bluuebunny/crossref_metadata_2025_split huggingface dataset:
P213 UNDERSTANDING THE INFLUENCE OF SOCIAL SUPPORT ON ANTIHYPERTENSIVE MEDICATION ADHERENCE IN URBAN NEPAL: A QUALITATIVE STUDY
Authors: Yao Zhengbang , Pangeni P M , Koirala S , Neupane D , Winch P J , Inagaki Y 
Published: September 2024

Background and objective:
Hypertension is a critical public health challenge in Nepal, particularly in urban settings, contributing to the high morbidity and mortality from cardiovascular diseases. Despite the presence of effective treatment options, adherence to antihypertensive medication remains suboptimal. Emerging evidence suggests that social support plays a crucial role in improving medication adherence. This study aims to explore the influence of social support on antihypertensive medication adherence among hypertensive patients in urban Nepalese communities, specifically within the Community-based management of non-communicable disease in Nepal (COBIN cohort) located in the eastern part of Pokhara Metropolitan City, Nepal.

Methods:
A qualitative study was conducted involving in-depth interviews with 19 hypertensive patients. An individual was eligible if 318 years old, taking antihypertensive medications for 3 two months and living in Lekhnath area of Pokhara. Interviews were conducted by an English-speaking researcher, with support from translator speaking both English and Nepali, using the interview guide. The study utilized a thematic analysis to explore patients’ perceptions and experience related to social support while taking antihypertensive medicines regularly.

Results:
The findings revealed a complex interplay of positive and negative influences of social support on antihypertensive medication adherence. Positive influence, being reminders from family members and healthcare providers, appeared to improve participants’ self-esteem and self-efficacy on adhering to medications. In contrast, social interactions including suggestions of taking traditional remedies and misinformation about prescribed antihypertensive medications appeared to diminish medication adherence. The role of Female Community Health Volunteers (FCHVs) was overall positive, bridging the gap between healthcare services and community needs, however its sustainability needs to be addressed.

Conclusion:
Social support is perceived to be pivotal in enhancing medication adherence among hypertensive patients in urban Nepal. Strengthening such support through community-based interventions and enhancing the role of FCHVs could significantly improve health outcomes. This study underscored the need for comprehensive strategies that integrate social support into hypertension management programs in low-resource settings.
P217 MAY MEASUREMENT MONTH 2019: BLOOD PRESSURE VARIABILITY IN RELATION TO AGE AND SEX
Authors: Kerr Gabriele , Beaney Thomas , Schlaich Markus , Schutte Aletta , Stergiou George , Poulter Neil 
Published: September 2024

Background and Objective:
Within-visit blood pressure variability (BPV) is predictive of cardiovascular events independent of mean blood pressure (BP) levels and may serve as marker of cardiovascular aging. This study aimed to explore changes in BPV by age, and sex in May Measurement Month (MMM) 2019 survey participants.

Methods:
Adults (≥18 years) were surveyed opportunistically from 92 countries and up to three standardized seated BP readings were recorded. This analysis included all participants who were not taking BP-lowering medication and with complete data on age, sex, and three valid BP recordings. Three indices of BPV were compared: the standard deviation (SD), coefficient of variation (CV), and variation independent of the mean (VIM). A linear regression model was created for each index. Models were adjusted for mean BP, age, sex, and an interaction between age and sex. Age and mean BP were each included as natural cubic splines with 11 and 5 knots, respectively, to allow for flexibility with modelling relationships.

Results:
Data from 842,356 participants were included. The mean age was 42.9 (SD 15.9) years and 51.5% were female. Patterns of BPV from 18-90 years and by sex were consistent across BPV indices. Systolic BPV was higher in female than male participants between the ages of 30 and 80. In female participants, systolic BPV declined with age from 18-25, after which systolic BPV increased with age. In male participants, systolic BPV declined with age from 18-45, after which systolic BPV increased with age. Diastolic BPV was highest at the youngest and oldest ages, and lowest between 45 and 55 in both sexes.

