Blood Pressure Research Articles

Abstract 4122957: C-C motif chemokine receptor-2 disruption Synergizes with Phosphodiesterase Type 5 Inhibition in Ameliorating Pulmonary Hypertension in Monocrotaline-treated Rats: Proof-of-Concept Study for a Combination therapy and Potential Mechanisms

Background: Whether and how any anti-inflammatory agents and their combination with conventional pulmonary vasodilators protect against pulmonary arterial hypertension (PAH) is unknown. Hypothesis: The disruption of C-C motif chemokine receptor (CCR) -2, a receptor for CCL-2, ameliorates PAH in any models with the reversal of the associated pro-inflammatory state and vascular cell phenotypes and synergizes with any conventional pulmonary vasodilators. Methods and Results: By using Ccr2 (-/-) rats generated by CRISPR/ Cas9 , we investigated PAH in Ccr2 (+/+) or Ccr2 (-/-) rats treated with monocrotaline (MCT), SU5416/hypoxia (SuHx), and chronic hypoxia (CH). Ccr2 (-/-) decreased the right ventricular systolic pressure, right ventricular hypertrophy, and mortality rate, and reversed increased expression of inflammatory cytokines/chemokines (IL-6, TNF-α, CCL2, IL-1β, TGF-β) in MCT-treated rats, but not in SuHx or CH models. Consistently, Ccr2 (-/-) decreased indices of pulmonary vascular diseases (PVDs) and perivascular macrophage infiltration, as well as reversed impaired BMPR2 signaling, increased endothelial apoptosis, impaired NO signaling (eNOS, peNOS/eNOS) and decreased phosphodiesterase (PDE)-5 expression in lungs in MCT-treated rats. Gene expression of the receptor for prostaglandin I 2 and endothelin was not altered in MCT-treated rats by Ccr2 (-/-). In cultured pulmonary arterial smooth muscle cells (PASMCs), Ccr2 (-/-) suppressed CCL2-induced hyperproliferation and dedifferentiation as well as reversed CCL2-induced decrease in PDE5 expression. Consistently, the whole-genome RNA sequencing analysis identified differentially expressed genes in CCL2-stimulated Ccr2 (-/-) PASMCs, which are related to cellular differentiation and contraction. Based on studies in rats and cultured PASMCs, we investigated whether a PDE5 inhibitor, tadalafil, synergizes with Ccr2 (-/-). Tadalafil administration ameliorated PH and PVDs in MCT-treated Ccr2 (-/-) rats but not in Ccr2 (+/+) rats, and further improved survival in Ccr2 (-/-) rats. Conclusions: PDE5 inhibition synergized with Ccr2 disruption in protecting against PAH in MCT-treated rats, which was mechanistically related to the restoration of proinflammatory states and associated vascular cell phenotypes. These findings confer a fundamental basis supporting that CCR2 may be a therapeutic target in intractable PAH patients with a certain CCR2-related inflammatory phenotype and refractory to conventional pulmonary vasodilators.

Abstract 4144514: Human Immunodeficiency Virus Associated Cardiomyopathy- A Rare Cause of Heart Failure With Reduced Ejection Fraction in Era of Highly Active Antiretroviral Therapy

Introduction: Human Immunodeficiency Virus Associated Cardiomyopathy (HIVAC) is characterized by left ventricular (LV) systolic or diastolic dysfunction with or without LV dilatation and heart failure symptoms. The introduction of antiretroviral therapy (ART) has changed the fulminant systolic heart failure presentation of HIV myocarditis to diastolic heart failure. We present a unique case of dilated cardiomyopathy in a young patient without advanced HIV illness which has rarely been documented in the literature. This is a rare presentation of HIVAC in the post-ART era. Case Report: A 32-year-old male with a past medical history (PMH) of the human immunodeficiency virus (HIV) presented with complaints of new onset worsening shortness of breath and lower extremity edema for four weeks. He was diagnosed with HIV seven years ago and was not compliant with ART. Laboratory testing showed a cluster of differentiation 4 (CD4) 823 and HIV load 2550. Myocarditis was ruled out by normal troponin levels and no new changes on the electrocardiogram (ECG). Transthoracic echocardiogram (TTE) showed dilated left ventricle (LV), LV global hypokinesis, LV ejection fraction (LVEF) 10-15%, dilated right ventricle, biatrial dilation, moderate to severe mitral regurgitation, severe tricuspid regurgitation, pulmonary artery (PA) systolic pressure 73 mmHg and no pericardial effusion. Coronary angiography was negative for coronary artery disease (CAD). The patient was started on carvedilol and outpatient evaluation for a left ventricular assistance device. Discussion: Systolic dysfunction in patients with HIVAC carried a poor prognosis in the pre-ART era and was common in patients with elevated c-reactive protein (CRP), tobacco use, and previous myocardial infarction (MI). After the advent of ART, systolic dysfunction is rare and replaced by diastolic cardiomyopathy in the setting of ART use. Diagnosis is usually by excluding other etiologies and biopsy is not necessarily required. Management is usually guideline-directed medical therapy (i.e. beta blocker, renin-angiotensin-aldosterone antagonists, sodium-glucose cotransporter-2) and device-based therapy but there is still data lacking to assess its benefit.

