Functional Cardiological Changes Resulting from Thoracoscopic Thoracic Sympathectomy: Systematic Review

Hyperhidrosis is a condition resulting from a systemic sympathetic hyperactivity. The gold standard treatment is the resection or surgical ablation of the paravertebral sympathetic chain: the endoscopic thoracoscopic sympathectomy (ETS). Non-cardiac thoracic surgeries carry a considerable incidence of pathological postoperative cardiac events, raising attention to possible worsen cardiac functional capacity after the resection of a pair of thoracic sympathetic ganglia. The aim of this study is to investigate literature evidences of postoperative cardiovascular functional changes on patients submitted to ETS as treatment for hyperidrosis. This is a systematic review of the literature. Clinical studies published between January 1999 and April 2019 were analyzed. The PICO strategy was used to construct the question of systematic reviews research. The process of selecting articles was organized according to PRISMA Diagram. The search in electronic databases resulted in seven articles, of which one was excluded for being out of scope of the research, leaving six articles. All studies showed a pattern of heart rate (HR) reduction after endoscopic thoracic sympathectomy. It was suggested a relation between the extension of the procedure and the presence of cardiac functional alterations. There was an improvement in myocardial physical conditioning and maintenance of functional capacity. To elucidate the real mechanisms involved in the maintenance of myocardial function, and even its improvement, it is necessary to develop further studies that directly evaluate them.

Hemodynamic changes in depressive patients

Objective: This study is aimed at exploring the relationship between hemodynamic changes and depressive and anxious symptom in depression patients. Methods: The cardiac function indices including the left stroke index (LSI), ejection fraction (EF), heart rate (HR), diastolic pressure mean (DPM), systolic pressure mean (SPM), left ventricle end-diastolic volume (LVDV), effective circulating volume (ECV), resistance total mean (RTM) and blood flow smooth degree (BFSD) were deter-mined in 65 patients with major depressive disorders and 31 healthy normal controls. The clinical symptoms were assessed with Hamilton depression scale (HAMD) and Hamilton anxiety scale (HAMA). Results: In patients with depression without anxiety, LSI, EF, LVDV, DPM, SPM, ECV, BFSD were significantly lower than those in controls, while RTM was higher than that in controls. Patients with comorbidity of depression and anxiety showed decreased LVDV, ECV, BFSD, and increased HR in comparison with the controls. The anxiety/somatization factor score positively correlated with LSI, EF, LVDV, but negatively correlated with RTM. There was negative correlation between retardation factor score and DPM, SPM, LVDV. Conclusion: The study indicated that there are noticeable changes in left ventricle preload and afterload, blood pressure, peripheral resistance, and microcirculation in depressive patients, and that the accompanying anxiety makes the changes more complicated.

Clinical study on long-snake moxibustion plus Western medicine in treating chronic heart failure due to heart-kidney yang deficiency

Objective To observe the clinical efficacy of long-snake moxibustion plus Western medicine for chronic heart failure due to heart-kidney yang deficiency.Methods A total of 80 patients were randomized into a control group and an observation group,with 40 cases in each group.The control group was treated with routine Western medicine,and the observation group was treated with long-snake moxibustion therapy on the basis of routine Western medicine.Left ventricular ejection fraction(LVEF),stroke volume(SV)and left ventricular end-diastolic diameter(LVEDd)were measured before and after treatment,and the heart function was assessed.The serum brain natriuretic peptide(BNP)level was measured,the 6 min walking distance was recorded,and the Minnesota living with heart failure questionnaire(MLHFQ)was assessed and scored.The serum galectin-3(Gal-3)and soluble growth stimulation expressed gene 2(sST2)protein levels were measured.Clinical efficacy was evaluated after treatment.Results The total effective rate of the observation group was higher than that of the control group,and the difference between the two groups was statistically significant(P<0.05).After treatment,LVEF and LVEDd in both groups were significantly improved(all P<0.05),and LVEF,SV and LVEDd in the observation group were superior to those in the control group(all P<0.05).The heart function classification in both groups were improved after treatment(both P<0.05),and the heart function classification in the observation group was superior to that in the control group(P<0.05).The serum BNP level in both groups decreased(both P<0.05),and the serum BNP level in the observation group was lower than that in the control group(P<0.05).The 6 min walking distance and MLHFQ scores in both groups were improved(all P<0.05),and the 6 min walking distance and MLHFQ score in the observation group were superior to those in the control group(both P<0.05).The serum Gal-3 and sST2 levels in the observation group decreased significantly(both P<0.05),and all lower than those in the control group(both P<0.05).Conclusion Long-snake moxibustion plus Western medicine has significant efficacy in treating chronic heart failure due to heart-kidney yang deficiency;it can improve heart function,reduce the serum BNP level,and improve the exercise endurance and quality of life in the patients.This may be related to the down-regulation of serum Gal-3 and sST2 levels.

