Difference In Systolic Pressure Research Articles

P2603Impaired right ventricular force-frequency relationship in patients with heart failure is associated with diastolic dysfunction and worse functional capacity

Abstract Background The force-frequency relationship (FFR) is an important intrinsic regulatory mechanism of cardiac contractility, related to changes in Ca2+ availability within the myocardial cell. In normal hearts this relationship is positive, so that an increase in contractile force is induced by elevation of the stimulation frequency. In heart failure (HF), the force-frequency relationship can be markedly depressed, but most studies focused their attention on left ventricular function and little is known about the right ventricle (RV). Purpose We aimed at performing a comprehensive analysis of HF phenotypes based on the right ventricular force-frequency relationship. To this purpose we stratified a large cohort of HF patients using the relationship between RV function (assessed by tricuspid annular plane systolic excursion, TAPSE) and heart rate (HR) during a symptom-limited cardiopulmonary exercise test (CPET). Material and methods We prospectively enrolled 184 HF patients, irrespective of their LV ejection fraction. We performed a stress echocardiographic evaluation using a tiltable cycle ergometer, recording standard images to assess LV systolic, diastolic, and valvular function. We divided patients in 2 groups using the slope of the linear relationship between TAPSE and HR at rest and at peak exercise, as follows: slope ≥0,01 for “positive” FFR, slope <0,01 for “flat or negative” FFR. Differences between groups were tested using unpaired t-tests for continuous variables (or Mann-Whitney U tests, when appropriate) and chi-square tests for categorical variables. Results 55 patients had a “flat or negative” FFR: they were slighty older (age 70±10 vs. 66±12; p=0,036), but the 2 groups had similar clinical characteristics such as hypertension, diabetes or COPD rate. Patients with a “flat or negative” FFR had a worse diastolic function, with higher left ventricular filling pressures (E/e' ratio 24±10 vs. 19±11 p=0,022) and left atrial volume (LAVi 55±29 ml/m2 vs. 44±20 ml/m2; p=0,009). No differences in LV ejection fraction, mitral regurgitation and pulmonary artery systolic pressure were observed between the groups. TAPSE at rest was similar between the groups (18±5 mm vs. 18±4 mm; p=0,553) but significantly different at peak exercise (16±4 mm vs. 22±5 mm; p<0,001). Average peak heart rate was similar in the 2 groups. Patients with a “flat or negative” FFR exhibited a significantly lower peak VO2 (11,6±3,0 ml/min/kg vs. 13,5±4,4 ml/min/kg; p=0,003), whereas they had a higher VE/VCO2 slope (35,1±9,6 vs. 32,3±8,2 p=0,05). RV Force-Frequency relationship Conclusion The “flat or negative” right ventricular force-frequency relationship identifies a peculiar phenotype, with a higher grade of diastolic dysfunction and an impaired exercise capacity. The inability to adapt right ventricular contractility with increasing heart rate seems not related to RV afterload (similar PASP increase) but rather to an intrinsic failure of the right heart.

Effect of low-dose dopamine on depression score in patients with heart failure

Objective. This study aimed to assess the effects of low-dose dopamine on patients with depression in the intensive coronary unit. Methods: Relatives of 43 ICU patients enrolled in the study. Sociodemographic characteristics of patients and their families recorded. Patients evaluated basal echocardiographic and biochemical values measured in the patient group. The Beck Anxiety and Depression Scale was used to assess anxiety and depression. The assessment performed by Beck scale at the 1stand 24th hour. Results: The final study population consisted of 42 patients hospitalized with heart failure. Mean patient age was 67.5 ± 12.6 years. Average EF was 23.5% ± 8.7% and mean ProBNP was 6343.76 pg/mL in our study population. Changes of before and after dopamine treatment in depression score of heart failure patients was showed significantly (before value: 18.95 ± 9.89; after value: 17.29 ± 10.30, p < 0.001) however systolic and diastolic pressure difference was not significant. Conclusion: Depression increased mortality and hospitalization in patients with heart failure. Therefore, it is an essential trial because of low-dose dopamine improve depression score in intensive care patients. However, prospective studies were needed to assess the long-term efficacy of dopamine.

