Prophylaxis of complications in operations for cancer of middle and lower thirds of the esophagus

Objective. Improvement of the surgical treatment results in esophageal cancer. Маterials and methods. Results of surgical treatment of 43 patients, having cancer of middle and lower thirds of the esophagus, were analyzed. Lewis operation was performed in 38 patients, and Garlock operation – in 5. Circular suture stapler with second row of a П-like manual sutures was applied in 28 patients. In 15 patients anastomosis was formatted, using hand-sewn two-row suture. The method of anastomosing choice had depended upon local and general factors: the tumor localization, the esophageal wall changes in anastomotic site, degree of the water-electrolyte disorders, the protein balance, concurrent pathology. Prophylaxis of postoperative morbidity consisted of preoperative correction of laboratory indices, treatment of concurrent pathology, choice of the anastomosis formation method, postoperative intensive therapy. Results. Postoperative complications had occurred in 1 (2.3%) patient. Mostly frequent postoperative complication after resection for esophageal cancer constitute insufficiency of esophago-gastric anastomosis, which occurs under impact of general and local factors. General factors: disorders of the blood circulation, caused by cardiac insufficiency, hypoxia due to pulmonary insufficiency, coagulopathy, disorders of the protein and water-electrolyte metabolism. Reduction of influence of general factors on the postoperative morbidity occurrence was achieved using the intensive preoperative preparation conduction. Conclusion. The postoperative morbidity prevention turns effective while its accomplishment on all stages of treatment: during preoperative preparation, intraoperatively and postoperatively.

E-Health Ultrasonic Diagnostic Monitoring for Analysis of Cardiac Insufficiency and Neuronal Regulation in Patients with Sepsis in Emergency Department under Image Reconstruction Algorithm

An anisotropic diffusion filtering- (ADF-) ultrasound (ADF-U) for ultrasound reconstruction was constructed based on the ADF to explore the diagnostic application of ultrasound imaging based on electronic health (E-health) for cardiac insufficiency and neuronal regulation in patients with sepsis. The 144 patients with sepsis were divided into an experimental group (78 patients with cardiac insufficiency) and a control group (66 patients with normal cardiac function), and another 58 healthy people were included in a blank control. The ultrasound examination was performed on all patients. In addition, new ultrasound image reconstruction and diagnosis were performed based on ADF and E-health, and its reconstruction effects were compared with those of the Bilateral Filter-ultrasonic (BFU) algorithm and the Wavelet Threshold-ultrasonic (WTU) algorithm. The left and right ventricular parameters and neuropeptide levels were detected and recorded. The results show that the running time, average gradient (AG), and peak signal-to-noise ratio (SNR) (PSNR) of the ADF-U algorithm were greater than those of the Bilateral Filter-ultrasonic (BFU) and Wavelet Threshold-ultrasonic (WTU), but the mean square error (MSE) was opposite ( P < 0.05 ); the left ventricular end-systolic volume (LVESV) and the vertical distance between the mitral valve E-point to septal separation (EPSS) in the experimental group were higher than those in the control and blank group, while the left ventricular ejection fraction (LVEF), stroke volume (SV), cardiac output (CO), and left ventricular fractional shortening (LVFS) were opposite ( P < 0.05 ); the systolic peak velocity of right ventricular free wall tricuspid annulus (Sm) and pulmonary valve blood velocity (PVBV) in the experimental group were lower than those of the control group and blank group ( P < 0.05 ); the messenger ribonucleic acid (mRNA) of Proopiomelanocortin (POMC) and Cocain and amphetamine-regulated transcript (CART) was higher than the mRNA IN control group and blank group ( P < 0.05 ). In short, the ADF-U algorithm proposed in this study improved the resolution, SNR, and reconstruction efficiency of E-health ultrasound images and provided an effective reference value for the diagnosis of cardiac insufficiency and neuronal adjustment analysis in patients with sepsis in the emergency department.

Silencing MR-1 Protects against Myocardial Injury Induced by Chronic Intermittent Hypoxia by Targeting Nrf2 through Antioxidant Stress and Anti-Inflammation Pathways

