Higher Proportion Of Hypertension Research Articles

Association between cardiac arrhythmia before pregnancy and gestational diabetes: a nationwide population-based study in Korea

Abstract Background Premature extra betas and supraventricular tachyarrhythmias are prevalent in the gestational period. Gestational diabetes mellitus (GDM) complicated a significant proportion of pregnancies worldwide. Purpose Given the high prevalence of cardiac arrhythmia (CA) among patients with diabetes, we aimed to investigate the association of CA with GDM. Methods This is a nationwide cohort study using the Korean Health Insurance database. We identified 1,113,729 women who gave birth between 2007 and 2015. After excluding subjects who did not undergo the national health screening test within a year before pregnancy, multi-pregnancy, and those with fasting blood glucose ≥126 mg/mL and/or diagnosed with diabetes before pregnancy CA was defined as atrial and ventricular premature beats, paroxysmal tachycardia, and atrial fibrillation. The primary outcome was the incidence of GDM. Subgroup analysis stratified by age and body mass index at pregnancy onset, and a history of hypertension before pregnancy were conducted. Results A total of 365,880 women were included in the final analysis. Of them, 3,253 (0.9%) had a diagnosis of CA. Subjects with CA were older at pregnancy onset (mean age 33.3±4.1 vs. 33.0±3.9 years, P<0.001), and had a higher proportion of hypertension (5.2% vs. 1.0%, P <0.001) than in subjects without CA. GDM was detected in 31,938 (8.7%) subjects and more commonly occurred in subjects with CA than those without (14.9% vs. 8.7%, P<0.001). After adjusting for confounding factors, the incidence of GMD was statistically significantly higher in those with CA (adjusted OR 1.78, 95% CI 1.615–1.970, P<0.001). Moreover, the relationship between CA with GDM was statistically significant regardless of age and body mass index (Figure 1). Meanwhile, despite a higher incidence of GDM, the association between CA and GDM was insignificant in subjects with a history of hypertension. Conclusion The risk of gestational diabetes was higher in subjects diagnosed with CA before or during pregnancy compared with those without CA.

Lack of association between nonalcoholic fatty liver disease and intracerebral hemorrhage: A community-based cohort study

BackgroundThe association between nonalcoholic fatty liver disease (NAFLD) and intracerebral hemorrhage (ICH) remains unclear. This study aimed to investigate whether NAFLD and its severity predict incident ICH. MethodsParticipants free of other liver diseases, prior stroke, myocardial infarction, cancer, or alcohol abuse in the Kailuan cohort were enrolled in this study. Abdominal ultrasonography was used to diagnose NAFLD and assess its severity. Participants were stratified into different groups including nonfatty liver, mild, moderate and severe NAFLD. Multivariable Cox proportional hazards regression models were used to evaluate the hazard ratios (HRs) and 95% CIs of ICH events in the 11-year follow-up. ResultsA total of 77,461 participants were enrolled in our study. Among them, NAFLD was diagnosed in 23,890 (30.83 %) participants, including 15,581 (20.11 %) with mild NAFLD, 6839 (8.83 %) with moderate NAFLD and 1470 (1.90 %) with severe NAFLD. We documented 692 ICH events during 848,579 person years of follow-up. Patients with more severe NAFLD tended to be older, had higher levels of BMI, higher proportions of hypertension, diabetes and other known risk factors for cerebrovascular disease. However, there was no significant associations between NAFLD, its severity and incident ICH events. Relative to nonfatty liver participants, the HRs for participants with mild NAFLD, moderate and severe NAFLD were 0.98 (95 % CI, 0.80 to 1.20), 1.19 (95 % CI, 0.92 to 1.54) and 1.29 (95 % CI, 0.81 to 2.06), respectively. ConclusionsNAFLD and its severity did not appear to be significantly associated with ICH after adjustment for potential risk factors.

Ankle-brachial Index as Predictor of Coronary Artery Disease in Diabetic Patients

Introduction: In India, the incidence of coronary artery disease (CAD) has doubled, and the association between diabetes mellitus, peripheral arterial disease, and CAD remains unclear. This study aimed to explore the relationship between ankle-brachial index (ABI) and CAD in diabetic patients, using the ABI as a diagnostic tool for peripheral arterial disease. Materials and Methods: A cross-sectional study at a tertiary care center analyzed 100 diabetes cases for CAD using angina history, past treatment, electrocardiography, and two-dimensional echocardiography. Blood pressure was measured in all limbs, and ABI was calculated by dividing ankle pressure by brachial pressure, selecting the lower ratio. Results: Out of 100 patients, 28 had ABI <0.9 and 72 had ABI ≥0.9. The majority of both groups were male. The highest percentage in both groups was aged 51–60. The ABI +VE group had higher proportions of hypertension, smokers, and dyslipidemia. The majority in the ABI −VE group were nonsmokers and without dyslipidemia. Both groups had a majority with body mass index ≥25 kg/m2. Mean diabetes duration was higher in the ABI +VE group, while mean glycated hemoglobin levels were higher in the ABI −VE group. Conclusion: In our study, the prevalence of ABI +VE patients was 28% and prevalence of CAD in this group was 42.85%, which is statistically significant. Hypertension, smoking, dyslipidemia, diabetes duration, and glycemic control were significantly associated with low ABI index (ABI <0.9).

