Presence Of Arterial Hypertension Research Articles

Possibilities of noninvasive diagnostics of cardiovascular diseases associated with atherosclerosis

Background. Despite the global trend towards a decrease in mortality from cardiovascular pathology of atherosclerotic genesis, this group of diseases continues to occupy a leading position in the structure of disability and mortality among the population of many countries. Aim. Identification of noninvasive markers of arterial wall lesions associated with the presence of arterial hypertension (AH) and coronary heart disease (CHD) in persons younger than 55 years. Materials and methods. The study included 81 people. Three groups were distinguished from them: 1st (n=31) – a control group of practically healthy individuals, average age – 43 (40; 48) years; 2nd group (n=21) – patients with coronary heart disease without a history of cardiovascular diseases (CVD), average age – 45,5±6,1; group 3 (n=29) – patients with AH without CHD, average age – 47 (35; 50) years. The parameters of a biochemical blood test were determined, volumetric sphygmography and a sample with post-occlusive reactive hyperemia were performed. Results. In groups of patients with CHD and AH, negative changes in the lipid profile and higher glucose levels were recorded compared to healthy individuals. According to the results of volumetric sphygmography, the pulse wave velocity in arteries of predominantly elastic type (R/L-PWV) in group 1 was 10.1±1.7 m/s, in group 2 – 12.9±1.8 m/s, in group 3 – 13.1 (12; 14) m/s (р1–2=0.029; р1–30.001); cardio-ankle vascular index (CAVI) – 6.5±0.7, 7.7 (7; 8.7) and 7.8 (7.3; 8.4), respectively (р1–20.001; р1–30.001). According to the data of the test with post-occlusive reactive hyperemia, a comparably high frequency of pathological values of flow-dependent vasodilation (FDV) and reactivity index (RI) was demonstrated in patients with CHD and AH (р1–20.05; р1–30.05). A multifactorial model of noninvasive diagnosis of CHD in individuals without a history of CVD, including non-high-density lipoprotein cholesterol, R/L-PWV, and FDV, has been developed. For patients with AH, glucose, lipid metabolism, R/L-PWV, pulse wave velocity in muscle-type arteries (B-PWV), augmentation index (AI), biological age, CAVI, FDV, RI were the risk factors for the presence of the disease in the anamnesis. Conclusion. The results obtained confirm the importance of an integrated approach in the screening diagnosis of CVD.

Associations of ECG Signs of Ischemic and Non-Specific Signs of Metabolic Changes in the Myocardium With Unfavorable Cardiovascular Prognosis in a 7-Year Prospective Follow-Up of Young People Under 45 Years.

To study ischemic and/or nonspecific ECG signs of metabolic changes in the myocardium and to determine their relationship with unfavorable cardiovascular prognosis in a 7-year prospective observation of young people under 45 years of age. A cross-sectional population survey of a random sample aged 25-44 years (n=1363) was conducted in Novosibirsk. The survey program used the standardized epidemiological Rose questionnaire. Biochemical tests were used to measure blood concentrations of total cholesterol (C), triglycerides (TG), low- and high-density lipoprotein cholesterol (LDL-C, HDL-C), and fasting blood plasma glucose. Systolic and diastolic BP (SBP, DBP), the presence of arterial hypertension (AH), body mass index (BMI), waist circumference (WC), and smoking status were assessed. ECG was recorded at rest in 12 standard leads followed by interpretation according to the Minnesota Code. The presence of ischemic and/or nonspecific ECG signs of metabolic changes in the myocardium was determined. Subjects with ECG signs of ischemic changes in the myocardium were selected for long-term follow-up and additional examination by cardiologists. Then the whole cohort was monitored for 7 years, and cardiovascular events were recorded, including using data from the WHO Myocardial Infarction Registry in Novosibirsk. For statistical analysis of the results, cardiovascular events were combined into a composite endpoint. During 7 years, 40 people (27 men and 13 women) had an unfavorable cardiovascular prognosis. Multivariate regression analysis showed that a 7-year unfavorable cardiovascular prognosis in people younger than 45 years was associated with signs of ischemic myocardial alterations identified on the background ECG (OR 5.319, 95% CI: 1.543-18.342, p=0.008) and nonspecific ECG signs of metabolic changes in the myocardium (OR 2.978, 95% CI: 1.216-7.216, p=0.017) regardless of age, gender, the presence of arterial hypertension (AH) and type 2 diabetes mellitus (DM2). In young people under 45 years of age, not only ECG signs of ischemic changes in the myocardium, but also nonspecific ECG signs of metabolic changes in the myocardium are associated with an unfavorable cardiovascular prognosis, directly and independently on age and gender, in a long-term, 7-year period.

