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Retroperitoneal fibrosis (RPF) is a rare disease associated with the formation of hard inflammatory and fibrous tissue in the retroperitoneum. Taking into consideration the fact that RPF is a rare disease with different subtypes, we compared the basal clinical and biochemical characteristics of the vascular and urorenal subtypes.From January 2005 until December 2021, 27 patients were identified as vascular subtype (18 males) and 11 as urorenal subtype (9 males).Patients with a primary urorenal origin had significantly worse kidney function as reflected by serum creatinine and eGFR (bothVascular subtype is more prevalent in our study with more cardiovascular risk factor present. Due to the diversity of symptoms, diagnosis of RPF becomes a challenge for specialists as well as therapy.

Hypertension is the most common finding in chronic kidney disease patients, with prevalence ranging from 60% to 90% depending on the stage and etiology of the disease. It is also a significant independent risk factor for cardiovascular disease, progression to end-stage kidney disease and mortality. According to the current guidelines, resistant hypertension is defined in the general population as uncontrolled blood pressure on three or more antihypertensive drugs in adequate doses or when patients are on four or more antihypertensive drug categories irrespective of the blood pressure control, providing that antihypertensive treatment included diuretics. The currently established definitions of resistant hypertension are not directly applicable to the end-stage kidney disease setting. The diagnosis of true resistant hypertension requires confirmation of adherence to therapy and confirmation of uncontrolled blood pressure values by ambulatory blood pressure measurement or home blood pressure measurement. In addition, the term “apparent treatment-resistant hypertension,” defined as an uncontrolled blood pressure on three or more antihypertensive medication classes, or use of four or more medications regardless of blood pressure level was introduced. In this comprehensive review we focused on the definitions of hypertension, and therapeutic targets in patients on renal replacement therapy, including the limitations and biases. We discussed the issue of pathophysiology and assessment of blood pressure in the dialyzed population, management of resistant hypertension as well as available data on prevalence of apparent treatment-resistant hypertension in end-stage kidney disease. To conclude, larger sample-size and even higher quality studies about drug adherence should be conducted in the population of patients with the end-stage kidney disease who are on dialysis. It also should be determined how and when blood pressure should be measured in the group of dialysis patients. Additionally, it should be stated what the target blood pressure values in this group of patients really are. The definition of resistant hypertension in this group should be revisited, and its relationship to both subclinical and clinical endpoints should be established.

The predictive value of heart rate (HR) measured using automated office blood pressure measurement (AOBPM) remains unknown.This study aimed to determine the impact of AOBPM HR on the cardiovascular events in hypertensive subjects with and without prior cardiovascular disease (CVD).Data of 9361 participants of the Systolic Blood Pressure Intervention Trial (median follow-up 3.26 years) were used to perform post-hoc analysis based on baseline AOBPM HR levels (50, 50-60, 60-70, 70-80 and80 b.p.m.). Clinical composite end-point (CE) was defined as myocardial infarction (MI), acute coronary syndrome other than MI, heart failure exacerbation, stroke or cardiovascular death. Cardiovascular-related and all-cause mortalities were also evaluated.A total of 1877 participants with and 7484 without CVD were included. Those with higher baseline HR were less frequently males and more often smokers, had higher BMI and eGFR, had lower baseline systolic blood pressure and higher diastolic blood pressure. No differences were observed in the CE frequency, its components and all-cause death between baseline HR groups. Elevated HR (70 b.p.m.) was associated with higher risk of CE, MI and cardiovascular death in multivariable Cox model. Moreover, the model determining the MI risk showed a J-shaped relationship with HR and a significant interaction term (P = 0.049) between HR and CVD history.High AOBPM HR is associated with a higher risk of cardiovascular events and mortality, whereas low HR may result in higher MI risk in patients who previously had CVD.

Background: Retroperitoneal fibrosis (RPF) is a rare disease characterized by the presence of inflammatory and fibrous retroperitoneal tissue that often encircles abdominal organs including the aorta and ureters. Data on the incidence of this disease are limited. Summary: The disease may be idiopathic or secondary to infections, malignancies, drugs, or radiotherapy. The idiopathic form is an immune-mediated entity and a part of the broader spectrum of idiopathic diseases termed chronic periaortitis, characterized by a morphologically similar fibroinflammatory changes in the aorta and surrounding tissues. Taking into account the dominant symptoms and clinical characteristics of patients with periaortitis, 2 subtypes of disease could be distinguished. The vascular subtype includes patients with nondilated aorta or with inflammatory abdominal aortic aneurysm, both with and without involvement of adjacent structures and with numerous risk factors for atherosclerosis. In the renoureteral subtype, obstructive uropathy manifesting with hydronephrosis and acute kidney injury is the predominant finding. Due to the variety of symptoms, diagnosis of RPF remains challenging, difficult, and often delayed. A series of diagnostic tests should be performed, in order to confirm the diagnosis idiopathic RPF. Laboratory workup includes evaluation of inflammatory indices and immunological studies. A biopsy and histopathological evaluation may be necessary to confirm diagnosis and differentiate the disease. Computed tomography, magnetic resonance imaging, and positron emission tomography are the modalities of choice for the diagnosis and follow-up of this disease. Management of ureteral obstruction, hydronephrosis, and aortic aneurysms often requires surgical evaluation and treatment. The pharmacological treatment of RPF has been evaluated in a few randomized trials and is mainly based on observational studies. Steroid therapy remains the gold standard of treatment. Key Messages: Nowadays, multidisciplinary team approach with clinical and diagnostic experience in both primary and secondary RPF as well as 2 major subtypes should be offered. Centers specialized in rare diseases with collaboration with other units and referral system yield the best possible outcomes.

