Currently available echocardiographic reference values are derived mainly from North American and European population studies, and no echocardiographic reference values are available for the Chinese ...population. The aim of this study was to establish normal values of echocardiographic measurements of the cardiac chambers and great arteries in a nationwide, population-based cohort of healthy Han Chinese adults.
A total of 1,586 healthy Han Chinese volunteers aged 18 to 79 years were screened at 43 collaborating laboratories throughout China. Standard M-mode and two-dimensional echocardiography was performed to obtain measurements of the cardiac chambers and great arteries. The impacts of gender and age on all echocardiographic measurements were analyzed.
A total of 1,394 qualified healthy subjects (mean age, 47.3 ± 16.0 years; 678 men) were ultimately enrolled. Except for left ventricular ejection fraction, values of cardiac chamber and great arterial dimensions were significantly higher in men than in women. Most measurements of the atrial and great arterial dimensions, left ventricular wall thickness, and left ventricular mass increased with age in both men and women.
Normal reference values of cardiac dimensional parameters were established for the first time in a nationwide, population-based cohort of healthy Han Chinese adults. Because most of these parameters were found to vary with gender and age, reference values stratified for gender and age should be used in clinical practice.
Background Intravenous cyclophosphamide with prednisone is an effective treatment for lupus nephritis, but with significant toxicities. We compared the efficacy and safety of tacrolimus versus ...intravenous cyclophosphamide as induction therapy. Study Design Multicenter noninferiority randomized controlled trial. Setting & Participants 81 patients with biopsy-proven lupus nephritis from 9 nephrology centers in China from 2006-2008. Intervention Prednisone and either tacrolimus (n = 42) or intravenous cyclophosphamide (n = 39) for 6 months. Tacrolimus was started at 0.05 mg/kg/d and titrated to achieve a trough blood concentration of 5-10 ng/mL. Intravenous cyclophosphamide was initiated at 750 mg/m2 of body surface area, then adjusted to 500-1,000 mg/m2 every 4 weeks for a total of 6 pulse treatments. Outcomes & Measurements The primary outcome was complete remission (proteinuria with protein excretion <0.3 g/24 h, serum albumin ≥3.5 g/dL, normal urinary sediment, and normal or stable serum creatinine level) at 6 months. Response (complete or partial remission), clinical parameters, and adverse effects were secondary end points. Results After the 6-month induction therapy, the tacrolimus group achieved higher cumulative probabilities of complete remission and response (52.4% vs 38.5% and 90.5% vs 82.1%, respectively) than the intravenous cyclophosphamide group, but differences were not statistically significant (log-rank test, P = 0.2 and P = 0.7, respectively). Proteinuria (log-transformed) was significantly decreased in tacrolimus- versus intravenous cyclophosphamide–treated patients after the first month of treatment, even with adjustment for baseline proteinuria (protein excretion, 0.01 vs 0.23 g/d; P = 0.02). After treatment, serum creatinine levels and estimated glomerular filtration rates were not significantly different between treatment groups. Adverse effects, such as leukopenia and gastrointestinal symptoms, were less frequent in the tacrolimus group. Limitations Nonblinded, small sample size, and short duration of follow-up. Conclusions In conjunction with prednisone, induction therapy with tacrolimus is at least as efficacious as intravenous cyclophosphamide and prednisone in producing complete remission of lupus nephritis and has a more favorable safety profile.
