Pressure Treatment Research Articles

Estimation of antihypertensive effect after initiating continuous positive airway pressure treatment in Japanese patients with sleep disordered breathing

Abstract Introduction It is true that patients with cardiovascular diseases including hypertension have already suffered from sleep disordered breathing (SDB). Furthermore, Continuous Positive Airway Pressure (CPAP) treatment shows antihypertensive effect by improving sympathetic nervous activity. On the other hand, we reported that CPAP treatment had a beneficial effect on hypertension, but 70% patients still remain inadequately treated. As a result, we need the strict blood pressure follow up for patient with SDB after initiating CPAP treatment at ESC congress 2022. Purpose Our aim in this study is to estimate the antihypertensive effect after initiating CPAP treatment, also estimate the differences of CPAP effect by focusing on Japanese non-obese body. Methods All patients were conducted full night polysomnography. One-hundred eighty patients showed obstructive SDB {apnea hypopnea index (AHI) >20/hour}, and CPAP treatment were initiated. We divided into three groups by using body mass index (BMI). Group A showed BMI < 25 kg/m2 (n = 59). Group B showed 25 ≦BMI < 30 kg/m2 (n = 68), and Group C showed 30 ≦ BMI kg/m2 (n = 53). If patients had already taken blood pressure-lowering agents, they had to continue blood pressure-lowering agents without changing other agents or dose intensification. According to Japanese society of hypertension guidelines for the managements of hypertension 2019 (JSH2019), we estimated the improvement of blood pressure to assess effectiveness of CPAP treatment after six-month follow up. Results The study group consisted of 180 SDB patients (152 males, 28 females). The mean age was 53 ± 12 years. Figure 1 showed polysomnographic data before initiating CPAP treatment. Group A was significantly lower apnea hypopnea index (AHI) than in Group B and C (p < 0.0001). Figure 2 showed the changes of blood pressure after initiating CPAP treatment (six-month). There was no significant difference respect to changes of systolic blood pressure (ΔSBP), but Group A showed the tendency for worsening SBP compared with other groups. Conclusions We could estimate that CPAP treatment had only limited effects in antihypertensive effect for Japanese patients, who especially had non-obese body and lower AHI level. We need the strict blood pressure follow up for patient with SDB after initiating CPAP treatment.Figure

A physiologic, precision-medicine approach to guided pharmacological treatment of hypertension substantially improves blood pressure in a large community-based cohort

Abstract Background Worldwide blood pressure (BP) control rates remain poor. Hypertension (HTN) guidelines provide BP targets and recommend drug treatment algorithms but ignore the potential to treat the underlying haemodynamic reason. Patient’s poor adherence to medication is often identified as a potential cause of poor HTN control. Purpose To improve rates of BP control by matching patients’ non-invasive haemodynamics to specific pharmacologic treatments and increasing patient engagement. Methods 13,715 hypertensive patients were identified via the electronic medical record (EMR) from two US primary care groups between 2014 and 2023. Impedance Cardiography (ICG) was done when BP was >140/90. Physiologic measurements included blood pressure, mean arterial pressure, cardiac index, cardiac power index, total peripheral resistance index, stroke index and heart rate (Figure 1). HTN etiology was classified as: Vasoconstriction, Hyperdynamic, or Mixed pattern based on the haemodynamic findings of the ICG. Printed clinical decision support (CDS) tools and later an EMR integrated CDS application were used to communicate recommendations to physicians. Printed reports were shared with patients to increase their engagement. Rates of successful blood pressure treatment were tracked by analysis of EMR data. Results The demographics of 13,715 patients were 14% black, 50% women, 17% age 18-49, 45% age 50-69, and 38% age ≥ 70 years. A total of 21,246 ICGs were performed classifying patients as Vasoconstriction 46%, Hyperdynamic with high heart rate (HR) or high stroke index (SI) 25%, and Mixed Haemodynamic (combination of Vasoconstriction and Hyperdynamic) 29% (Figure 1). No demographic features predicted the physiologic grouping. 7,892 patients in the first cohort were treated from 2014 thru 2023 and obtained >90% BP control rate in 2016. This high control rate has been sustained for 6 years. 5,823 patients in the second cohort were treated from 2019 thru 2023 and obtained >86% BP control rate. Conclusions Haemodynamic data may help personalize anti-hypertensive therapy and improve control of HTN to >86-90%. Providing patients with insights about why their BP is high and providing rationale for selecting treatment may motivate their adherence and persistence with therapy. Hypertension physiology is not predicted by demographic features among patients managed in a primary care setting.Haemodynamic Status (ICG Test Results)

