Intracranial hypertension as the primary symptom of malignant melanoma:A case report

BACKGROUND The etiological diagnosis of intracranial hypertension is quite complicated but important in clinical practice.Some common causes are craniocerebral injury,intracranial space-occupying lesion,subarachnoid hemorrhage,and hydrocephalus.When a patient presents with intracranial hypertension,the common causes are to be considered first so that other causes would be dismissed.With the morbidity lower than 9%,neuromelanin is very rare.Common symp-toms include nerve damage symptoms,epilepsy,psychiatric symptoms,and cognitive disorders.CASE SUMMARY We present a patient with melanoma which manifested with isolated intracranial hypertension without any other neurological signs.A 22-year-old male had repeated nausea and vomiting for 2 mo with Babinski sign(+)on both sides,nuchal rigidity,and subarachnoid hemorrhage.He had been diagnosed with melanoma and was given surgery and whole-brain radiation.Ultimately,the patient died 2 mo later.CONCLUSION Malignant melanoma should be taken into consideration in the differential diagnosis of intracranial hypertension.

Acute upper gastrointestinal bleeding due to portal hypertension in a patient with primary myelofibrosis:A case report

BACKGROUND Acute upper gastrointestinal bleeding is a common medical emergency that has a 10%hospital mortality rate.According to the etiology,this disease can be divided into acute varicose veins and nonvaricose veins.Bleeding from esophageal varices is a life-threatening complication of portal hypertension.Portal hypertension is a clinical syndrome defined as a portal venous pressure that exceeds 10 mmHg.Cirrhosis is the most common cause of portal hypertension,and thrombosis of the portal system not associated with liver cirrhosis is the second most common cause of portal hypertension in the Western world.Primary myeloproliferative disorders are the main cause of portal venous thrombosis,and somatic mutations in the Janus kinase 2 gene(JAK2 V617F)can be found in approximately 90% of polycythemia vera,50% of essential thrombocyrosis and 50% of primary myelofibrosis.CASE SUMMARY We present a rare case of primary myelofibrosis with gastrointestinal bleeding as the primary manifestation that presented as portal-superior-splenic mesenteric vein thrombosis.Peripheral blood tests revealed the presence of the JAK2 V617F mutation.Bone marrow biopsy ultimately confirmed the diagnosis of myelofibrosis(MF-2 grade).CONCLUSION In patients with acute esophageal variceal bleeding due to portal hypertension and vein thrombosis without cirrhosis,the possibility of myeloproliferative neoplasms should be considered,and the JAK2 mutation test should be performed.

Pulmonary Hypertension Crisis in Patient with Tetralogy of Fallot and Mixed Total Anomalous Pulmonary Vein Connection after the Primary Correction:A Rare Case Report

Tetralogy of Fallot(TOF)with total anomalous pulmonary vein connections(TAPVC)is a rare type of complex congenital heart disease among all TOF cases.Co-presentation of major aortopulmonary collateral arteries(MAPCAs)compensates for the lack of central pulmonary bloodflow and decreases the severity of right-to-left shunting in TOF.We present a case of a 2-year-old child with complex diagnoses of TOF,TAPVC,a large secun-dum atrial septal defect(ASD),and intraoperatively identified MAPCAs.She underwent surgery to repair the TAPVC,valve-sparing reconstruction of the right ventricular outflow tract,interventricular defect closure,and the creation of patent foramen ovale(PFO).After the operation,hemodynamic instability happened along with sudden blood pressure drop,desaturation,and increased central venous pressure,which subsided after adminis-tering inhalational nitric oxide(NO).A postoperative pulmonary hypertension crisis was suggested when the patient experienced recurrent symptoms after the termination of NO.Echocardiographicfindings of a D-shaped left ventricle(LV),right-to-left PFO shunt and high tricuspid valve gradientfirmly established the diagnosis.It was subsequently managed with continuous NO inhalation and sildenafil,which rendered a satisfactory outcome.Repaired TOF and TAPVC could be at particular risk of developing pulmonary hypertension crisis,especially in the presence of MAPCAs due to possible remodeling of the pulmonary vasculature.Furthermore,a relatively non-compliant LV function and small left atrial size may exacerbate the risk of developing postcapillary pulmonary hypertension after TAPVC repair.A successful postoperative outcome calls for a meticulous preoperative analysis of the anatomical lesions,as well as careful monitoring.

