Spontaneous honeybee behaviour is altered by persistent organic pollutants

The effect of environmental pollutants on honeybee behaviour has focused mainly on currently used pesticides. However, honeybees are also exposed to persistent organic pollutants (POPs). The aim of this laboratory based study was to determine if exposure to sublethal field-relevant concentrations of POPs altered the spontaneous behaviour of foraging-age worker honeybees. Honeybees (Apis mellifera) were orally exposed to either a sublethal concentration of the polychlorinated biphenyl (PCB) mixture Aroclor 1254 (100 ng/ml), the organochlorine insecticide lindane (2.91 ng/ml) or vehicle (0.01% DMSO, 0.00015% ethanol in 1M sucrose) for 1–4 days. The frequency of single event behaviours and the time engaged in one of four behavioural states (walking, flying, upside down and stationary) were monitored for 15 min after 1, 2, 3 and 4 days exposure. Exposure to Aroclor 1254 but not lindane increased the frequency and time engaged in honeybee motor activity behaviours in comparison to vehicle. The Aroclor 1254—induced hyperactivity was evident after 1 day of exposure and persisted with repeated daily exposure. In contrast, 1 day of exposure to lindane elicited abdominal spasms and increased the frequency of grooming behaviours in comparison to vehicle exposure. After 4 days of exposure, abdominal spasms and increased grooming behaviours were also evident in honeybees exposed to Aroclor 1254. These data demonstrate that POPs can induce distinct behavioural patterns, indicating different toxicokinetic and toxicodynamic properties. The changes in spontaneous behaviour, particularly the PCB-induced chronic hyperactivity and the associated energy demands, may have implications for colony health

Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

Background: Understanding the health consequences associated with exposure to risk factors is necessary to inform public health policy and practice. To systematically quantify the contributions of risk factor exposures to specific health outcomes, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 aims to provide comprehensive estimates of exposure levels, relative health risks, and attributable burden of disease for 88 risk factors in 204 countries and territories and 811 subnational locations, from 1990 to 2021. Methods: The GBD 2021 risk factor analysis used data from 54 561 total distinct sources to produce epidemiological estimates for 88 risk factors and their associated health outcomes for a total of 631 risk–outcome pairs. Pairs were included on the basis of data-driven determination of a risk–outcome association. Age-sex-location-year-specific estimates were generated at global, regional, and national levels. Our approach followed the comparative risk assessment framework predicated on a causal web of hierarchically organised, potentially combinative, modifiable risks. Relative risks (RRs) of a given outcome occurring as a function of risk factor exposure were estimated separately for each risk–outcome pair, and summary exposure values (SEVs), representing risk-weighted exposure prevalence, and theoretical minimum risk exposure levels (TMRELs) were estimated for each risk factor. These estimates were used to calculate the population attributable fraction (PAF; ie, the proportional change in health risk that would occur if exposure to a risk factor were reduced to the TMREL). The product of PAFs and disease burden associated with a given outcome, measured in disability-adjusted life-years (DALYs), yielded measures of attributable burden (ie, the proportion of total disease burden attributable to a particular risk factor or combination of risk factors). Adjustments for mediation were applied to account for relationships involving risk factors that act indirectly on outcomes via intermediate risks. Attributable burden estimates were stratified by Socio-demographic Index (SDI) quintile and presented as counts, age-standardised rates, and rankings. To complement estimates of RR and attributable burden, newly developed burden of proof risk function (BPRF) methods were applied to yield supplementary, conservative interpretations of risk–outcome associations based on the consistency of underlying evidence, accounting for unexplained heterogeneity between input data from different studies. Estimates reported represent the mean value across 500 draws from the estimate's distribution, with 95% uncertainty intervals (UIs) calculated as the 2·5th and 97·5th percentile values across the draws. Findings: Among the specific risk factors analysed for this study, particulate matter air pollution was the leading contributor to the global disease burden in 2021, contributing 8·0% (95% UI 6·7–9·4) of total DALYs, followed by high systolic blood pressure (SBP; 7·8% [6·4–9·2]), smoking (5·7% [4·7–6·8]), low birthweight and short gestation (5·6% [4·8–6·3]), and high fasting plasma glucose (FPG; 5·4% [4·8–6·0]). For younger demographics (ie, those aged 0–4 years and 5–14 years), risks such as low birthweight and short gestation and unsafe water, sanitation, and handwashing (WaSH) were among the leading risk factors, while for older age groups, metabolic risks such as high SBP, high body-mass index (BMI), high FPG, and high LDL cholesterol had a greater impact. From 2000 to 2021, there was an observable shift in global health challenges, marked by a decline in the number of all-age DALYs broadly attributable to behavioural risks (decrease of 20·7% [13·9–27·7]) and environmental and occupational risks (decrease of 22·0% [15·5–28·8]), coupled with a 49·4% (42·3–56·9) increase in DALYs attributable to metabolic risks, all reflecting ageing populations and changing lifestyles on a global scale. Age-standardised global DALY rates attributable to high BMI and high FPG rose considerably (15·7% [9·9–21·7] for high BMI and 7·9% [3·3–12·9] for high FPG) over this period, with exposure to these risks increasing annually at rates of 1·8% (1·6–1·9) for high BMI and 1·3% (1·1–1·5) for high FPG. By contrast, the global risk-attributable burden and exposure to many other risk factors declined, notably for risks such as child growth failure and unsafe water source, with age-standardised attributable DALYs decreasing by 71·5% (64·4–78·8) for child growth failure and 66·3% (60·2–72·0) for unsafe water source. We separated risk factors into three groups according to trajectory over time: those with a decreasing attributable burden, due largely to declining risk exposure (eg, diet high in trans-fat and household air pollution) but also to proportionally smaller child and youth populations (eg, child and maternal malnutrition); those for which the burden increased moderately in spite of declining risk exposure, due largely to population ageing (eg, smoking); and those for which the burden increased considerably due to both increasing risk exposure and population ageing (eg, ambient particulate matter air pollution, high BMI, high FPG, and high SBP). Interpretation: Substantial progress has been made in reducing the global disease burden attributable to a range of risk factors, particularly those related to maternal and child health, WaSH, and household air pollution. Maintaining efforts to minimise the impact of these risk factors, especially in low SDI locations, is necessary to sustain progress. Successes in moderating the smoking-related burden by reducing risk exposure highlight the need to advance policies that reduce exposure to other leading risk factors such as ambient particulate matter air pollution and high SBP. Troubling increases in high FPG, high BMI, and other risk factors related to obesity and metabolic syndrome indicate an urgent need to identify and implement interventions

Rôle de la résistine hypothalamique dans l'installation de l’inflammation hypothalamique et l’insulino-résistance : impact de la consommation aigüe ou chronique d'un régime hyper lipidique

