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Vitamin D and hypertension: Is there any significant relation? 维生素D与高血压:有显著关系吗?
Q1 Medicine Pub Date : 2023-06-14 DOI: 10.1002/cdt3.83
Naga P. Vakkalagadda, Sri H. Narayana, Gummadi S. Sree, Lakshmi D. Bethineedi, L. V. Simhachalam Kutikuppala, Gnana D. Medarametla

Around a billion individuals worldwide have hypertension. Of these, 95% have essential hypertension, a type of undiagnosed hypertension.1 The regulation of blood pressure (BP) involves numerous signaling pathways. Among them, the Renin Angiotensin System is well known. All these pathways are regulated by modulation of renal salt handling and tone of vascular smooth muscle (VSM) tissue. Any of these mechanisms can become faulty and alter the resistance arteries’ VSM tone, which can elevate BP. However, since the exact origin of PH and its pathophysiology are unknown, less effective, and generic treatments are used.2 The fact that more than 50% of hypertension patients in the USA do not have their BP under good control serves as an illustration of this. Antihypertensive treatment resistance affects an additional 5 million people and is defined as the inability to regulate BP despite the use of at least three antihypertensive drugs in combination.3

Increasing age, racial variables, history in household members, obese status, physical inactivity, larger amounts of salt consumption, stress, tobacco use, and heavy alcohol use are some of the potential etiological factors for essential hypertension.4 It has been examined in previous meta-analyses how vitamin D supplementation affects BP,5 but it is still unclear whether this connection is causal in the general population. This study focused on finding out the effect of vitamin D3 deficiency on BP.

Vitamin D, a steroid hormone, promotes the calcium and phosphate absorption from the gastro-intestinal tract (GIT) and reabsorption from the renal tubules. At low levels, it causes bone mineralization. At high doses, it causes bone resorption. It contributes significantly to mineral metabolism and skeletal homeostasis in this way.3

Up to 80% of human vitamin D comes from vitamin D3, which is produced in the skin by ultraviolet (UV) radiation from 7-dehydrocholesterol. Fish, egg yolk, fortified milk, cereal, juice, and yogurt are dietary sources of vitamin D that provide D2 as well as D3 forms and account for around 20% of the body's requirement. The significant vitamin D form, 25-hydroxyvitamin D [25(OH)D], is produced by the liver from D2 and D3 forms of vitamin D in the body. It is the most accurate measure of the action status and levels of vitamin D. It mostly depends on the serum vitamin D binding protein.4

According to the Institution of Endocrinology clinical practice guidelines, blood 25-hydroxyvitamin D [25(OH)D] results below 20 ng/mL (or 50 nmol/L) are considered deficient levels of vitamin D. Inadequate vitamin D status is ubiquitous among Chinese.4 Numerous studies have been published describing how vitamin D deficiency can lead to cancer,6-10 metabolic disor

全世界约有十亿人患有高血压。1 血压(BP)的调节涉及许多信号通路。其中,肾素血管紧张素系统是众所周知的。所有这些途径都通过调节肾盐处理和血管平滑肌(VSM)组织的张力来调节。这些机制中的任何一个都可能出现问题,并改变阻力动脉的血管平滑肌张力,从而导致血压升高。然而,由于 PH 的确切病因及其病理生理学尚不清楚,因此采用的治疗方法效果较差,而且是普通的治疗方法2。抗高血压治疗耐药性影响着另外 500 万人,其定义是,尽管联合使用了至少三种抗高血压药物,但仍无法控制血压。年龄增长、种族变量、家庭成员病史、肥胖状况、缺乏运动、食盐摄入量增加、压力、吸烟和大量饮酒是导致原发性高血压的一些潜在病因。维生素 D 是一种类固醇激素,可促进胃肠道(GIT)对钙和磷酸盐的吸收以及肾小管对钙和磷酸盐的重吸收。低剂量时,它能促进骨骼矿化。高剂量时,它会导致骨吸收。3 人体中高达 80% 的维生素 D 来自维生素 D3,它是在皮肤中通过紫外线(UV)辐射从 7-脱氢胆固醇中产生的。鱼类、蛋黄、强化牛奶、谷物、果汁和酸奶都是维生素 D 的膳食来源,可提供 D2 和 D3 两种形式,约占人体需要量的 20%。重要的维生素 D 形式--25-羟基维生素 D [25(OH)D],是由肝脏从体内的 D2 和 D3 形式维生素 D 生成的。4 根据美国内分泌学会的临床实践指南,血液中 25- 羟维生素 D [25(OH)D] 结果低于 20 ng/mL(或 50 nmol/L)即被视为维生素 D 缺乏。研究表明,维生素 D 与风险呈负相关。11 定期补充维生素 D 可以降低维生素 D 水平低的患者的血压水平,而无需服用大剂量药物。12 研究发现,25-羟基维生素 D 浓度每增加 10%,患高血压的风险就会降低 8.1%。迄今为止,研究人员已组织了多项随机临床试验,以确定服用维生素 D 是否能降低血压并确定其作为预防策略的作用。14-16 这些研究的结果好坏参半,因为它们的设计并不令人满意,维生素 D 影响高血压的机制仍有待破解。因此,许多荟萃分析研究试图整合之前的研究结果,从而评估服用维生素 D 在调节血压方面的功能关系。4 Zhang 等人早些时候发表的荟萃分析15 发现,当 25(OH)D 降低到 75 nmol/L 以下时,高血压的风险会显著增加,但在 75-130 nmol/L 的范围内,高血压的风险仍然突出。血压近似于 L 型(非线性 = 0.04)。然而,综合数据显示,维生素 D 干预后,收缩压和舒张压均未显著降低。原发性高血压由多种因素引起,这些因素通过遗传和生态决定因素与衰老相互作用。虽然维生素 D 的缺乏会促进血管张力的增加,16 但它可能并不是调节正常血压平衡的重要环境因素,但它确实会损害易感成人原发性高血压的病因,从而起到催化剂的作用。
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引用次数: 0
Posttreatment Lyme disease syndrome and myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and comparison of pathogenesis 治疗后莱姆病综合征和肌痛性脑脊髓炎/慢性疲劳综合征:发病机制的系统回顾和比较
Q1 Medicine Pub Date : 2023-06-11 DOI: 10.1002/cdt3.74
Natalie A. Bai, Christie S. Richardson

