Atherosclerosis is the leading cause of cardiovascular disease, which remains the global leader in mortality.Insulin-like growth factor I (IGF1) has been shown to reduce cardiovascular events.Administration of IGF1 reduced atherosclerosis and reduced plaque macrophages in ApoE-deficient (Apoe-/-) mice fed a high-fat diet.Our previous in vitro results suggest that macrophages play a major role in mediating the effects of IGF1 in atherosclerotic plaques, but the exact mechanism remains unclear.We hypothesized that strictly increasing IGF1 levels in macrophages would prevent atherosclerosis.
After breeding novel macrophage-specific IGF1-overexpressing transgenic mice into the Apoe-/- background (MF-IGF1 mice), we assessed atherosclerotic plaque burden, stability, and monocyte recruitment.We accelerated the development of atherosclerosis by feeding the animals a high-fat diet for three months.We also assessed cholesterol efflux and foam cell formation in vivo and in vitro.
Macrophage IGF1 overexpression downregulated plaque burden by 30%, reduced plaque macrophages by 47%, and promoted features that stabilize the plaque phenotype.Monocyte recruitment was reduced by 70% in MF-IGF1 mice and correlated with a 27% reduction in circulating levels of CXC chemokine ligand 12 (CXCL12).CXCL12 protein levels were reduced in plaques and peritoneal macrophages in MF-IGF1 mice.In vitro, IGF1 completely blocked oxidized low-density lipoprotein (oxLDL)-dependent increase in CXCL12 mRNA transcription (98% reduction, P<0.01), and IGF1 treatment reduced CXCL12 protein (56% reduction, P<0.001).
CXCL12 reduces the expression of ATP-binding cassette transporter A1 (ABCA1), a key cholesterol transporter that mediates cholesterol efflux from macrophages.We found a 2-fold increase in ABCA1 protein levels in peritoneal macrophages isolated from MF-IGF1 mice.We measured changes in cholesterol efflux by loading peritoneal macrophages with oxLDL and found a 42% increase in efflux in MF-IGF1 mice.We also found a 27% increase in cholesterol efflux in THP-1 cells treated with IGF1 (100 ng/mL) with apolipoprotein AI as the cholesterol receptor.
Our results demonstrate that macrophage IGF1 reduces atherosclerosis and reduces CXCL12, a chemokine newly involved in atherosclerosis progression.IGF1 may reduce CXCL12 by reducing monocyte recruitment and increasing ABCA1, thereby exerting its atheroprotective effect, thereby increasing cholesterol efflux capacity.
Mutations in the TTR gene (rs76992529; Val122Ile) are seen only in individuals of African ancestry (population frequency: 3-4%) resulting in misfolding of the tetrameric transthyretin complex, which is found in hereditary transthyretin amyloidosis. Degeneration (hATTR) accumulates as extracellular amyloid fibrils.Estimating the impact of this amyloidogenic TTR variant on heart failure (HF) risk and all-cause mortality in a large, geographically diverse cohort of African Americans could provide insight into the clinical significance of this variant.We assessed black participants in the Geographic and Racially Different Causes of Stroke (REGARDS) study to examine the association of the TTR Val122Ile mutation with HF and all-cause mortality.
We evaluated self-reported black American participants in the REGARDS study without HF at baseline.Poisson regression was used to estimate the incidence of heart failure and all-cause mortality.We used a multivariate-adjusted Cox regression model accounting for demographic, clinical and social factors, and genetic African ancestry to assess the risk of HF and all-cause mortality in individuals with the TTR Val122Ile genetic variant compared with those without the variant.
Among 7,514 black participants (median age: 64 years; 61% female), the population frequency of the TTR Val122Ile variant was 3.1% (232 carriers; 7,282 non-carriers).The incidence of HF (per 1000 person-years) was 15.9 (95% CI: 11.5-21.9) among variant carriers and 7.2 (95% CI: 6.6-7.9) among variant noncarriers.Val122Ile variant carriers had a higher risk of developing HF compared with non-carriers (HR: 2.46 [95% CI: 1.72–3.53]; P<0.0001).The incidence of all-cause mortality (per 1000 person-years) was 41.5 (95% CI: 34.6-49.7) among variant carriers and 33.9 (95% CI: 32.7-35.2) among variant non-carriers.Val122Ile variant carriers had a higher risk of all-cause mortality compared with non-carriers (HR: 1.44 [95% CI: 1.18-1.76]; P=0.0004).TTR variant carrier status and gender did not interact with HF and all-cause mortality outcomes.
