bluuebunny/crossref_metadata_2025 huggingface dataset:
CARDIOVASCULAR AND METABOLIC PHENOTYPES OF PATIENTS WITH PHEOCHROMOCYTOMA AND PARAGANGLIOMA
Authors: Pinna Alessia , Buralli Simona , Dalpiaz Hermann , Ubaldini Giulia Mori , Faconti Luca , Masi Stefano , Taddei Stefano , Bacca Alessandra
Published: May 2024

Objective:

Pheochromocytoma and paraganglioma are rare tumours that can originate either from sympathetic or parasympathetic tissue (PPGLs). While an overactivity of the sympathetic nervous system might contribute to the evolution of hypertension-mediated organ damage (HMOD), the cardiometabolic phenotype of patients with PPGLs remains largely unexplored. In this study, we explored the relationship between urinary metanephrine and normetanephrine levels with parameters of cardiac organ damage in these patients.

Design and method:

In the current study, we retrospectively recovered the echocardiographic data, 24-hour urinary metanephrine (MT) and normetanephrine levels (NorMT), the clinical examination and standard biochemical tests of 111 patients with PPGLs, initially referred to our hypertension clinic for elevated blood pressure and/or symptoms/imaging features suggestive of the disease. Patients underwent resting echocardiography, measurement of the 24-hour urinary metabolite levels, clinical examinationand blood collection for standard biochemical tests.

Results:

The average age of the population was 41±19 years old, 59% women, 92% with a diagnosis of arterial hypertension. Systolic and diastolic blood pressure were within the normal range. The average left ventricular mass indexed for the body surface area (LVMI) was 105±22g/m2. We found a significant correlation between NorMT levels and the values of diastolic (r=0.497; p=0.042) but not systolic blood pressure. The NorMT levels were strongly correlated with the LVMI (r=0.496; p=0.001). This correlation remained significant even after adjustment for sex and values of systolic or diastolic blood pressure. No correlations were observed between NorMT and parameters of left atrial remodeling, different patterns of left ventricular remodeling (as assessed by relative wall thickness, RWT), diastolic function and estimated glomerular filtration rate. Fasting plasma glucose was significantly correlated with MT (r=0.413; p=0.01) and borderline correlated with NorMT (r=0.308; p=0.060). No correlations were found between MT parameters of cardiac remodeling.

Conclusions:

In patients with PPGLs, the overproduction of NorMT is related to a greater severity of cardiac hypertrophy independently of the blood pressure control. Furthermore, MT and, to a lesser extent, NorMT were related to the fasting plasma glucose levels, suggesting a potential influence of NorMT and MT on the cardiometabolic profile of patients with sympathetic PPGLs.
SODIUM RESTRICTION CONCOMITANT WITH SUFFICIENT ALDOSTERONE SUPPRESSION MAY BE ASSOCIATED WITH RENOPROTECTIVE EFFECTS IN THE PATIENTS WITH PRIMARY ALDOSTERONISM
Authors: Kidoguchi Satoshi , Sugano Naoki , Yokoo Takashi
Published: May 2024

Objective:

Primary aldosteronism (PA) is an independent risk factor for various cardiovascular diseases and chronic kidney disease, which makes it important to treat this condition at an early phase. Currently, the use of mineralocorticoid receptor antagonists (MRAs) is recommended for the treatment of bilateral type, mainly idiopathic hyperaldosteronism. However, recent reports suggest that the benefit of the treatment with MRAs is only obtained in the patients with enough aldosterone suppression, which is indicated as post-treatment plasma renin activity (PRA) >=1.0 ng/mL/h. Since PRA is affected by the amount of sodium intake, PRA elevation after MRAs treatment might partially reflect an adherence to strict sodium restriction, thereby leads to organ protective effects in PA patients.

Design and method:

A total of 91 patients who received eplerenone or esaxerenone for PA treatment were included. The patients with PRA>=1.0 ng/mL/h at one year after the initiation of MRAs were determined as responders, and others were determined as non-responders. The differences between responders and non-responders were analyzed. In addition, these patients were followed for another two years (total three years), and the transitions of estimated glomerular filtration (eGFR) among responders and non-responders were also compared.

Results:

The doses of MRAs were equivalent between responders and non-responders. Estimated sodium intake was significantly lower in responders (responders: non-responders; 156.2±42.3 mmol/day: 124.7±41.8 mmol/day P<0.05). Multivariate logistic regression analysis has shown that estimated sodium intake was an independent predictor for responders. During three years’ period, eGFR was significantly decreased in non-responders (pre-treatment: post-treatment; 73.0±14.7 ml/min: 69.5±14.1 ml/min P<0.05), whereas it was comparatively preserved in responders (pre-treatment: post-treatment; 68.3±17.9 ml/min: 68.0±19.0 ml/min P=0.84).

Conclusions:

The present study have shown that responders in PA patients may partially benefit from an adherence to sodium restriction. Sodium restriction concomitant with sufficient suppression of aldosterone effect may exert renoprotective effects for PA patients.
UNLOCKING THE PUZZLE: INSIGHTS FROM A RARE CASE OF FIBROMUSCULAR DYSPLASIA
Authors: S Sreenath , Majeed Abdul , Mb Adarsh
Published: May 2024

Objective:

To present a rare or unusual manifestation of fibromuscular dysplasia (FMD) and highlight the diagnostic challenges encountered in identifying fibromuscular dysplasia, particularly in uncommon presentations.

