bluuebunny/crossref_metadata_2025 huggingface dataset:
Structural basis of water-mediated cis Watson–Crick/Hoogsteen base-pair formation in non-CpG methylation
Authors: Lin Shan-Meng , Huang Hsiang-Ti , Fang Pei-Ju , Chang Chi-Fon , Satange Roshan , Chang Chung-ke , Chou Shan-Ho , Neidle Stephen , Hou Ming-Hon
Published: July 2024

Non-CpG methylation is associated with several cellular processes, especially neuronal development and cancer, while its effect on DNA structure remains unclear. We have determined the crystal structures of DNA duplexes containing -CGCCG- regions as CCG repeat motifs that comprise a non-CpG site with or without cytosine methylation. Crystal structure analyses have revealed that the mC:G base-pair can simultaneously form two alternative conformations arising from non-CpG methylation, including a unique water-mediated cis Watson–Crick/Hoogsteen, (w)cWH, and Watson–Crick (WC) geometries, with partial occupancies of 0.1 and 0.9, respectively. NMR studies showed that an alternative conformation of methylated mC:G base-pair at non-CpG step exhibits characteristics of cWH with a syn-guanosine conformation in solution. DNA duplexes complexed with the DNA binding drug echinomycin result in increased occupancy of the (w)cWH geometry in the methylated base-pair (from 0.1 to 0.3). Our structural results demonstrated that cytosine methylation at a non-CpG step leads to an anti→syntransition of its complementary guanosine residue toward the (w)cWH geometry as a partial population of WC, in both drug-bound and naked mC:G base pairs. This particular geometry is specific to non-CpG methylated dinucleotide sites in B-form DNA. Overall, the current study provides new insights into DNA conformation during epigenetic regulation.
Molecular Insights into MpAGO1 and Its Regulatory miRNA, miR11707, in the High-Temperature Acclimation of Marchantia polymorpha
Authors: Hong Syuan-Fei , Wei Wei-Lun , Pan Zhao-Jun , Yu Jia-Zhen , Cheng Shiuan , Hung Yu-Ling , Tjita Veny , Wang Hao-Ching , Komatsu Aino , Nishihama Ryuichi , Kohchi Takayuki , Chen Ho-Ming , Chen Wan-Chieh , Lo Jing-Chi , Chiu Yen-Hsin , Yang Ho-Chun , Lu Mei-Yeh , Liu Li-Yu Daisy , Lin Shih-Shun
Published: July 2024

As a model plant for bryophytes, Marchantia polymorpha offers insights into the role of RNA silencing in aiding early land plants navigate the challenges posed by high-temperature environments. Genomic analysis revealed unique ARGONAUTE1 ortholog gene (MpAGO1) in M. polymorpha, which is regulated by two species-specific microRNAs (miRNAs), miR11707.1 and miR11707.2. Comparative studies of small RNA profiles from M. polymorpha cellular and MpAGO1 immunoprecipitation (MpAGO1-IP) profiles at various temperatures, along with analyses of Arabidopsis AGO1 (AtAGO1), revealed that MpAGO1 has a low selectivity for a diverse range of small RNA species than AtAGO1. Protein structural comparisons revealed no discernible differences in the guide strand small RNA recognition middle domain, MID domain, of MpAGO1 and AtAGO1, suggesting the complexity of miRNA species specificity and necessitating further exploration. Small RNA profiling and size exclusion chromatography have pinpointed a subset of M. polymorpha miRNAs, notably miR11707, that remain in free form within the cell at 22°C but are loaded into MpAGO1 at 28°C to engage in RNA silencing. Investigations into the mir11707 gene editing (mir11707ge) mutants provided evidence of the regulation of miR11707 in MpAGO1. Notably, while MpAGO1 mRNA expression decreases at 28°C, the stability of the MpAGO1 protein and its associated miRNAs is essential for enhancing the RNA-inducing silencing complex (RISC) activity, revealing the importance of RNA silencing in enabling M. polymorpha to survive thermal stress. This study advances our understanding of RNA silencing in bryophytes and provides groundbreaking insights into the evolutionary resilience of land plants to climatic adversities.
5. Determinant Factors Associated with Blood Pressure Variability in Hypertension: Insights from ABPM Study
Authors: Aini Widyani Fariza Nur , Gushaendri Idman , Firiana Lira , Probo Dewi Paskariatne
Published: July 2024

Background: The increasing use of ambulatory blood pressure monitoring (ABPM) in recent times represents a significant shift in enhancing the diagnosis of hypertension. ABPM, with continuous 24-hour measurements, outperforms conventional office-based methods by accurately portraying blood pressure dynamics throughout daily activities, including blood pressure variability. Blood pressure variability (BPV) has emerged as a strong risk factors for future cardiovascular events and target organ damage.

Objective: This study aimed to present demographic profile and identify the determinants of blood pressure variability of patients who underwent ABPM screening in Gatot Soebroto Army Hospital.

Methods: A retrospective, cross-sectional study was conducted from January to December 2023 with total sample of 159 patients aged 21-86 who underwent ABPM for 24 hours. Variables such as age, gender with ABPM’s parameters including hypertension’s stage and blood pressure variability were recorded. All univariate, bivariate, and multivariate analyses were performed.

Results: Among 159 patients, 92 (57.9%) were female, with 76 patients were elderly (47.8%). Majority had stage I hypertension (32.7%), and Non-Dipper BPV prevailed with 85 patients (53.45%). In bivariate analysis, only age demonstrated statistical significance with BPV (0.000; p<0.05), while gender and hypertension stage showed no significance. Multivariable logistic regression models indicated that age (adjusted OR 7.3, 95%CI 1.62-33.07) leaned more towards dipper variability.

