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Jin J, Hao W, Xie D. Meta-analysis of the correlation between pulmonary hypertension and echocardiographic parameters in patients with chronic kidney disease. PeerJ 2024; 12:e17245. [PMID: 38650651 PMCID: PMC11034503 DOI: 10.7717/peerj.17245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
Objective To investigate the correlation between pulmonary hypertension (PH) and echocardiographic parameters in patients with chronic kidney disease (CKD). Methods PubMed, Embase, Web of Science, Cochrane, VIP, CNKI, and Wanfang databases were systematically searched for articles published from inception to 19 May 2023. Study quality was estimated using the Quality Assessment of Case-Control Studies tool. Forest plots were drawn using R language software. The "metacor" function in the "meta" package was utilized for meta-analysis of the r-values and their standard errors. Heterogeneity and sensitivity analyses were carried out, with the main outcomes as r-value, p-value, and I2 value. Results Eleven studies were included, with 1,809 CKD patients. The correlations between 12 echocardiographic parameters and PH were analyzed. Except for FS and LVEF which were negatively correlated with CKD-PH, the other 10 parameters were positively correlated with CKD-PH. Among them, LA was highly correlated with CKD-PH (0.70 < r < 0.89); LVDD, RA, RV, LVMI, and LVDS were moderately correlated with CKD-PH (0.40 < r < 0.69); while PA, IVS, LVPW, SV, FS, and LVEF were lowly correlated with CKD-PH (0.20 < r < 0.39). The synthesized estimates were stable against heterogeneity. Conclusion CKD-PH patients may have large cardiac chambers, thickened septal tissue on both sides of the chambers, reduced pulmonary artery flow rates, and decreased left ventricular function.
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Affiliation(s)
- Jiahui Jin
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Nephrology, Yibin Second People’s Hospital, Yibin, China
| | - Wen Hao
- Department of Nephrology, Yibin Second People’s Hospital, Yibin, China
| | - Deqiong Xie
- School of Medicine and Life Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Department of Nephrology, Yibin Second People’s Hospital, Yibin, China
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Dwivedi J, Wal P, Dash B, Ovais M, Sachan P, Verma V. Diabetic Pneumopathy- A Novel Diabetes-associated Complication: Pathophysiology, the Underlying Mechanism and Combination Medication. Endocr Metab Immune Disord Drug Targets 2024; 24:1027-1052. [PMID: 37817659 DOI: 10.2174/0118715303265960230926113201] [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: 06/06/2023] [Revised: 07/03/2023] [Accepted: 07/20/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND The "diabetic lung" has been identified as a possible target organ in diabetes, with abnormalities in ventilation control, bronchomotor tone, lung volume, pulmonary diffusing capacity, and neuroadrenergic bronchial innervation. OBJECTIVE This review summarizes studies related to diabetic pneumopathy, pathophysiology and a number of pulmonary disorders including type 1 and type 2 diabetes. METHODS Electronic searches were conducted on databases such as Pub Med, Wiley Online Library (WOL), Scopus, Elsevier, ScienceDirect, and Google Scholar using standard keywords "diabetes," "diabetes Pneumopathy," "Pathophysiology," "Lung diseases," "lung infection" for review articles published between 1978 to 2023 very few previous review articles based their focus on diabetic pneumopathy and its pathophysiology. RESULTS Globally, the incidence of diabetes mellitus has been rising. It is a chronic, progressive metabolic disease. The "diabetic lung" may serve as a model of accelerated ageing since diabetics' rate of respiratory function deterioration is two to three-times higher than that of normal, non-smoking people. CONCLUSION Diabetes-induced pulmonary dysfunction has not gained the attention it deserves due to a lack of proven causality and changes in cellular properties. The mechanism underlying a particular lung illness can still only be partially activated by diabetes but there is evidence that hyperglycemia is linked to pulmonary fibrosis in diabetic people.
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Affiliation(s)
- Jyotsana Dwivedi
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
| | - Pranay Wal
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
| | - Biswajit Dash
- Department of Pharmaceutical Technology, ADAMAS University, West Bengal, India
| | | | - Pranjal Sachan
- PSIT- Pranveer Singh Institute of Technology (Pharmacy), Kanpur, India
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Zhang X, Deng X, Zhang L, Wang P, Tong X, Mo Y, Zhang Y, Zhang Y, Mo C, Zhang L. Single-cell RNA sequencing analysis of lung cells in COVID-19 patients with diabetes, hypertension, and comorbid diabetes-hypertension. Front Endocrinol (Lausanne) 2023; 14:1258646. [PMID: 38144556 PMCID: PMC10748394 DOI: 10.3389/fendo.2023.1258646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/15/2023] [Indexed: 12/26/2023] Open
Abstract
Background There is growing evidence that the lung is a target organ for injury in diabetes and hypertension. There are no studies on the status of the lungs, especially cellular subpopulations, and related functions in patients with diabetes, hypertension, and hypertension-diabetes after combined SARS-CoV-2 infection. Method Using single-cell meta-analysis in combination with bulk-RNA analysis, we identified three drug targets and potential receptors for SARS-CoV-2 infection in lung tissues from patients with diabetes, hypertension, and hypertension-diabetes, referred to as "co-morbid" patients. Using single-cell meta-analysis analysis in combination with bulk-RNA, we identified drug targets and potential receptors for SARS-CoV-2 infection in the three co-morbidities. Results The single-cell meta-analysis of lung samples from SARS-CoV-2-infected individuals with diabetes, hypertension, and hypertension-diabetes comorbidity revealed an upregulation of fibroblast subpopulations in these disease conditions associated with a predictive decrease in lung function. To further investigate the response of fibroblasts to therapeutic targets in hypertension and diabetes, we analyzed 35 upregulated targets in both diabetes and hypertension. Interestingly, among these targets, five specific genes were upregulated in fibroblasts, suggesting their potential association with enhanced activation of endothelial cells. Furthermore, our investigation into the underlying mechanisms driving fibroblast upregulation indicated that KREMEN1, rather than ACE2, could be the receptor responsible for fibroblast activation. This finding adds novel insights into the molecular processes involved in fibroblast modulation in the context of SARS-CoV-2 infection within these comorbid conditions. Lastly, we compared the efficacy of Pirfenidone and Nintedanib as therapeutic interventions targeting fibroblasts prone to pulmonary fibrosis. Our findings suggest that Nintedanib may be a more suitable treatment option for COVID-19 patients with diabetes and hypertension who exhibit fibrotic lung lesions. Conclusion In the context of SARS-CoV-2 infections, diabetes, hypertension, and their coexistence predominantly lead to myofibroblast proliferation. This phenomenon could be attributed to the upregulation of activated endothelial cells. Moreover, it is noteworthy that therapeutic interventions targeting hypertension-diabetes demonstrate superior efficacy. Regarding treating fibrotic lung conditions, Nintedanib is a more compelling therapeutic option.
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Affiliation(s)
- Xin Zhang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China
- Department of Gastroenterology, West China (Airport) Hospital of Sichuan University (The First People’s Hospital of Shuangliu District, Chengdu), Chengdu, China
| | - Xiaoqian Deng
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, China
| | - Liangliang Zhang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China
| | - Pengbo Wang
- School of Professional Studies, Columbia University, New York, NY, United States
| | - Xia Tong
- Department of Gastroenterology, West China (Airport) Hospital of Sichuan University (The First People’s Hospital of Shuangliu District, Chengdu), Chengdu, China
| | - Yan Mo
- Department of Neurology Medicine, The Aviation Industry Corporation of China (AVIC) 363 Hospital, Chengdu, China
| | - Yuansheng Zhang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China
| | - Yan Zhang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu, China
| | - Chunheng Mo
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, China
- State Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Lanlan Zhang
- Department of Pulmonary and Critical Care Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, West China Hospital, Sichuan University, Chengdu, China
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Bejeshk MA, Bagheri F, Salimi F, Rajizadeh MA. The Diabetic Lung Can Be Ameliorated by Citrullus colocynthis by Reducing Inflammation and Oxidative Stress in Rats with Type 1 Diabetes. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2023; 2023:5176645. [PMID: 37520024 PMCID: PMC10382246 DOI: 10.1155/2023/5176645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/29/2023] [Accepted: 07/09/2023] [Indexed: 08/01/2023]
Abstract
Background Diabetes impacts various organs in the body and some reports showed that the lung is also affected by diabetes, and an imbalance of inflammation and oxidative stress may participate to diabetic lung impairments. The present study is conducted to assess the impacts of Citrullus colocynthis (CC) on some aspects of these impairments. Methods Frothy two male Wistar rats (3-4 months old and weighing 200-250 g) were used in the present research. Animals were divided into 3 groups of control, Diabetes, and Diabetes + Drug. CC was administered to diabetic rats orally. The lung tissue and BALF oxidative stress and inflammatory indices including the MDA, TAC, SOD, Gpx, TNFα, IL-6, IL-17, and IL-10 were evaluated by the ELISA method. Results Our observations disclosed the ameliorative impacts of CC administration against oxidative stress and inflammation imbalance. Also, it was found that CC improved body weight and fasting blood sugar in rats with diabetes. Conclusion We can conclude that the administration of CC can be effective in improving diabetic lungs in rats.
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Affiliation(s)
- Mohammad Abbas Bejeshk
- Department of Physiology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Bagheri
- Pathology and Stem Cell Research Center, Department of Pathology, Afzalipour Medical Faculty, Kerman University of Medical Sciences, Kerman, Iran
- Legal Medicine Research Center, Legal Medicine Organization, Kerman, Iran
| | - Fouzieh Salimi
- Department of Clinical Biochemistry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Amin Rajizadeh
- Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
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5
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Mooradian AD. Diabetes-related perturbations in the integrity of physiologic barriers. J Diabetes Complications 2023; 37:108552. [PMID: 37356233 DOI: 10.1016/j.jdiacomp.2023.108552] [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: 03/21/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
One of the hallmarks of health is the integrity of barriers at the cellular and tissue levels. The two cardinal functions of barriers include preventing access of deleterious elements of the environment (barrier function) while facilitating the transport of essential ions, signaling molecules and nutrients needed to maintain the internal milieu (transport function). There are several cellular and subcellular barriers and some of these barriers can be interrelated. The principal physiologic barriers include blood-retinal barrier, blood-brain barrier, blood-testis barrier, renal glomerular/tubular barrier, intestinal barrier, pulmonary blood-alveolar barrier, blood-placental barrier and skin barrier. Tissue specific barriers are the result of the vasculature, cellular composition of the tissue and extracellular matrix within the tissue. Uncontrolled diabetes and acute hyperglycemia may disrupt the integrity of physiologic barriers, primarily through altering the vascular integrity of the tissues and may well contribute to the clinically recognized complications of diabetes. Although diabetes is a systemic disease, some of the organs display clinically significant deterioration in function while others undergo subclinical changes. The pathophysiology of the disruption of these barriers is not entirely clear but it may be related to diabetes-related cellular stress. Understanding the mechanisms of diabetes related dysfunction of various physiologic barriers might help identifying novel therapeutic targets for reducing clinically significant complications of diabetes.
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Affiliation(s)
- Arshag D Mooradian
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Florida Jacksonville College of Medicine, Jacksonville, FL, USA.
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6
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Gaur J, Singh RK, Kulkarni C, Dube S. Assessment of Pulmonary Hypertension in Chronic Kidney Disease Patients using Doppler Echocardiography. Heart Views 2023; 24:24-28. [PMID: 37124428 PMCID: PMC10144410 DOI: 10.4103/heartviews.heartviews_31_22] [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: 03/28/2022] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
Background The incidence of chronic kidney disease (CKD) is increasing globally and is associated with significant morbidity and mortality related to the cardiovascular system. There is limited data on pulmonary hypertension (PH) in CKD patients, especially from developing and underdeveloped countries. PH leads to hypoxia which is a significant cause of dyspnea in CKD patients with or without pulmonary edema. Hence, we planned this study to assess the PH in CKD patients using two-dimensional (2D) color Doppler echocardiography. Materials and Methods This is an observational cross-sectional study. A total of 100 CKD patients on hemodialysis or conservative management were enrolled in the study. Following the collection of demographic data, and routine/specific investigations, these patients were assessed for PH using 2D color Doppler echocardiography. Results PH was found in 47% of patients with CKD. Left ventricular (LV) hypertrophy, systolic and diastolic dysfunction, dilated right atrium/right ventricular and left atrial/LV chambers, and valvular hypertrophy were other echocardiography findings recorded in these patients. Low hemoglobin levels, high urea/creatinine levels, and duration of hemodialysis in CKD patients were found to be significantly associated with the presence of PH. Conclusion The majority of CKD patients have PH at various stages of disease-causing unexplained dyspnea in these patients. PH is common in end-stage CKD as compared to patients with a less severe stage of CKD. Hence, CKD patients should be evaluated for PH, especially in the presence of intractable dyspnea.
