Important Risk Factor Research Articles

Association between myasthenia gravis and Alzheimer's disease.

Myasthenia gravis (MG) and Alzheimer's disease (AD) are two of the most important diseases where the dysregulation of acetylcholine activity plays a crucial role. In the first, this dysregulation happens at the level of the neu-romuscular junction and in the second, in the central nervous system (CNS). To analyze the possible relationship between these two pathologies, analyzing the prevalence and the odds ratio of AD within patients previously diagnosed with MG. We will compare these data with respect to the prevalence of AD in the general population. We examined the data obtained by the electronic medical records of patients in the health care system of Castilla La Mancha using the Natural Language Process provided by a clinical platform of artificial intelligence known as the Savana Manager?. We identified 970,503 patients over the age of 60 years, of which 1,028 were diagnosed with MG. The proportion of the patients diagnosed with AD within this group (4.28%) was greater than the rest of the population (2.82%) (p = 0,0047) with an odds ratio of 1.54 (confidence interval at 95% 1.13-2.08; p = 0.0051) without finding significant differences in the bivariate analysis for the rest of the most important actual known risk factors for AD. Our results suggest that there might be an increase in the prevalence of AD in patients previously diagnosed with MG.

Um estudo observacional piloto para identificar valores de referência para o teste de caminhada de 6 minutos em hipertensos brasileiros

Abstract Introduction Systemic arterial hypertension (SAH) is responsible for 9.5 million deaths in the global popu-lation. Lifestyle factors, including physical inactivity, are important modifiable risk factors in the development of SAH. Thus, physical exercise has been shown to be effective to control SAH and before the prescription, the six-minute walk test (6-MWT) has been commonly used to assess the physical capacity. Objective To propose reference values for the 6-MWT test in Brazilian people with SAH. Methods A cross-sectional observational study was conducted with 302 hypertensive subjects (62.61 + 10.93 years) admitted to a cardiac rehabilitation program. Participants were divided into different age quartiles and submitted to 6-MWT. The walking distance data was compared between the quartiles and adjusted by mul-tiple linear regression analysis. Results The hypertensive subjects walked 388.07 + 115.03 m during the 6-MWT. No significant difference between the genders was found. However, when the age quartiles were compared, for the 46–59 age group, the women walked less than the men. Intra-group comparisons showed that the distance walked in the 6-MWT decreased with the increase in age, in both men and women. Conclusion The present study provides reference values for the 6-MWT, both for Brazilian men and women of different age groups. This data may be an important parameter for future clinical studies, prevention strategies, and clinical intervention.

Developing incisional hernia after open liver resection and liver transplantation: A single-center risk factor analysis

Abstract INTRODUCTION: Open liver surgery is one of the most common abdominal surgeries, which is associated with a higher risk of developing an incisional hernia (IH). This is mainly because of the extent and type of the surgical incisions in this type of surgery. Of course, many other risk factors may interfere with wound healing and can increase the risk of developing IH after this type of surgery. In this study, we analyzed several perioperative risk factors, particularly the type of surgical incision and the technical suture aspects. MATERIALS AND METHODS: Retrospectively, we analyzed the development of incisional hernia within the first 36 postoperative months clinically and image-morphologically among 155 patients who had undergone an open liver resection or liver transplantation and met the inclusion criteria between 2015 and 2020 in our institution. RESULTS: Most of the incisional hernias occurred during the first 16 postoperative months, with a peak incidence in the eighth postoperative month. The most important preoperative risk factors were the positive past medical history of other hernias (P = 0.05) and overweight/ obesity (P = 0.018). From the operative course, many risk factors were detected, like an intraoperative blood loss of > 1,000 ml (P = 0.043) and an intraoperative blood transfusion of > 10 PRBCs (P = 0.001), a Mercedes-star incision (P = 0.007), the use of Vicryl (polyglactin 910) sutures and interrupted suture techniques for the fascial reconstruction (P = 0.045) and (P = 0.006), and a long operative time of > 240 min (P = 0.033). Postoperative ascites formation as well as the need for revision operation due to a postoperative complication were associated with higher incidence rates of developing IH (P = 0.02) and (P = 0.014). CONCLUSIONS: The development of IH cannot be avoided. But the leading risk factors can be modified or optimized. From our experience and according to this analysis, we recommend the careful selection of the surgical approach for each patient and promotion of the use of the minimally invasive approaches, avoiding the angulated incisions as much as possible, applying the running suture technique with (polydioxanone) PDS-loops for the fascial reconstruction, minimizing the intraoperative blood loss and need for blood transfusion, shortening the operative time as much as possible, early detection of postoperative formation of ascites, and managing it properly. In the event of need for a revision operation due to a postoperative complication, a reinforced reconstruction of the fascia can be considered.

