Cardiac Corpuscles: A "New" Morphofunctional Entity? / Corpúsculos Cardíacos: ¿Una "Nueva" Entidad Morfofuncional?

SUMMARY: The existence of "transitional muscular structures" between subendocardial branches (Purkinje fibers) and ventricular working muscle fibers (WF) was first described by the German anatomist, Kurt Goerttler, in 1964. He designated them as "subendocardial nucleus organs." He supposed such fibers functioned as mechanoreceptors, controlling of the intensity of contraction of the ventricular musculature. Brazilian anatomist Ferraz de Carvalho described similar structures in 1993. A thorough literature search failed to identify any other research articles confirming or denying their existence. The objective of this work was to find such structures in subendocardial ventricular walls in human hearts. We collected fifteen formalin-preserved hearts from the Anatomy Department of São Paulo University and sectioned the apical portions on the right and left ventricles according to method used by Goerttler. We utilized conventional histology (light microscopy- LM), scanning electron microscopy (SEM), and a new preservation method called micro- plastination (MP). At the anterior wall of the right ventricle in the subendocardial region between the interventricular septum and moderator band, we found several bundles of fusiform and helicoidal fibers of similar histology to the WF. The bundles measured between 400 and 1150 µm in length and were separated from adjacent muscular fibers by thin collagen fiber, thus acting as a "pseudo capsule." Some structures seemed to be linked to PF and were appeared to be lymphatic and blood vessels and nerves. We called those structures "cardiac corpuscles" (CC). The observation of the previously "unknown" CC in this initial study confirmed the previous descriptions and its discovery may contribute to new perspectives in the study of cardiac muscle structure and function.

La existencia de "estructuras musculares de transición" entre los ramos subendocárdicos (fibras de Purkinje) y las fibras musculares ventriculares activas(FMV) fue descrita por primera vez por el anatomista alemán Kurt Goerttler en 1964, quien las denominó "órganos del núcleo subendocárdico". Supuso que tales fibras funcionaban como mecanoreceptores, controlando la intensidad de la contracción de la musculatura ventricular. El anatomista brasileño Ferraz de Carvalho describió estructuras similares en 1993. Una búsqueda bibliográfica exhaustiva no logró identificar ningún otro artículo de investigación que confirmara o negara su existencia. El objetivo de este trabajo fue encontrar dichas estructuras en las paredes ventriculares subendocárdicas de corazones humanos. Recolectamos 15 corazones conservados en formalina del Departamento de Anatomía de la Universidad de São Paulo y seccionamos las porciones apicales de los ventrículos derecho e izquierdo según el método utilizado por Goerttler. Utilizamos histología convencional (microscopía de luz-LM), microscopía electrónica de barrido (SEM) y un nuevo método de conservación llamado microplastinación (MP). En la pared anterior del ventrículo derecho en la región subendocárdica entre el tabique interventricular y la banda moderadora, encontramos varios haces de fibras fusiformes y helicoidales de histología similar a la FMV. Los haces medían entre 400 y 1150 µm de longitud y estaban separados de las fibras musculares adyacentes por una fina fibra de colágeno, actuando así como una "pseudocápsula". Algunas estructuras parecían estar vinculadas a la fibras de purkinje y parecían ser vasos linfáticos, sanguíneos y nerviosos. Llamamos a esas estructuras "corpúsculos cardíacos" (CC). La observación del CC previamente "desconocido" en este estudio inicial confirmó las descripciones anteriores y su descubrimiento puede contribuir a nuevas perspectivas en el estudio de la estructura y función del músculo cardíaco.

Left Ventricular Non-Compaction Cardiomyopathy: Case Report and Review of Literature

Non-compaction cardiomyopathy (NCC) is characterized by trabeculations in either one or both ventricles. Clinical presentation is highly variable: dyspnea, palpitation, thromboembolic events, arrhythmia, or sudden cardiac death. There are currently no universally-accepted criteria for classifying and diagnosing left ventricular non-compaction (LVNC) cardiomyopathy. Transthoracic echocardiography (TTE) is the diagnostic exam of choice. The diagnosis is often missed or delayed because of a lack of knowledge about this uncommon disease. Progression of LVNC is highly variable and prognosis is very difficult to predict. We report a case of a 50-year-old female patient with a history of total thyroidectomy under hormonal supplementation who consults for dyspnea and paroxysmal palpitations revealing an isolated LVNC. This case emphasizes the importance of imaging techniques, which are, TTE and cardiac magnetic resonance imaging (MRI) in early diagnosis, management, and follow-up.

Microcirculatory changes as a hallmark of aging in the heart and kidney / Cambios microcirculatorios como sello distintivo del envejecimiento en el corazón y riñón

SUMMARY: Changes in the microcirculation of multiple tissues and organs have been implicated as a possible mechanism in physiological aging. In particular, vascular endothelial growth factor is a secretory protein responsible for regulating angiogenesis via altering endothelial proliferation, survival, migration, extracellular matrix degradation and cell permeability. The aim of the present study was to evaluate the role of vascular endothelial growth factor in the progression of morphological alterations caused by physiological aging in the heart and kidney and to examine its relation to changes in capillary density. We used two age groups of healthy Wistar rats - 6- and 12-month- old. The expression of vascular endothelial growth factor was examined through immunohistochemistry and immunofluorescence and assessed semi-quantitatively. Changes in capillary density were evaluated statistically and correlated with the expression of vascular endothelial growth factor. We reported stronger immunoreactivity for vascular endothelial growth factor in the left compared to the right ventricle and also observed an increase in its expression in both ventricles in older animals. Contrasting results were reported for the renal cortex and medulla. Capillary density decreased statistically in all examined structures as aging progressed. The studied correlations were statistically significant in the two ventricles in 12-month-old animals and in the renal cortex of both age groups. Our results shed light on some changes in the microcirculation that take place as aging advances and likely contribute to impairment in the function of the examined organs.

