Astragalus Polysaccharides Lowers Plasma Cholesterol through Mechanisms Distinct from Statins

To determine the efficacy and underlying mechanism of Astragalus polysaccharides (APS) on plasma lipids in hypercholesterolemia hamsters. The effect of APS (0.25g/kg/d) on plasma and liver lipids, fecal bile acids and neutral sterol, cholesterol absorption and synthesis, HMG-CoA reductase activity, and gene and protein expressions in the liver and small intestine was investigated in twenty-four hypercholesterolemia hamsters. Treatment periods lasted for three months. APS significantly lowered plasma total cholesterol by 45.8%, triglycerides by 30%, and low-density lipoprotein-cholesterol by 47.4%, comparable to simvastatin. Further examinations revealed that APS reduced total cholesterol and triglycerides in the liver, increased fecal bile acid and neutral sterol excretion, inhibited cholesterol absorption, and by contrast, increased hepatic cholesterol synthesis and HMG-CoA reductase activity. Plasma total cholesterol or low-density lipoprotein-cholesterol levels were significantly correlated with cholesterol absorption rates. APS up-regulated cholesterol-7α-hydroxylase and LDL-receptor gene expressions. These new findings identify APS as a potential natural cholesterol lowering agent, working through mechanisms distinct from statins

Association between cardiovascular risk factors and atrial fibrillation

BackgroundThe most prevalent sustained arrhythmia in medical practice, atrial fibrillation (AF) is closely associated with a high risk of cardiovascular disease. Nevertheless, the risk of AF associated with cardiovascular risk factors has not been well elucidated. We pooled all published studies to provide a better depiction of the relationship among cardiovascular risk factors with AF.MethodsStudies were searched in the MEDLINE, Web of Science, and EMBASE databases since initiation until January 15, 2022. Prospective cohort studies assessing the relationship a minimum of single cardiovascular risk factors to AF incidence were included if they contained adequate data for obtaining relative risks (RR) and 95% confidence intervals (CI). Random-effects models were utilized to perform independent meta-analyses on each cardiovascular risk factor. PROSPERO registry number: CRD42022310882.ResultsA total of 17,098,955 individuals and 738,843 incident cases were reported for data from 101 studies included in the analysis. In all, the risk of AF was 1.39 (95% CI, 1.30–1.49) for obesity, 1.27 (95% CI, 1.22–1.32) per 5 kg/m2 for increase in body mass index, 1.19 (95% CI, 1.10–1.28) for former smokers, 1.23 (95% CI, 1.09–1.38) for current smokers, 1.31 (95% CI, 1.23–1.39) for diabetes mellitus, 1.68 (95% CI, 1.51–1.87) for hypertension, and 1.12 (95% CI, 0.95–1.32) for dyslipidemia.InterpretationAdverse cardiovascular risk factors correlate with an increased risk of AF, yet dyslipidemia does not increase the risk of AF in the general population, potentially providing new insights for AF screening strategies among patients with these risk factors.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, PROSPERO identifier (CRD42022310882)

Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Chronic Total Occlusion of Coronary Arteries: A Systematic Review and Meta-Analysis

Introduction. Chronic total occlusion (CTO) of coronary arteries constitutes a substantial clinical challenge and has historically been managed through medical management and coronary artery bypass grafting (CABG). However, with the advancement in interventional technology, the success rate of percutaneous treatment has been significantly improved, and percutaneous coronary intervention (PCI) has emerged as a primary mode of treatment for CTOs, demonstrating remarkable clinical efficacy. The objective of this systematic review and meta-analysis is to evaluate and contrast the outcomes of PCI and CABG in patients with CTO. Methods and Results. A systematic search was conducted in the databases of PubMed, Embase, and Web of Science. The primary endpoints evaluated in this meta-analysis were the occurrence of major adverse cardiac events (MACE) and all-cause mortality. Secondary endpoints included myocardial infarction (MI), cardiac death, and the need for repeat revascularization. Nine studies, encompassing a total of 8,674 patients, were found to meet the criteria for inclusion and had a mean follow-up duration of 4.3 years. The results of the meta-analysis revealed that compared to CABG, PCI was associated with a lower incidence of all-cause mortality (RR: 0.78, 95% CI: 0.66–0.92; P = 0.003) and cardiac death (RR: 0.55; 95% CI: 0.31–0.96; P < 0.05), but an increased risk of myocardial infarction (MI) (RR: 1.96; 95%CI: 1.07–3.62; P < 0.05) and repeat revascularization (RR: 7.13; 95% CI: 5.69–8.94; P < 0.00001). There was no statistically significant difference in MACE (RR: 1.11; 95% CI: 0.69–1.81; P = 0.66) between the PCI and CABG groups. Conclusion. In the present meta-analysis comparing PCI and CABG in patients with chronic total occlusion of the coronary arteries, the results indicated that PCI was superior to CABG in reducing all-cause mortality and cardiac death but inferior in decreasing myocardial infarction and repeat revascularization. There was no statistically significant difference in MACE between the two groups