Conclusion: Our study revealed a predominance of elderly female participants displaying non-dipper blood pressure variability. Furthermore, our analysis identified a significant correlation between age and blood pressure variability, suggesting that older individuals, elderly with age 60 and older, tend to exhibit a higher inclination toward dipper variability.
16. The Therapeutic Efficacy of Yoga in Hypertension during Pregnancy for Maternal Health – A Meta-Analysis of Clinical Trials
Authors: Gunawan Felicia Angelica , Homenta Rampengan Derren David Christian , Ramadhan Roy Novri , Amirah Shakira
Published: July 2024

Introduction: Hypertensive pregnancy disorders increase the risk of stroke, placental abruption, and preterm labor, posing potential harm to both mother and baby. Until 2019, hypertensive disorders were responsible for 50% of deaths during maternity. Yoga is an exercise that combines physical postures, breathing exercises, and meditation which could alter bodily functions, such as the nervous system.

Objective: This study aimed to analyze the efficacy of yoga for hypertension among pregnant women.

Methods: The literature search was established through PubMed, ScienceDirect, Google Scholar, and ClinicalKey, resulting in 476 articles. Through duplicate removal, 256 articles were screened based on title and abstract. 7 studies were assessed based on inclusion and exclusion criteria and 3 studies were selected for this meta-analysis Quality appraisal was done using RoB 2.0. Meta-analysis was done using RevMan 5.4.

Results: Meta-Analysis using three studies with 362 participants suggests a significant reduction in Systolic Blood Pressure (SBP) with an overall standardized mean difference of -1.58 mmHg and 95% confidence interval ([95% CI: -2.17 to -0.99], P < 0.0001) compared to the control group, while the analysis focuses on the effect of yoga on Diastolic Blood Pressure (DBP) shows a pooled standardized mean difference of -1.8mmHg with a ([95% CI: -3.95 to 0.34], P = 0.1) compared to control, indicating an insignificant result.

Conclusion: Yoga is more likely to affect systolic blood pressure (SBP) than diastolic blood pressure (DBP) due to increased blood flow during exercise, with SBP changes being more noticeable than DBP changes.
19. Association between Genotype Variation with COVID-19 Severity in Hypertensive Patients: A Systematic Review and Meta-Analysis
Authors: Maulana Rido , Ivan Ignatius , Eka P Bayushi , Sukmawan Renan , Widyantoro Bambang , Adda’i Muhammad Fajri , Santoso Anwar
Published: July 2024

Background: Genetic variations in ACE and ACE2 genes influence COVID-19 severity. Reduced ACE2 availability and increased ACE activity can elevate Angiotensin-II (AngII), contributing to COVID-19-related inflammation.

Objective: We aim to assess the relationship between genetic variations and the severity of COVID-19 in individuals with hypertension.

Method: We followed the 2020 PRISMA guidelines for reporting. We searched Cochrane Library, ProQuest, PubMed, LILACS, ScienceDirect, Springer, and Taylor & Francis from inception to September 24, 2023. Eligible studies included adults (≥18 years) with COVID-19 and hypertension (SBP ≥ 140 and/or DBP ≥ 90 mmHg), employing observational designs, providing data on genetic variations in ACE1, ACE2, or relevant polymorphisms. Methodological quality was evaluated using the Newcastle–Ottawa scale (NOS). Meta-analysis was conducted using RevMan 5.4.1.

Result: We found three case-control studies and one cross-sectional study, generating eight reports in total. The pooled analysis of severe COVID-19 in hypertensive patients with ACE1 polymorphism revealed significant associations in the allele (OR: 2.52; 95%CI, 1.31-4.83; p=0.005), additive (OR: 4.30; 95%CI, 1.04-17.73; p=0.04), and dominant (OR: 2.65; 95%CI, 1.41-4.97; p=0.002) models. Conversely, a protective role against severe COVID-19 in hypertensive patients was indicated in the recessive model (OR: 0.24; 95%CI, 0.07-0.87; p=0.03). Other results yieled no significant association with COVID-19 severity. NOS score for case-controls are 6-8 and cross-sectional are 10.

Conclusion: Our analysis linked ACE1 I/D polymorphism to severe COVID-19 in hypertensive individuals, with no significant relationship observed for ACE2 polymorphism. Additional research is needed given the limited relevant studies.
29. Evaluating the Optimal Timing for Medications in Patients with Essential Hypertension – A Meta-Analysis of Randomized Controlled Trials
Authors: Pradipta LD , Alamsyaputra A , Farissa IP , Harjoko RP
Published: July 2024

Background: Studies has indicated that administering medication at different times may result in varying effects on reducing high blood pressure and outcomes. Regrettably, those numerous studies exhibit contradictory findings.

Objective: This meta-analysis aimed to assess the efficacy of administering drugs for hypertension in the morning compared to the evening.

Method: A search was conducted using various online databases, including PubMed, Scopus, ScienceDirect, and ProQuest, to locate randomized controlled trials (RCTs) that were written in English and published before October 2023. The RCTs examined how reduction of blood pressure, cardiovascular events, heart failure, and cardiovascular death, were affected by dosing in the morning and evening. Independently, two reviewers extracted data and evaluated the quality of the trials. Meta-analysis was performed using Review Manager 5.4 software.

