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Objectives: This randomized clinical trial compared the effectiveness of music and informative videos as distraction tools to reduce the anxiety of patients during root canal treatment and retreatment. Method and materials: A total of 90 patients were enrolled in the study. The patients were randomly allocated to three groups: Group 1 listened to music during the treatment (n = 30), Group 2 watched an informative preoperative video (n = 30), and a control group underwent treatment without a distraction method (n = 30). Prior to treatment, the Corah Dental Anxiety Scale (CDAS) and a visual analog scale for pain were used to assess anxiety and preoperative pain. Systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation were recorded before the intervention (T1), after the local anesthetic (T2), following pulp extirpation or removal of root fillings (T3), and immediately following rubber dam removal (T4). One-way ANOVA, followed by post-hoc Bonferroni tests for multiple comparisons, were used to compare mean values of systolic blood pressure, diastolic blood pressure, heart rate, and oxygen saturation among the groups. A P value of 5% was considered as significant. Results: Listening to music reduced systolic blood pressure, heart rate (P < .001), and diastolic blood pressure (P = .003) in patients undergoing root canal treatment and retreatment at T4 compared to the baseline (T1). Music (P < .001) and informative video (P = .003) groups had significantly lower postoperative visual analog scale pain scores. Conclusion: Listening to music during root canal treatment and retreatment reduced anxiety levels in patients compared to informative preoperative videos and no distraction technique. [ABSTRACT FROM AUTHOR]

Context: Blood flow restriction resistance exercise studies often require caffeine abstinence to avoid cardiovascular effects that could change the blood flow restriction stimulus. However, effects may be attenuated for habituated users. Objective: To compare cardiovascular responses to blood flow restriction resistance exercise when habituated users consume or abstain from caffeine. Design: Thirty participants completed a 3-visit within-subject study beginning with familiarization and caffeine intake questionnaire. Methods: Visits 2 and 3 consisted of blood flow restriction resistance exercise (3 sets bicep curls to failure, 30% 1-repetition max, 40% arterial occlusion pressure [AOP]), following participants' normal caffeine consumption (CAFF) or abstaining (ABS). AOP, systolic (SBP) and diastolic (DBP) blood pressure, and heart rate were measured preexercise and postexercise. Prevalues and preexercise to postexercise change scores for SBP, DBP, AOP (all millimeters of mercury), heart rate (in beats per minute), and repetitions were compared between conditions. Results are represented as mean (SD). Results: Preexercise AOP was similar for CAFF (137.8 [14.4]) and ABS (137.1 [14.9], BF10 = 0.2), although pre-SBP was higher for CAFF (115.4 [9.8]) than ABS (112.3 [9.4], BF10 = 1.9). Pre-DBP was similar between conditions. The exercise-induced change in AOP was greater for CAFF (18.4 [11.2]) than ABS (13.2 [14.9]), though evidence was anecdotal (BF10 = 0.7). Exercise-induced changes in SBP, DBP, and heart rate were similar between conditions (all BF10 ≤ 0.40). More repetitions were completed for CAFF (63 [26]) than ABS (57 [17], BF10 = 2.1). Conclusions: The findings of this study suggest that for habituated users, maintaining daily caffeine habits will not have substantial effects on common cardiovascular variables relevant to blood flow restriction. [ABSTRACT FROM AUTHOR]

Purpose: Previous literature has demonstrated the mediating role of adiposity in the association between cardiorespiratory fitness (CRF) and cardiometabolic risk as well as the potential role of CRF in attenuating the adverse consequences associated with excess weight. This study aimed to evaluate the mediating role of CRF and adiposity in the possible association with cardiometabolic risk. Method: Observational 3-year longitudinal study that included 420 children and adolescents (10.50 [2.05] y of age at baseline; 56.2% girls). Body mass index (BMI) was calculated, and CRF was evaluated using field assessments. A clustered cardiometabolic risk score (cMetS) was calculated from glucose, systolic blood pressure, total cholesterol/high-density lipoprotein cholesterol ratio, and triglycerides z scores. Analyses evaluated the mediating role of BMI in the association between CRF and cMetS as well as whether CRF mediated the association between BMI and cMetS. Results: BMI at baseline was directly associated with the cMetS at follow-up (0.102; 95% confidence interval, 0.020 to 0.181), independently of CRF, whereas CRF was only indirectly associated with cMetS at follow-up through BMI (−0.036; 95% confidence interval, −0.070 to −0.009), meaning that the association between CRF and cMetS was explained via the mediation role of BMI. Conclusions: BMI presented direct association with cMetS, whereas CRF exhibited indirect association with cMetS mediated via BMI. [ABSTRACT FROM AUTHOR]

Acute hypoxic ventilatory response is an important reflex that helps maintain breathing during low oxygen levels, but it is attenuated by most general anaesthetics. Analgesic doses of ketamine and esketamine are known to have respiratory stimulant effects. In their recent study in the British Journal of Anaesthesia , Jansen and colleagues show that low-dose esketamine preserved the acute hypoxic ventilatory response, while increasing breathing rate, systolic blood pressure, and heart rate. Participants also exhibited higher levels of alertness and unpleasant psychotropic effects compared with the control condition. We review the pharmaco-physiological effects of acute hypoxia and its interactions with esketamine. We provide a summary of the effects of hypoxia and esketamine on the neurocircuitry that leads to arousal, activation of the sympathetic nerve system, and increased drive to upper airway dilator and respiratory pump muscles. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to evaluate associations between pre-pregnancy maternal obesity and adolescent blood pressures (BPs) among children born extremely preterm. Methods: This longitudinal observational cohort study included participants in the multicenter Extremely Low Gestational Age Newborn (ELGAN) study, born before 28 weeks of gestation, recruited at birth between 2002 and 2004, and followed prospectively through late adolescence. Between 2015 and 2022, three oscillometric BPs were obtained from participants (mean age 17.8 years). We used linear regression modeling to evaluate the association between maternal self-reported pre-pregnancy body mass index (BMI) and offspring adolescent systolic BP (SBP). In secondary analyses, we evaluated the association between maternal pre-pregnancy and offspring preadolescent (10-year-old) BMI and between offspring preadolescent BMI and adolescent SBP. Results: The 100 (24%) participants born to a mother with a history of pre-pregnancy obesity (BMI ≥ 30) had a greater mean SBP of 120.5 (± 14.3) mmHg compared to the 324 (76%) of adolescents born to mothers without pre-pregnancy obesity (SBP 115.6 (± 12.0) mmHg). Pre-pregnancy obesity was associated with higher offspring BMI (aβ 10.8, 95% CI 2.3, 19.2), and higher offspring BMI was associated with higher adolescent SBP (aβ 0.12, 95% CI 0.09,0.16). Conclusions: For ELGANs, higher maternal pre-pregnancy BMI was associated with higher adolescent SBP. Findings from secondary analyses suggest potential mediation through preadolescent BMI. Future research directions include multi-level interventions to reduce maternal pre-pregnancy obesity, followed by offspring obesity prevention interventions as a way of reducing intergenerational cardiovascular disease in high-risk infants born extremely preterm. [ABSTRACT FROM AUTHOR]

