The decreasing of hazard ratio for cancer incidence (HRCVD) in the range of twenty native tissues (lung, liver, brain, hematologic, neuroendocrine renal, pancreas, lymphoid, bladder, colon, lip-oral-head-neck, leukocy...The decreasing of hazard ratio for cancer incidence (HRCVD) in the range of twenty native tissues (lung, liver, brain, hematologic, neuroendocrine renal, pancreas, lymphoid, bladder, colon, lip-oral-head-neck, leukocytic, rectum and anus, thyroid, soft tissue, prostate, skin, ovarian, breast, uterine) as much, as decreasing of the level of cardiovascular pathology (CVD) in the host before malignization, have been described by C.F. Bell et al. in 2023. Earlier, in 2022, the decreasing of 5-year mortality from cancer in similar range of tissues discussed by us as the inverse dependence from the content of stem CD34 markers in tissues before malignization, with example of population in England. In present article we investigate the interrelation between both data more thoroughly, using accessible and more representative populations level of the data. The analysis shows that high level of HRCVD is able to predicts only high cancer death for tissue sites in the beginning of the range, being applied to the referent data of cancer cases and deaths in estimated population of USA 2024. Along with this, an increasing the content of CD34 stem marker in the native tissues of the same range was favorite for increasing of cancer’s cases at the end of the range, diminishing, in parallel, the signs of vasculo-endothelial pathology, i.e. HR CVD. Thus, the cases (incidence) of cancer depend directly rather from content of CD34, which preexisted in native sites, than that from HRCVD. Further analysis shows that CD34 content averaged over twenty cites dominates over that CD2 marker of total T-cells more than 7 times, in oppose to their ratio in the blood. The enhancement of stem CD34 marker in the range of tissues is accompanied by unidirectional rising of its maturing derivatives, vasculo-endothelial CD31 and total T-cells CD2 markers, which contents relate positively to increasing of cancer death in US population 2024. The increase of CD34 decreases cancer mortality (death: cases) in sites, but indirectly, rather due to enhancement of the denominator. The high HRCVD (more than 1.0) in range of 20 tissues, concerns of those of them, which have had highest mitotic activity (by Ki67), but lowest “stemness” (by CD34), “vascularity” (by CD31), cancer’s incidence (cases) and the worse results of therapy. Oppositely, the normal tissue with lowest HRCVD (below 1.0) and Ki67, but highest CD34, CD31, and cancer incidence (cases) are more sensitive to treatment. Thus, the residential hematopoietic “stemness” in native tissues acts as natural protectors for cardio-vascular system and promoter for cancer incidence in them. The steady and irreversible exhaustion of current regenerative resource (CRR) of BM, which assumed by us as a product of CD34 number and average telomeres length, manifests itself in acceleration of non-malignant CVD and deceleration of malignancy in population +70 (in term the death per 105), according to data extracted from WHO Mortality Database. The similar deficit of CD34 arises artificially during cytotoxic treatment of cancer, when rapid waste of local CRR forces malignant cells to search more “stemness” cites. The competition between malignant and native tissues of the host for scanty CRR seems to be the most important factor for evaluation and prediction of prevalence, curability, and long-term results in oncology.展开更多
Introduction: Respiratory distress is a clinical condition accompanied by an increase in work of breathing, with the respiratory accessory muscles brought into play to ensure normal arterial oxygenation. It is a major...Introduction: Respiratory distress is a clinical condition accompanied by an increase in work of breathing, with the respiratory accessory muscles brought into play to ensure normal arterial oxygenation. It is a major cause of morbidity and mortality in pediatrics. The aim of our study was to investigate the epidemiological, clinical and therapeutic aspects of respiratory distress in children aged between 1 month and 15 years seen in the emergency department of the Bangui paediatric university hospital. Methodology: This was a 3-month descriptive cross-sectional study, from January 1 to March 31, 2023. All children aged 1 month to less than 15 years presenting with respiratory distress were included. Results: A total of 3021 children were admitted to the emergency medical services of Bangui’s pediatric university hospital. Of these, 164 were included in the study. The predominance was male, with a sex ratio of 1.09. The 0 - 2 age group was the most represented, with 67 patients (42.85%). The majority of patients came from Bangui, accounting for 146 (89.02%) of cases. Respiratory difficulty (59.15%), characterized by dyspnea and cough, associated with fever, vomiting, physical asthenia and diarrhea, were the main reasons for consultation. The main pathologies noted were respiratory 92 (56.10%), followed by cardiac pathologies 21 (12.8%). Antibiotic administration (76.82%) was the most common therapeutic procedure used in the management of respiratory distress. Conclusion: Respiratory distress remains an important cause of infant mortality in our context, with major management problems.展开更多
Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible ligh...Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible light,whereas PCCT utilizes photon-counting detectors that directly transform X-ray photons into electric signals.This direct conversion allows photon-counting detectors to sort photons into discrete energy levels,thereby enhancing image quality through superior noise reduction,improved spatial and contrast resolution,and reduced artifacts.In pediatric applications,PCCT offers substantial benefits,including lower radiation doses,which may help reduce the risk of malignancy in pediatric patients,with perhaps greater potential to benefit those with repeated exposure from a young age.Enhanced spatial resolution facilitates better visualization of small structures,vital for diagnosing congenital heart defects.Additionally,PCCT’s spectral capabilities improve tissue characterization and enable the creation of virtual monoenergetic images,which enhance soft-tissue contrast and potentially reduce contrast media doses.Initial clinical results indicate that PCCT provides superior image quality and diagnostic accuracy compared to conven-tional CT,particularly in challenging pediatric cardiovascular cases.As PCCT technology matures,further research and standardized protocols will be essential to fully integrate it into pediatric imaging practices,ensuring optimized diagnostic outcomes and patient safety.展开更多
The COVID-19 pandemic has profoundly impacted global health, with far-reaching consequences beyond respiratory complications. Increasing evidence highlights the link between COVID-19 and cardiovascular diseases (CVD),...The COVID-19 pandemic has profoundly impacted global health, with far-reaching consequences beyond respiratory complications. Increasing evidence highlights the link between COVID-19 and cardiovascular diseases (CVD), raising concerns about long-term health risks for those recovering from the virus. This study rigorously investigates the influence of COVID-19 on cardiovascular disease risk, focusing on conditions such as heart failure and myocardial infarction. Using a dataset of 52,683 individuals aged 30 to 80, including both COVID-19 survivors and those unaffected, the study employs machine learning models—logistic regression, decision trees, and random forests—to predict cardiovascular outcomes. The multifaceted approach allowed for a comprehensive evaluation of the model’s predictive capabilities, with logistic regression yielding the highest Binary F1 score of 0.94, effectively identifying cardiovascular risks in both the COVID-19 and non-COVID-19 groups. The correlation matrix revealed significant associations between COVID-19 and key symptoms of heart disease, emphasizing the need for early cardiovascular risk assessment. These findings underscore the importance of machine learning in enhancing early diagnosis and developing preventive strategies for COVID-19-related heart complications. Ultimately, this research contributes to a broader understanding of the pandemic’s lasting health effects, highlighting the critical role of cardiovascular care in post-COVID-19 recovery.展开更多
