bluuebunny/crossref_metadata_2025 huggingface dataset:
CARDIOVASCULAR RISK FACTOR TRAJECTORIES AND INCIDENT CARDIOVASCULAR DISEASE IN OLDER ADULTS: THE KAILUAN STUDY
Authors: Chen Chaolei , Huang Yuqing , Wu Shouling , Feng Yingqing
Published: May 2024

Objective:

Long-term condition and longitudinal accumulation of cardiovascular risk factor (CRF) may be associated with adverse outcomes in the elderly, but the previous evidence is scarce. We studied the associations of CRF trajectories, their accumulation, with incident cardiovascular disease (CVD) in older adults.

Design and method:

From 2006, a population-based cohort of 8505 older adults have been repeatedly followed up for 14 years (until 31 December 2020). Blood pressure, serum lipids, height and weight, and blood glucose were assessed in all follow-ups and their trajectories from 2006 to 2010 were identified using latent class growth mixture modeling. Main outcome was incident CVD, which was a composite of coronary revascularization, myocardial infarction, heart failure, or stroke. The associations of CRF trajectories and incident CVD were studied for individual CRF trajectory and their accumulation, using Cox proportional hazards regression models.

Results:

We identified 3, 4, 2, 2 trajectories for systolic blood pressure (SBP), body mass index (BMI), total cholesterol (TC), and fasting blood glucose (FBG), respectively. Compared with low-increasing SBP, the multivariable-adjusted hazard ratio (HR) and 95% CI were 1.35 (1.19-1.54) for moderate-increasing SBP and 1.54 (1.28-1.86) for high-increasing SBP. Compared with low-stable BMI, the HRs (95% CIs) were 1.30 (1.11-1.53), 1.41 (1.19-1.66), 1.35 (1.07-1.71) for moderate-stable, elevated-stable, and high-stable BMI, respectively. Compared with low-stable TC, the HR (95% CI) were 1.19 (1.06-1.33) for high-stable TC. Compared with low-stable FBG, the HR (95% CI) were 1.38 (1.17-1.63) for high-stable FBG. A positive association was observed for the CRF trajectory accumulation with incident CVD (P for trend < 0.001), with HRs (95% CIs) of 1.54 (1.16-2.04), 2.15 (1.63-2.83), 2.58 (1.93-3.45) and 2.92 (1.95-4.36) for 1, 2, 3, 4 high CRF trajectories, respectively. Sensitivity analyses showed consistent results after excluding those who ever used antihypertensive, antidiabetic, or lipid-lowering drugs during 2006 to 2010, excluding events within the first year of follow-up, and considering death as competing risk.

Conclusions:

Longitudinal higher CRF trajectory was independently associated with higher CVD risk in older adults. Besides, the higher the number of adverse CRF trajectories, the higher was the observed CVD risk.
HDL CHOLESTEROL AND CARDIOVASCULAR EVENTS ON HYPERTENSIVE PATIENTS
Authors: Leão António , Abecassis Francisca , Beirão Pedro , Broa Ana Luísa , Cunha Vitória
Published: May 2024

Objective:

Evaluate cardiovascular events on hypertensive patients and their HDL-cholesterol levels

Design and method:

Retrospective single-center study including first visits of adult patients in a hypertension clinic of a tertiary hospital during 2015 and their follow-up until 2020.

Patients without follow-up and/or information about HDL cholesterol levels were excluded.

Information on demographics, comorbidities, blood pressure control (<140/90mmHg), number of drugs, and cardiovascular events were analyzed.

Subjects were divided in 3 groups: Group 1 - HDL <40mg/dL; Group 2- 40-80 mg/dL and Group 3 - >80mg/dL.

Results:

Of the 104 initial participants we included 71, 43 female (60.6%) with mean age 55.9 years (18-87), which were monitorized on average for 42.5 months (3-60).

Patients were taking on average 2.67 different anti-hypertensive drugs and, by the end of follow-up, 53 (74.6%) had controlled blood pressure.

The sample included 26 (36.6%) smokers, 18 (25.3%) patients with diabetes, 9 (12.7%) with obstructive sleep apnea SAOS, 6 (8.5%) with chronic kidney disease and there were 30 (42.3%) patients with BMI > 30

HDL cholesterol mean levels were 50.98 mg/dL (24-95). Group 1 included 19 (26.8%) patients, of these 15 (78.9%) had controlled blood pressure, and 3 presented cardiovascular events during the follow-up (2 acute myocardial infarction and 1 cerebrovascular event). Within group 2 there were 47 (66.2%) patients, 36 (76.6%) with controlled blood pressure and 2 cardiovascular events occurred (acute myocardial infarction). There were no cardiovascular events on group 3, which included 5 (7%) patients, 2 of those with controlled blood pressure.

Conclusions:

Some studies established a U shaped risk of cardiovascular events on the lower and higher end of HDL cholesterol. The first relation is well established, however the optimal higher level of HDL cholesterol is not defined.

On our study the majority of patients presented controlled blood pressure and HDL-C within target levels.

There was a small number of patients with HDL cholesterol >80mg/dL and no events occurred, which is a limitation to make any conclusions. On the other hand we verified that the patients with low levels of HDL cholesterol had more events.
THE METABOLIC SCORE FOR INSULIN RESISTANCE (METS-IR) PREDICTS CARDIOVASCULAR DISEASE AND ITS SUBTYPES IN PATIENTS WITH HYPERTENSION AND OBSTRUCTVE SLEEP APNEA
Authors: Yang Wenbo , Cai Xintian , Hu Junli , Wen Wen , Heizhati Mulalibieke , Yao Xiaoguang , Yao Ling , Zhu Qing , Hong Jing , Luo Qin , Liu Shasha , Li Nanfang
Published: May 2024

Objective:

We aimed to evaluate the METS-IR (metabolic score for insulin resistance) index for the prediction of incident cardiovascular disease (CVD) and its subtypes (coronary artery disease and stroke) in patients with hypertension and obstructive sleep apnea (OSA).

