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BMC Anesthesiol. 2025 Mar 20;25(1):133. doi: 10.1186/s12871-025-03004-2.

ABSTRACT

BACKGROUND: Postoperative sore throat (POST) is a common complication following endotracheal intubation after general anesthesia. This study aimed to examine the effect of administering lidocaine via the Trachospray device on POST severity and to assess its impact on hemodynamic responses (heart rate and blood pressure) during tracheal intubation.

METHODS: In a double-blind, randomized controlled trial was conducted, approved by the local ethics committee and registered on ClinicalTrials.gov. 100 patients aged 18-65 undergoing elective laparoscopic cholecystectomy and classified as ASA I-III were randomly divided into two groups. Group T received 10% lidocaine through Trachospray before intubation, while Group S was given distilled water. POST severity was evaluated at 2, 6, 12, and 24 h postoperatively. POST was evaluated on a 4-point scale, with scores of 0 (none) to 3 (severe).

RESULTS: Group T showed significantly lower POST severity and incidence at all time points compared to Group S (p = 0.001; p < 0.05). Additionally, hemodynamic responses (heart rate and blood pressure) were significantly lower in Group T following intubation (heart rate, p = 0.015; systolic blood pressure, p = 0.006; diastolic blood pressure, p = 0.010).

CONCLUSION: The use of 10% lidocaine via Trachospray before endotracheal intubation effectively decreases POST severity and incidence as well as the hemodynamic response to intubation, highlighting its potential to improve patient outcomes in the postoperative period.

PMID:40114047 | PMC:PMC11924844 | DOI:10.1186/s12871-025-03004-2

Vascul Pharmacol. 2025 Jun;159:107491. doi: 10.1016/j.vph.2025.107491. Epub 2025 Mar 18.

ABSTRACT

Myocardial infarction (MI) with resulting congestive heart failure is one of the leading causes of death worldwide. Current therapies for treating MI, such as devices, traditional medicine, and surgeries, come with many limitations as patients in their final stages of heart failure have little chances of experiencing any reversible changes. In recent decades, Mesenchymal stem cell (MSC) based therapy has become one of the most popular and rapidly developing fields in treating MI. Their supremacy for clinical applications is partially due to their unique properties and encouraging pre-clinical outcomes in various animal disease models. However, the majority of clinical trials registered for MSC therapy for diverse human diseases, including MI, have fallen short of expectations. This review intends to discuss the recent advances in the clinical application of using MSCs for cardiac repair and discuss challenges facing the clinical translation of MSCs for cardiac regeneration such as restoration of endothelial-cardiomyocyte crosstalk, immunomodulation and immune rejection, poor homing and migration, as well as low retention and survival. Furthermore, we will discuss recent strategies being investigated to help overcome some of these challenges.

PMID:40112941 | DOI:10.1016/j.vph.2025.107491

Pain Res Manag. 2025 Mar 12;2025:9187270. doi: 10.1155/prm/9187270. eCollection 2025.

ABSTRACT

Background: This study was designed to compare the effectiveness of the transversus abdominis plane (TAP) block with the addition of morphine to bupivacaine and the TAP block with bupivacaine plus intramuscular (IM) morphine. The aim of the study was to evaluate the effect of morphine administered with the TAP block on postoperative opioid consumption and pain scores and, secondarily, to determine whether the effect was systemic or local. Methods: This prospective, double-blind, randomized controlled trial included 52 patients. In the IM group, morphine at a dose of 0.1 mg/kg based on ideal body weight (IBW) was administered IM. In addition, a bilateral TAP block was performed under ultrasound guidance using a total of 40 mL of 0.25% bupivacaine, with 20 mL injected on each side. In the TAP group, an ultrasound-guided TAP block, including a total of 40 mL of 0.25% bupivacaine and 0.1 mg/kg morphine according to the IBW of patients, was administered bilaterally. Results: Total morphine consumption 24 h was 19.08 + 11.35 in the IM group and 11.81 + 7.02 in the TAP group, with an estimated difference in means of 7.2 (95% CI: 2.0, 12.5; p=0.008). The morphine consumption after 6, 12, and 24 h was lower in the TAP group than in the IM group (p=0.033, p=0.003, and p=0.008, respectively). The VAS scores at rest and during movement did not differ between the two groups. The total 24-h ondansetron consumption was higher in the IM group (p=0.046). The postoperative heart rates, blood pressure, and peripheral oxygen saturation at 0, 1, 6, 12, and 24 h did not differ significantly between the groups. Conclusions: The addition of morphine to the TAP block may be an effective method for postoperative analgesia in gynecologic surgery and may not increase systemic side effects, due to the possible local effects of morphine administered interfacial. Trial Registration: ClinicalTrials.gov identifier: NCT05420337.

