Synergetic effect of temperature and PM2.5 on mortality of cardiovascular and cerebrovascular diseases / 上海预防医学

ObjectiveTo explore the synergetic effect of temperature and PM2.5 on cardiovascular and cerebrovascular diseases. MethodWe collected cardiovascular and cerebrovascular death cases，air pollution and meteorological data during the same period in Pudong New Area from 2013 to 2018.We used generalized additive models （GAMs） with poisson regression including non-stratification model， nonparametric bivariate response model and pollution-stratified parametric model， to assess the interaction between temperature and PM2.5 and on the number of cardiovascular cerebrovascular and cerebrovascular disease deaths. ResultsThe exposure-response relationship between temperature and the number of cardiovascular and cerebrovascular deaths exhibited "U" type and the most comfortable temperature was 18.9 ℃. When the concentrations of PM2.5 increased by 10 μg·m-3， the deaths of total， male， female， ≤75 years and >75 years increased， respectively， by 0.60%（95%CI： 0.30%‒0.91%）， 0.77%（95%CI：0.34%‒1.20%）， 0.46%（95%CI：0.05%‒0.86%）， 0.66%（95%CI：0.03%‒1.30%） and 0.59%（95%CI：0.26%‒0.92%）. With the increase of PM2.5 concentration level， the impact of temperature on cardiovascular and cerebrovascular diseases gradually increased， and the impact was the most significant when the concentration of PM2.5 was more than 150 µg·m-3. There were different sensitive people in different seasons. ConclusionPM2.5 concentration levels of mild pollution and above can exacerbate the negative effects of temperature on cardiovascular and cerebrovascular diseases.

Expert consensus on clinical application of GBE50 Dispersible Tablets for ischemic cardiovascular and cerebrovascular diseases / 中国中药杂志

Ginkgo biloba Extract( GBE50) Dispersible Tablets is a new standardized prescription,which is widely used in the treatment of ischemic cardiovascular and cerebrovascular diseases. However,there are still many problems in its clinical application.Rational and safe use of GBE50 Dispersible Tablets is pivotal to the medication safety and clinical prognosis of patients. This consensus has been jointly formulated by clinical experts of traditional Chinese medicine and western medicine in cardiovascular and cerebrovascular diseases and followed the Manual for the Clinical Experts Consensus of Chinese Patent Medicine published by the China Association of Chinese Medicine. The present study identified clinical problems based on clinical investigation,searched the research papers according to PICO clinical problems,carried out evidence evaluation,classification,and recommendation by GRADE system,and reached the expert consensus with nominal group technique. The consensus combines evidence with expert experience. Sufficient evidence of clinical problems corresponds to " recommendations",while insufficient evidence to " suggestions". Safety issues of GBE50 Dispersible Tablets,such as indications,usage and dosage,and medication for special populations,are defined to improve clinical efficacy,promote rational medication,and reduce drug risks. This consensus needs to be revised based on emerging clinical issues and evidencebased updates in practical applications in the future.

The mechanism of NLRP3 inflammasome affecting vascular aging and the development of related drugs / 药学学报

Nucleotide binding oligomerization domain (NOD)-like receptor protein 3, NLRP3) inflammasomes regulate the secretion of caspase-1, interleukin-18 (IL-18), IL-1β, and other cytokines, and participates in aging. In recent years, it has been found that NLRP3 inflammasomes are abnormally activated in aging heart and vessels, and inhibition of NLRP3 inflammasomes can alleviate heart aging and vascular aging. This review summarizes the research of NLRP3 inflammasome in heart and vascular aging, and the related drugs to promote the discovery of the mechanism of NLRP3 inflammasome in heart and vascular aging and the development of related drugs.

Research progress on Chinese medicinal material-derived active polypeptides against ischemic cardiovascular and cerebrovascular diseases / 中国中药杂志

Ischemic cardiovascular and cerebrovascular diseases threatening human health and survival have high morbidity and mortality. The common cause of them is reduced blood supply caused by vascular stenosis, atherosclerosis, and infarction. However,the pathological processes of ischemic cardiovascular and cerebrovascular diseases are complex, involving oxidative stress, calcium overload, inflammation, apoptosis, autophagy and other mechanisms. Protein drugs such as recombinant tissue plasminogen activator(rt-PA) and urokinase have been proved with excellent therapeutic effects and huge economic and social benefits in the clinical treatment and interventional therapy. Among them, peptide drugs have shown unique advantages and potential prospects owing to their strong biological activity, high target specificity, biochemical diversity, and low toxicity. Chinese medicinal materials, characterized by multi-component and multi-target therapy, have also shown excellent clinical efficacy against ischemic cardiovascular and cerebrovascular diseases. However, the research and development of related peptides in Chinese medicinal materials is at the initial stage. Therefore, this paper reviewed the targets and action mechanisms of a variety of Chinese medicinal material-derived polypeptides with activities against ischemic cardiovascular and cerebrovascular diseases, aiming to provide support for the in-depth research as well as the clinical development and application of these polypeptides.

