Association between the Controlling Nutritional Status score and long-term outcome in patients with acute heart failure / 中华心血管病杂志

Objective: To evaluate the nutritional status by the Controlling Nutritional Status (CONUT) score and its association with the long-term prognosis in patients with acute heart failure (AHF). Methods: This prospective monocentric study consecutively enrolled patients admitted to our hospital for AHF from April 2012 to May 2016. Patients were divided into 3 groups based on the CONUT score at admission: normal (0-1), mild malnutrition (2-4) and moderate-severe malnutrition (5-12) groups. Baseline information was obtained and recorded within 24 hours after admission. All patients were followed up every 3 months by outpatient visit or telephone call until March 2019. The primary endpoint was all-cause mortality. The Kaplan-Meier survival curves and log-rank test were used to compare all-cause mortality between groups. Variables showing statistical significance in the univariate analysis were incorporated into multivariate Cox regression model to analyze the independent risk factors for all-cause mortality after discharge. Results: A total of 396 patients were enrolled in this study, including 114 patients with normal nutritional status, 200 patients with mild malnutrition and 82 patients with moderate-severe malnutrition. One hundred and fifty-eight patients died during a median follow-up of 34 (18, 46) months. The mortality was 32.4% (37/114), 39% (78/200) and 52.4% (43/82) in normal, mild malnutrition and moderate-severe malnutrition groups, respectively. The mortality was significantly higher in the moderate-severe malnutrition group than in normal nutrition group (P<0.05). However, there was no significant difference in mortality between normal and mild malnutrition group as well as between mild and moderate-severe malnutrition group (both P>0.05). Kaplan-Meier curves indicated that patients with high CONUT score group was at higher risk of all-cause mortality compared with those with low CONUT score (P=0.002). Cox proportional hazard analyses showed that the risk of all-cause mortality of moderate-severe malnutrition group was significantly higher than that of normal nutrition group (HR =1.648, 95%CI 1.021-2.660, P=0.041). Conclusions: The CONUT score of patients with AHF at admission is associated with the long-term prognosis. High CONUT score is an independent risk factor for all-cause mortality in AHF patients after discharge.

Growth differentiation factor-15 combined with N-terminal prohormone of brain natriuretic peptide increase 1-year prognosis prediction value for patients with acute heart failure: a prospective cohort study / 中华医学杂志(英文版)

BACKGROUND@#Clinical assessment and treatment guidance for heart failure depends on a variety of biomarkers. The objective of this study was to investigate the prognostic predictive value of growth differentiation factor-15 (GDF-15) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in assessing hospitalized patients with acute heart failure (AHF).@*METHODS@#In total, 260 patients who were admitted for AHF in the First Affiliated Hospital of Nanjing Medical University were enrolled from April 2012 to May 2016. Medical history and blood samples were collected within 24 h after the admission. The primary endpoint was the all-cause mortality within 1 year. The patients were divided into survival group and death group based on the endpoint. With established mortality risk factors and serum GDF-15 level, receiver-operator characteristic (ROC) analyses were performed. Cox regression analyses were used to further analyze the combination values of NT-proBNP and GDF-15.@*RESULTS@#Baseline GDF-15 and NT-proBNP were significantly higher amongst deceased than those in survivors (P < 0.001). In ROC analyses, area under curve (AUC) for GDF-15 to predict 1-year mortality was 0.707 (95% confidence interval [CI]: 0.648-0.762, P < 0.001), and for NT-proBNP was 0.682 (95% CI: 0.622-0.738, P < 0.001). No statistically significant difference was found between the two markers (P = 0.650). Based on the optimal cut-offs (GDF-15: 4526.0 ng/L; NT-proBNP: 1978.0 ng/L), the combination of GDF-15 and NT-proBNP increased AUC for 1-year mortality prediction (AUC = 0.743, 95% CI: 0.685-0.795, P < 0.001).@*CONCLUSIONS@#GDF-15, as a prognostic marker in patients with AHF, is not inferior to NT-proBNP. Combining the two markers could provide an early recognition of high-risk patients and improve the prediction values of AHF long-term prognosis.@*CLINICAL TRIAL REGISTRATION@#ChiCTR-ONC-12001944, http://www.chictr.org.cn.

