) refers to a complex cluster of metabolic disorders characterized by hyperglycemia caused by inadequate insulin secretion, insulin resistance, or excessive glucagon secretion. If not correctly treated, the prolonged effects of DM-associated metabolic perturbations lead to systemic vascular complications and cardiovascular disease (CVD), the principal cause of mortality among patients with DM. Given the increase in the global prevalence of diabetes, novel diagnostic and therapeutic procedures are necessary for its effective identification and treatment. Recent findings point to an important role of microRNA (miRNAs) in DM initiation and progression, as well as the occurrence of associated cardiovascular complications. miRNAs are short, highly conserved, single-stranded, non-coding RNAs that contribute to the maintenance of physiological homeostasis through the regulation of crucial processes such as metabolism, cell proliferation, and apoptosis. The increased availability of high-throughput methodologies for identifying and characterizing non-coding RNAs has led to considerable interest in miRNAs as potential biomarkers and therapeutic agents for DM. In this review, we first comprehensively detail the regulatory miRNAs involved in the pathophysiology of DM and diabetic cardiomyopathy (DCMP). Subsequently, we summarize findings regarding the utility of several of these miRNAs as potential prognostic and diagnostic biomarkers for DM and DM-associated CVD. Finally, we evaluate the potential of miRNA-based therapeutic approaches for treating DM and DCMP in the clinical setting.
糖尿病(Diabetes mellitus, DM)是指由胰岛素分泌不足、胰岛素抵抗或胰高血糖素分泌过多引起的以高血糖为特征的一组复杂的代谢紊乱。如果不正确治疗,糖尿病相关代谢紊乱的长期影响会导致系统性血管并发症和心血管疾病(CVD),这是糖尿病患者死亡的主要原因。鉴于全球糖尿病患病率的增加,需要新的诊断和治疗方法来有效识别和治疗糖尿病。最近的研究结果指出,microRNA (mirna)在糖尿病的发生和进展以及相关心血管并发症的发生中起着重要作用。mirna是一种短的、高度保守的单链非编码rna,通过调节代谢、细胞增殖和凋亡等关键过程来维持生理稳态。越来越多的高通量方法用于识别和表征非编码rna,这使得mirna作为糖尿病的潜在生物标志物和治疗药物引起了人们的极大兴趣。在这篇综述中,我们首先全面详细介绍了参与糖尿病和糖尿病性心肌病(DCMP)病理生理学的调控mirna。随后,我们总结了这些mirna作为糖尿病和糖尿病相关心血管疾病的潜在预后和诊断生物标志物的研究结果。最后,我们评估了基于mirna的治疗方法在临床环境中治疗DM和DCMP的潜力。
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引用次数: 0
Negative methylene diphosphonate scintigraphy in biopsy-confirmed hereditary transthyretin Ala117Ser cardiac amyloidosis: a case report 活组织检查证实遗传性甲状腺转蛋白Ala117Ser心脏淀粉样变性的二膦酸亚甲基显像阴性1例
Q4 Medicine Pub Date : 2023-07-01 DOI: 10.1097/cp9.0000000000000058
Zejia Wu, Shuang Xia, Dunliang Ma, Liwen Li
99m Tc-pyrophosphate ( 99m Tc-PYP) scintigraphy is highly sensitive and specific for the diagnosis of transthyretin cardiac amyloidosis (ATTR-CA). Commonly used alternative tracers included 99m Tc-3,3-diphosphono-1,2-propanodicarboxylic acid ( 99m Tc-DPD) and 99m Tc-hydroxymethylene diphosphonate ( 99m Tc-HMDP). A 61-year-old Chinese man presented with signs indicative of left ventricular hypertrophy. Genetic testing revealed heterozygous transthyretin Ala117Ser mutation. Scintigraphy using 99m Tc-methylene diphosphonate failed to show myocardial uptake. Five months later, the patient underwent permanent pacemaker implantation. Tafamidis was used irregularly, and the patient died 2 years later. 99m Tc-methylene diphosphonate may not be appropriate for diagnostic use in ATTR-CA patient with transthyretin Ala117Ser mutation.
