bluuebunny/crossref_metadata_2025_split huggingface dataset:
PREDICTORS OF BLOOD PRESSURE RESPONSE TO CPAP TREATMENT IN PATIENTS WITH SLEEP APNEA
Authors: Seidel Maximilian , Kiziler Muhammed F. , Mathiakis Marios , Bertram Sebastian , Wang Simon , Seibert Felix S. , Babel Nina , Westhoff Timm H. 
Published: May 2024

Objective:
Sleep apnea is associated with hypertension. Metaanalyses indicate that treatment of sleep apnea by continuous positive airway pressure (CPAP) reduces blood pressure (BP) by a mean of 3 mmHg. To date, predictors of BP response to CPAP remain incompletely understood. We hypothesized that the magnitude of CPAP-induced BP reduction depends on baseline apnea hypopnea index (AHI) and the extent of daytime sleepiness.

Design and method:
We performed a retrospective study on the association of BP response to CPAP with polysomnographic readings, intensity of sleepiness (measured by Epworth Sleepiness Scale, ESS), and epidemiologic parameters in 2461 patients with obstructive sleep apnea. BP response was defined as the difference between office BP at polysomonography examinations before and after initiation of CPAP.

Results:
555 patients fulfilled all in- and exclusion criteria and were included in the analysis. Median monthly CPAP usage was 143.7h (85.4-204.1h). BP was significantly higher at baseline than at follow-up (129.9±15.5 vs. 128.3±15.2, p=0.021) resulting in mean reduction of BP of -1.5±19.2 mmHg. Subjects with a higher than median baseline AHI (median 21) showed a more pronounced reduction of BP than those with lower AHI (AHI >21: 130.5±15.3 vs. 128.6±14.6, p=0.06; AHI <21: 129.5±15.8 vs. 127.9±15.8, p=0.18). CPAP therapy led to a significant reduction in sleepiness (8.3±4.8 vs. 6.6±4.5, p<0.0001). Those subjects with higher than median sleepiness score (ESS >8), however, did not show a significant difference in BP response compared to those with a lower sleepiness score. Receiver-operating characteristic (ROC) curve analyses investigating the accuracy of AHI and ESS to predict a BP reduction >5 mmHg revealed an AUC of 0.51 and 0.52, respectively.

Conclusions:
The study confirms that CPAP therapy for sleep apnea has a mild BP lowering effect. Although this effect is slightly higher in patients with above-average AHI, neither AHI nor ESS can be used to define threshold values predicting a BP decrease > 5 mmHg.
EVALUATION OF CHORIORETINAL VASCULARIZATION WITH OCT AND ANGIO-OCT IN PRIMARY ALDOSTERONISM
Authors: Rossi Federico , Giacomo Rossitto , Perozzo Elena Veronica , Bagordo Domenico , Seccia Teresa Maria , Bini Silvia , Galan Alessandro , Rossi Gian Paolo 
Published: May 2024

Objective:
Primary aldosteronism (PA), the most common cause of secondary hypertension, is associated with excess cardiovascular damage and, when unilateral, is amenable to surgical cure. Our objective was to determine whether the chorioretinal microvasculature is also affected.

Design and method:
Ocular CT-scan (OCT) and angio-OCT images of the superficial and deep retinal plexi were obtained in PA patients at diagnosis, in wash-out from RAAS-confounding drugs (WO), and again during mineralocorticoid receptor antagonist (MRA) therapy and 4-6 months after surgical cure (PS).
The images were analysed for choroidal thickness and, upon automated ImageJ processing, for indexes of total vascular area density (VAD) and length fraction (VLF), a surrogate for the number of open vessels.

Results:
We enrolled 11 patients with PA (51±10 yrs; 27%F); of these, 10 who had unilateral PA underwent curative surgery (p<0.05 for BP, sK+ and ARR). We found that MRA therapy had no effect on any of the investigated parameters. At variance, curative surgery determined a reduction of VAD in both superficial and deep plexi (-6.4% retinal area, p=0.017 and -3.5%, p=0.023, respectively) and of VLF in the superficial plexus (-2.2%, p=0.033). Moreover, choroidal thickness (on average: -21μm, p=0.003 at 2-way ANOVA) decreased after adrenalectomy.