Growth differentiation factor-15 combined with N-terminal prohormone of brain natriuretic peptide increase 1-year prognosis prediction value for patients with acute heart failure: a prospective cohort study / 中华医学杂志(英文版)

Background@#Clinical assessment and treatment guidance for heart failure depends on a variety of biomarkers. The objective of this study was to investigate the prognostic predictive value of growth differentiation factor-15 (GDF-15) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) in assessing hospitalized patients with acute heart failure (AHF).@*Methods@#In total, 260 patients who were admitted for AHF in the First Affiliated Hospital of Nanjing Medical University were enrolled from April 2012 to May 2016. Medical history and blood samples were collected within 24 h after the admission. The primary endpoint was the all-cause mortality within 1 year. The patients were divided into survival group and death group based on the endpoint. With established mortality risk factors and serum GDF-15 level, receiver-operator characteristic (ROC) analyses were performed. Cox regression analyses were used to further analyze the combination values of NT-proBNP and GDF-15.@*Results@#Baseline GDF-15 and NT-proBNP were significantly higher amongst deceased than those in survivors (P < 0.001). In ROC analyses, area under curve (AUC) for GDF-15 to predict 1-year mortality was 0.707 (95% confidence interval [CI]: 0.648–0.762, P < 0.001), and for NT-proBNP was 0.682 (95% CI: 0.622–0.738, P < 0.001). No statistically significant difference was found between the two markers (P = 0.650). Based on the optimal cut-offs (GDF-15: 4526.0 ng/L; NT-proBNP: 1978.0 ng/L), the combination of GDF-15 and NT-proBNP increased AUC for 1-year mortality prediction (AUC = 0.743, 95% CI: 0.685–0.795, P < 0.001).@*Conclusions@#GDF-15, as a prognostic marker in patients with AHF, is not inferior to NT-proBNP. Combining the two markers could provide an early recognition of high-risk patients and improve the prediction values of AHF long-term prognosis.@*Clinical trial registration@#ChiCTR-ONC-12001944, http://www.chictr.org.cn.

Association of CYBA rs7195830 polymorphism with estimated glomerular filtration rate in an adult Han sample from Jiangsu province, China / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Reactive oxygen species are thought to contribute to the development of renal damage. The P22phox subunit of nicotinamide adenine dinucleotide phosphate (NAPDH) oxidase, encoded by the cytochrome b245a polypeptide gene, CYBA, plays a key role in superoxide anion production. We investigated the association of CYBA rs7195830 polymorphism with estimated glomerular filtration rate (eGFR) and the role it plays in the pathogenesis of chronic kidney disease (CKD) in a Han Chinese sample.</p><p><b>METHODS</b>The Gaoyou study enrolled 4473 participants. Serum levels of creatinine were measured and eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration equations. The CYBA polymorphisms were genotyped. Then we investigated the association between eGFR and the rs7195830 polymorphism in the recessive model.</p><p><b>RESULTS</b>The AA genotype of rs7195830 was associated with significantly lower values of eGFR compared with the GG and AG genotypes ((102.76 ± 17.07) ml×min(-1)×1.73 m(-2) vs. (105.08 ± 16.30) ml×min(-1)± 1.73 m(-2)). The association remained significant in the recessive model after adjusting for age, gender, body mass index, smoking, hypertension, diabetes mellitus, uric acid, triglyceride, low density lipoprotein cholesterol and high density lipoprotein cholesterol (β=1.666, P=0.031). The rs7195832 AA genotype was an independent risk factor for CKD: eGFR <60 ml×min(-1)×1.73 m(-2) (odds ratio=3.32; 95% CI=1.21-9.13).</p><p><b>CONCLUSION</b>The AA genotype of rs7195830 is independently associated with lower estimated glomerular filtration rate and is significantly associated with CKD.</p>

