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1.
Arq. bras. cardiol ; 118(5): 927-934, maio 2022. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1374368

ABSTRACT

Resumo Fundamento Alguns estudos demonstraram uma maior prevalência de óbitos em portadores de fatores de risco cardiovascular (FRC) durante internação por COVID-19. Objetivos Avaliar o impacto do alto risco cardiovascular em pacientes internados em terapia intensiva por COVID-19 Métodos Estudo retrospectivo com pacientes admitidos em terapia intensiva, com diagnóstico confirmado de COVID-19 por RT-PCR e com pelo menos uma dosagem de troponina durante a internação. Os critérios para definição de paciente de alto risco cardiovascular (ARC) foram: histórico de doença cardiovascular estabelecida (infarto, AVC ou doença arterial periférica), diabetes, doença renal crônica com clearance < 60ml/min ou presença de 3 FRC (hipertensão, tabagismo, dislipidemia ou idade > 65 anos). O desfecho primário deste estudo é mortalidade hospitalar por todas as causas. P<0,05 foi considerado significativo. Resultados Foram incluídos 236 pacientes, média de idade= 61,14±16,2 anos, com 63,1% homens, 55,5% hipertensos e 33,1% diabéticos. Um total de 47,4% dos pacientes apresentavam ARC. Observou-se um aumento significativo da mortalidade conforme aumento do número de fatores de risco (0 FRC: 5,9%; 1 FRC: 17,5%; 2 FRC: 32,2% e ≥3 FRC: 41,2%; p=0,001). Na regressão logística ajustada para gravidade (escore SAPS3), o grupo de alto risco cardiovascular e troponina elevada apresentou maior ocorrência de mortalidade hospitalar (OR 40,38; IC95% 11,78-138,39). Pacientes sem alto risco cardiovascular, mas com troponina elevada, também exibiram associação significativa com o desfecho primário (OR 16,7; IC95% 4,45-62,74). Conclusão Em pacientes internados em terapia intensiva por COVID-19, a presença de alto risco cardiovascular afeta a mortalidade hospitalar somente em pacientes que apresentaram elevação de troponina.


Abstract Background Some studies have shown a higher prevalence of deaths in patients with cardiovascular risk factors (CRF) during hospitalization for COVID-19. Objectives To assess the impact of high cardiovascular risk in patients hospitalized in intensive care for COVID-19 Methods Retrospective study with patients admitted to an intensive care unit, with a diagnosis of COVID-19 confirmed by RT-PCR, and with at least one troponin measurement during hospitalization. The criteria for defining high cardiovascular risk (HCR) patients were: history of established cardiovascular disease (myocardial infarction, stroke, or peripheral arterial disease), diabetes, chronic kidney disease with clearance < 60ml/min, or presence of 3 CRFs (hypertension, smoking, dyslipidemia, or age > 65 years). The primary outcome of this study is all-cause in-hospital mortality. P<0.05 was considered significant. Results This study included 236 patients, mean age = 61.14±16.2 years, with 63.1% men, 55.5% hypertensive, and 33.1% diabetic; 47.4% of the patients also presented HCR. A significant increase in mortality was observed as the number of risk factors increased (0 FRC: 5.9%; 1 FRC: 17.5%; 2 FRC: 32.2% and ≥3 FRC: 41.2%; p=0.001). In the logistic regression adjusted for severity (SAPS3 score), the HCR and myocardial injury group had a higher occurrence of in-hospital mortality (OR 40.38; 95% CI 11.78-138.39). Patients without HCR but with myocardial injury also exhibited a significant association with the primary outcome (OR 16.7; 95% CI 4.45-62.74). Conclusion In patients hospitalized in intensive care for COVID-19, HCR impacts in-hospital mortality only in patients with myocardial injury.

2.
Article in Chinese | WPRIM | ID: wpr-936310

ABSTRACT

OBJECTIVE@#To explore the contribution of ferroptosis to myocardial injury in mouse models of sepsis and the role lipocalin-2 (Lcn2) in ferroptosis.@*METHODS@#Adult male C57BL/6 mice were randomized equally into sham-operated group, cecal ligation and puncture (CLP)-induced sepsis group, and CLP + Fer-1 group where the mice received intraperitoneal injection of 5 mg/mL Fer-1 (5 mg/kg) 1 h before CLP. The left ventricular functions (including LVEF%, LVFS%, LVIDd and LVIDs) of the mice were assessed by echocardiography at 24 h after CLP. Myocardial injury in the mice was observed with HE staining, and the changes of myocardial ultrastructure and mitochondria were observed using transmission electron microscopy (TEM). Serum TNF-α level was measured with ELISA, and the changes of myocardial iron content were detected using tissue iron kit. The protein expressions of myocardial Lcn2, glutathione peroxidase 4 (GPX4) and ferroptosis suppressor protein 1 (FSP1) were determined with Western blotting.@*RESULTS@#The septic mice showed significantly decreased LVEF%, LVFS% and LVIDd and increased LVIDs at 24 h after CLP (P < 0.05), and these changes were significantly improved by Fer-1 treatment. Sepsis caused obvious myocardial pathologies and changes in myocardial ultrastructure and mitochondria, which were significantly improved by Fer-1 treatment. Fer-1 treatment also significantly ameliorated sepsis-induced elevations of serum TNF-α level, myocardial tissue iron content, and Lcn2 protein expression and the reduction of GPX4 and FSP1 protein expression levels (P < 0.05).@*CONCLUSION@#GPX4- and FSP1-mediated ferroptosis are involved in myocardial injury in mice with CLP-induced sepsis, and inhibition of ferroptosis can attenuate septic myocardial injury, in which Lcn2 may play a role.