Abstract 4113716: Natural shear wave imaging as a predictor for left ventricular pressures: Can they reflect raised filling pressures?

Background: Current conventional echocardiographic assessment of diastolic function relies on predicting left ventricular (LV) filling pressure as a surrogate of diastolic function. High frame rate (HFR) Shear wave (SW) imaging is emerging as an innovative parameter for assessing myocardial stiffness, a key determinant of diastolic function. Natural SW are induced by valve closure (i.e. mitral valve closure (MVC)). Little is known so far, to which extent SWs could reflect changes in diastolic LV filling pressures. Purpose: We aimed at investigating the relationship between natural SW after MVC and LV diastolic pressures in an attempt to set up a cut-off value beyond which, elevated LV pressure can be suspected indicating diastolic dysfunction. Methods: Thirty patients (mean age 68.4±9.9 years) scheduled for clinically indicated left heart catheterization were prospectively recruited. Left ventricular end-diastolic pressure (LVEDP) was measured during the catheterization. Immediately afterwards, conventional as well as HFR (1167 ±86 Hz) echocardiography was performed. We drew an anatomical M-mode along the anteroseptal wall in the parasternal long axis view from base to apex and the display was colour coded for tissue acceleration. SWs appeared immediately after MVC as tilted green bands and their propagation velocity was measured semi-automatically (Figure 1) . Results: LVEDP in our cohort ranged from 7.5 to 29.5 mmHg. From conventional echocardiographic parameters, only mitral inflow to mitral relaxation velocity ratio (E/e’) correlated moderately with LVEDP (r=0.51, p=0.006). SW velocities after MVC showed strong positive correlation with LVEDP (r=0.78, p<0.001) (Figure 2) . A cut-off value for SW velocity of 5.8 m/s showed an excellent ability to discriminate normal from elevated LVEDP (AUC: 0.98; Sensitivity: 90%, specificity: 100%, accuracy: 97%) (Figure 3) . Conclusions: Our data showed that SW velocities at end-diastole after MVC could predict elevated LV filling pressures accurately. Natural shear wave imaging appears as a promising innovative tool for assessment of diastolic function.

Blood Pressure Regulation in Post–COVID POTS: Beyond Sinus Tachycardia

BACKGROUND: Postural orthostatic tachycardia syndrome (POTS) is a frequently diagnosed cardiovascular disorder after COVID-19 infection. POTS is characterized by the presence of excessive sinus tachycardia on standing without a fall in blood pressure (BP). We investigated the BP profile using 24-hour ambulatory BP monitoring in patients with new-onset POTS after COVID-19 compared with prepandemic population-based controls. METHODS: We performed a case-control study in 100 patients (mean age, 40.0±12.9 years; 85% women) with verified post–COVID-19 new-onset POTS diagnosed by a positive head-up tilt testing versus 100 controls from a population-based cohort with a negative active standing test, no history of syncope, POTS, or endocrine disease (mean age, 42.3±14.0 years; 78% women). Twenty-four-hour BP profile was assessed for circadian BP variation including hypotensive systolic BP (SBP) episodes (<80, <90, and <100 mm Hg). RESULTS: Patients with post–COVID-19 POTS had significantly higher nighttime SBP, but not daytime SBP, and more daytime SBP hypotensive episodes compared with controls. Nondipping (34% versus 19%; P <0.001) and reverse dipping patterns (9% versus 0%; P <0.001) were more frequent in post–COVID-19 POTS. In the logistic regression, patients with post–COVID-19 POTS had significantly higher mean 24-hour SBP (odds ratio, 1.08 [95% CI, 1.04–1.11]; P <0.001) and nighttime SBP (odds ratio, 1.07 [95% CI, 1.04–1.10]; P <0.001), independent of age and sex. CONCLUSIONS: Patients with post–COVID-19 POTS demonstrate higher mean 24-hour and nighttime SBP and show disruptions of circadian BP rhythm regulation compared with population-based controls, as well as more daytime hypotensive episodes. Future studies are needed to test whether patients with post–COVID-19 POTS may benefit from tailored BP therapy.