99m tc -焦磷酸显像(99m Tc-PYP)对转甲状腺素型心脏淀粉样变性(atr - ca)的诊断具有高度的敏感性和特异性。常用的替代示踪剂有99m tc -3,3-二膦-1,2-丙二羧酸(99m Tc-DPD)和99m tc -二膦酸羟亚甲基(99m Tc-HMDP)。一位61岁的中国男性表现出左心室肥厚的迹象。基因检测显示为杂合型转甲状腺素Ala117Ser突变。使用99m tc -二膦酸亚甲基显像未能显示心肌摄取。五个月后,患者接受了永久性心脏起搏器植入手术。不定期使用他法米地,患者于2年后死亡。99m tc -二膦酸亚甲基可能不适合用于甲状腺转视蛋白Ala117Ser突变的atr - ca患者的诊断。
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引用次数: 0
STAT3-CD163 cross-talk exhibits promising biomarkers for a progressive ischemic cardiomyopathy: integrative computational and gene expression profiling based on Gene Expression Omnibus datasets STAT3-CD163串音显示出进展性缺血性心肌病的有希望的生物标志物:基于基因表达综合数据集的综合计算和基因表达谱
Q4 Medicine Pub Date : 2023-07-01 DOI: 10.1097/cp9.0000000000000063
Mina W. Mohareb, Mohammed A. Kariem, Aly Tohamy, Noha M. Gamal, Rehab M. Mosaad, Nora N. Esmaiel, Alaaeldin G. Fayez
Background and purpose: Ischemic heart disease frequently leads to heart failure, often resulting in death. In this study, we aimed to identify common hub mRNAs and pathways involved in the pathological progression of ischemic cardiomyopathy (ICM). Methods: Validation quantitative reverse transcription-polymerase chain reaction (qRT-PCR) was carried out on peripheral blood and left ventricle specimens from patients in three groups with stable coronary artery disease (CAD), myocardial infarction (MI), and ICM and compared with corresponding controls. qRT-PCR was preceded by computational analysis of eight high-throughput RNA sequencing and microarray datasets from 499 patients and 233 controls, to determine possible common biologically meaningful differentially expressed genes (DEGs). To determine the potential pathological pathways, we performed Gene Ontology functional annotation, pathway enrichment analysis, protein–protein interaction (PPI) analysis, and constructed transcriptional factor/miRNA regulatory networks. Finally, approved drugs were screened. Results: Fifteen common DEGs with P < 0.01 were identified. STAT3, CEBPD, GLUL , and CD163 were hub-enriched mRNAs with an interaction score ≥ 0.50. Our qRT-PCR analysis showed an increased expression of STAT3 in all three patient groups and CD163 , mainly in cardiac samples, in a remarkably ascending manner. Interaction modules showed co-regulators supporting high STAT3-CD163 connectivity, suggesting a potential role for STAT3-CD163 cross-talk-mediated inflammatory responses in ICM progression. Conclusions: Our results provided a novel perspective for understanding the underlying mechanisms of ICM progression and exploring new therapeutic agents. Clinical trial registration: URL: www.clinicaltrials.gov. Unique identifier: NCT05508269.
背景与目的:缺血性心脏病常导致心力衰竭,常导致死亡。在这项研究中,我们旨在确定参与缺血性心肌病(ICM)病理进展的共同枢纽mrna和途径。方法:对三组稳定型冠心病(CAD)、心肌梗死(MI)和ICM患者外周血和左心室标本进行定量逆转录聚合酶链反应(qRT-PCR)验证,并与相应的对照组进行比较。在进行qRT-PCR之前,对来自499名患者和233名对照者的8个高通量RNA测序和微阵列数据集进行计算分析,以确定可能存在的共同的具有生物学意义的差异表达基因(DEGs)。为了确定潜在的病理通路,我们进行了基因本体功能注释、通路富集分析、蛋白-蛋白相互作用(PPI)分析,并构建了转录因子/miRNA调控网络。最后,对批准的药物进行筛选。结果:15例常见deg伴P <鉴定出0.01个。STAT3、CEBPD、GLUL和CD163是中心富集的mrna,相互作用评分≥0.50。我们的qRT-PCR分析显示,在所有三组患者中,STAT3和CD163的表达均显著升高,主要是在心脏样本中。相互作用模块显示支持STAT3-CD163高连通性的共同调节因子,提示STAT3-CD163串音介导的炎症反应在ICM进展中的潜在作用。结论:我们的研究结果为理解ICM进展的潜在机制和探索新的治疗药物提供了新的视角。临床试验注册:网址:www.clinicaltrials.gov。唯一标识符:NCT05508269。
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引用次数: 0
