Targeting myocardial inflammation: investigating the therapeutic potential of atrial natriuretic peptide in atrial fibrosis

BACKGROUND

Atrial Fibrillation (AF), a prevalent arrhythmic condition, is intricately associated with atrial fibrosis, a major pathological contributor. Central to the development of atrial fibrosis is myocardial inflammation. This study focuses on Atrial Natriuretic Peptide (ANP) and its role in mitigating atrial fibrosis, aiming to elucidate the specific mechanisms by which ANP exerts its effects, with an emphasis on fibroblast dynamics.

METHODS AND RESULTS

The study involved forty Sprague-Dawley rats, divided into four groups: control, Angiotensin II (Ang II), Ang II + ANP, and ANP only. The administration of 1 µg/kg/min Ang II was given to Ang II and Ang II + ANP groups, while both Ang II + ANP and ANP groups received 0.1 µg/kg/min ANP intravenously for a duration of 14 days. Cardiac fibroblasts were used for in vitro validation of the proposed mechanisms. The study observed that rats in the Ang II and Ang II + ANP groups showed an increase in blood pressure and a decrease in body weight, more pronounced in the Ang II group. Diastolic dysfunction, a characteristic of the Ang II group, was alleviated by ANP. Additionally, ANP significantly reduced Ang II-induced atrial fibrosis, myofibroblast proliferation, collagen overexpression, macrophage infiltration, and the elevated expression of Interleukin 6 (IL-6) and Tenascin-C (TN-C). Transcriptomic sequencing indicated enhanced PI3K/Akt signaling in the Ang II group. Furthermore, in vitro studies showed that ANP, along with the PI3K inhibitor LY294002, effectively reduced PI3K/Akt pathway activation and the expression of TN-C, collagen-I, and collagen-III, which were induced by Ang II.

CONCLUSIONS

The study demonstrates ANP's potential in inhibiting myocardial inflammation and reducing atrial fibrosis. Notably, ANP's effect in countering atrial fibrosis seems to be mediated through the suppression of the Ang II-induced PI3K/Akt-Tenascin-C signaling pathway. These insights enhance our understanding of AF pathogenesis and position ANP as a potential therapeutic agent for treating atrial fibrosis.

New retinoblastoma (RB) drug delivery approaches: anti-tumor effect of atrial natriuretic peptide (ANP)-conjugated hyaluronic-acid-coated gold nanoparticles for intraocular treatment of chemoresistant RB

Intraocular drug delivery is a promising approach for treatment of ocular diseases. Chemotherapeutic drugs used in retinoblastoma (RB) treatment often lead to side effects and drug resistances. Therefore, new adjuvant therapies are needed to treat chemoresistant RBs. Biocompatible gold nanoparticles (GNPs) have unique antiangiogenic properties and can inhibit cancer progression. The combination of gold and low-molecular-weight hyaluronan (HA) enhances the stability of GNPs and promotes the distribution across ocular barriers. Attached to HA-GNPs, the atrial natriuretic peptide (ANP), which diminishes neovascularization in the eye, is a promising new therapeutic agent for RB treatment. In the study presented, we established ANP-coupled HA-GNPs and investigated their effect on the tumor formation potential of chemoresistant RB cells in an in ovo chicken chorioallantoic membrane model and an orthotopic in vivo RB rat eye model. Treatment of etoposide-resistant RB cells with ANP-HA-GNPs in ovo resulted in significantly reduced tumor growth and angiogenesis compared with controls. The antitumorigenic effect could be verified in the rat eye model, including a noninvasive application form via eye drops. Our data suggest that ANP-HA-GNPs represent a new minimally invasive, adjuvant treatment option for RB.

Selective laser melting: Evaluation of the effectiveness and reliability of multi-scale multiphysics simulation environments

This study evaluates the effectiveness and reliability of Multi-scale Multiphysics Selective Laser Melting (SLM) Simulation Environments. A literature review and bibliometric analysis were conducted to identify the most widely used SLM Simulation Environments. The effectiveness of simulation environments was assessed through a SWOT analysis enhanced by an Analytic Network Process (ANP). The reliability of simulation environments was analysed through a design of experiment (DoE). The DoE solely assessed the ability of these environments to accurately predict part distortion. The results showed that the most robust SLM process simulation modelling systems are Ansys Additive Print, Comsol, Simufact Additive, Netfabb, and Simulia.

Evaluation of some nonroutine cardiac biomarkers among adults and children with beta-thalassemia major

BACKGROUND

Cardiac injury caused by iron overload is the leading cause of mortality and morbidity in patients with beta-thalassemia, owing to frequent blood transfusion, increased iron overload, and blood hemolysis.

OBJECTIVE

This research aimed to assess several novel cardiac biomarkers in the blood samples of children and adult patients with beta-thalassemia major (βTM), along with their respective control groups. These biomarkers included endothelin 1 (ET-1), N-terminal pro-brain natriuretic peptide (NT-proBNP), atrial natriuretic peptide (ANP), growth differentiation factor-15 (GDF-15), and renalase (RNLS).

METHODS

This case-control study was done on 46 patients with βTM (23 children <18 years, and 23 adults ≥18 years) from the Genetic Hematology Center in Thi-Qar province, Iraq, and 42 comparable controls in 2 groups (21 for each group) in the period from February to April 2023.

RESULTS

Levels of ET-1, NT-proBNP, ANP, GDF-15, RNLS, and ferritin were higher in the children and adults with βTM than in the control subjects.

CONCLUSION

Elevations of the novel cardiac biomarkers ET-1, NT-proBNP, ANP, GDF-15, and RNLS in the sera of children and adult patients with βTM when compared with comparable control subjects confirm that the majority of patients with βTM are at risk of cardiac and cardiovascular complications even when there are no obvious symptoms, especially in children, which gives suitable predictive biomarkers.

Determination of the most appropriate fertilizing method for apple trees using multi-criteria decision-making (MCDM) approaches

Appropriate tree fertilization with essential nutrients is considered as one of the major factors in enhancing the quality and quantity of horticultural crops. The most efficient way to fertilize trees is to dig holes around the trunks and fill them with appropriate chemical and organic fertilizer. Doing this operation with mechanized methods reduces costs and increases productivity compared to traditional methods. In the present study, multi-criteria decision-making (MCDM) methods, including deterministic analytical hierarchy process (AHP) and fuzzy analytical hierarchy process (FAHP), technique for order of preference by similarity to ideal solution (TOPSIS), fuzzy TOPSIS (FTOPSIS), and analytic network process (ANP), were used to score and select the appropriate fertilizing method for apple trees based on the growers and expert's perspectives. The criteria, including fertilizing operation cost, crop yield, the percentage of tree damages, ease of entering and moving fertilizing equipment in tree rows, field capacity (with or without machinery), comfort and safety of fertilizing operations, after-sales service, access to the required machinery and implements, crop selling price, and crop quality, were used in the above-mentioned methods. The fertilization methods (Hole digging) considered in the present study were traditional fertilization (Shovel), orchard Trencher, motor hole digger, fixed centerline tractor-mounted hole digger, and off-set tractor-mounted hole digger. Based on the results, the priority of mechanized fertilizing methods was determined as tractor-mounted hole diggers (AHP weight of 0.286, FAHP weight of 0.285, TOPSIS relative proximity of 0.65, and FTOPSIS relative proximity of 0.64), fixed centerline tractor-mounted hole diggers (AHP weight of 0.219, FAHP weight of 0.158, TOPSIS relative proximity of 0.56, and FTOPSIS relative proximity of 0.62), motor hole diggers (AHP weight of 0.171, FAHP weight of 0.079, TOPSIS relative proximity of 0.46, and FTOPSIS relative proximity of 0.31), and orchard trenchers (AHP weight of 0.12, FAHP weight of 0.057, TOPSIS relative proximity of 0.19, and FTOPSIS relative proximity of 0.20), respectively. Based on the ANP method, off-set and fixed centerline tractor-mounted hole diggers had the highest priority (weights of 0.43 and 0.27), followed by trencher (weight of 0.16), motor hole diggers (weight of 0.09), and the traditional method (weight of 0.04). Results showed that applying orchard tractors equipped with mounted diggers, especially off-set types, can play an important role in enhancing the quantity and quality of apples produced, as well as reducing the costs of fertilizing operations.

