Hypertension Syndrome Research Articles

[Progress in the diagnose and treatment of pulmonary arterial thrombosis in situ].

In situ pulmonary arterial thrombosis (ISPAT) refers to the formation of new blood clots in the pulmonary arterial system in the absence of pre-existing clots in the peripheral venous system. With the emergence and prevalence of COVID-19, ISPAT has become an increasingly important cause of pulmonary arterial thrombosis (PAT) alongside thromboembolism. Several factors such as hypoxia, inflammation, endothelial dysfunction, and hypercoagulable state can lead to ISPAT, which is associated with a number of conditions such as thoracic trauma, partial lung resection, pulmonary infectious disease, pulmonary vasculitis, connective tissue diseases, severe pulmonary hypertension, radiation pneumonitis, and acute chest syndrome in sickle cell disease. It is important to differentiate between pulmonary thromboembolism (PTE) and ISPAT for proper disease management and prognosis. In this review, we summarized the characteristics of ISPAT under different disease conditions, the methods to distinguish ISPAT from PTE, and the best treatment strategies. We hoped that this review could improve clinicians' understanding of this independent disease and provide guidance for the refined treatment of patients with PAT.

Hepatic artery infusion chemotherapy combined with camrelizumab plus rivoceranib for hepatocellular carcinoma with portal vein tumor thrombosis: a multicenter propensity score-matching analysis.

Portal vein tumor thrombosis (PVTT) signifies late-stage hepatocellular carcinoma (HCC) with high-risk progression and poor prognosis. As a standard treatment, sorafenib monotherapy has limited the efficacy in managing HCC with PVTT. Currently, both hepatic arterial infusion chemotherapy (HAIC) and the combination of camrelizumab and rivoceranib have shown favorable survival benefits for advanced HCC, surpassing the standard sorafenib treatment. In this study, we investigate the safety and efficacy of HAIC combined with camrelizumab and rivoceranib in treating HCC patients with PVTT. From January 2020 to December 2021, HCC patients with PVTT, who received either a triple regime of HAIC combined with camrelizumab and rivoceranib or a dual regime of camrelizumab and rivoceranib as their first-line treatment, were reviewed for eligibility at four hospital centers in China. To balance any intergroup differences, propensity score matching (PSM) was applied. The aim of this study is to compare the efficacy of the dual and triple combination treatment regimens based on survival prognosis and tumor response and evaluate the safety based on the occurrence of adverse reactions. In this study, a total of 411 patients who received either the triple treatment regime (HAIC combined with camrelizumab plus rivoceranib, referred to as the HAICCR group, n = 292) or the dual treatment regime (camrelizumab combined with rivoceranib, referred to as the CR group, n = 119) between January 2020 and December 2021 were included. The results showed that the HAICCR group exhibited significantly better overall survival (mOS: 19.60months vs. 11.50months, p < 0.0001) and progression-free survival (mPFS: 10.0months vs. 5.6months, p < 0.0001) compared to the CR group in the overall cohort. Moreover, the HAICCR group also had a significantly higher ORR (objective response rate, 55.5% vs. 42.0%, p = 0.013) and DCR (disease control rate, 89.0% vs. 79.0%) compared to the CR group. After PSM, a final matched cohort of 83 pairs was obtained, and the survival benefits were consistent in this cohort as well (mOS: 18.70months vs. 11.0months, p < 0.0001; mPFS: 10.0months vs. 5.6months, p < 0.0001). However, there was no significant difference in the ORR between the triple and dual combination regimes. Univariate and multivariate analysis showed that CTP (Child-Turcotte-Pugh) stage, ALBI (albumin-bilirubin index) grade, tumor number, and treatment regime were significant risk factors affecting overall survival, while AFP (α-fetoprotein) level, tumor number, metastasis, and treatment regime were significant risk factors affecting progression-free survival. As for safety, hypertension and hand-foot syndrome were the two most common adverse reactions in both groups, with no significant difference in the occurrence of adverse reactions between the two groups (p < 0.05). In the context of advanced HCC patients with PVTT, the combination regime of HAIC and camrelizumab plus rivoceranib demonstrates more excellent capacity for prolonging survival and offers a well-tolerated safety compared to the CR dual therapy approach. This triple regimerepresents a therapeutic modality of broad prospects and vast potential for HCC patients with PVTT.