A multi-device robotic-assisted PCI system: a proof-of concept study for left main bifurcation stenting with culotte technique in a porcine model 一种多设备机器人辅助PCI系统:猪模型左主干分叉支架术的概念验证研究
Q4 Medicine Pub Date : 2023-07-01 DOI: 10.1097/cp9.0000000000000060
Wenzheng Han, Ming Wang, Shaofeng Guan, Qian Gan, Weiyi Fang, Kun Xia, Xinkai Qu
Background and purpose: Robotic-assisted percutaneous coronary intervention (PCI) has been increasingly used for simple lesion. For complex lesions, extensive manual intervention is still required. This study aims to verify the stability and safety of this robot system in complex lesion under fifth-generation (5G) network before clinical trial. Methods: We developed a robotic system that allows simultaneous remote control of multiple devices using a 5G wireless network. The key feature of the system is a bionic thumb along with two-bionic forefingers. The system was tested in eight pigs (six over 18.3 km and two over 1,100 km). Two stents were placed in the left main bifurcation using the culotte technique. All procedures, barring device loading onto the robot system, including manipulation of the guiding catheter, wire adjustments, stent or balloon positioning, and notably the final kissing step, were conducted remotely. Results: The rate of procedure success was 100%, with no device-related complications. In comparison to short-distance remote control, the delay with long-distance remote control was minimal (90.9 ± 1.5 vs. 81.5 ± 2.7 ms for command data transmission; 163.2 ± 1.3 vs. 161.0 ± 1.4 ms for image transmission). The procedure time was shorter when using two pairs versus a single pair of bionic fingers (104.3 ± 10.2 vs. 126.0 ± 3.9 min), primarily due to less time needed for device loading and exchange (33.1 ± 4.2 vs. 56.1 ± 4.0 min). Conclusions: With the 5G network, long distance was not a significant barrier for robotic-assisted PCI for chronic total occlusion. A design of the independent bionic finger module enabled final kissing balloon inflation with reduced requirement for manual intervention. Whether the system could be used beyond left main bifurcation lesions requires further investigation.
背景与目的:机器人辅助经皮冠状动脉介入治疗(PCI)在单性病变中的应用越来越广泛。对于复杂的病变,仍然需要广泛的人工干预。本研究旨在临床试验前验证该机器人系统在第五代(5G)网络下复杂病变环境下的稳定性和安全性。方法:我们开发了一个机器人系统,可以使用5G无线网络同时远程控制多个设备。该系统的主要特点是一个仿生拇指和两个仿生食指。该系统在8头猪身上进行了测试(6头超过18.3公里,2头超过1100公里)。两个支架放置在左主分叉使用导管技术。所有程序,包括将设备装载到机器人系统上,包括导尿管的操作、导线调整、支架或球囊的定位,特别是最后的接吻步骤,都是远程进行的。结果:手术成功率100%,无器械相关并发症。与近距离遥控相比,远程遥控的指令数据传输延迟最小(90.9±1.5 ms vs 81.5±2.7 ms);163.2±1.3 vs. 161.0±1.4 ms图像传输)。与单对仿生手指相比,使用两对仿生手指的手术时间更短(104.3±10.2 vs 126.0±3.9 min),主要是由于设备加载和交换所需的时间更短(33.1±4.2 vs 56.1±4.0 min)。结论:在5G网络下,远距离不是机器人辅助PCI治疗慢性全闭塞的显著障碍。独立仿生手指模块的设计使最终的接吻气球膨胀减少了人工干预的要求。该系统是否可以用于左主干分叉病变以外的病变,需要进一步研究。
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引用次数: 0
Cancer treatment-related cardiotoxicity: a focus on sacubitril/valsartan 癌症治疗相关的心脏毒性:关注苏比里尔/缬沙坦
Q4 Medicine Pub Date : 2023-06-26 DOI: 10.1097/cp9.0000000000000056
F. Hu, Huajiong Yu, Zhao-yang Chen, Lianglong Chen
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引用次数: 0
Air pollution and cardiovascular heath in a changing climate 气候变化中的空气污染和心血管健康
Q4 Medicine Pub Date : 2023-06-01 DOI: 10.1097/cp9.0000000000000051
H. Kan, Tiantian Li, Zhenyu Zhang