Awareness of stroke among patients with chronic kidney disease on hemodialysis: a cross-sectional study.

Stroke is a major cause of mortality worldwide. Renal dysfunction is an important risk factor for stroke. Brazilian studies on stroke knowledge are generally population based. Studies stratifying stroke knowledge according to comorbidities are rare. Scientific data are essential to guide the awareness of stroke. To assess stroke knowledge in patients with chronic kidney disease (CKD) on hemodialysis. Cross-sectional analytical study of patients with CKD on hemodialysis in north-eastern Brazil. A self-administered questionnaire survey on stroke awareness was administered to patients with CKD on hemodialysis between April and November 2022. The chi-square test and other descriptive statistics were used. Univariate and multivariate analyses were performed using logistic regression. A total of 197 patients were included in the analysis. The Brazilian acronym for stroke was used by 53.5% of the participants. Less than 10.0% of the sample showed optimal decision-making ability regarding stroke. Of the participants, 29.9% knew at least one risk factor and one symptom; however, this was considered as having below the minimum capacity because they did not know the emergency service call number. In the analysis adjusted for income and education, females (odds ratio [OR], 0.40%; 95% confidence interval [CI], 0.20-0.82), older patients (OR, 0.24%; 95% CI, 0.09-0.63) and having at most one comorbidity (OR, 0.48%; 95% CI, 0.23-0.98) were factors for lower levels of knowledge or ideal decision-making capacity against stroke. Patients on hemodialysis, especially women and older people, have little knowledge about stroke.

The fascinating theory of fetal programming of adult diseases: A review of the fundamentals of the Barker hypothesis.

The theory of fetal programming of adult diseases was first proposed by David J.P. Barker in the eighties of the previous century, to explain the higher susceptibility of some people toward the development of ischemic heart disease. According to his hypothesis, poor maternal living conditions during gestation represent an important risk factor for the onset of atherosclerotic heart disease later in life. The analysis of the early phases of fetal development is a fundamental tool for the risk stratification of children and adults, allowing the identification of susceptible or resistant subjects to multiple diseases later in life. Here, we provide a narrative summary of the most relevant evidence supporting the Barker hypothesis in multiple fields of medicine, including neuropsychiatric disorders, such as Parkinson disease and Alzheimer disease, kidney failure, atherosclerosis, coronary heart disease, stroke, diabetes, cancer onset and progression, metabolic syndrome, and infectious diseases including COVID-19. Given the consensus on the role of body weight at birth as a practical indicator of the fetal nutritional status during gestation, every subject with a low birth weight should be considered an "at risk" subject for the development of multiple diseases later in life. The hypothesis of the "physiological regenerative medicine," able to improve fetal organs' development in the perinatal period is discussed, in the light of recent experimental data indicating Thymosin Beta-4 as a powerful growth promoter when administered to pregnant mothers before birth.

Determination of the Relationship Between the Development and Recurrence of Subacute Thyroiditis and Human Leukocyte Antigen Subtypes.

