bluuebunny/crossref_metadata_2025 huggingface dataset:
CARDIOVASCULAR COMPLICATIONS AFTER CADAVERIC RENAL TRANSPLANTATION
Authors: Mahmoud Nouha Ben , Ayed Amel , Salem Meriem Ben , Hamouda Mouna , Sala Manel Ben , Bchir Sirine , Letaief Ahmed , Aloui Sabra , Skhiri Habib
Published: June 2023

Objective:

Renal transplantation is the treatment for end-stage renal disease. Cadaveric donor renal transplantation (CDRT) is still uncommon in Tunisia, constituting less than 20% of total renal transplants. The aim of our study was to evaluate the results and cardiovascular complications in our center

Design and method:

A retrospective analysis of 30 CDRT was performed between November 1995 and December 2018.

Data analysis included. age, gender, cold ischemia time, graft function graft function, dialysis requirements dialysis requirements, rejection episodes rejection, infectious episodes, new onset diabetes after transplantation (NODAT), hypertension and cardiovascular events

Results:

Thirty patients underwent CDRT among 172 renal transplants performed in our unit. Among the donors, there were 23 males and 7 females, with a mean age of 32 ± 9 years.

All transplants were blood group compatible with 3 HLA matches in the majority of cases (45%). The mean age of the recipients was 34 ± 9 years.

Chronic glomerulonephritis (40%) and chronic chronic interstitial nephropathy (32%) represented the main type of native renal disease. 88.5% of the patients were hemodialysis before transplantation and the median time to transplantation on dialysis was dialysis was eight years. The mean nadir of creatinine was 108 ± 27 μmol/l.

Two biopsies showed acute tubular injury, four patients had acute rejection and two patients had allograft nephropathy allograft nephropathy with one case of segmental and focal hyalinosis. segmental and focal hyalinosis. The major infectious complication was a cytomegalovirus cytomegalovirus infection (33.3%) followed by a urinary tract infection (23.8%). Regarding metabolic complications metabolic complications, NODAT and hypertension were observed in three and four patients respectively.

Two patients presented an acute coronary syndrome treated with medical therapy. Five patients returned to dialysis. The rest (57.7%) have been followed up regularly in our consultation so far over a period of 87 months (range 16-209 months).

Conclusions:

CDRT is not common in our center, but the analysis shows good results and provides encouraging data that support broadening the criteria for potential donors eligible for organ donation especially in the face of increasing organ shortages. Cardiovascular complications are not as common
MACROPHAGIC ACTIVATION SYNDROME IN POST KIDNEY TRANSPLANTATION REVEALED BY PERITONITIS: CASE REPORT
Authors: Zemmouchi Souheila , Tebbani Rachida , Maouche Amina
Published: June 2023

Objective:

Macrophage activation syndrome is a rare but potentially fatal condition. The diagnosis is often difficult, because the symptoms are not very specific and can mimic those of sepsis, however, its diagnosis is based on the association of clinical and biological, non-specific signs, coupled with cytological or histological research of hemophagocytosis and an exhaustive etiological investigation.

Design and method:

We report the case of a 40-year-old man with a history of chronic renal failure of undetermined origin, who received a kidney transplant in 2011 from a living related donor. The clinical objective shows signs of dehydration associated with non-fetid diarrhea with the presence of a tense and sensitive abdomen on palpation evoking a surgical abdomen, all evolving in a febrile context; Haematological involvement such as bicytopenia and a positive CMV PCR. Our patient was operated on urgently for peritonitis, after performing peritoneal cleansing, the surgeon took biopsy samples from the various mesenteric lymph nodes.

Results:

The diagnosis of Macrophage activation syndrome is made in the face of clinical and biological arguments in favor, the histological study of the mesenteric lymph nodes revealing non-Langerhancan lymph node histiocytosis CD 68 + CD 10 evoking a syndrome of macrophage activation and confirmed by the myelogram

Conclusions:

Much progress remains to be made in the field of SAM in adults, the severity of its prognosis, essentially in a kidney transplant patient, requires an aggressive diagnostic approach and multidisciplinary therapeutic management.
EVALUATION OF DEPENDENCE OF AGE AND PERIPHERAL BLOOD PRESSURE IN TWO PULSE WAVE VELOCITY ESTIMATION METHODS
Authors: Martin Jose F. Vilela , Silva Marco A. Vieira da , Oliveira Ana Paula Silva de , Queiroz Ana Carolina Silva , Landim Manoel I. Paz , Yugar-Toledo Juan C. , Lopes Valquíria Silva , Fernandes Leticia A. Barufi , Uyemura Jessica Rodrigues , Polegati Aleandra , Cosenso-Martin Luciana N.
Published: June 2023

Objective:

To evaluate the dependence of age and blood pressure (BP) on the estimated pulse wave velocity (PWV) by Mobil-o-Graph and an equation derived from the Reference Values for Arterial Stiffness Collaboration.

Design and method:

This study is a secondary analysis of a database from a cross-sectional study conducted in a specialized center in inner Brazil to diagnose and treat non-communicable diseases. We included individuals with hypertension and at least one risk factor, dyslipidemia, diabetes, smoking, body mass index (BMI) > = 30 kg/m2. Three accurate office BP measurements were made and calculated the average (OBP) using Microlife equipment BP3AC1-1PC (Onbo Electronic Co, Shenzhen, China). The average of four measures of office PWV (oPWV) was calculated using Mobil-O-Graph device (I.E.M., Stolberg, Germany). Also, estimated PWV (ePWV) was calculated by utilizing age and the mean arterial pressure of OBP (MBP) from an equation derived by the Reference Values for Arterial Stiffness Collaboration as follows:

ePWV = 9.58748315543126-0.402467539733184*age+4.56020798207263*10-3*age2-2.6207705511664*10-5*age2*MBP+3.1762450559276*10-3*age*MBP-1.8321025*MBP

Five multilevel regression models were used to determine how much ePWV and PWV depend on age, age2, systolic OBP, MBP, and all of them together. Forkman test was used to compare the coefficient of determination (R2).

