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Wang W, Ma Q, Li D, Zhang W, Yang Z, Tian W, Huang N. Engineered endothelium-mimicking antithrombotic surfaces via combination of nitric oxide-generation with fibrinolysis strategies. Bioact Mater 2025; 43:319-329. [PMID: 39415940 PMCID: PMC11480950 DOI: 10.1016/j.bioactmat.2024.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 09/07/2024] [Accepted: 09/07/2024] [Indexed: 10/19/2024] Open
Abstract
Thrombosis associated with implants can severely impact therapeutic outcomes and lead to increased morbidity and mortality. Thus, developing blood-contacting materials with superior anticoagulant properties is essential to prevent and mitigate device-related thrombosis. Herein, we propose a novel single-molecule multi-functional strategy for creating blood-compatible surfaces. The synthesized azide-modified Cu-DOTA-(Lys)3 molecule, which possesses both NO release and fibrinolysis functions, was immobilized on material surfaces via click chemistry. Due to the specificity, rapidity, and completeness of click chemistry, the firmly grafted Cu-DOTA-(Lys)3 endows the modified material with excellent antithrombotic properties of vascular endothelium and thrombolytic properties of fibrinolytic system. This surface effectively prevented thrombus formation in both in vitro and in vivo experiments, owing to the synergistic effect of anticoagulation and thrombolysis. Moreover, the modified material maintained its functional efficacy after one month of PBS immersion, demonstrating excellent stability. Overall, this single-molecule multifunctional strategy may become a promising surface engineering technique for blood-contacting materials.
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Affiliation(s)
- Wenxuan Wang
- School of Materials Science and Engineering, Key Lab of Advanced Technology of Materials of Education Ministry, Southwest Jiaotong University, Chengdu, 610031, China
| | - Qing Ma
- School of Materials Science and Engineering, Key Lab of Advanced Technology of Materials of Education Ministry, Southwest Jiaotong University, Chengdu, 610031, China
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, Guangdong, 523059, China
| | - Da Li
- School of Materials Science and Engineering, Key Lab of Advanced Technology of Materials of Education Ministry, Southwest Jiaotong University, Chengdu, 610031, China
| | - Wentai Zhang
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, Guangdong, 523059, China
| | - Zhilu Yang
- Dongguan Key Laboratory of Smart Biomaterials and Regenerative Medicine, The Tenth Affiliated Hospital of Southern Medical University, Dongguan, Guangdong, 523059, China
| | - Wenjie Tian
- Cardiology Department, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan 610072, China
| | - Nan Huang
- School of Materials Science and Engineering, Key Lab of Advanced Technology of Materials of Education Ministry, Southwest Jiaotong University, Chengdu, 610031, China
- GuangZhou Nanchuang Mount Everest Company for Medical Science and Technology, Guangzhou, Guangdong, 510670, China
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Zhu Z, Geng Y, Ma L, Yao K, Chang R, Ma Y, Li J. Association between CBS gene T833C, G919A and 844ins68 polymorphisms in the 8th exon region and coronary artery disease: a meta-analysis. Clin Exp Hypertens 2024; 46:2328147. [PMID: 38488417 DOI: 10.1080/10641963.2024.2328147] [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: 06/02/2023] [Accepted: 03/01/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Several studies indicate that the cystathionine β-synthase (CBS) gene T833C, G919A and 844ins68 polymorphisms in the 8th exon region may be correlated with coronary artery disease (CAD) susceptibility, but the results have been inconsistent and inconclusive. Thus, a meta-analysis was conducted to provide a comprehensive estimate of these associations. METHODS On the basis of searches in the PubMed, EMBASE, Cochrane Library, Wanfang, VIP, and CNKI databases, we selected 14 case - control studies including 2123 cases and 2368 controls for this meta-analysis. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated accordingly using a fixed-effect or random-effect model. RESULTS The results indicated an increased risk between the CBS T833C gene polymorphisms and susceptibility to CAD under the dominant model (CC+CT vs. TT: OR = 1.92, 95% CI: 1.11 ~ 3.32), recessive model (CC vs. CT+TT: OR = 1.88, 95% CI: 1.17 ~ 3.03), and homozygous model (CC vs. TT: OR = 2.46, 95% CI: 1.04 ~ 5.83). In these three genetic models, no significant association was identified for CBS G919A (AA+AG vs. GG: OR = 1.48, 95% CI: 0.45 ~ 4.82),(AA vs. AG+GG: OR = 1.58, 95% CI: 0.93 ~ 2.70),(AA vs. GG: OR = 1.66, 95% CI: 0.40 ~ 6.92) or CBS 844ins68 (II+ID vs. DD: OR = 1.04, 95% CI: 0.80 ~ 1.35),(II vs. ID+DD: OR = 1.09, 95% CI: 0.51 ~ 2.36),(II vs. DD: OR = 1.10, 95% CI: 0.51 ~ 2.39). CONCLUSIONS This meta-analysis suggests that the CBS T833C gene polymorphism is significantly associated with the risk of CAD and it shows a stronger association in Asian populations. Individuals with the C allele of the CBS gene T833C polymorphism might be particularly susceptible to CAD.
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Affiliation(s)
- Zijiang Zhu
- Department of thoracic surgery, Gansu Provincial Central Hospital (Gansu Provincial Maternity and Child-care Hospital), Lanzhou, China
| | - Yuhan Geng
- School of Clinical Medicine, Ningxia Medical University, Yinchuan, China
| | - Long Ma
- Department of thoracic surgery, Gansu Provincial Central Hospital (Gansu Provincial Maternity and Child-care Hospital), Lanzhou, China
- Department of thoracic surgery, Gansu University of Chinese Medicine, Lanzhou, China
| | - Keying Yao
- School of Second Clinical Medical, Lanzhou University, Lanzhou, China
| | - Ruitong Chang
- Department of thoracic surgery, Gansu Provincial Central Hospital (Gansu Provincial Maternity and Child-care Hospital), Lanzhou, China
| | - Yongming Ma
- Department of thoracic surgery, Gansu Provincial Central Hospital (Gansu Provincial Maternity and Child-care Hospital), Lanzhou, China
- Department of thoracic surgery, Gansu University of Chinese Medicine, Lanzhou, China
| | - Jialong Li
- Department of thoracic surgery, Gansu Provincial Central Hospital (Gansu Provincial Maternity and Child-care Hospital), Lanzhou, China
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Yang S, Pi J, Ma W, Gu W, Zhang H, Xu A, Liu Y, Shi T, Yang F, Chen L. Prognostic value of the fibrinogen-to-albumin ratio (FAR) in patients with chronic heart failure across the different ejection fraction spectrum. Libyan J Med 2024; 19:2309757. [PMID: 38290043 PMCID: PMC10829812 DOI: 10.1080/19932820.2024.2309757] [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: 11/14/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
The ratio of fibrinogen to albumin (FAR) is considered a new inflammatory biomarker and a predictor of cardiovascular disease risk. However, its prognostic value for patients with chronic heart failure (CHF) with different ejection fractions (EFs) remains unclear. A total of 916 hospitalized patients with CHF from January 2017 to October 2021 in the First Affiliated Hospital of Kunming Medical University were included in the study. Death occurred in 417 (45.5%) patients out of 916 patients during a median follow-up time of 750 days. Among these patients, 381 patients suffered from HFrEF (LVEF <40%) and 535 patients suffered from HFpEF or HFmrEF (HFpEF plus HFmrEF, LVEF ≥ 40%). Patients were categorized into high-level FAR (FAR-H) and low-level FAR (FAR-L) groups based on the optimal cut-off value of FAR (9.06) obtained from receiver operating characteristic (ROC) curve analysis. Upon analysing the Kaplan - Meier plots, the incidence of death was significantly higher in all patients with FAR-H and patients in both HF subgroups (p < 0.001). The multivariate Cox proportional hazard analyses indicated that the FAR was an independent predictor of all-cause mortality, regardless of heart failure subtype. (HR 1.115, 95% CI 1.089-1.142, p < 0.001; HFpEF plus HFmrEF, HR 1.109, 95% CI 1.074-1.146, p < 0.0001; HFrEF, HR 1.138, 95% CI 1.094-1.183, p < 0.0001) The optimal cut-off value of FAR in predicting all-cause mortality was 9.06 with an area under the curve value of 0.720 (95% CI: 0.687-0.753, p < 0.001), a sensitivity of 68.8% and a specificity of 65.6%. After adjusting for the traditional indicators (LVEF, Lg BNP, etc.), the new model with the FAR had better prediction ability in patients with CHF. Elevated FAR is an independent predictor of death in CHF and is not related to the HF subtype.
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Affiliation(s)
- Sirui Yang
- Department of Cardiology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Jiangyuan Pi
- Graduate School of Kunming Medical University, Kunming, China
| | - Wenfang Ma
- Department of Cardiology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Wenyi Gu
- Department of Cardiology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Hongxing Zhang
- Department of Cardiology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Anyu Xu
- Department of Cardiology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Yanqing Liu
- Department of Cardiology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Tao Shi
- Department of Cardiology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Fazhi Yang
- Department of Cardiology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Lixing Chen
- Department of Cardiology, Kunming Medical University First Affiliated Hospital, Kunming, China
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Banks NF, Rogers EM, Helwig NJ, Schwager LE, Alpers JP, Schulte SL, Trachta ER, Lockwood CM, Jenkins ND. Acute effects of commercial energy drink consumption on exercise performance and cardiovascular safety: a randomized, double-blind, placebo-controlled, crossover trial. J Int Soc Sports Nutr 2024; 21:2297988. [PMID: 38197606 PMCID: PMC10783828 DOI: 10.1080/15502783.2023.2297988] [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: 07/11/2023] [Accepted: 12/16/2023] [Indexed: 01/11/2024] Open
Abstract
The aim of this study was to examine the acute effects of a non-caloric energy drink (C4E) compared to a traditional sugar-containing energy drink (MED) and non-caloric placebo (PLA) on exercise performance and cardiovascular safety. Thirty healthy, physically active males (25 ± 4 y) completed three experimental visits under semi-fasted conditions (5-10 h) and in randomized order, during which they consumed C4E, MED, or PLA matched for volume, appearance, taste, and mouthfeel. One hour after drink consumption, participants completed a maximal, graded exercise test (GXT) with measurement of pulmonary gases, an isometric leg extension fatigue test (ISOFTG), and had their cardiac electrical activity (ECG), leg blood flow (LBF), and blood pressure (BP) measured throughout the visit. Neither MED nor C4E had an ergogenic effect on maximal oxygen consumption, time to exhaustion, or peak power during the GXT (p > 0.05). Compared to PLA, MED reduced fat oxidation (respiratory exchange ratio (RER) +0.030 ± 0.01; p = 0.026) during the GXT and did not influence ISOFTG performance. Compared to PLA, C4E did not alter RER (p = 0.94) and improved impulse during the ISOFTG (+0.658 ± 0.25 V·s; p = 0.032). Relative to MED, C4E did not significantly improve gas exchange threshold (p = 0.05-0.07). Both MED and C4E increased systolic BP at rest (+7.1 ± 1.2 mmHg; p < 0.001 and + 5.7 ± 1.0 mmHg; p < 0.001, respectively), C4E increased SBP post-GXT (+13.3 ± 3.8 mmHg; p < 0.001), and MED increased SBP during recovery (+3.2 ± 1.1 mmHg; p < 0.001). Neither MED nor C4E influenced ECG measures (p ≥ 0.08) or LBF (p = 0.37) compared to PLA. C4E may be more efficacious for improving performance in resistance-type tasks without altering fat oxidation under semi-fasted conditions during fatiguing exercise bouts, but promotes similar changes in BP and HR to MED.
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Affiliation(s)
- Nile F. Banks
- University of Iowa, Integrative Laboratory of Applied Physiology and Lifestyle Medicine, Iowa City, IA, USA
| | - Emily M. Rogers
- University of Iowa, Integrative Laboratory of Applied Physiology and Lifestyle Medicine, Iowa City, IA, USA
| | - Nate J. Helwig
- University of Iowa, Integrative Laboratory of Applied Physiology and Lifestyle Medicine, Iowa City, IA, USA
| | - Laura E. Schwager
- University of Iowa, Integrative Laboratory of Applied Physiology and Lifestyle Medicine, Iowa City, IA, USA
| | - Justin P. Alpers
- University of Iowa, Integrative Laboratory of Applied Physiology and Lifestyle Medicine, Iowa City, IA, USA
| | - Sydni L. Schulte
- University of Iowa, Integrative Laboratory of Applied Physiology and Lifestyle Medicine, Iowa City, IA, USA
| | - Emma R. Trachta
- University of Iowa, Integrative Laboratory of Applied Physiology and Lifestyle Medicine, Iowa City, IA, USA
| | | | - Nathaniel D.M. Jenkins
- University of Iowa, Integrative Laboratory of Applied Physiology and Lifestyle Medicine, Iowa City, IA, USA
- University of Iowa, Abboud Cardiovascular Research Center, Iowa City, IA, USA
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Wu CK, Yar N, Chen YY. Continuous aspirin treatment improves cardiovascular events and all-cause mortality in hemodialysis patients with peripheral artery disease. Ren Fail 2024; 46:2380754. [PMID: 39039846 PMCID: PMC11268230 DOI: 10.1080/0886022x.2024.2380754] [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: 02/08/2024] [Accepted: 07/11/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND Hemodialysis (HD) patients with peripheral arterial disease (PAD) are at heightened risk of adverse vascular events, and aspirin positively affects those outcomes. We aimed to investigate the association between different patterns of aspirin use and clinical vascular events in chronic HD patients with PAD. METHODS This retrospective nationwide cohort study enrolled 758 chronic HD patients who had been diagnosed with PAD between January 1, 2008, and December 31, 2012, and followed up until the end of 2020. Patients were divided into three groups according to medication possession ratio (MPR) and continued use of aspirin (i.e., low MPR, high MPR but discontinuous prescription, and high MPR and continuous prescription). Percutaneous transluminal angioplasty (PTA), surgical bypass, lower leg amputation, cardiovascular events, cerebrovascular events, and all-cause mortality were evaluated. RESULTS High MPR and continuous aspirin use had the lowest incidence of all-cause mortality and cardiovascular events compared with the two other groups, and it was significantly associated with low risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality (aHR: 0.58 [0.41-0.83], 0.49 [0.25-0.95], 0.57 [0.40-0.81], and 0.70 [0.55-0.88], respectively). Kaplan-Meier analysis revealed that event-free rates of PTA, cardiovascular events, and all-cause mortality of patients with high MPR and continuous aspirin treatment were the highest among the three groups (p < 0.05). CONCLUSION Among HD patients with PAD, high MPR and continuous aspirin use significantly reduced the risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality and improved the event-free rates of PTA, cardiovascular events, and all-cause mortality during long-term follow-up.
