[Safety and efficacy of the early administration of levosimendan in patients with acute non-ST-segment elevation myocardial infarction and elevated NT-proBNP levels: An Early Management Strategy of Acute Heart Failure (EMS-AHF)].

Objectives: To investigated the safety and efficacy of treating patients with acute non-ST-segment elevation myocardial infarction (NSTEMI) and elevated levels of N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) with levosimendan within 24 hours of first medical contact (FMC). Methods: This multicenter, open-label, block-randomized controlled trial (NCT03189901) investigated the safety and efficacy of levosimendan as an early management strategy of acute heart failure (EMS-AHF) for patients with NSTEMI and high NT-proBNP levels. This study included 255 patients with NSTEMI and elevated NT-proBNP levels, including 142 males and 113 females with a median age of 65 (58-70) years, and were admitted in the emergency or outpatient departments at 14 medical centers in China between October 2017 and October 2021. The patients were randomly divided into a levosimendan group (n=129) and a control group (n=126). The primary outcome measure was NT-proBNP levels on day 3 of treatment and changes in the NT-proBNP levels from baseline on day 5 after randomization. The secondary outcome measures included the proportion of patients with more than 30% reduction in NT-proBNP levels from baseline, major adverse cardiovascular events (MACE) during hospitalization and at 6 months after hospitalization, safety during the treatment, and health economics indices. The measurement data parameters between groups were compared using the t-test or the non-parametric test. The count data parameters were compared between groups using the χ² test. Results: On day 3, the NT-proBNP levels in the levosimendan group were lower than the control group but were statistically insignificant [866 (455, 1 960) vs. 1 118 (459, 2 417) ng/L, Z=-1.25,P=0.21]. However, on day 5, changes in the NT-proBNP levels from baseline in the levosimendan group were significantly higher than the control group [67.6% (33.8%,82.5%)vs.54.8% (7.3%,77.9%), Z=-2.14, P=0.03]. There were no significant differences in the proportion of patients with more than 30% reduction in the NT-proBNP levels on day 5 between the levosimendan and the control groups [77.5% (100/129) vs. 69.0% (87/126), χ²=2.34, P=0.13]. Furthermore, incidences of MACE did not show any significant differences between the two groups during hospitalization [4.7% (6/129) vs. 7.1% (9/126), χ²=0.72, P=0.40] and at 6 months [14.7% (19/129) vs. 12.7% (16/126), χ²=0.22, P=0.64]. Four cardiac deaths were reported in the control group during hospitalization [0 (0/129) vs. 3.2% (4/126), P=0.06]. However, 6-month survival rates were comparable between the two groups (log-rank test, P=0.18). Moreover, adverse events or serious adverse events such as shock, ventricular fibrillation, and ventricular tachycardia were not reported in both the groups during levosimendan treatment (days 0-1). The total cost of hospitalization [34 591.00(15 527.46,59 324.80) vs. 37 144.65(16 066.90,63 919.00)yuan, Z=-0.26, P=0.80] and the total length of hospitalization [9 (8, 12) vs. 10 (7, 13) days, Z=0.72, P=0.72] were lower for patients in the levosimendan group compared to those in the control group, but did not show statistically significant differences. Conclusions: Early administration of levosimendan reduced NT-proBNP levels in NSTEMI patients with elevated NT-proBNP and did not increase the total cost and length of hospitalization, but did not significantly improve MACE during hospitalization or at 6 months.

[The diagnostic value of copeptin in the cardiorenal syndrome rats and the association with heart and kidney impairment].

To explore the diagnostic value of copeptin (CPP) in cardiorenal syndrome (CRS) in rats and the association between CPP and impairment of heart and kidney, 60 male SD rats were randomly divided into blank control group (CK group), kidney failure group (SNX group), heart failure group (MI group), and CRS group. Heart and kidney function and their histology changes in rats from each group were detected. The correlation between serum CPP and heart and kidney function indexes was performed with Pearson correlation analysis. The HE staining of heart and kidney showed that the tissue lesion was more severe in CRS group than in SNX group and MI group. There was a significant positive correlation between serum CPP and brain natriuretic peptide (BNP) (r=0.638, P<0.05). No correlation was observed between serum CPP and cardiac function index (left ventricular systolic pressure, left ventricular diastolic pressure, left ventricular end-diastolic pressure) or renal function index (serum creatinine, urine creatinine, blood urea nitrogen) (r=0.512, 0.189,-0.063, 0.207, 0.290, 0.595, respectively, all P>0.05). The CPP level is associated with the degree of heart and kidney damage in CRS rats.

Structural responses of metallic glasses under neutron irradiation.

