Acromegaly: Cardiovascular risk factors,cardiovascular manifestations and early vascular alterations in relation to disease activity

Acromegaly is associated with increased cardiovascular morbidity and mortality. 49 acromegaly patients were evaluated for presence of cardiovascular risk factors and manifestations using 2D-Echocardiography, strain, strain-rate, carotid intima media thickness (CIMT) and flow mediated dilatation (FMD) and correlated with disease activity. 32 patients with growth hormone (GH) level >1 ng/ml were considered active. Patients with active disease have more LV dysfunction as assessed by strain(p-0.031) and strain rate(p-0.001); trend towards lower ejection fraction(p-0.11) with significant correlation to GH(cc −0.252,p-0.05). Patient with active disease have reduced FMD(p- 0.042); with no difference in prevalence of cardiovascular risk factors and CIMT inrelation to disease activity.     

Reduced CD14 expression on classical monocytes and vascular endothelial adhesion markers independently associate with carotid artery intima media thickness in chronically HIV-1 infected adults on virologically suppressive anti-retroviral therapy

HIV infection causes systemic immune inflammation, and increases the risk for cardiovascular (CVD) disease even among those on virologically suppressive anti-retroviral treatment (ART). We performed a biostatistical analysis and screen of candidate cellular and plasma biomarkers for association with carotid artery intima-media thickness (CIMT), independent of traditional CVD risk factors such as age, gender, systolic blood pressure (SBP), lipid levels, smoking and diabetes. We conducted a multi-stage analysis based on a cross-sectional study of CVD risk in HIV-infected subjects age >45 years on ART for >6 months. The goal of this analysis was to identify candidate cellular and plasma biomarkers of CIMT in HIV-1 infected adults. We further sought to determine if these candidate biomarkers were independent of traditional CVD risk factors previously identified in HIV negative adults. High-resolution B-mode ultrasound images of the right common carotid common artery (CCA) were obtained. Plasma soluble inflammatory mediators, cytokines and chemokines were detected. Monocytes were defined by CD14/CD16 expression, and CD8+ T-cell activation by CD38/HLA-DR expression. Subjects were a median of 49.5 years old, 87% male, had a CIMT of 0.73 mm, FRS of 6%, a median viral load of 48 copies/mL, and CD4+ T cell count of 479 cells/μL. Soluble VCAM-1, and expansion of CD14dimCD16− monocytes each associated with higher CIMT independently of age and SBP. These factors are distinct components of a shared atherogenic process; 1) vascular endothelial molecular expression and 2) vascular monocytes that enter into the vascular endothelium and promote atherosclerotic plaque.     

Subclinical carotid atherosclerosis and hyperuricemia in relation to renal impairment in a rural Japanese population: The Nagasaki Islands study

Objective

The influence of hyperuricemia on atherosclerosis is controversial. Subclinical carotid atherosclerosis can be defined in two ways in terms of mean and maximum carotid intima-media thickness (CIMT): one with mean CIMT ≥ 1.1 mm and the other with maximum CIMT ≥ 1.1 mm. However, no studies have been reported of the association between hyperuricemia and subclinical carotid atherosclerosis while taking the two different ways of classification into account.

Methods

We conducted a cross-sectional study of 4133 subjects (1492 men and 2641 women) aged 30–89 years undergoing general health check-ups. For analysis of various associations, we calculated the multivariable odds ratios (ORs) for the two ways classifications of subclinical carotid atherosclerosis in relation to hyperuricemia.

Results

Hyperuricemia-related renal impairment constitutes a significant marker for subclinical carotid atherosclerosis with mean CIMT ≥ 1.1 mm for both men and women, while hyperuricemia per se was found to be beneficially associated with risk of subclinical carotid atherosclerosis with maximum CIMT ≥ 1.1 mm for men. The classical cardiovascular risk factors without adjustment for glomerular filtration rate (GFR) of ORs for subclinical carotid atherosclerosis (mean CIMT ≥ 1.1 mm) and subclinical carotid atherosclerosis (maximum CIMT ≥ 1.1 mm) were 2.20(1.10–4.22) and 0.84(0.63–1.13) for men and 2.12(1.02–4.38) and 0.92(0.66–1.27) for women. After further adjustment for GFR, the corresponding values were 1.54(0.74–3.20) and 0.67(0.49–0.92) for men and 1.32(0.61–2.88) and 0.80(0.57–1.12) for women.

Conclusion

Hyperuricemia-related renal impairment is a significant marker for subclinical carotid atherosclerosis for both men and women, while hyperuricemia per se may be inversely associated with subclinical carotid atherosclerosis for men as seen in a rural community-dwelling Japanese population.     

普罗布考对2型糖尿病合并轻度认知功能障碍患者的疗效观察

目的 观察普罗布考对T2DM合并轻度认知功能障碍（MCI）患者改善的情况. 方法 根据蒙特利尔认知评估（MoCA）量表北京版结果选取糖尿病合并MCI （MoCA＜26分）患者88例,随机分为治疗组46例与对照组42例.干预6个月,比较治疗前后两组MoCA评分、β淀粉样蛋白40（Aβ1-40）和颈动脉内-中膜厚度（CIMT）的差异. 结果 两组完成随访人数分别为42例和40例.治疗后,治疗组Aβ1-40较对照组降低[135.05（35.32,221.23）vs174.15（85.13,327.77） pg/ml,P＜0.01],两组MoCA评分比较,差异无统计学意义（P＞0.05）.两组治疗前后临床参数自身差值（△=治疗前一治疗后）比较,差异均有统计学意义[△MoCA：-4.00（-5.00,-2.00）vs-1.00（-3.00,0.00）,P＜0.01;△Aβ1-40：68.61（-58.59,198.76）vs9.00（-110.65,106.67）pg/ml,P=0.02; △CIMT：0.05（-0.05,0.20） vs-0.05（-0.10,0.10） mm,P=0.02]. 结论 普罗布考可降低T2DM合并MCI患者Aβ1-40水平,改善认知功能.     

