Aim: To observe the effect of electroacupuncture (EA) on acute myocardial ischemia (AMI) induced changes of cardiac sympathetic discharges and the effects of some related receptors in the spinal cord. Methods: A total...Aim: To observe the effect of electroacupuncture (EA) on acute myocardial ischemia (AMI) induced changes of cardiac sympathetic discharges and the effects of some related receptors in the spinal cord. Methods: A total of 53 rabbits anesthetized with mixture solution of 25% urethane (420 mg/kg) and 1.5% chloralose (50 mg/kg) were used in this study. AMI was induced by occlusion of the ventricular branch of the left coronary artery. Discharges of the left cardiac sympathetic nerve were recorded by using a bipolar platinum electrode. Bilateral "Ximen"(PC 40) and "Kongzhui"(LU 6) were stimulated electrically by using an EA therapeutic apparatus or an electrical stimulator. DPDPE δ opiate receptor agonist, 20 nmol, 10 μL, n=8), Naltrindole Hydrochloride (δ opiate receptor antagonist, 20 nmol, 10 μL, n=8), DAP5 (NMDA receptor antagonist, 5 nmol, 10 μL, n=9) and CNQX (non NMDA receptor antagonist, 5 nmol, 10 μL, n=8) were respectively injected into the thoracic subarachnoid space of the spinal cord in different groups, followed by observing their effects on changes of sympathetic activity evoked by EA of the abovementioned acupoints. Results: ① After AMI, sympathetic discharges increased (200.56±79.89%) in 10 cases and decreased (-59.34 ±7.06%) in other 9 cases in comparison with their individual basal values. After EA of "Ximen" (PC 4) and "Kongzhui"(LU 6), AMI induced increase and decrease changes of the sympathetic activity were suppressed significantly, but the effect of EA of LU 6 was weaker than that of EA of PC 4. ② Following EA of PC 4 and LU 6, sympathetic discharges increased significantly in 2 and 4 cases, decreased apparently in 7 and 3 cases, and had no striking changes in 1 and 3 cases respectively. The mean reaction threshold of sympathetic activity after EA of PC 4 and LU 6 were 2.1±0.65 mA and 3.28±1.13 mA separately. ③ After pre treatment with DPDPE, the reaction threshold of the cardiac sympathetic activity to EA of PC 4 elevated significantly (35.89±6.12%); while after pre treatment with Naltrindole, this reaction threshold decreased considerably (84.88±26.58%). Following intrathecal injection of DAP5 (n=9) and CNQX (n=9) , the reaction thresholds of the cardiac sympathetic activity to EA of PC 4 increased obviously (142.06±60.27% and 112.54±28.58% separately). It suggests that spinal δ opioid receptor, NMDA and non NMDA receptors are involved in EA induced changes of sympathetic activity. Conclusion: ① EA could regulate AMI induced changes of cardiac sympathetic activity; and ② spinal δ opioid receptors, NMDA and non NMDA receptors participate in the effect of EA on the cardiac sympathetic activity.展开更多
Objective:To investigate the therapeutic effects of supplemental oxygen on patients with myocardial infarction.Methods:This study was a randomized,double-blind clinical trial.The study population included all patients...Objective:To investigate the therapeutic effects of supplemental oxygen on patients with myocardial infarction.Methods:This study was a randomized,double-blind clinical trial.The study population included all patients who were admitted to the emergency room of Ali-ibn-Abitaleb and Khatam-al-Anbia hospitals in Zahedan within six hours of the onset of classic symptoms of myocardial infarction.The patients(n=47)were divided into two groups:the case group(with oxygen therapy)and the control group(without oxygen therapy).The initial follow-up was evaluated after one month and the second follow-up was evaluated after three months in the target population in terms of mortality caused by acute myocardial infarction,mortality caused by any other cause,and re-hospitalization caused by acute myocardial infarction.Results:Out of the 47 patients,27 were male(57.4%).The average age of the patients was(60.9±8.1)years.One month after admission,2 patients(8.7%)in the case group and 2 patients(8.3%)in the control group died due to acute myocardial infarction.A total of 7 patients(14.9%)died three months after admission.There was no significant difference between the control and case groups