Background. Patients with obstructive sleep apnea hypopnea syndrome (OSAHS) often have cardiac insufficiency mainly due to hypoxia/reperfusion injury caused by chronic intermittent hypoxia (CIH). Inflammation and oxidative stress are involved in the cardiovascular events of OSAHS patients. Studies have found that myofibrillation regulator-1 (MR-1) participates in the pathological process of OSAHS-induced myocardial injury, but the specific mechanism is still unclear. Methods. We used a CIH-induced rat model to simulate the process of OSAHS disease. Indices of myocardial injury, inflammation, and oxidative stress were detected using quantitative PCR and enzyme-linked immunosorbent assay (ELISA). After administration of adenoassociated viral vector (AAV) encoding silencing RNA against MR-1, we examined expression of the classic antioxidant stress pathway protein NF-E2-related factor 2 (Nrf2) using western blotting. Results. We found that levels of serum inflammatory factors tumor necrosis factor (TNF)-α, interleukin (IL)-1β, IL-6, and IL-8 were increased, and we further observed disturbance of the oxidative stress system, in which the content of reactive oxygen species (ROS), superoxide dismutase (SOD), reduced glutathione (GSH), and malondialdehyde (MDA) was enhanced in CIH-induced rats. Subsequently, we detected that expression of Nrf2 and heme oxygenase-1 (HO-1) was slightly increased, while the expression of Kelch-like ECH-associated protein 1 (Keap-1) was significantly increased in the CIH model. Interestingly, after administration of silencing MR-1 AAV, the elevated levels of inflammatory factors were reduced, and the disordered oxidative stress system was corrected. Additionally, the expression of Nrf2 and HO-1 was distinctly increased, but the high expression of Keap-1 was decreased. Conclusions. Our research results demonstrate that silencing MR-1 rescued the myocardium the injury from inflammatory and oxidative stress in CIH-induced rats by administration of the Nrf2 signaling pathway.

Empagliflozin—A New Chance for Patients with Chronic Heart Failure

The heart failure (HF) epidemic is one of the challenges that has been faced by the healthcare system worldwide for almost 25 years. With an ageing world population and a fast-paced lifestyle that promotes the development of cardiovascular disease, the number of people suffering from heart failure will continue to rise. To improve the treatment regimen and consequently the prognosis and quality of life of heart failure patients, new therapeutic solutions have been introduced, such as an inclusion of Sodium-glucose co-transporter 2 (SGLT-2) inhibitors in a new treatment regimen as announced by the European Society of Cardiology in August 2021. This article focuses on the SGLT2 inhibitor empagliflozin and its use in patients with heart failure. Empagliflozin is a drug originally intended for the treatment of diabetes due to its glycosuric properties, yet its beneficial effects extend beyond lowering glycemia. The pleiotropic effects of the drug include nephroprotection, improving endothelial function, lowering blood pressure and reducing body weight. In this review we discuss the cardioprotective mechanism of the drug in the context of the benefits of empagliflozin use in patients with chronic cardiac insufficiency. Numerous findings confirm that despite its potential limitations, the use of empagliflozin in HF treatment is advantageous and effective.

Morbidade Hospitalar por Insuficiência Cardíaca no Nordeste Brasileiro (2010-2014) / Hospital Morbidity for Cardiac Insufficiency in Northeastern Brazil (2010-2014)

Resumo: O Objetivo foi analisar o perfil de morbidade das internações por Insuficiência Cardíaca na região Nordeste do Brasil e sua relação com as variáveis sociodemográficas. Método: Estudo Ecológico compreendendo o período de 2010 a 2014. Os dados foram retirados do Sistema de Informações Hospitalares do Sistema Único de Saúde. Resultados: No período analisado, foram realizadas 297.751 internações por Insuficiência Cardíaca. A taxa padronizada por 100.000 habitantes sofreu redução em todos os Estados. Quando considerado apenas o número bruto de hospitalizações, alguns Estados tiveram pequena redução ou aumento nos casos. O sexo masculino (53,65%), com 60 anos ou mais (68,78%), atendidos em regime de urgência (94,57%) e no setor público (56,21%), de cor parda (44,6%), foi o predominante. Na maioria das faixas etárias o domínio foi do sexo masculino. Conclusão: Embora haja tendência de queda, ainda são altas as prevalências de hospitalização por Insuficiência Cardíaca nos Estados nordestinos. Palavras-chave: Insuficiência Cardíaca; Perfil de Saúde; Hospitalização; Morbidade; Epidemiologia. Abstract: The objective was analyze the morbidity profile of hospitalizations for heart failure in the Northeast region of Brazil and its relationship with sociodemographic variables. Method: Ecological Study covering the period from 2010 to 2014. Data were taken from the Hospital Information System of the Unified Health System. Results: During the analyzed period, 297,751 admissions due to Heart Failure were carried out. The standardized rate per 100,000 inhabitants was reduced in all states. When considering only the gross number of hospitalizations, some states had a small reduction or increase in cases. Predominance in cases involved: Males (53.65%), aged 60 years or more (68.78%), treated in an emergency room (94.57%) and in the public sector (56.21%), brown (44, 6%). In most age groups the domain was male. Conclusion: Although there is a downward trend, the prevalence of hospitalization due to heart failure is still high in the northeastern states.Keywords: Heart Failure. Health Profile. Hospitalization. Morbidity. Epidemiology.

