LV Group Research Articles

Procedural findings and follow-up results of catheter ablation of atrial fibrillation in patients after radiation therapy for breast cancer

Abstract Backround Data on breast cancer radiation therapy (RT) associated atrial cardiomyopathy and its potential role in the pathophysiology of atrial fibrillation (AF) is very limited. Objectives To investigate the effect of breast cancer radiotherapy (RT) on atrial cardiomyopathy and its possible role in the pathophysiology of atrial fibrillation. What is the therapeutic success of antral pulmonary vein isolation (PVI) with possible substrate modifications (CFAE) in patients with breast cancer radiation therapy and paroxysmal or persistent atrial fibrillation. Methods We searched the institution’s data base for patients who received RT for breast cancer and underwent subsequently 3D mapping guided AF ablation. Intraprocedural mapping data and short- and long-term results of ablation were evaluated according to "no low voltage" and "low voltage" present. Low voltage amplitudes in bipolar electrograms were defined as <0.5 mV for endocardial maps created during SR and <0.3mV during AF. Ablation strategy comprised pulmonary vein isolation (PVI) ± additional substrate modification according to the mapping results. Follow Up (FU) was evaluated using repetitive 7-days Holter ECG and clinical visits. Results We included 45 patients (all female, 70.9±7.2 years) with paroxysmal or persistent AF (n=18 and n=27). In 3D mapping, 60% of the patients (27/45) showed left atrial low voltage (LV group) with the majority showing low voltage in the anterior wall of the left atrium (LA) in 18 of 45 patients (40%). PVI with ablation of complex fractionated signals (CFAE) was predominantly performed (18/27). After one ablation, 33.3% (9) of the patients in the LV group were recurrence-free and after an average of 1.9 ablations, freedom from recurrence was achieved in 21 patients with low voltage (77.8%). In 18 patients, no low voltage was detected (NLV group) and PVI only was performed in the majority (14/18). In this NLV group, 61.1% (11) of the patients were recurrence-free after one ablation and freedom from recurrence was achieved in 72.2% (13) after an average of 1.2 ablations. Conclusion Thoracic radiation therapy in patients with breast cancer can lead to low voltage in the LA with the predominant low voltage location being the anterior wall of the LA. An extended ablation strategy (PVI & CFAE) can show good treatment options in these patients with atrial fibrillation, with high freedom from recurrence after a mean of two ablation procedures.Freedom from recurrence after ablationCharacteristics of left atrium (LA)

Effects of exercise training on growth and physiology of large-mouth bass (Micropterus salmoides) reared in a recirculating aquaculture system

Large-mouth bass originally lived in rivers and lakes and now is often raised in recirculating aquaculture systems (RAS). However, the shortcoming of RAS is that there is very limited space for swimming fish in a high-density culture environment, thus leading to a lack of exercise. To investigate the effects of exercise training on growth performance, digestive enzymes, stress, and antioxidant capacity of large-mouth bass in a RAS, three training water flow velocities with three replicates were used in the present study: low water velocity: 0.5 body length per second (bl/s) (LV); medium water velocity: 1 bl/s (MV); and high water velocity: 1.5 bl/s (HV). 270 large-mouth bass (average initial body weight 47.51 ± 1.44 g, initial body length 12.71 ± 0.06 cm) were randomly divided into nine tanks (30 fish per tank). After 27 days experiment, the results showed that the growth performance of large-mouth bass, including feed intake, weight gain rate, and specific growth rate, in the HV group was significantly higher compared to the other groups. On the physiological level, the lipase and amylase activities were significantly increased in the HV group compared to the other groups. For the stress response parameters, the cortisol, glucose and lactate concentrations in the HV group were significantly increased, which may indicate higher stress in the HV group. Regarding the antioxidant enzyme activities, the activities of catalase (CAT) and glutathione peroxidase (GSH-PX) in the LV group were significantly higher than those in the HV group, which indicated that fish suffered higher oxidative stress in the LV group. Regarding the immune-related parameters, LZM and ACP activities had no significant differences among the groups, while AKP activities in the MV and HV groups were significantly higher than that in the LV group. Overall, the results demonstrated that exercise training had significant effects on the growth, digestion, stress, and immune response of large-mouth bass. It is suggested that exercise training with 1.5 bl/s can enhance fish growth, however, it also presents a potential risk of inducing stress in fish. Therefore, in rearing large-mouth bass in RAS, the setting of water flow velocity should not only focus on the growth of large-mouth bass but also consider its welfare.

Enteral Feedings Do Not Increase the Risk of NEC in ELBW Infants Undergoing Treatment of Patent Ductus Arteriosus With Acetaminophen.

