Pressure Levels Research Articles

#1478 Effect of low vs standard dialysate sodium on 48-h ambulatory blood pressure in patients with intradialytic hypertension: a randomized crossover study

Abstract Background and Aims Intradialytic hypertension (IDH) is associated with increased risk for cardiovascular events and mortality. Patients with IDH exhibit higher 48-h blood pressure (BP) levels than patients without this condition. Volume and sodium excess are considered a major factor contributing in the development of this phenomenon. This study evaluated the effect of low (137 mEq/L) compared to standard (140 mEq/L) dialysate sodium concentration on 48-h BP in patients with IDH. Method In this randomized, single-blind, crossover study, 29 patients with IDH underwent 4 hemodialysis sessions with low (137 mEq/L) followed by 4 sessions with standard (140 mEq/L) dialysate sodium or vice-versa. Mean 48-h BP, pre-/post-dialysis and intradialytic BP, pre-dialysis weight, interdialytic weight gain (IDWG) and lung ultrasound B-lines were assessed. Results Mean 48-h SBP/DBP were significantly lower with low compared to standard dialysate sodium concentration (137.6 ± 17.0/81.4 ± 13.7 mmHg with low vs 142.9 ± 14.5/84.0 ± 13.9 mmHg with standard dialysate sodium, p = 0.005/p = 0.007 respectively); SBP/DBP levels were also significantly lower during the 44-h and different 24-h periods. Low dialysate sodium significantly reduced post-dialysis (SBP/DBP: 150.3 ± 22.3/91.2 ± 15.1 mmHg with low vs 166.6 ± 17.3/94.5 ± 14.9 mmHg with standard dialysate sodium, p < 0.001/p = 0.134 respectively) and intradialytic (141.4 ± 18.0/85.0 ± 13.4 mmHg with low vs 147.5 ± 13.6/88.1 ± 12.5 mmHg with standard dialysate sodium, p = 0.034/p = 0.013, respectively) BP compared with standard dialysate sodium. Pre-dialysis weight, IDWG and pre-dialysis B-lines were also significantly decreased with low dialysate sodium. Conclusion Low dialysate sodium concentration significantly reduced 48-h ambulatory BP compared with standard dialysate sodium in patients with IDH. These findings support low dialysate sodium as a major non-pharmacologic approach for BP management in patients with IDH. Registered at ClinicalTrials.gov with study number NCT05430438.

Tartaric acid ameliorates experimental non-alcoholic fatty liver disease by activating the AMP-activated protein kinase signaling pathway

Tartaric acid (TA) has been shown beneficial effects on blood pressure and lipid levels. However, its effect on non-alcoholic fatty liver disease (NAFLD) remains unknown. This study aimed to investigate the role of TA in experimental NAFLD. Mice were fed a Western diet for 8 weeks, followed by administration of TA or a vehicle for an additional 12 weeks while continuing on the Western diet. Blood biochemistry including transaminases and glucose tolerance test and liver tissue RNA sequencing (RNA-seq), lipid content, and histology were investigated. The HepG2 cell line was used to explore the mechanism by which TA regulates lipid metabolism. We found that TA significantly improved weight gain, insulin resistance, hepatic steatosis, inflammation and fibrosis in Western diet-fed mice. By comparing gene expression differences, we found that TA affects pathways related to lipid metabolism, inflammatory response, and fibrosis. Furthermore, TA effectively reduced oleic acid-induced lipid accumulation in HepG2 cells and downregulated the genes associated with fatty acid synthesis, which were enriched in the AMP-activated protein kinase (AMPK) signaling pathway. TA also enhanced the phosphorylation of AMPK which could be reverted by the AMPK inhibitor Compound C in HepG2 cells. Our study suggests that TA improves experimental NAFLD by activating the AMPK signaling pathway. These findings indicate that TA may serve as a potential therapy for the human NAFLD.

#1860 Oral semaglutide in diabetic kidney transplant recipients: Evaluating effectiveness and safety

Abstract Background and Aims Glucagon-like peptide 1 receptor agonists (GLP1-RA) have demonstrated cardiovascular and renal benefits in obese diabetic patients. However, the evidence for oral semaglutide in kidney transplant (KT) patients is very limited. Our study aims to analyze the effectiveness and safety of oral semaglutide in diabetic KT patients. Method Retrospective cohort study of KT with diabetes who started oral semaglutide in 3 Spanish hospitals (Puerta del Mar University Hospital, Jerez de la Frontera University Hospital and Puerto Real University Hospital) between December 2021 and December 2023. None of them had previously received subcutaneous GLP1-RA. Clinical and demographic variables were analyzed. Glomerular filtration rate (eGFR), proteinuria, and weight were collected at the start of the treatment and after 6 and 12 months. We analyze glycemic control, blood pressure, lipid profile and trough level, dose and C/D ratio of tacrolimus. Acute rejections (AR), de novo donor-specific antibodies (dnDSA) and adverse effects were documented. Parametric and non-parametric tests were performed according to the normality of the sample. Results In this period, 22 KT with DM started treatment with oral Semaglutide, of which 16 patients completed follow-up for 6 months and 11 patients for 1 year. Fourteen (63.6%) had developed post-transplant DM. The mean age was 61 years, and 77% were men. The mean baseline estimated glomerular filtration rate (eGFR) was 46.1 ml/min/1.73 m2, the baseline body mass index was 34.7 kg/m2 and the median KT vintage was 45 months. Three patients were on treatment with SGLT2i at the start of the drug. Variables compared during the follow-up are shown in Table 1. Four patients (18%) suffered gastrointestinal side effects. No dnDSA were documented during follow-up. One episode of AR was documented after drug initiation. Conclusions We show the longest series of oral semaglutide in KT patients. Our results support that it can be a good option for managing DM in KT, especially in obese patients.