Result: Initial screening yielded 551 studies, 12 RCTs involving 5157 patients with hypertension met the inclusion criteria in this study. Compared to morning treatment, evening administration of hypertensive medication could decrease 24-h systolic blood pressure (SBP) (MD = 3.79, 95%CI = 0.65 – 6.93, p = .02), 48-h SBP (MD = 1.46, 95%CI = 0.53 – 2.39, p = .002), cardiovascular events (OR = 3.3, 95%CI = 2.15 – 3.85, p<.001), heart failure (OR = 2.88, 95%CI = 2.03 – 5.35, p<.001), and cardiovascular death (OR = 4.45, 95%CI = 1.83 – 10.81, p = .001).

Conclusion: This meta-analysis showed that administering medication in the evening could reduce systolic blood pressure, cardiovascular events, heart failure, and cardiovascular death more effectively than in the morning.
34. Efficacy and Safety of Different Duration of Dual Antiplatelet Therapy in Acute Coronary Syndrome Patients with Chronic Kidney Disease: A Systematic Review
Authors: Suryohusodo Aileen A. , Tjhin Charens , Cahyadi Alius , Iryaningrum Maria R.
Published: July 2024

Background: Patients with chronic kidney disease (CKD) have a higher risk for cardiovascular events, including acute coronary syndrome (ACS), because of high inflammation, oxidative stress and endothelial dysfunction. Prolonged usage of dual antiplatelet therapy (DAPT) in this case, might be useful, or it might increase the risk of bleeding.

Objective: To evaluate the efficacy and safety of different duration of dual antiplatelet therapy (DAPT) in patients with concomitant chronic kidney disease and acute coronary syndrome.

Methods: We systematically searched PubMed, Cochrane, and Proquest from inception to July 2023 with the terms “acute coronary syndrome”, “chronic kidney disease”, and “dual antiplatelet therapy”. We included observational studies that assessed the impact of DAPT on major adverse cardiovascular events (MACE) and safety outcomes. Risk of bias assessment was assessed regarding selection, comparability, and outcome.

Results: We included eight studies involving a total of 166,290 participants, six studies with a retrospective design and two studies with a prospective design. The quality of evidence was generally good. Six studies showed a significant difference incidence of MACE in prolonged DAPT administration, which five of them showed a decrease incidence. One study reported a higher 2-year mortality in patients with CKD and prolonged DAPT compared to the general population. Five studies reported no significant difference in bleeding incidence after prolonged DAPT administration.

Conclusion: Prolonged DAPT administration may decrease the risk of MACE with no increased risk of bleeding occurrences in patients with concomitant CKD and ACS.
36. Efficacy Between Sacubitril/Valsartan versus olmesartan in Patients with Essential Hypertension: Systematic Review
Authors: Nathania Florean , Sabran Mohammad Z. , Zebua A. , Harjanto Jovanda A. , Rubismo Kenza Y. , Kurniawan Andree
Published: July 2024

Background: The term “essential hypertension” refers to high blood pressure that is not caused by another medical disease. Obesity, family history, and a bad diet are all possible factors. Presently sacubitril/valsartan or olmesartan is frequently used for essential hypertension as a monotherapy. However, the efficacy of sacubitril/valsartan versus olmesartan remains unclear for essential hypertension.

Objective: Hence, this systematic review aims to evaluate the efficacy between sacubitril/valsartan versus olmesartan as a treatment option in patients with essential hypertension.

Method: We extracted data from the PubMed Central (PMC), Science Direct, and PubMed databases using keywords ((sacubitril/valsartan) AND (olmesartan)) AND (essential hypertension) on December 5th 2023. Eligible studies were selected based on the inclusion and exclusion criteria. Studies included were associated with essential hypertension within the last 5 years, clinical trial, randomized controlled trial, and cohort. We exclude reviews, studies on animal, pediatric patients, case reports and series, meta-analysis, and unavailability of full papers. Then, the quality of studies included was assessed using the JADAD scale.

Result: Through inclusion criterias mentioned above, three studies were extracted from four eligible one. We include 3 randomized controlled trials in this systematic review. We assessed all of the studies using the JADAD scale in decent quality at all. Studies included sacubitril/valsartan exhibited better profile than olmesartan in terms of overall survival for essential hypertension patients.

Conclusion: It is shown that sacubitril/valsartan is superior compared with olmesartan for essential hypertension. However, we need more further research to clarify our results.
41. Effect of Beta-blockers (BB) Use in Heart Failure (HF) Patients with Group I Pulmonary Hypertension (PH): a systematic review
Authors: Septian M. , Rachmawan Y. P. , Pratiwi W.
Published: July 2024

Background: Right HF is the leading cause of death in PH patients, it is hypothesized that BB can be use for by the analogy of its role in left HF. Though, BB use remains contraindicated in pulmonary arterial hypertension (PAH) and it is currently lacking of BB use evidence in PH.

Objective: To summarize various previous studies of beta-blockers efficacy in heart failure patients with group I pulmonary hypertension.

Method: The systematic search was conducted using the electronic databases from PubMed, ScienceDirect and Cochrane library for the specific keywords. The method of selection of articles followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA).

Result: There were 5 studies included in the final qualitative analysis with a total sample size of 804 and consists of 3 cohort studies and 2 case-control studies which compared bisoprolol and carvedilol with placebo. Overall, the outcomes that assessed in all studies were echocardiography assessment, functional or exercise capacity, mortality and clinical worsening or hospitalization. Four studies showed no significant differences in use of BB in PH, van Campen et al revealed bisoprolol use have been decreased 6MWD and cardiac index. A cohort study from Moretti et al found a higher improvement in TAPSE with BB use, though there were no different for mortality, hospitalization and mPAP.