Channels formation in cellulose materials by accelerated transport of gas molecules and glycerin

In this study, a microporous separator was produced using cellulose acetate (CA), which demonstrates heightened thermal stability in comparison to existing materials like polypropylene (PP) or polyethylene (PE). Furthermore, a pliable component was integrated into the CA membrane using glycerin as the plasticizing agent. Subsequently, gas pressure was exerted onto these areas to induce the formation of nano-sized pores. Examination through Scanning Electron Microscopy (SEM) unveiled the presence of abundant pores in the glycerin-plasticized areas. This substantiates that the pores generated under gas pressure were not only more uniform but also smaller than those created under water pressure. The interaction between CA and glycerin was validated using Fourier-Transform Infrared Spectroscopy (FT-IR), offering confirmation that a portion of the glycerin was extracted following the application of gas pressure. Additionally, the application of Thermogravimetric Analysis (TGA) allowed for an assessment of the thermal stability of the CA membrane, along with a verification of glycerin's removal post gas pressure treatment. The findings indicated that the incorporation of glycerin diminished the thermal stability of the CA membrane due to the plasticization effect. Furthermore, it was observed that a minor quantity of glycerin still persisted after the gas pressure treatment. Following the analysis of gas permeation, the porosity of the CA membrane was quantified at 78.8 %, exhibiting an average pore size measuring 224 nm.

Characteristics of rice starches modified by single and dual heat moisture and osmotic pressure treatments

The effect of osmotic pressure treatment (OPT), heat moisture treatment (HMT), and their dual combination as HMT-OPT and OPT-HMT on functional and pasting properties, gel texture, crystallinity, thermal, morphological, and rheological properties, and in vitro digestibility of modified starches were investigated. HMT was done with 29 % moisture at 111 °C for 45 min while OPT was performed at 117 °C for 35 min with saturated sodium sulphate solution. All modifications increased amylose content, improved pasting stability, and reduced swelling power and solubility. Dual modifications caused higher morphological changes than single modified starches. HMT and OPT increased pasting temperature, setback and final viscosity while decreased peak viscosity and breakdown, whereas HMT-OPT and OPT-HMT reduced all pasting parameters except pasting temperature. 1047/1022 and 995/1022 ratios and relative crystallinity decreased. V-type polymorphs were formed, and gelatinization temperature range increased with lower gelatinization enthalpy. Starch gel elasticity, RS and SDS content were enhanced to a greater extent after HMT-OPT and OPT-HMT. HMT as a single and dual form with OPT showed prominent effect on pasting, thermal, crystalline, and rheological properties. Application of HMT, OPT and dual modified starches with improved functionalities may be targeted for suitable food applications such as noodles.

Abstract 14501: Process Evaluation of a Double Blind Randomized Controlled Trial to Assess the Efficacy and Safety of a Quadruple Ultra-Low-Dose Treatment for Hypertension Within a Federally Qualified Health Center Network (QUARTET USA)