Lyme disease is the most common vector-borne illness in the United States and has been causing significant morbidity since its discovery in 1977. It is well-documented that about 10% of patients properly treated with antibiotics never fully recover, but instead go on to develop a chronic illness dubbed, posttreatment Lyme disease syndrome (PTLDS) characterized by severe fatigue, cognitive slowing, chronic pain, and sleep difficulties. This review includes 18 studies that detail the symptoms of patients with PTLDS and uses qualitative analysis to compare them to myalgic encephalitis/chronic fatigue syndrome (ME/CFS), a strikingly similar syndrome. In the majority of the PTLDS studies, at least four of the six major symptoms of ME/CFS were also noted, including substantial impairment in activity level and fatigue for more than 6 months, post-exertional malaise, and unrefreshing sleep. In one of the included PTLDS articles, 26 of the 29 ME/CFS symptoms were noted. This study adds to the expanding literature on the post-active phase of infection syndromes, which suggests that chronic illnesses such as PTLDS and ME/CFS have similar pathogenesis despite different infectious origins.

莱姆病是美国最常见的病媒传播疾病,自1977年被发现以来,发病率一直很高。有充分的证据表明,大约10%接受过适当抗生素治疗的患者从未完全康复,而是发展成一种慢性疾病,称为治疗后莱姆病综合征(PTLDS),其特征是严重疲劳、认知减慢、慢性疼痛和睡眠困难。本综述包括18项研究,详细介绍了PTLDS患者的症状,并使用定性分析将其与肌痛性脑炎/慢性疲劳综合征(ME/CFS)进行比较,后者是一种非常相似的综合征。在大多数PTLDS研究中,ME/CFS的六种主要症状中至少有四种也被注意到,包括活动水平的严重损害和超过6个月的疲劳,运动后不适和不清醒的睡眠。在其中一篇纳入的PTLDS文章中,提到了29种ME/CFS症状中的26种。本研究增加了关于感染综合征后活跃期的文献,表明慢性疾病如PTLDS和ME/CFS具有相似的发病机制,尽管感染来源不同。
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引用次数: 0
Cyclophilin D as a potential therapeutic target of liver ischemia/reperfusion injury by mediating crosstalk between apoptosis and autophagy 亲环蛋白D通过介导细胞凋亡和自噬之间的串扰作为肝脏缺血再灌注损伤的潜在治疗靶点
Q1 Medicine Pub Date : 2023-06-11 DOI: 10.1002/cdt3.78
Mengjiao Yang, Zhihui Wang, Jin Xie, Md. Reyad-ul-Ferdous, Siying Li, Yongfeng Song

Background

Liver ischemia/reperfusion (I/R) injury is a complex and multifactorial pathophysiological process. It is well recognized that the membrane permeability transition pore (mPTP) opening of mitochondria plays a crucial role in cell death after I/R injury. Cyclophilin D (CypD) is a critical positive regulator of mPTP. However, the effect of CypD on the pathogenesis of liver I/R injury and whether CypD is a potential therapeutic target are still unclear.

