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[Role of myelin and lymphocyte protein in regulating pulmonary artery smooth muscle cell proliferation and apoptosis in pulmonary hypertension]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:1572-1577. [PMID: 36329594 PMCID: PMC9637499 DOI: 10.12122/j.issn.1673-4254.2022.10.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate the role of myelin and lymphocyte protein (MAL) in pulmonary hypertension (PAH). METHODS Blood samples were collected from 50 patients with PAH (PAH group) and 50 healthy individuals for detection of plasma MAL expression using ELISA.According to the echocardiographic findings, the patients were divided into moderate/severe group (n=18) and mild group (n=32), and the correlation between MAL protein level and the severity of PAH was analyzed.In a pulmonary artery smooth muscle cell model of PAH with hypoxia-induced abnormal proliferation, the effects of mal gene knockdown and overexpression on cell growth, proliferation and starvation-induced apoptosis were observed; the changes in NK-κB signaling pathway in the transfected cells were detected to explore the molecular mechanism by which MAL regulates PAMSC proliferation and apoptosis. RESULTS The plasma level of MAL was significantly higher in patients with PAH than in healthy individuals (P < 0.05), and the patients with moderate/severe PAH had significantly higher MAL level than those with mild PAH (P < 0.001).In PAMSCs, exposure to hypoxia significantly increased the mRNA and protein expression levels of MAL (P < 0.05), and MAL knockdown obviously inhibited hypoxia-induced proliferation and promoted starvation-induced apoptosis of the PAMSCs (P < 0.05).Knocking down mal significantly inhibited the activation of NK-κB signaling pathway that participated in regulation of PAMSC proliferation (P < 0.05). CONCLUSION The plasma level of MAL is elevated in PAH patients in positive correlation with the disease severity.MAL knockdown inhibits abnormal proliferation and promotes apoptosis of PAMSCs by targeted inhibition of the NF-κB signaling pathway to improve vascular remodeling in PAH.
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De la Cruz-Cano E, Jiménez-González CDC, Díaz-Gandarilla JA, López-Victorio CJ, Escobar-Ramírez A, Uribe-López SA, Huerta-García E, Ayala-Sumuano JT, Morales-García V, Gútierrez-López L, González-Garrido JA. Comorbidities and laboratory parameters associated with SARS-CoV-2 infection severity in patients from the southeast of Mexico: a cross-sectional study. F1000Res 2022; 11:10. [PMID: 35464048 PMCID: PMC9005987 DOI: 10.12688/f1000research.74023.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 01/08/2023] Open
Abstract
Background. Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) is the etiological agent of the coronavirus disease 2019 (COVID-19) pandemic. Among the risk factors associated with the severity of this disease is the presence of several metabolic disorders.
For this reason, the aim of this research was
to identify the comorbidities and laboratory parameters among COVID-19 patients admitted to the intensive care unit (ICU), comparing the patients who required invasive mechanical ventilation (IMV) with those who did not require IMV, in order to determine the clinical characteristics associated with the COVID-19 severity. Methods. We carried out a cross-sectional study among 152 patients who were admitted to the ICU from April 1
st to July 31
st, 2021, in whom the comorbidities and laboratory parameters associated with the SARS-CoV-2 infection severity were identified. The data of these patients was grouped into two main groups: “patients who required IMV” and “patients who did not require IMV”. The nonparametric Mann–Whitney U test for continuous data and the
χ2 test for categorical data were used to compare the variables between both groups. Results. Of the
152 COVID-19 patients who were admitted to the ICU, 66 required IMV and 86 did not require IMV. Regarding the comorbidities found in these patients, a higher prevalence of type 2 diabetes mellitus (T2DM), hypertension and obesity was observed among patients who required IMV vs. those who did not require IMV (
p<0.05). Concerning laboratory parameters, only glucose, Interleukin 6 (IL-6), lactate dehydrogenase (LDH) and C-reactive protein (CRP) were significantly higher among patients who required IMV than in those who did not require IMV (
p<0.05). Conclusion. This study performed in a Mexican population indicates that comorbidities such as: T2DM, hypertension and obesity, as well as elevated levels of glucose, IL-6, LDH and CRP are associated with the COVID-19 severity.
