BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the c...BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.展开更多
This study examines hemodynamic behavior in particular cases of pulmonary hypertension without treatment. Pulmonary hypertension represents an anomalous hemodynamic state and is characterized by an excessively high bl...This study examines hemodynamic behavior in particular cases of pulmonary hypertension without treatment. Pulmonary hypertension represents an anomalous hemodynamic state and is characterized by an excessively high blood pressure in the pulmonary artery. To simulate the hemodynamic abnormalities in pulmonary hypertension under different causes and pathologies, we construct a localized parameter circuit model governed by nonlinear ordinary derivative equations of the human circulatory system. Thus, two special cases are considered, namely pulmonary the artery stenosis and the left ventricular diastolic dysfunction. For each case of pulmonary hypertension development, we determine the relationships between blood pressure and chamber and vessel pressure-volume. When the pulmonary hypertension is due to pulmonary artery stenosis, it appears that the right ventricular pressure increases up to 90 mm Hg, likewise the rise in pulmonary artery resistance induces direct increment in pulmonary artery pressure. However, when the pulmonary hypertension is due to left ventricular diastolic dysfunction, we note that the left atrial pressure and the pulmonary vein pressure augment, leading to the growth of the pulmonary artery blood pressure. The established results within this paper are useful for understanding the hemodynamic mechanism of particular pulmonary hypertension.展开更多
BACKGROUND Postpartum pulmonary arterial hypertension(PAH)complicated with hereditary hemorrhagic telangiectasia(HHT)is a rare condition.Diagnosing and treating PAH in patients with HHT can be challenging.To the best ...BACKGROUND Postpartum pulmonary arterial hypertension(PAH)complicated with hereditary hemorrhagic telangiectasia(HHT)is a rare condition.Diagnosing and treating PAH in patients with HHT can be challenging.To the best of our knowledge,no previous reports have investigated the efficacy of pulmonary vasodilators in improving hemodynamics in postpartum patients with this disease.CASE SUMMARY In this paper,we report a postpartum case of HHT combined with PAH,pre-senting with worsening dyspnea.Genetic testing revealed that the patient carried a heterozygous variant of activin receptor-like kinase 1.The patient received various treatments,including diuretics,anticoagulants,sildenafil,macitentan,inhalation of nitric oxide,and iloprost.Changes in PaO2/FiO2,pulmonary artery systolic pressure as assessed by echocardiography,and N-terminus pro-brain natriuretic peptide levels suggested that,except for iloprost inhalation,the other treatments appeared to have limited efficacy.CONCLUSION To our knowledge,this is the first report on efficacy of pulmonary vasodilators in postpartum patients with HHT and PAH.展开更多
Hypertension, often called the “silent killer”, is a major risk factor for heart attacks and strokes in the elderly. Its effective management is crucial to prevent damage to the heart, brain, and kidneys. Isolated s...Hypertension, often called the “silent killer”, is a major risk factor for heart attacks and strokes in the elderly. Its effective management is crucial to prevent damage to the heart, brain, and kidneys. Isolated systolic hypertension (ISH) is particularly critical in the elderly population. Cardiovascular risk factors, including pulse pressure and wave velocity, are closely associated with systolic blood pressure and influenced by arterial stiffness and wave reflections. Managing ISH is complex due to the potential negative effects of certain medications and individual variability in treatment response. This paper will address these issues, evaluating antihypertensive drugs, combination therapy, personalized treatment plans, and updated guidelines for managing ISH.展开更多
Pulmonary arterial hypertension(PAH)is a progressive disease marked by degeneration of the lung’s blood vessels.As the disease progresses,the resistance to blood flow in the pulmonary arteries increases,putting a str...Pulmonary arterial hypertension(PAH)is a progressive disease marked by degeneration of the lung’s blood vessels.As the disease progresses,the resistance to blood flow in the pulmonary arteries increases,putting a strain on the right side of the heart as it pumps blood through the lungs.PAH is characterized by changes in the structure of blood vessels and excessive cell growth.Untreated PAH leads to irreversible right-sided heart failure,often despite medical intervention.Patients experience a gradual decline in function until they are unable to perform daily activities.Advances in treatment have improved the prognosis for many PAH patients.Currently approved therapies target the prostacyclin,endothelin,nitric oxide,or phosphodiesterase pathways to slow the progression of the disease.To address the unmet need for effective PAH therapies,research efforts are focused on identifying new targets and developing therapies that specifically address the underlying disease mechanisms and restore vascular wall homeostasis.Among these,sotatercept,a fusion protein that targets the transforming growth factor-βsuperfamily signaling pathway,has emerged as a promising therapeutic option.In this review,we examine the available evidence from clinical trials to assess the potential of sotatercept as a treatment for PAH.展开更多
Background:Current guidelines for managing pulmonary arterial hypertension(PAH)recommend a risk strati-fication approach.However,the applicability and accuracy of these strategies for PAH associated with congenital he...Background:Current guidelines for managing pulmonary arterial hypertension(PAH)recommend a risk strati-fication approach.However,the applicability and accuracy of these strategies for PAH associated with congenital heart disease(PAH-CHD)require further validation.This study aims to validate the reliability and predictive accuracy of a simplified stratification strategy for PAH-CHD patients over a three-year follow-up.Additionally,new prognostic variables are identified and novel risk stratification methods are developed for assessing and managing PAH-CHD patients.Methods:This retrospective study included 126 PAH-CHD patients.Clinical and biochemical variables across risk groups were assessed using Kruskal-Wallis and Fisher’s exact tests.Indepen-dent risk factors were identified using ordered logistic regression,while Kaplan-Meier and Cox proportional hazards regression analyses evaluated their impact on all-cause mortality.A new stratification model for the PAH-CHD population was constructed based on these analyses.Results:Significant survival differences across stratified risk groups were observed(p<0.001),validating the effectiveness of the simplified risk stratification method in PAH-CHD patients.Prothrombin activity was a strong independent predictor of adverse outcomes of PAH-CHD patients(Hazard ratio 0.95,p<0.001,C-index 0.70).A model combining N-terminal pro-brain natriuretic peptide,prothrombin activity,albumin,and right atrial area achieved an area under the curve of 0.89 and a C-index of 0.85.Conclusions:The simplified risk stratification method is applicable to PAH-CHD patients.Prothrombin activity is a strong independent predictor of adverse outcomes.A comprehensive risk stratification approach,incorporating both established and novel biomarkers,enhances accessibility and offers predictive efficacy during follow-up for PAH-CHD patients,comparable to established models.展开更多
