Waist-to-height-ratio (WHtR) has been proposed as another indicator for cardiometabolic risk factors including hypertension. Normally, hypertension can be diagnosed in the office setting by detecting high blood pressure for three occasions. However, patients with high office blood pressure may not exhibit high blood pressure outside the office. Ambulatory blood pressure monitoring (ABPM) is a procedure to measure blood pressure over 24-h. Sustained hypertension is characterized as hypertension detected by both office measurement and ABPM. This study aimed to evaluate the performance of WHtR in the diagnosis of sustained hypertension in patients with high office blood pressure.Demographic data, height, body weight, body mass index (BMI), and waist circumference were retrospectively reviewed in children and adolescents who underwent ABPM due to persistently high office blood pressure. Patients were separated into two groups: a sustained hypertension group and a normal ABPM group. BMI was adjusted to z-score using the WHO Anthroplus software. WHtR was calculated by the formula: waist circumference (cm)/height (m). The performances of different parameters were analyzed using the receiver operating characteristic (ROC) curve and multivariate logistic regression.p = 0.01) and a higher mean WHtR  than those of the normal ABPM group. For the diagnosis of sustained hypertension, the ROC analysis revealed that WHtR had a greater area under the ROC curve (AUC) than that of BMI z-score (0.772 vs. 0.723). WHtR remained associated with sustained hypertension  after adjusting for age, gender, and BMI z-score.Sixty patients  with a mean age of 12.9 ± 3.7 years had persistently high office blood pressure. Twenty-nine (48.3%) had high ambulatory blood pressure parameters so-called “sustained hypertension.” The sustained hypertension group had a higher mean BMI z-score (2.32 vs. 1.31, Apart from being a more user-friendly metric, WHtR tended to outperform BMI z-score in predicting sustained hypertension in children and adolescents with persistently high office blood pressure. The increased prevalence of hypertension in children and adolescents has become a major public health issue , 2. SeveSystematic reviews showed an association between hypertension and body mass index (BMI) together with various measures of abdominal adiposity and the hypertension rates increased in a graded manner as adiposity increased –14. GeneNormally, hypertension in children and adolescents can be diagnosed in the office setting by detecting blood pressure greater than the 95th percentile for gender, age, and height for three occasions. However, some children and adolescents may have high blood pressure in the office but do not show high blood pressure outside the office. In 2017, the American Academy of Pediatrics clinical practice guidelines recommended that ambulatory blood pressure monitoring (ABPM) be used to confirm hypertension in children and adolescents who have persistently high office blood pressure for three occasions . ABPM isPatients aged ≥6 years referred to the pediatric hypertension clinic at Ramathibodi Hospital Mahidol University due to high office blood pressure on three occasions and subsequently underwent 24-h ABPM were enrolled in the present study. Exclusion criteria included patients who did not have sufficient ABPM data, were previously diagnosed with hypertension, and had any underlying diseases or received any medications that may affect blood pressure.Demographic data, height, body weight, BMI, and waist circumference were collected. Waist circumference was measured while standing straight using a measurement tape with a precision of 1 mm. The tape was placed at the midline between the bottom of the lowest rib and the iliac crest. WHtR was calculated by the following formula: waist circumference (cm)/height (m) and BMI was adjusted to z-score for age and gender using the World Health Organization (WHO) Anthroplus software . ObesityOffice blood pressure was measured with an oscillometric device two times in the right arm while seated, using standard blood pressure measurement practice and appropriate cuff size. An average of the two blood pressure values was considered to be a blood pressure value for each occasion. High office blood pressure is defined as a systolic blood pressure (SBP) or a diastolic blood pressure (DBP) ≥95th percentile for gender, age, and height in children aged < 13 years; or ≥ 130/80 mmHg in children aged ≥ 13 years for three occasions according to the current pediatric guidelines  device, which has been validated for use in pediatric patients . An apprTo compare blood pressure parameters between patients of different ages, genders, and heights, blood pressure parameters were converted to blood pressure indices with the following formula: blood pressure value/cut-off value for high blood pressure for each patient.® Software, Version 26. The distribution of each parameter was tested with the Kolmogorov-Smirnov test. Descriptive data were presented as number (percentage), mean ± standard deviation (SD), or median  as appropriate. Demographic data were compared between the sustained hypertension group and the normal ABPM group. For comparative analysis, the chi-square test or Fisher's exact test was used for categorical data; and the Student t-test or Mann–Whitney U-test was used for continuous data, as appropriate. The receiver operating characteristic (ROC) curve was used to analyze the performances of the BMI z-score and WHtR for the diagnosis of sustained hypertension. Univariate logistic regression analysis was used to test the parameters associated with sustained hypertension. The parameters that were significantly associated with sustained hypertension from the univariate analysis, were further added to the multivariate logistic regression model. A p ≤ 0.05 was defined as statistical significance.Statistical analysis was performed using IBM SPSSp = 0.01) and a more proportion of obesity  were detected in the sustained hypertension group compared with the normal ABPM group. The sustained hypertension group also had a substantially higher mean waist circumference  and a higher mean WHtR  than those of the normal ABPM group.A total of 72 patients with persistently high office blood pressure were enrolled in the present study. Twelve patients with congenital anomalies of the kidney and urinary tract, attention deficit hyperactivity disorder, systemic lupus erythematosus, vesicoureteral reflux, obstructive sleep apnea, and coarctation of aorta were excluded as their underlying diseases or medication uses might affect blood pressure. Among sixty patients  with a mean age of 12.9 years, 29 patients (48.3%) had sustained hypertension. The demographic and clinical data between the two groups are shown in N = 29), seven patients had isolated daytime hypertension, 11 patients had isolated nocturnal hypertension and the remaining 11 patients had both daytime and nocturnal hypertension, accounting for 11.7, 18.3, and 18.3% of all high office blood pressure patients, respectively.The ABPM parameters between the sustained hypertension and normal ABPM groups are shown in p < 0.01) higher risk of sustained hypertension compared with those who did not have obesity while having WHtR ≥ 50 cm/m was 6.7 times  higher risk of sustained hypertension compared with those who had a WHtR < 50 cm/m. However, multivariate analysis revealed that WHtR was the only factor associated with sustained hypertension .Univariate analysis revealed that BMI z-score and WHtR were significantly associated with sustained hypertension as shown in For the diagnosis of sustained hypertension, the ROC analysis revealed that WHtR had a greater area under the curve (AUC) than that of BMI z-score . WHtR ≥ 50 cm/m had a sensitivity of 82.8% and a specificity of 58.1% whereas BMI z-score > 2 had a sensitivity of 69% and a specificity of 67.7% to detect sustained hypertension , Table 5Among children and adolescents suspected to have hypertension due to the detection of persistently high office blood pressure, the present study revealed that 48.3% had sustained hypertension. This was consistent with the previous studies reporting the prevalences of sustained hypertension ranging from 20 to 54% –39. The The associations between ABPM parameters and obesity have been well-described. The previous studies reported that white coat hypertension was seen in 10–30% of pediatric patients with obesity , 40, 41.In the present study, not only BMI z-score but also was WHtR significantly higher in the sustained hypertension group than the normal ABPM group. After adjusting with age, gender, and BMI z-score, WHtR was found to be the only independent parameter associated with sustained hypertension. In addition, WHtR at the cut-off point > 0.5 showed a good sensitivity of 82.8% while BMI z-score at the cut-off point of >2 (WHO criteria for obesity) showed a sensitivity of 69% to detect sustained hypertension. Therefore, WHtR tended to be a slightly better parameter for predicting sustained hypertension than BMI z-score.While WHtR is a parameter representing abdominal obesity, BMI is a parameter representing total body mass. As BMI cannot distinguish between fat and fat-free mass, an elevated BMI may not entirely reflect adiposity accumulation . On the Although many studies , 26–29 hThe available data regarding the performance of WHtR and the results of ABPM in children and adolescents with persistently high office blood pressure are limited. To our knowledge, this is the largest study that analyzed the performance of WHtR in predicting sustained hypertension by using ABPM. Nonetheless, the present study had some limitations. Firstly, auscultatory blood pressure was not performed for office blood pressure measurement. The other metabolic abnormalities associated with cardiovascular risks such as dyslipidemia and insulin resistance had not been collected. Data regarding the end-organ damages such as left ventricular mass index which is well-known and associated with sustained hypertension were unavailable. Lastly, the number of patients included in the present study was small. A larger study needs to be conducted to explore the performance of WHtR in predicting the risk of sustained hypertension among children with persistently high office blood pressure.In conclusion, sustained hypertension was detected in 48.3% of the patients with persistently high office blood pressure. Apart from being a more user-friendly metric, WHtR tended to outperform BMI z-score in predicting sustained hypertension confirmed by ABPM.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Ethics Committee for Human Research of Ramathibodi Hospital (MURA 2022/327). Written informed consent from the participants' legal guardian/next of kin was not required to participate in this study in accordance with the national legislation and the institutional requirements.NN, AS, KP, WP, SC, PS, and KT designed the study. NN, AS, KP, and WP performed the study. NN, AS, and KP drafted and revised the manuscript. All authors approved the final version of the manuscript.


