Traditional Chinese medicine method of tonifying kidney for hypertension: Clinical evidence and molecular mechanisms.

Hypertension is the most common chronic disease. A large amount of evidence showed that traditional Chinese medicine (TCM) method of tonifying kidney (TK) combined with routine treatment is more effective and safer in the treatment of hypertension. This study integrated meta-analysis, data mining, and network pharmacology to explore the efficacy and potential mechanisms of TK in the treatment of hypertension. Meta-analysis was performed to explore the efficacy and safety of TK combined with routine treatment in the treatment of hypertension. Data mining was used to screen the core herbs of the TK. Network pharmacology was used to predict the antihypertensive mechanism of TK core herbs. A total of 18 studies with 2,024 patients were included in this study. Meta-analysis showed that TK combined with routine treatment was superior to routine treatment alone in lowering blood pressure (systolic and diastolic blood pressures), lowering blood lipids (total cholesterol, triglyceride, low-density lipoprotein cholesterol), improving vascular endothelial functions (nitric oxide, endothelin) and TCM symptoms (headache dizziness, soreness, and weakness of waist and knees). In addition, TK was safe and has no obvious adverse reactions. Data mining showed that the core herbs of TK were Eucommia ulmoides Oliv. (Duzhong), Vitex negundo L. (Huangjing), Taxillus chinensis (DC.) Danser (Sangjisheng), Ligustrum lucidum W.T.Aiton (Nuzhenzi), Astragalus mongholicus Bunge (Huangqi), Rehmannia glutinosa (Gaertn.) DC. (Shudihuang). Network pharmacology predicted that core herbs antihypertensive components were oleanolic acid, ursolic acid, and civetone, and the antihypertensive targets were NOS3, NOS2, MMP9, TNF, PTGS2, HMOX1. In addition, the antihypertensive targets were enriched in cGMP-PKG signaling pathway, calcium signaling pathway, aldosterone-regulated sodium reabsorption, HIF-1 signaling pathway. In conclusion, TK combined with routine treatment for hypertension is effective and safe. The mechanism of TK may be related to GMP-PKG signaling pathway, calcium signaling pathway, aldosterone-regulated sodium reabsorption. On the premise of syndrome differentiation and treatment, it is promising to treat hypertension with TK. Systematic review registration: [https://www.crd.york.ac.uk/prospero/], identifier [CRD42022358276].

Relationship between obstructive sleep apnea-hypopnea syndrome and aortic dissection / 中国胸心血管外科临床杂志

@#Objective    To explore the relationship between obstructive sleep apnea-hypopnea syndrome (OSAHS) and aortic dissection (AD). Methods    Fifty three patients with AD diagnosed by CTA in our hospital from January 2016 to January 2018 were selected. All the patients with AD were scored by the STOP-BANG questionnaire. The patients who scored more than or equal to 3 received polysomnography (PSG) after surgical or conservative treatment, and according to whether the sleep apnea-hypopnea index was higher than or equal to 5. Fifty-three patients were divided into an OSAHS group and a non OSAHS group. Results    There were 18 patients with 17 males and 1 female at average age of 43.3±8.4 years in the OSAHS group, and 35 patients with 23 males and 12 females at average age of 56.6±12.9 years in the non OSAHS group. There was no statistical difference between the two groups in the Stanford classification of aortic dissection, the time of onset, personal history, the history of diabetes, coronary heart disease and hyperlipidemia, or post-treatment systolic/diastolic blood pressure before sleep (P>0.05). The age of patients in the OSAHS group was significantly less than that in the non OSAHS group (P<0.01), the proportion of men/women (P=0.021), weight (P<0.01), height (P=0.028), body mass index (P<0.01), and post-treatment systolic/diastolic blood pressure after waking up (P=0.028,P=0.044) in the OSAHS group were significantly higher than those in the non OSAHS group. In the OSAHS group, the proportion of previous hypertension was significantly higher than that in the non OSAHS group (P=0.042).   Conclusion    AD patients combined with OSAHS are mostly male patients. The number of young and high-fat people is significantly more than that in the non OSAHS group. OSAHS may be one of the risk factors for young, high-fat men with AD.

Systems Biology Approaches-based Biomarkers Discovery for Acute Aortic Dissection.

Acute aortic dissection (AAD) faces great challenges in early diagnosis and effective drug treatment. Recent developments in systems biology approaches allow high-throughput screening of novel diagnostic biomarkers and potential therapeutic targets. In this review, we summarize the currently available AAD biomarkers identified in the context of genomic, transcriptomic, proteomic, and metabolic profiles, and highlight the benefits of using a combination of these findings for a better understanding of the molecular nature of this life-threatening disease. This review also provides a reference for future studies that employ a comprehensive, multiple-level approach at the single-cell level to decipher the underlying molecular pathophysiology of AAD.

Transcriptomic responses of peripheral blood cells to coronary artery disease.

