bluuebunny/crossref_metadata_2025 huggingface dataset:
PS-P13-4: THE CONTRIBUTION OF RAISED BLOOD PRESSURE TO THE BURDEN OF CARDIOVASCULAR DISEASE AND DEATHS IN AUSTRALIA FROM 1990 TO 2019
Authors: Xu Xiaoyue , Islam Sheikh Mohammed Shariful , Schlaich Markus , Jennings Garry , Schutte Aletta
Published: January 2023

Objective:

The 2019 Global Burden of Disease (GBD) findings highlight raised systolic blood pressure (SBP) as the leading cause of death globally. In a high-income country, Australia, it is unclear how SBP ranks among other risk factors regarding the overall and cardiovascular disease (CVD) burden, and whether the situation has changed over time.

Design and method:

We analysed the 2019 GBD data with a focus on Australia. We assessed the ten leading risk factors for all-cause and CVD deaths and disability-adjusted life-years (DALYs) and compared findings with the Australia Burden of Diseases Study.

Results:

From 1990 to 2019, raised SBP remained the leading risk factor for attributable deaths (followed by dietary risks and tobacco use), accounting for 29,056/75,235 (39%) (95% Uncertainty Interval (UI) [24,863–32,915]) deaths in 1990; 21,845/76,893 (28%) [17,678–26,044] in 2010; and 25,498/90,393 (28%) [20,152–30,851] in 2019. From 1990 to 2019, contributions of SBP to cardiovascular deaths were 54% [46–62], 44% [37–51] and 44% [36–52]. Recently (2010 to 2019), the contribution of SBP to cardiovascular deaths and DALYs increased in males (9,361/17,551 (53%) deaths in 2010 to 11,042/20,420 (54%) in 2019; and 181,127/325,783 (56%) to 203,677/359,931 (57%) DALYs) and females (10,184/18,047 (56%) cardiovascular deaths in 2010 and 11,228/19,811(57%) in 2019; and DALYs from 140,625/240,510 (58%) to 154,013/260,348 (59%)).

Conclusions:

Raised SBP continues to be the leading risk factor for all-cause and cardiovascular deaths in Australia. We urge cross-disciplinary stakeholder engagement to implement effective strategies to detect, treat and control raised blood pressure as a central priority to mitigate the CVD burden.
PS-P14-3: EFFORTS OF “S-1 GRAND PRIX”, A DELICIOUS LESS SALT RECIPE CONTEST AIMED AT PREVENTING CARDIOVASCULAR DISEASES
Authors: Sato Kaoru , Watanabe Sachie , Nagao Nobuyuki , Takemoto Sayuri , Watanabe Satomi , Kawabata Nao , Masuzaki Miku , Ohtani Misato , Tanaka Katsuhisa , Akagawa Eiki , Asano Shigehiro , Miyamoto Yoshihiro
Published: January 2023

Purpose:

As the average salt intake of Japanese people is as high as 10 gram per day, it is necessary to reduce the salt intake for the prevention and treatment of cardiovascular diseases. We held a less salt recipe contest to promote delicious less salt recipes among society and examined the potentiality of “deliciously less salt meals”.

Method:

National Cerebral and Cardiovascular Center (NCVC) held the “The 5th S-1 Grand Prix”, a contest to develop delicious and less salt bento recipes on a nationwide scale. The contest named after its goal of reducing the salt intake by 1 gram in each meal. Under the theme of a delicious and attractive less salt bento meeting to the nutritional value standards (such as less than 2 gram of salt equivalent per meal), NCVC called for the bento recipe ideas from the 10th of May to 26th of July 2021. All the applied recipes are evaluated and tasted by NCVC contest board members, then the best one was decided for a “Grand-Prix” award. Contest was held on-line due to the COVID-19, the video presentation made by the applicants were evaluated for the final selection.

Result:

A total of 67 teams (25 teams in the general category, 15 teams in the student category, 27 teams in the disaster nutrition category) were applied to this contest. We encouraged governments, hospitals, dietitian training schools, and convention-related companies and organizations nationwide to apply the contest. Compared to the 4th tournament, the number of applicants were increased by 16 teams. More than half of the applicants were from “educational institutions such as universities”. Although the 5th tournament was held online, we were able to hold a recipe contest in a new format, such as using applicants’ video presentation for the final selection.

Discussion:

In the disaster nutrition category, many recipes for the delicious, preserved foods and cooking methods under the disaster were gathered, so that these less salt recipes can be widely adopted in the disaster foods. Through this attempt, we created an opportunity to make a delicious less salt meals, and motivated participants to cook “deliciously less salt meals”. In the future, more people will participate in this contest in order to get them to participate, we will consider the conditions of the recipe and the recruitment method.
PS-P14-5: THE LINK BETWEEN SALT KNOWLEDGE, SALT REDUCTION AWARENESS AND SALT REDUCTION BEHAVIOR
Authors: Nakamura Satoko
Published: January 2023

Objective:

The effects of salt on health are well known. However, salt intake is still high in Japan and the number of hypertensive patients is increasing. Therefore, we investigated the association between knowledge, awareness, and behavior towards salt among university students.

Design and Methods:

72 university students (11 males and 61 females) from the Department of Nutrition (group N) and 70 university students (10 males and 60 females) from other departments than nutrition (group O) was included in the study. Knowledge and awareness of salt and their behavior were investigated using questionnaires and a salt checklist.

