A retrospective analysis of 59 pregnant women who visited the obstetrics department of a provincial hospital was divided into 2 groups. The normal control group consisted of 32 normal, uncomplicated pregnant women; the preeclampsia group included 27 patients with systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg who developed proteinuria after 20 weeks of gestation. The levels of TNF-α and IL-6 in serum of normal pregnant women and pregnant women with preeclampsia were detected by enzyme-linked immunosorbent assay (ELISA). The results showed that compared with normal pregnant women, the serum levels of TNF-α and IL-6 in the early pregnant women of Zizhi were significantly increased, and the trend of increased TNF-α and IL-6 levels was related to the severity of complications. With the mean pulmonary arterypressure > 50 mmHg, the serum TNF-α level of pregnant women was significantly higher than that of pregnant women with mean pulmonary arterypressure < 50 mmHg. The analysis found that the serum levels of TNF-α and IL-6 in patients with hypoxic gestational hypertension were significantly increased, and the results of lung tissue immunohistochemistry also showed that serum TNF-α and IL-6 levels in patients with hypoxic gestational hypertension were significantly increased. And serum TNF-α and IL-6 levels were positively correlated with right ventricular systolic blood pressure (RVSP). Conclusion. This study revealed that the elevated levels of serum TNF-α and IL-6 are closely related to the pathophysiological process of gestational hypertension. Serum levels of TNF-α and IL-6 and ET were significantly increased, and the changes of serum TNF-α and IL-6 and ET levels had important clinical value for closely monitoring the severity of the disease and the development of the disease.In order to explore the changes and clinical significance of serum TNF- Pregnancy is a special physiological period for women, and various physiological indicators of the body will change, in order to facilitate the growth of the fetus in the mother and the later delivery. During pregnancy, the levels of progesterone and estrogen in pregnant women change significantly, and their serum levels reach their peaks in the third trimester; these hormones affect the synthesis, metabolism, and secretion functions of the liver and kidney. Pregnancy hypertension is a group of diseases associated with gestational hypertension, preeclampsia, and eclampsia; chronic hypertension is associated with complications of preeclampsia; pregnancy with complications of hypertension will increase with gestational age. Damage to pregnant women is shown in P = 0.005), combined with RBP4, predicting a 34% increase in DR in early-onset preeclampsia, and PAPP-A can be used as a useful indicator for predicting early-onset and severe preeclampsia [Gabbay-Benziv et al. cultured trophoblast cells in vitro and detected inhibin A, indicating that there is mRNA encoding inhibin A in trophoblast cells . Contro clampsia .Echocardiography was performed by an echocardiographer with more than 10 years of clinical experience. The following points should be noted during the examination: the echocardiographic image grade should not be lower than grade C. The calculated value of pulmonary artery pressure is uniformly plus 5 mmHg (mild) on the basis of the tricuspid transvalvular pressure difference. The report should include tricuspid regurgitation velocity, transvalvular pressure gradient, and estimated pulmonary systolic pressure. If the pulmonary artery pressure is above 50 mmHg, it should be regarded as pathological and should not be treated as a normal pregnant woman.Longitudinal axis of left ventricle: aortic main diameter, left atrium diameter, interventricular septum thickness, left ventricular end diastolic diameter, left ventricular systolic end diameter, and left ventricular posterior wall thicknessLong-axis view of the pulmonary trunk: pulmonary trunkRight heart measurements : right ventricular base diameter, right atrium diameter, left ventricular mass index (LVMI), and tricuspid annular presystolic amplitude (TAPSE)Measurement of left ventricular systolic function: left ventricular ejection fraction (EF), left ventricular short-term shortening (FS), stroke rate (SV), and minute output Measurement of left ventricular diastolic function: spectral diagram of mitral valve blood flow: E peak, A peak, E/A, and E peak time delay (EDT); Doppler imaging TDI: early systolic peak velocity (S), early diastolic peak velocity (e′), and late diastolic peak velocity (a′)Pulmonary arterial pressure measurement: tricuspid regurgitation velocity, tricuspid transvalvular pressure gradient, and estimated pulmonary artery systolic pressureThe main evaluation indicators included the following echocardiographic indicators:At the same time, this study also recorded the subjects' age, heart rate, height, and weight and asked the patients their prepregnancy weight as their standard weight .The inside diameter of the left ventricle and its walls are measured against the longitudinal axis of the left ventricle. When measuring, select an area perpendicular to the longitudinal axis and measure at or near the apex of the mitral valve. An electrical cursor is placed at the junction of the myocardial wall and the heart chamber, between the ventricular wall and the pericardium. The inner diameter of the chamber can be obtained with 2D ultrasound guided M-mode, but a better method is to obtain it directly with 2D ultrasound images, which avoids the bevel of the ventricle and makes it more accurate.Fractional shortening can be obtained from a 2D guided M-mode image, but it is best to measure radial lines directly on the 2D image. In the case of segmental wall motion abnormalities caused by coronary heart disease or conduction abnormalities, the overall function of the left ventricle based on diameter measurements is very problematic. In patients with uncomplicated hypertension, obesity, or valvular disease, such as without clinically confirmed myocardial infarction, such segmental differences are rare, so fractional shortening can provide clinically useful information. In patients with basal LV but increased medial and left venous volume, the LV value was higher than that of the basal LV.Calculate the fraction (EF) that differs from the mean values of the left ventricular systolic volume (EDV) and the left ventricular diastolic volume (ESV), and its formula is as follows:Left heart measurement should be done in 2D or 3D. The interface between the thick myocardium and the left ventricular cavity is closed, and the entire contour is closed with a straight line to the mitral annulus. Longer lines were selected in apical two-chamber view and four-chamber view. Left ventricular volume should be measured at apical four-chamber and two-chamber views. Select the largest left ventricular area of the left ventricle, and try not to shorten the left ventricle and underestimation of the left ventricular volume . When exIn the left heart, M type, 2D, and 3D are valid methods for counting left heart. All measurements should be made at the end of the diastole . Left ventricular diastolic diameter and wall thickness measured with M type or 2D both rely on geometric models to calculate the left ventricular diameter, while 3D ultrasound can measure LV volume directly, all the way to change the volume to size by taking the volume of myocardial by myocardial density. At the same time, the study also recorded age, heart rate, height, and weight and asked patients their weight before pregnancy based on their weight.The subjects of the analysis were the records of pregnant women who delivered inpatients in the obstetrics department of a provincial hospital between May 2021 and May 2022. The study included 59 participants who were divided into two groups. One of the groups was 27 pregnant women who suffered from prepain and gave birth in our hospital and was designated as the prepain group. Significant symptoms are two or more wet measurements of pregnant woman blood pressure after 20 weeks of gestation, systolic blood pressure > 140 mmHg, and/or diastolic pressure > 90 mmHg, and the measurement time was at least 4 hours, proteinuria. In another group, 32 pregnant women who gave birth without problems during pregnancy were identified as the normal control group. The gestational age and maternal age of pregnant women in pre-Ziton and control groups were always similar. All pregnant women had one pregnancy, and this study did not include women with high blood pressure, heart disease, kidney disease, or type 1 or type 2 diabetes.α and IL-6 were collected from the heart and stored at -80°C.The analysis groups were set up as follows: (1) normoxia control pregnancy group, (2) pregnancy-induced hypertension group, and (3) treprostinil treatment group . Blood s(1) Right Ventricular Systolic Blood Pressure Detection. Pentohexidine was administered intravenously (30 mg/kg) was injected intravenously, and the trachea was intubated and placed in a well-ventilated environment. The thoracic cavity was opened, a PE-50 polyethylene tube was inserted into the right ventricle, and the right ventricular systolic pressure was collected by energy-Lab data collection.(2) Extraction of Total RNA. Use TRIzol to extract total RNA from lung tissue, and the specific operation steps are as follows:50 mg of lung tissue was added to 1 ml of TRIzol, placed in liquid nitrogen, and homogenized by a homogenizerThe homogenized samples were placed at room temperature for 5 min to completely separate nucleic acid and proteinμl chloroform, shake for 15 s, and allow to stand at room temperature for 1 minAdd 200 g for 15 min at 4° C. After centrifugation, the sample was divided into three layers: the lower layer (red organic phenol-chloroform phase), the middle layer, and the upper colorless aqueous phase. RNA in the upper colorless aqueous phaseCentrifuge at 10,000 × Transfer the colorless water-free phase to a new EP tube, add 500 isopropanol, and allow to stand at room temperature for 10 minutesg for 15 min at 4° C to remove the top layerCentrifuge at 10,000 × g at 40° C for 5 min, and remove the top layerTo wash the RNA pellets, add 1 ml of precooled 75% ethyl alcohol, centrifuge at 7500 × Dry the RNA pellets at room temperature, adding about 50 (depending on the size of the pellets) RNase-free water, and store at 80° C to dissolve the RNA pellets(3) Reverse Transcription of RNA. cDNA was synthesized in vitro by Moloney's leukemia virus reverse transcriptase (M-MLV RT), and the operation steps were as follows:Add the following components in (b) After the mixture was heated at 70°C for 5 minutes, it was quickly cooled on ice for 5 minutes(c) After a brief centrifugation, the following components were added as shown in Table 2(d) The components were mixed gently and reacted at room temperature for 10 minutes and then heated at 45°C for 50 minutes(e) Heat at 70°C for 15 minutes to stop the reaction(4) Real-Time Quantitative PCR . The SYBR∗ Pemix Ex Tag™ kit was used for the real-time fluorescent quantitative PCR reaction. The specific steps are as follows:Prepare the reaction system according to the components in (b) Run the RT-PCR reaction. The reaction process is shown in Table 4(5) Immunohistochemistry. DewaxingParaffin sections of 4 thickness were sequentially placed in 100% xylene (a) and 100% xylene (b) at 37°C for 15 min eachThe slices were sequentially placed in 100% ethanol-100% ethanol-95% ethanol-80% ethanol-70% ethanol-plus % ethanol for 2 minutes eachThe slices were soaked in double-distilled water for 2 minutes and repeated 3 times (ii) Antigen Retrieval2O, treated at room temperature for 15 minutes, and then soaked in double-distilled water for 2 minutes, repeating 3 timesAfter dewaxing, the samples were placed in 3% HPreheat the 0.1 m citric acid solution in the microwave for 3 minutes, quickly put the slices into the sodium citrate solution, and continue to boil for 15 to 20 minutes(iii) Serum BlockingThe samples were cooled for 30 minutes and then soaked in