BACKGROUND Acute respiratory distress syndrome(ARDS)is a critical condition characterized by acute hypoxemia,non-cardiogenic pulmonary edema,and decreased lung compliance.The Berlin definition,updated in 2012,classifi...BACKGROUND Acute respiratory distress syndrome(ARDS)is a critical condition characterized by acute hypoxemia,non-cardiogenic pulmonary edema,and decreased lung compliance.The Berlin definition,updated in 2012,classifies ARDS severity based on the partial pressure of arterial oxygen/fractional inspired oxygen fraction ratio.Despite various treatment strategies,ARDS remains a significant public health concern with high mortality rates.AIM To evaluate the implications of driving pressure(DP)in ARDS management and its potential as a protective lung strategy.METHODS We conducted a systematic review using databases including EbscoHost,MEDLINE,CINAHL,PubMed,and Google Scholar.The search was limited to articles published between January 2015 and September 2024.Twenty-three peer-reviewed articles were selected based on inclusion criteria focusing on adult ARDS patients undergoing mechanical ventilation and DP strategies.The literature review was conducted and reported according to PRISMA 2020 guidelines.RESULTS DP,the difference between plateau pressure and positive end-expiratory pressure,is crucial in ARDS management.Studies indicate that lower DP levels are significantly associated with improved survival rates in ARDS patients.DP is a better predictor of mortality than tidal volume or positive end-expiratory pressure alone.Adjusting DP by optimizing lung compliance and minimizing overdistension and collapse can reduce ventilator-induced lung injury.CONCLUSION DP is a valuable parameter in ARDS management,offering a more precise measure of lung stress and strain than traditional metrics.Implementing DP as a threshold for safety can enhance protective ventilation strategies,po-tentially reducing mortality in ARDS patients.Further research is needed to refine DP measurement techniques and validate its clinical application in diverse patient populations.展开更多
BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal ...BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes.We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes.AIM To determine association between cardiovascular abnormalities and clinical and laboratory parameters.To study the time-line for resolution of various abnormalities.METHODS In this prospective study done in a tertiary care hospital,270 were recruited from June 2020 to January 2022.Baseline demographic data and clinical presentation were recorded.Laboratory parameters and echocardiography were done at admission.Follow-up was done at 2 weeks,3 months,6 months and 1 year after diagnosis.Descriptive statistics were used for parametric and non-parametric data.Risk factors were identified by multivariate regression analysis.RESULTS The 211(78.2%)had cardiac involvement and 102 needed intensive care unit(ICU)admission.Cardiovascular abnormalities observed were shock 123(45.6%),coronary dilatation 28(10.4%),coronary aneurysm 77(28.5%),left ventricular(LV)dysfunction 78(29.3%),mitral regurgitation(MR)77(28.5%)and pericardial effusion 98(36.3%).Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7%and 0.9%respectively.Multivariate regression analysis revealed breathlessness[odds ratio(OR)=3.91,95%CI:1.25-12.21,P=0.019]and hi-flow nasal cannula(HFNC)support(OR=8.5,95%CI:1.06-68.38,P=0.044)as predictors of cardiovascular involvement.Higher mean age(OR=1.16,95%CI:1.02-1.32,P=0.026),breathlessness(OR=4.99,95%CI:2.05-12.20,P<0.001),gallop(OR=4.45,95%CI:0.41-2.52,P=0.016),MR(OR=3.61,95%CI:1.53-8.53,P=0.004)and invasive ventilation(OR=4.01,95%CI:1.28-12.58,P=0.017)were predictive of LV dysfunction.Altered sensorium(OR=4.96,95%CI:2.23-11.02,P<0.001),headache(OR=6.61,95%CI:1.46-29.92,P=0.014),HFNC(OR=7.03,95%CI:2.04-24.29,P=0.002),non-rebreathing mask usage(OR=21.13,95%CI:9.00-49.61,P<0.001)and invasive ventilation(OR=5.64,95%CI:1.42-22.45,P=0.014)were risk factors for shock.Anemia was a risk factor for coronary involvement(OR=3.09,95%CI:1.79-5.34,P<0.001).CONCLUSION Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management.Although shock resolved quickly,resolution of ventricular function and coronary abnormalities were slower,and hence warrants a structured long-term follow-up protocol.展开更多
Type 2 diabetes mellitus is associated with a 2-4 times increased risk of cardiovascular(CV)disease.Glucagon-like polypeptide-1 receptor agonists(GLP1RA)and sodium-glucose cotransporter-2 inhibitors(SGLT2i)are two imp...Type 2 diabetes mellitus is associated with a 2-4 times increased risk of cardiovascular(CV)disease.Glucagon-like polypeptide-1 receptor agonists(GLP1RA)and sodium-glucose cotransporter-2 inhibitors(SGLT2i)are two important classes of drugs with CV benefits independent of their antihyperglycemic efficacy.The CV outcome trials of both GLP1RA and SGLT2i have demonstrated CV superiority/neutrality concerning major adverse CV events(MACE).While GLP1RAs have exhibited a significant reduction in ischemic stroke and myocardial infarction(MI),SGLT2i have demonstrated a uniformly significant reduction in hospitalization for heart failure(HF)as a class effect.The unique clinical benefits and the distinct but complementary mechanisms of action make the combination of these drugs a mechanistically sound one.Recent meta-analyses suggest an independent and additive benefit of combination therapy of GLP1RA/SGLT2i vs monotherapy.Zhu et al,in a recent issue of the World Journal of Diabetes,demonstrates a numerically lower hazard ratio(HR)for CV outcomes with combination therapy vs monotherapy with either agent,with a reduction in MACE compared to GLP1RA alone[HR=0.51,95%confidence interval(CI):0.16-1.65],or SGLT2i alone(HR=0.48,95%CI:0.15-1.54).The CV death rate was also lower with combination therapy compared to GLP1RA alone(HR=0.58,95%CI:0.08-3.39),or SGLT2i alone(HR=0.55,95%CI:0.07-3.25).Fatal and non-fatal MI and fatal and non-fatal stroke were reduced with combination therapy compared to GLP1RA alone(HR=0.45,95%CI:0.10-2.18 and HR=0.86,95%CI:0.12-6.23,respectively),or SGLT2i alone(HR=0.44,95%CI:0.09-2.10 and HR=0.74,95%CI:0.10-5.47,respectively).Hospitalization for HF was prevented with combination therapy compared to GLP1RA alone(HR=0.26,95%CI:0.03-1.88),or SGLT2i alone(HR=0.33,95%CI:0.04-2.53).They also demonstrated that GLP1RA or SGLT2i monotherapy may not provide significant improvement in CV death and recurrent MI in patients with prior MI or HF,proposing a role for combination therapy in this subgroup.Appropriate patient selection is vital to optimize CV risk reduction as well as the cost-effectiveness of this combination therapy.展开更多
BACKGROUND Recent studies have indicated that triglyceride glucose(TyG)-waist height ratio(WHtR)and TyG-waist circumference(TyG-WC)are effective indicators for evaluating insulin resistance.However,research on the ass...BACKGROUND Recent studies have indicated that triglyceride glucose(TyG)-waist height ratio(WHtR)and TyG-waist circumference(TyG-WC)are effective indicators for evaluating insulin resistance.However,research on the association in TyG-WHtR,TyG-WC,and the risk and prognosis of major adverse cardiovascular events(MACEs)in type 2 diabetes mellitus(T2DM)cases are limited.AIM To clarify the relation in TyG-WHtR,TyG-WC,and the risk of MACEs and overall mortality in T2DM patients.METHODS Information for this investigation was obtained from Action to Control Cardiovascular Risk in Diabetes(ACCORD)/ACCORD Follow-On(ACCORDION)study database.The Cox regression model was applied to assess the relation among TyG-WHtR,TyG-WC and future MACEs risk and overall mortality in T2DM cases.The RCS analysis was utilized to explore the nonlinear correlation.Subgroup and interaction analyses were conducted to prove the robustness.The receiver operating characteristic curves were applied to analysis the additional predicting value of TyG-WHtR and TyG-WC.RESULTS After full adjustment for confounding variables,the highest baseline TyG-WHtR cohort respectively exhibited a 1.353-fold and 1.420-fold higher risk for MACEs and overall mortality,than the lowest quartile group.Similarly,the highest baseline TyG-WC cohort showed a 1.314-fold and 1.480-fold higher risk for MACEs and overall mortality,respectively.Each 1 SD increase in TyG-WHtR was significantly related to an 11.7%increase in MACEs and a 14.9%enhance in overall mortality.Each 1 SD increase in TyG-WC corresponded to an 11.5%in MACEs and a 16.6%increase in overall mortality.Including these two indexes in conventional models significantly improved the predictive power for MACEs and overall mortality.CONCLUSION TyG-WHtR and TyG-WC were promising predictors of MACEs and overall mortality risk in T2DM cases.展开更多
BACKGROUND Although the link between cardiovascular disease(CVD)and various cancers is well-established,the relationship between CVD risk and colorectal cancer(CRC)remains underexplored.AIM To elucidate the relationsh...BACKGROUND Although the link between cardiovascular disease(CVD)and various cancers is well-established,the relationship between CVD risk and colorectal cancer(CRC)remains underexplored.AIM To elucidate the relationship between CVD risk scores and CRC incidence.METHODS In this population-based cohort study,participants from the 2009 National Health Checkup were followed-up until 2020.The cardiovascular(CV)risk score was calculated as the sum of risk factors(age,family history of coronary artery disease,hypertension,smoking status,and high-density lipoprotein levels)with high-density lipoprotein(≥60 mg/dL)reducing the risk score by one.The primary outcome was incidence of newly diagnosed CRC.RESULTS Among 2526628 individuals,30329 developed CRC during a mean follow-up of 10.1 years.Categorized by CV risk scores(0,1,2,and≥3).CRC risk increased with higher CV risk scores after adjusting for covariates[(hazard ratio=1.155,95%confidence interval:1.107-1.205)in risk score≥3,P<0.001].This association individuals not using statins.Moreover,even in participants without diabetes,a higher CV risk was associated with an increased CRC risk.CONCLUSION Increased CV risk scores were significantly associated with higher CRC risk,especially among males,younger populations,and non-statin users.Thus,males with a higher CV risk score,even at a younger age,are recommended to control their risk factors and undergo individualized CRC screening.展开更多
