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Pubblicazioni recenti - cardiovascular disease
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Differential Effects of Various Androgens on Polycystic Ovary Syndrome.
Horm Metab Res2021 Apr;():. doi: 10.1055/a-1422-3243.
de Medeiros Sebastião Freitas, Barbosa Bruna Barcelo, de Medeiros Ana Karine Lin Winck Yamamoto, de Medeiros Matheus Antônio Souto, Yamamoto Márcia Marly Winck,
Abstract
The hyperandrogenism in polycystic ovary syndrome (PCOS) is associated with the risk for the future development of the cardiovascular disease. The objective of the study is to verify whether different androgens have the same harmful effect. This cross-sectional study enrolled 823 women with PCOS: 627 (76.2%) with biochemical hyperandrogenism and 196 (23.8%) with normal androgen levels. The role of individual androgen was evaluated using univariate and multivariate logistic regression. In normoandrogenemic PCOS (NA-PCOS), free androgen index (FAI) predicted significant abnormality in visceral adipose index (VAI, OR=9.2, p=0.002) and dehydroepiandrosterone (DHEA) predicted against alteration in ?-cell function (OR=0.5, p=0.007). In hyperandrogenemic PCOS (HA-PCOS), FAI predicted derangements in waist triglyceride index (WTI), VAI, and lipid accumulation product (LAP) (OR ranging from 1.6 to 5.8, p<0.05). DHEA weakly predicted against VAI (OR 0.7, p=0.018), dehydroepiandrosterone sulfate (DHEAS) tended to predict against the conicity index (OR=0.7, p=0.037). After multiple regression, FAI retained significant strength to predict various anthropometric and metabolic abnormalities (OR ranging from 1.1 to 3.0, p<0.01), DHEA was kept as a protector factor against WTI, LAP, and VAI (OR ranging from 0.6 to 0.9; p<0.01) and DHEAS against the conicity index (OR=0.5, p<0.001). In conclusion, the free androgen index was the most powerful predictor of anthropometric and metabolic abnormalities of polycystic ovary syndrome. Conversely, DHEA and DHEAS demonstrated protective effects against disorders in some markers of obesity and abnormal metabolism.
Thieme. All rights reserved.
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Fibrinolysis in Acute and Chronic Cardiovascular Disease.
Semin Thromb Hemost2021 Apr;():. doi: 10.1055/s-0040-1718923.
Kietsiriroje Noppadol, Ariëns Robert A S, Ajjan Ramzi A,
Abstract
The formation of an obstructive thrombus within an artery remains a major cause of mortality and morbidity worldwide. Despite effective inhibition of platelet function by modern antiplatelet therapies, these agents fail to fully eliminate atherothrombotic risk. This may well be related to extensive vascular disease, beyond the protective abilities of the treatment agents used. However, recent evidence suggests that residual vascular risk in those treated with modern antiplatelet therapies is related, at least in part, to impaired fibrin clot lysis. In this review, we attempt to shed more light on the role of hypofibrinolysis in predisposition to arterial vascular events. We provide a brief overview of the coagulation system followed by addressing the role of impaired fibrin clot lysis in acute and chronic vascular conditions, including coronary artery, cerebrovascular, and peripheral vascular disease. We also discuss the role of combined anticoagulant and antiplatelet therapies to reduce the risk of arterial thrombotic events, addressing both efficacy and safety of such an approach. We conclude that impaired fibrin clot lysis appears to contribute to residual thrombosis risk in individuals with arterial disease on antiplatelet therapy, and targeting proteins in the fibrinolytic system represents a viable strategy to improve outcome in this population. Future work is required to refine the antithrombotic approach by modulating pathological abnormalities in the fibrinolytic system and tailoring therapy according to the need of each individual.
Thieme. All rights reserved.
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Validity of the 6-Minute Walk Test in Patients with End-Stage Lung Diseases Wearing an Oronasal Surgical Mask in Times of the COVID-19 Pandemic.
Respiration2021 Apr;():1-6. doi: 10.1159/000515606.
Just Isabell Anna, Schoenrath Felix, Passinger Philipp, Stein Julia, Kemper Dagmar, Knosalla Christoph, Falk Volkmar, Knierim Jan,
Abstract
BACKGROUND AND OBJECTIVES:
The 6-minute walk test (6MWT), as a clinical assessment tool for functional exercise capacity, is an integral component of lung allocation scores (LASs). In times of the coronavirus disease (COVID-19) pandemic, patients underwent 6MWTs wearing a surgical mask in ambulatory care. We investigated the impact of wearing a mask on 6-minute walk distances (6MWDs).
METHOD:
6MWDs of 64 patients with end-stage lung diseases wearing an oronasal surgical mask were retrospectively compared to previously investigated 6MWDs of the same cohort, in a pre-COVID-19 pandemic era, without wearing a mask. Four patients were excluded due to a primary vascular disease, 29 patients due to clinically unstable pulmonary functions, and 1 patient due to a psychiatric disorder.
