Arterial Pressure Research Articles

The angiotensin II receptors type 1 and 2 modulate astrocytes and their crosstalk with microglia and neurons in an in vitro model of ischemic stroke

BackgroundAstrocytes are the most abundant cell type of the central nervous system and are fundamentally involved in homeostasis, neuroprotection, and synaptic plasticity. This regulatory function of astrocytes on their neighboring cells in the healthy brain is subject of current research. In the ischemic brain we assume disease specific differences in astrocytic acting. The renin–angiotensin–aldosterone system regulates arterial blood pressure through endothelial cells and perivascular musculature. Moreover, astrocytes express angiotensin II type 1 and 2 receptors. However, their role in astrocytic function has not yet been fully elucidated. We hypothesized that the angiotensin II receptors impact astrocyte function as revealed in an in vitro system mimicking cerebral ischemia.Astrocytes derived from neonatal wistar rats were exposed to telmisartan (angiotensin II type 1 receptor-blocker) or PD123319 (angiotensin II type 2 receptor-blocker) under normal conditions (control) or deprivation from oxygen and glucose. Conditioned medium (CM) of astrocytes was harvested to elucidate astrocyte-mediated indirect effects on microglia and cortical neurons.ResultThe blockade of angiotensin II type 1 receptor by telmisartan increased the survival of astrocytes during ischemic conditions in vitro without affecting their proliferation rate or disturbing their expression of S100A10, a marker of activation. The inhibition of the angiotensin II type 2 receptor pathway by PD123319 resulted in both increased expression of S100A10 and proliferation rate. The CM of telmisartan-treated astrocytes reduced the expression of pro-inflammatory mediators with simultaneous increase of anti-inflammatory markers in microglia. Increased neuronal activity was observed after treatment of neurons with CM of telmisartan- as well as PD123319-stimulated astrocytes.ConclusionData show that angiotensin II receptors have functional relevance for astrocytes that differs in healthy and ischemic conditions and effects surrounding microglia and neuronal activity via secretory signals. Above that, this work emphasizes the strong interference of the different cells in the CNS and that targeting astrocytes might serve as a therapeutic strategy to influence the acting of glia-neuronal network in de- and regenerative context.

The Total Denervation of the Ischemic Kidney Induces Differential Responses in Sodium Transporters' Expression in the Contralateral Kidney in Goldblatt Rats.

The Goldblatt model of hypertension (2K-1C) in rats is characterized by renal sympathetic nerve activity (rSNA). We investigated the effects of unilateral renal denervation of the clipped kidney (DNX) on sodium transporters of the unclipped kidneys and the cardiovascular, autonomic, and renal functions in 2K-1C and control (CTR) rats. The mean arterial pressure (MAP) and rSNA were evaluated in experimental groups. Kidney function and NHE3, NCC, ENaCβ, and ENaCγ protein expressions were assessed. The glomerular filtration rate (GRF) and renal plasma flow were not changed by DNX, but the urinary (CTR: 0.0042 ± 0.001; 2K-1C: 0.014 ± 0.003; DNX: 0.005 ± 0.0013 mL/min/g renal tissue) and filtration fractions (CTR: 0.29 ± 0.02; 2K-1C: 0.51 ± 0.06; DNX: 0.28 ± 0.04 mL/min/g renal tissue) were normalized. The Na+/H+ exchanger (NHE3) was reduced in 2K-1C, and DNX normalized NHE3 (CTR: 100 ± 6; 2K-1C: 44 ± 14, DNX: 84 ± 13%). Conversely, the Na+/Cl- cotransporter (NCC) was increased in 2K-1C and was reduced by DNX (CTR: 94 ± 6; 2K-1C: 144 ± 8; DNX: 60 ± 15%). In conclusion, DNX in Goldblatt rats reduced blood pressure and proteinuria independently of GRF with a distinct regulation of NHE3 and NCC in unclipped kidneys.