Diagnostic and therapeutic challenges in implementing hypertension management after kidney transplantation.

Evidence for blood pressure (BP) measurement and hypertension management in kidney transplant recipients (KTR) remains lacking. Accurate BP measurement technique is a critical component of hypertension management, and 24-h ambulatory BP monitoring remains the gold standard for diagnosis of hypertension in KTR. BP target at different periods posttransplant is uncertain, but likely higher than that in nontransplant patients given factors related to long-standing uremic milieu and kidney transplantation such as vascular calcification altering transplant renal hemodynamic and allograft perfusion and immunosuppression. Dividing BP target into immediate, early, and late posttransplant periods can guide differential diagnoses of hypertension and BP control with a target SBP less than 160 mmHg in general and BP 115-135/65-85 mmHg for adult KTR receiving pediatric kidneys during the immediate posttransplant period, 130/80 mmHg during early and late posttransplant periods. Calcium channel blockers were shown to have favorable graft outcomes. Novel antihypertensive medications for resistant and refractory hypertension and device-based therapies are limited due to KTR's ineligibility for participating in clinical trials. In KTR, BP measurement and monitoring practice should follow the standard clinical practice guideline for nontransplant patients by considering posttransplant factors and immunosuppressive state. Novel treatment options required further studies.

The Effect of Spirulina Supplementation on Blood Pressure in Adults: A GRADE‐Assessed Systematic Review and Meta‐Analysis of Randomized Clinical Trials

ABSTRACTPrevious studies have yielded controversial results regarding the effect of spirulina on blood pressure (BP), which need updating. So, this updated systematic review and meta‐analysis of randomized controlled trials (RCTs) carry out a more accurate estimation of the effect of spirulina on BP in adults. This systematic searches (in PubMed/Medline, Scopus, and ISI Web of Science) until April 1, 2024, to identify related RCTs based on PICOS guidelines (population (individuals > 18 years old), the intervention (spirulina), the comparison (control or placebo group), the outcomes (systolic BP (SBP) and diastolic BP (DBP)), the study design (RCTs)), and PRISMA‐checklist (Supporting Information, data S2). We evaluated the impact of spirulina on DBP and SBP. Conventional procedures were employed for analyzing publication bias, heterogeneity, and sensitivity. The GRADE criteria and the Cochrane assessment method were employed to evaluate the risk of bias (ROB) and certainty of evidence across the studies, respectively. The result shows spirulina consumption decreases SBP (WMD: −4.41 mmHg, 95% CI: −6.74 to −2.07, I2 = 66.1%) and DBP (WMD: −2.84 mmHg, 95% CI: −4.65 to −1.03, I2 = 62.3%). Subgroup analysis demonstrated SBP and DBP were still lower in individuals with ≥ 120 and ≥ 80 mmHg, hypertension (HTN) individuals, overweight individuals, age > 50 years, and > 8 weeks of intervention. Indeed, we do not observe publication bias, ROB, or interference studies in the overall results of BPs, and based on GRADE, our outcomes have moderate quality. Because of the low number of studies and participants, the dose–response and meta‐regression are not significant. His study demonstrated spirulina intervention decreased SBP and DBP in HTN and overweight individuals, age > 50 years, and > 8 weeks of intervention. So, spirulina intake decreases BP and could be used in clinical practice. Furthermore, more and high‐quality RCTs are needed to establish the clinical efficacy of the spirulina and determine cutoff spirulina interventions based on dose and duration.Trial Registration: PROSPERO: CRD42024534608

Artificial intelligence driven clustering of blood pressure profiles reveals frailty in orthostatic hypertension