Introduction: This explanatory sequential mixed-methods process evaluation of the QUARTET USA clinical trial (NCT03640312) explores patient and health professional perceptions about the use of low-dose quadruple therapy (LDQT) as a novel strategy for hypertension management. Methods: Sixty-two patients took part in the trial. Survey data were collected from patients to understand their beliefs about blood pressure medications and treatment satisfaction with LDQT. A sub-sample of 13 English and Spanish patients and 11 health professionals, recruited via purposive sampling, took part in semi-structured qualitative interviews. Data collection took place between August 2019 and July 2022. Quantitative data were analyzed using descriptive statistics and cross-tabulations, and the qualitative data were analyzed using thematic analysis. Common themes from the two sets of findings were integrated. Results: 54.3% of patients believed in the necessity of their blood pressure medicines and 40.6% were concerned about the side effects and long-term effects of their medications. At trial completion, 80.4% of the patients were satisfied with the LDQT, 96.4% were certain the benefits of taking LDQT outweighed the disadvantages, and all participants reported that it was convenient to take. Both patients and health professionals found LDQT acceptable because it facilitated patients’ blood pressure control and medication adherence, and reduced patients’ perceived pill burden and adverse reactions. Health professionals stated that a limitation of LDQT was the inability to titrate the dose and that health insurance coverage and inclusion of LDQT in national hypertension guidelines could increase its widespread use. Conclusions: The LDQT strategy was acceptable to patients and health professionals for hypertension treatment. While LDQT therapy generally improved and maintained patients’ blood pressure control, medication adherence, and had a good safety profile, the limitation of its titration inflexibility and medication cost were raised by health professionals. Making LDQT therapy flexible by introducing stepped care combinations and ensuring health insurance coverage could increase its widespread implementation and scale-up.

Abstract 13909: It’s All About the Fat: Most Subjects With Metabolically Obese Normal Weight Have Either High Body Fat or Central Obesity

Introduction: Metabolically obese normal weight (MONW) refers to metabolic abnormalities despite normal body mass index (BMI). Hypothesis: Because obesity is generally defined by BMI, it is assumed that people with MONW do not have excessive adiposity but still have the metabolic dysregulation associated with adiposity. Methods: We included participants aged 20-65 of the National Health and Nutrition Examination Surveys from 1999-2006 and 2011-2018 with normal BMI (18.5-25 kg/m 2 ), fasting blood samples, and DEXA data. According to the AHA criteria, MONW was defined having ≥3 of the following criteria, besides a normal BMI: Hypertriglyceridemia (≥ 150 mg/dL) or treatment for elevated triglycerides; HDL cholesterol level < 40 mg/dL in men or <50 mg/dL in women or treatment for reduced HDL-C; elevated blood pressure (systolic ≥ 130 mmHg and/or diastolic ≥ 85 mmHg) or antihypertensive treatment or history of hypertension; elevated fasting plasma glucose ≥ 100 mg/dL or insulin/oral hypoglycemic treatment and central obesity by waist circumference (≥ 94 cm in men and ≥ 80 cm in women). High fat percentage was defined as ≥25% in men, ≥35% in women. Weighted logistic regression was performed to test the relation between MONW and high fat%, central obesity. Results: Of the 7,887 participants (53.6% men; mean age±SE was 39.23±0.24 years), 2433 (33.4%) had normal BMI included in the analysis. Among these, 148 had MONW (5%). Mean Fat% was 26.08±0.36% in those with MONW versus 21.90±0.17% in those without MONW for men, and 37.02±0.35% versus 33.31±0.21% for women. MONW subjects were 2.21 times more likely to have either central obesity or high fat % (OR 12.09, 95%CI: 6.18-23.67, p<0.01) and 2.18 times more likely to have high fat % (OR=2.84, 95%CI: 1.72-4.67, p<0.01) (see Figure). Conclusions: Most individuals with MONW have either increased fat content, central deposition of fat, or both. That highlights people with normal BMI may still have metabolic complications of adiposity.