Design and method:

CASE REPORT: 35/F, Kerala Tribal ethnicity, P2L2A0 H/O. HTN x 10 years on irregular indigenous medications. Presented to the ER with seizures followed by sudden onset right hemiplegia and slurring of speech. Initial assessment: Patient conscious, obeying commands. P- 130/min regular, BP - 216/120 mm Hg, Rt side- zero power with extensor plantar. CT Brain -Acute ICH 30x17 mm in Left insular cortex with surrounding edema. Admitted to the ward for young stroke evaluation. Past H/O: Intermittent headaches, pulsatile tinnitus and flank pain. Addicted to tobacco and ethanol, Normal bowel & bladder habits. Family H/O: HTN & Stroke + O/E: Poorly built, B/L Renal artery bruit +, No significant pulse/ BP asymmetry, No murmurs. Fundi: Grade III Hypertensive retinopathy changes. Plan: Control of hypertension and proceeded with workup for secondary hypertension

Results:

S. Creatinine - 2.6mg/dl

Urinalysis - Alb - Faint trace, No RBCs/ casts

HIV/ HBsAg/ Anti - HCV ELISA - Negative

ECG - sinus tachycardia, LVH

2D ECHO- Good LV function, LVH, No clots / vegetations, Grade II diastolic dysfunction

USG KUB - B/L shrunken kidneys (Rt: 7.8 x 3.3 cm, Lt: 7.2 x 3.1cm) with lost CMD

RAD: B/L raised doppler parameters in the mid to distal segment of main renal artery (PSV / RI) with tardus et parvus pattern; no evidence of thrombus.

CTA: B/L small sized kidneys with diffusely narrow caliber of both renal arteries with relative sparing of proximal portion. No ostial stenosis or beading of vessels seen. Aorta and its branches appear normal.

Management: Losartan, Chlorthalidone, Amlodipine, Smoking cessation

Conclusions:

Unlike atherosclerotic disease, which localizes at ostial and proximal segments of renal arteries, FMD more commonly involves the middle and distal arterial segments. FMD classically presents as renovascular hypertension but can also manifest as stroke in young adults. Our patient had focal FMD corresponding to Intimal fibroplasia histopathological variant.
A CAUSE OF PAROXYSMAL HYPERTENSION NOT TO BE OVERLOODED: CHILDREN'S PHEOCHROMOCYTOMA
Authors: Lahlou Haddad Haddad , Cherif Nacira
Published: May 2024

Objective:

We aimed to assess the clinical presentation, natural history, and treatment response of hypertension in children with pheochromocytoma.

Design and method:

O. Mohamed, an 8-year-old boy, without past medical history, hospitalized for paroxysmal hypertension evolving for 6 months with severe headaches, generating insomnia. No similar episodes in the family. Clinical features: BMI of 15. 1 kg/m2 (height: 1.26 m, weight: 24 kg). heart rate of 128 bpm (tachycardia) and blood pressure of 175/84 mm Hg (stage 2 for systolic hypertension and stage 1 for diastolic hypertension, table 1).

The physical examination was unremarkable except for tenderness in the right hypochondrium.

Biological tests: serum creatinine and proteinuria testing was normal.

Ophthalmic examination: stage I hypertensive retinopathy (Arterial narrowing).

Abdominal ultrasound: right adrenal mass, measuring 65–57–61 mm in size, well-defined, heterogeneous echo structure, with multiple echogenic areas. No calcifications.

Abdominal CT scan: Solid right adrenal mass (Figures 1 & 2) and no lymph node involvement.

Urinary Vanyl Mandelic Acid: high level at 27.18 μmol/l (normal < 10 μmol/l).

MIBG scintigraphy: intense pathological uptake, posterior, projecting over the right renal region, intensifying at 48 hours. No other sites of uptake.

Results:

In summary, right adrenal pheochromocytoma revealed by a severe paroxysmal hypertension. Preoperative management: Nicardipine IV. Alpha-blocker combined with a beta-blocker were not used. Evolution under medical treatment while waiting for excision of the tumor is favorable with a significant reduction in blood pressure. The child was operated with complete excision of the tumor. Pathological examination of the surgical specimen: ovoid formation made of epithelial cells with basophilic nuclei arranged in cords separated by thin vascular axes = aspect of pheochromocytoma Post-operative evolution was favorable with disappearance of symptoms and normalization of blood pressure after stopping antihypertensives. Actually, the patient is asymptomatic after 4-year follow-up with normal blood pressure and no relapse. The family investigation does not report any family cases.

Conclusions:

Pheochromocytoma is rare in children. It often presents with severe paroxysmal hypertension. Malignant forms are rare in children; however, rigorous surveillance is necessary for at least 5 years.
THE INFLUENCE OF WINTER SWIMMING ON STRUCTURAL CHANGES IN RETINAL MICROCIRCULATION
Authors: Matuszewska Urszula , Kaczmarczyk Karolina , Sajdak Wojciech , Dabrowska Edyta , Wolf Jacek , Narkiewicz Krzystof , Dabrowska-kugacka Alicja , Lasocka Zofia
Published: May 2024

Objective:

Winter swimming is perceived as beneficial for cardiovascular system. However, a number of studies have suggested that such activity can have a harmful impact in some individuals. The aim of our investigation was to assess the influence of winter swimming on structural changes in retinal microcirculation.

Design and method:

The examinations were performed before and after the winter swimming period – from November 2022 till April 2023 in 36 subjects (mean age 45±4.0 years, 65% women). The mean frequency of winter swimming activity was 1.3 times per week.

The evaluation of structural microvascular changes was performed in retinal arterioles using non-invasive tool - Adaptive Optics Camera Rtx1e (Imagine Eyes, Orsay, France). The camera enables the precise assessment of microvasculature with ultra-high resolution at a near-histological scale. The Rtx1e innovative technology allows for tracking of the exact fundus areas which is critical for prospective studies. We assessed the following structural parameters: lumen diameter (LD), wall thickness (WT), wall to lumen ratio (WLR), and wall cross-sectional area (WCSA).