Los cambios en la microcirculación de múltiples tejidos y órganos se han implicado como un posible mecanismo en el envejecimiento fisiológico. En particular, el factor de crecimiento endotelial vascular es una proteína secretora responsable de regular la angiogénesis mediante la alteración de la proliferación endotelial, la supervivencia, la migración, la degradación de la matriz extracelular y la permeabilidad celular. El objetivo del presente estudio fue evaluar el papel del factor de crecimiento del endotelio vascular en la progresión de las alteraciones morfológicas causadas por el envejecimiento fisiológico en el corazón y riñón y examinar su relación con los cambios en la densidad capilar. Utilizamos dos grupos de ratas Wistar sanas: 6 y 12 meses de edad. La expresión del factor de crecimiento del endotelio vascular se examinó mediante inmunohistoquímica e inmunofluorescencia y se evaluó semicuantitativamente. Los cambios en la densidad capilar se evaluaron estadísticamente y se correlacionaron con la expresión del factor de crecimiento del endotelio vascular. Informamos una inmunorreactividad más fuerte para el factor de crecimiento endotelial vascular en el ventrículo izquierdo en comparación con el derecho y también observamos un aumento en su expresión en ambos ventrículos en animales mayores. Se informaron resultados contrastantes para la corteza renal y la médula. La densidad capilar disminuyó estadísticamente en todas las estructuras examinadas a medida que avanzaba el envejecimiento. Las correlaciones estudiadas fueron estadísticamente significativas en los dos ventrículos en animales de 12 meses y en la corteza renal de ambos grupos de edad. Nuestros resultados arrojan luz sobre algunos cambios en la microcirculación que tienen lugar a medida que avanza el envejecimiento y probablemente contribuyan a un deterioro en la función de los órganos examinados.

Successful Correction of Postinfarction Interventricular Septum Rupture Diagnosed Online During the COVID-19 Pandemic (Clinical Case)

ABSTRACT Postinfarction interventricular septum defect is a rare, but very serious and sometimes fatal, complication of acute myocardial infarction. This article describes a clinical case of online diagnosis of a late-stage myocardial infarction and the subsequent successful endovascular repair of a postinfarction ventricular septum defect with a Myval™ occluder.

Resveratrol Attenuates Degeneration and Apoptosis of Cardiomyocytes Induced by Aortic Clamping

ABSTRACT Introduction: Objective: To investigate the potential beneficial effects of resveratrol (RVT) against ischemia-reperfusion injury of myocardial tissue during surgical treatment of ruptured abdominal aortic aneurysm. Methods: Four groups were established — control, ischemia/reperfusion (I/R), sham (I/R+solvent/dimethyl sulfoxide [DMSO]), and I/R+RVT. Ruptured abdominal aortic aneurysm model was used as the experimental protocol. Results: In the I/R and I/R+DMSO groups, malondialdehyde (MDA) levels in myocardial tissue were found to be significantly increased compared to the control group. The MDA level in myocardial tissue was significantly decreased in the I/ R+RVT group compared to the I/R group. In I/R and I/R+DMSO groups, glutathione peroxidase (GSH) levels in myocardial tissue were found to be significantly decreased compared to the control group. The GSH level in the myocardial tissue was significantly increased in the I/R+RVT group compared to the I/R group. In the light microscope, isotropic and anisotropic band disorganized atypical cardiomyocytes in the I/R group and degenerative cardiomyocytes and edematous areas in the I/R+DMSO group were observed. Degenerative cardiomyocytes and edematous areas were decreased in the I/R+RVT group. When heart tissue sections incubated with cleaved caspase-3 primary antibodies were examined under the light microscope, apoptotic cardiomyocytes were present in I/R and I/R+DMSO groups. A decrease in the number of apoptotic cardiomyocytes was observed in the I/R+RVT group. Conclusion: The findings of the present study indicate that RVT exhibits protective effects against ischemia-reperfusion injury occurring in the myocardium as a distant organ as a result of abdominal aorta clamping.

Myocardial insulin resistance and systemic arterial hypertension / Resistência insulinica miocárdica e hipertensão arterial sistêmica

Background: Low availability of Glut-4 transporters in the sarcolemma of cardiac cells characterizes myocardial insulin resistance (MIR), which is triggered separately from generalized insulin resistance. Insulin receptors are quite evident in the heart muscle and vessels, and mitochondrial activity performs a significant role in MIR preserving cellular homeostasis through cell reproduction, cells livelihoods, and energy generation. Objective: To evaluate the MIR mechanism and its association with hypertension by signaling pathways design. Methods: PubMed database was employed to search for reviews publications with MIR. The referenced data of the signaling pathway was chosen by aggregating references from the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. A signaling pathway was designed based on MIR research manuscripts, where we show several mechanisms included in the MIR. The KEGG server was employed to exploit the interrelationship protein-protein, and elaborate signaling pathway diagram. The signaling pathway mapping was carried out with PathVisio software. Results: We selected 42 articles from a total of 450 articles in the PubMed database that presented a significant association between the terms "insulin resistance myocardial" AND "signaling pathway" AND "systemic arterial hypertension". Founded on database-validated research papers, we chose well-founded pathways and we succeeded in representative description of these pathways. The reproduction contigs taken from the KEGG database designed the signaling pathway of the bio-molecules that lead to MIR. Thus, the acting among multiple mechanisms releases factors that participate in the development of MIR. Conclusion: The interaction among various mechanisms and molecular interactions are important factors in developing MIR (AU).