Acetaminophen (APAP) is an alternative to indomethacin and ibuprofen for treatment of patent ductus arteriosus (PDA). The side effect profile of non-steroidal anti-inflammatory drugs (NSAIDs) presents enteral feeding safety concerns; however, the safety of enteral feeding on APAP is largely unknown. Optimal feeding strategies during pharmacological PDA treatment are unknown, leading to practice variation. This study aims to assess the incidence of adverse gastrointestinal (GI) outcomes in neonates treated with APAP for PDA closure while receiving enteral feedings. Single-center retrospective cohort study of 59 extremely low birth weight (ELBW), premature neonates who received APAP for PDA treatment divided into Low Volume (LV; ≤ 20 mL/kg/day) and High Volume (HV; > 20 mL/kg/day) enteral feeding groups. The primary outcome was the incidence of any suspected or confirmed necrotizing enterocolitis (NEC). Timing of nutrition milestones, parenteral nutrition (PN) days, and adverse outcomes (feeding intolerance, liver dysfunction, death prior to discharge) were evaluated. The incidence of suspected or confirmed NEC was 19.5% in the LV group and 13.3% in the HV group (p = 0.593). The HV group reached full feeds 6 days sooner (18 vs 24 days, p = 0.024) and had fewer PN days (17 vs 23.5 days, p = 0.044) with no difference in adverse outcomes. Provision of > 20 mL/kg/day of enteral feeds during APAP treatment of PDA decreased time to full feeds and PN days compared to trophic feedings (≤ 20 mL/kg/day) with no difference in adverse GI outcomes. Continuing enteral feeding during APAP PDA treatment appears safe while improving achievement of nutritional milestones.

Tachyarrhythmias after extracardiac conduit Fontan procedure in the long-term follow-up: may native anatomy of single ventricle predict their occurrence?

Abstract Funding Acknowledgements Type of funding sources: None. Background Arrhythmic complications, especially tachycardias, represent a common and important comorbidity during long-term follow up (FU) in patients with Fontan palliation for complexes congenital heart diseases (CHDs) with univentricular hearts. Surgical Fontan technique has evolved from direct atrio-pulmonary connection via the intracardiac lateral tunnel to the latest extracardiac conduit (ECC) procedure. Despite its shorter FU compared to previous techniques, the ECC variation is nowadays the main approach for many improvements, including lower incidence of arrhythmic complications (especially atrial arrhythmias). Purpose The aim of this study was to evaluate, during a long-term FU, the incidence of tachyarrhythmias and their correlation with the morphology of CHDs’ single ventricle native anatomy in a large cohort of patients with previous ECC Fontan procedure. Methods In this single centre observational cohort study, we retrospectively evaluated 351 patients treated with ECC Fontan palliation in our Institution between January 1987 and October 2017. Exclusion criteria were ECC Fontan take-down and a FU less than 5 years. CHD diagnosis, single ventricle native anatomy and surgical history were reviewed. Patients had cardiac examination once a year. We divided the overall study population in 2 groups based on unique ventricle's morphology: left-type (LV group) or right-type (RV group). Results A total of 303 patients [56% males; mean age at last FU 20 (IQR 15-28) years; 64.7% LV group] with ECC Fontan were enrolled. The mean FU was 16 (IQR 11-20, the longest 33) years. No sudden arrhythmic cardiac death occurred. Ten patients (6 of the LV group) underwent cardiac transplantation for Fontan failure. During FU, 34 patients of the LV (17.3%) and 22 of the RV group (20.2%) showed at least one tachyarrhythmia after a mean time of 12.1 and 12.9 years from ECC procedure, respectively. One patient (LV group) had one tachyarrhythmia in the early time period, <30 days from procedure. LV group showed a higher incidence of supraventricular tachyarrhythmias (SVTs) than RV group (68% vs 41% of total arrhythmias, p=0.08); in contrast, in RV group we found a higher number of ventricular tachyarrhythmias (VTs) compared to the other group (73% vs 41%, p=0.04). We observed both types of tachyarrhythmias (SVT and VT) in 3 patients of LV and 2 of RV group. Conclusions This study, with one of the largest cohort and longest FU after ECC Fontan, shows that ECC is associated with higher arrhythmic complications than previously reported, even though with longer latency period than other Fontan procedures. Moreover, our results suggest that patients with right-type single ventricle native anatomy are significantly more prone to develop VTs compared to those with left-type ventricle. This may reflect the drawbacks of the right ventricle physiology within Fontan circulation where the right ventricle acts for long time as the main pump of the circulatory system.