Influence of Internet health management platform on improving self-management ability of hypertensive patients during pregnancy

Objective To explore the influence of Internet health management platform on blood pressure control and self-management of hypertensive patients during pregnancy. Methods A total of 66 patients with gestational hypertension who were hospitalized for delivery were randomly divided into the control group with 32 cases and the study group with 34 cases.Patients in the control group received routine education at discharge, followed up by telephone and community visits after discharge. After the patients in the study group were discharged from the hospital, they used the Internet health management platform-pregnancy treasure APP for knowledge education, targeted guidance and regular follow-up. Blood pressure control after discharge and disease self-management ability were compared between the two groups. Results There was no significant difference in systolic and diastolic blood pressure before discharge between the two groups(P>0.05). The systolic blood pressure and diastolic blood pressure in the study group were lower than those in the control group, and the differences were statistically significant(P 0.05). The scores of medication management, diet management, work and rest management were higher in the study group than those in the control group, and the differences were statistically significant(P<0.05). Conclusion The Internet health management platform can effectively control the blood pressure level of patients and improve the self-management ability of hypertensive patients during pregnancy. Key words: Internet; Pregnancy-induced hypertension; Self-management

Trends in the Incidence of Arterial Hypertension and its Association with 24-Hour Shift Work in the Enterprises of the Circumpolar Region

Work in the Arctic and a circumpolar region is associated with great risks for workers. In these regions there are a cold, strong wind, darkness during the polar night, constant light in the summer during the polar day and other factors. As a rule, the majority of employees works in shifts. The company organizes a 24-hour work schedule in shifts. Adverse weather conditions are superimposed on working conditions on shifts and cause nervous tension for workers. Nervous breakdowns can cause an exacerbation of cardiovascular diseases. We assumed that during shift work in the circumpolar region workers develop Arterial Hypertension. During the year we have been examining 2 groups of employees of a mining enterprise: 697 employees who worked 15/15 days in shifts, including night shifts, and 768 employees who worked in 5/2 days at 8-hour working day. Statistical processing of the initial data showed there are statistically significant differences in systolic pressure between people having two various working conditions. These differences have not been found for diastolic pressure.

Periprocedural and Long-Term Outcomes of Stent Implantation for De Novo Subclavian Artery Disease

The purpose of the current study was to investigate the periprocedural and long-term outcomes of stent implantation for de novo subclavian artery (SCA) disease. We retrospectively investigated consecutive patients with de novo SCA lesions undergoing elective endovascular therapy procedures at our center between April 2004 and September 2015. All patients were included in the analyses of periprocedural outcomes, including procedural and clinical success. Subsequently, patients who completed the clinical follow-up and were assessed with brachial systolic pressure differences between the diseased and the contralateral arms, or angiographic stenosis, after stent implantation with procedural success were included in the analyses of long-term outcomes, including primary patency. There were 62 patients (median 71.0 years, interquartile range 65.3-76.0 years; 45 men) with 62 de novo SCA lesions included in the analyses of periprocedural outcomes. There were 46 stenoses (74.2%) and 16 occlusions (25.8%). Our results indicated high procedural success rates for overall (95.2%), stenotic (97.8%), and occlusive (87.5%) lesions. Similarly, high clinical success rates were observed for overall (91.9%), stenotic (93.5%), and occlusive (87.5%) lesions. The median follow-up time was 6.0 years (interquartile range, 2.6-8.3 years). There were 48 patients with 48 de novo SCA lesions included in the analyses of long-term outcomes. Primary patency estimates were 97.7% (1 year), 97.7% (3 years), 93.1% (5 years), and 87.6% (7 years). Also, we observed a high estimate for freedom from reintervention for the target vessel (93.8%). Stent implantation for de novo SCA disease can be performed successfully and safely with favorable periprocedural and long-term outcomes.

