Hemodynamic Indices Research Articles

Diastolic blood pressure impact on pediatric refractory septic shock outcomes

Septic shock is the progression of sepsis, defined as cardiovascular dysfunction during systemic infection, and it has a mortality rate of 40%-80%. Loss of vascular tone is an important pathophysiological feature of septic shock. Diastolic blood pressure (DBP) was reported to be associated with vascular tone. This study aimed to identify the associations of several hemodynamic indices, especially DBP, with outcome in pediatric septic shock to allow for timely interventions. Children with persistent catecholamine-resistant shock had a pulse index continuous cardiac output (PiCCO®) system implanted for invasive hemodynamic monitoring and were enrolled in the current study. Serial cardiac index, systemic vascular resistance index (SVRI), systolic blood pressure (SBP), mean arterial pressure (MAP), and DBP were recorded during the first 24h following PiCCO® initiation. All hemodynamic parameters associated with 28-day mortality were further analyzed using receiver operating characteristic curve analysis. Thirty-three children with persistent catecholamine-resistant shock were enrolled. The median age was 12 years and the youngest children were 5 years old. Univariate analysis noted that SVRI, SBP, MAP, and DBP were significantly higher, and shock index was significant lower, in survivors compared with non-survivors (p<0.05). In the multivariate analysis, only SVRI and DBP remained independent predictors of 28-day mortality. DBP had the best correlation with SVRI (r=0.718, n=219, p<0.001). The area under the receiver operating characteristic curves of SVRI and DBP for predicting 28-day mortality during the first 24h of persistent catecholamine-resistant shock were >0.75, indicating a good prediction for mortality. DBP correlated well with SVRI and it can serve as a predictor for mortality in pediatric septic shock. Furthermore, DBP was a superior discriminator of mortality when compared with SBP and MAP. A lower DBP was an independent hemodynamic factor associated with 28-day mortality.

Comparative assessment of echocardiographic parameters in persons without diagnosed chronic non-communicable diseases depending on body mass index

Aim: To compare the indicators of structural remodeling and intracardiac hemodynamics in people without previously diagnosed chronic non-communicable diseases, depending on body mass index (BMI).Material and Methods. We analyzed the data of 123 people aged 21 to 59 years who did not have chronic non-infectious diseases and did not take any drug therapy that affects the indicators of central and peripheral hemodynamics, as well as lipid, carbohydrate and fat metabolism. All the examined persons were divided depending on the BMI into 2 groups, comparable in sex, but with age differences. The first group consisted of 60 people (75% women) with a BMI &lt; 30 kg/m2, whose median age was 40 years (Q1–Q3: 35–48 years). The second group included 63 subjects (76.1% women) with BMI ≥ 30 kg/m2 at the age of 48.5 years (Q1–Q3: 38–54 years). Structural and functional parameters of the heart were assessed during transthoracic echocardiography, which was performed on the Philips EPIQ CVx 2D ultrasound machine by one specialist.Results. In the group of persons with increased BMI, the average values of the left ventricular relative wall thickness (RWT LV) were higher – 0.37 [0.34; 0.40] versus 0.41 [0.37; 0.47], p = 0.01; left ventricular mass index (LVMI) – 64.0 [53.0; 76.5] g/m2 and 27.0 [23.1; 30.9] g/m2,7 vs. 82.0 [70.0; 92.0] g/m2 and 38.1 [34.5; 46.5] g/m2,7, p = 0.01; epicardial fat (EF) – 5 [4; 6] mm vs. 8 [5; 10] mm, p = 0.01, left ventricular global longitudinal strain (LV GLS) –21.8 [–23.6…–19.7]% vs. –19.2 [–21.2…–18.2] %, p = 0.01. Statistically direct correlations of BMI with LVMI g/m2,7 (ρ = 0.746; p = 0.01), EF (ρ = 0.563; p = 0.01), LV GLS (ρ = 0.418; p = 0 .01), RWT (ρ = 0.438; p = 0.01). With an increase in BMI by 1 kg/m2, one should expect an increase in the thickness of EF by 0.172 mm, longitudinal deformation of the LV by 0.151%, RWT by 0.003, LVMI, g/m2 by 1.200, LVMI g/m2,7 by 1.116.Conclusion. The increase in BMI is associated with changes in structural remodeling and systolic function of the LV. In individuals with increased BMI, to determine structural remodeling and changes in the geometry of the heart chambers, it is necessary to use growth indexing, to determine indicators of GLS LV, to determine the thickness of EF in order to detect intracardiac hemodynamic disorders in the early stages and timely prevention of complications.

