SOSTIENICI
Pubblicazioni recenti - cardiovascular
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STABILISE Technique via a Transapical Approach to Repair Residual Type A Aortic Dissection.
Aorta (Stamford)2021 Sep;():. doi: 10.1055/s-0041-1729851.
Fouquet Olivier, Dang Van Simon, Ammi Myriam, Daligault Mickael, Baufreton Christophe, Picquet Jean,
Abstract
The stent-assisted balloon-induced intimal disruption and relamination in aortic dissection or STABILISE concept is a novel endovascular strategy in Type A and Type B dissections. We report a case of Type A aortic dissection repair combining, first, an open thoracic aortic surgery with an elephant trunk procedure and, second, an endovascular treatment using the STABILISE technique via a combined transapical approach commonly used for transcatheter aortic valve implantation and a femoral pathway.
The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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Serum Levels of PCSK9 Are Increased in Patients With Active Ulcerative Colitis Representing a Potential Biomarker of Disease Activity: A Cross-sectional Study.
J Clin Gastroenterol2021 Sep;():. doi: 10.1097/MCG.0000000000001607.
Marinelli Carla, Zingone Fabiana, Lupo Maria Giovanna, Marin Raffaella, D'Incà Renata, Gubbiotti Alessandro, Massimi Davide, Casadei Cesare, Barberio Brigida, Ferri Nicola, Savarino Edoardo,
Abstract
BACKGROUND/GOAL:
Ulcerative colitis (UC) is characterized by chronic inflammation and progressive course, with potential extraintestinal complications including cardiovascular mortality. Serum proprotein convertase subtilisin/kexin type 9 (PCSK9) levels have been recently recognized as biomarkers of low-grade inflammation and cardiovascular disease. The aim of our study was to evaluate PCSK9 levels in patients with UC and different degrees of disease activity.
METHODS:
We prospectively recruited consecutive patients with UC attending our center at the University Hospital of Padua. Demographics, clinical characteristics, and biochemical data, including PCSK9, high sensitivity C-reactive protein, and fecal calprotectin, were recorded. Moreover, endoscopic procedures were performed in all subjects.
RESULTS:
We included 112 patients with UC (mean age=52.62±12.84?y; 52.62% males). Patients with UC and abnormal fecal calprotectin (?250?µg/g) and/or C-reactive protein (?3?mg/L) had greater levels of PCSK9 compared with UC patients with normal fecal calprotectin and high sensitivity C-reactive protein (P=0.03 and 0.005, respectively). Higher endoscopic scores in UC were characterized by greater levels of PCSK9 (P=0.03). Furthermore, we found a positive correlation between PCSK9 levels and fecal calprotectin (r=0.18, P=0.04), endoscopic Mayo Score (r=0.25, P=0.007), and UC-Riley Index (r=0.22, P=0.01). We also found a positive correlation between PCSK9 levels and both total and low-density lipoprotein cholesterol values (P
CONCLUSIONS:
Serum PCSK9 levels are increased in patients with biochemical and endoscopic evidence of active disease in UC. Further longitudinal studies are necessary to evaluate the role of PCSK9 as a potential biomarker of disease activity and cardiovascular risk in UC.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Left Ventricular Assist Device as a Bridge to Recovery: Single Center Experience of Successful Device Explantation.
ASAIO J2021 Sep;():. doi: 10.1097/MAT.0000000000001574.
Zhang Robert S, Hanff Thomas C, Peters Carli J, Evans Peter T, Marble Judy, Rame J Eduardo, Atluri Pavan, Urgo Kimberly, Tanna Monique S, Mazurek Jeremy A, Acker Michael A, Cevasco Marisa, Birati Edo Y, Wald Joyce W,
Abstract
Continuous-flow left ventricular assist devices (CF-LVAD) have been shown to enhance reverse remodeling and myocardial recovery in certain patients allowing for device removal. We sought to analyze the characteristics and describe outcomes of patients who underwent CF-LVAD explantation at a large academic center. We retrospectively identified all patients who underwent CF-LVAD explants due to recovery from 2006 to 2019. Patient baseline characteristics and data on pre- and postexplant evaluation were collected and analyzed. Of 421 patients who underwent CF-LVAD implantation, 13 underwent explantation (3.1%). Twelve HeartMate II and one HeartWare LVAD were explanted. All patients had nonischemic cardiomyopathy. Median time from heart failure diagnosis to LVAD implant was 12 months (interquartile range [IQR], 2-44) and the median time supported on LVAD was 22 months (IQR, 11-28). Two patients died within 30 days of explant. Three additional patients died during the follow-up period and all were noted to be nonadherent to medical therapy. After a mean follow-up duration of 5 years, overall survival was 52%. Mean pre-explant ejection fraction was 49%, which decreased at most recent follow-up to 32%. Mean pre-explant left ventricular internal diameter in diastole (LVIDD) was 4.37 cm and increased to 5.52 cm at most recent follow-up. Continuous-flow left ventricular assist device explantation is feasible and safe in select patients.