Results:

In terms of knowledge of salt, the target amount of salt intake (g/day) was answered as 7.2 ± 0.6 in group N and 15.0 ± 13.9 in group O, with no significant difference. When the target amount of 7–8 g/day of the Japanese Dietary Reference Intakes was used as the correct answer range, the percentage of correct answers was 86% in group N and 10% in group O (p < 0.001). The correct answer rate for seasonings with high salt content was 86% in group N and 27% in group O (p < 0.0001). There was no significant difference in the percentage of correct answers for low-salt condiments. The percentage of correct answers for diseases associated with salt intake was significantly higher in group N. The proportion with low-salt awareness was significantly higher in group N (p < 0.0001). The total score on the salt checklist was 10.7 ± 3.0 in group N and 13.4 ± 4.7 in group O (p < 0.0005).

Conclusion:

The students from the Department of Nutrition had a higher level of salt reduction awareness, more knowledge about salt and a lower total score on the salt checklist. Medical and food knowledge may be useful in linking salt reduction knowledge with awareness and behavior.
PS-P15-1: EFFECT OF GARLIC EXTRACT SUPPLEMENTATION ON BLOOD PRESSURE CONTROL IN PATIENTS WITH CHRONIC HEMODIALYSIS
Authors: Akbar Kiagus Muhammad Yusuf Arief , Fathurrachman Alif , Mulia Deddy Primadona , Wangsa Syahpri Putra , Kartika Herleni , Effendi Ian , Ali Zulkhair , Suhaimi Novadian , Slamet Suprapti , Saleh Irsan , Riyadi Ichram
Published: January 2023

Objective:

Studies have reported intradialytic hypertension and inadequate antihypertension drugs in hemodialysis patients. Garlic and its components like Allicin have biological activities in lowering blood pressure by induction of endothelin nitric oxide synthase (eNOS) to hydrogen sulfide (H2S), which leads to calcium channel closure and relaxation, which leads to vasodilation of vessels. This study aims to analyze the effect of garlic extract supplementation on lowering blood pressure in chronic hemodialysis patients at Moh Hoesin General Hospital, Palembang, Indonesia.

Design and method:

This study was a crossover randomized, placebo-controlled, double-blind trial. The subjects were 40 CKD stage 5 patients with chronic hemodialysis, randomly divided into 2 groups, namely the group that received 1000 mg of garlic extract per day (2x500 mg) for 6 weeks and the group that received a placebo, which was then carried out during a washing period for 2 weeks, and then the two groups were crossover. Each group measured the blood pressure before and after treatment.

Results:

The wilcoxon test revealed that systolic blood pressure before and after garlic extract administration was 144,5 ± 12,1 mmHg and 140 (125–164) mmHg with p = 0,037, respectively (vs placebo, p = 0,55). Diastolic blood pressure before and after garlic extract administration was 80 (70–100) mmHg and 80 (70–100) mmHg, with p = 0,703 (vs placebo, p = 0,9).

Conclusion:

There was an effect of garlic extract on lowering systolic blood pressure in patients with chronic HD at Moh Hoesin Hospital, Palembang, Indonesia.
PS-P15-3: PATIENTS WITH GLOMERULONEPHRITIS IN REMISSION HAVE DECREASED ARTERIAL STIFFNESS COMPARED TO CKD PATIENTS
Authors: Korman Avital Angel , Glasswin Erick , Ishay Rotem Tal-Ben , Amital Mor , Kukuy Olga , Leiba Adi
Published: January 2023

Background:

Arterial stiffness is the hallmark of the vascular aging process, in which a disruption in collagen to elastin balance in the large arteries with decreased compliance of the central vasculature leads to excess cardiovascular morbidity.

Carotid- Femoral Pulse wave velocity (PWV) is the preferred non-invasive way to quantify arterial stiffness. Apart from age, blood pressure, presence of long standing hypertension, diabetes or kidney impairment, inflammation has been quoted as an harbinger of arterial stiffness. However, in a prior work of our group we found Familial Mediterrenean Fever (FMF) patients to have a decreased PWV, possibly relaed to the relapsing-remitting type of the disease and a possible ptotective role of colchicine.

Objective:

To compare the PWV of patients with Glomerulonephritis (GN) in clinical remission to patients with non inflammatory CKD (either eGFR < 60 or uACR above 30 mg/gram), mostly related to hypertension and diabetes.

Methods:

We prospectively collected data on 58 patients from our Nephrology and Hypertension Center, which either had non inflammatory CKD (30 patients) or a glomerular disease in partial or complete remission (28 patients).

central (aortic) blood pressure and Pulse wave velocity (PWV) were measured using validated Sphygmocor XCEL ® device.

Results:

In a multivariate regession analysis adjusting for age, presence of hypertension, history of diabetes and creatinine values, having glomerular disease in remission was associated with a significant decrease in PWV (B- 3.262) indicating better arterial elasticity compared to CKD patients.

Conclusion:

Patients with glomerulonephritis in remission have better arterial elasticity compared to CKD patients, possibly similar to the general age and blood pressure matched population. This is in accordance with our findings in FMF patients, who were adherent to colchicine treatment and in clinical remission.

It is possible that prior treatment with anti-inflammatory and immunomodulatory drugs carry a beneficial effect on vascular health.
PS-P15-4: THE ROLE OF CARDIOPULMONARY EXERCISE TESTING IN OBESE HYPERTENSIVE PATIENTS: A STEP FORWARD IN DETERMINATION OF OPTIMAL TREATMENT
Authors: Ostojic Marina , Nedeljkovic Ivana
Published: January 2023

Introduction:

Obesity is a global problem. Morbid obesity (MO) represents a population with a body-mass index (BMI) of more than 40 kg/m2 eligible for surgical treatment (bariatric surgery). During the preoperative evaluation program, every patient must have a cardiopulmonary exercise test (CPET) for cardiopulmonary risk assessment. Also, in the morbid obese population, arterial hypertension (AH) is the most common comorbidity.

Objectives:

We aimed to compare the results of CPET in obese patients with and without AH treatment.