In a large cohort of black Americans, we demonstrate that the amyloid Val122Ile mutation in the TTR gene is associated with an approximately 2.5-fold higher risk of HF and an approximately 40% higher risk of all-cause mortality.With the advent of numerous hATTR therapies, the presence of the TTR Val122Ile mutation commonly found in people of African ancestry may be considered clinically actionable and prompt early access to treatment.
Activation of guanylate cyclase/natriuretic peptide receptor A (GC-A/NPRA) by the cardiac hormones atrial and brain natriuretic peptides (ANP and BNP) produces the second messenger cGMP.cGMP activates the downstream signaling and biological effects of ANP/NPRA for diuretic, diuretic, vasodilatory, antimitotic responses and cardiac antihypertrophic effects.The expression of the Npr1 gene (encoding GC-A/NPRA) is regulated by several external and internal stimuli, but the hormonal and epigenetic mechanisms that mediate Npr1 regulation are unknown.The aim of this study was to examine the role of vitamin D (vitD) in regulating Npr1 gene transcription and expression by regulating epigenetic factors.
Our bioinformatic study of the murine Npr1 promoter revealed the presence of four vitD response elements (VDREs) in the -583 to -495 region of the transcription start site, with a perfect VDRE-like consensus sequence.To characterize the mechanisms regulating Npr1 promoter activity, the constructs were transiently transfected in cultured rat thoracic aortic smooth muscle cells (RTASMCs) and mouse mesangial cells (MMCs) and measured for dual luciferase assay kits. Transcriptional activity.
Luciferase assay showed that treatment with vitamin D3 (1α,25-dihydroxy; VD3) increased Npr1 promoter activity more than 6-fold in a dose-dependent manner.Western blot and densitometric analysis showed that NPRA protein levels in MMCs increased significantly with increasing VD3 concentration, 3.5-fold in RTASMCs and 4.7-fold in RTASMCs, and the maximum effect was observed at 100 nM.VD3 increases the protein level of the vitD receptor (VDR) in a dose-dependent manner.In the presence of VD3, histone deacetylase (HDAC) activity was 50% inhibited as measured by an HDAC activity/inhibition ELISA kit.Furthermore, treatment with VD3 reduced class I HDAC enzymes, HDAC1 and HDAC3 protein levels, and dose-dependently enhanced histones, H3 at lysine residues 9 and 14 (H3-K9/14 ac) and lysine H4 at acid residue 12 (H4-K14ac).
The results suggest that VD3 epigenetically regulates Npr1 gene expression by regulating histone modifications.Identification of epigenetic targets of vitamin D signaling as regulators of Npr1 gene transcription and protein expression will have important implications for hypertension and cardiovascular regulation.
showed that entanglement and superconductivity improved intracellular conduction in pairs of isolated cardiomyocytes, improving coupling and left ventricular function.
Experiments were performed using artificial intelligence inside cells using quantum concepts of entanglement and superconductivity; intracellular electrical conductance across the junctional gap (GI) induced by enalapril (E.) and angiotensin II (Ang II) was measured.E. Inject at 1 ug/ml (25 ug/ml) over 4 minutes.A plateau is reached at the valve at 106% flow from the bag.Ang II.Injected at 1 ug/min, the GI was reduced (55%) and there was no plateau.
We think a plateau is reached after reducing entanglement, but not with Ang II.In the superconducting state, E. coli was more effective in improving coupling of failing myocytes, improving left ventricular function.
Coronavirus disease (COVID-19) ranges from asymptomatic infection to severe illness with multiple organ failure.Recent studies have shown an association between lower serum lipid levels, namely high-density lipoprotein (HDL), low-density lipoprotein (LDL), and total cholesterol (TC), and COVID-19 disease severity.However, the results lack consistency, and the extent of the association is currently unknown.
We performed a systematic review and meta-analysis of 1) differences in HDL, LDL, TC, and triglyceride (TG) levels between COVID-19 patients and healthy controls 2) with and without severe illness with COVID-19 Patient 3) COVID-19 patient died and survived.We have included articles from PubMed and Embase as of September 1, 2021.We analyzed the pooled mean difference (pMD) in lipid levels (mg/dL) of the above groups using a random-effects meta-analysis and assessed publication bias using a funnel plot.
