Central aortic systolic blood pressure (CBP) measured by carotid-femoral pulse wave analysis (cfPWA) is a gold standard method to estimate true arterial pressure. However, the impact of the CBP level measured by radial PWA on cardiovascular (CV) risk assessment is unclear. This study aimed to determine the impact on CV outcome assessment and the association between the optimal levels of non-invasively measured CBP and automated office blood pressure (OBP) in clinical practice.A total of 2,115 patients underwent non-invasive semiautomated radial artery applanation tonometry (Omron HEM-9000AI) in the Department of Internal Medicine, St. Vincent’s Hospital, from July 2011 to December 2015. The patients were followed for at least 5 years, and atherosclerotic cardiovascular (ASCVD) outcomes were collected.Among 2,115 patients  who were followed up, the median follow-up period was 52 months (range: 1–104 months). The total number of patients with ASCVD events was 163 (7.70%). In multivariate Cox regression analysis, a CBP of more than 125 mmHg and an automated OBP of more than 131 mmHg were independently associated with a significant increase in ASCVD outcomes. After adjusting for confounding factors, the hazard ratio for ASCVD events increased by 12.5, 11.7, and 12.7%, for every 10 mmHg increase in automated OBP, CBP, and central pulse pressure (PP), respectively.This study demonstrated that the automated OBP measured using the method used in real clinical practice and CBP measured by radial tonometry were associated with an increased risk for adverse ASCVD outcomes. Among snd death . Howevernd death , 4. In and death . Additiond death . HoweverArterial pressure varies continuously throughout the cardiac cycle, and the shape of the pressure waveform changes continuously throughout the arterial tree. Although diastolic and mean arterial pressures are relatively constant, systolic pressure may be up to 40 mmHg higher in the brachial artery than in the aorta . This phAmong patients who underwent non-invasive, semiautomated, radial artery applanation tonometry (Omron HEM-9010AI) in the Department of Internal Medicine at St. Vincent’s Hospital from July 2011 to December 2015, a total of 2,115 subjects  were enrolled in this study. Subjects who had an irregular cardiac rhythm were excluded due to the method used to measure radial PWA.There was no industry involvement in the design, implementation, or data analysis of this study. The present study was a single-center retrospective study and was approved by the Institutional Review Board (VC19RISI0266).The participants rested for at least 5 min in a quiet room prior to the BP measurement. The patients were comfortably seated with their legs uncrossed and their back and arms supported. Brachial BP was measured using an HEM-907 automatic cuff oscillometric device . The average of three readings was obtained for automated office SBP, diastolic BP (DBP), PP, and heart rate (HR). Next, the radial PWA was examined with a HEM-9010AI automated applanation tonometer  in the same way as our previous research .Blood specimens were obtained after a 12 to 14-h fast (8:00 p.m.–9:30 a.m.) to reduce the influence of circadian variation. Total cholesterol (TC) and triglyceride (TG) concentrations were assessed by using standard enzyme methods. The high-density lipoprotein (HDL) cholesterol level was measured after precipitation of very-low-density lipoproteins and low-density lipoprotein (LDL) with phosphotungstic acid, and LDL was calculated using the Friedewald formula. Fasting glucose levels were enzymatically measured by the hexokinase method. A blood sample from every patient was drawn and centrifuged within 30 min. The serum samples were stored at −80°C, and high sensitivity C-reactive protein (hs-CRP) was determined using an immunoturbidity assay , with an interassay variability coefficient of variation of 6.25%. The above method proceeded in the same way as in our previous study .Two-dimensional, M-mode, pulsed Doppler, and tissue Doppler echocardiography were performed using a Vivid 7 ultrasound machine  with a 2.5-MHz transducer. Standard two-dimensional measurements  were assessed as recommended by the American Society of Echocardiography . The mitThe primary endpoints were defined as the cumulative incidence of atherosclerotic CVD (ASCVD) events or death or high blood pressure (HBP) complications , or heart failure. Medical records were obtained from ASCVD-related physician visits during follow-up and were reviewed by cardiologists. ASCVD was defined as the presence of acute coronary syndrome  or a history of MI, stable or unstable angina, coronary or other arterial revascularization, cerebrovascular diseases (CVA), including stroke or transient ischemic attack, or peripheral arterial disease (PAD), defined as an ankle-brachial index < 0.9 measured, using an Omron VP-1000 Vascular Profiler  presumed to be of an atherosclerotic origin.t-test was used to compare the means when there were two groups. Proportions were compared using the two-way tables and chi-square tests. Multivariate analyses using the Cox proportional hazard regression model were applied to the variables that were significant in the univariate analysis and known important risk factors for ASCVD. In addition, multivariate analyses were schematized using a restricted cubic spline curve. Two-sided p-values of ≤ 0.05 indicated statistical significance. Statistical analyses were conducted using SAS 9.1 statistical software  and R version 3.6.3 .Continuous variables are presented as mean ± standard deviation (SD), and categorical variables are presented as absolute and relative frequencies (%). A 2. A history of HBP was present in 29.0% of the population, 27.0% of subjects were taking renin-angiotensin inhibitors, and 14.2% were taking beta-blockers. A total of 29.1% of enrolled patients were taking statins. Diabetes mellitus (DM) was present in 6.5% of participants. There was no difference between the groups in regard to BMI or a history of HBP. Patients with ASCVD events were older, were more frequently male, and were more likely to have a history of DM, smoking, coronary artery disease (CAD), and CVA than those who did not have ASCVD events. Baseline SBP, CBP, and HR were similar in both groups. However, PP was higher in the ASCVD event group. Lipid profiles were similar in both groups, and serum creatinine levels were higher in the ASCVD event group. The percentage of patients taking antihypertensive medications and lipid-lowering medications was significantly higher in the ASCVD event group.The characteristics of the study population and the mean values of the individual parameters of the arterial pressure are detailed in Among the entire cohort, the total number of patients with primary endpoints was 265 (12.5%). In total, 42 patients (1.98%) died, seven were cardiac deaths and 35 were deaths due to other causes. ACS events developed in 106 patients, including 13 patients with MI events. Additionally, 33 patients had CVA events, and 14 patients suffered from PADs. Furthermore, 21 patients had heart failure, of which the most common etiology was dilated cardiomyopathy. HBP complications developed in 49 patients.p = 0.046), CBP (p = 0.004), and central PP (p < 0.001) were significant determinants of ASCVD events. Additionally, the multivariate analysis results are presented in HRs) were adjusted for age, sex, BMI, CAD, HBP, DM, fasting glucose, and total cholesterol/high-density lipoprotein. After adjusting for confounding factors, the hazard ratio for ASCVD events increased by 12.5, 11.7, and 12.7% for every 10 mmHg increase in SBP, CBP, and central PP, respectively.The results of the univariate Cox proportional hazard regression analysis of the relationships of each BP value with ASCVD outcomes are shown in As shown in CI), for every 10 mmHg increase in SBP and radial CBP, respectively. Our study was performed in a relatively young age group (mean age 57.9 ± 13.6 years) that was randomly recruited, and the sample was not limited to high–risk patients with CVD, unlike many other SBP and CBP studies that targeted the elderly age group or high-risk CVD groups.The aim of this study was that suggesting a radial CBP value for predicting ASCVD events, which was compared with automated office SBP for ASCVD prediction. We suggested that measurements greater than 131 mmHg for office BP (OBP) and greater than 120 mmHg for radial CBP may be highly associated with ASCVD event occurrence. Additionally, the risk of ASCVD events increased by 12.5 and 11.7%, with a 95% confidence interval  had 25% lower rates of CVD events and a 27% lower risk of death from all causes than the standard treatment group (target SBP < 140 mmHg) . Based oHR and arterial pressure . Written informed consent for participation was not required for this study in accordance with the national legislation and the institutional requirements.AK was responsible for conceptualization, methodology, software, investigation, data curation, and writing–original draft. G-HK was responsible for conceptualization, formal analysis, investigation, resources, editing of the manuscript, visualization, and project administration. M-SK was responsible for conceptualization, formal analysis, investigation, editing of the manuscript, and visualization. All authors contributed to the article and approved the submitted version.


Collectrin was found to inversely correlate with serum creatinine and stages of AKI. Collectrin levels were lowest in AKI stage III  and also significantly lower in stage II  and stage I  compared to subjects without AKI. An optimal minimum collectrin cut-off value of 1606 [95% CI 1258 to 1954] pg/mL was determined to detect AKI. In conclusion, urinary collectrin represents an indicator of AKI that, unlike all other established AKI biomarkers, decreases with stage of AKI and thus may be associated with a novel pathogenic pathway.Acute kidney injury (AKI) is a leading complication in hospitalized patients of different disciplines due to various aetiologies and is associated with the risk of chronic kidney disease, the need for dialysis and death. Since nephrons are not supplied with pain signals, kidney injury is mostly diagnosed by serum creatinine with a time delay. Recent work has shown that certain urinary biomarkers are available for early detection of AKI. In total, 155 subjects, including 102 patients with AKI at various stages and 53 subjects without AKI, were enrolled, and their course and laboratory data were recorded. Urinary collectrin (TMEM27) was measured by a commercially available ELISA assay. Changes in serum creatinine were used to determine AKI stage. Patients with AKI presented with significantly lower levels of urinary collectrin compared to patients without AKI (1597 ± 1827 pg/mL vs. 2855 ± 2073;  Acute kidney injury (AKI) is an abrupt onset of deterioration in kidney function, associated with significant morbidity and mortality. With increased stage of AKI, the risk of death and need for renal replacement therapy (RRT) increases. Even after apparent recovery of AKI, there is a significant risk of chronic kidney disease (CKD), cardiovascular disease and death. This highlights the importance of research on test methods such as new biomarkers for the early diagnosis of AKI. Established clinically used markers such as serum creatinine (sCr) and blood urea nitrogen (BUN) often show an AKI with considerable delay after the causative noxious event. Better clinical outcomes may be achieved by detecting AKI early and taking appropriate action ,2 beforeNovel methods to measure the human urinary proteome have opened new paths to discover further peptides or proteins indicative of kidney injury ,12,13,140AT1   level can be used to differentiate AKI from non-AKI.In this study, the excretion of soluble collectrin in human urine was investigated in patients with AKI compared to individuals without AKI. Strikingly, this parameter is decreased in AKI. This makes collectrin the first parameter identified to date that is decreased in urine in AKI, for a reason not yet known. This is in contrast to all other established AKI-specific biomarkers such as the NephroCheck parameters TIMP2 and IGFBP7 ,10, neprSince collectrin is highly expressed at the proximal tubular brush border and apical membrane ,18,21, tMost likely, this effect is caused by a lack of collectrin trafficking into the primary cilia and changes in trafficking of vesicles into which collectrin has been shown to be involved by protein–protein interaction . ProteinIn our study, we could clearly demonstrate that the collectrin peptide is contained in urine. Therefore, the most likely underlying process is that the protein is cleaved from the membrane by a specific protease, and the resultant cleavage product has a yet unknown role in urine. The question still remains which proteases are involved in the cleavage process and why this process is inhibited when an injurious insult occurs at the proximal tubule or collecting duct.Testing for urinary collectrin may have further implications for experimental animal models. In this line, pharmacotherapeutic compounds in the test phase and surgical interventions and factors influencing haemodynamics could be evaluated for their effect in causing subclinical or clinical AKI. Furthermore, transgenic models that overexpress or have knocked out proteins could be studied for the impact on susceptibility to AKI . OverallThe main limitation of this study is its retrospective design. There is also a heterogeneous control group of patients with CKD and healthy individuals. On the other hand, the study is strengthened by a large sample size of a well-characterized cohort of patients with AKI of different stages, allowing clear results.Urinary collectrin is a novel biomarker for acute kidney injury that, in contrast to all other known AKI biomarkers, decreases during AKI. Collectrin could therefore be associated with a new pathogenic pathway. Beyond further pathomechanistic studies, prospective studies are needed to test its diagnostic and prognostic value and to determine whether specific types of AKI can be identified, particularly by collectrin.


