bluuebunny/crossref_metadata_2025 huggingface dataset:
Populism and Republicanism
Authors: Jäger Anton
Published: May 2024

Can republicans be populists and populists republicans? According to some powerful trends in political theory, both questions can only receive a resolutely negative answer. Populism and republicanism are bound to diverge in their mutually incompatible commitment to a republican ‘rule of law’ or a populist ‘rule by law’: while republicans celebrate the impersonal force of the rule of law, populists personalize political power into a rule by law, preferring immediate decisions by strongmen over careful deliberation in parliaments. Thus, it is very hard for populists to be republicans, and even harder for republicans to be populists. This chapter seeks to weaken the opposition by taking a historical step back. It focuses on the first self-declared populist movement in modern history, the American People’s Party of the late 19th century, and investigates its deep debts to the classical republican tradition. It shows how this original populism grew out of an attempt to adapt ancient republican principles to modern industrial circumstances, and the contradictions this attempt generated. In the latter sense, an investigation of an earlier populist republicanism not only yields important insights into the general nexus between populism and republicanism or the deficiencies of liberal democracy, but also central dilemmas of modern political life itself.
Republican Political Education
Authors: Pietrzyk-Reeves Dorota
Published: May 2024

This chapter argues that today’s interest in republicanism and a neo-republican perspective should include a normative vision of political education which refers to various key concepts of the classical republican tradition, but also has a practical component described here as self-education. The vision that is offered sees politics as an activity of free persons, and political education as primarily self-education, a process of learning that aims at greater political awareness, empowerment, recognition of civic duty, and a better judgement on political issues. These are key practical remedies to the diminished role of the public good and the shallowness of politics in a liberal-democratic order. Republican political education is also as a significant contribution to the preservation of a free society as a necessary condition of active political and civic involvement, community service, citizenship, civic intelligence, and political liberty. It fosters the conception of a republican democracy of vigilant citizens by indicating the resources that shape such vigilance. One of them is the very awareness of the political, of being a member of various groups and communities that have political goals, such that can be achieved only through political arrangements, deliberation, and compromise.
Republican Families?
Authors: Gheaus Anca
Published: May 2024

What would the institution of the family look like if it were reformed according to republican desiderata? Would it even survive such re-shaping? This chapter examines the charges that the family dominates women and children in what is taken to be their most convincing interpretations, and considers the theoretical and practical implications. The deepest source of women’s domination within the family is the gendered division of labour. Surprisingly perhaps, an analysis of how the gendered division of labour generates domination yields the conclusion that not only women, but also men who engage in very pronounced forms of gendered specialization, can be dominated; this raises the interesting questions of whether mutual (and potentially equal) dependencies can count as domination, and if yes, whether they are less or more objectionable than one-sided domination. Achieving non-domination in upbringing doesn’t seem, all things considered, in children’s interests. If so, justified child rearing should merely seek to minimize domination. Indeed, it is undesirable, and maybe impossible, to eliminate it not only from the family but from any imaginable form of upbringing—such as an orphanage or a kibbutz. The reason is that children need intimate relationships that can only exist in the absence of proper mechanisms that check the exercise of parental power; further, the kind of vulnerability that concerns republicans may be constitutive of the emotional intimacy that is essential to children’s well-being. Finally, the chapter argues that full eradication of domination from close relationships in general is undesirable.
Legitimacy and the Global Order
Authors: Kassner Joshua
Published: May 2024

In ‘Republican Law of Peoples’, Philip Pettit offers a republican account of a just international order. The argument in this chapter, though at times departing from Pettit’s account, is meant to be complementary to his view. Grounded in the contemporary republican commitment to freedom as non-domination, if we understand domination to be about a normative relationship between those capable of domination and those subject to such domination and we take sovereign states as they are in a world of global interdependence and interconnectedness, then there are certain structural features of the international order that render domination unavoidable. This does not undermine Pettit’s argument but builds upon and adds another layer of analysis to an understanding of the legitimacy of the international order grounded in a republican commitment to freedom as non-domination. The argument begins with a justification of the proposition that the legitimacy of the international order depends on the extent to which the practices, principles, and institutions that make up international order protect against domination. Then, several potential objections are identified and answered. Having responded to those objections, the implications the argument has for the legitimacy of the international order are outlined. Finally, the chapter concludes with some thoughts on what this means for the foreign policy of states and for the normative framework of international relations.
Republican Global Economic Justice
Authors: O’Shea Tom
Published: May 2024

This chapter discusses international economic justice from a civic republican perspective. It begins with a historical survey of republican thinking on international economic matters, with special attention to the idea and practice of slavery. This account reveals a number of stances bearing on international economic life that republicans have defended, including patriotic militarism, free-trading commercialism, and internationalist socialism. The chapter then outlines and evaluates the global dimensions of contemporary republican economic philosophy, considering economic domination by states, as well as non-state actors such as multinational corporations. Disagreement over the institutional or normative viability of cosmopolitanism has been an important factor in shaping republican approaches to international economic justice, so republican contributions to this debate are then evaluated. Finally, the account is rounded out with a sketch of future directions for republican thinking about global economic justice, focusing on commercial and socialist republicanisms.
The Critique of Transitional Justice
Authors: Meierhenrich Jens , Hinton Alexander Laban , Douglas Lawrence
Published: May 2024

