Miracle-dz/UniFAR-FTUs huggingface dataset:
Renin–angiotensin system, natriuretic peptides, obesity, metabolic syndrome, and hypertension: an integrated view in humans

The obesity pandemic is closely related to hypertension and metabolic syndrome. Visceral adipose tissue plays a key role in the metabolic and cardiovascular complications of being overweight. The pathophysiological link between visceral adiposity and cardiometabolic complications focuses on insulin sensitivity, sympathetic nervous system, renin–angiotensin–aldosterone system (RAAS) and, only recently, on cardiac natriuretic peptide system (CNPS). RAAS and CNPS are endogenous antagonistic systems on sodium balance, cardiovascular system, and metabolism. The circulating RAAS is dysregulated in obese patients, and adipose tissue has a full local renin–angiotensin system that is active at local and systemic level. Adipocyte biology and metabolism are influenced by local renin–angiotensin system, with angiotensin II acting as a ‘growth factor’ for adipocytes. CNPS induces natriuresis and diuresis, reduces blood pressure, and, moreover, has powerful lipolytic and lipomobilizing activity in humans but not in rodents. In obesity, lower plasmatic natriuretic peptides levels with increasing BMI, waist circumference, and metabolic syndrome have been documented. Thus, reduced CNPS effects coupled with increased RAAS activity have a central role in obesity and its deadly complications. We propose herein an integrated view of the dysregulation of these two antagonistic systems in human obesity complicated with hypertension, metabolic syndrome, and increased cardiovascular risk.
Vascular stiffness is related to superoxide generation in the vessel wall

Objectives Oxidative stress causes endothelial dysfunction and plays a major role in the pathogenesis of cardiovascular disease. Increased vascular stiffness is an intermediate phenotype in the development of cardiovascular disease. We hypothesized that vascular stiffness is partially determined by oxidative stress. Methods We examined 163 participants out of whom 80 had coronary artery disease. Vascular stiffness was assessed by pulse wave analysis, pulse wave velocity and measurement of aortic compliance by cardiac MRI. Circulating markers of oxidative stress and vascular superoxide generation in saphenous vein were measured. Results After adjustment for age, sex, BMI, heart rate, blood pressure and lipids only carotid-femoral pulse wave velocity and aortic compliance were different between patients and control group. Aortic compliance was reduced (11.4 ± 6.3 vs. 13.9 ± 7.3 ml × 10−3 per mmHg; P = 0.035) and vascular superoxide generation increased (1.01 ± 0.45 vs. 0.76 ± 0.44 nmol/mg per min; P = 0.035) in patients with coronary artery disease compared with those without. In a multiple stepwise regression analysis, aortic compliance was determined by age (P < 0.001) and vascular superoxide production (P = 0.033). CYBA C242T and NOS3 G894T polymorphisms had additive effects on vascular superoxide generation (P = 0.026) and xanthine oxidase activity was increased in patients with CAD (P = 0.043). Genetic factors (P = 0.033) and xanthine oxidase activity (P < 0.001) were also related to aortic compliance. Conclusion By measuring vascular superoxide generation and aortic compliance using cardiac MRI, we demonstrated a functional relationship between oxidative stress and vascular stiffness. Patients identified with high levels of vascular stiffness are most likely to benefit from strategies to reduce vascular oxidative stress.
Age and gender related patterns in carotid-femoral PWV and carotid and femoral stiffness in a large healthy, middle-aged population

Background The relationship between aortic (carotid–femoral) pulse wave velocity and stiffness measures based on local diameter and pressure readings is not yet fully understood. Methods We compared the relationship with age and gender of aortic pulse wave velocity to stiffness indices (compliance and distensibility coefficient) evaluated at the common carotid and femoral arteries in 2195 (1131 women) apparently healthy subjects, aged 35–55 years participating in the Asklepios study. Aortic pulse wave velocity was further compared with previously reported central arterial stiffness parameters on the same population. Subjects were divided into four age groups for analysis. Results Femoral arterial stiffness was higher in men than in women (P < 0.001) but did not change with age and no age–gender interaction was evident. Carotid arterial stiffness increased with age (P < 0.001) and showed a significant (P < 0.001) age–gender interaction, with carotid stiffness increasing more rapidly in women than in men, crossing over around the age of 45. Aortic pulse wave velocity did not differ between men and women, but did increase with age (P < 0.001). No age–gender interaction was evident. Conclusion The relation with age and gender of local and central stiffness measures is not the same over the age range 35–55 in apparently healthy men and women. Depending on the central stiffness parameter used, age–gender effects evident at the carotid artery are or are not found centrally. Though the relevance of these differences requires further evaluation in a longitudinal study with outcome data, they need to be kept in mind when designing or interpreting results from arterial stiffness evaluation studies.
Tratamento cirúrgico da endocardite infecciosa