Introdução: A baixa disponibilidade de transportadores Glut-4 no sarcolema das células cardíacas caracteriza a resistência à insulina miocárdica (MIR), que é desencadeada separadamente da resistência generalizada à insulina. Os receptores de insulina são bastante evidentes no músculo cardíaco e nos vasos, e a atividade mitocondrial desempenha uma função significativa no MIR, preservando a homeostase celular pela reprodução celular, subsistência das células e geração de energia. Objetivo: Avaliar o mecanismo MIR e sua associação com hipertensão por meio do desenho de vias de sinalização. Métodos: A base de dados PubMed foi empregada para pesquisar publicações de revisões com MIR. Os dados referenciados da via de sinalização foram escolhidos agregando referências do banco de dados Kyoto Encyclopedia of Genes and Genomes (KEGG). Uma via de sinalização foi projetada com base em manuscritos de pesquisa MIR, onde mostramos vários mecanismos incluídos no MIR. O servidor KEGG foi empregado para explorar a inter-relação proteína-proteína e elaborar o diagrama de vias de sinalização. O mapeamento das vias de sinalização foi realizado com o software PathVisio. Resultados: Foram selecionados 42 artigos de um total de 450 artigos na base de dados PubMed que apresentavam associação significativa entre os termos "insulin resistance miocárdio" AND "signalingway" AND "systemic arterial hypertension". Com base em trabalhos de pesquisa validados por banco de dados, escolhemos caminhos bem fundamentados e conseguimos uma descrição representativa desses caminhos. Os contigs de reprodução retirados do banco de dados KEGG desenharam a via de sinalização das biomoléculas que levam ao MIR. Assim, a atuação entre múltiplos mecanismos libera fatores que participam do desenvolvimento da MIR. Conclusão: A interação entre vários mecanismos e interações moleculares são fatores importantes no desenvolvimento de MIR (AU).

Bloodletting Acupuncture at Jing-Well Points Alleviates Myocardial Injury in Acute Altitude Hypoxic Rats by Activating HIF-1α/BNIP3 Signaling-Mediated Mitochondrial Autophagy and Decreasing Oxidative Stress / 中国结合医学杂志

OBJECTIVE@#To explore the protective effect and possible mechanisms of bloodletting acupuncture at Jing-well points (BAJP) pre-treatment on acute hypobaric hypoxia (AHH)-induced myocardium injury rat.@*METHODS@#Seventy-five rats were randomly divided into 5 groups by a random number table: a control group (n=15), a model group (n=15), a BAJP group (n=15), a BAJP+3-methyladenine (3-MA) group (n=15), and a BANA (bloodletting at nonacupoint; tail bleeding, n=15) group. Except for the control group, the AHH rat model was established in the other groups, and the corresponding treatment methods were adopted. Enzyme-linked immunosorbent assay (ELISA) was used to detect creatine kinase isoenzyme MB (CK-MB) and cardiac troponins I (CTnI) levels in serum and superoxide dismutase (SOD) and malondialdehyde (MDA) levels in myocardial tissue. Hematoxylin-eosin (HE) staining was used to observe myocardial injury, and terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling (TUNEL) staining was used to observe cell apoptosis. Transmission electron microscopy detection was used to observe mitochondrial damage and autophagosomes in the myocardium. The mitochondrial membrane potential of the myocardium was analyzed with the fluorescent dye JC-1. Mitochondrial respiratory chain complex (complex I, III, and IV) activities and ATPase in the myocardium were detected by mitochondrial respiratory chain complex assay kits. Western blot analysis was used to detect the autophagy index and hypoxia inducible factor-1α (HIF-1α)/Bcl-2 and adenovirus E1B 19k Da-interacting protein 3 (BNIP3) signaling.@*RESULTS@#BAJP reduced myocardial injury and inhibited myocardial cell apoptosis in AHH rats. BAJP pretreatment decreased MDA levels and increased SOD levels in AHH rats (all P<0.01). Moreover, BAJP pretreatment increased the mitochondrial membrane potential (P<0.01), mitochondrial respiratory chain complex (complexes I, III, and IV) activities (P<0.01), and mitochondrial ATPase activity in AHH rats (P<0.05). The results from electron microscopy demonstrated that BAJP pretreatment improved mitochondrial swelling and increased the autophagosome number in the myocardium of AHH rats. In addition, BAJP pretreatment activated the HIF-1α/BNIP3 pathway and autophagy. Finally, the results of using 3-MA to inhibit autophagy in BAJP-treated AHH rats showed that suppression of autophagy attenuated the treatment effects of BAJP in AHH rats, further proving that autophagy constitutes a potential target for BAJP treatment of AHH.@*CONCLUSION@#BAJP is an effective treatment for AHH-induced myocardial injury, and the mechanism might involve increasing HIF-1α/BNIP3 signaling-mediated autophagy and decreasing oxidative stress.