This chapter looks into the critique of transitional justice. It explains that historical sensitivity to genealogies of indigenous critique and their afterlives is relevant for developing a better understanding of the political present. Even though Supreme Court Justice Robert H. Jackson expressed the ethos of liberal internationalism that informed the rise of transitional justice in the late twentieth century, the ethos also heralded its decline in the twenty-first century. The chapter considers the meaning and efficacy of the modalities of transitional justice which now range from archives to truth commissions. It also elaborates on the dangers of ideology masked as eschatology.
What We Talk about When We Talk about Transitional Justice—And What We Don’t
Authors: Moon Claire
Published: May 2024

This chapter reprises and re-evaluates the origin story of transitional justice. It discusses the play of the post-atrocity “way of worldmaking” gifted by Nuremberg (crimes against humanity must be punished), against that bestowed by the end of the Cold War (violent authoritarians must be pacified rather than punished). It concentrates attention on a set of late-Cold War political conditions largely ignored by the field to date. It spotlights the Reagan Doctrine, an important artifact of late US Cold War foreign policy, in order to show how the political allegiances and norms it generated shaped early debates and cases in transitional justice. The chapter draws on examples from a range of constitutive events and artifacts in the emergence of the field, namely, founding debates and official documents which preceded and shaped important early cases in Chile (1990) and South Africa (1996) respectively. This early context—history, politics, and debates—provides a rich snapshot of a new way of worldmaking at the moment of its inception. This chapter argues that this history gifted transitional justice with a distinctive, modular, way of addressing atrocity that was designed to transcend political differences. It argues further that this modular way of knowing went on to indelibly imprint the field, and facilitated the proliferation of transitional justice far beyond the contexts it was originally set up to address. Finally, the chapter argues that the features of transitional justice that have made it so successful have also led to an over-extension of the field and an exhaustion of its meaning.
Regional Judicial Cooperation and Dialogue
Authors: De Visser Maartje
Published: May 2024

This chapter explores intra-Asian judicial dialogues that take place through personal encounters or electronic means. It suggests that instances of such judicial cooperation can vary in design along four dimensions: bilateral-multilateral, generalist-specialist, ad hoc-systematic, and formal-informal; and it illustrates the application of this framework through a series of case studies. Next, the factors that shape the frequency and contours of judicial cooperation are discussed. This is followed by an examination of five factors that account for the actual success and impact of judicial networking: the number of participants; the availability of resources to support the dialogue; the capacity and motivation of the judges; the regularity and quality of the interaction; and the structure and organization of participating courts. The conclusion identifies trends that appear likely to shape the future development of judicial dialogue and cooperation in Asia, namely transnational judicial education and the emergence of a genuinely regional consciousness among courts.
Electoral Systems
Authors: Reilly Benjamin , Kasuya Yuko
Published: May 2024

A “majoritarian turn” was identified by scholars of Asian electoral systems starting in the 1990s, based on the rise of mixed-member majoritarian electoral systems and more centripetal party competition. Beginning in the 2000s, the pendulum shifted, with more consensual approaches to democracy appearing. While maintaining the basic majoritarian thrust of electoral democracy, the new Asian model typically adds a range of consensual elements to represent key identity cleavages of gender, ethnicity, and territory. This shift typically involves institutional reforms, grafting gender quotas, multi-ethnic party lists, and quasi-federal elements onto ostensibly majoritarian state structures. Across much of Asia, this has led to the development of more inclusive political systems than was the case only a decade ago.
Religious Freedom
Authors: Neo Jaclyn L.
Published: May 2024

Asia is a religiously diverse region; indeed, according to one measure, roughly half of the world’s most religiously diverse countries are in the Asia-Pacific region. The region’s political systems also run the gamut from liberal democracies, authoritarian democracies, socialist or communist regimes, to absolute monarchies and they diverge widely in terms of how religious freedom is addressed by constitutional law. Notwithstanding the region’s great diversity and complexity, it is possible to discern some broad patterns in how constitutional arrangements of state and religion shape claims of religious freedom across Asia. This chapter canvasses the scope of religious freedom protections across the region and suggests three broad models of state–religion arrangements that help to illuminate the constitutional trends and patterns of religious freedom claims: (i) states that explicitly prioritize religion; (ii) those that explicitly subordinate religion to state interests; and (iii) those that explicitly commit to the separation of state and religion.
Authoritarian Learning
Authors: Heydemann Steven
Published: May 2024

Authoritarian learning plays an increasingly important role in global processes of autocratization and democratic backsliding yet remains understudied and undertheorized. This chapter reviews conditions that elevate the role of authoritarian learning in the international system. It assesses the state of research with a focus on definitional debates concerning what authoritarian learning is and is not. In contrast to more restrictive definitions, the chapter presents an expansive definition of authoritarian learning as a process in which autocratic actors assess the appropriateness and effectiveness of ideas, rules, norms, and practices based on their observed utility. It argues that such processes are evident in both authoritarian and democratic regimes, and operate at the domestic, regional, and international levels. Turning to research horizons in the study of authoritarian learning, it advocates for comparative work that will shed light on specific mechanisms and causal pathways of authoritarian learning.
The CO-to-H2 conversion factor in the Central Molecular Zone of the Milky Way using CO isotopologues
Authors: Kohno Mikito , Sofue Yoshiaki
Published: May 2024

