Effect of Shengmal Powder(生脉散) on Symptoms and Markers of Inflammatory Damage of Patients with Acute Viral Myocarditis

Objective: To evaluate the efficacy of Sheng-mai Power (SMP) in treating acute viral myocarditis. Methods: 102 patients with acute viral myocarditis were randomized to SMS group (n = 52) and placebo control group (n = 50 ). Semiquantitative integral methods were taken to observe changes of clinical symptoms such as dyspnea, palpitation and chest pain after 4 weeks of treatment, simultaneously EKG, 24h Holter, concentration of serum cardiac troponin-I, cardiac troponin T and neutralizing antibody test to the Coxsackie B virus were determined. Results: Dyspnea improved much more obvious in SMP group than in the placebo

Observation on Therapeutic Effects of Shengmai Powder (生脉散)in Treating Acute Viral Myocarditis

Objective: To evaluate the clinical efficacy of Shengmai Powder (SMP, 生脉散) in treating a-cute viral myocarditis objectively. Methods: One hundred and twenty-four patients with acute viral myocarditis were randomized into the treated group (SMG, n = 64) and the control group(CG, n = 60 ). Such myo-cardial nutrient medicine as ATP, CoA , Vit-C, were given to both groups. And to the treated group, 40 ml of Shengmai Injection per day was given intravenously for 2 weeks, which was followed by oral intake of Shengmai granule, one package three times daily for another 2 weeks in total. The same anti-arrhythmia agents were applied to both groups, and no fructose-1, 6-diphosphate (FDP) for either. Semi-quantitative scoring method was adopted to observe such symptoms as chest stuffiness, palpitation and chest pain before treatment and four weeks after treatment. Meanwhile, EGG, dynamic ECG by Holter monitor, left ventricular end-diastolic dimension (LVEDD), left ventricular ejection fraction (LVEF), serum neutralizing antibody of virus Coxsackie B, cardiac troponin I (cTnl) and cardiac troponin T (cTnT) were examined. Results: (1) Compared with the control group, more significant improvement was got in SMG in respects of chest stuffiness, palpitation, chest pain and arrhythmia (P<0.05 or P<0.01). (2) Negative converting rates of cTnl ,cTnT in the two groups were 59.46% vs35.48%, 68.75% vs42.31% respectively ( P<0. 05). (3) LVEDD before and after treatment in SMG was 52. 44 ± 3. 40 mm and 48. 81 ± 2. 23mm respectively, while that in the control group was 52. 31 ± 3. 74 mm and 49. 92 ± 2. 67mm respectively; LVEF before and after treatment in SMG was 60.67 ± 4. 62 % and 65. 02 ± 4. 16 % respectively, while that in the control group was 60.91 ± 4. 26 % and 63. 67 ± 3.17 % . There was obvious improvement in the two parameters in both groups, but the improvement in SMG was superior to that in the control group ( P<0. 05). Conclusion: SMP shows a good effect in improving clinical symptoms and signs, heart function, abnormal ECG and inflammatory injury indexes in patients with acute viral myocarditis.

Effect of intravenous gamma globulin on short- and mid-term clinical outcome in acute viral myocarditis in children

Acute viral myocarditis is an extremely diverse disease with a predictable good outcome with supportive therapy. The objective of this study was to look at the clinical outcome of patients receiving additional intravenous gamma globulin compared to those receiving conventional anti-congestive therapy alone. Patients and methods: This is a retrospective review of charts of children admitted with acute myocarditis. Group 1 was children who received intravenous gamma globulin (IVIG) along with conventional anti-congestive therapy. Group 2 were patients who received the conventional anticongestive therapy alone. Short-term outcome was survival to hospital discharge, and mid-term outcome was improvement of left ventricular ejection fraction at 6 months and one year follow-up. Results: A total of 36 patients were enrolled and 18 were males. The mean age of all patients was 2.3 ± 2.6 years and the mean duration of illness for the whole group was 6.7 ± 3.8 days. Group 1 comprised of 16 patients. There was no difference in short-term outcome with mortality of 2 patients in Group1 (12.5%) and 3(15%) in Group 2 (p = 0.2). At intermediate term follow up, recovery of ejection fraction in Group 1 was in 4/14 (28%) and in Group 2 it was 9/17 (55%) and at 12 months it was 10/13 (77%) in Group 1 and 15/16 (94%) in Group 2 (p = 0.02 and 0.19 respectively). Conclusion: Acute myocarditis has a high spontaneous cure rate. Our study did not show any significant difference in the short-term or midterm outcome between children receiving IVIG compared to those who did not.