BACKGROUND Mitochondrial myopathies are characterized by primary dysfunction of the mitochondrial respiratory chain;they typically present as chronic muscle weak-ness.Clinically visible acute respiratory dysfunctions ...BACKGROUND Mitochondrial myopathies are characterized by primary dysfunction of the mitochondrial respiratory chain;they typically present as chronic muscle weak-ness.Clinically visible acute respiratory dysfunctions associated with mito-chondrial myopathies occur rarely.CASE SUMMARY In this report,we present the case of a patient who developed postoperative hypoventilation after undergoing an uneventful administration of general anesthesia.A 34-year-old woman with no family history of myopathy underwent laparoscopic removal of a right-sided ureteric stone.Two days postoperatively,her oxygen saturation decreased rapidly,and blood gas analysis revealed hypercapnia.We promptly intubated and initiated the patient and initiated her on mechanical ventilation as she remained awake.Clinical examination findings were unremarkable;the results of laboratory investigations,including those for thyroid,hepatic,renal,and neuromuscular functions,were within normal limits.Muscle biopsy revealed muscle fibers of varying sizes as well as several dege-nerating and regenerating myofibers.Modified Gomori trichrome staining of the cross-sections revealed ragged red fibers.Based on these findings,we diagnosed the patient with mitochondrial myopathy.The patient’s condition gradually improved,and she was discharged on a home ventilator 73 days postoperatively.CONCLUSION Our case highlights that mitochondrial myopathy should be considered in the differential diagnosis of patients with postoperative respiratory failure.展开更多
Metabolic-associated fatty liver disease(MAFLD),formerly known as nonalcoho-lic fatty liver disease,is an increasing global health challenge with substantial implications for metabolic and cardiovascular health(CVH).A...Metabolic-associated fatty liver disease(MAFLD),formerly known as nonalcoho-lic fatty liver disease,is an increasing global health challenge with substantial implications for metabolic and cardiovascular health(CVH).A recent study by Fu et al investigated the relationship between CVH metrics,specifically Life’s Simple 7 and Life’s Essential 8,and the prevalence of MAFLD.While this study offered important insights into the relationship between CVH and MAFLD,several me-thodological limitations,unaddressed confounding factors,and potential biases that could impact the interpretation of their findings should be considered.The study’s cross-sectional nature restricted the ability to draw causal conclusions,and it did not fully account for potential confounding factors such as dietary habits,genetic predispositions,and medication use.Furthermore,relying on tran-sient elastography to diagnose MAFLD introduces certain diagnostic limitations.Longitudinal study designs,advanced statistical modeling techniques,and diverse population groups should be utilized to strengthen future research.Exploring the mechanistic pathways that link CVH metrics to MAFLD through multi-omics approaches and interventional studies will be essential in formulating targeted prevention and treatment strategies.Structural equation modeling and machine learning techniques could provide a more refined analysis of these interrelated factors.Additionally,future research should employ longitudinal study designs and explore genetic and epigenetic influences to enhance our un-derstanding of CVH and MAFLD interactions.展开更多
BACKGROUND The increasing risk of cardiovascular disease(CVD)associated with worsening environmental exposure is a critical health concern garnering global research attention.AIM To systematically assess the scope and...BACKGROUND The increasing risk of cardiovascular disease(CVD)associated with worsening environmental exposure is a critical health concern garnering global research attention.AIM To systematically assess the scope and characteristics of research on the relationship between environmental exposure and CVD.METHODS A thorough examination of publications on the relationship between environmental exposure and CVD from 1999 to 2022 was carried out by extensively screening the literature using the Web of Science Core Collection.The language of the selected publications was standardized to English.Afterward,different academic tools such as CiteSpace,VOSviewer,HistCite,Python,Matplotlib,and Bibliometrix were utilized to examine the research trends in this field.RESULTS The study’s findings indicated a steady increase in scientific publications among the 1640 analyzed documents,peaking in 2022 with 197 publications.The United States emerged as the leading nation regarding high-quality publications and international collaboration.Harvard University was identified as the most prolific institution.“Environmental research”was the most frequently contributing journal,and Muenzel T was recognized as the top contributor.Current research hotspots are primarily concentrated on themes such as“cardiovascular disease”,“exposure”,“risk”,“mortality”,and“air pollution”.CONCLUSION This study highlights increasing research on the link between environmental exposure and CVD,identifying key exposures and diseases while emphasizing the need for further investigation into underlying mechanisms.展开更多
Metabolic diseases have emerged as a leading cause of mortality from non-communicable diseases,posing a significant global public health challenge.Al-though the association between ceramides(Cers)and metabolic disease...Metabolic diseases have emerged as a leading cause of mortality from non-communicable diseases,posing a significant global public health challenge.Al-though the association between ceramides(Cers)and metabolic diseases is well-established,the role of the acid sphingomyelinase(ASMase)/Cer pathway in these diseases remains underexplored.This review synthesizes recent research on the biological functions,regulatory mechanisms,and targeted therapies related to the ASMase/Cer pathway in metabolic conditions,including obesity,diabetes,non-alcoholic fatty liver disease,and cardiovascular disease.The effects of the ASMase/Cer pathway on metabolic disease-related indicators,such as glycolipid metabolism,insulin resistance,inflammation,and mitochondrial homeostasis are elucidated.Moreover,this article discusses the therapeutic strategies using ASMase/Cer inhibitors for inverse prevention and treatment of these metabolic diseases in light of the possible efficacy of blockade of the ASMase/Cer pathway in arresting the progression of metabolic diseases.These insights offered herein should provide insight into the contribution of the ASMase/Cer pathway to metabolic diseases and offer tools to develop therapeutic interventions for such pathologies and their severe complications.展开更多
A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mel...A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mellitus(T2DM)based on data from randomized controlled trials(RCTs).We searched electronic databases including PubMed,Cochrane Library,Embase,and Web of Science to identify clinical trials published up to 31 March 2023.Data was pooled using a random-effects model if significant heterogeneity(I2>50%),otherwise use a fixed-effects model.Fifty-six trials that included 3317 patients were enrolled for analysis.Meta-analysis reported that probiotic/prebiotic/synbiotic supplementation significantly reduced systolic blood pressure(SBP)(weighted mean difference(WMD):-3.57 mmHg,95% confidence interval(CI):-5.36,-1.78;P=0.000),diastolic blood pressure(DBP)(WMD:-2.05 mmHg,95%CI:-3.07,-1.04;P=0.000),triglycerides(TG)(WMD:-16.10 mg/dL,95%CI:-20.16,-12.05;P=0.000),total cholesterol(TC)(WMD:-14.00 mg/dL,95%CI:-20.46,-7.55;P=0.000),low-density lipoprotein cholesterol(LDL-C)(WMD:-7.03 mg/dL,95%CI:-9.25,-4.81;P=0.000),fasting plasma glucose(FPG)(WMD:-16.57 mg/dL,95%CI:-20.39,-12.74;P=0.000),hemoglobin A1c(HbA1c)(WMD:-0.44%,95%CI:-0.68,-0.20;P=0.000),insulin(standardized mean difference(SMD):-0.37,95%CI:-0.53,-0.21;P=0.000),homeostatic model assessment of insulin resistance(HOMA-IR)(WMD:-1.05,95%CI:-1.56,-0.54;P=0.000),C-reactive protein(CRP)(SMD:-0.35,95%CI:-0.57,-0.13;P=0.002),tumor necrosis factor-α(TNF-α)(SMD:-1.07,95%CI:-1.57,-0.56;P=0.000),interleukin-6(IL-6)(SMD:-0.37,95%CI:-0.61,-0.13;P=0.003)levels,they also increased the high-density lipoprotein cholesterol(HDL-C)(WMD:3.70 mg/dL,95%CI:1.80,5.60;P=0.000)levels in T2DM patients,as compared to the placebo groups.This meta-analysis supports the use of probiotic/prebiotic/synbiotic supplementation as an adjunctive therapy to improve blood pressure,glycemic control parameters,lipid profile and inflammatory markers in patients with T2DM,which are well-known cardiovascular risk factors.展开更多
