Porous Ceramic Sternal Prosthesis Implantation in a 13-Year-Old Patient Presenting with Metastatic Ewing's Sarcoma

Ewing's sarcoma is the second most frequent primary malignant bone tumor in adolescents and young adults. Locations on the thoracic wall represent up to 20% of primary and secondary locations. We present the case of a 13-year-old patient treated with the use of a radiolucency porous bioceramic prosthesis as a sternal replacement for a wide tumor resection in an oncologic context. Focal radiation therapy was not possible due to the high risk of severe myocardial injuries caused by the sternal location of the tumor. The sternum CERAMIL® (I.CERAM, Limoges, France), in porous alumina (Al2O3) has already been implanted into adults in sternal replacement during its invasion by a tumor or its infectious destruction. There were no complication concerning the surgery. The last follow-up at 2 years postoperatively reveals a satisfactory clinical situation with any functional thoracic complaint and nor any functional respiratory symptoms. The porous alumina sternal prosthesis offers a reliable alternative for sternal replacement indications for children in an oncologic context.

Irisin as a Potential Biomarker Associated with Myocardial Injuries in Patients with Severe Hypothyroidism

Objective. Irisin, a novel myokine, has recently been considered to produce a cardioprotective effect. Potential biomarkers for myocardial injuries in patients with severe hypothyroidism have yet to be identified. We aimed to investigate whether serum irisin may serve as a promising biomarker for early detecting the myocardial injuries in patients with severe hypothyroidism. Methods. This cross-sectional study comprised 25 newly diagnosed drug-naive patients with severe primary hypothyroidism and 17 age- and sex-matched healthy controls. Circulating irisin levels and cardiac magnetic resonance (CMR) were evaluated in each participant. Left ventricular (LV) myocardial injuries were detected by CMR-based T1 mapping technique using a modified look-locker inversion recovery (MOLLI) sequence, which is quantified as native T1 values. Results. Compared with healthy controls, the severe hypothyroidism group had significantly lower levels of serum irisin, especially those with pericardial effusion ( P < 0.05 ). The severe hypothyroidism subjects exhibited lower peak filling rates (PFRs) and higher native myocardial T1 values than controls ( P < 0.05 ). Additionally, the ROC analysis displayed that the sensitivity and specificity of serum irisin for diagnosing pericardial effusion in patients with severe hypothyroidism were 73.3% and 100.0%, respectively. The AUC was 0.920 (0.861–1.000) ( P < 0.001 ). The cutoff value was 36.94 ng/mL. Moreover, the results in subgroup analysis revealed that the native T1 values of the low-irisin group were significantly higher than that of the high-irisin group ( P < 0.05 ). According to multivariate linear regression analysis, serum irisin concentrations were negatively and independently correlated with native myocardial T1 values after adjustment for age, sex, and other conventional confounding factors (β = −1.473, P < 0.05 ). Conclusions. Irisin may be a potential biomarker for predicting myocardial injuries in patients with severe hypothyroidism.

Association between Intraoperative Hyperlactatemia and Myocardial Injury after Noncardiac Surgery

Background: Oxygen demand–supply mismatch is supposed to be one of the major causes of myocardial injuries after noncardiac surgery (MINS). Impaired tissue oxygenation during the surgery can lead to intraoperative hyperlactatemia. Therefore, we aimed to evaluate the relationship between intraoperative lactate level and MINS. Methods: A total of 1905 patients divided into groups according to intraoperative hyperlactatemia: 1444 patients (75.8%) into normal (≤2.2 mmol/L) and 461 patients (24.2%) into hyperlactatemia (>2.2 mmol/L) groups. The primary outcome was the incidence of MINS, and all-cause mortality within 30 days was compared. Results: In the crude population, the risks for MINS and 30-day mortality were higher for the hyperlactatemia group than the normal group (17.7% vs. 37.7%, odds ratio [OR]: 2.83, 95% confidence interval [CI]: 2.24–3.56, p < 0.001 and 0.8% vs. 4.8%, hazard ratio [HR]: 5.86, 95% CI: 2.9–12.84, p < 0.001, respectively). In 365 propensity score-matched pairs, intraoperative hyperlactatemia was consistently associated with MINS and 30-day mortality (21.6% vs. 31.8%, OR: 1.69, 95% CI: 1.21–1.36, p = 0.002 and 1.1% vs. 3.8%, HR: 3.55, 95% CI: 1.71–10.79, p < 0.03, respectively). Conclusion: Intraoperative lactate elevation was associated with a higher incidence of MINS and 30-day mortality.