Conclusion: No superior effect from beta-blockers in use for HF patients with pulmonary hypertension in conclusion according to the previous studies. The large randomized controlled trials are needed to validate more this finding.
51. Risk of Hypertension in Women with Polycystic Ovary Syndrome: A Systematic Review
Authors: Resdiani A. , Sitepu M. , Aprami T.M.
Published: July 2024

Background: Polycystic ovary syndrome (PCOS) is the most common endocrine disease among women of reproductive age-. It affects 6-10% of women of reproductive age worldwide and is a common cause of infertility. Women with PCOS are known to be at increased risk of dyslipidemia, hypertension, glucose intolerance, type 2 diabetes and metabolic syndrome. These factors are considered classic risk factors for the development of cardiovascular diseases. A number of researches have been done to assess the risk factors of hypertension in PCOS patients with inconclusive results.

Aim: The exact risk factors and mechanisms regarding hypertension in women with PCOS are limited and unclear. The aim of this review is to summarize comprehensively the current knowledge on the risk factors of hypertension in women with PCOS.

Materials and Methods: Literature search was performed through PubMed, ScienceDirect, Cochrane Library, and Google Scholar (up to December 2023). All relevant articles published in English language were identified and reviewed using Centre for Evidence-based Medicine (CEBM) critical appraisal tool to prevent bias [1-5].

Results: Data collected from patients in three retrospective study and two cross sectional study. All the reports investigate the risk of cardiovascular diseases including hypertension in women with PCOS. The results of the five studies observed PCOS women had higher risk of developing metabolic disorders, including hypertension, obesity, dyslipidemia, insulin resistance and diabetes mellitus. Furthermore, hyperandrogenaemia is associated with elevated blood pressure independent of the patient’s age, insulin resistance, obesity and dyslipidemia.

Conclusion: Available studies show that women with PCOS more frequently have increased cardiovascular risk factors, including hypertension. Patients with PCOS should be screened for these diseases and educated about the lifestyle modifications that could prevent hypertension later in life.
60. Response to Revascularization in Resistant Hypertension Related to Renal Artery Stenosis: A Systematic Review of Case Reports
Authors: Kusumowardani Alivia Retra
Published: July 2024

Background: Treatment for resistant hypertension related to renal artery stenosis is focused mainly through medical therapy. Revascularization is not routinely recommended due to its limited advantage over medical therapy. However, there have been reported cases of revascularization that has improved the patients’ outcome.

Objective: This review of case reports is to identify the characteristics of patients who underwent revascularization and their response after follow up.

Methods: A search through the Medline database for case reports of revascularization in renal artery stenosis published during 2013 - 2023 was conducted.

Result: Nine articles met the criteria, explaining 10 cases. Average blood pressure before revascularization was 170/97 mmHg. Comorbidities mainly were hyperlipidemia and smoking. Medication histories have included calcium channel blockers (10 cases), beta blockers (7 cases), ACEi/ARBs (7 cases), and diuretics (6 cases). Some have also added alpha blockers (4 cases), alpha agonists (3 cases), second diuretics (2 cases), and direct vasodilator (1 case).

After revascularization, average blood pressure was reduced to 126/74 mmHg. Maintenance medications have been lowered from 4 to 2-3 types of medication, including calcium channel blockers (7 cases), beta blockers (4 cases), diuretics (3 cases), ACEi/ARBs (5 cases), alpha blockers (2 cases), and alpha agonists (2 cases). Revascularization has also shown to improve renal functions by increasing eGFR, lowering creatinine levels and proteinuria.

Conclusion: Select revascularization in renal artery stenosis is able to reduce blood pressure and lower the need for multiple maintenance medications in resistant hypertension.
68. Hypertension in Young Adults: An Under-Estimated Problem
Authors: Chandra Sonia , Lukito Antonia A. , Hutabarat Hardi
Published: July 2024

Background: Hypertension among young people affecting in 1 in 8 adults aged between 20 – 40 years. Higher BP at a young age is associated with abnormalities on heart and brain imaging. However, diagnosis rate is lower and treatment is often delayed in young people.

Case illustration: A 32-year-old men presented with shortness of breath and cough frothy sputum. Family history of hypertension. On examination, BP was 180/100, rales in both lungs, and pitting edema. Chest Xray was cardiomegaly with lung edema, and ECG LVH. Laboratory NTproBNP 4429 ng/L. Therefore, patient admitted to intensive, echocardiography result was reduced LVEF 40%, eccentric LVH. After several days BP was controlled, next evaluation test, the result was NTproBNP 1159 ng/L and reduced lung edema and CTR <50%, and the patient discharged with medications furosemide, valsartan sacubitril, dapaglifozin and nebivolol.

Discussion: The young hypertensive population is characterized by low awareness of HT, but already has a high prevalence of prehypertension. Although cardiovascular disease risk remain to be low due to young age, HT is associated with an increased risk of cardiovascular disease. To optimize HT control among young adults was regular physical activity and weight reduction, increasing awareness by regular BP checkup, improving treatment adherence to prevent HT-mediated organ damage.

Result: Several days after discharge, this patient already had go to work without any symptoms, also BP was controlled 110-120/70-80 mmHg.

