Arterial Pressure Research Articles

Hemodynamic considerations for prenatal treatment of severe Ebstein anomaly with circular shunt based on two cases and review of the literature.

Prenatal severe Ebstein anomaly might be complicated by a circular shunt. In these cases, persistently elevated right atrial and venous pressure (due to severe tricuspid regurgitation) is complicated by a systemic ineffective blood shunt via a DA, resulting in diminished end-organ perfusion and acidosis, due to overall low cardiac output. Affected fetuses are at a significantly higher risk of intrauterine fetal demise. Reduction of ductal flow by prenatal treatment with nonsteroidal anti-inflammatory drugs has recently been described as a potential treatment option. However, published data are limited and management during the antenatal course is not well defined. We provide a literature review to propose a possible algorithm for prenatal assessment and initiation of treatment.

Comparative Analysis of 5 cmH₂O Versus 10 cmH₂O PEEP on Cerebral Oxygen Saturation in Brain Tumor Surgery: A Randomized Controlled Clinical Study.

BACKGROUND The main concern regarding lung-protective ventilation strategies during neurosurgery is the reduction in venous return and increase in cerebral blood flow when using high positive end-expiratory pressure (PEEP). This study aimed to evaluate and compare the changes in regional cerebral oxygen saturations (rSO2) during the use of 5 cmH₂O and 10 cmH₂O PEEP in patients undergoing craniotomy for tumor resection. MATERIAL AND METHODS The study was designed as a prospective, single-blind randomized controlled study. Patients aged between 18 and 70 years, scheduled for an elective craniotomy for tumor resection, were divided into 2 groups: 5 cmH₂O PEEP (Group Low PEEP) and 10 cmH₂O PEEP (Group High PEEP). The PEEP was applied during general anesthesia, for controlled mechanical ventilation. The main outcome was the measurement of rSO2 before dura opening. Changes in rSO₂, hemodynamic parameters, and peripheral oxygen saturation (SpO₂) during different periods of surgery were compared between the groups. RESULTS Sixty-four patients were included. There were no significant differences between the 2 groups regarding demographic data. Mean arterial blood pressure and changes in SpO₂ were statistically similar in all periods between the groups (P=0.141 and P=0.081). When compared with the baseline value, SpO₂ increased significantly at all measurement times (P<0.05). No difference was observed in rSO₂ values compared with baseline rSO₂ values between the groups (P=0.218). CONCLUSIONS PEEP at the level of 10 cmH₂O can be safely applied during craniotomy without altering hemodynamics, and without causing a decrease in rSO₂.

A dynamic elastance-based protocol to guide intraoperative fluid management in major abdominal surgery: A randomised clinical trial.

Arterial hypotension during major surgery is related to postoperative complications and mortality. Both fluids and vasopressors increase blood pressure (BP) by inducing different physiological response. We devised a protocol which relies on dynamic arterial elastance (Eadyn) to guide BP optimisation during major abdominal surgery, and tested its effectiveness on tissue perfusion. to explore if an Eadyn-based optimisation protocol could affect lactate levels, fluid administration, and postoperative clinical complications. randomised open-label clinical trial. High-volume tertiary care centre for pancreatic surgery. From 58 patients scheduled for cephalic duodenopancreatectomy 46 were eligible for the study. The primary endpoint was the lactate value one hour after extubation. Secondary endpoints were fluid balance, intraoperative hypotension and postoperative complications. In the control group, hypotension (mean arterial pressure < 65 mmHg) was treated based on stroke volume variation (SVV) while in the experimental group the treatment was based on assessment of dynamic arterial elastance (Eadyn group). Patient demographic and preoperative laboratory data were recorded. All haemodynamic data, including oxygen delivery and consumption, were recorded at four time points: after intubation (T0), after fascia opening (T1), after fascia closing (T2) and one hour after extubation (T3). The patients were 70 [63 to 76] years and 15 (33%) were ASA 3. Lactate levels at T3 were similar between the control and Eadyn groups. Oxygen consumption was higher in the Eadyn group at T3, and lactate had a significant percentage decrease from T2 to T3: median [IQR], -24.5 [-30 to -14] vs. 0 [-24 to 7.6]%, P = 0.004). Those in Eadyn group received more vasopressors and had a lower fluid balance at T3: 2700 [2100 to 3800] vs. 2200 [1060 to 3000] ml, P = 0.020). There were no significant differences either in postoperative complications or hospital stay. A protocol including Eadyn to treat hypotension did not reduce lactate after major abdominal surgery, but it was associated with a significant reduction in fluid balance and increase in oxygen consumption. 05187273.

Acute Effect of Moderate-Intensity Interval Intradialytic Exercise on Cerebral Oxygenation in Hemodialysis Patients: A Randomized Crossover Trial.

