Role of cardiac magnetic resonance imaging in myocarditis patients with biopsy negative: a retrospective case series study / 中华心血管病杂志

Objective: To analyze the cardiac magnetic resonance (CMR) imaging feature of clinically diagnosed myocarditis patients with negative endocardial biopsy (EMB) results, and to further demonstrate the diagnostic value of CMR in these patients. Methods: This was a retrospective case series study. Fourteen patients, who were clinically diagnosed as myocarditis according to 2013 European Society of Cardiology (ESC) clinical diagnostic criteria for myocarditis, but with negative EMB results, were enrolled. All patients underwent CMR examinations. The morphological, functional and histological changes of the heart were assessed based on black blood sequence, cine sequence, T2W-STIR sequence and contrast agent late gadolinium enhancement,(LGE). Results: There were 10 males and 4 females in this cohort, the age was (25.6±13.2) years. The interval between symptom onset and CMR was 21 (13, 60) days, and the interval between symptom onset and EMB was 19 (9, 40) days. There were 13 patients with abnormal CMR results including myocardial oedema, fibrosis, decreased ejection fraction, pericardial effusion or increased cardiac chamber dimension. Nine out of 14 patients had CMR morphological and/or functional abnormalities, including 1 case of left atrium enlargement, 1 case of left ventricle enlargement, 3 cases of right ventricle enlargement, 4 cases of increased left ventricular end diastolic volume index. Left ventricular ejection fraction was<50% in three cases, right ventricular ejection fraction was<40% in 5 cases, and pericardial effusion depth>3 mm was detected in 3 cases. Of the 14 patients, 11 had histological changes, of which 6 had T2 ratio≥2. Among the 10 patients (10/14) with positive LGE, the most common patterns were subepicardial LGE of the lateral wall and/or midwall LGE of the septum (n=9); 2 cases showed extensively subendocardial LGE of the left ventricular wall. No LGE involved in the right ventricular wall in the whole cohort. Conclusion: CMR plays a complementary role in the diagnosis of myocarditis in clinically diagnosed myocarditis patients with negative EMB findings.

Astragaloside Ⅳ regulates Nrf2/Bach1/HO-1 signaling pathway and inhibits H9c2 cardiomyocyte injury induced by hypoxia-reoxygenation / 中国中药杂志

Astragaloside Ⅳ(AS-Ⅳ) has protective effects against ischemia-reperfusion injury(IRI), but its mechanism of action has not yet been determined. This study aims to investigate the protective effects and mechanism of AS-Ⅳ on H9c2 cardiomyocyte injury induced by hypoxia-reoxygenation(H/R). The H/R model of myocardial cells was established by hypoxic culture for 12 hours and then reoxygenation culture for 8 hours. After AS-Ⅳ treatment, cell viability, the reactive oxygen species(ROS) levels, as well as the content or activity of superoxide dismutase(SOD), malondialdehyde(MDA), interleukin 6(IL-6), and tumor necrosis factor alpha(TNF-α), were measured to evaluate the effect of AS-Ⅳ treatment. The effect of AS-Ⅳ on HO-1 protein expression and nuclear Nrf2 and Bach1 protein expression was determined by Western blot. Finally, siRNA was used to knock down HO-1 gene expression to observe its reversal effect on AS-Ⅳ intervention. The results showed that as compared with the H/R model group, the cell viability was significantly increased(P<0.01), ROS level in the cells, MDA, hs-CRP and TNF-α in cell supernatant and nuclear protein Bach1 expression in the cells were significantly decreased(P<0.01), while SOD content, HO-1 protein expression in cells and expression of nuclear protein Nrf2 were significantly increased(P<0.01) in H/R+AS-Ⅳ group. However, pre-transfection of HO-1 siRNA into H9c2 cells by liposome could partly reverse the above effects of AS-Ⅳ after knocking down the expression of HO-1. This study suggests that AS-Ⅳ has significant protective effect on H/R injury of H9c2 cardiomyocytes, and Nrf2/Bach1/HO-1 signaling pathway may be a key signaling pathway for the effect.

Study of arousal index in children with sleep-disordered breathing / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To explore which index is more suitable to show the degree of sleep fragment in children with sleep-disordered breathing (SDB).</p><p><b>METHODS</b>Between October 2009 and August 2011, Forty-five children (4 - 8 years) who were diagnosed as obstructive sleep apnea hypopnea syndrome (OSAHS) were enrolled in OSAHS group[obstructive apnea index (OAI) > 1 times/h or apnea hypopnea index (AHI) > 5 times/h, lowest oxygen saturation (LSaO2) < 0.92] and 54 children were enrolled in SDB group (1 ≤ AHI ≤ 5 times/h and OAI ≤ 1 times/h), 18 children with chorditis nodules made up control group (AHI < 1 times/h and LSaO2 ≥ 0.92, without SDB-related history). The difference of respiratory arousal index (RAI), spontaneous arousal index (SAI), total arousal index (ARtotI) and sleep pressure score (SPS) were compared among three groups. The correlation between RAI, SAI, ARtotI, SPS and AHI were also analyzed. Furthermore, RAI, SAI, ARtotI and SPS were compared before and after operation in 14 OSAHS children with detailed pre- and after polysomnography data.</p><p><b>RESULTS</b>The difference of SAI and ARtotI between SDB group and OSAHS group and ARtotI between OSAHS group and control group were not significant (P > 0.017), except this, the difference of other index between any two groups or SAI and ARtotI between otherwise two groups were significant (P < 0.017). RAI and SPS was correlated with AHI (coefficient correlation: 0.751, 0.829, P was 0.000). RAI and SPS decreased after operation and the difference was significant (Z were -3.045 and -2.982, P were 0.002 and 0.003). The difference of sleep structure was not significant.</p><p><b>CONCLUSIONS</b>RAI and SPS were more suitable to show the degree of sleep fragment than other arousal index.</p>