Correlation Analysis between Intrarenal Small Artery Intimal Thickening and Clinicopathological Features and Prognosis in Primary Membranous Nephropathy Patients

Background: Primary membranous nephropathy (PMN) is the most common pathological type of nephrotic syndrome in adults. Intrarenal small artery intimal thickening can be observed in most renal biopsies. The purpose of this study was to investigate the association between intrarenal small artery intimal thickening and clinicopathological features and prognosis in PMN patients. Methods: Data were continuously collected from patients who were diagnosed with PMN in Shenzhen Second People’s Hospital (The First Affiliated Hospital of Shenzhen University) from 2008 to 2021 for a retrospective cohort study. Regression analysis and survival analysis were used to analyze the relationship between intrarenal small artery intimal thickening and renal prognosis in PMN patients. Results: 300 PMN patients were enrolled in this study, including 165 patients (55%) with intrarenal small artery intimal thickening. Patients with intimal thickening were older, with higher BMI, systolic blood pressure and diastolic blood pressure, serum uric acid, a higher proportion of hypertension, acute kidney injury, nephrotic syndrome, more urine protein, and lower eGFR. Multivariate Cox regression analysis showed that after adjusting for age, gender, hypertension, BMI, urine protein, eGFR, and the use of ACEI/ARB and hormone immunosuppressants, intimal thickening was a risk factor for renal prognosis in PMN patients (HR = 3.68, 95% CI 1.36–9.96, p < 0.05). Kaplan-Meier survival curve analysis showed that the incidence of reaching the renal composite outcome was higher in the intimal thickening group (p < 0.05). Conclusion: The prognosis of PMN patients with intrarenal small artery intimal thickening is worse, so early intervention is very important for these patients.

Value of the A2DS2 Score Combined with the Neutrophil-to-lymphocyte Ratio in Predicting Acute Ischemic Stroke-associated Pneumonia

Objective: We aimed to explore the risk factors for acute ischemic stroke-associated pneumonia (SAP) and evaluate the predictive value of the Age, Atrial fibrillation, Dysphagia, Sex, Stroke Severity (A2DS2) score, neutrophil-to-lymphocyte ratio (NLR), and a combination of both indices for acute ischemic SAP. Methods: Overall, 1,505 patients with acute ischemic stroke (AIS) were enrolled and divided into SAP and non-SAP groups. Patients’ age, sex, and medical history (alcohol consumption, hypertension, diabetes, hyperlipidemia, coronary disease, atrial fibrillation, chronic obstructive pulmonary disease, and stroke history) were recorded. Clinical data were recorded, including consciousness disturbance, dysphagia, indwelling nasogastric tube, thrombolytic therapy, hospital stay length, National Institute of Health Stroke Scale (NIHSS) score, stroke position, TOAST classification, and blood pressure on admission. Laboratory indicators, including white blood cell (WBC) count, neutrophil count, lymphocyte count, creatinine, homocysteine, and fasting blood glucose, were also recorded. NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. All patients were scored using A2DS2. Binary logistic regression was used to analyze the relationships between A2DS2, NLR, and SAP. Receiver operating characteristic (ROC) curves were generated to evaluate the diagnostic value of A2DS2, NLR, and their combined indices for predicting SAP. Results: SAP occurred in 203 (13.5%) of the 1,505 enrolled patients. Patients in the SAP group were older and had a higher proportion of hypertension and chronic obstructive pulmonary disease history, consciousness disorder, dysphagia, indwelling nasogastric tube, fasting blood glucose level, NIHSS score, and longer hospital stay. The SAP group had a higher A2DS2 score than the non-SAP group. Similarly, the WBC count, neutrophil count, and NLR were significantly higher in the SAP group than in the non-SAP group. After excluding confounding factors, binary logistic regression analysis showed that age, NIHSS score, NLR, and A2DS2 score were independent risk factors for SAP. The ROC curves showed the A2DS2 score and NLR predicted SAP with an area under the curve (AUC) of 0.855 (sensitivity: 73.3%, specificity: 86.1%) and 0.849 (sensitivity: 79.7%, specificity: 80.6%), respectively, and the combined prediction of SAP AUC was 0.924 (sensitivity: 87.7%, specificity: 82.8%), which was higher than that of a single index, with improved the sensitivity of prediction. Conclusion: In patients with AIS, the A2DS2 score combined with NLR is of greater value in predicting the risk of acute ischemic SAP than a single indicator.