Cognitive dysfunction in hemodialysis (HD) patients is associated with decreased regional cerebral oxygenation (rSO2). Intradialytic exercise improves cognitive function; nonetheless, the acute effect of intradialytic exercise on cerebral circulation remains unknown. This study aimed to evaluate the acute effect of intradialytic exercise on rSO2 during HD. This single-center, open-label, randomized crossover trial included 20 HD patients. Patients received the control condition as usual care and the intradialytic exercise condition in random order. The intradialytic exercise condition involved the performance of anaerobic threshold-intensity interval exercise for 35 min. Cerebral oxygenation (rSO2, oxygenated hemoglobin, deoxygenated hemoglobin, and total hemoglobin) in the prefrontal cortex was measured using near-infrared spectroscopy during HD. Cardiovascular responses, including the heart rate, cardiac index, mean arterial pressure, and blood gas, were also assessed. The two conditions were compared using two-way repeated-measures analysis of variance. The analysis included 16 patients, four of whom were excluded because of artifacts in the cerebral oxygenation data. The rSO2 (P<0.001), oxygenated hemoglobin (P<0.001), and total hemoglobin (P=0.004) showed significant interactions and were significantly increased at end of exercise (rSO2 1.3%, 95%CI [0.5, 2.1]; oxygenated hemoglobin 0.01 mM, 95%CI [0.00, 0.02]; total hemoglobin 0.01 mM, 95%CI [0.00, 0.03]) and 15-min after exercise (rSO2 1.1%, 95%CI [0.2, 2.0]; oxygenated hemoglobin 0.01 mM, 95%CI [0.00, 0.03]; total hemoglobin 0.02 mM, 95%CI [0.00, 0.03]) in the intradialytic exercise condition compared with the control condition. The rSO2 at the end of HD in the control condition was significantly decreased compared with that during pre-HD (-1.5%, 95%CI [-2.7, -0.3]), but not in the intradialytic exercise condition (-1.2%, 95%CI [-2.8, 0.5]). Intradialytic exercise significantly increased rSO2 during and after exercise and improved rSO2 to the same extent as pre-dialysis.

Carbetocin Is More Effective in Stabilizing Hemodynamic Parameters Compared to Oxytocin During Cesarean Section

Background/Objectives: First-line uterotonics include carbetocin and oxytocin, which act on the oxytocin receptor with varying potencies. Methods: In 70 pregnant Caucasian women who delivered by cesarean section, the effects of oxytocin and carbetocin on heart rate and blood pressure were compared. The pregnant women were divided into two groups: the OXY group, which received intravenous oxytocin 5 IU on an even day of the month, and the CARBE group, which received intravenous carbetocin 100 µg on an odd day of the month. Blood pressure and heart rate were measured noninvasively every 3 min from the beginning of cesarean section until the lower uterine incision, and then at 1, 2, and 3 min after the fetus and placenta were removed and the uterotonic drugs were discontinued. Subsequent measurements were taken at 3 min intervals until the end of the cesarean procedure. Results: After the administration of uterotonic drugs, a significant decrease in systolic blood pressure was observed only in the group receiving oxytocin at the first (p &lt; 0.0001) and second minute after drug administration (p &lt; 0.0001). Diastolic arterial pressure was significantly different in the study groups at the sixth minute after oxytocin and carbetocin administration (p = 0.004). Mean arterial pressure values were significantly different in the two study groups at the first and sixth minute after drug administration (p = 0.006; p = 0.014). With regard to heart rate, significant differences between the groups were found at 6 min after uterotonic drug administration (p = 0.019). Conclusions: Blood pressure and heart rate variability are significantly higher after oxytocin than after carbetocin administration in women delivering by cesarean section.

Comparison of PDE-5 inhibitors used in erectile dysfunction with some candidate molecules: A study involving molecular docking, ADMET, DFT, biological target, and activity