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Affiliation(s)
- Jyoti Gaur
- Department of Medicine, Gandhi Medical College and HH, Bhopal, Madhya Pradesh, India
| | - Rakesh Kumar Singh
- Department of Cardiology, Gandhi Medical College and HH, Bhopal, Madhya Pradesh, India
| | - Chaitanya Kulkarni
- Department of Nephrology, Gandhi Medical College and HH, Bhopal, Madhya Pradesh, India
| | - Simmi Dube
- Department of Medicine, Gandhi Medical College and HH, Bhopal, Madhya Pradesh, India
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7
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Karlsen T, Engstrøm M, Steinshamn SL. Exercise and obstructive sleep apnoea: a 24-week follow-up study. BMJ Open Sport Exerc Med 2022; 8:e001366. [PMID: 36148385 PMCID: PMC9486338 DOI: 10.1136/bmjsem-2022-001366] [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] [Accepted: 09/05/2022] [Indexed: 11/04/2022] Open
Abstract
Objective Report on long-term follow-up results in the apnoea hypopnea index (AHI) and self-reported daytime sleepiness in participants with moderate to severe obstructive sleep apnoea at 12 weeks after completion of a high-intensity exercise training or control intervention. Methods Twenty-six participants with obstructive sleep apnoea (body mass index (BMI) 37 (36-39) kg/m, age 52 (49-55) years, apnoea-hypopnoea index 40.5 (31.3-50.2) events/hour), randomised to either 12 weeks of supervised high-intensity interval training (HIIT) (4×4 min of treadmill running or walking at 90%-95% of maximal heart rate) or no intervention (control), underwent a sleep evaluation follow-up 24 weeks after intervention initiation. Respiratory measures during sleep were registered at baseline, 12 weeks (postintervention) and 24 weeks (long-term follow-up). Results At the 24-week follow-up, there were no statistically significant differences between the groups in the AHI (HIIT 30.7 (17.2-44.1) and control 38.7 (22.8-54.5) events/hour), Epworth score (HIIT 7.0 (4.7-9.3) and control 5.5 (3.9-7.0)), mean oxygen saturation (HIIT 93.2 (92.5-93.9) and control 92.0 (91.1-92.8)) or oxygen desaturation events (HIIT 32.9 (20.4-45.4) and control 44.3 (27.3-61.3) n/hour). BMI remained unchanged from the baseline in both groups. In the HIIT group, only two participants reported having continued with HIIT at 24 weeks. Conclusion The effect of 12 weeks of supervised high-intensity exercise training on AHI and self-reported daytime sleepiness was lost at the 24-week follow-up.
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Affiliation(s)
- Trine Karlsen
- Faculty of Nursing and Health Sciences, Nord University, Bodo, Norway.,Cardiac Exercise Research Group, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Morten Engstrøm
- Neurology and Clinical Neurophysiology, St.Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Sigurd L Steinshamn
- Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, NTNU, Norwgian University of Science and Technology, Trondheim, Norway.,Clinic of Thoracic and Occupational Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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8
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Type-1 diabetes and pulmonary function tests. A meta-analysis. Respir Med 2022; 203:106991. [DOI: 10.1016/j.rmed.2022.106991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 11/20/2022]
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Gimenes GM, Santana GO, Scervino MVM, Curi R, Pereira JNB. A short review on the features of the non-obese diabetic Goto-Kakizaki rat intestine. Braz J Med Biol Res 2022; 55:e11910. [PMID: 36000611 PMCID: PMC9394691 DOI: 10.1590/1414-431x2022e11910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
The Goto-Kakizaki (GK) rat is a non-obese experimental model of type 2 diabetes
mellitus (T2DM) that allows researchers to monitor diabetes-induced changes
without jeopardizing the effects of obesity. This rat strain exhibits notable
gastrointestinal features associated with T2DM, such as marked alterations in
intestinal morphology, reduced intestinal motility, slow transit, and modified
microbiota compared to Wistar rats. The primary treatments for diabetic patients
include administration of hypoglycemic agents and insulin, and lifestyle
changes. Emerging procedures, including alternative therapies, metabolic
surgeries, and modulation of the intestinal microbiota composition, have been
shown to improve the diabetic state of GK rats. This review describes the
morpho-physiological diabetic-associated features of the gastrointestinal tract
(GIT) of GK rats. We also describe promising strategies, e.g., metabolic surgery
and modulation of gut microbiota composition, used to target the GIT of this
animal model to improve the diabetic state.
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Affiliation(s)
- G M Gimenes
- Programa de Pós-Graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, SP, Brasil
| | - G O Santana
- Programa de Pós-Graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, SP, Brasil
| | - M V M Scervino
- Programa de Pós-Graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, SP, Brasil
| | - R Curi
- Programa de Pós-Graduação Interdisciplinar em Ciências da Saúde, Universidade Cruzeiro do Sul, São Paulo, SP, Brasil.,Centro Bioindustrial, Instituto Butantan, São Paulo, SP, Brasil
| | - J N B Pereira
- Laboratório Estratégico de Diagnóstico Molecular, Instituto Butantan, São Paulo, SP, Brasil
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10
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Histopathological Changes In Lung Tissue Caused By Diabetes: A Review. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1070489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Diabetes mellitus associated with oxidative stress and inflammation can affect many organs. While the effects of diabetes on many organs are well known and documented, its mechanisms of action on the lung are known far less.
Hyperglycemia can lead to lung damage by increasing oxidative stresses and inflammation. Diabetes may be a trigger for pulmonary fibrosis, as studies suggest that there may be an important link between pulmonary fibrosis and diabetes.
In this review, the histopathological changes caused by diabetes in the lung tissue were summarized. In addition, changes in the lung due to inflammation, oxidative stress and pulmonary fibrosis mechanisms were evaluated.
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Shin J, Toyoda S, Nishitani S, Onodera T, Fukuda S, Kita S, Fukuhara A, Shimomura I. SARS-CoV-2 infection impairs the insulin/IGF signaling pathway in the lung, liver, adipose tissue, and pancreatic cells via IRF1. Metabolism 2022; 133:155236. [PMID: 35688210 PMCID: PMC9173833 DOI: 10.1016/j.metabol.2022.155236] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/11/2022] [Accepted: 06/01/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND COVID-19 can cause multiple organ damages as well as metabolic abnormalities such as hyperglycemia, insulin resistance, and new onset of diabetes. The insulin/IGF signaling pathway plays an important role in regulating energy metabolism and cell survival, but little is known about the impact of SARS-CoV-2 infection. The aim of this work was to investigate whether SARS-CoV-2 infection impairs the insulin/IGF signaling pathway in the host cell/tissue, and if so, the potential mechanism and association with COVID-19 pathology. METHODS To determine the impact of SARS-CoV-2 on insulin/IGF signaling pathway, we utilized transcriptome datasets of SARS-CoV-2 infected cells and tissues from public repositories for a wide range of high-throughput gene expression data: autopsy lungs from COVID-19 patients compared to the control from non-COVID-19 patients; lungs from a human ACE2 transgenic mouse infected with SARS-CoV-2 compared to the control infected with mock; human pluripotent stem cell (hPSC)-derived liver organoids infected with SARS-CoV-2; adipose tissues from a mouse model of COVID-19 overexpressing human ACE2 via adeno-associated virus serotype 9 (AAV9) compared to the control GFP after SARS-CoV-2 infection; iPS-derived human pancreatic cells infected with SARS-CoV-2 compared to the mock control. Gain and loss of IRF1 function models were established in HEK293T and/or Calu3 cells to evaluate the impact on insulin signaling. To understand the mechanistic regulation and relevance with COVID-19 risk factors, such as older age, male sex, obesity, and diabetes, several transcriptomes of human respiratory, metabolic, and endocrine cells and tissue were analyzed. To estimate the association with COVID-19 severity, whole blood transcriptomes of critical patients with COVID-19 compared to those of hospitalized noncritical patients with COVID-19. RESULTS We found that SARS-CoV-2 infection impaired insulin/IGF signaling pathway genes, such as IRS, PI3K, AKT, mTOR, and MAPK, in the host lung, liver, adipose tissue, and pancreatic cells. The impairments were attributed to interferon regulatory factor 1 (IRF1), and its gene expression was highly relevant to risk factors for severe COVID-19; increased with aging in the lung, specifically in men; augmented by obese and diabetic conditions in liver, adipose tissue, and pancreatic islets. IRF1 activation was significantly associated with the impaired insulin signaling in human cells. IRF1 intron variant rs17622656-A, which was previously reported to be associated with COVID-19 prevalence, increased the IRF1 gene expression in human tissue and was frequently found in American and European population. Critical patients with COVID-19 exhibited higher IRF1 and lower insulin/IGF signaling pathway genes in the whole blood compared to hospitalized noncritical patients. Hormonal interventions, such as dihydrotestosterone and dexamethasone, ameliorated the pathological traits in SARS-CoV-2 infectable cells and tissues. CONCLUSIONS The present study provides the first scientific evidence that SARS-CoV-2 infection impairs the insulin/IGF signaling pathway in respiratory, metabolic, and endocrine cells and tissues. This feature likely contributes to COVID-19 severity with cell/tissue damage and metabolic abnormalities, which may be exacerbated in older, male, obese, or diabetic patients.
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Affiliation(s)
- Jihoon Shin
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan; Department of Diabetes Care Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
| | - Shinichiro Toyoda
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shigeki Nishitani
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Toshiharu Onodera
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shiro Fukuda
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Shunbun Kita
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan; Department of Adipose Management, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Atsunori Fukuhara
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan; Department of Adipose Management, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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12
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Huang D, Chen C, Zuo Y, Du L, Liu T, Abbott GW, Hu Z. Protective effect of remote liver ischemic postconditioning on pulmonary ischemia and reperfusion injury in diabetic and non-diabetic rats. PLoS One 2022; 17:e0268571. [PMID: 35617238 PMCID: PMC9135201 DOI: 10.1371/journal.pone.0268571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/03/2022] [Indexed: 11/19/2022] Open
Abstract
Pulmonary ischemia and reperfusion (I/R) injury occurs in many clinical conditions and causes severe damage to the lungs. Diabetes mellitus (DM) predisposes to pulmonary I/R injury. We previously found that remote liver ischemia preconditioning protected lungs against pulmonary I/R injury. The aim of the present study was to investigate whether remote liver ischemic postconditioning (RLIPost) attenuates pulmonary damage induced by I/R injury in non-diabetic or diabetic rats. Male Sprague-Dawley rats were assigned into non-diabetic and diabetic groups. All rats except for the sham were exposed to 45 min of left hilum occlusion followed by 2 h of reperfusion. RLIPost was conducted at the onset of pulmonary reperfusion by four cycles of 5 min of liver ischemia and reperfusion. Lung injury was assessed by the wet/dry weight ratio, pulmonary oxygenation, histopathological changes, apoptosis and the expression of inflammatory cytokines. Reperfusion-associated protein phosphorylation states were determined. RLIPost offered strong pulmonary-protection in both non-diabetic and diabetic rats, as reflected in reduced water content and pulmonary structural damage, recovery of lung function, inhibition of apoptosis and inflammation after ischemia-reperfusion. RLIPost induced the activation of pulmonary STAT-3, a key component in the SAFE pathway, but not activation of the proteins in the RISK pathway, in non-diabetic rats. In contrast, RLIPost-induced pulmonary protection in diabetic lungs was independent of SAFE or RISK pathway activation. These results demonstrate that RLIPost exerts pulmonary protection against I/R-induced lung injury in non-diabetic and diabetic rats. The underlying mechanism for protection may be different in non-diabetic (STAT-3 dependent) versus diabetic (STAT-3 independent) rats.