Background: There are several studies investigating the role of human leukocyte antigens (HLA) in the development and recurrence of subacute thyroiditis (SAT). The HLA subtypes associated with SAT were usually determined in a population-based manner and HLA-B*35, HLA-B*18:01, HLA-C*04:01, and HLA-DRB1*01 were detected to play a role in the disease susceptibility and prognosis. The aim of this study was to determine HLA alleles associated with the tendency of recurrence and prevention of SAT within the Turkish population. Methods: This prospective study was conducted with 51 SAT patients and 720 healthy bone marrow donor volunteers. HLA-A, -B, -C, -DRB1, and -DQB1 were genotyped using next-generation sequencing. Results: The frequency of HLA-A*02:09, HLA-B*35:01/35:02/35:03, HLA-C*04:01, HLA-DRB1*12:01, and DRB1*13:03 were associated with an increased risk of SAT development (Odds Ratio: 22.4, 9.5, 10.3, 4.2, and 3.5, respectively). While HLA-A*02:09, HLA-B*35:01, HLA-B*44:02 HLA-C*07:18, and HLA-C*16:04 were associated with nonrelapsing SAT, HLA-DR*12:01was associated with relapsing SAT. HLA-B*35:02, HLA-B*35:03, and HLA-C*04:01 were more frequent both in relapsing and nonrelapsing groups according to control group. The frequency of HLA-B*18:01, reported as a risk factor previously, was similar in the SAT and control groups (p = 0.959). HLA-DRB1*11:01 was associated with a lower risk of SAT development. Conclusions: Along with -B*358 and -C*04, HLA-A*02:09 was detected as an important risk factor for SAT development in our population. HLA-DRB1*11:01 appears to be the protective HLA subtype against SAT. HLA-A*02:09, HLA-B*35:01, HLA-B*44:02, HLA-C*07:18, HLA-C*16:04, HLA-DQ*06:03, and HLA-DR*12:01 subtypes can establish a tendency to relapsing or nonrelapsing SAT.

Cochlear dysfunction as an early biomarker of cognitive decline in normal hearing and mild hearing loss.

Age-related hearing loss is an important risk factor for cognitive decline. However, audiogram thresholds are not good estimators of dementia risk in subjects with normal hearing or mild hearing loss. Here we propose to use distortion product otoacoustic emissions (DPOAEs) as an objective and sensitive tool to estimate the risk of cognitive decline in older adults with normal hearing or mild hearing loss. We assessed neuropsychological, brain magnetic resonance imaging, and auditory analyses on 94 subjects >64 years of age. We found that cochlear dysfunction, measured by DPOAEs-and not by conventional audiometry-was associated with Clinical Dementia Rating Sum of Boxes (CDR-SoB) classification and brain atrophy in the group with mild hearing loss (25 to 40dB) and normal hearing (<25dB). Our findings suggest that DPOAEs may be a non-invasive tool for detecting neurodegeneration and cognitive decline in the older adults, potentially allowing for early intervention.

Understanding internalizing and externalizing symptoms in trauma exposed community members.

Posttraumatic stress disorder (PTSD) is highly comorbid with internalizing and externalizing symptoms, but few studies have examined risk factors that can account for these comorbidities. The primary aim of this study is to investigate the role of blame attribution (i.e., self-blame and other blame) and impulsivity dimensions (i.e., negative and positive urgency) in predicting internalizing (i.e., social anxiety, depression, and worry) and externalizing symptoms (i.e., aggression, risky thrill-seeking, risky substance use, and sexual risk-taking) when statistically controlling for PTSD. Participants were 63 trauma-exposed community members (47.6% diagnosed with PTSD; Mage = 27.17, 84.1% female) interviewed using the Clinician-Administered PTSD Scale-5. We hypothesized that self- and other blame would predict internalizing symptoms and that self-blame, negative urgency, and positive urgency would predict externalizing symptoms after controlling for PTSD. Findings showed that self-blame was associated with all three internalizing symptoms and risky sex and that negative urgency predicted risky aggression. This study provides evidence that self-blame is an important risk factor for a broad range of internalizing symptoms and for at least one type of externalizing symptom and that the effects of self-blame are not fully explained by PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effect of tobacco smoking on the periodontal health in Parsa, Nepal: A comparative cross-sectional study

