Abstract ID 128798Poster Board 266 Hearts with diabetic cardiomyopathy (DCM) are more vulnerable to myocardial ischemic-reperfusion injury (MIRI) and less or not sensitive to cardioprotective strategies, and the underlying mechanism remains largely unknown and effective treatment is lacking. As a widely used intravenous anesthetics and a reactive oxygen species scavenger, propofol (PPF) can attenuate diabetic MIRI at a high dose. We earlier found that low-dose PPF together with Salvianolic acid A (SAA), a potent antioxidant that confers cardioprotection, exerted synergistic effects against MIRI under diabetic conditions via regulating the CD36/AMPK pathway that influences energy metabolism. Diabetes and MIRI can both increase histone deacetylase 6 (HDAC6) activity that affects mitochondrial complex I (mCI), leading to exacerbated oxidative stress injuries. In spite of the common ground on mitochondrial metabolism, the regulation between AMPK and HDAC6 remains unknown. The present study aimed to determine whether PPF and SAA attenuate MIRI in diabetic mice via AMPK/HDAC6. We found that 30 minutes (min) of coronary followed by 2 hours of reperfusion resulted in more profound MIRI in high fat diet (HFD) and streptozotocin (STZ) induced type 2 diabetic mice compared with non-diabetic mice, manifested as larger infarct size and reduction of left ventricular ejective fraction (EF), along with decreased AMPK activity and mitochondrial complex I expression but increased HDAC6 levels (all p<0.05). The abovementioned negative consequences of MIRI in diabetes were reversed by the application of low-dose PPF (46mg/kg) combined with SAA (10mg/kg) during MIRI, and the effects were superior to that achieved with high dose PPF (92mg/kg). Inhibition of AMPK using Compound C significantly exacerbated MIRI, and cancelled the cardioprotection produced by PPF and SAA. The findings are suggestive that PPF combined with SAA could confer superior cardioprotective effects against MIRI to the usage of high dose PPF alone by upregulating p-AMPK to inhibit HDAC6 in diabetic hearts.
To evaluate the clinical features and pregnancy outcomes in patients experiencing recurrent miscarriage (RM) with either low-titer or medium-high titer positivity of antiphospholipid antibodies (aPL).
ABSTRACT Background Antiphospholipid syndrome (APS) is an autoimmune disorder characterized by thrombotic events and adverse pregnancy outcomes, often associated with elevated antiphospholipid antibodies (aPLs). The 2023 ACR/EULAR criteria for APS necessitate persistent medium to high titers of aPLs for laboratory confirmation. However, the impact of persistently low‐titer aPLs in recurrent miscarriage (RM) patients remains controversial. This study aims to analyze the effect of treatment on pregnancy outcomes and maternal–fetal complications in patients with low‐titer aPLs. Methods The study encompassed 252 pregnancies in 237 RM patients tested for aPLs at the Third Hospital of Guangzhou Medical University from January 2018 to July 2022. Patients were divided into two groups based on aPLs titers: 86 with low‐titer aPLs (92 pregnancies) and 151 aPLs‐negative (160 pregnancies). Of the low‐titer group, 71 received treatment, while 21 and all aPLs‐negative patients did not. Seventy‐one treated patients with low‐titer aPLs were divided into two groups. Group A ( n = 15) received a standard treatment regimen that included low‐dose aspirin (LDA) and low‐molecular‐weight heparin (LMWH). In contrast, Group B ( n = 56) received a multidrug regimen, which included hydroxychloroquine (HCQ) and/or glucocorticoids (GC) and/or intravenous immunoglobulin (IVIG) in addition to the standard treatment of LDA and LMWH. Pregnancy outcomes and maternal–fetal complications were subsequently compared. Results The highest positivity rates were for aCL‐IgM (76.2% in the untreated low‐titer aPLs group and 81.7% in the treated low‐titer aPLs group), followed by aβ2GPI‐IgM (23.8% in the untreated low‐titer aPL group and 11.4% in the treated low‐titer aPLs group), and LA (5.6% in the untreated low‐titer aPLs group and 3.3% in the treated low‐titer aPLs group). Single antibody positivity was 90.5% in the untreated low‐titer aPL group