There is no consensus on the myocardial ischemia/reperfusion injury induction methods in animal studies

Dear Editor: Ischemic heart diseases (IHDs) are among the most important causes of death and disability worldwide. Every year, 10.6 million people are diagnosed with IHDs; in 2017, 8.9 million died due to this disease (1). The treatment of myocardial infarction is principally based on prompt blood supply restoration to salvage the ischemic tissue utilizing timely thrombolytic medications and coronary revascularization (2). However, the subsequent reperfusion provokes secondary cellular damage, broadly referred to as reperfusion injury (3). Although a compendium of therapeutic agents has been proposed to allay the detrimental consequences of reperfusion, they do not yet have desirable efficacies, and the research for discovering novel promising treatments is still ongoing. Preclinical studies are integral to the translation of preliminary research into clinical practice. Conventionally, plausible treatments and innovative drugs are tested in animal experiments to ascertain their effectiveness and safety. Experimentations on cardiac Ischemia/reperfusion injuries comprise a significant body of literature among the preclinical studies, and one can find a myriad of evidence in online databases. Through our systematic reviews, we have encountered various myocardial ischemia/reperfusion (I/R) models, including large vessel ligation, global ischemia by administrating Isoproterenol, and interrupted perfusion of isolated hearts mounted on the Langendorff apparatus. Moreover, the studies were inconsistent regarding the duration of ischemia and, the subsequent reperfusion phase(4, 5). The secondary damages in the course of I/R injury are proportionate to the extent and duration of the ischemia (6). Moreover, Pathways leading to myocardial damage during I/R injury are considered a dynamic and evolving process (7). Therefore, the efficacy of interventions in mitigating I/R injury may be misestimated depending on the duration of the ischemic and reperfusion phases. To surmount these concerns, we suggest an expert panel develop standardized guidelines for myocardial I/R injury induction in experimental studies to consolidate further the reliability and validity of the results obtained from preclinical studies, ultimately contributing to the better appraisal of the studies. In the meantime, tissue markers representative of the degree of infarction or tissue fibrosis can be used to compare the induced ischemia/reperfusion injuries in studies

Value of Los Angeles Motor Scale (LAMS) in the detection of large vessels occlusion in suspected stroke patients; a systematic review and meta-analysis

Introduction Los Angeles Motor Scale (LAMS) is a validated prehospital scoring tool to identify stroke patients with large vessel occlusions (LVOs). While some studies have reported conflicting data in regards to the diagnostic value of LAMS, this systematic review and meta-analysis aims to provide a more concrete evidence for the value of this clinical decision tool in the diagnosis of LVO in suspected stroke patients. Method Online databases of PubMed, Embase, Scopus, and Web of Science were searched until the end of October 2022, for studies evaluating the diagnostic performance of LAMS in the detection of LVOs in suspected stroke patients. Results The results of our analysis demonstrated an AUC of 0.83 (95% CI: 0.79, 0.86), sensitivity of 0.65 (95% CI: 0.54, 0.74), and specificity of 0.83 (95% CI: 0.79, 0.86) for the diagnostic value of LAMS score with a cut-off value of ≥ 4. The diagnostic odds ratio of LAMS score was 8.81 (95% CI: 6.24, 12.45). Sensitivity analyses reveled that diagnostic performance of LAMS improves when utilized for detection of occlusion in the more proximal segments of large vessels, with a sensitivity of 0.75 and specificity of 0.83. Conclusion A high level of evidence showed that LAMS scale does not have a promising diagnostic value in the identification of LVOs in suspected stroke patients. The sensitivity of 0.65 for this tool makes it obsolete as a proper triaging tool. As a suggestion, LAMS could be utilized in conjunction with other additional factors to increase its diagnostic performance

The therapeutic effect of Nesfatin-1 on acute myocardial ischemia/reperfusion injury; a systematic review and meta-analysis

