Effectiveness of high intensity interval training on cardiorespiratory fitness and endothelial function in type 2 diabetes:A systematic review

BACKGROUND Type 2 diabetes mellitus(T2DM)is a chronic metabolic syndrome characterized by insulin resistance and hyperglycemia that may lead to endothelial dysfunction,reduced functional capacity and exercise intolerance.Regular aerobic exercise has been promoted as the most beneficial non-pharmacological treatment of cardiovascular diseases.High intensity interval training(HIIT)seems to be superior than moderate-intensity continuous training(MICT)in cardiovascular diseases by improving brachial artery flow-mediated dilation(FMD)and cardiorespiratory fitness to a greater extent.However,the beneficial effects of HIIT in patients with T2DM still remain under investigation and number of studies is limited.AIM To evaluate the effectiveness of high intensity interval training on cardiorespiratory fitness and endothelial function in patients with T2DM.METHODS We performed a search on PubMed,PEDro and CINAHL databases,selecting papers published between December 2012 and December 2022 and identified published randomized controlled trials(RCTs)in the English language that included community or outpatient exercise training programs in patients with T2DM.RCTs were assessed for methodological rigor and risk of bias via the Physiotherapy Evidence Database(PEDro).The primary outcome was peak VO_(2 ) and the secondary outcome was endothelial function assessed either by FMD or other indices of microcirculation.RESULTS Twelve studies were included in our systematic review.The 12 RCTs resulted in 661 participants in total.HIIT was performed in 310 patients(46.8%),MICT to 271 and the rest 80 belonged to the control group.Peak VO_(2 ) increased in 10 out of 12 studies after HIIT.Ten studies compared HIIT with other exercise regimens(MICT or strength endurance)and 4 of them demonstrated additional beneficial effects of HIIT over MICT or other exercise regimens.Moreover,4 studies explored the effects of HIIT on endothelial function and FMD in T2DM patients.In 2 of them,HIIT further improved endothelial function compared to MICT and/or the control group while in the rest 2 studies no differences between HIIT and MICT were observed.CONCLUSION Regular aerobic exercise training has beneficial effects on cardiorespiratory fitness and endothelial function in T2DM patients.HIIT may be superior by improving these parameters to a greater extent than MICT.

Overexpression of mitogen-activated protein kinase phosphatase-1 in endothelial cells reduces blood-brain barrier injury in a mouse model of ischemic stroke

Ischemic stroke can cause blood-brain barrier(BBB)injury,which worsens brain damage induced by stroke.Abnormal expression of tight junction proteins in endothelial cells(ECs)can increase intracellular space and BBB leakage.Selective inhibition of mitogen-activated protein kinase,the negative regulatory substrate of mitogen-activated protein kinase phosphatase(MKP)-1,improves tight junction protein function in ECs,and genetic deletion of MKP-1 aggravates ischemic brain injury.However,whether the latter affects BBB integrity,and the cell type-specific mechanism underlying this process,remain unclear.In this study,we established an adult male mouse model of ischemic stroke by occluding the middle cerebral artery for 60 minutes and overexpressed MKP-1 in ECs on the injured side via lentiviral transfection before stroke.We found that overexpression of MKP-1 in ECs reduced infarct volume,reduced the level of inflammatory factors interleukin-1β,interleukin-6,and chemokine C-C motif ligand-2,inhibited vascular injury,and promoted the recovery of sensorimotor and memory/cognitive function.Overexpression of MKP-1 in ECs also inhibited the activation of cerebral ischemia-induced extracellular signal-regulated kinase(ERK)1/2 and the downregulation of occludin expression.Finally,to investigate the mechanism by which MKP-1 exerted these functions in ECs,we established an ischemic stroke model in vitro by depriving the primary endothelial cell of oxygen and glucose,and pharmacologically inhibited the activity of MKP-1 and ERK1/2.Our findings suggest that MKP-1 inhibition aggravates oxygen and glucose deprivation-induced cell death,cell monolayer leakage,and downregulation of occludin expression,and that inhibiting ERK1/2 can reverse these effects.In addition,co-inhibition of MKP-1 and ERK1/2 exhibited similar effects to inhibition of ERK1/2.These findings suggest that overexpression of MKP-1 in ECs can prevent ischemia-induced occludin downregulation and cell death via deactivating ERK1/2,thereby protecting the integrity of BBB,alleviating brain injury,and improving post-stroke prognosis.

