Pathophysiology

病理生理学
  • 文章类型: Journal Article
    近年来,随着外科技术的进步和体外心脏辅助装置如体外膜氧合(ECMO)的广泛使用,ALCAPA(来自肺动脉的异常左冠状动脉)的治疗结果已证明显著改善.然而,ALCAPA的手术适应症和方法,特别是冠状动脉壁内ALCAPA的手术方法,是否同时治疗MR仍存在争议。长期预后仍然令人沮丧,同时,不同中心的结果存在显著差异。本审查具体解决了上述这些问题。本文综述了病理生理学和分类,诊断,适应症,ALCAPA的手术策略和预后。相信本综述将为今后的研究者提供一定的参考,为今后降低先天性心脏病患儿的不良预后提供新的思路。
    In recent years, with advancements in surgical techniques and the widespread utilization of extracorporeal cardiac assist devices such as extracorporeal membrane oxygenation (ECMO), the treatment outcomes for ALCAPA (Anomalous left coronary artery from the pulmonary artery) have demonstrated significant improvements. However, the surgical indications and methods of ALCAPA, especially the surgical methods of ALCAPA with intramural coronary artery, and whether to treat MR at the same time are still controversial. The long-term prognosis remain discouraging simultaneously, with significant variations in outcomes across different centers. The present review specifically addresses these aforementioned concerns. This article reviews the pathophysiology and classification, diagnosis, indications, surgical strategy and prognosis of ALCAPA. We believe that this review will provide some reference for future researchers and provide new ideas for reducing the adverse prognosis of children with congenital heart disease in future.
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  • 文章类型: Journal Article
    血栓栓塞性疾病是许多血管炎的并发症。一个常见的观察是血栓栓塞事件与血管疾病的时期一致,但这种情况发生的机制尚不清楚。炎性血栓形成现在被认为是风湿性动脉炎的症状,和血管炎,如Behçet综合征(BS),和抗中性粒细胞胞浆抗体(ANCA)相关血管炎(AAV)或巨细胞动脉炎(GCA)。本系统综述旨在解释与病因学相关的最新发现,病理生理学,以及BS的治疗方法,AAV,和中/大血管血管炎。
    对PubMed的英文来源进行全面的文献检索,Scopus,MEDLINE,科学直接,ProQuest,AIM,CINAHIL,和ELDIS数据库用于查找相关文章和报告。相关论文(有全文)一直获得到2023年6月。两名独立审稿人筛选了所获得文章的标题和摘要,第三名仲裁员解决了审稿人之间的纠纷。
    越来越清楚的是某些全身性炎症性疾病,比如血管炎,与静脉和动脉血栓形成的高风险有关。已经注意到AAV中血栓栓塞性疾病的发病率增加,特别是在疾病活跃的时候。越来越多的证据支持在血管炎静脉血栓形成的治疗中使用免疫抑制。这些患者发生缺血性疾病的风险也较高。
    UNASSIGNED: Thromboembolic disease is a complication of many vasculitides. A common observation is that thromboembolic events coincide with the period of vasculitic disease, but the mechanism by which this occurs remains unclear. Inflammatory thrombosis is now recognized as a symptom of arteritis rheumatic, and vasculitides such as Behçet\'s syndrome (BS), and anti-neutrophil cytoplasmic antibodies (ANCA)-associated vasculitis (AAV) or giant cell arteritis (GCA). This systematic review aimed to explain recent findings related to etiology, pathophysiology, and treatment methods for BS, AAV, and medium/large-vessel vasculitis.
    UNASSIGNED: A comprehensive literature search on English sources from PubMed, Scopus, MEDLINE, Science Direct, ProQuest, AIM, CINAHIL, and ELDIS databases was used to find the relevant articles and reports. The relevant papers (having full text) were obtained until June 2023. Two independent reviewers screened the titles and abstracts of the obtained articles, and a third arbitrator resolved disputes between the reviewers.
    UNASSIGNED: It is becoming increasingly clear that certain systemic inflammatory diseases, like vasculitis, are linked to a higher risk of both venous and arterial thrombosis. An increased incidence of thromboembolic disease in AAV has been noted, particularly during times of active disease. Growing evidence supports the use of immunosuppression in the management of venous thrombosis in vasculitis. These patients also have a higher risk of developing ischemic disease.
