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Cancer and cardiovascular diseases are the two major causes of death worldwide. The application of anti-tumor drugs has significantly improved the prognosis of patients, the cardiovascular toxicity caused by the application of them has become an important factor affecting the survival and prognosis of cancer patients. Therefore, the prevention and treatment of cardiovascular toxicity related to cancer treatment is increasingly important. The cardiovascular toxicity associated with anti-tumor drugs exhibits different clinical manifestations and involves multiple pathological mechanisms. This article reviews the current research progress from the perspective of the characteristics, molecular mechanisms and prevention and treatment strategies of cardiovascular toxicity caused by cancer drugs.
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After the global pandemic of the new coronavirus, its rapid spreadand many victims, it is necessary to find an effective vaccine or drugs to overcome it. Most specialists consider that repositioning somemedications is the best, fastestand most reliable option for treating patients with the new coronavirus without delay. One of these drugs was an old antimalarial drug, hydroxychloroquine. The current review aimed to explore its potential mechanism, as well as its pharmacokinetics and toxicity, in an attempt to suggest a treatment protocol for its use in treating the COVID-19 virus effectively and safely. This study reviewed the published references on the popular search engines as well as the reference books regarding the pharmacological effects of HCQ.The results of this study suggested the following practical guidelines to optimize HCQ efficacy and safety in the management of COVID-19. HQC should be used as early as possible, i.e., once the viral infection is confirmed or suspected. A loading dose is recommended to be given in 3-4 divided doses to minimize cardiac toxicity. Maintenance daily dose (divided into two doses), should be continued until complete remission. Precautions,drug-interaction, contraindications, variable metabolic pathways in the particular population should be considered. This study suggests more clinical trials regarding the use of HCQ in the management of early identified COVID-19 patients under close medical observation to minimize HCQ cardiac toxicity
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The aim of this paper was to provide reference for the clinical safety use of aconite through the retrieval of literature about adverse reactions,predict its mechanism of cardiac toxicity by using network pharmacology,and provide ideas for the studies on toxicity mechanism of toxic Chinese medicines. The papers on adverse reactions of aconite were searched to established a database and summarize the adverse reactions of aconite. The results of literature review showed that the main causes for adverse reactions in clinical use of aconite included overdose use,short cooking time,consumption of medicinal liquor/medicinal diet,external use and misuse and so on. Therefore,the dosage of aconite should be strictly followed in clinical application,and the decoction method should be notified to the patients in detail to avoid taking the medicinal liquor and diet containing aconite,so as to prevent the occurrence of adverse reactions as much as possible,and make the best use of aconite in clinical application in avoid its toxicity. At the same time,based on the results of literature review,the network construction and visual analysis of cardio toxicity produced by aconite were carried out by using the network pharmacology technologies. RESULTS: showed that aconite can be applied to eight biological processes such as action potential of cardiac myocytes,cardiac conduction-related cell signal transduction,cardiac myocytes contraction,action potential involved in cardiac myocytes contraction,and signal transduction from atrial myocardial cells to atrioventricular node cells,and three target genes(SCN5 A,GJA1,GJA5). It was predicted that Aconiti Lateralis Radix Praeparata may influence cardiomyocyte depolarization,intercellular information transmission and material exchange by acting on three target genes(SCN5 A,GJA1,GJA5) and regulating the sodium channel protein and the expression of gap junction protein,thus affecting the heart rhythm as well as its structure and function and causing cardiac toxicity.