Relationship between testosterone and indexes indicating endothelial function in male coronary heart disease patients

Aim： To investigate the relationship between androgen level and the indexes indicating endothelial function in male patients with coronary heart disease （CHD）. Methods： We registered the following data for 106 50-70-year-old men： age, weight, blood lipid, including total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol and triglyceride, whether a smoker, sugar levels, blood pressure, free testosterone （FT）, vascular cell adhesion molecule- 1 （VCAM- 1） and the intima-media thickness （IMT） of common carotid artery, common carotid diameter, maximum velocity in systolic phase, minimum velocity in diastolic phase and resistent index. Among the 106 men, 51 were patients with CHD. The relationships between FT level, VCAM-1 concentration and IMT were examined, respectively, using a stepwise linear regression technique among all the 106 men. Results： There was no statistical difference in terms of age, blood pressure, whether a smoker, sugar levels, HDL-C, minimum velocity in diastolic phase, resistent index between male CHD patients and controls; whereas results for weight, total cholesterol, low density lipoprotein cholesterol, triglyceride, VCAM- 1 and IMT of male CHD patients were higher than those of controls; FT level and maximum velocity in systolic phase were lower. It was found that among all the objects, FT level was inversely correlated with IMT and VCAM-1 concentration. Condusion： FT level was inversely correlated with VCAM-I concentration and IMT which are indicators of endothelial function. （Asian JAndro12008 Mar; 10： 214-218）

Scalp electroacupuncture at the Baihui acupoint (DU 20) improves functional recovery in rats with cerebral ischemia Association with increased expression of vascular endothelial growth factors

In this study, we induced cerebral infarction in rats by occluding the right middle cerebral artery, and tested the effects of electroacupuncture at the Baihui acupoint （DU 20）. Motor and sensory function was tested using Garcia’s scale and motor weakness grading, and the expression of vascular endothelial growth factor in the brain was quantified using immunoblotting and immunohistochemistry. We found that scalp electroacupuncture at DU 20 significantly improved motor performance and sensory function in rats with stroke, and this was accompanied by an increased expression of vascular endothelial growth factor in the ischemic brain tissue and peri-ischemic area. In addition, Pearson correlation analysis showed that the improvements in functional recovery were correlated with the increased expression of vascular endothelial growth factor.

Ligliptin for treatment of type 2 diabetes mellitus with early renal injury: Efficacy and impact on endogenous hydrogen sulfide and endothelial function

BACKGROUND Diabetes is a clinically common chronic disease,and its incidence has been increasing in recent years.Diabetes is believed to accelerate the process of atherosclerosis in patients,and abnormal endothelial function is an important factor leading to diabetic kidney damage.AIM To investigate the efficacy of ligliptin in the treatment of type 2 diabetes mellitus(T2DM)with early renal injury and its effect on serum endogenous hydrogen sulfide(H2S),endothelial cell particles,and endothelial function.METHODS From January 2018 to April 2019,110 patients with T2DM and early kidney injury treated at our hospital were divided into an observation group(receiving ligliptin treatment,n=54)and a control group(receiving gliquidone therapy,n=56).Blood glucose and renal function before and after treatment were compared between the two groups.RESULTS The differences in fasting blood glucose,2 h blood glucose,and glycated hemoglobin were not statistically significant between the two groups after treatment.The urinary albumin excretion rate after treatment in the ligliptin group was 70.32±11.21μg/min,which was significantly lower than that of the gliquidone group(P=0.000).Serum endogenous H2S and endothelial cell microparticles of the ligliptin treatment group were 40.04±8.82 mol/L and 133.40±34.39,respectively,which were significantly lower than those of the gliquidone treatment group(P=0.000 for both);endothelin-dependent diastolic function and nitric oxide after treatment in the ligliptin group were 7.98%±1.22%and 190.78±30.32 mol/L,significantly higher than those of the gliquidone treatment group(P=0.000 for both).CONCLUSION Ligliptin treatment of T2DM with early renal injury has the same glucoselowering effect as gliquidone treatment.Ligliptin treatment has a better effect and it can significantly improve the renal function and vascular endothelial function of patients,and reduce serum endogenous H2S and endothelial cell particle levels.