Combination therapy for hypertension management: insights from the Indian experts

Cardiovascular diseases (CVDs) pose a significant global health challenge, with India bearing a disproportionate burden of CVD-related morbidity and mortality. Hypertension (HTN) is a major risk factor for CVDs, affecting nearly 30% of the Indian population. Achieving target blood pressure (BP) levels is crucial for reducing cardiovascular risk, necessitating aggressive antihypertensive therapy. Combination therapy has emerged as a cornerstone in HTN management, especially in high-risk patients. This review delves into the literature and perspectives of Indian cardiologists on combination therapy for HTN management. Despite the efficacy of contemporary antihypertensive medications, a substantial proportion of patients fail to reach target BP levels with monotherapy. Combination therapy offers synergistic effects, addressing multiple pathways involved in HTN pathogenesis. Recent guidelines recommend initiating treatment with two-drug combinations, transitioning to three-drug combinations in resistant cases. Combination therapy not only enhances BP control but also reduces the risk of cardiovascular events and mortality compared to monotherapy. Optimal management of HTN requires personalized approaches, considering individual patient profiles and comorbidities such as coronary artery disease (CAD), diabetes mellitus (DM), dyslipidemia, and heart failure (HF). In such cases, combination therapy plays a pivotal role in mitigating cardiovascular risks. ARB/CCB combination therapy, particularly telmisartan/amlodipine, demonstrates significant efficacy and tolerability across various patient populations, including those with metabolic risk factors and renal impairment. Expert recommendations highlight the importance of individualized therapy, patient education, early diagnosis, and initiation with dual therapy in India. Strategies to improve medication adherence and compliance, such as single-pill double or triple combinations, are emphasized. Moreover, awareness of newer treatment options and contactless diagnostic instruments is crucial for optimizing HTN management. In conclusion, combination therapy stands as a cornerstone in HTN management, offering enhanced efficacy, tolerability, and cardiovascular protection. Tailored approaches guided by expert recommendations are essential to address the growing burden of HTN and reduce the socioeconomic impact of CVDs in India.

#1713 Blood pressure goals in kidney transplant recipients: an analysis of the collaborative transplant study

Abstract Background and Aims Hypertension is an independent risk factor for cardiovascular disease, the leading cause of death in kidney transplant recipients. Because there is no “one size fits all” approach to blood pressure targets, particularly in the heterogenous group of kidney transplant recipients, identification of subgroup-specific targets, considering factors like age and sex, may be appropriate. However, currently available studies are limited because of sample sizes, and no subgroup analyses have been performed examining the effects of different blood pressure targets on allograft and patient survival. The aim of our study was to investigate the impact of different ACC/AHA blood pressure categories on graft survival and patient mortality and to identify subgroup-specific targets. Method This large-scale retrospective study included 1-year blood pressure data from 62, 556 kidney transplant recipients reported to the Collaborative Transplant Study from 209 centers in 39 countries. Hypertension was categorized according to 2017 ACC/AHA guidelines. The primary outcomes were death-censored graft failure and patient mortality during post-transplant year 1 to 6. Multivariable Cox regression analysis was performed to control for immunologic and nonimmunologic confounders. Results One year after transplantation, 77% of kidney transplant recipients had hypertension. Hypertension stages 1 (130–139/80–89 mmHg), 2a (140–159/90–99 mmHg), and 2b (≥160/≥100 mmHg) were associated with an 8%, 34%, and 102% increased risk of death-censored graft failure, respectively, whereas elevated blood pressure levels (120–129/<80 mmHg) did not significantly increase the risk. Patient mortality was only significantly higher in those with hypertension stage 2b with a Hazard Ratio of 1.21 (95% CI, 1.08–1.36; P < .001). In addition, the impact of hypertension stages on death-censored graft failure varied in different subpopulations (Fig. 1). Female recipients, younger recipients, recipients who received kidneys from donors younger than 60 years, re-transplanted recipients, and recipients with pre-transplant HLA antibodies had a significantly increased risk of death-censored graft failure associated with higher blood pressure levels (Fig. 1). Kidney transplant recipients with hypertension stage 2 continued to have an increased risk of graft failure one year after transplantation, even when they achieved normal blood pressure in the second year. Conclusion This study highlights the importance of treating hypertension early after kidney transplantation to improve long-term graft and patient survival. Attention should be paid to female, younger, and sensitized recipients, who may particularly benefit from optimal blood pressure control.