The effects of endometrial thickness on outcomes of pregnancy following embryo transfer: A retrospective cohort.

The safety of assisted reproductive technology can be assessed by examining birth weight as an outcome measure. The objective of this study was to evaluate the effect of endometrial thickness during embryo transfer on newborn birth weight and preterm labor. We conducted a retrospective cohort study at the infertility department of a teaching hospital affiliated with a university of medical sciences. Eligible women were ≥18 years old and conceived a singleton pregnancy with embryo transfer and an endometrial thickness of ≥7 mm. None of the patients had diabetes, blood hypertension, and polycystic ovarian syndrome. We assessed maternal and newborn characteristics and perinatal pregnancy outcomes. In total, 100 eligible patients with a mean (SD) age of 32.8 (6.2) years were included. The mean endometrial thickness during embryo transfer was 9.1 (1.2) mm, and the mean birth weight was 3040.7 (565.3)g. There were no statistically significant associations between endometrial thickness and preterm labor (p=0.215) and between endometrial thickness and stillbirth or intra-uterine fetal death (p=0.880). However, after adjusting for confounding factors, the association of endometrial thickness with birth weight was statistically significant [b=124.6 (51.6), p=0.018]. Within the range of ≥7mm, endometrial thickness during embryo transfer is a predictor of newborn weight; however, it is not related to the risk of preterm labor, stillbirth, or intra-uterine fetal death.

Cerebral Venous Thrombosis Indicative of Polycythemia Vera: Case Report

Polycythemia vera, a myeloproliferative disorder, seldom leads to cerebral venous thrombosis, making this association a rare occurrence. Here, we present the case of a 62-year-old patient without significant medical history, who was admitted due to a one-month history of intracranial hypertension syndrome. Upon admission, papillary edema (stage II) was observed, along with a lack of focal neurological signs. MRI angiography revealed thrombosis in the right lateral sinus. Further diagnostic investigation confirmed the presence of polycythemia vera. The patient was initiated on anti-edematous and anticoagulant therapy, followed by bloodlettings and cyto-reduction treatment, resulting in a favorable clinical outcome.

The sFLT-1/PlGF Ratio for the Prediction of Preeclampsia-Related Adverse Fetal and Maternal Outcomes in Women with Preexisting Diabetes.

To evaluate the predictive value of the sFlt-1/PlGF ratio for the prediction of preeclampsia in women with preexisting diabetes mellitus. This is a monocentric retrospective observational study conducted between January 2018 and December 2020. All singleton pregnancies with preexisting diabetes mellitus, who had a dosage of the sFlt-1/PlGF ratio between 30 and 34 + 6 weeks of gestation were included. The principal outcome was preeclampsia. The secondary outcomes were preterm preeclampsia, gestational hypertension, placental abruption, intrauterine fetal death, IUGR, small for gestational age and a composite outcome named "hypertensive disorder of pregnancy" including gestational hypertension, preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes and low platelet count). Of 63 patients, 22% presented preeclampsia. The area under the curve of sFlt-1/PlGF ratio was 0.90 (95% CI: 0.79-0.96) for the prediction of preeclampsia. The receiver operator characteristic analysis suggested that the optimal sFlt-1/PlGF cutoff to predict preeclampsia was 29, with a sensitivity of 86% (95% CI: 60.1-96.0) and a specificity of 92% (95% CI: 80.8-96.8). A cut-off of 38 provided a sensitivity of 71% (95% CI: 45.4-88.3), a specificity of 92% (95% CI: 80.8-96.8). Further analysis using multivariable methods revealed nephropathy was significantly associated with PE (p = 0.014). The use of the sFlt-1/PlGF ratio during the third trimester of pregnancy seems to be of interest as a prognostic tool to improve multidisciplinary management of patients with preexisting diabetes mellitus.