От неалкогольной к метаболически ассоциированной жировой болезни печени. Стеатометрия и кардиометаболические факторы как предикторы развития стеатогепатита

Non-alcoholic metabolic dysfunction-associated fatty liver disease is the most common liver sickness linked with the high risk of hepatic and extrahepatic complications. The article provides an overview of changes in the nomenclature of this disease, analysis of risk factors for its development and the results of own research. The aim of the study was to estimate the clinical significance of steatometry (CAP function) by Fibroscan and cardiometabolic factors in assessing the risk of steatohepatitis development. Material and methods. Patients with hepatic steatosis accompanied by metabolic disorders were examined. Steatometry as well as routine physical and laboratory examination, including biochemical blood tests and abdominal ultrasound were provided. Statistical analysis included χ2 test, Spearman's rank correlation test, Student's t-test, Mann–Whitney test, multiple linear regression analysis. Results. 74 patients were included. Main characteristics of the cohort: 62.2% male, mean age – 48.8 years, cases of steatohepatitis – 41.9%. It was revealed that the number of metabolic factors in an individual patient correlated with the presence of steatohepatitis (χ2 = 3.29; p < 0.05) and the severity of steatosis by steatometry (rs = 0.37; p < 0.05). Individual clinical and laboratory parameters influenced the severity of steatosis with varying degrees. The most significant parameters were: abdominal circumference, concentration of HDL, insulin, activity of ALT, GGTP, and the presence of arterial hypertension. Using these indicators, a formula for assessing the risk of severe liver steatosis was created. Conclusion. Steatometry is to be considered as an important diagnostic method for the prognosis assessment in patients who have risk factors for the development and progression of non-alcoholic metabolic dysfunction-associated fatty liver disease. Severe steatosis is a predictor of steatohepatitis. The number of metabolic factors present in an individual patient is important in assessing the risk of severe liver steatosis and steatohepatitis.

Niveles de Vitamina D en pacientes con y sin Enfermedad Renal Crónica, perfil clínico y epidemiológico: un análisis preeliminiar en un hospital de segundo nivel en quito, Ecuador.

Vitamin D has been associated with different effects unrelated to bone-mineral metabolism, such as its association with arterial hypertension. This study determines the prevalence profile of vitamin D deficiency and insufficiency in Ecuadorian patients, its epidemiological profile, and its relationship with other diseases such as arterial hypertension, diabetes mellitus, and chronic kidney disease. This is a pioneering study in Ecuador of a retrospective type, carried out at the Pablo Arturo Suarez Hospital over 6 months, in which it was found that the prevalence of vitamin D insufficiency was 28.5% (levels between 21 to 30 ng/ml) and deficiency was 57% (levels less than 20 ng/ml); Likewise, we ratify the inverse relationship between vitamin D levels and age, as well as finding a certain association between vitamin D levels and the presence of arterial hypertension; while no significant differences were found in its relationship with diabetes mellitus, chronic kidney disease without the use of renal replacement therapy and the general population. Keywords: vitamin D, chronic kidney disease, metabolism.

Niveles de Vitamina D en pacientes con y sin Enfermedad Renal Crónica, perfil clínico y epidemiológico: un análisis preeliminiar en un hospital de segundo nivel en Quito, Ecuador.

Vitamin D has been associated with different effects unrelated to bone-mineral metabolism, such as its association with arterial hypertension. This study determines the prevalence profile of vitamin D deficiency and insufficiency in Ecuadorian patients, its epidemiological profile, and its relationship with other diseases such as arterial hypertension, diabetes mellitus, and chronic kidney disease. This is a pioneering study in Ecuador of a retrospective type, carried out at the Pablo Arturo Suarez Hospital over 6 months, in which it was found that the prevalence of vitamin D insufficiency was 28.5% (levels between 21 to 30 ng/ml) and deficiency was 57% (levels less than 20 ng/ml); Likewise, we ratify the inverse relationship between vitamin D levels and age, as well as finding a certain association between vitamin D levels and the presence of arterial hypertension; while no significant differences were found in its relationship with diabetes mellitus, chronic kidney disease without the use of renal replacement therapy and the general population. Keywords: vitamin D, chronic kidney disease, metabolism.

Biofeedback Endurance Training for Gait Rehabilitation in Parkinson’s Disease: a Non-Randomized Controlled Study