Efficacy of compound xuanju capsule on type-III prostatitis-related sexual dysfunction / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the value of Compound Xuanju Capsule in the treatment of type-III prostatitis-related sexual dysfunction.</p><p><b>METHODS</b>We randomly divided 90 type-III prostatitis patients with sexual dysfunction diagnosed by NIH clinical criteria into an experiment group and a control group to be treated with Compound Xuanju Capsule and antibiotics, respectively. We analyzed the therapeutic results based on the scores on chronic prostatitis symptom index (CPSI), prostatitis-related sexual function index (PSFI ) and self-rating anxiety scale (SAS), and compared them between the two groups and with the baseline data.</p><p><b>RESULTS</b>The degree of prostatitis-related sexual dysfunction was not correlated with that of prostatitis symptoms. Prostatitis symptoms and sexual function were significantly improved in the experiment group than in the control (P < 0.05), and the SAS score was markedly lower in the former than in the latter (P < 0.05).</p><p><b>CONCLUSION</b>Compound Xuanju Capsule can not only alleviate the symptoms of type-III prostatitis, but also improve its related sexual dysfunction and anxiety.</p>

Relationship between high-sensitive c-reactive and blood pressure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the relationship between c-reactive protein (CRP) and blood pressure in a general population.</p><p><b>METHODS</b>We randomly selected 3889 subjects aged 18 - 74 years stratified by gender and age in Baqiao, a rural area of Jiangsu Province. A standardized questionnaire was used to collect information on medical history, smoking, alcohol intake and use of medications. Blood pressure was measured by mercury sphygmomanometer. Serum CRP (hCRP) concentration was measured using a high sensitivity BNprosec immunonephelometric assay. Subjects were divided into 4 groups according to their interquartile range of CRP levers: group Q1 (men hCRP < 2.04 mg/L; women hCRP < 1.80 mg/L); group Q2 (men 2.04 mg/L ≤ hCRP < 3.01 mg/L; women 1.80 mg/L ≤ hCRP < 2.76 mg/L); group Q3 (men 3.01 mg/L ≤ hCRP < 4.14 mg/L; women 2.76 mg/L ≤ hCRP < 3.84 mg/L); and group Q4 (men 4.14 mg/L ≤ hCRP; women 3.84 mg/L ≤ hCRP).</p><p><b>RESULTS</b>Systolic blood pressure (SBP, adjusted P = 0.016) and pulse pressure (PP, adjusted P = 0.003) of men and PP (adjusted P = 0.002) of women were increased in proportion to increased CRP levels. Diastolic blood pressure was not associated with CRP levels. Multiple stepwise regression analysis showed that logCRP was independently associated with SBP and PP in men and PP in women. hCRP was independently associated with hypertension in men. Compared with group Q1, male people in group Q4 faced a 40.4% (95% confidence interval: 4.9% - 87.9%) higher risk of hypertension.</p><p><b>CONCLUSIONS</b>hCRP was independently associated with PP in men and women, and SBP in men. hCRP was independently associated with hypertension in men but not in women in this study population.</p>

Increased stromal-cell-derived factor 1 enhances the homing of bone marrow derived mesenchymal stem cells in dilated cardiomyopathy in rats / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Stem cell transplantation has been shown to have beneficial effects on dilated cardiomyopathy. However, mechanism for stem cell homing to cardiac tissue in dilated cardiomyopathy has not yet been elucidated.</p><p><b>METHODS</b>Mesenchymal stem cells were obtained from rat bone marrow, expanded in vitro, and labeled with (99m)Tc. Cardiomyopathy model was induced by doxorubicin in rats. (99m)Tc labeled cells were infused into the left ventricles in cardiomyopathy and control rats. Sixteen hours after injection, animals were sacrificed and different tissues were harvested to measure specific radioactivity. By use of real-time polymerase chain reaction and immunohistochemistry, mRNA and protein expressions for stromal-cell-derived factor 1 in cardiac tissue were measured.</p><p><b>RESULTS</b>Labeling efficiency of mesenchymal stem cells was (70.0 ± 11.2)%. Sixteen hours after mesenchymal stem cell transplantation, the heart-to-muscle radioactivity ratio was increased significantly in cardiomyopathy hearts as compared to control hearts. Both mRNA and protein expressions of stromal-cell-derived factor 1 were up-regulated in cardiomyopathy hearts as compared with control hearts.</p><p><b>CONCLUSION</b>In dilated cardiomyopathy induced by doxorubicin up-regulated expression of stromal-cell-derived factor 1 in heart may induce mesenchymal stem cells home to the heart.</p>