Astaxanthin Alleviates the Process of Cardiac Hypertrophy by Targeting the METTL3/Circ_0078450/MiR-338-3p/GATA4 Pathway

Astaxanthin (ASX) is a natural antioxidant with preventive and therapeutic effects on various human diseases. However, the role of ASX in cardiac hypertrophy and its underlying molecular mechanisms remain unclear.Cardiomyocytes (AC16) were used with angiotensin-II (Ang-II) to mimic the cardiac hypertrophy cell model. The protein levels of hypertrophy genes, GATA4, and methyltransferase-like 3 (METTL3) were determined by western blot analysis. Cell size was assessed using immunofluorescence staining. The expression of circ_0078450, miR-338-3p, and GATA4 were analyzed by quantitative real-time PCR. Also, the interaction between miR-338-3p and circ_0078450 or GATA4 was confirmed by dual-luciferase reporter and RIP assays, and the regulation of METTL3 on circ_0078450 was verified by MeRIP and RIP assays.ASX reduced the hypertrophy gene protein expression and cell size in Ang-II-induced AC16 cells. Circ_0078450 was promoted under Ang-II treatment, and ASX reduced circ_0078450 expression in Ang-II-induced AC16 cells. Circ_0078450 could sponge miR-338-3p to positively regulate GATA4 expression, and GATA4 overexpression overturned the suppressive effect of circ_0078450 knockdown on Ang-II-induced cardiomyocyte hypertrophy. Also, the inhibitory effect of ASX on Ang-II-induced cardiomyocyte hypertrophy could be reversed by circ_0078450 or GATA4 overexpression. In addition, METTL3 mediated the m6A methylation of circ_0078450 to enhance circ_0078450 expression. Moreover, METTL3 knockdown suppressed Ang-II-induced cardiomyocyte hypertrophy by inhibiting circ_0078450 expression.Our data showed that ASX repressed cardiac hypertrophy by regulating the METTL3/circ_0078450/miR-338-3p/GATA4 axis.

Increased sLRP1 and decreased atrial natriuretic peptide plasma levels in newly diagnosed T2DM patients are normalized after optimization of glycemic control

Background

Low-density lipoprotein receptor-related protein 1 (LRP1) negatively modulates circulating atrial natriuretic peptide (ANP) levels. Both molecules are involved in the regulation of cardiometabolism.

Objectives

To evaluate soluble LRP1 (sLRP1) and ANP levels in people with newly diagnosed type 2 diabetes mellitus (T2DM) and determine the effects of metabolic optimization.

Methods

This single-center longitudinal observational study recruited patients with newly diagnosed T2DM (n = 29, HbA1c > 8.5%), and 12 healthy control, age- and sex-matched volunteers. sLRP1 and ANP levels were measured by immunoassays at T2DM onset and at one year after optimization of glycemic control (HbA1c ≤ 6.5%).

Results

T2DM had higher sLRP1 levels than the control group (p = 0.014) and lower ANP levels (p =0.002). At 12 months, 23 T2DM patients reached the target of HbA1c ≤ 6.5%. These patients significantly reduced sLRP1 and increased ANP levels. Patients who did not achieve HbA1c < 6.5% failed to normalize sLRP1 and ANP levels. There was an inverse correlation in the changes in sLRP1 and ANP (p = 0.031). The extent of sLRP1 changes over 12 months of metabolic control positively correlated with those of total cholesterol, LDL cholesterol, TG, TG/HDLc, and apolipoprotein B.

Conclusions

Newly diagnosed T2DM patients have an increased sLRP1/ANP ratio, and increased sLRP1 and decreased ANP levels are normalized in the T2DM patients that reached an strict glycemic and metabolic control. sLRP1/ANP ratio could be a reliable marker of cardiometabolic function.

Natriuretic Peptide Signaling in Uterine Biology and Preeclampsia

Endometrial decidualization is a uterine process essential for spiral artery remodeling, embryo implantation, and trophoblast invasion. Defects in endometrial decidualization and spiral artery remodeling are important contributing factors in preeclampsia, a major disorder in pregnancy. Atrial natriuretic peptide (ANP) is a cardiac hormone that regulates blood volume and pressure. ANP is also generated in non-cardiac tissues, such as the uterus and placenta. In recent human genome-wide association studies, multiple loci with genes involved in natriuretic peptide signaling are associated with gestational hypertension and preeclampsia. In cellular experiments and mouse models, uterine ANP has been shown to stimulate endometrial decidualization, increase TNF-related apoptosis-inducing ligand expression and secretion, and enhance apoptosis in arterial smooth muscle cells and endothelial cells. In placental trophoblasts, ANP stimulates adenosine 5'-monophosphate-activated protein kinase and the mammalian target of rapamycin complex 1 signaling, leading to autophagy inhibition and protein kinase N3 upregulation, thereby increasing trophoblast invasiveness. ANP deficiency impairs endometrial decidualization and spiral artery remodeling, causing a preeclampsia-like phenotype in mice. These findings indicate the importance of natriuretic peptide signaling in pregnancy. This review discusses the role of ANP in uterine biology and potential implications of impaired ANP signaling in preeclampsia.

Corin Deficiency Diminishes Intestinal Sodium Excretion in Mice

Sodium excretion, a critical process in sodium homeostasis, occurs in many tissues, including the kidney and intestine. Unlike in the kidney, the hormonal regulation of intestinal sodium excretion remains unclear. Atrial natriuretic peptide (ANP) is a crucial hormone in renal natriuresis. Corin is a protease critical for ANP activation. Corin and ANP are expressed mainly in the heart. In this study, we investigated corin, ANP, and natriuretic peptide receptor A (Npra) expression in mouse intestines. Corin and ANP expression was co-localized in enteroendocrine cells, whereas Npra expression was on the luminal epithelial cells. In Corin knockout (KO) mice, fecal Na⁺ and Cl^- excretion decreased compared with that in wild-type (WT) mice. Such a decrease was not found in conditional Corin KO mice lacking cardiac corin selectively. In kidney conditional Corin KO mice lacking renal corin, fecal Na⁺ and Cl^- excretion increased, compared to that in WT mice. When WT, Corin KO, and the kidney conditional KO mice were treated with aldosterone, the differences in fecal Na⁺ and Cl^- levels disappeared. These results suggest that intestinal corin may promote fecal sodium excretion in a paracrine mechanism independent of the cardiac corin function. The increased fecal sodium excretion in the kidney conditional Corin KO mice likely reflected an intestinal compensatory response to renal corin deficiency. Our results also suggest that intestinal corin activity may antagonize aldosterone action in the promotion of fecal sodium excretion. These findings help us understand the hormonal mechanism controlling sodium excretion the intestinal tract.

Atrial natriuretic peptide and leptin interactions in healthy men

Introduction

Atrial natriuretic peptide (ANP), a hormone secreted from the heart, controls cardiovascular and renal functions including arterial blood pressure and natriuresis. ANP also exerts metabolic effects in adipose tissue, liver and skeletal muscle, and interacts with the secretion of adipokines. We tested the hypothesis that ANP lowers concentrations of the anorexigenic adipokine leptin in healthy humans in vivo.

Methods

Human ANP or matching placebo was infused intravenously (iv) into healthy men in a controlled clinical trial.

Results

Within 135 minutes of iv ANP infusion, we observed an acute decrease in plasma leptin levels compared to controls. Free fatty acids markedly increased with ANP infusion in vivo, indicating activated lipolysis. In human SGBS adipocytes, ANP suppressed leptin release.

Discussion

The study shows that the cardiac hormone ANP reduces the levels of the anorexigenic adipokine leptin in healthy humans, providing further support for ANP as a cardiomyokine in a heart - adipose tissue axis. (registered in the German Clinical Trials Register and the WHO International Clinical Trials Registry Platform was granted under DRKS00024559).

The Natriuretic Peptide System: A Single Entity, Pleiotropic Effects

In the modern scientific landscape, natriuretic peptides are a complex and interesting network of molecules playing pleiotropic effects on many organs and tissues, ensuring the maintenance of homeostasis mainly in the cardiovascular system and regulating the water-salt balance. The characterization of their receptors, the understanding of the molecular mechanisms through which they exert their action, and the discovery of new peptides in the last period have made it possible to increasingly feature the physiological and pathophysiological role of the members of this family, also allowing to hypothesize the possible settings for using these molecules for therapeutic purposes. This literature review traces the history of the discovery and characterization of the key players among the natriuretic peptides, the scientific trials performed to ascertain their physiological role, and the applications of this knowledge in the clinical field, leaving a glimpse of new and exciting possibilities for their use in the treatment of diseases.

Research on the construction of the evaluation index system of game-based teaching

This research aims to combine the pursuit of literacy cultivation with a focused investigation into the evidence of game-based teaching (GBT). To achieve this, the study employs a mixed-methods approach including the interview method, Delphi method, and network hierarchical analysis (ANP) to analysis Expert opinions and construct a comprehensive GBT evaluation index system. The results indicated that a comprehensive GBT evaluation index system is comprised of five primary indicators: teaching objectives, game-based teaching methods, teaching content, game-based teaching processes, and game-based teaching characteristics. Additionally, there are 19 secondary indicators, such as objective content, game presentation, context construction, and flow experience. This study expects to effectively capture the unique attributes of game-based classes and to assist teachers in improving the design of GBT activities in practical applications.