Objective: The objective of this paper is to present possible differences in spondylometric dimorphic characteristics of lumbar spine in the period of progressive development. Material and methods: The research material included 24,517 individuals of both sexes aged from 3 to 25. Individuals that showed abnormal structure of the motor system and individuals reporting pain in the joints of the spine were excluded. Spondylometric research was carried out using the Penny & Giles electrogoniometric measuring system. Significance tests concerning position measurements (Student's t-test, Welch's t-test) were used as well as biometric profiles formed on the basis of Mollison index for each characteristic in the studied period of ontogenesis. The progress of development of the examined spondylometric characteristics in both sex groups was calculated on the basis of expressing the size of the feature in successive age groups as a percentage of its final size. Using the linear and polynomial regression models, the developmental lines of the studied spondylometric parameters were obtained in males and females. Results: In the development process of the studied spondylometric parameters, dimorphic diversity can be observed essentially only in adolescence. In general, in the whole studied period of ontogenetic development, the greater range of lumbar spine mobility is found in females. Minor sexual dimorphism is also evident in the dynamics of development and in the stage of development of the majority of examined characteristics in individual age ranges in relation to the final values, for the benefit of the female sex.

IntroductionRepeated measurements of ankle-brachial index (ABI) using Doppler method were shown to be accurate during atrial fibrillation. Oscillometric devices are effective in ABI measurement, but their accuracy during atrial fibrillation is unknown. The purpose of the study was to investigate whether atrial fibrillation influences ABI obtained with the automatic oscillometric method.Material and methodsNinety-nine patients with atrial fibrillation (mean age: 66.6 +(SD = 11) years, M/F  63/36) who underwent electrical cardioversion were investigated (198 lower extremities). The ABI measurements using oscillometric and Doppler methods were performed on both lower extremities before and after procedure.ResultsThe ABI measured using the oscillometric method on both lower limbs did not change after cardioversion (1.21 (IQR: 1.13-1.27) vs. 1.22 (IQR: 1.14-1.26), p = 0.664, respectively). The ABI measured before and after cardioversion using Doppler and oscillometric methods showed a significant difference (1.14 (IQR: 1.07-1.22) vs. 1.21 (IQR 1.13-1.27), p < 0.001 and 1.18 (IQR: 1.09-1.13) vs. 1.22 (IQR: 1.14-1.26), p < 0.001 respectively). Both methods showed a weak correlation before (r = 0.35, p < 0.001) and no correlation after cardioversion (r = 0.12, p = 0.07). The Bland-Altman plot showed poor agreement between measurements performed with the Doppler and oscillometric methods in sinus rhythm and during atrial fibrillation.ConclusionsThe automated oscillometric method of ABI measurements should not replace the reference Doppler method in patients with atrial fibrillation. More research related to the oscillometric measurements is needed in subjects with peripheral artery disease and atrial fibrillation.

Introduction: The basic functional assessment, on the basis of which rehabilitation programming is carried out in a patient after a stroke, consists in examining the efficiency of the upper and lower limbs, balance and i.a. muscle tension. Therefore, it is important to identify and understand the relationships between these basic data in order to make conclusions easier and to set good goals in rehabilitation. Objective: The aim of the study was to investigate the relation between the assessment of the motor efficiency of the lower limb, measured Fugl-Meyer Assessment Scale (FMA) and the balance, measured Berg Balance Scale (BBS) and between the FMA and the assessment of muscle tone, measured modified Ashworth scale in chronic-phase patients after an ischemic stroke before and after a 6-week rehabilitation process. Material and methods: The study group consisted of 37 patients after stroke (post-stroke duration > 1 year). All patients were subjected to a double functional assessment. Main measures: motor function in the lower limb, balance and spasticity in the lower limb. Spearman correlation coefficients was used to identify and analyze the relationship between the FMA and BBS as an assessment of the increased muscle tone. Results: There was a highly significant p

Background: The guidelines recommend intensive blood pressure control. Randomized trials have focused on the relevance of the systolic blood pressure (SBP) lowering, leaving the safety of the diastolic blood pressure (DBP) reduction unresolved. There are data available which show that low DBP should not stop clinicians from achieving SBP targets; however, registries and analyses of randomized trials present conflicting results. The purpose of the study was to apply machine learning (ML) algorithms to determine, whether DBP is an important risk factor to predict stroke, heart failure (HF), myocardial infarction (MI), and primary outcome in the SPRINT trial database. Methods: ML experiments were performed using decision tree, random forest, k-nearest neighbor, naive Bayesian, multi-layer perceptron, and logistic regression algorithms, including and excluding DBP as the risk factor in an unselected and selected (DBP < 70 mmHg) study population. Results: Including DBP as the risk factor did not change the performance of the machine learning models evaluated using accuracy, AUC, mean, and weighted F-measure, and was not required to make proper predictions of stroke, MI, HF, and primary outcome. Conclusions: Analyses of the SPRINT trial data using ML algorithms imply that DBP should not be treated as an independent risk factor when intensifying blood pressure control.

The aim of the study was the evaluation of the hormonal response of wheelchair rugby participants under the half-year training cycle. The study sample included 11 members of the Polish national wheelchair rugby team with spinal cord injury at the cervical level, ranging in age from 21 to 41 years, body weight (72.2 ± 11.53 kg), and body height (182.3 ± 6.11 cm). The disabled individuals with spinal cord injury subjected to the study constitute a homogeneous group in terms of age, body height, weight, and injury level. The study was carried out at the beginning and at the end of a 6-month training period. In the first and second examination, measurements of the peak oxygen uptake (peakVO2) and blood biochemical analysis were performed (Lactate dehydrogenase (LDH) activity and concentration of creatinine (Cr), total testosterone (TT), free testosterone (FT), and cortisol (C)). A significant change was observed in the concentration of C in the Wheelchair Rugby players’ blood between two research periods (p < 0.05 (ES:0.76)) and a correlation between the post-training change in FT/C concentration and the change in Cr concentration (r = −0.6014, p < 0.05). The 6-month training period did not result in overloads within the group of players. However, due to the significant loss of the capacity of the spinal cord injury (SCI) and the possibility of a life-threatening trend, the anabolic/catabolic status of the players should be monitored using blood biochemical indices.