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Affiliation(s)
- Dou Huang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Changwei Chen
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunxia Zuo
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lei Du
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ting Liu
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Geoffrey W. Abbott
- Bioelectricity Laboratory, Department of Physiology and Biophysics, School of Medicine, University of California, Irvine, CA, United States of America
| | - Zhaoyang Hu
- Laboratory of Anesthesia and Critical Care Medicine, National-Local Joint Engineering Research Centre of Translational Medicine of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- * E-mail:
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13
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Arghiani N, Nissan T, Matin MM. Role of microRNAs in COVID-19 with implications for therapeutics. Biomed Pharmacother 2021; 144:112247. [PMID: 34601190 PMCID: PMC8463393 DOI: 10.1016/j.biopha.2021.112247] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 02/09/2023] Open
Abstract
COVID-19 is a pneumonia-like disease with highly transmittable and pathogenic properties caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which infects both animals and humans. Although many efforts are currently underway to test possible therapies, there is no specific FDA approved drug against SARS-CoV-2 yet. miRNA-directed gene regulation controls the majority of biological processes. In addition, the development and progression of several human diseases are associated with dysregulation of miRNAs. In this regard, it has been shown that changes in miRNAs are linked to severity of COVID-19 especially in patients with respiratory diseases, diabetes, heart failure or kidney problems. Therefore, targeting these small noncoding-RNAs could potentially alleviate complications from COVID-19. Here, we will review the roles and importance of host and RNA virus encoded miRNAs in COVID-19 pathogenicity and immune response. Then, we focus on potential miRNA therapeutics in the patients who are at increased risk for severe disease.
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Affiliation(s)
- Nahid Arghiani
- Department of Molecular Biosciences, the Wenner-Gren Institute, Stockholm University, Stockholm, Sweden; School of Life Science, Department of Biochemistry and Biomedicine, University of Sussex, Brighton, United Kingdom
| | - Tracy Nissan
- Department of Molecular Biosciences, the Wenner-Gren Institute, Stockholm University, Stockholm, Sweden; School of Life Science, Department of Biochemistry and Biomedicine, University of Sussex, Brighton, United Kingdom.
| | - Maryam M Matin
- Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran; Novel Diagnostics and Therapeutics Research Group, Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran; Stem Cell and Regenerative Medicine Research Group, Iranian Academic Center for Education, Culture and Research (ACECR), Khorasan Razavi Branch, Mashhad, Iran.
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14
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Kwon S, Lee M, Crowley G, Schwartz T, Zeig-Owens R, Prezant DJ, Liu M, Nolan A. Dynamic Metabolic Risk Profiling of World Trade Center Lung Disease: A Longitudinal Cohort Study. Am J Respir Crit Care Med 2021; 204:1035-1047. [PMID: 34473012 DOI: 10.1164/rccm.202006-2617oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Rationale: Metabolic syndrome (MetSyn) increases the risk of World Trade Center (WTC) lung injury (LI). However, the temporal relationship of MetSyn, exposure intensity, and lung dysfunction is not well understood. Objective: To model the association of longitudinal MetSyn characteristics with WTC lung disease to define modifiable risk. Methods: Firefighters, for whom consent was obtained (N = 5,738), were active duty on September 11, 2001 (9/11). WTC-LI (n = 1,475; FEV1% predicted <lower limit of normal [LLN]) and non-WTC-LI (n = 4,263; FEV1% predicted ⩾LLN at all exams) was the primary outcome, and FVC% predicted <LLN and FEV1/FVC <0.70 were secondary outcomes. We assessed 1) the effect of concurrent MetSyn on longitudinal lung function by linear mixed models, 2) the temporal effect of MetSyn and exposure by Weibull proportional hazards, 3) the effects of MetSyn's rate of change by two-stage models, and 4) the nonlinear joint effect of longitudinal MetSyn components by a partially linear single-index model (PLSI). Measurements and Main Results: WTC-LI cases were more often ever-smokers, arrived in the morning (9/11), and had MetSyn. Body mass index ⩾30 kg/m2 and high-density lipoprotein <40 mg/dl were most contributory to concurrent loss of FEV1% predicted and FVC% predicted while conserving FEV1/FVC. Body mass index ⩾30 kg/m2 and dyslipidemia significantly predicted WTC-LI, FVC% predicted <LLN in a Weibull proportional hazards model. Dynamic risk assessment of WTC-LI on the basis of MetSyn and exposure showed how reduction of MetSyn factors further reduces WTC-LI likelihood in susceptible populations. PLSI demonstrates that MetSyn has a nonlinear relationship with WTC lung disease, and increases in cumulative MetSyn risk factors exponentially increase WTC-LI risk. An interactive metabolic-risk modeling application was developed to simplify PLSI interpretation. Conclusions: MetSyn and WTC exposure contribute to the development of lung disease. Dynamic risk assessment may be used to encourage treatment of MetSyn in susceptible populations. Future studies will focus on dietary intervention as a disease modifier.
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Affiliation(s)
- Sophia Kwon
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - Myeonggyun Lee
- Division of Biostatistics, Department of Population Health, and
| | - George Crowley
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine
| | - Theresa Schwartz
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York; and
| | - Rachel Zeig-Owens
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York; and.,Department of Epidemiology and Population Health and
| | - David J Prezant
- Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York; and.,Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Mengling Liu
- Division of Biostatistics, Department of Population Health, and.,Department of Environmental Medicine, New York University School of Medicine, New York, New York
| | - Anna Nolan
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine.,Department of Environmental Medicine, New York University School of Medicine, New York, New York.,Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York; and
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15
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Abbasi E, Mirzaei F, Tavilani H, Khodadadi I. Diabetes and COVID-19: Mechanism of pneumonia, treatment strategy and vaccine. Metabol Open 2021; 11:100122. [PMID: 34514363 PMCID: PMC8421075 DOI: 10.1016/j.metop.2021.100122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 08/24/2021] [Indexed: 12/26/2022] Open
Abstract
As of August 5, 2021, there were about 200,000,000 global confirmed patients of COVID-19, with more than 4,250,000 deaths. The COVID-19 disease which is a tremendous public health threat, jumps unpredictably and outbreaks very quickly. The overall mortality rate of COVID-19 infection is 1%-15% but reaches up to 17-38% in older cases with chronic disorders and in intensive care unit (ICU) subjects. Diabetic patients, particularly those whose disease is not well controlled can be more susceptible to COVID-19. Although diabetes was present in 5.3%-42.3% of fatalities from COVID-19, the underlying pathophysiological mechanisms of action of novel coronavirus in diabetic patients are unknown. Based on the elevating of global prevalence, diabetes is the main medical problem associated with COVID-19. It is plausible that diabetes can forecast elevated severity of pneumonia. The mortality of lung infection among diabetes is remarkably higher compared with non-diabetic patients. Mechanisms responsible for severe pneumonia in the diabetic patients as well as treatment of diabetic patients infected with COVID-19 are largely speculative. Hence, this paper will summarize the recent findings related to the mechanisms of pneumonia and treatment strategies in diabetic patients.
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Affiliation(s)
- Ebrahim Abbasi
- Department of Clinical Biochemistry, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Fatemeh Mirzaei
- Department of Anatomical sciences, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Heidar Tavilani
- Department of Clinical Biochemistry, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Iraj Khodadadi
- Department of Clinical Biochemistry, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
- Nutrition Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
- Corresponding author. Department of Clinical Biochemistry, School of Medicine, Hamadan University of Medical Sciences, Shahid Fahmideh Street, Hamadan, Iran.;
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16
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Pereira JNB, Murata GM, Sato FT, Marosti AR, Carvalho CRDO, Curi R. Small intestine remodeling in male Goto-Kakizaki rats. Physiol Rep 2021; 9:e14755. [PMID: 33580916 PMCID: PMC7881800 DOI: 10.14814/phy2.14755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Obesity is associated with the development of insulin resistance (IR) and type-2 diabetes mellitus (T2DM); however, not all patients with T2DM are obese. The Goto-Kakizaki (GK) rat is an experimental model of spontaneous and non-obese T2DM. There is evidence that the intestine contributes to IR development in GK animals. This information prompted us to investigate small intestine remodeling in this animal model. METHODS Four-month-old male Wistar (control) and GK rats were utilized for the present study. After removing the small intestine, the duodenum, proximal jejunum, and distal ileum were separated. We then measured villi and muscular and mucosa layer histomorphometry, goblet cells abundance, total myenteric and submucosal neuron populations, and inflammatory marker expression in the small intestinal segments and intestinal transit of both groups of animals. KEY RESULTS We found that the GK rats exhibited decreased intestinal area (p < 0.0001), decreased crypt depth in the duodenum (p = 0.01) and ileum (p < 0.0001), increased crypt depth in the jejunum (p < 0.0001), longer villi in the jejunum and ileum (p < 0.0001), thicker villi in the duodenum (p < 0.01) and ileum (p < 0.0001), thicker muscular layers in the duodenum, jejunum, and ileum (p < 0.0001), increased IL-1β concentrations in the duodenum and jejunum (p < 0.05), and increased concentrations of NF-κB p65 in the duodenum (p < 0.01), jejunum and ileum (p < 0.05). We observed high IL-1β reactivity in the muscle layer, myenteric neurons, and glial cells of the experimental group. GK rats also exhibited a significant reduction in submucosal neuron density in the jejunum and ileum, ganglionic hypertrophy in all intestinal segments studied (p < 0.0001), and a slower intestinal transit (about 25%) compared to controls. CONCLUSIONS The development of IR and T2DM in GK rats is associated with small intestine remodeling that includes marked alterations in small intestine morphology, local inflammation, and reduced intestinal transit.
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Affiliation(s)
| | | | - Fabio Takeo Sato
- Department of GeneticsEvolution, Microbiology and ImmunologyInstitute of BiologyState University of CampinasCampinasBrazil
| | | | | | - Rui Curi
- Interdisciplinary Post‐Graduate Program in Health SciencesCruzeiro do Sul UniversitySão PauloBrazil
- Department of Physiology and BiophysicsInstitute of Biomedical SciencesUniversity of São PauloSão PauloBrazil
- Butantan InstituteSão PauloBrazil
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17
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Kobos L, Shannahan J. Particulate matter inhalation and the exacerbation of cardiopulmonary toxicity due to metabolic disease. Exp Biol Med (Maywood) 2021; 246:822-834. [PMID: 33467887 DOI: 10.1177/1535370220983275] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Particulate matter is a significant public health issue in the United States and globally. Inhalation of particulate matter is associated with a number of systemic and organ-specific adverse health outcomes, with the pulmonary and cardiovascular systems being particularly vulnerable. Certain subpopulations are well-recognized as being more susceptible to inhalation exposures, such as the elderly and those with pre-existing respiratory disease. Metabolic syndrome is becoming increasingly prevalent in our society and has known adverse effects on the heart, lungs, and vascular systems. The limited evaluations of individuals with metabolic syndromehave demonstrated that theymay compose a sensitive subpopulation to particulate exposures. However, the toxicological mechanisms responsible for this increased vulnerability are not fully understood. This review evaluates the currently available literature regarding how the response of an individual's pulmonary and cardiovascular systems is influenced by metabolic syndrome and metabolic syndrome-associated conditions such as hypertension, dyslipidemia, and diabetes. Further, we will discuss potential therapeutic agents and targets for the alleviation and treatment of particulate-matter induced metabolic illness. The information reviewed here may contribute to the understanding of metabolic illness as a risk factor for particulate matter exposure and further the development of therapeutic approaches to treat vulnerable subpopulations, such as those with metabolic diseases.