The experimental group performed GSEs combined with physical therapy, while the control group only performed physical therapy, once a day, 5 days a week, for 4 weeks. The Berg Balance Scale (BBS) was used to test the balance function and the risk of falling, which was the primary outcome. The Timed Up and Go test (TUGT) evaluated the walking ability and the fall risk. The envelope ellipse area and the plantar pressure proportion of the affected side were used to measure the patient’s supporting capacity and stability in static standing. The anterior–posterior center of pressure displacement velocity was used to test the weight-shifting capacity. Compared to the control group, the swing phase of the affected side, swing phase’s absolute symmetric index, envelope ellipse area when eyes closed, and TUGT of the experimental group had significantly decreased after GSEs (p < 0.05); the BBS scores, TUGT, the anterior–posterior COP displacement velocity, and the plantar pressure proportion of the affected side had significantly increased after 4 weeks of training (p < 0.05). In conclusion, GSEs combined with physical therapy can improve the gait and balance function of people following stroke. Furthermore, it can enhance the weight-shifting and one-leg standing capacity of the affected side, thus reducing the risk of falling.This study aims to explore the effects of gaze stabilization exercises (GSEs) on gait, plantar pressure, and balance function in post-stroke patients (≤6 months). Forty post-stroke patients were randomly divided into an experimental group ( Over the past 30 years, the burden caused by stroke has greatly increased, which has been one of the most common causes of death worldwide . After aA specialized form of vestibular rehabilitation, gaze stabilization exercises (GSEs) include substitution and adaptation exercises based on the vestibulo-ocular reflex (VOR). Substitution exercises are developed to promote alternative strategies (saccadic eye movements and smooth tracking exercises) to substitute for missing vestibular function. Adaptation exercises refer to long-term changes in the neuronal response to head movements with the goal of reducing symptoms and normalizing gaze and postural stability . EvidencThe VOR is a critical step of gaze stabilization. Gaze stabilization and orientation are important in establishing a frame of reference during steering . When thGSEs may also activate the excitability of the vestibulospinal tract (VST) and enhance the sensory input to the medial VST (MVST) to promote the head–eye coordination of people following stroke . The VSTNowadays, GSEs are widely used in vestibular dysfunction and many other neurological disorders, such as dizziness, multiple sclerosis, and Parkinson’s disease ,24,25. SThe sample size was calculated using the G* power software , based on a comparison of outcome measures between the GSEs and control groups, represented by a minimum increase of four points in the Berg Balance Scale . AccordiIndividuals were included if they (1) had a stroke within the past 6 months, diagnosed by computed tomography (CT) or magnetic resonance imaging  ; (2) werIndividuals were excluded if they had (1) significant musculoskeletal or other neurological disorders diagnosed by CT or MRI; (2) balance dysfunction before the stroke (BBS < 40); (3) oculomotor nerve defects or presence of eye movement disorders, spontaneous or nonspontaneous nystagmus through clinical examinations ; (4) sevClinicalTrials.gov (accessed on 12 November 2022) (ChiCTR2100052242). All the participants were recruited from the Department of Rehabilitation Medicine of The First Affiliated Hospital of Nanjing Medical University and Nanjing Qixia District Hospital between June 2021 and January 2022. The ethics committee of The First Affiliated Hospital of Nanjing Medical University approved the experimental procedures (2021-SR-213). This study was a single-blind randomized controlled trial and the assessors were also blinded. The same physiotherapist conducted all the training. The assessor did not know how the participants were grouped.This study was a prospective, assessor-blinded clinical randomized controlled trial registered on The study flow chart is shown in Participants were first diagnosed with stroke by an experienced neurological physician through CT or MRI. After receiving an explanation of the experimental protocol, the participants were required to sign a written informed consent form to participate in this study.The GG performed GSEs for 4 weeks (5 times a week) and each exercise lasted for 5 min. After the first 2 exercises, there was a 10 min rest. The entire session lasted 30 min .The training was conducted in inpatient department settings with white walls as the background to reduce visual interference with the attention of the participants. The participants remained standing during the training, except for the rest. An experienced nurse closely observed changes in the participant during the intervention and carefully inquired whether the participant had any discomfort or any problems.Both the GG and CG were provided with physical therapy treatments for 30 min (including a 10 min rest), once a day, 5 days a week, for 4 weeks. The treatment plan was designed to improve postural stability and mobility through (1) standing balance training, (2) weight shifting training, (3) walking training, (4) muscle strength training, and (5) step-up-and-down training. Both groups received physical therapy treatments of the same difficulty.The Berg Balance Scale (BBS): The BBS is a 14-item scale that quantitatively assesses balance and risk for falls through direct observation of their performance. It is highly sensitive to changes in people following stroke . PatientTimed Up and Go test (TUGT): The TUGT measures the time taken for a patient to get out of a chair, walk straight for 3 m, turn, walk back to the chair, and sit down  TUGT is The other secondary outcomes were assessed by the ODONATE gait analysis system , which is highly reliable and valid in gait analysis, according to a previous study . A threeGait analysis: The gait analysis results include the stance phase (ST) of both sides, swing phase (SW) of both sides, and absolute symmetry index (ASI):The value of ASI represents the degree of asymmetry. An ASI value equal to 1 reflects full symmetry. ASI was calculated for ST and SW (ST-ASI and SW-ASI).Plantar pressure: During the evaluation process, the participants needed to wear a special pressure insole and step on the pressure mat. The plantar pressure was determined using a pair of sensors attached to the pressure insole. The proportion of the plantar pressure of the affected foot  and envelope ellipse area  of each participant was obtained by standing neutrally on the pressure mat for 20 s with eyes open and then 20 s with eyes closed. They were used to measure the supporting capacity and stability of the participants in static standing .During dynamic walking, the anterior–posterior velocity of each participant’s center of pressure displacement  reflects the ability of dynamic balance and mobility of the participants and was determined by the binocular vision sensor measurement camera and the pressure sensors .t-test for quantitative variables and the chi-square test for qualitative variables. Within-group differences in pre-and post-training that were normally distributed were analyzed using paired t-tests. One-way ANOVA was used to compare between-group differences in pre-and post-training. Effect sizes were determined by converting partial eta-squared (η2p), which was the most frequently used [The IBM SPSS Statistics software  was used for statistical analysis. Normality was checked using the Shapiro–Wilk test. Baseline characteristics were compared among groups using Student’s tly used . For thop > 0.05). During the study period, no adverse events were observed.The characteristics of the participants are presented in p < 0.001) was significantly different between CG and GG and improved compared to pre-training  was significantly different between CG and GG and improved compared to pretraining  and SW-ASI  of the GSEs group were significantly decreased between groups and compared to the pretraining values.Gait characteristics are mentioned in p > 0.05). In some cases, differences between the two groups were not normally distributed, and nonparametric statistical tests were applied for these variables, denoted with a superscript m in the last column of p = 0.018), APCOPV-AS , EEA-EC , PPF-EO , and PPF-EC  between groups (p < 0.05). In the GG, APCOPV-AS, PPF-EO, and PPF-EC varied significantly post-training than in the pretraining stage, but this was not so in the CG group (p < 0.05).At baseline, no statistically significant difference was observed between the two groups (This study provides a unique insight into the influence of GSEs on the balance function, gait, and plantar pressure of people following stroke. The findings suggest that after four weeks of GSEs, the swing phase of the affected side, the ASI of the swing phase, and the envelope ellipse area of the GSEs group had significantly decreased when the eyes closed. Furthermore, compared to the control group, the BBS scores, the anterior–posterior COP displacement velocity of the affected side, and the plantar pressure proportion of the affected side of the GSEs group had significantly increased after GSEs.Stroke-related motor, sensory, and visual deficits are associated with mobility impairments . Such moIn post-stroke gait, the asymmetric pattern with higher kinetic involvement of the unaffected side may be a specific adaption to the initial and ongoing paresis of the affected side. This adaptation may involve both automatic and intentional cognitive processes, to provide support, balance, and progression purposes . The asyOwing to their reduced movement, people following stroke show asymmetrical plantar pressure distribution and excessive postural sway while standing. The sway of their bodies increased approximately two-fold and their ability to stabilize decreased compared to the static standing posture of normal subjects. This increased swaying of the body in static standing leads to asymmetrical loading of the weight on both lower extremities and decreases the ability to move the center of gravity toward the affected side, which leads to instability of gait, decreased gait speed, and increased risk of falls . After GPost-stroke patients also tend to have insufficient supporting ability and reduced ability to shift the center of gravity on the affected side. Kamono and Ogihara demonstrated that the support phase duration of the stroke-affected leg is much shorter than that of the contralateral leg at low walking velocities . ConsequThe process of GSE implementation is convenient and can be performed in many settings, such as a home-based environment or virtual reality, and requires less manpower and resources. Therefore, gaze stabilization exercises may be incorporated into any rehabilitation program with significant gains in improving balance and mobility.This study had a few limitations that need to be acknowledged. First, the sample size was relevantly small, so some data did not fit a normal distribution. Second, GSEs may have different influences on specific stroke lesions, such as the vestibulospinal tract and the parietoinsular vestibular cortex. The basal ganglia, the cerebellum, the hippocampus, and subdivisions of the thalamus are all suggested to be part of the visual–vestibular network . Hence, The present study demonstrated that GSEs combined with physical therapy treatments can improve the gait and balance function of people following stroke. Furthermore, it can improve the weight-shifting and one-leg standing capacity of the affected side, thus reducing the risk of falls.