Copyright © 2021 by the American Society for Artificial Internal Organs.
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Venoarterial Extracorporeal Membrane Oxygenation in Severe Drug Intoxication: A Retrospective Comparison of Survivors and Nonsurvivors.
ASAIO J2021 Sep;():. doi: 10.1097/MAT.0000000000001583.
Duburcq Thibault, Goutay Julien, Preau Sebastien, Mugnier Agnes, Rousse Natacha, Moussa Mouhamed D, Vincentelli André, Cuny Jerome, Parmentier-Decrucq Erika, Poissy Julien,
Abstract
Selecting patients most likely to benefit from venoarterial extracorporeal membrane oxygenation (V-A ECMO) to treat refractory drug-induced cardiovascular shock remains a difficult challenge for physicians. This study reported short-term survival outcomes and factors associated with mortality in V-A ECMO-treated patients for poisoning. Twenty-two patients placed on V-A ECMO after drug intoxication from January 2014 to December 2020 were retrospectively analyzed. he primary endpoint of this study was survival at hospital discharge. Univariate descriptive analysis was performed to compare survivors and nonsurvivors during hospitalization. The overall survival at hospital discharge was 45.4% (n = 10/22). Survival rate tended to be higher in patients treated for refractory shock (n = 7/10) compared with those treated for refractory cardiac arrest (n = 3/12, p = 0.08). Low-flow duration and time from admission to ECMO cannulation were shorter in survivors (p = 0.02 and p = 0.03, respectively). Baseline characteristics before ECMO, including the class of drugs involved in the poisoning, between survivors and nonsurvivors were not statistically different except pH, bicarbonate, serum lactate, Sequential Organ Failure Assessment, and Survival After Veno-arterial-ECMO (SAVE) score. All patients with SAVE-score risk classes II/III survived whereas 85.7% (n = 12/14) of those with SAVE-score risk classes IV/V died. A lactic acid >9 mmol/L predicts mortality with a sensitivity/specificity ratio of 83.3%/100%. V-A ECMO for severe drug intoxication should be reserved for highly selected poisoned patients who do not respond to conventional therapies. Shortening the timing of V-A ECMO initiation should be a key priority in improving outcomes. Low-flow time >60min, lactic acid >9mmol/L, and SAVE-score may be good indicators of a worse prognosis.
Copyright © 2021 by the American Society for Artificial Internal Organs.
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Exercise, Physical Activity and Cardiometabolic Health: Pathophysiologic Insights.
Cardiol Rev2021 Sep;():. doi: 10.1097/CRD.0000000000000417.
Belanger Matthew J, Rao Prashant, Robbins Jeremy M,
Abstract
Physical activity and its sustained and purposeful performance - exercise - promote a broad and diverse set of metabolic and cardiovascular health benefits. Regular exercise is the most effective way to improve cardiorespiratory fitness, a measure of one's global cardiovascular, pulmonary and metabolic health and one of the strongest predictors of future health risk. Here, we describe how exercise affects individual organ systems related to cardiometabolic health, including the promotion of insulin and glucose homeostasis through improved efficiency in skeletal muscle glucose utilization and enhanced insulin sensitivity; beneficial changes in body composition and adiposity; and improved cardiac mechanics and vascular health. We subsequently identify knowledge gaps that remain in exercise science, including heterogeneity in exercise responsiveness. While the application of molecular profiling technologies in exercise science has begun to illuminate the biochemical pathways that govern exercise-induced health promotion, much of this work has focused on individual organ systems and applied single platforms. New insights into exercise-induced secreted small molecules and proteins that impart their effects in distant organs ("exerkines") highlight the need for an integrated approach towards the study of exercise and its global effects; efforts that are ongoing.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Exercise, Physical Activity, and Cardiometabolic Health: Insights into the Prevention and Treatment of Cardiometabolic Diseases.
Cardiol Rev2021 Sep;():. doi: 10.1097/CRD.0000000000000416.