Prevalence of Lifestyle Diseases in Non-Acclimatized Lowlanders at High Altitude in subdivision Darjeeling district of Eastern Himalayan Region, India

Background: Lifestyle diseases including overweight, obesity, hypertension and metabolic syndrome leads toheart diseases, increased risk for insulin resistance, diabetes and stroke. Obesity is one of the lifestyle diseases declared as worldwide epidemic which is a major health burden. The study determine the association of lifestylediseases with Body Mass Indexinnon-acclimatized lowlanders at altitude of 7500 ft above sea level and to estimate effect of altitude on anthropometric and biochemical parameters.Methods: The total of 300 male age between 20-57 years studied. The present retrospective study was done using Annual Medical Examination documents which were recorded at plains and at high altitude. The anthropometric indexes observed using Asia-pacific criteria from the World Health Organization and biochemical parametersobserved using metabolic syndrome according to the American Heart Association.Conclusion: The present study comprises of maximum cases of young adults at plains and middle-aged at high altitude. The maximum overweight cases were found at high altitude and general obese cases found at plains. There is a slight risk of hypertension and deranged lipid profile at this altitude but no risk of polycythaemia. The present study’s indicator of abdominal obesity at high altitude is the waist-hip ratio. Increase in altitude causes changes in body mass index, blood glucose levels and lipid profile. Additionally, positive correlation found between lifestyle diseases such as central or abdominal obesity(r=0.33,P&lt;0.05) and diastolic blood pressure (r=0.19,P&lt;0.05) with Body Mass Index at high altitude. The present study agreed with the various studies from India and abroad.

Immunological Implications in Diabetes: A Review on Various Diseases and Conditions

Abstract:: Diabetes Mellitus (DM) is a long-term metabolic condition that has significant social, health, and economic consequences. There are various forms of diabetes mellitus, but the two most common varieties are type I and type II. Insulin-dependent diabetes (IDDM) is one of the most wellknown autoimmune illnesses that cause insulin insufficiency and hyperglycemia by either damaging or destroying Langerhans' beta cells. Available scientific data evidenced the greatest genetic contribution of Human Leukocyte Antigen class II in the IDDM. Hyperglycemia and individual components of the insulin resistance (metabolic) syndrome put people with type II diabetes at increased risk for microvascular consequences (retinopathy, nephropathy, and neuropathy) as well as macrovascular issues (cardiovascular comorbidities). A number of pathophysiological abnormalities, including obesity, poor diet, and physical inactivity, as well as genetic variables, are involved in the disturbed glucose homeostasis associated with type II diabetes. Diseases like lipid abnormalities contribute to the progression of diabetes, whereas obesity and its related medical disorders (such as hypertension, diabetes, insulin resistance, and sleep apnea syndrome) are eventually linked to an elevated cardiovascular risk. Diabetes raises the incidence, intensity, and duration of peri-densities in people with diabetes compared to healthy persons, making it a risk factor for periodontal disease. Diabetes conditions in patients concurrently also increase the progression or risk of other diseases, i.e., cardiovascular- related diseases (hypertension, oxidative stress, hyperlipidemia), nervous system-related diseases, and COVID-19, by increasing the overall infection rate. There is widespread evidence that correlates the direct connection between diabetes and other diseases, including immunity disorders, CVS disorders, etc. This review provides a correlation between diabetes and another disease with an overall impact on the progression of cardiovascular diseases, neurological diseases, COVID-19, and periodontal diseases. This current review focuses on the collation of some plants that show antidiabetic activity, including plant part, family, chemical constituent, mechanism of action, and chemical used for extraction. Studies on the role, causes, clinical management, prevention, and treatment of diabetes heavily rely on epidemiological evidence. This review also explains different factors responsible for diabetes, like genetic factors, environmental factors, and viral infections.