Inhibitory effect of miR-138-5p on choroidal fibrosis in lens-induced myopia guinea pigs via suppressing the HIF-1α signaling pathway

Myopia is one of the most common eye diseases in children and adolescents worldwide. Currently, there is no effective treatment in clinical practice. Ocular tissue fibrosis is involved in the development of myopia and this study aimed to investigate the effect of miR-138-5p on choroidal fibrosis in myopic guinea pigs via regulating the HIF-1α signaling pathway. First, guinea pigs were randomly divided into a normal control (NC) group, a lens-induced myopia (LIM) group, a LIM + miR-138-5p-carried Lentivirus treatment (LV) group, and a LIM + miR-138-5p-Vector treatment (VECTOR) group. All animals were induced experimental myopia with a −6.0 diopter lens except those in the NC group. Meanwhile, animals in the LV group were supplemented with 5 μl of miR-138-5p-carried Lentivirus, while those in the VECTOR group were only supplemented with the same volume of miR-138-5p-Vector. After myopia induction for 2 and 4 weeks, the refractive status and other ocular parameters of the guinea pigs were measured. Further, the expression of hypoxia-inducible factor (HIF)-1α, transforming growth factor (TGF)-β, collagen I, hydroxyproline (HYP), interleukin 1 beta (IL-1β), tumor necrosis factor alpha (TNF-α), and a-smooth muscle actin (α-SMA) in choroidal tissues was investigated. Results showed that the refraction and axial length of the experimental myopic guinea pigs increased, and choroid fibrosis aggravated after experimental myopic induction. miR-138-5p can efficiently decrease the refraction and ocular length, and ameliorate the choroidal fibrosis of the experimental myopic guinea pigs via downregulating the fibrosis-related TGF-β1, collagen I, HYP, IL-1β, TNF-α, and α-SMA expression through inhibiting the HIF-1α signaling pathway. Our results provide new insight into controlling myopic development using microRNAs in clinical practice.

The Impact of Dominant Ventricular Morphology on the Early Postoperative Course After the Glenn Procedure.

The dominant ventricular morphology affects both the early and late outcomes of the Fontan procedure, but its impact on the patients' status immediately following the Glenn procedure is unknown. This study aims to evaluate the effect of the infants' dominant ventricular morphology on the immediate course after undergoing the Glenn procedure. This single-center, retrospective study included all patients who underwent the Glenn procedure between October 2003 and May 2016. The patients were divided into two groups according to their dominant ventricular morphology. Their postoperative records were reviewed and compared. Out of the 89 patients who underwent the Glenn procedure during the study period, 40 (44.9%) had dominant right ventricular morphology and 49 (55.1%) had left ventricular morphology. There were no significant group differences in baseline characteristics or operative data. The maximal postoperative vasoactive-inotropic score was significantly higher and the extent of ventricular dysfunction was significantly more severe in the dominant right ventricle group (P < 0.05). The length of hospitalization was slightly but not significantly longer in the hypoplastic LV group. It is concluded that patients with a dominant LV morphology had a superior ventricular function and required less inotropic support compared to that of a dominant RV morphology in the immediate postoperative course following the Glenn procedure. Survival was not affected by these differences. Further study to determine the pathophysiologic basis for these differences is warranted.

A proposal for grading the risk of lymph node metastasis after endoscopic resection of T1 colorectal cancer.

At present, for patients with early colorectal cancer as long as having any one risk factor of lymph node metastasis (LNM) after endoscopic resection (ER), additional surgery will be considered, regardless of the degree of LNM risk; however, most patients are free of LNM. This study aimed to further grade these patients according to LNM risk. We assessed 271 patients with T1 colorectal cancers treated initially with ER to analyze the correlation between LNM-associated risk factors and LNM rate. Differences in this rate between groups were estimated using the χ2 test or Fisher's exact test. Poorly differentiated adenocarcinoma (Por) (3.4% vs. 40%, p < 0.001) and lymphovascular infiltration (LV) (1.6% vs. 29.0%, p < 0.001) were the only parameters correlated with LNM. When we divided the cases into LV-negative (LV(-)) and LV-positive (LV(+)) groups, we found a significantly higher LNM rate in the LV(+) group (29.0% vs. 1.6%, p < 0.001). Additionally, the rate of LNM in those positive for each parameter did not differ from the control rate in the same group, except in the Por subgroup. When the cases were divided into four groups based on the presence of LV infiltration and Por, the LNM rate in each group was 2/233 cases (0.8%) in the LV(-)Por(-) group, 2/7 cases (28.5%) in the LV(-)Por(+) group, 7/28 cases (25.0%) in the LV(+)Por(-) group, and 2/3 cases (66.6%) in the LV(+)Por(+) group. Based on LV and histological differentiation, patients were classified into three LNM risk grades: low (LNM, 0.8%), moderate (LNM, 25.0-28.5%), and high (LNM, 66.6%).