Subject(s)
Animals , Ferroptosis , Heart Injuries , Lipocalin-2 , Male , Mice , Mice, Inbred C57BL , Sepsis/metabolism
3.
Article in Chinese | WPRIM | ID: wpr-941010

ABSTRACT

OBJECTIVE@#To evaluate the protective effect of excretory-secretory proteins from Trichinella spiralis muscle larvae (Ts-MES) on sepsis-induced myocardial injury in mice.@*METHODS@#Eighty male BALB/C mice were randomized equally into sham-operated group, myocardial injury group, Ts-MES treatment group and dexamethasone treatment group. In the latter 3 groups, sepsis-induced myocardial injury models were established by cecal ligation and perforation; the sham operation was performed by exposure of the cecum without ligation or perforation. Forty minutes after the operation, the mice were given intraperitoneal injections 150 μL PBS, 20 μg TS-MES or 0.3 mg/kg dexamethasone as indicated. At 12 h after the operation, 6 mice were randomly selected from each group for echocardiography, and 8 mice were used for observing the survival rate within 72 h. The remaining 6 mice were examined for myocardial pathologies with HE staining and serum levels of NTPro-BNP and cTnI with ELISA; the expressions of TNF-α, IL-6, IL-10 and TGF-β in the serum and myocardial tissue were detected using ELISA and qRT-PCR.@*RESULTS@#Compared with the sham-operated mice, the septic mice showed significantly decreased cardiac function indexes (LVEF, LVFS, and E/A) with lowered survival rate within 72 h (P < 0.001) and significantly higher myocardial injury scores and serum levels of NTPro-BNP and cTnI (P < 0.01). Treatment with TS-MES significantly improved the cardiac function and 72-h survival rate (P < 0.05) and lowered the myocardial injury scores and serum levels of NTPro-BNP and cTnI (P < 0.05) in the septic mice. Compared with the sham-operated mice, the septic mice had obviously increased TNF-α and IL-6 levels in the serum and myocardial tissue (P < 0.001), which were significantly lowered by treatment with TS-MES (P < 0.05). TS-MES and dexamethasone both increased the levels of IL-10 and TGF-β in the septic mice, but the changes were significant only in TS-MES-treated mice (P < 0.05).@*CONCLUSION@#Ts-MES are capable of protecting against myocardial injury in septic mice by reducing the production of pro-inflammatory cytokines and enhancing the levels of regulatory cytokines.


Subject(s)
Animals , Cytokines , Dexamethasone , Heart Injuries , Interleukin-10 , Interleukin-6 , Larva , Male , Mice , Mice, Inbred BALB C , Myocardium , Sepsis , Transforming Growth Factor beta , Trichinella spiralis , Tumor Necrosis Factor-alpha
4.
Article in Chinese | WPRIM | ID: wpr-940514

ABSTRACT

ObjectiveTo investigate the immunomodulatory mechanism of Kangxian Yixin prescription (KYP) on autoimmune injury mice and its relationship with the T helper 17 (Th17)/regulatory T cell (Treg) balance. MethodSixty healthy 8-week-old male BALBc mice were randomly divided into a normal group and an experimental group at a ratio of 1∶5. On the 0th, 7th, and 28th days, 0.2 mL of porcine cardiac myosin emulsion (containing 0.1 mg of porcine cardiac myosin) was subcutaneously injected into the groin, armpit, and back of the mice in the experimental group to induce an animal model of myocardial immune injury. Mice with myocardial immune injury were randomly divided into a model group (Model), a KYP group (20.4 g·kg-1·d-1, ig), and a valsartan group (12 mg·kg-1·d-1, ig). Mice in the control group and the model group received the same amount of normal saline by gavage. After four weeks of intervention, the heart tissues were collected. Hematoxylin-eosin (HE) staining and Masson staining were used to detect pathological damage in heart tissues. Enzyme-linked immunosorbent assay (ELISA) was used to detect the expression of type B-type natriuretic peptide (BNP), anti-cardiac antibody, interleukin-17 (IL-17), and interleukin-10 (IL-10) in the serum of mice, and the expression levels of Th17 cells and Tregs in the spleen were detected by flow cytometry. The protein expression of B-cell lymphoma-2 (Bcl-2) and Bcl-2-associated X (Bax) in heart tissues was detected by Western blot, and the mRNA expression of retinoid-related orphan receptor gamma t (RORγt) and forkhead box P3 (FoxP3) in the spleen was detected by quantitative real-time polymerase chain reaction (Real-time PCR). ResultCompared with the control group, the model group showed worsened pathological damage in heart tissues, elevated serum levels of BNP, anti-myocardial antibody, and IL-17, decreased serum expression of IL-10 (P<0.05), increased expression of Th17 cells and reduced expression of Tregs in spleen tissues (P<0.05), increased protein expression of Bax, diminished Bcl-2 protein expression, elevated Bax/Bcl-2 ratio, up-regulated mRNA expression of RORγt, dwindled mRNA expression of FoxP3, and elevated ratio of RORγt/FoxP3 (P<0.05). Compared with the model group, the KYP group and the valsartan group displayed relieved pathological damage in heart tissues, decreased serum expression of BNP, anti-myocardial antibody, and IL-17, increased serum expression of IL-10 (P<0.05), reduced expression of Th17 cells and increased Tregs in spleen tissues (P<0.05), dwindled protein expression of Bax and elevated protein expression of Bcl-2 in heart tissues (P<0.05), diminished Bax/Bcl-2 ratio, reduced mRNA expression of RORγt, up-regulated FoxP3, and down-regulated ratio of RORγt/FoxP3 (P<0.05). ConclusionKYP may improve myocardial immune damage by regulating the Th17/Treg cell balance.