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Humans , Aconitum , Chemistry , Toxicity , Cardiotoxicity , Drugs, Chinese Herbal , Toxicity , Myocytes, Cardiac , Plant Roots , Chemistry , ToxicityABSTRACT
Objective To reduce the risk of radiation-induced cardiac injury in patients with left breast cancer after breast-conserving surgery by multileaf collimator (MLC) shielding technique.Methods A total of 18 patients with left breast cancer after breast conserving surgery were selected to obtain 3DCT and 4DCT images at free breathing state.The target area was identified on the 3DCT image by registration with 4DCT images and to develop a hybrid intensity-modulated treatment plan (H_IMRT) and a heart sparing hybrid intensity-modulated treatment plan (HSH_IMRT) to introduce MLC shielding technology to reduce the cardiac exposure dose,and to perform dosimetry verification of the treatment plan by using the Compass verification system.The prescription dose was 50 Gy in 25 fractions.The dosimetry parameters of the target area and the organs at risk were compared between the two treatment plans and the dose verification result.Results The result of the treatment plan showed that compared with H_IMRT,the dose uniformity of the target area of HSH_IMRT was better,and the difference of conformability was not statistically significant (P＞0.05).The mean dose of the whole heart decreased by 23.67％ (t =13.693,P＜0.05) compared with the former.Dmax and D of other substructures of the heart were lower than the former.The result of dose verification showed that there was no statistically significant difference in uniformity and conformity between the two planned target doses (P＞ 0.05).The mean dose of the whole heart of HSH_IMRT was 24.88％ (t =13.782,P＜0.05) lower than that of H_IMRT,and except for the left ventricle and right ventricle,the Dmax of other heart substructures and D of all heart substructures decreased.Both the planned and the dose verification result showed that the V20 and the D of the affected lung were lower in HSH_IMRT.Conclusions Reasonable introduction of MLC shielding technology in H_IMRT can reduce the exposure dose of cardiac and further reduce the risk of radiation damage in heart.
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PURPOSE: To observe the effectiveness of the practical instruction sheet and the educational video for left-sided breast treatment in a patient receiving deep inspiration breath hold (DIBH) technique. Two parameters, simulation time and patient satisfaction, were assessed through the questionnaire. METHODS: Two different approaches, which were the instruction sheet and educational video, were combinedly used to assist patients during DIBH procedures. The guideline was assigned at least 1 week before the simulation date. On the simulation day, patients would fill the questionnaire regarding their satisfaction with the DIBH instruction. The questionnaire was categorized into five levels: extremely satisfied to dissatisfied, sequentially. The patients were divided into four groups: not DIBH technique, DIBH without instruction materials, the DIBH with instruction sheet or educational video, and DIBH with both of instruction sheet and educational video. RESULTS: Total number of 112 cases of left-sided breast cancer were analyzed. The simulation time during DIBH procedure significantly reduced when patients followed the instruction. There was no significant difference in simulation time on the DIBH procedures between patient compliance via instruction sheet or educational video or even following both of them. The excellent level was found at 4.6 ± 0.1 and 4.5 ± 0.1, for patients coaching via instruction sheet as well as on the educational video, respectively. CONCLUSION: Patient coaching before simulation could potentially reduce the lengthy time in the simulation process for DIBH technique. Practicing the DIBH technique before treatment is strongly advised.
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Humans , Breast Neoplasms , Breast , Cardiotoxicity , Patient Compliance , Patient Satisfaction , Unilateral Breast NeoplasmsABSTRACT
Cardiovascular disease remains the leading cause of mortality and morbidity in men and women both in the US and worldwide. With increased access to healthcare, it is predicted that life expectancies in developed countries will continue to rise and thus, lead to an increase in both cardiovascular disease and cancer. Similarly, improved survival rates in cancer patients have led to an increased awareness of the presence and potential worsening of cardiovascular disease in these patients. Cardiovascular complications due to side effects from cancer therapy or from cancer progression can be a common occurrence. Although recent advances in cancer therapeutics have led to improved survival rates and quality of life, the increase in life expectancy may be counteracted by the increased morbidity and mortality from progressive cardiac pathology. Examples of such complications include local invasion or distant metastatic spread, which can lead to superior vena cava syndrome, cardiac tamponade, or hyperviscosity syndromes. In addition, many chemo and radiation therapies can be directly toxic to the cardiovascular system. This review aims to discuss the potential cardiac toxicities of the most commonly used chemotherapeutics along with some strategies to manage these complex patients.