PMID:40109499 | PMC:PMC11922606 | DOI:10.1155/prm/9187270

Ann Intensive Care. 2025 Mar 19;15(1):32. doi: 10.1186/s13613-025-01458-8.

ABSTRACT

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) offers an immediate and effective mechanical cardio-circulatory support for critically ill patients with refractory cardiogenic shock or selected refractory cardiac arrest. As fluid therapy is routinely performed as a component of initial hemodynamic resuscitation of ECMO supported patients, this narrative review intends to summarize the rationale and the evidence on the fluid resuscitation strategy in terms of fluid type and dosing, the impact of fluid balance on outcomes and fluid responsiveness assessment in VA-ECMO patients. Several observational studies have shown a deleterious impact of positive fluid balance on survival and renal outcomes. With regard to the type of crystalloids, further studies are needed to evaluate the safety and efficacy of saline versus balanced solutions in terms of hemodynamic stability, renal outcomes and survival in VA-ECMO setting. The place and the impact of albumin replacement, as a second-line option, should be investigated. During VA-ECMO run, the fluid management approach could be divided into four phases: rescue or salvage, optimization, stabilization, and evacuation or de-escalation. Echocardiographic assessment of stroke volume changes following a fluid challenge or provocative tests is the most used tool in clinical practice to predict fluid responsiveness. This review underscores the need for high-quality evidence regarding the optimal fluid strategy and the choice of fluid type in ECMO supported patients. Pending specific data, fluid therapy needs to be personalized and guided by dynamic hemodynamic approach coupled to close monitoring of daily weight and fluid balance in order to provide adequate ECMO flow and tissue perfusion while avoiding harmful effects of fluid overload.

PMID:40106084 | PMC:PMC11923310 | DOI:10.1186/s13613-025-01458-8

Mol Cell Biochem. 2025 Mar 17. doi: 10.1007/s11010-025-05251-w. Online ahead of print.

ABSTRACT

Myocardial infarction is a cardiovascular disease that poses a serious threat to human health. The traditional view is that adult mammalian cardiomyocytes have almost no regenerative ability, but recent studies have shown that they have regenerative potential under specific conditions. This article comprehensively describes the research progress of post-infarction cardiomyocyte regeneration, including the characteristics of cardiomyocytes and post-infarction changes, regeneration mechanisms, influencing factors, potential therapeutic strategies, challenges and future development directions, and deeply discusses the specific pathways and targets included in the regeneration mechanism, aiming to provide new ideas and methods for the treatment of myocardial infarction.

PMID:40097887 | DOI:10.1007/s11010-025-05251-w

Braz J Cardiovasc Surg. 2025 Mar 18;40(2):e20220468. doi: 10.21470/1678-9741-2022-0468.

ABSTRACT

A 58-year-old man, who has undergone ascending aorta replacement, started to complain of pain in the lower limbs, shortness of breath, and progressive fatigue a few months after surgery. Transthoracic and transesophageal Doppler echocardiographies revealed a diseased bicuspid aortic valve and a subocclusive mass in the ascending aorta. Thoracic computed tomography angiography confirmed the presence of a subocclusive mass, pseudoaneurysm formation, and a distorted shape of the Dacron® graft. The patient underwent urgent surgery to remove the mass, which appeared to be a thrombus, and aortic valve and ascending aorta replacement. Kinking of vascular graft has been reported including surgical techniques to correct the excessive length to avoid gradients and guarantee laminar flow. When kinking is severe, high gradients and hemolysis can be detected. However, thrombus formation in the ascending aorta segment is less likely, due to the high blood velocity flow. Therefore, several concurrent causes should be considered. In this case, the most probable explanation for thrombus formation was kinking of a too long Dacron® graft, combined with extrinsic compression effect of the graft by the pseudoaneurysm at the anastomosis site and anomalous flow directed from the diseased bicuspid aortic valve. Various grades of Dacron® graft kinking might occur following ascending aorta replacement and undiagnosed at follow-up especially if resulting in mild symptoms, thus, careful visual and echocardiography evaluation should be done at the end of surgery. Finally, distorted Dacron® graft might trigger thrombus formation when inflammation and coagulation processes are set off during bacteria or viral infection.