Monitoring the changes in plasm C-reactive protein,fibrinogen and blood white cell in patients with primary hypertension combined with acute cerebral infarction

BACKGROUND： Inflammatory reaction and the increased level of its accompanying active protein play an important role in the occurrence and development of cerebral infarction. C-reactive protein, fibrinogen and white blood cell, as the monitoring index of inflammatory reaction, are very important in the occurrence and development of acute cerebral infarction. OBJECTIVE： To make a comparison between patients with primary hypertension accompanied with acute cerebral infarction and with simple primary hypertension by observing the changes in plasma C-reactive protein and fibrinogen levels as well as white blood cell and differential counts and analyzing their significances. DESIGN ： Controlled observation SETTING ： Ward Building for VIP, Shenzhen Hospital, Peking University. PARTICIPANTS： Totally 133 patients with primary hypertension were selected from Ward Building for VIP, Shenzhen Hospital, Peking University during September 2003 to September 2005, The diagnostic criteria were based on the hypertension diagnosis criteria formulated by the 7^th World Health Organization-International Society of Hypertension Guidelines （WHO-ISH） in 1998. The informed consents were obtained from all the participants. The involved patients were assigned into two groups： primary hypertension group, in which, there were 65 patients with primary hypertension （ degree 2）, including 42 males and 23 females, with mean age of （61 ±14）years and mean blood pressure of （162.7±6.8）/（94.2±8.4） mm Hg （1 mm Hg =0.133 kPa）, and primary hypertension combined with cerebral infarction group, in which, there were 68 patients with primary hypertension combined with cerebral infarction （ meeting the diagnostic criteria formulated in the 4^th National Cerebrovascular Diseases Meeting in 1995 and diagnosed by skull CT or MRI to exclude the patients with lacunar infarction）, including 42 males and 26 females, with mean age of （56±15） years and mean blood pressure of （176.4±9.2）/（96.3±9.7） mm Hg. METHODS： Plasm C-reactive protein and fibrinogen levels, and white blood cell and differential counts of patients in the two groups were examined 24 hours after stroke. The above indexes were re-examined in the primary hypertension combined with cerebral infarction group 72 hours after stroke. White blood cell and differential counts were performed with laser method （East Asia FE-95001 RAM-1, Japan）. The level of C-reactive protein was measured with turbidimetry （BNII Automatic Systems For Analysis, USA）. The level of fibrinogen was measured with algorithm method when prothrombin time was normal and with Clauss method when prothrombin time was abnormal （ACL Automatic Coagulation Analyzer, USA）. MAIN OUTCOME MEASURES： The plasm C-reactive protein and flbrinogen levels, and white blood cell and differential counts 24 hours after stroke in two groups and 72 hours after stroke in primary hypertension combined with cerebral infarction group. RESULTS： All the 133 involved patients participated in the result analysis. The plasm C-reactive protein and fibrinogen levels, and white blood cell and neutrophil counts in patients with primary hypertension were all within the normal range. The plasm C-reactive protein and fibrinogen levels, and white blood cell and neu- trophil counts in patients with primary hypertension combined with cerebral infarction were significantly higher than those in patients with primary hypertension 24 hours after stroke and 72 hours after stroke respectively[24 hours after stroke：（32.12±11.76） mg/L vs. （5.02±3.21 ） mg/L;（4.64±0.75） g/L vs. （3.12±0.49） g/L; （9.32±81）×10^9 L^- 1 vs. （5.78±1.32）×10^9L^- 1 （7.85±2.38）×10^9 L^- 1 vs.（3.49±1.28）×10^9 L^-1,t =7.094, 5.759,4.106,5.491, respectively,all P〈 0.01; 72 hours after stroke： （47.62±18.43） mg/L vs. （32.12±11.76） mg/L; （5.08±0.82） g/L vs. （4.64±0.75） g/L, t =2.864,2.220, respectively, both P 〈 0.05]. CONCLUSION： The increase in fibrinogen level and white blood cell count are the important index in monitoring primary hypertension combined with acute cerebral infarction. The increase in plasm C-reactive protein and fibrinogen levels 72 hours after stroke indicates that plasma C-reactive protein and fibrinogen are very important in the development of disease.

