bluuebunny/crossref_metadata_2025_split huggingface dataset:
P174 MAGNESIUM IMPROVES METABOLIC PROFILE AND HYPERTENSION
Authors: Kisters Klaus , Kisters Sophia , Hausberg Martin 
Published: September 2024

Background and Objective:
Magnesium is an essential electrolyte involved in about 600 enzymatic reactions and metabolic processes. Recent data show that nutritive magnesium supplementation decreases interleukin-6 levels and metabolic parameters.

Patients and Methods:
We conducted a prospective double-blinded, prospective study on magnesium and interleukin-6 and blood pressure values in 27 patients with a metabolic syndrome as compared to 27 controls (all patients beyond 60 years with normal renal function). Patients were supplemented with 400 mg magnesium daily. Measurements of parameters were performed before and after 6 and 12 weeks of treatment.

Results:
In the magnesium-treated group, interleukin-6 values decreased significantly from 4.94+/-3.30 to 4.53+/-6.89 after 6 weeks to 3.01+/-1.32pg/mL after 12 weeks (mean+/-SD, p < 0.01). In the control group, interleukin-6 was 3.73+/-4.36 before the start of supplementation, 4.87+/-4.35 after 6 weeks, and 4.41+/- 3,15 pg/mL after 12 weeks (n.s.). In the magnesium-treated group, there was also a significant decrease in both systolic and diastolic blood pressure after 12 weeks (systolic: 134.6+/-6.8 to 126.3+/-5.6 mmHG; diastolic: 84.1+/-3.9 to 79.4+/-1.6 mmHg)(mean+/-SD, p< 0.01).
HbA1c and lipd profile increased in patients slightly not reaching significane. Vitamin D status also improved significantly in patients after 12 weeks (p< 0.05).
For statistics Mann-Whitney U test was used.

Conclusions:
In patients wit metabolic syndrome, magnesium supplementation significantly decreased interleukin-6 and both systolic and diastolic blood pressure values, vitamin D significantly increased. Metabolic parameters improved. The anti-inflammatory effects of magnesium as well as anti-arteriosclerotic effects are of benefit for patients with a metabolic syndrome at a high risk for cardiovascular diseases and mortality.
P191 CO-EXISTING HYPERTENSION: AN INDEPENDENT RISK FACTOR FOR DIABETIC RETINOPATHY IN TYPE-2 DIABETES
Authors: Bukht Mohammad Sadaat , Ahmed Kazi Rumana 
Published: September 2024

Background and Objectives:
Hypertension has plausible reason to be show the interaction due to its independent effect on retina. Epidemiological studies also provide clue that for hypertension as a possible effect modifier in the risk development of retinopathy in diabetic patients. It is worth exploring whether subgroup in diabetic population with Hypertension have different risk potential of developing retinopathy. The present study aimed to assess the association of hypertension as a risk factor for diabetic retinopathy (DR) in type 2 diabetes mellitus.

Methods:
A total of 977 type-2 diabetic patients recruited retrospectively in 2008 from Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorder (BIRDEM) based on hospital records for determining the incidence of diabetic retinopathy (DR), who were naı̈ve type-2 diabetes during 1993. At the end of 15 year follow-up 495 patients were diagnosed as DR by retinal colour photography. Data on diabetes and lipid profile with serum creatinine, blood pressure and biophysical measures were obtained at baseline, 5, 10 and 15 years follow-up. Binary logistic regression model was used to assess the associations of co-existing hypertension with retinopathy risk adjusting for clinical, biochemical and anthropometric variables.

Results:
In all three follow-up points, including at baseline, mean systolic and diastolic blood pressure were found to significantly higher among patients who developed DR (P<.001). Binary logistic regression model confirmed coexisting hypertension (OR 3.2; 95% CI 2.2 -4.7) as a significant risk factor of DR adjusting for possible confounders; serum creatinine (OR 21.9; 95% CI 14.0 -35.4) and glycemic control status (OR 17.2; 95% CI 9.4 -31.4). Interaction between hypertension, glycemic control and raised serum creatinine did not appear to be statistically significant (P>0.05).