PMID:40101116 | PMC:PMC11921935 | DOI:10.21470/1678-9741-2022-0468

Medicine (Baltimore). 2025 Mar 14;104(11):e41934. doi: 10.1097/MD.0000000000041934.

ABSTRACT

Increased intra-abdominal pressure during laparoscopic surgery, anesthesia, patient position, and neuroendocrine response may increase the risk of arrhythmia. This study aimed to investigate the perioperative changes in the frontal QRS-T angle in patients undergoing laparoscopic cholecystectomy under general anesthesia. Therefore, electrophysiological parameters at different stages of laparoscopic cholecystectomy were studied using the frontal QRS-T angle and the risk of arrhythmia susceptibility was investigated. This prospective observational study included 48 patients aged 23 to 65 years with an American Society of Anesthesiologists score of 1 to 3 who underwent laparoscopic cholecystectomy in the operating room of Gaziosmanpaşa University Research and Application Hospital. Electrocardiographic recordings were obtained immediately before surgery, immediately before and after intra-abdominal carbon dioxide insufflation, 2 minutes after reverse Trendelenburg, immediately after extubation, and 2 hours postoperatively, and the frontal plane QRS-T angle, QT and QTc interval were studied. Rhythm disturbances, bleeding and complications were recorded. The frontal QRS-T angle, QT and QTc interval were significantly increased with intra-abdominal hypertension (IAH) compared to baseline (P < .001, P < .001, P < .001, respectively). Similarly, frontal QRS-T angle, QT, and QTc interval increased significantly with reverse Trendelenburg position compared to baseline (P < .001, P < .001, P < .001, respectively). The frontal QRS-T angle, which increased with IAH and the reverse Trendelenburg position, significantly decreased immediately after the patient woke up (P < .001). Heart rate and mean arterial pressure increased significantly with IAH compared to those just before carbon dioxide insufflation (P = .03, P < .001, respectively). The present study found that IAH induction and reverse Trendelenburg positioning increased the frontal QRS-T angle, QT, and QTc interval in patients undergoing laparoscopic cholecystectomy. These prolonged values may cause serious arrhythmias, particularly in patients with cardiac disease. Therefore, it is very important for anesthetists to be aware of electrocardiographic changes such as arrhythmias in patients undergoing laparoscopic cholecystectomy.

PMID:40101078 | PMC:PMC11922400 | DOI:10.1097/MD.0000000000041934

J Nanobiotechnology. 2025 Mar 17;23(1):213. doi: 10.1186/s12951-025-03289-y.

ABSTRACT

Acute myocardial infarction (AMI) destroys heart cells by disrupting the oxygen supply. Improving oxygen delivery to the injured area may avoid cell death and regenerate the heart. We present the creation of oxygen-producing injectable bio-macromolecular hydrogels using catalase (CAT) loaded alginate (Alg) and fibrin (Fib) incorporated with the Mesenchymal stem cells (MSCs) derived exosomes (Exo). The composite hydrogel additionally incorporates electrical stimulating qualities from gold nanoparticles (AuNPs). In vitro experiments showed that this composite hydrogel (Exo/Hydro/AuNPs/CAT) exhibits electrical conductivity similar to an actual heart and effectively releases CAT. The O2-generating hydrogel released oxygen for almost 5 days under hypoxia conditions. We showed that after 7 days of in vitro cell culture, produces the same paracrine factors as rat neonatal cardiomyocytes (RNCs), rat cardiac fibroblasts (RCFs), and Human Umbilical Vein Endothelial Cells (HUVECs), imitating capillary architecture and function. Our work demonstrated that the injectable conductive hydrogel loaded with CAT and AuNPs reduced left ventricular remodeling and myocardial dysfunction in rats after MI. Exo/Hydro/AuNPs/CAT boosted infarct margin angiogenesis, decreased cell apoptosis, and necrosis, and elevated Connexm43 (Cx43) expression. The therapeutic benefits and the ease of production of oxygen make this bioactive injectable conductive hydrogel an effective therapeutic agent for MI.

PMID:40091055 | PMC:PMC11912659 | DOI:10.1186/s12951-025-03289-y

Adv Sci (Weinh). 2025 Jun;12(21):e2417827. doi: 10.1002/advs.202417827. Epub 2025 Mar 16.