Correlation between angiotensinogen gene and primary hypertension with cerebral infarction in the Li nationality of China

Objective To investigate the relationship of four single nucleotide polymorphism （SNP） haplotypes in the angiotensinogen （AGT） gene to the primary hypertension with or without cerebral infarction in the Li nationality of Hainan, China. Methods Total 300 subjects were allocated into three different groups： Groupl, 100 patients who have primary hypertension; Group 2, 100 patients who have primary hypertension with cerebral infarction; and control group, 100 healthy individuals. The genotypes of all subjects were determined by PCR-sequencing to analyze the four poly- morphisms at position - 152 （G-A）, -20 （A-C）, - 18 （C-T）, and -6 （A-G） in the promoter region of AGT. Results The frequen- cies ofCT genotype of AGT-18 and T allele in Group 1 （P = 0.003, P = 0.004） and Group 2 （P = 0.002, P = 0.002） were both significantly higher than in healthy controls. The frequency of G allele of AGT-6 was significantly higher in Group 2 than in the control group （P = 0.016）, while there is no significant difference between Group 1 and the control. Haplotype analysis revealed that H6 haplotype frequency which included -20C and -6G was significantly increased in Group 2 （P = 0.003） compared with the control group, while H5 haplotype frequency which included -20C and -18T was signifi- cantly increased in Group 1 （P = 0.006） versus the control. Conclusion The -20 （A-C） and - 18 （C-T） of the AGT may play an important role in pathogenesis of primary hypertension; and -20 （A-C）, -18 （C-T）, and -6 （A-G） may be the genetic risk factors for the onset of primary hypertension with cerebral infarction in the Li nationality of Halnan, China.

Dry eye rate and its relationship with disease stage in patients with primary hypertension:a cross-sectional study in Vietnam

AIM:To determine the dry eye(DE)rate and its relationship with disease stage in patients with primary hypertension.METHODS:A cross-sectional study included 432 patients with primary hypertension(with an equal number of patients in each group:144 in stage Ⅰ,Ⅱ,and Ⅲ hypertension)and 144 healthy subjects as a control group.The Ocular Surface Disease Index(OSDI)and Schirmer Ⅰ test without anesthetics were conducted on all 576 subjects.Subjects with OSDI scores<13 and Schirmer Ⅰ values equal to or under 10 mm were diagnosed with DE.RESULTS:The ratio of DE in hypertension patients was higher than in the control group(41.7%versus 18.8%;P<0.001).The proportion of patients with DE increased gradually according to the hypertension stage:27.1% in stage Ⅰ,40.3% in stage Ⅱ,and 57.6% in stage Ⅲ,P<0.001.Age,duration of hypertension,plasma urea,creatinine,and high-sensitivity C-reactive protein(CRP-hs)levels in hypertension patients with DE were higher than those without DE,P<0.001.Advanced age,a long duration of hypertension,diabetes mellitus,elevated plasma creatinine,and CRP-hs levels were independent factors associated with DE in primary hypertension patients,P<0.001.CONCLUSION:DE is a common disorder associated with advanced age,a long duration of hypertension,diabetes mellitus,elevated plasma CRP-hs,and creatinine levels in patients with primary hypertension.

Recent advances in promising drugs for primary prevention of gastroesophageal variceal bleeding with cirrhotic portal hypertension

Background:Gastroesophageal variceal bleeding is one of the most severe complications of patients with cirrhosis.Although primary prevention drugs,including non-selectiveβ-blockers,have effectively reduced the incidence of bleeding,their efficacy is limited due to side effects and related contraindications.With recent advances in precision medicine,precise drug treatment provides better treatment efficacy.Data sources:Literature search was conducted in PubMed,MEDLINE and Web of Science for relevant articles published up to May 2022.Information on clinical trials was obtained from https://clinicaltrials.gov/and http://www.chictr.org.cn/.Results:The in-depth understanding of the pathogenesis and advances of portal hypertension has enabled the discovery of multiple molecular targets for promising drugs.According to the site of action,these drugs could be classified into four classes:intrahepatic,extrahepatic,both intrahepatic and extrahepatic targets and others.All these classes of drugs offer advantages over traditional treatments in prevention of gastroesophageal variceal bleeding in patients with cirrhotic portal hypertension.Conclusions:This review classified and summarized the promising drugs,which prevent gastroesophageal variceal bleeding by targeting specific markers of pathogenesis of portal hypertension,demonstrating the significance of using the precision medicine strategy to discover and develop promising drugs for the primary prevention of gastroesophageal variceal bleeding in patients with cirrhotic portal hypertension.