Impact of RAAS Receptors and Membrane-Bound Transporter System in the Left Ventricle during the Long-Term Control of Hypertension.

The Renin-Angiotensin-Aldosterone System (RAAS) has been implicated in systemic and neurogenic hypertension. The infusion of RAAS inhibitors blunted arterial pressure and efficacy of use-dependent synaptic transmission in sympathetic ganglia. The current investigation aims to elucidate the impact of RAAS-mediated receptors on left ventricular cardiomyocytes and the role of the sarcolemma-bound carrier system in the heart of the hypertensive transgene model. A significant increase in mRNA and the protein expression for angiotensin II (AngII) receptor subtype-1 (AT1R) was observed in (mREN2)27 transgenic compared to the normotensive rodents. Concurrently, there was an upregulation in AT1R and a downregulation in the MAS1 proto-oncogene protein receptor as well as the AngII subtype-2 receptor in hypertensive rodents. There were modifications in the expressions of sarcolemma Na+-K+-ATPase, Na+-Ca2+ exchanger, and Sarcoendoplasmic Reticulum Calcium ATPase in the transgenic hypertensive model. These observations suggest chronic RAAS activation led to a shift in receptor balance favoring augmented cardiac contractility and disruption in calcium handling through modifications of membrane-bound carrier proteins and blood pressure. The study provides insight into mechanisms underlying RAAS-mediated cardiac dysfunction and highlights the potential value of targeting the protective arm of AngII in hypertension.

Norepinephrine weaning guided by the Hypotension Prediction Index in vasoplegic shock after cardiac surgery: protocol for a single-centre, open-label randomised controlled trial – the NORAHPI study

IntroductionNorepinephrine (NE) is the first-line recommended vasopressor for restoring mean arterial pressure (MAP) in vasoplegic syndrome (vs) following cardiac surgery with cardiopulmonary bypass. However, solely focusing on target MAP values...

Impact of RAAS Receptors and Membrane-Bound Transporter System in the Left Ventricle during the Long-Term Control of Hypertension

The Renin–Angiotensin–Aldosterone System (RAAS) has been implicated in systemic and neurogenic hypertension. The infusion of RAAS inhibitors blunted arterial pressure and efficacy of use-dependent synaptic transmission in sympathetic ganglia. The current investigation aims to elucidate the impact of RAAS-mediated receptors on left ventricular cardiomyocytes and the role of the sarcolemma-bound carrier system in the heart of the hypertensive transgene model. A significant increase in mRNA and the protein expression for angiotensin II (AngII) receptor subtype-1 (AT1R) was observed in (mREN2)27 transgenic compared to the normotensive rodents. Concurrently, there was an upregulation in AT1R and a downregulation in the MAS1 proto-oncogene protein receptor as well as the AngII subtype-2 receptor in hypertensive rodents. There were modifications in the expressions of sarcolemma Na+-K+-ATPase, Na+-Ca2+ exchanger, and Sarcoendoplasmic Reticulum Calcium ATPase in the transgenic hypertensive model. These observations suggest chronic RAAS activation led to a shift in receptor balance favoring augmented cardiac contractility and disruption in calcium handling through modifications of membrane-bound carrier proteins and blood pressure. The study provides insight into mechanisms underlying RAAS-mediated cardiac dysfunction and highlights the potential value of targeting the protective arm of AngII in hypertension.

Ultrasound based estimate of central venous pressure: Are we any closer?

Central venous pressure (CVP) serves as a direct approximation of right atrial pressure and is influenced by factors like total blood volume, venous compliance, cardiac output, and orthostasis. Normal CVP falls within 8-12 mmHg but varies with volume status and venous compliance. Monitoring and managing disturbances in CVP are vital in patients with circulatory shock or fluid disturbances. Elevated CVP can lead to fluid accumulation in the interstitial space, impairing venous return and reducing cardiac preload. While pulmonary artery catheterization and central venous catheter obtained measurements are considered to be more accurate, they carry risk of complications and their usage has not shown clinical improvement. Ultrasound-based assessment of the internal jugular vein (IJV) offers real-time, non-invasive measurement of static and dynamic parameters for estimating CVP. IJV parameters, including diameter and ratio, has demonstrated good correlation with CVP. Despite significant advancements in non-invasive CVP measurement, a reliable tool is yet to be found. Present methods can offer reasonable guidance in assessing CVP, provided their limitations are acknowledged.