Imaging modalities for the diagnosis and disease activity assessment of Takayasu's arteritis: A systematic review and meta-analysis

Background

Early diagnosis of Takayasu's Arteritis (TAK) and detection of disease activity may reduce the risk of vascular complications. The objective of this study was to determine the effectiveness of imaging modalities for the management of TAK.

Searching for the right outcome? A systematic review and meta‐analysis of controlled trials using carotid intima‐media thickness or pulse wave velocity to infer antiatherogenic properties of thiazolidinediones

Introduction: Recent meta‐analyses cast doubt over purported beneficial effects of Peroxisome Proliferator Activated Receptor‐Gamma (PPAR‐γ) receptor agonists. Thiazolidinedione (TZD) trials using surrogate outcomes to postulate an antiatherogenic paradigm have been criticised as misinformative. We conducted an independent systematic review and meta‐analysis of controlled TZD studies incorporating carotid intima‐media thickness (CIMT) or pulse wave velocity (PWV) as primary outcome measures. The aim was to provide an evidence‐based overview of TZD intervention studies using markers prospectively linked to vascular outcome in type 2 diabetes. Methods: Systematic search of known databases for TZD intervention trials using mean thickness CIMT(n = 9) and ankle‐brachial PWV(n = 6) as primary outcome measures was performed. CIMT and PWV pooled weighted mean difference was calculated using a random effects model accounting for heterogeneity and publication bias. An indirect meta‐analysis provided a comparison of rosiglitazone and pioglitazone effects. Results: A composite of combined placebo and comparator controlled trials demonstrated a significant weighted mean difference of–0.06 mm for CIMT (95% CI–0.09 to–0.02, p = 0.001) and–0.72 ms^?1 for PWV (95% CI–1.28 to–0.16, p = 0.011) in favour of thiazolidiendione treatment. No TZD intraclass variation in CIMT (p = 0.96) or PWV (p = 0.33) change was observed. Conclusion: TZDs exhibit significant beneficial effects on aorto‐carotid atherosclerosis when assessed using prospectively validated non‐invasive techniques. Inferring clinical benefit in the absence of confirmatory outcome trials is questionable and caution should be exercised when interpreting intervention data with surrogate endpoints. TZD‐induced congestive cardiac failure or other unknown PPAR‐γ adverse effects are plausible explanations for the conflicting results of intervention trials using markers of atherosclerosis and clinical event outcomes.     

Non-classical monocytes predict progression of carotid artery bifurcation intima-media thickness in HIV-infected individuals on stable antiretroviral therapy

Background: Inflammation may contribute to cardiovascular disease (CVD) among antiretrovirally suppressed HIV-infected individuals. We assessed relationships of monocyte, CD8 T-cell activation and plasma biomarkers to changes in carotid artery intima-media thickness (CIMT).

Methods: Longitudinal study of HIV-infected subjects ≥40 years and on stable antiretroviral therapy (ART) ≥3 months. Peripheral blood mononuclear cells were immunophenotyped by multiparameteric flow cytometry to quantify classical (CD14⁺⁺CD16^–), intermediate (CD14⁺⁺CD16⁺), non-classical (CD14^low/+CD16⁺⁺) and transitional (CD14⁺CD16^–) monocyte subsets and activated (CD38⁺HLA-DR⁺) CD8⁺ T-cells at baseline. Plasma biomarkers were assessed by multiplex Luminex assay. High-resolution B-mode ultrasounds of right carotid arteries were obtained. Changes in CIMT over two years at the right common carotid artery (CIMT_CCA) and right bifurcation (CIMT_BIF) were outcome variables.

Results: We studied 50 subjects: 84% male, median age 49 (Q1, Q3; 46, 56) years, median CD4 count 461 (317, 578) cells/mm³, and with HIV RNA ≤ 50 copies/mL in 84%. Change in CIMT_BIF correlated with log values of baseline absolute count of non-classical monocytes (r = 0.37, p = 0.020), and with MCP-1 (r = 0.42, p = 0.0024) and TNF-α (r = 0.30, p = 0.036) levels. In multivariable linear regression, only non-classical monocytes and MCP-1 predicted the change in CIMT_BIF, independent of Framingham Risk Score and baseline CIMT_BIF. No correlation was noted between CD8 T-cell activation and CIMT_BIF change. Monocyte subsets, CD8 T-cell activation, and biomarker concentrations were not correlated with changes in CIMT_CCA.

Conclusions: Our findings highlight the role of non-classical monocytes and MCP-1 in the progression of CIMT_BIF in HIV-infected individuals on stable ART independent of traditional cardio-metabolic risk factors.     

强制性诱导运动疗法对偏瘫型脑瘫患儿上肢功能的影响

目的观察强制性诱导运动疗法（CIMT）对偏瘫型脑瘫患儿上肢功能的影响。方法22例0～3岁偏瘫型脑瘫患儿随机分为两组，对照组应用常规康复治疗；观察组在常规康复治疗基础上应用CIMT治疗，用低温板材塑形制作限制性器具，限制健侧手活动，对患儿进行集中、大量、重复的练习和与日常生活相关的活动，设计循序渐进的治疗方案，每天4h，每周6d，疗程2个月。治疗前后采用脑瘫儿童精细运动功能评估量表评定疗效。结果治疗后，两组患儿的精细运动能力均较治疗前提高（P〈0．05），但观察组的疗效优于对照组（P〈0．05）。结论应用CIMT治疗偏瘫型脑瘫患儿可提高患儿上肢功能的康复效果。