Obesity is closely linked to a cluster of metabolic disorders including chronic low-grade inflammation and insulin resistance, which constitutes a principal risk factor for type 2 diabetes. In rodents, cumulative evidence support that the consumption of high fat diet (HFD) is among the most important nutritional factors predisposing to obesity associated insulin resistance and low-grade inflammation. Indeed, HFD induces hypothalamic inflammation and deregulates energy homeostasis control through the alteration of hypothalamic insulin and leptin responsiveness, considered as the main anorexigenic hormones. In addition, it has been shown that unlike peripheral inflammation, which occurs as a consequence of obesity, hypothalamic inflammation develops selectively in the hypothalamic arcuate nucleus (ARC) within the first days of HFD exposure. These data suggest that hypothalamic inflammation is a critical step in the early onset of the deregulation of energy homeostasis by HFD. The cellular and molecular mechanisms underlying obesity-induced hypothalamic inflammation are still not fully characterized. In rodents, resistin is described as a causal factor in obesitymediated insulin resistance and type 2 diabetes. Resistin is mainly secreted by adipose tissue in rodents but an endogenous expression of resistin was also reported in the hypothalamus. However, its action at the central level is not fully understood. Our group recently demonstrated that central resistin, via hypothalamic TLR4, promotes overall insulin resistance through the promotion of inflammatory pathway. In this context, we aimed to investigate the role of resistin/TLR4 pathway in HFD-induced hypothalamic inflammation and insulin resistance. In the present study we report for the first time that both short and long term HFD are associated with a significant increase of resistin expression throughout the MBH. Our results revealed a transient increase in resistin mRNA expression in the ARC after 3 days of HFD, followed by a decline to baseline at day 8 and an expression that increases again after 8 weeks of HFD. We showed that the increase of resistin expression is concomitant with short term HFD-induced ARC reactive gliosis, known to early disrupt energy balance and to predispose to obesity. Interestingly, our results revealed that resistin is expressed by POMC neurons which are critical for energy balance and tanycytes that have the specificity to contact both cerebro-spinal fluid and fenestrated capillary in the mediane eminence. Interestingly, we show that resistin induces tanycytes inflammation through TLR4 suggesting that resistin could promote inflammation in tanycytes in response to short term HFD. Additionally, we show that ICV resistin markedly increases inflammatory markers in the hypothalamic arcuate nucleus in association with reactive gliosis involving recruitment of both microglia and astrocytes. Interestingly, we report that the knockdown of TLR4 almost completely abolished resistin-dependent both hypothalamic inflammation and reactive gliosis. Our data demonstrate that restitin/TLR4 pathway could play a critical role in HFD-diet induced hypothalamic inflammation in response to short and long term HFD which predispose to obesity, a hallmark of metabolic syndrome.La prévalence de l’obésité est en net progrès et constitue un problème majeur de santé publique. Cette pathologie est d’autant plus dangereuse qu’elle s’accompagne d’un cluster de désordres métaboliques dont l’inflammation chronique de bas grade et la résistance à l’insuline, principal facteur de risque du diabète de type 2. Les études montrent que la consommation d’un régime hyper lipidique (HFD) représente la cause majeure qui expose à l’obésité et aux pathologies qui lui sont associées. L’obésité induite par un régime HFD s’associe en effet à une inflammation hypothalamique ainsi qu’une altération des circuits neuronaux régissant le contrôle de la balance énergétique, ces altérations sont propices aux développements de résistances à l’insuline et à la leptine. De récentes études montrent que la consommation d’un régime HFD de quelques jours seulement s’accompagne d’une inflammation hypothalamique transitoire, antérieure à l’installation de l’obésité et à l’inflammation périphérique. Ces résultats suggèrent que l’inflammation hypothalamique précoce représente une étape critique dans le développement de l’obésité et de ses altérations. Les médiateurs et les voies de signalisations impliqués dans l’installation de l’inflammation hypothalamique ne sont pas totalement élucidées. Chez les rongeurs, la résistine est associée à l’inflammation et l’insulino-résistance au cours de l’obésité. Bien que majoritairement produite par le tissu adipeux, les études montrent que la résistine est également exprimée par l’hypothalamus ; toutefois, peu d’études renseignent sur son action au niveau central. Notre équipe a démontré chez le rat, qu’une perfusion centrale de résistine altère fortement la sensibilité à l’insuline via l’activation du récepteur TLR4 et l’induction des principales voies de l’inflammation. Dans ce contexte, l’objectif de cette étude a été d’investiguer le rôle de la voie résistine/TLR4 dans l’installation de l’inflammation hypothalamique associée au régime HFD. Nous montrons pour la première fois que, chez la souris, la consommation d’un régime HFD provoque une augmentation de l’expression génique de la résistine dans l’hypothalamus dès 3 jours de régime HFD. L’expression de la résistine est diminuée jusqu’au niveau basal après 8 jours et est de nouveau fortement augmentée après 8 semaines de régime HFD. Nous montrons que l’augmentation de l’expression de la résistine est concomitante avec la gliose réactionnelle associée au régime HFD de court terme, connue pour précocement altérer l’équilibre de la balance énergétique. De façon intéressante, nous montrons quel’augmentation de l’expression de la résistine est observée dans les neurones anorexigènes POMC, critiques pour le maintien de l’homéostasie énergétique ainsi que dans les tanycytes dont les prolongements contactent les capillaires fenêtrés du sang porte hypothalamohypophysaire et dont l’importance pour l’équilibre de la balance énergétique a été démontrée. De façon intéressante, nous montrons que la résistine active l’inflammation dans les tanycytes via TLR4 suggérant que la résistine pourrait promouvoir l’inflammation au sein des tanycytes en réponse au régime HFD, et ce même à court terme. De plus, nous montrons qu’une ICV de 3 jours de résistine chez la souris provoque une inflammation hypothalamique ainsi qu’une gliose réactionnelle au sein de l’ARC qui rappellent les effets du régime HFD. De façon intéressante, nos résultats montrent que l’invalidation du récepteur TLR4 aboli l’inflammation et la gliose réactionnelle hypothalamiques induites par l’ICV de résistine. L’ensemble nos données démontrent que la voie résistine/TLR4 pourrait jouer un rôle critique dansl’inflammation hypothalamique associée au régime HFD de court et long terme, quiprédispose à l’obésité

