ObjectiveTo systematically review the efficacy of Chinese medicine injection (CMI) for treating heart failure (HF).MethodsCNKI, WanFang Data, VIP, The Cochrane Library, PubMed, and EMbase databases were electronically searched from inception to January 2021 to identify randomized controlled trials (RCTs) on CMI for treating HF. Two reviewers independently screened literature, extracted data, and evaluated the risk of bias of included studies. Network meta-analysis was then performed by RevMan 5.2 software and Stata 16.0 software.ResultsA total of 47 studies were included involving 4 902 patients and 5 types of CMIs, including Shenmai, Shenfu, Yiqi Fumai (lyophilized), Shengmai, and Danhong injections. The results of network meta-analysis showed that the efficacy of combined CMIs was superior to conventional Western medicine alone. For the main efficacy, Shenmai, Shengmai, and Shenfu injections had significant advantages in improving the total clinical effectiveness. Shengmai, Shenmai, and Yiqi Fumai (lyophilized) injections were significantly more effective for reducing NT pro-BNP levels than other injections. Shenfu and Shengmai injections were significantly more effective for reducing BNP levels than other injections. Shenmai, Danhong and Shengmai injections were significantly more effective for improving the left ventricular ejection fraction than the other injections. These CMIs showed similar advantages for secondary efficacy indicators as for main efficacy indicators.ConclusionsThe combined 5 types of CMIs for treating HF can improve the clinical efficacy when compared with conventional Western medicine treatment. Shenmai injection, Yiqi Fumai injection (lyophilized), and Shengmai injection, which is part of Sheng Mai San, have clear advantages in terms of the overall curative effect or on individual indices.
Objective To evaluate the effectiveness and safety of reduced glutathione in the treatment of acute renal failure. Methods Twenty-three patients with acute renal failure were divided into the treatment group (n=10) and the control group (n=13) by simple randomisation. Patients in the treatment group received intravenous reduced glutathione 1200 mg daily. Patients in the control group were not treated with reduced glutathione. The therapeutic course for both groups was 4 weeks. Serum creatinine and urea nitrogen were determined before treatment as well as at the end of each of the 4 weeks. Proximal and distal renal tubular functions were evaluated at the end of the treatment. The time when clinical symptoms were improved was recorded and adverse drug reactions were monitored. Results The durations of nausea and vomiting as well as the oliguria stage were shorter in the treatment group than in the control group. The serum creatinine level in the treatment group decreased more markedly than that in the control group. At the end of the treatment, the renal tubular function was better in the treatment group than in the control group. Conclusion Reduced glutathione contributes to the early recovery of renal function in patients with acute renal failure. However, more high-quality and large-scale randomized controlled trials are needed.
ObjectiveTo explore the value of Aquaporin-3 (AQP-3) on the detection of early renal function damage by investigating the expressions of renal AQP-3 mRNA and protein of rats with obstructive jaundice (OJ). MethodsForty mature male Wistar rats were divided into two groups randomly: experimental group (n=20) in which the model of OJ rats was established, and control group (n=20, sham operation group). The levels of serum total bilirubin (TBIL), direct bilirubin (DBIL), creatinine (Cr)， and blood urea nitrogen (BUN) were detected by fullautomatic biochemical analyzer on 7 d and 14 d after operation. The expressions of renal AQP-3 mRNA and protein of rats were detected by RT-PCR and Western blotting, respectively. ResultsThe levels of serum TBIL and DBIL were significantly higher on 14 d than those on 7 d after operation in experimental group (P=0.000), which were significantly higher than those at corresponding time point in control group (P=0.000), while the difference within control group was not significant (P=0.154). Thus, the OJ models of rats were established successfully. The difference of serum Cr levels of rats between inter-and intragroup were not significant (Pgt;0.05). Serum BUN level on 14 d after operation in experimental group was significantly higher than those on 7 d after operation in experimental group and on 14 d after operation in control group (P=0.001), although serum Cr levels were not different between 7 d and 14 d after operation in control group (P=0.288). The expressions of AQP-3 protein of rats on 7 d and 14 d after operation in experimental group were significantly lower than those at corresponding time point in control group (P=0.033, P=0.000), meanwhile on 14 d after operation in experimental group was significantly lower than those on 7 d after operation in experimental group (P=0.000). The expressions of AQP-3 mRNA of rats on 7 d and 14 d after operation in experimental group were significantly higher than those at corresponding time point in control group (P=0.000), but the difference at different time point in two groups was not significant (P=0.139, P=0.059). ConclusionsThe changes of renal AQP-3 protein and mRNA expressions are prior to the changes of serum Cr and BUN levels of rats suffered from OJ complicated renal function damage, which are promised to improve the early diagnosis rate of renal function damage in rats with OJ.