Rao Prashant, Belanger Matthew J, Robbins Jeremy M,
Abstract
Physical activity (PA) and exercise are widely recognized as essential components of primary and secondary cardiovascular disease (CVD) prevention efforts and are emphasized in the health promotion guidelines of numerous professional societies and committees. The protean benefits of PA and exercise extend across the spectrum of CVD, and include the improvement and reduction of risk factors and events for atherosclerotic CVD (ASCVD), cardiometabolic disease, heart failure, and atrial fibrillation, respectively. Here, we highlight recent insights into the salutary effects of PA and exercise on the primary and secondary prevention of ASCVD, including their beneficial effects on both traditional and non-traditional risk mediators; exercise "prescriptions" for ASCVD; the role of PA regular exercise in the prevention and treatment of heart failure; and the relationships between, PA, exercise and atrial fibrillation. While our understanding of the relationship between exercise and CVD has evolved considerably, several key questions remain including the association between extreme volumes of exercise and subclinical ASCVD and its risk; high-intensity exercise and resistance (strength) training as complementary modalities to continuous aerobic exercise; and dose- and intensity-dependent associations between exercise and atrial fibrillation. Recent advances in molecular profiling technologies (i.e., genomics, transcriptomics, proteomics, and metabolomics) have begun to shed light on inter-individual variation in cardiometabolic responses to PA and exercise and may provide new opportunities for clinical prediction in addition to mechanistic insights.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Cytomegalovirus Donor Seropositivity Negatively Affects Survival After Heart Transplantation.
Transplantation2021 Sep;():. doi: 10.1097/TP.0000000000003961.
Heim Christian, Müller Philipp P, Tandler René, Cherikh Wida S, Toll Alice E, Stehlik Josef, Weyand Michael, Khush Kiran K, Ensminger Stephan M,
Abstract
OBJECTIVES:
Prior studies have shown that cytomegalovirus(CMV) infection is a risk factor for the development of cardiac allograft vasculopathy(CAV) and is associated with reduced long-term survival after heart transplantation. The aim of this ISHLT Transplant Registry study was to compare post-transplant survival in different CMV donor:recipient serologic combinations.
METHODS:
We performed a retrospective cohort study, using the ISHLT Thoracic Transplant Registry, on 15,885 adult primary heart transplant recipients with known CMV serologic status between 7/2004 and 6/2014. Post-transplant survival and risk of developing CAV were compared across 4 groups: CMV-seronegative recipients(R-) receiving CMV-positive grafts(D+), intermediate-risk patients(D+R+ and D-R+), and low-risk patients(D-R-).
RESULTS:
Baseline characteristics (donor/recipient age, BMI, recipient serum creatinine, blood group, donor cause of death, recipient diagnosis and ischemic time) were mostly balanced between the groups. Kaplan Meier survival analyses over a follow up of 10 years revealed significantly worse survival for both D+ groups as compared to the CMV low risk group (D+R+:56.61% (95%CI 53.94,59.41) vs. D-R-:63.09% (59.74,66.64) p<.01 and d vs. d-r- p whereas recipient seropositivity alone was not associated with reduced survival the risk of developing cav after htx significantly increased in as compared to d- groups.>
CONCLUSION:
In a large contemporary cohort, CMV status at the time of heart transplantation was not associated with CAV development. However, there was a significant association between donor CMV seropositivity and reduced short- and long-term survival after heart transplantation. Approaches to mitigate the impact of CMV on post-transplant survival are needed.Supplemental Visual Abstract; http://links.lww.com/TP/C292.
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
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Effect of GP IIb/IIIa inhibitor duration on the clinical prognosis of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction with no-/slow-reflow phenomenon.
Biomed Pharmacother2021 Sep;143():112196. doi: S0753-3322(21)00980-X.
Hu Xiangming, Wang Weimian, Ye Jingguang, Lin Yan, Yu Bingyan, Zhou Langping, Zhou Yingling, Dong Haojian,
Abstract
BACKGROUND:
In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) accompanied by the no-/slow-reflow phenomenon, the maintenance duration of GP IIb/IIIa inhibitor (GPI) is controversial. We compare the efficacy and safety of short- and long-term GPI infusion in STEMI patients with the no-/slow-reflow phenomenon.
