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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]

Background: The global COVID-19 lockdown restricted daily routines due to the psychological fear of infection, which imposed an unknown universal threat on female college students, affecting physiological health and well-being. However, scant information concerning the efficacy of yogic practice on female college students during the stressful COVID-19 pandemic situation is available. Methods: In a randomized controlled trial (n = 74, age = 21.65 [4.05] y), a study was conducted with a well-conceptualized yogic module for 5 days/week for 3 months (40 min daily in the morning) among yogic volunteers. Pre–post analysis of anthropometric, physiological, and biochemical indices in pandemic-stressed female college students was done for the control and yoga groups. Results: After 3 months of yogic practice, significant reduction (P <.05) in heart rate (d = 0.64, meandiff = 5.43), systolic blood pressure (d = 0.59, meandiff = 5.32), cortisol (d = 0.59, meandiff = 6.354), and triglycerides (P <.01, d = 0.45, meandiff = 13.95) was observed. After yogic follow-up significant improvement (P <.01) in high-frequency (d = 0.56, meandiff = −7.3), total power (d = 0.46, meandiff = −1150) and time domain parameters of heart rate variability led to ameliorate the stress index. Superoxide dismutase (P <.01, d = 0.78, meandiff = 0.69), catalase (P <.05, d = 0.48, meandiff = −7.37), glutathione (P <.001, d = 0.83, meandiff = −4.15), high-density lipoprotein (P <.05, d = 0.48, meandiff = −11.07), and dopamine (P <.001, d = 0.97, meandiff = −135.4) values along with inflammatory markers (P <.001) significantly improved among yogic volunteers after regular practice. Conclusions: Our findings suggest that a 3-month well-conceptualized yogic intervention during COVID-19 may be considered as a prophylactic tool to improve female college students' universal psychophysiological health by ameliorating autonomic functions, cardiometabolic risk factors, and immune metabolisms in an economical and environment-friendly manner. [ABSTRACT FROM AUTHOR]

Background: Tourniquets are widely used in limb fracture surgeries. Controversies still exist about the pressure inflated, including unified tourniquet inflation pressure (UTIP) and personalized tourniquet inflation pressure (PTIP). This study evaluated the hemostatic effect between UTIP and PTIP based on systolic blood pressure (SBP) in extremity fracture patients. Materials and methods: Patients with fresh extremity fractures requiring tourniquets during surgeries were prospectively enrolled and randomly assigned to the UTIP and PTIP groups. The inflation pressure was set to 250 mmHg for the upper extremities and 300 mmHg for the lower extremities in the UTIP group and SBP plus 50 mmHg for the upper extremities and SBP plus 100 mmHg for the lower extremities in the PTIP group. The primary outcome was a hemostatic effect evaluated by the surgeon (satisfied or dissatisfied). Other secondary outcomes included postoperative changes in limb swelling and tourniquet-related complications. Results: A total of 144 patients were enrolled and randomly assigned to the UTIP group or the PTIP group, and each group has 72 patients (36 upper limb and 36 lower limb). Totally, the hemostasis effect of the PTIP group was worse than that of the UTIP group by non-inferiority test. The hemostatic effect of upper limb fractures with SBP plus 50 mmHg for tourniquet inflation pressure was also worse than that with 250mmHg; however, there was no statistically significant difference between 300mmHg and SBP plus 100 mmHg in the lower limb group hemostasis effect due to a lack of power. Also, no difference was observed in the incidence of complications (p = 1.000) and postoperative changes in limb swelling during 2 days after surgery (upper limb: P1 = 0.546, P2 = 0.545; lower limb: P1 = 0.408, P2 = 0.857) between the PTIP and UTIP group. Conclusion: In the surgery of limb fractures, setting SBP + 50mmHg as tourniquet pressure may not be sufficient for upper limbs. Also, we found no difference between the SBP + 100mmHg and the unified 300mmHg for lower limb surgeries. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions High variations in serially measured blood pressures (BPs) portend a variety of adverse clinical events including dementia, cardiovascular sequelae and frailty. In this study, systolic blood pressure variability (BPV) was examined for its association with fall frequency and time to next fall among older adults living in nursing homes.BP values and falls over time were extracted from medical records of nursing home residents aged ≥65 years over a 10‐month period. BPV was measured as the standard deviation of 17 to 20 systolic values, and its correlation with falls and time to next fall were evaluated according to quartile values.One hundred patient charts were analyzed with nearly 2000 BP data points. All older adults had at least one fall incident. Higher BPV was related to more falls, shorter time between the first and second fall and fewer average days between falls. Subgroups of high BP and different diagnoses affected this association between BPV and falls.People who fall often show a high variability in BP; as the number of falls increases, the BPV also increases. This study suggests that BPV may be marker for patients who might benefit from more aggressive application of fall reduction strategies. Geriatr Gerontol Int 2024; ••: ••–••. [ABSTRACT FROM AUTHOR]

Objective: Investigating the impact of the Community Proactive Health Management Application on electronic health literacy, self‐management level, and blood pressure in hypertensive patients within the community. Methods: Between September and November 2020, two communities in Hengyang City, Hunan Province, China were selected as the intervention and control groups using convenience sampling. Subsequently, 30 hypertensive patients from each of the two communities were randomly selected to participate as study subjects. The control group patients received foundational hypertension management, whereas the intervention group received additional care through the Community Proactive Health Management Application. Results: Following a 3‐month period, the intervention group exhibited significantly higher total scores (t = 2.193, p = 0.032) and application dimension scores (t = 2.605, p = 0.012) for electronic health literacy compared to the control group. The total scores of electronic health literacy scale for both the intervention (t = −5.671, p < 0.001) and control (t = −3.613, p = 0.001) groups were higher after the intervention compared to before. The total score of the self‐management scale (t = 3.872, p < 0.001), as well as the scores for the treatment management (t = 6.580, p < 0.001) and habit management dimensions (t = 2.315, p = 0.024) of hypertensive patients in the intervention group, were significantly higher than those in the control group. The self‐management scores of both groups of hypertensive patients showed a significant increase compared to preintervention levels (intervention group t = −14.391, p < 0.001; control group t = −6.584, p < 0.001). The intervention group exhibited a statistically significant decrease in systolic blood pressure compared to the control group (Z = −2.036, p = 0.042). Following the intervention, both groups exhibited a significant reduction in systolic and diastolic blood pressure levels compared to preintervention levels (all p < 0.001). Conclusions: The Community Proactive Health Management Application has the potential to enhance the electronic health literacy and self‐management capabilities of hypertensive patients, enabling them to engage in better health management, reduce hypertension levels, and elevate their overall quality of life. [ABSTRACT FROM AUTHOR]

The invasive intra‐arterial approach is the gold standard for measuring blood pressure in intensive care units where accuracy is crucial. However, invasive procedures increase the risk of infections and mortality. This evidence‐based review aimed to determine whether continuous non‐invasive blood pressure (CNIBP) monitoring, using Radial Artery Applanation Tonometry (RAAT) devices, is as accurate as invasive methods. Six papers were included: three prospective cohort studies and three comparative studies. Most studies showed that mean arterial pressure is accurately recorded through RAAT monitoring; however, more research is needed to assess the accuracy of non‐invasive readings of systolic and diastolic blood pressures, as data are not always concordant. [ABSTRACT FROM AUTHOR]

Background: A prediction model that estimates mortality at admission to the intensive care unit (ICU) is of potential benefit to both patients and society. Logistic regression models like Simplified Acute Physiology Score 3 (SAPS 3) and APACHE are the traditional ICU mortality prediction models. With the emergence of machine learning (machine learning) and artificial intelligence, new possibilities arise to create prediction models that have the potential to sharpen predictive accuracy and reduce the likelihood of misclassification in the prediction of 30‐day mortality. Methods: We used the Swedish Intensive Care Registry (SIR) to identify and include all patients ≥18 years of age admitted to general ICUs in Sweden from 2008 to 2022 with SAPS 3 score registered. Only data collected within 1 h of ICU admission was used. We had 153 candidate predictors including baseline characteristics, previous medical conditions, blood works, physiological parameters, cause of admission, and initial treatment. We stratified the data randomly on the outcome variable 30‐day mortality and created a training set (80% of data) and a test set (20% of data). We evaluated several hundred prediction models using multiple ML frameworks including random forest, gradient boosting, neural networks, and logistic regression models. Model performance was evaluated by comparing the receiver operator characteristic area under the curve (AUC‐ROC). The best performing model was fine‐tuned by optimizing hyperparameters. The model's calibration was evaluated by a calibration belt. Ultimately, we simplified the best performing model with the top 1–20 predictors. Results: We included 296,344 first‐time ICU admissions. We found age, Glasgow Coma Scale, creatinine, systolic blood pressure, and pH being the most important predictors. The AUC‐ROC was 0.884 in test data using all predictors, specificity 95.2%, sensitivity 47.0%, negative predictive value of 87.9% and positive predictive value of 70.7%. The final model showed excellent calibration. The ICU risk evaluation for 30‐day mortality (ICURE) prediction model performed equally well to the SAPS 3 score with only eight variables and improved further with the addition of more variables. Conclusion: The ICURE prediction model predicts 30‐day mortality rate at first‐time ICU admission superiorly compared to the established SAPS 3 score. [ABSTRACT FROM AUTHOR]