Icariin ameliorates viral myocarditis by inhibiting TLR4-mediated ferroptosis

Objective:To explore the mechanism by which icariin alleviates viral myocarditis.Methods:CVB3-induced cardiomyocytes were used as an in vitro model of viral myocarditis to assess the effects of icariin treatment on cell viability,inflammation,and apoptosis.Moreover,the effects of icariin on ferroptosis and TLR4 signaling were assessed.After AC16 cells were transfected with TLR4 overexpression plasmids,the role of TLR4 in mediating the regulatory effect of icariin in viral myocarditis was investigated.Results:Icariin significantly elevated cell viability and reduced inflammatory factors TNF-α,IL-1β,IL-6,and IL-18.Flow cytometry revealed that icariin decreased apoptosis rate,and the protein expression of Bax and cleaved caspase 3 and 9 in CVB3-induced cardiomyocytes.Additionally,it suppressed ferroptosis including lipid peroxidation and ferrous ion,as well as the TLR4 signaling.However,TLR4 overexpression abrogated the modulatory effects of icariin.Conclusions:Icariin mitigates CVB3-induced myocardial injury by inhibiting TLR4-mediated ferroptosis.Further animal study is needed to verify its efficacy.

Viral etiologies of acute liver failure

Acute liver failure(ALF)is a rare cause of liver-related mortality worldwide,with an estimated annual global incidence of more than one million cases.While drug-induced liver injury,including acetaminophen toxicity,is the leading cause of ALF in the Western world,viral infections remain a significant cause of ALF and the most common cause in many developing nations.Given the high mortality rates associated with ALF,healthcare providers should be aware of the broad range of viral infections that have been implicated to enable early diagnosis,rapid treatment initiation when possible,and optimal management,which may include liver transplantation.This review aims to provide a summary of viral causes of ALF,diagnostic approaches,treatment options,and expected outcomes.

Huu S. TIEU’s Predicting Outcome of Severe Acute Respiratory Syndrome (SARS) and Preparing the Treatment for COVID-19 (Coronavirus) and Other Viral Pandemics

This project paper is to give a prediction for the future of other viral pandemics and to provide recommendations for preparing therapies that could help in the success of effective treatments and benefits for patients in life-threatening situations. The theory of prediction was proposed by Huu S. TIEU on March 25, 2019, and he hypothesized that any malfunctioning cell in the body could have a damaging effect. This paper discusses the prediction that Localized Oxygen Deprivation could be a contributing factor for a future epidemic or other viral pandemics that could affect body function. This paper is based on opinion and does not have sufficient evidence to support the claims made. Therefore, further in-depth study is needed to prove the findings. The author cites Hypoxia to support his idea, but he is not claiming that Hypoxia-Inducible Factor (HIF) has worked on his predictions. The author also tested a theory using cow blood curd for body function, but this test was not a structured test and the findings were not supported by other evidence. To further prove the idea or theory, further study into the subject should be conducted.

Contribution of Cardiac MRI in the Diagnosis of Acute Myocarditis

Objective: To describe the MRI abnormalities observed in acute myocarditis. Materials and Methods: Retrospective cross-sectional study with a descriptive aim, carried out at the North Franche-Comte Hospital, over a period of 12 months, from January 2021 to December 2021. It covered all patients who received an MRI of heart disease and were diagnosed with myocarditis. The diagnosis of myocarditis was retained in all patients on the basis of two arguments: a T2 PSIR hyper signal and a late enhancement at 15 min in T1 PSIR with gadolinium. Results: Myocarditis was diagnosed in 20 patients out of a total of 214 who performed cardiac MRI, i.e. 10.30% of cases. The average age was 33.7 ± 14.3 with extremes of 17 and 69 years. We observed a male predominance with 11 men (55%) for 9 women (45%) or a sex ratio of 1.2. Clinical suspicion of myocarditis and acute coronary syndrome were the main indications for MRI. The lesion sites were subepicardial (95%) and/or intramural (30%), respecting the subendocardium, interesting for the majority, segments 12 (anterolateral) in 50% and/or 11 (inferolateral) in 43% of cases. Global hypokinesia was observed in 30% of patients associated with a decrease in LVEF. There was no cardiac volume abnormality or valvular abnormality. Conclusion: Cardiac MRI is nowadays the most efficient non-invasive imaging in the diagnosis of acute myocarditis. The diagnosis of myocarditis was made on 2 pathognomonic signs, namely a T2 STIR hyper signal and late enhancement at 15 min in T1 PSIR after injection of gadolinium. The morphology and lesion locations were in agreement with those described in previous studies. Global hypokinesia and pericardial effusion were observed in some patients. On the other hand, there was neither valvular anomaly, nor cardiac volume anomaly.

