Analysis of differential metabolites in serum metabolomics of patients with aortic dissection.

BACKGROUND: Pathogenesis and diagnostic biomarkers of aortic dissection (AD) can be categorized through the analysis of differential metabolites in serum. Analysis of differential metabolites in serum provides new methods for exploring the early diagnosis and treatment of aortic dissection. OBJECTIVES: This study examined affected metabolic pathways to assess the diagnostic value of metabolomics biomarkers in clients with AD. METHOD: The serum from 30 patients with AD and 30 healthy people was collected. The most diagnostic metabolite markers were determined using metabolomic analysis and related metabolic pathways were explored. RESULTS: In total, 71 differential metabolites were identified. The altered metabolic pathways included reduced phospholipid catabolism and four different metabolites considered of most diagnostic value including N2-gamma-glutamylglutamine, PC(phocholines) (20:4(5Z,8Z,11Z,14Z)/15:0), propionyl carnitine, and taurine. These four predictive metabolic biomarkers accurately classified AD patient and healthy control (HC) samples with an area under the curve (AUC) of 0.9875. Based on the value of the four different metabolites, a formula was created to calculate the risk of aortic dissection. Risk score = (N2-gamma-glutamylglutamine × -0.684) + (PC (20:4(5Z,8Z,11Z,14Z)/15:0) × 0.427) + (propionyl carnitine × 0.523) + (taurine × -1.242). An additional metabolic pathways model related to aortic dissection was explored. CONCLUSION: Metabolomics can assist in investigating the metabolic disorders associated with AD and facilitate a more in-depth search for potential metabolic biomarkers.

Development and validation of a risk prediction model for valve regurgitation in Behçet's disease.

BACKGROUND: In Behçet's disease (BD), mild-to-severe valvular regurgitation (VR) poses a serious complication that contributes significantly to heart failure and eventually death. The accurate prediction of VR is crucial in the early stages of BD subjects for improved prognosis. Accordingly, this study aimed to develop a nomogram that can detect VR early in the course of BD. METHODS: One hundred seventy-two patients diagnosed with Behçet's disease (BD) were conducted to assess cardiac valve regurgitation as the primary outcome. The severity of regurgitation was classified as mild, moderate, or severe. The parameters related to the diagnostic criteria were used to develop model 1. The combination of stepAIC, best subset, and random forest approaches was employed to identify the independent predictors of VR and thus establish model 2 and create a nomogram for predicting the probability of VR in BD. Receiver operating characteristics (ROC) and decision curve analysis (DCA) were used to evaluate the model performance. RESULTS: Thirty-four patients experienced mild-to-severe VR events. Model 2 was established using five variables, including arterial involvement, sex, age at hospitalization, mean arterial pressure, and skin lesions. In comparison with model 1 (0.635, 95% CI: 0.512-0.757), the ROC of model 2 (0.879, 95% CI: 0.793-0.966) was improved significantly. DCA suggested that model 2 was more feasible and clinically applicable than model 1. CONCLUSION: A predictive model and a nomogram for predicting the VR of patients with Behçet's disease were developed. The good performance of this model can help us identify potential high-risk groups for heart failure. Key Points • In this study, the predictors of VR in BD were evaluated, and a risk prediction model was developed for the early prediction of the occurrence of VR in patients with BD. • The VR prediction model included the following indexes: arterial involvement, sex, age at hospitalization, mean arterial pressure, and skin lesions. • The risk model that we developed was better and more optimized than the models built with diagnostic criteria parameters, and visualizing and personalizing the model, a nomogram, provided clinicians with an easy and intuitive tool for practical prediction.

Group membership and adolescents' third-party punishment: a moderated chain mediation model.

Third-party punishment (TPP) reflects people's social preference for fairness norms and is fundamental to maintaining fairness norms on a large scale. Several empirical studies have shown that the offender's group membership impacts TPP, but the detailed mechanisms have yet to be fully elucidated. The current study used the third-party punishment game task to explore the relationship between group membership, perceived unfairness, anger, and adolescents' TPP. A total of 306 teenagers aged 12 to 15 were chosen as subjects through cluster sampling. The results showed that group membership (classmate vs. stranger) and gender can affect adolescents' TPP together, which manifests as adolescents enacting significantly harsher punishments on strangers than on classmates, especially for boys. Group membership indirectly affects TPP through the mediating effects of perceived unfairness, anger and through a chain mediation of perceived unfairness and anger. Moreover, gender positively moderate the relationship between group membership and perceived unfairness. Specifically, group membership significantly affects boys' perceived unfairness, but cannot predict girls' perceived unfairness. The above results can be used to guide adolescents toward appropriate justice concepts and moral awareness, thus enhancing TPP.

