Where we live: The impact of neighborhoods and community factors on cardiovascular health in the United States.

While the prevalence of cardiovascular risk factors has decreased in the United States in recent years, cardiovascular disparities by sex and race persist. Among the factors contributing to these disparities is the physical environment in which individuals live. Neighborhood characteristics, ranging from air pollution exposure to residential segregation, have been found to be related to cardiovascular health (CVH) and stroke risk. Through the use of cross-sectional, longitudinal, and analytic regression modeling, we are gaining clarity about the relationship between an individual's external environment and CVH. Moreover, differences in CVH vary by sex and/or race within the same neighborhood. The mechanism by which these disparities exist is still being explored. In this review, we examine the literature that has accumulated regarding how external environments and community factors affect individuals and populations by race and sex.

Clinical observation of interventional opportunity for acupuncture treatment of acute facial neuritis / 中国针灸

OBJECTIVE@#To observe the effect of different acupuncture intervention time on the improvement of the symptoms of acute facial neuritis and the length of recovery time, and to find the best interventional opportunity for acute facial neuritis.@*METHODS@#A total of 120 patients with acute facial neuritis (all unilateral onset) were randomly divided into 4 groups, namely group A, group B, group C and group D, 30 cases in each group. Acupuncture performed within 3 days after onset in the group A; oral mecobalamin dispersible tablets and multivitamin B tablets were received within 3 days after onset, and acupuncture was started from the 4th day in the group B; oral mecobalamin dispersible tablets and multivitamin B tablets were given within 5 days after onset, and acupuncture was administered from the 6th day in the group C; oral mecobalamin dispersible tablets and multivitamin B tablets were given within 7 days after onset, and acupuncture was applied from the 8th day in the group D. Penetration needling was the main acupuncture treatment, with infrared radiation on the cheeks, once a day, 6 days a week and 3 weeks were given. After treatment, the symptom scores (Portmann scores) of the 7th, 14th and 28th day after onset were compared. The time of improvement and the clinical effect of each group were compared.@*RESULTS@#On the 7th, 14th and 28th day after onset, the Portmann scores of the 4 groups were higher than those before treatment (all <0.05). On the 7th, 14th and 28th day after onset, the Portmann scores in the group A were higher than those in the other 3 groups (all <0.05). There was significant difference between both pairs of group B, group C and group D (all <0.05). The total effective rate in the group A was 96.7% (29/30), which was higher than 93.3% (28/30), 86.7% (26/30) and 83.3% (25/30) in the other 3 groups (all <0.05). The difference between the 4 groups in the beginning of improvement, significant improvement time and clinical recovery time was statistically significant (all <0.05), and the group A was optimal.@*CONCLUSION@#Early intervention of acupuncture with acute facial neuritis can appropriately slow the progression of facial nerve injury, improve the therapeutic effect, and shorten the clinical recovery time.

Analyzing cardiovascular treatment guidelines application to women and minority populations.

Despite nearly 30 years of treatment guidelines for cardiovascular diseases and risk factors and a parallel growth in the understanding of cardiovascular disease disparities by sex and race/ethnicity, such disparities persist. The goals of this review are to consider the possible role of three factors: the one-size-fits-all approach of most treatment guidelines, adoption of guideline-recommended treatments in clinical practice, and patient adherence to recommended practice, especially the relationship between adherence and patient perceptions. Guideline authors repeatedly call for more inclusion of women and minorities in the clinical trials that make guidelines possible, but despite challenges, guidelines are largely effective when implemented, as shown by a wealth of post hoc analyses. However, the data also suggest that one-size-fits-all treatment guidelines are not sufficiently generalizable and there is evidence of a distinct lag time between definitive clinical evidence and its widespread implementation. Patient perspectives may also play both a direct and indirect role in adherence to treatments. What emerges from the literature is an important continuing need for increased inclusion of women and minority subgroups in clinical trials to allow analyses that can provide evidence for differential treatments when needed. Increased effort is needed to implement definitive clinical improvements more rapidly. Patient input and feedback may also help inform clinical practice and clinical research with a better understanding of how to enhance patient adherence, but evidence for this is lacking for the groups most affected by disparities.

