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Yang G, Long Z, Chen F, Bao X, Zuo D, Tang H, Wu Z, Li H. Inhibitory Effect and Mechanism upon Glucose-Insulin-Potassium Administration on Postpartum Mice with Uterine Cramping Pain. Reprod Sci 2024:10.1007/s43032-024-01579-8. [PMID: 38744800 DOI: 10.1007/s43032-024-01579-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/19/2024] [Indexed: 05/16/2024]
Abstract
This study aimed to explore the effect of glucose-insulin-potassium (GIK) on postpartum uterine cramping pain(UCP) in mice and the possible underlying mechanisms. Thirty full-term pregnancy C57BL/6 mice, within 6 h after spontaneous labor, the mice were randomly assigned into the following three groups: the control group (group C), the oxytocin group (group O), and the GIK plus oxytocin group (group G). Group G and group O were administered GIK and normal saline, respectively, and 10 min later, oxytocin was injected intraperitoneally; group C received normal saline twice. The pain scores of the mice were assessed after establishment of the postpartum UCP model. The differential expressions of energy metabolism and oxidized lipid metabolites in the uterus were analyzed. The behavioral scores in group G were significantly lower than those in group O (P < 0.05).When compared to group O, group G showed a significant increase in ATP levels (P = 0.046), and group G exhibited elevated levels of amino acids, including L-glutamine, L-aspartic acid, and ornithine. Additionally, phosphate compounds (2-phosphoglyceric acid and 3-phosphoglyceric acid) showed elevated levels. When compared to group O, group G exhibited a decrease in 19R-hydroxy PGF2α, an increase in 9,10-EpOME and 12,13-EpOME, and a decrease in trans-EKODE-E-Ib. Additionally, group G showed an elevation in 16,17-EpDPE and 8-HDoHE. This study confirms the analgesic effect of GIK during postpartum oxytocin infusion. Metabolomics and glycolysis product analysis suggest that GIK's alleviation of UCP is associated with its enhancement of glycolysis and the influence of phenylalanine synthesis, aspartate metabolism, and arginine synthesis pathways. Additionally, the effects of GIK appears to be linked to its influence on the linoleic acid metabolic pathway.
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Affiliation(s)
- Guiying Yang
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, No.183 Xinqiao Street, 400037, Shapingba, Chongqing, China
| | - Zonghong Long
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, No.183 Xinqiao Street, 400037, Shapingba, Chongqing, China
| | - Fang Chen
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, No.183 Xinqiao Street, 400037, Shapingba, Chongqing, China
| | - Xiaohang Bao
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, No.183 Xinqiao Street, 400037, Shapingba, Chongqing, China
| | - Dukun Zuo
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, No.183 Xinqiao Street, 400037, Shapingba, Chongqing, China
| | - Hong Tang
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, No.183 Xinqiao Street, 400037, Shapingba, Chongqing, China
| | - Zhuoxi Wu
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, No.183 Xinqiao Street, 400037, Shapingba, Chongqing, China
| | - Hong Li
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, No.183 Xinqiao Street, 400037, Shapingba, Chongqing, China.
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Pan SS, Wang F, Hui YP, Chen KY, Zhou L, Gao WL, Wu HK, Zhang DS, Yang SY, Hu XY, Liang GY. Insulin reduces pyroptosis-induced inflammation by PDHA1 dephosphorylation-mediated NLRP3 activation during myocardial ischemia-reperfusion injury. Perfusion 2023; 38:1277-1287. [PMID: 35506656 DOI: 10.1177/02676591221099807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Previous studies proved that pyrin domain-containing protein 3 (NLRP3)-induced pyroptosis plays an important role in Myocardial ischemia-reperfusion injury (MIRI). Insulin can inhibit the activation of NLRP3 inflammasome, although the exact mechanism remains unclear. The aim of this study was to determine whether insulin reduces NLRP3-induced pyroptosis by regulating pyruvate dehydrogenase E1alpha subunit (PDHA1) dephosphorylation during MIRI. METHODS Rat hearts were subject to 30 min global ischemia followed by 60 min reperfusion, with or without 0.5 IU/L insulin. Myocardial ischemia-reperfusion injury was evaluated by measuring myocardial enzymes release, Cardiac hemodynamics, pathological changes, infarct size, and apoptosis rate. Cardiac aerobic glycolysis was evaluated by measuring ATP, lactic acid content, and pyruvate dehydrogenase complex (PDHc) activity in myocardial tissue. Recombinant adenoviral vectors for PDHA1 knockdown were constructed. Pyroptosis-related proteins were measured by Western blotting analysis, immunohistochemistry staining, and ELISA assay, respectively. RESULTS It was found that insulin significantly reduced the area of myocardial infarction, apoptosis rate, and improved cardiac hemodynamics, pathological changes, energy metabolism. Insulin inhibits pyroptosis-induced inflammation during MIRI. Subsequently, Adeno-associated virus was used to knock down cardiac PDHA1 expression. Knockdown PDHA1 not only promoted the expression of NLRP3 but also blocked the inhibitory effect of insulin on NLRP3-mediated pyroptosis in MIRI. CONCLUSIONS Results suggest that insulin protects against MIRI by regulating PDHA1 dephosphorylation, its mechanism is not only to improve myocardial energy metabolism but also to reduce the NLRP3-induced pyroptosis.