In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following tran...In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and treatment.By comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy group.The gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome therapies.Furthermore,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated PH.Despite these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal models.In conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.展开更多
Early onset of hypertension (HTN) raises the risk of cardiovascular disease (CVD), the leading cause of death in the U.S. For university students who do not follow healthy diets or lifestyles, high blood pressure (BP)...Early onset of hypertension (HTN) raises the risk of cardiovascular disease (CVD), the leading cause of death in the U.S. For university students who do not follow healthy diets or lifestyles, high blood pressure (BP) may be markedly prevalent. Researchers utilized a cross-sectional design to assess HTN prevalence and its risk factors among college students (N = 123). Self-administered surveys comprising four validated questionnaires: the Perceived Stress Scale (PSS), Rapid Eating Assessment for Participants-Shortened (REAPS), Dietary Approaches to Stop Hypertension Quality (DASH-Q), and the U.S. Adult Food Security Survey (FSS) were employed. Additionally, physical measurements were conducted, including height, weight, waist circumference (WC), and BP. Results indicated that 71.6% of students had elevated BP, with 24.4% classified as Stage 1 HTN and 23.6% as Stage 2 HTN. Notably, 60% of students reported low adherence to the DASH diet and a mean REAPS score of 26.3 out of 39. Students experiencing marginal food security had higher systolic blood pressure (SBP) 131.7 ± 16.8 mm Hg compared to those with high food security 123.03 ± 11.7 mm Hg (p = 0.028). Furthermore, REAPS scores showed a negative correlation with diastolic blood pressure (DBP) (β = −0.201, p = 0.03). Significant predictors for SBP included WC (β = 0.40, p β = −0.33, p β = 0.16, p = 0.046). The findings highlight the need for BP screenings and nutrition education programs to improve dietary habits among college students, which may help reduce HTN and its associated long-term risks for CVD.展开更多
Diabetes mellitus and hypertension are two of the most prevalent diseases affecting individuals across all age groups. Both conditions are linked to an increased risk of heart disease, peripheral vascular disease, str...Diabetes mellitus and hypertension are two of the most prevalent diseases affecting individuals across all age groups. Both conditions are linked to an increased risk of heart disease, peripheral vascular disease, stroke, retinopathy, and neuropathy. The study highlights that diabetes damages arteries and blood vessels, elevating the risk of heart attack and kidney failure. The coexistence of diabetes and hypertension exacerbates these complications, underscoring the importance of managing both conditions simultaneously. The study also focuses on Metformin, a well-established medication for treating type 2 diabetes. Recognized as one of the most effective treatment options, Metformin enhances blood glucose management by increasing insulin sensitivity, reducing insulin levels, and improving insulin action. This makes it a crucial drug for controlling diabetes efficiently and effectively. Furthermore, the findings indicate that diabetes predominantly affects individuals in low- and middle-income countries, contributing to higher mortality rates. The analysis of peer-reviewed journals and articles suggests that diabetes is a chronic disease with severe implications if preventive measures are not promptly implemented. Immediate action is necessary to mitigate the impact of diabetes and improve global health outcomes.展开更多
Background: Lumboperitoneal (LP) shunts have been used to manage benign intracranial hypertension (BIH) for an extended period. While they may swiftly and effectively alleviate symptoms, their application is accompani...Background: Lumboperitoneal (LP) shunts have been used to manage benign intracranial hypertension (BIH) for an extended period. While they may swiftly and effectively alleviate symptoms, their application is accompanied by potential complications. Objectives: This research aimed to retrospectively analyze the difficulties and complications related to LP shunt implantation. Methods: We conducted a retrospective analysis of the records of 47 patients who had LP shunt placement for the treatment of BIH at our hospital throughout the research period. A thorough history and physical examination were conducted in every case. All patients were asked about age, gender, body mass index, neurological history, and oral contraceptive usage. Post-operative complications, clinical and ophthalmological follow-up occurred at 1, 3, and 6 months post-op. Results: Patients were mostly women (93.6%). The mean age of the patients was 35, and 80.9 percent had BMIs exceeding 25. Many female patients (40.9%) used oral contraceptives. Nearly all patients (93.6%) reported decreased vision, and 87.2% suffered headaches. The most common issue was shunt obstruction (51%), followed by low tension headaches (63.8%). The peritoneal side (10.6%) had higher shunt slippage than the thecal (2.1%). Superficial infections and radiculopathy affected 10.6% of patients, whereas CNS infections, arachnoiditis, and shunt failure affected just 2.1%. Five patients (10.6%) had Chiari malformation, and 60% had syringomyelia. Conclusion: Using LP shunts to treat BIH seems to be a method devoid of major risks despite the high revision rates. At the same time, more severe complications such as CNS infections, arachnoiditis, and shunt failure were less common.展开更多
Hypertension high blood pressure (HTN) and diabetes Type 2 diabetes mellitus (T2DM) are noncommunicable diseases (NCDs) growing in sub-Saharan Africa, under the effect of urbanization, changes in socio-economic and li...Hypertension high blood pressure (HTN) and diabetes Type 2 diabetes mellitus (T2DM) are noncommunicable diseases (NCDs) growing in sub-Saharan Africa, under the effect of urbanization, changes in socio-economic and lifestyle-related factors. This study aimed to assess the prevalence of these conditions in the urban commune of Dubréka, in Guinea, and to assess the role of demographic and cultural factors in their incidence and management. A cross-sectional study was conducted with 287 participants (174 women and 113 men) in Dubréka. Data were summer collected on the characteristics of sociodemographics, BMI, blood pressure and fasting blood glucose. The prevalence of hypertension and diabetes was determined, and participants’ knowledge and treatment practices were assessed in the summer. The prevalence of hypertension in the study population was 73.52%, affecting both sexes, with women presenting a higher prevalence. The prevalence of diabetes is slightly higher (75.29%) than that of men (70.79%) was 36.59%, with men (38.05%) being slightly more affected than women (35.63%). Obesity and overweight were contributory important factors, affecting respectively 25.78% and 37.28% of the population. Among the hypertensive people, 84.83% were aware of their condition, but only 7.26% received treatment, with no case-controlled hypertension having no summer observed. Socio-economic factors, including the urban setting and proximity to the capital, have probably contributed to these results. The high prevalence of hypertension and diabetes in Dubréka reflects the broader epidemiological transition in sub-Saharan Africa, with women being disproportionately affected by hypertension linked to obesity. Access limited to health care, especially in terms of treatment and care, further aggravates the burden of these diseases. Public health interventions are urgently needed to improve awareness, treatment accessibility and culturally appropriate management strategies adapted to fight against the growing burden of NCDs in Guinea peri-urban.展开更多
