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1.
Article in Chinese | WPRIM | ID: wpr-933311

ABSTRACT

Objective:To investigate the role of Caveolin (Cav-3)/extracellular signal-regulated kinase (ERK) signaling pathway in reduction of myocardial ischemia-reperfusion (I/R) injury by morphine preconditioning in rats with chronic heart failure.Methods:Clean-grade healthy adult male Sprague-Dawley rats, weighing 200-250 g, were used in this study.Chronic heart failure was induced by ligating the left anterior descending coronary artery for 6 weeks.Thirty-six Langendorff-perfused hearts with chronic heart failure were divided into 4 groups ( n=9 each) by a random number table method: myocardial I/R group (group IR), morphine preconditioning group (group MP), morphine preconditioning plus methyl-β-cyclodextrin group (group MP+ MβCD), and methyl-β-cyclodextrin group (group MβCD). Global myocardial I/R was induced by 30 min ischemia followed by 120 min reperfusion.In group MP, after 15 min of equilibration, hearts were subjected to 3 cycles of 5 min perfusion with K-H solution containing 1 μmol/L morphine for preconditioning followed by 5 min perfusion with K-H solution, 30 min in total, and after the end of treatment, hearts were subjected to 30 min ischemia followed by 120 min reperfusion.In group MP+ MβCD, hearts were perfused with K-H solution containing 200 μmol/L methyl-β-cyclodextrin at 10 min before preconditioning with morphine, and the other treatments were similar to those previously described in group MP.In group MβCD, hearts were perfused with K-H solution containing 200 μmol/L methyl-β-cyclodextrin at 40 min before ischemia, and the other treatments were similar to those previously described in group IR.At the end of 15 min of equilibration (T 0) and 5 and 10 min of reperfusion (T 1, 2), coronary outflow was collected for determination of actate dehydrogenase (LDH) activity by chemical colorimetry.Myocardial infarct size (IS) and area at risk (AAR) were measured, and IS/AAR was calculated at the end of 120 min reperfusion.Myocardial tissues of left ventricle were taken to detect the expression of Cav-3, ERK1/2 and phosphorylated ERK1/2 (p-ERK1/2) by Western blot, and p-ERK1/2/ERK1/2 ratio was calculated. Results:Compared with group IR, IS, IS/AAR and LDH activity in coronary outflow were significantly decreased, the expression of Cav-3 was up-regulated, and p-ERK1/2/ERK1/2 ratio was increased in group MP ( P<0.05). Compared with group MP, IS, IS/AAR and LDH activity in coronary outflow were significantly increased, the expression of Cav-3 was down-regulated, and p-ERK1/2/ERK1/2 ratio was decreased in group MP+ MβCD ( P<0.05). Conclusions:The mechanism by which morphine preconditioning reduces I/R injury may be related to activation of Cav-3/ERK signaling pathway in rats with chronic heart failure.

2.
Article in Chinese | WPRIM | ID: wpr-933299

ABSTRACT

Objective:To evaluate the role of glucagon-like peptide-1 receptor (GLP-1R) signaling pathway in sevoflurane postconditioning-induced attenuation of myocardial ischemia-reperfusion (I/R) injury in rats.Methods:Eighty SPF healthy adult male Sprague-Dawley rats, aged 8-10 weeks, weighing 300-340 g, were divided into 4 groups ( n=20 each) by a random number table method: sham operation group (group S), myocardial I/R group (group I/R), myocardial I/R plus sevoflurane postconditioning group (group ISP), and myocardial I/R plus sevoflurane postconditioning plus GLP-1R antagonist group (group ISPE). The myocardial I/R injury model was developed by ligating the left anterior descending branch of the coronary artery for 40 min followed by 2-h reperfusion in anesthetized rats.In group ISP, the rats inhaled 2.4% sevoflurane for 15 min starting from the beginning of reperfusion.In group ISPE, GLP-1R antagonist Exendin9-39 50 μg/kg (in 1 ml 0.9% normal saline) was intraperitoneally injected once a day from 28 days before development of the model, the last intraperitoneal injection was completed at 40 min before inhalation of sevoflurane, and the other treatments were the same as those previously described in group ISP.Blood samples from the abdominal aorta were collected immediately after reperfusion to determine the serum levels of creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH). Then the rats were sacrificed, and the hearts were obtained for microscopic examination of the histopathological changes of myocardial tissues (by HE staining) and the ultrastructure of cardiomyocytes (with a transmission electron microscope) for determination of the myocardial infarct size (TTC staining), expression of GLP-1R in myocardium (by immunohistochemical staining), expression of GLP-1R, cyclic adenosine monophosphate (cAMP), protein kinase A (PKA), cAMP response element-binding protein (CREB), phospho-CREB (p-CREB), B-cell lymphoma-2 (Bcl-2) and Bcl-2 associated x protein (Bax) in myocardium (by Western blot). The ratios of p-CREB/CREB and Bcl-2/Bax were calculated. Results:Compared with group S, the serum levels of CK-MB and LDH and percentage of myocardial infarct size were significantly increased, the expression of GLP-1R was up-regulated, the expression of cAMP and PKA was down-regulated, and the p-CREB/CREB ratio and Bcl-2/Bax ratio were decreased in group I/R ( P<0.05). Compared with group I/R, the serum levels of CK-MB and LDH and percentage of myocardial infarct size were significantly decreased, the expression of GLP-1R, cAMP and PKA was up-regulated, and p-CREB/CREB ratio and Bcl-2/Bax ratio were increased in group ISP ( P<0.05). Compared with group ISP, the serum levels of CK-MB and LDH and percentage of myocardial infarct size were significantly increased, the expression of GLP-1R, cAMP and PKA was down-regulated, and the p-CREB/CREB ratio and Bcl-2/Bax ratio were decreased in group ISPE ( P<0.05). Conclusions:Sevoflurane postconditioning can attenuate myocardial I/R injury by activation of GLP-1R signal pathway and inhibition of cardiomyocyte apoptosis in rats.

