Prevalence of transthyretin cardiac amyloidosis in elderly patients diagnosed with heart failure

ObjectiveThere is increased interest in studying ATTR-CA, a pathology that primarily affects patients of geriatric age and is frequently underdiagnosed. We aim to establish the prevalence of ATTR-CA in a cohort of patients with a history of HFpEF and to describe its characteristics.MethodsWe conducted a prospective observational study. Patients ≥75 years, clinical history of HFpEF, atrial dilation ≥34 ml/m² and left ventricular wall thickening >13 mm, were included. Demographic and analytical parameters were collected, and a comprehensive geriatric assessment was performed, along with a transthoracic echocardiogram and cardiac scintigraphy. Finally, telephone follow-up was carried out at 6 and 12 months.Results50 patients were recruited, mean age 86 ± 6 years, 54% women. Age and functional class (I–II vs. III–IV) were factors associated with presenting with ATTR-CA. Patients with positive scintigraphy had a median time to admission of 5.2 months (confidence interval [CI] 95% 0–10.9), while in those with negative scintigraphy, it was 12.2 months (95% CI 11.7–12.8); log-rank: p = 0.064. Patients with positive scintigraphy had a median time to the combined endpoint (death and readmission) of 1.9 months (95% CI 0–6.1), and patients with negative scintigraphy of 11.9 months (95% CI 11.7–12); log-rank: p = 0.027.ConclusionsATTR-CA appears to be a prevalent etiology in elderly patients within the spectrum of HFpEF. Patients with a diagnosis of ATTR-CA had a shorter time to admission for HF and the combined event of death and admission than patients with a negative result on scintigraphy.     

血清SIRT1水平与射血分数保留的心力衰竭患者炎性因子、氧化应激的相关性分析及对预后的影响研究

摘要 目的：探讨血清去乙酰化酶1（SIRT1） 水平与射血分数保留的心力衰竭（HFpEF）患者炎性因子、氧化应激的相关性,分析SIRT1预测HFpEF患者预后的价值。方法：选择2019年10月至2021年6月青岛阜外心血管病医院收治的190例HFpEF患者为HFpEF组,92例心功能正常的健康体检志愿者为对照组。HFpEF患者出院后随访12个月,统计随访期间不良心血管事件发生情况,多因素Logistic回归分析HFpEF患者预后不良的影响因素。结果：HFpEF组血清SIRT1水平低于对照组（P＜0.05）,白细胞介素（IL）-6、肿瘤坏死因子-α（TNF-α）、C反应蛋白（CRP）、丙二醛（MDA）、晚期氧化蛋白产物（AOPP）水平高于对照组（P＜0.05）。HFpEF患者血清SIRT1水平与IL-6、TNF-α、CRP、MDA、AOPP呈负相关（r=-0.496、-0.502、-0.419、-0.533、-0.542,P＜0.05）。190例患者2例失访,余188例HFpEF患者中41例预后不良,147例预后良好。预后不良组美国纽约心脏病协会（NYHA）Ⅳ级比例、IL-6、TNF-α、CRP、MDA、AOPP、N末端B型利钠肽前体（NT-proBNP）水平、左室收缩末期内径（LVEDS）、左室舒张末期内径（LVEDD）、二尖瓣舒张早期血流峰值（E）与舒张晚期血流峰值（A）（E/A）高于预后良好组（P＜0.05）,血清SIRT1水平、左心室射血分数（LVEF）低于预后良好组（P＜0.05）。高IL-6、高MDA、高NT-proBNP是HFpEF患者预后不良的危险因素（P＜0.05）,SIRT1是HFpEF患者预后不良的保护因素（P＜0.05）。结论：HFpEF患者血清SIRT1水平降低,与HFpEF患者炎症反应、氧化应激以及预后不良的发生有关,可作为HFpEF患者预后评估的辅助指标。     