Phase 1: to determine the feasibility of desensitizing ventral branches of spinal nerves within the rectus sheath using an ultrasound-guided rectus sheath block (USRSB). Phase 2: to determine the effect of preoperative USRSB on intraoperative responses to surgical stimulation and postoperative pain. Cadaveric study and prospective, randomized, blinded, parallel-arm clinical trial. A group of five cat cadavers and 37 shelter-owned cats undergoing ovariohysterectomy. Phase 1: anatomical dissection was performed on one uninjected cadaver. Abdominal walls were dissected in four cadavers (eight hemiabdomens) following bilateral USRSB using 1:1 new methylene blue and 0.5% bupivacaine (0.8 mL kg–1 total). Phase 2: preoperative bilateral USRSB was performed with 0.8 mL kg–1 of 0.25% bupivacaine (RSB) or equivalent volume of 0.9% saline (CONTROL). Intraoperative systolic arterial blood pressure (SAP), heart rate (HR), respiratory rate (f R) and vaporizer setting (vap%) were recorded before skin incision, during celiotomy and abdominal wall closure. In recovery, cats were administered robenacoxib (2 mg kg–1; CONTROL) or 0.9% saline (0.1 mL kg–1; RSB) subcutaneously. Postoperative pain was evaluated for 6 hours using the Glasgow Composite Measure Pain Scale. Phase 1: spinal nerves T9–L3 were identified within the rectus sheath, and stained in 0%, 40%, 63%, 75%, 100%, 88%, 50% and 13% of hemiabdomens, respectively. Phase 2: 37 cats were included (RSB, n = 17; CONTROL, n = 20). Intraoperatively, SAP, HR and f R were not significantly different between groups. Vap% was significantly lower in RSB during celiotomy (p = 0.036) and closure (p = 0.044). Postoperatively, RSB cats were 5.3 times (95% CI 1.8–8.3) more likely to require rescue analgesia than CONTROL cats. During surgery, USRSB with bupivacaine offered minor benefits and provided markedly less postoperative analgesia than robenacoxib, indicating that relying on USRSB provides insufficient postoperative analgesia for ovariohysterectomy in cats. [ABSTRACT FROM AUTHOR]

Aims: Metformin has been attributed to cardiovascular protection even in the absence of diabetes. Recent observations suggest that metformin influences the gut microbiome. We aimed to investigate the influence of metformin on the gut microbiota and hypertensive target organ damage in hypertensive rats. Methods: Male double transgenic rats overexpressing the human renin and angiotensinogen genes (dTGR), a model of angiotensin II‐dependent hypertension, were treated with metformin (300 mg/kg/day) or vehicle from 4 to 7 weeks of age. We assessed gut microbiome composition and function using shotgun metagenomic sequencing and measured blood pressure via radiotelemetry. Cardiac and renal organ damage and inflammation were evaluated by echocardiography, histology, and flow cytometry. Results: Metformin treatment increased the production of short‐chain fatty acids (SCFA) acetate and propionate in feces without altering microbial composition and diversity. It significantly reduced systolic and diastolic blood pressure and improved cardiac function, as measured by end‐diastolic volume, E/A, and stroke volume despite increased cardiac hypertrophy. Metformin reduced cardiac inflammation by lowering macrophage infiltration and shifting macrophage subpopulations towards a less inflammatory phenotype. The observed improvements in blood pressure, cardiac function, and inflammation correlated with fecal SCFA levels in dTGR. In vitro, acetate and propionate altered M1‐like gene expression in macrophages, reinforcing anti‐inflammatory effects. Metformin did not affect hypertensive renal damage or microvascular structure. Conclusion: Metformin modulated the gut microbiome, increased SCFA production, and ameliorated blood pressure and cardiac remodeling in dTGR. Our findings confirm the protective effects of metformin in the absence of diabetes, highlighting SCFA as a potential mediators. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between maternal blood pressure (BP) and neonatal cord blood telomere length (TL) during pregnancy, and to clarify the sensitive period. Methods: We conducted a prospective cohort study with 621 mother‐newborn pairs from the Guangxi Zhuang Birth Cohort (GZBC) in China. Multiple informant models, restricted cubic spline regression (RCS) models, and quantile regression models were conducted to analyze the correlation between maternal BP and neonatal TL. Results: Maternal diastolic blood pressure (DBP) was inversely related to neonatal cord blood TL in the second trimester (P = 0.015) and the third trimester (P = 0.011). There was a male‐specific relationship between maternal BP and neonatal TL. A 1 mmHg increment in maternal systolic blood pressure (SBP) and DBP during the second trimester was related with 0.42% (95% CI: −0.80%, −0.04%) and 0.61% (95% CI: −1.13%, −0.09%) shorter TL in male newborns, respectively. Per unit increase of maternal DBP during the third trimester was related with 0.54% (95% CI: −1.03%, −0.05%) shorter TL in male newborns. Pregnant women with hypertensive disease of pregnancy (HDP) had male offspring with shorter TL (P = 0.003). However, no significant relationships were found in female newborns (P = 0.570). Conclusion: Maternal BP during pregnancy is inversely correlated with male neonatal TL and the second and third trimesters are sensitive windows. Synopsis: Maternal blood pressure during pregnancy is inversely correlated with male neonatal telomere length and the second and third trimesters are sensitive windows. [ABSTRACT FROM AUTHOR]

Introduction: Polycystic ovarian syndrome (PCOS) is the commonest endocrine condition affecting reproductive age women. Many biomarkers may aid assessment and management, however evidence is limited on their utility in clinical practice. We conducted a review of systematic reviews to identify the most useful biomarkers in the clinical management of PCOS. Methods: We searched MEDLINE, EMBASE, CENTRAL and HTA until August 2023 for reviews evaluating biomarkers in PCOS women compared to healthy controls. Methodological quality was assessed using the AMSTAR2 tool. We reported pooled evidence for each biomarker with 95% confidence intervals from the most recent, up‐to‐date, and best quality review. Results: From 3360 citations, we included 75 systematic reviews (88 biomarkers, 191,792 women). Most reviews (50/75, 67%) were moderate quality, but reported high heterogeneity (66/75, 88%). We identified 63 abnormal biomarkers in women with PCOS versus healthy controls. Of these, 22 core biomarkers could help evaluate the multisystemic impact of PCOS and inform patient management and surveillance: dehydroepiandrosterone, prolactin, sex hormone‐binding globulin, total and free testosterone, anti‐Mullerian hormone, systolic and diastolic blood pressure, c‐reactive protein, fibrinogen, oral glucose tolerance test, homoeostatic model assessment‐insulin resistance index, fasting insulin, total cholesterol, triglycerides, lipoprotein(a), HDL, LDL, non‐HDL‐cholesterol, ferritin, iron, and 25‐hydroxy‐vitamin D. Conclusion: We identified 22 core biomarkers assessing the multisystemic impact of PCOS and inform its clinical management. Future research is required to establish validated healthcare pathways. [ABSTRACT FROM AUTHOR]

High fruit and vegetable diets are associated with reduced chronic kidney disease and cardiovascular disease but are infrequently used in hypertension treatment. Low acid diets are also associated with reduced chronic kidney disease and cardiovascular disease, and fruits and vegetables or oral sodium bicarbonate (NaHCO 3) lowers dietary acid. We randomized 153 hypertensive macroalbuminuric patients receiving pharmacologic chronic kidney disease and cardiovascular disease protection to get fruits and vegetables, oral NaHCO 3 , or Usual Care. We assessed the course of kidney disease progression and cardiovascular disease risk indices over five years. Chronic kidney disease progression was slower in participants receiving fruits and vegetables or oral NaHCO 3 than Usual Care [mean (SE)] [−1.08 (0.06) and −1.17 (0.07) vs. −1.94 (0.11) mL/min/1.73m2/ year, respectively, P 's<.001). Yet, systolic blood pressure was lower, and cardiovascular disease risk indices improved more in participants receiving fruits and vegetables than in those receiving NaHCO 3 or Usual Care. These cardiovascular benefits of fruits and vegetables were achieved despite lower doses of pharmacologic chronic kidney disease and cardiovascular disease protection. The trial supports fruits and vegetables as foundational hypertension treatment to reduce chronic kidney disease progression and cardiovascular disease risk. [ABSTRACT FROM AUTHOR]

Thermogenic brown adipose tissue (BAT) has emerged as an attractive target for combating obesity. However, pharmacological activation of energy expenditure by BAT and/or induction of browning of white adipose tissue (WAT) has been hampered by cardiovascular side effects. To address these concerns, we developed polylactide- co -glycolide acid (PLGA) microspheres loaded with mirabegron (MIR), a selective beta-3 adrenergic receptor (ADRB3) agonist, to achieve sustained local induction and activation of thermogenic adipocytes. MIR-loaded PLGA microspheres (MIR-MS) effectively activated brown adipocytes and enhanced the thermogenic program in white adipocytes. Moreover, treating isolated inguinal WAT (iWAT) with MIR-MS resulted in increased expression of browning markers and elevated lipolysis mainly via ADRB3. In mice, injection of MIR-MS over four weeks induced browning of iWAT at the injection site. Importantly, local MIR-MS injection successfully mitigated unwanted cardiovascular risks, including high systolic blood pressure (SBP) and heart rate, as compared to MIR-treated mice. Finally, injecting MIR-MS into human subcutaneous WAT led to a significant induction of lipolysis and an increase in the expression of thermogenic marker uncoupling protein 1 (UCP1). Taken together, our findings indicate that MIR-MS function as a local drug release system that induces browning of human and murine subcutaneous WAT while mitigating undesirable cardiovascular effects. MIR-loaded PLGA microspheres provide a promising obesity treatment by inducing browning and thermogenic activation of white adipose tissue without eliciting cardiovascular side effects. [Display omitted] [ABSTRACT FROM AUTHOR]

