Fetomaternal outcomes in pregnancy with different cardiac disease at a tertiary care center in Udaipur

Background: The incidence of maternal cardiac diseases has an adverse effect on pregnancy outcomes. The present study was done the objective to determine the Incidence and distribution of cardiac disease in pregnant patients, to assess mode of delivery and fetomaternal outcome in pregnancy with heart disease patients.Methods: This was a hospital based prospective observational study that include 65 pregnant women with diagnosed cardiac disease or had symptoms and signs suggestive of cardiac disease during the period from January 2018 to December 2019. Baseline data recorded including age, parity, gestational age, cardiac lesions, New York heart association (NYHA) functional class, use of cardiac medications, thorough clinical examination including chest and cardiovascular auscultation, ECG and echocardiographic assessment of left and right ventricular systolic function. Fetomaternal outcome was analysed in the study.Results: The mean age of the patients was 24.33±2.93 years (ranging from 19-36 years). 34 patients (52.30%) were primigravida. Majority (58.46%) cases were from rural area. Majority patients (70.77%) are present between 37-40 weeks of gestational age. Most of patients had vaginal delivery (64.62%). 43 patients (66.15%) diagnosed with heart disease after pregnancy, while 22 patients (33.85%) are diagnosed before pregnancy for heart disease. Neonatal complications were seen in in 35.38% of patients. Cardiac complications were present in 40% of patients. majority of fetal complications are in nonoperated patients (46.15%).Conclusion: The management of pregnant women with cardiac diseases requires multidisciplinary approach to prevent morbidity and mortality. It is necessary to optimize healthcare facilities to obtain maximum maternal and fetal outcome.

Cardioprotective effect of taurine and ß-alanine against cardiac disease in myocardial ischemia and reperfusion-induced rats

BACKGROUND: The present study analyzed the synergistic protective effect of ß-alanine and taurine against myocardial ischemia/reperfusion. Myocardial infarct size, lipid peroxidation, and levels of glutathione peroxidase (Gpx), superoxide dismutase (SOD), reduced glutathione (GSH), catalase, tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), reactive oxygen species (ROS), apoptosis, and the mRNA and protein expression of Janus kinase 2 (JAK2) and signal transducer and activator 3 of transcription (STAT3) were determined. The molecular docking was carried out by using AutoDock 4.2.1. RESULTS: Combined treatment with ß-alanine and taurine reduced myocardial infarct size, lipid peroxidation, inflammatory marker, ROS levels, and apoptosis and increased Gpx, SOD activity, GSH, and catalase activity. Furthermore, combined treatment significantly reduced JAK2 and STAT3 mRNA and protein expression compared with the control. The small molecule was docked over the SH2 domain of a STAT3, and binding mode was determined to investigate the inhibitory potential of ß-alanine and taurine. ß-Alanine bound to SH2 domain with ΔG of -7.34 kcal/mol and KI of 1.91 µM. Taurine bound to SH2 domain with ΔG of -7.38 kcal/mol and KI of 1.95 µM. CONCLUSION: Taken together, these results suggest that the combined supplementation of ß-alanine and taurine should be further investigated as an effective therapeutic approach in achieving cardioprotection in myocardial ischemia/reperfusion.

A clinical study on peripartum cardiomyopathy at tertiary care hospital

Background: Cardiac diseases complicate 1-4% of pregnancies in women without pre-existing cardiac abnormalities. Cardiac disease in the pregnant woman can present a challenge to the obstetrician, cardiologist and neonatologist. Peripartum cardiomyopathy (PPCM) is an idiopathic disorder defined as heart failure occurring in women during the last month of pregnancy and up to 5 months postpartum. Aim is to study the burden of the disease, maternal outcome in PPCM.Methods: The present study was conducted among the antenatal women admitted in the department of Obstetrics and Gynecology at KIMS, Hubli with a previously diagnosed cardiac disease or diagnosed after admission during index pregnancy from December 2016 to May 2018. The mothers were followed up till discharge. Maternal outcome was noted as discharged or died.Results: A total of 11 cases of PPCM noted in our study out of which one case was developed before delivery, and 10 cases developed postnatally. Out of ten cases which were developed postnatally, 5 patients died giving around 50% of mortality rate.Conclusions: PPCM affects previously normal healthy women in the last month of pregnancy and up to 5 months after delivery. Careful assessment of risk factors contributing PPCM could help in their prevention. And these patients should be stratified in developing PPCM in future pregnancies through proper tools available.

