Effects of Diet and Sodium Reduction on Cardiac Injury,Strain, and Inflammation: The DASH-Sodium Trial

BackgroundThe DASH (Dietary Approaches to Stop Hypertension) diet has been determined to have beneficial effects on cardiac biomarkers. The effects of sodium reduction on cardiac biomarkers, alone or combined with the DASH diet, are unknown.ObjectivesThe purpose of this study was to determine the effects of sodium reduction and the DASH diet, alone or combined, on biomarkers of cardiac injury, strain, and inflammation.MethodsDASH-Sodium was a controlled feeding study in adults with systolic blood pressure (BP) 120 to 159 mm Hg and diastolic BP 80 to 95 mm Hg, randomly assigned to the DASH diet or a control diet. On their assigned diet, participants consumed each of three sodium levels for 4 weeks. Body weight was kept constant. At the 2,100 kcal level, the 3 sodium levels were low (50 mmol/day), medium (100 mmol/day), and high (150 mmol/day). Outcomes were 3 cardiac biomarkers: high-sensitivity cardiac troponin I (hs-cTnI) (measure of cardiac injury), N-terminal pro–B-type natriuretic peptide (NT-proBNP) (measure of strain), and high-sensitivity C-reactive protein (hs-CRP) (measure of inflammation), collected at baseline and at the end of each feeding period.ResultsOf the original 412 participants, the mean age was 48 years; 56% were women, and 56% were Black. Mean baseline systolic/diastolic BP was 135/86 mm Hg. DASH (vs. control) reduced hs-cTnI by 18% (95% confidence interval [CI]: ?27% to ?7%) and hs-CRP by 13% (95% CI: ?24% to ?1%), but not NT-proBNP. In contrast, lowering sodium from high to low levels reduced NT-proBNP independently of diet (19%; 95% CI: ?24% to ?14%), but did not alter hs-cTnI and mildly increased hs-CRP (9%; 95% CI: 0.4% to 18%). Combining DASH with sodium reduction lowered hs-cTnI by 20% (95% CI: ?31% to ?7%) and NT-proBNP by 23% (95% CI: ?32% to ?12%), whereas hs-CRP was not significantly changed (?7%; 95% CI: ?22% to 9%) compared with the high sodium-control diet.ConclusionsCombining a DASH dietary pattern with sodium reduction can lower 2 distinct mechanisms of subclinical cardiac damage: injury and strain, whereas DASH alone reduced inflammation. (Dietary Patterns, Sodium Intake and Blood Pressure [DASH – Sodium]; NCT00000608)     

Topic-Based,Recent Literature Review on Pulmonary Hypertension

Pulmonary hypertension is a complex condition but a relatively common manifestation of severe cardiopulmonary disease. By contrast, pulmonary arterial hypertension is uncommon and is more prevalent in young women. To better categorize patients and to guide clinical decision-making, 5 diagnostic groups and associated subgroups characterize the spectrum of disease. A multidisciplinary approach to evaluation and treatment is recommended by published guidelines and often entails referral to a designated pulmonary hypertension center. Several key publications during the last couple of years merit review. The PubMed database was searched for English-language studies and guidelines relating to pulmonary hypertension. The following terms were searched, alone and in combination: pulmonary hypertension, pulmonary arterial hypertension, portopulmonary hypertension, and chronic thromboembolic pulmonary hypertension. The focus was on those publications with new information on evaluation and management of pulmonary hypertension between January 1, 2019, and January 31, 2021. Of the subgroups, 2 were of particular interest for this review: portopulmonary hypertension and chronic thromboembolic pulmonary hypertension. Last, available data on the impact of the coronavirus disease 2019 pandemic and newer treatment agents in early trials were selectively reviewed. The review is therefore intended to serve as a practical, focused review of important topics germane to those clinicians caring for patients with pulmonary hypertension.     