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Affiliation(s)
- Lisa Kobos
- School of Health Sciences, College of Human and Health Sciences, Purdue University, West Lafayette, IN 47907, USA
| | - Jonathan Shannahan
- School of Health Sciences, College of Human and Health Sciences, Purdue University, West Lafayette, IN 47907, USA
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18
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Whitelock V, Rutters F, Rijnhart JJM, Nouwen A, Higgs S. The mediating role of comorbid conditions in the association between type 2 diabetes and cognition: A cross-sectional observational study using the UK Biobank cohort. Psychoneuroendocrinology 2021; 123:104902. [PMID: 33197721 DOI: 10.1016/j.psyneuen.2020.104902] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 11/18/2022]
Abstract
AIMS Using the UK Biobank cohort, a large sample of middle aged and older adults in the UK, the present study aimed to examine the cross-sectional association between type 2 diabetes and cognition and to assess the hypothesised mediating role of common comorbid conditions, whilst controlling for important demographic and lifestyle factors. METHODS Using regression models and general structural equation models, we examined the cross-sectional association between type 2 diabetes status and: fluid intelligence; reaction time; visual memory; digit span and prospective memory; and the hypothesised mediating role of common comorbid conditions: visceral obesity; sleep problems; macrovascular problems; respiratory problems; cancer and depressive symptoms in 47,468 participants from the UK Biobank cohort, of whom 1,831 have type 2 diabetes. We controlled for ethnicity, sex, age, deprivation, smoking status, alcohol consumption, physical activity levels and use of diabetes medication. RESULTS Participants with type 2 diabetes had a significantly shorter digit span, b = -0.14, CIs [-0.27, -0.11] than those without type 2 diabetes. Those with type 2 diabetes did not differ from those without type 2 diabetes on fluid intelligence, reaction time, visual memory and prospective memory. The associations that do exist between type 2 diabetes and cognition are consistently mediated via macrovascular problems, depressive symptoms, and to a lesser extent visceral obesity. Respiratory problems, sleep disturbances and cancer did not mediate the association between type 2 diabetes status and measures of cognition. CONCLUSIONS Comorbid conditions explain some of the observed association between type 2 diabetes and cognitive deficits. This suggests that prevention, management or treatment of these comorbid conditions may be important to reduce the likelihood of cognitive decline. Treatment studies with long follow-ups are needed to examine this.
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Affiliation(s)
- Victoria Whitelock
- Department of Psychology, School of Science and Technology, Middlesex University, The Burroughs, Hendon, London, NW4 4BT, United Kingdom
| | - Femke Rutters
- Amsterdam UMC, Vrije Universiteit, Dept. of Epidemiology and Data Science, Amsterdam Public Health Research Institute, 6200 MB, Amsterdam, The Netherlands.
| | - Judith J M Rijnhart
- Amsterdam UMC, Vrije Universiteit, Dept. of Epidemiology and Data Science, Amsterdam Public Health Research Institute, 6200 MB, Amsterdam, The Netherlands
| | - Arie Nouwen
- Department of Psychology, School of Science and Technology, Middlesex University, The Burroughs, Hendon, London, NW4 4BT, United Kingdom
| | - Suzanne Higgs
- The School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, United Kingdom
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19
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Díez-Manglano J, Asìn Samper U. Pulmonary function tests in type 2 diabetes: a meta-analysis. ERJ Open Res 2021; 7:00371-2020. [PMID: 33569495 PMCID: PMC7861023 DOI: 10.1183/23120541.00371-2020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the association between type 2 diabetes (T2D) and pulmonary function tests. METHODS After conducting an exhaustive literature search, we performed a meta-analysis. We employed the inverse variance method with a random-effects model to calculate the effect estimate as the mean difference (MD) and 95% confidence interval (CI). We calculated the heterogeneity with the I2 statistic and performed a meta-regression analysis by sex, body mass index (BMI), smoking and geographical region. We also conducted a sensitivity analysis according to the studies' publication date, size of the T2D group and the study quality, excluding the study with the greatest weight in the effect. RESULTS The meta-analysis included 66 studies (one longitudinal, two case-control and 63 cross-sectional), with 11 134 patients with T2D and 48 377 control participants. The pooled MD (95% CI) for the predicted percentage of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), forced expiratory flow at 25-75% of FVC, peak expiratory flow, and diffusing capacity of the lung for carbon monoxide were -7.15 (95% CI -8.27, -6.03; p<0.001), -9.21 (95% CI -11.15, -7.26; p<0.001), -9.89 (95% CI -14.42, -5.36; p<0.001), -9.79 (95% CI -13.42, -6.15; p<0.001) and -7.13 (95% CI -10.62, -3.64; p<0.001), respectively. There was no difference in the ratio of FEV1/FVC (95% CI -0.27; -1.63, 1.08; p=0.69). In all cases, there was considerable heterogeneity. The meta-regression analysis showed that between studies heterogeneity was not explained by patient sex, BMI, smoking or geographical region. The findings were consistent in the sensitivity analysis. CONCLUSIONS T2D is associated with impaired pulmonary function, independently of sex, smoking, BMI and geographical region. Longitudinal studies are needed to investigate outcomes for patients with T2D and impaired pulmonary function.
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Affiliation(s)
| | - Uxua Asìn Samper
- Dept of Internal Medicine, University Hospital Miguel Servet, Zaragoza, Spain
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20
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Fadini GP, Morieri ML, Boscari F, Fioretto P, Maran A, Busetto L, Bonora BM, Selmin E, Arcidiacono G, Pinelli S, Farnia F, Falaguasta D, Russo L, Voltan G, Mazzocut S, Costantini G, Ghirardini F, Tresso S, Cattelan AM, Vianello A, Avogaro A, Vettor R. Newly-diagnosed diabetes and admission hyperglycemia predict COVID-19 severity by aggravating respiratory deterioration. Diabetes Res Clin Pract 2020; 168:108374. [PMID: 32805345 PMCID: PMC7428425 DOI: 10.1016/j.diabres.2020.108374] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/28/2020] [Accepted: 08/12/2020] [Indexed: 02/06/2023]
Abstract
AIMS We investigated whether pre-existing diabetes, newly-diagnosed diabetes, and admission hyperglycemia were associated with COVID-19 severity independently from confounders. METHODS We retrospectively analyzed data on patients with COVID-19 hospitalized between February and April 2020 in an outbreak hospital in North-East Italy. Pre-existing diabetes was defined by self-reported history, electronic medical records, or ongoing medications. Newly-diagnosed diabetes was defined by HbA1c and fasting glucose. The primary outcome was a composite of ICU admission or death. RESULTS 413 subjects were included, 107 of whom (25.6%) had diabetes, including 21 newly-diagnosed. Patients with diabetes were older and had greater comorbidity burden. The primary outcome occurred in 37.4% of patients with diabetes compared to 20.3% in those without (RR 1.85; 95%C.I. 1.33-2.57; p < 0.001). The association was stronger for newly-diagnosed compared to pre-existing diabetes (RR 3.06 vs 1.55; p = 0.004). Higher glucose level at admission was associated with COVID-19 severity, with a stronger association among patients without as compared to those with pre-existing diabetes (interaction p < 0.001). Admission glucose was correlated with most clinical severity indexes and its association with adverse outcome was mostly mediated by a worse respiratory function. CONCLUSION Newly-diagnosed diabetes and admission hyperglycemia are powerful predictors of COVID-19 severity due to rapid respiratory deterioration.
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Affiliation(s)
| | | | | | | | | | - Luca Busetto
- Department of Medicine, University of Padova, Italy
| | | | - Elisa Selmin
- Department of Medicine, University of Padova, Italy
| | | | | | | | | | - Lucia Russo
- Department of Medicine, University of Padova, Italy
| | | | | | | | | | | | | | - Andrea Vianello
- Department of Cardiothoracic Vascular Sciences and Public Health, University of Padova, Italy
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21
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Katsiki N, Steiropoulos P, Papanas N, Mikhailidis DP. Diabetes Mellitus and Chronic Obstructive Pulmonary Disease: An Overview. Exp Clin Endocrinol Diabetes 2019; 129:699-704. [PMID: 31739346 DOI: 10.1055/a-1038-3883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common disease with an increasing prevalence, characterised by persistent respiratory symptoms and airflow limitation. Apart from cigarette smoking, certain occupational and environmental exposures, low socioeconomic status and genetic factors may contribute to the pathogenesis of COPD. Comorbidities, e. g. diabetes mellitus (DM), can negatively affect quality of life, COPD outcomes and cardiovascular risk. The present narrative review considers the potential links between COPD and DM, such as systemic inflammation, oxidative stress, hypoxaemia and hyperglycaemia. The effects of antidiabetic drugs on lung function and COPD outcomes, as well as the possibility of common therapeutic modalities are also briefly considered. Further research is needed in this field to elucidate these relationships as well as their potential clinical implications in daily practice.
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Affiliation(s)
- Niki Katsiki
- First Department of Internal Medicine, Diabetes Centre, Division of Endocrinology and Metabolism, AHEPA University Hospital, Thessaloniki, Greece
| | - Paschalis Steiropoulos
- Department of Pneumonology, Democritus University of Thrace School of Health Sciences, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | - Dimitri P Mikhailidis
- Department of Clinical Biochemistry, University College London, Royal Free Hospital Campus, London, United Kingdom of Great Britain and Northern Ireland
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22
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Glycation-induced modification of tissue-specific ECM proteins: A pathophysiological mechanism in degenerative diseases. Biochim Biophys Acta Gen Subj 2019; 1863:129411. [PMID: 31400438 DOI: 10.1016/j.bbagen.2019.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/29/2019] [Accepted: 08/05/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Glycation driven generation of advanced glycation end products (AGEs) and their patho-physiological role in human degenerative diseases has remained one of the thrust areas in the mainstream of disease biology. Glycation of extracellular matrix (ECM) proteins have deleterious effect on the mechanical and functional properties of tissues. Owing to the adverse pathophysiological concerns of glycation, there is a need to decipher the underlying mechanisms. SCOPE OF REVIEW AGE-modified ECM proteins affect the cell in the vicinity by altering protein structure-function, matrix-matrix or matrix-cell interaction and by activating signalling pathway through receptor for AGE. This review is intended for addressing the AGE-induced modification of tissue-specific ECM proteins and its implication in the pathogenesis of various organ-specific human ailments. MAJOR CONCLUSIONS The glycation affects the canonical cell behaviour due to alteration in the interaction of glycated ECM with receptors like integrins and discodin domain, and the signalling cues generated subsequently affect the downstream signalling pathways. Consequently, the variation of structural and functional properties of tissues due to matrix glycation helps in the initiation or progression of the disease condition. GENERAL SIGNIFICANCE This review offers comprehensive knowledge about the remodelling of glycation induced ECM and tissue-specific pathological concerns. As glycation of ECM affects the normal tissues and cell behaviour, the scientific discourse may also provide cues for developing candidate drugs that may help in attenuating the adverse effects of AGEs and perhaps open a research window of tailoring novel strategies for the management of glycation induced human degenerative diseases.
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23
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Khafaie MA, Salvi SS, Yajnik CS, Rahim F, Khafaei B. Role of blood glucose and fat profile in lung function pattern of Indian type 2 diabetic subjects. Multidiscip Respir Med 2019; 14:22. [PMID: 31304013 PMCID: PMC6600883 DOI: 10.1186/s40248-019-0184-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/24/2019] [Indexed: 12/19/2022] Open
Abstract
Background and objectives It has been hypothesized that changes in lung function can occur in patients with diabetes. Nevertheless, it is unclear how much of this correlation links with biomarkers of metabolism disorder. We have investigated the association between hypoglycaemic and fat profile with lung function in Indian diabetic subjects. Design Prospective observational study. Setting Diabetes care unit of King Edward Memorial (KEM) hospital. Patients Out of 465 patients who agreed to participate in this study, valid lung function data were available from 347 Type 2 diabetic subjects. Measurements Pulmonary function test including predicted forced vital capacity (% FVC), predicted forced expiratory volume in 1 second (% FEV1) and FEV1/FVC ratio were assessed. We also examined fat profile, glucose, HbA1c, hemoglobin and other hematological parameters. Results Four hundred sixty-five subjects aged 55 ± 11 participated in the study. Predicted forced vital capacity, % FEV1 and FEV1/FVC ratio was 85.88 ± 13.53, 85.87 ± 14.06 and 82.03 ± 6.83, respectively. Also, approximately 8 to 17% of the participant reported having at least one chronic respiratory symptom or lung disease. We found that high glycaemic measures (i.e. fasting and post-meal plasma glucose) are linked with dyspnea. In addition, HDL (high-density lipoprotein) concentration was directly associated with % FVC. Conclusions It is difficult to draw a clear conclusion about the cause-effect relationship or clinical impact based on this study alone. However, identification of clinically meaningful elements for developing a screening program is critical.