Role of hypothalamic resistin in the onset of hypothalamic inflammation and insulin resistance : impact of acute or chronic high fat diet consumption

La prévalence de l’obésité est en net progrès et constitue un problème majeur de santé publique. Cette pathologie est d’autant plus dangereuse qu’elle s’accompagne d’un cluster de désordres métaboliques dont l’inflammation chronique de bas grade et la résistance à l’insuline, principal facteur de risque du diabète de type 2. Les études montrent que la consommation d’un régime hyper lipidique (HFD) représente la cause majeure qui expose à l’obésité et aux pathologies qui lui sont associées. L’obésité induite par un régime HFD s’associe en effet à une inflammation hypothalamique ainsi qu’une altération des circuits neuronaux régissant le contrôle de la balance énergétique, ces altérations sont propices aux développements de résistances à l’insuline et à la leptine. De récentes études montrent que la consommation d’un régime HFD de quelques jours seulement s’accompagne d’une inflammation hypothalamique transitoire, antérieure à l’installation de l’obésité et à l’inflammation périphérique. Ces résultats suggèrent que l’inflammation hypothalamique précoce représente une étape critique dans le développement de l’obésité et de ses altérations. Les médiateurs et les voies de signalisations impliqués dans l’installation de l’inflammation hypothalamique ne sont pas totalement élucidées. Chez les rongeurs, la résistine est associée à l’inflammation et l’insulino-résistance au cours de l’obésité. Bien que majoritairement produite par le tissu adipeux, les études montrent que la résistine est également exprimée par l’hypothalamus ; toutefois, peu d’études renseignent sur son action au niveau central. Notre équipe a démontré chez le rat, qu’une perfusion centrale de résistine altère fortement la sensibilité à l’insuline via l’activation du récepteur TLR4 et l’induction des principales voies de l’inflammation. Dans ce contexte, l’objectif de cette étude a été d’investiguer le rôle de la voie résistine/TLR4 dans l’installation de l’inflammation hypothalamique associée au régime HFD. Nous montrons pour la première fois que, chez la souris, la consommation d’un régime HFD provoque une augmentation de l’expression génique de la résistine dans l’hypothalamus dès 3 jours de régime HFD. L’expression de la résistine est diminuée jusqu’au niveau basal après 8 jours et est de nouveau fortement augmentée après 8 semaines de régime HFD. Nous montrons que l’augmentation de l’expression de la résistine est concomitante avec la gliose réactionnelle associée au régime HFD de court terme, connue pour précocement altérer l’équilibre de la balance énergétique. De façon intéressante, nous montrons quel’augmentation de l’expression de la résistine est observée dans les neurones anorexigènes POMC, critiques pour le maintien de l’homéostasie énergétique ainsi que dans les tanycytes dont les prolongements contactent les capillaires fenêtrés du sang porte hypothalamohypophysaire et dont l’importance pour l’équilibre de la balance énergétique a été démontrée. De façon intéressante, nous montrons que la résistine active l’inflammation dans les tanycytes via TLR4 suggérant que la résistine pourrait promouvoir l’inflammation au sein des tanycytes en réponse au régime HFD, et ce même à court terme. De plus, nous montrons qu’une ICV de 3 jours de résistine chez la souris provoque une inflammation hypothalamique ainsi qu’une gliose réactionnelle au sein de l’ARC qui rappellent les effets du régime HFD. De façon intéressante, nos résultats montrent que l’invalidation du récepteur TLR4 aboli l’inflammation et la gliose