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  • 文章类型: Journal Article
    先天性心脏病(CHD)是心脏和/或大血管的结构异常,冠心病患者一生中各种疾病的风险增加,长期生存率降低。最终,CHD可能导致各种并发症,包括心力衰竭,心律失常,中风,肺炎,突然死亡。不幸的是,某些CHD的确切病因和病理生理学尚不清楚.尽管随着技术的进步,冠心病患者的生活质量和预后得到了显着改善,冠心病的影响是终身的,尤其是复杂的冠心病患者。因此,由于CHD的高患病率,其管理仍然是一个挑战.最后,国际准则之间在CHD方面存在一些分歧。在这次审查中,我们提供了最新的病理生理学,诊断,和最常见类型的冠心病的治疗,包括卵圆孔未闭,房间隔缺损,室间隔缺损,房室间隔缺损,动脉导管未闭,主动脉缩窄,大动脉转位,先天性矫正的大动脉转位,冠状动脉异常,左右心室流出道梗阻,法洛四联症和Ebstein异常。特别是,我们专注于这些领域已知的和未知的,旨在提高当前对各种类型冠心病的认识。
    Congenital heart disease (CHD) is a structural abnormality of the heart and/or great vessels and patients with CHD are at an increased risks of various morbidities throughout their lives and reduced long-term survival. Eventually, CHD may result in various complications including heart failure, arrhythmias, stroke, pneumonia, and sudden death. Unfortunately, the exact etiology and pathophysiology of some CHD remain unclear. Although the quality of life and prognosis of patients with CHD have significantly improved following technological advancement, the influence of CHD is lifelong, especially in patients with complicated CHD. Thus, the management of CHD remains a challenge due to its high prevalence. Finally, there are some disagreements on CHD among international guidelines. In this review, we provide an update of the pathophysiology, diagnosis, and treatment in most common type of CHD, including patent foramen ovale, atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, coarctation of the aorta, transposition of the great arteries, congenitally corrected transposition of the great arteries, coronary anomalies, left and right ventricular outflow tract obstruction, tetralogy of Fallot and Ebstein anomaly. In particular, we focus on what is known and what is unknown in these areas, aiming to improve the current understanding of various types of CHD.
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  • 文章类型: Journal Article
    背景:我们旨在揭示神经变性(N)标记神经颗粒蛋白(Ng)的潜在病理生理学,神经丝光(NfL),和海马体积(HCV),在阿尔茨海默病(AD)中使用脑脊液(CSF)蛋白质组学。
    方法:没有痴呆的个体被分类为A+(CSF淀粉样β[Aβ]42),T+(CSF磷酸化Tau181),和N+或N-基于Ng,NFL,或单独的HCV。产生CSF蛋白质组学并使用协方差分析在组之间进行比较。
    结果:只有少数个体是A+T+Ng-。与A+T+Ng-和A+T+NfL-相比,A+T+Ng+和A+T+NfL-显示不同的蛋白质组图谱,分别。Ng+和NfL+都与神经可塑性相关,虽然在相反的方向。与A+T+HC-相比,A+T+HCV+显示很少的蛋白质组变化,与氧化应激有关。
    结论:不同的N标记与不同的神经变性过程相关,不应等同。N标记物可以区别地补充淀粉样蛋白和tau蛋白以外的疾病分期。我们的发现表明,Ng可能不是最佳的N标记,鉴于其与tau病理生理学的不一致性低。
    结论:在阿尔茨海默病中,神经颗粒素(Ng)+,神经丝光(NfL)+,和海马体积(HCV)在脑脊液中显示差异蛋白表达。Ng+和NfL+与神经可塑性相关,虽然方向相反。HCV+显示很少的蛋白质组变化,与氧化应激有关。神经变性(N)标记物可以区别地改善淀粉样蛋白和tau蛋白以外的疾病分期。Ng可能不是最佳的N标记,因为它与tau关系更密切。
    BACKGROUND: We aimed to unravel the underlying pathophysiology of the neurodegeneration (N) markers neurogranin (Ng), neurofilament light (NfL), and hippocampal volume (HCV), in Alzheimer\'s disease (AD) using cerebrospinal fluid (CSF) proteomics.
    METHODS: Individuals without dementia were classified as A+ (CSF amyloid beta [Aβ]42), T+ (CSF phosphorylated tau181), and N+ or N- based on Ng, NfL, or HCV separately. CSF proteomics were generated and compared between groups using analysis of covariance.