Dysfunctional autophagy in RPE, a contributing factor in age-related macular degeneration.

Age-related macular degeneration (AMD) is a devastating neurodegenerative disease and a major cause of blindness in the developed world. Owing to its complexity and the lack of an adequate human model that recapitulates key aspects of the disease, the molecular mechanisms of AMD pathogenesis remain poorly understood. Here we show that cultured human retinal pigment epithelium (RPE) from AMD donors (AMD RPE) are functionally impaired and exhibit distinct phenotypes compared with RPE cultured from normal donors (normal RPE). Accumulation of lipid droplets and glycogen granules, disintegration of mitochondria, and an increase in autophagosomes were observed in AMD RPE cultures. Compared with normal RPE, AMD RPE exhibit increased susceptibility to oxidative stress, produce higher levels of reactive oxygen species (ROS) under stress conditions, and showed reduced mitochondrial activity. Measurement of the ratio of LC3-II/ LC3-I, revealed impaired autophagy in AMD RPE as compared with normal RPE. Autophagic flux was also reduced in AMD RPE as compared with normal RPE, as shown by inability of AMD RPE to downregulate p62 levels during starvation. Impaired autophagic pathways were further shown by analyzing late autophagic vesicles; immunostaining with lysosome-associated membrane protein 1 (LAMP-1) antibody revealed enlarged and annular LAMP-1-positive organelles in AMD RPE as opposed to smaller discrete puncta observed in normal RPE. Our study provides insights into AMD cellular and molecular mechanisms, proposes dysfunctional autophagy as an underlying mechanism contributing to the pathophysiology of the disease, and opens up new avenues for development of novel treatment strategies.

Population-level differences in revascularization treatment and outcomes among various United States subpopulations.

Despite recent general improvements in health care, significant disparities persist in the cardiovascular care of women and racial/ethnic minorities. This is true even when income, education level, and site of care are taken into consideration. Possible explanations for these disparities include socioeconomic considerations, elements of discrimination and racism that affect socioeconomic status, and access to adequate medical care. Coronary revascularization has become the accepted and recommended treatment for myocardial infarction (MI) today and is one of the most common major medical interventions in the United States, with more than 1 million procedures each year. This review discusses recent data on disparities in co-morbidities and presentation symptoms, care and access to medical resources, and outcomes in revascularization as treatment for acute coronary syndrome, looking especially at women and minority populations in the United States. The data show that revascularization is used less in both female and minority patients. We summarize recent data on disparities in co-morbidities and presentation symptoms related to MI; access to care, medical resources, and treatments; and outcomes in women, blacks, and Hispanics. The picture is complicated among the last group by the many Hispanic/Latino subgroups in the United States. Some differences in outcomes are partially explained by presentation symptoms and co-morbidities and external conditions such as local hospital capacity. Of particular note is the striking differential in both presentation co-morbidities and mortality rates seen in women, compared to men, especially in women ≤ 55 years of age. Surveillance data on other groups in the United States such as American Indians/Alaska Natives and the many Asian subpopulations show disparities in risk factors and co-morbidities, but revascularization as treatment for MI in these populations has not been adequately studied. Significant research is required to understand the extent of disparities in treatment in these subpopulations.

Grape phytochemicals and associated health benefits.

The phytochemicals present in fruits and vegetables may play an important role in deceasing chronic disease risk. Grapes, one of the most popular and widely cultivated and consumed fruits in the world, are rich in phytochemicals. Epidemiological evidence has linked the consumption of grapes with reduced risk of chronic diseases, including certain types of cancer and cardiovascular disease. In vitro and in vivo studies have shown that grapes have strong antioxidant activity, inhibiting cancer cell proliferation and suppressing platelet aggregation, while also lowering cholesterol. Grapes contain a variety of phytochemicals, like phenolic acids, stilbenes, anthocyanins, and proanthocyanidins, all of which are strong antioxidants. The phytochemical composition of grapes, however, varies greatly among different varieties. While extensive research exists, a literature review of the health benefits of grapes and their phytochemicals has not been compiled to summarize this work. The aim of this paper is to critically review the most recent literature regarding the concentrations, biological activities, and mechanisms of grape phytochemicals.