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Affiliation(s)
- Si-Si Pan
- Cardiovascular Surgery, The Affiliated Hospital of Guizhou Medical University, Guizhou, China
- Translational Medicine Research Center, Guizhou Medical University, Guizhou, China
| | - Feng Wang
- Translational Medicine Research Center, Guizhou Medical University, Guizhou, China
| | - Yong-Peng Hui
- Translational Medicine Research Center, Guizhou Medical University, Guizhou, China
| | - Kai-Yuan Chen
- Translational Medicine Research Center, Guizhou Medical University, Guizhou, China
| | - Liu Zhou
- Translational Medicine Research Center, Guizhou Medical University, Guizhou, China
| | - Wei-Long Gao
- Translational Medicine Research Center, Guizhou Medical University, Guizhou, China
| | - Hong-Kun Wu
- Translational Medicine Research Center, Guizhou Medical University, Guizhou, China
| | - Deng-Sheng Zhang
- Cardiovascular Surgery, The Affiliated Hospital of Zunyi Medical University, Guizhou, China
| | - Si-Yuang Yang
- Cardiovascular Surgery, The Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Xuan-Yi Hu
- Cardiovascular Surgery, The Affiliated Hospital of Guizhou Medical University, Guizhou, China
| | - Gui-You Liang
- Cardiovascular Surgery, The Affiliated Hospital of Guizhou Medical University, Guizhou, China
- Translational Medicine Research Center, Guizhou Medical University, Guizhou, China
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Bellon F, Solà I, Gimenez-Perez G, Hernández M, Metzendorf MI, Rubinat E, Mauricio D. Perioperative glycaemic control for people with diabetes undergoing surgery. Cochrane Database Syst Rev 2023; 8:CD007315. [PMID: 37526194 PMCID: PMC10392034 DOI: 10.1002/14651858.cd007315.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND People with diabetes mellitus are at increased risk of postoperative complications. Data from randomised clinical trials and meta-analyses point to a potential benefit of intensive glycaemic control, targeting near-normal blood glucose, in people with hyperglycaemia (with and without diabetes mellitus) being submitted for surgical procedures. However, there is limited evidence concerning this question in people with diabetes mellitus undergoing surgery. OBJECTIVES To assess the effects of perioperative glycaemic control for people with diabetes undergoing surgery. SEARCH METHODS For this update, we searched the databases CENTRAL, MEDLINE, LILACS, WHO ICTRP and ClinicalTrials.gov. The date of last search for all databases was 25 July 2022. We applied no language restrictions. SELECTION CRITERIA We included randomised controlled clinical trials (RCTs) that prespecified different targets of perioperative glycaemic control for participants with diabetes (intensive versus conventional or standard care). DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed the risk of bias. Our primary outcomes were all-cause mortality, hypoglycaemic events and infectious complications. Secondary outcomes were cardiovascular events, renal failure, length of hospital and intensive care unit (ICU) stay, health-related quality of life, socioeconomic effects, weight gain and mean blood glucose during the intervention. We summarised studies using meta-analysis with a random-effects model and calculated the risk ratio (RR) for dichotomous outcomes and the mean difference (MD) for continuous outcomes, using a 95% confidence interval (CI), or summarised outcomes with descriptive methods. We used the GRADE approach to evaluate the certainty of the evidence (CoE). MAIN RESULTS A total of eight additional studies were added to the 12 included studies in the previous review leading to 20 RCTs included in this update. A total of 2670 participants were randomised, of which 1320 were allocated to the intensive treatment group and 1350 to the comparison group. The duration of the intervention varied from during surgery to five days postoperative. No included trial had an overall low risk of bias. Intensive glycaemic control resulted in little or no difference in all-cause mortality compared to conventional glycaemic control (130/1263 (10.3%) and 117/1288 (9.1%) events, RR 1.08, 95% CI 0.88 to 1.33; I2 = 0%; 2551 participants, 18 studies; high CoE). Hypoglycaemic events, both severe and non-severe, were mainly experienced in the intensive glycaemic control group. Intensive glycaemic control may slightly increase hypoglycaemic events compared to conventional glycaemic control (141/1184 (11.9%) and 41/1226 (3.3%) events, RR 3.36, 95% CI 1.69 to 6.67; I2 = 64%; 2410 participants, 17 studies; low CoE), as well as those considered severe events (37/927 (4.0%) and 6/969 (0.6%), RR 4.73, 95% CI 2.12 to 10.55; I2 = 0%; 1896 participants, 11 studies; low CoE). Intensive glycaemic control, compared to conventional glycaemic control, may result in little to no difference in the rate of infectious complications (160/1228 (13.0%) versus 224/1225 (18.2%) events, RR 0.75, 95% CI 0.55 to 1.04; P = 0.09; I2 = 55%; 2453 participants, 18 studies; low CoE). Analysis of the predefined secondary outcomes revealed that intensive glycaemic control may result in a decrease in cardiovascular events compared to conventional glycaemic control (107/955 (11.2%) versus 125/978 (12.7%) events, RR 0.73, 95% CI 0.55 to 0.97; P = 0.03; I2 = 44%; 1454 participants, 12 studies; low CoE). Further, intensive glycaemic control resulted in little or no difference in renal failure events compared to conventional glycaemic control (137/1029 (13.3%) and 158/1057 (14.9%), RR 0.92, 95% CI 0.69 to 1.22; P = 0.56; I2 = 38%; 2086 participants, 14 studies; low CoE). We found little to no difference between intensive glycaemic control and conventional glycaemic control in length of ICU stay (MD -0.10 days, 95% CI -0.57 to 0.38; P = 0.69; I2 = 69%; 1687 participants, 11 studies; low CoE), and length of hospital stay (MD -0.79 days, 95% CI -1.79 to 0.21; P = 0.12; I2 = 77%; 1520 participants, 12 studies; very low CoE). Due to the differences within included studies, we did not pool data for the reduction of mean blood glucose. Intensive glycaemic control resulted in a mean lowering of blood glucose, ranging from 13.42 mg/dL to 91.30 mg/dL. One trial assessed health-related quality of life in 12/37 participants in the intensive glycaemic control group, and 13/44 participants in the conventional glycaemic control group; no important difference was shown in the measured physical health composite score of the short-form 12-item health survey (SF-12). One substudy reported a cost analysis of the population of an included study showing a higher total hospital cost in the conventional glycaemic control group, USD 42,052 (32,858 to 56,421) compared to the intensive glycaemic control group, USD 40,884 (31.216 to 49,992). It is important to point out that there is relevant heterogeneity between studies for several outcomes. We identified two ongoing trials. The results of these studies could add new information in future updates on this topic. AUTHORS' CONCLUSIONS High-certainty evidence indicates that perioperative intensive glycaemic control in people with diabetes undergoing surgery does not reduce all-cause mortality compared to conventional glycaemic control. There is low-certainty evidence that intensive glycaemic control may reduce the risk of cardiovascular events, but cause little to no difference to the risk of infectious complications after the intervention, while it may increase the risk of hypoglycaemia. There are no clear differences between the groups for the other outcomes. There are uncertainties among the intensive and conventional groups regarding the optimal glycaemic algorithm and target blood glucose concentrations. In addition, we found poor data on health-related quality of life, socio-economic effects and weight gain. It is also relevant to underline the heterogeneity among studies regarding clinical outcomes and methodological approaches. More studies are needed that consider these factors and provide a higher quality of evidence, especially for outcomes such as hypoglycaemia and infectious complications.