Right ventricular haemangioma as a rare cause of chest pain: a case report

Background Cardiac haemangioma is a rare primary cardiac tumour. Most patients with cardiac haemangioma have no typical symptoms, and some may present with non-specific manifestations, such as shortness of breath, heart palpitations, or cardiac insufficiency, making it difficult to distinguish cardiac haemangioma from other diseases. We report a case of cardiac haemangioma that present with chest pain. This haemangioma was finally completely excised to relieve the patient’s symptoms and a avoid poor prognosis. Case summary A 14-year-old boy presented with an intermittent and progressive non-exertional chest pain for 2 weeks. Echocardiography showed a space-occupying mass at the right ventricular apex, which was later confirmed by computed tomography angiography and magnetic resonance imaging (MRI). The mass was successfully resected, and postoperative pathology confirmed a cardiac cavernous haemangioma. The patient had an uneventful postoperative recovery at the 8-month follow-up. Discussion Cardiac haemangioma is a benign tumour with no typical clinical manifestations, and very few patients may present with chest pain. Preoperative echocardiography, computed tomography, and MRI are helpful for diagnosis, and surgery can relieve symptoms and may improve the prognosis of patients with cardiac haemangioma.

A Case of Neonatal Thyrotoxicosis with Cardiac Insufficiency

Neonatal thyrotoxicosis is rare and most of the cases are secondary to maternal Graves’ disease. It is usually transient, but can be associated with significant morbidity and mortality if not recognized promptly and treated adequately. Neonates born to mothers treated with antithyroid drugs or those who receive maternal thyroid blocking antibodies may exhibit normal thyroid function or even hypothyroidism at birth. Since there may not be any obvious symptoms of hyperthyroidism at birth, it may be overlooked. Therefore, such neonates should be evaluated properly and monitored regularly to prevent serious complications of hyperthyroidism. We report a case of a 21-day-old male infant who developed thyrotoxicosis with dyspnea, irritability, tachycardia, and cardiac insufficiency. He was born to a mother who was treated for Graves’ disease with antithyroid drugs during pregnancy. We have also discussed the importance of careful examination and monitoring to prevent the development of clinical hyperthyroidism.

Study of effect of serum magnesium concentration on clinical outcome of critically sick patients in medical intensive care unit

Background: Deficiency of magnesium is common and often ignored. It is associated with cardiac irregularity, cardiac insufficiency, seizure and electrolyte imbalance. As this element has multiple functions in our body it is important in the pathophysiology of several critical illnesses in intensive care unit (ICU). Hence the present study was undertaken to determine the usefulness of admission serum magnesium levels with regards to patient outcome considering mortality, need and duration of ventilator support, and acute physiologic assessment and chronic health evaluation 2 (APACHE 2) score.Methods: Demographic data such as age and sex were recorded. Patients were assessed for presenting complaints, history of other diseases and habits through an interview with the patients or care giver. These findings were recorded on a predesigned proforma patients was followed up for the outcomes such as mortality, need of ventilator support, duration of ICU stay and APACHE 2 score.Results: Regarding comparison between outcome of patients between two groups, 44% patients with magnesium level <1.7 mg/dl have improved and 72% patient didn’t improve. 44% patients with magnesium level >1.7 mg/dl have improved and 28% patient didn’t improve.Conclusions: From present observational study we can conclude that hypomagnesaemia is more common in patients more than 50 years of age and with male predominance. Pneumonia with septicaemia and cerebrovascular accident (CVA) was commonly associated with hypomagnesaemia. In present study we have observed that hypomagnesaemia is associated with high APACHE 2 score, poor outcome and more requirement of ventilatory support.

Resveratrol against Cardiac Fibrosis: Research Progress in Experimental Animal Models

Cardiac fibrosis is a heterogeneous disease, which is characterized by abundant proliferation of interstitial collagen, disordered arrangement, collagen network reconstruction, increased cardiac stiffness, and decreased systolic and diastolic functions, consequently developing into cardiac insufficiency. With several factors participating in and regulating the occurrence and development of cardiac fibrosis, a complex molecular mechanism underlies the disease. Moreover, cardiac fibrosis is closely related to hypertension, myocardial infarction, viral myocarditis, atherosclerosis, and diabetes, which can lead to serious complications such as heart failure, arrhythmia, and sudden cardiac death, thus seriously threatening human life and health. Resveratrol, with the chemical name 3,5,4′-trihydroxy-trans-stilbene, is a polyphenol abundantly present in grapes and red wine. It is known to prevent the occurrence and development of cardiovascular diseases. In addition, it may resist cardiac fibrosis through a variety of growth factors, cytokines, and several cell signaling pathways, thus exerting a protective effect on the heart.