Objective The objective of the study was to assess the influence of forward head posture on the mechanical parameters and pressure pain threshold of superficial neck muscles in clinically nonsymptomatic individuals with sedentary jobs. Methods Twenty-five office workers with forward head posture and 25 office workers with normal head posture were matched for sex, age, body mass index, and the nature and duration of their work and were compared at a single point. The study participants were divided into study groups on the basis of photometric craniovertebral angle measurements. The upper trapezius, sternocleidomastoid, and splenius capitis mechanical properties were assessed in the sitting position. Primary outcome measures were muscle stiffness (N/m), muscle tone (Hz), and muscle elasticity. The secondary variable was perceived pain threshold. Results No significant differences between the groups were found for biomechanical properties and perceived pain threshold in the studied muscles. Conclusion Forward head posture has no impact on muscle stiffness, tone, and elasticity, nor does it increase the pressure sensitivity of superficial neck muscles in healthy, mildly symptomatic office workers. It is most likely that not incorrect posture of the cervical spine, but probably other factors combined with forward head posture, like comorbid acute and chronic cervical pain and musculoskeletal disorders or prolonged sitting, contribute to changes in active myofascial tone and tensegrity as well as increased pressure sensitivity of neck muscles.

Objective. The aim of this study was to determine the effect of general rehabilitation gymnastics on subjective and objective characteristics of locomotor system in older women with chronic LBP. To satisfy this goal, the outcomes in exercising women were compared with the results of nonexercising controls. Material and Methods. The study group included 21 women with chronic LBP (age 65-75 years), participating in a 3-year general rehabilitation program combining strength, stretching, endurance, balance, and stabilization exercises with Muscle Energy Techniques (MET). Control group included 20 women with chronic LBP, who neither undertook the gymnastics nor participated in other forms of physical activity. The list of outcome measures included pain severity (Numeric Rating Scale), limitations in the activities of daily living (Oswestry Disability Index and Roland-Morris Disability Questionnaire), mobility of all spinal segments (tensometric electrogoniometry), and bioelectrical activity of back muscles (kinesiologic electromyography). Results. Exercising women presented with lesser severity of current pain (by 62%, p Conclusions. These findings may point to beneficial effects of the combined exercise program.

Background Work-related neck disorders are among the most common dysfunctions in office workers. Understanding cervical myofascial mechanical characteristics that differentiate symptomatic from asymptomatic office workers is crucial for the understanding of musculoskeletal dysfunctions in workers with neck pain. Objective To assess the effect of moderate work-related neck disorders on head posture and stiffness and perceived pain threshold of the upper trapezius (UT) and sternocleidomastoid (SCM) muscles. Design Cross-sectional study. Setting Work environment. Participants Sixteen office workers with diagnosed moderate work-related neck disorders and 16 asymptomatic office workers matched for sex, age, body mass index, and the nature and duration of their work. Intervention Not applicable. Outcome The primary outcome measure consisted of measurements of head posture using craniovertebral angle and myotonometric muscle stiffness (Newtons per meter) of the UT and SCM muscles. The secondary output variable was the perceived pain threshold algometry of the studied muscles. Results Compared with controls, subjects with work-related neck pain had a significantly smaller craniovertebral angle (by 8.3%; Cohen d = 0.88, P = .02) and greater stiffness of the UT myofascial tissue (by 11.3%; Cohen d = 1.05, P = .006). No significant differences in perceived pain threshold of the myofascial tissue of the UT or SCM muscles were found between groups. Conclusion In this study female office workers with neck pain had increased anterior positioning of the head and stiffness of the UT muscle in the sitting posture, which was not associated with changes in the pressure pain threshold of this muscle. Level of Evidence II

BackgroundThe alpha-adrenolytics (AA) are not recommended in patients with EF reduced heart failure due to safety concerns. The aim of our study was to assess the safety of AA in patients hospitalized due to exacerbation of HF and the influence of these drugs on long-term endpoints.MethodsData collected by the National Health Fund was used. Patients hospitalized due to HF exacerbation were included. The primary outcome was all-cause mortality and the secondary was the first readmission due to HF or all-cause death occurring more than 30 days after discharge.ResultsOf 140 668 patients hospitalized in the year 2013 n=53317 were included and followed for a median of 56.3 months. AA patients had lower long-term mortality (52.8% vs. 54.9%, unadjusted P=0.038). The treatment with AA positively and affected long-term survival (adjHR 0.82, 95%CI 0.78-0.87, P

Introduction Optimal diastolic blood pressure (DBP) during antihypertensive treatment in patients without a history of cardiovascular disease (CVD) remains unknown. Objectives This post‑hoc analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) data aimed to determine the optimal DBP evaluated using automated office blood pressure measurements (AOBPM) in hypertensive patients without a history of CVD. Patients and methods Data of 1470 patients with CVD and 7117 patients without CVD were used. Clinical composite endpoint (CE) was defined as the occurrence of myocardial infarction, acute coronary syndrome other than myocardial infarction, decompensation of heart failure, stroke, or cardiovascular death. Two different approaches based on the hazard ratio plot were used to identify the optimal DBP range. The first approach was to determine the 10 mm Hg-wide DBP range with the lowest risk for CE. In the second approach, it was assumed that the hazard ratio of CE at the boundary points of the optimal DBP range should be the same in patients with and without CVD. Results Two ranges of on-treatment DBP were proposed: 73.7 to 83.7 mm Hg (first approach) and 63.6 to 95.8 mm Hg (second approach). The risk for CE was increased by 3% and 20% at the boundary points of the range, respectively, depending on the method of DBP determination. Conclusions Due to the fact that the range determined by the second method was wide and substantially different from the one recommended by the European Society of Cardiology (70-79 mm Hg), we have concluded that a DBP range of 73.7 to 83.7 mm Hg, measured using AOBPM, should be considered optimal in patients without CVD.