in terms of mortality caused by acute ischemia within one and three months.After one month,2 patients(8.7%)in the case group and 1 patient(4.2%)in the control group died of other causes.After three months,4 patients(8.5%)in total died for other causes.There was no significant difference between the control and case groups in terms of mortality due to other causes within one and three months.One month after admission,5 patients(21.7%)of the case group and 4 patients(16.7%)of the control group were re-hospitalized due to acute myocardial ischemia.During the next three months,3 patients(13.0%)of the case group and 5 patients(20.8%)of the control group were re-hospitalized.There was no significant difference between the control and case groups regarding the rate of re-hospitalization caused by acute myocardial infarction within one and three months after admission.Conclusions:There is no significant relationship between oxygen therapy and death by acute myocardial ischemia,or any other causes.The relationship between oxygen therapy and the rate of re-hospitalization caused by acute myocardial ischemia is not found within one and three months after admission.The results show that oxygen therapy does not affect patients with acute myocardial ischemia within three months after admission.展开更多
Coronary artery anomaly is known as one of the causes of angina pectoris and sudden death and is an important clinical entity that cannot be overlooked.The incidence of coronary artery anomalies is as low as 1%-2%of t...Coronary artery anomaly is known as one of the causes of angina pectoris and sudden death and is an important clinical entity that cannot be overlooked.The incidence of coronary artery anomalies is as low as 1%-2%of the general population,even when the various types are combined.Coronary anomalies are practically challenging when the left and right coronary ostium are not found around their normal positions during coronary angiography with a catheter.If there is atherosclerotic stenosis of the coronary artery with an anomaly and percutaneous coronary intervention(PCI)is required,the suitability of the guiding catheter at the entrance and the adequate back up force of the guiding catheter are issues.The level of PCI risk itself should also be considered on a caseby-case basis.In this case,emission computed tomography in the R-1 subtype single coronary artery proved that ischemia occurred in an area where the coronary artery was not visible to the naked eye.Meticulous follow-up would be crucial,because sudden death may occur in single coronary arteries.To prevent atherosclerosis with full efforts is also important,as the authors indicated admirably.展开更多
Purpose: Prevention of myocardial injury is essential during cardiac surgery. Both crystalloid and blood cardioplegia are popular methods for myocardial protection. Most experimental studies have been in favor of bloo...Purpose: Prevention of myocardial injury is essential during cardiac surgery. Both crystalloid and blood cardioplegia are popular methods for myocardial protection. Most experimental studies have been in favor of blood cardioplegia. The objective of this study is to determine whether the use of warm blood cardioplegia (BCP) is superior to crystalloid cardioplegia (CCP) by means of myocardial injury markers and clinical outcome parameters. Materials and Methods: In a consecutive series of 293 patients, the first 150 received crystalloid cardioplegia, whereas the next 143 patients received blood cardioplegia. Postoperative myocardial injury was assessed by CTnI and CK-MB. Perioperative morbidity and mortality and clinical outcome parameters (need for inotropic support, ICU and hospital stay) were recorded. An unpaired student t-test was performed to analyse continuous postoperative variables relating to myocardial damage. The presence of possible confounders influencing the CTnI or CK-MB concentrations was tested using a student t-test for continuous variables, for categorical variables ANOVA was used. A final longitudinal model was created for CTnI and CK-MB. CTnI was analyzed by a mixed model with random intercept and slope. For all tests performed, statistical significance was 5%. Results: Both groups were well matched with respect to preoperative variables. No