#2251 Long-term systolic blood pressure variability as an independent risk factor for cardiovascular events in kidney transplant recipients

Abstract Background and Aims Cardiovascular (CV) events represent the main cause of death in patients undergoing renal transplantation. Several studies have described the role of blood pressure variability (BPV) in predicting all-cause mortality and fatal and non-fatal CV events in the general population and in diabetic patients. Systolic blood pressure variability (SBPV) has recently been proposed as a predictor of clinical outcomes in patients with chronic kidney disease. However, evidence is still scarce about the prognostic role of BPV in the setting of renal transplantation. The aim of the study was to evaluate the role of long-term SBPV in the development of fatal and non-fatal CV events (myocardial infarction, unstable angina or revascularization, stroke and hospitalization for heart failure) in subjects undergoing kidney transplantation. Method We performed a single-center retrospective observational analysis in a cohort of 272 kidney transplant patients (mean age 64 ± 13 years, 66% men), with a transplant duration ≥12 months and with at least 6 blood pressure measurements at defined intervals (3 months ±15 days) over an assessment period of 18 months. BPV was expressed as standard deviation of ambulatory systolic blood pressure (SBP) and patients were accordingly classified in tertiles (low <9.3 mmHg, medium 9.3-13 mmHg, high >13 mmHg). The role of SBPV was analyzed by Kaplan-Meier (logrank) and its independent effect by Cox Regression. Results Over a mean follow-up of 58.7 ± 17.2 months, 27 subjects (9.9%) developed CV events. For each increase of 2.7 mmHg in SBP standard deviation, the risk for fatal or non-fatal CV events increased almost 3-folds (P = 0.02) and patients in the highest tertile of SBP standard deviation showed a 4-fold increased risk (P = 0.01) (Fig. 1). This relationship was maintained even after incremental adjustment for time-averaged pulse pressure, age, diabetes, prior CV event, and dialysis vintage (HR 3.2, 95% CI 1.1–10.0, p 0.04) (Table 1). Conclusion Long-term BPV represents an independent risk factor for CV events in kidney transplant patients. It is therefore essential to seek for stable long-term blood pressure levels in this population in order to minimize the residual CV risk.

Mean Arterial Pressure and Neonatal Outcomes in Pregnancies Complicated by Mild Chronic Hypertension.

To estimate the association between mean arterial pressure during pregnancy and neonatal outcomes in participants with chronic hypertension using data from the CHAP (Chronic Hypertension and Pregnancy) trial. A secondary analysis of the CHAP trial, an open-label, multicenter randomized trial of antihypertensive treatment in pregnancy, was conducted. The CHAP trial enrolled participants with mild chronic hypertension (blood pressure [BP] 140-159/90-104 mm Hg) and singleton pregnancies less than 23 weeks of gestation, randomizing them to active treatment (maintained on antihypertensive therapy with a goal BP below 140/90 mm Hg) or standard treatment (control; antihypertensives withheld unless BP reached 160 mm Hg systolic BP or higher or 105 mm Hg diastolic BP or higher). We used logistic regression to measure the strength of association between mean arterial pressure (average and highest across study visits) and to select neonatal outcomes. Unadjusted and adjusted odds ratios (per 1-unit increase in millimeters of mercury) of the primary neonatal composite outcome (bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, or intraventricular hemorrhage grade 3 or 4) and individual secondary outcomes (neonatal intensive care unit admission [NICU], low birth weight [LBW] below 2,500 g, and small for gestational age [SGA]) were calculated. A total of 2,284 participants were included: 1,155 active and 1,129 control. Adjusted models controlling for randomization group demonstrated that increasing average mean arterial pressure per millimeter of mercury was associated with an increase in each neonatal outcome examined except NEC, specifically neonatal composite (adjusted odds ratio [aOR] 1.12, 95% CI, 1.09-1.16), NICU admission (aOR 1.07, 95% CI, 1.06-1.08), LBW (aOR 1.12, 95% CI, 1.11-1.14), SGA below the fifth percentile (aOR 1.03, 95% CI, 1.01-1.06), and SGA below the 10th percentile (aOR 1.02, 95% CI, 1.01-1.04). Models using the highest mean arterial pressure as opposed to average mean arterial pressure also demonstrated consistent associations. Increasing mean arterial pressure was positively associated with most adverse neonatal outcomes except NEC. Given that the relationship between mean arterial pressure and adverse pregnancy outcomes may not be consistent at all mean arterial pressure levels, future work should attempt to further elucidate whether there is an absolute threshold or relative change in mean arterial pressure at which fetal benefits are optimized along with maternal benefits. ClinicalTrials.gov, NCT02299414.

Passive Control Measures of Wind Flow around Tall Buildings

The growth and diversification of tall buildings demands higher performance standards that encompass serviceability and resilience. In this respect, the control of air flow around tall buildings poses challenges to minimising the energy that could induce large vibrations or forces. The present investigation scrutinises the flow around a tall structure with variations on its surface roughness by adding balconies to the facade, as a form of passive control of the flow loads. This is conducted through flow simulations across optimised computational arrays that capture 3D effects. To illustrate the applicability of the proposed approach, two types of facades rotated 0∘, 90∘ and 180∘ are considered while focusing on pressure and vorticity fields. It was found that the presence of balconies produces zig-zag patterns on the face where they are located, whereas balconies on the front facade reduce drag with respect to the smooth case. Furthermore, buildings with balconies on their lateral faces experience some increase in drag force and the improvement of the aerodynamics around the lateral pedestrian zones. No qualitative variations between triangular and rectangular balconies were found, excepting some changes in pressure magnitude on the rear side induced by balconies placed on the front and rear facades. Through the comparison of results, it was confirmed that the findings align with previous studies undertaken for medium and low-rise buildings. This reinforces the proposal of using such passive control measures to improve the aerodynamic performance of tall buildings. The study enables the quantification of flow configurations and forces on the building’s faces. Some of the proposed passive control measures effectively mitigate pressure levels while causing large local disturbs on pressure and vorticity that should be attended to by designers of this type of facades.