3.
Article in Chinese | WPRIM | ID: wpr-931633

ABSTRACT

Objective:To investigate the diagnostic value of electrocardiographic ST-segment changes for myocardial injury related to percutaneous coronary intervention.Methods:We included 60 patients who received percutaneous coronary intervention in Haining People's Hospital from January 2020 to February 2021 in this study. We detected serum troponin I level before and after treatment and recorded electrocardiographic ST-segment changes. Taking serum troponin I level as a reference, we divided these patients into myocardial injury and non-myocardial injury groups and analyzed the influential factors of myocardial injury.Results:Balloon inflation time and stent length were (85.6 ± 56.2) minutes and (25.2 ± 15.2) mm in the myocardial injury group, and they were (48.5 ± 39.2) minutes and (17.2 ± 8.2) mm in the non-myocardial injury group. There were no significant differences in balloon inflation time and stent length between the two groups ( t = -3.01, -2.42, both P < 0.05). The proportion of patients with electrocardiographic ST-segment changes was significantly higher in the myocardial injury group than in the non-myocardial injury group [(80.77% (21/26) vs. 5.88% (2/34), χ2= 34.95, P < 0.001). Multivariable logistic regression analysis results showed that electrocardiographic ST-segment changes were an influential factor of myocardial injury ( r = 69.25, P < 0.05). Conclusion:Electrocardiographic ST-segment changes are an independent influential factor of myocardial injury related to percutaneous coronary intervention. It can effectively judge the possibility of developing a myocardial injury and increase the safety of percutaneous coronary intervention.

4.
Article in Chinese | WPRIM | ID: wpr-930125

ABSTRACT

Objective:To observer the effect of electroacupuncture at "Neiguan", "Ximen" and "Hegu" acupoints of the Pericardium Meridian and observe the expression of CaMK Ⅱ mRNA and apoptosis in the myocardial ischemic rats with reperfused injury.Methods:The Wister rats were randomly divided into sham operation group, model group, Acupuncture Neiguan group, Acupuncture Ximen group and Acupuncture Hegu group, with 10 rats in each group. Exceptthe sham operation group, the othergroups were all ligated with the left anterior descending branch of the coronary artery. Before ligating the coronary artery, electroacupuncture was performed at "Neiguan", "Ximen" and "Hegu" points for 20 minutes respectively. After the ligation for 40 minutes, electroacupuncture was performed at the above points for 20 minutes and then restore coronary perfusion for 60 minutes. The ECG changes of rats were recorded. The level of CaMK Ⅱ mRNA was detected by RT-PCR and the apoptosis rate of cardiomyocytes was detected by TUNEL. The correlation between the expression rate of CaMK Ⅱ mRNA and the apoptosis rate of cardiomyocytes was analyzed according to the pearson correlation.Results:At 20, 40 and 60 min after the ligation of coronary artery and 30 and 60 min after the loosening of coronary artery, compared with the model group and Acupuncture Hegu group, the ST segment difference of Acupuncture Neiguan group and Acupuncture Ximen group was decreased ( P<0.01); The levels of CaMK Ⅱ mRNA (0.483 ± 0.050, 0.432 ± 0.079 vs. 0.935 ± 0.109) in Acupuncture Neiguan group and Acupuncture Ximen group were significantly decreased ( P<0.01). The apoptosis rate of cardiomyocytes (10.86% ± 2.17%, 9.66% ± 4.09% vs. 36.22% ± 1.69%) significantly decreased ( P<0.01). Conclusions:There is a positive correlation between CaMK Ⅱ mRNA level and cardiomyocyte apoptosis during myocardial ischemia-reperfusion. Acupuncture can effectively reduce CaMK Ⅱ mRNA level and cardiomyocyte apoptosis rate and protect cardiomyocytes.

5.
Article in Chinese | WPRIM | ID: wpr-909209

ABSTRACT

Objective:To investigate the protective effects of levosimendan combined with lyophilized recombinant human brain natriuretic peptide (rhBNP) on myocardium in patients with acute myocardial infarction complicated by heart failure.Methods:140 patients with acute myocardial infarction complicated by heart failure who received treatment in Changxing People's Hospital from June 2018 to June 2020 were included in this study. They were randomly assigned to receive either routine treatment (control group, n = 70) or routine treatment, levosimendan combined with rhBNP (study group, n = 70). Serum levels of creatine kinase (CK)-MB, cardiac troponin I (cTnI), lactate dehydrogenase (LDH), high-sensitivity C-reactive protein (hs-CRP), which were associated with myocardial injury, were measured in each group. In addition, the changes in cardiac ultrasound indexes left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD) and left ventricular ejection fraction (LVEF) were observed. Clinical effects on heart failure were evaluated. Adverse drug reactions were monitored during the treatment. Results:After treatment, CK-MB, cTnI, LDH and hs-CRP levels in the study group were (56.73 ± 12.15) U/L, (0.41 ± 0.19) μg/L, (126.83 ± 15.26) U/L and (1.59 ± 0.27) mg/L, respectively, which were significantly lower than those in the control group [(78.52 ± 14.07) U/L, (0.68 ± 0.21) μg/L, (187.25 ± 23.04) U/L, (2.84 ± 0.41) mg/L, t = 5.569-12.418, all P < 0.05]. LVEDD and LVESD in the study group were significantly lower than those in the control group, while LVEF in the study group was significantly higher than that in the control group ( t = 4.435-6.426, all P < 0.05). Total effective rate in the study group was significantly higher than that in the control group [88.57% (62/70) vs. 72.86% (51/70), χ2 = 5.552, P < 0.05]. There was no significant difference in total incidence of adverse drug reactions between study and control groups [11.43% (8/70) vs. 8.57% (6/70), χ2 = 0.317, P > 0.05]. Conclusion:Levosimendan combined with rhBNP can effectively alleviate myocardial injury in patients with acute myocardial infarction complicated by heart failure, improve myocardial function, is highly safe, and thereby deserves clinical application.