Relationship between Chinese medicine syndrome and peripheral blood stem cells in patients with ischemic heart failure / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the relationship of Chinese medicine syndromes with heart function and peripheral blood stem cells (PBSCs) count in patients with ischemic heart failure (IHF).</p><p><b>METHODS</b>Clinical materials of 208 inpatients with IHF were collected and the characteristics of their Chinese medicine syndromes were summarized, the number of PBSC was counted with flow cytometer, and the differences of left ventricular ejection fraction (LVEF), N-terminal brain natriuretic peptide (NT-proBNP) and PBSC count related to various syndrome factors and syndrome types were compared using One-way ANOVA.</p><p><b>RESULTS</b>LVEF >50% was found in patients with syndromes of qi-deficiency, yin-deficiency, turbid-phlegm and blood-stasis, while <50% in those of yang-deficiency and fluid-retention, showing significant differences between the former four syndromes and the latter two syndromes. Compared them with syndromes of qi-deficiency, yin-deficiency, turbid-phlegm and blood-stasis, NT-proBNP in the yang deficiency group and water retention group was higher (P<0.01); the PBSC count in patients with yang-deficiency syndrome factor was the least, which was significantly different to that in patients with the former four syndromes (P<0.01, P<0.05), but it was insignificantly different to that with water-retention; LVEF >50% in syndrome types of Xin-Fei qi-deficiency, deficiency of qi and yin, qi-deficiency with blood-stasis and phlegm accumulation in Fei, but <50% in syndrome types of Xin-Shen yang-deficiency and yang-deficiency with water-retention. Compared them with syndrome types of Xin-Fei qi-deficiency, deficiency of qi and yin, qi-deficiency with blood-stasis and phlegm accumulation in Fei, the difference was statistically significant (P<0.05, P<0.01); The highest level of NT-proBNP was shown in syndrome type of yang-deficiency with water-retention, the secondary was in Xin-Shen yang-deficiency, and all showed significant differences as compared with that in other syndrome types (P<0.05); while difference of PBSC count in patients with various syndrome types showed insignificance (P>0.05).</p><p><b>CONCLUSION</b>Chinese medicine syndrome is correlated with heart function and PBSC count in patients with IHF, and the PBSC count in patients with characteristics of yang-deficiency syndrome is lower.</p>

Association between the number of peripheral blood stem cells and cardiac function index in patients with ischemic heart failure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To observe the association between the number of peripheral blood stem cells (PBSC) and cardiac function index (NYHA grade, left ventricular ejection fraction, LVEF, N-terminal-proB-type Natriuretic Peptide, NT-pro BNP) in patients with ischemic heart failure (IHF).</p><p><b>METHODS</b>A total of 199 patients hospitalized in our department between August 2007 and April 2008 due to IHF were included in this study. NYHA grade, LVEF (measured by echocardiography), plasma NT-proBNP and number of PBSC were analyzed.</p><p><b>RESULTS</b>PBSC number was significantly decreased in proportion with increasing NYHA grade and PBSC number was significantly lower in patients with NYHA IV than that with class II and III (all P<0.01). LVEF was positively correlated with PBSC number (r = 0.35, P = 0.001), NT-proBNP was negatively correlated with PBSC number (r = - 0.39, P = 0.009). Multiple regression analysis showed that LVEF and NT-proBNP were major determinants of PBSC (Beta = 0.14, - 0.25, 95% CI = -0.01 - 0.02, -0.18 - -0.04, P<0.05, P<0.01).</p><p><b>CONCLUSION</b>PBSC number was significantly correlated to cardiac function in IHF patients.</p>

Study on the serum level of granulocyte-macrophage colony stimulating factor in some hematopathy patients / 中国实验血液学杂志

In order to explore the serum level of granulocyte-macrophage colony stimulating factor (GM-CSF) in hematopathy patients, radioimmunoassay was used to detect GM-CSF level in serum from 163 cases of hematopathy, including 36 chronic aplastic anemia, 42 chronic granulocytic leukemia, 54 acute myeloid leukemia, 31 acute lymphocytic leukemia, and 40 healthy adults as control. The results showed that the serum GM-CSF level increased in chronic aplastic anemia patients, and significantly decreased in acute and chronic leukemia patients. In conclusion, these findings indicated that secreting level of GM-CSF is abnormal in patients with acute/chronic leukemias and chronic aplastic anemia.