Results:

Table 1 shows the main clinical characteristics of the sample. Table 2 demonstrates the results for comparing the coefficient of determination for ePWV and oPWV. Age determines 75% of ePWV variance and 85% of oPWV (p = 0.0001), age2 78% of ePWV and 90% of oPWV (p = 0.0001), SBP 41% of ePWV and 18% of oPWV (p<0.0001), MBP 24% of ePWV and 5% of oPWV (p<0.0001). The model 5 shows that the variables studied together determine better the variance of ePWV (99%) than oPWV (94%).

Conclusions:

Age, age2, SBP, and MBP explain almost the overall variance of ePWV and oPWV. However, ePWV is significantly more dependent on BP than oPWV, which is considerably more dependent on age.
EFFICACITY OF COMBINATION ACID ACETYLSALICYLIC AND GLUCOCORTICOID IN TAKAYASU ATERITIS TREATMENT: A CASE CLINIC TAKAYASU ARTERITIS IN VIET NAM
Authors: Nguyen Thao
Published: June 2023

Objective:

This brings up the potential of medical management for patients who are diagnosed with Takayasu arteritis, instead of using invasive methods such as aortic stent placement or operations.

Design and method:

A young female 14 years old was diagnosed with Takayasu arteritis. Initial symptoms include fever, loss of appetite, weight loss, muscle pain, followed by palpitations and abdominal pain, and loose stools. The test showed an increased hypersensitive C-reactive protein level (CRPhs: 28.7 mg/L). Computed tomography angiography (CTA) chest with contrast shows two segments of thoracic aneurysms involving descending aorta, the aortic diameter of the superior and inferior segment aneurysms is #1.6-1.8 cm, #2x 2.1cm, respectively, and the length is #2.5cm, # 3.2cm, respectively. According to the American College Rheumatology 1994, we classified this patient as type III.

The patient was treated with corticosteroid therapy consisting of: prednisolone at an initial dose of 20 mg/day, reduced to a dose of 10 mg/day at month 3, and reduced to a dose of 5 mg/day after 6 months until now. In addition, we also added low-dose aspirin (81mg/day), ACE inhibitors, and beta-blockers to increase the effectiveness of treatment

Results:

After 3 months, Hs-CRP levels returned to normal (from 28.7 mg/L to 1.23 mg/L) and remained below the 3 mg/L thresholds during the next 15 months.

After 12 months of combined treatment with corticosteroids and aspirin as described above, the patient's aortic diameter had returned to almost normal on CTA. After that, we have reduced the patient's corticosteroid dose (prednisolone 5 mg/day) and are going to finish the treatment after 18 months.

Conclusions:

This successful case high value on the role of pharmacological therapy in cases of Takayasu arteritis. It also brings up a debate regarding the concept of surgery required in cases of Takayasu arteritis complicated with dilatation, aneurysm, or stenosis. The combination of glucocorticoid therapy with aspirin can reduce the cost of treatment as well as avoids the side effects of the combination of glucocorticoid with immunosuppressive drugs. This opens up great treatment opportunities for Takayasu arteritis patients in low-economic countries like Vietnam.
INCREASED LEVELS OF ADVANCED GLYCATION END PRODUCTS ARE ASSOCIATED WITH HIGHER AORTIC STIFFNESS IN YOUNGER INDIVIDUALS OF THE GENERAL POPULATION
Authors: Johansson Madeleine , Jujic Amra , Engström Gunnar , Nilsson Peter
Published: June 2023

Objective:

Advanced Glycation End products (AGEs) is an established risk marker in diabetic vascular disease, and associated with the degree of diabetes complications, renal failure, and atherosclerosis in older individuals. The relationship between aortic stiffness and AGEs has not been thoroughly examined in the younger population. We aimed to evaluate the association between AGEs and aortic stiffness in the general population of young and mid-aged adults with few comorbidities.

Design and method:

We cross-sectionally analysed 2518 participants from a prospective population-based cohort (mean age 41.8±14.5 years, 52.2% women). Advanced glycation end-products were measured as skin autofluorescence with AGE-Reader™, which is a well-validated, non-invasive method. Aortic stiffness was assessed by carotid-femoral pulse wave velocity (cf-PWV) and augmentation index adjusted for resting heart rate (Aix) at the arteria radialis using SphygmoCor®. Linear regression stratified by age equal to or below 50 years (n = 1689) and 51 years and above (n = 829) was used to analyse associations between AGEs, and PWV and Aix in a univariate model and multivariable model adjusted for sex, body mass index, systolic blood pressure, heart rate, fasting glucose, estimated glomerular filtration rate, low-density-lipoprotein, and current smoking.

Results:

Mean cf-PWV and Aix across quartiles of AGEs in both age groups are shown in Figure 1. We found that one unit increase in skin autofluorescence was significantly associated with direct aortic stiffness (cf-PWV) after adjustment in younger individuals below or equal to 50 years old (unstandardized beta-coefficient (B) cf-PWV 0.59 m/s, p<0.001), however not in older individuals (B 0.14m/s, p = 0.32). Higher levels of AGEs were significantly associated with indirect aortic stiffness as assessed by mean Aix in both younger individuals (B 8.27, p<0.001) and older individuals (B 3.98, p<0.001).

Conclusions:

Our findings show that higher levels of advanced glycation end products are positively associated with increased direct and indirect arterial stiffness in younger individuals with few comorbidities, independent of cardiometabolic risk factors. Future studies are warranted to elucidate the effect of reduced AGE dietary consumption and AGE-inhibition on aortic stiffness.
SHORT-TERM AIR POLLUTION EXPOSURE AND MEASURES OF ARTERIAL STIFFNESS AND CENTRAL HAEMODYNAMICS IN HEALTH YOUNG ADULTS
Authors: Pereira Telmo , Silva Ruben , Loureiro António , Seco Sílvia , Ferreira Ana , Conde Jorge
Published: June 2023

Objective:

The practice of outdoor physical exercise is increasingly present in modern societies, as the increasing levels of health literacy corresponds to greater awareness about the positive impact of physical activity. Notwithstanding, the exposure to polluted urban environments during outdoor activities may have deleterious biological effects that should not be overlooked. In particular, the effects of exposure to air pollution in vascular function has been reported in several studies, even though the current evidence is still inconsistent.