Chronic thromboembolic pulmonary hypertension(CTEPH)is a chronic,progressive,debilitating,and life-threa-tening complication of pulmonary embolism(PE).Recent technological advances have permitted various treat-ment op...Chronic thromboembolic pulmonary hypertension(CTEPH)is a chronic,progressive,debilitating,and life-threa-tening complication of pulmonary embolism(PE).Recent technological advances have permitted various treat-ment options for the treatment of CTEPH,including surgery,angioplasty,and medical treatment,depending on the location and characteristics of lesions.Pulmonary endarterectomy(PEA)is the treatment of choice for CTEPH,as it offers excellent long-term outcomes and a high probability of recovery.Moreover,various medical and interventional therapies are currently being developed for patients with inoperable CTEPH.This review mainly summarizes the current treatment approaches of CTEPH,offering more options for specialist physicians to,thus,better manage chronic thromboembolic syndromes.展开更多
Down syndrome is the most common chromosomal abnormality encountered in clinical practice with 50%of them having associated congenital heart disease(CHD).Shunt lesions account for around 75%of all CHDs in Down syndrom...Down syndrome is the most common chromosomal abnormality encountered in clinical practice with 50%of them having associated congenital heart disease(CHD).Shunt lesions account for around 75%of all CHDs in Down syndrome.Down syndrome patients,especially with large shunts are particularly predisposed to early development of severe pulmonary hypertension(PH)compared with shunt lesions in general population.This necessitates timely surgical correction which remains the only viable option to prevent long term morbidity and mortality.However,despite clear recommendations,there is wide gap between actual practice and fear of underlying PH which often leads to surgical refusals in Down syndrome even when the shunt is reversible.Another peculiarity is that Down syndrome patients can develop PH even after successful correction of shunt.It is not uncommon to come across Down syndrome patients with uncorrected shunts in adulthood with irreversible PH at which stage intracardiac repair is contraindicated and the only option available is a combined heartlung transplant.However,despite the guidelines laid by authorities,the rates of cardiac transplant in adult Down syndrome remain dismal largely attributable to the high prevalence of intellectual disability in them.The index case presents a real-world scenario highlighting the impact of severe PH on treatment strategies and discrimination driven by the fear of worse outcomes in these patients.展开更多
A particular type of endogenous noncoding RNAs known as circular RNAs(circRNAs)has now become possible biomarkers for several diseases because of their stability and tissue-specific expression patterns.CircRNAs might p...A particular type of endogenous noncoding RNAs known as circular RNAs(circRNAs)has now become possible biomarkers for several diseases because of their stability and tissue-specific expression patterns.CircRNAs might play a role in various of biological processes.The identification of particular circRNAs dysregulated in pulmonary arterial hypertension(PAH)raises the possibility of these molecules serving as biomarkers for the disease’s early diagnosis and treatment.This review mainly summarizes the role and potential of circRNA as a future biomarker in PAH related to congenital heart disease.This study presented several potential circRNA targets as diagnostic biomarkers for PAH,discussed their biological functions,and addressed the challenges that need to be considered for their application in clinical settings.展开更多
Background:Mufangji tang(MFJT)is composed of Ramulus Cinnamomi,Radix Ginseng,Cocculus orbiculatus(Linn.)DC.,and Gypsum.In clinical settings,MFJT has been effectively employed in addressing a range of respiratory disor...Background:Mufangji tang(MFJT)is composed of Ramulus Cinnamomi,Radix Ginseng,Cocculus orbiculatus(Linn.)DC.,and Gypsum.In clinical settings,MFJT has been effectively employed in addressing a range of respiratory disorders,notably including pulmonary arterial hypertension(PAH).However,the mechanism of action of MFJT on PAH remains unknown.Methods:In this study,a monocrotaline-induced PAH rat model was established and treated with MFJT.The therapeutic effects of MFJT on PAH rat model were evaluated.Network pharmacology was conducted to screen the possible targets for MFJT on PAH,and the molecular docking between the main active components and the core targets was carried out.The key targets identified from network pharmacology were tested.Results:Results showed significant therapeutic effects of MFJT on PAH rat model.Analysis of network pharmacology revealed several potential targets related to apoptosis,inflammation,oxidative stress,and vascular remodeling.Molecular docking showed that the key components were well docked with the core targets.Further experimental validation results that MFJT treatment induced apoptosis(downregulated Bcl-2 levels and upregulated Bax levels in lung tissue),inhibited inflammatory response and oxdative stress(decreased the levels of IL-1β,TNF-α,inducible NOS,and malondialdehyde,and increased the levels of endothelial nitric oxide synthase,nitric oxide,glutathione and superoxide dismutase),reduced the proliferation of pulmonary arterial smooth muscle cells(downregulated ET-1 andβ-catenin levels and ERK1/2 phosphorylation,increased GSK3βlevels).Conclusion:Our study revealed MFJT treatment could alleviate PAH in rats via induction of apoptosis,inhibition of inflammation and oxidative stress,and the prevention of vascular remodeling.展开更多
BACKGROUND Pulmonary hypertension is a serious complication in the treatment of maintenance hemodialysis patients,which seriously affects the quality of life of patients and threatens their life safety.Prevention,trea...BACKGROUND Pulmonary hypertension is a serious complication in the treatment of maintenance hemodialysis patients,which seriously affects the quality of life of patients and threatens their life safety.Prevention,treatment and improvement of pulmonary hypertension are of great significance to improve the quality of life of patients.AIM To investigate the intervention and control of pedal-powered bicycle in maintaining quality of life and pulmonary hypertension in hemodialysis patients.METHODS 73 patients with maintenance hemadialysis combined with pulmonary arterial hypertension at a hemodialysis center in a certain hospital from May 2021 to May 2022 are selected.Patients are divided into two groups,37 cases in the control group(group C)and 36 cases in the intervention group(group I).Patients are divided into two groups,group C is treated with oral administration of betaglandin sodium combined with routine nursing care.Based on group C,group I conducts power cycling exercises.RESULTS After treatment,group I patients had higher muscle strength,36-Item Short Form Health Survey scores,and Kidney Disease Targets Areas scores;The 6-minute walk distance test index level was higher and the Borg score was lower;The group I had lower systolic blood pressure,greater vital capacity,higher positive emotion,lower systolic pulmonary artery pressure index level,higher arterial partial oxygen pressure level,lower pulmonary vascular resistance index level,and higher blood oxygen saturation level[158.91±11.89 vs 152.56±12.81,1795.01±603.18 vs 1907.20±574.15,24.00(22.00,29.00)vs 24.00(22.00,28.00),P<0.001].CONCLUSION Aerobic exercise combined with Western medicine treatment can effectively improve patients'pulmonary hypertension,alleviate their negative emotions,and enable them to achieve a higher level of quality of life.展开更多