The Antihypertensive Effect of Marchin-13 Tang on L-NAME-induced Hypertension in Rats

Marchin-13 Tang is a traditional Mongolian medicine widely used to reduce blood pressure. The study aimed to evaluate the anti-hypertensive effect of Marchin-13 (M-13) Tang in the L-NAME-induced model of hypertension. The biological composition activity of M-13 Tang was examined using the UV spectrophotometric method. The experimental groups induced Hypertension models by L-NAME 40 mg/kg. The concentrations of serum nitric oxide (NO), Angiotensin-Converting Enzyme (ACE), superoxide dismutase (SOD), malondialdehyde (MDA), and catalase (CAT) were measured in M-13 Tang treatment groups by enzyme-linked immunosorbent assay (ELISA). The content of total phenolics was measured at 2.96±0.16%, while flavonoids were found to be present at a level of 1.81±0.1%. The reductions in mean arterial pressure (MAP) were statistically significant. They were observed from day 14 to day 21 after giving M-13 Tang at 90 mg/kg and 180 mg/kg (p<0.01). Moreover, treated with M-13 Tang 90 mg/kg and 180 mg/kg groups, serum levels of NO, SOD, and CAT were significantly (p<0.01) increased compared with the L-NAME (40 mg/kg) group. The levels of MDA and ACE showed a significant decrease in both the Marchin-13 Tang-treated groups compared to the L-NAME group (p<0.05). The results of our study illustrate that Marchin-13 effectively reduced blood pressure by mitigating oxidative stress, enhancing NO production, and decreasing ACE levels in hypertensive rats induced by L-NAME.

Association between Transient-Continuous Hypotension during Mechanical Thrombectomy for Acute Ischemic Stroke and Final Infarct Volume in Patients with Proximal Anterior Circulation Large Vessel Occlusion.

Background/Objectives: Periprocedural blood pressure changes in stroke patients with a large vessel occlusion are a known modifiable risk factor of unfavorable treatment outcomes. We aimed to evaluate the association between pre-revascularization hypotension and the final infarct volume. Methods: In our retrospective analysis, we included 214 consecutive stroke patients with an anterior circulation large vessel occlusion that underwent mechanical thrombectomy under general anesthesia. Noninvasively obtained blood pressure values prior to symptomatic vessel recanalization were analyzed as a predictor of post-treatment infarct size. Linear logistic regression models adjusted for predefined factors were used to investigate the association between blood pressure parameters and the final infarct volume. Results: In our cohort, higher baseline systolic blood pressure (aβ = 8.32, 95% CI 0.93-15.7, p = 0.027), its maximal absolute drop (aβ = 6.98, 95% CI 0.42-13.55, p = 0.037), and >40% mean arterial pressure decrease (aβ = 41.77, CI 95% 1.93-81.61, p = 0.040) were independently associated with higher infarct volumes. Similarly, continuous hypotension measured as intraprocedural cumulative time spent below either 100 mmHg (aβ = 3.50 per 5 min, 95% CI 1.49-5.50, p = 0.001) or 90 mmHg mean arterial pressure (aβ = 2.91 per 5 min, 95% CI 0.74-5.10, p = 0.010) was independently associated with a larger ischemia size. In the subgroup analysis of 151 patients with an M1 middle cerebral artery occlusion, two additional factors were independently associated with a larger ischemia size: systolic blood pressure maximal relative drop and >40% drop from pretreatment value (aβ = 1.36 per 1% lower than baseline, 95% CI 0.04-2.67, p = 0.043, and aβ = 43.01, 95% CI 2.89-83.1, p = 0.036, respectively). No associations between hemodynamic parameters and post-treatment infarct size were observed in the cohort of intracranial internal carotid artery occlusion. Conclusions: In patients with ischemic stroke due to a proximal middle cerebral artery occlusion, higher pre-thrombectomy treatment systolic blood pressure is associated with a larger final infarct size. In patients treated under general anesthesia, hypotension prior to the M1 portion of middle cerebral artery recanalization is independently correlated with the post-treatment infarct volume. In this group, every 5 min spent below the mean arterial pressure threshold of 100 mmHg is associated with a 4 mL increase in ischemia volume on a post-treatment NCCT. No associations between blood pressure and final infarct volume were present in the subgroup of patients with an intracranial internal carotid artery occlusion.

