Intermedin/adrenomedullin-2(IMD/AM2), a member of the calcitonin gene-related peptide/AM family,plays an important role in protecting the cardiovascular system. However, its role in the enhanced sympathoexcitation in ...Intermedin/adrenomedullin-2(IMD/AM2), a member of the calcitonin gene-related peptide/AM family,plays an important role in protecting the cardiovascular system. However, its role in the enhanced sympathoexcitation in obesity-related hypertension is unknown. In this study, we investigated the effects of IMD in the paraventricular nucleus(PVN) of the hypothalamus on sympathetic nerve activity(SNA), and lipopolysaccharide(LPS)-induced sympathetic activation in obesity-related hypertensive(OH)rats induced by a high-fat diet for 12 weeks. Acute experiments were performed under anesthesia. The dynamic alterations of sympathetic outflow were evaluated as changes in renal SNA and mean arterial pressure(MAP) in response to specific drugs. Male rats were fed a control diet(12% kcal as fat) or a high-fat diet(42% kcal as fat) for 12 weeks to induce OH. The results showed that IMD protein in the PVN was downregulated, but Toll-like receptor 4(TLR4) and plasma norepinephrine(NE, indicating sympathetic hyperactivity) levels, and systolic blood pressure were increased in OH rats. LPS(0.5 lg/50 nL)-induced enhancement of renal SNA and MAP was greater in OH rats than in obese or control rats. Bilateral PVN microinjection of IMD(50 pmol)caused greater decreases in renal SNA and MAP in OH rats than in control rats, and inhibited LPS-induced sympatheticactivation, and these were effectively prevented in OH rats by pretreatment with the AM receptor antagonist AM22-52.The mitogen-activated protein kinase/extracellular signalregulated kinase(ERK) inhibitor U0126 in the PVN partially reversed the LPS-induced enhancement of SNA. However,IMD in the PVN decreased the LPS-induced ERK activation,which was also effectively prevented by AM22-52. Chronic IMD administration resulted in significant reductions in the plasma NE level and blood pressure in OH rats. Moreover,IMD lowered the TLR4 protein expression and ERK activation in the PVN, and decreased the LPS-induced sympathetic overactivity. These results indicate that IMD in the PVN attenuates SNA and hypertension, and decreases the ERK activation implicated in the LPS-induced enhancement of SNA in OH rats, and this is mediated by AM receptors.展开更多
Obesity is caused by an excessive accumulation of fat,which poses a risk to human health.In China,the prevalence rates of overweight and obesity in adults were estimated to be 30.1%and 11.9%,respectively,ranking the f...Obesity is caused by an excessive accumulation of fat,which poses a risk to human health.In China,the prevalence rates of overweight and obesity in adults were estimated to be 30.1%and 11.9%,respectively,ranking the first in the world.Obesity is a major risk factor for hypertension.展开更多
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
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
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
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 The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,t...BACKGROUND The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,there is no data on the mortality of patients with HSS and HPS.AIM To perform a survival analysis of patients with HPS related to cirrhotic and non-cirrhotic(schistosomiasis)portal hypertension.METHODS From August 2023 to January 2024,medical records and the official mortality information service of 121 patients who participated in a cross-sectional study on HPS between 2010 and 2012 were analyzed.Survival curves were created using the Kaplan-Meier method,and comparisons were performed using the log-rank test.Cox regression models estimated the hazard ratios(HR).RESULTS Overall,data of 113 patients were analyzed;most(55.8%)had HSS and concomitant cirrhosis(HSS/cirrhosis).Meanwhile,HPS was present in 39(34.5%)patients.Death occurred in 65 patients[57.5%];95%confidence interval(CI):48%-67%.The average time to death was lower in those with HPS when compared to those without HPS(3.37 years vs 5.65 years;P=0.017).According to the cause of liver disease,patients with HSS/cirrhosis died earlier,and their risk of death was twice as high compared with patients with HSS without cirrhosis(HR:2.17;95%CI:1.3-3.60;P=0.003).Meanwhile,there were no differences when comparing the two groups with and without HPS(HR:1.01;95%CI:0.59-1.73;P=0.967).CONCLUSION Patients with HSS and concomitant cirrhosis had a lower survival rate,but there was no difference in survival regardless of the presence of HPS.展开更多
