Cuff-based blood pressure measurement: challenges and solutions.

OBJECTIVE: Accurate measurement of arterial blood pressure (BP) is crucial for the diagnosis, monitoring, and treatment of hypertension. This narrative review highlights the challenges associated with conventional (cuff-based) BP measurement and potential solutions. This work covers each method of cuff-based BP measurement, as well as cuffless alternatives, but is primarily focused on ambulatory BP monitoring. RESULTS: Manual BP measurement requires stringent training and standardized protocols which are often difficult to ensure in stressful and time-restricted clinical office blood pressure monitoring (OBPM) scenarios. Home Blood pressure monitoring (HBPM) can identify white-coat and masked hypertension but strongly depends on patient adherence to measurement techniques and procedure. The widespread use of nonvalidated automated HBPM devices raises further concerns about measurement accuracy. Ambulatory blood pressure measurement (ABPM) may be used in addition to OBPM. It is recommended to diagnose white-coat and masked hypertension as well as nocturnal BP and dipping, which are the BP values most predictive for major adverse cardiac events. Nonetheless, ABPM is limited by its non-continuous nature and susceptibility to measurement artefacts. This leads to poor overall reproducibility of ABPM results, especially regarding clinical parameters such as BP variability or dipping patterns. CONCLUSIONS: Cuff-based BP measurement, despite some limitations, is vital for cardiovascular health assessment in clinical practice. Given the wide range of methodological limitations, the paradigm's potential for improvement is not yet fully realized. There are impactful and easily incorporated opportunities for innovation regarding the enhancement of measurement accuracy and reliability as well as the clinical interpretation of the retrieved data. There is a clear need for continued research and technological advancement to improve BP measurement as the premier tool for cardiovascular disease detection and management.

Accurate blood pressure measurement is crucial for diagnosing, monitoring, and treating hypertension and preventing cardiovascular diseases.Manual blood pressure monitoring is common but may not always be reliable due to the stress and time constraints in clinical settings. It also fails to detect white-coat and masked hypertension.Home blood pressure monitoring helps to identify white-coat and masked hypertension but depends on how well patients follow the measurement instructions. Many devices are not validated, raising concerns about their accuracy.Ambulatory blood pressure measurement may be used in addition to office blood pressure measurement because of its better reproducibility and higher predictive value. It is recommended to diagnose white-coat and masked hypertension as well as nocturnal BP and dipping. However, it and can be prone to errors, affecting the reliability of results like BP variability or night-time dipping patterns.Patient's posture, physical activity, and conditions like atrial fibrillation can influence BP readings.Automated BP devices often have limitations in detecting measurement artefacts, underscoring the need for technological improvements.Despite its limitations, cuff-based blood pressure measurement is essential in everyday clinical practice but has unlocked potential for improvement.

Atopic dermatitis, STAT3- and DOCK8-hyper-IgE syndromes differ in IgE-based sensitization pattern.

BACKGROUND: Increased serum IgE levels are characteristic but not specific for allergic diseases. Particularly, severe atopic dermatitis (AD) overlaps with hyper-IgE syndromes (HIES) regarding eczema, eosinophilia, and increased serum IgE levels. HIES are primary immunodeficiencies due to monogenetic defects such as in the genes DOCK8 and STAT3. As it is not known to date why allergic manifestations are not present in all HIES entities, we assessed the specificity of serum IgE of AD and HIES patients in the context of clinical and immunological findings. METHODS: Clinical data, skin prick tests, specific IgE to aero- and food allergens, and T helper (Th) subpopulations were compared in AD and molecularly defined HIES patients. RESULTS: Total serum IgE levels were similarly increased in STAT3-HIES, DOCK8-HIES, and AD patients. The ratio of aeroallergen-specific IgE to total IgE was highest in AD, whereas DOCK8-HIES patients showed the highest specific serum IgE against food allergens. Overall, clinical allergy and skin prick test results complied with the specific IgE results. Th2-cell numbers were significantly increased in DOCK8-HIES and AD patients compared to STAT3-HIES patients and controls. AD patients showed significantly higher nTreg-cell counts compared to STAT3-HIES and control individuals. High Th17-cell counts were associated with asthma. Specific IgE values, skin prick test, and T-cell subsets of STAT3-HIES patients were comparable with those of healthy individuals except decreased Th17-cell counts. CONCLUSION: Hyper-IgE syndromes and atopic dermatitis patients showed different sensitization pattern of serum IgE corresponding to the allergic disease manifestations and Th-cell subset data, suggesting a key role of DOCK8 in the development of food allergy.

Influence of hydrothermal treatment on the structural modification of spent grain specific carbohydrates and the formation of degradation products using model compounds.

