[Clinical analysis of 17 cases of Gitelman syndrome].

OBJECTIVE: To analyze the clinical and laboratory characteristics of Gitelman syndrome. METHODS: Seventeen patients with Gitelman syndrome (male/female: 11/6) were analyzed for their clinical symptoms, laboratory test results, imaging findings, treatments and outcomes. RESULTS: Fifteen of the 17 patients presented with varying degrees of lower limb weakness, and 8 experienced flaccid paralysis. The laboratory tests showed hypokalemia (17/17), hypomagnesemia (17/17) and hypocalcemia (17/17). Blood renin activity (17/17), angiotensin II (14/17) and aldosterone levels (7/17) were significantly higher in the patients than in normal subjects. The symptoms were relieved by potassium alone or in combination with indomethacin, spironolactone and other potassium magnesium asparaginate, but the serum potassium and magnesium failed to recover the normal levels after the treatments. CONCLUSION: The primary clinical manifestations of Gitelman syndrome are lower extremity weakness with hypokalemia and hypomagnesemia. Combined drug therapies including potassium, magnesium, aldosterone antagonists and other drugs are recommended. The prognosis of the patients is favorable.

[The role of magnesium in the implementation of vascular reactions during anesthesia in cardiac surgery patients].

UNLABELLED: The purpose of the study is to examine the relationship between the concentration of magnesium in plasma and vascular reactions during cardiac surgery. MATERIALS AND METHODS: The study included 77 patients with coronary artery disease who underwent myocardial revascularization surgery. In the first group (n = 44) during the entire operation infusion solution "potassium and magnesium asparginate" (Berlin-Chemie) was carried out at a rate of 1.5-2 ml/kg/h, in the second group (n = 33) patients were injected magnesium free crystalloid solutions. An analysis of central hemodynamics (PiCCO Plus) and microcirculation (laser Doppler flowmetry LASMA) was carried out. CONCLUSION: Maintenance of normal concentrations of magnesium in blood plasma reduces the incidence of episodes of intraoperative hypertension and improves peripheral microcirculation.

[Use of a potassium and magnesium asparaginate solution to maintain the balance of potassium and magnesium during cardiosurgical interventions under extracorporeal circulation].

The study included 42 patients with coronary heart disease operated on the coronary arteries. A potassium and magnesium asparaginate (PMA) solution, 450-1000 ml, was injected in 30 patients for 5-7 hours; other crystalloid solutions was used in a control group (n = 12). The concentrations of potassium and magnesium were measured prior to surgery, following initial anesthesia, before and after extracorporeal circulation (EC). The measurements suggested a significant potassium and magnesium intake at surgery under EC. The use of PMA solution showed its advantage in stabilizing the study electrolytes at the main surgical stages. Inclusion of PMA into infusion therapy considerably reduced a need for an additional use of concentrated KCl solution to maintain potassium at the preoperative level. Of particular importance was the use of PMA to maintain magnesium that was held in the upper normal range throughout the operation, as shown by both the median values and an individual analysis. When PLA was not administered, the mean concentration of magnesium was consistent with that in the lower normal electrolyte range and 50% patients developed hypomagnesemia. The comparative analysis of the clinical course after EC in both groups of patients with different levels of magnesium was indicative of the better status of some hemostatic parameters with the level of magnesium being maintained in the upper normal range.

Effects of potassium aspartate and magnesium on ventricular arrhythmia in ischemia-reperfusion rabbit heart.

The aim of this study was to determine if the potassium aspartate and magnesium (PAM) prevent reperfusion-induced ventricular arrhythmias (RIVA) in ischemia-reperfusion (IR) rabbit heart. Thirty rabbits were randomly divided into control, ischemia and PAM groups. Arterially-perfused rabbit left ventricular preparations were made, and transmural ECG as well as action potentials from both endocardium and epicardium were simultaneously recorded in the whole process of all experiments. In control group rabbit ventricular wedge preparations were continuously perfused with Tyrode's solution, and in ischemia group and PAM groups the perfusion of Tyrode's solution was stopped for 30 min. Then the ischemia group was reperfused with Tyrode's solution and the PAM group with Tyrode's solution containing 2.42 mg/L PAM, respectively. ECG, QT interval, transmural repolarization dispersion (TDR) and action potentials from epicardium and endocardium were simultaneously recorded, and the RIVA of the wedge preparation was observed. Compared with control group, TDR and incidence of RIVA were significantly increased in ischemia group (P<0.05). The incidence of RIVA in control, ischemia and PAM group was 0/10, 9/10 and 1/10, respectively. Compared with ischemia group, TDR and incidence of RIVA were significantly reduced in PAM group (P<0.05). Potassium aspartate and magnesium significantly reduce TDR and prevent ventricular arrhythmia in ischemic rabbit heart.