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Affiliation(s)
- Filip Bellon
- Healthcare Research Group (GRECS), Institute of Biomedical Research in Lleida (IRBLleida), Lleida, Spain
- GESEC group, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
| | - Ivan Solà
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Gabriel Gimenez-Perez
- Endocrinology Section, Department of Medicine, Hospital General de Granollers, Granollers, Spain
- Department of Medicine, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallés, Spain
| | - Marta Hernández
- Department of Endocrinology and Nutrition, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida (IRBLLEIDA), Lleida, Spain
| | - Maria-Inti Metzendorf
- Institute of General Practice, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Esther Rubinat
- Healthcare Research Group (GRECS), Institute of Biomedical Research in Lleida (IRBLleida), Lleida, Spain
- GESEC group, Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- CIBER of Diabetes and Associated Metabolic Disease, Barcelona, Spain
| | - Didac Mauricio
- CIBER of Diabetes and Associated Metabolic Disease, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Department of Medicine, Faculty of Medicine, University of Vic & Central University of Catalonia, Vic, Spain
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Yang G, Cui Y, Bao X, Wu Z, Chen Q, Chen F, Liu W, Wang M, Luo L, Li H. Glucose-insulin-potassium alleviates uterine cramping pain following cesarean delivery: A randomized, controlled trial. Front Surg 2023; 9:1068993. [PMID: 36700014 PMCID: PMC9869677 DOI: 10.3389/fsurg.2022.1068993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives To explore the effect of glucose-insulin-potassium (GIK) therapy on uterine cramping pain (UCP) following cesarean delivery (CD). Design Single-center, randomized controlled study. Setting Second Affiliated Hospital of Army Medical University, Chongqing, China. Participants A total of 140 women, aged 20-40 years, who underwent CD with a transverse incision were randomly assigned to the GIK (P) or control (C) groups in a 1:1 ratio. Interventions GIK was intravenously administered to patients in Group P. Patients in Group C received normal saline (NS). After umbilical cord clamping, oxytocin was administered intravenously. The same GIK and NS regimens were administered on postoperative days 1 and 2, followed by oxytocin 10 min later. Primary and secondary outcome measures Following oxytocin administration, UCP was assessed using the visual analog scale (VAS), and the maximum VAS score (primary outcome) was recorded. Results Patients in Group P had significantly lower maximum VAS scores than those in Group C on postoperative days 1 (38.4 ± 21.1 vs. 52.3 ± 20.8, p < 0.001) and 2 (10 [0,30] vs. 30.5 [8.75,50], p < 0.001). Group P patients also had shorter pain duration on postoperative day 1 (39.6 ± 19.5 min vs. 50.6 ± 18.2 min, p = 0.001). Group P patients had a lower incidence of inadequate analgesia of UCP than Group C on days 1 (45.5% vs. 74.2%, p < 0.001) and 2 (10.6% vs. 47.0%, p < 0.001); the RRs for experiencing inadequate analgesia for UCP postpartum in Group P patients was 0.612 (95% CI: 0.454-0.826, p < 0.001) on day 1 and 0.226 (95% CI: 0.107-0.476, p < 0.001) on day 2. The absolute risk reduction (ARR) was 28.7%; thus number needed to treat (NNT) was 3 after rounding up. A subgroup analysis demonstrated that Group P patients undergoing repeat CD had lower maximum VAS scores for UCP on both postoperative days 1 and 2. Conclusion Our findings suggest that GIK can relieve UCP and shorten its duration. Our results provide information to facilitate the development of novel approaches for managing UCP.Clinical Trial Registration: This study was approved by the Medical Ethics Committee of Second Affiliated Hospital of Army Medical University (2020-109-01, 19/11/2020) and registered in the Chinese Clinical Trial Registry (http://www.chictr.org.cn, ChiCTR2100041607,01/01/2021).