Background: A previous study had established the safety and preserved of quality of life in patients with adrenal insufficiency (AI) who received prednisolone 5 mg once daily at sahur (predawn) during Ramadan fasting. It has been postulated that a lower dose of prednisolone between 2 and 3 mg may be sufficient for glucocorticoid replacement in this group of patients. This study aimed to assess the safety and effect on quality of life in patients with AI given prednisolone 2.5 mg during Ramadan fasting. Methods: Patients with AI on twice‐daily hydrocortisone, who had low or moderate risk of adrenal crisis and intended to fast, were recruited. Patients were given prednisolone 2.5 mg once daily taken at sahur(predawn) and Ramadan education was given. Weight, sleep duration, physical activity, biochemical parameters and quality of life measurements (SF‐36 questionnaire) were analysed at the end of Ramadan and compared against the patient's own baseline readings before the start of Ramadan. Results: A total of 16 patients (10 men, median age 60 [50.3, 68] years) were recruited. All patients were on 15–20 mg of hydrocortisone (in divided doses) before Ramadan, and intended to fast. Five of the participants had type 2 diabetes with low IDF‐DAR risk category. 18.7% of the participants were unable to complete all 29 days of fasting. Up to 62.5% of the participants reported at least one adverse event. There was a statistically significant reduction in weight (median: −1.6 [−2.5, −0.3] kg, p <.01), systolic blood pressure (median: −17.0 (−28.8, −4.3) mmHg, p <.01) and diastolic blood pressure (median: −13.0 (−17.8, −3.8) mmHg, p <.01). Quality of life measures were preserved in all domains. Conclusion: With prednisolone 2.5 mg daily in Ramadan fasting, more than half of the participants experienced symptoms of AI, with significant reduction in weight and blood pressure. We conclude that prednisolone 2.5 mg daily is insufficient during the somewhat stressful state of Ramadan fasting. Further studies with prednisolone 3–4 mg daily in settings with readily available prednisolone 1 mg tablets may further elucidate the safety of using lower dose prednisolone in Muslim patients who fast with AI during Ramadan. [ABSTRACT FROM AUTHOR]

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BACKGROUND The association with cardiovascular disease (CVD) is stronger for mean systolic blood pressure (SBP) estimated using ambulatory blood pressure monitoring (ABPM) vs. office measurements. Determining whether this is due to ABPM providing more measurement reliability or greater ecological validity can inform its use. METHODS We estimated the association of mean SBP based on 2 office measurements and 2, 5, 10, and 20 measurements on ABPM with incident CVD in the Jackson Heart Study (n  = 773). Hazard ratios (HRs) for CVD were estimated per standard deviation higher mean SBP. CVD events were defined by incident fatal or non-fatal stroke, non-fatal myocardial infarction, or fatal coronary heart disease. RESULTS There were 80 CVD events over a median of 15 years. The adjusted HRs for incident CVD were 1.03 (95% CI: 0.90–1.19) for mean office SBP and 1.30 (95% CI: 1.12–1.50), 1.34 (95% CI: 1.15–1.56), 1.36 (95% CI: 1.17–1.59), and 1.38 (95% CI: 1.17–1.63) for mean SBP using the first 2, 5, 10, and 20 ABPM readings. The difference in the HRs for incident CVD ranged from 0.26 (95% CI: 0.07–0.46) to 0.35 (95% CI: 0.15–0.54) when comparing mean office SBP vs. 2, 5, 10, or 20 sequential ABPM readings. The association with incident CVD was also stronger for mean SBP based on 2, 5, 10, and 20 randomly selected ABPM readings vs. 2 office readings. CONCLUSIONS Mean SBP based on 2 ABPM readings vs. 2 office measurements had a stronger association with CVD events. The increase in the strength of the association with more ABPM readings was small. [ABSTRACT FROM AUTHOR]

Context With advancements in long-term survival after pancreatectomy, postpancreatectomy diabetes has become a concern, and the risk factors are not yet established. Pancreatic islets are susceptible to ischemic damage, though there is a lack of clinical evidence regarding glycemic deterioration. Objective To investigate association between hypotension during pancreatectomy and development of postpancreatectomy diabetes. Design In this retrospective, longitudinal cohort study, we enrolled patients without diabetes who underwent distal pancreatectomy or pancreaticoduodenectomy between January 2005 and December 2018 from 2 referral hospitals in Korea. Main outcome measures Intraoperative hypotension (IOH) was defined as a 20% or greater reduction in systolic blood pressure. The primary and secondary outcomes were incident diabetes and postoperative Homeostatic Model Assessment (HOMA) indices. Results We enrolled 1129 patients (average age, 59 years; 49% men; 35% distal pancreatectomy). IOH occurred in 83% (median duration, 25 minutes; interquartile range, 5-65). During a median follow-up of 3.9 years, diabetes developed in 284 patients (25%). The cumulative incidence of diabetes was proportional to increases in the duration and depth of IOH (P <.001). For the median duration in IOH compared with a reference time of 0 minutes, the hazard ratio was 1.48 (95% CI, 1.14-1.92). The effect of IOH was pronounced with distal pancreatectomy. Furthermore, the duration of IOH was inversely correlated with 1-year HOMA β-cell function (P <.002), but not with HOMA insulin resistance. Conclusion These results support the hypothesis that IOH during pancreatectomy may elevate risk of diabetes by inducing β-cell insufficiency. [ABSTRACT FROM AUTHOR]

Background: A 12-month cluster randomized controlled trial (RCT) demonstrated the effectiveness of an application-based education program in reducing the salt intake and systolic blood pressure (SBP) of schoolchildren's adult family members. This study aimed to assess whether the effect at 12 months persisted at 24 months. Methods: Fifty-four schools were randomly assigned to either the intervention or control group. All participants (594 children in grade 3 and 1188 of their adult family members) who completed the baseline survey were contacted again 12 months after the trial. The primary outcome was the difference in salt intake change between the intervention and control groups at 24 months versus baseline and 12 months, measured by the mean two consecutive 24-h urinary sodium excretions. The secondary outcome was the difference in the change of blood pressure and salt-related Knowledge, Attitude, Practice (KAP) score. Results: The difference in salt intake change in adults between the intervention and control groups after adjusting for confounding factors was − 0.38 g/day at 24 months versus baseline (95% CI − 0.81 to 0.05, p = 0.09), following the − 0.83 g/day (95% CI − 1.25 to − 0.41, p < 0.001) at 12 months. The adjusted difference in SBP change was − 2.19 mm Hg (95% CI − 3.63 to − 0.76, p = 0.003) at 24 months versus baseline, following the − 1.80 mm Hg (95% CI − 3.19 to − 0.40, p = 0.01) at 12 months. The intervention group had a higher KAP score than the control group both at 12 months and at 24 months versus baseline. No significant changes were found in children. Conclusions: The effect of the education program on adults' salt intake faded, but the SBP lowering effect and the improvement of KAP score remained 12 months after the completion of the RCT. Continuous efforts are needed to maintain the salt reduction effects in real-world settings. Trial registration: ChiCTR1800017553. Registered on August 3, 2018. [ABSTRACT FROM AUTHOR]

To investigate the correlation between the density and volume of epicardial adipose tissue(EAT)and acute coronary syndrome (ACS). This study included 355 subjects (mean age: 60.65 ± 9.67 years; 54.65% male), comprising 175 patients with ACS and 180 without ACS. Propensity score matching was applied to balance the variables between the two groups, resulting in 96 successfully matched pairs. Clinical data, epicardial adipose tissue volume (EATV), and epicardial adipose tissue density (EATD) were compared. Independent factors influencing ACS were identified using logistic regression analysis, and the predictive ability of each variable was evaluated using receiver operating characteristic (ROC) curves. Systolic blood pressure, EATV, EATD, fasting blood glucose, triglycerides, and high-sensitivity C-reactive protein were significantly elevated in the ACS group compared with the non-ACS group (all p < 0.05). Spearman correlation analysis revealed a moderate positive correlation between EATV and BMI (r = 0.444, p < 0.001), while EATD showed a weak negative correlation with age (r = -0.177, p = 0.014) and a weak positive correlation with EATV (r = 0.239, p = 0.001). Univariable regression analysis demonstrated that both EATV (OR: 2.018, 95% CI: 1.334–3.052) and EATD (OR: 5.341, 95% CI: 3.293–8.663) were associated with ACS. After adjusting for other risk factors, logistic regression model confirmed that EATV (adjusted OR: 1.892, 95%CI: 1.211–2.955) and EATD (adjusted OR: 6.942, 95%CI: 3.875–12.437) were independent predictors of ACS (both p < 0.001), with EATD showing the highest predictive value (AUC = 0.859). This study identifies a close relationship between EAT and ACS, highlighting EATD and EATV as independent influencing factors for ACS. Among them, EATD demonstrated a stronger predictive value for ACS than both traditional risk factors and EATV. [ABSTRACT FROM AUTHOR]

