Stoma outlet obstruction (SOO) is a common complication of diverting ileostomy and usually detected at the advanced stage when the intestine is obviously obstructed. The objective of this study is to explore the efficacy of transatmospheric ileal stoma manometry (TISM) in early detection of SOO before the manifestation of intestinal obstruction.st July 2022 to 31st December 2022. The stoma pressure was measured by TISM at different time points.A single-center prospective study was performed in patients scheduled to undergo reversal ileostomy and laparoscopic anterior rectal resection and diverting ileostomy in Second Affiliated Hospital of Zhejiang University School of Medicine from 12O which was considered as normal standard of stoma pressure, and ranged from 1.2 to 8.56 cmH2O. After excluding two patients with anastomotic leakage, a total of 38 patients who were subjected to laparoscopic anterior rectal resection and diverting ileostomy were further included in this study. The incidence of anastomotic leakage was 5% and that of SOO was 12.5%. The mean postoperative obstruction time was 5.2 (3-7) days and the mean time from elevated stoma pressure to diagnosed as SOO was 2.8 (2-4) days in the five patients who developed SOO. The pressure measured at the third stoma manometry time point (second day after return of gut function)  and the postoperative hospital stay  showed significantly difference between the SOO and non-SOO groups. The pressures measured at the first time point (before return of gut function) , the second time point (the day of return of gut function) , and the fourth time point (discharge day)  showed no significant difference in both groups.The mean stoma pressure of the 30 patients before reversal ileostomy was 5.21 cmHTISM can be utilized for early detection of SOO and can be incorporated as a novel diagnostic method together with abdominal CT scan to realize the goal of ERAS. The incidence of the overall anastomotic leakage after low anterior resection for rectal cancer is 10-20% . TransanCohort 1: 30 patients scheduled to undergo reversal ileostomy after low anterior resection for rectal cancer were recruited from July 1st 2022 to December 31st 2022. The first radical surgery was either laparoscopic or robotic. The exclusion criteria were as follows (1): incomplete obstruction of the stoma which can be confirmed via enhanced abdominal CT scan with no sign of complete intestinal obstruction (2), preoperative albumin below 30 g/l, and (3) local stoma or systemic infection.Cohort 2: 40 patients with rectal cancer who underwent laparoscopic anterior rectal resection and diverting ileostomy from July 1st 2022 to 31st December 2022 were also enrolled. The exclusion criteria were as follows (1): open surgery or conversion to open surgery (2), non-neoplastic diseases (3), postoperative anastomotic leakage, massive bleeding, or death.The single-center prospective study was performed at Second Affiliated Hospital of Zhejiang University School of Medicine. The ileal stoma pressure was measured by TISM and the main outcome measure was the stoma pressure at different time measurement points. Patients were divided into the SOO and non-SOO groups as appropriate. Typical The manometry device consists of a fixed frame, a sliding scale (accuracy 0.02 mm), and an infusion tube  to measure the pressure of the proximal intestines at the stoma relative to the standard atmospheric pressure Figure 1The patient was placed in supine position without any pillow, and the stoma bag was removed to expose and then clean the stoma. The frame was fixed on the right side of the patient, and the height of the skin at the lower edge of the stoma was measured. The thickness of the abdominal wall was estimated according to the preoperative abdominal CT, and the infusion tube was gently inserted 4-8 cm into the small intestine at the proximal end of the stoma. After injecting 1.5 ml saline into the intestinal cavity, the water column was seen to slide down to a fixed position. The difference between the height of the water column and the height of the skin at the lower edge of the stoma was calculated as the pressure of the intestinal cavity at the particular time point.2O, it was measured 2-4 times more, including before and after the treatment for SOO. The pressure was measured three times at each time point to achieve the average value. However, in our actual operation, the second and third measurements yielded lower values compared to the first. Considering the possible effect of the stoma on manometry reading, the first measurement was used for the analysis.Stoma manometry was performed once or twice preoperatively, and at the following time points after the operation (1): before return of gut function (2), on the day of return of gut function (3), second day after return of gut function, and (4) the day of discharge. When the stoma pressure was greater than 8.56 cmHP value<0.05 was considered statistically significant. All statistical analyses were performed using SPSS 26.0 .The data were expressed as mean ± standard deviation (SD). For univariate analysis, Student’s t test and Mann-Whitney U test was used to compare the two groups. The optimal cutoff values to predict SOO were calculated with the maximum sum of sensitivity and specificity using the Youden index. 2O ranged from 1.2-8.56 cmH2O. This value will be used as the reference for our subsequent study. The average time spent on pressure measurement was 296.2 (195–506) s. Other pre-operative clinical characteristics of the included patients were also summarized in 30 patients scheduled to undergo reversal ileostomy after low anterior resection for rectal cancer were selected. The mean age of the patients at diagnosis was 64.53 (39–89) years and the mean time to stoma closure was 118.4 (55–338) days after initial-operation. In addition, all stomas were located in the right lower abdomen. In order to exclude the influence of other relevant factors, we first measured the pressure range in the small intestine proximal to the stoma. As shown in 2. All stomas were located in the right lower abdomen. The mean time to deflation was 1.32 (1–2) days, and the mean postoperative hospital stay was 8.68 (5–23) days, with no unplanned secondary surgeries. Clinical and surgical characteristics of the two groups of patients are shown in After excluding two patients with anastomotic leakage, 38 patients who were subjected to laparoscopic anterior rectal resection and diverting ileostomy were included in the subsequent analysis. The incidence of anastomotic leakage was 5% and that of SOO was 12.5%. The mean postoperative obstruction time was 5.2 (3–7) days and the mean time from elevated stoma pressure to diagnosis of SOO was 2.8 (2–4) days in the five SOO patients. The mean age of the 38 patients was 67.89 (48–90) years and the mean BMI was 23.08 (17.92-28.33) kg/m2O, p<0.001). In contrast, the stoma pressure before return of gut function , the day of return of gut function , and the day of discharge  did not show significant difference between the two groups . However, gender (p=0.837), operation time , intraoperative blood loss rate , time to return of gut function  and highest postoperative WBC  were not significantly different between the two groups . Then the obstruction gradually progressed to the proximal small intestine, and finally symptoms of intestinal obstruction such as abdominal distention and vomiting appeared after 2-4 days. In patients without SOO, the intestinal lumen was expanded to a certain extent and fecal water discharged through the stoma into the stoma bag, so that the intestinal lumen pressure was always maintained at a normal range (1.2-8.56 cmH2O).In patients without SOO, when the proximal intestinal canal accumulates fecal water and the intestinal lumen pressure reaches a critical value, the stoma opens and the fecal water flows into the stoma bag and then intestinal lumen pressure decreases, and the process is repeated. In contrast, in patients with SOO, due to stoma edema or small stoma opening, fecal water cannot be discharged, and the pressure in the proximal intestinal canal continues to rise, then the obstruction gradually spreads to the proximal small intestine, and patients gradually develop symptoms of intestinal obstruction such as abdominal distension and vomiting Figure 32O, and dilatation of the proximal small intestine at the stoma in abdominal CT scan or ultrasound as the novel diagnostic criteria for SOO. If SOO is detected at an early stage, typical symptoms of intestinal obstruction such as nausea and vomiting may not be considered as necessary factors for diagnosis.Based on our findings, we recommended intestinal pressure measurement at the stoma more than 8.53 cmHEffective early intervention following detection of elevated stoma pressure may halt further obstruction and accelerate patient recovery before the symptoms of intestinal obstruction. Patients with obstruction usually develop edema and inflammation in the stoma intestine, which can be relieved by corticosteroids and the use of an anal tube . StudiesTraditional manometry requires placing a catheter into the target site, inserting a ventilation tube, and then filling and deflating the catheter, which may cause discomfort to the patient and prolong the time to measure . The tec2O and the following abdominal CT indicates dilatation of the intestinal lumen at the stoma, the patient can be diagnosed with early SOO without presenting typical signs of intestinal obstruction. Then we should take early intervention measures such as insert an anal tube for treatment, therefore avoiding unnecessary fasting and parenteral nutrition which central venus catheterization may be needed, and remove the anal tube after 3-5 days. In the present study, for example, one patient with elevated stoma pressure and dilatation of the stoma lumen suggested by abdominal CT, we timely treated the patient with early insertion of an anal tube without fasting or parenteral nutrition, and the abdominal CT review before discharge did not show intestinal obstruction, and the patient discharged 7 days after surgery without any trouble. The length of hospital stay was significantly shorter compared to other 5 patients who were treated only after presenting the symptoms of small bowel obstruction.We propose to include TISM as a supplement to enhanced recovery after surgery (ERAS) in clinical practice. Also, TISM can be used as an effective part of multimodal prehabilitation to improve functional capacity and reduce postoperative complication rates of patients who receive stroma reduction surgery. A recent meta-analysis included three randomised controlled trials indicated the potential advantages of multimodal prehabilitation in clinical application of colorectal surgery . In thisFor the time to come, we will conduct a large cohort and multicenter prospective study to measure the pressure using TISM in patients with rectal cancer who underwent laparoscopic anterior rectal resection and diverting ileostomy. When we find that the stoma pressure relatively elevates and the examination (CT or ultrasound) suggests stoma dilatation, we immediately give symptomatic treatment such as inserting an anal tube, decongesting, avoiding fasting and parenteral nutrition, and removing the anal tube after the edema at the stoma has subsided. Based on the results of this study, our subsequent study will investigate whether early interventional treatment can reduce the rate of stoma outlet obstruction, accelerate patient early recovery, and reduce patient hospitalization time and costs.This study still has some limitations. The stoma of patients undergoing open surgery for manometry has not been included in this study. However, based on the limited comparison of stoma pressure after open (8 patients) and laparoscopic surgery (our unpublished study), we do not believe there is a significant difference between the two groups. Meanwhile, the stoma of the colon has not been pressure measured in our present study. Future multicenter randomized clinical trials of large sample size may be needed to achieve a more precise and universal conclusion.TISM can be used as a supplementary method for the early detection of SOO and allow timely treatment of the patients before they develop symptoms of obstruction.The original contributions presented in the study are included in the article/supplementary material. Further inquiries can be directed to the corresponding authors.The studies involving human participants were reviewed and approved by Second Affiliated Hospital of Zhejiang University. The patients/participants provided their written informed consent to participate in this study.XW wrote the original paper, analyzed data and completed the tables and figures, XW and YW collected data. KD and DX designed research, performed research, analyzed and interpreted data, critically reviewed the manuscript. All authors contributed to the article and approved the submitted version.