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Affiliation(s)
- Chung-Kuan Wu
- Division of Nephrology, Department of Internal Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Noi Yar
- College of Management, School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Yun-Yi Chen
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Research, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan, Taipei, Taiwan
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Liang X, Guo F, Zhang M, Wang C, Lin N, Liu L, Chen Y, Liu F, Du Y, Li L, Li X. Risk factors for cardiovascular diseases in patients with vitiligo: an analysis of current evidence. Ann Med 2024; 56:2326297. [PMID: 39300810 PMCID: PMC11418058 DOI: 10.1080/07853890.2024.2326297] [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] [Received: 02/03/2023] [Revised: 02/07/2024] [Accepted: 02/16/2024] [Indexed: 09/22/2024] Open
Abstract
OBJECTIVE The relationship between vitiligo and cardiovascular diseases remains controversial. This study aimed to systematically review the evidence comparing cardiovascular disease risk factors between patients with vitiligo and controls and to perform a meta-analysis of the results. DATA SOURCES A comprehensive database search was performed for all studies in PubMed, EMBASE, and Cochrane Central Register databases from inception to November, 2023. The main keywords used were vitiligo, hypertension, diabetes, hyperlipidemia, metabolic syndrome, obesity, smoking, alcohol consumption, C-reactive protein, and homocysteine. STUDY SELECTION Only observational studies and no randomized controlled trials were included. Of the 1269 studies initially selected, the full texts of 108 were assessed for eligibility, and 74 were ultimately included in the analysis. DATA EXTRACTION AND SYNTHESIS Three reviewers independently extracted the following data: study design, number and characteristics of participants, inclusion indicators, and disease duration. A meta-analysis of the single-group rates was performed for the diabetes, hypertension, hyperlipidemia, and obesity groups. Random-effects or fixed-effects models were used to calculate the sample-size weighted averages for the indicators included in the studies. MAIN OUTCOMES AND MEASURES The primary outcomes were co-morbidity analysis and co-morbidity rates of vitiligo with metabolic syndrome, obesity, hyperlipidemia, hypertension, and diabetes mellitus. Secondary outcomes were factors associated with vitiligo and cardiovascular disease. RESULTS This meta-analysis concluded that comorbidities in patients with vitiligo included metabolic syndrome, diabetes, obesity, hyperlipidemia, and hypertension, with comorbidity rates of 28.3%, 6.0%, 38.5%, 43.0%, and 15.8%, respectively. Simultaneously, we showed that the vitiligo group differed significantly from the control group in the following aspects: fasting blood glucose, insulin, systolic and diastolic blood pressure, total cholesterol, triglycerides, low-density lipoprotein, high-density lipoprotein, homocysteine, C-reactive protein, smoking, and alcohol consumption. However, no significant differences were observed between the vitiligo and control groups in terms of waist circumference, body mass index, or phospholipid levels. LIMITATIONS The vast majority of the studies were from Eastern countries; therefore, extrapolation of these results to Western populations is questionable. The significant heterogeneity may be due to different protocols, doses, durations, center settings, population registries, etc., which severely compromise the validity of the results. CONCLUSION This study summarized not only the factors associated with, but also those not associated with, cardiovascular disease in patients with vitiligo. This study provides a foundation for the prevention and treatment of cardiovascular disease in patients with vitiligo.
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Affiliation(s)
- Xin Liang
- Chinese Medicine Department, Songnan Town Community Health Service Center, Shanghai, China
| | - Fei Guo
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Miao Zhang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Chunxiao Wang
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Naixuan Lin
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Li Liu
- Chinese Medicine Department, Songnan Town Community Health Service Center, Shanghai, China
| | - Yan Chen
- Chinese Medicine Department, Songnan Town Community Health Service Center, Shanghai, China
| | - Fang Liu
- Chinese Medicine Department, Songnan Town Community Health Service Center, Shanghai, China
| | - Yuhua Du
- Chinese Medicine Department, Songnan Town Community Health Service Center, Shanghai, China
| | - Lei Li
- Chinese Medicine Department, Songnan Town Community Health Service Center, Shanghai, China
| | - Xin Li
- Chinese Medicine Department, Songnan Town Community Health Service Center, Shanghai, China
- Department of Dermatology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Dermatology, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
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Ashraf T, Aamir KF, Nadeem A, Hassan MU, Raza H, Rauf MA, Din JU, Shah S, Khan F, Akram Z, Ishaque M, Hanif B. Impact of educational intervention on hypertension management by primary care physician: A randomized control trial. PEC INNOVATION 2024; 4:100285. [PMID: 38737890 PMCID: PMC11087987 DOI: 10.1016/j.pecinn.2024.100285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 03/14/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
Objective The current study aimed to observe hypertension educational intervention's effect on general physicians (GPs) to improve blood pressure control and patient outcomes indirectly. Methods This randomized control trial includes 42 GPs divided into 2 groups. GPs in group 1 receive face-to-face education with structured educational material on hypertension management strategies by a senior cardiologist. GPs in group 2 receive the print version of education material. The data was collected from six major cities in Pakistan. GPs with at least three years of experience in the broad primary care disciplines, with ages above 18 years, were included in the study. Results A total of 42 physicians (21 from each group) completed questionnaires, while out of 420 hypertension patients, 105 newly diagnosed and already diagnosed patients enrolled under physicians of both groups. The educational material did just as well at informing clinicians as the face-to-face group intervention did and both the interventions had a significant effect on knowledge and BP control. Conclusion After the 3-month follow-up, both interventions, including face-to-face and educational approaches, demonstrated significant effectiveness in improving knowledge and blood pressure control. Innovation The study shows that hypertension educational intervention's effect on general physicians indirectly improves blood pressure control and patient outcomes. And emphasize for developing a hypertension educational program targeted at general physicians.
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Affiliation(s)
- Tariq Ashraf
- Karachi Institute of Heart Disease, Karachi, Pakistan
| | | | - Asif Nadeem
- Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
| | | | - Haseeb Raza
- Mukhtar A. Sheikh Hospital, Multan, Pakistan
| | | | - Jalal Ud Din
- Bolan Medical Complex Hospital, Quetta, Pakistan
| | | | - Fayza Khan
- Health Icon Medical Centre, Karachi, Pakistan
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Moiz A, Zolotarova T, Eisenberg MJ. Outpatient management of essential hypertension: a review based on the latest clinical guidelines. Ann Med 2024; 56:2338242. [PMID: 38604225 PMCID: PMC11011233 DOI: 10.1080/07853890.2024.2338242] [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] [Received: 08/29/2023] [Accepted: 03/15/2024] [Indexed: 04/13/2024] Open
Abstract
Background: Essential hypertension, a prevalent cardiovascular condition, poses a significant health burden worldwide. Based on the latest American clinical guidelines, half of adults in the United States have hypertension. Of these, only about a half are treated and about a quarter are adequately controlled for hypertension. Given its impact on morbidity and mortality, ensuring effective management of high blood pressure is crucial to reduce associated risks and improve patient outcomes.Objective: This review aims to provide a comprehensive and up-to-date summary of the latest cardiology guidelines and evidence-based research on essential hypertension, with a focus on guiding outpatient clinical practice.Methods: The review evaluates both non-pharmacological approaches and pharmacological interventions to offer clinicians practical insights. Notably, it emphasizes the importance of individualized treatment plans tailored to patients' specific risk profiles and comorbidities.Results: By consolidating the latest advancements in hypertension management, this review provides clinicians with an up-to-date reference, offering a nuanced understanding of treatment goals and strategies.Conclusion: Through the incorporation of evidence-based recommendations, healthcare practitioners can optimize patient care, mitigate potential complications, and improve overall outcomes in essential hypertension.
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Affiliation(s)
- Areesha Moiz
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Tetiana Zolotarova
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Mark J. Eisenberg
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
- Department of Medicine and Health Sciences, McGill University, Montreal, Canada
- Departments of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Canada
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Kavlie TL, Kildahl HA, Dalen H, Nordhaug DO, Slagsvold KH, Grenne BL, Holte E. Five-year outcomes of mitral valve repair for leaflet prolapse at a medium-sized Norwegian university hospital. SCAND CARDIOVASC J 2024; 58:2379336. [PMID: 39049811 DOI: 10.1080/14017431.2024.2379336] [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] [Received: 01/11/2024] [Revised: 05/20/2024] [Accepted: 07/08/2024] [Indexed: 07/27/2024]
Abstract
Objective. To evaluate patient characteristics and 5-year outcomes after surgical mitral valve (MV) repair for leaflet prolapse at a medium-sized cardiothoracic center. Background. Contemporary reports on the outcome of MV repair at medium-sized cardiothoracic centers are sparse. Methods. Patients receiving open-heart surgery with MV repair due to primary mitral regurgitation caused by leaflet prolapse between 2015 and 2021, without active endocarditis, were included. Clinical data, complications, re-interventions, mortality, and echocardiographic data were retrospectively registered from electronical patient charts, both pre-operatively and from post-operative follow-ups. Results. One hundred and three patients were included, 83% male, with a mean age of 62 years. All-cause mortality was 9% during a median follow-up time of 4.9 years. Re-intervention rate on the MV was 4%. Post-operative complications before last available follow-up visit at median 3.0 years were infrequent, with new-onset atrial fibrillation/flutter in 16%, post-operative MV regurgitation grade II or above in 17% and post-operative tricuspid regurgitation grade II or above in 14%. Conclusions. These data demonstrate that surgical MV repair for leaflet prolapse at a medium-sized cardiothoracic center was associated with low re-intervention rate and few severe complications. The presented results are comparable to data from surgical high-volume centers, indicating that surgical MV repair can be safely performed at selected medium-sized cardiothoracic centers.
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Affiliation(s)
- Trym Løvseth Kavlie
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Henrik Agerup Kildahl
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Thoracic Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Dag Ole Nordhaug
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Thoracic Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Katrine Hordnes Slagsvold
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Thoracic Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Bjørnar Leangen Grenne
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Espen Holte
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
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10
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Zeghbib W, Boudjouan F, Carneiro J, Oliveira ALS, Sousa SF, Pintado ME, Ourabah A, Vasconcelos V, Lopes G. LC-ESI-UHR-QqTOF-MS/MS profiling and anti-inflammatory potential of the cultivated Opuntia ficus-indica (L.) Mill. and the wild Opuntia stricta (Haw.) Haw. fruits from the Algerian region. Food Chem 2024; 460:140414. [PMID: 39084103 DOI: 10.1016/j.foodchem.2024.140414] [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: 12/28/2023] [Revised: 06/21/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024]
Abstract
Opuntia plants are abundant but still underexplored edible resources of the Algerian region. This work chemically characterizes extracts of different parts of the fruit of the commercial Opuntia ficus-indica (L.) Mill. and the wild Opuntia stricta (Haw.) Haw. growing in Bejaia, and evaluates their anti-inflammatory potential through different cell and cell-free bioassays. The LC-ESI-UHR-QqTOF-MS/MS analysis enabled the identification of 18 compounds, with azelaic acid and 1-O-vanilloyl-β-d-glucose reported here for the first time. Aqueous extracts of seeds were the most effective in scavenging superoxide anion radical (IC50 = 111.08 μg/mL) and presented the best anti-inflammatory potential in LPS-stimulated macrophages (IC50 = 206.30 μg/mL). The pulp of O. stricta suggested potential for addressing post-inflammatory hyperpigmentation, with piscidic and eucomic acids predicted with the strongest binding affinity towards tyrosinase, exhibiting higher scoring values than the reference inhibitor kojic acid. This pioneer study brings valuable perspectives for the pharmacological, nutritional and economic valorization of the wild O. stricta for functional foods.
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Affiliation(s)
- Walid Zeghbib
- Université de Bejaia, Faculté des Sciences de la Nature et de la Vie, Laboratoire de Biochimie Appliquée, 06000 Bejaia, Algeria; CIIMAR-Interdisciplinary Centre of Marine and Environmental Research, Terminal de Cruzeiros do Porto de Leixões, Avenida General Norton de Matos s/n, 4450-208 Matosinhos, Portugal.
| | - Fares Boudjouan
- Université de Bejaia, Faculté de Technologie, Laboratoire de Génie de l'Environnement, 06000 Bejaia, Algeria; Université de Bejaia, Faculté des Sciences de la Nature et de la Vie, Département de Biotechnologie, 06000, Bejaia, Algeria.
| | - João Carneiro
- CIIMAR-Interdisciplinary Centre of Marine and Environmental Research, Terminal de Cruzeiros do Porto de Leixões, Avenida General Norton de Matos s/n, 4450-208 Matosinhos, Portugal.
| | - Ana L S Oliveira
- CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal.
| | - Sérgio F Sousa
- LAQV@REQUIMTE, BioSIM, Departamento de Biomedicina, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Manuela Estevez Pintado
- CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal.
| | - Asma Ourabah
- Université de Bejaia, Faculté des Sciences de la Nature et de la Vie, Laboratoire de Biochimie Appliquée, 06000 Bejaia, Algeria.
| | - Vitor Vasconcelos
- CIIMAR-Interdisciplinary Centre of Marine and Environmental Research, Terminal de Cruzeiros do Porto de Leixões, Avenida General Norton de Matos s/n, 4450-208 Matosinhos, Portugal; FCUP-Faculty of Sciences, University of Porto, Rua do Campo Alegre s/n, 4169-007 Porto, Portugal.
| | - Graciliana Lopes
- CIIMAR-Interdisciplinary Centre of Marine and Environmental Research, Terminal de Cruzeiros do Porto de Leixões, Avenida General Norton de Matos s/n, 4450-208 Matosinhos, Portugal.
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11
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Kho E, Schenk J, Vlaar APJ, Vis MM, Wijnberge M, Stam LB, van Mourik M, Jorstad HT, Hermanns H, Westerhof BE, Veelo DP, van der Ster BJP. Detecting aortic valve stenosis based on the non-invasive blood pressure waveform-a proof of concept study. GeroScience 2024; 46:5955-5965. [PMID: 38509415 DOI: 10.1007/s11357-024-01136-w] [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: 04/14/2023] [Accepted: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
The incidence of aortic valve stenosis (AoS) increases with age, and once diagnosed, symptomatic severe AoS has a yearly mortality rate of 25%. AoS is diagnosed with transthoracic echocardiography (TTE), however, this gold standard is time consuming and operator and acoustic window dependent. As AoS affects the arterial blood pressure waveform, AoS-specific waveform features might serve as a diagnostic tool. Aim of the present study was to develop a novel, non-invasive, AoS detection model based on blood pressures waveforms. This cross-sectional study included patients with AoS undergoing elective transcatheter or surgical aortic valve replacement. AoS was determined using TTE, and patients with no or mild AoS were labelled as patients without AoS, while patients with moderate or severe AoS were labelled as patients with AoS. Non-invasive blood pressure measurements were performed in awake patients. Ten minutes of consecutive data was collected. Several blood pressure-based features were derived, and the median, interquartile range, variance, and the 1st and 9th decile of the change of these features were calculated. The primary outcome was the development of a machine-learning model for AoS detection, investigating multiple classifiers and training on the area under the receiver-operating curve (AUROC). In total, 101 patients with AoS and 48 patients without AoS were included. Patients with AoS showed an increase in left ventricular ejection time (0.02 s, p = 0.001), a delayed maximum upstroke in the systolic phase (0.015 s, p < 0.001), and a delayed maximal systolic pressure (0.03 s, p < 0.001) compared to patients without AoS. With the logistic regression model, a sensitivity of 0.81, specificity of 0.67, and AUROC of 0.79 were found. The majority of the population without AoS was male (85%), whereas in the population with AoS this was evenly distributed (54% males). Age was significantly (5 years, p < 0.001) higher in the population with AoS. In the present study, we developed a novel model able to distinguish no to mild AoS from moderate to severe AoS, based on blood pressure features with high accuracy. Clinical registration number: The study entailing patients with TAVR treatment was registered at ClinicalTrials.gov (NCT03088787, https://clinicaltrials.gov/ct2/show/NCT03088787 ). The study with elective cardiac surgery patients was registered with the Netherland Trial Register (NL7810, https://trialsearch.who.int/Trial2.aspx?TrialID=NL7810 ).