The aim of this study was to examine the moderating role of cardiorespiratory fitness (CRF) between the relationship of cardiometabolic risk factors and adiponectin in adolescents. This is a cross-sectional study conducted with 255 adolescents of both sexes, aged 11 to 17 years. Anthropometric and biochemical parameters such as body mass, height, fat mass (FM), fat-free mass, high-density lipoprotein, low-density lipoprotein, triglycerides, glucose, insulin, adiponectin, systolic blood pressure, diastolic blood pressure, and peak oxygen consumption (VO2peak) were measured. Body mass index z-score (BMI-z), tri-ponderal mass index (TMI), homeostasis model assessment insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and age peak height velocity were calculated. The moderation analyses were tested using linear regression models. Interaction was observed with low CRF, indicating that those who achieved more than 2.27 (BMI-z), 2.18 (TMI), 2.10 (FM), 2.57 (insulin), 2.65 (HOMA-IR), and 2.81 (QUICKI) in L·min−1 on the CRF test may experience reduced risks in cardiometabolic risk factors. Conclusion: The deleterious effects attributed to excess adiposity and unfavorable changes related to insulin resistance and sensitivity may be attenuated by CRF. What is Known: • Adiponectin, a protein derived from adipose tissue, may play a role as a potential marker of protection and predictor of cardiometabolic disorders and its relationship with cardiorespiratory fitness is controversial. What is New: • The deleterious effects attributed to overweight and unfavorable changes related to insulin resistance and sensitivity may be attenuated by high cardiorespiratory fitness in adolescents. [ABSTRACT FROM AUTHOR]

Strategies for controlling hypertension include reducing excess fat and increasing muscle mass. However, the effects of exercise interventions on hypertension in adolescents have been little investigated. The purpose was to evaluate the effect of 12 weeks of aerobic exercise on systolic blood pressure (SBP) and diastolic blood pressure (DBP) and the cardiometabolic profile of overweight hypertensive and non-hypertensive boys. The sample included 107 boys diagnosed as overweight, aged between 12 and 17, divided into two non-hypertension groups, one control (GCN, n = 14) and one with exercise (GEN, n = 55), as well as two groups of hypertensives, one control (GCH, n = 12) and one with exercise (GEH, n = 26). The boys were assessed at the study baseline and after 12 weeks in terms of anthropometric parameters, biological maturation, SBP, DBP and mean blood pressure (MBP), lipid, and metabolic profile. The aerobic training programs lasted 12 weeks and were carried out in three weekly sessions at different intensities. The high-intensity interval training session lasted around 35 min at an intensity of 80–100% of the reserve heart rate, and the moderate-intensity of continuous training session lasted 60 min at an intensity of 35–75% of the reserve heart rate. Caloric expenditure was equivalent between the exercises (p = 0.388). CGN and CGH participated only in school physical activities. Repeated measures analysis of variance and clinical effect analysis using Cohen's effect size were used, with a significance level established at p < 0.05. After 12 weeks, all groups increased their height (p < 0.05), but only the exercise groups showed a reduction in anthropometric variables (p < 0.05), with a possibly beneficial effect in GEN (d = − 0.203; p = 0.003). No differences were found in the variables for the GCN. The GCH and GEH groups reduced SBP (p < 0.05), but only GEH showed a reduction in DBP (p = 0.005) and MBP (p = 0.001). In relation to the lipid profile, GEH maintained HDL-c close to baseline values, while GCH showed a reduction in HDL-c (p = 0.021). Regarding the clinical effect of exercise on hypertension, GEH showed a large and very beneficial effect size on DBP (d = − 0.916; p = 0.006) and MBP (d = − 0.926; p = 0.005). Conclusion: Hypertensive boys who practiced physical exercise showed greater effects in reducing blood pressure, indicating the importance of non-drug therapeutic management in overweight adolescents. Trial registration: Brazilian Registry of Clinical Trials RBR-4v6h7b / RBR-6343y7. [ABSTRACT FROM AUTHOR]

Withdrawal of life-sustaining therapies (WDLST) in young individuals with traumatic brain injury (TBI) is an overwhelming situation often made more stressful by socioeconomic factors that shape health outcomes. Identifying these factors is crucial to developing equitable and goal-concordant care for patients and families. We aimed to identify predictors of WDLST in young patients with 1-TBI. We hypothesized uninsured payment method, race, and co-morbid status are associated with WDLST. We queried the 2021 Trauma Quality Improvement Program database for patients <45 years with TBI. Patients with WDLST were compared to patients without WDLST. Multivariable logistic regression (MLR) was performed. 61,115 patients were included, of whom 2,487 (4.1%) underwent WDLST. Patients in the WDLST cohort were older (29 vs 27, P <0.001), more likely to suffer from a penetrating mechanism (29% vs 11%, P <.0001), and have uninsured (22% vs 18%) or other payment method (5% vs 3%) when compared to the non-WDLST cohort. MLR identified age (AOR:1.019, 95% CI 1.014 – 1.024, P <.0001), non-Hispanic ethnicity (AOR:1.590, 95% CI 1.373–1.841, P <.0001), penetrating mechanism (AOR:3.075, 95% CI 2.727–3.467, P <.0001), systolic blood pressure (AOR: 0.992, 95% CI 0.990–0.993, P <0.0001), advanced directive (AOR:4.987, 95% CI 2.823–8.812, P <.0001), cirrhosis (AOR:3.854, 95% CI 2.641–5.625, P <.0001), disseminated cancer (AOR:6.595, 95% CI 2.370–18.357, P =0.0003), and interfacility transfer (AOR:1.457, 95% CI 1.295–1.640, P <0.0001) as factors associated with WDLST. Black patients were less likely to undergo WDLST when compared to white patients (AOR:0.687, 95% CI 0.603–0.782, P <.0001). The decision for WDLST in young patients with severe TBI may be influenced by cultural and socioeconomic factors in addition to clinical considerations. [ABSTRACT FROM AUTHOR]

This retrospective study aims to analyze the baseline characteristics and factors associated with poor outcomes in patients with necrotizing enterocolitis (NEC) complicating respiratory syncytial virus (RSV) infection. Using the Virtual Pediatric Systems data registry, patients under 2 years admitted to the pediatric intensive care unit (PICU) were screened. Patients with documented RSV infection and NEC, intestinal perforation, noninfectious gastroenteritis/colitis, or pneumatosis intestinalis occurring around the timing of RSV bronchiolitis diagnosis were included. Out of the screened patients, 41 were analyzed. Most patients (93%) were aged 30 days to 2 years, one-third had baseline anatomical cardiac defects, and 20% history of prematurity. Median PICU length of stay was 11.7 days. Seven patients died before hospital discharge. While not statistically significant, nonsurvivors tended to exhibit higher PRISM-3 scores, more acidemia, and lower systolic blood pressure. These findings emphasize the need for cautious assessment of gastrointestinal symptoms in critically ill patients with RSV infection. [ABSTRACT FROM AUTHOR]

Background: Vitamin D (25OHD) can modulate pathways and mechanisms that regulate blood pressure (BP). Observational studies in children and adults have shown an inverse association between 25OHD and BP. Studies evaluating associations between 25OHD and BP in pediatric chronic kidney disease are limited. Methods: We evaluated the associations between 25OHD and BP using data from the Chronic Kidney Disease in Children (CKiD) study. Clinic or ambulatory BP index was defined as participant's BP divided by 95th age-sex-height-specific BP percentile, an index > 1 suggests hypertension. Primary outcomes of interest were changes in systolic and diastolic clinic and ambulatory BP indices over follow-up. Linear mixed-effects models were used to evaluate associations between BP indices and 25OHD. Results: The study cohort consisted of 370 participants who contributed 970 person-visits. A subset of 194 participants with ambulatory BP data contributed 465 person-visits. There was an association between baseline 25OHD levels and clinic systolic BP index such that for every 10 ng/ml lower 25OHD, clinic systolic BP index was 1.0% higher (95%CI: 0.2–1.8, p = 0.016) between participants. The association between clinic diastolic BP index with baseline 25OHD was not significant. For within-person changes, longitudinal decreases in 25OHD were not significantly associated with concomitant increases in clinic systolic or diastolic BP index. There were no significant associations between 25OHD levels at baseline or longitudinally with 24-h ABPM indices. Conclusions: Low 25OHD levels were associated with higher clinic systolic BP in children with CKD. Vitamin D supplementation to maintain normal 25OHD levels might be a useful adjunctive treatment in optimizing BP control in these high-risk patients. [ABSTRACT FROM AUTHOR]

Objective: Prevention and improvement of hypertension is one of the most important health issues worldwide. The traditional Japanese diet contributes to the prevention of some non-communicable diseases associated with hypertension. However, whether traditional Japanese dietary patterns are associated with hypertension prevalence and systolic blood pressure (SBP) worldwide remains unknown. In this study, we aimed to investigate whether the traditional Japanese diet score (TJDS) is associated with hypertension prevalence and SBP. Methods: This cross-sectional and longitudinal ecological study from 2009 to 2019 included 141 countries with a population of at least 1 million. All data used for analysis were obtained from internationally available databases. The TJDS was calculated using country-specific supplies of five foods commonly eaten in the traditional Japanese diet (rice, fish, soybean, vegetables, and egg) and three less commonly eaten foods (wheat, milk, and red meat). Hypertension was defined by SBP ≥140 mmHg, diastolic blood pressure ≥90 mmHg, or use of antihypertensive medications. The mean SBP was >25 age-standardized data. A general linear model was used for the cross-sectional model in 2009, and a linear mixed model was used for the longitudinal analysis from 2009 to 2019. The covariates included gross domestic product, percentage of population aged >65 years, years of education, smoking rate, average body mass index, physical activity, and energy supply. Results: The TJDS was negatively associated with hypertension prevalence (β ± standard error: −0.861 ± 0.202, p < 0.001) and SBP (β ± standard error: −0.364 ± 0.154, p < 0.05) in the cross-sectional analysis. The TJDS was significantly negatively associated with hypertension prevalence (β ± standard error: −0.845 ± 0.200, p < 0.001) and SBP (β ± standard error: −0.312 ± 0.149, p < 0.05) in the 10-year longitudinal analysis controlled for full covariables. Conclusions: Traditional Japanese dietary patterns are associated with lower hypertension prevalence and SBP worldwide. [ABSTRACT FROM AUTHOR]