Positive influence of aspirin on coronary endothelial function: Importance of the dose

AIM: To investigate the effects of different doses of aspirin on coronary endothelial function. METHODS: The study included 139 Japanese subjects(mean age, 60 years; 53 women) with angiographically normal coronary arteries. Patients were distributed into GroupⅠ(n = 63), who was administered aspirin and Group Ⅱ(n = 76), the control, who were not administered aspirin. GroupⅠwas further divided into GroupⅠa(n = 50, low-dose aspirin, 100 mg) and GroupⅠb(n = 13, high-dose aspirin, 500 mg). After a routine coronary angiography, acetylcholine(ACh; 3 and 30 μg/min successively) and nitroglycerin(NTG) were infused into the left coronary ostium over 2 min. The change in the diameter of the coronary artery in response to each drug was expressed as the percentage change from baseline values.RESULTS: The patient characteristics did not differ between the two groups. The change in coronary diameter in response to ACh was greater in GroupⅠthan in Group Ⅱ(P = 0.0043), although the NTG-induced coronary vasodilation was similar between groups. ACh-induced dilation was greater in GroupⅠa than in GroupⅠb(P = 0.0231). Multivariate regression analysis showed that a low-dose of aspirin(P = 0.0004) was one of the factors associated with ACh-induced dilation at 30 μg/min.CONCLUSION: In subjects with angiographically normal coronary arteries, aspirin only had a positive influence on coronary endothelial function at the low dose of 100 mg. This improvement of coronary endothelial function may be involved in the preventive effect of aspirin against future coronary events.

Upregulation of sFlt-1 by Trophoblasts Induces the Barrier Dysfunction of Glomerular Endothelial Cells

This study examined the effect of over-expression of sFlt-1 by trophoblasts on the barrier function of glomerular endothelial cells and the role of VEGF in this process in order to explore the pathogenesis of glomerular disease in preeclampsia. SFlt-1 expression in the human trophoblasts （TEV-1 cells） was enhanced by transfecting sFlt-1 plasmid DNA into TEV-1 cells. The monolayer barrier fimction of glomerular endothelial cells （ciGEnCs） was determined by measuring the fluorescence intensity of bovine serum albumin （BSA） that crossed the monolayer of glomerular endothelial cells. The results showed that the over-expression of sFlt-1 by TEV-1 cells led to the barrier dysfunction of ciGEnCs, and the exogenous VEGF could alleviate the ciGEnCs dysfunction resulting from the over-expression of sFlt- 1 to a certain extent. It was concluded that the dysregulation of sFlt- 1 and VEGF in preeclamptic pregnancy may contribute to the barrier dysfunction of glomerular endothelial cells, and VEGF may play an important role in maintaining the barrier function of glomerular endothelial cells, but it may not be the sole factor.

Vascular Endothelial Glycocalyx as a Mechanism of Vascular Endothelial Dysfunction and Atherosclerosis

Atherosclerosis occurs as a result of organized processes that include vascular endothelial dysfunction, lipid accumulation, abnormal inflammatory reaction, excessive reactive oxygen species production, and vascular cell proliferation and migration. In patients with atherosclerosis, vascular endothelial dysfunction is commonly observed with the damage of vascular endothelial glycocalyx, which is an extracellular matrix bound to and encapsulating the endothelial cells that line the blood vessel wall. Unhealthy lifestyle choices such as smoking and physical inactivity also induce glycocalyx degradation. Additionally, vascular endothelial glycocalyx can be damaged by various pathological conditions including dehydration, acute infectious disease, trauma, sepsis, acute respiratory distress syndrome, Kawasaki disease, preeclampsia, gestational diabetes mellitus, hypertension, diabetes mellitus, chronic kidney disease, atherosclerosis, stroke, dementia, microvascular angina, acute coronary syndrome, and heart failure. Vascular endothelial glycocalyx has been shown to be important as a physical cytoprotective barrier for vascular endothelial cells and as a regulatory mechanism for intracellular cell signaling. Therefore, vascular endothelial glycocalyx has immense potential in the exploration of novel strategies for the evaluation of beneficial conditions of healthy vasculature.