The impact of brand trust on consumers' behavior toward agricultural products' regional public brand.

The importance of agricultural products' regional public brands, owned by relevant organizations and jointly used by several agricultural production and operation entities, is increasing in contemporary marketing research. Based on a survey of 544 consumers, this study investigates the influence of brand trust, attitude, subjective norms, and perceived behavioral control on their purchase intention and behavior toward agricultural products' regional public brand. Through SEM, we find that brand trust toward agricultural products' regional public brand positively influences consumer attitude, purchase intention, and purchase behavior. In addition, attitude and purchase intention mediate the relationship between brand trust and purchase behavior. While attitude and perceived behavioral control positively affect purchase intention, no similar effect is found for subjective norms. Moreover, multigroup invariance tests demonstrate that consumer behavior can be influenced by factors such as gender, age, monthly income, marital status, previous visits to the region, and purchase purpose. We therefore recommend that to bolster competitiveness, regional public brand stakeholders maintain agricultural product quality, ensure reliable purchasing and transportation channels, and enhance brand trust.

High-Efficiency Ce3+ Activated Orthorhombic Lanthanide Silicate Blue Phosphors for Plant Growth Lighting.

Plant growth can be controlled and freed from natural environmental interference through indoor plant cultivation. Artificial light sources with better quality are required to promote indoor plant growth. In this study, we used a simple high-temperature solid-state reaction to synthesize high-efficiency Ce3+-activated NaGdSiO4 (NGSO) phosphors. X-ray diffraction and Rietveld refinement were performed to determine the detailed crystal structure of the NGSO:Ce3+ phosphors. The morphology of NGSO:Ce3+ and the elemental state of Ce3+ were measured and analyzed. Under near-ultraviolet (n-UV) light excitation, the Ce3+-activated NGSO phosphors exhibit a broad emission band from 375 to 500 nm, and their emission peaks are at approximately 401 nm. This asymmetrical blue emission band is caused by the spin-allowed 5d → 4f transition of Ce3+ and overlaps well with the blue absorption region of carotenoids and chlorophyll. The temperature-dependent luminescence spectra were utilized to assess the thermal stability of NGSO:Ce3+. The external quantum efficiency (EQE) was measured to be 60.91%, and the internal quantum efficiency (IQE) was measured to be 73.39%. A blue LED device assembled from the NGSO:Ce3+ phosphor has demonstrated the application potential in accelerating plant growth.

Corrosion Behavior of Cobalt Oxide and Lithium Carbonate on Mullite-Cordierite Saggar Used for Lithium Battery Cathode Material Sintering.

Mullite-cordierite ceramic saggar is a necessary consumable material used in the synthesis process of LiCoO2 that is easily eroded during application. In our study, we systematically investigated the characteristics and surface corrosion behavior of waste saggar samples. We divided the cross sections of waste saggar into the attached layer, hardened layer, permeability layer, and matrix layer. Then, we examined the high-temperature solid-state reactions between saggar powder and lithium carbonate or cobalt oxide to identify erosion reactants correlating with an increase in the number of recycled saggars. The results of time-of-flight secondary ion mass spectrometric analysis (TOF-SIMS) prove that the maximum erosion penetration of lithium can reach 2 mm. However, our morphology and elemental distribution analysis results show that the erosion penetration of cobalt was only 200 µm. When enough lithium carbonate reacted, lithium aluminate and lithium silicate were the main phases. Our X-ray computed tomography (X-ray CT) analysis results show that the change in phase volume before and after the reaction, including the generation of oxygen and carbon dioxide gas, led to the internal crack expansion of the material-saggar interface. Our results can contribute to improving saggar and upgrading waste saggar utilization technology.

Retrograde recanalization of radial artery occlusion via the distal transradial artery: A single-center experience.

