Influencing factors of cardiac insufficiency caused by neonatal arrhythmia / 中国小儿急救医学

Objective:To explore the clinical characteristics of neonate with arrhythmia and the potential risk factors for cardiac insufficiency.Methods:Research data were collected from the cases of neonate with arrhythmia from January 2017 to June 2021 at the Neonatology Department at Children′s Hospital Capital Institute of Pediatrics.A retrospective analysis was conducted to summarize the clinical features and analyze the risk factors of arrhythmia leading to cardiac insufficiency.Results:A total of 90 cases were enrolled, with a male to female ratio of 1.43∶1(53∶37), and the median gestational age was 39(37, 40)weeks; with 16(17.8%) premature infants, 74 full-term infants(82.2%), and the median onset age was 3(0, 11)days.In this group, 63.3% cases(57/90)were irregular rhythmic arrhythmias, of which 66.7%(38/57)were atrial premature contractions, 23.3%(21/90) were tachyarrhythmias, and 13.3%(12/90)were bradyarrhythmias.Additionally, 80.0%(72/90)of the cases had no typical clinical manifestations.Besides, 37.7%(34/90)of the patients had single infection factor, and 4.4%(4/90)of the patients had infection with perinatal hypoxia asphyxia.The ratio of the premature birth, maternal autoimmune diseases and the tachyarrhythmia were higher in heart failure group than those in normal heart function group(71.4% vs.13.3%, P<0.001; 28.6% vs.3.6%, P=0.006; 100% vs.16.9%, P<0.001). The random forest model showed that the factors of premature delivery and maternal autoimmune disease had the greatest influence on cardiac function, and the analysis of 21 tachyarrhythmias showed that the duration of arrhythmia had the greatest influence on cardiac function. Conclusion:Atrial premature contraction is the most common in neonate with arrhythmia, and with non-typical clinical manifestations.The infection and the infection combined with perinatal asphyxia are the main influencing factors of neonate with arrhythmia.Premature delivery, maternal autoimmune disease and the duration of tachyarrhythmias are the main risk factors of neonatal arrhythmias leading to cardiac dysfunction.

Influencing factors of cardiac insufficiency caused by neonatal arrhythmia / 中国小儿急救医学

Objective:To explore the clinical characteristics of neonate with arrhythmia and the potential risk factors for cardiac insufficiency.Methods:Research data were collected from the cases of neonate with arrhythmia from January 2017 to June 2021 at the Neonatology Department at Children′s Hospital Capital Institute of Pediatrics.A retrospective analysis was conducted to summarize the clinical features and analyze the risk factors of arrhythmia leading to cardiac insufficiency.Results:A total of 90 cases were enrolled, with a male to female ratio of 1.43∶1(53∶37), and the median gestational age was 39(37, 40)weeks; with 16(17.8%) premature infants, 74 full-term infants(82.2%), and the median onset age was 3(0, 11)days.In this group, 63.3% cases(57/90)were irregular rhythmic arrhythmias, of which 66.7%(38/57)were atrial premature contractions, 23.3%(21/90) were tachyarrhythmias, and 13.3%(12/90)were bradyarrhythmias.Additionally, 80.0%(72/90)of the cases had no typical clinical manifestations.Besides, 37.7%(34/90)of the patients had single infection factor, and 4.4%(4/90)of the patients had infection with perinatal hypoxia asphyxia.The ratio of the premature birth, maternal autoimmune diseases and the tachyarrhythmia were higher in heart failure group than those in normal heart function group(71.4% vs.13.3%, P<0.001; 28.6% vs.3.6%, P=0.006; 100% vs.16.9%, P<0.001). The random forest model showed that the factors of premature delivery and maternal autoimmune disease had the greatest influence on cardiac function, and the analysis of 21 tachyarrhythmias showed that the duration of arrhythmia had the greatest influence on cardiac function. Conclusion:Atrial premature contraction is the most common in neonate with arrhythmia, and with non-typical clinical manifestations.The infection and the infection combined with perinatal asphyxia are the main influencing factors of neonate with arrhythmia.Premature delivery, maternal autoimmune disease and the duration of tachyarrhythmias are the main risk factors of neonatal arrhythmias leading to cardiac dysfunction.

Cuidados de enfermagem à pessoa com insuficiência cardíaca: scoping review / Nursing care for people with heart failure: scoping review / Atención de enfermería para personas con insuficiencia cardíaca: revisión de alcance

Objetivo: identificar os cuidados de enfermagem à pessoa com insuficiência cardíaca e mapeá-los nas necessidades humanas básicas. Métodos: Scoping review, com base nas recomendações do Instituto Joanna Briggs, nas bases Cummulative Index to Nursing and Allied Health Literature (CINAHL), Banco de Dados em Enfermagem (BDENF), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Medical Literature Analysis and Retrieval System Online (MEDLINE via EBSCO). Os achados foram analisados de forma descritiva e mapeados a partir das necessidades humanas. Resultados: Foram selecionados 28 artigos, publicados entre janeiro de 2000 a junho de 2020 e identificados 110 cuidados de enfermagem mapeados em 17 níveis das necessidades, prevalecendo as psicobiológicas (64%) nos níveis Oxigenação e Atividade física; psicossociais (19%) nos níveis Liberdade e participação e Educação para a saúde e aprendizagem; e psicoespirituais (17%) no nível Espiritualidade e Religiosidade. Conclusão: Foi possível identificar os cuidados de enfermagem para a pessoa com insuficiência cardíaca, enquanto subsídio na construção de instrumentos assistenciais. (AU)