The indication, surgical pathology and the results of surgical treatment of 28 patients operated on for infectious endocarditis between 1983 and 1994 are here evaluated. The clinical diagnosis was confirmed by echocardiography and cineangiography. Seventy-five percent of the patients were male and 25% female, with the mean age of 35.2 (14 to 67) years old. Ninety three percent were in functional class III or IV (N Y H A). Elapsed time between diagnosis and surgery was around 4 weeks (1-363 days). A positive hemoculture was present in 25% of the cases and the commonest bacteria found were streptococcus and staphilococcus. The aortic valve was the one usualy affected and vegetations was the usual finding. Surgical treatment consisted of valvuloplasty in 2 cases and valve replacement in 26. Complications were present in 39.28% of the cases, which resulted in the death of five of them (18%). We conclude that, although rare, the infectious endocarditis is a serious disease; if not prevented with adequate antibiotic prophilaxis or treated in due time, serious complications or even death might occur.
Chronic urotensin II infusion enhances macrophage foam cell formation and atherosclerosis in apolipoprotein E-knockout mice

Objective Our recent studies have indicated that urotensin II, the most potent vasoconstrictor peptide identified to date, potentiates human macrophage foam cell formation and vascular smooth muscle cell proliferation, and its levels are increased in the plasma of hypertensive patients with carotid atherosclerotic plaques. In the present study, we investigated the enhancing effect of urotensin II on atherosclerosis in apolipoprotein E-knockout mice and its suppression by 4-aminoquinoline, an urotensin II receptor-selective antagonist. Methods Urotensin II, urotensin II + 4-aminoquinoline, or vehicle was infused for 4 weeks through an osmotic mini-pump into 9-week-old apolipoprotein E-knockout mice on a high-fat diet. Aortic atherosclerosis and foam cell formation in exudate peritoneal macrophages were examined. Results Atherosclerotic lesions as well as plasma levels of urotensin II, reactive oxygen species, and oxidized low-density lipoprotein and oxidized low-density lipoprotein-induced foam cell formation were significantly greater in urotensin II-infused mice than vehicle-infused controls. Western blotting analysis showed increased expression of scavenger receptors (CD36 and scavenger receptor class A) and acyl-CoA:cholesterol acyltransferase-1 in these macrophages. Increases in these parameters were significantly reduced by addition of 4-aminoquinoline. In apolipoprotein E-knockout mice even without urotensin II infusion, the treatment with 4-aminoquinoline for 8 weeks significantly prevented the development of atherosclerotic lesions. Conclusion Our results provide the first evidence that increased plasma urotensin II level stimulates oxidized low-density lipoprotein and reactive oxygen species production and macrophage foam cell formation via increased expression of CD36, scavenger receptor class A, and acyl-CoA:cholesterol acyltransferase-1, contributing to the development of atherosclerosis in apolipoprotein E-deficient mice. Urotensin II receptor antagonism may be a promising therapeutic strategy against atherosclerosis.
Prevalence, awareness, treatment and control of hypertension in healthy unrelated male–female pairs of European regions: the dietary habit profile in European communities with different risk of myocardial infarction – the impact of migration as a model of gene–environment interaction project