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Affiliation(s)
- Eline Kho
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Jimmy Schenk
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Laboratory of Experimental Intensive Care and Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Marije M Vis
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Marije Wijnberge
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Lotte B Stam
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Martijn van Mourik
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Harald T Jorstad
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Henning Hermanns
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Berend E Westerhof
- Department of Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, Netherlands
| | - Denise P Veelo
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
| | - Bjorn J P van der Ster
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
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12
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Ding P, Chen F, Qi J, Peng W, Wu K, Ding J, Ye M, Hu L, Xu J, Mo X. Perioperative Brain Injury in Children with Aortic Arch Anomalies: A Retrospective Study of Risk Factors and Outcomes. Pediatr Cardiol 2024; 45:1659-1667. [PMID: 37561170 DOI: 10.1007/s00246-023-03246-2] [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] [Received: 04/20/2023] [Accepted: 07/20/2023] [Indexed: 08/11/2023]
Abstract
Complex pediatric cardiac disease is associated with brain impairment and neurodevelopmental disorders, particularly in patients requiring cardiac surgery for aortic arch anomalies. This study examines the incidence, risk factors, and outcomes of perioperative brain injury in children undergoing aortic arch repair who had aortic arch anomalies. A total of 145 children with aortic arch anomalies in our center undergoing aortic arch repair between January 2014 and December 2022 were enrolled. There were 129 (89.0%) with coarctation of the aorta (COA) and 16 (9.7%) with interrupted aortic arch (IAA). Risk factor analysis of brain injuries was done using perioperative imaging and included symptoms of hemorrhagic stroke, arterial ischemic stroke, white matter injury, cerebral sinus venous thrombosis, and other pathologies. Preoperatively, 50/145 (34.5%) patients had brain injuries. Multivariate analysis showed that an increased risk of hemorrhagic stroke was associated with newborns (odds ratio [OR], 2.09 [95% CI 0.08-3.50]), isolated COA (OR, 3.69 [95% CI 1.23-7.07]), mechanical ventilation (MV) ([OR, 2.56 [95% CI 1.25-4.03]), and sepsis (OR, 1.73 [95% CI 0.46-3.22]). Newborns ([OR, 1.91 [95% Cl 0.58-3.29]) and weight-for-age z score ([OR, -0.45 [95% CI -0.88 to -0.1]) were associated with an increased risk of white matter injury. New postoperative brain injuries were present in 12.9% of the patients (16/124). Deep hypothermic circulatory arrest (DHCA) was associated with new postoperative brain injuries compared with deep hypothermic low-flow (DHLF) plus antegrade cerebral perfusion (ACP) (([OR, 2.67 [95% CI, 0.58-5.75])). Isolated COA was almost associated with new postoperative brain injuries (OR, 1.13 [95% CI, -0.04 to 2.32]). Children diagnosed with isolated COA appeared to have a higher risk of perioperative brain injury, but the underlying mechanisms are still unclear. We focused on the intrinsic mechanism by which changes in hemodynamics caused by COA result in perioperative brain injury. Further research will be needed to optimize the personalized treatment and cerebral perfusion techniques for complex pediatric cardiac surgery.
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Affiliation(s)
- Peicheng Ding
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, No. 8 Jiangdongnan Road, JIanyeDistrict, Nanjing, 210008, China
| | - Feng Chen
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, No. 8 Jiangdongnan Road, JIanyeDistrict, Nanjing, 210008, China
| | - Jirong Qi
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, No. 8 Jiangdongnan Road, JIanyeDistrict, Nanjing, 210008, China
| | - Wei Peng
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, No. 8 Jiangdongnan Road, JIanyeDistrict, Nanjing, 210008, China
| | - Kaihong Wu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, No. 8 Jiangdongnan Road, JIanyeDistrict, Nanjing, 210008, China
| | - Jie Ding
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, No. 8 Jiangdongnan Road, JIanyeDistrict, Nanjing, 210008, China
| | - Mingtang Ye
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, No. 8 Jiangdongnan Road, JIanyeDistrict, Nanjing, 210008, China
| | - Liang Hu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, No. 8 Jiangdongnan Road, JIanyeDistrict, Nanjing, 210008, China
| | - Jiali Xu
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, No. 8 Jiangdongnan Road, JIanyeDistrict, Nanjing, 210008, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, Children's Hospital of Nanjing Medical University, No. 8 Jiangdongnan Road, JIanyeDistrict, Nanjing, 210008, China.
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13
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Xue D, Hajat A, Fohner AE. Conceptual frameworks for the integration of genetic and social epidemiology in complex diseases. GLOBAL EPIDEMIOLOGY 2024; 8:100156. [PMID: 39104369 PMCID: PMC11299589 DOI: 10.1016/j.gloepi.2024.100156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 06/11/2024] [Accepted: 07/06/2024] [Indexed: 08/07/2024] Open
Abstract
Uncovering the root causes of complex diseases requires complex approaches, yet many studies continue to isolate the effects of genetic and social determinants of disease. Epidemiologic efforts that under-utilize genetic epidemiology methods and findings may lead to incomplete understanding of disease. Meanwhile, genetic epidemiology studies are often conducted without consideration of social and environmental context, limiting the public health impact of genomic discoveries. This divide endures despite shared goals and increases in interdisciplinary data due to a lack of shared theoretical frameworks and differing language. Here, we demonstrate that bridging epidemiological divides does not require entirely new ways of thinking. Existing social epidemiology frameworks including Ecosocial theory and Fundamental Cause Theory, can both be extended to incorporate principles from genetic epidemiology. We show that genetic epidemiology can strengthen, rather than detract from, efforts to understand the impact of social determinants of health. In addition to presenting theoretical synergies, we offer practical examples of how genetics can improve the public health impact of epidemiology studies across the field. Ultimately, we aim to provide a guiding framework for trainees and established epidemiologists to think about diseases and complex systems and foster more fruitful collaboration between genetic and traditional epidemiological disciplines.
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Affiliation(s)
- Diane Xue
- Institute for Public Health Genetics, University of Washington School of Public Health, 1959 NE Pacific St, Room H-690, Seattle, WA 98195, USA
| | - Anjum Hajat
- Department of Epidemiology, University of Washington School of Public Health, Hans Rosling Population Health Building, 3980 15th Ave NE, Seattle, WA 98195, USA
| | - Alison E. Fohner
- Institute for Public Health Genetics, University of Washington School of Public Health, 1959 NE Pacific St, Room H-690, Seattle, WA 98195, USA
- Department of Epidemiology, University of Washington School of Public Health, Hans Rosling Population Health Building, 3980 15th Ave NE, Seattle, WA 98195, USA
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14
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Wetsch WA, Link N, Rahe-Meyer N, Dumcke R, Stock JM, Böttiger BW, Wingen S. Comparison of blended e-learning and face-to-face-only education for resuscitation training in German schools - A cluster randomized-controlled prospective study. Resusc Plus 2024; 20:100767. [PMID: 39309750 PMCID: PMC11415797 DOI: 10.1016/j.resplu.2024.100767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 08/28/2024] [Accepted: 08/30/2024] [Indexed: 09/25/2024] Open
Abstract
Background & Objectives Cardiopulmonary resuscitation (CPR) is the key for surviving cardiac arrest. Recent recommendations propose that CPR can - and should -be taught to schoolchildren. This e-learning-based study analyzes whether face-to-face CPR training can be partly substituted with e-learning by measuring CPR knowledge and self-efficacy in trainees. Methods In this cluster randomized-controlled prospective, students attending grades 5 to 7 of a German secondary school volunteered to participate and were randomly assigned to one of two groups with different methods for CPR training each: a traditional instructor-led group (control) where students received face-to-face teaching by a BLS instructor (45 min), and an e-learning group (intervention) where schoolchildren were able to accomplish their theoretical CPR training using an e-learning module (15 min). CPR knowledge and self-efficacy were measured and compared before (t0) and after (t1) the training using questionnaires. Face-to-face CPR training (45 min) on manikins proceeded in both groups hereafter. The formal hypothesis was that e-learning would result in better CPR knowledge. Results Overall, 375 students participated; 33 of which had to be excluded. 342 participants were included in statistical analysis (instructor-led group n = 109; e-learning group n = 233). The study was terminated early due to the Covid19 pandemic, and did not reach the required number of participants. Lacking statistical power, an analysis of the existing datasets failed to show superiority of e-learning vs. conventional training for CPR knowledge (p = 0.306). Both groups improved CPR knowledge (p < 0.001) and self-efficacy (p < 0.001) after CPR training and showed an equal, high level of satisfaction with their perceived training method (face-to-face: 4.1[4.0-4.2] vs. e-learning: 4.0[3.9-4.1]; p = 0.153; maximum 5 points). Conclusions This study failed to demonstrate superiority for e-learning but was terminated early and hence underpowered. Further research is necessary to prove the efficiency of e-learning tools for CPR.
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Affiliation(s)
- Wolfgang A. Wetsch
- University of Cologne, Faculty of Medicine, Albertus-Magnus-Platz 1, 50931 Cologne, Germany
- University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Nikolas Link
- University of Cologne, Faculty of Medicine, Albertus-Magnus-Platz 1, 50931 Cologne, Germany
| | - Niels Rahe-Meyer
- Franziskus Hospital Bielefeld, Department of Anaesthesiology and Intensive Care Medicine, Kiskerstraße 26, 33615 Bielefeld, Germany
| | - Rico Dumcke
- Bielefeld University, Faculty of Biology, Universitätsstrasse 25, 33615 Bielefeld, Germany
| | | | - Bernd W. Böttiger
- University of Cologne, Faculty of Medicine, Albertus-Magnus-Platz 1, 50931 Cologne, Germany
- University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Sabine Wingen
- University Hospital of Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
- FOM University of Applied Sciences, Agrippinawerft 4, 50678 Cologne, Germany
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15
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El-Abasy HM, Elsaid MEA, Abdelkader EM, Shehatou GSG. Metformin's cardioprotective role in isoprenaline-induced myocardial infarction: Unveiling insights into the AMPK, NF-κB, JAK2/STAT3 pathways, and cholinergic regulation. Life Sci 2024; 357:123115. [PMID: 39369846 DOI: 10.1016/j.lfs.2024.123115] [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: 06/19/2024] [Revised: 10/02/2024] [Accepted: 10/03/2024] [Indexed: 10/08/2024]
Abstract
AIM Despite advancements in treatment modalities, myocardial infarction (MI) remains a significant global cause of mortality and morbidity. Metformin (MET), a commonly used antidiabetic medication, has demonstrated potential in various cardioprotective mechanisms. This study investigated whether MET could alleviate the histopathological, electrocardiographic, and molecular consequences of MI in rats. MATERIALS AND METHODS The study hypothesis was tested using an isoprenaline (ISOP)-induced MI model, where male Wistar rats were injected with ISOP (85 mg/kg/day, s.c., for 2 days) and treated with MET at the doses of 500 and 1000 mg/kg/day for 18 days or left untreated. KEY FINDINGS ISOP-treated rats exhibited several indicators of MI, including significant ST-segment depression and prolonged QT-intervals on ECGs, worsened left ventricular histopathology with increased inflammatory cell infiltration, reduced expression of cardiac CHRM2, a cardioprotective cholinergic receptor, adaptive increases in AMPK and α7nAchR levels, and elevated levels of iNOS, NO, STAT3, JAK2, IL-6, TNF-α, and NF-κB. These effects were attenuated in rats treated with either low or high doses of MET. MET administration restored normal ECG recordings, diminished oxidative stress and inflammatory mediators, and downregulated NF-κB expression. Moreover, MET improved CHRM2 expression and normalized α7nAchR levels. Additionally, MET influenced the expression of key signaling molecules such as Akt, STAT3, and JAK2. SIGNIFICANCE These findings might suggest that MET exerts cardioprotective effects in ISOP-induced MI in rats by mitigating critical inflammatory signaling pathways and regulating protective cholinergic mechanisms in the heart.
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Affiliation(s)
- Hamsa M El-Abasy
- Department of Pharmacology and Biochemistry, Faculty of Pharmacy, Delta University for Science and Technology, International Coastal Road, Gamasa, Dakahliya, Egypt
| | - Mahmoud E A Elsaid
- Department of Pharmacology and Biochemistry, Faculty of Pharmacy, Delta University for Science and Technology, International Coastal Road, Gamasa, Dakahliya, Egypt.
| | - Eman M Abdelkader
- Department of Pharmacology and Biochemistry, Faculty of Pharmacy, Delta University for Science and Technology, International Coastal Road, Gamasa, Dakahliya, Egypt
| | - George S G Shehatou
- Department of Pharmacology and Biochemistry, Faculty of Pharmacy, Delta University for Science and Technology, International Coastal Road, Gamasa, Dakahliya, Egypt; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura, Dakahliya, Egypt
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16
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Hung MJ. Atrial fibrillation and prediabetes: Interplay between left atrium and systemic diseases. World J Diabetes 2024; 15:2242-2244. [DOI: 10.4239/wjd.v15.i11.2242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 09/10/2024] [Accepted: 09/18/2024] [Indexed: 10/16/2024] Open
Abstract
Atrial fibrillation (AF) is associated with multiple other comorbidities, i.e. multimorbidity. Prediabetes is one of the multiple comorbidities observed in patients with AF, whereby these two disease entities share the same pathophysiological mechanisms, namely oxidative stress and inflammation. Although prediabetes is reported to have a negative impact on major adverse cardiac or cerebrovascular events in hospitalized AF patients, information about the interactions between prediabetes and AF remains inconsistent. A more in-depth exploration of pathophysiology and more comprehensive prospective clinical studies of AF and diabetes would provide a thorough understanding of the timing of events and further treatment strategies. Deeper investigations are needed to clarify the interactions and causal relationships between AF and prediabetes.