RESULTS:
The median age of the patients included was 55 (46-58) years; 15 (48%) were male. Ten (32.2%) were on the Eurotransplant lung transplant waiting list with a median LAS of 34.3 (31.9-36.2). Twenty (64.5%) patients had chronic obstructive pulmonary diseases, 7 (22.6%) had interstitial lung diseases, and 4 (12.9%) had other end-stage lung diseases. The mean 6MWD without versus with wearing a mask was 306.9 (101.9) versus 305.7 (103.8) m, with a mean difference of -1.19 m (95% confidence interval -13.4 to 11.03). The observed difference is statistically equivalent to zero (p < 0.001). No significant differences in 6MWDs were observed between the clinical groups.
CONCLUSION:
Wearing an oronasal surgical mask did not affect the 6MWDs of patients with advanced lung diseases. Therefore, a masked 6MWT appears to provide a reliable examination of functional exercise capacity in this cohort.
© 2021 The Author(s) Published by S. Karger AG, Basel.
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Application of intravenous immunoglobulin (IVIG) to modulate inflammation in critical COVID-19 - A theoretical perspective.
Med Hypotheses2021 Apr;151():110592. doi: S0306-9877(21)00110-9.
Yaqinuddin Ahmed, Ambia Ayesha Rahman, Elgazzar Tasnim Atef, AlSaud Maha Bint Mishari, Kashir Junaid,
Abstract
COVID-19 is an airway disease that has affected ~125 million people worldwide, caused by a novel coronavirus termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), spread through respiratory droplets, direct contact, and aerosol transmission. Although most patients presenting with absent or mild symptoms recover completely, the highest morbidity and mortality rates are seen in the elderly, and patients with comorbidities such as cardiovascular diseases, cancer, immunosuppressive diseases, diabetes, and pre-existing respiratory illnesses. Several therapeutic strategies have been examined, but a wide-ranging therapeutic option for particularly severe cases of COVID-19 remains to be elucidated. Considering the indications presented by COVID-19 patients who present similarly with inflammatory conditions, intravenous immunoglobulin (IVIG) administration has been examined as a possible route to reduce proinflammatory markers such as ESR, CRP and ferritin by reducing inflammation, based on its anti-inflammatory effects as indicated by utilisation of IVIG for numerous other inflammatory conditions. Herein, summarising the recent key clinical evaluations of IVIG administration, we present our hypothesis that administration of IVIG within a specific dosage would be extremely beneficial towards reducing mortality and perhaps even the length of hospitalisation of patients exhibiting severe COVID-19 symptoms.
Copyright © 2021 Elsevier Ltd. All rights reserved.
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Association between long-term exposure to fine particulate matter and diabetic retinopathy among diabetic patients: A national cross-sectional study in China.
Environ Int2021 Apr;154():106568. doi: S0160-4120(21)00193-8.
Shan Anqi, Chen Xi, Yang Xueli, Yao Baoqun, Liang Fengchao, Yang Ze, Liu Fangchao, Chen Song, Yan Xiaochang, Huang Jianfeng, Bo Shaoye, Tang Nai-Jun, Gu Dongfeng, Yan Hua,
Abstract
BACKGROUND:
While the relationship between ambient air pollution and diabetes mellitus has recently been reported, data on the association between fine particulate matter (PM) and diabetic complications are limited, especially in microvascular diseases such as diabetic retinopathy.
OBJECTIVES:
To investigate the associations between long-term exposure to PM and the prevalence of diabetic retinopathy in adult diabetic patients in rural China.
METHODS:
The study population was based on the Rural Epidemiology for Glaucoma in China (REG-China), a national cross-sectional survey conducted in rural China. This analysis selected diabetic patients with or without diabetic retinopathy. A satellite-based spatiotemporal model was used to estimate personal PM exposure. Logistic regression models were used to investigate the effect of long-term PM exposure on diabetic retinopathy.
RESULTS:
The analysis included 3111 diabetic participants, 329 of whom were diagnosed with diabetic retinopathy. The median level of exposure to PM from 2000 to2016 was 59.9 ?g/m. For each 10 ?g/m increase in PM, the adjusted odds ratio (95% confidence interval) for diabetic retinopathy was 1.41 (1.27, 1.57). In subgroup analyses, the effect of PM on diabetic retinopathy was significantly stronger in participants who self-reported alcohol consumption.
CONCLUSION:
These findings suggest that long-term exposure to high PM was associated with the risk of diabetic retinopathy among diabetic patients in rural China.
Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.
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Preventing sepsis; how can artificial intelligence inform the clinical decision-making process? A systematic review.