Clinical implications of persistent joint pain after gout flare

ObjectivesA subset of gout patients developed persistent joint pain after flares. Analysis of this clinical phenomenon may shed further light on the factors related to worsening gout and even provide clues to its pathogenesis. MethodsWe analyzed the clinical, laboratory, and ultrasound data of gout patients to explore the associations of these data with persistent joint pain after gout flares. ResultsA total of 1029 gout patients were included: 182 (17.7%) patients with persistent joint pain and 847 (82.3%) patients with nonpersistent joint pain. Patients with persistent joint pain had more total involved joints, more gout flares in the past year, and more joints with simultaneous gout flares (P<0.01). Among the ultrasound-detected lesions, patients with persistent joint pain had a higher incidence of tophus (36.4% vs. 21.1%) and bone erosion (18.6% vs. 8.6%) (P<0.05). Higher UA and lower TBil were found in patients with persistent joint pain (P<0.001). Hypertension (54.9% vs. 38.7%) and metabolic syndrome (58.8% vs. 46.4%) were both more frequent in patients with persistent joint pain (P<0.05). TBil was negatively correlated with the incidence of persistent joint pain (P<0.001, r=−0.190), UA values (P<0.001, r=−0.125), and metabolic syndrome scores (P<0.001, r=−0.192). A correlation curve was fitted using LOESS (locally weighted region). ConclusionPersistent joint pain after gout flares is a marker of increased disease burden in gout. The significance of the level of total bilirubin for the exacerbation of gout deserves further study.

Coexistence of pulmonary arterial hypertension and straight back syndrome in a patient with a novel BMPR2 variant affecting cytoplasmic tail domain

BackgroundPathologic variants in the bone morphogenetic protein receptor-2 (BMPR2) gene cause a pulmonary arterial hypertension phenotype in an autosomal-dominant pattern with incomplete penetrance. Straight back syndrome is one of the causes of pseudo-heart diseases. To date, no cases of idiopathic or heritable pulmonary arterial hypertension with straight back syndrome have been reported.Case presentationA 30-year-old female was diagnosed with pulmonary arterial hypertension by right heart catheterization. Computed tomography revealed a decreased anteroposterior thoracic space with heart compression, indicating a straight back syndrome. Genetic analysis by whole exome sequencing identified a novel c.2423_2424delGT (p.G808Gfs*4) germline frameshift variant within BMPR2 affecting the cytoplasmic tail domain.ConclusionsThis is the first report of different straight back characteristics in heritable pulmonary arterial hypertension with a novel germline BMPR2 variant. This finding may provide a new perspective on the variable penetrance of the pulmonary arterial hypertension phenotype.

Vitamin E Can Down-regulate Some of Apoptotic Genes Involved in Pulmonary Hypertension Syndrome in Broiler Chicken

Vitamin E Can Down-regulate Some of Apoptotic Genes Involved in Pulmonary Hypertension Syndrome in Broiler Chicken

Resolution of the Council of Experts “The choice of antihypertensive therapy in patients with hypertension and obstructive sleep apnea syndrome”

On June 24, 2023, a meeting of the Council of Experts was held in videoconference mode with the support of Merck LLC, dedicated to the choice of antihypertensive therapy in patients with arterial hypertension and obstructive sleep apnea syndrome.