Brewer's spent grain (BSG) constitutes various valuable carbohydrates that may contribute to a healthy diet. These components may be obtained from BSG via hydrothermal treatment (HT), a procedure for dissolving water-inextricable carbohydrates. The objective of this study was to investigate HT as an environmentally friendly technology for extracting high-molecular-weight fiber with proven beneficial effects on human health. Cellulose, ß-glucan, and arabinoxylan (AX) served as model substances and were subjected to auto-hydrolysis at different temperatures and reaction times. The results were evaluated in terms of structural and chemical characteristics. When the treatment temperature was increased, the original weight-average molar mass of AX (370 kDa) and ß-glucan (248 kDa) decreased gradually (<10 kDa), and the molar mass distribution narrowed. Further investigations focused on the heat-induced formation and elimination of monosaccharides and undesirable by-products. The concentrations of by-products were successfully described by kinetic models that can be used to optimize the hydrolysis process.

Electrophysiological model of intact and processed plant tissues: cell disintegration criteria.

Frequency versus conductivity relationships of food cell system, based on impedance measurements as characterized by polarization effects of the Maxwell-Wagner type at intact membrane interfaces, are presented. The electrical properties of a biological membrane (represented as a resistor and capacitor) are responsible for the dependence of the total conductivity of the cell system on the alternating current frequency. Based on an equivalent circuit model of a single plant cell, the electrical conductivity spectrum of the cell system in intact plant tissue (potato, carrot, banana, and apple) was determined in a frequency range between 3 kHz and 50 MHz. The electrical properties of a cell system with different ratios of intact/ruptured cells could also be predicted on the basis of a description of a cell system consisting of elementary layers with regularly distributed intact and ruptured cells as well as of extracellular compartments. This simple determination of the degree of cell permeabilization (cell disintegration index, p(o)) is based upon electric conductivity changes in the cell sample. For accurate calculations of p(o), the sample conductivities before and after treatment, obtained at low- (f(l)) and high-frequency (f(h)) ranges of the so-called beta-dispersion, were used. In this study with plant cell systems, characteristic conductivities used were measured at frequencies f(l) = 3 kHz and f(h) = 12.5 MHz. The disintegration index was used to analyze the degree of cell disruption after different treatments (such as mechanical disruption, heating, freeze-thaw cycles, application of electric field pulses, and enzymatic treatment) of the plant tissues.

Biphasic inactivation kinetics of Escherichia coli in liquid whole egg by high hydrostatic pressure treatments.

Kinetic studies on the isothermal high hydrostatic pressure (HHP) inactivation of Escherichia coli in liquid whole egg (LWE) were performed at 5 and 25 degrees C in the pressure range of 250-400 MPa. The characteristic tailing inactivation curves were described by a first-order biphasic model. As compared to a previous rheological study, it is suggested that the phase change of LWE during pressure treatment affects the inactivation rate of E. coli. Within the processing criteria where the rheological properties of LWE were still comparable to those of fresh LWE, HHP treatments at 5 degrees C induced more E. coli inactivations than those at 25 degrees C. From the results of approximately 3 log reductions of E. coli and over 5 log reductions of Pseudomonas and Paenibacillus, HHP treatment of LWE at 5 degrees C is regarded to be as effective as conventional thermal pasteurization. However, no post-process contamination and the consistency of temperature during preparation, HHP treatment, and storage provide clear processing advantages.

Metastable states of water and ice during pressure-supported freezing of potato tissue.

Different ice modifications were obtained during freezing processes at several pressure levels from atmospheric pressure up to 300 MPa. In the pressure range between 210 and 240 MPa, a metastable ice I modification area was observed, as the nucleation of ice I crystals in the thermodynamically stable region of ice III was reached. A significant degree of supercooling was obtained before freezing the tissue water to ice III, which has to be considered when designing pressure-supported freezing processes. The effect of supercooling phenomenon on the phase transition time is discussed using a mathematical model based on the solution of the heat transfer governing differential equations. Phase transition and freezing times for the different freezing paths experimented are compared for the processes: freezing at atmospheric pressure, pressure-assisted freezing, and pressure-shift freezing. Different metastable states of liquid water are defined according to their process-dependent stability.

Measurement of glutathione in activated sludges.

Thermal, electric, mechanical or oxidative stress seem a promising way to reduce the production of excess activated sludge during biological wastewater treatment. However, the adaptation and the resistance of the sludge microbial ecosystem to stress conditions is a major question as it may definitively limit the effect of some treatments. Defence mechanisms developed by aerobic organisms, in particular, in response to oxidative stress involve various antioxidant activities and compounds such as glutathione. An HPLC method was developed for measuring reduced and total glutathione (GSH and GSHt) in perchloric acid sludge extracts. The method was sensitive, highly specific and validated for linearity, precision and recovery. Considering the extraction yield and the oxidation of GSH during extract storage, the measured GSH concentration was estimated to represent 60% of the GSH content from activated sludges. GSHt ranged from 0.32 to 3.34micromolg(-1) volatile solids and the GSH/GSHt ratio ranged from 32% to 91%. Measurements performed on sludges stressed in precise conditions selected to reach a reduction of sludge production showed a decrease of GSH and GSHt concentrations with thermal, mechanical, electric and ozone stress.