Transcriptomic response of peripheral blood cells to coronary artery diseases (CAD) is a long recognized phenomenon. Currently, accumulating evidence indicates that such response having significant clinical utility in CAD-associated events determination. In this review, we summarized the existing data of transcriptomic biomarkers at mRNA, microRNA, long non-coding RNA, and circular RNA for the diagnosis, progression and outcome prediction and treatment response of CAD. Furthermore, we also discussed the functional significance on the gene expression patterns caused by CAD, and emphasized the importance of inflammatory pathways in CAD tissues-blood cells interaction. Based on the current knowledge, we proposed a perspective on the future strategies to further improve the robustness and reproducibility of transcriptomic biomarkers in the personalized medicine of CAD patients.

Independent risk factors for hypoxemia after surgery for acute aortic dissection.

OBJECTIVES: To determine risk factors associated with postoperative hypoxemia after surgery for acute type A aortic dissection. METHODS: We retrospectively analyzed the clinical data of 192 patients with acute type A aortic dissection who underwent surgery in Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, China between January 2007 and December 2013. Patients were divided into hypoxemia group (n=55) [arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ≤ 200 mm Hg] and non-hypoxemia group (n=137) [PaO2/FiO2 > 200 mm Hg]. Perioperative clinical data were analyzed and compared between the 2 groups. RESULTS: The incidence of postoperative hypoxemia after surgery for acute aortic dissection was 28.6% (55/192). Perioperative death occurred in 13 patients (6.8%). Multivariate regression identified body mass index (BMI) > 25 kg/m2 (OR=21.929, p=0.000), deep hypothermic circulatory arrest (DHCA) (OR=11.551, p=0.000), preoperative PaO2/FiO2 ≤ 300 mm Hg (OR=7.830, p=0.000) and blood transfusion > 6U in 24 hours postoperatively (OR=12.037, p=0.000) as independent predictors of postoperative hypoxemia for patients undergoing Stanford A aortic dissection surgery. CONCLUSION: Our study demonstrated that BMI > 25 kg/m2, DHCA, preoperative PaO2/FiO2 ≤ 300 mm Hg, and blood transfusion in 24 hours postoperatively > 6U were independent risk factors of the hypoxemia after acute type A aortic dissection aneurysm surgery.

Independent risk factors for ventilator-associated pneumonia after cardiac surgery.

OBJECTIVE: To investigate the related factors and pathogens of ventilator-associated pneumonia (VAP) after heart surgery so as to provide evidences for clinical prevention and therapy. METHODS: In total 1,688 cases were collected from January 2004 to January 2011. Overall 105 patients developed VAP. Retrospectively analyzed these patients after heart surgery to determine the clinical data, pathogens and treatment measures. RESULTS: The frequency of ventilator-associated pneumonia was 6.2% (105/1 688), and mortality was 25.7% (27/105), 198 pathogen strains were isolated by bacterial culture, in which Gram negative bacteria accounted for 69.2% (137/198), Gram positive bacteria 27.8% (55/198), and fungi 3.0% (6/198). The independent risk factors for VAP after cardiac surgery were: age >70 (p < .01), emergent surgery (p < .01), perioperative blood transfusions (p < 0.01), reintubation (p < .01) and days of mechanical ventilation (MV) (p < .01). Median length of stay in the ICU for patients who developed VAP or not was, respectively, (24.7 ± 4.5) days versus (3.2 ± 1.5) days (p < .05), and mortality was, respectively, 25.7% versus 2.9% in both populations (p < .05). CONCLUSION: Age >70, emergent surgery, perioperative blood transfusions, reintubation and days of MV are the risk factors for VAP in patients following cardiac surgery. P. aeruginosa, P. klebsiella, S. aureus, and Acinetobacter baumannii were the main pathogens of VAP. According to the cause of VAP, active prevention and treatment measures should be developed and applied to shorten the time of MV and improve chances of survival.

[Clinical analysis of 105 cases of ventilator-associated pneumonia after heart surgery].

OBJECTIVE: To investigate the related factors and pathogens of ventilator-associated pneumonia (VAP) after heart surgery. METHODS: VAP was diagnosed in 105 patients out of 1688 cases (6.2%) who underwent heart surgery in our department between January 2004 and January 2011. Clinical data, pathogens and treatments were analyzed. RESULTS: Incidence of VAP was 6.2% (105/1688), and 53.0% (105/198) in patients who required more than 48 hours of mechanical ventilation. One hundred and ninety-eight pathogen strains were isolated by bacterial culture, in which Gram negative bacteria accounted for 69.2% (137/198), Gram positive bacteria 27.8% (55/198), and fungi for 3.0% (6/198). Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, and Staphylococcus aureus were the main pathogens of VAP. The independent risk factors for VAP were: age > 70 years, emergent surgery, perioperative transfusions, reintubation and days of mechanical ventilation (all P < 0.01). Median length of stay in the ICU for patients who developed VAP or not was (24.7 ± 4.5) days versus (3.2 ± 1.5) days, respectively (P < 0.05) and in-hospital mortality was 25.7% (27/105) versus 2.9% (46/1583) respectively (P < 0.05). CONCLUSIONS: Patients undergoing heart surgery have a high frequency of developing VAP, especially in patients that require more than 48 hours of mechanical ventilation. VAP is associated with high in-hospital mortality. Age > 70 years, emergent surgery, perioperative transfusions, reintubation and prolonged mechanical ventilation use are independent risk factors for VAP in patients following cardiac surgery. Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, Escherichia coli, and Staphylococcus aureus are the main pathogens of VAP.