Objective: to identify nursing care for people with heart failure and map them to basic human needs. Methods: Scoping review, based on the recommendations of the Joanna Briggs Institute, based on Cummulative Index to Nursing and Allied Health Literature (CINAHL), Banco de Dados em Enfermagem (BDENF), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Medical Literature Analysis and Retrieval System Online (MEDLINE via EBSCO). The findings were analyzed descriptively and mapped from human needs. Results: 28 articles were selected, published between January 2000 and June 2020 and 110 nursing care were identified, mapped on 17 levels of needs, with psychobiological (64%) prevailing on the levels of Oxygenation and Physical Activity; psychosocial (19%) at the levels Freedom and participation and Education for health and learning; and psycho-spiritual (17%) at the Spirituality and Religiosity level. Conclusion: It was possible to identify nursing care for people with heart failure, as a subsidy in the construction of care instruments. (AU)

Objetivo: identificar los cuidados de enfermería para las personas con insuficiencia cardíaca y mapearlos a las necesidades humanas básicas. Métodos: Revisión de alcance, basada en las recomendaciones del Instituto Joanna Briggs, basadas en Cummulative Index to Nursing and Allied Health Literature (CINAHL), Banco de Dados em Enfermagem (BDENF), Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) e Medical Literature Analysis and Retrieval System Online (MEDLINE via EBSCO). Los hallazgos se analizaron descriptivamente y se mapearon a partir de las necesidades humanas. Resultados: se seleccionaron 28 artículos, publicados entre enero de 2000 y junio de 2020 y se identificaron 110 cuidados de enfermería, mapeados en 17 niveles de necesidades, predominando los psicobiológicos (64%) en los niveles de Oxigenación y Actividad Física; psicosocial (19%) en los niveles Libertad y participación y Educación para la salud y el aprendizaje; y psicoespiritual (17%) a nivel de espiritualidad y religiosidad. Conclusión: fue posible identificar la atención de enfermería a las personas con insuficiencia cardíaca, como un subsidio en la construcción de instrumentos de atención. (AU)

Dihydromyricetin improves cardiac insufficiency by inhibiting HMGB1 in diabetic rats / 南方医科大学学报

OBJECTIVE@#To investigate the effect of dihydromyricetin (DHM) on cardiac insufficiency in diabetic rats and explore the underlying mechanism.@*METHOD@#Twenty-four male SD rats were randomized equally into normal control group, type 2 diabetes (T2DM) group fed on a high-glucose and high-fat diet for 6 weeks with low-dose streptozotocin (STZ) injection, metformin (MET) group with daily intragastric administration of MET (150 mg/kg) for 8 weeks after T2DM modeling, and dihydromyricetin (DHM) group with daily intragastric administration of DHM (250 mg/kg) for 8 weeks after modeling. The levels of fasting blood glucose, low density lipoprotein (LDL-C), triglyceride (TG), total cholesterol (TC), high density lipoprotein (HDL-C) and glycosylated hemoglobin (HbA1c) of the rats were measured, and plasma levels of insulin and high mobility group protein-1 (HMGB1) were detected with ELISA. The cardiac function of the rats was assessed using color echocardiography, ECG was measured using a biological signal acquisition system, and myocardial pathology was observed with HE staining. The protein expressions of HMGB1, nuclear factor-κB (NF-κB) p65 and phospho-NF-κB p65 (p-NF-κB p65) in the myocardial tissue were detected using Western blotting.@*RESULTS@#Compared with the control group, the rats in T2DM group showed significant anomalies in cardiac function after modeling with significantly increased plasma HMGB1 level and expressions of HMGB1, NF-κB p65 and p-NF-κB p65 proteins in the myocardial tissue (P < 0.05 or 0.01). Treatment with DHM significantly improved the indexes of cardiac function of the diabetic rats (P < 0.05 or 0.01), decreased plasma HMGB1 level and down-regulated the protein expressions of HMGB1 and p-NF-κB p65 in the myocardial tissue (P < 0.05 or 0.01).@*CONCLUSION@#DHM treatment can improve cardiac function in diabetic rats possibly by down-regulation of HMGB1 and phospho-NF-κB p65 expressions in the myocardium.

Carga horária de enfermagem aplicada ao paciente com infarto agudo do miocárdio / Nursing hour load applied to the patient with acute myocardial infarction / Carga horaria de enfermería aplicada al paciente con infarto agudo de miocardio

Objetivo: identificar a Carga Horaria de enfermagem aplicada ao Infarto agudo do Miocárdio, de acordo com a classificação de Killip. Método: pesquisa de campo com abordagem quantitativa, descritiva, exploratória, retrospectiva. Foram utilizados prontuários de pacientes que obtiveram como diagnostico inicial o Infarto Agudo do Miocárdio, e que apresentaram alterações nos marcadores bioquímicos Resultados: foram avaliados 200 prontuários. A partir dos dados obtidos conseguimos traçar uma progressão de carga horaria entre as categorias Killip, sobre as necessidades de assistência prestada. Conclusão: a carga horaria de enfermagem varia de acordo com a complexidade que o Infarto do Miocárdio pode manifestar. O paciente necessita de maior número de pessoal de enfermagem devido alta carga horaria para atender todas as intervenções necessárias

