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Objective:To explore if protective effects of dapagliflozin (Dapa) administration on attenuating DOX-induced myocardial injury in rats.Methods:A total of 30 specific pathogens free grade 8 week old male Sprague Dawley rats. Rats were randomly divided into three groups. Control group (Con group, n = 5), rats received intraperitoneal saline (1.25 ml/kg) injection once per week plus saline (8 mg/kg) daily via gavage for 6 weeks. Dox group ( n = 15) rats received intraperitoneal Dox (2.5 mg/kg) injection once per week plus saline (8 mg/kg) daily via gavage for 6 weeks. Dox + Dapa group ( n = 10), rats received intraperitoneal Dox (2.5 mg/kg) injection once per week plus Dapagliflozin (4 mg/kg) daily via gavage for 6 weeks, observed to week 10. Survival status, echocardiography, pathology, and expression of Bcl-2, Bax gene and protein were observed. Results:The survival rate of ats in Con, Dox, and Dapa+Dox groups was 100.0%, 66.7% and 90.0% respectively. The echocardiography were performed in Con, Dox, and Dapa+Dox groups left ventricular ejection fraction was (95.40 ± 2.51)%, (83.09 ± 4.92)% and (91.71 ± 3.45)%, respectively; left ventricular fraction shortening was (66.80 ± 7.43)%, (47.27 ± 5.10)% and (59.43 ± 6.92)%, respectively; Both indexes in Dapa+Dox group was higher than that in Dox group, but lower than that in Con group, all P<0.05; Left ventricular end-diastolic diameter was (4.80 ± 0.83) mm, (5.90 ± 0.83) mm and (4.85 ± 0.69) mm respectively; left ventricular end-systolic diameterwas (1.80 ± 0.44) mm, (2.90 ± 0.53) mm and (2.00 ± 0.57) mm in Con, Dox, and Dapa + Dox groups, respectively; Both indexes in Dapa + Dox group was decreased than that in Dox group, but Dapa + Dox group was increased than that in Con group, all P<0.05. Pathologic changes have been shown that myocardial fibers arranged neatly in the Con group under HE staining, while those broken myocardial fibers disordered arranged in the Dox group, and those changes in the Dapa + Dox group were slightly relieved than that in Dox group. The collagen volume fraction of rats in Con, Dox and Dapa+Dox groups were (2.64 ± 1.04)%, (16.85 ± 1.70)% and (6.75 ± 1.89)% under sirius red staining, Dapa+Dox group was lower than that in Dox group but higher than that in Con group, all P<0.05. Pathologic changes under transmission electron microscope have been shown that a few of normal structure mitochondria in the Con group. A large number of swollen mitochondria with disappeared mitochondrial crest in the Dox group; but neatly arranged with mitochondrial crest blurred in the Dapa+Dox group. The quantitative real-time PCR was used to detected Bcl-2 and Bax, there were 0.93 ± 0.09, 0.35 ± 0.30 and 0.89 ± 0.25 in Bcl-2, 0.99 ± 0.10, 3.10 ± 0.10 and 0.86 ± 0.04) in Bax, while Bcl-2/Bax 0.94 ± 0.17, 0.11 ± 0.06 and 1.03 ± 0.27, respectively. The westernblot was used to detected Bcl-2 and Bax, there were 1.00 ± 0.18, 0.32 ± 0.20 and 1.30 ± 0.41 in Bcl-2, 0.66 ± 0.11, 2.44 ± 0.66 and 0.90 ± 0.61 in Bax, while Bcl-2/Bax: 1.50 ± 0.18, 0.12 ± 0.05 and 1.80 ± 0.82, respectively; the above results shown that both myocardial Bax mRNA and protein expression in Dox group were higher than that in Dapa + Dox group and Con group, both P<0.05, and there was no difference in the two later groups, P>0.05; both the myocardial Bcl-2 mRNA and protein expression in Dox group were lower than that in Dapa+Dox group and Con group, both P<0.05, and there was no difference between two later groups, P>0.05; Bcl-2/Bax in Dox group was significantly lower thanthat in Dapa+Dox groupand Con group, both P<0.05, and there was no difference between Dapa+Dox group and Con group, P>0.05. Conclusions:Simultaneous dapagliflozin treatment significantly attenuated DOX-induced cardiotoxicity, which might be related to prevent myocardial apoptosis.
