Assessment of Regular Physical Activity in the Care of Hypertensive Patients at the Cardiology Institute of Abidjan and at the National Police Hospital (Ivory Coast)

Aim: Physical activity and other lifestyle changes are an important part of the guidelines for anti-hypertensive therapy. The effect of physical activity on hypertension and heart disease has been well described. No study in our context has been done on this issue. The aim of this study was to evaluate regular physical activity in the management of hypertensive patients at the Cardiology Institute of Abidjan and the National Police Hospital. Material and methods: This was a prospective and descriptive study held in the External Consultations and Rehabilitation Departments of the aforementioned structures. It started on July 20, 2017 and ended on September 7, 2017. The data were analyzed on SPSS version 22. A p-value of less than 0.05 was considered to be statistically significant. Results: Out of the 190 hypertensive patients recruited and educated, only 70 actually participated in the physical activities that took place in the Rehabilitation Department of Heart Institute. The mean age of the patients was 52 years ± 15 years. The most affected age group was between 40 and 49 years of age (47.40%).There was a male predominance with a sex ratio of 1.11. 63.16% of the patients had a superior. The follow-up time for Hypertension was more than one year in 73.68% of the cases. Our study highlighted the knowledge of the virtues of regular physical activity on the body in 94.74% of cases. Physical activity was prescribed in 94.74% of cases. It was practiced in 63.16% of cases. The mains reasons given for those who did not practice physical activity were “lack of willpower” (90%) and physical activity considered “too tiring” (70%). Physically active patients had a significant decrease of 17.98 mmHg in systolic blood pressure (p < 0.001) and 11.54 mmHg in diastolic blood pressure (p < 0.001). Conclusion: The practice of physical activity in the control of hypertension remains insufficient at the Abidjan Heart Institute. Despite this insufficiency, physical exercise seems to have a positive effect on blood pressure control associated with antihypertensive pharmacological treatment.

Role of radionuclide imaging for diagnosis of device and prosthetic valve infections

Cardiovascular implantable electronic device(CIED) infection and prosthetic valve endocarditis(PVE) remain a diagnostic challenge.Cardiac imaging plays an important role in the diagnosis and management of patients with CIED infection or PVE.Over the past few years,cardiac radionuclide imaging has gained a key role in the diagnosis of these patients,and in assessing the need for surgery,mainly in the most difficult cases.Both ^(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(^(18)F-FDG PET/CT) and radiolabelled white blood cell single-photon emission computed tomography/computed tomography(WBC SPECT/CT) have been studied in these situations.In their 2015 guidelines for the management of infective endocarditis,the European Society of Cardiology incorporated cardiac nuclear imaging as part of their diagnostic algorithm for PVE,but not CIED infection since the data were judged insufficient at the moment.This article reviews the actual knowledge and recent studies on the use of ^(18)F-FDG PET/CT and WBC SPECT/CT in the context of CIED infection and PVE,and describes the technical aspects of cardiac radionuclide imaging.It also discusses their accepted and potential indications for the diagnosis and management of CIED infection and PVE,the limitations of these tests,and potential areas of future research.

Effect of Acute Volume Loading on LV Function after Acute Cardiac Decentralization in Anesthetized Canines

The present study investigated the role of cardiac nerves on homeometric autoregulation in anesthetized dogs during acute volume loading. Ventricular pressure-volume loops (conductance catheter method) were constructed during acute volume loading with intact cardiac nerves (ICN) and after cardiac decentralization (DCN;bilateral ablation of thoracic vagosympathetic complexes, stellate ganglia and anterior and posterior ansae subclavia). Arterial pressure increased as expected after volume loading but no significant changes were observed for heart rate and other hemodynamic parameters. Coronary sinus venous oxygen content was also higher regardless of nerve status in response to the overall increase in cardiac work. Pressure-volume catheter data showed markedly higher end-systolic volumes after volume loading under ICN and DCN conditions;stroke volume (mL/beat) and stroke work (mL/mm Hg) were not changed but LV ejection fraction was significantly lower. End-diastolic volume and cardiac output did not change. In addition, systemic vascular resistance and tau were higher with volume loading but no differences between ICN and DCN were observed. These findings show that acute volume loading produces an immediate influence on LV function independent of cardiac nerve status.