Objective:

To study the effect of outdoor short-term exposure to air pollution in arterial stiffness and central haemodynamics in healthy young adults.

Design and method:

Twenty young and healthy participants (20 and 25 years) were enrolled in an observational study. Participants performed a mild outdoor walk (1 hour duration) in two ecological settings: green environment (control) and urban environment (experimental). The activities were performed in random order and with at least two weeks interval. Carotid-femoral pulse wave velocity was measured with the Complior device at baseline and at the end of the outdoor walk. Pulse wave analysis (PWA) was performed at baseline and with 15 minute intervals during the outdoor walk with the Mobil-o-Graph device. Air pollution was measured with appropriate devices, including ambulatory measurements of particulate matter (PM).

Results:

As expected, significant differences were observed in the measures of air pollution between control and experimental settings for all the major air components, particularly for PM1.0, PM2.5 and PM10 (mean difference, respectively, 18.71 ± 2.18 μg/m3, 19.53 ± 2.19 μg/m3 and 26.32 ± 2.66 μg/m3; p<.001). PWV was significantly higher after the exposure in the experimental setting (mean increase of 0.2 ± 0.02 m/s; p<.001), with no variation occurring in the control situation. Also brachial and central blood pressure (BP) depicted greater magnitude of increase during the outdoor walk in the urban setting, as compared with the green environment.

Conclusions:

Short-term exposure to air pollution during an outdoor walk was shown to be associated with arterial stiffness. The deleterious association of air pollution with vascular function is further buttressed by its hemodynamic impact, particularly increasing brachial and central BP.
EFFECTS AND ASSOCIATED BEHAVIOUR CHANGE TECHNIQUES OF EHEALTH-BASED INTERVENTIONS ON SODIUM REDUCTION AMONG ADULTS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Yan Yongyang , Chan Man Lee , Wang Man Ping , Kwok Jojo Yan Yan , Lee Jung Jae
Published: June 2023

Objective:

To evaluate the effects of eHealth-based interventions on sodium and blood pressure reduction in adults, and identify study characteristics and behaviour change techniques (BCTs) associated with greater sodium reduction effects.

Design and method:

A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted in 5 databases including RCTs published from January 2000 to September 2022. The 24-hour urinary sodium (24HUNa, primary outcome of this review), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were meta-analysed using random-effects models. I2 statistic was used to assess heterogeneity among studies, with I2 > 50% considered substantial heterogeneity. Publication bias and robustness of the results were evaluated by the Egger test and sensitivity analysis, respectively. The contents of sodium reduction interventions were mapped to BCT Taxonomy (V1). Subgroup analyses of 24HUNa were performed according to study characteristics, including participants’ health status (hypertension vs. heart failure vs. healthy adults), urinary measurement (24-hour urine vs. spot urine), trial period (1-6 months vs. 7-12 months vs. 13-18 months), intervention mode (individual- vs. group-based), and BCTs.

Results:

Twenty-eight RCTs (5720 participants, mean age: 54.72 ± 10.80) were included. eHealth-based interventions significantly reduced 24HUNa (mean difference, MD = - 0.34 g/24 hours, 95% CI: - 0.45 to - 0.23; I2 = 49%, equivalent to 0.85 g/salt reduction per day) and SBP (MD = - 2.84 mmHg, 95% CI: - 4.02 to - 1.66; I2 = 35%), but not DBP (MD = - 0.93 mmHg, 95% CI: -1.95 to 0.08; I2 = 56%). No publication bias was detected. The effects on 24UHNa and SBP remained significant in sensitivity analyses. Twenty-nine BCTs were identified and predominantly were goal setting and behaviour feedback. Subgroup analyses showed using BCTs (goal setting, problem solving, feedback on behaviour, self-monitoring of behaviour, instruction on how to perform the behaviour, or demonstration of the behaviour) associated with a large significant reduction in sodium intake. No significant differences were observed for other study characteristics.

Conclusions:

eHealth-based interventions effectively reduced sodium intake and SBP in adults. The identified useful BCTs for sodium reduction should be tested in future trials.
GLUCOMANNAN AND RED RICE EXTRACT REDUCE BLOOD LIPID LEVELS IN OVERWEIGHT PATIENTS
Authors: Jakovljevic Branko , Paunovic Katarina , Stojanov Vesna , Lovic Dragan
Published: June 2023

Objective:

This study aims to explore the changes in blood lipid levels, body composition, and blood pressure in healthy middle-aged overweight people with mild hypercholesterolemia following the 45-day intake of a dietary supplement containing both glucomannan and red rice extract.

Design and method:

The survey was designed as a single-arm non-randomized, non-blind intervention study. 31 study participants consumed a dietary supplement containing dietary fibers (Konjak glucomannan, E425ii) and red rice extract (Monascus purpureus) for 45 days. Participants were asked not to change their current diet. Their body weight, body composition, and blood pressure were measured every two weeks. Blood lipids were tested at the beginning and at the end of the intervention.

Results:

After 45 days, there was a significant decrease in total cholesterol (by 16-18%), LDL cholesterol (by 20-24%), and triglyceride levels (by 11-23%) in both genders. In addition, women lost on average about 1 kilogram of body weight, 1.5 kilograms in body fat, and decreased their body mass index by 0.5 kg/m2. No changes in body composition were observed among men, but their systolic pressure decreased by six mmHg on average.

