bluuebunny/crossref_metadata_2025_split huggingface dataset:
A TURN IN THE WRONG DIRECTION. WHAT IS MISSING?
Authors: Casian Mihnea , Gurzun Maria Magdalena , Ionita Iulia Theodora , Munteanu Alice Elena 
Published: June 2022

Objective:
The case highlights the importance of specific non-traditional cardiovascular risk factors in a patient with premature severe cardiovascular disease, despite an apparently adequate control of traditional cardiovascular risk factors.

Design and method:
Clinical Case.

Results:
We present the case of a 38 year-old female with Turner syndrome, with cardiovascular risk factors (mild dislypidemia, type 2 diabetes, grade 1 ESC/ ESH hypertension) who presents to the emergency department for newly-onset constrictive chest pain. Her chronic treatment consisted of a low-dose ACEi and metformin. Clinical exam was unremarkable, except for specific clinical phenotype, with normal BP values in both arms and without any signs of congestion. The electrocardiogram showed sinus rhythm of 65 beats/min, narrow QRS, negative T waves in inferior leads, as well a Q wave in lead III. Hs- troponin (1046pg/ml, ULN: 10pg/ml) and NT-proBNP levels (820,9pg/ml) were elevated. Echocardiography revealed a normal ejection fraction, with localized hypokinesia of the inferior wall and no significant valvular disease. The aortic valve was tricuspid and no signs of aortic coarctaction were observed from the suprasternal view. Coronarography was performed, showing significant CAD, with multiple lesions on ADA, LCXA and RCA. The two suboclusive lesions from the RCA were addressed using two drug eluting stents. The evolution was favourable under specific treatment. The baseline levels of LDLc (117 mg/dl) and glycosylated haemoglobin (5,7%) were not as high as we initially expected, given the severe CAD. Furthermore, the ambulatory 24 h BP monitoring after discharge confirmed that the previous treatment with low-dose ACEi was efficient in maintaining the target BP values.

Conclusions:
Turner syndrome is associated with a variety of cardiovascular manifestations, such as aortic coarctation, which leads to secondary hypertension, as well as an increased risk of cardiovascular events. In our patient, the hypertension was essential, without any arguments for secondary hypertension, as we would have expected. Furthermore, despite the fact the patient exhibited several traditional cardiovascular risk factors, they were controlled within the recommended targets (with the exception of LDLc, slightly higher than 100 mg/dl). The disease duration appears to be critical, as the patient was diagnosed with hypertension more than 15 years ago. We concluded that the advanced premature CAD is most likely the result of the hormonal imbalance and lack of hormone replacement therapy, for which the patient was no longer eligible. Drastic control of traditional cardiovascular risk factors in this case will probably prove to be insufficient.
SERUM URIC ACID LEVELS ARE NOT ASSOCIATED WITH THE SEVERITY OF ACUTE ISCHEMIC STROKE
Authors: Kiosi Maria , Kostourou Danai-Thomais , Mentizis Pavlos , Gkounta Anastasia , Minopoulou Ioanna , Kourtidou Christina , Chatzopoulos Georgios , Gogou Christiana , Kontana Anastasia , Kyziroglou Maria , Tziomalos Konstantinos 
Published: June 2022

Objective:
Previous studies reported discrepant results regarding the association between serum uric acid levels and the severity of acute ischemic stroke. We aimed to evaluate this association.

Design and method:
We prospectively studied 1,107 consecutive patients who were admitted for acute ischemic stroke (42.1% males, age 79.8 ± 7.2 years). Stroke severity was evaluated at admission with the National Institutes of Health Stroke Scale (NIHSS) and severe stroke was defined as NIHSS > = 21. Serum uric acid levels were measured at the second day after admission in the fasting state.

