Roles for c-Abl in postoperative neurodegeneration.

The nonreceptor tyrosine kinase c-Abl is inactive under normal conditions. Upon activation, c-Abl regulates signaling pathways related to cytoskeletal reorganization. It plays a vital role in modulating cell protrusion, cell migration, morphogenesis, adhesion, endocytosis and phagocytosis. A large number of studies have also found that abnormally activated c-Abl plays an important role in a variety of pathologies, including various inflammatory diseases and neurodegenerative diseases. c-Abl also plays a crucial role in neurodevelopment and neurodegenerative diseases, mainly through mechanisms such as neuroinflammation, oxidative stress (OS), and Tau protein phosphorylation. Inhibiting expression or activity of this kinase has certain neuroprotective and anti-inflammatory effects and can also improve cognition and behavior. Blockers of this kinase may have good preventive and treatment effects on neurodegenerative diseases. Cognitive dysfunction after anesthesia is also closely related to the abovementioned mechanisms. We infer that alterations in the expression and activity of c-Abl may underlie postoperative cognitive dysfunction (POCD). This article summarizes the current understanding and research progress on the mechanisms by which c-Abl may be related to postoperative neurodegeneration.

Heart failure with preserved ejection fraction based on aging and comorbidities.

Heart failure (HF) with preserved ejection fraction (HFpEF) is a leading cause of hospitalizations and mortality when diagnosed at the age of ≥ 65 years. HFpEF represents multifactorial and multisystemic syndrome and has different pathophysiology and phenotypes. Its diagnosis is difficult to be established based on left ventricular ejection fraction and may benefit from individually tailored approaches, underlying age-related changes and frequent comorbidities. Compared with the rapid development in the treatment of heart failure with reduced ejection fraction, HFpEF presents a great challenge and needs to be addressed considering the failure of HF drugs to improve its outcomes. Further extensive studies on the relationships between HFpEF, aging, and comorbidities in carefully phenotyped HFpEF subgroups may help understand the biology, diagnosis, and treatment of HFpEF. The current review summarized the diagnostic and therapeutic development of HFpEF based on the complex relationships between aging, comorbidities, and HFpEF.

Right ventricle may be involved in regional diastolic dysfunction earliest in primary hypertension patients.

BACKGROUND: Impaired ventricular diastolic function is common in hypertensive patients and is one of the major causes of heart failure. Both left and right ventricle diastolic dysfunction have been reported, but the order of involvement is not clear. METHOD: A total of 161 primary hypertensive patients and 40 healthy volunteers were enrolled. Pulsed wave tissue Doppler was used to measure regional diastolic dysfunction (defined as early peak diastolic [Em] and late diastolic [Am] velocity ratios (Em/Am) < 1) at right ventricular tricuspid valve annulus lateral side (RAVP1), right ventricular tricuspid valve annulus septum side (RAVP2), left ventricular mitral valve annulus septum side (LAVP1) and left ventricular mitral annulus lateral side (LAVP2). RESULTS: The prevalence of regional diastolic dysfunction at RAVP1, RAVP2, LAVP1, and LAVP2 was all higher in the hypertensive group (P < .001 for all). In both the hypertensive group and the control group, more cases were presented with RAVP1 diastolic dysfunction, while the least number of cases had LAVP2 diastolic dysfunction. In patients with stage 1 hypertension, most cases had RAVP1, or RAVP1 and RAVP2/LAVP1 diastolic dysfunction, while in patients with more advanced hypertension stages, significantly more cases had both RAVP1 and LAVP2, or all four locations diastolic dysfunction (P < .001). A similar trend was observed in patients with longer hypertension duration (duration of 6-9.9 years and 10-18 years compared with 2-5.9 years of duration, P < .001). CONCLUSIONS: With a more advanced stage and longer duration of hypertension, the range of regional diastolic dysfunction increased, showing a trend from the right ventricular wall, to the septum and left the ventricular wall. In primary hypertension, regional diastolic dysfunction in the right ventricle might happen earlier than that in the septum and the left ventricle.

N-terminal pro-brain natriuretic peptide levels had an independent and added ability in the evaluation of all-cause mortality in older Chinese patients with atrial fibrillation.

BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and has increased prevalence in older patients, leading to poor prognosis for these patients. There is a need for a biomarker or a model of prognostic evaluation in older patients with AF, especially in China. CHADS2 and CHA2DS2VASc scores have been applied to evaluate their prognosis in patients with AF. This analysis was designed to examine whether N-terminal pro-brain natriuretic peptide (NT-proBNP) levels significantly improved the evaluation of all-cause mortality in older Chinese patients with AF when added to CHADS2 and CHA2DS2VASc scores. METHODS: There were 219 older patients with AF, and follow-up was 100% complete over an average of 1.11 years. Cox regression analysis was applied to determine the variables independently associated with all-cause mortality. RESULTS: Median age was 85 years, and all-cause mortality was 24.2% (53 patients). Plasma NT-proBNP levels were significantly associated with all-cause mortality in univariate [hazard ratio (HR): 1.842; 95% confidence interval (CI): 1.530-2.218] and multivariate (HR: 1.377; 95% CI: 1.063-1.785) Cox regression analyses and had significantly higher c-statistic (0.771; 95% CI: 0.698-0.845) than CHADS2 (0.639; 95% CI: 0.552-0.726) and CHA2DS2VASc (0.633; 95% CI: 0.546-0.720) scores (P < 0.05 for all). The addition of NT-proBNP levels to CHADS2 (0.783; 95% CI: 0.713-0.854) and CHA2DS2VASc (0.775; 95% CI: 0.704-0.846) scores significantly increased their c-statistics (P < 0.001 for all). Model based on NT-proBNP levels including age, hemoglobin, fasting blood glucose, glomerular filtration rate and NT-proBNP levels had a significantly higher c-statistic (0.890; 95% CI: 0.841-0.938) than CHADS2 and CHA2DS2VASc scores (P < 0.001 for all). Model based on NT-proBNP levels had significantly higher c-statistic than the addition of NT-proBNP levels to CHADS2 and CHA2DS2VASc scores (P < 0.05). CONCLUSION: NT-proBNP levels were an independent biomarker associated with an increased all-cause mortality in older Chinese patients with AF, and had an independent and added ability to evaluate their all-cause mortality compared with CHADS2 and CHA2DS2VASc scores.

Single-marker and multi-marker approaches to appraise the relationships between biomarkers and microalbuminuria in Chinese middle-aged and elderly from communities: a cross-sectional analysis.

BACKGROUND: Analyzing the relationships between biomarkers representing distinct pathophysiologic pathways and microalbuminuria (MA) can strengthen the identifying ability for renal damage and illuminate previously unrecognized pathways for the pathogenesis of renal damage. The current analysis was to clarify the associations between biomarkers, including N-terminal prohormone of brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), homocysteine and uric acid (UA), and MA in Chinese middle-aged and elderly from communities. METHODS: All 839 residents had complete set of these biomarkers and full assessment of MA. RESULTS: Prevalence of participants with MA was 13.5% (113 participants). Levels of age, systolic blood pressure (SBP), fasting blood glucose (FBG), homocysteine and NT-proBNP and proportion of cigarette smoking in participants with MA significantly exceeded those in participants without MA (p < 0.05 for all). In single-marker and multi-marker models of linear and logistic regression analyses, homocysteine and NT-proBNP levels (p < 0.05 for all) rather than hsCRP and UA levels (p > 0.05 for all) were statistically significant in relation to MA. Additionally, no matter which biomarker was directed at, levels of age, SBP and FBG and proportion of cigarette smoking had significant associations with MA. Homocysteine and NT-proBNP levels (p < 0.05 for all) rather than hsCRP and UA levels (p > 0.05 for all) had significant abilities to identify MA. CONCLUSION: Both single-marker and multi-marker analyses confirmed that homocysteine and NT-proBNP were associated with MA in Chinese middle-aged and elderly from communities after adjustment for multiple confounders.

Association of arterial stiffness and central hemodynamics with moderately reduced glomerular filtration rate in Chinese middle-aged and elderly community residents: a cross-sectional analysis.