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Affiliation(s)
- Ming-Jui Hung
- Department of Internal Medicine, Section of Cardiovascular Imaging, Division of Cardiology, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Keelung 204201, Taiwan
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17
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Cui H, Zhang L, Zhu T, Liu R, Yuan X. Headache as the sole clinical manifestation of acute myocardial infarction: one case with cardiac cephalalgia and literature review. Coron Artery Dis 2024; 35:607-613. [PMID: 38870021 DOI: 10.1097/mca.0000000000001394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
OBJECTIVE Cardiac cephalalgia, once seen as a rare symptom of coronary artery disease, is now more recognized. It often comes with chest discomfort and autonomic dysfunction, worsened by physical activity. However, not all cases have chest symptoms or are activity induced. This report presents a case of cardiac cephalalgia and reviews 46 previous cases. METHOD We discuss a unique case where a patient had headache attacks without chest symptoms, autonomic dysfunction, or triggers. We reviewed English case reports of cardiac cephalalgia from 1982 to 2022 using PubMed ( http://www.ncbi.nlm.nih.gov/pubmed ). RESULTS A 69-year-old man presented with a sudden headache without triggers or typical symptoms. Coronary computed tomography angiography (CTA) showed diffuse stenosis in the left anterior descending and the first diagonal branch arteries. His headache improved after percutaneous coronary intervention. Cardiac cephalalgia is usually marked by severe headaches, autonomic signs, and often affects the occipital region. Electrocardiogram (ECG) might not always show abnormalities, and chest pain is not always present. In such cases, elevated cardiac enzymes can be crucial for diagnosis. CONCLUSION When a headache is the sole symptom of an acute coronary event, consider moderate to severe intensity, older age at onset, occipital localization, and autonomic signs. ECG, cardiac enzymes, and coronary CTA are valuable for accurate diagnosis and treatment.
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Affiliation(s)
- Huili Cui
- Department of Neurology, Zhengzhou People's Hospital Affiliated Henan University of Traditional Chinese Medicine, Zhengzhou, China
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18
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Tembelis M, Blumberg G, Colon-Flores L, Hong J, Hoffmann JC, Katz DS. Potpourri of Contrast Controversies and Myths: Where Is the Actual Evidence? Radiol Clin North Am 2024; 62:971-978. [PMID: 39393855 DOI: 10.1016/j.rcl.2024.04.007] [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: 10/13/2024]
Abstract
There are many misconceptions related to the usage of intravenous contrast agents for medical imaging. These misconceptions can affect patient care, as they can lead to nonoptimal examination usage. Knowledge of the current contrast-related misconceptions can help radiologists provide higher quality care to their patients.
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Affiliation(s)
- Miltiadis Tembelis
- Department of Radiology, NYU Grossman Long Island School of Medicine, NYU Langone Hospital - Long Island, 259 First Street, Mineola, NY 11501, USA.
| | - Gregg Blumberg
- Department of Radiology, NYU Grossman Long Island School of Medicine, NYU Langone Hospital - Long Island, 259 First Street, Mineola, NY 11501, USA
| | - Luis Colon-Flores
- Department of Radiology, NYU Grossman Long Island School of Medicine, NYU Langone Hospital - Long Island, 259 First Street, Mineola, NY 11501, USA
| | - Julie Hong
- Department of Surgery, New York-Presbyterian Queens Hospital, Flushing, NY, USA
| | - Jason C Hoffmann
- Department of Radiology, NYU Grossman Long Island School of Medicine, NYU Langone Hospital - Long Island, 259 First Street, Mineola, NY 11501, USA
| | - Douglas S Katz
- Department of Radiology, NYU Grossman Long Island School of Medicine, NYU Langone Hospital - Long Island, 259 First Street, Mineola, NY 11501, USA
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19
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Lopes Soares L, Portes AMO, Costa SFF, Leite LB, Natali AJ. Autonomic Dysregulation in Pulmonary Hypertension: Role of Physical Exercise. Hypertension 2024; 81:2228-2236. [PMID: 39234679 DOI: 10.1161/hypertensionaha.124.23573] [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: 09/06/2024]
Abstract
Pulmonary hypertension (PH) is a rare and severe condition characterized by increased pressure in the pulmonary circulation, often resulting in right ventricular failure and death. The autonomic nervous system (ANS) plays a crucial role in the cardiovascular and pulmonary controls. Dysfunction of ANS has been implicated in the pathogenesis of cardiopulmonary diseases. Conversely, dysfunctions in ANS can arise from these diseases, impacting cardiac and pulmonary autonomic functions and contributing to disease progression. The complex interaction between ANS dysfunction and PH plays a crucial role in the disease progression, making it essential to explore interventions that modulate ANS, such as physical exercise, to improve the treatment and prognosis of patients with PH. This review addresses autonomic dysfunctions found in PH and their implications for the cardiopulmonary system. Furthermore, we discuss how physical exercise, a significant modulator of ANS, may contribute to the prognosis of PH. Drawing from evidence of aerobic and resistance exercise training in patients and experimental models of PH, potential cardiovascular benefits of exercise are presented. Finally, we highlight emerging therapeutic targets and perspectives to better cope with the complex condition. A comprehensive understanding of the interaction between ANS and PH, coupled with targeted physical exercise interventions, may pave the way for innovative therapeutic strategies and significantly improve the treatment and prognosis of vulnerable patients.
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Affiliation(s)
- Leôncio Lopes Soares
- Department of Physical Education, Federal University of Viçosa, Minas Gerais, Brazil (L.L.S., S.F.F.C., L.B.L., A.J.N.)
| | | | | | - Luciano Bernardes Leite
- Department of Physical Education, Federal University of Viçosa, Minas Gerais, Brazil (L.L.S., S.F.F.C., L.B.L., A.J.N.)
| | - Antônio José Natali
- Department of Physical Education, Federal University of Viçosa, Minas Gerais, Brazil (L.L.S., S.F.F.C., L.B.L., A.J.N.)
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20
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Wang H, Lin P. Evaluation of ventricular repolarization in dermatomyositis and relationship with inflammation and autoimmunity. Heart Vessels 2024; 39:979-987. [PMID: 38748241 DOI: 10.1007/s00380-024-02413-6] [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] [Received: 11/13/2023] [Accepted: 05/09/2024] [Indexed: 10/19/2024]
Abstract
Dermatomyositis (DM) is a chronic multi-systemic inflammatory disorder of autoimmune origin, which has been associated with cardiovascular complications, including ventricular arrhythmias and sudden cardiac death. The Tp-e interval and Tp-e/QT ratio have been accepted as new markers for the assessment of myocardial repolarization and ventricular arrhythmogenesis. The aim of this study was to evaluate ventricular repolarization by using Tp-e interval and Tp-e/QT ratio in patients with DM, and to assess the relation with inflammation and autoimmunity. This study included 281 DM patients (180 females, 101 males; mean age 52.73 ± 15.80 years) and 281 control subjects (180 females, 101 males; mean age 53.38 ± 15.72 years). QTc, Tp-e interval and Tp-e/QT ratio were measured from the 12-lead ECG. The plasma level of blood routine test, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) was measured. These parameters were compared between groups. No statistically significant difference was found between two groups in terms of basic characteristics. In electrocardiographic parameters analysis, QTc, Tp-e interval and Tp-e/QT ratio were significantly increased in DM patients compared to the control group (441.44 ± 26.62 ms vs 422.72 ± 11.7 ms, 104.16 ± 24.34 ms vs 77.23 ± 16.25 ms and 0.27 ± 0.06 ms vs 0.20 ± 0.04 ms, all P value < 0.01). QTc, Tp-e interval and Tp-e/QT were positively correlated with NLR, CRP, and ESR (all P values < 0.01), and were increased in anti-Ro/SSA-52kD positive patients compared to those negative (452.33 ± 24.89 ms vs 438.55 ± 26.37 ms, 114.05 ± 22.68 ms vs 101.53 ± 24.13 ms, and 0.29 ± 0.06 ms vs 0.27 ± 0.05 ms, all P value < 0.01). Our study demonstrated that QTc, Tp-e interval, and Tp-e/QT ratio were increased in DM patients and were associated with inflammatory markers and anti-Ro/SSA-52kD positivity.
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Affiliation(s)
- Hui Wang
- Department of Geriatrics, Hangzhou Third People's Hospital, Shangcheng District, Hangzhou City, Zhejiang Province, China
| | - Ping Lin
- Department of Geriatrics, Hangzhou Third People's Hospital, Shangcheng District, Hangzhou City, Zhejiang Province, China.
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21
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Tsuda T, Robinson BW. Beneficial Effects of Exercise on Hypertension-Induced Cardiac Hypertrophy in Adolescents and Young Adults. Curr Hypertens Rep 2024; 26:451-462. [PMID: 38888690 DOI: 10.1007/s11906-024-01313-4] [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] [Accepted: 05/30/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE OF REVIEW Hypertension-induced cardiac hypertrophy is widely known as a major risk factor for increased cardiovascular morbidity and mortality. Although exercise is proven to exert overall beneficial effects on hypertension and hypertension-induced cardiac hypertrophy, there are some concerns among providers about potential adverse effects induced by intense exercise, especially in hypertensive athletes. We will overview the underlying mechanisms of physiological and pathological hypertrophy and delineate the beneficial effects of exercise in young people with hypertension and consequent hypertrophy. RECENT FINDINGS Multiple studies have demonstrated that exercise training, both endurance and resistance types, reduces blood pressure and ameliorates hypertrophy in hypertensives, but certain precautions are required for hypertensive athletes when allowing competitive sports: Elevated blood pressure should be controlled before allowing them to participate in high-intensity exercise. Non-vigorous and recreational exercise are always recommended to promote cardiovascular health. Exercise-induced cardiac adaptation is a benign and favorable response that reverses or attenuates pathological cardiovascular remodeling induced by persistent hypertension. Exercise is the most effective nonpharmacological treatment for hypertensive individuals. Distinction between recreational-level exercise and competitive sports should be recognized by medical providers when allowing sports participation for adolescents and young adults.
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Affiliation(s)
- Takeshi Tsuda
- Nemours Cardiac Center, Nemours Children's Health, 1600 Rockland Rd, Wilmington, DE, 19803, USA.
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadephia, PA, 19107, USA.
| | - Bradley W Robinson
- Nemours Cardiac Center, Nemours Children's Health, 1600 Rockland Rd, Wilmington, DE, 19803, USA
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadephia, PA, 19107, USA
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22
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Connolly BJ, Saxton SN. Recent updates on the influence of iron and magnesium on vascular, renal, and adipose inflammation and possible consequences for hypertension. J Hypertens 2024; 42:1848-1861. [PMID: 39258532 PMCID: PMC11451934 DOI: 10.1097/hjh.0000000000003829] [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: 02/06/2024] [Revised: 06/26/2024] [Accepted: 07/22/2024] [Indexed: 09/12/2024]
Abstract
The inflammatory status of the kidneys, vasculature, and perivascular adipose tissue (PVAT) has a significant influence on blood pressure and hypertension. Numerous micronutrients play an influential role in hypertension-driving inflammatory processes, and recent reports have provided bases for potential targeted modulation of these micronutrients to reduce hypertension. Iron overload in adipose tissue macrophages and adipocytes engenders an inflammatory environment and may contribute to impaired anticontractile signalling, and thus a treatment such as chelation therapy may hold a key to reducing blood pressure. Similarly, magnesium intake has proven to greatly influence inflammatory signalling and concurrent hypertension in both healthy animals and in a model for chronic kidney disease, demonstrating its potential clinical utility. These findings highlight the importance of further research to determine the efficacy of micronutrient-targeted treatments for the amelioration of hypertension and their potential translation into clinical application.
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Affiliation(s)
- Benjamin J Connolly
- Divison of Cardiovascular Sciences, The University of Manchester, Manchester, UK
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23
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Fan G, Zhou C, Hou T, Li X, Wang L, Wang C. Effects of Sacubitril/Valsartan on cardiac function, blood biochemistry and clinical efficacy in early ventricular remodeling after acute myocardial infarction. Biotechnol Genet Eng Rev 2024; 40:1894-1909. [PMID: 37043670 DOI: 10.1080/02648725.2023.2197312] [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: 02/16/2023] [Accepted: 03/24/2023] [Indexed: 04/14/2023]
Abstract
Ventricular remodeling (VR) after acute ST-elevation myocardial infarction (STEMI) is an important predictor for medium- and long-term prognosis. This study focuses on the relevant indexes of VR in patients with AMI, in which, the intervention effects of sacubitril/valsartan and enalapril were compared, guiding the clinical treatment. 58 patients with acute STEMI treated with PCI were divided into research group and control group. UCG was performed at 1 week, 1 month and 3 months after MI, and the patients' indexes were collected to compare VR and adverse reactions in the two groups. The test results showed that there was no statistical difference in the baseline data of patients in the two groups, which were comparable. In the blood biochemical index examination, no statistical difference was found in cTnI and NT-proBNP between the two groups. At 1 week after operation, the levels of cTnI and NT-proBNP in research group were lower than those in the control group. In ECG examination, there was no statistical significance in the levels of LVEF, LVEDD and LVESD at admission between the two groups. After 1 week, the results of LVEF, LVEDD, LVESD in the research group were higher than those in the control group. The results of this study show that sacubitril/valsartan can be used in patients with AMI instead of enalapril. Sacubitril/valsartan improves cardiac function in patients with emergency percutaneous coronary intervention (PCI) for AMI, inhibits ventricular remodeling, and has a low incidence of adverse cardiac events and adverse drug reactions.
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Affiliation(s)
- Guangci Fan
- Department of Cardiovascular (II), Hiser Medical Center of Qingdao, Qingdao Hiser Hospital Affiliated to Qingdao University, Qingdao, Shandong, China
| | - Chunyan Zhou
- Department of Pharmacy, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, Shandong, China
| | - Tingting Hou
- Department of Pharmacy, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, Shandong, China
| | - Xiaowen Li
- Department of Endoscopy Room, Zhangqiu District People's Hospital, Jinan, Shandong, China
| | - Liang Wang
- Department of Trauma Orthopedics, Zhangqiu District People's Hospital, Jinan, Shandong, China
| | - Chenghong Wang
- Department of Clinical Laboratory, Yantaishan Hospital of Yantai, Yantai, Shandong China
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24
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Gunaydin S, McCusker K, Nicotra W. Redosing of long acting cardioplegic solutions in adult cardiac surgery: A comparative study. Perfusion 2024; 39:1685-1691. [PMID: 37965876 DOI: 10.1177/02676591231216315] [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: 11/16/2023]
Abstract
INTRODUCTION Despite promising results regarding using long-acting cardioplegia in the adult population, little data exists specifically for operations requiring prolonged aortic cross-clamp needing additional doses. In this pilot study, we evaluated the outcomes of patients undergoing surgery with prolonged cross-clamp time based on four different redosing compositions. METHODS During the period from January 2019 until June 2022, 288 patients undergoing cardiac surgery with an expected cross-clamp time over 60 min were prospectively randomized regarding the type of the cardioplegia used: Group 1 (N = 150)- single-dose del Nido antegrade cardioplegia and Group 2 (N = 138)- single-dose Histidine-Tryptophane-Ketoglutarate (HTK) antegrade cardioplegia. In patients with ischemic time over 60 min, needing a redosing were further analyzed separately in four subgroups: (A) Cold whole blood (CWB) (4:1) (N = 95); (A1: DN-CWB; A2: HTK-CWB) and (B) St Thomas Solution (N = 92) (B1: DN-St Thomas; B2: HTK-St Thomas. Control groups were C1 (DN redosed by DN) and C2 (HTK by HTK). RESULTS Troponin levels in A1 and B1 groups were significantly lower than in DN-control. Respiratory support time and incidence of atrial fibrillation were significantly lower in Group A1 versus DN-control. CONCLUSIONS Long-acting cardioplegic techniques are becoming widely utilized in the adult population, with minimal data on redosing methods/compositions for prolonged cases. Due to the small patient population, further investigation is needed to delineate optimal redosing methods, but this report brings to attention the initial success of multiple strategies.