Clinical and diagnostic features of repeated mild traumatic brain injuries

Repeated mild traumatic brain injury (TBI) leads to new changes and exacerbates the existing ones caused by the primary trauma. The pathogenetic mechanisms of repeated TBI are the result of traumatic effects and their cumulation. They cause various morphological and functional changes in the brain. Objective — to improve the diagnosis of pathological changes in patients with repeated mild traumatic brain injury. Materials and methods. The study involved 199 patients with a history of repeated mild TBI. Men predominated among them — 158 (79.40 %). There were 80 (40.20 %) patients of youthful age (17—24 years), 78 (39.20 %) of young age (25—44 years), and 41 (20.60 %) of middle-aged (45—60 years). The number of repeated TBIs per patient ranged from two to five. All patients were examined in the remote period of TBI. The control group consisted of 30 people aged 18 to 50 years (mean age — (33.11 ± 3.09) years) who had no history of TBI. Cognitive impairment (CI) was assessed by neuropsychological examination using the Mini-Mental State Examination (MMSE), the Frontal Area Battery (FAB), and the clock drawing test. Methods of neuropsychological analysis, neuroimaging and neurophysiological methods were used. The data of clinical and neurological examinations and studies of cognitive functions were analyzed, structural changes of the brain and cerebrospinal tract were established on the basis of neuroimaging studies of the brain, and the peculiarities of cerebral hemodynamics in patients with mild repeated TBI were determined. The characteristics of neurophysiological changes in patients are given based on the study of the features of electroencephalographic changes and the study of cognitive evoked potentials of the brain. The immune status was evaluated in patients who had repeated mild TBI. Results. Repeated TBI in our study was observed in the form of mild concussions and brain contusions. Their number in one patient ranged from 1 to 5. Clinical manifestations of repeated mild TBI had peculiarities: cephalalgic, cerebral and cerebrospinal hypertensive syndrome, cognitive impairment, diffuse neurological symptoms, and pyramidal insufficiency prevailed in the clinical picture. Only in the main group were cases of a combination of three to eight neurological syndromes detected. A decrease in cognitive function was found in patients with repeated mild TBI compared to the control group according to neuropsychological testing. The analysis of cognitive evoked potentials revealed an increase in the latent period of the cognitive complex P300 in patients with repeated TBI compared with the control group, indicating a decrease in cognitive function. More frequent CP was detected in the main group. The use of modern neuroimaging methods revealed that patients with repeated TBI had increased width of the lateral ventricles on both sides, ventricle III, and the cavity of the septum compared with the control group, as well as a higher frequency of expansion of the septum and convexity of the subarachnoid spaces. Patients with repeated mild TBI are characterised by an increase in blood flow velocity in the extracranial parts of the carotid basin and a decrease in velocity in the vessels of the vertebrobasilar basin with a change in vascular resistance, in the segments of the intracranial part of the carotid basin — a decrease in blood flow velocity without a change in vascular resistance. Disorders of venous cerebral circulation (increased velocity in the internal jugular vein and Rosenthal veins) were recorded in the majority of the main group. According to the data of the CEG, in patients with repeated TBI against the background of diffuse changes in brain bioelectrical activity, focal changes in the left hemisphere of the brain are more common. Dominant arrhythmia was recorded in 97.78 % of patients in the main group. The amplitude of arrhythmia in patients with repeated TBI is lower compared to the control group, and the frequency of arrhythmic oscillations is higher. Conclusions. The use of clinical and diagnostic control allows to prevent the development of damage and obtain objective information about the state of the brain and its structures.

Risks of adverse outcomes and neonatal morbidity in pregnant women with SARS-CoV-2 depending on the trimester of infection

Introduction. COVID-19 in pregnant women adversely affects the course of the disease, pregnancy outcomes, and morbidity in newborns. However, studies on the impact of the gestational age at which SARS-CoV-2 infection occurs on the risk of neonatal morbidity are lacking.Aim. To assess the risks of adverse pregnancy outcomes and neonatal morbidity in newborns depending on the gestational age at which women were infected with SARS-CoV-2.Materials and methods. The study included 215 women infected with SARS-CoV-2 in the first, second, and third trimesters of pregnancy and 50 uninfected pregnant women. Newborns formed corresponding groups. Data for analysis (general clinical, anamnestic, childbirth outcomes, and newborn condition) were obtained from the records of pregnant, laboring, and postpartum women.Results. In 4.7% of women infected in the first trimester, pregnancy was accompanied by spontaneous miscarriage and in 1.9% by ectopic pregnancy development. In 1.9% of women infected in the second trimester, antenatal fetal demise in a full-term pregnancy was detected. Patients infected with SARS-CoV-2 more often underwent cesarean section (31.7%). The median weight and height of newborns from mothers infected with SARS-CoV-2 were lower than in the control group. The Apgar score at the first minute showed no differences, but at the fifth minute, it was lower than in the control group. Newborns from mothers infected with SARS-CoV-2 were more frequently diagnosed with cerebral ischemia (26.3%), motor disorder syndrome (20.7%), and persistent fetal circulation (27.8%). Only in newborns from mothers with SARS-CoV-2 were hypertensive syndrome (13.1%), posthypoxic cardiomyopathy (13.1%), and intraventricular hemorrhages (10.1%) detected. The Apgar score at the first minute in newborns from mothers infected with SARS-CoV-2 in the third trimester of pregnancy was higher compared to infections in the second trimester. Neonatal morbidity in this cohort of newborns was characterized by a high frequency of cerebral ischemia, motor disorder syndrome, hypertensive syndrome, and persistent fetal circulation. Infection in the third trimester increased the risk of neonatal morbidity: cerebral ischemia by 5.6 times, motor disorder syndrome by 13.78 times, hypertensive syndrome by 8.61 times, and persistent fetal circulation by 2.76 times.Conclusion. COVID-19 during pregnancy increases the risks of adverse outcomes and the development of neonatal pathology in newborns. The frequency of their development is associated with the gestational age at which women were infected. Infection of women with SARS-CoV-2 in the first and second trimesters of pregnancy increases the risk of spontaneous miscarriage and antenatal fetal death, in the third trimester – the development of intraventricular hemorrhages and posthypoxic cardiomyopathy in newborns.