Patients with masked hypertension are at an elevated risk of cardiovascular events and all-cause death. This risk is close to that of sustained hypertension. The mean value and short-term variability of systolic blood pressure are considered to be risk factors for organ damage in hypertension.  To investigate the mean value and short-term variability of systolic blood pressure in patients with masked hypertension.  According to the results of in-clinic and ambulatory blood pressure measurement, participants were divided into four groups: normotension group, controlled hypertension group, masked hypertension group, and sustained hypertension group. The mean value and short-term variability of systolic blood pressure of masked hypertension group were evaluated by comparison with the other three groups. P < 0.05), while the rate of the nocturnal systolic blood pressure decline was lower (P < 0.05). There were no statistically significant differences in the above indexes between the masked hypertension group and sustained hypertension group (P > 0.05).  A total of 250 subjects were enrolled, with an average age of 65.46 ± 8.76 years, and 166 (66.4%) were male, including 62 in the normotension group, 78 in the controlled hypertension group, 69 in the masked hypertension group, and 41 in the sustained hypertension group. Compared with the normotension group and controlled hypertension group, the mean value, blood pressure load, standard deviation, and coefficient of variation of systolic blood pressure over 24 hours and during the day and night, were all higher in the masked hypertension group ( There are higher mean value of systolic blood pressure and greater short-term variability in masked hypertension patients. Identification of masked hypertension is an important challenge in the clinic. Masked hypertension (MH) has recently been identified as a unique hypertension phenotype that occurs in both treated and untreated patients. MH is characterized by an elevated blood pressure when the patient is out of the clinic but a normal blood pressure when the patient is in the clinic. MH accounts for at least 15% of people with apparently normal blood pressure in the clinic , but repAlthough the harm of MH has been well recognized, limited research studies on the characteristics of systolic blood pressure (SBP) are available. Notably, multiple studies have shown that the elevated SBP impacts the risks of all-cause mortality, heart failure, stroke, and end-stage renal disease more than diastolic blood pressure does –7. AccorThere are a few studies analyzing the differences of blood pressure variability among different phenotypes of hypertension , 9. HoweA cross-sectional study was performed. Information was collected from patients hospitalized in Beijing Tongren Hospital whose vitals were stable from July 2020 to July 2021. This study was approved by Beijing Tongren Hospital Ethics Committee (no. TRECKY2021-192).2); (11) severe infectious diseases or autoimmune diseases; and (12) malignant tumors; mental disorders. Participants were constantly enrolled in the study. A total of 250 participants were eligible. All participants were collected a completed medical history survey and underwent laboratory examination and ambulatory blood pressure monitoring.Details on the inclusion and exclusion of participants are shown in A questionnaire was completed by participants and then verified by the study physician. The questionnaire items included demographic information, educational background, lifestyle , types of antihypertension drugs and years medications were used, other complications, and family history. The use of alcohol was defined as having consumed alcohol more than 12 times in the past 12 months . PhysicaStandard instruments were used for all measurements. Anthropometry included height, weight, body mass index (BMI), and blood pressure. Biochemical tests included fasting blood glucose (FBG), HbA1c, triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C). The morning after an overnight fast, blood samples were collected from the forearm vein into vacuum tubes containing EDTA. FBG was measured by the hexokinase method. Determination of cholesterol and triglycerides were performed by enzymatic methods using commercially available kits .Participants were instructed to rest in the sitting position for at least 5 minutes prior to measurements. Blood pressure was measured on the same arm throughout the study with a Hem-7051 blood pressure monitor . For each measurement, three consecutive blood pressure readings were obtained, and the average of these blood pressure readings was submitted to the clinic.An ambulatory blood pressure monitor  was installed on the passive arm of each participant to automatically measure and record blood pressure. In the daytime, it was programmed to perform measurements every 20 minutes between 08:00 and 22:00. In the nighttime, it was programmed to perform measurements every 60 minutes after 22:00. Participants wore the ambulatory blood pressure monitor for 24 hours. If a record contained 70% of the programmed readings, the coverage time was greater than 20 hours and there were at least 20 readings during the day and at least 7 readings during the night, the record was considered effective [The participants were divided into four groups according to in-clinic and ambulatory blood pressure values as guided by guidelines . The fouX ± SD, and the analysis of variance was used. The data that did not conform to a normal distribution were represented by the M  and were analyzed by the Mann–Whitney U test and the Kruskal–Wallis test. All factors were subjected to bilateral tests. Differences for which P < 0.05 were considered to be statistically significant.The data were recorded by two people and consistency test was carried out. EpiData 3.1 was used to input data. The SPSS 22.0 statistical software was used to process descriptive statistics and difference analyses. Counting data were described by frequency distributions and were analyzed by chi-square tests. After a Kolmogorov–Smirnov normality test, the measurement data conforming to a normal distribution were expressed as‾A total of 250 participants were included in this cross-sectional study. The average age of participants was 65.46 years, and 166 (66.4%) of the participants were male. The normotension group included 62 cases, the controlled hypertension group included 78 cases, the MH group included 69 cases, and the SH group included 41 cases. There were statistically significant differences in age, gender, BMI course of hypertension, number of antihypertension drugs, status of diabetes, and hyperlipidemia as well as levels of TG, FBG, and HbA1c among the four groups .P < 0.05). The rate of the nocturnal SBP decline was lower in the MH group compared with both the normotension group and the controlled hypertension group. The above indexes regarding SBP in the MH group were not statistically different from those in the SH group (P > 0.05).The SBP parameters of ambulatory blood pressure monitoring among four groups are summarized in In this study, we found that, as compared with participants with normal blood pressure or controlled hypertension, those with MH had a higher average value and blood pressure load and a higher standard deviation and coefficient of variation of SBP over all tested time frames. The rate of the nocturnal SBP decline was lower in participants with MH. These results suggest that the level of SBP and its short-term variability during all time periods (including night) are higher in patients with MH than in those with normal blood pressure. These differences support the idea that the blood pressure of people with MH, are in fact different from those of people with truly normal blood pressure. In addition, these differences in blood pressure suggest that their prognosis must be different. Therefore, it is important that we should pay much attention to identifying patients with MH.In this study, we found that MH patients had generally a high SBP level, which would be expected to negatively impact blood vessels and to result in subsequent damage to multiple organs. High SBP has also been associated with the progression of arteriosclerosis. For example, in a meta-analysis, after adjusting for demographic indicators, a correlation was found between SBP and arteriosclerosis progression. Specifically, after adjusting for age, patients' pulse wave velocity was shown to increase by 1.14 m/s for every 20 mmHg increase in SBP. However, the correlation between mean arterial pressure or diastolic pressure and pulse wave velocity was weak . ArterioWe also found that MH patients have high SBP variability, which also helped to explain the previously reported high cardiovascular risks in MH patients. Multiple studies have demonstrated the links between SBP variability and risks of coronary heart disease, stroke, end-stage renal disease, and all-cause death that are stronger than SBP itself –19. The On the other hand, although the effect of arteriosclerosis on blood pressure variability is not fully understood, the possibility of an alternate direction of causation cannot be ruled out. A major determinant of blood pressure variability depends on baroreceptor sensitivity . When thThis study had several limitations. First, the sample size of this study was small, and the participants were recruited from a city where inhabitants tended to receive optimal medical care, potentially leading to a certain survey bias. In the future, we plan to recruit participants from different regions of the country to further verify our conclusions. Second, the participants might have some activities during ambulatory blood pressure monitoring, which may affect the accuracy of the results and lead to a certain measurement bias. It is best to repeat ambulatory blood pressure monitoring in the future to ensure the accuracy of the results.MH is a common state of hypertension. We found that the level and variability of SBP over the course of 24 hours and specifically during the daytime and nighttime in people with MH were higher than those in people with normotension or controlled hypertension. In addition, those indexes in people with MH were similar to people with SH. These findings may help to explain why people with MH have target organ damages that are similar to people with SH. However, it is often difficult to identify MH patients because of normal blood pressure in the clinic, which can lead to a relatively poor prognosis when finally diagnosed. Therefore, it is important to pay much attention to developing strategies to increase the clinical detection rate of MH. Screening, diagnostic, and treatment strategies need to be further explored. The results of this study suggest future studies to explore whether reducing the SBP level and variability in MH patients can improve clinical outcomes.