Although heart transplantation remains to be the optimal treatment for advanced heart failure, its use has been largely limited due to shortage of available donor organs. Over the past two decades, left ventricular assist device (LVAD) has been significantly modified in size, durability and hemocompatibility. In addition to the bridge to transplantation, LVAD has become an attractive alternative to heart transplantation for end-stage heart failure as destination therapy for unsuitable candidates. Although the performance of LVAD has been improving greatly in recent years, there are still great challenges in the management of device complications and low quality of life after implantation. This review will summarize the types of LVAD, indications for implantation, postoperative management and adverse events.
Objective To investigate the physiological effects of different oxygen injection site on ventilatory status and oxygenation during noninvasive positive pressure ventilation ( NPPV) with portable noninvasive ventilators. Methods A prospective crossover randomized study was performed. Oxygen injection site was randomized into the outlet of the ventilator, the connection site between mask and circuit, and the mask under the condition of leak port immobilized in the mask. Oxygen flow was retained in the baseline level at the initial 5 to 10 minutes, and adjusted to obtain arterial oxygen saturation measured by pulse oximetry ( SpO2 ) ranging from 90% to 95% after SpO2 remains stable. SpO2 at the initial 5 to 10 minutes, oxygen flow, ventilatory status, oxygenation, hemodynamics and dyspnea indexes at0. 5 hour, 1 hour, and 2 hours of NPPV were compared between different oxygen injection sites. Results 10 patients were recruited into the study. Under the condition of the same oxygen flow, SpO2 with oxygen injection site in the outlet of the ventilator was significantly higher than that with oxygen injection site in the connection site between mask and circuit [ ( 98.9 ±0.9) % vs. ( 96.9 ±1.1) % , P =0. 003] , whereas SpO2 with oxygen injection site in the connection site between mask and circuit was significantly higher than that with oxygen injection site in the mask [ ( 96.9 ±1.1) % vs. ( 94.1 ±1.6) %, P = 0.000] . Oxygen flow with oxygen injection site in the mask was statistically higher than that with oxygen injection site at other sites ( P lt; 0.05) . Arterial oxygen tension/ oxygen flow with oxygen injection site in the outlet of the ventilator was significantly higher than that with oxygen injection site in the connection site between mask and circuit ( 67.9 ±31.1 vs. 37.0 ±15.0, P =0.007) , and than that with oxygen injection site in the mask ( 67.9 ± 31.1 vs. 25.0 ±9.1, P = 0.000) . pH, arterial carbon dioxide tension, hemodynamics and dyspnea indexes were not significantly different between different oxygen injection sites ( P gt; 0.05) .Conclusions When portable noninvasive ventilator was applied during NPPV, oxygen injection site significantly affects improvement of oxygenation, and shows a trend for affecting ventilatory status and work of breathing. When the leak port was immobilized in the mask, the nearer oxygen injection site approaches the outlet of the ventilator, the more easily oxygenation is improved and the lower oxygen flow is demanded.
