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Animal Models and Experimental Medicine Feb 2022Circular RNAs (circRNAs) are endogenous RNAs with a covalently closed single-stranded transcript. They are a novel class of genomic regulators that are linked to many... (Review)
Review
Circular RNAs (circRNAs) are endogenous RNAs with a covalently closed single-stranded transcript. They are a novel class of genomic regulators that are linked to many important development and disease processes and are being pursued as clinical and therapeutic targets. Using the most powerful RNA sequencing and bioinformatics techniques, a large number of circRNAs have been identified and further functional studies have been performed. It is known that circRNAs act as potential biomarkers, sponges for microRNAs (miRNAs) and RNA-binding proteins (RBPs), and regulators of mRNA transcription. They also participate in the translation of peptides or proteins. Many types of circRNAs are dysregulated in plasma or lung tissues, and they may be involved in regulating the proliferation and apoptosis of pulmonary artery endothelial cells (PAECs) and pulmonary artery smooth muscle cells (PASMCs), leading to pulmonary vascular remodeling in pulmonary hypertension (PH). One possible mechanism is that circRNAs can regulate the function of PAECs and PASMCs by acting as miRNA sponge. However, other potential mechanisms of action of circRNAs are still being actively explored in PH. This paper presents a systematic review of the biogenesis, biological characterization, relevant underlying functions, and future perspectives for studies of circRNAs in the pathogenesis of PH.
Topics: Computational Biology; Endothelial Cells; Humans; Hypertension, Pulmonary; MicroRNAs; RNA, Circular
PubMed: 35229989
DOI: 10.1002/ame2.12208 -
Arthritis and Rheumatism Sep 2013Pulmonary hypertension (PH) is a frequent and life-limiting complication of systemic sclerosis (SSc). However, data on survival rates and their evolution over time, as... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Pulmonary hypertension (PH) is a frequent and life-limiting complication of systemic sclerosis (SSc). However, data on survival rates and their evolution over time, as well as prognostic factors in SSc complicated by PH, are still conflicting. The aim of this study was to conduct a systematic review and meta-analysis of cohort studies to assess pooled survival and prognostic factors for survival in patients with SSc-associated PH.
METHODS
For this systematic review and meta-analysis, we searched the Medline and EMBase databases (January 1960 to January 2012). All cohort studies in which survival and/or prognostic factors for SSc-associated PH were reported were included in the analysis. We calculated the pooled survival rates and analyzed their evolution over time and identified prognostic factors for survival.
RESULTS
Twenty-two studies were included, representing a total of 2,244 patients with SSc-associated PH. The pooled 1-, 2-, and 3-year survival rates were 81% (95% confidence interval [95% CI] 79-84%), 64% (95% CI 59-69%), and 52% (95% CI 47-58%), respectively. Meta-regression did not reveal a significant change in survival over time, while baseline hemodynamic measures of PH severity were significantly correlated with survival. In patients with SSc complicated by pulmonary arterial hypertension (PAH), age, male sex, diffusing capacity for carbon monoxide (DLCO), pericardial effusion, and the parameters classically associated with the severity of idiopathic PAH, including the 6-minute walk distance, mean pulmonary artery pressure, cardiac index, and right atrial pressure, were significant prognostic factors. DLCO and pericardial effusion were the only prognostic factors in patients with interstitial lung disease-related PH.
CONCLUSION
Our meta-analysis revealed a poor pooled 3-year survival rate of 52% in patients with SSc-associated PH. Baseline hemodynamic measures of PAH severity, but not the period of time during which patients were included in the studies, correlated significantly with survival in patients with SSc-associated PAH. All of the prognostic factors typically observed in idiopathic PAH, including the 6-minute walk distance and right atrial pressure, were also prognostic factors in SSc-associated PAH.
Topics: Age Factors; Female; Humans; Hypertension, Pulmonary; Male; Prognosis; Scleroderma, Systemic; Sex Factors; Survival Rate
PubMed: 23740572
DOI: 10.1002/art.38029 -
Journal of Cardiothoracic and Vascular... Nov 2023The authors performed a systematic review to evaluate the effect of pharmacologic therapy on pulmonary hypertension in the perioperative setting of elective cardiac...