Conclusions:
OCT and angio-OCT images, which can accurately track changes in choroid- retinal vascularization, highlighted a decrease of retinal microvascular area and choroidal thickness in patients with unilateral PA, who were cured from PA.
CARDIOVASCULAR AND METABOLIC PHENOTYPES OF PATIENTS WITH PHEOCHROMOCYTOMA AND PARAGANGLIOMA
Authors: Pinna Alessia , Buralli Simona , Dalpiaz Hermann , Ubaldini Giulia Mori , Faconti Luca , Masi Stefano , Taddei Stefano , Bacca Alessandra 
Published: May 2024

Objective:
Pheochromocytoma and paraganglioma are rare tumours that can originate either from sympathetic or parasympathetic tissue (PPGLs). While an overactivity of the sympathetic nervous system might contribute to the evolution of hypertension-mediated organ damage (HMOD), the cardiometabolic phenotype of patients with PPGLs remains largely unexplored. In this study, we explored the relationship between urinary metanephrine and normetanephrine levels with parameters of cardiac organ damage in these patients.

Design and method:
In the current study, we retrospectively recovered the echocardiographic data, 24-hour urinary metanephrine (MT) and normetanephrine levels (NorMT), the clinical examination and standard biochemical tests of 111 patients with PPGLs, initially referred to our hypertension clinic for elevated blood pressure and/or symptoms/imaging features suggestive of the disease. Patients underwent resting echocardiography, measurement of the 24-hour urinary metabolite levels, clinical examinationand blood collection for standard biochemical tests.

Results:
The average age of the population was 41±19 years old, 59% women, 92% with a diagnosis of arterial hypertension. Systolic and diastolic blood pressure were within the normal range. The average left ventricular mass indexed for the body surface area (LVMI) was 105±22g/m2. We found a significant correlation between NorMT levels and the values of diastolic (r=0.497; p=0.042) but not systolic blood pressure. The NorMT levels were strongly correlated with the LVMI (r=0.496; p=0.001). This correlation remained significant even after adjustment for sex and values of systolic or diastolic blood pressure. No correlations were observed between NorMT and parameters of left atrial remodeling, different patterns of left ventricular remodeling (as assessed by relative wall thickness, RWT), diastolic function and estimated glomerular filtration rate. Fasting plasma glucose was significantly correlated with MT (r=0.413; p=0.01) and borderline correlated with NorMT (r=0.308; p=0.060). No correlations were found between MT parameters of cardiac remodeling.

Conclusions:
In patients with PPGLs, the overproduction of NorMT is related to a greater severity of cardiac hypertrophy independently of the blood pressure control. Furthermore, MT and, to a lesser extent, NorMT were related to the fasting plasma glucose levels, suggesting a potential influence of NorMT and MT on the cardiometabolic profile of patients with sympathetic PPGLs.
SODIUM RESTRICTION CONCOMITANT WITH SUFFICIENT ALDOSTERONE SUPPRESSION MAY BE ASSOCIATED WITH RENOPROTECTIVE EFFECTS IN THE PATIENTS WITH PRIMARY ALDOSTERONISM
Authors: Kidoguchi Satoshi , Sugano Naoki , Yokoo Takashi 
Published: May 2024

Objective:
Primary aldosteronism (PA) is an independent risk factor for various cardiovascular diseases and chronic kidney disease, which makes it important to treat this condition at an early phase. Currently, the use of mineralocorticoid receptor antagonists (MRAs) is recommended for the treatment of bilateral type, mainly idiopathic hyperaldosteronism. However, recent reports suggest that the benefit of the treatment with MRAs is only obtained in the patients with enough aldosterone suppression, which is indicated as post-treatment plasma renin activity (PRA) >=1.0 ng/mL/h. Since PRA is affected by the amount of sodium intake, PRA elevation after MRAs treatment might partially reflect an adherence to strict sodium restriction, thereby leads to organ protective effects in PA patients.

Design and method:
A total of 91 patients who received eplerenone or esaxerenone for PA treatment were included. The patients with PRA>=1.0 ng/mL/h at one year after the initiation of MRAs were determined as responders, and others were determined as non-responders. The differences between responders and non-responders were analyzed. In addition, these patients were followed for another two years (total three years), and the transitions of estimated glomerular filtration (eGFR) among responders and non-responders were also compared.

Results:
The doses of MRAs were equivalent between responders and non-responders. Estimated sodium intake was significantly lower in responders (responders: non-responders; 156.2±42.3 mmol/day: 124.7±41.8 mmol/day P<0.05). Multivariate logistic regression analysis has shown that estimated sodium intake was an independent predictor for responders. During three years’ period, eGFR was significantly decreased in non-responders (pre-treatment: post-treatment; 73.0±14.7 ml/min: 69.5±14.1 ml/min P<0.05), whereas it was comparatively preserved in responders (pre-treatment: post-treatment; 68.3±17.9 ml/min: 68.0±19.0 ml/min P=0.84).