Design and method:

A retrospective cohort study was conducted with 2031 adults with hypertension and OSA, participants from the Urumqi Research on Sleep Apnea and Hypertension study (UROSAH). The hazard ratios and 95% CIs (credibility interval) for CVD and its subtypes were estimated using multivariate Cox proportional hazards regression models.

Results:

After a median follow-up of 6.80 years (interquartile range: 5.90–8.00 years), a total of 317 (15.61%) participants developed new-onset CVD, including 198 (9.75%) incident coronary heart disease (CHD) and 119 (5.86%) incident stroke. After adjusting for as many relevant confounding factors as possible, each SD increase in METS-IR was associated with a 30% increased risk of new onset overall CVD events, a 32% increased risk of new onset CHD, and a 27% increased risk of new onset stroke. When METS-IR was assessed as tertiles, after adjustment for fully confounding factors, the highest tertiles versus the lowest tertiles were associated with a greater hazard of CVD (HR 2.05; 95% CI 1.52,-2.77), CHD (HR 1.96; 95% CI 1.35–2.84), and stroke (HR 2.24; 95% CI 1.35–3.72). The results of various subgroups and sensitivity analyses were similar. When METS-IR was added, CVD predictions were reclassified and identified more accurately than baseline models for the C-index, continuous net reclassification improvement, and integrated discrimination index. CHD and stroke showed similar results.

Conclusions:

METS-IR is a powerful predictor of CVD and its subtypes in patients with hypertension and OSA, which can facilitate the identification of high-risk individuals and provide individualized CVD prevention.
DIAGNOSTIC ACCURACY OF 24-HOUR URINARY ALDOSTERONE TO CREATININE RATIO AND 24-HOUR URINARY ALDOSTERONE FOR PRIMARY ALDOSTERONISM IN DIFFERENT AGE GROUP
Authors: Song Wei , Sun Kaiwen , Gong Minghui , Yang Minghui , Zhang Ying , Jiang Yinong
Published: May 2024

Objective:

The aim of this study was to explore and evaluate the diagnostic accuracy of 24-hour urinary aldosterone to creatinine ratio (UACR) and 24-hour urinary aldosterone and in different age group.

Design and method:

There were 423 patients eligible and consecutively enrolled in this study. After 1:2 propensity score matching (PSM) analysis, 100 patients were in primary aldosterone (PA) group and 194 patients were in essential hypertension (EH) group. The information of clinical characteristic and biochemistry measurement were collected and analysis. Receiver operator characteristic curve (ROC) was introduced and calculated area under the curve (AUC) to explore the diagnostic accuracy and the optimal cut-off value.

Results:

There was no significant difference for the average age in PA group (53.38±11.31) and in EH group (52.77±11.25) (P>0.05). The 24-hour UACR and urinary aldosterone was higher in PA group (1.1 ug/(mmol/L) vs. 0.7 ug/(mmol/L), 6.4 ug/24h vs. 4.8 ug/24h, P<0.05) among all age group. The optimal cut-off value of 24-hour UACR was 1.2 ug/(mmol/L) with 0.702 for AUC and 0.300 for the Youden index, in contrast with 11.4 ug/24h, 0.652 and 0.257 for 24-hour UACR. For those 55 years old or below, it was the same for both the two index, while the optimal cut-off value was declined to 0.8 ug/(mmol/L) for 24-hour UACR and 2.7 ug/24h for 24-hour urinary aldosterone among those over 55 years old.

Conclusions:

24-hour UACR was a promising index and was better than 24-hour urinary aldosterone on PA diagnosing. More research is needed to explore the underlying influence factors.
DOES ENDOTHELIAL FUNCTION DIFFER AMONG SEXES IN PATIENTS WITH DIABETES OR KIDNEY DISEASE?
Authors: Renier Marie , Michielsen Matthijs , Vandecruys Marieke , Decorte Elise , Craenenbroeck Amaryllis H. Van , Cornelissen Véronique
Published: May 2024

Objective:

Endothelial dysfunction is a known driver of disease progression in both type 2 diabetes mellitus (T2DM) and kidney disease. Brachial artery flow-mediated dilation (FMD), representing endothelium-dependent nitric oxide-mediated dilation in response to increased shear stress, is considered gold standard to quantify macrovascular dysfunction non-invasively. As evidence is mounting that men are more likely to suffer from macrovascular dysfunction than women, we hypothesized that this would be reflected in patient populations with T2DM and/or kidney disease.

Design and method:

Preliminary baseline data was collected from 2 ongoing randomized controlled trials in patients with T2DM and in kidney transplant recipients (KTRs) 3 months post-transplantation. FMD was assessed with the semi-automated UNEX EF device under standardized conditions. Biochemical analyses were done using routine techniques. Images were manually analyzed by a single researcher (MR) using PCAnalysis software (version 1.0.14).

Results:

Twenty-five subjects, 13 with T2DM and 12 KTRs were included. As expected, patients with T2DM had a higher BMI, higher HbA1c but higher eGFR compared to KTRs (Table 1). Compared to KTRs, patients with T2DM presented with a significantly worse FMD (FMD= 4.50% [IQR=5.77]) vs 10.88% [6.48]). Overall, no significant difference in FMD between men and women was found (p=0.11), but higher values could be observed in females (FMD= 9.08% [IQR=6.97] vs 4.50% [7.88]). As depicted in Figure 2, this tendency was also observed in the 2 subgroups: KTRs (M: FMD = 9.07% [IQR=9.62] | F: 11.92% [5.16]) and T2DM (M: FMD = 3.90% [IQR=5.00%] | F: 7.09% [6.83]).