Changes of ventricular septal myocardial injury current in left bundle branch area pacing / 中国综合临床

Objective:Explore the characteristics of injury current changes in ventricular septal myocardium during left bundle branch area pacing (LBBAP) surgery.Methods:Retrospective analysis of clinical data of patients who underwent permanent pacemaker implantation at The Second People's Hospital of Wuxi in Jiangsu Province from January 2020 to November 2022. Among them, 42 patients were treated with LBBAP (LBBAP group) and 56 patients with Right ventricle septum pacing (RVSP group). Compare the conventional parameters such as threshold, perception, impedance during electrode implantation, damage current values at 0, 5, and 10 minutes before and after electrode rotation, and the correlation between damage current and conventional parameters. The measurement data is represented by xˉ± s, analysis of variance is used for comparison between multiple groups, t-test is used for comparison between two groups, and repeated measurement analysis of variance is used for comparison between two groups at multiple time points; Counting data is represented as an example (%), and inter group comparisons are made using χ 2 Inspection; Pearson correlation analysis was used to analyze the correlation between the two variables. Results:There was no statistically significant difference in pacing threshold, perception, and impedance between the two groups of electrode implantation surgery (all P>0.05). The damage current values at 0, 5, and 10 minutes before and after electrode rotation in the LBBAP group were higher than those in the RVSP group [(7.19±1.26) mV compared to (5.33±0.79) mV, (22.50±3.06) mV compared to (10.85±1.70) mV, (15.75±2.63) mV compared to (8.01±1.09) mV, (9.24±2.00) mV compared to (5.51±0.98) mV]. The damage current values at 0 minutes after electrode rotation in both groups were higher than before electrode rotation, and gradually decreased thereafter, After 10 minutes of electrode placement, the damage current value of the LBBAP group was still higher than the level before electrode rotation (all P<0.05), while there was no statistically significant difference between the RVSP group and the level before electrode rotation ( P>0.05). The damage current value at 0 minutes after the LBBAP group electrode was in place was positively correlated with ventricular septal thickness and left ventricular posterior wall thickness ( r values 0.45 and 0.46, P values 0.003 and 0.002, respectively), and negatively correlated with conventional pacing parameter impedance ( r=-0.32, P=0.037). There was no correlation with threshold and perception ( r values 0.08 and 0.01, P values 0.604 and 0.968, respectively). The damage current value at 0 minutes after the RVSP group electrode was in place was negatively correlated with the threshold ( r=-0.28, P=0.036). Conclusions:The COI value of LBBAP interventricular septum myocardium increased significantly after the electrode was rotated out. The COI value at 0 min after the electrode put in place was positively correlated with the interventricular septum thickness and left ventricular posterior wall thickness, and negatively correlated with the electrode impedance, but there was no correlation with threshold and perception.

Evaluation of 18F-FDG PET/CT myocardial metabolism image quality / 中国医师杂志

Objective:To evaluate the value of 18F-fluorodeoxyglucose positron emission computed tomography ( 18F-FDG PET/CT) myocardial metabolic image quality by the ratio of the maximum standard uptake value (M/B) of left ventricular myocardium to cardiac blood pool. Methods:The clinical data of 145 non diabetes patients with coronary heart disease who were admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2016 to August 2022 were retrospectively selected. All patients received intravenous injection of 18F-FDG for myocardial glucose metabolism imaging. According to the visual (qualitative) analysis, the image was divided into three categories: the best, the second best and the worst. Group A was the best image quality group, while Group B was the second best and the worst image quality group. The left ventricular myocardium, cardiac blood pool and descending aorta were semi-quantitatively analyzed, and M/B was calculated. Results:All 145 patients underwent image fusion analysis. Image visual (qualitative) analysis showed that the myocardial metabolic image quality of 111 patients was evaluated as the best (111 patients in Group A), 19 patients as the second best, and 15 patients as the worst (34 patients in Group B). The SUVmax value of the descending aorta in the two groups was lower than that of the left ventricle, with statistically significant difference (all P<0.05). The M/B value of group A was higher than that of group B, with statistically significant difference ( P<0.05). Conclusions:For the evaluation of image quality and the reliability of image interpretation, M/B value may be a good evaluation index, which reduces the interference of image quality evaluation due to high 18F-FDG uptake in some heart blood pools (background), and improves the accuracy of evaluation of myocardial viability.

Exploring the mechanism of moxibustion in myocardial protection of rats with long-term fatigue exercise based on the classical pyroptosis pathway / 针灸推拿医学（英文版）