Abstract 12225: The Association of Intensive Blood Pressure Therapy to Mortality in Older Adults After an Injurious Fall. Geriatric Insights From SPRINT

Introduction: The primary finding of the Systolic Blood Pressure Intervention Trial (SPRINT) demonstrated that intensive (IT, <120 mmHg) compared to standard (<140 mmHg) blood pressure (BP) treatment on an index serious adverse event (SAE), injurious falls, was similar. However, mortality after the index fall has not been well studied. We hypothesized that the occurrence of falls may be associated with reduced mortality benefits. Methods: Using the publicly available SPRINT dataset we analyzed the association of IT on the primary outcome of all-cause mortality and the secondary outcome of non-cardiovascular (CV) mortality as a function of falls. Results: Among 9,361 SPRINT participants, 7.1% (n=666) had a fall. Falls were more likely in older adults (p<0.0001), among women (45.9% vs 34.8%), and those with baseline cardiovascular disease (20.3% vs 16.4%). Among those who fell, 7.8% (52/666) died which was 14.2% of all deaths in SPRINT (52/365). In those who fell, mortality increased with age (p<0.0001) and was highest in those ≥ 80 years (13.7%, Figure ). For all-cause mortality- Falls independently and significantly were associated with increased risk (HR 1.41,1.04-1.91, p=0.03 ) while IT significantly decreased the risk (HR 0.73, 0.60-0.91, p=0.004) . The joint effect (IT+Fall) demonstrated a non-significant increased risk (HR 1.03, 0.56-1.88, p int =0.92). For non-CV mortality- Falls independently and significantly were associated with increased risk (HR 1.63, 1.16-2.29, p=0.005) while IT did not significantly lower risk (HR 0.81, 0.63-1.03, p=0.09) . The joint effect (IT+Fall) demonstrated a non-significant increased risk (HR 1.21, 0.63-2.35, p int =0.56). Conclusions: Our findings suggest that current reporting of potential harm of the treatment effects of IT, measured by the index SAE, may underrepresent true risk and overstate treatment benefits.

Ultrahigh pressure field: A friendly pathway for regulating the cellular adhesion and migration capacity of collagen

Customized control of the biological response between the material matrix and cells is a crucial aspect in the development of the next generation of collagen materials. This study aims to investigate the effects of ultrahigh pressure treatment on the interaction between collagen and cells by subjecting bovine tendon collagen to different intensities of ultrahigh pressure field. The results indicate that ultrahigh pressure treatment alters the spatial folding of collagen, causing distortion of its triple helical conformation and exposing more free amino groups and hydrophobic regions. As a result, collagen's cell adhesion capability and ability to promote cell migration are significantly enhanced. Optimal cell adhesion and migration capabilities are observed in collagen samples treated at 500 MPa for 15 min. However, further increasing the intensity of the ultrahigh pressure treatment leads to severe damage to the triple-helical structure of collagen, along with re-aggregation of free amino groups and hydrophobic moieties, thereby reducing collagen's cell adhesion capability and ability to promote cell migration. Therefore, ultrahigh pressure treatment offers a promising method to effectively regulate collagen-cell adhesion and promote cell migration without the need for external components. This provides a potential means for the customized enhancement of collagen-based material interfaces.

Abstract 14793: Relationship Between Self-Rated Health and Clinical Outcomes in Hypertension: A Secondary Analysis of the Systolic Blood Pressure Intervention Trial (SPRINT)

Background: Self-rated health (SRH) is a well-known independent predictor of mortality. However, the association of SRH with clinical outcomes in patients with hypertension remains uncertain. SPRINT investigated the benefit of intensive (vs. standard) blood pressure treatment in patients with high-risk hypertension. Objective: To examine the association between SRH and the primary SPRINT outcome, which was defined as the composite of myocardial infarction, other acute coronary syndromes, stroke, heart failure, and cardiovascular death. Methods: A trained study personnel administered a questionnaire to assess SRH. Each participant rated their overall health as excellent, very good, good, fair, or poor (E, VG, G, F, P). We categorized SRH into excellent, very good, good and fair/poor. Multivariate Cox regression was used to examine the association of SRH and clinical outcomes in SPRINT. Results: We included 9,319 participants (aged 67.9±9 years, 35.6% women, 57.6% White) who had available data on SRH. After a median follow-up of 3.8 years, 724 and 500 primary outcome and all-cause mortality events occurred, respectively. Relative to SRH of excellent, the risk of the primary outcome (HR 95% CI) associated with very good, good, and poor/fair SRH was 1.11 (0.78-1.56; p=0.555), 1.45 (1.03-2.05; p=0.036) and 1.87 (1.28-2.75; p=0.001), respectively. Similarly, relative to excellent, the risk of all-cause mortality (HR 95% CI) associated with very good, good, and poor/fair SRH was 1.13 (0.73-1.76; p=0.581), 1.72 (1.12-2.64; p=0.014) and 2.11 (1.32-3.38; p=0.002), respectively. Poorer SRH was also associated with a higher risk of each component of the primary outcome and adverse events ( Table). Conclusion: In the SPRINT cohort, SRH was independently associated with the risk of cardiovascular outcomes, mortality, and adverse events. Further studies are needed to explore the utility of incorporating SRH in the assessment of risk in patients with hypertension.