BACKGROUND Hypertension(HTN)is a prevalent chronic health condition that significantly increases the risk of cardiovascular diseases-associated mortalities.Despite the use of antihypertensive medications,numerous pati...BACKGROUND Hypertension(HTN)is a prevalent chronic health condition that significantly increases the risk of cardiovascular diseases-associated mortalities.Despite the use of antihypertensive medications,numerous patients fail to achieve guidelinerecommended blood pressure(BP)targets.AIM To evaluates the efficacy of catheter-based ultrasound renal denervation(uRDN)for the treatment of HTN.METHODS Relevant studies were identified through searches in PubMed,Embase,the Cochrane Library,Web of Science,and China National Knowledge Infrastructure,with a cut-off date at April 1,2024.A random-effects model was employed in this study to mitigate potential biases.The risk of bias for included studies was assessed using the Cochrane Risk of Bias assessment tool.Statistical analyses were conducted using Review Manager version 5.3.This meta-analysis incorporated four studies encompassing a total of 627 patients.The reporting bias of this study was deemed acceptable.RESULTS Compared to the Sham group,the uRDN group demonstrated a significant reduction in daytime ambulatory systolic BP(SBP)[mean difference(MD)-3.87 mmHg,95%confidence interval(CI):-7.02 to-0.73,P=0.02],office SBP(MD-4.13 mmHg,95%CI:-7.15 to-1.12,P=0.007),and home SBP(MD-5.51 mmHg,95%CI:-8.47 to-2.55,P<0.001).However,there was no statistically significant reduction observed in either 24-hour or nighttime ambulatory SBP levels.Subgroup analysis shows that uRDN can significantly reduce the SBP in patients with non-resistant HTN(MD-6.19 mmHg,MD-6.00 mmHg,MD-7.72 mmHg,MD-5.02 mmHg,MD-3.61 mmHg).CONCLUSION The current evidence suggests that uRDN may effectively reduce home,office,and daytime SBP in patients with HTN,particularly in those with non-resistant HTN.展开更多
Background Pulmonary arterial hypertension (PAH) is a progressive condition with a poorprognosis in children. Lung transplantation (Ltx) remains the ultimate option when patients are refractory toPAH-speciffc therapy....Background Pulmonary arterial hypertension (PAH) is a progressive condition with a poorprognosis in children. Lung transplantation (Ltx) remains the ultimate option when patients are refractory toPAH-speciffc therapy. Reverse Potts shunt (RPS) has been introduced to treat suprasystemic PAH. This studyaims to investigate the clinical outcomes of suprasystemic PAH in children. Methods Embase, Pubmed,and the Cochrane Library databases were searched for related studies that reported the clinical outcomes ofsuprasystemic PAH following RPS in children. To investigate the clinical outcomes of RPS, meta-analyses ofthe early and overall mortalities were performed. Results Nine studies were included in this study. Theestimated early mortality was 14.4% (95% CI, 7.1% to 23.1%), and the overall mortality/Ltx was 23.2% (95%CI, 14.4% to 32.9%). The estimated 1-year survival was 86.3% (95% CI, 75.9% to 88.7%). A qualitative reviewshowed that the median value of 5-year survival free from Ltx of patients undergoing RPS was 68.6% (range:65% to 92.3%). Compared to Ltx, RPS did not signiffcantly increase the early mortality (OR, 2.48, 95% CI0.75 to 8.24, p = 0.14). RPS also signiffcantly improved the New York Heart Association/World HealthOrganization functional class, reduced the BNP/NT-pro BNP levels, decreased the PAH-speciffc therapy,and increased the six-minute-walking distance. Conclusions RPS may serve as an alternative treatmentfor suprasystemic drug-refractory PAH. Further large-scale and prospective cohort studies are needed tovalidate these ffndings.