INTRODUCTION. Parkinson’s disease is a disease with the highest rates of disability growth in the neurodegenerative pathology group, with the leading motor symptom — impaired walking and an increased risk of falling. There is evidence that Parkinson’s disease preserves stability for cycling. The issue of extending the effects of cycling training to daily activity, including walking, remains unclear.
 AIM. To evaluate the effect of a course of endurance training on a cycle ergometer with biofeedback (BFB) on a walking ability of a patient with Parkinson’s disease.
 MATERIALS AND METHODS. A total of 69 patients with stages 2–3 Parkinson’s disease according to the Hoehn and Yahr Rating Scale were included in the study, group 1: 34 people (60.05 ± 7.07 years) and group 2: 35 patients (61.75 ± 7.53 years). The patients were examined — anamnesis collection: duration of Parkinson disease, presence of arterial hypertension (AH), sports history, medication, assessment of systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), “6-minute walk” test (6MWT), motor function according to the MDS UPDRS scale — part III. The patients of group 1 had daily exercises on a digital bicycle ergometer with BOS for 10 days, the patients of group 2 — therapeutic gymnastics. The therapy was assessed by repeated 6MWT.
 RESULTS AND DISCUSSION. The Parkinson’s disease duration was longer in the patients of group 1. Concomitant hypertension was in 20 (57 %) patients of group 1 and 16 (47 %) patients of group 2 (p 0.05). 11 people of group 1 and 5 of group 2 had a sports history (p = 0.07). The indicators of SBP and DBP of groups 1 and 2 had normal values during the examination. BMI in both groups corresponded to excess body weight. Patients had risk factors of the modern world: hypertension and overweight. Motor disorders according to the MDS UPDRS — Part III scale were greater in group 1. Despite having serious motor impairments in group 1, after the therapy, the patients demonstrated an increase in the distance traveled in 6 minutes (392.18 ± 96.3 m vs. 476.43 ± 108.08 m; p 0.05), while no changes were found in group 2.
 CONCLUSION. BOS endurance training on a cycle ergometer is effective for walking rehabilitation of Parkinson’s disease patients.

Follistatin-like 1 (FSTL1) levels as potential early biomarker of cardiovascular disease in a Mexican population.

Cardiovascular diseases (CVD) are the leading cause of death globally. In recent years, follistatin-like protein 1 (FSTL1) has been proposed as an emerging potential clinical biomarker of CVD, since its concentration is upregulated in heart failure. The aim of the present study was to evaluate the association of FSTL1 levels and classic biomarkers with the risk of CVD in Mexican population. A case-control study was carried out in patients with cardiovascular diseases (CVD), arterial hypertension, but not CVD (cardiovascular risk factor-CRF), and healthy controls (control group) from the Mexican Institute of Social Security. Lipid profile, homocysteine (Hcys), serum amyloid A (SAA), FSTL1 concentration, PON1 concentration and activities [Arylesterase (ARE), and Lactonase (LAC)] were evaluated. High levels of FSTL1 were found in the CRF group and a positive association of FSTL1 (OR = 4.55; 95% CI 1.29-16.04, p = 0.02) with the presence of arterial hypertension, as well as Hcys (OR, 3.09; 95% CI 1.23-7.76, p = 0.02) and SAA (OR, 1.03; 95% CI 1.01-1.05, p < 0.01) with the presence of CVD. LAC activity (OR, 0.26; 95% CI 0.07-0.94, p = 0.04) and PON1 concentration (OR, 0.17; 95% CI 0.05-0.62, p = 0.01) were associated with a decrease in OR belonging to the group with CVD. Our results suggest that FSTL1 may be a useful biomarker for monitoring cardiovascular risk in clinical settings. However, longitudinal studies are needed to evaluate how FSTL1 could influence the association of PON1activity and Hcys with CVD.

Association Between Endothelial Cell Density and Corneal Thickness in Medium, Short, and Long Eyes of Han Chinese Cataract Patients

To evaluate the association between the endothelial cell density (ECD) and central corneal thickness (CCT) in medium, short, and long eyes of preoperative Han Chinese cataract patients. Retrospective cross-sectional study. We consecutively enrolled 410 eyes, namely, 50 short eyes (axial length [AL]<22.0 mm), 150 medium eyes (22.0≤AL<24.0 mm), 120 medium-long eyes (24.0≤AL<26.0 mm), and 90 long eyes (AL≥26.0 mm), of 410 adult patients scheduled for cataract surgery. The ECD and CCT were determined preoperatively with a noncontact specular microscope. The association between the CCT and ECD was identified by using a multivariable regression analysis. A thin cornea was defined as having a CCT less than 500 µm. After adjusting for age, the presence of arterial hypertension, the presence of diabetes mellitus, intraocular pressure, and AL, a positive association between the CCT and ECD was identified in short eyes (linear regression coefficient [B]=3.40; standardized B [β]=0.52; P = .03), medium eyes (B = 2.33; β=0.28; P = .002), medium-long eyes (B = 1.84; β=0.25; P = .02), and long eyes (B = 2.69; β=0.41; P = .04). In the total group, the multivariable logistic analysis showed a significant link between the presence of a thin cornea and a lower ECD (odds ratio [OR]=0.80 per 100 cells/mm2 increase; P = .001). For cataract patients of Han ethnicity, a significant association between a thin CCT and a lower ECD was shown across the AL spectrum and was most prominent in short eyes. Eyes with a thin cornea are more likely to have a lower ECD.

