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Application of dynamic pulse pressure and vasopressor tools for predicting outcomes in patients with sepsis in intensive care units.
Fang, WF, Huang, CH, Chen, YM, Hung, KY, Chang, YC, Lin, CY, Fang, YT, Chang, YT, Chen, HC, Huang, KT, et al
Journal of critical care. 2019;:156-162
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Abstract
PURPOSE We aimed to determine whether the combination of dynamic pulse pressure and vasopressor (DPV) use is applicable for mortality risk stratification in patients with severe sepsis. We proposed the use of the DPV tool and compared it with traditional sepsis severity indices. MATERIALS AND METHODS All adult patients who met the sepsis criteria of the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) between August 2013 and January 2017 were eligible for the study. Patients who expired within 3 days of admission to the intensive care unit (ICU) were excluded. The primary outcomes were 7-day and 28-day mortality. RESULTS The study participants included 757 consecutive adult patients. A subpopulation of 155 patients underwent immune profiling assays on days 1, 3, and 7 of ICU admission. The DPV tool had a better performance for predicting 7-day mortality (area under curve, AUC: 0.70), followed by the Sequential Organ Failure Assessment (SOFA) (AUC: 0.64), the plus pulse pressure (AUC: 0.64). For predicting 28-day mortality, the DPV tool was not inferior to the SOFA (AUC: 0.61), DPV tool (AUC: 0.59). CONCLUSIONS The DPV tool can be applied for 7-day and 28-day mortality risk prediction in patients with sepsis.
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Garlic Lowers Blood Pressure in Hypertensive Individuals, Regulates Serum Cholesterol, and Stimulates Immunity: An Updated Meta-analysis and Review.
Ried, K
The Journal of nutrition. 2016;(2):389S-396S
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Abstract
BACKGROUND Garlic has been shown to have cardiovascular protective and immunomodulatory properties. OBJECTIVES We updated a previous meta-analysis on the effect of garlic on blood pressure and reviewed the effect of garlic on cholesterol and immunity. METHODS We searched the Medline database for randomized controlled trials (RCTs) published between 1955 and December 2013 on the effect of garlic preparations on blood pressure. In addition, we reviewed the effect of garlic on cholesterol and immunity. RESULTS Our updated meta-analysis on the effect of garlic on blood pressure, which included 20 trials with 970 participants, showed a mean ± SE decrease in systolic blood pressure (SBP) of 5.1 ± 2.2 mm Hg (P < 0.001) and a mean ± SE decrease in diastolic blood pressure (DBP) of 2.5 ± 1.6 mm Hg (P < 0.002) compared with placebo. Subgroup analysis of trials in hypertensive subjects (SBP/DBP ≥140/90 mm Hg) at baseline revealed a larger significant reduction in SBP of 8.7 ± 2.2 mm Hg (P < 0.001; n = 10) and in DBP of 6.1 ± 1.3 mm Hg (P < 0.001; n = 6). A previously published meta-analysis on the effect of garlic on blood lipids, which included 39 primary RCTs and 2300 adults treated for a minimum of 2 wk, suggested garlic to be effective in reducing total and LDL cholesterol by 10% if taken for >2 mo by individuals with slightly elevated concentrations [e.g., total cholesterol >200 mg/dL (>5.5 mmol/L)]. Garlic has immunomodulating effects by increasing macrophage activity, natural killer cells, and the production of T and B cells. Clinical trials have shown garlic to significantly reduce the number, duration, and severity of upper respiratory infections. CONCLUSIONS Our review suggests that garlic supplements have the potential to lower blood pressure in hypertensive individuals, to regulate slightly elevated cholesterol concentrations, and to stimulate the immune system. Garlic supplements are highly tolerated and may be considered as a complementary treatment option for hypertension, slightly elevated cholesterol, and stimulation of immunity. Future long-term trials are needed to elucidate the effect of garlic on cardiovascular morbidity and mortality.
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Impact of prebiotic supplementation on T-cell subsets and their related cytokines, anthropometric features and blood pressure in patients with type 2 diabetes mellitus: A randomized placebo-controlled Trial.
