Abstract Purpose It is reported that insomnia and obstructive sleep apnea (OSA) increase the incidence of adverse cardiovascular events. The aim of this study was to analyze the risk of ...cardiovascular disease and mortality in elderly patients with comorbid insomnia and obstructive sleep apnea (COMISA). Methods We included 868 elderly patients with OSA who underwent sleep monitoring at a multicenter sleep room from January 2015 to October 2017. We collected demographic data, clinical features, medical history, sleep parameters, and laboratory findings. Cox proportional hazards analysis was used to identify the relationship between COMISA and adverse cardiovascular events and all-cause mortality. Results There were 181 elderly patients with COMISA. The median follow-up was 43 months, during which we observed major adverse cardiac events (MACE) in 90 patients. The Kaplan-Meier survival curve indicated a significant relationship between COMISA and MACE ( P log Rank < 0.001). Multivariate Cox regression analysis showed that COMISA increased the incidence of MACE (HR = 2.328, 95% CI: 1.349–4.018, P = 0.002), hospitalization for unstable angina (HR = 2.915, 95% CI: 1.397–6.081, P = 0.004), and the combination of all events (HR = 2.301, 95% CI: 1.393–3.803, P = 0.001). However, there were no significant differences in cardiovascular death, all-cause mortality, myocardial infarction, or hospitalized heart failure in patients with COMISA ( P > 0.05). Subgroup analyses showed that among COMISA patients, male sex (HR = 2.800, 95% CI: 1.458-5.377, P = 0.002), age < 70 years (HR = 4.050, 95% CI: 2.022–8.115, P < 0.001), and overweight and obesity (HR = 2.482, 95% CI: 1.383-4.453, P = 0.002) were associated with a higher risk of MACE. Conclusions Our results showed that COMISA increased the risk of MACE, unstable angina, and the compound occurrence of all events. Male, overweight or obese COMISA patients under 70 years of age have an increased risk of MACE.
Abstract
Background
The relationship between air pollution and atrial fibrillation (AF) recorded by electrocardiograph (ECG) has not yet been illustrated which worsens AF precaution and treatment. ...This research evaluated the association between air pollution and daily hospital visits for AF with ECG records.
Methods
The study enrolled 4933 male and 5392 female patients whose ECG reports indicated AF from 2015 to 2018 in our hospital. Such data were then matched with meteorological data, including air pollutant concentrations, collected by local weather stations. A case-crossover study was performed to assess the relationship between air pollutants and daily hospital visits for AF recorded by ECG and to investigate its lag effect.
Results
Our analysis revealed statistically significant associations between AF occurrence and demographic data, including age and gender. This effect was stronger in female (
k
= 0.02635,
p
< 0.01) and in patients over 65 y (
k
= 0.04732,
p
< 0.01). We also observed a hysteretic effect that when exposed to higher nitrogen dioxide(NO
2
), counting AF cases recorded by ECG may elevate at lag 0 with a maximum odds ratio(OR) of 1.038 (95% CI 1.014–1.063), on the contrary, O
3
reduced the risk of daily visits for AF and its maximum OR was at lag 2, and the OR value was 0.9869 (95% CI 0.9791–0.9948). Other air pollutants such as PM
2.5
, PM
10
, and SO
2
showed no clear relationship with the recorded AF.
Conclusion
The associations between air pollution and AF recorded with ECG were preliminarily discovered. Short-term exposure to NO
2
was significantly associated with daily hospital visits for AF management.
Purpose
This study sought to identify the changes and potential association between sleep characteristics and short-term memory, and mood states among volunteers at different altitudes and times.
...Method
A total of 26 healthy volunteers were recruited from the PLA General Hospital, and we conducted a longitudinal prospective survey for over 1 year from November 2019 to April 2021. First, we collected demographic data, sleep parameters by overnight polysomnography (PSG), short-term memory by digit span test, and mood states by completing a questionnaire with a brief profile of mood states among participants in the plain (53 m). Then, we continuously followed them up to collect data in the 3rd month at an altitude of 1,650 m (on the 3rd month of the 1-year survey period), the 3rd month at an altitude of 4,000 m (on the 6th month of the 1-year survey period), and the 9th month at an altitude of 4,000 m (on the 12th month of the 1-year survey period). Multiple linear regression analysis was used to construct models between sleep parameters and short-term memory, and mood states.