réactionnelle hypothalamiques induites par l’ICV de résistine. L’ensemble nos données démontrent que la voie résistine/TLR4 pourrait jouer un rôle critique dansl’inflammation hypothalamique associée au régime HFD de court et long terme, quiprédispose à l’obésité.Obesity is closely linked to a cluster of metabolic disorders including chronic low-grade inflammation and insulin resistance, which constitutes a principal risk factor for type 2 diabetes. In rodents, cumulative evidence support that the consumption of high fat diet (HFD) is among the most important nutritional factors predisposing to obesity associated insulin resistance and low-grade inflammation. Indeed, HFD induces hypothalamic inflammation and deregulates energy homeostasis control through the alteration of hypothalamic insulin and leptin responsiveness, considered as the main anorexigenic hormones. In addition, it has been shown that unlike peripheral inflammation, which occurs as a consequence of obesity, hypothalamic inflammation develops selectively in the hypothalamic arcuate nucleus (ARC) within the first days of HFD exposure. These data suggest that hypothalamic inflammation is a critical step in the early onset of the deregulation of energy homeostasis by HFD. The cellular and molecular mechanisms underlying obesity-induced hypothalamic inflammation are still not fully characterized. In rodents, resistin is described as a causal factor in obesitymediated insulin resistance and type 2 diabetes. Resistin is mainly secreted by adipose tissue in rodents but an endogenous expression of resistin was also reported in the hypothalamus. However, its action at the central level is not fully understood. Our group recently demonstrated that central resistin, via hypothalamic TLR4, promotes overall insulin resistance through the promotion of inflammatory pathway. In this context, we aimed to investigate the role of resistin/TLR4 pathway in HFD-induced hypothalamic inflammation and insulin resistance. In the present study we report for the first time that both short and long term HFD are associated with a significant increase of resistin expression throughout the MBH. Our results revealed a transient increase in resistin mRNA expression in the ARC after 3 days of HFD, followed by a decline to baseline at day 8 and an expression that increases again after 8 weeks of HFD. We showed that the increase of resistin expression is concomitant with short term HFD-induced ARC reactive gliosis, known to early disrupt energy balance and to predispose to obesity. Interestingly, our results revealed that resistin is expressed by POMC neurons which are critical for energy balance and tanycytes that have the specificity to contact both cerebro-spinal fluid and fenestrated capillary in the mediane eminence. Interestingly, we show that resistin induces tanycytes inflammation through TLR4 suggesting that resistin could promote inflammation in tanycytes in response to short term HFD. Additionally, we show that ICV resistin markedly increases inflammatory markers in the hypothalamic arcuate nucleus in association with reactive gliosis involving recruitment of both microglia and astrocytes. Interestingly, we report that the knockdown of TLR4 almost completely abolished resistin-dependent both hypothalamic inflammation and reactive gliosis. Our data demonstrate that restitin/TLR4 pathway could play a critical role in HFD-diet induced hypothalamic inflammation in response to short and long term HFD which predispose to obesity, a hallmark of metabolic syndrome

دراسة العلاقة بين الائتمان المصرفي القطاعي والاداء المالي خلال الفترة 2011-2018 (دراسة تطبيقية في مصرف بيمو السعودي الفرنسي)

