Comparison of the Development and Prognosis in Patients of Hypertriglyceridemic Pancreatitis with and without Diabetes

Aim. To investigate the clinical features and prognosis in patients of hyperlipidemic acute pancreatitis with or without diabetes. Methods. 157 patients with hypertriglyceridemic pancreatitis (HTGP) were included in this study. Patients with a previous history of diabetes were identified in the group of HTGP with diabetes (HTGPD), while patients without a history of diabetes were identified in the group of HTGP. The clinical characteristics and prognosis data of these patients in the two groups were analyzed. Results. Multivariate Cox regression analysis showed that age, body mass index, glycated serum protein (GSP), and Acute Physiology and Chronic Health Evaluation (APACHE) II score were significantly associated with mortality in patients with HTGP. The mortality was significantly higher in the HTGPD group than in the HTGP group ( p < 0.001 ). Compared to patients of HTGP, those of HTGPD had older age of onset, higher blood glucose levels, and higher GSP levels on admission. Electrocardiograms showed that patients of HTGPD had a significantly higher risk of heart ischemia than those of HTGP ( p < 0.05 ). Patients of HTGPD had higher APACHE II scores than those of HTGP ( p < 0.001 ). Single-factor analysis showed that higher triglyceride levels, GSP, LDL, and previous history of diabetes were associated with HTGP recurrence. Conclusions. Clinicians should be alert to patients of HTGP with diabetes. Diabetes is an important risk factor for HTGP and hyperglycemia may affect the development and prognosis of HTGP.

Nuclear Receptors in Myocardial and Cerebral Ischemia—Mechanisms of Action and Therapeutic Strategies

Nearly 18 million people died from cardiovascular diseases in 2019, of these 85% were due to heart attack and stroke. The available therapies although efficacious, have narrow therapeutic window and long list of contraindications. Therefore, there is still an urgent need to find novel molecular targets that could protect the brain and heart against ischemia without evoking major side effects. Nuclear receptors are one of the promising targets for anti-ischemic drugs. Modulation of estrogen receptors (ERs) and peroxisome proliferator-activated receptors (PPARs) by their ligands is known to exert neuro-, and cardioprotective effects through anti-apoptotic, anti-inflammatory or anti-oxidant action. Recently, it has been shown that the expression of aryl hydrocarbon receptor (AhR) is strongly increased after brain or heart ischemia and evokes an activation of apoptosis or inflammation in injury site. We hypothesize that activation of ERs and PPARs and inhibition of AhR signaling pathways could be a promising strategy to protect the heart and the brain against ischemia. In this Review, we will discuss currently available knowledge on the mechanisms of action of ERs, PPARs and AhR in experimental models of stroke and myocardial infarction and future perspectives to use them as novel targets in cardiovascular diseases.

Role of Creatine in the Heart: Health and Disease

Creatine is a key player in heart contraction and energy metabolism. Creatine supplementation (throughout the paper, only supplementation with creatine monohydrate will be reviewed, as this is by far the most used and best-known way of supplementing creatine) increases creatine content even in the normal heart, and it is generally safe. In heart failure, creatine and phosphocreatine decrease because of decreased expression of the creatine transporter, and because phosphocreatine degrades to prevent adenosine triphosphate (ATP) exhaustion. This causes decreased contractility reserve of the myocardium and correlates with left ventricular ejection fraction, and it is a predictor of mortality. Thus, there is a strong rationale to supplement with creatine the failing heart. Pending additional trials, creatine supplementation in heart failure may be useful given data showing its effectiveness (1) against specific parameters of heart failure, and (2) against the decrease in muscle strength and endurance of heart failure patients. In heart ischemia, the majority of trials used phosphocreatine, whose mechanism of action is mostly unrelated to changes in the ergogenic creatine-phosphocreatine system. Nevertheless, preliminary data with creatine supplementation are encouraging, and warrant additional studies. Prevention of cardiac toxicity of the chemotherapy compounds anthracyclines is a novel field where creatine supplementation may also be useful. Creatine effectiveness in this case may be because anthracyclines reduce expression of the creatine transporter, and because of the pleiotropic antioxidant properties of creatine. Moreover, creatine may also reduce concomitant muscle damage by anthracyclines.