Assessment of Quality of Studies.

<p>Assessment of Quality of Studies.</p

Association between Adiponectin Concentrations and Cardiovascular Disease in Diabetic Patients: A Systematic Review and Meta-Analysis

<div><p>Background</p><p>This systematic review and meta-analysis of prospective studies evaluates the association between adiponectin concentrations and risk of cardiovascular disease (CVD) in individuals with diabetes mellitus (DM).</p><p>Methods</p><p>PubMed and Embase were searched for prospective studies on the association of adiponectin concentrations and risk of CVD up to June 2013. Random-effect model was selected to pool the relative risk (RR) and 95% CI.</p><p>Results</p><p>Five prospective cohort studies and one nested case-control studies met the included criterion. The estimated summary RR and 95% CI of five prospective cohort studies for type 2 diabetes comparing top vs low tertile of adiponectin concentrations was 0.99 (95% CI: 0.67–1.45), with significant heterogeneity between studies (<i>p</i> = 0.037, <i>I</i>² = 60.9%). This heterogeneity was explained by one study conducted in Korean.</p><p>Conclusions</p><p>This study represents the first meta-analysis between adiponectin levels and CVD in diabetic patients and indicated no association was found. This result should be verified further by large sample size, long duration of follow-up, and well-designed prospective clinical trials.</p></div

Datasheet1_Association between cardiovascular risk factors and atrial fibrillation.pdf

BackgroundThe most prevalent sustained arrhythmia in medical practice, atrial fibrillation (AF) is closely associated with a high risk of cardiovascular disease. Nevertheless, the risk of AF associated with cardiovascular risk factors has not been well elucidated. We pooled all published studies to provide a better depiction of the relationship among cardiovascular risk factors with AF.MethodsStudies were searched in the MEDLINE, Web of Science, and EMBASE databases since initiation until January 15, 2022. Prospective cohort studies assessing the relationship a minimum of single cardiovascular risk factors to AF incidence were included if they contained adequate data for obtaining relative risks (RR) and 95% confidence intervals (CI). Random-effects models were utilized to perform independent meta-analyses on each cardiovascular risk factor. PROSPERO registry number: CRD42022310882.ResultsA total of 17,098,955 individuals and 738,843 incident cases were reported for data from 101 studies included in the analysis. In all, the risk of AF was 1.39 (95% CI, 1.30–1.49) for obesity, 1.27 (95% CI, 1.22–1.32) per 5 kg/m2 for increase in body mass index, 1.19 (95% CI, 1.10–1.28) for former smokers, 1.23 (95% CI, 1.09–1.38) for current smokers, 1.31 (95% CI, 1.23–1.39) for diabetes mellitus, 1.68 (95% CI, 1.51–1.87) for hypertension, and 1.12 (95% CI, 0.95–1.32) for dyslipidemia.InterpretationAdverse cardiovascular risk factors correlate with an increased risk of AF, yet dyslipidemia does not increase the risk of AF in the general population, potentially providing new insights for AF screening strategies among patients with these risk factors.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, PROSPERO identifier (CRD42022310882).</p

Selection of studies for systematic review of association between adiponectin concentrations and risk of cardiovascular diseases in diabetic patients.