Methods:

We investigated 84 patients (40 males, age 40.50 ± 10.38) scheduled for surgical treatment of morbid obesity. Patients were divided into two groups according to the presence of AH, adjusted for sex and age. All patients underwent CPET for the preoperative risk assessment and determination of cardiopulmonary function.

Result: The mean BMI was 45.37 ± 9.75 kg/m2. There was a significant difference in resting sistolic and diastolic blood pressure between the 2 groups (AH group, sistolic 144.33 ± 13–05 vs. 133 ± 11.26 mmHg, p = 0.001, diastolic AH group, 88.0 ± 7.36 mmHg vs. 84.10 ± 6.36 mmHg, respectively, p = 0.039) as well as at maximal effort (AH group, sistolic 182.13 ± 18.72 mmHg vs. 170.00 ± 13.00 mmHg p = 0.004; diastolic 101.67 ± 9.13 mmHg vs. 96.14 ± 9.16 mmHg, p = 0.018). There was no difference in peak oxygen consumption in AH patients compared to patients without AH (peakVO2 25.542.07 ml/kg/min vs. 26.78 ± 2.92 ml/kg/min, p = 0,147), and for VO2 at anaerobic threshold (VO2AT 14.153.11 ml/kg/min vs. 14.29 ± 3.62 ml/kg/min, P = 0–859). There was a significant difference in ventilatory response among those two groups of patients. Minute ventilation/carbon dioxide production (VE/VCO2) slope among the AH group was 24.89 ± 3.29, vs. 27.22 ± 3.97, p = 0.013, possibly due to demarcation of left ventricular diastolic dysfunction among the hypertensive group during exercise.

Conclusions:

CPET showed significant ventilatory impairment in MO patients with AH. Thus, individualized antihypertensive therapy should be the focus of preoperative programs for morbidly obese patients with AH.
PS-P16-5: ATHEROSCLEROTIC CARDIOVASCULAR DISEASE (ASCVD) RISK STRATIFICATION OF HYPERTENSIVE ADULTS AT A TERTIARY HOSPITAL
Authors: Gnilo Mariean Rocielle , Gonzales Eddieson
Published: January 2023

Background:

Most hypertensive patients have cardiometabolic risk factors, which raises the likelihood of developing atherosclerotic cardiovascular events. As a result, international professional societies have recommended the use of ASCVD risk assessment in the diagnosis and treatment of hypertension. However implementation of this recommendation remains a challenge in local practice.

Objective:

To determine the atherosclerotic cardiovascular risk stratification of adult patients with hypertension using a Cardiovascular Specialty Organization's Risk Factor Counting method at a tertiary hospital Outpatient Department

Methodology:

The research study employed a descriptive, cross-sectional study design of 122 hypertensive adults between November 2020 to October 2021. Data gathered were a clinicodemographic profile, family history, smoking status, body mass index, and diagnostic tests including 12 lead electrocardiogram, urinalysis, lipid profile, and fasting blood sugar or Hba1c. Statistical analysis was done using the SPSS version 26.

Results:

The majority of the 122 enrolled patients were aged 51 to 60 (37.7%) and 61 to 70 years old (23.0%) Results revealed that the majority of hypertensive adults in a tertiary hospital were high risk at 79.51% and 20.49% were low to intermediate risk. There was a significant difference in the risk classification distribution of patients based on their age, diabetes, dyslipidemia, BMI, and microalbuminuria or proteinuria. Diabetic and dyslipidemic patients were 35.6 and 5.52 times more likely, to be ASCVD high risk respectively. Obese I and Obese II were 6.96 and 5.24 times more likely to be at a high risk of ASCVD as well.

Conclusions:

In conclusion, the majority of hypertensive adults were at high risk for cardiovascular complications. Among the risk factors studied, diabetes, dyslipidemia, and body mass index, when compared to other risk variables, were significantly associated with high ASCVD risk.
PS-P16-8: DIAGNOSIS AND TREATMENT OF HYPERTENSION BY COMMUNITY HEALTH WORKERS IN RURAL NEPAL: MAIN RESULTS OF THE MUTU TRIAL
Authors: Neupane Dinesh , Koirala Sweta , Hu Xiao , Appel Lawrence J , Vaidya Abhinav , Matsushita Kunihiro
Published: January 2023

Objective:

To evaluate the effectiveness and safety of a community health worker intervention for diagnosing and managing hypertension (HTN) in rural Nepal.

Design & Methods:

We conducted a quasi-experimental study in two rural municipalities in Nepal, assigning one as an active site (7 communities) and the other as a comparison site (8 communities, which received enhanced usual care). The intervention in the active site involved three home visits for blood pressure (BP) monitoring and counseling by trained community-based community health workers (Female Community Health Volunteers) and treatment of HTN by trained community health workers based in government Health Posts under physician supervision using a simplified protocol with amlodipine. The comparison site received one home visit by Female Community Health Volunteers. A total of 1428 adults with untreated HTN (systolic BP of 140–179 and/or diastolic BP of 90–119 mm Hg) were enrolled. The primary outcome was a reduction in systolic BP at 12 months (measured in 94% of enrolled participants), and the secondary outcome was HTN control rate defined as BP < 140/90 mm Hg.

Results:

The mean baseline systolic BP was 145.4 mm Hg in the active site (n = 576, 46% women) and 146.9 mm Hg in the comparison site (n = 760, 46% women). At 12 months, while BP was lower in both sites, mean SBP fell more in the active site [net mean difference of -11.0 mm Hg, (95% CI: -12.5 to -9.6; P < 0.001)] (Table). The corresponding net difference in DBP was -6.0 mm Hg (95% CI: -6.8 to -5.1; P < 0.001). HTN control and medication treatment were both higher in the active site compared to the comparison site (Table). There were four deaths unrelated to the intervention (2 in the comparison site and 2 in the active site).

