Huan Ma

Strong correlation between lung ultrasound and chest computerized tomography imaging for the detection of acute lung injury/acute respiratory distress syndrome in rats.

BACKGROUND Lung ultrasound (LUS) is a clinical imaging technique for diagnosing acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). In humans and several large animals, LUS demonstrates similar specificity and sensitivity to computerized tomography (CT) scanning. Current study evaluated the degree of agreement between LUS and CT imaging in characterizing ALI/ARDS in rats. METHODS Thirty male Sprague-Dawley rats were imaged by LUS before randomization into three groups to receive intratracheal saline, 3 or 6 mg/kg LPS respectively (n=10). LUS and CT imaging was conducted 2 hours after instillation. Cross table analyses and kappa statistics were used to determine agreement levels between LUS and CT assessments of lung condition. RESULTS Before instillation, rats presented with a largely A-pattern in LUS images, however, a significantly increase B-lines were observed in all groups after instillation and showed dose response to LPS or to saline. One rat treated with 6 mg/kg lipopolysaccharide (LPS) presented with lung consolidation. The agreement between the LUS and the CT in detecting the main characteristics of ALI/ARDS in rat was strong (r=0.758, P<0.01, k=0.737). CONCLUSIONS In conclusion, LUS detects ALI/ARDS with high agreement with micro PET/CT scanning in a rat model, suggesting that LUS represents a positive refinement in rat ALI/ARDS disease models.

The Role of the Myocardial Microvasculature in Mental Stress–Induced Myocardial Ischemia

There is increasing evidence that mental stress can manifest as physical diseases. One such condition is mental stress–induced myocardial ischemia (MSIMI); a silent, transient, myocardial ischemic response to stressful conditions. We propose that the cardiac microvasculature may be an important site for the interplay between mental stress and MSIMI. This study is a review of the literature discussing the prevalence and emerging mechanisms underlying MSIMI. We identified several aspects underlying MSIMI, including psychological, genetic, and physiological causes. Several sources suggested that dysfunctional cardiac microvasculature might be a contributing factor in the development of stress‐induced myocardial ischemia. The literature also suggested that although MSIMI has distinct features and pathophysiology, its occurrence might indicate an increased future risk of cardiovascular events. We found that dysfunctional cardiac microvasculature may be the key point of interaction between mental stress and transient myocardial ischemia and that the development of MSIMI might be a “silent” indicator for future cardiac events.

The renoprotective effects of simvastatin and atorvastatin in patients with acute coronary syndrome undergoing percutaneous coronary intervention: An observational study

Abstract Some statins, such as atorvastatin, have proven renoprotective effects. The comparative renoprotective potential of simvastatin is less clear. This study aimed to compare the renoprotective effects of simvastatin with atorvastatin in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This observational study examined the medical records of 271 patients who were treated at the Guangdong Cardiovascular Institute from April 2004 to February 2008. Patients had received either 40 mg simvastatin (n = 128) or 20 mg atorvastatin (n = 143), daily, for a period of at least 6 months following PCI. Declined renal function (DRF) was defined at the occurrence of chronic kidney disease (CKD) or elevated CKD stages at 6-months post-PCI. Results showed that the incidence of DRF was similar among patients taking simvastatin or atorvastatin (25.00% vs 26.57%, respectively). Kaplan–Meier survival analysis showed that patients who developed DRF had a higher incidence of mortality and major adverse cardiovascular events (MACEs) than those without DRF (17.41% vs 28.57%, P = .0308). Multivariate logistic regression analysis identified diabetes and baseline estimated glomerular filtration rate as independent risk factors for DRF. Collectively, our results indicate that simvastatin has comparable renoprotective effects to atorvastatin in ACS patients undergoing PCI. Further studies are warranted to confirm the comparative renoprotective effects of statins.

Tongguan capsule ameliorates coronary artery stenosis in a 40-year-old woman

Cardiovascular disease is the leading cause of death worldwide, with coronary heart disease as the major contributor to this related mortality. There is a growing trend in the application of Chinese medicine in clinical practice for the treatment of coronary heart disease. However, there is a lack of knowledge surrounding the pharmacological, toxicological, and biological profiles of Chinese medicine. In this case report, we describe the therapeutic effects of Tongguan capsule in a 40-year-old woman diagnosed with stable angina pectoris. To the best of the authors’ knowledge, this is the first case documented of the therapeutic effect of Tongguan capsule in the treatment of coronary heart disease.