[Attenuation of irreversible rat heart injury by reperfusion with metabolic protectors].

The aim of this study was to evaluate the effects of intravenous infusion of potassium-magnesium aspartate (K-Mg-Asp), a glucose-insulin-potassium cocktail (GIK), a combination of glucose, insulin and potassium aspartate (GIKAsp), and insulin (I) alone during reperfusion after myocardial regional ischemia on metabolism of the risk area (AR) and cardiomyocyte membrane damage in rats in vivo. Acute myocardial infarction (MI) was induced by 40-min occlusion of the anterior descending coronary artery followed by 60-min reperfusion. At the onset of reperfusion, K-Mg-Asp, GIK, GIKAsp, I or the physiological solution (control) was infused into the jugular vein at a rate of 1 ml/kg/h. After reperfusion, MI size was estimated by myocardial staining with 2,3,5-triphenyltetrazolium chloride. In separate series transmural biopsies from the AR were taken for metabolite analysis. MI size in all experimental groups was less than that in the control and reduced in the following rank: K-Mg-Asp > GIKAsp > I > GIK. By the end of reperfusion with metabolic protectors, ATP and phosphocreatine levels in the AR were 2-2,5 times higher that in the control (56.3 +/- 3.4 and 81.8 +/- 7.9% of the initial values, respectively). The losses of aspartate and glutamate pool and lactate and glucose accumulation in the AR were significantly lower in the experimental groups than in control. At the end of the reperfusion, the total creatine content in the AR decreased to 32.3 +/- 2.3% of the initial value in control, but restored to 78.0 +/- 5.7; 76.7 +/- 5.5 and 62.4 +/- 5.6% under effects of GIK, I and K-Mg-Asp, respectively. The recovery of the majority indices of aerobic metabolism and cell membrane integrity was maximal in the GIK and I groups and insignificantly lower after reperfusion with K-Mg-Asp. Therefore the metabolic efficacy of the protectors on reperfusion corresponded to MI size limitation. The results suggest that myocardial reperfusion with GIK, I and K-Mg-Asp is a promising adjunctive therapy in patients with acute MI.

Effects of potassium aspartate and magnesium on ventricular arrhythmia in ischemia-reperfusion rabbit heart / 华中科技大学学报（医学）（英德文版）

The aim of this study was to determine if the potassium aspartate and magnesium (PAM) prevent reperfusion-induced ventricular arrhythmias (RIVA) in ischemia-reperfusion (IR) rabbit heart. Thirty rabbits were randomly divided into control, ischemia and PAM groups. Arterially-perfused rabbit left ventricular preparations were made, and transmural ECG as well as action potentials from both endocardium and epicardium were simultaneously recorded in the whole process of all experiments. In control group rabbit ventricular wedge preparations were continuously perfused with Tyrode's solution, and in ischemia group and PAM groups the perfusion of Tyrode's solution was stopped for 30 min. Then the ischemia group was reperfused with Tyrode's solution and the PAM group with Tyrode's solution containing 2.42 mg/L PAM, respectively. ECG, QT interval, transmural repolarization dispersion (TDR) and action potentials from epicardium and endocardium were simultaneously recorded, and the RIVA of the wedge preparation was observed. Compared with control group, TDR and incidence of RIVA were significantly increased in ischemia group (P<0.05). The incidence of RIVA in control, ischemia and PAM group was 0/10, 9/10 and 1/10, respectively. Compared with ischemia group, TDR and incidence of RIVA were significantly reduced in PAM group (P<0.05). Potassium aspartate and magnesium significantly reduce TDR and prevent ventricular arrhythmia in ischemic rabbit heart.

[Clinical investigation of the protective effects of potassium magnesium aspartate against arrhythmia and its possible anti-oxidative mechanism].