Erectile dysfunction (ED) is a urological condition defined as the inability of a man to achieve or maintain an erection. This condition negatively affects his sexual performance and the performance of his partner. Phosphodiesterase type 5 (PDE5) inhibitors are commonly used to treat ED. Arginase II plays an important role in regulating L-arginine to NO synthase in the smooth muscle of the human corpus cavernosum of the penis. NO is a molecule essential for regulating a variety of functions, including arterial blood pressure, penile erection, and energy balance. Substances such as vardenafil, alprostadil, papaverine, and resveratrol increase NO production, thereby supporting sexual function and vascular health. Additionally, NO donors such as L-arginine, L-citrulline, and α-lipoic acid provide effective alternatives when used in combination with PDE5 inhibitors. Medications used in the treatment of ED include vardenafil, alprostadil, and papaverine. In addition, although molecules such as L-arginine, citrulline, resveratrol, alpha-lipoic acid, and rutin are thought to play a role in ED, their pharmacological and molecular effects have not been sufficiently elucidated. The aim of this study was to investigate the effects of these molecules in the treatment of ED by computer-based calculations, to obtain new information about them and to inspire new treatment strategies for ED. The physicochemical, molecular and pharmacokinetic properties of the compounds were determined by SwissADME software, and ADMET (absorption, distribution, metabolism, excretion and toxicity) data were determined by ADMETlab 3.0 software. Biological target and activity data were obtained by MolPredictX and PASS Online software. While the Gaussian 09 program was used for DFT calculations, PyMOL, AutodockTools 4.2.6, AutoDock Vina, and Biovia Discovery programs were used for molecular docking studies. It was found that L-arginine, citrulline, resveratrol and α-lipoic acid were well absorbed from the intestine, while rutin showed limited absorption. When their metabolic risks were evaluated, L-arginine and citrulline were found to have lower toxicity. Molecular docking results of rutin and resveratrol were remarkable. The electronic properties of the compounds were explained by DFT calculations. L-arginine and citrulline were found to have low toxicity and positive therapeutic effects. L-arginine and citrulline stand out as promising candidates for future research. Although resveratrol data are promising, unfortunately their potential toxicity and metabolic interactions require further investigation. It is important to learn more about these compounds or conduct research to improve their therapeutic efficacy. Although computer-based calculations play an important role in toxicity predictions, drug interactions, pharmacokinetics and toxicity properties should be carefully evaluated.

Hemodynamics of Veno-Pulmonary Extracorporeal Membrane Oxygenation With Varying Right Ventricular Function in a Mock Circulatory Loop.

Veno-pulmonary extracorporeal membrane oxygenation (VP ECMO) is an emerging mechanical support therapy for patients with right ventricular (RV) injury. This study aimed to assess the hemodynamic impact of VP ECMO using a mock circulatory loop (MCL) to simulate patients with varying levels of RV injury and pulmonary vascular resistance (PVR). Right ventricular injury was simulated by changing the end-systolic pressure-volume relationship (47.5-100% of healthy RV), in combination with different PVR states (100-600 dyne·s·cm-5). Veno-pulmonary extracorporeal membrane oxygenation was introduced into the MCL circuit from 0 to 5 L/min at 1 L/min intervals. We demonstrated that the effect of VP ECMO support on pulmonary and systemic hemodynamics may vary significantly depending on RV function and RV afterload. A common observation across all cases was that high ECMO flow rates increased mean pulmonary arterial and left atrial pressure and reduced pulmonary artery pulsatility significantly. The absolute value of these parameters depended highly on RV function and corresponding PVR state. The study highlights the importance of considering RV injury severity and corresponding afterload when using VP ECMO to maintain cardiorespiratory stability and prevent pulmonary vasculature damage or hemorrhage. Further research is needed to establish the safe and effective use of VP ECMO in managing cardiac or respiratory failure.

Cardiac damage after polytrauma: the role of systematic transthoracic echocardiography - a pilot study

BackgroundHeart injuries following polytrauma (PT) are identified as a predictor of poor outcome. The diagnostic algorithm of cardiac damage after trauma consists of the systemic measurement of cardiac damage markers, a 3-channel ECG and if there are any suspicious findings, the conduction of a transthoracic echocardiography (TTE). The aim of this study was to implement a systematic analysis of cardiac function using TTE in PT-patients.MethodsThis study is a prospective non-randomized study, conducted in a German Level 1 Trauma Centre between January and July 2024. All polytraumatized patients with an ISS ≥ 16 were included immediately after entering the emergency department. Blood samples were withdrawn at 6 timepoints, at the Emergency room, 24 h, 48 h, three, five and ten days after admission to the hospital. Cardiac damage was measured by Troponin T (TnT) ECLIA, as well as NT-proBNP measurements. Entering the intensive care unit, transthoracic echocardiography was performed at two time points (day 1 and 2), by an experienced Cardiologist.ResultsDuring the pilot phase, cardiac contusion was detected in 14.3% of patients, with significantly elevated TnT levels on arrival, after 24 (**p ≤ 0.01) and 48 h (*p ≤ 0.05) compared to patients without cardiac contusion. Echocardiographic findings revealed that 25% of all patients had wall motion abnormalities, and 20% showed relaxation disorders. Right ventricular function, measured by TAPSE (tricuspid annular plane systolic excursion), RVEDD (right ventricular end diastolic diameter) and sPAP (systolic pulmonary arterial pressure), was slightly impaired in trauma patients, while the left ventricular function (ejection fraction (EF) and left ventricular end diastolic diameter (LVEDD)) was preserved. We observed the increase of TnT and an increase of the heart failure marker NT-proBNP over the time. These biomarkers were associated with pre-existing cardiac risk factors, the ISS and changes in the right or left ventricular function. Mitral valve insufficiency (grade 1) was present in 50% and tricuspid valve (grade 1) insufficiency in 30%.ConclusionsTaken together, we conducted for the first time of our knowledge, a systematic TTE analysis in PT-patients. We observed a slightly reduced right ventricular function, as well as mitral and tricuspid valve regurgitations in the patients.

