To facilitate the early detection of chronic diseases, we analyzed the clinical characteristics of anti‐gastric parietal cell antibody (PCA)‐positive population, revealed the early characteristics of the population.According to the retrospective analysis, current situation investigation and comparative analysis of the clinical characteristics and medical history of the subjects, the comparison between the groups was performed.(a) The positive rate of PCA detection in department of gastroenterology in our hospital was 35.80%. Among the individuals who underwent PCA, esophagogastroduodenoscopy (EGD) and pathological examination at the same time, 33.59% of the patients with PCA positive were diagnosed as atrophic gastritis by gastroscopy, which was much higher than 9.09% of the patients with PCA negative. (b) The incidence of gastroesophageal reflux, hypertension, ischemic heart disease (IHD) and cerebral ischemia in PCA‐positive population were 65.45%, 81.63%, 15.43%, and 31.61%, respectively, which were significantly higher than those in the control group. (c) The incidence rates of decreased red blood cells (RBC) and increased homocysteine (HCY) in laboratory‐related tests were 38.30% and 69.15%, respectively, which were much higher than those in control group.PCA has predictive value for a variety of chronic diseases and timely detection is of great significance. Due to the lack of effective diagnosis and treatment, the rate of misdiagnosis and missed diagnosis is also high. It has been reported that the misdiagnosis rate of disease such as inflammatory bowel disease in China is 36.8% and the missed diagnosis rate is as high as 60.9%.+/K+‐ATP enzyme and gastrin receptor on the surface of gastric parietal cells.12 and folic acid. Vitamin B12 is a methyltransferase cofactor and an important material basis for the methylation of many substances and the redox reaction in vivo. It is involved in the metabolism of many important substances. The decrease in gastric acid secretion prevents the reduction of Fe3+ to Fe2+ in food. Hemoglobin synthesis disorder leads to iron deficiency anemia. Lack of vitamin B12 and endocrine factors lead to obstruction of nucleic acid synthesis and cell mitosis, which eventually lead to pernicious anemia. When vitamin B12 is deficient, the methionine circulation is blocked, and HCY cannot be converted into methionine and excreted out of the body, which results in the increase of plasma HCY level and eventually leads to H‐type hypertension. Vitamin B12 deficiency can also affect the metabolism of choline, epinephrine, norepinephrine, and other non‐nutrients, and secondary to a variety of diseases. Therefore, PCA is the initiator of many chronic diseases and exists in the serum of patients before symptoms appear. Early detection is of great significance for the prevention and treatment of many chronic diseases.Parietal cell antibody (PCA) is an important member of autoantibody family. PCA is an immunoglobulin secreted by plasma cells against H22.1PCA‐positive group: In the past 5 years, PCA was detected in 6269 patients in the department of gastroenterology, with an average age of 57 ± 14 (age range 29‐82), including 2780 males and 3489 females, male: female = 1:1.26. The standard for admission was the occurrence of one or more digestive system symptoms such as nausea, vomiting, anorexia, acid reflux, belching, abdominal pain, and abdominal distention and one or more digestive system diseases. Those who are positive for PCA are the positive group. The study was approved by the Ethics Committee of Baoding NO.1 central hospitals (IRB: [2019]011), and informed consent was acquired from each individual.PCA‐negative group: According to the age and sex composition of the above group objects, 400 PCA‐negative patients were stratified sampling, with an average age was 56 ± 12 (age range 27‐81), including 180 males and 220 females, male: female = 1:1.22. The standard for admission was the occurrence of one or more digestive system symptoms such as nausea, vomiting, anorexia, acid reflux, belching, abdominal pain, and abdominal distention and one or more digestive system diseases.Physical examination group: According to the age and sex composition of the above group objects, 400 cases of physical examination population were stratified sampling to detect PCA, with an average age was 55 ± 11 (age range 29‐80), including 195 males and 205 females, male:female = 1:1.05.There was no significant difference in the baseline characteristics of age and sex among the three groups.2.22.2.1The medical records of patients with PCA results were collected and analyzed from January 2015 to June 2019, and the clinical characteristics and medical history of PCA‐positive patients were retrospectively analyzed and investigated, which compared with the control group.2.2.2Parietal cell antibody was detected in venous serum by indirect immunofluorescence assay and operated strictly in accordance with the standard operating procedures. We took double–blind reading. The titer of PCA > 100 was positive.2.2.312/L; female: 3.5‐5.0 × 1012/L. The criteria of Hcy increase is serum Hcy ≥ 15 umol/L in fasting state. Gastroesophageal reflux: Gastroesophageal reflux disease and esophageal mucosal damage caused by excessive contact (or exposure) of gastric juice in gastroesophageal lumen. Cerebral ischemia: A syndrome in which the blood supply of the brain is insufficient to meet the metabolic needs of the brain, resulting in a series of symptoms. Ischemic heart disease (IHD): The disease is caused by plaque building up along the inner walls of the arteries of the heart, which narrows the lumen of arteries and reduces blood flow to the heart.Diagnostic criteria of essential hypertension according to ”Guidelines for Prevention and treatment of Hypertension in China 2010”: Blood pressure was measured three times in different days, systolic blood pressure ≥18.62 kpa (140 mm Hg), and/or diastolic blood pressure ≥11.97 kpa (90 mm Hg).The criteria for the decrease in red blood cells: male: 4.0‐5.5 × 102.2.4The qualitative indexes in logistic regression model were age, AIG, gastroesophageal reflux, coronary heart disease, cerebral ischemia, and sex. The quantitative indexes are blood pressure, RBC, and HCY value. According to the abovementioned criteria, the quantitative index is transformed into qualitative index.A binary logistic regression analysis model is constructed to explore the relationship between AIG and related indicators. We describe the dependent variable as AIG and the independent variable as PCA, age, gastroesophageal reflux, hypertension, coronary heart disease, cerebral ischemia, decreased RBC, increased HCY, and gender.P < .01. The counting data of between groups were compared by chi‐square test.Statistical analysis was performed using SPSS version 19.0 software (IBM Corp.). The difference was statistically significant with 33.1χ2 = 100.53, P < .01, , of which 1015 were male and 1228 were female, male: female = 1:1.21. PCA‐positive rate was 11.25% (45/400) in 400 healthy people, which was much lower than that in the visiting population, 3.2χ2 = 278.15, P < .01. The accurate diagnosis rate of AIG in PCA‐positive population was much higher than that in PCA‐negative population. Among the PCA‐positive people, 615 cases were not diagnosed as AIG by EGD, accounting for 615/926 = 66.41%, and there were potential factors for the development of AIG in this population , of which 926 were positive for PCA and 2091 were negative. Of 926 PCA‐positive cases, 311 were diagnosed as atrophic gastritis by EGD, accounting for 311/926 = 33.59%; Of 2091 PCA‐positive cases, 190 were diagnosed as atrophic gastritis by EGD, accounting for 190/2091 = 9.09%. There was a significant difference between them, 3.3A retrospective analysis of clinical data of 2243 PCA‐positive people revealed that the incidence of gastroesophageal reflux was higher, accounting for 1468/2243 = 65.45%; medical history of cerebrovascular diseases such as hypertension, IHD, and cerebral ischemia accounted for a higher proportion, 1831/2243 = 81.63%, 346/2243 = 15.43%, and 709/2243 = 31.61%, respectively, which was significantly higher than that of negative and physical examination control groups. The proportion of gastroesophageal reflux, hypertension, IHD, and cerebral ischemia in the negative group was significantly higher than that in the physical examination group (Table 3.4According to the investigation and analysis of blood routine test, liver function, and kidney function test items in 2243 PCA‐positive people, it was found that the decrease in RBC and the increase in HCY were 792/2243 = 35.31% and 1551/2243 = 69.15%, respectively, which were significantly higher than those in the negative control and physical examination group (Table 3.5χ2 = 211.492, P < .001. The model can correctly classify 95.3% of the research objects. The sensitivity of the model is 59.1% and the specificity is 95.3%. The analysis in the model showed that if PCA was positive, the risk of AIG increased by 18.521 times. These results suggest that PCA is an independent risk factor for AIG (Table Binary Logistic regression was used to assess the relationship between AIG and PCA, age, AIG, gastroesophageal reflux, hypertension, IHD, cerebral ischemia, decreased RBC, increased HCY, and gender. Finally, the logistic regression model is statistically significant, 4The incidence of chronic gastritis in China is as high as 60%.In our study, the standard for admission was the occurrence of one or more digestive system symptoms in the population, so the current study did not analyze the common digestive system symptoms such as nausea, vomiting, anorexia, acid reflux, belching, abdominal pain, and abdominal distention. However, the incidence of gastroesophageal reflux is as high as 65.45%, which should cause high vigilance. This may be related to the abnormal peristalsis caused by hardening, inflammation, ulcer, and even atrophy of gastric body caused by PCA.In our study, we found that the proportion of increased HCY in PCA‐positive population was as high as 69.15%, and the proportion of cardio‐cerebral vascular disease such as hypertension was also higher. The main mechanism of this phenomenon is that PCA damages gastric parietal cells, resulting in the decrease of hydrochloric acid endocrine factors, vitamin B12 absorption barrier, methionine circulation obstruction, so that HCY cannot be converted into methionine and excreted out of the body, which accumulates in the blood stream and causes hyper HCY.3+ in food cannot be reduced to Fe2+, which can be absorbed by the body. It affects the synthesis of hemoglobin and leads to iron deficiency anemia; secondly, the decrease of gastric parietal cells leads to the decrease of endocrine factors secretion and absorption disorder of vitamin B12, which leads to the decrease of tetrahydrofolate synthesis, the disorder of nucleic acid synthesis, the obstruction of cell division, and finally formation of megaloblastic anemia. As the disease progresses, a large number of glands begin to atrophy, and a variety of nutrients are mal absorbed. Erythropoiesis is further affected, and a vicious cycle is formed.12 for life.12 has been deficient for many years before the occurrence of pernicious anemia.12 to reduce the titer of PCA and alleviate related diseases.12 is strongly correlated with the titer of PCA. In this survey, the percentage of decreased RBC in PCA‐positive population is much higher than that in control group, which deserves great attention.Gastrointestinal diseases can induce anemia through different mechanisms.We should attach great importance to gastropathy, and the role of stomach as the first pass of human metabolism is very important. In this study, many kinds of chronic diseases caused by injury of digestive function that PCA induced were discussed and analyzed from the aspects of theoretical basis and clinical practice. We found that PCA is closely related to gastritis, especially type A atrophic gastritis, gastroesophageal reflux, and other digestive system diseases, as well as H‐type hypertension, iron deficiency anemia, megaloblastic anemia, pernicious anemia, and other chronic diseases. The relationship between AIG and PCA was discussed by logistic regression analysis, and it was found that PCA was an independent risk factor for AIG. PCA appears in the serum of patients earlier than clinical symptoms, and early detection is of great value for early warning of a variety of chronic diseases. The detection of APC has little trauma and is widely used in clinic.The limitation of this study is that there is no longitudinal follow‐up survey of PCA‐positive people. In this study, we found that most of the PCA‐positive people could not be diagnosed as AIG by gastroscopy. This part of the population may develop into AIG as the disease progresses, which belongs to the potential population and needs further study.