BACKGROUND As living biodrugs,mesenchymal stem cells(MSCs)have progressed to phase 3 clinical trials for cardiovascular applications.However,their limited immediate availability hampers their routine clinical use.AIM ...BACKGROUND As living biodrugs,mesenchymal stem cells(MSCs)have progressed to phase 3 clinical trials for cardiovascular applications.However,their limited immediate availability hampers their routine clinical use.AIM To validate our hypothesis that cryopreserved MSCs(CryoMSCs)are as safe and effective as freshly cultured MSC counterparts but carry logistical advantages.METHODS Four databases were systematically reviewed for relevant randomized controlled trials(RCTs)evaluating the safety and efficacy of CryoMSCs from various tissue sources in treating patients with heart disease.A subgroup analysis was performed based on MSC source and post-thaw cell viability to determine treatment effects across different CryoMSCs sources and viability status.Weighted mean differences(WMDs)and odds ratios were calculated to measure changes in the estimated treatment effects.All statistical analyses were performed using RevMan version 5.4.1 software.RESULTS Seven RCTs(285 patients)met the eligibility criteria for inclusion in the metaanalysis.During short-term follow-up,^(Cryo)MSCs demonstrated a significant 2.11%improvement in left ventricular ejection fraction(LVEF)[WMD(95%CI)=2.11(0.66-3.56),P=0.004,I2=1%],with umbilical cord-derived MSCs being the most effective cell type.However,the significant effect on LVEF was not sustained over the 12 months of follow-up.Subgroup analysis demonstrated a substantial 3.44%improvement in LVEF[WMD(95%CI)=3.44(1.46-5.43),P=0.0007,I2=0%]when using MSCs with post-thaw viability exceeding 80%.There was no statistically significant difference in the frequency of major cardiac adverse events observed in rehospitalization or mortality in patients treated with ^(Cryo)MSCs vs the control group.CONCLUSION ^(Cryo)MSCs are a promising option for heart failure patients,particularly considering the current treatment options for cardiovascular diseases.Our data suggest that ^(Cryo)MSCs could be a viable alternative or complementary treatment to the current options,potentially improving patient outcomes.展开更多
Pulmonary fibrosis significantly contributes to the pathogenesis of acute respiratory distress syndrome(ARDS),markedly increasing patient mortality.Despite the established anti-fibrotic effects of mesenchymal stem cel...Pulmonary fibrosis significantly contributes to the pathogenesis of acute respiratory distress syndrome(ARDS),markedly increasing patient mortality.Despite the established anti-fibrotic effects of mesenchymal stem cells(MSCs),numerous challenges hinder their clinical application.A recent study demon-strated that microvesicles(MVs)from MSCs(MSC-MVs)could attenuate ARDS-related pulmonary fibrosis and enhance lung function via hepatocyte growth factor mRNA transcription.This discovery presents a promising strategy for managing ARDS-associated pulmonary fibrosis.This article initially examines the safety and efficacy of MSCs from both basic science and clinical perspectives,subsequently exploring the potential and obstacles of employing MSC-MVs as a novel therapeutic approach.Additionally,it provides perspectives on future research into the application of MSC-MVs in ARDS-associated pulmonary fi-brosis.展开更多
This paper aims at the presentation of an interface to simulate cardiovascular respiratory system. The authors are interested in the resolution of optimal control problem related to the performance of a 30 years old w...This paper aims at the presentation of an interface to simulate cardiovascular respiratory system. The authors are interested in the resolution of optimal control problem related to the performance of a 30 years old woman. The results show in the most case the determinant parameters of cardiovascular respiratory system reach the equilibrium value due to its controls that is heart rate and alveolar ventilation.展开更多
High ce rvical spinal co rd injuries induce permanent neuromotor and autonomic deficits.These injuries impact both central respiratory and cardiovascular functions through modulation of the sympathetic nervous system....High ce rvical spinal co rd injuries induce permanent neuromotor and autonomic deficits.These injuries impact both central respiratory and cardiovascular functions through modulation of the sympathetic nervous system.So far,cardiovascular studies have focused on models of complete contusion or transection at the lower cervical and thoracic levels and diaphragm activity evaluations using invasive methods.The present study aimed to evaluate the impact of C2 hemisection on different parameters representing vital functions(i.e.,respiratory function,cardiovascular,and renal filtration parameters)at the moment of injury and 7 days post-injury in rats.No ventilatory parameters evaluated by plethys mography were impacted during quiet breathing after 7 days post-injury,whereas permanent diaphragm hemiplegia was observed by ultrasound and confirmed by diaphragmatic electromyography in anesthetized rats.Interestingly,the mean arterial pressure was reduced immediately after C2 hemisection,with complete compensation at 7 days post-injury.Renal filtration was unaffected at 7 days post-injury;however,remnant systolic dysfunction chara cterized by a reduced left ventricular ejection fraction persisted at 7 days post-injury.Taken together,these results demonstrated that following C2 hemisection,diaphragm activity and systolic function are impa cted up to 7 days post-injury,whereas the respiratory and cardiovascular systems display vast ada ptation to maintain ventilatory parameters and blood pressure homeostasis,with the latter likely sustained by the remaining descending sympathetic inputs spared by the initial injury.A better broad characterization of the physiopathology of high cervical spinal cord injuries covering a longer time period post-injury could be beneficial for understanding evaluations of putative therapeutics to further increase cardiorespiratory recovery.展开更多
BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases cardiovascular disease(CVD)risk irrespective of other risk factors.However,large-scale cardiovascular sex and race differences are poorly understood.AIM To ...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases cardiovascular disease(CVD)risk irrespective of other risk factors.However,large-scale cardiovascular sex and race differences are poorly understood.AIM To investigate the relationship between NAFLD and major cardiovascular and cerebrovascular events(MACCE)in subgroups using a nationally representative United States inpatient sample.METHODS We examined National Inpatient Sample(2019)to identify adult hospitalizations with NAFLD by age,sex,and race using ICD-10-CM codes.Clinical and demographic characteristics,comorbidities,and MACCE-related mortality,acute myocardial infarction(AMI),cardiac arrest,and stroke were compared in NAFLD cohorts by sex and race.Multivariable regression analyses were adjusted for sociodemographic characteristics,hospitalization features,and comorbidities.RESULTS We examined 409130 hospitalizations[median 55(IQR 43-66)years]with NFALD.NAFLD was more common in females(1.2%),Hispanics(2%),and Native Americans(1.9%)than whites.Females often reported non-elective admissions,Medicare enrolment,the median age of 55(IQR 42-67),and poor income.Females had higher obesity and uncomplicated diabetes but lower hypertension,hyperlipidemia,and complicated diabetes than males.Hispanics had a median age of 48(IQR 37-60),were Medicaid enrollees,and had non-elective admissions.Hispanics had greater diabetes and obesity rates than whites but lower hypertension and hyperlipidemia.MACCE,all-cause mortality,AMI,cardiac arrest,and stroke were all greater in elderly individuals(P<0.001).MACCE,AMI,and cardiac arrest were more common in men(P<0.001).Native Americans(aOR 1.64)and Asian Pacific Islanders(aOR 1.18)had higher all-cause death risks than whites.CONCLUSION Increasing age and male sex link NAFLD with adverse MACCE outcomes;Native Americans and Asian Pacific Islanders face higher mortality,highlighting a need for tailored interventions and care.展开更多
