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Circadian clock is an internal mechanism evolved to adapt to cyclic environmental changes, especially diurnal changes. Keeping the internal clock in synchronization with the external clock is essential for health. Mismatch of the clocks due to phase shift or disruption of molecular clocks may lead to circadian disorders, including abnormal sleep-wake cycles, as well as disrupted rhythms in hormone secretion, blood pressure, heart rate, body temperature, etc. Long-term circadian disorders are risk factors for various common critical diseases such as metabolic diseases, cardiovascular diseases, and tumor. To prevent or treat the circadian disorders, scientists have conducted extensive research on the function of circadian clocks and their roles in the development of diseases, and screened hundreds of thousands of compounds to find candidates to regulate circadian rhythms. In addition, melatonin, light therapy, exercise therapy, timing and composition of food also play a certain role in relieving associated symptoms. Here, we summarized the progress of both drug- and non-drug-based approaches to prevent and treat circadian clock disorders.
Subject(s)
Circadian Rhythm , Circadian Clocks , Melatonin/physiologyABSTRACT
Objective To investigate the effects of different pacing sites of right ventricle on serum N terminal Pro brain natriuretic peptide (NT-ProBNP) and left ventricular systolic function.Methods A total of 76 patients with an implanted DDD pacemaker were randomly divided into right ventricular septal pacing group (RVSP group,n=40) and right ventricular apex pacing group (RVAP group,n=36) according to the ventricular leads position.Serum NT-proBNP level,left ventricular end diastolic dimension(LVEDD)and left ventricular ejection fraction(LVEF)were analyzed before and 6 months after operation in the two groups.Results There was no difference in serum NT-proBNP level between the two groups before operation,but the serum NT-proBNP level increased in both groups 6 months after operation,and it was higher in RVAP group than in RVSP group (P＜0.05).There were no significant differences in LVEDD and LVEF in RVSP group before and after implantation (P＞0.05).Compared with pre-implantation,LVEDD was increased and LVEF was decreased in RVAP group 6 months after implantation (both P＜0.05).Linear correlation analysis showed that serum NT-proBNP level was negatively correlated to LVEF (2γ=-0.76,P＜0.05).Conclusions Compared with RVAP,RVSP can keep the normal sequence of electrical activity and exert less adverse effects on left ventricular systolic function.Therefore,RVS is an ideal pacing location.
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Objective To evaluate the relationship between NT-probrain natriuretic peptide (NT-proBNP) levels and the degree of coronary artery stenosis in elderly patients with non-ST elevation acute coronary syndromes (NST-ACS).Methods The levels of NT-proBNP were determined in 258 elderly patients with NST-ACS divided into 3 quartile groups based on the degree of coronary artery stenosis,and 62 normal controls.And NT-pro BNP were compared among 4 groups.Results The serum levels of NT proBNP were increased in the NST-ACS patients with single,two or three-artery lesion compared with normal controls [(197.3±80.2)ng/L,(381.7±73.5)ng/L,(496.5± 99.8) ng/L vs.(68.2 ± 36.1) ng/L].The level of NT proBNP was enhanced along with increasing severity coronary artery disease (all P＜0.01).And with aging,the NT-proBNP levels were rising [aged＞60-69 years:(182.34±69.13) ng/L; aged≥70-79 years:(302.68±87.51)ng/L; aged≥80 years:(482.09±82.2)ng/L] (all P＜0.01).Conclusions The NT-proBNP level is enhanced along with aging and increasing severity of coronary artery stenosis in elderly NST-ACS patients.
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Objective To evaluate and analyze relationship of plasma level of N-terminal probrain natriuretic peptides (NT-proBNP) and serum level of cystatin C (CysC) with cardiac and renal functions in patients with chronic heart failure (CHF) , and explore significance of CysC measurement in early diagnosis for renal damage in patients with CHF. Methods Totally, 162 patients with CHF and 150 normal healthy (controls) undergone routine physical check-up at, Taizhou People's Hospital, Jiangsu were enrolled in the study. Their plasma level of NT-proBNP and serum level of CysC, as well as serum levels of creatinine ( SCr) , urea nitrogen ( BUN) were measured and echocardiography was performed. Glomerular filtration rate (eGFR) was evaluated by modification of diet in renal disease (MDRD) study group formula. Results Compared with the control group, blood levels of NT-proBNP, CysC, SCr, BUN and left ventricular end diastolic diameter ( LVEDD) all elevated, both eGFR and left ventricular ejection fraction ( LVEF) decreased (P <0. 05 or P <0. 01 ) in CHF group, and CHF patients were prone to complicate with renal dysfunction (P<0. 01). Blood levels of NT-proBNP and CysC elevated significantly and LVEF lowered significantly in CHF patients with NYHA functional classes II , III and IV than those in control group. There was significant difference in blood levels of NT-proBNP and CysC between patients with varied NYHA functional classes (P<0. 05). Blood levels of NT-proBNP and CysC reversely correlated with LVEF (r = -0. 36, P < 0. 01 and r = - 0. 39, P < 0. 01) . Blood level of CysC correlated with that of NT-proBNP ( r = 0. 87 , P < 0. 01). Results of logistic regression analysis showed that elevated blood levels of NT-proBNP and CysC were risk factors for mortality during hospitalization in patients with CHF. Conclusions Patients with CHF were more likely to complicate with renal dysfunction than controls, with main manifestations of more severe damaged eGFR, more severe heart failure and more obviously renal damage. Blood levels of NT-proBNP and CysC can be used as indicators for evaluating exacerbation of chronic condition, and serumlevel of CysC can be used as marker for early diagnosing renal damage in patients with CHF.