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Affiliation(s)
- Morteza A Khafaie
- 1Social Determinants of Health Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,2Department of Public Health, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Fakher Rahim
- 5Thalassemia and Hemoglobinopathy Research Centre, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Behzad Khafaei
- Department of Statistics, Omidieh Branch, Islamic Azad University, Omidieh, Iran
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24
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Mehta KS, Shirkande AK, Bhurke SP, Pajai AE, Swami RS, Jadhav SN. Pulmonary Hypertension in Various Stages of Chronic Kidney Disease in Indian Patients. Indian J Nephrol 2019; 29:95-101. [PMID: 30983749 PMCID: PMC6440332 DOI: 10.4103/ijn.ijn_407_17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The prevalence of pulmonary hypertension (PH) in chronic kidney disease (CKD) in Indian patients has been evaluated in this study. In addition, association of PH with CKD etiology, its prevalence in various CKD stages, correlation between the severity of PH with CKD duration, various related biochemical parameters, and their relation to PH in CKD patients were analyzed. This cross-sectional and prospective study included 200 CKD patients. Detailed history and clinical examination were recorded. Hemoglobin, blood urea nitrogen (BUN), serum creatinine, albumin, and calcium-phosphorus product were recorded. Pulmonary function test was evaluated and two-dimensional echo was done 4 hours post dialysis. The prevalence of PH in CKD patients was 60.5%, with mean pulmonary artery systolic pressure (PASP) of 38.52 ± 7.32 mmHg. The mean age of those with PH was 47.85 ± 13.09 years. PH was more common in males (p = 0.03). The prevalence of PH increased as CKD stage advanced (p < 0.001). Diabetes and hypertension had a strong association with PH (p < 0.001). The prevalence (p = 0.003) and severity (p = 0.011) of PH increased with increase in CKD duration. In patients on hemodialysis (HD), the prevalence (p < 0.001) and severity (p = 0.022) of PH was significant compared to those on conservative treatment. The prevalence (p < 0.001) and severity (p < 0.001) of PH significantly increased as duration of HD increased. The prevalence of PH was significantly higher in patients with arteriovenous fistula (p = 0.002). Serum creatinine (p = 0.02) and serum calcium-phosphorus product (p < 0.001) were significantly higher in patients with PH. The prevalence of PH in CKD patients was 60.5%. There was a positive correlation between PH and duration of CKD, duration of HD, BUN, serum creatinine, and serum calcium-phosphorus product.
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Affiliation(s)
- Kalpana S Mehta
- Department of Nephrology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Abhishek K Shirkande
- Department of Nephrology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Sandip P Bhurke
- Department of Nephrology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Atim E Pajai
- Department of Nephrology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Rudramani S Swami
- Department of Nephrology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
| | - Swapnil N Jadhav
- Department of Nephrology, Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, Maharashtra, India
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Pathobiological mechanisms underlying metabolic syndrome (MetS) in chronic obstructive pulmonary disease (COPD): clinical significance and therapeutic strategies. Pharmacol Ther 2019; 198:160-188. [PMID: 30822464 PMCID: PMC7112632 DOI: 10.1016/j.pharmthera.2019.02.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a major incurable global health burden and is currently the 4th largest cause of death in the world. Importantly, much of the disease burden and health care utilisation in COPD is associated with the management of its comorbidities (e.g. skeletal muscle wasting, ischemic heart disease, cognitive dysfunction) and infective viral and bacterial acute exacerbations (AECOPD). Current pharmacological treatments for COPD are relatively ineffective and the development of effective therapies has been severely hampered by the lack of understanding of the mechanisms and mediators underlying COPD. Since comorbidities have a tremendous impact on the prognosis and severity of COPD, the 2015 American Thoracic Society/European Respiratory Society (ATS/ERS) Research Statement on COPD urgently called for studies to elucidate the pathobiological mechanisms linking COPD to its comorbidities. It is now emerging that up to 50% of COPD patients have metabolic syndrome (MetS) as a comorbidity. It is currently not clear whether metabolic syndrome is an independent co-existing condition or a direct consequence of the progressive lung pathology in COPD patients. As MetS has important clinical implications on COPD outcomes, identification of disease mechanisms linking COPD to MetS is the key to effective therapy. In this comprehensive review, we discuss the potential mechanisms linking MetS to COPD and hence plausible therapeutic strategies to treat this debilitating comorbidity of COPD.
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26
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Crowley G, Kwon S, Haider SH, Caraher EJ, Lam R, St-Jules DE, Liu M, Prezant DJ, Nolan A. Metabolomics of World Trade Center-Lung Injury: a machine learning approach. BMJ Open Respir Res 2018; 5:e000274. [PMID: 30233801 PMCID: PMC6135464 DOI: 10.1136/bmjresp-2017-000274] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 03/19/2018] [Indexed: 12/15/2022] Open
Abstract
Introduction Biomarkers of metabolic syndrome expressed soon after World Trade Center (WTC) exposure predict development of WTC Lung Injury (WTC-LI). The metabolome remains an untapped resource with potential to comprehensively characterise many aspects of WTC-LI. This case–control study identified a clinically relevant, robust subset of metabolic contributors of WTC-LI through comprehensive high-dimensional metabolic profiling and integration of machine learning techniques. Methods Never-smoking, male, WTC-exposed firefighters with normal pre-9/11 lung function were segregated by post-9/11 lung function. Cases of WTC-LI (forced expiratory volume in 1s <lower limit of normal, n=15) and controls (n=15) were identified from previous cohorts. The metabolome of serum drawn within 6 months of 9/11 was quantified. Machine learning was used for dimension reduction to identify metabolites associated with WTC-LI. Results 580 metabolites qualified for random forests (RF) analysis to identify a refined metabolite profile that yielded maximal class separation. RF of the refined profile correctly classified subjects with a 93.3% estimated success rate. 5 clusters of metabolites emerged within the refined profile. Prominent subpathways include known mediators of lung disease such as sphingolipids (elevated in cases of WTC-LI), and branched-chain amino acids (reduced in cases of WTC-LI). Principal component analysis of the refined profile explained 68.3% of variance in five components, demonstrating class separation. Conclusion Analysis of the metabolome of WTC-exposed 9/11 rescue workers has identified biologically plausible pathways associated with loss of lung function. Since metabolites are proximal markers of disease processes, metabolites could capture the complexity of past exposures and better inform treatment. These pathways warrant further mechanistic research.
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Affiliation(s)
- George Crowley
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - Sophia Kwon
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - Syed Hissam Haider
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - Erin J Caraher
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - Rachel Lam
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA
| | - David E St-Jules
- Departmentof Population Health, Division of Health and Behavior, New York University School of Medicine, New York, USA
| | - Mengling Liu
- Department of Environmental Medicine, New York University School of Medicine, New York, USA.,Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York, USA
| | - David J Prezant
- Department of Population Health, Divison of Biostatistics, New York University School of Medicine, New York, USA.,Department of Medicine, Pulmonary Medicine Divison, Montefiore Medical Center and Albert Einstein College of Medicine, Brooklyn, New York, USA
| | - Anna Nolan
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, New York University School of Medicine, New York, USA.,Bureau of Health Services and Office of Medical Affairs, Fire Department of New York, Brooklyn, New York, USA.,Department of Population Health, Divison of Biostatistics, New York University School of Medicine, New York, USA
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Metabolic Syndrome and Pulmonary Function Indices. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2018. [DOI: 10.2478/rjdnmd-2018-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Background and aims: Metabolic syndrome (MetS) is a collection of metabolic risk factors including increased waist circumference (WC), elevated blood pressure (BP), increased triglyceride (TG), decreased high density lipoprotein (HDL-C) and increased fasting blood sugar (FBS). We aimed to examine the relevance between the MetS and its components with reduced lung functions in adult men.
Material and method: A total of 3899 adult men underwent screening examination between 2015-2016 in a cross-sectional survey.
Results: The mean (± SD) age of our population was 37.25 (± 4.9) years. The overall prevalence of MetS was 7.6%. The total prevalence of reduced lung function in men with MetS was 13.8%. The most common type of reduced lung function was the restrictive pattern (7.1%). The forced expiratory volume of first second (FEV1) and forced vital capacity (FVC) values were significantly lower in men with MetS (both p<0.001). Also these values were significantly lower in diabetic men compared to non-diabetics and those with impaired fasting glucose (IFG). WC and HDL were the most potent predictors of reduced FEV1 and FVC.
Conclusions: We obtained a positive independent association between MetS and reduced lung function in adult men which may be related mainly due to increased WC and decreased HDL.
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Suresh H, Arun BS, Moger V, Vijayalaxmi PB, Murali Mohan KTK. A Prospective Study of Pulmonary Hypertension in Patients with Chronic Kidney Disease: A New and Pernicious Complication. Indian J Nephrol 2018; 28:127-134. [PMID: 29861563 PMCID: PMC5952451 DOI: 10.4103/ijn.ijn_36_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary hypertension (PH) is a recently recognized complication of chronic kidney disease (CKD), especially in end-stage renal disease. It has prevalence estimates of 30%-50% and is an independent predictor of increased mortality in CKD patients. The aim of this study is to analyze the prevalence of PH in patients with CKD, its severity in different stages of CKD, and risk factors for it. One hundred and eight patients with CKD treated at Karnataka Institute of Medical Sciences, Hubli, Karnataka, between January 1, 2014, and June 30, 2015, were selected. Clinical evaluation and relevant investigations including echocardiography were done. Follow-up echocardiography was done at 3 and 6 months and assessed. The mean age of studied population was 43.53 ± 14.63 years. Sex ratio was 2.72:1 (male:female). PH was present in 47 of 108 (43.5%) cases at beginning, 41 of 83 (491.4%) at 3 months, and 32 of 64 (50%) at 6 months. The prevalence and severity of PH increased with progression of CKD stage, although not statistically significant. Heart failure with reduced ejection fraction and heart failure with preserved EF were significantly higher among PH group compared to non-PH group (P < 0.01). Mean hemoglobin in PH group was significantly lower, compared to non-PH group (P < 0.01). Mean interdialytic weight gain and central venous pressure were higher among PH group than non-PH group. Higher calcium phosphate product ≥50 was more prevalent in PH group than in non-PH group. The majority of them had moderate PH at the beginning of the study which remained same, despite being on hemodialysis. PH is a common complication in CKD patients with prevalence of 43.5%-50%. Left-sided heart failure, anemia, fluid retention, and increased calcium phosphate product are the risk factors for developing PH.