Posterior reversible encephalopathy syndrome (PRES), also known as reversible posterior leukoencephalopathy syndrome, is a neurological entity characterized by acute change in consciousness, visual impairment, headache, and seizures. It is associated with autoimmune disease, immunosuppressive agents, organ transplantation, acute glomerulonephritis, and sepsis. Typically, vasogenic edema is seen in the white matter of parieto-occipital lobes but can also involve atypical locations such as frontal lobes, thalamus, basal ganglia, and gray matter. While occurring extensively in adults, few cases, especially recurrent episodes, have been described in children. We report a case of recurrent PRES in a 17-year-old boy with end-stage renal disease on a peritoneal dialysis program who initially presented with hypertension and seizures. He emergently received intravenous antihypertensive medication with immediate and sustained improvement in his mental status. Information about recurrent PRES in children is limited because it is not commonly seen. We examine the clinical features of PRES and highlight important points for the diagnosis and management of this rare syndrome. This report demonstrates the importance of pediatricians to consider PRES in the differential diagnosis in children presenting with acute altered mental status. Blood pressure measurements, which are often overlooked in pediatric care, may assist in correctly diagnosing patients. Posterior reversible encephalopathy syndrome is a clinical-radiological condition with various etiologies that was first described in 1996 by Hinchey and his colleagues . AlthougTwo days before visiting our hospital, a 17-year-old boy with end-stage renal disease had intermittent headaches and nausea. However, given improvement with acetaminophen, his parents did not believe he was ill. Soon after, he experienced consciousness disturbance and presented to the emergency department with a whole-body tonic-clonic seizure for fifteen minutes. The patient had no prior history of seizures.2 using the Modification of Diet in Renal Disease Study equation. He had been on nightly peritoneal dialysis since his diagnosis. He was instructed to limit his daily intake of fluid to two liters, sodium to two grams, and phosphorus to one gram. Prior to arrival, he was receiving extended-release nifedipine, clonidine patch, furosemide, calcitriol, ergocalciferol, sevelamer carbonate, calcium carbonate, iron, and erythropoietin therapy. Further investigation with his parents revealed that the patient was not compliant with his medications or his daily fluid restriction.He was initially diagnosed with anemia and chronic renal failure due to bilateral renal hypoplasia at 15 years of age. His glomerular filtration rate at the time of diagnosis was estimated to be 2 ml/min per 1.73 mOn clinical examination, his vital signs revealed a temperature of 36.7°C, heart rate of 77 beats/min, respiratory rate of 25 breaths/min, and blood pressure of 210/120 mmHg. He required oxygen therapy to achieve oxygen saturation of 95%. The physical examination revealed a patient who was somnolent and incoherent, although neurologic exam  was without focal deficits. Fundoscopic examination was normal and revealed no sign of optic disc edema. He had a peritoneal dialysis catheter secured to his abdomen.2. Urinary testing indicated 2+ protein, which was unchanged from his prior testing. There were no other remarkable laboratory parameters on blood and urinary testing. Cranial computed tomography revealed minimal scattered hemorrhage in areas of edema in bilateral parietal and occipital lobes  on arrival, and his physical examination including fundoscopy was normal. His blood urea nitrogen and creatinine concentrations were high, similar to his prior values. A repeat cranial computed tomography revealed no additional findings compared to his prior imaging. He did not require mechanical ventilation. As his findings were suggestive of recurrent PRES, he was transferred to the intensive care unit on a continuous infusion of nicardipine. He did not have any more seizures and his drowsiness improved overnight. The patient remained on the continuous infusion for one day, and after his blood pressure stabilized, he was monitored closely on furosemide, a higher dose of clonidine patch, and a higher dose of extended-release nifedipine for four days. He was continued on his nightly peritoneal dialysis. The patient was discharged on the fifth day of hospitalization with higher doses of his antihypertensive medications and no anticonvulsants.Our case describes an adolescent boy with end-stage renal disease (ESRD) on a peritoneal dialysis program due to bilateral renal hypoplasia diagnosed two years prior, who was hospitalized twice for PRES within one week. We briefly review the implications of hypertension in ESRD, address crucial principles in the diagnosis and management of PRES, and highlight the importance of frequent follow-up to monitor for recurrence of PRES in children.Chronic kidney disease (CKD) and ESRD are catabolic states associated with progressive glomeruli and nephron destruction, which cause extracellular fluid overload and sodium retention. Renal scarring and regional ischemia cause increased response in the renin-angiotensin system and overactivity of the sympathetic system, which increases renin and angiotensin II release . Angioteth percentile to be evaluated with a complete blood cell count, urinalysis, serum urea nitrogen level, serum creatinine level, electrolytes, and renal ultrasonography because other renal disorders may cause hypertension. If no other etiology is evident, serum renin level, serum aldosterone level, serum plasma steroid levels, thyroid studies, serum metanephrines, and urine metanephrines should be obtained [Our patient was diagnosed with renal hypoplasia based on renal ultrasonography two years prior to his diagnosis of PRES. There is currently no consensus on the evaluation of hypertension in children discovered to have renal hypodysplasia. However, we recommend all children with persistent blood pressure above the 95obtained . Renal uAdequate volume control is crucial in the treatment of hypertension in children on dialysis, and antihypertensive medications should be considered if control of blood pressure remains poor. Salt-restricted diet (<2 grams/day) and fluid restriction (<2 liters/day) are often utilized. Loop diuretics are the diuretic class of choice in patients with ESRD. Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs) are recommended because they decrease proteinuria and slow the progression of disease , 8. Howeth percentile led to slower progression of CKD compared to standard targets of 50th to 90th percentile [th percentile in children with CKD stages II–IV [th percentile for gender, age, and height in children on dialysis to avoid complications.There is no consensus on recommended target blood pressure in children on dialysis. The ESCAPE trial in 2009 showed that intensified blood pressure management in children with CKD and hypertension receiving ramipril with target blood pressure less than the 50rcentile . As a rees II–IV . We recoPosterior reversible encephalopathy syndrome is a condition characterized by seizures, headache, nausea, vomiting, mental status changes, and visual disturbances associated with transient vasogenic edema seen on neuroimaging. Children with renal diseases and transplants are at the highest risk due to sudden increases in blood pressure. The estimated incidence of PRES in children with renal diseases is between 4% and 9%, although some patients may develop PRES without clinical seizures , 12, 13.PRES is commonly seen in children who are on immunosuppressive therapy for hemato-oncological diseases such as leukemia, lymphoma, aplastic anemia, lymphohistiocytosis, autoimmune lymphoproliferative syndrome, and Evans syndrome , 18. PREVasogenic cerebral edema is the primary feature seen in PRES. Currently, there are three theories regarding the etiology of the edema. The first theory centers around the autoregulatory failure of cerebral blood flow due to severe hyperperfusion. When the mean arterial pressure acutely exceeds the upper limit of autoregulation, hyperperfusion leads to interstitial hydrostatic edema , 23, 24.There are currently no guidelines for the diagnosis of PRES. Seizures are the most common presentation, with the majority presenting as generalized tonic-clonic seizures. Other symptoms include altered mental status, lethargy, severe headache, nausea, vomiting, and vision impairment. Ophthalmological symptoms may include visual blurring, scotomas, hemianopsia, and cortical blindness . Focal nMagnetic resonance imaging (MRI) is considered the gold standard to diagnose PRES. Edema is classically seen in the white matter of the parieto-occipital regions bilaterally , 2. T2-wIn addition to vasogenic edema, the presence of hemorrhage and contrast enhancement on MRI has been described in literature , 16. PrePrompt recognition of PRES and initiation of therapy are important to prevent serious neurological sequelae. The management includes regulation of blood pressure, treatment of seizures, and elimination of causative medications. After cerebral hemorrhage and infarction are ruled out, blood pressure should be lowered by no more than 25% within the first hour of presentation, followed by a slower reduction afterward . We recoMost symptoms of PRES develop abruptly, and clinical resolution is typically achieved within a few days with prompt supportive management. The prevalence of PRES specifically in children with kidney disease is not established. Previous reports have documented PRES in children with ESRD and Henoch-Schönlein purpura , 32. LimThere is debate whether PRES is truly reversible, as complications including intracranial hemorrhage and permanent neurologic sequelae have been reported , 3. UnleThe precise incidence of PRES in pediatric patients with kidney disease remains poorly established. Children with PRES and kidney disease are at higher risk for developmental delay, chronic imaging abnormalities with neurologic impairment, epilepsy, and recurrence of PRES , 13, 25.Posterior reversible encephalopathy syndrome is rare in the pediatric population. The condition should be in the differential diagnosis for any patient with known malignancy, autoimmune disease, kidney disease, or organ transplantation who presents with hypertension, neurological symptoms, and disturbance of consciousness. Head MRI investigation often reveals edema in the subcortical white matter of the posterior portion of the cerebral hemispheres. Rigorous control of hypertension, seizures, and blood concentrations of calcineurin inhibitors are important strategies in managing PRES and preventing recurrence. We report a rare case of recurrent PRES in a child with end-stage renal disease on a peritoneal dialysis program. Further advances with MRI are required to understand the pathophysiology of this condition, improve diagnostic accuracy, and predict outcomes in patients with recurrent PRES. Further research is necessary to investigate factors considered to trigger the development of recurrent PRES in children.