Long term survival of antenatally diagnosed functionally single ventricle congenital heart disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Antenatal diagnosis of single ventricle congenital heart disease (CHD) allows prenatal counselling, better parental preparation and support as well as improved perinatal management. Expectant parents frequently ask about likely outcomes and expected longer term survival. Our aim is to review the survival of antenatally diagnosed single ventricle CHD presenting at our institutions between January 2000 and July 2022. Methods Retrospective data was collected from the fetal cardiac and paediatric cardiology databases. Maternal data, fetal cardiac diagnosis, postnatal cardiac diagnosis and management were collected for each patient. The outcomes were separated into 2 groups – Cohort 1 (CO1) [2000 to 2007] and Cohort 2 (CO2) [2008 to 2022]. Results A total of 495 fetuses were diagnosed with single ventricle CHD in the 21 years and 7 months period, with outcomes illustrated in Table 1. For the small LV group with intention to treat at birth, there was 46% survival at over 10 years for the CO1 group and 69% survival at over 10 years for CO2 group. There was however no significant difference in the survival between the CO1 and CO2 groups (log rank test p=0.12). For the small RV group with intention to treat at birth, there was 71% survival at over 10 years for the CO1 group and 91% survival at over 10 years for CO2 group. There was significant difference in the survival between the CO1 and CO2 groups (log rank test p=0.03). No analysis was made for the unspecified hypoplasia as the numbers were too small. Conclusions For both the antenatal small LV and small RV groups, the termination rate and compassionate care option remained unchanged between both cohorts. Overall, there has been improvement in the survival for the antenatal small LV and RV groups with intention to treat. This is likely due to improved perinatal management with detailed management plan and designated delivery at tertiary neonatal hospital close to the cardiac surgical centre, improved surgical expertise and experience, improved cardiac intensive care management as well as availability of ECMO for the sicker patients. In the antenatal small LV groups, although there has been improvement in survival, this is not yet statistically significant due to more complex patients with more co-morbidity being accepted for surgery. Whereas for the antenatal small RV groups, we see statistically significant improvement with survival reaching 90% at 10 years, due to increased use of non-surgical intervention like ductal stenting over conventional BT shunts which carry higher morbidity and mortality risk. Our survival outcomes are comparable with other published data across the world.

Ultrasound-guided parasternal injection in dogs: a cadaver study

ObjectivesTo describe the technique of performing an ultrasound-guided distal parasternal intercostal block and to determine the distribution of two volumes of methylene blue dye solution injected in canine cadavers. Study designProspective cadaver study. AnimalsA group of seven canine cadavers weighing 12–34 kg. MethodsThe space between the transversus thoracic and the internal intercostal muscles is a virtual cavity. Ultrasound-guided injections in the distal (parasternal) intercostal space were performed using dye solution at 0.05 mL kg–1 in each intercostal space from the second to seventh (LV, low volume, six injections per dog) in one hemithorax, and 0.1 mL kg–1 in the third, fifth and seventh intercostal spaces (HV, high volume, three injections in each dog) on the contralateral side. Anatomical dissection was carried out to describe dye spread characteristics and staining of intercostal nerves. ResultsThe ultrasonographic landmarks for injection were identified in each cadaver. In the LV group the solution was found in every intercostal space (36/36), whereas the HV injection stained six intercostal spaces in two dogs, five in two, and in two dogs the solution was found in four and three spaces, respectively, demonstrating multisegmental distribution. Intrapleural staining was observed after two injections. Conclusions and clinical relevanceUltrasound-guided injection of 0.05 mL kg–1 at the distal intercostal space resulted in staining of the intercostal nerve in all dogs when performed in every space and may be an appropriate alternative to previously reported techniques. A single injection of 0.1 mL kg–1 may anaesthetize more than one intercostal nerve, but not consistently. Clinical investigations are warranted to better characterize and to refine this locoregional technique.

Treatment of Post-Breast Surgery Pain Syndrome with Botulinum Toxin: Analysis of The Response to the Addition of Levobupivacaine and to the Type of Surgery

Background: The spasm and/or contracture of the pectoralis major contribute to the post-breast surgery pain. The purpose of our study was to evaluate changes in the post-breast surgical pain syndrome after the infiltration of botulinum-toxin type-A (BTX-A), according to the type of surgery and the reconstitution of the botulinum-toxin. Methods: This retrospective study was conducted at the Rehabilitation Department with two cohorts: BTX-A reconstituted with saline solution (SS group) or with levobupivacaine (LV group). Data about pectoralis major contracture and pain (global, at night, at rest and during activity) before the infiltration and six weeks after that were collected from the medical records and compared between SS and LV groups, and between conservative breast surgery and mastectomy cases. Results: in the study, 48 women aged 53.3 (±11.10) years were included, with 26 (54.2%) in SS group and 22 (45.8%) in LV group. There were no differences between both groups except transitory paresis (3.8% vs 22.7%; P=0.022). In all patients, baseline circumstances vs after 6 weeks were compared, and we found significant differences in contracture (1,77 (±0.57) vs 0.97 (±0.79)), VAS global (5.45 (±1.92) vs 3.46 (±2.48)), VAS night (3.17 (±3.13) vs 1.61 (±2.29)), VAS rest (2.14 (±2.56) vs 1.21 (±1.98)) and VAS activity (4.31 (±2.55) vs 2.78 (±2.58)). We found higher improvements in the breast conservative surgery. Conclusion: A significant lower pain and contracture after BTX-A injection in the pectoralis major was observed, but its reconstitution in levobupivacaine may not be an effective method to increase the analgesic effect. There were higher improvements in the breast conservative surgery than in the mastectomy.