Since 1990,China has made considerable progress in resolving the problem of“treatment difficulty”of cardiovascular diseases(CVD).The prevalent unhealthy lifestyle among Chinese residents has exposed a massive propor...Since 1990,China has made considerable progress in resolving the problem of“treatment difficulty”of cardiovascular diseases(CVD).The prevalent unhealthy lifestyle among Chinese residents has exposed a massive proportion of the population to CVD risk factors,and this situation is further worsened due to the accelerated aging population in China.CVD remains one of the greatest threats to the health of Chinese residents.In terms of the proportions of disease mortality among urban and rural residents in China,CVD has persistently ranked first.In 2021,CVD accounted for 48.98%and 47.35%of deaths in rural and urban areas,respectively.Two out of every five deaths can be attributed to CVD.To implement a national policy“focusing on the primary health institute and emphasizing prevention”and truly achieve a shift of CVD prevention and treatment from hospitals to communities,the National Center for Cardiovascular Diseases has organized experts from relevant fields across China to compile the“Report on Cardiovascular Health and Diseases in China”annually since 2005.The 2024 report is established based on representative,published,and high-quality big-data research results from cross-sectional and cohort population epidemiological surveys,randomized controlled clinical trials,large sample registry studies,and typical community prevention and treatment cases,along with data from some projects undertaken by the National Center for Cardiovascular Diseases.These firsthand data not only enrich the content of the current report but also provide a more timely and comprehensive reflection of the status of CVD prevention and treatment in China.展开更多
文摘The decreasing of hazard ratio for cancer incidence (HRCVD) in the range of twenty native tissues (lung, liver, brain, hematologic, neuroendocrine renal, pancreas, lymphoid, bladder, colon, lip-oral-head-neck, leukocytic, rectum and anus, thyroid, soft tissue, prostate, skin, ovarian, breast, uterine) as much, as decreasing of the level of cardiovascular pathology (CVD) in the host before malignization, have been described by C.F. Bell et al. in 2023. Earlier, in 2022, the decreasing of 5-year mortality from cancer in similar range of tissues discussed by us as the inverse dependence from the content of stem CD34 markers in tissues before malignization, with example of population in England. In present article we investigate the interrelation between both data more thoroughly, using accessible and more representative populations level of the data. The analysis shows that high level of HRCVD is able to predicts only high cancer death for tissue sites in the beginning of the range, being applied to the referent data of cancer cases and deaths in estimated population of USA 2024. Along with this, an increasing the content of CD34 stem marker in the native tissues of the same range was favorite for increasing of cancer’s cases at the end of the range, diminishing, in parallel, the signs of vasculo-endothelial pathology, i.e. HR CVD. Thus, the cases (incidence) of cancer depend directly rather from content of CD34, which preexisted in native sites, than that from HRCVD. Further analysis shows that CD34 content averaged over twenty cites dominates over that CD2 marker of total T-cells more than 7 times, in oppose to their ratio in the blood. The enhancement of stem CD34 marker in the range of tissues is accompanied by unidirectional rising of its maturing derivatives, vasculo-endothelial CD31 and total T-cells CD2 markers, which contents relate positively to increasing of cancer death in US population 2024. The increase of CD34 decreases cancer mortality (death: cases) in sites, but indirectly, rather due to enhancement of the denominator. The high HRCVD (more than 1.0) in range of 20 tissues, concerns of those of them, which have had highest mitotic activity (by Ki67), but lowest “stemness” (by CD34), “vascularity” (by CD31), cancer’s incidence (cases) and the worse results of therapy. Oppositely, the normal tissue with lowest HRCVD (below 1.0) and Ki67, but highest CD34, CD31, and cancer incidence (cases) are more sensitive to treatment. Thus, the residential hematopoietic “stemness” in native tissues acts as natural protectors for cardio-vascular system and promoter for cancer incidence in them. The steady and irreversible exhaustion of current regenerative resource (CRR) of BM, which assumed by us as a product of CD34 number and average telomeres length, manifests itself in acceleration of non-malignant CVD and deceleration of malignancy in population +70 (in term the death per 105), according to data extracted from WHO Mortality Database. The similar deficit of CD34 arises artificially during cytotoxic treatment of cancer, when rapid waste of local CRR forces malignant cells to search more “stemness” cites. The competition between malignant and native tissues of the host for scanty CRR seems to be the most important factor for evaluation and prediction of prevalence, curability, and long-term results in oncology.
文摘Introduction: Respiratory distress is a clinical condition accompanied by an increase in work of breathing, with the respiratory accessory muscles brought into play to ensure normal arterial oxygenation. It is a major cause of morbidity and mortality in pediatrics. The aim of our study was to investigate the epidemiological, clinical and therapeutic aspects of respiratory distress in children aged between 1 month and 15 years seen in the emergency department of the Bangui paediatric university hospital. Methodology: This was a 3-month descriptive cross-sectional study, from January 1 to March 31, 2023. All children aged 1 month to less than 15 years presenting with respiratory distress were included. Results: A total of 3021 children were admitted to the emergency medical services of Bangui’s pediatric university hospital. Of these, 164 were included in the study. The predominance was male, with a sex ratio of 1.09. The 0 - 2 age group was the most represented, with 67 patients (42.85%). The majority of patients came from Bangui, accounting for 146 (89.02%) of cases. Respiratory difficulty (59.15%), characterized by dyspnea and cough, associated with fever, vomiting, physical asthenia and diarrhea, were the main reasons for consultation. The main pathologies noted were respiratory 92 (56.10%), followed by cardiac pathologies 21 (12.8%). Antibiotic administration (76.82%) was the most common therapeutic procedure used in the management of respiratory distress. Conclusion: Respiratory distress remains an important cause of infant mortality in our context, with major management problems.
文摘Photon-counting computed tomography(PCCT)represents a significant advancement in pediatric cardiovascular imaging.Traditional CT systems employ energy-integrating detectors that convert X-ray photons into visible light,whereas PCCT utilizes photon-counting detectors that directly transform X-ray photons into electric signals.This direct conversion allows photon-counting detectors to sort photons into discrete energy levels,thereby enhancing image quality through superior noise reduction,improved spatial and contrast resolution,and reduced artifacts.In pediatric applications,PCCT offers substantial benefits,including lower radiation doses,which may help reduce the risk of malignancy in pediatric patients,with perhaps greater potential to benefit those with repeated exposure from a young age.Enhanced spatial resolution facilitates better visualization of small structures,vital for diagnosing congenital heart defects.Additionally,PCCT’s spectral capabilities improve tissue characterization and enable the creation of virtual monoenergetic images,which enhance soft-tissue contrast and potentially reduce contrast media doses.Initial clinical results indicate that PCCT provides superior image quality and diagnostic accuracy compared to conven-tional CT,particularly in challenging pediatric cardiovascular cases.As PCCT technology matures,further research and standardized protocols will be essential to fully integrate it into pediatric imaging practices,ensuring optimized diagnostic outcomes and patient safety.
文摘The COVID-19 pandemic has profoundly impacted global health, with far-reaching consequences beyond respiratory complications. Increasing evidence highlights the link between COVID-19 and cardiovascular diseases (CVD), raising concerns about long-term health risks for those recovering from the virus. This study rigorously investigates the influence of COVID-19 on cardiovascular disease risk, focusing on conditions such as heart failure and myocardial infarction. Using a dataset of 52,683 individuals aged 30 to 80, including both COVID-19 survivors and those unaffected, the study employs machine learning models—logistic regression, decision trees, and random forests—to predict cardiovascular outcomes. The multifaceted approach allowed for a comprehensive evaluation of the model’s predictive capabilities, with logistic regression yielding the highest Binary F1 score of 0.94, effectively identifying cardiovascular risks in both the COVID-19 and non-COVID-19 groups. The correlation matrix revealed significant associations between COVID-19 and key symptoms of heart disease, emphasizing the need for early cardiovascular risk assessment. These findings underscore the importance of machine learning in enhancing early diagnosis and developing preventive strategies for COVID-19-related heart complications. Ultimately, this research contributes to a broader understanding of the pandemic’s lasting health effects, highlighting the critical role of cardiovascular care in post-COVID-19 recovery.