Methods

We constructed liver-specific CypD knockout and AAV8-peptidyl prolyl isomerase F (PPIF) overexpression mice. Then, a 70% liver I/R injury model was established in mice, with 90 min of ischemia and 6 h of reperfusion. The liver function was detected by the level of serum glutamic pyruvic transaminase (alanine transaminase) and glutamic oxaloacetic transaminase (aspartate aminotransferase), the liver damage score and degree of necrosis were measured by hematoxylin and eosin (H&E) staining of liver tissues. Reactive oxygen species (ROS) staining, apoptosis, and autophagy-related molecules were used to detect apoptosis and autophagy during liver I/R.

Results

The liver-specific knockout of CypD alleviated necrosis and dysfunction in liver I/R injury, by reducing the excessive production of ROS, and inhibiting cell apoptosis and autophagy. On the contrary, overexpression of CypD exacerbated I/R-induced liver damage.

Conclusion

We found that the downregulation of CypD expression alleviated liver I/R injury by reducing apoptosis and autophagy through caspase-3/Beclin1 crosstalk; in contrast, the upregulation of CypD expression aggravated liver I/R injury. Therefore, interfering with the expression of CypD seems to be a promising treatment for liver I/R injury.

背景肝脏缺血/再灌注(I/R)损伤是一个复杂的、多因素的病理生理过程。众所周知,线粒体的膜通透性转换孔(mPTP)开放在I/R损伤后的细胞死亡中起着至关重要的作用。亲环素D(CypD)是mPTP的一个重要的正调控因子。然而,CypD在肝脏I/R损伤发病机制中的作用以及CypD是否是潜在的治疗靶点仍不清楚。方法构建肝特异性CypD敲除和AAV8肽基脯氨酰异构酶F(PPIF)过表达小鼠。然后,在小鼠中建立70%的肝脏I/R损伤模型 缺血分钟数和6 再灌注h。通过血清谷丙转氨酶(丙氨酸转氨酶)和谷草转氨酶(天冬氨酸转氨酶)水平检测肝功能,通过肝组织苏木精和伊红(H&;E)染色测定肝损伤评分和坏死程度。活性氧(ROS)染色、细胞凋亡和自噬相关分子用于检测肝脏I/R过程中的细胞凋亡和自噬。结果CypD的肝特异性敲除通过减少ROS的过量产生,抑制细胞凋亡和自噬,减轻肝脏I/R损伤中的坏死和功能障碍。相反,CypD的过度表达加剧了I/R诱导的肝损伤。结论CypD表达下调可通过胱天蛋白酶3/Beclin1串扰减少细胞凋亡和自噬,从而减轻肝脏I/R损伤;相反,CypD表达的上调加重了肝脏I/R损伤。因此,干扰CypD的表达似乎是治疗肝脏I/R损伤的一种有前景的方法。
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引用次数: 0
Stroke-like presentation of acute toxic leukoencephalopathy due to capecitabine treatment with extensive intramyelinic edema 卡培他滨治疗引起的急性中毒性白质脑病伴广泛的髓内水肿的卒中样表现
Q1 Medicine Pub Date : 2023-06-08 DOI: 10.1002/cdt3.72
Julia Feige, Fritz Klausner, Johannes A. R. Pfaff, Eugen Trinka, Slaven Pikija, Mahdi Safdarian

Capecitabine is an oral prodrug of 5-fluorouracil (5-FU), which is widely used for adjuvant and neoadjuvant chemotherapy of different solid tumors, particularly breast and colorectal cancers.1 Neurotoxicity of capecitabine has been consistently reported as capecitabine-induced toxic leukoencephalopathy, which includes bilateral lesions in the corpus callosum and corticospinal tract presenting as acute or delayed central nervous system toxicity.2 This side effect requires discontinuation of chemotherapy3; however, neurological symptoms due to capecitabine are reported to be usually reversible upon drug withdrawal.1

The patients presenting with acute stroke-like symptoms with accompanied restricted diffusion outside typical vessel territory pose a significant diagnostic challenge. In the case of exclusively white matter involvement, the observed low apparent diffusion coefficient (ADC) could be due to the severe intramyelinic edema and not cell death, that is, cytotoxic edema. Multifocal leukoencephalopathy has been associated with capecitabine, but only a few cases have been reported in the literature.4

A 51-year-old woman was admitted due to acute onset of dizziness, dysarthria, and right-sided central facial paresis. The patient had been diagnosed with bilateral breast cancer 5 years ago for which neoadjuvant chemotherapy was done as well as surgical and radiation therapy. The primary tumor was a moderately differentiated invasive breast carcinoma of nonspecific type (right breast: stadium cT1b, human epidermal growth factor receptor 2 [HER2] negative with Ki67 10%–20%, and left breast: Stadium cT1c cN1 cM0. HER2 negative. Ki67 10%). Neoadjuvant chemotherapy regime consisted of four cycles of epirubicin/cyclophosphamide (every 2 weeks [q2w]) afterwards four cycles of paclitaxel (q2w) with granulocyte-colony-stimulating factor (G-CSF) support for 4 months. In the follow-up fluorodeoxyglucose-positron emission tomography (FDG-PET) scan, a solitary osseous metastasis was detected in the sacrum, for which capecitabine and bevacizumab had been initiated.