Int J Med Inform2021 Apr;150():104457. doi: S1386-5056(21)00083-6.
Hassan Nehal, Slight Robert, Weiand Daniel, Vellinga Akke, Morgan Graham, Aboushareb Fathy, Slight Sarah P,
Abstract
BACKGROUND AND OBJECTIVES:
Sepsis is a life-threatening condition that is associated with increased mortality. Artificial intelligence tools can inform clinical decision making by flagging patients at risk of developing infection and subsequent sepsis. This systematic review aims to identify the optimal set of predictors used to train machine learning algorithms to predict the likelihood of an infection and subsequent sepsis.
METHODS:
This systematic review was registered in PROSPERO database (CRD42020158685). We conducted a systematic literature review across 3 large databases: Medline, Cumulative Index of Nursing and Allied Health Literature, and Embase. Quantitative primary research studies that focused on sepsis prediction associated with bacterial infection in adults in all care settings were eligible for inclusion.
RESULTS:
Seventeen articles met our inclusion criteria. We identified 194 predictors that were used to train machine learning algorithms, with 13 predictors used on average across all included studies. The most prevalent predictors included age, gender, smoking, alcohol intake, heart rate, blood pressure, lactate level, cardiovascular disease, endocrine disease, cancer, chronic kidney disease (eGFR<60 mL/min), white blood cell count, liver dysfunction, surgical approach (open or minimally invasive), and pre-operative haematocrit < 30 %. All included studies used artificial intelligence techniques, with average sensitivity 75.7 ± 17.88, and average specificity 63.08 ± 22.01.
CONCLUSION:
The type of predictors influenced the predictive power and predictive timeframe of the developed machine learning algorithm. Predicting the likelihood of sepsis through artificial intelligence can help concentrate finite resources to those patients who are most at risk. Future studies should focus on developing more sensitive and specific algorithms.
Copyright © 2021 Elsevier B.V. All rights reserved.
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Rapid, ultrasensitive and non-enzyme electrochemiluminescence detection of hydrogen peroxide in food based on the ssDNA/g-CN nanosheets hybrid.
Food Chem2021 Apr;357():129753. doi: S0308-8146(21)00759-7.
Liu Zhijun, Wang Li, Liu Pengfei, Zhao Kairen, Ye Shuying, Liang Guoxi,
Abstract
Hydrogen peroxide (HO) is usually used as a fungicide in food, it is carcinogenic, accelerates aging or inducing toxic effects such as cardiovascular disease. Herein, to meet the demand for effective and fast detection of HO in food, a novel non-enzymatic electrochemiluminescence (ECL) sensor based on single-stranded DNA (ssDNA)/g-CN nanosheets (NS) was established. The ssDNA/g-CN NS hybrid was prepared by simple mixing g-CN NS and ssDNA solution together. The prepared ssDNA/g-CN NS exhibited improved peroxidase-like activity and was modified on a glassy carbon electrode to catalyze the ECL reaction of luminol-HO to amplify the luminescence signal. Under the optimized conditions, the proposed sensor exhibits high sensitivity with a limit of detection (LOD) as low as 33 aM HO, which is much lower than the vast majority of reported methods. This method enables the reliable responding to HO from the milk samples within 1 min.
Copyright © 2021 Elsevier Ltd. All rights reserved.
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Polyphenols: Natural compounds with promising potential in treating polycystic ovary syndrome.
Reprod Biol2021 Apr;21(2):100500. doi: S1642-431X(21)00021-8.
Mihanfar Aynaz, Nouri Mohammad, Roshangar Leila, Khadem-Ansari Mohammad Hassan,
Abstract
Polyphenols are natural compounds used by plants as a defense system against various stresses. In recent years, the importance of these polyhydroxyphenols has extensively increased due to their potent cardioprotection, anti-carcinogenic, anti-oxidant, anti-apoptotic, and anti-inflammatory properties. Therefore, various studies have reported promising results from the studies investigating their efficacy as a therapeutic strategy in various disorders such as human malignancies, cardiovascular diseases, nervous system impairments, diabetes, metabolic syndrome, aging, and inflammation-associated disorders, as well as a polycystic ovarian syndrome (PCOS). Since oxidative stress, hormonal, metabolic, and endocrine disturbances have been shown to play a crucial role in the initiation/progression of PCOS, polyphenols are suggested to be an effective treatment for this disorder. Therefore, this study aimed to discuss the therapeutic potential of multiple polyphenols in PCOS.
Copyright © 2021. Published by Elsevier B.V.
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Adverse associations of sedentary behavior with cancer incidence and all-cause mortality: A prospective cohort study: Sedentary behavior, cancer and mortality.
J Sport Health Sci2021 Apr;():. doi: S2095-2546(21)00046-6.