Preeclampsia is a multifactorial pregnancy-specific syndrome, which can result in significant alterations in cardiovascular hemodynamics. We report an observation of unexpected relative bradycardia in a previously healthy woman who presented with postpartum preeclampsia and acute pulmonary edema. We observed an increase in heart rate following normalization of blood pressure, which suggested that the initial slower than expected heart rate may reflect a baroreceptor response to hypertension. Whether this finding should be regarded as a severe aspect of the disease spectrum needs further study. Preeclampsia is a pregnancy-related condition characterized by new-onset hypertension with proteinuria and/or variable end-organ dysfunction. It is associated with significant alterations in cardiovascular physiology, often including endothelial dysfunction, and may lead to acute pulmonary edema -3.Bradycardia, usually of modest-to-moderate severity given the clinical presentation, has been reported as a rare feature of preeclampsia; its mechanism, however, has generally been considered to be unknown ,5. The cA previously healthy 34-year-old female presented to the emergency department (ED) with a three-day history of progressive shortness of breath. She had an uncomplicated spontaneous vaginal delivery four days back. Review of systems was remarkable for bilateral leg swelling, paroxysmal nocturnal dyspnea, orthopnea, and headache for the past one day. She had no significant medical illness in the past, in particular no preeclampsia or heart failure with her two prior pregnancies.In the ED, her temperature was 98.4 °F; respiratory rate, 20 breaths/min; blood pressure, 176/88 mmHg; and pulse rate, 60-64 beats/min. Her initial oxygen saturation was 88% on room air. Physical examination was remarkable for jugular venous distention, fine crackles on chest auscultation, and 2+ symmetrical edema of lower extremities which were warm to the touch. Complete blood count revealed mild anemia but was otherwise unremarkable. The basic metabolic panel was within the normal range. She had low serum albumin of 2.4 g/dL and positive proteinuria. The liver function test was notable for a total bilirubin of 0.1 mg/dL , alkaline phosphatase of 94 IU/L , aspartate aminotransferase 69 IU/L , alanine aminotransferase 68 IU/L . N-terminal pro-B-type natriuretic peptide (NT-proBNP) was 1,411 pg/mL ; and troponin I, 0.018 ng/mL . Electrocardiography demonstrated normal sinus rhythm with a ventricular rate of 65 bpm with no ST-T segment abnormality . Her follow-up TTE revealed an ejection fraction of 0.55 with normal estimated RAP and IVC diameter.The principal observation in this report is the potential for unexpected sinus bradycardia to be a presenting feature of preeclampsia, despite severe associated clinical findings. In this case, the combination of relative sinus bradycardia in conjunction with hypertension and acute pulmonary edema and oxygen desaturation in an otherwise young woman was deemed inappropriate. Potentially, the decreased heart rate was a reflex response to elevated blood pressure, as it normalized with treatment Table  and the Preeclampsia with severe features can be diagnosed in pregnant women with blood pressure ≥ 160/110 who have at least one of multisystemic signs, including renal dysfunction, elevated serum transaminases, pulmonary edema, thrombocytopenia, and new-onset cerebral or visual disturbances , diagnosPathophysiology of preeclampsiaAlthough the pathophysiology of preeclampsia is not fully understood, it is a complex disorder deemed due to placental insufficiency. It is speculated that the placenta, in response to impaired perfusion, produces proinflammatory molecules that result in maternal endothelial dysfunction . FurtherPreeclampsia is known to cause pulmonary edema as a result of increased intravascular hydrostatic pressure due to elevated blood pressure, decreased plasma oncotic pressure from hypoalbuminemia, increased capillary permeability related to endothelial dysfunction, and left ventricular diastolic dysfunction in the setting of increased cardiac afterload ,6,9. IntBradycardiaThe mechanism of bradycardia in preeclampsia is unknown ,5. Our pIn conclusion, relative bradycardia in the context of preeclampsia, especially given its multiple attendant complications, is unexpected. Its clinical significance is yet to be determined. Our observation suggests that the slower than expected heart rate may reflect a baroreceptor response to hypertension, which becomes apparent only in a subset of affected preeclamptic patients.


Dehydration risk increases with frailty and functional dependency, but a limited number of studies have evaluated this association in hospitalized geriatric patients. This cross-sectional study aimed to assess the prevalence and determinants of dehydration in patients admitted to the geriatric ward. Dehydration was diagnosed when calculated osmolarity was above 295 mMol/L. Logistic regression analyses (direct and stepwise backward) were used to assess determinants of impending dehydration. 358 of 416 hospitalized patients (86.1%) were included: 274 (76.5%) women, and 309 (86.4%) 75+ year-old. Dehydration was diagnosed in 209 (58.4%) cases. Significantly higher odds for impending dehydration were observed only for chronic kidney disease with trends for diabetes and procognitive medication when controlling for several health, biochemical, and nutritional parameters and medications. After adjusting for “dementia” the negative effect of “taking procognitive medications” became a significant one. Chronic kidney disease, diabetes, taking procognitive medications and hypertension were the main variables for the outcome prediction according to the stepwise backward regression analysis. This may indicate an additional benefit of reducing the risk of dehydration when using procognitive drugs in older patients with dementia. Different factors make older people especially prone to dehydration, and old age is pointed as an important determinant of inadequate hydration in hospitalized patients ,2. Very Inadequate hydration can contribute to increased morbidity in older adults. Unfavorable consequences of dehydration include, among others, the increased risk of delirium ,8, aspirAlthough serum osmolality measured with the use of standardized analytic procedures, with a cut-off of 301 ± 5 mmol/kg possessing the best diagnostic accuracy, is likely to be the best indicator of static dehydration , its dirAlthough it is indicated that dehydration risk increases with frailty and functional dependency, there is a limited number of research studies that evaluate this association in hospitalized older adults. Thus, the aim of this study was to examine the prevalence of impending dehydration  in patients admitted to the geriatric ward, and its association with health and functional ability characteristics, as well as with patients’ frailty status. + + K+) + 1.15 × glucose + urea + 14; each component measured in mmol/L) [Data collected during the cross-sectional study on frailty and multimorbidity in patients of the Department of Geriatrics  ,23 were  mmol/L) . Database included information on patient’s age, gender, place of residence, history of hospitalizations and incidents of falls in the previous year, prevalence of 15 chronic diseases , and medications taken before hospitalization. The ability to perform activities of daily living (ADL) was assessed with the Barthel Index  and 6 inImpending low-intake dehydration was diagnosed if the calculated osmolarity was above 295 mMol/L (“dehydration+” group) . Patient2 was used as the criterion of the chronic kidney disease (CKD). POMA score <19 was treated as suggestive for the high risk of falls. Sarcopenia was diagnosed in men if grip strength was lower than 27 kg, and in women if it was lower than 16 kg [Hyponatremia was diagnosed if serum sodium was below 135 mmol/L, and hypernatremia if it was above 145 mmol/L. The score of 6 or 7 of CFS was classified as severe frailty. Serum albumin <35 g/L, and MNA-SF score below 8 pointed to malnutrition. Abdominal obesity was defined as a waist circumference value above 0.90 m for men and above 0.85 m for women. If the active standing test in the first or the third minute showed a drop in systolic pressure (at least by 20 mm Hg) and/or in diastolic pressure (at least by 10 mmHg), orthostatic hypotension was diagnosed. If the serum hemoglobin was below 8.7 mmol/L in men and below 7.5 mmol/L in women, anemia was diagnosed. GFR <60 mL/min/1.73 mt-test for independent samples and Mann–Whitney U test were used to compare means and medians. Odds ratios with 95% confidence interval (CI) and p value were estimated by multivariable logistic regression methods (direct and stepwise backward) with impending dehydration as outcome variable. Dehydration predictors with a p value lower than 0.1, without those highly correlated to avoid multicollinearity effect, were included. In all analyses, a two-tailed p value of less than 0.05 was regarded as significant. Analyses did not include missing data.Analyses were done with IBM SPSS Version 18 Software suit . Variables’ distribution was checked with Shapiro–Wilk tests. They were presented as frequency and percentage , as means and standard deviation , or as medians and interquartile range . Proportions were compared using χ2 tests, while the Student’s The source study was approved by the Ethics Committee at Medical University of Bialystok (no R-I-002/305/2013). All the procedures performed in the study were in accordance with the ethical standards of the Medical University of Bialystok research committee and with the Helsinki declaration and its later amendments. The study can be classified as a study of ‘usual practice’. All study participants gave their informed consent to participate in it.p < 0.001), urea , and fasting glucose , and mean value of potassium  were observed. Hyponatremia was diagnosed in 6.7% of cases, significantly more often in the “dehydration-“ group . No cases of hypernatremia were diagnosed in the studied group.Plasma osmolarity was calculated in 358 (86.1%) of 416 patients admitted to the geriatric department, and they were included in the analysis . Most ofp = 0.001) and the number of drugs taken . In dehydrated patients, significantly higher percentages of multimorbidity  and polypharmacy  were noticed (p = 0.001), diabetes  and chronic kidney disease  in the “dehydration+” group were observed. Inadequately hydrated patients significantly more frequently were on diuretics , drugs affecting the renin-angiotensin-aldosterone system , beta-blockers , lipid-lowering medications , but less frequently on procognitive medications- acetylcholinesterase inhibitors (AChE-Is) and/or memantine . The “dehydration+” group and patients with proper hydration did not differ in age, sex, in percentage of people living alone or in a caring institution, and in many other analyzed