bluuebunny/crossref_metadata_2025_split huggingface dataset:
DRUG ADHERENCE AND PSYCHOLOGICAL FACTORS MATTER IN PATIENTS WITH RESISTANT HYPERTENSION - YES BUT WHICH ONES?
Authors: Pappaccogli Marco , Georges Coralie Mg , Petit Geraldine , Ritscher Sabrina , Lopez-Sublet Marilucy , Fanelli Elvira , Rabbia Franco , Wallemacq Pierre , De Timary Philippe , Toennes Stefan W. , Persu Alexandre 
Published: June 2022

Objective:
Altered psychological profiles are associated with drug adherence and drug resistance in patients with resistant hypertension (RHTN). However, treatment resistance may also result from increased arterial stiffness and target organ damage. The aim of this study was to assess the association of psychological factors with both drug adherence and drug resistance in two subtypes of patients with RHTN: younger patients without cardiovascular complications versus older or vascular patients.

Design and method:
Ninety-seven patients with RHTN were enrolled and split in two groups: patients 60y or older or with previous cardiovascular diseases (VRHTN), and younger patients without cardiovascular complications (NVRHTN). Drug adherence was assessed by urinary Liquid Chromatography coupled with tandem Mass Spectrometry. Drug resistance was evaluated by 24-hour ambulatory blood pressure adjusted for the number of antihypertensive drugs and drug adherence. Psychological profile was assessed using five validated questionnaires: the Brief Symptom Inventory (BSI), the Toronto Alexithymia Scale (TAS-20), the Emotion Regulation Questionnaire (ERQ), the Cognitive Emotion Regulation Questionnaire (CERQ) and the Post Traumatic Diagnostic Scale (PDS).

Results:
The proportion of fully adherent, partly adherent, and totally non-adherent patients was significantly different between NVRHTN (37, 39 and 24%) and VRHTN (67, 26 and 7 %) respectively (p-value = 0.010). After multiple regression analysis, independent predictors of poor drug adherence in NVRHTN were “adaptive strategies’’, male gender and family history of hypertension, accounting for 39.2% of the variability. Independent predictors of drug resistance were difficulties in planification and somatization, accounting for 39.0% of the variability. In the VRHTN group, predictors of drug adherence were yearly number of visits at the emergency department for hypertension and family history of cardiovascular events, accounting for 28.1% of the variability in drug adherence. Predictors of drug resistance were the number of visits at the emergency department and the total number of drugs prescribed per day, accounting for 35.0% of the variability in drug resistance.

Conclusions:
Poor drug adherence and altered psychological profiles appear to play a major role in younger patients with RHTN without cardiovascular complications. This subset of patients should be prioritized for assessment of drug adherence and psychological evaluation.
SACUBITRIL/VALSARTAN IMPROVES SEXUAL FUNCTION AND FIBROSIS OF THE CLITORAL AND VAGINAL TISSUES IN FEMALE SPONTANEOUSLY HYPERTENSIVE RATS
Authors: Zhuang Chenchen , Wang Wenjuan , Sun Runmin , Qi Miaomiao , Yu Jing 
Published: June 2022

Objective:
Female sexual dysfunction is common in hypertension. The effects of sacubitril/valsartan (SAC/VAL) as a potential therapy for hypertension and heart failure have not been studied in relation to sexual function and genital fibrosis in female spontaneously hypertensive rats (SHRs). To evaluate the effect of SAC/VAL on sexual function and genital fibrosis in female SHRs.

Design and method:
Thirty female SHRs were administered VAL (30 mg/kg/day), SAC/VAL (60 mg/kg/day) or saline. Ten normotensive female Wistar-Kyoto (WKY) rats were included in the control group. We assessed estrous cyclicity and sexual behavior in the female rats. In addition, the morphology of clitoral and vaginal tissues was evaluated by histological analyses. Western blotting and enzyme-linked immunosorbent assays were used to assess the levels of fibrotic markers in vaginal and clitoral tissues. Furthermore, the protein levels of phosphatase and tensin homolog deleted from chromosome 10 (PTEN), phosphoinositide-3-kinase (PI3K) and AKT expression were measured by western blotting. We investigated the effect of SAC/VAL on the fibrosis of vaginal and clitoral tissues, estrus cyclicity and sexual behavior, including sexual receptivity (lordosis quotient and intensity), plus the number of proceptive and aggressive events.