Association between early central venous pressure measurement and all-cause mortality in critically ill patients with heart failure: A cohort of 11,241 patients

BackgroundThe timing of central venous pressure (CVP) measurement may play a crucial role in heart failure management, yet no studies have explored this aspect. MethodsClinical information pertaining to patients in critical condition with a diagnosis of heart failure was retrieved from the MIMIC-IV database. The association between initial measurements of central venous pressure (CVP) and the incidence of mortality from all causes was analyzed using the Cox proportional hazards approach. Subgroup analysis and propensity score matching were conducted for sensitivity analyses. ResultsThis study included 11,241 participants (median age, 75 years; 44.70 % female). Utilizing restricted cubic spline and Kaplan–Meier survival analyses, it was determined that prognostic outcomes were better when CVP was measured within the initial 5-h window. Multivariate-adjusted 1-year (HR: 0.69; 95 % CI: 0.61–0.77), 90-day (HR: 0.70; 95 % CI: 0.62–0.80), and 30-day (HR: 0.67; 95 % CI: 0.57–0.78) all-cause mortalities were significantly lower in patients with early CVP measurement, which was proved robustly in subgroup analysis. Subsequent to the application of propensity score matching, a cohort of 1536 matched pairs was established, with the observed mortality rates continuing to be significantly lower among participants who underwent early CVP assessment. ConclusionsEarly CVP measurement (within 5 h) demonstrated an independent correlation with a decrease in both immediate and extended all-cause mortality rates among patients in critical condition suffering from heart failure.

The impact of interval training on adiponectin to leptin ratios and on blood pressures in severely obese adolescent girls: A randomized controlled trial

ABSTRACT Interval-training is widely implemented among populations with obesity to decrease metabolic-disorders; however, high-intensity-interval-training (HIIT) has rarely been studied in severely obese adolescent girls. Therefore, the aim of this study was to compare the effects of 8 weeks of (HIIT) or moderate-intensity interval-training (MIIT), on cardiometabolic risk factors and hormonal-ratios in severely-obese-girls. For this aim, 35 female-adolescents (14.4 ± 1.4 years) were assigned randomly into HIIT (n = 12) and MIIT (n = 12), groups and a control group (CG, n = 11). Both training groups significantly improved (p < 0.05): the body-mass, body-mass-index (BMIp95), body-fat (BF%), waist-circumference (WC), mean-arterial-pressure (MAP), with a slight increase in the HIIT group. However, HIIT induced greater improvements on the maximal oxygen uptake (VO2MAX) and the speed related (24.7 and 11.8%) compared to MIIT. Higher improvements occurred in HIIT group related to leptin and adiponectin concentrations and the A/L ratio at (p < 0.001). In conclusion, the findings indicate that both HIIT and MIIT can positively influence body composition and cardio-respiratory fitness. Given the significant correlation noted between the A/L ratio, BMIp95, BF%, and MAP post-HIIT, this training modality may be considered a more advantageous approach over MIIT for mitigating cardio-metabolic issues in severely obese adolescent girls.

Effects of Acute Beetroot Juice Supplementation and Exercise on Cardiovascular Function in Healthy Men in Preliminary Study: A Randomized, Double-Blinded, Placebo-Controlled, and Crossover Trial.