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Objective:To compare the efficacy of left parapharyngeal pressure (PLP) combined with cricoid pressure in preventing gastric insufflation during positive pressure ventilation by facemask.Methods:Two hundred and forty patients of both sexes, aged 18-75 yr, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing surgery under general anesthesia requiring endotracheal intubation, were selected and randomly divided into 4 groups ( n=60 each) using a random number table method: cricoid pressure group (group CP), left PLP group (group LP), cricoid pressure combined with left PLP7 group (group CP+ LP), and control group (group C). The gastric antrum cross-sectional area (CSA) was measured by ultrasound in all the patients before induction of anesthesia, and facemask ventilation in pressure-controlled mode with suction pressure of 25 cmH 2O was applied, the patients in 4 groups were treated with different manipulations, and 3 min later the CSA of gastric antrum was measured again.The gastric antrum CSA before and after ventilation and the difference were recorded.The occurrence of gastric insufflation was examined by ultrasound after ventilation. Results:Compared with the baseline before ventilation, the CSA of gastric antrum was increased after ventilation in C, CP and LP groups ( P<0.01), and no significant change was found in the CSA after ventilation in CP+ LP group ( P>0.05). The difference of gastric antrum CSA was decreased in turn in C, CP, LP and CP+ LP groups ( P<0.05 or 0.01). The incidence of gastric insufflation were 53%, 30%, 12% and 0 in C, CP, LP and CP+ LP groups, respectively.Compared with group C, the incidence of gastric insufflation was significantly decreased in LP and CP+ LP groups ( P<0.05), and no significant change was found in group CP ( P>0.05). Compared with group CP, the incidence of gastric insufflation was significantly decreased in group CP+ LP ( P<0.05), and no significant change was found in group LP ( P>0.05). Conclusion:The combination of left PLP and cricoid pressure can effectively prevent gastric insufflation during positive pressure ventilation by facemask.
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Objective:A comparative study of non-invasive hemodynamics and echocardiography in 139 cases of heart failure patients with preserved ejection fraction (HFpEF) at baseline and one year follow-up to explore its value on diagnosis, monitoring and prognosis in patients with HFpEF.Methods:The baseline and one year follow-up data of 139 patients with HFpEF in Affiliated Zhongshan Hospital of Dalian University patients who had been enrolled in the China PEACE 5P-HF from June 2016 to May 2018 were analyzed retrospectively. The general data were collected which contented age of the study subjects is (30 - 80) y, average age (64.0 ± 12.3) y, and 63.31% male, (88/139) and 36.69% female (51/139), 56.8% smokers (79/139). t-test way was used to analyze the baseline and one year follw-up data, The indexs included blood pressure (BP), estimated glomerular filtration rate (eGFR) and 6-munites walk test (6MWT). Non-invasive hemodynamic indicators included stroke volume (SV), ejection fractions (EF), cardiac index (CI), index of contratility (IC), pulmonary artery wedge pressure (PCWP), maximum angiectatic velocity(AMPC), left ventricular ejection time (LVET), left ventricular isovolumetric relaxation time (LVLVIVRT), pre-ejection period/left ventricular ejection fractions (PEP/LVET), left ventricular end diastolic pressure (LVEDP) and left cardiac work index (LCWI). Hemodynamic indicators included left ventricular end diastolic dimension(LVEDd), left ventricular end systolic dimension (LVEDs), interventricular septal thickness at diastole (IVSD), left ventricular ejection fractions (LVEF) and E/e′.Results:There was no significant difference between the baseline and one year follow-up data in SBP, DBP, NT-proBNP, eGFR, 6MWT ( P>0.05). There