Results:
SAC/VAL treatment improved hypertension-induced sexual dysfunction, exhibited as a prolonged estrus phase, increased receptivity and proceptive events, and decreased aggressive events, compared to those of VAL treatment and control SHRs without treatments. In addition, SAC/VAL-treated SHRs had lower levels of fibrotic markers than the levels of VAL-treated SHRs or SHRs without treatment. Moreover, SAC/VAL decreased p-PTEN expression and increased p-PI3K and p-AKT expression at the protein level compared to those in VAL treatment alone.

Conclusions:
SAC/VAL treatment is superior to VAL treatment in attenuating sexual dysfunction and fibrosis of vaginal and clitoral tissues, which may be related to the PTEN/PI3K/AKT pathway.
GENDER DIFFERENCES IN THE REGULATION OF BLOOD PRESSURE ASSESSED BY AMBULATORY BLOOD PRESSURE MONITORING – A SINGLE-CENTER EXPERIENCE
Authors: Stojanovic Milovan , Ilic Marina Deljanin , Ilic Stevan , Petrovic Dejan 
Published: June 2022

Objective:
It has been shown a significant difference in clinical characteristics of HTN and treatment response to antihypertensive therapy between males and females. The purpose of our article was to examine gender differences in the regulation of blood pressure (BP) by using ambulatory blood pressure monitoring (ABPM).

Design and method:
Two hundred seventy-five consecutive hypertensive patients were included in the study (146 females, mean age 64.11 ± 10.47 and 129 males, mean age 61.69 ± 13.59). All patients were on antihypertensive treatment for more than one year (average duration of HTN was 11.07 ± 8.24 years for women, and 10.31 ± 7.5 years for men). In all pts, AMBP was performed. The values obtained by AMBP were compared between the two groups.

Results:
There were no significant differences in the presence of coronary artery disease, obesity, diabetes mellitus, or heredity between the groups. There were more smokers among male patients (p = 0.007), while dyslipidemia was more present in female pts (p = 0.005). Male pts had higher values of systolic (124.05 ± 13.89 vs. 119.5 ± 16.58, p = 0.015) and diastolic BP (72.77 ± 8.42 vs. 69.24 ± 8.23, p = 0.001) and larger burden of high BP during the night (56.54 ± 35.52 vs. 33.11 ± 35.27, p = 0.000) compared to female pts. There were no significant differences in pulse pressure (PP) values between the male and female groups (51.17 ± 11.33 vs. 50.72 ± 10.38, p = 0.730). However, pathological values of PP (<40 mmHg or > 60 mmHg) were found in almost 1/3 of pts (34.92% in men and 28.57% in women). Also, there was no significant difference in dipping pattern but only 40 (31.01%) male and 50 (34.25%) female patients had dipper status. There was no statistically significant difference in antihypertensive therapy between the groups. The most commonly used drugs were the angiotensin-converting enzyme inhibitors (82.21% of all pts) and beta blockers (78.78%), while the angiotensin receptor blockers were the least used (15.98%).

Conclusions:
Results indicate that women have better BP control than men. However, a high frequency of pathological PP values and disturbed dipping status detected by ABPM, in women as well as men, should highlight the importance of better BP management in both genders.
REACHING OF THERAPEUTICS GOALS IN PATIENTS WITH HYPERTENSION AND DIABETES MELLITUS. DO MULTIPLE THERAPY WORKS?
Authors: Barragan Adriana Cecilia Puente , Leiva Veronica Gomez , Espejel Lilian Delgado 
Published: June 2022

Objective:
To analyze the efficacy of multiple pharmacological therapy on blood pressure control and therapeutics goals in a group of high-risk patients.

Design and method:
Blood pressure levels were analyzed in a group of 156 hypertensive patients with diabetes mellitus under pharmacological treatment, reviewed in the outpatient cardiology office. Blood pressure levels were classified according to the AHA and ESC classifications. Sociodemographic data, cardiovascular risk factors, number of drugs and therapeutic goals were recorded. Blood pressure measurement was performed using an digital manometer according to AHA and ESC guidelines. Results are shown in terms of measures of central tendency.

Results:
Average age was 55 ± 16 [20–93], 40% (62) were women. Smoking was the most common cardiovascular risk factor with 40% (62), followed by obesity 20% (31), CKD 10% (15), 25% (39) of the women were postmenopausal. The mean systolic blood pressure (SBP) obtained in the measurements was 124.27 mmHg (240–10 mmHg) and 74.7 mmHg (110–30 mmHg) of diastolic blood pressure (DBP), both in men and women (p = 0.06). Antihypertensive drug treatment was: 37% monotherapy, 42% dual,19% triple and 2% quadruple. Only 67% (104) were in therapeutics goals according to the ESC guidelines and 33% (52) according AHA guidelines respectively.