Conclusions:

Concurrent use of glucomannan and red yeast rice extract resulted in a significant reduction in blood lipid levels in both genders. It could be a safe and effective treatment option for the population of healthy middle-aged overweight people with mild hypercholesterolemia.
SALT-INDUCED VASCULAR DYSFUNCTION INVOLVES REDOX ACTIVATION OF PARP/TRPM2 SIGNALLING AND INFLAMMASOME ASSEMBLY
Authors: Alves-Lopes Rheure , Neves Karla , Montezano Augusto C. , Samji Sheon , Delles Christian , Touyz Rhian M.
Published: June 2023

Objective:

Many individuals with essential hypertension are salt sensitive. High salt diet (HSD) has deleterious effects on the vasculature by mechanisms not fully elucidated. We explored molecular mechanisms, focusing on pro-inflammatory pathways whereby HSD influences vascular function in hypertension focusing on PARP-regulated TRPM2, a redox-sensitive Ca2+ channel, and the inflammasome. In particular we assessed if HSD induces a pro-oxidant environment leading to PARP-induced TRPM2-activation, Ca2+ influx and inflammasome assembly, leading to vascular damage and hypertension.

Design and method:

C57BL/6 mice were treated with normal or 4% high salt diet (HSD) for 5 weeks. Vascular function/structure was assessed in mesenteric arteries mounted in wire/pressure myography. VSMCs from rodents and humans were exposed to normal (145 mM) and high salt medium (180 mM) (HSM).

Results:

In presence of HSM, VSMCs present increased ROS generation (Control:0.7033±0.05 vs HSM:1.243±0.09) and PARP activation (Control: 94.25±6.67 vs HSM: 369.6±79.46), effect no longer observed in presence of ROS scavenger tiron, and antioxidant PEG-catalase. HSM induces Ca2+ influx in VSMCs (Control: 25562±880.48 vs HSM: 30925±1263.85), effect reversed by tiron, PARP inhibitor (olaparib) and TRPM2 blocker (8-br). NLRP3 activation (IL-1beta and Il-18 production) in VSMCs is increased by HSM (IL18 - Control: 93.82±1.97 vs HSM:127.30±6.57; IL-1 beta Control: 99.86±2.49 vs HSM: 125.30±3.43) HSM, effect followed by myosin light chain phosphorylation, which is dependent on ROS, PARP and TRPM2 activation. Animals treated with HSD present increased systolic BP (Control: 121.3±2.15 vs HSD: 134.90±3.04), outward hypertrophic remodelling and increased vascular contractility, effect reversed by PARP and NLRP3 inhibitors.

Conclusions:

In conclusion, HSD-induced hypertension involves ROS generation leading to activation of PARP-TRPM2 axis, increased calcium influx, NLRP3 activation and consequent vascular hypercontractility. We define novel pathways linking HSD to pathophysiological mechanisms underlying salt-sensitive hypertension.
IMPACT OF NON-DIPPING PATTERN AND NOCTURNAL HYPERTENSION ON LEFT VENTRICULAR MASS INDEX IN UNTREATED WHITE-COAT HYPERTENSIVE SUBJECTS
Authors: Dragonas Damianos , Spiliopoulou Sotiria , Tsoutsoura Nefeli , Lykka Aikaterini , Dimitriou Athina , Manios Efstathios
Published: June 2023

Objective:

Several studies have demonstrated that subjects with white-coat hypertension (WCH) have an increased risk of adverse cardiovascular outcome and target organ damage (TOD) progression compared to normotensives. The potentially detrimental effect of non-dipping or nocturnal hypertension on TOD has not been fully elucidated in subjects with WCH. The aim of our study was to investigate the impact of both dipping status and nocturnal hypertension on the left ventricle mass index (LVMI) of WCH individuals.

Design and method:

A total of 387 untreated WCH subjects underwent echocardiographic measurements. LVM was estimated using Devereux's formula according to the Penn Convention Protocol. LVMI was defined as LVM divided by the body surface area. The study population was divided into dippers (blood pressure (BP) nocturnal fall >10%) and non-dippers (BP nocturnal fall <10%) as well as into nocturnal hypertensives (nighttime systolic BP> = 120mmHg or nighttime diastolic BP> = 70mmHg) and nocturnal normotensives (nighttime systolic BP<120mmHg and nighttime diastolic BP<70mmHg). Statistical analysis was performed by means of independent-samples t-test, chi-square test and linear regression.

Results:

The percentages of non-dippers and nocturnal hypertensives in WCH subjects were 49% and 28%, respectively. The variables associated with LVMI in the univariate analyses were: age, male gender, body mass index, 24-hour diastolic BP and non-dippers. The multivariate regression analyses demonstrated significant associations of LVMI with the following factors: age (B = 5.760, 95% CI: 3.282 to 8.239; p<0.001), male gender (B = 10.941, 95% CI: 5.756 to 16.125; p<0.001), body mass index (B = 0.685, 95% CI: 0.138 to 1.232; p = 0.014), 24-hour diastolic BP (B = -6.634, 95% CI: -11.212 to -1.456; p<0.011) and non-dippers (B = 8.415, 95% CI: 3.449 to 13.380; p = 0.001). Non-dipping pattern was correlated to an increase of 8.415 g/m2 in the LVMI in WCH subjects.

Conclusions:

Non-dipping status is positively and independently associated with LVMI in untreated WCH patients. In contrast, statistically significant association between nocturnal hypertension and LVMI was not observed.
EDUCATION LEVEL AND OBESITY IN WOMEN LIVING IN THE CROATIAN RURAL AREA DAMAGED BY AN EARTHQUAKE. “THE SILENT KILLER HUNT PROJECT”- CROATIAN SOCIETY OF HYPERTENSION PROJECT
Authors: Vujanic Sara , Bilic Katarina , Prgomet Luka , Skelin Juraj , Vogrinc Dora , Vuksic Antonia , Zeljko Lucija , Jelakovic Bojan
Published: June 2023

Objective:

The rates of obesity and the resultant morbidities are rising worldwide, making it a high-priority health issue for the medical community. Obesity prevalence varies depending on several factors, one of which is educational level and stress.

Our goal was to determine the relationship between the level of education and body mass index (BMI), mid-upper arm circumference and visceral fat percentage of women in the Croatian rural area damaged by an earthquake.

Design and method:

We analyzed the association between the level of education and BMI, mid-upper arm circumference and visceral fat percentage of 170 women (opportunistic screening). A structured questionnaire was prepared, and it included questions about the years of formal education. Weight, BMI, body fat percentage, and visceral fat were measured by using a metabolic scale with a body composition monitor.