هدف البحث إلى التعرف على التسهيلات المصرفية في مصرف بيمو وما هي استراتيجية تنويع أساليبها وفقاً للقطاع الاقتصادي, واكتشاف العلاقة بين التسهيلات المصرفية وفقا القطاع الاقتصادي والأداء المالي لمصرف بيمو السعودي الفرنسي. اعتمد البحث على المنهج الوصفي التحليلي لبيان مدى اتباع المصارف لاستراتيجية تنويع التسهيلات المصرفية وعلاقتها بالأداء المالي, وتمثلت بدراسة تطبيقية على أحد  المصارف الرائدة في سورية واستقرار سلاسله الزمنية وهو مصرف بيمو السعودي الفرنسي. ومن أهم النتائج يوجد علاقة ذات دلالة إحصائية بين الائتمان حسب القطاع ومؤشرات الأداء المالي لمصرف بيمو السعودي الفرنسي, والمعبر عنها بزوج مركب قانوني, وهي قوية جدا 0.999, وتبين العلاقة في النموذج بأن هناك تراجعا في كل من الائتمان لقطاع الصناعة والتجارة, بينما ازداد كل من قطاع الزراعة والخدمات, وذلك مترافقا مع انخفاض نسبة كفاية رأس المال وارتفاع كل من نسبة التعثر, نسبة العائد للأصول, نسبة التسهيلات إلى الودائع

Central Resistin/TLR4 impairs adiponectin signaling contributing to insulin and FGF21 resistance.

International audienceAdiponectin, an insulin-sensitizing hormone, and resistin, known to promote insulin resistance, constitute a potential link between obesity and type2 diabetes. In addition, Fibroblast growth factor 21 (FGF21) has similar effects as adiponectin in regulating glucose/lipid metabolism and insulin sensitivity. However, the interplay between adiponectin, FGF21 and resistin signaling pathways during the onset of insulin resistance is unknown. Here, we investigated whether central resistin promotes insulin resistance through the impairment of adiponectin and FGF21 signaling.We showed that chronic ICV resistin infusion down-regulated both hypothalamic and hepatic APPL1, a key protein in adiponectin signaling, associated with decreased Akt/APPL1 interaction and an increased Akt association with its endogenous inhibitor TRB3. Resistin treatment also decreased plasma adiponectin levels and reduced both hypothalamic and peripheral expression of adiponectin receptors. Additionally, we reported that ICV resistin increased plasma FGF21 levels and down-regulated its receptor components in the hypothalamus and peripheral tissues promoting FGF21 resistance. Interestingly we also showed that resistin effects were abolished in TLR4 knock out mice and in neuronal cells expressing TLR4 siRNAs. Our study reveals a novel mechanism of insulin resistance onset orchestrated by central resistin/TLR4 pathway that impairs adiponectin signaling and promotes FGF21 resistance

Maternal resistin predisposes offspring to hypothalamic inflammation and body weight gain

International audienceResistin promotes hypothalamic neuroinflammation and insulin resistance through Toll like receptor 4 (TLR4), this hormone is thought to be a link between obesity and insulin-resistance. Indeed, resistin plasma levels are higher in obese and insulin resistant subjects. However, the impact of maternal resistin on the predisposition of offspring to hypothalamic neuroinflammation is unknown. Here, female mice were treated with resistin during gestation/lactation periods, then hypothalamic neuroinflammation was investigated in male offspring at p28 and p90. At p28, resistin increased the expression of inflammation markers (IL6, TNFα and NFκB) and TLR4 in the hypothalamus and decreased both hypothalamic insulin and leptin receptors' expression. The hypothalamic up-regulation IL6, TNFα and TLR4 was sustained until p90 promoting most likely hypothalamic inflammation. Maternal resistin also increased IL6 and TNFα in the adipose tissue of offspring at p90 associated with a higher body weight gain. In contrast, liver and muscle were not affected. These findings reveal that the augmentation of maternal resistin during gestation and lactation promotes hypothalamic and adipose tissue inflammation of offspring as evidenced by sustained increase of inflammation markers from weaning to adulthood. Thus, maternal resistin programs offspring hypothalamic and adipose tissue inflammation predisposing then offspring to body weight gain