Nitrate-rich beetroot juice (NRBRJ) can potentially enhance exercise performance and improve cardiovascular function, leading to an increased use of NRBRJ over the years. However, the combined effects of NRBRJ supplementation and exercise on cardiovascular function remain unclear. Therefore, this study compared cardiovascular function responses to submaximal exercise with either placebo (PLA) or NRBRJ supplementation in healthy men. Twelve healthy men (aged 25.2 ± 2.3 years) completed the 30-min submaximal cycle ergometer exercise trials corresponding to 70% maximal heart rate (HRmax) with either PLA or NRBRJ supplementation in a random order. The mean exercise load, heart rate (HR), stroke volume (SV), cardiac output (CO), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and total peripheral resistance (TPR) were measured during exercise. The brachial-ankle pulse wave velocity (baPWV) and flow-mediated dilation (FMD) were measured before and after exercise. NRBRJ supplementation was more effective than PLA in increasing the mean exercise load and decreasing DBP and MAP during submaximal exercise. Furthermore, baPWV decreased in the NRBRJ trial and was considerably lower after exercise in the NRBRJ-supplemented group than in the PLA-supplemented group. FMD significantly increased in the PLA and NRBRJ trials; however, NRBRJ supplementation demonstrated a significantly higher FMD before and after exercise than PLA supplementation. In conclusion, acute NRBRJ supplementation and exercise were more effective than PLA supplementation and exercise in improving aerobic exercise capacity and cardiovascular function in healthy men.

Mediating effects of BMI on the association between DNA methylation regions and 24-h blood pressure in African Americans.

DNA methylation is an important epigenetic mechanism that may influence blood pressure (BP) regulation and hypertension risk. Obesity, a major lifestyle factor associated with hypertension, may interact with DNA methylation to affect BP. However, the indirect effect of DNA methylation on 24-hBP measurements mediated by obesity-related phenotypes such as BMI has not been investigated. Causal mediation analysis was applied to examine the mediating role of BMI in the relation between DNA methylation and 24-h BP phenotypes, including SBP, DBP and mean arterial blood pressure (MAP), in 281 African American participants. Analysis of 38 215 DNA methylation regions, derived from 1,549,368 CpG sites across the genome, identified up to 138 methylation regions that were significantly associated with 24-h BP measurements through BMI mediation. Among them, 38 (19.2%) methylation regions were concurrently associated with SBP, DBP and MAP. Genes associated with BMI-mediated methylation regions are potentially involved in various chronic diseases such as coronary artery disease and renal disease, which are often caused or exacerbated by hypertension. Notably, three genes (CDH4, NOTCH1 and COLGALT1) showed both direct associations with 24-h BP measurements and indirect associations through BMI after adjusting for age and sex covariates. Our findings suggest that DNA methylation may contribute to the regulation of 24-h BP in African Americans both directly and indirectly through BMI mediation.

Effects of different nitric oxide synthases on pulmonary and systemic hemodynamics in hypoxic stress rat model.

