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1.
Efficacy of L-carnitine supplementation for improving lean body mass and physical function in patients on hemodialysis: a randomized controlled trial.
Maruyama, T, Maruyama, N, Higuchi, T, Nagura, C, Takashima, H, Kitai, M, Utsunomiya, K, Tei, R, Furukawa, T, Yamazaki, T, et al
European journal of clinical nutrition. 2019;(2):293-301
Abstract
BACKGROUND Carnitine deficiency is common in patients on hemodialysis. However, the efficacy of L-carnitine supplementation for improving lean body mass (LBM) and physical function has not yet been evaluated. METHODS In this multicenter, prospective, parallel, randomized, controlled trial, 91 patients on hemodialysis who developed carnitine deficiency were randomly assigned to receive injections of 1,000 mg L-carnitine 3 times per week after each hemodialysis session (L-carnitine group) or no injections (control group) with monitoring for 12 months. RESULTS The data for 84 of the 91 patients were available for analysis (L-carnitine group, n = 42; control group, n = 42). Dry weight and body mass index did not significantly change in the L-carnitine group, but significantly decreased in the control group. Arm muscle area (AMA) did not change significantly in the L-carnitine group but decreased significantly in the control group; the difference in mean AMA between the groups was 6.22% (95% confidence interval [CI] 1.90-10.5; P = 0.037). Hand grip strength did not change significantly in the L-carnitine group, but decreased significantly in the control group. The difference in change in hand grip strength between the groups was 4.27% (95% CI 0.42-8.12; P = 0.030). Furthermore, LBM did not change significantly in the L-carnitine group but decreased significantly in the control group; the difference in mean LBM between the groups was 2.92 % (95% CI 1.28-4.61; P = 0.0007). CONCLUSIONS L-carnitine supplementation is useful in patients who develop carnitine deficiency on hemodialysis because it maintains physical function and LBM.
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2.
Myocardial protection with isoflurane during off-pump coronary artery bypass grafting: a randomized trial.
Tempe, DK, Dutta, D, Garg, M, Minhas, H, Tomar, A, Virmani, S
Journal of cardiothoracic and vascular anesthesia. 2011;(1):59-65
Abstract
OBJECTIVES To analyze the hemodynamic effects and myocardial injury using troponin-T and creatine phosphokinase (CPK-MB) with isoflurane and compare it with a control group in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. DESIGN This prospective, randomized study was performed in patients scheduled for elective OPCAB surgery during February 2007 to February 2009. SETTING Tertiary care, university teaching hospital. PARTICIPANTS Forty-five patients undergoing elective OPCAB surgery. INTERVENTIONS Patients were randomly allotted to receive either isoflurane (inspired concentration between 1.0% and 2.5%) or propofol (1.5 to 3.5 mg/kg/h) during OPCAB surgery. The concentration of these agents was titrated such that the BIS value was maintained between 50 and 60. MEASUREMENTS AND MAIN RESULTS The hemodynamic data were measured and recorded after induction of anesthesia (baseline), during the distal anastomosis of each coronary artery, and 5 and 30 minutes after giving protamine. In addition, blood samples for troponin-T and CPK-MB were obtained after induction (baseline), after 6 hours and 24 hours postoperatively. The cardiac index was significantly higher in the isoflurane group at all stages, except during distal anastomosis of the diagonal branch of the left anterior descending artery (p < 0.05). There was a significant increase in troponin-T levels at 6 and 24 hours after surgery in the propofol group (from 0.037 ± 0.013 ng/mL to 0.098 ± 0.045 ng/mL and 0.081 ± 0.025 ng/mL, respectively, p < 0.05). Significant increases in the troponin-T levels were observed at 6 hours (from 0.033 ± 0.011 ng/mL to 0.052 ± 0.025 ng/mL, (p < 0.05) in the isoflurane group, and the levels in the propofol group were significantly higher than the isoflurane group at 6 and 24 hours after surgery (p < 0.05). The CPK-MB levels increased in both groups, but were not statistically different. CONCLUSIONS Isoflurane provides protection against myocardial damage in a clinically used dosage as documented by lower levels of troponin-T in patients undergoing OPCAB surgery.
