Clinical Case Report of Acute Heart Injury and Acute Rhabdomyolysis Due to Cyanide Poisoning

Cyanide poisoning is one of the most dangerous poisonings, and it can be absorbed into the body through the mouth, inhalation and through the skin. A 32-year-old female patient was admitted to our poison control center because of high fever, severe vomiting, and seizures. Physical examination found that the patient was drowsy, had a high fever of 40 degrees Celsius, pulse of 140 beats/minute, and increased tendon and bone reflexes. Exploiting the patient’s information, it was discovered that the patient bought Cyanide to drink with the intention of committing suicide. The patient was quickly treated with gastric lavage and activated charcoal. Echocardiography recorded EF: 35%, reduced movement of the entire myocardium. CK blood test: 4562 U/L. The patient’s condition rapidly deteriorated and the patient was made ECMO, IHD and CVVHDF. After 3 days of treatment, the patient’s condition did not improve, so the family asked for the patient to go home. This article aims to describe the rapidly progressing and severe damage to the heart and muscles of patients with cyanide poisoning.

Quantitative Mitochondrial Proteomics Study on Protective Mechanism of Grape Seed Proanthocyanidin Extracts Against Ischemia/Reperfusion Heart Injury in Rat

Cardiac ischemia/reperfusion（I/R） injury is a critical condition,often associated with high morbidity and mortality.The cardioprotective effect of grape seed proanthocyanidin extracts（GSPE） against oxidant injury during I/R has been described in previous studies.However,the underlying molecular mechanisms have not been fully elucidated.This study investigated the effect of GSPE on reperfusion arrhythmias especially ventricular tachycardia（VT） and ventricular fibrillation（VF）,the lactic acid accumulation and the ultrastructure of ischemic cardiomyocytes as well as the global changes of mitochondria proteins in in vivo rat heart model against I/R injury.GSPE significantly reduced the incidence of VF and VT,lessened the lactic acid accumulation and attenuated the ultrastructure damage.Twenty differential proteins related to cardiac protection were revealed by isobaric tag for relative and absolute quantitation（iTRAQ） profiling.These proteins were mainly involved in energy metabolism.Besides,monoamine oxidase A（MAOA） was also identified.The differential expression of several proteins was validated by Western blot.Our study offered important information on the mechanism of GSPE treatment in ischemic heart disease.

Chemical Preconditioning by 3-nitropropionic Acid Reduces Ischemia-reperfusion Injury in Rat Heart

Summary： This study was designed to investigate the cardioprotective effects of preconditioning with 3-nitropropionic acid, an inhibitor of mitochondrial succinate dehydrogenase. 16 isolated rat hearts were randomly divided into two groups, a treatment group and a control group. The rats of the treatment group were treated intraperitoneally with 3-nitropropionic ac;.d （3-NPA, 4 mg/kg） and the rats of the control group were treated with saline. 24 h after the treatment, the isolated hearts were mounted on a Langendorff apparatus. After 30 min, the hearts were subjected to 30min ischemia and 60-min reperfusion. The HR, LVDP and ±dp/dtmax were measured at preischemia and 30 min, 60 min after the reperfusion. Coronary effluent was collected 15 min after the reperfusion for the determination of CK and LDH. At the end of the 60-min reperfusion the heart was removed for the determination of myocardial SOD and MDA. Our results showed that in the 3-NPA group LVDP and ±dp/dt recovered significantly better, myocardial MDA, CK and LDH were significantly lower and the myocardial SOD was significantly higher than in the control group. It is concluded that chemical preconditioning by 3-nitropropionate has cardioprotective effects against ischemia-reperfusion injury.