Conclusions:
There was a highly consistent pattern amongst three commonly used indices of BPV in their relationships with age and sex. The BPV of screened adults was lower in males than females and varied non-linearly with age, with markedly higher BPV at younger and older ages, with distinct patterns of variation observed between systolic and diastolic BPV.
P219 ASSOCIATION OF 24-HOURS BLOOD PRESSURE VARIABILITY WITH BRAIN MRI REGIONS OF INTEREST FOR ALZHEIMER'S DISEASE
Authors: Melgarejo Jesus , Charisis Sokratis , Vatcheva Kristina , Mejia-Arango Silvia , Mena Luis , Garza Shana , Satizabal Claudia , Silva Egle , Lee Joseph , Terwilliger Joseph , Gutierrez Jose , Seshadri Sudha , Maestre Gladys 
Published: September 2024

Introduction:
Variability in blood pressure (BP) has been associated with Alzheimer's disease (AD). However, it is unclear whether high variability in BP over 24-hours (24-h) is associated with the pre-clinical stage of AD. By examining brain MRI regions that atrophy decades before AD develops, we investigated the association between 24-h BP variability and MRI regions of interest for AD.

Methods:
We included baseline information of 324 participants aged ≥40 years old from a population-based study who underwent 24-h ambulatory BP monitoring and brain MRI scans. 24-h systolic BP variability was quantified using the average real variability (ARV) index. Brain MRI regions of interest for AD included the superior and middle frontal gyrus, supramarginal, superior, and precuneus gyrus, temporal pole, medial and inferior gyrus, entorhinal cortex, and hippocampus. We performed adjusted linear regression models to evaluate the association between 24-h systolic BP variability and MRI regions of interest for AD.

Results:
The mean age was 58.8±12.5 and 75.3% (n=244) were women. The mean thickness of MRI regions of interest for AD ranged from 2.12 mm3 to 4.04 mm3. In linear regression models, every +1.85 mmHg increase in 24-h systolic ARV was associated with lower thickness of the superior (adjusted mean mm3, -0.10; 95% confidence interval [CI], -0.21 and -0.01) and middle (adjusted-mean, -0.12 mm3; 95% CI, -0.24 and -0.01) frontal gyrus, medial temporal gyrus (adjusted mean, -0.21 mm3; 95% CI, -0.32 and -0.10), entorhinal cortex (adjusted-mean, 0.11 mm3; 95% CI, -0.21 and -0.01), and hippocampus (adjusted-mean, -0.14 mm3; 95% CI, -0.25 and -0.03); analyses also accounted for the 24-h systolic BP level. High 24-h systolic BP level was associated with lower thickness in 3/10 regions of interest for AD (P≤0.029).

Conclusions:
Elevated 24-h systolic BP variability is associated with thinning of brain MRI regions of interest for AD. Prospective data are needed to examine whether 24-h BP variability associated with thinning in brain MRI regions will increase the risk of AD.
P225 RISK FACTORS FOR CEREBROVASCULAR DISEASE IN WOMEN ADMITTED TO THE INTERNAL MEDICINE SERVICE OF THE EMERGENCY DEPARTMENT OF THE CENTRAL HOSPITAL IN SAN CRISTOBAL (TACHIRA, VENEZUELA)
Authors: Delgado E.A. Montilla , Menegaldo A. A. Bettiol 
Published: September 2024

Background and objective:
Cerebrovascular disease is a leading cause of mortality and disability worldwide. Research has focused on determining the risk factors for cerebrovascular disease independent of gender; however, it has been important to differentiate between men and women due to the variety of causes that occur in the latter. Therefore, the aim was to determine the risk factors for cerebrovascular disease in women admitted to the internal medicine service of the Central Hospital of San Cristóbal (Táchira, Venezuela).

Methods:
A case-control study was performed. Cases were female patients diagnosed with acute cerebrovascular disease (24 to 72 hours after symptom onset). Controls were hospitalized or community-based female subjects without pathologies associated with cardiovascular disorders. The case-control ratio was 1:2, of equal age or ± 5 years. All participants signed the informed consent form and completed the data collection form. Odds ratios (OR) were calculated, with 95% confidence intervals.

Results:
In the period between February 2 to July 15, 2020, 111 female participants entered the study, 37 cases (26 with ischemic cerebrovascular disease and 11 with hemorrhagic cerebrovascular disease) and 74 controls. Of the risk factors studied: arterial hypertension, diabetes mellitus, dyslipidemia, physical inactivity, smoking, alcohol consumption, overweight, obesity, atrial fibrillation, use of oral contraceptives, use of hormone replacement therapy, autoimmune diseases, only association was found between atrial fibrillation (OR 9.1736, 95% CI 3.3638-25.0173), autoimmune diseases (OR 9.1736, 95% CI 3.3638-5.0173) and ischemic cerebrovascular disease. No association was found with any risk factor and hemorrhagic cerebrovascular disease.