ObjectivesTo investigate the effect of prone position ventilation (PPV) on patients with acute respiratory distress syndrome (ARDS).MethodsPatients with ARDS who received PPV treatment in the this hospital were enrolled from January 1, 2017 to December 31, 2017. The changes in heart rate, respiratory mechanics and blood gas index before and after PPV in patients, the inhaled oxygen concentration (FiO2), oxygenation index (PaO2/FiO2), pressure sore and other related complications were observed and compared in patients before and after PPV.ResultsA total of 28 patients with ARDS were registered, including 21 males and 7 females. Fourteen patients were complicated with chronic obstructive pulmonary disease (COPD) and 20 were dead in 28 days. After PPV, the peak pressure and plateau pressure decreased significantly, PaO2 and SaO2 increased significantly, system compliance improved considerably but PaCO2 did not change. There was no significant difference in the changes of heart reat, respiratory rate, minute volume, tidal volume and positive end-expiratory pressure between before and after PPV. FiO2 decreased significantly, PaO2/FiO2 increased significantly, and pressure sore increased significantly on day 1 post-PPV in comparison to pre-PPV and on day 7 post-PPV in comparison to day 1 post-PPV. A total of 13 unplanned extubation occurred during the entire PPV procedure, 9 of them were gastric tube slipping, 2 were urethral catheter slipping, 1 was tracheal tube slipping, and 1 was deep venous catheter slipping. There were 17 cases of artificial airway obstruction, 7 cases of hypotension, 3 cases of arrhythmia, and 4 cases of keratitis. In the subgroup analysis, the age of the patients complicated with COPD was significantly higher, but there was no difference in additional baseline data and the survival rate.ConclusionPPV can significantly improve the patient's respiratory status, especially oxygenation and respiratory mechanics, but PPV can increase the incidence of complications such as pressure sore, and PPV does not improve the prognosis.
Objective To discuss the safety and validity of pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) patients with severe right heart failure (RHF). Methods PEA procedures were performed on 36 patients in Fu Wai Hospital from January 2015 to April 2016. There were 28 males and 8 females, with a mean age of 46.56±11.85 years. According to the New York Heart Association (NYHA) cardiac function classification, 36 patients were divided into preoperative severe RHF group (grade Ⅲ-Ⅳ,n=28) and preoperative without severe RHF group (grade Ⅱ,n=8). Hemodynamic parameters before and after PEA were recorded and 3-18 months' follow-up was done. Results All the patients having PEA surgeries had an obvious decrease of mean pulmonary arterial pressure (from 49.53±13.14 mm Hg to 23.58±10.79 mm Hg) and pulmonary vascular resistance (from 788.46±354.60 dyn·s/cm5 to 352.89±363.49 dyn·s/cm5, bothP<0.001). There was no in-hospital mortality among all the patients. Persistent pulmonary hypertension occurred in 2 patients, perfused lung in 2 patients, pericardial effusion in 2 patients. No mortality was found during the follow-up period. All patients improved to NYHA grade Ⅰ-Ⅱ (WHO grade Ⅰ-Ⅱ), and only 2 patients remained in the NYHA grade Ⅲ (P<0.01). Conclusion The CTEPH patients having PEA surgeries had an obvious improvement in both their hemodynamics results and postoperative heart function, which in return could improve their quality of life.