Introduction: For ages, smoking tobacco has been a part of cultural practice in different parts of Nepal. For periodontal diseases, one of the important risk factors is tobacco smoking, mainly cigarette smoking. Objectives: This study was conducted to find out the relationship among tobacco smoking and periodontal disease by means of clinical attachment loss (CAL), plaque score, and gingival score in cigarette smoker patients in comparison with nonsmokers. Methodology: A comparative cross-sectional study was done among 300 patients who visited the Outpatient Department of Periodontics, M. B. Kedia Dental College, Parsa, Nepal. The patients were divided into two groups, cigarette smokers and nonsmokers. Oral cavity examination was done using plaque index, gingival index, and CAL. Mann–Whitney test was done to determine the relation between tobacco smoker and overall periodontal health. Results: The result shows that the overall median plaque score of the patients was 1.08, the gingival score of the patients was 1.22, and CAL was 2.04. Furthermore, there was statistical significance between periodontitis and cigarette smoking. Conclusion: The present study concluded that smoking has a negative effect on periodontium health. More duration of cigarette smoking habit had higher severity of symptoms when compared to nonsmokers.

Comparison between patients with COPD and healthy subjects on spatiotemporal, moment and kinematic parameters: A quasi-experimental study.

Chronic obstructive respiratory diseases (COPD) not only cause damage to the respiratory system as well as the heart and blood vessels of the patient but also have a direct effect on the condition of the musculoskeletal system. The risk of falling is increasing due to dysfunction of the joints as well as aging, which occurs frequently in this population. Gait deficits are known as an important risk factor for falls. This research aimed to investigate the gait of COPD patients compared to healthy people to gain a better understanding of the reasons for falls. Twenty patients with COPD and 20 age and BMI-matched healthy individuals were included in this study. Sixteen markers were applied to the lower body of the subjects. Spatio-temporal, kinematic, and maximum moment parameters were measured in different phases in three lower body joints, including the hip, knee, and ankle. The results showed that all spatio-temporal parameters in patients were significantly lower than in healthy people. The ankle angle in the sagittal plane at initial contact was significantly difference (p = 0.03). As well as, in the frontal plane the hip angle in the mid-stance showed a significant difference (p = 0.02). There was also a significant difference in maximum hip moment in the sagittal plane between the two groups (p = 0.01). The larger hip angle of the patients can be related to the balance problems in the mediolateral direction. The moment showed a significant difference in the hip joint. Since the hip muscles are directly in a synergistic relationship with the trunk muscles, it seems the performance of these muscles is likely to be seriously damaged due to respiratory diseases.

Changes in the structure and function of the visual pathway in subjects at high risk for the development of Alzheimer's disease: 27 months of follow‐up

Aims/Purpose: In addition to advanced age, two of the most important risk factors for the development of Alzheimer's disease are having a family history of the disease (FH+) and being a carrier of at least one Ɛ4+ allele for the ApoE gene (ApoE Ɛ4+). AD generates changes in the retina and visual function when the disease is established, so the aim of the present work is to know if these changes appear in healthy subjects but with high genetic risk to develop the disease and to analyse if these changes evolve along 27 months of follow‐up.Methods: A retinal thickness analysis by optical coherence tomography and visual function by assessing visual acuity (VA), contrast sensitivity (CS), colour perception, perception digital test and visual field analysis was completed by all participants. For structural findings analysis subjects were divided into (FH+ ApoE Ɛ4+) and (FH‐ ApoE Ɛ4‐) groups and for functional analysis these subgroups were subdivided by ages between 40 and 60 years and subjects over 60 years.Results: After 27 months of follow‐up, the FH+ ApoE Ɛ4+ group experienced changes in the thickness of all retinal layers except the outer layers. In this group, the inner nuclear layer showed progressing changes, but there was no progression in visual function. However, compared to the FH‐ ApoE Ɛ4‐ group at 27 months, the improvement in visual acuity and contrast sensitivity (3 and 12 cpd) observed during the initial visit was maintained.Conclusions: In cognitively healthy individuals at high risk of developing AD structural changes in the retina continue to progress after 27 months, while functional changes detected at the beginning remain stable.