Results:

Winter swimming had profound effect on retinal microcirculation. We present the results in the following table.

Conclusions:

Winter swimming was associated with a significant reduction of WT, WCSA and WLR, and with an increase of LD. To the best of our knowledge, these findings provide the first evidence of beneficial impact of winter swimming on the retinal microcirculation status. Whether improvement in retinal microcirculation is accompanied by positive changes in other microvascular districts remains to be studied.
HYPERTENSION-SPECIFIC ASSOCIATION OF CARDIO-ANKLE VASCULAR INDEX WITH SUBCLINICAL LEFT VENTRICULAR FUNCTION IN A CHINESE POPULATION: DANYANG STUDY
Authors: Liu Ming , Zhang Xue , Liang Junya , Li Yibo , Gao Yun
Published: May 2024

Objective:

The association of arterial stiffness, as measured by cardio-ankle vascular index (CAVI), with subclinical cardiac dysfunction in hypertensive patients is unclear. Our study aims to examine their relationship in hypertensive patients compared with that in normotensive subjects.

Design and method:

Our study included 1887 subjects who were enrolled from Danyang between 2018 and 2019. CAVI was measured using VaSera VS-1500A device. We performed conventional echocardiography to measure ejection fraction (EF) and E/A, tissue Doppler to measure mitral annular early diastolic velocities (e’), and speckle tracking to estimate left ventricular (LV) global longitudinal strain (GLS).

Results:

Increased LV mass index (76.3, 80.0, and 84.0 g/m2), decreased GLS (21.1, 21.0, and 20.4%), lower E/A (1.2, 1.0, and 0.8) and e’ velocity (11.2, 9.4, and 8.2 cm/s), and higher E/e’ (7.6, 8.2, and 8.8) were significantly associated with higher CAVI on unadjusted analyses (P < 0.001). After adjustment for covariates, GLS, E/A, and e’ were still significantly decreased from tertiles 1 to 3 of CAVI (P < 0.04). Further sensitive analyses revealed similar association pattern for diastolic function. However, the relationship of higher CAVI to worse GLS was stronger in hypertensives (P = 0.008) but not normotensives (P = 0.167) (Figure 1). Compared with lowest tertile, subjects with top tertile of CAVI were at higher risk of subclinical LV systolic dysfunction in hypertensive patients (OR = 2.61; P = 0.005).

Conclusions:

Increased CAVI is associated with worse subclinical diastolic function. However, this relationship of CAVI to subclinical systolic function was more prominent in hypertensive patients.
EFFICACY OF ACETYLSALICYLIC ACID COMBINED WITH GLUCOCORTICOID IN THE TREATMENT OF TAKAYASU ARTERITIS: CASE REPORT
Authors: Nguyen Thao , Ha Thuan
Published: May 2024

Objective:

Takayasu arteritis (TA) is an idiopathic large-vessel vasculitis, predominantly impacting the aorta and its major branches. The management of TA includes pharmacotherapy or surgical intervention in the presence of complications.

Design and method:

A 14-year-old girl was admitted to our clinic for a thoracic aortic aneurysm. 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 hs-CRP level: 28.7 mg/L. Computed tomography angiography (CTA) chest with contrast showed 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 2.1 cm, respectively, and the length is #2.5 cm, # 3.2 cm, respectively.

According to JSC 2017, This patient was diagnosed with descending aorta aneurysms in Takayasu arteritis- type III (ACR 1994)

The patient underwent corticosteroid therapy, starting with prednisolone at an initial dose of 20 mg/day. The dosage was reduced to 10 mg/day at month 3 and maintained at 5 mg/day from month 6 until the completion of the 18-month therapy. Additionally, low-dose aspirin (81 mg/day), ACE inhibitors, and beta-blockers were incorporated to enhance treatment efficacy.

Results:

After 3 months, hs-CRP levels returned to normal. 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. The patient's symptoms improved after finishing treatment.

Conclusions:

Successful treatment of Takayasu arteritis in our case, highlights the significant role of pharmacotherapy. This cost-effective approach minimizes side effects, offering promising treatment options for Takayasu arteritis patients, especially in low-income countries like Vietnam
CORRELATION BETWEEN BETA - STIFFNESS INDEX AND ATHEROGENIC LIPID INDICES AS A MARKER OF SUBCLINICAL ATHEROSCLEROSIS IN PATIENTS WITH BETA THALASSEMIA MAJOR
Authors: Dimova Maria , Petrova Kristina
Published: May 2024

Objective:

Vascular impairment in patients with Beta-thalassemia major (BTM) is an extremely clinically relevant issue, associated with a high risk of accelerated atherosclerosis. Beta-stiffness index (BSI) is an echo-tracking parameter that can reveal increased carotid stiffness.

To examine the beta-steffness index in patients with BTM and healthy controls. To analyze parameters of lipid metabolism and atherogenic lipid indices (Castelli Risk Index I, CRI-I, Castelli Risk Index II, CRI-II, Atherogenic index of plasma, AIP, Atherogenic coefficient, as a marker of cardiovascular risk in BTM patients compared with healthy controls and to find out correlations between the BSI and atherogenic lipid indices in patients with BTM.

Design and method:

38 children and young patients with BTM (mean age 25.0±10.8 years, 20 female) and 40 healthy controls (mean age 23.1±11.0 years, 20 female). All subjects underwent carotid examination of beta-stiffness index by echo-tracking method with Aloka Hitachi prosound alfa 7, 7.5-MHz linear array of the right and left common carotid arteries about 1 cm proximal to the bulb. Blood test samples for lipid parameters – total cholesterol (TC), LDL, HDL, triglicerides (TG) were performed as well as calculations of the atherogenic lipid indices.