Conclusions:
Goal achievement is poor in this group of high-risk patients. Even though 63% of the patients had multiple pharmacological treatments, more than a third of patients were not reaching therapeutics goals in blood pressure control. This percentage doubles when more stringent goals are used, following the AHA guidelines.
AMBULATORY BLOOD PRESSURE MONITORING PARAMETERS IN HYPERTENSIVE PATIENTS WITH ABDOMINAL OBESITY IN THE DYNAMICS OF OLMESARTAN/ AMLODIPINE THERAPY
Authors: Koval Sergiy , Penkova Marina , Mysnychenko Olga , Reznik Larisa , Starchenko Tatyana , Lytvynov Vadym , Lytvynova Olga 
Published: June 2022

Objective:
Study the ambulatory blood pressure monitoring (ABPM) parameters in patients with arterial hypertension (AH) with abdominal obesity (AO) in the dynamics of antihypertensive therapy.

Design and method:
60 AH patients with AO were examined. All patients were prescribed a fixed combination of drugs: olmesartan and amlodipine once a day in the morning at doses: 20 mg / 5- 40 /10 mg. ABPM was performed according to the standard method before and after 6 months of treatment.

Results:
24-hour systolic BP (SBP) and diastolic BP (DBP) in patients were 150 (140–159) / 98 (82–105) mm Hg. 24-hour pulse BP - 58 (50–64) mm Hg. Daytime SBP variability in patients was 19 (12–25) mm Hg, daytime DBP variability was 15 (9–19) mm Hg. SBP variability at night was 15 (9–17) mm Hg, DBP variability at night was 13 (8–15) mm Hg. As a result of treatment, the target BP level was achieved in 80% of patients according to the office BP and in 60% -according to the ABPM. The number of patients with pathological variability of BP decreased from 49% to 23% (p < 0.05). An excessive morning rise in SBP at the beginning of the study was noted in 32% of patients, and at the end of the observation - in 11% (p < 0.05). The number of patients with nocturnal hypertension decreased from 42% to 15% after 6 months of treatment (p < 0.001). The distribution of patients by BP profiles revealed that at the beginning of the study «dipper» was in 40% of the patients, «over-dipper» - in 12%, «non-dipper» - in 38%, and «night-picker»- in 6%. After 6 months of treatment the number of patients with the «dipper» profile of ABPM increased to 88%, and with «over-dipper» decreased to 6%. The number of patients with unfavorable «non-dipper» and «night-picker» profiles of ABPM decreased to 5%(p < 0.05) and 1% (p > 0.05), respectively.

Conclusions:
The fixed combination of olmesartan/ amlodipine led to the normalization of parameters of the ABPM profile in hypertensive patients with AO.
BLOOD PRESSURE CONTROL WITH BITHERAPY VERSUS MONOTHERAPY IN OLDER PATIENTS IN THE AREA OF BLIDA (ALGERIA)
Authors: Cherif Abdelghani Bachir , Bennouar Salam 
Published: June 2022

Objective:
To describe hypertensive subjects over 60 years old, according to their bioclinical characteristics and their treatments by comparing monotherapy and combination therapy.

Design and method:
This is a cross-sectional study of 120 hypertensive patients aged over 60 between January 2021 and May 2021. The data were collected with a pre-established information sheet, from standardized files.

Results:
The mean age of the patients was 69,85 ± 7,82 years, 68 (56,7%) of the patients were men. The mean systolic/diastolic blood pressure was (137,45/76,06 ± 17,24/10.13 mmHg). The majority of patients (70%) were treated with dual antihypertensive therapy. The ARBs was the most prescribed class (72,5%). BP was controlled (reduced to < 140/90 mm Hg) in (64; 53,33%) patients, of whom 64,04% were on combination therapy. The comparison between the two groups under monotherapy and combination therapy was without significant difference.

Conclusions:
Few patients are treated with monotherapy, which reflects the recommendations of the European guidelines to treat with combination therapy. In summary, this study confirms the effectiveness of combination therapy for blood pressure control in the elderly.
Novel imaging techniques for sacroiliac joint assessment
Authors: Morbée Lieve , Jans Lennart B.O. , Herregods Nele 
Published: June 2022

Purpose of review
Imaging of the sacroiliac joints is one of the cornerstones in the diagnosis and monitoring of axial spondyloarthritis. We aim to present an overview of the emerging imaging techniques for sacroiliac joint assessment and provide an insight into their relevant benefits and pitfalls.