Objective: To explore the possible mechanism of moxibustion in myocardial protection of rats undergoing long-term fatigue exercise based on observing the classical pyroptosis pathway mediated by nuclear factor kappa-B (NF-κB)/nucleotide-binding oligomerization domain-like receptor protein 3 (NLRP3)/cysteinyl aspartate specific proteinase 1 (Caspase-1).Methods: A total of 50 specific-pathogen-free male Sprague-Dawley rats were bought. Ten unqualified rats were excluded, and the remaining 40 rats were divided into a normal group, a normal + Shenque (CV8) group, a model group, a model + non-meridian non-point group, and a model + Shenque (CV8) group according to the random number table method, with 8 rats in each group. Except for rats in the normal group and the normal + Shenque (CV8) group, rats in the other three groups were trained with an incline running table exercise protocol to create a long-term fatigue exercise model, 1 h/time, once a day for 5 d with 2 d off, for a total of 8 weeks. Rats in the normal group received no modeling or intervention. Rats in the normal + Shenque (CV8) group were not modeled but received mild moxibustion at Shenque (CV8); those in the model group were modeled only without intervention; those in the model + non-meridian non-point group received moxibustion at non-meridian and non-point spots after the modeling; those in the model + Shenque (CV8) group received moxibustion at Shenque (CV8) after modeling. The above moxibustion interventions were performed for 15 min/time once daily, for 5 d with 2 d off per week and a total of 8 weeks. Blood was collected from the femoral artery 4 h after the last exercise, and the serum interleukin (IL)-1β and IL-18 levels were measured. The NF-κB, NLRP3, apoptosis-associated speck-like protein containing a CARD (ASC), Caspase-1, and gasdermin D (GSDMD) expression levels were detected by Western blotting. Myocardial morphology and pyroptosis were observed by hematoxylin-eosin (HE) staining and electron microscopy. Results: The HE staining results showed that the myocardial cells in the model group and the model + non-meridian non-point group were disorganized with blurred transverse lines, widened interstitial spaces, interstitial edema, and inflammatory cell infiltration. The structure of myocardial cells in the model + Shenque (CV8) group was clearly visible, with slightly widened interstitial spaces and occasional infiltration of inflammatory cells in the interstitium. Compared with the normal group, the serum IL-1β and IL-18 levels were increased, and myocardial NF-κB, NLRP3, ASC, Caspase-1, and GSDMD expression levels were elevated in the model group and the model + non-meridian non-point group (P<0.01). Compared with the model group, the above indicators did not change significantly in the model + non-meridian non-point group, while all the above indicators were decreased in the model + Shenque (CV8) group (P<0.01). Compared with the model + non-meridian non-point group, all the above biochemical indicators were decreased in the model + Shenque (CV8) group (P<0.01). Transmission electron microscopy showed that the mitochondria number was increased in the model group and the model + non-meridian non-point group, some of the mitochondrial lumen was irregularly enlarged, the cell membrane structure was unclear, and chromatin was aggregated. The mitochondria number was increased, the swelling was reduced, and the nuclear membrane structure was more intact in the model + Shenque (CV8) group. Conclusion: Moxibustion at Shenque (CV8) regulates the NF-κB/NLRP3/Caspase-1 pathway and reduces the pyroptosisin the myocardium of rats with long-term fatigue exercise, thus reducing the myocardial injury caused by long-term fatigue exercise.

A case of ischemic stroke in a young adult caused by combined defects of protein C and protein S and noncompaction of the ventricular myocardium / 中华神经科杂志

Ischemic stroke in young adults has attracted more and more attention due to the diversity of its etiology. Although atherosclerosis is the most common cause of stroke in young adults, other or unknown causes are not uncommon . To improve clinicians′ understanding of the etiological diagnosis of stroke in young adults, this article reports a case of ischemic stroke in the First Affiliated Hospital of Jinan University. The patient was a 22-year-old male with acute onset who was diagnosed with acute ischemic stroke based on clinical presentation, physical examination, and magnetic resonance imaging of the brain. After actively searching for the cause, laboratory and genetic tests revealed that the patient had inherited thrombophilia (protein C and protein S deficiency), and cardiac magnetic resonance imaging examination found that the patient had noncompaction of the ventricular myocardium.

Effect of high concentration hydrogen on myocardial injury and expression of Mst1 in septic mice / 中华麻醉学杂志

Objective:To evaluate the effect of high concentration hydrogen on myocardial injury and expression of mammalian STE20-like protein kinases 1 (Mst1) in septic mice.Methods:One hundred and five clean-grade healthy male C57BL/6J mice, aged 6-8 weeks, weighing 20-25 g, were divided into 3 groups ( n=35 each) using a random number table method: sham operation group (group Sham), sepsis group (group SEP), and sepsis+ high concentration hydrogen group (group SEP+ HCH). The model of sepsis-induced myocardial injury was developed by cecal ligation and perforation in anesthetized mice. In SEP+ HCH group, high concentration hydrogen (66.7%) was inhaled for 1 h starting from 1 and 6 h after the successful preparation of the model. Twenty mice were taken from each group to observe the survival rate at day 7 after operation. Blood samples from the medial canthus were collected after deep anesthesia at 24 h after surgery for determination of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) concentrations (by enzyme-linked immunosorbent assay). Then the animals were sacrificed, and the heart tissues were taken for examination of the pathological results (with a light microscope) which were scored and for determination of apoptosis in myocardial cells (by TUNEL) and expression of Mst1, dynamic-related protein 1 (Drp1) and mitofusin 2 (Mfn2) in myocardium (by Western blot). Results:Compared with group Sham, the survival rate at 7 days after operation, pathological score, apoptosis index and concentrations of TNF-α and IL-6 were significantly increased, Mst1 and Drp1 expression was up-regulated, and Mfn2 expression was down-regulated in group SEP ( P<0.05). Compared with group SEP, the survival rate at 7 days after operation, pathological score, apoptosis index and concentrations of TNF-α and IL-6 were significantly decreased, Mst1 and Drp1 expression was down-regulated, and Mfn2 expression was up-regulated in group SEP+ HCH ( P<0.05). Conclusions:Inhalation of high-concentration hydrogen can attenuate the myocardial injury in septic mice, and the mechanism may be related to down-regulation of Mst1 expression, improvement in mitochondrial dynamics, and inhibition of apoptosis in myocardial cells.