characteristics. They differed significantly in the median number of chronic diseases , the percentage of patients with a BMI > 30 kg/m2 , and waist circumference median value , were observed , POMA score and increased risk of falls, WHR and percentage of patients with abdominal obesity, Norton scale score, median value of CFS and percentage of patients classified as severely frail. In the “dehydration+” group significantly higher- comparing to non-dehydrated patients- values of some parameters characterizing patient’s nutritional health, such as mean BMI  were not included in the logistic regression after testing for correlation with other variables and for their multicollinearity effect. Significantly higher odds for calculated osmolarity >295 mMol/L were observed only for chronic renal disease . There was also a trend for an association with variable “diabetes” , and with “taking procognitive medications” , when controlling for hypertension, ischemic heart disease, cardiac heart failure, chronic kidney disease, taking beta-blockers, lipid lowering medications, SSRI, diuretics, ACE or ARB, abdominal obesity, BMI > 30 kg/m2, and polypharmacy (Model 1). After adjusting for the variable “dementia” , the odds connected with “taking procognitive medications” became a significant one - Model 2. For both models, an overall prediction success rate of 65.7% was observed, with 78.7% of the “dehydration+” status (sensitivity) and 47.3% of “dehydration-“ status (specificity) correctly predicted. The adjustment for age and gender, as biologically important covariates (Model 3), did not influence the results. The prediction success was similar, with 78.1% of “dehydration+” cases and 46.4% of “dehydration–“ cases correctly predicted, for an overall success rate of 64.9%. A direct multivariable logistic regression analysis was carried out on impending dehydration as outcome and 14 predictors: hypertension, ischemic heart disease, cardiac heart failure, diabetes/ prediabetes, chronic kidney disease, taking procognitive medications, beta-blockers, statins, selective serotonin reuptake inhibitors (SSRI), diuretics, ACE-I or ARB, abdominal obesity, BMI > 30 kg/mpharmacy . A few vp < 0.001), diabetes , taking procognitive medications , and hypertension . Prediction success was the best in the case of Model 4, with 72.3% of “dehydration+” cases and 59.1% of “dehydration–“ cases correctly predicted, for an overall success rate of 66.8%.A stepwise backward logistic regression analysis was performed on impending dehydration at admittance to the department as outcome and 17 predictors constructing Model 4 . The resWater homeostasis is crucial for life. It is an essential body nutrient, although very often, it is not seen as such. Maintaining normal hydration in older patients is hindered by a number of factors ; therefoAccording to some studies, plasma hypertonicity might be an indicator of frailty starting to develop in nondisabled older adults, and a predictor of disability and mortality in this population . Despite2, and with higher waist circumference in the study. This may be due to the altered fluid distribution in obesity reflecting plasma hypertonicity [Patients with a calculated osmolarity higher than 295 mMol/L had a significantly higher mean value of BMI. Impeding dehydration was also significantly more frequently observed in patients with BMI > 30 kg/mtonicity . Obesitytonicity .Based on Model 4, it can be concluded that chronic kidney disease, diabetes, taking procognitive medications and hypertension turned out to be the main variables for the outcome- impending dehydration- prediction. The results of the presented analysis are consistent with findings of DRIE’s study conducted in the United Kingdom, suggesting that—apart from cognitive abilities—diabetes status and kidney function are connected with dehydration status in frail care homes residents . Aging iMany medications taken by older individuals can influence water homeostasis. Drugs taken at admittance, significantly more frequently reported in the “dehydration+” group included diuretics, ACE-Is/ARBs, beta-blockers, and statins. Diuretics force sodium wasting and reduce the diluting capacity of the kidney . InhibitThe study has limitations that ought to be emphasized. First of all, as is underlined above, the term “dehydration” used in the manuscript corresponds to “impending dehydration” in this study . Plasma osmolality measurement should have been performed in the “dehydration+” group to confirm this diagnosis. The results of the study can be generalized for the population with similar characteristics and for similar institutions only, and not for the whole population of older patients. Additionally, the retrospective design of the study, connected with the secondary analysis of previously collected data, resulted in the non-availability of some pieces of information (as indicated in the tables).The study results reveal the high prevalence of impending dehydration in older patients in the geriatric ward—above half of them had a calculated osmolarity higher than 295 mMol/L at admittance. Chronic kidney disease, diabetes and hypertension were the main independent predictors connected with significantly higher odds for dehydration status, and taking procognitive medications status proved to be related with significantly lower odds for dehydration after adjustment for diagnosed dementia. This may point to the additional benefit of using procognitive drugs in people with cognitive disability.


Heart rate acceleration and deceleration capacities are novel parameters that can quantify sympathetic and vagal modulation. However, how acceleration and deceleration capacities associated with circadian blood pressure (BP) variation remains unknown.A total of 141 patients with essential hypertension were included in our study. Based on the nocturnal decline rate of systolic BP (SBP), patients were divided into two groups, as dippers and nondippers. Baseline demographic characteristics, ambulatory blood pressure monitoring (ABPM) parameters, Holter recordings, and echocardiographic parameters were collected.p = .047) and deceleration capacity (DC)  were significantly higher in dippers than in nondippers. By multivariate logistic regression analysis, left atrial diameter (LAd) was found to be an independent risk factor for nondipper status in acceleration capacity model  and deceleration model . Sleep SBP was positively correlated to acceleration capacity  and negatively correlated to deceleration capacity .The absolute values of acceleration capacity (AC)  function than other ABPM parameters. Hypertension was defined as casual office SBP ≥ 140 mm Hg and/or diastolic BP (DBP) ≥ 90 mm Hg, ABPM daytime SBP ≥ 135 mm Hg and/or DBP ≥ 85 mm Hg, ABPM nighttime SBP ≥ 120 mm Hg and/or DBP ≥ 70 mm Hg, ABPM 24‐hr SBP ≥ 130 mm Hg and/or DBP ≥ 80 mm Hg, previously diagnosed hypertension, or currently using antihypertensive drugs  did not have complete medical records; (b) were with more than 1,000 atrial or ventricular premature beats within a whole day; (c) had a history of secondary hypertension, atrial fibrillation, atrial flutter, atrioventricular block, paced rhythm, sick sinus syndrome, diabetes mellitus, chronic liver disease, renal insufficiency, acute coronary syndrome, electrolyte imbalance, obstructive sleep apnea syndrome, or malignant tumor.2.3All patients included in our study underwent 24‐hr ABPM by an ABPM 6100 device (Welch Allyn Corp.) to record the circadian variation of BP. The right arm of hypertensive patients was selected for the placement of cuff. Patients were instructed to keep their daily routine during the monitoring period and to remain calm and maintain their body position when feeling the inflation of cuff. BP was measured every 15 min from 8:00 a.m. to 11:00 p.m. . BP was measured every 30 min during the nighttime (11:00 p.m.–8:00 a.m.). Recordings with more than 70% of valid BP measurements were considered to be reliable and included in the final analysis. The means of SBP and DBP were calculated at awake, sleep, and 24 hr for every patient. We defined the BP dipping status as the percentage decline in nocturnal SBP from day to night by the formula: (%) 100 × [1 – (sleep SBP/awake SBP)] . HRV was measured using a 24‐hr electrocardiographic Holter system (BI corp.). The following indices related to HRV, including time‐domain indices and frequency‐domain indices, were measured. Among time‐domain indices, we analyzed the full‐course standard deviation of the normal‐to‐normal (NN) intervals (SDNN), the mean of all the 5‐min standard deviations of NN intervals during the all‐day period (SDNN index), the square root of the mean of the sum of the squares of differences between adjacent NN intervals (RMSSD), and the number of pairs of successive NN intervals that differ by more than 50 ms divided by the total number of all NN intervals (pNN50). Frequency‐domain indices included high frequency (HF), low frequency (LF), and very low frequency (VLF). Average heart rate, fastest heart rate, and slowest heart rate calculated by the 24‐hr electrocardiographic Holter system (BI corp.) were also collected for every patient. The heart rate acceleration and deceleration capacities were calculated as previous described . The following parameters measured by the M‐mode technique for each patient: LAd , left ventricular end‐diastolic diameter , and left ventricular end‐systolic diameter . Simpson's biplane method was used to measure the left ventricular ejection fraction .2.6SD), while continuous variables with a skewed distribution were presented as median . Continuous variables were compared using independent sample t test or the Mann‐Whitney U test. Categorical variables, defined as frequency and percent, were compared using the chi‐square test or Fisher's exact test. To assess the correlation between continuous variables, Pearson's correlation coefficients were calculated. Multivariate logistic regression analysis was applied to determine independent risk factors for nondipper BP pattern. In our study, values of p less than .05 were considered to be statistically significant.IBM SPSS for Windows version 25.0 (IBM Corp.) was used to perform statistical analysis. Continuous variables with a normal distribution were presented as mean ± standard deviation (3p = .017) and awake DBP  were significantly lower in patients with nondipper hypertension than in patients with dipper hypertension, while age , sleep SBP , and sleep DBP  were significantly higher in patients with nondipper hypertension than in patients with dipper hypertension. However, there were no significant differences in other demographic and clinical variables between the two groups including antihypertensive medication. The cardiac electrophysiological indexes of included patients were shown in Table p = .012), SDNN , LF , and deceleration capacity  were significantly higher in patients with dipper hypertension than in patients