Background Blood pressure control is of great importance in the prevention of cardiovascular events. Aim To determine the prevalence, awareness, treatment and control of hypertension in healthy unrelated male–female pairs of European regions. Methods The dietary habit profile in European communities with different risk of myocardial infarction: the impact of migration as a model of gene–environment interaction (IMMIDIET) project was a cross-sectional study to investigate differences in the distribution of cardiovascular risk factors and dietary habits in healthy unrelated male–female pairs married or living together in European regions. Eight hundred and two unrelated male–female pairs were randomly recruited in Abruzzo (Italy), Limburg (Belgium) and south-west London (England). Blood pressure was measured using an automated device. Hypertension was defined as systolic blood pressure of at least 140 mmHg or diastolic blood pressure of at least 90 mmHg or current antihypertensive treatment. Results Overall, 24.4% of the population was hypertensive; among them, one-third was on antihypertensive treatment, but a significant proportion (56%) was unaware of the high blood pressure levels. Men were more often hypertensive than women (29.4 vs. 19.5%, P < 0.0001). Women were more often treated than men (49.8 vs. 28.9%, P < 0.0001). Women from south-west London showed blood pressure levels lower than those from Abruzzo and Limburg (P < 0.001 for both, adjusted for age, BMI and social status). No difference among countries was found in blood pressure levels in men. The adjusted prevalence of hypertension was 20.8% in south-west London, 23.6% in Limburg and 28.87% in Abruzzo (Abruzzo vs. south-west London P = 0.005). The prevalence of antihypertensive treatment was 43.5, 42.5 and 32.1% in Abruzzo, Limburg and south-west London, respectively. Out of those treated for hypertension, 42, 43 and 47.7% in Abruzzo, Limburg and south-west London, respectively, were well controlled. Conclusion In communities of healthy unrelated male–female pairs from three different European regions, more than half of hypertensive patients appeared to have blood pressure levels not at target values. Interventions are required to optimize the use and effectiveness of antihypertensive drug therapy in these patients.
Franz Volhard lecture: should doctors still measure blood pressure? The missing patients with masked hypertension

The traditional reliance on blood pressure (BP) measurement in the medical setting misses a significant number of individuals with masked hypertension, who have normal clinic BP but persistently high daytime BP when measured out of the office. We suggest that masked hypertension may be a precursor of clinically recognized sustained hypertension and is associated with increased cardiovascular risk compared with consistent normotension. We discuss factors that may contribute to clinic–daytime BP differences as well as the changing relationship between these two measures over time. Anxiety at the time of BP measurement and having been diagnosed as hypertensive appear to be two possible mechanisms. The identification of individuals with masked hypertension is of great clinical importance and requires out-of-office BP screening. Ambulatory BP monitoring is the best established technique for doing this, but home monitoring may be applicable in the future.
Prospects for the Compression of Morbidity

Although an upper limit to life expectancy has been proposed, most projections are for a continued decline in mortality rates and an increase in life expectancy for the next 50 years. Compression of morbidity can still occur during a period of increasing life expectancy if disability-free life expectancy increases more rapidly than life expectancy. This article considers the prospects for future increases in disability-free life expectancy as the proportion of the population dying at the oldest ages increases. The distribution of age at death is projected to change substantially during the first half of the next century, with many more deaths taking place at the oldest ages. Using current age-specific estimates of disability in the years prior to death, projections are presented that indicate that the shift in the distribution of age at death will lead to an increased number of years spent disabled prior to death for the total population aged 65 and older. It is proposed that a compression of morbidity may not be possible unless there is a reduction in the high rate of disability prior to death in the large segment of the future older population who will die at the oldest ages.
Modelling dynamic value streams in support of process design and evaluation

To remain competitive, most manufacturing enterprises (MEs) need cost-effective and responsive business processes with capability to realise multiple value streams specified by changes in customer needs. Models of MEs can play a critical role in enabling enhanced enterprise process and systems design and change based on analysis of their performance, and ongoing management and control of their operation. Typical models of MEs can provide reusable computational representations of organisational structures, processes, information, resources and related value flows in an enterprise. This paper presents a dynamic modelling approach to value stream mapping which enhances current best practice when reasoning about changing process and resource systems requirements. Here, coherent use of enterprise and simulation modelling techniques were deployed to develop value streams of a case study enterprise which is a make-to-order furniture manufacturing SME. The paper explains how models created during the modelling stages were validated and reused as a basis for informed SME decision making in relation to product realisation strategies and related organisation design and change decisions and actions.
Ambulatory arterial stiffness index is not correlated with the pressor response to laboratory stressors in normotensive humans