Superexpressão Gênica PTEN em Tecidos Miocárdicos de Pacientes de Cirurgia de Revascularização Miocárdica / Overexpression of the PTEN Gene in Myocardial Tissues of Coronary Bypass Surgery Patients

Resumo Fundamento: A doença arterial coronariana é um distúrbio complexo que causa morte em todo o mundo. Um dos genes envolvidos no desenvolvimento dessa doença pode ser o PTEN. Objetivos: Nosso objetivo foi investigar a expressão gênica e proteica do PTEN em amostras de tecido e sangue retiradas de pacientes submetidos à cirurgia de revascularização miocárdica. Métodos: Foram realizados estudos moleculares no Centro de estudos do genoma humano e células-tronco da Universidade Erciyes (GENKOK). Amostras do apêndice atrial direito e de sangue foram coletadas da veia central de 22 pacientes submetidos à cirurgia de revascularização miocárdica antes de iniciar e terminar a circulação extracorpórea. A expressão do PTEN foi determinada usando PCR quantitativo em tempo real e análise de Western Blot. O nível de significância aceito foi de p<0,05. Resultados: Não houve diferença significativa na expressão gênica do PTEN em amostras de sangue coletadas antes e depois da circulação extracorpórea. Entretanto, foi observado um aumento substancial nos níveis de expressão gênica e proteica de P-PTEN e PTEN nas amostras de tecido. A expressão gênica miocárdica PTEN aumentou significativamente ao final da circulação extracorpórea. A expressão gênica do PTEN no período pós-circulação extracorpórea aumentou em comparação com o período pré-circulação extracorpórea, mas não foi um aumento significativo em comparação com sujeitos saudáveis do grupo de controle. Conclusão: Este estudo revelou pela primeira vez o papel do gene PTEN analisando a expressão de mRNA e de proteína em pacientes com revascularização miocárdica, que se manifesta tanto em tecido miocárdico quanto em amostras de sangue. O aumento dos níveis de PTEN pode ser um marcador no tecido miocárdico para pacientes com doença arterial coronariana.

Abstract Background: Coronary artery disease is a complex disorder that causes death worldwide. One of the genes involved in developing this disease may be PTEN. Objectives: This study aimed to investigate the PTEN gene and protein expression in tissue and blood samples taken from coronary bypass surgery patients. Methods: Molecular studies were performed at Erciyes University Genome and Stem Cell Center (GENKOK). Right atrial appendage and blood samples were taken from the central vein of 22 coronary bypass surgery patients before starting and ending cardiopulmonary bypass. PTEN expression was determined using quantitative real-time PCR and western blot analysis. The significance level was accepted as p<0.05. Results: There was no significant difference in the PTEN gene expression in blood samples taken before and after cardiopulmonary bypass. However, a substantial increase in both protein and gene expression levels of P-PTEN and PTEN was observed in the tissue samples. Myocardial expression of the PTEN gene was significantly increased at the end of the cardiopulmonary bypass. PTEN gene expression in the post-cardiopulmonary bypass period was increased when compared to the pre-bypass period, but it was insignificant when compared to healthy controls. Conclusion: This study first revealed the role of the PTEN gene by analyzing both mRNA and protein expression in coronary bypass patients, appearing in both myocardial tissue and blood samples. Increased levels of PTEN may be a marker in myocardial tissue for patients with coronary artery disease.

Histologia do miocárdio normal e infartado / Histology of normal and infarcted myocardial

Introdução: O infarto do miocárdio é uma patologia que apresenta grande morbidade e mortalidade. Ele é resultado da necrose de cadiomiócitos provocada por dificuldade de oxigenação. Objetivo: O objetivo deste estudo foi rever a histologia do miocárdio e suas alterações histológicas quando infartado. Método: Trata-se de uma revisão narrativa em livros técnicos e artigos cinetíficos publicados na SciELO e PubMed. Resultados: O miocárdio é formado por cardiomiócitos, que se contraem em função dos sarcômeros dispostos em suas miofibrilas e apresentam eficiente comunicação elétrica entre si por meio de junções comunicantes. O infarto do miocárdio promove morte dos cardiomiócitos, alterações em elementos citoplasmáticos e na condução elétrica além da formação de tecido cicatricial fibroso. Conclusão: Em conclusão, o miocárdio é altamente vascularizado e formado por cardiomiócitos contráteis alongados e de composição sarcométrica. Em condições isquêmicas, como no infarto do miocárdio, há uma remodelação histológica no tecido muscular cardíaco que leva à fibrose e perda das funções contráteis.

Introduction: Myocardial infarction is a pathology that presents high morbidity and mortality. It is the result of cardiomyocyte necrosis caused by oxygenation difficulties. Objective: The aim of this study was to review the histology of the myocardium and its histological changes when infarcted. Method: This is a narrative review of technical books and scientific articles published in SciELO and PubMed. Results: The myocardium is formed by cardiomyocytes, which contract due to the sarcomeres arranged in their myofibrils and present efficient electrical communication with each other through gap junctions. Myocardial infarction promotes the death of cardiomyocytes, alterations in cytoplasmic elements and electrical conduction, in addition to the formation of fibrous scar tissue. Conclusion: In conclusion, the myocardium is highly vascularized and formed by elongated contractile cardiomyocytes with a sarcometric composition. In ischemic conditions, such as myocardial infarction, there is histological remodeling in cardiac muscle tissue that leads to fibrosis and loss of contractile functions

Tepid Modified Del Nido Cardioplegia in Adults Undergoing Cardiac Surgery: A Propensity-Matched Analysis

Abstract Introduction: Del Nido cardioplegia was reported to provide adequate myocardial protection and clinical outcomes with improved surgical flow in adult cardiac surgical procedures. And many clinicians have already modified the traditional formula. This study aims to investigate the efficacy and safety of tepid modified del Nido cardioplegia compared to cold blood cardioplegia in adult patients undergoing cardiac surgery. Methods: This retrospective study included one hundred consecutive adult patients undergoing cardiac surgical procedures using tepid modified del Nido cardioplegia. One hundred consecutive adult patients undergoing cardiac surgical procedures with cold blood cardioplegia were the control group. Propensity score matching yielded 89 modified del Nido and 89 cold blood cardioplegia patients. Results: There were no significant differences when comparing the two matched groups regarding the requirement for intraoperative defibrillation (P=0.36), postoperative peak troponin T levels (0.18), perioperative inotropic support (P=0.26), intra-aortic balloon pump requirement (P=0.62), and postoperative left ventricular ejection fraction at discharge (P=0.4) and on the sixth postoperative month (P=0.37). Mean cross-clamping time (P=0.005), cardiopulmonary bypass time (P=0.03), and total operation time (P=0.03) were significantly shorter in the del Nido group. Conclusion: Tepid modified del Nido cardioplegia may be a safe alternative to cold blood cardioplegia in adult patients undergoing cardiac surgical procedures.