Ambulatory blood pressure monitoring in children suffering from orthostatic hypertension

BackgroundIt is particularly important to utilize appropriate blood pressure measurement methods to evaluate the changes of orthostatic hypertension (OHT) for children, and this study was designed to analyze the blood pressure type in OHT children with 24 h semiautomatic ambulatory blood pressure monitoring.MethodsChildren who were diagnosed by head-up tilt table test as OHT patients (OHT group) and treated or hospitalized in the syncope specialist outpatient unit of the Second Xiangya Hospital of Central South University mainly for syncope or pre-syncope with unknown causes during the October, 2009 to September, 2013 were recruited in the study. Healthy children that came to the hospital for physical examination at the same time period according to age and sex were matched as control group. Semiautomatic ambulatory blood pressure monitoring of every child was recorded. The differences of daytime systolic (diastolic) pressure and night systolic (diastolic) pressure were calculated, and the average systolic pressure and diastolic pressure of the entire day, daytime and night were also calculated, respectively.ResultsThere were 23 boys and 17 girls in OHT group, aging (11.5 ± 1.9) years. There were 22 boys and 18 girls in the control group, aged (10.6 ± 2.4) years. The difference of daytime systolic pressure and night systolic pressure of the control group was higher than that of OHT group, while the average systolic pressure of the whole day, the average diastolic pressure of the whole day, the daytime average systolic pressure, the daytime average diastolic pressure, the night average systolic pressure and the night average diastolic pressure were higher than that of the control group (P > 0.05). The difference of daytime diastolic pressure and night diastolic pressure of the control group was higher than that of OHT group (P > 0.05). Most children of the OTH group had non-dipper blood pressure type (72.5%), while most children of the control group had a dipper blood pressure type (55.0%). In addition, the time domain SDNN and SDANN in the OHT group were higher than those in the control group (P < 0.01). And, the indicators including TP, ULF, VLF, and LF/HF were higher in the OHT group, when compared with control group (P < 0.01). Besides, in terms of subgroup analysis within the OHT group, the age difference between boys and girls was not statistically significant (P > 0.05). When compared with grils, the time domain SDNN increased (P = 0.003), and the frequency index TP, ULF, and VLF increased in boy group (P < 0.05).ConclusionOHT Children’s autonomic nervous system showed dysfunction, and differences of systolic blood pressure between day and night were much lower than those of healthy children, and the main blood type was non-dipper blood pressure with circadian rhythm disappearing.

Blood Pressure and Its Association with Gender, Body Mass Index, Smoking, and Family History among University Students.

Hypertension is one of the major risk factors associated with cardiovascular diseases. In this study, we will assess the frequency of hypertension among healthy university students and its association with gender, body mass index, smoking, and family history of both hypertension and cardiovascular diseases. We screened healthy university students ranging from 18 to 26 years of age. For each participant, we performed blood pressure measurements using a previously validated device and obtained demographic data, body mass index (BMI), smoking status, and family history of both hypertension and cardiovascular diseases. Out of the total number of 505 participants included in this study, 35.2% have blood pressure between 130/80 and 139/89, and 13.5% have blood pressure of more than 140/90. We found significant gender differences in both systolic pressure (p = 0.003) with mean difference = 18.08 mmHg (CI: 16.13 to 19.9) and diastolic pressure (p = 0.011) with mean difference = 3.6 mmHg (CI: 2.06 to 5.14), higher in males than in females. Upon comparing the mean difference in both systolic and diastolic blood pressure with BMI, we found significant differences in both systolic (p < 0.001) and diastolic (p = 0.002) blood pressure. We also found that smokers have significantly (p = 0.025) higher systolic blood pressure (mean difference = 4.2 mmHg, CI: 3.2 mmHg to 8.8 mmHg), but no significant difference for diastolic blood pressure (p = 0.386), compared to nonsmokers. First-degree family history of both hypertension and cardiovascular diseases affected systolic but not diastolic blood pressure. Taking into account the adverse short- and long-term effect of hypertension, we recommend adopting an awareness program highlighting the importance of screening blood pressure in young adolescent populations, keeping in mind that both high BMI and smoking are important modifiable factors.