BACKGROUND: Kidney impairment constitutes severe risk for cardiovascular disease, stroke and all-cause mortality, and early identification and prevention of kidney impairment is critical to effective management of prognostic risk in community residents. Previous studies have validated that carotid-femoral pulse wave velocity (cfPWV) is a significant factor associated with chronic kidney disease. However, whether cfPWV is associated with moderately reduced glomerular filtration rate (GFR) remains unclear. This analysis was designed to examine the association of moderately reduced GFR with cfPWV and central pulse pressure (cPP) in Chinese middle-aged and elderly community residents. METHODS: There were 875 community residents enrolled in this analysis, and then cfPWV and cPP were assessed in all participants following the standard procedure. RESULTS: Entire cohort had a median (range) age of 66 (45-88) years, and 65.4% were women. Both cfPWV and cPP differed significantly between participants with and without moderately reduced GFR (P < 0.05 for all). Logistic regression analyses indicated that cfPWV and cPP had the significant association with moderately reduced GFR (P < 0.05 for all). CONCLUSION: This analysis demonstrated the significant association of cfPWV and cPP with moderately reduced GFR in Chinese middle-aged and elderly community residents.

Poor sleep is responsible for the impaired nocturnal blood pressure dipping in elderly hypertensive: A cross-sectional study of elderly.

OBJECTIVE: This study was aimed to assess whether sleep disorder was associated with an increased risk of less nocturnal blood pressure (BP) dipping in elderly patients with hypertension. METHODS: Cases were 1006 patients, aged >60 years, who were admitted to hospital with diagnosed hypertension during 2016-2017, and were divided into three groups with the systolic nocturnal BP dipping of 10%, and 0% as the cut-off value. The patients' sleep was evaluated by Pittsburgh sleep quality index (PSQI). RESULTS: Compared to non-dipper BP rhythm patients (n = 382) and dipper BP rhythm patients (n = 132), reverse dipper patients (n = 492) exhibited higher PSQI score and had higher scores on six components with the exception of use sleep drug (p < 0.05). Multivariate logistic regression indicated that poor sleep, which was defined as high score of PSQI or its seven components, was associated with prevalence of reverse dipper in elderly hypertensive (odds ratio (OR) = 1.17, (95% confidence interval (CI), 1.13-1.21, p < 0.05) after adjusting for risk factors of hypertension. Multiple linear regression analysis showed that there was a significant negative correlation between PSQI score (include its seven components) and nocturnal BP dipping value after adjusting for risk factors of hypertension (ß = -0.584, p < 0.001). CONCLUSIONS: In elderly patients with hypertension, poor sleep quality individuals were more prone to reverse dipper BP rhythm. Even adjusting for the effect of known risk factors of hypertension, poor sleep may contribute to attenuated BP dipping in elderly hypertensive.

The relationship of serum alanine aminotransferase normal-range levels to arterial stiffness and metabolic syndrome in non-drinkers and drinkers: a Chinese community-based analysis.

BACKGROUND: Few studies have investigated the relationship between carotid-femoral pulse wave velocity (cfPWV) and serum alanine aminotransferase (ALT) normal-range levels across the world. The current analysis was designed to explore the relationship of serum ALT normal-range levels to cfPWV and metabolic syndrome (Mets) in non-drinkers and drinkers in a Chinese community-dwelling population. METHODS: There were 2202 participants with serum ALT levels within normal range enrolled for the current analysis. RESULTS: Median (range) age of participants was 53 (18-96) years, 51.5% were males, and 31.2% were drinkers. Prevalence of Mets was 29.4%. Median (range) of cfPWV was 10.1 (2.4-32.7) m/s. Hazard ratios for prevalence of Mets, central obesity and high triglyceride significantly increased with elevated levels of serum ALT in both non-drinkers and drinkers (p < 0.05 for all). Hazard ratios for prevalence of cfPWV > 10 m/s, high blood pressure and high blood glucose significantly increased with elevated levels of serum ALT in non-drinkers (p < 0.05 for all), but not in drinkers (p ≥ 0.05 for all). CONCLUSIONS: In a Chinese community-dwelling population, prevalence of Mets and its components (including central obesity and high TG) increased with an elevation in serum ALT levels within normal range in both non-drinkers and drinkers, while cfPWV and other components of Mets, such as high blood pressure and glucose, increased with an elevation in serum ALT levels in non-drinkers, but not in drinkers.

The neutrophil-to-lymphocyte ratio on admission is a good predictor for all-cause mortality in hypertensive patients over 80 years of age.

