Prevalence and prognosis of molecularly defined familial hypercholesterolemia in patients with acute coronary syndrome.

Background: Familial hypercholesterolemia (FH) can elevate serum low-density lipoprotein cholesterol (LDL-C) levels, which can promote the progression of acute coronary syndrome (ACS). However, the effect of FH on the prognosis of ACS remains unclear. Methods: In this prospective cohort study, 223 patients with ACS having LDL-C ≥ 135.3 mg/dL (3.5 mmol/L) were enrolled and screened for FH using a multiple-gene FH panel. The diagnosis of FH was defined according to the ACMG/AMP criteria as carrying pathogenic or likely pathogenic variants. The clinical features of FH and the relationship of FH to the average 16.6-month risk of cardiovascular events (CVEs) were assessed. Results: The prevalence of molecularly defined FH in enrolled patients was 26.9%, and coronary artery lesions were more severe in patients with FH than in those without (Gensini score 66.0 vs. 28.0, respectively; P < 0.001). After lipid lowering, patients with FH still had significantly higher LDL-C levels at their last visit (73.5 ± 25.9 mg/dL vs. 84.7 ± 37.1 mg/dL; P = 0.013) compared with those without. FH increased the incidence of CVEs in patients with ACS [hazard ratio (HR): 3.058; 95% confidence interval (CI): 1.585-5.900; log-rank P < 0.001]. Conclusion: FH is associated with an increased risk of CVEs in ACS and is an independent risk factor for ACS. This study highlights the importance of genetic testing of FH-related gene mutations in patients with ACS.

Impact of multidisciplinary chronic disease collaboration management on self-management of hypertension patients: A cohort study.

To explore the effect of the interdisciplinary chronic disease management (CDM) model on patients with hypertension. In this intervention study, the subjects were divided into CDM and control groups. Blood pressure control was monitored in both groups. After 1 year of follow-up, the endpoint events of patients and their knowledge, confidence, and behavior in response to the disease were assessed. When compared with the control group, patients in the CDM group obtained higher scores for self-perception and management assessment, and their blood pressure control was also better after discharge. The quality of life and the satisfaction level of patients in the control group were lower than those in the CDM group, while the unplanned readmission rate, incidence of complications, and the average length of hospital stay in the control group were higher than those in the CDM group. CDM model was beneficial to blood pressure control in hypertensive patients. It had also improved the quality of life and the satisfaction level of the hypertensive patients. Our study highlights the importance of the CDM model in the prognosis of hypertensive patients.

Outcome of mitral valve repair or replacement for non-ischemic mitral regurgitation: a systematic review and meta-analysis.

BACKGROUND: Mitral regurgitation (MR) is a rather common valvular heart disease. The aim of this systematic review and meta-analysis was to compare the outcomes, and complications of mitral valve (MV) replacement with surgical MV repair of non-ischemic MR (NIMR) METHODS: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched until October, 2020. Studies were eligible for inclusion if they included patients with MR and reported early (30-day or in-hospital) or late all-cause mortality. For each study, data on all-cause mortality and incidence of reoperation and operative complications in both groups were used to generate odds ratios (ORs) or hazard ratios (HRs). This study is registered with PROSPERO, CRD42018089608. RESULTS: The literature search yielded 4834 studies, of which 20 studies, including a total of 21,898 patients with NIMR, were included. The pooled analysis showed that lower age, less female inclusion and incident of hypertension, significantly higher rates of diabetes and atrial fibrillation in the MV replacement group than MV repair group. No significant differences in the rates of pre-operative left ventricle ejection fraction (LVEF) and heart failure were observed between groups. The number of patients in the MV repair group was lower than in the MV replacement group. We found that there were significantly increased risks of mortality associated with replacement of MR. Moreover, the rate of re-operation and post-operative MR in the MV repair group was lower than in the MV replacement group. CONCLUSIONS: In patients with NIMR, MV repair achieves higher survival and leads to fewer complications than surgical MV replacement. In light of these results, we suggest that MV repair surgery should be a priority for NIMR patients.

Generalized model for conic-V-shaped flexure hinges.

This paper presents a new class of flexure hinges, namely, conic-V-shaped flexure hinges (CFHs), which can be used as a generalized model for flexure hinges with profiles such as parabolic-V-shape, elliptical-V-shape, and hyperbolic-V-shape. Compliance and precision equations for the CFHs were derived as a set of nonlinear equations using Castigliano's second theorem. The parameters of the nonlinear equations inputted to the compliance and precision matrices were based on the generalized equations used for conic curves in polar coordinates. Furthermore, the compliance equations were verified by means of finite element analysis and experiments. The errors in the finite element and experimental results were within 10% and 8% compared to the analytical results, respectively. Finally, the effects of dimensional parameters on the analytical model could be effectively analyzed by numerical simulations and comparisons.

Visfatin Level and The Risk of Hypertension and Cerebrovascular Accident: A Systematic Review and Meta-Analysis.

High blood pressure is related with increased cerebrovascular accident. High visfatin / NAMPT(nicotinamide phosphoribosyltransferase) plasma levels may promote vascular inflammation and atherosclerotic plaque destabilization and have been evaluated as a marker for identifying stages of essential hypertension. However, its role in the pathogenesis of hypertension and cerebrovascular accident (CVA) is still uncertain. In order to review and meta-analyze observational studies investigating visfatin concentration and the risk for hypertension or CVA, a systematic search of PubMed, ovid EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) until December 07, 2016 was performed. After data extraction and quality assessment, a meta-analysis was performed using RevMan 5.3 and STATA 14.0. A total of 1693 adults from 8 studies for hypertension (974 with hypertension) and 1696 adults from 7 CVA studies (957 with CVA) were enrolled in the current meta-analysis. Cochran's Q-statistic and I2 test were applied to estimate the heterogeneity of the studies. The fixed-effects were used to compute the weighted mean difference in visfatin levels. Plasma visfatin concentration was much higher in hypertension and CVA patients than in healthy individuals. These evidences suggested the association of hypertension and CVA with higher plasma visfatin level.