Background Ambulatory arterial stiffness index (AASI) is a novel estimate of arterial stiffness, which independently predicts cardiovascular mortality, even in normotensive individuals. Additionally, other markers derived from ambulatory blood pressure (BP) monitoring, including variability, pulse pressure, nocturnal dipping, and morning BP surge, have all been shown to be predictive of end-organ damage and cardiovascular disease. Exaggerated cardiovascular reactivity to sympathoexcitatory stimuli may also predict future incidence of hypertension. The purpose of this investigation was to test the hypothesis that AASI and other derivations of ambulatory BP, including pulse pressure, 24-h blood pressure variability, dipping, and morning surge, would be correlated with the pressor response to common physiological stress maneuvers. Method We measured continuous heart rate and arterial BP during head-up tilt, mental stress, cold pressor test, and isometric handgrip to fatigue in 67 healthy, normotensive, nonobese individuals (43 women, 24 men, mean age ± SD: 28 ± 6 years). Then, 24-h ambulatory BP was obtained, and AASI was defined as 1 minus the slope of diastolic on systolic BP in individual 24-h ambulatory BP recordings. Results Although all measures were widely variable among patients, there was no relationship between AASI, pulse pressure, blood pressure variability, dipping, and morning surge with the pressor responses. Conclusion We conclude that in the absence of aging, cardiovascular, or autonomic disease, the novel stiffness index (AASI) or other ambulatory BP indices are either poorly correlated with or mechanistically unrelated to the complex pressor response to common provocations of sympathoexcitation.
Endothelium-dependent relaxation factor released by perivascular adipose tissue

Objective Recent studies have demonstrated that perivascular adipose tissue (PVAT) releases vascular relaxation factor(s), but the identity of this relaxation factor remains unknown. Here, we examined if angiotensin 1-7 [Ang-(1-7)] is one of the relaxation factors released by PVAT. Method Morphological and functional methods were used to study aorta from adult Wistar rats. Results Immunohistochemical staining showed abundant presence of Ang-(1-7) in aortic PVAT. In vessels with PVAT removed but intact endothelium (PVAT − E+), contraction induced by phenylephrine was attenuated by preincubation with Ang-(1-7). PVAT − E+ vessels precontracted with phenylephrine showed a concentration-dependent relaxation response to Ang-(1-7), and this response was abolished by the removal of endothelium. Relaxation response induced by Ang-(1-7) was also prevented by Ang-(1-7) receptor (Mas) antagonist (A779), nitric oxide synthase inhibitor, and nitric oxide scavenger. Ang-(1-7) did not cause a relaxation response in aorta precontracted with KCl, and the relaxation response to Ang-(1-7) was also blocked by calcium-dependent potassium (KCa) channel blockers. Incubation of PVAT + E+ vessels with A779 or angiotensin-converting enzyme 2 inhibitor DX600 or angiotensin-converting enzyme inhibitor enalaprilat increased the contraction induced by phenylephrine. Transfer of donor solution incubated with PVAT + E+ vessel to recipient PVAT − E+ vessel caused a relaxation response. This relaxation response was abolished when donor vessels were incubated with DX600 or enalaprilat or when recipient vessels were incubated with A779. Conclusion Ang-(1-7) released by PVAT acts on the endothelium to cause the release of nitric oxide, and nitric oxide acts as a hyperpolarizing factor through KCa channels to cause relaxation of the blood vessel.
Prevalence of skin disease among the elderly in different clinical environments

Although skin disease is a common and inevitable consequence of ageing, relatively few epidemiological studies have focused on the elderly demographic. Those that do exist are often difficult to find, while matching studies from numerous countries can easily become a daunting task for the busy clinician. Therefore, we undertook a comprehensive literature search for any manuscripts targeting elderly skin disease published in peer‐reviewed medical journals over the past 60 years. A total of 61 reports from 12 countries were eventually selected for inclusion. Among the community‐dwelling elderly, seborrheic keratosis, xerosis and Campbell de Morgan spots were shown to have the highest prevalence rates, affecting 88%, 85% and 75% respectively. These diseases also affected nursing home residents (seborrheic keratosis 85% and xerosis 77%), as did tinea unguium at 57%. Prevalence rates within the dermatology clinic were different, however, with none exceeding 25%. By subcategory, the most frequently presented conditions were actinic keratosis (25%), fungal infections (17%) and xerosis (14%). Overall, our review has shown that skin disease is very common among the elderly and its prevalence varies widely depending on the patients’ clinical environment. Considerable work remains to be undertaken regarding skin disease risk factors. With the projected exponential ageing of almost all industrialised societies throughout the 21st century, a greater commitment should now be directed towards this burgeoning subdiscipline of clinical medicine.
Masked hypertension: different blood pressure measurement methodology and risk factors in a working population