Background Available evidence does not indicate whether resting heart rate (RHR) is an independent risk factor or just marker of elevated risk. None of the studies assessed impact of RHR on cardiovascular events, when RHR was measured using automated blood pressure measurements (AOBPM). Purpose To assess the relationship between RHR (measured using AOBPM) and cardiovascular events risk in subjects with hypertension. Methods The data of SPRINT trial obtained via NHLBI were used to perform the analysis. SPRINT trial assessed intensive lowering of systolic BP to a target RHR was measured using AOBPM device and calculated as an average of 3 measurements during the baseline visit of the study. Clinical composite endpoint (CE) of the study was defined as: myocardial infarction, acute coronary syndrome, decompensation of heart failure, stroke or cardiovascular death. The relationship between RHR and CE was assessed according to presence of cardiovascular disease (CVD) in past medical history. The statistical methods included t-test and chi-square test, Cox proportional risk models. The Cox models were adjusted for adjusted for age, sex, current smoking status and mean SBP during the trial. Restricted cubic splines were used to describe the relationship between RHR and hazard ratio. Results Data of 1877 participants with CVD and 7484 participants without CVD were analyzed. Subjects with cardiovascular disease were older (69.7±9.5 vs 67.5 years ± 9.4, p The multivariable Cox proportional hazard risk model revealed that RHR>80 bpm is an independent risk factor for CE in subjects without CVD (hazard ratio 1.37, 95% CI 1.01–1.85, p=0.043) while not in subjects with CVD (hazard ratio 0.99, 95% CI 0.57–1.71, p=0.98). Conclusion Elevated RHR (>80 bpm) measured using AOBPM is an independent risk factor for cardiovascular events in subjects with hypertension and without CVD. Figure 1. Heart ratio vs hazard ratio. Funding Acknowledgement Type of funding source: None

Introduction Polycythemia vera (PV) is a rare myeloproliferative disease associated with an increased prevalence of hypertension and increased risk of cardiovascular complications. However, the precise mechanisms leading to the elevation of blood pressure (BP) and secondary target organ damage remain poorly understood. Objectives The study aimed to evaluate BP profile, assess the activity of the sympathetic nervous system and the renin‑angiotensin system, and provide a comprehensive assessment of subclinical target organ damage in patients with PV. Patients and methods Twenty consecutive patients with newly diagnosed PV and 20 control subjects were included. The following were assessed: BP, levels of catecholamines, urinary and plasma O‑methylated catecholamine metabolites, concentrations of aldosterone and renin. We also assessed microneurography sympathetic nervous system activity (MSNA) and baroreflex control of heart rate as well as subclinical target organ damage. Results At similar levels of BP, BP variability was decreased in the PV group (mean [SD] 24‑hour systolic BP, 9 [3] vs 12 [3] mm Hg; P = 0.003). Patients with PV had lower norepinephrine excretion (mean [SD], 16.54 [6.32] vs 25.46 [12.88] μg/d; P = 0.03) as well as decreased MSNA as assessed by microneurography compared with controls (mean [SD] MSNA, 30.7 [8.7] bursts/min vs 38.7 [5.4] bursts/min; P = 0.007 and MSNA 51.8 [11] bursts/100 beats vs 61.1 [11.3] bursts/100 heart beats; P = 0.04). Baroreflex control of HR was unaltered in the PV group. Increased hemoglobin levels and red blood cell count correlated with decreased retinal capillary flow in patients with PV. Conclusions Patients with PV, characterized by high hemoglobin concentrations and hematocrit levels had lower sympathetic nervous activity and decreased BP variability as compared with controls. There was no relationship between hemoglobin plasma concentration, hematocrit level, and target organ damage.

The association between elevated resting heart rate (RHR) as a cardiovascular risk factor and lowering of systolic blood pressure (SBP) to currently recommended values remain unknown. Systolic Blood Pressure Intervention Trial (SPRINT) data obtained from the NHLBI were used to describe the relationship between RHR and SBP reduction to &lt, 120 mmHg compared to SBP reduction to &lt, 140 mmHg. The composite clinical endpoint (CE) was defined as myocardial infarction, acute coronary syndrome, decompensation of heart failure, stroke, or cardiovascular death. Increased RHR was associated with a higher CE risk compared with low RHR in both treatment arms. A more potent increase of risk for CE was observed in subjects who were allocated to the SBP &lt, 120 mmHg treatment goal. A similar effect of intensive and standard blood pressure (BP) reduction (p for interaction, 0.826) was observed in subjects with RHR in the 5th quintile (hazard ratio, 0.78, with 95% confidence interval (CI), 0.55–1.11) and in other quintiles of baseline RHR (hazard ratio, 0.75, with 95% CI, 0.62–0.90). Lower in-trial than baseline RHR was associated with reduced CE risk (hazard ratio, 0.80, with 95% CI, 0.66–0.98). We concluded that elevated RHR remains an essential risk factor independent of SBP reduction.

The aim of this study was to analyze the effects of aging on the viscoelastic properties of the upper trapezius (UT) and the sternocleidomastoid (SCM) muscle during transition from lying to sitting position.The study included 39 older (mean age 67±5.9years) and 36 younger (21.1±1.8years) women. Tone, stiffness and elasticity of the UT and the SCM were measured by means of myotonometry (MyotonPRO) in lying and then, in sitting position. The results were compared using two-way analysis of variance.Irrespective of the position, older women presented with significantly higher muscle tone, stiffness and elasticity than younger subjects (P0.05). In both groups, the transition from lying to sitting position resulted in a decrease (P0.05) in the tone and stiffness, but not the elasticity (P0.05) of the SCM, and stimulated an increase in the tone, stiffness and elasticity of the UT (P0.05). The degree of changes in both study groups was similar, except from the absolute value of the UT elasticity, significantly higher increase in older women than in younger subjects (P0.05).Age contributes to an increase in the stiffness and tone of the UT and the SCM, as well as to a decrease in the elasticity of these muscles in female subjects. In contrast, age exerts only a slight effect on the mechanical properties of both muscles during transition from lying to sitting position.