Conclusion: The management of young onset hypertension is the same as that of older individuals. In this case, education for awareness BP also adherence to medication for better prognosis.
70. Hypertensive Emergency in Pregnancy Requiring Hemodialysis: A Case Report
Authors: Muzakky Muhamad Irvan , Wirdhani Vika , Fauziah Rathi Manjari
Published: July 2024

Background: The prevalence of hypertension in pregnancy in Indonesia reaches 3.3% and becomes the third cause of maternal mortality. Target organ damage, such as cardiorenal failure, can occur as a complication of hypertensive emergencies.

Case Illustration: A 40-year-old woman who was 22 weeks pregnant presented to the ER with progressive worsening dyspnea. She has had a history of uncontrolled hypertension and diabetes mellitus since three years before pregnancy. The initial blood pressure was 212/100 mmHg. Physical examination revealed pale conjunctiva, rales on lung auscultation, oedema in the extremities, and oliguria. Laboratory findings showed hemoglobin 7.4 g/dL, BUN 69.9 mg/dL, and creatinine 4.78 mg/dL. The patient was diagnosed with hypertensive emergency and acute pulmonary oedema due to acute CKD stage 5. She had nicardipine and furosemide and underwent dialysis. Unfortunately, the pregnancy had to be terminated due to fetal distress and IUFD. Blood pressure fell by 25% MAP in the first hour post-nicardipine and clinically improved after initial hemodialysis.

Discussion: Initial management of hypertensive emergencies generally includes the rapid reduction of blood pressure. First-line intravenous drugs include labetalol and hydralazine, but other agents may be used, including esmolol, nicardipine, and nifedipine. In our case, hemodialysis was recommended since the patient had acute pulmonary edema with fluid overload and oliguria, as well as urea levels above 24.9 mmol/L. After five hemodialysis sessions, the patient’s clinical and laboratory results improved.

Conclusion: In a hypertensive emergency, blood pressure must be reduced immediately. Dialysis in pregnancy may be necessary, according to clinical considerations.
71. Acute Ischemic Stroke with Acute Myocardial Infarction, Neurologist or Cardiologist First? A Rarely Reported Case
Authors: Maulana Chandra. A. , Soesanto Septo. A. , Mulawarman Rido , Trifitriana Monica , Yunanda Rizca , Utomo Galuh A. , Tondas Alexander E. , Zulkarnain Edrian
Published: July 2024

Introduction: Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) are both life-threatening medical conditions, bringing lethal prognosis if not addressed immediately. Cardio-cerebral infarction (CCI) term can be used to describe the simultaneous incident of AIS and AMI. However, the approach to immediate management of CCI remains unclear.

Case Illustration: A 51-year-old-man was brought to hospital complaining right-sided paresis without chest pain within 1 hour onset. Vital signs were stable on initial evaluation, with electrocardiography showing: sinus rhythm, HR 120 bpm and anteroseptal wall infarction. CCI was confirmed by non-contrast head computed tomography (CT) scan, showing temporal infarction, and rising Troponin I level.

Discussion: Neurologist was contacted first due to the chief complain, ordering: intravenous Actilyse and Manitol; oral Aspilet, Clopidogrel and Atorvastatin; and intensive care unit admission with interspecialty refferal to cardiologist. After 3 hours, left chest discomfort started growing, hence Furosemid and Morfin were administered by cardiologist. Patient dropped to somnolen state on second day, therefore subcutaneous Diviti and oral Carvilol were prescripted. On third day patient regained his conscioussness and chest discomfort were relieved. On day five, physioteraphy was scheduled and echocardiography was performed showing ischaemic cardiomyopathy with reduced ejection fraction. Thrombus was found on left ventricular apical explaining why CCI could happen.

Result: Patient was discharged after 8 days treatment with a better right-side motoric strength.

Conclusion: This case report shows that neurologist and cardiologist collaboration is needed to take the best decisions for CCI patient, resulting a better outcome that leads to reduction of mortality and morbidity.
77. Correlation of Adherence to Antihypertensive Medications and 10-year Risk Prediction of a Fatal or Non-fatal Major Cardiovascular Event in Hypertensive Patient
Authors: Pratama Bagus , Soraya Alvira Balqis , Indrawan Desta Eko , Kartika Juspeni , Teddy  , Burni Dobi Saputra , Waskito Clara Yulia , Rezkivan Jorghi , Hutasoit Januar Ishak , Ramadhanti Anisa , Halimatunisa Febrina , Pratiwi Jihan Nur
Published: July 2024

Background: Hypertension is the one of high mortality uncommunicable disease (35%) due to cardiovascular complication events. That complications are caused by low of standard hypertension treatment including lack of adherence to antihypertensive medication. The risk prediction of cardiovascular complication event could be simply done with WHO/ISH risk prediction chart. Patient adherence to antihypertensive medication is the main factor determining the success of therapy to preventing of complication.

Objective: To find out the correlation of adherence to antihypertensive medications and 10-year risk prediction of a fatal or non-fatal major cardiovascular event in hypertensive patient

Method: This study used a quantitative descriptive cross-sectional design and accidental-nonprobability-sampling with 150 respondents in Puskesmas Gadingrejo, Pringsewu, Lampung between January-March 2023. Source of research data by measuring the systolic blood pressure, body mass index, cholesterol total, filling out the Morisky Medication Adherence Scale-8 and WHO/ISH 10-year Risk Prediction of a Fatal or Non-fatal Major Cardiovascular Event SEAR-B Chart. Data analyzed using Chi-square test (BxK table).