BACKGROUND: Immuno-inflammation plays a major role in the process of hypertension. We aimed to evaluate the association between inflammatory markers, neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW) and all-cause mortality in elderly patients with hypertension. METHODS: A total of 341 hypertensive patients over 80 years of age were included to this study. The NLR and RDW were measured on admission and all the selected patients were followed up for up to 90 days. Kaplan-Meier curves were plotted to evaluate the association between the NLR and the all-cause mortality at follow-up. Using Cox regression models, we investigated the prognostic value of NLR and RDW for all-cause mortality. RESULTS: Patients with higher quartile of NLR linked to high mortality in hypertensive patients at 90 day after admission (16.47%,13.25%,1.14%,1.17% respectively; χ2 = 20.581,P = 0.000). Surviving patients had lower RDW (13.61 ± 1.37 VS 14.18 ± 1.38, p = 0.041) and NLR (4.97 ± 5.72 VS 7.95 ± 6.88,p = 0.011). The receiver operating curve (ROC) of the NLR for all-cause mortality had an area under the curve (AUC) =0.714 (95%CI: 0.629-0.798, P = 0.000), with acritical value of 2.97, with sensitivity of 92.6%, and a specificity of 52.5%. The ROC of the RDW to predict all-cause mortality, had an AUC =0.654 (95%CI:0.548-0.761, P = 0.008), with acritical value of 13.2%.The Kaplan-Meier curve showed a significant difference between different NLR levels (p = 0.002). Multivariate Cox proportional hazard analysis shown 3rd quartile of NLR(RR = 9.646, 95% CI 1.302-34.457, P = 0.041) and 4th quartiles(RR = 16.451, 95% CI 2.137-66.643, P = 0.007) were found to independently predict all-cause death in hypertensive patients over 80 years of age. Higher rank of NLR was link to higher incidence of all-cause death for such patients. CONCLUSION: The findings of the present study demonstrate the potential utility of NLR in risk stratification of elderly patients with hypertension to provide information for clinical treatment strategies.

Renal function had an independent relationship with coronary artery calcification in Chinese elderly men.

BACKGROUND: Although previous studies have analyzed the relationship between renal function and coronary artery calcification (CAC) in pre-dialysis and dialysis patients, limited studies have discussed the relationship between renal function and CAC in Chinese elderly men without obvious damage of renal function. The present study was designed to explore the relationship between renal function and CAC in Chinese elderly men without obvious damage of renal function. METHODS: This cross-sectional study was carried out in 105 male participants older than 60 years with glomerular filtration rate (GFR) ≥ 45 ml/min/1.73 m2. CAC was detected by high-definition computerized tomography (HDCT), which is a highly sensitive technique for detecting the CAC and provides the most accurate CAC scores up to date. RESULTS: Age was 72 ± 8.4 years on average and ranged from 60 to 89 years. Simple correlation analysis indicated that all kinds of CAC scores including the Agatston, volume and mass scores inversely correlated with GFR values (p < 0.05 for all). In multivariate linear regression analysis, GFR values were independently associated with all these CAC scores (p < 0.05 for all). CONCLUSION: Renal function had an independent relationship with CAC detected by HDCT in Chinese elderly men, demonstrating that the relationship between renal function and CAC started at the early stage of renal function decline.

Predictive abilities of cardiovascular biomarkers to rapid decline of renal function in Chinese community-dwelling population: a 5-year prospective analysis.

BACKGROUND: Predictive abilities of cardiovascular biomarkers to renal function decline are more significant in Chinese community-dwelling population without glomerular filtration rate (GFR) below 60 ml/min/1.73m2, and long-term prospective study is an optimal choice to explore this problem. Aim of this analysis was to observe this problem during the follow-up of 5 years. METHODS: In a large medical check-up program in Beijing, there were 948 participants with renal function evaluated at baseline and follow-up of 5 years. Physical examinations were performed by well-trained physicians. Blood samples were analyzed by qualified technicians in central laboratory. RESULTS: Median rate of renal function decline was 1.46 (0.42-2.91) mL/min/1.73m2/year. Rapid decline of renal function had a prevalence of 23.5% (223 participants). Multivariate linear and Logistic regression analyses confirmed that age, sex, baseline GFR, homocysteine and N-terminal pro B-type natriuretic peptide (NT-proBNP) had independently predictive abilities to renal function decline rate and rapid decline of renal function (p < 0.05 for all). High-sensitivity cardiac troponin T (hs-cTnT), carotid femoral pulse wave velocity and central augmentation index had no statistically independent association with renal function decline rate and rapid decline of renal function (p > 0.05 for all). CONCLUSIONS: Homocysteine and NT-proBNP rather than hs-cTnT had independently predictive abilities to rapid decline of renal function in Chinese community-dwelling population without GFR below 60 ml/min/1.73m2. Baseline GFR was an independent factor predicting the rapid decline of renal function. Arterial stiffness and compliance had no independent effect on rapid decline of renal function. This analysis has a significant implication for public health, and changing the homocysteine and NT-proBNP levels might slow the rapid decline of renal function.