    RESULTS: Only a few individuals were A+T+Ng-. A+T+Ng+ and A+T+NfL+ showed different proteomic profiles compared to A+T+Ng- and A+T+NfL-, respectively. Both Ng+ and NfL+ were associated with neuroplasticity, though in opposite directions. Compared to A+T+HCV-, A+T+HCV+ showed few proteomic changes, associated with oxidative stress.
    CONCLUSIONS: Different N markers are associated with distinct neurodegenerative processes and should not be equated. N markers may differentially complement disease staging beyond amyloid and tau. Our findings suggest that Ng may not be an optimal N marker, given its low incongruency with tau pathophysiology.
    CONCLUSIONS: In Alzheimer\'s disease, neurogranin (Ng)+, neurofilament light (NfL)+, and hippocampal volume (HCV)+ showed differential protein expression in cerebrospinal fluid. Ng+ and NfL+ were associated with neuroplasticity, although in opposite directions. HCV+ showed few proteomic changes, related to oxidative stress. Neurodegeneration (N) markers may differentially refine disease staging beyond amyloid and tau. Ng might not be an optimal N marker, as it relates more closely to tau.
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  • 文章类型: Journal Article
    我们的工作旨在探讨转化生长因子β1(TGF-β1)的相互作用作用,泛素特异性加工蛋白酶7(USP7),和Yes相关蛋白(YAP)在脓毒症继发性急性肺损伤(ALI)期间铁凋亡中的作用。我们的研究表明,在急性肺损伤的细胞和动物模型中,TGF-β1加重了铁死亡。此外,YAP通过调节TEAD4与GPX4/SLC7A11启动子的结合来上调谷胱甘肽过氧化物酶4(GPX4)和SLC7A11。此外,大肿瘤抑制激酶1(LATS1)敲低导致YAP表达刺激,而USP7通过去泛素化和稳定LATS1/2下调YAP。YAP过表达或USP7/LATS1沉默减少铁凋亡过程,通过反馈回路调节YAP。然而,TGF-β1通过YAP过表达或LATS1/USP7敲低消除铁死亡的抑制。通过阐明TGF-β1,USP7,LATS1/2和YAP之间的分子相互作用,我们在脓毒症继发性ALI中发现了一个新的铁凋亡调节轴.我们的研究揭示了铁死亡的病理生理学,并提出了脓毒症诱导的ALI的潜在治疗方法。
    Our work aimed to investigate the interactive roles of transforming growth factor β1 (TGF-β1), ubiquitin-specific-processing protease 7 (USP7), and Yes-associated protein (YAP) in ferroptosis during sepsis-secondary acute lung injury (ALI). Our study demonstrated that ferroptosis was aggravated by TGF-β1 in both cellular and animal models of acute lung injury. Additionally, YAP upregulated glutathione peroxidase 4 (GPX4) and SLC7A11 by regulating the binding of TEAD4 to GPX4/SLC7A11 promoters. Furthermore, large tumor suppressor kinase 1 (LATS1) knockdown resulted in YAP expression stimulation, while USP7 downregulated YAP via deubiquitinating and stabilizing LATS1/2. YAP overexpression or USP7/LATS1 silencing reduced ferroptosis process, which regulated YAP through a feedback loop. However, TGF-β1 annulled the repression of ferroptosis by YAP overexpression or LATS1/USP7 knockdown. By elucidating the molecular interactions between TGF-β1, USP7, LATS1/2, and YAP, we identified a new regulatory axis of ferroptosis in sepsis-secondary ALI. Our study sheds light on the pathophysiology of ferroptosis and proposes a potential therapeutic approach for sepsis-induced ALI.