Objective To report an acute ischemic left ventricular heart failure model of safe, simple, relatively steady, and reproducible in sheep. Methods Fourteen female sheep with a body weight of 36.80±3.43kg were used in this study. Heart failure model was induced by partial occluding the middle left circumflex coronary artery （LCX） combined with pacemaker-induced tachycardia. Hemodynamic measurement was done before and after heart failure, myocardial examination was observed. Results Heart failure model was induced successfully in 10 sheep. Cardiac output dropped from 3.74±0.48L/min to 2.02±0. 51L/min （P〈0. 01）, mean arterial pressure decreased from 116. 10± 14.15 mmHg（1kPa = 7.5mmHg） to 68. 10± 14. 72mmHg （P〈0.01）, central venous pressure rose from 7. 10±2.18mmHg to 10. 70± 3.50 mmHg （P〈0.05）, right ventricular end-diastolic pressure increased from 6.10±3.57mmHg to 9.90±4.41mmHg（P〈0.05）, left atrial pressure increased from 8.10±2.13 mmHg to 12.00± 4.57mmHg （P〈0. 01 ）, and left ventricular end-diastolic pressure increased from 8. 50± 4. 17mmHg to 13.10± 10. 64mmHg（P〉 0. 05）. The myocardial ultrastructure injuries was marked. Conclusions Acute ischemic left ventricular heart failure could be induced by partial occlusion of the middle LCX combined with pacemaker-induced taehyeardia in sheep. This model is simple, easy to manipulate, relatively steady, and reproducible . It may be used for assessing cardiac assist devices.
Objective To systematically review the efficacy and safety of different SGLT2 inhibitors in the treatment of heart failure. Methods The Cochrane Library, Web of Science, PubMed and EMbase databases were searched for randomized controlled trials on the efficacy and safety of SGLT2 inhibitors in patients with heart failure from inception to July 2, 2021. Two researchers independently screened literature, extracted data and evaluated the risk of bias of the included studies. Network meta-analysis was then performed using Stata 16.0 software. Results A total of 16 randomized controlled trials, including 15 312 patients, involving 5 interventions, namely dapagliflozin, empagliflozin, canagliflozin, sotagliflozin and ertugliflozin were included. Results of network meta-analysis showed that there was no significant difference in the compound outcome of hospitalization for heart failure or cardiovascular death, hospitalization for heart failure, all-cause mortality, risk of cardiovascular mortality and serious adverse reactions among patients with heart failure among 5 different SGLT2 inhibitors (P>0.05). Compared with placebo, both selective and non-selective SGLT2 inhibitors improved the risk of hospitalization for heart failure, hospitalization for heart failure, or compound cardiovascular mortality (P<0.05), while only selective SGLT2 inhibitors improved the risk of cardiovascular mortality, all-cause mortality, and serious adverse events (P<0.05). However, there was no significant difference between them (P>0.05). The area under the cumulative ordering probability curve of selective and non-selective SGLT2 inhibitors ranked first and second, except for the combined outcome of heart failure or cardiovascular death. Conclusion The current evidence indicates that there is no significant difference in the efficacy and safety of the 5 different SGLT2 inhibitors in the treatment of heart failure, and there is no significant difference between selective SGLT2 inhibitors and non-selective SGLT2 inhibitors. Due to the limited quantity and quality of included studies, more high-quality studies are needed to verify the above conclusion.
ObjectiveTo summarize the individualized selection of surgical treatment strategies and the key points of perioperative management for patients with heart valve disease complicated with severe chronic heart failure.MethodsThe clinical characteristics of 5 male patients with valvular heart disease complicated with severe chronic heart failure (CHF) were analyzed retrospectively from June 2017 to October 2018 in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, with an average age of 60.21 years.ResultsFive patients were given angiotensin receptor and neprilysin inhibitor (ARNI)-based anti-heart failure treatment after admission. The operation mode of these patients was decided to be valve replacement under cardiopulmonary bypass after individualized evaluation of patients’ improving symptoms. Three patients were treated with intra-aortic balloon pump (IABP) and continuous renal replacement therapy (CRRT) early after operation to assist patients in improving cardiac function. Five patients recovered oral anti-heart failure after awakening. All patients were discharged smoothly 2 weeks after operation.ConclusionIndividualized evaluation is needed for the choice of operation timing and mode, standardized preoperative treatment for heart failure, shortening the aortic blocking time during cardiopulmonary bypass, and early application of left ventricular adjuvant drugs or instruments are all important measures to help patients recover smoothly.