At our department, the patient reported a feeling of dizziness and difficulties in swallowing 1 day after starting capecitabine and bevacizumab. The CT at admission showed no infarction or hemorrhage and she was also outside thrombolysis therapeutic window. In the evening that day, there was a sudden onset of motoric aphasia. MR-tomography showed a pronounced hyperintense white matter lesion affecting the splenium of the corpus callosum and the medullary beds with pronounced fiber rarefication in arcuate fasciculus (Figure 1A–C). There was a mild pleocytosis of 15 cells/μL in the CSF, with normal protein and lactate. A JC virus polymerase chain reaction (PCR) from the CSF was negative. Onco-neural and antineuronal antibodies were all negative (Table 1). Clinical

卡培他滨是5-氟尿嘧啶(5-FU)的口服前药,广泛用于各种实体肿瘤的辅助和新辅助化疗,尤其是乳腺癌和结直肠癌卡培他滨的神经毒性一直被报道为卡培他滨诱导的中毒性白质脑病,包括胼胝体和皮质脊髓束双侧病变,表现为急性或迟发性中枢神经系统毒性这种副作用需要停止化疗3;然而,据报道,卡培他滨引起的神经系统症状在停药后通常是可逆的。出现急性卒中样症状并伴有典型血管外扩散受限的患者给诊断带来了重大挑战。在仅累及白质的情况下,观察到的低表观扩散系数(ADC)可能是由于严重的髓内水肿,而不是细胞死亡,即细胞毒性水肿。多灶性白质脑病与卡培他滨有关,但文献中仅有少数病例报道。一位51岁女性因急性起病头晕、构音障碍和右侧中央面部轻瘫而入院。患者5年前被诊断为双侧乳腺癌,并接受了新辅助化疗以及手术和放疗。原发肿瘤为非特异性中分化浸润性乳腺癌(右乳:stadium cT1b,人表皮生长因子受体2 [HER2]阴性,Ki67 10%-20%,左乳:stadium cT1c cN1 cM0)。HER2阴性。Ki67 10%)。新辅助化疗方案包括4个周期的表柔比星/环磷酰胺(每2周[q2w]),随后4个周期的紫杉醇(q2w),支持粒细胞集落刺激因子(G-CSF) 4个月。在后续的氟脱氧葡萄糖-正电子发射断层扫描(FDG-PET)扫描中,在骶骨中检测到孤立性骨转移,卡培他滨和贝伐单抗已开始治疗。在我科,患者报告在开始卡培他滨和贝伐单抗后1天出现头晕和吞咽困难的感觉。入院时CT未见梗死及出血,亦在溶栓治疗窗外。那天晚上,她突然患上了运动性失语症。核磁共振断层扫描显示胼胝体脾脏和髓床明显的高信号白质病变,弓状束纤维明显稀薄(图1A-C)。脑脊液轻度增多,15个/μL,蛋白和乳酸正常。脑脊液JC病毒聚合酶链反应(PCR)阴性。肿瘤神经和抗神经抗体均为阴性(表1)。停用卡培他滨1天后临床症状迅速缓解。约2个月后,对照MRI仅显示脾脏离散性高强度,纤维追踪正常(图1D-F)。出院后,对S1骶骨进行3周15 × 3 Gy(累计45 Gy)的孤立性转移放射治疗,作为转移性疾病的替代治疗。在这里,我们提出了一例急性发作的运动性失语症,在开始使用卡培他滨后立即发展,临床症状在停药后立即解决。卡培他滨口服后,通过三重酶过程(羧酸酯酶、胞苷脱氨酶和胸苷磷酸化酶)被激活,形成5-FU。5- fu会优先在癌细胞中产生,因为胸腺嘧啶磷酸化酶水平较高,6并通过肝脏中的二氢嘧啶脱氢酶(diypd)进行分解代谢。因此,DYPD缺乏会由于5-FU的积累而导致严重的毒性。然而,由于定期筛查,DYPD缺乏症现在是一种罕见的5-FU毒性原因。然而,没有定期筛选的DYPD基因的其他多态性,以及其他基因,如胸苷酸合成酶(TYMS),可能是毒性增加的原因。例如,与非纯合的患者相比,TS 3RG等位基因纯合的患者具有更高的毒性和更低的治疗反应卡培他滨中间代谢物50-脱氧-5-氟吡啶(50-DFUR)穿过血脑屏障,为卡培他滨在脑局部转化为5-FU的最后一步提供底物。卡培他滨诱导的白质脑病患者的病变大多局限于白质束,并且大多数是可逆的。然而,从“无异常”到广泛的白质受累(包括幕下束和幕上束)的报道与影像学不一致。