Effects of high hydrostatic pressure on peelability and quality of Crayfish (Procambarus clarkii).

Peeling of crayfish is a very important process in production. Crayfish peeling by machine can increase production efficiency and enhance the safety in production process. The tight muscle-shell attachment causes difficulty in peeling freshly caught crayfish. However, few studies have explored the changes in crayfish quality under favourable shell-loosening treatments. In this study, the shell-loosening properties of crayfish and changes in crayfish quality, microstructure, and protein fluorescent features were investigated after high hydrostatic pressure treatment (HHP). New methods were established to measure the peeling performance of crayfish, which are peelabibity and meat yelid rate (MYR). The normalization of peelability and MYR were verified by different weights of crayfish tails and different treatments. The peeling effect of HHP-treated crayfish was evaluated by a new quantitative measurement method, and meat yield rate (MYR) was calculated. The results showed that all the HHP treatments reduced crayfish peeling work and increased MYR. The HHP treatment provided better crayfish quality in terms of texture and color and enlarged the shell-loosening gap. Among all HHP treatments, 200 MPa treatment exhibited a lower peeling work , higher MYR, and an expansion of the shell-loosening gap reaching up to 573.8 um. At the same time, 200MPa treatment can maintain the quality of the crayfish. The findings outlined above suggest that high pressure is a promising method used to loosen crayfish shells. 200 MPa is an optimal HHP treatment condition for crayfish peeling, exhibiting a promising application in industrial processing. This article is protected by copyright. All rights reserved.

Pore characteristics of cake by filtration based on LBM-DEM-DLVO coupling method

Slurries containing fine particles are widely dewatered by flocculation combined with filtration. Understanding the microscopic filtration process of a flocculated slurry is helpful in designing flocculation and filtration schemes; however, there is currently limited research. In this study, the Lattice Boltzmann method–Discrete Element method–DLVO coupling method (LBM–DEM–DLVO) was used to conduct numerical experiments on the pore characteristics of cake by filtration. The numerical results demonstrate that the cake formed by filtration of the flocculated slurry contains two types of pores: interfloc and intrafloc pores. The diameter of the interfloc pores, which are the dominant channels for water seepage in the cake, is relatively large. The pore properties of the cake were significantly influenced by the interaction force between the particles in the floc and the filtration pressure; the mechanism was analyzed. Engineering proposals for dewatering are also presented. A multi-stage pressure treatment process and increased Finter during flocculation are recommended.

Brainstem impairment in obstructive sleep apnoea and the effect of CPAP treatment: an electrophysiological blink reflex study

PurposeThis study aimed to evaluate the functionality of the brainstem structures through the blink reflex (BR) test in patients with obstructive sleep apnoea (OSA) and to assess the effects of continuous positive airway pressure (CPAP) treatment on BR responses.MethodsPatients with moderate-severe OSA and controls underwent BR testing. Patients with OSA who were adherent to CPAP therapy repeated BR testing at 6 months follow-up. CPAP adherence was defined as CPAP use for ≥ 4 hour per night on > 5 nights per week with residual apnoea-hypopnea index less than 5 events per hour.ResultsA total of 22 patients with OSA (86% male, mean age 57.8 ± 10.6 years) and 20 controls (60% male, mean age 55.3 ± 9.3 years) were included. Patients with OSA showed longer right and left R1 latency, as well as delayed right ipsilateral and contralateral R2 latencies compared to controls. Patients with OSA who were compliant with CPAP treatment (n = 16; 88% men, mean age 58.8 ± 9.7 years) showed a significant decrease in latency of the right ipsilateral and contralateral R2 responses at 6 months.ConclusionThis study showed an abnormal pattern of BR responses in patients with OSA, consistent with a significant impairment of brainstem functionality in OSA. CPAP treatment partially improved the BR responses, suggesting the importance of treating OSA.

