Stiffness Index Values Research Articles

Do Photopletysmographic Parameters of Arterial Stiffness Differ Depending on the Presence of Arterial Hypertension and/or Atherosclerosis?

Hypertension and atherosclerotic cardiovascular diseases (ASCVD) increase cardiovascular risk and worsen patients' prognoses. One early predictor of increased risk is a change in arterial stiffness. This study aimed to evaluate arterial stiffness parameters using the non-invasive photoplethysmography (PPG) method in Polish patients with arterial hypertension (AH) and/or atherosclerosis (AS). The study group consisted of 333 patients (Caucasians, both sexes, aged 30-85 years old). Patients were analyzed in four groups depending on AH and AS (Group I: patients without AH or AS, Group II: AH patients, Group III: AS patients, and Group IV: AH/AS patients) and, in addition, according to sex and history of SARS-CoV-2 infection. Arterial stiffness parameters, i.e., reflection index (RI), peak-to-peak time (PPT), and stiffness index (SI) were automatically calculated with PPG based on the analysis of the pulse wave contour. Mean values of RI and SI were higher in men than women (p < 0.001 each). Diastolic blood pressure (DBP) also differed between sexes (p = 0.010). Mean SI values differed between the study groups (p = 0.038) with the highest SI found in AS/AH patients and the lowest-in patients without AH or AS. The mean SI values were significantly lower in women compared to men in both Group I and Group II (p = 0.006 and p < 0.001, respectively). The mean values of RI were also greater in men than in women in Group I and Group II (p < 0.001 for each group). Regarding COVID-19 history, only HR values differed between patients with and without COVID-19 in AH patients (p = 0.012). In AH patients, men had higher values of RI and SI compared to women (p < 0.001 and p < 0.001). On the other hand, AS women with COVID-19 had significantly greater mean values of SI (9.66 m/s ± 1.61) than men with COVID-19 (7.98 m/s ± 1.09) (p = 0.045). The present study confirmed that sex had a significant impact on arterial stiffness parameters. Both AH and AS affected arterial stiffness. Heart rate was greater in hypertensive patients after COVID-19 compared to hypertensive patients without COVID-19.

Effect of duration of hypertension on arterial stiffness

Background: Hypertension is one of the common and prime causes contributing to 18% of deaths globally. Prevalence of essential hypertension increases with age, and individuals with relatively high blood pressure at younger ages are at increased risk for the subsequent complications of hypertension. The morphological and physiological changes in vasculature have been described in the evolution and maintenance of hypertension. Hypertension can increase the risk of cerebral, cardiac, and renal events. Aims and Objectives: (1) To record the arterial stiffness index (SI) and reflection index (RI) in subjects with hypertension and a control group of age-matched normotensives. (2) To compare the above vascular parameters between control and hypertensive subjects. (3) To classify the hypertensive subjects based on the duration of the disease and compare the vascular parameters among them. Materials and Methods: A cross-sectional study on 160 subjects aged between 30 and 60 years was conducted. Institutional ethical committee approval and informed written consent were obtained. They were divided into four groups. Group 1- control group (Healthy subjects), and study group of hypertensives are classified into three groups based on the duration of illness. Arterial stiffness was evaluated by SI and RI, calculated from recording digital volume pulse (DVP). DVP was measured by an instrument known as finger pulse photo plethysmography. Results: The results were analyzed using analysis of variance test and were considered statistically significant with P &lt; 0.05 with respect to arterial stiffness indices compared with the duration of hypertension. Conclusion: This study concludes a strong positive correlation between two indices of arterial stiffness that is the RI and SI values increases with the duration of hypertension.

Arterial structure and function in patients with hemoblastoses before and after high-dose chemotherapy and autologous hematopoietic stem cell transplantation