正如de Oliveira所提示的,本例患者ADC低可能提示存在髓内水肿。 它假定在包裹和隔离轴突的髓鞘层的虚拟空间中存在非神经毒性水肿。其特征是水扩散受限,类似于不可逆的细胞毒性水肿,但对对照成像没有持久影响。后部可逆性白质脑病综合征(PRES)可出现类似的临床症状。PRES表现为血压升高、意识障碍、癫痫发作(几乎三分之二的患者)以及由于后脑区受累和血管源性水肿而引起的视觉障碍。少数病例(15%)出现局灶性神经症状,如本例患者的失语然而,它可能涉及白质束,有DWI限制,并表现为双侧。我们的患者也接受了贝伐单抗的治疗,这确实可能导致脑白质病变,主要是在pres11方面。然而,不能完全排除卡培他滨诱导的胼胝体病变通过同时使用贝伐单抗而增加的可能性。Marchiafava-Bignami病是由胼胝体渗透性脱髓鞘和坏死引起的它存在于长期使用乙醇和维生素B复合物缺乏症的患者中,这两种情况在我们的患者中都没有出现。急性期DWI也未见任何变化。可逆性脾损害(RSL),最可能发生于病毒感染和低血糖、高钠血症、急性酒精中毒、癫痫发作。它也可能在停药后24小时至3周内出现。13在一项回顾性研究中,6名患有实体癌的成年患者在第一个治疗周期的3天内接受5-FU或卡培他滨治疗后出现急性中毒性白质脑病伴脾脏病变。脑MRI示胼胝体T2/FLAIR高信号,扩散受限,无增强。卡培他滨停药后,所有患者均在症状出现后8.5天内完全临床放射学恢复。14Obadia等人报道了一名45岁的女性接受卡培他滨治疗伴有转移性骨病变的乳腺癌,患者表现为恶心、头痛、肌肉痉挛、构音障碍和吞咽障碍。MRI显示双侧和对称的深部白质、胼胝体和皮质脊髓束高信号强度,停药后消退。2 2005年,Videnovic等报道了4例晚期乳腺癌患者和1例胰腺癌患者卡培他滨诱导的5例脑白质病变。所有患者均为40至74岁的女性,在开始使用卡培他滨治疗肿瘤进展的7天内出现神经系统症状,包括恶心、精神错乱、短期记忆丧失、头痛、眩晕、共济失调和构音障碍。脑MRI显示胼胝体、桥臂和深脑室周围物质区域信号增加。所有病例均以胼胝体的脾部为主。所有患者的卡培他滨停药后数天内均有改善。15Wagner-Altendorf等人报道了一例卡培他滨化疗后出现双侧皮质脊髓束变性和进行性痉挛性四肢瘫痪的患者,停药后症状明显恶化,最终死于吸入性肺炎。如果预期的益处大于风险,在某些情况下恢复卡培他滨可能是可行的。例如,Perrain等人建议在排除DYPD缺陷后,在选定的病例中恢复使用卡培他滨Bougea等人也报道了一名50岁女性,由于可逆性多灶性白质脑病,在卡培他滨、贝伐单抗和奥沙利铂治疗下出现孤立性构音障碍和失调,再给化疗后未复发然而,Tipples等人建议,即使排除DYPD缺陷,也要寻求替代化疗方案然而,在Saif报道的一名年轻的转移性结直肠癌患者中,未发现MRI异常,该患者在开始使用卡培他滨后出现临床急性小脑综合征。患者发现TYMS基因型缺陷,停药卡培他滨后得到改善。17-23综上所述,卡培他滨诱导的白质脑病是一种急性毒性现象,主要由暴露于高度活跃的白质束中的5-FU代谢物引起的髓内水肿引起,可在开始治疗后数天内发生。重要的鉴别考虑是可逆性脾损害,主要是由于癫痫发作或药物戒断。 临床医生应该意识到这种可能的副作用,因为早期停止治疗通常会导致良好的临床结果。神经毒性的症状各不相同,但主要包括共济失调、构音障碍、头痛和精神错乱。在开始使用卡培他滨后,任何突然的神经系统状态改变都应通过脑MRI进行调查,MRI通常显示胼胝体和皮质脊髓束脾皮质下白质改变(脑白质病)。停止卡培他滨通常会导致临床和影像学异常的快速恢复。Slaven Pikija、Julia Feige、Fritz Klausner和Johannes A. R. Pfaff收集了该病例的数据。Slaven Pikija和Mahdi Safdarian起草了手稿。所有的作者都阅读并确认了最终的手稿。作者声明无利益冲突
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引用次数: 1
Fruit and vegetable intake and the risk of arterial hypertension in China: A prospective cohort study 中国果蔬摄入与动脉高压风险的前瞻性队列研究
Q1 Medicine Pub Date : 2023-06-05 DOI: 10.1002/cdt3.76
Zhi He, Yanhui Jia, Jianxin Li, Jie Cao, Fangchao Liu, Hongfan Li, Jichun Chen, Dongsheng Hu, Chong Shen, Yingxin Zhao, Xiaoqing Liu, Ling Yu, Jianfeng Huang, Xiangfeng Lu, Dongfeng Gu, Shufeng Chen