double-distilled water for 2 minutes, repeating 3 timesAfter the double-distilled water on the tissue evaporated, immediately add serum-containing peroxidase blocking agent to block, and incubate at 37°C for 30 minutes(iv) Antibody Incubationα or IL-6 antibody, and incubate at 4°C overnightIncubate with primary antibody, incubate at 37°C for 30 minutes, discard the blocking solution, add TNF-After incubation with the secondary antibody, after recovering the primary antibody, the samples were washed three times with PBS for 5 minutes each time. After washing, biotinylated rabbit anti-goat secondary antibody was added and incubated at room temperature for 15 minutes(v) Color Rendering(vi) CounterstainingAfter adding the chromogenic substrate 3,3-diaminobenzidine , the sample reacts with horseradish peroxidase-labeled streptavidin, and the color is observed under a microscope. Rinse with clean water after sufficient color development. (vii) DehydrationThe slides were washed in double-distilled water for 3 minutes and then counterstained with hematoxylin for 30 seconds after repeated 3 times. Rinse twice with tap water for 6 minutes each time. (viii) Cover SheetThe slides were washed in double-distilled water for 3 minutes, repeated 3 times and then placed in 70% ethanol-80% ethanol-90% ethanol-95% ethanol-100% ethanol-100% ethanol-xylene-xylene for 2 minutes, and finally soaked in xylene . (viii) Drop the neutral gum next to the tissue, cover with a coverslip, and lay down one side first and then the other to avoid air bubbles. Dry the sealed slides in a 65°C oven overnight.t-test or unilateral ANOVA. The correlation of the differences was evaluated by Pearson's correlation coefficient [P < 0.5 was considered statistically significant.Unless otherwise specified, all data are indicated as average ± SD. Tukey's post hoc tests were performed using Prism version 5 software to determine whether there was a discrepancy between the control panel and the test group using fficient . P < 0.5The clinical characteristics of all participants in the concept of pregnancy are shown in α and IL-6 were detected by ELISA assay, and blood levels of TNF-α in pregnant women were detected at an earlier stage than in the control group. The Ziji group has grown. In addition, we found plasma levels of TNF-α and IL-6 in the blood, due to which pregnancy causes patients with pulmonary arterial hypertension, and pathophysiological changes in pulmonary arterial hypertension increase morbidity and mortality for pregnant women. Hypertension during pregnancy is determined by the average value of pulmonary arterial pressure [α levels of pregnant women with mean pulmonary arterypressure ≥ 50 mmHg, significantly higher than the average pulmonary arterypressure < 50 mmHgin pregnant women (Blood levels of TNF-pressure . We retrnt women .α levels in pregnant women mean pulmonary arterial pressure ≥ 50 mmHg is higher than in pregnant women who mean pulmonary arterial pressure less than 50 mmHg. In the meandata + standarddeviation,P < 0.01means the significant difference compared to the control group. Levels of IL-6 in pregnant women, which means pulmonary arterial pressure ≥ 50 mmHg and pulmonary arterial pressure less than 50 mmHg, meet TNF-α levels. Based on the above results, serum levels of TNF-α and IL-6 were significantly elevated in pregnant women with gestational hypertension and were associated with the severity of complications.Plasma TNF-α and IL-6 levels can be used as biomarkers in prenatal hypertension, we examined blood TNF-α and IL-6 levels in pregnancy samples treated with treprostinil [To determine which plasma TNF-rostinil . Treprosα and IL-6 levels are higher in pregnant women with higher blood pressure than in pregnant women, indicating that TNF-α and IL-6 levels are higher, associated with high blood pressure. Right ventricular systolic blood pressure was significantly higher in patients exposed to hypoxia than in normoxic controls. When treated with treprostinil, right ventricular systolic blood pressure in hypoxic-induced hypertensive depression of pregnancy was decreased. Plasma levels of TNF-α and IL-6 can also be used in the treatment and prevention of gestational hypertension.Studies have shown that blood TNF-


Increased afterload affects many of the flow dependent metrics assessed during transthoracic echocardiography (TTE) especially in the evaluation valvular disease. A single timepoint blood pressure (BP) may not accurately reflect the afterload present at the time of flow-dependent imaging and quantification. We assessed the magnitude of change in BP at discrete timepoints during routine TTE.We conducted a prospective study where participants underwent automated BP measurement while undergoing a clinically indicated TTE. The first reading was obtained right after the patient lay supine and subsequent readings were taken at 10-min intervals during image acquisition.We included 50 participants . After 10 min, 40 (80%) participants had a drop in systolic BP of >10 mmHg. Compared to the baseline, there was a significant drop in systolic BP , and diastolic BP  at 10 min. The systolic BP remained different from the baseline value throughout the duration of the study .BP recorded just prior to TTE does not accurately reflect the afterload present during most of the study. This finding has important implications for valvular heart disease imaging protocols that incorporate flow dependent metrics, where the presence or absence of hypertension may lead to under- or over-estimation of disease severity. •A single, initial BP is measured during routine transthoracic echocardiogram.•However, SBP and DBP can drop by 20 and 15 mmHg respectively in first 10 minutes.•A single initial measure may not reflect afterload during load-dependent imaging.•This impacts the accuracy of flow-dependent valvular disease imaging protocols. SystemiCurrent guidelines for conducting a comprehensive transthoracic echocardiogram recommend measurement and documentation of systemic blood pressure though do not offer any additional guidance . As a re2This is a prospective study of serial BP measurements to assess for changes in loading conditions among patients referred for clinically indicated transthoracic echocardiogram (TTE) at a single academic medical center . Participants were >18 years old and approached for consent once they were moved into a private examination room. Subjects gave written informed consent to participate in the study and the study was approved by the IRB at Tufts Medical Center as conforming to the ethical guidelines of the 1975 Declaration of Helsinki. Consistent with current guidelines [2.1initial, T10, Tfinal). A change in BP and HR was calculated by finding the difference between systolic blood pressure (SBP) readings, diastolic blood pressure (DBP) readings, and HR readings taken at each discrete 10-min mark . Since study times varied, after T10, a Tfinal time point was used. Tfinal reflects data recorded any time after and including 20 min from study start. SBP, DBP, and HR readings at the end of the study  and at the start of the study  were also compared. A mean change was calculated between each interval. All calculated means were reported with their associated standard deviation (SD). Paired t-test was used to assess statistical significance.BP and HR measurements were analyzed in 10-min intervals and at the end of the study  participants were in the hypertensive range and at study end  11 (22%) participants were in the hypertensive range. The mean decrease in SBP from Tinitial to T10 was 20.0 with an SD of 12.8 mmHg; (P < 0.05) and mean decrease in DBP was 15.7 with an SD of 13.2 mmHg; (P < 0.05). At T10, 40 (80%) participants had ≥10 mmHg decrease in SBP with 23 (46%) participants showing a ≥20 mmHg decrease in SBP. Similarly, with DBP, at T10, 33 (66%) had a ≥10 mmHg while 17 (34%) had a ≥20 mmHg drop in DBP. From T10 to Tfinal there was a mean increase in SBP of 7.6 with an SD of 13.0 mmHg; (P < 0.05) and in DBP of 8.9 with an SD of 12.8 mmHg; (P < 0.05). However, from Tinitial to Tfinal there was a mean decrease in SBP of 12.4 with an SD of 16.0 mmHg (p < 0.05) and in DBP of 6.8 with an SD of 14.8 mmHg (p < 0.05). In our study population, 22 (44%) participants were in the hypertensive range (stage I or higher) at TA subgroup analysis was conducted by whether the participant was undergoing treatment with anti-hypertensive medications at the time of the TTE study. 31 participants were undergoing treatment for hypertension (HTN-Tx) at the time of the study and 19 participants were not (no HTN-Tx). The HTN-Tx group had statistically significant (p < 0.05) higher SBPs than the no HTN-Tx group at all reported time points. These findings are summarized in 4The main finding from our study is that the office-based BP documented immediately prior to TTE imaging does not accurately reflect loading conditions present later in the imaging protocol. Our study showed a significant drop in blood pressure for 80% of the participants over the course of the study and 44% of the participants would have had blood pressure readings in the hypertensive range when they were in fact normotensive 10 min into the study. Blood pressure drop during the study is likely related to the prolonged period of supine rest that occurs during image acquisition.Consideration could be given to changing the timing of BP measurement to 10 min after starting image acquisition to obtain a BP value that is more reflective of the loading conditions present during most of the study. Further, automatic blood pressure monitors can be used for certain cases , so that BP measurements can be made throughout a study and recorded just prior to load-dependent imaging. The ease-of-use of these automatic devices make them minimally disruptive. Given the importance of accurately assessing afterload when evaluating several pathologic states, it appears appropriate to re-consider how BP is assessed, in a minimally disruptive manner, during routine TTE imaging.4.1Our findings suggest that a single BP measurement recorded at the start of the study is insufficient and does not accurately predict the loading conditions present during much of the imaging protocol. BP is central to clinical decision-making and the presence or absence of hypertension can lead to misclassification of disease severity and downstream treatment recommendations . In the The significance of our findings is further illustrated with two clinical cases. Consider a 75-year-old woman with dyspnea. She is referred for TTE to evaluate a systolic murmur where her initial blood pressure is documented at 162/84. Her imaging reveals aortic stenosis (AS) that appears severe based on the valve morphology (severely thickened with restricted motion) but the transvalvular hemodynamics fall into the moderate range. The stroke volume is low. In the setting of systemic hypertension, guidelines recommend treating her blood pressure and follow up imaging when she is normotensive. If in fact her blood pressure had normalized during the TTE (as we show frequently happens) her case would be labeled as low gradient severe AS and should be treated. These discrepant care pathways emerge from the observation that transvalvular flow is significantly impacted by afterload . And theThese issues are also relevant for assessing mitral regurgitation (MR). There is extensive evidence demonstrating the apparent variability of MR with changes in blood pressure . In the 5Current guidelines recommend the treatment of hypertension prior to assessing the severity of aortic and mitral valvular disease. Our study shows that during a routine TTE the SBP and DBP can drop as much as 20 mmHg and 15 mmHg respectively in the first 10 min. Therefore, BP recorded just prior to TTE does not accurately reflect the afterload present during most of the study. This finding has important implications for valvular heart disease imaging protocols that incorporate flow dependent metrics, where the presence or absence of hypertension may lead to under- or over-estimation of disease severity.