Results:

In our studied female population the average value of BMI was 29. 8 ± 6. 04 kg/m2, mid-upper arm circumference was 31. 6 ± 3. 30 cm and visceral fat percentage was 10. 5 ± 3. 87 %. By dividing the observed population into 2 subsets based on educational status (low educated and highly educated) there was a noticeable difference between the measured variables. Mean values of BMI, mid-upper arm circumference and visceral fat percentage in highly educated and low educated categories were 28. 2 ± 6. 25 kg/m2, 30. 5 ± 4. 14 cm, 8. 88 ± 3. 35 % and 30. 4 ± 5. 9 kg/m2, 32. 0 ± 4. 32 cm, 11. 1 ± 3. 89 %, respectively. Each of these factors had statistical significance with the following p values: BMI p <0.040, mid-upper arm circumference p <0.049, visceral fat percentage p <0.001.

Conclusions:

Our results have shown that BMI, mid-upper arm circumference, and visceral fat percentage are higher in women with the lower level of education. This observation highlights the role of patient education in our endeavors to improve health and quality of life on a population level. Average values are higher than in other rural parts of Croatia indicating that earthquake stress further contributed to obesity.
THE ASSOCIATION OF HYPERTENSION AND OBESITY: WHAT IMPACT ON THE LONGITUDINAL SYSTOLIC FUNCTION OF THE LEFT VENTRICLE
Authors: Bendiab Nabila Taleb , Benkhedda Salim , Ouabdesselam Souhila
Published: June 2023

Objective:

Hypertension and obesity are well known each result in heart failure with preserved ejection fraction. Indeed, there is ample evidence that the accumulation of adipose tissue in obese subjects negatively affects the left atrial and ventricular structure, as well as diastolic and systolic function. Predisposing factors for heart failure with preserved LVEF are advanced age, hypertension, diabetes, dyslipidemia and obesity.

The development of the 2D strain has made it possible to make an early diagnosis of ventricular dysfunction in patients with cardiovascular risk factors.

Design and method:

This work consists of performing in a series of 128 hypertensive patients divided into two subgroups: 58 obese patients and 70 patients with normal BMI. A complete cardiographic echo study was performed in both subgroups, including LVEF by Simpson biplane method, calculation of indexed left ventricular mass and parietal relative thickness, analysis of diastolic function and finally study of longitudinal LV deformation by speckle tracking technique.

Results:

We note in this work that dyslipidemia and diabetes were significantly more prevalent in the HTA+obesity arm. The average blood pressure figures were slightly higher in the HTA+obesity arm.

LVH was clearly predominant in the HTA+obesity arm with a more consequent decrease in the longitudinal contraction index. In obese hypertensive patients, LVH was most often concentric (53.4%). An increase in filling pressures was found in 11 obese hypertensive patients compared to only 4 non-obese hypertensive patients (p = 0.0001), with a good correlation with the decrease in GLS.

These results suggest that increased BMI is closely associated with atrioventricular interaction in patients with hypertension, with a perfect correlation with impairment of longitudinal systolic function and diastolic function compared to the control group.

Conclusions:

Although the pathophysiological mechanism behind obesity is disputed, several possible explanations have been proposed: obesity has been considered a state of chronic volume overload, increased blood volume, neurohormonal activation, thus increasing oxidative stress. Therefore, obesity is associated with mild ventricular dilation (eccentric remodeling). However, this finding is in contrast to other studies that associate obesity with a concentric rather than eccentric remodeling of the LV.
DYSLIPIDEMIA AND HYPERGLYCEMIA IN HYPERTENSIVE PATIENTS ASSOCIATE WITH GNB3 (RS5443) AND NOS3 (RS2070744) GENES’ ALLELIC STATE
Authors: Sydorchuk Andrii , Sydorchuk Larysa , Voroniuk Ksenia , Semianiv Marianna , Sydorchuk Ruslan , Kushnir Oksana
Published: June 2023

Objective:

More than 700 million people worldwide live with untreated essential arterial hypertension (EAH). The objective of the study was to evaluate the risks of metabolic disorders in EAH patients depending on guanine nucleotide-binding protein-↓3 subunit (GNB3, rs5443) and endothelial nitric oxide synthase (NOS3, rs2070744) genes’ allelic state.

Design and method:

The cohort case-control study involved 100 EAH patients (moderate-very high cardiovascular risks, aged 45-65 years) and 48 practically healthy (control). Metabolic disorders were evaluated by glucose blood value and lipids panel: total cholesterol (TC), triglycerides (TG), Low-, and High- density lipoprotein cholesterol (LDL-C, HDL-C) levels. The atherogenic index (AI) was calculated by the equation: (TC-HDL-C)/HDL-C. GNB3 (rs5443) and NOS3 (rs2070744) genotyping perfrmed by TaqMan probes in CFX96 Real-Time PCR Detection System.

Results:

Hyperglycemia (>6.1 mmol/l), hypertriglyceridemia (TG>1.7 mmol/l) and decreased HDL-C (<1.2 mmol/l) were relatively more common in EAH patients than in the control group by 36.11% (⇙2 = 17.88; p<0.001), 23.61% (⇙2 = 6.43; p = 0.011) and 25.0% (⇙2 = 8.32; p = 0.004) respectively. Therefore, the fasting hyperglycemia increases the EAH risk in the examined population ninefold [OR95%CI:2.86-27.08; p<0.001], hypertriglyceridemia and decreased HDL-C elevates the risk almost 3 and 3.5 times as well [OR95%CI:1.23-5.56; p = 0.009 and OR95%CI:1.46-8.71; p = 0.003], respectively. The risk of metabolic disorders (dyslipidemia and hyperglycemia) in EAH patients does not depend on NOS3 gene polymorphism (rs2070744).