Machine learning to predict hemodynamically significant CAD based on traditional risk factors, coronary artery calcium and epicardial fat volume.

We sought to establish an explainable machine learning (ML) model to screen for hemodynamically significant coronary artery disease (CAD) based on traditional risk factors, coronary artery calcium (CAC) and epicardial fat volume (EFV) measured from non-contrast CT scans. 184 symptomatic inpatients who underwent Single Photon Emission Computed Tomography/Myocardial Perfusion Imaging (SPECT/MPI) and Invasive Coronary Angiography (ICA) were enrolled. Clinical and imaging features (CAC and EFV) were collected. Hemodynamically significant CAD was defined when coronary stenosis severity ≥ 50% with a matched reversible perfusion defect in SPECT/MPI. Data was randomly split into a training cohort (70%) on which five-fold cross-validation was done and a test cohort (30%). The normalized training phase was preceded by the selection of features using recursive feature elimination (RFE). Three ML classifiers (LR, SVM, and XGBoost) were used to construct and choose the best predictive model for hemodynamically significant CAD. An explainable approach based on ML and the SHapley Additive exPlanations (SHAP) method was deployed to generate individual explanation of the model's decision. In the training cohort, hemodynamically significant CAD patients had significantly higher age, BMI and EFV, higher proportions of hypertension and CAC comparing with controls (P all < .05). In the test cohorts, hemodynamically significant CAD had significantly higher EFV and higher proportion of CAC. EFV, CAC, diabetes mellitus (DM), hypertension, and hyperlipidemia were the highest ranking features by RFE. XGBoost produced better performance (AUC of 0.88) compared with traditional LR model (AUC of 0.82) and SVM (AUC of 0.82) in the training cohort. Decision Curve Analysis (DCA) demonstrated that XGBoost model had the highest Net Benefit index. Validation of the model also yielded a favorable discriminatory ability with the AUC, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 0.89, 68.0%, 96.8%, 94.4%, 79.0% and 83.9% in the XGBoost model. A XGBoost model based on EFV, CAC, hypertension, DM and hyperlipidemia to assess hemodynamically significant CAD was constructed and validated, which showed favorable predictive value. ML combined with SHAP can offer a transparent explanation of personalized risk prediction, enabling physicians to gain an intuitive understanding of the impact of key features in the model.

Thirty day postoperative outcomes following laparoscopic adrenalectomy for functional adrenal tumors.

Functional adrenal tumors (FATs) are rare and if left untreated, there is a substantial risk of morbidity and mortality due to uncontrolled excess hormone secretion. The three most common FATs are cortisone-producing tumors (hypercortisolism), aldosterone-producing tumors (hyperaldosteronism), and catecholamines-producing tumors (pheochromocytomas). The study aims to evaluate demographic characteristics and 30-day outcomes after laparoscopic adrenalectomy of FATs. Patients who underwent laparoscopic adrenalectomy for FATs were selected from the ACS-NSQIP database (2015-2017), and divided into three groups (hyperaldosteronism, hypercortisolism, and pheochromocytoma). Preoperative demographics, medical comorbidities, and 30-day postoperative outcomes among the three groups were analyzed using the chi-squared test, analysis of variance (ANOVA) and Kruskal-Wallis one-way analysis of variance. Multivariable logistic regression was performed to assess the effects independent variables on the likelihood of increased overall morbidity. Of a total of 2410 patients who underwent laparoscopic adrenalectomy, 345 (14.3%) patients with FATs were included. Patients in the hypercortisolism group were younger, had higher proportion of females, had higher BMI, had a higher proportion of White ethnicity and had a higher proportion of diabetes. The hyperaldosteronism group had a higher proportion of Black ethnicity and a higher proportion of hypertension (HTN) requiring medication. Thirty day postoperative outcomes showed that the pheochromocytoma group had a higher rate of serious morbidity, overall morbidity, and highest readmission rates. There were three deaths, 1 in the pheochromocytoma and 2 in the hypercortisolism groups. Operative time (in minutes) was longer in the hypercortisolism group. Median length of stay was higher in hypercortisolism (2days) and pheochromocytoma (1.5day) groups. Functional adrenal tumors show distinct variations in patient demographics and postoperative outcomes. It is essential to use this information during the preoperative period to optimize patients prior to intervention and counsel patients about potential postoperative outcomes.