Application of ultrasound-assisted thermal processing for preservation and quality retention of liquid foods.

A continuously working pilot plant-scale prototype was used to evaluate the effects of continuous-flow ultrasound-temperature treatment for bacterial decontamination of model suspensions and various liquid food systems such as milk, fruit, and vegetable juices. Escherichia coli K12 DH 5 alpha and Lactobacillus acidophilus were used as test microorganisms. In addition, treated juices were investigated for damage caused by heat or ultrasound-induced degradation of sensory and nutritional properties after treatment and storage. Changes in color and destruction of heat-labile and slightly oxidizable L-ascorbic acid content were monitored as an index to measure processing effects. Results were assessed with respect to the total energy requirement and compared with those using a conventional, indirect heating method having similar processing conditions. For the bacteriological process evaluation, the temperature- and time-dependent process lethality was used as the basis; for the quality- and energy-related investigations, the degree of bacterial inactivation was used. At identical degrees of bacterial inactivation, the ultrasound-assisted thermal treatments required a lower processing temperature than treatment with conventional thermal processing. However, according to energy balances, the total energy consumption was not reduced compared to conventional heating. Indications for a positive influence on shelf life, with improvements in surface color stability (lightness) and L-ascorbic acid retention, were found among quality parameters of treated orange juice.

Sludge pre-treatment with pulsed electric fields.

The anaerobic stabilization process depends - among other things - on the bio-availability of organic carbon. Through pre-treatment of the sludge which leads to the destruction of micro-organisms and to the setting-free of cell content substances (disintegration), the carbon can be microbially converted better and faster. Moreover, effects on the digestion are likely. However, only little experience is available in sludge treatment with pulsed electric fields. Laboratory-scale digestion tests have been run to analyse the influence of pulsed electric fields on the properties of sludge, anaerobic degradation, sludge water reload and foaming of digesters. The results will be compared with those of other disintegration methods (high pressure homogeniser, thermal treatment). The effect of pre-treatment on the sludge is shown by the COD release. Degrees of disintegration have been achieved up to 20%. The specific energy input was high. The energy consumption has been decreased by initial improvements (pre-heating to 55 degrees C). The filament bacteria were partially destroyed. The foam reduction in the digesters was marginal. The anaerobic degradation performance has been improved in every case. The degradation rate of organic matter increased about 9%. Due to the increase of degradation, there is a higher reload of the sludge-water with COD and nitrogen compounds.

On robust methodologies for managing public health care systems.

Authors focus on ontology-based multidimensional data warehousing and mining methodologies, addressing various issues on organizing, reporting and documenting diabetic cases and their associated ailments, including causalities. Map and other diagnostic data views, depicting similarity and comparison of attributes, extracted from warehouses, are used for understanding the ailments, based on gender, age, geography, food-habits and other hereditary event attributes. In addition to rigor on data mining and visualization, an added focus is on values of interpretation of data views, from processed full-bodied diagnosis, subsequent prescription and appropriate medications. The proposed methodology, is a robust back-end application, for web-based patient-doctor consultations and e-Health care management systems through which, billions of dollars spent on medical services, can be saved, in addition to improving quality of life and average life span of a person. Government health departments and agencies, private and government medical practitioners including social welfare organizations are typical users of these systems.

Phosphorylcholine-targeting immunization reduces atherosclerosis.

OBJECTIVES: The present study evaluated the effect of phosphorylcholine (PC) immunization on the extent of experimental atherosclerosis. BACKGROUND: Immunization against oxidized lipoprotein (oxLDL) or Streptococcus pneumoconiae reduces atherosclerosis. Phosphorylcholine is the main epitope recognized by both antipneumococcus and anti-oxLDL antibodies. Therefore we reasoned that PC-specific antibodies might play an important role in atherogenesis. METHODS: Apolipoprotein E knockout mice were immunized with PC every second week over 4 months. At the end of the study, serum antibodies directed to either PC or oxLDL were measured. Splenic and peritoneal B cells were analyzed by flow cytometry. Aortic root atherosclerotic lesions were quantified by morphometry and phenotyped by immunohistochemistry. Immune and control sera were also tested for their effect on foam cell formation in macrophage culture in the presence of oxLDL. RESULTS: The PC-immunized mice showed 3-fold increase in titers of anti-PC and -oxLDL antibodies compared with control mice (p < 0.01). The PC-immunized mice also showed a significant increase in the number of splenic mature B cells. The extent of atherosclerotic aorta root lesions was reduced by >40% in the PC-immunized mice (p < 0.01). Immunohistochemistry showed reduced expression of major histocompatibility complex class II antigens (p < 0.05) and the presence of B-cell clusters in plaques of PC-immunized mice. Finally, PC-immune serum was able to reduce macrophage-derived foam cell formation in the presence of oxLDL in vitro. CONCLUSIONS: Phosphorylcholine immunization drives a specific humoral immune response that reduces foam cell formation in vitro and is atheroprotective in vivo.