6.
Article in Chinese | WPRIM | ID: wpr-907683

ABSTRACT

Objective:To analize the mechanism of Xiaoxianxiong Decoction on myocardial ischemiareperfusion injury by network pharmacological method and molecular docking technology. Methods:The effective components and corresponding target proteins of Xiaoxianxiong Decoction were screened by TCMSP, and the predicted target protein names were converted to gene names in UniProt database. The gene target of myocardial ischemia reperfusion injury was screened through the GeneCards and OMIM database. Venn online software was used to obtain the common target of drugs and diseases, then the visual analysis and the "compound-target" network diagram was constructed by using Cytoscape software. The protein interaction network was made by using STRING database and Cytoscape software, and the network topology was analyzed. Molecular docking software (autodock Vina) was used to verify the molecular docking between the top five active components and the top ten core targets, and the GO function of target genes and enrichment analysis of KEGG pathway were analyzed by Bioconductor R software package. Results:After the screening, 38 effective chemical components and 187 target genes of Xiaoxianxiong Decoction and 511 disease-related target genes were obtained. 72 common target genes of drug diseases were obtained. The core targets involved AKT1, MMP9, IL1B, EGF, etc. Go function analysis showed 1 095 biological processes, 24 cell components, 61 molecular functions, and KEGG pathway analysis found 111 related signal pathways. Conclusion:This study predicted that Xiaoxianxiong Decoction could treat myocardial ischemia-reperfusion injury through multiple targets such as AKT1, MMP9, IL1B, EGF, and multiple pathways such as IL-17 signaling pathway and PI3K-Akt signaling pathway, which laid a foundation for further study on the material basis and molecular mechanism of this compound.

7.
Chinese Journal of Anesthesiology ; (12): 1510-1513, 2021.
Article in Chinese | WPRIM | ID: wpr-933284

ABSTRACT

Objective:To evaluate the role of endoplasmic reticulum stress in myocardial ischemia-reperfusion (I/R) injury and the relationship with autophagy in rats.Methods:Thirty-six healthy adult male Sprague-Dawley rats, weighing 250-300 g, were divided into 3 groups ( n=12 each) using a random number table method: sham operation group (Sham group), myocardial I/R group (IR group), and endoplasmic reticulum stress inhibitor 4-PBA group (PBA group). Myocardial I/R was produced by occlusion of left anterior descending branch of coronary artery for 30 min followed by reperfusion for 120 min.Sham group only underwent thoracotomy without block of left anterior descending branch of coronary artery.Endoplasmic reticulum stress inhibitor 4-PBA 500 mg·kg -1·d -1 was given intragastrically for 3 consecutive days before the I/R model was developed in PBA group, while the equal volume of normal saline was given instead in Sham and IR groups.The blood samples from the iliac vein were collected at 120 min of reperfusion for determination of the plasma creatine kinase isoenzymes (CK-MB) and cardiac troponin I (cTnI) concentrations (by enzyme-linked immunosorbent assay). The rats were then sacrificed, and myocardial tissues were removed for detection of myocardial glucose-regulated protein 78 (GRP78) and microtubule-associated protein 1 light chain 3 Ⅱ (LC3 Ⅱ) and autophagy-related protein 5 (ATG5) expression (by Western blot). Result:Compared with Sham group, the concentrations of CK-MB and cTnI in plasma were significantly increased in IR and PBA groups, the expression of GRP78, ATG5 and LC3Ⅱ was up-regulated, and the pathological damage was aggravated in IR group ( P<0.05). Compared with IR group, the concentrations of CK-MB and cTnI in plasma were significantly decreased, the expression of GRP78, ATG5 and LC3Ⅱ was down-regulated ( P<0.05), and the pathological changes were significantly attenuated in PBA group. Conclusion:Endoplasmic reticulum stress is involved in the process of myocardial I/R injury, and the mechanism may be related to promotion of autophagy in rats.

8.
Chinese Journal of Anesthesiology ; (12): 1382-1386, 2021.
Article in Chinese | WPRIM | ID: wpr-933261

ABSTRACT

Objective:To evaluate the role of phosphoglycerate mutase 5 (phosphoglycerate mutase family member 5, PGAM5) in myocardial ischemia-reperfusion (I/R) injury in diabetic rats and the relationship with mitochondrial quality.Methods:SPF healthy male Sprague-Dawley rats, aged 6-8 weeks, weighing 200-220 g, were used in this study.Type 1 diabetes mellitus was induced by 1% streptozotocin diluted in citrate buffer solution 60 mg/kg.The rats were continuously fed for 8 weeks after successful establishment of the model.Seventy-two rats with type 1 diabetes mellitus were divided into 4 groups ( n=18 each) by a random number table method: diabetic sham operation group (DS group), diabetic myocardial I/R group (DIR group), diabetic myocardial I/R plus AAV9-PGAM5 shRNA group (DIR+ PGAM5 shRNA group), and diabetic myocardial I/R plus AAV9-GFP group (DIR+ GFP group). The myocardial I/R model was established by ligation of the left anterior descending coronary artery for 30 min followed by reperfusion for 2 h starting from 8 weeks after establishment of type 1 diabetes mellitus model.AAV9-PGAM5 shRNA and AAV9-GFP 2×10 12 μg/kg were slowly injected via tail vein 3 weeks before ischemia.In group AAV9-PGAM5 shRNA, left ventricular systolic pressure (LVSP) and the maximum rate of increase or decrease in left ventricular systolic pressure (±dp/dt max) were monitored and recorded at the end of reperfusion, and then blood samples from the the right carotid artery were collected for determination of serum troponin Ⅰ(cTnI), creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH) levels (by enzyme-linked immunosorbent assay). The animals were sacrificed and hearts were obtained for determination of myocardial infarct size (by Evans Blue plus TTC double staining method) and expression of PGAM5, autophagy-related proteins (LC3B, p62), dynamin-related protein 1 (Drp1), and mitochondrial autophagy receptor protein (FUNDC1) (by Western blot) and for microscopic examination of pathological changes of myocardial tissues (by HE staining). Results:Compared with group DS, the LVSP and ±dp/dt max were significantly decreased, the serum levels of cTnI, CK-MB and LDH were increased, myocardial infarct size was increased, the expression of PGAM5, LC3B, Drp1 and FUNDC1 was up-regulated, and the expression of p62 was down-regulated in group DIR and group DIR+ GFP ( P<0.05). Compared with group DIR, LVSP and ±dp/dt max were significantly increased, the serum levels of cTnI, CK-MB and LDH were decreased, myocardial infarct size was decreased, the expression of PGAM5, LC3B, Drp1 and FUNDC1 was down-regulated, and the expression of p62 was up-regulated in group DIR+ PGAM5 shRNA ( P<0.05), and no significant change was found in the parameters mentioned above in group DIR+ GFP ( P>0.05). Conclusion:PGAM5 is involved in the myocardial I/R injury in diabetic rats, which is related to the reduction of mitochondrial quality.