BACKGROUND Timely and accurate evaluation of the patient's pulmonary arterial pressure(PAP)is of great significance for the treatment of congenital heart disease.Currently,there is no non-invasive gold standard me...BACKGROUND Timely and accurate evaluation of the patient's pulmonary arterial pressure(PAP)is of great significance for the treatment of congenital heart disease.Currently,there is no non-invasive gold standard method for evaluating PAP.AIM To assess the prognostic value of lipocalin-2(LCN2)in relation to PAP in patients with congenital heart disease associated with pulmonary artery hypertension.METHODS We conducted a retrospective analysis of 69 pediatric patients diagnosed with ventricular septal defects.The patients’clinical and laboratory data were collected.The serum LCN2 concentrations were compared between the pulmonary arterial hypertension(PAH)group and the nonPAH group.The correlation of LCN2 concentration with PAH classification was evaluated using binary logistic regression analysis.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic potential of LCN2 for PAH.RESULTS Serum LCN2 concentration significantly correlated with patients’mean PAP(r=0.544,P<0.001),but not correlated with creatinine(P=0.446)or blood urea nitrogen(P=0.747).LCN2 levels were significantly correlated with PAH in both univariate[odds ratio(OR)1.107,95%CI:1.033-1.185,P=0.004)]and multivariate regression analysis(OR 1.150,95%CI:1.027-1.288,P=0.015).ROC curve analysis revealed an area under the curve of 0.783 for LCN2.At the cutoff value of 19.42 ng/mL,the sensitivity and specificity of LCN2 for diagnosing PAH is 90.19%and 55.56%,respectively.LCN2 concentration also significantly correlated with the post-repair mean PAP in patients with congenital heart disease(r=0.532,P=0.009).CONCLUSION LCN2 is emerging as a candidate biomarker for assessing PAP in patients with congenital heart disease.Its high sensitivity in diagnosing PAH makes it a valuable tool in patient management.展开更多
BACKGROUND Liver transplantation(LTx)is vital in patients with end-stage liver disease,with metabolic dysfunction-associated steatotic liver disease being the most common indication.Primary sclerosing cholangitis(PSC)...BACKGROUND Liver transplantation(LTx)is vital in patients with end-stage liver disease,with metabolic dysfunction-associated steatotic liver disease being the most common indication.Primary sclerosing cholangitis(PSC)is an important indication.Portopulmonary hypertension,associated with portal hypertension,poses a significant perioperative risk,making pretransplant screening essential.CASE SUMMARY We report the case of a 41-year-old woman with PSC who developed severe pul-monary hypertension years after a successful LTx.She presented with worsening dyspnea on exertion and presyncope.Diagnostic evaluation confirmed severe precapillary pulmonary hypertension without evidence of recurrent portal hy-pertension.Initial management with Sildenafil and Macitentan led to a significant improvement in her symptoms,exercise capacity,and biomarkers.This case highlights the rare development of de novo pulmonary hypertension in a liver transplant recipient without recurrent portal hypertension,possibly linked to autoimmune processes or primary liver disease itself.The patient’s positive re-sponse to the combination therapy underscores the importance of prompt diag-nosis and aggressive management.CONCLUSION In conclusion,pulmonary arterial hypertension post-LTx is a rare but serious complication with a poor prognosis,necessitating further research to better understand its mechanisms and to develop effective strategies for prevention and treatment.展开更多
Objective:To systematically evaluate the effectiveness of mobile health(mHealth)interventions on self-management and blood pressure(BP)control in patients with hypertension and to provide recommendations for the clini...Objective:To systematically evaluate the effectiveness of mobile health(mHealth)interventions on self-management and blood pressure(BP)control in patients with hypertension and to provide recommendations for the clinic and future research.Methods:Databases including Embase,Cochrane Library,CINAHL,CNKI,SinoMed,Wanfang,and Weipu were searched to collect systematic reviews(SRs)and meta-analyses on mHealth interventions for hypertension management.Two researchers independently screened the articles and extracted data,and the Assessment of Multiple Systematic Reviews(AMSTAR 2)was used to evaluate the methodological quality of the included reviews.Results:A total of 11 SRs were included:1 review was rated as high quality,3 as low quality,and 7 as critically low quality.The mobile phone was the most common intervention type,followed by the internet.Seven reviews performed meta-analyses and showed that mHealth was associated with a significant reduction in systolic blood pressure(SBP),from 2.28 mmHg(95%CI-3.90 to-0.66;I^(2)=40%)to 14.77 mmHg(95%CI 11.76-17.77;I^(2)=89.7%),and diastolic blood pressure(DBP),from 1.50 mmHg(95%CI-2.20 to-0.08;I^(2)=62%)to 8.17 mmHg(95%CI 5.67-10.67;I^(2)=86%).Self-management behaviors included medication adherence(MA),diet,smoking,alcohol drinking,physical activity,and BP monitoring.There were inconsistent results on the effectiveness of mHealth interventions.Conclusions:mHealth interventions can improve BP control,MA,diet,and smoking in patients with hypertension,but the evidence for the efficacy of mHealth on physical activity and alcohol drinking improvement is limited.The methodological quality of existing SRs on the management of BP in patients with hypertension was relatively low,and more well-designed SRs or meta-analyses were needed to provide more evidence.mHealth interventions are useful for improving BP control of patients with hypertension.展开更多
Objective:To analyze the characteristics of ambulatory blood pressure in elderly patients with hypertension and find out the risk factors of abnormal circadian rhythm.Methods:According to the circadian rhythm of patie...Objective:To analyze the characteristics of ambulatory blood pressure in elderly patients with hypertension and find out the risk factors of abnormal circadian rhythm.Methods:According to the circadian rhythm of patients'blood pressure,they were divided into Group A,Group B and Group C,and all the data of hypertension patients in this study were collected,including age,gender,BMI,smoking,drinking,basic diseases(diabetes,cerebrovascular disease,hyperlipidemia,etc.),fasting blood glucose,ambulatory blood pressure(24-hour mean systolic pressure,24-hour mean diastolic pressure,daytime mean systolic pressure and daytime mean diastolic pressure).Results:There were significant differences in mean systolic blood pressure and mean diastolic blood pressure at night among Group A,Group B and Group C(P<0.05).Age,hyperlipidemia and fasting blood glucose were risk factors for circadian rhythm abnormality(P<0.05),and 24-hour urinary sodium was a protective factor for circadian rhythm abnormality(P<0.05).Conclusion:Age,hyperlipidemia and fasting blood glucose are risk factors for circadian rhythm abnormality(P<0.05),and 24-hour urinary sodium is a protective factor for circadian rhythm abnormality(P<0.05).展开更多
文摘BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.