Results
The prevalence of sleep apnea syndrome (SAS) significantly increased with rising elevation (
P
< 0.01). The apnea-hypopnea index (AHI), the mean apnea time (MAT), the longest apnea time (LAT), and the duration of time with SaO
2
< 90% (TSA90) were increased (
P
< 0.05), and the mean pulse oxygen saturation (MSpO
2
), the lowest pulse oxygen saturation (LSpO
2
), and heart rate were significantly decreased with increasing altitude (
P
< 0.05). Digit span scores were decreased with increasing altitude (
P
< 0.001). A negative mood was more severe and a positive mood increasingly faded with rising elevation (
P
< 0.001). Additionally, linear correlation analysis showed that higher AHI, LAT, and MAT were strongly associated with a greater decline in short-term memory (in the 3rd and 9th month at an altitude of 4,000 m, respectively:
r
s
= −0.897, −0.901;
r
s
= −0.691, −0.749;
r
s
= −0.732, −0.794,
P
< 0.001), and also were strongly associated with more severe negative mood (in the 3rd month at altitudes of 1,650 m and 4,000 m, respectively:
r
s
= 0.655, 0.715, 0.724;
r
s
= 0.771, 0.638, 0.737,
P
< 0.000625). Multiple linear regression pointed out that AHI was a significant predictor of negative mood among people at different altitudes (in the 3rd month at an altitude of 1,650 m: TMD = 33.161 + 6.495*AHI; in the 3rd month at an altitude of 4,000 m: TMD = 74.247 + 1.589*AHI,
P
< 0.05).
Conclusion
SAS developed easily in high altitudes, most often in CSA (central sleep apnea, CSA). The sleep, short-term memory, and negative mood were significantly more damaged with elevation in volunteers. Sleep parameters were closely associated with short-term memory and mood states in volunteers at high altitudes; the higher the sleep parameters (AHI, LAT, and MAT) scores, the more significant the mood disorders and the more obvious impairment of short-term memory. AHI was a critical predictor of the negative mood of volunteers at different altitudes. This study provides evidence that could help with the prevention and control of sleep disorder, cognitive disorder, and negative mood among populations with high altitudes.
The adrenergic system contributes to the stress‐induced onset and progression of cancer. Adrenergic fibers are the primary source of norepinephrine (NE). The underlying mechanisms involved in ...NE‐induced colon cancer remain to be understood. In this study, we describe the function and regulatory network of NE in the progression of colon cancer. We demonstrate that NE‐induced phosphorylation of cAMP response element‐binding protein 1 (CREB1) promotes proliferation, migration, and invasion of human colon cancer cells. The downstream effector of NE, CREB1, bound to the promoter of miR‐373 and transcriptionally activated its expression. miR‐373 expression was shown to be necessary for NE‐induced cell proliferation, invasion, and tumor growth. We confirmed that proliferation and invasion of colon cancer cells are regulated in vitro and in vivo by miR‐373 through targeting of the tumor suppressors TIMP2 and APC. Our data suggest that NE promotes colon cancer cell proliferation and metastasis by activating the CREB1–miR‐373 axis. The study of this novel signaling axis may provide mechanistic insights into the neural regulation of colon cancer and help in the design of future clinical studies on stress biology in colorectal cancer.
We propose a NE–CREB1–miR‐373 signaling axis in human colon cancer cells. NE promotes the progression of colon cancer via CREB1 activity‐dependent transcription, enhancing the expression of oncogenic miR‐373 and reducing the expression of the miR‐373 targets APC and TIMP2. This novel NE‐CREB1‐miR‐373 signaling axis may potentially serve as a new therapeutic target for colorectal cancer.
This study was done to investigate the inhibition effects of miR-30a-3p on mitotic arrest deficient 2 like 1 (MAD2L1) expression and the proliferation of gastric cancer cells.
Cluster analysis and ...the TCGA database were used to screen the key genes highly expressed in gastric cancer. Based on the LinkedOmics website, the correlation between the miR-30a-3p and the cell cycle-related target gene
in gastric cancer was analyzed. The mRNA and protein expression levels were detected with the quantitative real-time PCR and Western blot analysis. The cell proliferation and cell cycle were also detected and analyzed.
Bioinformatics analysis showed that MAD2L1 was highly expressed in tumor tissues compared with normal tissues. Compared with normal tissues, the miR-30a-3p was significantly decreased in the gastric cancer tissues. Moreover, MAD2L1 was significantly negatively correlated with the miR-30a-3p expression. Furthermore, over-expression of miR-30a-3p decreased the expression of MAD2L1 at the protein level, which inhibited the proliferation of AGS and BGC-823 gastric cancer cells. In addition, the cell cycles of AGS and BGC-823 cells were arrested at the G0/G1 phase.