METHODS:
From June 2016 to December 2019, we continuously included patients with on-set STEMI who underwent pPCI, accompanied by the no-/slow-reflow, during interventional procedures at Guangdong Provincial People's Hospital and Zhuhai Golden Bay Hospital. The hemorrhage events, heart function, and major adverse cardiovascular events (MACE) were compared between
RESULTS:
In total, 127 patients were divided into two groups based on the duration of tirofiban use (less and more than 24 h). There was no significant difference between two groups in terms of baseline characteristics, plaque condition, and coronary physiological function. The two groups showed similar in-hospital MACE (1 [1.85%] vs. 4 [5.48%], p = 0.394) and 1-year MACE-free survival (log-rank test p = 0.9085). The 1-year MACE remained consistent between the two groups in all subgroups of different risk factors of no-/slow-reflow. There was no significant difference in heart function and in-hospital hemorrhage events (3.7% vs. 1.37%, p = 0.179).
CONCLUSION:
In the real world, prolonging the duration of GPI may not significantly improve the clinical outcome in patients with STEMI with no-/slow-reflow.
Copyright © 2021 The Authors. Published by Elsevier Masson SAS.. All rights reserved.
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Regulation and functions of NLRP3 inflammasome in cardiac fibrosis: Current knowledge and clinical significance.
Biomed Pharmacother2021 Sep;143():112219. doi: S0753-3322(21)01003-9.
Zhang Xiaoqing, Qu Huiyan, Yang Tao, Kong Xiaoni, Zhou Hua,
Abstract
Cardiac fibrosis can lead to heart failure, arrhythmia, and sudden cardiac death, representing one of the leading causes of death due to cardiovascular diseases. Cardiac fibrosis involves several multifactorial processes that cannot be effectively controlled by the available therapies. Therefore, current research has focused on the development of novel drugs that can be used to prevent cardiac fibrosis. Recent studies on the functions of inflammasome have provided an in-depth understanding of the regulatory functions of inflammasome in cardiac fibrosis. This review summarizes the latest research on the functions of the NLRP3 inflammasome in various cardiovascular diseases. The latest findings indicate that the NLRP3 inflammasome mediates several inflammatory responses and is associated with pyroptosis, mitochondrial regulation, and myofibroblast differentiation in cardiac fibrosis. These novel findings provide insight into the vital role of the NLRP3 inflammasome in the pathogenesis of cardiac fibrosis, which can be used to identify new targets for its prevention and treatment.
Copyright © 2021 The Authors. Published by Elsevier Masson SAS.. All rights reserved.
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A predictive model for identifying low medication adherence among older adults with hypertension: A classification and regression tree model.
Geriatr Nurs2021 Sep;42(6):1309-1315. doi: S0197-4572(21)00279-2.
Chu Han-Yu, Huang Hui-Chuan, Huang Chun-Yao, Chu Ching-Chi, Su Chien-Tien, Tsai I-Lin, Hu Huey-Lan Sophia, Guo Shu-Liu,
Abstract
Various individual characteristics may affect medication adherence; however, few studies have investigated the effect of interrelationships among these various individual characteristics on medication adherence. This cross-sectional study explored the interrelationships among risk factors for medication adherence and established a predictive model of low medication adherence among older adults with hypertension. Convenience sampling was used to recruit 300 older adults with hypertension. The following parameters were recorded: demographic and disease characteristics, health beliefs, self-efficacy, social support, and medication adherence of antihypertensive drugs. Classification and regression tree (CART) analysis was performed to develop a predictive model of low medication adherence. The CART model revealed that health belief, disease duration, self-efficacy, and social support interacted to contribute to various pathways of low medication adherence. The predicted accuracy of the model was validated with a low misclassification rate of 26%. The proposed classification model can help identify risk cases with low medication adherence. Suitable health education programs based on these risk factors to manage and improve medication adherence for older adults with hypertension could be considered.
Copyright © 2021 Elsevier Inc. All rights reserved.
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A review on pharmacological activities and synergistic effect of quercetin with small molecule agents.
Phytomedicine2021 Sep;92():153736. doi: S0944-7113(21)00279-8.
Zou Haoyang, Ye Haiqing, Kamaraj Rajamanikkam, Zhang Tiehua, Zhang Jie, Pavek Petr,
Abstract
BACKGROUND:
Quercetin is a natural flavonoid, which widely exists in nature, such as tea, coffee, apples, and onions. Numerous studies have showed that quercetin has multiple biological activities such as anti-oxidation, anti-inflammatory, and anti-aging. Hence, quercetin has a significant therapeutic effect on cancers, obesity, diabetes, and other diseases. In the past decades, a large number of studies have shown that quercetin combined with other agents can significantly improve the overall therapeutic effect, compared to single use.
PURPOSE:
This work reviews the pharmacological activities of quercetin and its derivatives. In addition, this work also summarizes both in vivo and in vitro experimental evidence for the synergistic effect of quercetin against cancers and metabolic diseases.