Lin Yuan, Liu Qiong, Liu Fangchao, Huang Keyong, Li Jianxin, Yang Xueli, Wang Xinyan, Chen Jichun, Liu Xiaoqing, Cao Jie, Shen Chong, Yu Ling, Lu Fanghong, Wu Xianping, Zhao Liancheng, Li Ying, Hu Dongsheng, Lu Xiangfeng, Huang Jianfeng, Gu Dongfeng,
Abstract
BACKGROUND:
Inconsistent results have been reported in developed countries for relationships between sedentary behavior and cancer incidence and mortality, but evidence from the Chinese population is scarce. This study aimed to investigate such relationships in large Chinese population-based prospective cohorts and to explore the joint effect and interaction of sedentary behavior and moderate-to-vigorous physical activity (MVPA) on these relationships.
METHODS:
We included 95,319 Chinese adults without cancer from 3 large cohorts and assessed their sedentary behavior and physical activity with a unified questionnaire. Cancer incidence and mortality were confirmed by interviewing participants or their proxies and checking hospital records and death certificates. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) for cancer and mortality were estimated using Cox proportional hazards regression models.
RESULTS:
During 559,002 person-years of follow-up, 2388 cancer events, 1571 cancer deaths, and 4562 all-cause deaths were recorded. Sedentary behavior was associated with increased risk of developing cancer and deaths in a dose-response manner. The multivariable-adjusted HRs (95%CIs) were: HR?=?1.16, 95%CI: 1.01?1.33; HR?=?1.24, 95%CI: 1.04?1.48; and HR?=?1.15, 95%CI: 1.04?1.28 for cancer incidence, cancer mortality, and all-cause mortality, respectively, for those having ?10 h/day of sedentary time compared to those having <6 h/day of sedentary time. Sedentary populations (?10 h/day) developed cancer or died 4.09 and 2.79 years earlier, respectively, at the index age of 50 years. Failure to achieve the recommended level of MVPA may further aggravate the adverse associations, with the highest cancer and mortality risks being observed among participants with both ?10 h/day of sedentary time and <150 min/week of MVPA. Limitations of this study include the fact that physical activity information was obtained via questionnaire instead of objective measurement and that there were insufficient incident cases for the analysis of associations between sedentary behavior and site-specific cancers.
CONCLUSION:
Sedentary behavior was associated with an increased risk of cancer and all-cause mortality among Chinese adults, especially for those with ?10 h/day of sedentary time. It is necessary to reduce sedentary time, in addition to increasing MVPA levels, for the prevention of cancer and premature death.
Copyright © 2021. Production and hosting by Elsevier B.V.
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Association between coronary artery calcium score and stent expansion in percutaneous coronary intervention.
Int J Cardiol2021 Apr;():. doi: S0167-5273(21)00657-4.
Komaki Soichi, Ishii Masanobu, Ikebe Sou, Kaichi Ryota, Mori Takayuki, Marume Kyohei, Kurogi Kazumasa, Yamamoto Nobuyasu,
Abstract
BACKGROUND:
Measurement of the coronary artery calcification score using multidetector computed tomography (MDCT) is a useful noninvasive test for the diagnosis of coronary artery disease. However, whether pre-intervention assessment of the target vessel coronary artery calcification (TV-CAC) score is associated with stent expansion failure and future target lesion revascularization (TLR), remains unknown. This study aimed to determine the association between the TV-CAC score measured by MDCT and stent expansion rate in patients who underwent IVUS-guided PCI for stable angina.
METHODS:
We conducted a retrospective observational study including 135 consecutive patients (186 target lesions) who underwent MDCT and were scheduled for the first PCI. The patients were divided into 2 groups based on the median value of the TV-CAC score. The primary outcome was the stent expansion rate measured by IVUS after stent implantation. The secondary outcome was TLR within 1?year.
RESULTS:
Stent expansion rate was associated with the TV-CAC score (p?
CONCLUSIONS:
Our study demonstrates that pre-intervention assessment of TV-CAC using MDCT is a predictor of stent expansion. The TV-CAC score might predict the complexity and help in the PCI operative strategy.
Copyright © 2021. Published by Elsevier B.V.
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Identification of a novel presumed cardiac sarcoidosis category for patients at high risk of disease.
Int J Cardiol2021 Apr;():. doi: S0167-5273(21)00658-6.
Rosenbaum Andrew N, Kolluri Nikhil, Elwazir Mohamed Y, Kapa Suraj, Abou Ezzeddine Omar F, Bois John P, Chareonthaitawee Panithaya, Schmidt Tyler J, Cooper Leslie T,
Abstract
BACKGROUND:
Histologic evidence is required for a definitive diagnosis of cardiac sarcoidosis (CS) by published guidelines; however, the sporadic nature of the disease may produce false negative biopsy results, causing CS to be underdiagnosed. We sought to establish a clinical category of CS absent histologic findings.