文摘BACKGROUND Acute respiratory distress syndrome(ARDS)is a critical condition characterized by acute hypoxemia,non-cardiogenic pulmonary edema,and decreased lung compliance.The Berlin definition,updated in 2012,classifies ARDS severity based on the partial pressure of arterial oxygen/fractional inspired oxygen fraction ratio.Despite various treatment strategies,ARDS remains a significant public health concern with high mortality rates.AIM To evaluate the implications of driving pressure(DP)in ARDS management and its potential as a protective lung strategy.METHODS We conducted a systematic review using databases including EbscoHost,MEDLINE,CINAHL,PubMed,and Google Scholar.The search was limited to articles published between January 2015 and September 2024.Twenty-three peer-reviewed articles were selected based on inclusion criteria focusing on adult ARDS patients undergoing mechanical ventilation and DP strategies.The literature review was conducted and reported according to PRISMA 2020 guidelines.RESULTS DP,the difference between plateau pressure and positive end-expiratory pressure,is crucial in ARDS management.Studies indicate that lower DP levels are significantly associated with improved survival rates in ARDS patients.DP is a better predictor of mortality than tidal volume or positive end-expiratory pressure alone.Adjusting DP by optimizing lung compliance and minimizing overdistension and collapse can reduce ventilator-induced lung injury.CONCLUSION DP is a valuable parameter in ARDS management,offering a more precise measure of lung stress and strain than traditional metrics.Implementing DP as a threshold for safety can enhance protective ventilation strategies,po-tentially reducing mortality in ARDS patients.Further research is needed to refine DP measurement techniques and validate its clinical application in diverse patient populations.
文摘BACKGROUND In multisystem inflammatory syndrome in children(MIS-C)with coronavirus disease 2019,there was paucity of data from low-income and middle-income countries on cardiovascular involvement and its longitudinal outcomes.We planned to estimate the pattern of cardiovascular involvement among children with MIS-C and its mid-term outcomes.AIM To determine association between cardiovascular abnormalities and clinical and laboratory parameters.To study the time-line for resolution of various abnormalities.METHODS In this prospective study done in a tertiary care hospital,270 were recruited from June 2020 to January 2022.Baseline demographic data and clinical presentation were recorded.Laboratory parameters and echocardiography were done at admission.Follow-up was done at 2 weeks,3 months,6 months and 1 year after diagnosis.Descriptive statistics were used for parametric and non-parametric data.Risk factors were identified by multivariate regression analysis.RESULTS The 211(78.2%)had cardiac involvement and 102 needed intensive care unit(ICU)admission.Cardiovascular abnormalities observed were shock 123(45.6%),coronary dilatation 28(10.4%),coronary aneurysm 77(28.5%),left ventricular(LV)dysfunction 78(29.3%),mitral regurgitation(MR)77(28.5%)and pericardial effusion 98(36.3%).Coronary artery aneurysm/dilatation during follow-up at 2 weeks and 1 year were 25.7%and 0.9%respectively.Multivariate regression analysis revealed breathlessness[odds ratio(OR)=3.91,95%CI:1.25-12.21,P=0.019]and hi-flow nasal cannula(HFNC)support(OR=8.5,95%CI:1.06-68.38,P=0.044)as predictors of cardiovascular involvement.Higher mean age(OR=1.16,95%CI:1.02-1.32,P=0.026),breathlessness(OR=4.99,95%CI:2.05-12.20,P<0.001),gallop(OR=4.45,95%CI:0.41-2.52,P=0.016),MR(OR=3.61,95%CI:1.53-8.53,P=0.004)and invasive ventilation(OR=4.01,95%CI:1.28-12.58,P=0.017)were predictive of LV dysfunction.Altered sensorium(OR=4.96,95%CI:2.23-11.02,P<0.001),headache(OR=6.61,95%CI:1.46-29.92,P=0.014),HFNC(OR=7.03,95%CI:2.04-24.29,P=0.002),non-rebreathing mask usage(OR=21.13,95%CI:9.00-49.61,P<0.001)and invasive ventilation(OR=5.64,95%CI:1.42-22.45,P=0.014)were risk factors for shock.Anemia was a risk factor for coronary involvement(OR=3.09,95%CI:1.79-5.34,P<0.001).CONCLUSION Significant number of children with MIS-C had cardiovascular involvement contributing to higher ICU management.Although shock resolved quickly,resolution of ventricular function and coronary abnormalities were slower,and hence warrants a structured long-term follow-up protocol.
文摘Type 2 diabetes mellitus is associated with a 2-4 times increased risk of cardiovascular(CV)disease.Glucagon-like polypeptide-1 receptor agonists(GLP1RA)and sodium-glucose cotransporter-2 inhibitors(SGLT2i)are two important classes of drugs with CV benefits independent of their antihyperglycemic efficacy.The CV outcome trials of both GLP1RA and SGLT2i have demonstrated CV superiority/neutrality concerning major adverse CV events(MACE).While GLP1RAs have exhibited a significant reduction in ischemic stroke and myocardial infarction(MI),SGLT2i have demonstrated a uniformly significant reduction in hospitalization for heart failure(HF)as a class effect.The unique clinical benefits and the distinct but complementary mechanisms of action make the combination of these drugs a mechanistically sound one.Recent meta-analyses suggest an independent and additive benefit of combination therapy of GLP1RA/SGLT2i vs monotherapy.Zhu et al,in a recent issue of the World Journal of Diabetes,demonstrates a numerically lower hazard ratio(HR)for CV outcomes with combination therapy vs monotherapy with either agent,with a reduction in MACE compared to GLP1RA alone[HR=0.51,95%confidence interval(CI):0.16-1.65],or SGLT2i alone(HR=0.48,95%CI:0.15-1.54).The CV death rate was also lower with combination therapy compared to GLP1RA alone(HR=0.58,95%CI:0.08-3.39),or SGLT2i alone(HR=0.55,95%CI:0.07-3.25).Fatal and non-fatal MI and fatal and non-fatal stroke were reduced with combination therapy compared to GLP1RA alone(HR=0.45,95%CI:0.10-2.18 and HR=0.86,95%CI:0.12-6.23,respectively),or SGLT2i alone(HR=0.44,95%CI:0.09-2.10 and HR=0.74,95%CI:0.10-5.47,respectively).Hospitalization for HF was prevented with combination therapy compared to GLP1RA alone(HR=0.26,95%CI:0.03-1.88),or SGLT2i alone(HR=0.33,95%CI:0.04-2.53).They also demonstrated that GLP1RA or SGLT2i monotherapy may not provide significant improvement in CV death and recurrent MI in patients with prior MI or HF,proposing a role for combination therapy in this subgroup.Appropriate patient selection is vital to optimize CV risk reduction as well as the cost-effectiveness of this combination therapy.
文摘BACKGROUND Recent studies have indicated that triglyceride glucose(TyG)-waist height ratio(WHtR)and TyG-waist circumference(TyG-WC)are effective indicators for evaluating insulin resistance.However,research on the association in TyG-WHtR,TyG-WC,and the risk and prognosis of major adverse cardiovascular events(MACEs)in type 2 diabetes mellitus(T2DM)cases are limited.AIM To clarify the relation in TyG-WHtR,TyG-WC,and the risk of MACEs and overall mortality in T2DM patients.METHODS Information for this investigation was obtained from Action to Control Cardiovascular Risk in Diabetes(ACCORD)/ACCORD Follow-On(ACCORDION)study database.The Cox regression model was applied to assess the relation among TyG-WHtR,TyG-WC and future MACEs risk and overall mortality in T2DM cases.The RCS analysis was utilized to explore the nonlinear correlation.Subgroup and interaction analyses were conducted to prove the robustness.The receiver operating characteristic curves were applied to analysis the additional predicting value of TyG-WHtR and TyG-WC.RESULTS After full adjustment for confounding variables,the highest baseline TyG-WHtR cohort respectively exhibited a 1.353-fold and 1.420-fold higher risk for MACEs and overall mortality,than the lowest quartile group.Similarly,the highest baseline TyG-WC cohort showed a 1.314-fold and 1.480-fold higher risk for MACEs and overall mortality,respectively.Each 1 SD increase in TyG-WHtR was significantly related to an 11.7%increase in MACEs and a 14.9%enhance in overall mortality.Each 1 SD increase in TyG-WC corresponded to an 11.5%in MACEs and a 16.6%increase in overall mortality.Including these two indexes in conventional models significantly improved the predictive power for MACEs and overall mortality.CONCLUSION TyG-WHtR and TyG-WC were promising predictors of MACEs and overall mortality risk in T2DM cases.