Review on circulation monitoring technology for patients with cardiac diseases undergoing non-cardiac surgery / 中国胸心血管外科临床杂志

@#Patients with cardiac diseases undergoing non-cardiac surgery have high risk and mortality. Management of these kind of patients is complicated and difficult. Appropriate use of circulation monitoring is good for clinical decision making and prognosis improvement. This article reviews the circulation monitoring technologies for patients with cardiac diseases undergoing non-cardiac surgeries from pressure monitoring, haemodynamics monitoring and cardiac structure and function monitoring. To choose suitable circulation monitor individually according to advantages, disadvantages and interference factors of every technology, the comorbidities and surgical characteristics can provide references for clinical decision making.

Strategy and management of cardiopulmonary bypass with cardiac surgery for pregnant women / 局解手术学杂志

Objective To evaluate the strategy and management of cardiopulmonary bypass ( CPB) with cardiac surgery for pregnant women.Methods The clinical data of 4 pregnant women with severe cardiac diseases ,who received cardiac surgery with CPB in our hospital form January 2016 to June 2017 were retrospectively analyzed ,meanwhile the maternal and neonatal outcomes were reviewed also .Results Among 4 patient s,there were 1 case of subacute bacterial endocarditis ,2 cases of congenital heart disease complicated with subacute bacterial endocarditis,1 case of rheumatic heart disease.The New York Heart Association(NYHA) functional classification:there were 2 cases with class Ⅲand 2 cases with classⅣ.Operations included 2 mitral valve replacement and tricuspid valve plasty ,1 right coronary artery fistula re-pair and aortic valve replacement ,1 patent ductus arteriosus closure and mitral valve repalcement ,aortic valve replacememnt ,pulmonary valve replacement,tricuspid valve plasty.The CPB time ranged from 85 to 287 minutes(median 135 minutes),the aortic cross clamp time ranged from 52 to 178 minutes (median 89 minutes),the gestational age of pateints received cardia surgery ranged from 25 to 32 weeks(median 29 weeks).All patients were followed up for 1 to 16months(median 6 months),with no death;4 neonatal outcomes included 3 of full-term labor with cesarean section ,all of the 3 newborns were alive and no malformation ,1 of death in the uterus and spontaneous abortion at 2 days post-operative .Conclusion Cardiac surgery can be performed with relative safety during pregnancy .According to the physiological characteristics of pregnancy ,a reasonable CPB plan should be formulated pre-operative ,better maternal and fetal survival rates may be achieved by optimized management of CPB and used fetal mornitoring perioperative ,reduce the incidence of complications .

Instrumento para aplicação do processo de enfermagem para pacientes hospitalizados em unidades cardiológicas: um estudo quaseexperimental / Instrument for the application of the nursing process for patients in cardiological units: a quasi-experimental study

Objetivos: construir um instrumento para aplicação do processo de enfermagem para pacientes hospitalizados em unidades cardiológicas; treinar os enfermeiros destas unidades para o uso do instrumento e; avaliar a qualidade dos registros antes e após o treinamento por meio do Quality of Diagnosis, Interventions and Outcomes (Q-DIO). Métodos: Trata-se de um estudo quase-experimental que avaliou os registros de enfermagem de prontuários de pacientes de unidades cardiológicas, de um hospital universitário na cidade do Rio de Janeiro/RJ. Foi realizado em duas fases: a elaboração do instrumento para aplicação do processo de enfermagem para os pacientes com distúrbios cardiológicos hospitalizados, baseado na linguagem padronizada NANDA-I, NIC E NOC (NNN) baseada em uma revisão integrativa sobre registros de enfermagem para pacientes com doenças cardiovasculares e na sequência foi realizado um treinamento com enfermeiros das unidades cardiológicas sobre registro de enfermagem e uso do instrumento. O Q-DIO foi aplicado para avaliação da qualidade dos registros antes e após o treinamento. Resultados: O instrumento elaborado possibilitou o registro de enfermagem pautado nos domínios da NANDA-I e a seleção dos diagnósticos, intervenções e resultados foi de acordo com a literatura. O treinamento foi realizado com enfermeiros das unidades cardiológicas e proporcionou uma troca de experiências teórico-práticas positivas. Após o treinamento com os enfermeiros sobre o uso de linguagens padronizadas NNN e o uso do instrumento, o escore total do Q-DIO aumentou no momento pós-intervenção (14,8±5,7vs.29,0±10,5; p=0,003). Conclusão: A qualidade dos registros foi considerada satisfatória após treinamento e utilização do instrumento para aplicação do processo de enfermagem, no entanto, são necessárias mais pesquisas experimentais sobre o processo de enfermagem e sobre a qualidade do registro de enfermagem principalmente referente às intervenções de enfermagem