METHODS:
Patients evaluated for CS were stratified into 3 groups: probable CS and definite CS based on Heart Rhythm Society (HRS) criteria and presumed CS, ie, patients without any histologic evidence of sarcoidosis, but with unexplained high-grade atrioventricular block or ventricular arrhythmia and findings suggestive of CS on either cardiac magnetic resonance imaging or positron emission tomography. The primary end point was hospitalization-free and overall survival at 10?years.
RESULTS:
A total of 383 patients were included in the study: 59, definite CS; 223, probable CS; and 101, presumed CS (62, isolated CS and 39, systemic CS). Compared with patients meeting HRS criteria for CS, patients with presumed CS had lower odds of New York Heart Association class III or IV symptoms (odds ratio [OR], 0.44 [95% CI, 0.23-0.83]; P?=?.01) but greater odds of previous ventricular tachycardia (OR, 2.4 [95% CI, 1.4-4.0]; P?=?.001) or history of resuscitated sudden cardiac arrest (OR, 2.9 [95% CI, 1.0-8.6]; P?=?.05). Hospitalization-free and overall survival were similar among groups (P?=?.51 and P?=?.71, respectively).
CONCLUSIONS:
Clinical categorization of patients with presumed CS identified a high-risk cohort comparable to patients with histologic evidence of disease, although caution should be exercised in reaching this diagnosis without paying due diligence to the differential diagnosis.
Copyright © 2021. Published by Elsevier B.V.
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Purification, characterization and anti-atherosclerotic effects of the polysaccharides from the fruiting body of Cordyceps militaris.
Int J Biol Macromol2021 Apr;():. doi: S0141-8130(21)00843-6.
Yang Xiaoqian, Lin Ping, Wang Jin, Liu Na, Yin Fan, Shen Nuo, Guo Shoudong,
Abstract
Hyperlipidemia is one major cause of atherosclerosis, which is a basic pathological change of cardiovascular diseases. Polysaccharide is a water-soluble component with lipid-lowering effects. In this study, alkaline-extracted polysaccharides were obtained from the fruiting body of C. militaris. Polysaccharides were purified via anion exchange and size exclusion chromatography. Their structural characteristics were investigated via chemical and spectroscopic methods. CM3I was mainly composed of ?4)?-D-Glcp(1???glycosyls and differed from starch due to the presence of ?4,6)?-D-Glcp(1???glycosyls. CM3II was characterized by its backbone, which was composed of ?4)-?-D-Manp(1???6)-?-D-Manp(1???6)-?-D-Manp(1???linked glycosyls, and especially the presence of O-methyl. Moreover, CM3II exhibited powerful anti-atherosclerotic effects via lowering plasma lipid levels in apolipoprotein E-deficient mice. The underlying mechanisms were attributed to its promoting effect on LXR? and inhibitory effect on SREBP-2. Collectively, CM3I and CM3II are different from the previously reported polysaccharides from C. militaris, and CM3II has a potential application in hypolipidemia and anti-atherosclerosis.
Copyright © 2018. Published by Elsevier B.V.
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Assessment of muscle-strengthening exercise in public health surveillance for adults: A systematic review.
Prev Med2021 Apr;():106566. doi: S0091-7435(21)00150-X.
Shakespear-Druery Jane, De Cocker Katrien, Biddle Stuart J H, Gavilán-Carrera Blanca, Segura-Jiménez Víctor, Bennie Jason,
Abstract
There is strong scientific evidence that muscle-strengthening exercise (i.e. use of weight machines, push-ups, sit-ups) is independently associated with a reduced risk of multiple chronic diseases (e.g. diabetes, hypertension, cardiovascular disease). However, prevalence rates for meeting the muscle-strengthening exercise guideline (?2 times/week) are significantly lower (~20%) than those reported to meet the aerobic physical activity guideline (e.g. walking, jogging, cycling) (~50%). It is therefore important to understand public health surveillance approaches to assess muscle-strengthening exercise. The aim of this review was to describe muscle-strengthening exercise assessment in public health surveillance. Informed by the PRISMA guidelines, an extensive keyword search was undertaken across 7 electronic data bases. We identified 86,672 possible articles and following screening (n?=?1140 in full-text) against specific inclusion criteria (adults aged ?18?years, English, studies containing <1000 participants), extracted data from 156 manuscripts. Fifty-eight different survey systems were identified across 17 countries. Muscle-strengthening exercise frequency (85.3%), duration (23.7%) and intensity (1.3%) were recorded. Muscle-strengthening exercise questions varied significantly, with some (11.5%) requiring a singular 'yes' vs 'no' response, while others (7.7%) sought specific details (e.g. muscle groups targeted). Assessments of duration and intensity were inconsistent. Very few studies measured the validity (0.6%) and reliability (1.3%) of muscle-strengthening exercise questions. Discrepancy exists within the current assessment systems/surveys used to assess muscle-strengthening exercise in public health surveillance. This is likely to impede efforts to identify at risk groups and trends within physical activity surveillance, and to accurately assess associations between muscle-strengthening exercise and health-related outcomes.