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Objective To investigate the potential heart sparing effects of tangential volumetric modulated arc therapy (T-VMAT) by comparing its dosimetric properties with conventional wedged tangential fields (W-TF) technique and 6-field intensity-modulated radiotherapy (6F-IMRT) in the locoregional radiotherapy of left breast cancer after conserving surgery,including internal mammary nodal irradiation.Methods Fifteen patients with left breast cancer were enrolled in this study.Three plans were generated for each patient:W-TF,6F-IMRT and T-VMAT with two arc segments of 50°.The prescription dose to planning tumor volume (PTV) was 50 Gy in 25 fractions.Dose-volume parameters and indices of conformity were calculated and compared for the PTV and organs at risk (OAR).Results Compared with W-TF,T-VMAT not only significantly decreased D D and the high dose areas (above 10 Gy) of the heart and left anterior descending branch (LAD) (P ＜ 0.05),but also had the trend of sparing the V5Gy although there was statistically significant difference (P ＞ 0.05).T-VMAT also significantly decreased Dmean V5Gy,V10Gy and V20Gy of the heart,as well as the D V5Gy and V10 Gy of LAD (P ＜ 0.05),compared to 6F-IMRT.Furthermore,T-VMAT did not result in higher V20Gy of ipsilateral lung and higher V5Gy of contralateral breast compared with W-TF (P ＞ 0.05).T-VMAT achieved distinctly better target coverage and conformity,meanwhile obviously lowered hot volume of V110 compared to W-TF (P ＜ 0.05).Conclusions T-VMAT not only significantly decreased the high dose areas,but also had the trend of sparing the low dose area for the heat and LAD.Moreover,there was no significant difference for V20Gy of ipsilateral lung and V5Gy of contralateral breast between T-VMAT and W-TF.
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Objective: To analyze the curative effects of traditional Chinese herbal decoction on breast carcinoma patients in doxorubicin-induced cardiotoxicity by meta-analysis to provide evidences for doctors in treating breast carcinoma patients who were in doxorubicin-induced cardiotoxicity by traditional Chinese herbal decoction.Method: Published papers about the curative effects of traditional Chinese herbal decoction on doxorubicin-induced cardiotoxicity in breast carcinoma patients in clinical random control experiment were collected. To analyze the prescription rules and do metaanalysis in the eligible ones by the software RevMan5.2. Evaluate clinical effects of traditional Chinese medicine in treating breast carcinoma patients who were in doxorubicin-induced cardiotoxicity.Results: Ten references and 648 cases in total meeting eligibility criteria were included. Compared with pure anthracycline-based chemotherapy drugs, the breast carcinoma patients who received Anthracycline-based chemo therapy drugs with traditional Chinese medicine, their ECG changes less, their difference was statistically significant (OR=0.23, 95％ CI (0.16, 0.16), P ＜0.00001) . They had better cardiac function. the difference was statistically significant (OR=0.18, 95％ CI (0.09, 0.09), P ＜0.00001) . Their left ventricular systolic function improved. Their difference was statistically significant (MD = 3.82, 95％CI (0.29, 0.29), P=0.03 ＜ 0.05) . The myocardial enzyme spectrum, cardiac troponin I and myocardial troponin T were improved. Conclusion: To some extent, decoction of Chinese herbal medicine has effects on breast carcinoma patients with myocardial anthracycline-based drugs damage.
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OBJECTIVE To evaluate the cardiotoxicity of a widen-spectrum antineoplastic drug, gambogic acid, through quantitative multiple cellular phenotypic characterization. METHODS H9c2 cell line was used as a model with doxorubicin (Dox) and amiodarone (Ami) as positive controls, hypaconi?tine as negative control and 0.1% DMSO as normal control. An optimized protocol was established to identify the morphology and function of cell nuclei. The effect of drugs on cell viability, nuclear area (Hoechst33342), mitochondria mass (MitoTracker Deep Red) and cytoplasmic calcium ion mobilization (Rhod2 AM)was studied. EC50 and Z′values were calculated to evaluate the degree of toxicology and to estimate the precision and false-positive rate, respectively. RESULTS Dose-response analysis indicated that EC50 of Dox on cell viability, nuclear area, mitochondrial mass was 0.72, 0.014 and 1.21μmol · L-1, respectively. On the other hand, EC50 of Ami on the parameters of cell viability, nuclear area and mitochon?drial mass was 14.83, 6.72 and 4.54μmol·L-1, respectively with Z′value above 0.5. Hypaconitine decreased the SER ridge of mitochondria. Gambogic acid caused significant mortality of H9c2 cells and induced nuclear shrinkage as Ami did. The EC50 values of cell viability and nuclear area were 0.24 and 1.16 μmol · L- 1. Meanwhile,gambogic acid disturbed the mitochondrial function as indicated by the increased mitochondrial area (EC50=0.44 μmol · L-1), abnormal SER Ridge(EC50=0.99 μmol · L-1) and decreased mitochondrial mass(EC50=1.21 μmol · L- 1). Cellular calcium mobilization was lower than normal (EC50=0.41 μmol · L-1). CONCLUSION The EC50 values of positive controls calculated from our assessment are similar those reported in literature. A multi-parameter and simultaneous evaluation enables a comprehensive analysis of the morphology of nuclei and mitochondria of cardiomyocytes and a preliminary assessment of the mechanisms of toxicity.