Immune checkpoint inhibitors (ICI) are cancer therapies that have been associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). Blood pressure (BP) measurements are routinely performed during day oncology center visits for administration of ICI therapy but are often not assessed temporally to screen and monitor hypertension, which could independently increase the risk of ASCVD in cancer survivorship. This study reports the feasibility of using serial BP measurements from routine visits to day oncology center to diagnose and monitor hypertension control in cancer patients receiving ICIs. Immune checkpoint inhibitors (ICI) are immuno-oncological cancer therapies that have transformed the prognoses of numerous cancers . HoweverWe performed a single-center retrospective analysis of consecutive ambulatory patients treated with ICIs at Monash Health, Melbourne, Australia between January 2018 and December 2020. Institutional ethics was obtained for the study. Patients were identified from the hospital’s pharmacy database, using prescription data comprising available ICIs. All patients presented to a day oncology center for ICI administration at 3- or 4-weekly intervals, depending of ICI regimen. At each visit, our institutional protocol mandated BP measurements to be obtained to ensure clinical stability prior to ICI administration. Demographics, baseline CVRFs, medication history, cancer history, ICI regimen, recorded BP measurements and prescription of new antihypertensive therapies were determined from electronic medical records.t-test. A two-tailed p < 0.05 was considered statistically significant.The primary endpoint was the number of patients with hypertensive readings, defined as systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg. Analysis was performed using mean BP recordings among patients who had ≥2 BP measurements. Categorical variables were analyzed using Chi square analysis and continuous variables via A total of 366 patients attending 3639 day oncology center visits were identified. There were 156 patients (42.6%) with documented history of hypertension prior to ICI therapy, of whom 142 (91.0%) were taking regular antihypertensives. BP measurements were documented in 3548 visits (97.5%) for ICI administration, of which 771 readings (21.7%) were hypertensive. The median number of BP measurements for the entire cohort was 6 (interquartile range 3-12). A total of 352 patients (96.2%) had baseline BP measurements prior to commencement of first ICI dose (at first day oncology center visit). The mean baseline systolic and diastolic BP was 124.0 ± 14.8 mmHg and 74.2 ± 10.4 mmHg, respectively.p < 0.01) and diastolic BP  prior to ICI initiation (Table There were 318 patients (86.9%) who had ≥2 recorded BP measurements available for analysis (median number of BP measurements 7 [interquartile range 4–14]). Twenty-four (7.5%) had hypertensive mean BP recordings; Of these, 12 (50%) had no known history of hypertension. Patients with hypertensive mean BP recordings had higher baseline systolic BP (142.0 ± 13.6 mmHg vs 122.6 ± 13.9 mmHg, In this study of 366 consecutive real-world patients treated with ICIs for cancer, we have reported the feasibility of utilizing routine BP measurements obtained during standard cancer care for hypertension screening and surveillance. We found that BP measurements were obtained in 97.5% of day oncology center visits for ICI administration and serial measurements were available in 86.9% of patients. Additionally, 7.5% of patients had hypertensive mean BP readings on serial measurements, with elevated baseline readings suggesting undiagnosed or uncontrolled hypertension at time of first ICI dose. Although these results need to be interpreted with caution as patients in the study could have been in pain or anxious prior to receiving ICI therapy, these measurements did not prompt further confirmation with 24-h ambulatory or home BP monitoring or change in antihypertensive therapy. To the authors’ knowledge, this is the first study to report hypertension screening and surveillance using routine BP measurements recorded during visits to day oncology center as part of standard cancer care.Hypertension is a prevalent modifiable CVRF, affecting approximately 32% of adults aged 40 to 59 years in the United States . AlthougRegular BP measurements obtained during standard cancer care presents a pragmatic opportunity for widespread screening and monitoring of hypertension in patients treated with ICIs as recommended by guidelines. However, this is not commonly performed in routine oncological practice for a number of reasons. Firstly, BP measurements are often only assessed in isolation to ensure clinical stability prior to ICI administration. Additionally, oncologists are understandably more focused on cancer treatment and prognoses rather than BP control during standard cancer follow up, possibly leading to elevated serial BP readings being unnoticed. These challenges may be addressed by integrating automatic systems into electronic medical records to calculate mean BP readings and alert clinicians to patients who are persistently hypertensive over serial measurements. Confirmatory 24-h ambulatory or home BP monitoring can subsequently be undertaken to differentiate sustained from white-coat hypertension, thus identifying patients treated with ICIs who could benefit from lifestyle modification and subsequent antihypertensives. Streamlined referral systems to cardio-oncology services could also be adopted to allow holistic and simultaneous oncological and cardiovascular care in these patients.The results of this study should be interpreted in the context of several limitations, including the small patient population, single-center setting, and retrospective design. Although pragmatic, it is unclear whether the BP measurements used in the study analysis were obtained in a standardized fashion according to guideline recommendations . AdditioIn conclusion, hypertension screening and surveillance through the repurposing of routine BP measurements obtained during standard oncological care is a feasible strategy that could be used to guide hypertension management in patients treated with ICIs. This strategy is pragmatic and could help address the increasing need for cardiovascular risk reduction during cancer survivorship as recommended by the 2022 ESC Cardio-Oncology Guidelines. This model could further be expanded to all cancer patients attending day oncology centers for administration of systemic therapies.Immune checkpoint inhibitors are associated with atherosclerotic cardiovascular disease.Although not associated with immune checkpoint inhibitors, hypertension is prevalent and is associated with cardiovascular mortality and morbidity in patients with cancer.Blood pressure is routinely checked in standard cancer care but not used to screen or monitor for hypertension.Blood pressure measurements obtained during standard cancer care could be used to screen and monitor for hypertension.Cancer patients treated with immune checkpoint inhibitors may have undiagnosed hypertension.Patients with hypertensive readings from routine cancer care measurements could be referred for confirmatory 24-h or home blood pressure monitoring.


Intraprocedural blood gas samples (1 ml) from within cerebral collateral arteries (ischemic) and matched systemic control samples were obtained according to a prespecified protocol in 51 patients.paO2ischemic = 185.3 mm Hg vs. paO2systemic = 193.6 mm Hg; p = 0.035) and K+ concentrations . The cerebral Na+:K+ ratio was significantly increased and negatively correlated with baseline tissue integrity . Correspondingly, cerebral Na+ concentrations were most strongly correlated with infarct progression after recanalization . We found more alkaline cerebral pH values , with a time-dependent shift towards more acidotic conditions .We observed a significant reduction in cerebral oxygen partial pressure  contains supplementary material, which is available to authorized users. Despite major recent advances in endovascular stroke treatment , large-v2+) and sodium (Na+) overload, extracellular accumulation of potassium (K+), oxidative stress, and neuroinflammation [The cessation of cerebral blood flow (CBF) during LVO stroke results in a severe reduction of oxygen and glucose supply within the downstream vascular territory  and is aammation –10. Thesammation , 12. In ammation ; howeverammation –16. Few ammation , 17, 18.In this study, we now aim to retrace the aforementioned key experimental observations in a large and highly noise-controlled cohort where microcatheter aspiration attempts and analyses of cerebral samples were performed consecutively in every eligible anterior circulation LVO stroke patient. The biological relevance of changes in blood gas and ion composition was addressed by hypothesis-based association with 1) temporal, 2) clinical functional and 3) radiological structural parameters assessed during cerebral ischemia and in the clinical course after recanalization.We report a prospective observational single-center study conducted between 12 December 2018 and 31 August 2020, to investigate alterations in arterial blood gas (ABG) parameters within the collateral circulation  of LVO stroke patients. Endovascular sampling of ischemic blood from collateral blood vessels during the early phase of infarct formation was performed by microcatheter aspiration according to a prespecified protocol during emergency EVT . SystemiInclusion criteria were defined as follows: (I) patients aged older than 18 years presenting with disabling first ever acute ischemic stroke which qualifies for EVT according to current guidelines and consensus recommendations , 25 and Patients were excluded based on the following criteria: (I) noninvasive or invasive angiographic confirmation of bilateral or multifocal vessel occlusions other than defined, (II) invasive angiographic confirmation of residual or restored antegrade CBF at the level of the EVT-qualifying lesion, (III) LVO in conjunction with either ≥ 50% cervical ICA stenosis or ICA dissection, (IV) intraprocedural percutaneous transluminal angioplasty (PTA) or stent implantation and (VI) principle deviations from the interventional protocol and sampling procedure –23. The All endovascular treatments were performed by board-certified neurointerventionalists or supervised neurointerventional fellows on a biplane angiography system . Endovascular access for EVT was established by means of a transfemoral approach through the common femoral artery (CFA) using the modified Seldinger technique. According to our in-house standard of practice, pressurized flush systems  were used to avoid thrombus formation on the inner surface of catheters. A detailed description of the standard procedure of mechanical thrombectomy has been published previously . Recanal2+-balanced lithium heparin  and immediately analyzed (< 5 min) in a point-of-care blood gas analyzer . All syringes were carefully connected to the inlet of the analysis system without trapped air. A final sample volume of 200 µl was assessed for the following parameters: (1) pH, (2) arterial partial pressure of carbon dioxide (paCO2), (3) arterial partial pressure of oxygen (paO2), (4) base deviation in plasma (BE (B)), (5) standard bicarbonate (HCO3− std), (6) oxygen saturation of hemoglobin (sO2), (7) Na+ ion concentration, (8) K+ ion concentration, (9) Na+:K+ ratio, (10) Ca2+ ion concentration, and (11) chloride (Cl−) ion concentration.Arterial whole-blood samples were collected anaerobically in blood gas syringes containing CaProspective data collection included (but was not limited to) the following demographic, clinical, radiological, interventional, and sampling-related variables: age, sex, cerebrovascular risk factors, baseline drug treatment, preprocedural blood pressure and heart rate, previous alteplase administration, National Institute of Health Stroke Scale (NIHSS) at admission and at 48 h, time of non-invasive and angiographic image acquisition, occlusion location, leptomeningeal collateral status, Alberta Stroke Program Early CT Score (ASPECTS) at baseline and at 48 h, time of blood sampling and analysis, time of recanalization and reperfusion status, devices and technical management of EVT, peri-interventional and postinterventional complications, and short-term clinical outcome as assessed by the modified Rankin Scale (mRS) at hospital discharge.P value < 0.05 was considered statistically significant.Statistical analysis was performed using GraphPad Prism . Gaussian distribution of data was determined by the D’Agostino-Pearsons omnibus normality test. Numerical data were given as mean  or median ; categorical data were presented as number (percentage). Related samples were analyzed using Student’s t test or Wilcoxon signed-rank test, depending on parametric or nonparametric distribution of the data. Spearman’s rank correlation coefficient was applied to detect principal associations between ischemic ABG parameters and clinical-radiological variables. Post-hoc subgroup analyses by collateral status and infarct extent were conducted to further characterize relevant associations. A two-sided n = 366 consecutive patients who were treated by EVT were assessed for study eligibility according to a prespecified study protocol [N = 48 patients were excluded due to posterior circulation LVO and n = 11 patients due to bilateral or multifocal vessel occlusions. N = 50 patients did not qualify for inclusion upon invasive angiographic imaging either due to spontaneous recanalization or subocclusion with residual antegrade flow before EVT. Microcatheter-aspiration of ischemic blood samples was attempted in n = 257 patients with angiographically proven LVO of the following target sites: intracranial ICA‑T segment, MCA-M1, and proximal MCA-M2 segment, respectively. Microcatheter-aspiration of cerebral blood samples through blood gas syringes succeeded in n = 72 patients (28%). Out of this group, n = 51 consecutive patients (20%) met all a priori defined sampling and interventional criteria of inclusion and entered data analyses. The full patient flow without missing cases is given in Fig. Between 18 December, 2018, and 31 August, 2020, The clinical, radiological, interventional, and sampling-related characteristics of the study population are presented in Table n = 34 (66.7%) were female and n = 17 (33.3%) were male. The median age of patients was 78 years (IQR 69–83 years). Arterial hypertension was the most prevalent comorbid disease , followed by atrial fibrillation . Hypercholesterolemia was found in n = 16 (31.4%) patients. Of the patients 10 (19.6%) had diabetes mellitus at the time of stroke diagnosis, 6 patients (11.8%) were current smokers, 8 patients (15.7%) were former smokers, and n = 37 patients (72.5%) had no smoking history. At the time of hospital admission, n = 45 (88.2%) patients received antihypertensive therapy, n = 13 (25.5%) patients received antiplatelet medication, and n = 20 (39.2%) patients received anticoagulant therapy. The median preprocedural systolic blood pressure was 161 mm Hg (IQR 150–178 mm Hg) and the median preprocedural diastolic blood pressure was 89 mm Hg (IQR 75–99 mm Hg). The median heart rate at baseline was 80 (IQR 71–96) beats per minute. Baseline clinical stroke severity as assessed by the NIHSS at hospital admission was 13 (IQR 8–17). The time of stroke onset was unknown in n = 17 patients (33.3%). Non-contrast computed tomography (NCCT) revealed a median baseline ASPECTS of 9 (IQR 8–9). A total of N = 34 (66.7%) patients were treated by EVT alone and n = 17 patients (33.3%) were treated by EVT with previous intravenous alteplase administration. The median time from symptom onset to groin puncture was 255 min (IQR 181–353 min). Invasive angiography confirmed the persistence of cerebral LVO in all patients and showed n = 15 (29.4%) intracranial ICA occlusions, n = 7 (13.7%) ICA‑T occlusions, n = 19 (37.3%) MCA-M1, and n = 17 (33.3%) MCA-M2 occlusions. The median invasive collateral score was 2 (IQR 0–3) [Among included patients, IQR 0–3) . SuccessIQR 0–3) . The medn = 20 (39.2%) patients and n = 7 patients (13.7%) died during hospital stay. All other patients  were discharged either home, to a rehabilitation facility or to another hospital.Median ASPECTS on follow-up imaging at 48 h after intervention was 8 (IQR 6–9) . Follow-n = 102 matched regional ischemic  and systemic arterial blood samples  were drawn from n = 51 LVO stroke patients. The data on ABG analysis of both sampling sites are presented in Table A total of paCO2, paO2, BE (B), HCO3− std, and sO2. Significantly more alkaline conditions were present within collateral blood vessels . Concomitantly, the oxygen partial pressure was significantly decreased under vascular occlusion as compared to systemic level . By contrast, there were no sampling site-related differences in carbon dioxide partial pressure , standard bicarbonate , and buffer base concentrations . Likewise, we found no differences in oxygen saturation of hemoglobin .The following ABG parameters were examined: pH, + ion concentration, K+ ion concentration, Na+:K+ ratio, iCa2+ ion concentration and Cl− ion concentration. The were no significant differences in sodium concentrations between the sampling sites . By contrast, potassium concentrations were significantly decreased within the hemodynamically compromised collateral circulation as compared to systemic levels . Consistently, the regional ischemic Na+:K+ ratios were significantly increased . There were no significant differences between ischemic and systemic ionized calcium  and chloride concentrations .We assessed the following ion parameters: Nap = 0.055). There was also a borderline statistical insignificance for the association of local HCO3− std  and BE (B)  with occlusion duration. All other ischemic ABG parameters showed no correlation with the time from stroke onset to ischemic sampling . Regional ischemic pH values were found to be negatively associated with the duration of stroke, but the correlation was just above the threshold for statistical significance ; however, none of the other ischemic ABG parameters showed any association with either clinical stroke severity on admission or at 48 h.Spearman’s rank correlation coefficient was used to investigate associations between the ischemic ABG parameters and clinical stroke severity at baseline and at 48 h after recanalization. These data are given in Table +:K+ ratios , K+ concentrations , and Cl− concentrations  distal to the occlusion site. No other associations between baseline infarct extent and ischemic ABG parameters were seen. Analysis of dichotomized data  did not show a difference between any of the ischemic ABG parameters (Supplementary Information).The Na+ concentrations within collateral blood vessels were found to be negatively correlated with postinterventional infarct extent 24–48 h after recanalization . There were no other correlations between the ischemic ABG parameters and tissue integrity on follow-up imaging.Results of correlation analysis between regional ischemic ABG parameters and infarct extent before and after EVT are given in Table n = 20 (39.2%) patients, whereas dynamic infarct progression equivalent to a median ∆ ASPECTS of 1 (IQR 1–2) was observed in n = 31 (60.8%) patients. Progressive infarction was positively correlated with the Na+ concentrations within the occluded vascular territory . No other associations were found with respect to preinterventional to postinterventional infarct progression.We further analyzed the association between imaging defined preinterventional to postinterventional worsening of stroke (∆ ASPECTS) and regional ischemic ABG parameters. Infarct extent remained constant in To the best of our knowledge, no dedicated animal and only few preliminary human reports exist on regional disturbances of blood gas and ion homeostasis measured directly within the cerebral collateral circulation during acute ischemic stroke –16, 32. p = 0.035) and (2) potassium concentrations  within the collateral circulation. (3) The regional Na+:K+ ratio is increased and (4) correlated with the extent of ischemic brain edema as assessed by the ASPECTS system . (5) Regional intravascular sodium release is correlated with infarct progression after recanalization . Finally, (6) more alkaline conditions are present within the arterial compartment of the ischemic penumbra  which change (7) towards more acidotic pH values over time .Our main findings are the following: human LVO stroke results in a (1) regional reduction in oxygen partial pressure  and well above (paO2ischemic = 213.98 mm Hg vs. paO2systemic = 251.43 mm Hg) the limits for arterial blood [paO2, as were observed in our study, are explained by preinterventional and peri-interventional high-flow oxygenation which is known to lead to an up to fourfold increase in paO2 [2 removal during no/low-flow conditions or inadequate oxidative phosphorylation, is to be expected in or in close vicinity to the infarct core, it can be inferred that cerebral samples were extracted from penumbral regions where an infarct milieu is gradually developing [The relative reduction in oxygen partial pressure distal to the occlusion site is consistent with previous observations which, however, found oxygen partial pressure both within  [Normal neuroelectric activity and water content of the brain require the careful orchestration and proper distribution of intracellular and extracellular ions. The observed relative hypokalemia and increase in Naa+ gains , 7. The a+ gains , 43. Thi< 0.001) , 43, 44.The major strength of this study is its prospective consecutive design including control of a large set of baseline clinical, radiological, interventional, and analytical variables. Still, this study remains observational and could be carried out only at a single-center limiting causal inference and generalizability. Furthermore, additional information regarding cerebral sodium content and pH based on, e.g., sodium and chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) is not available , 46; howIn conclusion, subtle but distinct disturbances of cerebral oxygen supply, ion composition and acid-base balance occur and dynamically progress during the phase of occlusive ischemia in stroke patients and are related to acute tissue damage. Combined, these data additionally advocate to restore physiologic cerebral circulatory conditions in LVO stroke, notwithstanding that promising new concepts of add-on cerebroprotection are emerging.Supplementary Figure 1 ; Supplementary Tables 1 and 2 .