significant difference could be found in maximum postoperative levels of CTnI (8.8 ± 18.4 μg/l in BCP vs 9.6 ± 16.5 μg/l in CCP, p = 0.6455) or CK-MB (19.2 ± 31.0 μg/l in BCP vs 26.4 ± 41.5 μg/l in CCP, p = 0.1209). Nor was there any significant difference in other postoperative variables. Testing treatment effect over time proved only significant influence of the surgical intervention type on CTnI levels in time (p < 0.001). Conclusion: This study could not show significantly higher myocardial injury in the group of patients receiving crystalloid cardioplegia versus warm blood cardioplegia. This suggests that warm blood cardioplegia does not confer superior myocardial protection. Surgical intervention type has an important effect on CTnI concentration in time, while the type of cardioplegia does not.展开更多
Objective:To explore the clinical effect of long-term aerobic exercise combined with resistance training in patients with myocardial ischemia caused by coronary heart disease and its influence on cardiac function, exe...Objective:To explore the clinical effect of long-term aerobic exercise combined with resistance training in patients with myocardial ischemia caused by coronary heart disease and its influence on cardiac function, exercise endurance and quality of life. Methods:100 patients with myocardial ischemia caused by coronary heart disease from January 2017 to January 2019 were randomly divided into control group (n = 50 cases) and observation group (n = 50 cases). The control group was given resistance training, while the observation group was combined with long-term aerobic exercise on the basis of the control group. The two groups were treated for 3 months. The cardiac function, exercise endurance and quality of life were compared between the two groups. Results:The levels of IVST (8.20+1.32) mm, LVDD (46.43+4.13) mm and LVSD (32.59+3.15) mm in the observation group were lower than those in the control group at 3 months after treatment. The level of LVEF (67.49+5.77)% in the observation group was higher than that in the control group at 3 months after treatment. The difference between the two groups was significant (P<0.05). The ET (55.42+2.9) in the observation group was higher than that in the control group (P<0.05). 2) The levels of ng/L and TXB2 (93.23 + 6.26) ng/L were significantly lower than those of the control group, and the difference between the two groups was statistically significant (P<0.05). The 6-minute walking distance (561.25 +43.64) m and the quality of life score (95.31 +6.39) in the observation group were higher than those in the control group 3 months after treatment, and the difference between the two groups was statistically significant (P<0.05). Conclusions:Long-term aerobic exercise combined with resistance training can improve cardiac function, exercise tolerance and quality of life in patients with myocardial ischemia caused by coronary heart disease, which is worthy of popularization and application.展开更多
Amyotrophic lateral sclerosis(ALS) is a progressive neurodegenerative disorder that almost exclusively involves motor neurons although autonomic dysfunction has also been reported. We present an 84-year-old female wit...Amyotrophic lateral sclerosis(ALS) is a progressive neurodegenerative disorder that almost exclusively involves motor neurons although autonomic dysfunction has also been reported. We present an 84-year-old female with no documented history of heart disease, who was admitted with negative T waves in the electrocardiogram precordial leads mimicking myocardial ischaemia. No other abnormalities were shown in the rest of the cardiologic evaluation, suggesting autonomic nervous system dysfunction. A neurophysiological study demonstrated acute and chronic denervation in multiple muscles with normal nerve conduction studies, confirming ALS diagnosis. Previous studies have shown that subclinical sympathetic hyperfunction and parasympathetic hypofunction might result in cardiovascular dysfunction in ALS patients. It is important to detect disturbances of autonomic cardiac control because this dysfunction may influence survival and quality of life, leading to a decrease in life expectancy in ALS patients.This Case Report may support the impairment of cardiac autonomic control in patients with ALS.展开更多