Study on the Effect of Simvastatin on Left Ventricular Mass and Endothelial Function and the Relationship between Their Changes in the Patients with Essential Hypertension

Objective:To study the effect of Simvastatin on the left ventricular mass and endothelial function and to investigate the relationship between their changes in the patients with essential hypertension(EH). Methods: 50 patients with hypertension without severe complication were divided into two groups in a randomized,controlled and single blind trial.Group I(n=25)were given Simvastatin and hydragogue for 12 weeks while Group Ⅱ were given hydragogue during the same time.We detected the left ventricular mass and the brachial artery dilatation induced by reactive hyperemia(DIRH)or nitroglycerin(DING)respectively with ultrasonography in all patients before and after treatment.25 normal subjects without any treatment were taken as the control. Results:The left ventricular mass index(LVMI)was higher in the two groups of patients[(133.61±31.02)g/m 2;(118.04±39.62)g/m 2]than that in the control(88.79±22.73)g/m 2 before treatment(P<0.01,0.000 1,respectively)while the blood pressure was higher.The DIRH was lower in the two groups of patients(5.93±2.24)%;(6.54±3.16)%than that in the control(13.09±2.99)%,P<0.000 1.There was no significantly differences in age,serum concentrations of total cholesterol,triglyceride,sugar,blood pressure or the DING between two groups of patients and the control(P>0.05).And there was no significant difference in the all variables between group Ⅰ and group Ⅱ before treatment.After treatment the LVMI decreased[(133.61±31.02)g/m 2 VS(91.07±16.01)g/m 2,P<0.01]and the DTRH increased[(5.93±2.24)% VS(13.53±2.38)%,P<0.01]in the patients of group Ⅰ while there was no significant change in LVMI and DIRH in the patients of group Ⅱ.The blood pressure in the two groups of patients was decreased to the normal.Compared with group Ⅱ,the changes of LVMI and DIRH was higher in patients of group Ⅰ though the serum concentrations of total cholesterol,triglyceride or sugar were not significantly different.No significant change in serum concentrations oftotal cholesterol,triglyceride or sugar was found during treatment in the two groups of patients.Analysis showed that the LVMI correlated with DIRH and the change of LVMI correlated better with the change of DIRH(r=-0.56;0.69,P<0.000 1,respectly). Conclusions: The increase of left ventricular mass was related with endothelial dysfunction in essential hypertension.Being independent of the changes of serum concentrations of total cholesterol,triglyceride or sugar and blood pressure,Simvastatin could inhibit the increase of left ventricular mass and improve endothelial function.

The Effects of Naoxintong Capsule on the Vascular Endothelial Function and Inflammatory Factors in Spontaneously Hypertensive Rats

Objective:To investigate the effects of Naoxintong(NXT)capsule on vascular endothelial function and inflammatory mechanism in spontaneously hypertensive rats.Methods:A total of 100 spontaneously hypertensive rats were divided into model group,positive control group,NXT low-dose group,NXT medium-dose group and NXT high-dose group.Rats in the model group were given an equal dose of normal saline once a day;the positive control group was given telmisartan 50 mg/(kg·d)once a day;the low,middle and high dose groups were given the NTX 0.5,1.0,2.0 mg/(kg·d)once a day,respectively.Rats in each group were continuously intragastrically administered for 12 weeks.The vascular endothelial function index,inflammation index and blood pressure of each group were observed at the end of 8 weeks.Results:Endothelin(ET),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),C-reactive protein(CRP)and systolic blood pressure levels were lower in the positive control group and NXT group compared with model group.In the model group,the NO level was lower than the positive control group and NXT group;the levels of ET,IL-6,TNF-α,CRP and systolic blood pressure in the middle-dose group and the high-dose group were lower than those in the positive control group and NXT low-dose group.Furthermore,the level of NO was higher in positive control group and NXT middle and high dose group compared with model group.The levels of ET,IL-6,TNF-α,CRP and systolic pressure in NXT high dose group were lower than in NXT middle dose group,while the level of NO was higher in NXT high group than in NXT middle dose group and the difference was statistically significant(p<0.05).Conclusions:NXT has obviously antihypertensive effect on spontaneously hypertensive rats,and its mechanism may be related to the improvement of vascular endothelial function and inflammatory factors.