DIA-based serum proteomics revealed the protective effect of modified siwu decoction against hypobaric hypoxia

Ethnopharmacological relevanceSiwu decoction (SWD) is a common traditional formula for nourishing blood, and its derived formulas are also widely used in traditional Chinese medicine (TCM) clinic. However, the protective effects of SWD and its derived formulas on blood deficiency and blood stasis caused by rushing to the plateau are rarely reported, and the underlying mechanism has not been fully elucidated. Aim of the studyThis study explores the pharmacological effects and mechanisms of modified siwu decoction (MSWD) adding Persicae Semans (Prunus persica (L.) Batsch) and Carthami Flos (Carthamus tinctorius L.) against hypobaric hypoxia (HH). The acute toxicity of MSWD was also evaluated to further validate the potential of MSWD as a therapeutic candidate for HH. Materials and methodsHypoxic models of C57BL/6 J and KM male mice were used to evaluate the pharmacological effect of MSWD. 2 μL serum sample of C57BL/6 J mice was digested into peptide mixtures and analyzed with DIA mode on an Orbitrap Fusion Lumos mass spectrometer after LC separation. The peptide and protein identifications were limited to a 1% FDR. Screening of differential expressed proteins, correlation analysis, hierarchical clustering analysis, principal components analysis and Mfuzz analysis were all performed by R packages. The protein−protein interaction network was analyzed using the STRING website and constructed with Cytoscape software. ResultsMSWD showed a protective effect against acute hypoxia exposure through increasing the number of red blood cells and improving hemodynamics indexes in mice. Meanwhile, the biochemical results showed that MSWD could reduce the inflammation and oxidative stress, reduce the content of organ injury biomarkers and significantly improve the high-intensity exercise ability of mice. Subsequently, serum DIA proteomic results revealed significant changes in proteomic characteristics after MSWD intervention. Specifically, proteins related to oxidative stress and ubiquitin-proteasome system, such as Sod1, Gstp1, Vcp and Usp14, were down-regulated after MSWD intervention, suggesting that the protective effect of MSWD involved the reduction of oxidative stress and energy expenditure. MSWD also intervened in energy metabolism and lipid metabolism processes by altering the expression levels of Eno1, Sphk1 and Apoa1 to ameliorate hypoxia-induced disorders. At the same time, MSWD acute toxicity test showed no obvious toxicity. ConclusionsMSWD has a good protective effect against HH by ameliorating hypoxia-induced disorders of energy and lipid metabolism, supporting MSWD as a safe drug candidate for the prevention and treatment of acute hypoxia fatigue.

Effects of Moracizine Combined with Metoprolol on Hemodynamic Indices of the Left Atrium and Quality of Life in Patients with Atrial Fibrillation.

Drugs are the first choice of treatment for atrial fibrillation (AF), but there is currently a lack of efficient drug treatment options. The aim of this study was to investigate a combination drug treatment plan which may serve as a reference for the treatment of AF. A total of 316 AF patients admitted to Jiaozhou Central Hospital in Qingdao from October 2020 to October 2022 were selected for this retrospective study. They were divided into a control group (CG, metoprolol, n = 156) and an observation group (OG, moracizine combined with metoprolol, n = 160) based on the treatment they received. The CG and OG groups were compared for clinical efficacy, occurrence of AF, cardiac output (CO), cardiac indexes (CI), stroke volume (SV), stroke indexes (SI) and improvement in QOL. The OG had a better effective rate of treatment, higher levels of CO, CI, SV and SI, and higher QOL scores compared to the CG, as well as a lower AF recurrence rate and AF burden (all p < 0.05). Moracizine combined with metoprolol is an effective treatment for AF patients. This drug combination was found to reduce the AF recurrence rate and burden in AF patients, and to improve their hemodynamic indices and QOL.

Acute hypoxia elicits prefrontal oxygenation asymmetry in young adults.