AbstractGravity, an invisible but constant force , challenges the regulation of blood pressure when transitioning between postures. As physiological reserve diminishes with age, individuals grow more susceptible to such stressors over time, risking inadequate haemodynamic control observed in orthostatic hypotension. This prevalent condition is characterized by drops in blood pressure upon standing; however, the contrary phenomenon of blood pressure rises has recently piqued interest. Expanding on the currently undefined orthostatic hypertension, our study uses continuous non‐invasive cardiovascular data to explore the full spectrum of blood pressure profiles and their associated frailty outcomes in community‐dwelling older adults. Given the richness of non‐invasive beat‐to‐beat data, artificial intelligence (AI) offers a solution to detect the subtle patterns within it. Applying machine learning to an existing dataset of community‐based adults undergoing postural assessment, we identified three distinct clusters (iOHYPO, OHYPO and OHYPER) akin to initial and classic orthostatic hypotension and orthostatic hypertension, respectively. Notably, individuals in our OHYPER cluster exhibited indicators of frailty and sarcopenia, including slower gait speed and impaired balance. In contrast, the iOHYPO cluster, despite transient drops in blood pressure, reported fewer fallers and superior cognitive performance. Surprisingly, those with sustained blood pressure deficits outperformed those with sustained rises, showing greater independence and higher Fried frailty scores. Working towards more refined definitions, our research indicates that AI approaches can yield meaningful blood pressure morphologies from beat‐to‐beat data. Furthermore, our findings support orthostatic hypertension as a distinct clinical entity, with frailty implications suggesting that it is worthy of further investigation.

NCOG-14. THE ROLE OF POSTOPERATIVE BLOOD PRESSURE MANAGEMENT IN EARLY POSTOPERATIVE HEMORRHAGE IN AWAKE CRANIOTOMY GLIOMA PATIENTS

Abstract INTRODUCTION Awake surgery is widely used to maximize the extent of resection and enhance neuro-oncological outcome in gliomas. Postoperative hemorrhage can severely deteriorate the patients’ neurological outcome. Higher postoperative blood pressure can increase the risk of postoperative hemorrhage, but optimal perioperative patient and blood pressure management is unclear. The aim of this study was to investigate the role of postoperative blood pressure and other common radiological and epidemiological features with the incidence of postoperative hemorrhage. MATERIAL & METHODS In this retrospective analysis, we included all patients who underwent awake surgery between 2010 and 2023 at our institution. We assessed the blood pressure both intra- and postoperatively as well as the heart rate for the first 12 hours. We compared a cohort with postoperative hemorrhage, who required further treatment (surgical revision or intravenous antihypertensive therapy), with a cohort with no postoperative hemorrhage. RESULTS We included 48 patients with a median age of 39 years. 9 patients (19%) showed a preoperative history of arterial hypertension, 8 of them were on antihypertensive treatment. 23 patients (48%) showed signs of a hemorrhage on early postoperative MRI, of whom 9 (19%) required further treatment, which was surgery in 2 cases and conservative therapy in 7 cases. Patients with postoperative hemorrhage showed significantly higher postoperative systolic blood pressure during the hours 3-12 (p<0.05) as well as intraoperatively during the hours 1-5 (p<0.05). In ROC and Youden Test, a strong impact of systolic blood pressure over 140 mmHg during the early postoperative course could be shown. DISCUSSION Postoperative hemorrhage is a serious complication in awake surgery glioma patients. However, with early treatment, no significant difference in Performance scores at follow-up could be found. To avoid postoperative hemorrhage, treating physicians should aim strictly on systolic blood pressure of under 140 mmHg for the postoperative course.

Novel metrics for tracking blood pressure changes incontinuous cuffless blood pressure estimations

Recent studies revealed the importance of tracking continuous blood pressure (BP) changes in monitoring and controlling hypertension and diagnosing cardiovascular diseases. However, current evaluation protocols utilize distance measures as primary metrics, which cannot properly evaluate the ability of the estimation model to track BP changes. This paper proposes a comprehensive evaluation framework which evaluates the distance and trend similarity metrics, and the composite metric of both between the reference and estimated BPs. The results of applying both widely used conventional metrics and the new proposed metrics for BP estimations are demonstrated in an example of comparing the reference with a set of different BP estimations. Then, the metrics are applied to BP estimations obtained using state-of-the-art (SOTA) algorithms. It is shown that even though SOTA algorithms have a low mean and standard deviation of absolute difference, they are not capable of tracking short-term blood pressure changes. Additionally, the proposed metrics are normalized metrics and range from -1 to 1, making them intuitively interpretable, similar to well-known correlation coefficients. Therefore, we suggest that the proposed evaluation framework should be used regularly in evaluating continuous BP monitoring systems.