Conclusions:
The present study have shown that responders in PA patients may partially benefit from an adherence to sodium restriction. Sodium restriction concomitant with sufficient suppression of aldosterone effect may exert renoprotective effects for PA patients.
UNLOCKING THE PUZZLE: INSIGHTS FROM A RARE CASE OF FIBROMUSCULAR DYSPLASIA
Authors: S Sreenath , Majeed Abdul , Mb Adarsh 
Published: May 2024

Objective:
To present a rare or unusual manifestation of fibromuscular dysplasia (FMD) and highlight the diagnostic challenges encountered in identifying fibromuscular dysplasia, particularly in uncommon presentations.

Design and method:
CASE REPORT: 35/F, Kerala Tribal ethnicity, P2L2A0 H/O. HTN x 10 years on irregular indigenous medications. Presented to the ER with seizures followed by sudden onset right hemiplegia and slurring of speech. Initial assessment: Patient conscious, obeying commands. P- 130/min regular, BP - 216/120 mm Hg, Rt side- zero power with extensor plantar. CT Brain -Acute ICH 30x17 mm in Left insular cortex with surrounding edema. Admitted to the ward for young stroke evaluation. Past H/O: Intermittent headaches, pulsatile tinnitus and flank pain. Addicted to tobacco and ethanol, Normal bowel & bladder habits. Family H/O: HTN & Stroke + O/E: Poorly built, B/L Renal artery bruit +, No significant pulse/ BP asymmetry, No murmurs. Fundi: Grade III Hypertensive retinopathy changes. Plan: Control of hypertension and proceeded with workup for secondary hypertension

Results:
S. Creatinine - 2.6mg/dl
Urinalysis - Alb - Faint trace, No RBCs/ casts
HIV/ HBsAg/ Anti - HCV ELISA - Negative
ECG - sinus tachycardia, LVH
2D ECHO- Good LV function, LVH, No clots / vegetations, Grade II diastolic dysfunction
USG KUB - B/L shrunken kidneys (Rt: 7.8 x 3.3 cm, Lt: 7.2 x 3.1cm) with lost CMD
RAD: B/L raised doppler parameters in the mid to distal segment of main renal artery (PSV / RI) with tardus et parvus pattern; no evidence of thrombus.
CTA: B/L small sized kidneys with diffusely narrow caliber of both renal arteries with relative sparing of proximal portion. No ostial stenosis or beading of vessels seen. Aorta and its branches appear normal.
Management: Losartan, Chlorthalidone, Amlodipine, Smoking cessation

Conclusions:
Unlike atherosclerotic disease, which localizes at ostial and proximal segments of renal arteries, FMD more commonly involves the middle and distal arterial segments. FMD classically presents as renovascular hypertension but can also manifest as stroke in young adults. Our patient had focal FMD corresponding to Intimal fibroplasia histopathological variant.
A CAUSE OF PAROXYSMAL HYPERTENSION NOT TO BE OVERLOODED: CHILDREN'S PHEOCHROMOCYTOMA
Authors: Lahlou Haddad Haddad , Cherif Nacira 
Published: May 2024

Objective:
We aimed to assess the clinical presentation, natural history, and treatment response of hypertension in children with pheochromocytoma.

Design and method:
O. Mohamed, an 8-year-old boy, without past medical history, hospitalized for paroxysmal hypertension evolving for 6 months with severe headaches, generating insomnia. No similar episodes in the family. Clinical features: BMI of 15. 1 kg/m2 (height: 1.26 m, weight: 24 kg). heart rate of 128 bpm (tachycardia) and blood pressure of 175/84 mm Hg (stage 2 for systolic hypertension and stage 1 for diastolic hypertension, table 1).
The physical examination was unremarkable except for tenderness in the right hypochondrium.
Biological tests: serum creatinine and proteinuria testing was normal.
Ophthalmic examination: stage I hypertensive retinopathy (Arterial narrowing).
Abdominal ultrasound: right adrenal mass, measuring 65–57–61 mm in size, well-defined, heterogeneous echo structure, with multiple echogenic areas. No calcifications.
Abdominal CT scan: Solid right adrenal mass (Figures 1 & 2) and no lymph node involvement.
Urinary Vanyl Mandelic Acid: high level at 27.18 μmol/l (normal < 10 μmol/l).
MIBG scintigraphy: intense pathological uptake, posterior, projecting over the right renal region, intensifying at 48 hours. No other sites of uptake.