Conclusions:

Although no significant differences in vascular function between sexes were detected, our preliminary data showed a tendency for higher FMD-values in women; both in T2DM and KTRs. This supports the statement that male subjects seem to suffer more from macrovascular dysfunction. Further research is needed to elucidate the underlying pathways via which sex impacts the disease process in T2DM and kidney disease and to evaluate how personalized preventive lifestyle measures might differentially impact on outcome.
DIGITAL OPTICAL QUANTIFICATION OF EXTRAVASCULAR FLUID AND OEDEMA SEVERITY IN HYPERTENSION AND HEART FAILURE
Authors: Matskeplishvili Simon , Gurfinkel Yu , Sasonko M , Yakimov B , Dyachuk L , Usherzon M , Shirshin E
Published: May 2024

Objective:

Early diagnosis of fluid retention as a complication of arterial hypertension severity and prediction of acute decompensation is complicated due to the absence of specific symptoms and objective measurable criteria. Here we present a new non-invasive indicator of the hypertension severity based on the digital high-resolution soft tissue optical imaging in nail-fold capillaries.

Design and method:

One hundred and twenty-nine (129) adults with arterial hypertension were enrolled in the study, including 79 patients with NYHA I–III functional classes of heart failure, and 50 healthy subjects. Vital digital capillaroscopy (VDC) of the nail-fold was performed following a 12-hour overnight fasting in a temperature-controlled room. Nail-fold capillaries and pericapillary tissue were assessed using a ultra-high resolution digital capillaroscope equipped with a high-speed CCD-camera on fingers of the left hand gently fixed into the device. We measured the linear size (mm) of perivascular zone (PZ) around nail-fold capillaries. Additionally, double-photon digital tomography with Fluorescence Lifetime IMaging (FLIM) was used to investigate the molecular PZ composition.

Results:

We observed significant differences in the linear size of the PZ in patients with arterial hypertension complicated with heart failure and the control group. The absolute dimension of PZ outperformed standard echocardiographic parameters. Only in patients with arterial hypertension and moderate-severe heart failure there was an echocardiographic evidence of systolic LV dysfunction with reduced LVEF (42±12%). This was confirmed by the distribution of subjects in the control and study groups by the PZ size and bivariate density analysis. FLIM confirmed that the PZ size is mostly determined by accumulation of extravascular free water.

Conclusions:

This simple VDC measurement of the linear size of nail-fold perivascular zone has high sensitivity and specificity in identification pericapillary edema in hypertensive patients. The positive predictive value of this parameter exceeds that for all other non-invasive parameters, namely, LVEF. Dimension of the PZ is determined by amount of extravascular free water as confirmed by FLIM. This approach could be of interest for monitoring of hypertension treatment, providing important information of diuretic titration to prevent patient decompensation with very early diagnosis of the interstitial fluid retention.
PULSE PRESSURE DYNAMICS: UNRAVELING THE IMPACT ON TARGET ORGAN DAMAGE, INDEPENDENT OF MEAN ARTERIAL PRESSURE
Authors: Mahmud Azra , Khan Danyal , Iqbal Mohammad Naveed
Published: May 2024

Objective:

As individuals age, pulse pressure (PP) naturally increases due to arteriosclerosis and diffuse vascular stiffening. In the absence of an identifiable cause, a wide PP signals target organ damage (TOD) and adverse clinical outcomes. While hypertension is endemic in South Asia, there is paucity of data regarding determinants of PP and relationship with TOD in this region. We therefore aimed to explore the determinants of PP in an ambulatory patient population.

Design and method:

We analysed electronic medical records of subjects (n=8,362, 64% females 64%) attending a Medicine outpatient Department (OPD) at Shalamar Hospital, a tertiary care hospital, in Lahore, Pakistan during the period September 1st, 2021 to September 30th, 2023. Haemodynamic data included single measure of systolic and diastolic BP and heart rate. HTN was defined according to ESH and ACC guidelines. History of CVD included ishaemic heart disease and stroke. Relationshp between variables was analysed using univariate and multivariate analysis. Pp was analysed both as a continuous and categorical variable (>50, mm Hg).

Results:

Of the 8,362 subjects attending the OPD, 62% and 100% had a diagnosis of HTN as per ESH and ACC guidelines, respectively. PP>50, mm Hg was present in 56% and 45% of HTN as defined by ESH and ACC respectively. PP>50, mm Hg was associated with age (OR=2.7), female gender (OR=1.46), chronic kidney disease (CKD, OR= 3.6), CVD (OR=1.47) and diabetes mellitus (DM, OR=1.54). In a stepwise regression model, age, gender, heart rate, DM, CKD and CVD were associated with PP, independent of mean arterial pressure (R2=0.45, p<0.0001).

Conclusions:

To the best of our knowledge, this is the first large study, exploring the determinants of PP in Pakistan. While the study is retrospective, using single office BP measurements, it highlights the importance of PP as an independent predictor of TOD. Prospective studies are the need of the hour to elucidate the pathophysiology and outcome of high PP in this population.
ISOCITRATE DEHYDROGENASE 2 INHIBITION INDUCES ENDOTHELIAL SENESCENCE BY SUPPRESSION OF MITOPHAGY AND INCREASED ROS PRODUCTION
Authors: Kim Cuk Seong , Kim Minsoo , Vu Giang -Huong
Published: May 2024

Objective:

Endothelial senescence impairs vascular function and thus is a primary event of age-related vasculature diseases. Isocitrate dehydrogenase 2 (IDH2) plays an important role in inducing alpha-ketoglutarate (alpha-KG) production and preserving mitochondrial function. However, the mechanism and regulation of IDH2 in endothelial senescence have not been elucidated.

Design and method:

We confirmed vascular endothelial senescence using human umbilical vein endothelial cells(HUVECs) and IDH2 Knockout mouse.

Results:

We demonstrated that downregulation of IDH2 induced accumulation of miR-34b/c, which impaired mitophagy and elevated mitochondrial reactive oxygen species (ROS) levels by inhibiting mitophagy-related markers (PTEN-induced putative kinase 1 (PINK1), Parkin, LC-II/LC3-I, and p62) and attenuating Sirtuin deacetylation 3 (Sirt3) expression. The mitochondrial dysfunction induced by IDH2 deficiency disrupted cell homeostasis and the cell cycle and led to endothelial senescence. However, miR-34b/c inhibition or alpha-KG supplementation restored Sirt3, PINK1, Parkin, LC-II/LC3-I, p62, and mitochondrial ROS levels, subsequently alleviating endothelial senescence.