Copyright © 2021. Published by Elsevier Inc.
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A Mobile Health Intervention to Increase Physical Activity in Pulmonary Arterial Hypertension.
Chest2021 Apr;():. doi: S0012-3692(21)00699-1.
Hemnes Anna R, Silverman-Loyd Luke, Huang Shi, MacKinnon Grant, Annis Jeffrey, Whitmore Carolyn S, Mallugari Ravinder, Oggs Rashundra N, Hekmat Rezzan, Shan Rongzi, Huynh Pauline P, Yu Chang, Martin Seth S, Blaha Michael J, Brittain Evan L,
Abstract
BACKGROUND:
Supervised exercise training improves outcomes in patients with pulmonary arterial hypertension (PAH). The effect of an unsupervised activity intervention has not been tested.
RESEARCH QUESTION:
Can a text-based mobile health intervention increase step counts in patients with PAH?
STUDY DESIGN AND METHODS:
We performed a randomized, parallel arm, single-blind clinical trial. We randomized patients to usual care or a text message-based intervention for 12 weeks. The intervention arm received three automated text messages per day with real-time step count updates and encouraging messages rooted in behavioral change theory. Individual step targets increased by 20% every four weeks.
MEASUREMENTS:
The primary endpoint was mean Week 12 step counts. Secondary endpoints included the six minute walk test, quality of life, right ventricular function, and body composition.
RESULTS:
Among 42 randomized participants, the change in raw steps between baseline and Week 12 was higher in the intervention group (1409 steps (IQR -32, 2220) vs. -149 steps (IQR -1010, 735); p=0.02), which persisted after adjustment for age, sex, baseline step counts, and functional class (model estimated difference 1250 steps, P = 0.03). The intervention arm took a higher average number of steps on all days between days 9 to 84 (P <0.05 all days). There was no difference in Week 12 six minute walk distance. Analysis of secondary endpoints suggested improvements in the emPHasis-10 score (adjusted change -4.2, P =0.046), a reduction in visceral fat volume (adjusted change -170ml, p=0.023), and nearly significant improvement in tricuspid annular plane systolic excursion (Model estimated difference 1.2mm, P = 0.051).
INTERPRETATION:
This study demonstrated the feasibility of an automated text message-based intervention to increase physical activity in patients with PAH. Additional studies are warranted to examine the effect of the intervention on clinical outcomes.
Copyright © 2021. Published by Elsevier Inc.
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A pre-specified analysis of the DAPA-CKD trial indicates effects of dapagliflozin on major adverse kidney events in patients with IgA nephropathy.
Kidney Int2021 Apr;():. doi: S0085-2538(21)00396-3.
Wheeler David C, Toto Robert D, Stefansson Bergur V, Jongs Niels, Chertow Glenn M, Greene Tom, Hou Fan Fan, McMurray John J V, Pecoits-Filho Roberto, Correa-Rotter Ricardo, Rossing Peter, Sjöström C David, Umanath Kausik, Langkilde Anna Maria, Heerspink Hiddo J L, ,
Abstract
Immunoglobulin A (IgA) nephropathy is a common form of glomerulonephritis, which despite use of renin-angiotensin-aldosterone-system blockers and immunosuppressants, often progresses to kidney failure. In the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease trial, dapagliflozin reduced risk of kidney failure and prolonged survival in participants with chronic kidney disease with and without type 2 diabetes, including those with IgA nephropathy. Here we randomized participants with estimated glomerular filtration rate (eGFR) 25-75 mL/min/1.73m and urinary albumin-to-creatinine ratio 200-5000 mg/g (22.6-565 mg/mol) to dapagliflozin 10mg or placebo, as adjunct to standard care The primary composite endpoint was a sustained decline in eGFR of 50% or more, end-stage kidney disease, or death from a kidney disease-related or cardiovascular cause. Of 270 participants with IgA nephropathy (254 [94%] confirmed by previous biopsy), 137 were randomized to dapagliflozin and 133 to placebo, and followed for median 2.1 years. Overall, mean age was 51.2 years; mean eGFR, 43.8 mL/min/1.73m; and median urinary albumin-to-creatinine ratio, 900 mg/g. The primary outcome occurred in six (4%) participants on dapagliflozin and 20 (15%) on placebo (hazard ratio, 0.29; 95% confidence interval, 0.12, 0.73). Mean rates of eGFR decline with dapagliflozin and placebo were -3.5 and -4.7 mL/min/1.73m/year, respectively. Dapagliflozin reduced the urinary albumin-to-creatinine ratio by 26% relative to placebo. Adverse events leading to study drug discontinuation were similar with dapagliflozin and placebo. There were fewer serious adverse events with dapagliflozin. It had no new safety findings in this population. Thus, in participants with IgA nephropathy, dapagliflozin reduced the risk of chronic kidney disease progression with a favorable safety profile.