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 observe the clinical efficacy of traditional Chinese medicine(TCM)essential oil Tuina(Chinese therapeutic massage)combined with conventional Western medication in treating hypertension and its influence o...Objective:To observe the clinical efficacy of traditional Chinese medicine(TCM)essential oil Tuina(Chinese therapeutic massage)combined with conventional Western medication in treating hypertension and its influence on TCM symptoms and anxiety.Methods:Eighty patients with hypertension were included and divided into an observation group and a control group using the random number table method,with 40 cases in each group.The control group was treated with conventional oral Western medication once a day.The observation group was treated with additional TCM essential oil Tuina once every other day.The two groups were treated for 4 weeks.The changes in blood pressure,TCM symptom score,and anxiety,as well as safety,were observed after treatment.Results:After treatment,the systolic blood pressure,diastolic blood pressure,TCM symptom score,and Hamilton anxiety scale score in the two groups were lower than those before treatment(P<0.05),and those of the observation group were lower compared to the control group with statistically significant differences(P<0.05).There were no adverse reactions,such as allergy and dry cough,in the two groups.Conclusion:Based on conventional Western medication,TCM essential oil Tuina was safe and effective in the treatment of hypertension,which both reduced blood pressure and improved clinical symptoms and anxiety.展开更多
The authors declare that in the correspondence“Obesity paradox in pulmonary hypertension secondary to chronic lung diseases”,[1]which was published in Vol.137,Issue 18,pages 2260–2262 of the Chinese Medical Journal...The authors declare that in the correspondence“Obesity paradox in pulmonary hypertension secondary to chronic lung diseases”,[1]which was published in Vol.137,Issue 18,pages 2260–2262 of the Chinese Medical Journal,the author contribution should be corrected as“Changwei Wu and Wenhui Wu contributed equally to this work”.The authors deeply apologize for any inconvenience caused.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
BACKGROUND Liver cirrhosis and portal hypertension(PHT)can lead to lymphatic abnormalities and coagulation dysfunction.Because lymphangiogenesis may relieve liver cirrhosis and PHT,the present study investigated the g...BACKGROUND Liver cirrhosis and portal hypertension(PHT)can lead to lymphatic abnormalities and coagulation dysfunction.Because lymphangiogenesis may relieve liver cirrhosis and PHT,the present study investigated the gene expression alterations in the lymphatic system and the effectiveness of platelet-mediated lymphangiogenesis in improving liver cirrhosis and PHT.AIM To investigate the role of lymphangiogenesis in preclinical PHT models.METHODS Immunohistochemistry and transcriptome sequencing of bile duct ligation(BDL)and control lymphatic samples were conducted to reveal the indicated signaling pathways.Functional enrichment analyses were performed on the differentially expressed genes and hub genes.Adenoviral infection of vascular endothelial growth factor C(VEGF-C),plateletrich plasma(PRP),and VEGF3 receptor(VEGFR)inhibitor MAZ-51 was used as an intervention for the lymphatic system in PHT models.Histology,hemodynamic tests and western blot analyses were performed to demonstrate the effects of lymphatic intervention in PHT patients.RESULTS Lymphangiogenesis was increased in the BDL rat model.Transcriptome sequencing analysis of the extrahepatic lymphatic system revealed its close association with platelet adherence,aggregation,and activation.The role of PHT in the rat model was investigated by activating(PRP)and inhibiting(MAZ-51)the lymphatic system.PRP promoted lymphangiogenesis,which increased lymphatic drainage,alleviated portal pressure,reduced liver fibrosis,inhibited inflammation,inhibited angiogenesis,and suppressed mesenteric artery remodeling.MAZ-51 reversed the above improvements.CONCLUSION Via VEGF-C/VEGFR-3,platelets impede fibrosis,angiogenesis,and mesenteric artery remodeling,ultimately alleviating PHT.Thus,platelet intervention is a therapeutic approach for cirrhosis and PHT.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
BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively ...BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively reduces portal pressure,predicting long-term survival remains challenging due to the multifactorial nature of patient outcomes.Accurate survival prediction tools are lacking,and existing models often omit critical factors such as portal vein diameter.This study aimed to develop and validate a nomogram incorporating key clinical and biochemical variables to predict 1-year and 2-year survival following TIPS in PHT patients.We hypothesized that this model would provide improved risk stratification and guide clinical decisions.AIM To develop and validate a nomogram for predicting 1-year and 2-year survival in PHT patients post-TIPS.METHODS This retrospective cohort study included 848 TIPS-treated PHT patients with gastrointestinal bleeding from two tertiary hospitals(2013-2021).Mortality was the primary endpoint.Predictive variables were selected using least absolute shrinkage and selection operator regression,and a nomogram was developed with Cox regression to predict 1-year and 2-year survival.Model performance was evaluated through receiver operating characteristic curves,calibration plots,and decision curve analysis.RESULTS The mean age of the included(848)patients was 53.00 years±12.51,where 69.58%were men.Results showed that portal vein diameter,serum creatinine,potassium,and alpha-fetoprotein were the independent predictors of post-TIPS survival.Besides,the model showed strong discriminatory ability(C-index,0.816 in the training set;0.827 in the validation set)and good calibration.The area under the curve for 1-year and 2-year survival in the training set were 0.890[95%confidence interval(CI):0.802-0.948]and 0.838(95%CI:0.803-0.869),respectively.The area under the curve for 1-year and 2-year survival in the validation set were 0.934(95%CI:0.815-0.987)and 0.864(95%CI:0.811-0.907),respectively.CONCLUSION The developed nomogram could reliably predict 1-year and 2-year survival in patients undergoing TIPS for PHTinduced gastrointestinal bleeding.展开更多
基金supported by the National Natural Science Foundation of China(81000106 and81470539)
文摘Intermedin/adrenomedullin-2(IMD/AM2), a member of the calcitonin gene-related peptide/AM family,plays an important role in protecting the cardiovascular system. However, its role in the enhanced sympathoexcitation in obesity-related hypertension is unknown. In this study, we investigated the effects of IMD in the paraventricular nucleus(PVN) of the hypothalamus on sympathetic nerve activity(SNA), and lipopolysaccharide(LPS)-induced sympathetic activation in obesity-related hypertensive(OH)rats induced by a high-fat diet for 12 weeks. Acute experiments were performed under anesthesia. The dynamic alterations of sympathetic outflow were evaluated as changes in renal SNA and mean arterial pressure(MAP) in response to specific drugs. Male rats were fed a control diet(12% kcal as fat) or a high-fat diet(42% kcal as fat) for 12 weeks to induce OH. The results showed that IMD protein in the PVN was downregulated, but Toll-like receptor 4(TLR4) and plasma norepinephrine(NE, indicating sympathetic hyperactivity) levels, and systolic blood pressure were increased in OH rats. LPS(0.5 lg/50 nL)-induced enhancement of renal SNA and MAP was greater in OH rats than in obese or control rats. Bilateral PVN microinjection of IMD(50 pmol)caused greater decreases in renal SNA and MAP in OH rats than in control rats, and inhibited LPS-induced sympatheticactivation, and these were effectively prevented in OH rats by pretreatment with the AM receptor antagonist AM22-52.The mitogen-activated protein kinase/extracellular signalregulated kinase(ERK) inhibitor U0126 in the PVN partially reversed the LPS-induced enhancement of SNA. However,IMD in the PVN decreased the LPS-induced ERK activation,which was also effectively prevented by AM22-52. Chronic IMD administration resulted in significant reductions in the plasma NE level and blood pressure in OH rats. Moreover,IMD lowered the TLR4 protein expression and ERK activation in the PVN, and decreased the LPS-induced sympathetic overactivity. These results indicate that IMD in the PVN attenuates SNA and hypertension, and decreases the ERK activation implicated in the LPS-induced enhancement of SNA in OH rats, and this is mediated by AM receptors.