5.
Article in Chinese | WPRIM | ID: wpr-932632

ABSTRACT

Objective:To explore the potential mechanism of PD-1 inhibitor P on RIMI from the perspective of immune microenvironment.Methods:To establish a mouse model of radiation-induced myocardial injury (RIMI), twenty C57BL/6 mice were randomly divided into 4 groups, 5 in each group. Group A was the healthy control group; Group B was the PD-1 inhibitor group; Group C was the simple irradiation group, with a heart irradiation of 15 Gy; Group D was the irradiation+ PD-1 inhibitor group. One month after irradiation, the mice were anesthetized and sacrificed. The morphological changes of myocardial tissues were observed by HE staining. The myocardial fibrosis was assessed by Masson staining. CD 3+ , CD 3+ CD 4+ , CD 3+ CD 8 lymphocyte subsets and cytokines (IL-4, IL-6, IL-17A, TNF-α, TGF-β 1 and INF-γ) levels were determined by flow cytometry. The apoptosis rate of myocardial cells was detected by TUNE. Results:One month after irradiation, there was no obvious myocardial fibrosis in group B, and collagen fibers were distributed in the interstitium of myocardial cells in groups C and D. Semi-quantitative analysis results showed that the myocardial collagen volume fraction (CVF) of groups A, B, C and D were (1.97±0.36)%, (2.83±1.03)%, (5.39±0.77)% and (7.72±1.43)%, respectively. The CVF between group A and group B was similar ( P=0.314), and the differences in CVF between the other groups were statistically significant (all P<0.05). Compared with group A, the absolute value and percentage of CD 3+ T lymphocytes were significantly increased in groups B, C and D (all P<0.01). The values in group D were significantly higher than those in group B and group C (all P<0.01); The absolute value and percentage of CD 3+ CD4 T lymphocytes were similar among four groups (all P>0.05); The absolute value and percentage of CD 3+ CD 8 T lymphocytes in group D were significantly higher than those in groups A, B and C (all P<0.001). The expression levels of IL-6, IL-17A, and TGF-β 1 in group D were significantly higher compared with those in groups A, B and C (all P<0.001). The apoptotic index was gradually increased in four groups, and the differences in apoptotic index among four groups were statistically significant (all P<0.001). Conclusion:PD-1 inhibitors can aggravate RIMI by promoting myocardial immune inflammatory response.

6.
Article in Chinese | WPRIM | ID: wpr-930245

ABSTRACT

Objective:To explore the basic biological characteristics of lncRNA B230352I09 and its role in the process of myocardial injury.Methods:We analyzed the biological characteristics of lncRNA B230352I09 on the UCSC website and predicted the possible binding protein of lncRNA B230352I09 by the catRAPID. Real-time fluorescence quantitative (RT) PCR method was applied to detect the expression of lncRNA B230352I09 in heart tissues at different time points (0, 1, 3, 7d) within 7 days after birth, the organs distribution and expression of lncRNA B230352I09 in neonatal mouse and the expression pattern of lncRNA B230352I09 in the heart of mice with myocardial injury. In addition, we constructed hypoxia model by culturing primary cardiomyocytes to detect the effect of lncRNA 230352I09 overexpression on hypoxic cardiomyocyte apoptosis by Hoechst staining kit, the effect of lncRNA B230352I09 overexpression on ROS content of hypoxic cardiomyocyte by DCFDA probe and changes in mitochondrial membrane potential of hypoxic cardiomyocytes by JC-1 Fluorescent probes.Results:Full-length of mouse B230352I09 was 663bp, located in the chr7:123031415-123066439 forward strand. RBBP6 gene was adjacent to B230352I09, which may be the target of lncRNA B230352I09 by catrapid prediction analysis. With the development of the heart, the expression level of lncRNA B230352I09 showed a gradual downward trend. The main expression organs of lncRNA B230352I09 in 1-day-old mice were heart, brain, kidney and liver. In heart tissue, lncRNA B230352I09 expression in non-cardiomyocytes was significantly less than in cardiomyocytes [ (1.0± 0.03) vs. (9.2± 3.29), P=0.013]. After myocardial injury, the expression level of lncRNA B230352I09 showed an increasing trend compared with the normal developing mice, but there was no statistical significance. Hoechst staining showed that lncRNA B230352I09 could inhibit the apoptosis of hypoxic cardiomyocytes. Detecting the content of ROS in cardiomyocytes showed that compared with the hypoxia group, the generation of ROS was significantly reduced in the lncRNA B230352I09 overexpression group ([(3.8±0.71) vs. (1.65±0.56), P=0.015]). JC-1 fluorescent probe was used to detect the mitochondrial membrane potential, and the results showed that the mitochondrial membrane potential of cardiomyocytes in the lncRNA B230352I09 overexpression group was significantly higher than that in the hypoxia group. Conclusions:In heart tissue, lncRNA B230352I09 was mainly expressed in cardiomyocytes. LncRNA B230352I09 has a protective effect in the process of myocardial injury in mice, mainly by inhibiting apoptosis of cardiomyocytes, reducing ROS production, and protecting mitochondrial membrane potential of cardiomyocytes.