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Affiliation(s)
- H Suresh
- Department of Cardiology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - B S Arun
- Department of General Medicine, MVJ Medical College, Bengaluru, Karnataka, India
| | - V Moger
- Department of Nephrology, Karnataka Institute of Medical Sciences, Hubli, Karnataka, India
| | - P B Vijayalaxmi
- Department of General Medicine, SDM Medical College, Dharwad, Karnataka, India
| | - K T K Murali Mohan
- Department of General Medicine, MVJ Medical College, Bengaluru, Karnataka, India
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Zhang Q, Wang L, Zeng H, Lv Y, Huang Y. Epidemiology and risk factors in CKD patients with pulmonary hypertension: a retrospective study. BMC Nephrol 2018; 19:70. [PMID: 29554879 PMCID: PMC5859392 DOI: 10.1186/s12882-018-0866-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 03/07/2018] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Pulmonary hypertension (PH) is a rare disease often associated with high mortality and is recently recognized as a common complication secondary to chronic kidney disease (CKD). Epidemiological data for this disorder across the spectrum of CKD is poorly understood. METHODS We retrospectively analyzed 705 CKD patients with complete clinical records from July 2013 to September 2015. All the patients were estimated by echocardiography and PH was defined as pulmonary artery systolic pressure (PASP) > 35 mmHg. The prevalence of PH in CKD patients was investigated, and their association was evaluated with a logistic regression model. RESULTS The overall prevalence of PH was 47.38%, in which mild, moderate and severe PH accounted for 22.13, 15.04 and 10.21%, respectively. The prevalence of PH in CKD stage 1-5 was 14.29, 33.33, 38.89, 40.91 and 64.47%. The prevalence of total PH was 57.63% in PD patients and 58.82% in HD patients. Compared with the non-dialysis patients, the prevalence of PH was much higher in patients receiving dialysis. Body mass index (BMI), hemoglobin, triglyceride (TG), proteinuria, parathyroid hormone (PTH) and estimated glomerular filtration rate (eGFR) were independent risk factors of PH in CKD patients. CONCLUSIONS The prevalence of PH is increased with the deterioration of renal function, however, which has no direct relation to the severity of PH. PH occurs more frequently in dialysis patients. Higher BMI and TG, more sever anemia, proteinuria and secondary hyperparathyroidism, poor renal dysfunction predict predict the more prevalence of PH in CKD patients.
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Affiliation(s)
- Qian Zhang
- Division of Nephrology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Le Wang
- Division of Nephrology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Hongbing Zeng
- Division of Nephrology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yongman Lv
- Division of Nephrology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yi Huang
- Division of Nephrology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China.
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De Santi F, Zoppini G, Locatelli F, Finocchio E, Cappa V, Dauriz M, Verlato G. Type 2 diabetes is associated with an increased prevalence of respiratory symptoms as compared to the general population. BMC Pulm Med 2017; 17:101. [PMID: 28716044 PMCID: PMC5513377 DOI: 10.1186/s12890-017-0443-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 07/09/2017] [Indexed: 02/07/2023] Open
Abstract
Background To estimate the prevalence of respiratory symptoms in individuals with type 2 diabetes, as compared to the general population. Methods Between 2007 and 2010 the screening questionnaire of GEIRD (Gene Environment Interactions in Respiratory Diseases) study was administered to two samples of Verona general population, aged respectively 45-64 years and 65-84 years, and to a convenience sample of individuals with type 2 diabetes, consequently recruited at the local Diabetes Centre. Ninety-four and 165 people with type 2 diabetes, aged respectively 45-64 and 65-84 years, were compared with 676 and 591 subjects in the same age range from the general population. The influence of type 2 diabetes on respiratory symptoms was evaluated by logistic regression models, controlling for sex, age (45-54, 55-64, 65-74, 75-84 years), education level, smoking habits and heavy vehicle traffic exposure and adjusting standard errors of ORs for intra-sample correlation. Results Compared to the general population, dyspnoea limiting walking pace on level ground (grade 2 dyspnoea) was more frequently reported by people with type 2 diabetes, irrespective of age (p < 0.001), while self-reported chronic cough/phlegm was more common in those aged 45-64 years (p = 0.02). These results were confirmed by multivariable analysis: compared to their counterparts from the general population, people with type 2 diabetes aged 45-54 years showed an increased risk of reporting grade 2 dyspnoea (OR = 3.92, 95% CI 3.28-4.68) or chronic cough/phlegm (OR = 1.69, 1.60-1.78). Similar figures held significant at older ages (75-84 years), although partially blunted (dyspnoea: OR = 1.79, 1.68-1.91; chough/phlegm: OR = 1.09, 1.03-1.16). As such, the interaction between age class and type 2 diabetes was significant for both respiratory disorders. The proportion of self-reported dyspnoea among individuals with type 2 diabetes significantly increased across incremental body-mass index (BMI), from 15.4 to 25.4% and further to 41.3% respectively in normoweight, overweight and obese patients (p = 0.048). Conclusions People with type 2 diabetes more frequently reported grade 2 dyspnoea and chronic cough/phlegm than the general population of the same age, although presenting similar smoking habits. Diabetes appears to anticipate the lung ageing process, recorded in the general population. The increased occurrence of dyspnoea at incremental BMI among individuals with type 2 diabetes may reflect both cardiovascular and respiratory impairment in this high-risk patient population.
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Affiliation(s)
- F De Santi
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - G Zoppini
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - F Locatelli
- Unit of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, Strada Le Grazie, 8 -, 37134, Verona, Italy
| | - E Finocchio
- Unit of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, Strada Le Grazie, 8 -, 37134, Verona, Italy
| | - V Cappa
- Unit of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, Strada Le Grazie, 8 -, 37134, Verona, Italy
| | - M Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona, Verona, Italy
| | - G Verlato
- Unit of Epidemiology and Medical Statistics, Department of Diagnostic and Public Health, University of Verona, Strada Le Grazie, 8 -, 37134, Verona, Italy.
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Karlsen T, Nes BM, Tjønna AE, Engstrøm M, Støylen A, Steinshamn S. High-intensity interval training improves obstructive sleep apnoea. BMJ Open Sport Exerc Med 2017; 2:bmjsem-2016-000155. [PMID: 29616142 PMCID: PMC5875631 DOI: 10.1136/bmjsem-2016-000155] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2016] [Indexed: 12/29/2022] Open
Abstract
Background Three hours per week of vigorous physical activity is found to be associated with reduced odds of sleep-disordered breathing. Aim To investigate whether 12 weeks of high-intensity interval training (HIIT) reduced the apnoea–hypopnea index (AHI) in obese subjects with moderate-to-severe obstructive sleep apnoea. Methods In a prospective randomised controlled exercise study, 30 (body mass index 37±6 kg/m2, age 51±9 years) patients with sleep apnoea (AHI 41.5±25.3 events/hour) were randomised 1:1 to control or 12 weeks of supervised HIIT (4×4 min of treadmill running or walking at 90%–95% of maximal heart rate two times per week). Results In the HIIT group, the AHI was reduced by 7.5±11.6 events/hour (within-group p<0.05), self-reported sleepiness (Epworth scale) improved from 10.0±3.6 to 7.3±3.7 (between-group p<0.05) and maximal oxygen uptake improved from 28.2±7.4 to 30.2±7.7 mL/kg/min (between-group p<0.05) from baseline to 12 weeks. The AHI, self-reported sleepiness and VO2maxwere unchanged from baseline to 12 weeks in controls (baseline AHI 50.3±25.5 events/hour, Epworth score 5.9±4.3, maximal oxygen uptake 27.0±6.8 mL/kg/min). Body weight remained unchanged in both groups. Conclusion Twelve weeks of HIIT improved the AHI and self-reported daytime sleepiness in subjects with obese sleep apnoea without any change in the desaturation index and body weight.
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Affiliation(s)
- Trine Karlsen
- K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Bjarne Martens Nes
- K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arnt Erik Tjønna
- K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Morten Engstrøm
- Department of Neurology and Clinical Neurophysiology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Asbjørn Støylen
- Department of Cardiology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Norway
| | - Sigurd Steinshamn
- K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Thoracic Medicine, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Evaluation and Management of Pulmonary Hypertension in Kidney Transplant Candidates and Recipients. Transplantation 2017; 101:166-181. [DOI: 10.1097/tp.0000000000001043] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Kim YS, Kim HY, Ahn HS, Sohn TS, Song JY, Lee YB, Lee DH, Lee JI, Lee TK, Jeong SC, Hong M, Chae HS, Han K, Yeo CD. Glomerular filtration rate affects interpretation of pulmonary function test in a Korean general population: results from the Korea National Health and Nutrition Examination Survey 2010 to 2012. Korean J Intern Med 2016; 31:1101-1109. [PMID: 26996347 PMCID: PMC5094924 DOI: 10.3904/kjim.2015.148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 06/22/2015] [Accepted: 07/06/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND/AIMS The pulmonary abnormalities (principally restrictive abnormalities) are characteristic of renal transplant recipients or those with end-stage renal disease. Our aim was to explore whether the prevalence of spirometric abnormalities was influenced by the estimated glomerular filtration rates (GFRs) in a Korean general population. METHODS We used data obtained during the 2010 to 2012 Korean National Health and Nutrition Examination Survey, a national cross-sectional survey. We analyzed data from subjects for whom spirometric assays and estimated GFRs were of acceptable quality. RESULTS A total of 8,809 subjects (3,868 male and 4,941 female) was included. In both males and females with GFR values < 60 mL/min/1.73 m2, the linear trends toward the presence of obstructive and restrictive patterns were significant. However, the percent predicted forced vital capacity (FVC) decreased with a decline in the estimated GFR, but only in males (p for trend < 0.0031). Multivariate linear regression analysis showed a decline in the estimated GFR was independently associated with falls in the percent predicted FVC and the forced expiratory volume in 1 second/FVC ratio in both males and females. However, the percent predicted FVC was independently predictive only in males (p = 0.002). CONCLUSIONS Impaired pulmonary function was associated with a decline in the estimated GFR. The percent predicted FVC decrease paralleled the decline in estimated GFR in male only. Careful interpretation of pulmonary function test data is required in patients with decreased GFRs or impaired renal function, especially males.
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Affiliation(s)
- Young Soo Kim
- Epidemiology Study Cluster, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Hee Yeon Kim
- Epidemiology Study Cluster, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Hyo-Suk Ahn
- Epidemiology Study Cluster, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Tae Seo Sohn
- Epidemiology Study Cluster, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Jae Yen Song
- Epidemiology Study Cluster, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Young Bok Lee
- Epidemiology Study Cluster, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Dong-Hee Lee
- Epidemiology Study Cluster, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Jae-Im Lee
- Epidemiology Study Cluster, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Tae-Kyu Lee
- Epidemiology Study Cluster, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Seong Cheol Jeong
- Epidemiology Study Cluster, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Mihee Hong
- Epidemiology Study Cluster, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Hiun Suk Chae
- Epidemiology Study Cluster, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Dong Yeo
- Epidemiology Study Cluster, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Uijeongbu, Korea
- Correspondence to Chang Dong Yeo, M.D. Division of Pulmonology, Department of Internal Medicine, College of Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, 271 Cheonbo-ro, Uijeongbu 11765, Korea Tel: +82-31-820-3893 Fax: +82-31-820-3747 E-mail:
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Ye SB, Choi YS, Choi YH, Bae CH, Kim YW, Park SY, Song SY, Kim YD. Effect of High Glucose on MUC5B expression in Human Airway Epithelial Cells. Clin Exp Otorhinolaryngol 2016; 10:77-84. [PMID: 27384035 DOI: 10.21053/ceo.2016.00045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/28/2016] [Accepted: 05/11/2016] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Excessive production of mucus results in plugging of the airway tract, which can increase morbidity and mortality in affected patients. In patients with diabetes, inflammatory airway disease appears with more frequent relapse and longer duration of symptoms. However, the effects of high glucose (HG) on the secretion of mucin in inflammatory respiratory diseases are not clear. Therefore, this study was conducted in order to investigate the effect and the brief signaling pathway of HG on MUC5B expression in human airway epithelial cells. METHODS The effect and signaling pathway of HG on MUC5B expression were investigated using reverse transcriptase-polymerase chain reaction (RT-PCR), real-time PCR, enzyme immunoassay, and immunoblot analysis with specific inhibitors and small interfering RNA. RESULTS HG increased MUC5B expression and epidermal growth factor receptor (EGFR) expression, and activated the phosphorylation of EGFR and p38 mitogen-activated protein kinase (MAPK). Pretreatment with EGFR inhibitor significantly attenuated the HG-induced phosphorylation of p38 MAPK, and pretreatments with p38 inhibitor or EGFR inhibitor significantly attenuated HG-induced MUC5B expression. In addition, knockdown of p38 MAPK by p38 MAPK siRNA significantly blocked HG-induced MUC5B expression. CONCLUSION These findings suggest that HG induces MUC5B expression via the sequential activations of the EGFR/p38 MAPK signaling pathway in human airway epithelial cells.