Study of various dietary interventions in patients with hypertension and metabolic syndrome

Obesity is an independent risk factor оf cardiovascular diseases (CVD), type 2 diabetes mellitus and arterial hypertension (HT). Optimization of CVD control methods is one of the most relevant and urgent problems for Russia. Many studies have shown that body weight correlates with blood pressure, and this relationship is due to complex pathogenetic mechanisms. Therefore, therapeutic approaches in a patient with obesity, metabolic syndrome and HT require consideration of all pathophysiologic changes associated with these diseases. Non-pharmacological treatments such as lifestyle changes including weight loss, following dietary guidelines and increasing physical activity can directly affect of BP levels and improve BP control. A wide range of nutritional interventions are effective in treating obesity and comorbidities, and clinicians must consider all options and provide personalized interventions. The Mediterranean diet, vegetarian diets, DASH-diet, Nordic diet, and low-carbohydrate diets have all been associated with improved metabolic health with or without changes in body weight. Recent evidence reinforce more the role of dietary fiber supplementation to the daily diet in patients with HT and metabolic syndrome, although no evidence of significant benefit has been found. Taking into account national dietary characteristics, we have proposed a study in which we plan to study the effect of the Russian diet with fiber supplementation on metabolic parameters in patients with HT. It is planned to evaluate the effect of diet therapy on indicators of metabolic disorders of intestinal metabolites.

Abstract 2238: Reducing cardiovascular disease risk in cancer survivors: Impact of a 16-week circuit-based interval exercise intervention

Abstract Introduction: Obesity and physical inactivity pose a significant health concern for cancer survivors in developing comorbid conditions such as type 2 diabetes, hypertension, and metabolic syndrome that lead to a heightened risk of cardiovascular disease (CVD). Therefore, regular physical activity plays a central role in reducing the risk of CVD. The Framingham risk score (FRS) is an established assessment of CVD risk that combines six risk factors including age, gender, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), systolic blood pressure, diabetes, and smoking status. The objective of the study was to investigate the effects of a 16-week circuit, interval-based exercise training intervention on FRS and the 10-year FRS-predicted risk of developing CVD among breast, prostate, and colorectal cancer survivors. Methods: This single center, pilot randomized controlled trial consisted of 90 sedentary, overweight or obese (BMI &amp;gt; 25.0 kg/m2) survivors of breast, prostate or colorectal cancers, randomized to exercise (n=60) or usual care (n=30). The 16-week intervention comprised supervised moderate to vigorous intensity aerobic (65-85% of VO2max) and resistance (65-85% of 1-repetition maximum) exercise sessions conducted in a circuit-based interval fashion, occurring three times per week. Blood samples were obtained at baseline and post-intervention time points to measure fasting plasma levels of HDL-C and LDL-C, along with resting systolic blood pressure and diagnosis of diabetes. Paired t-test and repeated measure ANOVA were used to determine between-group differences. Results: Participants (age 63.2 ± 10.8 years) were diagnosed with breast (35%), prostate (30%), and colorectal (35%) cancers and consisted of 55% female participants, participants had a mean BMI of 34.7±5.9, and 85% were obese. Chemotherapy and/or radiation therapy was completed by 75% of participants. Retention and adherence rates to exercise were high (100% and 92%, respectively). Compared to usual care, circuit, interval-based exercise significantly reduced total FRS (between group mean difference, -12.0 points p&amp;lt;0.001) and 10-year CVD risk (-10.0%; p&amp;lt;0.001). Conclusions: This study underscores the critical role of circuit-based, interval exercise interventions in mitigating the elevated cardiovascular risk faced by sedentary, overweight, or obese cancer survivors. The significant reduction in FRS components highlights the potential of structured exercise programs to enhance cardiovascular health, thereby reducing the burden of comorbid conditions and CVD risk in cancer survivors. Citation Format: Amber J. Normann, Rebekah L. Wilson, Cami N. Christopher, Mary K. Norris, Simone Cuomo, Christina M. Dieli-Conwright. Reducing cardiovascular disease risk in cancer survivors: Impact of a 16-week circuit-based interval exercise intervention [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 2238.