Under hypoxia, exaggerated compensatory responses may lead to acute mountain sickness. The excessive vasodilatory effect of nitric oxide (NO) can lower the hypoxic pulmonary vasoconstriction (HPV) and peripheral blood pressure. While NO is catalyzed by various nitric oxide synthase (NOS) isoforms, the regulatory roles of these types in the hemodynamics of pulmonary and systemic circulation in living hypoxic animals remain unclear. Therefore, this study aims to investigate the regulatory effects of different NOS isoforms on pulmonary and systemic circulation in hypoxic rats by employing selective NOS inhibitors and continuously monitoring hemodynamic parameters of both pulmonary and systemic circulation. Forty healthy male Sprague-Dawley (SD) rats were randomly divided into four groups: Control group (NG-nitro-D-arginine methyl ester, D-NAME), L-NAME group (non-selective NOS inhibitor, NG-nitro-L-arginine methyl ester), AG group (inducible NOS inhibitor group, aminoguanidine), and 7-NI group (neurological NOS inhibitor, 7-nitroindazole). Hemodynamic parameters of rats were monitored for 10 min after inhibitor administration and 5 min after induction of hypoxia [15% O2, 2200 m a. sl., 582 mmHg (76.5 kPa), Xining, China] using the real-time dynamic monitoring model for pulmonary and systemic circulation hemodynamics invivo. Serum NO concentrations and blood gas analysis were measured. Under normoxia, mean arterial pressure and total peripheral vascular resistance were increased, and ascending aortic blood flow and serum NO concentration were decreased in the L-NAME and AG groups. During hypoxia, pulmonary arterial pressure and pulmonary vascular resistance were significantly increased in the L-NAME and AG groups. This compensatory mechanism activated by inducible NOS and endothelial NOS effectively counteracts the pulmonary hemodynamic changes induced by hypoxic stress. It plays a crucial role in alleviating hypoxia-induced pulmonary arterial hypertension.

Transcriptomic profiling highlights cell proliferation in the progression of experimental pulmonary hypertension in rats

Pulmonary arterial hypertension (PAH) is a progressive disease characterized by pulmonary vascular remolding and occlusion, leading to the elevated pulmonary arterial pressures, right ventricular hypertrophy, and eventual heart failure if left untreated. Understanding the molecular mechanisms underlying the development and progression of pulmonary hypertension (PH) is crucial for devising efficient therapeutic approaches for the disease. Lung homogenates were collected weekly and underwent RNA-sequencing in the monocrotaline (MCT)-induced PH rat model to explore genes associated with PH progression. Statistical analyses revealed 1038, 1244, and 3125 significantly altered genes (P < 0.05, abs (log2fold change) > log21.5) between control and MCT-exposed rats during the first, second, and third week, respectively. Pathway enrichment analyses revealed involvement of cell cycle and innate immune system for the upregulated genes, GPCR and VEGF signaling for the downregulated genes. Furthermore, qRT-PCR validated upregulation of representative genes associated with cell cycle including Cdc25c (cell division cycle 25C), Cdc45, Top2a (topoisomerase IIα), Ccna2 (cyclin A2) and Ccnb1 (cyclin B1). Western blot and immunofluorescence analysis confirmed increases in PCNA, Ccna2, Top2a, along with other proliferation markers in the lung tissue of MCT-treated rats. In summary, RNA sequencing data highlights the significance of cell proliferation in progression of rodent PH.

Peri-operative fever and LVAD: SIRS or impaired right ventricular strain?

An inflammatory milieu after left ventricular assist device (LVAD) implantation is associated with multi-organ dysfunction and pre-operative heightened inflammatory state is associated with right ventricular failure after LVAD implantation. We performed a retrospective analysis of 30 LVAD patients in our institution within the last 2 years for the development of fever and compared them to 30 non-LVAD open-heart surgery patients. Our results suggest that patients undergoing LVAD implantation are more likely to develop fever in the immediate post-operative period compared to other open-heart surgeries. This is independent of pharmacological treatment, age, or ethnical background. Females and obese patients were more likely to develop fever. Patients with right ventricular dysfunction, as demonstrated by elevated central venous pressure (CVP), had the strongest correlation with fever development. These results pose the question if there is a systemic inflammatory response-like phenomenon driven by increased right ventricular dysfunction.

The Effects of Head Elevation on Intracranial Pressure, Cerebral Perfusion Pressure, and Cerebral Oxygenation Among Patients with Acute Brain Injury: A Systematic Review and Meta-Analysis.