Effects of low vs. high frequency local vibration on mild-moderate muscle spasticity: Ultrasonographical and functional evaluation in patients with multiple sclerosis

BackgroundLocal vibration (LV) is a physiotherapy application that aims to reduce spasticity. The study aimed to compare the effects of 50 Hz vs. 100 Hz LV on mild-moderate spasticity, functional performance and muscle architecture. MethodsThirty-three patients were randomly divided into three groups: 50 Hz LV group, 100 Hz LV group and the control group. Physical therapy was applied for one hour a day, three days a week, for a total of eight weeks. LV was applied to the right and left medial gastrocnemius muscles for five minutes. Clinical (spasticity, ankle joint position sense, balance, gait) and ultrasonographic (gastrocnemius fascicle length and pennation angle) measurements were performed before and after treatment. ResultsThe study was completed with 27 patients. The decrease in spasticity and the increase in fascicle length were found to be statistically significant in the 50 Hz group (both p<0.05). Ankle joint position sense, single-leg stance time, limits of stability/postural sway range in the medio-lateral direction significantly improved in the vibration treatment groups (all p<0.05). The antero-posterior limits of stability and postural sway showed significant improvement in all groups (all p<0.05). While the 50 Hz group showed significant improvement for all walking parameters; velocity, step length and base of support values improved in the 100 Hz group (all p<0.05). The exercise group showed significant improvement only for single support and stance phase percentages of the gait cycle (both p<0.05). According to between group comparisons, significant difference was found only in medio-lateral limits of stabillity (p<0.05). Medio-lateral limits of stabillity scores were better for the 50 Hz group than the 100 Hz and exercise group. ConclusionOur findings show that LV does not have any substantial effect except for medio-lateral limits of stability. Clinical Trial NumberNCT04192786.

Influence of viscosity and chemical composition of composite resins in non-carious cervical restorations: 12-month randomized clinical trial

Objective: The objective of this double-blind, randomized controlled clinical trial was to evaluate the clinicalperformance of two methacrylate-based flowable composite and ormocer-based flowable composite in non-cariouscervical lesions (NCCLs) of adult patients. Material and Methods: 183 restorations were performed on NCCLsusing the Futurabond U adhesive system, applied in the selective enamel etching mode in all cavities. After theadhesive application, the cavities were restored with one out of the three evaluated flowable composites (n = 61per group): ormocer-based flowable composite (Admira Fusion Flow, ORM), low viscosity methacrylate-basedcomposite (GrandioSO Flow, LV) and high viscosity methacrylate-based composite (GrandioSO Heavy Flow, HV).After 12 months of clinical performance, these restorations were evaluated according to FDI and USPHS criteriain the following items: retention/fracture, marginal adaptation, marginal staining, postoperative sensitivity andcaries recurrence. Results: eight restorations were lost/fractured after 12 months of clinical evaluation (1 inthe ORM and 7 in the HV group). The retention rates for 12- months (95% confidence interval) were 98.4%(91.3%-99.7%) for the ORM group, 100% (94.5%-100%) for the LV group and 88.5% (78.1%-94.3%) for theHV group, with no statistical difference identified between any pair of groups (p &gt; 0.05). Five restorationspresented small marginal adaptation defects at the 12-months evaluation recall, and all of them were consideredclinically acceptable. Conclusion: The clinical performance of the universal adhesive associated to ormocer-basedor methacrylate-based flowable composite were found to be promising after 12-month of clinical evaluation.KEYWORDSDental bonding; Dental restoration; Clinical trial.