PDK1 plays a critical role in regulating cardiac function in mice and human / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>PDK1 is an essential protein kinase that plays a critical role in mammalian development. Mouse lacking PDK1 leads to multiple abnormalities and embryonic lethality at E9.5. To elucidate the role of PDK1 in the heart, we investigated the cardiac phenotype of mice that lack PDK1 in the heart in different growth periods and the alteration of PDK1 signaling in human failing heart.</p><p><b>METHODS</b>We employed Cre/loxP system to generate PDK1(flox/flox): α-MHC-Cre mice, which specifically deleted PDK1 in cardiac muscle at birth, and tamoxifen-inducible heart-specific PDK1 knockout mice (PDK1(flox/flox):MerCreMer mice), in which PDK1 was deleted in myocardium in response to the treatment with tamoxifen. Transmural myocardial tissues from human failing hearts and normal hearts were sampled from the left ventricular apex to analyze the activity of PDK1/Akt signaling pathways by Western blotting.</p><p><b>RESULTS</b>PDK1(flox/flox): α-MHC-Cre mice died of heart failure at 5 and 10 weeks old. PDK1(flox/flox) -MerCreMer mice died of heart failure from 5 to 21 weeks after the initiation of tamoxifen treatment at 8 weeks old. We found that expression levels of PDK1 in human failing heart tissues were significantly decreased compared with control hearts.</p><p><b>CONCLUSION</b>Our results suggest that PDK1 signaling network takes part in regulating cardiac viability and function in mice, and may be also involved in human heart failure disease.</p>

Relationship between serum resistin level and large arterial elasticity in patients with essential hypertension / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the association between serum resistin concentration and large arterial elasticity in patients with essential hypertension (EH).</p><p><b>METHODS</b>271 recruited subjects were divided into the control group (n = 134) and EH group (n = 137). Blood pressure, waist circumference, hip, body mass index (BMI) were measured. Serum resistin concentration was assessed by enzyme immunoassay, fasting serum insulin and TNF-alpha were measured using radioimmunity kits. Insulin resistance was evaluated by insulin resistance index (HOMA-IR). Brachial ankle pulse wave velocity (baPWV) was tested by the full-automatic arteriosclerosis diagnostic instrument.</p><p><b>RESULTS</b>(1) The serum resistin concentration, baPWV and TNF-alpha were significantly increased in EH group compared to the control group [(0.65 +/- 0.12) ng/ml vs (0.59 +/- 0.13) ng/ml; (1513.24 +/- 182.30) cm/s vs (1301.69 +/- 151.15) cm/s; (5.69 +/- 1.98) ng/ml vs (3.83 +/- 2.38) ng/ml; all P < 0.01]. (2) Pearson correlation analysis showed that resistin was positively correlated with baPWV, TNF-alpha. and HOMA-IR in EH group (r = 0.219, r = 0.212, r = 0.183, P < 0.05 respectively); partial correlation analysis revealed that resistin was positively correlated with baPWV and TNF-alpha (r = 0.238, P < 0.01; r = 0.207, P < 0.05), but not with HOMA-IR. (3) Multivariate regression analysis showed that SBP, age, TNF-alpha, resistin were risk factors of impaired baPWV in EH group (R(2) = 0.368, P < 0.01).</p><p><b>CONCLUSION</b>Large arterial elasticity was decreased in proportion to increasing serum resistin level in hypertensive patients.</p>

