Ambulatory blood pressure monitoring in children: A retrospective single-center study

Objectives(1) Compare 24-hour ambulatory blood pressure monitoring (ABPM) diagnoses in a pediatric population with the new 2022 guidelines to the original diagnoses with the 2014 guidelines. (2) Determine whether findings of hypertension from ABPM could be predicted from prior patient data. (3) Determine whether ABPM readings could predict left ventricular mass index (LVMI) in patients who obtained an echocardiogram (ECHO).Study designSingle-center retrospective study on patients referred to Pediatric Nephrology Clinic for evaluation of elevated blood pressure who underwent ABPM from 2015 to 2018. Predictions of hypertension were obtained using a logistic regression model, and predictions of LVMI were performed using regression models including (a) the wake systolic and diastolic BP indices, or (b) additionally including the standard deviation (SD) of wake SBP and DBP.ResultsWith the change in 2022 to new ABPM guidelines from the AHA, comparing the old and new guidelines led to 70% of previous pre-hypertensive diagnoses now meeting criteria for diagnosis of hypertension, and a rise from 21% of the ABPMs meeting criteria for hypertension to 51% now meeting criteria. In a logistic regression model, prior patient data were not predictive of a diagnosis of hypertension from ABPM (Nagelkerke's R2 = 0.04). Among the individual variables studied, none were statistically significant. For prediction of LVMI, the SD of wake SBP and DBP were significantly associated with increased LVMI, but the wake SBP and DBP indices were not.ConclusionsIn our patient population, the new ABPM guidelines led to a significant increase in diagnoses of hypertension. Prior patient data was not sufficient to predict a diagnosis of hypertension by ABPM, supporting the need for evaluation by ABPM as the gold standard. Our analysis of the relationship between ABPM readings and LVMI supports the hypothesis that BP variability contributes to increased LVMI. These data are consistent with growing evidence in the adult literature that BP variability detected by ABPM is associated with left-ventricular hypertroph

Assessment of combined exposure to intermediate-frequency electromagnetic fields and pulsed electromagnetic fields among library workers in Japan

ObjectiveTo assess exposure levels to electromagnetic fields (EMFs) among library workers in Japan, focusing on co-exposure to intermediate-frequency EMF (IF-EMF) and pulsed EMF, to propose a new epidemiological research methodology.MethodsThe evaluated exposure sources were an electromagnetic type-electronic article surveillance gate (EM-EAS, IF-EMF (operating frequency 220 Hz-14 kHz)) and an activator/deactivator of anti-theft tags termed as “book check unit” (BCU, pulsed EMF). Short-term exposures were: (E1) whole-body exposure from the EAS gate when sitting within 3 m; (E2) local exposure to transient IF-EMF while passing through or beside the EAS gate; and (E3) local exposure to a pulsed magnetic field on BCU use. E1–E3 were evaluated based on exposure levels relative to magnetic flux density at the occupational reference level (RL; E1) or as per occupational basic restrictions (BR; E2 and E3) delineated by the International Commission on Non-Ionizing Radiation Protection (ICNIRP) 2010 guidelines. Exposure indices based on mid-term exposure (D1–D3), assuming exposure according to employment on a weekly basis, were used to assess exposure in actual working conditions. D1 represents continuous exposure from an EAS gate when sitting within 3 m of the gate. D2 and D3 represent repeated transient exposures occurring during gate pass or on the operation of a BCU. A link to a web-based questionnaire was distributed to librarians working at all libraries where the authors had mailed institutional questionnaires (4,073 libraries). Four exposure patterns were defined according to various exposure scenarios.ResultsWe obtained information on exposure parameters and working conditions from the 548 completed questionnaires. The ICNIRP guideline levels were not exceeded in any of the E1–E3 scenarios. Median of the D1 (% ICNIRP RL × hour/week) was 1, and >85% respondents had values <10. However, the maximum value was 513. Altogether, these results indicate that continuous exposure was low in most cases. The same tendency was observed regarding repeated transient exposure from EM-EAS gates (i.e., the median value for D2 (% ICNIRP BR × gate pass) was 5). However, there were several cases in which D1 and D2 values were >10 times the median. The median of D3 (% ICNIRP BR × BCU operation) was 10, and most respondents' D3 values were greater than their D2 values, although the derived results depended on the assumptions made for the estimation.ConclusionWe conducted an assessment of combined exposures to IF-EMF and pulsed EMF among library workers in Japan by evaluating both short-term exposures (E1–E3) and exposure indices based on mid-term exposures (D1–D3) assuming actual working conditions per questionnaire results. These results provide useful information for future epidemiological studies