Local Application of Combined Drugs of Natural Essential Oils for the Prevention of Acute Pharyngitis

Objective: Viral pharyngitis, commonly known as a sore throat, is a widespread condition affecting people of all ages globally. This study aimed to assess the effectiveness of a medical device containing the combined drugs of natural essential oils (CDNEO) formulation in managing throat pain in patients with acute viral pharyngitis. With the growing resistance to traditional antibacterial treatments, essential oils have attracted interest for their potential analgesic, anti-inflammatory, and antibacterial properties. Results: The study involved 81 patients randomly divided into two groups: those taking a medical device containing combined drugs of natural essential oils (CDNEO) and those taking a placebo. A questionnaire was used to assess throat pain among the participants, with 45 receiving the CDNEO and 36 the placebo. The CDNEO group experienced a significant reduction in throat pain, with the average VAS score decreasing from 5.36 to 1.09, compared to the placebo group, which saw a decrease from 4.97 to 2.19. This difference, with p Conclusion: By using a double-blind research method, it was possible to evaluate the effectiveness of the oils more objectively, since there was also a control placebo group. The study shows that CDNEO significantly reduces throat pain and decreases the need for additional pain relief medication in patients with acute viral pharyngitis. The findings suggest that natural essential oils could serve as an alternative treatment for pharyngitis, particularly in efforts to minimize NSAID use and combat antibiotic resistance.

Impairment of Myocardial and Skeletal Mitochondria in Mice with Viral Myocarditis and Their Correlation

In order to investigate the impairment of mitochondrial membrane phospholipid local- ization and DNA3867 (mtDNA3867) deletion and the correlation between cardiac and skeletal muscle cells in mice with viral myocarditis, 50 BALB/c mice were divided into two groups randomly. In ex- perimental group (n=40), the mice were intraperitoneally injected with 0.1 mL Eagle liquid with CVB3 (TCID50=108), while in the control group (n=10), the mice were subjected to equal volume of Eagle liquid. The impairment of mitochondrial membrane phospholipid localization and mtDNA3867 deletion rate of cardiac and skeletal muscle were detected separately at day 3, 11 and 24 after injec- tion. The correlation of mitochondrial membrane phospholipid localization and mtDNA3867 deletion rate between cardiac and skeletal muscle cells cells was analyzed using Spearman method. At the day 3 after injection, in both cardiac and skeletal muscle cells, mtDNA3867 deletion rate was significantly higher in experimental group than in control group (P<0.05), but the localization of mitochondrial membrane phospholipid showed no difference between two groups (P>0.05). At day 11 after injec- tion, the mtDNA3867 deletion rate of both cells in experimental group was increased to the peak level (P<0.05), and the impairment of mitochondrial membrane phospholipid localization of both cells also increased markedly in experimental group as compared with control group (P>0.05). At the day 24 after injection, the impairment of mitochondrial membrane phospholipid localization and mtDNA3867 deletion of both cells showed a recovery tendency, but still severer than those at the day 3 after injec- tion (P<0.05). The impairment of mitochondrial membrane phospholipid localization and mtDNA3867 deletion were consistent and synchronistic between cardiac and skeletal muscle cells, and showed good correlations (P<0.05). The impairment of mitochondria plays an important role in the patho- genesis of viral myocarditis, and the skeletal muscle cells might act as a peripheral 'window' to re- flect the mitochondrial damage of cardiac myocytes.