Clinical Evaluation of Lowering the Morbidity of Cerebrovascular Disease and the Plasma Cysteine Levels by B Group Vitamins Based on Meta-analysis / 中国药师

Objective:To assess the effect of B group vitamins on cerebrovascular diseases, and also to evaluate the relationship between B group vitamins and homocysteine(Hcy). Methods:Using the words homocysteine,folic acid,folate,cerebrovascular dis-ease,B group vitamins and randomized controlled trial as the keywords,PubMed,the Cochrane library,WanFang Database,VIP and CNKI were searched. The randomized controlled trials about preventive effect of folic acid,vitamin B12or vitamin B6on cerebrovascular disease occurring published between 1998 and July 2016 were searched by manually retrieving relevant journals. Two reviewers inde-pendently screened the trials,extracted the data and evaluated the quality of included trials. The Cochrane Collaboration's RevMan 5.3 software was used for the statistical analysis. Results:Twelve trials involving 36 053 patients were included. The results of meta-analysis showed that B group vitamins could lower the risk of stroke(RR=0.90,95% CI:0.82-0.99,P=0.02). The sensitivity a-nalysis conducted after the exclusion of low-quality trials did not change the overall results, and B group vitamins could lower plasma Hcy concentration (MD= -3.40,95% CI:-4.21--2.59, P<0.000 01). Conclusion: B group vitamins can lower plasma Hcy concentration,and lower the risk of stroke. B group vitamins supplementation should be recommended for the secondary prevention of stroke. The results of this study still need more reasonable design combined with strict implementation of larger samples of randomized double-blind controlled trials.

Research progress in anti-cardiovascular and cerebrovascular disease activity of Citri Reticulatae Pericarpium / 中草药

Citri Reticulatae Pericarpium is a common Chinese materia medica, with extensive distribution, abundant resource, and high medicinal value. Epidemiologic studies showed that Citrus flavonoid intake can relieve the symptom of cardiovascular and cerebrovascular disease. Numerous in vitro and in vivo studies have found that Citri Reticulatae Pericarpium and its composition were good to treat cardiovascular and cerebrovascular disease, including hypolipidemic, anti-fatty liver, anti-thrombusis, anti-atherosclerosis, cardio-cerebral-vascular protection, and anti-oxidant and anti-inflammatory effects closely related to the above. Evidence obtained from these studies indicates that Citri Reticulatae Pericarpium has the potential in the prevention and treatment of cardiovascular and cerebrovascular disease.

The study of cause of early death and a matched study for the risk factors in patients undergoing maintenance hemodialysis / 中华危重病急救医学

ObjectiveTo explore the cause of early death (death within 3-12 months after hemodialysis) and the related influencing factors patients undergoing maintenance hemodialysis (MHD) as to provide a scientific basis for the prevention of early death.Methods A retrospective matched controlled study was conducted. Fifty-one patients who underwent MHD from January 2004 to April 2014 and died within 3-12 months after hemodialysis in hemodialysis center of the 174th Chinese People's Liberation Army Hospital were included in the case group by retrospective analysis method. According to 1∶2 matched controls, 102 patients underwent hemodialysis in the same period (±2 months) and survived over 12 months were selected as control group. All patients received regular hemodialysis (dialysis 2-3 times per week), with conventional limitation of water and sodium intake, routine treatments such as control of blood pressure, treatment of anemia and disorders of calcium and phosphorus contents. Causes of short-term death were analyzed. Clinical and biochemical parameters of two groups were collected when dialysis was started, and the single factor and multiple factors logistic regression was used to analyze the related risk factors when dialysis was started. Receiver operating characteristic curve (ROC) was plotted to evaluate the value of above parameters in predicting the early death in patents with MHD.Results The main causes of early death of 51 patients with MHD were mainly cardiovascular and cerebrovascular diseases (27 cases, 52.9%), and infections (15 cases, 29.4%). It was shown by single factor analysis that the age [odds ratio (OR) = 6.625, 95% confidence interval (95%CI) = 3.232-13.580,P = 0.000], diabetes (OR = 3.875, 95%CI = 0.654 - 10.622,P = 0.031), specialist intervention time before dialysis (OR = 0.349, 95%CI =0.287 - 0.572,P = 0.004), the emergence of cardiovascular and cerebrovascular events before dialysis (OR = 9.667, 95%CI = 4.632 - 20.174,P = 0.000), the first dialysis for emergency dialysis (OR = 3.875, 95%CI = 1.713 - 8.765, P = 0.005), blood albumin level (OR = 0.294, 95%CI = 0.068 - 0.550,P = 0.008), leukocyte count (OR = 6.286, 95%CI = 1.648 - 23.982,P = 0.026), neutrophil count (OR = 2.833, 95%CI = 1.630 - 4.923,P = 0.001) might be the factors correlating with early death. Eight independent factors were statistically significant, and their effect on the MHD patients was analyzed by logistic regression analysis inα = 0.05 level. The results showed that patients with old age (OR = 1.054, 95%CI = 1.019-1.090,P = 0.002), and the emergence of cardio-cerebrovascular events (OR = 7.469, 95%CI = 2.474 - 22.545,P = 0.000)were early death risk factors of MHD patients, and early specialist intervention before dialysis was a protective factor (OR = 0.286, 95%CI = 0.113-0.722,P = 0.008). ROC curve showed that age had moderate diagnostic value for early death of MHD [area under ROC curve (AUC) = 0.756], the cut-off value was 59.0 years old, the sensitivity was 66.7%, and the specificity was 77.5%. The diagnostic value of early specialist intervention before dialysis was relatively low (AUC = 0.367), the cut-off value was 0.875 years, the sensitivity was 39.2%, and the specificity was 33.3%.Conclusion Old age, the emergency of cardiovascular and cerebrovascular events before dialysis is associated with early death, and specialist intervention ahead of dialysis can reduce the risk of early death.