Relationship between serum resistin level and large arterial elasticity in patients with essential hypertension / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the association between serum resistin concentration and large arterial elasticity in patients with essential hypertension (EH).</p><p><b>METHODS</b>271 recruited subjects were divided into the control group (n = 134) and EH group (n = 137). Blood pressure, waist circumference, hip, body mass index (BMI) were measured. Serum resistin concentration was assessed by enzyme immunoassay, fasting serum insulin and TNF-alpha were measured using radioimmunity kits. Insulin resistance was evaluated by insulin resistance index (HOMA-IR). Brachial ankle pulse wave velocity (baPWV) was tested by the full-automatic arteriosclerosis diagnostic instrument.</p><p><b>RESULTS</b>(1) The serum resistin concentration, baPWV and TNF-alpha were significantly increased in EH group compared to the control group [(0.65 +/- 0.12) microg/L vs (0.59 +/- 0.13) microg/L; (1513.24 +/- 182.30) cm/s vs (1301.69 +/- 151.15) cm/s; (5.69 +/- 1.98) microg/L vs (3.83 +/- 2.38) microg/L; all P < 0.01]. (2) Pearson correlation analysis showed that resistin was positively correlated with baPWV, TNF-alpha. and HOMA-IR in EH group (r = 0.219, r = 0.212, r = 0.183, P < 0.05 respectively); partial correlation analysis revealed that resistin was positively correlated with baPWV and TNF-alpha (r = 0.238, P < 0.01; r = 0.207, P < 0.05), but not with HOMA-IR. (3) Multivariate regression analysis showed that SBP, age, TNF-alpha, resistin were risk factors of impaired baPWV in EH group (R(2) = 0.368, P < 0.01).</p><p><b>CONCLUSION</b>Large arterial elasticity was decreased in proportion to increasing serum resistin level in hypertensive patients.</p>

Decreased small arterial compliance with increased serum vascular endothelial growth factor-A and circulating endothelial progenitor cell in dilated cardiomyopathy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Evidence showed that both myocardium and blood vessels were damaged in dilated cardiomyopathy (DCM). However, the changes in arterial compliance, serum cytokines and circulating endothelial progenitor cells (EPC), and their correlations remain unknown.</p><p><b>METHODS</b>Sixty-five DCM patients and 49 healthy volunteers were studied. Both large artery compliance (C(1)) and small artery compliance (C(2)) were measured with the CVProfilor DO-2020. Quantitative enzyme-linked immunosorbent assays (ELISAs) were used to measure the levels of vascular endothelial growth factor-A (VEGF-A) and VEGF receptor 2 (VEGF-R(2)). Circulating EPC was assessed by EPC colony-forming assays and flow cytometry (CD133(+)/CD34(+) cells). Phagocytized DiI-acLDL and binded FITC-UEA-I were used to analyze endothelial lineage marker expression by immunofluorescence.</p><p><b>RESULTS</b>Although C(2) was markedly lower in DCM patients than in control group ((3.8+/-1.8) ml/mmHg x 100 vs (5.0+/-2.2) ml/mmHg x 100, P<0.0001), there was no statistically significant difference in C(1) between the two groups (P>0.05). Levels of VEGF-A, the numbers of colony-forming units (CFU) and the fractions of EPC were obviously higher in DCM patients than in control group ((127.6+/-139.5) pg/ml vs (58.8+/-42.9) pg/ml, P<0.0001; (2.5+/-1.5)% vs (0.5+/-0.3)%, P < 0.05; 23.5+/-12.8 vs 10.8+/-7.4, P<0.01, respectively) and however, there was no significant difference in VEGF-R(2) between two groups (P>0.05). LgVEGF-A was positively correlated with the number of EPC-CFU (r=0.435; P<0.05) and inversely correlated with C(2) (r= -0.543; P<0.001) in DCM patients.</p><p><b>CONCLUSIONS</b>The reduction of C(2), a sensitive marker reflecting endothelial dysfunction, was observed in DCM patients and closely related to the increase in serum VEGF-A.</p>