Cerebrovascular reactivity can be evaluated by prefrontal cortex (PFC) hemodynamic responses and oxygenation changes secondary to hypoxia using near-infrared spectroscopy (NIRS). However, whether there are hemispheric differences in these NIRS-determined PFC hemodynamic responses and oxygenation changes remains unknown. This study was performed to determine whether there are differences in the PFC hemodynamic responses and oxygenation changes secondary to hypoxia between the left and right frontal poles (FPL and FPR, respectively). Fifteen young men participated in the study. During conduction of an isocapnic hypoxia protocol with a 10-min hypoxic phase at partial pressure of end-tidal oxygen () of 45Torr, hemodynamic and oxygenation indices comprising oxygenated hemoglobin (oxy-Hb), deoxygenated Hb (deoxy-Hb), total Hb (total-Hb), and tissue oxygen saturation () over FPL and FPR were measured by NIRS. The heart rate (HR) was evaluated by electrocardiography. In response to hypoxia, the HR increased, oxy-Hb decreased, deoxy-Hb increased, total-Hb increased above baseline, and decreased. There was no difference in the change in total-Hb between FPL and FPR. However, there were greater changes in oxy-Hb, deoxy-Hb, and over FPL than over FPR, indicating that PFC oxygenation asymmetry occurs in response to hypoxia. Moreover, the change in total-Hb over FPL was associated with the increase in HR. NIRS-determined hemodynamic responses and oxygenation changes secondary to hypoxia might not simply reflect the direct effect of hypoxia on cerebral vessels. Although there is no hemispheric difference in the PFC hemodynamic responses to hypoxia as in total-Hb, PFC oxygenation asymmetry occurs in young adults.

Адаптивные реакции кровообращения студентов в динамике годичного цикла обучения в вузе

Increasing training loads significantly affects the health of students. The cardiovascular system can react especially sharply to such changes. The purpose of the research is to analyze the indicators of systemic hemodynamics and adaptive reactions in students at Volgograd State University in the dynamics of the academic year. The study of hemodynamics was carried out in 2021–2023, from September to May. The following indicators were used: systolic and diastolic blood pressure, pulse pressure, mean hemodynamic pressure, systolic blood flow volume, minute volume of blood flow and peripheral vascular resistance. When analyzing the parameters of systemic hemodynamics, it was found that seasonal changes in the values of mean hemodynamic pressure, systolic blood volume, minute volume of blood circulation and total peripheral vascular resistance are insignificant among students during the academic year. At the same time, a trend of changes in systemic hemodynamics was revealed during the three years of study. So, in comparison with the first year, the students in the second year showed an increase in the pumping function of the heart; in the third year of study, an increase in the chronotropic function was revealed. The change in hemodynamic indicators is also consistent with fluctuations in the adaptive potential, a decrease in which is noted during the examination and summer periods. At the same time, the level of adaptation in girls is, as a rule, higher than in boys, which indicates more effective adaptive capabilities of the female body.

Multiscale multimodal characterization and simulation of structural alterations in failed bioprosthetic heart valves.

Calcific degeneration is the most frequent type of heart valve failure, with rising incidence due to the ageing population. The gold standard treatment to date is valve replacement. Unfortunately, calcification oftentimes re-occurs in bioprosthetic substitutes, with the governing processes remaining poorly understood. Here, we present a multiscale, multimodal analysis of disturbances and extensive mineralisation of the collagen network in failed bioprosthetic bovine pericardium valve explants with full histoanatomical context. In addition to highly abundant mineralized collagen fibres and fibrils, calcified micron-sized particles previously discovered in native valves were also prevalent on the aortic as well as the ventricular surface of bioprosthetic valves. The two mineral types (fibres and particles) were detectable even in early-stage mineralisation, prior to any macroscopic calcification. Based on multiscale multimodal characterisation and high-fidelity simulations, we demonstrate that mineral occurrence coincides with regions exposed to high haemodynamic and biomechanical indicators. These insights obtained by multiscale analysis of failed bioprosthetic valves serve as groundwork for the evidence-based development of more durable alternatives. STATEMENT OF SIGNIFICANCE: Bioprosthetic valve calcification is a well-known clinically significant phenomenon, leading to valve failure. The nanoanalytical characterisation of bioprosthetic valves gives insights into the highly abundant, extensive calcification and disorganization of the collagen network and the presence of calcium phosphate particles previously reported in native cardiovascular tissues. While the collagen matrix mineralisation can be primarily attributed to a combination of chemical and mechanical alterations, the calcified particles are likely of host cellular origin. This work presents a straightforward route to mineral identification and characterization at high resolution and sensitivity, and with full histoanatomical context and correlation to hemodynamic and biomechanical indicators, hence providing design cues for improved bioprosthetic valve alternatives.