文摘This study examines hemodynamic behavior in particular cases of pulmonary hypertension without treatment. Pulmonary hypertension represents an anomalous hemodynamic state and is characterized by an excessively high blood pressure in the pulmonary artery. To simulate the hemodynamic abnormalities in pulmonary hypertension under different causes and pathologies, we construct a localized parameter circuit model governed by nonlinear ordinary derivative equations of the human circulatory system. Thus, two special cases are considered, namely pulmonary the artery stenosis and the left ventricular diastolic dysfunction. For each case of pulmonary hypertension development, we determine the relationships between blood pressure and chamber and vessel pressure-volume. When the pulmonary hypertension is due to pulmonary artery stenosis, it appears that the right ventricular pressure increases up to 90 mm Hg, likewise the rise in pulmonary artery resistance induces direct increment in pulmonary artery pressure. However, when the pulmonary hypertension is due to left ventricular diastolic dysfunction, we note that the left atrial pressure and the pulmonary vein pressure augment, leading to the growth of the pulmonary artery blood pressure. The established results within this paper are useful for understanding the hemodynamic mechanism of particular pulmonary hypertension.
基金Supported by the Shanghai Sailing Program,No.21YF1440300 and No.22YF1407700and the National Natural Science Foundation of China,No.82200061.
文摘BACKGROUND Postpartum pulmonary arterial hypertension(PAH)complicated with hereditary hemorrhagic telangiectasia(HHT)is a rare condition.Diagnosing and treating PAH in patients with HHT can be challenging.To the best of our knowledge,no previous reports have investigated the efficacy of pulmonary vasodilators in improving hemodynamics in postpartum patients with this disease.CASE SUMMARY In this paper,we report a postpartum case of HHT combined with PAH,pre-senting with worsening dyspnea.Genetic testing revealed that the patient carried a heterozygous variant of activin receptor-like kinase 1.The patient received various treatments,including diuretics,anticoagulants,sildenafil,macitentan,inhalation of nitric oxide,and iloprost.Changes in PaO2/FiO2,pulmonary artery systolic pressure as assessed by echocardiography,and N-terminus pro-brain natriuretic peptide levels suggested that,except for iloprost inhalation,the other treatments appeared to have limited efficacy.CONCLUSION To our knowledge,this is the first report on efficacy of pulmonary vasodilators in postpartum patients with HHT and PAH.
文摘Hypertension, often called the “silent killer”, is a major risk factor for heart attacks and strokes in the elderly. Its effective management is crucial to prevent damage to the heart, brain, and kidneys. Isolated systolic hypertension (ISH) is particularly critical in the elderly population. Cardiovascular risk factors, including pulse pressure and wave velocity, are closely associated with systolic blood pressure and influenced by arterial stiffness and wave reflections. Managing ISH is complex due to the potential negative effects of certain medications and individual variability in treatment response. This paper will address these issues, evaluating antihypertensive drugs, combination therapy, personalized treatment plans, and updated guidelines for managing ISH.
文摘Pulmonary arterial hypertension(PAH)is a progressive disease marked by degeneration of the lung’s blood vessels.As the disease progresses,the resistance to blood flow in the pulmonary arteries increases,putting a strain on the right side of the heart as it pumps blood through the lungs.PAH is characterized by changes in the structure of blood vessels and excessive cell growth.Untreated PAH leads to irreversible right-sided heart failure,often despite medical intervention.Patients experience a gradual decline in function until they are unable to perform daily activities.Advances in treatment have improved the prognosis for many PAH patients.Currently approved therapies target the prostacyclin,endothelin,nitric oxide,or phosphodiesterase pathways to slow the progression of the disease.To address the unmet need for effective PAH therapies,research efforts are focused on identifying new targets and developing therapies that specifically address the underlying disease mechanisms and restore vascular wall homeostasis.Among these,sotatercept,a fusion protein that targets the transforming growth factor-βsuperfamily signaling pathway,has emerged as a promising therapeutic option.In this review,we examine the available evidence from clinical trials to assess the potential of sotatercept as a treatment for PAH.
基金This work was supported by the National Natural Science Foundation of China(82070052)the Joint Funds of the Natural Science Foundation of Gansu Province(23JRRA1544)granted to Yunshan Cao.
文摘Background:Current guidelines for managing pulmonary arterial hypertension(PAH)recommend a risk strati-fication approach.However,the applicability and accuracy of these strategies for PAH associated with congenital heart disease(PAH-CHD)require further validation.This study aims to validate the reliability and predictive accuracy of a simplified stratification strategy for PAH-CHD patients over a three-year follow-up.Additionally,new prognostic variables are identified and novel risk stratification methods are developed for assessing and managing PAH-CHD patients.Methods:This retrospective study included 126 PAH-CHD patients.Clinical and biochemical variables across risk groups were assessed using Kruskal-Wallis and Fisher’s exact tests.Indepen-dent risk factors were identified using ordered logistic regression,while Kaplan-Meier and Cox proportional hazards regression analyses evaluated their impact on all-cause mortality.A new stratification model for the PAH-CHD population was constructed based on these analyses.Results:Significant survival differences across stratified risk groups were observed(p<0.001),validating the effectiveness of the simplified risk stratification method in PAH-CHD patients.Prothrombin activity was a strong independent predictor of adverse outcomes of PAH-CHD patients(Hazard ratio 0.95,p<0.001,C-index 0.70).A model combining N-terminal pro-brain natriuretic peptide,prothrombin activity,albumin,and right atrial area achieved an area under the curve of 0.89 and a C-index of 0.85.Conclusions:The simplified risk stratification method is applicable to PAH-CHD patients.Prothrombin activity is a strong independent predictor of adverse outcomes.A comprehensive risk stratification approach,incorporating both established and novel biomarkers,enhances accessibility and offers predictive efficacy during follow-up for PAH-CHD patients,comparable to established models.
基金Supported by Clinical Research Center for Hepatopathy and Intestinal Diseases of Fujian Province,No.2023GBYJ-YL-1.