were significant increase in SV, EF, CI, IC in one year′ follow-up compared with that in baselinee [(73.39 ± 29.47) ml vs. (63.39 ± 30.08) ml, (64.87 ± 9.16)% vs. (61.81 ± 9.02)%, (3.06 ± 1.10) ml/(min·m 2) vs. (2.62 ± 1.06) ml/(min·m 2), (0.039 ± 0.037) L/s vs. (0.028 ± 0.015) L/s] ( P<0.05). PCWP in one year′ follow-up was significantly decreased compared with that in baselin [(9.21 ± 3.34) mmHg (1 mmHg = 0.133 kPa) vs. (9.87 ± 3.13) mmHg]( P<0.05), However, AMPC, LVE, LVLVIVRT, PEP/LVET, LVEDP, LCWI in baseline and one year′ follow-up showed no significant difference ( P>0.05). The Hemodynamic indicators in baseline and one year′s follow-up were as followed: LVEF in one year′ follow-up was significantly elevated compared with that in the baseline [(63.53 ± 8.39)% vs. (61.02 ± 7.16)%]; E/e′ in one year′s follow-up was significantly decresed compared with that in the baseline [12.89 ± 5.86 vs. 14.32 ± 6.61]( P<0.05); there were no significant differences in LVEDd, LVEDs and IVSD in baseline compared with those in one year′s followed-up ( P>0.05). Conclusions:Hemodynamic indicators including SV, EF, CI, IC and PCWP could be new reflections of early diagnosis, monitoring and prognosis on HFpEF. The combination of non-invasive hemodynamics and echocardiography on HFpEF can be more significant in reflecting the changes of myocardial remodeling and cardiac function.
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Objective:To analyze the correlation and diagnostic value of serum homocysteine (Hcy), methionine (Met) and cysteine (Cys) in patients with chronic heart failure (CHF).Methods:One hundred and seventy-eight patients with acute decompensation CHF (CHF group) and 70 healthy persons (healthy control group) from October 2018 to September 2019 in Affiliated Zhongshan Hospital of Dalian University were continuously enrolled. In CHF group, heart failure with reduced ejection fraction (HFrEF) was in 53 cases, heart failure with mid-range ejection fraction (HFmrEF) was in 50 cases, and heart failure with preserved ejection fraction (HFpEF) was in 75 cases. Serum levels of Hcy, Met and Cys were detected by tandem mass spectrometry. Serum level of N-terminal brain natriuretic peptide precursor (NT-proBNP) was detected by electrochemical luminescence immunity. The left ventricular end-diastolic diameter (LVEDd), left ventricular end-systolic diameter (LVESd) and early diastolic peak blood flow velocity of mitral valve annulus/early diastolic peak velocity of mitral annulus (E/e′) were detected by echocardiography, then left ventricular eject fraction (LVEF) was calculated. Correlation was analyzed by Pearson correlation analysis. The receiver operator characteristic (ROC) curve was drawn, and the area under curve (AUC) was used to evaluate the efficacy of serum Hcy, Met, Cys, NT-proBNP and LVEF in the diagnosis of CHF.Results:The Hcy, Met, Cys, NT-proBNP, LVEDd and E/e′ in CHF group were significantly higher than those in healthy control group: (12.64 ± 5.02) μmol/L vs. (8.71 ± 3.47) μmol/L, (23.38 ± 5.75) μmol/L vs. (20.52 ± 4.18) μmol/L, (343.45 ± 44.49) μmol/L vs. (290.53 ± 48.38) μmol/L, (5 759.43 ± 3 806.22) pg/L vs. (40.24 ± 31.91) pg/L, (52.67 ± 12.27) mm vs. (46.41 ± 12.27) mm and (17.32 ± 5.61)% vs. (9.54 ± 2.64)%, the LVEF was significantly lower than that in healthy control group: (45.27 ± 4.93)% vs. (62.37 ± 5.41)%, and there were statistical differences ( P<0.01 or <0.05). The Hcy and Cys in patients with HFmrEF and HFrEF were significantly higher than those in patients with HFpEF: (16.29 ± 8.18) and (18.68 ± 8.99) μmol/L vs. (13.75 ± 6.48) μmol/L, (346.64 ± 51.85) and (361.40 ± 52.34) μmol/L vs. (329.35 ± 55.16) μmol/L, and there were statistical differences ( P<0.05); there were no statistical differences between patients with HFmrEF and patients with HFrEF ( P>0.05). The serum Met in patients with HFrEF was significantly higher than that in patients with HFpEF and HFmrEF: (28.74 ± 8.22) μmol/L vs. (24.76 ± 7.60) and (25.15 ± 6.96) μmol/L, and there was statistical difference ( P<0.05); there was no statistical difference between patients with HFpEF and patients with HFmrEF ( P>0.05). Pearson correlation analysis result showed that serum Hcy, Met and Cys were positively correlated with NT-proBNP ( r = 0.632, 0.206 and 0.455; P<0.01), positively correlated with E/e′( r = 0.463, 0.198 and 0.346; P<0.01), and negatively correlated with LVEF ( r = -0.491, -0.152 and -0.330; P<0.05 or <0.01). ROC curve analysis result showed that ROC the cut-off value for the diagnosis of CHF with serum NT-proBNP based on the maximum Youden index (0.994) was 120 pg/L, and AUC was 0.994 (95% CI was 0.997 to 1.000); the cut-off value for the diagnosis of CHF with serum Hcy based on the maximum Youden index (0.646) was 10.56 μmol/L, and AUC was 0.899 (95% CI 0.859 to 0.939); the cut-off value for the diagnosis of CHF with serum Met based on the maximum Youden index (0.218) was 25.58 μmol/L, and AUC was 0.637 (95% CI 0.563 to 0.711); the cut-off value for the diagnosis of CHF with serum Cys based on the maximum Youden index (0.391) was 298.05 μmol/L, and AUC was 0.765 (95% CI 0.700 to 0.830); the AUC of LVEF less than 0.5. Conclusions:Serum Hcy, Met and Cys levels in patient with CHF are significantly increased, which are positively correlated with NT-proBNP and E/e′, negatively correlated with LVEF. Moreover, serum Hcy has certain application value in the diagnosis of CHF.
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The nutritional status, serum protein, albumin, calcium, zinc, iron, SF, FEP, vitamin A, activity of RBC transketolase, and blood glutathione redu-ctase of 349 normal primigravidas, 30 healthy non-pregnant women and 42 toxemic gravidas were estimated longitudinally from the 1st trimester to delivery. It was noted that serum protein, albumin, Ca, Zn, and Fe decreased markedly in the course of pregnancy. The content of serum vitamin A showed no variation or decrease in the 3rd trimester in 1/3 of the pregnant women observed. Insufficiency of thiamine and riboflavin were noted in 16.7% and 47% of the normal pregnant women respectively. The adequate nutrients intakes in pregnancy were considered to be: Energy, +200 kcal/d; Protein, + 15g/d in the 2nd trimester and +25g/d in the 3rd trimester; Calcium 1000 mg/d in the 2nd trimester and 1500mg/d in the 3rd trimester; Zinc, 20mg/d; Iron 26 or 30 mg/d by supplementation if possible; vitaminA 1000 ?gRE/d; both thiamine and riboflavin 1.8 mg/d.
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The biochemical study of the nutritional status of 101 healthy pregnant women and cord blood samples showed that maternal serum protein, albumin, hemoglobin (Hb), iron (Fe), zinc (Zn) and calcium (Ca) were decreased, and serum transferrin and copper (Cu) were increased in the course of gestation.Correlation coefficients and stepwise regression analysis suggested that the concentrations of serum protein, Fe, Zn, Ca,Hb were positively correlated with the intake of calories, proteins, animal foods (especially fish and meats), Ca and vitamin C.The concentration of cord blood Ca,Zn and Fe were found highly related to the maternal serum levels in the late stage of pregnancy (P
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A nutritional survey of 101 uncomplicated primigravidas and the relationship between maternal diet and infant birth weight were investigated. The maternal intake of protein, calcium, riboflavin and retinol during the pregnancy was lower than the amount that RDA suggested especially in the 2nd and 3rd trimesters. The intake of calories, fat, thiamine, riboflavin and nicotinic acid in the 2nd and 3rd trimesters were increased in compa-rision with the 1st. The correlation and stepwise regression analysis indicated that maternal intake of calories, protein, fat, carbohydrate, iron, calcium and riboflavin during pregnancy was significantly correlated to the birth weight.