Management of hypertension in primary aldosteronism

Hypertension causes significant morbidity and mortal-ity worldwide, owing to its deleterious effects on the cardiovascular and renal systems. Primary hyperaldo-steronism(PA) is the most common cause of revers-ible hypertension, affecting 5%-18% of adults with hypertension. PA is estimated to result from bilateral adrenal hyperplasia in two-thirds of patients, and from unilateral aldosterone-secreting adenoma in approxi-mately one-third. Suspected cases are initially screened by measurement of the plasma aldosterone-renin-ratio, and may be confirmed by additional noninvasive tests. Localization of aldostosterone hypersecretion is then determined by computed tomography imaging, and in selective cases with adrenal vein sampling. Solitary adenomas are managed by laparoscopic or robotic re-section, while bilateral hyperplasia is treated with min-eralocorticoid antagonists. Biochemical cure following adrenalectomy occurs in 99% of patients, and hemo-dynamic improvement is seen in over 90%, prompting a reduction in quantity of anti-hypertensive medica-tions in most patients. End-organ damage secondary to hypertension and excess aldosterone is significantly improved by both surgical and medical treatment, asmanifested by decreased left ventricular hypertrophy, arterial stiffness, and proteinuria, highlighting the im-portance of proper diagnosis and treatment of primary hyperaldosteronism. Although numerous independent predictors of resolution of hypertension after adrenalec-tomy for unilateral adenomas have been described, the Aldosteronoma Resolution Score is a validated multifac-torial model convenient for use in daily clinical practice.

Effectiveness of Adherence to Standardized Hypertension Management by Primary Health Care Workers in China:a Cross-sectional Survey 3 Years after the Healthcare Reform

The standardized hypertension management provided by primary health care workers is an important part of China＇s recent health care reform efforts. Investigating 5,116 hypertensive patients from a cross-sectional survey conducted by the Chinese Center for Disease Control and Prevention in 2012, this study found that adherence to standardized hypertension management is associated with positive effects on hypertension- related knowledge, healthy lifestyle behavior, antihypertensive medical treatments, and blood pressure control. It will be necessary to provide primary health care workers with sufficient training and reasonable incentives to ensure the implementation and effectiveness of hypertension management.

Clinical relevance of the glucocorticoid receptor gene polymorphisms in glucocorticoid-induced ocular hypertension and primary open angle glaucoma

AIM: To avoid the side effects of ocular hypertension of glucocorticoid(GC) usage in eye, we must identify susceptible individuals, which exists in about one-third of all population. Further, the majority of all primary open angle glaucoma(POAG) patients show this phenotype.Glucocorticoid receptor(GR) regulates C responsiveness in trabecular meshwork(TM) cells. In this study, single nucleotide polymorphism(SNP) genotyping was used to determine whether there are differences in the Bcl I(rs41423247) and N363S(rs6195) polymorphisms of the GR gene in healthy and POAG patients, and glucocorticoid-induced ocular hypertension(GIOH)populations.METHODS: Three hundred and twenty-seven unrelated Chinese adults, including 111 normal controls, 117 GIOH subjects and 99 POAG patients, were recruited. DNA samples were prepared and the Bcl I and N363 S polymorphisms were screened using real-time polymerase chain reaction(RT-PCR)-restriction fragment length polymorphism(RFLP) analysis. Frequencies of the Bcl I and N363 S polymorphisms were determined and compared using Fisher’s exact test and the Chi-squared test.RESULTS: Only the Bcl I polymorphism was identified in the Chinese Han population. The frequency of the G allele was 21.6 % in normal controls, 18.3% in GIOH patients, and 13.64% in the POAG patients. There was no significant difference in polymorphism or allele frequency in the 3 groups. Furthermore, no N363 S polymorphism was found in the study subjects.CONCLUSION: The Bcl I polymorphisms in GR gene had no association with GIOH and POAG patients, and N363 S polymorphism might not exist in the Chinese Han population. Therefore, the Bcl I polymorphism might not be responsible for the development of GC-induced ocular hypertension or POAG.

