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   Table of Contents - Current issue
July-September 2019
Volume 4 | Issue 3
Page Nos. 71-102

Online since Monday, September 30, 2019

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A scientific update on myocardial infarction: A life-threatening issue Highly accessed article p. 71
Apoorva Bhushan, Mayank Kulshreshtha
Cardiovascular diseases (CVDs) are the principal cause of mortality in India, 52% of population suffer CVDs before 70 years of age. Myocardial infarction (MI) makes up the largest proportion of CVDs. Coronary heart disease, namely stable angina pectoris, unstable angina pectoris, heart failure, and sudden death, is the main results of MI. The aim of this review is to summarize and present the scientific data regarding the physiology of the cardiac system, herbal research, risk factors, precautions, and pharmacological/nonpharmacological treatment of MI. Data were collected with the help of PubMed, Google Scholar, Medknow, and other online resources. The published scientific data revealed that MI is the result of obesity, smoking, family history, age, male gender, etc., and that the herbal resources are better than the synthetic or chemical treatment of MI. Because the synthetic molecules were not found to be safe, they can generate other health issues. Given problems with the pharmacological treatment of MI, precaution, and a good lifestyle is the better solution.
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A web-based, real-time quality control and progress monitoring tool for multicenter environmental health surveys p. 81
Yi Zhang, Jianlong Fang, Peng Du, Jiaonan Wang, Runmei Ma, Hongtai Pei, Tiantian Li
Background: Large multicenter surveys are increasingly popular in the environmental health field. The quality of the data and management of surveys is crucial to the success of the project. However, none of the existing survey tools include remote, multirole, and real-time quality control of the survey. We have therefore developed an electronic investigation system (EIS), with multirole real-time quality control and progress monitoring modules. Methods and Results: Our investigation system has three levels of quality control officers. Questionnaires verified by the lower-level quality control officers can also be verified at a higher level. The strictly hierarchical verification roles improve quality control even more than retaining quality control officers at each study center. Project investigators can also monitor the progress of the project and each center daily and annually, for a real-time understanding of the performance of each investigator and quality control officer. Conclusion: Our EIS has met the requirements for multicenter studies in the environmental health field. Researchers may use our design to conduct multicenter surveys more efficiently in future.
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Clinical significance of electrocardiograph abnormalities: Analysis on electrocardiographs of 75 Marfan cases complicated with aortic disease p. 87
Yaping He, Sui-Shane Huang, Zhenning Nie
Purpose: Marfan syndrome (MFS) is one of the most common hereditary connective tissue disorders, with various adverse manifestations ranging from typical ocular, cardiovascular, and musculoskeletal abnormalities to manifestations involving the lungs, skin, and central nervous system. In patients with MFS, the most lethal manifestations are aortic lesion presenting as aortic insufficiency, thoracic and abdominal aortic dilatation, aneurysm, and dissection. Clinically, these patients often present with various types of arrhythmias and abnormal electrocardiographs (EKGs); however, there have been few studies of MFS-associated arrhythmias either in China or abroad. This investigation aims to elucidate the association between Marfan-associated aortic lesions and accompanying arrhythmia characteristics. Methods: From September 2016 to January 2018, 75 consecutive patients diagnosed with MFS and aortic disease manifestation were enrolled in the study (MFS group). During the same time period, 76 consecutive nonMFS patients with aortic disease were enrolled as positive controls (dissection group) and 100 consecutive healthy patients were enrolled during routine health checkups as negative controls (checkup group). EKG characteristics between the three groups were analyzed. Results: Compared to the checkup group, both the MFS group and dissection group showed more EKG abnormalities (P < 0.01). Even though there was no significant difference in the incidence of EKG abnormalities between the MFS group and the dissection group (P > 0.05), the MFS group showed a significantly higher occurrence of sinus bradycardia and first-degree atrioventricular block (P < 0.05) compared to the dissection group. Furthermore, the MFS group showed a significantly higher occurrence of left ventricular high voltage with accompanying ST-T change (P < 0.01) compared to the dissection group. Finally, the MFS group showed a significantly higher occurrence of left atrial abnormality (P < 0.05) compared to the dissection group. Conclusion: Patients with MFS and aortic disease manifestation have unique EKG abnormality characteristics. This may be associated with the connective tissue disease affecting the physiological electric conduction in the heart and long-term volume overload leading to myocardial damage.