Using M-mode ultrasonography to assess diaphragm dysfunction and predict the success of mechanical ventilation weaning in elderly patients

Background Ultrasonography (US) is a non-invasive and commonly available bedside diagnostic tool. The aim of this study was to assess the utility of M-mode US on ventilator weaning outcomes in elderly patients. Methods This was a single center, prospective, observational study in patients aged 80 years or older who were in the medical intensive care unit, had undergone mechanical ventilation for >48 hours, and met the criteria for a spontaneous breathing trial (SBT). For 30 minutes at the start of SBT, each hemi-diaphragmatic movement and the velocity of contraction were evaluated by M-mode US. The the area under the receiver operating characteristic curve (AUROC) was calculated to determine the ability for measured variables to predict successful ventilator weaning. Results Forty patients were enrolled and assessed, grouped by those who had US-diagnosed diaphragm dysfunction (DD; 30/40; 75%) and those who did not (10/40; 25%). Patients with DD had a significantly longer total mechanical ventilation duration (536.4±377.05 vs. 250±109.02 hours, P=0.02) and weaning time (425.9±268.31 vs. 216.0±134.22 hours, P=0.002) than patients without DD. Patients with DD also had a higher incidence of weaning failure than patients without DD (24/30 vs. 4/10, P=0.017). Analysis of the receiver operating characteristic (ROC) curve (ROC) curve showed that the optimal cut-off values to predict weaning success were >10.7 mm for the right diaphragmatic movement, and >21.32 mm/s for the right diaphragmatic velocity of contraction; AUROC were 0.839 (95% CI, 0.689-0.936) and 0.833 (95% CI, 0.682-0.932), respectively. The sensitivity, specificity, positive and negative likelihood ratios for predicting weaning success were 83.33% vs. 66.67%, 75.00% vs. 92.86%, 3.33 vs. 9.33, and 0.22 vs. 0.36, for right diaphragmatic movement and diaphragmatic contraction velocity, respectively. Conclusions When assessed by M-mode US, DD appeared to be common in ventilated patients aged 80 years or older and was associated with a higher incidence of weaning failure. Larger right diaphragmatic movements or faster right diaphragmatic contraction velocity appeared to be good predictors of mechanical ventilation weaning success in elderly patients.

GW26-e0093 Expression of 5-Lipoxygenase and 5-Lipoxygenase-Activating Protein in Immune Cells

OBJECTIVES Arachidonic acid (AA), an omega-6 (n-6) fatty acid, can be converted to inflammatory leukotrienes (LTs) by 5-lipoxygenase (5LO), which is activated by 5-lipoxygenase-activing protein (FLAP) and then lead to the expression of LTB4, which play a role in coronary heart disease (CHD).omega-3 (n-3) fatty acids are the metabolic counterparts to n-6 fatty acids and have anti-inflammatory effects. Thus, the tissue ratio of n-6/n-3 fatty acids may influence LT production. However, whether alteration of tissue n-6/n-3 fatty acid ratio has an effect on 5-LO and FLAP expression is not well known. The fat1 transgenic mouse, expressing an n-3 fatty acid desaturase, is capable of endogenously converting n-6 fatty acids to n-3 fatty acids, and thereby has a tissue n-6/n-3 fatty acid ratio close to 1:1. The aim of the study was to compare 5-LO and FLAP expression status in immune cells between fat-1 transgenic mice and wild type (WT) littermates. METHODS Immune cells from fat-1 transgenic mice (n1⁄45) and WT mice (n1⁄45) were harvested from the spleen and cultured for 24h. Mononuclear cells were also isolated from the blood. Cellular n-6/n-3 fatty acid profiles were analyzed using gas chromatography. The mRNA and protein expressions of 5-LO and FLAP in the cells were evaluated using real time RT-PCR and immunoblot (WB) assays, respectively. the expression of LTB4 level was assessed by Elisa assay.