Mapeamento Potencial de Superfície Corporal durante a Despolarização Ventricular em Ratos Após Exercício Exaustivo Agudo / Body Surface Potential Mapping during Ventricular Depolarization in Rats after Acute Exhaustive Exercise

Resumo Fundamento O exercício físico exaustivo pode causar alterações significantes nas propriedades elétricas do miocárdio. Objetivo Avaliar, através do mapeamento potencial de superfície corporal, a atividade elétrica do coração de ratos durante a despolarização ventricular após exercício exaustivo agudo. Métodos Ratos machos com doze semanas de idade foram submetidos a exercício agudo em esteira a 36 m/min até a exaustão. Eletrocardiogramas unipolares (ECGs) da superfície do tronco foram registrados em ratos anestesiados com zoletil três a cinco dias antes (Pré-Ex), 5 e 10 minutos após exercício exaustivo (Pós-Ex 5 e Pós-Ex 10, respectivamente) simultaneamente com ECGs nas derivações dos membros. Os mapas potenciais de superfície corporal instantâneos (BSPMs, body surface potential maps ) foram analisados durante a despolarização ventricular. Os valores de p <0,05 foram considerados estatisticamente significantes. Resultados Comparado com o Pré-Ex, uma conclusão precoce da segunda inversão de distribuições de potencial, uma conclusão precoce da despolarização ventricular, bem como uma diminuição na duração da fase média e a duração total da despolarização ventricular nos BSPMs foram reveladas no Pós-Ex5. Além disso, em comparação com o Pré-Ex, um aumento na amplitude do extremo negativo do BSPM no pico da onda R no ECG na derivação II (pico RII) e uma diminuição na amplitude do extremo negativo do BSPM a 3 e 4 ms após o pico RII foram demonstrados no Pós-Ex 5. No Pós-Ex 10, os parâmetros dos BSPMs não diferiram daqueles do Pré-Ex. Conclusão Em ratos, o exercício exaustivo agudo causa alterações reversíveis nas características temporais e de amplitude dos BSPMs durante a despolarização ventricular, provavelmente relacionadas a alterações na excitação da massa principal do miocárdio ventricular.

Abstract Background Exhaustive physical exercise can cause substantial changes in the electrical properties of the myocardium. Objective To evaluate, using body surface potential mapping, the electrical activity of the heart in rats during ventricular depolarization after acute exhaustive exercise. Methods Twelve-week-old male rats were submitted to acute treadmill exercise at 36 m/min until exhaustion. Unipolar electrocardiograms (ECGs) from the torso surface were recorded in zoletil-anesthetized rats three to five days before (Pre-Ex), 5 and 10 minutes after exhaustive exercise (Post-Ex 5 and Post-Ex 10, respectively) simultaneously with ECGs in limb leads. The instantaneous body surface potential maps (BSPMs) were analyzed during ventricular depolarization. P values <0.05 were considered statistically significant. Results Compared with Pre-Ex, an early completion of the second inversion of potential distributions, an early completion of ventricular depolarization, as well as a decrease in the duration of the middle phase and the total duration of ventricular depolarization on BSPMs were revealed at Post-Ex 5. Also, compared with Pre-Ex, an increase in the amplitude of negative BSPM extremum at the R-wave peak on the ECG in lead II (RII-peak) and a decrease in the amplitude of negative BSPM extremum at 3 and 4 ms after RII-peak were showed at Post-Ex 5. At Post-Ex 10, parameters of BSPMs did not differ from those at Pre-Ex. Conclusion In rats, acute exhaustive exercise causes reversible changes in the temporal and amplitude characteristics of BSPMs during ventricular depolarization, most likely related to alterations in the excitation of the main mass of the ventricular myocardium.

Risk of cardiovascular disease in soccer referees: a cross sectional study

Introducrion: although the mortality rate among soccer players is low, it causes much impact on the entire community and is a fascinating conundrum. Objetive: to evaluate the cardiovascular risk of soccer referees, to describe the frequency of cardiovascular risk considering age groups younger and older than 35 years old and to relate the Framingham and PROCAM indices for the comparison of cardiovascular risk in soccer referees. Methods: We analyzed 50 referees of Paulista Soccer Federation subjected to clinical and laboratory based evaluations at the Center for Sports Health at the Faculty of Medicine of ABC, and were divided into two groups: lower and higher than 35 years of age. For analysis involving all variables of the study it was initially carried out as a descriptive evaluation of the entire group, and then the Framingham and PROCAM methods were applied in a two-dimensional way. Finally, the logistic regression analysis was applied. Anthropometric statistics, blood pressure, laboratory tests and ergospirometric values were within normal limits. Results: referees older than 35 years old presented significant increased values of waist circumference, body mass index, glucose blood levels, lower VO2max and higher cardiovascular risk according to Framingham and PROCAM. Conclusion: the risk for coronary heart disease was higher in referees older than 35 years old.