Evaluation of transnasal humidified rapid-insufflation ventilatory exchange technology in rigid esophagoscopy for foreign body removal under general anesthesia

Objective: To explore the efficacy of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) technology in rigid esophagoscopy for foreign body removal under general anesthesia. Methods: Patients who underwent rigid esophagoscopy for foreign body removal under general anesthesia from September to December 2022 at Beijing Tongren Hospital were prospectively included. After entering the operating room, all patients received high-flow oxygen for 5 minutes, with an inhaled temperature of 37 ℃, an oxygen concentration of 100%, and an oxygen flow rate of 30 L/min. After anesthesia induction, the oxygen flow rate was adjusted to 60-80 L/min until the patients awoke. The primary outcome was the success rate of THRIVE defined as percutaneous oxygen saturation (SpO2)≥95% throughout anesthesia, while the safety outcome was the incidence of complications associated with THRIVE. The operation time, apnea time, anesthesia duration, heart rate, mean arterial pressure, and SpO2 were recorded at the following time points,such as entering the operating room (T0), after 5 minutes of high-flow oxygenation (T1), post-anesthesia induction (T2), during esophagoscope insertion (T3), at the end of the procedure upon esophagoscope withdraw (T4), upon awakening (T5), and upon exiting the operating room (T6). Results: Fifty patients (17 males and 33 females) were enrolled, with an age of (54.0±20.5). The success rate of THRIVE technology was 86%(43/50). A total of 7 patients required airway intervention, among which 6 patients underwent mask compression ventilation and 1 patient underwent endotracheal intubation intraoperatively. Three cases occurred before the end of esophagoscopy and required interruption of esophagoscopy for airway intervention. No complications related to THRIVE technology were observed. The heart rate of all patients was (86±12) beats/min at T6, which was significantly higher than that of (79±15) beats/min at T2 (P<0.001). The mean arterial pressure (MAP) was (90.4±13.3) mmHg (1 mmHg=0.133 kPa) at T2, which were significantly lower than that of (105.5±14.2) mmHg at T0 and (102.0±13.7) mmHg at T1. The mean arterial pressures at T4 and T5 were (84.8±15.0) and (82.9±14.5) mmHg, respectively, which were significantly lower than the (90.4±13.3) mmHg at T2 (all P<0.001). No cardiovascular or respiratory adverse events occurred during the procedure or the postoperative recovery monitoring period. Conclusion: THRIVE technology can be safely and effectively applied in rigid esophagoscopy for foreign body removal under general anesthesia, providing effective oxygenation, and maintaining stable circulation.

Impact of renal artery stenosis on renovascular hypertension and the therapeutic role of renal artery stenting: a comprehensive review

Background Renal artery stenosis (RAS) is characterized by reduced renal perfusion, activating the renin-angiotensin-aldosterone system (RAAS), which can lead to secondary hypertension, ischemic nephropathy, and cardiac destabilization syndrome. These conditions have significant healthcare implications. Renovascular hypertension (RVH) in RAS patients can be managed through medical therapy and revascularization, either endovascular or surgical. While renal artery stenting (RAS) was once viewed as the most effective treatment for atherosclerotic renovascular disease, recent trials suggest no significant difference in RVH management between medical therapy alone and combined with renal artery stenting. However, certain subgroups have exhibited favorable outcomes in blood pressure control post-stenting. Summary This comprehensive review synthesizes data, including findings from the HERCULES trial, which showed a reduction in blood pressure from 162.3±18.5/77.7±11.5 mmHg to 145.7±20.7/75.4±11.0 mmHg over 36 months (P&lt;0.0001). Additionally, the ASPIRE-2 study demonstrated significant decreases in blood pressures from 168±25/82±13 mmHg to 149±25/77±12 mmHg at 24 months (P&lt;0.001). The review delves into the prevalence, pathophysiology, clinical manifestations, diagnosis, and treatment of RAS-related RVH, specifically analyzing the efficacy and safety of renal artery stenting. Key Messages The analysis indicates that renal artery stenting may be particularly advantageous for certain patient subgroups, enhancing blood pressure outcomes and overall clinical status. Nevertheless, the criteria for selecting candidates for this intervention remain under debate. Future research should focus on high-risk RAS patients to explore long-term benefits and refine the utilization of renal artery stents, ultimately improving RVH management.