Risk factors associated with glomerular filtration rate in Mexican adults with type 2 diabetes mellitus

IntroductionType 2 diabetes mellitus (T2DM) is related to glomerular filtration rate (GFR) impairment, which is one of the main causes of chronic kidney disease. The objective of this study was to identify the risk factors related to GFR in Mexican adults with T2DM, using a validated multiple linear regression model (MLRM), with emphasis in body adiposity, glycemic control, duration of the diabetes and other relevant risk factors. Materials and methodsA cross-sectional, analytical, and observational study was carried out in 252 adults with a previous diagnosis of T2DM. Body mass index (BMI) and waist circumference (WC) were determined and a fasting blood sample was collected for glucose, creatinine and HbA1c determinations. GFR was calculated with the Cockcroft–Gault equation adjusted for body surface area. Four MLRM were performed to determine the factors related to the GFR; it was evaluated whether these models complied with the statistical assumptions of the linear regression model. ResultsThe average age of the participants was 60 ± 12 years, 62.3% of them were women. GFR correlated with BMI and WC; age and duration of the diabetes were associated inversely. Model 4 of the MLRM reported a coefficient of determination of 53.5% where the variables BMI (β = 1.31), male sex (β = −6.01), duration of T2DM (β = −0.57), arterial hypertension (β = −6.53) and age (β = −1.45) were simultaneously and significantly related to the GFR. ConclusionsOlder age, male sex, longer duration of T2DM and the presence of arterial hypertension were associated with a decrease in the GFR; BMI and WC were directly associated. No effect of glucose and HbA1c on GFR was observed.

Aneurysm Wall Contrast on Magnetic Resonance Imaging: A New Predictor of Rupture of Saccular Intracranial Aneurysms

Background. Recent studies suggest that accumulation of contrast agent in the aneurysm’s wall may predict a high risk of aneurysm growth or rupture.Objective. To compare the enhancement of the aneurysm wall with other characteristics that affect at the risk of rupture.Materials and Methods. The study included 95 patients with 132 previously identified saccular aneurysms, who underwent magnetic resonance imaging (MRI) according to a specialized protocol using 3.0 Tesla MRI scanner. The presence or absence of aneurysm’s wall enhancement compared with the following characteristics: gender and age of the patient, the size and shape of the aneurysm, the presence of arterial hypertension, and the PHASES score.Results. Accumulation of contrast agent by the aneurysm’s wall was associated with the aneurysm dome size (p &lt; 0,001, Sp = 78,1 %, Se = 72,1 %) and PHASES score (p &lt; 0,001, Sp = 64,1 %, Se =57,1 %). No relationship between age, gender, arterial hypertension, shape, and aneurysm location and contrast enhancement was found (p &gt; 0,05).Conclusion. Contrast enhancement of the aneurysm wall on MRI can be considered an additional risk marker of its rupture.

Factores de riesgo asociados con la tasa de filtración glomerular en adultos mexicanos con diabetes mellitus tipo 2

IntroductionType 2 diabetes mellitus (T2DM) is related to glomerular filtration rate (GFR) impairment, which is one of the main causes of chronic kidney disease. The objective of this study was to identify the risk factors related to GFR in Mexican adults with T2DM, using a validated multiple linear regression model (MLRM), with emphasis in body adiposity, glycemic control, duration of the diabetes and other relevant risk factors. Materials and methodsA cross-sectional, analytical, and observational study was carried out in 252 adults with a previous diagnosis of T2DM. Body mass index (BMI) and waist circumference (WC) were determined and a fasting blood sample was collected for glucose, creatinine and HbA1c determinations. GFR was calculated with the Cockcroft-Gault equation adjusted for body surface area. Four MLRM were performed to determine the factors related to the GFR; it was evaluated whether these models complied with the statistical assumptionsof the linear regression model. ResultsThe average age of the participants was 60±12 years, 62.3% of them were women. GFR correlated with BMI and WC; age and duration of the diabetes were associated inversely. Model 4 of the MLRM reported a coefficient of determination of 53.5% where the variables BMI (β=1.31), male sex (β=-6.01), duration of T2DM (β=-0.57), arterial hypertension (β=-6.53) and age (β=-1.45) were simultaneously and significantly related to the GFR. ConclusionsOlder age, male sex, longer duration of T2DM and the presence of arterial hypertension were associated with a decrease in the GFR; BMI and WC were directly associated. No effect of glucose and HbA1c on GFR was observed.