FACTORS ASSOCIATED WITH DYSGLYCEMIA AND ITS POST-SURGICAL RESOLUTION IN PATIENTS WITH PHEOCHROMOCYTOMAS AND PARAGANGLIOMAS

Objective: Pheochromocytomas and paragangliomas (PPGLs) are a group of rare neuroendocrine tumors. Dysglycemia has been observed in patients with PPGLs in some small case series. However, few large studies, and none in China, have described the outcomes of dysglycemia after resection, and the factors associated with the development and resolution of dysglycemia in patients with PPGLs. Design and method: We retrospectively analyzed the clinical data of consecutive patients with PPGLs admitted between January 2018 and June 2020. Clinical characteristics were compared between patients with and without dysglycemia. Multivariable logistic regression analysis was used to identify independent predictors and the receiver operating characteristic curves was used to evaluate the diagnostic performance of the variables. Results: Among 163 patients in this study, 47.9% had preoperative dysglycemia. Patients with dysglycemia were older at diagnosis and have a higher proportion of hypertension. The white blood cell count and 24-hour urinary epinephrine (24hU-E) concentration were higher in patients with dysglycemia. Multivariable logistic regression analysis showed that age [odds ratio (OR), 1.040; 95% confidence interval (CI), 1.011–1.070; p = 0.006], hypertension (OR, 3.318; 95% CI, 1.375 – 8.009; p = 0.008), and 24hU-E concentration (OR, 1.013; 95% CI, 1.005 –1.022; p = 0.016) were independent predictors of preoperative dysglycemia. Taking age, hypertension and 24hU-E into account in the same model, the area under the receiver operating characteristic curve of the model for predicting preoperative dysglycemia was 0.737. The proportion of patients with dysglycemia was significantly decreased after surgery (p &lt; 0.001) and patients with postoperative dysglycemia in remission had larger preoperative tumor diameters (p = 0.005). Conclusions: Dysglycemia affects almost half of patients with PPGLs. Age, hypertension, and 24hU-E concentration are predictors of preoperative dysglycemia. Removal of PPGLs can improve dysglycemia in most patients, and the postoperative remission of dysglycemia is associated with the preoperative tumor diameter. These results are of great importance for risk assessment and selection of optimal therapy of dysglycemia in patients with PPGLs.

Association of Life's Simple 7 with mild cognitive impairment in community-dwelling older adults in China: a cross-sectional study.

Life's Simple 7 (LS7), a metric composed of seven intervenable cardiovascular risk factors, is initiated by the American Heart Association to improve cardiovascular health. The components of LS7 have been reported as risk factors for dementia. However, few studies investigated the association between LS7 metric and mild cognitive impairment (MCI). The study was carried out in a primary care facility between 8 June and 10 July 2022. A total of 297 community-dwelling residents aged 65 years or older were recruited. Sociodemographic, comorbidity, and lifestyle characteristics were collected through the questionnaires, and biological parameters were obtained from blood sample examinations. Logistic regression was used to analyze the association between LS7 scores (overall, behavioral, and biological) and individual components with MCI, adjusting sex, age, education, and cardiovascular disease (CVD). In comparison with the cognitively intact group (n = 195), the MCI group (n = 102) had a lower education level and a higher proportion of hypertension. Multivariate logistic regression analysis, adjusting sex, age, education, and CVD demonstrated a significant association between MCI and overall LS7 score [odd ratio = 0.805, 95% confidence interval (0.690, 0.939)] and biological score [odd ratio = 0.762, 95% confidence interval (0.602, 0.965)]. Life's Simple 7 was associated with MCI in community-dwelling older adults, indicating that LS7 could be used as guidance in the prevention of dementia in the community.

Abstract 6755: The impact of renin-angiotensin system inhibitors on survival outcomes of pancreatic adenocarcinoma patients