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  • 文章类型: Journal Article
    在消化系统疾病中,末梢细胞与组织平滑肌动力学的调节密切相关。它们广泛分布于胆道系统,并通过CCK的调节及其对平滑肌细胞的电生理作用等机制对胆道运动产生影响。探讨端粒细胞与良性胆道疾病的关系,如胆囊结石疾病和胆道扩张综合征,我们对受这些条件影响的组织进行了组织病理学分析。此外,我们进行了端粒细胞的免疫组织化学和免疫荧光双重染色实验。结果表明,与对照组相比,病理条件下胆囊和胆管中的端粒细胞数量明显减少。这揭示了端粒细胞数量减少与胆囊运动受损和胆道纤维化之间的密切关系。此外,进一步的研究表明,胆固醇胆结石中的端细胞与胆囊收缩素-A受体(CCK-AR)之间存在相关性,表明胆固醇水平升高可能会损害端细胞,导致CCK-AR的数量减少,并最终导致胆囊运动受损。因此,我们假设端粒细胞可能在维持胆道稳态中起关键作用,它们的缺乏可能与良性胆道疾病的发展有关,包括胆结石疾病和胆道扩张。
    Telocytes are closely associated with the regulation of tissue smooth muscle dynamics in digestive system disorders. They are widely distributed in the biliary system and exert their influence on biliary motility through mechanisms such as the regulation of CCK and their electrophysiological effects on smooth muscle cells. To investigate the relationship between telocytes and benign biliary diseases,such as gallbladder stone disease and biliary dilation syndrome, we conducted histopathological analysis on tissues affected by these conditions. Additionally, we performed immunohistochemistry and immunofluorescence double staining experiments for telocytes. The results indicate that the quantity of telocytes in the gallbladder and bile duct is significantly lower in pathological conditions compared to the control group. This reveals a close association between the decrease in telocyte quantity and impaired gallbladder motility and biliary fibrosis. Furthermore, further investigations have shown a correlation between telocytes in cholesterol gallstones and cholecystokinin-A receptor (CCK-AR), suggesting that elevated cholesterol levels may impair telocytes, leading to a reduction in the quantity of CCK-AR and ultimately resulting in impaired gallbladder motility.Therefore, we hypothesize that telocytes may play a crucial role in maintaining biliary homeostasis, and their deficiency may be associated with the development of benign biliary diseases, including gallstone disease and biliary dilation.
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  • 文章类型: Letter
    暂无摘要。
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  • 文章类型: Journal Article
    术后急性肾损伤(AKI)是深低温停循环(HCA)患者的常见并发症;其潜在的发病机制尚不清楚。在这项研究中,我们建立了大鼠体外循环模型,并证明了HCA期间的低体温,而不是拘禁,是AKI发生的原因。通过招募56名接受HCA手术的患者并分析血液样本,我们发现HCA后AKI与缓激肽增加相关.动物实验证实了这一点,并表明HCA期间的体温过低通过增加激肽释放酶表达来增加缓激肽水平。机械上,缓激肽通过B2R抑制Nrf2-xCT通路,引起肾脏氧化应激损伤。Icatibant的应用,B2R抑制剂,逆转Nrf2-xCT通路和氧化应激损伤的变化。最后,Icatibant在体内逆转了低温诱导的AKI。这一发现揭示了HCA后AKI的发病机制,并有助于为HCA后AKI患者提供治疗策略。
    Postoperative acute kidney injury (AKI) is a common complication in patients undergoing deep hypothermic circulatory arrest (HCA); however, its underlying pathogenesis is unclear. In this study, we established a rat cardiopulmonary bypass model and demonstrated that hypothermia during HCA, rather than circulatory arrest, was responsible for the occurrence of AKI. By recruiting 56 patients who underwent surgery with HCA and analyzing the blood samples, we found that post-HCA AKI was associated with an increase in bradykinin. Animal experiments confirmed this and showed that hypothermia during HCA increased bradykinin levels by increasing kallikrein expression. Mechanistically, bradykinin inhibited the Nrf2-xCT pathway through B2R and caused renal oxidative stress damage. Application of Icatibant, a B2R inhibitor, reversed changes in the Nrf2-xCT pathway and oxidative stress damage. Finally, Icatibant reversed hypothermia-induced AKI in vivo. This finding reveals the pathogenesis of AKI after HCA and helps to provide therapeutic strategy for patients with post-HCA AKI.