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3.
Effects of Darbepoetin Alfa on plasma mediators of oxidative and nitrosative stress in anemic patients with chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.
Parissis, JT, Kourea, K, Andreadou, I, Ikonomidis, I, Markantonis, S, Ioannidis, K, Paraskevaidis, I, Iliodromitis, E, Filippatos, G, Kremastinos, DT
The American journal of cardiology. 2009;(8):1134-8
Abstract
Increased oxidative and nitrosative stress are important mediators of left ventricular (LV) and vascular dysfunction in patients with chronic heart failure (CHF). This study investigated the effects of darbepoetin alfa on plasma markers of oxidative and nitrosative stress in patients with CHF with anemia. Thirty patients with CHF (LV ejection fraction [LVEF] <40%, hemoglobin <12.5 g/dl, and serum creatinine <2.5 mg/dl) were randomly assigned (1:1) to receive either a 3-month darbepoetin alfa regimen at 1.5 microg/kg every 20 days plus oral iron or placebo plus oral iron. Plasma B-type natriuretic peptide (BNP), markers of oxidative (oxidative, malondialdehyde, carbonyl proteins; antioxidative, glutathione) and nitrosative (nitrotyrosine) stress, LVEF, and 6-minute walked distance were assessed at baseline and after treatment. A significant improvement in LVEF and 6-minute walked distance was observed in only darbepoetin-treated patients. Plasma BNP (F = 14.8, p = 001), malondialdehyde (F = 9.4, p = 0.006), protein carbonyl (F = 9.2, p = 0.006), and nitrotyrosine (F = 4.4, p = 0.045) were significantly decreased, along with an increase in antioxidative glutathione (F = 4.2, p = 0.049) after darbepoetin alfa treatment. These factors were unaffected in placebo-treated patients. Darbepoetin-induced percentages of change in carbonyl protein significantly correlated with respective changes in plasma BNP (r = 0.55, p <0.05) and LVEF (r = -0.46, p <0.05). Finally, a drug-induced percentage of decrease in nitrotyrosine significantly correlated with the respective improvement in 6-minute walked distance (r = -0.63, p <0.05). In conclusion, darbepoetin alfa attenuated deleterious effects of oxidative and nitrosative stress into the cardiovascular system of anemic patients with CHF, improving also cardiac function and exercise capacity.
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4.
[The summary of the clinic study of Zhi-Xin-Fang treating the heart failure resulting from cardiomyopathy].
Liang, BW, Min, CY, Qiu, WZ, Zhao, RH, Wei, GJ, Bu, JM
Zhong yao cai = Zhongyaocai = Journal of Chinese medicinal materials. 2008;(3):470-2
Abstract
OBJECTIVE To observe the therapeutic and prognostic effects and to evaluate the safety of Zhi-Xin-Fang on heart failure resulting from cardiomyopathy. METHODS 62 patients with cardiomyopathy combined with heart failure were treated with standard western medical therapy as treatment group. The other 60 patients with the same diseases were administered with both Zhi-Xin-Fang and standard western medicines as control. Several parameters were observed to evaluate the effect of Zhi-Xin-Fang on the heart failure, containing the therapeutic effect of clinical symptom and physical signs, the improvement of heart function and the ultrasonic caridogram. We also observed the effect of Zhi-Xin-Fang to relieve the clinical symptom and improve the heart function and quality of life and prognosis. RESULTS As the NYHA classify for heart failure, the effective rate for the treatment group was 95% , more effective than the control group (effective rate: 80.65%) (P<0.05). There was significant improvement for LVEF and LVDS for both groups. However, the treatment group was better than the control group (P<0.05). The clinical symptom was significantly improved compared to the untreatment in both groups. The treatment group was better than the control group for effective rate (P<0.05) but not for the total effective rate. There was no significant difference for the function of liver and kidney, blood routine method, electrolyte compared to before for the two groups. CONCLUSION The standard western medicines combined with Zhi-Xin-Fang is a good therapy for treating heart failure resulting from cardiomyopathy. The combined therapy can relieve the cinical symptom of heart failure, improve the heart function and quality of life. It is also safer for the patients. However, its long-term prognosis should be further studied in the future.