7.
Article in Chinese | WPRIM | ID: wpr-930215

ABSTRACT

Objective:To investigate the effect of curcumin on the nucleotide-binding oligomerization domain-like receptor protein (NLRP3) inflammasome in cardiomyocytes of rats with early sepsis and its mechanism.Methods:Twenty-four male SD rats were randomly divided into three groups: the sham-operated group (sham group, n=8), the sepsis group ( n=8), and the curcumin intervention group (Cur group, n=8). A rat model of sepsis was prepared by cecal ligation and perforation (CLP). After modeling, 100 mg/kg of curcumin was intraperitoneally injected and repeated 24 h later. Rats in the sepsis group were injected with normal saline. The levels of myocardial injury-specific troponin T (cTnT) in rat plasma were detected by ELISA at 6, 24, and 48 h. Hematoxylin-eosin (HE) staining was used to observe the pathological injury of the myocardium in the myocardial tissue of rat at 48 h. The apoptosis of cardiomyocytes was detected by TUNEL assay. The expression levels of Cleaved caspase-1, NLRP3 and IL-1β protein were detected by Western blot, and the ultrastructural changes of the cardiomyocytes were observed under a transmission electron microscope. Results:The levels of cTnT in rat plasma at 6, 24, and 48 h in the Cur group were significantly lower than those in the sepsis group ( P<0.05). HE staining showed infiltration, cell edema and necrosis of myocardial inflammatory cells in the sepsis group, while only partial cell edema and necrosis were observed in the Cur group. TUNEL assay showed that the apoptosis of cardiomyocytes in the Cur group was significantly lower than that in the sepsis group [(28.4±2.3)% vs. (43.6±3.8)%, P<0.05]. The expression levels of Cleaved caspase-1, NLRP3 and IL-1β in the Cur group were lower than those in the sepsis group and higher than those in the sham-operated group ( P<0.05). Under transmission electron microscopy, the nuclei in the sham-operated group had intact membranes and uniform chromatin distribution; in the sepsis group chromatin margination, pyknosis, mitochondrial cristae breakage, cavitation, and partial breakage of sarcomere were observed; while in the Cur group partial chromatin margination, slightly edema and dilation of mitochondria, with basically complete morphology were observed. Conclusions:Curcumin inhibits NLRP3-mediated acute myocardial injury in septic rats, and its mechanism may be related to pyroptosis induced by the down-regulation of the expression of Cleaved caspase-1 and IL-1β protein.

8.
Article in English | WPRIM | ID: wpr-928581

ABSTRACT

OBJECTIVES@#To evaluate myocardial injury in neonates born to pregnant women with pregnancy complicated by severe preeclampsia by myocardial work indices.@*METHODS@#A prospective cohort study was performed on 25 preterm infants born to the pregnant women with severe preeclampsia from June 2020 to April 2021 (severe preeclampsia group), and 25 preterm infants born to the pregnant women without severe complications in pregnancy were enrolled as the control group. Echocardiography was performed within 24 hours and at 48-72 hours and 14-28 days after birth to measure conventional parameters. Two-dimensional speckle-tracking echocardiography was performed to construct a noninvasive left ventricular pressure-strain loop based on two-dimensional myocardial strain and left ventricular systolic pressure noninvasively measured, so as to calculate myocardial work indices.@*RESULTS@#Compared with the control group, the severe preeclampsia group had significant reductions in left ventricular global work index and global constructive work within 24 hours after birth (P<0.05), a significant reduction in left ventricular global work efficiency and a significant increase in global waste work at 48-72 hours after birth (P<0.05), and a significant reduction in left ventricular global work efficiency at 14-28 days after birth (P<0.05).@*CONCLUSIONS@#Subclinical myocardial injury persists in the neonatal period in preterm infants born to pregnant women with severe preeclampsia.


Subject(s)
Echocardiography/methods , Female , Humans , Infant , Infant, Newborn , Infant, Premature , Pre-Eclampsia , Pregnancy , Pregnant Women , Prospective Studies
9.
Article in English | WPRIM | ID: wpr-927669

ABSTRACT

Objective@#This study aimed to examine the effects of microcirculatory dysfunction and 654-1 intervention after cardiopulmonary resuscitation on myocardial injury.@*Methods@#Landrace pigs were divided into a sham operation group (S group, n= 6), ventricular fibrillation control group (VF-C group, n= 8) and 654-1 intervention group (VF-I group, n= 8). Hemodynamics was recorded at baseline, at recovery of spontaneous circulation (ROSC), and 1 h, 2 h, 4 h and 6 h thereafter. Sidestream dark field (SDF) technology was used to evaluate and monitor the microcirculation flow index, total vessel density, perfusion vessel ratio, De-Backer score, and perfusion vessel density in animal viscera at various time points.@*Results@#After administration of 654-1 at 1.5 h post-ROSC, the hemodynamics in the VF-I group, as compared with the VF-C group, was significantly improved. The visceral microcirculation detected by SDF was also significantly improved in the VF-I group. As observed through electron microscopy, significantly less myocardial tissue injury was present in the VF-I group than the VF-C group.@*Conclusion@#Administration of 654-1 inhibited excessive inflammatory by improving the state of visceral microcirculation.


Subject(s)
Animals , Cardiopulmonary Resuscitation , Microcirculation , Swine , Ventricular Fibrillation/therapy
10.
Clinics ; 76: e3538, 2021. tab, graf
Article in English | LILACS | ID: biblio-1350609

ABSTRACT

OBJECTIVES: This study presents the cardiology referral model adopted at the University of São Paulo-Hospital das Clínicas complex during the initial period of the coronavirus disease (COVID-19) pandemic, main reasons for requesting a cardiologic evaluation, and clinical profile of and prognostic predictors in patients with COVID-19. METHODS: In this observational study, data of all cardiology referral requests between March 30, 2020 and July 6, 2020 were collected prospectively. A descriptive analysis of the reasons for cardiologic evaluation requests and the most common cardiologic diagnoses was performed. A multivariable model was used to identify independent predictors of in-hospital mortality among patients with COVID-19. RESULTS: Cardiologic evaluation was requested for 206 patients admitted to the ICHC-COVID. A diagnosis of COVID-19 was confirmed for 180 patients. Cardiologic complications occurred in 77.7% of the patients. Among these, decompensated heart failure was the most common complication (38.8%), followed by myocardial injury (35%), and arrhythmias, especially high ventricular response atrial fibrillation (17.7%). Advanced age, greater need of ventilatory support on admission, and pre-existing heart failure were independently associated with in-hospital mortality. CONCLUSIONS: A hybrid model combining in-person referral with remote discussion and teaching is a viable alternative to overcome COVID-19 limitations. Cardiologic evaluation remains important during the pandemic, as patients with COVID-19 frequently develop cardiovascular complications or decompensation of the underlying heart disease.