Independência funcional, aspectos clínicos e fatores sociodemográficos em pacientes na fase aguda do Acidente Vascular Cerebral: uma análise de associação

ABSTRACT Purpose To analyze the association of functional independence with clinical aspects of neurological impairment, the location and extent of neuronal damage and sociodemographic factors in patients in the acute phase of stroke. Methods Analytical cross-sectional study in 90 adult and older patients affected by ischemic stroke, admitted to the hospital within 24 hours of the vascular event. Sociodemographic factors and clinical aspects data were collected from electronic medical records and/or interviews in order to depict the patients'profile, Oxfordshire Community Stroke Project, Alberta Stroke Programme Early CT Score, National Institute of Health Stroke Scale, and Functional Independence Measure. Results Neurological impairment, according to the National Institute of Health Stroke Scale, was associated with functioning in the first 24 hours after the stroke. Furthermore, the presence of arterial hypertension, age, inactive work, smoking and extent of neuronal damage were associated with functional dependence, but did not remain in the final model of this study. Conclusion Functional dependence is associated with arterial hypertension, age, inactive work, smoking, extent of neuronal damage, and degree of neurological impairment in the first 24 hours after the vascular event. Furthermore, a higher level of neurological impairment was independently associated with increased levels of functional dependence.

Фактори несприятливого прогнозу в жінок із високим ризиком гострої тромбоемболії легеневої артерії

The aim – to determine the risk factors of an unfavorable prognosis in patients with pulmonary embolism (PE) depending on gender.Materials and methods. A retrospective analysis of the data of 635 patients with a verified diagnosis of PE according to multispiral computed tomographic angiography (MSCT-angiography) of pulmonary vessels and/or according to autopsy results, who were consecutively hospitalized at Kharkiv City Clinical Hospital No. 8 for the period from January 1, 2017 to January 1, 2023. Patients were divided into two groups: IA group included patients with high-risk acute PE who were discharged from the hospital, IВ group – patients with high-risk acute PE who died during the hospital period. Clinical and anamnestic, laboratory and instrumental indicators were analyzed, statistical processing of data depending on gender was carried out.Results and discussion. When analyzing the obtained data, it was established that in the group of deceased patients with a high risk there was probably a higher proportion of women (72 % at p=0.014). Deceased males had more severe clinical manifestations than deceased females, as evidenced by significantly lower SpO2 values (p=0.022) and larger right ventricular dimensions on echocardiography (p=0.036). In turn, such a risk factor of PE as obesity was more common in women than in men (61.1 % vs. 28.6 % at p=0.039). In order to determine independent factors associated with in-hospital mortality in high-risk PE patients in women, we conducted uni- and multifactorial logistic regression analysis of the influence of the studied factors. Since the small number of deceased men in the sample (n=14) does not allow us to draw reasonable conclusions, the analysis of factors affecting mortality is given only for the group of women. Factors associated with in-hospital death were the presence of arterial hypertension in the anamnesis (p=0.043), a decrease in systolic blood pressure (p=0.0003) in the acute period, and the localization of a thrombus at the bifurcation of the pulmonary arteries (p=0.012). After performing the regression analysis, we derived a formula for individual prediction of the risk of in-hospital death for gender with high-risk PE. Using the ROC analysis, it was established that the sensitivity of the obtained prognostic formula is 75.0 %; specificity – 83.9 (area under the ROC curve 0.867; 95 % confidence interval 0.762–0.938, p&lt;0.0001). The formula developed by us includes available general clinical indicators and allows specifying the individual risk of in-hospital mortality for female patients with high-risk PE.Conclusions. The results of a comparative analysis of two subgroups of patients with high-risk PE who died, depending on gender, showed that men were more likely to have lower SpO2 values and larger right ventricular sizes according to echocardiography. In turn, such risk factors as obesity were more common in women than in men. According to multivariate logistic regression analysis, additional independent factors that are associated with the development of death during the hospital period in women with high-risk PE are the presence of arterial hypertension in the anamnesis, a decrease in systolic blood pressure in the acute period, and the localization of a thrombus at the bifurcation of the pulmonary arteriesof. Proposed formula, according to which Y&gt;0.5 establishes an additional high risk of in-hospital death in women with high-risk PE.

Left ventricular remodeling in perimenopausal women

Aim to reveal specific features of the left ventricle (LV) structural and functional state and the pro-inflammatory status indicators in women of perimenopausal age.&#x0D; Material and methods. The cross-sectional study included 80 women (age 45 to 55 years) who were divided into 2 groups: a menopausal transition group and an early postmenopausal group according to the STRAW + 10 classification. Anthropometric measurements were taken; blood tests for homocysteine C, interleukin-6 (IL6), C-reactive protein (CRP), and echocardiography were performed according to the standard technique.&#x0D; Results. The study findings were as follows: 1. women in early postmenopause had higher levels of CRP when compared with women in the menopausal transition (4.5 (1.5; 8.0) mg/l versus 2.5 (0.6; 7.4) mg/l), in obese women, the level of IL6 was higher than in normal-weight women regardless of menopausal status (1.8 (0.6; 2.8) pg/ml versus 0.6 (0.2; 1.3) pg/ml); 2. the distribution of participants according to the type of myocardial remodeling did not differ in the comparison groups; 3. the presence of arterial hypertension and menopause was associated with myocardial hypertrophy; 4. significant differences were found in the distribution of myocardial geometry in women with obesity and overweight when compared to women with a normal body mass index (BMI) regardless of menopausal status; 5. significant direct correlation was registered between the structural and volume parameters of the LV and age, blood pressure, BMI, waist to hips circumference ratio. A positive correlation was found between the level of pro-inflammatory biomarkers and structural parameters of LV.&#x0D; Conclusion. In women of perimenopausal age, a myocardial remodeling was revealed that could not be explained by traditional risk factors. The activation of the systemic inflammatory response in menopause and obesity was accompanied by the pathological LV remodeling and myocardial hypertrophy.