It is anticipated that the phase III trial in the United States will begin in 2023. Thus, we have demonstrated that α2 ARs could be suitable targets for treating or managing hypovolemic/hemorrhagic shock. Further understanding of ARs in shock would help find new potential pharmacological targets.Shock is a severe, life-threatening medical condition with a high mortality rate worldwide. All four major categories of shock —hypovolemic, distributive, cardiogenic, and obstructive, involve a dramatic mismatch between oxygen supply and demand, and share standard features of decreased cardiac output, reduced blood pressure, and overall hypoperfusion. Immediate and appropriate intervention is required regardless of shock type, as a delay can result in cellular dysfunction, irreversible multiple organ failure, and death. Studies have shown that dysfunction and downregulation of adrenergic receptors (ARs) are often implicated in these shock conditions; for example, their density is shown to be decreased in hypovolemic and cardiogenic shock, while their reduced signaling in the brain and vasculature decrease blood perfusion and oxygen supply. There are two main categories of ARs, α, and β, each with its subtypes and distributions. Our group has demonstrated that a dose of .02 mg/kg body wt of centhaquine (CQ) specifically activates α2B ARs on venous circulation along with the central α2A ARs after hypovolemic/hemorrhagic shock. Activating these receptors by CQ increases cardiac output (CO) and reduces systemic vascular resistance (SVR), with a net increase in blood pressure and tissue perfusion. The clinical trials of CQ conducted by Pharmazz Inc. in India have demonstrated significantly improved survival in shock patients. CQ improved blood pressure and shock index, indicating better blood circulation, and reduced lactate levels in the blood compared to in-use standard resuscitative agents. After successful clinical trials, CQ is being marketed as a drug (Lyfaquin Shock is the clinical manifestation of extreme dysoxia. Dysoxia is a lack of oxygen supply to, or lack of oxygen used by cells, which limits energy production and leads to cellular dysfunction. Prolonged and/or severe dysoxia can result in an imbalance between oxygen supply and demand at the organ and organ system level, which, if left unchecked or corrected in an untimely or inappropriate manner, causes multiple organ dysfunction and multiple organ failure (MOF) . While avia Gi protein. On the other hand, α1-ARs activation stimulates phospholipase C to generate diacylglycerol and inositol trisphosphate (IP3) mediated by a pertussis toxin-insensitive G protein termed Gp  (The autonomic nervous system (ANS) is known to reflexly regulate MAP through efferent (sympathetic and or parasympathetic) nerves, which affect cardiac output, vasoconstriction, or vasodilation to change the SVR or TPR. The activity of these nerves is mediated through various catecholamines and their adrenergic receptors (ARs). Catecholamines and ARs work through at least four potential mechanisms. First, AR signaling affects blood pressure through actions on the central nervous system; second, by directly controlling the cardiovascular tone; third, by modulating renal sodium flux; fourth, by affecting renin release and modulating the renin-angiotensin-aldosterone system . The catx or Gz) . Moreovex or Gz) . TherefoThe main role of adrenergic receptors is to facilitate the necessary physiologic changes to body systems to promote survival in times of “crisis.” This crisis can be physiological or pathophysiological, as the compensation in times of shock illustrates. As previously discussed, α-adrenergic receptors play an important role in sympathetic response and vasoconstriction, leading to increased effective circulating volume (ECV)  while aln = 5), who were suffering from prolonged and therapy-refractory shock before they started this treatment. Three out of five patients showed an increase in blood pressure and recovered, while two died (n = 75) compared to patients treated with standard antiseptic shock measures (n = 76). Moreover, the esmolol-treated patients had no hazardous effect on circulatory function or perfusion. In times of shock, there is a lack of oxygen, that is, present or dysoxia. As this occurs, the body attempts to compensate by stimulating ARs through α and β stimulation to increase oxygen delivery to tissues, specifically the vital tissues of the brain and heart. Through α ARs stimulation, there is a compensatory increase in blood pressure and effective circulating volume; through β stimulation, there is a compensatory increase in heart rate and contractility. Concomitantly, RAAS activation through decreased renal perfusion mediated by vasoconstriction caused by α receptors, which promotes sodium and water retention, further increasing ECV in an attempt to shunt more oxygen to the brain and heart. As this compensation continues, other organs are starved of nutrients and oxygen, leading to local arteriolar dilation to increase flow to those areas. This flow is postulated to indicate endothelial dysfunction in the brain that initiates the process of decompensated shock . The protwo died . In 2006two died . Schmitt− mouse but not in α2B− or α2C− mouse  to 4 h (p = 0.0494) after resuscitation. After 3 days of resuscitation, significantly higher percentage (69.35%) of CQ patients than control patients (46.88%) had blood lactate level 1.5 mm or less. After 28 days, we observed significantly lower mortality (2.94%) in CQ group than control group (11.76%). CQ patients also showed an increase in PP and SBP. A significant increase in PP in the CQ group suggested improved stroke volume due to CQ resuscitation. A significantly greater number of patients had improved base deficit in CQ than the control group. Also, an 8.8% absolute reduction in 28-day all-cause mortality was observed in the CQ group along with improved acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) scores (N = 56) and 2.20% in the CQ group (N = 91) (p = 0.03), which indicated statistically significant reduction in mortality in CQ group (®) for hypovolemic/hemorrhagic shock in India (Distribution of α2A and α2B ARs varies based on the vascular bed and size of the vessels and species . Large a) scores . The metCQ group . Based oin India , and a pp = 0.024) of hypoxia-inducible factor 1a (HIF-1α) and reduced (p = 0.03) mitochondrial DNA damage than control rats. We also observed reduced acute kidney injury and apoptosis in kidneys in CQ rats  are required to regulate the shock-induced decompensatory vasodilation and reestablish blood circulation, vascular volume and improve survival in different types of shock.The common characteristics of the decompensatory phase of various types of shock include compromised cardiovascular activities with severe hypotension. Resuscitation with several vasopressors has demonstrated encouraging results, with an increase in vasocontraction and MAP at the initial phase of resuscitation. However, the complex sympathetic and parasympathetic signaling mediated through various ARs complicates the outcomes. Hence, for a better understanding of shock etiology and adrenergic receptor physiology, pharmacological interventions must be investigated for their efficacious use in the treatment and prevention of decompensated shock. Our group has addressed this issue by exploring the effect of α2 specific agonist, CQ, in hypovolemic/hemorrhagic shock. CQ activates α2B and α2A ARs, causing an increase in CO and a decrease in SVR with net results of increased blood pressure as well as tissue perfusion. It also helps in reducing blood lactate levels and improves survival. The clinical trials of CQ conducted in India demonstrated significantly improved survival, improved blood circulation, and reduced lactate level in shock patients compared to in-use standard resuscitative agents. Thus, α2 ARs could be suitable targets for treating or managing hypovolemic/hemorrhagic shock. Nonetheless, a deeper investigation of ARs and pharmacologic modulation of ARs using potent agonists like centhaquine (Lyfaquin


Lithium is well recognized as the first-line maintenance treatment for bipolar disorder (BD). However, besides therapeutic benefits attributed to lithium therapy, the associated side effects including endocrinological and renal disorders constitute important parameters in prescribing patterns and patient adherence. The objectives of this study is to (i) determine whether long-term lithium therapy is associated with a decrease in renal function, hyperparathyroidism and hypercalcemia and (ii) identify risk factors for lithium-induced chronic kidney disease (CKD).We conducted a single-centered cohort study of adult patients (≥ 18 years) treated with lithium, who were enrolled at Rennes University Hospital in France between January 1, 2018 and June 1, 2020. Required data were collected from the patient’s medical records: demographics characteristics , biologic parameters , medical comorbidities (hypertension and diabetes), lithium treatment duration and dosage, and length of hospitalization.A total of 248 patients were included (mean age: 60.2 ± 16.5 years). Duration of lithium treatment correlated with (i) deterioration of renal function estimated at − 2.9 mL/min/year (p < 0.0001) and (ii) the development of hyperparathyroidism (p < 0.01) and hypercalcemia (p < 0.01). We also noted that patients with lithium blood level > 0.8 mEq/mL had significantly lower GFR than patients with lithium blood level < 0.8 mEq/mL . Neither diabetes mellitus nor hypertension was associated with more rapid deterioration of renal function.This study suggests that the duration of lithium treatment contribute to the deterioration of renal function, raising the question of reducing dosages in patients with a GFR < 60 mL/min. Overdoses has been identified as a risk factor for CKD, emphasizing the importance of regular re-evaluation of the lithium dose regimen. Also, long-term lithium therapy was associated with hyperparathyroidism and hypercalcemia. Particular vigilance is required on these points in order to limit the occurrence of endocrinological and renal lithium adverse effects. Lithium is well recognized as the first-line maintenance treatment for bipolar disorder (BD) in all international clinical practice guidelines since it is effective in preventing relapses of mood episodes and in reducing risk of suicide  with an incidence that might be as high as 85%  is a much more debated issue in the literature, with various studies suggesting both a positive and negative relationship  determine whether long-term lithium therapy is associated with a decrease in renal function and hyperparathyroidism (ii) identify risk factors for lithium-induced nephrotoxicity.This study was designed as a single-centered. We conducted a cohort study of adult patients (≥ 18 years) on lithium, who were hospitalized for any cause more than 24 h in Rennes University Hospital in France between January 1, 2018 and June 1, 2020. No specific ethical approval was sought. All information used within the study was anonymized and not traceable to a single individual.We collected the required data from the patient’s medical records: demographics characteristics , biologic parameters (glomerular filtration rate (GFR), lithium blood level, parathormone (PTH) and calcium), medical comorbidities (hypertension and diabetes), lithium treatment duration and dosage. Only biological parameters at entry were considered. For lithium blood level assessment, blood samples from patients on once-daily lithium therapy were collected 24 h after the last dose, while blood samples from patients on twice-daily lithium therapy were collected 12 h after the last dose. GFR were estimated by CKD-EPI equations. Common nephrotoxic drugs at admission and discharge considered in this study (and listed according to the literature) are displayed in Table p < 0.05 in all cases.The significance of intergroup differences [expressed as the mean ± standard error of the mean (SEM)] was determined using an unpaired t-test. A chi-squared test was used to compare percentages. Linear regression analysis was used to assess the relationship between biological variables  and time of lithium exposure. Multiple regression analysis were used to adjust GFR for age, sex, number of nephrotoxic medications, hypertension, diabetes and of time of lithium exposure. All analyses were performed using Prism software . The threshold for statistical significance was set to A total of 248 patients were included. Table 2 and 70 patients (28.8%) developed CKD stage 3 or more severe (CDK < 60 mL/min/1.73 m2). Eight patients reached ESRD at median age of 59 (± 11.3) years.Mean lithium therapy duration was 10.6 ± 10.9 years corresponding to an estimated cumulative lithium dose of 2221 ± 2570 g per patient. The mean CKD-EPI was 77.5 ± 31.9 mL/min per 1.73 mMean lithium serum levels was 0.9 ± 0.8 mEq/L. Slightly more than 31% of the patients had a lithium blood level within the norms (i.e. between 0.5 and 0.8 mEq/L) while 37% were overdosed and 31% underdosed. More than half of patients [n = 133 (53.6%)] had no lithium blood level checked during their hospitalization. Regarding the distribution of the lithium dose, more than 86% of psychiatrists prescribe it in a single daily dose, 12% in 2 daily doses and only 2% in 3 daily doses. Lastly, the median age of the extended-release lithium group was significantly lower than the immediate-release lithium group .Table Interestingly, decreased in renal function was non-significantly associated with a decrease in the average number of nephrotoxic drugs per patient Table .Table 4NEstimated creatinine clearance inversely correlated with the length of lithium therapy Fig. A p < 0.B  and 30 (17.6%) patients had hypercalcemia (> 2.5 mmol/L). Parathyroid hormone (PTH) level was measured in 37 patients (51.5 ± 49.0 pg/mL). We found correlation between the number of years on lithium therapy and the increase in calcium (p = 0. 0049) and PTH (p = 0.0063)  were associated with renal function impairment. We found that age and time of exposure to lithium (but not diabetes mellitus or hypertension) emerged as risk factors for decreased renal function (p < 0.0001) Table .Table 5HIn this study, we showed that (i) long-term lithium therapy is associated with a decrease in renal function, hyperparathyroidism and hypercalcemia and that (ii) the risk factors identified for renal toxicity should lead to close monitoring of renal function in these patients.2  were not associated with a more rapid deterioration of renal function Table . In the Lastly, it is known that there are several medications which can interfere both with serum lithium levels and renal function whose use needs to be closely monitored. Amongst these include the use of non-steroidal anti-inflammatory drugs, angiotensin-converting enzyme inhibitors, and thiazide diuretics while loop and potassium-sparing diuretics are generally considered to cause less disruption to serum lithium levels , associated with education of the patient regarding co-medications or the procedure to follow in case of signs of overdose or dehydratation.Overall, precautions to be taken in case of lithium treatment include:Lithium therapy result in increased risk of CKD overtime, raising the question of reducing dosages in patients with a GFR < 60 mL/min. Overdoses has been identified as a risk factor for CKD, emphasizing the importance of regular re-evaluation of the lithium dose regimen. Although difficult to implement, a prospective study would be interesting in order to identify more easily the impact of comorbidities and comedications on the evolution of renal function, which did not emerge in our study.