文摘BACKGROUND Although the link between cardiovascular disease(CVD)and various cancers is well-established,the relationship between CVD risk and colorectal cancer(CRC)remains underexplored.AIM To elucidate the relationship between CVD risk scores and CRC incidence.METHODS In this population-based cohort study,participants from the 2009 National Health Checkup were followed-up until 2020.The cardiovascular(CV)risk score was calculated as the sum of risk factors(age,family history of coronary artery disease,hypertension,smoking status,and high-density lipoprotein levels)with high-density lipoprotein(≥60 mg/dL)reducing the risk score by one.The primary outcome was incidence of newly diagnosed CRC.RESULTS Among 2526628 individuals,30329 developed CRC during a mean follow-up of 10.1 years.Categorized by CV risk scores(0,1,2,and≥3).CRC risk increased with higher CV risk scores after adjusting for covariates[(hazard ratio=1.155,95%confidence interval:1.107-1.205)in risk score≥3,P<0.001].This association individuals not using statins.Moreover,even in participants without diabetes,a higher CV risk was associated with an increased CRC risk.CONCLUSION Increased CV risk scores were significantly associated with higher CRC risk,especially among males,younger populations,and non-statin users.Thus,males with a higher CV risk score,even at a younger age,are recommended to control their risk factors and undergo individualized CRC screening.
文摘BACKGROUND Mitochondrial myopathies are characterized by primary dysfunction of the mitochondrial respiratory chain;they typically present as chronic muscle weak-ness.Clinically visible acute respiratory dysfunctions associated with mito-chondrial myopathies occur rarely.CASE SUMMARY In this report,we present the case of a patient who developed postoperative hypoventilation after undergoing an uneventful administration of general anesthesia.A 34-year-old woman with no family history of myopathy underwent laparoscopic removal of a right-sided ureteric stone.Two days postoperatively,her oxygen saturation decreased rapidly,and blood gas analysis revealed hypercapnia.We promptly intubated and initiated the patient and initiated her on mechanical ventilation as she remained awake.Clinical examination findings were unremarkable;the results of laboratory investigations,including those for thyroid,hepatic,renal,and neuromuscular functions,were within normal limits.Muscle biopsy revealed muscle fibers of varying sizes as well as several dege-nerating and regenerating myofibers.Modified Gomori trichrome staining of the cross-sections revealed ragged red fibers.Based on these findings,we diagnosed the patient with mitochondrial myopathy.The patient’s condition gradually improved,and she was discharged on a home ventilator 73 days postoperatively.CONCLUSION Our case highlights that mitochondrial myopathy should be considered in the differential diagnosis of patients with postoperative respiratory failure.
文摘Metabolic-associated fatty liver disease(MAFLD),formerly known as nonalcoho-lic fatty liver disease,is an increasing global health challenge with substantial implications for metabolic and cardiovascular health(CVH).A recent study by Fu et al investigated the relationship between CVH metrics,specifically Life’s Simple 7 and Life’s Essential 8,and the prevalence of MAFLD.While this study offered important insights into the relationship between CVH and MAFLD,several me-thodological limitations,unaddressed confounding factors,and potential biases that could impact the interpretation of their findings should be considered.The study’s cross-sectional nature restricted the ability to draw causal conclusions,and it did not fully account for potential confounding factors such as dietary habits,genetic predispositions,and medication use.Furthermore,relying on tran-sient elastography to diagnose MAFLD introduces certain diagnostic limitations.Longitudinal study designs,advanced statistical modeling techniques,and diverse population groups should be utilized to strengthen future research.Exploring the mechanistic pathways that link CVH metrics to MAFLD through multi-omics approaches and interventional studies will be essential in formulating targeted prevention and treatment strategies.Structural equation modeling and machine learning techniques could provide a more refined analysis of these interrelated factors.Additionally,future research should employ longitudinal study designs and explore genetic and epigenetic influences to enhance our un-derstanding of CVH and MAFLD interactions.
文摘BACKGROUND The increasing risk of cardiovascular disease(CVD)associated with worsening environmental exposure is a critical health concern garnering global research attention.AIM To systematically assess the scope and characteristics of research on the relationship between environmental exposure and CVD.METHODS A thorough examination of publications on the relationship between environmental exposure and CVD from 1999 to 2022 was carried out by extensively screening the literature using the Web of Science Core Collection.The language of the selected publications was standardized to English.Afterward,different academic tools such as CiteSpace,VOSviewer,HistCite,Python,Matplotlib,and Bibliometrix were utilized to examine the research trends in this field.RESULTS The study’s findings indicated a steady increase in scientific publications among the 1640 analyzed documents,peaking in 2022 with 197 publications.The United States emerged as the leading nation regarding high-quality publications and international collaboration.Harvard University was identified as the most prolific institution.“Environmental research”was the most frequently contributing journal,and Muenzel T was recognized as the top contributor.Current research hotspots are primarily concentrated on themes such as“cardiovascular disease”,“exposure”,“risk”,“mortality”,and“air pollution”.CONCLUSION This study highlights increasing research on the link between environmental exposure and CVD,identifying key exposures and diseases while emphasizing the need for further investigation into underlying mechanisms.
基金Supported by Ganzhou City’s“Light of the Soviet Area”Talent Project,No.GZSQZG202301009。
文摘Metabolic diseases have emerged as a leading cause of mortality from non-communicable diseases,posing a significant global public health challenge.Al-though the association between ceramides(Cers)and metabolic diseases is well-established,the role of the acid sphingomyelinase(ASMase)/Cer pathway in these diseases remains underexplored.This review synthesizes recent research on the biological functions,regulatory mechanisms,and targeted therapies related to the ASMase/Cer pathway in metabolic conditions,including obesity,diabetes,non-alcoholic fatty liver disease,and cardiovascular disease.The effects of the ASMase/Cer pathway on metabolic disease-related indicators,such as glycolipid metabolism,insulin resistance,inflammation,and mitochondrial homeostasis are elucidated.Moreover,this article discusses the therapeutic strategies using ASMase/Cer inhibitors for inverse prevention and treatment of these metabolic diseases in light of the possible efficacy of blockade of the ASMase/Cer pathway in arresting the progression of metabolic diseases.These insights offered herein should provide insight into the contribution of the ASMase/Cer pathway to metabolic diseases and offer tools to develop therapeutic interventions for such pathologies and their severe complications.
基金Jiangsu College of Nursing 2023 Special Fund for Research and Development of Medical-Educational Integration。
文摘A systematic review and meta-analysis study was conducted to assess the effectiveness of probiotic/prebiotic/synbiotic supplementation on the effects of cardiovascular risk factors in patients with type 2 diabetes mellitus(T2DM)based on data from randomized controlled trials(RCTs).We searched electronic databases including PubMed,Cochrane Library,Embase,and Web of Science to identify clinical trials published up to 31 March 2023.Data was pooled using a random-effects model if significant heterogeneity(I2>50%),otherwise use a fixed-effects model.Fifty-six trials that included 3317 patients were enrolled for analysis.Meta-analysis reported that probiotic/prebiotic/synbiotic supplementation significantly reduced systolic blood pressure(SBP)(weighted mean difference(WMD):-3.57 mmHg,95% confidence interval(CI):-5.36,-1.78;P=0.000),diastolic blood pressure(DBP)(WMD:-2.05 mmHg,95%CI:-3.07,-1.04;P=0.000),triglycerides(TG)(WMD:-16.10 mg/dL,95%CI:-20.16,-12.05;P=0.000),total cholesterol(TC)(WMD:-14.00 mg/dL,95%CI:-20.46,-7.55;P=0.000),low-density lipoprotein cholesterol(LDL-C)(WMD:-7.03 mg/dL,95%CI:-9.25,-4.81;P=0.000),fasting plasma glucose(FPG)(WMD:-16.57 mg/dL,95%CI:-20.39,-12.74;P=0.000),hemoglobin A1c(HbA1c)(WMD:-0.44%,95%CI:-0.68,-0.20;P=0.000),insulin(standardized mean difference(SMD):-0.37,95%CI:-0.53,-0.21;P=0.000),homeostatic model assessment of insulin resistance(HOMA-IR)(WMD:-1.05,95%CI:-1.56,-0.54;P=0.000),C-reactive protein(CRP)(SMD:-0.35,95%CI:-0.57,-0.13;P=0.002),tumor necrosis factor-α(TNF-α)(SMD:-1.07,95%CI:-1.57,-0.56;P=0.000),interleukin-6(IL-6)(SMD:-0.37,95%CI:-0.61,-0.13;P=0.003)levels,they also increased the high-density lipoprotein cholesterol(HDL-C)(WMD:3.70 mg/dL,95%CI:1.80,5.60;P=0.000)levels in T2DM patients,as compared to the placebo groups.This meta-analysis supports the use of probiotic/prebiotic/synbiotic supplementation as an adjunctive therapy to improve blood pressure,glycemic control parameters,lipid profile and inflammatory markers in patients with T2DM,which are well-known cardiovascular risk factors.