Abdominal aortic aneurysm (AAA) is a degenerative disease of the aortic wall with potentially fatal complications. The widespread adoption of endovascular aneurysm repair (EVAR), which is less invasive and equally (if not more) effective for abdominal aortic aneurysms (AAA), is due to the obvious advantages of the procedure compared to the traditional open repair. As the popularity of endovascular procedures grows, related complications become more evident, with kidney damage being one of them. Although acute kidney injury following EVAR is relatively common, its true incidence is still uncertain. The purpose of this study was to assess the incidence of acute kidney injury among patients treated with endovascular repair of ruptured AAA. In addition, we aimed to determine the predictors of PC-AKI in patients with abdominal aortic aneurysm treated with EVAR. Patients and Methods: We retrospectively analyzed a prospective registry of abdominal aortic aneurysm of 247 patients operated endovascularly at a single center between 2015 and 2021. Due to a lack of clinical data, data of 192 patients were reviewed for postcontrast acute kidney injury. Additional comorbidities were included in this study: hypertension, diabetes mellitus, atrial fibrillation, chronic coronary syndrome, COPD, and chronic kidney disease. Follow-up examinations were performed before the procedure and 48 h after contrast administration. Results: The group of 36 patients developed PC-AKI, which is 19% of the entire study population. Hypertension, diabetes, chronic kidney disease, male gender, and incidence of PC-AKI were more prevalent in patients with higher aortic aneurysm diameter ≥67 mm. In multiple regression analyses, independent predictors of PC-AKI were serum creatinine, chronic kidney disease, male gender, and aortic aneurysm diameter ≥67 mm. Conclusions: One of the major complications after EVAR is acute kidney injury, which is linked to higher death and morbidity rates. Independent risk factors for postcontrast acute kidney injury were chronic kidney disease, male gender, and aortic diameter. Only aortic diameter could be modifiable risk factor, and earlier surgery could be considered to yield better outcomes. More research is critically needed to determine how AKI affects long-term outcomes and to look at preventive options. In clinical medicine, contrast agents are frequently used to enhance the visibility of interior organs and structures in X-ray-based imaging procedures including computed tomography (CT) and radiography. High contrast density is achieved by iodine contrast media, which contain one or two tri-iodobenzene rings. Iodine-based contrast agents are often categorized into iso-, low-, and high-osmolar substances based on their osmolarity. In recent years, the use of contrast agents has increased, particularly for several diagnostic imaging procedures such as angiography . From mip < 0.001). In The data of 192 patients were analyzed. The median age of those patients was 73 years. The proportion of female patients was 24%. The group of 36 patients developed PC-AKI, which is 19% of the entire study population. Mean iodine contrast volume was 149.6 mL in the whole population, 179.3 mL in the PC-AKI population, and 142.1 mL in the non-PC-AKI population. Mean aortic diameter for all study participants was 57.2 mm. Aortic diameter in the population with PC-AKI was 66.9 mm, and in the population without PC-AKI, it was 55.7 mm. Chronic kidney disease pre-existed in 67 of all study participants: 24 patients with PC-AKI and 43 patients without PC-AKI. In p = 0.01.The correlations between eGFR and iodine contrast volume, as well as with aortic aneurysm diameter, determined using Pearson’s correlation, are presented as rank correlation (r) in Nowadays, due to its clear advantages in reducing perioperative morbidity and mortality, EVAR has become the standard procedure for AAA repair ,13,14. TOne of the major complications after EVAR is acute kidney injury, which is linked to higher death and morbidity rates. This study showed that pre-existing chronic kidney disease is an independent risk factor for postcontrast acute kidney injury. Additionally, male sex and aortic diameter are other independent factors in development of PC-AKI. Only aortic diameter could be a modifiable risk factor, and earlier surgery could be considered to yield better outcomes. More research is critically needed to determine how AKI affects long-term outcomes and to look at preventive options.This research is a retrospective analysis based on a prospective registry of abdominal aortic aneurysm patients that was conducted at a single center between 2015 and 2021. A group of 247 patients with AAA was operated endovascularly. Due to a lack of clinical data, 55 participants were omitted from this study. In total, data from 192 patients were reviewed for postcontrast acute kidney injury. Additional comorbidities were included in this study: hypertension, diabetes mellitus, atrial fibrillation, chronic coronary syndrome, COPD, and chronic kidney disease. Follow-up examinations were performed before the procedure and 48 h after contrast administration.2 and Mann–Whitney U tests when appropriate. The correlations between psychical variables and eGFR were determined using Pearson’s correlation. Data are presented as rank correlation (r). The threshold of statistical significance for all tests was set at p < 0.05. All analyses were performed using MS Excel  and XL Stat . For the purpose of this study, PC-AKI was defined as an absolute increase of serum creatinine ≥0.3 mg/dL or a relative increase ≥150% from baseline value within the first 48–72 h of intervention.Normality of the distribution was assessed with Shapiro–Wilk test. The characteristics of the studied population are presented as means with standard deviations (SD) for normally distributed continuous, and as the number of cases and percentage . Statistical significance of differences between two groups were determined using the χ


N = 11) were recruited by advertisement in university departments. The subjects were exposed to the established PLR sequence and the heart rate (HR), mean arterial pressure (MAP), SV, and CO were sampled at 1 Hz, while electrocardiogram was recorded at 1000 Hz. Relative powers reflecting autonomic nervous system activity were assessed from spectral analysis of HRV. In response to PLR, SV increased , while HR  and MAP  decreased, with no change in CO . The HRV low‐frequency component was reduced , while the high‐frequency activity increased , with a 63% decrease in the low/high frequency ratio (p < 0.0078). Thus, HRV indicated a reduced sympathetic index  and an increased parasympathetic index . Gravitational depletion and expansion of CBV during PLR were associated with a counterregulatory autonomic response. Healthy volunteers appeared volume responsive in terms of SV, but not CO. Responses to PLR are influenced by the ANS, and HRV analysis should be included in the assessment of the PLR test.In the intensive care and perioperative setting, circulation is often supported by intravenous fluid preceded by prediction of fluid responsiveness during a passive leg raising (PLR) maneuver. An increase in stroke volume (SV) or cardiac output (CO) of 10%–15% indicates that the subject may increase the flow upon volume expansion. However, the semi‐recumbent position as an initial position in PLR likely reduces SV by gravitational displacement of central blood volume (CBV) to lower extremities, thereby accentuating volume responsiveness during leg raising in healthy people. Coincident with gravitational perturbations in hemodynamics, remedial changes occur in the autonomic nervous system (ANS), as expressed in spectral power in heart rate variability (HRV). This study aims to clarify these concomitant changes during PLR. A convenience number of healthy volunteers ( Passive leg raising is accompanied by distinct changes in parasympathetic and sympathetic indices from semi‐recumbent position to legs passively raised. This may fundamentally affect the central hemodynamic responses to the test and influence the predictive power of the PLR. To assess the option of volume expansion, an international peer assembly recently emphasized the use of dynamic indices in preload responsiveness, supplanting the indiscriminate use of a fluid bolus which at best elicits a positive response in 50% of patients  were included by advertisements in university departments. Mean ± SD, (range) age 31.5 ± 16.2 years, (22–67), and weight 84.5 ± 12.7 kg, (75–110). Lacking previous data for power calculation, a cohort of 10–15 was deemed reasonable. The subjects were nonsmokers and abstained from alcohol and caffeine‐containing beverages from the day prior to the experiment. To ensure normovolemia, the participants were encouraged to have a normal breakfast, including fluid  ad libitum. No fluid was administered during the study. The volunteers were informed in writing and verbally about the study and signed a consent form.2.2The electrocardiogram (ECG) was sampled at 1000 Hz. Finapres  continuously and noninvasively measured cardiovascular variables. Based on the Modelflow developed by Peñáz and Wesseling, brachial artery pressure is reconstructed from a reverse transfer function applied to finger arterial blood pressure measured by clamping finger arteries  were selected from the Finometer recordings  and ECG. Sequences were visually assessed as stable and free of artifacts.2.4.2www.kubios.com)  to Kubios Premium 3.0.1  Figure , and the) Figure . PNS inc) Figure , accepti2.5t‐tests for HR, MAP, SV, and CO. Further analyses included one‐way paired Gaussian analysis of variance (ANOVA) of mean values, as warranted by the normality of data . In view of the multiple significant results, post hoc power calculation was waived after consultation with in‐hospital statistical expertize  during PLR, while there was no significant change in CO (4.1% ± 12.8%), 3/11 were responsive in terms of CO. Conversely, PLR reduced HR  and MAP . All variables returned to baseline when the subjects were placed in the semi‐recumbent position, SR2 , while the SNS index decreased  during PLR. This ran in parallel with the increase in SV which may be seen as a response to the augmentation of CBV.4.2The PLR has been promulgated as a dependable and innocuous assessment of preload responsiveness in the ICU and recovery room. Its exact execution was honed in a study by Jabot showing that the sequence “semirecumbent to PLR” induces a larger increase in cardiac preload than “supine to PLR” and thus “SR to PLR” may be preferred for predicting fluid responsiveness  incorporating the Peñáz/Wesseling Modelflow and physiocal algorithms . Similarly, Si 53 years later related the PLR threshold values of ΔCO and ΔSV to Global Ejection Fraction  on October 4, 2017 (No. 10‐72‐212‐17).COPE: The author fully adheres to the Committee on Publication Ethics (COPE) Code of Conduct and its Best Practice Guidelines. The report of this observational study followed the STROBE checklist of items (https://www.strobe‐statement.org).


