AIMS
Zinc-finger protein 418 (ZNF418) has been confirmed to be expressed in myocardial tissue. However, the role and mechanism of ZNF418 in pathological myocardial remodelling after myocardial infarction (MI) have not been reported. This study was to elucidate the effect and mechanism of ZNF418 on ventricular remodelling after MI in mice.


METHODS AND RESULTS
MI mice and H9c2 cardiomyocytes were used to conduct in vivo and in vitro experiments, respectively. ZNF418 expression was regulated by adeno-associated virus 9 and adenovirus vectors. Pathological analysis, echocardiography, and molecular analysis were performed. ZNF418 was down-regulated in the left ventricular tissues of post-MI mice. In contrast, ZNF418 overexpression decreased mortality and improved cardiac function in MI mice. The MI mice exhibited a significantly increased cross-sectional area of myocardial cells and elevated protein expression levels of myocardial hypertrophy markers ANP, BNP, and β-MHC (all P < 0.05). Moreover, a significantly increased area of myocardial fibrosis and protein expression levels of myocardial fibrosis markers collagen I, collagen III, and CTGF were observed in MI mice (all P < 0.05) in MI mice. All of the above negative effects in MI mice were ameliorated in ZNF418 overexpressed mice (all P < 0.05). Mechanistically, ZNF418 overexpression inhibited the activation of the MAPK signalling pathway, as evidenced by the in vivo and in vitro experiments.


CONCLUSIONS
Overexpression of ZNF418 could improve cardiac function and inhibit pathological cardiac remodelling by inhibiting the MAPK signalling pathway in post-MI mice.

Overexpression of zinc-finger protein 418 inhibits pathological cardiac remodelling after acute myocardial infarction.

Background and Purpose: Heart transplantation frequency is increasing in the United States with 4545 procedures in 2023. Most research for physical therapy interventions for heart transplant (HT) recipients addresses outpatient cardiac rehabilitation with limited research in phase I cardiac rehabilitation. This case report describes clinical decision-making related to physical therapy interventions and demonstrates effectiveness utilizing multiple outcome measures for a HT recipient in phase I cardiac rehabilitation. Case Description: A 60-year-old male received a HT. Physical therapy was initiated 3 days postoperatively with multiple impairments and activity limitations identified. The patient participated in 14 physical therapy sessions over 22 hospital days. In week 1, intervention prescription focused on functional and strength training. In week 2, improved functional status allowed for endurance training. In week 3, balance training and home safety education were added in anticipation of hospital discharge. Outcomes: The patient participated in 100% of sessions in which he was medically stable. The patient demonstrated clinically meaningful improvement in functional capacity on the JH-HLM (5-point improvement, exceeds MDC of 0.6) and in aerobic capacity on the 6MWT (80-meter improvement, exceeds MCID of 54 meters). Discussion and Conclusion: This case report provides a framework for physical therapists regarding intervention prescription, progression, use of outcome measures, and physiologic considerations for a HT recipient participating in phase I cardiac rehabilitation. More research is needed. In conclusion, this case report demonstrates that phase I cardiac rehabilitation is effective in improving functional and aerobic capacity in a HT recipient. 

Providing Physical Therapy Interventions for a Patient After Heart Transplantation in the Acute Care Setting

CD163+ macrophages attenuate pressure overload-induced left ventricular systolic dysfunction and cardiac mitochondrial dysfunction via interleukin-10.

Abstract Objective Regional citrate anticoagulation (RCA) is recommended as the first choice of anticoagulation strategies in continuous renal replacement therapy (CRRT). However, when using calcium-containing replacement fluid, whether RCA can achieve sufficient anticoagulant effect among different CRRT modalities remains unclear. Materials and methods In this open-label, three-arm, randomized trial, AKI patients receiving RCA-CRRT with calcium-containing replacement fluids were randomized to continuous veno-venous hemofiltration (CVVH), continuous veno-venous hemodialysis (CVVHD) and continuous veno-venous hemodiafiltration (CVVHDF) groups from 2022 to 2023. The primary outcomes were circuit lifespan and early circuit failure. Secondary endpoints included the safety of the three groups and 30-day all-cause mortality. Results A total of 121 patients were enrolled, with 40 in CVVH group, 40 in CVVHD group, and 41 in CVVHDF group. The circuit lifespan in CVVHDF group (70 h, IQR 65–72) was significantly longer than that in CVVHD (47 h, IQR 31.5–54) and CVVH group (64 h, IQR 46–71) ( P &lt; 0.001). Meanwhile, 27 circuits remained patent for 72 h (CVVH: 10/40, 25%; CVVHD: 1/40, 2.5%; CVVHDF: 16/41, 39.02%; P = 0.003). A significantly lower incidence of severe venous chamber thrombosis was observed in the CVVHDF group (2.4%, 1/41) relative to the CVVH (5%, 2/40) and CVVHD (50%, 20/40) groups ( P &lt; 0.001). Furthermore, early circuit failure (lifespan &lt; 48 h) was observed in 35 circuits, occurring significantly more frequently in the CVVHD group (52.5%, 21/40) than in either the CVVH (22.5%, 9/40) or CVVHDF (12.2%, 5/41) groups ( P = 0.004). Conclusion Our findings suggested that RCA-CRRT with calcium-containing replacement solution appeared to be safe and effective, with CVVHDF showing potentially prolonged filter survival compared to alternative modalities, which might support its consideration as a possible option in clinical practice. Trial registration This study was registered in the Chinese Clinical Trial Registry ( www.chictr.org.cn ) under the registration number ChiCTR2200061065 on 15 June 2022. 