Background: Smart devices that are able to measure blood pressure (BP) are valuable for hypertension or heart failure management using digital technology. Data regarding their diagnostic accuracy in comparison to standard noninvasive measurement in accordance to Riva-Rocci are sparse. This study compared a wearable watch-type oscillometric BP monitor (Omron HeartGuide), a wearable watch-type infrared BP monitor (Smart Wear), a conventional ambulatory BP monitor, and auscultatory sphygmomanometry. Methods: Therefore, 159 consecutive patients  performed observed single measurements with the smart device compared to auscultatory sphygmomanometry (n = 109) or multiple measurements during 24 h compared to a conventional ambulatory BP monitor on the upper arm (n = 50). The two BP monitoring devices were simultaneously worn on the same arm throughout the monitoring period. In a subgroup of 50 patients, single measurements were also performed with an additional infrared smart device. Results: The intraclass correlation coefficient (ICC) between the difference and the mean of the oscillometric Omron HeartGuide and the conventional method for the single measurement was calculated for both systole (0.765) and diastole (0.732). This is exactly how the ICC was calculated for the individual mean values calculated over the 24 h long-term measurement of the individual patients for both systole (0.880) and diastole (0.829). The ICC between the infrared device and the conventional method was “bad” for SBP (0.329) and DBP (0.025). Therefore, no further long-term measurements were performed with the infrared device. Conclusion: The Omron HeartGuide device provided comparable BP values to the standard devices for single and long-term measurements. The infrared smart device failed to acquire valid measurement data. Hypertension is one of the main risk factor for cardiovascular diseases ,2, whichThe Omron HeartGuide device is a new smart device with an integrated oscillometric BP measurement tool in its wristband, and it is able to store recorded measurements and enables connection to personal smartphones ,14. The In this study, we hypothesized that the BP values recorded by smart devices would correlate with the BP values recorded by conventional BP monitors, which in turn means that smart devices would be an alternative to the conventional blood pressure measurement methods.The BP of 109 consecutive patients on the cardiology ward of the Johannes Wesling university hospital in Minden, Germany, was measured in accordance with Riva-Rocci and compared with a single BP measurement using the smart device . A subgrIn addition, 50 consecutive patients who received 24 h BP monitoring for diagnostic purposes were equipped with an Omron HeartGuide watch over this period. These patients were asked to use the smart device to measure their BP one minute after the BP monitor had measured the BP on the upper arm. The recordings of the BP monitor were read out after 24 h. The measured values were then compared with the data from the long-term BP measurement. Due to the invalid data of the single measurement with the infrared device, we performed no further long-term measurements comparing this device with standard BP monitor. All participants provided their written informed consent to participate. The study was approved by the local ethics committee (AZ:2020-647).All participants for the single measurement were patients in the cardiology department of the Johannes Wesling university hospital. Adult outpatients who were scheduled to conduct a 24 h long-term BP measurement in clinical practice were consecutively recruited at the cardiology department of the Johannes Wesling university hospital in Minden, Germany, for the long-term measurement. The inclusion criterion was age ≥18 years. The exclusion criteria were pregnancy and breast-feeding period. These criteria were selected in accordance to the recommendations of our local ethics committee.The participant selection process was performed using the following flow diagramm :The Omron HeartGuide device  is a patient-self-initiated automatic oscillometric device for measuring BP at the wrist . In thisWe used the HeartGuide device cuff size that is appropriate for those with wrist circumferences in the range of 16.0–19.0 cm. The BP values measured by the watch were transferred via Bluetooth to a smartphone on which the Omron HeartAdvisor app was installed. All BP values are listed with the date and time on the smartphone or in the app. These lists can be sent to a PC via the app [The TV962SM smart device  is also worn on the wrist. We chose this device because it was a cheap alternative to the Omron device, with an online reputation of valid BP measurement. Again, no prior studies were conducted. This device measures and analyzes with infrared light the pulse wave that emanates from the heart. Infrared light is absorbed by the blood in the arteries more than by surrounding tissue or bone, and this allows BP to be measured by changing the intensity of the light. A calculation based on signal-processing algorithms is superimposed on the sensor-based measurement, which ultimately makes it possible to estimate the BP. The reference point is the pulse ,18. The The 24 h long-term BP measurements were recorded using an automatic oscillometric device with a BP cuff worn on the upper arm (ambulatory BP monitor). After the 24 h had elapsed, the data were read out by qualified medical staff. The results were visualized in table format.The single BP measurements were performed using a conventional BP cuff and a stethoscope.The participants were seated in a quiet room at a comfortable room temperature, with their back supported, their legs uncrossed, and the measurement arm supported so that the wrist was at heart level. The BP measurements were started after a resting period of five minutes. Then the wrist circumference was measured. For the BP measurements using a standard manual sphygmomanometer, qualified medical stuff measured the participant’s BP according to Riva-Rocci using a stethoscope and a calibrated sphygmomanometer. Then, 60 s after the measurements using the standard sphygmomanometer, the BP was measured using the Omron HeartGuide. The measurement with the Omron HeartGuide was instructed and observed by a qualified medical staff member. A visualization of the BP measurement procedure is shown in In the 50 patients of the single measurement, a third measurement was performed using the infrared Smart Wear watch. Therefore, the participants remained in a sitting position. After the measurement with the Omron HeartGuide, the watch was removed and the smart-wear watch was put on the same wrist. After one minute of resting time the BP was measured. Therefore, the patients were asked not to move and keep their arm in a comfortable relaxed position on their lap. The end of measurement was indicated by a vibration of the device, and the value was displayed. After the inclusion of 50 patients, an interim analysis was performed.The Omron HeartGuide (at the wrist) and the ambulatory BP monitor (at the upper arm) were worn on the same arm. The ambulatory BP monitor measured the BP automatically every 30 min at daytime (6.00 a.m. to 10.00 p.m.) and every 60 min at night time (10.00 p.m. to 6.00 a.m.). The patients were instructed how to measure the BP with the Omron HeartGuide and asked to measure the BP one minute after the device on the upper arm had measured the BP. They were also informed which position they should take to measure in the right way. The first measurement was observed by a qualified medical stuff. All other measurements were performed without observation.The statistical analyses of the single measurement and long-term measurement data were broadly similar and described only once here. The primary outcome for both were systolic blood pressure values (SBP) and diastolic blood pressure values (DBP). From the long-term measurements (24 h), we computed the average over 24 h, as an aggregated measure for the primary outcome. The SBP and DBP of all measurement methods were described using means and standard deviation. Furthermore, the two different devices  were compared to the Riva-Rocci  as the mean and standard deviation of the patient specific differences. Associations of baseline variables  with SBP and DBP were analyzed using Spearman rho correlation. The reliability of the smart watches was assessed using Bland–Altman plots against the Riva-Rocci measurement. For each patient, the difference between the respective smart watch and the RR measurement was plotted against the mean of the two values. In this way, systematic bias in terms of general under or overestimation of BP was assessed. Bland–Altman plots were presented with the mean difference as solid horizontal line and the lower and upper 1.96 standard deviations of the mean difference. The Bland–Altman plots were then used to assess whether all/most measured values were within the tolerance ranges, i.e., the lower and upper 1.96 standard deviations of the mean difference. If this was the case, the measuring method with the smart device was attested to have sufficient accuracy compared to the standard measuring method. As additional information on the association between the BP measurement methods, the two-way mixed intra class correlation coefficient was calculated. The ICC were interpreted according to Cicchetti, and Koo and Li:According to Cicchetti, ICC values less than 0.4 are indicative of poor reliability (“bad”), values between 0.4 and 0.59 indicate moderate reliability (“average”), values between 0.6 and 0.74 indicate good reliability (“good”), and values greater than 0.74 indicate excellent reliability (“very good”). According to Koo and Li, ICC values less than 0.5 are indicative of poor reliability (“bad”), values between 0.5 and 0.75 indicate moderate reliability (“average”), values between 0.75 and 0.9 indicate good reliability (“good”), and values greater than 0.90 indicate excellent reliability (“very good”).Additionally, for the long-term measurement, the non-aggregated data were compared between the smart watch device and the clinical long-term measurements using computing differences. The differences were displayed as a scatter plot over time (24 h) and the general trend was assessed using LOESS regression. No inference statistics were computed for this exploratory analysis.2.Patient characteristics are listed in The mean difference between the systole of Omron HeartGuide and the auscultatory sphygmomanometry was −5.28 ± 1.71 mmHg and those of the diastole was −0.81 ± 1.17 mmHg . In the The intraclass correlation coefficient (ICC) according to Cicchetti was “very good” for systolic blood pressure (SBP) and “good” for diastolic blood pressure (DBP). The ICC according to Koo and Li was “good” for SBP (0.765) and “average” for DBP (0.732). To investigate whether the differences in BP values between the individual measurement methods depended on age, BMI, or wrist circumference, Spearman rho correlation was performed. There was no correlation between the difference in the SBP or DBP of both devices and age/BMI/wrist circumference in the Spearman rho correlation. Thus, the differences in BP values did not depend on the factors involved.In the infrared watch group, the ICC according to Cicchetti was “bad” for SBP (0.329) and for DBP (0.025). The ICC according to Koo and Li was also “bad” for the SBP and for DBP. The mean difference between the systole of the Smart Wear watch and the auscultatory sphygmomanometry was 11.92 ± 2.89 mmHg and those of the diastole was 2.86 ± 1.74 mmHg. The Bland–Altman plot is shown in 2.Patient characteristics are listed in The subjects took a total of 968 measurements with the smart device. A total of 811 paired measurements of ABPM followed by WBPM were successfully obtained from the 50 participants. The mean difference between the systole of Omron HeartGuide and the ABPM was 0.72 ± 1.44 mmHg, and that of the diastole was 4.27 ± 0.97 mmHg  The ICC Gold standard for professional BP measurement performed by medical staff is auscultatory sphygmomanometry . DiffereThe individual measurements were carried out under strict control, to obtain correct and valid measurements. However, only a snapshot of the BP was taken during this examination. We carried out and documented exactly one successful BP measurement both with the smart device and with