C5L2 Deficiency Enhances Development of Atherosclerosis in ApoE Knockout Mice

Background: The complement system is important in development of atherosclerosis via regulation of lipid and glucose metabolism as well as inflammation. Aim: The aim of the present study was to further analyze the contribution of C5L2 to the development of atherosclerosis. We proposed that, with DIO feeding, C5L2 deficiency would promote a phenotype that encourages atherosclerosis development. Coupled to ApoE deficiency, double knockout (2KO) mice would show exacerbated atherosclerotic plaque formation. Methods: First, Wildtype (WT) and C5L2-/-(C5L2KO) and subsequently, ApoE-/-(ApoEKO) and C5L2/ApoE double knockout mice were placed on diets inducing obesity (DIO) or standard chow diet for 12 - 15 weeks. Plasma lipids, glucose, cytokines and hepatic glycogen and lipid contents, mRNA levels and enzyme activities and atherosclerotic plaque size were measured. Results: C5L2KO had increased hepatic glucose oxidation (+90%, p < 0.001), reduced liver glycogen content on chow diet (-34%, p < 0.05) but increased with DIO (+51%, p < 0.05) vs WT. Glucose clearance was delayed in C5L2/ApoE-2KO vs ApoEKO mice with chow (p < 0.0001) and DIO diet (p = 0.0026). C5L2KO mice had increased hepatic lipid content and fatty acid synthesis but decreased lipid oxidation vs WT. Plasma cholesterol was further elevated in C5L2/ApoE-2KO vs ApoEKO with DIO feeding (p < 0.05). Hepatic cytokine expression was increased in C5L2KO mice compared to WT mice. Atherosclerotic plaque size was increased in C5L2/ ApoE-2KO mice compared with apoEKO on chow (p < 0.05) and DIO regimen (p < 0.001). Conclusions: C5L2 disruption worsens glucose and lipid metabolism, increases hepatic and circulating inflammation, and aggravates atherosclerosis.

代谢相关药物对3T3-L1脂肪细胞促酰化蛋白分泌的影响

目的:建立使用3T3-L1脂肪细胞评价药物影响促酰化蛋白(ASP)分泌的细胞模型和测定ASP分泌的ELISA方法,观察代谢相关药物二甲双胍、罗格列酮钠及立莫那班对ASP分泌的影响及机制,以及与补体C3、非酯化脂肪酸(NE-FA)释放、甘油三酯总量(TG mass)、脂肪酸摄取量的关系。方法:以3T3-L1前脂肪细胞为实验对象,诱导细胞分化,分别加入乳糜微粒、二甲双胍、罗格列酮钠及立莫那班作用48 h。采用ELISA法测定ASP、C3含量,使用酶标比色法测定NEFA含量,脂肪细胞FA摄取速度在荧光酶标仪进行动力学方法测量,采用分光光度法测定TG含量,考马斯亮蓝染料结合法测定细胞总蛋白。结果:乳糜微粒刺激ASP分泌(达411%±133%P<0.05);罗格列酮钠和立莫那班抑制ASP产生(-53%～-85%,P<0.05),同时抑制前体蛋白C3分泌(-37%～-65%,P<0.05);二甲双胍抑制ASP分泌(-54%～-100%,P<0.05),对前体蛋白C3分泌无影响;二甲双胍降低TG含量(达-60%,P<0.05)和FA摄取速度(达-75%,P<0.05)。结论:成功建立了评价药物影响促酰化蛋白(ASP)分泌的3T3-L1前脂肪细胞模型,并建立了测定ASP分泌的ELISA方法。

interrelationships between ghrelin, insulin and glucose homeostasis: physiological relevance

Ghrelin is a 28 amino acid peptide mainly derived from the oxyntic gland of the stomach. Both acylated(AG) and unacylated(UAG) forms of ghrelin are found in the circulation. Initially, AG was considered as the only bioactive form of ghrelin. However, recent advances indicate that both AG and UAG exert distinct and common effects in organisms. Soon after its discovery, ghrelin was shown to promote appetite and adiposity in animal and human models. In response to these anabolic effects, an impressive number of elements have suggested the influence of ghrelin on the regulation of metabolic functions and the development of obesityrelated disorders. However, due to the complexity ofits biochemical nature and the physiological processes it governs, some of the effects of ghrelin are still debated in the literature. Evidence suggests that ghrelin influences glucose homeostasis through the modulation of insulin secretion and insulin receptor signaling. On the other hand, insulin was also shown to influence circulating levels of ghrelin. Here, we review the relationship between ghrelin and insulin and we describe the impact of this interaction on the modulation of glucose homeostasis.