9.
Article in Chinese | WPRIM | ID: wpr-885976

ABSTRACT

Objective: To observe the effect of electroacupuncture (EA) pretreatment on the protein expression of c-fos in fastigial nucleus (FN) and lateral hypothalamus area (LHA) in rats with acute myocardial ischemia-reperfusion injury (MIRI), and to explore the role and mechanism of FN and LHA in EA at the Heart Meridian fighting against acute MIRI reaction. Methods: Seventy Sprague-Dawley rats were randomly divided into a sham operation group, a model group, an EA-Heart Meridian group and an EA-Lung Meridian group, with 14 rats in each group; an LHA lesion plus EA-Heart Meridian group (LHA+EA-Heart Meridian group) and a FN lesion plus EA-Heart Meridian group (FN+EA-Heart Meridian group), with 7 rats in each group. Except the sham operation group, the left anterior descending branch of coronary artery was ligated to establish acute MIRI rat models in the other 5 groups. In the three groups with EA-Heart Meridian treatment, Shenmen (HT 7) and Tongli (HT 5) were selected; Taiyuan (LU 9) and Lieque (LU 7) were selected in the EA-Lung Meridian group. All the EA groups received EA stimulation prior to modeling, with 1 mA in current intensity and 2 Hz in frequency, 20 min each time, once a day for a total of 7 d. The sham operation group and the model group did not receive EA stimulation. The electrocardiogram was observed in the rats to analyze the ST-segment deviation and cardiac arrhythmia score. The expression of c-fos protein in FN and LHA was detected by immunohistochemistry method. Results: Compared with the sham operation group, the ST-segment deviation, cardiac arrhythmia score and the expression of c-fos protein in the FN and LHA increased significantly in the model group (all P<0.05). Compared with the model group, the ST-segment deviation, cardiac arrhythmia score and the expression of c-fos protein in FN and LHA decreased significantly in the EA-Heart Meridian group (all P<0.05). Compared with the EA-Heart Meridian group, the ST-segment deviation and cardiac arrhythmia score increased significantly in the EA-Lung Meridian group, LHA+EA-Heart Meridian group and FN+EA-Heart Meridian group (all P<0.05); the expression of c-fos in FN increased significantly in the EA-Lung Meridian group and LHA+EA-Heart Meridian group (both P<0.05); the expression of c-fos in LHA increased significantly in the EA-Lung Meridian group and FN+EA-Heart Meridian group (both P<0.05). Conclusion: FN and LHA are involved in the mechanism of EA at Heart Meridian to improve the acute MIRI reactions, and the cerebellum may participate in the improvement of cardiac function by EA through the cerebellum-hypothalamus projection.

10.
Article in Chinese | WPRIM | ID: wpr-911308

ABSTRACT

Objective:To investigate the role of receptor-interacting protein kinse3 (RIPK3)-mediated necroptosis in diabetic mellitus-caused abolition of cardioprotection induced by sevoflurane postconditioning in rats.Methods:Eighty rats with diabetes mellitus, aged 4-5 weeks, weighing 90-100 g, were divided into 4 groups ( n=20 each) using a random number table method: sham operation group (group Sham), myocardial ischemia-reperfusion (I/R) group (group I/R), sevoflurane postconditioning group (group SP) and sevoflurane postconditiong plus RIPK3 inhibitor GSK-872 group (group GSK). Myocardial I/R was induced by 40 min occlusion of the left anterior descending branch of the coronary artery followed by 120 min reperfusion.In group SP, 2.4% sevoflurane was inhaled for 15 min at the beginning of reperfusion.In group GSK, GSK-872 3.3 mg/kg (dissolved in normal saline) was intraperitoneally injected at 24 and 2 h before surgery, and the other treatments were similar to those previously described in group SP.After 120 min of reperfusion, blood samples from the abdominal aorta were collected for determination of concentrations of serum lactate dehydrogenase (LDH) and creatine kinase-MB (CK-MB). Myocardial tissues were taken for determination of percentage of myocardial infarct size (by TTC staining) and expression of RIPK3, phospho-Ca 2+ -calmodulin-dependent protein kinase Ⅱ (p-CaMKⅡ) and phospho-mixed lineage kinase domain-like protein (p-MLKL) (by Western blot), and the ultrastructure of myocardium was observed by transmission electron microscopy. Results:Compared with group Sham, the serum LDH and CK-MB concentrations and percentage of myocardial infarct size were significantly increased, the expression of RIPK3, p-MLKL and p-CaMKⅡ in myocardial tissues was up-regulated ( P<0.05), and the damage to cardiomyocytes was severe in group I/R.Compared with group I/R, no significant change was found in the parameters mentioned above in group SP ( P>0.05). Compared with group SP, the serum LDH and CK-MB concentrations and percentage of myocardial infarct size were significantly decreased, the expression of RIPK3, p-MLKL and p-CaMKⅡ in myocardial tissues was down-regulated ( P<0.05), and the damage to cardiomyocytes was reduced in group GSK. Conclusion:The mechanism of diabetic mellitus-caused abolition of cardioprotection induced by sevoflurane postconditioning is related to excessive activation of RIPK3-mediated necroptosis in rats.