Efficacy of milrinone plus sildenafil in the treatment of neonates with persistent pulmonary hypertension: A single center, randomized controlled trial from a resource limited setting.

Objective: To compare the outcomes of milrinone plus sildenafil versus sildenafil alone in the treatment of persistent pulmonary hypertension (PPH) in neonates. Study Design: Randomized Controlled Trial. Setting: Department of Neonatology, The Children’s Hospital and Institute of Child Health, Multan, Pakistan. Period: December 2023 to May 2024. Methods: A total of 42 neonates, diagnosed to have PPH were enrolled. Neonates were randomized to either oral sildenafil monotherapy (n=21) or oral sildenafil and intravenous (IV) milrinone (n=21). Primary outcome was decrease in pulmonary artery systolic pressure (PASP). Secondary outcomes were improvement in oxygen saturation, duration of hospitalization, treatment related side effects, and mortality. Results: In a total of 42 neonates, 25 (59.5%) were boys. The mean age at the time of enrollment was 9.63±3.51 days. The mean PASP at the time of enrollment was 55.73±7.91 mmHg. PASP was statistically similar at baseline (p=0.5512), and day-3 (p=0.2163). At day-7, PASP was significantly reduced in sildenafil plus milrinone group was reported in comparison sildenafil group (37.62±8.04 mmHg vs. 42.92±8.25 mmHg, p=0.0413). SPO2, mortality, and post-treatment complications were statistically similar among neonates of both study groups. The duration of hospitalization was significantly less among neonates of sildenafil plus milrinone group vs. sildenafil group (13.58±2.93 days vs. 16.82±4.24 days, p=0.0063). Conclusion: Combined oral sildenafil and IV milrinone was more efficacious than sildenafil alone in reducing pulmonary arterial pressure.

First Trimester Ultrasound Biomarkers for Predicting Preeclampsia: A Prospective Cohort Study in Surabaya, Indonesia

Introduction: Preeclampsia (PE) remains a leading cause of maternal and perinatal morbidity and mortality worldwide, particularly in developing countries like Indonesia. Early identification of high-risk women is crucial for timely intervention. This study aimed to evaluate the predictive performance of first-trimester ultrasound biomarkers, specifically uterine artery pulsatility index (UtA-PI) and mean arterial pressure (MAP), combined with maternal characteristics, for predicting PE in a cohort of pregnant women in Surabaya, Indonesia. Methods: This prospective cohort study enrolled pregnant women attending their first-trimester antenatal care visit at Private Hospital, Surabaya, between January 2022 and December 2023. Inclusion criteria were singleton pregnancies, gestational age between 11 and 13 weeks 6 days, and availability of complete follow-up data until delivery. Maternal characteristics (age, body mass index, parity, smoking history, family history of PE) were recorded. UtA-PI was measured using transabdominal Doppler ultrasound, and MAP was calculated from blood pressure measurements. The primary outcome was the development of PE, defined according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Logistic regression analysis was used to develop a prediction model, and its performance was assessed using receiver operating characteristic (ROC) curves and area under the curve (AUC). Results: A total of 850 pregnant women were included in the final analysis. The incidence of PE was 8.2% (n=70). The prediction model incorporating maternal age, BMI, prior history of PE, UtA-PI, and MAP demonstrated good predictive performance for overall PE (AUC = 0.85; 95% CI, 0.81-0.89). For early-onset PE (delivery &lt;34 weeks), the AUC was 0.92 (95% CI, 0.87-0.97), and for late-onset PE (delivery ≥34 weeks), the AUC was 0.78 (95% CI, 0.73-0.83). UtA-PI and MAP were significant independent predictors of PE (p&lt;0.001). A risk score was developed, with a cut-off value showing a sensitivity of 80% and specificity of 75% for overall PE. Conclusion: The combination of maternal characteristics, UtA-PI, and MAP in the first trimester provides a valuable tool for predicting PE in an Indonesian population. This model demonstrates particularly strong performance for predicting early-onset PE, which is associated with greater maternal and fetal morbidity. Early identification of high-risk women allows for targeted surveillance and potential preventative strategies.

Changes in Macrophages in Pulmonary Hypertension: A Focus on High-altitude Pulmonary Hypertension.