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5.
[Clinical research of the effect of shengmai injection on the management of "shock heart " after burns].
Zhang, XL, Huang, YS, Dang, YM, Zhang, JP
Zhonghua shao shang za zhi = Zhonghua shaoshang zazhi = Chinese journal of burns. 2006;(4):281-4
Abstract
OBJECTIVE To investigate the effect of Shengmai injection on the management of "shock heart" after burns. METHODS Twenty patients with severe burns were enrolled in the study and randomly divided into two groups according to the clinical research method, i.e. treatment group (n= 10, with intravenous infusion of 40 ml Shengmai injection together with 250ml 50 g/L glucose solution for 3 days, 1 time/ per day) and control group(n = 10, with intravenous infusion of 290 ml 50 g/L glucose injection liquid for 3 days, 1 time/per day). Beside the venous line used for routine fluid resuscitation for burn shock, another venous line was set up after hospitalization for the administration of the drug. Blood samples were obtained from the femoral vein in both groups at 12 post-burn hour( PBH) , and on 1, 2, 3, 4 and 5 post burn days (PBD) for the determination of serum contents of creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH) and cardiac troponin I (cTnI). The changes in hepatic and renal function, as well as coagulability were determined before drug infusion and on 1 , 2, 3, 5 and 7 PSDs. RESULTS The serum content of CK-MB, LDH and cTnI reached the peak at 12 PBH in both groups[ (52+/-20)U/L, (5.9+/-1.3) micromol x s(-1) L(-1), (0. 274+/-0. 231) microg/L in treatment group and [(9+/-31)U/L, (8.5+/-1l.8) micromol x s(-1) x L(-1) , (0. 584+/-0. 192) microg/L in control group]. All of them decreased with the passage of time, but in the treatment group they decreased more markedly within 2 or 3 PBD compared with those in control group ( P < 0.05). CONCLUSION Early administration of Shengmai intravenously is beneficial to the protection of myocardial cells and in the management of the "shock heart" damage.
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6.
Epidural anesthesia for coronary artery bypass surgery compared with general anesthesia alone does not reduce biochemical markers of myocardial damage.
Barrington, MJ, Kluger, R, Watson, R, Scott, DA, Harris, KJ
Anesthesia and analgesia. 2005;(4):921-928
Abstract
High thoracic epidural anesthesia/analgesia (HTEA) for coronary artery bypass grafting (CABG) surgery may have myocardial protective effects. In this prospective randomized controlled study, we investigated the effect of HTEA for elective CABG surgery on the release of troponin I, time to tracheal extubation, and analgesia. One-hundred-twenty patients were randomized to a general anesthesia (GA) group or a GA plus HTEA group. The GA group received fentanyl (7-15 microg/kg) and a morphine infusion. The HTEA group received fentanyl (5-7 microg/kg) and an epidural infusion of ropivacaine 0.2% and fentanyl 2 microg/mL until postoperative Day 3. There were no differences in troponin I levels between study groups. The time to tracheal extubation [median (interquartile range)] in the HTEA group was 15 min (10-320 min), compared with 430 min (284-590 min) in the GA group (P < 0.0001). Analgesia was improved in the HTEA group compared with the GA group. Mean arterial blood pressure poststernotomy and systemic vascular resistance in the intensive care unit were lower in the HTEA group. We conclude that HTEA for CABG surgery had no effect on troponin release but improved postoperative analgesia and was associated with a reduced time to extubation.
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7.
Feasibility of continuous venous infusion of SonoVue for qualitative assessment of reversible coronary perfusion defects in stress myocardial contrast echocardiography.