Hypertension Screening and Follow-up Management by Primary Health Care System among Chinese Population Aged 35 Years and Above

Objective To describe hypertension screening and follow-up management among Chinese population aged 35 years and above within the primary health care system. Methods Data from 2010 China Chronic Disease and Risk Factor Surveillance System were used. We investigated previous hypertension diagnosis, screening, and follow-up assessments within the primary health care system. The prevalence of self-reported and criterion-based hypertension, screening rates, demographic and socioeconomic characteristics associated with screening, and patterns of follow-up assessments were recorded. The SAS software system was used for statistical analyses. Results About 17.1% reported a previous hypertension diagnosis. The rate difference between the two measures of prevalence was 27.2%. Among those without self-reported hypertension, 27.7% reported never visiting a clinic during the past I year and 60.4% of those attending a clinic reported ever being screened. Younger age group was associated with lower screening proportion; odds ratios of 35-, 45-, 55-, and 〉65 years were 1.7 （95% CI： 1.5-1.9）, 1.5 （95% CI： 1.3-1.7）, 1.3 （95% CI： 1.2-1.4）, and 1.0, respectively. About 35.1% of the patients had undergone follow-up assessments four or more times during the past I year. Conclusion Majority of the Chinese population aged 35 years and above, particularly the less educated, elderly population, and rural residents were unaware of that they were suffering from hypertension. Most patients did not receive enough management services by the primary health care system. Thus, strengthening both the screening and follow-up management is needed.

Bimatoprost/timolol fixed combination(BTFC) in patients with primary open angle glaucoma or ocular hypertension in Greece

AIM：To evaluate the efficacy and tolerability of the fixed combination of bimatoprost 0.03%and timolol 0.5%（BTFC）in patients in Greece with primary open angle glaucoma（POAG）or ocular hypertension（OHT）whose previous therapy provided insufficient lowering of intraocular pressure（IOP）.·METHODS：A multicenter,prospective,open-label,non-interventional,observational study of the use of BTFC in clinical practice was conducted at 41 sites in Greece.The primary endpoint was the reduction in IOP from baseline at study end,approximately 12wk after initiation of BTFC therapy.·RESULTS：A total of 785 eligible patients were enrolled in the study and 97.6%completed the study.The mean±SD IOP reduction from baseline at 12wk after initiation of BTFC was 6.3±2.8 mm Hg（=764;〈0.001）.In patients（=680）who replaced their previous IOP-lowering monotherapy（a single drug,or a fixed combination of 2drugs in a single ophthalmic drop）with once-daily BTFC,the mean±SD IOP reduction from baseline at 12wk was 6.2±2.8 mm Hg（〈0.001）.IOP was reduced from baseline in 99.2%of patients,and 58.0%of patients reached or exceeded their target IOP.Substantial mean IOP reductions were observed regardless of the previous therapy.BTFC was well tolerated,with 96.0%of patients who completed the study rating the tolerability of BTFC as＂good＂or＂very good.＂Adverse events were reported in 8.3%of patients;only 0.6%of patients discontinued the study due to adverse events.·C ONCLUSION：In clinical practice in Greece,BTFC is well tolerated and effectively lower the IOP in patients with POAG or OHT who requires additional IOP lowering on their previous therapy.

Three-dimensional choroidal vascularity index and choroidal thickness in fellow eyes of acute and chronic primary angle-closure using swept-source optical coherence tomography