Decay resistance and dimensional stability of wood impregnated with castor oil using a pressure treatment

Abstract This study was conducted to investigate the uptake of castor oil (CAO) in some wood specimens and the effect of CAO on the leaching ability, dimensional stability and fungal-decay resistance of the wood specimens. CAO was infused into the specimens using a pressure treatment. Uptakes of CAO penetrated in yellow poplar (YEP), Japanese cedar (JAC) and Douglas fir (DOF) blocks were higher than 100 %. The leaching ability of the CAO-based suspensions against saline water was the lowest in YEP, followed by Japanese larch (LAR), JAC and DOF. The retention values were 90 % or higher in most of the specimens. Radial and tangential swellings of CAO-treated strips submerged in saline water for 2 weeks were restrained compared to control specimens. No significant differences were found between bending strength and Janka hardness of CAO-treated and control strips. CAO treatment provided acceptable decay resistance to most wood specimens against Fomitopsis palustris and Trametes versicolor. Retention of CAO in the leached strips were identified through X-ray microscopic observation. Based on the results, CAO was determined to be an effective agent for improving the dimensional stability of wood. These results demonstrate the great potential of CAO as an environmentally friendly wood preservative and dimensional stabilizer, allowing CAO-permeated wood as raw materials for both indoor and outdoor use.

Effects of conditioning sports activity on hypertensive patients

The study aimed to investigate whether regular physical activity plays a role in the treatment of high blood pressure in Algerian individuals, given that over 90% of hypertension cases do not respond well to pharmaceutical or surgical treatment. Regular physical activity is an accessible and cost-effective way to maintain health, and recent scientific studies have shown its effectiveness in treating various chronic diseases, such as diabetes and respiratory disorders. To address this, the study was divided into three parts: Preliminary Chapter: This section introduces the research problem, hypotheses, objectives, definitions, challenges faced, and previous studies on the subject. Theoretical Background: This part consists of three chapters. The first chapter covers physical activity, including its concept, historical evolution, types, and its various health, psychological, and economic benefits. The second chapter discusses the cardiovascular system's role in maintaining normal blood pressure and the effects of engaging in physical activity on different body systems. It emphasizes physical activity's crucial role in prevention and the treatment of certain diseases. The third chapter addresses high blood pressure, its nature, types, scientific causes, complications, medications, and how to reduce and manage blood pressure while considering potential side effects.

5 Antihypertensive Medication Use and Cognition in Older Adults

Objective:Hypertension is a common disorder that has been inconsistently associated with worse cognition in older adults. Antihypertensive medications offer treatment for high blood pressure but previous studies on the association between blood pressure, antihypertensive use, and cognitive performance in older adults have yielded inconsistent findings. Individuals without high blood pressure may also take antihypertensive medications for other medical conditions, including migraines. It is unclear whether antihypertensive medications have any effect on cognitive performance in older adults, and whether the differences, if any, are similar in hypertensives and normotensives.Participants and Methods:4,969 participants from the National Alzheimer Coordinating Center (NACC) database were included in this study (Mage=72.4 years, SD=7.3 years). Cognitive assessment included Letter Fluency, Category Fluency (animals and vegetables), Trail Making Test A & B, Digit Ordering (forward and backward), and MoCA total score. Participants were included if they had a clinician diagnosis of hypertension or normotension and recorded history of whether they take any antihypertensive medication. Participants with a history of stroke were excluded. Cognitive differences between medication groups were investigated in hypertensive participants and normotensive participants using Bayesian Mann-Whitney tests.Results:Bayesian Mann-Whitney tests in hypertensive individuals showed no cognitive differences between those taking antihypertensive medications and those not taking antihypertensives (all BF10s < 3). Bayesian Mann-Whitney tests in normotensive individuals showed individuals taking antihypertensive medications performed worse on Trail Making Test B compared to individuals not taking antihypertensives (123.6 seconds vs 108.8 seconds; BF10 = 35.1), with a small effect size (d=-.156).Conclusions:These results suggest that antihypertensive use in older adults with normal blood pressure may be associated with worse executive functioning. Antihypertensive use in normotensive older adults may lower blood pressure and reduce cerebral perfusion, resulting in worse cognitive functioning. Future studies should investigate long-term antihypertensive use and associated cognitive changes in both hypertensive and normotensive individuals.