We performed correlation analyses between the 12CO and 13CO J = 1–0 line intensities in order to derive the variability of the CO-to-H2 conversion factor (XCO,iso) in the central molecular zone (CMZ) of our Galaxy. New high-resolution XCO,iso maps at a resolution of ∼30″ and a longitude–velocity diagram (LVD) at resolution ${\sim }{30^{\prime\prime}}\times 2$ km s−1 are presented using the 12CO and 13CO archival survey data obtained by the Nobeyama 45 m telescope. We revealed the variation of XCO,iso in the CMZ within the range of XCO,iso ∼ (0.2–1.3) × 1020 cm−2 (K km s−1)−1, if we assume a normalization value of 0.59 × 1020 cm−2 (K km s−1)−1. The mean value is obtained as XCO,iso = (0.48 ± 0.15) × 1020 cm−2 (K km s−1)−1 in the CMZ of our Galaxy.
Symplasmic phloem loading and subcellular transport in storage roots are key factors for carbon allocation in cassava
Authors: Rüscher David , Vasina Viktoriya V , Knoblauch Jan , Bellin Leo , Pommerrenig Benjamin , Alseekh Saleh , Fernie Alisdair R , Neuhaus H Ekkehard , Knoblauch Michael , Sonnewald Uwe , Zierer Wolfgang
Published: May 2024

Cassava (Manihot esculenta) is a deciduous woody perennial shrub that stores large amounts of carbon and water in its storage roots. Previous studies have shown that assimilating unloading into storage roots happens symplasmically once secondary anatomy is established. However, mechanisms controlling phloem loading and overall carbon partitioning to different cassava tissues remain unclear. Here, we used a combination of histological, transcriptional, and biochemical analyses on different cassava tissues and at different timepoints to better understand source–sink carbon allocation. We found that cassava likely utilizes a predominantly passive symplasmic phloem loading strategy, indicated by the lack of expression of genes coding for key players of sucrose transport, the existence of branched plasmodesmata in the companion cell/bundle sheath interface of minor leaf veins, and very high leaf sucrose concentrations. Furthermore, we showed that tissue-specific changes in anatomy and non-structural carbohydrate contents are associated with tissue-specific modification in gene expression for sucrose cleavage/synthesis, as well as subcellular compartmentalization of sugars. Overall, our data suggest that carbon allocation during storage root filling is mostly facilitated symplasmically and is likely mostly regulated by local tissue demand and subcellular compartmentalization.
High-throughput single-microbe RNA sequencing reveals adaptive state heterogeneity and host-phage activity associations in human gut microbiome
Authors: Shen Yifei , Qian Qinghong , Ding Liguo , Qu Wenxin , Zhang Tianyu , Song Mengdi , Huang Yingjuan , Wang Mengting , Xu Ziye , Chen Jiaye , Dong Ling , Chen Hongyu , Shen Enhui , Zheng Shufa , Chen Yu , Liu Jiong , Fan Longjiang , Wang Yongcheng
Published: May 2024

Microbial communities such as those residing in the human gut are highly diverse and complex, and many with important implications for health and diseases. The effects and functions of these microbial communities are determined not only by their species compositions and diversities but also by the dynamic intra- and inter-cellular states at the transcriptional level. Powerful and scalable technologies capable of acquiring single-microbe-resolution RNA sequencing information in order to achieve a comprehensive understanding of complex microbial communities together with their hosts are therefore utterly needed. Here we report the development and utilization of a droplet-based smRNA-seq (single-microbe RNA sequencing) method capable of identifying large species varieties in human samples, which we name smRandom-seq2. Together with a triple-module computational pipeline designed for the bacteria and bacteriophage sequencing data by smRandom-seq2 in four human gut samples, we established a single-cell level bacterial transcriptional landscape of human gut microbiome, which included 29,742 single microbes and 329 unique species. Distinct adaptive response states among species in Prevotella and Roseburia genera and intrinsic adaptive strategy heterogeneity in Phascolarctobacterium succinatutens were uncovered. Additionally, we identified hundreds of novel host-phage transcriptional activity associations in the human gut microbiome. Our results indicated that smRandom-seq2 is a high-throughput and high-resolution smRNA-seq technique that is highly adaptable to complex microbial communities in real-world situations and promises new perspectives in the understanding of human microbiomes.
Grin and bare it: the recent kerfuffle over bare trusts
Authors: Nitikman Joel
Published: May 2024

Recent changes to the Canadian Income Tax Act have resulted in the concept of bare trusts coming under discussion. In this article, Joel Nitikman, K.C. explores the history, definition and details of the concept of a bare trust and concludes that a trustee may have significant powers and even numerous inherent fiduciary duties and yet still be a bare trustee.
Self-management behavior strategy based on behavioral economics in patients with hypertension: a scoping review
Authors: Peng Guotian , Yan Fanghong , Sun Ruiyi , Zhang Yanan , Zhao Rongrong , Zhang Guoli , Qiao Pengyu , Ma Yuxia , Han Lin
Published: May 2024