Denervation-Induced Sarcopenia Model.

Rheumatoid arthritis (RA) is an important risk factor for sarcopenia. Physical inactivity, systemic inflammatory factors, and medication directly or indirectly induce skeletal muscle loss in RA patients. The sarcopenia-induced systemic or local proinflammatory microenvironment also contributes to the onset and progression of autoimmune disease. Accumulated evidence suggests the importance of treatment and management of sarcopenia in patients with RA to improve their long-term prognosis. To elucidate the relationship between skeletal muscle and systemic immune homeostasis, a denervation-induced skeletal muscle-losing mouse model is introduced in this chapter. By developing local amyotrophy in the sciatic nerve-dominant area in a RA model, the underlying mechanism of sarcopenia in RA could be assessed. Also, an examination of the efficacy of anti-rheumatic regents on sarcopenia and the influence of sarcopenia management on RA improvement is also achievable.

Whole-Genome Comparative Copy Number Alteration Profiling between Malignant Pleural Mesothelioma and Asbestos-Induced Chronic Pleuritis.

Malignant pleural mesothelioma (MPM) is rare and aggressive cancer. The most important risk factor for MPM is exposure to asbestos. In this study, we scanned the genomes of individuals MPM and asbestos-induced chronic pleuritis (AICP) to compare and determine copy number alterations (CNAs) between two asbestos-related diseases. We used high-resolution SNP arrays to compare CNA profiles between MPM (n = 55) and AICP (n = 18). DNAs extracted from pleural tissues in both groups. SNP array analysis revealed common losses at 1p, 3p, 6q, 9p, 13q, 14q, 15q, 16q, 22q and frequent gains at chromosomes 1, 3, 5, 7, 8, and 6p, 12q, 15q, 17p, 20q in MPMs (frequencies max 67%-min 30%; these alterations were not detected in AICPs. Besides detecting well-known MPM-associated CNAs, our high -resolution copy number profiling also detected comparatively rare CNAs for MPMs including losses like 9q33.3, 16q and gains of 1p, 1q, 3p, 3q, 6p, 7q, 15q, 12q, 17p, 20q at significant frequencies in the MPM cohort. We also observed Copy Number gains clustered on the NF2 locus in AICPs, whereas this region was commonly deleted in MPMs. According to this distinct genomic profiles between the two groups, AICPs genomes can be clearly distinguished from highly altered MPM genomes. Hence, we can suggest that SNP arrays can be used as a supporting diagnostic tool in terms of discriminating asbestos-related malignant disease such as MPM and benign pleural lesions, which can be challenging in most instances.

Evaluation of the Effect of Biomarker Levels Associated with Disease Severity on Mortality in COVID-19 Patients in the Gaziantep Region of Turkey

This study aimed to investigate the effect of clinical and some specific laboratory parameters on the prognosis and mortality of critically ill COVID-19 patients who need to be followed in the intensive care unit (ICU). This is a retrospective cohort study. A total of 180 patients treated in the ICU were included in the study. The data of clinical and levels of D-dimer, cardiac troponin I (cTnI), Ferritin, and CK-MB were researched. The multivariate and univariate logistic regression models were employed to investigate the risk factors affiliated with in-hospital death. There was a significant difference in mortality between women and men (p=0.002). Hypertension was the most common comorbid disease, mortality was detected to be significantly greater in patients over 65 years of age. The serum D-dimer, cTnI, CK-MB, and ferritin levels were found to be higher in patients at risk. In the multivariate logistic regression model, we detected that ferritin above 300 μg/l (p=0.05) alongside cancer was associated with mortality. This study showed that advanced age is an important risk factor as well as the mortality of patients with cancer –especially those with a ferritin value above 300 μg/l and patients with a high cTnI value.