Results:
Serum uric acid levels did not correlated with the NIHSS (r = 0.018, p = NS) and did not differ between patients with severe stroke and those with non-severe stroke (5.9 ± 2.2 and 5.7 ± 1.8 mg/dl, respectively; p = NS). In binary logistic regression analysis, independent predictors of severe stroke were age (relative risk (RR) 1.079, 95% confidence interval (CI) 1.042–1.117, p < 0.001), female gender (RR 1.841, 95% CI 1.138–2.980, p < 0.05), atrial fibrillation (RR 1.678, 95% CI 1.076–2.618, p < 0.05) and diastolic blood pressure at admission (RR 1.020, 95% CI 1.005–1.035, p < 0.01).

Conclusions:
Serum uric acid levels do not appear to be associated with the severity of acute ischemic stroke.
THE MORTALITY RISK IN PATIENTS HOSPITALIZED FOR ISCHEMIC STROKE BETWEEN 2003 AND 2019
Authors: Mayer Otto , Kielbergerov Lenka , Bruthans Jan 
Published: June 2022

Objective:
Stroke represents the ultimate complication of hypertension. Mainly due to improved hypertension control, stroke incidence and mortality from cerebrovascular events decreased in the Czech Republic since the ‘80 s. On the other hand, how this favorable trend affects the case fatality and consequent mortality of individuals who suffered from stroke remains questionable. In patients hospitalized for ischemic stroke, we evaluated the mortality trends in the last two decades.

Design and method:
9076 patients [mean age 71.8 (±SD 12.3), 51.9% males] hospitalized for ischemic stroke at baseline between 2003 and 2019 were followed in the prospective study. The vital status we ascertained up to 31.12.2020, all other circumstances from the hospital information system

Results:
In total, 5583 of our patients died during follow-up. The case fatality was 9.1%, 30-day mortality 14.2%, and 1-year mortality 28.4%. In patients hospitalized from 2003–2015, the 5-year mortality was 49.8%. No significant changes were noted for case fatality, 30-days, 1-year mortality, as well as 5-years mortality risk across the year of hospitalization or more extensive periods (2003–07, 2008–11, 2012–15 and 2016–19). As expected, any age decade of patients was associated with two-fold higher mortality risk, and a significant predictor was also hospitalization >10 days. In contrast, the male gender did not predict increased risk Intravenous thrombolysis as part of initial management markedly increased over time (from 2.4% in 2003–07 to 48.1% in 2016–19), but this procedure did not significantly affect the mortality risk (neither 1-year nor 5- years in partial sample).

Conclusions:
Despite favorable trends in cerebrovascular events from a population perspective, the individual prognosis of patients who have suffered a stroke remains very poor.
HEART RATE VARIABILITY AND BRAIN FUNCTIONING IN HYPERTENSIVE PATIENTS
Authors: German-Sallo Marta , Preg Zoltan , Pál Tünde , Andrássy Krisztina , Tatar Maria-Cristina , Szentendrey Dalma Bálint 
Published: June 2022

Objective:
Decreased heart rate variability (HRV) reflecting autonomic nervous dysfunction has been associated with increased mortality in cardiovascular diseases. Less is known about the relationship between HRV and hypertension associated cognitive impairment. The study aimed to compare HRV parameters in well-controlled hypertensive patients with and without cognitive dysfunction, as marker of functional brain damage caused by hypertension.

Design and method:
Data about 226 hypertensive patients were obtained, 53% males, between 37 and 98 years (mean age 66 years ± 10). The mean blood pressure was 135/81 mmHg (±19/11 mmHg) (under hypertensive medication). Cognitive abilities were measured with the multi-domain Montreal Cognitive Assessment questionnaire (MoCA) defining cognitive decline below 24 points. All patients had 24- hour Holter monitoring. Time domain [pNN(50), NN(50) SDNN, rMSSD] and the LF/HF frequency domain HRV parameters were analyzed in patients with normal and impaired cognition, and in different cognitive domains with the IBM SPSS v20 software.