Goals: to build an instrument for the application of the nursing process for hospitalized patients in cardiac units; to train nurse of these units for the use o the instrument and; to assess the quality of the records before and after the treatment through the Quality of Diagnosis, Interventions and Outcomes (Q-DIO). Methods: It is a quasi-experimental study that evaluated the nursing records of patients of cardiac units of an academic hospital in the city of Rio de Janeiro/RJ. It was performed in two phases: the elaboration of the instrument for the application of the nursing process for hospitalized patients with cardiac disorders based on a standardized language NANDA-I, NIC E NOC (NNN) based on a integrative revision about the nursing records for patients with cardiac diseases and in the sequence it was performed a training with nurses from cardiac units about the nursing records and the usage of the instrument. The Q-DIO was applied for the evaluation of the quality of the records before and after the training. Outcomes: The elaborated instrument enabled the nursing records based on NANDA-I domains and the diagnosis selection, interventions and results was according to the literature. The training was performed with nurses from cardiac units and provided a positive theoretical-practical exchange of experiences. After the training with the nurses about the use of the NNN standardized language and the use of the instrument, the total score of the Q-DIO increased in the post-intervention moment (14,8±5,7vs.29,0±10,5; p=0,003). Conclusion: The quality of the records was considered satisfactory, after training and the usage of the instrument for the application of the nursing process, however it is necessary to have more experimental research about the nursing process and about the quality of the nursing process mainly for the nursing interventions

Cardiac diseases with pregnancy - A study of maternal and fetal outcome.

Background: Total 0.2% to 4% of all pregnancies are complicated by cardiac diseases. In non western countries, rheumatic heart diseases (RHD) constitute 56-89% of the cases and congenital heart diseases only 9-19%. Aim and objectives: To review all obstetric patients with co-existing cardiac diseases admitted to a tertiary care center over a period of one year and ascertain the causes of admissions and the maternal and perinatal morbidity and mortality. Material and methods: A retrospective, analytical study of all patients with cardiac diseases who delivered over a period of January 2013 to December 2013 was conducted. A tabulated representation of the data was done. The various cardiac diseases were categorized according to their severity, NYHA category, type of pathology, the maternal and perinatal outcome was assessed and maternal mortality and perinatal mortality was recorded. Conclusion: Total 69% cardiac lesions in pregnancy were rheumatic in origin and 15% belonged to high risk category while 13.1% were NYHA type IV. Total 69% deliveries were by vaginal route Epidural analgesia preferred in LSCS of cardiac patients. Perinatal and maternal complications were observed to increase with increase in NYHA class.

MicroRNA-1 in Cardiac Diseases and Cancers

MicroRNAs (miRs) are endogenous approximately22-nt non-coding RNAs that participate in the regulation of gene expression at post-transcriptional level. MiR-1 is one of the muscle-specific miRs, aberrant expression of miR-1 plays important roles in many physiological and pathological processes. In this review, we focus on the recent studies about miR-1 in cardiac diseases and cancers. The findings indicate that miR-1 may be a novel, important biomarker, and a potential therapeutic target in cardiac diseases and cancers.

Aorta bivalva: Frecuencia y lesiones asociadas. Estudio prospectivo en 2,750 ecocardiogramas consecutivos / Bicuspid aorta valve: Frequency and associated injuries. Prospective study in 2750 echocardiograms in a row

