Lower Systolic Pressure Research Articles

The effects of centre-based rehabilitation after acute myocardial infarction on exercise capacity and risk factors for coronary heart disease

Background Rehabilitation following acute myocardial infarction (AMI) is a crucial part of secondary prevention for coronary heart disease. The aim of our study was to determine the efficiency of our national in-patient rehabilitation program in improving exercise capacity and lowering risk factors for coronary heart disease. Methods 25 patients 3-9 weeks after AMI, undergoing 2 week in-patient cardiac rehabilitation, were included in our study. We performed exercise stress testing and measurement of classic risk factors before and after the rehabilitation. Classic risk factors were compared with 25 age matched adults without known risk factors for coronary heart disease. Results Patients after AMI had lower exercise capacity than healthy adults (p≤0.002 for double product, maximal load, systolic blood pressure, heart rate and time of load). Patients recieved appropriate drug therapy after myocardial infarction, which presented as lower diastolic and a trend to lower systolic blood pressure (p=0.002 and 0.080), lower total and LDL cholesterol values (both p<0.001) than healthy adults, but higher values of metabolic syndrome parameters (higher waist cifcumference p=0.045, higher hip-waist ratio, lower HDL cholesterol, both p<0.001, and a trend to higher body mass index). Although we observed significant increases in exercise capacity (higher, maximal load, systolic blood pressure,double product and time of load, all p≤0.003), no changes in classic risk factors during rehabilitaiton were demonstrated. Conclusions In-patient program of cardiac rehabilitation efficiently elevates exercise capacity in patients after AMI, but fails to influence classic risk factors for coronary heart disease, which might be due to lack of controlled cardioprotective diet during rehabilitation.

Elderly CAD Patients: Keep Systolic Value Below 140 mm Hg

Elderly hypertensive patients who had coronary artery disease and a baseline systolic blood pressure greater than 150 mm Hg had signifi cantly fewer cardiovascular deaths and strokes if they achieved a systolic pressure of less than 140 mm Hg, compared with similar patients who achieved a systolic pressure of 140-149 mm Hg. The fi ndings were noted in a posthoc analysis of data collected from more than 8,000 patients in an international treatment study. The researchers compared outcomes for patients who achieved these two diff erent levels of systolic pressure as a way to assess the new hypertension treatment goal of a systolic pressure less than 150 mm Hg in patients aged 60 years or older as recommended by the group originally appointed as the Eighth Joint National Committee ( JNC 8) ( JAMA 2014;311:507-20 ). Their fi nding that the patients who achieved the lower systolic pressure level of less than 140 mm Hg had a signifi cantly lower rate of cardiovascular death and stroke as compared with patients whose systolic pressure remained in the 140-149 mm Hg range provided “important information to focus the risk-benefi t discussion for patients who had on-treatment blood pressure in the 140-150 mm Hg range,” wrote Sripal Bangalore, MD, a cardiologist at New York University and his associates in a recently published article ( J Am Coll Cardiol 2014;64:784-93). At least one expert questioned the ability of such a post-hoc analysis to address BP goals in a meaningful way. “To adjudicate between a target of 140 mm Hg and 150 mm Hg it would be necessary to perform a prospective trial in which the population was randomized to these targets,” commented Alan H. Gradman, MD, in an editorial that accompanied the study ( J Am Coll Cardiol 2014;64:794-6). More aggressive BP lowering could result in increased adverse events, he said. Despite these limitations, other experts hailed the new fi nding as important evidence against the recommendations of the former JNC 8 committee. “This study supports the concerns raised by many stakeholders, including the American College of Cardiology [ACC], the American Heart Association [AHA], and a number of the individual members of the JNC 8 panel ( Ann Intern Med 2014;160:499-503 ), about the panel’s 2013 recommendations to raise blood pressure targets in older patients,” said Patrick T. O’Gara, MD, ACC president, and Elliott Antman, MD, AHA president, in a joint written statement released to coincide with the new report’s publication. “This new research suggests that raising the threshold for treatment of hypertension in patients 60 years of age or older with coronary artery disease may be detrimental to the best interest of patients and the public. It Elderly CAD Patients: Keep Systolic Value Below 140 mm Hg

Comparison of Outcomes of Ambulance Users and Nonusers in ST Elevation Myocardial Infarction

