Eosinophils were common inflammatory cells involved in the occurrence and development of various inflammatory diseases. Multiple recent studies have pointed to the increasingly important role of eosinophils in respiratory diseases. This article aims to compare the expression differences of blood eosinophil counts between asthma, chronic obstructive pulmonary disease (COPD), and asthma-COPD overlap (ACO).  Patients with asthma, COPD, and ACO who were seen in the First Affiliated Hospital of Guangzhou Medical University from January 2012 to June 2019 were included. We collected information such as age, gender, diagnosis, the eosinophil counts from the medical records. Moreover, the levels of 10 cytokines in the plasma of each group were detected by using the Meso Scale Discovery method. p < 0.001; COPD: P = 0.001); in asthma and COPD, the number of eosinophils in males was more significant than that in females . Second, asthma patients had higher blood eosinophil counts than those with COPD and ACO (p < 0.001). Moreover, we found out that eosinophil levels were highly expressed in the stable group of all three diseases. Finally, we found that most cytokines in ACO patients showed a downward trend when the level of eosinophils was low, whereas the results were reversed in asthma patients; 7 cytokines had similar trends in COPD and ACO patients.  We included 9787 patients with asthma, 15806 patients with COPD, and 831 ACO patients. From our results, it can be first found that eosinophil levels were age-related in the three diseases (asthma and ACO:  In conclusion, eosinophils have their own unique endotypes in asthma, COPD, and ACO patients, which were reflected in the fluctuation of their levels and changes in cytokine secretion. Asthma and chronic obstructive pulmonary disease (COPD) are common chronic respiratory diseases, and the prevalence of both diseases increases yearly worldwide . MoreoveEosinophils are important inflammatory cells in the body. They actively promote various inflammatory cascades by producing and releasing chemokines or cytokines . EosinopCOPD is characterized by airway obstruction that is not completely reversible. Studies have found that the incidence of eosinophilic inflammation in COPD patients may be as high as 45% . In COPDIt is the common method for clinicians to diagnose asthma and COPD by combining family medical histories and clinical characteristics, supplemented by various diagnostic methods such as lung function and bronchial provocation testing . Recentl9/L for eosinophils and 7 × 109/L for neutrophils were chosen as representative upper reference levels . To further evaluate the mechanism of eosinophil proliferation and expression differences in asthma, COPD, and ACO, we selected pretreatment blood samples for cytokine analysis. Plasma was collected within one week before the measurement of cytokines, excluding a few sample volumes, hemolysis, and cloudy or milky plasma. The ethics committee approved the study from the First Affiliated Hospital of Guangzhou Medical University (GYFYY-2016-73), and individual consent for this retrospective analysis was waived.This study is a retrospective analysis aimed at distinguishing the eosinophilic endotypes in asthma, COPD, and ACO using levels of inflammatory cells and cytokines. We compared eosinophil and neutrophil counts in asthma, COPD, and ACO patients; contrasted the diversification of eosinophil and neutrophil between the acute and the stable groups. The cutoff levels of 0.3 × 10The current study selected 26424 adults, including outpatient and inpatient, from the First Affiliated Hospital of Guangzhou Medical University between January 2012 and June 2019. We collected basic information such as the patient's age, gender, and diagnosis through medical records. The diagnostic basis and inclusion and exclusion criteria of each group were as follows: According to the 2011 GINA diagnostic guidelines, 9787 patients in the asthma group had different degrees of respiratory symptoms, and FEV1 increased by more than 12% after using bronchodilators [γ, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, and TNF-α. For plasma collection, we took 3–5 ml of peripheral blood, which would be centrifuged at 3000 rpm at room temperature for 5 minutes, and then collected the plasma and stored it at −80°C. Considering the problems of sample volume, hemolysis, and cloudy or milky plasma, we excluded 16 samples that could not be used in this experiment. Finally, only 30 patients in each group were left for cytokine detection. 96-well plates filled with different antibodies and plasma were then energized to obtain the cytokine levels of the 90 patients.We obtained eosinophil and neutrophil counts from each participant's routine blood tests in their medical records. To further understand the influence of eosinophils in asthma, COPD, and ACO, we selected pretreatment blood samples for cytokine analysis. To ensure the accuracy of the results, the plasma was collected within one week before the cytokine detection for the experiment. The Meso Scale Discovery (MSD) method was used to analyze the levels of ten cytokines at different eosinophil levels in each patient. The ten cytokines tested included IFN-U test. p values <0.05 were considered statistically significant. All figures in this study were drafted by using GraphPad Prism 8.All data were analyzed by using the Statistical Package for the Social Science software 24.0 . The numerical values in this study were presented as the mean ± standard deviation (SD). We used Dunnett's test to analyze the correlation between the three groups and the two types of blood cells. Pearson correlation coefficient was used to evaluate whether gender or age correlated with eosinophil or neutrophil levels in the three groups. Finally, the correlation of the ten cytokines with different levels of eosinophils in the three groups was determined by using the Mann-Whitney r = −0.082, p < 0.001; neutrophils: r = 0.117, p < 0.001). Moreover, we discovered that the ACO group also had a similar relationship . In contrast to the other groups, in the COPD group, we found that both eosinophil and neutrophil blood levels negatively correlated with age . The distributions of eosinophils and neutrophils at different ages are shown in Figures In this study, the demographics of asthma, COPD, and ACO were summarized in p < 0.001; COPD: p=0.012). Further, we found out that the average levels of eosinophils in males were higher than those in females. In contrast, there was no obvious correlation in the ACO group (p=0.534). Eosinophil levels in males and females are presented in There are many clinical indicators that vary slightly with gender, and the detection levels of each index are no exception. We compared the correlation between the eosinophil levels in the three groups with gender. For asthma and COPD groups, there was a significant correlation between eosinophil counts and sex (asthma: p < 0.001). However, we did not find any obvious differences between the COPD and ACO groups (p=0.995). Interestingly, when we compared the neutrophil counts, we found an opposite trend in the results. The neutrophil counts in the COPD and ACO groups were significantly higher than those in the asthma group . However, the values for the COPD and ACO groups were not statistically different (p=0.948). The distribution patterns of the two blood cells in the three groups are presented in Figures On comparing the eosinophil counts of the three groups, we found that the asthma group had significantly higher values than those of the COPD and ACO groups (both ent p=0.98. The dips p=0.99. Interes9/L). This distribution was much higher than 29.4% of acute asthma patients. In contrast, the population with neutrophil levels higher than 7 (109/L) were mainly acute patients and higher than those in stable patients (41.0% and 14.4%).Comparing the distribution of eosinophils in patients with stable and acute diseases , we foun9/L) (COPD: 48.1% and ACO: 51.8%), which was higher than the percentage of high eosinophils (COPD: 15.2% and ACO: 14.8%). Moreover, in both COPD and ACO, there was no difference in the proportions of eosinophils above 0.3 (109/L) and neutrophils greater than 7 (109/L) in the stable group. The ratio of COPD patients with high levels of eosinophil or neutrophil was 28.7% and 22.8%, respectively, and ACO was 30.2% and 32.5%.We obtained similar results after comparing the cellular levels of patients in the COPD and ACO groups, respectively. Regardless of COPD or ACO patients, nearly half of patients in the acute group had neutrophil levels greater than 7 (109/L) cutoff of eosinophils. The number of samples with eosinophils greater than or equal to 0.3 (109/L) and less than 0.3 (109/L) was 18 and 12 in the asthma group; the COPD group was 6 and 24, respectively; the ACO group was 10 and 20, respectively. Interestingly, we found that most of the cytokines  in the asthma patients tend to increase when the low expression of eosinophils; but in the ACO group, only INF-γ and IL-10 showed an increase. Moreover, except for IL-2, IL-6, and TNF-α, the COPD and ACO group had the same cytokine changed trend: when the expression of eosinophils was low, the secretion of INF-γ and IL-10 were increased; IL-12p70, IL-13, IL-1β, IL-4, and IL-8 were decreased. However, only IL-1β and IL-2 had the same changing trend between asthma and ACO groups. The levels of the ten cytokines in the three groups are shown in Inflammation is a major factor among these three diseases, so we further performed cytokine analysis in each group. The characteristics of patients from each group were summarized in Asthma, COPD, and ACO are increasingly common diseases that endanger our health. The prevalence of asthma is much higher in children and teenagers, but COPD and ACO are more common in adults, especially above 40 years old . Not onlp < 0.001), but no significant differences were found between COPD and ACO. This indicated that asthma and COPD were dominated by different types of inflammation. In addition, although the eosinophil level of ACO was only slightly higher than that of COPD patients, this may indicate that ACO had a more pronounced effect on eosinophils under the action of asthma. Therefore, we speculated that on the basis of asthma, eosinophilic expression was more prominent in ACO than in COPD.In our study, we compared eosinophils in the three groups. The results showed that the levels of eosinophils in asthma patients were significantly higher than those in COPD and ACO patients  and compared the trend of the changes in cytokines at different levels of eosinophils. We found that at low levels of eosinophils, the secretion of cytokines such as L-12p70, IL-13, and IL-4 in patients with asthma increased, while in the ACO group, the opposite result was shown that most cytokines had a decreasing trend. Furthermore, seven cytokines, including INF-γ, IL-10, IL-12p70, and IL-13, showed the same trend in COPD and ACO groups. Some studies put forward that the levels of IL-8 in asthma were lower than those in COPD [α values in both COPD and ACO were significantly higher than those in asthma [Cytokines are secreted proteins involved in growth, differentiation, and activation . For exa in COPD , 31. MeaNevertheless, our study still has some limitations. Eosinophil counts were gathered for this research between 2012 and 2019. However, the 2021 strategic report of the Global COPD Initiative proposed that the term asthma-COPD overlap was no longer used due to the difficulty of diagnosing. Instead, the emphasis was on the individualized treatment of patients with asthma or nonCOPD. Therefore, this study can only represent the results of the previous disease. Due to the lack of pre-enrollment treatment history, body mass index, smoking history, and so on, we could not rule out the possibility that other confounding factors may affect eosinophil levels. In addition, there were less research on the different comparisons based on different levels of eosinophil, and we only analyzed the cytokines in this study. Finally, the kinds of cytokines and sample numbers were restricted, which let us not find significant differences between the different EOS levels in the three diseases.In conclusion, eosinophils have their own unique endotypes in asthma, COPD, and ACO patients, which were reflected in the fluctuation of their levels and changes in cytokine secretion. The mechanism of action of eosinophils in these diseases remains the main direction of future research.