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  • 文章类型: Journal Article
    大多数功能磁共振研究主要检查了受影响的肾脏的改变,经常忽略对侧肾脏。我们的研究旨在探讨成像参数是否准确地描绘了单侧输尿管梗阻大鼠模型中肾皮质和髓质的变化。从而展示了体素内不相干运动(IVIM)在评估对侧肾脏变化中的实用性。
    六只大鼠进行MR扫描,随后处死用于基线组织学检查。在诱导左输尿管梗阻后,扫描48只大鼠,在第3、7、10、14、21、28、35和42天进行组织病理学检查。表观扩散系数(ADC),纯分子扩散(D),伪扩散(D*),和灌注分数(f)值使用IVIM测量。
    在阻塞的第10天,UUO10组与假手术组的皮质和髓质ADC值均有显著差异(p<0.01)。在其他时间点,UUO3组与假手术组之间的皮质D值显示出统计学上的显着差异(p<0.01),而在UUO组之间则没有统计学差异。此外,UUO21组与假手术组皮质和髓质f值差异有统计学意义(p<0.01)。尤其是,UUO21组和UUO组的皮质f值在阻塞时间较短(3、7、10、14天)时表现出显著差异(p<0.01)。
    在肾脏梗阻后的对侧肾脏中观察到明显的血液动力学改变。IVIM准确捕获通畅肾脏的变化。特别是,皮质f值显示出评估对侧肾脏修饰的最高潜力。
    UNASSIGNED: Most functional magnetic resonance research has primarily examined alterations in the affected kidney, often neglecting the contralateral kidney. Our study aims to investigate whether imaging parameters accurately depict changes in both the renal cortex and medulla in a unilateral ureteral obstruction rat model, thereby showcasing the utility of intravoxel incoherent motion (IVIM) in evaluating contralateral renal changes.
    UNASSIGNED: Six rats underwent MR scans and were subsequently sacrificed for baseline histological examination. Following the induction of left ureteral obstruction, 48 rats were scanned, and the histopathological examinations were conducted on days 3, 7, 10, 14, 21, 28, 35, and 42. The apparent diffusion coefficient (ADC), pure molecular diffusion (D), pseudodiffusion (D*), and perfusion fraction (f) values were measured using IVIM.
    UNASSIGNED: On the 10th day of obstruction, both cortical and medullary ADC values differed significantly between the UUO10 group and the sham group (p < 0.01). The cortical D values showed statistically significant differences between UUO3 group and sham group (p < 0.01) but not among UUO groups at other time point. Additionally, the cortical and medullary f values were statistically significant between the UUO21 group and the sham group (p < 0.01). Especially, the cortical f values exhibited significant differences between the UUO21 group and the UUO groups with shorter obstruction time (at time point of 3, 7, 10, 14 day) (p < 0.01).
    UNASSIGNED: Significant hemodynamic alterations were observed in the contralateral kidney following renal obstruction. IVIM accurately captures changes in the unobstructed kidney. Particularly, the cortical f value exhibits the highest potential for assessing contralateral renal modifications.
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  • 文章类型: Journal Article
    细胞外囊泡(EV)是多种多样的,膜结合囊泡从细胞释放到细胞外环境。它们源自内体或细胞膜,并且通常包括外泌体和微泡。这些电动汽车是细胞间通讯的关键媒介,携带各种内容物,如核酸,蛋白质,和脂质,调节靶细胞的生理和病理过程。此外,EV的分子货物可以反映有关原始细胞的关键信息,使它们成为疾病诊断和预后的潜在生物标志物。在过去的十年里,电动汽车作为心血管生理学和病理学中细胞类型之间的关键通信者的作用已得到越来越多的认可.来自不同细胞来源的电动汽车,或者在不同的细胞条件下来自相同的来源,会对管理层产生明显的影响,诊断,和心血管疾病的预后。此外,必须考虑心血管衍生的电动汽车对周围器官代谢的影响。这篇综述旨在总结心血管研究领域在电动汽车的作用和意义方面的最新进展。我们的目标是为心血管疾病的早期预防和治疗提供新的见解和方向,强调电动汽车的治疗潜力和诊断价值。
    Extracellular vesicles (EVs) are diverse, membrane-bound vesicles released from cells into the extracellular environment. They originate from either endosomes or the cell membrane and typically include exosomes and microvesicles. These EVs serve as crucial mediators of intercellular communication, carrying a variety of contents such as nucleic acids, proteins, and lipids, which regulate the physiological and pathological processes of target cells. Moreover, the molecular cargo of EVs can reflect critical information about the originating cells, making them potential biomarkers for the diagnosis and prognosis of diseases. Over the past decade, the role of EVs as key communicators between cell types in cardiovascular physiology and pathology has gained increasing recognition. EVs from different cellular sources, or from the same source under different cellular conditions, can have distinct impacts on the management, diagnosis, and prognosis of cardiovascular diseases. Furthermore, it is essential to consider the influence of cardiovascular-derived EVs on the metabolism of peripheral organs. This review aims to summarize recent advancements in the field of cardiovascular research with respect to the roles and implications of EVs. Our goal is to provide new insights and directions for the early prevention and treatment of cardiovascular diseases, with an emphasis on the therapeutic potential and diagnostic value of EVs.
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