Background

Population-based epidemiological evidence regarding the association between fruit and vegetable intake and the incidence of hypertension is inconsistent. This prospective cohort study aimed to investigate the association between fruit and vegetable intake and the risk of new-onset hypertension.

Methods

Based on the project of Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR), 58,981 Chinese adults without hypertension at baseline were included. Information on fruit and vegetable intake was collected using a food-frequency questionnaire. Cox proportional hazards models were performed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of incident hypertension.

Results

During 640,795 person-years of follow-up, 21,008 new cases of hypertension were recorded. Compared with participants in the lowest quintile (Q1) of total fruit and vegetable (TFV) intake, the HRs (95% CIs) of incident hypertension were 0.90 (0.86–0.95), 0.85 (0.81–0.90), 0.82 (0.78–0.86), and 0.83 (0.78–0.88) for the Q2 to Q5 group (ptrend < 0.001), respectively. In further analyses categorizing participants according to the recommended intake level (500 g/day), we found that increasing the intake of TFV, even though it was still insufficient for the recommendation, also had a protective effect against the incident hypertension. When considering the intake of fruit or vegetable separately, we found similar trends as the TFV intake.

Conclusion

These results suggest that a higher intake of fruit and vegetable is beneficial for preventing hypertension in Chinese adults.

背景:关于水果和蔬菜摄入与高血压发病率之间关系的基于人群的流行病学证据是不一致的。这项前瞻性队列研究旨在调查水果和蔬菜摄入与新发高血压风险之间的关系。方法:根据中国动脉粥样硬化性心血管疾病风险预测项目(China-PAR),纳入58981名基线无高血压的中国成年人。有关水果和蔬菜摄入量的信息是使用食物频率问卷收集的。采用Cox比例风险模型来估计偶发高血压的风险比(HR)和95%置信区间(CI)。结果:在640795人年的随访中,记录了21008例新的高血压病例。与水果和蔬菜总摄入量最低五分之一(Q1)的参与者相比,Q2至Q5组发生高血压的HR(95%CI)分别为0.90(0.86-0.95)、0.85(0.81-0.90)、0.82(0.78-0.86)和0.83(0.78-8.88)(p趋势 结论:这些结果表明,增加水果和蔬菜的摄入量有利于预防中国成年人的高血压。
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引用次数: 0
Digital health in chronic obstructive pulmonary disease 慢性阻塞性肺疾病的数字健康
Q1 Medicine Pub Date : 2023-06-02 DOI: 10.1002/cdt3.68
Huanyu Long, Shurun Li, Yahong Chen

Chronic obstructive pulmonary disease (COPD) can be prevented and treated through effective care, reducing exacerbations and hospitalizations. Early identification of individuals at high risk of COPD exacerbation is an opportunity for preventive measures. However, many patients struggle to follow their treatment plans because of a lack of knowledge about the disease, limited access to resources, and insufficient clinical support. The growth of digital health—which encompasses advancements in health information technology, artificial intelligence, telehealth, the Internet of Things, mobile health, wearable technology, and digital therapeutics—offers opportunities for improving the early diagnosis and management of COPD. This study reviewed the field of digital health in terms of COPD. The findings showed that despite significant advances in digital health, there are still obstacles impeding its effectiveness. Finally, we highlighted some of the major challenges and possibilities for developing and integrating digital health in COPD management.

慢性阻塞性肺疾病(COPD)可以通过有效的护理来预防和治疗,减少病情恶化和住院。早期识别COPD加重高风险个体是采取预防措施的机会。然而,由于缺乏对疾病的了解,获得资源的机会有限,以及临床支持不足,许多患者难以遵循他们的治疗计划。数字卫生的发展——包括卫生信息技术、人工智能、远程卫生、物联网、移动卫生、可穿戴技术和数字治疗方面的进步——为改善慢性阻塞性肺病的早期诊断和管理提供了机会。本研究回顾了数字健康领域在COPD方面的应用。调查结果表明,尽管数字医疗取得了重大进展,但仍存在阻碍其有效性的障碍。最后,我们强调了在COPD管理中发展和整合数字健康的一些主要挑战和可能性。
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引用次数: 1
Prevalence and sociodemographic determinants of selected noncommunicable diseases among the general population of Cyprus: A large population-based cross-sectional study 塞浦路斯一般人群中选定非传染性疾病的流行率和社会人口统计学决定因素:一项基于人群的大型横断面研究
Q1 Medicine Pub Date : 2023-05-09 DOI: 10.1002/cdt3.70
Maria Kyprianidou, Demosthenes Panagiotakos, Konstantinos C. Makris, Maria Kambanaros, Costas A. Christophi, Konstantinos Giannakou

Background

Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide. The aim of this study was to determine the prevalence of NCDs among the population of Cyprus and to identify the distribution of the socioeconomic and demographic determinants among individuals with the most frequent NCDs.