Influence of Antihypertensive Drugs on Left Ventricular Hypertrophy Regression in Hypertensive Patients

Background: Hypertension and its effect on heart in the form of left ventricular hypertrophy are the important predictors of heart failure. Hypertension treatment and left ventricular hypertrophy regression is crucial in the prevention of cardiovascular disease. However, the impact of antihypertensive treatment on left ventricular hypertrophy is less studied and which particular class of antihypertensive medicine is more effective is largely unexplored in our population. We designed this study to explore this issue in subjects taking treatment by evaluation initial and after six months echocardiography findings. Methods: One hundred fifty subjects aged 25-75 years, taking antihypertensive medicine were enrolled in the study. Along with basic demographic and epidemiological data, initial and after 6 months echocardiographic findings were analyzed for the presence of LV hypertrophy regression. Choice of medicine and necessary changes for the achievement of blood pressure targets were done on treating physician’s discretion.Results: Out of 150 subjects, data for 130 subjects were available for final analysis. Mean age was 54.4 years with standard deviation of 12.3 years. Apart from age, smoking, overweight and obesity, dyslipidemia, and diabetes were the important risk factors with a prevalence of 28%, 26%, 22% and 20% respectively. Although the decrease in rates of LV hypertrophy over the duration of 6 months were not significant in overall and in subjects treated with various antihypertensive medicines, the reductions in LV mass index (108.76+/-11.3 to 98.46+/-11.23) in overall and in different antihypertensives were significant (p&lt;0.001). The decrease in LV mass index was statistically significant in subjects taking angiotensin converting enzyme inhibitors or angiotensin receptor blockers when compared to subjects taking calcium channel blockers (p&lt;0.05). This decrease in LV mass index was not significant when compared between CCBs and mixed drugs.Conclusion: There was regression in LV hypertrophy among subjects taking antihypertensive treatment. It was more obvious in subjects taking angiotensin converting enzyme inhibitors/angiotensin receptor blockers when compared with subjects taking calcium channel blockers or both.

High Reproductive Risk and Contraception

Background: Patients with high reproductive risk have important risk factors for the development of complications, including maternal death. Rejection of a method is influenced by various factors, including: biological, cultural and social factors. Objective: Identify the main sociocultural and demographic factors associated with not choosing a contraceptive method in women at high reproductive risk. Material and Methods: it is an observational, cross-sectional, analytical and prospective study with non-probabilistic sampling carried out in pregnant women with high reproductive risk who were offered contraception through a questionnaire. Results: 75 patients with high reproductive risk (20%) were included, with an average age of 27 years, occupation as a housewife (48%), living in an urban area (66.7%), complete primary schooling (22.67%), Catholic religion (72%), married (57.3%), middle class (72%); alcoholism in 2 patients (2.67%) and 2 other drugs (2.67%); 68% rejected contraception; for personal reasons (76.4%). A significant relationship was found with the Jehovah’s Witness religion (p = 0.018). Conclusions: rejection of contraception is influenced by personal history and religion, with implications for reproductive health