Results:
Cognitive dysfunction was present in 63.73% of the studied group. Time domain parameters pNN(50), NN(50) and r MSSD were significantly higher in patients with altered cognition (p = 0.002, p = 0.001, p = 0.02). Frequency domain HF was also significantly higher in this group (p = 0.03). Male individuals had significantly higher LF/HF ratio (men 1.08% vs. women 0.97%, p = 0.006). Patients with hypertension grade II had higher LF/HF ratio compared to grade III (1.069 vs. 0.98%, p = 0.01). Analyzes of cognitive domains in the total study group revealed low SDNN, rMSSD values in language, abstraction domains, with statistical significance in the domains of visuospatial-executive (SDNN p = 0.013, rMSSD p = 0.001) and attention (SDNN p = 0.044). Higher LF/HF ratio was found in all cognitive domains, excepting attention, with statistical difference in delayed recall (p = 0.015).

Conclusions:
Our data suggest a gender difference regarding sympathovagal balance in hypertensive patients with enhanced sympathetic activity in males. Although higher HRV was observed in cognitively impaired well-controlled hypertensive patients, time domain HRV parameters reflecting impaired autonomic nervous function were related to some specific cognitive domains. Future studies are needed to better understand these findings.
COGNITIVE IMPAIRMENT AND CAROTID INTIMA-MEDIA THICKNESS IN PATIENTS WITH RESISTANCE HYPERTENSION
Authors: Gulkevych Oksana , Mishchenko Larysa , Logvynenko Alla , Matova Olena 
Published: June 2022

Objective:
To determine predictors of cognitive impairment in patients with resistance hypertensin (RH) after 3-years of follow-up.

Design and method:
In 98 patients with RH (average age 52.4 ± 1.2, 60 males, mean hypertension history at the baseline 12.8 ± 0.9 years) we measured office blood pressure, ultrasonographically diameter (D) of common carotid (CCA) artery, carotid intima-media thickness (IMT), performed Montreal cognitive assessment (MoCA) test, ambulatory blood pressure monitoring twice: initially and after a mean period of 3 years. Also morning fasting venous blood samples were obtained from all subjects for uric acid, lipid profile, glucose assays. Age and other cardiovascular risk factors were included in the analysis.

Results:
There was a significant deterioration in the MoCA results during the follow-up: 23.2 ± 0.2 at the baseline vs 22.6 ± 0.2 after 3 years, p = 0,02. The cognitive decline was significantly associated with initial measurement of IMT (b = -0.232, p = 0.01). This association was independent of age, body mass index and hypertension history. No statistically significant associations were obtained between the MoCA results and systolic blood pressure, diastolic blood pressure, total cholesterol, triglycerides, LDL cholesterol, serum uric acid, glucose.

Conclusions:
Our data suggested that cognitive impairment in patients with resistance hypertension associated with severity of the carotid structure damage and carotid intima-media thickness at the baseline was independent predictor of cognitive decline in these patients.
ASSOCIATION BETWEEN TRIGLYCERIDE-GLUCOSE INDEX AND LOW APPENDICULAR LEAN MASS IN CHINESE ADOLESCENTS
Authors: Zhou Jinyu , Bai Ling , Tong Lingling , Ding Wenqing 
Published: June 2022

Objective:
It has been verified that the triglyceride-glucose (TyG) index is an effective surrogate marker of insulin resistance in numerous studies. This study aims to explore the association between TyG index and appendicular lean mass (ALM) in Chinese adolescents.

Design and method:
A total of 1336 adolescents (805 boys, 60.25%) aged 12 to 18 years in China were randomly selected through a stratified cluster sampling. All participants were divided into four groups according to the tertiles of TyG index, and ALM was measured by Bioelectrical Impedance Analysis (BIA).

Results:
After adjusted for age, ALM/weight was negatively associated with the TyG index both in boys (r = -0.267, P < 0.001) and girls (r = -0.209, P < 0.001), while other indexes were positively correlated with TyG index (all P values < 0.05), especially for fasting plasma glucose (Boys: r = 0.476, P < 0.001; Girls: r = 0.393, P < 0.001). The results of binary logistic regression showed that the low ALM/weight in the third tertile of TyG index versus the control was 2.36(1.42–3.94) in boys while there was no association between TyG index group and ALM/weight in girls(P = 0.087). This relationship remained similar after adjusting for confounding factors such as total cholesterol level, fasting plasma glucose, and mean blood pressure.