Of the 441 articles retrieved, 29 articles (26 retrospective cohorts and 3 prospective cohorts) met the inclusion criteria, with a total of 256,721 participants.Patients with COVID-19 had lower levels of HDL (pMD = -6.95) and TC (pMD = -14.9) (Table 1 and Figure 1).LDL and TG levels did not differ between patients with and without COVID-19.Severe COVID-19 patients had lower levels of HDL (pMD = -4.4), LDL (pMD = -4.4) and TC (pMD = -10.4) compared with non-severe COVID-19 patients.Patients who died had lower levels of HDL (pMD = -2.5), LDL (pMD = -10.6) and TC (pMD = -14.9).TG levels did not differ from COVID-19 severity or mortality.None of the above analyses showed statistically significant publication bias.
Our analysis showed that patients with COVID-19 had lower blood lipid levels compared to healthy controls.In COVID-19 patients, lower HDL, LDL, and TC levels were associated with severity and mortality.We believe that lower lipoprotein levels are secondary to systemic inflammation and liver dysfunction.Blood lipid levels can be explored as potential prognostic factors in COVID-19 patients.
Atrial and brain natriuretic peptides (ANP and BNP) are circulating hormones of cardiac origin that play key roles in regulating blood pressure and fluid homeostasis and improving cardiac remodeling through vasodilatory and diuretic effects.Both ANP and BNP act by binding to transmembrane guanylate cyclase/natriuretic peptide receptor-A (GC-A/NPR-A).Systemic disruption of the Npr1 gene (encoding GC-A/NPRA) results in volume overload, hypertension, and congestive heart failure.However, the underlying mechanism has not been precisely identified.The aim of this study was to investigate whether Npr1 plays a critical role in regulating glucose homeostasis in Npr1 gene-disrupted mice.
Adult males and females (16-18 weeks) Npr1 knockout haplotype (Npr1+/-, 1-copy), wild-type (Npr1+/+, 2-copy) and gene duplication (Npr1+ +/++, 4 -copy) Mice were fasted for 16 hours and had free access to water.Oral and intraperitoneal administration of glucose (2 g/kg body weight) was performed in mice to determine oral glucose tolerance test (OGTT) and intraperitoneal glucose tolerance test (IPGTT).Blood glucose levels were determined by tail bleeds at 0, 15, 30, 60, 90, and 120 minutes using the AlphaTRAK Blood Glucose Monitoring System (Zoetis Inc, Kalamazoo, MI).Systolic blood pressure (SBP) was determined by a non-invasive computerized tail-cuff method (Visitech 2000).
Results showed that blood glucose levels in 2-copy mice (OGTT: 101 ± 4 mg/dL) increased to a maximum at 15 minutes after glucose (2 g/kg body weight) administration and decreased to near basal levels at 120 minutes in males. and females 98 ± 3 mg/dL, IPGT: males 100 ± 3 mg/dL, females 97 ± 4 mg/dL), whereas in 1-copy mice, blood glucose levels remained elevated even after 120 minutes (OGTT: males 244 ± 6 mg/dL, female 220 ± 4 mg/dL, IPGT: male 250 ± 5 mg/dL, female 225 ± 6 mg/dL) compared to 2-copy mice.4-copy mice also had significantly lower blood glucose levels at 120 minutes (OGTT: 78 ± 3 mg/dL for males, 73 ± 2 mg/dL for females, IPGT: 76 ± 4 mg/dL for males and 70 ± 3 mg/dL for females). dL) compared to 2-copy mice.The SBP was significantly higher in 1-copy mice (134 ± 3 mmHg in males and 125 ± 3 mmHg in females) than in 2-copy mice (101 ± 2 mmHg in males and 92 ± 2 mmHg in females).Likewise, 4-copy mice also had significantly lower SBP than 2-copy mice (85 ± 3 mmHg in males and 78 ± 2 mmHg in females).The maximal blood glucose level was significantly lower with the OGTT compared with the IPGTT.
The current findings show that Npr1 significantly prevented the sharp rise in blood glucose levels following glucose challenge and ameliorated glucose intolerance in wild-type and gene-replicated mice, suggesting that Npr1 plays a key role in regulating glucose levels and loss of Npr1 Action adversely affects kidney and cardiac function in mutant mice.This work was supported by an NIH grant (HL062147).
Central Arkansas Veterans Healthcare System John L. McClellan Memorial Veterans Hospital, Little Rock, Arkansas
Patients with chronic kidney disease (CKD) and non-ST-segment elevation myocardial infarction (NSTEMI) represent a significant clinical challenge.The agreement between randomized and observational studies is uncertain.(1) Do randomized studies and observational studies support the use of invasive treatments to the same extent (2) Are outcomes influenced by levels of renal function?(3) Is the mortality rate the same with drug treatment alone in randomized and observational studies?