6 The Role of CPAP Treatment on Associations Between Obstructive Sleep Apnea and Cognition Among Black and White Older Adults

Objective:Obstructive sleep apnea (OSA) may be a modifiable risk factor for late-life cognitive impairment. We previously demonstrated that non-Hispanic Black older adults are less likely to be diagnosed with OSA despite having equal or greater health risk for OSA compared to non-Hispanic White older adults, and this disparity in diagnosis was strongest among individuals with lower education. Here, we aimed to determine 1) whether there are racial differences in continuous positive airway pressure (CPAP) treatment, 2) how CPAP treatment may influence OSA-cognition associations, and 3) whether CPAP differentially influences OSA-cognition associations across racial groups.Participants and Methods:Cross-sectional data were obtained from 424 socioeconomically diverse community-dwelling adults ages 55-83 (63.4±3.2 years, 41.7% male, 53.5% Black) from the Michigan Cognitive Aging Project. Physician-diagnosed OSA and current CPAP use were self-reported. Global cognition was operationalized as a composite of five factor scores derived from a comprehensive neuropsychological battery. Racial group differences were investigated with chi-square and Fisher’s exact tests with statistical significance set at the .05 level. Associations between OSA and cognition (adjusted for age, gender, race, and years of education) were investigated with linear regressions. Subsequent models isolated effects of uncontrolled OSA by excluding individuals using CPAP. Racial differences in OSA-cognition associations were investigated with race-stratified models.Results:Fewer Black participants (9.2%) reported diagnosed OSA compared to White participants (12.3%; x2 (1, N=424) =5.314, p=.021, cp=.112). In the whole sample, 47.3% of participants with diagnosed OSA reported CPAP use, and this proportion did not differ across race (x2 [1, N=86] =.048, p=.826). In the whole sample, OSA diagnosis was only associated with cognition when CPAP users were excluded (excluding CPAP users: ß=-.085, SE=.037, p=.024; including CPAP users: ß=-.067, SE=.036, p=.062). In race-stratified models, diagnosed OSA was only associated with cognition among Black participants, and this association was stronger when CPAP users were excluded (excluding CPAP users: ß=-.142, SE=.060, p=.018; including CPAP users: ß=-.126, SE=.058, p=.030). Diagnosed OSA was not associated with cognition among White participants, irrespective of whether CPAP users were included (excluding CPAP users: ß=-.084,SE=.068, p=.215; including CPAP users: ß=-.056, SE=.064, p=.378).Conclusions:Our findings support CPAP treatment as a potential intervention to mitigate late-life cognitive impairment among those with OSA. Despite being less likely to receive a diagnosis of OSA, Black older adults were equally likely to engage in CPAP treatment as White older adults when diagnosed. The detrimental impact of OSA on cognition may be more salient among Black older adults, which may reflect racial disparities in cardiovascular risk and/or resources that promote cognitive reserve. However, CPAP appears to be an effective treatment to reduce OSA-related cognitive impairment for Black older adults, highlighting the critical importance of diagnosis and treatment in this group. Intervention efforts that abate racial inequalities in access to quality healthcare in order to facilitate acquisition of a formal OSA diagnosis and CPAP treatment may help to reduce preventable cognitive health disparities among older adults.