Conclusions:

This study demonstrates that IDH2 deficiency is critical for the suppression of alpha-KG levels, which induced endothelial senescence via miR-34b/c inhibition of mitophagy and mitochondrial ROS elevation in endothelial cells (Figure 7). Therefore, the IDH2/alpha-KG/miR-34b/c axis may provide a potential therapeutic target for age-related vascular diseases.
RELAXIN LIKE PEPTIDE B7-33 AND IT'S DERIVATIVES DEMONSTRATE EFFICACY IN RODENT MODELS OF PREECLAMPSIA
Authors: Uddin Mohammad Nasir , Amaral Lorena , Pantho Ahmed F , Afroze Syeda H , Kuehl Thomas J , Vora Niraj , Lindheim Steven R , Zawieja David C , Lamarca Babbette B
Published: May 2024

Objective:

Preeclampsia (PreE) is a hypertensive pregnancy disorder, which occurs in approximately 10% of all gestations. The literature suggests potential therapeutic role of H2 relaxin in PreE. A novel H2 relaxin B-chain-only peptide variant B7-33 has recently been developed.

This single-chain peptide displayed equivalent efficacy to the natural H2 relaxin in several functional assays both in vitro and in vivo. The Aim of this study is to evaluate whether B7-33 attenuates preE syndrome in rodent models of PreE.

Design and method:

Rat Model 1. The efficacy of B7-33 was evaluated in the Reduction of Uterine Perfusion Pressure (RUPP) model as described previously. RUPP rats are randomly assigned to 4 groups (N=8/group): 1) vehicle, 2) B733; 3) B733-Fc; and 4) B733-HSA. Rats are dosed twice weekly (i.v.) from GD10 to GD 20.

Rat Model 2. Timed-pregnant rats are used, and the model is conducted as previously described. DOCA and saline administration begin at approximately GD2. Three groups of animals are studied (n=8 per group). 1) normal pregnant rats; 2) pregnant animals injected (i.p.) initially with 12.5 mg of DOCA, followed by a weekly injection of 6.5 mg, and whose drinking water was replaced with 0.9% saline; 3) rats administered DOCA and saline as for Group 2, and given B733 35 ug i.p. biweekly from GD10-20. BP, proteinuria and inflammatory markers were evaluated. Statistical comparisons were performed using analysis of variance with Duncan's post hoc test.

Results:

RUPP rats have increased MAP, plasma TNF-alpha, and plasma sFlt-1 along with decreased NO index compared to normal pregnancy. Treatment with B733 and B7-33 fusion proteins lowers MAP, TNF-alpha, and sFlt-1 back to that of normal pregnancy. B7-33 data are consistent with earlier data with serelaxin in the RUPP model. All fusions tested ameliorate hypertension in the RUPP animals. B7-33 normalizes BP and proteinuria in the DOCA rat model of preE.

Conclusions:

Both B7-33 and B7-33 fusion proteins attenuate preE syndrome in RUPP and DOCA rat models of PreE. We conclude that B7-33 is an ideal candidate for development as a novel therapeutic in preE.
HIGH PULSE PRESSURE IS A POTENTIAL HEMODYNAMIC BIOMARKER IN HYPERTENSIVE DISORDERS IN PREGNANCY
Authors: Takács Johanna , Alasztics Bálint , Járai Dóra , Rigó János , Koller Akos
Published: May 2024

Objective:

Hypertensive disorders in pregnancy (HDP) represent a significant public health concern worldwide. In these disorders, high arterial systolic and diastolic pressures (sP and dP) have been well-appreciated, yet the pulse pressure (PP) values have received relatively less attention in the clinical practice and guidelines. We hypothesized that high PP correlates with proteinuria and intrauterine growth retardation (IUGR) and thus aimed to measure arterial blood pressure parameters, proteinuria and IUGR and investigate the relationship among them in women with HDP.

Design and method:

The data of 2132 women with HDP (age:33.05±5.24 years) were analyzed together with the blood pressure data (sP, dP and PP), proteinuria and IUGR, and correlations among them were calculated.

Results:

Three groups were formed: 1) elevated sP (n=148), 2) elevated dP (n=122), and 3) elevated sP+dP (n=1862). There was a very strong positive relationship between sP and PP (r(2130) = 0.788, p<0.001, R2=0.621), while there was no relationship between dP and PP. The relationship between sP and PP was very strong positive in the elevated sP group (r(146)=0.900, p<0.001, R2=0.810), moderate in the elevated dP group (r(120)=0.591, p<0.001, R2=0.349), and strong in the elevated sP+dP group (r(1860)=0.826, p<0.001, R2=0.682). The relationship between dP and PP was weak negative in the elevated sP group (r(146)=-0.378, p<0.001, R2=0.143), moderate in the elevated dP group (r(120)=-0.677, p<0.001, R2=0.458), and very weak positive in the elevated sP+dP group (r(1860)=0.088, p<0.001, R2=0.008). Proteinuria and IUGR occurred more frequently in the elevated sP+dP group (53.5% and 17.9%) than in the elevated sP (37.2% and 9.5%) and elevated dP (15.6% and 9%) groups.

Conclusions:

The present findings suggest that in HDP the increased PP provides the driving force for the increased cardiac output and that increases in PP are primarily due to increases in systolic blood pressure. Moreover, PP correlates with proteinuria and IUGR. These findings underline the importance of following not only systolic and diastolic but pulse pressure, as well, before, during and after pregnancy and if necessary, initiate the appropriate therapy to reduce the risk of fetal and maternal target organ damage caused by high blood pressure.
LONG-TERM CARDIOVASCULAR OUTCOMES AFTER A PREGNANCY COMPLICATED BY HYPERTENSIVE DISORDERS
Authors: Piani Federica , Bragagni Alessio , Baracchi Alessandro , Cromi Debora , Ruscelli Federico , Scarduelli Sara , Vincenzi Sofia , Agnoletti Davide , Esposti Daniela Degli , Borghi Claudio
Published: May 2024

Objective:

The maternal vasculature undergoes significant adaptations during pregnancy to meet the increased metabolic demands of the developing fetus. These adaptations include increased cardiac output and blood volume, as well as reduced systemic vascular resistance to support the fetoplacental unit. In Hypertensive disorders of pregnancy (HDP) there is an impaired cardiovascular adaptation to pregnancy with effects extending beyond the duration of the pregnancy. In the present study we aimed to characterize long-term cardiovascular status of women who suffered from HDP.