OBJECTIVE: To investigate the protective effects of potassium magnesium aspartate against oxidative stress status and lipid oxidative damage in the patients with angina and arrhythmia due to coronary artery disease, its therapeutic effect on arrhythmia and its possible mechanism. METHODS: With single blind protocol, 98 patients with angina and arrhythmia due to coronary artery disease were randomly divided into (1)Experiment group (n = 65), who received routine remedy for coronary heart disease plus potassium magnesium aspartate. (2)Control group (n = 33), who received only routine therapy for coronary heart disease without potassium magnesium aspartate. Reduced glutathione (GSH), oxidized glutathione (GSSG), malondialdehyde (MDA) and oxidized low density lipoprotein (ox-LDL) in plasma of all patients were examined before and one week after treatment, all patients with arrhythmia were equipped with Holter for continuous monitoring of cardiac rhythm. RESULTS: After one week's treatment, the GSH level in plasma of experiment group and the ratio of GSH and GSSG (GSH/GSSG) were significantly increased comparing with control group (both P<0.01), while GSSG, MDA and ox-LDL levels significantly lowered comparing with control group(all P<0.01). The premature beats diminished 86.5% in experiment group, but the decrease rate in control group was only 47.4% (P<0.01). The improvement in indexes of oxidative stress status (including GSH/GSSG, MDA and ox-LDL) and the reduction of premature beats showed close correlation with each other (all P<0.01). No adverse effects of the drug were found after one week of administration of Potassium magnesium aspartate. CONCLUSION: Potassium magnesium aspartate can strikingly improve oxidative stress status and decrease lipid oxidative damage in the patients with coronary heart disease, and the frequent premature beats were also significantly reduced by potassium magnesium aspartate. The analysis of above results reveals an intrinsic relationship between the improvement of oxidative stress status and the good therapeutic effects on frequent premature beats by potassium magnesium aspartate, which may suggest an involvement of oxidative stress in the pathogenesis of arrhythmias.

[Comparative study of the antiarrhythmic activity of L-, D-and DL-stereoisomers of potassium magnesium aspartate].

Injection forms of potassium (K) and magnesium (Mg) aspartate (Asp) were compared in preventing cardiac disorders caused by electrolytic disturbances, primarily low K and Mg levels (e.g. caused by the treatment with cardiac glycosides and diuretic drugs). Widely used K- and Mg-Asp preparations (asparkam, panangin, pamaton) are synthesized from aspartic acid representing a racemic mixture of L- and D-stereoisomers. Differences in metabolism and utilization of D- and L-amino acids probably influence the pharmacological properties of K and Mg L- and D-aspartates. Moreover, the pharmacologically effective doses of Mg and K salts can induce toxicity, which depends on the nature of anions. The aim of this study was to compare of antiarrhythmic action of K and Mg L-, D-, and DL-Asp stereoisomers using calcium chloride (CaCl2) and aconitine induced arrhythmia models in rats and strophanthin-K induced arrhythmia model in guinea pigs. It was found that intravenously administered K- and Mg-L-Asp exhibited higher activity compared to K- and Mg-D- and DL-Asp on the strophanthin-K, CaCl2, and aconitine induced arrhythmia models. Indeed, K- and Mg-L-Asp more effectively decreased the incidence of arrhythmias, increased the time to onset of the first arrhythmia, decreased percentage loss of rats, and increased the survival life of animals after the first arrhythmia onset in rats with arrhythmias induced by strophanthin-K and CaCl2 as compared to K and Mg-D- and DL-Asp. At the same time K- and Mg-L-Asp was better than D- and DL-Asp with respect to acute toxicity (LD50), effective dose (ED50) and antiarrhythmic (therapeutic) ratio (LD50/ED50) in rats with aconitine-induced arrhythmia model.

Effect of cold blood cardioplegia enriched with potassium-magnesium aspartate during coronary artery bypass grafting.