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Affiliation(s)
- Serdar Gunaydin
- Department of Cardiac Surgery, University of Health Sciences, Ankara, Turkey
| | - Kevin McCusker
- Department of Clinical Perfusion, Lawrence Technological University, Southfield, Michigan
| | - William Nicotra
- Department of Cardiac Surgery, St Clair Hospital, Pittsburgh, PA, USA
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25
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Dahal K, Lee J. Commentary: Scleroderma and Coronary Vasospasm After Cardiac Surgery: A Serious Combination. J Cardiothorac Vasc Anesth 2024; 38:2817-2818. [PMID: 39122643 DOI: 10.1053/j.jvca.2024.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Affiliation(s)
- Khagendra Dahal
- Division of Cardiology, Creighton University School of Medicine, Omaha, NE.
| | - Juyong Lee
- Division of Cardiology, University of Connecticut Health Center, Farmington, CT
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26
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Ibrahim AOKZ, Prabhakar AP, Lopez-Candales A. QTc Interval: A frequently unrecognized electrocardiographic interval. Am J Med Sci 2024; 368:532-537. [PMID: 38701971 DOI: 10.1016/j.amjms.2024.04.020] [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: 03/14/2023] [Revised: 02/19/2024] [Accepted: 04/29/2024] [Indexed: 05/06/2024]
Abstract
The QT interval, an electrocardiographic temporal representation of the ventricular depolarization and repolarization, is an integral parameter that must be carefully evaluated to gather critical information regarding electrical instability that may cause malignant ventricular dysrhythmias or sudden cardiac death. The QT interval is affected by several inheritable and acquired factors, such as genetic mutations, electrolyte disturbances, and medication interactions. We strongly believe that prompt and accurate recognition of any QT interval abnormalities is critical in many clinical settings. This concise review article highlights the importance of accurate measurement of the QT interval, enhances understanding of the most prevalent factors yielding abnormalities within the QT interval and the prognostic value of the QT interval, as well as provides several key practical reminders for healthcare professionals to strengthen our clinical practice.
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Affiliation(s)
- Ali Osama Kamal Zaki Ibrahim
- Department of Medicine, University Health Truman Medical Center, University of Missouri-Kansas City, Kansas City, MO
| | - Akruti Patel Prabhakar
- Department of Medicine, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Angel Lopez-Candales
- Division of Cardiovascular Diseases, University Health Truman Medical Center, Hospital Hill University of Missouri-Kansas City, 2301 Holmes Street, Kansas City, MO 64108, USA.
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27
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Oksuz F, Yarlioglues M, Karacali K, Erat M, Celik IE, Duran M. Relationship between uric acid to albumin ratio and saphenous vein graft disease in patients with coronary artery bypass graft. Coron Artery Dis 2024; 35:572-576. [PMID: 38704823 DOI: 10.1097/mca.0000000000001378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
OBJECTIVE Saphenous vein graft disease (SVGD) remains a challenging issue for patients with coronary artery bypass grafting (CABG). It is associated with poor outcomes and atherosclerosis is the major cause of SVGD. Uric acid to albumin ratio (UAR) is a new marker which associated with cardiovascular mortality. We aim to evaluate the relationship between the SVGD and UAR. METHODS We retrospectively enrolled 237 patients who underwent elective coronary angiography (CAG) for stable angina or positive stress test results >1 year after CABG. The patients were divided into two groups; SVGD (+) patients and SVGD (-) patients. The SVGD was defined as presence of at least 50% stenosis in at least 1 SVG. RESULTS UAR were significantly higher in the SVGD (+) group ( P < 0.001). Similarly, Hs-CRP, white blood cell count, and neutrophil count were significantly higher in SVGD (+) group ( P = 0.03, P = 0.027 P = 0.01, respectively). In multivariate logistic regression analysis, time interval after CABG [OR = 1.161, 95% confidence interval (CI) 1.078-1.250; P < 0.001] and UAR (OR = 2.691, 95% CI 1.121-6.459; P < 0.001) were found to be independent predictors of SVGD. CONCLUSION Our results suggested that UAR could be a simple and available marker to predict SVGD in patients with CABG who underwent elective percutaneous coronary intervention.
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Affiliation(s)
- Fatih Oksuz
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
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28
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Li Z, Wei H, Li R, Wu B, Xu M, Yang X, Zhang Y, Liu Y. The effects of antihypertensive drugs on glucose metabolism. Diabetes Obes Metab 2024; 26:4820-4829. [PMID: 39140233 DOI: 10.1111/dom.15821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/28/2024] [Accepted: 07/08/2024] [Indexed: 08/15/2024]
Abstract
Abnormal glucose metabolism is a common disease of the endocrine system. The effects of drugs on glucose metabolism have been reported frequently in recent years, and since abnormal glucose metabolism increases the risk of microvascular and macrovascular complications, metabolic disorders, and infection, clinicians need to pay close attention to these effects. A variety of common drugs can affect glucose metabolism and have different mechanisms of action. Hypertension is a common chronic cardiovascular disease that requires long-term medication. Studies have shown that various antihypertensive drugs also have an impact on glucose metabolism. Among them, α-receptor blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and calcium channel blockers can improve insulin resistance, while β-receptor blockers, thiazides and loop diuretics can impair glucose metabolism. The aim of this review was to discuss the mechanisms underlying the effects of various antihypertensive drugs on glucose metabolism in order to provide reference information for rational clinical drug use.
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Affiliation(s)
- Zhe Li
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, China
- The First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Hongxia Wei
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, China
- The First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Ru Li
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, China
- The First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Baofeng Wu
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, China
- The First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Ming Xu
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, China
- The First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Xifeng Yang
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, China
- The First Clinical Medical College, Shanxi Medical University, Taiyuan, China
| | - Yi Zhang
- Department of Pharmacology, Shanxi Medical University, Taiyuan, China
- Medicinal Basic Research Innovation Center of Chronic Kidney Disease, Ministry of Education, Shanxi Medical University, Taiyuan, China
| | - Yunfeng Liu
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, China
- Medicinal Basic Research Innovation Center of Chronic Kidney Disease, Ministry of Education, Shanxi Medical University, Taiyuan, China
- Clinical Research Center For Metabolic Diseases Of Shanxi Medical University, Taiyuan, China
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29
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Fu X, Lu H, Gao M, Li P, He Y, He Y, Luo X, Rao X, Liu W. Nitric oxide in the cardio-cerebrovascular system: Source, regulation and application. Nitric Oxide 2024; 152:48-57. [PMID: 39299647 DOI: 10.1016/j.niox.2024.09.005] [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: 12/23/2023] [Revised: 06/13/2024] [Accepted: 09/16/2024] [Indexed: 09/22/2024]
Abstract
Nitric oxide (NO) plays a crucial role as a messenger or effector in the body, yet it presents a dual impact on cardio-cerebrovascular health. Under normal physiological conditions, NO exhibits vasodilatory effects, regulates blood pressure, inhibits platelet aggregation, and offers neuroprotective actions. However, in pathological situations, excessive NO production contributes to or worsens inflammation within the body. Moreover, NO may combine with reactive oxygen species (ROS), generating harmful substances that intensify physical harm. This paper succinctly reviews pertinent literature to clarify the in vivo and in vitro origins of NO, its regulatory function in the cardio-cerebrovascular system, and the advantages and disadvantages associated with NO donor drugs, NO delivery systems, and vascular stent materials for treating cardio-cerebrovascular disease. The findings provide a theoretical foundation for the application of NO in cardio-cerebrovascular diseases.
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Affiliation(s)
- Xiaoming Fu
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herbal Medicine, Jiangxi University of Chinese Medicine, Nanchang, 330006, China
| | - Haowei Lu
- Department of Pharmacy, The Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, 330006, China
| | - Meng Gao
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herbal Medicine, Jiangxi University of Chinese Medicine, Nanchang, 330006, China
| | - Pinghe Li
- Lanzhou Foci Pharmaceutical Co., Ltd, Lanzhou, 730030, China
| | - Yan He
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herbal Medicine, Jiangxi University of Chinese Medicine, Nanchang, 330006, China
| | - Yu He
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herbal Medicine, Jiangxi University of Chinese Medicine, Nanchang, 330006, China
| | - Xiaojian Luo
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herbal Medicine, Jiangxi University of Chinese Medicine, Nanchang, 330006, China.
| | - Xiaoyong Rao
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herbal Medicine, Jiangxi University of Chinese Medicine, Nanchang, 330006, China.
| | - Wei Liu
- National Pharmaceutical Engineering Center for Solid Preparation in Chinese Herbal Medicine, Jiangxi University of Chinese Medicine, Nanchang, 330006, China.
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30
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Johnson AJ, Tidwell W, McRae A, Henson CP, Hernandez A. Angiotensin-II for vasoplegia following cardiac surgery. Perfusion 2024; 39:1676-1684. [PMID: 37955639 PMCID: PMC11487862 DOI: 10.1177/02676591231215920] [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: 11/14/2023]
Abstract
INTRODUCTION The objective of this study was to describe the implementation and outcomes of a protocol outlining angiotensin-II utilization for vasoplegia following cardiac surgery. METHODS This was a retrospective chart review at a single-center university hospital. Included patients received angiotensin-II for vasoplegia refractory to standard interventions, including norepinephrine 20 mcg/min and vasopressin 0.04 units/min, following cardiac surgery between April 2021 and April 2022. RESULTS 30 patients received angiotensin-II for refractory vasoplegia. Adjunctive agents at angiotensin-II initiation included corticosteroids (26 patients; 87%), epinephrine (26 patients; 87%), dobutamine (17 patients; 57%), dopamine (9 patients; 30%), milrinone (2 patients; 7%), and hydroxocobalamin (4 patients; 13%). At 3 hours, the median mean arterial pressure increased from baseline (70 vs 61.5 mmHg, p = .0006). Median norepinephrine doses at angiotensin-II initiation, 1 hour, 3 hours, and angiotensin-II discontinuation were 0.22, 0.16 (p = .0023), 0.10 (p < .0001), and 0.07 (p < .0001) mcg/kg/min. Median dobutamine doses decreased throughout angiotensin-II infusion from eight to six mcg/kg/min (p = .0313). Other vasoactive medication doses were unchanged. Three patients (10%) subsequently received hydroxocobalamin. Thirteen (43.3%) and five (16.7%) patients experienced mortality by day 28 and venous or arterial thrombosis events, respectively. CONCLUSIONS The administration of angiotensin-II to vasoplegic patients following cardiac surgery was associated with increased mean arterial pressure, reduced norepinephrine dosages, and reduced dobutamine dosages.
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Affiliation(s)
- Andrew J Johnson
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William Tidwell
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew McRae
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, TN, USA
| | - C Patrick Henson
- Department of Anesthesia, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Antonio Hernandez
- Department of Anesthesia, Division of Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Bhandari M, Pradhan A, Vishwakarma P, Singh A, Sethi R. Sodium glucose cotransporter 2 inhibitors in the management of heart failure: Veni, Vidi, and Vici. World J Cardiol 2024; 16:550-563. [DOI: 10.4330/wjc.v16.i10.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 08/25/2024] [Accepted: 09/06/2024] [Indexed: 10/17/2024] Open
Abstract
Heart failure (HF) is a chronic disease associated with high morbidity and mortality rates. Renin-angiotensin-aldosterone system blockers (including angiotensin receptor/neprilysin inhibitors), beta-blockers, and mineralocorticoid receptor blockers remain the mainstay of pharmacotherapy for HF with reduced ejection fraction (HFrEF). However, despite the use of guideline-directed medical therapy, the mortality from HFrEF remains high. HF with preserved ejection fraction (HFpEF) comprises approximately half of the total incident HF cases; however, unlike HFrEF, there are no proven therapies for this condition. Sodium glucose cotransporter-2 inhibitors (SGLT-2is) represent a new class of pharmacological agents approved for diabetes mellitus (DM) that inhibit SGLT-2 receptors in the kidney. A serendipitous finding from seminal trials of SGLT-2is in DM was the significant improvement in renal and cardiovascular (CV) outcomes. More importantly, the improvement in HF hospitalization (HHF) in the CV outcomes trials of SGLT-2is was striking. Multiple mechanisms have been proposed for the pleiotropic effects of SGLT-2is beyond their glycemic control. However, as patients with HF were not included in any of these trials, it can be considered as a primary intervention. Subsequently, two landmark studies of SGLT-2is in patients with HFrEF, namely, an empagliflozin outcome trial in patients with chronic HF and a reduced ejection fraction (EMPEROR-Reduced) and dapagliflozin and prevention of adverse outcomes in HF (DAPA-HF), demonstrated significant improvement in HHF and CV mortality regardless of the presence of DM. These impressive results pitchforked these drugs as class I indications in patients with HFrEF across major guidelines. Thereafter, empagliflozin outcome trial in patients with chronic HF with preserved ejection fraction (EMPEROR-Preserved) and dapagliflozin evaluation to improve the lives of patients with preserved ejection fraction HF (DELIVER) trials successively confirmed that SGLT-2is also benefit patients with HFpEF with or without DM. These results represent a watershed as they constitute the first clinically meaningful therapy for HFpEF in the past three decades of evolution of HF management. Emerging positive data for the use of SGLT-2is in acute HF and post-myocardial infarction scenarios have strengthened the pivotal role of these agents in the realm of HF. In a short span of time, these classes of drugs have captivated the entire scenario of HF.