Context Renin is a marker of blood volume. There is no consensus on the validity of plasma renin measurement for adjusting mineralocorticoid (MC) substitution in patients with primary adrenal insufficiency (PAI). Objective This work aimed to investigate if plasma renin could be used to adjust MC substitution in patients with PAI. Methods A total of 150 patients with at least one measurement of plasma renin followed for PAI at 2 tertiary expert centers between 2008 and 2022 were retrospectively included. As supraphysiological hydrocortisone might have additional MC activity, we integrated the individual hydrocortisone dose to obtain the MC equivalent dose (Eq-MC). Renin less than 20 mIU/L was considered oversubstituted, renin between 20 and 60 mIU/L as correctly substituted, and renin over 60 mIU/L as undersubstituted. Results The mean dose of fludrocortisone was 82.3 ± 46 μg/day. Plasma renin was abnormal in 56.7% of cases (7 patients oversubstituted and 78 patients undersubstituted). Abnormalities in electrolyte levels were observed in only 12.7% of patients. Plasma renin correlated negatively with sodium (P <.01) and systolic blood pressure (P =.026), and positively with potassium (P <.01). Doses changes in Eq-MC had a statistically significant effect on renin levels (P =.0037), with an increase of MC dose correlating with a decrease in renin level and vice versa; no correlation was observed using electrolytes or blood pressure. Conclusion Plasma renin correlates with electrolytes and blood pressure. While dose changes significantly alter renin levels, electrolytes and blood pressure do not, suggesting that renin may provide more information about MC replacement therapy than electrolytes and blood pressure. [ABSTRACT FROM AUTHOR]

BACKGROUND In this paper, we use the Health and Retirement Study (HRS) to examine the relationship between an estimated measure of pulse wave velocity (ePWV) and cognitive impairment with no dementia and dementia, respectively. METHODS We modeled the relationship between ePWV and cognitive status in 2006/2008 using data from 8,492 men and women (mean age 68.6 years) controlling for age, blood pressure, sociodemographic, and socioeconomic characteristics (sex, race and ethnicity, education, income, wealth), health behaviors (smoking and physical activity), body mass index (BMI), health status and related medication use (history of cardiovascular disease, diabetes, and stroke), and cerebrovascular disease (CVD)-related biomarkers (C-reactive protein, cystatin-C, hemoglobin A1c, total cholesterol, high-density lipoprotein [HDL] cholesterol). We assess cognitive function with the 27-item Langa-Weir Telephone Interview for Cognitive Status (TICS) scale. ePWV is derived from an equation based on participant age and resting blood pressure. RESULTS In a model that controlled for the constituent components of ePWV (age, age squared, systolic and diastolic blood pressure), ePWV is associated with increased odds of having cognitive impairment with no dementia (OR = 2.761) and dementia (OR = 6.344) relative to a group with no cognitive impairment or dementia. After controlling for the constituent components of ePWV, sociodemographic and socioeconomic characteristics, health behaviors, BMI, health status and medication use, and CVD-related biomarkers, ePWV remains significantly associated with dementia (OR = 3.969) but not cognitive impairment with no dementia (OR = 1.782). CONCLUSIONS These findings suggest that ePWV may be a novel research tool and biomarker of vascular aging that can be used in large, population-representative studies to examine cognitive aging and dementia risk. [ABSTRACT FROM AUTHOR]

BACKGROUND Hypertension may result in atrial fibrillation (AF) and lipid metabolism disorders. The Sirtuins3 (SIRT3)/AMP-activated protein kinase (AMPK) signaling pathway has the capacity to regulate lipid metabolism disorders and the onset of AF. We hypothesize that the SIRT3/AMPK signaling pathway suppresses lipid metabolism disorders, thereby mitigating salt-sensitive hypertension (SSHT)-induced susceptibility to AF. METHODS The study involved 7-week-old male Dahl salt-sensitive that were fed either a high-salt diet (8% NaCl; DSH group) or a normal diet (0.3% NaCl; DSN group). Then DSH group was administered either oral metformin (MET, an AMPK agonist) or intraperitoneal injection of Honokiol (HK, a SIRT3 agonist). This experimental model allowed for the measurement of Systolic blood pressure (SBP), the expression levels of lipid metabolism-related biomarkers, pathological examination of atrial fibrosis, and lipid accumulation, as well as AF inducibility and AF duration. RESULTS DSH decrease SIRT3, phosphorylation-AMPK, and very long-chain acyl-CoA dehydrogenase, (VLCAD) expression, increased FASN and FABP4 expression and concentrations of free fatty acid and triglyceride, atrial fibrosis and lipid accumulation in atrial tissue, enhanced level of SBP, promoted AF induction rate and prolonged AF duration, which are blocked by MET and HK. Our results also showed that the degree of atrial fibrosis was negatively correlated with VLCAD expression, but positively correlated with the expression of FASN and FABP4. CONCLUSIONS We have confirmed that a high-salt diet can result in hypertension, and associated atrial tissue lipid metabolism dysfunction. This condition is linked to the inhibition of the SIRT3/AMPK signaling pathway, which plays a significant role in the progression of susceptibility to AF in SSHT rats. [ABSTRACT FROM AUTHOR]

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Background: Epigenome‐wide association studies have identified multiple DNA methylation sites (CpGs) associated with alcohol consumption, an important lifestyle risk factor for cardiovascular diseases. This study aimed to test the hypothesis that an alcohol consumption epigenetic risk score (ERS) is associated with blood pressure (BP) traits. Results: We implemented an ERS based on a previously reported epigenetic signature of 144 alcohol-associated CpGs in meta-analysis of participants of European ancestry. We found a one-unit increment of ERS was associated with eleven drinks of alcohol consumed per day, on average, across several cohorts (p < 0.0001). We examined the association of the ERS with systolic blood pressure (SBP), diastolic blood pressure (DBP), and hypertension (HTN) in 3,898 Framingham Heart Study (FHS) participants. Cross-sectional analyses in FHS revealed that a one-unit increment of the ERS was associated with 1.93 mm Hg higher SBP (p = 4.64E−07), 0.68 mm Hg higher DBP (p = 0.006), and an odds ratio of 1.78 for HTN (p < 2E−16). Meta-analysis of the cross-sectional association of the ERS with BP traits in eight independent external cohorts (n = 11,544) showed similar relationships with BP levels, i.e., a one-unit increase in ERS was associated with 0.74 mm Hg (p = 0.002) higher SBP and 0.50 mm Hg (p = 0.0006) higher DBP, but not with HTN. Longitudinal analyses in FHS (n = 3260) and five independent external cohorts (n = 4021) showed that the baseline ERS was not associated with a change in BP over time or with incident HTN. Conclusions: Our findings demonstrate that the ERS has potential clinical utility in assessing lifestyle factors related to cardiovascular risk, especially when self-reported behavioral data (e.g., alcohol consumption) are unreliable or unavailable. [ABSTRACT FROM AUTHOR]

Objective: To analyse the correlation between urinary albumin excretion rate (UAER) and estimated glomerular filtration rate (eGFR) and the risk factors for reducing eGFR in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 431 T2DM patients admitted between January 2019 and March 2020 were selected and divided into two groups according to eGFR level. Comparing the differences between baseline data and clinical indicators, multivariate logistic regression was used to analyse the risk factors of eGFR reduction and to analyse the association between UAER and eGFR. Results: In total, 167 patients were included in the study group and 264 patients were included in the conventional group. The study group participants were older, had longer diabetes duration, and had higher fatty liver, peripheral vascular disease (PVD), hypertension prevalence, and mean body mass index (P < 0.05). The levels of various indicators were lower than those of the conventional group (P < 0. 05). Additionally, PVD, nocturnal systolic blood pressure, fatty liver, and beta-2-microglobulin (β 2-MG) were independent risk factors for eGFR decline, with high density lipoprotein (HDL) and fasting C-peptide (CP) as protective factors. There was no obvious correlation between UAER and eGFR. Conclusion: Peripheral vascular disease, systolic blood pressure, fatty liver, and beta-2-microglobulin are risk factors for decreased eGFR levels in patients with T2DM, which should be applied for control DKD. HDL and fasting CP have important effects on maintaining eGFR, and blood pressure and fasting CP can be used as new targets for subsequent diabetic kidney disease treatment. [ABSTRACT FROM AUTHOR]

Introduction: Caffeine, the most widely consumed psychoactive drug globally, has been associated with vascular changes in various organs, including the retina. Researchers have reported vascular constriction in the retina in response to caffeine, although data on its effects remain limited and somewhat contradictory. Further research is needed to clarify the specific impact of caffeine on retinal blood vessels and its potential implications for ocular health. Purpose: To investigate the effects of 200 mg of caffeine on systolic and diastolic blood pressure (SBP and DBP) and retinal vessel density (VD) assessed by optical coherence tomography angiography (OCTA). Methods: Prospective randomized, double‐blind placebo‐controlled, IRB‐approved study in 59 healthy low caffeine users (< 136 mg of caffeine daily). Baseline 3 × 3 and 6 × 6 mm OCTA scans centered on the fovea as well as a 6 × 6 mm scans centered on the optic nerve head (ONH) were obtained. Participants were randomly assigned into caffeine group (CG, n = 42) receiving 200 mg caffeine pill or placebo group (PG, n = 17). OCTA scans were repeated at 60 and 120 min after intervention. VD was measured with Advanced Retina Imaging (ARI) network software (Carl Zeiss Meditec, Dublin, CA) for superficial capillary plexus (SCP) and deep capillary plexus (DCP). SBP/DBP readings were recorded before each imaging session. Ordinary one‐way analysis of variance (ANOVA) of each group was performed using GraphPad Prism Version 9.3.0. Results: Both groups had comparable demographics and OCTA parameters at baseline. Two hours after intervention, the CG had a significantly higher SBP (123 ± 7 mmHg) and DBP (81 ± 5 mmHg) compared to the control group (118 ± 7 mmHg, 77 ± 6 mmHg) (p value = 0.012, 0.023). Regarding the OCTA VD metrics, there were no significant differences in VD between the caffeine and placebo groups, regardless of whether the scans were centered on the macula or ONH. Additionally, the comparison across different OCTA scan modalities, specifically the 3 × 3 mm and 6 × 6 mm scans, showed no discernible differences among groups. Conclusion: In conclusion, 200 mg of caffeine elevated blood pressure after 2 h but did not impact the retinal VD. This underscores the intricate relationship between caffeine, blood pressure, and retinal vascular dynamics, prompting further exploration of their implications for ocular health, especially in subjects with vascular disease. [ABSTRACT FROM AUTHOR]