Colorimetric Assessment of Surface Sealants for Discoloration of a Nanofilled Resin Composite

Objective: This in vitro study was aimed to assess the effect of different surface sealants on discoloration of a nonofilled resin-based composite quantitatively, using a colorimeter.Methods: 40 specimens were prepared using nanofilled resin composite, Filtek Universal Restorative (A2 shade, 3M, USA). Sprecimens were polymerized from both sides, polished using polishing discs (SofLex, 3M, USA) and divided by test groups (n = 10 for each), regarding the sealant used; Permaseal (Ultradent Products, USA), Biscover LV (Bisco, USA), Optiglaze Clear (GC Corp., Japan) and control group. Samples were discolored for 144 hours in coffee solution, and color measurements were performed using colorimeter (ShadeStar, Dentsply Sirona, USA). Nominal color codes of specimens regarding Vita Classical Shade Guide, were converted to corresponding numerical values. Level of color change after sealant application (∆Vita1) and after discoloration (∆Vita2) were calculated. Shapiro Wilk and Kruskal Wallis tests were used forstatistical analyses.Results: Color changes in Permaseal, Optiglaze and control groups were significant (p &amp;lt; 0.001) compared to Biscover, for ∆Vita1 scores. Remarkable level of darkening was observed for all groups, for ∆Vita2 scores. Permaseal revealed significantly the highest level of darkening, among all (p &amp;lt; 0.001), but no difference with control group. Optiglaze showed significantly lower level of darkening compared to the control group (p &amp;lt; 0.001), whereas no difference with Biscover (p ≥ 0.05). Biscover group showed similar level of darkening with Optiglaze and control groups (p ≥ 0.05).Conclusion: Permaseal sealant presented significantly the highest discoloration, whereas Biscover and Optiglaze sealants presented similar and lower. Colorimeter might be determined as repeatable method for measuring discoloration in vitro.

Peroxiredoxin 6 overexpression regulates adriamycin-induced myocardial injury, oxidative stress and immune response in rats.

BackgroundAdriamycin is an anthracycline drug used to treat a variety of tumors. Adriamycin has a much stronger affinity for myocardial tissue than other body tissues. Cancer patients treated with adriamycin are prone to toxic damage to heart tissue. Peroxiredoxin 6 (PRDX6) is a novel antioxidant enzyme in metabolic diseases, the aim of this study was to investigate the role of PRDX6 in myocardial injury.MethodsSixty male specific-pathogen-free Wistar rats were enrolled and divided equally into the control group (control), the Adriamycin group, the Adriamycin + empty vector lentivirus (Adriamycin + LV) group, and the Adriamycin + Peroxiredoxin 6 overexpression (Adriamycin + PRDX6) group. Western blot, reverse transcription-polymerase chain reaction (PCR), enzyme-linked immunosorbent assay, hematoxylin and eosin staining (HE) and immunohistochemistry were used in this research.ResultsThe myocardial tissues of the Adriamycin group had significantly lower expression levels of PRDX6 and PRDX6 mRNA than those of the control group, and the myocardial tissues of the Adriamycin + PRDX6 rats had significantly higher expression levels of PRDX6 and PRDX6 mRNA than those of the Adriamycin + LV group. Serum creatine kinase isoenzyme (CK-MB), myoglobin (Mb), cardiac troponin I (cTnI), myocardial injury, positive rate of caspase-3, B-cell lymphoma 2 (Bcl-2)/Bcl-2-associated X protein (Bax) levels, malondialdehyde (MDA), lactate dehydrogenase (LDH), IL-1β, IL-6, inducible nitric oxide synthase (iNOS), and IL-4 proteins in the adriamycin-induced rats were significantly higher than those in the control group, while superoxide dismutase (SOD) activity was significantly lower than that in the control group. PRDX6 overexpression reversed the above results.ConclusionsPRDX6 overexpression can alleviate adriamycin-induced myocardial injury in rats, which may be related to oxidative stress regulation and the levels of inflammatory factors.

Acute Response Of Blood Glucose After Two Resistance Training Protocols With Different Execution Velocities

PURPOSE: Studies have demonstrated that a single session of resistance training (RT) can reduce glycemia in subjects with or without diabetes. The aim of this study was to compare the acute response of blood glucose after 2 resistance training protocols with different execution velocities in amateur weightlifting athletes. METHODS: A randomized clinical trial was conducted in 24 amateur weightlifting athletes (23.5± 6.2 years). The participants were randomized into 2 groups: high velocity (MV, n =12) or low velocity (LV, n =12). The RT training protocol was based on a session with these characteristics: 3 sets of 12 repetitions at 60% of a maximum repetition in each of the exercises (bench press, squat and military press). The only difference between the training session was that the MV group performed all the repetitions at 100% of their maximum velocity and the LV group performed at 50%. This variable was controlled with the T-force system. An oral glucose tolerance test (OGTT) was conducted with metabolic measurements immediately after each RE protocol and every 30 min until 120 min of recovery. For the statistical analysis, the area under the blood glucose curve (AUC) was calculated at each time point. Cohen’s d for effect size were also calculated to determine the magnitude of the group differences. The criteria to interpret the magnitude of the ES was as follows: trivial (< 0.2), small (0.2-0.59), moderate (0.60-1.19), large (1.2-2.0), or very large (> 2.0) RESULTS: The responses of blood glucose following each protocol and OGTT was similar in all groups, reaching the glycemic peak at 30 min of recovery. However, The MV group exhibited significantly lower values in the AUC when compared with LV group over two hours monitoring period (P=0.021, ES=1.198). CONCLUSIONS: The present study showed that RT at different velocities can generate different metabolic responses. In conclusion, the results of this study indicated that RT at a high velocity could be the optimum for postprandial glucose control.