Results:

The mean AIP values in patients were 0.17±0.30 and in health controls -0,34±0.19, p=0.0001. The Castelli Risk index I in patients was 3.64±1.19 and in healthy controls was 2,75±0.74 (p=0.0001) –tabl.1. There was positive correlation between beta-stiffness index of both carotid arteries and some lipid parameters – tabl.2.

Conclusions:

Young adults with BTM are at increased risk of atherosclerosis and the subclinical impairment can be easily detected by methods of carotid ultrasound examination using beta-stiffness index and by atherogenic lipid indices.
TESTOSTERONE EXACERBATES THE LEFT VENTRICULAR HYPERTROPHY OF THE FEMALE OVARIECTOMIZED SPONTANEOUSLY HYPERTENSIVE RATS THROUGH INHIBITING THE ACTIVATION OF AMPK- FOXO1/MURF1 SIGNAL
Authors: Zhu Lulu , Wang Wengting , Chen Jianshu , Wang Qiongying , Yu Jing
Published: May 2024

Objective:

Relative elevated testosterone concentrations induced left ventricular hypertrophy of the postmenopausal hypertension women, but the molecular mechanisms are poorly understood. MuRF1, a muscle-specific E3 ubiquitin ligase in the proteasome ubiquitination process, was newly identified as a negative regulatory factor of the heart and muscle tissue. There have been little study to certify whether MuRF1 take part in testosterone-induced the left ventricular hypertrophy of the postmenopausal hypertensive women.

Design and method:

Femal spontaneously hypertensive rats (SHR) (n = 28, 12week ages) were divided into three groups: (1) Sham group (n=6), (2) ovariectomized (OVX, n=6), (3) ovariectomized + testosterone intervention (OVX+T, 2mg/kg, QOD, n=6), in addition, the age-matched Wistar-Kyota (WKY) as the control. Testosterone was intramuscularly injected after ovariectomy and replaced every three days at 2mg/kg concentration for 4 weeks. we compared the weight/tibial length and the levels of IVST, LVPWT, LVM among four groups, and measured the expression of the myosin heavy chain (MHC), AMPK, FOXO1, MuRF1 and ubiquitinated proteins, as well as the phosphorylation expression of AMPK (p-AMPK) and Forkhead box O 1 (p-FOXO1) proteins by using Western Blot method. ANOVA analysis was used for comparison among the different groups. There was statistically significant difference when the p value was less than 0.05. The data were processed by SPSS 26.0 software.

Results:

After 4 weeks of testosterone intervention, compared to other three groups, the rats from OVX+T group showed the greatest elevation in blood pressure, the weight/tibial length and the levels of IVST, LVPWT, LVM and the protein expression of the MHC protein, but had a lowest expression of the p-AMPK, p-FOXO1, MuRF1 and ubiquitinated proteins.

Conclusions:

Collectively, Atrophy-related MuRF1 molecular might as an essential molecular mechanism modulated testosterone-induced the left ventricular hypertrophy of female ovariectomized SHR in AMPK- FOXO1-dependent signalling pathway manner.
PREGNANCY-RELATED SPONTANEOUS CORONARY ARTERY DISSECTION: CLINICAL PROFILE, PREGNANCY COMPLICATIONS AND OUTCOMES- SCAD-POL REGISTRY ANALYSIS
Authors: Zalewska Joanna , Michalowska Ilona , Gamski Maciej , Gziut-rudkowska Aneta , Wolny Rafal , Prejbisz Aleksander , Kadziela Jakub Jan , Januszewicz Andrzej , Witkowski Adam , Kadziela Jacek
Published: May 2024

Objective:

Pregnancy associated spontaneous coronary artery dissection (P-SCAD) remains poorly characterized cause of acute coronary syndrome during pregnancy and in postpartum period. The aim of the study was to assess clinical presentation, comorbidities and the outcomes of P-SCAD as compared with spontaneous coronary artery dissection not associated with pregnancy (SCAD).

Design and method:

The study group consisted of 83 women (aged 44.8 ± 9.7y, 36% with hypertension) with a history of at least one pregnancy, including 11 P-SCAD and 72 SCAD cases registered in SCAD-POL Registry. All medical information and angiography images were reviewed. Patients underwent echocardiography for left ventricle ejection fraction (LVEF) assessment and head-to pelvis computed tomography angiography for fibromuscular dysplasia (FMD) screening.

Results:

P-SCAD occurred between 2 and 32 weeks after delivery. Women with P-SCAD were younger (33.1 ± 4.9 vs 46.4 ± 9.1y, p<0.001), were characterized by higher number of pregnancies (3.6 ± 1.2 vs 2.5 ± 1.1, p<0.01) and more often experienced at least 1 miscarriage (63.5% vs 27.8%, p<0.05). The course of pregnancies in the P-SCAD group was more frequently complicated with hypertension (45.5% vs 6,9% p<0.005) and pre-eclampsia (27.3 vs 1.4% p<0.01), non-significantly with diabetes (27.3 vs 6.9%, p=0.07). All P-SCAD patients had at least one pregnancy terminated by caesarean section as compared to 35.8% in SCAD group (p<0.0001).

The prevalence of ST-segment elevation at presentation was comparable between P-SCAD and SCAD patients (43.1% vs. 63.6%, p=ns). However P-SCAD patients more often required coronary bypass grafting (18.2% vs 1.6%, p <0.05). At discharge, left ventricle dysfunction (EF<50%) was observed in 50% of P-SCAD and 29% of SCAD subjects (p=ns). The frequency of FMD was non-significantly higher in P-SCAD subjects (45.5% vs 29.5%). Recurrent SCAD occurred in 2 P-SCAD (18.2%) and 2 SCAD (3.4%) patients.