High levels of circulating N‐terminal pro‐brain natriuretic peptide in patients with hepatitis C

Summary. Many patients chronically infected by hepatitis C virus (HCV) experience symptoms like fatigue, dyspnea and reduced physical activity. However, in many patients, these symptoms are not proportional to the liver involvement and could resemble symptoms of chronic heart failure. To our knowledge, no study evaluated serum levels of N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) in a large series of patients with HCV chronic infection (HCV+). Serum NT‐proBNP was assayed in 50 patients HCV+ and in 50 sex‐ and age‐matched controls. HCV+ patients showed significantly higher mean NT‐proBNP level than controls (P = 0.001). By defining high NT‐proBNP level as a value higher than 125 pg/mL (the single cut‐off point for patient under 75 years of age), 34% HCV+ and 6% controls had high NT‐proBNP (Fisher exact test; P < 0.001). With a cut‐off point of 300 pg/mL (used to rule out chronic heart failure in patients under 75 years of age) 10% HCV+ and 0 controls had high NT‐proBNP (Fisher exact test; P = 0.056). With a cut‐off point of 900 pg/mL (used for ruling in chronic heart failure in patients with age 50–75) 8% HCV+ patients and 0 controls had high NT‐proBNP (Fisher exact test; P = 0.12). The study demonstrates high levels of circulating NT‐proBNP in HCV+ patients compared to healthy controls. The increase of NT‐proBNP may indicate the presence of a sub‐clinical cardiac dysfunction. Further prospective studies quantifying these symptoms in correlation with echocardiography are needed to confirm this association.     

Should intravesical Bacillus Calmette‐Guérin be employed in transplant recipients with bladder carcinoma?

H.‐Y. Sun, N. Singh. Should intravesical Bacillus Calmette‐Guérin be employed in transplant recipients with bladder carcinoma?
Transpl Infect Dis 2010: 12: 358–362. All rights reserved Abstract: Bacillus Calmette‐Guérin (BCG) exerts its antitumor activity through induction of pro‐inflammatory cytokines, while immunosuppressive agents prevent organ rejection by suppressing pro‐inflammatory and promoting anti‐inflammatory responses. Thus, in the setting of transplant populations, the use of intravesical BCG for bladder cancer has the possibility of either promoting allograft rejection or being rendered ineffective by the action of immunosuppressive agents that block pro‐inflammatory responses. We discuss the potential immunologic interactions between BCG and immunosuppression, and review relevant outcomes in renal transplant recipients with bladder cancer receiving intravesical BCG.     

氨基末端脑钠素前体与2型糖尿病自主神经病变的相关性分析

目的：探讨2型糖尿病（T2DM）伴自主神经病变(AN)(T2DAN)患者氨基末端脑钠素前体（NT-ProBNP）的变化情况,阐明NT-ProBNP与T2DAN的相关关系。方法：单纯T2DM组患者40例,T2DAN组患者35例,另选取本院体检中心健康体检者21例作为对照组,应用酶联免疫吸附实验(ELISA)检测各组患者血浆中NT-ProBNP水平。结果：T2DAN组NT-ProBNP水平明显高于T2DM组及对照组(均P<0.01)。NT-ProBNP与病程、空腹血糖(FPG)、糖化血红蛋白(HｂA1c)、平卧位心率(HR)及立卧位收缩压(SBP)变化呈正相关关系,相关系数(r)分别为0.957、0.932、0.912 、0.876及0.924(P<0.01),与空腹血清C-肽(FC-P)、深呼吸心率变化(HRV)、立卧位HRV、30∶15比值及乏氏指数呈负相关关系,相关系数(r)分别为－0.755、－0.766、－0.698、－0.732及－0.812(P<0.01)。结论：在T2DAN患者中,血浆NT-ProBNP过度表达与T2DAN有明确相关性。     