The aim of the study is to compare a non-contact tonometer (NCT) and goldmann applannation tonometer (GAT) in the evaluation of intraocular pressure (IOP) and mean ocular perfusion pressure (MOPP) in patients with thyroid-associated ophthalmopathy (TAO).  In this study, a total of 30 patients  were recruited. All patients underwent a routine ophthalmic assessment and their medical history was acquired. Clinical assessment included the 24-hour measurement of intraocular pressure and blood pressure, an orbital computed tomography (CT) scan, and a visual field  of visual field −2 dB or lower and a normal group with MD over −2 dB. z = 0.669, P=0.504), 24-hour MOPP fluctuation  measured by GAT and NCT had no significant difference between the two tonometers.  Bland–Altman's analysis showed similar results of IOP at every time point and revealed an agreement of mean IOP between the two tonometers . The 24-hour MOPP SD value in NCT (2.28) and GAT (1.77) showed that the two instruments had the same diagnostic efficacy . The areas under the receiver operator characteristic (ROC) curve of the 24-hour mean ocular perfusion pressure (MOPP) SD (GAT: 0.778, NCT: 0.713;  The measurement of IOPs, MOPPs, and their diagnostic efficacy of visual field defect showed consistency between NCT and GAT. The study highlights the importance of monitoring the 24-hour MOPP and IOP in TAO patients. Furthermore, it suggests that the less invasive NCT can replace GAT as a long-term monitoring device in TAO patients. Dysthyroid optic neuropathy (DON) is the most severe complication of thyroid-associated ophthalmopathy (TAO) . Early cNormal blood perfusion is vital in maintaining the structure and function of the surrounding tissue. Therefore, blood perfusion (BP) disorder caused by abnormal blood pressure fluctuation contributes to damage in organs such as the heart and brain or aggravates pre-existing tissue damage , 3. OculStudies have shown that the 24-hour IOP and MOPP fluctuation could aggravate optic neuropathy in glaucoma –8. In TAAlthough Goldmann's applannation tonometer (GAT) has always been considered the gold standard for measuring IOP , it requThe participants in this study were patients diagnosed with TAO using Bartley's diagnostic criteria at The Eye Hospital of Wenzhou Medical University from January 2018 to March 2019. The study adhered to the tenets of the Declaration of Helsinki and was approved by the local ethics committee . Informed consent was obtained from all patients. All patients underwent a review of their medical history, 24-hour blood pressure examination , and a comprehensive eye exam including best-corrected visual acuity test, exophthalmos measurement, slit-lamp microscopic examination, dilated fundoscopic examination, 24-hour Goldmann tonometry , 24-hour NCT examination , and visual field (VF) test . The VF test was repeated to ensure the reliability of the measurement .Patients with one or more of the following conditions were excluded from the study: (1)had any other oculopathy that affected visual function and eye movement, (2) had undergone orbital wall decompression surgery, ocular radiation therapy, or other eye surgery, (3) in the acute stage or patients with lagophthalmos (4) do not accept 24-hour IOP test or blood pressure monitoring, (5) were undergoing treatment to control IOP and blood pressure, and (6) a history of diabetes and hypertension.Patients were classified into two groups based on the mean deviation  from a visual field test: a visual field defect group (MD < −2 dB) and a normal group (MD ≥ −2 dB).Patients were admitted to the hospital to monitor BP and IOP over a 24-hour period. To avoid damage to the cornea and disturbing their sleep, measurements were taken at 05:00, 07:00, 10:00, 14:00, 18:: 00, and 22:00. Systolic and diastolic BP  were measured with a brachial sphygmomanometer on the upper left arm with the patient sitting upright for at least 5 min to keep calm and reduce possible errors prior to the measurement. IOP was measured with GAT after the NCT test, and the measurement location was required to be the center of cornea. Both IOP tests were performed with the patient seated and used neutral position of the neck to minimize the measurement error caused by different body positions , 14; patPerfusion pressure (PP) was defined as the difference between SBP and DBP. Mean arterial pressure (MAP) was defined as the average pressure throughout the cardiac cycle and represented an individual's perfusion pressure and it was calculated by the formula: MAP = DBP + 1/3 (SBP − DBP) . MOPP wat-test was used to study IOP, PP, and OPP values among the two groups. The Chi-square (χ2) test was used to detect the difference between the two sample rates, and the Pearson correlation coefficient was used to determine the correlation between the visual field test result and parameters BP, IOP, and MOPP. A Bland–Altman analysis was carried out to investigate NCT and GAT's agreement in IOP measurement. Finally, ROC curve analysis was used to compare the diagnostic efficacy of 24-hour MOPP measured by the two tonometers in TAO patients with and without VF defect. .Statistical analysis was performed using SPSS 25.0  and MedCalc v.18 . Descriptive statistics  were initially evaluated. The independent-samples P=0.562). All relevant information for the patients is shown in A total of 30 patients (60 eyes) were enrolled in this study from January 2018 to March 2019, including 16 females and 14 males. The average age was 47.97 ± 10.93 years old (26–67 years old). Among the 60 eyes, 36 eyes were classified as VF defected, and 24 eyes as VF normals. MD value of the left and right eye was −5.5 ± 7.6 dB and −6.5 ± 7.6 dB, respectively, and the differences between the two groups were not statistically significant (P=0.059). The Bland–Altman's analysis revealed a bias of the mean IOP between NCT and GAT of 1 mmHg, with 95% limits of agreement of 8.8 to −6.8 mmHg  and GAT (17.94 ± 2.77 mmHg) (6.8 mmHg . The Bla6.8 mmHg .P < 0.05). Additionally, the differences in the 24-hour MOPP SD and fluctuation values between the two groups strongly correlated with MD values of VF . The cut off values of 24-hour MOPP fluctuation measured by GAT and NCT were 6.546 and 7.905, respectively. The areas under the ROC curve of the 24-hour MOPP fluctuation values measured by GAT and NCT were 0.683 and 0.757, respectively, and, similarly to SD, there was no significant difference between the two tonometers . The 24-hour MOPP SD value in NCT (2.28) and GAT (1.77) had the same diagnostic efficacy   .In this study, two different tonometric instruments, namely, NCT and GAT, were compared for the evaluation of 24-hour IOP and MOPP in TAO patients. The results indicated that although there were some discrepancies in the measurements between the two tonometers, the most of the IOP data at every time point and the 24-hour mean IOP values measured by NCT and GAT were in agreement. There was no significant difference in the mean, fluctuation, and SD value of 24-hour IOP between TAO patients with and without VF defect, with either instrument. However, the fluctuation and SD of 24-hour MOPP were significantly different and found to correlate to the MD of the visual field test. The ROC curve analysis revealed that there was no significant difference in the diagnostic efficacy for the 24-hour MOPP SD value and the fluctuation value between NCT and GAT in TAO patients for either of the groups .In previous studies, TAO patients showed increased IOP, ranging between 4.8% and 24% –19. ThisPrevious studies suggested that NCT showed higher readings of IOP compared to GAT. However, Tonnu et al.  found thLately, the development of VF defects in glaucoma patients due to an abnormal ocular perfusion pressure such as hypotension, nocturnal hypotension, and low MOPP , 25, andThere are also some shortcomings in this study. Firstly, only a few IOP measurements were obtained within 24 hours. Considering that frequent GAT measurement may damage the cornea, and after a careful review of the literature , we founIn conclusion, it is of great clinical significance to strengthen the monitoring of 24-hour IOP and MOPP in TAO patients. Although NCT has some disadvantages, it can still be used as a long-term monitoring tool for the 24-hour MOPP and IOP monitoring in TAO patients.