<p>Selection of studies for systematic review of association between adiponectin concentrations and risk of cardiovascular diseases in diabetic patients.</p

Incidence Rate of Type 2 Diabetes Mellitus after Gestational Diabetes Mellitus: A Systematic Review and Meta-Analysis of 170,139 Women

Objective. The reported incidence of type 2 diabetes mellitus (T2DM) after gestational diabetes (GDM) varies widely. The purpose of this meta-analysis was to define the incidence rate of T2DM among women with a history of GDM and to examine what might modulate the rate. Research Design and Methods. We searched PubMed and Embase for terms related to T2DM after GDM up to January 2019. Large cohort studies with sample size ≥300 and follow-up duration of at least one year were included. Data from selected studies were extracted, and meta-analysis was performed using the random-effects model. Subgroups analyses were based on the sample size of gestational diabetes, geographic region, maternal age, body-mass index, diagnostic criteria, and duration of follow-up. Results. Twenty-eight studies involving 170,139 women with GDM and 34,627 incident cases of T2DM were identified. The pooled incidence of T2DM after GDM was 26.20 (95% CI, 23.31 to 29.10) per 1000 person-years. Women from Asia and those with older age and higher body mass index seem to experience higher risk of developing T2DM. The incidence rate of T2DM was lowest when applying IADPSG (7.16 per 1000 person-years) to diagnose GDM. The risk of developing T2DM after GDM increased linearly with the duration of follow-up. The increments per year of follow-up were estimated at 9.6‰. The estimated risks for T2DM were 19.72% at 10 years, 29.36% at 20 years, 39.00% at 30 years, 48.64% at 40 years, and 58.27% at 50 years, respectively. Conclusions. The findings of very high incidence of T2DM after GDM add an important insight into the trajectory of the development of T2DM in the long-term postpartum periods, which could provide evidence for consultant and might motivate more women with GDM to screen for T2DM. This trial is registered with PROSPERO identifier CRD42019128980

Characteristics of the identified prospective studies of adiponectin concentrations and risk of CVD.

a<p>The Newcastle-Ottawa quality assessment scale was chosed for quality assessment, maximum score 9 DM,diabetes mellitus; RR, relative risk; HR, hazard ratio; OR, odds ratio; CI, confidence interval; CVD, cardiovascular disease; CHD, coronary heart disease; SD, standard deviation; HMW, high molecule weigh; NA, not available; HDL, high density lipoprotein; BMI, body mass index; CRP, C-reactive protein; sTNFR2, soluble fractions of tumor necrosis factor-α receptor 2; BP, blood presure; MBP, mean blood pressure; ECG, electrocardiograph; HbA1c, hemoglobin A1c; GFR, glomerular filtration rate; NSAIDs, non-steroidal antiinflammatory drugs; MI, myocardial infarction.</p

Efficacy of using Maryland forceps versus electrocoagulation hooks in da Vinci robot-assisted thoracoscopic mediastinal tumor resection

Abstract Background To compare the difference of short-term curative effect between the use of Maryland forceps (MF) and electrocoagulation hooks (EH) in da Vinci robot-assisted thoracoscopic mediastinal tumor resection. Methods Retrospectively analyze 84 patients with mediastinal tumors who underwent robot-assisted thoracoscopic surgery (RATS) at the Department of Thoracic Surgery in Gansu Provincial Hospital from February 2019 to February 2023. Two groups were divided according to the intraoperative use of energy devices, including 41 cases in the MF group and 43 cases in the EH group. Perioperative clinical data was gathered to compare the short-term efficacy of patients in both groups. Results There were no significant differences in baseline characteristics such as sex (P = 0.685), age (P = 0.165), and tumor size (P = 0.339) between the two groups. Compared with the EH group, patients in the MF group have shorter operative time (P = 0.030), less intraoperative bleeding (P = 0.010), less total postoperative drainage volume (P = 0.001), shorter postoperative drainage time (P = 0.022), shorter hospital stay (P = 0.019), and lower levels of interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-alpha (TNF-α), and cortisol. No statistically significant differences were found between the two groups in terms of total hospitalization costs (P = 0.123), postoperative visual analog scale (VAS) pain scores (P = 0.064), and postoperative complications (P = 0.431). Conclusion Using MF in RATS for mediastinal tumor is safe and effective, which can reduce the amount of bleeding, reduce the degree of inflammatory reaction, and conducive to the quick recovery of patients