COURSE OF INHALATION ANAESTHESIA WITH SEVOFLURANE DURING SURGICAL TREATMENT OF PATIENTS WITH MALIGNANT LUNG TUMOURS

Abstract. Aim. Study of the effect of pain intensity on the energy efficiency of blood circulation in patients with lung malignancies after operations under anesthesia using sevoflurane.&#x0D; Materials and methods. 29 patients with malignant lung formations have been examined, who underwent open surgical interventions on the volume of lob- or pneumonectomy or resection of part of the lung. The average age of the examined patients was (55±5.6) years, among them men – 17, women – 12. Pain intensity, perfusion systemic pressure, cardiac index, blood flow power, arteriovenous difference in oxygen content, blood lactate concentration, oxygen reserve, circulatory reserve have been determined. These indicators have been determined in four stages: 1) before the operation; 2) awakening; 3) the first day after surgery; 4) the fifth day after surgery.&#x0D; Results and their discussion. The intensity of pain determined by the visual analog scale (VAS) was maximum on the 1st day after surgery (4.8±0.8 points), and on the 5th day it returned to the level of the awakening stage. Analgesia was performed with morphine (0.27±0.04 mg/kg on the 1st day) and infusion of infulgan at a dose of 1 g 3 times a day. The circulatory reserve was minimal at the stage of awakening and on the 1st day after surgery (from (381±66) to (390±71) mW/m2), on the 5th day it reached the preoperative level (448±82 mW/m2). Separate indicators of blood circulation do not have a strong dependence on the level of pain that was determined by VAS, but indicators of the energy component of circulation are closely related to the severity of pain.&#x0D; Conclusions. The maximum severity of pain in patients with malignant lung formations operated under inhaled anesthesia with sevoflurane is observed on the first day after surgery. Different indicators of hemodynamics and oxygen transport are associated with the intensity of pain measured by VAS with different strengths, which makes it impossible to evaluate the effectiveness of anesthesia. Indicators of circulatory energy efficiency are closely related to the intensity of pain measured using VAS, which proves the value of using monitoring of circulatory energy indicators in assessing the quality of anesthesia.

Efficacy of Flavonoid Apigenin on Hemodynamic indices, Baroreflex Function, Cardiac and Kidney Remodeling and Vasoactive-Inflammatory Biomarkers in Experimental Renal Hypertension

The hypothesis stated here that, the long-term prevention by natural flavonoid phenolic compound, for example apigenin (Apg), improves baroreflex sensitivity and vascular resistance and occurs beneficial action for attenuation the renal hypertension (RH). One-kidney, 1-clip rats (1K1C) were treated with Apg for 2 weeks after 1 week of surgical intervention. At the end of the study in the control RH group the blood pressure (BP) increased on average by 43.5%, decreased in heart period (HP) by 9.8%, cardiochronotropic (vagal) component of baroreflex sensitivity (BRS) by 50%, and adrenergic component by 34%. Thus, in 1K1C experimental model of hypertension, provides switching to parasympathetic component and accompanied with proportionally nearly two-fold increase in epinephrine (EPN) and norepinephrine (NE) without changes in EPN/NE ratio. Morphometric changes in the kidney and heart confirmed the development of kidney and cardiac hypertrophy and renal functioning disturbances (blood urea nitrogen (BUN) increased in more than two-fold) and markers of sodium reabsorption in proximal tubule, total trans-EETs, decreased in 1.6-fold. The pronounced increased proinflammatory cytokines, interleukin 1b (IL1 b), endothelin -1 (ET-1) and tumor necrosis factor (TNF)-a confirmed the formation of “sterile inflammation” which strengthening by the nearly two-fold decreasing in the level of anti-inflammatory (vasodilatory) mediators, prostaglandin E2 (PGE2). Preventive long-term regime treatment with Apg (5mg/kg i.p./daily) in RH rats significantly decreased BP by 18.6%, increased parasympathetic component of BRS by 38.5% without marked altered its sympathetic component. Such deremodeling in BRS sensitivity associated with significant decreased in heart and kidney hypertrophy and functional activity of kidney, normalization of BUN and total EETs, reducing in circulating plasma level of catecholamines, and markedly attenuated progression of inflammation, decreased of proinflammatory levels of cytokines. Thus, Apg provides preventive beneficial pluripotent action in RH rats by exerting antihypertensive, cardio- and renoprotective effects and attenuation of “sterile inflammation”.

