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Hydrocephalus Revisited: New Insights straight into Characteristics associated with Neurofluids in Macro- along with Microscales.
Objective Butyrate, a short-chain fatty acid (SCFA) produced by the intestinal microbiota, plays a protective role in cardiovascular diseases (CVDs), but the mechanisms involved in this process remain unelucidated. We aimed to explore the effect of butyrate on myocardial ischemia/reperfusion (I/R) injury through the gut-brain neural circuit. Methods Rats were randomly divided into four groups sham group (sham), I/R group (I/R), I/R+ butyrate group (butyrate), and I/R+ butyrate+ vagotomy group (vagotomy). The rats were treated with sodium butyrate for 4 weeks, and the gut-brain neural circuit was investigated by subdiaphragmatic vagotomy. Results Butyrate treatment significantly reduced the infarct size and decreased the expression of creatine kinase (CK), creatine kinase myocardial isoenzyme (CK-MB), and lactate dehydrogenase (LDH) compared with the values found for the I/R group. In addition, the I/R-induced increases in inflammation, oxidative stress, and apoptosis were attenuated by butyrate. However, the above-mentioned protective effects were diminished by subdiaphragmatic vagotomy. The RNA sequencing results also revealed that the butyrate-induced protective changes at the cardiac transcription level were reversed by vagotomy. An analysis of the heart rate variability (HRV) and the detection of norepinephrine (NE) showed that butyrate significantly inhibited the I/R-induced autonomic imbalance, but this inhibition was not observed in the vagotomy group. Butyrate treatment also suppressed the neural activity of the paraventricular nucleus (PVN) and superior cervical ganglion (SCG), and both of these effects were lost after vagotomy. Conclusions Butyrate treatment significantly improves myocardial I/R injury via a gut-brain neural circuit, and this cardioprotective effect is likely mediated by suppression of the sympathetic nervous system.Background Ischaemic heart disease (IHD) and cerebrovascular disease are two closely inter-related clinical entities. Cardiovascular magnetic resonance (CMR) radiomics may capture subtle cardiac changes associated with these two diseases providing new insights into the brain-heart interactions. Objective To define the CMR radiomics signatures for IHD and cerebrovascular disease and study their incremental value for disease discrimination over conventional CMR indices. Methods We analysed CMR images of UK Biobank's subjects with pre-existing IHD, ischaemic cerebrovascular disease, myocardial infarction (MI), and ischaemic stroke (IS) (n = 779, 267, 525, and 107, respectively). Each disease group was compared with an equal number of healthy controls. We extracted 446 shape, first-order, and texture radiomics features from three regions of interest (right ventricle, left ventricle, and left ventricular myocardium) in end-diastole and end-systole defined from segmentation of short-axis cine images. Systematic fea discrimination. A notable overlap of the radiomics signatures of IHD and cerebrovascular disease was also found. Conclusions This study demonstrates the potential value of CMR radiomics over conventional indices in detecting subtle cardiac changes associated with chronic ischaemic processes involving the brain and heart, even in the presence of more heterogeneous clinical pictures. Radiomics analysis might also improve our understanding of the complex mechanisms behind the brain-heart interactions during ischaemia.Heart failure is associated with a substantial risk of mortality and morbidity. Findings from recent cardiovascular outcome trials have shown promise for sodium-glucose cotransporter-2 (SGLT2) inhibitors in preventing heart failure in patients with type 2 diabetes mellitus (T2DM). Notably, the benefits of SGLT2 inhibitors were consistent despite the presence of risk factors like atherosclerosis. Increasing evidence suggests that SGLT2 inhibitors may confer their cardioprotective effects through multiple mechanisms, ranging from improving cardiac and vascular performance to metabolism. The reduction of heart failure risk by SGLT2 inhibitors may also be attributed to the preservation of renal function. Indeed, renal insufficiency is a frequent comorbidity of patients with heart failure and T2DM; hence, the natriuretic and kidney protective effects offered by SGLT2 inhibitors may contribute to limiting adverse cardiac outcomes. In this article, we discuss the latest findings from the cardiovascular and renal outcome trials, paying special attention to the interlink between heart and kidney function, and how effective treatment of heart failure-irrespective of T2DM diagnosis-may require agents that offer both cardiac and renal protection.Background Direct oral anticoagulants (DOACS) are approved for use in non-valvular atrial fibrillation (AF). This systematic review and meta-analysis aimed to evaluate the efficacy and safety of DOACs vs. warfarin and update the evidence for treatment of AF and valvular heart disease (VHD). Methods We identified randomized clinical trials (RCTs) and post-hoc analyses comparing the use of DOACS and Warfarin in AF and VHD, including biological and mechanical heart valves (MHV), updating from 2010 to 2020. Through systematic review and meta-analysis, by using the "Rev Man" program 5.3, the primary effectiveness endpoints were stroke and systemic embolism (SE). The primary safety outcome was major bleeding, while the secondary outcome included intracranial hemorrhage. We performed prespecified subgroup analyses. Data were analyzed by risk ratio (RR) and 95% confidence interval (CI) and the I-square (I 2) statistic as a quantitative measure of inconsistency. Risk of bias and methodological quality assessment of included trials was evaluated with the modified Cochrane risk-of-bias tool. Results We screened 326 articles and included 8 RCTs (n = 14.902). DOACs significantly reduced the