with nondipper hypertension, while heart rate acceleration capacity  was significantly lower in dippers than in nondippers. However, other indexes of cardiac electrophysiology showed no significant differences between dippers and nondippers. When it comes to echocardiographic parameters, only LAd  showed a significantly difference between dippers and nondippers.In total, 141 hypertensive patients, including 20 dippers (14.2%) and 121 nondippers (85.8%), were included in our retrospective study. Demographic, antihypertensive treatment, variables of ABPM, cardiac electrophysiological data, and echocardiographic parameters were compared between dippers and nondippers. The baseline demographic and clinical characteristics of dipper and nondipper hypertensive patients were shown in Table r = .194, p = .021), and sleep SBP . Age was found to be positively correlated to acceleration capacity  and negatively correlated to deceleration capacity . What's more, heart rate deceleration capacity was found to be negatively correlated to sleep SBP  and deceleration capacity .Correlation analyses among ABPM parameters, echocardiographic variables, heart rate acceleration capacity, and deceleration capacity were shown in Table p = .013) and deceleration capacity model  and deceleration capacity model (odds ratio 1.146, 95% confidence interval 1.003–1.309, p = .045; Table To determine the independent risk factors of nondipper status, multivariate logistic regression analysis was performed in our study. Age was found to be an independent risk factor for BP nondipper status in both acceleration capacity model (odds ratio 1.069, 95% confidence interval 1.014–1.127, 4As a normal physiologic state, BP is high during daytime and low during nighttime. Dipper status, which is considered to be a normal physiologic change, is defined as the average sleep SBP decreasing by more than 10% from average awake SBP. Meanwhile, nondipper status demonstrates a blunted nighttime BP drop or even increase in nighttime BP. Previous studies suggested that disturbed circadian BP variation was correlated to damage of target organs and increased cardiovascular morbidity and mortality.Several factors, including intrinsic factors and extrinsic factors, contribute to disturbed circadian variation of BP. Imbalance of ANS is one of the most important factors for abnormal BP variation (Biaggioni, In the present study, shortened absolute values of acceleration capacity and deceleration capacity were found in hypertensive patients with nondipper status, which may suggest that decrease in both sympathetic and vagal activity in nondippers with compared to dippers. However, in the multivariate logistic regression analysis, heart rate acceleration capacity and deceleration capacity were not independent risk factors for nondipper hypertension, which may result from the limited number of patients included in our study.Left atrial diameter was significantly higher in nondippers than in dippers in our study and shown to be an independent risk factor for nondipper status, which were consistent with a previous study focusing on the relationship between echocardiographic parameters and BP variation (Tigen et al., Age was significantly lower in dipper than in nondippers and an independent risk factor for abnormal BP variation. What's more, age was positively correlated to acceleration capacity and negatively correlated to deceleration capacity. With the change of age, several components of ANS changed, including baroreceptor reflex function, the plasma level of norepinephrine, 6‐adrenoceptor sensitivity, and postreceptor signaling change (Goldstein et al., The fastest heart rate was significantly higher in dippers than nondippers. As described above, evaluated by heart rate acceleration capacity and deceleration capacity, nondippers showed impaired sympathetic and vagal activity. The decrease of fastest heart rate in nondippers compared to dippers may result from reduced sympathetic activity (Shaffer, McCraty, & Zerr, When it comes to the relationship between ABPM parameters and acceleration capacity, and deceleration capacity, acceleration capacity was positively correlated to 24 hr SBP and sleep SBP, and negatively correlated to dip rate. Sleep SBP was the only ABPM parameter that found to be correlated to deceleration capacity. To our surprise, nocturnal decline rate of SBP was not significantly correlated to deceleration capacity. In our present study, sleep SBP seemed to be better correlated to acceleration capacity and deceleration capacity than other ABPM parameters, which means sleep SBP may play a more important role in the change of ANS function than other ABPM parameters. With the increase of sleep SBP, the absolute values of acceleration and deceleration capacity decreased. There have been more and more studies showing nocturnal blood pressure to be a predictor for target organ damage and adverse cardiovascular events (Hansen et al., The limitations of the present study were as follows. Firstly, there were only 141 patients with hypertension included in our study, which may be one of the reasons for why acceleration capacity and deceleration capacity were not independent risk factors for nondipping status after multivariate logistic regression analyses. Secondly, our study was a retrospective study. More prospective studies are needed to investigate the association of deceleration and acceleration capacities with BP variation.5The absolute values of acceleration capacity and deceleration capacity were decreased in patients with nondipper hypertension compared to patients with dipper hypertension. However, acceleration capacity and deceleration capacity were not independent risk factors for BP nondipper status. Age and LAd were found to be independent risk factors for BP nondipper status. Sleep SBP may be better correlated to the impairment of ANS activity than other ABPM parameters.None declared.All authors contributed significantly to this study. Liyuan Yan and Jianling Jin contributed equally to this work and should be considered as co‐first authors. Jiamin Yuan, Liyuan Yan and Jianling Jin designed the study. Xin Zhao and Xingmei Huang collected the data. Wei Zhu and Shili Jiang analyzed the data. Meiwen Gao made the Tables and Figures. Jiamin Yuan, Liyuan Yan and Jianling Jin wrote the paper. All authors reviewed and approved the manuscript.The single‐center retrospective study was performed in full accordance with the principles outlined in the Declaration of Helsinki, and permission was obtained from the ethics committee of Soochow University.


As a very common risk factor of cardiovascular disease (CVD) and premature death, hypertension is preventable, and extensively controlling blood pressure to targets set forth by the current guideline is key to prevent and manage the debilitating disorder and CVD. In recent decades, the advancement of multiomics studies including genomics, epigenomics, transcriptomics, proteomics, metabolomics, and gut microbiome has uncovered many potential biomarkers for hypertension and its related cardiovascular complications including myocardial infarction, heart failure, and stroke –3. Due tThe paper written by Dr. X. Peng et al. reported a longitudinal association between dynamic fasting glucose and risk of incident stroke in 12,321 Chinese adults. They found that a higher variance in addition to a higher level of fasting glucose predicted a higher risk of incident stroke, independent of lifestyle behaviors and metabolic factors. These results suggest that high variability of fasting glucose may be a risk factor for stroke. The homeostasis of glucose metabolism should be maintained for community members, diabetic patients in particular.In the paper written by Dr. M.-C. Chen et al., the authors examined whether serum angiopoietin-like protein 3 (ANGPTL3) levels at baseline could predict adverse cardiovascular events in 90 patients with coronary artery disease (CAD). After a median follow-up of 54 months, 33 patients developed major adverse cardiovascular events, and these patients had higher ANGPTL3 levels at baseline compared with those who were free of adverse cardiovascular events during the follow-up. Cox regression models revealed that a higher baseline level of ANGPTL3 was significantly associated with an increased risk of developing adverse cardiovascular events for CAD patients. ANGPTL3 may be a predictor for major adverse cardiovascular events in CAD patients, but the efficacy and effectiveness of screening ANGPTL3 for CAD patients warrant further evaluation.Leveraging data from 285 ischemic stroke patients receiving intravenous r-tPA thrombolysis within 4.5 hours of stroke onset, Dr. Y.-L. Liu and colleagues found that higher neutrophil-to-lymphocyte ratio at admission predicted risks of hemorrhagic transformation after r-tPA thrombolysis in acute ischemic stroke patients. Neutrophil-to-lymphocyte ratio, a parameter that can be easily estimated from blood cell count analysis, could be a useful marker for predicting hemorrhagic transformation in acute ischemic stroke patients after intravenous r-tPA thrombolysis.The paper written by Dr. J. Zhang and colleagues reported a modification effect of platelet count on the association between homocysteine and blood pressure in more than 30,000 hypertensive patients. The association between homocysteine and blood pressure was much stronger in participants having low platelet count, compared with those having high platelet count. These results indicate that platelet count may be useful in the identification of individuals who are major beneficiaries of reducing-homocysteine treatments, but the clinical application still have a long way to go.Dr. H. Xie et al. conducted a nested case-control study to examine the association between plasma urotensin II and the risks of incident hypertension by exploring 723 participants who developed hypertension and 1,096 participants who remained free of hypertension after about 5 years of follow-up. In contrast to prior case-control studies, they did not observe a significant association between urotensin II and hypertension. The causal effect of urotensin II on hypertension is still unspecified.Dr. X. Jia et al. conducted an animal study to test the effect of resveratrol on pregnant hypertension reduction using mice models of high-salt diet-induced hypertension. They found that resveratrol supplementation could decrease blood pressure, serum urea, serum creatinine, and urinary protein in hypertensive pregnant mice. Resveratrol could be a promising candidate of an effective blood pressure lowering agent for pregnancy-induced hypertension, but further evidence is needed from clinical trials in humans.Learning the new biomarkers of hypertension may help clinicians and researchers to understand the underlying mechanisms and provide additional motivation for undertaking the difficult challenge to reduce hypertension and its related cardiovascular disorders.