High-altitude pulmonary hypertension (HAPH) is a condition characterized by elevated pulmonary arterial pressure exceeding normal physiological values, resulting from a combination of high-altitude low-pressure, hypoxic environments, genetic susceptibility, immune dysfunction, and neurogenic disturbances. This condition predominantly manifests as right heart failure, severely impacting quality of life and life expectancy. Macrophages, as one of the most prevalent innate immune cells, have been increasingly recognized for their crucial role in the pathogenesis of HAPH. The low-pressure and hypoxic environment, along with other etiological factors, lead to metabolic abnormalities in tissue cells and the microenvironment. This results in increased secretion of chemokines, cytokines, and growth factors in the microenvironment, which promote the proliferation of tissue-resident macrophages and the differentiation of monocytes recruited from the blood into macrophages. This exacerbates the inflammatory cascade, further promoting cell proliferation, tissue repair, and inhibition of apoptosis. These processes contribute to the migration and proliferation of pulmonary arterial smooth muscle cells, endothelial cells, and fibroblasts, leading to vascular remodeling and ultimately the development of pulmonary arterial hypertension. This review examines the role of macrophage-mediated immune responses in high-altitude pulmonary arterial hypertension, with a focus on hypoxia as a key feature.

A Combined Model of Spleen Stiffness and Baveno VII Criteria for Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease: An International Multicenter Study

ABSTRACTAimsThe renewing Baveno VII consensus proposed criteria for the diagnosis of clinically significant portal hypertension (CSPH) in patients with compensated advanced chronic liver disease (cACLD). The performance of a combined model of spleen stiffness measurement (SSM) by spleen‐dedicated 100 Hz (SSM@100 Hz) or conventional 50 Hz (SSM@50 Hz) and Baveno VII criteria to rule‐in or rule‐out CSPH had not been well validated. This study aims to compare the performance of the combined model with Baveno VII criteria alone to rule‐in and rule‐out CSPH in cACLD.MethodsThis international multicenter study included cACLD patients who underwent paired liver stiffness measurement (LSM), SSM@100 Hz or SSM@50 Hz, platelet count (PLT), and hepatic venous pressure gradient (HVPG). CSPH was defined as HVPG ≥ 10 mmHg. Patients with SSM@100 Hz were prospectively recruited from China between August 2021 and March 2022, while a global cohort of patients with SSM@50 Hz from Croatia, Japan, and Singapore was retrospectively included between December 2014 and June 2022. The diagnostic performance of different models was assessed using sensitivity, specificity, positive predictive value, and negative predictive value.ResultsA total of 206 patients with cACLD were recruited from seven university centers and 110 patients were included in the final analysis (54 from the SSM@100 Hz cohort and 56 from the SSM@50 Hz cohort). The success rate of SSM@100 Hz was significantly higher than that of SSM@50 Hz (103/105 [98.1%] vs. 86/101 [85.1%]; p &lt; 0.001). While the combined model (SSM &gt; 50 kPa or LSM ≥ 25 kPa) and Baveno VII criteria (LSM ≥ 25 kPa) had a positive predictive value and specificity &gt; 90% to rule‐in CSPH, the combined model correctly ruled‐in more cACLD patients with CSPH compared to Baveno VII criteria alone (35/110 [31.8%] vs. 22/110 [20.0%]; p &lt; 0.001). Furthermore, the combined model (SSM &lt; 21 kPa or [LSM ≤ 15 kPa and PLT ≥ 150 × 109/L]) and Baveno VII criteria (LSM ≤ 15 kPa and PLT ≥ 150 × 109/L) had a sensitivity and negative predictive value &gt; 90% to rule‐out CSPH. Compared to the Baveno VII criteria alone, the combined model correctly ruled‐out more patients without CSPH, although there was no statistical difference (39/110 [35.5%] vs. 34/110 [30.9%]; p = 0.063). The findings remained broadly similar when subgroup analyses were performed in the SSM@100 Hz cohort and the SSM@50 Hz cohort. Notably, the combined model reduced patients in the gray zone compared to Baveno VII criteria alone (36/110 [32.7%] vs. 54/110 [49.1%]; p &lt; 0.001).ConclusionsWhether using SSM@100Hz or SSM@50Hz, the combined model of SSM and Baveno VII criteria was superior to Baveno VII criteria alone to rule‐in and rule‐out CSPH in cACLD patients, which may guide therapeutic decisions by minimizing cACLD patients in the gray zone.Trial RegistrationClinicalTrials.gov; No.NCT05251272.

