Evaluation of a novel cuffless photoplethysmography-based wristband for measuring blood pressure according to the regulatory standards.

Aims: Elevated blood pressure (BP) is a key risk factor in cardiovascular diseases. However, obtaining reliable and reproducible BP remains a challenge. This study, therefore, aimed to evaluate a novel cuffless wristband, based on photoplethysmography (PPG), for continuous BP monitoring. Methods and results: Predictions by a PPG-guided algorithm were compared to arterial BP measurements (in the sub-clavian artery), obtained during cardiac catheterization. Eligible patients were included and screened based on AAMI/European Society of Hypertension (ESH)/ISO Universal Standard requirements. The machine learning-based BP algorithm required three cuff-based initialization measurements in combination with ∼100 features (signal-derived and patient demographic-based). Ninety-seven patients and 420 samples were included. Mean age, weight, and height were 67.1 years (SD 11.1), 83.4 kg (SD 16.1), and 174 cm (SD 10), respectively. Systolic BP was ≤100 mmHg in 48 samples (11%) and ≥160 mmHg in 106 samples (25%). Diastolic BP was ≤70 mmHg in 222 samples (53%) and ≥85 mmHg in 99 samples (24%). The algorithm showed mean errors of ±3.7 mmHg (SD 4.4 mmHg) and ±2.5 mmHg (SD 3.7 mmHg) for systolic and diastolic BP, respectively. Similar results were observed across all genders and skin colours (Fitzpatrick I-VI). Conclusion: This study provides initial evidence for the accuracy of a PPG-based BP algorithm in combination with a cuffless wristband across a range of BP distributions. This research complies with the AAMI/ESH/ISO Universal Standard, however, further research is required to evaluate the algorithms performance in light of the remaining European Society of Hypertension recommendations. Clinical trial registration: www.clinicaltrials.gov, NCT05566886.

Risk of heart failure among colon and rectal cancer survivors: a population-based case-control study.

AIMS: This population-based case-control study aims to investigate the occurrence of heart failure (HF) among colon and rectal cancer survivors compared with a cancer-free control population taking into account pre-existing cardiovascular risk factors and the influence of treatment. METHODS AND RESULTS: Colon and rectal cancer survivors diagnosed between 2007 and 2014 were selected from a linked cohort of cancer and primary care data in the Netherlands and matched based on gender, birth year, general practitioner (GP) practice, and follow-up period to cancer-free controls. The occurrence of HF was identified based on GP recorded diagnoses after index date (diagnosis date for cases). A Cox proportional hazards model was used to estimate hazard ratios (HRs), adjusted for age, sex, hypertension, diabetes, and hypercholesterolaemia. A total of 5333 colon cancer cases and 2468 rectal cancer cases could be matched to a total of 31 204 cancer-free controls. A statistically significant increased risk of HF was seen among all cases compared with cancer-free controls (HR 1.33; 95% confidence interval: 1.12-1.59). This was also seen when analysing colon cancer and rectal cancer separately. Being diagnosed with stage IV cancer, having hypertension, or having hypercholesterolaemia statistically significantly increased the risk of HF among colon cancer. Hypertension was a statistically significant risk factor for developing HF among rectal cancer cases. CONCLUSIONS: Colon and rectal cancer survivors are at increased risk for developing HF. More awareness should be created by treating physicians and GPs for this potential increased risk in order to further improve survival.

Lactic Acidosis in Prostate Cancer: Consider the Warburg Effect.

Lactic acidosis is a commonly observed clinical condition that is associated with a poor prognosis, especially in malignancies. We describe a case of an 81-year-old patient who presented with symptoms of tachypnea and general discomfort. Arterial blood gas analysis showed a high anion gap acidosis with a lactate level of 9.5 mmol/L with respiratory compensation. CT scanning showed no signs of pulmonary embolism or other causes of impaired tissue oxygenation. Despite treatment with sodium bicarbonate, the patient developed an adrenalin-resistant cardiac arrest, most likely caused by the acidosis. Autopsy revealed Gleason score 5 + 5 metastatic prostate cancer as the most probable cause of the lactic acidosis. Next-generation sequencing indicated a nonsense mutation in the TP53 gene (887delA) and an activating mutation in the PIK3CA gene (1634A>G) as candidate molecular drivers. This case demonstrates the prevalence and clinical relevance of metabolic reprogramming, frequently referred to as "the Warburg effect," in patients with prostate cancer.

Survival and health care costs until hospital discharge of patients treated with onsite, dispatched or without automated external defibrillator.

BACKGROUND: This study aimed to determine whether automated external defibrillator (AED) use during resuscitation is associated with lower in-hospital health care costs. METHODS: For this observational prospective study, we included all treated out-of-hospital cardiac arrests of suspected cardiac cause. Clinical, survival and cost data were collected from July 2005 until March 2008. Cost data were based on hospital transport, duration of admission in hospital wards, diagnostics and interventions. We divided the study population in three groups based on AED use: (1) onsite AED, (2) dispatched AED, (3) no AED. The endpoint was survival to discharge. P<0.05 is indicated by *. RESULTS: Of the 2126 included patients, 136 were treated with an onsite AED, 365 with a dispatched AED and 1625 without AED. Overall (95% confidence interval [CI]) survival rate was 43% (35-51%), 16% (13-20%) and 14% (12-16%), respectively*. Per 100 survivors, the mean duration admitted at intensive care unit [ICU] were 267 (166-374), 495 (344-658), and 537 (450-609) days, respectively*; total duration of hospital admission was 2188 (1800-2594), 3132 (2573-3797), and 2765 (2519-3050) days, respectively*. Mean costs per survivor for hospital stay were euro9233 (euro7351-euro11,280), euro14,194 (euro11,656-euro17,254), and euro13,693 (euro12,226-euro15,166), respectively*; total health care costs were euro29,575 (euro24,695-euro34,183), euro34,533 (euro29,832-euro39,487) and euro31,772 (euro29,217-euro34,385), respectively. For both survivors and non-survivors, total costs per patient were euro14,727 (euro11,957-euro18,324), euro7703 (euro6141-euro9366) and euro6580 (euro5875-euro7238), respectively*. CONCLUSIONS: Onsite AED use was associated with higher survival rates. Surviving patients of the onsite AED group had lower total costs, mainly due to the shorter ICU stay.