Early changes and rules of cardiac function and hemodynamics in rabbits with experimental myocardial contusion

Objective: To study changes and rules of the left ventricular functions in rabbits with myocardial contusion through parallel functional analysis by using echocardiography combined with cardiac catheter intervention. Methods: Thirty healthy rabbits were selected and impacted to make moderate or severe myocardial contusion by BIM II biomedical impact machine. The changes of hemodynamics and cardiac systolic and diastolic functions were respectively observed before injury and 1, 4, 8 and 24 hours after injury. Results: After myocardial contusion, the heart rate, systolic pressure, diastolic pressure and mean arterial pressure of rabbits decreased remarkably at 1 4 hours. The left ventricular end systolic pressure (LVESP), the maximum increasing rate of the left intraventricular pressure (+dp/dtmax), isovolumic pressure (IP) and the maximum systolic velocity of the left ventricle (Vmax) also decreased markedly. And then these parameters recovered to the level of preinjury at 8 24 hours. The left ventricular end diastolic pressure (LVEDP), the rate of the left intraventricular pressure (-dp/dtmax) and the decreasing time constant of the left intraventricular pressure (T) increased remarkably 1 hour after myocardial contusion, and did not decrease until 8 hours after myocardial contusion. Detection by echocardiography showed that ejection fraction of the left ventricle markedly decreased at 24 hours after myocardial contusion, while the systolic volume decreased obviously as early as 1 hour after myocardial contusion, at 4 8 hours it recovered a little and again decreased at 24 hours. The end systolic volume and end diastolic volume increased after myocardial contusion, but statistical significance was only seen at 8 hours after myocardial contusion.Conclusions: Cardiac functions of the left and right ventricles are markedly injured after myocardial contusion with disorders of the left ventricle diastolic function and of the right ventricle systolic function as the dominant injury. While the systolic function of the left ventricle can recover. Echocardiography shows clinical importance in detection of early injuries of cardiac functions.

Clinical effect observation on acupuncture for chronic obstructive pulmonary disease

Objective： To observe the clinical effect of acupuncture on chronic obstructive pulmonary disease （COPD）, and the improvements of patients＇ pulmonary ventilation function and 6-minute walk test （6-MWT） distance. Methods： A total of 80 COPD patients [grade 3-4 in Global Initiative for Chronic Obstructive Lung Disease （GOLD）, qi deficiency of the lung and kidney in traditional Chinese medicine （TCM） pattern] were randomly allocated into a treatment group （n=40） and a control group （n=40）. Salmeterol Xinafoate and Fluticasone Propionate powder （Seretide, 50 μg/250 μg） for inhalation was used for basic treatment in both groups （once in the morning and once in the evening）. Patients in the treatment group received acupuncture at Feishu （BL 13）, Shenshu （BL 23）, O.ihai （CV 6）, Guanyuan （CV 4）, Dingchuan （EX-B 1）, Danzhong （CV 17） and Zusanli （ST 36] twice a week for 3 months. After 3 months of treatment, clinical effects, lung ventilation functions and 6-MWT distance were observed and compared in the two groups. Results： After 3 months of treatment, the total effective rate was 95.0% in the treatment group, versus 80.0% in the control group, showing a statistical difference （P〈O.05）; the phlegm expectoration, dyspnea and shortness of breath were more significantly improved in the treatment group than those in the control group （P〈0.01, P〈0.05）; and the 6-MWT distance and forced expiratory volume in 1 second percentage of predicted value （FEV1%） were more significantly improved in the treatment group than those in the control group （P〈0.05, P〈0.01）. Conclusion： Seretide inhaler combined with acupuncture can improve signs and symptoms in COPD patients, increase the 6-MWT distance, imorove FEV1% and obtain better results than Seretide alone.