How geographical factors and decision-makers' perceptions influence the prioritization of ecosystem services: Analysis in the Spanish rice field areas in RAMSAR Mediterranean wetlands

Mediterranean wetlands provide many ecosystem services to humans and other organisms. However, these services are being increasingly damaged. The prioritization of ecosystem services is essential to start a decision-making process focused on environmental policies, highlighting the necessity of equilibrium between sustainability and human well-being. This study analyzes the similarities and differences among the ecosystem services provided by the Spanish RAMSAR Mediterranean wetlands, where rice production is the main economic activity. These areas are the Ebro Delta, the Albufera Natural Park and the Guadalquivir Marshes (Doñana Biosphere Reserve). Despite being different areas, environmental and agricultural policies sometimes treat their characteristics without distinction since they are conceptually englobed in the same category. This analysis aims to study whether geographical and sociocultural factors could influence the prioritization of ecosystem services. The prioritization of the three study areas was conducted using the Analytic Network Process (ANP), a multi-criteria decision-making method which allows decision-makers to manage the ecosystem's complexity. The results are helpful for future policies and in understanding the complex network of interconnections among ecosystem services. Additionally, results show that there are statistically significant differences in priorities among the three study areas due to geographical and cultural reasons. Moreover, results have also shown that decision-makers' judgements influenced the priorities depending on their background and personal or professional preferences. It emphasizes the necessity of implementing environmental policies from a theoretical and global scale to a participatory and local one, considering a broader range of stakeholders' perceptions to reflect the complexity of the ecosystem services network.

Exploring the Critical Driving Forces and Strategy Adoption Paths of Professional Competency Development for Various Emergency Physicians Based on the Hybrid MCDM Approach

The implementation of competency-based medical education (CBME) focuses on learners' competency outcomes and performance during their training. Competencies should meet the local demands of the healthcare system and achieve the desired patient-centered outcomes. Continuous professional education for all physicians also emphasizes competency-based training to provide high-quality patient care. In the CBME assessment, trainees are evaluated on applying their knowledge and skills to unpredictable clinical situations. A priority of the training program is essential in building competency development. However, no research has focused on exploring strategies for physician competency development. In this study, we investigate the professional competency state, determine the driving force, and provide emergency physicians' competency development strategies. We use the Decision Making Trial and Evaluation Laboratory (DEMATEL) method to identify the professional competency state and investigate the relationship among the aspects and criteria. Furthermore, the study uses the PCA (principal component analysis) method to reduce the number of components and then identify the weights of the aspects and components using the ANP (analytic network process) approach. Therefore, we can establish the prioritization of competency development of emergency physicians (EPs) with the VIKOR (Vlse kriterijumska Optimizacija I Kompromisno Resenje) approach. Our research demonstrates the priority of competency development of EPs is PL (professional literacy), CS (care services), PK (personal knowledge), and PS (professional skills). The dominant aspect is PL, and the aspect being dominated is PS. The PL affects CS, PK, and PS. Then, the CS affects PK and PS. Ultimately, the PK affects the PS. In conclusion, the strategies to improve the professional competency development of EPs should begin with the improvement from the aspect of PL. After PL, the following aspects that should be improved are CS, PK, and PS. Therefore, this study can help establish competency development strategies for different stakeholders and redefine emergency physicians' competency to reach the desired CBME outcomes by improving advantages and disadvantages.

Knowledge management strategy for managing disaster and the COVID-19 pandemic in Indonesia: SWOT analysis based on the analytic network process

Indonesia has significant expertise in disaster management due to its disaster geography. Collective expertise and knowledge are valuable resources for lowering disaster risk and enhancing disaster resilience. Additionally, in the current pandemic situation, a clearer understanding of COVID-19 is growing, which could make a difference in how effectively we respond to this and future pandemics. Therefore, it is crucial to record and maintain information related to the event in order to handle any crisis and COVID-19 pandemic appropriately. The goal of this study is to explore KM implementation approaches for handling disasters and the COVID-19 pandemic in Indonesia. In order to collect data for this study, 20 experts were interviewed and 30 experts participated in a Focus Group Discussion (FGD). SWOT analysis was utilised in this study to find different KM implementation strategies. The Analytic Network Process (ANP) was used to prioritize several previously discovered strategies. The study finds that the approach which must be prioritised is to ensure that knowledge products can be accessed by the public, and they must include the community (family) as subjects in establishing knowledge management methods (not only the government or institutions).

Localization of natriuretic peptide receptors A, B, and C in healthy and diseased mouse kidneys

The natriuretic peptides (NPs) ANP (atrial natriuretic peptide) and BNP (B-type natriuretic peptide) mediate their widespread effects by activating the natriuretic peptide receptor-A (NPR-A), while C-type natriuretic peptide (CNP) acts via natriuretic peptide receptor-B (NPR-B). NPs are removed from the circulation by internalization via the natriuretic peptide clearance receptor natriuretic peptide receptor-C (NPR-C). In addition to their well-known functions, for instance on blood pressure, all three NPs confer significant cardioprotection and renoprotection. Since neither the NP-mediated renal functions nor the renal target cells of renoprotection are completely understood, we performed systematic localization studies of NP receptors using in situ hybridization (RNAscope) in mouse kidneys. NPR-A mRNA is highly expressed in glomeruli (mainly podocytes), renal arterioles, endothelial cells of peritubular capillaries, and PDGFR-receptor β positive (PDGFR-β) interstitial cells. No NPR-A mRNA was detected by RNAscope in the tubular system. In contrast, NPR-B expression is highest in proximal tubules. NPR-C is located in glomeruli (mainly podocytes), in endothelial cells and PDGFR-β positive cells. To test for a possible regulation of NPRs in kidney diseases, their distribution was studied in adenine nephropathy. Signal intensity of NPR-A and NPR-B mRNA was reduced while their spatial distribution was unaltered compared with healthy kidneys. In contrast, NPR-C mRNA signal was markedly enhanced in cell clusters of myofibroblasts in fibrotic areas of adenine kidneys. In conclusion, the primary renal targets of ANP and BNP are glomerular, vascular, and interstitial cells but not the tubular compartment, while the CNP receptor NPR-B is highly expressed in proximal tubules. Further studies are needed to clarify the function and interplay of this specific receptor expression pattern.

The advanced nurse practitioner in context: Systemic processes

BACKGROUND

Healthcare systems are becoming increasingly complex. Systems thinking can help us to understand this complexity and how to apply that understanding to design and evaluate interventions that improve health outcomes. With the current emphasis on developing advanced nursing practice, it is timely to examine systemic processes that characterize ANP systems and their interactions with wider healthcare systems, and how these processes enable and constrain the role.

OBJECTIVE

To make explicit the systemic processes that characterize the Advanced Nurse Practitioner (ANP) system and how they enable and constrain the role.

DESIGN

An interpretive descriptive study.

SETTING

The study was conducted in a large Hospital Group, consisting of eleven acute hospitals, within the Irish Healthcare System.

PARTICIPANTS

Twenty nine participants, including ANPs, nurses, nurse managers, medics and allied health professionals, participated in the study.

METHODS

Data were collected through seven in-depth interviews and four focus groups. Data were analyzed using the Organic Systems Framework (OSF), where attention was on language indicative of the processes of individuation, integration, differentiation and homogenization.

RESULTS

Participants emphasize how ANP systems exert power by individuating and differentiating; however, restrictive regulations and medical control constrain this power. Integration and homogenization are expressed as ANPs encourage and engage in collaborative practice towards common purposes. When hierarchical structures and professional self-interest dominate, however, these processes are submerged, resulting in unbalanced systems.

CONCLUSION

ANP systems realize their power through increased autonomy by individuating and differentiating. Hierarchical structures positioning ANPs in subservient roles should be challenged. Processes of integration and homogenization are expressed in collaborative practices. We recommend that ANPs realize and articulate the value and diversity that they bring to health systems to strengthen their contribution to them.

CLINICAL RELEVANCE

Lack of awareness of the systemic processes that enable and constrain the ANP role affects the role's potential contribution to the healthcare system. Systems thinking and employing the OSF as an analysis framework can help us to understand these processes and their implications, and how to apply that understanding to design and evaluate interventions that improve health outcomes.