右美托咪定联合芬太尼对心脏瓣膜置换术患者细胞免疫功能的影响及心脑保护作用研究

摘要 目的：观察右美托咪定联合芬太尼对心脏瓣膜置换术患者细胞免疫功能的影响及在心脑保护中的作用。方法：纳入海南医学院第二附属医院2019年4月~2021年6月间接收的体外循环（CPB）下心脏瓣膜置换术患者97例,根据信封抽签法将患者分为对照组（芬太尼,48例）和观察组（右美托咪定联合芬太尼,49例）。对比两组血流动力学指标[平均动脉压（MAP）、心率（HR）]、心肌损伤指标[肌钙蛋白（cTnI）、肌酸激酶同工酶（CK-MB）、心型脂肪酸结合蛋白（HFABP）]、脑损伤指标[神经元特异性烯醇化酶（NSE）、S-100β]、细胞免疫功能、镇痛情况及不良反应发生率。结果：观察组CPB开始后10 min（T2）时间点HR、MAP低于对照组,CPB结束（T3）、术毕（T4）时间点HR、MAP高于对照组（P<0.05）。两组术前（T1）、术后24 h、术后48 h视觉模拟评分法（VAS）评分升高后降低（P<0.05）,观察组术后24 h、术后48 h VAS评分低于对照组（P<0.05）。观察组术后48 h CD4⁺、CD4⁺/CD8⁺高于对照组,CD8⁺低于对照组（P<0.05）。观察组术后48 h cTnI、CK-MB、HFABP低于对照组（P<0.05）。观察组术后48 h NSE、S100B低于对照组（P<0.05）。观察组的不良反应发生率低于对照组（P<0.05）。结论：心脏瓣膜置换术患者选用右美托咪定联合芬太尼麻醉方案,有助于减轻疼痛,稳定血流动力学,减轻免疫抑制,同时还可发挥心脑保护效果,降低不良反应发生率,是一种可靠的麻醉方案。     

Planar cell polarity regulators in asymmetric organogenesis during development and disease

The phenomenon of planar cell polarity is critically required for a myriad of morphogenetic processes in metazoan and is accurately controlled by several conserved modules. Six “core” proteins, including Frizzled, Flamingo (Celsr), Van Gogh (Vangl), Dishevelled, Prickle, and Diego (Ankrd6), are major components of the Wnt/planar cell polarity pathway. The Fat/Dchs protocadherins and the Scrib polarity complex also function to instruct cellular polarization. In vertebrates, all these pathways are essential for tissue and organ morphogenesis, such as neural tube closure, left–right symmetry breaking, heart and gut morphogenesis, lung and kidney branching, stereociliary bundle orientation, and proximal–distal limb elongation. Mutations in planar polarity genes are closely linked to various congenital diseases. Striking advances have been made in deciphering their contribution to the establishment of spatially oriented pattern in developing organs and the maintenance of tissue homeostasis. The challenge remains to clarify the complex interplay of different polarity pathways in organogenesis and the link of cell polarity to cell fate specification. Interdisciplinary approaches are also important to understand the roles of mechanical forces in coupling cellular polarization and differentiation. This review outlines current advances on planar polarity regulators in asymmetric organ formation, with the aim to identify questions that deserve further investigation.     

Stress activated cytokines and the heart

The ability of myocardium to successfully compensate for, and adapt to, stress ultimately determines whether the heart will decompensate and fail, or whether it will instead maintain preserved function. Despite the importance of the myocardial response to environmental stress, very little is known with respect to the biochemical mechanisms that are responsible for mediating and integrating the stress response in the heart. In the present review we will summarize recent experimental material which suggests that cytokines that are expressed within the myocardium in response to a environment injury, namely tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6), may play an important role in initiating and integrating homeostatic responses within the heart. However, these ‘stress-activated’ cytokines all have the potential to produce cardiac decompensation when expressed at sufficiently high concentrations. Accordingly, the theme that will emerge from this discussion is that the short-term expression of stress-activated cytokines within the heart may provide the heart with an adaptive response to stress, whereas long-term expression of these molecules may be frankly maladaptive by producing cardiac decompensation.     

Effect of dietary caffeine and zinc on the activity of antioxidant enzymes,zinc, and copper concentration of the heart and liver in fast-growing rats

The purpose of this study was to determine the relationship between concentrations of Zn and Cu and the activities of superoxide dismutase and glutathione peroxidase in the heart and liver of young rat pups whose dams were fed a diet supplemented with caffeine and/or Zn. Four groups of dams with their newborn pups were fed one of the following diets for 22 d: 20% protein basal diet; the basal diet supplemented with caffeine (2 mg/100 body wt); the basal diet supplemented with Zn (300 mg/kg diet); or the basal diet supplemented with caffeine plus Zn. The Cu levels in the livers of the pups were decreased by maternal intake of the caffeine and Zn diet. The maternal intake of the caffeine diet increased Mn-superoxide dismutase (MnSOD) activity and Cu, Zn-superoxide dismutase (CUZnSOD) in the heart of the pups. On the other hand, the activity of Cu,ZnSOD was significantly reduced in the liver of pups whose dams consumed a caffeine, Zn, or caffeine plus Zn diet. Cu, ZnSOD activity in the liver of the pups seems to be correlated with Cu levels in the tissue. Selenium-dependent glutathione peroxidase (GSH-Px) activities in the heart and liver showed no difference among the groups. The effect of dietary caffeine and/or Zn on the activity of antioxidant enzymes in the heart and liver were different in young rats. The activities of these enzymes in the heart were lower than in the liver of 22-d-old rats. Our experiments indicate that the heart has limited defenses against the toxic effects of peroxides when compared to the liver.     