Development and Testing of a Novel Anaesthesia Induction/Ventilation Protocol for Patients With Cardiogenic Shock Complicating Acute Myocardial Infarction

BackgroundCardiogenic shock is a life-threatening condition and patients might require rapid sequence induction (RSI) and mechanical ventilation. In this study, we evaluated a new RSI/mechanical ventilation protocol in patients with acute myocardial infarction complicated by cardiogenic shock. MethodsWe included consecutive adult patients who were transferred to the emergency department. The RSI protocol included 5 phases: preoxygenation, pretreatment, induction/paralysis, intubation, and mechanical ventilation (PPIIM). A posteriori, we selected historical patients managed with standard RSI as a control group. The primary outcome was hemodynamic derangement or hypoxemia from enrollment until intensive care unit (ICU) admission. ResultsWe studied 31 consecutive patients who were intubated using the PPIIM protocol and 22 historical controls. We found significant differences in systolic (85.32 ± 4.23 vs 71.72 ± 7.98 mm Hg; P < 0.0001), diastolic (58.84 ± 5.84 vs 39.05 ± 5.63 mm Hg; P < 0.0001), and mean arterial pressure (67.71 ± 4.90 vs 49.90 ± 5.66 mm Hg; P < 0.0001), as well as in partial pressure of oxygen (85.80 ± 19.82 vs 164.73 ± 43.07 mm Hg; P < 0.0001) between the PPIIM and control group at 5 minutes of automated ventilation. Also, statistically significant differences were observed in diastolic (59.74 ± 4.93 vs 47.86 ± 11.47 mm Hg; P < 0.0001) and mean arterial pressure (68.65 ± 4.10 vs 60.23 ± 11.67 mm Hg; P < 0.0001), as well as in partial pressure of oxygen (119.84 ± 50.57 vs 179.50 ± 42.17 mm Hg; P < 0.0001), and partial pressure of carbon dioxide (39.81 ± 10.60 vs 31.00 ± 9.30 mm Hg; P = 0.003) between the 2 groups at ICU admission. Compared with the control group, with PPIIM more patients survived to ICU admission (100% vs 77%) and hospital discharge (71% vs 31.8%), as well as at 90 days (51.6% vs 18.2%), and at 180 days (38.7% vs 13.6%). ConclusionsThe PPIIM protocol allows safe intubation of acute myocardial infarction patients with cardiogenic shock and improves hemodynamic and oxygenation parameters.

The effect of WeChat+ family centered health intervention on the self-efficacy of elderly hypertensive patients in general clinic

Objective To investigate the influence of WeChat+ family centered health intervention on the self-efficacy of elderly hypertensive patients in General clinic. Methods A total of 102 elderly hypertensive patients aged≥60 years in General clinic from February 2017 to July 2017 were enrolled. They were divided into experimental group and control group with the table of random number, with 51 cases in each group. The experimental group used the WeChat+ family centered health intervention model, while the control group adopted the traditional health education model. The changes of blood pressure and self-efficacy were evaluated before intervention, 3 months and 6 months after intervention respectively. Results There were no statistic significant difference in blood pressure and self-efficacy total score between the two groups before intervention(P>0.05). At 3 months after intervention, the blood pressure (systolic pressure/diastolic pressure) of the patients were (144.20±4.60), (80.00±5.00) mmHg(1 mmHg=0.133 kPa) in the experimental group, those of which were (154.20±7.16), (87.00±3.81) mmHg in the control group, the differences were statistically significant (t=-2.628,-2.490, P<0.05). At 6 months after intervention, the blood pressure (systolic pressure/diastolic pressure) of the patients were (141.60±6.43), (76.00±4.85) mmHg in the experimental group, those of which were (151.60±5.94), (85.40±4.56) mmHg in the control group, the differences were statistically significant (t=-2.555,-3.158, P<0.05). There were differences in systolic and diastolic pressure in patients with different groups at different time, and the differences were statistically significant(F=18.668, 18.174, P<0.01). The total score of self-efficacy at 3 months and 6 months after intervention was (30.14±0.43), (32.56±0.23) points in the experimental group and (28.14±0.15), (29.40±0.19) points in the control group, the difference was statistically significant(t=9.736, 23.819, P<0.05). The differences in the total score of patients′ self-efficacy in different groups at different time had statistically significance (F=2 631.551, P<0.01). Conclusions The WeChat+ family centered health intervention model can significantly improve the self-efficacy of the elderly patients with high blood pressure in the General clinic. Key words: Aged; Hypertension; Health management; Self-efficacy; General medicine