Comparison of Dexmedetomidine, Lidocaine, and Fentanyl in Attenuation Hemodynamic Response of Laryngoscopy and Intubation in Patients Undergoing Cardiac Surgery

Introduction and Objective. Laryngoscopy and intubation are accompanied by sympathetic responses. These transient responses appear as an increase in blood pressure and heart rate. In patients with cardiovascular problems, the hemodynamic changes may lead to life-threatening risks, such as heart ischemia, acute heart failure, and cerebrovascular events. Materials and Methods. This clinical trial was conducted on 90 patients, aged 30–70 years, who had heart surgery. The participants were categorized into three groups. Group D received 1 µg/kg intravenous dexmedetomidine in 10 minutes, group L received 1.5 mg/kg lidocaine (1%) 90 seconds before intubation, and group F received 2 µg/kg fentanyl. The vital signs (HR, SBP, DBP, and MAP) were measured before intubation and 1st, 3rd, 5th, and 10th minutes after intubation. Data were analyzed with SPSS 19 software (chi-square, one-way ANOVA, or Kruskal–Wallis). Results. The age (P=0.389) and gender distributions of patients were similar in all three groups. Dexmedetomidine significantly attenuated HR in the 3rd (P=0.001), 5th (P=0.001), and 10th (P=0.003) minutes after intervention. It also reduced the systolic blood pressure in the 5th (P=0.024) and 10th (P=0.006) minutes. This reduction was significantly higher in the dexmedetomidine group than that in the two other groups. In addition, dexmedetomidine caused a greater reduction in MAP in the 1st (P=0.048), 5th (P=0.0001), and 10th (P=0.0001) minutes. Discussion. All three medications were effective in controlling HR; however, dexmedetomidine caused bradycardia in the 3rd, 5th, and 10th minutes. Lidocaine resulted in an increase in MAP in the 1st minute after intubation; whereas, dexmedetomidine reduced MAP at the 5th and 10th minutes after intubation. Changes in blood pressure and mean arterial pressure in the fentanyl group was lower than the two other groups. Conclusion. As a result, dexmedetomidine was not suitable for hemodynamic control and led to hypotension and bradycardia; on the other hand, fentanyl was more effective than two other medications in patients undergoing cardiac surgery. This trial is registered with IRCT2017013132320N1.

Abstract 266: The Effect of Different Kinds of Chest Compression Waveforms on the Heart Ischemia-Reperfusion Injury After Cardiac Arrest

Purpose: This study was aimed to compare the effect of different kinds of chest compression waveforms on the heart ischemia-reperfusion injury after cardiac arrest (CA) in a rat model. Materials and methods: After the CA model was successfully established with continuous electrical stimulation of ventricular fibrillation, rats were divided into four different chest compression groups randomly, including manual group, triangular wave group, sine wave group and trapezoidal wave group. The success rates of return of spontaneous circulation (ROSC) of those four groups were calculated, and all ROSC rats were executed 30 minutes after ROSC. Further comparisons were made among those four groups, including pathological changes, superoxide dismutase (SOD) activities, malondialdehyde (MDA) and superoxide (O 2 - ) content. Results: The success ROSC rates for those four groups (manual group, triangular wave group, sine wave group and trapezoidal wave group) were 30%, 40%, 40% and 90% respectively. There were inflammatory cell infiltration and edema in the heart tissue of those four groups. The activities of SOD in trapezoidal wave group were 85.91±1.91 U/mg, much higher than those of the other three groups (P <0.05). On the other hand, the MDA and O 2 - levels of trapezoidal wave group were much lower than those of the other three groups (p<0.05). Conclusion: Our study demonstrated that trapezoidal wave chest compression may be beneficial in improving the success rate of ROSC and alleviate heart injury. Its possible mechanism might lie in its anti-oxidative stress capability during the chest compression.