MAD2L1 is a pro-oncogene which is up-regulated in gastric cancer. The miR-30a-3p can down-regulate the MAD2L1 expression, inhibiting the proliferation of gastric cancer cells and affect the cell cycle.
(Sanghuang) is a widely used traditional Chinese medicine fungus, and its natural products have great potential for clinical application in immune enhancement. This study aimed to explore the ...immune-enhancing activity and underlying mechanisms of the polysaccharides and flavonoids derived from
(
) and to provide a theoretical and experimental basis for the development of novel drugs.
Wild
YASH1 from the Loess Plateau in Yan'an region was collected, and polysaccharides and total flavonoids were extracted, isolated and identified from mycelium and sporophore.
antioxidant activity was detected through the scavenging activity of hydroxyl radicals and total antioxidant capacity. Cell Counting Kit-8 and trypan blue detection kit were used to detect the effect of extract polysaccharides and flavonoids on the proliferation and phagocytosis ability of immune cells. To assess the effect of the drugs on cytokine secretion by immune cells and immune recovery in immunocompromised mice, the expression of interleukin (IL)-2, IL-6, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α were examined at the cellular and animal levels. The species composition, abundance of gut microbiota and the altered content of short-chain fatty acids in the feces were analyzed to elucidate the possible mechanisms of drugs by 16S ribosomal RNA (rRNA) amplifiers sequencing and liquid chromatography-tandem mass spectrometry (LC-MS/MS).
Both polysaccharides and flavonoids derived from mycelium or sporophore had antioxidant activity and may stimulate the expression and secretion of IL-2, IL-6, and IFN-γ in immune cells while inhibiting TNF-α expression and secretion and increasing IL-2, IL-6, and IFN- γ expression levels in mice. Furthermore, polysaccharides and flavonoids from mycelium and sporophore showed different effects on the metabolic response of intestinal short-chain fatty acids (SCFAs) in mice, and the use of these drugs remarkably changed the species composition and abundance of intestinal flora in mice.
Polysaccharides and flavonoids from
YASH1 mycelium and sporophore have
antioxidant activity, and they affect the promotion of cell proliferation, stimulation of IL-2, IL-6, and IFN-γ secretion, and inhibition of TNF-α expression in immune cells. Polysaccharides and flavonoids from
YASH1 may enhance immunity in immunocompromised mice and remarkably affect the intestinal flora and content of SCFAs.
Background and purpose
Abdominal obesity (AO) is a well-known independent risk factor for stroke in the general population although it remains unclear in the case of the elderly, especially in ...Chinese older patients with obstructive sleep apnea (OSA), considering the obesity paradox. This study aimed to investigate the association between AO and stroke among Chinese older patients with OSA.
Methods
Data were collected from January 2015 to October 2017, and 1,290 older patients (age 60–96 years) with OSA (apnea–hypopnea index ≥ 5 events/h on polysomnography) were consecutively enrolled from sleep centers at six hospitals, evaluated for AO defined as waist circumference (WC) using the standardized criteria for the Chinese population, and followed up prospectively for a median period of 42 months. Logistic regression and Cox regression analyses were used to determine the cross-sectional and longitudinal associations between AO and stroke risk in these participants and different groups of the severity of OSA.
Results
Participants with AO had a higher prevalence of stroke at baseline. A higher incidence of stroke during a median follow-up period of 42 months in participants with AO than in participants without AO (12.4%
vs
. 6.8% and 8.3%
vs.
2.4%, respectively; both
P
< 0.05) was predicted. Cross-sectional analysis revealed an association between AO and stroke (odds ratio OR1.96, 95% confidence interval CI 1.31–2.91), which was stronger among participants with moderate OSA only (OR 2.16, 95%CI 1.05–4.43). Cox regression analysis showed that, compared to participants without AO, participants with AO had a higher cumulative incidence of stroke (hazard ratio HR 2.16, 95% CI 1.12–4.04) during a median follow-up of 42 months, and this association was observed in patients with severe OSA only (HR 3.67, 95% CI 1.41–9.87) but not for individuals with mild OSA (HR = 1.84, 95% CI 0.43–6.23) and moderate OSA (HR = 1.98, 95% CI 0.73–6.45).
Conclusion
The risk of stroke is associated with AO among Chinese older patients who have OSA, both at baseline and during follow-up, and the strength of the association varied by OSA severity. Active surveillance for early detection of AO could facilitate the implementation of stroke-preventive interventions in the Chinese older OSA population.