Role of Cardiac Natriuretic Peptides in Heart Structure and Function

Cardiac natriuretic peptides (NPs), atrial NP (ANP) and B-type NP (BNP) are true hormones produced and released by cardiomyocytes, exerting several systemic effects. Together with C-type NP (CNP), mainly expressed by endothelial cells, they also exert several paracrine and autocrine activities on the heart itself, contributing to cardiovascular (CV) health. In addition to their natriuretic, vasorelaxant, metabolic and antiproliferative systemic properties, NPs prevent cardiac hypertrophy, fibrosis, arrhythmias and cardiomyopathies, counteracting the development and progression of heart failure (HF). Moreover, recent studies revealed that a protein structurally similar to NPs mainly produced by skeletal muscles and osteoblasts called musclin/osteocrin is able to interact with the NPs clearance receptor, attenuating cardiac dysfunction and myocardial fibrosis and promoting heart protection during pathological overload. This narrative review is focused on the direct activities of this molecule family on the heart, reporting both experimental and human studies that are clinically relevant for physicians.

Review A State of Natriuretic Peptide Deficiency

Measurement of natriuretic peptides (NPs) has proven its clinical value as biomarker, especially in the context of heart failure (HF). In contrast, a state partial NP deficiency appears integral to several conditions in which lower NP concentrations in plasma presage overt cardiometabolic disease. Here, obesity and type 2 diabetes have attracted considerable attention. Other factors - including age, sex, race, genetics, and diurnal regulation - affect the NP "armory" and may leave some individuals more prone to development of cardiovascular disease. The molecular maturation of NPs has also proven complex with highly variable O-glycosylation within the biosynthetic precursors. The relevance of this regulatory step in post-translational propeptide maturation has recently become recognized in biomarker measurement/interpretation and cardiovascular pathophysiology. An important proportion of people appear to have reduced effective net NP bioactivity in terms of receptor activation and physiological effects. The state of NP deficiency, then, both entails a potential for further biomarker development and could also offer novel pharmacological possibilities. Alleviating the state of NP deficiency before development of overt cardiometabolic disease in selected patients could be a future path for improving precision medicine.

Intelligent model for contemporary supply chain barriers in manufacturing sectors under the impact of the COVID-19 pandemic

The COVID-19 pandemic has cast a shadow on the global economy. Since the beginning of 2020, the pandemic has contributed significantly to the global recession. In addition to the health damages of the pandemic, the economic impacts are also severe. The consequences of such effects have pushed global supply chains toward their breaking point. Industries have faced multiple obstacles, threatening the fragile flow of raw materials, spare parts, and consumer goods. Previous studies showed that supply chain barriers have multi-faceted impacts on industries and supply chains, which demand appropriate measures. In this regard, seven major barriers that directly impact industries have been identified to determine which industry is most affected by the COVID-19 pandemic. This paper utilized a hybrid multi-criteria decision-making (MCDM) approach under a neutrosophic environment using trapezoidal neutrosophic numbers to rank those barriers. The Analytical Network Process (ANP) quantifies the effects and considers the interrelationships between the determined barriers (criteria) involved in decision-making. Subsequently, the Measurement Alternatives and Ranking according to the COmpromise Solution (MARCOS) method was adopted to rank six industries according to the impact of those barriers. Results show that the lack of inventory is the largest barrier to influencing industries, followed by the lack of manpower. Sensitivity analysis is performed to detect the change in the rank of industries according to the change in the relative importance of the barriers.

Applying fuzzy inference system and analytic network process based on GIS to determine land suitability potential for agricultural

Determining soil characteristics and land limitations through the land suitability assessment process is a very important step, due to its important role in sustainable management and reducing the effects of land degradation for the continuous production of agricultural crops. In this study, land suitability potential for wheat cultivation was determined by analytic network process (ANP)-fuzzy and traditional parametric methods including Storie and square root in lands with an area of about 4300 ha located in northwestern Iran. For this purpose, according to the land use maps, topography, slope, geology, and satellite image of the study area, the initial soil units were identified and soil was sampled by digging profiles in these units from the soil horizons of the profiles. According to the results, the ANP-fuzzy method had a more accurate evaluation in determining the land suitability potential, based on the determination coefficient (R²) value between wheat yield and land suitability index compared to parametric methods. The application of ANP-fuzzy method determined 2328.05 ha, 53.79% of land highly suitable (S1), 1577.69 ha, 36.45% moderately suitable (S2), 419.6 ha, 9.69% marginally suitable (S3), and 3.02 ha, 0.07% currently unsuitable (N1). The most important limiting characteristics were slope, soil depth, ESP, Gypsum, pH, and soil salinity. Therefore, due to optimal weighting of characteristics, determining suitable limits of critical points, and applying ideal fuzzy membership functions, the ANP-fuzzy method can be applied as a superior method for assessing land potential for sustainable agricultural crop production in other parts of the world.

Smarter and Greener Cities After COVID-19: An Integrated Decision-Making Framework to Prioritize Investment Alternatives

Locking down cities to curb the transmission of coronavirus brought the global economy to a grinding halt. Cities are like engines of growth; when they stop, so does the growth. Therefore, it becomes paramount to build cities that continue to function and do not collapse amidst any crisis. Since economic recovery is underway, this paper examines priority areas for investment to expedite recovery and build back stronger cities. These areas are evaluated based on their contribution to revitalizing public health, economic, social, energy, and environmental sectors. For the analysis, analytical network process (ANP) and fuzzy-VIKOR are applied. ANP obtains the relative importance of sectors and their respective critical factors after solving a complex relationship among them. The economic sector has the highest weight of 25.8% among the five sectors, while job creation has the highest weight of 10.3% among the fifteen factors. Fuzzy-VIKOR is used to evaluate different areas and it is found that renewable energy has a greater contribution to the sustainable recovery of major sectors and the long-term aim of building inclusive green and resilient cities. These insights shall contribute to the conversations already ongoing among city governments, urban planners, civil society organizations, and city dwellers seeking practical solutions to unprecedented challenges posed by the pandemic.

Modulation of blood pressure regulatory genes in the Agtrap-Plod1 locus associated with a deletion in Clcn6

The AGTRAP-PLOD1 locus is a conserved gene cluster containing several blood pressure regulatory genes, including CLCN6, MTHFR, NPPA, and NPPB. Previous work revealed that knockout of Clcn6 on the Dahl Salt-Sensitive (SS) rat background (SS-Clcn6) resulted in lower diastolic blood pressure compared to SS-WT rats. Additionally, a recent study found sickle cell anemia patients with mutations in CLCN6 had improved survival and reduced stroke risk. We investigated whether loss of Clcn6 would delay the mortality of Dahl SS rats on an 8% NaCl (HS) diet. No significant difference in survival was found. The ability of Clcn6 to affect mRNA expression of nearby Mthfr, Nppa, and Nppb genes was also tested. On normal salt (0.4% NaCl, NS) diets, renal Mthfr mRNA and protein expression were significantly increased in the SS-Clcn6 rats. MTHFR reduces homocysteine to methionine, but no differences in circulating homocysteine levels were detected. Nppa mRNA levels in cardiac tissue from SS-Clcn6 rat in both normotensive and hypertensive conditions were significantly reduced compared to SS-WT. Nppb mRNA expression in SS-Clcn6 rats on a NS diet was also substantially decreased. Heightened Mthfr expression would be predicted to be protective; however, diminished Nppa and Nppb expression could be deleterious and by preventing or blunting vasodilation, natriuresis, and diuresis that ought to normally occur to offset blood pressure increases. The conserved nature of this genetic locus in humans and rats suggests more studies are warranted to understand how mutations in and around these genes may be influencing the expression of their neighbors.

Maritime Environment Assessment and Management Using through Balanced Scorecard by Using DEMATEL and ANP Technique

Previous studies have found that the occurrence of maritime accidents often lacks a sound environment management mechanism. The reason is that maritime safety needs management functions to promote each other. This study aims to assess the risk analysis of maritime accidents, applying balanced scorecard (BSC) concepts integrating decision-making trial and evaluation laboratory (DEMATEL) with analytic network process (ANP). The empirical results are that the balanced scorecard could be applied as a maritime procedure management method in maritime risk analysis. A total of 30 questionnaires were collected via scholar questionnaire, and five criteria or key factors for strengthening risk assessment of marine accidents were determined. According to the application of BSC, the risk analysis criteria constructed can assist maritime authorities to reduce the maritime accidents.