pdf/efficacy-and-safety-of-regional-citrate-anticoagulation-bybp120tqwtz.pdf

Efficacy and safety of regional citrate anticoagulation using calcium-containing replacement solution in different modalities of continuous renal replacement therapy: a randomized controlled trial

Background Cardiac rehabilitation (CR) improves outcomes in patients with heart failure. However, data on CR efficacy in patients with acute decompensated heart failure is limited. This study is designed to assess the efficacy and safety of CR in patients hospitalized in cardiac intensive care unit (CICU) with acute decompensated heart failure (ADHF). Methods This is a single-center, randomized controlled, single-blind clinical trial. A total of 120 participants hospitalized in CICU with ADHF will be randomly allocated in the ratio of 1:1 to two groups: CR group and control group. Participants will receive tailored and progressive CR intervention or attention control. The CR intervention include personalized breathing training, small muscle group resistance training, and aerobic endurance training based on the physical fitness assessment results. The subjects will receive the CR training for 5 days and will be followed up for 6 months. The primary endpoints are the score of the short physical performance battery (SPPB) and 6-month all-cause rehospitalization. The secondary endpoints include cardio-pulmonary function, activities of daily living (ADL), in-hospital mortality rate and 6-month all-cause mortality rate. Discussion This randomized, controlled, clinical trial will assess whether CR improves physical function and reduces rehospitalization in patients hospitalized in CICU with ADHF. The results will provide further research-based evidence for the clinical application of CR in patients with ADHF. Trial Registration Chinese Clinical Trial Registry ChiCTR2100050151. Registered on 19 August 2021.

/pdf/the-efficacy-and-safety-of-phase-i-cardiac-rehabilitation-in-2g8mqq06.pdf

The Efficacy and Safety of Phase I Cardiac Rehabilitation in Patients Hospitalized in Cardiac Intensive Care Unit With Acute Decompensated Heart Failure: A Study Protocol for a Randomized, Controlled, Clinical Trial

BACKGROUND
Calcium-free (Ca-free) solutions are theoretically the most ideal for regional citrate anticoagulation (RCA) in continuous renal replacement therapy (CRRT). However, the majority of medical centers in China had to make a compromise of using commercially available calcium-containing (Ca-containing) solutions instead of Ca-free ones due to their scarcity. This study was designed to probe into the potential of Ca-containing solution as a secure and efficient substitution for Ca-free solutions.


METHODS
In this prospective, randomized single-center trial, 99 patients scheduled for CRRT were randomly assigned in a 1:1:1 ratio to one of three treatment groups: continuous veno-venous hemodialysis Ca-free dialysate (CVVHD Ca-free) group, continuous veno-venous hemodiafiltration calcium-free dialysate (CVVHDF Ca-free) group, and continuous veno-venous hemodiafiltration Ca-containing dialysate (CVVHDF Ca-containing) group at cardiac intensive care unit (CICU). The primary endpoint was the incidence of metabolic complications. The secondary endpoints included premature termination of treatment, thrombus of filter, and bubble trap after the process.


RESULTS
The incidence of citrate accumulation (18.2% vs. 12.1% vs. 21.2%) and metabolic alkalosis (12.1% vs. 0% vs. 9.1%) did not significantly differ among three groups (p > 0.05 for both). The incidence of premature termination was comparable among the groups (18.2% vs. 9.1% vs. 9.1%, p = 0.582). The thrombus level of the filter and bubble trap was similar in the three groups (p > 0.05 for all).


CONCLUSIONS
In RCA-CRRT for CICU population, RCA-CVVHDF with Ca-containing solutions and traditional RCA with Ca-free solutions had a comparable safety and feasibility.


TRIAL REGISTRATION
ChiCTR2100048238 in the Chinese Clinical Trial Registry.

Safety and Feasibility of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy With Calcium-Containing Solutions: A Randomized Controlled Trial.

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The Efficacy and Safety of Phase I Cardiac Rehabilitation in Patients Hospitalized in Cardiac Intensive Care Unit With Acute Decompensated Heart Failure: A Study Protocol for a Randomized, Controlled, Clinical Trial

Overexpression of zinc-finger protein 418 inhibits pathological cardiac remodelling after acute myocardial infarction.

Safety and Feasibility of Regional Citrate Anticoagulation for Continuous Renal Replacement Therapy With Calcium-Containing Solutions: A Randomized Controlled Trial.