Background: In 2017, the American College of Cardiology and American Heart Association (ACC/AHA) lowered blood pressure (BP) thresholds to define hypertension in adults outside pregnancy. If used in pregnancy, these lower thresholds may identify women at increased risk of adverse outcomes, which would be particularly useful to risk-stratify nulliparous women. In this secondary analysis of the SCOPE cohort, we asked whether, among standard-risk nulliparous women, the ACC/AHA BP categories could identify women at increased risk for adverse outcomes. Methods and findings: Included were pregnancies in the international SCOPE cohort with birth at ≥20 weeks' gestation, 2004 to 2008. Women were mostly of white ethnicity, in their 20s, and of normal-to-overweight body mass index (BMI). Excluded were pregnancies ending in fetal loss at <20 weeks' gestation, and those terminated at any point in pregnancy. Women were categorized by highest BP during pregnancy, using ACC/AHA criteria: normal (BP <120/80 mmHg), "Elevated BP" (BP 120 to 129 mmHg/<80 mmHg), "Stage-1 hypertension" (systolic BP [sBP] 130 to 139 mmHg or diastolic BP [dBP] 80 to 89 mmHg), and "Stage-2 hypertension" that was non-severe (sBP 140 to 159 mmHg or dBP 90 to 109 mmHg) or severe (sBP ≥160 mmHg or dBP ≥110 mmHg). Primary outcomes were preterm birth (PTB), low birthweight, postpartum hemorrhage, and neonatal care admission. Adjusted relative risks (aRRs) and diagnostic test properties were calculated for each outcome, according to: each BP category (versus "normal"), and using the lower limit of each BP category as a cut-off. RRs were adjusted for maternal age, BMI, smoking, ethnicity, and alcohol use. Of 5,628 women in SCOPE, 5,597 were included in this analysis. When compared with normotension, severe "Stage 2 hypertension" was associated with PTB (24.0% versus 5.3%; aRR 4.88, 95% confidence interval, CI [3.46 to 6.88]), birthweight <10th centile (24.4% versus 8.8%; aRR 2.70 [2.00 to 3.65]), and neonatal unit admission (32.9% versus 8.9%; aRR 3.40 [2.59 to 4.46]). When compared with normotension, non-severe "Stage 2 hypertension" was associated with birthweight <10th centile (16.1% versus 8.8%; aRR 1.82 [1.45 to 2.29]) and neonatal unit admission (15.4% versus 8.9%; aRR 1.65 [1.31 to 2.07]), but no association with adverse outcomes was seen with BP categories below "Stage 2 hypertension." When each BP category was assessed as a threshold for diagnosis of abnormal BP (compared with BP values below), only severe "Stage 2 hypertension" had a useful (good) likelihood ratio (LR) of 5.09 (95% CI [3.84 to 6.75]) for PTB. No BP threshold could rule-out adverse outcomes (i.e., had a negative LR <0.2). Limitations of our analysis include lack of ethnic diversity and use of values from clinical notes for BP within 2 weeks before birth. This study was limited by: its retrospective nature, not all women having BP recorded at all visits, and the lack of detail about some outcomes. Conclusions: In this study, we observed that 2017 ACC/AHA BP categories demonstrated a similar pattern of association and diagnostic test properties in nulliparous women, as seen in the general obstetric population. BP thresholds below the currently used "Stage 2 hypertension" were not associated with PTB, low birthweight, postpartum hemorrhage, or neonatal unit admission. This study does not support implementation of lower BP values as abnormal in nulliparous pregnant women. Laura Slade, Maya Blackman and colleagues assess the associations between differing blood pressure thresholds and adverse pregnancy outcomes in a cohort of standard-risk nulliparous women. Author summary: Why was this study done?: In 2017, the American College of Cardiology (ACC) and American Heart Association (AHA) revised what they considered to be normal blood pressure (BP) outside pregnancy. No pregnancy guidelines have revised their definition of hypertension, which is a systolic blood pressure ≥140 mmHg or a diastolic blood pressure ≥90 mmHg, which ACC/AHA criteria outside pregnancy classify as "Stage 2 hypertension." We performed a secondary analysis of the SCOPE pregnancy cohort, asking whether among standard-risk nulliparous women, the ACC/AHA BP categories before "Stage 2 hypertension" could identify women at risk for adverse pregnancy outcomes. What did the researchers do and find?: For the available outcomes of preterm birth (PTB), birthweight <10th percentile, postpartum hemorrhage, and neonatal unit admission, only "Stage 2 hypertension" was associated with an increased risk of adverse outcomes. The association with the adverse outcomes evaluated was particularly true for severe "Stage 2 hypertension," defined as a systolic blood pressure ≥160 mmHg or a diastolic blood pressure ≥90 mmHg. What do these findings mean?: The findings of this study do not support implementation of lower BP values as abnormal in nulliparous pregnant women. Our findings are limited by a lack of ethnic diversity in our study population and use of clinical BP measurements for values within 2 weeks before birth. [ABSTRACT FROM AUTHOR]

Introduction: Delirium, frequently experienced by ischemic stroke patients, is one of the most common neuropsychiatric syndromes reported in the Intensive Care Unit (ICU). Stroke patients with delirium have a high mortality rate and lengthy hospitalization. For these reasons, early diagnosis of delirium in the ICU is critical for better patient prognosis. Therefore, we developed and validated prediction models to classify the real-time delirium status in patients admitted to the ICU or Stroke Unit (SU) with ischemic stroke. Methods: A total of 84 delirium patients and 336 non-delirium patients in the ICU of Ajou University Hospital were included. The 8 fixed features [Age, Sex, Alcohol Intake, National Institute of Health Stroke Scale (NIHSS), HbA1c, Prothrombin time, D-dimer, and Hemoglobin] identified at admission and 12 dynamic features [Mean or Variability indexes calculated from Body Temperature (BT), Heart Rate (HR), Respiratory Rate (RR), Oxygen saturation (SpO2), Systolic Blood Pressure (SBP), and Diastolic Blood Pressure (DBP)] based on vital signs were used for developing prediction models using the ensemble method. Results: The Area Under the Receiver Operating Characteristic curve (AUROC) for delirium-state classification was 0.80. In simulation-based evaluation, AUROC was 0.71, and the predicted probability increased closer to the time of delirium occurrence. We observed that the patterns of dynamic features, including BT, SpO2, RR, and Heart Rate Variability (HRV) kept changing as the time points were getting closer to the delirium occurrence time. Therefore, the model that employed these patterns showed increasing prediction performance. Conclusion: Our model can predict the real-time possibility of delirium in patients with ischemic stroke and will be helpful to monitor high-risk patients. [ABSTRACT FROM AUTHOR]

Objective: To systematically evaluate the association between hypertension and hearing loss. Methods: A standardized search for studies on hypertension and hearing loss in PubMed, Embase, Scopus, and Web of Science was performed using subject terms, free terms, and keyword combinations for the period of library construction to March 2024. Meta-analysis was performed using RevMan 5.4 and STATA 18.0. Results: A total of 12 studies were included, assessing 594,676 participants. The combined OR using the random effects model was 1.849 (95% CI: 1.549, 2.208). Heterogeneity in this analysis was high (I 2 = 98%, p < 0.1), and by sensitivity analysis we found that the heterogeneity may have originated from 3 studies, the removal of which significantly reduced the heterogeneity and had a small effect on the effect size [OR (95%CI): 1.893 (1.834, 1.953), I 2 = 0.0%, p = 0.465]. Conclusion: Hypertension may be one of the risk factors for hearing loss. Identification of hypertension can help in early assessment and management of hearing loss risk. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023460001. [ABSTRACT FROM AUTHOR]