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Affiliation(s)
- Monika Bhandari
- Department of Cardiology, King Georg’s Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Akshyaya Pradhan
- Department of Cardiology, King Georg’s Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Pravesh Vishwakarma
- Department of Cardiology, King Georg’s Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Abhishek Singh
- Department of Cardiology, King Georg’s Medical University, Lucknow 226003, Uttar Pradesh, India
| | - Rishi Sethi
- Department of Cardiology, King Georg’s Medical University, Lucknow 226003, Uttar Pradesh, India
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32
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Eid N, Abdel Wahab M, Thanu AS. Bioresorbable stent unloading during percutaneous coronary intervention: Early detection and management. World J Cardiol 2024; 16:616-618. [DOI: 10.4330/wjc.v16.i10.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2024] [Revised: 09/24/2024] [Accepted: 09/30/2024] [Indexed: 10/17/2024] Open
Abstract
In this letter, we comment on a recent case report by Sun et al in the World Journal of Cardiology. The report describes the successful management of a rare complication: The unloading or detachment of a bioresorbable stent (BRS) during percutaneous coronary intervention (PCI) in a male patient. The unloading of BRS was detected via angiography and intravascular ultrasound (IVUS) imaging of the left coronary artery and left anterior descending artery. Although this case is interesting, the authors’ report lacked crucial details. Specifically, insufficient information about the type of BRS used, potential causes of BRS unloading, or whether optical coherence tomography (OCT) imaging for coronary arteries was performed before, during, or after PCI. The OCT imaging of coronary arteries before PCI can potentially prevent BRS unloading due to its higher resolution compared to IVUS. In addition, despite detecting myocardial bridging during the PCI, the authors did not provide any details regarding this variation. Here we discuss the various types of BRS, the importance of OCT in PCI, and the clinical relevance of myocardial bridging.
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Affiliation(s)
- Nabil Eid
- Department of Anatomy, Division of Human Biology, School of Medicine, IMU University, Kuala Lumpur 57000, Kuala Lumpur, Malaysia
| | - Mohamed Abdel Wahab
- Department of Pediatrics, School of Medicine, IMU University, Clinical Campus, Batu Paha 83000, Johor, Malaysia
| | - Amardev Singh Thanu
- M. Kandiah Faculty of Medicine and Health Sciences, University Tunku Abdul Rahman, Kajang 43000, Selangor, Malaysia
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Kurian AL, Lucke-Wold B. Evaluating neuromuscular electrical stimulation for preventing and managing intensive care unit-acquired weakness: Current evidence and future directions. World J Cardiol 2024; 16:604-607. [DOI: 10.4330/wjc.v16.i10.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 09/03/2024] [Accepted: 09/20/2024] [Indexed: 10/17/2024] Open
Abstract
Intensive care unit-acquired weakness (ICU-AW) is a prevalent issue in critical care, leading to significant muscle atrophy and functional impairment. Aiming to address this, Neuromuscular Electrical Stimulation (NMES) has been explored as a therapy. This systematic review assesses NMES's safety and effectiveness in enhancing functional capacity and mobility in pre- and post-cardiac surgery patients. NMES was generally safe and feasible, with intervention sessions varying in frequency and duration. Improvements in muscle strength and 6-minute walking test distances were observed, particularly in preoperative settings, but postoperative benefits were inconsistent. NMES showed promise in preventing muscle loss and improving strength, although its impact on overall functional capacity remained uncertain. Challenges such as short ICU stays and body composition affecting NMES efficacy were noted. NMES also holds potential for other conditions like cerebral palsy and stroke. Further research is needed to optimize NMES protocols and better understand its full benefits in preventing ICU-AW and improving patient outcomes.
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Affiliation(s)
- Annu Lisa Kurian
- College of Medicine, Florida State University, Tallahassee, FL 32304, United States
| | - Brandon Lucke-Wold
- Department of Neurosurgery, University of Florida, Gainesville, FL 32611, United States
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Zhang YX, Hu HS, Sun BQ. Effectiveness and mechanisms of sodium-dependent glucose transporter 2 inhibitors in type 2 diabetes and heart failure patients. World J Cardiol 2024; 16:611-615. [DOI: 10.4330/wjc.v16.i10.611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Revised: 09/29/2024] [Accepted: 10/11/2024] [Indexed: 10/17/2024] Open
Abstract
We comment on an article by Grubić Rotkvić et al published in the recent issue of the World Journal of Cardiology. We specifically focused on possible factors affecting the therapeutic effectiveness of sodium-dependent glucose transporter inhibitors (SGLT2i) in patients with type 2 diabetes mellitus (T2DM) and their impact on comorbidities. SGLT2i inhibits SGLT2 in the proximal tubules of the kidneys, lowering blood glucose levels by inhibiting glucose reabsorption by the kidneys and causing excess glucose to be excreted in the urine. Previous studies have demonstrated a role of SGLT2i in cardiovascular function in patients with diabetes who take metformin but still have poor glycemic control. In addition, SGLT2i has been shown to be effective in anti-apoptosis, weight loss, and cardiovascular protection. Accordingly, it is feasible to treat patients with T2DM with cardiovascular or renal diseases using SGLT2i.
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Affiliation(s)
- Yan-Xi Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, Guangdong Province, China
| | - Hai-Sheng Hu
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, Guangdong Province, China
| | - Bao-Qing Sun
- Department of Clinical Laboratory, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Disease, National Center for Respiratory Medicine, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou 510120, Guangdong Province, China
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Sloan L. SGLT2 inhibitors across the spectrum of chronic kidney disease: a narrative review. Postgrad Med 2024. [PMID: 39434704 DOI: 10.1080/00325481.2024.2418795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 10/09/2024] [Accepted: 10/16/2024] [Indexed: 10/23/2024]
Abstract
Chronic kidney disease (CKD) is a growing public health concern, affecting at least 1 in 7 adults in the United States, and accounting for a large proportion of healthcare spending. The risk of mortality rises steeply with declining kidney function, mostly due to cardiovascular-related deaths. Since CKD is asymptomatic in the early stages, diagnosis is sometimes delayed. However, early diagnosis is important for timely initiation of interventions to reduce disease progression, and to avoid the need for hospitalizations, dialysis, or kidney transplantation. This review focuses on the impact of sodium glucose transporter 2 inhibitors (SGLT2i) on CKD based on mechanistic and clinical trial evidence. These agents affect the kidneys through changes in sodium transport and metabolic factors that interfere with the primary pathological mechanisms shared by most kidney diseases. Following clinical trials of SGLT2i in patients with type 2 diabetes which demonstrated reductions in the risk of major adverse CV events, death, and hospitalizations for heart failure (HHF), and in patients with heart failure (HF) with and without diabetes which showed reductions in death and HHF, recent trials in patients with CKD have provided overwhelming support for the use of SGLT2i as foundational therapy across a broad spectrum of patients with CKD, regardless of diabetes status, primary kidney disease (except polycystic kidney disease), or kidney function. While clinical trials in CKD generally recruit patients with a high risk of events, patients at lower risk could also benefit from SGLT2i in terms of reduction of CKD progression, HF and death, as well as other beneficial effects including reductions in blood sugar, body weight and blood pressure.
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Affiliation(s)
- Lance Sloan
- Texas Institute for Kidney and Endocrine Disorders, Lufkin, TX, USA
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Cefarelli M, Malvindi PG, Bifulco O, Buratto B, Berretta P, Zingaro C, Capestro F, Pierri MD, Alfonsi J, D'Alfonso A, Di Eusanio M. Impact of preoperative computed tomography scan on neurological outcomes in coronary artery bypass grafting patients: A propensity-score analysis. Asian Cardiovasc Thorac Ann 2024:2184923241292098. [PMID: 39428858 DOI: 10.1177/02184923241292098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2024]
Abstract
INTRODUCTION Neurological complications pose significant risks in coronary artery bypass grafting (CABG). This study explores the potential benefits of preoperative chest computed tomography (CT) in optimizing outcomes and reducing neurological events in high-risk CABG patients. METHODS From January 2017 to June 2023, a retrospective cohort study of CABG patients categorized groups based on preoperative chest CT use. Multivariate analysis evaluated the associations between CT imaging and patient characteristics, followed by propensity match analysis to balance preoperative features across groups. RESULTS The study included 1786 patients, with 435 having undergone preoperative CT and 1351 without. Propensity matching created two well-balanced groups of 413 patients each. At multivariate analysis, CT patients were elderly (71.1 ± 8.9 years; p = 0.03) with a higher incidence of pulmonary disease (19.5%; p < 0.01), peripheral arterial disease (29.2%; p < 0.01), and previous cerebrovascular disease (23.4%; p = 0.02). In the matched CT cohort, the perioperative cerebral stroke rate was 0.7% (vs. 1.9% in without preoperative CT [WCT] cohort; p = 0.223), and the 30-day mortality rate was 0.2% (vs. 1.7% in WCT cohort; p = 0.069). Patients who had a preoperative CT study presented a higher prevalence of porcelain aorta (6.3% vs. 1.5%; p = 0.0003) and required more often a no-touch aorta procedure (20.3% vs. 14.5%; p = 0.035). CONCLUSIONS Patients undergoing preoperative chest CT before CABG were typically older and had systemic atherosclerosis and pulmonary disease. Propensity-matched analysis indicated low mortality and perioperative cerebral stroke rates in these high-risk patients. These findings support the integration of chest CT into preoperative evaluations for high-risk patients to develop tailored strategies in coronary artery bypass surgery.
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Affiliation(s)
- Mariano Cefarelli
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Pietro Giorgio Malvindi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Olimpia Bifulco
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Beatrice Buratto
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Paolo Berretta
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Carlo Zingaro
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Filippo Capestro
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Michele Danilo Pierri
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Jacopo Alfonsi
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Alessandro D'Alfonso
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
| | - Marco Di Eusanio
- Cardiac Surgery Unit, Lancisi Cardiovascular Center, Polytechnic University of Marche, Ancona, Italy
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Singh A, Sohal A, Batta A. Recent developments in non-invasive methods for assessing metabolic dysfunction-associated fatty liver disease. World J Gastroenterol 2024; 30:4324-4328. [DOI: 10.3748/wjg.v30.i39.4324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 09/22/2024] [Accepted: 09/25/2024] [Indexed: 10/12/2024] Open
Abstract
The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) is increasing, affecting over one-third of the global population and contributing to significant morbidity and mortality. Diagnosing MAFLD, especially with advanced fibrosis, remains challenging due to the limitations of liver biopsy, the current gold standard. Non-invasive tests are crucial for early detection and management. Among these, the fibrosis-4 index (Fib-4) is widely recommended as a first-line test for screening for liver fibrosis. Advanced imaging techniques, including ultrasound-based elastography and magnetic resonance elastography, offer high accuracy but are limited by cost and availability. Combining biomarkers, such as in the enhanced liver fibrosis score and FibroScan-AST score, enhances diagnostic precision and is recommended to further stratify patients who are considered to be intermediate or high risk from the Fib-4 score. We believe that the future lies in the combined use of biomarkers to improve diagnostic accuracy.
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Affiliation(s)
- Anmol Singh
- Department of Medicine, Tristar Centennial Medical Center, Nashville, TN 37203, United States
| | - Aalam Sohal
- Department of Gastroenterology and Hepatology, Creighton University School of Medicine, Phoenix, AZ 85012, United States
| | - Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
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Naito N, Takagi H. Meta-analysis of improved mitral regurgitation after aortic valve replacement. Perfusion 2024:2676591241291338. [PMID: 39425526 DOI: 10.1177/02676591241291338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2024]
Abstract
BACKGROUND This meta-analysis aimed to compare survival outcomes among patients experiencing improvement in untreated significant mitral regurgitation (MR) following surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR) for severe aortic stenosis, in contrast to those without improvement. METHODS We conducted a comprehensive search through February 2024. Pooled hazard ratios (HR) with 95% confidence intervals (CI) were computed. Kaplan-Meier curves depicting all-cause mortality were reconstructed using individual patient data derived from the included studies. RESULTS A systematic review identified twelve non-randomized studies encompassing 4040 patients. The pooled all-cause mortality of the meta-analysis demonstrated a significant reduction in patients whose MR improved compared to those with persistent MR after aortic valve replacement (AVR) (HR [95% CI] = 0.55 [0.47-0.64], p < .01). The hazard ratio, derived from reconstructed time-to-event data, indicated lower all-cause mortality in patients with improved MR after AVR relative to the other cohort (HR [95% CI] = 0.50 [0.40-0.62], p < .01 in all patients, 0.48 [0.34-0.68], p < .01 in patients undergoing SAVR, and 0.58 [0.42-0.80], p < .01 in those receiving TAVR). CONCLUSION In conclusion, this meta-analysis revealed that improved MR after AVR, whether surgically or by transcatheter approach, correlates with superior survival. The benefits of simultaneous or staged intervention on the mitral valve in individuals undergoing AVR warrant validation in future investigations.
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Affiliation(s)
- Noritsugu Naito
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
| | - Hisato Takagi
- Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan
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Tran DC, Do MD, Le LHG, Thai TT, Hoang SV, Truong BQ. Relationship between the AGT M235T genetic variant and the characteristics and prognosis of coronary atherosclerosis in patients with acute myocardial infarction. Mol Biol Rep 2024; 51:1072. [PMID: 39425811 DOI: 10.1007/s11033-024-09986-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 10/05/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND Along with environmental components, genetic factors play an essential role in the pathophysiology and progression of acute myocardial infarction (AMI). There is limited and conflicting data on the influence of the AGT M235T genetic variant on coronary atherosclerosis and death in AMI patients. METHODS We carried out a prospective cohort study among 504 Vietnamese AMI patients selected between January 2020 and May 2021. All patients underwent invasive coronary angiography, had AGT M235T genetic variant genotyped using the polymerase chain reaction method, and were followed up for 12-month all-cause mortality. RESULTS The proportions of the MM, MT, and TT genotypes were 0.4%, 20.8%, and 78.8%, respectively. There was no significant difference between the TT genotype and the MM + MT genotype groups regarding the position and number of stenosed coronary artery branches and the Gensini score. The AGT M235T genetic variant did not affect 12-month mortality (hazard ratio of TT vs. MM + MT: 1.185; 95% confidence interval: 0.596-2.354; P = 0.629). Subgroup analyses by age, sex, hypertension, diabetes mellitus, dyslipidemia, obesity, smoking, and angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker therapy also did not reveal an association between the AGT M235T variant and all-cause mortality. CONCLUSION In summary, the AGT M235T genetic variant was not found to be associated with coronary atherosclerosis characteristics and 12-month mortality in Vietnamese patients with AMI. Further multicenter studies with larger sample sizes and extended follow-up periods are needed to investigate this issue.
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Affiliation(s)
- Duy Cong Tran
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, District 5, Ho Chi Minh City, 700000, Vietnam
- University Medical Center Ho Chi Minh City, 215 Hong Bang, District 5, Ho Chi Minh City, 700000, Vietnam
- Department of Cardiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Minh Duc Do
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, District 5, Ho Chi Minh City, 700000, Vietnam.
| | - Linh Hoang Gia Le
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, District 5, Ho Chi Minh City, 700000, Vietnam
| | - Truc Thanh Thai
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Sy Van Hoang
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, District 5, Ho Chi Minh City, 700000, Vietnam
- Department of Cardiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Binh Quang Truong
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang, District 5, Ho Chi Minh City, 700000, Vietnam.
- University Medical Center Ho Chi Minh City, 215 Hong Bang, District 5, Ho Chi Minh City, 700000, Vietnam.