Chronic kidney disease (CKD) is a common chronic condition with high incidence and insidious onset. Glomerular injury (GI) and tubular injury (TI) represent early manifestations of CKD and could indicate the risk of its development. In this study, we aimed to classify GI and TI using three machine learning algorithms to promote their early diagnosis and slow the progression of CKD.Demographic information, physical examination, blood, and morning urine samples were first collected from 13,550 subjects in 10 counties in Shanxi province for classification of GI and TI. Besides, LASSO regression was employed for feature selection of explanatory variables, and the SMOTE (synthetic minority over-sampling technique) algorithm was used to balance target datasets, i.e., GI and TI. Afterward, Random Forest (RF), Naive Bayes (NB), and logistic regression (LR) were constructed to achieve classification of GI and TI, respectively.A total of 12,330 participants enrolled in this study, with 20 explanatory variables. The number of patients with GI, and TI were 1,587 (12.8%) and 1,456 (11.8%), respectively. After feature selection by LASSO, 14 and 15 explanatory variables remained in these two datasets. Besides, after SMOTE, the number of patients and normal ones were 6,165, 6,165 for GI, and 6,165, 6,164 for TI, respectively. RF outperformed NB and LR in terms of accuracy , sensitivity , specificity , and AUC  for both GI and TI; the four variables contributing most to the classification of GI and TI represented SBP, DBP, sex, age and age, SBP, FPG, and GHb, respectively.RF boasts good performance in classifying GI and TI, which allows for early auxiliary diagnosis of GI and TI, thus facilitating to help alleviate the progression of CKD, and enjoying great prospects in clinical practice. Chronic kidney disease (CKD) is a common chronic condition worldwide, with a prevalence of 13.4% , emerginIn 2012, Luxia Zhang employed logistic regression to predict CKD, but it comes with drawbacks . The firFeature selection is of great necessity in constructing classifiers, since the presence of irrelevant features may be responsible for the poor model performance . L1 reguIn this study, we aimed to (1) employ LASSO algorithm to conduct feature selection for GI and TI; (2) use the classical and widely accepted SMOTE (Synthetic Minority Over-sampling Technique) algorithm to handle the imbalanced classes of GI and TI; (3) employ the mature machine learning algorithm, Random Forest (RF) to make a classification of GI and TI, respectively, and compare its performance with logistic regression (LR) and Naive Bayes (NB), thus achieving the auxiliary diagnosis of GI and TI and providing a new idea for clinical practice in delaying the progression of CKD.Shanxi Provincial People’s Hospital conducted CKD screening for permanent residents aged ≥ 40 years in the northern region of Shanxi Province (Ningwu County), the central regions , and the southern regions  from April 2019 to November 2019. A total of 13,550 residents volunteered for this screening, and 12,285 were eventually enrolled in the study, including 5,206 men and 7,079 women aged 41–91 years.Inclusion criteria: (1) residents aged 40 years or older; (2) conscious participants without communication impairment; (3) participants understanding the significance of the study and willing to sign a written informed consent; (4) participants with no cognitive impairment or mental illness; (5) more than 1 year of local residents as of the survey date. Exclusion criteria: (1) Severely incomplete information recorded; (2) poor compliance; (3) pregnant women or those with a history of substance abuse.Questionnaires, physical examination, and laboratory analysis were used to collect data. (1) The questionnaire comprised demographic information , lifestyle . The questionnaire was administered online and completed by the subjects themselves or their family members. (2) Physical examination included height, weight and blood pressure , which were measured twice and then the mean value was calculated. All data were measured by a medical professional. Body mass index (BMI) was calculated by weight in kilograms divided by the square of height in meters.(3) Fasting venous blood was collected from subjects for fasting blood glucose (FPG), glycated hemoglobin (GHb), homocysteine (Hcy), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein (HDL-C). (4) Morning urine specimens were collected from subjects. After centrifugation at 3,000 r/min for 10 min, the supernatant was extracted (low-speed centrifuge Anhui Zhongke Zhongjia SC3616), and α1-microglobulin (α1MG), urinary creatinine (UCr), and microalbuminuria (MAU) were determined by latex turbidimetry, sarcosine oxidase, and immunoturbidimetry, respectively.2), normal weight (18.5–24.0 kg/m2), overweight (24.0–28.0 kg/m2), obesity (≥28 kg/m2). ACR was defined as urinary microalbumin divided by urinary creatinine multiplied 8.84; MCR was defined as urinary microglobulin divided by urinary creatinine multiplied 8.84.Information on the annual income, educational levels, health history, and lifestyle of the study participants was obtained from the questionnaire. Annual income was defined as < 5K yuan, 5K–10K yuan, 10K–20K yuan, > 20K yuan; education levels were defined as ≤ primary school, ≤ middle school, ≤ high school, ≥ bachelor’s degree; smoking was classified as yes or no; alcohol consumption was classified as always (>100 g/time and 3 times/week), sometimes (<3 times/week or < 100 g/time) and rarely; exercise was classified as “none or a little” or “regular” . BMI was defined as underweight (<18.5 kg/m(1) Questionnaire: demographic information ; lifestyle . (2) Morning blood: HDL, LDL, TG, TC, Hcy, FPG, GHb. (3) Physical examination: SBP, DBP, BMI. 20 variables in total.ACR ≥ 30 mg/g was defined as GI; MCR > 23 mg/g was defined as TI. The presence of GI, TI was assigned 1; otherwise, they were defined as 0. In this study, we employed RF, LR and NB to make a classification of GI and TI, respectively.Absolute Shrinkage and Selection Operator (LASSO) is one of the common methods for feature selection. It is characterized by the inclusion of an L1 regularization penalty term in fitting generalized linear regression, which makes the sum of the absolute values of the regression coefficients of the model lower than a particular value. It aims to minimize the sum of squared residuals, forcing the regression coefficients of variables that contribute less to the model to be compressed to zero and achieving a feature sparse process , 15. LASThe Synthetic Minority Over-Sampling Technique (SMOTE) is an oversampling technique that is an effective algorithm for dealing with imbalances between data classes . It’s emRF, a data-driven integrated learning algorithm, could obtain multiple new training data by an autonomous sampling of the training set, constructing multiple classification trees based on the parallelization of these new data, and achieving de-correlation between the trees by introducing the selection of independent variables. By doing so, the diversity of the classification trees originates from both sample and independent variable perturbations to achieve the effect of reducing the model variance, and finally to vote on the classification results of multiple trees to obtain the final classification results , 24. TheSD) or median ± interquartile [)], as appropriate.Qualitative data are expressed as percentages (%), and quantitative data are expressed as mean ± standard deviation (M±The datasets were divided into training set (80%) and testing set (20%). The former ones were used for models training, i.e., RF, NB, and LR, while the latter ones were employed for evaluation of model performance. All analyses were implemented in R software (version 4.0.3).The evaluation parameters comprised Accuracy (1), Specificity (2), Sensitivity (3) and area under the receiver operating curve (AUC). The predicted result was defined as True Positive (TP) when patients with renal conditions were classified as patients and True Negative (TN) when healthy ones were classified as healthy. Besides, the predicted result was False Positive (FP) if healthy subjects are considered patients; similarly, False Negative (FN) if patients are considered healthy subjects. Accuracy is to evaluate how accurate the machine learning algorithms are to detect what it is supposed to measure. Specificity is the ability to correctly exclude those without renal conditions and Sensitivity is to correctly identify those with renal conditions.A total of 12,330 people were included in this study, 5,230 men and 7,100 women, the number of GI was 1,587 (12.8%) and the number of TI was 1,456 (11.8%). Besides, the number of participants with both GI and TI was 2,439 (19.7%). Other parameters are detailed in As shown in As shown in When constructing model for GI, the number of GI and non-GI in the training set were both 4,932, and 1,233 in the testing set, respectively. When constructing model for GI, the number of TI and non-TI in the training set were 4,973 and 4,891, respectively, and 1,273 and 1,192 in the testing set. The accuracy, sensitivity, specificity and AUC of RF for classification of GI and TI performed better than NB and LR in both the training set and testing set, which shows that RF does have a high diagnostic value for classification .We indicated the contribution of the explanatory variables to the model by %IncMSE, and the larger the %IncMSE, the more important the variables were for the RF model. The four variables that contributed most to the classification of GI in the RF model represented SBP, DBP, sex, and age. The four variables that were most important for the classification of TI constituted age, SBP, FPG, and GHb .In this study, ACR and MCR levels were used as screening indicators for GI and TI, and ACR ≥ 30 mg/g was considered GI; MCR > 23 mg/g was considered TI. Besides, the machine learning model RF was used to classify them, and we compared its classification performance with NB, and LR.This study suggested that the accuracy, sensitivity, specificity and AUC of the RF algorithm outperformed other classifiers in both the training set and testing set. Yet its performance in the testing set was comparatively lower than that in the training set, because the classification performance based on the training set was prone to overfitting , while tOf note, the RF model is sensitive to response variables with unbalanced data. Imbalanced classes in the data would leave the output of the model tending to larger classes, causing some classification errors, and leading to a less accurate classification performance . As suchSince RF model is data-driven, a visible functional equation is unavailable to determine the extent to which the explanatory variables contribute to the model based on the regression coefficients. However, a more intuitive alternative for the model is that by outputting feature importances, the model could explain the importance of the variables on the explanatory variables. This study demonstrated that the four explanatory variables with the greatest output weight of RF classifier for GI represented SBP, DBP, sex, and age; and the four explanatory variables for TI constituted age, SBP, FPG, and GHb.In a hypertensive state, abnormal glomerular hemodynamics, spasmodic constriction of renal arteries would reduce renal blood flow, leading to renal ischemia and long-term hyperperfusion and hyperfiltration of glomerular capillaries, resulting in damage to glomerular vascular endothelial cells and podocytes , 27. Mea2 for the definition of CKD may lead to overdiagnosis of CKD in women (It has been documented that kidney disease in China is more prevalent in male patients, suggesting that sex is also one contributor to degenerative changes in kidney structure and function. The prevalence of CKD has been reported to be higher in women than in men. A representative study pooling 33 population-based studies worldwide evaluated the global prevalence of stage 1–5 CKD at 10.4% among men and 11.8% among women aged 20 years and older . The reain women . A folloin women . The effAfter the age of 40, the glomerular filtration rate decreases at a rate of 1 ml/min/1.73 per year, resulting in stiffening of the renal vessel wall, glomerular atrophy, sclerosis, tubular atrophy, and interstitial fibrosis, which eventually lead to renal