Studies were selected based on the following criteria: (1) randomised or observational reports of patients with NSTEMI and CKD (2) number of patients and mortality available for invasive and conservative treatment at each level of renal function, including estimated glomerular filtration rate (eGFR) 30–60 and <30.A meta-analysis with subgroup comparisons was completed by calculating odds ratios for deaths from invasive versus conservative treatments.
(1) Five randomized studies and four observational studies met selection criteria, with a total of 362,486 patients receiving invasive or conservative treatment between 1994 and 2020
(2) In randomized studies, the odds ratio for death due to invasive treatment in patients with eGFR 30-60 was 0.739, confidence interval (CI) was 0.382-1.431, p = 0.370.In an observational study of eGFR 30-60, the odds ratio for invasive treatment for death was 0.144, CI 0.012-0.892, p=0.037.
(3) In randomized studies, the odds ratio for death due to invasive treatment in patients with eGFR <30 was 0.790, CI 0.135–4.63, p=0.794.In observational studies, patients with eGFR <30 had an odds ratio of 0.384 for death, CI 0.281–0.552, p<.05.
(4) The mean risk of death in patients with eGFR 30-60 treated with conservative treatment alone was 0.128 (CI -0.001-0.227) in the randomized study group and 0.44 (CI 0.227-0.6525) in the observational study group, p<0.01 . In the randomized study Median risk of death was 0.345 (CI -0.103–0.794) in patients with eGFR <30 receiving conservative treatment alone and 0.463 (CI 0.00–0.926) in observational studies, p=0.579.
(1) Despite the favorable effect of invasive treatment in both randomized and interventional studies, the odds ratio for death in observational studies was statistically significant.
(2) Observational studies have shown that invasive treatment has a significantly lower odds ratio for death in patients with eGFR 30-60 and eGFR <30.
(3) Patients in the observation group had a higher risk of death with conservative treatment alone.
(4) More research is needed to develop a model for selecting patients who will benefit most from invasive or conservative treatment.
(5) Limitations of this study include differences in the number of patients in the study groups, lack of hemodynamic and angiographic data according to eGFR, and the possibility that some studies included patients with unstable angina pectoris other than NSTEMI.
Despite technological advances in cardiology, cardiogenic shock as a complication of acute myocardial infarction remains a medical challenge.Recently, the National Cardiogenic Shock Management Standardization Campaign was launched in the United States, and the National Cardiogenic Shock Initiative aims to improve survival, especially in patients with acute coronary syndrome (ACS).Our goal was to determine how cardiogenic shock secondary to ACS requiring mechanical circulatory support is managed in our institution and to compare clinical characteristics between survivors and non-survivors.
A retrospective study of patients aged 18-89 years requiring temporary mechanical circulatory support in the ACS setting at the University of Texas Lubbock Medical Center from August 2018 to August 2019.Survivor and non-survivor discharges were compared.Fisher's exact test and Wilcoxon rank-sum test were used for categorical and continuous variables.
A total of 39 patients were included, 90% were male, the mean age was 62 years, 62% had diabetes, and the mean body mass index was 29.01±5.84 kg/m2.Intra-aortic balloon pump was the most commonly used mechanical support device, followed by Impella (92% vs 8%).The overall mortality rate was 18%.Elevated heart rate and lactate on admission during mechanical support use were associated with mortality (105 bpm vs 83.91 bpm, p=0.02) (6.85 mmol/l vs 2.55 mmol/lp, 0.003. Percutaneous coronary intervention (PCI) The presence of prior mechanical support or coronary artery bypass grafting (CABG) in 44% of patients was associated with survival (53% vs 0% p=0.01).
Elevated heart rate and lactate levels during placement of mechanical support are associated with mortality in patients with cardiogenic shock secondary to acute coronary syndrome.Initiation of mechanical support before PCI was associated with survival.Larger and more rigorous studies are needed to elucidate these associations.
Managing hidradenitis suppurativa (HS) can be challenging.In many cases, patients' symptoms improved after initial conservative intervention.Unfortunately, some cases become refractory and lead to cosmetic and painful relapses.Surgery is often used to debride or remove affected tissue to promote healing.We describe a patient who was refractory to surgery who underwent surface electron beam radiation therapy.