Epidemiological associations between hyperuricemia and cardiometabolic risk factors: a comprehensive study from Chinese community.

BACKGROUND: This study aimed to assess the associations of serum uric acid (SUA) levels and hyperuricemia with cardiometabolic risk factors in a Chinese community-dwelling population. METHODS: A large cohort of 4706 residents was enrolled in this study. Physical examinations and laboratory tests were performed following a standardized protocol. Multiple linear and logistic regression analyses were conducted with adjustment of cardiometabolic risk factors including age, sex, body mass index (BMI), blood pressure (BP), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-c), low-density lipoprotein-cholesterol (LDL-c) and fasting blood glucose (FBG) levels using SPSS version 17 software. RESULTS: The prevalence of hyperuricemia was 7.6 %. There were significant differences in age, BMI, BP, TG, HDL-c, LDL-c and FBG levels and the proportion of men between participants with and without hyperuricemia. Multiple linear regression analysis showed that SUA levels were positively associated with age, sex, BMI, BP, TG and LDL-c levels, but negatively associated with HDL-c and FBG levels. Multiple logistic regression analysis showed that per unit increase in age was associated with a 1.014 times higher odds of the presence of hyperuricemia. Men had a 1.858 times higher odds of the presence of hyperuricemia compared with women. Per unit increases in BMI, BP, TG and LDL-c levels were associated with 1.103, 1.016, 1.173 and 1.200 times higher odds of the presence of hyperuricemia, respectively. Per unit increases in HDL-c and FBG levels were associated with 0.616 and 0.900 times lower odds of the presence of hyperuricemia, respectively. CONCLUSIONS: In a Chinese community-dwelling population, age, sex, BMI, BP, TG, HDL-c, LDL-c and FBG levels are cardiometabolic risk factors that are significantly associated with SUA levels, as well as the presence of hyperuricemia.

Prevalence, clinical predictors, and prognostic impact of chronic renal insufficiency in very old Chinese patients with coronary artery disease.

BACKGROUND AND AIMS: An aging population leads to the increased prevalence of coronary artery disease (CAD) and chronic renal insufficiency (CRI). Nevertheless, the prevalence, clinical predictors, and prognostic impact of CRI in very old Chinese patients with CAD are unclear. METHODS: Baseline characteristics were obtained from 1,050 old patients with CAD. The endpoint was all-cause mortality during the mean follow-up period of 417 days. RESULTS: The median age of the subjects was 86 years (range 60-104 years). CRI was present in 372 patients (35.4%). Age [hazard ratio (HR) 1.032, 95% confidence interval (95% CI) 1.010-1.054], chronic heart failure (CHF) (HR 2.361, 95% CI 1.747-3.191), hypertension (HR 1.878, 95% CI 1.291-2.731), hemoglobin (HR 0.973, 95% CI 0.965-0.981), serum albumin (HR 0.954, 95% CI 0.912-0.995), HDL-C (HR 0.371, 95% CI 0.238-0.580), and LDL-C levels (HR 0.795, 95% CI 0.656-0.965) were independent predictors of CRI (all P < 0.05). In addition, CRI was independently associated with mortality in patients with CAD (HR 1.366, 95% CI 1.024-1.822, P = 0.034). Age (HR 1.036, 95% CI 1.015-1.059), acute myocardial infarction (AMI; HR 1.795, 95% CI 1.239-2.602), CHF New York Heart Association class IV (HR 1.691, 95% CI 1.187-2.410), heart rate (HR 1.019, 95% CI 1.011-1.026), hemoglobin (HR 0.982, 95% CI 0.975-0.990), and serum albumin levels (HR 0.905, 95% CI 0.874-0.938) were also independently related to mortality in CAD patients (all P < 0.05). CONCLUSIONS: A high prevalence of CRI with a high associated mortality rate existed in very old Chinese patients with CAD. CRI was an independent risk factor of adverse prognosis for these patients, and multiple predictors could be used to identify CAD patients at increased risk for CRI or poor survival.