Background: High dose chemotherapy (HDCT) preceding autologous hematopoietic stem cell transplantation (autoSCT) can be toxic for cardiovascular system, which can be mediated with the development of endothelial dysfunction. No studies on the assessment of arterial stiffness and endothelial function after HDCT and autoSCT have been performed before.&#x0D; Aim: To evaluate endothelial function and arterial rigidity parameters by photoplethysmography in patient candidates for HDCT with autoSCT, to identify associated factors and to analyze changes of these parameters over time after HDCT and autoSCT.&#x0D; Materials and methods: In this cohort prospective observational study in 71 patients with verified hemoblastosis (mean age 43.8 ± 12.6 years) we assessed endothelial function and stiffness by photoplethysmography (AngioScan-01, Russia) before and after HDCT with autoSCT. Thirty two (32, 45%) patients had multiple myeloma (ММ), 39 (55%), lymphoproliferative disorders (LPD). We measured the stiffness index (SI), reflection index (RI), augmentation index normalized by heart rate of 75 beats per minute (AIp75) and performed the occlusion test with measurement of occlusion index (ОI) and phase shift (PS).&#x0D; Results: Mean RI in the total study group before HDCT with autoSCT was increased to RI 34.9% [24.5; 50.6], OI decreased to OI 1.5 [1.25; 1.80], and PS module decreased to PS 6.7 ms [3.9; 8.9]. After HDCT with autoSCT the PS module increased to 8.4 ms [5.0; 12.4] (p = 0.001) and OI increased to 1.7 [1.3; 2.2] (p = 0,007), which indicates an improvement in endothelial function.&#x0D; Changes in other parameters of arterial function were non-significant. We also analyzed a selected group of the patients with MM who had higher cardiovascular risk, compared to the LPD patients: they were older (53 vs 36.1 years; p 0.001), had higher rates of arterial hypertension (p 0.001) and diabetes mellitus (p = 0.048). Compared to the LPD patients, the MM patients had higher baseline values of SI (7.5 m/s [7.3; 7.9]), RI (42.9% [32.1; 53.6]), and AIp75 (6.3% [-1.65; 13.8]), indicating higher vascular stiffness. They also had lower PS module values (5.0 ms [2.1; 8.5]). The LPD patients had been more frequently treated with anthracyclines (p 0.001) and radiation (p = 0.002). After HDCT with autoSCT, they had a higher increment of OI, namely, from 1.4 [1.3; 1.8] to 1.7 [1.4; 2.1] (p = 0.003).&#x0D; Conclusion: This study was the first to show a high rate of endothelial dysfunction and vascular stiffness abnormalities in patients with hemoblastoses who were candidates for HDCT with autoSCT. After HDCT with autoSCT, changes of endothelial function and stiffness were multidirectional. Despite a significant improvement, endothelial function parameters were not normalized. We were unable to find any predictors of the abnormalities. Thus, the identified baseline abnormalities in stiffness and endothelial function cannot be a contraindication to HDCT with autoSCT.

Analysis of Corneal Biomechanical Properties in Different Keratotopographic Patterns of Keratoconus.

To analyze the frequency of main keratotopographic patterns at the 1st, 2nd, and 3rd stages of keratoconus and investigate corneal biomechanical properties across different patterns. The study comprised two stages. The first stage was computational-experimental, where we utilized COMSOL Multiphysics® software (COMSOL AB, Stockholm, Sweden) to mathematically model corneal mechanical behavior under intraocular pressure and pulsed air jet action in both normal and keratoconic conditions. The second stage was the clinical phase, during which we retrospectively analyzed the examination results of both healthy subjects and patients with keratoconus. In total, the study included 256 eyes (256 subjects). Among them, 174 eyes (174 healthy individuals) had normal corneas with different refractions, and 82 eyes (82 individuals) had stages 1, 2, and 3 of keratoconus based on Amsler-Krumeich classification. The keratotopographic characteristics of the participants were assessed using Sirius (Schwind, Germany) and Pentacam AXL (OCULUS Optikgeräte GmbH, Germany) keratotomographs, while the corneal biomechanical properties were studied using noncontact tonometry with the Corvis ST device (OCULUS Optikgeräte GmbH, Germany). The study focused on evaluating corneal stiffness index values in the central optical zone under various keratotopographic patterns. In addition, it compared the elastic coefficient values c1, c2, and c3 for the model of hyperelastic behavior of corneal material outside the keratoconus zone. Furthermore, the study examined the values of reduced stiffness zone characteristics, including the stiffness reduction factor ψmax, effective radius Rk, and the ratio of maximum and minimum strain intensity in keratoconus of different stages. The mean age of the patients in the study was 30.16 ± 8.31 years, with 166 men and 90 women participating. The study revealed typical keratotopographic patterns in the examined keratoconus stages, as well as their occurrence frequency. In the 1st stage of keratoconus, the pattern of asymmetric astigmatism was noted more frequently (in 75% of cases). In the 2nd stage, the pattern with an ectasia zone in the lower cornea was observed in 80% of cases, and in the 3rd stage, a centrally located keratotopographic ectasia pattern was found in 42% of cases. Comparative analysis showed that the greatest decrease in stiffness parameter (SpA1) and stress-strain index occurred in the central pattern (by 64% and 46%, respectively), while the least decrease was observed in local corneal radius reduction in the lower cornea (by 42% and 33%, respectively). The decrease in strength properties in keratoconus occurs in a local area, the size and degree of which are determined by the disease stage. The indicated biomechanical parameters are consistent regardless of the shape and localization of keratotopographic patterns but are relevant to diagnostic specifications using the Corvis ST pneumotonometer, which assesses corneal properties in the apical zone.