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The potassium channel encoded by the human ether-a-go-go related gene (hERG) plays a very important role in the physiological and pathological processes in human. hERG potassium channel determines the outward currents which facilitate the repolarization of the myocardial cells. Some drugs were withdrawn from the market for the serious side effect of long QT interval and arrhythmia due to blockade of hERG channel. The strategies for lead compound optimization are to reduce inhibitory activity of hERG potassium channel and decrease cardiac toxicity. These methods include reduction of lipophilicity and basicity of amines, introduction of hydroxyl and acidic groups, and restricting conformation.
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OBJECTIVE:To study the cardiac and skeletal toxicity of retinoic acid (RA) in Danio rerio at early life stage. METHODS:Danio rerio embryos of 24 hours post fertilization(hpf)were used as toxicity model and were exposed under medium with various concentrations of RA(0.1,1,10,25,100 μmol/L). The morphology of embryos and larvae hearts were observed 24,48 h after exposed. LC50 was calculated. Danio rerio larvae of 4 days post fertilization (dpf) were used as skeletal deformity model and were exposed with a series of RA at various concentration(0.1,1,10,25,50μmol/L). They were sacrificed 5 d later, and then Danio rerio skeleton were fixed for staining with alizarin red. The microscopic was used to observe the difference of stained skeleton area. RESULTS:RA caused significant adverse effects on hatching capabilities of Danio rerio embryos,and the ob-vious malformation features were produced during the culture process. 1-100 μmol/L RA could cause heart malformation in Danio rerio embryos and larvae,and the main heart malformation characteristics included heart linearization,pericardial edema,yolksa-cedema,hemocytes accumulation incardiac region. 100 μmol/L RA could inhibit the hatching capabilities of Danio rerio embryos, and caused lethal effects on embryos and larvae. The LC50 were 36.44,23.69 μmol/L after exposed for 24,48 h. 0.1-50 μmol/L RA induced vertebral column sclerotization of Danio rerio embryos and larvae in advance,which was positively associated with the con-centration of RA. CONCLUSIONS:RA can cause cardiac and skeletal toxicity in Danio rerio embryo and larvae,which is positive-ly associated with the concentration of RA.
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Aim To study the effect of pectin-adriamy-cin conjugate ( PAC) on cardiac toxicity .Methods 50 female SD rats were randomly divided into 5 groups with 10 animals in each group .Adriamycin ( ADM ) group received 3 mg? kg -1 , ip, every other day for 6 times.PAC group received ADM equivalent 1.5,3 and 6 mg? kg -1 , ip, every other day for 6 times.Control group received normal saline parallel to ADM .Rats were sacrificed and the echocardiogram , cardiac en-zymes , the oxidative stress levels in myocardial cells and histopathological changes after 48 h administration were detected.S180 ascites tumor bearing mice models were established to investigate the antitumor activity of PAC.Results The survival rate of ADM group was 50% and that of PAC each group was 100%.PAC could significantly increase body weight ,heart index and immune index and increase HR ,EF,FS,reduce LVIDd, LVIDs.PAC could also significantly increase the AST , LDH, CK, CK-MB level in serum .GSH-Px and SOD activities of PAC group were significantly increased and MDA contents were reduced , and histopathological changes decreased .PAC could effectively inhibit the growth of tumor cells and extend the survival period of mice.Conclusion PAC induces a significant reduc-tion in cardiotoxicity by increasing survival rate , im-mune and cardiac function , improving cardiac en-zymes ,oxidative stress and myocardial cell injury , and also PAC has obvious antitumor effect .