Methods

A cross-sectional study was conducted using stratified sampling. Socioeconomic and demographic characteristics and the presence of NCDs were collected through a standardized questionnaire. The diseases were classified using the 10th revision of the International Classification of Diseases (ICD-10).

Results

In total, 1140 individuals participated in the study, among whom 590 (51.7%) had at least one chronic disease. The most prevalent NCDs were hyperlipidemia (17.4%), hypertension (12.9%), and thyroid diseases (8.4%). We identified more males than females with hyperlipidemia aged 25–44 years old and >65 years old (p = 0.024), more males compared to females with hypertension (p = 0.001) and more females compared to males with thyroid diseases (p < 0.001). Individuals with hypertension and hyperlipidemia were more likely to be married, to have completed a higher education, and to have a high annual income.

Discussion

In Cyprus, the majority of the general population had at least one NCD. Hyperlipidemia, hypertension, and thyroid disease are relatively common, even at younger ages, highlighting the need for the development of public health programs aimed at addressing and preventing NCDs.

背景非传染性疾病(ncd)是世界范围内发病率和死亡率的主要原因。本研究的目的是确定塞浦路斯人口中非传染性疾病的流行情况,并确定最常见的非传染性疾病个体中社会经济和人口统计学决定因素的分布。方法采用分层抽样的横断面研究方法。通过标准化问卷收集了社会经济和人口特征以及非传染性疾病的存在情况。采用第十版国际疾病分类(ICD-10)对疾病进行分类。结果共1140人参与研究,其中590人(51.7%)患有至少一种慢性疾病。最常见的非传染性疾病是高脂血症(17.4%)、高血压(12.9%)和甲状腺疾病(8.4%)。我们发现25-44岁和65岁高脂血症患者中男性多于女性(p = 0.024),高血压患者中男性多于女性(p = 0.001),甲状腺疾病患者中女性多于男性(p < 0.001)。患有高血压和高脂血症的人更有可能结婚,完成高等教育,年收入高。在塞浦路斯,大多数一般人口至少有一种非传染性疾病。高脂血症、高血压和甲状腺疾病相对常见,甚至在年轻人中也是如此,这突出了制定旨在解决和预防非传染性疾病的公共卫生计划的必要性。
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引用次数: 0
Advances in immune response to pulmonary infection: Nonspecificity, specificity and memory 肺部感染免疫反应的研究进展:非特异性、特异性和记忆性
Q1 Medicine Pub Date : 2023-05-08 DOI: 10.1002/cdt3.71
Jianqiao Xu, Lixin Xie

The lung immune response consists of various cells involved in both innate and adaptive immune processes. Innate immunity participates in immune resistance in a nonspecific manner, whereas adaptive immunity effectively eliminates pathogens through specific recognition. It was previously believed that adaptive immune memory plays a leading role during secondary infections; however, innate immunity is also involved in immune memory. Trained immunity refers to the long-term functional reprogramming of innate immune cells caused by the first infection, which alters the immune response during the second challenge. Tissue resilience limits the tissue damage caused by infection by controlling excessive inflammation and promoting tissue repair. In this review, we summarize the impact of host immunity on the pathophysiological processes of pulmonary infections and discuss the latest progress in this regard. In addition to the factors influencing pathogenic microorganisms, we emphasize the importance of the host response.

肺免疫应答由参与先天免疫和适应性免疫过程的各种细胞组成。先天免疫以非特异性方式参与免疫抵抗,而适应性免疫通过特异性识别有效地消除病原体。以前认为适应性免疫记忆在继发性感染中起主导作用;然而,先天免疫也参与免疫记忆。训练免疫是指先天免疫细胞在第一次感染引起的长期功能性重编程,在第二次感染时改变免疫反应。组织弹性通过控制过度炎症和促进组织修复来限制感染引起的组织损伤。本文综述了宿主免疫对肺部感染病理生理过程的影响,并讨论了这方面的最新进展。除了影响病原微生物的因素外,我们还强调了宿主反应的重要性。
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引用次数: 0
Prevalence of familial hypercholesterolemia and its association with coronary artery disease: A Chinese cohort study 家族性高胆固醇血症的患病率及其与冠状动脉疾病的关系:一项中国队列研究
Q1 Medicine Pub Date : 2023-04-25 DOI: 10.1002/cdt3.69
Xiapikatijiang Aihaiti, Shufeng Chen, Jianxin Li, Zhennan Lin, Qingmei Cui, Xue Xia, Fangchao Liu, Chong Shen, Dongsheng Hu, Keyong Huang, Yingxin Zhao, Fanghong Lu, Xiaoqing Liu, Jie Cao, Ling Yu, Ying Li, Huan Zhang, Zhenyan Fu, Liancheng Zhao, Jianfeng Huang, Dongfeng Gu, Xiangfeng Lu