Influence of cardiac nerve status on cardiovascular regulation and cardioprotection

Neural elements of the intrinsic cardiac nervous system transduce sensory inputs from the heart, blood vessels and other organs to ensure adequate cardiac function on a beat-to-beat basis. This inter-organ crosstalk is critical for normal function of the heart and other organs; derangements within the nervous system hierarchy contribute to pathogenesis of organ dysfunction. The role of intact cardiac nerves in development of, as well as protection against, ischemic injury is of current interest since it may involve recruitment of intrinsic cardiac ganglia. For instance, ischemic conditioning, a novel protection strategy against organ injury, and in particular remote conditioning, is likely mediated by activation of neural pathways or by endogenous cytoprotective bloodborne substances that stimulate different signalling pathways. This discovery reinforces the concept that inter-organ communication, and maintenance thereof, is key. As such, greater understanding of mechanisms and elucidation of treatment strategies is imperative to improve clinical outcomes particularly in patients with comorbidities. For instance, autonomic imbalance between sympathetic and parasympathetic nervous system regulation can initiate cardiovascular autonomic neuropathy that compromises cardiac stability and function. Neuromodulation therapies that directly target the intrinsic cardiac nervous system or other elements of the nervous system hierarchy are currently being investigated for treatment of different maladies in animal and human studies.

Abnormal Adipokines Associated with Various Types of Obesity in Chinese Children and Adolescents

Objective To explore the role of adipokines including insulin, resistin, leptin, adiponectin, acylation stimulating protein （ASP） and complement C3 （C3） in various types of obesity （peripheral obesity, abdominal obesity and mixed obesity） in Chinese children and adolescents, and their relationships with body size and pubertal development. Methods Children and adolescents （n=3 508） aged 6 to 18 years, with 1 788 boys and 1 720 girls were assessed for body mass index, waist circumference, pubertal development, blood insulin, resistin, leptin, adiponectin, ASP and C3 levels. Three types of obesity [peripheral obesity （n=43）, abdominal obesity （n=473）, mixed obesity （n=1 187）] and non‐obese control （n=1 805） were defined with combined use of Chinese body mass index and waist circumference criteria. Results Serum resistin, leptin and adiponectin levels were higher in girls than those in boys （all P0.01）. Insulin and leptin increased and adiponectin decreased across five Tanner stages in both girls and boys （all P0.001）, while ASP changed only in girls （P0.001） and C3 only in boys （P0.001）. Insulin, leptin and ASP were higher, but adiponectin was lower in all three types of obesity vs. the non‐obese control （all P0.05）. The greatest abnormalities of all six adipokines were found in the mixed obesity group. With inclusion of body mass index and waist circumference in simultaneous regression analyses, both body size indices were independently and significantly correlated with insulin, leptin and adiponectin after age and gender adjustment. Compared with waist circumference, the body mass index was stronger in interpreting insulin, leptin, adiponectin and ASP levels, whereas it was weaker in explaining variance of plasma C3. Conclusions Obese children have a worse metabolic profile with high insulin, resistin, leptin, ASP and C3, and low adiponectin levels. The adipokine profile in mixed obesity is worse than that in peripheral or abdominal obesity. Identification of obese subjects with a malignant adipokine profile using a combination of body mass index and waist circumference is important for the prevention of obesity‐related disease.

新发贫血对慢性心力衰竭发病率和死亡率的影响:来自COMET研究的结果

Aims: Anaemia is a common comorbidity in chronic heart failure(CHF). The predictors of new onset anaemia(NOA) and its long-term prognostic value, particularly in patients treated with beta-blockers, are not known. Methods and results: In COMET, 3029 patients with CHF in NYHA Ⅱ-IV and EF< 35%were randomized to carvedilol or metoprolol tartrate and were followed for an average of 58 months. Plasma haemoglobin(Hb) concentrations were measured at a central laboratory at randomization, at four monthly intervals for the first year and annually thereafter. According to WHO criteria, anaemia was defined when Hb measured< 13 g/dL for men and< 12 g/dL for women. We considered anaemia to be severe when Hb< 11.5 g/dL for men and< 10.5 g/dL for women. The baseline mean Hb was 14.2±1.5 g/dL(n=2996) and 15.9%of patients had anaemia(males, 16.0%; females, 15.2%). At baseline, severe anaemia was found in 3.3%of patients(males, 3.6%; females, 2.0%). During the study, all-cause mortality(RR 1.47) death or hospitalization(RR 1.28), and heart failure hospitalization(RR 1.43, all P< 0.0001) were higher in anaemic when compared with non-anaemic patients. In patients without anaemia at baseline, at the end of the study, the cumulative frequency of NOA was 28.1%in males and 27.0%in females. NOA increased over time from 14.2%at year 1 to 27.5%at year 5. Predictors of NOA were: higher age, diuretic dose, creatinine(all P< 0.0001), higher serum potassium, lower serum sodium, body mass index, and use of aldosterone antagonists, carvedilol, and digitalis(all P< 0.03). Treatment with carvedilol(vs. metoprolol tartrate) was associated with a 24%increased risk to develop NOA(P=0.0047),but not severe anaemia(P=0.18). Patients with a Hb decrease of >3 g/dL(RR 3.37, P< 0.0001) or of 2.0-3.0 g/dL(RR 1.47, P=0.011) from baseline had an increased subsequent mortality when compared with patients having Hb increases of 0-1.0 g/dL. Conclusion: In stable ambulatory CHF patients, development of NOA is frequent and can be predicted by a set of clinical variables. Decreases in Hb over time relate to future increased morbidity and mortality.