11.
Article in Chinese | WPRIM | ID: wpr-911281

ABSTRACT

Objective:To evaluate the relationship between the mitochondrial mechanism of diabetic mellitus-caused abolition of cardioprotection induced by ischemia postconditioning (IPO) and succinate dehydrogenase (SDH) in rats.Methods:Thirty-six SPF male non-diabetic Sprague-Dawley rats, aged 16-20 weeks, weighing about 300 g, were divided into 3 groups ( n=12 each) using a random number table method: sham operation group (ND+ Sham group), ischemia-reperfusion (I/R) group (ND+ I/R group) and IPO group (ND+ IPO group). Seventy-two rats with diabetes mellitus were divided into 6 groups ( n=12 each) using a random number table method: sham operation group (DM+ Sham group), I/R group (DM+ I/R group), DM+ IPO group, sham operation+ dimethyl malonate group (group DM+ Sham+ Dme), I/R+ dimethyl malonate group (group DM+ I/R + Dme) and IPO+ dimethyl malonate group (group DM+ IPO+ Dme). The model of cardiopulmonary bypass (CPB) was established, and the model of total I/R injury was induced by ligating the ascending aorta for 30 min followed by 60 min of reperfusion.The animals underwent 3 cycles of 30-s reperfusion followed by 30-s ischemia starting from the onset of reperfusion in each IPO group.In each Dme group, dimethyl malonate was infused through the tail vein at a rate of 4 mg· kg -1·min -1 for 40 min starting from the beginning of CPB.At the end of reperfusion, the myocardial tissues were taken for measurement of mitochondrial respiratory control ratio (RCR) (by the Lufthansa electrode method), mitochondrial membrane potential (MMP) (by the JC-1 method) and the opening of mitochondrial permeability transition pore (mPTP) (by absorptiometry) and for determination of the activity of reactive oxygen species (ROS) (with the fluorescent probe), succinate dehydrogenase (SDH) (using spectrophotometric method) and the contents of succinic acid and fumarate. Results:Compared with ND+ Sham group, the activities of SDH and ROS, opening of mPTP and content of fumarate were significantly increased, and MMP, RCR and succinic acid content were decreased in ND+ I/R ( P<0.05). Compared with group ND+ I/R, the activities of SDH and ROS, opening of mPTP and content of fumarate were significantly decreased, and MMP, RCR and succinic acid content were increased in ND+ IPO ( P<0.05). Compared with group DM+ Sham, the activities of SDH and ROS, opening of mPTP and content of fumarate were significantly increased, and MMP, RCR and succinic acid content were decreased in group DM+ I/R ( P<0.05). Compared with group DM+ I/R, no significant change was found in the parameters mentioned above in group DM+ IPO ( P>0.05). Compared with group DM+ IPO, the activities of SDH and ROS, opening of mPTP and content of fumarate were significantly decreased, and MMP, RCR and succinic acid content were increased in group DM+ IPO+ Dme ( P<0.05). Compared with group DM+ I/R+ Dme, the activities of SDH and ROS, opening of mPTP and content of fumarate were significantly decreased, and MMP, RCR and succinic acid content were increased in group DM+ IPO+ Dme ( P<0.05). Conclusion:The mitochondrial mechanism of diabetic mellitus-caused abolition of cardioprotection induced by IPO may be related to the enhancement of SDH activity in rats.

12.
Article in Chinese | WPRIM | ID: wpr-911246

ABSTRACT

Objective:To evaluate the effect of activating adenosine A2B receptors on autophagy during myocardial ischemia-reperfusion (I/R) and the role of phosphatidylinositol 3-kinase/serine/threonine protein kinase (PI3K/Akt) signaling pathway in rats.Methods:Forty-eight clean-grade healthy male Sprague-Dawley rats, weighing 220-280 g, were divided into 4 groups ( n=12 each) using a random number table method: sham operation group (group Sham), myocardial I/R group (group I/R), adenosine A2B receptor agonist BAY 60-6583 group (group BAY) and BAY 60-6583+ PI3K inhibitor LY 294002 group (group BAY+ LY). Myocardial I/R was induced by occlusion of the anterior descending branch of the left coronary artery for 30 min followed by 120-min reperfusion.BAY 60-6583 1 mg/kg was intraperitoneally injected at 5 min before reperfusion in group BAY.BAY 60-6583 1 mg/kg was intraperitoneally injected at 5 min before reperfusion and LY 294002 10 mg/kg was intraperitoneally injected at 10 min before reperfusion in group BAY+ LY.Blood samples were obtained at the end of reperfusion for determination of concentrations of lactate dehydrogenase (LDH) and creatine kinase-MB (CK-MB) in serum (by enzyme-linked immunosorbent assay). The animals were sacrificed, and myocardial tissues were obtained for measurement of the percentage of myocardial infarct size (by Evan Blue and TTC double-staining) and for determination of the expression of microtubule-associated protein 1 light chain 3 (LC3Ⅰ), LC3Ⅱ, Beclin-1 and phosphorylated Akt (p-Akt) (by Western blot). The ratio of LC3Ⅱ/LC3Ⅰ was calculated. Results:Compared with group Sham, the serum LDH and CK-MB concentrations and percentage of myocardial infarct size were significantly increased, the expression of p-Akt was down-regulated, the expression of Beclin-1 and LC3Ⅱ was up-regulated, and the ratio of LC3Ⅱ/LC3Ⅰ was increased in group I/R ( P<0.05). Compared with group I/R, the concentrations of serum LDH, CK-MB and percentage of myocardial infarct size were significantly decreased, the expression of p-Akt was up-regulated, the expression of Beclin-1 and LC3Ⅱ was down-regulated, and the ratio of LC3Ⅱ/LC3Ⅰ was decreased in the group BAY ( P<0.05), and no significant change was found in the parameters mentioned above in group BAY+ LY ( P>0.05). Compared with group BAY, the concentrations of serum LDH, CK-MB and percentage of myocardial infarct size were significantly increased, the expression of p-Akt was down-regulated, the expression of Beclin-1 and LC3Ⅱ was up-regulated and the ratio of LC3Ⅱ/LC3Ⅰ was increased in group BAY+ LY ( P<0.05). Conclusion:Activating adenosine A2B receptors can decrease autophagy of myocardial cells during myocardial I/R injury, and the mechanism may be related to activating PI3K/Akt signaling pathway in rats.