Conclusions:

P-SCAD patients required more frequently surgical treatment than women with SCAD. Pregnancies in patients with P-SCAD were more often complicated by hypertension, eclampsia and miscarriage, that potentially could have impact on P-SCAD occurrence. Further studies are warranted to explore the results of this hypothesis-generating analysis.
SEVERITY OF EMOTIONAL DISTRESS AND POST-TRAUMATIC STRESS DISORDER AMONG HYPERTENSIVE AND NORMOTENSIVE UKRAINIAN REFUGEE WOMEN IN DIFFERENT LIVING CONDITIONS
Authors: Shalimova Anna , Stoenoiu Maria S. , Cubala Wieslaw J. , Burnier Michel , Persu Alexandre , Narkiewicz Krzysztof
Published: May 2024

Objective:

The ongoing conflict in Ukraine has led to the exposure of a substantial number of residents to traumatic events and significant stress. A considerable portion of the Ukrainian population, particularly women and children, has sought refuge outside the country to evade the war's impact. Among the Ukrainian refugees in Poland, varying living conditions prevail, potentially influencing the intensity of their stress levels. This study aims to investigate the potential association between living conditions (within or outside dormitories) and the severity of emotional distress and post-traumatic stress disorders (PTSD) in Ukrainian women seeking asylum in Poland.

Design and method:

The study included 98 refugee women living in dormitories and 52 refugees renting apartments in Sopot, Poland. Relevant demographic and clinical data were obtained. Blood pressure (BP) was measured using validated oscillometric devices. Furthermore, subjects filled validated questionnaires for depression, stress and anxiety (DASS) and PTSD (PCL-5). Subjects with and without hypertension were compared for both general and psychological characteristics.

Results:

There were no significant differences in BP levels and the percentage of normotensive and hypertensive patients between two groups. Nevertheless, compared to subjects living in dormitories, refugees leasing apartments exhibited significantly higher DASS scores (30.6±15.7 vs. 19.9±13.4, p<0.0001). This group also included a higher proportion of women with moderate to severe scores for depression (65 vs 32%, p<0.0001), anxiety (83 vs 53%, p<0.001), and stress (69 vs 40%, p<0.0001). Furthermore, refugees renting apartments scored higher for PTSD score (33.5±14.7 vs 21.6±14.1, p<0.0001) particularly regarding intrusion (cluster B, p=0.002), negative alteration in cognition (cluster D, p=0.01) and hyper-arousal (cluster E, p=0.0001) dimensions, and a higher proportion met the criteria of PTSD (60 vs 27%, p<0.0001).

Conclusions:

Refugees residing in leased apartments exhibited comparable rates of hypertension but demonstrated heightened emotional distress and PTSD compared to their counterparts in dormitories. These differences may reflect the positive impact of social support and cohabitation with individuals who share similar traumatic experiences. Further investigations will include in-depth cardiovascular assessment, 24-hour ambulatory BP measurement, reassessment of stress/PTSD questionnaires, and psychiatric consultation.
ESTROGEN DEFICIENCY AGGRAVATES LEFT VENTRICULAR DIASTOLIC DYSFUNCTION AND MITOCHONDRIAL DYSFUNCTION IN IN HEART FAILURE WITH PRESERVED EJECTION FRACTION MICE
Authors: Qi Miaomiao , Wang Qiongying , Yu Jing
Published: May 2024

Objective:

Postmenopausal estrogen deficiency is associated with an increased cardiovascular risk, hypertension, and heart failure. Mitochondrial dysfunction plays a key role in pathology of heart failure with preserved ejection fraction (HFpEF). We aimed to investigate the effect and mechanism of estrogen deficiency on left ventricular diastolic dysfunction and mitochondrial dysfunction in HFpEF mice.

Design and method:

Eighteen 6-week-old female C57BL/6J mice were randomly divided into normal control group, sham HFpEF group and ovariectomized (OVX) HFpEF group. Mice were fed high-fat diet (HFD) and L-NAME (0.5g/L in drinking water) for 10 weeks to establish a “two-hit” mouse model of HFpEF, showing risk factors such as hypertension, obesity, metabolic dysfunction, and so on. Body weight and blood pressure were measured weekly. Left ventricular (LV) structure and function was monitored by echocardiography. At the end of experiment, animals were starved and histological measures of chamber morphometry and collagen density evaluated. Oxidative stress, mitochondrial function and mitophagy activity were evaluated by western blotting. Statistical analysis was conducted by software SPSS 22.

Results:

Compared with normal group, all HFpEF animals increased body weight and blood pressure (P<0.05). Echocardiographic evaluation revealed persistent preservation of the left ventricular ejection fraction (LVEF) in all HFpEF mice. HFpEF mice exhibited a robust increase in lung weight and indicative of pulmonary congestion. Additionally, cardiac hypertrophy, cardiomyocyte hypertrophy as well as cardiac fibrosis were observed in mice with HFpEF. Compared with sham group, body weight, lung wet weight and cardiac mass significantly increased in OVX group. Mice in OVX group had lower E/A, prolonged IVRT than sham group. Cardiomyocyte hypertrophy and myocardial fiber arrangement were increased, but there were no significant differences in systolic blood pressure, diastolic blood pressure, EF and FS% between the two groups. The expression of ACE-SOD2, NOX4 and Drp1 was significantly higher than that in the sham group, while the expression of Mfn2 protein decreased. Mitophagy-related proteins including LC3, P62, PINK1 and Parkin proteins significantly increased in the OVX group.