Conclusion:

In rural communities of Nepal, a health system intervention with trained community health workers diagnosing and treating hypertension, supervised by a physician, substantially lowered BP and achieved higher control rates compared to usual care. The success of this intervention provides strong support of enhanced roles for community health workers to diagnose and treat HTN. Scaling up such interventions could potentially address the major workforce gaps that lead to low HTN control rates, particularly in rural communities of low and middle-income countries.
PS-R06-5: CASE REPORT OF INCREASED ARTERIAL STIFFNESS IN MOYAMOYA DISEASE IN A YOUNG CHINESE PATIENT PRESENTING AS RECURRENT STROKE IN SINGAPORE
Authors: Sule Ashish Anil , Cangco Noe M , Cesar Benedict A
Published: January 2023

Introduction:

Moyamoya disease (MMD) is characterised by progressive stenosis of distal ICA and the resulting hazy network of basal collateral vessels. Increase arterial stiffness in MMD is not well described.

Case report:

We describe a young patient ML, a 42-year-old Chinese female, presented to hospital in June 2015 with headaches, on a background of known hypertension diagnosed at the age of 28 years.

Her systemic examination was normal. Investigations were unremarkable. She was followed in General Medicine (GM) clinic from 2015, which ruled out secondary causes of hypertension, including renovascular disease, renal artery stenosis, phaeochromocytoma and hyperthyroidism. ML was treated for presumptive essential hypertension. Over time, her BP remained stable on candesartan 16 mg and bisoprolol 2.5 mg once daily. She continued to have intermittent headaches. Recurrent ischaemic strokes and diagnosis of Moyamoya disease

ML presented with intermittent right-sided facial numbness in February 2017. A magnetic resonance imaging (MRI) brain done showed no acute infarct or hemorrhage, but moderately severe narrowing of the left terminal internal carotid artery (ICA), associated with poor flow signals in both the A1 segment of the left anterior cerebral artery (ACA) and the M1 segment of the left middle cerebral artery (MCA). She was started on clopidogrel 75 mg and atorvastatin 40 mg daily. The second stroke occurred in March 2019, when ML presented with acute right upper and lower limb weakness, and right facial, upper and lower limb numbness. Magnetic resonance angiography (MRA) demonstrated severe stenosis at the left terminal ICA, also involving the left M1 and A1 segments; collateral flow was observed. The third stroke happened in April 2019, presenting with acute right-sided facial and upper limb weakness, with BP of 201/86mmHg. MRI and MRA of the brain revealed new acute infarcts scattered in the territories of the left MCA and ACA. A CT angiogram re-demonstrated severe steno-occlusive disease involving the left ICA T-junction and left M1 and A1 segments, with extensive basal collaterals. In light of these findings, Moyamoya disease (MMD) was diagnosed.

ML underwent a left external carotid-internal carotid bypass in June 2019. An arterial stiffness study by syphgmoCor in June 2020 using markedly increased arterial stiffness.

Conclusion:

We present first and very rare case of hypertension in a young patient with MMD associated with increased arterial stiffness. Systemic vascular affection in MMD may be the cause of increased arterial stiffness.
PS-R06-6: CEREBRAL AMYLOID ANGIOPATHY-RELATED INFLAMMATION PRESENTING WITH POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME
Authors: Yoo Bong Goo
Published: January 2023

Background:

Cerebral amyloid angiopathy related inflammation (CAAri) is a rare CAA variant, characterized by headaches, seizures, acute or subacute encephalopathy, or focal neurological deficits. Radiologically, CAAri presents with widespread white matter lesions on brain MRI in addition to the hemorrhagic imaging features of CAA. We report a patient with CAAri who showed posterior reversible encephalopathy syndrome.

Case Report:

A 77 year old man presented with generalized tonic clonic seizure that persisted for 30 minutes and decreased in consciousness level. He had past medical history of dementia, diabetes and hypertension. His initial blood pressure was 170/90 mmHg and pulse rates were 144/minute. On neurological examination, his consciousness level was stupor and there are no lateralizing signs. Cerebrospinal fluid analysis was unremarkable except elevated protein level of 75 mg/dL. Diffusion weighted images (DWI) and fluid attenuated inversion recovery (FLAIR) images showed diffuse hyperintensities involving the bilateral temporoparietooccipital lobes. Gradient echo images revealed multiple microbleeds in bilateral cortical and subcortical regions as can be seen in CAA. A diagnosis of CAAri was considered, and the patient was started on steroids and valproic acid with clinical improvement. Nine days after admission, follow up DWI and FLAIR images demonstrated improvement of previously shown lesions.

Conclusions:

Aside from the most common subacute presentations, CAAri can have a PRES like presentation. It is hypothesised that in this form, CAAri causes altered vascular autoregulation and impaired blood brain barrier integrity in the face of precipitating factors such as hypertension.
PS-R06-7: CAUDAL REGRESSION SYNDROME AS A CAUSE OF SECONDARY HYPERTENSION
Authors: Renna Nicolás Federico , Ramirez Jesica Magalí
Published: January 2023

Hypertension (HT) is a disease with a mainly multifactorial etiology. Although monogenic, embryological, epigenetic causes are rare and the interdisciplinary approach is essential to arrive at the diagnosis. We present the case of a 22-year-old patient with a history of congenital myelomeningocele and daughter of non-consanguineous parents, hospitalized for a hypertensive crisis (220/112 mmHg). It is referred to rule out genetic causes of hypertension.