Resistin inhibits neuronal autophagy through Toll-like receptor 4

International audienceAutophagy is a non-selective degradation pathway induced in energy-deprived cells and in non-starved cells by participating in cellular inflammatory responses mainly through the elimination of injured and aged mitochondria that constitute an important source of reactive oxygen species. We have previously reported that resistin/TLR4 signaling pathway induces inflammation and insulin resistance in neuronal cell. However, the impact of resistin-induced inflammation on neuronal autophagy is unknown. In the present study, we hypothesized that resistin-induced neuroinflammation could be attributed, at least partially, to the impairment of autophagy pathways in neuronal cells. Our data show that resistin decreases neuronal autophagy as evidenced by the repression of the main autophagy markers in SH-SY5Y human neuroblastoma cell line. Furthermore, the silencing of TLR4 completely abolished these effects. Resistin also inhibits AMPK phosphorylation and increases that of Akt/mTOR contrasting with activated autophagy where AMPK phosphorylation is augmented and mTOR inhibited. In vivo, resistin treatment inhibits the mRNA expression of autophagy markers in the hypothalamus of WT mice but not in Tlr4-/- mice. In addition, resistin strongly diminished LC3 (a marker of autophagy) labeling in the arcuate nucleus of WT mice, and this effect is abolished in Tlr4-/- mice. Taken together, our findings clearly reveal resistin/TLR4 as a new regulatory pathway of neuronal autophagy

Effect of Nitric Oxide Pathway Inhibition on the Evolution of Anaphylactic Shock in Animal Models: A Systematic Review

Nitric oxide (NO) induces vasodilation in various types of shock. The effect of pharmacological modulation of the NO pathway in anaphylactic shock (AS) remains poorly understood. Our objective was to assess, through a systematic review, whether inhibition of NO pathways (INOP) was beneficial for the prevention and/or treatment of AS. A predesigned protocol for this systematic review was published in PROSPERO (CRD42019132273). A systematic literature search was conducted till March 2022 in the electronic databases PubMed, EMBASE, Scopus, Cochrane and Web of Science. Heterogeneity of the studies did not allow meta-analysis. Nine hundred ninety unique studies were identified. Of 135 studies screened in full text, 17 were included in the review. Among six inhibitors of NO pathways identified, four blocked NO synthase activity and two blocked guanylate cyclase downstream activity. Pre-treatment was used in nine studies and post-treatment in three studies. Five studies included both pre-treatment and post-treatment models. Overall, seven pre-treatment studies from fourteen showed improvement of survival and/or arterial blood pressure. Four post-treatment studies from eight showed positive outcomes. Overall, there was no strong evidence to conclude that isolated blockade of the NO/cGMP pathway is sufficient to prevent or restore anaphylactic hypotension. Further studies are needed to analyze the effect of drug combinations in the treatment of AS

Relation between cardiology follow-up visits, evidence-based statin prescribing, and statin adherence (from the Veterans Affairs Health Care System)

Statin use remains suboptimal in patients with atherosclerotic cardiovascular disease (ASCVD). We assessed whether outpatient care with a cardiology provider is associated with evidence-based statin prescription and statin adherence. We identified patients with ASCVD aged ≥18 years receiving primary care in 130 facilities and associated community-based outpatient clinics in the entire Veterans Affairs Health Care System between October 1, 2013 and September 30, 2014. Patients were divided into: (1) patients with at least 1 outpatient cardiology visit and (2) patients with no outpatient cardiology visits in the year before the index primary care visit. We assessed any- and high-intensity statin prescription adjusting for several patient- and facility-level covariates, and statin adherence using proportion of days covered (PDC). We included 1,249,061 patients with ASCVD (mean age: 71.9 years; 98.0% male). After adjusting for covariates, patients who visited a cardiology provider had greater odds of being on a statin (87.4% vs 78.4%; Odds ratio [OR] 1.25, 95% Confidence interval [CI] 1.24 to 1.26), high-intensity statin (34.5% vs 21.2%; OR: 1.21, 95% CI 1.21 to 1.22), and higher statin adherence (mean PDC 0.76 ± 0.29 vs 0.70 ± 0.34, PDC ≥0.8: 62.0% vs 57.3%; OR 1.09, 95% CI 1.09 to 1.11). A dose response relation was seen with a higher number of cardiology visits associated with a higher statin use and statin adherence. In conclusion, compared with outpatient care delivered by primary care providers alone, care delivered by a cardiology provider for patients with ASCVD is associated with a higher likelihood of guideline-based statin use and statin adherence