The Anti-Aging Potential of Extracts from Chaenomeles sinensis

The Chaenomeles sinensis fruit is used as an effective antitussive agent, analgesic, and diuretic in traditional Chinese medicine. It has been reported that C. sinensis fruit extracts have antimicrobial and anti-inflammatory effects. However, there are very few reports about the effects of C. sinensis extracts on skin. In this study, we investigated the effect of C. sinensis extracts on skin aging. The results of in vitro assays showed that whole fruit extracts of C. sinensis had superoxide dismutase (SOD)-like activity and inhibited the activity of dermal extracellular matrix proteases: Elastase and collagenase. The inhibitory effect of the whole fruit (containing seeds) extract on elastase activity was higher than that of the sarcocarp (seeds removed) extract. Further, the sarcocarp extract showed a higher level of SOD-like activity and a greater inhibitory effect on collagenase activity than the whole fruit extract. In particular, among the three activities studied, the sarcocarp extract showed the most significant inhibitory effect on collagenase activity at low concentrations. The polyphenol-rich fraction obtained from the sarcocarp showed significant collagenase inhibition. Based on these results, we concluded that phenolic compounds from C. sinensis sarcocarp have the potential to protect against skin aging through anti-collagenase activity

Differential expression of adenylyl cyclases in the rat nephron

Background. Adenylyl cyclases (ACs) are a family of enzymes that catalyze the formation of the second-messenger cyclic adenosine 3′,5′-monophosphate (cAMP). At least nine isoforms of AC have been cloned. These isoforms differ in their tissue distribution and basal activity. AC isoforms also differ in their capacity to be stimulated or inhibited by G protein α3i, αs and β/α subunits, protein kinase C, and intracellular calcium. The distribution of ACs in the kidney is only partially known, although it is known that ACs play important roles in kidney signal transduction. Several receptors are known to couple to AC, but their linkage to individual AC isoforms in the kidney is not known. Methods. This study investigated the tissue distribution of AC isoforms along the nephron of Wistar-Kyoto rats using reverse transcription-polymerase chain reaction (RT-PCR), immunohistochemistry, and immunoblotting. Results. While AC VI and IX mRNA were found in all nephron segments, there was no expression of AC VIII mRNA. ACs II through V and VIImRNA were variably found in specific nephron segments. mRNA for AC isoforms II, III, VI, VII, and IX were expressed in renal proximal tubules. All of the AC isoforms studied, except VIII, were found in glomeruli. Immunoblotting and immunohistochemistry confirmed the mRNA results. AC isoforms II, III, IV, and IX were expressed in luminal rather than in basolateral membranes. However, immunohistochemical studies were not feasible for the other isoforms that could be expressed in basolateral membranes. Conclusion. Knowledge of the distribution of ACs may help establish the linkage between receptors and specific AC isoforms and define their functions

Impaired renal D\u3csub\u3e1\u3c/sub\u3e-like and D\u3csub\u3e2\u3c/sub\u3e-like dopamine receptor interaction in the spontaneously hypertensive rat

D1-like (D1, D5) and D2-like (D2, D3, D4) dopamine receptors interact in the kidney to produce a natriuresis and a diuresis. Disruption of D1 or D3 receptors in mice results in hypertension that is caused, in part, by a decreased ability to excrete an acute saline load. We studied D1-like and D2-like receptor interaction in anesthetized spontaneously hypertensive rats (SHR) by the intrarenal infusion of Z-1046 (a novel dopamine receptor agonist with rank order potency of D3≥D4\u3eD2≥D5≥D 1). Z-1046 increased glomerular filtration rate (GFR), urine flow, and sodium excretion in normotensive Wistar-Kyoto rats but not in SHRs. The lack of responsiveness to Z-1046 in SHRs was not an epiphenomenon, because intrarenal cholecystokinin infusion increased GFR, urine flow, and sodium excretion to a similar extent in the two rat strains. We conclude that renal D1-like and D2-like receptor interaction is impaired in SHRs. The impaired D1-like and D2-like receptor interaction in SHRs is not caused by alterations in the coding sequence of the D3 receptor, the D2-like receptor expressed in rat renal tubules that has been shown to be involved in sodium transport. Because the diuretic and natriuretic effects of D1-like receptors are, in part, caused by an interaction with D2-like receptors, it is possible that the decreased Z-1046 action in SHRs is secondary to the renal D1-like receptor dysfunction in this rat strain

Blood Pressure Outcomes in NICU-Admitted Infants with Neonatal Hypertension: A Pediatric Nephrology Research Consortium Study

Objective To describe the blood pressure outcomes of NICU-admitted infants with idiopathic (non-secondary) hypertension (HTN) who were discharged on antihypertensive therapy. Study Design Retrospective ,multicenter study of 14 centers within the Pediatric Nephrology Research Consortium (PNRC). We included all infants with a diagnosis of idiopathic HTN discharged from neonatal intensive care units (NICU) on antihypertensive treatment. The primary outcome was time to discontinuation of antihypertensive therapy, grouped into ≤6 months, \u3e6 months – 1 year, and \u3e 1 year). Comparisons between groups were made with chi-squared tests, Fisher’s exact tests, and analysis of variance. Results Data from 118 infants (66% male) were included. Calcium channel blockers were the most prescribed class of antihypertensives (56%) in the cohort. The percentages remaining on antihypertensives after NICU discharge were 60% at 6 months, 26% at 1 year, and 7% at 2 years. Antenatal steroid treatment was associated with decreased likelihood of antihypertensive therapy \u3e1 year after discharge. Conclusions This multicenter study reports that most NICU-admitted infants diagnosed with idiopathic HTN will discontinue antihypertensive treatment by 2 years after NICU discharge. These data provide important insights into the outcome of neonatal HTN but should be confirmed prospectively