Results:
In summary, right adrenal pheochromocytoma revealed by a severe paroxysmal hypertension. Preoperative management: Nicardipine IV. Alpha-blocker combined with a beta-blocker were not used. Evolution under medical treatment while waiting for excision of the tumor is favorable with a significant reduction in blood pressure. The child was operated with complete excision of the tumor. Pathological examination of the surgical specimen: ovoid formation made of epithelial cells with basophilic nuclei arranged in cords separated by thin vascular axes = aspect of pheochromocytoma Post-operative evolution was favorable with disappearance of symptoms and normalization of blood pressure after stopping antihypertensives. Actually, the patient is asymptomatic after 4-year follow-up with normal blood pressure and no relapse. The family investigation does not report any family cases.

Conclusions:
Pheochromocytoma is rare in children. It often presents with severe paroxysmal hypertension. Malignant forms are rare in children; however, rigorous surveillance is necessary for at least 5 years.
THE INFLUENCE OF WINTER SWIMMING ON STRUCTURAL CHANGES IN RETINAL MICROCIRCULATION
Authors: Matuszewska Urszula , Kaczmarczyk Karolina , Sajdak Wojciech , Dabrowska Edyta , Wolf Jacek , Narkiewicz Krzystof , Dabrowska-kugacka Alicja , Lasocka Zofia 
Published: May 2024

Objective:
Winter swimming is perceived as beneficial for cardiovascular system. However, a number of studies have suggested that such activity can have a harmful impact in some individuals. The aim of our investigation was to assess the influence of winter swimming on structural changes in retinal microcirculation.

Design and method:
The examinations were performed before and after the winter swimming period – from November 2022 till April 2023 in 36 subjects (mean age 45±4.0 years, 65% women). The mean frequency of winter swimming activity was 1.3 times per week.
The evaluation of structural microvascular changes was performed in retinal arterioles using non-invasive tool - Adaptive Optics Camera Rtx1e (Imagine Eyes, Orsay, France). The camera enables the precise assessment of microvasculature with ultra-high resolution at a near-histological scale. The Rtx1e innovative technology allows for tracking of the exact fundus areas which is critical for prospective studies. We assessed the following structural parameters: lumen diameter (LD), wall thickness (WT), wall to lumen ratio (WLR), and wall cross-sectional area (WCSA).

Results:
Winter swimming had profound effect on retinal microcirculation. We present the results in the following table.

Conclusions:
Winter swimming was associated with a significant reduction of WT, WCSA and WLR, and with an increase of LD. To the best of our knowledge, these findings provide the first evidence of beneficial impact of winter swimming on the retinal microcirculation status. Whether improvement in retinal microcirculation is accompanied by positive changes in other microvascular districts remains to be studied.
HYPERTENSION-SPECIFIC ASSOCIATION OF CARDIO-ANKLE VASCULAR INDEX WITH SUBCLINICAL LEFT VENTRICULAR FUNCTION IN A CHINESE POPULATION: DANYANG STUDY
Authors: Liu Ming , Zhang Xue , Liang Junya , Li Yibo , Gao Yun 
Published: May 2024

Objective:
The association of arterial stiffness, as measured by cardio-ankle vascular index (CAVI), with subclinical cardiac dysfunction in hypertensive patients is unclear. Our study aims to examine their relationship in hypertensive patients compared with that in normotensive subjects.

Design and method:
Our study included 1887 subjects who were enrolled from Danyang between 2018 and 2019. CAVI was measured using VaSera VS-1500A device. We performed conventional echocardiography to measure ejection fraction (EF) and E/A, tissue Doppler to measure mitral annular early diastolic velocities (e’), and speckle tracking to estimate left ventricular (LV) global longitudinal strain (GLS).

Results:
Increased LV mass index (76.3, 80.0, and 84.0 g/m2), decreased GLS (21.1, 21.0, and 20.4%), lower E/A (1.2, 1.0, and 0.8) and e’ velocity (11.2, 9.4, and 8.2 cm/s), and higher E/e’ (7.6, 8.2, and 8.8) were significantly associated with higher CAVI on unadjusted analyses (P < 0.001). After adjustment for covariates, GLS, E/A, and e’ were still significantly decreased from tertiles 1 to 3 of CAVI (P < 0.04). Further sensitive analyses revealed similar association pattern for diastolic function. However, the relationship of higher CAVI to worse GLS was stronger in hypertensives (P = 0.008) but not normotensives (P = 0.167) (Figure 1). Compared with lowest tertile, subjects with top tertile of CAVI were at higher risk of subclinical LV systolic dysfunction in hypertensive patients (OR = 2.61; P = 0.005).