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Affiliation(s)
- Eduardo De la Cruz-Cano
- División Académica de Ciencias Básicas. CICTAT. Laboratorio de Bioquímica y Biología Molecular., Universidad Juárez Autónoma de Tabasco, Cunduacán,, Tabasco., 86690, Mexico.,Laboratorio de Análisis Clínicos., Secretaría de Salud, Hospital General de Comalcalco., Comalcalco., Tabasco, 86300, Mexico
| | - Cristina Del C Jiménez-González
- División Académica Multidisciplinaria de Comalcalco. Laboratorio de Análisis Clínicos., Universidad Juárez Autónoma de Tabasco., Comalcalco., Tabasco., 86650, Mexico
| | - José A Díaz-Gandarilla
- División Académica Multidisciplinaria de Comalcalco. Laboratorio de Análisis Clínicos., Universidad Juárez Autónoma de Tabasco., Comalcalco., Tabasco., 86650, Mexico
| | - Carlos J López-Victorio
- División Académica de Ciencias Básicas. CICTAT. Laboratorio de Bioquímica y Biología Molecular., Universidad Juárez Autónoma de Tabasco, Cunduacán,, Tabasco., 86690, Mexico
| | - Adelma Escobar-Ramírez
- División Académica de Ciencias Básicas. CICTAT. Laboratorio de Bioquímica y Biología Molecular., Universidad Juárez Autónoma de Tabasco, Cunduacán,, Tabasco., 86690, Mexico
| | - Sheila A Uribe-López
- División Académica Multidisciplinaria de Jalpa de Méndez. Laboratorio de Inmunología y Microbiología Molecular., Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, Tabasco, 86205, Mexico
| | - Elizabeth Huerta-García
- División Académica Multidisciplinaria de Jalpa de Méndez. Laboratorio de Inmunología y Microbiología Molecular., Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, Tabasco, 86205, Mexico
| | | | - Vicente Morales-García
- División Académica Multidisciplinaria de Comalcalco. Laboratorio de Análisis Clínicos., Universidad Juárez Autónoma de Tabasco., Comalcalco., Tabasco., 86650, Mexico
| | - Liliana Gútierrez-López
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina., Instituto Politécnico Nacional., Ciudad de México, Ciudad de México, 11340, Mexico
| | - José A González-Garrido
- División Académica de Ciencias Básicas. CICTAT. Laboratorio de Bioquímica y Biología Molecular., Universidad Juárez Autónoma de Tabasco, Cunduacán,, Tabasco., 86690, Mexico
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Effect of different modes of positive airway pressure treatment on obesity hypoventilation syndrome: a systematic review and network meta-analysis. Sleep Med 2022; 91:51-58. [DOI: 10.1016/j.sleep.2022.01.008] [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: 05/09/2021] [Revised: 10/27/2021] [Accepted: 01/05/2022] [Indexed: 11/20/2022]
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Ge H, Jiang Y, Jin Q, Wan L, Qian X, Zhang Z. Nomogram for the prediction of postoperative hypoxemia in patients with acute aortic dissection. BMC Anesthesiol 2018; 18:146. [PMID: 30342471 PMCID: PMC6195757 DOI: 10.1186/s12871-018-0612-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Postoperative hypoxemia is quite common in patients with acute aortic dissection (AAD) and is associated with poor clinical outcomes. However, there is no method to predict this potentially life-threatening complication. The study aimed to develop a regression model in patients with AAD to predict postoperative hypoxemia, and to validate it in an independent dataset. METHODS All patients diagnosed with AAD from December 2012 to December 2017 were retrospectively screened for potential eligibility. Preoperative and intraoperative variables were included for analysis. Logistic regression model was fit by using purposeful selection procedure. The original dataset was split into training and validating datasets by 4:1 ratio. Discrimination and calibration of the model was assessed in the validating dataset. A nomogram was drawn for clinical utility. RESULTS A total of 211 patients, involving 168 in non-hypoxemia and 43 in hypoxemia group, were included during the study period (incidence: 20.4%). Duration of mechanical ventilation (MV) was significantly longer in the hypoxemia than non-hypoxemia group (41(10.5140) vs. 12(3.75,70.25) hours; p = 0.002). There was no difference in the hospital mortality rate between the two groups. The purposeful selection procedure identified 8 variables including hematocrit (odds ratio [OR]: 0.89, 95% confidence interval [CI]: 0.80 to 0.98, p = 0.011), PaO2/FiO2 ratio (OR: 0.99, 95% CI: 0.99 to 1.00, p = 0.011), white blood cell count (OR: 1.21, 95% CI: 1.06 to 1.40, p = 0.008), body mass index (OR: 1.32, 95% CI: 1.15 to 1.54; p = 0.000), Stanford type (OR: 0.22, 95% CI: 0.06 to 0.66; p = 0.011), pH (OR: 0.0002, 95% CI: 2*10- 8 to 0.74; p = 0.048), cardiopulmonary bypass time (OR: 0.99, 95% CI: 0.98 to 1.00; p = 0.031) and age (OR: 1.03, 95% CI: 0.99 to 1.08; p = 0.128) to be included in the model. In an independent dataset, the area under curve (AUC) of the prediction model was 0.869 (95% CI: 0.802 to 0.936). The calibration was good by visual inspection. CONCLUSIONS The study developed a model for the prediction of postoperative hypoxemia in patients undergoing operation for AAD. The model showed good discrimination and calibration in an independent dataset that was not used for model training.
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Affiliation(s)
- Huiqing Ge
- 0000 0004 1759 700Xgrid.13402.34Department of Respiratory Care, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ye Jiang
- 0000 0004 1759 700Xgrid.13402.34Department of Respiratory Care, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qijun Jin
- 0000 0004 1759 700Xgrid.13402.34Department of Respiratory Care, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Linjun Wan
- 0000 0004 1759 700Xgrid.13402.34Department of Respiratory Care, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ximing Qian
- 0000 0004 1759 700Xgrid.13402.34Department of Cardiovascular Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhongheng Zhang
- 0000 0004 1759 700Xgrid.13402.34Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No 3, East Qingchun Road, Hangzhou, 310016 Zhejiang Province China
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Willson C, Watanabe M, Tsuji-Hosokawa A, Makino A. Pulmonary vascular dysfunction in metabolic syndrome. J Physiol 2018; 597:1121-1141. [PMID: 30125956 DOI: 10.1113/jp275856] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/30/2018] [Indexed: 12/20/2022] Open
Abstract
Metabolic syndrome is a critically important precursor to the onset of many diseases, such as cardiovascular disease, and cardiovascular disease is the leading cause of death worldwide. The primary risk factors of metabolic syndrome include hyperglycaemia, abdominal obesity, dyslipidaemia, and high blood pressure. It has been well documented that metabolic syndrome alters vascular endothelial and smooth muscle cell functions in the heart, brain, kidney and peripheral vessels. However, there is less information available regarding how metabolic syndrome can affect pulmonary vascular function and ultimately increase an individual's risk of developing various pulmonary vascular diseases, such as pulmonary hypertension. Here, we review in detail how metabolic syndrome affects pulmonary vascular function.
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Affiliation(s)
- Conor Willson
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | - Makiko Watanabe
- Department of Physiology, University of Arizona, Tucson, AZ, USA
| | | | - Ayako Makino
- Department of Physiology, University of Arizona, Tucson, AZ, USA
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Maddineni U, Worrall EF, Baker EA, Earasi M, Mathieu F, Guruli G. Urologic Surgery with Multisystem Comorbidities: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1047-1052. [PMID: 30171179 PMCID: PMC6135146 DOI: 10.12659/ajcr.909554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 06/20/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Originally implemented for colorectal surgery, enhanced perioperative protocols have been incorporated into many surgical fields in an effort to improve outcomes. The cornerstone of many strategies includes patient education, liberalized oral intake on the day of surgery, no routine bowel prep, targeted multimodal analgesia, cautious use of IV hydration, early extubation, avoidance of NG tubes and/or surgical drains, and encouraging early postoperative ambulation. CASE REPORT We report on the successful outcome of a single patient with a rare autosomal dominant disorder (hereditary hemorrhagic telangiectasia) with multisystem involvement including pulmonary, cardiac, hematologic, gastrointestinal, renal, oncologic, and hepatic comorbidities, scheduled for open nephrectomy. CONCLUSIONS Prospective and retrospective studies are needed to specifically elucidate the role of similar management in higher-risk surgical candidates.