Result: This research showed data with the most respondent is on age group of 60-69-years-old (40%), women (76%), low-education (40%), unemployed (35,3%), no family history of hypertension (76%), no smoking status (73,3%), absence of diabetes mellitus (82%), no complication (93,3%), normal body mass index (58%), systolic blood pressure between 140-159 mmHg (45,3%), and total cholesterol is 7 mmol/L (36%). Bivariate analysis the significancy results was p=0,000 (p<0,05).

Conclusion: The adherence to antihypertensive medications is correlated to 10-year risk prediction of a fatal or non-fatal major cardiovascular event in hypertensive patient.
Chimeric antigen receptor adoptive immunotherapy in central nervous system tumors: state of the art on clinical trials, challenges, and emerging strategies to addressing them
Authors: Del Baldo Giada , Carai Andrea , Mastronuzzi Angela
Published: July 2024

Purpose of review

Central nervous system (CNS) tumors represent a significant unmet medical need due to their enduring burden of high mortality and morbidity. Chimeric antigen receptor (CAR) T-cell therapy emerges as a groundbreaking approach, offering hope for improved treatment outcomes. However, despite its successes in hematological malignancies, its efficacy in solid tumors, including CNS tumors, remains limited. Challenges such as the intricate tumor microenvironment (TME), antigenic heterogeneity, and CAR T-cell exhaustion hinder its effectiveness. This review aims to explore the current landscape of CAR T-cell therapy for CNS tumors, highlighting recent advancements and addressing challenges in achieving therapeutic efficacy.

Recent findings

Innovative strategies aim to overcome the barriers posed by the TME and antigen diversity, prevent CAR T-cell exhaustion through engineering approaches and combination therapies with immune checkpoint inhibitors to improving treatment outcomes.

Researchers have been actively working to address these challenges. Moreover, addressing the unique challenges associated with neurotoxicity in CNS tumors requires specialized management strategies. These may include the development of grading systems, monitoring devices, alternative cell platforms and incorporation of suicide genes. Continued research efforts and clinical advancements are paramount to overcoming the existing challenges and realizing the full potential of CAR T-cell therapy in treating CNS tumors.
Descemet Membrane Endothelial Keratoplasty for Late Corneal Edema Secondary to Obstetrical Forceps–Related Tears
Authors: Herskowitz William R. , Seery Christopher W. , Camacho Matthew , Dubovy Sander , Koo Ellen H.
Published: July 2024

Purpose:

The purpose of our paper is to describe the outcome of Descemet membrane endothelial keratoplasty (DMEK) in patients with a history of known obstetrical forceps–related tears who developed clinically significant corneal edema in their eighth decade of life.

Methods:

Case series.

Results:

Two patients with a known history of obstetrical forceps–related tears presented with corneal edema and vertical tears of Descemet membrane consistent with birth trauma. DMEK was performed for both cases. Case 1 underwent pseudophakic DMEK, and Case 2 underwent combined phacoemulsification and DMEK (triple-DMEK). DMEK grafts were fully attached in both cases at postoperative 1-day and 1-week appointments, as confirmed on slit-lamp examination and anterior segment optical coherence tomography. There was marked improvement in best-corrected visual acuity and corneal edema in both patients.

Conclusions:

We demonstrate that DMEK can afford excellent results in patients with a history of obstetrical forceps injury, who experience corneal edema later in life. In addition, we show that the triple-DMEK can be done successfully in this entity.
Alterations in Neural Activation During Facial Emotion Processing in Adolescent Male Participants With Klinefelter Syndrome
Authors: Vreeland Allison , Reiss Allan L. , Ross Judith , Foland-Ross Lara C.
Published: July 2024

Objective:

Klinefelter syndrome (KS) is the most common sex-chromosome aneuploidy (47,XXY), affecting 1 in 500 male participants. The phenotype of male participants with KS includes both physical features, such as tall stature and testicular insufficiency, and behavioral alterations, including difficulties in social functioning, anxiety, and depression. Studies examining underlying neural alterations associated with the behavioral phenotype, however, are sparse. We aimed to address this gap in knowledge using functional magnetic resonance imaging in conjunction with an emotion processing paradigm.

Method:

Functional magnetic resonance imaging was conducted on 38 children and adolescents with KS (M
age = 12.85, SD = 2.45) and 47 typical developing (control) boys (M
age = 12.04, SD = 1.82) as they completed a facial emotion processing task. Group differences in activation occurring during the processing of angry versus neutral faces were examined while controlling for age.

Results:

The results indicated that relative to typically developing boys, boys with KS exhibited anomalous increases in activation of frontal, temporal, and occipital cortices. Within the KS group, secondary analyses indicated that greater activation in these regions was associated with more internalizing symptoms (e.g., anxiety, depression, withdrawn behaviors) and greater social impairments (e.g., social cognition, social communication, social motivation, social communication and interaction, functional communication).

Conclusion:

The findings from this study indicate a possible neural correlation for difficulties in social and emotional function in KS and add to a growing body of research aimed at increasing our understanding of neural biomarkers in this condition. Future studies that examine the influence of testosterone-replacement therapy on these differences are warranted.
Behavioral Intervention that Extends Sleep Duration Leads to Greater Self-Control in School-Aged Children
Authors: Spaeth Andrea M. , Hawley Nicola L. , Carskadon Mary A. , Raynor Hollie A. , Jelalian Elissa , Owens Judith A. , Wing Rena R. , Hart Chantelle N.
Published: July 2024

Objective:

Short sleep and evening phase preference associate with impaired self-control, yet few studies have assessed the efficacy of sleep extension for improving this behavioral domain. Thus, this secondary analysis of a behavioral sleep intervention measured whether an intervention that enhanced children's sleep also affected self-control. Differences by chronotype were also explored.