Development of an empirical model for the prediction of the sound absorption coefficient for thin and low-density fibrous materials

Currently, FEA software such as ABAQUS uses empirical models to predict the sound absorption coefficient of poroelastic materials. However, based on a recent review of the literature it was found that the current sound absorption empirical models are inadequate for accurate prediction of thin (t < 20 mm), low-density materials (ρB < 50 kg/m3). Therefore, the predictions of the sound pressure levels in vehicle cabins, using such software, will be inaccurate since the trim materials are thin and have a low density. Thus, this research aimed to develop an empirical model that can accurately predict the sound absorption coefficient of these materials. Hence, polypropylene fibres consisting of four different diameters were manufactured and converted into nonwovens. Thereafter, airflow resistivity and impedance tube experimental testing were performed on the specimens. Subsequently, statistical analysis of the data was performed using SAS software. SAS was used to identify which independent variables should be included in the models to be developed. The empirical models were developed using the regression analysis toolbox in Microsoft Excel. Once the models were developed, various checks were performed to validate the assumptions of linear regression. The software NumXL was used to perform Cook’s distance tests. Thereafter, the models were validated against the validation dataset, where it was found that the developed exponential model performed best. Finally, the exponential model was compared to existing models using two data sets i.e. an internal dataset, and an external dataset derived from the literature. The developed model outperformed all the historic models on both datasets.

A study on optimizing public spaces in rural heritage tourist sites from spatial perception: The case of Jinggang historic town

The development of cultural and rural tourism has fostered the expansion of heritage sites while concurrently presenting challenges such as resource wastage and cultural degradation. Optimizing spatial use requires a comprehensive understanding of the dynamics inherent to these sites. An emerging trend involves the integration of human perception technology into spatial perception research. Thus, to examine the correlation between alterations in physical and visual environments, tourists’ perceived changes, and primary influencing elements in rural heritage tourism sites, Jinggang – a historic and cultural town in Changsha, Hunan province, China – was selected as the research site. A comprehensive interdisciplinary analysis was conducted by integrating physical environment data from public spaces. These data include air temperature (Ta), relative humidity (RH), wind speed (WS), equivalent sound pressure level (ESPL), visual environment data (including green view index [GVI], sky view index [SVI], road and pavement view index (R&PVI), and construction view index [CVI]), along with biosensing data (level of stress [LS]) collected from tourists. The findings indicate the following: (i) the LS of the public space in Jinggang falls within the normal range but remains generally high, with the humanistic landscape, dominated by traditional architecture, scoring higher than the natural landscape; (ii) regarding spatial perception, the quantity of physical environment elements influencing LS surpasses that of visual environment elements, and the most relevant indicators, including ESPL, R&PVI, and CVI, all contribute to tourists’ LS; and (iii) ESPL significantly influences LS within the environment domain, where higher environmental noise decibels correspond to tourists’ increased LS. The study concludes that historic towns possess distinct characteristics as types of rural heritage tourism sites. This study provides valuable insights into enhancing spatial environmental quality and promoting an appealing and sustainable rural setting by implementing public space optimization strategies in rural heritage sites.

An objective identification technique for potential vorticity structures associated with African easterly waves

Abstract. Tropical Africa and the North Atlantic Ocean are significantly influenced by African easterly waves (AEWs), which play a fundamental role in tropical rainfall and cyclogenesis in that region. The dynamics of AEWs can be described in a potential vorticity (PV) framework. The important impact of latent heat release by cloud processes is captured in this framework by the diabatic generation of PV anomalies. This paper introduces an innovative approach for the identification and tracking of PV structures within AEWs. By employing AEW tracking and computing the wave phase of each point within the AEW domain using a Hilbert transform, we are able to effectively identify and collect 3-D PV structures associated with specific AEWs. To facilitate a climatological analysis, performed here over the months of June to October from 2002 to 2022, these structures are subsequently characterized by low-dimensional descriptors, including their location, intensity, and orientation. Our climatological analysis reveals the seasonal evolution and the structural attributes of PV anomalies within AEWs over the study domain. PV feature locations closely align with the African easterly jet's latitudinal shift during the summer season. Analysis of the mean pressure level of the 3-D PV structures shows a remarkable shift during their life cycle, indicating deep moist convection characteristics over land and more shallow convection characteristics over the ocean. On average, PV features identified within AEW troughs tilt downshear over land and equatorward over the ocean. The trough-centered analysis reveals distinct differences between satellite-estimated and model-predicted rainfall. Agreement between the results of a more traditional composite analysis and our new feature analysis provides confidence in our feature approach as a novel diagnostic tool. The feature framework provides a low-dimensional representation of the PV structure of AEWs, which facilitates future statistical analyses of the relation of this structure to, for example, tropical cyclogenesis or the predictability of tropical rainfall.