The genealogy shows a history of hypertension and ischaemic heart disease in both parental lines, in two previous generations. Physical examination revealed bilateral pes cavus in the lower limbs, edema, and overlapping of the second toe over the first toe on the left foot. She presented calf atrophy and incontinence, with the use of a bladder catheter and a continent stoma, as post-surgical sequelae.

As a relevant finding, elevated aldosterone and plasma renin activity. Normal blood and urine catecholamines, VMA and normetanephrines. MRI of the abdomen and pelvis revealed a double left renal artery corroborated by CT angiography, a right extrarenal pelvis and a bicornuate uterus of normal size. Doppler of renal arteries showed no signs of significant stenosis. Right renal artery 43 cm/s and left renal artery 103 cm/s. The patient presents diagnostic criteria compatible with a caudal regression syndrome, a spectrum of clinical phenotypes with malformations in the lower hemibody that involve the 3 embryonic layers.

It is postulated that, in this case, the hypertension is secondary to the embryological defect. The patient continues to be medicated with perindopril/indapamide 10/2.5 mg with adequate blood pressure control.

JOURNAL/jhype/04.03/00004872-202301001-01322/figure1/v/2023-10-24T163949Z/r/image-jpeg
PS-R07-1: CASE OF PSEUDOHYPERALDOSTERONISM WITH IMPROVEMENT OF HYPERTENSION AND HYPOKALEMIC WEAKNESS BY DISCONTINUATION OF PEONY AND LICORICE FORMULA.
Authors: Gotoh Shuji , Shimizu Hideaki , Kasahara Rika , Kishima Yukari , Nagashima Ai , Matsuoka Hiroki , Hayakawa Takuto , Naruse Yuki , Kawada Kyogo
Published: January 2023

Case:

An 80-year-old woman was admitted to our hospital with lower extremity weakness. She was treated for hypertension (HT), type 2 diabetes, and Alzheimer's disease.

Her medications included brotizolam 0.25 mg, rivastigmine tape 18 mg, celecoxib 200 mg, sofarcon 50 mg, losartan 50 mg, hydrochlorothiazide 12.5 mg, rosuvastatin 2.5 mg, propiverine 10 mg, empagliflozin 10 mg, linagliptin 5 mg, esomeprazole 20 mg, peony and licorice formula (PLF) 7.5 grams, and olopatadine 5 mg.

On admission her blood pressure (BP) was 191/73 mmHg.

Manual muscles testing (MMT) for the upper limbs was 4/5 bilaterally throughout. Lower limb MMT included iliopsoas 1/5, quadriceps 1/5, hamstrings 1/5, anterior tibialis 4/5, gastrocnemius 4/5 bilaterally, respectively.

Basic blood tests revealed serum K + 2.0 mEq/L, urinary K + 21.0 mEq/L, creatinine kinase 1,488 U/L, renin activity 0.8 ng/mL/hr, and aldosterone 4.0 pg/mL (CLEIA method).

During admission to the intensive care unit, frequent blood sampling was performed to correct the serum K + level. A calcium channel blocker (CCB) was commenced for HT on admission day. Spironolactone was commenced on post-admission day (PAD) 1. The serum K+ level stabilized, and potassium chloride administration was terminated PAD 6. BP also improved over time, and the CCB was discontinued on PAD 23. On the same day, she was discharged from the hospital with continuation of spironolactone.

In this case, there were a total of 11 prescription drugs including PLF from three clinics. We diagnosed HT and lower extremity weakness due to pseudohyperaldosteronism (PHA). The HT improved after discontinuation of PLF.

Licorice is found in about 70% of Chinese herbal medicines. Risk factors for PHA include short stature and weight, elderly and female, renal dysfunction, and diuretic administration. As Japan has entered a super-aging society, the number of patients using geriatric healthcare facilities and chronic care wards is increasing. The frequency of blood sampling is particularly low in such facilities, so it is difficult to notice hypokalemia among such patients. PHA and hypokalemic myopathy due to licorice should be considered in the case of lower limb weakness in elderly patients.

In conclusion, it is important to identify PHA caused by licorice-containing Chinese herbal medicines in elderly patients with HT. In addition, healthcare facilities for the elderly it is advised that serum K+ is checked in patients with worsening HT, weakness and polypharmacy.
PS-R07-6: RENOVASCULAR HYPERTENSION SECONDARY TO MASSIVE ILIOPSOAS HEMATOMA
Authors: Noda Ryunosuke , Komatsu Jun , Han Wei , Ichikawa Daisuke , Shibagaki Yugo , Yazawa Masahiko
Published: January 2023

An 81-year-old female with stage G3 chronic kidney disease and post left nephrectomy for upper tract urothelial carcinoma 20 years ago, was admitted to our hospital for heart failure. She acutely developed right thigh pain, and contrast-enhanced computed tomography (CT) revealed an idiopathic iliopsoas hematoma for which transcatheter arterial embolization (TAE) was performed. Subsequently, her hypertension worsened despite multiple antihypertensive medications (Nifedipine, Carvedilol, Doxazosin, Spironolactone), remained uncontrolled over one month. At this point, plasma renin activity and plasma aldosterone concentration were both elevated on taking carvedilol and spironolactone. An angiotensin II receptor blocker (ARB, Olmesartan) was additionally started for refractory hypertension. Oliguric acute kidney injury (AKI) developed on the day following ARB administration, and her serum creatinine increased from 0.98 to 2.0 mg/dL. After stopping the ARB, the kidney function immediately recovered to the previous level. On review of the previously performed contrast CT, the remnant (right) kidney was ventrally displaced, and the right renal artery was kinked by the massive iliopsoas hematoma (Figure 1a and 1b). Three months after TAE, the hematoma completely disappeared, and the right kidney and renal artery returned to their original positions. Renal Doppler ultrasonography before the appearance, and after the disappearance of hematoma, demonstrated no abnormalities indicative of renal artery stenosis. Furthermore, hypertension also improved over the three months after TAE. Renal artery stenosis is primarily caused by atherosclerosis, fibromuscular dysplasia, and rarely external compression. We report a rare case of renovascular hypertension which would be induced by renal artery kinking due to massive iliopsoas hematoma.