Yip, GW, Chandrasekaran, K, Miller, TD, Hagen, ME, Langins, AP, Khandheria, BK
The international journal of cardiovascular imaging. 2003;(6):473-81
Abstract
OBJECTIVE To study the feasibility of continuous intravenous SonoVue contrast echocardiography for qualitative assessment of reversible myocardial perfusion in dipyridamole stress tests. METHODS Eleven patients (10 male and 1 female, mean age 66 years) with a history of chest pain and a clinical indication for stress sestamibi single photon emission computed tomography (SPECT) underwent concurrent SonoVue 99mTc myocardial contrast echocardiography (MCE). RESULTS Of the total 176 segments obtained, 53 (30%) were regarded as indeterminate, 39 (22%) as discordant, and 84 (48%) as concordant between MCE and SPECT imaging. Two patients had abnormal SPECT results. The overall feasibility and specificity of MCE were 70 and 74%, respectively. The concordant (p = 0.59) and discordant (p = 0.55) segments were comparable with either MCE technique. However, continuous low-mechanical-index imaging produced fewer indeterminate segments (17 segments, 32%) than intermittent harmonic B-mode imaging (36 segments, 68%) (p = 0.04). Significantly more indeterminate segments were found in the left anterior descending artery territory. However, the overall concordance was similar (p = 0.5) in all three coronary artery territories. The concordance and discordance rates at different left ventricular levels (i.e., basal, mid, and apical) were similar (p = 0.50 and 0.08, respectively). CONCLUSION Continuous-infusion SonoVue contrast echocardiography is feasible, with high specificity, for detecting myocardial perfusion defects as assessed by dipyridamole SPECT.
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8.
[Angiotensin II type 1 antagonist suppress left ventricular hypertrophy and myocardial fibrosis in patient with end stage renal disease (ESRD)].
Shibasaki, Y, Nishiue, T, Masaki, H, Matsubara, H, Iwasaka, T
Nihon rinsho. Japanese journal of clinical medicine. 2002;(10):1992-8
Abstract
Fibrosis of left ventricle commonly occurs in end stage renal disease(ESRD) patients and is an independent risk factor of cardiovascular events. Angiotensin II type 1 receptor antagonist may be able to reverse fibrosis of left ventricle in ESRD patients. Ultrasonography-integrated backscatter(IBS) of myocardial walls is directly related to the morphometrically evaluated collagen content in humans. In this study, 30 chronically hemodialyzed patients with hypertension were randomly allocated to receive antihypertensive therapy with either angiotensin II type 1 receptor(AT1-R) antagonist losartan(n = 10), angiotensin-converting enzyme(ACE) inhibitor enalapril(n = 10) or calcium antagonist amlodipine(n = 10). IBS of posterior wall of left ventricule were measured by IBS before and after 6 months treatment. Baseline demographic and clinical characteristics did not differ in three subgroups. Although losartan(34.2 +/- 1.8 to 30.2 +/- 2.4 dB: p = 0.0094) treatment demonstrated significant reduce of IBS values, enalapril(30.3 +/- 1.5 to 31.7 +/- 1.4 dB: p = 0.3268) and amlodipine (31.6 +/- 1.6 to 33.1 +/- 1.9 dB: p = 0.4632) did not changed it significantly before and after 6 months treatment. All three groups reduced left ventricular mass index(Losartan 154.5 +/- 9.9 to 114.6 +/- 5.8 g/m2: p = 0.0002) (enalapril 155.6 +/- 14.3 to 135.3 +/- 10.4 g/m2: p = 0.0275) (amlodipine 156.6 +/- 7.3 to 137.2 +/- 4.1 g/m2: p = 0.0589). Three groups manifested a similar significant decrease in the mean blood pressure. Plasma angiotensin II concentration was markedly increased by 5.0-fold relative to the control levels before treatment in Losartan treatment, in contrast unchanged in enalapril and only 2.0-fold increased in amlodipine treatment. This study indicates that losartan reduce of fibrosis of left ventricule and this effect may be via an anti-AT1-R effect.