Objective: to identify the nursing time load applied to acute myocardial infarction, according to the Killip classification. field research with quantitative, descriptive, exploratory, retrospective approach. The medical records of patients Methods: who obtained an initial diagnosis of acute myocardial infarction and who presented alterations in the biochemical markers were used. Results: 200 medical records were evaluated. From the data obtained we were able to trace a progression of time load between the Killip categories, on the assistance needs provided. Conclusion: the nursing time load varies according to the complexity that the Myocardial Infarction can manifest. The patient needs a larger number of nursing personnel due to high workload to attend all necessary interventions

Objetivo: identificar la carga horaria de enfermería aplicada al infarto agudo de miocardio, de acuerdo con la clasificación de Killip. Métodos: investigación de campo con abordaje cuantitativo, descriptivo, exploratorio, retrospectivo. Se utilizaron prontuarios de pacientes que obtuvieron como diagnóstico inicial el Infarto Agudo del Miocardio, y que presentaron alteraciones en los marcadores bioquímicos. Resultados: se evaluaron 200 prontuarios. A partir de los datos obtenidos conseguimos trazar una progresión de carga horaria entre las categorías Killip, sobre las necesidades de asistencia prestada. Conclusión: la carga horaria de enfermería varía de acuerdo con la complejidad que el Infarto del Miocardio puede manifestar. El paciente necesita un mayor número de personal de enfermería debido a una alta carga horaria para atender todas las intervenciones necesarias

Severe cardiac insufficiency secondary to cardiotoxicity with clinical and morpho-functional improvement after optimised clinical treatment: case report / Insuficiência cardíaca grave secundária a cardiotoxicidade com melhora clínica e morfo-funcional após tratamento clínico otimizado: relato de caso

Many therapies used for cancer (pathology whose cases are progressively increasing in the world) such as chemotherapy and radiotherapy have numerous adverse effects, with cardiotoxicity being one of the most important. This can be defined from the detection, by an imaging method, of a reduction of at least 10% in the left ventricular ejection fraction (LVEF), bringing it to a value below 53%. Anthracyclines (such as Doxorubicin), Trastuzumab, and Taxanes (Docetaxel) are among the most associated chemotherapeutics. To emphasize the importance of optimized treatment for heart failure and to review the main updates on the theme of cardiotoxicity. Case report and bibliographic review on the latest updates to the management of cardiotoxicity and associated heart failure. When correctly identifying the main risk factors associated with chemotherapy and the individual to develop myocardial injury, it is possible to perform the monitoring by means of two main predictors: the myocardial tension strength and the biomarkers. In this sense, changes associated with these predictors may allow early intervention through appropriate treatment and, with the advancement of research, even prevention, mainly using the association of Carvedilol with Enalapril. Continuous monitoring and early initiation of drug therapy for heart failure are clearly associated with a lower degree of myocardial injury and a lower rate of complications. In addition, there is still an increasingly promising possibility in relation to preventive drug therapy, however, there is still a lack of studies on this topic.

Muitas terapias utilizadas para o câncer (patologia cujos casos estão aumentando progressivamente no mundo) como a quimioterapia e a radioterapia possuem inúmeros efeitos adversos, sendo a cardiotoxicidade um dos mais importantes. Esta pode ser definida a partir da detecção, por um método de imagem, de uma redução de, pelo menos, 10% na fração de ejeção do ventrículo esquerdo (FEVE), levando a mesma para um valor inferior a 53%. As Antraciclinas (como a Doxorrubicina), o Trastuzumab, e os Taxanos (Docetaxel) estão entre os quimioterápicos mais associados. Enfatizar a importância do tratamento otimizado para insuficiência cardíaca e revisar sobre as principais atualizações do tema cardiotoxicidade. Relato de caso e revisão bibliográfica sobre últimas atualizações de condutas referentes ao manejo da cardiotoxicidade e insuficiência cardíaca associada. Ao se identificar corretamente os principais fatores de risco associados à quimioterapia e ao indivíduo para desenvolver a injúria miocárdica, é possível realizar o monitoramento por meio de dois preditores principais: a força de tensão miocárdica e os biomarcadores. Nesse sentido, alterações associadas a esses preditores podem permitir a intervenção precoce por meio do tratamento adequado e, com o avanço das pesquisas, até mesmo a realização da prevenção, principalmente utilizando-se a associação de Carvedilol com Enalapril. Monitorização contínua e início precoce da terapia medicamentosa para insuficiência cardíaca estão claramente associadas com um menor grau de injúria miocárdica e um menor índice de complicações. Além disso, ainda há a possibilidade cada vez mais promissora em relação à terapia medicamentosa preventiva, porém, ainda há carência de estudos em relação a este tema.

Health education: the effectiveness of interventions in patients with heart failure / Educación para la salud: la efectividad de las intervenciones en pacientes con insuficiencia cardíaca / Educação em saúde: efetividade das intervenções em pacientes com insuficiência cardíaca

ABSTRACT Objectives: To evaluate the effectiveness of NIC interventions "Teaching: Disease Process", "Health Education" and "Cardiac Care" in the improvement of NOC results in individuals with Heart Failure (HF), and the Nursing Diagnosis (ND) "Ineffective Health Control". Methods: Retrospective cohort, conducted at a Health Education in Nursing outpatient clinic. Fourteen patients with HF had follow-up for one year in six bimonthly consultations. The effectiveness of interventions was verified through the change of the result scores through the Friedman's Non-Parametric Test and Analysis of Non-Parametric Variance for repeated measures. The level of significance was 5%. Results: The interventions were implemented in consultations in a variety of activities. There was a significant improvement in the result scores until the fourth visit (p<0.001). Conclusions: The interventions were effective in improving outcomes in patients with HF and Ineffective Health Control.

