The Role of Intestinal Flora and Its Metabolites in Heart Failure.

Intestinal flora is a complex collection of microbial communities that participate in the physiological and pathological activities of the human body through various pathways. In recent years, numerous studies have reported that intestinal flora are involved in the occurrence and development of heart failure (HF) and its metabolic products could play an important role in this progression, suggesting a great value in the clinical treatment of this condition. This study reported the interaction between intestinal flora and HF, and with intestinal flora metabolites, such as short-chain fatty acids, trimethylamine N-oxide and bile acids and urotoxins, considered as the starting point, the mechanism of the roles in HF was summarized. Additionally, the current research status and the development prospects of applying flora and metabolites to the clinical therapeutic decision of HF were discussed.

Safety and efficacy of His-Purkinje system pacing in the treatment of patients with atrial fibrillation and heart failure: a systematic review and meta-analysis.

Aim: To evaluate the safety and efficacy of the His-Purkinje system pacing (HPCSP) in the treatment of individuals with atrial fibrillation (AF) complicated by heart failure (HF). Methods: The PubMed, Cochrane Library, Web of Science, and Embase databases were searched through September 1, 2022. The literature was initially screened based on the inclusion and exclusion criteria. The baseline characteristics of the subjects, implantation success rate, New York Heart Association (NYHA) classification, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), QRS duration, pacing threshold, and impedance were extracted and summarized; statistical analysis was performed using RevMan 5.3 software. Results: In all, 22 articles were included, involving 1,445 patients. Compared to biventricular pacing (BiVP), HPCSP resulted in improved cardiac function, including increased ejection fraction (MD = 5.69, 95% CI: 0.78-10.60, P = 0.02) and decreased LVEDd (MD = -3.50, 95% CI: -7.05-0.05, P = 0.05). It was also correlated with shorter QRS duration (MD = -38.30, 95% CI: -60.71--15.88, P < 0.01) and reduced all-cause mortality and rehospitalization events (RR = 0.72, 95% CI: 0.57-0.91, P < 0.01) in patients. Left bundle branch pacing (LBBP) lowered the pacing threshold (MD = 0.47; 95% CI: 0.25-0.69; P < 0.01), and there was no statistical difference in the rate of endpoint events when comparing these two physiologic pacing modalities (RR = 1.56, 95% CI: 0.87-2.80, P = 0.14). Conclusion: The safety and efficacy of HPCSP in patients with AF and HF were verified in this meta-analysis. HPCSP can reverse cardiac remodeling and has great clinical application value. Relatively speaking, His-bundle pacing (HBP) can maintain better ventricular electro-mechanical synchronization, and the pacing parameters of LBBP are more stable. Systematic Review Registration: PROSPERO (CRD42022336109).

Effects of Empagliflozin on Gut Microbiota in Heart Failure with a Preserved Ejection Fraction: The Design of a Pragmatic Randomized, Open-Label Controlled Trial (EMPAGUM).

Although empagliflozin has been recommended for individuals with heart failure, its effects on heart failure with preserved ejection fraction (HFpEF) remain uncertain from a physiopathological standpoint. The metabolites produced by gut microbiota have been shown to have a crucial role in the development of heart failure. Sodium-glucose cotransporter-2 inhibitors (SGLT2) have been shown to change the make-up of the gut microbiota in rodent studies. There is mixed evidence from similar studies investigating whether or not SGLT2 can affect the microbiota in the human gut. This trial is a pragmatic, randomized, open-label controlled study with empagliflozin as an intervention. We will enroll 100 patients with HFpEF and randomly assign them to one of two groups to receive either empagliflozin or a placebo. Patients in the Empagliflozin group will be given 10 mg of the drug daily, while those in the Control group will not be given empagliflozin or any other SGLT2. The purpose of the trial is to validate the changes that occur in gut microbiota in patients with HFpEF who take empagliflozin and to investigate the function of gut microbiota and their metabolites in the process.

Contralateral C7 nerve transfer through posterior vertebral approach combined with selective posterior rhizotomy of the affected cervical nerve in the treatment of central upper limb spastic paralysis: A case report.

INTRODUCTION: C7 nerve transfer alone can improve upper limb motor function and partial spasticity. Selective posterior rhizotomy (SPR) of the cervical nerve alone can comprehensively improve spasticity but without neuromotor regeneration. We propose a novel possible improvement of contralateral C7 (CC7) nerve transfer through the posterior vertebral approach, which was combined with SPR of the affected cervical nerve. PATIENT CONCERNS: A 33-year-old male patient presented with cerebral hemorrhage of the left basal ganglia, paralysis of the right limbs, and hypesthesia 8 months earlier. The dysfunction of the affected hand was already present at admission. The patient reported a previous history of hypertension for several years and oral antihypertensive drugs, and blood pressure was controlled within a normal range. DIAGNOSIS: Central upper limb spastic paralysis. The muscle strength of the right lower limb was grade IV. The Fugl-Meyer score of the right upper limb was 7 points, and the modified Ashworth score was 10. INTERVENTIONS: The patient underwent CC7 transfer and SPR. OUTCOMES: The patient successfully underwent CC7 transfer and SPR without complications. On the day after surgery, the left upper limb motions were normal. The Fugl-Meyer score was 9, and the modified Ashworth score of the right upper limb was 2. CONCLUSIONS: CC7 nerve transfer through the posterior vertebral approach combined with SPR of the affected cervical nerve can possibly improve the surgical outcomes of selected patients with upper limb motor dysfunction and partial spasticity. This method has not been reported in the literature before, and additional studies are necessary.