Head elevation is recommended as a tier zero measure to decrease high intracranial pressure (ICP) in neurocritical patients. However, its quantitative effects on cerebral perfusion pressure (CPP), jugular bulb oxygen saturation (SjvO2), brain tissue partial pressure of oxygen (PbtO2), and arteriovenous difference of oxygen (AVDO2) are uncertain. Our objective was to evaluate the effects of head elevation on ICP, CPP, SjvO2, PbtO2, and AVDO2 among patients with acute brain injury. We conducted a systematic review and meta-analysis on PubMed, Scopus, and Cochrane Library of studies comparing the effects of different degrees of head elevation on ICP, CPP, SjvO2, PbtO2, and AVDO2. A total of 25 articles were included in the systematic review. Of these, 16 provided quantitative data regarding outcomes of interest and underwent meta-analyses. The mean ICP of patients with acute brain injury was lower in group with 30° of head elevation than in the supine position group (mean difference [MD] - 5.58mm Hg; 95% confidence interval [CI] - 6.74 to - 4.41mm Hg; p < 0.00001). The only comparison in which a greater degree of head elevation did not significantly reduce the ICP was 45° vs. 30°. The mean CPP remained similar between 30° of head elevation and supine position (MD - 2.48mm Hg; 95% CI - 5.69 to 0.73mm Hg; p = 0.13). Similar findings were observed in all other comparisons. The mean SjvO2 was similar between the 30° of head elevation and supine position groups (MD 0.32%; 95% CI - 1.67% to 2.32%; p = 0.75), as was the mean PbtO2 (MD - 1.50mm Hg; 95% CI - 4.62 to 1.62mm Hg; p = 0.36), and the mean AVDO2 (MD 0.06µmol/L; 95% CI - 0.20 to 0.32µmol/L; p = 0.65).The mean ICP of patients with traumatic brain injury was also lower with 30° of head elevation when compared to the supine position. There was no difference in the mean values of mean arterial pressure, CPP, SjvO2, and PbtO2 between these groups. Increasing degrees of head elevation were associated, in general, with a lower ICP, whereas CPP and brain oxygenation parameters remained unchanged. The severe traumatic brain injury subanalysis found similar results.

MiRNA-122 as a biomarker for insulin resistance and risk of cardiovascular diseases in obese children

BackgroundObesity in children is a major worldwide concern that has several negative health consequences in both the short and long term. The objective of this study was to evaluate the expression level of microRNA-122 in obese Egyptian children and investigate its potential associations with insulin resistance and cardiovascular diseases. MethodsThe study included 70 obese and 30 age-matched normal-weight control children. Anthropometric measurements, systolic, and diastolic blood pressures were assessed, and quantitative real-time polymerase chain reaction was used to determine the expression of circulating microRNA-122. Pancreatic beta cell function (HOMA2-%B), insulin resistance (HOMA2-IR), and insulin sensitivity (HOMA2-%S) was assessed by the homeostasis model assessment version 2 (HOMA2). McAuley index and single-point insulin sensitivity estimator (SPISE) was used to further evaluate insulin sensitivity. Levels of serum biochemical parameters were measured. ResultsThe obese group showed significantly higher levels of microRNA-122, fasting blood glucose, triglycerides, total cholesterol, LDL, VLDL, non-HDL cholesterol, cardiac risk ratios, atherogenic coefficient, atherosclerotic index, insulin levels, HOMA2-%B, and HOMA2-IR compared to the control group. In obese children, microRNA-122 exhibited a significant negative correlation with HDL while a significant positive correlation with the cardiac risk ratio 1 and the atherogenic coefficient. MicroRNA-122 had predictive ability for insulin resistance and cardiovascular diseases risk in obese children. However, a significant decrease in HDL levels, HOMA2-%S, McAuley, and SPISE insulin sensitivity indices was found in obese children. ConclusionsModifications in blood levels of microRNA-122 in obese children may indicate a possible role in the etiology of childhood obesity and its associated consequences. As a result, it could function as a preliminary biomarker and potential indicator of further metabolic diseases.