METHODS:
An extensive systematic search for pharmacological activities and synergistic effect of quercetin was performed considering all the relevant literatures published until August 2021 through the databases including NCBI PubMed, Scopus, Web of Science, and Google Scholar. The relevant literatures were extracted from the databases with following keyword combinations: "pharmacological activities" OR "biological activities" OR "synergistic effect" OR "combined" OR "combination" AND "quercetin" as well as free-text words.
RESULTS:
Quercetin and its derivatives possess multiple pharmacological activities including anti-cancer, anti-oxidant, anti-inflammatory, anti-cardiovascular, anti-aging, and neuroprotective activities. In addition, the synergistic effect of quercetin with small molecule agents against cancers and metabolic diseases has also been confirmed.
CONCLUSION:
Quercetin cooperates with agents to improve the therapeutic effect by regulating signal molecules and blocking cell cycle. Synergistic therapy can reduce the dose of agents and avoid the possible toxic and side effects in the treatment process. Although quercetin treatment has some potential side effects, it is safe under the expected use conditions. Hence, quercetin has application value and potential strength as a clinical drug. Furthermore, quercetin, as the main effective therapeutic ingredient in traditional Chinese medicine, may effectively treat and prevent coronavirus disease 2019 (COVID-19).
Copyright © 2021. Published by Elsevier GmbH.
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Letter: In response to a recent letter by Prior et al.
Thromb Res2021 Jul;207():66. doi: S0049-3848(21)00376-5.
van der Beelen S H E, Agten S M, Suylen D P L, Wichapong K, Hrdinova J, Mees B M E, Spronk H M H, Hackeng T M,
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Detection of transdermal biomarkers using gradient-based colorimetric array sensor.
Biosens Bioelectron2021 Sep;195():113650. doi: S0956-5663(21)00687-4.
Yu Jingjing, Wang Di, Tipparaju Vishal Varun, Jung Wonjong, Xian Xiaojun,
Abstract
Accurate assessment of dietary macronutrients intake is critical for the effective management of multiple diseases, such as obesity, diabetes, cardiovascular disease, metabolic disease, and cancer. Conventional self-reporting method is burdensome, inaccurate, and often biased. Though blood analysis and breath analysis can provide evidence-based information, they are either invasive or subject to human errors. Here we reported a wearable transdermal volatile biomarkers detection system based on novel colorimetric sensing technology for dietary macronutrients intake assessment. This technique quantifies the emission rates of transdermal volatile biomarkers via a gradient-based colorimetric array sensor (GCAS). The optical system of the GCAS device tracks the localized color development associated with the chemical reaction between the volatile biomarkers and the porous sensing probes, and determines the biomarkers emission rates through image processing algorithms. The localized chemical reaction and the image-based signal processing also make the GCAS capable for multiplexed detection of multiple analytes simultaneously. The GCAS sensor has been applied for transdermal acetone detection on 5 subjects in a keto diet intervention. The study indicates that the transdermal acetone increases after the subjects consuming keto diets and it decreases to basal level after intaking carb-rich diets. The transdermal acetone response from the GCAS sensor correlates well with breath acetone concentration in the range between 0 and 40 ppm and the correlation factor (R) is as high as 0.8877. This method provides a noninvasive, low-cost, and wearable tool for assessing dietary macronutrients intake outside of lab or hospital settings. It could be widely applied in disease management, weight control, and nutrition management.
Copyright © 2021 Elsevier B.V. All rights reserved.
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Dietary intakes of monounsaturated fatty acids and risk of mortality from all causes, cardiovascular disease and cancer: A systematic review and dose-response meta-analysis of prospective cohort studies.
Ageing Res Rev2021 Sep;():101467. doi: S1568-1637(21)00214-2.
Lotfi Keyhan, Salari-Moghaddam Asma, Yousefinia Mahsa, Larijani Bagher, Esmaillzadeh Ahmad,
Abstract
BACKGROUND:
Findings on the link between dietary intakes of monounsaturated fatty acids (MUFA) and risk of mortality are conflicting. This study aimed to summarize existing literature regarding the association between MUFA intake and risk of mortality from all causes, cardiovascular diseases (CVDs), and cancer.
METHODS:
PubMed, Scopus, and ISI Web of Science was systematically searched up to December 2020. Prospective cohort studies which investigated MUFA intake in relation to mortality from all causes, CVD, or cancer were eligible for this systematic review. Publications that had reported risk ratios (RRs) or hazard ratios (HRs) and 95% confidence intervals (CIs) as effect size, were considered.