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Peng Z, Wu Q, Zhao CL, Gong SS. Lipid metabolism and hearing loss: association of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with adolescent hearing health. Lipids Health Dis 2024; 23:340. [PMID: 39427157 DOI: 10.1186/s12944-024-02331-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 10/14/2024] [Indexed: 10/21/2024] Open
Abstract
BACKGROUND The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) is a novel lipid measure for assessing the risk of cardiovascular disease. Lipid metabolism disorders are reportedly associated with hearing impairment. This study aimed to investigate the potential association between NHHR and hearing. METHODS The data used in this study were obtained from the National Health and Nutrition Examination Survey (NHANES) cycles of 2005-2010 and 2017-2018, including 4,296 participants aged 6-19 years. The NHHR was calculated from lipid profiles, and hearing was assessed using pure-tone audiometry. Weighted multivariate logistic regression analyses were used to investigate the association between the NHHR and hearing loss. Subgroup and sensitivity analyses were performed to verify the robustness of the results. RESULTS Univariate analysis revealed significant associations between the NHHR and hearing threshold at all categorized frequency (low, speech, or high-frequency) (P < 0.001). Three models were used: an unadjusted model, a model adjusted for age, sex, and race, and a model further adjusted for PIR, BMI, and diabetes. Multiple regression analysis confirmed these associations consistently across all models. When considered as a continuous variable, NHHR had a significant association with enhanced hearing thresholds at all categorized frequencies: low-frequency (β:0.56, 95% CI: 0.36-0.75), speech-frequency (β:0.55, 95% CI: 0.36-0.7), and high-frequency (β:0.55, 95% CI: 0.36-0.74). The adjusted models showed persistent positive correlations after controlling for covariates. The NHHR was consistently positively associated with hearing loss. The NHHR and auditory thresholds showed a general dose-response association across all frequencies. CONCLUSIONS NHHR is a promising biomarker for predicting adolescent hearing threshold shifts and hearing loss. The study highlights the importance of early lipid monitoring and management as strategies to prevent or reduce hearing impairment.
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Affiliation(s)
- Zhe Peng
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China.
- Clinical Center for Hearing Loss, Capital Medical University, Beijing, 100050, China.
| | - Qian Wu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China
- Clinical Center for Hearing Loss, Capital Medical University, Beijing, 100050, China
| | - Chun-Li Zhao
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China
- Clinical Center for Hearing Loss, Capital Medical University, Beijing, 100050, China
| | - Shu-Sheng Gong
- Department of Otolaryngology-Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, No.95, Yong'an Road, Xicheng District, Beijing, 100050, China.
- Clinical Center for Hearing Loss, Capital Medical University, Beijing, 100050, China.
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Liu X, Dai X, Yu X, Zhou H, Xie J. A Bioequivalence Study of Azilsartan in Healthy Chinese Subjects. Clin Pharmacol Drug Dev 2024. [PMID: 39422643 DOI: 10.1002/cpdd.1479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 09/25/2024] [Indexed: 10/19/2024]
Abstract
Azilsartan is an angiotensin II receptor blocker used for treating adult hypertension. It significantly improves cardiovascular outcomes in patients with high-risk hypertension, heart failure, and diabetic nephropathy. A single-center, randomized, open-label, single-dose, dual-cycle, dual-crossover clinical trial was conducted to evaluate the bioequivalence of azilsartan under fasting and postprandial conditions in 60 Chinese healthy volunteers. Thirty healthy subjects were enrolled in each test group, with random cross-administration for fasting and postprandial tests. The concentration of azilsartan in human plasma was evaluated using liquid chromatography-tandem mass spectrometry after a single oral administration of test and reference preparations, each at a dose of 20 mg (1 tablet). Pharmacokinetic parameters were determined using WinNonlin8.2 software, and bioequivalence was evaluated using SAS 9.4 software. The geometric mean ratios and 90% confidence intervals for maximum concentration, area under the plasma concentration-time curve from time 0 to the time of last measurable concentration, and area under the plasma concentration-time curve from time 0 to infinity of the test and reference preparations in the fasting and postprandial test groups were in the range of 80%-125%. The incidence of adverse events in the fasting and postprandial test groups was 30% (9/30) and 33.3% (10/30), respectively. No serious adverse events or unexpected adverse drug reactions were observed. In conclusion, the test and reference preparations of azilsartan tablets demonstrate bioequivalence and good safety in healthy Chinese subjects under fasting and postprandial conditions.
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Affiliation(s)
| | - Xiangrong Dai
- Zhaoke Pharmaceutical (Guangzhou) Ltd., Guangzhou, China
| | - Xiaohui Yu
- Zhaoke Pharmaceutical (Guangzhou) Ltd., Guangzhou, China
| | - Huan Zhou
- National Drug Clinical Trial Institution, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Jing Xie
- National Drug Clinical Trial Institution, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
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Hu H, Xu Z, Zhang Z, Song P, Stull F, Xu P, Tang H. Rational design of a flavoenzyme for aerobic nicotine catabolism. mBio 2024; 15:e0205024. [PMID: 39191403 PMCID: PMC11481913 DOI: 10.1128/mbio.02050-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Accepted: 07/23/2024] [Indexed: 08/29/2024] Open
Abstract
Enzymatic therapy with nicotine-degrading enzyme is a new strategy in treating nicotine addiction, which can reduce nicotine concentrations and weaken withdrawal in the rat model. However, when O2 is used as the electron acceptor, no satisfactory performance has been achieved with one of the most commonly studied and efficient nicotine-catabolizing enzymes, NicA2. To obtain more efficient nicotine-degrading enzyme, we rationally designed and engineered a flavoenzyme Pnao, which shares high structural similarity with NicA2 (RMSD = 1.143 Å) and efficiently catalyze pseudooxynicotine into 3-succinoyl-semialdehyde pyridine using O2. Through amino acid alterations with NicA2, five Pnao mutants were generated, which can degrade nicotine in Tris-HCl buffer and retain catabolic activity on its natural substrate. Nicotine-1'-N-oxide was identified as one of the reaction products. Four of the derivative mutants showed activity in rat serum and Trp220 and Asn224 were found critical for enzyme specificity. Our findings offer a novel avenue for research into aerobic nicotine catabolism and provide a promising method of generating additional nicotine-catalytic enzymes. IMPORTANCE Nicotine, the main active substance in tobacco, results in cigarette addiction and various diseases. There have been some attempts at using nicotine oxidoreductase, NicA2, as a therapeutic for nicotine cessation. However, it uses cytochrome c as it is electron acceptor, which is impractical for therapeutic use compared with using O2 as an oxidant. Thus, amino acid alteration was performed on Pnao using NicA2 as model. Five of the mutants generated degraded nicotine at a rate similar to NicA2, and one of the catabolic compounds was identified as nicotine-1'-N-oxide. Our research highlights a new direction in developing enzymes that efficiently catabolize nicotine without co-enzymes and suggests that structure-similar human original MAOA (or B) may assist with nicotine cessation after being engineered.
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Affiliation(s)
- Haiyang Hu
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, and School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Zhaoyong Xu
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, and School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiyao Zhang
- Department of Chemistry, Western Michigan University, Kalamazoo, Michigan, USA
| | - Peizhi Song
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, and School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Frederick Stull
- Department of Chemistry, Western Michigan University, Kalamazoo, Michigan, USA
| | - Ping Xu
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, and School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - Hongzhi Tang
- State Key Laboratory of Microbial Metabolism, Joint International Research Laboratory of Metabolic and Developmental Sciences, and School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
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Song Q, Zhang C, Wang W, Wang C, Yi C. Exploring the genetic landscape of the brain-heart axis: A comprehensive analysis of pleiotropic effects between heart disease and psychiatric disorders. Prog Neuropsychopharmacol Biol Psychiatry 2024:111172. [PMID: 39423935 DOI: 10.1016/j.pnpbp.2024.111172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 10/02/2024] [Accepted: 10/10/2024] [Indexed: 10/21/2024]
Abstract
BACKGROUND The genetic links between heart disease and psychiatric disorders are complex and not well understood. This study uses genome-wide association studies (GWAS) and advanced multilevel analyses to explore these connections. METHODS We analyzed GWAS data from seven psychiatric disorders and five types of heart disease. Genetic correlations and overlaps were examined using linkage disequilibrium score regression (LDSC), high-definition likelihood (HDL), and Genetic analysis incorporating Pleiotropy and Annotation (GPA). Pleiotropic single-nucleotide variations (SNVs) were identified with pleiotropic analysis under the composite null hypothesis (PLACO) and annotated via Functional mapping and annotation of genetic associations (FUMA). Potential pleiotropic genes were identified using Multi-marker Analysis of GenoMic Annotation (MAGMA) and Summary data-based Mendelian Randomization (SMR). Mendelian randomization was employed to assess causal relationships. RESULTS Among 35 trait pairs, 32 showed significant genetic correlations or overlaps. PLACO identified 15,077 SNVs, with 287 recognized as pleiotropic loci and 20 colocalization sites. MAGMA and SMR revealed 75 potential pleiotropic genes involved in diverse pathways, including cancer, neurodevelopment, and cellular organization. Mouse Genome Informatics (MGI) queries provided evidence linking multiple genes to heart or psychiatric disorders. CONCLUSIONS This analysis reveals loci and genes with pleiotropic effects between heart disease and psychiatric disorders, highlighting shared biological pathways. These findings illuminate the genetic mechanisms underlying the brain-heart axis and suggest shared biological foundations for these conditions, offering potential targets for future prevention and treatment strategies.
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Affiliation(s)
- Qifeng Song
- Department of Cardiovascular Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Yangzhou, Jiangsu 225000, China
| | - Cheng Zhang
- Nanjing Vocational Health College, Nanjing, Jiangsu 210000, China
| | - Wei Wang
- Department of Cardiovascular Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Yangzhou, Jiangsu 225000, China
| | - Cihan Wang
- Medical College, Yangzhou University, Yangzhou, Yangzhou, Jiangsu 225000, China
| | - Chenlong Yi
- Department of Cardiovascular Surgery, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Yangzhou, Jiangsu 225000, China; Department of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Stone GW, Valgimigli M, Erlinge D, Han Y, Steg PG, Stables RH, Frigoli E, James SK, Li Y, Goldstein P, Mehran R, Mehdipoor G, Crowley A, Chen S, Redfors B, Snyder C, Zhou Z, Bikdeli B. Bivalirudin vs Heparin Anticoagulation in STEMI: Confirmation of the BRIGHT-4 Results. J Am Coll Cardiol 2024; 84:1512-1524. [PMID: 39384262 DOI: 10.1016/j.jacc.2024.07.045] [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] [Received: 03/18/2024] [Revised: 06/26/2024] [Accepted: 07/15/2024] [Indexed: 10/11/2024]
Abstract
BACKGROUND In the BRIGHT-4 (Bivalirudin With Prolonged Full-Dose Infusion During Primary PCI Versus Heparin Trial-4), anticoagulation with bivalirudin plus a 2- to 4-hour high-dose infusion after percutaneous coronary intervention (PCI) reduced all-cause mortality and bleeding without increasing reinfarction or stent thrombosis compared with heparin alone in patients with ST-segment elevation myocardial infarction (STEMI). These findings require external validation. OBJECTIVES This study sought to determine outcomes of bivalirudin vs heparin anticoagulation during PCI in STEMI. METHODS We performed an individual-patient-data meta-analysis of all large randomized trials of bivalirudin vs heparin in STEMI patients undergoing primary PCI performed before BRIGHT-4. The primary endpoint was all-cause mortality. RESULTS Six trials randomizing 15,254 patients were included. Pooled across all regimens of bivalirudin and glycoprotein IIb/IIIa inhibitor (GPI) use, bivalirudin reduced 30-day all-cause mortality (2.5% vs 2.9%; adjusted OR: 0.78; 95% CI: 0.62-0.99), cardiac mortality (adjusted OR: 0.69; 95% CI: 0.54-0.88), and major bleeding (adjusted OR: 0.53; 95% CI: 0.44-0.64) but increased reinfarction (adjusted OR: 1.30; 95% CI: 1.02-1.65) and stent thrombosis (adjusted OR: 1.43; 95% CI: 1.05-1.93) compared with heparin. In 4 trials in which 6,244 patients were randomized to bivalirudin plus a high-dose post-PCI infusion vs heparin without planned GPI use (the BRIGHT-4 regimens), 30-day all-cause mortality occurred in 1.8% vs 2.9% of patients, respectively (adjusted OR: 0.74; 95% CI: 0.48-1.12), and bivalirudin reduced cardiac mortality (adjusted OR: 0.62; 95% CI: 0.39-0.97) and major bleeding (adjusted OR: 0.49; 95% CI: 0.35-0.70), with similar rates of reinfarction (adjusted OR: 0.89; 95% CI: 0.58-1.38) and stent thrombosis (adjusted OR: 0.80; 95% CI: 0.41-1.57). CONCLUSIONS In STEMI patients undergoing primary PCI, bivalirudin with a 2- to 4-hour post-PCI high-dose infusion reduced cardiac mortality and major bleeding without an increase in ischemic events compared with heparin monotherapy with provisional GPI use, confirming the BRIGHT-4 results.
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Affiliation(s)
- Gregg W Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | | | | | - Yaling Han
- General Hospital of Northern Theater Command, Shenyang, China
| | - Philippe Gabriel Steg
- Université Paris-Cité, FACT (French Alliance for Cardiovascular Trials), INSERM U-1148, AP-HP, Hôpital Bichat, Paris, France; Imperial College, Royal Brompton Hospital, London, United Kingdom
| | - Rod H Stables
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; University of Liverpool, Liverpool, United Kingdom
| | - Enrico Frigoli
- Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Yi Li
- General Hospital of Northern Theater Command, Shenyang, China
| | | | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ghazaleh Mehdipoor
- Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center, Bronx, New York, USA
| | | | - Shmuel Chen
- Weill Cornell Medical Center, New York-Presbyterian Hospital, New York, New York, USA
| | - Björn Redfors
- Cardiovascular Research Foundation, New York, New York, USA
| | - Clayton Snyder
- Cardiovascular Research Foundation, New York, New York, USA
| | - Zhipeng Zhou
- Cardiovascular Research Foundation, New York, New York, USA
| | - Behnood Bikdeli
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; YNHH/ Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut, USA
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Meloni A, Saba L, Positano V, Pistoia L, Campanella A, Spasiano A, Putti MC, Fotzi I, Cossu A, Corigliano E, Massa A, Keilberg P, Cademartiri F, Cau R. Global longitudinal strain by cardiac magnetic resonance is associated with cardiac iron and complications in beta-thalassemia major patients. Int J Cardiol 2024; 413:132319. [PMID: 38971535 DOI: 10.1016/j.ijcard.2024.132319] [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] [Received: 04/23/2024] [Revised: 05/24/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND The aim of this cross-sectional study was to investigate the association of left ventricular (LV) strain parameters with demographics, clinical data, cardiovascular magnetic resonance (CMR) findings, and cardiac complications (heart failure and arrhythmias) in patients with β-thalassemia major (β-TM). METHOD We considered 266 β-TM patients (134 females, 37.08 ± 11.60 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project and 80 healthy controls (50 females, mean age 39.77 ± 11.29 years). The CMR protocol included cine images for the assessment of global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) using feature tracking (FT) and for the quantification of LV function parameters, the T2* technique for the assessment of myocardial iron overload, and late gadolinium enhancement (LGE) technique. RESULTS In comparison to the healthy control group, β-TM patients showed impaired GLS, GCS, and GRS values. Among β-TM patients, sex was identified as the sole independent determinant of all LV strain parameters. All LV strain parameters displayed a significant correlation with LV end-diastolic volume index, end-systolic volume index, mass index, and ejection fraction, and with the number of segments exhibiting LGE. Only GLS exhibited a significant correlation with global heart T2* values and the number of segments with T2* < 20 ms. Patients with cardiac complications exhibited significantly impaired GLS compared to those without cardiac complications. CONCLUSION In patients with β-TM, GLS, GCS, and GRS were impaired in comparison with control subjects. Among LV strain parameters, only GLS demonstrated a significant association with cardiac iron levels and complications.