Dehghan, P, Farhangi, MA, Tavakoli, F, Aliasgarzadeh, A, Akbari, AM
Complementary therapies in medicine. 2016;:96-102
Abstract
BACKGROUNDS AND AIMS Type 2 diabetic mellitus (T2DM) asone of the main causes of morbidity and mortality is associated with immune system disturbances and metabolic abnormalities. In the current study we aimed to evaluate the effects of oligofructose-enriched inulin on T-cell subsets and their related cytokines, anthropometric and metabolic parameters in patients with T2DM. METHODS Forty-six diabetic females patients were randomly allocated into intervention (n=27) and control (n=22) groups. Subjects in the intervention group received a daily dose of 10g of oligofructose-enriched inulin and subjects in control group received a placebo for two months. Anthropometric variables, metabolic parameters including fasting serum glucose (FSG), hemoglobin A1c (HbA1c), lipid profile and blood pressure were measured at the beginning and after two months. Immune markers also included serum interleukin (IL)-4, IL-12 and interferon (IFN)-γ concentrations were assessed and CD3(+), CD4(+), CD8(+) and CD11b(+)T-cell counts were determined by flow cytometry at baseline and end of the trial. RESULTS After two months intervention, significant improvements in anthropometric variables, blood pressure and serum lipids occurred in prebiotic-treated group (P<0.001). Serum IL-4, IL-12 and IFN-γ concentrationsalso significantly decreased in intervention group (P<0.001). No significant changes in CD3(+), CD4(+), CD8(+) and CD11b(+) T-cell counts were observed in treatment groups after intervention. CONCLUSION The present study showed several beneficial effects of oligofructose-enriched inulin on the improvement of the glycemic status, lipid profile, and immune markers in patients with T2DM. Further studies are needed to confirming our findings and to better clarify the underlying mechanisms.
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Maca reduces blood pressure and depression, in a pilot study in postmenopausal women.
Stojanovska, L, Law, C, Lai, B, Chung, T, Nelson, K, Day, S, Apostolopoulos, V, Haines, C
Climacteric : the journal of the International Menopause Society. 2015;(1):69-78
Abstract
OBJECTIVE Lepidium meyenii (Maca) has been used for centuries for its fertility-enhancing and aphrodisiac properties. In an Australian study, Maca improved anxiety and depressive scores. The effects of Maca on hormones, lipids, glucose, serum cytokines, blood pressure, menopausal symptoms and general well-being in Chinese postmenopausal women were evaluated. METHODS A randomized, double-blind, placebo-controlled, cross-over study was conducted in 29 postmenopausal Hong Kong Chinese women. They received 3.3 g/day of Maca or placebo for 6 weeks each, in either order, over 12 weeks. At baseline, week 6 and week 12, estradiol, follicle stimulating hormone (FSH), sex hormone binding globulin (SHBG), thyroid stimulating hormone (TSH), full lipid profiles, glucose and serum cytokines were measured. The Greene Climacteric, SF-36 Version 2, Women's Health Questionnaire and Utian Quality of Life Scales were used to assess the severity of menopausal symptoms and health-related quality of life. RESULTS There were no differences in estradiol, FSH, TSH, SHBG, glucose, lipid profiles and serum cytokines amongst those who received Maca as compared to the placebo group; however, significant decreases in diastolic blood pressure and depression were apparent after Maca treatment. CONCLUSIONS Maca did not exert hormonal or immune biological action in the small cohort of patients studied; however, it appeared to reduce symptoms of depression and improve diastolic blood pressure in Chinese postmenopausal women. Although results are comparable to previous similar published studies in postmenopausal women, there might be a cultural difference among the Chinese postmenopausal women in terms of symptom reporting.
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Oral supplementation with 25(OH)D3 versus vitamin D3: effects on 25(OH)D levels, lower extremity function, blood pressure, and markers of innate immunity.