OBJECTIVE
The authors performed a systematic review to evaluate the effect of pharmacologic therapy on pulmonary hypertension in the perioperative setting of elective cardiac surgery (PROSPERO CRD42023321041).
DESIGN
Systematic review of randomized controlled trials with a Bayesian network meta-analysis.
SETTING
The authors searched biomedical databases for randomized controlled trials on the perioperative use of inodilators and pulmonary vasodilators in adult cardiac surgery, with in-hospital mortality as the primary outcome and duration of ventilation, length of stay in the intensive care unit, stage 3 acute kidney injury, cardiogenic shock requiring mechanical support, and change in mean pulmonary artery pressure as secondary outcomes.
PARTICIPANTS
Twenty-eight studies randomizing 1,879 patients were included.
INTERVENTIONS
Catecholamines and noncatecholamine inodilators, arterial pulmonary vasodilators, vasodilators, or their combination were considered eligible interventions compared with placebo or standard care.
MEASUREMENTS AND MAIN RESULTS
Ten studies reported in-hospital mortality and assigned 855 patients to 12 interventions. Only inhaled prostacyclin use was supported by a statistically discernible improvement in mortality, with a number-needed-to-treat estimate of at least 3.3, but a wide credible interval (relative risk 1.26 × 10 - 0.7). Inhaled prostacyclin and nitric oxide were associated with a reduction in intensive care unit stay, and none of the included interventions reached a statistically evident difference compared to usual care or placebo in the other secondary clinical outcomes.
CONCLUSIONS
Inhaled prostacyclin was the only pharmacologic intervention whose use is supported by a statistically discernible improvement in mortality in the perioperative cardiac surgery setting as treatment of pulmonary hypertension. However, available evidence has significant limitations, mainly the low number of events and imprecision.
PubMed: 37652847
DOI: 10.1053/j.jvca.2023.07.041 -
Bioengineering (Basel, Switzerland) Sep 2022The choice of valve substitute for aortic valve surgery is tailored to the patient with specific indications and contraindications to consider. The use of an autologous... (Review)
Review
INTRODUCTION
The choice of valve substitute for aortic valve surgery is tailored to the patient with specific indications and contraindications to consider. The use of an autologous pulmonary artery (PA) with a simultaneous homograft in the pulmonary position is called a Ross procedure. It permits somatic growth and the avoidance of lifelong anticoagulation. Concerns remain on the functionality of a pulmonary autograft in the aortic position when exposed to systemic pressure.
METHODS
A literature review was performed incorporating the following databases: Pub Med (1996 to present), Ovid Medline (1958 to present), and Ovid Embase (1982 to present), which was run on 1 January 2022 with the following targeted words: biomechanics of pulmonary autograft, biomechanics of Ross operation, aortic valve replacement and pulmonary autograph, aortic valve replacement and Ross procedure. To address the issues with heterogeneity, studies involving the pediatric cohort were also analyzed separately. The outcomes measured were early- and late-graft failure alongside mortality.
RESULTS
a total of 8468 patients were included based on 40 studies (7796 in pediatric cohort and young adult series and 672 in pediatric series). There was considerable experience accumulated by various institutions around the world. Late rates of biomechanical failure and mortality were low and comparable to the general population. The biomechanical properties of the PA were superior to other valve substitutes. Mathematical and finite element analysis studies have shown the potential stress-shielding effects of the PA root.
CONCLUSION
The Ross procedure has excellent durability and longevity in clinical and biomechanical studies. The use of external reinforcements such as semi-resorbable scaffolds may further extend their longevity.
PubMed: 36135002
DOI: 10.3390/bioengineering9090456 -
Roczniki Panstwowego Zakladu Higieny 2022Background. SARS-CoV-2 virus is one of the largest RNA viruses, included in the coronavirus group, showing tropism to airway epithelial cells. SARS-CoV-2 causes an acute...