Conclusions:
Elevated TyG index was associated with the risk of low ALM/weight independent of confounding factors in Chinese boys.
ISRADIPINE FOR THE TREATMENT OF ACUTE SEVERE HYPERTENSION IN CHILDREN
Authors: Short Braden , Moon Kwi , Larkins Nicholas G. , Hijazzi Sally 
Published: June 2022

Objective:
There is scarce data on the use of oral agents to treat acute severe hypertension in children, despite being common practice for children with no or minimal symptoms. The aim of this study was to evaluate the safety and efficacy of isradipine in children with acute hypertensive episodes, following a hospital-wide change from nifedipine to isradipine as the preferred calcium channel blocker for acute severe hypertension.

Design and method:
We reviewed the first 10 inpatients to receive isradipine at the sole tertiary paediatric hospital in Western Australia from June 2021. Patient characteristics and blood pressure (BP) measurements (systolic, diastolic and mean arterial pressure (MAP)) at baseline and during the six hours following isradipine administration were extracted. Linear regression and Spearman rank correlation coefficient were used to examine the relationship between dose and BP reduction. Adverse events and requirement for additional antihypertensives were also recorded.

Results:
A total of 10 patients (median 7 years, interquartile range [IQR] 4–11 years, youngest 2 years) received 23 doses of isradipine for discrete episodes of acute severe hypertension. The median systolic BP and MAP at treatment initiation were 140 mmHg (IQR 132–148) and 111 mmHg (IQR 104–119), respectively. The median dose administered was 0.09 mg/kg/dose (IQR 0.06–0.09). The median reduction of systolic and diastolic blood pressure were 13% (IQR 9–20%) and 11% (IQR 2–28%), respectively. The MAP dropped by 13% (IQR 7 to 25%). BP reached treatment targets following 18 doses (78%). In the 5 cases requiring a further antihypertensive dose, 3 received clonidine, one a further dose of isradipine, and one their regular antihypertensive agent. The systolic BP and MAP fell by more than 25% following a total of 4 (17%) and 6 (26%) of doses, respectively. There was no relationship between dose and outcome over the narrow range of mg/kg/dose administered. No child had a BP drop of more than 50% or any adverse events recorded.

Conclusions:
Isradipine was a safe and effective treatment for acute severe hypertension among our initial cohort. Further data is being collected to expand the pharmacodynamic information available for isradipine use in children.
DIFFERENCES IN METABOLOMICS IN CHILDREN WITH HIGH AND LOW ARTERIAL STIFFNESS. A CASE-CONTROL STUDY
Authors: Poikilidou Maria , Yavropoulou Maria , Tsave Olga , Stamou Maria , Grammatikopoulou Artemida , Georgianos Panagiotis , Zebekakis Pantelis 
Published: June 2022

Objective:
Studies in children have shown a progressive increase in arterial stiffness by measuring pulse wave velocity (PWV) during childhood, indicating a structural alteration to the arterial wall starting already in early life. Metabolomic studies also show differences in molecules between different disease states in children. The aim of the current study was to identify molecular markers between age and gender-matched children with high and low PWV.

Design and method:
The study included the screening of 132 children that came for random visits to a tertiary pediatric clinic. 50 children (25 in the highest PWV tertile-Group 1, and 25 in the lowest PWV tertile-Group 2) were chosen for the metabolomic study. The groups were matched for age and gender and underwent an ABPM, and PWV, Aix measurements as well as measurements of central BP. We used t-test to explore differences between the two groups. We used mass spectrometry and constructed a heat map displaying the differences in each metabolite concentration between the two groups.