COMPARATIVE EVALUATION OF ACCURACY OF RECORDING BLOOD PRESSURE EITHER BY AUTOMATED OSCILLOMETRIC METHOD OR BY SPHYGMOMANOMETER IN BOTH NORMOTENSIVE AND HYPERTENSIVE PATIENTS - A PROSPECTIVE OBSERVATIONAL STUDY

Objectives: Automatic devices based on oscillometric principle are widely used for the estimation of blood pressure (BP). Mercury sphygmomanometer mean systolic BP (MSBP) and its derived cuff pressure are the traditional mode of estimation which is a validated and authenticated procedure. Automated machines using oscillometric method are slowly replacing the conventional technique. This study was done to compare the BP recorded by the mercury sphygmomanometer MSBP and the automated technique using oscillometric method automated office BP (AOBP).Methods: Two hundred subjects aged 40–65 years with mid-arm circumference 27–34 cm were recruited. MSBP and AOBP were recorded adhering to guidelines given by the American Heart Association Joint National Committee. The subjects were divided into two groups as normotensive (Group 1) and hypertensive (Group 2), and statistical analysis was performed.Results: The mean systolic and diastolic pressures estimated by oscillometric method and sphygmomanometer were calculated and compared with each other by paired t-test separately for Groups 1 and 2. In mormotensives (Group 1), the mean systolic pressure MSBP was 114.21±7.5 mmHg and AOBP was 118.24±11.0 mmHg. The mean diastolic MSBP was 72.1±3.5 mmHg and AOBP was 76.4±1.2 mmHg. Subjects of Group 2 (hypertensive) showed mean systolic pressure MSBP of 144.42±18.5 mm Hg and AOBP of 159.74±22 mmHg. The mean diastolic MSBP was 87.2±9.5 mmHg and AOBP was 96.9±9.2 mmHg. In Group 1, the difference was statistically not significant, while in Group 2, comparison by paired t-test showed a mean difference of systolic pressure by 15.32±1.25 (p&lt;0.005), and mean difference of diastolic pressure by 8.9±5.8 (p&lt;0.005).Conclusion: Hence, we conclude that oscillometric pressure recordings by the automated device are closer to manual measurements in normotensives but showed a significant high value in hypertensives. We suggest caution in treating hypertensives with values derived from automated machines only.

Labetalol o alfa-metildopa oral en el tratamiento de la hipertensión severa en preeclámpticas

Objetivo. Comparar la eficacia del labetalol oral con alfa-metildopa oral en el tratamiento de la hipertensión severa en preeclámpticas. Diseño. Estudio de casos y controles. Institución. Hospital Central “Dr. Urquinaona”, Maracaibo, Venezuela. Participantes. 200 preeclámpticas que fueron asignadas al azar para ser tratadas con labetalol oral (grupo A) o con alfa-metildopa oral (grupo B). Principales medidas de resultado. Eficacia del tratamiento de la hipertensión, tasa de persistencia de la hipertensión y efectos adversos relacionados con el uso de los fármacos. Resultados. No se encontraron diferencias entre los grupos con relación a edad materna, edad gestacional al momento de la inclusión en el estudio e índice de masa corporal (p = ns). Tampoco se observaron diferencias estadísticamente significativas en los valores de presión arterial sistólica, diastólica y media entre los grupos (p = ns). Se observó que las pacientes tratadas con labetalol oral presentaron valores significativamente más bajos de presión arterial sistólica, diastólica y media comparadas con las pacientes tratadas con alfa-metildopa oral (p &lt; 0,0001). Ninguna paciente en el grupo A presentó persistencia de la hipertensión comparado con 17 pacientes en el grupo B (p &lt; 0,0001). El síntoma más común en el grupo A fue la cefalea y en el grupo B, las náuseas, que mostraron ser significativamente más frecuentes (p = 0,006). Conclusión. El labetalol oral fue más efectivo que la alfa-metildopa en el tratamiento de la hipertensión severa en preeclámpticas.