Abstract Introduction Pancreatic adenocarcinoma (PDAC) is a highly aggressive malignancy with significant morbidity and mortality. RAS (renin-angiotensin system) inhibitors have been used for hypertension, and the potential role of using RAS inhibitors in pancreatic adenocarcinoma have been investigated in pre-clinical models by enhancing drug delivery and reducing hypoxia. However, the clinical benefit of RAS inhibitors in pancreatic cancer patients was still unclear. Methods We retrospectively investigated the impact of RAS inhibitors on survival outcomes of pancreatic adenocarcinoma patients in Taichung Veterans General Hospital between January 2014 and July 2021. Patients with histologically proven pancreatic adenocarcinoma were included in the study. Clinical feature with drugs exposure and survival outcome were analyzed. Results A total of 384 pancreatic cancer patients were analyzed. Among them, 70 patients had concurrent use of RAS inhibitors and 314 patients had no concurrent medication use. Among patients with RAS inhibitors use, the diagnosed age was significantly older (70.0 vs. 68.0, p = 0.023), and a higher proportion of hypertension (100.0% vs. 51.0%, p &amp;lt; 0.0001), chronic kidney disease (27.5% vs. 9.1%, p &amp;lt; 0.0001), and diabetes (64.3% vs 39.5%, p &amp;lt; 0.0001) than those without RAS inhibitors use. The 12-month progression-free survival were 22.9% and 13.7% in the RAS inhibitors and control group (p = 0.008), respectively. The Overall survival was not significantly different in the both groups (p = 0.356). In the multivariate analysis, the use of RAS inhibitors had a significantly better progression-free survival outcome (Hazard ratio = 0.025, CI:0.52-0.96). The advanced disease status, poor ECOG performance status and the elevated level of CA19-9 were correlated with poor progression-free survival. Conclusion In our study, although higher percentage of existed comorbidities in the RAS inhibitor group, we demonstrated that the use of RAS inhibitors among pancreatic cancer patients might provide a better progression-free survival outcome. Further prospective study and investigation are warranted. Citation Format: Kuan-Yu Tseng, Cheng-Wei Chou. The impact of renin-angiotensin system inhibitors on survival outcomes of pancreatic adenocarcinoma patients. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 6755.

Marked paper: Type 2 diabetes mellitus indicates increased postoperative complications and poor prognosis in colorectal cancer patients receiving curative surgery.

This study aimed to evaluate the impact of type 2 diabetes mellitus (T2DM) on the short-term outcomes and long-term survival of patients with colorectal cancer (CRC) who underwent curative resection. This study retrospectively included 136 patients (T2DM group) with resectable CRC and T2DM from Jan 2013 to Dec 2017. Propensity score-matched control group consisting of 136 patients (non-T2DM group) were selected from 1143 CRC patients without T2DM. The short-term outcomes and prognosis were compared between the T2DM and non-T2DM group. A total of 272 patients (136 patients for each group) were included in this study. Patients in T2DM group had higher body mass index (BMI), higher proportion of hypertension and cerebrovascular diseases (P<0.05). T2DM group had more overall complications (P=0.001), more major complications (P=0.003) and higher risk of reoperation (P=0.007) when compared with non-T2DM patients. T2DM patients had longer hospitalization time than non-T2DM (20.7 ± 10.2 vs. 17.5 ± 6.2, P=0.002). As for the prognosis, T2DM patients had worse 5-year overall survival (OS) (P=0.024) and 5-year disease-free survival (DFS) (P=0.019) in all stage. Moreover, T2DM and TNM stage were the independent predictors of OS and DFS for CRC patients. T2DM increases overall complications and major complications, and prolongs the hospitalization time after CRC surgery. In addition, T2DM indicates the poor prognosis of CRC patients. A prospective study with large sample size is required to confirm our findings.

Building of a Clinical Prediction Model for Hemodynamic Depression after Carotid Artery Stenting

Objective To analyze the risk factors and build a clinical prediction model for hemodynamic depression (HD) after carotid artery stenting (CAS). Methods A total of 116 patients who received CAS in the Department of Vascular Surgery,Drum Tower Clinical College of Nanjing Medical University and the Department of Vascular Surgery,the Affiliated Suqian First People's Hospital of Nanjing Medical University from January 1,2016 to January 1,2022 were included in this study.The patients were assigned into a HD group and a non-HD group.The clinical baseline data and vascular disease characteristics of each group were collected,and multivariate Logistic regression was employed to identify the independent predictors of HD after CAS and build a clinical prediction model.The receiver operating characteristic (ROC) curve was drawn,and the area under the ROC curve (AUC) was calculated to evaluate the predictive performance of the model. Results The HD group had lower proportions of diabetes (P=0.014) and smoking (P=0.037) and higher proportions of hypertension (P=0.031),bilateral CAS (P=0.018),calcified plaque (P=0.001),eccentric plaque (P=0.003),and the distance<1 cm from the minimum lumen level to the carotid bifurcation (P=0.009) than the non-HD group.The age,sex,coronary heart disease,symptomatic carotid artery stenosis,degree of stenosis,and length of lesions had no statistically significant differences between the HD group and the non-HD group (all P>0.05).Based on the above predictive factors,a clinical prediction model was established,which showed the AUC of 0.807 and the 95% CI of 0.730-0.885 (P<0.001).The model demonstrated the sensitivity of 62.7% and the specificity of 87.7% when the best cut-off value of the model score reached 12.5 points. Conclusions Diabetes,smoking,calcified plaque,eccentric plaque,and the distance<1 cm from the minimum lumen level to the carotid bifurcation are independent predictors of HD after CAS.The clinical prediction model built based on the above factors has good performance in predicting the occurrence of HD after CAS.