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引用次数: 0
Artificial intelligence in medical practice: current status and future perspectives 人工智能在医疗实践中的应用:现状与未来展望
Q4 Medicine Pub Date : 2023-04-05 DOI: 10.1097/cp9.0000000000000040
Yuxiang Dai, Junbo Ge
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引用次数: 0
All-cause mortality in moderate and severe COVID-19 patients with myocardial injury receiving versus not receiving azvudine: a propensity score-matched analysis. 中重度新冠肺炎心肌损伤患者服用与不服用azvudine的全因死亡率:倾向评分匹配分析。
Q4 Medicine Pub Date : 2023-04-01 Epub Date: 2023-05-31 DOI: 10.1097/CP9.0000000000000049
Ru Chen, Yi Guo, Shan Deng, Jian Wang, Meng Gao, Hongli Han, Lin Wang, Hongwei Jiang, Kai Huang

Omicron is currently the dominant strain of severe acute respiratory syndrome coronavirus 2, but little is known about the characteristics and management of omicron related myocardial injury, particularly the potential benefit of the antiviral agent azvudine.

Methods: Patients with confirmed and suspected coronavirus disease 2019 (COVID-19) admitted to Wuhan Union Hospital from December 7, 2022, to December 30, 2022, were included in this study. Cox regression was conducted to identify risk factors for all-cause mortality. A propensity score-matched analysis was performed at a 1:1 ratio with a caliper of 0.1 pooled standard deviations of relevant confounders.

Results: The final analysis included a total of 332 patients (167 confirmed cases and 165 suspected cases), 42.77% (142/332) of the patients were 80 years of age or older and 68.67% (228/332) of them were men, 158 patients were treated with azvudine. In the matched cohort, the total mortality was 30.30% (60/198), 40 (20.20%, 40/198) patients received noninvasive ventilation and 22 (11.11%, 22/198) received invasive ventilation, 34 (17.17%, 34/198) patients were admitted to intensive care unit (ICU). The rate of shock, multiple organ damages and arrhythmia were 11.62% (23/198), 20.20% (40/198), and 12.12% (24/198), respectively. There was no significant difference on these clinical outcomes in patients treated with azvudine or not. Azvudine reduced early mortality (within 14 days from admission) (hazard ratio: 0.37, 95% confidence interval: 0.18-0.77) even after adjusting for other treatments including glucocorticoids, immunoglobin and anticoagulant therapy, but not the final in-hospital mortality of patients.

Conclusions: Patients with COVID-19-related myocardial injury had a high mortality of about 30.30% (60/198). Azvudine improved the early survival of the patients but not final mortality.

奥密克戎目前是严重急性呼吸综合征冠状病毒2型的主要毒株,但对奥密克龙相关心肌损伤的特征和管理,特别是抗病毒药物阿兹夫定的潜在益处知之甚少。方法:纳入2022年12月7日至12月30日武汉协和医院收治的2019年确诊和疑似冠状病毒病(新冠肺炎)患者。Cox回归分析用于确定全因死亡率的危险因素。以1:1的比例进行倾向评分匹配分析,相关混杂因素的标准差为0.1。结果:最终分析共包括332名患者(167例确诊病例和165例疑似病例),42.77%(142/332)的患者年龄在80岁或以上,68.67%(228/332)为男性,158名患者接受了阿兹夫定治疗。在匹配队列中,总死亡率为30.30%(60/198),40名(20.20%,40/198)患者接受了无创通气,22名(11.11%,22/198)患者进行了有创通气,34名(17.17%,34/198)患者入住重症监护室(ICU)。休克、多器官损伤和心律失常的发生率分别为11.62%(23/198)、20.20%(40/198)和12.12%(24/198)。在接受或不接受azvudine治疗的患者中,这些临床结果没有显著差异。即使在调整了包括糖皮质激素、免疫球蛋白和抗凝治疗在内的其他治疗后,阿兹夫定也降低了早期死亡率(入院后14天内)(风险比:0.37,95%置信区间:0.18-0.77),但没有降低患者的最终住院死亡率。结论:COVID-198相关心肌损伤患者的死亡率约为30.30%(60/198)。阿兹夫定提高了患者的早期生存率,但没有提高最终死亡率。