At baseline, serum GPC4 was significantly associated with decreased eGFR (adjusted odds ratio (OR) per standard deviation = 4.75 [2.66–8.48]; P <  0.001), albuminuria , and, accordingly, with CKD . GPC4 levels also significantly and independently predicted the incidence of newly diagnosed decreased eGFR . ROC analysis indicated an additional predictive value of GPC4 to a basic prediction model for newly diagnosed CKD and eGFR < 60 mL/min/1.73 m2. Our study, therefore, indicates that high serum GPC4 is associated with decreased prevalent and future kidney function.Serum glypican-4 (GPC4) has been identified as an insulin-sensitizing adipokine serving as a marker for body mass index and insulin resistance in humans. The association of circulating GPC4 with kidney function is to date largely unexplored. Therefore, we aimed to evaluate the association between serum GPC4 and prevalent as well future kidney function in a prospective cohort study. The study included 456 Caucasian coronary angiography patients. After a median follow up period of 3.4 years, data on kidney function was reassessed in all patients. Chronic kidney disease (CKD) was defined by decreased estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m Main risk factors for CKD are hypertension and diabetes3. Criteria for the definition of CKD are based on decreased glomerular filtration rate (GFR) or markers of kidney damage such as albuminuria4. Much interest has focused on further kidney markers to improve early disease management and risk prediction, particularly in high risk subjects such as coronary patients. In this regard, uromodulin7 and fibroblast growth factor 23 (FGF23)10 have been proposed as new promising biomarkers of kidney disease.Chronic kidney disease (CKD) is strongly associated with an increased risk of cardiovascular and all-cause mortality12. In 2012, Ussar et al. showed that the cell surface protein glypican-4 (GPC4) also plays the role of an adipokine13. GPC4 belongs to the family of heparan sulfate proteoglycans (HSPGs), which are linked to the cell membrane by a glycosylphosphatidylinositol (GPI) anchor and mediate interactions with a variety of extracellular ligands such as growth factors and adhesion molecules14. GPC4 as well as other HSPGs can be released from the cell surface into extracellular space by phospholipase‐mediated cleavage of the GPI anchor or by proteolytic shedding16. Ussar et al. demonstrated that both membrane-bound and released GPC4 can interact with the insulin receptor and enhance insulin signalling in pre-adipocytes promoting adipocyte differentiation13. The authors further showed that serum GPC4 is a marker for body mass index (BMI) and insulin resistance in mice and humans13, which has been confirmed by subsequent studies20. Recently, Cha et al. revealed that circulating GPC4 is linked with estimated GFR (eGFR) and urinary albumin excretion in individuals with diabetes21. Another study showed a significant correlation of GPC4 with creatinine in patients with metabolic syndrome22. However, to our best knowledge, no other reports on the association of serum GPC4 with kidney function exist so far. Moreover, it is unclear, whether GPC4 can predict the development of future decreased kidney function.Adipose tissue has been recognised as a highly active endocrine organ secreting various biologically active adipokines, whose altered expression and secretion have been associated with a number of pathologies, including CKDIn order to get deeper insights into the association of GPC4 with kidney function, we investigated the association of serum GPC4 with CKD as well as with decreased estimated GFR and albuminuria at baseline and after a 3.4-year follow up period in a well characterized cohort of coronary angiography patients. In addition, we evaluated its diagnostic and prognostic value as a new biomarker for decreased kidney function.P-value < 0.001; Supplemental Table P = 0.002) and with eGFR independently from ACR .GPC4 levels ranged from 1.6 ng/mL to 12.8 ng/mL; the median GPC4 level was 5.5 [interquartile range: 4.6–6.9] ng/mL. Patients’ baseline characteristics of the total study cohort as well as stratified according to GPC4 quartiles are given in Table Ptrend < 0.001). Particularly, serum GPC4 differed highly significantly between patients with normal filtration rates (G1) and mildly decreased filtration rates (G2) and between individuals with mildly decreased filtration rates and moderately decreased filtration rates (G3a). GPC4 differed significantly between categories of severity of albuminuria  and between risk categories of CKD progression . Consequently, serum GPC4 was significantly elevated in patients with CKD compared to patients without CKD .Figure 2, albuminuria, and CKD remained significant after correction for age, sex, BMI, T2DM, CAD, smoking, blood pressure, and C-reactive protein (CRP) in multivariable logistic regression analysis. Respective odds ratios with 95% confidence intervals for one standard deviation change of log-transformed GPC4 are illustrated in Fig. Association of serum GPC4 with eGFR < 60 mL/min/1.73 m2, albuminuria, and CKD at baseline as well as at follow up compared to uromodulin and FGF23 and, therefore, outperformed these markers for the diagnosis of baseline and future kidney function  analyses were used to compare the performance of GPC4 as a biomarker for kidney function with the new circulating biomarkers uromodulin and FGF23. GPC4 showed higher area under the curve (AUC) values for the diagnosis of eGFR < 60 mL/min/1.73 mP < 0.001 and r = 0.245; P < 0.001, respectively; adjusted results from analysis of covariance are shown in Supplemental Table After a median follow up period of 3.4 [3.1–3.5] years, kidney function was reassessed in all patients. Serum GPC4 determined at baseline was significantly correlated with eGFR and ACR assessed at follow up . Similarly, patients with newly diagnosed albuminuria at follow up showed significant higher baseline GPC4 levels compared to patients with no albuminuria at baseline and at follow up . Consequently, GPC4 levels were also significantly increased in patients with newly diagnosed CKD at follow up compared to patients with no CKD at baseline and at follow up .eGFR < 60 mL/min/1.73 m2, albuminuria, and CKD during a 3.4-year period  occurs in inflammatory states and during ischemia and results in the release of measurable glycocalyx components into the circulation27. As GPC4 contributes to the formation of the glycocalyx, circulating GPC4, derived from endothelial glycocalyx shedding may, therefore, represent a surrogate marker of kidney dysfunction caused by damage to the glycocalyx. In fact, the glycocalyx shed markers syndecan-1 and hyaluronan have been previously associated with different CKD stages supporting this hypothesis29.Increased GPC4 levels in patients with decreased kidney function may be a result of impaired glomerular filtration, responsible for elevated plasma levels of creatinine and urea as well. In fact, among the investigated parameters the strongest correlation was found between serum GPC4 und eGFR. However, unlike circulating creatinine and urea, serum GPC4 was strongly correlated with urinary albuminuria too. Albuminuria associated with progression of kidney disease is likely caused by the degradation of the glycocalyx, a hydrogel comprised of glycosoaminoglycans, glycoproteins and associated serum proteins that covers the luminal surface of the glomerular endothelium and that normally acts as a barrier against albumin filtration30. GPC4 can interact with the insulin receptor enhancing insulin signalling in preadipocytes and plays a role in adipocyte differentiation13. Insulin also performs distinct actions in kidney tissue that regulate metabolic and growth pathways as well as the kidney microcirculation. Consequently, resistance to the metabolic actions of insulin affects kidney structure and function31. It has been speculated that an increase of circulating GPC4 could represent a regulatory mechanism by which fat acts to counteract insulin resistance32. This hypothesis could be applicable for kidney tissue as well, assuming that increased GPC4 levels mirror elevated demand of insulin needed for maintenance of kidney function and kidney repair.Since GPC4 is highly expressed in tubular epithelial cells in the adult kidney, it may also have a physiological function33, which triggers adaptive responses involved in kidney repair and regeneration, but may also promote disease progression, depending on the magnitude and duration of its activation36. The picture is even more complex, as membrane-bound GPC4 enhances Wnt signalling, but GPC4 secreted to the extracellular environment acts as competitive inhibitor of the Wnt signalling pathway33. Therefore, functional studies are needed to understand the biological role of circulating GPC4 in kidney disease.GPC4 is also involved in the control of the wingless/int-1 (Wnt) signalling pathway23 and, therefore, may not be specific to the malfunction of a particular organ. In addition, despite the statement of the manufacturer, that the used ELISA shows high specificity to human GPC4, any assay cross- reactivity to GPC4 analogues cannot be fully excluded. Therefore, the specificity of the GPC4 ELISA needs to be confirmed before it could be used as a predictive biomarker in the future. Importantly, due to the observational design of the present study, the pathophysiological mechanisms of the association between circulating GPC4 and impaired kidney function remain speculative and need to be investigated in further studies.Our study has several strengths and limitations. By design, our study population was composed of angiography coronary patients of European ancestry; our results therefore are not necessarily applicable to other ethnicities or the general population. However, the high-risk patient population of coronary angiography patients we chose to investigate is of particular clinical interest. The prospective part of our study represents the first observation linking GPC4 to the future decline of kidney function. However, GPC4 levels have been associated with various obesity-related traitsIn summary, our study shows that serum GPC4 is strongly