Correlation analysis demonstrated that serum TMAO was positively correlated with C-reactive protein level and either left or right baPWV. Thus, we supposed that serum TMAO levels were associated with PAS in patients with advanced non-dialysis CKD.Trimethylamine N-oxide (TMAO) is a gut-derived uremic toxin involved in cardiovascular diseases (CVD). Peripheral arterial stiffness (PAS), measured by the brachial-ankle pulse wave velocity (baPWV) is a valuable indicator of the existence of CVD alongside other diseases. The study recruited 157 patients with chronic kidney disease (CKD) stages 3 to 5, and aimed to determine the correlation between serum TMAO and PAS, defined as a baPWV of >18.0 m/s. Patients with CKD who were diagnosed with PAS  were older, had a higher percentage of hypertension or diabetes mellitus, higher systolic blood pressure, and higher fasting glucose, C-reactive protein, and TMAO levels. Furthermore, besides old age and SBP, patients with CKD who had higher serum TMAO were more likely to have PAS, with an odds ratio of 1.016 (95% confidence interval = 1.002–1.029,  Patients with chronic kidney disease (CKD) were found to accumulate all kinds of waste products, including noxious metabolic by-products absorbed via the intestines as the kidneys lost their excretion abilities . ExistinPrevious studies have shown that vascular stiffening, as measured by pulse wave velocity (PWV), was correlated with CVD, which was long recognized as the main cause of long-term adverse outcomes in CKD through the possible mechanisms of oxidative stress, low-grade inflammation, or disordered mineral metabolism ,19,20. Ip = 0.001); however, when classifying patients into CKD stages, no significant difference was observed between those in the PAS and control groups (p = 0.019). Viewed more closely, a trend could be observed showing a higher percentage of CKD stages 4 and 5 in patients belonging to the PAS group compared to the control group . A total of 68 (43.3%) and 89 (56.7%) patients were categorized in the PAS and control groups . Comparep < 0.001), 1.042-fold , and 1.016-fold  increased risk of PAS occurrence . Second, both left and right baPWV were significantly positively correlated with aging, SBP, and serum TMAO. Third, in addition to the positive association with baPWV, serum TMAO level was found to be positively correlated with aging  and CRP , but negatively associated with eGFR .p = 0.046), and 1.036-fold (p = 0.021) higher risk of developing PAS, respectively. It indicated that there was increased possibility of TMAO in relation to the occurrence of PAS in advanced CKD. To examine the potential risk of TAMO related with PAS in CKD patients, a subgroup analysis was performed by dividing patients into groups with or without DM, HTN, and hyperlipidemia . The anaIn this study, TMAO associated with aging and high SBP could be a useful marker for the occurrence of PAS in patients with advanced CKD. Furthermore, serum TMAO increased as patients got older, exhibited a greater inflammatory status, or exhibited a decline of renal function.CVD has been known to be the leading cause of long-term morbidity or mortality in patients with dialytic or non-dialytic CKD . In thisIn addition to the traditional risk factors, such as old age or high BP (SBP or DBP), gut-derived uremic toxins, such as indoxyl sulfate, p-cresol sulfate, and TMAO, were demonstrated to play important roles in CVD pathogenesis ,3,4. ThrAside from the harmful effects on renal function, many studies reported the TMAO effects on CV and long-term adverse outcomes. Evidence had shown an association between TMAO and severity and mortality in patients with heart failure . Tarng eThis study had several limitations. First, it was a cross-sectional and single-center design with a limited sample size of patients with CKD. Furthermore, patients with stage 1–2 CKD and on dialysis were excluded. Therefore, the results could not be extrapolated to other populations, except for advanced CKD. Second, gut microbiota was not assessed in this study, and the mechanism by which TMAO affects PAS remains unclear. Third, the association between TMAO and PAS (baPWV) was not stronger than age and SBP. Nevertheless, we thought that there could be a role of TMAO in the development of PAS, probably through the activation of inflammatory responses. Fourth, we did not record the dietary contents of these CKD patients. Indeed, plasma TMAO still presents in animals without microbiota , and theIn addition to older age and elevated SBP, increased serum TMAO was independently indicative of PAS in patients with stage 3–5 CKD. Besides the positive correlation with baPWV, serum TMAO was also positively associated with serum CRP levels. These findings suggested that TMAO may be an important upstream modulator of the PAS development process among patients with advanced CKD who are diagnosed with stage 3–5 CKD, but the detailed mechanism remains to be investigated.2, 15–29 mL/min/1.73 m2, and <15 mL/min/1.73 m2 [From January to December 2016, patients with CKD who were diagnosed with stage 3 to 5 CKD and were old than 18 years with regular follow-up were recruited. CKD was defined using the eGFR by the Chronic Kidney Disease Epidemiology Collaboration equation [The demographic and baseline characteristics regarding the smoking status, DM, HTN, and use of medications were recorded by medical record review.2). The serum fasting glucose, blood urea nitrogen, creatinine, albumin, total cholesterol, triglyceride, low-density lipoprotein cholesterol, blood urea nitrogen, creatinine, and CRP levels were determined using an autoanalyzer  after overnight fasting for at least 8 h.Body height and weight were examined to the nearest 0.5 cm and 0.5 kg and BMI was calculated as weight (kg) divided by height squared (m9-TMAO: 85.1 m/z). The retention time for TMAO and d9-TMAO was 2.54 min. The procurement and analysis of all examinations were performed using the Empower® 3.0 software .We used a Waters e2695 high-performance liquid chromatography system containing a mass spectrometer  to determine serum TMAO levels according to a previous study . Mass spUsing this apparatus for volume plethysmography , patients lay in a supine position with four pneumatic cuffs wrapped around both upper arms and ankles, connected to both plethysmographic and oscillometric sensors to assess baPWV after blood sampling, and rested for 10 min ,26. We ut-test or Mann–Whitney μ-test were used for the Kolmogorov–Smirnov test, as appropriate. Numbers with percentages and compared between categorical variables were calculated using the chi-squared test. Factors showing significant differences in p < 0.05 was indicative of statistical significance.The Kolmogorov–Smirnov test was used to examine the normality of continuous variables. The results indicated that these continuous data were expressed as the mean ± standard deviation or median with an interquartile range. To compare the difference of continuous variables between the control and PAS groups, the Student’s independent


The binary logistics analysis of factors affecting the effectiveness of omalizumab in the treatment of allergic asthma were total serum IgE and the presence of comorbidities . (d) Conclusions: Combining omalizumab with ICS-LABA for 16 weeks significantly improves asthma symptoms in Chinese adults and can be used as an add-on treatment. In addition, high serum IgE levels and the presence of comorbidities were predictors of its therapeutic efficacy.(a) Background: Omalizumab is an anti-IgE humanized monoclonal antibody marketed in China for the conventional treatment of poorly controlled moderate-to-severe allergic asthma. Numerous clinical trials have demonstrated the effectiveness of omalizumab, but the data from studies in actual clinical treatment are still relatively limited. (b) Methods: Thirty-two patients with moderate-to-severe allergic asthma treated with omalizumab on the basis of ICS-LABA  were selected. Clinical characteristics before and after treatment were collected to analyze the relationship between changes in serum total IgE levels and peripheral blood EOS (eosinophil) levels, FEV1 (forced expiratory volume in 1 second), PEF (peak expiratory flow), OCS  dosage, ATC (asthma control test) score, and the number of acute exacerbations and the treatment response, in order to observe the efficacy of omalizumab in addition to primary therapy, and to investigate whether baseline clinical characteristics such as serum total IgE and EOS levels could predict a treatment response. (c) Results: Using the ACT score as an evaluation, 68.75% of patients benefited from omalizumab treatment at the end of 16 weeks. The response group has a reduction in OCS dosage ( Asthma is a chronic inflammatory disease with both airway hyperresponsiveness and variable airflow limitation, characterized by recurrent episodes of wheezing and shortness of breath, with or without chest tightness or cough . It has Immunoglobulin E  is an imGlucocorticoids are the cornerstone of asthma treatment and play an irreplaceable role. Inhaled corticosteroids (ICS) have become the drug of choice for long-term treatment because of their effective local anti-inflammatory effects and low adverse effects. According to the 2022 Global Initiative for Asthma (GINA)  guidelinOmalizumab has more than 10 years of clinical experience abroad, and its efficacy and safety have been proven. However, differences in internal and external factors such as different ethnic groups, geography, and dietary structure, especially for omalizumab as a biologic agent, may significantly exacerbate these differences. Omalizumab was launched in mainland China in August 2017, and thus far, it is still in its infancy, with clinical application experience, effects, and relevant data in the domestic population still lacking. In order to enrich the clinical application data and to better guide its clinical use, this study compared the changes in EOS (eosinophil) count and EOS percentage, total serum IgE level, FEV1 (forced expiratory volume in 1 second), PEF (peak expiratory flow), ACT (asthma control test) score, allergic status, and the presence of comorbidities before and after 16 weeks of omalizumab treatment in allergic asthma adult patients on the basis of budesonide/formoterol powder inhalation, to observe the efficacy of omalizumab in combination with budesonide/formoterol in the treatment of moderate-to-severe allergic asthma, and to investigate whether baseline clinical characteristics such as total serum IgE and EOS levels are predictive of a response to treatment.This study protocol was approved by the institutional ethics committee, and all subjects gave informed consent.Thirty-two patients with moderate-to-severe allergic asthma treated with omalizumab in the Department of Pulmonary and Critical Care Medicine of the First Hospital of Jiaxing from October 2020 to June 2022 were enrolled. Guidelines for bronchial asthma prevention and management, 2020 edition)-moderate asthma was defined as those who could achieve complete control using grade 3 therapy, and severe asthma was defined as fully or incompletely controlled with grade 4 or 5 asthma medications; (b) confirmed allergy status: elevated total serum IgE, positive specific IgE test, positive skin prick test, or a combination of other allergic diseases ; (c) poor control after ≥3 months of conventional 320/9 mcg twice daily budesonide/formoterol therapy; (d) treatment with omalizumab.Inclusion criteria: (a) moderate-to-severe asthma patients aged ≥ 12 years who met the criteria of the Asthma Group of the Chinese Thoracic Society  (GuideliExclusion criteria: (a) hypersensitivity to budesonide/formoterol DPI or to the active ingredient omalizumab; (b) receiving allergen-specific immunotherapy (AIT) or other biologically targeted therapies ; (c) acute asthma exacerbations; and (d) combined with diseases that severely affect ventilation, such as bronchiectasis, lung cancer, allergic bronchopulmonary aspergillosis (ABPA), acute respiratory infections, etc.Clinical data were collected retrospectively from the hospital’s electronic medical record