#1202 Long-term evaluation of coronary calcifications in kidney transplanted patients: a single center follow up of 15 years

Abstract Background Patients with chronic kidney disease (CKD) have a relevant cardiovascular (CV) risk. Vascular calcification, particularly at coronary levels, have been related to the increased CV mortality. Few data are available on the long-term behavior of coronary artery calcifications (CAC) in kidney transplantation (KTx). In a previous paper (Alfieri C et al. Sci Rep. 2019 May 3;9(1):6869), our group explored the prevalence, the clinical and biochemical factors related with CAC and the factors implicated with CAC progression in a group of 64 KTx patients (KTXps) followed up for 5 years. Here we present the preliminary data about CAC follow up of the same population followed up for 15 years after KTx. Methods In 2007 we studied a total of 67 KTxps transplanted in our unit between 2007 and 2008. At the present time, 19 of them were lost from the follow up: 8 died, 4 because of major cardiovascular event (MACE), 11 KTxps had a graft loss and the other 20 did not adhere to the control. For this study, we evaluated 28 KTxps (M = 18; mean age 60 ± 9 yrs). Clinical parameters, blood and urinary analyses were recorded for 15 years, with particular attention for the year before CAC evaluation. For the statistical analysis the mean values of these evaluations were considered. At baseline and after 15 years from KTx, coronary TC for the evaluation of CAC using Agatson score was performed. According to the score obtained, patients were categorized in 4 groups both at baseline and at 15th year: 1) 0-10; 2) 10-100; 3) 100-400; 4) >400. The progression of CAC was determined considering the modification in CAC category (Cat-Prog+T15) and using the formula proposed by Sevrukov (AJR, 2005 Dec;185(6):1546-53) (Prog+). Results At baseline and at 15 yrs after KTx, 46% and 18% of pts were in the 1st group, 14% and 25% in the 2nd, 29% and 18% in the 3rd and 11% and 39% in 4th, respectively. CAC at 15yrs were significantly higher than baseline (156 ± 50 vs 334 ± 71 p < 0.0001). Both at baseline and after 15yrs CAC correlated directly with age (p = 0.0001; p = 0.01 resp.) and with each other (p < 0.0001). In the 79% Cat-Prog+T15 was found, in the 10,7% of more than 1 class of CAC. Prog+ was discovered in the 71% of KTxps. They were characterized to have higher systolic blood pressure levels (P = 0.05, with no difference in specific therapy), lower mean Hb and Ca levels (p = 0.02; p = 0.07 resp). In a logistic model, mean Ca Levels resulted the only independent factor inversely related with CAC15prog+ (p = 0.04). During the 15 years of KTx a MACE was experienced by the 25% of KTxps, just older than the others. Apparently, no impact for CACs was found in MACE. Conclusions To the best of our knowledge, our study is the first one to evaluate CACs in the same cohort of KTxps for such a long time. According to the preliminary data obtained, the prevalence of CAC in KTxps is quite high, and is related to age. CAC worsening, after 15 years of KTX was observed in a consistent part of the cohort and was related to different parameters, especially to Ca levels. Future researches, possibly involving a higher number of KTxps could explain better these findings and explore more deeply the relation of CACs with MACE in the long term.

#1182 Arterial hypertension and chronic obstructive pulmonary disease—problems of choice of therapy