基金This work was supported by grants from the National Natural Science Foundation of China(No.81870176,91439109 and 81370206)the Program for New Century Excellent Talents in University(China)(No.NCET-11-0181).
文摘Obesity is caused by an excessive accumulation of fat,which poses a risk to human health.In China,the prevalence rates of overweight and obesity in adults were estimated to be 30.1%and 11.9%,respectively,ranking the first in the world.Obesity is a major risk factor for hypertension.
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.
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.
文摘BACKGROUND The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,there is no data on the mortality of patients with HSS and HPS.AIM To perform a survival analysis of patients with HPS related to cirrhotic and non-cirrhotic(schistosomiasis)portal hypertension.METHODS From August 2023 to January 2024,medical records and the official mortality information service of 121 patients who participated in a cross-sectional study on HPS between 2010 and 2012 were analyzed.Survival curves were created using the Kaplan-Meier method,and comparisons were performed using the log-rank test.Cox regression models estimated the hazard ratios(HR).RESULTS Overall,data of 113 patients were analyzed;most(55.8%)had HSS and concomitant cirrhosis(HSS/cirrhosis).Meanwhile,HPS was present in 39(34.5%)patients.Death occurred in 65 patients[57.5%];95%confidence interval(CI):48%-67%.The average time to death was lower in those with HPS when compared to those without HPS(3.37 years vs 5.65 years;P=0.017).According to the cause of liver disease,patients with HSS/cirrhosis died earlier,and their risk of death was twice as high compared with patients with HSS without cirrhosis(HR:2.17;95%CI:1.3-3.60;P=0.003).Meanwhile,there were no differences when comparing the two groups with and without HPS(HR:1.01;95%CI:0.59-1.73;P=0.967).CONCLUSION Patients with HSS and concomitant cirrhosis had a lower survival rate,but there was no difference in survival regardless of the presence of HPS.
基金Supported by Sichuan Provincial Medical Research Youth Innovation Project,No.Q22063Guang'an District People's Hospital Joint Development Research Project,No.2024 LHFZ04。
文摘BACKGROUND Hypertension(HTN)is a prevalent chronic health condition that significantly increases the risk of cardiovascular diseases-associated mortalities.Despite the use of antihypertensive medications,numerous patients fail to achieve guidelinerecommended blood pressure(BP)targets.AIM To evaluates the efficacy of catheter-based ultrasound renal denervation(uRDN)for the treatment of HTN.METHODS Relevant studies were identified through searches in PubMed,Embase,the Cochrane Library,Web of Science,and China National Knowledge Infrastructure,with a cut-off date at April 1,2024.A random-effects model was employed in this study to mitigate potential biases.The risk of bias for included studies was assessed using the Cochrane Risk of Bias assessment tool.Statistical analyses were conducted using Review Manager version 5.3.This meta-analysis incorporated four studies encompassing a total of 627 patients.The reporting bias of this study was deemed acceptable.RESULTS Compared to the Sham group,the uRDN group demonstrated a significant reduction in daytime ambulatory systolic BP(SBP)[mean difference(MD)-3.87 mmHg,95%confidence interval(CI):-7.02 to-0.73,P=0.02],office SBP(MD-4.13 mmHg,95%CI:-7.15 to-1.12,P=0.007),and home SBP(MD-5.51 mmHg,95%CI:-8.47 to-2.55,P<0.001).However,there was no statistically significant reduction observed in either 24-hour or nighttime ambulatory SBP levels.Subgroup analysis shows that uRDN can significantly reduce the SBP in patients with non-resistant HTN(MD-6.19 mmHg,MD-6.00 mmHg,MD-7.72 mmHg,MD-5.02 mmHg,MD-3.61 mmHg).CONCLUSION The current evidence suggests that uRDN may effectively reduce home,office,and daytime SBP in patients with HTN,particularly in those with non-resistant HTN.