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Dynamic changes and the relationship between cardiac function damage and glycogen synthase kinase-3 β expression induced by coronary microembolization in rats p. 91
Binghui Kong, Zhenbai Qin, Jing Zheng, Manyun Long
Background: Coronary microembolization (CME) is a severe complication in the treatment of acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). It is a distal microvascular embolism caused by the shedding of atherosclerotic plaque debris, which can directly lead to “no blood flow” or “slow blood flow”. Aims: This study investigates the dynamic changes and the relationship between cardiac function damage and GSK-3β expression induced by coronary microembolization (CME) in rats. Materials and Methods: Specific Sprague Dawley rats (SD rats) were evenly divided into a microembolization group (CME group) and a sham operation group (Sham group). Each group of rats was randomly subdivided into 0h, 3h, 9h, and 24h groups. Results: Echocardiographic parameters showed that the left ventricular ejection fraction (LVEF) of the CME group was significantly lower than that of the sham group with the exception of the 0h time point (P < 0.05). The results of ELISA showed that the levels of TNF-α and IL-1β in myocardial tissue of the CME group began to increase at 3h, reached a peak at 9h, and decreased at 24h (P < 0.05). Western blot analysis showed that the protein expression of NF-κB p65 in the CME group began to increase at 3 h, peaked at 9h, and decreased at 24h. The protein expression of phospho-GSK-3β(Ser 9) began to decrease at 3 h, reached a low peak at 9 h, and increased at 24 h (P < 0.05). Conclusion: GSK-3βis involved in the damage of cardiac function induced by CME and shows obvious time-variation, which may be achieved by regulating the expression of TNF-α in myocardium.
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Coronary artery stenting in a patient with factor XI deficiency p. 97
Mingqiang Fu, Chenguang Li, Shufu Chang, Jianying Ma, Junbo Ge
Factor XI deficiency is a rare coagulopathy which has a higher risk of bleeding following trauma or an operation. Stable coronary artery disease patients complicated by factor XI deficiency draw extraordinary caution when coronary artery stents are needed, for interventional cardiologists must balance the need for antithrombosis and bleeding complications. Currently, there is no guideline for the management of such patients. Here, we describe a patient with coronary artery disease with factor XI deficiency who underwent an uneventful percutaneous coronary intervention.
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Dynamic obstruction of left ventricular outflow tract due to bilateral pulmonary embolism p. 100
Xin-Lin Liu, Yan Wu, Jun-Xiang Liu, Xin Zhou
A 68-year-old male patient with a history of nonobstructive hypertrophic cardiomyopathy was admitted to the cardiac intensive care unit due to sudden onset of near syncope and hypotension. The diagnosis of acute bilateral pulmonary embolism was confirmed by pulmonary computed tomographic angiography. On day 2 of admission, left ventricular outflow tract (LVOT) obstruction was demonstrated by increased peak systolic blood flow (454 cm/s) and increased transvalvular pressure gradient (83 mmHg), as well as systolic anterior motion of the mitral valve leaflet. LVOT obstruction underwent a gradual normalization and was completely resolved on day 21 after symptom onset, and the patient was discharged. Acute pulmonary embolism is a rare cause of LVOT obstruction. In this case, the concomitant existence of nonobstructive hypertrophic cardiomyopathy exacerbated LVOT obstruction due to right ventricle overload-induced leftward deviation of interventricular septum and may render the patients at higher risk for sudden death. More active anticoagulation therapy should be considered in this situation.
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