hypofunction . In diabThere are also some limitations in this paper. Firstly, the study constructed the models with data from Shanxi Province, and no other external datasets are available to validate the model performance. Our ongoing work is to collect samples from other areas, to validate the generalization capabilities of the model. Secondly, this study was initially considered for cost-effectiveness and other indicators reflecting CKD were not collected, such as blood creatinine, which will also be the focus of our next step. Additionally, as CKD was more prevalent in people aged ≥ 40 years, this study centered on those over 40 years. In the future, we consider surveys on those aged 18–40 years to improve the prediction model in younger groups. Finally, GI and TI were defined only by surrogate parameters, ACR and MCR, which may not well accurately reflect the renal conditions. In our future work, we would conduct a follow-up for those with positive urine protein.In short, as early manifestations of CKD, GI and TI have emerged as a global public health issue; their early diagnosis and corresponding treatment are of great importance. Our results demonstrate the potential value of machine learning algorithms in GI and TI-assisted diagnosis, which facilitates reducing the workload of doctors, while achieving automated diagnosis and treatment decisions, and thus could be promoted in clinical practice.The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by the Ethics Committee of Shanxi Provincial People’s Hospital. The patients/participants provided their written informed consent to participate in this study.WS was responsible for the data analysis and the writing of the manuscript. XZ, QD, QW, and YahL helped polish the manuscript. AL, WZ, LS, LQ, and RL gave precious advice on the statistical methods. YafL was responsible for the conception and design of the research. All authors read and approved the final draft.


A statistically significant positive linear correlation was found between plasma sodium concentration and daytime systolic BP variability  as well as between plasma sodium concentration and nighttime diastolic BP variability . The preliminary results suggest the probable relationship between the lower plasma concentration of sodium and increased intensity of SB and BP variability among suspected sleep bruxers.Plasma sodium plays a major role in regulating blood pressure (BP). An augmented variability of BP is considered a risk factor for the development of arterial hypertension, which is prevalent among patients with suspected sleep bruxism (SB). The aims of this study were to assess the plasma concentration of electrolytes and their effect on the intensity of SB and BP variability among sleep bruxers. A total of 51 patients were enrolled in this prospective, observational study. A single full-night polysomnographic examination was conducted in the Wroclaw Medical University Sleep Laboratory, Poland, and based on the guidelines of the American Academy of Sleep Medicine, the results were analyzed. The monitoring of ambulatory BP was performed the next day, and the plasma levels of sodium, potassium, magnesium, and calcium were measured. The mean age of the studied group was 33.9 ± 11.2 years, and the mean bruxism episode index (BEI) was 4.94 ± 3.53. The study revealed statistically significant differences in the plasma concentrations of sodium in the SB group. A decreased sodium concentration was observed in the group of mild bruxers (2 ≤ BEI < 4) (139.7 ± 1.4 vs. 142.8 ± 3.2,  The plasma level of sodium plays a major role in regulating blood pressure (BP). Evidence suggests that even small increases in plasma sodium concentration may directly affect BP . This caThis study aimed to assess the plasma concentration of electrolytes and their effect on the intensity of SB and BP variability among suspected sleep bruxers. The null hypothesis that was set before the study started was that plasma sodium concentration has an association with BP in SB. The primary aim was to evaluate the association of electrolytes plasma concentration level on the fluctuations of blood pressure among sleep bruxers.n = 19), the severe bruxism group , and the control group that did not present bruxism events . This study was approved by the Wroclaw Medical University Bioethical Committee, Poland (no. ID KB-407/2022) and was conducted in accordance with the Declaration of Helsinki. All patients signed an informed consent form before participation.In this prospective, observational study, a total of 51 patients were recruited by qualified dentists in the Clinic of Prosthetic Dentistry, Department of Prosthetic Dentistry, Wroclaw Medical University, Poland. The main inclusion criterion for the patients to be included in the study was the diagnosis of suspected SB based on positive clinical inspection . ExaminaThe included patients were referred to video polysomnography in the Sleep Laboratory of the Department and Clinic of Internal Medicine, Occupational Diseases, Hypertension and Clinical Oncology at the Wroclaw Medical University, Poland. The inclusion criteria were age above 18 years, presence of probable SB, and written consent for examination. The exclusion criteria were the presence of severe mental disorders, active malignancy, respiratory and/or cardiac insufficiency, active inflammation, hypothyreosis, or chronic kidney disease; pregnancy; the use of medication that could affect the levels of sodium ) and neuromuscular function; and inability to undergo polysomnographic examination. While admitted to the Sleep Laboratory, blood samples were taken from patients by venipuncture, and the plasma concentrations of sodium (mmol/L), calcium (mg/dL), potassium (mmol/L), and magnesium (mg/dL) were determined at the main laboratory of the University Clinical Hospital, Wroclaw, Poland.Polysomnograms were assessed in 30-s epochs according to the American Academy of Sleep Medicine (AASM) 2013 standard criteria for sleep scoring using Nox-A1 . The bioelectrical function of the brain was recorded by electroencephalography; eye movements were evaluated by electrooculography; muscular tension was assessed from tibial electrodes (electromyogram); airflow was recorded from the nasal pressure sensor, and chest and abdomen movements were assessed by inductive plethysmography. The body position of the patient was recorded, and bilateral masseter electromyography (EMG) was also performed. SB was determined based on EMG, and the audio and video evaluation bruxism episodes were scored according to the standards of the AASM in the following three forms: phasic, tonic, and mixed. For SB, EMG bursts should not be separated by >3 s to be considered as part of the same episode, and the EMG activity had to be at least twice the amplitude of the background EMG. The scoring and manual analysis of the collected data were performed by a qualified physician (author HM) from the Sleep Laboratory, Wroclaw Medical University, Poland, in accordance with the AASM guidelines on the Noxturnal system ).The next day, after performing the polysomnographic examination, the BP of the patients was monitored for 24 h. The ambulatory blood pressure monitoring (ABPM) device  was installed by a qualified technician, and the measurement was performed according to the recommendations of the European Society of Hypertension . After thttps://www.naukowiec.org/dobor.html, accessed on 12 August 2020).Statistical analysis was conducted using the statistical software Dell Statistica Version 13 . For quantitative variables arithmetic means, standard deviations (SD), and range of values  were calculated for the estimated parameters in the studied groups. The distribution of variables was tested using the W–Shapiro–Wilk test. Following, in the comparative analyses of the mean values of quantitative variables, in cases of quantitative variables with normal distribution a one-way parametric ANOVA test was used. In cases of the absence of a normal distribution of variables, a one-way, non-parametric Kruskal–Wallis ANOVA was used to test the null hypotheses. First, the ranks of Kruskal–Wallis were analyzed. Then, in the case of statistical significance in the rank analysis, the differences between individual pairs of mean values were tested using the z-test for multiple comparisons. The study group consisted of patients with suspected bruxism, therefore the size of the fraction in the sample size calculator is 15% (the estimated frequency of bruxism in the population), then subgroups were separated taking into account the severity of bruxism—and compared in ANOVA. The calculator that was used was the online sample size calculator  post-hoc test. In order to detect an association between studied variables analysis of correlation was performed. In cases of quantitative variables with normal distribution, Pearson’s correlation coefficients r were estimated, whereas in cases of quantitative variables without normal distribution Spearman’s r coefficients were calculated. The results at the level of 2-sided n = 51) were classified into the following three groups: mild bruxism group , severe bruxism group , and control group without bruxism . The mean polysomnographic parameters of the study group are presented in The mean age of all subjects was 33.9 ± 11.2 years. The mean BMI of the studied group was 22.5 ± 3.9, which was within the normal range. The participants (2+ (mg/dL), K+ (mmol/L), Ca2+ (mg/dL)) did not show statistically significant differences among considered groups, which are shown in A comparison of the biochemical parameters of the patients demonstrated the statistically significant differences in plasma sodium concentrations among the studied groups . WhereasThe mean 24-h SBP was 109.86 ± 7.3 mm Hg, and the mean DBP was 68.26 ± 5.5 mm Hg in the entire study group. No statistically significant differences were observed between the various parameters of BP in mild (2 ≤ BEI < 4) and severe bruxers (BEI ≥ 4) compared to the controls. The various parameters of BP are presented in p < 0.05) as well as between sodium concentration and nighttime DBP variability . The correlations between blood pressure parameters and the concentration of sodium are presented in A statistically significant positive linear correlation was found between sodium concentration and daytime SBP variability (r = 0.32, The most important finding of this study was the decreased sodium concentration in sleep bruxers compared to nonbruxers. Moreover, a relationship between sodium level and BP variability parameters was found in the SB groups. SB is no longer considered a simple dental behavior of peripheral etiology but rather a complex neurological phenomenon of neurodegenerative and inflammatory etiology with cardiovascular consequences . Data coMoreover, serotonin receptors have an effect on BP along with playing a role in regulating the serum level of sodium . As statThis study did not show statistically significant differences in the concentrations of magnesium, calcium, and potassium in bruxers compared to the controls. The levels of electrolytes may be associated with the intensity of bruxism, and magnesium treatment has also been attempted ; howeverThe main strength of this study was the use of polysomnography, which is a gold standard in the diagnosis of SB. Moreover, the examination was conducted in controlled conditions of a sleep laboratory with video recording, which increases the accuracy of the SB diagnosis. The study also has the following limitations: plasma osmolality and the level of the antidiuretic hormone were not taken into consideration, and the size of the subgroup of nonbruxers was not large. The report is a preliminary report and definitely, a future examination in that field is needed. What is more, almost all Na- concentration was within the reference range of 135–145 mmol/L, and that would be very interesting to see whether there is a cut-off point there that the risk of SB increases with a lower concentration of plasma sodium.1.The plasma concentration of sodium was decreased in bruxers compared to nonbruxers.2.A relationship exists between plasma sodium concentration and BP variability among patients with SB.3.As the results are present in a preliminary study, there is a need for further studies on the pathomechanisms of SB and their relationship with electrolyte plasma concentration as well as the inflammation factors.