Cellular injuries upon exposure of Escherichia coli and Lactobacillus rhamnosus to high-intensity ultrasound.

AIMS: To examine cellular injuries occurring in cells of Escherichia coli (Gram-negative bacteria) and Lactobacillus rhamnosus (Gram-positive bacteria) in response to a high-intensity ultrasound treatment using classical plate count technique and flow cytometry. METHOD AND RESULTS: According to plate count results, E. coli (D-value 8.3 min) was far more sensitive than L. rhamnosus (D-value 18.1 min) in their response to the ultrasound intensity applied (20 kHz, 17.6 W). The dye precursor carboxyfluorescein diacetate (cFDA) could freely diffuse across the cytoplasmic membrane of intact cells of Gram-positive bacteria L. rhamnosus, resulting in its intracellular enzymatic conversion and emission of green fluorescence. In contrast, the presence of an outer membrane on E. coli, which represents the class of Gram-negative bacteria, apparently disabled the penetration of viability marker cFDA. Ultrasound application on E. coli yielded in an increasing population with disintegrated outer membrane, which allowed penetration of cFDA and its intracellular enzymatic conversion as well as accumulation. In both organisms evaluated only a small population was labelled by propidium iodide upon exposure to ultrasound for up to 20 min. Within the experimental conditions investigated ultrasound did not considerably affect the cytoplasmic membrane, although according to plate count results viability loss occurred. CONCLUSIONS: The results compiled suggest, that ultrasound induced cell death, which may not be related to membrane damage. SIGNIFICANCE AND IMPACT OF THE STUDY: Limitation on the use of bacteriocins, which are aimed on destabilization of cytoplasmic membrane but inhibited by the outer membrane, could be overcome by ultrasound-assisted physical disruption of the outer membrane.

Nutritional improvement of plant foods by non-thermal processing.

As a result of the increasing consumer demand for minimally-processed fresh-like food products with high sensory and nutritional qualities, there is a growing interest in non-thermal processes for food processing and preservation. Key advanced technologies such as high-pressure processing, pulsed electric fields, dense gases and ultrasound are being applied to develop gentle but targeted processes to further improve the quality and safety of processed foods. These technologies also offer the potential for improving existing processes as well as for developing new process options. Furthermore, by adding new process dimensions (such as hydrostatic pressure, electric fields, ultrasonics, supercritical CO2) to the conventional process variables of temperature and time, they facilitate enlargement of the availability of unit operations. These operations might be applied effectively in unique combination processes, or as subsequent processing tools in more-targeted and subsequently less-intensive processes for food preservation and modification than the currently-applied processes.

Effects of pulsed electric fields on inactivation and metabolic activity of Lactobacillus plantarum in model beer.

AIMS: Inactivation and sublethal injury of Lactobacillus plantarum at different pulsed electric field (PEF) strengths and total energy inputs were investigated to differentiate reversible and irreversible impacts on cell functionality. METHODS AND RESULTS: Lactobacillus plantarum was treated with PEF in model beer (MB) to determine critical values of field strength and energy input for cell inactivation. Below critical values, metabolic activity and membrane integrity were initially reduced without loss of viability. Above critical values, however, irreversible cell damage occurred. Presence of nisin or hop extract, during PEF treatment, resulted in an additional reduction of cell viability by 1;5 log cycles. Also, addition of the hop extract resulted in an additional two log cycles of sublethal injury. Partial reversibility of membrane damage was observed using propidium iodide (PI) uptake and staining. Inoculated MB containing hops was stored after PEF to evaluate the efficacy of such treatment for beer preservation. CONCLUSION: Cells were inactivated only above critical values of 13 kV x cm(-1) and 64 kJ x kg(-1); below these values cell damage was reversible. Storage experiments revealed that surviving cells were killed after 15 h storage in MB containing hops. SIGNIFICANCE AND IMPACT OF THE STUDY: Both reversible and irreversible cell damage due to PEF treatment was detected, depending on specific treatment conditions. The combination of PEF and hop addition is a promising nonthermal method of preservation for beer.