文摘In this article,we provide commentary on the recent article by Zhao et al.We focus on the shifts in the gut microbiota of patients with hepatitis B virus(HBV)-associated cirrhosis/portal hypertension(PH)following transjugular intrahepatic portosystemic shunt(TIPS)and the implications for understanding the mechanisms,diagnosis,and treatment.By comparing the gut microbiota composition and dynamic changes before and after TIPS in patients with and without hepatic encephalopathy,the authors found an increase in non-probiotic bacteria in those who developed hepatic encephalopathy post-TIPS,with Morganella species present only in the hepatic encephalopathy group.The gut microbiota changes post-TIPS among patients without the occurrence of hepatic encephalopathy suggest potential therapeutic benefits through prophylactic microbiome therapies.Furthermore,the specific gut microbiota alterations may hold promise to predict the risk of hepatic encephalopathy in individuals undergoing TIPS for HBVrelated PH.Despite these promising findings,future studies are needed to address limitations,including a small sample size,a relatively short evaluation period for gut microbiota alterations,the absence of data on dynamic alterations in gut microbiota post-TIPS and their correlation with blood ammonia levels,and the lack of validation in animal models.In conclusion,Zhao et al's study has shed new light on the link of gut microbiota with post-TIPS hepatic encephalopathy,potentially through the intricate gut-liver axis,and has important clinical implications for improving the management of patients with HBV-related PH.
文摘Early onset of hypertension (HTN) raises the risk of cardiovascular disease (CVD), the leading cause of death in the U.S. For university students who do not follow healthy diets or lifestyles, high blood pressure (BP) may be markedly prevalent. Researchers utilized a cross-sectional design to assess HTN prevalence and its risk factors among college students (N = 123). Self-administered surveys comprising four validated questionnaires: the Perceived Stress Scale (PSS), Rapid Eating Assessment for Participants-Shortened (REAPS), Dietary Approaches to Stop Hypertension Quality (DASH-Q), and the U.S. Adult Food Security Survey (FSS) were employed. Additionally, physical measurements were conducted, including height, weight, waist circumference (WC), and BP. Results indicated that 71.6% of students had elevated BP, with 24.4% classified as Stage 1 HTN and 23.6% as Stage 2 HTN. Notably, 60% of students reported low adherence to the DASH diet and a mean REAPS score of 26.3 out of 39. Students experiencing marginal food security had higher systolic blood pressure (SBP) 131.7 ± 16.8 mm Hg compared to those with high food security 123.03 ± 11.7 mm Hg (p = 0.028). Furthermore, REAPS scores showed a negative correlation with diastolic blood pressure (DBP) (β = −0.201, p = 0.03). Significant predictors for SBP included WC (β = 0.40, p β = −0.33, p β = 0.16, p = 0.046). The findings highlight the need for BP screenings and nutrition education programs to improve dietary habits among college students, which may help reduce HTN and its associated long-term risks for CVD.
文摘Diabetes mellitus and hypertension are two of the most prevalent diseases affecting individuals across all age groups. Both conditions are linked to an increased risk of heart disease, peripheral vascular disease, stroke, retinopathy, and neuropathy. The study highlights that diabetes damages arteries and blood vessels, elevating the risk of heart attack and kidney failure. The coexistence of diabetes and hypertension exacerbates these complications, underscoring the importance of managing both conditions simultaneously. The study also focuses on Metformin, a well-established medication for treating type 2 diabetes. Recognized as one of the most effective treatment options, Metformin enhances blood glucose management by increasing insulin sensitivity, reducing insulin levels, and improving insulin action. This makes it a crucial drug for controlling diabetes efficiently and effectively. Furthermore, the findings indicate that diabetes predominantly affects individuals in low- and middle-income countries, contributing to higher mortality rates. The analysis of peer-reviewed journals and articles suggests that diabetes is a chronic disease with severe implications if preventive measures are not promptly implemented. Immediate action is necessary to mitigate the impact of diabetes and improve global health outcomes.
文摘Background: Lumboperitoneal (LP) shunts have been used to manage benign intracranial hypertension (BIH) for an extended period. While they may swiftly and effectively alleviate symptoms, their application is accompanied by potential complications. Objectives: This research aimed to retrospectively analyze the difficulties and complications related to LP shunt implantation. Methods: We conducted a retrospective analysis of the records of 47 patients who had LP shunt placement for the treatment of BIH at our hospital throughout the research period. A thorough history and physical examination were conducted in every case. All patients were asked about age, gender, body mass index, neurological history, and oral contraceptive usage. Post-operative complications, clinical and ophthalmological follow-up occurred at 1, 3, and 6 months post-op. Results: Patients were mostly women (93.6%). The mean age of the patients was 35, and 80.9 percent had BMIs exceeding 25. Many female patients (40.9%) used oral contraceptives. Nearly all patients (93.6%) reported decreased vision, and 87.2% suffered headaches. The most common issue was shunt obstruction (51%), followed by low tension headaches (63.8%). The peritoneal side (10.6%) had higher shunt slippage than the thecal (2.1%). Superficial infections and radiculopathy affected 10.6% of patients, whereas CNS infections, arachnoiditis, and shunt failure affected just 2.1%. Five patients (10.6%) had Chiari malformation, and 60% had syringomyelia. Conclusion: Using LP shunts to treat BIH seems to be a method devoid of major risks despite the high revision rates. At the same time, more severe complications such as CNS infections, arachnoiditis, and shunt failure were less common.
文摘Hypertension high blood pressure (HTN) and diabetes Type 2 diabetes mellitus (T2DM) are noncommunicable diseases (NCDs) growing in sub-Saharan Africa, under the effect of urbanization, changes in socio-economic and lifestyle-related factors. This study aimed to assess the prevalence of these conditions in the urban commune of Dubréka, in Guinea, and to assess the role of demographic and cultural factors in their incidence and management. A cross-sectional study was conducted with 287 participants (174 women and 113 men) in Dubréka. Data were summer collected on the characteristics of sociodemographics, BMI, blood pressure and fasting blood glucose. The prevalence of hypertension and diabetes was determined, and participants’ knowledge and treatment practices were assessed in the summer. The prevalence of hypertension in the study population was 73.52%, affecting both sexes, with women presenting a higher prevalence. The prevalence of diabetes is slightly higher (75.29%) than that of men (70.79%) was 36.59%, with men (38.05%) being slightly more affected than women (35.63%). Obesity and overweight were contributory important factors, affecting respectively 25.78% and 37.28% of the population. Among the hypertensive people, 84.83% were aware of their condition, but only 7.26% received treatment, with no case-controlled hypertension having no summer observed. Socio-economic factors, including the urban setting and proximity to the capital, have probably contributed to these results. The high prevalence of hypertension and diabetes in Dubréka reflects the broader epidemiological transition in sub-Saharan Africa, with women being disproportionately affected by hypertension linked to obesity. Access limited to health care, especially in terms of treatment and care, further aggravates the burden of these diseases. Public health interventions are urgently needed to improve awareness, treatment accessibility and culturally appropriate management strategies adapted to fight against the growing burden of NCDs in Guinea peri-urban.