Design and method:

Fifty-eight women who attended at least one post-partum visit in our HDP Clinic (IRCCS Policlinico Sant’Orsola-Malpighi, Bologna, Italy) and a follow-up visit after at least 5 years from delivery were enrolled in the study. Exclusion criteria included multiple pregnancy, fetal genetic or congenital abnormalities, maternal history of organ transplantation or chronic kidney disease (CKD), and absence of a post-partum echocardiographic evaluation. In the follow-up visit participants underwent a complete cardiovascular assessment including echocardiography and multiparametric vascular function assessment.

Results:

Two major cardiovascular events occurred, one stroke and one myocardial infarction, both in women with index-pregnancy complicated by preeclampsia (PE). While not statistically significant, women with HDP-non-PE and PE displayed a trend towards an increased risk of developing composite cardiovascular outcome, and women with PE tended to experience it sooner (Figure 1). Nearly half of the women with a history of HDP, whether PE or HDP-non-PE, developed chronic hypertension. Some women also developed hyperuricemia, CKD, and type 2 diabetes at follow-up, most of them with a previous history of PE. Structural and functional cardiac changes were observed in a few cases, especially among women with PE, and vascular dysfunction was more common in women with a history of HDP compared to those with normotensive pregnancies (Figure 2).

Conclusions:

Results of the present study adds on literature on long-term cardiovascular impact of HDP and further emphasize the importance of a timely follow-up of women who suffered from HDP and particularly PE.
SFLT-1/PLGF RATIO AND HYPERTENSIVE STATES OF PREGNANCY IN REAL LIFE: ANALYSING RISK OF PREECLMAPSIA
Authors: Martínez-morales Eduardo , Rodriguez Claudia Martin , González Esther Rubio , Sánchez Paula López , Testillano Lucía Martín , Pujol Javier Relea , Garcia Irene Garcia , Sanchez Paola Carolina Villegas , García Maria Mercedes Pérez , Fernández Maria Isabel Galán , Arroyo Ana Maria Huerta , Briales Paula Sánchez , Vidas María Marques , Recio María De Valdenebro , Sánchez Ana Muñoz , Salazar Maria Luisa Serrano , Carratalá Rosario Llópez , Jarrín Felipe Zalamea , Sánchez Beatriz , Pérez Jose María Portolés
Published: May 2024

Objective:

To analyse the relationship between sFlt-1/PlGF ratio and the occurrence and severity of preeclampsia.

Design and method:

An observational, retrospective, cross-sectional study; collecting data of pregnant women who undergo sFlt-1/PlGF ratio determination between Jan-Sept 2022 in a tertiary hospital. We collected baseline characteristics, data related with the pregnancy, birth and development and severity of hypertensive disorders of pregnancy (HDP),as well as treatment at discharge.

Results:

Among 109 recruited patients, 5 were excluded due to loss of follow-up. We analysed 104 women (mean age of 33.9 years SD 5.0). 52.5% were primiparous, 10.6% had in vitro pregnancies and 4.8% had twins. Nearly all were non-diabetic (99%), with 11.5% developing gestational diabetes.7.7% had pre-pregnancy hypertension and 15.4% had prior HDP (68.8% of them were preeclampsia). 90.4% women breastfed. Other characteristics are specified in table 1.

During pregnancy, 64.4% developed HDP, being the mean week of diagnosis 35.8 (SD 4.1): 45.2% presented pre-eclampsia (PE) / eclampsia; 4.8% had chronic hypertension and 14.4% had gestational hypertension. Just 18.3% received acetylsalicylic acid as prophylaxis. At discharge, 38.5% continued with antihypertensive treatment.

The sFlt-1/PlGF median ratio was 43.7, (interquartile range [13.0-81.6]) and a 53.9% obtained a pathological value (>38). It correctly classified PE in 77.9% cases, with a 83.7% sensitivity and 72.7% specificity. Positive and negative predictive values were 73.2% and 83.3% respectively.

A pathological sFlt-1/PlGF ratio is associated with a higher risk of PE (OR 13.7 CI95% [13.2-35.8]), regardless use of acetylsalicylic acid. Besides, when stratified it into tertiles, those patients with a range 26-63 (second tertil) had an OR of 6.5 [1.9-22.4] while in the range >63 (third tertil)had an OR 45.0 [11.0-184.0] vs first tertil: therefore the higher the ratio, the higher the risk of PE.

Conclusions:

The sFlt-1/PlGF ratio is an important tool to predict preeclampsia. A pathological sFlt-1/PlGFratio increases this risk of PE more than 13 times compared with a normal value. Moreover, the risk of PE increases as the ratio increases.
AORTIC FUNCTION AND NTRATIVE STRESS IN A RAT MODEL OF POLYCYSTIC OVARY SYNDROME
Authors: Benko Rita , Pang Kaito Skyler Senuma , Korsós-novák Ágnes , Bányai Bálint , Szekeres Mária , Várbíró Szabolcs , Horváth Eszter M.
Published: May 2024

Objective:

Polycystic ovary syndrome (PCOS) represents the most prevalent endocrine disorder in women of fertile age; besides infertility, an elevated cardiovascular risk was described. Vitamin D hypovitaminosis affects about 80-90% of PCOS patients. Our team assessed aortic function and nitrative stress in a hyperandrogenic rat model and the effectiveness of Vitamin D substitution.