Burnout syndrome (BOS) in academic physicians is a psychological state resulting from prolonged exposure to job stressors. It leads to a decline in overall job performance, which could result in misjudgment and serious clinical errors. The current study identifies the prevalence, as well as the potential demographic and workload variables that contribute significantly to BOS in academic clinicians. We distributed a modified version of the Maslach Burnout Inventory (MBI) scale to the academic clinicians in our institution; 326/900 responded, with 56.21% male and 43.46% female. The MBI scale comprised of three dimensions of burnout: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA). Higher scores in EE and DP and lower scores in PA were associated with a higher risk for burnout. In considering the work-life of academic clinicians, this study used a modified version of the MBI to reflect three hypothesized sources of burnout: interactions with students/trainees, interactions with patients, and interactions with administration, as reflected in these three dimensions. Along both the EE and DP dimensions of the MBI, burnout was highest for interactions with administration (51% and 44.8%), moderate for interactions with patients (26.4% and 34.5%), and lowest for interactions with students (11.7% and 9.8%). The highest scores along the personal accomplishment component was found for interactions with students and patients (33.7% and 33.4%). Regression analyses identified several factors associated with higher scores on the EE and DP scales: younger age, surgical specialty, low academic rank, academic main practice, female gender, numerous night shifts, and living alone. Furthermore, higher patient volume contributed significantly to the increasing PA. This study suggests that administrative interaction contributes significantly to burnout amongst physicians, followed by patient care and trainees. Furthermore, surgeons, females, single, early career, and younger faculty staff members are at higher risk of suffering from burnout. Further studies are needed to characterize the nature of administrative interactions that contribute to burnout and to solidify other contributing variables. Burnout was originally defined as “the extinction of motivation or incentive, especially where one’s devotion to a cause or relationship fails to produce the desired results” ,2. The tEmployment is generally perceived as an essential element of the overall well-being of an individual. In developed countries, burnout syndrome (BOS) is ranked next to cardiovascular disease and diabetes in prevalence ,6. AmeriBurnout is commonly observed in individuals who work with people, particularly in educators at all levels and healthcare workers, whose careers are characterized by high levels of work-related stress . BurnoutClinician faculty educators are at significant risk of burnout, since many are practicing clinicians and researchers expected to handle the pressures associated with multiple roles simultaneously .Educators have been particularly prone to burnout and well-studied in a variety of educators, including elementary ,16, middThe current study aims to measure the prevalence of burnout within the Faculty of Health Sciences at McMaster University—a tertiary academic referral health center in Ontario, Canada. The study also aims to investigate potential demographic and workload variables that contribute to self-reported measures of burnout.We hypothesize that administrative interaction serves as a main source of burnout compared to interaction with trainees and patients.A Research Ethics Board (REB) approval (13-800) was obtained prior to the study commencement for the study protocol, survey, recruitment email, and poster. The participants’ personal information was not reported in any of the findings. Data for this study were collected from February to July, 2014.The survey was completed by 326 clinical academic faculty members in clinical specialties working at McMaster University in the departments of Medicine, Critical Care, Surgery, Family Medicine, Obstetrics, and Gynecology, Pediatrics, Anesthesia, Psychiatry, Emergency Medical Oncology, Radiology, and Pathology . The totThe specialties were further polarized into two main categories: surgically focused specialties , which represented 35%, and non-surgically focused specialties , representing 65%. The study population was further categorized based on their academic rank, their highest level of education, living status, gender, and marital status .®). The modification of the scale included the three hypothesized categories of burnout—trainees, patients, and administration—within the same modified version on the same scale administered at the same setting (The Maslach Burnout Inventory (MBI) was used for measuring burnout among academic healthcare providers . The ori setting .®, a web-based survey platform, was used for data collection. The survey link was distributed to participants via email by their corresponding department chairs.Survey Monkeyp-values < 0.05 were considered statistically significant. An exploratory factor analysis was used to investigate the construct validity for the modified scale of the three sources of interactions  to each of the 22 items of the scale. A multiple regression analysis was carried out to examine the contribution of each of the study variables and how these variables explained the variance of the burnout scores.A statistical analysis was performed using SPSS Statistical Software 22, . All statistical tests were two-tailed, and These variables included age, gender, marital status, living situation, total years of work experience as faculty, majority of practice community vs. academic, academic rank, specialty, level of higher education achieved, number of night/shifts call per month, average number of patients, patient load per month, number of active research projects the physicians were currently involved in, nature of work, and whether the job was full-time or part-time.The determinant analysis was larger than zero for all responses, which were deemed significant.Kaiser–Meyer–Olkin (KMO) of sampling adequacy: KMO for the category due to students was 0.92, due to patients was 0.92, and due to administration was 0.91.p < 0.001).Bartlett’s test for sphericity was significant for the three responses  indexes were calculated and are presented in To estimate the prevalence of burnout among the academic clinicians, the burnout percentages for the three types of interaction categories  were calculated and are presented in A regression analysis was used to determine the contributing variables for burnout syndrome. Thirteen variables were included as predictors for burnout: age, gender, marital status, living situation, years of work experience, practice type (community vs. academic), academic rank, specialty, education achieved, number of work hours/month, patient load per month, number of active research projects, and full or part-time practice.To satisfy the requirement of multiple regressions, categorical and ordinal data variables were converted to dummy variables of two values: 0 and 1. The sample size variable ratio was calculated to be 25, which is acceptable for a regression analysis.Marital status: single and separated were coded as 0 and married as 1.Specialty: surgical specialties  were coded as 0, while non-surgical specialties  were coded as 1.Academic rank: professor and associate professor were coded as 0; while assistant professor, associate clinical professor, assistant clinical professor, and clinical scholar were coded as 1.Living situation: alone was 0, while living with others was 1.Educational level: postgraduate education, Ph.D., MBA, Masters, and diploma was coded as 0, while no postgraduate degree was coded as 1.The following variables were converted to dummy variables:Multiple regressions with stepwise methods in entering the predictor (independent) variable were used. The results are summarized in Multiple regression was used to compare three sources of EE  according to the contribution of the 13 predictors, and to explain the variance of the EE burnout.The results of the multiple regression were as follows .Specialty and age contributed to the variance of the emotional exhaustion subscale of burnout due to interaction with trainees. These two variables explained 6% of the EE burnout variance. Four variables  accounted for 10% of the EE due to patients’ variance. Five variables  contributed significantly to the regression model and accounted for 20% of the variance of EE due to interactions with administration.Specialty contributed to the variance of all the three types of interactions of the EE burnout subscale. The beta weights of this variable in EE burnout due to patients’ interaction (−0.12) were lower than both EE burnout due to administration interactions (−0.22) and EE burnout due to trainees’ interaction (−0.22). The negative direction of beta indicated that non-surgical specialties negatively contributed to the EE subscale of burnout compared to surgical specialties.To analyze the DP burnout dimension, the same 13 variables were used as predictors. The same scales of measurements and coding of the dummy variables were used. Multiple regressions with stepwise methods in entering the predictors’ variables were used to analyze DP burnout. The results for the DP burnout are summarized in Three out of the 13 variables contributed to the variance of the students’ DP burnout. The three variables were: specialty, number of night shifts per month, and setting of practice (community versus academic). The contribution of these three variables was 0.14% of the DP burnout variance. Five variables  explained 0.15% of the variance of DP due to patients. Six variables  contributed significantly to DP and explained 0.25% of the variance of DP due to administration.Only specialty and number of night shifts contributed to the variance of all three categories of the sources of DP burnout. The beta weights of these variables were higher in DP burnout due to administration in both categories  than both DP burnout due to students  and due to patients . The results indicated a negative direction of beta for specialty and a positive direction for night shifts in all the three categories of DP. Furthermore, DP burnout for the non-surgical specialty was less than the surgical specialty. This suggests that the more night shifts, the higher the DP burnout for the three categories.To analyze the PA burnout dimension, the same 13 variables were used as predictors . The resTwo variables  out of the 13 predictors contributed to the students’ PA burnout variance. These variables explained 5% of the PA burnout variance. Specialty, setting of practice (community versus academic), number of in-patients per month, and academic rank explained 14% of the PA due to patients. Specialty and setting of practice (community versus academic) contributed significantly to PA and explained 0.12% of the variance of PA due to administration.Only specialty contributed to the variance of all three categories of the interactions of PA burnout. The beta weights of this variable were higher in PA burnout due to administration (0.30) than both due to students (0.16) and due to patients (0.19). The results indicated a significant positive direction of beta for specialty in all three main burnout interactions of PA burnout. This suggests that PA for