BACKGROUND
Background. SARS-CoV-2 virus is one of the largest RNA viruses, included in the coronavirus group, showing tropism to airway epithelial cells. SARS-CoV-2 causes an acute respiratory infectious disease, Covid-19. According to WHO reports, mortality due to Covid-19 is higher in the elderly and in those burdened with comorbidities such as diabetes, obstructive pulmonary disease, coronary artery disease, cancer, hypertension, hepatitis B, obesity or chronic kidney disease.
OBJECTIVE
The aim of the study was to review the current literature on the influence and importance of vitamin D levels on the course of SARS-CoV-2 infection.
MATERIAL AND METHOD
A systematic review of studies published from January 1, 2009 to June 31, 2021 has been performed. For this purpose, bibliographic databases such as PubMed and Scopus were searched. The following keywords and combinations were used: Covid-19, vitamin D, 25-hydroxy-vitamin D, vitamin D supplementation, SARS-CoV-2.
RESULTS
It has been shown that vitamin D plays an important role in the mechanisms of the innate immunity in the course of the acute respiratory infections. The overlapping factors of the severity of COVID-19 disease, vitamin D deficiency, and the prevalence of obesity, age scare, ethnicity, has led some researchers to hypothesize that vitamin D supplementation may be promising as a preventive or therapeutic measure for COVID-19.
CONCLUSIONS
A very important factor that has an immunomodulatory character is vitamin D, the adequate supplementation of which can be a preventive or therapeutic measure in case of SARS-CoV-2 infection, especially in elderly people, with obesity and other chronic diseases.
Topics: Aged; COVID-19; Humans; SARS-CoV-2; Vitamin D; Vitamin D Deficiency; Vitamins
PubMed: 35322953
DOI: 10.32394/rpzh.2022.0191 -
Journal of Thrombosis and Haemostasis :... Feb 2008Pulmonary embolism (PE) and intracardiac thrombosis (ICT) are rare but potentially lethal complications during orthotopic liver transplantation (OLT). (Review)
Review
BACKGROUND
Pulmonary embolism (PE) and intracardiac thrombosis (ICT) are rare but potentially lethal complications during orthotopic liver transplantation (OLT).
METHODS
We aimed to review clinical and pathological correlates of PE and ICT in patients undergoing OLT. A systematic review of the literature was conducted using MEDLINE and ISI Web of Science.
RESULTS
Seventy-four cases of intraoperative PE and/or ICT were identified; PE alone in 32 patients (43%) and a combination of PE and ICT in 42 patients (57%). Most frequent clinical symptoms included systemic hypotension and concomitant rising pulmonary artery pressure, often leading to complete circulatory collapse. PE and ICT occurred in every stage of the operation and were reported equally in patients with or without the use of venovenous bypass or antifibrinolytics. A large variety of putative risk factors have been suggested in the literature, including the use of pulmonary artery catheters or certain blood products. Nineteen patients underwent urgent thrombectomy or thrombolysis. Overall mortality was 68% (50/74) and 41 patients (82%) died intraoperatively.
CONCLUSION
Mortality was significantly higher in patients with an isolated PE, compared to patients with a combination of PE and ICT (91% and 50%, respectively; P < 0.001). Intraoperative PE and ICT during OLT appear to have multiple etiologies and may occur unexpectedly at any time during the procedure.