Conclusions:
The risk factors for cerebrovascular disease in the female population are modifiable and treatable, being pertinent to determine their presence and carry out the necessary actions to reduce morbimortality in this population group.
P226 EMPAGLIFLOZIN IS ABLE TO REDUCE COLLAGEN DEPOSITION IMPROVING HEART FUNCTION IN MYOCARDIAL INFARCTED RATS
Authors: Durante da Silva Bruno , Souza Biologist Leandro , Barbosa Biologist Maikon , Borges Luciano , Nascimento-Carvalho Msc Bruno , Moreira Nathalia Juocys D. , Consolim-Colombo Fernanda , Nascimento Biologist Antonio , Godoy Biologist Andressa , De Angelis Katia , Irigoyen Maria Claudia 
Published: September 2024

Cardiovascular diseases, particularly Acute Myocardial Infarction (AMI), are the leading cause of death worldwide. Studies show that empagliflozin improves cardiac function and outcomes in patients with heart failure. This study hypothesizes that different doses of empagliflozin (3 mg/kg and 10 mg/kg) affect collagen deposition and cardiac function differently.
Male Wistar rats were divided into four groups: control (Ctrl), infarcted (AMI), infarcted treated with empagliflozin 3 mg/kg (AMI+EMPA3), and infarcted treated with empagliflozin 10 mg/kg (AMI+EMPA10). Infarcted groups underwent left coronary artery occlusion. Treated groups received empagliflozin for 14 days via oral gavage. Echocardiographic evaluation was followed by euthanasia and tissue collection. Collagen deposition was assessed histologically and stained with picrosirius red, with area calculations done. Data were analyzed using the 1-way ANOVA test.
Echocardiographic results showed an improvement in diastolic function index (E’/A’) in the AMI+EMPA10 group (1.654 ± 0.3) in relation to the Ctrl (0.98 ± 0.5), AMI (0.58 ± 0.1) and AMI+EMPA3 (1.02 ± 0.4). Systolic function, measured by ejection fraction, was reduced in AMI (30.14 ± 9.7%) and AMI+EMPA3 (33.68 ± 13.2%) compared to Ctrl (77.09 ± 8.1%). The AMI+EMPA10 group showed improved ejection fraction (50.69 ± 14.5%). Fractional area change showed similar patterns (Ctrl: 61.18 ± 5.7; AMI: 23.94 ± 5.7%; AMI+EMPA3: 27.39 ± 7.2%; AMI+EMPA10: 38.46 ± 7.1%).
Histology revealed no difference in total left ventricle area among groups, but collagen area was increased in AMI (81.30 ± 16.2 mm2) and AMI+EMPA3 (86.64 ± 15.3 mm2) compared to Ctrl (62.89 ± 16.2 mm2), but not in AMI+EMPA10 (77.68 ± 8.5 mm2).
In conclusion, empagliflozin treatment improved left ventricular diastolic and systolic function dose-dependently and reduced collagen deposition in infarcted rats.

Supported by: CNPq 312962/2020-7
Development and Validation of a Two-step Model to Predict Outcomes After Endovascular Treatment for Patients With Acute Ischemic Stroke
Authors: Wang Xinyan , Liang Fa , Wu Youxuan , Jia Baixue , Wang Anxin , Zhang Xiaoli , Zhang Kangda , Hou Xuan , Jian Minyu , Wang Yunzhen , Liu Haiyang , Miao Zhongrong , Han Ruquan 
Published: September 2024

Background:
Physicians and patients are eager to know likely functional outcomes at different stages of treatment after acute ischemic stroke (AIS). The aim of this study was to develop and validate a 2-step model to assess prognosis at different time points (pre- and posttreatment) in patients with AIS having endovascular thrombectomy (EVT).

Methods:
The prediction model was developed using a prospective nationwide Chinese registry (ANGEL-ACT). A total of 1676 patients with AIS who underwent EVT were enrolled into the study and randomly divided into development (n=1351, 80%) and validation (n=325, 20%) cohorts. Multivariate logistic regression, least absolute shrinkage and selection operator regression, and the random forest recursive feature elimination algorithm were used to select predictors of 90-day functional independence. We constructed the model via discrimination, calibration, decision curve analysis, and feature importance.