Objectives: Endovascular abdominal aortic aneurysm repair (EVAR) is a common procedure for abdominal aortic aneurysm (AAA), based on minimal invasiveness compared with open surgical repair (OSR). However, general anes...Objectives: Endovascular abdominal aortic aneurysm repair (EVAR) is a common procedure for abdominal aortic aneurysm (AAA), based on minimal invasiveness compared with open surgical repair (OSR). However, general anesthesia can cause considerable perturbations in patients with AAA undergoing operative repair. The aim of this study was to compare the incidence of myocardial ischemic events in association with hemodynamic changes during EVAR and OSR under general anesthesia. Methods: We retrospectively reviewed the anesthetic and medical records of patients who underwent elective abdominal aortic aneurysm repair. ST segment changes on electrocardiography and hemodynamic changes were reviewed by the attending physicians. Results: Among 120 patients, EVAR and OSR were performed in 81 and 39 patients, respectively. There were no significant differences in preoperative morbidity between the two groups. The amount of estimated blood loss was significantly lower in EVAR than OSR. The incidence of ST?segment changes in the two groups (EVAR: 16%, OSR: 23%) was not statistically different. ST segment changes occurred mainly postoperatively at resolution of anesthesia in EVAR, compared with intraoperatively in OSR. ST segment changes were mostly accompanied by tachycardia in EVAR patients, whereas they were associated with hypotension in OSR. Conclusion: Our results demonstrated a comparable incidence of perioperative ST segment changes under general anesthesia in EVAR and OSR. Patients who undergo EVAR and develop tachycardia are at risk of myocardial ischemia at resolution of anesthesia.展开更多
Objective: To observe the influence of electrolytic destruction of nucleus soli tary tract (NTS) and hypothalamic paraventricular nucleus (PVN) on the effect of electroacupuncture (EA) in improving ischemic myocardia ...Objective: To observe the influence of electrolytic destruction of nucleus soli tary tract (NTS) and hypothalamic paraventricular nucleus (PVN) on the effect of electroacupuncture (EA) in improving ischemic myocardia cellular transmembrane action potential (TMAP). Methods: 38 Japanese breed big-ear wh ite rabbits (ane sthetized with 20% Urethane, 4 mL/kg) were randomly divided into acute myocardia l ischemia (AMI) group (n=8), PVN destruction group ( n=12) and PVN+NTS destructio n group (n=18). AMI model was established by occlusion of the descending anterio r branch (DAB) of the coronary artery. TMAP of myocytes was recorded by using a glass microelectrode which was fixed to a suspending spring silver wire. Bilater al "Neiguan"(PC 6) in all the 3 groups were punctured and stimulated electri call y by using parameters of continuous waves, frequency of 7 Hz, intensity of 6 mA a nd duration of 30 minutes. Results: After AMI, ECG-ST elevated significantly whil e APA lowered, APD50 and APD90 shortened clearly in comparison with those of pre -AMI in the 3 groups. Compared with AMI group, ECG-ST values of PVN destructi on group and PVN+NTS destruction group were significantly higher (P <0.05～0.01), whi le APA, APD50 and APD90 all significantly lower in all the recording time course s(P<0.05). The facts displayed that electrolytic destru ction of PVN and PVN+NT S could produce ischemic myocardial injury and reduce the protective effect of E A on ischemic myocardial cells. Comparison between PVN destruction and PVN+NTS g roups showed that all the 4 indexes of the later group were evidently worse than those of the former group (P<0.05), suggesting after des truction of these two n uclei, the effect of EA was worsened further. Conclusion: Electrolytic destru ction of PVN and NTS weakens the protective effect of EA on ischemic myocardial cells, both NTS and PVN take part in the effect of EA of "Neiguan"(PC 6) Point i n improving ischemic myocardium.展开更多