Background: Radial artery occlusion (RAO) often occurs after catheterization when using a transradial artery approach. Objective: This prospective study assessed the success and feasibility of accessing the distal transradial artery (dTRA) for retrograde recanalization of RAO. Methods: From June 2019 to December 2021, 44 consecutive patients who had undergone cardiac catheterization resulting in RAO were given retrograde recanalization via the dTRA. According to the result of the procedure (primary endpoint), patients' cases were analyzed as successful or failed. Rates of post-operative patency and adverse events were calculated up to 12 months. Results: The procedural success rate was 88.6%. Compared with the successful group, a significantly higher percentage of patients in the failed group were current smokers and/or suffered from diabetes mellitus (each, 80.0% cf. 33.3%, P = 0.046); had undergone at least 3 previous cardiac catheterizations (60.0% cf. 12.8%, P = 0.011), lower rate of anticoagulation (30.77% cf. 0%, P = 0.048) and exhibited chronic total occlusion (100.0% cf. 51.28%, P = 0.041). In each group, one patient each had minor bleeding at the access site and hematoma. The patency rates in the successful group at postoperative 3, 6, and 12 months were 48.7, 43.6, and 35.9%, respectively. Conclusion: The dTRA approach for retrograde recanalization of RAO showed a high procedural success rate, but with patency rates of <50% at follow-up.

Eu2+-activated MgAl2Si4O6N4: a novel oxonitridoalumosilicate blue phosphor for white LEDs.

Recently, blue-emitting phosphors have attracted great interest due to their application in full-spectrum white light illumination. In this paper, a novel blue-emitting MgAl2Si4O6N4:Eu2+ phosphor was successfully synthesized through the solid-state reaction method in a reducing atmosphere. Under the excitation of near-ultraviolet (n-UV) light, the MgAl2Si4O6N4:0.02Eu2+ phosphor effectively emits a broad blue emission band centered at 456 nm with the FWHM as large as 81 nm. With the increasing Eu2+ concentration, the emission bands of MgAl2Si4O6N4:Eu2+ shift to a shorter wavelength and the FWHMs broaden gradually. Moreover, the MgAl2Si4O6N4:0.02Eu2+ phosphor exhibits a slight thermal quenching at a higher temperature. After fabricating the as-prepared MgAl2Si4O6N4:0.02Eu2+ phosphor into a white LED device, the intense neutral white light emission is obtained with excellent CRI (87.4) and CCT (5645 K). These results suggest that the blue MgAl2Si4O6N4:Eu2+ phosphor is a promising candidate in n-UV excited white LEDs.

Diagnosis of rapidly progressed primary cardiac lymphoma in liver transplant recipient: A case report.

Primary cardiac lymphomas (PCLs) are extremely rare and affect the heart. Patients with PCLs usually have delayed diagnosis and treatment. As a consequence, their prognosis is quite unfavorable, and their median survival is approximately 7 months. Herein, we report a 64-year-old man who underwent liver transplantation, presented with chest pain and exertional dyspnea, developed a huge cardiac mass within 2 months and passed away on day 3 of hospitalization. Histological examination revealed diffuse large B-cell lymphoma (DLBCL), which is a rare cardiac tumor with a poor prognosis. In this case, DLBCL was only detected postmortem. The extension of the mass and its relationship with the heart were explored with non-invasive cardiac imaging. Despite the rarity of DLBCL, it should be considered in the differential diagnosis of cardiac tumors.

Evolocumab enables rapid LDL-C reduction and inflammatory modulation during in-hospital stage of acute coronary syndrome: A pilot study on Chinese patients.

Background and aims: Proprotein convertase subtilisin/kexin type 9 (PCSK9) has long been considered a key regulator in lipid metabolism. Its role as a potential player in immune response has recently earned much attention. However, the effects of evolocumab, an approved PCSK9 monoclonal antibody, on lipid reduction and inflammation regulation in Chinese patients with acute coronary syndrome (ACS) during their in-hospital stage after an index event are not well known. Methods: We conducted a case-crossover pilot study (http://www.clinicaltrials.gov/, NCT04730648) involving 31 patients hospitalized for ACS with elevated low-density lipoprotein cholesterol (LDL-C) level (≥70 mg/dL despite high-intensity statin) and 8 age- and gender-matched patients without coronary heart disease (CHD) as the baseline control. The patients with ACS received one dose of subcutaneous evolocumab (140 mg) on top of 10 mg/day rosuvastatin during hospitalization. Blood samples at baseline and 72 h post-evolocumab administration were collected for lipid and cytokine assessments. Results: The patients without CHD shared similar risk factors and LDL-C levels with the patients with ACS but exhibited a more activated inflammatory status. After single-dose in-hospital evolocumab, the median LDL-C level of patients with ACS decreased from 109.0 to 41.4 mg/dL as early as 72 h, accompanied with reductions in other atherogenic lipids. Systemic inflammatory pattern was also altered, rendering a decrease in pro-inflammatory and anti-inflammatory cytokines. Conclusion: In this case-crossover study of the effect of PCSK9 antibody among Chinese patients, evolocumab on top of high-intensity statin during hospitalization led to a remarkable and rapid reduction in atherogenic lipids and an alteration in inflammatory status at early-stage post-ACS.