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Affiliation(s)
- Upendra Maddineni
- Department of Anesthesiology, McGuire Veterans Administration Medical Center, Richmond, VA, U.S.A
| | - Eric F. Worrall
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, U.S.A
| | - Erik A. Baker
- Department of Anesthesiology, McGuire Veterans Administration Medical Center, Richmond, VA, U.S.A
| | - Madhavi Earasi
- Department of Anesthesiology, McGuire Veterans Administration Medical Center, Richmond, VA, U.S.A
| | - Francis Mathieu
- Department of Anesthesiology, McGuire Veterans Administration Medical Center, Richmond, VA, U.S.A
| | - Georgi Guruli
- Department of Urology, McGuire Veterans Administration Medical Center, Richmond, VA, U.S.A
- Department of Urology, Virginia Commonwealth University, Richmond, VA, U.S.A
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Hanipah ZN, Mulcahy MJ, Sharma G, Punchai S, Steckner K, Dweik R, Aminian A, Schauer PR, Brethauer SA. Bariatric surgery in patients with pulmonary hypertension. Surg Obes Relat Dis 2018; 14:1581-1586. [PMID: 30449514 DOI: 10.1016/j.soard.2018.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/03/2018] [Accepted: 07/14/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Data regarding the outcomes of bariatric surgery in patients with pulmonary hypertension (PH) is limited. The aim of this study was to review our experience on bariatric surgery in patients with PH. SETTING An academic medical center. METHODS Patients with PH who underwent either a primary or revisional bariatric surgery between 2005 and 2015 and had a preoperative right ventricle systolic pressure (RVSP) ≥35 mm Hg were included. RESULTS Sixty-one patients met the inclusion criteria. Fifty (82%) were female with the median age of 58 years (interquartile range [IQR] 49-63). The median body mass index was 49 kg/m2 (IQR 43-54). Procedures performed included the following: Roux-en-Y gastric bypass (n = 33, 54%), sleeve gastrectomy (n = 24, 39%), adjustable gastric banding (n = 3, 5%), and banded gastric plication (n = 1, 2%). Four patients (7%) underwent revisional bariatric procedures. Median operative time and length of stay was 130 minutes (IQR 110-186) and 3 days (IQR 2-5), respectively. The 30-day complication rate was 16% (n = 10) with pulmonary complications noted in 4 patients. There was no 30-day mortality. One-year follow-up was available in 93% patients (n = 57). At 1 year, median body mass index and excess weight loss were 36 kg/m2 (IQR 33-41) and 51% (IQR 33-68), respectively. There was significant improvement in the RVSP after bariatric surgery at a median follow-up of 22 months (IQR 10-41). The median RVSP decreased from 44 (IQR 38-53) to 40 mm Hg (IQR 28-54) (P = .03). CONCLUSION Bariatric surgery can be performed without prohibitive complication rates in patients with PH. In our experience, bariatric patients with PH achieved significant weight loss and improvement in RVSP.
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Affiliation(s)
- Zubadiah Nor Hanipah
- Bariatric and Metabolic Institute, Department of Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Surgery, Faculty of Medicine and Health Sciences, University Putra Malaysia, Selangor, Malaysia
| | - Michael J Mulcahy
- Bariatric and Metabolic Institute, Department of Surgery, Cleveland Clinic, Cleveland, Ohio; Deparment of Surgery, Tripler Army Medical Center, Honolulu, Hawaii
| | - Gautam Sharma
- Bariatric and Metabolic Institute, Department of Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Suriya Punchai
- Bariatric and Metabolic Institute, Department of Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Karen Steckner
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Raed Dweik
- Department of Pulmonary Medicine and Critical Care Medicine, Cleveland Clinic, Ohio
| | - Ali Aminian
- Bariatric and Metabolic Institute, Department of Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Philip R Schauer
- Bariatric and Metabolic Institute, Department of Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Stacy A Brethauer
- Bariatric and Metabolic Institute, Department of Surgery, Cleveland Clinic, Cleveland, Ohio.
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