Triglyceride glucose index and poor sleep patterns in non-diabetic adults: Evidence from NHANES 2005-2016.

Sleep disorders are commonly encountered in modern populations. This cross-sectional study aimed to investigate the associations between triglyceride glucose (TyG) index and poor sleep patterns in non-diabetic adults. Data of non-diabetic adults aged 20-70 years were extracted from the US National Health and Nutrition Examination Survey database 2005-2016. Pregnant women, individuals with diabetes and cancer history, and individuals lacking complete data on sleep patterns or parameters for calculating TyG index were excluded. Poor sleep pattern was defined as having two or more following conditions: (1) abnormal sleep duration, defined as less than 7 h or longer than 9 h; (2) self-reported trouble sleeping; and (3) physician-confirmed sleep disorders. Associations between poor sleep patterns, TyG index, and an additional index incorporating body mass index (BMI), TyGBMI, and other study variables were determined by univariable and multivariable logistic regression analysis. Among 9,390 included participants, 1,422 had poor sleep patterns and 7,968 did not. The individuals with poor sleep patterns had a higher mean TyG index, were older, had higher BMI, and had higher proportions of hypertension and history of CVD than those without poor sleep pattern (all p < 0.001). Multivariable analysis showed no significant association between poor sleep pattern and TyG index. However, among the components of poor sleep pattern, TyG index in the highest quartile (Q4) was significantly associated with trouble sleeping [adjusted OR (aOR): 1.46, 95%CI: 1.04-2.03) as compared with the lowest TyG quartile (Q1). In addition, TyG-BMI in Q4 was indepently associated with increased likelihood for poor sleep patterns (aOR: 2.18, 95%CI: 1.61-2.95), trouble sleeping (aOR: 1.76, 95%CI: 1.30-2.39), abnormal sleep duration (aOR: 1.41, 95%CI: 1.12-1.78), and sleep disorders (aOR: 3.11, 95%CI: 2.08-4.64) as compared to Q1. Among US adults without diabetes, elevated TyG index is correlated with self-reported trouble sleeping, independent of BMI. Future studies should build upon this preliminary work and examine these associations longitudinally and through treatment trials.

Whether jugular venous reflux relates to more serious ischemic white matter lesions?

ObjectiveTo evaluate whether jugular venous reflux (JVR) relates to more serious ischemic white matter lesions (WMLs). Patients and MethodsFifty cases were enrolled and divided into absent to mild ischemic WMLs group and moderate to severe ischemic WMLs group. Then the univariate and multivariate analyses were conducted to evaluate the relationship between JVR and moderate to severe ischemic WMLs, and a receiver operating characteristic (ROC) curve was used to evaluate the predictive value of JVR for moderate to severe ischemic WMLs. ResultsThere were 28 patients in the absent to mild ischemic WMLs group and 22 patients in the moderate to severe ischemic WMLs group. There was no significant difference between the two groups in gender, blood lipid indexes, proportions of diabetes, and abnormal deep cerebral veins (all p > 0.05). However, compared with the absent to mild ischemic WMLs group, the moderate to severe ischemic WMLs group was older and had a higher proportion of hypertension and JVR (p = 0.005; p < 0.001; p < 0.001, respectively). Multivariate logistic regression analysis showed that JVR was an independent risk factor for moderate to severe ischemic WMLs (OR = 17.679, 95 % CI: 3.056–102.286, p = 0.001). Furthermore, the area under curve of JVR combined with hypertension was 0.912 (p < 0.001), and the specificity of predicting moderate to severe ischemic WMLs was 92.9 %. ConclusionOur study suggested that JVR might relate to more severe ischemic WMLs.

Effects of severe obstructive sleep apnea on functional prognosis in the acute phase of ischemic stroke and quantitative electroencephalographic markers

ObjectiveTo investigate the effect of severe obstructive sleep apnea (OSA) on functional prognosis in the acute phase and quantitative electroencephalography (EEG) markers during sleep in ischemic stroke patients. MethodsThis study included 125 mild-to-moderate acute ischemic stroke patients with OSA who underwent polysomnography (PSG) within one week of stroke onset between January 2015 and June 2020. Patients were grouped according to their apnea-hypopnea index (</≥ 30/h). Poor functional prognosis was defined as modified Rankin Scale score ≥3. The EEG recorded by PSG was extracted during different sleep stages for power spectrum analysis. The delta/alpha power ratio (DAR), (delta + theta)/(alpha + beta) ratio (the slowing ratio, TSR), and the relative power (RP) of each frequency band were calculated. Differences in clinical, PSG, and quantitative EEG characteristics were compared between the groups. Additionally, we explored predictors of poor functional prognosis. ResultsPatients with severe OSA had a higher proportion of hypertension, lower relative power of high-frequency bands, and higher delta RP, TSR, and DAR (p < 0.05). Severe OSA was associated with a 3.6-fold increase in risk of poor prognosis (p < 0.05). Increased delta RP and TSR, as well as decreased alpha, beta, and sigma RP, may be independent predictors of a poor functional prognosis. ConclusionsSevere OSA is an independent risk factor for a poor functional prognosis in patients with acute ischemic stroke, and quantitative EEG during sleep showed a significant slow wave enhancement, suggesting more severe brain dysfunction. The treatment of severe OSA may improve functional prognosis.