Subject(s)
Humans , Cardiology , COVID-19 , Referral and Consultation , Pandemics , SARS-CoV-2
11.
Article in Chinese | WPRIM | ID: wpr-911253

ABSTRACT

Objective:To evaluate the myocardial protective effect of goal-directed circulation management guided by cardiac index (CI) monitored by pressure recording analytical method (PRAM) in infants undergoing pediatric liver transplantation.Methods:A total of 120 pediatric patients, aged 5-15 months, weighing 5.5-10.0 kg, scheduled for elective living donor liver transplantation (all diagnosed with congenital biliary atresia) were selected and divided into 2 groups ( n=60 each) using a random number table method: routine group (group R) and goal-directed management guided by CI group (group CI-G). Patients in group R received routine hemodynamic monitoring according to central venous pressure (CVP), continuous invasive arterial pressure, blood gas analysis and other monitoring methods to guide intraoperative circulation management.Patients in CI-G group received intraoperative hemodynamic monitoring through radial artery using PRAM/Mostcare, and related treatments were guided by PRAM hemodynamic monitoring indicators.The intraoperative volume of fluid intake, highest and lowest values of parameters of hemodynamics such as heart rate (HR), mean arterial pressure (MAP) and CVP, the maximum fluctuations (△ RHR, △ RMAP and △ RCVP) and the development of reperfusion syndrome within 5 min of reperfusion were recorded.At the beginning of anesthesia (T 0), at 5 min before reperfusion (T 1), at 30 min of neohepatic phase (T 2), at 3 h of neohepatic phase (T 3) and at 12 h after operation (T 4), concentrations of serum cardiac troponin I (cTnI), N-terminal plasma brain natriuretic peptide precursor (NT-pro-BNP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α) and high mobility group protein B1 (HMGB1) were determined.Mechanical ventilation time, duration of intensive care unit (ICU) stay, the development of heart failure and pulmonary infection, length of hospital stay were recorded. Results:Compared with group R, the intraoperative volume of fluid intake, highest value of CVP, △ RHR, △ RMAP and the incidence of reperfusion syndrome were significantly decreased, lowest value of MAP was increased, concentrations of serum cTnI, NT-pro-BNP, IL-6, TNF-α and HMGB1 was decreased, mechanical ventilation time and duration of ICU were shortened, and the incidence of heart failure during ICU stay were decreased in group CI-G( P<0.05). Conclusion:The goal-directed circulation management guided by CI monitored by PRAM can accurately guide the use of volume and vasoactive drugs, stabilize circulation, which can produce myocardial protective effect to some extent in infants undergoing pediatric liver transplantation.

12.
Journal of Chinese Physician ; (12): 1461-1465, 2021.
Article in Chinese | WPRIM | ID: wpr-909725

ABSTRACT

Objective:To explore the related factors influencing prognosis of patients with grade Ⅲ cholangitis with myocardial injury.Methods:91 patients with grade III cholangitis complicated with myocardial injury treated in the emergency department of Beijing Friendship Hospital Affiliated to Capital Medical University from June 2015 to December 2020 were collected retrospectively. They were divided into endoscopic retrograde cholangiopancreatography (ERCP) group ( n=75) and non-ERCP group ( n=16) according to whether ERCP was performed. According to 28-day survival patients were divided into survival group ( n=56) and death group ( n=35). The level of serum cardiac troponin T (cTnT), cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), N terminal pro-brain natriuretic peptide (NT-proBNP), white blood cell (WBC), platelet (PLT), serum creatinine (Scr), alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), International Standardized Ratio (INR), Glasgow Coma Score (GCS) at different time points were detected and the risk factors influencing the prognosis of patients were analyzed. Results:The cTnT ( P=0.018), NT-proBNP ( P<0.001), PLT ( P=0.016), GCS score ( P=0.07) on day 3 and cTnI ( P=0.027), cTnT ( P=0.002), CK-MB ( P=0.046), NT-proBNP ( P<0.001), PLT ( P=0.041), GCS score ( P<0.001) on day 7 in the ERCP group were significantly different with the non-ERCP group respectively. The survival rate within 28 days of the ERCP group was significantly different from that in the non-ERCP group ( P<0.001). The cTnT ( P=0.006) on day 1, the cTnT ( P=0.021), NT-proBNP ( P=0.02), WBC ( P=0.037), GCS score ( P<0.001) on day 3, and the cTnI ( P=0.029), cTnT ( P=0.008), CK-MB ( P<0.001), PLT ( P=0.008), NT-proBNP ( P=0.004), GCS ( P<0.001) on day 7 in survival group were significantly different from the death group. Logistic regression showed that the mean value of myocardial injury markers and ERCP process were significantly correlated with the 28 days survival rate. Conclusions:In patients with Grade Ⅲ cholangitis-related myocardial injury, the levels of myocardial injury markers, NT-proBNP, platelet (PLT) and Glasgow Coma Score (GCS) are related to mortality. ERCP for patients can significantly improve 28 days survival and prognosis.

13.
Journal of Chinese Physician ; (12): 1441-1443, 2021.
Article in Chinese | WPRIM | ID: wpr-909720

ABSTRACT

Acute biliary tract infection is a common digestive system emergency, which is prone to complications and high risk of death. Therefore, paying attention to the early identification of the severity of the disease in patients with acute biliary tract infection and taking appropriate intervention measures for complications will help to improve the survival rate of patients and shorten the length of hospital stay. Six articles in this column introduced the early severity identification and diagnosis methods of acute cholangitis and the clinical characteristics of common complications such as liver abscess and sepsis myocardial injury, and elaborated the treatment effect from the perspective of Western medicine and traditional Chinese medicine.