Phosphodiesterases and Compartmentation of cAMP and cGMP Signaling in Regulation of Cardiac Contractility in Normal and Failing Hearts

Cardiac contractility is regulated by several neural, hormonal, paracrine, and autocrine factors. Amongst these, signaling through β-adrenergic and serotonin receptors generates the second messenger cyclic AMP (cAMP), whereas activation of natriuretic peptide receptors and soluble guanylyl cyclases generates cyclic GMP (cGMP). Both cyclic nucleotides regulate cardiac contractility through several mechanisms. Phosphodiesterases (PDEs) are enzymes that degrade cAMP and cGMP and therefore determine the dynamics of their downstream effects. In addition, the intracellular localization of the different PDEs may contribute to regulation of compartmented signaling of cAMP and cGMP. In this review, we will focus on the role of PDEs in regulating contractility and evaluate changes in heart failure.

Children With Short Stature Display Reduced ACE2 Expression in Peripheral Blood Mononuclear Cells

BACKGROUND

The cause of short stature remains often unknown. The renin-angiotensin system contributes to growth regulation. Several groups reported that angiotensin-converting enzyme 2 (ACE2)-knockout mice weighed less than controls. Our case-control study aimed to investigate if children with short stature had reduced ACE2 expression as compared to controls, and its significance.

MATERIALS AND METHODS

children aged between 2 and 14 years were consecutively recruited in a University Hospital pediatric tertiary care center. Cases were children with short stature defined as height SD ≤ -2 diagnosed with growth hormone deficiency (GHD) or idiopathic short stature (ISS), before any treatment. Exclusion criteria were: acute diseases, kidney disease, endocrine or autoimmune disorders, precocious puberty, genetic syndromes, SGA history. ACE and ACE2 expression were measured in peripheral blood mononuclear cells, angiotensins were measured by ELISA.

RESULTS

Children with short stature displayed significantly lower ACE2 expression, being 0.40 fold induction (0.01-2.27) as compared to controls, and higher ACE/ACE2, with no differences between GHD and ISS. ACE2 expression was significantly and inversely associated with the risk of short stature, OR 0.26 (0.07-0.82), and it had a moderate accuracy to predict it, with an AUC of 0.73 (0.61-0.84). The cutoff of 0.45 fold induction of ACE2 expression was the value best predicting short stature, identifying correctly 70% of the children.

CONCLUSIONS

Our study confirms the association between the reduction of ACE2 expression and growth retardation. Further studies are needed to determine its diagnostic implications.

The heart, an endocrine gland: natriuretic peptides

The natriuretic peptide family consists of three biologically active peptides: atrial natriuretic peptide (ANP), brain (or B-type) natriuretic peptide (BNP), and C-type natriuretic peptide (CNP). ANP and BNP, secreted by the heart, act as cardiac hormones, whereas CNP is an endothelial peptide. The aim of this manuscript is to review the production, action mechanisms, effects and clinical applications of natriuretic peptides.

The Natriuretic Peptides for Hypertension Treatment

Hypertension is a common pathological condition predisposing to a higher occurrence of cardiovascular diseases and events. Unfortunately, treatment of hypertension is still suboptimal worldwide. More efforts are needed to implement the availability of anti-hypertensive drugs. The family of natriuretic peptides, including atrial and brain natriuretic peptides (ANP and BNP), play a key role on blood pressure regulation through the natriuretic, diuretic and vasorelaxant effects. A large number of experimental and human studies, ranging from pathophysiological to genetic investigations, supported ANP as the most relevant component of the family able to modulate blood pressure and to contribute to hypertension development. On this background, it is expected that ANP-based therapeutic approaches may give a significant contribution to the development of efficacious therapies against hypertension. Since native ANP cannot be administered due to its short half-life, several approaches were attempted over the years to overcome the difficulties inherent to the ANP instability. These approaches included ANP recombinant and fusion peptides, gene therapy, inhibition of ANP degradation by neprilysin inhibition, and designer peptides. The most relevant achievements in the field are discussed in this article. Based on the available evidence, therapies targeting ANP represent efficacious and clinically applicable anti-hypertensive agents.

Constructing the advanced nurse practitioner identity in the healthcare system: A discourse analysis

AIMS

To explore how Advanced Nurse Practitioners (ANP) are positioned within current nursing and health system structures in Ireland by making explicit the discourses that construct ANPs' identities and how they both enable and constrain their roles.

BACKGROUND

Ambiguity and confusion characterize debates about the ANP role having a profound impact on ANP identity and how they realize their roles. Without clear definitions, boundaries are difficult to ascertain, the full potential of the ANP is not realized and, consequently, ANPs are underutilized. Although this study is relevant outside Ireland's borders, it is of particular concern in the Irish setting as current policy aims to increase ANP numbers.

DESIGN

A qualitative discourse analysis using Gee's Tools of Inquiry.

METHOD

Data were collected between April 2019 and January 2020 through seven in-depth interviews and four focus groups and analysed using Gee's Tools of Inquiry. Participants included ANPs, nurses, doctors and allied healthcare professionals.

FINDINGS

Five key discourses emerged. Language-in-use established, first, that ANPs add value to the healthcare system and, second, highlighted the centrality of nursing to ANPs' identity. The third discourse builds an educated and skilled identity for ANPs, one that, however, lacked the expertise and influence of their medical colleagues. The fourth discourse constructs an identity for ANPs as medical substitutes, lesser roles, yet innovative additions to the system and a threat to existing structures. The final discourse constructs tensions between independence and autonomy, on the one hand, and control, on the other.

CONCLUSION

This study alerts healthcare professionals to ways in which discourses influence opinion and frame ANPs' identity. Healthcare professionals should challenge Conversations and Discourses that disparage the ANP role. ANPs need to clearly articulate their role, the value that it adds to the healthcare system and demonstrate how it aligns with and complements other healthcare professionals' roles.

IMPACT

By identifying and critiquing extant Discourses and Conversations, healthcare professionals, and health system leaders and managers will gain a better understanding of the issues that both enable and constrain the ANP role.

Hemodynamic phenotyping of transgenic rats with ubiquitous expression of an angiotensin-(1-7)-producing fusion protein

Activation of the angiotensin (Ang)-converting enzyme (ACE) 2/Ang-(1-7)/MAS receptor pathway of the renin-angiotensin system (RAS) induces protective mechanisms in different diseases. Herein, we describe the cardiovascular phenotype of a new transgenic rat line (TG7371) that expresses an Ang-(1-7)-producing fusion protein. The transgene-specific mRNA and the corresponding protein were shown to be present in all evaluated tissues of TG7371 with the highest expression in aorta and brain. Plasma Ang-(1-7) levels, measured by radioimmunoassay (RIA) were similar to control Sprague-Dawley (SD) rats, however high Ang-(1-7) levels were found in the hypothalamus. TG7371 showed lower baseline mean arterial pressure (MAP), assessed in conscious or anesthetized rats by telemetry or short-term recordings, associated with increased plasma atrial natriuretic peptide (ANP) and higher urinary sodium concentration. Moreover, evaluation of regional blood flow and hemodynamic parameters with fluorescent microspheres showed a significant increase in blood flow in different tissues (kidneys, mesentery, muscle, spleen, brown fat, heart and skin), with a resulting decrease in total peripheral resistance (TPR). TG7371 rats, on the other hand, also presented increased cardiac and global sympathetic tone, increased plasma vasopressin (AVP) levels and decreased free water clearance. Altogether, our data show that expression of an Ang-(1-7)-producing fusion protein induced a hypotensive phenotype due to widespread vasodilation and consequent fall in peripheral resistance. This phenotype was associated with an increase in ANP together with an increase in AVP and sympathetic drive, which did not fully compensate the lower blood pressure (BP). Here we present the hemodynamic impact of long-term increase in tissue expression of an Ang-(1-7)-fusion protein and provide a new tool to investigate this peptide in different pathophysiological conditions.

Sex-specific mortality prediction by pro-C-type natriuretic peptide measurement in a prospective cohort of patients with ST-elevation myocardial infarction

OBJECTIVE

To determine the predictive value of pro-C-type natriuretic peptide (pro-CNP) measurement in plasma sampled on admission from patients presenting with ST-elevation myocardial infarction (STEMI).

DESIGN

Prospective cohort study.

SETTING

Two University Hospitals in Denmark.

PARTICIPANTS

1760 consecutive patients (470 females and 1290 males) with confirmed STEMI.

MAIN OUTCOMES AND MEASURES

The main outcome was all-cause mortality at 1 year after presentation and the primary measure was pro-CNP concentration in plasma at admission in all patients and longitudinal measurements in a consecutive subgroup of 287 patients. A reference population (n=688) defined cut-off values of increased pro-CNP concentrations.