Seeking nuclear materials that possess a high resistance to particle irradiation damage is a long-standing issue. Permanent defects, induced by irradiation, are primary structural changes, the accumulation of which will lead to structural damage and performance degradation in crystalline materials served in nuclear plants. In this work, structural responses of neutron irradiation in metallic glasses (MGs) have been investigated by making a series of experimental measurements, coupled with simulations in ZrCu amorphous alloys. It is found that, compared with crystalline alloys, MGs have some specific structural responses to neutron irradiation. Although neutron irradiation can induce transient vacancy-like defects in MGs, they are fully annihilated after structural relaxation by rearrangement of free volumes. In addition, the rearrangement of free volumes depends strongly on constituent elements. In particular, the change in free volumes occurs around the Zr atoms, rather than the Cu centers. This implies that there is a feasible strategy for identifying glassy materials with high structural stability against neutron irradiation by tailoring the microstructures, the systems, or the compositions in alloys. This work will shed light on the development of materials with high irradiation resistance.

Effect of light deprivation on expression of extended vascular endothelial growth factor and neovascularization in retina of neonatal rats.

OBJECTIVE: The aim of this study is to analyze the effect of light deprivation on the expression of vascular endothelial growth factor (VEGF) and neovascularization in the retina of neonatal rats. MATERIALS AND METHODS: Thirty-six neonatal SD rats (male and female) were used in this study. These rats were numbered randomly and assigned into 3 groups (12 rats in each group), ie. 10-day group (routine feeding after birth, eyeball enucleation on 10th day), 14-day group (routine feeding after birth, eyeball enucleation on 14th day) and light deprivation group (routine feeding within 1st week after birth, feeding with light deprivation within 2nd week after birth, eyeball enucleation on 14th day). The expression level of VEGF mRNA was measured by RT-PCR, and the percentage of the retinal vascular area was calculated by PAS staining, and the number of vascular endothelial cells was counted with a microscope in a double-blind manner. RESULTS: It was found that the expression levels of VEGF mRNA and the number of vascular endothelial cells in 10-day group and light deprivation group were significantly higher than 14-day group (p < 0.05), while the difference between the 10-day group and light deprivation group was not significant. The percentage of retinal vascular area in the 10-day group and light deprivation group was significantly lower than 14-day group (p < 0.05), while the difference between the 10-day group and the light deprivation group was not significant. CONCLUSIONS: The light deprivation delayed the growth of neovessels in the retina.

Effects of tumor necrosis factor and E-selectin on coronary artery flow.

OBJECTIVE: The aim of the study is to investigate the correlation between tumor necrosis factor (TNF-α), E-selectin and coronary artery flow following myocardial ischemia-reperfusion model (IR) in Yorkshire pigs. MATERIALS AND METHODS: Establishment of IR model in pigs. Following the injury model, Experiment group was administrated intravenously Shenfu injection solution (SFI, 1 mL/kg). The control group received the same amount of saline. After 30 min of blood reflux, thrombolysis in myocardial infarction frame count (TFC) was recorded following surgery. TNF-α, E-selectin expression was determined by ELISA in the venous sheath, coronary sinus, artery sinus, and proximal segment of the coronary artery. RESULTS: After the blood reflowing, TFC in both groups were upregulated, and TFC increased more than the control group. The difference is statistically significant (p<0.05) at the time of 30 min. TNF-α, E-selectin expression increased after IR. After reperfusion, TNF-α, E-selectin levels further increased and the myocardial injury was aggravated. SFI inhibited inflammation in the experimental group. TNF-α, E-selectin levels at coronary sinus, artery sinus, and distal segment of coronary artery after surgery was positively correlated with TIMI in the experimental group (p<0.05). TNF-α, E-selectin levels significantly increased after reperfusion (p<0.05). CONCLUSIONS: The result demonstrated that TNF-α, E-selectin levels were positively correlated with coronary artery reflow only in the experimental group but not in the control group.

Correlation study between interleukin-6 levels and coronary reflow.

OBJECTIVE: To analyze the correlation between local interleukin-6 (IL-6) levels in different parts of blood vessel and the record of Thrombolysis in Myocardial Infarction (TIMI) frame count (TFC) after myocardial ischemia-reperfusion (IR) model. MATERIALS AND METHODS: Establishment of IR model in Yorkshire pigs, the pigs were divided into two groups (n=6). Experiment group pigs were administrated with Shenfu injection (SF) intravenously (1 mL/kg), control group was given saline injection. The blood reflowed after 30 min. TIMI was recorded to evaluate the coronary blood flow and myocardial perfusion. IL-6 levels in venous sheath, coronary sinus, artery sinus, and proximal coronary artery were determined by ELISA. RESULTS: The records of TIMI in experimental group were higher than that in control group. The difference was statistically significant (p < 0.05). The level of IL-6 increased obviously compared with control group after reperfusion (p < 0.05). Shenfu injection reduced the level of IL-6. IL-6 level at the coronary sinus was positively correlated with TIMI in experimental group (p = 0.03, R2 = 0.97) but not in control group. CONCLUSIONS: IL-6 levels were significantly increased after reperfusion, which aggravated myocardial injury. IL-6 may be associated with coronary reflow, but further study is needed.

Stretchable and compressible strain sensors based on carbon nanotube meshes.