Abstract Background and Aims The development of hypertension in COPD is based on the early formation of endothelial dysfunction in the small and large circulatory circles, increased sympathetic activity with an imbalance in the synthesis of catecholamines, a violation of the role of the lungs in the metabolism of vasoactive substances, oxidative stress, chronic systemic inflammation, an imbalance in the renin-angiotensin-aldosterone system (RAAS). There are few studies confirming the role of RAAS components in the pathogenesis of cardiovascular changes in patients COPD. The activity of angiotensin converting enzyme (ACE) increases with hypoxia, which may play an important role in increasing the degree of systemic hypertension. An increase in the function of the RAAS is possible both under the direct influence of hypoxia and indirectly through activation of the sympathoadrenal system. To evaluate the efficacy and tolerability of the angiotensin II receptor antagonist valsartan (Nortivan) at a dose 80-160 mg per day in patients with hypertension of 1-2 degrees and COPD of stage II-IV. Method The study design is a local, open, incomparable study on the efficacy and safety of the drug Nortivan in patients with hypertension in combination with COPD. We examined 18 patients with stage II-IV in remission, suffering from grade I and II hypertension, determined in accordance with the generally accepted classification of blood pressure levels (VNOK, 2010). Results The criteria for exclusion from the study were the presence in patients of complications of hypertension, coronary heart disease, decompensated chronic pulmonary heart, endocrine diseases requiring drug correction, kidney pathology, chronic heart failure, oral steroid therapy. 10 days in the last 6 months before inclusion in the study, oncological diseases and any other conditions that could interfere with the interpretation and evaluation of the results of the study. Patients who had not previously received antihypertensive treatment were included in the study immediately, and the rest underwent a washing period for 2 weeks. Patients received Nortivan as antihypertensive therapy for 24 weeks. The effectiveness of therapy was controlled by daily monitoring blood pressure. The choice of quality criteria for the effectiveness of therapy parameters SMAD is associated with literature data and own observations on the prevalence of diurnal blood pressure profiles in patients with hypertension and COPD with no decrease or increase in blood pressure at night, when office blood pressure figures are to a lesser extent reflect the effectiveness of antihypertensive therapy. The initial dosage was 80 mg/day. With insufficient hypotensive effect, the dose of the drug was doubled at the 4th week of treatment. The basic COPD therapy did not change throughout the study period and included anticholinergic drugs (ipratropium bromide, tiotropium bromide), beta2-adrenomimetic (fe-noterol) or a combination thereof. Initially and after 24 weeks of treatment, a complete laboratory examination was performed: a clinical blood test, a biochemical blood test. The thickness of the intima-media complex of the carotid arteries and ECG was also studied. The criterion The safety of the therapy was assessed by the indicators of respiratory function, daily pulse oximetry. Conclusion The use of the drug Nortivan has shown high efficacy and safety in patients Grade I–II hypertension in combination with stage II-IV COPD. A statistically and clinically significant normalization of SMAD indicators with correction of pathological types of daily curves due to a decrease in the number of patients with an increase in or the absence of a decrease in blood pressure during the night period. The safety of using the drug in the clinical group with bronchial obstruction syndrome was confirmed by the dynamics of ventilation indicators according to spirometry and the results of daily pulse oximetry, which showed the absence of exacerbation of hypoxia during therapy.

#1809 Twice against thrice-weekly hemodialysis: the TATH trial

Abstract Background and Aims Frequency of hemodialysis is still a debatable topic. Incremental hemodialysis has gained popularity and requires a smooth increase in dialysis frequency while maintaining a sufficient residual diuresis. In developing countries and some developed countries, a twice-weekly schedule independent of residual kidney function is still performed, sometimes because of lack of resources and some other times because of patients’ resistance to undergo three sessions per week. This study aimed to compare the survival of patients on twice versus thrice-weekly hemodialysis. Method This is a prospective, multicenter, non-randomized trial, that included incident patients on chronic hemodialysis between January 2018 and August 2021. Patients terminally ill were excluded. Patients were divided into two arms: twice-weekly and thrice-weekly hemodialysis. CASTOR eCRF (electronic case report form) was used for data capture. Demographics, comorbidities, laboratory tests, medications, residual diuresis and dialysis prescription were collected from the patients' medical records at dialysis initiation. Patients were followed at 1 month, 3 months, 6 months, one year and two years for their mortality, hospitalisations for pulmonary edema or hyperkalemia, uncontrolled severe hypertension and erythropoietin (EPO) dose requirement. This trial was terminated before reaching the required sample size of 800 because of the pandemic and economic crisis in the country. Missing baseline factors and covariates were imputed using multiple imputation algorithms, then entered in a logistic regression model to estimate propensity scores. A survival analysis with a cox-regression model including propensity score as a covariate assessed the difference between twice-weekly and thrice-weekly dialysis. This trial was registered on Clinicaltrials.gov ID NCT03415776. Results A total of 203 consecutive patients of 10 dialysis units were included, 133 in the thrice-weekly arm and 70 in the twice-weekly. Mean age was 67 ± 15 years, 54.2% were males, 55.5% had diabetes, 53.7% had coronary artery disease. Median eGFR at dialysis initiation was 6 (4, 8) mL/min/1.73 m2. Baseline median 24-hour diuresis was 500 (500, 1000) mL with higher diuresis in patients on twice-weekly (P = 0.051). Baseline mean hemoglobin was 9.6 ± 1.6 g/dL. 41.7% were initiated with AV fistula with more patients in the thrice-weekly initiated with temporary catheter. Median number of dialysis hours per week was 12 (10, 12) and 8 (8, 9) in thrice- and twice-weekly respectively. High-flux membranes with ultrapure dialysate were used in 55% of thrice-weekly and 74.3% of twice-weekly. Mean blood flow was 329 ± 76 mL/min. In univariate analysis, residual diuresis was significantly higher in twice-weekly at 1 month, 3 months (P = .002), 6 months (it dropped at 6 months to a median of 100 (0, 500) in thrice-weekly versus 225 (175, 875) in twice-weekly) and at one year (P = .015). Inter-dialytic weight gain and blood pressure levels were not statistically different at 1, 3, 6 months and one year. 22.5% of patients on thrice-weekly did not need antihypertensive medications at 6 months versus 12.1% in the twice-weekly. Serum potassium was significantly higher in twice-weekly at 3 months and at one year. Cumulative dose of EPO administered during 2 years was significantly higher in twice-weekly with a median of 720000 UI versus 500000 UI in thrice-weekly (P = .001) without a difference in hemoglobin but lower ferritin in twice-weekly (P = .005). There was no difference in hospitalisations' rates between the two arms. A cox regression model including propensity scores as a covariate did not show any survival difference between the two arms (Fig. 1). Conclusion Patients on twice-weekly hemodialysis had a similar survival and hospitalisations' rates at two years as patients on thrice-weekly hemodialysis. However, a twice-weekly schedule was accompanied with higher EPO dose requirements, higher serum potassium levels, more antihypertensive therapy despite more preserved residual diuresis.