Topics: Adolescent; Adult; Child; Child, Preschool; Combined Modality Therapy; Female; Heart Diseases; Hospital Mortality; Humans; Hypertension, Pulmonary; Hypotension; Infant; Infant, Newborn; Intraoperative Complications; Liver Transplantation; Male; Middle Aged; Pulmonary Embolism; Risk Factors; Shock; Thrombelastography; Thrombosis
PubMed: 18005235
DOI: 10.1111/j.1538-7836.2008.02831.x -
Cureus Dec 2022Pulmonary hypertension (PH) is an insidious disease that often presents in late stages due to nonspecific signs and symptoms. Right heart catheterization (RHC) is the... (Review)
Review
Pulmonary hypertension (PH) is an insidious disease that often presents in late stages due to nonspecific signs and symptoms. Right heart catheterization (RHC) is the gold standard diagnostic test, and echocardiogram (ECHO) is the best screening tool. However, the strength of evidence and diagnostic utility of various echocardiographic parameters to screen for is not well elucidated. This systematic review (SR) is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Literature searches was performed for the period of January 1, 2016, to June 1, 2021, on seven databases. We included full-text studies with adult patients that used RHC for comparison and provided sensitivity and specificity results. Likelihood ratios (LRs) and diagnostic odds ratios (DORs) were calculated. Risk of bias was assessed using the Quality Assessment Tool for the Observational Cohort and Cross-Sectional Studies. We identified 102 studies, but only 14 satisfied our inclusion criteria. The most significant parameters identified for PH screening based on LRs are, in descending order, tricuspid regurgitation gradient peak >36mmHg, systolic pulmonary artery pressure >41mmHg, and tricuspid regurgitation velocity >2.9 m/s. There is strong correlation between LR and DOR for these parameters. This SR indicates the superiority of some ECHO parameters over others to aid in the screening and severity assessment of PH. Variables with low LR (-) ratios may help to prevent unnecessary invasive assessment for PH. Clinicians should utilize a multi-parameter approach when interpreting echocardiograms for PH assessment.
PubMed: 36620785
DOI: 10.7759/cureus.32185 -
Sports Medicine - Open Sep 2018Swimming-induced pulmonary oedema (SIPE) can affect people with no underlying health problems, but may be life threatening and is poorly understood. The aim of this... (Review)
Review
BACKGROUND
Swimming-induced pulmonary oedema (SIPE) can affect people with no underlying health problems, but may be life threatening and is poorly understood. The aim of this systematic review was to synthesise the evidence on SIPE incidence, prevalence, risk factors, short- and long-term outcomes, recurrence and effectiveness of interventions to prevent recurrences.
METHODS
We carried out a literature search using bibliographic databases and reference lists. Risk of bias was assessed by adapting existing quality assessment tools including those developed by the National Heart Lung and Blood Institute.
RESULTS
Nine studies met the inclusion criteria. Quantitative synthesis was not possible because of study heterogeneity. Five studies, which differed from each other in case definition, swimming environment, population characteristics and denominators, reported an incidence of 0.01% of UK triathlons raced over 5 years in unspecified swimming environments (one study, not fully reported, of men and women of unspecified age); 0.5% of river races swum over 3 days in Sweden (one study, of men and women up to the age of 70); and 1.8-26.7% of time trials in the sea around Israel (three studies of male teenage military trainees). One study reported that 1.4% of triathletes in the USA had experienced SIPE. One study found that hypertension, female sex, fish oil use, long course distance and another lower initial lung volumes and flows were risk factors for SIPE. A third study reported that higher mean pulmonary artery pressures and pulmonary artery wedge pressures, and lower tidal volumes were associated with SIPE. Three studies suggested that SIPE symptoms usually resolve within 24 h, although a restrictive deficit in lung function persisted for a week in one small study. We found no studies that reported deaths from SIPE. The single small study of longer-term outcomes reported no difference between affected and unaffected swimmers. Two studies suggested that around 30% of people report recurrences of SIPE. Two very small uncontrolled studies of the effect of sildenafil for recurrence prevention were inconclusive.
CONCLUSIONS
SIPE may be an important public health problem affecting the growing number of recreational open water swimmers. Further research should clarify the frequency of SIPE among recreational open water swimmers, confirm reported risk factors and explore others, explore long-term consequences and test interventions to prevent recurrences.
PubMed: 30238206
DOI: 10.1186/s40798-018-0158-8 -
Journal of Cardiothoracic Surgery Aug 2022Pulmonary arterial hypertension (PAH) is a progressive disease. Although great progress has been made in its diagnosis and treatment in recent years, its mortality rate... (Review)
Review
Pulmonary arterial hypertension (PAH) is a progressive disease. Although great progress has been made in its diagnosis and treatment in recent years, its mortality rate is still very significant. The pathophysiology and pathogenesis of PAH are complex and involve endothelial dysfunction, chronic inflammation, smooth muscle cell proliferation, pulmonary arteriole occlusion, antiapoptosis and pulmonary vascular remodeling. These factors will accelerate the progression of the disease, leading to poor prognosis. Therefore, accurate etiological diagnosis, treatment and prognosis judgment are particularly important. Here, we systematically review the pathophysiology, diagnosis, genetics, prognosis and treatment of PAH.