Photoplethysmographic Measurement of Arterial Stiffness in Polish Patients with Long-COVID-19 Syndrome-The Results of a Cross-Sectional Study.

The coronavirus disease 2019 (COVID-19) is associated with an increase in the incidence of cardiovascular diseases (CVD) that persists even several months after the onset of infection. COVID-19 may also have an impact on arterial stiffness, which is a risk factor for CVD. We aimed to analyze if and to what extent arterial stiffness measured by photoplethysmography differed among COVID-19 convalescents depending on the acute phase severity and time elapsed since disease onset. A total of 225 patients (mean age 58.98 ± 8.57 years, 54.7% women) were analyzed after COVID-19 hospitalization at the Cardiac Rehabilitation Department of the Ustron Health Resort (Poland). In the entire study population, no differences were found in the mean values of stiffness index (SI) and reflection index (RI) depending on the severity of the acute COVID-19 and the time since the onset of the disease. There were no differences in the heart rate (HR) according to the severity of acute COVID-19; the mean HR was higher in patients who had COVID-19 less than 12 weeks before the study than in convalescents more than 24 weeks after the acute disease (p = 0.002). The mean values of SI and RI were higher in men than in women (p &lt; 0.001), while the heart rate (HR) was similar in both sexes (p = 0.286). However, multiple linear regression analyses after adjusting for factors influencing arterial stiffness, i.e., sex, age, body mass index, smoking status, hypertension, diabetes, the severity of the acute COVID-19, and the time from the disease onset, confirmed that age, sex, time from disease onset, and diabetes are the most important determinants that could influence arterial stiffness.

RESULTS OF ULTRASOUND ELASTOMETRY OF THE LIVER IN INDIVIDUALS WITH CHRONIC VIRAL HEPATITIS B (BASED ON HOSPITAL ATTENDANCE REGISTER DATA IN AZERBAIJAN)

The aim of this study is to identify the frequency and severity of liver damage using ultrasound elastometry in chronic viral hepatitis B (HBV) among the population of different regions of Azerbaijan. Objects and methods. The study involved patients residing in Baku, Sumgait and certain regions of Azerbaijan and seeking medical care at the Medical Centre “Medikus clinic“ in Baku. There were examined 639 participants with HBV, 398 men and 241 women. They were divided into 5 age groups: 1st group included individuals aged from 18 to 29, 2nd group involved patients aged 30-39, 3rd group included patients aged 40-49, 4th group was formed by 50-59 year old patients and 5th group included individuals of 60 years and older. In order to verify the HBV diagnoses, specific laboratory investigation methods and their evaluation criteria were applied. The study was carried out by ELISA using the Access 2 Immunoassay System (Beckman Coulter). The participants were diagnosed as B hepatitis positive, when their indicator equalled to 5 IU/ml. The study was conducted on by applying the “Rotor Gene Q“(Germany). Elastometry was performed by using 2D – Supersonic Aixplorer SWE (France).The examination was carried out according to the Cut–offs scale, and liver fibrosis was determined according to the METAVIR scale (sensitivity of the method is more than 80%, specificity is more than 90%). The level of hepatic tissue density was estimated in cRa. The density value of more than 5 kPa was regarded as pathological. Ultrasound elastometry of the liver will enable to assess the intensity of its fibrosis and predict its possible complications, which, along with other preventive measures, will significantly reduce disability and mortality. Results. The data on the liver elastometry indicators of men and women with confirmed diagnosis of chronic HBV, regardless of their region of residence are presented. In male patients, there is an obvious reliable association between an increase in the stiffness of the liver tissue and an increase in the age of the individuals (1 - 5.3±0.4 kPa; 2 – 5.4±0.2; 3 – 6.3±0.6; 4 – 8.2±0.8; 5 – 10.8±0.8 (p&lt;0.001)). Among women under 50 years, the hepatic tissue stiffness index values corresponded the normal ones (less than 5 kPa), and then significantly increased, then in the last age group it decreased unreliably (1 – 4.4±0.2; 2 – 4.2±0.1; 3 – 4.2±0.1; 4 – 9.7±1.4 (p&lt;0.001); 5 – 8.3±1.2). Comparing the results obtained, it can be stated that in males with HBV, gender and age play a significant role in the development of liver fibrosis. In all age groups, this indicator was higher than the standard. Among women under the age of 50, the process does not develop, but it sharply picked up the growth rate after 50 years, and then stabilized. In men, the discussed indicator was higher compared to women. Conclusion. Chronic HBV has a significant negative effect on the indicator of assessing the degree of development of fibrous tissue. The age of 50 years in patients with chronic HBV is an important factor, which in many cases, without gender differences, significantly increases the rate of formation of fibrous tissue in the liver.