Gradual Clamping Reduced Ischemia-Reperfusion Injury in an Isolated Rat Heart Model

Objectives: We hypothesized that the organisms and their organs or tissues could adapt themselves to the gradual changes of environment for surviving or reducing damage. This study explored whether gradual clamping (GC) could reduce myocardial ischemia-reperfusion (IR) injury in rat heart. Methods: Twelve rats were randomized to IR group and GC group, then the hearts were isolated and perfused with Langendorff apparatus. Before cardioplegia, the perfusion was stopped abruptly in IR group while slowly with 5-minute in GC group. The hearts were subjected to 30-minute ischemia and 60-minute reperfusion. The left ventricular develop pressure (LVDP) and systolic pressure (LVSP), the maximal rate of the increase and decrease of left ventricular pressure (+dp/dtmax, ﹣dp/dtmax) were measured by polygraph system at different time points. The recovery of the variables was expressed as the ratio of these values at individual time point after reperfusion to the baseline respectively. Results: The recovery of LVDP after reperfusion was better than that in IR group (P = 0.034). No significant difference in the recovery of LVSP, +dp/dtmax and ﹣dp/dtmax between groups was observed. Conclusions: Gradual clamping could improve the recovery of LVDP after IR, suggesting that gradual clamping could reduce myocardial IR injury.

Altered heart rate variability and pulse-wave velocity after spinal cord injury

BACKGROUND Heart rate variability(HRV) and pulse-wave velocity(PWV),indicators of cardiac function,are altered in patients with spinal cord injury(SCI),suggesting that autonomic cardiac function and arterial stiffness may underlie the high risk of cardiovascular complications in these patients.No study has simultaneously investigated HRV and PWV in the same patients.AIM To evaluate cardiovascular complications in SCI patients by comparing HRV and PWV between patients with and without SCI.METHODS In this cross-sectional pilot study,patients with(n = 60) and without SCI(n = 60) were recruited from December 7,2019 to January 21,2020.Each participant received a five-minute assessment of HRV and the cardiovascular system using the Medicore HRV Analyzer SA-3000 P.Differences in HRV and PWV parameters between participants with and without SCI were statistically examined.RESULTS We observed a significant difference between participants with and without SCI with respect to the standard deviation of all normal-to-normal intervals,square root of the mean sum of squared successive risk ratio interval differences,physical stress index,total power,very-low frequency,low frequency,high frequency,and arterial elasticity.CONCLUSION Patients with SCI have weaker sympathetic and parasympathetic activity as well as lower arterial elasticity compared to those without,suggesting that SCI may increase cardiac function loading.

Protective effects of L-arginine against ischemia-reperfusion injury in non-heart beating rat liver graft

BACKGROUND: Although the use of non-heart beating donors (NHBDs) could bridge the widening gap between organ demand and supply, its application to liver transplantation is limited due to the high incidence of primary graft loss. Prevention of liver injury in NHBDs will benefit the results of transplantation. This study was conducted to evaluate the protective effects of L-arginine on liver grafts from NHBDs. METHODS: One hundred and four Wistar rats were randomly divided into 7 groups: normal control (n=8) controls 1, 2 and 3 (C-1, C-2, C-3, n=16), and experimental 1, 2 and 3 (E-1, E-2, E-3, n=16). For groups C-1 and E-1, C-2 and E-2, and C-3 and E-3, the warm ischemia time was 0, 30, and 45 minutes, respectively. Liver grafts were flushed with and preserved in 4 degrees C Euro-collins solution containing 1 mmol/L L-arginine for 1 hour in each experimental group. Recipients of each experimental group were injected with L-arginine (10 mg/kg body weight) by tail vein 10 minutes before portal vein reperfusion. Donors and recipients of each experimental control group were treated with normal saline. Then transplantation was performed. At 1, 3, and 24 hours after portal vein reperfusion, blood samples were obtained to determine the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), nitric oxide (NO) and plasma endothelin (ET). At 3 hours after portal vein reperfusion, grafts samples were fixed in 2.5% glutaraldehyde for electron microscopic observation. RESULTS: At I hour after portal vein reperfusion, the levels of NO in groups E-1, E-2, E-3 and C-1, C-2, C-3 were lower, while the levels of plasma ET, serum ALT and AST were higher than those in the normal control group (P<0.05). At 1, 3, and 24 hours, the levels of NO in groups E-1, E-2, E-3 were higher, while the levels of plasma ET, serum ALT and AST were lower than those in the corresponding control groups (C-1, C-2, C-3) (P<0.05). The levels of NO in groups C-2 and C-3 were lower than in group C-1 (P<0.05), and the level of NO in group C-3 was lower than in group C-2 (P<0.05). At 1, 3 and 24 hours, the levels of plasma ET, serum ALT, and AST in groups E-1, E-2, E-3 were lower than those in the corresponding control groups (C-1, C-2, C-3) (P<0.05). The levels of plasma ET, serum ALT, and AST were lower in group C-3 than in groups C-1 and C-2 (P<0.05). Pathological changes in groups E-1, E-2, E-3 were milder than those in the corresponding experimental control groups (C-1, C-2, C-3). CONCLUSIONS: The imbalance between NO and ET plays an important role in the development of ischemia-reperfusion injury of liver grafts from NHBDs. L-arginine can attenuate injury in liver grafts from NHBDs by improving the balance between NO and ET.