Jcerity Endoscoper Airway is a new back-open endoscopic laryngeal mask airway device with a unique design. Our study sought to compare the implantation, ventilation quality and complications of JEA (Jcerity Endoscoper airway) versus LMA  Supreme in the procedure of cerebral aneurysm embolization.In this prospective, randomised clinical trial, 182 adult patients with American Society of Anesthesiologists class Ι-II scheduled for interventional embolization of cerebral aneurysms were randomly allocated into the Jcerity Endoscoper airway group and the LMA Supreme group. We compared success rate of LMA implantation, ventilation quality, airway sealing pressure, peak airway pressure, degree of blood staining, postoperative oral hemorrhage, sore throat and other complications between the groups.P = 0.04), and there were also more oral hemorrhages and pharyngeal pain than JEA group . No differences were observed between groups in terms of other airway complications related to the LMA.There were no significant differences between the groups in terms of one-time success rate of LMA implantation, ventilation quality, airway sealing pressure or airway peak pressure. However, LMA Supreme group showed a higher degree of blood staining than the JEA group when the laryngeal mask airway was removed (The JEA could not only achieve comparable one-time success rate of implantation and quality of ventilation as the LMA Supreme, but also have lower blood staining degree of mask and less sore throat in patients undergoing perioperative anticoagulation for cerebral aneurysm interventional embolization.ChiCTR2100044133; Registered 11/03/2021.Chinese Clinical Trial Registry, Statement: This study adheres to CONSORT guidelines. With the popularization of endovascular techniques, interventional embolization of unruptured cerebral aneurysms with general anesthesia under digital subtraction angiography (DSA) has become the primary treatment –6. In orHowever, patients undergoing cerebral aneurysm embolization generally need anticoagulation and antiplatelet therapy before surgery , 10, andThe JEA  was originally designed for painless gastroscopy and treatment Fig. . As a neTherefore, the main purpose of this study was to compare the implantation, ventilation quality and complications associated with JEA and LMA Supreme in aneurysm embolization, so as to further optimize the anesthesia airway management mode of such operations.−2; estimated operation time > 3 h; reduced lung compliance; incisor defect; mouth opening limitations. Patients were divided to JEA group and LMA Supreme group. A biostatistician independent of data management conducted the randomization using SAS 9.4 software  to generate random numbers (with a ratio of 1:1). Therefore, the final study population included 182 patients who were randomly divided into two groups: the JEA group (n = 92) and the LMA Supreme group (n = 90). The study flow diagram is showen in Fig. We conducted a randomized, controlled, non-inferiority trial between April 2021 and July 2021 in the First Affiliated Hospital of Zhengzhou University in China. This trial was approved by the ethics committee of the First Affiliated Hospital of Zhengzhou University (2019-KY-276), and each patient provided informed written consent. All methods were carried out in accordance with relevant guidelines and regulations and with CONSORT recommendations. Prior to patient enrollment, the trial was registered as a clinical trial at Chinese Clinical Trial Registry . The first patient was recruited and registered on April 1, 2021.We studied 200 adult patients with physical status of I-II according to the American Society of Anesthesiologists, who were scheduled for elective cerebral aneurysm embolization under general anesthesia. Exclusion criteria were as follows: neck deformity; high risk of aspirating stomach contents; known or expected difficult airways; obesity (body mass index [BMI] > 30 kg.m2), non-invasive blood pressure measurement, and determination of end-tidal carbon dioxide and bispectral index (BIS). Before induction, patients were pre-oxygenated for no less than 3 min. Inducing drugs included etomidate (0.2 To 0.3 mg•kg−1), sufentanil (0.1ug·kg−1), cisatracurium (0.15 to 0.2 mg•kg−1) and dezocine 0.1 mg•kg−1. The selected JEA or LMA Supreme was inserted according to the manufacturer’s instruction manual. Before insertion, each LMA was lubricated with Obucaine gel. Volume controlled ventilation  was used to verify the size and position of the LMA device. Optimal ventilation defined as normal thorax expansion, normal airway pressure without air leak and normal pressure-volume curve [Thirty minutes before anesthesia, all patients were given penehyclidine hydrochloride 0.01 mg·kg by intravenous injection. All patients were routinely monitored using electrocardiogram, pulse oximetry . The number of LMA attempts with or without assistance was recorded by an independent observer, and the success rate of the first or second placement was recorded. We recorded the duration of implantation time.2O); SpO2 < 95%; and reflux. When hiccup, laryngospasm, bronchospasm, leakage or high inspiratory pressure occurred, we increased the depth of anesthesia or administered neuromuscular blockers. If high inspiratory pressure or audible leakage was detected, we adjusted the position of the LMA or the patient’s head.We recorded complications related to airway management: tooth or mucosal trauma; cough; hiccup; laryngospasm; bronchospasm; high inspiratory pressure .The primary endpoint was one-time success rate of implantation which defined as a successful insertion on first attempt after induction of anaesthesia. The secondary endpoints included quality of ventilation and complication related to airway management. Quality of ventilation was scored on a 3-point scale : (1) Opt−1. When the peak airway pressure did not rise or there was air leakage in the mouth, the airway pressure was the maximum leakage pressure. If the maximum air leakage pressure was less than 15 cm H2O, the LMA was replaced. If there was gas leakage in the mouth, we opened the expiratory valve to avoid alveolar trauma. If the maximum pressure reached 40 cm H2O, we recorded 40 cm H2O as the airway sealing pressure. Airway sealing pressure was recorded at various time points ; FBS view of VC: When LMA was successfully inserted, a 4.0-mm FBS was introduced near the end of laryngeal mask through it’s airway channel by the same anesthesiologist familiar with FBS. If resistance was encountered, operated the tip of FBS and classified the laryngoscope view. The position of the laryngeal mask was determined by FBS. The optimal positioning was defined as that the tip of laryngeal mask was located behind the arytenoid cartilage, epiglottis was not folded or blocked the airway, and the vocal cords could be seen. Any deviation from these standards was considered to be suboptimal positioning.Additional prespecified endpoints included time taken of implantation , the number of attempts to insert, peak airway pressure, airway sealing pressure and fiber optic bronchoscope (FBS) view of vocal cords (VC). Peak airway pressure was recorded at the beginning of controlled ventilation; Airway sealing pressure  was measP > 0.05 indicated normality). Normally distributed continuous variables were presented as mean ± standard deviation (SD). An unpaired t-test was used to compare continuous variables, the Mann-Whitney test was used to compare skewed variables and the χ2 test or Fischer exact test was used to compare categorical variables between Jcerity Endoscoper and LMA Supreme groups. All statistical tests were two-sided and p values <0.05 were considered significant.The required sample size to show non-inferiority of JEA versus LMA Supreme based on the primary outcome measure of one-time implantation rate was estimated to be 176 patients. This estimation was calculated on the basis of an expected one-time implantation rate of 93% for JEA and 96.7% for LMA Supreme  with nonNo differences were observed between the two groups in terms of age, sex, BMI or duration of surgery Table .Table 1PAll patients successfully completed the operation and returned to the ward safely. No adverse events of ventilation occurred during the operation. Except for one patient in LMA Supreme group who needed to be changed to endotracheal intubation, all patients successfully underwent LMA. The success rate of one-time implantation in JEA group was 93.48%, and that of the LMA Supreme group was 96.67%. There was no significant difference between the two groups. There were five patients in the JEA group and two in the LMA Supreme group who required a second attempt to implant by evacuating the gas in the cuff or lifting the mandible. One patient in JEA group was successfully ventilated by changing LMA to one size smaller, and there was no significant difference between the two groups. No differences were observed between the two groups in terms of LMA insertion times, number of insertion attempts, quality of ventilation, peak airway pressure, or FBS view of VC  Table .Table 2AP > 0.05) . Complications such as laryngeal nerve injury, vocal cord paralysis, and arytenoid cartilage dislocation were not observed in either group , as same as insertion time and number of insertion attempt , postoperative sore throat (P = 0.03), postoperative oral hemorrhage (P = 0.02) in the JEA group were significantly lower (Table et al. [Our study also showed that compared with the LMA Supreme group, the blood staining degree of the mask (t P = 0.0, postopee et al.  also repe et al. , 24. On e et al. , 24, whiAccording to previous studies, although LMA placement avoids direct irritation and injury to the glottis and trachea, it could cause damage to soft tissue of mouth, pharynx and larynx, sore throat and bleeding were still common postoperative complications . Belena’There are several limitations in our study. First, and for obvious reasons, the anesthesiologist involved in timing the events in the operating room was not blind to the type of device. To mitigate this, postoperative outcome assessors and patients were blinded to the group assignment. Second, we only investigated the date about the airway management in patients undergoing perioperative anticoagulation for cerebral aneurysm interventional embolization, but we did not record the detailed date on anticoagulation time and degree, which might have resulted in bias and could have affected the power of study. However, preoperative anticoagulation therapy for patients with cerebral aneurysms is consistent with norms and basically unified.In conclusion, we found that JEA can not only achieve comparable one-time success rate of implantation and quality of ventilation as the LMA Supreme, but also have lower blood staining degree of mask and less sore throat, which confirmed the superiority of JEA as an airway management tool in patients undergoing cerebral aneurysm interventional embolization.