Results:
The mean age of the study population was 11.4 ± 2.7 years. Group 1 had significantly higher BMI percentiles than Group 2 (94.7 ± 8.7 and 74.3 ± 27.6, p < 0.001), higher 24-hour SBP (117.3 ± 110.9 ± 9.0mmHg, p = 0.025) and higher 24-hour DBP (70.7 ± 7.3 vs 65.8 ± 5.8mmHg, p = 0.018), higher central SBP (95.1 ± 8.5 vs 89.3 ± 9.7mmHg, p = 0.028), and DBP 69.6 ± 8.6 vs 60.8 ± 11.0mmHg, p = 0.003). Similarly, significant differences occurred also between clinic SBP and DBP. Table 1. shows the metabolites that were significantly upregulated in Group 1.

Conclusions:
The current metabolomic study found differences in certain metabolites between children in the highest and lowest ends of arterial stiffness. These metabolites involve sphingolipids, sterol lipids, fatty acyls, carboxylic acids, glycerophospholipids as well as other compounds that are not yet fully identified on their properties.
VASCULAR AGE IN ADOLESCENTS WITH PRIMARY HYPERTENSION
Authors: Obrycki Lukasz , Pac Michal , Sarnecki Jedrzej , Feber Janusz , Litwin Mieczyslaw 
Published: June 2022

Objective:
There is evidence that children with primary hypertension (PH) are more mature than their normotensive peers in terms of bone and the immune system age. The aim of our study was to evaluate vascular age and its relationship with hypertension-mediated organ damage (HMOD) in adolescents with PH.

Design and method:
We assessed 362 children [90 girls; 15.5 (13.9;16.8) years] referred for work-up of office hypertension and 64 normotensive (NT) subjects [12 girls; 14.5 (13.8;15.6) years] not different in terms of age, body mass (BM) and BMI. We analyzed age- and height-related pulse wave velocity (PWV); the expected vascular age (based on measured PWV) was obtained from pooled pediatric and adult PWV norms and the difference (VascAgeDiff) between the vascular and chronological age was calculated. In all patients we obtained ambulatory blood pressure monitoring (ABPM) and HMOD: left ventricular mass index (LVMi), carotid intima-media thickness (cIMT) and pulse wave analysis (PWA) parameters: stroke volume (SV), cardiac output (CO), aortic BP (AoBP), total peripheral resistance (TPR).

Results:
Based on office, ABPM and AoBP, patients were classified into white coat hypertension (WCH) - 166 patients, ambulatory prehypertension (AmbPreHT) – 32; spurious hypertension (sHT – isolated systolic hypertension and normal AoBP) – 55; true hypertension (tHT – elevated office, ambulatory and AoBP) – 99. VascAgeDiff progressively increased from NT through sHT, WCH, AmbPreHT to tHT (3.5; 6.2; 7.2; 10.0; 10.7 years; p < 0.01). VascAgeDiff correlated (univariate analysis) significantly with weight, BMI z-score, office systolic (SBP) and diastolic blood pressure (DBP), AoBP, 24-h mean arterial pressure, 24-h DBP, CO, serum uric acid and LDL cholesterol level (p < 0.05). Multivariate regression analysis including above mentioned parameters revealed that significant predictors of VascAgeDiff were: weight, SBP, DBP, AoBP, CO and serum LDL cholesterol (p < 0.05).

Conclusions:
Out study suggests early vascular aging in adolescents with PH, even at mildly increased BP levels (WCH, prehypertension). Vascular changes were associated with increased weight, DBP, AoBP, CO and LDL cholesterol.
INFLUENCE OF PRO-INFLAMMATORY ADIPOKINES IN THE VASCULAR PHENOTYPE OF OVERWEIGHT AND OBESE ADOLESCENTS
Authors: De Blas Ana , Álvarez-Pitti Julio , Torro Maribel , Aguilar Francisco , Ponce Francisco , Lurbe Empar 
Published: June 2022

Objective:
Obesity is a complex disease that leads to an adipocyte dysfunction favoring a profile characterized by insulin and leptin resistance with low adiponectin values. The objective of the present study is to assess in overweight and obese subjects the impact of the unfavorable profile of adipokines in blood pressure and vascular function.

