Physiological insulin concentrations protect against ischemia-induced loss of cardiac function in rats

Effect of glucose-insulin-potassium on lactate levels at the end of surgery in patients undergoing cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy: study protocol for a randomized controlled trial

INTRODUCTION

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) has been established as an effective treatment for peritoneal cancer (PC). However, this kind of combination therapy is associated with a high lactate level. Moreover, studies have suggested that the rate of complications early after surgery directly increased with elevated lactate levels. Glucose-insulin-potassium (GIP), a potent cardioprotective intervention, has been demonstrated to adjust blood glucose (BG) levels and reduce lactate levels. However, the insulin-glucose ratio should be adjusted according to the surgery performed. Here, we aimed to evaluate the advantages of using modified GIP during CRS/HIPEC to reduce the lactate level at the end of surgery and further reduce the incidence of early postoperative complications.

METHODS AND ANALYSIS

The modified GIP versus conventional management during surgery study is a single-center, randomized, single-blinded outcome assessment clinical trial of 80 patients with PC who are between 18 and 64 years old and undergoing CRS/HIPEC. Participants will be randomly allocated to receive modified GIP or conventional treatment (1:1). The primary outcome will be the plasma lactate level at the end of surgery. The secondary outcomes will include the highest levels and fluctuation ranges of lactate and BG during surgery, extubation time, APACHE-II score 24 h after surgery, postoperative defecation and exhaust time, postoperative lactate clearance time, postoperative liver and kidney function, incidence of complications within 7 days after surgery, length of intensive care unit stay (LIS), length of hospital stay (LHS), and total cost of hospitalization.

ETHICS AND DISSEMINATION

The trial protocol was approved by the Scientific Research Ethics Committee of Beijing Shijitan Hospital Affiliated with Capital Medical University, approval number sjtky11-1x-2022(118). The results will be published in international peer-reviewed journals.

TRIAL REGISTRATION

ChiCTR2200057258. Registered on March 5, 2022.

Targeting Cardiac Metabolic Pathways: A Role in Ischemic Management

Among the vast number of noncommunicable diseases encountered worldwide, cardiovascular diseases accounted for about 17.8 million deaths in 2017 and ischemic heart disease (IHD) remains the single-largest cause of death in countries across all income groups. Because conventional medications are not without shortcomings and patients still refractory to these medications, scientific investigation is ongoing to advance the management of IHD, and shows a great promise for better treatment modalities, but additional research can warrant improvement in terms of the quality of life of patients. Metabolic modulation is one promising strategy for the treatment of IHD, because alterations in energy metabolism are involved in progression of the disease. Therefore, the purpose of this review was to strengthen attention toward the use of metabolic modulators and to review the current level of knowledge on cardiac energy metabolic pathways.

Detection of environmental estrogenicity using transgenic medaka hatchlings (Oryzias latipes) expressing the GFP-tagged choriogenin L gene

The discharge of environmental estrogenic substances into the environment has an adverse effect on human and wildlife, especially aquatic organisms. Therefore, a simple, practical and sensitive method of detecting environmental estrogenicity is required. Previously, we established a transgenic medaka (Oryzias latipes) strain harboring choriogenin L (ChgL) tagged with green fluorescence protein (GFP), which is expressed in the liver in response to estrogen (E2). This strain of medaka could be a very useful tool in detecting aquatic estrogenicity. The appropriate conditions for analysis of estrogenicity were determined at various E2 concentrations, exposure periods and the developmental stages of medaka hatchlings. Furthermore, the relationship between E2 concentrations and GFP fluorescence intensity was investigated. It was found that fluorescence intensity of GFP depends largely on E2 concentration, exposure time and developmental stage. Hatchling at 4-day post-hatch (DPH) showed optimum conditions for exposure to E2 with optimum GFP intensity at 9 DPH. Additionally, the exposure period was optimized so that exposure from 4 DPH for 5 days showed a significant change in GFP intensity. E2 concentrations of 0, 12.5, 25, 50 and 100 ng/L were used, with 25 ng/L showing a clear increase in GFP intensity at day 6 of exposure. The sensitivity of vitellogenin (Vtg) induction was also examined by Western blot and enzyme-linked immunosorbent assay (ELISA) using whole-body homogenates of E2-exposed (0, 12.5, 25, 50 and 100 ng/L) juvenile medaka. Vitellogenin induction, as determined by Western blot, was found in those juveniles exposed to E2 at a concentration of 100 ng/L. Whereas, Vtg induction was detected by ELISA from juveniles exposed to 12.5 ng/L of E2. The results suggest that ChgL-GFP transgenic medaka could be a simple and practical tool in detecting environmental estrogenicity considering the actual concentrations of estrogenic activity in contaminated and/or wastewater.