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Aconiti Lateralis Radix (Fuzi) is a toxic traditional Chinese medicine with definite efficacy. In order to improve the quality control of its different prepared products and ensure the security in clinic, it is significant to establish a method of quality evaluation related to clinic adverse effects. Aiming at the important biological marker of early cardiac toxicity reaction, there was no method to detect it. In this manuscript, a novel approach for measuring the minimal toxic dose (MTD) of premature ventricular contractions (PVC) poisoning of rats was established. Then, the determination methodology and conditions were optimized to meet the needs of the quality and biological assessment, including animal sex, weight, stability of standards and test solutions. Using this method, the MTD value of different Fuzi products were determined, such as Heishunpian, Baifupian, Zhengfupian, Baofupian, and Paotianxiong. The results showed that the MTD of Fuzi was significantly decreased after detoxification processed (P<0.05) and the MTD of Heishunpian, Zhengfupian, Baofupian and Baifupian was as much as 15.76, 22.36, 19.65 and 20.97 times to that of unprocessed Shengfuzi. In addition, Paotianxiong could not induce PVC in rats, which indicated that Paotianxiong was nontoxic and safe.This method could appropriately reflects the cardiotoxity of Fuzi and its prepared samples. Together with the chemical composition analysis, the contents of diester alkaloids were explored including aconitine, mesaconitine and hypaconitine as well as monoester alkaloids in Fuzi and its prepared products were significantly associated with PVC. Furthermore, there may be some components undetermined facilitating arrhythmia to be worth exploring. This research provides an overall and comprehensive approach to diagnose early clinical cardiotoxity and control the quality of Fuzi, which could not only be a complementary solution for the chemical evaluation, but a new method to ensure its efficacy and security of clinical application.
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Objective:To evaluate the efficacy and safety of pegylated liposomal doxorubicin (PLD) in CHOP regimen for un-treated elderly patients with advanced diffuse large B-cell lymphoma (DLBCL). Methods:In a prospective phase II study, we analyzed the feasibility of PLD-modified CHOP regimen in elderly patients with advanced stages of DLBCL. PLD was administered at 30 mg/m2 in combination with cyclophosphamide, vincristine, and prednisone at standard doses every 21 d for six cycles. CD20 positive patients were given option for rituximab treatment. Results:From November 2011 to March 2014, 30 patients with a median age of 70 years (range:63 to 80) were enrolled in this study. Up to 24 cases (80.0%) obtained an International Prognostic Index of≥3. The overall re-sponse rate was 86.7%, and the complete remission rate was 66.7%. With a median follow-up of 20.1 months, the 18-month overall and progression-free survival rates were 82.4%and 70.1%, respectively. The main toxicity was neutropenia, reaching grades 3 to 4 in the 24 cases (80.0%). No significant changes existed in patients' left ventricular ejection fraction and serum troponin-T during the study. Four patients (13.3%) showed asymptomatic abnormal changes in electrocardiogram after PLD infusion. Conclusion:CHOP regimen with PLD is an effective alternative for the treatment of DLBCL in elderly patients, exhibiting an acceptable toxicity.
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Doxorubicin (DOX) treatment (12 µg/g body weight, once a week for 2 weeks) resulted in a significant decrease in the heart rate along with an increase in QRS, ST, and QT intervals. Histopathological studies showed cardiomyocyte degeneration, cytoplasmic vacuolation and macrophage infiltration in cardiac tissue. A marked increase in the rate of apoptosis was also observed. An increased oxidative stress was evidenced by significantly higher levels of lipid peroxidation (LPO) and depletion of reduced glutathione. A decrease in the activity of cellular antioxidant defence enzymes was also observed. The decrease in the heart rate and ECG alterations were prevented significantly by AAILE (100 µg/g body weight, po) co-treatment, started two weeks prior to DOX treatment and continued till the termination of the experiment. The cardioprotection was also evident from histopathology and decrease in the rate of apoptosis in cardiomyocytes. AAILE co-treatment also prevented DOX-induced increase in LPO and decrease in antioxidant defence enzymes. The results suggest that AAILE administration prevents DOX-induced cardiotoxicity.