Aims Materials and Methods Results Conclusions This study aimed to explore the effect of discontinuation of long‐term spironolactone treatment on markers of kidney function in individuals with type 2 diabetes (T2D) at high risk of kidney disease enrolled in the Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria (PRIORITY) study.An observational study following the nested randomised part of the PRIORITY study was conducted. A total of 115 individuals with T2D and normoalbuminuria but high risk for progression based on urinary proteomics, randomised to daily spironolactone (n = 50) or placebo (n = 65) for a median of 2.5 years, were re‐examined approximately 6 weeks after the final visit in the PRIORITY study. Primary endpoint was relative change in geometric mean of urinary albumin‐creatinine ratio (UACR) between the final visit in PRIORITY (baseline) and follow‐up. Secondary endpoints were change in estimated glomerular filtration rate (eGFR), systolic blood pressure (SBP) and serum potassium.No change in UACR was observed in neither the spironolactone (geometric mean change: 17%; 95% CI −12, 55; p = 0.28) nor the placebo (5%; 95% CI −13, 26; p = 0.63) group at follow‐up. No difference in UACR between the groups was observed at follow‐up (relative difference in geometric mean: 11%, 95% CI −26, 67; p = 0.60). For eGFR and SBP, an increase after discontinuation of spironolactone was observed, as well as for SBP after placebo discontinuation. Potassium levels were lower after discontinuation of spironolactone, but higher after placebo discontinuation (all p < 0.05).UACR did not change after discontinuation of long‐term treatment with spironolactone. However, an increase in eGFR was observed supporting a haemodynamic effect of spironolactone in the kidneys. [ABSTRACT FROM AUTHOR]

Alcohol is widely used but recognized as a risk factor for several adverse health outcomes based on observational studies. How alcohol affects lifespan remains controversial, with no trial to make such an assessment available or likely. We conducted a Mendelian randomization (MR) to assess the effect of alcohol on lifespan in men and women, including a possible role of smoking and education. Strong (p < 5e− 8), independent (r2 < 0.001) genetic predictors of alcohol consumption in 2,428,851 participants of European ancestry from the Sequencing Consortium of Alcohol and Nicotine use (GSCAN) consortium genome wide association study (GWAS) were applied to sex-specific GWAS of lifespan (paternal and maternal attained age) and age at recruitment to the UK Biobank. We used multivariable MR to allow for smoking and education, with systolic and diastolic blood pressure as control outcomes. Inverse variance weighted was the primary analysis with sensitivity analysis. Alcohol consumption decreased lifespan overall (− 1.09 years (logged alcoholic drinks per week), − 1.89 to − 0.3) and in men (− 1.47 years, − 2.55 to − 0.38), which remained evident after adjusting for smoking (− 1.81 years, − 3.3 to − 0.32) and education (− 1.85 years, − 3.12 to − 0.58). Estimates from sensitivity analysis were similar, and when using the genetic variant physiologically associated with alcohol use. Alcohol consumption was associated with higher blood pressure as expected. Our study indicates that alcohol does not provide any advantages for men or women but could shorten lifespan. Appropriate interventions should be implemented. [ABSTRACT FROM AUTHOR]

Background: Globorisk is one of the prediction tools for 10-year risk assessment of cardiovascular disease, featuring an office-based (non-laboratory-based) version. This version does not require laboratory tests for determining the CVD risk. The present study aims to determine the 10-year CVD risk using the office-based Globorisk model and factors associated with the 10-year CVD risk. Methods: In this study, baseline data from 6810 individuals participating in the Fasa cohort study, with no history of CVD or stroke, were utilized. The risk equation of the office-based Globorisk model incorporates age, sex, systolic blood pressure (SBP), body mass index (BMI), and smoking status. The Globorisk model categorizes the risk into three groups: low risk (< 10%), moderate risk (10% to < 20%), and high risk (≥ 20%). To identify factors associated with the 10-year CVD risk, the predicted risk was categorized into two groups: <10% and ≥ 10%. Multivariable logistic regression analysis was employed to determine factors associated with an increased CVD risk. Results: According to the 10-year CVD risk categorization, 78.3%, 16.4%, and 5.3% of men were in the low, moderate, and high risk groups, respectively, while 85.8%, 10.0%, and 4.2%, of women were in the respective risk groups. Multivariable logistic regression results indicated that in men, the 10-year CVD risk decreases with being an opium user, and increases with being illiterate, having abdominal obesity, and low or moderate physical activity compared to high physical activity. In women, being married, and higher fiber consumption decrease the 10-year CVD risk, while being illiterate, low or moderate physical activity compared to high physical activity, having abdominal obesity, opium use, and being in wealth quintiles 1 to 4 compared to quintile 5 increase the risk. Conclusions: Considering the factors associated with increased CVD risk, there is a need to enhance awareness and modify lifestyle to mitigate and reduce the risk of CVD. Additionally, early identification of individuals at moderate to high risk is essential for preventing disease progression. The use of the office-based Globorisk model can be beneficial in settings where resources are limited for determining the 10-year CVD risk. [ABSTRACT FROM AUTHOR]

Introduction: Smoking has been recognized as a contributing factor to frailty in older adults. Nevertheless, it remains uncertain whether the degree of smoking has a discernible impact on frailty among older smokers. This cross-sectional study was conducted to investigate the correlation between serum cotinine levels, a biomarker reflecting tobacco exposure, and the presence of frailty within a nationally representative cohort of older adults. Method: A total of 1626 individuals aged ≥ 60 who identified as smokers were included in the analysis. Participants were selected based on self-reported current smoking status. According to the Fried Phenotype, frailty is assessed through five dimensions: unintentional weight loss, slow walking speed, weakness, self-reported exhaustion, and low physical activity. Participants with three or more of these conditions were categorized as frailty, those with at least one but less than three as pre-frailty, and those with none as robust. Multinomial logistic regression models were employed to explore the relationship between serum cotinine level quartiles, with the lowest quartile as the reference group, and the various frailty statuses, with robustness as the reference category. These models were adjusted for covariates, including age, sex, race/ethnicity, alcohol drinking, daily protein intake, systolic blood pressure, serum albumin level, depressive symptoms, and cognitive function. The data used for this analysis were sourced from the National Health and Nutrition Examination Survey for the years 2011 to 2014. Results: The median age of the participants was 69.0 years. The majority were male (62.2%) and non-Hispanic White (49.0%). The distribution of frailty statuses among the participants revealed that the highest proportion had pre-frailty (50.7%), followed by robustness (41.1%), and frailty (8.2%). Multinomial logistic regression showed that participants in the 4th quartile of serum cotinine level exhibited a higher probability of pre-frailty versus robustness (Odds ratio [OR] 1.599, 95% confidence interval [CI] 1.017, 2.513, P = 0.042). Participants in the 3rd quartile of serum cotinine level had higher odds of frailty versus robustness (OR 2.403, 95% CI 1.125, 5.134, P = 0.024). Moreover, participants whose serum cotinine levels were higher than the literature cutoffs (≥ 15 ng/ml) were more likely to be pre-frail (Odds ratio [OR] 1.478, 95% confidence interval [CI] 1.017, 2.150, P = 0.035) or frail (Odds ratio [OR] 2.141, 95% confidence interval [CI] 1.054, 4.351, P = 0.041). Conclusions: A higher serum cotinine level is linked to an elevated probability of pre-frailty and frailty among older smokers. Initiatives geared towards assisting older smokers in reducing or quitting their smoking habits might possibly play a crucial role in preventing pre-frailty and frailty. [ABSTRACT FROM AUTHOR]

Background: Dementia is a major public health burden, particularly among the older persons with significant implications for individuals, caregivers, and society. Identifying mild cognitive impairment early can facilitate timely intervention and care.This cross-sectional study aims to investigate the association between Framingham risk score (FRS), a widely used tool for cardiovascular disease (CVD) risk prediction, and cognitive impairment among older persons with chronic illness in Malaysia. Methods: A total of 289 participants aged 60 years and above with chronic illness were recruited from Klinik Primer Hospital Tuanku Chanselor Muhriz via simple random sampling via computer generator. The Montreal Cognitive Assessment Bahasa Malaysia version (MoCA-BM) was used to assess cognitive function and the FRS was calculated on the basis of CVD risk factors. Results: The prevalence of cognitive impairment among the participants was found to be 19.7%. Multiple Logistic Regression revealed that age (AOR 1.101, 95% CI = 1.041,1.163, p < 0.001), systolic blood pressure (AOR 1.048, 95%CI = 1.024, 1.072, p < 0.001) diabetes (AOR 2.655, 95% CI = 1.194, 5.906, p = 0.017) increased the odds of having cognitive impairment among older persons with chronic illness whereas secondary education (AOR 0.087, 95% CI = 0.008, 0.963, p = 0.047) and higher education (AOR 0.037, 95% CI = 0.002, 0.833, p = 0.038) reduced the likelihood of having cognitive impairment. Individuals with higher FRS were more likely to have cognitive impairment (AOR 1.099, 95% CI = 1.049, 1.172, p < 0.001). The optimal cutoff point for the FRS to determine cognitive impairment is 30 for males with a sensitivity and specificity of 84.4% and 51.2% while the optimal cut off point for females is 18.5 with a sensitivity and specificity of 76% and 63.1% respectively. Conclusions: These findings suggest that the FRS which was originally designed for CVD risk assessment may also serve as a valuable predictive tool for cognitive impairment among older persons with chronic illness. Integrating FRS into routine primary care assessments could enhance the early identification of individuals at risk and enable appropriate cognitive screenings and interventions. Further research such as a longitudinal cohort study in a larger and more diverse population is warranted to validate the association of CVD risks with the development of dementia. [ABSTRACT FROM AUTHOR]