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Affiliation(s)
- Guiying Yang
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Yu Cui
- Department of Anesthesiology, the Affiliated Hospital, School of Medicine, UESTC Chengdu Women’s & Children’s Central Hospital, Chengdu, China
| | - Xiaohang Bao
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Zhuoxi Wu
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Qin Chen
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Feng Chen
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Wenjun Liu
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Mingming Wang
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Li Luo
- Department of Gynaecology and Obstetrics, Second Affiliated Hospital of Army Medical University, Chongqing, China
| | - Hong Li
- Department of Anesthesiology, Second Affiliated Hospital of Army Medical University, Chongqing, China,Correspondence: Hong Li
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Hagerman A, Schorer R, Putzu A, Keli-Barcelos G, Licker M. Cardioprotective Effects of Glucose-Insulin-Potassium Infusion in Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis. Semin Thorac Cardiovasc Surg 2022; 36:167-181. [PMID: 36356908 DOI: 10.1053/j.semtcvs.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
The infusion of glucose-insulin-potassium (GIK) has yielded conflicting results in terms of cardioprotective effects. We conducted a meta-analysis to examine the impact of perioperative GIK infusion in early outcome after cardiac surgery. Randomized controlled trials (RCTs) were eligible if they examined the efficacy of GIK infusion in adults undergoing cardiac surgery. The main study endpoint was postoperative myocardial infarction (MI) and secondary outcomes were hemodynamics, any complications and hospital resources utilization. Subgroup analyses explored the impact of the type of surgery, GIK composition and timing of administration. Odds ratio (OR) or mean difference (MD) with 95% confidence interval (CI) were calculated with a random-effects model. Fifty-three studies (n=6129) met the inclusion criteria. Perioperative GIK infusion was effective in reducing MI (k=32 OR 0.66[0.48, 0.89] P=0.0069), acute kidney injury (k=7 OR 0.57[0.4, 0.82] P=0.0023) and hospital length of stay (k=19 MD -0.89[-1.63, -0.16] days P=0.0175). Postoperatively, the GIK-treated group presented higher cardiac index (k=14 MD 0.43[0.29, 0.57] L/min P<0.0001) and lesser hyperglycemia (k=20 MD -30[-47, -13] mg/dL P=0.0005) than in the usual care group. The GIK-associated protection for MI was effective when insulin infusion rate exceeded 2 mUI/kg/min and after coronary artery bypass surgery. Certainty of evidence was low given imprecision of the effect estimate, heterogeneity in outcome definition and risk of bias. Perioperative GIK infusion is associated with improved early outcome and reduced hospital resource utilization after cardiac surgery. Supporting evidence is heterogenous and further research is needed to standardize the optimal timing and composition of GIK solutions.
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Affiliation(s)
- Andres Hagerman
- Dept. of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Raoul Schorer
- Dept. of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Alessandro Putzu
- Dept. of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - Marc Licker
- University of Geneva, Faculty of Medicine, Geneva, Switzerland.
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Brennan S, Esposito S, Abdelaziz MIM, Martin CA, Makwana S, Sims MW, Squire IB, Sharma P, Chadwick AE, Rainbow RD. Selective protein kinase C inhibition switches time-dependent glucose cardiotoxicity to cardioprotection. Front Cardiovasc Med 2022; 9:997013. [PMID: 36158799 PMCID: PMC9489859 DOI: 10.3389/fcvm.2022.997013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/15/2022] [Indexed: 12/03/2022] Open
Abstract
Hyperglycaemia at the time of myocardial infarction has an adverse effect on prognosis irrespective of a prior diagnosis of diabetes, suggesting glucose is the damaging factor. In ex vivo models of ischaemia, we demonstrated that deleterious effects of acutely elevated glucose are PKCα/β-dependent, and providing PKCα/β are inhibited, elevated glucose confers cardioprotection. Short pre-treatments with high glucose were used to investigate time-dependent glucose cardiotoxicity, with PKCα/β inhibition investigated as a potential mechanism to reverse the toxicity. Freshly isolated non-diabetic rat cardiomyocytes were exposed to elevated glucose to investigate the time-dependence toxic effects. High glucose challenge for >7.5 min was cardiotoxic, proarrhythmic and lead to contractile failure, whilst cardiomyocytes exposed to metabolic inhibition following 5-min high glucose, displayed a time-dependent protection lasting ∼15 min. This protection was further enhanced with PKCα/β inhibition. Cardioprotection was measured as a delay in contractile failure and KATP channel activation, improved contractile and Ca2+ transient recovery and increased cell survival. Finally, the effects of pre-ischaemic treatment with high glucose in a whole-heart coronary ligation protocol, where protection was evident with PKCα/β inhibition. Selective PKCα/β inhibition enhances protection suggesting glycaemic control with PKC inhibition as a potential cardioprotective therapeutics in myocardial infarction and elective cardiac surgery.