Light Walking Patterns and Postprandial Cardiometabolic Responses in Young Obese Adults: A Randomized Crossover Study

Abstract Context Recent studies suggest that light-intensity physical activity may enhance cardiometabolic health and reduce mortality risk in adults. However, more information is required to understand the patterns of light-intensity physical activity and postprandial cardiometabolic health. Objective This study examined the effects of different light-intensity walking patterns on postprandial cardiometabolic responses in young obese adults. Design A randomized crossover trial was conducted. Setting The study was conducted in the laboratory. Participants The study analyzed baseline (fasting) and 6-hour postprandial concentrations of glucose, insulin, triglycerides, and blood pressure (BP) in 16 young obese adults. Interventions Participants underwent four 7-hour experimental conditions with a 7–20-day washout period: uninterrupted sitting (SIT), 30-minute light-intensity walking (EX+SIT), 3-minute light-intensity walking every 30 minutes (BR), and 30-minute light-intensity walking with 3-minute light-intensity walking every 30 minutes (EX+BR). Main Outcome Measures Incremental areas under the curve (iAUC) for each outcome and average BP were compared between SIT and walking conditions. Results Compared with SIT, all walking conditions reduced iAUCs for glucose and average diastolic BP (all p<0.05). Only EX+SIT and EX+BR reduced iAUCs for insulin (p<0.05). No significant differences were found for triglycerides iAUC and systolic BP between the four conditions (all p>0.05). Conclusions All patterns of light-intensity walking reduced postprandial glucose concentrations and diastolic BP in young obese adults, suggesting benefits for glycemic control. Continuous 30-minute light-intensity walking alone, or combined with brief 3-min bouts also attenuated postprandial insulin concentrations, highlighting light-intensity walking as a promising strategy for improving cardiometabolic health in young obese adults.

Rheumatoid arthritis: a rare cause of pachymeningitis and optic neuritis

Introduction: Rheumatoid pachymeningitis and optic neuritis are rare complications of rheumatoid arthritis (RA) and are a diagnosis of exclusion. Case description: A 75-year-old male with a history of seronegative RA presented to the emergency department with left eye pain and blurry vision lasting two days. He had been diagnosed with seronegative RA around nine months previously. His blood pressure was elevated at 204/75 mmHg upon arrival. Physical examination revealed left conjunctival injection, mild ptosis, painful extraocular movements and tenderness over the orbit and sinuses. Initial treatments included painkillers and intravenous labetalol, which alleviated his symptoms and decreased his blood pressure. Laboratory tests showed a C-reactive protein of 2.5 mg/dl and an erythrocyte sedimentation rate of 32 mm/h, with other blood work unremarkable. A computed tomography (CT) angiogram of the head and neck showed no high-grade stenosis. Given his RA history, initial concerns included scleritis. A magnetic resonance imaging (MRI) of the brain and orbit revealed inflammation around the left optic nerve, and pachymeningitis at the left cerebral convexity and interhemispheric fissure, suggesting hypertrophic pachymeningitis. An ophthalmologic examination was unremarkable. Treatment was adjusted to include pulse doses of intravenous methylprednisolone for optic neuritis, resulting in significant pain relief. Though inadequate for complete testing, a lumbar puncture indicated an inflammatory disorder with elevated glucose (199 mg/dl), protein (109 mg/dl), and unremarkable WBC/RBC and Gram staining. Cytology and culture were unremarkable. The most likely diagnosis at this point was rheumatological meningitis and rheumatological optic neuritis. The patient improved markedly with high-dose steroids over four days and was discharged on prednisone. Conclusion: In cases of optic neuritis and pachymeningitis, RA should remain on the differential in patients with or without a prior diagnosis.

Association between iron and vitamin intake and cardiorespiratory fitness in adolescents of both sexes

Abstract Cardiovascular parameters and cardiorespiratory fitness in adolescents may be influenced by eating habits. The aim was to evaluate the association between the levels of some nutrients and micronutrients with blood pressure and VO2max in adolescents. A total of 60 adolescents (15.77 ± 0.96 years old) participated in the study, of whom 35 were girls and 25 were boys. Eating habits were assessed frequency questionnaire (FFQ). Before and after a cardiorespiratory fitness test (YOYO TEST), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were collected. A backward elimination method of multiple regression was performed to analyse the data. A positive association was found between VO2max and the intake of iron (), vitamin D (), vitamin B6 () and vitamin B12 () for girls. Additionally, no significant associations were found between sugar, fibre and fat intake and VO2max. There was a positive association between SBP and sugar intake () for girls and negative association between DBP after exertion and fibre intake () and body mass index () for boys. There is a positive association between the intake of iron, vitamins and VO2max in girls and intake of sugar with SBP for girls and negative association between fibres and DBP after exertion for boys.