Epigallocatechin gallate (EGCG) alleviates inflammation and endothelial dysfunction and improves pregnancy outcomes in preeclampsia (PE)-like rats via eNOS/Nrf2/HO-1 pathway

Background and purposeEpigallocatechin gallate (EGCG), a natural antioxidant, has shown protective effect in many diseases. We explore the effect and potential regulatory mechanisms of EGCG in preeclampsia (PE)-like rats. Methods and materialsPE was mimicked in pregnant rats. EGCG was orally administered at a dosage of 25(Low, L) or 50 mg/kg (High, H) from gestational day (GD) 6–17. The blood pressure signatures, heart rates were monitored. The 24-h proteinuria and serum were analyzed. On GD 18, rats were sacrificed, and pups and placentas were weighed. Kidneys and placentas were analyzed using immunohistochemistry (IHC) and hematoxylin-eosin staining (H&E). Placentas were examined using western blot for sFlt1, eNOS, Nrf2, HO-1, SLC7A11. MDA, GSH, GPx and Fe2+ were measured. ResultsEGCG inhibits systolic blood pressure, BUN, CREA, ALT, AST, UA and proteinuria levels in PE-like rats. EGCG enhances the pup weight and crown-rump length and reduces the rate of fetus growth restriction in PE group. Endothelial dysfunction and infiltration of inflammatory cells were found in kidney cortex and placenta tissues in PE group and were inhibited by EGCG treatment. sFlt1 was activated in placentas in PE group and inhibited by EGCG while eNOS/Nrf2/HO-1 were inhibited in PE group and restored by EGCG. MDA and Fe concentrations were elevated in PE group and reduced by EGCG while the GSH level, SLC7A11 and the GPx activity were inhibited in PE group and restored by EGCG. ConclusionEGCG alleviates inflammation, endothelial dysfunction and placental ferroptosis, improves pregnancy outcomes in PE-like rats via eNOS/Nrf2/HO-1.

Multi-Physics Coupled Acoustic-Mechanics Analysis and Synergetic Optimization for a Twin-Fluid Atomization Nozzle

Fine particulate matter produced during the rapid industrialization over the past decades can cause significant harm to human health. Twin-fluid atomization technology is an effective means of controlling fine particulate matter pollution. In this paper, the influences of the main parameters on the droplet size, effective atomization range and sound pressure level (SPL) of a twin-fluid nozzle (TFN) are investigated, and in order to improve the atomization performance, a multi-objective synergetic optimization algorithm is presented. A multi-physics coupled acoustic-mechanics model based on the discrete phase model (DPM), large eddy simulation (LES) model, and Ffowcs Williams-Hawkings (FW-H) model is established, and the numerical simulation results of the multi-physics coupled acoustic-mechanics method are verified via experimental comparison. Based on the analysis of the multi-physics coupled acoustic-mechanics numerical simulation results, the effects of the water flow on the characteristics of the atomization flow distribution were obtained. A multi-physics coupled acoustic-mechanics numerical simulation result was employed to establish an orthogonal test database, and a multi-objective synergetic optimization algorithm was adopted to optimize the key parameters of the TFN. The optimal parameters are as follows: A gas flow of 0.94 m3/h, water flow of 0.0237 m3/h, orifice diameter of the self-excited vibrating cavity (SVC) of 1.19 mm, SVC orifice depth of 0.53 mm, distance between SVC and the outlet of nozzle of 5.11 mm, and a nozzle outlet diameter of 3.15 mm. The droplet particle size in the atomization flow field was significantly reduced, the spray distance improved by 71.56%, and the SPL data at each corresponding measurement point decreased by an average of 38.96%. The conclusions of this study offer a references for future TFN research.

Auditory Effects of Acoustic Noise From 3-T Brain MRI in Neonates With Hearing Protection.

Neonates with immature auditory function (eg, weak/absent middle ear muscle reflex) could conceivably be vulnerable to noise-induced hearing loss; however, it is unclear if neonates show evidence of hearing loss following MRI acoustic noise exposure. To explore the auditory effects of MRI acoustic noise in neonates. Prospective. Two independent cohorts of neonates (N = 19 and N = 18; mean gestational-age, 38.75 ± 2.18 and 39.01 ± 1.83 weeks). T1-weighted three-dimensional gradient-echo sequence, T2-weighted fast spin-echo sequence, single-shot echo-planar imaging-based diffusion-tensor imaging, single-shot echo-planar imaging-based diffusion-kurtosis imaging and T2-weighted fluid-attenuated inversion recovery sequence at 3.0 T. All neonates wore ear protection during scan protocols lasted ~40 minutes. Equivalent sound pressure levels (SPLs) were measured for both cohorts. In cohort1, left- and right-ear auditory brainstem response (ABR) was measured before (baseline) and after (follow-up) MRI, included assessment of ABR threshold, wave I, III and V latencies and interpeak interval to determine the functional status of auditory nerve and brainstem. In cohort2, baseline and follow-up left- and right-ear distortion product otoacoustic emission (DPOAE) amplitudes were assessed at 1.2 to 7.0 kHz to determine cochlear function. Wilcoxon signed-rank or paired t-tests with Bonferroni's correction were used to compare the differences between baseline and follow-up ABR and DPOAE measures. Equivalent SPLs ranged from 103.5 to 113.6 dBA. No significant differences between baseline and follow-up were detected in left- or right-ear ABR measures (P > 0.999, Bonferroni corrected) in cohort1, or in DPOAE levels at 1.2 to 7.0 kHz in cohort2 (all P > 0.999 Bonferroni corrected except for left-ear levels at 3.5 and 7.0 kHz with corrected P = 0.138 and P = 0.533). A single 40-minute 3-T MRI with equivalent SPLs of 103.5-113.6 dBA did not result in significant transient disruption of auditory function, as measured by ABR and DPOAE, in neonates with adequate hearing protection. 2. Stage 5.