Background Regular Nordic Walking training could improve fitness and reduce tenderness in selected muscle groups in office workers. Objective An assessment of the effects of a 12-week Nordic Walking training program on the perceived pain threshold (PPT) and the flexibility of selected upper-body muscle groups in postmenopausal female office workers. Methods 39 office workers were selected at random for the treatment group (NWg, n = 20) and the control group (Cg, n = 19). The persons from the NW group completed a 12-week Nordic Walking training program (3 times a week/1 hour). PPTs measurements in selected muscles and functional tests evaluating upper-body flexibility (Back Scratch - BS) were carried out twice in every participant of the study: before and after the training program. Results A significant increase in PPT (kg/cm2) was observed in the following muscles in the NW group only: upper trapezius (from 1,32 kg/cm2 to 1,99 kg/cm2), mid trapezius (from 2,92 kg/cm2 to 3,30 kg/cm2), latissimus dorsi (from 1,66 kg/cm2 to 2,21 kg/cm2) and infraspinatus (from 1,63 kg/cm2 to 2,93 kg/cm2). Moreover, a significant improvement in the BS test was noted in the NW group compared with the control group (from -1,16±5,7 cm to 2,18±5,1 cm in the NW group vs from -2,52±6,1 to -2,92±6,2 in the control group). Conclusions A 12-week Nordic Walking training routine improves shoulder mobility and reduces tenderness in the following muscles: trapezius pars descendens and middle trapezius, infraspinatus and latissimus dorsi, in female office workers.

Background/Introduction Automated office blood pressure measurements (AOBPM) is recommended for the diagnosis of arterial hypertension. Nevertheless, use of automated office blood pressure in monitoring of treated patients with hypertension is limited by the discrepancies between AOBPM, auscultatory and research grade measurements of blood pressure. The treatment targets using AOBPM are not well-determined. Purpose This post-hoc analysis is aimed to establish the optimal range for on-treatment diastolic blood pressure (DBP) measured with AOBPM in hypertensive patients without cardiovascular disease but at high risk, who achieved systolic blood pressure treatment goal (SBP). Methods Data of 3715 subjects without prior cardiovascular disease treated to achieve SBP goal On-treatment blood pressure was computed as mean of AOBPM readings in a period from 6th month until to end of the study, which was considered as with a stable blood pressure. Optimal on-treatment DBP range was established on the basis of hazard ratio plot for clinical endpoint after adjustment for age, sex, SBP, smoking habits and history of chronic kidney disease. The target DBP range was set to be 10 mm Hg wide, what is line with current ESC/ESH guidelines. To evaluate nonlinear relationship between continuous variables and outcome cubic spline methods were used. Results Data of 3715 (38.3% female and 61.7% male) subjects aged 67.3±9.2 mm Hg were analysed. Mean on-treatment SBP and DBP were 120.8±8.5 mm Hg and 68.2±8.1 mm Hg, respectively. Lowest hazard risk of primary endpoint was found in on-treatment DBP range 62.8–72.8 mm Hg with a minimum at 67.8 mm Hg (Figure 1). Hazard risk increased linearly toward lower and higher values than selected optimal DBP range. Figure 1 Conclusion(s) In treated hypertensives at high cardiovascular risk, but without prior cardiovascular disease who achieved SBP treatment goal, on treatment DBP 62.8–72.8 mm Hg range should be considered when treatment is monitored using AOBPM.

Background Hypertension is the most prevalent and leading risk factor for stroke. SPRINT (The Systolic Blood Pressure Intervention Trial) assessed the effects on cardiovascular event risk of intensive compared with standard systolic blood pressure reduction. In this secondary analysis of SPRINT data, we investigated how low on‐treatment diastolic blood pressure ( DBP ) influenced risk for stroke events. Methods and Results For this analysis, we used SPRINT _ POP (Primary Outcome Paper) Research Materials from the National Heart, Lung and Blood Institute (NHLBI) Biologic Specimen and Data Repository Information Coordinating Center. Data for 8944 SPRINT participants were analyzed from the period after target blood pressure was achieved until the end of the trial. Overall, there were 110 stroke events, including 49 from the intensive‐treatment arm and 61 in the standard‐treatment group. In participants with DBP DBP ≥70 mm Hg (hazard ratio, 1.467; 95% CI 1.009–2.133; P =0.0445). Univariable Cox proportional hazard risk analysis showed that in the whole group, age and cardiovascular and chronic renal diseases were stroke risk factors. These risk factors were related to lower DBP and higher pulse pressure, however, not to study arm. Multivariable Cox proportional hazard analysis revealed that only age, history of cardiovascular disease, current smoking status and on‐treatment systolic blood pressure were significantly related to stroke risk. Conclusions Low on‐treatment DBP is not related to the risk for the first stroke, in contrast to older age, the history of cardiovascular disease, current smoking status, and on‐treatment systolic blood pressure. Clinical Trial Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT 01206062.

Automated office blood pressure measurement (AOBPM) is recommended for diagnosing hypertension; however, optimal treatment targets using this method are not established. Discrepancies between automated and office measurements of blood pressure have been described, producing uncertainty regarding the use of AOBPM in clinical practice. The Systolic Blood Pressure Intervention Trial (SPRINT) results improved our understanding of target AOBPM systolic blood pressure (SBP) levels; however, diastolic blood pressure (DBP) targets remain unknown. Therefore, we sought to determine the optimal on-treatment DBP range. The analysis was performed on the participants of the SPRINT trial who had hypertension and prior cardiovascular disease. We analyzed the data of 1470 participants (mean age 70.3 ± 9.3 years, 24.1% female) selected from the SPRINT trial database of National Heart, Lung and Blood Institute. The mean achieved SBP and DBP were 127.9 ± 10.7 and 68.3 ± 9.4 mm Hg, respectively. Most of the participants (57.4%) had a DBP lower than 70 mm Hg, while only 11.7% had DPB ≥80 mm Hg. Clinical composite endpoint was defined as myocardial infarction, acute coronary syndrome not resulting in myocardial infarction, stroke, acute decompensated heart failure or death from cardiovascular causes. There were 159 (10.8%) clinical endpoint events. The participants with on-treatment AOBPM DBP range of 68.6-78.6 mm Hg showed the lowest hazard risk of a clinical composite endpoint. These results correspond to the office DBP range of 70-80 mm Hg recommended in ESC guidelines. This is the first attempt to determine the range of optimal DBP values using population-based AOBPM in patients with prior cardiovascular disease.