Endothelial dysfunction in cirrhosis: Role of inflammation and oxidative stress

This review describes the recent developments in the pathobiology of endothelial dysfunction(ED) in the context of cirrhosis with portal hypertension and defines novel strategies and potential targets for therapy. ED has prognostic implications by predicting unfavourable early hepatic events and mortality in patients with portal hypertension and advanced liver diseases. EDcharacterised by an impaired bioactivity of nitric oxide(NO) within the hepatic circulation and is mainly due to decreased bioavailability of NO and accelerated degradation of NO with reactive oxygen species. Furthermore, elevated inflammatory markers also inhibit NO synthesis and causes ED in cirrhotic liver. Therefore, improvement of NO availability in the hepatic circulation can be beneficial for the improvement of endothelial dysfunction and associated portal hypertension in patients with cirrhosis. Furthermore, therapeutic agents that are identified in increasing NO bioavailability through improvement of hepatic endothelial nitric oxide synthase(e NOS) activity and reduction in hepatic asymmetric dimethylarginine, an endogenous modulator of e NOS and a key mediator of elevated intrahepatic vascular tone in cirrhosis would be interesting therapeutic approaches in patients with endothelial dysfunction and portal hypertension in advanced liver diseases.

Effect of Trimetazidine Dihydrochloride Tablets adjuvant therapy on inflammatory reaction, oxidative stress, vascular endothelial function and myocardial function in patients with coronary heart disease complicated with heart failure

Objective: To investigate the effects of Trimetazidine Dihydrochloride Tablets on inflammatory reaction, oxidative stress, vascular endothelial function and myocardial function in patients with coronary heart disease complicated with heart failure. Methods: A total of 98 patients with coronary heart disease and heart failure who met the criteria of the study were selected as the subjects, based on the random data table they were divided into the control group (n=49) and observation group (n=49), the patients in the control group were treated with Metoprolol Tartrate Sustained-release Tablets treatment, and the patients in the observation group were treated with Metoprolol Tartrate Sustained-release Tablets combined with Trimetazidine Dihydrochloride Tablets, the levels of inflammatory reaction, oxidative stress, vascular endothelial function and myocardial function indexes were compared between the two groups before and after treatment. Results: The difference of the CRP, TNF-α, MDA, SOD, NO, ET-1, LVEF, LVEDD and LVESD levels in the two groups before treatment were not statistically significant;Compared with the levels of the two groups before treatment, the two groups of CRP, TNF-α, MDA, ET-1, LVEDD and LVESD levels after treatment were significantly decreased, and the level of the observation group after treatment was significantly lower than those levels in the control group, the difference was statistically significant;The levels of SOD, NO and LVEF of the two groups after treatment were significantly higher than those in the same group before treatment, and the observation group levels [(88.09±7.51) U/ml, (72.58±14.64) mol/L, (48.34±5.09)% ] were significantly higher than the control group [(79.44±7.27) U/ml, (61.89±11.06) mol/L, (44.19±4.58)%], the difference was statistically significant. Conclusion: Trimetazidine Dihydrochloride Tablets in the treatment of coronary heart disease with heart failure can effectively inhibit the release of inflammatory factors, improve oxidative stress state, vascular endothelial function and myocardial function, has an important clinical value.