Results:
The incidence of 90-day functional independence was 46.3% and 40.6% in the development and validation cohorts, respectively. The area under the curve (AUC) for model 1 which included 5 pretreatment predictors (age, admission National Institutes for Health Stroke Scale score, admission glucose level, admission systolic blood pressure, and Alberta Stroke Program Early Computed Tomography score) was 0.699 (95% confidence interval [CI], 0.668-0.730) in the development cohort and 0.658 (95% CI, 0.592-0.723) in the validation cohort. Two treatment-related predictors (time from stroke onset to puncture and successful reperfusion) were added to model 2 which had an AUC of 0.719 (95% CI, 0.688-0.749) and 0.650 (95% CI, 0.585-0.716) in the development cohort and validation cohorts, respectively.

Conclusions:
The 2-step prediction model could be useful for predicting the functional independence in patients with AIS 90-days after EVT.
Advanced Management of Distal Lower Extremity Congenital Constriction Bands for Foot Salvage
Authors: Bautista Catherine H. , Vitale Alexandra S. , Chen Joanna , Ormiston Laurel , Collar Yagas Lucia , Johns Dana N. 
Published: September 2024

Summary:
Constriction ring syndrome is a rare congenital condition characterized by the formation of fibrous amniotic bands, which can result in limb or digit deformation, malformation, or autoamputation. Surgical intervention is necessary for patients with progressive or severe forms of constriction banding, but the timing and operative approach vary widely. Here, the authors present a case report detailing the successful removal of multiple congenital constriction bands (CBs), uniquely affecting the distal ankle and foot in an infant meeting Patterson type-2 criteria. This type is characterized by CBs resulting in distal deformation with or without swelling. In this case, urgent intervention was prompted by concerns of vascular compromise, and amputation was considered due to the severity of the banding. However, the authors advocated for a staged approach, with the aim of preserving the patient’s limb. A series of three separate procedures tailored to the patient’s banding pattern and subsequent tissue complications were required to achieve restoration of ankle and foot functions, as well as satisfactory cosmesis. This case report underscores the importance of a customized surgical approach in addressing complex CBs and emphasizes the need for proactive consideration of salvage interventions by surgeons.
Barriers to Care After Intimate Partner Violence Acquired Brain Injury: Current Systems Silence Survivors and Providers
Authors: Tsu Loretta , Varty Maureen , Reinken Desiree , Coats Heather 
Published: September 2024

Objective:A qualitative meta-synthesis was conducted to answer the following question—What barriers are experienced by survivors of intimate partner violence and service providers when seeking or providing resources or care after experiencing brain injury (BI)?Setting:This approach was completed through 2 main phases—a systematic search and literature appraisal and reciprocal translation with interpretive triangulation of the extracted data. The databases searched were PubMed, CINAHL, and PsycInfo.Participants:The initial search yielded 559 articles. The final synthesis included 16 articles for the qualitative meta-synthesis.Design:After data extraction, a qualitative exploratory design evaluated the experiences of survivors and service providers when connecting with resources.Results:The findings highlight larger systemic barriers preventing smooth relationships between survivors and providers. Survivor barriers include risk-driven safety mechanisms and a lack of awareness and understanding of BI. Provider barriers are a lack of clarity within providers’ scope and training limitations, diagnosis complexity, first responder’s initial response to survivors, lack of open discussion, screening limitations, financial barriers, infrastructure barriers, and lack of resources. Systemic barriers include stigmatization, BI symptoms mistaken as other diagnoses like mental health, access and awareness of resources, and navigation of complex systems.Conclusion:This qualitative meta-synthesis demonstrates that survivors and providers face multiple individual and systemic barriers when seeking and providing resources after BI. Future research is needed to understand survivors’ help-seeking behaviors and assistance needs and providers’ education about BI and organizational relationships and networks. Recommendations are made for future research to understand how to reduce barriers for providers working with survivors, from trauma-informed education and communication to connecting with resources, where to concentrate, and initiatives for collaboration to increase the network of resources yet improve its accessibility.
Give It a Rest: The Impact of Rest Days on Musculoskeletal Injuries Among Starting Pitchers in Major League Baseball
Authors: Waldrop Matthew , Sitton Zachary , Swisher Jeremy , Mullur Kiran , Davis Stephen 
Published: September 2024