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Affiliation(s)
- Antonella Meloni
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Luca Saba
- Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria di Cagliari - Polo di Monserrato, Cagliari, Italy
| | - Vincenzo Positano
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy; U.O.C. Ricerca Clinica, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Alessandra Campanella
- Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria di Cagliari - Polo di Monserrato, Cagliari, Italy
| | - Anna Spasiano
- Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale "A. Cardarelli", Napoli, Italy
| | - Maria Caterina Putti
- Dipartimento della Salute della Donna e del Bambino, Clinica di Emato-Oncologia Pediatrica, Azienda Ospedaliero-Università di Padova, Padova, Italy
| | - Ilaria Fotzi
- SOC Oncologia, Ematologia e Trapianto di Cellule Staminali Emopoietiche, Meyer Children's Hospital IRCCS, Firenze, Italy
| | - Antonella Cossu
- Ambulatorio Trasfusionale - Servizio Immunoematologia e Medicina Trasfusionale Dipartimento dei Servizi, Presidio Ospedaliero "San Francesco", Nuoro, Italy
| | | | - Antonella Massa
- Servizio Trasfusionale, Ospedale "Giovanni Paolo II", Olbia, Italy
| | - Petra Keilberg
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
| | - Riccardo Cau
- Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria di Cagliari - Polo di Monserrato, Cagliari, Italy
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Dai W, Li YQ, Zhou Y. Clinical implications of the latest advances in gastrointestinal tumor research. World J Gastrointest Oncol 2024; 16:4055-4059. [DOI: 10.4251/wjgo.v16.i10.4055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/25/2024] [Accepted: 06/14/2024] [Indexed: 09/26/2024] Open
Abstract
In this editorial, we provide commentary on six articles recently published in the World Journal of Gastrointestinal Oncology. These articles collectively present the latest findings in the field of gastric and colorectal cancer (CRC) research. The global incidence of gastric cancer varies based on geographical location, age, and sex. The disease predominantly affects middle-aged and elderly individuals, with a slightly higher prevalence in men than in women. CRC is characterized by a low 5-year survival rate and high mortality rate. It primarily affects individuals over the age of 50, and the risk of disease increases with age. Both gastric and CRC pose significant health threats, thus requiring more effective diagnostic, therapeutic, and supportive care strategies to improve patient outcomes. The articles discussed in this editorial encompass topics such as screening, diagnosis, mechanisms of progression, and postoperative recovery in gastric and CRC, and the findings offer valuable insights for clinical decision-making in the diagnosis, treatment, and prognosis of gastrointestinal cancers.
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Affiliation(s)
- Wei Dai
- Tumor Biological Diagnosis and Treatment Center, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu Province, China
| | - Yuan-Qi Li
- Tumor Biological Diagnosis and Treatment Center, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu Province, China
| | - You Zhou
- Tumor Biological Diagnosis and Treatment Center, The Third Affiliated Hospital of Soochow University, Changzhou 213003, Jiangsu Province, China
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Rejali A, Ebrahimian-Hosseinabadi M, Kharazi AZ. Polyglycerol Sebacate/polycaprolactone/reduced graphene oxide composite scaffold for myocardial tissue engineering. Heliyon 2024; 10:e38672. [PMID: 39398017 PMCID: PMC11470604 DOI: 10.1016/j.heliyon.2024.e38672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 09/26/2024] [Accepted: 09/27/2024] [Indexed: 10/15/2024] Open
Abstract
The aim of this research was to fabricate and evaluate polyglycerol sebacate/polycaprolactone/reduced graphene oxide (PGS-PCL-RGO) composite scaffolds for myocardial tissue engineering. Polyglycerol sebacate polymer was synthesized using glycerol and sebacic acid prepolymers, confirmed by Fourier-transform infrared spectroscopy (FTIR) and X-ray diffraction (XRD). Six PGS-PCL-RGO composite scaffolds (S1-S6) with various weight ratios were prepared in chloroform (CF) and acetone (Ace) solvents at 8 CF:2Ace and 9 CF:1Ace volume ratios, using the electrospinning method at a rate of 1 ml/h and a voltage of 18 kV. The scaffolds' chemical composition and microstructure were characterized by FTIR, XRD, and scanning electron microscopy (SEM). Further investigations included tensile testing, contact angle testing, four-point probe testing for electrical conductivity, degradation testing, and cytotoxicity testing (MTT). The results showed that adding 2%wt RGO to the composite scaffold decreased fiber diameter and degradation rate, while increasing electrical conductivity and ductility. The 33%PGS-65%PCL-2%RGO (S3) composite scaffold exhibited the lowest degradation rate (23.87 % over 60 days) and the highest electrical conductivity (51E-3 S/m). Mechanical evaluations revealed an elastic modulus of 2.46 MPa and elongation of 62.43 %, aligning closely with the heart muscle's elastomeric properties. The contact angle test indicated that the scaffold was hydrophilic, with a water contact angle of 61 ± 2°. Additionally, the cell toxicity test confirmed that scaffolds containing RGO were non-toxic and supported good cell viability. In conclusion, the 33%PGS-65%PCL-2%RGO composite scaffold exhibits mechanical and structural properties similar to heart tissue, making it an ideal candidate for myocardial tissue engineering.
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Affiliation(s)
- Azadeh Rejali
- Department of Biomedical Engineering, Faculty of Engineering, University of Isfahan, Isfahan, Iran
| | | | - Anousheh Zargar Kharazi
- Department of Biomaterials, Nano Technology and Tissue Engineering, School of Advanced Technologies in Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Zhou J, Wang B, Wang M, Zha Y, Lu S, Zhang F, Peng Y, Duan Y, Zhong D, Zhang S. Daucosterol alleviates heart failure with preserved ejection fraction through activating PPAR α pathway. Heliyon 2024; 10:e38379. [PMID: 39416818 PMCID: PMC11481624 DOI: 10.1016/j.heliyon.2024.e38379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 09/23/2024] [Accepted: 09/23/2024] [Indexed: 10/19/2024] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) has been increasing in the population in recent years and is mainly characterized by preserved left ventricle ejection fraction (LVEF), diastolic dysfunction and systemic inflammation. Daucosterol (DAU), a glycoside of β-sitosterol, has good anti-inflammatory and antioxidative properties; however, its effects and mechanisms in HFpEF have not been investigated. To detect whether DAU could alleviate HFpEF, C57BL/6J male mice were fed with N-nitro-l-arginine methyl ester (L-NAME) in drinking water and high fat diet (HFD) and treated with DAU by gavage (i.g.) for 10 weeks. The results showed that DAU treatment significantly alleviated HFpEF in mice. Mechanistically, by controlling PPARα and preventing NF-κB phosphorylation, DAU reduced oxidative stress and the inflammatory response. In conclusion, our study provides a new clue for natural product DAU in alleviating HFpEF.
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Affiliation(s)
- Jie Zhou
- Key Laboratory of Metabolism and Regulation for Major Diseases of Anhui Higher Education Institutes, College of Food and Biological Engineering, Hefei University of Technology, Hefei, China
| | - Bei Wang
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Mengyao Wang
- Key Laboratory of Metabolism and Regulation for Major Diseases of Anhui Higher Education Institutes, College of Food and Biological Engineering, Hefei University of Technology, Hefei, China
| | - Yang Zha
- Key Laboratory of Metabolism and Regulation for Major Diseases of Anhui Higher Education Institutes, College of Food and Biological Engineering, Hefei University of Technology, Hefei, China
| | - Shengyuan Lu
- Key Laboratory of Metabolism and Regulation for Major Diseases of Anhui Higher Education Institutes, College of Food and Biological Engineering, Hefei University of Technology, Hefei, China
| | - Feng Zhang
- Key Laboratory of Metabolism and Regulation for Major Diseases of Anhui Higher Education Institutes, College of Food and Biological Engineering, Hefei University of Technology, Hefei, China
| | - Ying Peng
- Key Laboratory of Metabolism and Regulation for Major Diseases of Anhui Higher Education Institutes, College of Food and Biological Engineering, Hefei University of Technology, Hefei, China
| | - Yajun Duan
- Department of Cardiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Dingrong Zhong
- Department of Pathology, China-Japan Friendship Hospital, Beijing, China
| | - Shuang Zhang
- Key Laboratory of Metabolism and Regulation for Major Diseases of Anhui Higher Education Institutes, College of Food and Biological Engineering, Hefei University of Technology, Hefei, China
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Li J, Wei J, Fu P, Gu J. Identification of novel proteins for coronary artery disease by integrating GWAS data and human plasma proteomes. Heliyon 2024; 10:e38036. [PMID: 39386869 PMCID: PMC11462259 DOI: 10.1016/j.heliyon.2024.e38036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 09/06/2024] [Accepted: 09/16/2024] [Indexed: 10/12/2024] Open
Abstract
Background Most coronary artery disease (CAD) risk loci identified by genome-wide association studies (GWAS) are located in non-coding regions, hampering the interpretation of how they confer CAD risk. It is essential to integrate GWAS with molecular traits data to further explore the genetic basis of CAD. Methods We used the probabilistic Mendelian randomization (PMR) method to identify potential proteins involved in CAD by integrating CAD GWAS data (∼76,014 cases and ∼264,785 controls) and human plasma proteomes (N = 35,559). Then, Bayesian co-localization analysis, confirmatory PMR analysis using independent plasma proteome data (N = 7752), and gene expression data (N1 = 213, N2 = 670) were performed to validate candidate proteins. We further investigated the associations between candidate proteins and CAD-related traits and explored the rationality and biological functions of candidate proteins through disease enrichment, cell type-specific, GO, and KEGG enrichment analysis. Results This study inferred that the abundance of 30 proteins in the plasma was causally associated with CAD (P < 0.05/4408, Bonferroni correction), such as PLG, IL15RA, and CSNK2A1. PLG, PSCK9, COLEC11, ZNF180, ERP29, TCP1, FN1, CDH5, IL15RA, MGAT4B, TNFRSF6B, DNM2, and TGF1R were replicated in the confirmatory PMR (P < 0.05). PCSK9 (PP.H4 = 0.99), APOB (PP.H4 = 0.89), FN1 (PP.H4 = 0.87), and APOC1 (PP.H4 = 0.78) coding proteins shared one common variant with CAD. MTAP, TCP1, APOC2, ERP29, MORF4L1, C19orf80, PCSK9, APOC1, EPOR, DNM2, TNFRSF6B, CDKN2B, and LDLR were supported by PMR at the transcriptome level in whole blood and/or coronary arteries (P < 0.05). Enrichment analysis identified multiple pathways involved in cholesterol metabolism, regulation of lipoprotein levels and telomerase, such as cholesterol metabolism (hsa04979, P = 2.25E-7), plasma lipoprotein particle clearance (GO:0034381, P = 5.47E-5), and regulation of telomerase activity (GO:0051972, P = 2.34E-3). Conclusions Our integration analysis has identified 30 candidate proteins for CAD, which may provide important leads to design future functional studies and potential drug targets for CAD.
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Affiliation(s)
- Jiqing Li
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, 250012, Shandong, China
| | - Jiate Wei
- Office of Hospital Management Research, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Ping Fu
- Jinan Center for Disease Control and Prevention, Jinan, 250012, Shandong, China
| | - Jianhua Gu
- Department of Emergency Medicine, Qilu Hospital of Shandong University, Shandong University, Jinan, 250012, Shandong, China
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Grace SL, Ghanbari M, da Cruz MMMA, Vanderlei LCM, Ghisi GLDM. Psychometric validation of the Cardiac Rehabilitation Barriers Scale Revised (CRBS-R) for hybrid delivery. BMJ Open 2024; 14:e090261. [PMID: 39414267 PMCID: PMC11481153 DOI: 10.1136/bmjopen-2024-090261] [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] [Received: 06/20/2024] [Accepted: 09/23/2024] [Indexed: 10/18/2024] Open
Abstract
OBJECTIVE To test the measurement properties of the revised version of the English Cardiac Rehabilitation Barriers Scale (CRBS-R), suitable for hybrid delivery, structural validity, internal reliability, as well as face, cross-cultural, construct and criterion validity were assessed. DESIGN Cross-sectional study, where participants completed an online survey via Qualtrics (2023-2024). SETTING Multicentre, with cardiac rehabilitation (CR) programmes recruiting patients globally; most patients stemmed from a hybrid programme in Iran and supervised programme in Brazil. PARTICIPANTS Participants include inpatients or outpatients with a cardiovascular diagnosis or procedure that is indicated for participation in CR. MEASURES In addition to sociodemographic and CR use items, the 21-item CRBS-R was administered. It assesses multilevel barriers and was revised based on a literature review. Responses range from 1 to 5, with higher scores indicating greater barriers. RESULTS 235 patients participated from all 6 WHO regions. Items were rated as highly applicable, and open-ended responses revealing no key barriers were omitted, supporting face and cross-cultural validity. Cronbach's α for the total CRBS-R was 0.82. Principal components analysis resulted in the extraction of 4 components, which collectively accounted for 60.5% of the variance and were all internally consistent. Construct validity was supported by associations of total CRBS scores with work status (p=0.04), exercise history (p=0.01) and social support (p=0.03). Total CRBS-R scores were significantly lower in patients who were referred and enrolled versus those who were not (both p≤0.01), confirming criterion validity. CONCLUSIONS The CRBS-R is a reliable and valid scale comprising four subscales, applicable to hybrid CR across diverse settings. It can serve as a valuable tool to support identification of patient's CR barriers, to optimise secondary prevention utilisation globally.
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Affiliation(s)
- Sherry L Grace
- Faculty of Health, York University, Toronto, Ontario, Canada
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Mahdieh Ghanbari
- Yazd Cardiovascular Research Center, Non-communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | | | - Gabriela Lima de Melo Ghisi
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Department pf Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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