鳜鱼的耗氧率及其池塘养殖

本文较详细地报道了鳜鱼的耗氧率和窒息点,并对鳜鱼和作其饲料的鱼同池饲养的可能性进行了探讨。结果表明,鳜鱼耗氧量和体重正相关（ｒ＝０．９９）,耗氧率与体重反相关（ｒ＝－０．９７）;在水温２０℃,鱼种耗氧率约为０．１４ｍｇ／ｇ．ｈ．,成鱼约为０．１２ｍｇ／ｇ．ｈ．;耗氧量和耗氧率均与水温正相关（ｒ＝０．９０,ｒ＝０．９４）,水温１３—３０℃时,体重２３０±１１．７ｇ的鳜鱼。耗氧量为１４．３１—４２．１３ｍｇ／尾。ｈ．,耗氧率为０．０５９—０．１７５ｍｇ／ｇ．ｈ．;鳜鱼耗氧率昼夜变化与家鱼相反,黄昏至凌晨是高峰期,为０．１２—０．１５ｍｇ／ｇ．ｈ．（Ｔ＝２０℃）,白天是低谷期,为０．０７—０．１０ｍｇ／ｇ．ｈ;;鳜鱼的窒息点与家鱼类较接近,变化范围为０．４５—０．７６ｍｇ／Ｌ;鳜鱼和作其饲料的鱼在同一池塘中饲养,既可持续不断地提供鳜鱼充足的适口饵料,又简单易行,成本低,效益高,有较大的价值。     

Enhancement of acetaldehyde-protein adduct formation by L-ascorbate

The effect of L-ascorbate on the binding of [14C]acetaldehyde to bovine serum albumin was examined. In the absence of ascorbate, acetaldehyde reacted with albumin to form both unstable (Schiff bases) and stable adducts. Ascorbate (5 mM) caused a time-dependent increase in the formation of total acetaldehyde-albumin adducts, which were comprised mainly of stable adducts. Significant enhancement of adduct formation by ascorbate was observed at acetaldehyde concentrations as low as 5 microM. An ascorbate concentration as low as 0.5 mM was still effective in stimulating stable adduct formation. The electron acceptor, 2,6 dichlorophenolindophenol, prevented the ascorbate-induced increase in albumin-adduct formation. Ascorbate also caused enhanced acetaldehyde adduct formation with other purified proteins, including cytochrome c and histones, as well as the polyamino acid, poly-L-lysine. These results indicate that ascorbate, acting as a reducing agent, can convert unstable acetaldehyde adducts to stable adducts, and can thereby increase and stabilize the binding of acetaldehyde to proteins.     

Interaction of metabolic inhibitors with actin fibrils

Summary The dependence of the arrangement of fibrillar actin in cultured endothelial cells on metabolic conditions was investigated with cellular elements derived from the heart of Xenopus laevis tadpoles. Either primary culture or an established cell line (XTH-2) were used in these studies The metabolic stage of the cells was influenced by inhibiting respiration and lactate production. The actin pattern was revealed either by indirect immunofluorescence or by tetramethylrhodaminyl (TRITC)-phalloidin fluorescence. Total block of energy supply causes in all cases a distinct loss of actin fibrils, while inhibition of respiration alone increases the variability of actin organization. In primary XTH cells but not in XTH-2 cells cyanide disintegrates most of the actin fibres during 3 h of treatment. This effect is independent of the inhibition of respiration, since actin gels prepared from skeletal muscle also undergo destruction in the presence of cyanide. It is concluded that the actin fibrils of the primary cells and the established line behave differently to changing metabolic conditions and to application of KCN.     

The response of the atrium to direct mechanical wounding in the adult heart of the newt,Notophthalmus viridescens

Summary Wound repair and proliferation were examined in the injured newt atrium with light- and electron-microscopic techniques including autoradiography. Hearts were injured by removing a piece approximately 0.5 mm² of the atrial wall. The five-day wound was an endothelial and mesothelial-lined blood clot bordered by a 150-m necrotic zone. Repair progressed from the periphery inward with areas of macrophage activity replaced by fibroblasts and connective tissue. The wound at 25 days consisted of a scar with few myocytes. There was no difference in the proliferative behavior between the right and left atria. Proliferative cells were localized to a 500-m reactive zone surrounding the wound. The maximum mesothelial cell thymidine-labeling index of 20.5% and mitotic index of 1.4% were seen 5 days after injury. The peak connective tissue cell thymidine-labeling index of 10.2% and mitotic index of 0.4% were seen 10 days after wounding. The peak thymidine-labeling index of 9.8% for myocardial cells was recorded 10 days after injury with a mitotic index of 0.2%. Proliferation returned to control levels by 25 days post-injury. Electron microscopy demonstrated that myocytes engaged in DNA synthesis were indistinguishable from control myocytes. Z-band material was not observed in mitotic myocytes, but myofilaments and junctions were present.