Conclusions:
Increased CAVI is associated with worse subclinical diastolic function. However, this relationship of CAVI to subclinical systolic function was more prominent in hypertensive patients.
EFFICACY OF ACETYLSALICYLIC ACID COMBINED WITH GLUCOCORTICOID IN THE TREATMENT OF TAKAYASU ARTERITIS: CASE REPORT
Authors: Nguyen Thao , Ha Thuan 
Published: May 2024

Objective:
Takayasu arteritis (TA) is an idiopathic large-vessel vasculitis, predominantly impacting the aorta and its major branches. The management of TA includes pharmacotherapy or surgical intervention in the presence of complications.

Design and method:
A 14-year-old girl was admitted to our clinic for a thoracic aortic aneurysm. Initial symptoms include fever, loss of appetite, weight loss, muscle pain, followed by palpitations and abdominal pain, and loose stools. The test showed an increased hs-CRP level: 28.7 mg/L. Computed tomography angiography (CTA) chest with contrast showed two segments of thoracic aneurysms involving descending aorta, the aortic diameter of the superior and inferior segment aneurysms is #1.6-1.8 cm, #2x 2.1 cm, respectively, and the length is #2.5 cm, # 3.2 cm, respectively.
According to JSC 2017, This patient was diagnosed with descending aorta aneurysms in Takayasu arteritis- type III (ACR 1994)
The patient underwent corticosteroid therapy, starting with prednisolone at an initial dose of 20 mg/day. The dosage was reduced to 10 mg/day at month 3 and maintained at 5 mg/day from month 6 until the completion of the 18-month therapy. Additionally, low-dose aspirin (81 mg/day), ACE inhibitors, and beta-blockers were incorporated to enhance treatment efficacy.

Results:
After 3 months, hs-CRP levels returned to normal. After 12 months of combined treatment with corticosteroids and aspirin as described above, the patient's aortic diameter had returned to almost normal on CTA. The patient's symptoms improved after finishing treatment.

Conclusions:
Successful treatment of Takayasu arteritis in our case, highlights the significant role of pharmacotherapy. This cost-effective approach minimizes side effects, offering promising treatment options for Takayasu arteritis patients, especially in low-income countries like Vietnam
CORRELATION BETWEEN BETA - STIFFNESS INDEX AND ATHEROGENIC LIPID INDICES AS A MARKER OF SUBCLINICAL ATHEROSCLEROSIS IN PATIENTS WITH BETA THALASSEMIA MAJOR
Authors: Dimova Maria , Petrova Kristina 
Published: May 2024

Objective:
Vascular impairment in patients with Beta-thalassemia major (BTM) is an extremely clinically relevant issue, associated with a high risk of accelerated atherosclerosis. Beta-stiffness index (BSI) is an echo-tracking parameter that can reveal increased carotid stiffness.
To examine the beta-steffness index in patients with BTM and healthy controls. To analyze parameters of lipid metabolism and atherogenic lipid indices (Castelli Risk Index I, CRI-I, Castelli Risk Index II, CRI-II, Atherogenic index of plasma, AIP, Atherogenic coefficient, as a marker of cardiovascular risk in BTM patients compared with healthy controls and to find out correlations between the BSI and atherogenic lipid indices in patients with BTM.

Design and method:
38 children and young patients with BTM (mean age 25.0±10.8 years, 20 female) and 40 healthy controls (mean age 23.1±11.0 years, 20 female). All subjects underwent carotid examination of beta-stiffness index by echo-tracking method with Aloka Hitachi prosound alfa 7, 7.5-MHz linear array of the right and left common carotid arteries about 1 cm proximal to the bulb. Blood test samples for lipid parameters – total cholesterol (TC), LDL, HDL, triglicerides (TG) were performed as well as calculations of the atherogenic lipid indices.

Results:
The mean AIP values in patients were 0.17±0.30 and in health controls -0,34±0.19, p=0.0001. The Castelli Risk index I in patients was 3.64±1.19 and in healthy controls was 2,75±0.74 (p=0.0001) –tabl.1. There was positive correlation between beta-stiffness index of both carotid arteries and some lipid parameters – tabl.2.

Conclusions:
Young adults with BTM are at increased risk of atherosclerosis and the subclinical impairment can be easily detected by methods of carotid ultrasound examination using beta-stiffness index and by atherogenic lipid indices.