JOURNAL/jhype/04.03/00004872-202301001-01329/figure1/v/2023-10-24T163949Z/r/image-jpeg
PS-R07-8: A CASE OF PRIMARY ALDOSTERONISM CAUSED BY BILATERAL ALDOSTERONE-PRODUCING MICROTUMORS WITH A UNILATERAL ADRENAL MASS
Authors: Mizumoto Teruhiko , Kakizoe Yutaka , Date Ryosuke , Itai Yohei , Izumi Yuichiro , Adachi Masataka , Kuwabara Takashige , Mukotyama Masashi
Published: January 2023

Introduction:

Primary aldosteronism (PA) is defined as a disease in which overproduction of aldosterone causes various complications such as hypertension, cardiovascular disorder and kidney disease. We herein report a case of PA caused by bilateral aldosterone-producing microtumors with a unilateral adrenal mass.

Case presentation:

A 54-year-old man was referred to our hospital with a clinical suspicion of PA. He had a history of hypertension and chronic kidney disease for 10 years and had experienced paresthesia that was caused by putaminal hemorrhage in the past. In the initial examination, he exhibited hypertension (150/90 mmHg), high aldosterone (pg/mL)-to-renin (ng/mL/h) ratio (1,744), and overt hypokalemia (K, 2.9 mEq/L). The serum creatinine level was 1.89 mg/dL. The captopril challenge test showed no changes in his blood pressure or plasma aldosterone concentration. These results led to a clinical diagnosis of PA. Computed tomography (CT) revealed the presence of left adrenal mass, so that we suspected that the mass should be responsible for overproduction of aldosterone. We performed adrenal venous sampling. Unexpectedly, the adrenal venous sampling highly suggested the presence of aldosterone-producing microtumors in bilateral adrenal glands (lateralized ratio, 1.3; left contralateral ratio, 0.2). After evaluation, we decided that there was no indication for the removal of left adrenal mass. Then, a low dose of a mineralocorticoid receptor (MR) antagonist was started. Although the dose of an MR antagonist could not be increased sufficiently due to poor renal function, he exhibited an improved control of blood pressure and was followed up thereafter.

Discussion and Conclusion:

Although PA is one of the most common causes of secondary hypertension, making an accurate diagnosis and appropriate treatment is sometimes problematic due to the difficulty in assessing the site of aldosterone overproduction. The Japanese Endocrine Society clinical guideline states that PA with unilateral adrenal tumor in young patients may not require adrenal venous sampling. From the current case, however, we should always consider the possibility of bilateral microtumors or hyperplasia even in the presence of a unilateral adrenal mass.
PS-R07-10: A MOTHER AND HER DAUGHTER CASES OF PRIMARY ALDOSTERONISM
Authors: Nemoto Yuhi , Honda Kazuya , Hasegawa Koji , Hashimoto Shigeatsu
Published: January 2023

The majority of cases of primary aldosteronism (PA) occur sporadically. Familial forms of PA are rare with four subtypes defined. We reported a case of familial cluster of primary aldosteronism in two members, daughter and her mother.

Case presentation Case 1:

Daughter A 20-year-old woman with a history of hypertension and proteinuria for three years without treatment, was admitted for the treatment of accelerated hypertension of 182/121 mmHg and end stage kidney disease. Blood examination revealed low plasma renin activity (PRA) of 0.7 ng/ml/h, and high plasma aldosterone concentration (PAC) of 349 pg/mL, high aldosterone/renin ratio (ARR) of 498.6, and serum potassium (sK) of 4.9 mEq/L. (Plasma ACTH 12.9 pg /mL, plasma cortisol 7.4 mcg/dL) These findings suggested PA. Abdominal CT scan showed no adrenal mass. After control of accelerated hypertension with nifedipine GITS and alpha adrenoceptor blocker, confirmatory tests for PA, saline infusion test (SIT) were carried out and was positive test (PAC 240 min after infusion 264pg/mL). Adrenal venous sampling revealed bilateral hyper-aldosterone secretion. She was given diagnosis of bilateral adrenal hyperaldosteronism. Her blood pressure was decreased to 118/77 along with administration of spironolactone 25 mg/day. Her parents have hypertension. We investigate the cause of hypertension in her parents. Blood test of her father revealed PRA 3.4 ng/m/h, PAC 18.3 pg/ml, and sK 4.7 mEq/L.

Case 2:

Mother A 45-year-old women with hypertension treated with amlodipine 5 mg was referred to our hospital to examine the renal function after renal donation to her daughter. Blood test revealed mild renal dysfunction (eGFR 72,2), normal sK(4.0 mEq/L), low PRA (0.9 ng/ml/h), high PAC (118 pg/mL) for high salt intake (11.6 g/day as high as salt loading test). Abdominal CT scan showed no adrenal mass. SIT was positive (PAC 240 min after infusion 60.0 pg/mL). She was given diagnosis of PA.