A deep learning model for efficient end-to-end stratification of thrombotic risk in left atrial appendage

Clot formation in the left atrial appendage (LAA) poses a high risk of ischemic strokes and systemic embolism to patients with atrial fibrillation (AF), the most common type of sustained heart arrhythmia that affects more than 35 million people worldwide. Hemodynamic metrics evaluated using computational fluid dynamics (CFD) have been employed to assess the risk of thrombosis in LAA, but its utilization in clinical settings is limited due to their cumbersome operations and high computational cost. To this end, we propose UDGCNN (U: U-net, DGCNN: Dynamic Graph Convolutional Neural Network) that can utilize data from the point cloud of patient-specific LAA geometries as inputs and predict multiple hemodynamic indexes for systematic assessment of the thrombotic risk. The novelty of the proposed model lies in introducing edge convolution layers to the PointNet structure to improve the model’s capacity to learn local features, which is essential for training and predicting complex patient-specific geometries. Moreover, the network structure of UDGCNN is optimized by integrating the Encoder-Decoder structure and skip-connection to extract hierarchical features from the point cloud. The accuracy and efficiency of the UDGCNN is examined by training and testing on 371 LAA geometries from patients with AF, the largest patient-specific dataset in the literature. Using mean absolute error and model inference time as metrics, we demonstrate that UDGCNN can provide an assessment of multiple hemodynamic metrics in 3D patient-specific geometries with prediction error ∼30% lower than those of the state-of-art PointNet model, whereas the inference time is 500-fold shorter compared to computational time CFD simulation. It is noted that UDGCNN is a general computational framework that can be extended to study various cardiovascular diseases. In summary, this study presents a new computational tool that enables end-to-end stratification of thrombotic risk in LAA based on bioimaging, thereby advancing the current screening approach in clinical practice.

The prognostic value of systemic vascular resistance in heart failure patients with permanent atrial fibrillation: a retrospective study

Heart failure (HF) and permanent atrial fibrillation (AF) interact mutually, exacerbating hemodynamic effects and causing adverse outcomes and increased healthcare costs. Monitoring hemodynamic indicators in patients with these comorbidities is crucial for effective clinical management. Transthoracic impedance cardiography (ICG) has been widely employed in assessing hemodynamic status in clinical settings. Given the limited research on the prognostic significance of ICG parameters in HF with permanent AF, we undertook this study. A total of 66 HF patients with permanent AF were included in this retrospective study, and the primary outcome was rehospitalization due to worsening HF within 180-day post-discharge. Cox regression analysis was performed to explore the connection between ICG-evaluated parameters and the outcome risk. Receiver operating characteristic (ROC) curve analysis determined the optimal cutoff values of risk factors, subsequently applied in plotting Kaplan Meier (KM) survival curves. Multivariate Cox regression analysis revealed that systemic vascular resistance (SVR) both on admission and at discharge independently predicted rehospitalization for worsening HF. ROC analysis established optimal SVR cutoff values: 320.89 (kPa s/L) on admission and 169.94 (kPa s/L) at discharge (sensitivity 70%, specificity 94.4%, area under the curve (AUC) 0.831, respectively, sensitivity 90%, specificity 55.6%, AUC 0.742). KM survival curves analysis showed that patients with SVR > 320.89 (kPa s/L) on admission had an 8.14-fold (P < 0.001) increased risk of the end-point event compared with those with SVR ≤ 320.89 (kPa s/L). Similarly, patients with SVR > 169.94 (kPa s/L) at discharge faced a risk elevated by 6.57 times (P = 0.002) relative to those with SVR ≤ 169.94 (kPa s/L). In HF patients with permanent AF, SVR measured by ICG emerges as an independent risk factor and clinical predictor for HF deterioration-related readmission within 180 days after discharge. Higher SVR levels, both upon admission and at discharge, correlate with an incremental rehospitalization risk.

The Role of Metabolic Syndrome in The Nature of Postinfarction Remodeling of The Heart in Patients with Chronic Heart Failure

The aim is to study of heart’s structure and hemodynamic indicators according to composition of metabolic syndrome components in the patient with chronic heart failure (CHF)functional class (FC) IIIII. 62 men-patient with cardiosclerosis after heart attack were examined by the way of echocardiography on CHF FC II-III (NYHA). According to metabolic syndrome components they are devided into 3 groups: 1 st group (n=20), patients without signs of metabolic syndrome; 2nd group (n=21) patients with combination of dyslipidemia (DLP), abdominal obesity (AO), arterial hypertenion (AG) and hypertriglyceridemia; 3rd group (n=21) with different combination of dyslipoproteinemia, diabetes and obesity also AG and hypertriglyceridemia. in CHF passed with metabolic syndrome is seen a clear sign of heart’s systolic and diastolic.the presence of metabolic syndrome in CHF also its progressing is the subject to be hypertrophy of left ventricle, breaking the transmitral blood flow, also thickening of barier between ventricles and left ventricle back thickness