Effect of Astragalus Injection on Levels of Blood Selenium and Immunity Function in Children with Viral Myocarditis

Objective: To observe the effect of Astragalus Injection (AD on levels of blood selenium (Se) and cytokines, and T cellular immune function with viral myocarditis (VM) in children. Methods: Eighty children with VM were randomly divided into 2 groups. The control group consisted of 38 patients, to whom conventional therapy, including energy mixture, vitamin C and coenzyme Q10, etc. were given. The treated group (n = 42), to whom combination therapy of conventional therapy and Al were given. The levels of blood Se and cytokine, including interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and also evaluation of T lymphocyte subsets and cardiac function were observed. Results: The results showed that after treatment, the levels of blood Se were significantly higher (P<0.01), while IL-1,IL-6 and TNF-a were significantly lower (P<0.01) than those before treatment in the control group. The left ventricular end diameter (LVED) were significantly decreased (P<0.01), left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were significantly increased than those before treatment in the treated group(P<0.01, P<0.05). T lymphocyte subsets got normalized (P<0.01), and compared with the control group, the difference was significant (P<0.01). Conclusion: Astragalus membranaceus possesses anti-viral effect, adjusts the balance of cytokine and T cellular immunity, and improves the clinical manifestation and cardiac function. It is an effective approach in treating viral myocarditis.

Effect of Astragalus membranacaus on Electrophysiological Activities of Acute Experimental Coxsackie B3 Viral Myocarditis in Mice

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STUDY OF PERSISTENT VIRAL INFECTION IN AN ANIMAL MODEL OF VIRAL MYOCARDITIS BY PCR

Objective To study the role of persistent viral infection in the mechanism of viral myocarditis. Methods A mice model of CVB3m viral myocarditis wes made and the viral RNA in mice myocardium and whole bind sample wes tested by using polymerase chain reaction (PCR ) technique. The pathological changes in mice myocardium were determined. Results De day 3, the viral gene in whole bind and myocardium wes found, which portly became negative on day 8, but the change of myocardial anthology borne obvious. Although the bind specimens wers tested negatively on day 12, the viral gene in mice myocardium remained positive within 120d. Conclusion This study indicates that persistent viral infection plays a role in the pathogenesis of viral myocarditis.

Effects of Shenmai Injection(参麦注射液)Combined with Meglumine Adenosine Cyclophosphate Injection on Cardiac Function and Peripheral Serum Levels of TNF-α,TGF-β1 and IFN-γ in Patients with Viral Myocarditis

Objective: To explore effects of Shenmai Injection(参麦注射液) combined with Meglumine Adenosine Cyclophosphate Injection on cardiac function and peripheral serum levels of tumor necrosis factor-α(TNF-α), transforming growth factor-β1(TGF-β1) and interferon-γ(IFN-γ) in patients with viral myocarditis.Methods: A total of 70 patients with viral myocarditis admitted in Cardiovascular Medicine Department of our hospital from June 2016 to June 2018 were selected and divided into a control group(treated with Meglumine Adenosine Cyclophosphate Injection) and an observation group(additionally treated with Shenmai Injection(参麦注射液) on the treatment basis of the control group) according to random number method, with 35 cases in each group.Before and after the treatment, cardiac functional indexes like cardiac index(CI), left ventricular ejection fraction(LVEF) and left ventricular shortening fraction(FS), serum levels of TNF-α, TGF-β1 and IFN-γ, clinical efficacy and adverse reactions occurred in the 2 groups were recorded and compared.Results: Therapeutic effective rate in the observation group was 88.57%, higher than 68.57% in the control group(P < 0.05).After the treatment, cardiac functional indexes like CI, LVEF and FS were higher than those in the control group(P < 0.05).After the treatment, the serum expression levels of TNF-α and TGF-β1 were lower than those in the control group(P < 0.05), while the serum expression level of IFN-γ was higher than that in the control group(P < 0.05).There was no statistically significant difference in the adverse reaction rates between the 2 groups(P > 0.05).Conclusion: The treatment of patients with viral myocarditis by Shenmai Injection(参麦注射液) combined with Meglumine Adenosine Cyclophosphate Injection is more effective, reducing inflammation and restoring cardiac function.