Treatment of arterial hypertension in patients with severe obesity

IntroductionObesity is one of the most important cardiovascular risk factors for mortality. It increases the risk of developing hypertension and influences the response to antihypertensive drugs. Ambulatory blood pressure measurement (ABPM) is a tool for a detailed analysis of mean blood pressure values and assessing the blood pressure (BP) profile during the night with the daily values and optimal treatment determination.AimThe study aimed to evaluation the type of antihypertensive drugs and control assessment of hypertension based on ABPM in patients with severe obesity.Material and methodsThe study group consisted of 129 overweight and obese patients (group 1: BMI &lt; 40 kg/m&lt;sup&gt;2&lt;/sup&gt;; group 2: BMI ≥ 40 kg/m&lt;sup&gt;2&lt;/sup&gt;).They were interviewed, taking into account the antihypertensive drugs taken. We divided drugs into 5 groups: beta-blockers, angiotensin converting enzyme inhibitors (ACE-I) / angiotensin II receptor blockers (ARB), diuretics, calcium channel blockers and others. Mean systolic BP and diastolic BP from the day, day and night, mean heart rate from day to day was assessed based on ABPM.Results and discussionThe most frequently administered drugs in both groups were ACE-I/ARB. The second most often taken drug was β-blocker and diuretics. Group 1 was significantly older than group 2. Based on the analysis, HR level was significantly dependent on age, BMI, and diabetes. The systolic BP and diastolic BP level was dependent on age and sex.ConclusionsOnly a combination of individually designed pharmacological therapy with personalized dietary interventions, regular exercise, cognitive behavioral therapy, and bariatric interventions, when needed, could guarantee the final success. ABPM should be used routinely in every patients to control assessment of hypertension.

Danhong formula alleviates endothelial dysfunction and reduces blood pressure in hypertension by regulating MicroRNA 24 - Phosphatidylinositol 3-Kinase-Serine/Threonine Kinase- Endothelial Nitric Oxide Synthase axis

Ethnopharmacological relevanceEssential hypertension (EH) is one of the important risk factors of cardio-cerebrovascular diseases, and it can significantly increase the incidence and mortality of acute myocardial infarction, cerebral infarction and hemorrhage. Danhong Formula (DHF) was consisting of Radix et Rhizoma Salviae Miltiorrhizae (Salvia miltiorrhiza Bge., Labiatae, Danshen in Chinese) and Flos Carthami (Carthamus tinctorius L., Compositae, Honghua in Chinese) (Plant names have been checked with http://www.the plant list.org on June 28th, 2023) was approved by State Food and Drug Administration of China, that has been used for thousands of years in the treatment of cardiovascular diseases in China with proven safety and efficacy. Though our previous studies have found that DHF improved endothelial dysfunction (ED) and decreased high blood pressure (BP), the underlying mechanisms of its antihypertensive effect still remain unclear. Aim of the studyThis study investigated whether DHF regulated MicroRNA 24- Phosphatidylinositol 3-Kinase-Serine/Threonine Kinase- Endothelial Nitric Oxide Synthase (miR-24 - PI3K/AKT/eNOS) axis to produce antihypertensive effect and improve endothelial dysfunction. Materials and methodsFirstly, the chemical components of DHF were analyzed by UHPLC-MS. After that, BP was continuously monitored within the 1st, 3rd, and 4th week in SHR to evaluate the antihypertensive effect of DHF intraperitoneal injection. In addition, not only the contents of serum nitric oxide (NO), prostacyclin (PGI2), and angiotensin II (Ang II) were detected, but also the isolated aorta ring experiment was conducted to evaluate the vasomotoricity to evaluate of DHF on improving endothelial dysfunction. Key proteins or mRNA expression associated with miR-24 - PI3K/AKT/eNOS axis in aorta were detected by capillary Western blot, immunohistochemistry or RT-PCR to explore the underlying mechanisms. Index of NO, Ang II PGI2 and key proteins or mRNA expression were also conducted in miR-24-3p over-expression HUVECs model. ResultsCompared with SHR control group, DHF (4 mL/kg/day, 2 mL/kg/day, 1 mL/kg/day) treatment significantly reduced high BP in SHR and selectively increased acetylcholine (Ach) induced vasodilation, but not sodium nitroprusside (SNP) in a manner of concentration dependency in isolated aorta ring. DHF (4 mL/kg/day, 1 mL/kg/day) treatment was accompanying an increment of NO and PGI2, and lowering AngII in SHR. Moreover, DHF treatment significantly up-regulated expression of p-PI3K, p-AKT, mTOR, eNOS and p-eNOS, but down-regulated miR-24-3p expression in aorta. Compared with miR-24-3p over-expression HUVECs model group, DHF treatment inhibited miR- 24-3p expression and up-regulated p-PI3K, p-AKT, mTOR and eNOS mRNA expression. Similarly, DHF treatment increased PI3K, AKT, mTOR and eNOS protein expression in HUVECs by Western blot. ConclusionsThese findings suggest that DHF alleviates endothelial dysfunction and reduces high BP in SHR mediated by down-regulating miR-24 via ultimately facilitating up-regulation of PI3K/AKT/eNOS axis. This current study firstly demonstrates a potential direction for antihypertensive mechanism of DHF from microRNA aspect and will promote its clinical applications.