Preliminary results of posterior contralateral cervical 7 nerve transposition in the treatment of upper limb plegia after a stroke.

OBJECTIVE: This study aimed to explore a shorter and safer contralateral C7 transposition pathway for the treatment of central upper limb paralysis. METHODS: From July 2018 to March 2019, 10 patients with central upper limb paralysis underwent posterior cervical 7 nerve transposition. The age of these patients ranged within 31-58 years old (average: 44 years old). These patients comprised of eight male patients and two female patients. Nine patients had cerebral hemorrhage, and one patient had a cerebral infarction. Furthermore, nine patients presented with spastic paralysis of the upper limbs and one patient presented with nonspastic paralysis. The duration of plegia before the operation ranged from 6 to 60 months (average: 26 months). The surgical procedure included transposition of the contralateral cervical 7 nerve root via a posterior vertebral approach under general anesthesia, and the distal part of the contralateral cervical 7 nerve was anastomosed with the proximal part of the ipsilateral cervical 7 nerve. RESULTS: The length of the contralateral cervical 7 nerve was 5.16 ± 0.21 cm, which was directly anastomosed with the ipsilateral cervical 7 nerve. Neither case needed nerve transplantation. Most patients had temporary numbness in their healthy fingers, which all disappeared within three months. Up to now, the follow-up results are as follows: The spasticity of the affected upper limbs in five patients is lower than that before the operation, the pain and temperature sensation of the affected upper limbs in six patients are better than before the operation. CONCLUSION: The distance of nerve transposition can be shortened by a posterior vertebral approach operation, where the contralateral C7 nerve can be anastomosed directly with the ipsilateral C7 nerve which may be effective for nerve regeneration and functional recovery. However, this conclusion still needs further research and verification.

Treatment of Central Paralysis of Upper Extremity Using Contralateral C7 Nerve Transfer via Posterior Spinal Route.

BACKGROUND: Contralateral C7 nerve transfer is widely applied for the treatment of brachial plexus injuries or central paralysis of the upper extremities. The surgical approach has evolved from the precervical subcutaneous route to the prespinal route, which is currently the most commonly used one. We report a patient with central paralysis of the right upper extremity treated with contralateral C7 nerve transfer via the posterior spinal route. CASE DESCRIPTION: A 59-year-old female patient was admitted on 3 July, 2018 with right hemiplegia. The muscle strength of the right lower and upper extremities was grade 4 and 0, respectively. On the basis of magnetic resonance imaging, she was diagnosed with central paralysis of the right upper extremity. Considering the short length of the patient's healthy C7 nerve, contralateral C7 nerve transfer via the posterior spinal route was performed. No intraoperative complication was encountered. The patient reported slight numbness of the volar side of the left thumb, middle finger, and index finger after surgery. The patient showed a right shrug movement 1.5 months after surgery. CONCLUSION: We propose carrying out contralateral C7 nerve transfer via the posterior spinal route because of the shorter distance, no need for nerve transplantation, and low occurrence of the complications encountered with the prespinal route (such as vertebral artery injuries, esophageal fistula, and upper extremity pain when swallowing).

Myocardial perfusion at rest in uncomplicated type 2 diabetes patients without coronary artery disease evaluated by 320-multidetector computed tomography: A pilot study.

Using computed tomography myocardial perfusion imaging (CTP) to investigate resting myocardial perfusion alterations in uncomplicated type 2 diabetes mellitus (T2DM) patients without obstructive coronary artery disease (CAD).A total of 34 participants with 544 myocardial segments were included prospectively: 17 uncomplicated T2DM patients with no significant coronary artery stenosis on coronary computed tomography angiography and 17 healthy controls. Myocardial perfusion was evaluated by transmural perfusion ratio (TPR). Parameters of cardiac structure and function were measured for cardiac comprehensive assessment. Analyses included descriptive statistics and group comparisons.TPR of segments 5, 7, 9, 10 to 14 were significantly reduced in T2DM group compared with controls (P < .05). When 16 myocardial segments were localized into different areas according to the wall orientations, axial levels of left ventricle and coronary artery territories, respectively, TPR of each area in T2DM group were significantly lower than those in the control group (P < .05). No significant differences were found in cardiac anatomy and function analyses between 2 groups.In uncomplicated T2DM patients without obstructive CAD, myocardial perfusion impairments were present and may develop prior to cardiac morphological and functional abnormalities, which can be early detected by CTP.

Immunopontentiating and antitumor activities of a polysaccharide from Pulsatilla chinensis (Bunge) Regel.

One water-soluble polysaccharide (PCPw) was isolated and purified from the roots of Pulsatilla chinensis by DEAE cellulose-52 and Sephadex G-100 column chromatography, and its antitumor activity was evaluated on 4T1 tumor-bearing mice through transplantable animal tumor. After 10 days of PCPw (50, 100 and 200 mg/kg) treatment once daily in tumor-bearing mice, PCPw oral administration could not only significantly inhibit the growth of transplantable 4T1 tumor in mice but also promote concanavalin A (Con A), lipopolysaccharide (LPS)-stimulated splenocytes proliferation, the serum lysozyme level and 2,4-dinitrofluorobenzene (DNFB)-induced delayed-type hypersensitivity (DTH) reactions, especially at the dose of 100 mg/kg. Meanwhile, significant improvements in peripheral blood abnormality and anemia were observed in PCPw-treated group. These results suggested that PCPw could improve both cellular and humoral immune response and might be explored as a potential natural antitumor drug.