Experience in Treating Viral Myocarditis with Master Lei's Huoxue Decoction

Modem medical treatment of viral myocarditis by suppressing viral replication and improving cardiomyocyte metabolism has a good effect on the acute infectious period of viral myocarditis,but the curative rate is poor,especially the sequelae of viral myocarditis,which often lingers for years to decades.The use of traditional Chinese medicine can achieve a certain curative effect by promoting the positive and dispelling evil spirits as well as balancing yin and yang.After long-term observation,it is found to have clear eff ect on improving myocardial injury caused by viral myocarditis.

Viral and Bacterial Etiology of Acute Febrile Respiratory Syndrome among Patients in Qinghai, China

Objective This study was conducted to investigate the viral and bacterial etiology and epidemiology of patients with acute febrile respiratory syndrome(AFRS) in Qinghai using a commercial routine multiplex-ligation-nucleic acid amplification test(NAT)-based assay. Methods A total of 445 nasopharyngeal swabs specimens from patients with AFRS were analyzed using the RespiFinderSmart22 kit(PathoFinder BV, Netherlands) and the LightCycler 480 real-time PCR system. Results Among the 225(225/445, 51%) positive specimens, 329 positive pathogens were detected, including 298(90.58%) viruses and 31(9%) bacteria. The most commonly detected pathogens were influenza virus(IFV;37.39%;123/329), adenovirus(AdV;17.02%;56/329), human coronaviruses(HCoVs;10.94%;36/329), rhinovirus/enterovirus(RV/EV;10.03%;33/329), parainfluenza viruses(PIVs;8.51%;28/329), and Mycoplasma pneumoniae(M. pneu;8.51%;28/329), respectively. Among the co-infected cases(17.53%;78/445), IFV/AdV and IFV/M. pneu were the most common co-infections. Most of the respiratory viruses were detected in summer and fall. Conclusion In our study, IFV-A was the most common respiratory pathogen among 22 detected pathogens, followed by AdV, HCoV, RV/EV, PIV, and M. pneu. Bacteria appeared less frequently than viruses, and co-infection was the most common phenomenon among viral pathogens. Pathogens were distributed among different age groups and respiratory viruses were generally active in July, September, and November. Enhanced surveillance and early detection can be useful in the diagnosis, treatment, and prevention of AFRS, as well as for guiding the development of appropriate public health strategies.

Risk factors analysis of prognosis of adult acute severe myocarditis

BACKGROUND Adult severe myocarditis is primarily caused by infection with any number of a variety of viruses.It arises quickly,progresses rapidly,and may lead to severe heart failure or circulatory failure presenting as rapid-onset hypotension and cardiogenic shock with a high hospital mortality rate.AIM To analyze the risk factors affecting the short-term prognosis of adult acute severe myocarditis(ASM).METHODS Adult patients with ASM(ASM group,n=218)and acute nonsevere myocarditis(ANSM group,n=80)who came to our department from January 2014 to January 2020 were enrolled in this study.Patients with ASM were divided into the ASM survival group(n=185)and ASM nonsurvival group(n=33)according to the treatment results during hospitalization.The clinical symptoms,laboratory examinations,treatment methods,complications,and the relationship between the treatment results of the two groups were retrospectively compared and discussed.The risk factors for death in patients with severe myocarditis were analyzed by binary logistic regression.A follow-up to 5.5 years was conducted on patients in the ASM survival group and ANSM group after discharge,and the readmission rate and incidence rate of dilated cardiomyopathy were analyzed.RESULTS Compared with the ASM survival group,the ASM nonsurvival group had longer QRS complex,higher incidence of cardiogenic shock,higher serum creatinine(SCr,235μmol/L vs 89μmol/L,P<0.05),higher sensitive cardiac troponin I(cTnI,4.45μg/L vs 1.66μg/L,P<0.05)and brain natriuretic peptide(BNP,1756 pg/mL vs 401 pg/mL,P<0.05).The binary logistic regression revealed that there were statistical differences between the two groups in SCr,cTnI,and BNP values(all P<0.05).After discharging from the hospital,patients in the ASM group and ANSM group had no significant differences in the readmission rate and incidencerate of dilated cardiomyopathy.CONCLUSION Elevated SCr,cTnI,and BNP are independent predictors for poor prognosis in patients with ASM.The long-term prognosis of patients in the ASM survival group is good.