Flexible strain sensors have promising applications in healthcare and human movement detection. Herein, we report stretchable and compressible strain sensors based on carbon nanotube meshes (CNTMs) with unique structures consisting of macroscopic grids and microscopic spider-web networks. The stretchable strain sensor shows good reliability for long cyclic tests and can be used for weak stimuli and large motion detection. The compressible strain sensor also shows good reliability after long cyclic tests and can be used to detect large strains induced by walking or running motion. Both the stretchable and compressible CNTM strain sensors are reliable and stable at detecting large stretching and compressing deformation.

Clinical significance of dynamic changes in hs-CRP and ADAMTS13 levels in the blood serum of patients with no-reflow after PCI operation.

OBJECTIVE: To evaluate the clinical significance dynamic changes in hs-CRP and ADAMTS13 levels in patients with no-reflow after PCI operation. PATIENTS AND METHODS: 156 patients with STEMI single-vessel were enrolled in this study. Patients were divided into the reflow and the no-reflow groups. ADAMTS13 and hs-CRP levels were compared between the two groups. RESULTS: ADAMTS13 and hs-CRP levels in the no-reflow group were significantly lower than those in the reflow group after PCI operation. The ADAMTS13 level in the reflow group peaked at 3 h and then dropped. The ADAMTS13 level was not changed significantly in the no-reflow group and reflow group before and after the operation. In the reflow group, serum hs-CRP level fell sharply within 3 h after operation, while in the no-reflow group it was decreased within 3 h to 3 days after the operation. After the operation, LVEDD was decreased significantly in both groups compared to that of before PCI, but the difference between two groups was not statistically significant. CTFC (frame) and WMSI levels in the reflow group were significantly lower than those in the no-reflow group after the operation, and the differences were statistically significant. CONCLUSIONS: ADAMTS13 and hs-CRP levels in patients with STEMI were negatively correlated and this correlation was independent from LVDD, LVEF, BMI, WMSI, MAP, LDL, HDL and other factors which can influence STEMI reflow after the operation. Results obtained from the present study provides a valuable theoretical basis for the drug research and development as well as future studies on the no-reflow phenomenon. It also offers an important clinical application value.

Effects of light on the development of melanoposin containing retinal ganglion cells in rats.

OBJECTIVE: The present study was planned to evaluate the effect of light on the development of light-sensitive retinal ganglion cells. MATERIALS AND METHODS: The Sprague-Dawley (SD) rats were segregated into 3 groups (n=18) which included routine feeding 10-day group 1, routine feeding 14-day group 2 and light-deprivation feeding 14-day group 3. The group 1 animals were routinely fed for 10 days in normal light conditions and were sacrificed for analyses on day 10. Similarly, group 2 animals were routinely fed for 14 days in normal light conditions and were sacrificed for analyses on day 14. The group 3 animals were kept were routinely fed for 7 days which was followed by their feeding in a light-deprived conditions and were sacrificed on day 14. RESULTS: The expression of the opsin gene determined by real-time PCR in retinal tissues showed a significant decline in the light-deprived group 3 when compared to other two groups. Furthermore, the melanopsin protein also showed a significant decline in its protein expression in light-deprived group 3 as observed by immune-blot analyses. The immuno-fluorescence analyses also showed the similar trend confirming the effect of light on the development of retinal ganglion cells. CONCLUSIONS: Light is essential for the proper development process of retinal ganglion cells as light directly affects regulatory opsin gene expression.

Comparison of three different PCR-based methods to predict the penicillin nonsusceptible Streptococcus pneumoniae isolates from China.

AIM: To find a quick and reliable diagnostic technique for penicillin nonsusceptible Streptococcus pneumoniae (PNSSP) from Nanjing, China. METHODS AND RESULTS: A total of 130 S. pneumoniae clinical isolates and 50 healthy carriers' isolates were collected from seven teaching hospitals in Nanjing between March 2005 and June 2007. Three different methods, PCR, seminested-PCR, and PCR-RFLP, were applied in detecting PNSSP. The prevalence of PNSSP was 73.9%, the penicillin-resistance rate of children's group and adults' group were 87.8% and 31.2%, respectively. The PCR method had difficulty in identifying intermediate-resistant and resistant isolates, the PCR-RFLP method could only be used for susceptible isolates and had poor sensitivity. Seminested-PCR was fast, sensitive for detection, and successfully differentiated between moderately and highly resistant S. pneumoniae; 96.1% of the PCR results were in agreement with the minimum inhibitory concentration (MIC) data. CONCLUSIONS: The penicillin resistance rate in isolates from children was much higher than of isolates from adults in China. Seminested-PCR for pbp1A was the best diagnostic method. SIGNIFICANCE AND IMPACT OF THE STUDY: We compared three different strategies for the first time in identification of PNSSP in China. In conclusion, seminested-PCR can be applied in clinical microbiology laboratories for detection of serious infections caused by S. pneumoniae.