Is Replantation Associated With Better Hand Function After Traumatic Hand Amputation Than After Revision Amputation?

Replantation is an established treatment for traumatic upper extremity amputation. Only a few studies, however, have assessed the patient-reported outcomes of replantation, and the findings of these studies have been conflicting. (1) Is replantation associated with better hand function than revision amputation? (2) Is replantation associated with better health-related quality of life, less painful cold intolerance, and more pleasing hand esthetics than revision amputation after a traumatic hand amputation? In this retrospective, comparative study, we collected the details of all patients who sustained a traumatic upper extremity amputation and were treated at the study hospital. Between 2009 and 2019, we treated 2250 patients, and we considered all patients who sustained a traumatic amputation of two or more digital rays or a thumb as potentially eligible. Based on that, 15% (334 of 2250) were eligible; a further 2% (8 of 334) were excluded because of a subsequent new traumatic amputation or bilateral amputation, and another 22% (72 of 334) refused participation, leaving 76% (254 of 334) for analysis here. The primary outcome was the DASH score. Secondary outcomes included health-related quality of life (EuroQOL-5D [EQ-5D-5L] Index), painful cold intolerance (the Cold Intolerance Symptom Severity score), and hand esthetics (the Michigan Hand Questionnaire aesthetic domain score). The minimum follow-up time for inclusion was 18 months. Patients were classified into two treatment groups: replantation (67% [171 of 254], including successful replantation in 84% [144 of 171] and partially successful replantation in 16% [27 of 171], in which some but not all of the replanted tissue survived), and revision (complete) amputation (33% [83 of 254], including primary revision amputation in 70% [58 of 83] and unsuccessful replantation followed by secondary amputation in 30% [25 of 83]). In this cohort, replantation was performed if possible, and the reason for choosing primary revision amputation over replantation was usually an amputated part that was too severely damaged (15% [39 of 254]) or was unattainable (2% [4 of 254]). Some patients (3% [8 of 254]) refused to undergo replantation, or their health status did not allow replantation surgery and postoperative rehabilitation (3% [7 of 254]). Gender, age (mean 48 ± 17 years in the replantation group versus 50 ± 23 years in the revision amputation group; p = 0.41), follow-up time (8 ± 4 years in the replantation group versus 7 ± 4 years in the revision amputation group; p = 0.18), amputation of the dominant hand, smoking, extent of tissue loss, or presence of arterial hypertension did not differ between the groups. Patients in the replantation group less frequently had diabetes mellitus (5% [8 of 171] versus 12% [10 of 83]; p = 0.03) and dyslipidemia (4% [7 of 171] versus 11% [9 of 83]; p = 0.04) than those in the revision group and more often had cut-type injuries (75% [129 of 171] versus 60% [50 of 83]; p = 0.02). After controlling for potential confounding variables such as age, injury type, extent of tissue loss before treatment, and accident of the dominant hand, replantation was not associated with better DASH scores than revision amputation (OR 0.82 [95% confidence interval (CI) 0.50 to 1.33]; p = 0.42). After controlling for potential cofounding variables, replantation was not associated with better EQ-5D-5L Index scores (OR 0.93 [95% CI 0.56 to 1.55]; p = 0.55), differences in Cold Intolerance Symptom Severity scores (OR 0.85 [95% CI 0.51 to 1.44]; p = 0.79), or superior Michigan Hand Questionnaire esthetic domain scores (OR 0.73 [95% CI 0.43 to 1.26]; p = 0.26) compared with revision amputation. Replantation surgery was conducted, if feasible, in a homogenous cohort of patients who underwent amputation. If the amputated tissue was too severely damaged or replantation surgery was unsuccessful, the treatment resulted in revision (complete) amputation, which was not associated with worse patient-reported outcomes than successful replantation. These results contradict the assumed benefits of replantation surgery and indicate the need for credible evidence to better guide the care of these patients. Level III, therapeutic study.