[Association between peroxisome proliferator-activated receptor gene single nucleotide polymorphisms and arterial stiffness in adult Chinese population].

OBJECTIVE: To analyze the association between single nucleotide polymorphisms (SNPs) of peroxisome proliferator-activated receptor(PPAR) and arterial stiffness in adult Chinese population (> 50 years). METHODS: Cardiovascular risk factors from participants of Beijing epidemiological investigation were analyzed. Carotid-femoral pulse wave velocity (cfPWV) was measured by Complior system. The subjects were divided into normal arterial stiffness group (cfPWV < 12 m/s, n = 844) and increased arterial stiffness group (cfPWV > 12 m/s, n = 530). Three valid SNPs including rs1053049, rs1800234 and rs8192678 in the PPAR and PPARγC1a gene were genotyped by TaqMan allelic discrimination assays. RESULTS: The age [(67.9 ± 8.8) years vs. (58.0 ± 9.7) years], prevalence of hypertension [71.1% (377/530) vs. 30.5% (257/844)] and diabetes mellitus [21.7% (115/530) vs. 11.0% (93/844)] were all significantly higher in increased arterial stiffness group than in normal group (all P < 0.05). The frequencies of CC, CT and TT type of rs8192678 [CC: 32.2% (272/844) vs. 30.8% (163/530), CT: 48.7% (411/844) vs. 52.1% (276/530), TT: 19.1% (161/844) vs. 17.2% (91/530)], rs1053049 [CC: 55.7% (470/844) vs. 51.3% (272/530), CT: 36.7% (310/844) vs. 39.1% (207/530), TT: 7.6% (64/844) vs. 9.6% (51/530)] and rs1800234 [CC: 88.4% (746/844) vs. 90.4% (479/530), CT + TT: 11.6% (98/844) vs. 9.6% (51/530)] were similar between the two groups. There was also no association between haplotypes and the increased arterial stiffness in this cohort. CONCLUSIONS: In this community-based population, we found that aging, hypertension and diabetes mellitus were associated but SNPs of PPAR and PPARγC1a were not associated with arterial stiffness.

[Relationship between serum N-terminal pro-brain natriuretic peptide and metabolic syndrome: a cross-sectional study].

OBJECTIVE: To explore the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and metabolic syndrome (MS). METHODS: A total of 1323 Beijing residents (559 male) were investigated. MS was defined by the modified 2004 Chinese Diabetes Society criteria and 439 cases were diagnosed as MS according to this criteria. Multivariate logistic regression analysis was used to estimate the odds ratios (OR) of MS. Multiple linear regression analysis was performed to analyze the association between NT-proBNP and characteristic variables. RESULTS: NT-proBNP was significantly lower in MS group compared to non-MS group [32.51 (29.17, 36.14) ng/L vs.38.55 (35.73, 41.50) ng/L, P = 0.012] after adjusted for age and gender. NT-proBNP level decreased with the presence of MS components (from 0 to 4 or 5) (45.92, 37.24, 35.40, 31.55 and 33.65 ng/L respectively, P = 0.043 for linear trend). Among the components, groups with larger waist circumference, higher fasting glucose and triglycerides were associated with lower NT-proBNP level. After adjustment for potential confounders, compared with the lowest NT-proBNP quartile, the adjusted odds ratio of the second, third and fourth quartile for having MS were 0.782 (95%CI: 0.544 - 1.122, P > 0.05), 0.709 (95%CI: 0.489 - 1.028, P > 0.05), 0.604 (95%CI: 0.405 - 0.900, P < 0.05), respectively. Multiple linear regression analysis showed that female gender (ß = 0.248, P < 0.001), age (ß = 0.167, P < 0.001), systolic blood pressure (ß = 0.154, P < 0.001) were positively related to NT-proBNP level while waist circumference (ß = -0.082, P = 0.004), diastolic blood pressure (ß = -0.085, P = 0.015), triglycerides (ß = -0.101, P < 0.001), total cholesterol (ß = -0.078, P = 0.004), eGFR (ß = -0.150, P < 0.001) were negatively correlated to NT-proBNP level. CONCLUSION: In this cohort, higher serum NT-proBNP concentration is associated with lower incidence of metabolic syndrome.