Endothelial Function and Carotid Artery Wall Thickening in Patients with Early Essential Hypertension

To investigate the relationship between endothelial function and carotid artery wall thickening in patients with early mild essential hypertension, the percent dilatation of humerus diameter and intimal-medial thickening (IMT) of common carotid artery was measured by using high-resolution ultrasound in 20 patients with early mild essential hypertension and 18 patients with normotension.The patients with hypertension had not been treated and their history of increased blood pressure was less than 12 months. In essential hypertension group, the percent dilatation of humerus diameter decreased significantly (2. 65 ± 0. 98 % vs6. 38 ± 1. 61 % ) ; IMT of carotid artery increased (0. 88 ± 0. 16mm vs 0. 58 ±0. 08). There was significant negative correlation between IMT and the percentdilatation of humerus diameter (γ= - 0. 82, P<0. 05), and no correlation be-tween IMT and 24 h mean systolic, diastolic pressure (γ= 0. 12 and γ= 0.07,respectively ; P> 0. 05). Our results suggested that there was endothelial dys-function in early mild essential hypertension. Endothelial dysfunction may not on-ly contribute to the pathogenesis of hypertension but also serve as the most impor-tant inducing factor leading trans formation from hypertension to atherosclerosis.

Effects of hormone replacement therapy on endothelial function in menopausal women

Objective To observe the effects of hormone replacement therapy (HRT) on endothelial function in menopausal women. Methods A total of 30 menopausal women were treated with 2.5 mg of Tibolone (Livial) daily. At the same time,30 women with natural menopause without any treatment served as the control group. Endothelium-dependent (EDD),endothelium-independent (NID) vasodilatation function,and estradiol (E2) were examined by the non-invasive high-resolution ultrasonography before the treatment and at 12th,24th,36th and 48th week of treatment,respectively. Results After hormone treatment,E2 increased significantly and EDD was improved significantly (P<0.05),and E2 was positively related with EDD (r=0.8092,P<0.001). No change of EDD was observed in the control group whereas a significant increase was observed in the treatment group. Conclusion Endothelium-dependent vasodilatation dysfunction is prominent in menopausal women. Tibolone can help improve the condition.

Effect of rosuvastatin on the vascular endothelial function and inflammatory cytokine in patients after PCI

Objective:To evaluate the effect of rosuvastatin on the vascular endothelial function and inflammatory cytokine in patients after PCI.Methods:A total of 120 patients with ACS who were admitted in our hospital from December, 2014 to June, 2016 were included in the study and randomized into the observation group and the control group. PCI was performed in the two groups. The patients in the control group were given routine treatments. On this basis, the patients in the observation group were given rosuvastatin (20 mg) 3 d before operation, every night before sleep, continuously for 1 month. The efficacy was evaluated 24 h and 1 month after operation. Hs-CRP, IL-10, TNF-α, vWF, ET-1, NO, TG, TC, and LDL levels before operation, 24 h and 1 month after operation in the two groups were detected.Results:vWF and ET-1 levels 1 month after operation in the observation group were significantly lower than those in the control group, while NO was significantly higher than that in the control group. hs-CRP, IL-10, and TNF-α 24 h and 1 month after operation in the observation group were significantly lower than those in the control group. TC, TG, and LDL levels 24 h and 1 month after operation in the observation group were significantly lower than those in the control group.Conclusions:Rosuvastatin can effectively reduce the serum inflammatory cytokine level, improve the vascular endothelial function, and decrease the occurrence of thrombus and restenosis in patients with ACS after PCI.

Effects of low molecular heparin combined with Roy adaptation model on hypercoagulable state, endothelial function and placental blood perfusion in patients with preeclampsia

Objective: To investigate the effects of low molecular heparin combined with Roy adaptation model on hypercoagulable state, endothelial function and placental blood perfusion in patients with preeclampsia. Methods: A total of 71 patients with preeclampsia who were treated in Zigong Third People's Hospital between December 2014 and February 2017 were retrospectively analyzed and divided into the control group (n=38) who accepted conventional low molecular heparin therapy and the study group (n=33) who accepted low molecular heparin combined with Roy adaptation model therapy. The differences in hypercoagulable state, endothelial function and placental blood perfusion were compared between the two groups before intervention and after 8 weeks of intervention. Results: Before intervention, there was no statistically significant difference in the hypercoagulable state, endothelial function and placental blood perfusion between the two groups of patients. After 8 weeks of intervention, peripheral blood coagulation indexes TT and AT-Ⅲ levels of study group were higher than those of control group while D-D level was lower than that of control group;serum endothelial function index NO content was higher than that of control group while ET-1 content was lower than that of control group;ultrasonic placental blood perfusion parameters FI, VI and VFI levels were higher than those of control group. Conclusion: Low molecular heparin combined with Roy adaptation model intervention could further reduce the hypercoagulable state, decrease the vascular endothelial injury, and eventually increase the placental blood perfusion in patients with preeclampsia.