Abstract 18 — Standardized Mortality Ratio and Risk Factors for Mortality and Recurrence in Hong Kong Chinese Patients with Antiphospholipid Syndrome

Background To report standardized mortality ratio (SMR) and assess risk factors for mortality and recurrence in Hong Kong Chinese patients with antiphospholipid syndrome (APS). Methods Patients followed up in 16 public hospitals in Hong Kong were identified by the Hospital Authority Clinical Data Retrieval System (CDARS) using the ICD-10 diagnostic code of APS. Their diagnoses were verified using the 2006 modified consensus criteria (1) for APS. The mortality, thrombosis recurrence rate and their associated risk factors were studied by Kaplan-Meier method and Cox Regression. Results Four hundred twenty-three Chinses APS patients were identified. Among them, 288 patients fulfilled the 2006 criteria for APS and were classified as definite APS, while 135 patients had probable APS. APS was primary in 204 patients and secondary in 219 patients. On presentation, 369 patients had thrombotic events. Arterial thrombosis occurred in 177 patients and venous thrombosis occurred in 189 patients. Obstetric morbidities occurred in 77 patients. Twenty three patients had both obstetric and thrombotic events. Over a mean follow-up of 9.7±7.2 years, 75 (17.7%) patients succumbed. The age and sex adjusted SMR relative to general population was 4.34[95% CI 3.44-5.41]. In thrombotic APS patients, mortality was associated with age [Formula: see text]60 years at diagnosis (HR 5.30 [95% CI 3.11-9.03]; p&lt;0.001), presence of arterial hypertension (HR 1.89 [95% CI 1.11-3.19]; p =0.018), and presence of arterial thrombosis (HR 1.81 [95% CI 1.06-3.10]; p=0.031). Recurrence of thrombosis occurred in 89 (21%) patients (15% arterial, 5.2% venous). Recurrence of thrombosis was found to be associated with triple positive antibodies (HR 2.71 [95% CI 1.15-6.42]; p=0.023) independent of other risk factors in a multivariate model. Conclusion Increased mortality rate was observed in Chinese APS patient, with older age at diagnosis, presence of arterial hypertension and arterial thrombosis being independent risk factors for mortality. Recurrence of thrombotic events was not uncommon and associated with the presence of triple positive aPL antibodies.

Cognitive Performance and Diabetic Retinopathy: What Your Eyes Can Reveal About Your Brain.

Diabetic retinopathy (DR) is a chronic diabetes complication. People with Type 2 Diabetes Mellitus (T2DM) have two times the risk for dementia, suggesting it is a new chronic diabetes complication. Evaluate the association of DR with cognitive performance in a T2DM population. Cross-sectional study with 400 T2DM adults from whom socio-demographic, clinical, laboratory data were collected, and screening test for depression symptoms (Patient Health Questionaire- 9 (PHQ-9)), Mini-Mental State Examination (MMSE), Semantic Verbal Fluency Test, Trail Making Test A and B, Word Memory test were performed. All cognitive test scores were converted into Global Cognition z-Score (GCS(z)). The association between GCS(z) < 0 with DR was performed using a multivariate binary logistic regression model adjusted for age ≥ 65 years, school years ≤ 6 years, DM duration ≥ 10 years, depression symptoms score > 9 at PHQ-9, arterial hypertension, physical activity, diabetic retinopathy, macular edema, and cardiovascular disease. After exclusions, the 251 eligible patients were 56.6% female, with a mean age of 61.1 (±9.8) years, DM duration of 12.6 (±8.9) years, and 7.6 (±4.2) years of school education. DR prevalence was 46.5%. Multivariate Logistic Regression Model showed an association between DR and GCS(z) < 0, with odds ratio (CI95%) of 2.50 (1.18-5.34), adjusted for age, low education level, arterial hypertension and depression symptoms (OD and CI95% respectively: 5.46(2.42-12.34); 12.19 (5.62-26.46); 2.55 (0.88-7.39); 3.53 (1.55-8.07)). In this T2DM population, having DR increased the chance for worse cognitive performance even when adjusted for age, low education level, presence of arterial hypertension, and depression symptoms.

Influence of visceral fat on cardio-respiratory homeostasis depending on sex, age and presence of arterial hypertension

Introduction. The study of vegetative homeostasis requires the accounting of sensitive, non-invasive parameters of multidimensional ambulatory metabolic and cardiorespiratory monitoring, including bioimedansometry, heart rate variability (HRV) and respiratory function (RF).Aim. To determine concomitant changes in HRV, RF, depending on the level of visceral fat (VF) and the presence of arterial hypertension (AH), associated with gender, age to determine the targets of preventive effects.Materials and methods. 215 boys and girls aged 18 to 30 years and 93 men and women with hypertension aged 45 to 59 years underwent, bioimpedancometry, HRV monitoring using ten-minute recordings, and the study of respiratory function.Results and discussion. In young people with a BMI over 25 kg/m2, a high level of HF was associated with an increase in LF/ HF and SDANN values, which reflected a reduction in parasympathetic activity and an increase in sympathetic activity, as well as changes in RF with a decrease in the Tiffno index and maximum half-expiratory flow (MHF). In middle-aged individuals with AH and BMI exceeding 25 kg/m2, a direct correlation was found between the value of VF and age, waist circumference, diastolic blood pressure, with a higher stress index of cardiac rhythm regulation and more pronounced sympathetic activity in terms of the LF/HF parameter. A lower total HRV, low parasympathetic activity and tension in the regulation of the heart rhythm in persons with AH were detected even with an intermediate value of VF.Conclusions. The study of autonomic homeostasis required the accounting of the individual dynamics of the parameters of HRV and the RF even within normal values. Changes in HRV associated with an intermediate increase in VF should be monitored with an emphasis on SDANN, LF/HF, stress index and vegetative index, and changes in RF – with an emphasis on the Tiffno index and MHF.