Associations between cardiac structure and function and depressive disorder: A centenarian study in China.

Background: Depressive disorder is a common comorbidity in patients with cardiovascular diseases and is associated with increased hospitalization and death rates. The relationships between cardiac structure and function and depressive disorder remains unclear in the older adults, especially in centenarians. Therefore, this study aimed to explore the possible associations between cardiac structure and function and depressive disorder among centenarians. Methods: In the China Hainan Centenarian Cohort Study, the 15-item Geriatric Depression Scale scores and echocardiography were used to evaluate depressive disorder and cardiac structure and function, respectively. All information, including epidemiological questionnaires, physical examinations, and blood tests, was obtained following standardized procedures. Results: A total of 682 centenarians were enrolled in the study (mean age: 102.35 ± 2.72 years). The prevalence of depressive disorder in centenarians is 26.2% (179 older adults), of whom 81.2% (554 older adults) are women. Centenarians with depressive disorder have significantly higher left ventricular ejection fraction (60.02 ± 3.10) and interventricular septum thickness (9.79 ± 1.54). Stepwise multiple linear regression analysis detected positive associations of left ventricular ejection fraction (Bets: 0.093) and interventricular septum thickness (Bets: 0.440) with Geriatric Depression Scale scores. Both left ventricular ejection fraction (odds ratio: 1.081) and interventricular septum thickness (odds ratio: 1.274) were independently associated with depressive disorder in multiple logistic regression analysis (P < 0.05, all). Conclusions: The prevalence of depressive disorder remains very high, and associations were found between left ventricular ejection fraction, interventricular septum thickness, and depressive disorder in Chinese centenarians. Future studies should focus on their temporal relationships to improve cardiac structure and function, prevent depressive disorder, and achieve healthy aging by coordinating their relationships.

Efficacy and safety of a modified dosage regimen of nesiritide in patients older than 75 years with acute heart failure.

BACKGROUND AND AIMS: To explore efficacy and safety of a modified dosage regimen of nesiritide in patients (≥75 years) with acute heart failure (AHF). METHODS: Total 140 patients (≥75 years) with AHF were enrolled in this study. They were randomly and evenly divided into two group--control and nesiritide group. The control group received only conventional treatment for AHF, while the nesiritide group received conventional treatment plus a continual intravenous infusion of nesiritide at a rate of 0.0075-0.015 µg·kg(-1)·min(-1) for 10-15 hours (total 0.5- 1.0 mg) once daily for 13 days. RESULTS: Medical research council scales in nesiritide group were significantly lower than those in control group on day 4, 8 and 14. Scores of edema had no significant difference, but were lower in nesiritide group on day 8 and 14. The nesiritide group had markedly more net body fluid losses. NT-proBNP, serum creatinine, blood pressure, cTnI, 30-day and 60-day mortality had no significant difference between two groups. CONCLUSIONS: Nesiritide resulted in improvements in dyspnea and edema, and similar adverse effects compared with conventional treatment. In spite of no reduction on short-term mortality and a reversible influence on renal function, nesiritide was still an important choice for the elderly (≥75 years) with AHF.