Microalbuminuria associated with systolic blood pressure and arterial compliance in Chinese metabolic syndrome patients / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>There is significant evidence showing that microalbuminuria and arterial compliance are sensitive markers for early cardiovascular diseases. However, whether microalbuminuria is associated with reduced arterial compliance in Chinese metabolic syndrome (MS) patients remains unknown.</p><p><b>METHODS</b>According to the definition of MS proposed by ATPIII in 2001, USA, subjects (n = 362) were divided into three groups according to the number of risk factors: group 1 (control), group 2 (medium, < 3 risk factors) and group 3 (MS, = 3 risk factors). Both large artery compliance (C1) and small artery compliance (C2) were measured with the CVProfilor DO-2020 Cardiovascular Profiling System, and microalbuminuria was evaluated with the ratio of albumin to urine creatinine.</p><p><b>RESULTS</b>(1) As C1 and C2 levels elasticity decreased, albumin creatinine ratio (ACR) and the prevalence of microalbuminuria increased within those groups with MS risk factors. C1 and C2 were negatively correlated with the ranking of MS risk factors, ACR was positively correlated with the ranking of MS risk factors (all P < 0.05). (2) Subjects were also categorized into a microalbuminuria group and a normal group, C1 and C2 in the microalbuminuria group were lower than in the normal group. (3) Multivariate regression analysis showed that increased systolic blood pressure (SBP) and reduced arterial compliance were the main risk factors for microalbuminuria in the MS group.</p><p><b>CONCLUSIONS</b>The risk of developing microalbuminuria was higher in the subjects with multiple metabolic abnormalities. Increased systolic blood pressure and reduced arterial compliance may be the main predictors for microalbuminuria in MS.</p>

Association between serum adiponectin and mean blood pressure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the relationship between serum adiponectin and mean blood pressure (BP).</p><p><b>METHODS</b>A total of 187 subjects were divided into four groups according to BP levels: optimal blood pressure group (n = 38), high normal blood pressure group (n = 50), treated hypertension group (n = 54) and untreated hypertension group (n = 45). Serum adiponectin and microalbuminuria were detected by radioimmunology assay. Insulin resistant index defined as HOMA-IR and urinary concentration of microalbuminuria/urinary concentration of creatinine defined as albumin creatinine ratio (ACR) were calculated.</p><p><b>RESULTS</b>(1) Serum adiponectin decreased in proportion to BP increase and the serum adiponectin level was significantly higher in treated hypertension group than untreated hypertension group. (2) Correlation analysis showed that adiponectin concentration was negatively correlated with mean blood pressure (P < 0.01). (3) Multivariate regression analysis revealed that mean blood pressure and HOMA-IR were independent predictors of serum adiponectin level.</p><p><b>CONCLUSIONS</b>Mean blood pressure was the main determinant of serum adiponectin level and negatively correlated to serum adiponectin level.</p>

Efficacy and safety of olmesartan medoxomil versus losartan potassium in Chinese patients with mild to moderate essential hypertension / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of olmesartan medoxomil compared with losartan potassium in patients with mild to moderate essential hypertension.</p><p><b>METHOD</b>This is a randomized, double-blind, double-dummy, active-controlled, parallel, multi-center study. After a 2-week placebo run-in period, a total of 287 eligible subjects were randomized at 1:1 ratio to receive olmesartan medoxomil 20 mg or losartan potassium 50 mg, once daily for 8 weeks. The blood pressure was assessed after 4 weeks treatment. If the subject's seating diastolic blood pressure (SeDBP) was still >or=90 mm Hg, the dosage was doubled for another 4 weeks; for those subjects whose SeDBP was <90 mm Hg after 4-week treatment, the initial dosage remained unchanged and the treatment continued until completion of the study.</p><p><b>RESULTS</b>(1) The mean trough reduction in SeDBP from baseline in olmesartan group was significantly greater than that in losartan group after 4 weeks (11.72 mm Hg vs 9.23 mm Hg, P=0.004) and 8 weeks treatment (12.94 mm Hg vs 11.01 mm Hg, P=0.035). (2) The number and percentage of responders in olmesartan group (81, 65.3%) were statistically higher than those (68, 52.7%) in losartan group (P=0.028) after 4 weeks treatment and were similar between the two groups after 8 weeks treatment (P>0.05). (3) Individual and overall trough/peak ratios of DBP and SBP in 24-hour ambulatory blood pressure monitoring were higher in olmesartan group than losartan group. The hypotensive effect of olmesartan was more durable than losartan at 24 hour interval. (4) The incidence of study drug-related adverse events (AEs) in olmesartan group (10.5%) was similar as that in losartan group (13.9%, P>0.05). Most of these AEs were mild and transient.</p><p><b>CONCLUSION</b>This study shows that olmesartan medoxomil, at oral dose of 20 mg-40 mg once daily was effective and safe for hypertension treatment and the hypotensive effect was superior to losartan potassium (50 mg-100 mg once daily).</p>