associated with kidney function-related traits and for the first time predicts the development of CKD. The value of GPC4 as a new biomarker for kidney malfunction and kidney disease progression has to be further evaluated in subsequent studies.37. Hypertension was defined according to the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure38. T2DM was diagnosed according to American Diabetes Association criteria39. The study has been approved by the Ethics Committee of the University of Innsbruck, Austria, and written informed consent was given by all participants before taking part in the study. All methods were performed in accordance with the relevant guidelines and regulations.From September 2005 through April 2008, we enrolled 1048 consecutive Caucasian patients who were referred to elective coronary angiography for the evaluation of established or suspected stable CAD at the Academic Teaching Hospital Feldkirch, Austria. Out of these, 456 subjects had available serum samples for GPC4 analysis and data on kidney function at baseline as well as at follow up. Patients with acute kidney injury were not included. Coronary angiography was performed with the Judkin's technique and coronary artery stenoses with stenotic narrowing ≥ 50% were defined as significant CAD7. Serum GPC4 levels were determined using the same batch of a commercial enzyme-linked immunosorbent assay (ELISA) kit  following the manual of the manufacturer. The kit had a detection range of 0.031–2.000 ng/mL; the intra-assay coefficient of variation (CV) was below 10% and the inter-assay CV was below 12%. Serum samples were diluted 1:4 using phosphate buffered saline as a dilution buffer prior to analysis.Venous blood samples were collected after an overnight fast of 12 h before angiography was performed. Routine blood variables were determined in fresh serum samples by standard laboratory methods at the Medical Central Laboratories, Feldkirch, Austria. Serum samples were stored at −80 °C until used for analysis of FGF23, uromodulin, and GPC4. FGF23 measurements were performed at Immundiagnostik AG  and serum uromodulin was detected as previously described2; G2: eGFR = 60–89 mL/min/1.73 m2; G3a: eGFR = 45–59 mL/min/1.73 m2; G3b: eGFR = 30–44 mL/min/1.73 m2; G4: eGFR = 15–29 mL/min/1.73 m2. Urinary albumin excretion was expressed as ACR in a random morning urine specimen.GFR was estimated (eGFR) using the ‘Chronic Kidney Disease Epidemiology Collaboration’ (CKD-EPI) serum creatinine equation. GFR categories were defined as follows: G1: eGFR ≥ 90 mL/min/1.73 m2 or albuminuria. Due to the observational design of the study, our definition of CKD was based on single measurements of kidney function. Prognosis of CKD was classified into four risk-categories according to the classification system proposed by the 2012 KDIGO recommendations4, which were based on GFR categories (G1-G5) and ACR categories (A1-A3) and were as follows: Low risk: G1 and A1 or G2 and A1; moderately increased risk: G1 and A2, G2 and A1, G2 and A2 or G3a and A1; high risk: G1 and A3, G2 and A3, G3a and A2 or G3b and A1; very high risk: G3a and A3, G3b and A2, G3b and A3, G4 or G5.Urinary albumin concentration was determined by immunoturbidometry . Both serum and urinary creatinine concentrations were measured with a modified Jaffé method . ACR levels lower than 30 mg/g (category A1) were defined as normal and albuminuria was diagnosed as an ACR of 30 mg/g or greater. Moderately increased albuminuria  was defined as an ACR of 30 to 300 mg/g and severely increased albuminuria  as an ACR of 300 mg/g or greater. CKD was diagnosed in case of eGFR ˂ 60 mL/min/1.73 mAfter a median period of 3.4 years, patients were re-invited to undergo a follow-up investigation and kidney function was reassessed.2, albuminuria, and CKD, respectively, as the dependent variable. A basic model comprising ACR, age, sex, blood pressure, BMI, T2DM, CRP, smoking history, and the presence of significant CAD as independent variables was compared with a second model including GPC4 as an additional marker. Receiver operating characteristic and the respective AUC were calculated. The statistical significance of the difference between AUCs was tested with the method of DeLong40. All statistical analyses were performed with SPSS 27.0  software.Differences in baseline characteristics according to GPC4 quartiles were tested for statistical significance with Chi-squared tests for trend for categorical and Jonckheere Terpstra tests for continuous variables, respectively. Continuous variables are given as median and interquartile range .The datasets generated and/or analysed during the current study are available in the Mendeley Data repository, ‘Data on the association of serum glypican-4 with prevalent and future kidney function’ (Supplementary Information.


Although cardiopulmonary exercise testing (CPET) is considered the gold standard, a preoperative abdominal CT scan might also provide information concerning preoperative aerobic fitness for risk assessment. This study aimed to investigate the association between preoperative CT‐scan‐derived body composition variables and preoperative CPET variables of aerobic fitness in colorectal surgery.In this retrospective cohort study, CT images at level L3 were analysed for skeletal muscle mass, skeletal muscle radiation attenuation, visceral adipose tissue (VAT) mass and subcutaneous adipose tissue mass. Regression analyses were performed to investigate the relation between CT‐scan‐derived body composition variables, CPET‐derived aerobic fitness and other preoperative patient‐related variables. Logistic regression analysis was performed to predict a preoperative anaerobic threshold (AT) ≤ 11.1 ml/kg/min as cut‐off for having a high risk for postoperative complications.R2 of 51.1%) was lower in patients with a lower skeletal muscle mass index, together with higher age, lower body mass and higher American Society of Anesthesiologists (ASA) score. Higher ASA score  and higher VAT mass  were associated with an increased risk of an AT ≤ 11.1 ml/kg/min.Data from 78 patients  were analysed. A correlation coefficient of 0.55 was observed between absolute AT and skeletal muscle mass index. Absolute AT (Body composition variables from the preoperative CT scan were moderately associated with preoperative CPET‐derived aerobic fitness. Higher ASA score and higher VAT mass were associated with an increased risk of an AT ≤ 11.1 ml/kg/min. Although cardiopulmonary exercise testing (CPET) is the gold standard test to assess aerobic fitness, it is not always available in clinical practice. From this study, it appears that the routinely performed preoperative abdominal computed tomography scan cannot replace CPET for preoperative risk assessment on aerobic fitness in colorectal surgery.Colorectal cancer is the third most common type of cancer . After r2peak) have an increased risk of postoperative complications [Cardiopulmonary exercise testing (CPET) is increasingly utilized for risk assessment before major surgery to evaluate the risk of adverse perioperative events . CPET isications , 7, 8, 92peak) in community‐dwelling elderly men, while a recent study by West and others [For preoperative risk assessment, measurements of body composition using the routinely performed abdominal CT scan are increasingly gaining ground. Sarcopenia , a low sd others  in patieAlthough CPET is the gold standard to assess aerobic fitness, it would be of interest for time and cost savings to investigate whether the routinely performed preoperative abdominal CT scan can (assist to pre)select unfit patients. Therefore, the aim of this study was to preoperatively investigate the association between body composition variables derived from the abdominal CT scan and CPET variables of aerobic fitness in patients scheduled for colorectal surgery.The present retrospective study was reported according to the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) guideline.Data from all patients ≥60 years old with colorectal cancer or dysplasia planned for elective colorectal resection at the hospital Medisch Spectrum Twente, with a veterans‐specific activity questionnaire (VSAQ) score ≤ 7 metabolic equivalents of task (METs) and who underwent a preoperative abdominal CT scan and preoperative CPET between February 2013 and May 2017 were included. The VSAQ is a brief self‐administered questionnaire to estimate aerobic fitness, in which a score ≤ 7 METs was used to preselect those patients with a low perceived aerobic fitness [2) of skeletal muscle tissue, VAT and subcutaneous adipose tissue (SAT) were coloured automatically, and manually corrected if necessary, by two trained and blinded researchers . Skeletal muscle tissue, VAT and SAT areas were normalized for the patient's body height to calculate the L3 index (cm2/m2). The SM‐RA was assessed by calculating the average Hounsfield units (HU) value of skeletal muscle mass. Low SM‐RA is associated with increased intermyocellular and intramyocellular fat (myosteatosis) [A single slice of each patient's routinely performed preoperative abdominal CT scan was selected at the level of the third lumbar vertebra (L3) on which both transverse processes were visible. CT scans were all screened for their quality. Patients with a CT scan of poor quality  were excluded from analysis. Scans were analysed using sliceOmatic 5 (TomoVision) software for Microsoft Windows®. The cross‐sectional areas (cmeatosis) .As part of the study protocol, an incremental CPET was performed by patients preoperatively under controlled conditions at the lung function department, using a calibrated electronically braked cycle ergometer in upright position . The following standardized pre‐test instructions were given to the patients: (1) consume the last (light) meal at least 2 h before exercise testing, (2) adhere to usual use of medication and (3) wear comfortable sporting clothes and shoes. CPET comprised a 2‐min resting phase to assess baseline cardiopulmonary values, followed by 3 min of unloaded cycling (warm‐up), after which the work rate was progressively increased with constant increments of 5, 10 or 15 W/min, depending on the patient's subjective physical fitness level and aimed at reaching a maximal