Remote tracking and monitoring of different objects becomes the everyday life need in various aspects of human life. Nowadays, it concerns not only the strategic areas such as security, defence or life threatening parameters such as human vital signs, but due to the wide availability of technologies and techniques, the remote objects monitoring is applied also to industrial or business applications such as logistics, monitoring of high value objects or others, as well as monitoring of all sorts of general use objects such as vehicles, equipment or others. This paper propose the concept of Smart Tools Monitoring system designed and prototyped to monitor the location and status of hand tools during the operation phase in the factory. As part of the project the analysis and tests of the applicability of available techniques and technologies have been performed in factory settings in order to find out the specifics of such environments in terms of distance, interferences and electromagnetic noise generated by machines. This paper presents the system concept as well as design and operational findings from the feasibility study.

Objectives: The aim of the study was to determine if, and to what extent, structural and functional changes of the secundines influence biometric parameters of neonates from dichorionic twin pregnancies. Material and methods: The study included neonates from dichorionic, diamniotic twin pregnancies, along with their secundines. Based on histopathological examination of the secundines, the mass and dimensions of the placenta, length and condition of the umbilical cord, chorionicity, focal lesions, and microscopic placental abnormalities were determined for 445 pairs of twins. Morphological development of examined twins was characterized on the basis of their six somatic traits, while birth status of the newborns was assessed based on their Apgar scores. Statistical analysis included Student t-tests, Snedecor’s F-tests, post-hoc tests, non-parametric chi-squared Pearson’s tests, and determination of Spearman coefficients of rank correlation. Results: The lowest values of analyzed somatic traits were observed in twins who had placentas with velamentous or marginal cord insertion. Inflammatory lesions in the placenta and placental abruption turned out to have the greatest impact of all analyzed abnormalities of the secundines. Inflammatory lesions in the placenta were associated with lower values of biometric parameters and a greater likelihood of preterm birth. Neonates with a history of placental abruption were characterized by significantly lower birth weight and smaller chest circumference. Conclusions: Morphological changes in the secundines have a limited impact on biometric parameters of neonates from dichorionic twin pregnancies. In turn, functional changes exert a significant effect and more often contribute to impaired fetal development.

Introduction Hyperoxia increases total peripheral resistance by acting locally but also inhibits the activity of carotid body chemoreceptors. We studied the effect of hyperoxia on central pressure in normotensive subjects. Material and methods Medical air followed by 100% oxygen was provided to 19 subjects (12/7 female/male, age 28.2 ±1.1 years) for 15 min through a non-rebreather mask. Central blood pressure was then measured using applanation tonometry. Results After the first 2 min of hyperoxia, heart rate decreased significantly (65 ±2.6 beats/min vs. 61 ±2.1 beats/min, p = 0.0002). Peripheral and central blood pressure remained unchanged, while hemoglobin oxygen saturation and subendocardial viability ratio index increased (97 ±0.4% vs. 99 ±0.2%, p = 0.03; 168 ±8.4% vs. 180 ±8.2%, p = 0.009). After 15 min of 100% oxygen ventilation, heart rate and peripheral and central blood pressures remained unchanged from the first 2 min. The augmentation index, augmentation pressure and ejection duration increased as compared to baseline values and those obtained at 2 min (–5.1 ±2.9% vs. –1.2 ±2.6%, p = 0.005 and –4.6 ±2.7% vs. –1.2 ±2.6%, p = 0.0015; –1.3 ±0.7 mm Hg vs. –0.2 ±1.2 mm Hg, p = 0.003 and –1.1 ±0.7 mm Hg vs. –0.2 ±1.2 mm Hg, p = 0.012; 323 ±3.6 ms vs. 330 ±3.5 ms, p = 0.0002 and 326 ±3.5 ms vs. 330 ±3.5 ms, p = 0.021, respectively). Conclusions The present study shows that hyperoxia does not affect central blood pressure in young healthy subjects and may improve myocardial blood supply estimated indirectly from applanation tonometry.

This study determined relationships between age, BMI and cranio-vertebral angle (CVA) (independent variables) and stiffness and elasticity of sternocleidomasteoid [SCM] and upper trapezius [UT] (dependent variables) muscles in sitting posture in 95 women across adult life. Moreover, a stepwise regression was performed to determine to what extent the dependent variables are explained by age, BMI and CVA. Age was moderately correlated with BMI (r = 0.41), and both age and BMI were moderately negatively correlated with CVA (r = −0.54 and −0.55, respectively). High (r = 0.73) and moderate (r = 0.53) linear relationships were present between age and logarithmic decrement (inversely related to elasticity) and stiffness of SCM muscle, respectively. Low (r = 0.36) and moderate (r = 0.47) relationships were present between age and logarithmic decrement and stiffness of UT muscle, respectively. Age accounted for 53% variance in elasticity and 28.5% variance in stiffness of SCM, and for 13% variance in elasticity and 22% variance in stiffness of UT muscle. Introduction of BMI but not CVA to the model explained the variance of these parameters by additional 0–8%. Among the studied factors age is the major correlate of stiffness and elasticity of neck muscles across the adult life.

Context: Kinesio taping® (KT) is a therapeutic modality frequently used in the clinical practice for the treatment of various musculoskeletal disorders. It is often applied in patients with chronic...