A substantial proportion of type 1 diabetes (T1D) patients free from known cardiovascular disease (CVD) show premature arterial stiffening, with age, blood pressure, and HbA1c—as gold standard of glycemic control—as main predictors. However, the relationship of arterial stiffness with other time-varying parameters of glycemic control and glycation has been far less explored. This study investigated the relationship of arterial stiffness with several short- and long-term parameters of glycemic control and glycation in patients with T1D, such as advanced glycation end-products (AGEs) and continuous glucose monitoring (CGM)-derived parameters.Cross-sectional study at a tertiary care centre including 54 patients with T1D free from known CVD. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (cf-PWV). Current level and 10-year history of HbA1c were evaluated, and skin AGEs, urinary AGEs, and serum soluble AGE-receptor (sRAGE) concentrations. CGM for 7 days was used to determine time in range, time in hyper- and hypoglycemia, and glycemic variability.s = + 0.28), mean 10-years HbA1c (rs = + 0.36), skin AGEs (rs = + 0.40) and the skin AGEs-to-sRAGE ratio (rs = + 0.40), but not with urinary AGE or serum sRAGE concentrations; and not with any of the CGM-parameters. Multiple linear regression for cf-PWV showed that the model with the best fit included age, T1D duration, 24-h mean arterial pressure and mean 10-years HbA1c .Cf-PWV was associated with current HbA1c (rLonger-term glycemic exposure as reflected by current and mean 10-years HbA1c is a key predictor of arterial stiffness in patients with T1D, while no relationship was found with any of the short-term CGM parameters. Our findings stress the importance of early and sustained good glycemic control to prevent premature CVD in patients with T1D and suggest that HbA1c should continue to be used in the risk assessment for diabetic complications. The role of skin glycation, as a biomarker for vascular aging, in the risk assessment for CVD is an interesting avenue for further research. Arterial stiffness is a potential biomarker for complication risk in patients with type 1 diabetes (T1D), as its predictive role in the development of microvascular and cardiovascular disease (CVD) has been reported . We haveThe Lancet Diabetes & Endocrinology, the landscape of glycaemia management based on HbA1c is changing , poor [8.1–9.0% (65–75 mmol/mol)] or very poor [> 9% (> 75 mmol/mol)]. Mean and standard deviation (SD) of 10-years HbA1c history was collected to reflect patients’ long-term glycemic exposure and variability, respectively, provided that at least sixteen HbA1c values were available for the 10-year period and with a maximum of one year without HbA1c.Blood HbA1c was determined with high-performance liquid chromatography (HPLC)  using an AGE reader , as described elsewhere /[sRAGE]) was calculated. was subcutaneously inserted in the lower abdomen measuring interstitial glucose concentration every 5 min for a 7-day period. Patients were instructed to rely on their usual glycemia measurement method, to maintain normal daily activities, and to not actively use the study CGM device or check the information depicted on the screen . Alarms for high or low glucose were disabled except the < 54 mg/dL alarm for ethical reasons. Data were extracted from the Dexcom® Clarity platform and processed with the web-based application Glyculator 2.0. The following CGM-parameters were collected: mean blood glucose (MBG), estimated HbA1c [% (mmol/mol)], TIR (70–180 mg/dL), TBR , TAR , area under the curve total , AUChyper (> 180 mg/dL) and AUChypo (< 70 mg/dL)  depending on the distribution. Pearson (r) correlations were used to examine linear associations between normally distributed continuous variables, in any other case Spearman correlation (rs) was used. Multivariate linear regression (step-up approach) was used to investigate associations between one or more independent variables with the dependent variable of interest, i.e., to evaluate predictors of cf-PWV. To in- or exclude predictor variables in the regression model, multicollinearity within the model was evaluated with the variance inflation factor (VIF), with VIF > 4 denoting significant multicollinearity. Level of significance for all statistical tests was set at p < 0.05. An a priori sample size calculation for F-test—Linear multiple regression fixed model was performed, using G*Power software version 3.1.9.4. The regression model needs to contain at least the factors proven to be associated with arterial stiffness, being age, BP and HbA1c level  m/s, ranging from 5.1 to 14.5 m/s.s = + 0.69, p < 0.001), T1D duration , brachial office SBP , and 24-h brachial SBP and MAP . There were significant associations between cf-PWV and renal parameters serum creatinine , eGFR  and UACR . Cf-PWV was not significantly different between men and women , and was not associated with age at onset of T1D or with other metabolic markers BMI, waist circumference, total daily insulin dose or lipid profile parameters.Cf-PWV showed moderate to good associations with traditional CV risk factors age . Cf-PWV was not associated with serum sRAGE concentrations or urinary AGEs, but did significantly associate with the skin AGEs-to-sRAGE ratio (rs = + 0.40). Cf-PWV was not associated with HbA1c-variability (i.e. SD-HbA1c over 10 years).Parameters of glycemic control and glycation are shown in Table Bivariate models showed that skin AGEs predicted cf-PWV independent from current HbA1c and mean 10-years HbA1c (p < 0.01), while the abovementioned association of the skin AGEs-to-sRAGE ratio with cf-PWV was not independent from skin AGEs.Concerning CGM-derived (short-term) glycemic control, cf-PWV was not associated with any of the CGM-parameters .2 = 0.645, p < 0.001) ; (b) skin AGEs could not be included in a model simultaneously with age and mean 10-years HbA1c due to multicollinearity, and this was not overcome by standardizing the predictor variables; (c) neither in a 2nd model including [T1D duration + 24 h-MAP + mean 10-years HbA1c + skin AGEs] or in a 3rd model including [age + T1D duration + 24 h-MAP + skin AGEs], skin AGEs showed independent predictive value; (d) the model held when corrected for smoking status. There was no significant additional independent impact of adding the skin AGEs-to-sRAGE ratio, serum creatinine, eGFR or other outcome parameters to the abovementioned model.The regression model  that achieved the best fit for predicting cf-PWV included age, T1D duration, 24-h-MAP and mean 10-years HbA1c, explaining more than 60% of variance in cf-PWV  suggest that HbA1c should continue to be used in the risk assessment for diabetic complications, next to other glycemic control parameters such as TIR, complementing instead of competing each other; and (2) show the importance of early and sustained good glycemic control to prevent premature CVD in patients with T1D.Next to HbA1c, traditional CVD risk factors age and BP together with T1D duration , 30, 31 In recent clinical practice, besides HbA1c several CGM-derived (shorter-term) parameters became available, adding value in reflecting glycemic control and in all-day clinical management of T1D . AlthougIn our study population, however, neither TIR or TAR nor parameters of GV were significantly associated with cf-PWV, despite that current HbA1c did so. A recent cross-sectional study conducting similar research in T1D neither found significant associations between TIR and carotid artery wall thickness or endothelial function . Hence, average level of glycemic control, thereby missing associations with the outcome. Thirdly, even though patients were asked to maintain normal daily activities and not to actively use the CGM device, it is not unlikely that they paid more attention to the device than they normally do. These three points are illustrated in our study by the finding that HbA1c was only moderately correlated with TIR (r = − 0.51). Lastly, it should be mentioned that glucose management and insulin delivery strategies have dramatically changed the past decade, with CGM use and newer insulin pumps leading to improvements in glycemic control. Patients who had shown poor control for years now show better glucose curves with substantially improved HbA1c (and TIR). Again, since vascular damage is primarily the result of longer-term exposure to hyperglycemia, this can explain why 10-years HbA1c and skin AGEs were more strongly (and independently) associated with cf-PWV than current HbA1c.Three points that could explain the lack of relationship between CGM-parameters and arterial stiffness should be noted. Firstly, inter-individual variation in glycation rate of HbA1c is an important explanatory variable in the relationship between HbA1c and TIR—and thus also in the association of TIR with arterial stiffness. Secondly, TIR was calculated over seven days whereas a sampling duration of 14 days has been suggested to reflect a patient’s level of glycemic control over the last three months more accurately . Hence, Not unexpectedly, longer-term measures as mean 10-years HbA1c and skin AGEs showed stronger  associations with arterial stiffness than current HbA1c. This again illustrates the importance of long-term glycemic exposure for vascular health as recently pointed out once more by DCCT analyses, advocating intensive insulin therapy aimed at lowering HbA1c as early and long as safely possible , 39. Thei.e., independent from skin AGEs alone.Our study did not find associations of arterial stiffness with urinary AGEs or with sRAGE concentrations, while two prospective studies (9- and 12 years of follow-up) have shown independent predictive value of sRAGE levels for CVD and mortality , 42. NotThe strength of our study is that several possible correlates of arterial stiffness—assessed by the gold standard cf-PWV method—were evaluated in a well-described study population, such as various patient and disease characteristics, HbA1c history, AGE forms, and CGM-parameters. The limitation lies in its cross-sectional design, so that statements on causality cannot be inferred, and in its rather small sample size. The reported associations—or the lack thereof—now need to be further explored in follow-up studies, investigating the factors involved in the development and progression of arterial stiffness in T1D. Finally, although the added value of arterial stiffness is mainly pronounced in patients without previous CVD, our CVD-free study cohort does not reflect the entire T1D population and our findings cannot be extrapolated to patients with established CVD.The present study demonstrated that longer-term glycemic exposure as reflected by current and mean 10-years HbA1c is a key predictor of arterial stiffness in patients with T1D, while no relationship was found with any of the short-term CGM-parameters. Our findings stress the importance of early and sustained good glycemic control to prevent premature CVD in patients with T1D and suggest that HbA1c should continue to be used in the risk assessment for diabetic complications. The role of skin glycation, as a biomarker for vascular aging, in the risk assessment for CVD is an interesting avenue for further research.