在行择期经皮冠状动脉介入治疗患者中依诺肝素与普通肝素的比较

背景:尽管普通肝素有一定局限性,但其已被作为经皮冠状动脉介入治疗(PCI)的常规抗凝剂。一些小规模研究提示,静脉使用依诺肝素是安全有效的替代选择。本研究的主要目的是评价在择期PCI患者中使用依诺肝素与普通肝素相比的安全性。

Comparison between Diastolic Subendocardial Tissue Pressures Measured Directly or Calculated from Pressure-Flow Relations

Changes in intramyocardial tissue pressure modulate the relationship between coronary pressure and flow during the cardiac cycle. The present study compared the relation between measured and calculated diastolic subendocardial tissue pressure and coronary pressure at zero flow in anesthetized dogs after modulation of either coronary sinus (i.e. Fogarty catheter) or left ventricular intracavity (i.e. volume loading) pressure. Experiments were conducted in anesthetized, instrumented dogs;coronary pressure flow relations were constructed during pharmacologic vasodilatation and intramyocardial tissue pressure was measured using micromanometer pressure sensors. Elevated coronary sinus pressures did not affect subendocardial pressure-flow relations signifying that diastolic tissue pressure within this layer is the effective coronary back pressure. Higher left ventricular intracavity pressure did not affect either diastolic subendocardial tissue pressure or pressure flow relations within this layer. Results show a direct linear relation (y = 1.106x - 0.652;r2 = 0.59. P = 0.001) between measured and calculated diastolic subendocardial tissue pressure and coronary pressure at zero-flow over a wide range of pressures after either LV systemic or coronary sinus pressure modulation. Knowledge of back pressure in the subendocardium is useful for the evaluation of efficacy of cardiac interventions on myocardial perfusion particularly at the level of the microcirculation.

Multivariate Asthma Phenotypes in Adults: The Quebec City Case-Control Asthma Cohort

Background and Objectives: Asthma is a heterogeneous disease where patient severity can be classified according to various models based on numerous variables. Large collections of well-phenotyped subjects are needed to find distinct clusters of patients for personalized medicine and future genetic studies. The objective of this study is to describe the collection of the Quebec City Case-Control Asthma Cohort and to identify homogeneous subgroups of asthma patients based on clinical characteristics. Methods: This cohort is part of an ongoing project initiated in 2007 to elucidate the genetic basis of asthma. All subjects are randomly recruited at the same site following advertisements. Subjects are unrelated French Canadian white adults 18 years of age or older. Each participant underwent a spirometry, methacholine challenge, and allergy skin-prick tests. Blood was collected for DNA, cell counts and total serum IgE measurements. So far, 982 subjects have been recruited and classified as cases (n = 566) or controls (n = 416). We performed factor and cluster analyses on collected phenotypes from this set to identify subgroups of phenotypically similar asthmatic patients. Results: Factor analysis with 13 variables led to the selection of five factors: lung function, numbers of allergens, blood eosinophil percentage, smoking status and age. K-means cluster analysis on the reduced dataset produced four significantly different groups with the following characteristics: smoking history, low atopy and low lung function, high atopy, and young non-smoking with average atopy. Conclusions: The Quebec City Case-Control Asthma Cohort is a new resource for local and collaborative clinical and genetic research on asthma. This new collection reveals distinct multivariate phenotypes of adult asthma that are likely to be important for future genetic studies and targeted therapies.