14.
Chinese Critical Care Medicine ; (12): 1088-1093, 2021.
Article in Chinese | WPRIM | ID: wpr-909458

ABSTRACT

Objective:To investigate the predictive neutrophil/lymphocyte ratio (NLR) combined with soluble growth stimulating expression gene 2 protein (sST2) on in-hospital major adverse cardiovascular events (MACE) in patients with myocardial injury following moderate-severe acute carbon monoxide poisoning (ACOP).Methods:A single-cente prospective observational approach was conducted. Moderate-severe ACOP patients with myocardial damage from November 2016 to February 2020 in department of emergency medicine of Harrison International Peace Hospital Affiliated to Hebei Medical University were enrolled. The baseline data of the patients, NLR and sST2 (T0 sST2) on admission, sST2 at 3 days after admission (T3 d sST2), and the other myocardial injury and biochemical indicators were collected. According to whether MACE occurred, the patients were divided into MACE group and non-MACE group. The clinical data of the two groups were compared. Pearson correlation analysis was used to analyze the correlation of each index. Binary Logistic regression was used to analyze the independent risk factors of in-hospital MACE in patients with moderate-severe ACOP myocardial injury. The receiver operator characteristic curve (ROC curve) was drawn and area under ROC curve (AUC) was calculated to analyze the predictive value of NLR, sST2, and NLR combined with sST2 for the occurrence of in-hospital MACE in patients with moderate-severe ACOP myocardial injury.Results:A total of 278 patients with moderate-severe ACOP myocardial injury were included in the final analysis, and the incidence of MACE was 11.51% (32/278). Cardiac troponin I (cTnI), lactic acid (Lac), NLR, and T3 d sST2 in the MACE group were significantly higher than those in the non-MACE group [cTnI (μg/L): 0.83±0.15 vs. 0.46±0.37, Lac (mmol/L): 2.96±1.14 vs. 2.43±1.35, NLR: 13.14±4.37 vs. 9.49±4.21, T3 d sST2 (μg/L): 59.88±23.42 vs. 39.83±12.60, all P < 0.05], there was no significant difference in T0 sST2 between the MACE group and the non-MACE group (μg/L: 269.09±90.89 vs. 240.14±113.02, P > 0.05). Pearson correlation analysis showed that there were significantly positive correlations in NLR with acute physiology and chronic health evaluationⅡ(APACHEⅡ), T3 d sST2 with APACHEⅡ, and NLR with T3 d sST2 ( r values were 0.226, 0.209, 0.193, all P < 0.01). Binary Logistic regression analysis showed that T3 d sST2 and NLR were both independent risk factors for MACE in moderate-severe ACOP patients with myocardial injury [odds ratio ( OR) and 95% confidence interval (95% CI) respectively was 1.064 (1.039-1.090), 1.176 (1.066-1.298), both P < 0.01]. ROC curve analysis showed that the predictive efficacy of NLR combined with T3 d sST2 for the occurrence of in-hospital MACE in patients with ACOP myocardial injury (AUC = 0.876) was better than that of NLR (AUC = 0.754) and T3 d sST2 (AUC = 0.813). When the optimal critical value of NLR was 10.02 and that of T3 d sST2 was 43.50 μg/L, the sensitivity of predicting the occurrence of MACE in patients with moderate-severe ACOP myocardial injury was 69.8% and 86.2% respectively, and the specificity was 74.3% and 70.4%, respectively. The specificity and sensitivity of the combined detection was 83.4% and 79.8%, respectively. Conclusions:NLR and T3 d sST2 were independent predictors of in-hospital MACE in moderate-severe ACOP patients with myocardial injury, and combined application of NLR and T3 d sST2 had good predictive value. For patients with moderate-severe ACOP myocardial injury with NLR > 10.02 and T3 d sST2 > 43.50 μg/L, the occurrence of in-hospital MACE should be alert.