The Association between Serum Resistin Level, Resistin (-420C/G) Single Nucleotide Variant, and Markers of Endothelial Dysfunction, including Salt Taste Preference in Hypertensive Patients.

Background: Resistin action links to conditions such as diabetes, obesity, but its role in hypertension is less well understood. This study aimed to estimate the relationship between resistin (−420G/C) single nucleotide variant (SNV) and markers associated with endothelial dysfunction in hypertension. Methods: The study enrolled 162 hypertensive patients (HT) and 165 non-hypertensive (NHT) patients. Resistin serum concentration was estimated with immuoenzymatic assay. Anthropometric measurements, blood pressure and arterial stiffness index (SI), uric acid (UA) serum concentration, and salty taste preference of normal (NS) or high (HS) were assessed in the study. Genotyping was achieved by polymerase chain reaction-restriction fragment length polymorphism. Results: Resistin concentration and SI do not differ significantly between HT and NHT individuals; UA significantly increased in HT subjects. Resistin, UA, and SI did not differ among particular resistin genotypes in HT, NHT, NS, or HS groups. GG and CG genotypes were more frequent (OR 1.57 (95% CI; 1.01–2.43); p = 0.04) in hypertensive individuals than the NHT group, but less frequent (OR 0.58 (95% CI; 0.37–0.91); p = 0.01) in HS patients compared to NS individuals. Concerning HT patients with different salt preferences, GG + CG genotypes were less frequent (OR 0.50 (95% CI; 0.26–0.97); p = 0.04) in the HS group than in NS individuals. HT carriers of GG and CG genotype have significantly increased UA concentrations compared to the respective NHT subjects. HS individuals carrying GG and CG genotypes have higher SI values than the NS group. Allele G of SNV (−420G/C) adjusted for age, BMI, serum resistin, UA concentration, salt taste preference, SI, and HR values increased the risk of developing hypertensive phenotype 1.8 fold. Conclusions: Resistin SNV (−420G/C) is related to several markers associated with endothelial dysfunction, including salt taste preference in hypertensive patients.

Diagonistic Value of ARFI in Breast Lesions

Breast cancer became the most prominent cancer type in women worldwide. Its prevalence increased in recent years due to changes in life style and relapse among the patients seemed to be higher. Acoustic radiation force impulse (ARFI) imaging in based on the principle of the ultrasonic elasticity and the elestography accurately predict and measure the changes in breast cancer tissue compared to the normal tissue. It is a technical alternative to the palpation and able to measure lesser than 10 mm size. In contrast to biopsy, where the reduced deformability would occur and lead to biopsy failing. In fibroadenoma, due to its complications, many false positives could be detected and the ARFI elastography serve as an effective alternative method for breast cancer confirmation. The tissue stiffness index value is used to differentiate the benign and malignant tissue samples. ARFI further, use B- mode elasticity and help in recommending the biopsy confirmation.

A novel Stewart-type parallel mechanism with topological reconfiguration: Design, kinematics and stiffness evaluation

A new approach is put forward to enhance the stiffness of parallel mechanisms by topological reconfiguration. First, a novel 6-DOF Stewart-type parallel mechanism is designed and analyzed. This mechanism can be reconfigured into three topological configurations, each permitting one rotational motion by means of lockable prismatic joints. Then, an overall rotational stiffness matrix is analytically deduced by relating the external loads exerted on the end-effector to the magnitude of the induced micro-angular displacements. It is proved that the minimum eigenvalue of this matrix can serve as a stiffness index of the parallel mechanism. Subsequently, an optimization objective function is developed for stiffness enhancement through topological reconfiguration, and a singularity-free path planning model for full mobility motion control is formulated. Finally, numerical simulations are provided to compare the stiffness index values of the unlocked and locked mechanisms. The results show that the stiffness of the latter is substantially larger than that of the former, thereby demonstrating the effectiveness of the proposed approach.