Hyperkalaemic acidosis: blood pressure is the diagnostic clue

AbstractPseudohypoaldosteronism type 2 (PHA2) is a rare inherited condition of altered tubular salt handling. It is characterized by the specific constellation of hyperkalaemic hyporeninemic hypertension, hyperchloremic metabolic acidosis and hypercalciuria. Molecular genetic testing confirms the diagnosis in the majority of cases. Thiazides constitute effective treatment. Due to its rarity, the diagnosis is often delayed. We here present two children with PHA2, who were initially treated with fludrocortisone and bicarbonate complicated mainly by exacerbation of their hypertension. Discontinuation of their previous therapy and commencement of thiazide diuretics led to normalisation of their blood pressure and electrolyte and acid–base status.

Scleroderma Renal Crisis and Musculoskeletal Corticosteroid Injections

Background/Objective Inflammatory arthritis frequently affects patients with systemic sclerosis (SSc) but musculoskeletal corticosteroid (MSKC) injections are often avoided due to concerns of scleroderma renal crisis (SRC). This study investigated the incidence of SRC following MSKC injections. Methods In a 136-SSc cohort, 46 subjects underwent a total of 330 MSKC injections each receiving a significant dosage of triamcinolone acetonide (mean, 95.2 ± 44.2 mg per injection session). Blood pressure (BP), serum creatinine and glucose, urine protein, and complications were retrospectively reviewed before and after injection. Results MSKC and control subjects were similar in age (MSKC: 58.9 ± 12.1 vs. 55.5 ± 14.9 years), female (MSKC: 97.8% [45/46] vs. 89.9% [81/90]), antinuclear antibody (MSKC: 71.7% [33/46] vs. 81.1% [73/90]), anti-centromere antibody (MSKC: 47.8% [22/46] vs. 37.8% [34/90]), anti-topoisomerase antibody (MSKC: 26.1% [12/46] vs. 26.7% [24/90]), and anti–RNA polymerase III antibody (MSKC: 17.4.1% [8/46] vs. 24.4% [22/90]) (all p > 0.05). Pre- and post-MSKC demonstrated nonsignificant changes in systolic BP (pre: 127 ± 22 vs. post: 127 ± 21 mm Hg, p = 1.0), diastolic BP (pre: 71 ± 13 vs. post: 71 ± 11 mm Hg, p = 1.0), creatinine (pre: 0.78 ± 0.56 vs. post: 0.76 ± 0.20 mg/dL, p = 0.64), glucose (pre: 100 ± 21 vs. post: 99 ± 24 mg/dL, p = 0.67), and urine protein-creatinine ratio (pre: 0.14 ± 0.12 vs. post: 0.12 ± 0.11 mg/mg, p = 0.41). One case of SRC with mortality occurred in the controls and none in the MSKC group. No infections, hematologic abnormalities, or tendon rupture were noted. Conclusion MSKC injections in established SSc are generally safe with low incidences of SRC and complications. However, it is still prudent to monitor high-risk individuals and recent-onset SSc post–MSKC injection.

A Novel and Comprehensive Wellness Assessment for Lifestyle‐Based Interventions

ABSTRACTObjectiveWhile weight status and clinical laboratory measures are important in assessing obesity‐related disease severity and chronic disease risk, including a broader range of emotional, psychosocial, and behavioral factors would provide greater context of an individual's overall state of wellness and could be used to better guide treatment decisions. The purpose of this research was to develop a comprehensive Lifestyle Wellness assessment for use in lifestyle‐based wellness interventions and programs.MethodsA cross‐sectional exploratory factor analysis (EFA) was conducted using baseline data from N = 138 adults participating in behavioral weight loss trials. An unweighted least squares extraction method with oblique rotation was used. Twenty‐one putative measures spanning constructs related to metabolic health, emotional health/wellbeing, body weight and composition, diet quality, and fitness were analyzed for retention.ResultsMean body mass index (BMI) was 38.0 ± 6.6 kg/m2, mean age was 57.3 ± 11.1 years, and 77.5% of participants were female. The EFA produced a five‐factor model with 13 items that explained 80.3% of the variance. The retained factors included: (1) Psychosocial State: mindfulness, resilience, quality of life, and happiness; (2) Blood Pressure State: systolic and diastolic blood pressure; (3) Lipid State: total cholesterol and LDL‐cholesterol; (4) Fitness State: grip strength, jump height, and percent body fat; and (5) Body State: BMI and waist circumference.ConclusionsLifestyle Wellness is a comprehensive assessment that enables innovative wellness‐related research such as metabolically healthy obese phenotypes and weight‐neutral interventions. Future research should include investigations in additional populations with greater age, sex/gender, and body size diversity.