Case report: Echocardiographic diagnosis of double orifice mitral valve in an asymptomatic woman.

Double orifice mitral valve (DOMV) is a rare congenital anomaly that is often associated with cardiac malformation. Valve dysfunction usually presents in childhood; therefore, most cases are diagnosed with DOMV in childhood. Its prevalence and prognostic relevance in adulthood are unknown. Here, we report a case of a 38-year-old woman who presented to the outpatient clinic with an abnormal electrocardiogram and was found to have an isolated double orifice mitral valve malformation on transthoracic echocardiography. Echocardiography is the diagnostic tool of choice for patients with double orifice mitral valves. We should familiarize ourselves with the echocardiographic features of DOMV in order to improve the detection.

Long-term prognosis analysis of PARACHUTE device implantation in patients with ischemic heart failure: a single-center experience of Chinese patients.

BACKGROUND: Heart failure (HF) is one of the leading causes of mortality and morbidity. The PARACHUTE device is designed to partition for left ventricular (LV) apical aneurysm post extensive anterior myocardial infarction (MI). However, the long-term prognosis of the PARACHUTE device post-implantation is unclear. METHODS: From November 2015 to April 2017, six subjects with New York Heart Association Classes II, III and IV ischemic HF, LV ejection fraction between (LVEF) 15 and 40%; and LV anterior apical aneurysm were enrolled in our center. The cumulative event rates for MI, hospitalization, and mortality were documented. Further assessment of LVEF, LV end-diastolic diameter (LVEDD), and estimated pulmonary artery pressure were determined by echocardiography core laboratory. For quantitative data comparison, paired t-test was employed. RESULTS: Device implantation was successful in all six enrolled subjects, and acute device association adverse events were not observed. At 4.6 ± 1.7 years follow-up, major adverse cardiac events (MACEs) were found in 50% patients, and the survival rate was 86.7%. We observed that the LVEF was significantly elevated after deployment (46.00 ± 6.00% vs. 35.83 ± 1.47%, P = 0.009). Besides, the LVEDD elevated after MI (51.17 ± 3.71 vs. 62.83 ± 3.25, P < 0.001) was revealed, but the device sustained preserved LVEDD after implantation. CONCLUSION: The PARACHUTE device is an alternative therapy for patients with severe LV maladaptive remodeling. However, the device seems to increase the HF ratio. TRIAL REGISTRATION: NCT02240940.

Satisfactory Long-term Outcomes of Thoracic Endovascular Aortic Repair With a Bare Stent for Acute Complicated Type B Aortic Dissections.

PURPOSE: To compare the clinical outcomes after thoracic endovascular aortic repair (TEVAR) with a bare stent to those after TEVAR alone in patients with complicated acute type B aortic dissection (cATBAD). MATERIALS AND METHODS: A prospective, randomized trial was conducted at 2 medical centers in China between 2010 and 2013. Patients with cATBAD were randomly assigned to receive TEVAR with a bare stent (n=42) or TEVAR only (n=42). Patients were scheduled to undergo computed tomography angiography at 3, 6, and 12 months and then annually to 5 years. The primary endpoint was all-cause mortality at 5 years; secondary outcomes were a composite of complications (endoleak, stent-graft-induced new entry, aortic rupture, and secondary intervention) and aortic remodeling at 1 and 5 years. RESULTS: All-cause death occurred in 1 (2.4%) patient in the TEVAR with bare stent group (lung cancer) and 5 patients (11.9%) in the TEVAR group (4 aorta-related) during the 5-year follow-up (log-rank p=0.025). The 1- and 5-year rates of complications and secondary interventions did not differ between the groups. Patients in the TEVAR with bare stent group had higher increases in the thoracic true lumen diameter (19.7±3.6 vs 17.0±6.2 mm, p=0.018) and abdominal true lumen diameter (13.7±4.8 vs 7.2±6.1 mm, p<0.001) and a higher incidence of complete false lumen thrombosis (80.9% vs 47.6%, p=0.005) at the 1-year follow-up. However, no between-group differences in the changes of aortic remodeling parameters were observed between the 1- and 5-year follow-up periods. CONCLUSION: The addition of a distal bare stent to a thoracic stent-graft during TEVAR was associated with significantly improved long-term survival in cATBAD patients vs TEVAR only, likely due to the prevention of true lumen collapse and improvement of complete false lumen thrombosis of the dissected aorta.