Joubert Syndrome (JS) is a rare genetic developmental disorder. We are aiming for increasing awareness of this disease especially kidney involvement in children with JS.Clinical and genetic data of 17 cases of JS in Beijing children’s hospital in the past 21 years were collected retrospectively.Twelve males and 5 females, aged from 12d to 15y8m. The most common involvement was neurological system involvement. The second most common involvement was renal involvement: end stage kidney disease in 6 cases (35%), hematuria in 5 cases (29%), proteinuria in 5 cases (29%), renal diffuse lesions in 4 cases (24%), renal cystic lesions in 2 cases (12%), and echogenic enhancement of parenchyma in 2 cases (12%). 10 cases did genetic tests. 3 cases with renal deficiency all had RPGRIP1L gene mutation.The most common involvement of JS is neurological involvement, and the second is renal involvement. Pediatricians should improve awareness of JS and conduct systemic evaluation of children. More attention should be paid to renal involvement which may be onset hidden but fatal. Early recognition and diagnosis are the goals to delay the start to dialysis and improve quality of patients’ life. The RPGRIP1L gene mutation maybe the most common gene mutation in JS and may have correlations with renal involvement. Joubert Syndrome  is a rare genetic developmental disorder. It is a predominantly autosomal recessive ciliopathy condition characterized by a distinctive cerebellar and brainstem defect in brain MRI known as the “molar tooth sign”  because of its resemblance to the cross-section of a tooth on axial imaging . The patient in the video showed horizontal eye movement disorder.Ten of 17 cases did exon sequencing tests. 3 had RPGRIP1L gene compound heterozygous mutation, 2 had CC2D2A gene compound heterozygous mutation, 1 hadCSPP1 gene compound heterozygous mutation, 1 had C5ORF42 gene compound heterozygous mutation, 1 had CPLANE1 gene compound heterozygous mutation, 1 had ARL13B gene compound heterozygous mutation and 1 had NPHP1 gene homozygous mutation. 3 cases with renal deficiency all had RPGRIP1L gene mutation. The results are summarized in Table We next examined associations between the clinical features of JS and each genetic cause. The gene-phenotype correlations showed in Fig. Bar graph indicates each involvement and the more frequently related genes, showing gene-phenotype correlation in Joubert syndrome. The RPGRIP1L gene was strongly correlated with the renal phenotype.The current outcome of 17 patients was concluded through telephone follow-up, among which 7 patients were lost to follow-up, with a total loss rate of 41.2%. The follow-up period ranged from 11 months to 156 months. Among the 6 JS patients with end stage kidney disease, 2 were lost to follow-up, 1 died of ESRD after 5 years’ hemodialysis when he was 20y, 1 received kidney transplantation, and 2 were still receiving maintenance dialysis . The mortality rate of JS children with end stage kidney disease was as high as 16.7%.Cilia dysfunction can lead to a series of complex and serious diseases, involving multiple systems, including kidney, liver, nervous system, eyes, respiratory system, reproductive system, bone, etc. These diseases are known as ciliopathies. Joubert Syndrome (JS) is a typical ciliopathies caused by disruption of ciliary transition-zone architecture .Joubert syndrome is a rare autosomal recessive genetic disorder although a few X-linked recessive cases have been reported . An estiThe main clinical manifestations of JS are neurological system involvement like development lag, intellectual disability, dystonia, eye movement loss, ataxia, abnormal respiratory rhythm, etc. In our study, abnormal development of JS central nervous system includes retardation of intellectual development, serious intellectual deficiency and intelligence measured at boundary value. The incidence of neurological involvement was the highest, and nearly half of neurological symptoms was mental retardation, suggesting that mental retardation was the most common manifestation of JS in clinical practice. Another manifestation of the neurological system was ataxia and dystonia. Most children were found to be abnormal when sitting alone or walking alone in infancy. It is of great significance to do brain MRI, intelligence measurement and genetic test for diagnosis of JS in children with mental retardation at an early stage.Although neurological system involvement is the most common, it progresses relatively slowly and is not the major cause of death. In a cohort of 565 patients with JS (40 of them deceased), deceased status was found to be associated with extra-neurological features instead of neurological features .Nearly 1/3 of JS patients have kidney involvement according to previous reports. Our study suggests that kidney is the second most common JS involved organ after neurological system, and the incidence of end stage kidney disease can reach to 35%6/17), which is basically consistent with previous research data. Jennifer C. Dempsey did a survey of motality of JS of the approximately 850 families, finding that the most common causes were kidney failure  and respiratory failure . The main cause of death in patients older than 6 years old is renal insufficiency [, which iPrevious reports on JS focus more on the evaluation and treatment of neurological system function, but lack sufficient attention to the kidney. As we observed, lots of JS patients never did any tests related to kidney after they were diagnosed. We suspect the reason why we used to pay more attention to neurological system instead of kidney is that there is no diagnosis criteria relevant to kidney. Also, the kidney is known as a “silent” organ, meaning kidney failure is a latent process and can be easily neglected. As we can see, the primary manifestation of 6 patients in our study were end stage kidney disease. 4 of 6 had hemodialysis while 2 had peritoneal dialysis. Patients with end-stage renal failure have to choose kidney transplant or dialysis. Complicaitons of end stage renal failure like heart failure, pulmonary edema, anemia, secondary hyperparathyroidism, metabolic bone disease influence the quality of life badly and increase motality of patients, posing a great economic burden on society and families. Therefore, early renal assessment plays an important role in improving the long-term survival rate of children.It has been previously reported that renal damage in JS patients can be manifested as renal tubular structure abnormalities and/or cystic lesions of renal cortex medulla oblongata, which may lead to polydipsia, polyuria and renal cystic lesions, and then develop into acute/chronic renal insufficiency, and eventually kidney failure. However, our study found that the incidence of abnormal urinalysis, such as albuminuria (29%) and hematuria (29%), was higher than that of renal cystic lesions (12%), suggesting that noninvasive simple urinalysis can be used as the first choice for renal examination in children suspected of JS, and urological ultrasonography should be completed at the same time. For patients suspected of JS clinically, evaluation of renal function and structure should be carried out as soon as possible. Urine concentrating ability is also an effective means of monitoring for CKD in patients. Urinary concentrating defect was a significantly sign in patients with CKD in an early stage . In a study of 93 patients with JS, CKD was predicted in > 75% with urine osmolality < 600 mOsm/kg. Early detection of renal structure or function damage, early intervention and proper complication assessment may delay the timing of kidney transplantation or dialysis.Joubert syndrome is a disease with strong clinical heterogeneity. Joubert syndrome-related disorders (JSRD) has neurological signs along with variable multiorgan involvement including skeletal changes such as polydactyly, ocular coloboma, retinal dystrophy, renal disease (cystic dysplasia/nephronophthisis), and hepatic fibrosis. Nowadays JS has been considered as a type of renal ciliopathy. As we found in the study, kidney involvement of JS is very common, but the classical diagnostic criteria of JS has no kidney related criteria. Our research shows that there are 6 cases in children have end stage renal disease, so we should attach importance to JS renal involvement, the kidney related criteria into the diagnostic criteria may be an effective measure.Joubert syndrome is a model for untangling recessive disorders with extreme genetic heterogeneity . There aIt is reported that kidney disease affects up to 1/3 of patients with Joubert syndrome and is more common in those with pathogenic variants in CEP290, TMEM67 and AHI1 genes. According to previous reports, variation of RPGRIP1L gene can lead to Joubert syndrome, but the detection rate is low, only 1–2% , mostly −/− mouse led to the discovery of RPGRIP1L mutations as the cause of NPHP type 8 [Three patients with RPGRIP1L gene and NPHP1 gene mutation all had end stage renal failure, suggesting that RPGRIP1L gene and NPHP1 gene mutation may be related to kidney involvement especially end stage kidney disease. More attention should be paid to kidney involvement in patients with RPGRIP1L gene and NPHP1 gene mutation. RPGRIP1L gene is also known as NPHP8 gene which is one of genes cause nephronophthisis . NPHP constitutes the most frequent genetic cause of endstage renal disease (ESRD) in children and young adults . In nephP type 8 . A studyP type 8 . In the P type 8 .Our report supports the notion that genotype-phenotype correlations may help guide individualized management in JS patients. More further basic researches are needed to explore possible associations between systemic involvement and genetic causes.Abnormal eye movement is the most characteristic and frequently occurring developmental abnormality in JS patients, which is specifically manifested as absence of follow-up and disappearance of vestibular eyeball reflex. Nystagmus is also common, and may also be accompanied by strabismus and ptosis. Our study found that JS ocular abnormalities including eye movement disorder, drooping eyelids, too wide eye spacing accounted for 30%, lower than the previous related data. Ophthalmic examination should be performed routinely to improve the rate of early diagnosis of ocular abnormalities. Other ocular defects include lesions of the retinal pigment epithelium, choroid, and sensory nerves. Lesions of the eye are usually screened and evaluated by visual acuity, fundus, and electro retinogram.A small number of JS patients will have liver lesions, mostly in the form of liver fibrosis, which is specifically manifested as abnormal liver-related enzymes in the serum and gradually manifested as hepatosenomegaly, portal hypertension and esophageal varices, and eventually develops into liver fibrosis. In our study, there were 2 cases with abnormal liver enzymes (12%) and 1 case with abnormal liver structure (thickening of echo) (6%), which were significantly less than the cases with nervous system and kidney involvement.Some JS patients due to skeletal dysplasia refers to toe deformity, scoliosis, some patients have abnormal characteristics of maxillofacial, such as encephalocele craniocerebral deformity, mouth facial midline defects , 1 patient had “congenital cleft palate repair” surgery when 4 years old, 1 patient had polydactyly and do the resection surgery when 9 years old. So when we see patients who have skeletal dysplasia or polydactyly and kidney injury should take nephronophthisis including JS into consideration. It is an obvious sign.JS is a systemic disease and should be evaluated systemically as soon as possible when a patient is clinically suspected to have this disease. It is necessary to improve the pediatrician’s awareness of the disease to provide a more comprehensive assessment of patients. Wesuggestto attach importance to JS renal involvement. Adding the kidney related criteria into the diagnostic criteria may be an effective measure to recognize it.There is no unified data on the specific mortality of JS. In our study, 1 of 17 patient died, the motality rate is 5.9%. But there is statistical error due to the limited sample capacity.The average age of death in children with Joubert syndrome is around 7 years, with renal insufficiency being the main cause of death in patients older than 6 years [With the rapid development of medical technology and gene detection methods in recent years, though Joubert syndrome is a rare disease, the detection rate is increasing year by year. In addition to the nervous system, kidney is the main affected organ of JS. More attention should be paid to kidney involvement. We suggest to attach importance to JS renal involvement. Adding the kidney related criteria into the diagnostic criteria may be an effective measure to recognize it more earlily. Early identification of kidney damage in children with JS, appropriate intervention and monitoring are helpful to improve the quality of life and survival years of children. Patients should be monitored for signs and symptoms of CKD including blood pressure measurements and serum creatinine, blood urea nitrogen (BUN), and blood count with hematocrit/hemoglobin . Gene re