RESUMEN Objetivos: Evaluar la efectividad de las intervenciones NIC "Enseñanza: Proceso de Enfermedad", "Educación para la Salud" y "Cuidados Cardíacos" en la mejora de resultados NOC en individuos con insuficiencia cardíaca (IC) y el diagnóstico de enfermería (DE) "Control Ineficaz de la Salud". Métodos: Ccohorte retrospectivo conducido en un ambulatorio de enfermería de educación para la Salud. Se incluyeron 14 pacientes con IC acompañados durante un año, en seis consultas presenciales bimestrales. La efectividad de las intervenciones fue verificada por medio del cambio de los escores de los resultados, con uso de las Pruebas no paramétricas de Friedman y Análisis de Variancia no Paramétrica para medidas repetidas. El nivel de significancia adoptado fue del 5%. Resultados: Llas intervenciones fueron implementadas en las consultas con variación de las actividades. Se observó una mejoría significativa de los resultados obtenidos hasta la cuarta consulta (p <0,001). Conclusiones: Llas intervenciones fueron efectivas en la mejora de los resultados en pacientes con IC y Control Ineficaz de la Salud.

RESUMO Objetivos: Avaliar a efetividade das intervenções NIC "Ensino: Processo de Doença", "Educação em Saúde" e "Cuidados Cardíacos" na melhora de resultados NOC em indivíduos com Insuficiência Cardíaca (IC), e o Diagnóstico de Enfermagem (DE) "Controle Ineficaz da Saúde". Métodos: Coorte retrospectivo, conduzido num ambulatório de enfermagem de Educação em Saúde. Foram incluídos 14 pacientes com IC acompanhados durante um ano em seis consultas presenciais bimestrais. A efetividade das intervenções foi verificada por meio da mudança dos escores dos resultados por meio dos Testes Não-Paramétricos de Friedman e Análise de Variância Não-Paramétrica para medidas repetidas. O nível de significância adotado foi de 5%. Resultados: As intervenções foram implementadas nas consultas com variação das atividades. Houve melhora significativa dos escores dos resultados até a quarta consulta (p<0,001). Conclusões: As intervenções foram efetivas na melhora dos resultados em pacientes com IC e no Controle Ineficaz da Saúde.

Health education: the effectiveness of interventions in patients with heart failure / Educación para la salud: la efectividad de las intervenciones en pacientes con insuficiencia cardíaca / Educação em saúde: efetividade das intervenções em pacientes com insuficiência cardíaca

ABSTRACT Objectives: To evaluate the effectiveness of NIC interventions "Teaching: Disease Process", "Health Education" and "Cardiac Care" in the improvement of NOC results in individuals with Heart Failure (HF), and the Nursing Diagnosis (ND) "Ineffective Health Control". Methods: Retrospective cohort, conducted at a Health Education in Nursing outpatient clinic. Fourteen patients with HF had follow-up for one year in six bimonthly consultations. The effectiveness of interventions was verified through the change of the result scores through the Friedman's Non-Parametric Test and Analysis of Non-Parametric Variance for repeated measures. The level of significance was 5%. Results: The interventions were implemented in consultations in a variety of activities. There was a significant improvement in the result scores until the fourth visit (p<0.001). Conclusions: The interventions were effective in improving outcomes in patients with HF and Ineffective Health Control.

RESUMEN Objetivos: Evaluar la efectividad de las intervenciones NIC "Enseñanza: Proceso de Enfermedad", "Educación para la Salud" y "Cuidados Cardíacos" en la mejora de resultados NOC en individuos con insuficiencia cardíaca (IC) y el diagnóstico de enfermería (DE) "Control Ineficaz de la Salud". Métodos: Ccohorte retrospectivo conducido en un ambulatorio de enfermería de educación para la Salud. Se incluyeron 14 pacientes con IC acompañados durante un año, en seis consultas presenciales bimestrales. La efectividad de las intervenciones fue verificada por medio del cambio de los escores de los resultados, con uso de las Pruebas no paramétricas de Friedman y Análisis de Variancia no Paramétrica para medidas repetidas. El nivel de significancia adoptado fue del 5%. Resultados: Llas intervenciones fueron implementadas en las consultas con variación de las actividades. Se observó una mejoría significativa de los resultados obtenidos hasta la cuarta consulta (p <0,001). Conclusiones: Llas intervenciones fueron efectivas en la mejora de los resultados en pacientes con IC y Control Ineficaz de la Salud.