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Affiliation(s)
- Sang Baik Ye
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeungnam University College of Medicine, Gyeongsan, Korea
| | - Yoon Seok Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeungnam University College of Medicine, Gyeongsan, Korea
| | - Yo Han Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeungnam University College of Medicine, Gyeongsan, Korea
| | - Chang Hoon Bae
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeungnam University College of Medicine, Gyeongsan, Korea
| | - Yong-Woon Kim
- Department of Physiology, Yeungnam University College of Medicine, Gyeongsan, Korea
| | - So-Young Park
- Department of Physiology, Yeungnam University College of Medicine, Gyeongsan, Korea
| | - Si-Youn Song
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeungnam University College of Medicine, Gyeongsan, Korea
| | - Yong-Dae Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Yeungnam University College of Medicine, Gyeongsan, Korea.,Regional Center for Respiratory Diseases, Yeungnam University Medical Center, Daegu, Korea
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Serotonin transporter gene (5-HTT) polymorphism and major depressive disorder in patients in Bogotá, Colombia. BIOMEDICA 2016; 36:285-94. [DOI: 10.7705/biomedica.v36i3.3014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/10/2015] [Indexed: 02/08/2023]
Abstract
<p><strong>Introducción.</strong> El polimorfismo 5-HTT se ha asociado con el trastorno de depresión mayor, aunque el planteamiento ha generado controversia.<br /><strong>Objetivo.</strong> Determinar la asociación del polimorfismo 5-HTT con la depresión mayor en Bogotá, Colombia.<br /><strong>Materiales y métodos.</strong> Se hizo un estudio de casos y controles pareado por sexo y edad (±5 años), con una razón de uno a uno (68:68). El trastorno de depresión mayor se diagnosticó con el cuestionario Mini-International Neuropsychiatric Interview, y, el polimorfismo 5-HTT, mediante reacción en cadena de la polimerasa (PCR).<br /><strong>Resultados.</strong> Las mujeres predominaron entre los participantes (82,4 %). El alelo corto (short, S) predominó en los casos comparados con los controles (S: 72,1 % Vs. 63,2; L (long): 27,9 % Vs. 36,8 %), y el genotipo SL fue más frecuente en los casos (SL: 45,6 % Vs. 36,8 %; LL: 27,9 % Vs. 36,8 %; SS: 26,5 % Vs. 26,5 %), aunque no significativamente. Hubo diferencias significativas en menores de 37 años, con predominio del alelo S en los casos (p=0,0384; odds ratio - OR=2,75; IC95%: 0,88-8,64). El análisis multivariado ajustado por trastornos concomitantes de ansiedad mostró una asociación significativa de la depresión mayor con el genotipo SL (p=0,049; OR=3,20; IC95% 1,003-10,233); el alelo S estuvo cerca de la significación estadística (p=0,063; OR=2,94; IC95% 0,94-9,13), y fue estadísticamente significativo en los casos de menores de 37 años (p=0,026; OR=10,79; IC95% 1,32-80,36).<br /><strong>Conclusiones.</strong> El genotipo SL se asoció con el trastorno de depresión mayor en pacientes de todas las edades. El alelo S se asoció significativamente con el trastorno de depresión mayor en pacientes menores de 37 años al ajustar por trastornos concomitantes de ansiedad.</p>
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Aksu O, Aydın B, Doguç DK, Ilhan I, Ozturk O, Altuntas A, Demirkan H, Koroglu BK, Tamer MN. The evaluation of Nesfatin-1 levels in patients with OSAS associated with metabolic syndrome. J Endocrinol Invest 2015; 38:463-9. [PMID: 25432328 DOI: 10.1007/s40618-014-0216-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 11/14/2014] [Indexed: 01/23/2023]
Abstract
PURPOSE The association of obstructive sleep apnea syndrome (OSAS) and metabolic syndrome (MS) has been demonstrated in studies and in recent years; the effect of OSAS on insulin resistance independent of the level of obesity is being investigated. Nesfatin-1 is a newly defined 82 amino acid protein with a precursor molecule of NUCB2 (nucleobindin 2). Nesfatin-1 is not only essential in regulation of food ingestion but also important in regulation of some brain functions, autonomic regulation, stress, mental state, and paradoxical sleep. We aimed to evaluate the relationship between OSAS and MS and the MS dependent or independent effect of Nesfatin-1 on this relationship. METHODS Patients admitted with clinical signs of OSAS are included. Patients are divided into three groups based on Apnea-Hypopnea Index (AHI) on Polysomnography (PSG) as mild, moderate, and severe OSAS. A total of 59 patients were included the control patients. Several OSAS parameters and laboratory findings which are and are not MS dependent are compared. Nesfatin-1 levels are evaluated in all OSAS patients with and without MS. RESULTS There were significantly more males in all groups (p = 0.007). There was no significant difference between groups in terms of Nesfatin-1 levels. Nesfatin-1 levels were significantly lower in MS group compared to non-MS group (p = 0.021). CONCLUSION Nesfatin-1 which is known to play a role in the pathophysiology of insulin resistance can be a beneficial target in developing new therapeutic targets for treatment of patients with obesity without any toxic effects in the future.
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Affiliation(s)
- O Aksu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Suleyman Demirel University, School of medicine, 3200, Isparta, Turkey.
| | - B Aydın
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Suleyman Demirel University, School of medicine, 3200, Isparta, Turkey
| | - D K Doguç
- Department of Biochemistry, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - I Ilhan
- Department of Biochemistry, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - O Ozturk
- Department of Chest Disease, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - A Altuntas
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - H Demirkan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Suleyman Demirel University, School of medicine, 3200, Isparta, Turkey
| | - B K Koroglu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Suleyman Demirel University, School of medicine, 3200, Isparta, Turkey
| | - M N Tamer
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Suleyman Demirel University, School of medicine, 3200, Isparta, Turkey
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Wang X, DuBois DC, Sukumaran S, Ayyar V, Jusko WJ, Almon RR. Variability in Zucker diabetic fatty rats: differences in disease progression in hyperglycemic and normoglycemic animals. Diabetes Metab Syndr Obes 2014; 7:531-41. [PMID: 25419150 PMCID: PMC4234283 DOI: 10.2147/dmso.s69891] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Both obesity and chronic inflammation are often associated with insulin resistance and type 2 diabetes. The Zucker diabetic fatty (ZDF) rat (fa/fa) is an obese animal model frequently used in type 2 diabetes research. The current study determines whether chronic administration (from 5 weeks of age through 24 weeks of age) of salsalate, a salicylate with anti-inflammatory properties, would be effective in mitigating diabetes disease progression in ZDF rats. Although a trend existed for lower blood glucose in the salsalate-treated group, significant differences were obscured by high animal-level variability. However, even in the non-drug-treated group, not all ZDF rats became diabetic as expected. Therefore, animals were parsed into two groups, regardless of drug treatment: normoglycemic ZDF rats, which maintained blood glucose profiles identical to nondiabetic Zucker lean rats (ZLRs), and hyperglycemic ZDF rats, which exhibited progressive elevation in blood glucose. To ascertain the differences between ZDF rats that became hyperglycemic and those that did not, relevant physiological indices and expression levels of adiponectin, tumor necrosis factor-α, interleukin-6, and glucocorticoid-induced leucine zipper messenger RNAs in adipose tissue were measured at sacrifice. Plasma C-reactive protein concentrations and expression levels of cytokine and glucocorticoid-induced leucine zipper messenger RNAs suggested more prevalent chronic inflammation in hyperglycemic animals. Early elevation of the insulin-sensitizing adipokine, adiponectin, was present in both ZDF groups, with the rate of its age-related decline faster in hyperglycemic animals. The most marked difference between the two groups of ZDF animals was in insulin output. Although the two ZDF populations had very similar elevated plasma insulin concentrations for the first 10 weeks, after that time, plasma insulin decreased markedly in the animals that became hyperglycemic, whereas it remained high in the normoglycemic ZDF rats. Thus, hyperglycemic ZDF animals exhibit both insulin resistance and progressive beta cell failure, whereas normoglycemic ZDF rats exhibit a lesser degree of insulin resistance that does not progress to beta cell failure. In these respects, the normoglycemic ZDF rats appear to revert back to a phenotype that strongly resembles that of nondiabetic Zucker fatty rats from which they were derived.
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Affiliation(s)
- Xi Wang
- Department of Biological Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Debra C DuBois
- Department of Biological Sciences, State University of New York at Buffalo, Buffalo, NY, USA
- Department of Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Siddharth Sukumaran
- Department of Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - Vivaswath Ayyar
- Department of Biological Sciences, State University of New York at Buffalo, Buffalo, NY, USA
| | - William J Jusko
- Department of Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
- New York State Center of Excellence in Bioinformatics and Life Sciences, Buffalo, NY, USA
| | - Richard R Almon
- Department of Biological Sciences, State University of New York at Buffalo, Buffalo, NY, USA
- Department of Pharmaceutical Sciences, State University of New York at Buffalo, Buffalo, NY, USA
- New York State Center of Excellence in Bioinformatics and Life Sciences, Buffalo, NY, USA
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Divo MJ, Cabrera C, Casanova C, Marin JM, Pinto-Plata VM, de-Torres JP, Zulueta J, Zagaceta J, Sanchez-Salcedo P, Berto J, Cote C, Celli BR. Comorbidity Distribution, Clinical Expression and Survival in COPD Patients with Different Body Mass Index. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2014; 1:229-238. [PMID: 28848824 DOI: 10.15326/jcopdf.1.2.2014.0117] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Rationale: Contrary to the general population, in patients with chronic obstructive pulmonary disease (COPD) a low body mass index (BMI) is associated with excess mortality, while obesity appears protective (obesity paradox). We hypothesized that BMI is associated with a distinct number and expression of comorbidities in patients with COPD. The type of comorbidity may relate to mortality variability. Objectives and Methods: We followed 1659 COPD patients for a median of 51 months [IQR 27-77] with detailed comorbidity records and tracking pulmonary function, exercise capacity, dyspnea, health status, and cause of death. The cohort was categorized into the 5 National Heart Lung and Blood Institute (NHLBI) BMI groups with determination made about each group's relationship to specific comorbidities, clinical parameters and risk for death. Results: Whereas osteoporosis, substance abuse, abdominal aortic aneurism and peripheral arterial disease were more prevalent in patients with low BMI, metabolic and cardiac problems were more frequent in those with high BMI. The BMI was inversely related to the ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC)(FEV1 %), BODE (Body mass index, airway Obstruction, Dyspnea, Exercise capacity) index and hyperinflation, had a "U" shape with dyspnea and the St. George's Respiratory Questionaire (SGRQ) score and an inverse "U" with exercise capacity. The crude mortality rate was 60%, 43%, 37%, 36% and 28% from the lowest to highest BMI groups (p<.0001). More respiratory deaths were observed in the lowest BMI group even though they had a lower number of comorbidities. Conclusions: Different BMI categories are associated with distinct clinical expressions of COPD and comorbidity patterns. The relationship between BMI and mortality in patients with COPD remains an unresolved paradox.
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Affiliation(s)
- Miguel J Divo
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Carlos Cabrera
- Pulmonary Department, Hospital Universitario de Gran Canaria Dr Negrin, Las Palmas de Gran Canarias, Spain
| | - Ciro Casanova
- Pulmonary Department, Hospital Universitario La Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | - Jose M Marin
- Respiratory Service, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Victor M Pinto-Plata
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Juan P de-Torres
- Department of Pulmonology, University Clinic of Navarra, Pamplona, Spain
| | - Javier Zulueta
- Department of Pulmonology, University Clinic of Navarra, Pamplona, Spain
| | - Jorge Zagaceta
- Department of Pulmonology, University Clinic of Navarra, Pamplona, Spain
| | | | - Juan Berto
- Department of Pulmonology, University Clinic of Navarra, Pamplona, Spain
| | - Claudia Cote
- Division of Pulmonary and Critical Care Medicine, the Bay Pines Veterans Affairs Healthcare System, University of South Florida, Tampa
| | - Bartolome R Celli
- Pulmonary and Critical Care Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Tsukiji J, Cho SJ, Echevarria GC, Kwon S, Joseph P, Schenck EJ, Naveed B, Prezant DJ, Rom WN, Schmidt AM, Weiden MD, Nolan A. Lysophosphatidic acid and apolipoprotein A1 predict increased risk of developing World Trade Center-lung injury: a nested case-control study. Biomarkers 2014; 19:159-65. [PMID: 24548082 DOI: 10.3109/1354750x.2014.891047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
RATIONALE Metabolic syndrome, inflammatory and vascular injury markers measured in serum after World Trade Center (WTC) exposures predict abnormal FEV1. We hypothesized that elevated LPA levels predict FEV₁ < LLN. METHODS Nested case-control study of WTC-exposed firefighters. Cases had FEV₁ < LLN. Controls derived from the baseline cohort. Demographics, pulmonary function, serum lipids, LPA and ApoA1 were measured. RESULTS LPA and ApoA1 levels were higher in cases than controls and predictive of case status. LPA increased the odds by 13% while ApoA1 increased the odds by 29% of an FEV₁ < LLN in a multivariable model. CONCLUSIONS Elevated LPA and ApoA1 are predictive of a significantly increased risk of developing an FEV₁ < LLN.