Topics: Animals; Cell Proliferation; Disease Models, Animal; Familial Primary Pulmonary Hypertension; Humans; Hypertension, Pulmonary; Muscle, Smooth, Vascular; Pulmonary Arterial Hypertension; Pulmonary Artery
PubMed: 36038916
DOI: 10.1186/s13019-022-01947-y -
The Cochrane Database of Systematic... Mar 2015Most ischaemic strokes are caused by a blood clot blocking an artery in the brain. Clot prevention with anticoagulants might improve outcomes if bleeding risks are low.... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Most ischaemic strokes are caused by a blood clot blocking an artery in the brain. Clot prevention with anticoagulants might improve outcomes if bleeding risks are low. This is an update of a Cochrane review first published in 1995, with recent updates in 2004 and 2008.
OBJECTIVES
To assess the effectiveness and safety of early anticoagulation (within the first 14 days of onset) in people with acute presumed or confirmed ischaemic stroke.
SEARCH METHODS
We searched the Cochrane Stroke Group Trials Register (June 2014), the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR), the Database of Reviews of Effects (DARE) and the Health Technology Assessment Database (HTA) (The Cochrane Library 2014 Issue 6), MEDLINE (2008 to June 2014) and EMBASE (2008 to June 2014). In addition, we searched ongoing trials registries and reference lists of relevant papers. For previous versions of this review, we searched the register of the Antithrombotic Trialists' (ATT) Collaboration, consulted MedStrategy (1995), and contacted relevant drug companies.
SELECTION CRITERIA
Randomised trials comparing early anticoagulant therapy (started within two weeks of stroke onset) with control in people with acute presumed or confirmed ischaemic stroke.
DATA COLLECTION AND ANALYSIS
Two review authors independently selected trials for inclusion, assessed trial quality, and extracted the data.
MAIN RESULTS
We included 24 trials involving 23,748 participants. The quality of the trials varied considerably. The anticoagulants tested were standard unfractionated heparin, low-molecular-weight heparins, heparinoids, oral anticoagulants, and thrombin inhibitors. Over 90% of the evidence relates to the effects of anticoagulant therapy initiated within the first 48 hours of onset. Based on 11 trials (22,776 participants) there was no evidence that anticoagulant therapy started within the first 14 days of stroke onset reduced the odds of death from all causes (odds ratio (OR) 1.05; 95% confidence interval (CI) 0.98 to 1.12) at the end of follow-up. Similarly, based on eight trials (22,125 participants), there was no evidence that early anticoagulation reduced the odds of being dead or dependent at the end of follow-up (OR 0.99; 95% CI 0.93 to 1.04). Although early anticoagulant therapy was associated with fewer recurrent ischaemic strokes (OR 0.76; 95% CI 0.65 to 0.88), it was also associated with an increase in symptomatic intracranial haemorrhages (OR 2.55; 95% CI 1.95 to 3.33). Similarly, early anticoagulation reduced the frequency of symptomatic pulmonary emboli (OR 0.60; 95% CI 0.44 to 0.81), but this benefit was offset by an increase in extracranial haemorrhages (OR 2.99; 95% CI 2.24 to 3.99).
AUTHORS' CONCLUSIONS
Since the last version of the review, no new relevant studies have been published and so there is no additional information to change the conclusions. Early anticoagulant therapy is not associated with net short- or long-term benefit in people with acute ischaemic stroke. Treatment with anticoagulants reduced recurrent stroke, deep vein thrombosis and pulmonary embolism, but increased bleeding risk. The data do not support the routine use of any of the currently available anticoagulants in acute ischaemic stroke.
Topics: Anticoagulants; Brain Ischemia; Humans; Randomized Controlled Trials as Topic; Risk; Stroke
PubMed: 25764172
DOI: 10.1002/14651858.CD000024.pub4