Dynamic changes in aortic stiffness after substantial weight loss by laparoscopic sleeve gastrectomy in patients with obesity: a 1-year follow-up study

Arterial stiffness has been identified as a powerful and independent risk factor for cardiovascular disease. Obesity is associated with an increased risk of aortic stiffness (AS) and adverse cardiovascular events....

The Relationship of Modifiable Risk Factors with Indicators of Arterial Stiffness and Vascular Age in Patients with Arterial Hypertension

Aim. To study the relationship of modifiable risk factors (RF) with indicators of arterial stiffness and vascular age based on the contour analysis of the pulse wave velocity in hypertensive patients.Material and methods. The material of the study was the data from a survey of patients undergoing clinical observation at the polyclinic of MMC SOGAZ. A total of 107 patients were examined, in which 70 were men and 37 were women. The average age was 52.3±18.29. Photoplethysmography was used as a special research method, performed using the AngioScan-01 diagnostic complex. The main indicators used to evaluate the stiffness of large vessels were: stiffness index (SI), reflection index (RI), augmentation index (Alp75), age index (AGI), pulse wave types (PV) and vascular age (VA).Results. The mean values of arterial stiffness indices in patients with essential arterial hypertension (AH) and healthy individuals (control) had significant differences. The mean SI, Alp75, and VA values in the group of patients with AH were 7.8±1.03, 7.0±14.44 and 50.8±15.93 versus 7.2±1.73, 0.5±18.02 and 43.8±16.94, respectively (p&lt; 0.05). In both groups, a strong inverse correlation of passport age with C-type PV was revealed (r=0.74, p&lt; 0.01), which reflected the dynamics of a gradual age-dependent decrease in vascular compliance. The average VA value in the control group was 63.1±16.99 years with an average passport age of 59.5±8.79 years, which significantly differed from VA in hypertensive patients (p&lt; 0,05). Overweight, hypercholesterolemia, elevated low-density lipoprotein levels, lack of adequate antihypertensive control, and left ventricular diastolic dysfunction were significantly associated with early vascular (arterial) aging.Conclusion. Patients with hypertension, in addition to high blood pressure, significantly differ from normotensive control in terms of arterial stiffness. The lack of control over modifiable RF of patients with hypertension is associated with early vascular aging.

Promotion of Arterial Stiffness by Childhood Cancer and Its Characteristics in Adult Long-Term Survivors.

BackgroundVascular alterations induced by antineoplastic treatment might be considered as a possible underlying mechanism of increased cardiovascular sequelae in childhood cancer survivors (CCSs). We aimed to evaluate arterial stiffness among long‐term CCSs and to compare the data against a population‐based sample.Methods and ResultsArterial stiffness was assessed by digital photoplethysmography (stiffness index; m/s) among 1002 participants of the CVSS (Cardiac and Vascular Late Sequelae in Long‐Term Survivors of Childhood Cancer) study, diagnosed with neoplasia (1980–1990) before an age of 15 years. A population‐based sample from the GHS (Gutenberg Health Study) (n=5252) was investigated for comparison. All subjects underwent a comprehensive, standardized clinical examination in the same study center. CCSs had higher stiffness index (β=0.66 m/s; 95% CI, 0.51–0.80 m/s) in multivariable linear regression analysis after adjustment for cardiovascular risk factors compared with the population sample of comparable age range. Stiffer vessels were found among CCSs also in absence of arterial hypertension (β=0.66; 95% CI, 0.50–0.81) or history of chemotherapy/radiotherapy (β=0.56; 95% CI, 0.16–0.96) in fully adjusted models. Moreover, stiffness index differed by tumor entity, with highest values in bone and renal tumors. Almost 5.2‐fold higher prevalence of stiffness index values exceeding age‐specific, population‐based reference limits was observed among CCSs compared with GHS participants.ConclusionsThis is the first study demonstrating increased arterial stiffness among long‐term CCSs. The data suggest that vascular compliance might differ in survivors of childhood cancer from the established development concept for arterial stiffness in the population; cancer growth and antineoplastic treatment might be relevant determinants of the pathobiological features.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT02181049.