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Affiliation(s)
- Sean Brennan
- Department of Cardiovascular, Metabolic Medicine and Liverpool Centre for Cardiovascular Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- *Correspondence: Sean Brennan,
| | - Simona Esposito
- Department of Cardiovascular, Metabolic Medicine and Liverpool Centre for Cardiovascular Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, United Kingdom
| | - Muhammad I. M. Abdelaziz
- Department of Cardiovascular, Metabolic Medicine and Liverpool Centre for Cardiovascular Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Christopher A. Martin
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, United Kingdom
| | - Samir Makwana
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, United Kingdom
| | - Mark W. Sims
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, United Kingdom
| | - Iain B. Squire
- Department of Cardiovascular Sciences, University of Leicester, Glenfield General Hospital, Leicester, United Kingdom
- Leicester NIHR Biomedical Research Centre, Glenfield General Hospital, Leicester, United Kingdom
| | - Parveen Sharma
- Department of Cardiovascular, Metabolic Medicine and Liverpool Centre for Cardiovascular Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Amy E. Chadwick
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, Liverpool, United Kingdom
| | - Richard D. Rainbow
- Department of Cardiovascular, Metabolic Medicine and Liverpool Centre for Cardiovascular Sciences, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
- Richard D. Rainbow,
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7
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Lomivorotov V, Ponomarev D, Boboshko V, Shmyrev V, Ismoilov S, Efremov S, Kamenshchikov N, Akselrod B, Pasyuga V, Urusov D, Ovezov A, Evdokimov M, Turchaninov A, Bogachev-Prokofiev A, Bukamal N, Afifi S, Belletti A, Bellomo R, Landoni G. Calcium administration In patients undergoing CardiAc suRgery under cardiopulmonary bypasS (ICARUS trial): Rationale and design of a randomized controlled trial. Contemp Clin Trials Commun 2021; 23:100835. [PMID: 34485754 PMCID: PMC8406154 DOI: 10.1016/j.conctc.2021.100835] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 07/27/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Weaning from cardiopulmonary bypass (CPB) is a critical step of any cardiac surgical procedure and often requires pharmacologic intervention. Calcium ions are pivotal elements for the excitation-contraction coupling process of cardiac myocytes. Thus, calcium administration might be helpful during weaning from CPB. Methods We describe a multicenter, placebo-controlled, double blind randomized clinical trial to assess the effect of calcium chloride on the need for inotropic support among adult patients during weaning from CPB. The experimental group (409 patients) will receive 15 mg/kg of calcium chloride. The control group (409 patients) will receive an equivalent volume of 0.9% sodium chloride. Both drugs will be administered intravenously as a bolus at the beginning of weaning from CPB. Results The primary outcome will be the need for inotropic support between termination of CPB and completion of surgery. Secondary outcomes will be: duration of inotropic support, vasoactive-inotropic score 30 min after transfer to intensive care unit and on postoperative day 1, plasma alpha-amylase on postoperative day 1, plasma Ca2+ concentration immediately before and 10–15 min after calcium chloride administration, non-fatal myocardial infarction, blood loss on postoperative day 1, need for transfusion of red blood cells, signs of myocardial ischemia on electrocardiogram after arrival to intensive care unit, all-cause mortality at 30 days or during hospital stay if this is longer than 30 days. Discussion This trial is designed to assess whether intravenous calcium chloride administration could reduce the need for inotropic support after cardiopulmonary bypass weaning among adults undergoing cardiac surgery.
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Affiliation(s)
- Vladimir Lomivorotov
- E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
- Novosibirsk State University, Novosibirsk, Russian Federation
| | - Dmitry Ponomarev
- E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
- Corresponding author.
| | - Vladimir Boboshko
- E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Vladimir Shmyrev
- E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Samandar Ismoilov
- E. Meshalkin National Medical Research Centre, Novosibirsk, Russian Federation
| | - Sergey Efremov
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Nikolay Kamenshchikov
- Сardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation
| | - Boris Akselrod
- Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | - Vadim Pasyuga
- Federal Center for Cardiovascular Surgery, Astrakhan, Russian Federation
| | - Dmitry Urusov
- District Clinical Hospital, Khanty-Mansiysk, Russian Federation
| | - Alexey Ovezov
- Moscow Regional Research and Clinical Institute (MONIKI), Moscow, Russian Federation
| | - Mikhail Evdokimov
- Federal Center for Cardiovascular Surgery, Penza, Russian Federation
| | | | | | - Nazar Bukamal
- Sh. Mohammed Bin Khalifa Bin Sulman Al-Khalifa Cardiac Center, Awali, Bahrain
| | - Sarah Afifi
- King Abdullah Medical City, Makkah, Saudi Arabia
| | | | | | - Giovanni Landoni
- IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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Licker M, Diaper J, Ellenberger C. Accountability, research transparency and data reporting. BMC Anesthesiol 2020; 20:199. [PMID: 32795264 PMCID: PMC7427052 DOI: 10.1186/s12871-020-01107-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/23/2020] [Indexed: 11/24/2022] Open
Abstract
More than one published paper are often derived from analyzing the same cohort of individuals to make full use of the collected information. Preplanned study outcomes are generally mentioned in open databases while exhaustive information on methodological aspects are provided in submitted articles.
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Affiliation(s)
- Marc Licker
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, CH-1211, Geneva, Switzerland. .,Faculty of Medicine, University of Geneva, CH-1211, Geneva, Switzerland.
| | - John Diaper
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, CH-1211, Geneva, Switzerland
| | - Christoph Ellenberger
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, CH-1211, Geneva, Switzerland
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9
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Priebe HJ. Problems of subgroup analysis in randomized controlled trial. BMC Anesthesiol 2020; 20:186. [PMID: 32738887 PMCID: PMC7395332 DOI: 10.1186/s12871-020-01105-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 07/22/2020] [Indexed: 12/03/2022] Open
Abstract
Multiple subgroup analyses of the same data increase the risk of generating false positive findings. All outcomes and planned subgroup analyses should thus be prespecified and described in the original trial registry. When outcome changes during an ongoing trial seem justifiable, publications must disclose and explain such changes.
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Affiliation(s)
- Hans-Joachim Priebe
- Department of Anesthesiology and Critical Care, Medical Center University of Freiburg, Hugstetter Straße 55, 79095, Freiburg, Germany.
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10
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Whittaker A, Aboughdir M, Mahbub S, Ahmed A, Harky A. Myocardial protection in cardiac surgery: how limited are the options? A comprehensive literature review. Perfusion 2020; 36:338-351. [DOI: 10.1177/0267659120942656] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
For patients undergoing cardiopulmonary bypass, myocardial protection is a key for successful recovery and improved outcomes following cardiac surgery that requires cardiac arrest. Different solutions, components and modes of delivery have evolved over the last few decades to optimise myocardial protection. These include cold and warm and blood and crystalloid solution through antegrade, retrograde or combined cardioplegia delivery approach. However, each method has its own advantages and disadvantages, posing a challenge to establish a gold-standard cardioplegic solution with an optimised mode of delivery for enhanced myocardial protection during cardiac surgery. The aim of this review is to provide a brief history of the development of cardioplegia, explain the electrophysiological concepts behind myocardial protection in cardioplegia, analyse the current literature and summarise existing evidence that warrants the use of varying cardioplegic techniques. We provide a comprehensive and comparative overview of the effectiveness of each technique in achieving optimal cardioprotection and propose novel techniques for optimising myocardial protection in the future.