A comprehensive clinical diagnostic score system for prediction of coronary artery spasm in patients with acute chest pain.

BACKGROUND: Currently, there is no validated multivariate model to predict probability of coronary artery spasm (CAS) in patients with acute chest pain. METHODS: A total of 976 consecutive patients with acute chest pain were enrolled. Patients were divided into two groups based on the presence of significant CAS. To adjust potential confounders, a multivariable analysis was performed and a clinical diagnostic score system for CAS was utilized for score derivation. RESULTS: Multivariable analysis model selected 6 predictors for CAS. The integer score was assigned to each predictors: angina at rest alone (10 points), positive of hyperventilation test (8 points), allergies (3 points), asthma, ST-segment elevation and myocardial bridge (2 points each). We showed that the clinical diagnostic score system had accuracy in predicting CAS, as measured by the area under the curve (AUC), which was 0.952-0.966. The cut-off baseline value for the clinical diagnostic score system was set to 11-12 points with specificity of 91.0-93.3% and sensitivity of 90.7-92.9%, respectively. CONCLUSION: A clinical diagnostic score system was derived and validated as an accurate tool for estimating the pretest probability of CAS in patients with acute chest pain.

Sympathectomy versus conventional treatment for refractory coronary artery spasm.

BACKGROUND: There is no clear consensus on the potential efficacy and indications for sympathectomy to prevent recurrence of vasospasm in patients with refractory coronary artery spasm (CAS). OBJECTIVE: To compare the clinical outcomes of sympathectomy with those of conventional treatment in patients with refractory CAS. PATIENTS AND METHODS: Patients with refractory CAS were randomly assigned to sympathectomy group (n = 37) or conventional treatment group (n = 42). The primary end point was a composite of major adverse cardiac event (MACE) episodes (including cardiac death, nonfatal myocardial infarction, unstable angina, heart failure, and life-threatening arrhythmia), and the secondary end point was death from any cause within 24 months after randomization. RESULTS: During the follow-up period of 24 months, the incidence of MACE in the sympathectomy and conventional treatment groups was 16.22 and 61.90%, respectively (P = 0.0001). All-cause death as the secondary end point occurred in zero and six (14.29%) patients, respectively (P = 0.0272). The Kaplan-Meier curve for MACE and all-cause death showed a significant between-group difference (log-rank test, P = 0.0013 and 0.0176, respectively). CONCLUSION: Compared with conventional treatment, sympathectomy significantly reduced the composite end point of MACE episodes and death from any cause in patients with refractory CAS by effectively preventing recurrence of vasospasm.

Genetic deletion of GIT2 prolongs functional recovery and suppresses chondrocyte differentiation in rats with rheumatoid arthritis.

The current study was conducted for investigating the mechanism by which GIT2 gene deletion affects the functional recovery and chondrocyte differentiation in rats with rheumatoid arthritis (RA). Thirty-two rats were randomly divided into normal, model, GIT2 gene knockout (GIT2-KO), and model + GIT2-KO groups. Hematoxylin-eosin (HE) staining was performed for the observation of synovial tissues. Immunohistochemistry examinations were conducted to determine type II collagen expression as well as identify chondrocyte differentiation. qRT-PCR and Western blotting techniques were adopted in order to expressions of interleukin-1ß (1L-1ß), tumor necrosis factor-α (TNF-α), Aggrecan, and Sry-related HMG box 9 (Sox9). A tape measure and Vernier caliper were used to measure the degree of swelling. Compared with synovial tissues in the model group, those in the model + GIT2-KO group, were thicker and comprised of a mass of inflammatory cells (P < 0.05). Compared with the model group, the type II collagen expressions of the cartilage tissues of the rats decreased in the model + GIT2-KO group (P < 0.05). In terms of the degree of swelling in cartilage tissues, the model group displayed a lesser degree of swelling than in that of the model + GIT2-KO group (P < 0.05). When compared with the model + GIT2-KO group, the mRNA expressions of 1L-1ß, TNF-α, Aggrecan, Sox9 and the relevant protein expressions were lower in the model group (all P < 0.05). GIT2 gene deletion might weaken chondrocyte differentiation in rats with RA, as a result acting to ultimately prolong the functional recovery of RA.

Chemokine-Like Receptor 1 Regulates the Proliferation and Migration of Vascular Smooth Muscle Cells.