Introduction In recent years, various peptides have been introduced for the complementary treatment and management of post-reperfusion injuries. Nesfatin-1, a peptide secreted by the nervous system and peripheral tissues, modulates cardiac function, and plays an important role in the cardiovascular response to stress conditions. This systematic review and meta-analysis aims to investigate the preclinical evidence on the effect of Nesfatin-1 administration in the improvement of cardiac ischemia/reperfusion injury. Method Online databases of PubMed, Embase, Web of Science, and Scopus were searched until November 2nd, 2022, for articles investigating the therapeutic effects of Nesfatin-1 administration on myocardial ischemia/reperfusion injury in preclinical models. Cardiac functions, infarct size, myocardial tissue fibrosis, inflammation, oxidative stress, apoptosis, necroptosis, and necrosis were chosen as outcomes. The results are reported as an overall standardized mean difference (SMD) and 95% confidence interval (CI). Results Our results demonstrate that the administration of Nesfatin-1 improves cardiac parameters such as ejection fraction (SMD = 3.94, 95% CI: 0.30 to 7.58), heart rate (SMD = 3.30, 95% CI: 0.41 to 6.18), and negative dp/dt (SMD = 2.05, 95% CI: 0.60 to 3.50) and positive dp/dt (SMD = 2.78, 95% CI: 0.56 to 4.99). Nesfatin-1 was shown to significantly reduce myocardial infarct size (SMD = -4.32, 95% CI: -5.95 to -2.69 and fibrosis (SMD = -3.91, 95% CI: -5.67 to -2.15). Apoptotic score (SMD = -2.07, 95% CI: -3.51 to -0.63) and oxidative stress were also reduced subsequent to Nesfatin-1 administration. Nesfatin-1 was not shown to decrease inflammation, necroptosis, and necrosis. Conclusion In conclusion, we demonstrated that Nesfatin-1 could serve as a potential therapeutic agent in ameliorating the secondary damages during myocardial I/R injury. Nesfatin-1 administration can preserve cardiac function by reducing oxidative stress, apoptosis, and myocardial necrosis. However, much more studies are required to endorse further clinical translation of Nesfatin-1 to be utilized in the management of myocardial I/R injury

Effects of Epothilone Administration on Locomotion Recovery after Spinal Cord Injury: A Systematic Review of Animal Studies

This is a systematic review and meta-analysis of existing evidence regarding the possible effects of epothilones on spinal cord injury (SCI). This study aimed to investigate the possible effects of epothilone administration on locomotion recovery in animal models of SCI. Despite increasing rates of SCI and its burden on populations, no consensus has been reached about the possible treatment modality for SCI. Meanwhile, low-dose epothilones have been reported to have positive effects on SCI outcomes. Electronic databases of Web of Science, Scopus, Embase, and Medline were searched using keywords related to epothilones and SCI until the end of 2020. Two researchers screened the articles, and extracted data were analyzed using STATA ver. 14.0. Final results are reported as a standardized mean difference (SMD) with a 95% confidence interval (CI). After the screening, five studies were included in the analysis. Rats were used in all the studies. Two types of epothilones were used via intraperitoneal injection and were shown to have positive effects on the motor outcomes of samples with SCI (SMD, 0.87; 95% CI, 0.51 to 1.23; p=0.71). Although a slightly better effect was observed when using epothilone B, the difference was not significant (coefficient, −0.50; 95% CI, −1.52 to 0.52; p=0.246). The results of this study suggest that epothilones have positive effects on the improvement of motor function in rats, when administered intraperitoneally until a maximum of 1 day after SCI. However, current evidence regarding the matter is still scarce

Endocarditis caused by Aspergillus fumigatus in a patient 9 months after COVID-19 infection recovery: a case report and review of the literature

Abstract Background Aspergillus spp. are among the fungal pathogens that can cause life-threatening infections in patients with a history of COVID-19. Case presentation We present the case of a 58-year-old Iranian woman with post-COVID-19 Aspergillus fumigatus endocarditis complicated by numerous thromboembolisms. She underwent mitral valve replacement surgery and multiple lower extremity embolectomies and was treated with voriconazole, which led to her final recovery. Conclusions Aspergillus endocarditis should be considered in any patient with suspected endocarditis who has a history of COVID-19 infection and does not respond to routine antibiotic and antifungal therapy, as COVID-19 interferes with proper immune function, and lack of underlying cardiac conditions and immunodeficiencies does not preclude the diagnosis. Culture and histopathological evaluation of vegetations and emboli, as well as PCR, can confirm the diagnosis. Early initiation of antifungal therapy and surgical removal of infected valves and emboli can improve prognosis in patients with Aspergillus endocarditis