AIM: The aim of this investigation is to evaluate the effect of enriched with potassium-magnesium aspartate cold-blood cardioplegia on early reperfusion injury and postoperative arrhythmias in patients with ischemic heart disease undergoing coronary artery bypass grafting (CABG), using measurements of cardiac troponin I (CTnI), hemodynamic indexes and clinical parameters. METHODS: Forty patients with three-vessel coronary artery disease (CAD) and stable angina, receiving first-time elective CABG, were randomly divided into 2 groups: patients in control group (C group n=20) received routine institutional cold blood cardioplegia (4 degrees C) concentration of Mg2+4 mmol/L, Ca2+1.2 mmol/L and K+ 24mmol/L during myocardial arrest. Patients in P group (n=20) received modified cold blood cardioplegia enriched with potassium-magnesium aspartate and maintained concentration of Mg2+10 mmol/L, Ca2+1.2 mmol/L and K+20mmol/L in the final blood cardioplegia solution. Clinical outcomes were observed during operation and postoperatively. Serial venous blood samples for CTnI were obtained before induction, after cardiopulmonary bypass (CPB), and postoperative 6, 24, and 72 hours. Hemodynamic indexes were obtained before and after bypass by the radial catheter and Swan-Ganz catheter. RESULTS: In both groups, there were no differences regarding preoperative parameters. There were no cardiac related deaths in either group. The time required to achieve cardioplegic arrest after cardioplegia administration was significantly shorter in P group (47.5+/-16.3 s) than in C group (62.5+/-17.6 s) (P<0.01). The number of patients showing a return to spontaneous rhythm after clamp off was significantly greater in P group (n=20, 100%) than in C group (n=14, 70%) (P<0.01). Eight patients in C group had atrial fibrillation (AF) compared with two patients in P group (P<0.05) in the early of postoperative period. The level of CTnI increased 6 hours and 12 hours postoperatively, and there was a significant difference between groups (P<0.05). P group also shortened the time of postoperative mechanical ventilation (P<0.05) after surgery. CONCLUSIONS: Cold blood cardioplegia enriched with potassium-magnesium aspartate is beneficial on reducing reperfusion injury.

Effect of interferon-gamma on hepatic fibrosis in chronic hepatitis B virus infection: a randomized controlled study.

BACKGROUND & AIMS: Hepatic fibrosis due to chronic HBV infection has enormous socioeconomic impact. Besides strategies targeting virus elimination, prevention or reversal of liver fibrosis is amenable. Given the antifibrotic activity of interferon-gamma (IFN-gamma), a randomized open-labeled multicenter trial was initiated to test IFN-gamma in HBV infection. METHODS: HBsAg-positive patients with biopsy proven hepatic fibrosis (n = 99, stages 2-4, Scheuer criterion) were treated with diammone-glycyrrhizinate and potassium-magnesium aspartate. Sixty-six randomly assigned patients were treated with 50 mug IFN-gamma intramuscularly on a daily basis for 3 months and on alternate days the subsequent 6 months. Efficacy was evaluated by liver biopsy and serologic markers. RESULTS: Fifty-four patients in the IFN-gamma group and 29 patients in the control group completed the study. The hepatic fibrosis score was significantly reduced in 63% of IFN-gamma treated patients compared with 24.1% in the control group by using a semiquantitative scoring system evaluating both liver architecture and fibrotic deposits. Mean values for the total fibrosis score decreased from 13.8 +/- 5.8 to 10.1 +/- 5.1 in the IFN-gamma group (P = .0001), whereas they were unchanged in control subjects (13.2 +/- 6.8 vs 12.6 +/- 4.8, P = .937). The Scheuer system showed 12 out of 54 patients improved >or=1 stage(s) in the IFN-gamma group compared with 1 of 29 in the control group. Antifibrotic activity might be attributed to decreased transforming growth factor-beta signaling via phosphorylated Smad2 and reduced number of activated, alpha-smooth muscle actin positive hepatic stellate cells. CONCLUSIONS: IFN-gamma treatment for 9 months improves fibrosis scores in patients with chronic HBV infection most likely by antagonizing profibrogenic transforming growth factor-beta effects.

[A case of familial restrictive cardiomyopathy]. / Sluchai semeinoi restriktivnoi kardiomiopatii.

According to estimates of WHO experts cases with diagnosed cardiomyopathy account for 40-60 per 100,000. Restrictive cardiopathy (RCP) is encountered in 5% of all the diagnosed cases of cardiomyopathy. Two patients (a mother and her daughter) with suspected of family RCP were examined using ECG, Holter ECG monitoring, echo-CG, histological tests, x-ray, blood biochemical tests. Echo-CG was most informative for verification of RCP diagnosis. The daughter had edema, enlarged liver, arterial hypertension, cardiac arrhythmia. The mother had arrhythmia, dyslipidemia. Based on the above symptoms, the patients received combined drug therapy with positive results.