Conclusions:

Our findings indicated that estrogen deficiency may aggravate left ventricular diastolic dysfunction and mitochondrial dysfunction in HFpEF mice by activating mitophagy.
LEGACY OF ARTERIAL HYPERTENSION OF BLACK WOMEN WITH A PAST HISTORY OF PREECLAMPSIA
Authors: Ouankou Christian Ngongang , Mfeukeu-kuate Liliane , Njonnou Sylvain Raoul Simeni , Choukem Simeon Pierre
Published: May 2024

Objective:

Preeclampsia increases the longterm risk of cardiovascular disease. Some of the women affected by this condition remain hypertensive after delivery. This study aimed to determine the prevalence of hypertension using ambulatory BP monitoring (ABPM) and office measurements.

Design and method:

We conducted a cross- sectional study which included women who delivered between January 2015 and June 2021 and were diagnosed and followed up for preeclampsia in three major obstetrical and gynaecologic units in Yaounde. We excluded from the study all women who had a history of chronic hypertension or a known Cardiopathy. Sociodemographic data and past history were recorded, a physical exam,ecg, an ultrasound and ABPM was performed to all participants.

Results:

101 participants were included. The mean age was 30.56 years. 40.6% of women had hypertension (sustained hypertension, with sometime masked hypertension) with ABPM. Sustained hypertension was most common (26.7%), followed by masked hypertension (11.9%) and white-coat hypertension (2%). With office BP measurement, only 28.7% of women would have been diagnosed hypertensive. 29.8% of women had a disadvantageous dipping pattern. Among those that develop chronic hypertension, 18.8% had LVH at electrocardiography, 7.9% had both LVH and an abnormal left ventricular geometry on ultrasound while in normotensive women 1.9% had LVH at Ecg with 1% having both LVH and abnormal geometry at ultrasound. 20.8% of these women were obese during the follow up compared to 11.9% in the normotensive group. We had 26 patients (25,74%) with severe office hypertension and 32,3% were obeses. The fundus was normal in the majority of cases and we had no signs of neurological deficits or impaired cognition. Renal function was always normal or subnormal. Finally, we had two cases of heart failure.

Conclusions:

Many women affected by preeclampsia remain hypertensive after delivery. Masked hypertension and white-coat hypertension are risk factors for future cardiovascular disease and can only be diagnosed with ABPM. It is important to provide adequate follow-up for these women in order to intervene on the factors leading to this outcome.
ROLE OF THR174MET POLYMORPHISM IN THE AGT GENE IN THE DEVELOPMENT OF PREECLAMPSIA
Authors: Kurbanov Bakhodir , Navruzova Rano , Kurbanov Djakhangir , Djamilova Khilola
Published: May 2024

Objective:

The causes of preeclampsia are multifactorial, complex and not fully understood. Many scientists believe that the main reason for the development of preeclampsia is profound pathological changes in the vascular system and internal organs of a pregnant woman. The purpose of the study was to investigate the role of the Thr174Met polymorphism in the AGT gene in the development of preeclampsia.

Design and method:

The main group included 65 pregnant women with severe preeclampsia, the control group included 60 apparently healthy pregnant women. The age of the women examined ranged from 19 to 41 years.

The material for the study was DNA samples from patients. Isolation of DNA from blood and PCR analysis were carried out using sets of reagents and test systems from Amply Prime Ribo-prep.

Results:

A study of the genotypes of the Thr174Met polymorphism in the AGT gene demonstrated that the Thr/Thr genotype, as well as the Thr allele, was insignificantly less likely to be identified among patients with severe preeclampsia (x2=1.92; p=0.17; RR=1.19; 95%CI:0.73-1.94; OR=1.69; 95%CI:0.80-3.56).

The Thr/Met genotype, on the contrary, statistically significantly prevailed among this category of patients with severe preeclampsia (x2=1.48; p=0.23; RR=0.72; 95%CI:0.72; OR=0.62; 95%CI:0.29-1.34)

The Met/Met genotype also statistically prevailed in severe preeclampsia, relative to patients in the control group (x2=0.29; p=0.61; RR=0.62; 95%CI:0.15-2.56; OR=0.61; 95%CI:0.1-3.71). The heterozygous

An increase in the number of unfavorable Thr/Met and Met/Met genotypes of this locus is associated exclusively with an increase in the risk of developing severe preeclampsia.

The results of the study indirectly indicate the disregulatory effect of unfavorable genotypic variants of this polymorphism on the expression of angiotensinogen which is an important confirmation of the importance of genetic factors to the formation of arterial hypertension and the development of preeclampsia.

Conclusions:

According to the odds ratio, functionally unfavorable genotypes can increase this form of pathology up to 5 times. These data allow us to conclude that the Thr174Met polymorphism of the AGT gene makes a certain contribution to the formation of the genetic structure of predisposition to the development and severity of preeclampsia.
CONTRACEPTION IN WOMEN WITH CARDIOVASCULAR RISK; UNIVERSITY HOSPITAL CENTER OF TLEMCEN, ALGERIA
Authors: Abdrebbi Samira Benbekhti
Published: May 2024

Objective:

Study the vascular risk in women using oral hormonal contraception.

Design and method:

Descriptive study, interested in studying the blood pressures of women using contraception compared to women not using it. The data were entered and analyzed by Epi-info 6 software.

Results:

In total, 122 women were included in our study, 36 of whom were aged between 21 and 55 years, or 29.5% of cases. Women aged over 60 represented 73.7% of cases; 54.1% were married. There were 98 women users of oral contraception (OC), all ages combined, or 80.3%, compared to 25 women who did not use OC, or 20.5%. The prevalence of hypertension was 74.2% among female OC users; and 68% among women who do not use CO. Epidemiological profile and associated risk factors of hypertensive women using oral contraception: In number of 72. Women aged under 50 represented 23.6% and those aged over 60: 76.4%. A low socioeconomic level was noted for 72.2% and medium for 23.6%. Low educational level: 45.8%, Women who did not have a profession represented 70%. Married women represented 60% of cases and widows 38.9% with an average number of children of five. The average duration of hypertension was 12.15 ± 7.75 years, with a length of service ranging from one year to 40 years. The average duration of contraception was 24 ±7.6 years. Associated risk factors: diabetes 44.4%, hypercholesterolemia: 18.1%, migraine 14%, obesity: 12.5% and tobacco 4.2%.