Objectives This study tested whether interleukin (IL)-17A is involved in the pathogenesis of mouse myocardial ischemia/reperfusion (I/R) injury and investigated the mechanisms. Background ...Inflammatory processes play a major role in myocardial I/R injury. We recently identified IL-17A as an important cytokine in inflammatory cardiovascular diseases such as atherosclerosis and viral myocarditis. However, its role in myocardial I/R injury remains unknown. Methods The involvement of IL-17A was assessed in functional assays in mouse myocardial I/R injury by neutralization/repletion or genetic deficiency of IL-17A, and its mechanism on cardiomyocyte apoptosis and neutrophil infiltration were further studied in vivo and in vitro. Results Interleukin-17A was elevated after murine left coronary artery ligation and reperfusion. Intracellular cytokine staining revealed that γδT lymphocytes but not CD4+ helper T cells were a major source of IL-17A. Anti–IL-17A monoclonal antibody treatment or IL-17A knockout markedly ameliorated I/R injury, as demonstrated by reduced infarct size, reduced cardiac troponin T levels, and improved cardiac function. This improvement was associated with a reduction in cardiomyocyte apoptosis and neutrophil infiltration. In contrast, repletion of exogenous IL-17A induced the opposite effect. In vitro study showed that IL-17A mediated cardiomyocyte apoptosis through regulating the Bax/Bcl-2 ratio, induced CXC chemokine-mediated neutrophil migration and promoted neutrophil-endothelial cell adherence through induction of endothelial cell E-selectin and inter-cellular adhesion molecule-1 expression. Conclusions IL-17A mainly produced by γδT cells plays a pathogenic role in myocardial I/R injury by inducing cardiomyocyte apoptosis and neutrophil infiltration.
The aim of the present review was to investigate the association between the use of oral β-blockers and prognosis in patients with acute myocardial infarction (AMI) who underwent percutaneous ...coronary intervention (PCI) treatment. A systematic literature search was conducted in Pubmed (from inception to September 27, 2014) and Embase (Ovid SP, from 1974 to September 29, 2014) to identify studies that compared the outcome of patients with AMI taking oral β-blockers with that of patients not taking after PCI. Systematic review and meta-analysis were performed with random-effects model or fixed-effects model. Ten observational studies with a total of 40,873 patients were included. Use of β-blockers was associated with a reduced risk of all-cause death (unadjusted relative risk 0.58, 95% confidential interval 0.48 to 0.71; adjusted hazard ratio 0.76, 95% confidential interval 0.62 to 0.94). The potential benefit of β-blockers in preventing all-cause death was not similar in all population but was restricted to those with reduced ejection fraction, with low use proportion of other secondary prevention drugs or with non–ST-segment elevation myocardial infarction. The association between the use of β-blockers and improved survival rate was significant in ≤1-year follow-up duration. Rates of cardiac death, myocardial infarction, and heart failure readmission in patients using β-blockers were not significantly different from those in patients without β-blocker therapy. In conclusion, there is lack of evidence to support routine use of β-blockers in all patients with AMI who underwent PCI. Further trials are urgently needed to address the issue.
Background Autonomous secretion of aldosterone in patients with primary aldosteronism increases glomerular filtration rate and causes kidney damage. The influence of a mild decrease in kidney ...function on residual hypertension after adrenalectomy is unexplored. Study Design Nonconcurrent prospective study. Setting & Participants The study was based on the Taiwan Primary Aldosteronism Investigation (TAIPAI) database. 150 patients (61 men; overall mean age, 47.2 ± 11.6 years) with a diagnosis of aldosterone-producing adenoma had undergone unilateral adrenalectomy at National Taiwan University Hospital from July 1999 to January 2007. Predictor Presurgery estimated glomerular filtration rate (eGFR). Outcomes & Measurements Residual hypertension after adrenalectomy, defined either as less than 75% of recorded blood pressure measurements with systolic blood pressure less than 140 mm Hg and diastolic blood pressure less than 90 mm Hg or requiring antihypertensive medications during the first year after surgery. Results Before surgery, 27 (18%), 72 (48%), and 51 (34%) patients had moderately to severely decreased (<60 mL/min/1.73 m2 ), mildly decreased (60 ≤ eGFR < 90 mL/min/1.73 m2 ), or nondecreased eGFR (≥90 mL/min/1.73 m2 ), respectively. After surgery, 16 (59.3%), 29 (40.3%), and 10 (19.3%) patients in each category had postsurgery residual hypertension. Compared with patients without decreased eGFR before surgery, adjusted odds ratios for postsurgery residual hypertension were 2.7 (95% confidence interval, 1.03 to 7.0; P = 0.04) and 2.8 (95% confidence interval, 1.05 to 9.3) for mildly and moderately to severely decreased eGFR, respectively. Limitations Arbitrary definition for residual hypertension. Conclusions Two-thirds of patients with aldosterone-producing adenoma were cured of hypertension by means of unilateral adrenalectomy. Kidney function impairment, even mild, appears to be associated with a high incidence of postsurgery residual hypertension.