the auscultatory method, so that, in the end, we had one pair of BP values for both devices for each study participant.The mean difference between the systole of Omron HeartGuide and the auscultatory sphygmomanometry was −5.28 ± 1.71 mmHg and that of the diastole was −0.81 ± 1.17 mmHg. Thus, the Omron HeartGuide measured lower BP values of SBP as well as DBP than the conventional auscultatory method. This difference could be explained by the amplification of pulse pressure between brachial and radial arteries . In one We compared our results to those from the Japanese study. The ICC for SBP was comparable between the Japanese (0.726)  and our There was also another Japanese study that compared other WBPMs (Omron HEM-6410T-ZM or Omron HEM-6410T-ZL) with a standard mercury sphygmomanometer . The meaThe mean differences between the reference BPs and HEM-6410T-ZL readings were 2.4 ± 7.3 mm Hg and 0.7 ± 7.0 mm Hg for SBP and DBP according to criterion 1 of the same guidelines . In thatThe long-term study enabled the integration and examination of the device in daily life. There is growing evidence that daytime BP variability is an independent predictor of hypertensive target organ damage and cardiovascular events  and thatWe compared our results to those of the Japanese study, which was the first study to compare WBPM using an oscillometer device (HeartGuide) and traditional ABPM. The ICC for SBP was higher in our study (0.880) than in the Japanese study (0.640) . The ICCUnlike the Omron HeartGuide, which measures BP with the help of a cuff system, the Smart Wear watch measures and analyzes the pulse wave that emanates from the heart with infrared light. As reported previously ,27,28,29A big advantage of the smart device is that it can measure BP without much effort or large BP cuffs. This makes BP measurement using this device possible everywhere.Since the measurements with the Omron HeartGuide can only be triggered manually and the wearer of this watch has to sit down and position the arm correctly, measurements are difficult to take at night or during the sleeping period, mainly because the measurements at night in the long-term study were carried out in a more or less awake and active state. It would be a benefit in the future if this device could automatically measure BP at night without changing the position of the arm.However, the patients who wear this smart device for diagnostic purposes must be very compliant and perform the measurement correctly. Otherwise, it falsifies the results. Easier handling of the Omron HeartGuide would be desirable in the future. Unfortunately, no automatic night measurements are currently possible with the Omron HeartGuide. Because nighttime measurements are indispensable when diagnosing hypertension or when differentiating between primary and secondary arterial hypertension by differentiating between “dippers” and “non-dippers”, this possibility would improve both the screening for arterial hypertension and the control of drug-treated hypertension .The transmission process of the measured BP values through the app  to the sAt present, the BP values recorded by the Omron HeartGuide can only be sent via Bluetooth to the individual smartphone of the user. For data transfer to the doctor a manually encryption and an active transfer by e-mail, for example, as a written document is necessary. This small step requires a certain amount of effort. However, if the BP values were made available directly to the doctor, virtual therapy control would be possible without personal contact.Another disadvantage of the smart device may be that some patients could get carried away with their hypertension, by taking too many ambulatory measurements ,33.In the long-term measurement, the participants could not be checked during the period of the long-term study as to whether the measurements were carried out correctly. False measurement leads to false results. For example, participants mostly waited more than a minute before taking the measurement with the Omron HeartGuide after the measurement of the device on the upper arm.Since the participants for the individual measurements were recruited in the department of cardiology, some patients had cardiac insufficiency with dyspnea at rest. In nine failed measurements, four participants had such severe resting dyspnea that a movement error was reported due to the strong thorax rise and fall and a measurement was not possible. Therefore, subsequent studies must determine whether the device is suitable for monitoring heart failure therapy in all stages, since heart failure is usually associated with dyspnea with heavy breathing effort.One wheelchair user was also included in our study. He described that having the device on the upper arm, in particular, was very obstructive for the movement of the arms to push the wheelchair wheels. A device on his wrist would not bother him at all with his mobility.Our study included only a small patient collective. We recruited 50 patients for the long-term measurement and 109 patients for the single measurement. A larger patient cohort would be advantageous for a better conclusiveness. Furthermore, this study was not randomized or blinded. The measurement was carried out only by one person and not by several people, so that a comparison or statement regarding the measurement quality cannot be made. In the long-term study over 24 h, an average of only 16 BP values that could later be evaluated were recorded with the smart device. This may have been due to patient compliance.The Omron HeartGuide is a suitable smart device for monitoring or controlling BP with highly reproducible BP values compared to the standard methods in clinical use. The Omron HeartGuide may allow telemetric treatment observation and improvement in an outpatient setting. As a glimpse into the future, the Omron HeartGuide could be a good alternative to a long-term BP monitor on the upper arm, according to further studies, and could therefore be used for 24 h long-term measurements, both in hospitals and in the outpatient area. The infrared smart device failed to acquire valid measurement data.


This study aimed to explore the predictive value of liver and spleen stiffness measurement based on two-dimensional shear wave elastography for the portal vein pressure in patients with compensatory viral cirrhosis.From January 2017 to August 2019, 107 patients with compensatory viral cirrhosis and 76 patients with viral hepatitis were enrolled as cirrhosis group and hepatitis group, respectively. Patient data were obtained during admission, and this study was a review and analysis of patient data. Liver stiffness measurement (LSM), spleen stiffness measurement (SSM), portal vein diameter and spleen thickness were compared between the two groups, and their diagnostic value for compensatory viral cirrhosis was analyzed. According to the hepatic vein pressure, the cirrhosis group patients were divided into non-hypertensive group  < 5 mmHg), mild group  and severe group . LSM, SSM, portal vein diameter and spleen thickness of the three groups were compared, and the correlation between SSM and hepatic vein pressure was analyzed.P < 0.05). The area under the curve (AUC) of combined detection was larger than that of LSM, SSM and spleen thickness detection alone in liver cirrhosis diagnosis . LSM, SSM, portal vein diameter and spleen thickness increased with the increase of hepatic vein pressure in patients with liver cirrhosis . LSM, SSM, portal vein diameter and spleen thickness were all positively correlated with hepatic vein pressure (P < 0.05). ROC curve showed that AUC of combined detection was greater than that of LSM, SSM, portal vein diameter and spleen thickness alone detection in the diagnosis of clinically significant portal hypertension . The increase of LSM, SSM, portal vein diameter and spleen thickness were the influencing factors for hepatic vein pressure rising .LSM, SSM, portal vein diameter and spleen thickness in the cirrhosis group were higher than those in hepatitis group (all There was an increase of LSM and SSM in patients with compensatory viral cirrhosis, which were positively correlated with hepatic venous pressure, and combined index detection has diagnostic and predictive value for the change of portal venous pressure. Many liver diseases develop liver cirrhosis in their advanced stages. In the compensatory stage liver cirrhosis has no typical clinical manifestations; however, in the decompensated stage, it can be manifested as ascites, esophageal and gastric variceal bleeding and other complications. Portal hypertension is the main complication of liver cirrhosis. Most of the normal liver blood supply comes from the portal vein. The anatomical structure of the portal vein is relatively special, with its the beginning and end are capillaries. When the degree of liver cirrhosis is aggravated, the blood vessels in the liver parenchyma gradually become thinner, and the pressure of the portal vein increases, forcing much blood to flow reversely and enter the collateral circulation, resulting in esophageal and gastric varices, which affects the prognosis of patients . The degP > 0.05, From January 2017 to August 2019, 107 patients with compensatory viral cirrhosis and 76 patients with viral hepatitis were taken as cirrhosis group and hepatitis group, respectively. There were no significant differences in general data between the two groups  who met the diagnostic criteria of chronic viral hepatitis  and the (1) Patients with cirrhosis caused by other reasons; (2) patients complicated with hepatocellular carcinoma, portal vein thrombosis and other serious complications; (3) patients with splenic lesions; (4) patients complicated with blood diseases; (5) patients with connective tissue diseases; and (6) patients with active infectious diseases.Two-dimensional shear wave belongs to the shear wave velocity imaging technology. Plane shear wave is the multi-point focused acoustic radiation force pulse generated by a common ultrasonic probe. The ultra-high-speed image processing technology can obtain two-dimensional shear wave elastic map, which can reflect the absolute hardness of the liver. Real-time shear-wave elastography of liver was performed on all patients using supersonic imagine aixplorer machine and SC6-1 abdominal probe. The patient was placed in a supine position, and his right upper limb was raised and placed on his head, fully exposing the right abdomen. Two-dimensional ultrasonography was performed from the right axillary front to the midaxillary line between the 4th and 7th ribs. The coupling agent was evenly applied on the skin surface with avoiding the thick pipe structures such as hepatic blood vessels and bile ducts and the location of gallbladder. The probe was vertical to the skin. After the 2D image was clearly displayed, the machine was switched to SWE mode. The sampling frame range was 4cm*3cm, the area of interest was set to 20.0 mm, and the elastic measurement SCALE was set to 40 kPa. Liver parenchyma about 2 cm below the capsule of the right lobe of liver was selected as the upper edge. Patients were asked to hold their breath for 3 to 5 s in a calm state, and the measurement was considered successful if the color of the sampling box was more than 90% full. The region with relatively uniform image color was selected for detection, and the average value of elastic modulus in the detection region was displayed. It was detected for 5 times in total and the average value was taken as LSM. For SSM detection, the patient was placed in the right decubitus position, with the left arm fully extended up and placed on the top of the head. The left midline or the posterior axillary line between the 9th and 11th ribs was selected. The probe was placed in the thickest middle part of the spleen, and the sampling range was set to 4 cm*3 cm. The spleen parenchyma about 1 cm below the capsule was selected as the upper margin, and the area of interest was 20.0 mm. The elastic measurement SCALE was 70 kPa. The measurement method was the same as that of LSM .Philips EPIQ7 and Mindray M5 color Doppler ultrasound diagnostic instrument with probe frequency of 3–9 MHz were applied. The patient was placed in supine position with his hands raised above his head. When scanning was not satisfactory, the position of the patient could be changed appropriately, and his breathing should be