Current State of Ventilator Setting and Their Relationship with Mortality Rate in Patients under Mechanical Ventilation: A Cross-Sectional Study

Background: Given the importance of implementing lung protective strategies to prevent lung injury caused by ventilators and death of patients, it is necessary to monitor the current condition of hospitals and examine the relationship between the parameters set on the ventilators and patient mortality. This study conducted to determine the current state of ventilator setting and their relationship with mortality rate in patients under mechanical ventilation: a cross-sectional study. Methods: This is a cross-sectional study that was conducted between June to December 2020 in one of the hospitals affiliated to Tehran University of Medical Sciences. The initial tidal volume set on the ventilator was recorded for 304 patients under mechanical ventilation and then, their heights were measured and their tidal volumes were determined based on the standard formula. Other parameters set on the ventilator as well as systolic and diastolic blood pressures of patients were also recorded and their survival rate was investigated. The data was analyzed by SPSS software, using descriptive statistics and logistic regression model. Results: Among patients, who were under mechanical ventilation, 77.6% were hospitalized in intensive care units and the rest were hospitalized in general wards. The mean adjusted tidal volume for patients was 472.91 ± 32.13 ml. The mean peak inspiratory pressure and plateau pressure were 28.00±6.98 and 13.88±4.93 CmH2O, respectively. Also, 37.2% of patients died during the hospitalization. The results of adjusted odds ratio based on multivariate logistic regression model for predictors of mortality rate showed that the variables of patients' age [OR=1.040 (1.019-1.062)], the hospital’s general ward in comparison with the ICU [OR=11.379 (5.130-25.240)] and the peak inspiratory pressure [OR=1.072 (1.007-1.141)] had a direct and significant relationship with mortality rate (in all cases P&lt;0.05). Meanwhile, the plateau pressure [OR=0.886 (0.808 -0.972)] had an inverse and significant relationship with mortality rate (P&lt;0.05). Conclusion: Despite the recommendations regarding lung protective strategies, in some cases, some parameters set in the ventilator are outside the recommended levels, which can effect on patients mortality. So monitoring and controlling the implementation of lung protective strategies and paying attention to controlling pressures set on the ventilator are among measures that should be taken in medical centers in order to prevent lung injuries and maintain patient safety.

Hemodynamic comparison between minimally invasive and conventional approaches in off-pump coronary artery bypass grafting: A randomized controlled trial

This study aimed to investigate the hypothesis that minimally invasive coronary artery bypass grafting (CABG) induces fewer hemodynamic alterations compared to conventional approaches, attributing this to reduced heart rotation during grafting. Given the critical role of hemodynamic stability in patient outcomes and the growing popularity of minimally invasive CABG, we sought to assess and compare the hemodynamic responses during left anterior descending artery grafting. This randomized controlled trial was conducted at a tertiary center, enrolling a total of 60 patients, with 30 in each group. Parameters such as heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), and perfusion index (PI) were measured at baseline, after octopus stabilization prior to grafting, at 3 minutes during grafting, and at the end of grafting. Additionally, serum lactate levels were assessed at baseline and upon completion of grafting. The baseline HR was comparable between the groups. However, the trends in HR revealed a significant increase in the conventional group after octopus stabilization (P value = 0.0038), at 3 minutes post-initiation of grafting (p &amp;#60; 0.001), and at the completion of grafting (P value = 0.001). MAP and CVP remained comparable at all time points. Notably, PI showed a significant increase in the conventional group during positioning (after octopus stabilization), at 3 minutes post-initiation of grafting, and at the completion of grafting. There were no significant differences in lactate levels between the groups. Despite no significant differences in MAP, CVP, and lactate levels, our findings highlight significant disparities in HR and PI between the two groups. We conclude that the observed variations in heart rate may be attributed to minimal positional changes in the minimally invasive approach compared to the conventional approach.

Unexpected internal jugular vein (IJV) valve encountered during Central Venous Pressure (CVP) Catheter insertion: clinical snapshot

Unexpected internal jugular vein (IJV) valve encountered during Central Venous Pressure (CVP) Catheter insertion: clinical snapshot