Methods:

Sixty-seven children (8–11 yr), who reportedly slept <9.5 hr/d, were randomized to either a control or sleep intervention condition (i.e., 4-session behavioral intervention to enhance sleep by 1–1.5 hr/night). Chronotype was assessed using the Child Chronotype Questionnaire at baseline, and self-control was assessed using the Self-Control Rating Scale (SCRS, a caregiver report) at baseline and 8 weeks postrandomization. Total sleep time (TST) was measured using wrist actigraphy for 1 week at both baseline and 8 weeks postrandomization. Partial correlations and mixed-model ANOVAs were used for statistical analyses, with age as a covariate.

Results:

At baseline, children with shorter TST (r = −0.29, p = 0.02) and an evening preference (r = 0.26, p = 0.049) were perceived as having lower self-control by their caregivers. Significant condition*time interaction effects were found for TST (p < 0.001) and SCRS score (p = 0.046): From baseline to follow-up, children randomized to the sleep intervention exhibited a significant increase in TST and were perceived as having greater self-control by their caregiver; children randomized to the control condition exhibited no change in TST or in SCRS score. The condition*chronotype*time interaction effect was not significant.

Conclusion:

A brief sleep intervention that enhanced TST also resulted in enhanced caregiver reported self-control in school-age children. Results add to the growing evidence for the importance of sleep health in children.
Comparison of intravenous versus perineural dexamethasone as a local anaesthetic adjunct for peripheral nerve blocks in the lower limb
Authors: Desai Neel , Pararajasingham Suji , Onwochei Desire , Albrecht Eric
Published: July 2024

BACKGROUND

As a local anaesthetic adjunct, the systemic absorption of perineural dexamethasone in the lower limb could be restricted because of decreased vascularity when compared with the upper limb.

OBJECTIVES

To compare the pharmacodynamic characteristics of intravenous and perineural dexamethasone in the lower limb.

DESIGN

Systematic review of randomised controlled trials with meta-analysis.

DATA SOURCES

Systematic search of Central, Google Scholar, Ovid Embase and Ovid Medline to 18 July 2023.

ELIGIBILITY CRITERIA

Randomised controlled trials, which compared the intravenous with perineural administration of dexamethasone as a local anaesthetic adjunct in peripheral nerve blocks for surgery of the lower limb.

RESULTS

The most common peripheral nerve blocks were femoral, sciatic and ankle block. The local anaesthetic was long acting in all trials and the dose of dexamethasone was 8 mg in most trials. The primary outcome, the duration of analgesia, was investigated by all nine trials (n = 546 patients). Overall, compared with intravenous dexamethasone, perineural dexamethasone increased the duration of analgesia from 19.54 to 22.27 h, a mean difference [95% confidence interval (CI) of 2.73 (1.07 to 4.38) h; P = 0.001, I
2 = 87]. The quality of evidence was moderate owing to serious inconsistency. However, analysis based on the location of the peripheral nerve block, the type of local anaesthetic or the use of perineural adrenaline showed no difference in duration between intravenous and perineural dexamethasone. No differences were shown for any of the secondary outcomes related to efficacy and side effects.

CONCLUSION

In summary, moderate evidence supports the superiority of perineural dexamethasone over intravenous dexamethasone in prolonging the duration of analgesia. However, this difference is unlikely to be clinically relevant. Consideration of the perineural use of dexamethasone should recognise that this route of administration remains off label.
Potential for organ donation after controlled circulatory death: a retrospective analysis
Authors: Dias Francisco Santos , Fernandes Diana Martins , Cardoso-Fernandes António , Silva Adriana , Basílio Carla , Gatta Nuno , Roncon-Albuquerque Roberto , Paiva José Artur
Published: July 2024

Objectives:

Despite the discrepancy between demand and availability of organs for transplantation, controlled circulatory death donation has not been implemented in Portugal. This study aimed to estimate the potential increase in organ donation from implementing such a program.

Material and Methods:

All deceased patients within the intensive care medicine department at Centro Hospitalar Universitário de São João, throughout the year 2019, were subjected to retrospective analysis. Potential gain was estimated comparing the results with the number of donors and organs collected during the same period at this hospital center. Differences in variables between groups were assessed using t tests for independent samples or Mann–Whitney U tests for continuous variables, and chi-squared tests were used for categorical variables.

Results:

During 2019, 152 deaths occurred after withdrawal of life-sustaining therapies, 10 of which would have been potentially eligible for donation after controlled circulatory death. We can anticipate a potential increase of 10 prospective donors, a maximum 21% growth in yearly transplantation activity, with a greater impact on kidney transplantation. For most patients, the time between withdrawal of organ support and death surpassed 120 minutes, an outcome explained by variations in withdrawal of life-sustaining measures and insufficient clinical records, underestimating the potential for controlled circulatory arrest donation.