Comparison study of Mongolian milkvetch root and Indigowood treating murine viral myocarditis

Objective To investigate perfect therapeutic measure of Chinese traditional herbs through observing curative effect of single dose traditional Chinese medicine on murine viral myocarditis(VMC).Method Balb/C mice were inoculated intraperitoneally with diluted solution of coxsackievirus B3(CVB3) , and then were divided into three groups randomly: infected control group, Mongolian milkvetch root treated group; Indigowood treated group. The mice were put to death and their hearts were examined on day 3,5,7,10,14,21 post inoculated, and were stained with hemotoxylin and eosin(HE) to observe myocardial lesions and to estimate myocardial histopathological scores, simultaneously to separate virus from myocardium. In addition, we observed myocardial ultrastructure by electron microscopy on 7th day post inoculated. Result Compared with infected control group, myocardial histopathological scores of both Mongolian milkvetch root treated group from 5th day to 21st day post inoculated and Indigowood treated group on 5th day and 7th day post inoculated showed significant decrease(P< 0.05).Conclusion Mongolian milkvetch root could protect myocardial cells.

STUDY ON PERSISTENT INFECTION OF COXSACKIEVIRUSGROUP B IN MURINE MODEL OF CHRONICVIRAL MYOCARDITIS

Objective To investigate the dynamic change of coxsackievirus B3 (CVB3) in murine model ofchronic myocarditis and revel the molecular mechanism of the persistent infection of the tirus.Methods Strand - specific RT- PCR(ssRT- PCR), quantitative RT- PCR (qRT - PCR) and multiplexRT- PCR(mRT- PCR). Results The positive strand of CVB3 RNA existed in heart tissue up to 3 monthsalthough its amount decreased by 103～4 folds from acute to chronic phase. The negative strand RNA for virusreplication kept its amount on la moleculars per gram heart tissue. Some conserved areas of virus RNA 5’NTRand 3’NTR were lost in chronic phase. Conclusion The virus kept replication during the whole phase ofmyocarditis and speeded down on chronic period in the status of persistent infection. That may be due to theterminal lose of CVB RNA.

Acute myocarditis triggering coronary spasm and mimicking acute myocardial infarction

A 24-year-old healthy man consulted to our center because of typical on-and-off chest-pain and an electrocardiogram showing ST-segment elevation in inferior leads. An urgent coronary angiography showed angiographically normal coronary arteries. Cardiovascular magnetic resonance imaging confirmed acute myocarditis. Although acute myocarditis triggering coronary spasm is an uncommon association, it is important to recognize it, particularly for the management for those patients presenting with ST-segment elevation and suspect myocardial infarction and angiographically normal coronary arteries. The present report highlights the role of cardiovascular magnetic resonance imaging to identify acute myocarditis as the underlying cause.

Clinical value of high-dose VitC + immunoglobulin for the treatment of viral myocarditis in children

Objective: To study the clinical value of high-dose VitC + immunoglobulin for the treatment of viral myocarditis in children. Methods: Children who were diagnosed with viral myocarditis in the hospital between May 2014 and March 2017 were selected as the research subjects and divided into two groups by random number table, observation group received high-dose VitC+ immunoglobulin combined with conventional symptomatic and supportive treatment and control group received conventional symptomatic and supportive treatment. The serum levels of myocardial injury indexes, myocardial remodeling indexes and inflammatory response indexes were measured before treatment as well as at 1 week and 2 weeks after treatment. Results: 1 week and 2 weeks after treatment, serum CK-MB, cTnI, MDA, BNP, PINP, ICTP, MMP2, MMP9, TGFβ1, TNF-α, ICAM-1, MIP-1α and IL-17 levels of both groups of patients were significantly lower than those before treatment, and serum CK-MB, cTnI, MDA, BNP, PINP, ICTP, MMP2, MMP9, TGFβ1, TNF-α, ICAM-1, MIP-1α and IL-17 levels of observation group were lower than those of control group. Conclusion: High-dose VitC +immunoglobulin can reduce the myocardial damage and inhibit the myocardial remodeling and inflammatory response in children with viral myocarditis.