A 44-year-old man presented with diffuse thickening of the buttocks, gluteal cleft, perineum, and bilateral thigh HS.The patient was refractory to surgical debridement and treatment with antibiotics and corticosteroids.He received split-course electron beam radiation therapy with a total dose of 30 Gy in 10 divided doses and maintained a partial response for 2 weeks after the start of treatment.Objective physical examination within 1 month of treatment showed a 25% reduction in the total area of inflammation and marked flattening of the raised areas.At that time, patients reported subjective reductions in pain and drainage.The response was considered durable at 6 and 12 months after treatment.
Radiation therapy has anecdotal benefits for a variety of benign diseases and has been studied at low doses (sometimes single doses) in the management of HS.We chose to use a split course that we believe is the safest and possibly longest-lasting in terms of mitigating side effects.
Patient's treatment area showing hidradenitis suppurativa in the buttocks, gluteal cleft, perineum and bilateral thighs before treatment
Superficial electron beam radiation therapy is effective in treating benign disease and holds promise for refractory HS.Studies of total dose and fractionation regimens are needed to optimize and guide future use.
In the general US population, 1 in 5,000 people have mitochondrial myopathy.Clinical manifestations can be roughly divided into three categories: chronic progressive external ophthalmoplegia, skeletal-CNS syndrome or simple myopathy.Cardiac abnormalities occur in 30-32% of cases, mainly as hypertrophic cardiomyopathy, dilated cardiomyopathy, or conduction abnormalities.We present a case of bilateral lower extremity weakness, pain, and swelling with a muscle biopsy diagnosis of mitochondrial myopathy.Case description: A 21-year-old male graduate student was referred to our hospital after 3 weeks of leg weakness, pain, and swelling after arriving in the United States from India.Examination revealed tachycardia, 2+ points of pitting edema in both knees, 4/5 MRC-grade weakness, mild tenderness in proximal and distal muscle groups of the upper and lower extremities, no deep tendon reflexes, foot drop, and bilateral ptosis and restricted extraocular movement.Preliminary laboratory results showed creatinine kinase increased by 691 IU/L, brain natriuretic peptide increased by 3437 pg/mL, troponin increased by 47.1 ng/L, myoglobin increased by 195 ng/mL, and lactate increased by 7.7 mmol /L, serum bicarbonate decreased by 12 mmol/L.Lumbar puncture results in suspected Guillain-Barre syndrome are unreliable due to traumatic taps.Electrocardiogram showed left axis deviation with left anterior bundle block.Chest X-ray and CT angiography of chest/abdomen/pelvis showed cardiac enlargement and volume overload.His bedside ECHO showed mild left systemic hypokinesia, 40-44% lower ejection fraction, and mild pulmonary hypertension.The patient was admitted to the medical intensive care unit due to a drop in maximum inspiratory pressure.Ophthalmology confirmed ophthalmoplegia, excluding cranial nerve palsy, myasthenia gravis, and retinitis pigmentosa.Gq1b antibody negative.Extensive autoimmune and infectious workup is non-contributing.Muscle biopsy of the patient's rectus femoris muscle showed scattered blue and cytochrome-c oxidase-negative fibers with increased perimuscular and endomysial connective tissue, consistent with active and chronic primary mitochondrial myopathy.Endomyocardial biopsy showed active lymphocytic myocarditis.The patient has been successfully treated with furosemide, metoprolol, and methylprednisolone.
Myopathy should be considered in the differential diagnosis of patients with suspected Guillain-Barre syndrome.We report an interesting case of myopathy with prominent cardiac manifestations.Myositis manifesting as myocarditis should raise suspicion of mitochondrial disease.Our experience underscores the importance of using an interdisciplinary team approach to diagnose rare pathologies with widely variable multisystem involvement.
The purpose of this study was to explore the possibility of diagnosing Gaisbock in patients with chronic polycythemia and hypertension.
An obese 40-year-old Caucasian man was admitted to the hospital with recurrent leg swelling and increased oxygen demand after two weeks of hospitalization with COVID-19 pneumonia.After reviewing the patient's medical history, he was found to have untreated hypertension and polycythemia spanning a decade at several visits.Recent medical history includes a diagnosis of deep vein thrombosis (DVT) in the same leg two and a half months ago, and treatment with Xarelto.
The patient reported a 12-year history of low testosterone.However, he has not used any testosterone supplements for the past nine months.He reported daytime fatigue, frequent awakenings at night, and frequent snoring.This patient had never had a sleep study or used CPAP.The patient smoked half a can of chewing tobacco per day for 13 consecutive years, one pack per day, for 10 consecutive years, and quit smoking 12 years ago.He spent most of his life doing hard work in the construction industry.
Post time: Jun-29-2022