基金Chongqing Medical University Program for Youth Innovation in Future Medicine(W0204)Natural Science Foundation Project of Chongqing,Chongqing Science and Technology Commission(CSTB2023NSCQ-BHX0010)+1 种基金Chongqing Postdoctoral Research Project Special Support(2023CQBSHTB3074)Science and Technology Research Program of Chongqing Municipal Education Commission(KJQN202400421).
文摘Background Pulmonary arterial hypertension (PAH) is a progressive condition with a poorprognosis in children. Lung transplantation (Ltx) remains the ultimate option when patients are refractory toPAH-speciffc therapy. Reverse Potts shunt (RPS) has been introduced to treat suprasystemic PAH. This studyaims to investigate the clinical outcomes of suprasystemic PAH in children. Methods Embase, Pubmed,and the Cochrane Library databases were searched for related studies that reported the clinical outcomes ofsuprasystemic PAH following RPS in children. To investigate the clinical outcomes of RPS, meta-analyses ofthe early and overall mortalities were performed. Results Nine studies were included in this study. Theestimated early mortality was 14.4% (95% CI, 7.1% to 23.1%), and the overall mortality/Ltx was 23.2% (95%CI, 14.4% to 32.9%). The estimated 1-year survival was 86.3% (95% CI, 75.9% to 88.7%). A qualitative reviewshowed that the median value of 5-year survival free from Ltx of patients undergoing RPS was 68.6% (range:65% to 92.3%). Compared to Ltx, RPS did not signiffcantly increase the early mortality (OR, 2.48, 95% CI0.75 to 8.24, p = 0.14). RPS also signiffcantly improved the New York Heart Association/World HealthOrganization functional class, reduced the BNP/NT-pro BNP levels, decreased the PAH-speciffc therapy,and increased the six-minute-walking distance. Conclusions RPS may serve as an alternative treatmentfor suprasystemic drug-refractory PAH. Further large-scale and prospective cohort studies are needed tovalidate these ffndings.
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 observe the clinical efficacy of traditional Chinese medicine(TCM)essential oil Tuina(Chinese therapeutic massage)combined with conventional Western medication in treating hypertension and its influence on TCM symptoms and anxiety.Methods:Eighty patients with hypertension were included and divided into an observation group and a control group using the random number table method,with 40 cases in each group.The control group was treated with conventional oral Western medication once a day.The observation group was treated with additional TCM essential oil Tuina once every other day.The two groups were treated for 4 weeks.The changes in blood pressure,TCM symptom score,and anxiety,as well as safety,were observed after treatment.Results:After treatment,the systolic blood pressure,diastolic blood pressure,TCM symptom score,and Hamilton anxiety scale score in the two groups were lower than those before treatment(P<0.05),and those of the observation group were lower compared to the control group with statistically significant differences(P<0.05).There were no adverse reactions,such as allergy and dry cough,in the two groups.Conclusion:Based on conventional Western medication,TCM essential oil Tuina was safe and effective in the treatment of hypertension,which both reduced blood pressure and improved clinical symptoms and anxiety.
文摘The authors declare that in the correspondence“Obesity paradox in pulmonary hypertension secondary to chronic lung diseases”,[1]which was published in Vol.137,Issue 18,pages 2260–2262 of the Chinese Medical Journal,the author contribution should be corrected as“Changwei Wu and Wenhui Wu contributed equally to this work”.The authors deeply apologize for any inconvenience caused.
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).
基金Supported by the National Natural Science Foundation of China,No.82100639,No.82200630,and No.81970526Postdoctoral Scientific Research Foundation of Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,No.202401023+3 种基金Clinical Research Program of Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,No.JYLJ202124Shanghai Municipal Commission of Health and Family Planning,No.20244Y0195 and No.20234Y0132the Fundamental Research Program Funding of Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,No.JYZZ162Science Foundation of Xinjiang Uygur Natural Autonomous Region,No.2022D01F17.