Arterial hypertension and stiffness in women of different age groups and reproductive status

Objective: study of the relationship between arterial hypertension and arterial stiffness in women to identify potential markers of target organ damage and therapeutic targets of antihypertensive therapy.Materials and methods: the study involved 161 women who were divided into three groups depending on age and reproductive function. Group 1 consisted of 52 women aged 18 to 30; group 2 – 54 women aged 31 years before menopause; 3rd group – 55 women in the postmenopausal period. All women were questioned, clinical examination, determination of anthropometric data, measurement of carotid-femoral pulse wave velocity, determination of arterial stiffness by volumetric sphygmography, 24-hour blood pressure monitoring with assessment of aortic stiffness and characteristics of the central pulse wave.Results: 24-hour blood pressure monitoring revealed arterial hypertension in 38 (34,8%) women: 15 (27,8%) women in the 2nd group and 23 (41,8%) women in the 3rd group. Correlation analysis revealed the most significant correlations between the presence of arterial hypertension (R=0,45-0,71; p&lt;&lt;0,01) with central aortic pressure, double product index and average daily aortic pulse wave velocity in the aorta (PWVao), regardless of the state reproductive function. For women of reproductive age with arterial hypertension, the ambulatory vascular stiffness index (AASI: R=0,36; p=0,01) is more significant, while in the menopausal period, the arterial stiffness index (ASI: R=0,33; p=0,01). Correlation analysis did not reveal significant relationships between carotid-femoral pulse wave velocity and cardio-ankle vascular index (CAVI) with arterial hypertension in women of the 2nd and 3rd groups. The relationship between carotid-femoral pulse wave velocity and arterial hypertension in women was confirmed by analysis of variance (p=0,007).Conclusion: Central aortic pressure, carotid-femoral pulse wave velocity, AASI, ASI, PWVao – direct and indirect indicators of arterial stiffness – are interconnected with the presence of arterial hypertension in women of reproductive and menopausal age. In this regard, these indicators are potential markers of target organ damage in arterial hypertension.

Determinants of myocardial work indices in women.

By incorporating myocardial deformation and afterload, novel echocardiographic myocardial work indices appear to be advantageous compared to load-dependent left ventricular (LV) deformation analyses. As such, these indices may provide a more accurate and, above all, load-independent estimation of LV function in patients with chronically increased afterload. To date however, data on the relation of these indices to clinical and conventional echocardiographic parameters are scarce. Our aim was to evaluate the relationship between myocardial work indices and age, body mass index (BMI), NTproBNP, the clinical history of arterial hypertension and diastolic dysfunction as well as selected conventional echocardiographic parameters in women. We analyzed echocardiographic data of women included in the Berlin Female Risk Evaluation (BEFRI) trial. Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW) and Global Work Efficiency (GWE) were calculated using commercially available software based on noninvasive pressure-strain loops. The impact of selected clinical and echocardiographic characteristics on myocardial work parameters was investigated by uni- and multivariate regression analyses. A total of 224 women were included in the final analysis. 155 of them were normotensive and 69 had a history of arterial hypertension. Diastolic dysfunction was more prevalent in subjects with arterial hypertension. Study participants with arterial hypertension showed higher GWI and GCW whereas GWW and GWE did not significantly differ between groups. GCW and GWW were lower and GWE higher in the presence of normal diastolic function. In multivariate regression analyses, arterial hypertension, LV GLS, and interventricular septal thickness were significantly associated with GWI. GCW showed significant associations with the clinical history of arterial hypertension, LV GLS, age and IVRT. Similarly, LV GLS, IVRT and mitral inflow E wave deceleration time were identified to be significant determinants of GWW and GWE. Our data confirm that, in a randomly selected sample of the general urban female population, myocardial work parameters are predominantly determined by LV GLS. In addition, the presence of arterial hypertension was identified to be a significant determinant of GWI and GCW, but not for GWW and GWE. Finally, a prolonged LV relaxation time was significantly associated with GWW and GWE, suggesting more wasted myocardial work and lower GWE values with increasing LV relaxation time.