RESULTS

In all patients, an increased pro-CNP concentration was associated with a higher all-cause mortality after 1 year (HR 1.6, 95% CI 1.1 to 2.4, P_logrank=0.009) including an interaction of sex (p=0.03). In separate sex-stratified analyses, female patients showed increased all-cause mortality (HR_{1 year} 2.6, 95% CI 1.5 to 4.6), P_logrank <0.001), whereas no differences were found in male patients (HR_{1 year} 1.1, 95% CI 0.7 to 1.9, P_logrank=0.66). After adjusting for potential risk factors, we found increased pro-CNP concentrations≥the median value to be independently associated with increased risk of mortality in female patients within 1 year (HR per 1 pmol/L increase: 1.04, 95% CI 1.01 to 1.06, p=0.007). Moreover, we found indications of sex differences in pro-CNP concentrations over time (higher pro-CNP in males (4.4, 95% CI -0.28 to 9.1 pmol/L, p=0.07) and interaction of sex and time (p=0.13)), and that hypertension was independently associated with higher pro-CNP (4.5, 95% CI 0.6 to 8.4 pmol/L, p=0.03).

CONCLUSIONS

In female but not male patients presenting with STEMI, high concentrations of pro-CNP (≥median) at admission independently indicate a higher risk of all-cause mortality. The findings are remarkably specific for female patients, suggesting a different vascular phenotype beyond traditional measures of coronary artery flow compared with male patients.

Revealing how language builds the identity of the advanced nurse practitioner

AIMS AND OBJECTIVES

To explore how language works to enable and constrain the role of the advanced nurse practitioner (ANP) in the health system.

BACKGROUND

Nurses and doctors are produced within historically established disciplinary boundaries. These boundaries are becoming more porous, offering the possibility of a more liberated identity for ANPs that will allow them to reach their full potential. Current uncertainty and confusion about ANPs' identity result in their role being underutilised.

DESIGN

A critical discourse analysis design was used to explore participants' language-in-use. Findings are reported according to the COREQ research checklist.

METHOD

Data were collected through seven in-depth interviews and four focus groups and analysed using Gee's (2010) Identity Building Tool. Participants included ANPs, nurses (including nurse managers), doctors and allied healthcare professionals.

RESULTS

Four discourses were revealed. Participants' language-in-use worked to privilege the ANP's uniquely holistic identity. However, this aspect is also associated with a controlled identity, predominantly constrained by medics and restricted from advancing. The third discourse, the medicalised identity builds an identity that positions ANPs as medical replacements who are assigned trivial medical tasks. The final discourse constructs an independent powerful identity for the ANP that is influential and autonomous.

CONCLUSIONS

Circulating discourses and conversations can influence and shape the construction of the ANP identity. Healthcare professionals need to identify and counter discourses and conversations that construct ANPs' ways of knowing and knowledge as inferior and their role as subservient. Otherwise, ANPs' identity will continue to be controlled and their advancement restricted.

RELEVANCE TO CLINICAL PRACTICE

Confusion concerning the role and identity of the ANP can limit their contribution to the healthcare system. Healthcare professionals need to be aware of how language-in-use can prevent the role from developing and reaching its full potential in enhancing healthcare provision and delivery. Reporting follows the COREQ criteria.

Presentation of landscape-fuzzy approach of forest capability evaluation (LFAFCE) for degraded sites

Evaluation of forest sites capability (EFSC) is important for the restoration of degraded areas. The current costly EFSC approaches developed based on forest stand structure criteria is too costly for less developed countries (LDC) and not suitable for severely degraded lands. This paper describes an inexpensive Landscape-fuzzy approach for forest capability evaluation (LFAFCE) that can be used to restore degraded forest areas especially in LDC. Five physical criteria of slope, hillshade, altitude, precipitation, and geo formation were evaluated in the Zagros region of western Iran using the fuzzy membership functions, prioritized by analytic network process (ANP), and combined with GIS-based weighted linear combination. We then performed multi-criteria evaluation integrated by GIS. Given the positive correlation between the independent variable of EFSC and the dependent variable of the dominant tree height, the model results were validated based on the linear regression of the relationship between the two variables. The results of the validation showed that the linear regression model with appropriate coefficient of determination was significant. The results of EFSC by LFAFCE showed that most of the forest area was allocated to two classes: well (75%) and moderate (21.8%). In total, only 3.2% of the area belonged to the marginal (0.4%), high (0.1%), and unsuitable regions (2.7%) classes. Our results demonstrate that LFAFCE is valid for low-cost evaluation of degraded area in Zagros and for other similar areas, if calibrated, where normal forest mass parameters are not available.

Glipizide Combined with ANP Suppresses Breast Cancer Growth and Metastasis by Inhibiting Angiogenesis through VEGF/VEGFR2 Signaling

BACKGROUND

Breast cancer is one of the most common cancers worldwide among women, and angiogenesis has an important effect on its growth and metastasis. Glipizide, which is a widely used drug for type 2 diabetes mellitus, has been reported to inhibit tumor growth and metastasis by upregulating the expression of natriuretic peptide receptor A (NPRA). Atrial natriuretic peptide (ANP), the receptor of NPRA, plays an important role in angiogenesis. The purpose of this study was to explore the effect of glipizide combined with ANP on breast cancer growth and metastasis.

METHODS

To investigate the effect of glipizide combined with ANP on breast cancer, glipizide, ANP or glipizide combined with ANP was intraperitoneally injected into MMTV-PyMT mice. To explore whether the anticancer efficacy of glipizide combined with ANP was correlated with angiogenesis, a tube formation assay was performed.

RESULTS

Glipizide combined with ANP was found to inhibit breast cancer growth and metastasis in MMTV-PyMT mice, which spontaneously develop breast cancer. Furthermore, the inhibitory effect of ANP combined with glipizide was better than that of glipizide alone. ANP combined with glipizide significantly inhibited tube formation of human umbilical vein endothelial cells (HUVECs) by suppressing vascular endothelial growth factor (VEGF)/VEGFR2 (vascular endothelial growth factor receptor 2) signaling.

CONCLUSIONS

These results demonstrate that glipizide combined with ANP has a greater potential than glipizide alone to be repurposed as effective agents for the treatment of breast cancer by targeting tumor-induced angiogenesis.

Atrial natriuretic peptide protects vertebral endplate chondrocytes against H2O2‑induced apoptosis and oxidative stress through activation of the Nrf2/HO‑1 signaling pathway

The present study aimed to investigate the effect of atrial natriuretic peptide (ANP) on cell apoptosis and oxidative stress in H₂O₂-induced vertebral endplate chondrocytes (EPCs), and to assess the associated mechanisms involved. Cell viability and apoptosis were evaluated using the Cell Counting Kit-8 method and TUNEL assay, respectively. In addition, the scavenging capability was detected using various enzymatic assays, and the quantity of nitric oxide (NO) and malondialdehyde (MDA), and activity of superoxide dismutase (SOD) were assessed. The expression levels of apoptosis-related proteins, activation of the nuclear factor erythroid 2-related factor 2 (Nrf2)/heme oxygenase-1 (HO-1) signaling pathway induced by H₂O₂ and the effect of treatment with ANP on vertebral EPCs were detected by western blotting. The results revealed that ANP protected EPCs from H₂O₂-induced cell damage. H₂O₂-induced intracellular MDA was decreased by ANP, and the levels of SOD and NO were increased in the presence of ANP. ANP also inhibited the H₂O₂-induced alterations in the expression levels of cleaved-caspase-3, Bax and Bcl-2. Finally, ANP blocked H₂O₂-induced oxidative stress through activating the Nrf2/HO-1 signaling pathway. These findings suggested that ANP may effectively protect EPCs through inhibition of H₂O₂-induced oxidant injury and cell death by activating the Nrf2/HO-1 signaling pathway.

miR-145-5p targets paxillin to attenuate angiotensin II-induced pathological cardiac hypertrophy via downregulation of Rac 1, pJNK, p-c-Jun, NFATc3, ANP and by Sirt-1 upregulation

Pathological cardiac hypertrophy is associated with many diseases including hypertension. Recent studies have identified important roles for microRNAs (miRNAs) in many cardiac pathophysiological processes, including the regulation of cardiomyocyte hypertrophy. However, the role of miR-145-5p in the cardiac setting is still unclear. In this study, H9C2 cells were overexpressed with microRNA-145-5p, and then treated with Ang-II for 24 h, to study the effect of miR-145-5p on Ang-II-induced myocardial hypertrophy in vitro. Results showed that Ang-II treatment down-regulated miR-145-5p expression were revered after miR-145-5p overexpression. Based on results of bioinformatics algorithms, paxillin was predicted as a candidate target gene of miR-145-5p, luciferase activity assay revealed that the luciferase activity of cells was substantial downregulated the following co-transfection with wild paxillin 3'UTR and miR-145-5p compared to that in scramble control, while the inhibitory effect of miR-145-5p was abolished after transfection of mutant paxillin 3'UTR. Additionally, overexpression of miR-145-5p markedly inhibited activation of Rac-1/ JNK /c-jun/ NFATc3 and ANP expression and induced SIRT1 expression in Ang-II treated H9c2 cells. Jointly, our study suggested that miR-145-5p inhibited cardiac hypertrophy by targeting paxillin and through modulating Rac-1/ JNK /c-jun/ NFATc3/ ANP / Sirt1 signaling, therefore proving novel downstream molecular pathway of miR-145-5p in cardiac hypertrophy.