Major considerations of enteral nutritional therapy in patients with congestive heart failure: a systematic review

Introduction: Nutrition in the cardiovascular area has focused on improving lifestylerelated diseases such as hypertension, diabetes, dyslipidemia, obesity, and metabolic syndrome from the point of view of primary and secondary prevention, that is, “nutrition for weight loss ” and nutritional guidance has been required. Congestive heart failure (CHF) is a serious and growing public health problem worldwide. Approximately 25 million people are carriers of this disease and two million new cases are diagnosed each year, and enteral nutrition has been highlighted. Objective: It was to develop a systematic review of the main clinical outcomes that highlight the importance of enteral nutritional therapy in patients with congestive heart failure. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from October to November 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 143 articles were found. A total of 45 articles were evaluated and 34 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 21 studies with a high risk of bias and 17 studies that did not meet GRADE and AMSTAR-2. It was concluded enteral nutrition is highly recommended in an attempt to mitigate weight loss in these patients. Enteral diet therapy can be infused continuously or intermittently. Studies have shown that more debilitated and less active patients better accept the diet via continuous tube, slowly and for a long period, even in those with heart disease.

O250: Blood Pressure Homeostasis and Hyper-perfusion Syndrome Following Carotid Surgeries

Abstract Objectives We aim to compare blood pressure homeostasis in patients undergoing bilateral versus unilateral carotid surgeries. Our primary endpoints are the incidence of postoperative hypertension and hyperperfusion syndrome (HPS). Secondary endpoints are major adverse cardiovascular events and all-cause mortality. Methods All patients undergoing carotid endarterectomy (CEA) from 2003 to 2022 were reviewed. We performed 1230 carotid interventions, of which 690 procedures had ten years of follow-up. Results Both the unilateral (512) and bilateral (91) carotid interventions caused a significant acute elevation in blood pressure (p&amp;lt;0.001). In unilateral carotid interventions, the mean SBP was 137 ± 19.90 mmHg preoperatively and 152 ± 25.80 postoperatively (p&amp;lt;0.001). Smoking (p=0.007), hyperfibrinogenemia (p=0.004), emergency admission (p=0.005), ipsilateral carotid stenosis &amp;gt;90% (p=0.022), and previous ipsilateral carotid intervention (p=0.003) were significantly associated with the development of postoperative hypertension. No incidence of HPS occurred in the unilateral group. In bilateral carotid interventions, the mean SBP was 138 ± 20.50 mmHg preoperatively and 159 ± 24.60 mmHg postoperatively (p&amp;lt;0.001). Emergency admission (p=0.012) and plaque morphology (p=0.035) were significantly associated with postoperative hypertension. Three patients with bilateral carotid interventions had HPS (3.3%) and developed hemorrhagic stroke within 30 days. Multivariate analysis found postoperative stage II hypertension following bilateral carotid procedures to be an independent predictor of stroke (p=0.004). However, postoperative hypertension was not an independent predictor of myocardial infarction (p=0.475) and mortality (p=0.608). Conclusion Significant acute elevation in blood pressure occurred following carotid surgeries. We observed HPS post bilateral carotid interventions, with postoperative hypertension being an independent predictor of peri-operative stroke.

Onco-Hypertension in Patients with Kidney Disease.

