Central and Peripheral Cannulation for Cardiopulmonary Bypass in Fetal Sheep: A Comparative Study

Objective:In-utero correction is an option for treatment of critical congenital heart diseases (CHDs). Fetal cardiac surgery for CHDs is dependent on the reliable use of fetal cardiopulmonary bypass (CPB), but this technology remains experimental. In this study, we established fetal CPB models with central and peripheral cannulation to explore the differences between the two cannulation strategies.Methods: Ten fetal sheep with 90–110 gestational days were randomized into central cannulation (n = 5) and peripheral cannulation (n = 5) groups. All fetal CPB models were successfully established. At each time point (0, 30, and 60 min after initiation of CPB), echocardiography was performed. Blood samples were also collected for blood gas analysis and tests of myocardial enzymes and liver and kidney function.Results: In the central cannulation group, right ventricular Tei index significantly increased (p = 0.016) over time. Compared with the peripheral cannulation group, the left ventricular Tei index of the central cannulation group was significantly higher (1.96 ± 0.31 vs. 0.45 ± 0.19, respectively; p = 0.028) and the stroke volume was lower (0.46 ± 0.55 vs. 2.13 ± 0.05, respectively; p = 0.008) at 60 min after CPB. Levels of liver and kidney injury markers and of acid-base balance, including alanine aminotransferase (ALT), aspartate aminotransferase/ALT ratio, blood urea nitrogen (BUN), BUN/creatinine ratio, base excess and bicarbonates, were significantly higher for peripheral than for central cannulation. Other important physiologic parameters, including heart rate, blood pressure, myocardial enzymes, umbilical artery beat index and resistance index, left ventricular Tei index, and left and right ventricular stroke volume, were comparable between the two groups.Conclusions: Both central and peripheral cannulations can be used to establish fetal CPB models. Central cannulation causes more adverse impacts for cardiac function, whereas peripheral cannulation is more susceptible to complications related to inadequate organ perfusion.

Mechanisms of Paeoniflorin against myocardial ischemia reperfusion injury based on network pharmacology

Ischemic heart disease (IHD) is the primary reason of death of cardiovascular diseases. Paeoniflorin (PF), a monoterpene glycoside extracted from Radix Paeoniae Rubra or Paeoniae Radix Alba, can ameliorate myocardial ischemia/reperfusion injury (MIRI), but its mechanism is not still defined. In this study, network pharmacology was utilized, the protein interaction network between PF and MIRI targets were screened for bioenrichment analysis. Moreover, the anti-MIRI effects of PF (30, 60 and 120 mg/kg) were investigated in vivo on rats for verification. The myocardial infarction area was assessed by TTC/Evans blue staining and morphological changes of tissues were evaluated using hematoxylin and eosin staining. The contents of myocardial enzymes and oxidation resistance were measured. The cell apoptosis was evaluated using TUNEL staining and the expression of proteins was estimated using Western Blot. In the results, the relevant targets and the biological processes of PF against MIRI were screened out, indicating its anti-MIRI potential pharmacological effects of PF. 120 mg/kg PF can shrink infarction area after ischemia/reperfusion, ameliorate pathological morphology in myocardial tissue, lower the levels of myocardial enzymes, and attenuate oxidative stress. Furthermore, PF could reduce the positive rate of TUNEL staining caused by MIRI. Moreover, 120 mg/kg PF could depress the protein levels of Bax, Caspase-3, Beclin-1 and Cathepsin B and increase the protein level of Bcl-2 on rats after reperfusion. In conclusion, Paeoniflorin has an anti-MIRI effect in rats via coordinate regulation of anti-oxidative stress, anti-apoptosis and inhibition of autophagy.

Exercise Preconditioning to Improve Myocardial Ischemia Tolerance Via the NO-PKC-KATP Signaling Pathway

Background: Exercise preconditioning (EP) has a similar effect on ischemic preconditioning. Yet the specific endogenous trigger substance, intermediary substance and effect substance involved in EP have yet to be fully defined.Methods: 32 SD rats were divided into four groups: group A (control sham operation group); group B (control ischemia/reperfusion (I/R) model group); group C (train and I/R model group); and group D (train, inhibitor, and I/R model group). Rat model of acute endurance exercise was established. Then, in vivo I/R experiment and index test of the serum myocardial enzymes, the heart functions, Kir6.1 and Kir6.2 gene expressions and NOS and PKC protein expressions were carried out.Results: Compared with the A group, the heart function of the B group decreased significantly, and the serum myocardial enzymes increased significantly. Compared with the B group, the C group had less heart function decline and less myocardial injury. Injection L-NAME attenuated the cardioprotection induced by exercise preconditioning. B group's PKC protein expression was higher than the A group's; the C group's PKC protein expression was significantly higher than the B group's, and the D group's PKC protein expression was significantly lower than the C group's. In addition, the B group's Kir6.1 and Kir6.2 gene expressions were higher than the A group's; the C group's Kir6.1 and Kir6.2 gene expressions were significantly higher than the B group's, and the D group's Kir6.1 and Kir6.2 gene expressions were significantly lower than the C group's.Conclusions: Moderate intensity endurance exercise can induce a cardioprotective effect on I/R myocardium. Exercise preconditioning induces myocardial protective function via the NO-PKC-KATP signaling pathway.