Bischoff-Ferrari, HA, Dawson-Hughes, B, Stöcklin, E, Sidelnikov, E, Willett, WC, Edel, JO, Stähelin, HB, Wolfram, S, Jetter, A, Schwager, J, et al
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research. 2012;(1):160-9
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Abstract
To test the effect of 25(OH)D(3) (HyD) compared to vitamin D(3) on serum 25-hydroxyvitamin D levels (25(OH)D), lower extremity function, blood pressure, and markers of innate immunity. Twenty healthy postmenopausal women with an average 25(OH)D level of 13.2 ± 3.9 ng/mL (mean ± SD) and a mean age of 61.5 ± 7.2 years were randomized to either 20 µg of HyD or 20 µg (800 IU) of vitamin D(3) per day in a double-blind manner. We measured on 14 visits over 4 months, 25(OH)D serum levels, blood pressure, and seven markers of innate immunity (eotaxin, interleukin [IL]-8, IL-12, interferon gamma-induced protein 10 kDa [IP-10], monocyte chemotactic protein-1 [MCP-1], macrophage inflammatory protein beta [MIP-1β], and "Regulated upon Activation, Normal T-cell Expressed, and Secreted" [RANTES]). At baseline and at 4 months, a test battery for lower extremity function (knee extensor and flexor strength, timed up and go, repeated sit-to-stand) was assessed. All analyses were adjusted for baseline measurement, age, and body mass index. Mean 25(OH)D levels increased to 69.5 ng/mL in the HyD group. This rise was immediate and sustained. Mean 25(OH)D levels increased to 31.0 ng/mL with a slow increase in the vitamin D(3) group. Women on HyD compared with vitamin D(3) had a 2.8-fold increased odds of maintained or improved lower extremity function (odds ratio [OR] = 2.79; 95% confidence interval [CI], 1.18-6.58), and a 5.7-mmHg decrease in systolic blood pressure (p = 0.0002). Both types of vitamin D contributed to a decrease in five out of seven markers of innate immunity, significantly more pronounced with HyD for eotaxin, IL-12, MCP-1, and MIP-1 β. There were no cases of hypercalcemia at any time point. Twenty micrograms (20 µg) of HyD per day resulted in a safe, immediate, and sustained increase in 25(OH)D serum levels in all participants, which may explain its significant benefit on lower extremity function, systolic blood pressure, and innate immune response compared with vitamin D(3).
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Reactive oxygen species and vascular biology: implications in human hypertension.
Touyz, RM, Briones, AM
Hypertension research : official journal of the Japanese Society of Hypertension. 2011;(1):5-14
Abstract
Increased vascular production of reactive oxygen species (ROS; termed oxidative stress) has been implicated in various chronic diseases, including hypertension. Oxidative stress is both a cause and a consequence of hypertension. Although oxidative injury may not be the sole etiology, it amplifies blood pressure elevation in the presence of other pro-hypertensive factors. Oxidative stress is a multisystem phenomenon in hypertension and involves the heart, kidneys, nervous system, vessels and possibly the immune system. Compelling experimental and clinical evidence indicates the importance of the vasculature in the pathophysiology of hypertension and as such much emphasis has been placed on the (patho)biology of ROS in the vascular system. A major source for cardiovascular, renal and neural ROS is a family of non-phagocytic nicotinamide adenine dinucleotide phosphate (NADPH) oxidases (Nox), including the prototypic Nox2 homolog-based NADPH oxidase, as well as other Noxes, such as Nox1 and Nox4. Nox-derived ROS is important in regulating endothelial function and vascular tone. Oxidative stress is implicated in endothelial dysfunction, inflammation, hypertrophy, apoptosis, migration, fibrosis, angiogenesis and rarefaction, important processes involved in vascular remodeling in hypertension. Despite a plethora of data implicating oxidative stress as a causative factor in experimental hypertension, findings in human hypertension are less conclusive. This review highlights the importance of ROS in vascular biology and focuses on the potential role of oxidative stress in human hypertension.
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[Role of vitamin D3 in arterial blood pressure control].
Bednarski, R, Donderski, R, Manitius, J
Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 2007;(136):307-10
Abstract
The basic function of vitamin D3 in human body is to maintain the calcium-phosphate homeostasis. Its metabolic function is mediated by the nuclear VDR receptor. The existance of vitamin D3 receptors outside tissues and organs which take part in calcium-phosphate metabolism has resulted in not treating it as an anti rickets agent only. Lower arterial blood pressure observed in people living in sunny areas and decrease of arterial blood pressure values after exposure to UVB radiation could confirm the relationship between vitamin D3 and hypertension. Perhaps through its influence on calcium-phosphate metabolism, RAA system, immune system, control of endocrine glands and endothelium function the vitamin D3 contributes to lowering arterial blood pressure and lessening the risk of cardiovascular disease.