Design and method:

Female Wistar rats at the age of 3-4 weeks were randomly assigned into four groups. Eight rats received no treatment (controls, C), eight rats received weekly Vitamin D per os (140 IU/100 g body weight, group D), eight received cutaneous testosterone daily (3.3 mg/100 g, T) and eight received Vitamin D and testosterone (T+D). At the eighth week of the treatment, aortic rings were isolated for analysis: they were cut into 3-4 mm long segments for myography, other segments were formaldehyde fixed and paraffin embedded to assess, by immunohistochemical methods, nitrative stress markers (nitrotyrosine, NT) and DNA breaks signaled by nuclear poly(ADP-ribose) polymer (PAR) detection.

Results:

The weight gains of the two testosterone-treated groups were significantly higher between the 6-8 weeks compared to the other two groups, Vitamin D treatment did not influence body weight. Rats in the C and D groups had 3 or 4 estruses in the last 14 days. T rats had 1 or 2 estruses during the same period. T+D rats had 1-2 (N=3), or 3-4 (N=5) estruses.

Aortic contraction, induced by the alpha1-adrenergic agonist phenylephrine, was significantly elevated in T and T+D animals in comparison to controls and Vitamin D treated rats. The endothelium-mediated aortic relaxation, as a response to acetyl-choline and insulin, was unaltered; however, estrogen-induced relaxation was significantly impaired in T and T+D groups.

According to resorcin-fuchsin staining, no fibrotic alteration was detected. Nitrative stress and poly(ADP-ribosyl)ation were similar in all four groups.

Conclusions:

Eight weeks of testosterone administration caused increased weight gain and sex cycle lengthening. The latter was reversible by Vitamin D supplementation in 62.5% of the rats. Testosterone or Vitamin D did not alter vascular histology. Hyperandrogenism increased alpha1-adrenerg mediated vasoconstriction and compromised estrogen-mediated relaxation without altering nitrative stress.
ARTERIAL BLOOD PRESSURE PHENOTYPES DEFINED BY AMBULATORY BLOOD PRESSURE MONITORING IN PREGNANCY AND ITS PROGNOSTIC VALUE FOR FUTURE MATERNAL AND NEONATAL EVENTS
Authors: Aguiar Tiago , Cruz Inês , Costa Carlos , Carvalho Simão , Pacheco Adriana , Carvalho Diana , Barbosa Eliana , Bastos José
Published: May 2024

Objective:

We have previously demonstrated that some ambulatory blood pressure monitoring (ABPM) values can predict maternofoetal evens in hypertensive pregnant women. The analysis of the different blood pressure (BP) phenotypes in pregnant women is still an unknown topic.

Design and method:

A retrospective cohort study which followed a sequential number of 274 pregnant women referred to Cardiology/Hypertension consult (mean age of 32 years), from 2007 to 2022, who underwent ABPM made with a Spacelabs 90207. Data was collected and analysed in SPSS Statistics through different parametric tests. An event was defined as the composite endpoint of multiple adverse events: preeclampsia or eclampsia, foetal or neonatal death, prematurity, low weight at birth, gestational diabetes, and maternal death.

Results:

In a survival Kaplan-Meier curve of events, when we compared normal versus hypertensive groups, those with hypertension had worse survival with a log rank of 6.594 (p=0.010). In a further comparison, Kaplan-Meier analysis revealed a worse survival in the hypertensive without medication group, followed by the non-controlled hypertensive and controlled hypertensive groups, with a log rank of 11.737 (p=0.003). (Fig 1)

An independent-samples T test followed by a multi-variate analysis was performed, revealing significant differences between the hypertensive and non-hypertensive group for maternal age (p=0.034) and birth weight (p=0.023). In the multi-variate analysis, the hypertensive group was notably associated with a higher rate of caesarean delivery (70.2% versus 34.6%, p=0.007). Further analysis showed significant differences in birth weight between the controlled hypertensive group and the hypertensive without medication (p=0.001) and non-controlled hypertensive (p=0.002) groups.

Conclusions:

This study further corroborates the importance of ABPM in the diagnosis and follow-up of hypertensive pregnant women, having a major impact in both maternal and neonatal morbidity. Normotensive pregnant women had a better prognosis as compared to hypertensive pregnant women, defined by ABPM values. ABPM should be an essential tool to manage pregnant women.
EVALUATING THE PROGNOSTIC VALUE OF DIFFERENT BLOOD PRESSURE PHENOTYPES ON AMBULATORY BLOOD PRESSURE MONITORING IN WOMEN
Authors: Aguiar Tiago , Cruz Inês , Costa Carlos , Carvalho Simão , Pacheco Adriana , Barbosa Eline , Bastos José
Published: May 2024

Objective:

Ambulatory blood pressure monitoring (ABPM) is a highly valuable and well-validated tool in the diagnosis and treatment follow-up of hypertensive patients. It remains unclear whether the different blood pressure (BP) phenotypes have a different prognostic impact in women.

Design and method:

A retrospective cohort study which followed a sequential number of 947 patients who underwent ABPM. BP phenotypes were defined as: controlled hypertension (CH); resistant hypertension (RH); and white-coat uncontrolled hypertension (WCUH). A composite endpoint (CE) of all-cause mortality and hospitalization from cardiovascular causes was utilized.

Results:

The sample comprised of 50.8% women (n=486) and 48.2% men (n=461) (mean age of 59 years). The sampled included 129 (13.5%) cases of CH, 103 (10.7%) cases of RH, and 289 (30.1%) cases of WCUH.

A Kaplan-Meier survival curve analysis was performed, with women demonstrating a superior survival as compared to men, with a log rank of 31.7 (p<0.001). Women with WUCH and RH showed superior survival with a log rank of 11.5 and 15.2, respectively (p<0.001). (Fig 1)

In a multi-variate analysis, men showed a greater hazard ratio (HR) as compared to women in: 24h systolic BP (SBP) with a HR of 1.05 (p=0.08) versus 1.02 (p=0.43); 24h pulse pressure (PP) with a HR of 1.07 (p=0.05) versus 1.02 (p=0.34); night SBP with a HR of 1.04 (p=0.02) versus 1.03 (p=0.06); night PP with a HR of 1.10 (p<0.01) versus 1.04 (p=0.08); and SBP dipping with a HR of 0.93 (p=0.03) versus 0.95 (p=0.08). HR for RH women for night SBP, night DBP and SBP dipping were 1.06, 1.13 and 0.89, respectively (p<0.01).