Relationship between hypothermia and heart rate yarialion in severe brain injury

AIM:To investigate effects of heart automatic nerve variations and hypothermia(HT) therapy on heart rate variation(HRV).METHODS:We studied the dynamic electrocardiagraph(ECG) of 41 cases of severe brain injury.The patients were devided into HT therapy group(n=21,body temprature 32-33℃),non-HT therapy group(n=20) and normal control(n=20).RESULTS:In group 1,the reduction of time domain indexes and frequency domain indexes were 3-6 folds and 30-50folds respectively compared with those of the control group,while the corresponding indexes reduction were 2-3 folds and 4-5folds in the group 2(P<0.05,P<0.01,respectively).The difference between groups were significant(P<0.05-0.01);the HRV reduction was more significant in the cerebrovascular accident patients than that of brain injured(P<0.05-0.01);the HRV indexes increased significantly in resuscitated patients than those in coma(P<0.01);the HRV in dead was much lower than that in survival(P=0.01).CONCLUSION:Injury of central nervous system can induce abnormal function of automatic nerve of heart and reduction of HRV.HT therapy can reduce HRV on a higher level;HRV examination can be applied into the prediction of prognosis of the brain injured.

Evaluation with Heart Rate Variability for the Treatment Effect of Aminophylline in Patients with Bradycardia after Cervical Spinal Cord Injury: A Preliminary Study

After cervical spinal cord injury (SCI), the autonomic nervous system (ANS) becomes impaired and then, bradycardia can develop. In view of this, we performed to prescribe aminophylline as pharmacotherapy for bradycardia. The study population consisted of 36 patients with cervical SCI. Bradycardia developed in 20 patients (55.6%), of these patients, 8 showed spontaneous recovery. Twelve patients had persistent bradycardia, therefore, aminophylline was administered at 0.5 mg/kg/hr by intravenous infusion. Their average heart rate increased within 24 hours after the start of infusion. In heart rate variability analysis for 7 preliminarily selected patients, the spectral waveforms of “oligowave type” indicating ANS impairment tended to appear in relatively early phase after injury (i.e., 2 days to 2 weeks after injury), whereas “normal type” was observed in the late phase (i.e., at 4 weeks). “Sympathetic block type” was observed throughout the follow-up period (2 days to 4 weeks). “Sympathetic block type” was also observed in a non-bradycardic patient on day 2. These results underscore the importance of treating ANS impairment with aminophylline while keeping in mind that bradycardia can occur even in post-SCI patients without clinical manifestations.

Intraoperative Blood Glucose Levels and Postoperative Acute Kidney Injury in Pediatric Patients Having Congenital Heart Surgery under Cardiopulmonary Bypass

Purpose:This study sought to explore the effect of intraoperative mean blood glucose levels and variability on postoperative acute kidney injury(AKI)in children undergoing congenital cardiac surgery.Methods:We conducted a prospective nested case-control study in children(age<18 years)undergoing congenital heart surgery with cardiopulmonary bypass(CPB)at the Fuwai Hospital between April 01,2022 and July 30,2022.Cases were individuals who developed AKI within the first postoperative 7 days(AKI group)and controls were those without AKI(Non-AKI group)according to KDIGO criteria.AKI and Non-AKI groups unmatched and 1:1 matched by age,sex,and baseline serum creatinine were separately analyzed.Multivariate logistic and conditional logistic regressions were used to assess the associations between blood glucose variables and AKI.Results:688 consecutively approached patients were included in the final analysis.On multivariate analysis,intra-CPB(adjusted odds ratio[OR]0.802;95%confidence interval[CI],0.706 to 0.912;p=0.001)and post-CPB(adjusted OR 0.830;95%CI,0.744 to 0.925;p=0.001)blood glucose levels were associated with postoperative AKI.There were no significant differences in pre-CPB blood glucose(adjusted OR 0.926;95%CI,0.759 to 1.129;p=0.446)or intraoperative glycemic fluctuations(adjusted OR 0.905;95%CI,0.723 to 1.132;p=0.382)between AKI and Non-AKI groups.Results based on matched cases and controls were consistent with those from the unmatched analyses.Conclusion:Higher intraoperative blood glucose levels during and after CPB were protective factors against postoperative AKI in pediatric patients after congenital heart surgery.