Background IL-25 is thought to participate in allergic inflammation by propagating T h 2-type responses. Objective To address the hypothesis that allergen provocation increases expression of IL-25 ...and its receptor IL-25R in the asthmatic bronchial mucosa and skin dermis of atopic subjects. Methods Sequential single and double immunostaining was used to evaluate the numbers and phenotypes of IL-25 and IL-25R immunoreactive cells in bronchial biopsies from mild atopic subjects with asthma (n = 10) before and 24 hours after allergen inhalation challenge and skin biopsies from atopic subjects (n = 10) up to 72 hours after allergen subepidermal injection. Results IL-25 immunoreactivity was expressed by a majority of epidermal cells in both organs at baseline and was not further augmented by challenge. IL-25R immunoreactive cells were rare in the epidermis before or after challenge. Allergen challenge was associated with significantly ( P < .01) increased expression of IL-25 and IL-25R immunoreactivity in the submucosa of both organs. IL-25 immunoreactivity colocalized with eosinophils, mast cells, and endothelial cells, whereas IL-25R immunoreactivity colocalized with eosinophils, mast cells, endothelial cells, and T lymphocytes. In both organs, correlations were observed between increases in IL-25 expression and the magnitudes of the late-phase allergen-induced clinical responses. Conclusion Allergen provocation induces functionally relevant, increased expression of IL-25 and its receptor in the asthmatic bronchial mucosa and dermis of sensitized atopic subjects. In addition to T cells, eosinophils, mast cells, and endothelial cells are potential sources and targets of IL-25 in the course of allergic inflammation.
There is no gold standard in diagnosing sarcopenia. We aimed to assess the validity of screening sarcopenia using SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls).
...Prospective cohort study.
Community hospital in Taiwan.
Community-dwelling senior citizens.
Participants were interviewed with a structured questionnaire annually. The questionnaire items were recoded into the 5 items of SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls). In the baseline year, a subgroup was tested for grip strength and body composition. Healthcare utilization and mortality were based on self-report and hospital records. Our main outcome was 4-year mortality. Secondary outcomes included hospitalization, emergency care use, and quality of life (QOL) measured using the CASP-12 scale (control, autonomy, self-realization, pleasure (control, autonomy, self-realization, pressure).
There were 670 participants. The mean age was 76.1 (standard deviation 6.36). One-half were men (n = 340, 50.7%). The prevalence of sarcopenia was 6.1% (n = 41). SARC-F scores were inversely associated with grip strength (P = .001) and skeletal muscle composition (P = .045). Participants with sarcopenia were mostly women (P = .005) and older (P < .001). In univariate analysis, sarcopenia was associated with 1- to 4-year mortalities (P = .033, .001, .001, <.001, respectively), overall hospitalization (P = .004), overall emergency care use (P = .017), and QOL (P < .001). In multivariate model, sarcopenia odds ratio (OR) 7.35, 95% confidence interval (CI) 2.67-20.18, age (OR 1.19, 95% CI 1.09-1.29 for each year), and taking vitamin D supplements (OR 0.29, 95% CI 0.11-0.74) were factors associated with mortality.
Sarcopenia screened using SARC-F was associated with subsequent QOL, overall hospitalization, overall emergency care use, and 4-year mortality. SARC-F can serve as a quick screening tool of sarcopenia.