Conclusion:

This study effectively highlights public health benefits of controlled circulatory arrest donation. Legislation allowing donation through this method represents a social gain and enables patients who will never meet brain death criteria to donate organs as part of the end-of-life process in intensive care medicine, within a framework of complete ethical alignment.
Association of serum creatinine trajectories with 1-year mortality after valvular heart surgery: a retrospective cohort study
Authors: Cho Jin Sun , Choi Mingee , Shim Jae-Kwang , Park Jin Ha , Shin Hye Jung , Choi Hee Won , Kwak Young-Lan
Published: July 2024

Background:

Acute renal dysfunction is defined by the maximum increase in serum creatinine (sCr) without considering the pattern of change in sCr. We aimed to identify longitudinal patterns (trajectories) of postoperative sCr concentrations and investigate their association with long-term outcomes in patients undergoing valvular heart surgery.

Materials and methods:

In this retrospective review of 3436 patients who underwent valvular heart surgery, we applied trajectory projection cluster analysis to identify the trajectories of sCr changes from baseline during the 7 postoperative days. Primary and secondary endpoints were to investigate the associations of sCr trajectories with mortality using Kaplan–Meier curves and Cox proportional hazards regression analysis and a composite of major adverse kidney events (MAKEs) at 1 year after surgery, respectively.

Results:

Four clusters were identified: Clusters 1 and 2, a minimal change in sCr (90.1% of patients); Cluster 3, a significant and persistent increase in sCr (4.1% of patients); and Cluster 4, a significant but transient increase in sCr (5.8% of patients). The 1-year postoperative mortality rate was higher in Cluster 3 (18.4%) and Cluster 4 (11.6%) than in Cluster 1+2 (2.7%). The Kaplan–Meier survival curve demonstrated significant differences in mortality rates among the clusters (log-rank test, P<0.001). In the multivariable Cox analysis, the sCr trajectory cluster was an independent prognostic factor for mortality. Cluster 3 had a higher prevalence of MAKEs (37.6%) compared with Cluster 1+2 (6.8%, P<0.001) and Cluster 4 (24.1%, P=0.045). The cluster was an independent prognostic factor for MAKEs.

Conclusion:

The sCr trajectory clusters exhibited significantly different risks of mortality and MAKEs 1 year after surgery. Through these sCr trajectories, we confirmed that both the extent of sCr increase and its sustainability during the first 7 postoperative days were closely associated with the long-term prognosis after valvular heart surgery.
From Research on TCM Images to Historiography of TCM Images——Comments on History of Chinese Image Culture: Medical Image Volume
Authors: WEI Ran , HUANG Zuozhen
Published: July 2024

Zhong Hua Tu Xiang Wen Hua Shi Yi Yao Tu Xiang Juan (《中华图像文化史•医药图像卷》History of Chinese Image Culture: Medical Image Volume) is a history of images of Chinese medicine. This work meticulously traces the evolution of Chinese medicine from the pre-Qin and Han dynasties through to the late Qing dynasty and the Republican era, utilizing a rich array of medical and non-medical images. Through detailed analysis and interpretation of these images, the volume reconstructs the developmental trajectory of traditional Chinese medicine (TCM) theories, while also revealing the impact of ideological, cultural, and societal contexts on medical culture and theoretical advancement. Zhong Hua Tu Xiang Wen Hua Shi Yi Yao Tu Xiang Juan has pushed the research of Chinese medical images from purely literary studies to a broader historical context, broadened the research object of Chinese medical history, and constructed a basic framework for the new research field of image medical history. The book not only facilitates a deeper understanding of TCM's historical and contemporary developments, but also holds significant value for scholars engaged in historical literature research or clinical practice, aiming to integrate historical insights.
Progress for all: addressing disparities in sarcoidosis
Authors: Obi Ogugua Ndili , Sharp Michelle , Harper Logan
Published: July 2024

Purpose of review

The impact of healthcare disparities in the treatment, care, and outcomes of patients with sarcoidosis has been described. There is paucity of literature on ways to address these disparities with a goal to improving health outcomes for patients with sarcoidosis.

Recent findings

Recent findings in other respiratory and systemic diseases suggest that multifaceted interventions directed at improving care at various levels including individual, family, and larger societal levels have been successful in dismantling some of the social and structural barriers to care and consequently have resulted in a reduction in disparate disease outcomes. We explore what some of these interventions would look like in sarcoidosis.

The impact of healthcare disparities in the treatment, care, and outcomes of patients with sarcoidosis has been described. We outline various steps and approaches aimed at addressing these health disparities with a goal to improving outcomes for those most impacted by disease.
Optimal long-term anticoagulation after acute pulmonary embolism: current state of the art and a look into the near future
Authors: Kimmerle Andreas Rainer , Noflatscher Maria , Raggam Reinhard Bernd
Published: July 2024

Purpose of review

This review aims to summarize the current state of the art and future directions in optimal long-term anticoagulation following acute pulmonary embolism (PE).

Recent findings

Actual studies and guidelines underscore the preference for direct oral anticoagulants (DOAC) in standard therapeutic doses for maintenance therapy post-PE, while considering patient-specific factors and dose-reduction criteria. Risk stratification should always include the assessment of concomitant trigger- or risk factors regarding their strength and persistence. The use of tools like specific scores can facilitate the identification of optimal candidates for long-term therapy, emphasizing once more personalized approaches and strategies. Special patient groups, such as cancer associated thrombosis, chronic thromboembolic pulmonary hypertension or antiphospholipid syndrome require even more tailored therapy approaches.

Optimal long-term anticoagulation post-PE should be guided by straightforward and individual risk assessment strategies. The array of indications for DOACs has gotten wider in last years, also within special patient groups. Still, chronic thromboembolic pulmonary hypertension and antiphospholipid syndrome remains domain of vitamin K agonists.