Objectives To estimate the prevalence of masked hypertension when the same ambulatory device is used for both manual and ambulatory blood pressure measurements and to measure associations with lifestyle risk factors in a working population. Methods White-collar workers were recruited from three public organizations. Blood pressure was measured at the workplace using Spacelabs 90207 for manual measurements (mean of the first three readings taken by a trained assistant) followed by ambulatory measurements (mean of every other reading obtained during the working day). Masked hypertension was defined as manual blood pressure measurement of less than 140/90 mmHg and ambulatory blood pressure measurement of at least 135/85 mmHg. Smoking, alcohol intake, BMI and leisure physical activity were also assessed. Results Blood pressure measurements were obtained from 2370 workers (80% participation, 61% women; mean age = 44 years). Masked hypertension was diagnosed in 15.02% of the participants. The prevalence was higher in men [adjusted odds ratio (OR) = 2.38, 95% confidence interval (CI) = 1.86–3.05]. The prevalence in men increased with age (adjusted OR = 2.08 for 40–49 years, 95% CI = 1.33–3.26 and adjusted OR = 1.91 for ≥50 years, 95% CI = 1.20–3.04) and BMI (adjusted OR = 1.78 for BMI ≥ 27, 95% CI = 1.21–2.64). The prevalence in women increased with BMI (adjusted OR = 1.65 for BMI ≥27, 95% CI = 1.14–2.39) and alcohol intake (adjusted OR = 2.12 for at least six drinks per week, 95% CI = 1.34–3.35). Conclusion Masked hypertension is frequent and still present when blood pressure is measured out of the office, using the same device for manual and ambulatory measurements. Sex, age, BMI and alcohol intake are associated with masked hypertension.
Evaluación de la técnica Monolisa HCV Ag-Ab ULTRA (BioRad) en un hospital general

Introduccion Se evaluo una nueva tecnica para la determinacion simultanea de anticuerpos y antigeno del virus de la hepatitis C (VHC) (Monolisa HCV Ag/Ab ULTRA; BioRad, Marnes la Coquette, France). Metodos Se estudiaron dos grupos de poblacion y 7 paneles (75 muestras) de seroconversion. Grupo 1: 1.360 sueros con solicitud de determinacion de anticuerpos VHC. Grupo 2: 333 sueros de 183 pacientes hemodializados. Las muestras se ensayaron con la tecnica Ortho HCV 3.0 (Ortho-Clinical Diagnostics, Amersham, UK) y la tecnica Monolisa HCV Ag-Ab ULTRA. Resultados Grupo 1: en los 1.360 sueros, se obtuvo resultado positivo en 74 casos con la tecnica de rutina y en 77 casos con la tecnica Monolisa. En 1.353 muestras coincidieron los resultados, 1.281 (−) y 72 (+). Cinco muestras fueron positivas solo por Monolisa y 2 solo por Ortho (concordancia global: 99,5%). Grupo 2: 325 muestras dieron resultados coincidentes, 308 (−) y 17 (+). Siete muestras dieron resultado positivo por Monolisa y negativo por Ortho. La sensibilidad de la tecnica Monolisa en pacientes hemodializados fue claramente superior a la tecnica Ortho (100 y 70,8%, respectivamente). Frente a los paneles de seroconversion la tecnica Monolisa detecto 43 muestras positivas frente a las 18 de la tecnica de anticuerpos consiguiendo una reduccion del periodo ventana de hasta 72 dias. Conclusiones La tecnica Monolisa presento una elevada concordancia respecto a la tecnica Ortho en la poblacion general. En pacientes hemodializados se mostro mas sensible que nuestra tecnica de rutina. Por otro lado, el periodo ventana se redujo significativamente.