Background: The Advanced Trauma Life Support classification (ATLS) of hypovolemic shock is a widely used teaching and treatment reference in emergency medicine, but oversimplifies clinical reality. A decade ago, a landmark study compared vital parameters to base deficit (BD) in trauma patients. The investigators concluded that BD had higher accuracy to detect the need for early blood product administration. BD was subsequently introduced in the ATLS shock classification and has since been widely accepted as a laboratory standard for hypovolemia. The aim of this study is to investigate whether a methodological bias may have inadvertently contributed to the study's results and interpretation. Methods: In the current study, we replicate the original study by simulating a cohort of trauma patients with randomly generated data and applying the same methodological strategies. First, a predefined correlation between all predictor variables (vital parameters and BD) and outcome variable (transfusion) was set at 0.55. Then, in accordance with the methods of the original study we created a composite of ATLS parameters (highest class amongst heart rate, systolic blood pressure, and Glasgow Coma Scale) and compared it with BD for resulting transfusion quantity. Given the preset correlations between predictors and outcome, no predictor should exhibit a stronger association unless influenced by methodological bias. Results: Applying the original imbalanced grouping and composite allocation strategies caused a systematic overestimation of shock class for traditional ATLS parameters, favoring the association between BD and transfusion. This effect persisted when the correlation between BD and transfusion was set substantially worse (rho = 0.3) than the correlation between ATLS parameters and transfusion (rho = 0.8). Conclusions: In this fully reproducible simulation, we confirm the inadvertent presence of methodological bias. It is physiologically reasonable to include a metabolic parameter to classify hypovolemic shock, but more evidence is needed to support widespread and preferred use of BD. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular dysfunction is a significant factor contributing to weaning failure in mechanically ventilated children. Understanding the cardiopulmonary pathophysiological changes that occur during weaning is a prerequisite for the early recognition of weaning failure of cardiovascular origin. This study aimed to assess the effect of weaning trials on central hemodynamics and to identify the indices predictive of cardiac-related weaning failure. Methods: This prospective observational study was conducted in the Pediatric Intensive Care Unit (PICU) and included mechanically ventilated patients aged between 2 and 30 months who were on minimal ventilatory settings and ready for weaning. Patients who were hemodynamically unstable, diagnosed with neuromuscular diseases, or diagnosed with cardiac diseases were excluded. Hemodynamic parameters were evaluated during weaning from ventilation via echocardiography and noninvasive cardiometry during pressure support (PS) ventilation and at the end of the spontaneous breathing trial (SBT). Results: The study included 50 patients, comprising 30 males (60%) and 20 females (40%) with ages ranging from 2 to 30 months. Echocardiography revealed a significant increase in the cardiac index (CI), tricuspid annular plane systolic excursion (TAPSE), and the E/A ratio at the end of SBT. Moreover, right ventricular systolic pressure (RVSP) significantly decreased. Noninvasive cardiometry revealed a significant increase in the index of contractility (ICON) and CI at the end of SBT (p-value = 0.023 and < 0.001, respectively). Of the 12 (25%) patients who failed their first extubation trial, they exhibited a significantly lower CI and TAPSE (p values = 0.001 and 0.001, respectively). Conclusion: This study identified that weaning from mechanical ventilation in children is associated with hemodynamic changes, which can impact weaning success and reveal potential ventricular dysfunction. Bedside echocardiography was found to detect cardiac dysfunctions during weaning, and noninvasive cardiometry was considered a reliable tool that supports echocardiography for detecting changing trends in CI in PICUs. However, accurate values should be confirmed by echocardiography. [ABSTRACT FROM AUTHOR]

Background: Dietary patterns are important factors associated with cardiovascular diseases (CVDs). We examined the association between dietary patterns derived from factor analysis and CVD risk factors. Methods: In the present cross-sectional study, a total of 3,687 adults (aged 40 to 70 years) with one or more types of CVDs were enrolled as participants. A validated semi-quantitative food-frequency questionnaire was utilized to assess food intakes, and then dietary patterns were extracted by factor analysis. Fasting blood sugar (FBS), lipid profile, anthropometric indices, and blood pressure (BP) were measured. Multivariable-adjusted logistic regression analysis was employed to ascertain the odds ratio (OR) of CVD risk factors associated with posteriori dietary patterns. In this study, healthy and unhealthy dietary patterns were identified. Results: Adherence to a healthy dietary pattern was associated with a decrease in systolic BP (SBP) (OR = 0.78; 95% confidence interval (CI): 0.62–0.99) and high-density lipoprotein cholesterol (HDL-C) levels (OR = 1.32; 95% CI: 1.06–1.64). Additionally, greater adherence to the unhealthy dietary pattern was positively associated with SBP (OR = 1.43; 95% CI: 1.13–1.80) and diastolic BP (DBP) (OR = 1.33; 95% CI: 1.01–1.76). Conclusions: We concluded that greater adherence to an unhealthy dietary pattern was associated with an increase in SBP and DBP. On the other hand, greater adherence to a healthy dietary pattern could be effective in reducing SBP. Further investigation is recommended to validate these findings. [ABSTRACT FROM AUTHOR]

Introduction: The subarachnoid space in the brain contains crucial blood vessels and cerebrospinal fluid. Aneurysms in these vessels can lead to subarachnoid hemorrhage (SAH), a serious stroke subtype with high morbidity and mortality rates. SAH treatment includes procedures like coiling and clipping, but these are available only at comprehensive stroke centers (CSCs), necessitating urgent diagnosis and transfer to specialized facilities. Methods: This IRB-approved study was conducted by Polk County Fire Rescue (PCFR) in Florida. PCFR, serving an 850,000-person population, implemented a three-step SAH protocol. The protocol uses both Ottawa SAH criteria and recurring symptoms, such as new-onset seizures and high systolic blood pressure, that were identified by EMS. Acute management included administering labetalol, levetiracetam, and ondansetron. Results: Of 2175 stroke patients, 80 screened positive for SAH and were eligible for transfer. Patients had a median age of 66, and 33% had an initial systolic BP over 220 mmHg. The interfacility transfer rate dropped from 12.9 to 3.6% after implementing the protocol. Conclusion: The PCFR protocol's effectiveness suggests its potential for nationwide implementation. Early SAH recognition and prompt transfer to CSCs reduce complications and improve outcomes. Accurate field diagnosis by EMTs can prevent unnecessary transfers and enhance patient care. Future improvements may include portable diagnostic tools and enhanced EMT training to further improve SAH patients' pre-hospital care. [ABSTRACT FROM AUTHOR]