RESUMO Objetivos: Avaliar a efetividade das intervenções NIC "Ensino: Processo de Doença", "Educação em Saúde" e "Cuidados Cardíacos" na melhora de resultados NOC em indivíduos com Insuficiência Cardíaca (IC), e o Diagnóstico de Enfermagem (DE) "Controle Ineficaz da Saúde". Métodos: Coorte retrospectivo, conduzido num ambulatório de enfermagem de Educação em Saúde. Foram incluídos 14 pacientes com IC acompanhados durante um ano em seis consultas presenciais bimestrais. A efetividade das intervenções foi verificada por meio da mudança dos escores dos resultados por meio dos Testes Não-Paramétricos de Friedman e Análise de Variância Não-Paramétrica para medidas repetidas. O nível de significância adotado foi de 5%. Resultados: As intervenções foram implementadas nas consultas com variação das atividades. Houve melhora significativa dos escores dos resultados até a quarta consulta (p<0,001). Conclusões: As intervenções foram efetivas na melhora dos resultados em pacientes com IC e no Controle Ineficaz da Saúde.

Non-compaction of ventricular myocardium in children / 中华实用儿科临床杂志

Non-compaction of ventricular myocardium (NVM),a rare congenital and inherited cardiomyopathy,is characterized by prominent trabeculations and deep intertrabecular recesses in communication with the ventricular cavity.NVM has diverse clinical presentations without specificity,of which the major characteristics are cardiac insufficiency,arrhythmias and thrombosis.Echocardiography and cardiac magnetic resonance imaging are necessary technologies to diagnose NVM.Symptomatic therapy is the only choice for most patients.Furthermore,if medical treatment fails,the heart transplantation could be performed.As a whole,NVM has a high mortality and entirely different prognosis,however,the prognosis of asymptomatic patients is relatively good.

Non-compaction of ventricular myocardium in children / 中华实用儿科临床杂志

Non-compaction of ventricular myocardium (NVM), a rare congenital and inherited cardiomyopathy, is characterized by prominent trabeculations and deep intertrabecular recesses in communication with the ventricular cavity.NVM has diverse clinical presentations without specificity, of which the major characteristics are cardiac insufficiency, arrhythmias and thrombosis.Echocardiography and cardiac magnetic resonance imaging are necessary technologies to diagnose NVM.Symptomatic therapy is the only choice for most patients.Furthermore, if medical treatment fails, the heart transplantation could be performed.As a whole, NVM has a high mortality and entirely different prognosis, however, the prognosis of asymptomatic patients is relatively good.

Prognostic value of myocardial injury in patients with COVID-19 / 中华心血管病杂志

Objective: To analyze the prognostic value of myocardial injury in patients with COVID-19. Method: Confirmed cases of COVID-19 patients admitted from January 31st to February 5th at isolation ward of Renmin Hospital of Wuhan University were divided into non-survival group （33 cases）and survival group (169 cases)according to the clinical outcomes 5 weeks after admission. Data including demographics, comorbidities, vital signs, laboratory results were obtained. Cardiac injury was defined as serum concentration of high sensitivity cardiac troponin I (hs-cTnI) above 0.04 μg/L. Univariate and multivariate Cox regression were used to analyze the prognostic value of myocardial injury in patients with COVID-19. Kaplan-Meier analysis was used to plotted survival curve and analyze the impact of myocardial injury on the survival outcome of COVID-19 patients. Results: A total of 202 patients were included, the age was 63 (51, 70) years old, 88 (43.6%) of them were male, 85 (42.1%) of them had comorbidities, 125 (61.9%) of them were severely to critically ill. Till March 11, 33 patients died, all of them were critically ill patients. The age, proportion of males, comorbidities, respire rate, serum levels of hs-cTnI and incidence of heart failure in the non-survival group were significantly higher than those in the survival group (all P<0.05). The hospitalization time of non-survival group was significantly shorter than that of survival group (6(4, 9) vs. 32(23, 36), P<0.001). Myocardial injury was an important prognostic factor of COVID-19 (HR=5.382, 95%CI 2.404-12.050, P<0.001). Kaplan-Meier survival analysis showed that the presence of myocardial injury was significantly associated with the reduced survival rate among COVID-19 patients (P<0.001). Conclusion: Myocardial injury is an important prognostic factor of COVID-19, COVID-19 patients with myocardial injury face a significantly higher risk of death.

Respostas comportamentais e estratégias de enfrentamento de idosos no tratamento da insuficiência cardíaca / Respuestas comportamentales y estrategias de enfrentamiento de ancianos en el tratamiento de la insuficiencia cardíaca / Behavioral responses and strategies for the age of elderly persons in the heart failure treatment

Objetivo conhecer as respostas comportamentais e as estratégias de enfrentamento de idosos no tratamento da insuficiência cardíaca. Método estudo qualitativo, descritivo, fundamentado no referencial teórico de Callista Roy. Foram entrevistados 10 idosos acompanhados em um ambulatório de cardiologia em junho de 2015. Resultados na categoria respostas comportamentais dos idosos frente ao tratamento, encontrou-se problemas adaptáveis nos modos fisiológicos (oxigenação, atividade/repouso e nutrição), de autoconceito (desmotivação, tristeza, solidão e medo), de desempenho de papéis (perda do papel primário de pai, trabalhador) e de interdependência (apoio familiar e dos pares). Todavia, apresentaram alguns mecanismos de adaptação, como uso de lembretes ou caixa organizadora para as medicações, redução de alimentos industrializados e diminuição de sódio nos alimentos, redução de custos com o cadastro em farmácias populares. Conclusão os idosos, apesar de criarem alguns mecanismos de adaptação, ainda demonstraram falhas na condução do tratamento da insuficiência cardíaca, principalmente em relação à dieta e ao uso de medicamentos.

