Expert Consensus on Nutritional Support for Children with Congenital Heart Disease(2023 Edition)

The second edition of the expert consensus on pediatric nutrition was formed based on a global update of pedia-tric nutrition guidelines or consensus worldwide,the management of congenital heart disease,and the results of multi-center clinical nutrition research for congenital heart disease following thefirst Chinese consensus edition of 2016.The consensus was also shaped by the results of three discussion sessions and two questionnaires con-ducted by the 13-member collaboration group.This process was informed by both clinical guidelines and expert consensus.The quality of literature,both in English and Chinese,and the level of recommendations were evaluated using the Grading of Recommendations Assessment,Development,and Evaluations(GRADE)system.

Prenatal congenital heart defects in southern China:detection rate and termination of preqnancy,2006-2016

Objective Congenital heart defect (CHD) is one of the most common birth anomalies with high morbidity and mortality. Previous studies of CHD mostly focus on the postnatal prevalence, mortality and successful rate of operation, etc. This study aimed to explore the detection rate of prenatal CHD and CHD factors that attribute to termination of pregnancy (TOP).

Mediating Role of Glucose-Lipid Metabolism in the Association between the Increased Risk of Coronary Heart Disease and Exposure to Organophosphate Esters,Phthalates,and Polycyclic Aromatic Hydrocarbons

There is a lack of human evidence concerning the cardiovascular effects of combined exposure to endocrine disruptors.This case-control study sought to investigate coronary heart disease(CHD)associations with exposure to organophosphate flame retardants(OFRs),phthalates(PAEs),and polycyclic aromatic hydrocarbons(PAHs)among 148 adults with coronary-angiography-diagnosed CHD and 320 healthy adults from southern China.The mediating role of glucose-lipid metabolism was also explored.Bayesian kernel machine regression suggested that when exposure status was fixed to the 75th percentile with the median value as the reference,exposure to OFRs,PAEs,and PAHs was associated with an 84%(95%CI:36%−134%),132%(12%−252%),and 214%(89%−331%)increased risk of developing CHD,respectively.Weighted quantile sum regression indicated urinary bis(2-butoxyethyl)phosphate(BBOEP),dibutyl phosphate(DBP),monoisononyl phthalate(miNP),and metabolites of phenanthrene may be major contributors to the overall effect of mixtures.In further analyses on identified chemical risk factors,mediation analyses suggested exposure to phenanthrene may increase the risk of CHD via elevating total cholesterol and blood glucose,while exposure to DiNP mainly associates with serum lipids.Besides,we observed a slight mediation effect of oxidative DNA damage between urinary BBOEP and risk of CHD.These results provide potential direction for further experimental studies.Longitudinal evidence is needed to clarify the causation of the results.

Injectable conductive gelatin methacrylate/oxidized dextran hydrogel encapsulating umbilical cord mesenchymal stem cells for myocardial infarction treatment

Umbilical cord mesenchymal stem cells(UCMSCs)transplantation has been proposed as a promising treatment modality for myocardial infarction(MI),but the low retention rate remains a considerable challenge.Injectable natural polymer hydrogels with conductivity ability are highly desirable as cell delivery vehicles to repair infarct myocardium and restore the cardiac function.In this work,we developed a hydrogel system based on gelatin methacrylate(GelMA)and oxidized dextran(ODEX)as cell delivery vehicles for MI.And dopamine could be used as a reductant of graphene oxide(GO)to form reductive GO(rGO).By adjusting the amount of rGO,the conductivity of hydrogels with 0.5 mg/mL rGO concentration(≈10^(-4)S/cm)was similar to that of natural heart tissue.In vitro cell experiments showed that the prepared hydrogels had excellent biocompatibility and cell delivery ability of UCMSCs.More importantly,GelMA-O5/rGO hydrogel could promote UCMSCs growth and proliferation,improve the myocardial differentiation ability of UCMSCs,and up-regulate the expression of cTnI and Cx43.Further in vivo experiments demonstrated that GelMA-O5/rGO/UCMSCs Hydrogel could significantly improve the ejection fraction(EF)of rats and significantly reduce myocardial infarct area compared to PBS group,promote the survival of UCMSCs,enhance the expression level of cTnI and Cx43,and decrease the expression level of caspase-3.The findings of this study suggested that the injectable conductive GelMA-O5/rGO hydrogel encapsulating UCMSCs could improve damaged myocardial tissue and reconstruct myocardial function,which will be a promising therapeutic strategy for cardiac repair.

Expert consensus on the use of human serum albumin in adult cardiac surgery

Introduction Albumin,which is a 65-kDa liver-synthesized protein,accounts for nearly 50%of total plasma protein and contributes to approximately 80%of intravascular oncotic pressure.Albumin helps maintain microvascular integrity,functions as an antioxidant,and transports hormones,fatty acid,bile salts,bilirubin,electrolytes(e.g.,calcium,magnesium,copper,zinc,et al.),and drugs.[1–3]Human serum albumin(HSA)is a sterile,liquid albumin product derived from large pools of human plasma by fractionation and pasteurization.The medical use of HAS could date back to approximately the time of World War II.

Emerging Evidence Linking the Liver to the Cardiovascular System: Liver-derived Secretory Factors

Cardiovascular diseases(CVDs)remain the leading cause of morbidity and mortality worldwide.Recently,accumulating evidence has revealed hepatic mediators,termed as liverderived secretory factors(LDSFs),play an important role in regulating CVDs such as atherosclerosis,coronary artery disease,thrombosis,myocardial infarction,heart failure,metabolic cardiomyopathy,arterial hypertension,and pulmonary hypertension.LDSFs presented here consisted of microbial metabolite,extracellular vesicles,proteins,and microRNA,they are primarily or exclusively synthesized and released by the liver,and have been shown to exert pleiotropic actions on cardiovascular system.LDSFs mainly target vascular endothelial cell,vascular smooth muscle cells,cardiomyocytes,fibroblasts,macrophages and platelets,and further modulate endothelial nitric oxide synthase/nitric oxide,endothelial function,energy metabolism,inflammation,oxidative stress,and dystrophic calcification.Although some LDSFs are known to be detrimental/beneficial,controversial findings were also reported for many.Therefore,more studies are required to further explore the causal relationships between LDSFs and CVDs and uncover the exact mechanisms,which is expected to extend our understanding of the crosstalk between the liver and cardiovascular system and identify potential therapeutic targets.Furthermore,in the case of patients with liver disease,awareness should be given to the implications of these abnormalities in the cardiovascular system.These studies also underline the importance of early recognition and intervention of liver abnormalities in the practice of cardiovascular care,and a multidisciplinary approach combining hepatologists and cardiologists would be more preferable for such patients.