system from patients who met the inclusion criteria and who had received budesonide/formoterol in combination with omalizumab, before and after 16 weeks of treatment. The baseline data collected before patients starting omalizumab treatment included: demographic characteristics such as age, sex, weight, and body mass index (BMI); course of asthma, co-morbid allergic diseases, comorbidities, blood count, total serum IgE, FEV1, PEF, oral glucocorticoid (OCS) dose, asthma control test (ACT) score, number of acute exacerbations, and other clinical characteristics. The changes before and after 16 weeks of treatment were recorded, collected, and documented.Patients were assessed for asthma control before and after treatment using the ACT score recommended by the Chinese guidelines ,14, and Penicillium punctatum/branch molds/Trichoderma spp.), Humulus, and cross-reactive sugar antigen determinants, while ingested allergens include egg whites, milk, peanuts, sea fish assemblages , soy, beef, lamb, shrimp, and crab.In this study, a response after 16 weeks of omalizumab treatment was required to meet any of the following conditions: (a) an improvement in ACT score ≥ 3 (MID); and (b) a pre-treatment ACT score < 20 (poor or poorly controlled asthma) and a post-treatment ACT score ≥ 20 (well controlled asthma). In pulmonary function tests: the FEV1 unit is liters per second (L/s); PEF is in liters (L). ICS doses were converted to equivalent budesonide doses (mg/d), and OCS doses were converted to equivalent prednisone doses (mg/d). The normal range of reference values for serum total IgE antibodies is 0–100 ng/mL. A clear history of allergy is defined as a clear occurrence of an allergic reaction to inhalation, ingestion, and contact with certain items or the use of certain drugs, Inhaled allergens include tree assemblages (willow/poplar/elm), common ragweed, Artemisia, house dust, cat hair, dog epithelium, cockroaches, mold assemblages  or a Mann-Whitney U-test , and a chi-squared test for categorical variables. Differences in the baseline data and changes in clinical parameters before and after treatment were compared between non-response and response outcomes, respectively. Paired-sample t-tests were used for compliance with a normal distribution, and Wilcoxon tests were used for paired and non-normally distributed data. To analyze the predictors of treatment response after 16 weeks, and to compare the differences in clinical parameters between the non-response and response outcomes, binary logistic regression analysis was used to analyze the relationship between total serum IgE, the presence of comorbidities, EOS count, whether serum-specific IgE was positive, and FEV1 and PEF response or non-response, to derive odds ratios (OR) and 95% confidence intervals (CI); and Cox regression forest plots were produced. Values of p < 0.05 were considered to represent a statistically significant difference, and all p-values were the result of two-sided tests.SPSS software version 26.0  and GraphPad Prism 7 software  were applied for statistical analysis and graph production. Continuous variables that conformed to a normal distribution were expressed as mean ± standard deviation (SD); those that did not conform to a normal distribution were expressed as a median ; categorical variables were expressed as percentages. Comparisons between groups of continuous variables were evaluated using a https:/www.xolairhcp.com/starting-treatment/dosing.html, accessed on 1 December 2022A total of 32 patients with moderate-to-severe allergic asthma treated with subcutaneous omalizumab were included. ICS-LABA contained both budesonide formoterol 320ug/9ug/suction from AstraZeneca, and omalizumab from Novartis Pharma Ltd. All patients were treated with budesonide formoterol 320 plus omalizumab via subcutaneous injection. The dose and dosing interval of omalizumab were determined according to the patient’s total serum IgE level (ng/mL = 2 IU/mL) and body weight (kg) prior to treatment, and according to the Chinese dosing schedule recommended in the drug instructions. Doses of omalizumab 150–600 mg were given subcutaneously every 4 weeks . Drug inp > 0.05. There were two cases of combined rhinosinusitis , six cases of asthma–COPD overlap (ACO 18.75%), and one case of gastro-esophageal reflux disease . Among the allergy states, three cases (9.38%) were allergic to food, six cases (18.75%) were allergic to inhalants, seven cases (21.87%) were allergic to drugs, three cases (9.38%) were allergic to skin (chronic urticaria and atopic dermatitis), of which totaled seven cases (21.87%) of patients with allergic rhinitis, and three patients had more than six allergens in serum-specific IgE detection. The median total serum IgE level was 503.80 (315.68–956.00) ng/ml, and the median peripheral blood EOS count and percentage were 0.43 × 109/L (0.10−0.78 × 109/L) and 5.20% (1.63–8.40%), respectively; the mean values of FEV1 and PEF were 2.06 ± 0.63 (L/s) and 4.56 ± 0.90 (L). Patients had a poor level of control at baseline with a mean ACT score of 16.38 ± 1.91 and a median number of episodes of 0.00 (0.00–1.00)/3 months, with two of the non-responders having 4 episodes/3 months. Patients were all on 320 budesonide formoterol DPI prior to initial treatment, and 11 (34.38%) were also additionally on OCS at a median dose of 0.00 (0.00–13.75). The differences in baseline characteristics between non-response and response were statistically significant between the OCS dose, total serum IgE, and the number of episodes, with p-values of 0.024, 0.016, and <0.001, respectively  and 19 female patients (59.37%) with an asthma course of 4.00 (2.00–10.00) years were included. Gender, age, BMI, and the course of disease were comparable in on-responders and responders, ectively .p < 0.05), suggesting that the overall efficacy of omalizumab was good, reflecting a reduced OCS dosage, decreased number of acute exacerbations, and improved asthma control after treatment , a significant improvement in ACT scores (both p < 0.001), and a reduction in the number of acute exacerbations  after omalizumab treatment; irrespective of whether the patient met the response criteria, they still had improved symptoms and a reduced oral hormone use. Of course, the responding group had more significant serum total IgE, EOS counts and percentages, and FEV1, which could explain more fully the evaluation of the efficacy of omalizumab in allergic asthma , with patients with a high total serum IgE and comorbidity being less likely to respond and potentially showing a lower effectiveness in treatment.A binary logistic regression analysis using the total serum IgE, the presence of comorbidities , EOS count, whether the serum IgE was positive, and FEV1 and PEF as correlates yielded an Rest plot . Based oThis study investigated the therapeutic effect of omalizumab in a population with moderate-to-severe allergic asthma in a third-tier city  in China. It can improve overall asthma control, reduce the dosage of OCS, and reduce the number of acute exacerbations, similar to the results of the few other studies in first-tier cities in China. Using the ACT score as an evaluation, 68.75% of patients benefited from omalizumab treatment at the end of 16 weeks; high total serum IgE and patients with comorbidities predicted a poorer response to omalizumab treatment, and high eosinophil counts or percentage did not predict the response to omalizumab treatment. All of the patients in this study were treated with ICS-LABA as a basic therapy, with some patients being additionally treated with a controller drug such as OCS, but most patients still had poor symptom control and baseline ACT scores of below 20, reflecting the heavy disease burden in asthma patients and highlighting the need to initiate omalizumab as an additional therapy in these patients.Several of the main biologically targeted drugs currently available for asthma target key pathways in the pathogenesis of asthma are: IgE, interleukin (IL)-5, and IL-4/IL-13, all of which modulate Th2-type inflammation, and which therefore may share some common characteristics in their target populations ,18. MepoTotal serum IgE includes both active free IgE and IgE that has been inactivated via binding to omalizumab; after starting omalizumab treatment, the total serum IgE level increases because the half-life of IgE is increased by the binding of omalizumab to IgE. The total IgE levels at this time do not reflect free IgE levels, and therefore it is not recommended to evaluate the effect of treatment based on the changes in total serum IgE levels after treatment ,20. StudHowever, a number of studies ,24 suggep < 0.05) decrease in blood eosinophil count and percentage after 16 weeks of treatment, compared to beforehand. The unique inhibitory effect of omalizumab on IgE can inhibit the inflammatory response at the root, and as an important cell involved in the allergic reaction, the decrease in eosinophils can reflect the effectiveness of omalizumab and the good control of asthma symptoms.In the GINA guidelines, a better reduction in the risk of acute asthma exacerbations is observed in patients with peripheral blood eosinophils ≥ 260/μL treated with omalizumab for asthma ,29. In tp < 0.001) compared to beforehand, while the improvement in PEF was not significant. Similar to the above study, these results have demonstrated the good effect of omalizumab in controlling symptoms and improving lung function, which is particularly important for the long-term quality of life of asthma patients.Among the parameters of asthma assessment, lung function is the most objective measure of disease severity and control, and FEV1 and PEF quantify the degree of airway obstruction . After oMost of the patients had a history of allergy or combined with other allergic diseases, mostly combined with allergic rhinitis (55.17%) and atopic dermatitis (27.59%), and their symptoms of other allergic diseases were improved after treatment with omalizumab. Epidemiological surveys  show thaThere are no standardized criteria for assessing the efficacy of biologically targeted asthma treatments. Currently, subjective criteria , the Asthma Control Questionnaire (ACQ), the Asthma Quality of Life Questionnaire (AQLQ), etc., and objective criteria  are used to assess efficacy. In this study, OCS dosage, the number of acute exacerbations, and changes in ACT scores, as well as pulmonary function FEV1 and PEF, were used to assess efficacy. The ACT score was used as the evaluation criterion in this study, and patients with an improvement in ACT score up to a MID score of 3 after treatment , or withThe response rate after 12 months of treatment with omalizumab was 64.7% in a large foreign study of 788 patients , as evalThis study has the following shortcomings: it is a retrospective observational study, the sample size is small and needs to be validated in a multicenter prospective clinical study with a large sample, the observation period of 16 weeks may be too short and it cannot be excluded that the number of responders increases with the duration of treatment, and this study only analyzes the predictive effect of baseline total IgE levels and eosinophil counts on the response to omalizumab for asthma, and does not address dynamic changes; future repeated measures models could be performed for further study.Omalizumab combined with ICS-LABA was effective in treating moderate-to-severe asthma in Chinese adults, with reduced oral hormone use, improved ACT scores, and fewer acute exacerbations after 16 weeks of treatment. Omalizumab can therefore be used as an add-on treatment. In addition, high serum IgE levels and the presence of comorbidities were predictors of the response to treatment. Moderate-to-severe allergic asthma poses a serious disease burden for Chinese patients, and the application of omalizumab in the clinic in 2018 brings new options for patients, but the number of patients currently using it is small due to geographical and economic reasons, and there is an urgent need to accumulate clinical application experience, research data, and more precise positioning to benefit more patients.