Conclusions:
Co-existing hypertension is a significant risk factor of DR irrespective of nephropathy or glycolic control status among Type 2 diabetes mellitus.
P193 BLOOD PRESSURE CHANGES IN THE IMMEDIATE POST OPERATIVE PERIOD OF LIVE-RELATED KIDNEY DONORS IN AN INDIAN COHORT: SHOULD WE BE LOOKING MORE?
Authors: Chavan Abhijit , Singh Narinder Pal , Dighe Tushar , Sajgure Atul , Yadav Prabhakar , Bale Charan , Wakhare Pavan , shinde Nilesh , kulkarni Akshay 
Published: September 2024

Background & Objective:
Kidney donation is associated with physiological changes (hyperfiltration, changes in renin-angiotensin-aldosterone system & vascular tone) and its effects can be more pronounced in the elderly. The immediate reduction in GFR after nephrectomy can pose a risk for development or worsening of hypertension. There is a paucity of data determining the impact of reduced GFR on BP in post-operative period. Our study aims to analyze the hemodynamics in the post-operative period after nephrectomy.

Methods
This was a prospective observational study of 30 donors who underwent live-related Donor Nephrectomy. Parameters like demography, pre- and post-nephrectomy BP (reading taken daily for every 3 hours till post-operative day (POD) 4 using BPL oscillometric device) were studied. Continuous variables were were expressed as mean & standard deviation. The Student's paired t-test was used for comparison using SPSS Windows software.

Results
The age of donors ranged from 23-73 years. Mean SBP/DBP was 112.69 ± 5.44/76.77 ± 3.78 mmHg in donors <50 years, while in donors aged >50 years the mean SBP/DBP was 126.6 ± 7.9/81.7 ± 3.82 mmHg. Post-donation in donors aged <50 years (17 donors), mean S.B.P/DBP on POD 1 was 108.38 ± 4.77/76.20 mmHg followed by 108.92 ± 4.24/76.84,110.12 ± 5.42, 114 ± 4.8/78.88 ± 2.66 on POD-2, 3 & 4 respectively. After Nephrectomy in donors aged more than 50 years(13 donors), mean SBP/DBP on POD 1 was 124.38 ± 4.56/78.20 mmHg followed by 126.40 ± 4.54/79.88,127.72 ± 6.22, 130.22 ± 3.8/84.58 ± 4.24 on POD-2, 3 & 4 respectively. The BP on POD-4 was significantly higher in donors with age more than 50 years than donors with age less than 50 years (p<0.05).

Conclusion:
After nephrectomy, blood pressure changes in the immediate post-operative period in the elderly need to be monitored closely. Frequent BP monitoring after nephrectomy should be implemented to determine risk of HTN in kidney donors.
P203 IMPACT OF IMPLEMENTING A COMMUNITY CARE STRATEGY TO REDUCE THE RISK OF CARDIOVASCULAR DISEASE IN SANTANDER, COLOMBIA: PRELIMINARY RESULTS OF THE RE-HOPE STUDY
Authors: Giraldo-Castrillon Yessica , Hernandez-Quiñones Daniela , Sanchez-Martinez Yuri , Martinez-Bello Daniel , Otero-Wandurraga Johanna , Castañeda-Hernandez Alvaro , Lopez-Lopez Jose P. , Jaramillo Patricio López 
Published: September 2024

Background:
Hypertension is the main risk factor of cardiovascular disease (CVD), affecting 1.28 billion adults and resulting in 1.16 million deaths. In Colombia, hypertension affected 7.8 million adults in 2019. Different sociocultural and health system-related barriers may interfere with hypertension management. Our aim was to determine the preliminary impact of this community-based strategy on the changes in hypertension control in Colombia.

Methods
The Re-Hope study is a community-based strategy to reduce CVD risk in 13 municipalities of Santander, Colombia. Nursing assistants referred patients to the cardiovascular risk program (CVRP), facilitated medical appointments, and provided health counseling. A longitudinal analysis was conducted on data from the first three follow-up visits. Included were adults >18 years with hypertension not enrolled in the CVRP. Standardized questionnaires gathered sociodemographic, medication, and lifestyle data. Anthropometric and blood pressure measurements were taken. Hypertension was defined as systolic BP >140 mmHg, diastolic BP >90 mmHg, self-reported hypertension, or antihypertensive medication use. Pharmacological adherence was assessed with the Morisky 4-item scale. Tobacco and alcohol use were categorized as never or current consumers. Blood pressure changes were evaluated with a paired t-test, and categorical variable changes with McNemar and Stuart-Maxwell tests. Analysis was done using Stata software.

Results
A total of 2,585 participants were included. The mean age was 65.1 years (SD 11.9) and 64.3% were women. After 6 months of follow-up, the mean systolic and diastolic blood pressure reduced 17.03 mmHg (SD 17.95) and 7.04 mmHg (SD 11.22), respectively. Hypertension control increased on 11.7%. Antihypertensive combination therapy increased by 4.4% for dual therapy and 4.6% for triple therapy. The low pharmacological adherence was reduced by 3.35%.