Background:The potential impact of pre-existing coronary artery stenosis(CAS)on acute pulmonary embolism(PE)episodes remains underexplored.This study aimed to investigate the association between pre-existing CAS and t...Background:The potential impact of pre-existing coronary artery stenosis(CAS)on acute pulmonary embolism(PE)episodes remains underexplored.This study aimed to investigate the association between pre-existing CAS and the elevation of high-sensitivity cardiac troponin I(hs-cTnI)levels in patients with PE.Methods:In this multicenter,prospective case-control study,88 cases and 163 controls matched for age,sex,and study center were enrolled.Cases were patients with PE with elevated hs-cTnI.Controls were patients with PE with normal hs-cTnI.Coronary artery assessment utilized coronary computed tomographic angiography or invasive coronary angiography.CAS was defined as≥50%stenosis of the lumen diameter in any coronary vessel>2.0 mm in diameter.Conditional logistic regression was used to evaluate the association between CAS and hs-cTnI elevation.Results:The percentage of CAS was higher in the case group compared to the control group(44.3%[39/88]vs.30.1%[49/163];P=0.024).In multivariable conditional logistic regression model 1,CAS(adjusted odds ratio[OR],2.680;95%confidence interval[CI],1.243-5.779),heart rate>75 beats/min(OR,2.306;95%CI,1.056-5.036)and N-terminal pro-B type natriuretic peptide(NT-proBNP)>420 pg/mL(OR,12.169;95%CI,4.792-30.900)were independently associated with elevated hs-cTnI.In model 2,right CAS(OR,3.615;95%CI,1.467-8.909)and NT-proBNP>420 pg/mL(OR,13.890;95%CI,5.288-36.484)were independently associated with elevated hs-cTnI.Conclusions:CAS was independently associated with myocardial injury in patients with PE.Vigilance towards CAS is warranted in patients with PE with elevated cardiac troponin levels.展开更多
文摘Aim: To observe the effect of electroacupuncture (EA) on acute myocardial ischemia (AMI) induced changes of cardiac sympathetic discharges and the effects of some related receptors in the spinal cord. Methods: A total of 53 rabbits anesthetized with mixture solution of 25% urethane (420 mg/kg) and 1.5% chloralose (50 mg/kg) were used in this study. AMI was induced by occlusion of the ventricular branch of the left coronary artery. Discharges of the left cardiac sympathetic nerve were recorded by using a bipolar platinum electrode. Bilateral "Ximen"(PC 40) and "Kongzhui"(LU 6) were stimulated electrically by using an EA therapeutic apparatus or an electrical stimulator. DPDPE δ opiate receptor agonist, 20 nmol, 10 μL, n=8), Naltrindole Hydrochloride (δ opiate receptor antagonist, 20 nmol, 10 μL, n=8), DAP5 (NMDA receptor antagonist, 5 nmol, 10 μL, n=9) and CNQX (non NMDA receptor antagonist, 5 nmol, 10 μL, n=8) were respectively injected into the thoracic subarachnoid space of the spinal cord in different groups, followed by observing their effects on changes of sympathetic activity evoked by EA of the abovementioned acupoints. Results: ① After AMI, sympathetic discharges increased (200.56±79.89%) in 10 cases and decreased (-59.34 ±7.06%) in other 9 cases in comparison with their individual basal values. After EA of "Ximen" (PC 4) and "Kongzhui"(LU 6), AMI induced increase and decrease changes of the sympathetic activity were suppressed significantly, but the effect of EA of LU 6 was weaker than that of EA of PC 4. ② Following EA of PC 4 and LU 6, sympathetic discharges increased significantly in 2 and 4 cases, decreased apparently in 7 and 3 cases, and had no striking changes in 1 and 3 cases respectively. The mean reaction threshold of sympathetic activity after EA of PC 4 and LU 6 were 2.1±0.65 mA and 3.28±1.13 mA separately. ③ After pre treatment with DPDPE, the reaction threshold of the cardiac sympathetic activity to EA of PC 4 elevated significantly (35.89±6.12%); while after pre treatment with Naltrindole, this reaction threshold decreased considerably (84.88±26.58%). Following intrathecal injection of DAP5 (n=9) and CNQX (n=9) , the reaction thresholds of the cardiac sympathetic activity to EA of PC 4 increased obviously (142.06±60.27% and 112.54±28.58% separately). It suggests that spinal δ opioid receptor, NMDA and non NMDA receptors are involved in EA induced changes of sympathetic activity. Conclusion: ① EA could regulate AMI induced changes of cardiac sympathetic activity; and ② spinal δ opioid receptors, NMDA and non NMDA receptors participate in the effect of EA on the cardiac sympathetic activity.