A trial of ademetionine in the treatment of intrahepatic biliary stasis viral hepatitis.

OBJECTIVE: To observe the efficacy and safety of ademetionine in the treatment of viral hepatitis with intrahepatic biliary stasis. METHODS: In this series, 110 patients with viral hepatitis associated intrahepatic biliary stasis were randomly divided into Groups A and B. Patients in Group A received ademetionine for four weeks. Patients in Group B received potassium magnesium aspartate for four weeks. RESULTS: In Group A, at the end of treatment, the effective rate for skin pruritus in patients with cholestatic hepatitis was 86.67% (13/15), and the effective rate for skin pruritus and anorexia were 88.24% (15/17) and 82.35% (14/17), respectively in patients with chronic hepatitis combining intrahepatic cholestasis, which were significantly higher than that in Group B (P<0.05). STB, SCB, TBA, ALT and AST were lower in Group A than Group B (P<0.05). The decrease of ALP and the increase of albumin after treatment were more significant in Group A than in Group B (P<0.05). CONCLUSION: Ademetionine has better efficacy than potassium magnesium aspartate in the treatment of patients with cholestatic viral hepatitis.

[A preclinical evaluation of the pharmacological activity of a mixed potassium and magnesium glutamate]. / Doklinicheskaia otsenka farmakologicheskoi aktivnosti smeshannogo glutamata kaliia i magniia.

Mixed magnesium and potassium glutamates with different ion ratio are synthesized. The antiarrhythmic activity of the compounds obtained is studied on the models of strophantin, calcium chloride, aconitine arrhythmia, and arrhythmia after Harriss. It is found that magnesium and potassium glutamate of the composition KMg(HGlu)4.4H2O exhibits higher activity compared to glutamate of the composition KMg(HGlu)4.3H2O on the strophantin and calcium chloride arrhythmia models. The study performed on the strophantin and calcium chloride models as well as on the Harriss arrhythmia model showed that KMg(HGlu)4.4H2O is more effective as antiarrhythmic drug than asparkam and panangine but, at the same time, the effect of KMg(HGlu)4.4H2O within the aconitine model is somewhat less pronounced compared to panangine.

[The role of magnesium in the pathogenesis and therapy of bronchial asthma]. / Rola magnezu w patogenezie i terapii astmy oskrzelowej.

Magnesium is the fourth most abundant metal found in the body. It plays a crucial role in numerous biological processes. It is a natural calcium antagonist. New experimental data suggest that Mg+2 influences a variety of lung structures. Intracellular Mg+2 is thought to modulate smooth muscle contractions and it is known to have a direct effect on calcium uptake, resulting in smooth muscle relaxation. Magnesium has been forgotten cation from the therapeutical point of view, but now several clinical reports point to the salutary actions of Mg+2 in various lung diseases. Many reports suggests that magnesium sulfate and aspartate has certainly a role as an adjunct to traditional therapy in asthma and asthma-like conditions and have been helpful in the treatment of acute exacerbations of asthma.

[Potentiated polarized liquid therapy and heart emergency].

Kalium and Magnesium ions are important cations in human body, both of them take part in many processes of metabolism in coordination. Injection of Kalii L-aspartatis and Magnesii L-aspartatis added to polarized liquid (GIK-Glucose, Insulin, Kalii Chlorid) might potentiate its effect and reduce carbon dioxide and ammonia in blood. 72 patients with various heart emergencies and other critical diseases were treated with potentiated polarized liquid (GIKL) with remarkable efficacy. A preliminary study on its clinical use and mechanism was carried out.

Restoring sinus rhythm after intraoperatively occurring isorhythmic AV dissociation by the use of K-Mg aspartate or Mg aspartate.

In a prospective randomized clinical trial we tested the efficiency of different electrolyte infusions for the treatment of intraoperatively occurring isorhythmic AV dissociation (ID). Only infusions containing Mg were effective in restoring sinus rhythm: the infusion of K-Mg aspartate led to a conversion of intraoperatively occurring ID into sinus rhythm in 72% (p less than 0.01) of the patients and the infusion with Mg aspartate alone did so in 67% (p less than 0.01) of the patients. The rate of spontaneous conversion was 22% in the control group treated with Ringer's solution. The use of infusions containing K aspartate was ineffective in restoring sinus rhythm.