Effect of aerobic exercise + relaxation training on the cytokine secretion and endothelial injury in patients with coronary heart disease

Objective: To study the effect of aerobic exercise + relaxation training on the cytokine secretion and endothelial injury in patients with coronary heart disease. Methods: Patients who were diagnosed with stable angina pectoris in West China Hospital, Sichuan University between August 2014 and October 2017 were enrolled in the study and divided into the exercise training group who accepted aerobic exercise + relaxation training and the normal control group who accepted routine intervention. The levels of cytokines and endothelial injury molecules in serum as well as the expression of oxidative stress molecules in peripheral blood were determined before intervention as well as 56 d and 112 d after intervention. Results: Compared with the corresponding indexes of same group before intervention, serum FGF21, MIF, MIP-1α, SDF-1α, sICAM1, vWF, ET-1, sVCAM-1 and ESM1 levels as well as peripheral blood MPO, NOX2, NOX4, LOX-1 and CX3CR1 expression intensity of both groups of patients were significantly lower 56 d and 112 d after intervention, and serum FGF21, MIF, MIP-1α, SDF-1α, sICAM1, vWF, ET-1, sVCAM-1 and ESM1 levels as well as peripheral blood MPO, NOX2, NOX4, LOX-1 and CX3CR1 expression intensity of exercise training group 56 d and 112 d after intervention were lower than those of normal control group. Conclusion: Aerobic exercise + relaxation training can reduce the secretion of inflammatory cytokines and the degree of endothelial oxidative stress injury in patients with coronary heart disease.

Value of serum Fractalkine and Vaspin contents for the diagnosis of coronary heart disease and the correlation with cardiac function and myocardial injury

Objective: To study the value of serum Fractalkine and Vaspin contents for the diagnosis of coronary heart disease and the correlation with cardiac function and myocardial injury. Methods: A total of 80 patients with coronary heart disease were divided into stable angina pectoris group (n=45) and unstable angina pectoris group (n=35) according to the clinical seizure characteristics and signs. 50 subjects with normal cardiac function who received physical examination in the hospital over the same period were selected as the normal control group. The serum Fractalkine and Vaspin contents, cardiac function parameter levels under ultrasonic cardiogram and serum myocardial enzyme spectrum contents of each group were detected. Pearson test was used to further assess the inner link of serum Fractalkine and Vaspin contents with disease severity in patients with coronary heart disease. Results: Serum Fractalkine contents of stable angina pectoris group and unstable angina pectoris group were higher than that of normal control group while Vaspin contents were lower than that of normal control group, and serum Fractalkine content increased while Vaspin content decreased with the aggravation of angina pectoris. Cardiac function parameters LVEDD, LVEDV, LVESD and LVESV levels of stable angina pectoris group and unstable angina pectoris group were higher than those of normal control group, serum myocardial enzyme spectrum indexes CK, CK-MB, LDH, AST and ALT contents were higher than those of normal control group, and the levels of above indexes increased with the aggravation of angina pectoris. Serum Fractalkine content in patients with coronary heart disease was positively correlated with the decrease of cardiac function and the degree of myocardial injury while Vaspin content was negatively correlated with the decrease of cardiac function and the degree of myocardial injury. Conclusion: Serum Fractalkine and Vaspin contents are abnormal in patients with coronary heart disease, and the abnormal degree is directly related to the cardiac function and myocardial injury.