文摘Objective:To investigate the therapeutic effects of supplemental oxygen on patients with myocardial infarction.Methods:This study was a randomized,double-blind clinical trial.The study population included all patients who were admitted to the emergency room of Ali-ibn-Abitaleb and Khatam-al-Anbia hospitals in Zahedan within six hours of the onset of classic symptoms of myocardial infarction.The patients(n=47)were divided into two groups:the case group(with oxygen therapy)and the control group(without oxygen therapy).The initial follow-up was evaluated after one month and the second follow-up was evaluated after three months in the target population in terms of mortality caused by acute myocardial infarction,mortality caused by any other cause,and re-hospitalization caused by acute myocardial infarction.Results:Out of the 47 patients,27 were male(57.4%).The average age of the patients was(60.9±8.1)years.One month after admission,2 patients(8.7%)in the case group and 2 patients(8.3%)in the control group died due to acute myocardial infarction.A total of 7 patients(14.9%)died three months after admission.There was no significant difference between the control and case groups in terms of mortality caused by acute ischemia within one and three months.After one month,2 patients(8.7%)in the case group and 1 patient(4.2%)in the control group died of other causes.After three months,4 patients(8.5%)in total died for other causes.There was no significant difference between the control and case groups in terms of mortality due to other causes within one and three months.One month after admission,5 patients(21.7%)of the case group and 4 patients(16.7%)of the control group were re-hospitalized due to acute myocardial ischemia.During the next three months,3 patients(13.0%)of the case group and 5 patients(20.8%)of the control group were re-hospitalized.There was no significant difference between the control and case groups regarding the rate of re-hospitalization caused by acute myocardial infarction within one and three months after admission.Conclusions:There is no significant relationship between oxygen therapy and death by acute myocardial ischemia,or any other causes.The relationship between oxygen therapy and the rate of re-hospitalization caused by acute myocardial ischemia is not found within one and three months after admission.The results show that oxygen therapy does not affect patients with acute myocardial ischemia within three months after admission.
文摘Coronary artery anomaly is known as one of the causes of angina pectoris and sudden death and is an important clinical entity that cannot be overlooked.The incidence of coronary artery anomalies is as low as 1%-2%of the general population,even when the various types are combined.Coronary anomalies are practically challenging when the left and right coronary ostium are not found around their normal positions during coronary angiography with a catheter.If there is atherosclerotic stenosis of the coronary artery with an anomaly and percutaneous coronary intervention(PCI)is required,the suitability of the guiding catheter at the entrance and the adequate back up force of the guiding catheter are issues.The level of PCI risk itself should also be considered on a caseby-case basis.In this case,emission computed tomography in the R-1 subtype single coronary artery proved that ischemia occurred in an area where the coronary artery was not visible to the naked eye.Meticulous follow-up would be crucial,because sudden death may occur in single coronary arteries.To prevent atherosclerosis with full efforts is also important,as the authors indicated admirably.
文摘Purpose: Prevention of myocardial injury is essential during cardiac surgery. Both crystalloid and blood cardioplegia are popular methods for myocardial protection. Most experimental studies have been in favor of blood cardioplegia. The objective of this study is to determine whether the use of warm blood cardioplegia (BCP) is superior to crystalloid cardioplegia (CCP) by means of myocardial injury markers and clinical outcome parameters. Materials and Methods: In a consecutive series of 293 patients, the first 150 received crystalloid cardioplegia, whereas the next 143 patients received blood cardioplegia. Postoperative myocardial injury was assessed by CTnI and CK-MB. Perioperative morbidity and mortality and clinical outcome parameters (need for inotropic support, ICU and hospital stay) were recorded. An unpaired student t-test was performed to analyse continuous postoperative variables relating to myocardial damage. The presence of possible confounders influencing the CTnI or CK-MB concentrations was tested using a student t-test for continuous variables, for categorical variables ANOVA was used. A final longitudinal model was created for CTnI and CK-MB. CTnI was analyzed by a mixed model with random intercept and slope. For all tests performed, statistical significance was 5%. Results: Both groups were well matched with respect to preoperative variables. No significant difference could be found in maximum postoperative levels of CTnI (8.8 ± 18.4 μg/l in BCP vs 9.6 ± 16.5 μg/l in CCP, p = 0.6455) or CK-MB (19.2 ± 31.0 μg/l in BCP vs 26.4 ± 41.5 μg/l in CCP, p = 0.1209). Nor was there any significant difference in other postoperative variables. Testing treatment effect over time proved only significant influence of the surgical intervention type on CTnI levels in time (p < 0.001). Conclusion: This study could not show significantly higher myocardial injury in the group of patients receiving crystalloid cardioplegia versus warm blood cardioplegia. This suggests that warm blood cardioplegia does not confer superior myocardial protection. Surgical intervention type has an important effect on CTnI concentration in time, while the type of cardioplegia does not.