RESULTS:
A total of 17 prospective cohort studies were included. These studies included 1,022,321 participants aged ?20 years in total, and 191,283 all-cause deaths, 55,437 CVD deaths, and 64,448 cancer deaths were totally reported. Combining 15 effect sizes from 11 studies, MUFA intake was inversely associated with risk of all-cause mortality (RR: 0.94; 95% CI: 0.90, 0.98; I=55.5; P=0.005). Based on 17 effect sizes from 11 studies, we found no significant association between MUFA intake and risk of CVD mortality (RR: 0.95; 95% CI: 0.89, 1.01; I=37.0; P=0.06). Combining 10 effect sizes from 6 studies, MUFA intake was not significantly associated with cancer mortality (RR: 0.99; 95% CI: 0.96, 1.03, I=13.3%, P=0.32). Also, an additional 5% of energy from MUFA was associated with a 3% reduced risk of all-cause mortality (RR: 0.97; 95%CI: 0.96, 0.98), but not with CVD (RR: 0.98; 95%CI: 0.95, 1.01) and cancer mortality (RR: 0.99; 95%CI: 0.97, 1.01).
CONCLUSIONS:
MUFA intake was found to be inversely associated with risk of all-cause mortality. However, no link was found between MUFA consumption and mortality from CVD or cancer.
Copyright © 2021. Published by Elsevier B.V.
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A Meta-Analysis on the Global Prevalence, Risk factors and Screening of Coronary Heart Disease in Non-alcoholic Fatty Liver Disease.
Clin Gastroenterol Hepatol2021 Sep;():. doi: S1542-3565(21)01035-1.
Kai Toh Jonathan Zhi, Pan Xin-Hui, Lin Tay Phoebe Wen, Ng Cheng Han, Yong Jie Ning, Xiao Jieling, Koh Jin Hean, Tan En Ying, Xuan Tan Eunice Xiang, Dan Yock Young, Loh Poay Huan, Foo Roger, Chew Nicholas Ws, Sanyal Arun J, Muthiah Mark D, Siddiqui Mohammad Shadab,
Abstract
BACKGROUND AND AIMS:
Cardiovascular disease remains the leading cause of death in patients with non-alcoholic fatty liver disease (NAFLD). Studies examining the association of coronary heart disease (CHD) and NAFLD are cofounded by various cardiometabolic factors particularly diabetes and body mass index. Hence, we seek to explore such association by investigating the global prevalence, independent risk factors and influence of steatosis grade on manifestation of CHD among patients with NAFLD.
METHODS:
Two databases, Embase and Medline, were utilised to search for articles relating to NAFLD and CHD. Data including but not limited to continent, diagnostic methods, baseline characteristics, prevalence of CHD, CHD severity, NAFLD severity, and risk factors were extracted.
RESULTS:
Of the 38 articles included, 14 reported prevalence of clinical coronary artery disease (CAD) and 24 subclinical CAD. The pooled prevalence of CHD was 44.6% (CI: 36.0% - 53.6%) among 67,070 NAFLD patients with an odds ratio of 1.33 (CI: 1.21% - 1.45%, p
CONCLUSION:
Steatosis was found to be related with CHD involvement, with moderate to severe steatosis related to clinical CAD. Early screening and prompt intervention for CHD in NAFLD are warranted for holistic care in NAFLD.
Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.
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Dose-dependent toxicological effects in rats following a 90-day dietary exposure to PCB-156 include retinoid disruption.
Reprod Toxicol2021 Sep;():. doi: S0890-6238(21)00149-0.
Vieira Silva A, Chu I, Feeley M, Bergman Å, Håkansson H, Öberg M,
Abstract
The toxicity of PCB-156 (2,3,3',4,4',5-hexachlorobiphenyl) was investigated in rats following subchronic dietary exposure. Groups of 10 male and female Sprague-Dawley rats were administered PCB-156 in the diet at 0, 0.01, 0.1, 1 or 10?ppm for 90 days. Dose-dependent increases were detected for the liver, lung and kidney weights, as well as for the liver EROD, PROD and UDPGT enzyme activities and liver uroporphyrin concentration. Dose-dependent decreases were observed in final body weight, body weight gain, and thymus weight. Apolar retinoid concentrations were decreased in the liver and lungs and increased in the kidneys. Histopathological examination of the liver, thyroid, and thymus showed mild to moderate dose-related changes. A LOAEL of 0.01?ppm was established, based on reduced apolar liver retinoid concentration. Benchmark dose-modelling corroborated the sensitivity of liver retinoid endpoints. The lower confidence limits (BMDL) for a 5% decrease in apolar liver retinoid concentrations were 0.0009 and 0.0007?ppm, respectively, in males and females, corresponding to a daily dose of 0.06?µg PCB-156 per kg body weight. Organizing dose-response data for the individual hepatic endpoints along the PCB-156 dosing scale revealed a sequence of events compatible with a causal link between depletion of apolar retinoids and the other liver biochemistry and pathology findings. Taken together, data suggest that the retinoid endpoints should be further evaluated for a causal relationship to PCB-induced liver toxicity and that retinoid system endpoints are identified and characterized to support health risk assessment in the emerging research fields of endocrine disruption and mixture toxicology.