Recent findings
Evaluation of structural and active inflammatory lesions in sacroiliitis are both important for understanding the disease process. Dual-energy computed tomography (CT) can detect inflammatory bone marrow edema in the sacroiliac joints and provides an alternative for magnetic resonance imaging (MRI). Three-dimensional gradient echo sequences improve the visualization of erosions on MRI. Susceptibility weighted MRI and deep learning-based synthetic CT are innovative MRI techniques that allow for generating ‘CT-like’ images and better depict osseous structural lesions than routine MRI sequences.

Summary
New imaging innovations and developments result in significant improvements in the imaging of spondyloarthritis. Advanced MRI techniques enhance its potential for the accurate detection of structural and active inflammatory lesions of sacroiliitis in one single imaging session.
Quo vadis reactive arthritis?
Authors: Zeidler Henning , Hudson Alan P. 
Published: June 2022

Purpose of review
We provide an overview of recent articles which describe new thinking regarding HLA-B27-associated reactive arthritis (ReA), including those additional infection-related arthritides triggered by microbes that often are grouped under the term ReA.

Recent findings
With the advent and continuation of the pandemic, an increasing number of cases and case series of post-COVID-19 arthritis have been reported and classified as ReA. Further, arthritis after COVID-19 vaccination is a new entity included within the spectrum of ReA. New causative microorganisms identified in case reports include Clostridium difficile, Mycoplasma pneumoniae, Giardia lamblia, Leptospira, and babesiosis. SARS-CoV-2 is emerging as a significant etiologic agent for apparent ReA.

Summary
It is now clear that comprehensive clinical and laboratory investigations, synovial fluid analyses, and close follow-up of patients all are essential to differentiate ReA from diseases that may present with similar clinical attributes. Further, and importantly, additional research is required to define the wide diversity in causative agents, epidemiology, and rare case presentations of these arthritides. Finally, new classification and diagnostic criteria, and updated treatment recommendations, are essential to the advancement of our understanding of ReA.
Effect of the COVID-19 Pandemic on Accredited Continuing Medical Education in the United States
Authors: McMahon Graham T. 
Published: June 2022

Introduction:
The pandemic created new demands on the accredited continuing medical education (CME) community. Facing economic, resource, and personal challenges, educators had to cancel or repurpose in-person learning, and design and deliver effective online education. This short report analyzes the effect of this pandemic on CME in the United States.

Methods:
Organizations accredited by the Accreditation Council for Continuing Medical Education are required to submit detailed data about their educational programs annually. This report compares 2019 and 2020 data sets to evaluate pandemic-related changes in the availability, formats, and participation in CME.

Results:
After years of comparative stability, 2020 saw significant shifts in CME. Compared with 2019, the number of accredited organizations, activities, hours of instruction, and revenue declined in 2020. In contrast, engagement in CME by physicians and other health care professionals increased to the record levels. Virtual learning formats predominated. Almost half of accredited organizations delivered activities addressing pandemic-related topics, mostly in online formats.

Discussion:
Educators anticipate continuing to offer activities in online and hybrid formats. This transformation presents new challenges and opportunities for CME. It is important that institutional leaders appropriately resource CME staff and faculty to design and deliver education targeting ongoing pandemic-related issues such as vaccine hesitancy, medical misinformation, and clinician burnout.
Frameworks for Integrating Learning Analytics With the Electronic Health Record
Authors: Pusic Martin V. , Birnbaum Robert J. , Thoma Brent , Hamstra Stanley J. , Cavalcanti Rodrigo B. , Warm Eric J. , Janssen Anna , Shaw Tim 
Published: June 2022