Objective: Hypertension, a common chronic disease, often leads to serious complications. While conventional management relies on antihypertensive drugs, which can cause side effects and adherence issues, alternative treatments like herbal medicine are gaining attention. This study examines the efficacy and safety of modified Saengmaeksan, an East Asian herbal remedy, in treating hypertension. Methods: This single-arm, prospective, observational study will be conducted at Kyunghee Bichedam Korean Medicine Clinic from October 23, 2023 to August 30, 2024, enrolling 30 hypertensive patients. Over 12 weeks, participants will undergo 4 visits, receiving modified Saengmaeksan twice daily for 8 weeks, with a subsequent 4-week follow-up. Primary outcome is the change in systolic blood pressure from the baseline to week 8. Secondary outcomes include diastolic blood pressure changes, radial artery tonometry, and quality of life evaluations. Safety assessments will include monitoring hematologic parameters and adverse events. Data will be analyzed using an ANCOVA model for adjusting confounders. Discussion: Modified Saengmaeksan has shown potential for lowering blood pressure in clinical settings, supported by animal and cell studies. However, human studies are scarce. This research will employ radial artery tonometry to analyze blood pressure comprehensively, exploring Saengmaeksan's hemodynamic effects. The study's goal is to support the approval of modified Saengmaeksan as a hypertension treatment by the South Korean Food and Drug Administration and to promote the industrialization of traditional herbal medicine in managing hypertension. The findings will provide essential data for future clinical research, aiding in feasibility assessments and sample size determinations for randomized controlled trials. [ABSTRACT FROM AUTHOR]

Adiposopathy principally characterized by adipocyte hypertrophy in visceral fat pads with excess triglyceride accumulation augments the sickening of adipocyte tissue cells. Adipocyte sickening is the central precursor of chronic-low grade/systemic inflammation and impaired lipid profile in metabolically sick obese patients over metabolically healthy obese subjects. With these pathophysiology alterations, obese patients are susceptible to metabolic syndrome associated with hyperglycemia, insulin resistance, dyslipidemia, hypertension, coronary artery atherosclerosis, endothelial dysfunction, cardiac failure, and liver steatosis. Brown seaweeds enriched in all essential nutrients, especially polyphenols, have been widely consumed as a staple diet. In-vitro and in-vivo studies showed polyphenols derived from brown seaweeds could reverse metabolic impairments via attenuating hyperglycemia, inflammation, systolic blood pressure, oxidative stress, and insulin resistance. However, human clinical trials remain inadequate to witness the therapeutic potential of brown algal polyphenols against metabolic syndrome, especially adiposopathy-linked metabolic syndrome. The article unveils the therapeutic efficacy of brown algal polyphenols in crude or purified formulations with their effective human therapeutic-dose concentrations 2838 mg/day (crude)/85–177 mg/day (pure fractions) to attenuate adiposopathy-linked metabolic ailments in metabolically unhealthy obese patients. [ABSTRACT FROM AUTHOR]

Background: The coexistence of pheochromocytoma and hyperaldosteronism is a rare and clinically significant finding with diagnostic challenges that need to be considered in the workup of patients with hypertension. Case presentation: This case report describes a 47-year-old Iranian man who initially presented with cold symptoms, chills, and headaches. Despite being diagnosed with panic disorder, his symptoms worsened, leading to a systolic blood pressure crisis. The results indicated elevated levels of 24-hour urine vanillylmandelic acid, metanephrine, and normetanephrine, suggesting increased catecholamine levels. An increase in serum aldosterone was also observed. Further evaluation revealed a 4 cm left adrenal mass and subsequent tests confirmed the diagnosis of pheochromocytoma and hyperaldosteronism. The patient underwent left adrenal gland resection, resulting in complete resolution of symptoms and normalization of test results. Conclusion: This case highlights the importance of considering rare coexisting endocrine disorders in patients presenting with hypertension. Appropriate diagnosis and management of concomitant pheochromocytoma and hyperaldosteronism are crucial for favorable outcomes and may offer insights into potential overlaps in disease pathways. [ABSTRACT FROM AUTHOR]

Objective: Neurological deterioration after mild traumatic brain injury (TBI) has been recognized as a poor prognostic factor. Early detection of neurological deterioration would allow appropriate monitoring and timely therapeutic interventions to improve patient outcomes. In this study, we developed a machine learning model to predict the occurrence of neurological deterioration after mild TBI using information obtained on admission. Methods: This was a retrospective cohort study of data from the Think FAST registry, a multicenter prospective observational study of elderly TBI patients in Japan. Patients with an admission Glasgow Coma Scale (GCS) score of 12 or below or who underwent surgical treatment immediately upon admission were excluded. Neurological deterioration was defined as a decrease of 2 or more points from a GCS score of 13 or more within 24 h of hospital admission. The model predictive accuracy was judged with the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC), and the Youden index was used to determine the cutoff value. Results: A total of 421 of 721 patients registered in the Think FAST registry between December 2019 and May 2021 were included in our study, among whom 25 demonstrated neurological deterioration. Among several machine learning algorithms, eXtreme Gradient Boosting (XGBoost) demonstrated the highest predictive accuracy in cross-validation, with an AUROC of 0.81 (±0.07) and an AUPRC of 0.33 (±0.08). Through SHapley Additive exPlanations (SHAP) analysis, five important features (D-dimer, fibrinogen, acute subdural hematoma thickness, cerebral contusion size, and systolic blood pressure) were identified and used to construct a better performing model (cross-validation AUROC of 0.84 and AUPRC of 0.34; testing data AUROC of 0.77 and AUPRC of 0.19). At the cutoff value from the Youden index, the model showed a sensitivity, specificity, and positive predictive value of 60, 96, and 38%, respectively. When neurosurgeons attempted to predict neurological deterioration using the same testing data, their values were 20, 94, and 19%, respectively. Conclusion: In this study, our predictive model showed an acceptable performance in detecting neurological deterioration after mild TBI. Further validation through prospective studies is necessary to confirm these results. [ABSTRACT FROM AUTHOR]

Background: High blood pressure is a prevalent condition in patients with chronic kidney disease on hemodialysis. Adequate control of high blood pressure is essential to reducing deaths in this group. The present study aimed to observe mortality prospectively in a group of patients in hemodialysis and hemodiafiltration programs in whom the use of antihypertensives was optimized with the point-of-care dry weight (POC-DW) technique. Methods: The present observational, prospective study was carried out at the Pafram hemodiafiltration unit in Morona Santiago, Ecuador, and the hemodialysis unit of the Fundación Renal del Ecuador in Guayaquil, Ecuador, from August 2019 to December 2023. Patients who were receiving hemodiafiltration were included. Weight was optimized with POC-DW for eight weeks. In Group 1, patients whose use of antihypertensive drugs was not required to control systolic blood pressure with a value less than 150 mmHg predialysis, less than 130 mmHg postdialysis, and a peridialytic blood pressure (defined as post-HD minus pre-HD SBP) between 0 and − 20 mmHg were analyzed. In Group 2, patients who required antihypertensive drugs for not meeting the aims of systolic blood pressure were included. The variables included clinical, demographic, mortality, description of the treatment, and routine laboratory tests in dialysis programs. The sample was nonprobabilistic. Survival analysis was performed for the study groups. The log-rank test (Mantel-Cox) was used for survival comparisons. Results: The study included 106 patients. Optimal blood pressure control without antihypertensive treatment was achieved in 52 patients (49.1%) (Group 1). In 54 patients (50.9%), antihypertensive agents were required (Group 2). There was more significant mortality in the group that received antihypertensives: 11 patients in group 1 (21.2%) versus 25 patients in group 2 (46.3%) (P = 0.005). Survival was more significant in group 1, with an HR of 2.2163 (1.125–4.158) (P = 0.0243). Conclusion: In hemodiafiltration and hemodialysis programs, blood pressure control with active ultrafiltration measures and without using antihypertensives is essential for survival in patients with CKD. [ABSTRACT FROM AUTHOR]