Prenatal Particulate Matter (PM) Exposure and Natriuretic Peptides in Newborns from Mexico City

(1) Background: The aim of this study was to assess associations between particulate matter (PM) exposure and natriuretic peptide concentrations in cord blood from newborns. (2) Methods: we conducted a cross-sectional study in Mexico City with 101 pregnant women from CIMIGEN Hospital. Atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP) and C-type natriuretic peptide (CNP) were measured in plasma from cord blood in 51 newborns by ELISA. We estimated PM exposure (PM2.5 and PM10) at first, second and third trimester of pregnancy. (3) Results: The median and interquartile range for ANP, BNP and CNP plasma concentrations were 66.71 (46.92-80.23), 98.23 (73.64-112.30) and 1129.11 (944.10-1452.02) pg/mL, respectively. PM2.5 and PM10 levels for the whole pregnancy period were 22.2 µg/m³ and 41.63 µg/m³, respectively. Employing multivariable linear regression models adjusted for maternal age, newborn sex, smoking before pregnancy, maternal occupation and newborns' length and height, we observed a 2.47 pg/mL (95%CI: -4.67, -0.27) decrease in BNP associated with PM2.5 exposure during second trimester. Adjusted for the same set of confounders, third trimester PM10 exposure was inversely associated with ANP concentrations (beta estimate: -0.90; 95% CI: -1.80, -0.03). Neither PM10 nor PM2.5 were associated with CNP at any trimester of pregnancy. (4) Conclusions: Prenatal exposure to particulate matter was associated with ANP and BNP decrease in newborns.

Lessons from Wolfram Syndrome: Initiation of DDAVP Therapy Causes Renal Salt Wasting Due to Elevated ANP/BNP Levels, Rescued by Fludrocortisone Treatment

Initiation of desmopressin acetate (DDAVP) for untreated diabetes insipidus (DI) in Wolfram syndrome (WS) causes abrupt volume expansion resulting in particularly high secretion of Atrial Natriuretic Peptide (ANP) and/or Brain Natriuretic Peptide (BNP), which in turn blocks all stimulators of zona glomerulosa steroidogenesis, resulting in secondary mineralocorticoid deficiency and acute hyponatremia, causing renal salt wasting (RSW). Two sisters, a 19-y-old girl (A) and a 7-y-old girl (B) with WS, presented with severe polyuria-polydipsia due to never treated DI. Both had neurogenic bladder and "B" had severe hydronephrosis secondary to untreated grade III bilateral vesicoureteral reflux. They initiated therapy with oral melt DDAVP which resulted in RSW. ANP was found ×50 and BNP ×2-4 fold elevated. Fludrocortisone 100-200 × 2 μg/d controlled natriuresis and restored electrolytes to normal within 48 h. Fludrocortisone treatment rescues otherwise potentially life-threatening hyponatremia due to RSW and the secondary mineralocorticoid deficiency driven by elevated ANP and/or BNP, caused by sudden volume expansion following DDAVP initiation.

Update on Biomarkers Associated to Cardioembolic Stroke: A Narrative Review

Background: In the last years, several studies were conducted that evaluated biomarkers that could be helpful for cardioembolic stroke diagnosis, prognosis, and the determination of risk of stroke recurrence. Methods: We performed a narrative review of the main studies that evaluated biomarkers related to specific cardioembolic causes: atrial fibrillation, patent foramen ovale, atrial cardiomyopathy, and left ventricular wall motion abnormalities. Results: BNP and NT-proBNP are, among all biomarkers of cardioembolic stroke, the ones that have the highest amount of evidence for their use. NT-proBNP is currently used for the selection of patients that will be included in clinical trials that aim to evaluate the use of anticoagulation in patients suspected of having a cardioembolic stroke and for the selection of patients to undergo cardiac monitoring. NT-proBNP has also been incorporated in tools used to predict the risk of stroke recurrence (ABC-stroke score). Conclusions: NT-proBNP and BNP continue to be the biomarkers most widely studied in the context of cardioembolic stroke. The possibility of using other biomarkers in clinical practice is still distant, mainly because of the low methodological quality of the studies in which they were evaluated. Both internal and external validation studies are rarely performed for most biomarkers.

Cardio-protective effects of angiotensin-(1-5) via mas receptor in rats against ischemic-perfusion injury

Angiotensin-(1-5) [Ang-(1-5)], which is a metabolite of Ang-(1-7) catalyzed by angiotensin-converting enzyme, is a novel pentapeptide of the renin-angiotensin system. Ang-(1-7), Ang III and Ang IV have a cardio-protective effect via Mas receptor, Ang II type 2 receptor (AT₂R) and AT₄R, respectively. However, it is not clear whether Ang-(1-5) has cardio-protective effects. The aim of this study is to investigate whether Ang-(1-5) protects the heart against ischemia-reperfusion (I/R) injury. After sacrificing Sprague-Dawley rats, the hearts were perfused with Krebs-Henseleit buffer for a 20 min pre-ischemic period with and without Ang-(1-5) followed by 20 min global ischemia and 50 min reperfusion. Ang-(1-5) (1 μM) improved changes in post-ischemic left ventricular developed pressure (LVDP), ±dP/dt, and post-ischemic left ventricular end-diastolic pressure (LVEDP) induced by reperfusion compared to control hearts. Ang-(1-5) decreased myocardial infarct size and LDH activity, and increased coronary flow and the amount of atrial natriuretic peptide (ANP) in coronary effluent during reperfusion compared to control hearts. Pretreatment with Mas receptor antagonist but not with AT₁R or AT₂R antagonist attenuated the improvement of changes in I/R-induced ventricular hemodynamics by Ang-(1-5). Ang-(1-5) treatment decreased Bax, caspase-3 and caspase-9 protein levels, and increased Bcl-2 protein level, which were attenuated by A779 pretreatment. Ang-(1-5) treatment increased Mn-superoxide dismutase, catalase, and heme oxygenase-1 protein levels, which was attenuated by A779 pretreatment. These results suggest that the cardio-protective effects of Ang-(1-5) against I/R injury may be partly related to activating anti-oxidant and anti-apoptotic enzymes via Mas receptor.

Evaluating the sustainability of big data centers using the analytic network process and fuzzy TOPSIS

The big data revolution has created data center sustainability problems, whose solutions require the consideration of environmental factors. The purpose of this study is to establish a big data center sustainability evaluation index and provide guidance for sustainable data center construction. This research formulated a big data center sustainability evaluation model that integrates multiple-criteria decision-making methods based on the analytic network process and fuzzy technique for order preference by similarity to an ideal solution (TOPSIS). Furthermore, a case study was used to examine the proposed model. The refrigeration system, layout and ventilation, data center location, data volume, and server power consumption are the five most crucial factors in determining the sustainability level of a big data center. The areas that require further development are the balancing of tasks on different IT equipment, renewable energy use, and waste heat utilization. This research provides a method or guide that can be used by managers when they build new big data centers or upgrade and optimize existing big data centers to make them more sustainable. This study is the first to assess the sustainability of a big data center according to multiple criteria decision-making methods, in which fuzzy theory is applied to evaluate the imprecise and subjective judgments of decision-makers. This study provides a systematic evaluation framework that is based on qualitative and quantitative criteria and comprises the four factors of big data level, equipment level, room level, and data center level. Big data is new oil, but it is not clean oil. It is both a vital driver of economic growth and a source of environmental damage. We need to ensure that big data centers are run in a sustainable way.

Angiotensin Receptor-Neprilysin Inhibitors and the Natriuretic Peptide Axis

PURPOSE OF THE REVIEW

The purpose of this review is to describe the effects of angiotensin receptor neprilysin inhibitor (ARNI) therapy on the natriuretic peptide axis (NPA), with a particular focus on B-type natriuretic peptide (BNP), atrial natriuretic peptide (ANP), and C-type natriuretic peptide (CNP) to better understand the biology behind the improved outcomes in patients with heart failure with reduced ejection fraction (HFrEF).