Objetivo conocer las respuestas comportamentales y estrategias de enfrentamiento de ancianos en el tratamiento de la insuficiencia cardíaca. Método estudio cualitativo, descriptivo, basado en el referencial teórico de Callista Roy. Fueron entrevistadas 10 personas adultas mayores acompañadas en una consulta de cardiología en junio de 2015. Resultados En la categoría de respuestas comportamentales de los ancianos, frente al tratamiento, se encontraron problemas adaptables en los modos fisiológicos (oxigenación, actividad/reposo y nutrición), de autoconcepto (desmotivación, tristeza, soledad y miedo), desempeño de papeles (pérdida del papel primario de padre, trabajador) e interdependencia (apoyo familiar y de los pares). Sin embargo, presentaron algunos mecanismos de adaptación, como uso de recordatorios o caja organizadora para medicaciones, reducción de alimentos industrializados y disminución de sodio en los alimentos, reducción de costos con registro en farmacias populares. Conclusión los ancianos, a pesar de crear algunos mecanismos de adaptación, señalaron fallas en la conducción del tratamiento de la insuficiencia cardíaca, principalmente en relación a la dieta y al uso de medicamentos.

Objective to know the behavioral responses and coping strategies of the elderly in the treatment of heart failure. Method This is a qualitative and descriptive study, based on the theoretical framework of Callista Roy. Ten elderly people were interviewed in a cardiology outpatient clinic in June 2015. Results in the category of elderly behavioral responses to treatment, adaptive problems were found in physiological modes (oxygenation, activity/rest and nutrition), self-concept (demotivation, sadness, loneliness and fear), role performance (loss of the primary role of father, worker) and interdependence (family and peer support). However, they presented some adaptation mechanisms, such as the use of reminders or an organizer for medications, reduction of processed foods and sodium in foods, and reduction of costs with registration in popular pharmacies. Conclusion despite the fact that some adaptation mechanisms were created, the elderly still showed deficiencies in the management of heart failure, especially in relation to diet and medication use.

Prevention and treatment of preeclampsia complicated with cardiac insufficiency / 中国实用妇科与产科杂志

Complication with twins or hypoproteinemia and long-term use of fetal protection drugs and other factors in preeclampsia pregnant women significantly increase the risk of heart failure.Combining typical clinical manifestations with auxiliary examinations can diagnose preeclampsia complicated with cardiac insufficiency.The early symptoms of cardiac insufficiency are easy to be neglected.We should pay attention to the manifestations of early heart failure.Active control of preeclampsia and timely termination of pregnancy are the main measures to prevent cardiac insufficiency.Preeclampsia is also a major risk factor for long-term cardiovascular complications.It is necessary to synthesize multidisciplinary diagnosis and treatment and strengthen long-term follow-up.

Effect of Huangqi-Baoxin decoction combined with routine western medicine therapy on cardiac function in patients with diabetic cardiomyopathy / 国际中医中药杂志

Objective@#To explore the effect of Huangqi-Baoxin decoction combined with conventional western medicine on the cardiac function of the patients with diabetic cardiomyopathy (DCM).@*Methods@#A total of 103 DCM patients who met the inclusion criteria were divided into the control group (51 cases) and the research group (52 cases) by random number table method. The control group was treated with conventional therapy, while the study group was treated with Huangqi-Baoxin decoction on the basis of the control group. Both groups were treated for 3 months. TCM syndromes were scored before and after treatment. The serum GSH-Px, SOD and CRP levels were measured by ELISA. Left ventricular ejection fraction (LVEF) and E/A ratio of early diastolic peak velocity to late diastolic peak velocity (E/A) were measured by echocardiography and then evaluate the clinical efficacy.@*Results@#The total effective rate was 92.3% (48/52) in the study group and 76.5% (39/51) in the control group. There was significant difference between the two groups (χ2=4.922, P=0.027). After treatment, the scores of palpitation, shortness of breath, chest tightness and chest pain, fatigue, hypochondriac mass, spontaneous sweating, edema and total scores in the study group were significantly lower than those in the control group (t values were 10.603, 9.997, 10.546, 10.074, 5.211, 3.981, 6.438, 13.502, P<0.01). After treatment, LVEF (46.03% ± 1.70% vs. 42.33% ± 1.63%, t=11.271) and E/A (1.02 ± 0.17 vs. 0.90 ± 0.16, t=3.796) in the study group were significantly higher than those in the control group (P<0.01). After treatment, the serum GSH-Px and SOD levels in the study group were significantly higher than those in the control group (t values were 7.585, 6.816, P<0.01), and CRP level was significantly lower than the control group (t=10.854, P<0.01).@*Conclusions@#The Huangqi-Baoxin decoction combined with routine western medicine therapy can improve the clinical symptoms and cardiac function of DCM patients, reduce oxidative stress injury and inhibit inflammation.