Design and method:
Overweight and obese adolescents referred for cardiovascular risk assessment were included in a cross-sectional study. Height, body weight, and body composition were measured by bioelectrical impedance analysis. Hemodynamics were assessed by office blood pressure. Pulse wave velocity (PWV) and central blood pressure (cBP) were measured with Sphigmocorâ device. The logarithm of Aortic pulse pressure (AoPP) was calculated. Metabolic profile including fasting glucose and insulin levels, lipids profile and uric acid was assessed. Leptin and adiponectin were measured and the leptin/adiponectin ratio (L/A r) was calculated.

Results:
A total of 60 subjects (mean age 12.5 years, 53% male, and 68% obese) were included. Participants with obesity (mean BMI Z-score 2,3 ± 0.2) had higher levels of daytime SBP (118 Vs 116 mmHg; p = 0.05), and no differences in PWV (5.5 vs 5 m/s; p = 0.06) as compared to overweight. No differences were found in the metabolic profile, in contrast, leptin, was higher in subjects with obesity (43 vs 30 ng/L p = 0.045). Overall, a positive and significant correlation was found between leptin and PWV. Focusing on cBP values, a significant and negative correlation among adiponectin and AoPP was observed. In contrast a positive correlation to L/A r was found (figure). The multiple regression analysis showed that PWV was partially explained by L/A r and AoPP by adiponectin, when age, sex, BMI Zscore, insulin, leptin, and L/A r were included in the model.

Conclusions:
Obesity leads to an adipokines profile that is related to unfavorable vascular phenotypes in youth.
THE RELATIONSHIP BETWEEN THE DISTRIBUTION OF BODY FAT AND THE LEVEL OF OSTEOCALCIN IN CHINESE ADOLESCENTS
Authors: Bai Ling , Zhou Jinyu , Tong Lingling , Ding Wenqing 
Published: June 2022

Objective:
Current studies on body fat distribution and bone metabolism in adolescents are very limited. This study aimed to examine the relationship between the body fat distribution and serum osteocalcin levels in adolescents.

Design and method:
A total of 1068 subjects (564 boys,52.8%) aged 12–18 years from Ningxia were randomly selected through a stratified cluster sampling. Serum osteocalcin levels were measured by ELISA. An automatic bioelectric impedance analysis (BIA) was used to measure body compositions, which included body fat mass(BFM),trunk fat mass(TFM),limbs fat mass(LFM),visceral fat level(VFL).

Results:
In the total population, serum osteocalcin levels were negatively correlated with BFM, TFM, LFM, and fat mass percentage (FMP) (r = -0.076, -0.066, -0.094 and -0.117, respectively, all P < 0.05); Serum osteocalcin levels were positively correlated with limb fat mass percentage (LFMP) (r = 0.167, P < 0.001). Logistic regression analysis showed that the odds ratios (ORs) of FMP in the third and second quintiles suggesting high levels of osteocalcin is 0.28 (95% confidence interval [CI],0.13—0.57) and 0.44(95% CI, 0.25—0.76) compared with the lowest quartile level among total population, respectively. Additionally, the corresponding ORs for high levels of osteocalcin were 0.2 (95%CI, 0.05–0.72) in the fourth quantile of FMP,0.21 (95%CI, 0.08–0.55) in the third quantile of FMP and 0.45(95% CI, 0.25–0.82) in the second quantile of FMP in boys, respectively. Compared with the reference subgroup, the fourth quantile level of LFMP could better predict high osteocalcin levels between boys and girls, and the ORs were 7.46 (95%CI, 2.79—19.96) and 2.60(95%CI: 1.36—4.96), respectively.

Conclusions:
FMP have a negative impact on bone resorption in in Chinese adolescents, especially in boys. However, LFMP has a protective effect on bone metabolism between Chinese boys and girls.