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Affiliation(s)
- Jun Tsukiji
- Division of Pulmonary, Critical Care and Sleep Medicine, School of Medicine, New York University , New York, NY , USA
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Correlation between Obstructive Sleep Apnea Syndrome and Cardiac Disease Severity. Cardiovasc Psychiatry Neurol 2014; 2014:631380. [PMID: 24701348 PMCID: PMC3950406 DOI: 10.1155/2014/631380] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Revised: 12/29/2013] [Accepted: 01/12/2014] [Indexed: 11/23/2022] Open
Abstract
Background. Obstructive sleep apnea (OSA) syndrome is one of the most common respiratory disorders in humans.
There is emerging evidence linking OSA to vascular disease, particularly hypertension. The underlying pathophysiological mechanisms that link OSA
to cardiovascular diseases such as hypertension, congestive heart failure, and atrial fibrillation are not entirely understood.
The aim of this study was to investigate the association of obstructive sleep apnea hypopnea syndrome (OSAHS) with coronary atherosclerotic disease (CAD).
Methods. A questionnaire survey based on Berlin questionnaire and Epworth Sleepiness Scale (ESS) was conducted among
406 patients to assess demographic data and the symptoms, such as excessive daytime sleepiness and snoring.
Epworth Sleepiness Scale and Berlin questionnaire were completed by all of the patients. Venous blood samples were
obtained for biochemical tests. Characteristics of coronary arteries were collected from angiographies' reports.
All patients were divided into two groups based on results from Berlin questionnaire: low risk patients for OSA and high risk patients for OSA.
Data were analyzed by SPSS software version 13. Results. Mean age of patients was
61.8 ± 10.5.
212 (52.2%) patients were categorized as high risk group for apnea. Also, excessive daytime sleepiness was reported in 186 patients (45.8%). The severity of coronary artery involvement, daytime sleepiness, and electrocardiogram abnormalities was significantly higher in high risk patients for OSA compared with low risk patients. High risk patients had higher level of FBS and LDL and lower level of HDL cholesterol (P < 0.05). Conclusion. Our study found a strong correlation between the number of stenotic vessels and OSA. Based on our findings, OSA can be a predisposing factor for cardiac diseases.
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Daniele TMDC, de Bruin VMS, e Forte AC, de Oliveira DSN, Pompeu CMR, de Bruin PFC. The relationship between physical activity, restless legs syndrome, and health-related quality of life in type 2 diabetes. Endocrine 2013. [PMID: 23203003 DOI: 10.1007/s12020-012-9841-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
To evaluate the relationship between physical activity with co morbidities and health-related quality of life in type 2 diabetic patients with and without restless legs syndrome (RLS). This is an observational study, set at tertiary care diabetic outpatient clinic, where 200 consecutive type 2 diabetic patients and 47 controls participated. Physical activity level was established by the International Physical Activity Questionnaire (IPAQ) and RLS diagnosis and RLS severity were established using the criteria defined by the International Restless Legs Syndrome Study Group; excessive daytime sleepiness was evaluated by the Epworth Sleepiness Scale, quality of sleep by the Pittsburgh Sleep Quality Index and Health-Related Quality of Life by the Short-Form Health Survey (SF-36). Depressive symptoms were investigated by Beck Depression Inventory (BDI- II). Among all diabetic patients (58 % women, mean age 52.7 ± 5.7), disease duration varied from 1 to 30 years (11.7 ± 7.5). Diabetic patients had more hypertension (76 %), peripheral neuropathy (65 %), and depressive symptoms (31 %) than controls; no gender differences were found between cases with and without depressive symptoms. RLS patients (72 % female) had worse quality of sleep. With regards to the quality of life domains, more active RLS diabetic patients had better perception of functional capacity, physical limitation, pain, and general health state (p < 0.05). RLS symptom severity did not vary according to physical activity (IPAQ level). This study shows that the physical activity is associated with a better perception of functional capacity, physical limitation, and pain in diabetic patients with RLS; thus a more active lifestyle should be encouraged.
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Hsu JH, Chien IC, Lin CH, Chou YJ, Chou P. Increased Risk of Chronic Obstructive Pulmonary Disease in Patients with Schizophrenia: A Population-Based Study. PSYCHOSOMATICS 2013. [DOI: 10.1016/j.psym.2012.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Decramer ML, Hanania NA, Lötvall JO, Yawn BP. The safety of long-acting β2-agonists in the treatment of stable chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2013; 8:53-64. [PMID: 23378756 PMCID: PMC3558319 DOI: 10.2147/copd.s39018] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Inhaled long-acting bronchodilators are the mainstay of pharmacotherapy for chronic obstructive pulmonary disease (COPD). Both the twice-daily long-acting β(2)-adrenoceptor agonists (LABAs) salmeterol and formoterol and the once-daily LABA indacaterol are indicated for use in COPD. This review examines current evidence for the safety of LABAs in COPD, focusing on their effect on exacerbations and deaths. METHODS We searched PubMed for placebo-controlled studies evaluating long-term (≥24 weeks) use of formoterol, salmeterol, or indacaterol in patients with stable COPD, published between January 1990 and September 2012. We summarized data relating to exacerbations and adverse events, particularly events related to COPD. RESULTS From 20 studies examined (8774 LABA-treated patients), there was no evidence of an association between LABA treatment and increased exacerbations, COPD-related adverse events, or deaths. Where analyzed as an efficacy outcome, LABA treatment was generally associated with significant or numerical reductions in COPD exacerbations compared with placebo. Incidences of COPD-related adverse events were similar for active and placebo treatments. The incidence of adverse events typically associated with the β(2)-agonist drug class such as skeletal muscle tremors and palpitations was low (often <1% of patients), and there were no reports of increased incidence of cardiac arrhythmias. The systemic effects of β(2)-adrenoceptor stimulation, such as high glucose and potassium levels, were considered minor. CONCLUSION Current evidence from clinical studies of the safety and tolerability profile of LABAs supports their long-term use in COPD.
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Affiliation(s)
- Marc L Decramer
- Respiratory Division, UZ Leuven, Campus Gasthuisberg, Herestraat 49, Leuven, Belgium.
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Luppi F, Beghè B, Roversi P. BPCO e altre malattie polmonari croniche. ITALIAN JOURNAL OF MEDICINE 2012. [DOI: 10.1016/j.itjm.2011.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bolignano D, Rastelli S, Agarwal R, Fliser D, Massy Z, Ortiz A, Wiecek A, Martinez-Castelao A, Covic A, Goldsmith D, Suleymanlar G, Lindholm B, Parati G, Sicari R, Gargani L, Mallamaci F, London G, Zoccali C. Pulmonary hypertension in CKD. Am J Kidney Dis 2012; 61:612-22. [PMID: 23164943 DOI: 10.1053/j.ajkd.2012.07.029] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 07/27/2012] [Indexed: 12/12/2022]
Abstract
Pulmonary arterial hypertension is a rare disease often associated with positive antinuclear antibody and high mortality. Pulmonary hypertension, which rarely is severe, occurs frequently in patients with chronic kidney disease (CKD). The prevalence of pulmonary hypertension ranges from 9%-39% in individuals with stage 5 CKD, 18.8%-68.8% in hemodialysis patients, and 0%-42% in patients on peritoneal dialysis therapy. No epidemiologic data are available yet for earlier stages of CKD. Pulmonary hypertension in patients with CKD may be induced and/or aggravated by left ventricular disorders and risk factors typical of CKD, including volume overload, an arteriovenous fistula, sleep-disordered breathing, exposure to dialysis membranes, endothelial dysfunction, vascular calcification and stiffening, and severe anemia. No specific intervention trial aimed at reducing pulmonary hypertension in patients with CKD has been performed to date. Correcting volume overload and treating left ventricular disorders are factors of paramount importance for relieving pulmonary hypertension in patients with CKD. Preventing pulmonary hypertension in this population is crucial because even kidney transplantation may not reverse the high mortality associated with established pulmonary hypertension.
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Affiliation(s)
- Davide Bolignano
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
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Marchini JFM, Souza FLN, Schmidt A, Cunha SFC, Salgado W, Marchini JS, Nonino CB, Ceneviva R, Santos JED. Low educational status, smoking, and multidisciplinary team experience predict hospital length of stay after bariatric surgery. Nutr Metab Insights 2012; 5:71-6. [PMID: 23882150 PMCID: PMC3698470 DOI: 10.4137/nmi.s10315] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Objective: The objective of the present study was to identify new risk factors associated with longer hospitalization following bariatric surgery. Methods: Patient clinical, social, and biochemical data in addition to multidisciplinary team experience were analyzed in a cohort that included all patients undergoing bariatric surgery at our hospital. The primary outcome was length of hospital stay (LOS). Mortality was recorded to validate the obesity surgery mortality risk score (OS-MRS). Results: This study included 299 sequential patients, 41 ± 10 years of age, and BMI of 50 ± 8 kg/m2 who underwent bariatric surgery. Two thirds (196) of patients were hypertensive, a third (86) were diabetic and a third (91) were current or former smokers. Overall, LOS was 8 ± 5 days. The predictors of a longer LOS were smoking (P < 0.05) and less multidisciplinary team experience (P < 0.05). Looking at only the last three years of data, LOS was 6 ± 5 days, and the predictors of a longer LOS were low educational attainment (P < 0.02) and smoking (P < 0.01) but not team experience. The global mortality was 2.6%, with the OS-MRS identifying a high-risk group. Conclusion: Excluding the initial learning phase, longer LOS independent predictors were patient low educational attainment and smoking. These predictors can help guide care to reduce complications.
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Kwon CH, Rhee EJ, Song JU, Kim JT, Kwag HJ, Sung KC. Reduced lung function is independently associated with increased risk of type 2 diabetes in Korean men. Cardiovasc Diabetol 2012; 11:38. [PMID: 22524685 PMCID: PMC3464774 DOI: 10.1186/1475-2840-11-38] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 04/02/2012] [Indexed: 12/17/2022] Open
Abstract
Background Reduced lung function is associated with incident insulin resistance and diabetes. The aim of this study was to assess the relationship between lung function and incident type 2 diabetes in Korean men. Methods This study included 9,220 men (mean age: 41.4 years) without type 2 diabetes at baseline who were followed for five years. Subjects were divided into four groups according to baseline forced vital capacity (FVC) (% predicted) and forced expiratory volume in one second (FEV1) (% predicted) quartiles. The incidence of type 2 diabetes at follow-up was compared according to FVC and FEV1 quartiles. Results The overall incidence of type 2 diabetes was 2.2%. Reduced lung function was significantly associated with the incidence of type 2 diabetes after adjusting for age, BMI, education, smoking, exercise, alcohol, and HOMA-IR. Both FVC and FEV1 were negatively associated with type 2 diabetes (P < 0.05). In non-obese subjects with BMI < 25, the lowest quartile of FVC and FEV1 had a significantly higher odds ratio for type 2 diabetes compared with the highest quartile after adjusting for age and BMI (2.15 [95% CI 1.02-4.57] and 2.19 [95% CI 1.09-4.42]). Conclusions Reduced lung function is independently associated with the incidence of type 2 diabetes in Korean men.
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Affiliation(s)
- Chang-Hee Kwon
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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