A 52-year-old man with ischemic cardiomyopathy presented with progressive, severe orthostatic hypotension refractory to medical therapy. Standard abdominal and leg compression devices were used without success. A novel, inflatable abdominal compression device was created that alleviated the patient's symptoms and maintained his blood pressure. Orthostatic hypotension (OH) is one of the most common causes of syncope (9%), being diagnosed in about 20-30% of people aged 65 years and older . It is hA 52-year-old man  with advanced ischemic cardiomyopathy (ejection fraction 20%) on home dobutamine presented to the emergency room with lightheadedness with standing. His other medical history included a left ventricular thrombus with prior strokes on warfarin, coronary artery disease with previous bypass graft surgery, and diabetes. His medications on admission included midodrine 5 mg three times a day, dobutamine 2.5 mcg/kg/min, spironolactone 25 mg twice a day, and empagliflozin 10 mg daily. His blood pressure was 141/83 mmHg with a heart rate of 81 bpm while lying down and 98/69 mmHg with a heart rate of 85 bpm with standing, reproducible on multiple occasions. His review of systems was otherwise negative.An echocardiogram showed an ejection fraction of 20%, normal right ventricular function, and trivial valvular disease. A left heart catheterization showed patent grafts and stable native disease. A right heart catheterization on dobutamine 2.5 mcg/kg/min revealed a right atrial pressure of 7 mmHg, mean pulmonary artery pressure of 30 mmHg, a pulmonary capillary wedge pressure of 17 mmHg and a cardiac index of 1.7 L/min/m2 which was similar to his prior testing. His laboratory testing was notable for a hemoglobin A1c of 6.5%, normal renal function, thyroid studies, cortisol stimulation testing, and immunoglobulin-free light chains. CT brain imaging revealed stable, remote infarctions in the left middle cerebral artery distribution without any new infarcts or lesions. He underwent a tilt table test that was consistent with severe orthostatic hypotension (OH)  and in parallel developed an inflatable abdominal belt using Duke Biomedical Engineering resources (see Figure OH represents the inability to compensate for gravitational challenges on the heart and vascular system. With standing, approximately 500 to 1000 mL of blood pools in the splanchnic circulation and lower extremities leading to a decrease in the blood return to the heart, a reduction in cardiac output, and ultimately, blood pressure. To prevent this fall in pressure, the baroreceptor reflex is activated by the decline in pressure leading to increased sympathetic activity, increased peripheral vascular resistance, and increased chronotropy. This compensatory mechanism can be affected by a variety of conditions leading to OH, defined as a sustained drop in systolic blood pressure by ≤20 mmHg or diastolic pressure by ≤10 mmHg.This case illustrates an extreme of OH in a patient with HF that was treated with a mechanical compression device Figure . StudiesIn patients with OH, the splanchnic vascular compartment is a well-recognized but often-underutilized therapeutic target for OH , 5. InitOH is a common medical condition that affects patients of all ages and comorbidities. Treatment is focused on intravascular volume expansion, medical therapy to raise blood pressure, and mechanical compression. OH is much less common and represents a particularly challenging phenotype in HF, given the conflicting goals of the treatment for OH and HF. Inflatable abdominal compression offers an effective treatment option for OH in patients with and without HF that should be further studied and utilized in the future.


Vesicoureteral reflux (VUR) is associated with urinary tract infections (UTI) and renal scars. The kidney damage is correlated with the grade of reflux and the number of UTI, but other factors may also play a role. Uromodulin (UMOD) is a protein produced by kidney tubular cells, forming a matrix in the lumen. We evaluated whether the common variant rs4293393 in the UMOD gene was associated with febrile UTI (FUTI) and/or scars in a group of children with VUR. A total of 31 patients with primary VUR were enrolled. Renal scars were detected in 16 children; no scar was detected in 15 children. Genotype rs4293393 TC (TC) was present in 8 patients, 7 (88%) had scars; genotype rs4293393 TT (TT) was found in 23 patients, and 9 (39%) had scars. Among children with scars, those with TC compared with those with TT were younger (mean age 77 vs. 101 months), their reflux grade was comparable (3.7 vs. 3.9), and the number of FUTI was lower (2.9 vs. 3.7 per patient). Children with VUR carrying UMOD genotype rs4293393 TC seem more prone to developing renal scars, independent of FUTI. Vesico-ureteral reflux (VUR) is a common congenital anomaly of the urinary tract ,2. VUR iEscherichia coli [Uromodulin (UMOD) is a glycoprotein that is exclusively synthesized in the kidney by the epithelial cells of the thick ascending limb of the loop of Henle (TAL) and the distal convoluted tubule. It is the most abundant protein in healthy human urine. Uromodulin is encoded by the UMOD gene on chromosome 16p12.3.6. The UMOD locus includes single-nucleotide polymorphisms (SNPs) that are in complete linkage disequilibrium in a large block encompassing the gene promoter. Among these SNPs, the rs4293393 UMOD variant has two alleles: T, the major allele associated with risk of hypertension and chronic kidney disease, and C, the minor allele associated with recurrent UTIs . UMOD inChildren with VUR followed at our Unit consecutively for 12 months were enrolled. Inclusion criteria were children with documented VUR and RS on DMSA scintigraphy, normal estimated glomerular filtration rate (eGFR) and blood pressure, and no other urinary tract malformation. Patients with secondary VUR, reduced eGFR, high blood pressure were excluded. Age, sex, family history of urinary tract malformations, urinary disorders , previous episodes of FUTI, assumption of antibiotic therapy/prophylaxis and surgery for correction of VUR were registered. In all the children age, weight, height, and systolic (SBP) and diastolic (DBP) blood pressure were assessed with validated devices. Blood samples were taken to measure: serum blood urea nitrogen, serum creatinine; DNA extracted for UMOD genotyping. The eGFR was calculated according to the Schwartz formula . Grade oInformed consent was obtained from the parents of all our children. Genotyping of SNP for rs4293393 (T/C) was carried out on genomic DNA extracted from white blood cells at LGC Genomics  using a competitive allele-specific PCR technique (KASPar v4.0) . Additional quality control criteria included inter- and intra-plate duplicate testing and clear separation of signal clusters .https://www.R-project.org/ (accessed on 20 December 2022)). The chi square test for independence was used to compare categorical variables. Non-parametric methods  were used to compare the distribution of a continuous variable in groups. Regression models were used for further analyses, including multiple logistic regression analysis considering the presence of scars as binary outcome.Data were analyzed by the open-source software R: R Core Team . R: A language and environment for statistical computing  with VUR were enrolled. Reflux was bilateral in 15 and unilateral in 16 children  respectively. All children except one had reflux grades higher than 2. Kidney scars were detected in 16 children : 9 males and 7 females; reflux was grade 3.3, bilateral in 8; FUTI were 3.3 per patient; all except one were on antibiotic prophylaxis and 5 had UTI during treatment; eight children had a surgical correction.No scar was detected in 15 children : 8 males and 7 females; reflux grade was 3.5, bilateral in 7; FUTI were 2.0 per patient; one had a surgical correction; all except one were on antibiotic prophylaxis and 3 had UTI during treatment. p = 0.018). The reflux grade was comparable in the two groups whereas FUTI were more frequent in the TC group as shown in Genotype rs4293393 (TC) was present in 8 patients, with 7 (88%) having scars, whereas the genotype rs4293393 (TT), was found in 23 patients, with 9 (39%) having scars. The difference between the occurrence of scars and the genotype at rs4293393 was significant , with lower reflux grade (3.7 vs 3.9), and lower number of FUTI (2.9 vs. 3.7 per patient); see In this study we evaluated factors which may be related to the formation of scars in children affected by VUR. One of the major problems in the treatment of such patients is to avoid the production of irreversible kidney damage. It has been questioned whether the kidney lesion associated with VUR is congenital or caused by the UTI associated with the reflux . In our E. coli [Our study tested the possible association of UMOD genotype and kidney damage in a small group of children with VUR. We found that the UMOD genotype rs423393 TC may be a predisposing factor for kidney scars. Uromodulin is known to show antimicrobial properties in urine; Umod-knockout mice are more prone to UTIs induced by type-1 fimbriated E. coli . FurtherE. coli . UromoduE. coli . We limiE. coli . The disE. coli . InsteadE. coli . A prospHere we found that UTIs are more frequent in children carrying TT, but non-significantly. Since TT patients are older, they probably had higher chances to develop a FUTI. No difference was noticed in reflux grade.Antibiotic prophylaxis has been shown to be effective in reducing the number of UTI but not renal scars and its use has been questioned ; whetherA few studies investigated the relation between VUR and UMOD. Andriole  noticed Our study has several limitations. The number of patients was small, although we were able to find a significant difference between patients with scars or without kidney scars. The number of febrile UTI was calculated based on the history referred by parents. Reflux grading may change over the years and our classification may not represent the initial grade. The presence of a scar in a kidney is dependent on the observer, although in our study a radiologist and a nephrologist independently estimated the presence of a scar. Although we excluded children with secondary VUR we did not perform urodynamic studies to detect functional bladder disorders which have also been related to VUR and kidney scars. Finally, we did not correlate genotypes with UMOD levels in the urine of our patients. A prospective study should be done in a larger number of children with VUR.Children with VUR carrying the UMOD genotype rs4293393 TC seem more prone to develop kidney scars independently from febrile urinary tract infections.