Contrary, in T-allele patients of the GNB3 gene (rs5443) prevailed subjects with elevated LDL-C (>3.0 mmol/l) over those with CC-genotype by 13.89% (p = 0.05). Other parameters of lipid metabolism and hyperglycemia did not differ significantly between GNB3 (rs5443) genes allelic state. However, the mutational T-allele of the GNB3 gene (825C>T) increases the risk of hyperlipidemia 8.5 times [OR 95%CI:0.99-72.70; p = 0.05] due to atherogenic LDL-C, with the protective role of CC-genotype [OR = 0.12; OR 95%CI:0.01-1.0; p = 0.048].

Conclusions:

Fasting hyperglycemia, hypertriglyceridemia and lowered HDL-C, enhance the arterial hypertension risk 3-9 times (p<0.01). The polymorphic site of GNB3 (rs5443) gene, but not NOS3 (rs2070744) gene associate with hyperlipidemia in hypertensive patients.
APE1/REF-1 AFFECTS ADIPOCYTE DIFFERENTIATION BY REGULATING ADIPOGENIC TRANSCRIPTION FACTORS IN 3T3-L1 CELLS
Authors: Lee Eunok , Joo Hee -Kyoung , Lee Yu -Ran , Kim Sungmin , Lee Kwon -Ho , Lee Sang -Do , Jeon Byeong -Hwa
Published: June 2023

Objective:

Apurinic/apyrimidinic endonuclease 1/redox factor-1 (APE1/Ref-1) is a multifunctional protein involved in DNA repair and redox regulation. The redox activity of APE1/Ref-1 is involved in inflammatory responses and regulation of DNA binding of transcription factors related to cell survival pathways.

Design and method:

To determine the changes in APE1/Ref-1 expression during the adipogenic differen-tiation of preadipocytes, we investigated APE1/Ref-1 expression on days 0, 2, 4, 6, and 8 of 3T3-L1 cell differentiation (Figure 1A)

To evaluate the effect of APE1/Ref-1 on MDI-induced adipocyte differentiation, 3T3-L1 cells were transfected with adenovirus expressing APE1/Ref-1.

Having established that overexpression of APE1/Ref-1 suppressed adipocyte differ-entiation, the effect of gene silencing of APE1/Ref-1 during MDI-induced adipocyte differ-entiation was evaluated in 3T3-L1 cells with transfection of APE1/Ref-1 siRNA.

Finally, the effect of E3330, a redox inhibitor of APE1/Ref-1, on adipocyte differentiation was evaluated in 3T3-L1 cells.

Results:

In this study, we investigated the effect of APE1/Ref-1 on the regulation of adi-pocyte differentiation in 3T3-L1 cells. During adipocyte differentiation, APE1/Ref-1 expression sig-nificantly decreased with the increased expression of adipogenic transcription factors such as CCAAT/enhancer binding protein (C/EBP)-alpha and peroxisome proliferator-activated receptor gamma, and the adipocyte differentiation marker adipocyte protein 2 (aP2) in a time-dependent manner. However, APE1/Ref-1 overexpression inhibited C/EBP-alpha, PPAR-gamma, and aP2 expression, which was upregulated during adipocyte differentiation. In contrast, silencing APE1/Ref-1 or redox inhibition of APE1/Ref-1 using E3330 increased the mRNA and protein levels of C/EBP-alpha, PPAR-gamma, and aP2 during adipocyte differentiation.

Conclusions:

In conclusion, our study demonstrated that endogenous APE1/Ref-1 is downregu-lated during adipocyte differentiation, whereas overexpression of APE1/Ref-1 inhibits ad-ipocyte differentiation; in contrast, silencing APE1/Ref-1 and redox inhibition using E3330 promotes adipocyte differentiation through the modulation of expression of adipogenic transcriptional factors. Overall, these results suggest that the redox function of APE1/Ref-1 exerts an anti-adipogenic function by inhibiting adipocyte differentiation.
THE INFLUENCE OF EXCESSIVE WEIGHT GAIN ON DISTURBANCE OF THE UTERINE-PLACENTAL BLOOD FLOW IN PREGNANT WOMAN WITH ARTERIAL HYPERTENSION
Authors: Kerimkulova Aiman , Medubayeva Madina , Latypova Natalia , Markabayeva Akbayan , Nurpeissova Riza , Idrissov Alisher , Zholdybay Aigerim , Abilkasym Zhansaya
Published: June 2023

Objective:

To evaluate the development of violations of uterine-placental blood flow depending on weight gain during pregnancy in women with arterial hypertension.

Design and method:

A prospective cohort examination of 110 pregnant women with arterial hypertension (including chronic and gestational arterial hypertension) and 80 women of the control group (practically healthy women without increasing blood pressure) was conducted. The study was conducted on the basis of perinatal centers of Astana (Kazakhstan) in 2018-2019. The weight gain for the period of pregnancy in women with hypertension and control groups was studied. The body mass index (BMI) was calculated and weight gain for the period of pregnancy in the studied groups.

Results:

One of the main causes of the development of complications during pregnancy by the fetus is a violation of uterine-placental blood circulation (UPC), which depends not only on blood pressure levels. Disorders of the UPC were detected in pregnant women with hypertension and control groups of 20% and 2.5%, respectively (p = 0.0003). In pregnant women with hypertension, the odds ratio of chances of the development of UPC disorders increased by 4.4 times compared to the pregnant woman of the control group. Excessive increase in body weight during pregnancy in pregnant women with hypertension was detected in 16% and in the control group 5% (p = 0.018). The relative probability of developing a violation of the UPC with an excessive increase in the weight of a pregnant woman with hypertension soared by 50%. In the control group of pregnant women with a normal pressure level, excess weight gain was detected in 6.3% and there were no violations of the UPC.