Efficacy and safety of high-viscosity cement in percutaneous vertebroplasty for treatment of Osteoporotic vertebral compression fractures: A retrospective cohort study.

To evaluate the efficacy and safety of high viscosity bone cement in the percutaneous vertebroplasty (PVP) for treatment of single-level osteoporotic vertebral compression fractures.Eighty patients were enrolled in this study. All patients were received PVP, and they were divided into 2 groups according to the viscosity of bone cement, either high viscosity bone cement (HV group) or low viscosity cement (LV group). Oswestry Disability Index questionnaire and visual analog scale as clinical assessments were quantified. The operative time and injected bone cement volume were recorded. The anterior vertebral height (AVH) and bone cement leakage were evaluated in the radiograph.No significant difference was observed in the operative time. Both groups showed significant improvements in pain relief and functional capacity status (visual analog scale and Oswestry disability index scores) after surgery. Less bone cement volume was injected into the the injured vertebra in the HV group and statistical significance was found between both groups. In the HV group, there was lower leakage rate and less patients of severe leakage compared with the LV group. However, the correction of AVH showed no significant differences between the 2 groups and no significant loss of AVH was observed in 2 groups.High-viscosity and low-viscosity PVP have the similar effects in improving quality of life and relieving pain. There were lower cement leakage rate and less patients of severe leakage in the PVP with high-viscosity bone cement.

Left ventricular size and function after percutaneous closure of patent ductus arteriosus in Chinese adults

BackgroundLeft ventricular (LV) systolic dysfunction can occur after patent ductus arteriosus (PDA) closure and data in adult Chinese patients are lacking. MethodsWe examined adult Chinese patients who underwent successful transcatheter PDA closure at Zhongshan Hospital. Echocardiographic studies were performed before closure, before discharge, and at 1, 3, 6, and 12 months after closure. A total of 430 patients were included between January 2010 and December 2016. Patients were divided into two groups based on LV end-diastolic diameter (LVEDD): Dilated LV Group: >56 mm (n = 191) and Non-dilated LV Group: ≤56 mm (n = 239). ResultsLVEDD and LV ejection fraction (LVEF) were significantly decreased immediately after closure. Reductions in LVEDD (−10.5% ± 7.1% vs. −4.6% ± 7.0%, P < 0.001) and LVEF (−8.9% ± 12.6% vs. −2.1% ± 8.6%, P < 0.001) were greater in the Dilated LV Group. LV end-systolic diameter (LVESD) remained unchanged compared to levels before closure (−4.0% ± 5.4%, P = 0.257; −2.6% ± 5.4%, P = 0.201). 48 patients in the Dilated LV Group (25.1%) and 7 patients in the Non-dilated LV Group (2.9%) developed late LV systolic dysfunction. In multivariable analysis, LVEF ≥60%, LVEDD <63 mm, and mean pulmonary arterial pressure (mPAP) <29 mmHg were predictive of normal LV function after closure. ConclusionMany adult Chinese patients developed early LV dysfunction after PDA closure and some patients developed late LV dysfunction. LVEF, LVEDD, and mPAP were identified as significant predictors of late LV systolic function.

Mitral valve replacement in mitral stenosis; the problem of small left ventricle

BackgroundMitral valve stenosis in adults especially due to rheumatic heart disease may be associated with a smaller than normal left ventricular cavity. Mitral valve replacement in such cases may lead to hemodynamic instability either during weaning from cardiopulmonary bypass or in the early postoperative period manifested by the need for inotropic support and even mortality due to low cardiac output syndrome.Patients and methods184 patients with predominately severe stenotic mitral valves who underwent elective isolated mitral valve replacement in the period between January 2012 and January 2018 at our hospital were included in this study. Patients were divided into 2 matched groups; (small LV group) consisting of 86 cases and (normal or dilated LV group) consisting of 98 cases.ResultsThere were no statistically significant differences in operative details among both groups apart from the need for inotropic support and intra-aortic balloon pump due to low cardiac output which were statistically significantly higher in (small LV group) than (normal or dilated LV group) with a p-values of 0.01 and 0.03 respectively. Within the ICU stay only the incidence of occurrence of heart failure was significantly higher in (small LV group) with a p-value of 0.008. No statistically significant difference could be elicited in the in-hospital mortality between both groups (p-value = 0.1).ConclusionPatients with mitral valve stenosis and small left ventricular cavity are in a higher need for inotropic and even mechanical support after mitral valve replacement as well as at a higher risk for the development of heart failure before hospital discharge than patients with mitral stenosis and normal-sized left ventricular cavity.