Conclusions:

Many epidemiological data has investigated the link between oral contraceptive use and elevated blood pressure. In our study, hypertensive women who used oral contraception had significant risk factors; long-standing high blood pressure with an average of more than ten years and taking oral contraception for a long time with an average of more than twenty years. A woman with high blood pressure will be more limited than other women in her choice of contraceptive method.
Comprehensive Noninvasive Fetal Screening by Deep Trio-Exome Sequencing
Authors: Miceikaitė Ieva , Hao Qin , Brasch-Andersen Charlotte , Fagerberg Christina R. , Torring Pernille M. , Kristiansen Britta S. , Ousager Lilian B. , Sperling Lene , Ibsen Mette H. , Löser Katrin , Larsen Martin J.
Published: May 2024

(Abstracted from N Engl J Med 2023;388:1559–1571

Genetic testing has become an integral part of prenatal care, with many recent advances in clinicians’ ability to detect genetic disorders. Advancements in trio-exome sequencing in particular have shown diagnostic utility.
ARTIFICIAL INTELLIGENCE-ENHANCED ANALYSIS OF RETINAL VASCULATURE IN AGE-RELATED MACULAR DEGENERATION
Authors: Huang Ryan S. , Mihalache Andrew , Popovic Marko M. , Munn Colyn , Melo Isabela Martins , Pecaku Aurora , Friedman Alon , Wong David T. , Muni Rajeev H.
Published: May 2024

Purpose:

To investigate associations between quantitative vascular measurements derived from intravenous fluorescein angiography (IVFA) and baseline characteristics on optical coherence tomography (OCT) in neovascular age-related macular degeneration (nAMD) patients.

Methods:

The authors prospectively recruited patients with active choroidal neovascularization secondary to AMD over 50 years old, presenting to a single center in Toronto, Canada from 2017 to 2023. Ultra-widefield IVFA images were processed using the artificial intelligence RETICAD FAassist system to extract quantitative information on blood flow, perfusion, and blood–retinal–barrier (BRB) permeability. Associations between IVFA parameters with functional and anatomical outcomes were examined using univariable and multivariable regression models.

Results:

Eighty-one nAMD eyes and seven healthy control eyes were included. Compared with healthy controls, BRB permeability in the central and peripheral retina was significantly higher in nAMD patients (P < 0.001). On univariable analysis, BRB permeability measured centrally was significantly associated with central macular thickness (P = 0.035), whereas perfusion and blood flow measured centrally were significantly associated with macular volume (P = 0.043 and 0.037, respectively). On multivariable analysis, BRB permeability remained significantly associated with central macular thickness (P = 0.026).

Conclusion:

Central BRB permeability measured on IVFA was significantly associated with baseline central macular thickness in nAMD patients. Future work should longitudinally explore associations between IVFA parameters and clinical characteristics in diverse nAMD populations.
Implications of intraocular ossification after repeated vitrectomies: exploring a novel surgical intervention.
Authors: Hershko Sarah , Van den Heurck Jonas , Neetens Ingrid , Claes Carl
Published: May 2024

Purpose:

To describe the management of a case of retinal detachment combined with extensive intraocular ossification (IOO) using an innovative surgical technique of repair.

Methods:

Surgical procedures involved open sky approach and the use of a bone punch instrument for the removal of the ossified structures.

Results:

The applied surgical techniques effectively removed the ossified material, contributing to retinal reattachment and preservation of functional vision. Particularly challenging was the rapid rebleeding and re-ossification observed after the removal of intraocular ossification, a phenomenon not yet described in the existing literature. This necessitated an additional vitrectomy using a similar approach.

Conclusion:

This paper highlights the challenges associated with IOO and the innovative surgical approach used for its management. The utilization of a bone punch instrument, although effective, necessitates caution due to its non-standard application in intraocular surgery. Further investigation and clinical experience are essential to refine the methodology and evaluate long-term outcomes in IOO management.
Transcutaneous electrical acupoint stimulation reduces postoperative patients’ length of stay and hospitalization costs: a systematic review and meta-analysis
Authors: Liu Yilong , Fan Jiefu , Zhang Xiaoqing , Xu Wenping , Shi Zhiwen , Cai Jiarong , Wang Peiqin
Published: May 2024

Objective:

To study the effects of transcutaneous electrical acupoint stimulation (TEAS) on length of stay (LOS) and hospitalization costs in postoperative inpatients.

Methods:

Two researchers collectively searched PubMed, Embase, Cochrane Library, China Network Knowledge Infrastructure, and Wanfang Database. The search time was set from the beginning to 25 April 2023, to identify randomized controlled trials articles that met the criteria. Statistical analyses were performed using the Stata software (version 16.0). The risk of bias was assessed using the Cochrane risk-of-bias tool, and publication bias was evaluated using a funnel plot and Egger’s test. The quality of evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results:

Thirty-four randomized controlled trials were included. The main results showed that TEAS reduced hospitalization costs [standardized mean difference (SMD)=−1.92; 95% CI: −3.40, −0.43), LOS (SMD=−1.00; 95% CI: −1.30, −0.70) and postoperative LOS (SMD=−0.70; 95% CI: −0.91, −0.49] in postoperative patients. Subgroup analyses further revealed that TEAS was effective in reducing both the overall and postoperative LOS in patients undergoing multiple surgical procedures. It is worth noting that the observed heterogeneity in the results may be attributed to variations in surgical procedures, stimulation frequencies, and stimulation points utilized in different trials.