Conclusions
The implementation of a community-based care strategy in Santander at the first three visits achieved a relevant reduction of hypertension values and greater use of combined antihypertensive therapy. Continuation of the study is required to identify the total results.
P214 PREDICTION OF AMBULATORY BRACHIAL CUFF-BASED OSCILLOMETRIC PULSE WAVE VELOCITY USING A NOVEL METHOD FOR ESTIMATING TOTAL ARTERIAL COMPLIANCE
Authors: Gallo-villegas Jaime , Álvarez-Montoya Diego , Aristizábal-Ocampo Dagnovar 
Published: September 2024

Background and Objective:
Total arterial compliance (Ct) serves as a critical determinant of arterial hemodynamics, providing insights into the mechanical and structural characteristics of large arteries and influencing ventricular-arterial coupling. To estimate Ct, we developed a method utilizing data from 24-hour ambulatory blood pressure monitoring (24-h ABPM) recordings. Our objective is to evaluate the reliability of Ct in estimating oscillometric pulse wave velocity (oPWV), with the potential to eliminate the requirement for additional oPWV measurements.

Methods:
A cross-sectional study was conducted, involving 162 patients who underwent 24-h ABPM, resulting in a total of 8,113 blood pressure (BP) recordings. oPWV was measured during 24-h ABPM using a Custo Screen 310 device (Custo, Ottobrunn, Germany), which has been validated. Ct was estimated employing a two-element Windkessel model based on mean systolic pressure. The formula utilized for Ct estimation was Ct/BSA= (38/PPth)×(4/5)×(Td/T)-(3/7), where BSA denotes body surface area, Td represents diastolic time, T signifies the cardiac period, and PPth denotes theoretical pulse pressure. A linear regression model (LRM) was developed to estimate oPWV from Ct.

Results:
Among the participants, 55.1% were men, with an average age of 55.7±16.2 years and a body mass index of 27.4±3.7 kg/m2. The analyzed records revealed an average systolic blood pressure of 125.6±18.7 mmHg, diastolic blood pressure of 79.5±12.2 mmHg, heart rate of 71.0±12.2 beats per minute, Ct of 0.9±0.3 mL/mmHg, and oPWV of 7.2±1.8 m/s. The best predictive model (R2=0.42; r=0.65) for oPWV was based on the ratio of systolic time (Ts) to Ct as follows: oPWV=3.3 × 6.0 ×[Ts/(Ct/BSA)]. Indexed Ct demonstrated an inverse relationship with oPWV (Figure). Residuals analysis confirmed compliance with assumptions.

Conclusions:
The Ts/Ct ratio inversely predicts oPWV, indicating an inverse relationship between Ct and oPWV in this population. These findings suggest that estimated Ct has the potential to replace oPWV in clinical practice for cardiovascular risk stratification.
Radiographic Accuracy of Identifying Anterolateral Tibial Plafond Involvement in Pronation Abduction Ankle Fractures
Authors: Robles Abrianna S. , Rockov Zachary A. , Gross Melissa M. , Ewing Brett A. , Lieder Charles M. , Weatherford Brian M. , Levack Ashley E. , Garlich John M. , Haller Justin M. , Earhart Jeffrey S. , Marecek Geoffrey S. 
Published: September 2024

OBJECTIVES:
To evaluate the incidence of anterolateral tibial plafond involvement in pronation-abduction (PAB) ankle fractures and analyze the accuracy of radiographs in detecting anterolateral tibial plafond involvement, impaction, and predicting the need for direct visualization and an articular reduction.

METHODS:

Design:
A multi-institutional retrospective chart review.

Setting:
Five Level 1 trauma centers in the United States.

Patient Selection Criteria:
Adult patients with PAB ankle fractures (OTA/AO 44B2.3, 44C2.2, 44C2.3) from 2020 to 2022 were reviewed by 7 fellowship-trained orthopaedic trauma surgeons. They were queried about the presence of anterolateral tibial plafond involvement and impaction, and whether they would need direct visualization and an articular reduction using both radiographs and CT.

Outcome Measurements and Comparisons:
The presence of anterolateral tibial plafond impaction was tabulated separately using radiographs and CT scans. The accuracy of radiographs and changes in surgical plan after CT review were calculated using CT as the gold standard.