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OBJECTIVE To observe the protection of vitamin C on the cardiac injury induced by 50 nm titanium dioxide inmice.METHODS Kunming mice were ad mistered by ig of vitamin C 100,200 and 400 mg·kg -1 for 2 d.And then the mice were ad mistered by ig of nano-TiO2 2 g·kg -1 and vitamin C (100.0,200.0 and 400.0 mg·kg -1 )for 3 d,the interval of treatment with nano-TiO2 and vitamin C was 4 h.The mice were scarified 24 h later after the last ad ministration.Electrocardiogra m (ECG)was determinated by physiological recorder.The myocardial enzy mes activities in serum and superoxide dismutase (SOD)and glutathione peroxidase(GSH-Px)activities in serum and myocardial tissue were determinated by bioche mical method.Cometassay was used to detect the DNA da mage of the heart. Heart tissue was used for histopathological exa mination by HE staining.RESULTS Co mpared with the control,ECG showed higher S-T and T-wave a mplitude of nano-TiO2 2 g·kg -1 (P<0.05).The myocar-dial enzy mes activities significantly increased and activities of SOD and GSH-Px significantly decreased in nano-TiO2 group,compared with the control group(P <0.05).Cometassay showed that olive tail mo ment (OTM)was significantly increased after nano-TiO2 2 g·kg -1 ,compared with the control group (P<0.05).The histopathology showed ede ma of myocardial cells,myofibril disorders and increasing infla mmatory cells.Vita min C 100,200 and 400 mg·kg -1 can decrease S-T in ECG,OTM,myocardial enzy mes activities,increase the SOD and GSH-Px activities in serum and myocardial tissue;reduce myocardial hypertrophy and infla mmatory cells.CONCLUSION nano-TiO2 can induce myocardial injury inmice and vitamin C can alleviate the da mage.The mechanism may be associated with the antioxidant ability of vitamin C inmyocardial tissue.
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OBJECTlVE To investigate the myocardiaI toxicity of doxorubicin on the myocardium of rabbits and mechanism. METHODS Doxorubicin 2 mg·kg-1 was injected once a week for eight weeks. After discontinuation of doxorubicin,observation was performed for another 8 weeks. Every weekend, uItrasound examination,cardiac catheterization,angiotensinⅡ(AngⅡ)Western bIotting and pathoIogi-caI examination were performed to anaIyze eject fraction( EF),maximaI rate of rise of Ieft ventricuIar pressure(+dp/ dtmax ),AngⅡexpression IeveI,apoptosis index(AI)and the structure of the myocardium. RESULTS At the 7th injection,EF decreased( P ﹤0.05),but reached the bottom vaIue at the 8th injection. At the 3rd injection,Ieft ventricuIar +dp/ dtmax decreased( P ﹤0.05)and reached the bottom vaIue one week after withdrawaI. After that,it increased and reached a high vaIue six weeks after withd-rowaI. But it was stiII Iower than before administration. At the 2nd injection,AngⅡ expression increased (P﹤0.05). At 1 week after withdrawaI,it reached the top vaIue,but than decreased and reached a Iow vaIue six weeks after withdrowaI,but was stiII higher than before administration. At the 1st injection,AI increased( P ﹤ 0.05). At 1 week after withdrawaI,it reached the top vaIue,but then decreased and reached a Iow vaIue 5 weeks after withdrawaI. But it was stiII higher than before administration. CONCLUSlON Doxorubicin cardiac toxicity can induce an eIevated IeveI of myocardiaI AngⅡ,possibIy associated with increased aIdosterone and myocardiaI tension. Increased Ang Ⅱ may induce further myocardiaI structuraI damage and ventricuIar remodeIing through the ROS and caIcium imbaIance.