Conclusions:

ABPM is an essential tool for the diagnosis and follow-up of different BP phenotypes. Women revealed a more favourable cardiovascular prognosis as compared to men, suggesting a lower dependence on blood pressure. In true RH women, nighttime variables showed a significant impact on cardiovascular events.
Long-Term Blood Pressure Control After Hypertensive Pregnancy Following Physician-Optimized Self-Management: The POP-HT Randomized Clinical Trial
Authors: Kitt Jamie , Fox Rachael , Frost Annabelle , Shanyinde Milensu , Tucker Katherine , Bateman Paul A. , Suriano Katie , Kenworthy Yvonne , McCourt Annabelle , Woodward William , Lapidaire Winok , Lacharie Miriam , Santos Mauro , Roman Cristian , Mackillop Lucy , Delles Christian , Thilaganathan Basky , Chappell Lucy C. , Lewandowski Adam J. , McManus Richard J. , Leeson Paul
Published: May 2024

(Abstracted from JAMA 2023;330:1991–1999

Worldwide, about 10% of pregnancies are affected by an abnormal rise in maternal blood pressure (BP). Individuals whose BP remains high 6 weeks after birth are more likely to have higher BP 5 to 10 years later.
Benzodiazepine Discharge Prescriptions From Emergency Departments Across the United States Between 2012 and 2019: A National Analysis
Authors: Ramdin Christine , Mina George , Nelson Lewis , Mazer-Amirshahi Maryann
Published: May 2024

Objectives

Benzodiazepines are commonly misused medications frequently implicated in overdose deaths. Data show that benzodiazepine prescribing is associated with increased misuse. We sought to determine national trends in benzodiazepine prescribing from the emergency department (ED).

Methods

This is a retrospective review of the National Hospital Ambulatory Medical Care Survey from 2012 to 2019. Our primary outcome was to evaluate trends in ED visits where a benzodiazepine was prescribed at discharge. Secondarily, we identified commonly prescribed benzodiazepines and assessed trends over time. We examined demographic data and used descriptive statistics and Spearman rho or Pearson correlation coefficient as applicable.

Results

Between 2012 and 2019, there were 13,848,578 visits where benzodiazepines were prescribed at ED discharge. In 2012 and 2019, there were 1,407,478 visits (1.1% of all ED visits) and 1,361,372 visits (0.9%), respectively, where benzodiazepines were prescribed (mean [SD], 1,731,072 [287,623] [1.26%]), with no trend (P = 0.31). Common benzodiazepines prescribed were diazepam (5,980,279 visits, 43.2% of all prescriptions), alprazolam (3,306,549, 23.9%), and clonazepam (2,105,963, 15.2%), with no changes over time. Fifteen percent of prescriptions were for patients 65 years or older.

Conclusion

Despite reports of increased misuse, there was no change in ED discharge benzodiazepine prescribing. Concerningly, alprazolam, a benzodiazepine with high misuse potential, was frequently prescribed despite limited ED indications, and there was a large percentage of visits where benzodiazepines were prescribed to older adults despite warnings for adverse effects in this population. Future studies should assess rational prescribing and the role of targeted interventions to curb inappropriate use.
Isolated Kratom Use Disorder Treated With Extended-Release Buprenorphine Taper
Authors: Swart Benjamin B. , Reznikoff Charles , Steen Katie
Published: May 2024

This case report highlights a 36-year-old male without history of psychiatric disease, chronic pain, or substance use disorder who developed severe substance use disorder per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria to kratom. He was successfully treated with sublingual buprenorphine after a 3-year period of intermittent withdrawal management and trials of oral and extended-release injectable naltrexone. After a period of abstinence from kratom, he was tapered from buprenorphine using 2 monthly injections of 100 mg extended-release buprenorphine. His case underscores some of the current uncertainties around kratom use disorder diagnosis and treatment.
Immunomodulation occurs in high-enriched dietary docosahexaenoic acid in rat
Authors: Diau Guan-Yeu , Kuo Shih-Ming , Chen Shyi-Jou
Published: May 2024

Background

The immunomodulation dietary adjuvant therapy for clinical workup in surgery is a very common demand and challenge clinical concern. The enteral or parenteral use of n-3 polyunsaturated fatty acids is one of the common protocols in certain area. This animal study investigated the skin fatty acids tissue level and relationship between immunological parameters after various dietary docosahexaenoic acid (DHA, 20:6n-3) supplement after burn challenge.

Materials and Methods

Forty-five male 4-week-old Wistar rats were divided into three groups and received either a regular diet (RD) or DHA-enforced diet at 1% (1P) and 5% (5P) for 2 weeks. Then, all the animals treated with the same controlled scalding burn injury. Some of the rats killed during the acute stage at 5 days after the burn for tissue pathological examination CD3, CD4, CD8, and CD68. The rest of the rats data were collected at 4 weeks later. Tissue fatty acid levels were analyzed via gas chromatography. The pathological grading, subpopulation of blood immune cells CD4 and CD8, and the serum cytokine IL-2 and IFN-γ were also examined.

Results

The dietary supplementing DHA could increase the skin tissue DHS concentration. Tissue DHA increased in RD 2.40 ± 0.91% < 1P 6.07 ± 0.92% < 5P 13.53 ± 1.24%. In contrast, tissue 20:4n-6 concentrations were quite constant and not affected by the dietary manipulations. The skin pathology did not show differences in CD3, CD4, CD8, and CD68 in acute stage. Only the serum INF-γ did show elevation statistically in 5P 80.11 ± 29.45 > RD 42.90 ± 30.85 and 1P 50.77 ± 40.75 pg/mL (P = 0.029). The subpopulation of blood CD4, CD8, and serum IL-2 did not show differences statistically. Pathological grading of the burned skin tissue showed significant difference between RD and 1P 4 weeks after the burn (P = 0.012). The body weight gain was prominent in 5P.