705 Evaluation of Burn Resuscitation Practices at a Large Burn Center

Abstract Introduction Large burns cause a systemic inflammatory response in the entire body leading to profound capillary leak, tissue edema and hemodynamic instability, a condition known as burn shock. If not managed appropriately, the patient can go into cardiac collapse and multi-organ failure. Adequate and timely burn resuscitation is a cornerstone in burn care. Different formulas have been studied to estimate fluid needs during the first 24hrs. The purpose of this study was to retrospectively evaluate burn resuscitation practices of large burns (20% TBSA and greater) and their associated outcomes at a large urban burn center. Methods This was a retrospective chart review of adult patients admitted to the burn center with burns of 20% TBSA or greater who survived the first 48hrs of admission. Primary outcome was evaluating the percentage of patients who received resuscitation according to predetermined volume ranges (&amp;lt; or equal to 4ml/kg/% TBSA vs &amp;gt;4ml/kg/%TBSA). Secondary outcomes included the use of adjuncts (colloids and ascorbic acid), markers of over- and under-resuscitation, the use of perfusion markers to guide resuscitation, and ICU and hospital length of stay. Results One hundred and fifty one adults with burns of 30–50% TBSA were included. Fifty nine per cent of them received a median of 2.9ml/kg/%TBSA (low volume- LV group) compared to 41% that received 5.1ml/kg/%TBSA (high volume-HV group). The HV group received more adjuncts in form of colloids (73% vs 61%) and ascorbic acid infusion (55% vs 37% of patients). Majority of patients in both groups had an adequate urine output and showed an improved base deficit at 24hrs from admission which were used as resuscitation markers; lactate levels were trended infrequently. The most common over-resuscitation complication was pulmonary edema, found in both groups in ~ 30% of patients. Only 6% of patients in both groups required renal replacement therapy initiation at 96hrs from admission. Patients in the LV group had a shorter ICU and hospital length of stay (16 vs 36 days, and 27 vs 39 days, respectively, p value &amp;lt; 0.05). Conclusions Patients who received median resuscitation volumes of ~ 3ml/kg/%TBSA had better outcomes compared to patients who received higher volumes. Protocolized monitoring of resuscitation markers is key to tailoring resuscitation efforts to patient’s individual response. The effect of the different adjunct therapies (colloids, ascorbic acid) should be further investigated. Applicability of Research to Practice Burn resuscitation is a cornerstone of specialized critical burn care. Additional data regarding the amount and type of resuscitation volume used and its associated outcomes can advance practice to guide successful resuscitation and decrease early set backs that may further complicate the patient’s clinical course.

Neuromuscular Electrical Stimulation Improves Energy Substrate Metabolism and Survival in Mice With Acute Endotoxic Shock.

ABSTRACTThis study investigated the therapeutic benefits of neuromuscular electrical stimulation (NMES).C57BL/6 mice were administered lipopolysaccharide (LPS; 20 mg/kg body weight) by intraperitoneal injection and divided into control (C) and NMES groups (n = 10–12 each). The latter received NMES to the bilateral gastrocnemius muscle for 1 h at low or high frequency (LF = 2 Hz and HF = 50 Hz, respectively) and low or high voltage (LV = 10 V and HV = 50 V, respectively). In LF–LV and LF–HV groups, NMES was performed twice and the results were compared with those for mice that received one round of NMES. Changes in energy metabolism were measured by indirect calorimetry up to 24 h; survival was evaluated up to 72 h after LPS administration; peroxisome proliferator-activated receptor gamma coactivator (PGC)-1α expression in the liver and gastrocnemius muscle was evaluated by quantitative PCR; and plasma concentration of interleukin (IL)-6 was determined by enzyme-linked immunosorbent assay.Survival was improved only in the LF–LV group with one round of NMES (P < 0.01) and the LF–HV group with two rounds of NMES (P < 0.05). Fatty acid oxidation (FAO) was slightly increased in these two groups, whereas carbohydrate oxidation (CHO) was decreased or not changed. Significant upregulation of PGC-1α in muscle as well as a decrease in plasma IL-6 level were also observed in these two groups (P < 0.05).Thus, NMES exerts therapeutic effects under conditions that induce a mild switch in energy metabolism from glucose to lipid predominant metabolism through PGC-1α upregulation and suppression of inflammation, and may be an effective early intervention even in hemodynamically unstable patients.