Background: Diabetic kidney disease (DKD) has become the leading cause of end-stage renal disease in the world. However, the current conventional approaches have not yet achieved satisfactory efficacy. As one of the most influential products in botanical medicine, Ginkgo biloba L. leaves extract (GBE) demonstrates various pharmacological effects on DKD and is gradually used as an adjunctive therapy for this disease. A comprehensive analysis is necessary to evaluate the efficacy and safety of GBE as an adjuvant treatment for DKD. Objective: This meta-analysis aimed to evaluate the efficacy and safety of GBE as a supplementary treatment to conventional renin-angiotensin-aldosterone system inhibitors for DKD patients, providing a reference for subsequent research and clinical practice. Methods: This study has been registered in PROSPERO as CRD42023455792. Ten databases were searched from their inception to 21 July 2023. Randomized controlled trials about GBE and DKD were included. Review Manager 5.4 and Stata 16.0 were employed to conduct the analysis. Heterogeneity was assessed through the χ2 test and the I2 test, and the effect model was chosen accordingly. Meta-regression and subgroup analysis were performed to investigate the sources of heterogeneity and the influence of different factor levels on efficacy. The publication bias was evaluated with the funnel plot and Egger's test, and the evidence quality was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) method. Results: A total of 41 studies with 3,269 patients were finally enrolled in this study. None of the included studies reported whether renal or cardiovascular disease progression events occurred. Compared with angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) alone, the combination with GBE was more beneficial in improving urinary albumin excretion rate (UAER) [mean difference (MD) = -22.99 μg/min, 95% confidence interval (CI): −27.66 to −18.31, p < 0.01], serum creatinine (SCr) [MD = −8.30 μmol/L, 95% CI: −11.55 to −5.05, p < 0.01], blood urea nitrogen (BUN) [MD = −0.77 mmol/L, 95% CI: −1.04 to −0.49, p < 0.01], 24-hour urinary total protein (24hUTP) [MD = −0.28 g/d, 95% CI: −0.35 to −0.22, p < 0.01], cystatin C (Cys-C) [MD = −0.30 mg/L, 95% CI: −0.43 to −0.17, p < 0.01], total cholesterol (TC) [MD = −0.69 mmol/L, 95% CI: −1.01 to −0.38, p < 0.01], triglyceride (TG) [MD = −0.40 mmol/L, 95% CI: −0.56 to −0.23, p < 0.01], low-density lipoprotein cholesterol (LDL-C) [MD = −0.97 mmol/L, 95% CI: −1.28 to −0.65, p < 0.01], fasting blood glucose (FBG) [MD = −0.30 mmol/L, 95% CI: −0.54 to −0.05, p = 0.02], hematocrit [MD = −4.58%, 95% CI: −5.25 to −3.90, p < 0.01] and fibrinogen [MD = −0.80 g/L, 95% CI: −1.12 to −0.47, p < 0.01]. No significant improvement was found in 2-hour postprandial glucose (2hPG), glycated hemoglobin (HbA1c), diastolic blood pressure (DBP) and systolic blood pressure (SBP). No significant difference was detected in adverse events. Conclusion: Combining GBE with ACEI/ARB may improve UAER, SCr, BUN, 24hUTP, Cys-C, TC, TG, LDL-C, hematocrit and fibrinogen in DKD patients. It also seems beneficial for oxidative stress and inflammation but has minimal impact on glucose and blood pressure. Combined GBE therapy is generally tolerated, but safety monitoring remains essential during its use. More long-term high-quality clinical studies and in-depth molecular research are still necessary to provide stronger evidence regarding the benefits and safety of GBE in DKD. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display%5frecord.php?RecordID=455792, identifier CRD42023455792 [ABSTRACT FROM AUTHOR]

Background: There is no unified prognostic scoring system for light chain cardiac amyloidosis (AL-CA), particularly stage IIIb AL-CA. This study aimed to use invasive haemodynamic information to investigate markers that can more accurately evaluate the prognosis of patients with stage IIIb AL-CA. Methods: In this retrospective cohort study, we conducted invasive haemodynamic measurements concurrently with myocardial biopsies to diagnose AL-CA. We used Cox regression analysis and time-dependent receiver operating characteristic curve analysis to study the associations between these measurements and overall mortality. Echocardiographic parameters were also recorded and analysed via logistic regression to explore their relationships with haemodynamic changes. Results: Although traditional haemodynamic parameters, such as the cardiac index (CI), pulmonary artery wedge pressure (PAWP), pulmonary artery pressure, and vascular resistance, did not correlate with mortality, the PAWP/CI ratio emerged as a vital prognostic marker. Patients with a PAWP/CI ratio above 11 mmHg/L/min/m2 had markedly poorer survival. Kaplan‒Meier analysis highlighted the prognostic significance of the ratio, revealing distinct survival differences. Furthermore, logistic regression confirmed that echocardiographically measured pulmonary artery systolic pressure independently correlated with increases in the PAWP/CI ratio. Conclusions: In stage IIIb AL-CA patients, the PAWP/CI ratio, which surpasses traditional haemodynamic indicators, significantly predicts all-cause mortality, emphasizing its prognostic value. Our findings suggest that echocardiography-derived PASP could alternatively reflect the PAWP/CI ratio. [ABSTRACT FROM AUTHOR]

This study aims to assess the outcomes of therapeutic options for aortic arch pathologies by comparing thoracic endovascular aortic repair (TEVAR) with open arch replacement (OAR) using woven polyester grafts from a mechanical and biomechanical perspective, with emphasis on ex vivo perfused human thoracic aortas reproducing heart rate and stroke volume conditions. Eleven non-diseased thoracic aortas from human cadavers were divided into TEVAR (n = 5) and OAR (n = 6) and tested using a custom-built mock circulation loop. Pressure, diameter, and stroke volume were monitored during perfusion before and after the intervention. Samples undergoing TEVAR showed a higher ascending systolic pressure post-intervention than OAR (TEVAR: 137 ± 9 mmHg vs OAR: 126 ± 6 mmHg, p = 0. 017). After the intervention, a significant discrepancy in the mean pressure differences between the ascending and descending aorta Δ P was observed (TEVAR: 9 ± 3 mmHg vs OAR: 1 ± 2 mmHg, p = 0. 004). Input impedance at zero frequency, approximating Windkessel resistance, was higher for TEVAR than for OAR (TEVAR: 1. 78 ± 0. 04 vs OAR: 1. 66 ± 0. 03 mmHg s/ml, p = 0. 004). A correlation was found between the resistance and the negative peak of the time-normalized wave intensity analysis (Kendall's coefficient τ = − 0. 35 and p = 0. 023). Another correlation was observed between resistance and Δ P (τ = 0. 51 , p = 0. 001). Looking at the replication of heart rate and stroke volume over the course of the study, the observed differences can largely be attributed to the type of intervention. The results suggest that TEVAR has adverse effects compared to OAR, particularly with regard to left ventricular afterload. Clinicians should consider the possibility of increased afterload and altered wave dynamics when deciding on TEVAR, particularly in patients with pre-existing impaired cardiovascular conditions. [Display omitted] • A unique comparison of two predominant interventions for aortic arch pathologies. • Evaluation of clinically feasible measures in a mock circulation loop. • Stressing the importance of biomechanics in the evaluation of patient outcomes. • Revealing the potential of physiological investigation of new grafts before trials. [ABSTRACT FROM AUTHOR]

This study investigates the effects of alcoholic (AB) and non-alcoholic beer (NAB) consumption on blood pressure and the activity of enzymes regulating the renin–angiotensin system (RAS) in Wistar–Kyoto (WKY) and spontaneously hypertensive rats (SHRs), with WKY rats used as normotensive controls for SHRs. The RAS is crucial for long-term blood pressure regulation, with angiotensin II (AngII) being a potent vasoconstrictor. The aim was to explore the biochemical mechanisms by which beer might influence cardiovascular health. WKY and SHRs were divided into groups receiving tap water (TW), non-alcoholic beer (NAB), alcoholic beer (AB), TW or NAB and TW or AB for 12 weeks. Systolic blood pressure (SBP), body weight, and biochemical parameters (electrolytes, glucose, renal and liver function, lipid profile) were monitored, and the RAS enzyme activity in serum and various tissues was analyzed. Beer consumption, regardless of alcohol content, did not significantly affect SBP or body weight. However, NAB and AB altered the serum electrolyte levels in both strains. AB consumption increased liver enzyme activity. Significant changes were observed in the RAS enzyme activity across tissues, varying by strain, beer type, and tissue. Moderate beer consumption did not elevate blood pressure in WKY or SHRs. Nevertheless, beer modulated RAS-regulating enzyme activities, indicating potential impacts on cardiovascular homeostasis. [ABSTRACT FROM AUTHOR]