Nowadays, semantic lexical resources, like ontologies, are becoming increasingly important in many systems, in particular those providing access to unstructured textual data. Typically, such resources are built based on already existing repositories and by analyzing available texts. In practice, however, building new or enriching existing resources of such type cannot be accomplished without using an appropriate tool. In this paper the SAUText is presented; it is a new system which provides the infrastructure for carrying out research involving the usage of semantic resources and the analysis of unstructured textual data. In the system a dedicated repository for storing various kinds of text data is used and parallelization is taken advantage of in order to speed up the analysis. As an example of a method for knowledge discovery available in the system, a new approach for synonym discovery is introduced.

Context:The extent of knee extensor and flexor weakness after disruption of knee ligaments affects a rehabilitation output and functional recovery and may give prognostic information on a possible risk of development of knee osteoarthritis.Objective:The hypothesis tested was whether patients with a multiple-ligament tear would have larger abnormalities in strength of the knee extensors and flexors than patients with an isolated-ligament rupture.Design:Cross-sectional study, level III.Setting:Outpatient orthopedic clinic.Participants:3 groups of recreationally active men: noninjured control (CON, n = 12), with an anterior cruciate ligament injury (ACLI, n = 10), and with combined anterior and posterior cruciate ligament injury (APCLI, n = 9), matched according to age, body mass, and height.Intervention:All patients received conservative treatment and rehabilitation and awaited ligament reconstruction surgery.Main Outcome Measures:Isokinetic maximum-repetition peak torque per body mass (PT/BM) and total work (TW), PT and TW limb-symmetry index (LSI), and flexor-to-extensor PT ratio were evaluated during concentric knee extension-flexion movements at lower (60°/s) and higher (240°/s) isokinetic velocities.Results:The main finding was that compared with the individuals with ACLI, patients with APCLI produced in their injured limbs lower mean TW (extension: 30.3%, flexion: 28.2%) and had lower mean TW LSI (extension 74% in APCLI vs 91.6% in ACLI; flexion 61.3% in APCLI vs 90.8% in ACLI) at the higher but not lower speed of isokinetic testing. However, at the lower velocity the quantified size of reduction in PT/BM and TW was greater in subjects with APCLI than ACLI as compared with the CON individuals.Conclusions:After bi-cruciate-ligament injury the capacity to produce torque by concentric muscle contractions throughout knee-extension and-flexion movements performed with high speed is lower in injured limbs than after isolated anterior cruciate ligament tear.

Objective Beyond lipid-lowering properties, statins decrease sympathetic nervous activity. Due to the limited number of studies and included participants, a meta-analysis of randomized, placebo-controlled studies using microneurography (MSNA) was performed to assess sympatholytic effect of statins. Methods We conducted a comprehensive search of online databases (Cochrane, Embase, and EBSCO) for published human studies up to April 2014. Randomized controlled trials (parallel and crossover design) were eligible for inclusion if results of statins versus placebo treatments on sympathetic activity were measured with MSNA. Results Data from five studies with a total number of subjects n = 82 were included into the meta-analysis. MSNA expressed as bursts/min and as bursts/100 heartbeats was lower in the statin group than in the placebo group with a mean difference of −4.37 95 % CI (−7.03; −1.70), p

Common practice in field hockey requires athletes to adopt a semi-crouched posture, so players have a greater risk of musculoskeletal disorders than non-athletes. The aim of the present study was to assess how field hockey determines asymmetry in morphological and functional characteristics of the body by comparing athletes to control participants. The sample consisted of 15 male field hockey players from the Polish Youth National Team and 14 male university students. Antimeric differences in the chosen variables between body sub-regions were assessed. All morphological characteristics (bone mineral density, fat mass, and lean mass) were estimated using a dual energy X-ray absorptiometry. Additionally, the range of motion in transverse and frontal planes of the cervical, thoracic and lumbar spine was measured by using an electrogoniometric system. The results showed that the values of all morphological characteristics were higher in the left body segments, both in athletes and controls. However, the differences between sides were much more pronounced in the field hockey players. With regard to functional traits, higher values were obtained for the right body side in athletes but for the left side of the body among the controls. The difference between right and left side bending increased from the cervical spine (2.7%) through thoracic spine (7.8%) to lumbar spine (16.5%) in athletes. Rotational asymmetry in the thoracic spine was the largest in both groups. These findings indicate that it is important to monitor all athletes to prevent injury and health problems connected with strong morphological asymmetry.

BACKGROUND The aim of this study was to evaluate the effects of a 12-week Nordic Walking (NW) intervention on nitric oxide synthase activity (eNOS), levels of antibodies against oxidatively modified low-density lipoproteins (oLAb), plasma antioxidant capacity (TAC), thiobarbituric acid reactive substance (TBARS) concentration, carbohydrate and lipid metabolism, and atherosclerosis risk factors (AIP) in postmenopausal women. METHODS A sample of 39 women, divided into two comparable groups: training (N.=20) and control (N.=19), took part in the study. Participants in the training group performed a 12-week supervised NW training: 60-minute sessions of exercise, repeated three times per week. The biochemical and anthropometric data were obtained before and after the intervention. During the first and the last training sessions, the individual walking distance in trained group was measured. RESULTS After the intervention, significant differences in covered distance, body mass, BMI, fat mass, insulin level (P

Background: The importance of increased resting heart rate in hypertensive patients was highlighted in the European Society of Hypertension statement on the identification and management of hypertensive patient with elevated heart rate. Methods: Review of the available literature. Results: Increased heart rate is an independent predictor of cardiovascular morbidity and mortality even after adjustment for other conventional cardiovascular risk factors. Resting heart rate is correlated with blood pressure and prospectively related to the development of hypertension, as shown in numerous general population and hypertensive cohorts. Patients with hypertension may be characterized by increased sympathetic activation, and increased heart rate is considered a simple marker of increased sympathetic nervous activity. The definition of tachycardia is debatable as in clinical practice, tachycardia is generally defined as resting heart rate over 100 beats per minute (bpm) but this definition does not take into account epidemiological data and risk related to increased heart rate. Available evidence suggests that a lower threshold defining an increased resting heart rate should be adopted. In large hypertensive cohorts, approximately one third of the studied subjects had resting heart rate above 80-85 bpm and many of these patients had features of the metabolic/insulin resistance syndrome. Furthermore, the prevalence of hypertension increases with age and the hemodynamic pattern of hypertension in older subjects is not characterized by increased heart rate. Conclusions: These reasons, in addition to the fact that heart rate, is variable and depends on multiple factors, may explain why not all patients with hypertension are tachycardic at rest.