Copyright © 2021. Published by Elsevier Inc.
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Commentary on Controversy and Debate 4 paper series: Questionable utility of the relative risk in clinical research.
J Clin Epidemiol -
A Systematic Review and Meta-analysis of the Incidence of Acute Aortic Dissections in Population-Based Studies.
J Vasc Surg2021 Sep;():. doi: S0741-5214(21)02132-7.
Gouveia E Melo Ryan, Mourão Mariana, Caldeira Daniel, Alves Mariana, Lopes Alice, Duarte António, Fernandes E Fernandes Ruy, Mendes Pedro Luís,
Abstract
OBJECTIVE:
To perform a systematic-review and meta-analysis of all population-based studies reporting on incidence of acute aortic dissections.
METHODS:
We searched MEDLINE, EMBASE, CENTRAL and Open Grey databases from inception to August 2020 for population-based studies reporting on the incidence of AAD. A systematic review was conducted following the PRISMA guidelines using a registered protocol (CRD42020204007). Data was pooled using a random-effects model of proportions using Freeman-Tukey double arcsine transformation. The main outcome was the incidence of AAD. Secondary outcomes were incidence type A aortic dissections (TAAD) and type B aortic dissections (TBAD); incidence of aortic dissection repair and medical management and incidence of in-hospital mortality. In addition, we estimated the proportion of aortic dissection repair and mortality (in hospital, overall and specific mortality according to sub-type) among patients with AAD.
RESULTS:
Thirty-three studies were included. The pooled incidence of AADs was 4.8 per 100 000 individuals/year (95%CI: 3.6; 6.1). Incidence of TAAD was 3.0 per 100 000/year (95%CI: 1.8; 4.4) and incidence of TBAD was 1.6 per 100 000/year (95%CI: 1.1; 2.2). The incidence of AAD needing repair was 1.4 per 100 000/year (95%CI: 1.0; 2.0) [1.4 (95%CI: 1.2; 1.7) for TAAD and 0.4 (95%CI: 0.2; 0.7) for TBAD]. Incidence of medically managed AAD was 3.4 per 100 000/year (95%CI: 2.4; 4.5). Incidence of in-hospital death due to AAD was 1.3 per 100 000 individuals/year (95%CI: 0.9; 1.9); 1.0 (95%CI: 0.6; 1.4; I97%) for TAAD and 0.3 for TBAD (95%CI: 0.2; 0.4; I96%).
CONCLUSION:
A global estimate regarding the incidence rate of acute aortic dissections was achieved. Incidence of acute aortic dissection varied significantly between study designs and geographical regions. More accurate information on acute aortic dissection epidemiology is crucial for public-health decisions, clinical understanding, and healthcare management.
Copyright © 2021. Published by Elsevier Inc.
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Morbidity and Mortality Associated with Open Repair of Visceral Aneurysms.
J Vasc Surg2021 Sep;():. doi: S0741-5214(21)02131-5.
DeCarlo Charles, Mohebali Jahan, Dua Anahita, Conrad Mark F, Mohapatra Abhisekh,
Abstract
BACKGROUND:
The Society for Vascular Surgery (SVS) recently published clinical practice guidelines on the management of visceral aneurysms. However, studies investigating perioperative outcomes of open repair of visceral aneurysms have been limited to single-center experiences with variable results that span multiple decades. This study sought to detail the morbidity and mortality associated with open repair of visceral aneurysms using a national database in the contemporary era.
METHODS:
National Surgical Quality Improvement Program data, years 2013-2019, were queried for patients who underwent open repair of visceral aneurysms, which were classified as mesenteric, renal, or splenic by Current Procedural Terminology and International Classification of Diseases codes. The primary endpoint was the composite of major complication (cardiovascular, pulmonary, progressive renal failure, deep wound infection, return to OR, sepsis) and 30-day mortality. Logistic regression was used to identify predictors of the primary endpoint for nonruptured aneurysm cases.