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Affiliation(s)
- Abigail Whittaker
- Department of Medicine, St George’s, University of London, London, UK
| | - Maryam Aboughdir
- Department of Medicine, St George’s, University of London, London, UK
- Department of Medicine, Imperial College London, London, UK
| | - Samiha Mahbub
- Department of Medicine, St George’s, University of London, London, UK
| | - Amna Ahmed
- Department of Medicine, Imperial College London, London, UK
| | - Amer Harky
- Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
- School of Medicine, University of Liverpool, Liverpool, UK
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11
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Nogi M, Kawakami R, Ishihara S, Hirai K, Nakada Y, Nakagawa H, Ueda T, Nishida T, Onoue K, Soeda T, Okayama S, Watanabe M, Saito Y. Low Insulin Is an Independent Predictor of All‐Cause and Cardiovascular Death in Acute Decompensated Heart Failure Patients Without Diabetes Mellitus. J Am Heart Assoc 2020; 9:e015393. [PMID: 32406318 PMCID: PMC7660870 DOI: 10.1161/jaha.119.015393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Insulin beneficially affects myocardial functions during myocardial ischemia. It increases glucose‐derived ATP production, decreases oxygen consumption, suppresses apoptosis of cardiomyocytes, and promotes the survival of cardiomyocytes. Patients with chronic heart failure generally have high insulin resistance, which is correlated with poor outcomes. The role of insulin in acute decompensated heart failure (ADHF) remains unclear. This study aimed to investigate the prognostic value of serum insulin level at the time of admission for long‐term outcomes in patients with ADHF. Methods and Results We enrolled 1074 consecutive patients who were admitted to our department for ADHF. Of these 1074 patients, we studied the impact of insulin on the prognosis of ADHF in 241 patients without diabetes mellitus. The patients were divided into groups according to low, intermediate, and high tertiles of serum insulin levels. Primary end points were all‐cause death and cardiovascular death. During a mean follow‐up of 21.8 months, 71 all‐cause deaths and 38 cardiovascular deaths occurred. Kaplan–Meier analysis showed that all‐cause and cardiovascular mortality was significantly higher in the low‐insulin group than those in the intermediate‐ and high‐insulin groups (log‐rank P=0.0046 and P=0.038, respectively). Moreover, according to the multivariable analysis, low serum insulin was an independent predictor of all‐cause and cardiovascular mortality (hazard ratio, 2.37 [95% CI, 1.24–4.65; P=0.009] and 2.94 [95% CI, 1.12–8.19; P=0.028], respectively). Conclusions Low serum insulin levels were associated with increased risk of all‐cause and cardiovascular death in ADHF patients without diabetes mellitus.
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Affiliation(s)
- Maki Nogi
- Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Rika Kawakami
- Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Satomi Ishihara
- Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Kaeko Hirai
- Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Yasuki Nakada
- Cardiovascular Medicine Nara Medical University Kashihara Japan
| | | | - Tomoya Ueda
- Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Taku Nishida
- Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Kenji Onoue
- Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Tsunenari Soeda
- Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Satoshi Okayama
- Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Makoto Watanabe
- Cardiovascular Medicine Nara Medical University Kashihara Japan
| | - Yoshihiko Saito
- Cardiovascular Medicine Nara Medical University Kashihara Japan
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12
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Beating heart technique in tricuspid valve replacement among patients which have a TAPSE index lower than 15 mm. JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.699528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Zhao K, Zhang Y, Li J, Cui Q, Zhao R, Chen W, Liu J, Zhao B, Wan Y, Ma XL, Yu S, Yi D, Gao F. Modified Glucose-Insulin-Potassium Regimen Provides Cardioprotection With Improved Tissue Perfusion in Patients Undergoing Cardiopulmonary Bypass Surgery. J Am Heart Assoc 2020; 9:e012376. [PMID: 32151220 PMCID: PMC7335515 DOI: 10.1161/jaha.119.012376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/23/2019] [Indexed: 12/11/2022]
Abstract
Background Laboratory studies demonstrate glucose-insulin-potassium (GIK) as a potent cardioprotective intervention, but clinical trials have yielded mixed results, likely because of varying formulas and timing of GIK treatment and different clinical settings. This study sought to evaluate the effects of modified GIK regimen given perioperatively with an insulin-glucose ratio of 1:3 in patients undergoing cardiopulmonary bypass surgery. Methods and Results In this prospective, randomized, double-blinded trial with 930 patients referred for cardiac surgery with cardiopulmonary bypass, GIK (200 g/L glucose, 66.7 U/L insulin, and 80 mmol/L KCl) or placebo treatment was administered intravenously at 1 mL/kg per hour 10 minutes before anesthesia and continuously for 12.5 hours. The primary outcome was the incidence of in-hospital major adverse cardiac events including all-cause death, low cardiac output syndrome, acute myocardial infarction, cardiac arrest with successful resuscitation, congestive heart failure, and arrhythmia. GIK therapy reduced the incidence of major adverse cardiac events and enhanced cardiac function recovery without increasing perioperative blood glucose compared with the control group. Mechanistically, this treatment resulted in increased glucose uptake and less lactate excretion calculated by the differences between arterial and coronary sinus, and increased phosphorylation of insulin receptor substrate-1 and protein kinase B in the hearts of GIK-treated patients. Systemic blood lactate was also reduced in GIK-treated patients during cardiopulmonary bypass surgery. Conclusions A modified GIK regimen administered perioperatively reduces the incidence of in-hospital major adverse cardiac events in patients undergoing cardiopulmonary bypass surgery. These benefits are likely a result of enhanced systemic tissue perfusion and improved myocardial metabolism via activation of insulin signaling by GIK. Clinical Trial Registration URL: clinicaltrials.gov. Identifier: NCT01516138.