maintained steadily. The longitudinal section of the first porta hepatis under the right costal margin was taken as the standard measurement section. The examination showed that the common bile duct was full length and posterior to the head of pancreas. The portal vein was measured at 1∼2 cm from the first hilum. The splenic hilum and splenic vein were shown by scanning along the intercostal oblique section. The diameter line from the hilum to the opposite side of the spleen was measured as the thickness of the spleen .Hepatic venous pressure gradient refers to the measurement of hepatic venous wedge pressure and free pressure by jugular catheter. Before examination, the necessity and risks of hepatic venous pressure testing should be explained to patients and their families. The testing can be carried out only after signing the informed letter of interventional diagnosis and treatment. The patient was instructed to take supine position and turn his head to the opposite side of puncture as far as possible. The right internal jugular vein was selected as puncture point, and local anesthesia was performed with 2% lidocaine. After successful puncture of the right internal jugular vein with the Seldinger technique, the 5F venipecture sheath  was inserted with the guide wire. The Cordis 5F multifunctional angiography catheter  was inserted into the main right hepatic vein under X-ray fluoroscopy. After successful introduction was confirmed by angiography by infusion of 2 mL iohexol, the automatic manometer was connected to read the pressure data, namely, the free hepatic venous pressure (FHVP). Guided by the guide wire, the multifunctional catheter was continued to reach the end of the hepatic vein, and 2 mL iohexol was injected to confirm the angiography. The pressure data at this time was read as the wedged hepatic venous pressure (WHVP). The difference of the two was the hepatic venous pressure gradient (HVPG). Based on the hepatic venous pressure, the cirrhosis group was divided into the non-hypertension group , the mild group , and the severe group  .(1) LSM, SSM, portal vein diameter and spleen thickness were compared between the cirrhosis group and the hepatitis group, and their diagnostic value for compensatory viral cirrhosis was analyzed. (2) LSM, SSM, portal vein diameter and spleen thickness of the non-hypertension group, mild group and severe group were compared, and the correlation between each index and hepatic vein pressure, as well as the diagnostic value of clinically significant portal vein hypertension, was analyzed.χ2 test. The measurement data were expressed by (t test. ROC curve was used to analyze the diagnostic value of LSM, SSM, portal vein diameter and spleen thickness for compensatory viral cirrhosis. Spearman test was applied to analyze the correlation of LSM, SSM, portal vein diameter and spleen thickness with hepatic vein pressure. Logistic regression was used to analyze the correlation of LSM, SSM, portal vein diameter and spleen thickness with clinically significant portal hypertension. P < 0.05 meant that the difference was statistically significant.SPSS22.0 software was used to process the data. The categorical data were expressed as %, and the difference between groups was compared by P < 0.05, The values of LSM, SSM, portal diameter and spleen thickness in cirrhosis group were all higher than those in hepatitis group. The results showed that LSM, SSM, portal vein diameter and spleen thickness were correlated with the severity of liver disease, which provided a basis for further correlation analysis (all P < 0.05, The AUC of combined detection was greater than that of LSM, SSM and spleen thickness detection alone. The results showed that the combined detection of LSM, SSM, portal vein diameter and spleen thickness was effective, and the combined detection could be used to diagnose cirrhosis (all P < 0.05, LSM, SSM, portal vein diameter and spleen thickness increased with the increase of hepatic vein pressure. The results showed that LSM, SSM, portal vein diameter and spleen thickness were correlated with hepatic venous pressure in cirrhotic patients (all P < 0.05, LSM, SSM, portal vein diameter and spleen thickness were positively correlated with hepatic vein pressure. These results indicate that LSM, SSM, portal vein diameter and spleen thickness may reflect hepatic venous pressure to some extent (all P < 0.05, ROC curve showed that AUC of combined detection was greater than that of SSM, portal diameter and spleen thickness detection alone. The results indicate that the combined detection of LSM, SSM, portal diameter and spleen thickness can be used to diagnose clinically significant portal hypertension (all P < 0.05, The increase of LSM, SSM, portal vein diameter and spleen thickness were the influencing factors for the increase of hepatic vein pressure. It was further proved that these indicators were related to hepatic venous pressure (all Portal hypertension is the main cause of esophageal and gastric varices rupture and bleeding and even death in patients with cirrhosis. According to clinical data, portal hypertension is a common complication in patients with cirrhosis, which can cause ascites, varicose esophagogastric fundus and splenomegaly, and can lead to death in severe cases . It has As portal hypertension is closely related to the severity of liver disease, the detection of portal venous pressure is of vital importance for evaluating the severity and prognosis of cirrhosis patients . RelevanLSM and SSM in patients with compensatory viral cirrhosis is positively correlated with hepatic vein pressure, and the combined detection of LSM and SSM has diagnostic and predictive value for changes in portal vein pressure.10.7717/peerj.15956/supp-1Supplemental Information 1Click here for additional data file.


To study the development of microalbuminuria (MAU) in essential hypertension (EHT), we investigated the association of MAU with central blood pressure (CBP), direct renin concentration (DRC), plasma aldosterone (PA), and uric acid (UA).We determined 24 h-urinary albumin excretion (24 h-UAE) in patients with EHT who were hospitalized at TEDA International Cardiovascular Hospital from June 2020 to May 2022. We defined MAU as 24 h-UAE in the range of 30 mg/24 h to 300 mg/24 h. Univariate and multivariate analyses were conducted to determine the associations of MAU with CBP, DRC, PA, and UA in EHT, considering demographic and clinical information. We also plotted receiver operating characteristic curves (ROCs) for predicting MAU using these results.More than a quarter of patients  were diagnosed with MAU in EHT. A higher body mass index (BMI), longer duration of hypertension, and higher severity were associated with MAU. Also, nearly 10% more creatinine levels were recorded in the MAU group than in the control group . The increase was also observed for PA  and UA  in the MAU group compared to that in the control group. Several variables were associated with MAU, including central diastolic blood pressure (CDBP) , PA  and UA . For MAU prediction, the area under the curve (AUC) was 0.709  when CDBP, PA, and UA were used in combination, and the optimal probability of the cut-off value was 0.337.We found that CDBP, PA, and UA, used for MAU prediction, might be associated with its development during EHT.The online version contains supplementary material available at 10.1186/s12872-023-03515-1. Hypertension is a global public health concern with a high prevalence and a low rate of diagnosis and control . ComplicSeveral studies have shown that CBP is a good indicator of pressure without resistance of vessels compared to peripheral blood pressure(BP) , which cThe prevalence of hyperuricemia is increasing every year . In the More severe renal damage occurs in primary aldosteronism, and some studies have shown that the aldosterone/renin ratio (ARR) can also predict renal damage in EHT . This fiConsidering that CBP, DRC, PA, and UA are associated with renal injury, elucidating the relationship between these factors and MAU in EHT might provide new information. MAU occurs before the decrease in the estimated glomerular filtration rate (eGFR) . In thisHypertensive patients hospitalized at the Hypertension Center of TEDA International Cardiovascular Hospital from June 2020 to May 2022 were included in this study. Concerning the inclusion criteria, the patients needed to meet the diagnostic criteria of hypertension and an ad libitum sodium diet. Additionally, patients previously under antihypertensive medication  needed to be switched to diltiazem terazosin for at least four weeks. The exclusion criteria were as follows: (1) Patients with definite secondary hypertension factors; (2) Patients with severe cardio-cerebrovascular complications ; (3) Missing data on CBP, 24 h-UAE, DRC, and PA; (4) Patients with 24 h-UAE ≥ 300 mg/24 h; (5) Patients with previous kidney diseases ; (6) Patients using glucocorticoids, spironolactone, or contraceptives were excluded since they might affect the DRC and PA; (7) Patients with acute infection within two weeks.This study was conducted in accordance with the ethical standards of the declaration of Helsinki. The study was approved by the Ethics Committee of TEDA International Cardiovascular Hospital Research Project. The need for informed consent was waived by the Ethics Committee of TEDA International Cardiovascular Hospital Research Project as this was a retrospective study.The baseline characteristics and medication histories of the patients were collected by hypertension specialists. The laboratory data on white blood cells (WBCs), red blood cells (RBCs), hemoglobin (HGB), fasting glucose, sodium and 24 h-urinary sodium, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), creatinine, UA, DRC, PA, and 24 h-UAE were collected. The above blood tests and urine-related tests were conducted by the laboratory examination department of TEDA International Cardiovascular Hospital.Blood collection conditions: (1) collection time: 08:00 a.m., after maintaining a non-reclining position  for 2 h; the individual was maintained in a sitting position for 10 min, and then the blood sample was collected. (2) Blood was collected carefully to avoid hemolysis. (3) The blood sample to be measured for DRC was kept at room temperature during delivery. The PA and DRC were measured via a fully automated chemiluminescence immunoassay . ARR is The SphygmoCor-XCEL  was used for measuring CBP. It is the internationally recognized gold standard for the non-invasive evaluation of CBP. The patient was prepared for the examination depending on the requirements. The patient was asked to lay flat on the examination bed with the right upper limb externally rotated and abducted at 45° to the torso. A suitable cuff was placed in the center of the brachial artery of the exposed upper arm. The arm was positioned in a way that the cuff was at the same level as the heart. CSBP, CDBP, and CPP were then obtained using the software. We measured systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP) in the right brachial artery with calibrated electronic sphygmomanometer following a standardized protocol and hypertension guidelines.− 1.234× Age− 0.179[×0.79 ]. BMI was calculated as body weight in kilograms divided by the square of body height in meters.The modified and simplified MDRD equation was used to calculate eGFR . The modSmoking was defined as smoking at least 1 cigarette/d for at least six months. Alcohol consumption was defined as alcohol consumption of at least 1 drink/week for at least six months. Hypertension was defined as the self-reported history of hypertension and/or administration of antihypertensive medication and/or elevated BP on the day of investigation; the mean value of three measurements of SBP ≥ 140 and/or the mean value of DBP ≥ 90 mm Hg (1 mm Hg = 0.133 kPa). MAU was defined as 30 mg/24 h ≤ 24 h-UAE < 300 mg/24 h.All patients were divided into two groups according to 24 h-UAE, the control group (24 h-UAE < 30 mg/24 h), and the MAU group (in the range of 30 mg/24 h to 300 mg/24 h).2-test was used for comparing categorical data between groups.Continuous variables with normal distribution were expressed as the mean ± SD and the median with P25–P75 was used to express the data that were not normally distributed. Student’s t-tests or non-parametric tests were conducted to compare data between groups. Paired t-test was used to compare the differences in CBP and BP. Categorical data were represented by numbers (%), and the χAfter the logarithmic calculation of 24 h-UAE was performed, the correlation of CBP, DRC, PA, and UA with 24 h-UAE and MAU was evaluated. In multivariate logistic regression, gender, age, and variables that were significant in the univariate analysis  were included for adjusting. The variable screening method was backward: conditional, the probability of a variable entering the equation was 0.05, excluding 0.10, and the other parameters were system default. The ROC curves were used to determine the value of CDBP, PA, and UA in predicting MAU in EHT, and the differences between the AUC of each predictor were evaluated for distinguishing between the MAU and control group. All statistical analyses were performed using IBM SPSS25.0 and MedCalc19.0.