Combined high-intensity interval and resistance training improves cardiorespiratory fitness more than high-intensity interval training in young women with overweight/obesity: a randomized controlled trial

ObjectiveThis study aimed to compare the effects of high-intensity interval training (HIIT) combined with resistance training (RT) versus HIIT alone on body composition, cardiorespiratory fitness and glycolipid metabolism in young women with overweight/obesity.MethodsThis randomized controlled trial divided 40 subjects into an experimental group (HIIT+RT) and a control group (HIIT). Both groups underwent training three times per week for eight weeks. Body composition, cardiorespiratory fitness and glycolipid levels were assessed before and after the intervention.ResultsThe results revealed that compared to baseline, both the experimental and control groups showed significant improvements in body weight, body mass index (BMI), Body fat, waist circumference (WC), waist-hip ratio (WHR), peak oxygen uptake (VO2peak), vital capacity (VC), oxygen pulse (VO2/HR), minute ventilation, resting heart rate, blood oxygen saturation, blood pressure, fasting blood glucose, triglycerides and high-density lipoprotein cholesterol (p<0.05). Additionally, a significant increase in muscle mass and a significant reduction in 2-hour postprandial glucose were observed in the experimental group (p<0.05). Muscle mass (mean difference: 2.75%), VO2peak (mean difference: 1.61 mL/min/kg), VC (mean difference: 334mL), and VO2/HR (mean difference: 0.51mL/beat) showed greater improvement in the HIIT+RT group compared to the HIIT group (p<0.05).ConclusionIn conclusion, an 8-week regimen of either combined HIIT and RT or HIIT significantly improves body composition, cardiorespiratory fitness and glycolipid metabolism in women with overweight/obesity. However, the combined training appears to offer more benefits than HIIT alone. Further research is needed to evaluate the long-term effects and feasibility of combined training.Trial registrationhttps://www.chictr.org.cn/, identifier ChiCTR2300075961.

Lifestyle intervention improves cardiometabolic profiles among children with metabolically healthy and metabolically unhealthy obesity

BackgroundIn recent years, there has been a surge of interest in the metabolic phenotype among children with obesity characterized by the absence of associated cardiometabolic risk factors (CRFs), known as metabolically healthy obesity (MHO), as opposed to those with metabolically unhealthy obesity (MUO). This study investigated the effect of lifestyle intervention on CRFs among children with MHO and MUO.MethodsA total of 102 school-aged children with obesity (54 girls and 48 boys) aged 8–16 years completed a 16-week school-based lifestyle modification intervention program, MyBFF@school Phase I. The intervention consisted of physical activity, healthy eating promotion, and psychological empowerment. MHO and MUO statuses were defined based on the 2018 consensus-based criteria. Fasting venous blood collection, body composition measurement, clinical assessment and physical fitness testing were conducted at baseline and at the end of week 16.ResultsAfter the intervention, the CRFs of the children with MUO improved with significant decreases in systolic (p < 0.001) and diastolic (p = 0.01) blood pressure and a significant increase in high-density lipoprotein cholesterol (HDL-C) (p = 0.005), while the CRFs of the children with MHO had a significant decrease in uric acid (p = 0.04). Additionally, 51.6% of the children with MHO transitioned to the MUO, while 26.8% of the children with MUO crossed over to the MHO at the end of the intervention. Furthermore, the odds of having high systolic blood pressure among children with MUO were 59% lower at week-16 than at baseline (OR = 0.41 (95% CI = 0.18, 0.92), p = 0.03).ConclusionsOur findings demonstrated that CRFs improved more prominently among children with MUO following the intervention. More importantly, our findings indicate that MHO in children is transient, hence, strategies to protect children against MUO are warranted.Trial registration: ClinicalTrials.gov NCT02212873.