RESULTS:
There were 263 nonruptured aneurysms (137 mesenteric, 66 renal, and 60 splenic) and 41 ruptured aneurysms (24 mesenteric, 1 renal, and 16 splenic) that underwent open repair. For nonruptured aneurysms, mean age was 59.4±14.7 years and 48.3% were female. In nonruptured cases, the 30-day mortality was 1.9% and major complication rate was 12.9%; return to OR (5.3%) and prolonged ventilator support (3.8%) were particularly common. As expected, rupture was associated with significantly higher mortality (22.0%, P
CONCLUSION:
Open repair of visceral aneurysms is associated with acceptable morbidity and mortality, and these risks are significantly greater once ruptured. Male sex, bleeding risk, and low albumin are all risk factors for adverse events and should be taken into consideration for operative planning and postoperative care.
Copyright © 2021. Published by Elsevier Inc.
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Insight into Shenqi Jiangtang Granule on the improved insulin sensitivity by integrating in silico and in vivo approaches.
J Ethnopharmacol2021 Sep;():114672. doi: S0378-8741(21)00901-6.
Shi Shulong, Sun Mingliang, Liu Yaping, Jiang Jiajia, Li Feng,
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE:
Presently, insulin resistance has been a growing concern that urgently needs to be addressed, because it not only places patients at risk of developing type 2 diabetes mellitus but also results in metabolic syndrome and different aspects of cardiovascular diseases. Shenqi Jiangtang Granule (SJG) is a classic traditional Chinese medicine (TCM) prescription that is widely used to treat diabetes mellitus and its complications in clinical practice. While studies have revealed that SJG with multi-ingredients and multi-targets characteristics possesses potential anti-insulin resistance pharmacological properties, its mechanisms of action and molecular targets for the treatment of insulin resistance are still obscure, which prompt us to conduct an in-depth research.
AIM OF THE STUDY:
This study was purposed to uncover the pharmacological mechanism of SJG against insulin resistance through integrating network pharmacology and experimental validation.
MATERIALS AND METHODS:
The putative ingredients of SJG and its related targets were discerned from the TCMSP database. Subsequently, insulin resistance-associated targets were retrieved from GeneCard, OMIM, and GEO database. Compound-target, protein-protein interaction (PPI), and compound-target-pathway networks were established using Cytoscape software. GO and KEGG pathway analyses were performed to identify possible enrichment of genes with specific biological themes. Molecular docking was used to verify the correlation between the main active ingredients and hub targets. Optimal docking conformation was further analyzed by molecular dynamics (MD) simulation. Finally, the potential molecular mechanisms of SJG acting on insulin resistance, as predicted by the network pharmacology analyses, were validated experimentally in insulin-resistant rat model.
RESULTS:
136 active compounds, 211 corresponding targets in addition to 1463 disease-related targets were collected, of which 94 intersection targets were obtained. 29 key targets including AKT1, VEGFA, IL-6, CASP3, and PTGS2 were identified through PPI network analysis. Hub module of PPI network was closely associated with inflammation. GO and KEGG analyses also revealed that inflammation-related pathways may be a central factor for SJG to modulate insulin resistance. Molecular docking test showed a good binding potency between primary active ingredients and core targets, and the binding mode of optimal docking conformation was stable in MD simulation. A rat model of insulin resistance was successfully induced by chronic high-fat diet (HFD) consumption. Through a series of in vivo studies, including HEC, ITT, and HOMA-IR measurement, it was revealed that SJG exhibited a beneficial effect on ameliorating insulin resistance, as demonstrated by a significant increase of GIR and a significant decrease of AUC and HOMA-IR index value. Further molecular biological analysis showed that SJG can decrease the mRNA expression level and serum concentration of inflammatory cytokines (TNF-?, IL-6, and IL-1?), along with suppressing the p-NF?B protein overexpression, indicating its anti-inflammatory activity. Also, it can contribute to the reversal of the impaired hepatic insulin signaling pathway, as evidenced by up-regulated protein expression of p-Akt and GLUT2.
CONCLUSIONS:
Through in silico and in vivo approaches, the present study not only provides a unique insight into the possible mechanism of SJG in insulin resistance after successfully filtering out associated key target genes and signaling pathways, but also suggests a novel promising therapeutic strategy for curing insulin resistance.
Copyright © 2021. Published by Elsevier B.V.
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