The following variables were examined: gastric pressure at baseline and gastric pressure and the CO2 injection volume when patients initially felt abdominal tension and bothersome symptoms following the CO2 injection. The relationship between belching and bothersome symptoms was also investigated.Thirty drug-resistant FD patients and 30 non-FD patients were recruited. Gastric pressure was assessed using an external pressure transducer, and the CO2 injection volume than in non-FD patients. The frequency of belching was significantly lower in the drug-resistant FD group than in the non-FD group.No significant differences were observed in basal gastric pressure between the groups. Initial and bothersome symptoms in the upper abdomen in drug-resistant FD patients developed at a significantly lower gastric pressure and significantly smaller CO2 injection volume than in non-FD patients. These patients also had difficulties with belching.Bothersome symptoms in drug-resistant FD patients develop at a lower gastric pressure and smaller CO Thus, the measurement of continuous gastric pressure and CO2 injection volume may be an effective measure to evaluate gastric mucosal hypersensitivity. However, little is known about the relationship between bothersome symptoms and gastric pressure or CO2 injection volume in drug-resistant FD patients. Then, in this study, we investigated the relationship between them using the previously described our method in drug-resistant FD patients and non-FD patients. We also investigated the association between belching and bothersome symptoms.Although there is a lack of organic disease in the upper gastrointestinal (GI) tract, patients with functional dyspepsia (FD) have upper abdominal symptoms and their quality of life (QOL) is markedly reduced –3. Primasitivity , compareDrug-resistant FD patients who exhibited dyspepsia symptoms for longer than 6 months and non-FD patients without GERD symptoms, such as heartburn and regurgitation, were recruited for this case-control study at a single center  between March 2021 and October 2021. All subjects were confirmed to have no organic diseases by endoscopy. Data on the drug-resistant FD and non-FD patients were collected during endoscopy.Drug-resistant FD is defined as the presence of at least 1 symptom of dyspepsia other than “belching” on the revised F scale  with a sPatients with the absence of systemic or metabolic disease, negative results in the fecal occult blood test (the 2-day method), and normal abdominal ultrasonography were classified as the drug-resistant FD group. The symptoms of patients in this group were not attenuated by the administration of proton pump inhibitors (PPIs) or prokinetic agents. In the present study, FD was diagnosed according to the criteria of evidence-based clinical guidelines for FD by the Japanese Society of Gastroenterology .Helicobacter pylori eradication, those who were in a follow-up period for chronic gastritis or atrophic gastritis and those who underwent endoscopy for the purpose of screening for upper GI tract. To investigate the association between belching and bothersome abdominal symptoms, patients who were suspected of having GERD in previous endoscopy or medical interviews were excluded from the non-FD group because belching may be associated with GERD.Non-FD patients included those who had gastric and/or duodenal ulcer scarring, including after Endoscopic examination was carried out by the same endoscopist (EM or KI) while conscious. The patients were on medications at the time of examination as we did not observe any effects of the medications on symptoms.2 at a constant speed, and gastric pressure and the CO2 injection volume were assessed [2 injection volume measurements are outlined in An endoscope  was inserted through the oral cavity and its tip was positioned inside the fornix. The spray tube was moved through the forceps hole and its tip was fixed slightly past the endoscope. Any gastric juice or clogs in the spray tube were removed by flushing with a small amount of air, and this was followed by the measurement of basal gastric pressure. If the amount of liquid in the stomach was large, aspiration was conducted to remove a small amount and create an empty space for the measurement of basal gastric pressure. Breathing was shallow and basal gastric pressure was assessed as the intermediate pressure of breathing in a stable state. The air supply button was repeatedly pressed to deliver a continuous injection of COassessed . Gastric2 being injected was measured continuously by a flow sensor and meter , which were installed between the CO2 insertion device  and the endoscope, and this information was also shown on the monitor. Data were stored on a PC. Instructions were given to patients to indicate any sensation of upper abdominal tension during the CO2 injection by lifting their right hand, at which point gastric pressure and the volume of CO2 injected were recorded [An endoscopic monitor displayed gastric pressure data, which were stored on a PC by a data collection system . The volume of CO2 again, patients were instructed to raise their right hand when they experienced bothersome symptoms, and the gastric pressure and CO2 injection volume at that time were recorded. CO2 injection was terminated if they experienced “belching” after the onset of initial symptoms. The presence of belching before or at the time of the onset of bothersome symptoms was investigated.After injecting COBody mass index (BMI), the degree of gastric mucosal atrophy, and the presence of hiatal hernia were examined on the day of endoscopy. The Kimura-Takemoto Classification was employed to assess gastric mucosa atrophy : the absCalculations of the sample size were based on the estimated proportion of drug-resistant FD and non-FD patients with gastric hypersensitivity. Since patient backgrounds were similar in the present and previous studies, the same settings were used to calculate sample sizes as those described in the previous study. Accordingly, 56% of drug-resistant FD patients and 18% of non-FD patients were assumed to gastric hypersensitivity. Therefore, each group needed to include 30 patients in order to detect differences in at least 38% between groups by Fisher’s exact test with a two-sided alpha error of 0.05 and power of 0.80.2 injection volume between groups. Fischer’s exact test was performed to compare sex, the presence of gastric mucosal atrophy, hiatal hernia and the presence of belching before or at the time when bothersome symptoms occurred between the groups. P<0.05 was regarded as significant.Data are presented as medians (25–75 percentiles). The Mann-Whitney U test was used to compare the differences in age, BMI, gastric pressure and COThe clinical characteristics of patients in each group are shown in the There was no significant (p = 0.0993) difference in basal gastric pressure between the groups (resistant group: 6.0 mmHg (4.5–7.3), non-FD group: 6.5 (5.8–7.5)).2 injection volume (Gastric pressure  at the tn volume  was sign2 injection volume (Gastric pressure  at the tn volume  was signFrequency of belching before or at the time when bothersome symptoms occurred in the drug-resistant FD group was significantly (p = 0.0127) lower than in the non-FD group .2 injection volume in the drug-resistant FD patients than in non-FD patients. Similarly, bothersome symptoms occurred with a lower gastric pressure and a smaller CO2 injection volume in the drug-resistant FD patients. This may reflect the impact of gastric mucosal hypersensitivity in drug-resistant FD patients.Consistent with our previous findings , we demo2 volume [2 injection volume are suitable indicators of drug resistance and/or gastric hypersensitivity. are suitable indicators of drug resistance and/or gastric hypersensitivity. Although it is invasive, the barostat remains the gold standard test for assessing gastric hypersensitivity [We previously reported that the cut-off value of gastric pressure for drug resistance was 12.7 mmHg . Based o2 volume . This fu2 is injected per second using the endoscopic CO2 regulation unit (UCR). Indeed, the specific unit we used in the present study had an injection volume of 30–31 mL per second. As the approximate CO2 injection volume can be estimated based on the duration of injection, drug resistance and gastric hypersensitivity may be evaluated based on CO2 injection volume without the need for special equipment. Using our method, we plan to further examine the presence of drug resistance in FD patients prior to the start of their treatments.Although a pressure sensor is required to measure gastric pressure, it has been reported that 30 mL of COIn our previous study , we recr2 injection volume than those in the non-FD group. The primary aim of the study goal was not to describe the disease state of drug-responsive FD; rather, our aim was to examine the gastric pressure and CO2 injection volume at the time of awareness of initial and bothersome symptoms in drug-resistant FD. We observed that the symptoms improved in a small subset of patients with drug-resistant FD and their gastric pressure and CO2 injection volume were within the standard ranges. In future studies, we intend to examine a drug-responsive FD patient population to determine whether our findings are limited to drug-resistant FD.Our study revealed that patients in the drug-resistant FD group experience both the initial and bothersome symptoms at a lower gastric pressure and a smaller COThe frequency of belching before or at the same time when bothersome symptoms occurred was significantly lower than that in drug-resistant FD group, suggesting that gastric pressure and gastric volume increase in the resistant group, compared with non-FD group because of less frequency of belching.In the drug-resistant FD group, it was rare for the patients to experience belching before the onset of bothersome symptoms, as the threshold for bothersome symptoms would be lower than that for belching. In contrast, non-FD patients experienced belching before the onset of bothersome symptoms because the threshold for belching would be lower than that for the onset of bothersome symptoms. As a result, gastric pressure is less likely to