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Affiliation(s)
- Kun Zhao
- Department of Cardiovascular SurgeryFourth Military Medical UniversityXi'an,China
- School of Aerospace MedicineFourth Military Medical UniversityXi'an,China
- Department of Thoracic SurgeryProvincial Cancer Hospital of ShannxiXi'an,China
| | - Yue Zhang
- Department of Ultrasonic DiagnosisXijing HospitalFourth Military Medical UniversityXi'an,China
| | - Jia Li
- School of Aerospace MedicineFourth Military Medical UniversityXi'an,China
| | - Qin Cui
- Department of Cardiovascular SurgeryFourth Military Medical UniversityXi'an,China
| | - Rong Zhao
- Department of Cardiovascular SurgeryFourth Military Medical UniversityXi'an,China
| | - Wensheng Chen
- Department of Cardiovascular SurgeryFourth Military Medical UniversityXi'an,China
| | - Jincheng Liu
- Department of Cardiovascular SurgeryFourth Military Medical UniversityXi'an,China
| | - Bijun Zhao
- Department of Cardiovascular SurgeryFourth Military Medical UniversityXi'an,China
| | - Yi Wan
- Department of Health Statistics andFourth Military Medical UniversityXi'an,China
- Department of Health ServicesFourth Military Medical UniversityXi'an,China
| | - Xin-Liang Ma
- Department of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPA
| | - Shiqiang Yu
- Department of Cardiovascular SurgeryFourth Military Medical UniversityXi'an,China
| | - Dinghua Yi
- Department of Cardiovascular SurgeryFourth Military Medical UniversityXi'an,China
| | - Feng Gao
- School of Aerospace MedicineFourth Military Medical UniversityXi'an,China
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14
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Affiliation(s)
- Christopher T Ryan
- Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston TX
| | - Todd K Rosengart
- Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston TX
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15
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Licker M, Diaper J, Sologashvili T, Ellenberger C. Glucose-insulin-potassium improves left ventricular performances after aortic valve replacement: a secondary analysis of a randomized controlled trial. BMC Anesthesiol 2019; 19:175. [PMID: 31492103 PMCID: PMC6731577 DOI: 10.1186/s12871-019-0845-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 08/27/2019] [Indexed: 12/18/2022] Open
Abstract
Background Patients with left ventricular (LV) hypertrophy may suffer ischemia-reperfusion injuries at the time of cardiac surgery with impairment in left ventricular function. Using transesophageal echocardiography (TEE), we evaluated the impact of glucose-insulin potassium (GIK) on LV performances in patients undergoing valve replacement for aortic stenosis. Methods In this secondary analysis of a double-blind randomized trial, moderate-to-high risk patients were assigned to receive GIK (20 IU insulin with 10 mEq KCL in 50 ml glucose 40%) or saline over 60 min upon anesthetic induction. The primary outcomes were the early changes in 2-and 3-dimensional left ventricular ejection fraction (2D and 3D-LVEF), peak global longitudinal strain (PGLS) and transmitral flow propagation velocity (Vp). Results At the end of GIK infusion, LV-FAC and 2D- and 3D-LVEF were unchanged whereas Vp (mean difference [MD + 7.9%, 95% confidence interval [CI] 3.2 to 12.5%; P < 0.001) increased compared with baseline values. After Placebo infusion, there was a decrease in LV-FAC (MD -2.9%, 95%CI − 4.8 to − 1.0%), 2D-LVEF (MD -2.0%, 95%CI − 2.8 to − 1.3%, 3D-LVEF (MD -3.0%, 95%CI − 4.0 to − 2.0%) and Vp (MD − 4.5 cm/s, 95%CI − 5.6 to − 3.3 cm/s). After cardiopulmonary bypass, GIK pretreatment was associated with preserved 2D and 3D-LVEF (+ 0.4%, 95% 95%CI − 0.8 to 1.7% and + 0.4%, 95%CI − 1.3 to 2.0%), and PGLS (− 0.9, 95%CI − 1.6 to − 0.2) as well as higher Vp (+ 5.1 cm/s, 95%CI 2.9 to 7.3), compared with baseline. In contrast, in the Placebo group, 2D-LVEF (− 2.2%, 95%CI − 3.4 to − 1.0), 3D-LVEF (− 6.0%, 95%CI − 7.8 to − 4.2), and Vp (− 7.6 cm/s, 95%CI − 9.4 to − 5.9), all decreased after bypass. Conclusions Administration of GIK before aortic cross-clamping resulted in better preservation of systolic and diastolic ventricular function in patients with LV hypertrophy undergoing aortic valve replacement. Trial registration ClinicalTrials.gov: NCT00788242, registered on November 10, 2008.
