Inflammation and immunity play a causal role in the pathogenesis of pulmonary vascular remodelling and pulmonary arterial hypertension (PAH). However, the pathways and mechanisms by which inflammation and immunity contribute to pulmonary vascular remodelling remain unknown. RNA sequencing was used to analyse the transcriptome in control and rats injected with monocrotaline (MCT) for various weeks. Using the transcriptional profiling of MCT‐induced PAH coupled with bioinformatics analysis, we clustered the differentially expressed genes (DEGs) and chose the increased expression patterns associated with inflammatory and immune response. We found the enrichment of Toll‐like receptor (TLR) and Nod‐like receptor (NLR) pathways and identified NF‐κB‐mediated inflammatory and immune profiling in MCT‐induced PAH. Pathway‐based data integration and visualization showed the dysregulated TLR and NLR pathways, including increased expression of TLR2 and NLRP3, and their downstream molecules. Further analysis revealed that the activation of TLR and NLR pathways was associated with up‐regulation of damage‐associated molecular patterns (DAMPs) and RIPK3‐mediated necroptosis was involved in the generation of DAMPs in MCT‐induced PAH. Collectively, we identify RIPK3‐mediated necroptosis and its triggered TLR and NLR pathways in the progression of pulmonary vascular remodelling, thus providing novel insights into the mechanisms underlying inflammation and immunity in the pathogenesis of PAH.

To investigate the relationship between health beliefs and preventive behaviors against noncommunicable diseases (NCDs). A survey was conducted in Health Management Center of the First Affiliated Hospital of Fujian Medical University from August 2019 to December 2019. An structured questionnaire was designed to collect the data on sociodemographic characteristics, health belief model (HBM) constructs and NCD-related behaviors. Structural equation model was used to describe the relationship between health beliefs and the behaviors. Among 4453 participants, the most common unhealthy behaviors were sedentary living and working, mood disorders and staying up late. Female, aging, living in urban areas, good physical health were associated with healthy behaviors. HBM constructs including perceived barriers, self-efficacy, cues to action, perceived benefits, perceived severity, and perceived susceptibility were directly or indirectly related to NCD-related behaviors. Perceived barriers (effect coefficient=0.495) and self-efficacy (effect coefficient=0.435) were found to have the greatest impact on the behaviors. Health beliefs are verified to be associated with preventive behaviors against NCDs. Changing sedentary living and working, mood disorders and staying up late are the top priority of health education. Health education based on HBM, especially focusing on helping overcome difficulties and building confidence of behavior change, may be more effective for the prevention of NCDs.

Introduction: Microalbuminuria is a risk factor for cardiovascular morbidity and mortality in hypertensive patients. However, the relationship between low-grade albuminuria, a higher level of albuminuria below microalbuminuria threshold, and hypertension-related organ damage is unclear. Left ventricular (LV) hypertrophy (LVH) is well recognized to be a subclinical organ damage of hypertension, and LV diastolic dysfunction is also reported to be an early functional cardiac change of hypertension that predicts heart failure. The present study aimed to investigate the association of low-grade albuminuria with LVH and LV diastolic dysfunction in hypertensive patients. Methods: This cross-sectional observational clinical study was retrospectively performed in 870 hypertensive patients admitted to our hospital. Urinary albumin to creatinine ratio (UACR) was calculated to assess the levels of albuminuria: macroalbuminuria (≥300 mg/g), microalbuminuria (≥30 mg/g, but <300 mg/g), and normal albuminuria (<30 mg/g). Low-grade albuminuria was defined as sex-specific highest tertile within normal albuminuria (8.1–29.6 mg/g in males and 11.8–28.9 mg/g in females). LVH and LV diastolic dysfunction were identified as recommended by American Society of Echocardiography. Results: Of the 870 patients, 765 (87.9%) had normal albuminuria, 77 (8.9%) had microalbuminuria, and 28 (3.2%) had macroalbuminuria. Percentage of LVH and LV diastolic dysfunction was increased with ascending UACR. UACR was independently associated with LVH and LV diastolic dysfunction, even in patients with normal albuminuria. Multivariable logistic regression showed that the patients with the highest tertile within normal albuminuria had nearly 80% increase in LVH and nearly 60% increase in LV diastolic dysfunction (adjusted OR for LVH 1.788, 95% CI 1.181–2.708, p = 0.006; adjusted OR for LV diastolic dysfunction 1.567, 95% CI 1.036–2.397, p = 0.034). After further stratification analyses in patients with normal albuminuria, it was shown that this independent association persisted in female patients, those who were younger than 70 years old, and those with duration of hypertension <15 years. Conclusion: Low-grade albuminuria was associated with LVH and LV diastolic dysfunction in hypertensive patients, especially in patients younger than 70 years old, and those with duration of hypertension <15 years.