effort within 8–12 min. Throughout CPET, patients had to maintain a pedalling frequency between 60 and 80 revolutions/min. The protocol continued until the patient's pedalling frequency fell definitely <60 revolutions/min, despite strong verbal encouragement. After test termination, the patient completed a 5‐min recovery phase of unloaded cycling (cool‐down).2), carbon dioxide production (VCO2) and the respiratory exchange ratio averaged at 10‐s intervals . Flow volume (3‐L syringe) and gas calibration (ambient air and a gas mixture of 16% oxygen and 5% carbon dioxide) were performed manually before each test. Heart rate (HR), 12‐lead electrocardiography, blood pressure and pulse oximetry were continuously monitored.During CPET, patients breathed through a facemask (Hans Rudolph) connected to a Triple V volume transducer to calculate breath‐by‐breath minute ventilation, oxygen uptake  or a respiratory exchange ratio at peak exercise >1.10. The AT was defined as the point at which the ventilatory equivalent for oxygen and the partial end‐tidal oxygen tension reached a minimum and thereafter began to rise in a consistent manner, coinciding with an unchanged ventilatory equivalent for carbon dioxide and partial end‐tidal carbon dioxide tension [2 and VO2 changed) [2peak, AT and OUES values were normalized for body mass as well.CPET data were interpreted by a trained and experienced clinical exercise physiologist . The highest HR achieved during the CPET was defined as HR tension . If thischanged) . AbsolutBaseline patient characteristics included sex, age, body height, body mass, body mass index (BMI), smoking status, use of beta‐blocker, METs score on the VSAQ, clinical signs of metastasis, American Society of Anesthesiologists (ASA) score (I–IV) and Charlson comorbidity index . Body composition and aerobic fitness outcomes were reported separately for men and women, as it is known that values significantly differ between sexes.t test or the Mann–Whitney U test, as appropriate, was used. Univariable associations with a P < 0.10 were included in the multivariable analysis. For predicting continuous outcomes, linear regression analyses (method: enter) were performed to investigate the association between continuous CPET variables  and preoperative independent variables.Data were analysed with the Statistical Package for the Social Sciences for Windows . Continuous data were presented as mean and standard deviation or as median and interquartile range where appropriate. Categorical data were summarized by frequency and percentage. Pearson or Spearman correlation coefficients were calculated to examine univariable associations between continuous variables, depending upon the distribution of the variables. To investigate the univariable association between a continuous variable  and a categorical variable, one‐way ANOVA, the independent samples P < 0.10), using the t test, Mann–Whitney U test, Fisher's exact test or chi‐squared test, as appropriate. A logistic regression model was performed to select which of the remaining variables were significant in a forward stepwise procedure . In the case of multicollinearity between variables, the variable that produced the best model fit (based on the −2 log likelihood) was included in the model. With the final selected significant variables, a new logistic regression model was made (method: enter) to utilize the maximum number of observations. Receiver operating characteristic (ROC) analysis was used to assess the independent ability of predictive variables to discriminate between patients with and without a relative AT ≤11.1 ml/kg/min; this AT cut‐off was based on the work by West and others [P < 0.05 was considered statistically significant.A multivariable logistic regression analysis was performed to predict whether a patient had a relative AT ≤ 11.1 ml/kg/min. Preoperative variables were tested for their association with a relative AT ≤ 11.1 ml/kg/min  had a VSAQ score ≤ 7 METs, of which 91 patients (48.1%) underwent a preoperative CPET.2peak could not be determined due to a poor effort at the CPET . Patient characteristics of the remaining 78 patients  are presented in Table Of these 91 patients, 13 patients were excluded: in two patients (2.2%) SM‐RA could not be measured using their CT scan; in nine patients (9.9%) raw preoperative CPET data were not available; and in two patients (2.2%) the AT and VO2peak. Normalized for body mass, mean ± SD values of VO2peak and AT were 15.6 ± 3.7 ml/kg/min and 10.6 ± 1.9 ml/kg/min, respectively. Mean ± SD time between the CT scan and CPET was 15.2 ± 15.3 days. CPET results are shown in Table All 78 patients performed the CPET without any complications or adverse events during or after the test. The AT was indeterminable in two 2.6%) patients, while they attained a valid VO.6% patie2/m2 in men (range 31.1–91.5) and 36.6 ± 8.1 cm2/m2 in women (range 20.4–66.7). CT scan measurements are depicted in Table Mean ± SD skeletal muscle mass index was 50.9 ± 10.6 cmP < 0.001) was found between the absolute AT and skeletal muscle mass index. Between the relative AT and skeletal muscle mass index, a correlation coefficient of 0.16 (P = 0.156) was observed. A Pearson correlation coefficient of 0.28 (P = 0.014) was found between the relative AT and SM‐RA.In the univariable analysis Table , a PearsP < 0.10 in the univariable analysis  were included in a multivariable linear regression analysis to predict the absolute AT. BMI was also associated with absolute AT (P < 0.10) but was not included in the multivariable analysis because of multicollinearity between BMI, body mass and body height. In the final multivariable model (R2 51.1%), a lower age, a higher body mass, a lower ASA score and a higher skeletal muscle mass index were associated with a higher absolute AT  were included in the multivariable linear regression analysis to predict the relative AT. Body mass was also associated with relative AT (P < 0.10) but was not included in the multivariable analysis because of multicollinearity between body mass and BMI. In the final multivariable model (R2 28.6%), a higher BMI, a higher ASA score and a lower SM‐RA were associated with a lower relative AT  and were included in a forward stepwise multivariable analysis. A higher ASA score  and a higher VAT mass  were associated with an increased risk of a relative AT ≤ 11.1 ml/kg/min. Another logistic regression model was made (method: enter), with ASA and VAT mass, to include all patients . In this final model, a higher ASA score  and a higher VAT mass  were associated with an increased risk of a relative AT ≤ 11.1 ml/kg/min. Patients with an ASA score of 3 or 4 were almost six times more likely to have a relative AT ≤ 11.1 ml/kg/min.A multivariable logistic regression analysis was performed to investigate if a preoperative relative AT ≤ 11.1 ml/kg/min can be predicted from body composition variables derived from the abdominal CT scan and other patient characteristics. In the univariable analysis, age, body mass, BMI, VAT mass, ASA score, VSAQ score and Charlson score were associated with a relative AT ≤ 11.1 ml/kg/min (with a P = 0.002)  of 0.71  was lower in patients with a lower skeletal muscle mass index, together with a higher age, a lower body mass and a higher ASA score. Variation in relative AT values (R2 28.6%) could be less well explained by body composition variables and other patient‐related variables.This study aimed to investigate the association between body composition variables derived from the preoperative abdominal CT scan and preoperative CPET variables of aerobic fitness in patients scheduled for colorectal surgery, to evaluate whether the preoperative CT scan can (assist to pre)select unfit patients. The results demonstrated that body composition variables were significantly associated with preoperative aerobic fitness, expressed as the absolute and relative AT, absolute and relative VO2peak and OUES) than with relative variables  of aerobic fitness. This can be explained by the fact that skeletal muscle mass represents an absolute measure of the body's skeletal muscle mass, and a higher absolute skeletal muscle mass generally results in greater exercise‐induced peripheral oxygen extraction and utilization by the exercising muscles, which is an important determinant for absolute aerobic fitness. Aerobic fitness refers to the maximal capacity of the pulmonary and cardiovascular system to take in and transport oxygen to the exercising muscles, and of those exercising muscles to extract and utilize oxygen from the blood for aerobic respiration [r 0.44, P < 0.001) and relative VO2peak . The current study also found that SM‐RA was significantly correlated with relative AT and relative VO2peak in the univariate analysis  with relative VO2peak. Consistent with the current study results, no significant correlation coefficient was found between skeletal muscle mass index and relative AT.Body composition variables such as skeletal muscle mass correlate better with absolute measures of aerobic fitness  [A previous study has shown that patients undergoing major elective colorectal surgery with an AT ≤ 11.1 ml/kg/min have an increased risk for postoperative complications  population.Body composition variables derived from the preoperative CT scan are moderately associated with aerobic fitness as determined from the preoperative CPET. A higher ASA score and a higher VAT mass were associated with an increased risk of a relative AT ≤ 11.1 ml/kg/min as a cut‐off to classify patients scheduled for colorectal surgery as having an increased risk for postoperative morbidity. It seems that the CT scan cannot replace the CPET for preoperative risk assessment on aerobic fitness; however, it may contribute to the (pre)selection of unfit patients.Ethical approval for the study protocol (registration number P13‐18) was provided by the Medical Ethics Committee Twente  in September 2013.Written informed consent was obtained from each participant.All authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.Protocol/project development: AB, NvM, JK, BB. Data collection or management: AB, LvW, DvD, SP, SOD. Data analysis: AB, JvdP, BB. Manuscript writing/editing: AB, LvW, DvD, SP, JvdP, NvM, SOD, JK, BB.