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Objective To investigate the effects of different doses of dexmedetomidine pretreat-ment on cardiac toxicity of bupivacaine in rats.Methods Forty eight adult male SD rats weighing 250-300 g were randomly divided into 4 groups (n=12):saline control group (group C),dexmedetomi-dine 5 μg/kg group(group D5),dexmedetomidine 10 μg/kg group(group D10)and dexmedetomidine 1 5 μg/kg group(group D1 5 ).A Ⅱ-lead electrocardiogram(ECG)was continuously monitored,the femoral artery was cannulated for direct measurement of MAP and the femoral vein was cannulated for infusion of drugs.Groups D5,D10 and D1 5 were received infusion of dexmedetomidine 5,10 and 1 5μg/kg respectively 1 5 minutes before administration of bupivacaine,while the equal volume of saline was given in group C,then all rats received infusion 0.75% bupivacaine at the rate of 2 mg·kg-1· min-1 until asystole occurred.The doses of bupivacaine and the times of bupivacaine-induced convul-sions,arrhythmia and asystole were recorded respectively,and the myocardial concentration of bupiv-acaine was observed.Results Compared with group C,the doses of bupivacaine and the times of bupivacaine-induced convulsions,arrhythmia and asystole were all increased in groups D5,D10 and D1 5 (P <0.05).Compared with group D5,the above parameters were increased in groups D10 and D1 5 (P <0.05 ).There was no statistical significance of the above parameters between groups D10 and group D1 5.Conclusion Dexmedetomidine pretreatment can raise the threshold toxic dose of bupi-vacaine,delay the time of occurrence of cardiotoxicity of bupivacaine,so that to prevent the cardiac toxicities of bupivacaine in rats,and it produces a dose-dependent protective effect within a certain dose range.
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PURPOSE: We explored whether the deep inspiration breath hold (DIBH) technique using Abches during left-sided breast irradiation was effective for minimizing the amount of radiation to the heart and lung compared to free breathing (FB). MATERIALS AND METHODS: Between February and July 2012, a total of 25 patients with left-sided breast cancer underwent two computed tomography scans each with the DIBH using Abches and using FB after breast-conserving surgery. The scans were retrospectively replanned using standardized criteria for the purpose of this study. The DIBH plans for each patient were compared with FB plans using dosimetric parameters. RESULTS: All patients were successfully treated with the DIBH technique using Abches. Significant differences were found between the DIBH and FB plans for mean heart dose (2.52 vs. 4.53 Gy), heart V30 (16.48 vs. 45.13 cm3), V20 (21.35 vs. 54.55 cm3), mean left anterior descending coronary artery (LAD) dose (16.01 vs. 26.26 Gy, all p < 0.001), and maximal dose to 0.2 cm3 of the LAD (41.65 vs. 47.27 Gy, p = 0.017). The mean left lung dose (7.53 vs. 8.03 Gy, p = 0.073) and lung V20 (14.63% vs. 15.72%, p = 0.060) of DIBH using Abches were not different significantly compared with FB. CONCLUSION: We report that the use of a DIBH technique using Abches in breathing adapted radiotherapy for left-sided breast cancer is easily feasible in daily practice and significantly reduces the radiation doses to the heart and LAD, therefore potentially reducing cardiac risk.
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Humans , Breast Neoplasms , Breast , Coronary Vessels , Heart , Lung , Mastectomy, Segmental , Radiotherapy , Respiration , Retrospective StudiesABSTRACT
The purpose of this study is to highlight potential risks associated with the use of oral hypoglycemics as monotherapy in treatment of type 2 diabetes mellitus. For this study 40 Wistar albino rats were equally divided into four groups. Group I served as diabetic control and II, III and IV were treated with acarbose with regular diet, acarbose with cooked cornstarch diet and rosiglitazone respectively. Diabetes was induced with a single dose of alloxan monohydrate IP at a dose of 150 mg/kg body weight. Drug samples were administered orally for a period of 4 weeks and effects of the drugs were studied on day 7, 15 and 30 for serum level of sodium and potassium. Results showed decrease in sodium and potassium level in all treated groups on day 7. On day 30 levels were increased in group II and IV but decreased significantly in group III. It has been concluded that chronic doses of rosiglitazone and acarbose with regular diet may cause abnormal levels of electrolytes which may cause irregular cardiac contractility. Administration of acarbose with cornstarch diet may be beneficial in regulating cardiac contractility.