RESULTS:
Sixty-one fractures in 61 patients were evaluated using CT and/or plain radiographs. Using plain radiographs, anterolateral tibial plafond involvement and impaction were identified in 61% and 36% of cases, respectively. In the 38 fractures with both plain radiographs and CT scans, anterolateral tibial plafond involvement was identified in 66% of radiographs and 74% of CT scans (P = 0.4). Plafond impaction was identified in 42% of plain radiographs and 37% of CT scans (P = 0.62). There was no difference in the rate of involvement between radiographs and CT scan. The diagnosis of anterolateral tibial plafond impaction using plain radiographs was correct in 74% of fractures when compared with using CT imaging, resulting in a sensitivity of 71%, a specificity of 75%, a positive predictive value (PPV) of 62%, and a negative predictive value (NPV) of 82%. Plain radiographs correctly predicted the need for direct visualization and an articular reduction in 74% of cases and had a PPV of 59% and an NPV of 86%.

CONCLUSIONS:
Anterolateral tibial plafond involvement and impaction were present on CT in 74% and 37% of pronation-abduction (PAB) ankle fractures, respectively. Plain radiographs had higher NPV for identifying impaction and the need for articular reduction than they did sensitivity, specificity, or PPV. CT is an important tool for preoperative planning that should be considered when planning for operative fixation of PAB ankle fractures.

Level of Evidence:
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Comparison of Rural and Urban Differences in Geographic Proximity to Outpatient Stroke Rehabilitation Services in Tennessee
Authors: Tran Phoebe M. , Fogelson Benjamin , Heidel Robert E. , Baljepally Raj 
Published: September 2024

Purpose:
Great travel distances and long travel times can be barriers to outpatient stroke rehabilitation services (OSR) receipt, but there is limited information on differences in proximity to specific OSR services between urban and potentially medically underserved rural areas. Accordingly, we compared travel distance and time to the nearest service for different OSR services between rural and urban counties in Tennessee.

Methods:
We conducted data scraping on Google Maps to locate Tennessee facilities offering any of the 13 American Heart Association recognized OSR services. We conducted manual validation by calling located facilities and visiting facility websites. We used the Wilcoxon rank sum test to examine if mean travel distance and time to a specific OSR service differed significantly between rural and urban counties.

Results:
All OSR services but audiology were available in Tennessee. In rural counties, social work had the highest median of mean travel distance (135.2 km), chaplaincy the highest median of mean travel time (113.5 min), and physical therapy the lowest distance (37.7 km) and time (36.3 min). Except for social work, rural counties had significantly higher travel distance and time than urban counties (P < .01) for all OSR services.

Conclusions:
Rural Tennessee counties had significantly higher travel distance and time for almost all OSR services compared to urban areas. These findings from a largely rural state with high stroke risk factor prevalence suggest that additional focus on establishing maximum travel limits for OSR are warranted to overcome transportation barriers to enhance post-stroke services access in similar areas.
Role and Outcomes of Supported Community Living Programs in Post-Hospital Brain Injury Rehabilitation Programs
Authors: Logan Daniel M. , Parrott Devan , Altman Irwin M. , Eicher Vicki , McGrath Claire , Salisbury David B. , Walters G. Joseph , Malec James F. 
Published: September 2024

Objectives:
(1) To determine the proportion of participants admitted to supported community living (SCL) programs over the course of 5 years who improve, decline, or maintain functioning and community integration and (2) to examine the associations of time since injury, time in program, and age to their functional trajectory.

Setting:
Data from SCL programs serving individuals with acquired brain injury (ABI).

Participants:
104 individuals with traumatic brain injury (TBI), stroke, or other ABI.

Main Measures:
Sex, age, time since injury, Mayo-Portland Adaptability Inventory (4th edition; MPAI-4).

Design:
Retrospective analyses of MPAI-4 total and MPAI-4 indices using Linear Mixed Models (LMM) of Rasch-derived T-scores from admission to 5 years into service delivery.

Results:
MPAI-4 total, index, and subscale scores for yearly intervals of SCL services from admission to 5 years showed a high degree of stability in function (defined using the standard error of measurement (SEM) for the MPAI-4, defined as change ≥3 T-score points) with all intervals showing at least 89% of patients with improved scores or no change. The rate of change over time did not significantly vary by time since injury, time in the program, or age.