A Study of the Relationship between the Taste Sensitivity of Phenylthiocarbamide (PTC) and Blood Pressure (Random Sample from the Students of Qurna College/Basrah-Iraq)

The present study aimed to detect the relationship between taste sensitivity of phenylthiocarbamide (PTC) and pressure (systolic and diastolic) among a group of 138 individuals of both sexes (64 males and 74 females), representing a random sample of students and some professors of, aged (20 - 50) years. The study also included the relationship between eating salted foods and their effect on pressure among males and females of tasters and non-tasters of (PTC) substance. The results showed an increase in the proportion of the phenotypic style of tasters compared to non-tasters among males (75%, 25%) and females (77.03%, 22.97%) respectively. The average of systolic pressure was (117.91 mm/Hg, 107.06 mm/Hg) and diastolic (78.22 mm/Hg, 68.71 mm/Hg) among tasters and on-tasters for both sexes respectively. The results showed significant differences in systolic pressure among non-tasters female compared to their counterpart tasters [X2 (DF = 1) 5.783, P ≤ 0.05]. Such an effect doesn’t appear among males. The results showed an increase of non-tasters (66.58%) among those with abnormal blood pressure and (68.42%) of those who consumed salted foods.

IMPACT OF BLOOD PRESSURE COMPONENTS ON LEFT VENTRICULAR HYPERTROPHY REMODELING.

SUMMARY – According to present findings, the impact of particular arterial pressure components on the occurrence of left ventricular hypertrophy (LVH) differs. We sought to determine which individual component of arterial pressure has the greatest impact on the LVH geometric pattern/degree. The study included 192 patients (87 men), aged 43-80 (median 68) years with hypertension and LVH. Patients were classified into three groups according to type of hypertrophy (concentric, eccentric and asymmetric) and into three subgroups according to the degree of hypertrophy (mild, moderate and severe). All patients had their blood pressure measured, and they underwent electrocardiography and echocardiography. Antihypertensive drugs and the duration of previous treatments were taken into consideration. Pulse pressure was significantly higher in patients with concentric LVH than in those with eccentric and asymmetric LVH (p=0.029), the values of which did not differ statistically. It rose with LVH degree (not significantly, p=0.217). There were no significant differences in systolic pressure among study groups (p=0.177). We concluded that pulse pressure had the greatest impact on the left ventricular geometry, particularly of the concentric type.

KOMBINASI STRETCHING ACTIVE DAN BRISK WALKING TERHADAP PENURUNAN TEKANAN DARAH KLIEN HIPERTENSI

This research was motivated by teh increasing of hypertension accidents.In 2013 patient hypertension as many as 168 people, 2014 increased 190 people and 2015 as many as 225. One of the non pharmacological managements of patient hypertension is activity excercise. Activity excersise is recomended for patients with hypertension is stretching active and brisk walking which can decrease blood pressure the patient. The purpose of this study was to determine the effect of the combination of active stretching and brisk walking to the decrease in blood pressure. This research method was quasi experimental design with one group pretest-posttest. Intervention in the form of implementation of active stretching and brisk walking for 2 weeks. The study sample as many as 19 people in Puskesmas Plus Mandiangin London in 2016. The results show that there is the influence of a combination of active stretching and brisk walking to the decrease in blood pressure. Results Wilcoxon Signed Rank Test showed the difference in systolic and diastolic pressure before and after the intervention (p = 0.000). The average difference in systolic blood pressure measurements pre-post is (20.526 ± 12.236). And the average difference in diastolic blood pressure measurements pre-post is (12.632 ± 5.620). This study concludes that significantly active stretching and brisk walking can lower blood pressure in hypertensive patients.