Objective: Coronary slow flow (CSF) is linked to myocardial ischemia, malignant arrhythmias, and cardiovascular mortality. On the other hand, hypertension (HTN) is an important risk factor for vascular disorders. There is limited research on the relationship between CSF and HTN. This study aimed to investigate TIMI frame count (TFC), which is an indicator of CSF, in dipper and non-dipper hypertensive individuals with normal coronary arteries.Methods: The study was conducted as a retrospective observational study. Patients diagnosed with CSF and dipper or non-dipper hypertension were included in this study. Blood tests were routinely conducted for all patients. ECG was conducted for each patient, and echocardiography was performed. Coronary artery images were obtained in the CAG laboratory. Blood pressure (BP) measurements were obtained from the ambulatory Holter records. The patients were separated into two groups based on ambulatory Holter monitoring. The relationship between CSF and HTN was also examined.Results: A total of 71 patients, comprising 25 women (37.2%) and 46 men (62.8%) with an average age of 52.75±9.42 years, were enrolled in the research. Based on ambulatory BP, the individuals were separated into two groups: non-dipper (n=36) and dipper (n=35). The pulse rate was significantly higher in the non-dipper group (p<0.001). In terms of mean systolic and diastolic blood pressure, there were no substantial differences across the groups . The daytime mean systolic and diastolic BP did not significantly differ across the groups (p = 0.842 and p = 0.421). The dipper group had substantially lower nighttime systolic and diastolic BP values (p <0.001). The LAD, Cx, and RCA TIMI frame scores were significantly lower in the dipper group (p<0.001).Conclusion: In this study, non-dipper patients had a greater CSF rate than dipper. Coronary slow flow (CSF) is defined as prolonged opacification of the distal artery in the absence of substantial angiographic coronary obstruction . ThromboCSF may generate angina-like chest pain during rest or exertion ,5. It haBlood pressure (BP) is highest in the morning, gradually decreases over the day, and remains lowest at night. According to ambulatory BP monitoring, dipper hypertension is diagnosed when nighttime BP drops by more than 10% compared to daytime values, whereas non-dipper hypertension is diagnosed when the reduction is less than 10% . HyperteWe aimed to investigate coronary slow flow in dipper and non-dipper hypertensive patients with normal coronary arteries.Study design and subjectThis retrospective study was conducted at a tertiary center between 2018 and 2022. Patients with chest pain who had normal coronary angiography and were diagnosed with arterial hypertension by ambulatory blood pressure monitoring were enrolled in this study. The CSF was determined by the AHA guidelines for coronary artery revascularization published in 2021 . SeventyStudy protocolBlood tests were routinely performed for all patients. ECG was conducted for each patient; and echocardiography was performed. The formula for calculating the body mass index (BMI) was weight divided by the square of height. Coronary artery images were obtained in the coronary angiography (CAG) laboratory. Blood pressure (BP) measurements were obtained from the ambulatory Holter records.DefinitionsThe ambulatory blood pressure device (DMS 300-3A Holter Recorder) was worn by trained and experienced personnel. Every 15 minutes between 07:00 and 23:00, and every 20 minutes between 23:00 and 07:00, blood measurements were taken. Using small time intervals, the interval from 10:00 to 22:00 was considered daytime, while the span from 24:00 to 6:00 was considered nighttime. Non-dipper HTN was classified as reducing less than 10% or remaining unchanged in the mean systolic and diastolic BP levels. Dipper HTN was classified as reducing more than 10% in the mean systolic and diastolic BP levels.The patients' coronary arteries were examined using the Philips Integris H 3000 angiography system . The TFC of individuals with normal coronary arteries was independently determined for each coronary artery. Nitrate was not supplied to any patient during CAG because it might have influenced the measurement findings. Coronary artery images were reviewed by two experts who were blinded to the research.StatisticsIBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. Armonk, NY: IBM Corp. was used for the analysis. Initial continuous variables are represented as mean ± standard deviation or median (interquartile range). The normality distribution of the variables was analyzed utilizing the Kolmogorov-Smirnov and Shapiro-Wilk tests. Frequencies and percentages were used to represent categorical variables. The chi-squared test or Fisher’s exact test was utilized for categorical variables. Student’s t-test or Mann-Whitney U-test was utilized to compare continuous variables, as appropriate. If the p-value was less than 0.05, all tests were deemed statistically significant.A total of 71 patients, comprising 25 women (37.2%) and 46 men (62.8%) with an average age of 52.75±8.22 years, were enrolled in the research. The patients' clinical characteristics were summarized in Table When their distribution according to disease states was examined, 12.6% had diabetes mellitus (DM), and 29.6% had hyperlipidemia. The smoking rate was found to be 53.5%. The mean BMI was 23.53±2.7, and the mean LVEF was 65.63±3.2. Beta-blockers were the most used anti-hypertensive drug, with a rate of 40.8%. Patients were separated into two groups based on ambulatory blood pressure: dipper (n=35) and non-dipper (n=36). There were no substantial differences in the hematological and biochemical parameters between the groups, as shown in Table The BMI was substantially higher in the non-dipper group p=0.032). Patients' 24-hour ambulatory blood pressure results were analyzed and evaluated (Table 2. PatienThe pulse rate was significantly higher in the non-dipper group (p<0.001). In terms of mean systolic and diastolic BP, there were no substantial differences across the groups . The daytime mean systolic and diastolic BP did not significantly differ across the groups . The dipper group had substantially lower nighttime systolic and diastolic BP values (p <0.001). The variations in systolic and diastolic BP were substantially higher among dippers compared to non-dippers (p <0.001). The mean TIMI frame score of the coronary arteries was calculated (Table The left anterior descending artery (LAD), circumflex artery (Cx), and right coronary artery (RCA) TIMI frame scores were substantially lower in the dipper group (p<0.001).The findings of the research revealed that TFC, which is an indicator of CSF, was higher in non-dipper hypertensive patients. The LAD, Cx, and RCA TIMI frame scores were significantly lower in the dipper group.Coronary circulation is typically observed in two compartments. The first compartment contains epicardial vessels, known as conducting vessels owing to their lack of resistance to blood flow. The second compartment is composed of the microvascular vessel, known as the resistance vessel, that controls myocardial blood flow . MicrovaGibson et al. suggested TFC as a straightforward and quantitative method for producing a standard coronary blood flow assessment indicator by analyzing angiographic data from the TIMI-4 trial . A high In a study by Xu et al., TIMI scores were higher in the hypertension group than in the normotensive group . When paCrea et al. reported that platelet count, high-sensitivity C-reactive protein, and serum uric acid were higher in hypertensive patients with CSF than in the control group . In receLimitationsThe study population was small. Tests for other biochemical and echocardiographic markers showing an association with the slow coronary flow were not performed. The diameters of the coronary arteries did not match. Vasoconstriction, which may result from an elevation in sympathetic tone, may have influenced the TIMI frame counts.In this study, TFC, an indicator of CSF, was observed to be higher in non-dipper hypertensive patients who underwent coronary angiography. Previous studies have shown that endothelial dysfunction, subclinical atherosclerosis, and inflammation are related to the occurrence of CSF. Our findings support that CSF may be part of systemic vascular disturbance. Considering that this situation can lead to fatal arrhythmia and sudden death, non-dipper hypertensive patients should be followed up more frequently and treated effectively. Further clinical studies are needed to examine the relationship between non-dipper HTN and CSF.