In a systematic province-wide evaluation of care and outcomes of ST elevation myocardial infarction (STEMI), we sought to examine whether a previously documented association between ambulance use and outcome remains after control for clinical risk factors. All 82 acute care hospitals in Quebec (Canada) that treated at least 30 acute myocardial infarctions annually participated in a 6-month evaluation in 2008 to 2009. Medical record librarians abstracted hospital chart data for consecutive patients with a discharge diagnosis of myocardial infarction who presented with characteristic symptoms and met a priori study criteria for STEMI. Linkage to administrative databases provided outcome data (to1year) and co-morbidities. Of 1,956 patients, 1,222 (62.5%) arrived by ambulance. Compared with nonusers of an ambulance, users were older, more often women, and more likely to have co-morbidities, low systolic pressure, abnormal heart rate, and a higher Thrombolysis In Myocardial Infarction risk index at presentation. Ambulance users were less likely to receive fibrinolysis or to be sent for primary angioplasty (78.5% vs 83.2% for nonusers, p= 0.01), although if they did, treatment delays were shorter (p <0.001). The 1-year mortality rate was 18.7% versus 7.1% for nonusers (p <0.001). Greater mortality persisted after adjusting for presenting risk factors, co-morbidities, reperfusion treatment, and symptom duration (hazard ratio 1.56, 95% confidence interval 1.30 to 1.87). In conclusion, ambulance users with STEMI were older and sicker than nonusers. Mortality of users was substantially greater after adjustment for clinical risk factors, although they received faster reperfusion treatment overall.

Surgical treatment for aortic coarctation and/or aortic hypoplasty associated with intracardiac anomalies in infants

Objective To summarize the experiences of surgical treatment for aortic coarctation and/or aortic hypoplasty associated with intracardiac anomalies in infants. Methods The clinical data of 51 cases with aortic coarctation and/or aortic hypoplasty hospitalized in Wuhan Children's Hospital between Jan.2010 and Jun.2013 were analyzed retrospectively.Thirty-two patients had received a expanded end-to-end anastomosis and 19 patients had got a end-to-side anastomosis.Autologous pericardial patch, bovine pericardial patch or autologous pulmonary patch was taken according to the circumstances during surgery. Results There were 2 intraoperative deaths because of serious low cardiac output syndrome, and 2 postoperative deaths, which could not take off long-term respiratory assistance after surgery in aortic one child and low cardiac output syndrome in the other.Three patients appeared trachyphonia but recovered basically after 3 months follow-up.Forty-seven patients were followed up for 2 months-3 years, among them, 3 patients had significant upper to lower extremity systolic blood pressure gradient[>20 mmHg(1 mmHg=0.133 kPa)], and a second operation was proposed recently for 1 of them, while the other 2 children were in follow-up.The other 44 patients did not appear obvious restenosis.The 47 cases of children had no neurologic symptoms. Conclusions There have to be positive diagnoses and strictly surgery indications for aortic coarctation and/or hypoplasty associated with intracardiac anomalies in infants.Selective antegrade cerebral perfusion or deep hypothemic circulatory arrest depends on the surgon's discretion.Both expanded end-to-end anastomosis and end-to-side anastomosis can achieve good operation effects. Key words: Aortic coarctation; Aortic hypoplasty; Surgical treatment

Predictors of successful percutaneous transvenous mitral commissurotomy using the Bonhoeffer Multi-Track system in patients with moderate to severe mitral stenosis: Can we see beyond the Wilkins score?

ObjectiveTo know the predictors of a successful outcome of percutaneous transvenous mitral commissurotomy (PTMC) other than described in the Wilkins scoring system.MethodsTwo hundred fifty-eight consecutive patients were enrolled for this observational study in a tertiary care heart center of Pakistan who had a Wilkins score of ≤8. Patients with more than mild mitral regurgitation (MR) or having a clot in the left atrium were excluded. The Bonhoeffer multi-track system was used as a default technique. Successful PTMC was defined as achieving a mitral valve area (MVA) of ≥1.5 cm2 with no more than mild MR.ResultsOut of 258 PTMC procedures, 197 were successful. The Bonhoeffer multi-track system was used in ~94% cases. Among unsuccessful procedures, 41 patients did not achieve the required valve area, and 21 patients developed more than mild MR, including those 8 patients who did not achieve the required valve area and had more than mild MR. Bigger mean annulus size (33.5±2.6 versus 32.8±2.1 mm; p=0.02) and pre-procedure MVA (0.93±0.1 versus 0.87±0.1 cm2; p=0.002) had a significant effect on successful PTMC. Lower mean preprocedure systolic right ventricular pressure on echo (65.4±19.4 versus 75.3±18 mm Hg; p=0.000) and on cath (74±21.5 versus 81.5±24.6 mm Hg; p=0.002), lower grade of left ventricular dysfunction (p=0.04), and tricuspid regurgitation on echo (p=0.003) also had positive effects on the outcome.ConclusionBigger preprocedure mitral valve annulus size and mitral valve area, and better left and right ventricular hemodynamics are correlated with successful PTMC.