EFFECTIVENESS OF PROGRESSIVE MOBILIZATION LEVEL I AND II ON HEMODYNAMIC STATUS AND DECUBITUS ULCER RISK IN CRITICALLY ILL PATIENTS

Background: Patient immobility remains to be one of the primary causes of pressure ulcers. Therefore, mobilization is necessity for patients being treated in the intensive care unit. However, the occurrence of pressure ulcers is dependent on not only the mobilization but also the bed itself and the type of mattress. This study used the same mattress and bed and compared the effectiveness of progressive mobilization with regular mobilization.&#x0D; Objective: This study aims to examine the effectiveness of progressive mobilization level I and II on hemodynamic status and decubitus ulcer risk in critically ill patients.&#x0D; Methods: This was a quasi-experimental study using repeated measure design. There were 40 respondents selected using purposive sampling, which 20 respondents assigned in each group. A Braden scale was used to measure the risk of decubitus ulcer. Paired t-test and repeated measures ANOVA were performed for data analysis.&#x0D; Results: Paired t-test showed that there was a significant difference of systolic pressure, diastolic pressure, MAP, heart rate, and Braden score after given intervention with p-value &lt;0.05. However, repeated ANOVA test showed that diastolic pressure had p-value &gt;0.05, thus could not be continued to post-hoc test. The progressive mobilization of level I and II in critical patients can stabilize systolic pressure (52.46%), stabilize MAP (58.43%), stabilize heart rate (68.99%), and reduce the risk of decubitus (55.03%) for 7 days of recurrent intervention.&#x0D; Conclusion: The progressive mobilization of level I and II can reduce the risk of decubitus and stabilize the patient's hemodynamic status in critical patients.

Clinical analysis of surgical treatment for aortic coarctation

Objective To summarize the methods and experiences of one-stage repair of aortic coarctation. Methods During January 2009 and September 2016, 31 patients underwent surgery for coarctation of aorta (COA) in our department. Of them, fifteen patients were accompanied by patent ductus arteriosus (PDA), five associated with ventricular septal defect (VSD), five with VSD and PDA, and six patients were single COA. All patients accepted one-stage repair and follow-up. The surgical strategies and follow-up results were retrospectively reviewed. Results Excision of coarctation and anastomoses was performed in 24 patients, a bypass with artificial graft was performed in 3 patients, longitudinally section transverse suture was performed in 2 patients, and aortoplasty with patch graft was used in 2 patients. Accompanied intracardiac malformations were repaired simutaneously. One patient died of low cardiac output syndrome 1 d after operation. Other patients recovered smoothly. Thirty patients were followed up from 6 months to 7 years. The anastomotic systolic pressure difference disappeared in 21 patients. Eight patients still suffered from systolic pressure difference (5-20 mmHg), but had no need of reoperation. One patient suffered from anastomotic recoarctation 2 years and 3 months after operation and the pressure difference was 48 mmHg. After exerting balloon dilatation, the pressure difference reduced to 17 mmHg. Conclusions Surgery is an effective method of COA treatment. The surgical strategies should be selected according to the characters of coarctation lesions, intracardiac malformations, and the age of patient. Key words: Aortic coarctation/SU

Validation of noninvasive blood pressure equipment: which peripheral artery is best for comparison studies in dogs?