Effect of Huangqi-Baoxin decoction combined with routine western medicine therapy on cardiac function in patients with diabetic cardiomyopathy / 国际中医中药杂志

Objective To explore the effect of Huangqi-Baoxin decoction combined with conventional western medicine on the cardiac function of the patients with diabetic cardiomyopathy (DCM). Methods A total of 103 DCM patients who met the inclusion criteria were divided into the control group (51 cases) and the research group (52 cases) by random number table method. The control group was treated with conventional therapy, while the study group was treated with Huangqi-Baoxin decoction on the basis of the control group. Both groups were treated for 3 months. TCM syndromes were scored before and after treatment. The serum GSH-Px, SOD and CRP levels were measured by ELISA. Left ventricular ejection fraction (LVEF) and E/A ratio of early diastolic peak velocity to late diastolic peak velocity (E/A) were measured by echocardiography and then evaluate the clinical efficacy. Results The total effective rate was 92.3% (48/52) in the study group and 76.5% (39/51) in the control group. There was significant difference between the two groups (χ2=4.922, P=0.027). After treatment, the scores of palpitation, shortness of breath, chest tightness and chest pain, fatigue, hypochondriac mass, spontaneous sweating, edema and total scores in the study group were significantly lower than those in the control group (t values were 10.603, 9.997, 10.546, 10.074, 5.211, 3.981, 6.438, 13.502, P<0.01). After treatment, LVEF (46.03% ± 1.70% vs. 42.33% ± 1.63%, t=11.271) and E/A (1.02 ± 0.17 vs. 0.90 ± 0.16, t=3.796) in the study group were significantly higher than those in the control group (P<0.01). After treatment, the serum GSH-Px and SOD levels in the study group were significantly higher than those in the control group (t values were 7.585, 6.816, P<0.01), and CRP level was significantly lower than the control group (t=10.854, P<0.01). Conclusions The Huangqi-Baoxin decoction combined with routine western medicine therapy can improve the clinical symptoms and cardiac function of DCM patients, reduce oxidative stress injury and inhibit inflammation.

Effects of Shenmai injection combined with enteral nutrition on immune function of patients with severe cardiac insufficiency / 中国中西医结合急救杂志

Objective To observe the effect of Shenmai injection combined with enteral nutrition (EN) on immune function in patients with severe cardiac insufficiency. Methods Fifty-seven patients with severe cardiac insufficiency admitted to the Department of Critical Care Medicine of Taizhou Hospital of Zhejiang Province from June 2015 to June 2018 were divided into an EN group (31 cases) and an EN group combined with Shenmai injection group (26 cases). The EN group was given EN on the basis of routine western medicine treatment, while in the EN combined with Shenmai injection group was treated additionally by intravenous drip of Shenmai injection 100 mL/d on the basis of above EN group treatment. The efficacies of the two groups were evaluated after consecutive 7-day treatment in the two groups. The changes in levels of subsets of T-lymphocytes (CD3+, CD4+, CD8+, CD4+/CD8+) and immunosuppressive cells CD14+ monocyte human leukocyte antigen DR (HLA-DR) were observed before and after treatment. Results After treatment, the levels of T-cell subsets CD3+, CD4+, CD4+/CD8+ and CD14+ monocytes HLA-DR in the peripheral blood of the two groups were significantly higher than those before treatment [CD3+: EN group was 0.539±0.126 vs. 0.379±0.093,Shenmai injection group was 0.652±0.185 vs. 0.393±0.091; CD4+: EN group was 0.402±0.121 vs. 0.275±0.066,Shenmai injection group was 0.524±0.168 vs. 0.281±0.077; CD4+/CD8+:EN group was 1.83±0.70 vs. 1.11±0.70,Shenmai injection group was 2.81±0.91 vs. 1.19±0.58; CD14+HLA-DR:EN group was (43.3±7.1)% vs. (35.4±5.7)%,Shenmai injection group was (54.9±6.2)% vs. (36.1±8.3)%]; After treatment, CD8+ in EN group decreased (0.223±0.052 vs. 0.253±0.081), while CD8+ in shenmai injection group increased (0.288±0.051 vs. 0.259±0.078), and the increase degrees of the above-mentioned indexes in EN combined with Shenmai injection group were more obvious than those in the EN group after treatment [CD3+: 0.652±0.185 vs. 0.539±0.126, CD4+: 0.524±0.168 vs. 0.402±0.121, CD8+: 0.288±0.051 vs. 0.223±0.052, CD4+/CD8+: 2.81±0.91 vs. 1.83±0.70, CD14+HLA-DR: (54.9±6.2)%, (43.3±7.1)%, all P < 0.05]. Conclusion The combined use of Shenmai injection and early EN can improve the immune function of T-lymphocytes in patients with severe cardiac insufficiency. The mechanism may be related to the enhancement of the activation of T lymphocytes and promotion of the CD14+ monocytes increase and immune function.

Autoantibodies against the second extracellular loop of the β1-adrenoceptor induced cardiac insuffi-ciency through up-regulating chemokine CXCL16 / 中华微生物学和免疫学杂志