Vertical earthquake vulnerability of long-span spherical lattice shells with low rise-span ratios

This paper presents an approach for quickly predicting vulnerable areas of long-span spherical lattice shells under vertical earthquakes using the equivalent continuum analogy. According to the moment theory from classical shell mechanics, the equations for locating the position of maximum nodal displacement are deduced in the elastic range, while considering the heterogeneity in equivalent stiffness. Based on the plastic limit analysis theory, a defined relative stiffness index is proposed by integrating the curvature variation over the corresponding node-bearing area to predict the position of maximum nodal displacement in the plastic range. Several spherical single-layer lattice shells are analyzed using the finite element method to verify the proposed method, and the relative stiffness index, which could be used as an indicator to validate and adjust structural design configurations. As a large-span shell is expected to perform better when each ring has a similar equivalent stiffness index, thereby avoiding abrupt changes in stiffness. The case study indicates that the vulnerable area in such a long-span single-layer lattice shell can be predicted and controlled based on the relative stiffness index values. Additionally, the desired seismic damage-endurance capacity can be obtained by adjusting the relative stiffness index of each ring to ensure that the structure is sufficiently resilient. The method for predicting displacement-based vulnerable areas using the equivalent continuum analogy provides a practical tool for a quick assessment of preliminary design schemes of new lattice shells and can be also applicable to existing and ready-for-retrofit lattice shells.

Vascular Remodeling Markers in Patients with Essential Arterial Hypertension Depending on Presence of Type 2 Diabetes Mellitus

Aim. To study some vascular remodeling markers in hypertensive patients depending on the presence of type 2 diabetes mellitus.Material and methods. The study included patients with essential hypertension 1-2 degrees of increase in blood pressure with/without type 2 diabetes (30 and 32 patients respectively). Using photoplethysmography in combination with reactive hyperemia test structural and functional markers of vascular remodeling were determined: in large vessels – stiffness index and phase shift; in microvessels – reflection index and the occlusion index. Using the computer video capillaroscopy of the nail bed the density of the capillary network at rest, after venous occlusion and after the test with reactive hyperemia was determined. ELISA was used for determining the level of humoral markers of endothelium dysfunction and vascular bed remodeling: metalloproteinase 9, metalloproteinase 9 inhibitor, E-selectin, endothelin, transforming growth factor (TGF-β1), endothelial growthfactor A.Results. In compare with hypertensive patients in hypertensive patients with type 2 diabetes significantly higher stiffness index values (11.15 [10.05; 12.35] vs 10.15 [8.83; 11.83] m/s; p=0.04) were found as well as significantly lower (p=0.00) capillary network density at rest (26.4 [24.2; 27.6] vs 35.1 [33.0; 45.0] cap/mm2; p=0.00) after the tests with reactive hyperemia (29 [24; 33.3] vs 40.0 [35.0;43.3] cap/mm2; p=0.00) and venous occlusion (32.5 [27.8; 34.5] vs 40.0 [33.0; 45.0] cap/mm2). In hypertensive patients with type 2 diabetes significantly higher levels of TFG-β1 (11648 [4117.8; 37933.8] vs 3938.5 [1808.8; 7694] pg/ml; p=0.00) and significantly lower levels of endothelin-1 (0,46 [0,29;1,3] vs 1.73 [0.63; 2.30] ng/ml; p=0.01) was detected in compare with hypertensive patients without type 2 diabetes.Conclusion. In both groups some signs of vascular remodeling were found at the level of both large arteries and microvessels (arterioles and capillaries). However, the group of hypertension + type 2 diabetes mellitus had statistically significantly more pronounced changes in arterial stiffness, capillary network density, as well as humoral markers levels of fibrosis and endothelial dysfunction.

The effect of nebivolol and ramipril on selected biochemical parameters, arterial stiffness, and circadian profile of blood pressure in young men with primary hypertension: A 12-week prospective randomized, open-label study trial.

Background:The pleiotropic effects of hypotensive drugs should always be taken into consideration. There is limited data on the effect of such drugs on reducing global cardiovascular risk in young hypertensives. The aim of this study was to evaluate the effect of nebivolol and ramipril on biochemical parameters, arterial stiffness, and circadian profile of blood pressure (BP) in young men undergoing treatment for hypertension (HT).Methods:A total of 80 patients aged 16 to 28 years of age with grade 1 HT were enrolled into the prospective randomized, open-label trial. They were randomized to receive 5 mg of nebivolol or 5 mg of ramipril, daily. Arterial stiffness index (SI), the circadian profile of BP registered in ambulatory blood pressure monitoring (ABPM), and biochemical parameters—including lipid profile, insulinemia, glycemia, and high sensitivity C-reactive protein (hsCRP) levels—were evaluated before and after the twelve-week period.Results:After the treatment period, we observed significant decreases in both ABPM systolic blood pressure (SBP) in group of nebivolol (P = .0007) and ramipril (P = .0001) and in ABPM diastolic blood pressure (DBP) in group of nebivolol (P = .0018) and ramipril (P = .0006). Reductions in the nondippers percentage were found in group of nebivolol and ramipril (P = .0077, P = .0001 respectively). Ramipril treatment resulted in a significant plausible modification in high-density lipoprotein (HDL) (P = .0390), glucose (P = .0213), and hsCRP (P = .0053) concentrations, as well as decreased SI (P = .0009) value, while nebivolol treatment showed no such benefits.Conclusions:Despite the similar hypotensive effect of nebivolol and ramipril, ramipril seems to possess better clinical potential in reducing cardiovascular risk in young men with HT.