Objetivo: Evaluar mediante un estudio prospectivo, observacional y transversal, la incidencia de la aorta bivalva y su asociación con patología aórtica en el laboratorio de ecocardiografía. Material y métodos: Se analizaron todos los enfermos consecutivos estudiados mediante ecocardiografía del 1º de septiembre de 2009 al 14 de enero de 2011 en búsqueda de aorta bivalva y su asociación con otra patología aórtica. Resultados: Se realizó un total de 2,750 estudios en este periodo de tiempo. En 72 (2.6%) no fue posible precisar con claridad el número de valvas. Se detectaron 137 enfermos con aorta bivalva (4.9%). El promedio de edad fue 13.3 años ± 9.6, mediana de 11 años, 81 fueron hombres (59.1%) y 56 fueron mujeres (40.9%), 14 (10.2%) tuvieron por lo demás corazón estructuralmente normal. En 99 (72.3%) se encontraron lesiones relacionadas con patología aórtica: 50 (36.5%) fueron coartación aórtica, 22 (16.1%) doble lesión aórtica, 10 (7.3%) estenosis subaórtica, 9 (6.6%) estenosis aórtica, 1 (0.7%) dilatación aneurismática de raíz aórtica con coartación aórtica, 2 (1.5%) con dilatación aórtica no significativa de la raíz aórtica, 3 (2.2%) insuficiencia aórtica, 1 (0.7%) interrupción del arco aórtico, 1 (0.7%) desarrolló endocarditis, y en 24 casos (17.5%) con aorta bivalva se encontraron lesiones no relacionadas con patología aórtica. Conclusiones: La aorta bivalva en un laboratorio de ecocardiografía es relativamente frecuente: 4.9% en este trabajo. En los pacientes con corazón estructuralmente normal se encontró aorta bivalva en el 0.5% de la población. La presencia de aorta bivalva estuvo asociada con lesión significativa en ella misma o con otras lesiones del tracto de salida izquierdo en el 3.6% de los casos. La dilatación aórtica y coartación aórtica estuvieron presentes en un paciente (0.7%). La presencia de endocarditis bacteriana asociada a aorta bivalva la encontramos en el 0.7%. Es importante el seguimiento a largo plazo de aquellos pacientes que presentan aorta bivalva dado que hasta en un 30% de los casos pueden desarrollar complicaciones.

Objective: To evaluate by a prospective, observational and cross study the incidence of bicuspid aorta valve and associated aortic disease in the echocardiography laboratory. Material and methods: We analyzed all the consecutive patients studied by echocardiography from the 1st of September 2009 to January 14, 2011, in search of bicuspid aortic bivalve and its associations. Results: A total of 2,750 studies were made in this period of time. In 72 (2.6%) was not possible to specify clearly the number of valves. There were detected 137 patients with bicuspid aortic (4.9%). The age average was 13.27 years ± 9.64, median 11 years, 81 were men (59.1%), 56 women (40.9%), 14 (10.2%) were otherwise structurally normal heart. It was found that 99 (72.3%) had aortic disease-related injuries: 50 (36.5%) had aortic coarctation, 22 (16.1%) double aortic lesion, 10 (7.3%) subaortic stenosis, 9 (6.6%) aortic stenosis, 1 (0.7%) dilation of aortic root aneurysm with aortic coarctation, 2 (1.5%) no significant expansion of the root aortic, 3 (2.2%) aortic regurgitation, 1 (0.7%) interrupted aortic arch, 1 (0.7%) developed endocarditis a in 24 cases (17.5%) with bicuspid aortic lesions were not related to aortic disease. Conclusions: The bicuspid aorta in an echocardiography lab is relatively frequent: 4.9% in this work. In patients with structurally normal heart bicuspid aorta were found in 0.5% of the population. The presence of bicuspid aorta was associated with significant injury to herself or with other lesions of the left outflow tract in 3.6% of cases. The aortic dilatation and aortic coarctation was present in 0.7% patients. The presence of bacterial endocarditis associated with bicuspid aortic found in 0.7%. It is important to the long-term monitoring of those patients with bicuspid aortic as much as 30% of cases can develop complications.

Association between the kinin-forming system and cardiovascular pathophysiology

All the components of the kallikrein-kinin system are located in the cardiac muscle, and its deficiency may lead to cardiac dysfunction. In recent years, numerous observations obtained from clinical and experimental models of diabetes, hypertension, cardiac failure, ischaemia, myocardial infarction and left ventricular hypertrophy, have suggested that the reduced activity of the local kallikrein-kinin system may be instrumental for the induction of cardiovascular -related diseases. The cardioprotective property of the angiotensin converting enzyme inhibitors is primarily mediated via kinin releasing pathway, which may cause regression of the left ventricular hypertrophy in hypertensive situations. The ability of kallikrein gene delivery to produce a wide spectrum of beneficial effects makes it an excellent candidate in treating hypertension, cardiovascular and renal diseases. In addition, stable kinin agonists may also be available in the future as therapeutic agents for cardiovascular and renal disorders.