A case-crossover study between heat waves and daily death from cardiovascular and cerebrovascular disease / 中华流行病学杂志

Objective To explore the impct of heat wave on the daily deaths caused by cardiovascular disease and cerebrovascular diseases in Beijing.Methods A case-crossover design was used to study the impact of 5 heat waves on the daily number of deaths from cardiovascular diseases and cerebrovascular disease,from Jan.1,1999 to Jun.30,2000.We also investigated the relationship between the heat wave and acute myocardial infarction deaths.The 7th day before death was chose as the indicator of self-control.The OR value of different lengths of risk period was calculated.The highest OR value and its corresponding risk period was used to reflect the impact of heat wave on daily number of cardiovascular and cerebrovascular disease deaths,lag days and their durations.Results There were five heat waves during the study period.The first heat wave lasted for 9 days,with the maximum temperature as 38.8 ℃ and average humidity as 46.7%.The Off value for the cardiovascular disease death,cerebrovascular disease death and acute myocardial infarction death were 1.384(95%CI:1.128-1.697),1.776(95%CI:1.456-2.167)and 1.276(95%CI:0.905-1.799)respectively.The second heat wave lasted 3 days,with the maximum temperature of 36.8 ℃ and average humidity of 61.0%.The OR value for the three causes of death were 1.385(95%CI:0.678-2.826),1.300(95% CI:0.726-2.329)and 2.000(95% CI:0.684-5.851)respectively.The third heat wave continued for 7 days,with the maximum temperature of 41.5 ℃,and average humidity of 58.5%.The OR value for the daily death counts caused by cardiovascular disease,cerebrovascular diseases and acute myocardial infarction were 2.613(95%CI:2.116-3.228),2.317(95%CI:1.875-2.863)and 3.088(95%CI:2.098-4.546)respectively.The fourth wave lasted for 3 days,with the maximum temperature as 39.6 ℃ and average humidity as 31.9%.The OR value for the deaths caused by cardiovascular disease,cerebrovascular diseases and acute myocardial infarction were 1.333(95%CI:0.724-2.457),2.429(95%CI:1.007-5.856)and 3.333(95%67:0.917-12.112)respectively.The fifth heat wave lasted for 4 days.The maximum temperature was 37.4 ℃,and the average humidity was 42.0% during the period.The OR value for daily death counts caused by cardiovascular disease,cerebrovascular disease and acute myocardial infarction were 2.333(95%CI:1.187-4.588),1.727(95%CI:0.822-3.630)and 1.800(95%CI:0.603-5.371)respectively.Conclusions(1)There were significant increases for daily death counts of both cardiovascular and cerebrovascular disease in Beijing during the heat wave and there appeared hysteresis effect as well.The lag phase of cardiovascular disease and cerebrovascular disease death was generally 2-4 days and acute myocardial infarction death usually was 0-2 days.(2)The rising of maximum temperature was greater at the beginning day of heat wave than the previous day,but the lag time was shorter,and the risk of death was greater,especially for the risk of deaths from cerebrovascular disease.(3)Fluctuations of daily maximum air temperature during the heat wave could increase the risk of death from cardiovascular disease.

Cases of cardiovascular and cerebrovascular disease treating by classical prescriptions / 中华中医药杂志

Under the guidance of Chinese medical classical books,for example Plain Questions of Huangdi,s Internal Classic, on the theory basis of Treatise on Febrile Diseases and Synopsis of Golden Chamber, for cardiovascular and cerebrovascular disease diagnosed by Western medicine,we have been satisfied with the effect in clinical practice by paying attention to the principal syndrome and six channels differentiation of symptoms and signs, for example yang depletion, palmus; yin and yang def iciency; phlegm and fluid; fluid adversion attacking heart;cold knot etc.