Autonomic failure (AF) complicates Parkinson’s disease (PD) in one-third of cases, resulting in complex blood pressure (BP) abnormalities. While autonomic testing represents the diagnostic gold standard for AF, accessibility to this examination remains limited to a few tertiary referral centers.The present study sought to investigate the accuracy of a machine learning algorithm applied to 24-h ambulatory BP monitoring (ABPM) as a tool to facilitate the diagnosis of AF in patients with PD.Consecutive PD patients naïve to vasoactive medications underwent 24 h-ABPM and autonomic testing. The diagnostic accuracy of a Linear Discriminant Analysis (LDA) model exploiting ABPM parameters was compared to autonomic testing (as per a modified version of the Composite Autonomic Symptom Score not including the sudomotor score) in the diagnosis of AF.n = 80 PD patients  with a mean age of 64 ± 10 years old and disease duration of 6.2 ± 4 years. The prevalence of AF at the autonomic testing was 36%. The LDA model showed 91.3% accuracy  in predicting AF, significantly higher than any of the ABPM variables considered individually .The study population consisted of LDA model based on 24-h ABPM parameters can effectively predict AF, allowing greater accessibility to an accurate and easy to administer test for AF. Potential applications range from systematic AF screening to monitoring and treating blood pressure dysregulation caused by PD and other neurodegenerative disorders. Autonomic failure (AF) complicates Parkinson’s disease (PD) in up to one-third of cases. Cardiovascular AF disrupts neural networks controlling blood pressure (BP) and heart rate (HR), resulting in complex abnormalities in BP control, such as orthostatic hypotension (OH), supine hypertension (SH), abnormal circadian rhythm, and increased BP variability (BPV) . These aUnfortunately, accessibility to cardiovascular autonomic reflex testing (CART), the gold standard for diagnosing AF, is limited due to the complexity of the examination, technical skillset, and expensive equipment required to carry out this complex diagnostic test . As a reRecent studies showed that selected abnormalities in the 24-h BP profiles, such as a reversed circadian rhythm  and incrConsecutive patients referred to the Autonomic Unit of the Department of Medical Science, University of Torino  between September 2016 and June 2019 were offered to participate in a single-centre, cross-sectional study investigating the diagnostic potential of a machine-learning algorithm applied to ABPM as a tool to diagnose AF in PD.Diagnosis of PD as per the EFNS/MDS-ES recommendations  for at lOther neurological diseases associated with primary AF ; diabetes mellitus or diseases potentially associated with secondary AF ; non-sinAfter the acquisition of written informed consent, those meeting all the inclusion and none of the exclusion criteria underwent CART followed by 24 h-ABPM within 10 days.Deep breathing: patients were asked to breathe deeply and evenly at 6 breaths/min for 1 min.Valsalva manoeuvre: patients were asked to blow into a mouthpiece attached to an aneroid pressure gauge at a pressure of 40 mmHg, for 15 s.Head-up tilt test: patients were asked to lye supine on the tilt table for 10 min, then the table was tilted up to a 60° upright position for 5 consecutive minutes. For this test, in addition to the beat-to-beat recording, the BP was measured with an automatic sphygmomanometer  at baseline, 1 min, 3 min, and 5 minAutonomic testing has been performed as per a standard procedure and cardiovagal and adrenergic indexes calculated according to a modified version of the Composite Autonomic Symptom Score (CASS), without the sudomotor score . BrieflyBP and HR variations were analysed with dedicated software  and scored using age-related normal ranges .OH was defined as a sustained reduction of systolic blood pressure ≥ 20 mmHg or diastolic blood pressure ≥ 10 mmHg within three minutes from standing .SH was defined as systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg recorded after at least 5 min of supine rest .AF was diagnosed when the sum of the cardiovagal and adrenergic score was ≥ 2.24-h ABPM were performed using a Spacelabs portable device  with appropriately sized arm-cuff placed on the non-dominant side, as per current guidelines . BP was BP load, defined as the percentage of blood pressure values exceeding reference values during daytime (≥ 135/85 mmHg) and nighttime (≥ 120/70 mmHg).Reverse dipping, defined as a systolic day-night difference ≤ 0 mmHg .Weighted blood pressure variability (w-BPV), defined as the sum of the standard deviation of diurnal and nocturnal systolic BP, normalized for daytime and night-time duration. W-BPV was considered increased when > 11 .Postprandial hypotension (PPH), defined as a reduction in systolic blood pressure ≥ 20 mmHg within 120 min after a meal, using the mean of the last three BP measurements before the meal as reference .Δ15/24h) [Hypotensive episodes, defined as any record of systolic BP values lower than average 24-h systolic BP by at least 15 mmHg between awakening and lunch time (Hypo-epΔ15/24h) .Δ15/24h within 90 min from awakening (Hypo-awΔ15/24h) [Awakening hypotension, defined as the presence of at least one Hypo-ep Δ15/24h) .ABPM was performed according to definitions and reference values for ABPM data interpretation proposed by the European Society of Hypertension . Specifit-test for continuous variables with normal distribution and Mann–Whitney test for continuous variables with non-normal distribution; multiple comparisons (between more than 2 groups) were evaluated with One-way ANOVA analysis and Bonferroni’s correction. Categorical variables were compared using chi-square test or Fisher’s exact test according to the sampling number of analysed groups.Analyses were performed with SPSS . Normal distribution of continuous variables was tested using the Shapiro–Wilk test. Continuous variables were expressed as mean ± standard deviation. Qualitative variables were expressed as absolute values of frequency and percentage values. Differences between two independent groups were evaluated using Student’s P values less than 0.05 were considered statistically significant.Univariate logistic regression analysis was used to evaluate the correlation between selected categorical ABPM abnormalities and AF; subsequently, multivariate logistic regression was performed to correct for age, sex, LEDD and disease duration. For categorical variables, 2 × 2 contingency tables were built setting ABPM parameters as a diagnostic test and the presence of AF as the real outcome. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were then calculated.For continuous variables, a receiver operating characteristic (ROC) analysis was used to estimate the predictive accuracy . Sensitivity, specificity, PPV, and NPV were calculated after the selection of the optimum ROC cut point, based on the balance between sensitivity and specificity (highest Youden index).coeff1 × variable1 + LDAcoeff2 × variable2 + … + LDAcoeffn × variablen > cut-off. The presence/absence of AF was set as an outcome; the following variables were used to train the model: 24-h, daytime and nighttime blood pressure values , 24-h, daytime and nighttime blood pressure standard deviations (SD), daytime and nighttime blood pressure loads (systolic and diastolic), w-BPV, PPH, reverse dipping, Hypo-awΔ15/24h, number of Hypo-epΔ15/24h.Supervised machine learning algorithms were trained using Python 3.5 . Linear discriminant analysis (LDA) , 22 was The study population consisted of 80 PD patients, 54 males (67.5%) and 26 females (32.5%), with a mean age of 64 ± 10 years, and PD duration of 6.2 ± 4 years. All patients were treated with dopaminergic drugs with a levodopa equivalent daily dose (LEDD) of 668 ± 351 mg .According to the CART assessment, 29 patients (36%) were diagnosed with AF (AF+). This group was older but had similar disease duration and LEDD compared to the group without AF (AF−). Night-time average BP and BP loads were higher in patients AF+. Also, this group showed a higher incidence of reverse dipping, increased SD of systolic daytime BP, and hypotensive episodes compared to AF− Table .Table 1AThe LDA model was able to discriminate patients AF+ with 91.3% accuracy, 98.0% specificity, and 79.3% sensitivity, which was significantly higher than any of the ABPM variables considered individually  , hampering their potential as a screening tool.Clinical manifestations of AF encompass both short- and long-term dysregulations in BP regulatory mechanisms. The former include OH and SH, the latter include nocturnal hypertension, abnormal circadian rhythm, and increased BPV . SH and The present analyses confirm the previous finding that hypotensive episodes and reverse dipping are accurate markers of AF in PD , 20, whiThe strength of this study is the innovative approach involving machine learning for the detection of AF, that demonstrated high accuracy and specificity, and relatively high sensitivity.The assessment of patients in their real-life environment allows exploring the everyday BP profiles, which may be more informative on the risk of organ damage development than the standardized but artificial values obtained through CART. Several limitations, however, should also be considered in the interpretation of the results.First, the number of patients with AF was relatively low due to the stringent exclusion criteria, aiming at limiting confounders related to additional pharmacological treatment or concurrent clinical conditions; to reduce this bias, patients were carefully selected without vasoactive medications or known cardiovascular comorbidities, or severe cognitive impairment. Second, dopaminergic drugs have not been withheld during CART and ABPM, to assess BP fluctuations in a real-life environment. Still, the impact of dopaminergic drugs may have influenced the BP recordings. To that extent, the finding that LEDD values were not significantly different among groups and most associations remained significant after adequate correction in multivariate analysis seems reassuring. Third, the possibility exists that ABPM could better capture adrenergic impairment, thus limiting the diagnosis of AF with a prominent cardiovagal impairment, although the analysis of the 6 misidentified patients does not seem to confirm this hypothesis. Fourth, the variability in each individual patient’s day schedule might have influenced the ABPM recordings, as those with greater motor disability are less likely to engage in strenuous physical activities or prolonged standing.This should be considered as a pilot study, but a wide range of future applications for machine learning in the field of ABPM can be easily envisioned. The machine learning approach needs to be tested and validated on larger samples, evaluating the possibility to discriminate patients with prevalent cardiovagal vs. adrenergic vs. mixed autonomic impairment, with associated clinical implications. It seems reasonable to assume that patients with prevalent cardiovagal impairment should display a peculiar BP profile, since adrenergic vasoconstriction is usually preserved while HR variations are minimal or absent. Similarly, one would expect that patients with prevalent adrenergic impairment, with minimal vasoconstrictive function but preserved compensatory shifts in HR, could be differentiated by those with mixed AF. The extent to which machine learning applied to ambulatory recordings of blood pressure and heart rate can assist in detecting distinctive patterns of blood pressure dysregulation with potentially relevant clinical implications remains to be clarified. In the meantime, these data suggest that this technology can be successfully applied to ABPM recordings to diagnose AF when CART is not easily available or difficult to obtain, favoring more appropriate referrals to a second-level CART evaluation, with the main advantage of lowering healthcare costs, improving the appropriateness of referrals, and providing an additional, real-life, measure of circadian blood pressure fluctuations. Additional possible applications include monitoring the efficacy of treatments aiming at correcting OH without resulting in excessive SH.