Spontaneous hemoperitoneum in a 29‐week pregnancy with a history of endometriosis: A case report and review of the literature

AbstractSpontaneous hemoperitoneum in pregnancy (SHIP) is defined as sudden, nontraumatic intraperitoneal bleeding that occurs during pregnancy or up to 42 days postpartum. The incidence ranges between 4 and 4.9 per 100 000 births. Although seen rarely, it is associated with perinatal morbidity and mortality due to maternal hemodynamic instability. Endometriosis was shown to be present in 71% of SHIP cases. A 30‐year‐old primigravid woman with a spontaneous conception, at 29 weeks of gestation, presented to our obstetrics and gynecology emergency department with complaints of abdominal and back pain. In terms of her medical history, a laparoscopic cystectomy was performed in August 2022 due to a 90 mm × 50 mm endometrioma in the right ovary. However, deep endometriosis and adenomyosis were not observed. After decelerations appeared on the non‐stress test, the repeat hemoglobin values dropped to 7.2 g/dL, with blood pressure at 70/50 mm Hg and a pulse rate of 95/min. The decision was made for laparotomy and emergency delivery of the baby. It is crucial to consider SHIP, especially in pregnant patients with a history of endometriosis surgery. Managing such high‐risk cases in specialized centers and easily identifying predisposing factors for SHIP can lead to improved outcomes, despite its rarity and poor prognosis.

Correlation between Fundus Damage and Renal Function Deterioration in Chronic Kidney Disease Patients

Introduction: This study aimed to explore the correlation between the extent of fundus damage and the severity strategies for chronic kidney disease (CKD). Methods: We collected data from 118 CKD patients, including general information, renal function indicators, and fundoscopic examination results. The stages of CKD and degrees of fundus lesions were graded. SPSS 25.0 software facilitated the analysis of correlations using Kendall's tau-b correlation analysis and ordinal regression analysis. Results: Statistically significant differences were observed among multiple CKD stages in the distribution of age, systolic blood pressure, diastolic blood pressure, hemoglobin, total cholesterol, homocysteine, cystatin C, serum creatinine, blood urea, eGFR, 24-hour urine protein, urine microalbumin, urine microalbumin/urine creatinine, and blood β2 microglobulin, complement C3. Notably, the levels of cytokeratin 19 fragment and transforming growth factor β significantly increased in all CKD stages. Kendall's tau-b correlation analysis revealed a significant positive correlation between CKD stage and fundus lesion grade. Ordinal regression analysis indicated that sex differences, total cholesterol levels, and hemoglobin levels were significant predictors of fundus lesion risk. Compared with patients at stage 5 CKD, the risk of fundus damage significantly lower in patients in stage 2 and stage 3, further demonstrating a positive correlation between renal function deterioration and increased risk of fundus damage. Conclusions: Routine fundus screening and early intervention for fundus lesions are vital for assessing CKD deterioration, providing new directions for future related research.

Impact of Environmental Noise and Sleep Health on Pediatric Hypertension Incidence: ABCD Study

Background Pediatric hypertension is linked to environmental factors like neighborhood noise disrupting sleep, which is crucial for health. The specific interaction between noise and sleep health in causing hypertension still needs to be explored. Methods and Results We analyzed data from 3320 participants of the ABCD (Adolescent Brain Cognitive Development) study, recruited across 21 US cities and monitored from 2018 to 2020 through 2020 to 2022. Participants with complete data on Fitbit‐tracked sleep, blood pressure, height, neighborhood noise, and covariates (biological sex, race and ethnicity, pubertal stage, waist circumference) were included. Hypertension was defined as average blood pressure ≥95th percentile for age, sex, and height. Sleep health was categorized on the basis of daily duration: healthy (9–12 hours), moderately healthy (±1 hour from optimal), and low (≥1 hour deviation). Noise exposure was measured as median nighttime anthropogenic noise levels by zip code. The incidence of hypertension increased from 1.7% (95% CI, 1.4–2.1) in 2018 to 2020 to 2.9% (95% CI, 2.4–3.6) in 2020 to 2022. Adolescents with healthier sleep had a lower risk of developing hypertension (relative risk, 0.63 [95% CI, 0.25–0.82]), while no significant effects were found for neighborhood noise alone or in combination with sleep health. Conclusions Adequate sleep significantly reduces the risk of hypertension in adolescents, independent of environmental noise exposure. These findings underscore the importance of promoting good sleep hygiene among youth to mitigate hypertension risk.