Background: There are significant discrepancies in the optic nerve sheath diameter (ONSD) reported in the literature. We aimed to determine the ultrasonographic imaging features of ONSD and ophthalmic vessels in a healthy population, using a standardized protocol, and to estimate the effect of demographics and positioning changes on imaging measurements. Methods: We measured the mean values of the ONSD in supine and sitting position and the Doppler imaging parameters of the ophthalmic, central retinal and short posterior ciliary arteries. Inter-observer reliability was assessed using intraclass correlation coefficient (ICC). Linear regression models were fitted to predict the effect of demographic and clinical determinants on the imaging features. Results: A total of 50 measurements were obtained for each observer. The mean ONSD was 5.9 mm and there was a mean reduction of 0.2 mm when assessed in sitting position (p < 0.001). Doppler analysis showed higher peak-systolic velocity and resistive index in the ophthalmic artery (35.6 cm/s vs. 12.0 cm/s; 0.78 vs. 0.70) compared to the central retinal artery (p < 0.001). Age, sex, heart rate and systolic blood pressure were significant determinants of the imaging features, with ONSD being larger in males (p < 0.001) and increasing with heart rate (p = 0.001). ICC estimates indicated 'good' inter-observer reliability of the ONSD and the ophthalmic and central retinal arteries velocities and resistance. Conclusions: Our findings suggest a significant impact of patient demographics and positioning during ultrasonography on the normal imaging features of the ONSD and ophthalmic vessels. The heterogeneity in methodology and clinical cohorts may justify previous discrepancies in the literature. These findings can assist in the interpretation of imaging features in clinical settings and in the standardization of point of care ONSD ultrasonography. [ABSTRACT FROM AUTHOR]

Modern treatment, a healthy diet, and physical activity routines lower the risk factors for metabolic syndrome; however, this condition is associated with all-cause and cardiovascular mortality worldwide. This investigation involved a randomized controlled trial, double-blind, parallel study. Fifty-eight participants with risk factors of metabolic syndrome according to the inclusion criteria were randomized into two groups and given probiotics (Lacticaseibacillus paracasei MSMC39-1 and Bifidobacterium animalis TA-1) (n = 31) or a placebo (n = 27). The participants had a mean age of 42.29 ± 7.39 and 43.89 ± 7.54 years in the probiotics and placebo groups, respectively. Stool samples, anthropometric data, and blood chemistries were taken at baseline and at 12 weeks. The primary outcome was achieved by the probiotics group as their low-density lipoprotein-cholesterol level dramatically lowered compared to the placebo group (the difference was 39.97 ± 26.83 mg/dl, p-value <0.001). Moreover, significant reductions in body weight, body mass index, waist circumference, systolic blood pressure, and total cholesterol were observed in the volunteers treated with probiotics compared to the placebo. In the gut microbiome analysis, the results showed statistically significant differences in the beta diversity in the post-intervention probiotics group. Blautia, Roseburia, Collinsella, and Ruminococcus were among the gut microbiomes that were more prevalent in the post-intervention probiotics group. In addition, this group exhibited increases in the predicted functional changes in ATP-binding cassette (ABC) transporters, as well as ribonucleic acid transport, the biosynthesis of unsaturated fatty acids, glycerophospholipid metabolism, and pyruvate metabolism. In conclusion, this research demonstrated that the probiotics L. paracasei MSMC39-1 and B. animalis TA-1 have the efficacy to lower risk factors associated with metabolic syndrome. [ABSTRACT FROM AUTHOR]

Background: Major depressive disorder (MDD) is a recurrent and persistent mental illness. However, there is a lack of research that distinguishes the severity of comorbid anxiety disorders in MDD, and insufficient evidence exists regarding the prevalence of MDD patients with comorbid moderate-to-severe anxiety in the Chinese population. Methods: The study included 1718 MDD patients (894 with moderate-to-severe anxiety symptoms and 824 without moderate-to-severe anxiety symptoms). Clinical symptoms and development were assessed using the Hamilton Depression Rating Scale-17 (HAMD-17), Hamilton Anxiety Rating Scale-14 (HAMA-14), Positive and Negative Syndrome Scale (PANSS), and Clinical Global Impression (CGI). The blood pressure and thyroid hormone levels were measured. Results: We found that the incidence of MDD patients with moderate-to-severe anxiety symptoms was 52.04%. The prevalence of recent suicide attempts in MDD comorbid moderate-to-severe anxiety patients was 31.8%, which was 4.24 times higher than that in patients without moderate-to-severe anxiety. Additionally, suicide attempters had elevated levels of thyroid stimulating hormone (TSH), anti-thyroglobulin (TgAb), thyroid peroxidases antibody (TPOAb), systolic blood pressure (SBP), and diastolic blood pressure (DBP) compared to non-suicide attempters. We further identified CGI score, TSH, TPOAb, and DBP as influential factors for recent suicide attempts in MDD individuals who had moderate-to-severe anxiety symptoms. These indexes could distinguish between suicide attempts and non-suicide attempts in MDD patients with moderate-to-severe anxiety symptoms. Conclusions: Our findings mainly indicated a high prevalence of recent suicide attempts in MDD patients with moderate-to-severe anxiety. Several clinical correlates, thyroid hormones, and blood pressure might contribute to recent suicide attempts in MDD patients with moderate-to-severe anxiety symptoms. [ABSTRACT FROM AUTHOR]

Background: Epidemiological and genetic studies have elucidated associations between antihypertensive medication and Alzheimer's disease (AD), with the directionality of these associations varying upon the specific class of antihypertensive agents. Methods: Genetic instruments for the expression of antihypertensive drug target genes were identified using expression quantitative trait loci (eQTL) in blood, which are associated with systolic blood pressure (SBP). Exposure was derived from existing eQTL data in blood from the eQTLGen consortium and in the brain from the PsychENCODE and subsequently replicated in GTEx V8 and BrainMeta V2. We performed two-sample Mendelian randomization (MR) to estimate the potential effect of different antihypertensive drug classes on AD using summary statistics from a meta-analysis (111,326 cases and 677,663 controls) and further replicated in FinnGen cohorts (9301 cases and 367,976 controls). The reverse causality detection, assessing horizontal pleiotropy, Bayesian co-localization, phenotype scanning, and protein quantitative trait loci (pQTL) analysis were implemented to consolidate the MR findings further. Results: A 1-standard deviation (SD) lower expression of the angiotensin-converting enzyme (ACE) gene in blood was associated with a lower SBP of 3.92 (95% confidence interval (CI), 2.69–5.15) mmHg but an increased risk of AD (odds ratio (OR), 2.46; 95% CI, 1.82–3.33). A similar direction of association was also observed between ACE expression in prefrontal cortex (OR, 1.19; 95% CI, 1.10–1.28), frontal cortex (OR, 1.19; 95% CI, 1.11–1.27), cerebellum (OR, 1.13; 95% CI, 1.09–1.17), cortex (OR, 1.59; 95% CI, 1.33–1.28) and ACE protein levels in plasma (OR, 1.13; 95% CI, 1.09–1.17) and AD risk. Colocalization supports these results. Similar results were found in external validation. We found no evidence for an association between genetically estimated blood pressure (BP) and AD risk. Conclusions: There findings suggest an adverse association of lower ACE messenger RNA and protein levels with an elevated risk of AD, irrespective of its BP-lowering effects. These findings warrant greater pharmacovigilance and further investigation into the effect of ACE inhibitors, particularly those that are centrally acting, on neurodegenerative symptoms in patients with AD. [ABSTRACT FROM AUTHOR]