be high and lead to bothersome symptoms in non-FD patients.2 injection volume in the drug-resistant FD group than in the non-FD group, suggesting that the symptoms were associated with gastric pressure and intragastric volume. In the treatment of FD, the basic treatment strategy is diet recommendation to reduce the intake volume. Also, it may be effective to reduce gastric pressure in addition to the diet recommendation. Acute administration of L-menthol is known to reduce gastric pressure in healthy subjects [Acid suppression, acotiamide (prokinetic agent) and rikkunshito  are recommended for the initial treatment of FD . The secsubjects . Althougsubjects , there aIn our patient cohort, there were significant differences in the age, presence of gastric mucosal atrophy, and BMI. There is no consensus as to whether age is associated with FD, although several studies suggested that FD is more common in the younger population , 18. PatH. pylori eradication. The degree of acid secretion in the two groups was considered to differ such that gastric acid secretion was higher in the drug-resistant FD group. Although gastric acid is involved in the symptoms of FD [Gastric atrophy was more common in the non-FD group. This may be attributed to many of the patients in the non-FD group having ulcer scars, chronic gastritis or a history of ms of FD –22, patims of FD , 23, howOur study was a single-center study with a limited number of patients. As such, there were differences in the age and proportion of patients with gastric mucosal atrophy between the groups. The diagnosis of our FD patients was based on the Japanese Gastroenterological Association criteria, not the Roma IV criteria .In addition, our study population only consisted of patients with drug-resistant FD. In future studies, we intend to include patients with drug-responsive FD to determine whether our findings are characteristic of drug-resistant FD.2 injection volume than in non-FD patients. They had also difficulties with belching, suggesting that this plays a role in the increase in gastric pressure and intragastric volume.Bothersome symptoms in drug-resistant FD patients develop at a lower gastric pressure and a smaller CO


Among the enrolled patients, 43 (13.9%) had HRVs. The area under the receiver operating characteristic curve of PLER for predicting HRVs  was significantly higher than that for PLT and LSM (p < 0.01). PLER was an independent risk factor for HRVs. VariScreen, PLEASE, and PLER could spare 20 (6.5%), 91 (29.4%), and 60 (19.4%) endoscopies, with 0, 3 (3.3%), and 1 (1.7%) HRVs missed, respectively. The EB6C and P120A36 criteria could spare 45 (14.5%) and 36 (11.6%) endoscopies, with 1 (2.2%) and 1 (2.8%) HRVs missed, respectively. The P150M6 criterion and ALBI-PLT score missed 6.8% and 10.3% of HRVs, respectively. We found that PLER performed better than other non-invasive tests. VariScreen secured the screening of HRVs in patients with HBV-related cirrhosis beyond Baveno VI criteria.We aimed to validate the performance of the ratio of the platelet count (PLT) to liver stiffness measurement (LSM) in excluding high-risk varices (HRVs) in patients with hepatitis B virus (HBV)-related compensated cirrhosis beyond Baveno VI criteria. A total of 310 patients were assessed. The performances of the PLT:LSM ratio (PLER), PLER adjusted for the international normalized ratio, etiology, age, and sex (PLEASE), and the sequential algorithm for HRV screening (VariScreen) in excluding HRVs were evaluated and compared with those of expanded Baveno VI criteria (LSM <25 kPa and PLT >110×10 Patients with decompensated liver cirrhosis have a much worse prognosis than patients with compensated liver cirrhosis. Esophagogastric varices (EV) and esophagogastric variceal bleeding (EVB) are common manifestations of hepatic decompensation . Early iEndoscopy is the reference method for identifying HRVs . Recentl9/L  (9/L and model for end-stage liver disease (MELD) score = 6 (P150M6 criterion)  >36 g/L (P120A36 criterion)  ; PLT >15iterion) ; PLT >12iterion) ; and ALBiterion) . Howeveriterion) . A diffeiterion) .Recently, a screening strategy based on the PLT/LSM ratio (PLER) has been found to be effective for excluding HRVs safely , but the9/L.The inclusion criteria were as follows: 1) HBV infection, 2) compensated cirrhosis, 3) transient elastography (TE) and endoscopy undertaken within 3 months, and 4) LSM ≥20 kPa and/or PLT ≤150×10The exclusion criterion was at least one of the following: 1) other causes of cirrhosis except HBV infection , liver cancer, or other malignancies; 2) interventional treatment for the complications of portal hypertension; 3) previous splenectomy; 4) prior treatment with non-selective beta-blockers; 5) pregnancy; 6) other serious injuries to organs; and 6) infection with the human immunodeficiency virus.Patients with HBV-related compensated cirrhosis admitted to Suining Central Hospital  or the Affiliated Hospital of Zunyi Medical University  from September 2014 to April 2022 were reviewed retrospectively. A total of 390 patients were recruited, and finally, 310 patients were included in the analysis .Patient characteristics at baseline were collected, including demographic data and laboratory parameters , PLT, white blood cell count and levels of ALB, alanine transaminase (ALT), aspartate transaminase (AST), blood urea nitrogen, creatinine (Cr), gamma-glutamyl transpeptidase (GGT), and globulin). If patients had multiple measurements of laboratory parameters, we used the results closest in time to the TE procedure.Cirrhosis was diagnosed by liver biopsy or as a composite of clinical signs and the findings of endoscopy, imaging, and laboratory tests. “Decompensated cirrhosis” was defined as the presence of EVB, ascites, or new hepatic encephalopathy.The MELD score was calculated according to the following formula :MELD=3.Gastroscopic data were collected. The EVB risk was judged by using the varix stage . “HRVs” were defined as medium/large varices or small varices with red wale marks.The LSM by TE used a FibroScan™ device . The LSM was taken in the fasting state and expressed in kPa. As active hepatitis in patients with liver cirrhosis could elevate LSM , we perf9)/LSM (kPa)  . “PLEASE9/L  was used to calculate receiver operating characteristic (ROC) curves. The accuracy of each diagnostic criterion was evaluated according to the area under the ROC curve (AUROC). AUROC values were compared using the DeLong test. To assess the accuracy of NITs, we used the sensitivity, specificity, positive prediction value (PPV), and negative predictive value (NPV) for ruling out HRVs. Missed HRVs/spared endoscopies were calculated to reflect the safety of NITs for excluding HRVs.Data analyses were undertaken using SPSS 19.0 . For patients with HRVs and patients without HRVs, comparison of characteristics at baseline was conducted using χAmong the 310 patients enrolled in our study, 105 (33.9%) patients had EVs, 62 (20.0%) had small EVs without red wale signs, and 43 (13.9%) had HRVs (medium or large EV). The MELD score was 10.3 ± 3.8, with 125 (40.3%) patients having a MELD score ≥10.0, 199 patients (64.2%) being graded as class A, and 108 (34.8%) patients being graded as class B in the Child–Pugh–Turcotte system.9/L, 30 (two with HRVs) did not meet Baveno VI criteria due to having only LSM ≥20 kPa, and 95 (four with HRVs) did not meet Baveno VI criteria due to having only PLT ≤150×109/L. HRV prevalence in patients who did not meet both LSM and PLT criteria was significantly higher than that in patients who did not meet either the LSM criterion or PLT criterion (p < 0.01).Of the 310 patients, 185 (37 with HRVs) did not meet Baveno VI criteria due to having both LSM ≥20 kPa and PLT ≤150×10PLER, the INR, and the LSM score were significantly higher in patients with HRVs, whereas levels of ALT, AST, GGT, and PLT were significantly lower in those who did not have HRVs .p < 0.01)  than PLT  and LSM  ( < 0.01) . At a cuThe univariate analysis showed that risk factors for HRVs in patients beyond Baveno VI criteria were the INR, PLT, ALT level, LSM, and PLER score . PLER waNext, we explored the performance of PLER, PLEASE, and VariScreen according to the cutoff values recommended by Arthur and colleagues . We comp9/L and 125×109/L; and an LSM of 21.5 and 12.0 kPa, respectively, and one patient had a medium varix with a PLT of 161×109/L and LSM of 34.8 kPa. PLER could spare 60 (19.4%) patients from having endoscopies, with missing HRVs in one (1.7%) patient. EB6C could spare 45 (14.5%) patients from having endoscopies, with missing HRVs in one (2.2%) patient. PLER and the EB6C criterion missed the same patient with PLT = 125×109/L, LSM of 12 kPa, and a large varix. The P120A36 criterion could spare 36 (11.6%) patients from having endoscopies, with missing HRVs in one (2.8%) patient with PLT = 151×109/L, ALB = 42 g/L, and a large varix.VariScreen had the highest sensitivity (100%) and NPV (100%) among all NITs . VariScrThe P150M6 criterion and ALBI-PLT score had low sensitivity and NPV. Although the use of the P150M6 criterion could spare 74 to 78 patients from having endoscopies, HRVs would be missed in 6.8% and 10.3% of cases, respectively.9/L to exclude CSPH . Second, the acceptable threshold of the prevalence of missed HRVs in patients within and beyond Baveno VI criteria was defined as <5%. Patients who were within Baveno VI criteria had been excluded from endoscopies after Baveno VI criteria had been accepted for clinical use, so we could not define the acceptable threshold of missed HRVs in patients beyond Baveno VI criteria. However, our results showed that even taking the strictly defined criterion of no missed HRVs, VariScreen could secure screening of HRVs in patients beyond Baveno VI criteria. Third, we included only Asian patients with HBV-related cirrhosis. The generalizability of our results to that of other ethnicities and etiologies remains to be validated.We compared, for the first time, the performance of PLER with other NITs in patients with HBV-related cirrhosis beyond Baveno VI criteria. PLER  performed better than other NITs. VariScreen secured HRV screening in patients with HBV-related cirrhosis beyond Baveno VI criteria.