Hemodynamic parameters during robotic radical prostatectomy in elderly patients with increased cardiac risk

BACKGROUND: We studied the hemodynamic changes associated with steep Trendelenburg position and prolonged pneumoperitoneum during robot-assisted laparoscopic prostatectomy in elderly patients with cardiac diseases. METHODS: Hemodynamic variables were measured at baseline supine position, at 30 min, 1, 2, 3 and 4 h during CO2 insufflation in post-Trendelenburg position, and after deflation in the supine position. RESULTS: In comparison with normal subjects, the cardiac index and systemic vascular resistance index of patients with cardiac diseases were significantly affected by the Trendelenburg position and pneumoperitoneum (P < 0.001). However, other variables of heart rate, mean arterial pressure and central venous pressure were not differed between the groups. CONCLUSIONS: We conclude that attention should be paid to maintain adequate hemodynamic status during prolonged pneumoperitoneum in the Trendelenburg position, and which is unfeasible in patients with severe heart failure and unstable angina.

Oxygen Uptake Efficiency Slope： A New Index of Cardiopulmonary Functional Reserve for Adults / 中国康复理论与实践

@#Objective To investigate the efficacy of the oxygen uptake efficiency slope (OUES), obtained from submaximal exercise, as an index of cardiopulmonary functional reserve in adults. Methods Exercise tests, following a symptom-limited standard Bruce protocol with simultaneous respiratory gas measurement, were performed on a treadmill in 33 healthy adults free of clinically recognized cardiovascular disease and 31 patients with heart disease. The OUES was derived from the relation between oxygen uptake (VO2) and minute ventilation (VE) during incremental exercise and was determined by VO2=alog10VE+b, where a=OUES. The OUES was calculated from data of the first 75%, 90% and 100% of exercise duration (as 75%OUES，90%OUES and 100%OUES). Results The 100%OUES，90%OUES and 75%OUES were not significantly different from each other（F=0.212，P=0.809）. The 75%OUES was slightly lower (1.9%) than the 100%OUES. The 100%OUES, the 90%OUES and the 75%OUES correlated with the peak VO2 （r=0.836,r=0.824 and r=0.777, P<0.001, respectively）. The VAT correlated with the peak VO2 （r=0.878，P<0.001），and the VE/VCO2 at VAT correlated with the peak VO2 （r=-0.584，P<0.001）. The 100%OUES correlated with the 90%OUES and the 75%OUES （r=0.991 and r =0.945, P<0.001, respectively）. Conclusion The OUES is an index of exercise performance and cardiopulmonary functional reserve on healthy adults and patients with cardiac disease. The 75%OUES from submaximal exercise can be an index of cardiopulmonary functional reserve for patients with cardiac disease.

The hemodynamic effects of a reversed Trendelenburg in elderly patients with increased cardiac risk during laparoscopic cholecystectomy / 대한마취과학회지

BACKGROUND: We studied the hemodynamic changes induced by pneumoperitoneum and a reversed Trendelenburg in elderly patients with increased cardiac risk (ASA class III; n = 30; age 70.8 +/- 4.9 years, mean +/- SD) and compared the results with elderly patients at normal risk (ASA class II; n = 30; age 69.2 +/- 4.1 years) during laparoscopic cholecystectomy. METHODS: The transesophageal Doppler monitor was performed after induction of general anesthesia (pre-incision), after onset of pneumoperitoneum (insufflation), after head-up (20degrees) and a left lateral tilt (15degrees) (reversed Trendelenburg) and after deflation and horizontal position (desufflation). Mean arterial pressure (MAP), heart rate, cardiac index (CI) and systemic vascular resistance (SVR) were measured, respectively. RESULTS: Induction of pneumoperitoneum and head-up tilt in patients with cardiac risk resulted significantly in a decrease in CI and an increase in SVR compared with patients with normal risk (P < 0.05), and that remained until deflation, but no interval changes in MAP and heart rate. The CI, MAP and heart rate decreased and SVR increased significantly in patients with cardiac risk compared with patients with normal risk before incision (P < 0.05). No complications occurred. The results indicate that pneumoperitoneum and a reversed Trendelenburg are associated with significant but relatively benign hemodynamic changes. CONCLUSIONS: Anesthesia for laparoscopic cholecystectomy in elderly patients with increased cardiac risk should be performed with an adequate hemodynamic monitoring.