Background: Public health economic modelling is an approach capable of managing the intricacies involved in evaluating interventions without direct observational evidence. It is used to estimate potential long-term health benefits and cost outcomes. The aim of this review was to determine the scope of health economic models in the evaluation of salt and/or alcohol interventions globally, to provide an overview of the literature and the modelling methods and structures used. Methods: Searches were conducted in Medline, Embase, and EconLit, and complemented with citation searching of key reviews. The searches were conducted between 13/11/2022 and 8/11/2023, with no limits to publication date. We applied a health economic search filter to select model-based economic evaluations of public health policies and interventions related to alcohol consumption, dietary salt intake, or both. Data on the study characteristics, modelling approaches, and the interventions were extracted and synthesised. Results: The search identified 1,958 articles, 82 of which were included. These included comparative risk assessments (29%), multistate lifetables (27%), Markov cohort (22%), microsimulation (13%), and other (9%) modelling methods. The included studies evaluated alcohol and/or salt interventions in a combined total of 64 countries. Policies from the UK (23%) and Australia (18%) were the most frequently evaluated. A total of 58% of the models evaluated salt policies, 38% evaluated alcohol policies, and only three (4% of included modelling studies) evaluated both alcohol- and salt-related policies. The range of diseases modelled covered diabetes and cardiovascular disease-related outcomes, cancers, and alcohol-attributable harm. Systolic blood pressure was a key intermediate risk factor in the excessive salt-to-disease modelling pathway for 40 (83%) of the salt modelling studies. The effects of alcohol consumption on adverse health effects were modelled directly using estimates of the relative risk of alcohol-attributable diseases. Conclusions: This scoping review highlights the substantial utilisation of health economic modelling for estimating the health and economic impact of interventions targeting salt or alcohol consumption. The limited use of combined alcohol and salt policy models presents a pressing need for models that could explore their integrated risk factor pathways for cost-effectiveness comparisons between salt and alcohol policies to inform primary prevention policymaking. [ABSTRACT FROM AUTHOR]

We investigated the effects of low and high frequency isometric handgrip exercise training (IHGT) on resting blood pressure, and the affective/perceptual responses during training. Sixty young normotensive adults were randomised to either a no-intervention control group (CON: n = 20; 12 female) or a group performing either two (LOW: n = 20; 18 female) or four (HIGH: n = 20; 13 female) sessions/week of IHGT for 4 weeks. IHGT involved 4 × 2-min holds at 30% maximal voluntary contraction using the dominant hand. Resting blood pressure was measured before and after training. Affective valence was measured during the first session of each training week. Systolic blood pressure was reduced following both LOW (adjusted mean change [95% CI]: −4.5 [−6.8, −2.2] mmHg) and HIGH (−5.3 [−7.6, −3.0] mmHg) frequency IHGT groups compared to CON (+0.5 [−1.8, 2.8] mmHg; p < 0.01), with no difference between LOW and HIGH. There were no changes in diastolic blood pressure. During the first session, affective valence decreased by 2.5 ± 2.6 units and became negative (lowest affect: −0.75 ± 1.84 units). However, affective responses improved as training progressed. Low and high frequency IHGT similarly reduce resting blood pressure in young normotensive adults. Negative affective responses in the early phase of training improve as the intervention progresses. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Patients living with chronic diseases require more medical attention, including more visits to primary care. However, primary care providers are overburdened, and this specialty is attracting fewer new providers than before. Clinical pharmacists can augment these efforts by improving disease state control. In this cohort study, we aimed to demonstrate a retail pharmacy hired and trained clinical pharmacist within a value-based primary care clinic network can improve hypertension (HTN) and type 2 diabetes mellitus (T2DM) control. Methods: In this cohort study, a pharmacist, enabled by a collaborative drug therapy management agreement, prescribed and titrated therapies for HTN and T2DM. Primary outcomes were pre- to post-index changes in hemoglobinA1c, systolic, and diastolic blood pressure (BP) measures. Results: The HTN cohort consisted of 43 patients and the T2DM cohort consisted of 125 patients. The difference-in-differences (β) in the HTN group was −10.2 mmHg (P <.01) for systolic BP and −2.0 mmHg (P =.42) for diastolic BP. The β in the T2DM group was −1.16% (P <.001). Conclusions: Statistically significant reductions in systolic BP and hemoglobinA1c were observed in the pharmacist-managed group compared with matched controls. These results demonstrate that pharmacist integration into a value based primary care clinic may improve measures of chronic disease associated with morbidity and mortality. [ABSTRACT FROM AUTHOR]

Background: Retinal vein occlusion (RVO) is a relatively uncommon condition with a complex pathophysiology. However, its association with traditional cardiovascular risk factors is well established. In this study, we compared arterial stiffness and endothelial function between patients with RVO and healthy controls. Methods: We enrolled 28 consecutive patients with RVO, either central (CRVO) or branch (BRVO), and 30 healthy controls. We measured: (i) perfused boundary region of the sublingual arterial microvessels (a marker of endothelial glycocalyx thickness), (ii) pulse wave velocity (PWV), augmentation index (AIx), and central systolic blood pressure (cSBP). Results: No statistically significant differences regarding age, gender, and major cardiovascular risk factors were noted between patients and controls. Compared to controls, patients with RVO had higher PBR, PWV, AIx, and cSBP values (p < 0.05). For each of these indices, no statistically significant differences were noted between patients with CRVO and BRVO (p > 0.05). Conclusions: Patients with RVO demonstrated reduced endothelial glycocalyx thickness and increased arterial stiffness compared to healthy controls. These findings further elucidate the role of atherosclerosis and endothelial dysfunction in the pathophysiology of the disease and indicate the need for the evaluation of subclinical cardiovascular disease in such patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: Decreased muscle strength and lower hand grip strength (HGS) values are observed in patients with type 2 diabetes (T2D). This study aimed to present the values of hand grip strength as a valuable tool in T2D treatment monitoring in the context of body size and lifestyle elements in 347 patients with type 2 diabetes from Ulaanbaatar, Mongolia. Methods: A retrospective cross-sectional study was performed at hospitals in Ulaanbaatar, Mongolia. The maximum grip strengths of the right and left hands were measured three times, alternatively, using a digital hand dynamometer. The maximum grip strength of the dominant hand was used for the analysis. Results: The values of HGS in both hands dropped with increased age, systolic blood pressure (SBP), the duration of diabetes, and low glucose blood levels, whereas they increased with height. Patients who smoked had the lowest three values of HGS (the average value for each hand), whereas patients who quit smoking had the highest values. Second-order interactions between diastolic blood pressure (DBP) and sex showed a significant effect on the average HGS of both hands and for the left hand in particular (where HGS decreased only in females, whereas it increased in males). Conclusions: HGS is influenced by important socioeconomic and anthropometric factors in patients with type 2 diabetes, making it a valuable indicator of general health. [ABSTRACT FROM AUTHOR]

Background/Objectives: Obesity remains a global health concern and is associated with increased risk of type 2 diabetes, hypertension, and cardiovascular disease overall. Dissimilar hypertension guidelines are available for clinicians, namely those prepared by the American Heart Association (AHA) and the European Society of Cardiology (ESC), which may lead to distinctive appreciation of health outcomes of patients with obesity after bariatric and metabolic surgery, such as hypertension remission. The main goal of this study was to compare the effects of applying stricter (AHA) versus looser (ESC) blood pressure criteria on hypertension diagnosis pre-bariatric surgery and remission assessment one year post-op. Methods: A retrospective analysis of clinical data from patients who underwent surgical treatment for obesity at a single university hospital was performed. To evaluate the hypertension improvement or remission, two different types of blood pressure (BP) categorization were considered (based on AHA and ESC guidelines), in which each patient would fit according to their BP values pre- (m0) and 12 months postoperative (m12). Results: From a sample of 153 patients submitted for surgical treatment of obesity, more patients were considered with hypertension based on the AHA guideline (130 vs. 102; p < 0.001), while a higher rate of hypertension remission at 12 months after bariatric surgery was observed when following the ESC guideline (58.82 vs. 53.08%). Baseline patients' clinical characteristics based on each hypertension outcome were mostly independent of the guideline used (p > 0.05), where only age and systolic blood pressure were relatively higher in "ESC groups". Conclusions: We conclude that only minor differences exist between the two guidelines used. If evaluated based on ESC guidelines, it is expected that less patients are considered with hypertension, and the remission rate may be, at least numerically, higher. [ABSTRACT FROM AUTHOR]