文摘Chronic thromboembolic pulmonary hypertension(CTEPH)is a chronic,progressive,debilitating,and life-threa-tening complication of pulmonary embolism(PE).Recent technological advances have permitted various treat-ment options for the treatment of CTEPH,including surgery,angioplasty,and medical treatment,depending on the location and characteristics of lesions.Pulmonary endarterectomy(PEA)is the treatment of choice for CTEPH,as it offers excellent long-term outcomes and a high probability of recovery.Moreover,various medical and interventional therapies are currently being developed for patients with inoperable CTEPH.This review mainly summarizes the current treatment approaches of CTEPH,offering more options for specialist physicians to,thus,better manage chronic thromboembolic syndromes.
文摘Down syndrome is the most common chromosomal abnormality encountered in clinical practice with 50%of them having associated congenital heart disease(CHD).Shunt lesions account for around 75%of all CHDs in Down syndrome.Down syndrome patients,especially with large shunts are particularly predisposed to early development of severe pulmonary hypertension(PH)compared with shunt lesions in general population.This necessitates timely surgical correction which remains the only viable option to prevent long term morbidity and mortality.However,despite clear recommendations,there is wide gap between actual practice and fear of underlying PH which often leads to surgical refusals in Down syndrome even when the shunt is reversible.Another peculiarity is that Down syndrome patients can develop PH even after successful correction of shunt.It is not uncommon to come across Down syndrome patients with uncorrected shunts in adulthood with irreversible PH at which stage intracardiac repair is contraindicated and the only option available is a combined heartlung transplant.However,despite the guidelines laid by authorities,the rates of cardiac transplant in adult Down syndrome remain dismal largely attributable to the high prevalence of intellectual disability in them.The index case presents a real-world scenario highlighting the impact of severe PH on treatment strategies and discrimination driven by the fear of worse outcomes in these patients.
基金supported by“Hibah Penelitian Dana Masyarakat FKKMK UGM”grant No.1528/UN1/FKKMK/PPKE/PT/2024 and“Riset dan Inovasi Untuk Indonesia Maju Gelombang 4”grant No.172/IV/KS/11/2023-6815/UN1/DITLIT/Dit-Lit/KP.01.03/2023 received by Anggoro Budi Hartopo.
文摘A particular type of endogenous noncoding RNAs known as circular RNAs(circRNAs)has now become possible biomarkers for several diseases because of their stability and tissue-specific expression patterns.CircRNAs might play a role in various of biological processes.The identification of particular circRNAs dysregulated in pulmonary arterial hypertension(PAH)raises the possibility of these molecules serving as biomarkers for the disease’s early diagnosis and treatment.This review mainly summarizes the role and potential of circRNA as a future biomarker in PAH related to congenital heart disease.This study presented several potential circRNA targets as diagnostic biomarkers for PAH,discussed their biological functions,and addressed the challenges that need to be considered for their application in clinical settings.
基金supported by the Qingdao Medical Research Guidance Plan(2020-WJZD049).
文摘Background:Mufangji tang(MFJT)is composed of Ramulus Cinnamomi,Radix Ginseng,Cocculus orbiculatus(Linn.)DC.,and Gypsum.In clinical settings,MFJT has been effectively employed in addressing a range of respiratory disorders,notably including pulmonary arterial hypertension(PAH).However,the mechanism of action of MFJT on PAH remains unknown.Methods:In this study,a monocrotaline-induced PAH rat model was established and treated with MFJT.The therapeutic effects of MFJT on PAH rat model were evaluated.Network pharmacology was conducted to screen the possible targets for MFJT on PAH,and the molecular docking between the main active components and the core targets was carried out.The key targets identified from network pharmacology were tested.Results:Results showed significant therapeutic effects of MFJT on PAH rat model.Analysis of network pharmacology revealed several potential targets related to apoptosis,inflammation,oxidative stress,and vascular remodeling.Molecular docking showed that the key components were well docked with the core targets.Further experimental validation results that MFJT treatment induced apoptosis(downregulated Bcl-2 levels and upregulated Bax levels in lung tissue),inhibited inflammatory response and oxdative stress(decreased the levels of IL-1β,TNF-α,inducible NOS,and malondialdehyde,and increased the levels of endothelial nitric oxide synthase,nitric oxide,glutathione and superoxide dismutase),reduced the proliferation of pulmonary arterial smooth muscle cells(downregulated ET-1 andβ-catenin levels and ERK1/2 phosphorylation,increased GSK3βlevels).Conclusion:Our study revealed MFJT treatment could alleviate PAH in rats via induction of apoptosis,inhibition of inflammation and oxidative stress,and the prevention of vascular remodeling.
基金Zhejiang Province Medicine and Health Science and Technology Programme,No.2019RC092 and No.2020KY394the Public Welfare Project of Zhejiang Provincial Department of Science and Technology,No.LGF19H170003.
文摘BACKGROUND Pulmonary hypertension is a serious complication in the treatment of maintenance hemodialysis patients,which seriously affects the quality of life of patients and threatens their life safety.Prevention,treatment and improvement of pulmonary hypertension are of great significance to improve the quality of life of patients.AIM To investigate the intervention and control of pedal-powered bicycle in maintaining quality of life and pulmonary hypertension in hemodialysis patients.METHODS 73 patients with maintenance hemadialysis combined with pulmonary arterial hypertension at a hemodialysis center in a certain hospital from May 2021 to May 2022 are selected.Patients are divided into two groups,37 cases in the control group(group C)and 36 cases in the intervention group(group I).Patients are divided into two groups,group C is treated with oral administration of betaglandin sodium combined with routine nursing care.Based on group C,group I conducts power cycling exercises.RESULTS After treatment,group I patients had higher muscle strength,36-Item Short Form Health Survey scores,and Kidney Disease Targets Areas scores;The 6-minute walk distance test index level was higher and the Borg score was lower;The group I had lower systolic blood pressure,greater vital capacity,higher positive emotion,lower systolic pulmonary artery pressure index level,higher arterial partial oxygen pressure level,lower pulmonary vascular resistance index level,and higher blood oxygen saturation level[158.91±11.89 vs 152.56±12.81,1795.01±603.18 vs 1907.20±574.15,24.00(22.00,29.00)vs 24.00(22.00,28.00),P<0.001].CONCLUSION Aerobic exercise combined with Western medicine treatment can effectively improve patients'pulmonary hypertension,alleviate their negative emotions,and enable them to achieve a higher level of quality of life.