不稳定型心绞痛患者NT—proBNP与TNF—α水平的相关研究

目的检测不稳定型心绞痛（UAP）患者血浆N端脑钠肽前体（NT—proBNP）、血清肿瘤坏死因子（TNF）-α浓度,探讨UAP患者血浆NT—proBNP与血清TNF-α水平相关性及其临床意义。方法选取UAP患者38例为观察组,稳定型心绞痛（SAP）患者30例作为对照组,年龄、性别相匹配的同期于我院健康查体者30例为正常对照（CON）组。测定血浆NT—proBNP和血清TNF-α浓度及左室射血分数（LVEF）,分析结果并作直线相关分析。结果LVEF正常时,UAP、SAP患者血浆NT—proBNP浓度均明显高于CON组（P〈0．001,P〈0．02）,UAP患者血浆NT—proBNP浓度显著高于SAP患者（P〈0．001）;UAP、SAP患者血清TNF-α浓度均明显高于CON组（P〈0．001）;UAP患者与SAP患者血清TNF-α浓度相比差异无统计学意义（P〉0．10）。LVEF低下的UAP患者血浆NT—proBNP、血清TNF—a浓度均明显高于LVEF正常的UAP患者（P〈0．002）。UAP患者的血浆NT—proBNP浓度与血清TNF-α浓度呈正相关（r=0．53,P〈0．001）,与LVEF呈负相关（r=-0．44,P〈0．001）。结论不论LVEF正常与否,UAP患者的血浆NT—proBNP、血清,TNF-α均明显升高;NT—proBNP浓度与TNF-α呈正相关,与LVEF呈负相关。除心功能外,NT—proBNP、TNF-α水平与心肌缺血有关。     

宫颈环形电切术治疗宫颈上皮内瘤样病变238例

目的 观察宫颈环形电切术治疗Ⅱ～Ⅲ级、Ⅲ级宫颈上皮内瘤样病变(CIN)的临床疗效及其安全性.方法 回顾性分析经阴道镜下活检诊断为Ⅱ～Ⅲ级、Ⅲ级CIN的238例患者的临床资料.均采用宫颈环形电切术(LEEP)行宫颈锥形切除,观察手术后感染和出血、病灶残留情况,随访手术治疗效果和复发情况,随访观察高危型人类乳头瘤病毒(HPV)感染持续及其转阴时间.结果 术后发生宫颈感染21例(8.82%),术后平均出血时间为9 d;术后发生病灶残留25例(10.50%);术后平均随访时间20个月,复发9例(3.78%);术后高危型HPV感染持续平均时间为7个月.结论 宫颈环形电切术在切除高级别CIN病变的同时,还能有效清除高危型HPV感染,用于治疗宫颈上皮内瘤变是安全有效的.     

PPAR-γ pro12ala基因多态性与甲状腺相关性眼病的相关性研究

目的通过研究过氧化物酶体增殖激活受体-γ（PPAR-γ）pro12ala位点基因多态性在山西地区部分汉族人中的分布规律及其与甲状腺相关性眼病（TAO）的关系,从而探讨TAO可能的遗传因素及发病机制,为TAO的防治提供一定的实验依据。方法研究对象共有166例,共分为3组,其中TAO患者51例,Graves病（GD）患者55例及正常对照者60例,分别选取研究对象的外周抗凝血来提取基因组DNA,采用聚合酶链式反应-限制性片段长度多态性（PCR-RFLP）的研究方法,来检测研究对象PPAR-γ pro12ala位点基因型和等位基因的频率。结果 G等位基因TAO组频率明显高于GD组与正常对照组（27.8%vs13.6%,13.3%,P〈0.05）;CG＋GG基因型的频率TAO患者组明显高于GD患者组与正常对照组（52.9%vs25.5%,26.7%,P〈0.05）,GD组及正常对照组的基因频率的差异无统计学意义。结论山西地区部分汉族人群中存在PPAR-γpro12ala位点基因多态性;PPAR-γ pro12ala位点基因多态性可能与山西地区部分汉族人TAO的发病相关。     

甲氨喋呤对肠黏膜上皮细胞增殖和凋亡影响的研究

目的:探讨甲氨喋呤对肠黏膜上皮IEC-6细胞增殖和凋亡的影响。方法:采用CCK-8法检测细胞增殖效应,TUNEL的流式细胞术分析凋亡细胞,分光光度法检测细胞内Caspase-3活性程度。结果:1)实验组细胞生长抑制率明显高于对照组,且随MTX药物浓度的增加和作用时间的延长而增加。2)0.05、0.5和5μg/mL MTX作用24 h,细胞凋亡率增加。与对照组相比,差异有统计学意义,P<0.01。3)0.05、0.5和5μg/mL MTX作用24 h,Caspase-3活性增加,3组Caspase-3的活性分别是对照组的1.97、3.07和5.01倍。与对照组相比,各浓度药物组Caspase-3活性明显增强(P<0.05),且呈浓度依赖性。结论:甲氨喋呤对IEC-6细胞增殖有抑制作用,并通过诱导Caspase-3活化导致细胞凋亡。