Analysis of the Analgesic Effect of Dexmedetomidine Combined with Ropivacaine Retractor Tube Block After Total Knee Arthroplasty

Objective: This paper aims to explore and analyze the analgesic effect of dexmedetomidine combined with ropivacaine retractor tube block after total knee arthroplasty. Methods: The study period was from January 2023 to July 2023. 50 patients admitted to our hospital after total knee arthroplasty were selected as the study subjects, and were divided into the study group (n = 25) and the control group (n = 25) according to double-blind method. The study group was given dexmedetomidine combined with ropivacaine and the control group was given ropivacaine. The analgesic effect and hemodynamic indexes were compared between the groups. Results: At 3 hours postoperatively, the analgesic effects of resting numeric rating scale (NRS) score and activity NRS score between the groups were compared, and the difference was not statistically significant (P &gt; 0.05). At 12 hours and 24 hours postoperatively, the resting NRS score and activity NRS score of the study group were significantly better than those of the control group, and the difference was statistically significant (P &lt; 0.05). Before treatment, hemodynamic indexes such as output per beat, cardiac output, cardiac index, and other hemodynamic indexes were compared between the groups, the difference was not statistically significant (P &gt; 0.05). After treatment, hemodynamic indexes such as output per beat, cardiac output, cardiac index, and other hemodynamic indexes of the study group were significantly better than those of the control group, the difference was statistically significant (P &lt; 0.05). Conclusion: Dexmedetomidine combined with ropivacaine retractor block has better analgesic effect after total knee arthroplasty, and it can be widely used and promoted in the clinic.

Noninvasive hemodynamic indices of vascular aging: an in silico assessment.

Vascular aging (VA) involves structural and functional changes in blood vessels that contribute to cardiovascular disease. Several noninvasive pulse wave (PW) indices have been proposed to assess the arterial stiffness component of VA in the clinic and daily life. This study investigated 19 of these indices, identified in recent review articles on VA, by using a database comprising 3,837 virtual healthy subjects aged 25-75 yr, each with unique PW signals simulated under various levels of artificial noise to mimic real measurement errors. For each subject, VA indices were calculated from filtered PW signals and compared with the precise theoretical value of aortic Young's modulus (EAo). In silico PW indices showed age-related changes that align with in vivo population studies. The cardio-ankle vascular index (CAVI) and all pulse wave velocity (PWV) indices showed strong linear correlations with EAo (Pearson's rp > 0.95). Carotid distensibility showed a strong negative nonlinear correlation (Spearman's rs < -0.99). CAVI and distensibility exhibited greater resilience to noise compared with PWV indices. Blood pressure-related indices and photoplethysmography (PPG)-based indices showed weaker correlations with EAo (rp and rs < 0.89, |rp| and |rs| < 0.84, respectively). Overall, blood pressure-related indices were confounded by more cardiovascular properties (heart rate, stroke volume, duration of systole, large artery diameter, and/or peripheral vascular resistance) compared with other studied indices, and PPG-based indices were most affected by noise. In conclusion, carotid-femoral PWV, CAVI and carotid distensibility emerged as the superior clinical VA indicators, with a strong EAo correlation and noise resilience. PPG-based indices showed potential for daily VA monitoring under minimized noise disturbances.NEW & NOTEWORTHY For the first time, 19 noninvasive pulse wave indices for assessing vascular aging were examined together in a single database of nearly 4,000 subjects aged 25-75 yr. The dataset contained precise values of the aortic Young's modulus and other hemodynamic measures for each subject, which enabled us to test each index's ability to measure changes in aortic stiffness while accounting for confounding factors and measurement errors. The study provides freely available tools for analyzing these and additional indices.

PCV-VG combined individualized PEEP determination in one-lung ventilated patients with PEEP step change direction: A randomized controlled trial.