文摘BACKGROUND As living biodrugs,mesenchymal stem cells(MSCs)have progressed to phase 3 clinical trials for cardiovascular applications.However,their limited immediate availability hampers their routine clinical use.AIM To validate our hypothesis that cryopreserved MSCs(CryoMSCs)are as safe and effective as freshly cultured MSC counterparts but carry logistical advantages.METHODS Four databases were systematically reviewed for relevant randomized controlled trials(RCTs)evaluating the safety and efficacy of CryoMSCs from various tissue sources in treating patients with heart disease.A subgroup analysis was performed based on MSC source and post-thaw cell viability to determine treatment effects across different CryoMSCs sources and viability status.Weighted mean differences(WMDs)and odds ratios were calculated to measure changes in the estimated treatment effects.All statistical analyses were performed using RevMan version 5.4.1 software.RESULTS Seven RCTs(285 patients)met the eligibility criteria for inclusion in the metaanalysis.During short-term follow-up,^(Cryo)MSCs demonstrated a significant 2.11%improvement in left ventricular ejection fraction(LVEF)[WMD(95%CI)=2.11(0.66-3.56),P=0.004,I2=1%],with umbilical cord-derived MSCs being the most effective cell type.However,the significant effect on LVEF was not sustained over the 12 months of follow-up.Subgroup analysis demonstrated a substantial 3.44%improvement in LVEF[WMD(95%CI)=3.44(1.46-5.43),P=0.0007,I2=0%]when using MSCs with post-thaw viability exceeding 80%.There was no statistically significant difference in the frequency of major cardiac adverse events observed in rehospitalization or mortality in patients treated with ^(Cryo)MSCs vs the control group.CONCLUSION ^(Cryo)MSCs are a promising option for heart failure patients,particularly considering the current treatment options for cardiovascular diseases.Our data suggest that ^(Cryo)MSCs could be a viable alternative or complementary treatment to the current options,potentially improving patient outcomes.
文摘Pulmonary fibrosis significantly contributes to the pathogenesis of acute respiratory distress syndrome(ARDS),markedly increasing patient mortality.Despite the established anti-fibrotic effects of mesenchymal stem cells(MSCs),numerous challenges hinder their clinical application.A recent study demon-strated that microvesicles(MVs)from MSCs(MSC-MVs)could attenuate ARDS-related pulmonary fibrosis and enhance lung function via hepatocyte growth factor mRNA transcription.This discovery presents a promising strategy for managing ARDS-associated pulmonary fibrosis.This article initially examines the safety and efficacy of MSCs from both basic science and clinical perspectives,subsequently exploring the potential and obstacles of employing MSC-MVs as a novel therapeutic approach.Additionally,it provides perspectives on future research into the application of MSC-MVs in ARDS-associated pulmonary fi-brosis.
文摘This paper aims at the presentation of an interface to simulate cardiovascular respiratory system. The authors are interested in the resolution of optimal control problem related to the performance of a 30 years old woman. The results show in the most case the determinant parameters of cardiovascular respiratory system reach the equilibrium value due to its controls that is heart rate and alveolar ventilation.
基金supported by funding from the Chancellerie des Universites de Paris(Legs Poix)(to SV)Fondation Medisite(to SV)+1 种基金INSERM(to SV,AM,AF)Universite de Versailles Saint-Quentin-en-Yvelines(to SV,AM,AF)。
文摘High ce rvical spinal co rd injuries induce permanent neuromotor and autonomic deficits.These injuries impact both central respiratory and cardiovascular functions through modulation of the sympathetic nervous system.So far,cardiovascular studies have focused on models of complete contusion or transection at the lower cervical and thoracic levels and diaphragm activity evaluations using invasive methods.The present study aimed to evaluate the impact of C2 hemisection on different parameters representing vital functions(i.e.,respiratory function,cardiovascular,and renal filtration parameters)at the moment of injury and 7 days post-injury in rats.No ventilatory parameters evaluated by plethys mography were impacted during quiet breathing after 7 days post-injury,whereas permanent diaphragm hemiplegia was observed by ultrasound and confirmed by diaphragmatic electromyography in anesthetized rats.Interestingly,the mean arterial pressure was reduced immediately after C2 hemisection,with complete compensation at 7 days post-injury.Renal filtration was unaffected at 7 days post-injury;however,remnant systolic dysfunction chara cterized by a reduced left ventricular ejection fraction persisted at 7 days post-injury.Taken together,these results demonstrated that following C2 hemisection,diaphragm activity and systolic function are impa cted up to 7 days post-injury,whereas the respiratory and cardiovascular systems display vast ada ptation to maintain ventilatory parameters and blood pressure homeostasis,with the latter likely sustained by the remaining descending sympathetic inputs spared by the initial injury.A better broad characterization of the physiopathology of high cervical spinal cord injuries covering a longer time period post-injury could be beneficial for understanding evaluations of putative therapeutics to further increase cardiorespiratory recovery.
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases cardiovascular disease(CVD)risk irrespective of other risk factors.However,large-scale cardiovascular sex and race differences are poorly understood.AIM To investigate the relationship between NAFLD and major cardiovascular and cerebrovascular events(MACCE)in subgroups using a nationally representative United States inpatient sample.METHODS We examined National Inpatient Sample(2019)to identify adult hospitalizations with NAFLD by age,sex,and race using ICD-10-CM codes.Clinical and demographic characteristics,comorbidities,and MACCE-related mortality,acute myocardial infarction(AMI),cardiac arrest,and stroke were compared in NAFLD cohorts by sex and race.Multivariable regression analyses were adjusted for sociodemographic characteristics,hospitalization features,and comorbidities.RESULTS We examined 409130 hospitalizations[median 55(IQR 43-66)years]with NFALD.NAFLD was more common in females(1.2%),Hispanics(2%),and Native Americans(1.9%)than whites.Females often reported non-elective admissions,Medicare enrolment,the median age of 55(IQR 42-67),and poor income.Females had higher obesity and uncomplicated diabetes but lower hypertension,hyperlipidemia,and complicated diabetes than males.Hispanics had a median age of 48(IQR 37-60),were Medicaid enrollees,and had non-elective admissions.Hispanics had greater diabetes and obesity rates than whites but lower hypertension and hyperlipidemia.MACCE,all-cause mortality,AMI,cardiac arrest,and stroke were all greater in elderly individuals(P<0.001).MACCE,AMI,and cardiac arrest were more common in men(P<0.001).Native Americans(aOR 1.64)and Asian Pacific Islanders(aOR 1.18)had higher all-cause death risks than whites.CONCLUSION Increasing age and male sex link NAFLD with adverse MACCE outcomes;Native Americans and Asian Pacific Islanders face higher mortality,highlighting a need for tailored interventions and care.
文摘Since 1990,China has made considerable progress in resolving the problem of“treatment difficulty”of cardiovascular diseases(CVD).The prevalent unhealthy lifestyle among Chinese residents has exposed a massive proportion of the population to CVD risk factors,and this situation is further worsened due to the accelerated aging population in China.CVD remains one of the greatest threats to the health of Chinese residents.In terms of the proportions of disease mortality among urban and rural residents in China,CVD has persistently ranked first.In 2021,CVD accounted for 48.98%and 47.35%of deaths in rural and urban areas,respectively.Two out of every five deaths can be attributed to CVD.To implement a national policy“focusing on the primary health institute and emphasizing prevention”and truly achieve a shift of CVD prevention and treatment from hospitals to communities,the National Center for Cardiovascular Diseases has organized experts from relevant fields across China to compile the“Report on Cardiovascular Health and Diseases in China”annually since 2005.The 2024 report is established based on representative,published,and high-quality big-data research results from cross-sectional and cohort population epidemiological surveys,randomized controlled clinical trials,large sample registry studies,and typical community prevention and treatment cases,along with data from some projects undertaken by the National Center for Cardiovascular Diseases.These firsthand data not only enrich the content of the current report but also provide a more timely and comprehensive reflection of the status of CVD prevention and treatment in China.