the non-surgical specialties is higher than the surgical specialties for the three categories of burnout.Academic clinicians have more human interactions in comparison with non-academic clinicians: specifically, interactions with trainees and administration. Therefore, academic clinicians were hypothesized to be at a higher risk of burnout. We hypothesized that the three main sources of burnout in academic physicians are: interactions with trainees, with patients, and with administration. This study utilized a novel modification of Maslach’s Burnout Inventory to identify the main sources and prevalence of burnout for academic clinicians. In addition, we investigated the contributing factors to burnout, as it relates to demographic and workload variables.Due to this novel modification, the psychometric properties of the scale were tested to ensure that our modified scale bore the same dimensionality as that of the original unmodified MBI scale.This is the first study investigating the three main interactions related to burnout in a single scale in one administration. Our study showed that the least source of burnout in academic clinicians was associated with trainee interactions, followed by patient interactions, while the highest burnout levels were related to interactions with administration. The impact of administrative interactions on burnout symptoms was a particularly interesting and novel finding. Respondents may have perceived interactions with administration in different ways: e.g., office work, EHR , secretaries, charts, academic, or hospital roles. Further studies are required to pinpoint the specific administrative interactions related to burnout in academic clinicians.A study on 465 academic clinicians showed that the majority (68%) reported patient care as the aspect of work they found most meaningful, followed by research (19%), and education (9%). The least was administration (3%). Those spending less than 20% of their time on the most meaningful activity had higher rates of burnout on the multivariate analysis. This study concluded that spending more time on administrative responsibilities predisposes academic physicians to burnout. EHR were shown to be a source of burnout . AlthougTrainee interactions demonstrated the least source of burnout for academic clinicians in the present study. This might be because trainees  share a great deal of the workload in an academic institute. In addition, trainees work under the supervision of the academic physician; therefore, they are under their authority, which may render the interaction less stressful for clinicians.One of the main objectives of this study was to investigate the independent variables contributing to burnout to implement better interventional methods to target these variables in the workplace.Our results showed that younger physicians reported higher levels of emotional exhaustion due to interactions with trainees and patients, as well as more depersonalization in response to patient interaction. This is consistent with previous research showing that burnout is more prevalent in younger workers ,26 and yThe current study revealed that females rated higher on the DP subscale due to interactions with administration than males. The Physicians Work Life study of a random stratified sample of 6000 physicians revealed that female physicians were 60% more likely to report burnout than male physicians . FurtherIn this study, marital status was a contributing variable to burnout, with single physicians being more prone to burnout. It was hypothesized that the reason married workers experienced lower levels of burnout is that they were usually older, psychologically mature, and stable. Furthermore, they had higher interpersonal skills and were more skillful in problem-solving and adaptability due to their involvement with their families .Certain specialties are more prone to burnout. This study showed that surgical specialties contributed to burnout. Studies from various surgical subspecialty societies in the US estimated that burnout rates among surgeons ranged from 30–48% ,33. SurgLower academic rank was positively correlated with burnout and inversely correlated with PA due to patient interactions. This may be due to a similar explanation as the age above.Patient load was reported to play a critical role in burnout amongst clinicians. In this study, the number of patients under the care of an academic clinician per month had a significant positive correlation with PA due to the student and patient interactions. This corroborates other studies showing that the most meaningful aspect of an academic clinician’s job is patient care . PatientThis study was a single center study, and, therefore, the results could be institution-specific. Another limitation was that the exact survey response rate for this study could not be accurately calculated. This was because the email distribution list was outdated: it included faculty that had vacated their position, retired, or ones with duplicated emails, including that of their admins. Furthermore, some were non-clinical faculty . This led to an estimated response rate of 36.2%.This study investigated the prevalence of burnout and the potential etiological variables of the work-related stressors of burnout in academic physicians in a single academic center. Our results demonstrated, as hypothesized, that academic clinicians have an increased risk of burnout syndrome, and this is primarily due to interaction with administration.This study used a novel modification of Maslach’s Burnout Inventory to identify the potential etiological factors associated with burnout in clinician educators. Three different interactions were queried: students/trainees, patients, and administration. Our results indicated that the interactions with the administration were the primary source of burnout for faculty members, followed by patients, and, lastly, trainees. Our results also demonstrated that burnout is more common in young physicians, surgical specialties, and among individuals who are single or separated. More studies in this area are required to solidify the contributing variables of burnout in our healthcare system.In addition to having psychological implications, burnout syndrome causes workers to become disengaged in their work and become less confident. More seriously, burnout has been linked to significant clinical errors. This has substantial repercussions on patient care, as well as the quality of training for future physicians. Treating burnout is resource-intensive and still experimental. The best remedy is prevention. Therefore, it is essential to investigate the contributing variables to burnout for academic clinicians and to develop effective preventative measures to render the work environment less stressful, more productive, and, ultimately, transpire to better patient care.


Scientific references lack sufficient amount of data on analyses of the reasons for hospital admissions or assessment of efficacy of arterial hypertension treatment at hospitals. Methodology. A cross-sectional retrospective study consisted of 204 patients aged 18–65 years admitted to the hospital due to hypertension between January 2018 and December 2018. The study was based on analysis of electronic records, obtained from the medical database of the selected healthcare facility.  The aim of the study was to evaluate the efficacy of antihypertensive drug therapy on the blood pressure control among hospitalized hypertensive patients. β-blockers and tritherapy such as diuretics + β-blockers and calcium channel antagonists and diuretics + ACEI and ARBs. The highest blood-pressure lowering effects were observed among patients receiving combination therapy of a ACEI, a diuretic, and a ARBs. Tritherapy induced a significant mean reduction of inpatients`s SBP compared with bitherapy (p=0.0001).  As a result of the treatment applied at the hospital, 65.19% of the patients achieved the desired degree of blood pressure normalization (≤130/80 mmHg). Vast majority of the patients during their stay at the ward would receive three or more hypertensive drugs (63.73%). The most frequently prescribed antihypertensive drug combinations included bitherapies such as diuretics + ACEI and ACEI +  During their hospital stay, vast majority of patients (65.19%) achieved normal values of blood pressure, mostly owing to combined treatment with several hypertensive drugs. Efficacy of the most frequently used combinations of hypertensive drugs in normalizing arterial pressure varies. Arterial hypertension (AH) remains the most modifiable risk factor for cardiovascular disease, and according to the World Health Organization (WHO), it is still the first cause of premature death in the world. It is estimated that 7.5mln people die every year due hypertension complications, making up 12.8% of all deaths worldwide  show thaThe aim of the study was to analyze the reasons for hospital admission and evaluate the efficacy of antihypertensive drug therapy on the blood pressure control among hypertensive patients treated in hospital conditions.The retrospective cross-sectional survey was conducted at the leading provincial clinic of hypertension treatment in Poland over the time of one year (from 01/01/2018 to 12/31/2018). Based on the available data from the selected healthcare facility's medical database and on the adopted inclusion and exclusion criteria, 204 patients aged 18–65 years, suffering from hypertension, were qualified for assessment of efficacy of hypertension treatment at hospitals.The patient's age between 18 and 65 yearsDiagnosed and treated hypertensionAdmission to hospital as a result of the lack of control of blood pressure despite outpatient pharmacotherapyUrgent admission to hospital as a result of high blood pressureInclusion criteria in the study were as follows:The patient's age under 18 and above 65 yearsPending diagnosis of hypertensionExclusion criteria in the study were as follows:The present cross-sectional retrospective survey relied on analysis of medical records of hospitalized hypertensive patients. Data collected from these medical records concerned the sex, age, duration of the diseases, admission mode, any comorbidities, blood pressure values at admission to and discharge from the ward, average daily blood pressure values, type of pharmacotherapy used, and recommendations given to patients upon discharge from the hospital. Evaluation of the efficacy of hypertension treatment in hospital environment was based on the patient's medical data, percentage of patients whose blood pressure values were normalized with the medical procedures and pharmacotherapy type used, and based on average daily blood pressure values (24-Hour Ambulatory Blood Pressure Monitoring) of the patients during hospital treatment. In accordance with the latest guidelines of the American Heart Association/American College of Cardiology 2017 (AHA/ACC 2017) and European guidelines, ESC/ESH 2018 values below 130/80 mm Hg were adopted as target blood pressure values [2) test, Mann–Whitney U test, Kruskal–Wallis test on ranks (ANOVA), and post-hoc test of multiple comparisons of mean rank packages for all samples were also used. Spearman's rank correlation was also calculated. Results were identified as statistically significant at the significance level of p=0.05. Statistica 7.1 package by StatSoft was used.The collected data were analyzed using MS Excel