Effects of Full Inhalation of Sevoflurane and Total Intravenous Anesthesia on Hemodynamics, Serum Myocardial Enzymes, and Myocardial Markers in Elderly Patients Undergoing Hysterectomy

Objective. To compare the effects of sevoflurane inhalation and intravenous anesthesia on hemodynamics, serum myocardial enzymes, and myocardial markers in elderly patients undergoing hysterectomy. Methods. Group A and group B were established randomly regarding a total of 126 elderly patients who underwent an elective hysterectomy. Patients in group A were given full anesthesia with sevoflurane, and patients in group B were given anesthesia with intravenous anesthesia. The operation time, anesthesia time, and recovery time in Postanesthesia Care Unit (PACU) were compared; plasma cortisol concentration, hemodynamics, serum myocardial enzymes, and myocardial markers were detected and compared between the two groups of patients before anesthesia ( T 0 ), after anesthesia ( T 1 ), and after surgery ( T 2 ). Results. Group A observed a longer extubation time and recovery time in PACU than group B ( P < 0.05 ). Results show a lower systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and plasma cortisol concentration of T 1 by comparison with those of T 0 ( P < 0.05 ), but no significant difference remains in terms of intergroup SBP, DBP, and HR ( P > 0.05 ), and there was no interaction effect of groups and time ( P > 0.05 ). The two groups showed no great disparity in the levels of lactate dehydrogenase (LDH), aspartate transaminase (AST), creatine kinase (CK), and CK-MB as a subtype of CK before surgery between the two groups of patients ( P > 0.05 ). After surgery, LDH, AST, CK, and CK-MB levels in both groups were witnessed a surge, in which group A obtained higher levels of LDH, AST, CK, and CK-MB (all P < 0.05 ). Conclusion. Total intravenous anesthesia will not increase the hemodynamic fluctuation of elderly patients undergoing hysterectomy and can reduce the damage to the myocardium of patients with surgical trauma, which can protect the myocardium of elderly patients to a certain extent, so it can be adopted as the optimal anesthesia protocol for surgery.

Abnormal myocardial enzymes are important indicators of poor prognosis in COVID-19 patients

Objective: Researching the prognostic value of myocardial enzymes in COVID-19 patients. Materials & methods: We collected 113 confirmed COVID-19 patients. The dynamic changes of CK, LDH and α-HBDH in patients were studied retrospectively, the correlation between myocardial enzyme index, clinical classification and outcome of patients and its significance to prognosis. Results: There are significant statistical differences between LDH, α-HBDH, CK and the clinical classification, and patient’s outcome. In the receiver operating characteristic curve analysis, LDH, α-HBDH and CK have a good diagnostic value for the death outcome of patients. Conclusion: LDH, α-HBDH and CK were the components of myocardial enzyme profiles, and our results found that they were significantly positively correlated with clinical classification and prognosis of COVID-19 patients. The values of LDH, α-HBDH and CK increased with the increase of the severity of admission clinical classification and the deterioration of outcome. Therefore, we propose that continuous monitoring of LDH, α-HBDH and CK indicators can warn the deterioration of COVID-19 to a certain extent, regardless of whether patients with cardiovascular diseases are combined or not, and prompt early intervention.

Dynamic Analysis of Myocardial Enzymes and Electrocardiogram in Pediatric Pneumonia

Objective: The condition of pediatric pneumonia changes rapidly. Non-invasive myocardial enzymes and electrocardiogram (ECG) can reflect the myocardial damage of patients noninvasively. The purpose of this study was to investigate the dynamic changes of myocardial enzymes and ECG in the pediatric pneumonia. Method: A total of 18 pediatric pneumonia cases in our hospital from April 2018 to February 2019 were chosen. Another 18 healthy children were chosen as control group. The activity of creatine kinase (CK), creatine kinase isoenzymes (CK-MB), lactate dehydrogenase (LDH), and Glutamic oxaloacetic transaminase (GOT) was collected, and the ECG were recorded in all subjects. Result: Before treatment, the CK, CK-MB, LDH and GOT in pneumonia group was higher than the data in control group. After treatment, the level decreased significantly, but still slight higher than the data in control group. Compare with control groups, the incidence of abnormal ECG increased significantly. There was no statistical difference of incidence between control group and the patients after treatment. Conclusion: The serum myocardial enzymes such as CK, CK-MB, LDH and GOT and ECG changes are useful markers for monitoring the myocardial injury in pediatric pneumonia.