基金Natural Science Fund Project of Shaanxi Provincial Education Department(No.12JK0707)regular project of Shaanxi Provincial Sports Bureau(No.2019029).
文摘Objective:To explore the clinical effect of long-term aerobic exercise combined with resistance training in patients with myocardial ischemia caused by coronary heart disease and its influence on cardiac function, exercise endurance and quality of life. Methods:100 patients with myocardial ischemia caused by coronary heart disease from January 2017 to January 2019 were randomly divided into control group (n = 50 cases) and observation group (n = 50 cases). The control group was given resistance training, while the observation group was combined with long-term aerobic exercise on the basis of the control group. The two groups were treated for 3 months. The cardiac function, exercise endurance and quality of life were compared between the two groups. Results:The levels of IVST (8.20+1.32) mm, LVDD (46.43+4.13) mm and LVSD (32.59+3.15) mm in the observation group were lower than those in the control group at 3 months after treatment. The level of LVEF (67.49+5.77)% in the observation group was higher than that in the control group at 3 months after treatment. The difference between the two groups was significant (P<0.05). The ET (55.42+2.9) in the observation group was higher than that in the control group (P<0.05). 2) The levels of ng/L and TXB2 (93.23 + 6.26) ng/L were significantly lower than those of the control group, and the difference between the two groups was statistically significant (P<0.05). The 6-minute walking distance (561.25 +43.64) m and the quality of life score (95.31 +6.39) in the observation group were higher than those in the control group 3 months after treatment, and the difference between the two groups was statistically significant (P<0.05). Conclusions:Long-term aerobic exercise combined with resistance training can improve cardiac function, exercise tolerance and quality of life in patients with myocardial ischemia caused by coronary heart disease, which is worthy of popularization and application.
文摘Amyotrophic lateral sclerosis(ALS) is a progressive neurodegenerative disorder that almost exclusively involves motor neurons although autonomic dysfunction has also been reported. We present an 84-year-old female with no documented history of heart disease, who was admitted with negative T waves in the electrocardiogram precordial leads mimicking myocardial ischaemia. No other abnormalities were shown in the rest of the cardiologic evaluation, suggesting autonomic nervous system dysfunction. A neurophysiological study demonstrated acute and chronic denervation in multiple muscles with normal nerve conduction studies, confirming ALS diagnosis. Previous studies have shown that subclinical sympathetic hyperfunction and parasympathetic hypofunction might result in cardiovascular dysfunction in ALS patients. It is important to detect disturbances of autonomic cardiac control because this dysfunction may influence survival and quality of life, leading to a decrease in life expectancy in ALS patients.This Case Report may support the impairment of cardiac autonomic control in patients with ALS.
文摘Objectives: Endovascular abdominal aortic aneurysm repair (EVAR) is a common procedure for abdominal aortic aneurysm (AAA), based on minimal invasiveness compared with open surgical repair (OSR). However, general anesthesia can cause considerable perturbations in patients with AAA undergoing operative repair. The aim of this study was to compare the incidence of myocardial ischemic events in association with hemodynamic changes during EVAR and OSR under general anesthesia. Methods: We retrospectively reviewed the anesthetic and medical records of patients who underwent elective abdominal aortic aneurysm repair. ST segment changes on electrocardiography and hemodynamic changes were reviewed by the attending physicians. Results: Among 120 patients, EVAR and OSR were performed in 81 and 39 patients, respectively. There were no significant differences in preoperative morbidity between the two groups. The amount of estimated blood loss was significantly lower in EVAR than OSR. The incidence of ST?segment changes in the two groups (EVAR: 16%, OSR: 23%) was not statistically different. ST segment changes occurred mainly postoperatively at resolution of anesthesia in EVAR, compared with intraoperatively in OSR. ST segment changes were mostly accompanied by tachycardia in EVAR patients, whereas they were associated with hypotension in OSR. Conclusion: Our results demonstrated a comparable incidence of perioperative ST segment changes under general anesthesia in EVAR and OSR. Patients who undergo EVAR and develop tachycardia are at risk of myocardial ischemia at resolution of anesthesia.