Factors Associated with Bone Health in Malaysian Middle-Aged and Elderly Women Assessed via Quantitative Ultrasound

Risk factors for osteoporosis may vary according to different populations. We aimed to investigate the relationship between risk factors of osteoporosis and bone health indices determined via calcaneal quantitative ultrasound (QUS) in a group of Malaysian women aged 50 years or above. A cross-sectional study was performed on 344 Malaysian women recruited from a tertiary medical centre in Kuala Lumpur, Malaysia. They answered a self-administered questionnaire on their social-demographic details, medical history, lifestyle, and physical activity status. Their height was measured using a stadiometer, and their body composition estimated using a bioelectrical impedance device. Their bone health status was determined using a water-based calcaneal QUS device that generated three indices, namely speed of sound (SOS), broadband ultrasound attenuation (BUA), and stiffness index (SI). A T-score was computed from SI values using a reference database from a mainland Chinese population. Women with three or more lifetime pregnancies, who were underweight and not drinking coffee had a significantly lower BUA. Stepwise multiple linear regression showed that SOS was predicted by age alone, BUA and SI by years since menopause, body mass index (BMI), and number of lifetime pregnancies, and T-score by years since menopause and percentage of body fat. As a conclusion, suboptimal bone health in middle-aged and elderly Malaysian women as indicated by QUS is associated with old age, being underweight, having a high body fat percentage, and a high number of lifetime pregnancies. Women having several risk factors should be monitored more closely to protect their bones against accelerated bone loss.

Quantification of vascular function changes under different emotion states: A pilot study.

Recent studies have indicated that physiological parameters change with different emotion states. This study aimed to quantify the changes of vascular function at different emotion and sub-emotion states. Twenty young subjects were studied with their finger photoplethysmographic (PPG) pulses recorded at three distinct emotion states: natural (1 minute), happiness and sadness (10 minutes for each). Within the period of happiness and sadness emotion states, two sub-emotion states (calmness and outburst) were identified with the synchronously recorded videos. Reflection index (RI) and stiffness index (SI), two widely used indices of vascular function, were derived from the PPG pulses to quantify their differences between three emotion states, as well as between two sub-emotion states. The results showed that, when compared with the natural emotion, RI and SI decreased in both happiness and sadness emotions. The decreases in RI were significant for both happiness and sadness emotions (both P< 0.01), but the decreases in SI was only significant for sadness emotion (P< 0.01). Moreover, for comparing happiness and sadness emotions, there was significant difference in RI (P< 0.01), but not in SI (P= 0.9). In addition, significant larger RI values were observed with the outburst sub-emotion in comparison with the calmness one for both happiness and sadness emotions (both P< 0.01) whereas significant larger SI values were observed with the outburst sub-emotion only in sadness emotion (P< 0.05). Moreover, gender factor hardly influence the RI and SI results for all three emotion measurements. This pilot study confirmed that vascular function changes with diffenrt emotion states could be quantified by the simple PPG measurement.

Effects of Weight Bearing and Non-Weight Bearing Sports on Bone Quality in Male Collegiate Athletes