Conclusions:

According to the results of the study, in pregnant women with hypertension, violations of the UPC were significantly more common compared to the control group. The odds ratio of the chances of developing uterine-placental blood flow surges by 4.4 times in pregnant women with hypertension compared to pregnant women with a normal level of pressure. Excessive weight gain in pregnant women with hypertension increases the development of impaired UPC.
CASE REPORT OF A RARE CAUSE OF SECONDARY HYPERTENSION ILLUSTRATING THE IMPORTANCE OF CARDIO-OBSTETRICS PRECONCEPTION COUNSELING
Authors: Meister Theo , Soria Rodrigo , Bubulyte Laura , Spano Giancarlo , Vladimirmakalo Vladimir , Raio Luigiraio , Rexhaj Emrush
Published: June 2023

Objective:

Our objective is to illustrate the value of preconception management of rare case of secondary hypertension namely Middle Aortic Coarctation (MAC), which is characterized by a constriction of the upper abdominal aorta. During pregnancy, MAC can lead to feto-maternal unfavorable hemodynamic balance (Fig.1). On the one hand, elevation of the arterial blood pressure (BP) of the upper part of the body increases the maternal cardiovascular risk i.e. stroke or aortic dissection. On the other hand, hypo-perfusion of the lower part of the body reduces uterine perfusion, increases fetal risk of preeclampsia, placental insufficiency or fetal growth restriction.

Design and method:

Here, we report the case of a 30-year-old woman with severe hypertension and plans to become pregnant. She previously underwent percutaneous transluminal angioplasty (PTA) and aortic stenting and presented with elevated BP in both arms (right 177/117 mmHg, left 180/121 mmHg) and decreased ABI bilaterally (Tab. 1). A computed tomography angiography of the aorta was performed showing an aortic stent in a supraceliac position with 79% in-stent stenosis. She underwent a new PTA with in-stent re-stenting (Fig. 2).

Results:

Post PCA, the four extremities BP measurements showed a reduction of her BP values and a normalization of the ABI bilaterally (Table 1). 24h-ABPM confirmed the BP reduction (mean 24h- systolic BP of 135 mmHg, diastolic BP of 101 mmHg), but still remaining-elevated. Therefore, we started an antihypertensive treatment with a successful BP control (125/82 mmHg).

Conclusions:

The management of MAC in already pregnant women can be particularly challenging. Indeed, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers are contraindicated. Furthermore, PTA during pregnancy expose the fetus to radiation and reports for CoA angioplasty and stenting during pregnancy are very limited. Herby, we decided on an interventional rather than conservative approach. This case illustrates the importance of preconception screening and treatment of chronic hypertension in women with plans to become pregnant. It highlights the fact that secondary causes of hypertension do not have to be overlooked in this population.
ANTIFIBROTIC POTENTIAL OF ANGIOTENSIN (1-7) IN HEMODYNAMICALLY OVERLOADED RAT HEART
Authors: Sykora Matus , Kratky Vojtech , Kopkan Libor , Tribulova Narcis , Bacova Barbara Szeiffova
Published: June 2023

Objective:

Heart failure is a clinical syndrome characterized by cardiac dysfunction due to structural abnormalities of the myocardium that results in the inability of the heart to eject sufficient volume of the blood to the circulation. HF is a major cause of morbidity and mortality in the world. The ECM is a highly dynamic structure controlling the proper functioning of heart muscle. ECM remodelling with enhanced deposition of collagen due to hemodynamic overload impairs cardiomyocyte adhesion and electrical coupling that contributes to cardiac mechanical dysfunction and arrhythmias.

Design and method:

We aimed to explore ECM and connexin-43 (Cx43) signalling pathways in hemodynamically overloaded rat heart as well as the possible implication of Ang(1-7) to prevent/attenuate adverse myocardial remodelling. Males, 8 weeks-old, normotensive Hannover Spraque-Dawley rats (HSD), hypertensive Ren-2 transgenic rats (TGR) and Ang(1-7)-transgenic rats (TGR(A1-7)) underwent aortocaval fistula (ACF) to produce volume overload. 5 weeks later, were right and left ventricular tissue samples used for biometric, biochemical, and proteomic analyzes.

Results:

Cardiac hypertrophy in response to volume overload was significantly less pronounced in TGR(A1-7) comparing to HSD rats. Moreover, a marker of fibrosis, hydroxyproline, was increased in both ventricles of volume overloaded TGR while reduced in Ang(1-7) right heart ventricle. Protein level and activity of MMP-2 were reduced in both ventricles of volume overloaded TGR/TGR(A1-7) compared to HSD. SMAD2/3 protein levels were decreased in the right ventricle of TGR(A1-7) compared to HSD/TGR in response to volume overload. In parallel, Cx43 and pCx43 implicated in electrical coupling were increased in TGR(A1-7) versus HSD/TGR. PKC↑ and PKC↗ showed a decrease in the TGR group compared to HSD and a decrease in the TGR(A1-7) ACF group compared to HSD and TGR after ACF in both chambers.

Conclusions:

It can be concluded that Ang(1-7) exhibits cardioprotective and anti-fibrotic potential in condition of cardiac volume overload. If we look at the results comprehensively, it can be concluded that Ang(1-7) exhibits cardioprotective and antifibrotic potential in condition of cardiac volume overload. Supported by grants VEGA 2/0006/23, APVV 21-0410.
ROLE OF METALLOPROTEINASES AND ROS GENERATION IN THE AORTA OF ELASTASE-2 KNOCKOUT MICE IN ABDOMINAL AORTIC ANEURYSM MODEL
Authors: Mestriner Fabiola , Ribeiro Mauricio S. , C Ariel Emiliano Souza DO , Dugaich Vinicius Flora , Mel Marcela M. Blascke DE , Bruch Pedro , Kovacs Henrique Z. , Vasconcelos Jocianny , Francisco Daniely F. , Corsi Carlos , Campos Ligia Borges , Neto Julio , Costa Rafael Menezes DA , Castro Michele Mazzaron de , Passaglia Rita Tostes , Becari Christiane
Published: June 2023

Objective:

Elastase-2 (ELA-2) enzyme generates angiotensin-II (AngII) in arteries and is implicated in abnormal vascular remodeling in animal models. Our group demonstrated previously that ELA-2 knockout (ELA-2KO) mice were less susceptible to developing an aorta dilation in response to AngII infusion. This study hypothesizes that metalloproteinases and ROS generation in ELA-2KO mice mediate less susceptibility to aorta dilation and abdominal aortic aneurysm (AAA).