文摘BACKGROUND Liver cirrhosis and portal hypertension(PHT)can lead to lymphatic abnormalities and coagulation dysfunction.Because lymphangiogenesis may relieve liver cirrhosis and PHT,the present study investigated the gene expression alterations in the lymphatic system and the effectiveness of platelet-mediated lymphangiogenesis in improving liver cirrhosis and PHT.AIM To investigate the role of lymphangiogenesis in preclinical PHT models.METHODS Immunohistochemistry and transcriptome sequencing of bile duct ligation(BDL)and control lymphatic samples were conducted to reveal the indicated signaling pathways.Functional enrichment analyses were performed on the differentially expressed genes and hub genes.Adenoviral infection of vascular endothelial growth factor C(VEGF-C),plateletrich plasma(PRP),and VEGF3 receptor(VEGFR)inhibitor MAZ-51 was used as an intervention for the lymphatic system in PHT models.Histology,hemodynamic tests and western blot analyses were performed to demonstrate the effects of lymphatic intervention in PHT patients.RESULTS Lymphangiogenesis was increased in the BDL rat model.Transcriptome sequencing analysis of the extrahepatic lymphatic system revealed its close association with platelet adherence,aggregation,and activation.The role of PHT in the rat model was investigated by activating(PRP)and inhibiting(MAZ-51)the lymphatic system.PRP promoted lymphangiogenesis,which increased lymphatic drainage,alleviated portal pressure,reduced liver fibrosis,inhibited inflammation,inhibited angiogenesis,and suppressed mesenteric artery remodeling.MAZ-51 reversed the above improvements.CONCLUSION Via VEGF-C/VEGFR-3,platelets impede fibrosis,angiogenesis,and mesenteric artery remodeling,ultimately alleviating PHT.Thus,platelet intervention is a therapeutic approach for cirrhosis and PHT.
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).
基金Supported by the“14th Five-Year”Talent Training Program of Beijing Shijitan Hospital,Capital Medical University,No.2023 LJRCLFQ.
文摘BACKGROUND Portal hypertension(PHT)is a life-threatening complication of cirrhosis,often resulting in gastrointestinal bleeding that requires transjugular intrahepatic portosystemic shunt(TIPS).While TIPS effectively reduces portal pressure,predicting long-term survival remains challenging due to the multifactorial nature of patient outcomes.Accurate survival prediction tools are lacking,and existing models often omit critical factors such as portal vein diameter.This study aimed to develop and validate a nomogram incorporating key clinical and biochemical variables to predict 1-year and 2-year survival following TIPS in PHT patients.We hypothesized that this model would provide improved risk stratification and guide clinical decisions.AIM To develop and validate a nomogram for predicting 1-year and 2-year survival in PHT patients post-TIPS.METHODS This retrospective cohort study included 848 TIPS-treated PHT patients with gastrointestinal bleeding from two tertiary hospitals(2013-2021).Mortality was the primary endpoint.Predictive variables were selected using least absolute shrinkage and selection operator regression,and a nomogram was developed with Cox regression to predict 1-year and 2-year survival.Model performance was evaluated through receiver operating characteristic curves,calibration plots,and decision curve analysis.RESULTS The mean age of the included(848)patients was 53.00 years±12.51,where 69.58%were men.Results showed that portal vein diameter,serum creatinine,potassium,and alpha-fetoprotein were the independent predictors of post-TIPS survival.Besides,the model showed strong discriminatory ability(C-index,0.816 in the training set;0.827 in the validation set)and good calibration.The area under the curve for 1-year and 2-year survival in the training set were 0.890[95%confidence interval(CI):0.802-0.948]and 0.838(95%CI:0.803-0.869),respectively.The area under the curve for 1-year and 2-year survival in the validation set were 0.934(95%CI:0.815-0.987)and 0.864(95%CI:0.811-0.907),respectively.CONCLUSION The developed nomogram could reliably predict 1-year and 2-year survival in patients undergoing TIPS for PHTinduced gastrointestinal bleeding.