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Affiliation(s)
- Marc Licker
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, CH-1211, Geneva, Switzerland. .,Faculty of Medicine, University of Geneva, CH-1211, Geneva, Switzerland. .,Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital Geneva & Faculty of Medicine, CH-1206, Geneva, Switzerland.
| | - John Diaper
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, CH-1211, Geneva, Switzerland
| | - Tornike Sologashvili
- Division of Cardiovascular Surgery, University Hospital of Geneva, Geneva, Switzerland
| | - Christoph Ellenberger
- Department of Anesthesiology, Pharmacology and Intensive Care, University Hospital of Geneva, CH-1211, Geneva, Switzerland
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16
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Licker M, Ellenberger C. Answer to the letter: Research transparency, preplanned study endpoints and availability of results. J Clin Monit Comput 2019; 34:189-190. [PMID: 31030331 DOI: 10.1007/s10877-019-00316-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 04/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Marc Licker
- Department of Acute Medicine, University Hospital of Geneva Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Christoph Ellenberger
- Department of Acute Medicine, University Hospital of Geneva Faculty of Medicine, University of Geneva, Geneva, Switzerland
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17
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Priebe HJ. Pre-specified outcomes must be followed. J Clin Monit Comput 2019; 34:187-188. [PMID: 30976953 DOI: 10.1007/s10877-019-00312-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 04/05/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Hans-Joachim Priebe
- Department of Anesthesiology and Critical Care, Medical Center University of Freiburg, Hugstetter Straße 55, 79095, Freiburg, Germany.
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18
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Pretreatment with glucose-insulin-potassium improves ventricular performances after coronary artery bypass surgery: a randomized controlled trial. J Clin Monit Comput 2019; 34:29-40. [PMID: 30788810 PMCID: PMC7223403 DOI: 10.1007/s10877-019-00280-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 02/12/2019] [Indexed: 12/19/2022]
Abstract
Heart failure is the main cause of poor outcome following open heart surgery and experimental studies have demonstrated that glucose–insulin–potassium (GIK) infusion exerts cardioprotective effects by reducing myocardial ischemia–reperfusion injuries. This randomized controlled trial was designed to assess the effects of GIK on left ventricular function in moderate-to-high risk patients undergoing on-pump isolated coronary artery bypass surgery (CABGS), or combined with aortic valve replacement. The primary outcomes were the effects of GIK on two- and three-dimensional left ventricular ejection fraction (2D and 3D-LVEF), and on transmitral flow propagation velocity (Vp), that occurred between the pre- and post-CPB periods. GIK administration was associated with favorable interaction effects (p < 0.001) on 2D-LVEF, 3D-LVEF and Vp changes over the study periods. In GIK pretreated patients (N = 54), 2-D and 3D-LVEF and Vp increased slightly during surgery (mean difference [MD] + 3.5%, 95% confidence interval [95% CI] − 0.2 to 7.1%, MD + 4.0%, 95% CI 0.6–7.4%, and MD + 22.2%, 95% CI 16.0–28.4%, respectively). In contrast, in the Placebo group (N = 46), 2D-and 3D-LVEF, as well as Vp all decreased after CPB (MD − 7.5% [− 11.6 to − 3.4%], MD − 12.0% [− 15.2 to − 8.8%] and MD − 21.3% [− 25.7 to − 16.9%], respectively). In conclusion, the administration of GIK resulted in better preservation of systolic and diastolic ventricular function in the early period following weaning from CPB.
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Carbó R, Rodríguez E. A glucose-insulin-potassium solution improves glucose intake in hypoxic cardiomyocytes by a differential expression of glucose transporters in a metabolic syndrome model. J Biosci 2019. [DOI: 10.1007/s12038-018-9833-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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20
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Jensen RV, Andreadou I, Hausenloy DJ, Bøtker HE. The Role of O-GlcNAcylation for Protection against Ischemia-Reperfusion Injury. Int J Mol Sci 2019; 20:ijms20020404. [PMID: 30669312 PMCID: PMC6359045 DOI: 10.3390/ijms20020404] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 01/12/2019] [Accepted: 01/15/2019] [Indexed: 01/13/2023] Open
Abstract
Ischemia reperfusion injury (IR injury) associated with ischemic heart disease contributes significantly to morbidity and mortality. O-linked β-N-acetylglucosamine (O-GlcNAc) is a dynamic posttranslational modification that plays an important role in numerous biological processes, both in normal cell functions and disease. O-GlcNAc increases in response to stress. This increase mediates stress tolerance and cell survival, and is protective. Increasing O-GlcNAc is protective against IR injury. Experimental cellular and animal models, and also human studies, have demonstrated that protection against IR injury by ischemic preconditioning, and the more clinically applicable remote ischemic preconditioning, is associated with increases in O-GlcNAc levels. In this review we discuss how the principal mechanisms underlying tissue protection against IR injury and the associated immediate elevation of O-GlcNAc may involve attenuation of calcium overload, attenuation of mitochondrial permeability transition pore opening, reduction of endoplasmic reticulum stress, modification of inflammatory and heat shock responses, and interference with established cardioprotective pathways. O-GlcNAcylation seems to be an inherent adaptive cytoprotective response to IR injury that is activated by mechanical conditioning strategies.
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Affiliation(s)
- Rebekka Vibjerg Jensen
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark.
| | - Ioanna Andreadou
- Laboratory of Pharmacology, Faculty of Pharmacy, National and Kapodistrian University of Athens Panepistimiopolis, 15771 Zografou, Greece.
| | - Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore 169857, Singapore.
- National Heart Research Institute Singapore, National Heart Centre, Singapore 169609, Singapore.
- Yong Loo Lin School of Medicine, National University Singapore, Singapore 119228, Singapore.
- The Hatter Cardiovascular Institute, University College London, London WC1E 6HX, UK.
- The National Institute of Health Research University College London Hospitals Biomedical Research Centre, Research & Development, London W1T 7DN, UK.
- Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Monterrey 64849, Mexico.
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Skejby, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark.
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Duncan AE. GIK: The Cure We Have Been Waiting For? Anesth Analg 2018; 126:1121-1123. [PMID: 29547419 DOI: 10.1213/ane.0000000000002845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Andra E Duncan
- From the Department of Cardiothoracic Anesthesia and Outcomes Research, Cleveland Clinic, Cleveland, Ohio
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