BACKGROUND We aimed to explore how chemokine-like receptor 1 (CMKLR1) influences the proliferation and migration of vascular smooth muscle cells (VSMCs). MATERIAL AND METHODS Normal VSMCs, negative control VSMCs interfered by CMKLR1 gene, and VSMCs with stable knockdown of CMKLR1 gene were divided into the control group, PDGF group, negative-shRNA group, and CMKLR1-shRNA group. Both cell number counting and BrdU incorporation assays were employed to investigate the proliferation status of VSMCs. Transwell migration assay was used to measure the migration status of VSMCs. Inflammation markers, including cytokines IL-1ß, IL-6, TNF-α, and chemokines MCP-1 in VSMCs, were detected by real-time quantitative RT-PCR. Western blotting assay was used to detect protein expressions of the MAPK pathway in VSMCs. RESULTS The number of VSMCs and the OD value of BrdU in PDGF group were significantly higher than those in the control group (both P<0.05). Compared with the control and negative-shRNA group, the CMKLR1-shRNA group exhibited significantly reduced VSMCs number and BrdU OD value (both P<0.05). Transwell migration assay indicated that PDGF-BB promoted whereas CMKLR1-shRNA inhibited the migration of VSMCs. The expression of IL-1ß, IL-6, TNF-α, and MCP-1 were up-regulated in the PDGF group but down-regulated in the CMKLR1-shRNA group. Compared with normal VSMCs, the protein level of p-ERK1/2 was up-regulated in VSMCs treated with PDGF-BB, while it was down-regulated in the CMKLR1-shRNA group. CONCLUSIONS CMKLR1 exacerbated the proliferation and migration of VSMCs by activating ERK1/2.

Effects of high mobility group box 1 and nuclear factor κB on neointimal hyperplasia after common carotid artery balloon injury.

This study is to investigate the effects of high mobility group box 1 (HMGB-1) and nuclear factor κB (NF-κB) on intimal hyperplasia after carotid artery balloon injury. A total of 28 male SD rats were subjected to balloon catheter injury at left side carotid artery and this side was considered as experimental group. The right side was taken as control group. Common carotid arteries were harvested at 6 h, 3 d, 7 d and 14 d after balloon injury. The intimal thickness and lumen area were analyzed by HE staining and computerized method. HMGB-1 expression was tested by RT-PCR and NF-κB was detected by EMSA. Among the 28 rats, 4 were excluded due to failed modeling or death and the other 24 rats were included for analysis. Carotid endarterectomy, intimal hyperplasia and restenosis were found after balloon injury. Intimal hyperplasia appeared on 3 d and was significant on 14 d after injury. The ratio of intima/media in the experimental group increased significantly compared with the control group (P < 0.05). HMGB-1 was scarcely expressed in control group. It increased 6 h and peaked on 14 d after injury, with significant difference compared with the control group (P < 0.01). Similarly to HMGB-1, NF-κB was rarely expressed in control group, and its level increased since 6 h and peaked on 14 d after injury. Intimal hyperplasia after carotid artery balloon injury was found in rat model and this might be induced by enhanced expression of HMGB-1 and NF-κB.

[Impact of visit-to-visit blood pressure variability on vascular function in elderly hypertensive patients].

OBJECTIVE: To assess the relationship between visit-to-visit blood pressure (BP) variability (BPV) and vascular endothelial function in a cohort of elderly hypertensive patients. METHODS: A total of 174 elderly patients with essential hypertension were included in the study. The participants had their office BP measured during the 12-month follow-up. Right brachial artery diameter was assessed at rest, during reactive hyperemia (flow-mediated dilation, FMD), and after nitroglycerin administration (nitroglycerin-mediated dilation, NMD). The participants were divided into two groups according to FMD% or FMD/NMD ratio. The correlations between BPV and endothelial function were analyzed by univariate analysis and multiple linear regression analysis. RESULTS: The participants classified as having a decreased endothelial function according to FMD/NMD ratio had significantly lower FMD% and higher BPV and NMD% (P<0.05). The percentage of CCBs use in normal endothelial function group was significantly higher than that in decreased endothelial function group (79.55% vs 63.95%, P<0.05). Multiple linear regression analysis revealed a significant negative association between FMD/NMD ratio and BPV, and this association remained significant after adjustment for age, body mass index, and mean BP levels. CONCLUSIONS: FMD/NMD ratio is a better marker of endothelial function than FMD, and an increased visit-to-visit variability of BP is associated with a decreased endothelial function.