Effect of N-acetylcysteine on pulmonary fibrosis, endothelial injury and vasoactive factors in patients with chronic pulmonary heart disease

Objective:To study the effect of N-acetylcysteine on pulmonary fibrosis, endothelial injury and vasoactive factors in patients with chronic pulmonary heart disease.Methods:Patients with COPD complicated by chronic pulmonary heart disease who were treated in Zigong Third People's Hospital between October 2015 and December 2016 were selected and randomly divided into two groups, NAC group received N-acetylcysteine combined with conventional therapy, and the control group received conventional therapy. Serum levels of pulmonary fibrosis indexes, endothelial injury and oxidative stress injury indexes and vasoactive factors were measured before and after treatment.Results:14 d and 28 d after treatment, serum TGF-β1,β-catenin, uPA, MMP7, ET-1, VEGF, IMD, ADM, MDA, 8-iso-PGF2 and AOPP levels of both groups of patients were significantly lower than those before treatment and serum TGF-β1,β-catenin, uPA, MMP7, ET-1, VEGF, IMD, ADM, MDA, 8-iso-PGF2 and AOPP levels of NAC group were significantly lower than those of control group.Conclusion:N-acetylcysteine can significantly inhibit pulmonary fibrosis, endothelial injury and vasoactive factor secretion in patients with chronic pulmonary heart disease.

Effect of levocarnitine+coenzyme Q10 adjuvant therapy on vasoactive molecules,endothelial injury and oxidative stress in patients with chronic heart failure

Objective: To study the effect of levocarnitine + coenzyme Q10 adjuvant therapy on vasoactive molecules, endothelial injury and oxidative stress in patients with chronic heart failure. Methods: A total of 90 patients with chronic heart failure who were treated in the hospital between December 2014 and December 2016 were collected and divided into control group and observation group by random number table method, 45 cases in each group. Control group received conventional therapy, and observation group received levocarnitine + coenzyme Q10 adjuvant therapy on the basis of conventional therapy. The differences in vasoactive molecule, endothelial injury and oxidative stress levels were compared between the two groups before and after treatment. Results: Before treatment, the differences in vasoactive molecule, endothelial injury and oxidative stress levels were not statistically significant between the two groups of patients. After treatment, serum vasoactive molecules ET-1, AngⅡ and TXB2 contents of observation group were lower than those of control group while NO content was higher than that of control group;endothelial function indexes FMD level was higher than that of control group;serum oxidative stress indexes SOD and T-AOC contents were higher than those of control group while MDA and ROS contents were lower than those of control group. Conclusion: Levocarnitine + coenzyme Q10 adjuvant therapy can optimize the vascular activity, and reduce the endothelial injury and systemic oxidative stress response in patients with chronic heart failure.

The role and modulation of autophagy in experimental models of myocardial ischemia-reperfusion injury

A physiological sequence called autophagy qualitatively determines cellular viability by removing protein aggregates and damaged cyto-plasmic constituents, and contributes significantly to the degree of myocardial ischemia-reperfusion （I/R） injury. This tightly orchestrated cata-bolic cellular‘housekeeping’ process provides cells with a new source of energy to adapt to stressful conditions. This process was first described as a pro-survival mechanism, but increasing evidence suggests that it can also lead to the demise of the cell. Autophagy has been implicated in the pathogenesis of multiple cardiac conditions including myocardial I/R injury. However, a debate persists as to whether autophagy acts as a protec-tive mechanism or contributes to the injurious effects of I/R injury in the heart. This controversy may stem from several factors including the va-riability in the experimental models and species, and the methodology used to assess autophagy. This review provides updated knowledge on the modulation and role of autophagy in isolated cardiac cells subjected to I/R, and the growing interest towards manipulating autophagy to increase the survival of cardiac myocytes under conditions of stress-most notably being I/R injury. Perturbation of this evolutionarily conserved intracellular cleansing autophagy mechanism, by targeted modulation through, among others, mammalian target of rapamycin （mTOR） inhibitors, adenosine monophosphate-activated protein kinase （AMPK） modulators, calcium lowering agents, resveratrol, longevinex, sirtuin activators, the proapoptotic gene Bnip3, IP3 and lysosome inhibitors, may confer resistance to heart cells against I/R induced cell death. Thus, therapeutic ma-nipulation of autophagy in the challenged myocardium may benefit post-infarction cardiac healing and remodeling.