Cancer, hypertension, and kidney disease are closely interrelated. Knowledge of the potential hypertensive and nephrotoxic effects of antineoplastic medications is critical to minimizing interruptions in cancer treatment. Antineoplastic medications can cause hypertension, proteinuria, and kidney injury, often mediated by common mechanisms. Notably, inhibitors of the vascular endothelial growth factor pathway have the strongest association with both hypertension and proteinuria, typically acute in onset and often reversible after drug discontinuation. The abrupt rise in blood pressure can cause clinically significant hypertensive syndromes and contribute to overall morbidity. Significant proteinuria can herald kidney failure. Close monitoring of blood pressure and renal function during antineoplastic therapy and appropriate hypertension treatment are important. This article reviews available literature and proposes a step-by-step approach to manage cancer patients with concurrent hypertension and kidney disease. For antineoplastic medications with known hypertensive effect, blood pressure should be checked at baseline and serially during cancer treatment. Hypertensive crisis with end-organ damage, significant proteinuria, microscopic hematuria, or unexplained acute kidney injury necessitates drug cessation until further evaluation and resolution. In patients with chronic kidney disease and cancer therapy-related hypertension, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker is the preferred antihypertensive choice. Finally, multidisciplinary collaboration in these patients will yield the best results.

Maternal Blood Adipokines and Their Association with Fetal Growth: A Meta-Analysis of the Current Literature.

Background: Assessing fetal growth constitutes a fundamental aim within the realm of prenatal care. Impaired prenatal growth increases the risk of perinatal mortality, morbidity, and poor newborn outcomes. Growth restriction increases the risk of premature birth problems, as well as the risk of poor neurodevelopmental outcomes and future non-communicable disorders such as hypertension and metabolic syndrome as adults. The objective of this systematic review is to accumulate current literature evidence to assess the patterns of serum adipokine levels among women with growth-restricted fetuses and assess their potential alterations in those high-risk pregnancies. Methods: Medline, Scopus, CENTRAL, Clinicaltrials.gov, and Google Scholar databases were systematically searched from inception until 31 March 2023. All observational studies reporting serum adipokine values among women with appropriately grown and growth-restricted fetuses were held eligible. Results: The current systematic review encompassed a total of 20 studies, incorporating a patient population of 1850 individuals. Maternal blood leptin emerged as the adipokine most investigated, as evidenced by 13 studies encompassing a collective sample size of 1081 patients, all of which explored its potential correlation with intrauterine growth restriction. Elevated levels of leptin were detected in fetuses with intrauterine growth restriction, although the observed difference did not reach statistical significance. Furthermore, regarding adiponectin, the meta-analysis conducted indicated that there were not any statistically significant differences observed in the mean values of adiponectin. The available data on the remaining three adipokines were extremely limited, making it difficult for any solid conclusions to be extracted. Conclusions: Though limited and inconsistent, the existing data suggest that fetal growth restriction is not linked to leptin, adiponectin, visfatin, resistin, or RBP4. More substantial prospective studies are needed to comprehend the importance of established and novel adipokines.

Multiple-autoimmune syndrome causing interstitial lung disease in the presence of pulmonary hypertension and Erasmus syndrome

Connective tissue diseases constitute a group of inflammatory disorders that can concurrently affect multiple organs. Pulmonary manifestations of connective tissue diseases include interstitial lung disease, pulmonary hypertension, pleural diseases, and airway compromise. Both interstitial lung disease and pulmonary arterial hypertension have high morbidity and mortality in these patients. Interstitial lung disease affects 40 % - 50 % of patients with connective tissue diseases, predominantly systemic sclerosis, rheumatoid arthritis, and inflammatory myopathies. Parenchymal compromise is heterogeneous and depends on the underlying disease. Conversely, pulmonary arterial hypertension is found mostly in systemic sclerosis, systemic lupus erythematosus and mixed connective tissue disease. Delays and the diagnosis of connective tissue disorder associated interstitial lung disease are frequent as evidence is limited and as they often present concomitantly or overlap with other pulmonary diseases. Timely diagnosis and treatment are fundamental to decrease mortality. Treatment varies by the type of connective tissue disease, nevertheless, evidence of these complications in the context of multiple-autoimmune syndrome is still limited.&#x0D; We present a complex case of a 47-year-old male with a multiple-autoimmune syndrome (systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, Sjögren syndrome and mixed connective tissue disease) complicated by interstitial lung disease and pulmonary hypertension,   and occurring concurrently with silicosis (Erasmus syndrome), and pulmonary embolism. This case shows the diverse manifestations of connective tissue of the lungs, emphasizes the intricate nature of diagnosing and managing connective tissue disorder-related pulmonary complications in the context of multiple autoimmune syndromes, and the importance of a multidisciplinary team for the diagnostic and therapeutic approach of the patient.