ABSTRACT

Myocardial ischemia/reperfusion (I/R) injury is a major contributor to myocardial damage, leading to adverse cardiac remodeling and dysfunction. Recent studies have highlighted the potential of gut microbiota-derived metabolites in modulating cardiac outcomes. Here, the cardioprotective effects of a commensal bacterium Flavonifractor plautii (F. plautii) and its metabolite desaminotyrosine (DAT) against myocardial I/R injury are investigated. We showed that prophylactic gavage of F. plautii attenuates myocardial I/R injury as evidenced by improved cardiac function and reduced cardiac injury. We also found that its metabolite DAT recapitulates these cardioprotective effects against myocardial I/R injury. Transcriptomic analysis has revealed that DAT preserves cardiac tissue and attenuates immune responses against myocardial I/R injury. Mechanistically, DAT promotes cardiomyocyte survival through the modulation of the nicotinamide adenine dinucleotide phosphate (NADP+/NADPH) ratio. Further, DAT suppressed macrophage proinflammatory activities and cardiac inflammation via the reduction in interleukin-6 (IL-6) production. Taken together, our findings indicate that F. plautii and its metabolite DAT exert pleiotropic cardioprotective effects against myocardial I/R injury, suggesting them as potential prophylactic therapeutic options for alleviating myocardial I/R injury.

PMID:40089859 | PMC:PMC12140293 | DOI:10.1002/advs.202417827

Cardiovasc Res. 2025 May 23;121(5):702-729. doi: 10.1093/cvr/cvaf023.

ABSTRACT

Animal models offer invaluable insights into disease mechanisms but cannot entirely mimic the variability and heterogeneity of human populations, nor the increasing prevalence of multi-morbidity. Consequently, employing human samples-such as whole blood or fractions, valvular and vascular tissues, myocardium, pericardium, or human-derived cells-is essential for enhancing the translational relevance of cardiovascular research. For instance, myocardial tissue slices, which preserve crucial structural and functional characteristics of the human heart, can be used in vitro to examine drug responses. Human blood serves as a rich source of biomarkers, including extracellular vesicles, various types of RNA (miRNA, lncRNA, and circRNAs), circulating inflammatory cells, and endothelial colony-forming cells, facilitating detailed studies of cardiovascular diseases. Primary cardiomyocytes and vascular cells isolated from human tissues are invaluable for mechanistic investigations in vitro. In cases where these are unavailable, human induced pluripotent stem cells serve as effective substitutes, albeit with specific limitations. However, the use of human samples presents challenges such as ethical approvals, tissue procurement and storage, variability in patient genetics and treatment regimens, and the selection of appropriate control samples. Biobanks are central to the efficient use of these scarce and valuable resources. This scientific statement discusses opportunities to implement the use of human samples for cardiovascular research within specific clinical contexts, offers a practical framework for acquiring and utilizing different human materials, and presents examples of human sample applications for specific cardiovascular diseases, providing a valuable resource for clinicians, translational and basic scientists engaged in cardiovascular research.

PMID:40084813 | PMC:PMC12101359 | DOI:10.1093/cvr/cvaf023

J Cardiovasc Transl Res. 2025 Mar 13. doi: 10.1007/s12265-025-10596-0. Online ahead of print.

ABSTRACT

Human-induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) constitute a promising therapy for myocardial infarction (MI). The lack of an effective immunosuppressive regimen, combined with single-cell transplantations, results in suboptimal outcomes, such as poor engraftment and compromised therapeutic efficacy. This study aimed to confirm the increased retention of hiPSC-CMs microtissues (CMTs) over single-cell grafts. To ensure the long-term survival of CMTs for potential cardiac applications, CMTs were transplanted in a porcine model of MI using a triple immunosuppression protocol designed to limit immune cell infiltration. Acute evaluation of spherical hiPSC-CMs aggregates and dissociated aggregates followed by the development of a triple immunosuppression protocol were performed in healthy animals. Long-term survival of CMTs was later examined in pigs that underwent a transient coronary occlusion. Two weeks post-MI, the immunosuppression treatment was initiated and on day 28 the animals were transplanted with CMTs and followed for four more weeks. Acutely, CMTs showed superior retention compared to their dissociated counterparts. The immunosuppression regimen led to no organ damage and stable levels of circulating drugs once optimal dose was achieved. Two weeks post-xenotransplantation in healthy pigs, histology revealed that immunosuppressed animals displayed a significant decrease in total cellular infiltrates, particularly in CD3+ T cells. Pigs that underwent coronary occlusion, which later were immunosuppressed and treated with CMTs (5 × 107 cells), showed cell engraftment onto the native myocardium four weeks post-transplantation. This study supports the use of a triple immunosuppression cocktail to ensure long-term survival of CMTs for the treatment of MI.