13.
Article in Chinese | WPRIM | ID: wpr-911242

ABSTRACT

Objective:To evaluate the role of hypoxia-inducible factor-1α (HIF-1α) in the renal injury induced by myocardial ischemia-reperfusion (I/R) in diabetic rats and its relationship with solute carrier family7 member11 (SLC7A11).Methods:SPF-grade healthy male Sprague-Dawley rats, aged 4 weeks, weighing 100-130 g, were fed with high-fat and high-sucrose diet freely.The weight of the rats was measured once a week.After the weight of the animals reached 240 g, 1% streptozotocin (STZ)-citrate buffer 35 mg/kg was injected intraperitoneally to induce type 2 diabetes mellitus.After injection of STZ, the animals were fed with high-fat and high-sucrose diet continuously.Blood samples were collected from the tail vein for determination of blood glucose concentrations 1 week later.When random blood glucose was ≥16.7 mmol/L for 3 times, the model of type 2 diabetes mellitus was considered to be established successfully.After the model was established successfully, the animals were fed with high-fat and high-sucrose diet continuously for 6 weeks.Eighteen rats with type 2 diabetes mellitus were selected and divided into 3 groups ( n=6 each) using a random number table method: diabetic sham operation group (group DS), diabetic myocardial I/R group (group DIR) and diabetic myocardial I/R+ HIF-1α agonist DMOG group (DIR+ DMOG group). Twelve non-diabetic rats were divided into 2 groups ( n=6 each) using a random number table method: non-diabetic sham operation group (NS group) and non-diabetic myocardial I/R group (NIR group). The rat myocardial I/R injury model was established by ligating the anterior descending branch of the left coronary artery for 30 min followed by 120 min reperfusion in anesthetized rats.Blood samples were collected from the right internal carotid artery at 120 min of reperfusion for determination of the serum creatinine (Cr), urea nitrogen (BUN) and neutrophil gelatinase-associated lipocalin (NGAL) concentrations (by enzyme-linked immunosorbent assay). Renal tissues were obtained for examination of the pathological changes (by HE staining method) and for determination of the expression of HIF-1α and SLC7A11 (by Western blot). The damage to the renal tubules was scored. Results:Compared with group NS, the concentrations of serum Cr, BUN and NGAL and renal tubular damage score were significantly increased in group DS and group NIR, the expression of HIF-1α and SLC7A11 was down-regulated in group DS, and the expression of HIF-1α and SLC7A11 was up-regulated in group NIR ( P<0.05). Compared with group DS, the concentrations of serum Cr, BUN and NGAL and renal tubular damage score were significantly increased, and the expression of HIF-1α and SLC7A11 was up-regulated in group DIR ( P<0.05). Compared with group NIR, the concentrations of serum Cr, BUN and NGAL and renal tubular damage score were significantly increased, and the expression of HIF-1α and SLC7A11 was down-regulated in group DIR ( P<0.05). Compared with group DIR, the concentrations of serum Cr, BUN and NGAL and renal tubular damage score were significantly decreased, and the expression of HIF-1α and SLC7A11 was up-regulated in group DIR+ DMOG ( P<0.05). Conclusion:HIF-1α is involved in the renal injury induced by myocardial I/R, which is related to regulation of the expression of SLC7A11 in rats.

14.
Article in Chinese | WPRIM | ID: wpr-911220

ABSTRACT

Objective:To evaluate the role of adiponectin in sevoflurane pretreatment-induced improvement in cognitive function in mice with myocardial ischemia/reperfusion (I/R).Methods:Thirty SPF healthy adult male wild-type C57 mice, aged 8-10 weeks, weighing 20-25 g, were divided into 3 groups ( n=10 each) using a random number table method: sham operation group (group Sham), myocardial I/R group (group MI/R) and sevoflurane pretreatment group (group SP). Another 10 SPF healthy male adiponectin knockout SPF mice, aged 8-10 weeks, weighing 20-25 g, were selected and served as APNKO group.Myocardial I/R was induced by 30 min occlusion of anterior descending branch of left coronary artery followed by reperfusion.In SP and APNKO groups, sevoflurane pretreatment included 3 cycles of 10-minute inhalation of 2% sevoflurane-93% O 2-5% CO 2 interspersed with 15-minute inhalation of 95% O 2-5% CO 2, and then the model was established.At 1, 2 and 4 days of reperfusion, cognitive function was assessed by Morris water maze test. Results:There was no significant difference in swimming velocity at each time point between the 4 groups ( P>0.05). Compared with group Sham, the escape latency was significantly prolonged, and the frequency of crossing the original platform was decreased at each time point in group MI/R ( P<0.05). Compared with group MI/R, the escape latency was significantly shortened, and the frequency of crossing the original platform was increased at each time point in group SP ( P<0.05). Compared with group SP, the escape latency was significantly prolonged, and the frequency of crossing the original platform was decreased at each time point in group APNKO ( P<0.05). Conclusion:Adiponectin is involved in the process of sevoflurane pretreatment-induced improvement in cognitive function in mice with myocardial I/R.

15.
Article in Chinese | WPRIM | ID: wpr-911215

ABSTRACT

Objective:To evaluate the relationship between the mechanism of protective effect of hydromorphone postconditioning on myocardium and phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathway-mediated autophagy in rats.Methods:Forty healthy male Sprague-Dawley rats, weighing 220-250 g, were divided into 5 groups ( n=8 each) using a random number table method: sham operation group (Sham group), ischemia-reperfusion (I/R) group (group IR), hydromorphone postconditioning group (group HP), PI3K inhibitor group (group W) and hydromorphone postconditioning+ PI3K inhibitor group (group HP+ W). Myocardial ischemia was induced by 30 min occlusion of left anterior descending branch of coronary artery followed by 120 min reperfusion.In group HP, hydromorphone 0.1 mg/kg was injected via femoral vein at 5 min before reperfusion in group HP.In group HP+ W, hydromorphone 0.1 mg/kg and wortmannin (PI3K inhibitor) 15 μg/kg were injected via femoral vein at 5 min before reperfusion.In group W, wortmannin 15 μg/kg was injected via femoral vein at 5 min before reperfusion.At the end of reperfusion, the myocardial infarct size (IS) was determined by TTC staining, the activities of serum lactate dehydrogenase (LDH) was detected by colorimetry, myocardial specimens were collected for microscopic examination of the ultrastructure (with a electron microscope), the expression of phosphorylated Akt (p-Akt) and microtubule-associated protein 1 light chain 3 (LC3) was determined by Western blot and the ratio of LC3-Ⅱ/Ⅰwas calculated. Results:Compared with Sham group, IS and the activities of serum of LDH were significantly increased, p-Akt expression in myocardial tissues was up-regulated, the ratio of LC3-Ⅱ/Ⅰwas increased ( P<0.05), autophagic vacuoles were increased and the damage of ultrastructure of cardiomyocytes was obvious in group IR.Compared with group IR, IS and the activities of serum of LDH were significantly decreased, p-Akt expression in myocardial tissues was up-regulated, the ratio of LC3-Ⅱ/Ⅰwas decreased ( P<0.05), autophagic vacuoles were decreased and the damage of ultrastructure of cardiomyocytes was attenuated in group HR.Compared with group HR, IS and the activities of serum of LDH were significantly increased, p-Akt expression in myocardial tissues was down-regulated, the ratio of LC3-Ⅱ/Ⅰwas increased ( P<0.05), autophagic vacuoles were increased and the damage of ultrastructure of cardiomyocytes was aggravated in group HR+ W. Conclusion:The mechanism of protective effect of hydromorphone postconditioning on myocardium is related to activation of PI3K/Akt signaling pathway and inhibition of autophagy in rats.