El sistema formador de quinina y su relación con los trastornos cardiovasculares / The kinin-forming system and cardiovascular disorders

Cardiovascular diseases are the most common cause of death worldwide. In Kuwait, death related to cardio vascular diseases may account for about 40%. Thus, it will be the greatest health care burden of the twenty-first century. Hypertension and diabetes are the two major risk factors in the development of cardiac hypertrophy, ischemic heart disease, cardiac failure, cardiac arrhythmias and myocardial infarction. The kallikrein-kinin components (plasma and urinary kininogens, kallikreins, kininases and kinins) are able to regulate BP and blood glucose levels via promoting; vasodilator, natriuretic effects and glucose metabolism. These components are located in the cardiac tissue, kidney and vascular smooth muscle. The kinin system is found to be abnormally depressed in various experimental animal models of hypertension and diabetes which might be responsible for inducing cardiac complications. It has been pointed out that the development of a compound having renal kallikrein-like activity may serve the purpose of excreting excessive sodium from the kidney in the treatment of hypertension. Also it has been demonstrated that transgenic mice over-expressing renal tissue kallikrein were hypotensive and that administration of aprotinin, a tissue kallikrein inhibitor, restored the BP of the transgenic mice. These findings highlight a role of tissue kallikrein in the regulation of BP. It has been proposed that tissue kallikrein gene delivery into various hypertensive models exhibits protection, such as reduction in high BP, attenuation of cardiac hypertrophy, inhibition of renal damage and stenosis. This may indicate the prospect of this kallikrein gene therapy for cardiovascular pathology. Several reports indicate that urinary kallikrein excretion is decreased in essential hypertension in humans and in models of experimental hypertension. Thus, reduced urinary kallikrein may reflect a deficiency in the endogenous kallikrein/kinin vasodilatory system that contributes to the pathogenesis of hypertension. Previous studies conducted in white and black population in the USA demonstrated that urinary kallikrein excretion is diminished in family members at risk for hereditary (essential) hypertension and that urinary kallikrein is one of the major genetic markers associated with family history of hypertension. Also evidence for genetic linkage between the kallikrein locus and blood pressure has been reported in the rat. Previous studies have suggested that diminished urinary kallikrein excretion is associated with salt sensitivity of blood pressure. Kallikrein excretion is also diminished in African-Americans and deficiency of the kallikreinkinin renal vasodilatory system may explain many of the unique features of essential hypertension and heart diseases in some black subjects.

Las enfermedades cardiovasculares son la causa más frecuente de muerte en todo el mundo. En Kuwait, la muerte relacionada a enfermedades cardiovasculares puede llegar al 40%. De este modo, será la mayor carga para el sistema de salud del siglo XXI. La hipertensión y la diabetes son los dos factores de riesgo mayores en la producción de hipertrofia cardíaca, cardiopatía isquémica, insuficiencia cardíaca, arritmias cardíacas e infarto de miocardio. Los componentes del sistema calicreína-quinina (quininógenos plasmáticos y urinarios, calicreínas, quininasas y quininas) regulan la PA y los niveles de glucosa sanguínea mediante estimulación de la vasodilatación, efectos natriuréticos y metabolismo de la glucosa. Esos componentes se localizan en el tejido cardíaco, riñón y células musculares lisas. El sistema quinina se encuentra deprimido anormalmente en varios modelos animales experimentales de hipertensión y diabetes que podrían ser responsables de la aparición de complicaciones cardíacas. Se ha señalado que el hallar un compuesto con actividad renal similar a la calicreína puede ser útil al propósito de excretar el exceso de sodio por el riñón en el tratamiento de la hipertensión. También se demostró que los ratones transgénicos que sobreexpresan calicreína por el tejido renal eran hipotensos y que la administración de aprotinina, un inhibidor de la calicreína tisular, restaura la PA de los ratones transgénicos. Esos hallazgos realzaron el papel de la calicreína tisular en la regulación de la PA. Se ha propuesto que el gen de la calicreína tisular entregado en varios modelos de hipertensión ejerce protección, como reducción de la PA aumentada, atenuación de la hipertrofia cardíaca, inhibición de la estenosis y del daño renal. Esto puede indicar la posibilidad de este tratamiento con gen de calicreína para trastronos cardiovasculares. Varios informes indican que la excreción urinaria de calicreína está disminuida en la hipertensión esencial en humanos y en modelos de hipertensión experimental. De este modo, la reducción de la calicreína urinaria puede reflejar una deficiencia en el sistema vasodilatador endógeno calicreína/quinina que contribuye a la patogénesis de la hipertensión. Algunos estudios previos realizados en la población blanca y negra en los EE.UU. demostraron que la excreción urinaria de calicreína está disminuida en miembros familiares con riesgo de hipertensión hereditaria (esencial) y que la calicreína urinaria es uno de los mayores marcadores genéticos asociado con historia familiar de hipertensión. También se informó la existencia de unión genética entre el locus de la calicreína y la presión sanguínea, en ratas. Algunos estudios sugirieron que la excreción urinaria disminuida de calicreína se asocia con sensibilidad de la presión sanguínea a la sal. La excreción de calicreína también está disminuida en afroamericanos y la deficiencia del sistema renal vasodilatador de calicreína-quinina puede explicar muchas de las características singulares de la hipertensión y de las enfermedades cardíacas en algunos sujetos de raza negra.