Conclusions:

TEAS can help postoperative patients reduce their LOS and hospitalization cost. However, considering the bias identified and heterogeneity, the results of this review should be interpreted with caution.
Comparison of drug-eluting bead with conventional transcatheter arterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a randomized clinical trial
Authors: Zhou Tan-Yang , Tao Guo-Fang , Zhou Guan-Hui , Zhang Yue-Lin , Zhu Tong-Yin , Chen Sheng-Qun , Wang Hong-Liang , Wang Bao-Quan , Jing Li , Chen Feng
Published: May 2024

Background:

Drug-eluting bead transarterial chemoembolization (DEB-TACE) has shown efficacy for treating hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). However, whether DEB-TACE is superior to conventional TACE (cTACE) remains unclear.

Objective:

This randomized controlled trial aimed to compare the efficacy and safety of DEB-TACE versus cTACE in treating HCC with PVTT.

Methods:

The study was conducted at a tertiary care center in Southeast China. HCC patients with PVTT were randomized at a 1:1 ratio into the DEB-TACE or cTACE groups. The primary endpoint was progression-free survival (PFS), and the secondary endpoints were overall survival (OS) and the incidence of adverse events (AEs). An independent review committee assessed the radiologic response according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST). AEs were assessed by the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Systemic therapies were not restricted.

Results:

Between September 2018 and July 2020, 163 patients were randomized to undergo DEB-TACE (n=82) or cTACE (n=81). Nine patients were excluded, and 154 patients were included in the final analysis; the median age was 55 years (range, 24–78 years), and 140 (90.9%) were male. The median PFS in the DEB-TACE group was 6.0 months (95% CI, 5.0–10.0) versus 4.0 months (95% CI, 3.0–5.0) in the cTACE group (hazard ratio, 0.63; 95% CI, 0.42–0.95; P=0.027). The DEB-TACE group showed a higher response rate [51 (66.2%) vs. 36 (46.8%); P=0.0015] and a longer median OS [12.0 months (95% CI, 9.0–16.0) vs. 8.0 months (95% CI, 7.0–11.0), P=0.039] than the cTACE group. Multivariate analysis showed that the treatment group, ALBI score, distant metastasis and additional TKIs were the four independent prognostic factors correlated with PFS. In addition, the treatment group, PVTT group and combination with surgery were independently associated with OS. AEs were similar in the two groups, and postembolization syndrome was the most frequent AE.

Conclusion:

DEB-TACE is superior to cTACE in treating HCC patients with PVTT, demonstrating improved PFS and OS with an acceptable safety profile, and may thus emerge as a promising treatment strategy for HCC patients with PVTT.

Trial registration:

Chinese Clinical Trial Registry ChiCTR1800018035.
Call for Action to Target Interhospital Variation in Cardiovascular Mortality, Readmissions, and Length-of-Stay
Authors: Van Wilder Astrid , Bruyneel Luk , Cox Bianca , Claessens Fien , De Ridder Dirk , Janssens Stefan , Vanhaecht Kris
Published: May 2024

Background:

Excessive interhospital variation threatens healthcare quality. Data on variation in patient outcomes across the whole cardiovascular spectrum are lacking. We aimed to examine interhospital variability for 28 cardiovascular All Patient Refined-Diagnosis-related Groups (APR-DRGs).

Methods:

We studied 103,299 cardiovascular admissions in 99 (98%) Belgian acute-care hospitals between 2012 and 2018. Using generalized linear mixed models, we estimated hospital-specific and APR-DRG-specific risk-standardized rates for in-hospital mortality, 30-day readmissions, and length-of-stay above the APR-DRG-specific 90th percentile. Interhospital variation was assessed based on estimated variance components and time trends between the 2012–2014 and 2016–2018 periods were examined.

Results:

There was strong evidence of interhospital variation, with statistically significant variation across the 3 outcomes for 5 APR-DRGs after accounting for patient and hospital factors: percutaneous cardiovascular procedures with acute myocardial infarction, heart failure, hypertension, angina pectoris, and arrhythmia. Medical diagnoses, with in particular hypertension, heart failure, angina pectoris, and cardiac arrest, showed strongest variability, with hypertension displaying the largest median odds ratio for mortality (2.51). Overall, hospitals performing at the upper-quartile level should achieve improvements to the median level, and an annual 633 deaths, 322 readmissions, and 1578 extended hospital stays could potentially be avoided.

Conclusions:

Analysis of interhospital variation highlights important outcome differences that are not explained by known patient or hospital characteristics. Targeting variation is therefore a promising strategy to improve cardiovascular care. Considering their treatment in multidisciplinary teams, policy makers, and managers should prioritize heart failure, hypertension, cardiac arrest, and angina pectoris improvements by targeting guideline implementation outside the cardiology department.
A Novel NUTM1-NSMCE2 Fusion Gene in a Pediatric Chest NUT Carcinoma
Authors: De Leonardis Francesco , Greco Miani Vittorio , Vallese Silvia , Barresi Sabina , Marulli Giuseppe , Novielli Chiara , Dall’Igna Patrizia , Maruccia Michele , Santoro Nicola
Published: May 2024

Nuclear protein of the testis carcinoma is an exceedingly rare and poorly differentiated carcinoma characterized by BDR4::NUTM1 gene translocation. Typically, the tumor affects young adults, and no standardized recommendations for therapeutic management have been available since 2022; the clinical course remains mostly dismal. We report the successful multimodal treatment of a 13-year-old boy affected by a primary chest NUT-carcinoma with a novel NUTM1 rearrangement that remains in complete continuous remission at 30 months from diagnosis.