The efficacy of pressure-controlled volume-guaranteed ventilation (PCV-VG) combined with a gradient-directional change in positive end-expiratory pressure (PEEP) during one-lung ventilation (OLV) in patients who underwent thoracoscopic surgery was investigated. Ninety patients were randomly divided into the PC (PCV-VG + 5 cm H2 O fixed PEEP), PI (PCV-VG + incremental PEEP titration), and PD (PCV-VG + decremental PEEP titration) groups. Hemodynamic (heart rate [HR] and mean arterial pressure [MAP]), respiratory mechanics (Ppeak , Pmean, and Cdyn), and arterial blood gas (pH, PaCO2 , PaO2 , and PaO2 /FiO2 ) indices were evaluated at T1 (10 min of two-lung ventilation [TLV]), T2 (10 min of OLV), and T3 (10 min of recovery, TLV). Enzyme-linked immunosorbent assay was performed to detect neutrophil elastase (NE), clara cell secretory protein (CC16), and interleukin-8 (IL-8) levels at T1 and T3. At T2 and T3 , Ppeak was lower in the PI and PD groups than in the PC group, while Pmean and Cdyn were higher than in the PC group. Ppeak in the PD group was lower than that in the PI group; however, Pmean was higher at T2 and T3 (P < 0.05). At T2 , PaO2 and PaO2 /FiO2 were higher, but PaO2 /FiO2 and VD /VT were lower in the PD and PI groups than in the PC group (P < 0.05). NE, CC16, IL-6, and IL-8 levels were elevated in all three groups at T3 , but the PI and PD groups had lower levels than the PC group (P < 0.05). The incidences of postoperative pulmonary complications (PPCs) and surgical intensive care unit hospitalizations in the PD and PI groups were much lower. Gradient-directed altered PEEP titration could improve respiratory mechanics, arterial blood gases, and inflammatory responses and reduce the incidence of PPCs in patients undergoing thoracoscopic surgery.

Effect of remifentanil co-administered with propofol on stress response and postoperative complications in patients with cerebral hemorrhage undergoing surgical anesthesia

Purpose: To determine the anesthetic effect and related indicators following concurrent administration of remifentanil and propofol in cerebral hemorrhage surgery patients.Methods: A total of 88 cerebral hemorrhage patients admitted in Lishui People’s District Hospital, Nanjing, China, from December 2019 to December 2020, were assigned to two groups, viz, control group which received fentanyl and propofol for anesthesia, while study group was administered remientanil combined with propofol for anesthesia There were 44 patients in each group. Hemodynamic index, brain injury marker index, stress response index, awakening condition, propofol dosage, anesthetic effect, and adverse reactions were assessed and recorded.Results: Heart rate (HR), diastolic blood pressure (DBP), and systolic blood pressure (SBP) at T2 and T3 of the two groups were less than those at T1. At T3, the study group’s HR, DBP, and SBP were substantially higher than those of control group (p &lt; 0.05); At 12 and 24 h after operation, brain injury markers and stress response indices in study group were significantly lower compared to control group (p &lt; 0.05), while in comparison to control group (79.55 %), the degree of anesthesia in the study group was higher (95.45 %; p &lt; 0.05). The incidence of adverse reactions in the study group (15.91 %) was lower than in control group (43.18 %; p &lt; 0.05).Conclusion: Remifentanil, when combined with propofol anesthesia, stabilizes hemodynamics, protects against brain injury, and reduces stress reactions in patients undergoing cerebral hemorrhage surgery. The combination is also highly effective and safe. However, validation of these findings in larger clinical trials is required.

Geometric versus Hemodynamic Indexes for Rupture-Destined Aneurysms: A Retrospective Cohort and a Repeated-Measures Study

Plain Language SummaryThe incidence of intracranial aneurysm (IA) is 2–3% in the general population, and with the widespread use of neurovascular imaging techniques, more IAs are being diagnosed. IA management is crucial as it can lead to fatal subarachnoid hemorrhage, causing high mortality and neurological issues. About 1% of patients with IA experience severe hemorrhage annually, which raises questions about the best method to assess rupture risk. Past studies used geometric indexes and computational fluid dynamics to differentiate between ruptured and unruptured aneurysms. However, these studies mostly focused on cross-sectional data and did not analyze the evolutionary changes of ruptured aneurysms. In this study, we call such aneurysms rupture-destined aneurysms (RDAs) to differentiate from stable unruptured intracranial aneurysm (UIA). In the present study, the key findings could be summarized as below: (1) the RDA group showed a significantly higher hemodynamic instability than the UIA group; (2) the UIA group showed features of hemodynamic stability, even with geometric growth; (3) aneurysmal rupture risk should be assessed using both geometric and hemodynamic information.