Copyright © 2021. Published by Elsevier Inc.
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SGLT-2 inhibition in IgA nephropathy: the new standard-of-care?
Kidney Int2021 Apr;():. doi: S0085-2538(21)00385-9.
Barratt Jonathan, Floege Jürgen,
Abstract
Despite supportive measures that slow the rate of progression of chronic kidney disease in IgA nephropathy (IgAN) many patients still progress to end stage kidney disease. Currently employed immunosuppressive strategies lack conclusive efficacy data, while there is evidence for treatment emergent toxicity. A subanalysis of the DAPA-CKD trial, which encompassed 270 patients with a diagnosis of IgAN, now provides early evidence that dapagliflozin may be a safe and effective addition to current standard of care in IgAN.
Copyright © 2021. Published by Elsevier Inc.
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Multi-walled carbon nanotube-based nanobiosensor for the detection of cadmium in water.
Environ Res2021 Apr;():111148. doi: S0013-9351(21)00442-4.
P Sreekanth S, Alodhayb Abdullah, Assaifan Abdulaziz K, Alzahrani Khalid Eidah, Ramamoorthy Muthumareeswaran, Alkhammash Hend I, Pandiaraj Saravanan, Alswieleh Abdullah M, Van Le Quyet, R Mangaiyarkarasi, Grace Andrews Nirmala, Raghavan Vimala,
Abstract
Industrial and agricultural processes have led to the prevalence of cadmium in the ecosystem. A successive build-up of cadmium in food and drinking water can result in inadvertent consumption of hazardous concentrations. Such environmental contamination of cadmium can pose a substantial threat to human and animal life. In humans, it is known to cause hypertension, cardiovascular diseases, DNA lesions, inhibition of DNA repair protein or disturb the functioning of lung, liver, prostate and kidney. The development of a reliable method for Cd (II) ions detection would reduce the exposure and complement existing conventional methods. In this study, a DNA based electrochemical method is employed for the detection of Cd (II) ions using ethyl green (EG) and multi-walled carbon nanotube (MWCNT). Glassy carbon electrode (GCE)/MWCNT forms the working electrode for differential pulse voltammetry (DPV) analysis for the detection of Cd (II) ions. The dsDNA is immobilized onto the working electrode. The indicator dye EG, preferably binds to ssDNA and its reduction peak current is noticeably less in the presence of dsDNA. The Cd (II) ions after interacting with dsDNA, unwinds the dsDNA to ssDNA, upon which the EG molecules bind to ssDNAs, giving a higher reduction peak current. The difference in the reduction peak currents in the presence and absence of Cd (II) ions is proportional to its concentration. The linear detection range achieved in this method is 2 nM to 10.0 nM with a sensitivity of around 5 nA nM and the limit of detection is 2 nM, which is less than the permissible limit of WHO for human exposure. This study considerably broadens the possible application of multi-walled carbon nanotube modified electrodes as biosensors and holds prospects for the detection of other heavy metals in environmental samples.
Copyright © 2021 Elsevier Inc. All rights reserved.
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Trends and Outcomes of Surgical Re-exploration Following Cardiac Operations in the United States.
Ann Thorac Surg2021 Apr;():. doi: S0003-4975(21)00703-7.
Tran Zachary, Williamson Catherine, Hadaya Joseph, Verma Arjun, Sanaiha Yas, Chervu Nikhil, Gandjian Matthew, Benharash Peyman,
Abstract
BACKGROUND:
Surgical re-exploration following cardiac surgery has been associated with increased in-hospital complications and mortality in limited series. The present study examined trends in reoperation and its impact on clinical outcomes and resource use in a nationally-representative cohort. We sought to determine patient and hospital factors associated with re-exploration and reoperative mortality, defined as failure-to-rescue-surgical (FTR-S).
METHODS:
Adult hospitalizations entailing cardiac operations (coronary artery bypass and/or valve) were identified using the 2005-2018 National Inpatient Sample. Procedures were tabulated using International Classification of Diseases codes. Hospitals were ranked into tertiles according to risk-adjusted mortality, with the lowest stratified as high-performing. Multivariable regression models examined factors associated with re-exploration as well as clinical outcomes including FTR-S and resource utilization.