PMID:40082315 | DOI:10.1007/s12265-025-10596-0

Elife. 2025 Mar 13;13:RP100797. doi: 10.7554/eLife.100797.

ABSTRACT

Haploinsufficiency for GATA6 is associated with congenital heart disease (CHD) with variable comorbidity of pancreatic or diaphragm defects, although the etiology of disease is not well understood. Here, we used cardiac directed differentiation from human embryonic stem cells (hESCs) as a platform to study GATA6 function during early cardiogenesis. GATA6 loss-of-function hESCs had a profound impairment in cardiac progenitor cell (CPC) specification and cardiomyocyte (CM) generation due to early defects during the mesendoderm and lateral mesoderm patterning stages. Profiling by RNA-seq and CUT&RUN identified genes of the WNT and BMP programs regulated by GATA6 during early mesoderm patterning. Furthermore, interactome analysis detected GATA6 binding with developmental transcription factors and chromatin remodelers, suggesting cooperative regulation of cardiac lineage gene accessibility. We show that modulating WNT and BMP inputs during the first 48 hr of cardiac differentiation is sufficient to partially rescue CPC and CM defects in GATA6 heterozygous and homozygous mutant hESCs. This study provides evidence of the regulatory functions for GATA6 directing human precardiac mesoderm patterning during the earliest stages of cardiogenesis to further our understanding of haploinsufficiency causing CHD and the co-occurrence of cardiac and other organ defects caused by human GATA6 mutations.

PMID:40080060 | PMC:PMC11906159 | DOI:10.7554/eLife.100797

Int J Mol Sci. 2025 Mar 5;26(5):2309. doi: 10.3390/ijms26052309.

ABSTRACT

Myocardial infarction remains a leading cause of death worldwide due to the heart's limited regenerative capability and the current lack of viable therapeutic solutions. Therefore, there is an urgent need to develop effective treatment options to restore cardiac function after a heart attack. Stem cell-derived cardiac cells have been extensively utilised in cardiac tissue regeneration studies. However, the use of Matrigel as a substrate for the culture and maturation of these cells has been a major limitation for the translation of this research into clinical application. Hydrogels are emerging as a promising system to overcome this problem. They are biocompatible and can provide stem cells with a supportive scaffold that mimics the extracellular matrix, which is essential for repairing damaged tissue in the myocardium after an infarction. Thus, hydrogels provide an alternative and reproducible option in addressing myocardial infarction due to their unique potential therapeutic benefits. This review explores the different types of natural and synthetic polymers used to create hydrogels and their various delivery methods, the most common being via injection and cardiac patches and other applications such as bioprinting. Many challenges remain before hydrogels can be used in a clinical setting, but they hold great promise for the future of cardiac tissue regeneration.

PMID:40076929 | PMC:PMC11900105 | DOI:10.3390/ijms26052309

Kardiol Pol. 2025;83(4):417-426. doi: 10.33963/v.phj.104577. Epub 2025 Mar 11.

ABSTRACT

Induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) hold great promise for revolutionizing regenerative medicine. Preclinical studies indicate their potential to repair damaged myocardial tissue in animal models of heart disease. Despite ongoing advances in the field, the incomplete maturation of iPSC-CMs remains a critical barrier that significantly hinders their translation into clinical applications. The maturation of cardiomyocytes is crucial for the successful integration of iPSC-CMs into damaged heart tissue. Compared to adult cells, immature CMs have impaired structural characteristics, contractile function, and electrophysiological properties. Recent studies have focused on identifying key factors, such as altered cell metabolic pathways or mechanical and electrical stimulation, that may promote iPSC-CM maturation. Progress in this area has profound implications for the development of personalized disease models and cell therapies that promote the regeneration and repair of damaged heart tissue. This review describes the current achievements in the application of regenerative medicine using iPSC-CM and tissue engineering, highlighting the molecular mechanisms, culture strategies, and biophysical approaches that have contributed to improved maturation of these cells. Numerous studies are currently being carried out using both in vitro and in vivo models to better understand the complex mechanism of regeneration of the damaged heart. The combination of stem cell therapy and 3D cardiac cell cultures aims to repair and regenerate damaged cardiac tissue more effectively.

PMID:40066964 | DOI:10.33963/v.phj.104577