International Circulation: Dr Engstrom， in recent years Cyclosporin A has emerged as a promising therapy to limit myocardial ischemic reperfusion injury. Does the management of Cyclosporin A in patients with AMI still remain a therapeutic option?
　　《国际循环》：Engstrom医生，近年来环孢素A已经成为了一种能够限制心肌缺血再灌注的损伤的很有前景的治疗方式。采用环孢素治疗AMI患者是否依旧是一种治疗选择呢？
　　Dr Engstrom: Well actually the fact is that during reperfusion the mitochondria in the cells are disrupted and one of the mechanisms to avoid this disruption is to administer drugs that block certain channels in the mitochondria. And one of those compounds that are able to do so is Cyclosporin A among others， for instance， the GLP-1 analogs. So I think that the whole field is a promising field， whether you end up with Cyclosporin A as the most promising candidate or other candidates remains to be settled still.
　　Engstrom医生：其实事实是这样的，在再灌注期间，细胞内的线粒体被破坏了，阻碍破环的其中一项机制就是通过给药来阻止线粒体某些特定渠道。环孢素A和其他药物，比如GLP-1类似物的作用之一就具有这种疗效。所以，我认为该领域很有前景，是否将环孢素A作为最有前景的备选药物还是选用其他备选药物仍尚未确定。
　　International Circulation: What is the current status of research and management of Cyclosporin A?
　　《国际循环》：环孢素当前的研究和管理状态如何？
　　Dr Engstrom: There has been one study showing in humans that Cyclosporin A may add some benefit to the outcome of the patients when treated for perfusing STEMI. It is a minor study， so we are still awaiting a more conclusive and a larger study with a clinical endpoint.
　　Engstrom医生：有一项研究显示，对于接受治疗的患者，环孢素A还能在其他方面改善治疗效果。这是一个小样本研究，我们仍在等待具有临床观察终点的更确凿的较大研究的研究结果。
　　International Circulation: Could you please talk about the clinical status of the application of Cyclosporin， pre-conditioning and post-conditioning in patients with AMI?
　　《国际循环》：能否请您谈一谈环孢素在AMI患者预适应和后适应的临床应用现状？
　　Dr Engstrom: Post-conditioning is what we call ischemic conditioning or mechanical post-conditioning. And what is done when you do post-conditioning is the fact that you re-open the artery in STEMI， then you occlude with a balloon， you reopen it， re-occlude for sometime in order to more gradually establish the final reperfusion， so that the reperfusion injury is not that large. This of course is a very simple technique， and it costs nothing because the balloon you use is the same balloon that you would use anyway. The results from mechanical post-conditioning are actually quite promising. So in my view， the years ahead will show: what is the precise mechanism behind the effect of mechanical post-conditioning. And by the time those mechanisms have been settled you are able to construct compounds that are more directly act on pivotal pathways.
　　Engstrom医生：后适应也就是我们所说的缺血后适应或机械后适应。当你应对后适应的做法其实就是对血管的再通，再使用气囊封闭，其后再通，然后再堵塞一段时间，目的是较缓和的逐步建立最终的再灌注，降低再灌注造成的损伤。这当然是一个非常简单的技术，并且几乎没什么花费，因为使用的气囊与手术时用到的那个是同一个气囊。实际上，机械后适应的疗效是非常可靠的。所以我认为，未来几年我们将会了解机械后适应背后的确切机制。当这些机制明确后，将能够构建直接作用于关键途径的化合物。
　　International Circulation: Could you please talk about the effects of pre-conditioning and post-conditioning on emerging PCI in patients with AMI?
　　《国际循环》：能否请您谈谈预适应和后适应对于采用PCI疗法的AMI患者的影响？
　　Dr Engstrom: The fact is that the whole issue is the reperfusion injury. So in order to have a drug or another therapeutic target that is beneficial， you have to establish reperfusion. That means you have to have an occluded artery that is reperfused afterwards in order to get all those things going. So that means that minor “infarcs” in which there is only plate rupture but no full occlusion may not really experience reperfusion at all. So in those cases， during emerging “infarcs”， I think there is no roll for these techniques.
　　Engstrom医生：事实上，整个问题就是再灌注损伤。因此，想要获得药物或其他疗法的有益疗效，你就需要实现再灌注的建立。这意味着，为了使灌注顺利进行，再灌注后不得不让动脉闭塞。而这意味着，小幅“梗死”--这种情况下，只有斑板破裂，而没有发生完全的闭塞--可能并没有真正经历再灌注。所以，在这类情况下，我认为这些技术对新发“梗死”没什么作用。
　　International Circulation: Ok Dr Engstrom thank you.
　　《国际循环》：好的，Engstrom医生，非常感谢您。