Introduction: Genetic studies may provide valuable information about patients who are at high risk of developing diabetes nephropathy. Before the appearance of albuminuria, there are genetic mutations that can predispose the development of kidney disease. Material and methods: The study included 130 adolescents with type 1 diabetes. Patients were divided into two groups according to the presence of microalbuminuria. This study was performed to examine clinical and laboratory differences between adolescents with type 1 diabetes with and without microalbuminuria and the distribution of the ACE, AGTR1, and MTHFR gene polymorphisms. Results: The mean microalbuminuria in the first group 6.41±7.35 significantly differs from the second group 0.82±0.48 (p<0.001). HbA1c, 24-hour proteinuria, and day-time systolic blood pressure were significantly higher in the MA group (p<0.05). Smaller systolic blood pressure percentage nocturnal decline was observed in the microalbuminuric group (p 0.030). The frequencies of the ACE DD, ID, and II genotypes were 12.5%, 50.0%, and 37.5%, respectively, among T1D patients with MA, and 19.3%, 56.1%, 24.6%, in the control group without MA (P =.510). The frequencies of the AGTR1 AA, AC, and CC genotypes were 62.5%, 25.0%, and 12.5% among TID patients with MA, and 49.1%, 43.9%, 8.0%, in the group without MA (p 0.326). The frequencies of the MTHFR CC, CT and TT genotypes were 37.5%, 50.0%, 12.5% among TID patients with MA, and 37.7%, 45.6%, 16.7% in the group without MA (p 0.901). Conclusion: Our data suggest that common variants in the AGTR1, ACE, and MTHFR genes are not strongly associated with diabetic nephropathy in our patients with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Background: Shock index (SI) is calculated as heart rate divided by systolic blood pressure. In the obstetric population, SI of ≥ 0.9 is associated with maternal adverse outcomes. Our primary aim was to investigate the association between SI and post-spinal hypotension in non-elective cesarean section. Methods: In this prospective, observational study, term parturient of ASA physical status II, and urgency categories 2 and 3, undergoing non-elective cesarean section with spinal anesthesia were enrolled. We performed univariable and multivariable logistic regression to explore the association between baseline SI (categorized as < 0.9 and ≥ 0.9) and hypotension after spinal anesthesia. The diagnostic ability of the baseline SI to predict post-spinal hypotension was assessed using ROC (receiver operating characteristics) curves. Results: Three hundred forty-two parturient were recruited, and among them, 335 were analyzed. One hundred fifty-five (46.27%) parturients developed post-spinal hypotension, and 114 (34.03%) reported post-delivery hypotension. Preoperative SI (adjusted odds ratio [AOR], 2.77; 95% CI, 1.15–6.66; p = 0.023) and thoracic sensory block height > 4 (AOR, 2.33; 95%CI, 1.14–4.76; p = 0.020) were associated with post-spinal hypotension. Preoperative SI (AOR, 4.34; 95%CI, 1.72–10.94; p = 0.002) and anxiety (AOR,1.22; 95%CI, 1.06–1.40; p = 0.004) were associated with post-delivery hypotension. Area under the ROC curve for SI alone in predicting hypotension before and after delivery was 0.53 (95%CI 0.49–0.57) and 0.56 (95%CI 0.51–0.60) respectively. However, the model performance as reflected by ROC curve for the multivariable logistic regression analysis was 0.623 for post-spinal hypotension and 0.679 for post-delivery hypotension, respectively. Conclusion: In parturients undergoing non-elective cesarean section, baseline SI ≥ 0.9 was associated with post-spinal and post-delivery hypotension. While the SI alone showed limited predictive power for post-spinal and post-delivery hypotension, integrating it with other risk factors improved the model's predictive ability. Trial registration: Registration number: NCT04692870. Date of registration: 05/01/2021. Website: https://clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Background: Telemedicine holds immense potential to revolutionise healthcare delivery, particularly in resource-limited settings and for patients with chronic diseases. Despite proven benefits and policy reforms, the use of telemedicine remains low due to several patient, technology, and system-level barriers. Assisted telemedicine employs trained health professionals to connect patients with physicians, which can improve access and scope of telemedicine. The study aims to describe the design, service utilisation and chronic disease outcomes following the implementation of an assisted telemedicine initiative. Methods: This is an observational implementation study. Barriers and potential solutions to the implementation of telemedicine were identified through interviews with key stakeholders. The assisted telemedicine solution using an interoperable platform integrating electronic health records, point-of-care diagnostics, and electronic clinical decision support systems was designed and piloted at three telemedicine clinics in Tamil Nadu, India. Nurses were trained in platform use and facilitation of tele-consultations. Health records of all patients from March 2021 to June 2023 were included in the analysis. Data were analysed to assess the utilisation of clinic services and improvements in health outcomes in patients with diabetes mellitus and hypertension. Results: Over 2.4 years, 11,388 patients with a mean age of 45 (± 20) years and median age of 48 years, predominantly female (59.3%), accessed the clinics. The team completed 15,437 lab investigations and 26,998 consultations. Among 5542 (48.6%) patients that reported chronic conditions, diabetes mellitus (61%) and hypertension (45%) were the most frequent. In patients with diabetes mellitus and hypertension, 43% and 75.3% were newly diagnosed, respectively. Diabetes mellitus and hypertension patients had significant reductions in fasting blood sugar (-33.0 mg/dL (95% CI (-42.4, -23.7, P < 0.001)), and systolic (-9.6 mmHg (95% CI (-12.1, -7.0), P < 0.0001)) and diastolic blood pressure (-5.5 mmHg (95% CI (-7.0, -4.08), P < 0.0001)) at nine months from first visit, respectively. Conclusions: The 'Digisahayam' model demonstrated feasibility in enhancing healthcare accessibility and quality by bridging healthcare gaps, diagnosing chronic conditions, and improving patient outcomes. The model presents a scalable and sustainable approach to revolutionising patient care and achieving digital health equity, with the potential for adaptation in similar settings worldwide. [ABSTRACT FROM AUTHOR]

Background: Olfactory function is closely related to mood and the endocrine system. However, the role of olfactory function in bipolar disorder combined with metabolic syndrome remains unclear. The purpose of this study was to explore the associations among olfactory function, tumor necrosis factor alpha (TNF-α), and metabolic syndrome and its components in patients with bipolar disorder. Methods: Ninety-six bipolar disorder patients were divided into two groups with and without metabolic syndrome. We also included 46 healthy controls. Olfactory function was assessed using the Sniffin' Sticks test. Blood samples were collected to measure metabolic indicators and serum TNF-α levels. Results: Significant differences in olfactory function were found among the three groups. Compared with the healthy controls, the bipolar disorder without metabolic syndrome group showed poorer olfactory identification ability (P < 0.001) and the bipolar disorder with metabolic syndrome group showed impaired olfactory sensitivity (P = 0.003) and olfactory identification (P < 0.001). Moreover, the bipolar disorder with metabolic syndrome group had poorer olfactory identification ability than the bipolar disorder without metabolic syndrome group (P = 0.015). Both bipolar disorder groups showed lower TNF-α levels than healthy controls. However, there was no significant difference between the two patient groups. Correlation analysis showed that, in the bipolar disorder with metabolic syndrome group, olfactory identification was negatively correlated with systolic blood pressure (r = − 0.424, P = 0.031), and serum TNF-α level was negatively correlated with body mass index (BMI; r = − 0.398, P = 0.049), triglyceride (r = − 0.503, P = 0.010), total cholesterol (r = − 0.491, P = 0.013), low-density lipoprotein-cholesterol (r = − 0.491, P = 0.013), and high-density lipoprotein-cholesterol (r = − 0.454, P = 0.023). Conclusions: The olfactory identification ability of patients with bipolar disorder is worse than that of healthy controls, and the occurrence of metabolic syndrome will further aggravate the olfactory identification impairment of those patients. Furthermore, there may be a stronger link between serum TNF-α level and multiple metabolic indicators in bipolar disorder patients with metabolic syndrome than in bipolar disorder patients without metabolic syndrome. [ABSTRACT FROM AUTHOR]

ABSTRACT Spot central and peripheral blood pressure are predictors for future hypertension, but the associations between central or peripheral systolic blood pressure (SBP) changes and new‐onset hypertension are unclear. Annual changes in central and peripheral SBP over a mean interval of 2.36 years were calculated for 815 Chinese community residents without cardiovascular disease and hypertension at the first two visits, with the formula: ([2nd SBP−1st SBP]/1st SBP) × 100%/time interval (years). The independent and joint associations of these SBP changes with new‐onset hypertension at the third visit were assessed with multivariable logistic regression models. During a mean follow‐up interval of 4.37 years since the second visit, 171 new cases of hypertension were observed. Central and peripheral SBP changes were significantly associated with new‐onset hypertension (central SBP change rate: odds ratio [OR]: 1.19 [95% confidence intervals (CI) 1.13, 1.26]; peripheral SBP change rate: OR: 1.25 [95% CI 1.17, 1.33]), even after adjusting for each other. Compared to the group with neither SBP increased, the group with both SBPs increased showed a significantly higher risk of new‐onset hypertension (OR: 4.52 [95% CI 2.54, 8.04]). The model including both SBP changes had a higher area under the curve (AUC) for predicting hypertension in receiver operating characteristic (ROC) analyses than those with either change alone. Central and peripheral SBP changes are independently and jointly associated with new‐onset hypertension. It is recommended to regularly monitor both central and peripheral blood pressures. [ABSTRACT FROM AUTHOR]

There is a need to investigate the effect of lifestyle modifications on cardiometabolic health-related issues that occur during menopause. The aim of this study was to compare the effect of resistance and endurance circuit training program alone (exercise group, n = 34) with the effect of time-restricted eating (16:8) combined with a training program (combination group, n = 28) on cardiometabolic health in 62 menopausal women (aged 51.3 ± 4.69 years). Testing was conducted before and after a 12-week period and included an assessment of body composition, glycemic control, lipid panel, blood pressure, and anthropometric measurements. Decreases in body mass index and systolic blood pressure were significantly greater in the combination group than in the exercise group (F(1,60) = 4.482, p = 0.038, η2 = 0.07; F(1,57) = 5.215, p = 0.026, η2 = 0.08, respectively, indicating moderate effects). There were significant decreases in fat mass (p = 0.001, r = 0.654), glucose level (p = 0.017, r = 0.459), insulin level (p = 0.013, r = 0.467), homeostatic model assessment for insulin resistance (p = 0.009, r = 0.499), waist circumference (p = 0.002, r = 0.596), and waist-to-height ratio (p = 0.003, r = 0.588) (indicating moderate effect) in the combination group, while there were no significant changes in the exercise group. There were no changes in lipid panel indicators in either group. This is the first study to investigate the effect of time-restricted eating combined with exercise in menopausal women. The results of the study provide evidence that the combination of time-restricted eating and exercise leads to a greater body mass index reduction than exercise alone in menopausal women. Trial registration: ClinicalTrials.gov, NCT06138015 registered 18 November 2023—Retrospectively registered, https://clinicaltrials.gov/study/NCT06138015. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Sri Lankans do not have a specific cardiovascular (CV) risk prediction model and therefore, World Health Organization(WHO) risk charts developed for the Southeast Asia Region are being used. We aimed to develop a CV risk prediction model specific for Sri Lankans using machine learning (ML) of data of a population-based, randomly selected cohort of Sri Lankans followed up for 10 years and to validate it in an external cohort. Material and methods: The cohort consisted of 2596 individuals between 40–65 years of age in 2007, who were followed up for 10 years. Of them, 179 developed hard CV diseases (CVD) by 2017. We developed three CV risk prediction models named model 1, 2 and 3 using ML. We compared predictive performances between models and the WHO risk charts using receiver operating characteristic curves (ROC). The most predictive and practical model for use in primary care, model 3 was named "SLCVD score" which used age, sex, smoking status, systolic blood pressure, history of diabetes, and total cholesterol level in the calculation. We developed an online platform to calculate the SLCVD score. Predictions of SLCVD score were validated in an external hospital-based cohort. Results: Model 1, 2, SLCVD score and the WHO risk charts predicted 173, 162, 169 and 10 of 179 observed events and the area under the ROC (AUC) were 0.98, 0.98, 0.98 and 0.52 respectively. During external validation, the SLCVD score and WHO risk charts predicted 56 and 18 respectively of 119 total events and AUCs were 0.64 and 0.54 respectively. Conclusions: SLCVD score is the first and only CV risk prediction model specific for Sri Lankans. It predicts the 10-year risk of developing a hard CVD in Sri Lankans. SLCVD score was more effective in predicting Sri Lankans at high CV risk than WHO risk charts. [ABSTRACT FROM AUTHOR]