In a subsample (n = 343), we also examined associations with six domains of functioning. Controlling for age and cardiovascular disease, body mass index (BMI) and employment status independently predicted the odds ratio of having elevated pulse pressure. Elevated pulse pressure was also primarily associated with the physical domains of functioning. Outpatients with psychotic disorders that have high BMI and are unemployed thus seem to be at increased risk for elevated pulse pressure and should therefore be particularly considered for blood pressure screenings.Elevated pulse pressure is associated with metabolic and neurocognitive diseases. Preliminary small-scale studies among patients with psychotic disorders have indicated that these patients had an increased pulse pressure compared with controls. However, it is unclear whether and how these associations are manifested among larger heterogenous samples of patients with psychotic disorders. We examined elevated pulse pressure and its associations with demographic and clinical characteristics in a clinically representative sample of outpatients with psychotic disorders ( This included background information such as demographic information, and results from health check-ups (e.g. disease status). The primary criterion was that patients had completed an annual check-up that was recorded in the hospital quality register between 2016 and 2019. During this period, a total of 2179 patients had an annual check-up recorded; of these, 1289 patients had complete blood pressure and body mass index (BMI) measurements recorded within the same 7 day period as the annual check-up (Supplementary file 1 available at https://doi.org/10.1192/bjo.2022.52).An observational cross-sectional study design was employed.11 This is a general assessment instrument that can be used in both patient and general population settings and has been cross-culturally validated both in patients with mental disorders and in those with somatic disorders.12 The questionnaire contains two items corresponding to each domain of functioning , and the domains are directly linked to disability concepts according to the International Classification of Functioning, Disability and Health.12 The Swedish version has been psychometrically validated in the patient population.11 Specifically, the Swedish instrument was validated against patients’ age, clinically diagnosed comorbidities, living conditions, antipsychotic treatment status and psychotic symptom severity.11 Of particular interest for this population and the current study, the previous validation study showed that patients who were rated low on psychotic symptom severity generally also self-assessed as having lower functional impairments.11 This indicates that the instrument accounts for psychotic symptomology.At a few outpatient units, we also had information about patients’ functioning, assessed using the 12 item World Health Organization Disability Assessment Schedule 2.0 (WHODAS-2.0), a self-administered questionnaire.13 See Supplementary file 2 for all included variables.Pulse pressure was used both as a continuous (mm/Hg) and a dichotomous variable. The threshold for elevated pulse pressure was set at ≥60 mm/Hg following the 2018 European Society of Cardiology guidelines.t-tests, χ²-tests, Mann–Whitney U-tests and Spearman's rho. Multiple linear regression analyses were used to assess how much of the variance (measured with adjusted R2) the significant independent variables accounted for with pulse pressure as a dependent variable. Finally, binary logistic regression analyses (enter method) were used to identify independent predictors of elevated pulse pressure (≥60 mm/Hg).Descriptive (e.g. frequencies and dispersions) and inferential statistics were used to examine the data. Both parametric and non-parametric statistical tests were applied depending on the distribution of data  and the variable type . Normality was assessed using the Shapiro–Wilk test and complemented by evaluating histograms with normality curves to display the shape and spread of distributions. Thus, associations and differences were assessed using independent samples P-values were defined with a two-tailed significance level at 0.05.SPSS  was used for all statistical analyses. A clinically representative sample of 1289 patients was obtained. The mean age was 52.2 , 592 (46%) were female, the mean systolic blood pressure was 128.1 , the mean diastolic blood pressure was 80.2  and the mean pulse pressure was 47.9 . Most patients were on antipsychotic medication (91%) and had been diagnosed with a psychotic disorder for more than 10 years (75%).v. 51 years, t = −7.9, P = <0.001), a higher proportion were diagnosed with psychotic disorder more than 10 years ago  and a lower proportion of patients had undergone a medical examination within a year .Of all patients, 257 (20%) had elevated pulse pressure (≥60). Compared with patients with normal pulse pressure, patients with elevated pulse pressure were significantly older , chronic obstructive pulmonary disease (COPD) , CVD  and history of cancer .Furthermore, patients with elevated pulse pressure had a higher prevalence of diabetes , female sex , BMI , CVD , diabetes , COPD , having been born in Sweden , being employed  and mobility .Using Spearman's rho, statistically significant associations were found between pulse pressure and the following variables: age (P = 0.036) and being employed  were independently associated with elevated pulse pressure (2 = 0.11) and 16% (adjusted R2 = 0.162), respectively.When controlling for age and CVD, binary logistic regression analysis revealed that BMI  and their sex composition .The 343 patients with recorded WHODAS-2.0 were similar to patients without such recordings in terms of their age (mean 51.7 P = 0.043) and mobility (P = 0.001) were statistically significant, as was the WHODAS-2.0 sum score (P = 0.008)  in all dimensions of functioning. However, only the dimensions of household (= 0.008) .Table 23 Elevated pulse pressure was particularly related to the physical dimensions of functioning such as mobility and ability to perform household chores. Unlike previous research, we did not find any statistically significant associations between elevated pulse pressure and cognitive impairments.7Similar to previous research in patients without psychiatric disorders, we found that elevated pulse pressure was related to patients’ physical health status indicators such as BMI and presence of diabetes, CVD and COPD.9 Interestingly, in our study, other aspects of socioeconomic status such as the patients’ education level and living situation were not significantly associated with pulse pressure. The clear association with elevated pulse pressure and being employed might therefore relate to functioning, as increased impairment in physical dimensions of functioning (e.g. mobility) and the sum disability score were associated with elevated pulse pressure, which in turn might explain the patient's ability to work. Another potential explanation for this association might be patients’ income, which we unfortunately did not have information about. Patients in employment tend to have better financial situations, and this might influence their opportunity to access treatment for hypertension and other medical conditions, as observed in previous studies.14When controlling for age and CVD, we found that patients that were employed had a significantly lower OR for elevated pulse pressure (roughly a 40% reduction). This is consistent with research using cohorts from the general population, which also found that employment status was a significant predictor of elevated pulse pressure.15 These findings suggest that psychotic outpatients with high BMI and patients that are unemployed are the most at risk of elevated pulse pressure, which needs to be considered in clinical practice. A limitation of the current study was its cross-sectional design. Cross-sectional designs have inherent predictive constraints, because the temporal link between exposure and outcome cannot be established as both are examined at the same time. Thus, it is not possible to determine a true cause and effect relationship. Future studies should therefore consider using longitudinal designs. This would allow researchers to examine the predictive validity of pulse pressure more robustly in the identification of health status and functioning in patients with psychotic disorders. Another limitation of the current study was the potential for selection effects to influence the representativeness of the study sample. Of the 2179 patients that had an annual health check-up recorded, 1289 (59%) had complete blood pressure and BMI recordings obtained within the same 7 day period. This could mean that patients with more severe mental or physical disease or disability were not accurately represented in the sample. However, the sample was heterogenous in terms of demographic (e.g. wide age distribution) and clinical (e.g. wide BMI distribution) parameters, which reflects the clinical patient population.Blood pressure is regularly measured in psychiatric settings, and pulse pressure is easily calculated. It is therefore worth considering using pulse pressure more actively as a prognostic marker in clinical practice.


Black adults with chronic kidney disease (CKD) have higher rates of hypertension as compared to White adults with CKD. Little is known of how race and ethnicity associate with the prevalence of hypertension in pediatric CKD patients. The aim was to compare ambulatory blood pressure monitoring (ABPM) results for patients with CKD enrolled in the Chronic Kidney Disease in Children (CKiD) study across racial-ethnic groups.Patients from the CKiD study who identified as non-Hispanic White, non-Hispanic Black, or Hispanic were included to analyze differences in ABPM results across these racial-ethnic groups. The outcomes were fitted using 3 progressively adjusted models.p = 0.001 and p = 0.004, respectively). Additionally, Black participants had higher odds of abnormal wake systolic load , wake diastolic load , sleep systolic load , sleep diastolic load , systolic non-dipping , and diastolic non-dipping . Compared to White participants, Hispanic participants demonstrated only a lower sleep diastolic load .This study included 501 CKiD participants with at least one successful ABPM study. Compared to White participants, Black participants had 4.2 mmHg higher mean sleep systolic blood pressure and 2.7 mmHg higher mean sleep diastolic blood pressure (Black children with CKD have higher absolute nocturnal blood pressures and higher rates of abnormal dipping. Further studies are needed to determine the etiology of these differences and the clinical implications of racial-ethnic differences in ABPM outcomes within the pediatric CKD population.A higher resolution version of the Graphical abstract is available as Supplementary informationThe online version contains supplementary material available at 10.1007/s00467-022-05659-2. These diagnoses include masked hypertension, nocturnal hypertension, and white-coat hypertension, all of which require the use of ambulatory blood pressure monitoring (ABPM), the preferred method for the diagnosis and monitoring of hypertension.Hypertension remains a major public health challenge and is an extensively studied risk factor for cardiovascular disease in both pediatric and adult populations. In the adult population, the rate of mortality from heart disease or stroke doubles for every 20 mmHg increase in systolic blood pressure and 10 mmHg increase in diastolic blood pressure above 140/90 mmHg . Over ti. showed that 38% of CKiD patients had masked hypertension, and that abnormal ABPM was associated with left ventricular hypertrophy [Hypertension is highly prevalent in adult and pediatric patients with chronic kidney disease (CKD). The prevalence of hypertension in adults with CKD ranges between 60 and 90% and in the pediatric population between 50 and 80%, depending on the CKD stage . As suchIt has been shown that the prevalence of clinic-defined hypertension and ABPM-defined hypertension differs according to racial and ethnic group. For instance, the Coronary Artery Risk Development in Young Adults (CARDIA) study demonstrated a higher prevalence of abnormal ambulatory blood pressure monitoring in Black participants as compared to White participants . More spAdditionally, the increasing prevalence of pediatric hypertension seen in recent decades is more pronounced in Black and Hispanic children and adolescents –12. At pData from this study were obtained from the NIH/NIDDK data repository of the CKiD study . The CKiFor our study, we included patients older than 5 years of age, who had one or more successful ABPM studies and who identified as non-Hispanic White (hereafter referred to as