Oncological Crisis: Managing Superior Vena Cava Syndrome in the Emergency Department

Superior vena cava syndrome (SVCS) results from obstruction of the superior vena cava (SVC) and is commonly associated with malignancies. However, its presentation can vary, and in rare cases, it may present as an oncological emergency with atypical symptoms. A 54-year-old male presented to the Emergency Department (ED) with syncope, breathlessness, and fever. Clinical examination revealed elevated jugular venous pressure, hypoxia, and engorged veins. Imaging identified superior vena cava obstruction due to a compressing mediastinal mass, alongside lung hyperinflation and emphysema. The patient’s history included Chronic Obstructive Pulmonary Disease (COPD) and extensive smoking. In the ED, he was managed with oxygen therapy, corticosteroids, and nebulization. A biopsy confirmed malignancy, and the patient was subsequently treated with chemotherapy. This case highlights the rare presentation of malignant SVCS as syncope and emphasizes the importance of including SVCS in the differential diagnosis for patients with a history of malignancy presenting with breathlessness and engorged veins. Effective management in the ED requires a multidisciplinary approach to address the complexities of oncological emergencies and improve patient outcomes. Keywords: Superior vena cava syndrome, Mediastinal mass, Chronic obstructive pulmonary disease, Emergency department, R-CHOP Regimen

Effect of garlic on sodium fluoride-induced hypertension and elevated cardiac enzymes in male albino rats

Introduction: Garlic, also known as Allium sativum, has been used for centuries to protect the heart and reduce blood pressure. Objectives: This study aims to evaluate the antihypertensive effects and cardioprotective effects of garlic against the effects of sodium fluoride (NaF) on the blood pressure and heart tissue. Materials and Methods: Thirty adult male Albino rats used in the study. Rats were assigned into three groups consisting of one control group, NaF, and NaF + garlic. After a week of acclimatization, the rats were sedated with ketamine and thoracotomy, blood samples were collected, and heart tissues were dissected. Heart specimens were taken from the left ventricle and stained with hematoxylin and eosin for histological examination. Masson’s trichrome was conducted to examine collagen fibers. Results: The study findings indicated that exposure to NaF leads to an increase in indicators of cellular demise and a decrease in markers of survival in cardiac tissue, suggesting the occurrence of apoptosis. This exposure also disrupts blood lipid profiles, resulting in elevated cholesterol and triglyceride levels and reduced high-density lipid (HDL) levels. Furthermore, it enhances the activity of oxidative stress enzymes while lowering the levels of glutathione (GSH). Conversely, garlic exposure is associated with decreased arterial blood pressure, improved histopathological structure, and reduced serum levels of oxidative stress biomarkers. Conclusion: After thorough evaluation, it has been determined that garlic therapy may hold potential as a treatment for various cardiovascular diseases.

Exploring the predictive value of carotid Doppler ultrasound and clinical features for spinal anesthesia-induced hypotension: a prospective observational study

BackgroundThe induction of spinal anesthesia is often followed by hypotension, which has been associated with post-operative end-organ damage. A timely prediction of spinal anesthesia-induced hypotension (SAIH) paired with appropriate interventions may reduce the risk of adverse outcomes. This study investigated the value of carotid Doppler ultrasound measurements and clinical variables, both individually and combined, to predict SAIH.MethodsAdult patients who were scheduled for elective surgery under spinal anesthesia were included. Carotid ultrasound imaging and baseline vital sign measurements were performed pre-operatively, well in advance of the induction of spinal anesthesia. The occurrence of hypotension was observed for ten minutes after the induction of spinal anesthesia. Logistic regression models studied linear relationships within the derived set of ultrasound and clinical features, and support vector machine models evaluated nonlinear relationships.ResultsA total of 40 patients were included, and 45% of them developed SAIH. The logistic regression models performed better than the support vector machine models. The best-performing logistic regression model combined carotid ultrasound and clinical features and had a sensitivity of 75 [73–81]%, specificity of 75 [71–81]%, AUROC of 0.81 [0.75—0.95], positive predictive value of 75 [65–81]%, negative predictive value of 75 [71–88]% and F1 score of 0.75 [0.71–0.76]. The key features that were shown to predict SAIH were baseline mean arterial pressure, fasting time, ASA class, and weight.ConclusionsCombining carotid Doppler ultrasound measurements and clinical variables can predict the occurrence of SAIH.Trial registrationThe study was retrospectively registered at clinicaltrials.gov (NCT06711289) on 2 December 2024.

Which is more effective in hypertension?: Salt-free diet vs DASH diet.

In the management of hypertension lifestyle changes are recommended along with pharmacological treatment. This randomized controlled intervention study aimed to compare the effects of a dietary approaches to stop hypertension (DASH) diet and a salt-free diet on blood pressure in hypertension patients. This study was conducted with 60 patients with primary hypertension. One group (n = 30) was given an individualized DASH diet, the other group was given a salt-free diet (n = 30), and the participants were followed for 2-months. The patients' blood pressures were monitored daily throughout the study, and their biochemical parameters were monitored at the beginning of the study, in the first and second months. At the end of the second month, there was no difference between the 2 groups in terms of diastolic blood pressure, while the systolic blood pressure (SBP) of the salt-free diet group (121.03 ± 9.73 mm Hg) was statistically significantly lower than the DASH diet group (126.81 ± 8.91 mm Hg) (P = .021). The salt-free diet was more efficient than for lowering SBP. However, the fact that sodium and soluble fiber intakes in the DASH diet group were higher than those in the salt-free diet group at the end of the first month, unlike at the beginning (P < .05), suggests that restricting the salt content of the DASH diet in hypertension could lead to more favorable outcomes on blood pressure, considering its suitability for a healthy diet.