How particle size reduction improves pectin extraction efficiency in carrot pomace

Particle size reduction of raw materials is suggested to improve the extraction efficiency of pectin. However, conflicting reports have been published in literature, questioning to what extent particle size reduction is beneficial. This study investigated the role of reduced particle size and altered microstructure on the extraction efficiency and structure of pectin obtained from carrot pomace. High shear mixing and high pressure homogenization at different pressure levels (5–100 MPa) resulted in samples with a median particle diameter between 563 μm and 68 μm. Particle size reduction was shown to increase the pectin extraction yield. High shear mixing followed by high pressure homogenization, more specifically, resulted in a 50% increase of the pectin yield, resulting in the extraction of 62% of the pectin content. Interestingly, the extent to which the extraction yield was improved was more related to changes in the microstructure than to the particle size as such, with tissue disruption leading to more outspoken changes in pectin extractability than further disintegration of cell fragments. The additional fraction of extracted pectin is thought to originate from the middle lamella rather than the primary cell wall. Overall, particle size reduction did not alter the molecular structure of the extracted pectin.

Impact of positive end-expiratory pressure on renal resistive index in mechanical ventilated patients.

Growing evidence shows the complex interaction between lung and kidney in critically ill patients. The renal resistive index (RRI) is a bedside measurement of the resistance of the renal blood flow and it is correlated with kidney injury. The positive end-expiratory pressure (PEEP) level could affect the resistance of renal blood flow, so we assumed that RRI could help to monitoring the changes in renal hemodynamics at different PEEP levels. Our hypothesis was that the RRI at ICU admission could predict the risk of acute kidney injury in mechanical ventilated critically ill patients. We performed a prospective study including 92 patients requiring mechanical ventilation for ≥ 48h. A RRI ≥ 0.70, was deemed as pathological. RRI was measured within 24h from ICU admission while applying 5,10 and 15 cmH2O of PEEP in random order (PEEP trial). Overall, RRI increased from 0.62 ± 0.09 at PEEP 5 to 0.66 ± 0.09 at PEEP 15 (p < 0.001). The mean RRI value during the PEEP trial was able to predict the occurrence of AKI with AUROC = 0.834 [95%CI 0.742-0.927]. Patients exhibiting a RRI ≥ 0.70 were 17/92(18%) at PEEP 5, 28/92(30%) at PEEP 10, 38/92(41%) at PEEP 15, respectively. Thirty-eight patients (41%) exhibited RRI ≥ 0.70 at least once during the PEEP trial. In these patients, AKI occurred in 55% of the cases, versus 13% remaining patients, p < 0.001. RRI seems able to predict the risk of AKI in mechanical ventilated patients; further, RRI values are influenced by the PEEP level applied. Clinical gov NCT03969914 Registered 31 May 2019.

Initial evaluation of humidity profiles retrieved by the EOS-07 millimetre-wave humidity sounder

ABSTRACT The vertical profiles of specific humidity in the troposphere measured by the millimetre-wave humidity sounder (MHS) onboard of the Earth Observation Satellite (EOS)-07 (Microsoft 2B) are validated using ground-based radiosonde observations during July-August 2023. MHS onboard EOS-07 (hereafter referred as EOS-07/MHS) is a 6-channel cross-track scanning radiometer operating in the 183.31 ± 16.25 GHz band. The EOS-07 observations are used to retrieve three-dimensional specific humidity profiling from 1000 hPa (surface) to 100 hPa (16 km) atmospheric pressure levels with a spatial resolution of 10 km at nadir. The EOS-07/MHS measurements over India have a high correlation coefficient of 0.98 with the radiosonde observations. The mean relative bias is found to be 0.44 ± 0.55 g kg−1 below 350hPa and 2.8 ± 2.3 g kg−1 above 350 hPa. It is also found that above the 350 hPa level, MHS seems to be systematically overestimating the radiosonde measurements. After that, the EOS-07/MHS measurements are used to construct the diurnal variation of humidity during the active phases of the Indian summer monsoon. The observations are consistent with the present understanding of the Indian summer monsoon system. The present results are very encouraging and demonstrate the great potential of EOS-07/MHS observations of humidity for meteorological application, especially in understanding the hydrological cycle.