风湿性二尖瓣关闭不全的前尖扩张成形术

The mechanism of insufficiency in rheumatic valve disease includes 1. annulus dilatation and 2. restricted leaflet motion. Aiming at improving the treatment o f restriction, augmentation of the anterior mitral leaflet (AML) was achieved wi th a piece of autologous pericardium. Methods: between January 1995 and December 1999, out of 274 patients refered for rheumatic mitral disease, 143 patients un derwent a repair (52%), 81%of them had pure regurgitation with no stenosis. Ri ng annuloplasty was performed in all cases. Two techniques used for treating the restrictive componant of the regurgitation were compared in two consecutive coh ort of patients: no AML augmentation (n=62) and AML augmentation (n=81). Mean ag e was 42±3 years and all preoperative variables were comparable except for the incidence of redo patients who all underwent AML extension. Results: in hospital mortality was 0.7%(n=1 with AML extension) and there was one early reoperation for a pericardial patch dehiscence. After a mean follow up of 3.2 years, there was one sudden death (no AML extension). The reoperation rate was lower with (2 .5%) than without (12.9%)AML augmentation (p< 0.05). Echographic study showed a lower incidence of recurrency of mitral insufficiency when AML augmentation ha d been performed (grade 2:9%and grade 3:3%) as compared to no AML augmentation (grade 2:35%and grade 3:14%) (p< 0.05). The mitral orifice area was larger (A ML augmentation: 2.2+0.3 cm2 vs no AML augmentation: 1.8+0.4cm2). Conclusion: ring annuloplasty alone failed to correct rheumatic mitral insufficiency in all cases. AML augmentation improved the quality of the repair and decreased the ris k of reoperation.

糖尿病及高血压对冠状动脉血流储备的累积副作用

Background: this study aimed to assess the hypothesis that essential hypertens ion (EH) may increase coronary microcirculation dysfunction in patients with typ e 2 diabetes mellitus(DM). Microvascular dysfunction has been reported in patien ts with DM or EH. Discordant results have been reported on cumulative adverse ef fects of the simultaneous presence of DM and EH on coronary flow velocity reserv e (CFR). Methods: CFR were compared in 13 hypertensive diabetics (group 1), 12 n ormotensive diabetics (group 2), 11 hypertensive non diabetics (group 3) and 29 normotensive non diabetic patients (group 4). CFR was calculated using an intrac oronary Doppler tipped flow wire. Results: CFR was significantly lower in patie nts with both DM and EH (2.2±0.4 in group 1 vs 2.8±0.5, 2.8±0.6 and 2.9±0.7 in groups 2, 3 and 4 respectively, p< 0.01). The presence of hypertension reduce d CFR in diabetic patients with angiographically abnormal but unobstructed coron ary arteries (2.1±0.3 in hypertensive vs 3.1±0.2 in normotensive diabetic pati ents, p< 0.02). No cumulative adverse effect was observed in diabetics with angi ographically normal coronary arteries (2.3±0.6 in hypertensive vs 2.6±0.5 in n ormotensive diabetic patients, NS). Multivariate analysis revealed that combinat ion of DM and EH (p< 0.007) was independently related to CFR. Conclusions: the p resence of hypertension appears to worsen coronary microangiopathy in diabetic p atients with unobstructed coronary artery disease. The cumulative effect of EH a nd DM on CFR impairment has consequences for decision making during coronary ang ioplasty and could identify patients at risk for cardiomyopathy.

Extracorporeal membrane oxygenation in COVID-19 associated acute respiratory distress syndrome:A narrative review

Venovenous extracorporeal membrane oxygenation(VV-ECMO)is an established rescue therapy in the management of refractory acute respiratory distress syndrome(ARDS).Although ECMO played an important role in previous respiratory viral epidemics,concerns about the benefits and usefulness of this technique were raised during the coronavirus disease 2019(COVID-19)pandemic.Indeed,the mortality rate initially reported in small case series from China was concerning and exceeded 90%.A few months later,the critical care community published the findings from several observational cohorts on the use of extracorporeal membrane oxygenation(ECMO)in COVID-19-related ARDS.Contrary to the preliminary results,data from the first surge supported the use of ECMO in experienced centers because the mortality rate was comparable to those from the ECMO to Rescue Lung Injury in Severe ARDS(EOLIA)trial or other large prospective studies.However,the mortality rate of the population with severe disease evolved during the pandemic,in conjunction with changes in the management of the disease and the occurrence of new variants.The results from subsequent studies confirmed that the outcomes mainly depend on strict patient selection and center expertise.In comparison with non-COVID-related ARDS,the duration of ECMO for COVID-related ARDS was longer and increased over time.Clinicians and decision-makers must integrate this finding in the ECMO decision-making process to plan their ICU capacity and resource allocation.This narrative review summarizes the current evidence and specific considerations for ECMO use in COVID-19-associated ARDS.

孕期哮喘

医生经常会遇到一些患有哮喘的孕妇对哮喘及其规范治疗知之甚少（见病例摘要框图）。在处理完患者的急性哮喘发作后，医生应该就哮喘、哮喘对妊娠的影响以及哮喘控制最佳方法给患者提出指导意见。