Mild cognitive impairment (MCI) is a prevalent and underdiagnosed condition in chronic kidney disease (CKD), that shares common pathophysiological factors such as chronic inflammation.To evaluate the association of MCI in CKD stages 1-5 using inflammatory markers and changes by magnetic resonance imaging (MRI).Cross-sectional study in adult patients with pre-dialysis CKD. MCI was assessed by the Montreal Cognitive Assessment (MoCA) and the estimated glomerular filtration rate (eGFR) by the Chronic Kidney Disease Epidemiology Collaboration equation. Sociodemographic and clinical data were collected from medical records. The cytokines IL-4, IL-6, IL-17, TNF-α and hs-CRP were determined. Brain MRI was performed in a 1.5 Tesla device, without paramagnetic contrast. A descriptive analysis followed by a comparison of abnormal versus normal MoCA scores among all studied variables. A linear regression analysis was performed using MoCA as a dependent variable, adjusted for confounding factors.Of 111 invited patients, eighty completed the neuropsychological assessment and 56 underwent MRI, and were included in the study. Mean age was 56.3 ± 8.3 years and 51.8% (n = 29) had altered MoCA. When compared to the group with normal MoCA, the group with altered MoCA had higher levels of IL-6 and IL-17. There was no correlation between altered MoCA with eGFR or with MRI abnormalities.MCI assessed by MoCA was prevalent in patients with pre-dialysis CKD, it was associated with inflammation and showed no correlation with MRI changes. This phenomenon led to the predominance of non-communicable chronic diseases (NCDs), highlighting systemic arterial hypertension (SAH) and diabetes mellitus (DM), a favorable scenario for the increased prevalence of cardiovascular diseases (CVD), chronic kidney disease (CKD) and dementia syndromes. A similar phenomenon occurs with cognitive impairment (CI) and dementias, particularly in low and middle-income countries, in which CI is associated with population aging, low socioeconomic and educational levels and a higher frequency of potentially risk factors modifiable, such as SAH, sedentary lifestyle, alcohol abuse, etc.The prevalence of CKD has increased significantly, being estimated at around 11% of the world population. Among the dementias, Alzheimer’s disease accounts for about two thirds of the cases, followed by vascular dementia, mixed dementia, Lewy body dementia and frontotemporal degeneration. As a general rule, we use specific protocols to assess CI. In these, the most cited cognitive screening instruments are the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), associated with the assessment of functional activities, usually performed using the functional activities questionnaire by Pfeffer et al., in addition to laboratory tests for syphilis (VDRL), vitamin B12 dosing, thyroid hormones and human immunodeficiency virus (HIV) serology. These are associated with running neuroimaging exams, represented by computerized tomography (CT) and/or magnetic resonance (MR) of the brain, aiming to exclude reversible causes of CI11.In Latin America, dementias are a growing problem, as a result of the high levels of illiteracy and the demographic transition observed in that continent. Preceding the diagnosis of dementia, initially mild and progressive CI occurs, often undiagnosed. Mild cognitive impairment (MCI), described by Petersen et al., is defined as cognitive impairment without functional repercussions, being an intermediate condition between normality and dementia. Since then, there have been several reports of CI at different stages of CKD, affecting up to two-thirds of this population. Etiologically, MCI is attributed to factors such as uremic toxins, inflammation and oxidative stress, among others. These factors determine endothelial dysfunction and, later, vascular lesions identifiable by brain MRI and characterized by white matter hyperintensities, subclinical cerebral infarcts or cortical atrophies. Therefore, in initial cases of CI in CKD, these changes, of a functional nature, cannot be identified by MRI, making early diagnosis difficult.In recent years, the association of CKD categories 4 and 5 with dementia has been reported by different authors. The hypothesis is that, in CKD, cognitive alterations are initially of a functional nature and, therefore, not identifiable by MRI. Given the above, this study focuses on evaluating the MCI detected by MoCA, inflammatory markers and changes in brain MRI, in patients with CKD under conservative treatment.We know that CI impacts the treatment of CKD, as it interferes with the understanding of the guidelines from healthcare professionals, reducing adherence to dietary guidelines and pharmacological treatment in this population. Thus, it is essential to diagnose MCI as early as possibleThis study was approved by the Research Ethics Committee (CEP) of the Federal University of Juiz de Fora, under protocol nº. 183,387.This is a cross-sectional study of a database created for cognitive analysis of patients with pre-dialysis CKD, called NEFROCOG. For this base, we invited the patients scheduled for clinical consultations at the Hiperdia Minas Center in Juiz de Fora-MG (CHM-JF) from March 2013 to December 2014. The patients were contacted by telephone and scheduled for individual neuropsychological evaluation, on a day different from that of their clinical appointment.We used a convenience sample, consisting of 111 patients seen by the CHM-JF of secondary care in SAH, DM and CKD. Of these, 14 were participated in a pilot project - carried out to calibrate the tests. The following were defined as inclusion criteria: patients with CKD in categories 1 to 5, undergoing conservative treatment ; age > 21 and < 65 years; they all agreed to participate in the study and signed the Informed Consent Form (ICF). We excluded those patients with a previous history of cerebrovascular accident (CVA); infectious or degenerative diseases of the Central Nervous System (CNS); presence of delirium and/or psychotic disorders; previous history of traumatic brain injury; visual and auditory disorders that prevented the tests from being carried out; HIV and/or Acquired Immunodeficiency Syndrome (AIDS); and contraindication or intolerance to performing MRI.The sociodemographic and clinical variables analyzed were collected from the patients’ records or investigated with them. The following variables were evaluated: age, hemispheric dominance, educational level (< 4 years or > 4 years), sex, color, marital status and family income. Clinical variables included: SAH, DM, CVD, hypothyroidism, depression, smoking, alcoholism, sedentary lifestyle, CKD category and use of medications, namely: opiates, anti-Parkinsonians, hypnotics, antiepileptics, benzodiazepines, antidepressants, angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), beta blockers, calcium channel blockers, adrenergic blockers, vasodilators, diuretics, statins, fibrate, vitamin D, oral antidiabetics, insulin, erythropoietin, iron, levothyroxine, nitrates and aspirin.For laboratory variables, we collected blood samples by venipuncture after the patient fasted for 12 hours during the same period of the clinical evaluation. We evaluated the following: hemoglobin, urea, creatinine, sodium, potassium, blood glucose, glycated hemoglobin, calcium, phosphorus, magnesium, alanine aminotransferase/aspartate aminotransferase (ALT/AST), total cholesterol, high-density lipoproteins (HDL), low-density lipoproteins (LDL), triglycerides, albumin, uric acid, ferritin, transferrin saturation index (IST), parathormone (PTH), thyroid stimulating hormone (TSH), vitamin B12, folic acid, vitamin D3, ultrasensitive C-reactive protein (US-CRP), VDRL, fluorescent treponemal antibodies (FTA-ABS), hepatitis B surface antigen (HBsAg R), antibody to hepatitis B surface antigen (Anti-HBs), antibody to hepatitis C surface antigen (anti -HCV), estimated glomerular filtration rate (eGFR) and proteinuria.Inflammatory markers represented by interleukins (IL) IL-4, IL-6 and IL-17 and by tumor necrosis factor alpha (TNF-α) were also evaluated. For this purpose, 10 mL blood samples were collected in tubes without anticoagulant. The tubes were centrifuged at 3,500 rpm and the collected sera were frozen at-86°C. The measurements of these markers were performed using the Enzyme Linked Immune Sorbent Assay (ELISA) technique. The samples were quantified by comparison with recombinant standard curves .Two medical professionals (one neurologist and on psychologist) performed the assessments, conducted in a silent environment, in a single session of approximately one hour.We ran a structured anamnesis and applied clinical depression questionnaires for the tests were applied in the same sequence for all patients and corrected only by the neurologist/psychologist examiner. The sequence of the neuropsychological tests’ application considered both the mental wear of the individual when performing each test and the interference of one test with another, which could generate, for example, learning. We must also consider that some tests are distracting. tests were used to diagnose depression and MoCA, in the Brazilian version, to diagnose CI. To interpret the MoCA, the cutoff point adopted for the Brazilian population (≤ 25 points) was reduced to ≤ 24 points, as a strategy to adjust the sample’s educational level. The choice of MoCA was due to the good sensitivity of the test to detect MCI when compared to the MMSE.The Mini International Neuropsychiatric Interview/Mini International Neuropsychiatric Interview-Plus (M.I.N.I/M.I.N.I-PLUS) questionnaire was also used to assess the patient’s functionality. This test was applied to the companion simultaneously, with the patient’s assessment or over the telephone.The Pfeffer et al.The questionnaires and tests, the functions and domains assessed, as well as the cutoff point used for their correction, are shown in . We used three visual scales to assess the