Potential use of the S-protein-Angiotensin converting enzyme 2 binding pathway in the treatment of coronavirus disease 2019.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the pathogen that causes coronavirus disease 2019 (COVID-19), infects humans through a strong interaction between the viral spike protein (S-protein) and angiotensin converting enzyme 2 (ACE2) receptors on the cell surface. The infection of host lung cells by SARS-CoV-2 leads to clinical symptoms in patients. However, ACE2 expression is not restricted to the lungs; altered receptors have been found in the nasal and oral mucosa, vessel, brain, pancreas, gastrointestinal tract, kidney, and heart. The future of COVID-19 is uncertain, however, new viral variants are likely to emerge. The SARS-CoV-2 Omicron variant has a total of 50 gene mutations compared with the original virus; 15 of which occur in the receptor binding domain (RBD). The RBD of the viral S-protein binds to the human ACE2 receptor for viral entry. Mutations of the ACE2-RBD interface enhance tight binding by increasing hydrogen bond interactions and expanding the accessible surface area. Extracorporeal membrane oxygenation, hyperbaric oxygen, and aggressive dialysis for the treatment of COVID-19 have shown various degrees of clinical success. The use of decoy receptors based on the ACE2 receptor as a broadly potent neutralizer of SARS-CoV-2 variants has potential as a therapeutic mechanism. Drugs such as 3E8 could block binding of the S1-subunit to ACE2 and restrict the infection of ACE2-expressing cells by a variety of coronaviruses. Here, we discuss the development of ACE2-targeted strategies for the treatment and prevention of COVID-19.

How Should Anesthesiologists Face Coronavirus Disease 2019?

Coronavirus disease 2019 (COVID-19) is a highly contagious disease. Most infected patients manifest mild flu-like symptoms, but in some cases, the patients rapidly develop severe lung infections and pneumonia. It is estimated that about 15-20% of patients with COVID-19 develop hypoxemia and require some form of oxygen therapy and ventilation support. Further, exacerbation of the disease usually requires an emergency tracheal intubation, where the patients are more prone to coughing and aerosol diffusion, placing the anesthesiologist at an extremely high risk of infection. In this review, after a brief introduction to the epidemiology and pathogenesis of the COVID-19, we describe various recommendations that the anesthesiologists should employ to avoid the chances of infection during the management of severely ill patients. We describe key steps such as not removing the patient's mask prematurely and using sedatives, analgesics, and muscle relaxants for rapid and orderly intubation. The use of spinal cord and regional nerve block anesthesia should also be promoted to avoid general anesthesia. Since the patients with COVID-19 may also have disorders related to other parts of the body (other than lungs), short-acting drugs are recommended to actively maintain the perfusion pressure of the peripheral and important organs without metabolism of the drugs by the liver and kidney. Multimodal analgesia is advocated, and non-steroidal anti-inflammatory analgesic drugs can be used appropriately. In this review, we also discuss key studies and experiences of anesthesiologists from China, highlights research findings, and inform on the proper management of patients with perspective on anesthesiologists.

Association of serum lipids with arterial stiffness in a population-based study in Beijing.

BACKGROUND: Some cardiovascular risk factors such as age, hypertension and diabetes have been confirmed to be positively correlated with arterial stiffness. However, the relationship between serum lipids and arterial stiffness is incompletely understood. Recent studies have been far from conclusive and consistent data were not obtained. We investigated the relationship between serum lipids and pulse wave velocity (PWV) in community-dwelling individuals in Beijing, China. METHODS: This was a population-based, cross-sectional sample of adults (n = 2375; 48·1% men; age range, 40-96 years) from two communities in Beijing. A questionnaire was used for the risk factors of arterial stiffness. Anthropometry, blood pressure and heart rate were measured. Values of fasting plasma glucose (FPG), serum total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and uric acid were measured. Carotid-femoral PWV (cfPWV) and carotid-radial PWV (crPWV) were assessed non-invasively. RESULTS: Carotid-femoral pulse wave velocity was significantly positively related to TC (r = 0·221; P < 0·0001), LDL-C (r = 0·193; P < 0·0001) and inversely related to HDL-C (r = -0·240; P < 0·0001), but not with TG (r = 0·073; P = 0·6721). crPWV was inversely related to HDL-C (r = -0·272; P < 0·0001), but not with TC (r = 0·007; P = 0·4781), LDL-C (r = 0·021; P = 0·6393) or TG (r = 0·008; P = 0·2498). The multiple regression analysis showed that LDL-C was independently associated with cfPWV and that HDL-C was inversely associated with cfPWV and crPWV. TC and TG were not independently related to cfPWV and crPWV. CONCLUSIONS: These data show the correlation between some of the parameters of serum lipids and arterial stiffness. LDL-C was independently associated with aortic stiffness, and HDL-C was independently inversely associated with aortic stiffness and peripheral stiffness.