Hypertensive patients often do not make the most favorable choices and behaviors for managing disease. Behavioral economics strategies offer new ideas for guiding patients toward health behavior. The scoping review aimed to summarize behavioral economics strategies designed to improve hypertension self-management behaviors. A literature search was conducted in September 2022 using the following electronic databases: Embase, Medline, CINAHL, PsycINFO, Web of Science, Cochrane Library, CNKI, Wan Fang Database for Chinese Periodicals, and CBM-SinoMed. We screened the literature for experimental studies written in Chinese or English reporting on BE strategies designed to improve self-management behavior in hypertension. We searched 17 820 records and included 18 articles in the final scoping review. We performed qualitative synthesis by the categories of choice architecture. The most common BE strategies were those targeting decision information and decision assistance, such as changing the presentation of information, making information visible, and providing reminders for actions. Most strategies targeted BP, diet, medication adherence, and physical activity behavior. Ten out of 18 studies reported statistically significant improvement in self-management behavior. Further research on BE strategies should focus on addressing the challenges, including changing the decision structure, encompassing a more comprehensive range of target behaviors, and examining the long-term effects of BE strategies.
Evaluation of Ergot Resistance in Hard Red Spring Wheat in North Dakota
Authors: Lux LeAnn , Green Andrew , Scherer Jessica , Hansen Bryan , Dusek Gabriel , Kilber Harlee , Friskop Andrew
Published: May 2024

Higher levels of ergot (Claviceps purpurea [Fr.] Tul.) were reported in North Dakota hard red spring wheat (HRSW) in 2018, leading to questions pertaining to management and cultivar resistance. To better understand pathogen and HRSW cultivar responses, greenhouse experiments were conducted from 2020 to 2021 to evaluate the aggressiveness of nine C. purpurea isolates and ergot resistance in 21 HRSW cultivars. Results from the aggressiveness assay indicated significant cultivar-by-isolate interactions for the total weight of sclerotia produced and ergot incidence. Mean data across all cultivars by isolate combinations suggested isolates CC-3 and IA-Tim were the most aggressive, and these were subsequently used in ergot resistance experiments. Results from ergot resistance screening indicated that none of the HRSW cultivars were immune to C. purpurea because all cultivars produced sclerotia. However, differences in ergot incidence, kernel incidence, aborted kernel incidence, total sclerotia weight, sclerotia length, and sclerotia width occurred among cultivars. Both ‘ND-Frohberg’ and ‘TCG-Spitfire’ had the lowest ergot incidence values and were among the lowest in total sclerotia weight. ‘Waldron’ and ‘LCS-Trigger’ had the highest ergot incidence and the highest total sclerotia weight. Given that most concerns with ergot occur postharvest, we suggest two categories to describe ergot resistance: host resistance (fate of inoculation for a stigma) and logistical resistance (size characteristics of a sclerotium that influence its ability to remain with a seed lot after harvest and cleaning). This research provides a strong foundation for our understanding of HRSW resistance to ergot that will influence variety decisions in ergot-prone areas in North Dakota.
Susceptibility of Table Beet Cultivars to Foliar Diseases in New York
Authors: Sharma Pratibha , Murphy Sean , Kikkert Julie R. , Pethybridge Sarah J.
Published: May 2024

A collection of foliar diseases affects table beet production in New York. The predominant diseases are bacterial leaf spot (BLS) caused by the bacterium Pseudomonas syringae pv. aptata; Cercospora leaf spot (CLS) caused by the fungus Cercospora beticola; and Phoma leaf spot (PLS) caused by the fungus Phoma betae (syn. Neocamarosporium betae). Little is known of the potential to use host resistance in an integrated program for table beet disease management. Field trials evaluated the susceptibility of selected table beet cultivars (Bohan, Bresko, Manolo, Pablo, Red Cloud, Ruby Queen, Subeto, and Bazzu/Irazu) to BLS, CLS, and PLS. Bohan was one of the least susceptible to BLS but was moderately and highly susceptible to CLS and PLS, respectively. Bresko was moderately susceptible to BLS and CLS and was among the least susceptible to PLS. Manolo was one of the least susceptible to BLS and PLS but was highly susceptible to CLS. Pablo and Red Cloud were moderately or highly susceptible to all diseases. Subeto was moderately susceptible to BLS and CLS but was the least susceptible to PLS. Ruby Queen, the processing standard, was the least susceptible to BLS and PLS and was moderately susceptible to CLS. Bazzu and Irazu (2021 and 2022, respectively) were among the least susceptible to all diseases and were the only cultivars tested with reduced CLS susceptibility. These findings emphasize the need to evaluate table beet cultivar susceptibility to the spectrum of foliar diseases. This information may underpin cultivar selection based on the varying importance of diseases in specific production situations.
Knockdown of LAP2α inhibits adipogenesis of human adipose‐derived stem cells and ameliorates high‐fat diet‐induced obesity
Authors: Gu Hang , Pan Yuan , Xiao Han , Zhao Lijun , Tang Yiman , Ge Wenshu
Published: May 2024