Comparative sensitivity in Chinese rare minnow (Gobiocypris rarus) and Japanese Medaka (Oryzias latipes) exposed to ethinylestradiol

Morphological and biochemical indices, including hepatosomatic index, gonadosomatic index, and vitellogenin (VTG) induction, were compared between two teleostean species to determine their relative sensitivity of exposure to 17-alpha -ethinylestradiol (EE2). Chinese rare minnow (Gobiocypris rarus) and Japanese medaka (Oryzias latipes) were exposed to aqueous concentrations of EE2 ranging from 0.2 to 100 ng/L for 21 days. A stronger liver response to EE2 in Chinese rare minnow was observed than that in Japanese medaka. In Japanese medaka, significantly increased male GSI could be observed at 50 and 100 ngEE2/L. The semi-quantitative estimation by integrated optic density following electrophoresis showed that exposure of male Chinese rare minnow and Japanese medaka to EE2 resulted in significant (P<0.05) induction of VTG at 0.2 and 2 ngEE2/l, respectively. It indicated that the sensitivity of Chinese rare minnow to the stress of EE2 is about 10-fold greater than that of Japanese medaka.

Glucose-insulin-potassium and reperfusion in acute myocardial infarction: rationale and design of the Glucose-Insulin-Potassium Study-2 (GIPS-2)

BACKGROUND

The combination of reperfusion therapy and high-dose glucose-insulin-potassium (GIK) infusion seems beneficial in acute myocardial infarction (MI). Current evidence, however, is not considered conclusive.

STUDY DESIGN

The Glucose-Insulin-Potassium Study-2 (GIPS-2) will investigate whether GIK, in adjunction to reperfusion therapy, is beneficial in MI patients without signs of heart failure at admission. A total of at least 1044 patients with an acute MI treated with either thrombolysis or primary percutaneous coronary intervention will be randomized to an infusion of high-dose GIK or no infusion. The primary end point of the study is 30-day mortality. Secondary end points are mortality at 1 year, recurrence of MI, repeat intervention, and infarct size.

IMPLICATIONS

If high-dose GIK significantly reduces mortality at 30 days in all patients, the adjunction of this treatment to reperfusion therapy may become part of standard regimen for patients with acute MI without heart failure.

Vitellogenin-immunohistochemistry in the Liver and the Testis of the Medaka, Oryzias latipes, Exposed to 17β-estradiol andp-nonylphenol

Vitellogenin (VTG) produced in male fish has been used for a biomarker to study endocrine disrupters. However, the characteristics of VTG produced in male fish have not been studied well. In this study, we investigated the localization of VTG in the liver and the testis of male medaka (Oryzias latipes) treated with 17beta-estradiol (E2) and p-nonylphenol (NP). The male fish were exposed to 1 microg/L E2 and 500 microg/L NP for 1-12 days. Control groups were kept in water including only vehicle. The frozen sections of the liver and the testis were stained with immunohistochemical methods using an antiserum against medaka VTG as the first antibody. In the E2 and NP treated liver, the hepatocytes showed immunoreactivity. In particular, the cytoplasm close to the cell membrane surrounding the sinusoids was strongly immunopositive. In the testis of both treatments, the interstitial tissues and the cells (spermatocytes) in the seminiferous tubules were immunopositive. The concentration of VTG became gradually higher in both tissues with longer treatments. These results suggest that germ cells in the testis treated with E2 and NP are able to incorporate and accumulate VTG.