Progress of Therapeutic Technique for Cardiac Diseases Makes Cardiac Rehabilitation Medicine Education More Necessary / 中国康复理论与实践

@# The author discussed the necessitude of synchronization of cardiac interventional therapy and cardiac rehabilitation, and the methodology of cardiac rehabilitation medicine education in the article.

Basic and clinical research of stem cell transplantation in myocardial infarction / 基础医学与临床

Stem cell therapy for myocardial repair after myocardial infarction is a new and promising treatment modality.But the mechanism is still not very clear.Currently,stem cells are used in clinical study to evaluate its beneficial effect on repairing infarcted/hibernating myocardium after myocardial infarction and heart failure.But there is no final conclusion on the safety of stem cell transplantation.

Detection of enteroviral sequence in endomyocardial tissues from patients with cardiac diseases in northern Brazil

No presente trabalho, são mostrados resultados de um estudo piloto direcionado à detecção de seqüências de enterovirus em tecido cardíaco obtido a partir de biópsias endomiocárdicas de pacientes com doenças cardíacas na região Amazônica. Seis amostras coletadas de três pacientes foram analisadas por RT-PCR obtendo-se três espécimes positivos e três negativos. Esses achados preliminares sugerem a participação dos enterovirus na etiologia de doenças cardíacas, principalmente miocardites, e justificam estudos mais amplos nesse assunto.

In the present report we describe the results from a pilot study aimed at detecting enterovirus sequence in cardiac tissues, obtained through endomyocardial biopsies, from patients suffering from cardiac diseases in the Amazon region. Six samples that were collected from three patients were analysed by RT-PCR showing 3 positive and 3 negative results. These preliminary findings suggest the participation of enteroviruses in the etiology of cardiac diseases, mainly myocarditis, and warrant further and broader local studies on this subject.

The changing patterns of cardiac diseases in 4 hospital medical schools in 2 Decades.

A retrospective study of 1,293,843 in-patients of the medical schools Siriraj, Chulalongkorn, Ramathibodi and Chiangmai hospitals in the alternate years from 1969 to 1987 (covering almost two decades), according to ICU 8-9, reveals that the proportion to all in-patient admission of 1. all cardiac patient admissions has steadily increased; 2. all cardiac failure admissions has significantly increased, but those due to anaemia and thyroid disturbances are unchanged; 3. all congenital heart disease admissions remained unchanged from 1969 to 1979, but significantly increased thereafter; 4. hypertensive cardiovascular admissions has remained unchanged; 5. rheumatic heart disease admission has decreased; 6. cardiac infection admissions has remained unchanged, but non-infection cardiac inflammation admissions has increased; 7. ischemic heart disease admissions has increased; 8. cardiac beriberi admissions decreased from 1969 to 1979, and unchanged thereafter; 9. cor pulmonale admissions has increased; and 10. cardiomyopathy admissions has increased, particularly after 1977. This information will help in planning for admission and the budgets of hospital medical schools and medical centres. It will also be useful in the planning of preventing specifice heart diseases, such as ischemic heart disease, which is increasing rapidly in the general population.