Adipogenesis, a pivotal cellular process involving the differentiation of mesenchymal stem cells (MSCs) to mature adipocytes, plays a significant role in various physiological functions. Dysregulation of adipogenesis is implicated in conditions such as obesity. However, the complete molecular understanding of adipogenesis remains elusive. This study aimed to uncover the novel role of lamina‐associated polypeptide 2 alpha (LAP2α) in human adipose‐derived stem cells (hASCs) adipogenesis and its impact on high‐fat diet (HFD)‐induced obesity and associated metabolic disturbances. LAP2α expression was assessed during the adipogenic differentiation of hASCs using RT‐qPCR and western blotting. The functional role of LAP2α in adipogenesis was explored both in vitro and in vivo through loss‐ and gain‐of‐function studies. Moreover, mice with HFD‐induced obesity received lentivirus injection to assess the effect of LAP2α knockdown on fat accumulation. Molecular mechanisms underlying LAP2α in adipogenic differentiation were investigated using RT‐qPCR, Western blotting, immunofluorescence staining, and Oil Red O staining. LAP2α expression was upregulated during hASCs adipogenic differentiation. LAP2α knockdown hindered adipogenesis, while LAP2α overexpression promoted adipogenic differentiation. Notably, LAP2α deficiency resisted HFD‐induced obesity, improved glucose intolerance, mitigated insulin resistance, and prevented fatty liver development. Mechanistically, LAP2α knockdown attenuated signal transducer and activator of transcription 3 (STAT3) activation by reducing the protein level of phosphorylated STAT3. A STAT3 activator (Colivelin) counteracted the negative impact of LAP2α deficiency on hASCs adipogenic differentiation. Taken together, our current study established LAP2α as a crucial regulator of hASCs adipogenic differentiation, unveiling a new therapeutic target for obesity prevention.
Emerging concepts of myosin 18A isoform mechanobiology in organismal and immune system physiology, development, and function
Authors: DeKryger William , Chroneos Zissis C.
Published: May 2024

Alternative and combinatorial splicing of myosin 18A (MYO18A) gene transcripts results in expression of MYO18A protein isoforms and isoform variants with different membrane and subcellular localizations, and functional properties. MYO18A proteins are members of the myosin superfamily consisting of a myosin‐like motor domain, an IQ motif, and a coiled‐coil domain. MYO18A isoforms, however, lack the ability to hydrolyze ATP and do not perform ATP‐dependent motor activity. MYO18A isoforms are distinguished by different amino‐ and carboxy‐terminal extensions and domains. The domain organization and functions of MYO18Aα, MYO18Aβ, and MYO18Aγ have been studied experimentally. MYO18Aα and MYO18Aβ have a common carboxy‐terminal extension but differ by the presence or absence of an amino‐terminal KE repeat and PDZ domain, respectively. The amino‐ and carboxy‐terminal extensions of MYO18Aγ contain unique proline and serine‐rich domains. Computationally predicted MYO18Aε and MYO18Aδ isoforms contain the carboxy‐terminal serine‐rich extension but differ by the presence or absence of the amino‐terminal KE/PDZ extension. Additional isoform variants within each category arise by alternative utilization or inclusion/exclusion of small exons. MYO18Aα variants are expressed in somatic cells and mature immune cells, whereas MYO18Aβ variants occur mainly in myeloid and natural killer cells. MYO18Aγ expression is selective to cardiac and skeletal muscle. In the present review perspective, we discuss current and emerging concepts of the functional specialization of MYO18A proteins in membrane and cytoskeletal dynamics, cellular communication and signaling, endocytic and exocytic organelle movement, viral infection, and as the SP‐R210 receptor for surfactant protein A.
The Proportions of Term or Late Preterm Births After Exposure to Early Antenatal Corticosteroids, and Outcomes: Systematic Review and Meta-Analysis of 1.6 Million Infants
Authors: Ninan K. , Gojic A. , Wang Y. , Asztalos E.V. , Beltempo M. , Murphy K.E. , McDonald S.D.
Published: May 2024

(BMJ. 2023;382:e076035 | doi: 10.1136/bmj-2023-076035 l. http://dx.doi.org/10.1136/bmj-2023-076035)

Preterm birth is a major cause of morbidity and mortality in both newborns and children. Women at risk of preterm delivery often receive antenatal corticosteroids, depending on their gestational age. These steroids enhance fetal lung maturation; however, unnecessary corticosteroid exposure is a concern. Guidelines recommend tracking and minimizing such exposure to discourage overuse. Animal studies indicate potential risks to fetal brain development and long-term health. This systematic review explored the outcomes of infants exposed to early antenatal corticosteroids, emphasizing the importance of their reasonable use in mitigating risks.
PREDICTION OF CARDIOVASCULAR EVENTS IN HYPERTENSIVE SUBJECTS WITH ARTIFICIAL INTELLIGENCE TOOLS
Authors: Rodilla Enrique , Iriarte Olast Arrizibita , Serrano Blanca Miranda , Ruilope Luis Miguel , Gil Germán Sedano , Arduán Alberto Ortiz , Costa Jose Antonio , Beristain Onintza Sayar
Published: May 2024

Objective:

Cardiovascular diseases contribute substantially to morbi-mortality at the global level. To effectively address the increasing incidence of cardiovascular events, advanced preventive strategies are needed. Predictive modeling is a crucial tool to identify individuals at risk and facilitate proactive interventions to improve clinical outcomes.

This study develops and evaluates a model for predicting cardiovascular events (ischemic heart disease and stroke in previously event-free hypertensive subjects) by integrating clinical data, biomarkers and established risk factors. Most importantly, it predicts the likelihood of cardiovascular events after the initial patient visit.

Design and method:

The first step we have performed, enrich the dataset by creating variables using statistical measures, Principal Component Analysis (PCA) and Latent Class Analysis (LCA). Three different prediction algorithms are applied: XGBoost, Random Forest and Logistic Regression. The models were trained with 70% of the dataset and 30% for validation. Each algorithm maintains a balance between predictive accuracy and interpretability. The models predict cardiovascular events in patients with no history of cardiovascular disease after their baseline visit.