15.
Chinese Critical Care Medicine ; (12): 809-814, 2021.
Article in Chinese | WPRIM | ID: wpr-909409

ABSTRACT

Objective:To analyze the prognostic risk factors of patients with sepsis and the clinical characteristics of patients with septic myocardial injury.Methods:A retrospective study was conducted. The clinical data of 300 patients with sepsis admitted to emergency department of Zhongshan Hospital of Fudan University from September 2017 to June 2020 were enrolled, including basic information, blood test indicators and auxiliary inspection indicators. The patients were grouped according to myocardial injury and the clinical characteristics of patients with septic myocardial injury were analyzed. According to 28-day prognosis, they were divided into survival group and non-survival group. The differences in various indicators between the two groups were compared, and binary Logistic regression was used to explore independent risk factors for death in patients with sepsis.Results:In 300 patients, 47 patients were excluded for previous heart disease or lack of the main inspections, and 253 patients were enrolled finally. ① Myocardial injury occurred in 136 out of 253 patients (53.8%), and 117 without myocardial injury. Compared with the non-myocardial injury group, the myocardial injury group had higher blood white blood cell count [WBC (×10 9/L): 9.7 (6.7, 13.4) vs. 8.3 (5.4, 12.2)] and procalcitonin [PCT (μg/L): 0.61 (0.18, 4.63) vs. 0.23 (0.09, 0.99)] at admission, and more Staphylococcal infections (17.6% vs. 2.6%), more arrhythmia (sinus tachycardia: 30.9% vs. 23.1%), more ST-T changes (26.5% vs. 23.1%), lower left ventricular ejection fraction [LVEF: 0.60 (0.54, 0.65) vs. 0.62 (0.60, 0.66)], higher pulmonary artery systolic pressure [PASP (mmHg, 1 mmHg = 0.133 kPa): 38.0 (32.2, 46.0) vs. 33.0 (30.0, 40.2)], and worse prognosis (28-day mortality: 44.1% vs. 6.0%, all P < 0.05). Logistic regression analysis showed that PCT increased [odds ratio ( OR) = 1.039, 95% confidence interval (95% CI) was 1.018-1.060, P < 0.01], LVEF decreased ( OR = 0.828, 95% CI was 0.729-0.941, P < 0.01) and sinus tachycardia ( OR = 3.512, 95% CI was 1.417-8.702, P < 0.01) were clinical characteristics of septic patients with myocardial injury. ② A total of 186 of the 253 patients survived, and 67 died with 28-day mortality of 26.5%. Compared with the survival group, non-survival group had higher myocardial markers and inflammation markers at admission [cardiac troponin T (cTnT, μg/L): 0.06 (0.02, 0.17) vs. 0.02 (0.01, 0.05), N-terminal pro-brain natriuretic peptide (NT-proBNP, ng/L): 3 037.0 (1 308.7, 12 033.7) vs. 893.9 (272.8, 2 825.5), creatine kinase (CK, U/L): 144.5 (57.5, 660.8) vs. 89.5 (47.8, 201.0), WBC (×10 9/L): 10.5 (6.7, 14.6) vs. 8.6 (6.0, 12.0), C-reactive protein (CRP, mg/L): 89.2 (54.8, 128.5) vs. 63.8 (19.3, 105.6), PCT (μg/L): 2.13 (0.31, 11.79) vs. 0.28 (0.10, 1.25), all P < 0.05], and more sinus tachycardia and atrial arrhythmia (41.8% vs. 22.0%, 29.9% vs. 17.7%, both P < 0.05). Logistic regression analysis showed that cTnT increased ( OR = 2.115, 95% CI was 1.189-5.459, P < 0.05), sinus tachycardia ( OR = 2.557, 95% CI was 1.103-5.929, P < 0.05) and atrial arrhythmia ( OR = 2.474, 95% CI was 1.025-5.969, P < 0.05) were independent risk factors for 28-day death in patients with sepsis. Conclusions:Myocardial injury is an independent risk factor for death in patients with sepsis. PCT elevation, LVEF decreased and sinus tachycardia are main characteristics of patients with septic myocardial injury, which should attract clinical attention.

16.
Article in Chinese | WPRIM | ID: wpr-907275

ABSTRACT

Myocardial dysfunction is an essential complication of sepsis and a significant cause of death in patients with sepsis.Sepsis has been shown to mediate myocardial dysfunction through multiple molecular pathways.With the application of technologies such as 16SrRNA and shotgun sequencing and the in-depth understanding of related pathophysiological mechanisms, it has been discovered that there is a complex interaction between gut microbiota and sepsis.Not only does sepsis change the gut microbiota, but the gut microbiota also widely affects the occurrence and development of sepsis.Some treatment methods based on gut microbiota are also considered to have good application prospects.In addition, intestinal microecology has been proved by a large number of studies to be related to various cardiovascular diseases.However, the current understanding of the mechanism by which the gut microbiota plays a role in sepsis-mediated myocardial dysfunction is still minimal.This article summarizes the pathophysiological mechanisms of sepsis, gut microbiota, and myocardial dysfunction that affect each other, which is helpful to deepen the understanding and thinking of researchers in the related fields.

17.
China Pharmacy ; (12): 2846-2853, 2021.
Article in Chinese | WPRIM | ID: wpr-906650

ABSTRACT

OBJECTIVE:To study the improvement effects of paeon iflorin(PF)on myocardial injury in type 2 diabetes mellitus(T2DM)model rats and its mechanism. METHODS :The experiment was set up in the normal group ,model group , positive control group (metformin 90 mg/kg),PF high-dose ,medium-dose and low-dose groups (90,60,30 mg/kg),with 8 rats in each group. Except for normal group ,other groups were given high-glucose and high-fat diet and intraperitoneal injection of streptozotocin (30 mg/kg) to induce T 2DM model. After modeling , administration groups were given relevant medicine intragastrically,normal group and model group were given constant volume of normal saline intragastrically ,once a day ,for consecutive 4 weeks. The body weight ,fasting blood glucose and oral glucose tolerance were measured ;serum levels of glycosylated serum protein (GSP),total cholesterol (TC),triacylglycerol(TG),glutathione peroxidase (GSH-Px),superoxide dismutase(SOD),malondialdehyde(MDA),creatine kinase isoenzyme-MB (CK-MB) and troponin Ⅰ (cTn Ⅰ) were determined. The pathomorphological changes of myocardium were observed. The apoptosis index of rat cardiomyocytes was ( detected. The protein expression of B-cell lymphoma 2 (Bcl-2),Bcl-2 related X protein (Bax)and caspase- 3 in rat myocardium were detected by immunohistochemistry and Western blot. RE SULTS:Compared with normal group ,the body weight ,serum levels of GSH-Px and SOD ,protein expression of Bcl- 2 in myocardium were decreased significantly in model group(P<0.01);while fasting blood glucose ,area under blood glucose curve ,serum levels of biochemical indexes (GSP,TC, TG,MDA,CK-MB,cTnⅠ),cardiomyocyte apoptosis index ,protein expression of Bax and caspase- 3 in myocardium were increased significantly (P<0.05 or P<0.01). The arrangement of myocardium was relatively irregular ,and some muscle fibers were broken. Compared with model group ,except for body weight ,serum levels of SOD and MDA ,the protein expression of Bax in myocardium in PF low-dose group , above indexes of PF groups were reversed significantly (P<0.05 or P<0.01). CONCLUSIONS:PF can regulate glycolipid metabolism ,enhance antioxidant ability ,inhibit cardiomyocyte apoptosis and improve myocardial injury in T 2DM model rats ;the mechanism may be associated with increasing the protein expression of Bcl- 2 and down-regulating the protein expression of Bax and caspase- 3 in myocardium.