Objectives1) To determine which peripheral artery commonly used for invasive arterial blood pressure (IBP) monitoring yields the least bias when compared with noninvasive blood pressure (NIBP) values obtained at the antebrachium of the dog, and 2) to identify and describe differences in systolic (SAP), mean (MAP) and diastolic arterial pressures (DAP) among different anatomical locations. Study designProspective experimental study. AnimalsTwenty adult hound dogs weighing 24.5 ± 1.1 kg (mean ± standard deviation). MethodsFour peripheral arteries—dorsal pedal, median caudal, intermediate auricular and superficial palmar arteries—were catheterized with 20 gauge, 3.8 cm catheters. One NIBP cuff was placed in the middle third of the antebrachium. Four sets of IBP and NIBP measurements were simultaneously collected every 2 minutes. A linear mixed model was performed to analyze the collected data. ResultsIBP values varied depending on the arterial catheterization site. The difference was greater for SAP. NIBP measured at the antebrachium had the best agreement with IBP measured at the median caudal artery. Conclusion and clinical relevanceIBP varies among anatomical locations. The smallest bias and narrowest limits of agreement were obtained at the median caudal artery, providing the best overall agreement with the equipment studied. The median caudal artery may be the preferable anatomical location for clinical comparison studies between IBP and NIBP in dogs when the cuff is on the antebrachium.

HEALING TOUCH AS SELF-CARE FOR VETERANS WITH HYPERTENSION

Seventy-eight million Americans suffer from hypertension, a key factor of cardiovascular diseases nationally and worldwide. Stress has been implicated as one of the contributors to hypertension (HTN). One out of every three veterans are diagnosed with high blood pressure. Roger’s Theory of Science of Unitary Human Beings and Lazarus’ Transactional Theory of stress were used to guide this study. The purpose of this pilot study was to examine whether the use of self-care healing touch, can reduce stress and anxiety in veterans 60 and older, diagnosed with hypertension. In this a pre-intervention, post-intervention randomized two-group experimental pilot study, 24 veterans, 10 African American, 9 Caucasians, 6 other, were recruited from Los Angeles County. Participants were randomized into 2 groups (intervention and control) for this 4 week study. Outcome measures included changes in blood pressure, self-reported stress using the Daily Stress Inventory (DSI) and anxiety measured using the Geriatric Anxiety Inventory (GAI). Results showed a significant difference in the systolic blood pressure in the intervention group compared to the control group at Week 4. There was a marginal significance found in the heart rate, but no statistical significance seen in the stress or anxiety results on this minimal sampling study.

Palpable mass of the neck in the course of Takayasu arteritis.

Takayasu arteritis is a rare, idiopathic inflammatory disease of the aorta and its major branches, usually affecting young women of Asian descent. In the course of the disease stenosis, occlusions as well as dilatations and aneurysms of vessels occur. Because of many possible localizations of pathological changes, the symptoms have a wide range, but the most common are a weak pulse or its absence on the brachial artery and a difference in systolic pressure above 10 mm Hg between the upper extremities. Here we present a case report of a young woman with Takayasu arteritis, who presented a palpable mass in the back of her neck, significantly diminished after treatment with glucocorticoids.

Perioperative α-receptor blockade in phaeochromocytoma surgery: an observational case series

BackgroundMortality associated with surgery for phaeochromocytoma has dramatically decreased over the last decades. Many factors contributed to the dramatic decline of the mortality rate, and the influence of an α-receptor blockade is unclear and has never been tested in a randomized trial. We evaluated intraoperative haemodynamic conditions and the incidence of complications in patients with and without α-receptor blockade undergoing surgery for catecholamine producing tumours. MethodsHaemodynamic conditions and perioperative complications were assessed in 110 patients with (B) and 166 without (N) α-receptor blockade. Data were analysed as a consecutive case series of 303 cases and subsequently via propensity score matching, and presented as mean and confidence interval (CI). ResultsNo difference in maximal intraoperative systolic arterial pressures (B = 178 mm Hg (CI 169-187) vs N = 185 mm Hg (CI 177-193; P = 0.2542) and hypertensive episodes above 250 mm Hg were found (P = 0.7474) for the closed case series. No major complications occurred. Propensity score matching (75 pairs) revealed a significant difference of 17 mm Hg in maximal intraoperative systolic bp for these selected pairs (P = 0.024). ConclusionsOnly a slight difference in mean maximal systolic arterial pressure was detected between patients with or without an α-receptor blockade. There was no difference in the incidence of excessive hypertensive episodes between groups and no major complications occurred. The basis for the general recommendation of perioperative α- receptor blockade for phaeochromocytoma surgery demands further study.