Results:

A total of 4,145 consecutive patients were referred to a hospital’s hypertension unit. The population’s mean age is 55.9±14, with 51% women. The average follow-up time is 3,028 days, yielding an incidence density of 1.93 (95% CI: 1.78-2.09) per 100 patient-years. The XGBoost model achieves 85% accuracy, 87% sensitivity, and 71% specificity. When reducing the model to the 30 most influential variables, there is a modest decrease in predictive accuracy (80%). Logistic Regression provides an interpretable model with an accuracy of 80%, sensitivity of 56%, and specificity of 84%. Meanwhile, Random Forest exhibits a high accuracy of 86%, with notably lower sensitivity at 13%.

Conclusions:

Our findings underscore the resilience and stability of the XGBoost model, effectively balancing predictive accuracy and interpretability. The inclusion of the Logistic Regression model, with its interpretative capacity, remains crucial, especially when transparency in model decisions is paramount. This study emphasizes the importance of tailoring predictive models to the specific requirements of applications. Future research could explore possible techniques for the interpretability of the XGBoost model.
PERSONAL BLOOD PRESSURE VARIABILITY IS NOT ASSOCIATED WITH SEASONAL BLOOD PRESSURE EFFECTS: A 4-YEAR PROSPECTIVE COHORT OF 1,151 PARTICIPANTS FROM ELDERLY CENTRES IN HONG KONG
Authors: Tsoi Kelvin Kf , Hao Ziyu , Chen Yize , Chan Howard H , Yiu Karen Kl
Published: May 2024

Objective:

Personal blood pressure variability (BPV) is demonstrated to be an important risk factor for cardiovascular diseases, but blood pressure fluctuates over the years with seasonal effects. This study aimed to investigate the association between personal BPV and year-round seasonal blood pressure fluctuations among the elderly in Hong Kong.

Design and method:

Elderly participants aged above 55 years were recruited from 76 elderly centres and were prospectively followed up between September 2016 and January 2020. Personal interviews were conducted to assess personal health conditions. Nursing calls and social worker engagement were offered for those with suboptimal BP readings. The inclusion criteria were the participants who reported more than 80% of weekly BP records in at least 2 years of follow-up. Standard deviation (SD) was applied to quantify the personal variability levels of systolic and diastolic BPV. A machine learning classification method, K-means, was used to further classify participants into low, medium, and high levels of overall BPV. The seasonal fluctuations of blood pressure readings were extracted by a time series model. Temperature data were extracted from the Hong Kong Observatory and were correlated with the seasonal blood pressure variability across the participants with different levels of BPV.

Results:

A total of 500,914 blood pressure records were collected from 1,151 elderly participants with a mean age of 79 years. Machine learning classified 588 (51%), 462 (40%), and 101 (9%) participants with low, medium and high levels of BPV, respectively. Seasonal fluctuations were shown to be reversely correlated with the temperature data (r > 85% with all p-values < 0.001) (Figure 1) regardless of the personal BPV levels.

Conclusions:

Blood pressure variability is a personal risk factor that is irrelevant to seasonal blood pressure fluctuations. Early intervention to control for suboptimal blood pressure variability would provide additional benefits to patients with a higher risk of cardiovascular diseases.
PEAK NOCTURNAL HOME BLOOD PRESSURE AS AN EARLY AND STRONG NOVEL RISK FACTOR FOR STROKE: THE PRACTITIONER-BASED NATIONWIDE J-HOP NOCTURNAL BP STUDY
Authors: Kario Kazuomi , Okawara Yukie , Kanegae Hiroshi , Tomitani Naoko , Hoshide Satoshi
Published: May 2024

Objective:

Recent evidence suggests a correlation between nighttime blood pressure BP) measured through ambulatory BP monitoring (ABPM), the nocturnal BP dipping phenotype, and cardiovascular risk. However, the clinical implications of elevated peak nighttime home BP are currently unknown. This analysis investigated the association between peak nighttime home systolic BP (SBP) and cardiovascular events in outpatients with one or more cardiovascular risk factors.

Design and method:

In the Japan Morning Surge-Home Blood Pressure (J-HOP) study, nighttime home BP was automatically measured three times every night for 14 days using a nighttime home BP monitoring device (HEM-5001, Omron Healthcare) at baseline. Peak nighttime home SBP was defined as average of the highest three values recoded during the 14-night measurement period. Cardiovascular events (stroke, coronary artery disease, heart failure, aortic dissection) were tracked over a mean 7.1 years’ follow-up period.

Results:

This analysis included 2545 individuals (mean age 63.3±10.3 years, 49% male) with their nighttime home BPs. After adjustment for covariates (including age, sex, and average office, morning, evening, and nighttime home SBP), individuals with peak nighttime home systolic blood pressure (SBP) in the highest quintile (Q5, >=149.0 mmHg) demonstrated a significantly elevated risk of stroke compared to those in the lowest quintile (Q1, <119.3 mmHg) (hazard ratio [HR] 4.24, 95% confidence interval [CI] 1.07–16.77; p=0.039 overall and 8.92, 1.49–53.43; p=0.017 in the subgroup with >=6 nighttime home SBP measurements). Even when controlling for average real variability of nighttime BP, peak nighttime home SBP remained an independent predictor of stroke risk. On spline regression analysis, the average peak nighttime home SBP cut-off value for predicting an increased risk of incident stroke was 136 mmHg.