AIM:To compare the three-dimensional choroidal vascularity index(CVI)and choroidal thickness between fellow eyes of acute primary angle-closure(F-APAC)and chronic primary angle-closure glaucoma(F-CPACG)and the eyes of normal controls.METHODS:This study included 37 patients with unilateral APAC,37 with asymmetric CPACG without prior treatment,and 36 healthy participants.Using swept-source optical coherence tomography(SS-OCT),the macular and peripapillary choroidal thickness and three-dimensional CVI were measured and compared globally and sectorally.Pearson’s correlation analysis and multivariate regression models were used to evaluate choroidal thickness or CVI with related factors.RESULTS:The mean subfoveal CVIs were 0.35±0.10,0.33±0.09,and 0.29±0.04,and the mean subfoveal choroidal thickness were 315.62±52.92,306.22±59.29,and 262.69±45.55μm in the F-APAC,F-CPACG,and normal groups,respectively.All macular sectors showed significantly higher CVIs and choroidal thickness in the F-APAC and F-CPACG eyes than in the normal eyes(P<0.05),while there were no significant differences between the F-APAC and F-CPACG eyes.In the peripapillary region,the mean overall CVIs were 0.21±0.08,0.20±0.08,and 0.19±0.05,and the mean overall choroidal thickness were 180.45±54.18,174.82±50.67,and 176.18±37.94μm in the F-APAC,F-CPACG,and normal groups,respectively.There were no significant differences between any of the two groups in all peripapillary sectors.Younger age,shorter axial length,and the F-APAC or F-CPACG diagnosis were significantly associated with higher subfoveal CVI and thicker subfoveal choroidal thickness(P<0.05).CONCLUSION:The fellow eyes of unilateral APAC or asymmetric CPACG have higher macular CVI and choroidal thickness than those of the normal controls.Neither CVI nor choroidal thickness can distinguish between eyes predisposed to APAC or CPACG.A thicker choroid with a higher vascular volume may play a role in the pathogenesis of primary angle-closure glaucoma.

Prevalence of Primary Open Angle Glaucoma among Patients with Diagnosis of Systemic Hypertension and Diabetes Mellitus: The Colombian Glaucoma Study

Objective: To establish the prevalence and risk factors of Primary Open Angle Glaucoma (POAG) among patients with Systemic Hypertension (SH) and Diabetes Mellitus (DM) in six cities of Colombia. Methods: A cross-sectional study among hypertensive and diabetic patients was conducted in Colombia. This study included 2067 subjects older than 50 years of age diagnosed with SH and/or DM. Participants underwent a complete ophthalmic examination including intraocular pressure (IOP) measurement by Goldmann tonometry and blood pressure measurement. The glaucoma diagnosis was confirmed by structural and functional evidence. Interviews and standardized questionnaires were used to evaluate participants’ lifestyle and other health conditions. Results: Among participants with DM/SH, 142 cases of POAG were confirmed for a prevalence of 5.6% [95% CI: 4.6 - 6.6], while 9.1% were glaucoma suspects [95% CI: 7.8% - 10.4%]. The majority of confirmed cases (77.5%) were undiagnosed. The prevalence of POAG was significantly higher with male gender, greater age, and diastolic blood pressure > 90 mmHg as risk factors. Conclusion: We found a high prevalence of POAG in patients with adequate SH and DM care in a novel Latino population. We also found great unawareness of the disease in this population. Our results have potentially enormous public health implications for Colombia and other Latino populations.

Vision loss as the initial presentation during primary pulmonary hypertension treatment

Dear Editor,As we all know,pulmonary hypertension is a state of persistent pulmonary artery pressure above 25 mm Hg at rest and greater than 30 mm Hg during exercise.Based on the mechanism or underlying etiology,pulmonary hypertension was classified as primary with no identifiable cause or secondary because of increased pressure in the pulmonary venous or pulmonary capillary system[1].

Effect of auricular plaster for primary hypertension in older people:A meta-analysis

BACKGROUND Hypertension is a critical public health problem globally.Antihypertensive drugs can create an extra burden on hypertension patients'self-regulation leading to an imbalance of blood supply and demand.This study aimed to evaluate the effect of auricular plaster therapy combined with western medicine to treat primary hypertension in older people.AIM To carry out a systematic review and meta-analysis for the effect of auricular plaster in elderly hypertension patients.METHODS Multiple databases like PubMed,EMBASE,Cochrane Library,Chinese Biomedical Literature on Disc,China National Knowledge Infrastructure,Wan Fang and Chinese Science and Technology Periodical Database were used to search for the relevant studies and full-text articles involved in the evaluation of auricular plaster combined with western medicine and western medicine alone for primary hypertension in older people.All included articles were quality assessed and the data analysis was conducted with the Review Manager(5.4).Forest plots,sensitivity analysis and funnel plots were also performed on the included articles.RESULTS In this analysis,fourteen(14)relevant studies were included.The Meta-analysis showed a significant difference in the effective ratio(OR=3.62;95%CI,2.46 to 5.33;P<0.00001),diastolic blood pressure change(5.68 mmHg;95%CI,3.49 to 7.87;P<0.00001),systolic blood pressure change(MD=8.78 mmHg;95%CI,5.04 to 12.53;P<0.00001)and symptom score(MD=3.20;95%CI,1.23 to 5.18;P=0.001)between auricular plaster combined with western medicine group and western medicine alone group.One bias was detected as selection bias and another two in reporting bias.Sensitivity analysis fulfilled the stability of the results.CONCLUSION Our study suggested that auricular plaster combined with western medicine improved primary hypertension better than western medicine alone.Limited by the quality of included studies,further studies should be performed to confirm our findings.