Background

Familial hypercholesterolemia (FH) is underrecognized, and its association with coronary artery disease (CAD) remains limited, especially in China. We aimed to investigate the prevalence of FH and its relationship with CAD in a large Chinese cohort.

Methods

FH was defined using the Make Early Diagnosis to Prevent Early Death (MEDPED) criteria. The crude and age-sex standardized prevalence of FH were calculated based on surveys of the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project during 2007−2008. The associations of FH with incident CAD and its major subtypes were estimated with the cohort-stratified multivariate Cox proportional hazard models based on the data from the baseline to the last follow-up (2018−2020).

Results

Among 98,885 included participants, 190 participants were defined as FH. Crude and age−sex standardized prevalence and 95% confidence interval (CI) of FH were 0.19% (0.17%–0.22%) and 0.13% (0.10%–0.16%), respectively. The prevalence varied across age groups and peaked in the group of 60–<70 years (0.28%), and the peak prevalence (0.18%) in males was earlier, yet lower than the peak crude prevalence in females (0.41%). During a mean follow-up of 10.7 years, 2493 cases of incident CAD were identified. After multivariate adjustment, FH patients had a 2.03-fold greater risk of developing CAD compared to non-FH participants.

Conclusions

The prevalence of FH was estimated to be 0.19% in the participants, and it was associated with an elevated risk of incident CAD. Our study suggests that early screening of FH has certain public health significance for the prevention of CAD.

家族性高胆固醇血症(FH)未被充分认识,其与冠状动脉疾病(CAD)的关联仍然有限,特别是在中国。我们的目的是在一个庞大的中国队列中调查FH的患病率及其与CAD的关系。方法采用早期诊断预防早期死亡(MEDPED)标准对FH进行定义。根据中国动脉粥样硬化性心血管疾病风险预测(China- par)项目2007 - 2008年的调查,计算了FH的粗患病率和年龄-性别标准化患病率。根据基线至最后一次随访(2018 - 2020)的数据,使用队列分层多变量Cox比例风险模型估计FH与冠心病及其主要亚型的关联。结果98,885名参与者中,190名参与者被定义为FH。FH的粗患病率和年龄-性别标准化患病率及95%可信区间(CI)分别为0.19%(0.17%-0.22%)和0.13%(0.10%-0.16%)。不同年龄组患病率差异较大,60 ~ 70岁年龄组患病率最高(0.28%),男性患病率最高(0.18%)较早,但低于女性粗患病率最高(0.41%)。在平均10.7年的随访中,发现2493例冠心病。多因素调整后,与非FH参与者相比,FH患者发生CAD的风险高出2.03倍。结论:FH患病率估计为0.19%,与冠心病发生风险升高有关。本研究提示FH的早期筛查对预防冠心病具有一定的公共卫生意义。
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引用次数: 0
A superficial siderosis-related transient focal neurological episode in a patient with Marfan syndrome 马凡氏综合征患者的一过性局灶性神经系统发作
Q1 Medicine Pub Date : 2023-04-21 DOI: 10.1002/cdt3.63
Slaven Pikija, Eugen Trinka, Pfaff Johannes, Andreea Toma, Mahdi Safdarian

Sagittal computed tomography of lumbal spine showing dural ectasia and Tarlow Cyst (red arrows) (A). Magnetic resonance imaging (MRI) axial slice, susceptibility-weighted imaging (SWI) sequences showing siderosis in cerebellar sulci (red arrows) and in the inset uncharacteristic iron deposition in dental nuclei, more pronounced on the left side (red arrows) (B, inset). MRI, SWI, axial slice, showing numerous foci of superficial siderosis (C).

腰椎矢状位计算机断层扫描显示硬脑膜扩张和Tarlow囊肿(红色箭头)(A)。磁共振成像(MRI)轴向切片,敏感性加权成像(SWI)序列显示小脑沟铁沉着(红色箭头)和插图中非特征性的牙核铁沉积,在左侧更明显(红色箭头)(B,插图)。MRI, SWI,轴向切片,显示许多浅表性铁沉着灶(C)。
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引用次数: 0
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Chronic Diseases and Translational Medicine
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