RELATIONS OF ENDOTHELIAL FUNCTION AND BLOOD FLOW IN BRACHIAL ARTERY AND CORONARY ARTERY

Objective:To determine the relations between endothelium-dependent vasodilator function and blood flow in the brachial and coronary arteries in patients with suspected coronary artery disease.Methods:Twenty-eight patients with suspected coronary artery disease underwent brachial artery endothelial function test by using high-resolution B-mode ultrasound before coronary angiography(CAG)and coronary flow reserve(CFR)test by using intracoronary Doppler technique.The correlation of coronary artery dilatation induced by an increase in blood flow after intracoronary adenosine infusion and brachial artery flow-mediated dilatation(FMD) following reactive hyperemia was evaluated.The relation between the change of brachial artery blood flow and CFR was also studied.Results:There was a positive correlation between brachial FMD and percent change of coronary diameter after adenosine infusion(12.50%±9.35% vs 11.38%±7.55%,r=0.425,P=0.02).There was also a weak negative relation between brachial flow change following reactive hy-peremia and CFR(r=-0.397,P=0.04).Conclusion:There is a correlation between the coronary endo-thelial function and the CFR by ultrasonic determination of brachial flow changes following reactive hyperemia.

Influence of folic acid and vitamin B12 combined therapy on plasma Hcy, inflammatory factor levels and blood vessels endothelial function in patients with vascular dementia and type H hypertension

Objective:To investigate influence of folic acid and vitamin B12 combined therapy on plasma homocysteine (Hcy) level, blood vessels endothelial function and inflammatory factors in patients with vascular dementia and type H hypertension.Methods:100 cases of patients with vascular dementia and type H hypertension accorded with the inclusion criteria were selected as research objects. They were randomly divided as the control group and the therapeutic group, 50 cases each. For control group, Enalapril tablets were administered by mouth for treatment. For therapeutic group, folic acid and vitamin B12 treatment were provided on the basis of treatment for control group. Treatments were continued for 12 weeks. Plasma Hcy levels, inflammatory factors [(interleukin-6 (IL-6), interleukin-8 (IL-8) and hypersensitive C reaction protein (hs-CRP)], blood vessels endothelial function indexes variation in patients before and after treatment were observed and detected.Results:Plasma Hcy, IL-6, IL-8 and hs-CRP levels in two groups of patients after treatment were significantly decreased comparing with the same group before treatment, and the above index levels in therapeutic group after treatment were significantly lower than control group (P<0.05);For comparison of blood vessels endothelial function indexes in the patients, NO levels in two groups after treatment were increased in various degrees, and endothelin-1 (ET-1) were decreased. The differences between levels of the two indexes in therapeutic group before and after treatment were significant, and levels after treatment in therapeutic group were significantly better than in control group (P<0.05). While variations of the differences in control group before and after treatment were not significant (P>0.05);After treatment, diastolic pressure and systolic pressure in the two groups of patients were significantly improved comparing with before treatment (P<0.05). However, after treatment, the differences of levels between therapeutic group and control group were not significant (P>0.05). MMSE score in therapeutic group after treatment was significantly higher than before treatment, and significantly higher than in control group (P<0.05).Conclusions: Combined therapy of folic acid and vitamin B12 for treating vascular dementia with type H hypertension could effectively decrease plasma Hcy and inflammatory factor levels, and improve blood vessels endothelial function and dementia degree on patients. It has certain clinical value which deserves to be promoted.