RESULTS:
Of an estimated 3,490,245 hospitalizations, 78,003 (2.23%) required re-exploration with decreasing incidence over time. Valvular procedures, preoperative intra-aortic balloon pump and liver disease were associated with greater likelihood of re-exploration. Reoperation was associated with increased odds of mortality (adjusted odds ratio (AOR): 3.86, 95%CI: 3.61-4.12), perioperative complications and resource utilization. Increasing time from index operation to re-exploration was associated with higher odds of mortality (AOR:1.10/day, 95%CI: 1.07-1.12). High-performing hospitals were associated with lower odds of re-exploration (AOR: 0.88, 95%CI: 0.82-0.95) and FTR-S (AOR: 0.29, 95%CI: 0.23-0.35).
CONCLUSIONS:
Surgical re-exploration following cardiac surgery has declined over time. High performing hospitals demonstrated lower rates of re-exploration and subsequent failure-to-rescue. Although unable to identify specific practices, our study highlights the presence of significant variation in takeback rates and further study of underlying factors is warranted.
Copyright © 2021. Published by Elsevier Inc.
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The Association Between the Risk of Hypertensive Disorders of Pregnancy and Folic Acid: A Systematic Review and Meta-Analysis.
J Pharm Pharm Sci2021 ;24():174-190. doi: 10.18433/jpps31500.
Yu Yahui, Sun Ximu, Wang Xinrui, Feng Xin,
Abstract
PURPOSE:
Although folic acid (FA) supplementation has been shown to reduce general cardiovascular risks, its impact on hypertensive disorders of pregnancy (HDP) is unclear. We performed a systematic review and meta-analysis to clarify the association between FA and the risk of HDP (pre-eclampsia (PE) and gestational hypertension (GH)).
METHODS:
PubMed, EmBase, and Cochrane Library were searched up to June 18, 2020, stratified by type of disease, initiation time of FA, form of FA and pre-conception Body Mass Index (BMI). The quality assessment of included studies was evaluated using Newcastle-Ottawa Scale (NOS) for cohort studies and Cochrane Collaboration's Risk of Bias Assessment Tool for randomized controlled trials (RCTs). Between-study heterogeneity was quantified using Cochran's Q-statistic and I2 statistics. Sensitivity analysis was performed by excluding the studies one by one, and publication bias was analyzed using funnel plots.
RESULTS:
Twenty studies with 359041 patients were identified for inclusion in the meta-analysis which included 3 RCTs and 17 cohort studies. Pooled estimates showed RR of 0.83 (95%CI 0.74-0.93, P=0.0008) for association between low dose FA (LD-FA) and the risk of PE, but LD-FA was not associated with GH (RR 1.05, 95% CI 0.97-1.13, P=0.20). In addition, the results of subgroup analysis showed that post-conception LD-FA had a 31% decreased risk of PE (RR 0.69, 95% CI 0.59-0.80, P<0.00001), and LD-FA in patients with pre-conception BMI<25 kg/m2 had a 32% decreased risk of PE (RR 0.68, 95% CI 0.56-0.81, P<0.0001) Conclusions: LD-FA significantly decreased the risk of PE but not GH, and post-conception LD-FA and pre-conception BMI<25 kg/m2 were considered as protective factors to reduce the risk of PE.
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Polycystic ovary syndrome and reproductive health of women: a curious association.
Int J Adolesc Med Health2021 Apr;():. doi: 10.1515/ijamh-2021-0031.
Zehravi Mehrukh, Maqbool Mudasir, Ara Irfat,
Abstract
Reproductive health is a broad concept that encompasses mortality, morbidity, and quality of life associated with the reproductive system, mechanism, and incidents encountered at all ages by men and women. Orthodox Indian society finds the conversation on reproductive health to be a taboo and discourages open conversations about it. Polycystic ovary syndrome (PCOS) is a reproductive-age metabolic endocrine disorder found in females. Females suffering from PCOS are prone to reproductive, metabolic, and cardiovascular disorders. In this paper, we will systematically review about effect of PCOS on Reproductive Health of Women. The numerous electronic databases such as: BMJ, LANCET, PUBMED, Unicef Website, WHO Website and Google Scholar have been comprehensively searched for studies linked to PCOS, its various effects and effect on women's reproductive health. For additional analyses, we have reviewed reference lists of reviews and collected papers. The effects of PCOS on women's reproductive health have been verified by several scientific reports worldwide. PCOS is a hormonal condition, as per multiple reports, with the ability to lead to different outcomes. It still appears to be a common cause among females of infertility. An integral aspect of the treatment of this disease is the early diagnosis of long-term morbidities by effective screening tests. In the future, studies must concentrate on the missing holes in our growing perception of this disease. Several studies have confirmed that reproductive morbidity, including irregular uterine bleeding, abortion, miscarriage, and other risk of pregnancy during reproductive years, is associated with PCOS. PCOS is an amalgam of physiological and psychosocial dysfunction, not just an endocrine disorder.
© 2021 Walter de Gruyter GmbH, Berlin/Boston.
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