Introduction Bone quality has been correlated with lifetime physical activity. The bone quality of male collegiate athletes was measured to investigate the effect of weight bearing load in sports on bone health. For the purpose of this study, soccer, football, and cross-country were considered weight bearing sports (WB), while cycling and swimming were non-weight bearing (NWB) sports.  Methods Bone scans were completed with an Achilles InSight Ultrasonometer device (Figure 1). Male collegiate athletes (n=50); ten subjects from each sport received a calcaneal bone scan on both feet. All tests were performed in the fall sports season when subjects were in-season training for competition. Strength training regimens differed for each sport. The subjects had no history of musculoskeletal injuries within 12 months prior to the bone scans. This device provided three values used for analysis of bone health: Broadband Ultrasound Attenuation (BUA: dB/MHz), Speed of Sound (SOS: m/sec), and Stiffness Index (SI). Stiffness index is calculated from combining the BUA and SOS values. The BUA, SOS, and SI were compared between sport, weight bearing vs. non-weight bearing activities, and foot dominance using a two-way ANOVA with repeated measures, with significance at p<0.05.  Results Bone quality among weight bearing sports was significantly (p<0.01) greater than non-weight bearing sports based on the stiffness index (Figure 2a). There were significant differences (p<0.01) in SI values for dominate foot between cycling and all WB sports (soccer, football, cross-country), but swimming was only significantly different (p<0.01) from soccer (Figure 2b). These results could be attributed to increased impact load, multi-directional movement patterns and increased strength training in WB sports. Energy balance, nutrition, hormone mediated bone turnover and genetic factors may also contribute to these results.  Conclusions Collegiate male athletes in weight bearing sports have greater bone quality than athletes in non-weight bearing sports. Health professionals and coaches should educate athletes on developing behavioral strategies to optimize bone health through proper diet and weight bearing exercise as a preventative measure.

Relationship between Fragmented QRS Complex and Aortic Stiffness in Chronic Hemodialysis Patients

Objective: This study aimed to evaluate the correlation between fragmented QRS complex (fQRS), aortic stiffness, and diastolic dysfunction in hemodialysis patients. Subjects and Methods: A sample of 56 patients who received hemodialysis treatment was stratified into 2 groups according to their electrocardiography (ECG) patterns with or without fQRS. Baseline characteristics and laboratory parameters of patients were documented. Conventional echocardiographic and Doppler echocardiographic procedures were performed in all patients. The mean early (Em) diastolic and late (Am) diastolic myocardial velocities were calculated. These tests were performed before dialysis. The Student t test, Mann-Whitney U test, χ² test, Spearman correlation, and multivariate linear regression analysis were used to analyze parameters where appropriate. Results: Of the 56 patients under hemodialysis, fQRS in ECG was detected in 26 (46.4%). Echocardiographic evaluation showed that deceleration time (237.57 ± 40.10 ms; p = 0.030), isovolumic relaxation time (126.84 ± 15.62 ms; p < 0.001), early (E)/late (A) ventricular filling velocity (E/A) ratio (1.15 ± 0.40; p ≤ 0.001), and aortic stiffness index value (9.62 ± 4.53; p = 0.016) exhibited a statistical increase in hemodialysis patients with fQRS compared to patients without fQRS. E (58.23 ± 19.96 m/s; p = 0.004), and Em (5.96 ± 2.08 cm/s; p = 0.023) velocity levels were significantly lower in hemodialysis patients with fQRS than patients without fQRS. Aortic stiffness closely correlated with diastolic dysfunction (deceleration time r = 0.273, p = 0.042; isovolumic relaxation time r = 0.497, p < 0.001; E/A ratio r = -0.449, p = 0.001). On multivariate linear regression analysis, fQRS and aortic stiffness were independently associated in hemodialysis patients (β = 0.321, p = 0.049). Conclusions: Increased aortic stiffness and left ventricular systolic dysfunction were observed more frequently in hemodialysis patients with fQRS than in patients without fQRS. fQRS is an important determinant of aortic stiffness in hemodialysis patients.

Effects of age, sex, and ethnicity on bone health status of the elderly in Kuala Lumpur, Malaysia.

BackgroundOsteoporosis is a significant health problem in the developing countries and its prevalence data are important for the estimation of health care burden and policy making. This study aimed to determine the age-related changes in bone health and the prevalence of osteoporosis in males and females aged 50 years or above living in Kuala Lumpur, Malaysia.MethodsA cross-sectional study was conducted between December 2014 and December 2015. Subjects answered a demographic questionnaire and underwent body anthropometric and bone health measurement. Assessment of bone health was performed using a quantitative ultrasound device that generated speed of sound, broadband ultrasound attenuation, stiffness index, and T-score based on stiffness index value as bone health indices.ResultsThe prevalence of osteoporosis was 10.6% in males and 8.0% in females. Significant age-related decline of bone health indices (speed of sound, broadband ultrasound attenuation, stiffness index, and T-score) and a concurrent increase in the prevalence of osteoporosis and osteopenia were observed in females (P<0.05) but not in males (P>0.05). Ethnic differences in bone health indices and prevalence of osteoporosis/osteopenia were not observed (P>0.05).ConclusionA significant proportion of males and females age 50 years or above have suboptimal bone health. Preventive measures such as early screening should be implemented to retard the progression of osteoporosis.