Pulmonary arterial hypertension (PAH) is a serious disease characterized by elevated pulmonary artery pressure, inflammatory cell infiltration and pulmonary vascular remodeling. However, little is known about the pathogenic mechanisms underlying the disease onset and progression. RNA sequencing (RNA-seq) was used to identify the transcriptional profiling in control and rats injected with monocrotaline (MCT) for 1, 2, 3 and 4 weeks. A total of 23200 transcripts and 280, 1342, 908 and 3155 differentially expressed genes (DEGs) were identified at the end of week 1, 2, 3 and 4, of which Svop was the common top 10 DEGs over the course of PAH progression. Functional enrichment analysis of DEGs showed inflammatory/immune response occurred in the early stage of PAH development. KEGG pathway enrichment analysis of DEGs showed that cytokine-cytokine receptor interaction and neuroactive ligand-receptor interaction were in the initiation and progression of PAH. Further analysis revealed impaired expression of cholinergic receptors, adrenergic receptors including alpha1, beta1 and beta2 receptor, and dysregulated expression of γ-aminobutyric acid receptors. In summary, the dysregulated inflammation/immunity and neuroactive ligand receptor signaling pathways may be involved in the onset and progression of PAH.

The level of lactate dehydrogenase (LDH) has been proved to be positively associated with albuminuria, which represents glomerular endothelial damage in hypertension (HTN). In this study, the relationship between LDH and endothelial function evaluated by flow-mediated dilation (FMD) was investigated in hypertensives. 1507 subjects (aged 61.2 ± 12.5 years) were enrolled. All hypertensives (n = 1216) were subdivided into 3 groups: LDH1 (lowest tertile of LDH, n = 399), LDH2 (mediate tertile of LDH, n = 409) and LDH3 (highest tertile of LDH, n = 408). Meanwhile, 291 normotensives served as controls. FMD of right anterior tibial artery was assessed by high-resolution color Doppler ultrasound. The level of LDH in hypertensives was significantly higher than normotensives (p < 0.001). Whereas, FMD was obviously more blunted in hypertensives (p < 0.001). There was an increasing trend of FMD < 8% from control, LDH1, LDH2 to LDH3 group (χ² = 36.751, p < 0.001). Stepwise multiple liner regression analysis demonstrated an independent correlation between LDH and FMD in hypertensives (β = − 0.145, p < 0.05). After stratified analysis, the relevance persisted in the male, young and middle-aged, hypertensives with grade 2 HTN, duration of HTN < 3 years, metabolic syndrome and those without statin therapy. In conclusion, the level of LDH was inversely correlated with FMD among hypertensives. Those hypertensives with increased LDH need to be scanned for target organ damage, such as microalbuminuria and endothelial dysfunction, and more frequent following up are also recommended.

Background: The triadic relationship among the number of NCDs, preventive behaviors and health beliefs has not been fully explored, especially the role of health beliefs. Aims: To explore the association between the number of NCDs and preventive behaviors, as well as the mediating effect of health beliefs and its dimensions among middle-aged and older adults. Provide scientific evidence for developing targeted behavior intervention. Methods: Data from 2095 middle-aged and older adults who completed demographic information, health beliefs and preventive behaviors questionnaire. Mediation analysis was used to explore the association of health beliefs and its dimensions between the number of NCDs and preventive behaviors. Results: Health beliefs and self-efficacy positively impacted preventive behaviors, whereas perceived severity, while perceived barriers had negative effects. Health beliefs (β = − 0.1809, 95% CI − 0.2658 to − 0.0960) and its dimensions(Perceived barriers:β = − 0.0881, 95% CI − 0.1533 to − 0.0232, self-efficacy: β = − 0.2706, 95% CI − 0.3592 to − 0.1892) partially mediated the associations between the number of NCDs and preventive behaviors. The negative mediation effects indicates that as the number of NCDs increases, preventive behaviors decrease, partly due to a decline in health beliefs and self-efficacy, as well as an increase in perceived barriers (scored inversely, meaning higher barriers). These mediation pathways exhibited modest strength, highlighting the importance of health beliefs on behavior change. Conclusions: An increasing number of NCDs is associated with reduced engagement in preventive behaviors. Health beliefs and its dimensions play a partial mediating role in this relationship. Effective intervention targeting health beliefs may help promote positive behavioral changes.