Conclusions:

We propose exaggerated peak nighttime home SBP determined from >=6 measurements as a novel risk factor for stroke, independent of conventional office and home BP values.
SIGNIFICANT INCREASES IN PERIPHERAL AND CENTRAL BLOOD PRESSURE IN CHILDREN AT MUCH LOWER BODY MASS INDEX THAN EXPECTED
Authors: Wilmsmeier Lisa , Von Der Born Jeannine , Sugianto Rizky I , Grabitz Carl , Schmidt Bernhard Mw , Braun Ana Celine , Homeyer Denise , Tegtbur Uwe , Melk Anette
Published: May 2024

Objective:

Cardiovascular (CV) complications are the most common causes of death worldwide. Increased body weight and higher blood pressure (BP) are known risk factors for CV disease with a known association of higher body mass index (BMI) with higher BP. Our study intended to describe at which BMI-level significant increases in either central (cBP) or peripheral BP (pBP) can be detected in young children.

Design and method:

We measured cBP and pBP in 1,183 schoolchildren (first/second graders; mean age 7.9±0.6 years; 51% male). pBP measurements were performed with a validated oscillometric device (Dinamap-VC150-GE). cBP was measured noninvasively with the Mobil-O-Graph (IEM). Multivariable linear regression models (corrected for age, sex, height) were used to compare pBP/cBP values of children with a BMI<50th percentile (pct) with children separated in five groups according to BMI pct (>=50th-<65thpct; >=65th-<75thpct; >=75th-<85thpct; >=85th-<95thpct; >=95thpct).

Results:

BMI was 17±3 kg/m2 (M±SD), 275 children (22.8%) were overweight (BMI>=85th pct), 126 (10.5%) obese (BMI>=95thpct). Peripheral systolic blood pressure (pSBP) was 104±8mmHg (M±SD), peripheral diastolic blood pressure (pDBP) 61±6mmHg (M±SD); 5% of the cohort displayed hypertensive pBP values >=95thpct. In the unadjusted analysis, we saw an increase in pSBP (Fig.1A) and cSBP (Fig.1B) already at a BMI around 60thpct. Further analysis comparing the corrected means revealed that pSBP showed already a significant increase for children with a BMI>=75thpct (ß=1.8, p=0.026) when compared to children with a BMI<50thpct. For the model including pDBP no significant effects were seen. cSBP significantly increased already in children with a BMI >=65thpct. (ß=1.7, p=0.031), while cDBP increased significantly in children with a BMI >=75thpct (ß=1.5; p=0.012) when compared to children with a BMI<50thpct.

Conclusions:

Our findings suggest that increases in body weight affect pBP and particularly cBP at much lower BMI pct level than expected. These results are alarming as pediatricians usually get concerned at BMI levels above the 85thpct (defined as cut-off for overweight in children based on WHO growth reference values). Given the important interaction between both risk factors and their track from childhood to adulthood, effective overweight prevention must take place in early childhood.
NIGHTTIME BLOOD PRESSURE ASSESSED USING HOME OR AMBULATORY BLOOD PRESSURE MONITORS IN YOUNG ADULTS WITH TYPE 1 DIABETES: RELATIONSHIP WITH PRECLINICAL TARGET-ORGAN DAMAGE
Authors: Theodosiadi Aikaterini , Kollias Anastasios , Vakali Elena , Destounis Antonios , Tsiroukidou Kyriaki , Karypidou Erieta , Menti Ariadni , Vazeou Andriani , Zografou Ioanna , Doumas Michael , Stergiou George
Published: May 2024

Objective:

To investigate the association between nighttime blood pressure (BP) measured with home (HBPM) versus ambulatory monitors (ABPM) with indices of preclinical target-organ damage in adolescents and young adults with type 1 diabetes (T1D).

Design and method:

Individuals aged 12-30 years with T1D underwent 24h ABPM (20-min intervals, Microlife WatchBP O3), home monitoring (duplicate morning and evening measurements for 7 days; 3 measurements/night for 3 nights; Microlife WatchBP Home-N) and assessment of indices of preclinical target-organ damage [left ventricular mass index (LVMI), intima-media thickness of common carotid artery and bulb (IMT), albumin-to-creatinine ratio (ACR) in two different morning urine samples].

Results:

Data from 93 individuals were analyzed (57% males, mean age 21±5.5 years, BMI 24±4 kg/m2, HbA1c 7.2±1.0%, T1D duration 11.2±6.5 years, 24-hour systolic/diastolic ambulatory BP 112±9.3/67±5.6 mmHg, 24h ambulatory hypertension 3.2%). LVMI measurements were available in 79 participants, IMT in 65, and ACR in 88 participants. Nighttime ambulatory and home BP were correlated with LVMI (r=0.35/0.31 for systolic and r=0.26/0.25 for diastolic BP, respectively, p<0.05) and IMT (r=0.34/0.46 for systolic and r=0.29/0.42, for diastolic BP, respectively, p<0.01). ACR was correlated with HbA1c (r=0.24, p<0.05), and inversely with nighttime systolic BP dip in ABPM (r=-0.23, p<0.05). Results of multivariable regression analysis are presented in Table 1.