Using Chemerin and Inflammation Markers to Predict Coronary Ar-tery Disease in Metabolic Syndrome Patients

The systemic inflammation plays a role in both metabolic syndrome (MetS) and coronary artery disease (CAD). This study was undertaken to determine chemerin's role and inflammation indicators in the emergence of CAD in MetS patients. The study was conducted on 120 subjects (male and female), whose ages (35 to 65)years. The study subjects divided into three groups which are 45 MetS patients with CAD and 40 MetS patients without CAD, and 25 control, who underwent coronary angiography for the evaluation of CAD. The chemerin level, as well as the levels of inflammatory markers such as interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), leptin, and tumor necrosis factor-alpha (TNF-α), were measured by enzyme-linked immunosorbent assay (ELIZA). The results show that the concentrations of chemerin, TNF-α, leptin, and Il-6 were significantly elevated in MetS patients with CAD compared with control group. Triglycerides, cholesterol, and LDL-C were significantly increased, while HDL-C was significantly decreased in MetS patients compared with control. The present study show that chemerin is associated with markers of inflammation and predictors such as IL-6, hs-CRP and TNF-alpha, which important risk factors determining CAD in Iraqi subjects with MetS. Adipokines might also be seen as crucial clinical biomarkers and pharmacological targets for lowering the mortality and incidence of CAD in MetS patients.

Prevalence of chronic obstructive pulmonary disease among non-smokers in rural areas of Lucknow district, Uttar Pradesh, India

Background: Chronic obstructive pulmonary disease (COPD) is a chronic progressive disease of the airways and lung parenchyma and the risk factors include both genetic and environmental factors. Tobacco smoking has remained the most important risk factor associated with it. The occurrence of COPD in non-smokers is not widely appreciated, even though its relative burden is higher in developing countries than developed countries. There is limited information on the risk factors associated with spirometrically confirmed COPD in non-smokers in the general population and more data from population-based studies are needed. Hence, the objective of this study was to determine the prevalence of COPD and associated risk factors among non-smokers in rural areas of Lucknow district, Uttar Pradesh, India. Methods: This cross-sectional study with multi-stage random sampling was conducted among 552 non-smoking participants aged 18 years and above in rural areas of Lucknow. It was conducted using pre-designed questionnaire for data collection. COPD assessments were done using a combination of clinical history and portable spirometry. Data collected was analysed using SPSS 23.0 version. Results: FEV1/FVC &lt;0.7 was used to define COPD which yielded a prevalence of 8.5 percent among non-smoking participants. Gender, occupation, type of family, presence of ex-smoker, presence of dampness and livestock in the house were the risk factors that showed statistically significant association with COPD. Conclusions: The higher prevalence noted in this study highlights the need for enhanced community-based screening programme for secondary prevention of COPD among adults.