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引用次数: 0
Differentiating the effects of fine and coarse particulate air pollution on the onset of stable and unstable angina: a case-crossover study in 305 Chinese cities 细颗粒物和粗颗粒物污染对稳定型和不稳定型心绞痛发病的影响:中国305个城市的病例交叉研究
Q4 Medicine Pub Date : 2023-04-01 DOI: 10.1097/CP9.0000000000000052
Yixuan Jiang, Qingli Zhang, Xinlei Zhu, Xiaowei Xue, Qinglin He, Ya Gao, Renjie Chen
Background and purpose: Associations between fine and coarse particulate matters (i.e., PM2.5 and PM2.5–10, respectively) and the onset of angina have rarely been investigated. We aimed to systematically explore the impacts of PM2.5 as well as PM2.5–10 on the onset of stable and unstable angina at the hourly timescale. Methods: We performed a time-stratified case-crossover study among 995,734 angina patients from 1,655 hospitals in 305 Chinese cities from January 2015 to December 2021. Concentrations of PM2.5 and PM2.5–10 were collected at the hourly timescale from nearby fixed-site monitoring stations. Hourly onset information of unstable and stable angina was obtained from the Chinese Cardiovascular Association Database-Chest Pain Center. We applied conditional logistic regressions combined with polynomial distributed lag models to explore the lagged exposure–response associations. Subgroup analyses were performed to explore potential effect modifiers including age, sex, season, and region. Results: Transient exposure to PM2.5 was significantly associated with elevated risk of unstable and stable angina onset. The associations occurred immediately in the concurrent hour of exposure, attenuated thereafter, and turned to null at approximately lag 12 h for unstable angina and 9 h for stable angina. Each interquartile range increase in the PM2.5 concentrations over 0 to 12 h was associated with 1.32% (95% confidence interval [95% CI]: 0.94%–1.70%) and 1.69% (95% CI: 0.99%–2.39%) increase in the onset risk of unstable and stable angina, respectively. The results remained similar after controlling for co-pollutants. Greater magnitudes of associations were found among females and during cold season. Null associations were observed between PM2.5–10 and any type of angina. Conclusion: Our study indicates that acute exposure to PM2.5, rather than PM2.5–10, was significantly associated with the onset of both unstable and stable angina, underscoring the need of continued efforts in controlling particulate matter air pollution.
背景与目的:细颗粒物和粗颗粒物(分别为PM2.5和PM2.5 - 10)与心绞痛发病之间的关系很少被研究。我们的目的是系统地探讨PM2.5和PM2.5 - 10在小时尺度上对稳定性和不稳定性心绞痛发作的影响。方法:2015年1月至2021年12月,我们对中国305个城市1655家医院的995734例心绞痛患者进行了时间分层病例交叉研究。PM2.5和PM2.5 - 10的浓度在附近的固定监测站以小时为单位收集。不稳定型和稳定型心绞痛的每小时发病信息来源于中国心血管协会胸痛中心数据库。我们运用条件逻辑回归结合多项式分布滞后模型来探讨滞后暴露-反应的关联。进行亚组分析,探讨潜在的影响因素,包括年龄、性别、季节和地区。结果:短暂暴露于PM2.5与不稳定型和稳定型心绞痛发病风险升高显著相关。这种关联在暴露的同一小时内立即发生,随后减弱,在不稳定型心绞痛12小时后变为零,稳定型心绞痛9小时后变为零。PM2.5浓度在0 ~ 12 h内每增加一个四分位数范围,不稳定型和稳定型心绞痛发病风险分别增加1.32%(95%可信区间[95% CI]: 0.94% ~ 1.70%)和1.69% (95% CI: 0.99% ~ 2.39%)。在控制了共污染物后,结果仍然相似。在女性和寒冷季节发现了更大程度的关联。PM2.5-10与任何类型的心绞痛均无关联。结论:我们的研究表明,急性暴露于PM2.5,而不是PM2.5 - 10,与不稳定型和稳定型心绞痛的发病都有显著关系,这强调了继续努力控制颗粒物空气污染的必要性。
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引用次数: 1
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Cardiology Plus
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