Women Farmers Group as Peer Educator in Prevent Hypertension

The results of the 2018 Basic Health Research, farmers have a higher proportion of hypertension than other occupations, namely 36.14%. One of the characteristics of the farming population is the low level of education. These factors contribute to the low implementation of healthy living behavior, especially in the prevention of hypertension. Women farmer groups play an important role as peer educators who can implement hypertension prevention behavior in their families and their environment. This study aims to increase knowledge about preventing hypertension in women's farmer groups in Karanganyar District, South Lampung Regency. The benefit of this study is the implementation of healthy living behavior to prevent hypertension. The activity was carried out with a target of 194 people who are members of 10 women farmer groups. The intervention is health education about hypertension prevention. The results obtained, before the education was carried out, the knowledge of farmers was not good as many as 106 people (54,6%) and after education the knowledge of farmers was not good as many as 14 people (7,2%). From the results of McNemar's analysis, it was found that there was a significant difference between knowledge before and after health education (p = 0.001). Health education carried out continuously as an effort to maintain health in the farming community in Karanganyar District, Lampung Regency, Lampung.

Association of skin lesion severity with clinical features of psoriatic arthritis

Objective: To investigate the relationship between psoriasis severity and clinical features in psoriatic arthritis (PsA). Methods: Patients were recruited from the Chinese REgistry of Psoriatic ARthritis (CREPAR) between December 2018 and June 2021, and data were collected including the baseline demographic characteristics, various clinical manifestations (including arthritis, nail disease, comorbidities), laboratory tests[including erythrocyte sedimentation rate(ESR), C-reactive protein (CRP)], health assessment questionnaire (HAQ). Body surface area (BSA) and psoriasis area and severity index (PASI) were selected for the tools of assessment of cutaneous psoriasis. Patients were divided to two groups, including the severe psoriasis group (BSA>10%) and the non-severe psoriasis group (BSA≤10%). Disease assessment included ankylosing spondylitis disease activity score (ASDAS), disease activity score 28 (DAS28) and disease activity in psoriatic arthritis (DAPSA). Results: 1 074 eligible patients with PsA were recruited, and 106 (9.9%) had severe psoriasis. Compared with non-severe psoriasis group, the severe psoriasis group had more peripheral joint involvement (including patients with ever or current peripheral arthritis, 94.3% vs. 85.6%), more polyarticular joint involvement (including patients with current peripheral arthritis, 74.0% vs. 58.2%), more axial joint involvement (51.4% vs. 39.9%), more nail disease (72.6% vs. 61.4%), more frequency of smoking (20.2% vs. 18.7%), and higher proportion of hypertension (23.4% vs. 14.4%). In addition, the severe psoriasis group had higher level of ESR [33(10, 70) mm/1h vs. 20(9, 38) mm/1h] and CRP [18.6(5.0, 60.8) mg/L vs. 7.0(2.4, 18.1) mg/L], higher values of DAS28-ESR (4.5±1.7 vs. 3.7±1.5), DAS28-CRP (4.2±1.5 vs. 3.4±1.4), ASDAS-ESR (3.5±1.4 vs. 2.6±1.2), and ASDAS-CRP(3.4±1.6 vs. 2.5±1.2), higher scores of HAQ [0.6(0.1, 1.0) vs. 0.3(0.0, 0.8)]. Conclusion: Patients with PsA with severe psoriasis bore a heavier disease burden. Therefore, clinicians were supposed to pay more attention to them. In addition to skin lesions, they should also focus on examination of other clinical manifestations, such as joints and nails.