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Objective To study whether prostaglandin E1 (LipoPGE1) could prevent contrast medium-induced nephropathy (CIN) in patients with coronary heart disease (CHD) plus diabetes mellitus type 2 (DM).Methods Total 198 CHD patients with DM received coronary angiography (CAG) or PCI were randomly divided into PGE1 group and control group.All patients received routine treatment,and the PGE1 group also received 20 ml normal saline and 20 μg PGE1 (intravenous injection,1 time/d) for 10 days.The rate of CIN and the level of serum urea nitrogen (BUN),creatinine (Scr),cystatin C (Cys C) were measured before and 48 hours and 5 days after contrastmedium administration.Results The level of Scr,BUN and Cys C were lower in PGE1 group [(113.92±54.89)μmmol/ L,(7.85±4.05)mmol/L,(1.38±0.34)mg/L]for 48 hours and[(86.72±35.26)μmmol/L,(6.61 ± 3.09 ) mmol/L,( 1.29 ± 0.29) mg/L]for 5 days than in control group [(129.22±50.18)μmmol/L,(9.26±3.95)mmol/L,(1.56±0.23)mg/L]for 48 hours and[(109.83+31.76)μmmol/ L,(8.07±3.11)mmol/L,(1.37±0.21)mg/L]for 5 days (all P＜0.05).The dose of contrast-medium was positively correlated with the level of Scr and BUN (r=0.74,P＜0.05 and r =0.82,P＜0.01,respectively).The patients' renal function in the PGE1 group was better than in control group after contrast-medium administration (P ＜0.05).BUN and Scr were positively correlated with the volume of contrast-medium (r=0.74,P＜0.05,r=0.82,P＜0.01).Conclusions PGE1 may prevent contrast medium-induced nephropathy in patients with CHD combined with DM.
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Objective To investigate the efficacy and safety of Lipo-prostaglandin E1 (LipoPGE1) in the treatment of non-ST segment elevation acute myocardial infarction (NSTEAMI).Methods A total of 86 patients with NSTEAMI were randomly and equally divided into LipoPGE1 group (n= 43) which received intravenous LipoPGE1 combined with low-molecular-weight heparin,aspirin, clopidogrel and other basic therapy, and the control group (n=43) which received placebo combined with the same therapy. The basic clinical settings, curative effect, main adverse cardiovascular events (MACEs) within 30 days including sudden death, new-onset myocardial infarction and target vessel revascularization, bleeding complications and drug adverse effects were observed. Results There were no significant differences in basic clinical characteristics between the two groups. Compared with control group, the patients in LipoPGE1 group showed. significant improvements of ECG (93.0% vs. 74.4%), angina (95.3% vs. 81.4%, both P＜0. 05), the incidences of left heart failure (2.3% vs. 14.0%) and MACEs within 30 days (4.7% vs.18.6%)(both P＜0.05). There were no serious drug adverse effects. Conclusions The LipoPGE1 combined with heparin, aspirin and clopidogrel is effective and safe in the treatment of NSTEAMI,which could improve the clinical symptoms, distal myocardium perfusion and cardiac function,decrease the incidence of MACEs.
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Objective To study the feasibility, safety, effectiveness of left atrial circumferential ablation of pulmonary veins for atrial fibrillation(Af) guided by EnsiteNavX mapping system. Methods Seventeen patients with paroxysmal or persistent Af were included. Real time 3-dimensional left artial (LA) and pulmonary veins (PVs) maps were constructed through EnsiteNavX mapping system. Pulmonary veins isolation was performed by encircle the left and right sides PVs at adistance of 1 to 2 cm away from the ostium of PVs. Results Seventeen patients were all reached the endpoint of abalation completely. The mean procedure time and fluoroscopy time were (226.1 ± 36.2) minutes and (41.3 ± 12.8) minutes. Mean radiofrequency energy delivery time was (61.9 ±15.4) minutes. Recur-rence of Af occurred in two patients, one was repeat ablation succnssfully. During 3 ～ 36 months followup, fourteen patients (82.3%) were free of Af without any antiarrhythmic drugs. Recurrence of Af occurred in three(11.7%) patients treated with amiodarone. No complications occurred during the procedure and the following up. Conclusion Left atrial circumferential isolation of pulmonary veins for Af guided by Ensite NavX mapping system was effective and salty.