Mid-term results of patterned laser trabeculoplasty for uncontrolled ocular hypertension and primary open angle glaucoma

AIM:To describe the safety and efficacy of patterned laser trabeculoplasty(PLT)as an adjunctive treatment in primary open angle glaucoma(POAG)and ocular hypertension(OHT)after 18-month follow-up in Hispanic population.METHODS:A single-center,retrospective study was conducted.All patients with OHT or POAG undergoing PLT from June 2016 to August 2016 were included in the study.Investigated parameters were intraocular pressure(IOP),the number of IOP-lowering medications,best corrected visual acuity(BCVA),laser parameters and postoperative adverse events.Primary efficacy outcome measures were the proportion of eyes achieving an IOP reduction≥20%at 18 mo versus baseline medicated IOP or a reduction in the number of medications while maintaining IOP values.RESULTS:From 40 PLT-treated eyes(mean baseline IOP 20.3±1.7 mm Hg),24 patients were analyzed(age 63.4±7.3 y).The mean IOP reductions from baseline across visits(months 1,3,6,9,12,and 18)ranged from 14.1%to 20.8%.Success rate after 18-month follow-up was 61.7%with a mean IOP of 16±3.2 mm Hg(P<0.001).The number of glaucoma IOP-lowering medications per eye(preoperative 2.1±1.1 and postoperative 2.3±1.1,P=0.86)and the mean BCVA(preoperative 0.10±0.22 and postoperative 0.11±0.22 logMAR,P=0.42)remained stable.Adverse events comprised transitory IOP spikes in 4 eyes(10%)and peripheral anterior synechiae in 7 eyes(17.5%).CONCLUSION:Mid-term results of PLT show that this procedure may be an efficacious and safe technique to approach medically uncontrolled OHT or POAG patients.

Ultrasound evaluation of left ventricular remodeling and systolic synchrony in patients with primary hypertension and the correlation with serum cytokines and MMPs

Objective:To study the correlation of the ultrasound parameters of left ventricular remodeling and systolic synchrony in patients with primary hypertension with serum cytokines and matrix metalloproteinases (MMPs).Methods:134 patients with primary hypertension receiving three-dimensional echocardiography examination in our hospital between May 2013 and March 2016 were selected and divided into the group A with normal pattern (n=71), group B with concentric hypertrophy (n=39) and group C with eccentric hypertrophy (n=24) according to the left ventricular internal diameter at end-diastole (LVIDd) and left ventricular mass index (LVMI), and the ultrasound parameters of left ventricular remodeling and systolic synchrony as well as serum content of cytokines and MMPs were determined.Results: The time to minimal systolic volume of 16-segmental standard deviation (SDI), maximum time difference (DIF), Tpe, Tpe interphase and its correction (Tpec), LVIDd, LVMI and left ventricular remodeling index (LVRI) of group B and group C were significantly higher than those of group A (P<0.05), and SDI, DIF, Tpe, Tpec, LVIDd, LVMI and LVRI of group C were significantly higher than those of group B (P<0.05);serum tumor necrosis factor-α (TNF-α), interleukin-17 (IL-17), transforming growth factor-β1 (TGF-β1), matrix metalloproteinase 2 (MMP2), MMP3 and MMP9 content of group B and group C were significantly higher than those of group A (P<0.05), and serum TNF-α, IL-17, TGF-β1, MMP2, MMP3 and MMP9 content of group C were significantly higher than those of group B (P<0.05) and positively correlated with LVIDd, LVMI, LVRI, SDI, DIF, Tpe and Tpec;serum TIMP1 and TIMP2 content of group B and group C were significantly lower than those of group A (P<0.05), and serum TIMP1 and TIMP2 content of group C were significantly lower than those of group B (P<0.05) and negatively correlated with LVIDd, LVMI, LVRI, SDI, DIF, Tpe and Tpec.Conclusions:The ultrasound parameters of left ventricular remodeling and systolic synchrony significantly change in patients with primary hypertension and are closely related to the changes in the content of serum cytokines and MMPs.