Introdução: embora a taxa de mortalidade entre os jogadores de futebol seja baixa, ela causa muito impacto em toda a comunidade e é um enigma fascinante.Objetivo: avaliar o risco cardiovascular de árbitros de futebol, descrever a frequência de risco cardiovascular considerando faixas etárias menores e maiores de 35 anos e relacionar os índices de Framingham e PROCAM para comparação de risco cardiovascular em árbitros de futebol.Métodos: foram analisados 50 árbitros da Federação Paulista de Futebol submetidos a avaliações clínicas e laboratoriais no Centro de Saúde Esportiva da Faculdade de Medicina do ABC, divididos em dois grupos: menores e maiores de 35 anos. Para a análise envolvendo todas as variáveis do estudo foi realizada inicialmente como uma avaliação descritiva de todo o grupo e, em seguida, foram aplicados os métodos de Framingham e PROCAM de forma bidimensional. Por fim, foi aplicada a análise de regressão logística. Estatísticas antropométricas, pressão arterial, exames laboratoriais e valores ergoespirométricos estavam dentro da normalidade.Resultados: os árbitros com mais de 35 anos apresentaram valores significantemente aumentados de circunferência da cintura, índice de massa corporal, glicemia, menor VO2máx e maior risco cardiovascular segundo Framingham e PROCAM.Conclusão: o risco de doença coronariana foi maior em árbitros com mais de 35 anos.

Giant Epicardial Cyst Eroding Left Ventricular Wall Mimicking as Simple Pericardial Cyst

Abstract Epicardial cysts are rarer benign tumors than pericardial cysts. There have been few reports on surgical management of epicardial cysts. A 17-year-old normotensive boy presented with chest pain and palpitations, which on evaluation was found to be a mediastinal mass (pericardial cyst). Surgical resection of the cyst via thoracotomy was planned. The cyst was diagnosed as an epicardial cyst intraoperatively. However, due to the epicardial origin of cyst and posterior adhesions, resection was done via midline approach. The base was formed by visceral pericardium and eroding into myocardium of left ventricle, so the resection was concluded with on-pump surgery. In case of erroneous diagnosis or undesirable finding, a safer midline approach with on-pump surgery, as an alternative to minimally invasive approach for complicated epicardial cysts (erosion into ventricle/lying in close proximity to important structures or near to coronary arteries) should be considered.

Investigación anatómica del ápex cardíaco / Anatomical investigation of the cardiac ápex

RESUMEN Objetivo: Comprender la anatomía cardíaca es la clave para resolver incógnitas sobre su función. La estructura miocárdica continua y helicoidal desempeña un papel fundamental en los movimientos de torsión-detorsión. El ápex, parte constitutiva del ventrículo, ¿tiene relevancia en la dinámica cardíaca o es simplemente un fondo de saco? El objetivo del presente trabajo fue responder este interrogante. Material y métodos: Se utilizaron para los estudios anátomo-histológicos cuatro corazones de bovinos jóvenes y cuatro corazones humanos (dos embriones y dos adultos). Para esta investigación se realizaron dos procedimientos: a) desplegamiento del miocardio continuo para observar la disposición de las fibras en la punta del ventrículo izquierdo, denominada zona apexiana; b) cortes horizontales y longitudinales para estudiar la estructura del ápex. Los primeros se realizaron entre los 2/3 medio y apexiano, y los longitudinales seccionando la punta ventricular izquierda con una orientación ápex-base. Resultados: Hemos encontrado en todos los corazones humanos y bovinos estudiados que el ápex corresponde únicamente al ventrículo izquierdo, en donde se ubica el giro del segmento descendente en la continuidad ascendente del miocardio continuo. El fondo de saco apexiano no posee prácticamente plano muscular en su extremo final. Está tapizado por dentro por el endocardio y por fuera por el epicardio. El plano muscular es apenas un 10% en espesor del miocardio contiguo. La transiluminación reafirma este concepto estructural. Conclusiones: El ápex es un fondo de saco prácticamente sin músculo, en el que el endocardio y el epicardio se hallan adosados, pero que cumple funciones del soporte de las presiones intraventriculares y es parte constitutiva de los movimientos de torsión y detorsión.

ABSTRACT Objective: Understanding cardiac anatomy is the key to solve unknown issues about its function. The continuous and helical myocardial structure plays a fundamental role in its torsion-detorsion motions. Does the apex, a constitutive part of the ventricle, have relevance in cardiac dynamics or is it simply a cul-de-sac? The aim of this study was to answer this question. Methods: Four young bovine and four human hearts (two embryos and two adults) were used for the anatomo-histological studies. Two procedures were carried out for this investigation: a) the continuous myocardium unfolding to observe the fiber arrangement at the tip of the left ventricle, called the apical zone; and b) horizontal and longitudinal sections to study the structure of the apex. The horizontal sections were performed between the middle 2/3 and the apex, and the longitudinal ones, sectioning left ventricular apex, with an apex-base orientation. Results: In all the human and bovine hearts studied we found that the apex corresponds only to the left ventricle, where the twist of the descending segment is located, in the ascending continuity of the myocardium. The apical cul-de-sac has practically no muscular plane at its end. It is internally lined by the endocardium and externally by the epicardium. The muscular plane has only 10% thickness of the adjacent myocardium, a structural concept confirmed by transillumination. Conclusions: The apex is a cul-de-sac practically devoid of muscle, in which the endocardium and epicardium are attached, but which performs the functions of supporting intraventricular pressures and being a constitutive part of the torsion and detorsion motions.