White), non-Hispanic Black (hereafter referred to as Black), and Hispanic. Patients less than 5 years of age were excluded given the decreased reliability of ABPM in this age group. The time period of study entry for these patients was between 2005 and 2014. The latest year of follow-up in this cohort was 2016.The primary exposure of interest was self-reported racial-ethnic group. Participants in the CKiD study or patient representatives reported the racial-ethic group with which the patient identified and are categorized as White, Black, and Hispanic for the purposes of this study. Given the small patient population, participants of other races including Asian, Native-American, and mixed race were excluded from the analysis. CKD etiology was classified as glomerular and non-glomerular. The glomerular category included primary and secondary focal segmental glomerulosclerosis (FSGS) and the non-glomerular category included congenital anomalies of the kidney and urinary tract (CAKUT), cystic disorders, and hereditary disorders. Estimated glomerular filtration rate (eGFR) was calculated according to the bedside Schwartz equation and used to define CKD stages .Ambulatory blood pressure monitoring (ABPM) occurred for study participants 1 year after study entry and was repeated every 2 years thereafter. SpaceLabs® 90,217 monitors  were used for all ABPM. Monitors were sent from the ABPM center at the University of Texas Health Science Center in Houston to the CKiD study site and then returned to the ABPM center for analysis. All of the clinical sites received training in monitor placement and measured participant’s arm circumference for appropriate cuff size selection. Ambulatory blood pressure monitors were worn for 24 h and measured blood pressure (BP) every 20 min during both day and night. Each participant self-reported periods of sleep, wake, and times of medication administration.A successful ABPM study was defined as one where the monitor was worn ≥ 21 h, with ≥ 18 h with at least 1 recording per hour. Each study had to have at least 1 successful blood pressure measurement in ≥ 75% of wake and sleep hours. Ambulatory blood pressure monitoring parameters of interest were mean wake systolic and diastolic measurements and mean sleep systolic and diastolic measurements. Wake and sleep systolic and diastolic hypertension were defined as blood pressure ≥ 95th percentile for height and gender using Soergel et al.’s ambulatory blood pressure values in healthy children . Ninety-n, and percentages, and the Fischer exact test where appropriate for categories less than 5.Baseline characteristics were reported as means and standard deviations, and differences in continuous baseline characteristics between racial ethnic groups were compared using analysis of variance (ANOVA). The chi-square test was used to compare categorical variables, presented as total, Linear mixed effects models were used for the continuous outcomes, wake and sleep mean systolic, and diastolic blood pressure, and generalized estimating equation models for the remaining categorical outcomes. Models were sequentially adjusted for relevant covariates, and the White cohort was used as the reference group. Model 1 included race-ethnicity, age, and gender. Model 2 was additionally adjusted for body mass index (BMI), height z score, CKD stage, and CKD etiology (glomerular vs. non-glomerular) and Model 3 was additionally adjusted for antihypertensive use (yes or no).p value of < 0.05 was considered significant. Data was analyzed using SAS Studio statistical software.The impact of time from baseline CKiD visit was considered for each model and was only significant for the wake systolic hypertension categorical outcome. Since time was significant for this outcome, it was included in all of its 3 models. Due to missing data on height and weight in addition to age at time of ABPM over 20 years, BMI z score could not be imputed on 46 participants. Therefore, absolute BMI was used in the primary models and a sensitivity analysis was performed to determine the impact of using BMI z score or obesity, defined as BMI ≥ 95th percentile, in the population with BMI z score availability. Additional sensitivity analyses were conducted to determine the impact of using eGFR vs. CKD stage and to determine whether or not results differed when analyzing the first available test in simple linear regression as opposed to all available tests in mixed effects models. A p = 0.004). Additionally, of those with an ABPM study, only 48% of Black patients had more than one ABPM study as compared to 55% of White participants and 64% of Hispanic participants.At the time of collection from the public database, 891 patients were enrolled in the CKiD study, 696 of which had ABPM studies. Of these, only 622 patients had successful studies. We narrowed our cohort to patients of Black, White, and Hispanic ethnic groups. We then excluded 7 patients < 5 years of age with the assumption, based on clinical experience, that ABPM studies in very young children may be inaccurate. Our study population consisted of 501 remaining patients—360 White, 77 Black, and 64 Hispanic patients . There was no difference in frequency of CKD stages among the groups, with almost half of the patients having CKD stage 3. The mean body mass index (BMI) was highest in the Black participants (22.5 kg/m2), lowest in White participants (20.0 kg/m2), and intermediate in Hispanic participants (21.1 kg/m2)  and was higher in Black participants when compared to White participants  but not different between Hispanic and White participants . There was no difference in height z-scores. The percent of patients prescribed anti-hypertensives did not differ among the racial-ethnic groups, with 66% of patients in the cohort prescribed anti-hypertensives. Furthermore, there was no significant difference in the use of angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) yet the frequency of ACEI or ARB use was lowest in Black children.The mean age of the patient cohort at the baseline visit was 12.7 years with 39% female and 61% male patients. There was no significant difference among the racial-ethnic groups in age or gender (Table p = 0.04)). During waking hours, 15% of the cohort experienced systolic hypertension , as defined by reference values, with Black participants demonstrating the highest frequency of wake systolic hypertension among the racial-ethnic groups ). Twenty-two percent of the cohort experienced diastolic hypertension during sleep hours with Black participants again demonstrating the highest frequency of sleep diastolic hypertension among the racial-ethnic groups ). The frequency of abnormal systolic and diastolic dipping (non-dipping) was highest in Black participants  for systolic non-dipping and 28.6% in Black, 11.4% in White, and 10.9% in Hispanic (p = 0.003) for diastolic non-dipping).When comparing the first ABPM report for each participant ) and abnormal diastolic load while awake ) when compared to White participants. There were no differences in awake blood pressure load between Hispanic and White participants ) ) and abnormal sleep diastolic load ) as compared to White participants. Hispanic participants demonstrated lower odds of abnormal sleep diastolic load when compared to White participants with an OR (CI) of 0.54   of systolic non-dipping in Black participants as compared to White participants was 2.02  and the odds ratio (CI) of diastolic non-dipping was 2.69 . There was no difference in the odds of systolic or diastolic non-dipping in the Hispanic cohort as compared to the White cohort  and sleep diastolic hypertension , p = 0.02) in Black participants as compared to White participants. Additionally, when Hispanic participants were used as the reference group in a repeated measures analysis, Black participants similarly demonstrated higher odds of sleep systolic and diastolic hypertension, abnormal wake and sleep systolic load, and abnormal systolic and diastolic dipping when compared to Hispanic participants (data not shown). Sensitivity analyses evaluating the impact of BMI z score instead of absolute BMI attenuated the association of higher wake diastolic load in Black participants, which was no longer significantly higher in Black as compared to White participants (p = 0.07). All other outcomes were unchanged. Similarly, findings were mostly unchanged when using obesity category (yes/no) instead of absolute BMI. Differences included wake diastolic load which was no longer significantly higher in Black participants (p = 0.05). Otherwise, findings noted in the primary analysis using absolute BMI were replicated in this analysis using obesity as a categorical variable. Finally, the use of eGFR instead of CKD stage in the original models did not change the results.In addition to replicating the findings of the repeated measures analysis, a fully adjusted, simple linear regression of single ABPM studies demonstrated additional findings of higher odds of wake diastolic hypertension (2.23 (1.03–4.83), lower odds of abnormal nocturnal diastolic load, we did not note major differences between White and Hispanic pediatric patients with CKD.In this study, we demonstrate that Black pediatric patients with chronic kidney disease have higher mean nocturnal systolic and diastolic blood pressures and higher rates of nocturnal systolic hypertension when compared to White pediatric participants. Even though the absolute difference in mean blood pressure may not appear clinically significant, the diagnosis based on normative values does suggest differences in rates of hypertension between the Black and White participants. We also demonstrate higher rates of abnormal nocturnal load as well as abnormal dipping (non-dipping) within the Black cohort. Aside from Our findings are consistent with several adult studies which describe higher rates of abnormal ABPM, specifically nocturnal hypertension and non-dipping in Black, non-CKD, adult patients , 18, 19.The association of nocturnal hypertension with intermediate cardiovascular outcome underscores the clinical importance of racial differences in nocturnal hypertension. When compared to normotensive children, Seeman et al. demonstrated that children with isolated nocturnal hypertension have higher age-adjusted LVMI with nighttime systolic hypertension being the most important predictor of LVMI . FurtherSgambat et al. also investigated racial differences in ABPM within the CKiD population and similarly showed an association between Black race and higher odds of ambulatory hypertension defined as a mean blood pressure at or above the 95th percentile or blood pressure load above 25% . This asAlthough this study is not able to assess differences in socio-economic status and its impact on access to medical care, or access to medications and environmental stressors impacting disease, it is critical to consider broader social determinants of health, especially given recent data demonstrating the role of socioeconomic status in disparate cardiovascular outcomes within pediatric CKD . In factDespite the higher rates of hypertension in Hispanic children within the general population , we did Several issues relating to the interpretation of pediatric ABPM warrant discussion. When investigating rates of hypertension, it is important to consider the reference data of normative values that are used to define hypertension. In this study, the ABPM results are compared to the normative values published by Soergel et al. . This daWe do appreciate that this study has limitations. One major limitation is the sample size, overall, and, specifically, the representation of minority groups. With a larger sample size, it is possible that a difference in wake hypertension rates would be present. It is also possible that a larger sample size would reflect a difference in hypertension rates between Hispanic and White patients. Given the small sample size, we did not exclude patients taking medications, like steroids, which might elevate blood pressure. This is an additional potential source of confounding. Additionally, our study uses 95th percentiles as defined by Soergel et al. whereas there is a more recent shift toward the use of percentiles defined by Wuhl et al. . These pDespite these limitations, this is one of few studies demonstrating racial-ethnic differences in ABPM results in a pediatric population with CKD. This study analyzed a wide variety of ABPM measurements and had a sample of patients from multiple pediatric nephrology centers in North America. Given our findings, it is important to consider potentially modifiable contributors to these differences and the clinical implications on long-term cardiovascular health within pediatric CKD.Supplementary file1 (PPTX 58 KB)Supplementary file2 (DOCX 54 KB)Below is the link to the electronic supplementary material.