基金This studyis subsidized by National Science Foundation of China (No .30171179) .
文摘Objective: To observe the influence of electrolytic destruction of nucleus soli tary tract (NTS) and hypothalamic paraventricular nucleus (PVN) on the effect of electroacupuncture (EA) in improving ischemic myocardia cellular transmembrane action potential (TMAP). Methods: 38 Japanese breed big-ear wh ite rabbits (ane sthetized with 20% Urethane, 4 mL/kg) were randomly divided into acute myocardia l ischemia (AMI) group (n=8), PVN destruction group ( n=12) and PVN+NTS destructio n group (n=18). AMI model was established by occlusion of the descending anterio r branch (DAB) of the coronary artery. TMAP of myocytes was recorded by using a glass microelectrode which was fixed to a suspending spring silver wire. Bilater al "Neiguan"(PC 6) in all the 3 groups were punctured and stimulated electri call y by using parameters of continuous waves, frequency of 7 Hz, intensity of 6 mA a nd duration of 30 minutes. Results: After AMI, ECG-ST elevated significantly whil e APA lowered, APD50 and APD90 shortened clearly in comparison with those of pre -AMI in the 3 groups. Compared with AMI group, ECG-ST values of PVN destructi on group and PVN+NTS destruction group were significantly higher (P <0.05～0.01), whi le APA, APD50 and APD90 all significantly lower in all the recording time course s(P<0.05). The facts displayed that electrolytic destru ction of PVN and PVN+NT S could produce ischemic myocardial injury and reduce the protective effect of E A on ischemic myocardial cells. Comparison between PVN destruction and PVN+NTS g roups showed that all the 4 indexes of the later group were evidently worse than those of the former group (P<0.05), suggesting after des truction of these two n uclei, the effect of EA was worsened further. Conclusion: Electrolytic destru ction of PVN and NTS weakens the protective effect of EA on ischemic myocardial cells, both NTS and PVN take part in the effect of EA of "Neiguan"(PC 6) Point i n improving ischemic myocardium.
基金supported by grants from the National Key Research and Development Program of China(No.2022YFC2703902)the National High Level Hospital Clinical Research Funding(No.2022-PUMCH-B-099)the Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(Nos.2020-I2M-C&T-B-003,and 2021-I2M-1-018).
文摘Background:The potential impact of pre-existing coronary artery stenosis(CAS)on acute pulmonary embolism(PE)episodes remains underexplored.This study aimed to investigate the association between pre-existing CAS and the elevation of high-sensitivity cardiac troponin I(hs-cTnI)levels in patients with PE.Methods:In this multicenter,prospective case-control study,88 cases and 163 controls matched for age,sex,and study center were enrolled.Cases were patients with PE with elevated hs-cTnI.Controls were patients with PE with normal hs-cTnI.Coronary artery assessment utilized coronary computed tomographic angiography or invasive coronary angiography.CAS was defined as≥50%stenosis of the lumen diameter in any coronary vessel>2.0 mm in diameter.Conditional logistic regression was used to evaluate the association between CAS and hs-cTnI elevation.Results:The percentage of CAS was higher in the case group compared to the control group(44.3%[39/88]vs.30.1%[49/163];P=0.024).In multivariable conditional logistic regression model 1,CAS(adjusted odds ratio[OR],2.680;95%confidence interval[CI],1.243-5.779),heart rate>75 beats/min(OR,2.306;95%CI,1.056-5.036)and N-terminal pro-B type natriuretic peptide(NT-proBNP)>420 pg/mL(OR,12.169;95%CI,4.792-30.900)were independently associated with elevated hs-cTnI.In model 2,right CAS(OR,3.615;95%CI,1.467-8.909)and NT-proBNP>420 pg/mL(OR,13.890;95%CI,5.288-36.484)were independently associated with elevated hs-cTnI.Conclusions:CAS was independently associated with myocardial injury in patients with PE.Vigilance towards CAS is warranted in patients with PE with elevated cardiac troponin levels.