Efficacy of adaptive servoventilation in patients with congestive heart failure and Cheyne-Stokes respiration / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Congestive heart failure (CHF) is associated with Cheyne-Stokes respiration (CSR), which may hasten CHF. Adaptive servoventilation (ASV) is a novel method of ventilatory support designed for removal of CSF in CHF patients. This study compares the efficacy of ASV in patients with CHF and CSR with the efficacy of oxygen therapy.</p><p><b>METHODS</b>Fourteen patients with CHF and CSR were recruited. During sleep, nasal oxygen therapy and ASV treatment were each performed for two weeks. Comparison before and after each treatment was made for the following items: a) parameters of sleep respiration, sleep structure and quality; b) left ventricle ejection fraction (LVEF) and 6-minute walk distance.</p><p><b>RESULTS</b>Compared with the baseline levels of apnoea hypopnoea index of 34.5 +/- 6.1 before treatment, the apnoea hypopnoea index significantly decreased following oxygen therapy to 27.8 +/- 8.2, P < 0.05 and further reduced following ASV treatment to 6.5 +/- 0.8, P < 0.01. The minimal pulse oxygen saturation markedly increased following oxygen therapy from a baseline of (84.3 +/- 2.6)% to (88.6 +/- 3.7)%, P < 0.05 and further increased following ASV treatment (92.1 +/- 4.9)%, P < 0.01. Stages I + II sleep as percentage of total sleep time decreased from (81.9 +/- 7.1)% to (78.4 +/- 6.7)% following oxygen therapy and further to (72.4 +/- 5.0)% following ASV treatment. Stages III + IV sleep as percentage of total sleep time decreased from (8.4 +/- 5.5)% to (6.0 +/- 3.0)% following oxygen therapy and but increased to (11.9 +/- 5.4)% following ASV treatment. The arousal index of 30.4 +/- 8.1 before treatment significantly decreased following oxygen therapy to 25.6 +/- 5.7, P < 0.05 and further declined following ASV treatment to 18.2 +/- 6.1, P < 0.01. No significant difference was shown in above percentages between day 14 of oxygen therapy and before treatment (P > 0.05). LVEF was significantly higher on day 14 of ASV treatment (37.2 +/- 4.1)% than on day 14 of oxygen therapy (33.2 +/- 5.1)% and before treatment (30.2 +/- 4.6)% (all P < 0.05). Six-minute walk distance was the shortest before treatment (226 +/- 28) m, longer on day 14 of oxygen therapy (289 +/- 26) m, and the longest on day 14 of ASV treatment (341 +/- 27) m (all P < 0.01).</p><p><b>CONCLUSION</b>ASV treatment is of better efficacy and greater clinical significance in improvement of CHF by eliminating CSR than oxygen therapy.</p>