MRI images - Fazekas, MTA  and the GCA  (We performed MRI images of the brain using a high-field Siemens/Avanto apparatus (1.5 Tesla), without paramagnetic contrast. For this purpose, we used a specific protocol recommended for the study of cognitive alterations and dementiatrophy) . The imaWe ran a descriptive analysis of the data with the mean, standard deviation, median or percentage according to the characteristic of the variable. We assessed normality using the Kolmogorov-Smirnoff test. A comparison was made between patients with normal MoCA vs. altered sociodemographic, clinical, laboratory, inflammatory and imaging variables, using the Chi-square and/or Student’s t tests for independent data, and the Mann-Whitney test to compare medians. The correlations between MoCA and eGFR with all variables were performed using the Pearson or Spearman correlation tests. Finally, we performed a linear regression using the MoCA as the dependent variable; and age, gender and eGFR as confounding variables. For each model, we used an inflammatory marker as an associated confounding variable, as there was a lot of collinearity between them, preventing them from being placed in a single model. We used the SPSS 17.0 software, Chicago, Illinois®.We invited 111 patients to participate in the study; 13 of whom refused, and four were scheduled but did not attend the evaluations. The remaining 94 signed the Consent Form and underwent the evaluations. Of these, 14 made up the pilot study, leaving eighty complete evaluations. After applying the inclusion criteria, eight patients were excluded and 16 refused to undergo brain MRI, making a final sample of 56 patients .To present the results, the patients were divided into two groups: normal MoCA (≥ 24 points) and altered MoCA (< 24 points).Regarding the sociodemographic parameters, there was a tendency to change the MoCA in older patients , as well as in patients with schooling < 4 years, when compared to those > 4 years (p = 0.04). Regarding comorbidities, patients with DM tended to have an altered MoCA . In other comorbidities, as well as in the different CKD categories, there were no significant changes .As for the use of medications, there were significant changes in patients using diuretics , oral antidiabetics  and AAS . There were no statistically significant values for the other medications .In the laboratory evaluation, plasma sodium  and ferritin  were slightly higher in the group of patients with altered MoCA. However, these data were not statistically significant, or clinically relevant. The same was true in relation to triglycerides, which were lower in the group with altered MoCA . Importantly, there was no statistically significant difference in the other exams, including eGFR . Further had a score of 0 in 17.1% of the cases; and a score of 1 in 60.7%, that is, mild or no changes in the white matter, not explaining a CI of a vascular nature. Moderate microangiopathy or Fazekas 2 were found in only 19.6% of the cases. However, as they are mostly hypertensive patients, SAH per se would justify the presence of these alterations.Neuroimaging was performed by MRI, the gold standard for evaluating the white matter lesions by detecting microangiopathies or leukoaraiosis, MCI markers of a vascular nature. These lesions, evaluated by the Fazekas scale, scale, used to assess mesial changes in the temporal lobes, correlated with Alzheimer’s disease, in 81.8% of the cases, and 16.4% had mild changes. Thus, similarly to the previous scale, there were no alterations related to Alzheimer’s disease detected using the MTA scale.There were no changes (MTA 0) in the MTA. In 98.2% of the cases, cortical atrophy ranged between 0 (74.5%) and 1 (23.6%), that is, there was no atrophy in most cases and, when present, it was mild. Only 1.8% had severe cortical atrophy. Therefore, there were no statistically significant image changes in the normal MoCA and altered MoCA groups  than that observed in the usual population of the pre-dialysis CKD outpatient clinic (66.2 ± 13.4 years) of the CHM-JF. There is evidence in the literature that correlates MoCA with education, being significantly higher in individuals with high education, thus resulting in the cutoff point of 26 used in the original study, contrasting with other studies validated in other countries that used various cut-off points. The higher the educational level, the greater the cognitive reserve and the better the performance on tests, thus acting as a protective factor for dementia. In this study, we adopted the cutoff point of 24, as it has already been suggested in previous studies in the Brazilian population and in patients with CKD.Regarding education, the MoCA was lower in those with < 4 years of education when compared to those > 4 years. The sample compared to the National Household Sample Survey (PNAD), 2019, revealed a higher percentage of individuals with more than 4 years of education (89.1% vs 32.2%) using secondary data evaluated the relationship between cognition and DM with MRI findings, and reported a worse performance on the MMSE associated with a decrease in gray matter, with a higher albumin/creatinine ratio and a reduction in eGFR. Our study found no association of proteinuria or eGFR with CC assessed by MoCA.As for comorbidities related to CKD, there were significant changes found in patients with DM, a population known to be at higher vascular risk. A study by Freedman et al..Due to the high prevalence of SAH in our sample, we could not establish its association with CI, although there are numerous citations that correlate SAH as one of the main traditional risk factors for vascular compromise and secondarily to CI and CKD itself addressing the use of antihypertensive drugs and cognition in the elderly, despite highlighting the heterogeneity of the studies, showed an association between the use of ARB and improvements in episodic memory, while diuretics and other antihypertensive drugs did not have any association. The same occurred with the use of acetylsalicylic acid, associated with a higher prevalence of CVD and, for this reason, it is believed to be associated with worse MoCA performance.Regarding the use of medications, there were significant changes in patients using oral antidiabetics, which, as discussed above, cause worse cognitive performance. Another therapeutic class associated with worse cognitive performance was diuretics. This fact may be related to the greater use of this therapeutic class in patients in more advanced categories of CKD and the likely association of CKD with other comorbidities. A systematic review. In this study, higher ferritin values were associated with better MoCA performance, but it seems that this increase is not associated with inflammation, but with iron reserves. In our study, we can speculate that hypertriglyceridemia may be associated with CKD, a condition in which dyslipidemia is observed in up to 75.7% of cases, and hypertriglyceridemia in up to 50%.As for laboratory findings, the relationship between CI and anemia in CKD is a known fact. The drop in ferritin is related to worse functionality, lower MoCA scores in verbal and working memory, and in attention have shown a correlation between impaired renal function and CI, but most of these studies were carried out in populations over 65 years of age, in whom CKD is associated with the aging process. In the literature, it has been reported that CI, including dementia, occurs in 16% to 38% of patients with end-stage CKD. In the REGARDS study, a cohort with 23,405 patients, with a mean of 64.9 years, they reported that, in cases of eGFR < 60 mL/minute, 10 mL reduction in eGFR increased by 11% the prevalence of cognitive decline. Another prospective cohort showed a correlation between worsening renal function and CI in a multibreed population, with eGFR less than 90 mL/minute and follow-up for 2.8 years; and they concluded that CKD was linearly associated with cognitive decline in this population, adjusted for multiple risk factors, even in patients with slightly reduced renal function. On the other hand, the CRIC study in younger patients with mild to moderate CKD (57.7 ± 11.0 years), with a mean eGFR of 45.0 ± 16.9 mL and a mean of 6 years of follow-up, concluded that CI is not associated with additional risk of CKD progression. In our study, consisting of patients under 65 years of age and with a predominance of earlier CKD categories, there was an important prevalence of CI, but this was not linearly associated with eGFR.Previous studies, initially leading to functional changes and, subsequently, to the worsening of CKD and structural vascular lesions. A systematic review on the association between IL-6 and CKD concluded that IL-6 is directly related to the progression of CKD, which may be a possible marker of kidney damage to be used both in the diagnosis and in the follow-up of this population. Similarly, it can be speculated that, based on the data from the present study, IL-6 may also be a marker of CI in CKD.A relevant finding was the association of inflammatory markers with MoCA, especially in linear regression, with significant associations of dosages in the increase of pro-inflammatory cytokines IL-6 and IL-17, as well as a statistical trend in TNF-α. The same was did not happen for the anti-inflammatory cytokine IL-4. These findings corroborate those in the literature that report the importance of inflammation in the context of CKD, and the likely involvement of the endothelium and, secondarily, of the blood-brain barrier (BBB) correlate CI in CKD with vascular lesions, especially those located in the white matter, secondary to compromised microcirculation  resulting from this fact, the use of neuroimaging as a diagnostic resource, with emphasis on MRI, which, when compared to CT, has greater sensitivity in the early detection of these lesions, considered specific markers of CI of a vascular nature. Studies correlating white matter lesions or microangiopathies (leukoaraiosis) associated or not with microinfarcts, microbleeds and cortical atrophies with CI are frequent. Differently in the present study, there was no correlation between altered MoCA and MRI findings, as the images were within normal limits or with very subtle alterations, not justifying the CI detected in 51.8% of the patients evaluated. This discrepancy could be explained by the functional nature of these alterations that precede the anatomical ones reported in previous studies. On the other hand, when CI was compared to inflammatory markers, a direct relationship was found with pro-inflammatory cytokines, especially IL-6. These findings suggest the hypothesis of the functional nature of CI in the population evaluated.Numerous publicationsAmong the limitations of the present study is the fact that this is a cross-sectional study, carried out in a single center and with a small sample size. On the other hand, it is worth mentioning as positive points the performance of MRI in all patients, in addition to the dosage of inflammatory markers.. The addition of this tool to the clinical routine of nephrologists may contribute to the early diagnosis of CI and enable the implementation of preventive and therapeutic measures in patients with chronic kidney disease.A fact of clinical relevance was the demonstration of the MoCA usefulness, a simple, easy-to-perform and low-cost tool that can be applied by non-specialized professionalsThe MCI assessed by MoCA was prevalent in patients with pre-dialysis CKD, was associated with inflammatory markers and did not show any correlation with changes seen in the MRI.