risk of stroke/SE (RR 0.80, 95% CI 0.68-0.94; P = 0.008; moderate quality evidence; I 2 = 2%) and intracranial hemorrhage (RR 0.40, 95% CI 0.24-0.66; P = 0.0004; I 2 = 49%) with a similar risk of major bleeding (RR 0.83, 95% CI 0.56-1.24; P = 0.36; I 2 = 88%) compared to Warfarin. Conclusions In this update, DOACs remained with similar efficacy and safety compared to warfarin in thromboprophylaxis for AF and VHD.Background Since evidence regarding the relationship between physical activity (PA) and atrial fibrillation (AF) incidence is inconsistent among studies, we performed a dose-response meta-analysis to comprehensively evaluate the exposure-effect association between PA and incident AF and the potential sex difference in the general population. Methods The PubMed and Embase databases were searched for eligible studies published up to July 2020 (PROSPERO CRD42018091692). The non-linear or linear exposure-effect relationship between PA and AF was examined using the robust error meta-regression method. Results A total of 16 prospective studies involving 1,449,017 individuals and 39,884 AF cases were included. read more We observed an inverse non-linear association between PA level and incident AF (I 2 = 0%, p non-linearity less then 0.001). In the linear model, a 5 metabolic equivalent of task (MET)-h/week increase in PA was associated with a decreased risk of AF [risk ratio (RR) = 0.992, 95% confidence interval (CI) 0.988-0.996, I 2 = 0%]. In the sex-stratified analysis, we observed an inverse non-linear relationship between PA level and AF risk in females (I 2 = 90%, p non-linearity less then 0.0001) but not in males (I 2 = 0%, p non-linearity = 0.40). In the linear model, a 5 MET-h/week increase in PA was associated with a reduced risk of AF in females (RR = 0.982, 95% CI 0.975-0.989, I 2 = 71%) but not in males (RR = 0.998, 95% CI 0.994-1.002, I 2 = 0%), with a significant interaction observed between the two groups (p interaction less then 0.0001). Conclusion There was an inverse non-linear relationship between PA level and incident AF in the general population. The beneficial effect of PA in reducing AF risk might be predominantly observed in females.Objective This study was conducted in order to determine the reference values for right ventricular (RV) volumes and ejection fraction (EF) using three-dimensional echocardiography (3DE) and to identify sources of variance through a systematic review and meta-analysis. Methods This systematic review was preregistered with the International Prospective Register of Systematic Reviews (https//www.crd.york.ac.uk/PROSPERO/) (CRD42020211002). Relevant studies were identified by searches of the PubMed, Embase, and Cochrane Library databases through October 12, 2020. Pooled reference values were calculated using the random-effects model weighted by inverse variance. Meta-regression analysis and Egger's test were used to determine the source of heterogeneity. A subgroup analysis was performed to evaluate the reference values across different conditions. Results The search identified 25 studies of 2,165 subjects. The mean reference values were as follows RV end-diastolic volume, 100.71 ml [95% confidence interval (CI),ter-software discrepancies.Objective Sleep has a significant influence on the incidence of myocardial infarction (MI). The purpose of this study was to investigate the association between sleep timing including bedtime, wake-up time and sleep midpoint, and the incidence of MI. Methods A total of 4,576 patients (2,065 men, 2,511 women; age 63.4 ± 11.0 years) were selected from the Sleep Heart Health Study. Sleep timings on weekdays and weekends were recorded or calculated based on the sleep habits questionnaire completed by the participants at baseline. Bedtime was divided into 1000 PM and before, 1001 PM-1100 PM, 1101 PM-1200 AM, and later than 1200 AM. Cox proportional hazards regression analysis was used to examine the relationship between sleep timings and MI. Results Participants with a weekday bedtime later than 1200 AM, between 1101 PM-1200 AM, and 1000 PM or before had a higher incidence of MI than those with a bedtime between 1001 PM and 1100 PM (9.2% vs. 7.0% vs. 6.9% vs. 5.1%, respectively; P = 0.008). Multivariable Cox regression analysis showed that sleeping on weekdays later than 1200 AM was associated with an increased risk of incident MI after adjusting for potential covariates (hazard ratio, 1.628; 95% confidence interval, 1.092-2.427; P = 0.017). However, there was no significant association between late bedtime on weekends and MI. In addition, no significant association of late wake-up time and delayed sleep midpoint on both weekdays and weekends with the incidence of MI was observed. Conclusion Sleeping late on weekday (>1200 AM) independently increased the risk of MI. This finding emphasizes the importance of a proper bedtime for the maintenance of the health of the cardiovascular system.Background The electrocardiogram (ECG) is a key tool in patient management. Automated ECG analysis supports clinical decision-making, but traditional fiducial point identification discards much of the time-series data that captures the morphology of the whole waveform. Our Symmetric Projection Attractor Reconstruction (SPAR) method uses all the available data to provide a new visualization and quantification of the morphology and variability of any approximately periodic signal. We therefore applied SPAR to ECG signals to ascertain whether this more detailed investigation of ECG morphology adds clinical value. Methods Our aim was to demonstrate the accuracy of the SPAR method in discriminating between two biologically distinct groups. As sex has been shown to influence the waveform appearance, we investigated sex differences in normal sinus rhythm ECGs. We applied the SPAR method to 9,007 10 second 12-lead ECG recordings from Physionet, which comprised; Dataset 1 104 subjects (40% female), Dataset 2 8,903 subjects (54% female).
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