ABSTRACT Currently, healthcare systems operate under conventional management practices and entail storing and processing substantial medical data. Integrating the Internet of Things (IoT) and wireless sensor networks (WSNs) technologies has facilitated the development of IoT‐enabled healthcare, which possesses advanced data processing capabilities and extensive data storage. This paper proposes a WSN and IoT framework for patient monitoring in high‐speed 5G communications. Based on an artificial neural network (ANN), an intelligent health monitoring system was developed using IoT technology to monitor a person's blood pressure, heart rate, oxygen level, and temperature. Furthermore, the system helps the elderly being in critical cases in their homes to communicate and update their medical condition with the hospital, especially in critical cases, to be treated as soon as possible, especially in remote areas. The experimental results showed the superiority and effectiveness of the proposed system. Moreover, relying on ANNs to extract the basic features, the accuracy reached 96%. The proposed system was implemented practically, and the results were displayed in real time and compared with commercial medical devices. Maximum relative errors are heart rate (2.19), body temperature (2.94), systolic blood pressure (3.4), diastolic blood pressure (2.89), and SpO2 (1.05). On the other hand, the proposed system is much faster than other wireless communication methods, regardless of the detection quality. [ABSTRACT FROM AUTHOR]

Several epidemiological studies have investigated the association between sugar intake, the levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP) and the risk of hypertension, but findings have been inconsistent. We carried out a systematic review and meta-analysis of observational studies to examine the associations between sugar intake, hypertension risk, and BP levels. Articles published up to February 2, 2021 were sourced through PubMed, EMBASE and Web of Science. Pooled relative risks (RRs) and 95% confidence intervals (CIs) were estimated using a fixed- or random-effects model. Restricted cubic splines were used to evaluate dose-response associations. Overall, 35 studies were included in the present meta-analysis (23 for hypertension and 12 for BP). Sugar-sweetened beverages (SSBs) and artificially sweetened beverages (ASBs) were positively associated with hypertension risk: 1.26 (95% CI, 1.15–1.37) and 1.10 (1.07–1.13) per 250-g/day increment, respectively. For SBP, only SSBs were significant with a pooled β value of 0.24 mmHg (95% CI, 0.12–0.36) per 250 g increase. Fructose, sucrose, and added sugar, however, were shown to be associated with elevated DBP with 0.83 mmHg (0.07–1.59), 1.10 mmHg (0.12–2.08), and 5.15 mmHg (0.09–10.21), respectively. Current evidence supports the harmful effects of sugar intake for hypertension and BP level, especially SSBs, ASBs, and total sugar intake. [ABSTRACT FROM AUTHOR]

Background: Recent studies have drawn attention to the association between preserved ratio impaired spirometry (PRISm) and cognitive function decline. High systolic blood pressure (SBP) is a known risk factor for both PRISm and dementia. This study aimed to investigate whether elevated SBP may mediate the relationship between PRISm and cognitive function in older adults. Methods: This study analyzed 732 participants aged ≥ 60 years who had completed spirometry and cognitive function tests in the National Health and Nutrition Examination Survey (NHANES) 2011–2012. Multivariable linear regression was employed to assess the relationship between PRISm and cognitive function, as measured through the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Word Learning sub-test, the Animal Fluency test (AFT), the Digit Symbol Substitution test (DSST), and global cognition tests. All cognitive tests were modeled as z-scores, and global cognition was calculated as the sum of the z-scores of the CERAD, AFT, and DSST. Mediation analyses were conducted to test the mediating effect of SBP on the association between PRISm and cognitive function. Results: Participants with PRISm had lower AFT (β = -0.300; 95% confidence interval [CI] = -0.479 to -0.122; p = 0.001), DSST (β = -0.157; 95% CI = -0.309 to -0.004; p = 0.044), and global cognition scores (β = -0.211; 95% CI = -0.369 to -0.053; p = 0.009) than those with normal spirometry, after adjusting for all potential confounders. SBP was considerably associated with AFT (β = -0.084; 95% CI = -0.162 to -0.005; p = 0.038) and DSST (β = -0.132; 95% CI = -0.207 to -0.057; p < 0.001), mediating 7.9% and 18.0% of the association of PRISm with cognitive function, respectively. Furthermore, SBP mediated 17.1% of the association of PRISm with global cognition. Conclusions: The findings suggested the potential role of SBP as a mediator of associations between PRISm and cognitive decline in older adults. [ABSTRACT FROM AUTHOR]

Background: One of the most important causes of cardiovascular disease is hypertension. Lifestyle modification has been emphasized in preventing and controlling blood pressure. This research aimed to determine the effect of educational intervention by application of PRECEDE‐PROCEED model on lifestyle change in hypertensive patients in the villages of Fasa City, Fars Province, Iran. Methods: This research is a quasi‐experimental study that was conducted on 300 hypertensive patients in 2020–2021. Data gathering tools were a demographic information questionnaire, a questionnaire based on the PRECEDE‐PROCEED model, and a lifestyle questionnaire (LSQ). The educational intervention consisted of ten sessions lasting 45 or 50 min. Before and 6 months after the educational intervention, the two groups each completed a questionnaire. The systolic and diastolic blood pressure (DBP) levels, as well as physical exercise and health variables, nutrition and weight control, mental health, and spiritual health were measured before and 6 months after the educational intervention. Results: The results showed that there was no significant difference between the two groups before in cues of PRECEDE‐PROCEED model; however, the experimental group had a significant increase in cues of PRECEDE‐PROCEED model 6 months after the intervention. The results showed that the experimental group had a significant increase 6 months after the intervention in terms of physical exercise and health variables, nutrition and weight control, mental health, and spiritual health. The mean blood pressure (both diastolic and systolic) in the experimental group was significantly reduced after the intervention. Conclusions: The study's results showed the effectiveness of an educational intervention based on the PRECEDE‐PROCEED model on lifestyle change in hypertensive patients. It also highlights the need to pay further attention to the education aimed at controlling hypertension through a healthy lifestyle and correct behavioral habits. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Recent studies have indicated a potential association of hypertension with Hashimoto's thyroiditis (HT) and other autoimmune diseases, yet the impact of antihypertensive drugs on HT risk is not well understood. Methods: We employed a drug-target Mendelian randomization approach to investigate the prolonged impact of 9 classes of antihypertensive medications on HT susceptibility in European and Asian populations. Genetic variants close to or within genes associated with the drug targets and systolic blood pressure (SBP) were utilized to mimic the effects of antihypertensive medications. We focused on drugs linked to a lower risk of coronary artery disease for our main analysis. We gathered genetic data on SBP and HT risk from comprehensive genomewide association studies available for European and Asian groups. For a supplementary analysis, we used expression quantitative trait loci (eQTLs) related to drug target genes as proxies. Results: Our analysis revealed that the use of calcium channel blockers (CCBs) is linked to a reduced risk of HT in both European (OR [95% CI]: 0.96 [0.95 to 0.98] per 1 mmHg decrease in SBP; p = 3.51×10-5) and Asian populations (OR [95% CI]: 0.28 [0.12, 0.66]; p = 3.54×10-3). Moreover, genetically mimicking the use of loop diuretics (OR [95% CI]: 0.94 [0.91, 0.97]; p = 3.57×10-5) and thiazide diuretics (0.98 [0.96, 0.99]; p = 3.83×10-3) showed a significant association with a decreased risk of HT only in European population. These outcomes were confirmed when eQTLs were employed to represent the effects of antihypertensive medications. Conclusion: The study suggests that CCBs and diuretics could potentially reduce the risk of HT in different populations. Additional research is needed to assess the feasibility of repurposing antihypertensive medications for the prevention of HT. [ABSTRACT FROM AUTHOR]

Asymptomatic intracranial atherosclerotic stenosis (aICAS) is a major risk factor for cerebrovascular events. The study aims to construct and validate a nomogram for predicting the risk of aICAS. Participants who underwent health examinations at our center from September 2019 to August 2023 were retrospectively enrolled. The participants were randomly divided into a training set and a testing set in a 7:3 ratio. Firstly, in the training set, least absolute shrinkage and selection operator (LASSO) regression and multivariate logistic regression were performed to select variables that were used to establish a nomogram. Then, the receiver operating curves (ROC) and calibration curves were plotted to assess the model's discriminative ability and performance. A total of 2563 neurologically healthy participants were enrolled. According to LASSO-Logistic regression analysis, age, fasting blood glucose (FBG), systolic blood pressure (SBP), hypertension, and carotid atherosclerosis (CAS) were significantly associated with aICAS in the multivariable model (adjusted P < 0.005). The area under the ROC of the training and testing sets was, respectively, 0.78 (95% CI: 0.73–0.82) and 0.65 (95% CI: 0.56–0.73). The calibration curves showed good homogeneity between the predicted and actual values. The nomogram, consisting of age, FBG, SBP, hypertension, and CAS, can accurately predict aICAS risk in a neurologically healthy population. [ABSTRACT FROM AUTHOR]