16.
Article in Chinese | WPRIM | ID: wpr-911214

ABSTRACT

Objective:To evaluate the role of Notch1/hairy and enhancer of split homolog1(Hes1) signaling pathway in high glucose and hypoxia-reoxygenation (H/R) injury to cardiomyocytes.Methods:H9c2 cardiomyocytes were cultured in low-glucose DMEM culture medium supplemented with 10% fetal bovine serum.The cells were divided into 6 groups ( n=12 each) using a random number table method: control group (group C), H/R group, H/R+ Jagged-1 group (group H/R+ J), high glucose group (group HG), high glucose+ H/R group (group HG+ H/R) and high glucose+ H/R+ Jagged-1 group (group HG+ H/R+ J). The cells were incubated in low-glucose culture medium for 72 h in group C. After incubated in low-glucose culture medium for 72 h, the cells were exposed to 24-h hypoxia in an incubator filled with 95% N 2-5% CO 2 at 37℃, immediately followed by 6-h reoxygenation in an incubator filled with 95% O 2-5% CO 2 at 37℃ in group H/R.In group H/R+ J, Jagged-1 (Notch1/Hes1 signaling pathway specific activator) 5μg/ml was added to low-glucose culture medium and the cells were incubated for 72h before H/R.In group HG, H9c2 cardiomyocytes were incubated in high-glucose culture medium containing 33 mmol/L glucose for 72 h. In group HG+ H/R, the cells were incubated in high-glucose medium for 72 h before H/R.In group HG+ H/R+ J, Jagged-1 5μg/ml was added to high-glucose culture medium, and the cells were incubated for 72 h before H/R.At 6 h of reoxygenation, the supernatant of the culture medium was collected for detection of the activities of superoxide dismutase (SOD) and lactic dehydrogenase (LDH), the cell viability (by CCK-8 assay) and the cell apoptosis rate (by flow cytometry) and for determination of expression of Notch1, Hes1 and c-caspase-3 (by Western blot). Results:Compared with group C, the cell survival rate and SOD activity were significantly decreased, and apoptosis rate and LDH activity were increased in H/R, H/R+ J and HG groups, expression of Notch1, Hes1 and c-caspase-3 was up-regulated in H/R and H/R+ J groups, and the expression of Notch1 and Hes1 was down-regulated and c-caspase-3 expression was up-regulated in group HG ( P<0.05). Compared with group H/R, the cell survival rate and SOD activity was significantly increased, apoptosis rate and LDH activity were decreased, expression of Notch1 and Hes1 was up-regulated, and c-caspase-3 expression was down-regulated in group H/R+ J, and the cell survival rate and SOD activity were significantly decreased, apoptosis rate and LDH activity were increased, expression of Notch1 and Hes1 was down-regulated, and c-caspase-3 expression was up-regulated in group HG+ H/R ( P<0.05). Compared with group HG, the cell survival rate and SOD activity were significantly decreased, and apoptosis rate and LDH activity were increased in HG+ H/R and HG+ H/R+ J groups ( P<0.05), and expression of Notch1 and Hes1 was down-regulated, and c-caspase-3 expression was up-regulated in group HG+ H/R ( P<0.05). Compared with group HG+ H/R, the cell survival rate and SOD activity were significantly increased, apoptosis rate and LDH activity were decreased, expression of Notch1 and Hes1 was up-regulated, and c-caspase-3 expression was down-regulated in group HG+ H/R+ J ( P<0.05). Compared with group H/R+ J, the cell survival rate and SOD activity were significantly decreased, apoptosis rate and LDH activity were increased, expression of Notch1 and Hes1 was down-regulated, and c-caspase-3 expression was up-regulated in group HG+ H/R+ J ( P<0.05). Conclusion:Activation of Notch1/Hes1 signaling pathway is the endogenous protective mechanism of high glucose and H/R injury to cardiomyocytes.

17.
Article in Chinese | WPRIM | ID: wpr-911199

ABSTRACT

Objective:To evaluate the role of nuclear factor E2-related factor 2 (NRF2) in myocardial ischemia-reperfusion (I/R) injury and the relationship with ferroptosis in diabetic rats.Methods:Forty-eight SPF healthy adult male Sprague-Dawley rats, aged 6-8 weeks, weighing 200-220 g, were divided into 5 groups by a random number table method: sham operation group (group S, n=6), myocardial I/R group (group NIR, n=12), diabetes mellitus+ sham operation group (group DS, n=6), diabetes mellitus+ myocardial I/R group (group DIR, n=12) and diabetes mellitus+ myocardial I/R+ NRF2 agonist sulforaphane group (group DIR+ SFN, n=12). Type 1 diabetes mellitus was induced by intraperitoneal injection of 1% streptozotocin-citrate buffer 60 mg/kg.Sulforaphane 500 μg·kg -1·d -1 was injected intraperitoneally before ischemia for 3 consecutive days in group DIR+ SFN.At the 8th week after establishing the model, myocardial I/R was produced by occlusion of the anterior descending branch of the left coronary artery for 30 min followed by reperfusion.At 2 h of reperfusion, the left ventricular systolic pressure (LVSP), HR, and the maximum rate of increase and decrease of left ventricular systolic pressure (±dp/dt max) were recorded.Blood samples were taken from the carotid artery and the animals were then sacrificed for determination of concentration of cardiac troponin I (cTnI) in serum (using enzyme-linked immunosorbent assay), myocardial Fe 2+ and malondialdehyde (MDA) contents, superoxide dismutase (SOD) activity (by colorimetry) and myocardial infarct size (using TTC) and for determination of expression of NRF2, ferroportin1 (FPN1) and acyl-CoA synthetase long-chain family member 4 (ACSL4) (by Western blot), and the pathological changes of lung tissues were observed by hematoxylin-eosin staining. Results:Compared with group S, LVSP, HR, and ±dp/dt max were significantly decreased, serum cTnI concentration and myocardial Fe 2+ and MDA contents were increased, SOD activity was decreased, expression of ACSL4 was up-regulated and expression of NRF2 and FPN1 was down-regulated in group NIR ( P<0.05). Compared with group DS, LVSP, HR, and ±dp/dt max were significantly decreased, serum cTnI concentration and myocardial Fe 2+ and MDA contents were increased, SOD activity was decreased, expression of ACSL4 was up-regulated and expression of NRF2 and FPN1 was down-regulated in group DIR ( P<0.05). Compared with group NIR, LVSP, HR, and ±dp/dt max were significantly decreased, serum cTnI concentration and myocardial Fe 2+ and MDA contents were increased, SOD activity was decreased, myocardial infarct size was increased, expression of ACSL4 was up-regulated and expression of NRF2 and FPN1 was down-regulated in group DIR ( P<0.05). Compared with group DIR, LVSP, HR, and ±dp/dt max were significantly increased, serum cTnI concentration and myocardial Fe 2+ and MDA contents were decreased, SOD activity was increased, myocardial infarct size was decreased, expression of ACSL4 was down-regulated and expression of NRF2 and FPN1 was up-regulated in group DIR+ SFN ( P<0.05). Conclusion:NRF2 is involved in the process of myocardial I/R injury, which is related to promoting ferroptosis in diabetic rats