ADRA2B gene insertion/deletion polymorphism and artery compliance / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The ADRA2B gene insertion/deletion (I/D) polymorphism is associated with various cardiovascular and metabolic phenotypes. Large (C1) and small (C2) artery compliance, assessed by pulse wave analysis, is considered as sensitive markers or risk factors for cardiovascular disease. Therefore whether the ADRA2B I/D polymorphism is associated with C1 and C2 need to be investigated.</p><p><b>METHODS</b>A total of 227 men and 243 women were enrolled in a Chinese family-based study. C1 and C2 were measured by pulse wave analysis. ADRA2B genotypes were determined by polymerase chain reaction. Statistical methods included generalized estimation equations and quantitative transmission disequilibrium test.</p><p><b>RESULTS</b>The II (31.9%), ID (46.8%) and DD (21.3%) genotype frequencies were in Hardy-Weinberg equilibrium (P = 0.73). The covariates selected by stepwise regression for C1 and C2 were age, systolic pressure and gender. The population based association analysis showed that C1 and C2 were not associated with ADRA2B genotype both before (C1: P = 0.28; C2: P = 0.27) and after (C1: P = 0.58; C2: P = 0.18) the adjustment. The family-based analyses of 128 informative offspring showed that transmission of the D-allele was not associated with C1 or C2, both before (C1: P = 0.42; C2: P = 0.85) and after (C1: P = 0.31; C2: P = 0.82) the adjustment.</p><p><b>CONCLUSION</b>The study do not support that the ADRA2B gene I/D polymorphism has a major gene effect on C1 or C2 in the Chinese population of current sample size.</p>

Relationship between the aldosterone synthase (CYP11B2)-344C/T polymorphism and small artery compliance / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the relationship between the aldosterone synthase (CYP11B2)-344C/T polymorphism and small artery compliance (C(2)).</p><p><b>METHODS</b>C(2) was measured by CVProfilor DO-2020 in 224 subjects, including 123 subjects with an abnormal C(2) and 101 normal controls. Genotypes of CYP11B2 were determined by polymerase chain reaction-based restriction fragment length polymorphism analysis.</p><p><b>RESULTS</b>The frequencies of the CYP11B TT genotype and T allele in subjects with an abnormal C(2) were slightly higher than in normal controls, but the differences did not reach statistical significance (55.3% vs 41.6%, P > 0.05, 75.6% vs 66.8%, P > 0.05. However, when CT was combined with CC, the frequency of TT in subjects with an abnormal C(2) was significantly higher than in normal controls (P < 0.05). By CANOVA, TT subjects had a lower C(2) than CT and CC subjects (P < 0.05). Logistic regression analysis revealed that TT genotype was associated with abnormal C(2) (P = 0.043, OR = 1.93 95% CI 1.02-3.63).</p><p><b>CONCLUSIONS</b>The CYP11B-344C/T polymorphism is associated with small artery compliance, and TT subjects are susceptible to abnormality of small arterial compliance.</p>

Association of cardiovascular risk factors and small arterial elasticity / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the major cardiovascular risk factors affecting small arterial elasticity and the effect of combined multiple risk factors on it.</p><p><b>METHODS</b>Arterial elasticity indexes (C(1)-large artery and C(2)-small artery) were measured with CVProfilor DO-2020. The status of insulin resistance was evaluated with HOMA (homeostasis model assessment). Subjects were categorized into abnormal C(2) group and control group according to the level of C(2). The former group was further divided into four subgroups (0 to 3) based on the number of risk factors.</p><p><b>RESULTS</b>(1) The levels of age, total cholesterol (TC), low density lipoprotein- cholesterol (LDL-C), fasting blood glucose (FBG), systolic blood pressure (SBP) and diastolic blood pressure (DBP) in abnormal C(2) group were higher than those in control group, whereas C(2) itself was lower than that in control group (P all < 0.05). Age, TC, LDL-C, FBG, SBP and DBP were significantly inversely correlated with C(2). (2) With the clusters of risk factors increasing, C(2) was decreasing (6.5 +/- 2.6 vs 5.4 +/- 2.3 vs 4.7 +/- 2.7 vs 3.1 +/- 1.6, P < 0.001). C(2) decreased significantly in subjects with multiple risk factors (subgroup 3). (3) Fasting plasma insulin and HOMA-IR (insulin resistance index) were significantly higher in subgroup 3 than in the other subgroups (P < 0.05, P < 0.001 respectively).</p><p><b>CONCLUSIONS</b>The elevations of age, TC, LDL-C, FBG, SBP and DBP were the major cardiovascular risk factors on the reduction of C(2), and the effects on it were continuously. With their concurrent effects, multiple risk factors could decrease small arterial elasticity much more significantly. Insulin resistance seems to be closely related to the clusters of multiple risk factors.</p>