F1,379 = 16.50, p < 0.001) between males and females waist circumference. Pearson’s correlation also revealed significant positive relationships in sedentary time , WC , and systolic blood pressure . The results revealed that systolic and diastolic blood pressure are significantly related to multiple measures of weight status, and sedentary behaviour. The results also highlight that active youth had lower resting heart rate compared to inactive peers. The present findings provide a foundation of knowledge for future research and highlight the major need for research and policy interventions, to address the concerning health habits of Al-Ahsa youth and broader Kingdom of Saudi Arabia.The prevalence of hypertension is becoming more common in children and adolescents than ever before. Thus, the aim of this study was to evaluate the associations between the built environment on physical activity, sedentary behaviour, waist circumference, and health amongst adolescents in Saudi Arabia. A systolic and diastolic blood pressure, resting heart rate and waist circumference of 380 boys and girls aged between 15–19 years old  were measured. The International physical activity Questionnaire Short Form was used to assess the physical activity levels and time spent sitting. The statistical analysis conducted were means and standard deviation, 2-way and 3-way of variance (ANOVA), Bonferroni post hoc tests, Chi-squared distribution and Pearson’s correlations. Among males, 16.75% were classified as hypertensive, 12.69% as pre-hypertensive, and 70.56% as normal whereas, females, 23.20% were classified as hypertensive, 12.15% as pre-hypertensive and 64.64% as normal. There were significant differences ( Hypertension is one of the major public health concerns considered to be the most common risk factor for heart disease . The preTraditionally, studies have focused on individual demographics and psychological correlates to promote PA and prevent obesity ,22,23. TFollowing an institutional ethical approval an individual, parental, and school consents were gained prior commencing the data collection. A total of 380 secondary-school boys and girls aged 15–19 years old  representing different geographical areas such as urban, rural farm and rural desert of the Al-Ahsa Governorate participated in this study. Direct measurements of waist circumference (WC) were obtained to the nearest 0.5 cm in accordance with the guidelines of . The cutSystolic blood pressure, diastolic blood pressure and resting heart rate were assessed using a digital portable device . Previous research has supported the use of BOSO-Medicus PC . The bloThe IPAQ-SF was used to assess the time spent sitting. The IPAQ-SF is a 7-item scales, assessing the number of minutes spent in vigorous, moderate intensity activities, walking and time spent sitting in the previous seven days. Previous research has used the IPAQ and reported that it is the most valid and reliable tool for measuring PA levels and sitting time ,53,54,55A range of statistical procedures were conducted to establish associations and differences in the under-researched population’s health and lifestyle habits from different locations and across genders such as urban, rural farm and rural dessert. The descriptive characteristics included mean and standard deviation (SD). Furthermore, comparisons were made between the lifestyle habits of youth from different weight status classification. Comparisons between genders, geographical locations, and age groups were analysed using the 2-way and 3-way of variance (ANOVA) on the participants sedentary behaviour, WC, systolic, and diastolic blood pressure. Moreover, Bonferroni post hoc tests were used to identify which groups were statistically significantly different. Prevalence rates according to gender and geographical locations were compared using Chi-squared distribution statistics. Furthermore, Pearson’s correlations were performed to establish relationships between health status variables .p > 0.05) between males and females in sedentary time . In regard to geographical location, Univariate ANOVA revealed significant differences between participants in sedentary time (p < 0.015): participants from urban location spent more time sitting (3.29 h per day) than participants from rural farm location (2.95 h per day), but no significant difference was found between urban and rural desert, or between rural farm and rural desert (p > 0.05). Pearson’s correlation revealed significant positive relationships between sedentary time , WC , and systolic blood pressure . The descriptive statistics of mean and SD are outlined in Participants were asked how much time they spent sitting on a weekday. This included time spent sitting at a desk, visiting friends, reading, sitting, or lying down to watch television. The results showed no significant difference  between males and females in WC. Males (mean = 75.80 cm) had higher WC than females (mean = 70.38 cm). With reference to the WC gender-specific classifications, the percentages of “at-risk” males and females were 26.13% and 20.99%, respectively. The univariate ANOVA showed a highly significant difference , and WC . The Bonferroni post hoc pairwise comparisons revealed that there were significant differences between, WC of normal systolic blood pressure and hypertensive systolic blood pressure . These are highlighted by the mean values in (p < 0.001) lower systolic blood pressure (118.03 mm Hg) compared to individual with higher . Additionally, participants with lower WC reported minimum health risks such as lower systolic blood pressure (p < 0.001) compared to those risk who reported higher (118.94 and 124.67 mm Hg). Univariate ANOVA revealed a significant difference between BP and WC  between males and females in systolic blood pressure. Males (121.75 mm Hg) had higher systolic blood pressure than females (118.71 mm Hg). However, there was no significant difference between males (71.26 mm Hg) and females (70.72 mm Hg) in diastolic blood pressure (p > 0.05). Although males had significantly higher systolic blood pressure than females, Chi-square analysis revealed no significant gender difference (p > 0.05) regarding systolic blood pressure percentile interpretation. Among males, 16.75% were classified as hypertensive, 12.69% as pre-hypertensive, and 70.56% as normal. Among the females, 23.20% were classified as hypertensive, 12.15% as pre-hypertensive and 64.64% as normal. Moreover, Chi-square analysis revealed no significant difference (p > 0.05) between males and females regarding diastolic blood pressure percentile interpretation. In males, 4.06% were classified as hypertensive, 7.10% as pre-hypertensive and 80.83% as normal. Among the females 9.39% were classified as hypertensive, 6.63% as pre-hypertensive and 83.97% as normal. Furthermore, the percentage of youth who had either systolic or diastolic hypertension was 19.70% and 29.28% for males and females, respectively. Approximately 14% of males and 11% of females were pre-hypertensive and 66.16% of males and 59.67% had normal blood pressure. With respect to gender, univariate ANOVA showed a significant difference  lower resting heart rate than females . The results showed no significant difference between males or females from different geographical locations (p > 0.05). Rural farm males had significantly (p = 0.022) lower systolic blood pressure than urban males . Furthermore, univariate ANOVA revealed a significant difference  between active (75.6 bpm) youth and inactive youth (87 bpm) in resting heart rate. In addition, males had significantly (p < 0.001). In addition to the relation between weight with PA and blood pressure, both WC and waist height ratio had highly significant negative relationships with total METmin/wk  and highly significant positive correlations with systolic blood pressure . Moreover, total METmin/wk had highly significant negative correlations with systolic blood pressure  and resting heart rate , and a highly significant positive correlation with average steps per day . Finally, average steps per day had highly significant correlations with diastolic blood pressure  and resting heart rate   lower percentage of systolic or diastolic hypertension (9.09%); inactive youth had almost three times more as a percentage (26.48%).Pearson’s correlation revealed highly significant positive relationships between different measures of weight status  see . In addip = 0.045, 69.89 cm and 73.72 cm, respectively), waist height ratio , systolic blood pressure , and resting heart rate . However, there was no significant difference between PA in diastolic blood pressure, average steps per day  and total METmin/wk . However, there was no significant difference between PA in diastolic blood pressure and resting heart rate (p > 0.05). Moreover, Chi-square analysis revealed that 18.22% of normal weight youth had significantly  higher percentage of systolic or diastolic hypertensive (18.22%) whereas overweight or obese had nearly double this percentage (34.27%).Moreover, univariate ANOVA showed that active youth had significantly lower than inactive in WC , and more than double of hypertensive diastolic blood pressure (9.39%) compared to males . This prevalence of hypertension is higher compared with the findings from several previous international studies ,63,64 In%, and moElevated resting heart rate in young people is predictive of later development of hypertension in adulthood . PreviouThis study found its strength in evaluating the association between built environment on hypertension, waist circumference and PA amongst adolescences in Saudi Arabia. To the best of authors knowledge, this is the first study conducted in Saudi Arabia focusing on youth hypertension and health factors. The additional strength of this study was collecting data through various methods and the number of individuals participated in this study. This study contributes to the scarce literature and further highlight the necessity for future research and policy interventions, to address the concerning health habits of under research population. Despite the strength, this study is not without limitations. Limitations included participants from one region such as Al-Ahsa and targeted adolescents only. Collecting data from other regions and age groups may have yield different results. Additionally, qualitatively exploring reasons for sedentary behaviour and high WC may have provided an insight into why certain habits if any are followed.This study provided an important insight into the influences of built environmental factors on Saudi youth health risk factors, including hypertension, sedentary behaviour, PA, WC, weight status and blood pressure. To the researcher’s knowledge, this is the first study in exploring the association between built environmental within youth in Saudi Arabia. Hence, the results of the current study support the generalizability of findings on the association between environmental factors across Western countries and Saudi Arabia. This study also provides a foundation of knowledge for future research to build upon and deliver interventions targeting sedentary behaviour and improving health amongst this group. Such findings will therefore further highlight the major need for research and policy interventions, to address the concerning health habits of Al-Ahsa youth and broader Kingdom of Saudi Arabia.


To the Editor:,Uromodulin is exclusively expressed and secreted by cells of the ascending limb of the loop of Henle and the distal tubule into the urine and the bloodstream and is hypothesized to be a marker for overall nephron/tubular mass.In this work, we evaluated these associations in a subgroup of 936 individuals from a previously described cohort of patients with kidney failure treated with continuous ambulatory peritoneal dialysis (CAPD) from Guangzhou, China.sUMOD measurements were performed as previously described.th, 75th percentiles] of 15.8  months before study enrollment. Median residual urine volume was 500  mL/day and residual kidney function was 1.6  mL/min/1.73 m2. The median sUMOD level was 9.2  ng/mL  participants died during a median follow-up interval of 46.8  months, and the number and rate of events was comparable across all sUMOD quartiles . Mortali,,Our findings are in contrast to previous studies demonstrating both a strong correlation of sUMOD with estimated glomerular filtration rate, ie, higher in healthy individuals versus those with chronic kidney disease, as well as an association with mortality.To our knowledge this is the first cohort with a large number of patients receiving CAPD and sufficient follow-up time in which the association of sUMOD with residual kidney function and mortality has been assessed. This allowed us to perform a thorough multivariable analysis, adjusting for a large set of covariables that is associated with mortality in patients receiving CAPD. However, we only included patients treated with CAPD, so no inferences can be made regarding patients treated with automated peritoneal dialysis or hemodialysis. We only measured uromodulin in a single specimen, so the impact of natural variability of sUMOD concentrations could have impacted the results at these low levels. The cohort consisted of Chinese participants only, which limits the comparability and generalizability of sUMOD concentrations and outcomes to other populations and published data, eg, in patients with chronic kidney disease, who are predominantly White.In conclusion, sUMOD levels were substantially lower in kidney failure patients receiving CAPD compared with patients with chronic kidney disease, likely reflecting low nephron/tubular mass. In addition, sUMOD was not associated with residual kidney function and mortality in these patients and can therefore not be recommended as a prognostic biomarker for mortality in this population.