and 87.3% in the treated low‐titer aPLs group, with double positivity at 9.5% in the untreated low‐titer aPLs group and 12.7% in the treated low‐titer aPLs group. No triple positivity was detected. The treated low‐titer aPLs group had more previous miscarriages ( p < 0.05) and a higher ANA positivity rate ( p < 0.05) than the aPLs‐negative group. Additionally, the treated low‐titer aPLs group had lower complement levels than the aPLs‐negative group. Immunoglobulin IgM levels were higher in both the untreated and treated low‐titer aPL groups compared to the aPLs‐negative group ( p < 0.05). Post treatment, the live birth rate in the low‐titer group significantly exceeded that of the untreated group (67.6% vs. 33.3%; p = 0.005). The miscarriage rate was notably lower in untreated low‐titer patients compared to aPLs‐negative patients (32.4% vs. 66.7%; p = 0.005). No significant differences were observed in maternal or fetal complications between the groups. In the standard treatment group (Group A), there were 8 (53.3%) live births, whereas the multidrug treatment group (Group B) had 40 (71.4%) live births, a significantly higher rate than in the standard treatment group, although the difference lacked statistical significance. Conclusions The study indicates that untreated RM patients with low‐titer positive aPLs have a higher recurrence of miscarriage compared to the aPLs‐negative RM group. However, recurrence significantly decreases following appropriate intervention, suggesting the benefits of treatment for RM patients with low‐titer aPLs.
Background Systemic lupus erythematosus (SLE) is an autoimmune disease based on the pathology of small-vessel inflammation, which can affect multiple organs. Diffuse alveolar hemorrhage (DAH) is a rare and severe complication of SLE with high mortality, most commonly seen in young women. It often appears along with clinical manifestations of sudden dyspnea, hemoptysis, and rapid onset of hypoxemia, which develops into respiratory failure and even multiple organs damage. Case report The case of a 28-year-old female who was diagnosed with SLE complicated with DAH is presented here. The patient, who experienced recurring DAH, responded poorly to the common therapy of high-dose glucocorticoid plus cyclophosphamide and plasma exchange. After the treatment was adjusted to a multi-target regimen of glucocorticoid, tacrolimus, mycophenolate mofetil, and belimumab, the symptoms began to improve. Conclusion The multi-target regimen may be a new treatment strategy of SLE complicated with DAH.
Postoperative delirium (POD) is a prevalent perioperative complication among elderly individuals and is a cause of significant detrimental consequences for both individuals and society. Pharmacological and nonpharmacological prevention methods/therapies have been proposed to mitigate the risk of POD. Nevertheless, the efficacy of pharmacological interventions is controversial, and some of them cause side effects. Therefore, numerous studies have explored the effectiveness of nonpharmacological interventions in mitigating POD and have recommended the use of nonpharmacological multicomponent interventions by an interdisciplinary team as primary interventions. However, dedicated units aimed at promoting comanagement are rare and are only present in academic hospitals. Therefore, there is increasing interest in nonpharmacological mono-component interventions for preventing POD, which offer advantages such as easy application, cost-effectiveness, patient acceptability and noninvasiveness. These interventions are divided into cognitive training and noncognitive interventions. The former is aimed at increasing cognitive reserve, thus decreasing the incidence rate of POD. Noncognitive interventions, including sensory stimuli (music therapy, odor enrichment), improving sleep disturbances, physical activity, acupuncture and transcranial magnetic/direct current stimulation, are aimed at decreasing the risk factors for POD. This review provides a comprehensive overview of recently reported nonpharmacological mono-component interventions for preventing POD and briefly describes their clinical value.
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