Conclusions:

In adolescents and young adults with T1D, nighttime BP measured at home and in ABPM appear to exhibit similar correlations with indices of asymptomatic target-organ damage.
APOCYNIN PREVENTS BLOOD PRESSURE RISING AND IMPROVES KIDNEY FUNCTION IN RATS WITH 5/6 NEPHRECTOMY
Authors: Vukovic Andrija , Karanovic Danijela , Mihailovic-stanojevic Nevena , Miloradovic Zoran , Nesovic-ostojic Jelena , Brkic Predrag , Ivanov Milan , Kovacevic Sanjin , Vajic Una -JOVANA , Jovovic Djurdjica , De Luka Silvio R.
Published: May 2024

Objective:

High blood pressure and proteinuria play major roles in chronic kidney disease (CKD), a high-mortality condition that affects millions of people. Reactive oxygen species (ROS) produced by NADPH oxidases are implicated in many pathophysiological processes including hypertension and CKD. Apocynin (APO) shows the anti-oxidative activity by inhibiting the assembly of NADPH oxidase and overproduction of ROS. The aim of this study was to investigate the effects of apocynin on oxidative stress, blood pressure and kidney function in normotensive rats with CKD induced by 5/6 nephrectomy through ligation of renal poles (Nx-L).

Design and method:

Male Wistar rats were divided into three groups. One group was control (sham surgery) and two other groups underwent two-step surgical procedure of 5/6 nephrectomy induced by ligation of renal poles. Unlike conventional Nx which leads to high mortality due to hemorrhage in or after surgery, here we induced Nx by ligation of the upper and lower poles (leads to necrosis of these poles) of left kidney after removal the right kidney one week later. After 4 weeks from this procedure, control and model group (Nx-L) received vehicle, while Nx-L+APO received apocynin 20 mg/kg/day (i.p.) for 4-week-period. Mean blood pressure (MAP), proteinuria, and oxidative stress marker (thiobarbituric acid reactive species-TBARS) in plasma and urine were measured.

Results:

In model group we observed significantly increased MAP (121,13±2,01vs.94,88±4,13mmHg, p<0.001), plasma creatinine (55,4±1,3vs. 41,3±2,3μmol/l, p<0.001), and proteinuria (0,036±0,006vs.0,017±0,001mg/min/kg, p<0.01) levels compared to those in control. Furthermore, significant increase of plasma TBARS level (5,47±0,77vs.2,75±0,52nmol/ml, p<0.01) and urine TBARS excretion (1,10±0,06vs.0,86±0,04nmol/min/kg, p<0.01) were detected in model compared to control. Interestingly, APO treatment significantly reduced blood pressure to the level of control (83,88±5,14vs.94,88±4,13mmHg). APO significantly reduced urine protein loss (0,024±0,002vs.0,036±0,006mg/min/kg, p<0.05) and plasma creatinine level (49,9±1,5vs.55,4±1,3μmol/l, p<0.05) as well as reduced plasma lipid peroxidation (2,19±0,26vs.5,47±0,77nmol/ml, p<0.001) in comparison to model group.

Conclusions:

Our results show that APO treatment prevents blood pressure rising and ameliorates kidney function in rats with 5/6 nephrectomy trough improvement of systemic oxidative status. Therefore, NADPH oxidase presents a potential therapeutic target in this form of kidney disease.
CLINICAL SIGNIFICANCE OF NIGHTTIME BLOOD PRESSURE: EXPLORING THE ASSOCIATION OF NOCTURNAL HYPOTENSIVE PHENOTYPE AND HISTORY OF FALLS IN ELDERLY HYPERTENSIVE PATIENTS
Authors: Croce Alessandro , Bilo Grzegorz , Pengo Martino F. , Ornago Alice Margherita , Ricco Alice , Bellelli Giuseppe , Parati Gianfranco
Published: May 2024

Objective:

falls are a major health problem in elderly, approximately 28–35% of individuals aged > 65 years’ experience falls each year. Previous studies suggested that unexplained falls may mask a syncope or pseudo-syncope in almost 50% of cases, and that patients with reflex syncope have a higher prevalence of systolic blood pressure (SBP) drops on ambulatory blood pressure monitoring (ABPM), the so-called hypotensive phenotype. However, it is not clear whether hypotensive phenotype may be itself associated with falls. We investigate if hypotensive phenotype is associated with history of falls in elderly hypertensive.

Design and method:

a cross-sectional study that included treated hypertensive patients aged >=75 years evaluated at the Hypertension Center of Istituto Auxologico Italiano IRCCS in Milan. We excluded patients with a life expectancy of less than 6 months. All participants underwent ABPM. History of falls within the last year was recorded and multidimensional geriatric assessment to estimate frailty using Frailty accumulation index was performed. Daytime and night-time hypotensive phenotypes were defined as at least one SBP drops <90 mmHg on ABPM during daytime and night-time, respectively. The same analysis was repeated by considering cut-off of SBP <80 mmHg both during day and night-time.

Results:

we enrolled 105 patients, mainly females (n=80, 76%) with a mean age of 82 (± 4) years.

In 74 (70%) patients day-time hypotensive phenotype was present at ABPM, while nighttime hypotensive phenotype was present in 24 of them (23%). Among participants 21 (20%) experienced a fall in the last 12 months; compared for age, sex, BMI, frailty index and BP patients with falls and not have no significant differences. Regardless of SBP cut-off, nocturnal hypotensive phenotype was associated with history of falls while daytime hypotensive phenotype was not. (Figure 1).

Conclusions:

In our study, nighttime but not daytime BP drops were associated with falls in treated hypertensive elderly patients. The mechanistic role of nighttime hypotensive phenotype and its association with syncope and falls will need to be evaluated in larger prospective studies to better clarify the utility of ABPM in falls prediction in elderly.