Atrial fibrillation may affect blood pressure measurements. The ankle-brachial index (ABI) is a ratio of systolic blood pressure measured on the lower and upper limbs that may also be affected by arrhythmia. The purpose of the study was to investigate whether atrial fibrillation influenced ABI results. Ninety-nine patients (age 66.6±11 years, 63 males and 36 females) who underwent electrical cardioversion of atrial fibrillation were investigated. ABI measurements using the Doppler method were performed on both lower extremities before and after electrical cardioversion. Measurements were repeated three times and then averaged. The ABI using both lower limbs was lower before electrical cardioversion than after restoration to sinus rhythm (right side: 1.132 (1.065-1.210) during atrial fibrillation vs. 1.179 (1.080-1.242) in sinus rhythm, P=0.019; left side: 1.142 (1.075-1.222) during atrial fibrillation vs. 1.170 (1.098-1.255) in sinus rhythm, P=0.011). However, the upper 95% confidence interval (CI) margins for the median differences in ABI were 0.045 and 0.040 for right and left, respectively, suggesting that the observed difference was clinically insignificant. There was a significant correlation between measurements obtained before and after electrical cardioversion on both lower limbs (r=0.61, P

The amounts of data being processed today are enormous and they require specialized systems to store them, access them and do computations. Therefore, a number of NoSql databases and big data platforms were built to address this problem. They usually lack transaction support which features atomicity, consistency, isolation, durability and at the same time they are distributed, scalable, and fault tolerant. In this paper, we present a novel transaction processing framework based on Cassandra storage model. It uses Paxos protocol to provide atomicity and consistency of transactions and Cassandra specific read and write paths improvements to provide read committed isolation level and durability. Unlike built-in Light Weight Transactions (LWT) support in Cassandra, our algorithm can span multiple data partitions and provides tunable contention control. We verified correctness and efficiency both theoretically and by executing tests over different workloads. The results presented in this paper prove the usability and robustness of the designed system.

The relationship between the sympatholytic effects of statins and their lipid-lowering activity remains unclear. Ezetimibe lowers cholesterol, but its sympatholytic activity is unknown. The purpose of study was to compare the influence of equipotent doses of simvastatin and ezetimibe on sympathetic activity. This randomized double-blinded study was performed in 22 hypertensive patients (age, 45.6 ± 2.2 years; female/male, 2/20) with untreated hypercholesterolemia. The subjects were administered 20 mg/d of simvastatin (n = 11) or 20 mg/d of ezetimibe (n = 11) for 6 weeks. Pre- and post-treatment measurements of muscle sympathetic nerve activity (MSNA), baroreceptor control of heart rate (baroreflex sensitivity), and impedance cardiography were recorded. Simvastatin and ezetimibe produced similar reductions of total (−58.0 ± 23.4 vs. −45.2 ± 17.2 mg/dL; P = .15, respectively) and low-density lipoprotein cholesterol (−52.6 ± 20.9 vs. −37.9 ± 17.6 mg/dL; P = .09, respectively). There was a significant difference in the effect of simvastatin and ezetimibe on muscle sympathetic nerve activity (−8.5 ± 5.1 vs. −0.7 ± 3.5 bursts/min; P = .0005). Simvastatin improved baroreflex sensitivity as compared with ezetimibe (10.0 ± 14.3 vs. −2.8 ± 6.1 ms/mm Hg; P = .01). There was no difference in the effect of both treatments on blood pressure, heart rate, cardiac output, stroke volume, total peripheral resistance, high-density lipoprotein, and triglycerides. Simvastatin reduced sympathetic activity via lipid-independent mechanisms, but ezetimibe exerts no sympatholytic effects.

Previous studies have shown that hyperoxia-induced deactivation of carotid body chemoreceptors reduces sympathetic activity in hypertensive patients but it does not affect blood pressure. The maintenance of blood pressure can be explained by the direct, vasoconstrictive effect of hyperoxia, which offsets diminished sympathetic activity. This study compares the effect of acute hyperoxia on hemodynamic parameters between hypertensive and normotensive subjects. Twelve males with hypertension (age 39.4±2.4 years; body mass index 27.4±1.1 kg m(-2)) and 11 normotensive males (age 39.9±2.7 years; body mass index 25.4±0.7 kg m(-2)) received, via non-rebreathing mask ventilation, ambient air, followed by 100% oxygen for 20 min. The stroke volume, heart rate, cardiac output, blood pressure, total peripheral resistance, respiratory rate, baroreceptor control of heart rate and oxygen saturation were recorded continuously. Several 30 s periods were analyzed before, during and after inducing hyperoxia. At baseline, the hypertensive subject's blood pressure was higher and their baroreflex control of heart rate was lower when compared with the normotensive control group. After the first 30 s of hyperoxia, systolic, diastolic and mean blood pressures, as well as the total peripheral resistance, decreased significantly in hypertensives but not in normotensives. After 20 min of 100% oxygen ventilation, systolic and mean blood pressures and total peripheral resistance was increased in hypertensive patients, and the cardiac output and stroke volume had decreased in both groups. The results of this study confirm that deactivation of carotid body chemoreceptors can acutely decrease blood pressure in humans.

Objective:Automated office blood pressure measurement (AOBPM) is currently recommended for the diagnosis of hypertension. However, optimal treatment targets using this method are not established. Discrepancies between AOBPM, auscultatory and research grade measurements of blood pressure were describ

Objective:Although ambulatory blood pressure monitoring (ABPM) is recommended in pregnant patients with hypertension, few data are available on ABPM values and targets in pregnant hypertensives and in normal normotensive pregnancies. The aim of the study was to evaluate blood pressure (BP) values in