Discussion:

Potential factors leading to BHA include rare disease-predisposing germline variants, circulating angiotensin II type 1 receptor autoantibodies, and paracrine activation of aldosterone production by adrenal mast cells have been reported. Primary hyperaldosteronism in 2 family members, a mother and daughter, suggests familial hyperaldosteronism which caused by germline mutation. We now investigate germline variants for BHA.
Environmental eustress promotes liver regeneration through the sympathetic regulation of type 1 innate lymphoid cells to increase IL-22 in mice
Authors: Liu Tingting , Li Jin , Li Qian , Liang Yiyi , Gao Jian , Meng Zihong , Li Peiying , Yao Ming , Gu Jinyang , Tu Hong , Gan Yu
Published: January 2023

Background and Aims:

The liver has the unique ability of regeneration, which is extremely important for restoring homeostasis after liver injury. Although clinical observations have revealed an association between psychological stress and the liver, whether stress has a causal influence on the liver regeneration remains markedly less defined.

Approach and Results:

Rearing rodents in an enriched environment (EE) can induce eustress or positive psychological stress. Herein, EE-induced eustress was found to significantly enhance the ability of liver regeneration after partial hepatectomy or carbon tetrachloride-induced liver injury based on the more rapid restoration of liver/body weight ratio and the significantly increased number of proliferating hepatocytes in EE mice. Mechanistically, the cytokine array revealed that IL-22 was markedly increased in the regenerating liver in response to EE. Blockade of IL-22 signaling abrogated the enhanced liver regeneration induced by EE. Group 1 innate lymphoid cells (ILCs), including type 1 ILCs (ILC1s), have been identified as the major sources of IL-22 in the regenerating liver. EE housing led to a rapid accumulation of hepatic ILC1s after partial hepatectomy and the EE-induced enhancement of liver regeneration and elevation of IL-22 was nearly eliminated in ILC1-deficient Tbx21
-/- mice. Chemical sympathectomy or blockade of β-adrenergic signaling also abolished the effect of EE on ILC1s and attenuated the enhanced liver regeneration of EE-housed mice.

Conclusion:

The study findings support the brain-liver axis and suggest that environment-induced eustress promotes liver regeneration through the sympathetic nerve/ILC1/IL-22 axis.
Sutured Descemet Membrane Endothelial Keratoplasty in Patients With Complex Anatomy or Difficulty Positioning
Authors: Li Gavin , Shekhawat Nakul S. , Eghrari Allen O.
Published: January 2023

Purpose:

In Descemet membrane endothelial keratoplasty (DMEK), some patients cannot adhere to postoperative positioning requirements or lack anatomic support for a gas bubble in the anterior chamber. We describe a suturing technique that stabilizes the graft postoperatively without tearing or tenting it.

Methods:

One to two 10-0 nylon sutures with a spatulated needle are used to secure DMEK grafts. Tied with minimal tension, the sutures traverse the corneal stroma at a steep, almost perpendicular angle and approach the graft from the limbus at an angle tangential to the circular graft to prevent vaulting the tissue off the central cornea. We report preoperative and postoperative best spectacle-corrected visual acuity, corneal pachymetry, and anterior segment optical coherence tomography confirming graft attachment in 3 patients.

Results:

In case 1 (aphakia, postvitrectomy, and positioning difficulty), pachymetry decreased from 637 μm preoperatively to 495 μm and best spectacle-corrected visual acuity improved from 20/70 to 20/50 at postoperative week 1. In case 2 (aphakia, limited follow-up, and medication adherence), pachymetry decreased from 1106 μm preoperatively to 783 μm at postoperative month 1. In case 3 (tube shunt and loss of gas bubble at 2 hours), slit-lamp examination at postoperative day 1 showed corneal clearing and graft attachment. Pachymetry decreased from over 795 μm preoperatively to 582 μm at postoperative month 1. Anterior segment optical coherence tomography confirmed graft attachment in all patients.

Conclusions:

Single or opposing tangentially oriented sutures can be safely applied to secure DMEK grafts postoperatively in challenging cases.
Patient Outcomes Based on the 2011 CDC Guidelines for Field Triage of Injured Patients
Authors: Fernandez Antonio R. , Bourn Scott S. , Hall Garrett D. , Crowe Remle P. , Myers J. Brent
Published: January 2023

Background:

The Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients drive the destination decision for millions of emergency medical services (EMS)-transported trauma patients annually, yet limited information exists regarding performance and relationship with patient outcomes as a whole.

Objective:

To evaluate the association of positive findings on Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients with hospitalization and mortality.

Methods:

This retrospective study included all 911 responses from the 2019 ESO Data Collaborative research dataset with complete Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients and linked emergency department dispositions, excluding children and cardiac arrests prior to EMS arrival. Patients were categorized by Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients step(s) met. Outcomes were hospitalization and emergency department or inhospital mortality.

Results:

There were 86,462 records included: n = 65,967 (76.3%) met no criteria, n = 16,443 (19.0%) met one step (n = 1,571 [9.6%] vitals, n = 1,030 [6.3%] anatomy of injury, n = 993 [6.0%] mechanism of injury, and n = 12,849 [78.1%] special considerations), and n = 4,052 (4.7%) met multiple. Compared with meeting no criteria, hospitalization odds increased threefold for vitals (odds ratio [OR]: 3.07, 95% confidence interval [CI]: 2.77–3.40), fourfold for anatomy of injury (OR: 3.94, 95% CI: 3.48–4.46), twofold for mechanism of injury (OR: 2.00, 95% CI: 1.74–2.29), or special considerations (OR: 2.46, 95% CI: 2.36–2.56). Hospitalization odds increased ninefold when positive in multiple steps (OR: 8.97, 95% CI: 8.37–9.62). Overall, n = 84,473 (97.7%) had mortality data available, and n = 886 (1.0%) died. When compared with meeting no criteria, mortality odds increased 10-fold when positive in vitals (OR: 9.58, 95% CI: 7.30–12.56), twofold for anatomy of injury (OR: 2.34, 95% CI: 1.28–4.29), or special considerations (OR: 2.10, 95% CI: 1.71–2.60). There was no difference when only positive for mechanism of injury (OR: 0.22, 95% CI: 0.03–1.54). Mortality odds increased 23-fold when positive in multiple steps (OR: 22.7, 95% CI: 19.7–26.8).