sheets. The chi-squared  were male. Average age of the study subjects was 41.77 ± 14.53 years. The largest percentage of patients (29.41%) admitted to the hospital due to hypertension were aged 50–65 years. Analysis of the available medical records leads to a conclusion that the most common comorbidities in the study group of patients suffering from hypertension include obesity (54.41%), type 2 diabetes (42.64%), angina pectoris (12.25%), heart failure (8.82%), and previous brain stroke (5.88%) .p < 0.001). According to the analysis of the records, the largest number of patients (62.75%) were those referred to the hospital due to primary  hypertension identified in the International Classification of Diseases (ICD10) with code I10. The remaining patients had the following diseases diagnosed upon admission: hypertensive disorder affecting the heart, without heart failure (23.53%) hypertensive disorder affecting the heart, with heart failure (8.82%), secondary hypertension (7.84%), and resistant hypertension (1.96%) (Most of the patients (73.53%) were admitted to the ward urgently, while 26.47% of admissions were planned. Urgent admissions were applied to patients with elevated systolic blood pressure values ( (1.96%) .U test with a significance rate of p=0.049 has shown statistically significant differences in terms of systolic blood pressure between sexes. Women had a higher systolic pressure. Systolic blood pressure values upon discharge from the hospital amounted to 128.00 mmHg ± 15.14 mmHg, while diastolic blood pressure values 78.17 mmHg ± 10.32 mmHg. Average daily systolic blood pressure values during hospitalization amounted to 128.54 mmHg ± 14.53 mmHg, while diastolic blood pressure values were 75.77 mmHg ± 8.64 mmHg. Statistical analysis using the Mann–Whitney U test with significance rate of p=0.031 has shown statistically significant differences in terms of average daily systolic blood pressure value between sexes. Men had higher average daily systolic pressure values. No statistically significant differences between sexes were found in systolic or diastolic blood pressure values upon admission to or discharge from the hospital  than those for men (8.48 ± 3.47 vs 7.10 ± 2.75 days). A positive correlation has also been shown between the subjects' age and length of hospital stay . The older the subject, the longer their stay at the hospital was.Average length of stay at the hospital ward was 7.52 ± 3.05 days. The Mann–Whitney U test has shown that, during hospitalization, men would be receiving a significantly larger number of hypertensive drugs than women . In addition to this, statistical analysis using Spearman's rank correlation has shown a correlation between the number of hypertensive drugs administered during the subjects' hospital stay and their age and average daily values of systolic and diastolic blood pressure values. The older the subjects and the higher their average daily values of systolic and diastolic blood pressure values were, the greater the number of hypertensive drugs received during their hospital stay would be (p=0.001).Analysis of medical records has shown that the number of hypertensive drugs used during hospitalization in the study group was 3.18 ± 1.47 on average. Vast majority of the patients during their stay at the ward would receive three or more hypertensive drugs (63.73%). 23.04% of the patients were treated with two hypertensive drugs while monotherapy was administered to 13.23% of the patients admitted to the hospital due to hypertension. The Mann–Whitney β-blockers, 63.81%–ARBs, 61.27%–ACEI, 53.43%–calcium channel antagonist, and 5.39%–a fixed-dose combination drug. Of diuretics, the most frequently used active ingredients included indapamide (26.47% of the subjects) and torasemide (38.23%), and of β-blockers, bisoprolol (28.92%) and carvedilol (16.17%). Of hypertensive drugs from the ARBs group, the most frequently used were walsartan (36.17% of the subjects) and telmisartan (11.54%), of calcium channel antagonists, amlodipine (45.58%), and of fixed-dose combination drugs, perindopril combined with amlodipine (19.60%)  .Eighty-four patients (41.17%) received acetylsalicylic acid, while 70.58% had statins introduced into their therapy during their hospital stay. 17.64% of the patients required potassium and magnesium supplementation. Due to a large percentage of patients with type 2 diabetes, 45.58% of the patients received oral antidiabetic agents.As a result of the treatment applied at the hospital, 65.19% of the patients achieved the desired degree of blood pressure normalization (≤130/80 mmHg).), including 35.29% with blood pressure values below ≤120/70 mmHg.β-blocker and an ACEI. Same percent of patients (9.3%) received pharmacological treatment in the form of a combination of two hypertensive drugs, a diuretic and an ACEI. A large portion of the study group (26.47%) during their hospital stay would receive pharmacotherapy based on a combination of three hypertensive drugs: a β-blockers, a diuretic, and a calcium channel antagonist. Another most frequently recorded polytherapy was a combination of an ACEI, a diuretic, and a ARB, administered to 25 patients (12.25%).Detailed analysis of pharmacotherapy administered to hospitalized hypertensive patients has shown that 19 patients (9.3%) received pharmacological treatment in the form of a combination of two hypertensive drugs, a p=0.0001). The percentage of hospitalized patients with controlled BP was the highest among patients receiving biotherapy based on a combination of a ß-blockers + an ACEI . Nevertheless, in this group of patients, the average systolic and diastolic blood pressure upon admission to the hospital was the lowest among compared blood-pressure-lowering regimens. Statistically significant differences were found in the efficacy of hypertension treatment using bitherapy based on a combination of a ß-blockers + an ACEI and a bitherapy based on a combination of a diuretic and an ACEI. In group of patients receiving ß-blockers + an ACEI, the average systolic blood pressure values upon discharge from the hospital was significantly lower compared with the group of patients receiving a diuretic and an ACEI (p < 0.0001)  .β-blockers + diuretics + calcium channel antagonist and a tritherapy based on a combination of a diuretic, an ACEI, and an ARBs. In group of patients receiving β-blockers + diuretics + calcium channel antagonist, the average systolic and diastolic blood pressure values upon discharge from the hospital were significantly lower compared with the group of patients receiving a diuretic, an ACEI, and an ARBs (p < 0.0001)  .In spite of progress in diagnostics, identification, and treatment of hypertensive disorder, only in 60% of the patients, the therapy manages to reduce blood pressure values to less than 140/90 mmHg . ResultsThe largest percentage of patients (29.41%) admitted to the hospital due to arterial hypertension were aged 60–80 years. 69.61% of the hospitalized patients were male. Most of the patients (73.53%) were admitted to the ward urgently, while 26.47% of admissions were planned. The main cause for hospital admission was high blood pressure among patients with a diagnosed primary  hypertension (62.75%). These results are corroborated in the studies by other authors. According to the study by Bachórzewska-Gajewska et al.  to analyOur study found that average systolic blood pressure values upon admission to the hospital amounted to 168.92 mmHg ± 15.05 mmHg while diastolic blood pressure values to 109.25 mmHg ± 14.47 mmHg. Women had statistically significantly higher systolic blood pressure values upon admission. As a result of the treatment applied at the hospital, 65.19% of the patients achieved the desired degree of blood pressure normalization (≤130/80 mmHg), while 35.29% of the patients had blood pressure values of ≤120/70 mmHg upon discharge from the hospital. These results corroborate with the studies by other authors [According to the available references, most patients in order to normalize their elevated blood pressure values require a polytherapy based on a combination of three or more hypertensive drugs , 11, 13.β-blockers (69.60%), ARBs (63.81%), ACEI (61.27%), calcium channel antagonists (53.43%), and fix-dose combination drugs (5.39%). These results corroborate with those of the studies by other authors. In the study by Potchoo et al. [Detailed analysis of pharmacotherapy administered to patients admitted to the hospital due to high blood pressure has shown that a largest number of patients were receiving diuretics (87.75%), o et al.  evaluatio et al. , 13, 19.ß-blocker in combination with an ACEI (9.3%), an ACEI in combination with a diuretic (9.3%), a ß-blocker in combination with a diuretic and a calcium channel antagonist (26.47%), and an ACEI in combination with a diuretic and a ARBs (12.25%). Moreover, statistical analysis performed has shown a statistically significant differences among comparative analysis of the most frequently used combinations of hypertensive drugs in terms of lowering blood pressure values during the hospital stay. The highest blood-pressure-lowering effects were observed among patients receiving combination therapy of an ACEI, a diuretic, and an ARBs. Tritherapy induced a significant mean reduction of inpatients`s SBP compared with bitherapy. These results are corroborated in other research papers [Detailed analysis of polytherapy administered to patients admitted to the hospital due to high blood pressure has shown that the largest number of patients were receiving the following combinations of hypertensive drugs: a h papers , 20–22. h papers , 39.13% h papers . Law et h papers  concludeOur studies are innovative as scientific references lack sufficient amount of data on analyses of the reasons for hospital admissions or assessment of efficacy of arterial hypertension treatment at hospitals. Moreover, no research papers to date have performed a comparative analysis to assess the efficacy of the most frequently used combinations of hypertensive drugs (bitherapy and tritherapy) in normalizing elevated blood pressure values. Available research data only directly compare combinations of antihypertensive drugs based on biotherapy , 24. Then = 204) and may be difficult to be generalized. It would be very interesting to roll the study out to other centres afterwards. In addition, in the comparative analysis of the effectiveness of the most commonly used forms of polytherapy in the normalization of blood pressure, we limited the comparative analysis only in relation to hypertensive drug groups, without taking into account active substances and drug doses, which was due to the small number of the studied group. Considering insufficient number of studies related to analyses of the reasons for hospital admissions and assessment of efficacy of arterial hypertension treatment at hospitals in Poland however, this study might be recognized as an important contribution in the field.Our study has some limitations though. The most important limitation is the fact that this study sample was recruited from a single center. The study population was relatively small  achieved normal values of arterial pressure, mostly owing to combined treatment with several hypertensive drugs. Efficacy of the most frequently used combinations of hypertensive drugs in normalizing arterial pressure varies. Hypertensive therapy should be individualized.