Effects of Obstructive Sleep Apneas on Endothelial Function and Autonomic Modulation in Adult Man

Objective To study the effects of obstructive sleep apneas on endothelial function and autonomic modulation. Methods From June 2009 to June 2011, male patients with obstructive sleep apnea hypopnea syndrome (OSAHS) were consecutively enrolled in this study. Patients with an apnea/hypopnea index (AHI) of greater than 15 and without previous treatment for OSAHS were included as Group OSAHS and obese subjects with an AHI of less than 5 were included as non-OSAHS controls (Group Control). Electrocardiography and beat-to-beat blood pressure were continuously recorded from the radial artery by applanation tonometry which was synchronized with polysomnography recording. Endothelial function was measured by arterial augmentation index (AAI). Spectral analysis of heart rate variability (HRV) and blood pressure variability (BPV) were computed for cardiac parasympathetic modulation (high frequency power, HF); sympathetic modulation (low frequency power, LF), sympathovagal balance (LF/HF power of R-R variability, LF/HF) and BPV sympathetic modulation (BPV LF) in normalized units [total power of the components/(total power-very LF power)×100]. Results Finally, 27 moderate-severe OSAHS patients and 22 non-OSAHS obese controls were recruited in the Group OSAHS and Group Control, respectively. In Group OSAHS, the age was 43.3±9.3 year-old, body mass index (BMI) was 36.8±8.7 kg/m 2 ; in Group Control, the age was 42.9±8.6 year-old, BMI was 34.4±7.9 kg/m 2 ; there were no significant differences in age and BMI between the Group OSAHS and Group Control (all P>0.05). The baseline AAI (12.5%±2.2% vs. 8.2%±2.1%) and BPV LF (68.3%±13.5% vs. 61.1%±11.7%) of the Group OSAHS were significantly higher than those of the Group Control (all P<0.05). And after overnight sleep, systolic BP (143.7±14.2 vs. 132.8±13.3 mm Hg), diastolic BP (87.7±7.7 vs. 78.6±5.5 mm Hg), HRV LF (69.7%±14.4% vs. 64.3%±12.1%), HRV LF/HF (3.7±2.0 vs. 2.3±1.3) and BPV LF (77.8%±15.6% vs. 68.3%±13.5%) of the Group OSAHS were significantly increased (all P<0.001), while HRV HF was significantly decreased (21.1%±9.3% vs. 27.5%±10.3%, P<0.05) from baseline.Conclusions The baseline endothelial function and autonomic modulation are impaired in OSAHS patients, which happened prior to hypertension and other cardiovascular complications. And the load effects of overnight obstructive breathing events could induce blood pressure and sympathetic activity increasing in the morning in OSAHS patients without acute aggravation in endothelial dysfunction.

Ultrasonic evaluation of the relationship between left ventricular hypertrophy or left ventricular geometry and endothelial function in patients with essential hypertension

Objective： To assess the relationship between left ventricular hypertrophy （LVH） or left ventricular geometry （LVG） and endothelial function in patients with essential hypertension （EH）. Methods： Seventy-six patients and 30 normal subjects were first examined by echocardiography. Brachial artery dilatation induced by reactive hyperemia （DIRH） or nitroglycerin （DING） was detected using high-resolution ultrasonography. Results： DIRH was lower in patients with hypertension than in the controls, and the decrease in DIRH was greater in the patients with LVH than that in patients without LVH （4.36±2.54% vs 8.56 ± 1.87 %; P 〈 0.0001）. There were no significant differences in age, serum concentrations of total cholesterol, triglycerides or sugar, blood pressure and the brachial artery dilatation induced by nitroglycerin between the two groups （P 〉 0.05）. While there was no significant difference in DIRH between the patients with normal left ventricular geometry or cardiac remodeling, the patients showing either eccentric or concentric left ventricular hypertrophy had lower DIRH than the patients with normal left ventricular geometry or cardiac remodeling. The DIRH was the lowest in patients with concentric hypertrophy. Although bivariate analysis showed that the left ventricular mass index （LVMI） correlated well with the brachial artery dilatation induced by reactive hyperemia, diastolic blood pressure and mean blood pressure （r=-0.61, P 〈 0.0001; r=0.27, P 〈 0.05; r=0.31, P 〈 0.05, respectively）, a multivariate stepwise regression demonstrated that LVMI correlated only with the brachial artery dilatation induced by reactive hyperemia. Conclusion： Left ventricular hypertrophy was related to endothelial dysfunction in essential hypertension. The endothelial dysfunction might be basic and important in the progression of left ventricular hypertrophy.