The correlation of deceleration capacity of rate with the cardiac function and micro-inflammatory state in patients with both primary hypertension and type 2 diabetes mellitus

Objective:To study the correlation of deceleration capacity of rate with the cardiac function and micro-inflammatory state in patients with both primary hypertension and type 2 diabetes mellitus.Methods: A total of 60 patients with both primary hypertension and type 2 diabetes mellitus who were treated in our hospital between May 2012 and February 2016 were collected as the observation group, and 50 patients with primary hypertension who were treated in our hospital during the same period were selected as the control group. According to the median of deceleration capacity of rate (DC), the observation group of patients were further divided into high DC group and low DC group (n=30). The 24 h dynamic electrocardiogram of the included patients were obtained to calculate the DC value;color Doppler diasonograph was used to measure the echocardiogram of the two groups, and obtain the left cardiac function indexes and strain rate indexes;enzyme-linked immunosorbent assay (ELISA) was used to detect the contents of serum pro-inflammatory factors and anti-inflammatory factors.Results: The DC value of observation group was lower than that of control group;left cardiac function indexes IVSTd, LVIDd and LVIDs levels of low DC group and high DC group were higher than those of control group, strain rate indexes SRs, SRe and Sra levels were lower than those of control group, and serum pro-inflammatory factors CRP, IL-6, IL-18 and PCT contents were higher than those of control group while anti-inflammatory factors IL-10 and IL-13 contents were lower than those of control group;IVSTd, LVIDd and LVIDs levels of low DC group were higher than those of high DC group, SRs, SRe and Sra levels were lower than those of high DC group, and serum CRP, IL-6, IL-18 and PCT contents were higher than those of high DC group while IL-10 and IL-13 contents were lower than those of high DC group.Conclusion:DC value is lower in patients with both primary hypertension and type 2 diabetes mellitus, and can intuitively reflect the cardiac function and systemic micro-inflammatory state.

Spatiotemporal changes of gross primary productivity and its response to drought in the Mongolian Plateau under climate change

Gross primary productivity(GPP)of vegetation is an important constituent of the terrestrial carbon sinks and is significantly influenced by drought.Understanding the impact of droughts on different types of vegetation GPP provides insight into the spatiotemporal variation of terrestrial carbon sinks,aiding efforts to mitigate the detrimental effects of climate change.In this study,we utilized the precipitation and temperature data from the Climatic Research Unit,the standardized precipitation evapotranspiration index(SPEI),the standardized precipitation index(SPI),and the simulated vegetation GPP using the eddy covariance-light use efficiency(EC-LUE)model to analyze the spatiotemporal change of GPP and its response to different drought indices in the Mongolian Plateau during 1982-2018.The main findings indicated that vegetation GPP decreased in 50.53% of the plateau,mainly in its northern and northeastern parts,while it increased in the remaining 49.47%area.Specifically,meadow steppe(78.92%)and deciduous forest(79.46%)witnessed a significant decrease in vegetation GPP,while alpine steppe(75.08%),cropland(76.27%),and sandy vegetation(87.88%)recovered well.Warming aridification areas accounted for 71.39% of the affected areas,while 28.53% of the areas underwent severe aridification,mainly located in the south and central regions.Notably,the warming aridification areas of desert steppe(92.68%)and sandy vegetation(90.24%)were significant.Climate warming was found to amplify the sensitivity of coniferous forest,deciduous forest,meadow steppe,and alpine steppe GPP to drought.Additionally,the drought sensitivity of vegetation GPP in the Mongolian Plateau gradually decreased as altitude increased.The cumulative effect of drought on vegetation GPP persisted for 3.00-8.00 months.The findings of this study will improve the understanding of how drought influences vegetation in arid and semi-arid areas.