Delayed diagnosis and inaccurate judgment of the severity of the disease may be the principal reasons for the poor prognosis associated with neonatal midgut volvulus. We aimed to develop a nomogram model that timely assesses the risks of intestinal ischemia and necrosis in the neonate with midgut volvulus.We retrospectively analyzed the clinical data from neonates with midgut volvulus who were admitted to Guangzhou Women and Children’s Medical Center from January 2009 to December 2019. Univariate and multivariate analyses were used to obtain independent factors to build a predictive model. The independent factors were used to develop the nomogram model.P < 0.001). The sensitivity was 90.48%, and the specificity was 93.10%. A nomogram model was established using the six independent predictors, with a C-index of 0.859 and a favorable consistency between the predicted and actual intestinal ischemia and necrosis rates according to the internal validation.Heart rate, mean arterial pressure, serum C-reactive protein, serum sodium, serum albumin, and pH levels were independent predictors for intestinal ischemia and necrosis in patients with midgut volvulus. The area under the receiver operating characteristic curve (AUC) of the predictive model was 0.985 (95% confidence interval, 0.966–0.999; The constructed nomogram model could be a superior tool for predicting intestinal ischemia and necrosis in neonates with midgut volvulus. Midgut volvulus (MGV) refers to a condition in which the midgut twists around the axis of the superior mesenteric artery and is often related to malrotation . The incIn this study, we aimed to develop a nomogram model based on objective clinical data available within 2 h of admission to predict whether neonates with MGV have intestinal ischemia and necrosis. This new model is expected to help clinicians accurately estimate the urgency of treating neonates with MGV and perform super emergency operations to improve the prognosis.Neonates with a preoperative suspected diagnosis of MGV admitted to Guangzhou Women and Children’s Medical Center from January 2009 to December 2019 were enrolled in the present study. The preoperative suspected diagnosis was based on medical history, physical examination, ultrasound, or upper gastrointestinal radiography. The final diagnosis of MGV and bowel ischemia and necrosis was determined based upon the operative and pathologic findings. Patients with a surgically confirmed absence of midgut volvulus were excluded. Cases with severe cardiac malformations, congenital diaphragmatic hernia, gastroschisis, omphalocele, and other digestive tract malformations were also excluded.n = 21) or a non-intestinal ischemia and necrosis group (n = 87), with the latter population randomly selected from among 210 cases without intestinal ischemia and necrosis.Patients were apportioned to an intestinal ischemia and necrosis group  was employed for the internal validation of the predictive model. The independent factors were used to develop the nomogram model. The predictive accuracy of the nomogram was determined by concordance index (C-index) calculation and calibration plots.The present study was approved by the ethics committee of Guangzhou Women and Children’s Medical Center (no. 192A01), and written informed patient consent was obtained from each patient’s family.t-test. Variables showing statistical significance (P < 0.05) in the univariate analysis were brought into the logistic regression and further screened by stepwise regression. Hosmer-lemeshow test and receiver operating characteristic (ROC) curve were used to evaluate the prediction model. An internal validation of the prediction model was carried out by leaving one cross-validation. The nomogram prediction model was established using the RMS package of R version 3.6.1 . The nomogram was internally validated using bootstraps with 2,000 resamples. We used the Harrell concordance index (C-index) in the nomogram to assess the model performance, and a two-sided P value < 0.05 was considered to be statistically significant. A flowchart displaying the process of building the nomogram is shown in We performed statistical analysis using SAS version 9.4 . Categorical variables were expressed as numbers and percentages and were compared using the chi-squared test and Fisher’s exact probability test. Measurement data that were not normally distributed are represented by median (interquartile range) values. Comparisons between two groups were performed by the Wilcoxon rank-sum test. Meanwhile, those data conforming to normal distribution were described by mean ± standard deviation values, and comparisons between the two groups were performed by P > 0.05; (1) Intestinal ischemia and necrosis during the operation were found in 21 of the final 231 cases (9.1%). There was no significant difference in sex, gestational age, delivery method, or birth weight between the two groups (P < 0.01); the incidences of abdominal distension, heart rate (HR), and mean arterial pressure measured within 2 h after admission in the former group were significantly higher than those in the latter group . In the intestinal ischemia and necrosis group, the levels of white leukocytes, C-reactive protein (CRP), glucose, and blood potassium detected within 2 h of admission were significantly higher than those in the non-intestinal ischemia and necrosis group, while the levels of hemoglobin, blood sodium, serum albumin, pH, and base excess (BE) were significantly lower than those in the non-intestinal ischemia and necrosis group (P < 0.05).(2) According to univariate analysis, the median age at admission and the incidence of biliary vomiting in the intestinal ischemia and necrosis group were significantly lower than in the non-intestinal ischemia and necrosis group  In the multivariate analysis, HR, mean arterial pressure (MAP), CRP, serum sodium, albumin (ALB), and pH value determined within 2 h after admission were the independent predictors of intestinal ischemia and necrosis in patients with MGV .The prediction model formula established was as follows:P = 0.998; max-rescaled R2 = 0.837). The area under the ROC curve was 0.985 . When P > 0.2 , it was judged as intestinal ischemia and necrosis. Leave-one-out cross-validation (LOO-CV) was employed for the internal validation of the predictive model. The accuracy was 92.59%, the sensitivity was 90.48%, the specificity was 93.10%, the positive predictive value was 76.00%, and the negative predictive value was 97.59% , it is considered indicative that the patient has intestinal ischemia and necrosis. After 2,000 bootstrap self-help sampling verifications, the nomogram model predicted intestinal ischemia and necrosis with a C-index of 0.859 and a corrected C-index of 0.855, with good discrimination. The correction curve is shown in The nomogram model is constructed according to the factors in the multivariate logistic regression model . The totA high index of suspicion for midgut volvulus is based on the history and physical examination findings. In neonates, MGV typically presents with the sudden onset of bilious vomiting, and soon after the onset of vomiting, the lower abdomen may appear scaphoid. With complete obstruction, the patient develops intestinal ischemia with abdominal distension, bloody stools, and lethargy. Doppler ultrasonography or upper GI contrast radiography can assist doctors in the diagnosis. If the diagnosis of midgut volvulus is highly suspected, the nomogram model can be used to identify whether intestinal ischemia or intestinal necrosis is present.For example, if a patient highly suspected of having midgut volvulus has an HR of 120 beats/min, a score of 21 points is assigned; for a MAP of 70 mmHg, a score of 16 points is assigned; for a CRP level of 75 mg/L, a score of 26 points is assigned; for an Na concentration of 135 mmol/L, a score of 24 points is assigned; for an ALB concentration of 40 g/L, a score of 20 points is assigned; for a pH value of 7.42, a score of 35 points is assigned. Then, the total score is 142 points, and the probability of intestinal ischemia and necrosis is 0.3; thus, it is judged that the patient has intestinal ischemia and necrosis, and we should immediately give the patient absolute priority for surgery.MGV is often caused by congenital intestinal malrotation, a variation in intestinal position, and incomplete mesenteric attachment. Approximately 75% of MGV cases occur in the first year of life, and most cases occur during the neonatal period , 13.The prognosis of patients with MGV displays a polarizing trend, with children exhibiting a good prognosis achieving a quality of life similar to that of the normal population, while children exhibiting a poor prognosis suffer serious complications, such as short bowel, total intestinal necrosis, and even death . The incIn our study, based on univariate and multivariate logistic regression analyses, it was concluded that HR; MAP; pH; and serum CRP, sodium, and albumin levels are independent predictors for intestinal ischemia and necrosis in patients with MGV. Using these predictors, we developed a nomogram to visualize the results of the regression analysis; when the total score exceeds 140 points (P = 0.20), it is considered indicative of the patient having intestinal ischemia and necrosis.P < 0.05).Intestinal necrosis often appears as dehydration and shock, and the early manifestations of shock are increased HR and increased blood pressure. Silvia et al. reported that the major risk factor for death among neonates with an intestinal volvulus is hemodynamic instability . A stranP < 0.05). We plan to further verify some of our novel findings in subsequent studies.In addition, we newly uncovered serum albumin – a negative acute-phase reactant synthesized by the liver – as an independent risk factor for intestinal necrosis caused by MGV. However, in the presence of systemic inflammation, the liver synthesizes acute-phase proteins other than serum albumin. Therefore, some people posit that low serum albumin levels reflect an inflammatory state . HoweverThere were several limitations of our current study. As this study was a preliminary and single-center retrospective study and the number of cases included was relatively limited, the findings need to be externally evaluated in a greater number of neonates with MGV. In the future, a larger prospective study involving multiple centers and a larger number of patients should be undertaken to validate and improve the nomogram.HR, MAP, serum CRP, albumin, serum sodium levels, and pH values were the factors closely related to intestinal ischemia and necrosis. The constructed nomogram model, which combines the HR, MAP, serum CRP, albumin, serum sodium levels, and pH values, can be a superior tool for predicting intestinal ischemia and necrosis in neonates with midgut volvulus.The original contributions presented in this study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.The studies involving human participants were reviewed and approved by Guangzhou Women and Children’s Hostipal. Written informed consent to participate in this study was provided by the participants’ legal guardian/next of kin.XG, ZW, and WZ: study concept and design. XG: drafting of the manuscript, statistical analysis, and interpretation of data. WZ, ZW, and QH: critical revision of the manuscript for important intellectual content. JY and JL: administrative, technical, or material support. All authors contributed to the manuscript revision, read, and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.