Few prospective cohort studies have assessed the relationship between Cystatin C (Cys-C) and risk of stroke in elderly patients with obstructive sleep apnea (OSA). The study sought to examine the ...association between baseline serum Cys-C and long-term risk of stroke among elderly OSA patients.
A total of 932 patients with OSA, no history of stroke, ≥60 years of age, and complete serum Cys-C records were included in this study. All patients had completed polysomnography (PSG). OSA was defined as an apnea-hypopnea index (AHI) of ≥5 events per hour. Participants were categorized into four groups according to baseline serum Cys-C concentration, split into quartiles. Multivariate Cox regression were used to evaluate the association between Cys-C and the incidence of new-onset stroke.
Stroke occurred in 61 patients during the median 42-month follow-up period. The cumulative incidence rate of stroke was 6.5%, which included 54 patients with ischemic stroke and 7 patients with hemorrhagic stroke. The cumulative incidence of stroke was higher among patients with baseline serum Cys-C concentration of ≥1.15 mg/L when compared with other groups (
< 0.001). After adjusting for potential confounding factors in the Cox regression model, patients with a serum Cys-C concentration of ≥1.15 mg/L had a 2.16-fold higher risk of developing stroke compared with patients with serum Cys-C ≤ 0.81 mg/L (HR, 2.16, 95%CI, 1.09-6.60;
= 0.017). Additionally, there was a higher risk in those of age ≥70 years (HR, 3.23, 95%CI, 1.05-9.24;
= 0.010). The receiver-operating characteristic curves showed that the capability of Cys-C to identify elderly patients with OSA who had a long-time risk of stroke was moderate (AUC = 0.731, 95% CI: 0.683-0.779,
= 0.001).
Increased Cys-C concentration was identified as a risk factor in the incidence of stroke in elderly patients with OSA, independent of gender, BMI, hypertension and other risk factors. Additionally, it conferred a higher risk in patients of age ≥70 years.
The prognostic significance of obstructive sleep apnea (OSA) in elderly patients with type 2 diabetes is unclear. The aim of this study was to determine the risk of cardiovascular disease (CVD) and ...mortality in elderly patients with OSA complicated with type 2 diabetes compared to patients with OSA without type 2 diabetes.
From January 2015 to October 2017, 1113 eligible elderly patients with OSA, no history of cardiovascular, ≥60 years of age, and complete follow-up records were enrolled in this consecutive multicentre prospective cohort study. All patients had completed polysomnography (PSG) examinations. An apnoea-hypopnoea index of ≥5 events per hour recorded by polysomnography was defined as the diagnostic criterion for OSA. We collected baseline demographics, clinical characteristics, sleep parameters and follow-up outcomes. The primary aim of this study was to identify the risk of incident major adverse cardiovascular events (MACE). Secondary outcomes were all-cause mortality, components of MACE and a composite of all events. Kaplan-Meier survival analysis and Cox proportional hazards models were used to evaluate whether type 2 diabetes was associated with incident events.
A total of 266 (23.9%) patients had OSA complicated with type 2 diabetes. MACE occurred in 97 patients during the median 42-month follow-up. Kaplan-Meier survival curves indicated a significant relationship between type 2 diabetes and MACE (log-rank P = 0.003). Multivariable Cox regression analysis showed that type 2 diabetes increased the risk of MACE (HR = 1.64, 95% CI:1.08-2.47, P = 0.019), hospitalisation for unstable angina (HR = 2.11, 95% CI:1.23-3.64, P = 0.007) and a composite of all events in elderly patients with OSA (HR = 1.70, 95% CI:1.17-2.49, P = 0.007). However, there were no significant differences in the incidence of cardiovascular death, all-cause mortality, MI and hospitalisation for heart failure between patients with and without diabetes (P > 0.05). The subgroup analysis demonstrated that females (AHR = 2.46, 95% CI:1.17-5.19, P = 0.018), ≥ 70 years (AHR = 1.95, 95% CI:1.08-3.52, P = 0.027), overweight and obese (AHR = 2.04, 95% CI:1.29-3.33, P = 0.002) with mild OSA (AHR = 2.42, 95% CI: 1.03-5.71, P = 0.044) were at a higher risk for MACE by diabetes.
OSA and type 2 diabetes are interrelated and synergistic with MACE, hospitalisation for unstable angina and a composite of all events development. Overweight and obese females, ≥ 70 years with mild OSA combined with type 2 diabetes presented a significantly high MACE risk.
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