18.
Article in Chinese | WPRIM | ID: wpr-906303

ABSTRACT

Objective:To evaluate the clinical efficacy of Qingkailing injection in the treatment of children with sepsis and heat syndrome, and investigate its anti-inflammatory, anticoagulant and protective effects. Method:Eighty patients were randomly divided into control group and observation group with forty cases in each group according to the number table. Both groups received comprehensive treatment measures such as fluid resuscitation, anti-infection, anti-inflammatory, anticoagulation, vasoactive drugs, and protection of vital organ functions. While patients in observation group additionally took Qingkailing injection, 5-10 mL each time, intravenous drip after dilution, 1 time/day. Treatment course was five days in both groups. Before and after treatment, the scores of quick sequential organ failure assessment (qSOFA), pediatric critical illness score (PCIS) and acute physiology and chronic health evalution Ⅱ (APACHEⅡ) were graded; procalcitonin (PCT), serum amyloid A protein (SAA) before and after treatment, heparin-binding protein (HBP), tumor necrosis factor-<italic>α</italic> (TNF-<italic>α</italic>), high-sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), IL-10, N-terminal brain sodium Peptide precursor (NT-proBNP), high-sensitivity cardiac troponin T (hs-cTnT) level, cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), <italic>D</italic>-dimer (<italic>D-</italic>D ), fibrinogen (FIB) and antithrombin Ⅲ (AT-Ⅲ) levels were detected. Result:The APACHEⅡ and qSOFA scores in the observation group were lower than those in the control group (<italic>P</italic><0.05), while the PCIS score was higher than that in the control group (<italic>P</italic><0.05). The levels of PCT, SAA,HBP,TNF-<italic>α</italic>, hs-CRP and IL-6 in the observation group were lower than those in the control group (<italic>P</italic><0.01), while the IL-10 level was higher than that in the control group (<italic>P</italic><0.01). The levels of NT-proBNP, hs-cTnT, cTnI, CK-MB, <italic>D</italic>-D and FIB in the observation group were lower than those in the control group (<italic>P</italic><0.01), while the AT-Ⅲ activity was higher than that in the control group (<italic>P</italic><0.01). Conclusion:Qingkailing injection as the adjuvant therapy in children with sepsis and fever syndrome, can play the role of anti-inflammatory, anticoagulant, reducing infection and myocardial damage, thereby reducing the severity of the disease and improving the prognosis.

19.
Chinese Journal of Biotechnology ; (12): 1168-1177, 2021.
Article in Chinese | WPRIM | ID: wpr-878622

ABSTRACT

Mitochondrion is a multifunctional organelle in cells and responsible for energy production, cell apoptosis and various life processes. Dysfunctional mitochondria are associated with hundreds of diseases. Increasing evidences have shown that extracellular mitochondria can be endocytosed by cells, directly into cells, and then play roles in cells. Mitochondria are the organelles that are extremely sensitive to oxygen content and pH of microenvironment that induces the adverse effect based on the cellular environment: mitochondria will increase cell survival and viability when they arrive in cells of physiological environment, but mitochondria will cause cell death when they enter the hypoxic and acidic tumor tissues, because they can produce a large amounts of oxygen free radicals. The pharmacological feature of environmental responsiveness of mitochondria could make them as a potential biological drug to kill cancer cells and restore the function of damaged tissues. Currently, mitochondria are used in the treatment of central nervous system diseases (Parkinson's disease, depression, schizophrenia, etc.), peripheral system diseases (ischemic myocardial injury, fatty liver, emphysema, etc.) and tumor. In this review, we summarize the research progress, medical application and challenges of mitochondrial therapy.


Subject(s)
Apoptosis , Mitochondria
20.
Article in Chinese | WPRIM | ID: wpr-873552

ABSTRACT

@#Objective    To explore the difference of myocardial injury between off-pump coronary artery bypass grafting (OPCAB) and modified perfusion on-pump coronary artery bypass grafting (ONCAB). Methods    A total of 558 patients who underwent coronary artery bypass grafting in Beijing Anzhen Hospital from 2017 to 2019 were included. According to whether or not they received modified perfusion cardiopulmonary bypass, all the 558 patients were divided into two groups including an OPCAB group (OP group) and an ONCAB group (ON group). There were 465 patients in the OP group including 282 males and 183 females with an average age of 63.58±7.87 years. In the ON group, there were 93 patients including 64 males and 29 females with an average age of 63.91±7.51 years. Creatine kinase MB (CK-MB) and cardiac specific troponin I (cTnI) were measured 24 hours before operation, 30 minutes after operation, 12 hours after operation, 36 hours after operation and 48 hours after operation. Results    No perioperative death occurred in all patients. CK-MB (5.00 ng/mL vs. 8.60 ng/mL, Z=–2.189, P=0.029) and cTnI (3.00 ng/mL vs. 7.80 ng/mL, Z=–5.307, P=0.000) in postoperative 12 hours in the ON group were less than those in the OP group. CK-MB (5.00 ng/mL vs. 5.60 ng/mL, Z=–2.280, P=0.023) and cTnI (0.10 ng/mL vs. 1.02 ng/mL, Z=–6.418, P=0.000) in postoperative 36 hours in the ON group were less than those in the OP group. cTnI (0.07 ng/mL vs. 0.81 ng/mL, Z=–1.946, P=0.032) in postoperative 48 hours in the ON group was less than that in the OP group. Conclusion    Compared with OPCAB, modified perfusion ONCAB has less myocardial damage. 

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