Nonsustained atrial tachycardia in 24-hour Holter monitoring: a potential cardiac source of embolism in acute ischemic stroke

BackgroundWhether nonsustained atrial tachycardia (NSAT) has a causative role similar to paroxysmal atrial fibrillation (AF) in ischemic stroke is unclear. We investigated the clinical and imaging features of ischemic stroke patients with NSAT to demonstrate that these patients would have a higher proportion of embolic strokes.MethodsWe retrospectively reviewed ischemic stroke patients who underwent Holter monitoring and selected patients with NSAT. The clinical and imaging characteristics were compared between patients with and without NSAT, and the risk factors for embolic stroke were evaluated. Moreover, the images of the selected patients were analyzed according to the Trials of Org 10172 in Acute Stroke Treatment classification.ResultsFrom a total of 1,051 patients who had 24-hour Holter monitoring, 681 patients were selected for the study. Among the selected patients, NSAT was detected in 243 patients. The patients with NSAT had a significantly higher proportion of imaging findings suggestive of cerebral embolism compared with patients without NSAT (27% vs. 14%, P<0.001). Moreover, the presence of NSAT was a statistically significant factor associated with imaging findings suggestive of cerebral embolism in the univariate (OR, 2.22; 95% CI, 1.51–3.27; P<0.001) and multivariate (OR, 2.26; 95% CI, 1.53–3.34; P<0.001) analyses. The patients with NSAT had a significantly older age at diagnosis, higher proportion of female sex, higher proportion of hypertension, lower proportion of smokers, higher CHA2DS2-VASc score, and higher left atrium index value compared with patients without NSAT.ConclusionsThe embolic pattern of acute ischemic stroke in patients with NSAT was frequently observed and shared clinical characteristics of AF rather than those of atherosclerosis. As NSAT may be a potential source of cardiac embolism, we suggest a more intensive search for modifiable risk factors such as AF in ischemic stroke in patients with NSAT.

Dyslipidemia may be a risk factor for progression in children with IgA nephropathy.

IgA nephropathy (IgAN) is often chronically progressive and commonly accompanied by dyslipidemia. However, the intrinsic relationship between dyslipidemia and IgAN remains to be elucidated. This study aimed to investigate the impact of different types of dyslipidemia on clinical and pathological characteristics in children with IgAN. In our retrospective cohort study from January 2006 to January 2021, 276 children with IgAN were ultimately included in the baseline analysis, and 169 were included in the follow-up analysis. The clinical and pathological features of different types of dyslipidemia and their effect on kidney prognosis were analyzed. Children in the dyslipidemia group had more severe clinical characteristics (higher blood urea nitrogen, serum uric acid, and 24-h proteinuria; higher proportion of hypertension; and lower serum albumin and estimated glomerular filtration rate) and pathological changes (higher proportion of Lee grades IV-V and E1, S1, and C2 in MEST-C). Furthermore, the clinical and pathological characteristics were worse in the mixed hyperlipidemia group. Multivariate logistic analysis showed that hypertension, steroid treatment, lower serum albumin, severe proteinuria, and segmental glomerulosclerosis were independent risk factors for dyslipidemia in children with IgAN. The Kaplan-Meier analysis revealed that the probability of kidney survival in children with dyslipidemia was lower than that in those without dyslipidemia, with a median follow-up of 5.9years. Children with IgAN and dyslipidemia, especially mixed hyperlipidemia, are prone to more severe clinical and pathological changes. Our study provides further insight into dyslipidemia as a potential risk factor in children with IgAN. A higher resolution version of the Graphical abstract is available as Supplementary information.

Silent brain infarction is associated with carotid siphon calcification in ischemic stroke patients

BackgroundSilent brain infarction (SBI) had a higher prevalence in ischemic stroke patients than healthy population. Intracranial artery calcification, as the important component of atherosclerosis, is a known risk factor of ischemic stroke. Whether it is also the risk factor of SBI is uncertain. We aimed to assess the association between SBI and carotid siphon calcification (CSC) in ischemic stroke patients. MethodsWe retrospectively collected consecutive data of acute ischemic stroke patients with and without SBI by Magnetic Resonance Imaging (MRI) and calcification using non-contrast Computerized Tomography (NCCT). We used a histopathologically validated method to score the circularity, thickness, and morphology of calcification. Clinical characteristics, prevalence and pattern (intimal and medial) of CSC were compared between patients with and without SBI. The association of CSC and SBI was investigated by logistic regression analysis. ResultsTotally, 303 acute ischemic stroke patients were enrolled, of whom 260 (85.8%) had CSC. Patients with SBI were older (64.5 ± 10.4 years vs. 61.3 ± 12.1 years, P = 0.032), had a higher proportion of hypertension (77.5% vs. 65.7%, P = 0.035). Of the 260 CSC patients, there’s no significant difference except for hyperlipidemia between patients with SBI and without SBI. The prevalence of intimal pattern of CSC was higher in those with SBI (adjusted odds ratio 2.42, 95% CI 1.219–4.794). ConclusionsPatients with SBI at acute phase of ischemic stroke have more risk factors than mentioned previously. SBI associated with the intimal pattern of CSC which relate to the atherosclerosis process in symptomatic ischemic stroke patients.