Conclusions:
The expectations for services in the SCL portion of the care continuum for ABI are unique. Unlike intensive rehabilitation programs which focus on improvement often earlier in the course of recovery, the goal of SCL services is sustained functioning over the long term. Analyses reported here indicate this can be achieved for at least 5 years, potentially mitigating the increased risk for rehospitalization and increased care needs in the ABI population. This study highlights a key finding of MPAI-4 stability within these understudied brain injury service lines. Additional exploration of comorbidities and more nuanced delineation of diagnostic information could further clarify factors influencing outcome stability over time.
Global analysis of vasoactive agents in septic shock management: Exploring trends and bridging knowledge gaps
Authors: Sharifan Amin 
Published: September 2024

Background:
The swift administration of vasoactive agents is essential for effectively managing septic shock. However, the unavailability of norepinephrine—the primary recommended agent—in certain clinical settings necessitates the exploration of alternative solutions. This study aimed to identify both the key focus areas and the under-researched aspects related to this topic.

Methods:
The Scopus database was searched from inception until August 2, 2024, using a comprehensive list of keywords related to the topics of “septic shock”, “vasopressors”, and “hypotension”. Articles lacking original data, namely narrative reviews, errata, corrections, and conference papers, were excluded from the analysis. No language restrictions were applied. The retrieved search results were examined for publication and citation trends, international contributions by countries and institutions, keyword usage, and funding sources. Data visualization was accomplished using VOSviewer, the built-in Scopus analyzer, the bibliometrix R package, and Microsoft Excel.

Results:
A total of 7474 publications were retrieved. These studies were published between 1958 and 2024, with the year 2022 representing the highest number of publications, and 2016 having the most citations. While publications had raised until 2022 and dwindled since then, citations had fluctuating patterns throughout the years. The research landscape was marked by contributions from 207 countries, with 160 institutions publishing at least 22 studies each. The United States emerged as the leader in both publications and international collaborations in this field, followed by France, the United Kingdom, China, and Germany. Notably, all of the top 20 countries in terms of publication volume were classified as high-income or upper-middle-income nations, except India. This disparity can largely be explained by the differences in funding allocated to studies in these countries. Furthermore, 28,442 keywords relevant to this topic were collected. The demographic representation in the studies showed a predominance of males and older adults compared to their counterparts and a significant proportion of the studies were clinical investigations. Among the various vasopressors examined, terlipressin, angiotensin II, methylene blue, and selepressin were identified as the least studied agents.

Conclusion:
Consensus definitions and statements in critical care, particularly for controversial topics, are essential for enhancing communication and improving patient care. There is a need for prioritized research and funding in the Global South regarding enhanced septic shock management. Further studies on vasoconstrictor agents with limited evidence are warranted to strengthen the body of knowledge in this area.
The role of new inflammatory indices in the prediction of endoscopic and histological activity in inflammatory bowel disease patients
Authors: Cesaro Nicola , Valvano Marco , Monaco Sabrina , Stefanelli Gianpiero , Fabiani Stefano , Vernia Filippo , Necozione Stefano , Viscido Angelo , Latella Giovanni 
Published: September 2024

Background and aim
Inflammatory indices are promising indicators that can be used to evaluate inflammation in inflammatory bowel diseases (IBDs). The present study aimed to investigate the test accuracy of several inflammatory indices to identify endoscopic, and histological activity in a cohort of IBD patients.

Study:
All IBD patients who underwent colonoscopy and blood examination (within 4 weeks and without therapeutic change) were included. For these patients, 10 different inflammatory biomarkers were collected. Our primary outcome was the assessment of accuracy [evaluated with a receiver operating characteristics (ROC) analysis] of each inflammatory biomarker and indices. Furthermore, we tried to establish the optimal cutoff to identify patients with endoscopic and histologic activity among the inflammatory biomarkers and indices with higher performance.

Results
Regarding endoscopic activity, at the ROC analysis, the systemic inflammation response index (SIRI) showed the best accuracy [area under the curve (AUC), 0.627; confidence interval (CI), 0.552–0.698]. Whereas the ROC analysis showed a suboptimal AUC for the neutrophil-to-lymphocytes ratio (NLR) and platelets-to-lymphocytes ratio; (AUC, 0.620; CI, 0.545–0.691 and AUC, 0.607; CI, 0.532–0.679, respectively). Concerning histological activity, the C-reactive protein albumin ratio (CAR) presented a higher accuracy among the calculated inflammatory biomarkers (AUC, 0.682; CI, 0.569–0.781) while SIRI and NLR presented a subdued diagnostic performance.

Conclusion
SIRI and CAR presented the best test accuracy in an IBD outpatient setting to identify endoscopic and histological activity. However, the test accuracy of all the evaluated Inflammatory indices appeared suboptimal. Fecal calprotectin has still the highest accuracy in predicting endoscopic and histological activity in patients with IBD.