Background Incident patients treated with continuous ambulatory peritoneal dialysis (CAPD) are often prescribed either 3 or 4 exchanges per day. However, the effects on residual kidney function and ...clinical outcomes of 3 versus 4 exchanges are not known. Study Design Prospective, randomized, controlled, open-label study. Setting & Participants Incident CAPD patients aged 18 to 80 years with glomerular filtration rates (GFRs; mean of renal urea and creatinine clearance from a 24-hour urine collection) ≥ 2 mL/min and urine volume ≥ 500 mL/d. Exclusion criteria included refusal for informed consent, history of maintenance hemodialysis therapy or transplantation, or limited life expectancy. Intervention 24-month intervention with 3- or 4-exchange CAPD using glucose-based peritoneal dialysis fluids. Outcomes Primary outcomes were GFR, urine volume, and anuria-free survival. Secondary outcomes included peritonitis, patient survival, and technique survival. Results The study recruited 139 patients, 70 in the 3-exchange group and 69 in the 4-exchange group. Baseline body mass indexes were 21.4 ± 3.0 and 21.9 ± 3.2 kg/m2 for the 3- and 4-exchange groups, respectively ( P = 0.4). After 24 months, for 3 versus 4 exchanges, GFR (1.6 ± 2.0 vs 1.7 ± 1.9 mL/min; P = 0.8), urine volume (505 ± 522 vs 474 ± 442 mL/d; P = 0.8), and anuria-free survival (log-rank test statistic = 0.055; P = 0.8) did not differ between groups, but Kt/V (1.95 ± 0.39 vs 2.19 ± 0.48; P = 0.03) and ultrafiltration (404 ± 499 vs 742 ± 512 mL/d; P = 0.004) were lower in the 3-exchange group. The 3-exchange group had nominally longer peritonitis-free survival time (log-rank test statistic = 3.811; P = 0.05), and nominally fewer patients had peritonitis in this group, though this was not statistically significant (13% vs 26%; P = 0.06). Patient survival (log-rank test statistic = 0.978; P = 0.3) and technique survival (log-rank test statistic = 0.347; P = 0.6) were similar between groups. Limitations Single-center design; no formal sample-size calculations. Conclusions In this small trial, CAPD regimens with 3 and 4 exchanges had similar effects on residual GFR, urine volume, and time to anuria. Incremental peritoneal dialysis starts appear safe when patients are monitored.
Sputum eosinophilia is a treatable trait for chronic cough. It is currently not clear whether the blood eosinophil counts could be used to identify sputum eosinophilia in patients with chronic cough. ...This study aimed to evaluate the diagnostic accuracy of blood eosinophils in comparison to other common type 2 biomarkers for identifying sputum eosinophilia in patients with chronic cough.
In this prospective study, a total of 658 patients with chronic cough were enrolled. Induced-sputum test, routine blood test, total immunoglobulin E (TIgE), and fractional exhaled nitric oxide (FeNO) level were measured. The percentage of sputum eosinophils (Eos%) ≥ 2.5% was defined as sputum eosinophilia. The area under the curve (AUC) of blood eosinophil counts, TIgE, and FeNO alone or in combination for predicting sputum eosinophilia were analyzed.
The AUC of blood eosinophil counts for predicting sputum eosinophilia in chronic cough patients was moderate 0.826 (0.767–0.885), as compared to that of FeNO 0.784 (0.720–0.849), P = 0.280 and TIgE 0.686 (0.613–0.760), P = 0.001. When combining blood eosinophil counts and FeNO for detecting sputum eosinophilia, a significantly larger AUC 0.868 (0.814–0.923), with a sensitivity of 84.2% and a specificity of 82.8% was yielded, as compared to each single marker alone (all P < 0.05).
Blood eosinophil counts have a moderate diagnostic value for identifying sputum eosinophilia in patients with chronic cough, while a combination of blood eosinophil counts and FeNO measurement can provide additional predictive value.
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