Predictors of dural venous sinus pressure gradient in patients with idiopathic intracranial hypertension.

Growing evidence suggests that venous outflow obstruction from venous sinus stenosis (VSS) may lead to increased intracranial pressure (ICP) in patients with idiopathic intracranial hypertension (IIH). There is a paucity of evidence examining clinical predictors of elevated cerebral venous pressure gradient (CVPG) from VSS in patients with IIH. In this study, the authors examined predictors of elevated CVPG, determined the sensitivity and specificity of common presenting symptoms of IIH, and identified the optimal opening pressure threshold on lumbar puncture (LP) to determine which patients should undergo venous manometry (VM). Patient demographics, presenting symptoms, complications, and opening pressure on LP were collected. Venous pressure gradient across a stenotic dural venous sinus and maximum venous pressure values were recorded from cerebral venograms. VM was considered positive when the CVPG was ≥ 8 mm Hg between two contiguous segments of a dural venous sinus. Sensitivity, specificity, and multivariable logistic regression analysis was performed. The predominant patient population was young (mean age 38.9 years), obese (BMI ≥ 30; 83.8%), and female (95.0%). Sensitivity and specificity for papilledema were 74% and 70% (area under the curve [AUC] 0.71, 95% CI 0.63-0.80), and 70% and 63% (AUC 0.66, 95% CI 0.57-0.75) for pulsatile tinnitus. Vision changes demonstrated a sensitivity of 80% and specificity of 50% (AUC 0.63, 95% CI 0.54-0.72). VSS seen on magnetic resonance venography (MRV) demonstrated a sensitivity of 90% and specificity of 53% (AUC 0.71, 95% CI 0.63-0.79). Youden's index analysis identified an opening pressure ≥ 25 cm H2O on LP (AUC 0.72, 95% CI 0.60-0.83) as an optimal threshold for predicting elevated CVPG. Predictors of elevated CVPG on VM include childbearing age, African American race, papilledema, pulsatile tinnitus, obesity (BMI ≥ 30), focal VSS with unilateral dominance in venous drainage seen on MRV, or an opening pressure on LP ≥ 25 cm H2O.

Dobutamine improves haemodynamics and oxygen delivery in standing and isoflurane-anaesthetised horses.

Dobutamine is a first-line therapy for hypotension in anaesthetised horses, but the effects on haemodynamic parameters in standing and anaesthetised horses are not well studied. To investigate the effects of dobutamine in escalating dosages on haemodynamic performance in awake and anaesthetised horses. Randomised cross-over experimental study. Six healthy adult horses were enrolled, including both standing and isoflurane-anaesthetised experiments with 1-week washout. Heart rate, mean arterial pressure (MAP), central venous pressure, pulmonary arterial pressure, and thermodilution cardiac output (CO) were measured at baseline and at dobutamine infusion rates of 0.5, 1, and 2 mcg/kg/min. Arterial and mixed-venous blood was sampled, and oxygen delivery (DO2), oxygen extraction ratio (O2 ER), and fShunt were calculated. After confirming normal distribution, variables were compared with baseline and between groups using two-factorial ANOVA (alpha = 5%). MAP increased significantly during dobutamine infusion in both groups (Standing 92 ± 8 to 119 ± 8 mmHg, p < 0.001; Anaesthetised 58 ± 12 to 91 ± 16 mmHg, p < 0.001), and was significantly higher in awake versus anaesthetised horses at all time points (p < 0.001). CO increased significantly during dobutamine infusion (Standing 39 ± 5 to 68 ± 5 L/min, p < 0.001; Anaesthetised 21 ± 2 to 38 ± 3 L/min, p < 0.001), and was significantly higher in standing horses (p < 0.001). DO2 (p < 0.001) increased significantly, and O2 ER (p < 0.001) decreased significantly in both groups with dobutamine infusion. FShunt (p = 0.02) decreased significantly during dobutamine infusion in anaesthetised horses. Small sample size; study performed in a lateral recumbency. Dobutamine produces a dose-dependent increase in CO and MAP and improves DO2 under standing and isoflurane-anaesthetised conditions. Dobutamine dosages of 2 mcg/kg/min reach standing baseline MAP and CO.