Design and method:

Male wild type (C57bl/6, WT) and ELA-2KO (CELA-2aTm1Bdr) mice were treated with either saline or AngII (2.28g/g/min) for twenty-eight days by subcutaneously mini-pumps infusion. Mice were divided into four groups: WT treated with saline (WT+SAL, n = 5), ELA-2KO treated with saline (ELA-2KO+SAL, n = 5), WT treated with AngII (WT+AngII,n = 5), and ELA-2KO treated with AngII (ELA-2KO+AngII, n = 5). The vascular ultrasound (US) was done before treatment and once a week during 28 days of treatment. The MMP- 2 and MMP-9 analyzes were done by zymography, ROS generation by DHE analyses, and alfa-actin expression by immunofluorescence in all aorta mice groups. ANOVA and Kruskal Wallis tests were used to compare the average between groups. This study is approved by CEUA (n.131/2019).

Results:

AngII treatment was associated with increased MMPs expression in the WT group aorta (WT+AngII vs. WT+SAL p<0.05). The aorta ELA-2KO group showed no difference in MMPs in response to AngII infusion compared to ELA-2KO+SAL group (p = 0.81). The ROS generation had upregulated in aorta ELA-2KO+Ang II mice compared to ELA-2KO+SAL (p<0.001) and aorta WT+AngII compared with WT+SAL (p<0.0001). AngII treatment was associated with decreased ROS generation in the aorta ELA-2KO+AngII group compared with WT+AngII (p = 0.0051). The alfa-actin expression was similar in all groups. Our data demonstrate that AngII treatment did not increase the expression of MMPs in aorta ELA-2KO but was associated with an upregulation for ROS generation.

Conclusions:

Taken together, this suggests that ELA-2KO mice's resistance to developing an aorta dilation/AAA is related to MMPs and ROX generation. Our results also highlight the importance of the local/tissue response in the pathophysiology of AAA.
LONG TERM EFFECT OF RENAL DENERVATION ON 24 HOUR ABPM AND BLOOD PRESSURE LOAD IS LARGELY DEPENDENT OF BASELINE ARTERIAL STIFFNESS
Authors: Postadzhiyan Arman , Tochev Sotir , Andreeva Lora , Velchev Nizar Rifai Vassil , Finkov Bojidar
Published: June 2023

Objective:

The aim of the study was to evaluate the long term effect of renal sympathetic denervation (RSD) on 24h ambulatory blood pressure measurement (ABPM) and blood pressure load (BP load) in patients with resistant hypertension depending of the baseline arterial stiffness status.

Design and method:

Consecutive patients with resistant hypertension who underwent RSD workout at the University Hospital Saint Anna, Sofia, ESH Excellence center of hypertension, were included. RSD was performed on the grounds of resistant hypertension defined as mean daytime systolic BP >135 mmHg or diastolic BP >85 mmHg in 24-hr ambulatory blood pressure measurement (ABPM) despite the intake of at least three antihypertensive agents, including a diuretic. Cardio ankle vascular index (CAVI) was measured using the VaSera system (Fukuda Denshi Co, Japan). RSD was performed with the Symplicity Flex™ catheter (Medtronic, Minneapolis, MN, USA) according to a standardized protocol.

Results:

The study included 32 patients with treatment-resistant hypertension and performed successful RSD. CAVI was measured before the intervention and the results of the procedure on 24h daytime, nighttime and 24 blood pressure and systolic and diastolic BP load were evaluated by serial ABPM measurements. A long-term effect of the RSD, reported as a reduction in 24-hour systolic blood pressure above 10 mmHg at month 12, was found in 22 patients (68.8%). Despite similar baseline out-of-office and office blood pressure and concomitant antihypertensive therapy, patients with lower arterial stiffness had a more significant blood pressure effect of renal denervation, a result that persisted within 12 months of follow-up. Along with reduction of all ABPM parameters more profound and clinically meaningful change of BP load during daytime, nighttime and 24h period was also noticed in this group of patients. (Table 1)

Conclusions:

The long term effect of renal denervation on 24h ABPM and BP load is largely dependent of baseline arterial stiffness. The results of the present study justify the incorporation of arterial stiffness evaluation in clinical decision workout of the procedure.
PHARMACOGENOMICS-GUIDED DRUG THERAPY FOR HYPERTENSION
Authors: Sun/Ningling Ningling Sun , Shu/Chang Chang Shu , Zhang/Yanwei Yanwei Zhang
Published: June 2023

Objective:

The hypertension control rate is only 16.8% in China, and superior reasonable treatment is contributive to improve the rate. This study is aimed to evaluate whether pharmacogenomics-guided drug therapy is superior to conventional therapy in lowering blood pressure.

Design and method:

DNA samples were collected from 93 hypertensive patients. All patients entered a 4-week conventional treatment period, and then entered a 4-week pharmacogenomics-guided drug therapy period (the antihypertensive regimen was adjusted according to the pharmacogenomic report). The hypertension control rate and reduction of blood pressure (BP) were analyzed. High-throughput targeted sequencing panel was designed to detect efficacy and adverse-related genes of 24 commonly used antihypertensive drugs (5 types) and 52 gene loci were analyzed related to drug Efficacy (E): “E-”, “E”, “E+”, Tolerance (T): “T-”, “T”, “T+” and Metabolic (M): “M-”, “M”, “M+”. Clinical drug administration was guided according to relevant judgement results.

Results:

Compared with the conventional therapy group, the hypertension control rate of office and home blood pressure in the precise treatment group increased by 14.75% and 25.81%, respectively. The reduction of BP in the precise treatment group was greater than conventional therapy group ( Table and Figure).

Conclusions:

Compared with conventional therapy, the pharmacogenomics-guided drug therapy can control blood pressure more effectively.

Table. Comparison of Reduction in Office Systolic Blood Pressure (SBP)and Home SBP between the Precise Treatment Group and the Conventional Therapy Group

Figure: Comparison of Reduction in Office SBP and Home SBP between the Precise Treatment Group and the Conventional Therapy Group