OBJECTIVE:Examine the impact of rest days on musculoskeletal (MSK) injury incidence in Major League Baseball (MLB) starting pitchers.DESIGN:Descriptive epidemiological study.SETTING:MLB pitching and injury reports.PARTICIPANTS: MLB starting pitchers.METHODS:Data (2022-2023) were obtained from Baseball-Reference.com and fangraphs.com. Teams were grouped by average rest days between starts (Group A <5 rest days, Group B>5 rest days). Poisson regression was used to compare main outcome measure incidence rate ratios (IRRs).INDEPENDENT VARIABLES:Number of rest days between starts.MAIN OUTCOME MEASURES:Pitches per start, MSK injury incidence, injured list (IL) days for MSK injury.RESULTS:From 2022 to 2023, the average MLB rest days between starts was 4.80. Group A had 54 teams. Group B had 6 teams. The range of average rest days per start by team was 4.56 to 5.73 with a mean of 4.80. Group B pitchers spent 10.7 days on IL for MSK injuries per 1000 pitches, while Group A spent 13.6 days on IL (IRR = 0.78 [95% CI, 0.72-0.85];P< 0.0001). Group B averaged 0.93 more pitches per start than Group A (P= 0.0164). Group B had a lower number of IL assignments for MSK injuries per 1000 pitches (0.245 vs 0.351, IRR = 0.70 [95% CI, 0.38-1.18];P= 0.1715).CONCLUSIONS:Starting pitchers on MLB teams averaging>5 rest days between starts spent less time on the IL for MSK injuries than MLB teams averaging < 5 rest days from 2022 to 2023. There was no clinically significant difference in pitch count and no significant difference in the number of IL assignments for MSK injuries.
Systematic review with meta-analysis of the effectiveness of subcutaneous biologics versus intravenous biologics in inflammatory bowel diseases
Authors: Elford Alexander T. , Heldt Rishni , Kamal Shahed , Christensen Britt , Segal Jonathan P. 
Published: September 2024

Background
Biologic therapies are commonly used for inflammatory bowel disease (IBD) patients. Multiple biologic medicines can now be given both intravenously and subcutaneously. The different administration routes present provide different advantages regarding dose escalation, healthcare resource utilisation, pharmacokinetics, convenience and safety. Comparator effectiveness studies between intravenous and subcutaneous administration are lacking.

Aim
Our primary outcome was to compare the effectiveness between intravenous and subcutaneous biologics in rates of clinical remission.

Methods
We performed a systematic review and meta-analysis to include all relevant articles from MEDLINE (Ovid), EMBASE, PubMed and Cochrane Central Register of Controlled Trials from 1 January 2003 to 28 January 2024. Studies that compared intravenous and subcutaneous administration of the same biologic therapy in IBD patients and reported effectiveness outcomes were included. This study was registered on PROSPERO (CRD42023442675).

Results
Twenty studies met the inclusion criteria for the systematic review. Nine vedolizumab cohort studies were meta-analysed for clinical remission and no difference was found in clinical remission rates between intravenous and subcutaneous administration (relative risk = 0.99; 95% confidence interval: 0.88, 1.11). Six infliximab cohort studies were meta-analysed for clinical remission and no difference was found in clinical remission rates between intravenous and subcutaneous administration (relative risk = 0.91; 95% confidence interval: 0.77, 1.08).

Conclusions
Our findings in the first meta-analysis comparing the effectiveness of intravenous and subcutaneous biologic therapies in IBD suggest there is no difference in the effectiveness between these two administration routes. However, further high-quality studies, particularly head-to-head studies are needed to confirm this finding.
Recent advances in the understanding of the peritoneal membrane
Authors: Seghers François , Tintillier Michel , Morelle Johann 
Published: September 2024

Purpose of review
The efficiency of peritoneal dialysis (PD) as a life-sustaining replacement therapy for patients with kidney failure relies on the integrity and function of the peritoneal membrane. Here, we review the most recent advances in the understanding of the peritoneal membrane and its role in PD.

Recent findings
A recent update of the ISPD guidelines proposed a revised definition of membrane dysfunction, emphasizing the importance of fluid balance in patients treated with PD and identified three main mechanisms leading to insufficient peritoneal ultrafiltration (UF). The Bio-PD study, the first genomewide association study in PD, demonstrated that 20% of the interindividual variability in the peritoneal solute transfer rate is genetically determined, and identified several loci of potential relevance for peritoneal transport. A candidate-gene approach identified and characterized a common and functional variant in the promoter of the AQP1 gene associated with water transport and clinical outcomes in PD. Innovative strategies to preserve the integrity of the peritoneal membrane and to enhance UF are also discussed, including the use of gliflozins; steady glucose concentration PD; modulation of GLUT proteins; and cytoprotective additives.

Summary
A comprehensive understanding of the peritoneal membrane and of the mechanisms driving UF may help individualizing PD prescription and improving outcomes in patients treated with PD.