Objective To screen out the cytokines relating to cardiac insufficiency caused by au-toantibodies against the second extracellular loop of the β1-adrenoceptor(β1-AA) using cytokine chip tech-nique, and to analyze the changes in signaling pathways. Methods Blood samples were collected from 67 patients with coronary artery disease(CAD) and 42 healthy subjects. ELISA was performed to detect β1-AA in plasma. BALB/c mice were passively immunized with the monoclonal antibodies against β1-AA (β1-AA mAb). Dynamic changes in mouse cardiac structure and functions were detected by heart ultrasound. Hema-toxylin and eosin (HE) and Masson staining were used to observe morphological changes in heart tissues.Cytokine chip technique was used to screen out the cytokines causing myocardial injury. Gene Ontology (GO) and KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway enrichment analysis were used to classify the differentially expressed cytokines. Results Patients with CAD showed increased titer and posi-tive rate of β1-AA as compared with healthy subjects(P<0.001). The mouse model of heart injury was in-duced by β1-AA at the 8th week after immunization. A total of 37 differentially expressed cytokines were found in the model group,of which 11 cytokines were up-regulated and 26 cytokines were down-regulate as compared with those in the mouse control group. The level of CXCL16 was significantly increased in β1-AA-positive mice. GO analysis showed that CXCL16 was mainly involved in life processes including the positive regulation of cell death, migration, locomotion and cellular component movement. KEGG pathway enrich-ment analysis showed CXCL16 was significantly enriched in the pathway of cytokine-cytokine receptor inter-action and chemokine signaling pathway. ELISA showed that compared with β1-AA-negative patients, CXCL16 level was significantly increased in β1-AA-positive patients (P<0.01). A positive correlation was found between β1-AA and CXCL16 (P<0.01,r=0.43). Conclusion CXCL16 may play a critical role in the development of cardiac insufficiency induced by β1-AA.

Cardiac functional medication support / 中国小儿急救医学

Heart failure is a complex syndrome with heterogeneous etiology,some unclear mecha-nism and poor prognosis. Medication therapy is the first and most commonly used method. Although the understanding of the pathophysiological mechanism of heart failure is deepening continually and new thera-peutic medications are also being used in clinical practice. However,there are still many pathogenesis and clinical mechanism unclear and there is a lack of effective therapeutic medications. The study of heart failure in children and clinical drug therapy is far worse than that of adults. There are well-established guidelines for the management of heart failure in the adult population,but an equivalent consensus in children is lacking. High quality clinical research is needed for improving drug treatment regimens in children.

Clinical study of 62 cases of anomalous left coronary artery from the pulmonary artery / 临床儿科杂志

Objective To explore the clinical manifestation, treatment and prognosis of anomalous left coronary artery from the pulmonary artery (ALCAPA). Method The clinical data of patients with ALCAPA from January 2011 to September 2016 were retrospectively analyzed. All the patients were divided into infant group (<12 months) and child group (≥12 months). Results In the 62 patients (38 infants and 24 children) with ALCAPA, the median ΔLVDD (actually measured LVDD – the normal upper limit of LVDD in this age group) of infant group and child group was 13.6 (8.4～17.5) mm and 8.5 (3.3～13.7) mm respectively. The mean LVEF of the infant group was 40.6±2.4 ％, lower than that of the children group (59.0±2.9) ％, and the difference was statistically significant (P<0.01). Sixty children were treated with surgery. The mean cardiopulmonary bypass duration of infant group (137.1±8.4 min) was longer than that of the children group (105.9±6.6 min), and the difference was statistically significant (P=0.010). The median mechanical ventilation time after operation in infant group (6 d, 3～7 d), was longer than that in the children group (2 d, 1～4 d), and the difference was statistically significant (P<0.01). The median follow-up time of 60 patients was 38 months. Six patients died within 1 month after surgery (5 cases in the infant group and 1 in the children group), and there were no deaths more than 1 month after surgery. In 22 cases, the flow rate of pulmonary valve increased rapidly within 1 week after operation (>1.8 m/s). Conclusion ALCAPA is easily misdiagnosed as dilated cardiomyopathy. The clinical manifestations of infants were more severe than those of children. The mortality was high within 1 month after surgery, and the long-term prognosis was better.

Application value of PICCO and CVP monitoring in treatment of patients with septic shock complicated with cardiac insufficiency / 吉林大学学报(医学版)

Objective: To investigate the efficacies of pulsed continuous cardiac output (PICCO) and central venous pressure (CVP) monitoring in the treatment of the patients with sepsis shock complicated with cardiac insufficiency, and to clarify the clinical significance of PICCO and CVP monitoring. Methods: A total of 137 cases of septic shock combined with cardiac insufficiency patients were randomly divided into CVP group (n= 68) and PICCO group (n= 69). The patients in CVP group were treated with CVP monitoring to guide therapy, and the patients in PICCO group were treated with PICCO monitoring to guide therapy. The levels of lactic acid and B brain natriuretic peptide (BNP), central venous oxygen saturation (ScvO2), heart rate (HR), mean arterial pressure (MAP) and CVP of the patients in two groups were detected before treatment and 6, 24, 48 h after treatment, respectively; the hemodynamic parameters of the patients of PICCO group were recorded; the vasoactive drug use time, the ICU hospitalization time, the incidence rates of multiple organ dysfunction syndrome (MODS), the mechanical ventilation time and the 28 d-mortality rates of the patients were recorded. Results: Compared with CVP group, the levels lactic acid and BNP and HR of the patients in PICCO group at 6, 24, and 48 h after treatment were significantly decreased (P0. 05). There were no significant differences in the incidence rates of MODS and 28 d-mortality rates between two groups (P>0. 05); however the use time of vasoactive drugs, the ICU hospitalization time and the mechanical ventilation time of the patients in PICCO group were significantly shorter than those in CVP group (P< 0. 05). Conclusion; PICCO monitoring guides the treatment of septic shock complicated with cardiac insufficiency better than CVP monitoring, and has positive clinical significance.