Cardiorenal biomarkers in acute heart failure

Managing patients with heart failure （HF） is a challenging task within itself, but the presence of associated worsening renal function can greatly increase mortality and morbidity. Early diagnosis and treatment is the key to prevent re-hospitalizations and reduce healthcare costs. Biomarkers have long been established as highly sensitive and specific tools in diagnosing and prognosticating patients with HF. Reflecting distinct pathophysiological events and ongoing cellular insult, biomarkers have been proven superior to conventional laboratory tests. Availability of better assays and rapid analysis has allowed the use of biomarkers as point-of-care tests in the emergency department and at the patient＇s bed-side. Acute HF patients often go on to develop worsening renal function, termed as acute cardiorenal syndrome. The growing breadth of studies has shown the implications of combining multiple biomarkers to better chart outcomes and produce desirable results in such patients.

Apelin-12 improves metabolic and functional recovery of rat heart after global ischemia

This work was designed to explore efficacy of apelin-12 (A-12) as a cardioprotective agent when given before ischemia or at reperfusion using the isolated working heart model. Hearts of male Wistar rats were subjected to 30-min stabilization period followed by 35-min global ischemia and 30-min reperfusion. A short-term infusion of Krebs-Henseleit buffer (KHB) con-taining A-12 (35, 70, 140, 280 or 560 ?M) was ap-plied prior to ischemia (A-12-I) or at onset of reperfusion (A-12-R). KHB infusion was used as control. A-12 infusions induced a dose-dependent increase in recovery of coronary flow, contractile and pump function during reperfu-sion, with the largest augmentation of these indices in the A-12-I group. Both A-12 groups exhibited a significant reduction of LV diastolic pressure rise during reperfusion compared with control. Enhanced functional recovery in the A-12-I group was combined with a decrease in LDH leakage in perfusate on early reperfusion (by 36% vs. control, p < 0.05). Preischemic infusion of 140 ?M A-12 markedly increased myocardial ATP content, enhanced preservation of the total adenine nucleotide pool and improved recovery of the energy charge in reperfused hearts. There was a trend towards increase in myocardial phosphocreatine by the end of re- perfusion in the A-12-I group;however this benefit did not reach statistical significance. At the end of reperfusion, myocardial lactate and lactate/pyruvate ratio were on average 5-fold lower in A-12-I treated hearts compared with control ones and did not differ significantly from the initial values. Therefore, improved cardiac dysfunction after I/R injury and less cell mem-brane damage induced by A-12 are associated with maintaining high energy phosphates, particularly ATP, in reperfused myocardium. Changes in energy metabolism may play a role in mechanisms of cardioprotection afforded by A-12 during I/R stress.

Acupuncture preconditioning protects against myocardial ischemia/reperfusion injury mediated apoptosis through miR-214/NCX1 activation: a hypothesis

Early reperfusion of ischemic cardiac tissue is usually the best option to improve clinical outcome of angina pectoris, especially of acute myocardial infarction. However, myocardial reperfusion may cause an abnormal increase of intracellular Ca^2+-mediated cardiomyocyte death and consequent loss of cardiac function, which is referred to myocardial ischemia/reperfusion (I/R) injury. Recently, the microRNA-214 (miR-214)/Na^+/Ca^2+ exchanger (NCX) 1 co-expression is a key factor in cellular protection against myocardial apoptosis for myocardial I/R injury. Once activated, miR-214/NCX1 axis can inhibit several Ca^2+ downstream signaling effectors that mediate cell death simultaneously. Studies have shown that acupuncture preconditioning has a protective effect on myocardial I/R injury, but its mechanism deserves further research. It has been proved that acupuncture preconditioning for ischemic myocardium successfully inhibit multiple Ca2+ handling related microRNAs that mediate cell death pathways, and miR-214 is one of its targets. In terms of clinical practice, coronary heart disease (CHD) patients benefit a lot from this intervention. However, there is barely no study correlating acupuncture preconditioning to the miR-214/NCX1 co-expression in patients with CHD. This review aims to discuss whether there is some evidence to justify a recommendation of acupuncture preconditioning in CHD patients as a non-pharmacological therapeutic method to activate the miR-214/NCX1 co-expression network model.