18.
Arq. bras. cardiol ; 114(1): 78-86, Jan. 2020. tab, graf
Article in English | LILACS | ID: biblio-1055096

ABSTRACT

Abstract Background: Euterpe oleracea Mart. (açaí) is a fruit with high antioxidant capacity and could be an adjuvant strategy to attenuate ischemia-reperfusion injury. Objective: To evaluate the influence of açaí in global ischemia-reperfusion model in rats. Methods: Wistar rats were assigned to 2 groups: Control (C: receiving standard chow; n = 9) and Açaí (A: receiving standard chow supplemented with 5% açaí; n = 10). After six weeks, the animals were subjected to the global ischemia-reperfusion protocol and an isolated heart study to evaluate left ventricular function. Level of significance adopted: 5%. Results: There was no difference between the groups in initial body weight, final body weight and daily feed intake. Group A presented lower lipid hydroperoxide myocardial concentration and higher catalase activity, superoxide dismutase and glutathione peroxidase than group C. We also observed increased myocardial activity of b-hydroxyacyl coenzyme-A dehydrogenase, pyruvate dehydrogenase, citrate synthase, complex I, complex II and ATP synthase in the A group as well as lower activity of the lactate dehydrogenase and phosphofructokinase enzymes. The systolic function was similar between the groups, and the A group presented poorer diastolic function than the C group. We did not observe any difference between the groups in relation to myocardial infarction area, total and phosphorylated NF-kB, total and acetylated FOXO1, SIRT1 and Nrf-2 protein expression. Conclusion: despite improving energy metabolism and attenuating oxidative stress, açai supplementation did not decrease the infarcted area or improve left ventricular function in the global ischemia-reperfusion model.


Resumo Fundamento: Euterpe oleracea Mart. (açaí) é uma fruta com alta capacidade antioxidante e pode ser uma estratégia adjuvante para atenuar a lesão de isquemia-reperfusão. Objetivo: Avaliar a influência do açaí no modelo global de isquemia-reperfusão em ratos. Metodologia: Ratos Wistar foram divididos em 2 grupos: Controle (C: recebendo ração padrão; n = 9) e Açaí (A: recebendo ração padrão suplementada com 5% de açaí; n = 10). Após seis semanas, os animais foram submetidos ao protocolo global de isquemia-reperfusão e a estudo do coração isolado para avaliar a função ventricular esquerda. Nível de significância adotado: 5%. Resultados: Não houve diferença entre os grupos quanto ao peso corporal inicial e final, e a ingestão diária de ração. O grupo A apresentou menor concentração miocárdica de hidroperóxido lipídico e maior atividade de catalase, superóxido dismutase e glutationa peroxidase do que o grupo C. Também observamos aumento da atividade miocárdica da b-hidroxiacil coenzima-A desidrogenase, piruvato desidrogenase, citrato sintase, complexo I, complexo II e ATP sintase no grupo A, bem como menor atividade das enzimas lactato desidrogenase e fosfofructoquinase. A função sistólica foi semelhante entre os grupos, e o grupo A apresentou função diastólica pior que C. Não foram observadas diferenças entre os grupos em relação à área de infarto do miocárdio, e expressão proteica de NF-kB total e fosforilado, e das proteínas FOXO1, SIRT1 e Nrf-2. Conclusão: apesar de melhorar o metabolismo energético e atenuar o estresse oxidativo, a suplementação de açaí não diminuiu a área infartada nem melhorou a função ventricular esquerda no modelo global de isquemia-reperfusão.


Subject(s)
Animals , Male , Rats , Plant Extracts/pharmacology , Myocardial Reperfusion Injury/physiopathology , Oxidative Stress/drug effects , Energy Metabolism/drug effects , Euterpe/chemistry , Oxidative Stress/physiology , Disease Models, Animal , Energy Metabolism/physiology
20.
Acta cir. bras ; 35(12): e351206, 2020. graf
Article in English | LILACS | ID: biblio-1152686

ABSTRACT

Abstract Purpose: To investigate the protective effect of L-carnitine on myocardial injury in rats with heatstroke. Methods: orty-eight rats were randomly divided into control, heatstroke and 25, 50 and 100 mg/kg L-carnitine groups. The last three groups were treated with 25, 50 and 100 mg/kg L-carnitine, respectively, for seven successive days. Then, except for the control group, the other four groups were transferred into the environment with ambient temperature of (39.5 ± 0.4 °C) and relative humidity of (13.5 ± 2.1%) for 2 h. The core temperature (Tc), mean arterial pressure (MAP), heart rate (HR) and serum and myocardial indexes were detected. Results: Compared with the heatstroke group, in the 100 mg/kg L-carnitine group, the Tc was significantly decreased, the MAP and HR were significantly increased, the serum creatine kinase, lactate dehydrogenase, alkaline phosphatase, aspartate aminotransferase, tumor necrosis factor α and interleukin 1β levels were significantly decreased, the myocardial superoxide dismutase and glutathione peroxidase levels were significantly increased, the myocardial malondialdehyde level was significantly decreased and the cardiomyocyte apoptosis index and myocardial caspase-3 protein expression level were remarkably decreased (p < 0.05). Conclusions: The L-carnitine pretreatment can alleviate the myocardial injury in heatstroke rats through reducing the inflammatory response, oxidative stress and cardiomyocyte apoptosis.


Subject(s)
Animals , Carnitine/pharmacology , Heat Stroke/metabolism , Heat Stroke/drug therapy , Rats , Oxidative Stress , Malondialdehyde/metabolism , Myocardium/metabolism
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