–1·1.73 m–2. According to eGFR (< 90 mL·min–1·1.73 m–2), 4.4% of patients could be considered to have reduced kidney function. The CSBP was around 10 mmHg lower than SBP , and CPP was approximately 14 mmHg lower than PP . However, CDBP was higher than DBP .Among 404 EHT patients , more than a quarter of patients  were diagnosed with MAU. Disease histories showed that the EHT were with low prevalence of diabetes, coronary heart disease and cerebrovascular disease . The level of UA was 386.8 ± 95.3 µmol/L and kidney function (eGFR) was 131.4 ± 28.7 mL·min2 vs. 26.6 ± 3.6 kg/m2, P < 0.001), longer duration of hypertension (P = 0.019), and a higher proportion of grade 3 hypertension  than the control group. Nearly 10% more creatinine was recorded in the MAU group than that in the control group . The MAU group also had higher values of PA  and UA  than the control group. Also, WBC , CSBP , CDBP , and 24 h-UAE  were significantly higher in the MAU group than that in the control group  and more than 10 years . The incidence of MAU in patients with hypertension for 5–9 years was not significantly different from that in patients with hypertension over 10 years .We assessed the temporal link between the incidence of MAU and hypertension. The incidence of MAU increased as the duration of hypertension increased, CDBP , CPP , DRC , PA , and UA  were significantly related to Log 24 h-UAE Table .A logistic regression analysis was performed to determine the relationship between CBP, DRC, PA, UA, and MAU. The results of the univariate logistic analysis showed that CSBP , CDBP , DRC , PA , and UA  were significantly associated with MAU (Table S2).After adjusting confounding factors , CDBP , PA , and UA  were still significantly associated with MAU. Other related factors for MAU were grade 3 hypertension  and duration of hypertension  , PA (P < 0.001), and UA (P < 0.001) alone.Three main findings were highlighted in this study. First, high CDBP and UA are independent risk factors for MAU in EHT. Second, PA, but not DRC and ARR, are independently associated with MAU in EHT. Finally, the combined test of CDBP, PA, and UA can more reliably predict MAU in EHT.In 2019, the Taiwan Society of Cardiology (TSOC) and the Taiwan Society of Hypertension (THS) developed a consensus for the clinical application of CBP in patients with hypertension, and CBP ≥ 130/90 mmHg was defined as hypertension . A signiSeveral studies have shown that CBP might be more relevant than peripheral BP in predicting target organ damage and cardiovascular outcomes , 16, 17.After correcting for risk factors, we found that CDBP was independently associated with MAU in EHT. Other studies showed similar findings; for example, a cross-sectional study with 1,280 hypertensive patients found that CDBP greater than 90 mmHg was associated with MAU, changes in carotid artery intima-media thickness, and left ventricular hypertrophy . HoweverThe renin-angiotensin-aldosterone system (RAAS) is the main regulatory system of hemodynamics in humans, and impairments in RAAS strongly affect the development and maintenance of arterial hypertension . In prim2 found no significant associations between UA and MAU [Most studies could not fully elucidate the relationship between UA and MAU. The Uric Acid Right for Heart Health (URRAH) Project analyzed clinical data of 26,971 individuals and found that UA increased with a decrease in renal function . The pre and MAU . The fin and MAU . HoweverThe URRAH study found a threshold of 4.7 mg/dL for predicting total mortality, 5.6 mg/dL for predicting cardiovascular disease mortality, and 5.7 mg/dL for predicting fatal myocardial infarction . We founIn hypertensive patients, UA as well as CBP alone has some predictive value in predicting MAU. There have been no studies in which CBP and PA combined with UA predicted MAU in EHT. In the present study, we found that the combination of the three significantly increased the area under the curve and was higher than alone, contributing to the early identification of MAU.This study had several limitations. (1) After excluding missing data on participants and the data on those who were administered drugs to interfere with RAAS, the number of selected participants, i.e., the sample size, was small. (2) This was a retrospective study, and we could not determine the causal relationship between MAU and related factors. (3) As this was a single-center study, the conclusions might not be applicable to populations from other centers or regions.In conclusion, we found that CDBP, PA, and UA were associated with MAU in the process of EHT. Their combined application had a better predictive value for MAU in EHT than their single application. Combined testing and intervention targeting might help in the diagnosis and prevention of MAU in EHT.Below is the link to the electronic supplementary material.Supplementary Material 1


Methods and Applications in Physiology series. This series essentially aims at emphasizing the latest experimental techniques developed to understand the main fundamental questions in physiology. Therefore, this Research Topic covers the latest advances in technologies that will foster and advance scientific discoveries.The present Research Topic, entitled “Methods and Applications in Clinical and Translational Physiology” is part of the Mekjavic et al.). Subjects participating in this study, conducted in Slovenia, undertook two trials, during which they were confined to normoxic vs. hypoxic conditions; the Authors concluded that the greater postprandial blood-glucose response following hypoxic confinement suggests the potential development of insulin resistance .Our Research Topic has collected eight original articles and one review. The opening article is a randomized crossover study designed to determine the effect of hypoxia on metabolism in men with excess weight  and a new low-cost force plate to measure balance and postural sway . The first device, called eEGG, which stands for electronic Egg, has been tested by German scientists and has been shown to have a strong correlation with the hand dynamometer, strongly suggesting that this new device could be used in medical practice . Similarly, the force plate, evaluated both in young and elderly subjects was reliable when assessing several parameters related to the center-of-pressure .Then, two articles describe a novel device to measure pain  and a metabolomic  study. In the first one, aiming at identifying serum biomarkers clinically useful in acute aortic dissection, Deng, Liu, and others combine two established methodologies, namely, “isobaric Tags for Relative and Absolute Quantitation” (iTRAQ) and label-free methods, demonstrating that FGL1, MMP9, PI16, and Lumican may serve as potential biomarkers in patients with acute aortic dissection . In the metabolomic study, Semporé and collaborators provide new insights into the biological modifications that accompany exercise in lower extremity artery disease, thereby contributing to a better understanding of the pathophysiology underlying walking impairment .Next, we have a proteomic .In the following study, Mexican researchers demonstrate that females undergoing peritoneal dialysis present higher serum levels of icodextrin metabolites–a specific fraction of dextrin (a starch-derived water-soluble glucose polymer) that has been successfully used as colloid osmotic agent–which may exert an increased colloid-osmotic pressure followed by reduced ultrafiltration volumes and increased blood volume and blood pressure  and showing that, compared to gas tamponade, intravitreal silicone oil results in a significantly greater decrease in the thickness of the peripapillary retinal nerve fiber layer in patients with proliferative diabetic retinopathy .Then, we have two studies important in ophthalmology, mathematically proving the potential for mechanical damage to the corneal wound in cataract surgery .A systematic review examining the effects of duloxetine in patients with knee osteoarthritis concludes this Research Topic, showing that this treatment may be an effective treatment for improving pain and depressive symptoms in these patients (


In this study, we aimed to explore the antihypertensive effect of 23 and 52% concentrations of low-sodium salt combined with the Chinese Modified Dietary Approaches to Stop Hypertension (CM-DASH) diet in patients with hypertension and type 2 diabetes.We conducted a randomized controlled single-blind trial with a semi-open design. One hundred and thirty-two participants were randomly assigned into Group A (control group), Group B , Group C , and Group D  for 8 weeks of dietary intervention. All participants were followed weekly to collect data on blood pressure, salt use, and adverse events. Blood and 24-h urine samples were analyzed at baseline, 4 weeks, and the end of the intervention.p < 0.001). Comparison between groups showed that the systolic blood pressure was lower in Groups C and D than in Groups A  and B , and the diastolic blood pressure was lower in Group D than in Group A . The 24-h urinary Na+ and Na+/K+ values were significantly decreased in participants using low-sodium salt (p < 0.001). No serious adverse events occurred during the trial.At the end of the intervention, the mean blood pressure decreased significantly by 10.81/5.03 mmHg, 14.32/6.32 mmHg, 14.20/6.59 mmHg, and 19.06/7.82 mmHg in Groups A–D, respectively, compared with baseline (Our preliminary results suggest that 23 and 52% concentrations of low-sodium salt combined with the CM-DASH diet can effectively reduce sodium intake and increase potassium intake in patients with hypertension and type 2 diabetes mellitus, thus achieving “salt reduction” and attaining standard, smooth, comprehensive management of patients with hypertension and type 2 diabetes.http://www.chictr.org.cn/, ChiCTR2000029017. Low-sodium salt is ordinary table salt (90–99% sodium chloride) mixed with varying proportions of potassium chloride (KCl), which also has a salty flavor, thereby reducing sodium chloride (NaCl) intake. A 5-year trial in China confirmed the health benefits and safety of low-sodium salt; however, the trial did not assess blood potassium markers, and it was unclear whether hyperkalemia could be a consequence . A revieTherefore, in this trial, we used two low-sodium salt concentrations (52 and 23% NaCl) and a meal pack to explore the effects of their combined intervention with the Chinese Modified (CM)-DASH diet on reducing the blood pressure, reducing sodium intake, and increasing potassium intake in patients with hypertension and type 2 diabetes.2.2.1.Based on the pretest data estimation , 15, 30–2.2.This trial was conducted in Chongqing, China, from July to December 2021; 132 participants who were eligible for the test were selected from the Sihai Community Health Service Center of Chongqing Nan’an District People’s Hospital and the Health Management  Center of the Second Affiliated Hospital of Chongqing Medical University. The flow diagram depicting the enrolment of the participants in the study is shown in 2.2.1.The inclusion criteria were as follows: hypertension and type 2 diabetes; age ≥ 50 and ≤ 75 years; residence near the hospital without plan to move residence or leave the city during the trial; strict adherence to two daily meals provided by the investigators during the centralized feeding phase; and provision of informed consent (including their family members).The diagnostic criteria for hypertension were based on the Chinese Guidelines for the Prevention and Treatment of Hypertension (2018 Revised Edition) , and the2.2.2.The exclusion criteria were as follows: presence of malignant tumors, acute myocardial infarction, stroke in the past 3 months or other serious diseases and expected survival time < 1 year; increased cortisol disorder or aldosteronism; acute diseases, such as upper respiratory tract infection, fever, or severe diarrhea; disabilities, such as hearing or speech impairment, dementia, severe depression, or other mental disorders preventing normal communication; unavailability for regular follow-up or loss to follow-up after study entry; renal dysfunction or chronic kidney disease at stage 4 or above; abnormal liver function, with alanine aminotransferase or aspartate aminotransferase levels >2 times the upper limit of normal or total bilirubin level greater than the upper limit of normal; abnormal blood potassium level, <3.5 mmol/L or > 5.5 mmol/L, or current use of potassium-preserving diuretics; pregnancy, possibility of pregnancy, or other contraindications for the use of the trial meal; current consumption of a low-sodium diet or participation in other clinical studies; or other ineligible conditions as determined by the investigators.2.3.n = 34); Group B ; Group C ; and Group D .We performed a randomized controlled single-blind trial (patients were blinded to the specific grouping) with a semi-open design. After completion of the baseline survey, physical examination, and 24-h urine collection, participants were randomly classified using a random number table method into Group A , and the third and fourth weeks comprised the centralized feeding phase . Breakfast was eaten at home according to the diet recommendations. Lunch and dinner were prepared by the hospital canteen staff according to the diet recommendations and salt requirements under the guidance and supervision of the researchers. Lunch was eaten in the hospital, dinner was eaten at home, and all patients were asked not to add extra salt. The fifth to eighth week comprised the home nursing stage . All patients participated in weekly follow-up visits wherein their blood pressure was measured and trial salt was distributed. Additionally, the participants were reminded to strictly abide by the requirements of salt intake and diet and to reduce the frequency of eating out. Specialized doctors were also required to monitor the participants’ drug use and ensure the safety of the trial.2.3.2.The test salt was used throughout the trial as a substitute for the participants’ household salt. Group A received common salt . Group B received 52% low-sodium salt . Groups C and D received 23% low-sodium salt . We provided a quantitative spoon for the participants to control the amount of salt used in the household (<5 g per person per day). In addition, we used an electronic scale (precision: 0.1 g) to weigh the salt consumption weekly and estimate the daily salt consumption for each family member.2.3.3.According to the recommendations of the Chinese Guidelines for the Prevention and Control of Type 2 Diabetes (2018 Edition) and the Chinese Guidelines for the Prevention and Control of Hypertension (2017 Revision), respectively, patients with diabetes should adopt a diversified dietary pattern that is “based on cereals, high in dietary fiber intake, and low in salt, sugar, and fat,” and patients with hypertension should have a diet based on fruits, vegetables, low-fat dairy products, whole grains rich in dietary fiber, and plant-derived protein and should reduce the intake of saturated fat and cholesterol. Accordingly, the investigators combined the information on the DASH Dietary Energy Supply Estimation Table, the Dietary Pagoda for Chinese Residents (2016), the dietary habits of Chinese residents, the availability of food, as well as the participants’ body mass levels, incidence of obesity, and level of physical activity to create a diet suitable for Chinese patients with hypertension and type 2 diabetes mellitus. The CM-DASH dietary model was developed for Chinese patients with hypertension and type 2 diabetes based on the daily energy requirement per kilogram of ideal body mass for light physical activity in patients who are overweight or obese. The main requirements were as follows: (1) use of brown rice, corn, soybeans, red beans and other grains to make mixed-grain rice; (2) use of lean meat and poultry, an average daily intake of lean meat, poultry, fish, and other meats of 80–120 g and minimization of consumption of red meat and eating more white meat (skinless chicken and fish); (3) daily consumption of approximately 250 g of low-fat milk and dairy products ; (4) Eating more low-sugar green leafy vegetables (about 500 g/day); (5) ensuring a moderate intake of fruit  and nuts ; and (6) a daily intake of edible oil (vegetable oil) <30 g, and salt intake <5 g. The CM-DASH diet contains less fat, saturated fat, and calories than the standard DASH diet and is more in line with Chinese dietary habits. An older man with hypertension and type 2 diabetes mellitus with a body mass of about 60 kg who engaged in light physical activity was used as an example. All participants cooked food at home  using the recommended recipes .2.3.4.The meal packs  dietary treatment for type 2 diabetes and hypertension is based on Chinese dietary structure and habits; it follows the principles of dietary treatment of hypertension and diabetes, screening the use of Chinese medicines in the treatment of hypertension and diabetes and the results of using modern hypertension and diabetes nutritional medicine. It uses mixed-grain and homogenized meals as the core of the nutritional intervention treatment and was provided as an intervention for Group D. It included the following items: CM-DASH Homogenized Meal Solid Drink , CM-DASH Solid Drink  and CM-DASH Eight Treasures Rice (Rice for Mid-Dinner). The ingredients of each item are shown in 2.4.Participants attended follow-up appointments in the hospital once a week. Blood pressure was measured three times by trained professionals between 8 and 9 a.m., with an interval of about 2 min. The average of the last two blood pressure measurements was used for the analysis. According to the oscillometer technique, automated upper-arm cuff devices were used .2.5.Laboratory measurements included 24-h urinary electrolytes and blood electrolytes. All indices were tested in the Second Affiliated Hospital of Chongqing Medical University. The test instrument was a fully automated chemiluminescence immunoassay analyzer .2.6.p < 0.05 was considered statistically significant.The normality of the data was tested using the Kolmogorov–Smirnov test, with normally distributed data expressed as mean ± standard deviation (M ± SD) and non-normally distributed data expressed as median and upper and lower quartiles . Levene’s test was used to test the data’s homogeneity of variance. Inter-and intra-group comparisons were performed using the paired t-test and one-way analysis of variance, as well as the Kruskal–Wallis H test and Wilcoxon’s signed-rank test. The blood pressure values measured continuously were analyzed using a generalized estimation equation (GEE). SPSS version 26.0  was used for all statistical analyzes. All tests were two-sided, and 2.7.http://www.chictr.org.cn/). All participants and their families provided written informed consent before enrollment in the trial.The study protocol was approved by the Ethics Committee of Chongqing Medical University . All procedures reported in this study have been conducted in an ethical and responsible manner and in full compliance with all relevant codes of experimentation and legislation . The mean diastolic blood pressure (DBP) of Group D was lower than that of Group A . The GEE showed a significant decrease in blood pressure from baseline in all groups, with a more significant decrease in Group D compared with all other groups  of Groups C and D were lower than those of Group A [−6.54 mmHg, 95% confidence interval (CI) -12.58 to −0.49, 3.3.+/K+ ratio decreased in the low-sodium group (p < 0.001). Except for Group A, all of the groups showed a trend of increase in potassium and decrease in sodium 24-h after the intervention, with no difference among groups. As an indicator of safety, serum K+ and Na+ fluctuated during the trial but were within normal limits  during the follow-up period, of which two cases (5.88%) were in Group A, two cases (6.67%) were in Group B, one case (3.03%) was in Group C, and five cases (15.15%) were in Group D, three of which were hypoglycemic adverse reactions. All adverse reactions were short-term symptoms that resolved on their own .4.Lifestyle interventions, especially dietary interventions, are essential for the prevention and management of chronic diseases such as hypertension and diabetes. Among the many dietary patterns worldwide, the Eastern  and Mediterranean dietary patterns have been shown to have positive effects , 18–20, The results of this study showed that patients with hypertension and type 2 diabetes had a significant decrease in SBP/DBP immediately after the start of CM-DASH dietary intervention. At the end of the first week of intervention, the mean decreases were 8.62 mmHg/4.25 mmHg, 12.17 mmHg/7.25 mmHg, 10.99 mmHg/ 6.02 mmHg, and 17.61 mmHg/ 5.85 mmHg in Groups A–D, respectively. The decrease in SBP was most pronounced in Group D, which could be because the components of the meal pack (CM-DASH Nutrition Dietary Pack) included 23% low-sodium salt and various supplementary foods rich in dietary fiber . The SBP of Group C was not significantly lower than that of Group B, possibly because the 23% low-sodium salt had a lower sodium content and a more unpalatable taste than the 52% low-sodium salt and common salt; the patients were in the stage of adaptation to low-salt diet in the first week. However, the results consistently showed that the decrease in blood pressure was significant after the patients changed their unbalanced dietary habits . Even in the absence of NaCl restriction (Group A), salt intake restriction combined with a modified DASH diet resulted in a decrease in blood pressure, with implications for shortening the duration of their treatment and saving health care resources.During the centralized feeding period (weeks 3 and 4), blood pressure decreased below baseline in all four groups  and remained at these levels, though there was a small increase in the later period. This result indicates that the centralized feeding model has good health benefits and is a practical guide for controlling blood pressure. At the end of the intervention, the blood pressure of Groups A–D decreased by 10.81 mmHg/5.03 mmHg, 14.32 mmHg/6.32 mmHg, 14.20 mmHg/ 6.59 mmHg, and 19.06 mmHg/ 7.82 mmHg, respectively. The results of our study corroborate those of previous studies wherein the decrease in SBP was significantly greater than that in DBP; SBP is an important reference index for predicting cardiovascular disease risk factors among older patients with hypertension. Thus, an SBP reduction can effectively lower the risk for future cardiovascular and cerebrovascular adverse events –28. The p = 0.000). At the end of the intervention, the respective 24-h urinary potassium levels of Groups B, C, and D increased by 0.4, 0.4, and 0.7 g, respectively, from the baseline. Overall, our results showed that, even short-term lifestyle (dietary) interventions can yield good health benefits. We speculate that a more pronounced improvement in sodium and potassium intakes in an extended intervention period would result in even greater benefits to the prognosis of patients with hypertension and type 2 diabetes.A meta-analysis examining the relationship between salt intake and blood pressure showed that every 1.0 g/day reduction in salt intake in patients with hypertension resulted in a 1.2 mmHg decrease in SBP . The res+/K+ ratio can better predict sodium and potassium content in the body . The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study.LM contributed to the conception and design of the study. All authors contributed to the article and approved the submitted version.This research was supported by the Science and Technology Bureau of Chongqing (STBC), China (Project No: cstc2019jscx-msxm X0267). However, STBC did not participate in the design, implementation, data collection, analysis, or manuscript writing processes of the study.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.