Abstract
The information systems designed to support clinical care have evolved separately from those that support health professions education. This has resulted in a considerable digital divide between patient care and education, one that poorly serves practitioners and organizations, even as learning becomes ever more important to both. In this perspective, we advocate for the enhancement of existing health information systems so that they intentionally facilitate learning. We describe three well-regarded frameworks for learning that can point toward how health care information systems can best evolve to support learning. The Master Adaptive Learner model suggests ways that the individual practitioner can best organize their activities to ensure continual self-improvement. The PDSA cycle similarly proposes actions for improvement but at a health care organization's workflow level. Senge's Five Disciplines of the Learning Organization, a more general framework from the business literature, serves to further inform how disparate information and knowledge flows can be managed for continual improvement. Our main thesis holds that these types of learning frameworks should inform the design and integration of information systems serving the health professions. An underutilized mediator of educational improvement is the ubiquitous electronic health record. The authors list learning analytic opportunities, including potential modifications of learning management systems and the electronic health record, that would enhance health professions education and support the shared goal of delivering high-quality evidence-based health care.
Using Administrative Data in Primary Care to Evaluate the Effectiveness of a Continuing Professional Development Program Focused on the Management of Patients Living With Obesity
Authors: Zevin Boris , Morkem Rachael , Soleas Eleftherios , Dalgarno Nancy , Barber David 
Published: June 2022

Abstract

Introduction:
There are guidelines for referral to medical and/or surgical weight loss interventions (MSWLI) in Ontario; however, only about one-third of eligible patients in our region are being referred for consideration of MSWLI.

Methods:
A planning committee, including a registered dietician, psychiatrist, endocrinologist, bariatric surgeon, family physician, and educationalists, developed an interdisciplinary continuing professional development (CPD) program focused on practical approaches to the management of patients living with obesity. The Kirkpatrick model was used to evaluate the educational outcomes of the CPD program specifically focusing on Level-2, -3, and -4 outcomes based on self-reported questionnaire and health administrative data.

Results:
Eighteen primary care providers from the CPD program agreed to participate in this study, and 16 primary care providers (89%) completed the postintervention questionnaire and granted us access to their MSWLI referral data; 94% of study participants reported changes to their knowledge, comfort, and confidence (Level 2), as well as expected change in their future behaviour (Level 3) following the CPD program. However, there was no change in Kirkpatrick Level-4 outcomes, despite more than 90% of participants indicating that they will be making changes to their practice after the program.

Discussion:
The CPD program in our study was overwhelmingly well received and participants reported knowledge (Level 2) and behavioural (Level 3) changes following participation; however, there was no detectable change in their clinical practice (Level 4). The methodology described in our proof-of-concept study can be modified and adopted to evaluate Level-4 outcomes in other studies of effectiveness of CPD interventions.
A Phase I Study of Apolizumab, an Anti-HLA-DR ß-chain Monoclonal Antibody, in Patients With Solid Tumor Malignancies
Authors: Fracasso Paula M. , Goodner Sherry A. , Wildi Jonathan D. , Naughton Michael J. , Linette Gerald P. , Govindan Ramaswamy , Tan Benjamin R. , Blum Kristie A. , Jones Gary J. , Pearce Tillman E. , Levitt Daniel J. , Clamon Gerald H. 
Published: June 2022

Background:
Human leukocyte antigen (HLA)-DR, a member of the major histocompatibility complex class II antigen family, is a target for antibody-based therapeutics. Apolizumab (Hu1D10, Remitogen), a humanized IgG1 monoclonal anti-HLA-DR ß-chain antibody targets the antigen, 1D10, expressed on a wide variety of hematologic and solid tumor malignancies. In this Phase 1 trial, the maximum tolerated dose and dose-limiting toxicity of weekly apolizumab in patients with advanced solid tumor malignancies were determined.

Patients and Methods:
Eligible patients with refractory solid tumors were initially screened for ID10 Ag on their tumor. Patients whose tumors expressed 1D10 were administered apolizumab 0.5, 1.0, 1.5, or 3.0 mg/kg intravenously over 90 minutes weekly for 4 consecutive weeks, followed by a 4-week break, and assessment of response. Patients whose disease had not progressed were offered additional treatment.

Results:
Tumors from 75 patients were screened for 1D10 Ag of which 17 patients were positive and underwent treatment. The first 3 dose levels were well-tolerated. Dose-limiting toxicities of grade 3 infusion-related hypersensitivity reactions and grade 3 headache and hypertension occurred in 2 patients, respectively, at apolizumab 3.0 mg/kg. Four patients, 1 each with breast carcinoma, melanoma, renal cell carcinoma, and sarcoma had stable disease for a median of 15 weeks (range: 12 to 19 wk).

Conclusion:
Apolizumab can be administered safely at a maximum tolerated dose of 1.5 mg/kg for 4 consecutive weeks. Adverse events and limited clinical data in both hematologic and solid tumor malignancies resulted in discontinuation of clinical development of apolizumab. HLA-DR remains an interesting immunotherapeutic target.