Myocardial Protection with Beta Blocker Treatment in Infants with Heart Failure Due to Congenital Heart Defects and Duchenne Muscular Dystrophy

Our first intention to treat infants’ heart failure with beta blockers was to improve the clinical condition as shown in our prospective randomized trial. We only use non-selective beta blockers in these infants, carvedilol in those with left ventricular dysfunction and propranolol in those with congenital heart disease without ventricular dysfunction. Despite a significant improvement of Ross’s heart failure score, we could not convince most colleagues within the last 25 years if the concept of neurohumoral activation in heart failure is not well-established pediatric cardiology. Recently, Honghai Liu et al. published that cardiomyocyte cytokinesis failure was increased in congenital heart disease. Inactivation of the beta adreno receptors genes and administration of the beta-blocker propranolol increased cardiomyocyte division in neonatal mice, which increased the number of cardiomyocytes (endowment) and conferred benefit after myocardial infarction in adults. We currently realize that propranolol in infants with congenital heart disease not only decrease highly elevated NT-Pro-BNP values but also decrease cardiac troponin T values that may indicate myocardial injury due to neurohumoral activation. We reproduce this observation, primarily seen in infants with congenital heart disease, in an infant with Duchenne muscular dystrophy. These observations were in good accordance with current data from H. Liu et al., who showed that treatment with non-selective beta blockers early after birth might rescue cytokinesis defects and prevent heart dysfunction in adulthood in a mouse model.

Side effects of different doses of ephedrine in rats with cerebral ischemia/reperfusion injury

Ephedrine has a protective effect against cerebral ischemia,but its side effects limit its clinical application.Results from a previous study showed that 1.5 mg/kg per day ephedrine can promote motion recovery in rats following cerebral ischemia/reperfusion without significant side effects.In the present study,ephedrine at doses of 3.0,2.5 and 2.0 mg/kg was used to treat rats with cerebral ischemia/reperfusion and the effects of ephedrine on the heart,liver,kidney and cerebrum were observed.Results showed that the blood pressure of rats with cerebral ischemia/reperfusion injury following ephedrine treatment was lower than in rats that recovered naturally from cerebral ischemia/reperfusion,but the pressure decreased with increasing doses of ephedrine.In addition,serum aspartate transaminase,alkaline phosphatase and creatinine concentration in rats with cerebral ischemia/reperfusion injury following ephedrine treatment were greater than in rats that recovered naturally from cerebral ischemia/reperfusion.The concentrations of these enzymes were decreased with increasing doses of ephedrine.Ephedrine-treated rats displayed hyperemia,degeneration and edema in the cerebrum,liver,heart and kidney.Results demonstrated that ephedrine exhibited side effects on the cerebrum,heart,liver and kidney in rats following cerebral ischemia/reperfusion in a dose-dependent manner.

Effect of sequential mechanical ventilation on cardiac function, endothelial injury and oxidative stress response in patients with cor pulmonale

Objective: To study the effect of sequential mechanical ventilation on cardiac function, endothelial injury and oxidative stress response in patients with cor pulmonale (CCP). Methods: Patients with cor pulmonale complicated by respiratory failure who were treated in Dongfeng People's Hospital between May 2014 and February 2017 were selected and randomly divided into the sequential group who received sequential mechanical ventilation combined with conventional therapy and the control group who received invasive positive pressure ventilation combined with conventional therapy. The serum levels of cardiac function-related neurohumoral indicators, endothelial injury indicators and oxidative stress response indicators were detected before treatment as well as 3 d and 7 d after treatment. Results: 3 d and 7 d after treatment, serum NT-proBNP, Copeptin, Ang-II, ALD, ET-1, vWF, sST2 levels of both groups of patients were significantly lower than those before treatment while NO, SOD, GSH-Px and T-AOC levels were significantly higher than those before treatment;serum NT-proBNP, Copeptin, Ang-II, ALD, ET-1, vWF, sST2, NO, 8-iso-PGF2a, MDA, SOD, GSH-Px and T-AOC levels of sequential group 3 d after treatment were not significantly different from those of control group;serum NT-proBNP, Copeptin, Ang-II, ALDET-1, vWF, sST2, 8-iso-PGF2a and MDA levels of sequential group 7 d after treatment were significantly lower than those of control group while NO, SOD, GSH-Px and T-AOC levels were significantly higher than those of control group. Conclusion: Sequential mechanical ventilation for cor pulmonale can improve the cardiac function and reduce the degree of endothelial injury and oxidative stress response.