Comparison of risk factors for hemorrhagic stroke and ischemic stroke, a prospective long-term follow-up cohort study

Objective: To analyze and compare the risk factors for hemorrhagic stroke and ischemic stroke and understand the exposure levels in population. Methods: A cohort study of risk factors of stroke was conducted in a rural community in Fengxian District of Shanghai in 2003, and the common risk factors of stroke were investigated at baseline survey, the cerebrovascular hemodynamics indexes were detected, the cerebrovascular function score was calculated according to the unified integral rule, and the incidence of stroke was observed in follow up. The risk factors for hemorrhagic stroke and ischemic stroke were analyzed by cohort study. The risk factors for two subtypes of stroke were compared. Result: A total of 10 565 participants were included in the study, with a mean follow-up period of (11.15±2.26) years, and 103 hemorrhagic stroke cases and 268 ischemic stroke cases were observed during follow-up period. The independent risk factors of hemorrhagic stroke included decreased cerebrovascular function score [hazard ratio (HR)=1.56, 95%CI: 1.23-1.98], history of alcohol consumption (HR=2.46, 95%CI: 1.39-4.34), hypertension (HR=1.75, 95%CI: 1.00-3.07) and older age (HR=1.07, 95%CI: 1.04-1.10). The independent risk factors of ischemic stroke included decreased cerebrovascular function score (HR=1.43, 95%CI: 1.25-1.65), smoking history (HR=1.52, 95%CI: 1.13-2.05), hypertension (HR=1.51, 95%CI: 1.10-2.07), family history of stroke (HR=1.89, 95%CI: 1.13-3.15), left ventricular hypertrophy (HR=1.74, 95%CI: 1.07-2.81) and older age (HR=1.07, 95%CI: 1.05-1.08). Conclusions: Decreased cerebrovascular function score, hypertension, and older age were common independent risk factors of both types of stroke, alcohol consumption history was an independent risk factor of hemorrhagic stroke, and smoking history, and family history of stroke and left ventricular hypertrophy were independent risk factors of ischemic stroke.

Comparative Effectiveness of Mechanical Circulatory Support Devices in Cardiogenic Shock

In patients with cardiogenic shock, this review compares the efficacy of percutaneous microaxial left ventricular assist devices (pLVADs) to intra-aortic balloon pumps (IABPs) or no mechanical circulatory support (MCS). End-organ hypoperfusion brought on by insufficient cardiac output characterizes the potentially fatal disease known as cardiogenic shock. Relevant papers were found by a thorough search of internet resources and were incorporated into the study. The main outcomes evaluated were: (1) Short-term mortality, (2) hemodynamic indices, (3) organ function, and (4) Length of hospital stay. Considered secondary outcomes were: (1) Adverse events, (2) quality of life, and (3) long-term survival. As shown by increased cardiac output and mean arterial pressure, the findings of this research imply that pLVADs may provide superior hemodynamic support versus IABPs or no MCS. In addition, pLVADs may have better organ function and lower short-term mortality rates than IABPs or no MCS. However, using pLVADs was also linked to a higher risk of unfavorable outcomes, such as bleeding and vascular issues. Data on long-term survival and quality-of-life outcomes were sparse and ambiguous. In conclusion, as compared to IABPs or no MCS, pLVADs may offer more effective hemodynamic support and better short-term outcomes in patients with cardiogenic shock. More investigation is required to fully comprehend the long-term advantages, hazards, and effects of pLVADs on the quality of life in this patient population.

Practice and effect evaluation of early restrictive fluid resuscitation strategy in the nursing care of patients with sepsis in the emergency department: a retrospective cohort study.

To explore the practice and effect evaluation of the early restrictive fluid resuscitation strategy in the nursing care of patients with sepsis in the emergency department. A total of 239 sepsis patients, who were treated in the emergency department of our hospital from January to September 2020, were selected as the participants of this study, and a retrospective analysis was performed. According to different fluid resuscitation, they were divided into an improved group and a control group. One hundred and twelve patients who received restrictive fluid resuscitation were in the improved group; another 127 patients who received adequate fluid resuscitation were in the control group. The ICU stay time, ventilator use time and 28-day mortality rate of the two groups were observed. The hemodynamic indexes, acute physiology and chronic health evaluation (APACHE) II score, sequential organ failure assessment (SOFA) score and complications of the two groups before and after treatment were compared. After treatment, in the improved group, the APACHE II and SOFA scores were lower than in the control group, fluid replacement decreased, lactate clearance increased, ICU admission time shortened and the proportion of ventilator time to ICU admission time decreased. The incidence of acute respiratory distress syndrome (ARDS), cTn I and brain natriuretic peptic in the improved group were significantly lower than those in the control group. From the dimension within the group, the APACHE II score, SOFA score, heart rate and shock index were lower after treatment than before treatment in the improved and control groups. Restricted fluid resuscitation can effectively alleviate the condition of emergency sepsis patients, improve haemodynamics, reduce the incidence of ARDS and prevent patient deaths. It is worthy of clinical application.