RECENT FINDINGS

BNP, ANP, and CNP are the three main natriuretic peptides (NP); they share a common structure and ultimately mediate their actions by activating cyclic guanosine monophosphate (cGMP). ARNI therapy results in a decrease of N-terminal pro-BNP (NT-proBNP) and increase of BNP levels respectively. It is been questioned whether these changes may result from unique laboratory assays characteristics rather than actual biological implications. It appears to be that the prognostic accuracy of BNP for cardiovascular outcomes remains independent and comparable to that of NT-proBNP while on ARNI therapy. ANP levels also increase with ARNI therapy, but no consistent change has been described for CNP levels. There is evidence that the changes in BNP and NT-proBNP correlate with improvement in echocardiographic parameters of volume and function. The dual effect of neprilysin inhibition and angiotensin receptor blockade has substantial implications on the natriuretic peptide axis (NPA). The changes seen in BNP and NT-proBNP specifically have shown to correlate with improvement in echocardiographic parameters. Further results exploring the biologic effects of ARNI therapy on other NPs are still pending and likely will provide further insights in the mechanisms behind the improvement in cardiac function and clinical outcomes.

The Emerging Role of Atrial Natriuretic Peptide in Psychiatry

INTRODUCTION

Atrial natriuretic peptide (ANP), composed by 28 amino-acids, is well known to modulate fluid and electrolyte homeostasis, the hypothalamic-pituitary-adrenal (HPA) axis activity and the immune system. Since ANP is produced in both heart and in the central nervous system (CNS), in the last years, increasing attention has been devoted to its possible role in neuropsychiatric disorders. Indeed, scattered data would indicate its possible role in anxiety, major depression, addictive behaviors, post-traumatic stress disorder and other stress-related disorders. Further, ANP has been hypothesized to represent one of the factors linking depression to cardiovascular health and the immune system.

AIMS

Given the paucity of available information, the aim of this paper was to review the current literature on the role of ANP in the CNS and in the pathophysiology of different neuropsychiatric and stress-related conditions.

DISCUSSION

Supporting data on ANP in psychiatric disorders are still limited to animal studies, or to a few "real" findings in patients gathered some decades ago that should be replicated in larger clinical samples.

CONCLUSION

Further studies are necessary to understand the possible implications of ANP in neuropsychiatry, because potentially it might represent a new way for innovative psychopharmacological treatments in different conditions, all underlaid by hyperactive HPA axis.

Natriuretic peptides and Forkhead O transcription factors act in a cooperative manner to promote cardiomyocyte cell cycle re-entry in the postnatal mouse heart

Background

Cardiomyocytes proliferate rapidly during fetal life but lose their ability of proliferation soon after birth. However, before terminal withdrawal from the cell cycle, cardiomyocytes undergo another round of cell cycle during early postnatal life in mice. While a transient wave of increased DNA synthesis in cardiomyocyte has been observed in postnatal mouse hearts, the molecular mechanisms describing cardiomyocyte cell cycle re-entry remain poorly understood. Atrial and B-type natriuretic peptides (ANP and BNP) are abundantly expressed in embryonic heart ventricles. After birth, the expression of both genes is strongly reduced in the ventricular myocardium. Forkhead O (FOXO) transcription factors are expressed in both embryonic and postnatal heart ventricles. Their transcriptional activity negatively affects cardiomyocyte proliferation. Upon phosphorylation, FOXO is translocated to the cytoplasm and is transcriptionally inactive. Despite these important findings, it remains largely unknown whether natriuretic peptides and FOXO cooperatively play a role in regulating cardiomyocyte cell cycle activity during early postnatal life.

Results

We observed that the expression of ANP and BNP and the level of phosphorylated FOXO were transiently increased in the postnatal mouse heart ventricles, which coincided with the burst of cardiomyocyte cell cycle re-entry during early postnatal life in mice. Cell culture studies showed that ANP/BNP signaling and FOXO cooperatively promoted cell cycle activity in neonatal mouse cardiomyocytes. The enhanced cell cycle activity observed in combined treatment of ANP/BNP and dominant-negative FOXO (DN-FOXO), which can bind FOXO recognition sites on DNA but cannot activate transcription, was primarily mediated through natriuretic peptide receptor 3 (Npr3). In mice, simultaneous application of ANP and DN-FOXO in postnatal hearts reactivated cell cycle in cardiomyocytes, resulting in reduced scar formation after experimental myocardial infarction.

Conclusions

Our data demonstrate the cooperative effects of natriuretic peptide and DN-FOXO on promoting cardiomyocyte cell cycle activity and mouse cardiac repair and regeneration after injury.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12861-020-00236-y.

A model for evaluating green credit rating and its impact on sustainability performance

The development of economic activities and social progress index leads to the governmental considerations for the environmental challenge's issues. The Green Credit Policy (GCP) in China for manufacturing, as a part of a sustainable finance package, initiatives restrictions with suppliers to reduce harmful pollution for the environment. The study mainly validates the impact of GCP on manufacturing for diminishing the emerged pollution to the environment. The study develops Neutrosophic Multiple-Criteria Decision-Making Framework (N-MCDMF) according to neutrosophic theory and various MCDM methods of grey relational analysis (GRA), analytic network process (ANP), the Decision-Making Trial and Evaluation Laboratory technique (DEMATEL), and the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) to support the decision-makers with highly systematic procedures in the uncertain and inconsistent environmental conditions. The N-MCDMF evaluates the conditions of GCP and recommends the optimal Supply Chain Management (SCM) in manufacturing alternatives. A case study is presented for the validation of the issues of applicability and flexibility for the proposed N-MCDMF. The results obtained from the implementation of the N-MCDMF indicates the applicability and flexibility of the proposed approach. In addition, results show that SCM in manufacturing can provide more cooperation for the environment to reduce harmful pollution and to attain sustainability for achieving motivations under the restrictions of GCP.

Methods for Monitoring Endocytosis in Astrocytes

Endocytosis is a vesicle-based mechanism by which eukaryotic cells internalize extracellular material. There are several types of this universal mechanism linked to different types of endocytosed cargo, including pathogens; therefore, several approaches can be applied. Here, we describe techniques that are applicable to study the internalization of flaviviruses; dextrans; transporters, such as, glutamate transporter vGlut1; and peptidergic signaling molecules, including atrial natriuretic peptide into astrocytes, the most heterogeneous neuroglial cells, which play a key homeostatic role in the central nervous system.

A risk evaluation framework for the best maintenance strategy: The case of a marine salt manufacture firm

This paper intends to contribute with a multi-criteria decision-making (MCDM) framework to support risk evaluation for maintenance activities carried out on critical systems in industry. We propose to first select the best maintenance strategy tailored to companies' requirements and systems' features, and second to perform a risk prioritisation aimed at highlighting priorities of intervention. The Analytic Network Process (ANP) is suggested to select the maintenance policy representing the best trade-off considering the complex and varied interdependencies amongst a diversity of clustered elements characterising the system. Then, the main risks related to the interventions associated to the selected maintenance policy are ranked using the ELimination Et Choix Traduisant la REalité III (ELECTRE III) method, using the same criteria weighted by the previous ANP application. This hybrid MCDM framework is applied to a core subsystem of a real-world marine salt manufacture firm.

Seasonal morphology and immunoreactivity of cytokeratin and atrial natriuretic peptide in dromedary camel poll glands

Poll glands are characteristic feature of dromedary camels; although they yield a yellowish offensive secretion, especially during rutting (breeding) season, their function is not yet exactly specified. The present study shows the seasonal morphology and immunoreactivity of cytokeratin (CK) and atrial natriuretic peptide (ANP) in the camel poll gland; the result could clearly specify the role of the gland in camel reproduction. Poll glands are compound tubulo-alveolar in structure. During rutting season, the secretory units showed wide lumina and simple squamous epithelium surrounded by myoepithelial cells; the lumina became narrower and the epithelium changed to simple cuboidal during non-rutting season. Many glandular lobules showed abundant interlobular connective tissue with fewer and smaller secretory units during non-rutting season compared to rutting season. Positive CK and ANP immunoreactivity was detected in the cytoplasm of epithelial cells of secretory units and ducts together with the myoepithelial cells and blood vessels. Although CK immunoreactivity was more intense during rutting season in comparison to non-rutting season, there was no seasonal variation in ANP immunoreactivity. During both seasons, while the glandular capsule, connective tissue septa, interstitium showed negative CK immunoreactions, they reacted moderately to ANP. In conclusion, the poll gland undergoes annual structural and functional changes which are suggested to correlate with the male seasonal sexual behaviour. Further, the biological role of CK and ANP proteins together with their immunohistochemical expression in the camel poll gland suggests a stimulatory effect in the glandular secretory cells, and hence, they might modify camel sexual activity.