Representation of Real-World Adults with CKD in Clinical Trials Supporting Blood Pressure Treatment Targets

Representation of Real-World Adults with CKD in Clinical Trials Supporting Blood Pressure Treatment Targets

An alternative negative pressure treatment for enteroatmospheric fistula resulting from small intestinal leakage caused by incision dehiscence

BackgroundTo investigate the efficacy of an alternative negative pressure treatment for the treatment of enteroatmospheric fistula transformed from small intestinal leakage due to incision dehiscence after abdominal surgery. MethodsPatients with an enteroatmospheric fistula from small intestinal leakage owing to incision dehiscence following abdominal surgery between January 2010 and December 2019 were retrospectively reviewed. ResultsA total of 83 patients (mean age: 38.3 ± 11.6 years; Body mass index: 19.9 ± 2.2 kg/m2) were enrolled. Of the 83 patients, 59 (71.1 %) achieved fistula closure. High-output fistula (Hazard ratio = 0.48; 95 % Confidence interval: 0.29–0.81; P = 0.006) and abdominal wall thickness >2 cm (Hazard ratio = 2.76; 95 % Confidence interval: 1.35–5.67; P = 0.006) were identified as factors affecting fistula closure. Lastly, 11/83 (13.3 %) patients exhibited re-dehiscence. ConclusionAppropriately applying the alternative negative pressure treatment may enable fistula closure in patients with enteroatmospheric fistula resulting from small intestinal leakage caused by incision dehiscence.

Effect of curry leaves in lowering blood pressure among hypertensive Indian patients

Hypertension, commonly known as high or rising blood pressure, is characterized by a consistently elevated blood arterial pressure. It is a significant medical condition called hypertension raises your risk of developing problems with your heart, brain, kidneys, and other organs. Curry leaves work well as a treatment for high blood pressure. Curry leaves are thought to have a potent therapeutic impact for the treatment of high blood pressure since they are low in salt and high in potassium. Therefore, it is of interest to reduce the level of blood pressure among adults in rural area with the help of curry leaves. According to the statistical analysis, the experimental group's post-test mean score for hypertension was 155 with a standard deviation of 13.892 while the control group's post-test mean score was 162 with a standard deviation of 17.20. The estimated unpaired value of t = 11.07 was deemed to be statistically significant at the p 0.05 level and the mean difference was 7. As a result, the null hypothesis was rejected and the research hypothesis was accepted. Giving Curry leaf powder to patients with hypertension as a consequence was an effective intervention.

Diagnostic accuracy of optic nerve sheath diameter on ultrasound for the detection of increased intracranial pressure in patients with traumatic brain injury: A systematic review and meta‑analysis.

The timely diagnosis and treatment of elevated intracranial pressure (ICP) reduces morbidity rates and prevents mortality. The aim of the present systematic review and meta-analysis was to determine the diagnostic accuracy of optic nerve sheath diameter (ONSD) vs. standard invasive ICP measurements in patients with traumatic brain injury (TBI). The PubMed, Embase, Web of Science and Cochrane Library databases were systematically searched for studies including adult patients with TBI with suspected elevated ICP, and the sonographic ONSD measurements were compared with those from a standard invasive method. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool by two independent authors. A bivariate random effects model was used to summarize the pooled sensitivity, specificity and diagnostic odds ratio (DOR). A total of eight prospective studies with 222 patients with TBI were included. The pooled sensitivity was 0.82 [95% confidence interval (CI), 0.75-0.88], the specificity was 0.82 (95% CI, 0.71-0.90) and the DOR was 17.75 (95% CI, 7.02-44.83) with partial evidence of heterogeneity. The accuracy of the area under the summary ROC was 0.87. An ultrasound-determined elevated ICP has reasonable performance indicators with high sensitivity and specificity in patients with TBI. As such, this method may be a useful complementary monitoring tool in acute care.