For the purposes of the control group, the electronic records of patients treated in the emergency department with a diagnosis of R11.0 (Nausea and vomiting) (n = 53) without an established cause were randomly reviewed. In addition to the main aim, other research outcomes were to determine differences between groups in the following variables: duration of symptoms, family history, birth , birth weight, weight during examination, difference between birth weight and weight during an examination, type of vomiting, the thickness of the muscle wall and its length, and to calculate whether there is a correlation between the thickness and length of the pylorus muscle and the duration of vomiting in relation to variables from acid-base status. Results: In relation to the variables of interest between the groups, statistically significant differences were observed in the duration of symptoms , weight at examination , difference in weight between birth and examination , and type of vomiting . In the acid-base status between the groups, a statistically significant difference was recorded for pH , bicarbonate , total carbon dioxide , base excess , potassium , ionized calcium , and glucose . Regardless of the group, the correlations between the duration of vomiting  and the thickness  and length  of the pylorus muscle in relation to pH did not exist or were weak. Conclusions: In a world where radiological methods are not equally available everywhere, with promising acid-base indicators, prospective multicenter studies and meta-analyses must be pursued in the future in order not to miss the possible much greater diagnostic potential of acid-base status.Background: Hypertrophic pyloric stenosis is a condition in newborns in which the hypertrophic pyloric muscle causes gastric obstructive symptoms of progressive vomiting leading to hypochloremic hypokalemic metabolic alkalosis. The main aim of the research was to assess whether, based on the acid-base status, we can distinguish newborns who vomit due to pylorostenosis, compared with newborns who vomit for other unspecific reasons. Methods: The electronic records of patients in the hospital information system treated under the diagnosis Q40.0  ( If acid-base balance disorders are primarily caused by a change in the extracellular concentration of hydrogen carbonate (HCO3−), we are talking about metabolic acid-base disorders. Vomiting only stomach contents, without contents from the lower parts of the digestive system, leads to the loss of hydrochloric acid (HCl) secreted by the gastric mucosa. The result is the loss of acid from the extracellular fluid and the development of metabolic alkalosis. This type of alkalosis is primarily specific to newborns with hypertrophic pyloric stenosis. Treatment of metabolic alkalosis requires suppression of the primary cause of vomiting itself and compensation of sodium, potassium, and chloride deficits, which enables the optimal functioning of the renal corrective mechanisms. Just by giving a sodium chloride (NaCl) solution in which sodium and chloride are in an equivalent ratio, we introduce a relative excess of chloride into the body, which pushes hydrogen carbonate out of the anion column of the ionogram and corrects alkalosis [Regulation of the balance of hydrogen ions  were reviewed retrospectively. The search included all patients who were treated at the Children’s Hospital Zagreb with a diagnosis of Q40.0  in the period from 1 January 2014 to 1 January 2022. The inclusion criterion was all patients who underwent surgery in whom the diagnosis was confirmed during the surgery, and the exclusion criterion was the lack of data for analysis. All operations were performed using an open surgical technique . For the purposes of the control group, the electronic records of patients treated in the emergency department of the Children’s Hospital Zagreb with a diagnosis of R11.0 without an established cause  were also randomly reviewed in such a way that they were comparable in terms of gender and ages with group Q40.0. In this group, patients older than three months and patients who lacked the necessary data for analysis were excluded.For the purpose of the research, electronic records of patients in the hospital information system ; duration of symptoms; birth before, at, or after term; birth weight, weight at the examination, and their difference; and type of vomiting were recorded for each patient. In the Q40.0 group, the thickness of the pyloric muscle and its length were also recorded. Regarding the acid-base status, the values of the following variables were recorded: pH, pCO® 500 Systems . Abdominal ultrasound with a targeted examination of the pyloric region was performed by one of the five radiologists who participated in the diagnosis of this condition in the past 8 years. If the first ultrasound finding was not clear due to artifacts , it was repeated (sometimes twice) within 24 h, until the final thickness and length of the pyloric muscle were determined with great certainty. All ultrasound examinations were performed on a Logiq E9® device .The acid-base status of the patients was measured from capillary blood after a sample was taken professionally by a laboratory technician. In all patients, capillary blood was taken within 3 h of the examination. Blood was analyzed on RAPIDPointThe main outcome of the study was to determine whether the values from the acid-base status, regardless of the ultrasound performed, can suggest that a patient is a newborn with hypertrophic pyloric stenosis rather than a newborn who is vomiting for some other unspecified reason. The secondary outcomes of the study were to determine at what age parents brought newborns with symptoms of hypertrophic pyloric stenosis; whether there was an association with family history; whether the newborns were born before or at term; duration of symptoms; birth weight and weight at clinical examination, and the difference in weight in the same period; whether explosive vomiting dominated in relation to regurgitation; the thickness of the muscle wall and its length; and, in addition, to calculate whether there is a correlation between the thickness of the pylorus muscle and the duration of vomiting in relation to variables from acid-base status.t-test or Mann–Whitney U test as appropriate. In order to calculate the correlation, Pearson’s or Spearman’s correlation coefficient was calculated, depending on the distribution normality, and the results were interpreted according to the following intervals: 0–±0.25 ↔ no correlation, ±0.26–±0.50 ↔ weak correlation, ±0.51–±0.75 ↔ good correlation, ±0.76–±1 ↔ excellent correlation. A multiple regression analysis was also performed for the data of interest. The obtained data were analyzed using the Microsoft Excel® software program (XLSTAT®) for Windows, version 2020.5.1 . A significance level of 0.05 was used.Descriptive statistics were used to characterize the patient cohort. Collected measurements were analyzed for normal distribution using the Shapiro–Wilk test. Categorical variables were expressed in absolute numbers and percentages. Fisher’s exact test was used to assess differences in the distribution of categorical data. Continuous variables were expressed as mean with standard deviation (SD) and median (Mdn) with interquartile range (IQR) and were analyzed using the Student’s p = 1.000) and age (p = 0.674) were randomly selected.During the selected period, a total of 69 newborns with a diagnosis of hypertrophic pyloric stenosis (Q40.0) were surgically treated at the Children’s Hospital Zagreb. Complete documentation for all variables of interest was missing in 16 patients, and thus a total of 53 patients were included in the study. For the control group, 53 patients (R11.0) comparable in terms of gender  male and 12 (22.64%) female children were surgically treated. The median age at which children presented to the emergency department with symptoms of hypertrophic pyloric stenosis was 31  days. Only one patient (1.89%) had information in the family history stating that one of the parents also had pyloric stenosis. Five children (9.43%) were born before term, whereas forty-eight (90.57%) were born at term. The median duration of symptoms was 4  days. The mean birth weight was 3506 (±558) g, and the mean weight at examination was 3880 (±601) g. The mean difference in weight from birth to examination was 374 (±568) g. Forty-five (84.91%) children presented with explosive vomiting, and eight (15.09%) with regurgitation. The mean thickness of the pyloric muscle was 4.857 (±0.879) mm, whereas the median was 4.9  mm. The mean muscle length was 17.317 (±3.809) mm, whereas the median was 17 .In the randomly selected patients who made up this group, there were also 41 (77.36%) male and 12 (22.64%) female children. The median age at which children presented to the emergency department with symptoms of vomiting without an identified cause was 35  days. None of the patients had information about hypertrophic pyloric stenosis in their family history. Six children (11.32%) were born before term, whereas forty-seven (88.68%) were born at term. The median duration of symptoms was 2  days. The mean birth weight was 3428 (±525) g, whereas the mean weight at examination was 4439 (±1025) g. The mean difference in weight from birth to examination was 1010 (±858) g. Thirty-one (58.49%) children presented with regurgitation, whereas twenty-two (41.51%) presented with explosive vomiting.According to the previously mentioned variables, statistically significant differences were observed in family history, duration of symptoms, weight at examination, the difference in weight between birth and examination, and type of vomiting .3), total carbon dioxide (CO2), base excess (BE), potassium (K+), ionized calcium (Ca2+), and glucose  (p = 0.311) , muscle thickness ↔ HCO3 , muscle thickness ↔ total CO2 , muscle thickness ↔ BE , muscle thickness ↔ potassium , muscle thickness ↔ sodium , muscle thickness ↔ chloride , muscle thickness ↔ ionized calcium .The correlation values of interest were as follows: muscle thickness ↔ pH  a, muscle= 0.311) b, musclep = 0.005) and potassium  proved to be the most influential variables.In relation to the previous parameters, multiple regression analysis determined that 33% of the dependent variable (muscle thickness) was explained by nine explanatory variables. Among the explanatory variables, based on the sum of squares type III, sodium  , ↔ HCO3 , ↔ total CO2 , ↔ BE , ↔ potassium , ↔ sodium , ↔ chloride , ↔ ionized calcium . In relation to the previous parameters, through multiple regression analysis, it was determined that 47% of the dependent variable (the duration of vomiting) was explained by nine explanatory variables. Among the explanatory variables, based on the sum of squares of type III, sodium  and potassium  proved to be the most influential variables.The correlations of values from acid-base status and duration of vomiting in the pylorostenosis group were as follows: ↔ pH  a, ↔ pCO2p = 0.290) , ↔ HCO3 , ↔ total CO2 , ↔ BE , ↔ potassium , ↔ sodium , ↔ chloride , ↔ ionized calcium . In relation to the previous parameters, through multiple regression analysis, it was determined that 25% of the dependent variable (the duration of vomiting) was explained by nine explanatory variables. Among the explanatory variables, based on the sum of squares of type III, ionized calcium  proved to be the most influential variable.The correlations of values from acid-base status and duration of vomiting in the control group were as follows: ↔ pH  b, pCO2 , who were older with longer duration of symptoms at the time of presentation to the health facility. All parameters except urea were associated with the duration of symptoms. As the duration of symptoms increased, sodium, potassium, and chloride levels tended to decrease, whereas base excess, bicarbonate, and carbon dioxide tended to increase [p > 0.05). An interesting indicator was that in the normacidemic group no one had hypokalemia, whereas in the alkalemic group 15% of patients were hypokalemic (<3.5 mmol/L). For the above reason, the authors concluded that the use of sodium chloride is the mainstay of therapy, but in more severe cases, potassium supplementation is also needed. Two years after the previous study, Shanbhogue et al. [p < 0.05) between the degree of initial biochemical disturbance and the rate at which correction occurs if we stick to a certain protocol. The markers with the highest correlation and significance were chloride, urea, and base excess (p < 0.01).In a study by Al-Jazaeri et al. , patientincrease . A studyincrease  aimed toe et al. , in addie et al. , most ofe et al. ,31, resee et al.  found thp < 0.0001), and sex (p = 0.006). When the mentioned variables were put into a logistic regression with pyloric stenosis as the dominant variable, the variables of significance were pH (p = 0.0001), base excess (p = 0.0001), and chloride (p = 0.009). Based on these variables, a model was created to predict pyloric stenosis  with a specificity of 99%, a sensitivity of 40%, a positive predictive value of 88%, and a negative predictive value of 78% if all three variables were present. If two variables were present, the specificity was 98%, and the sensitivity was 65%, whereas with one variable, the specificity was 84%, and the sensitivity was 83%. There is no doubt that the sensitivity and specificity of ultrasound as the gold standard in the diagnosis of hypertrophic pyloric stenosis exceeds these values [2 in both groups and a statistically significant decrease in potassium in the pylorostenosis group.The only study similar to ours was undertaken by Oakley et al.  more thae values ,33. ExceIn the developed world, the acid-base status in a child with hypertrophic pyloric stenosis has started to be understood less and less as a possible diagnostic tool for pyloric stenosis itself, but primarily serves as an indicator of biochemical variables that should be corrected if there is a deviation, all in order to avoid depression of the respiratory center and apnea during and after the operation itself, especially if the child was hyperventilated during anesthesia ,35. RadiThe study has limitations primarily in the size of the patient sample. The reason for the small sample comes from the fact of the low incidence of hypertrophic pyloric stenosis and the fact that the study included one tertiary center. In addition, the study is retrospective, which means that certain useful indicators, which were not adequately recorded, were lost . Furthermore, an ultrasound was performed by several radiologists during the observed period. The results would certainly be more valid if the ultrasound was performed by a single radiologist.Given that we have determined that there is a statistically significant difference in certain acid-base variables, such as pH, bicarbonate, total carbon dioxide, base excess, potassium, ionized calcium, and glucose, and in the context of variables such as family history, duration of symptoms, weight at an examination, the difference in weight between birth and examination, and type of vomiting, there is no doubt that the diagnostic potential of acid-base status exists, especially considering the fact that in many parts of the world ultrasound and radiologists are still not widely available. Additional prospective multicenter studies and meta-analyses will certainly be needed to confirm our conclusion more firmly in the future.