Conclusions:

Patients meeting multiple Centers for Disease Control and Prevention Guidelines for Field Triage of Injured Patients steps were at greater risk of hospitalization and death. When meeting only one step, anatomy of injury was associated with greater risk of hospitalization; vital sign criteria were associated with greater risk of mortality.
Feasibility of Risk Factor–Based Screening for Posttraumatic Stress Disorder in Trauma
Authors: Petersen-Pugmire Karen , Jimenez Brian , Carter Raquiah , Faroqui Naqeeb , Parks Madeline , Bliton John
Published: January 2023

Background:

Posttraumatic stress disorder (PTSD) following traumatic injury can have severe psychiatric consequences. Current recommendations from the American College of Surgeons Committee on Trauma require implementing PTSD screening but specify neither who should be screened nor how. It is unknown whether narrowed screening selection criteria could identify an acceptable proportion of patients with PTSD.

Objective:

This study aimed to determine the feasibility of implementing risk factor–based PTSD screening in trauma patients by evaluating the sensitivity and clinical practicality.

Methods:

This is a prospective diagnostic study of a consecutive series of general ward patients at an urban Level I trauma center from December 2021 to March 2022. Screening indications included (a) interpersonal injury, (b) surgery, (c) intracranial hemorrhage, (d) less than 30 years of age, or (e) clinical suspicion. The protocol was assessed by measuring the proportion of positive screens captured by only clinical suspicion to estimate sensitivity and by qualitatively evaluating barriers to implementation.

Results:

Among the 200 patients screened, the number of patients who screened positive was 51 (25.5%). Eight patients were screened on clinical suspicion alone, seven (87.5%) of whom had positive screens, compared with 44 of the 192 (22.9%) patients who were screened for indications. Thus, 7 of 51 (13.7%; 95% confidence interval: 6.8%–26.7%) patients with PTSD-level symptoms would not have been screened on the basis of their risk factors. There were also practical difficulties in implementation.

Conclusion:

Limiting PTSD screening to only those injured patients with additional risk factors would have reduced overall sensitivity at our center. Consequently, we have implemented universal screening instead.
Navigating Trauma Patients and Families Through Unfamiliar Territory
Authors: Lee Donna B.
Published: January 2023

Background:

Trauma teams work diligently to manage the complex medical needs of trauma patients. In addition to medical care, there is also a need to assist patients and their families as they navigate the emotional and physical journey of trauma. The role of trauma nurse navigator was developed to address these holistic needs.

Objective:

This article aims to describe the implementation of a trauma nurse navigator role.

Methods:

This article describes the development and implementation of a trauma nurse navigator role at a Level II trauma center in 2018. The trauma nurse navigator serves as a patient resource and utilizes creative problem solving to optimize care. The trauma nurse navigator also serves on the multidisciplinary team, working with providers, nursing staff, rehabilitation staff, and case management to provide seamless care to trauma patients.

Results:

Implementation of the trauma nurse navigator role was well received by patients, families, and the multidisciplinary trauma team. The trauma nurse navigator role expanded the psychosocial support of trauma patients and increased patient satisfaction.

Conclusion:

Although other specialties have seen the benefits of including a patient navigator on the team, this is a potential for trauma centers as they strive to provide high-quality patient care.
Double-bundle versus single-bundle anterior cruciate ligament reconstruction in preventing the progression of osteoarthritis: A protocol for systematic review and meta-analysis of randomized controlled trials
Authors: Zhou Yun , Li Linji , Chen Ran , Gong Min
Published: January 2023

Background:

The knee has a high incidence of osteoarthritis (OA) following the anterior cruciate ligament (ACL) injury, which was reduced by ACL reconstruction including double-bundle (DB) techniques and single-bundle (SB) techniques. However, the effectiveness of preventing the progression of OA after the ACL reconstruction using DB and SB techniques is controversial.

Methods:

This meta-analysis was performed following the preferred reporting items for systematic reviews and meta-analyses guidelines. The databases, including PubMed, Embase, and Cochrane Library, were searched. Randomized controlled trials comparing DB with SB ACL reconstruction and reporting clinical outcomes of radiological OA were included. Quality of the included studies was assessed using the Cochrane Collaboration’s risk of bias tool. The outcome was analyzed using the risk ratio (RR) and its corresponding 95% confidence interval (CI).

Results:

Ten Randomized controlled trials studies were included in this meta-analysis (accounting 1062 knees: 475 SB and 587 DB). The rate of radiological OA after the ACL reconstruction was 39% in SB group and 34% in DB group. The results of meta-analysis showed no difference in the occurrence of radiological OA between DB group and in SB group (RR, 1.05; 95% CI, 0.85–1.30, P = .63), including subgroup of radiological scores of OA (subgroup of Minimal OA: RR, 0.95; 95% CI, 0.61–1.48; P = .82; subgroup of Notable OA: RR, 1.16; 95% CI, 0.75–1.78; P = .51), subgroup of follow-up time in 5 years and more than 5 years (RR, 0.98; 95% CI, 0.80–1.20; P = .85), and subgroup of autograft graft for ACL (RR, 0.97; 95% CI, 0.79–1.19; P = .77). However, the DB group had less incidences of knee OA than the SB group in subgroup of less than 5 years (RR, 1.48; 95% CI, 1.13–1.92; P = .004) and subgroup of allograft type (RR, 1.42; 95% CI, 1.06–1.91; P = .02).

Conclusion:

Overall, this meta-analysis showed that the DB technique was no more effective in preventing the progression of OA than the SB technique in ACL reconstruction at midterm follow-up.