Conclusions

The immunomodulation did occur only at higher concentration dietary DHA supplement revealed by the increase serum INF-γ. However, only optimal concentration dietary group (1P) could decrease the tissue destruction after the burn. The increased body weight gain also indicated that the higher dietary supplement of DHA (5P) could serve the high energy requirement after burn.
Total Resection of Pediatric Desmoid Tumor of the Left Neck with Utilization of 3D Virtual Surgical Planning
Authors: Brown Hannah G. , Torres Bryan S. , Nuñez Julisa , Wong Richard J. , Hajjar Fouad M. , Abongwa Chenue , Sawh-Martinez Rajendra F. , Lopez Joseph
Published: May 2024

A 13-year-old girl with a painful left neck mass was referred to our institution due to suspicions of malignancy. The patient reported pain that accompanied her frequent neck spasms. Computed tomography revealed a large, soft-tissue mass in the left neck, deep to the sternocleidomastoid. The lesion anteriorly displaced the internal carotid artery and both displaced and crushed the internal left jugular vein. Uniquely, a three-dimensional virtual reality model combining magnetic resonance imaging and computed tomography data was used to determine the lesion’s resectability and visualize which structures would be encountered or require protection while ensuring total resection. During operation, we confirmed that the mass also laterally displaced the brachial plexus, cranial nerves X and XI, and spinal nerves C3–C5 (including the phrenic) of the cervical plexus. Postsurgical pathological analysis confirmed a diagnosis of desmoid tumor, also known as aggressive fibromatosis, whereas DNA sequencing revealed a CTNNB1 mutation, a somatic genetic marker found in approximately 90% of desmoid tumor cases. When possible, the most widely used method for the treatment of desmoid tumors has been gross resection. Chemotherapy, radiotherapy, and local excision are also used in the treatment of fibromatoses when complete resection is judged infeasible. In this case, a complete surgical resection with tumor-free surgical margins was performed. A standard cervical approach with a modified posterolateral incision site was implemented to avoid a conspicuous anterior neck scar. No flap, nerve repair, or reconstruction was warranted. At 1 year of postsurgical follow-up, the patient showed minimal scarring and no signs of recurrence.
Successful Intraoperative Salvage of a Venous Congested Deep Inferior Epigastric Perforator Flap Using a Cross-thoracic Saphenous Vein Graft
Authors: Yu Victor J. , Joseph Jeremy T. , Kemp Tamara L. , Ortiz Kenneth J. , DeJesus Ramon A.
Published: May 2024

For autologous breast reconstruction using the deep inferior epigastric perforator flap, the internal mammary vessels are a common choice for recipient vessels. However, if these vessels are discovered to be inadequate, this may require the utilization of alternative vessels for successful salvage. Here, we demonstrate the use of a venous conduit for flap salvage in a patient undergoing bilateral deep inferior epigastric perforator flap breast reconstruction. Intraoperative venous congestion was identified on the left side. A contributing factor was an unresolvable size discrepancy between the deep inferior epigastric and the internal mammary venae comitantes. A saphenous vein graft can be used to drain the donor inferior epigastric vein to the contralateral internal mammary venae comitantes. In this discussion, adequate venous drainage was obtained with this approach, and the flap remained viable with good Doppler signals without further complications over a year postoperatively.
Is “Clack” Enough? Rib Remodeling Guided by Ultrasound
Authors: Manzaneda Cipriani Raúl Martín
Published: May 2024

Rib remodeling is a surgical technique that allows waist contouring in women and men. This study proposes that the “clack” sound heard in ultrasound-guided scarless rib remodeling (RibXcar technique) is not evidence of the completion of the surgery, but rather, the use of ultrasound is necessary to identify angulations, loss of bone strength, and ultrasound visualization of the loss of bone continuity, and thus consider cosmetic rib surgery to be complete. This study was performed on 100 Peruvian women aged 18–40 years who voluntarily agreed to a rib remodeling procedure. The RibXcar technique was used, and intraoperative ultrasound was performed to obtain objective information during each patient’s procedure. Of the total number of patients who underwent surgery with the RibXcar technique, the “clack” sound was detected in 90% of patients, and no “clack” sound was detected in the remaining 10% of patients. However, the use of ultrasound revealed monocortical fractures in 100% of patients. It is observed that of the total number of patients, only in 90% was the “clack” heard; however, in 100% there was a monocortical fracture evaluated in the immediate postoperative period. We suggest not considering the “clack” as the end point of the surgery; instead, define the end point after the use of the ultrasound examination, which provides information on angulations, the loss of bone resistance, and ultrasound visualization of the loss of bone continuity.
The Effect of Aromatherapy on Anxiety and Pain in Patients Undergoing Oculoplastic Surgery
Authors: Chang Michael , Schaefer Jamie , Leonard Anthony , Ellison Pavithra Ranganathan , Cui Ruifeng , Evans Raquel , Calvert Nina , Thuro Bradley , Fay Aaron , Nguyen John
Published: May 2024

Purpose:

To determine the effect of aromatherapy on postoperative anxiety and pain in patients undergoing oculoplastic surgery.

Methods:

A randomized controlled study of 60 patients who underwent monitored anesthesia care sedation for oculoplastic procedures from August 2018 to November 2020. Patients were randomized to an aromatherapy (n = 32) or placebo (n = 28) condition. Anxiety was measured with State-Trait Anxiety Inventory and visual analog scale for anxiety. Pain was measured with a visual analog scale for pain.

Results:

Compared with control patients, aromatherapy patients had significantly lower postoperative State-Trait Anxiety Inventory state anxiety (24.1 vs. 29.1; p = 0.05) and visual analog scale pain scores (1.9 vs. 3.2; p = 0.05). Aromatherapy patients also had shorter stays in the postanesthesia care unit than control patients (57.7 vs. 79.4 minutes; p = 0.03).

Conclusions:

Patients who received aromatherapy reported lower postoperative anxiety and pain. Aromatherapy may be a useful adjuvant analgesic and/or anxiolytic for patients undergoing oculoplastic procedures with monitored anesthesia care sedation.