Background: Hypertension significantly impacts global health, leading to coronary heart disease, stroke, and renal disease. Addressing it in young adults is crucial due to its potentially reversible causes and early intervention. Aims and Objectives: (1) To study the clinical profile of newly diagnosed hypertension in young patients (2) To study the etiological profile of hypertension in young. Materials and Methods: In this cross-sectional study after obtaining clearance from the institutional ethics committee, the patients fulfilling the inclusion criteria were enrolled after obtaining informed consent. Data were collected using a pretested proforma, meeting the objectives of the study. A detailed assessment of patients was performed including history and clinical examination of all systems. Laboratory investigations were conducted and analyzed. Results: The mean age of participants was 34.38±4.729 years, with 63% being male. Common symptoms included headache (18%) and giddiness (18%). A significant proportion (58%) had secondary hypertension, primarily due to renal and endocrine causes. Essential hypertension accounted for 42% of cases. The mean systolic and diastolic blood pressures were 178.06±14.112 mmHg and 92.17±11.441 mmHg, respectively. Lifestyle factors such as smoking and alcohol use were noted in 12% and 4% of participants, respectively. Conclusion: Early detection and management of hypertension in young adults are crucial to prevent long-term complications. Secondary hypertension is common in this demographic, requiring specific treatments. [ABSTRACT FROM AUTHOR]

Background: Propofol as an intravenous (IV) induction agent frequently causes significant hypotension and requires monitoring and prompt intervention. The plethysmographic waveform, obtained from a pulse oximeter, relies on two components of light absorption-red and infrared, representing changes in blood volume and cardiovascular status of the patient. Aims and Objectives: The current study aimed to obtain a baseline value and positive predictive value (PPV) of plethysmographic variability index (PVI) to predict hypotension and also compare the PPV of PVI and perfusion index (PI) to predict hypotension induced by propofol. Materials and Methods: Seventy patients posted for elective surgery were first given IV crystalloids 2 h before surgery and then induced with propofol IV. Hemodynamic parameters, PI and PVI were recorded from baseline until 3 min post-intubation. Hypotension was defined as a fall in systolic blood pressure >30% or mean arterial pressure (MAP) <60 mmHg. Patients were then grouped into those who developed hypotension (Group H) and those who did not (Group NH). Statistical analysis of MAP, PVI, and PI was done. Receiver operating characteristic (ROC) curves were plotted and analyzed. The PPV of PVI and PI was calculated and compared. Results: Hypotension occurred in 56 patients. The mean baseline MAP was lower in Group H (91.3±10.54 mmHg vs. 99.93±3.36 mmHg). The fall in MAP was highest at 3 min post-induction (Group H 59.38±7.09, Group NH 79.36±8.05). The difference in baseline PVI was not statistically significant (Group H 15.59±3.67, Group NH 15.43±5.65). PVI peaked in Group H when MAP was minimum (59.38±7.09 mmHg) at 3 min post-induction. The difference in baseline PI was not significant at any time point (Group H 1.13±1.02, Group NH 0.92±0.47) Area under the ROC curve of 0.534 for PVI and 0.559 for PI were not statistically significant hence showing no correlation between baseline PVI and PI and propofol-induced hypotension. Conclusion: Baseline PVI and PI can serve as screening tools and not diagnostic tools for predicting hypotension. Baseline PVI =19 is more accurate to predict post-induction hypotension than the values mentioned in previous studies. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve replacement (TAVR) has become a viable alternative to surgical aortic valve replacement (SAVR) for high-risk patients with aortic stenosis. One such high-risk group is patients with pulmonary hypertension (PH), which is known to increase surgical risk and adversely affect outcomes. This study aims to compare midterm and long-term survival in TAVR and SAVR among patients with PH. A retrospective review of patients with PH undergoing an aortic valve replacement was conducted at a single institution. From May 2012 to June 2020, 427 patients with PH underwent a primary isolated TAVR (n = 249) or SAVR (n = 178). PH was assessed using an estimated pulmonary artery systolic pressure ≥40 mmHg. Propensity score matching was used to adjust for confounders. Before matching, Kaplan–Meier estimated survival was significantly lower for TAVR compared to SAVR (P < 0.01). After matching, 87 well-balanced pairs remained. Post propensity score matching, Kaplan–Meier estimated survival was still significantly lower for the TAVR group as compared to the SAVR group (P = 0.045). These data support the feasibility and safety of SAVR in selected patients with PH, and the presence of PH should not preclude consideration of SAVR in appropriate surgical candidates. Further multicenter research is needed to explore confounders and deepen our understanding of the long-term outcomes in this high-risk population. [ABSTRACT FROM AUTHOR]

Menopause occurs due to the depletion of the ovarian reserve, leading to a progressive decline in estrogen (E2) levels. This decrease in E2 levels increases the risk of developing several diseases and can coexist with chronic kidney disease (CKD). Arterial hypertension (AH) is another condition associated with menopause and may either contribute to or result from CKD. Ovariectomy (OVX) induces hypoestrogenism, which can lead to mitochondrial bioenergetic dysfunction in the kidneys. Previous studies have suggested that exercise training has beneficial effects on adults with CKD and AH. To investigate the effects of OVX and resistance training (RT) on hemodynamic parameters and mitochondrial bioenergetic function of the kidney, female Wistar rats were divided into ovariectomized (OVX) and intact (INT) groups. These rats were either kept sedentary (SED) or subjected to RT for thirteen weeks. The RT involved climbing a vertical ladder with a workload apparatus. Hemodynamic parameters were assessed via tail plethysmography. Mitochondrial respiratory function was evaluated with high-resolution respirometry. Gene expression related to the electron transport chain (ETC) and oxidative phosphorylation (OXPHOS) was evaluated by real-time qPCR. At week 13, key hemodynamic parameters (systolic blood pressure and mean arterial pressure) were significantly elevated in the OVX-SED group. Compared with those in the other groups, mitochondrial bioenergetics were impaired in the OVX-SED group. In contrast, the trained groups presented improved mitochondrial bioenergetic function compared with the sedentary groups. OVX led to reduced gene expression related to the mitochondrial ETC and OXPHOS, whereas RT both prevented this reduction and increased gene expression in the trained groups. Our results indicate that hypoestrogenism significantly decreases OXPHOS and ETC capacity in the kidneys of sedentary animals. However, RT effectively increased the expression of genes related to mitochondrial ETC and OXPHOS, thereby counteracting the effects of OVX. [ABSTRACT FROM AUTHOR]

The optimal management of hospital-presenting sepsis remains poorly understood. We investigated the initial management in patients presenting with sepsis in the general ward, the association between fluid resuscitation and clinical outcomes, and the factors affecting fluid resuscitation. A retrospective study was conducted on patients who presented with sepsis-induced hypotension in the general ward. Patients were divided into Less 30 (fluid resuscitation less than 30 mL/kg) and More 30 (fluid resuscitation 30 mL/kg or more) groups. Multivariable logistic regression analysis was performed. The median resuscitation fluid volume was 500 mL (9.2 mL/kg) and 2000 mL (35.9 mL/kg) in the Less 30 (n = 79) and More 30 (n = 11) groups, respectively. The intensive care unit (ICU) mortality was similar between the two groups (43.0% vs. 45.5%). Twenty-two patients received continuous renal replacement therapy (CRRT) in the Less 30 group, whereas none received it in the More 30 group (27.8% vs. 0%). Fluid resuscitation ≥30 mL/kg was not associated with ICU mortality. Low body weight and systolic blood pressure were associated with fluid resuscitation ≥30 mL/kg. Most hospital-presenting sepsis patients received less than 30 mL/kg of fluid, and fluid resuscitation was not associated with ICU mortality. [ABSTRACT FROM AUTHOR]