基金Supported by the Scientific Achievements Transformation Incubation Fund of Beijing Children's Hospital,No.ZHFY3-1-015.
文摘BACKGROUND Timely and accurate evaluation of the patient's pulmonary arterial pressure(PAP)is of great significance for the treatment of congenital heart disease.Currently,there is no non-invasive gold standard method for evaluating PAP.AIM To assess the prognostic value of lipocalin-2(LCN2)in relation to PAP in patients with congenital heart disease associated with pulmonary artery hypertension.METHODS We conducted a retrospective analysis of 69 pediatric patients diagnosed with ventricular septal defects.The patients’clinical and laboratory data were collected.The serum LCN2 concentrations were compared between the pulmonary arterial hypertension(PAH)group and the nonPAH group.The correlation of LCN2 concentration with PAH classification was evaluated using binary logistic regression analysis.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic potential of LCN2 for PAH.RESULTS Serum LCN2 concentration significantly correlated with patients’mean PAP(r=0.544,P<0.001),but not correlated with creatinine(P=0.446)or blood urea nitrogen(P=0.747).LCN2 levels were significantly correlated with PAH in both univariate[odds ratio(OR)1.107,95%CI:1.033-1.185,P=0.004)]and multivariate regression analysis(OR 1.150,95%CI:1.027-1.288,P=0.015).ROC curve analysis revealed an area under the curve of 0.783 for LCN2.At the cutoff value of 19.42 ng/mL,the sensitivity and specificity of LCN2 for diagnosing PAH is 90.19%and 55.56%,respectively.LCN2 concentration also significantly correlated with the post-repair mean PAP in patients with congenital heart disease(r=0.532,P=0.009).CONCLUSION LCN2 is emerging as a candidate biomarker for assessing PAP in patients with congenital heart disease.Its high sensitivity in diagnosing PAH makes it a valuable tool in patient management.
文摘BACKGROUND Liver transplantation(LTx)is vital in patients with end-stage liver disease,with metabolic dysfunction-associated steatotic liver disease being the most common indication.Primary sclerosing cholangitis(PSC)is an important indication.Portopulmonary hypertension,associated with portal hypertension,poses a significant perioperative risk,making pretransplant screening essential.CASE SUMMARY We report the case of a 41-year-old woman with PSC who developed severe pul-monary hypertension years after a successful LTx.She presented with worsening dyspnea on exertion and presyncope.Diagnostic evaluation confirmed severe precapillary pulmonary hypertension without evidence of recurrent portal hy-pertension.Initial management with Sildenafil and Macitentan led to a significant improvement in her symptoms,exercise capacity,and biomarkers.This case highlights the rare development of de novo pulmonary hypertension in a liver transplant recipient without recurrent portal hypertension,possibly linked to autoimmune processes or primary liver disease itself.The patient’s positive re-sponse to the combination therapy underscores the importance of prompt diag-nosis and aggressive management.CONCLUSION In conclusion,pulmonary arterial hypertension post-LTx is a rare but serious complication with a poor prognosis,necessitating further research to better understand its mechanisms and to develop effective strategies for prevention and treatment.
基金supported by Chongqing Science and Technology Bureau Technology Innovation and Application Development Project(No.cstc2019jscx-msxmX0170)Chongqing Science and Health Joint Medical Research Project(No.2021MSXM208).
文摘Objective:To systematically evaluate the effectiveness of mobile health(mHealth)interventions on self-management and blood pressure(BP)control in patients with hypertension and to provide recommendations for the clinic and future research.Methods:Databases including Embase,Cochrane Library,CINAHL,CNKI,SinoMed,Wanfang,and Weipu were searched to collect systematic reviews(SRs)and meta-analyses on mHealth interventions for hypertension management.Two researchers independently screened the articles and extracted data,and the Assessment of Multiple Systematic Reviews(AMSTAR 2)was used to evaluate the methodological quality of the included reviews.Results:A total of 11 SRs were included:1 review was rated as high quality,3 as low quality,and 7 as critically low quality.The mobile phone was the most common intervention type,followed by the internet.Seven reviews performed meta-analyses and showed that mHealth was associated with a significant reduction in systolic blood pressure(SBP),from 2.28 mmHg(95%CI-3.90 to-0.66;I^(2)=40%)to 14.77 mmHg(95%CI 11.76-17.77;I^(2)=89.7%),and diastolic blood pressure(DBP),from 1.50 mmHg(95%CI-2.20 to-0.08;I^(2)=62%)to 8.17 mmHg(95%CI 5.67-10.67;I^(2)=86%).Self-management behaviors included medication adherence(MA),diet,smoking,alcohol drinking,physical activity,and BP monitoring.There were inconsistent results on the effectiveness of mHealth interventions.Conclusions:mHealth interventions can improve BP control,MA,diet,and smoking in patients with hypertension,but the evidence for the efficacy of mHealth on physical activity and alcohol drinking improvement is limited.The methodological quality of existing SRs on the management of BP in patients with hypertension was relatively low,and more well-designed SRs or meta-analyses were needed to provide more evidence.mHealth interventions are useful for improving BP control of patients with hypertension.
文摘Objective:To analyze the characteristics of ambulatory blood pressure in elderly patients with hypertension and find out the risk factors of abnormal circadian rhythm.Methods:According to the circadian rhythm of patients'blood pressure,they were divided into Group A,Group B and Group C,and all the data of hypertension patients in this study were collected,including age,gender,BMI,smoking,drinking,basic diseases(diabetes,cerebrovascular disease,hyperlipidemia,etc.),fasting blood glucose,ambulatory blood pressure(24-hour mean systolic pressure,24-hour mean diastolic pressure,daytime mean systolic pressure and daytime mean diastolic pressure).Results:There were significant differences in mean systolic blood pressure and mean diastolic blood pressure at night among Group A,Group B and Group C(P<0.05).Age,hyperlipidemia and fasting blood glucose were risk factors for circadian rhythm abnormality(P<0.05),and 24-hour urinary sodium was a protective factor for circadian rhythm abnormality(P<0.05).Conclusion:Age,hyperlipidemia and fasting blood glucose are risk factors for circadian rhythm abnormality(P<0.05),and 24-hour urinary sodium is a protective factor for circadian rhythm abnormality(P<0.05).