The Different Effect of Decellularized Myocardial Matrix Hydrogel and Decellularized Small Intestinal Submucosa Matrix Hydrogel on Cardiomyocytes and Ischemic Heart

Injectable decellularized matrix hydrogels derived from either myocardium or small intestinal submucosa (pDMYO-gel, pDSIS-gel) have been successfully used for myocardial injury repair. However, the relationship between tissue-specific biological functions and protein composition in these two materials is not clear yet. In this study, the protein composition, mechanical properties, and morphology of these two hydrogels and their effects on the behavior of neonatal rat cardiomyocytes (NRCMs) and human umbilical vein endothelial cells (HUVECs), are investigated. The results show that pDMYO-gel is more conducive to growth, adhesion, spreading, and maintenance of normal NRCM beating, due to its higher proportion of extracellular matrix (ECM) glycoproteins (49.55%) and some unique functional proteins such as annexin-6 (ANXA6), agrin (AGRN), cathepsin D (CTSD) and galectin-1 (LGALS1), whereas pDSIS-gel is more conducive to the proliferation of HUVECs. Animal study shows that pDMYO-gel has a better effect on improving cardiac function, inhibiting myocardial fibrosis and maintaining ventricular wall thickness in acute myocardial infarction models in vivo. Therefore, it is proposed that injectable pDMYO-gel hydrogel may be more suitable for functional recovery of myocardial injuries.

Severe Acute Respiratory Syndrome Coronavirus Associated Myocarditis

Myocardial injury is common in patients with coronavirus disease 2019 (COVID-19). Among COVID-19 related myocardial injuries, etiology may vary, including myocarditis, myocardial infarct, sepsis-associated myocardial injury, and/or stress-induced cardiomyopathy. More data from prospective cohorts and case series are needed to understand the exact mechanism of COVID-19 associated myocardial injuries. It is clinically suspected that myocarditis is the cause of myocardial injury. However, myocarditis has a heterogeneous clinical presentation and tends to be underdiagnosed in critically ill COVID-19 patients. Due to the potential of rapid deterioration in the patient’s condition, it is imperative to recognize myocarditis as a sequel to COVID-19, and a multidisciplinary team should be formed for managing all clinically suspected patients with COVID-19 associated myocarditis. Further studies are needed to recognize better and understand the relationship between myocarditis and COVID-19.

Cannabinoid Receptors in Myocardial Injury: A Brother Born to Rival

Cannabinoid receptors typically include type 1 (CB1) and type 2 (CB2), and they have attracted extensive attention in the central nervous system (CNS) and immune system. Due to more in-depth studies in recent years, it has been found that the typical CB1 and CB2 receptors confer functional importance far beyond the CNS and immune system. In particular, many works have reported the critical involvement of the CB1 and CB2 receptors in myocardial injuries. Both pharmacological and genetic approaches have been used for studying CB1 and CB2 functions in these studies, revealing that the brother receptors have many basic differences and sometimes antagonistic functions in a variety of myocardial injuries, despite some sequence or location identity they share. Herein, we introduce the general differences of CB1 and CB2 cannabinoid receptors, and summarize the functional rivalries between the two brother receptors in the setting of myocardial injuries. We point out the importance of individual receptor-based modulation, instead of dual receptor modulators, when treating myocardial injuries.

Phytochemicals as Potential Therapeutics for SARS-CoV-2–Induced Cardiovascular Complications: Thrombosis and Platelet Perspective

After gaining entry through ACE2 aided by TMPRSS2, the SARS-CoV-2 causes serious complications of the cardiovascular system leading to myocarditis and other myocardial injuries apart from causing lung, kidney and brain dysfunctions. Here in this review, we are going to divulge the cellular and immunological mechanisms behind the cardiovascular, thrombotic and platelet impairments that are caused in COVID-19. In addition, we also propose the significance of various anti-platelet and anti-thrombotic phytochemicals in the treatment of COVID-19. The virus induces many immune-modulatory cytokines and chemokines which help in the intravascular coagulation and create a pro-thrombotic environment along with pulmonary embolism and thrombocytopenia. Different types of innate and adaptive immune cells and their granular contents regulate the pathophysiology of SARS-CoV-2 induced endothelial and platelet dysfunctions which correlate the involvement of platelets with myocardial injury and intravascular thrombi directly or indirectly. Hence, by exploiting the natural bioactive compounds from medicinal plants and inhibiting the platelet mediated thrombus formation can be beneficial for the treatment of SARS-CoV-2 infection.