English

Spinal anaesthesia is very popular for cesarean section and currently both hyperbaric and plain solutions of local anaesthesia along with opioids are used. Difference in the baricity can affect the intrathecal distribution of local anaesthetics. AIM: We compared the effects of intrathecal hyperbaric (heavy) 0.5% bupivacaine and isobaric (plain) 0.75%ropivacaine combined with 25micro grams fentanyl regarding the degree of sensory and motor block, quality of intraoperative anaesthesia, side effects and post-operative analgesia in patients undergoing cesarean section by doing a randomized controlled study. MATERIALS AND METHODS: Sixty women undergoing caesarean section were randomized into two groups, Group BF (n=30), group RF (n= 30). Group BF received 10 mg (2 ml) of 0.5% hyperbaric bupivacaine with 25µgs of preservative free fentanyl and Group RF received 15mgs (2ml) 0.75% plain Ropivacaine (isobaric) with 25µgs of fentanyl for spinal anaesthesia. In case of insufficient blocks both the groups were supplemented with analgesic dose of ketamine. RESULTS: No difference was observed in onset time, highest level and recovery of sensory block. Recovery of motor block was slightly prolonged in RF group. The incidence of insufficient block requiring ketamine supplementation and duration of postoperative analgesia was same in both groups. The side effects were also similar in both the groups except for hypotension lower systolic pressure in BF group. The neonatal outcome was unaffected. CONCLUSION: In this study we did not find any difference in the two groups despite difference in density suggesting that the spread of spinal solution is not dependent on density in patients undergoing caesarean section.

Hypertension in Primary Open Angle Glaucoma

The impact of vascular factors in POAG is well known and controversial. Some reports have shown high blood pressure in POAG, some low systolic blood pressure and some described no difference in blood pressure between POAG and controls. However decreased ocular perfusion pressure was found in most of the studies. Our study aims to assess the role of hypertension in POAG . It was cross-sectional case-control hospital based study carried out from 1st June 2012 to 1st June 2013. There were 40 cases and 100 controls included in the study. The role of hypertension were compared with those hypertensive patients with glaucoma (cases) and hypertensive patients without glaucoma (controls). Age above 50 years (odds ratio: 4.827 with 95% CI 1.862-12.517), male genders (odds ratio: 3.10 with 95% CI 1.356-7.146) and low diastolic perfusion pressure (odds ratio: 3.857 with 95% CI 1.362-11.224) showed strongly positive association with POAG. High systolic blood pressure (odds ratio: 1.476 95% CI 0.627-3.476), high diastolic blood pressure (odds ratio: 1.348 95% CI 0.587-3.096) and low systolic perfusion pressure (odds ratio: 1.8661 with 95% CI 0.649- 5.335) were weakly associated with glaucoma in our study. Age above 50 years, male gender and low diastolic perfusion pressure were strong risk factor for the development of POAG.

Nutritional characteristics of chronic fatigue syndrome in Korean college students (628.16)

This study was conducted to investigate the relationship nutritional characteristics and chronic fatigue in college students in Korea. Total subjects were 130 students which numbers of male and female were sixty respectively. The measurement for chronic fatigue was Korean version of Fatigue Assessment Instrument (FAI). And blood pressure and body fat contents etc. were analyzed. In the case that the average BMI was 21, the group with high systolic pressure showed lower FAI scores than the group with low systolic pressure. The same pattern was showed in diastolic pressure and % body fat except blood glucose level. Moreover the sleep tended to be longer in the high systolic pressure group even though there was no significant difference. Between the group that BMI was under 18.9 and the group BMI was over 24, the former group showed higher FAI scores than the latter. The results might suggest that some increase of blood pressure and body fat could alleviate the chronic fatigue syndrome in adults.Grant Funding Source: Kyungnam University

Childhood family living arrangements and blood pressure in black men: the Howard University Family Study.

Black men have higher blood pressure (BP) levels and consequently higher prevalence of hypertension compared with men from other ethnic groups in the United States. Socio-familial factors in childhood have been found to play an important role in hypertension, but few studies have examined this relationship among black men. We investigated whether childhood family living arrangements are independently associated with mean BP and hypertension in a cross-sectional sample of 515 unrelated black male participants aged ≥20 years enrolled in the Howard University Family Study between 2001 and 2008. Black men who lived with both parents compared with the reference group of men who never lived with both parents during their lifetime had lower systolic BP (-4.4 mm Hg [95% confidence interval {CI}, -7.84 to -0.96]), pulse pressure (-3.9 mm Hg [95% CI, -6.28 to -1.51]), and mean arterial BP (-2.0 mm Hg [95% CI, -4.44 to 0.51]). This protective effect was more pronounced among men who lived with both parents for 1 to 12 years of their lives; they had decreased systolic BP (-6.5 mm Hg [95% CI, -10.99 to -1.95]), pulse pressure (-5.4 mm Hg [95% CI, -8.48 to -2.28]), mean arterial pressure (-3.3 mm Hg [95% CI, -6.56 to 0.00]), and a 46% decreased odds of developing hypertension (odds ratio=0.54; 95% CI, 0.30 to 0.99). No statistically significant associations were found for diastolic BP. These results provide preliminary evidence that childhood family structure exerts a long-term influence on BP among black men.

Cold pressor response in high landers versus low landers.

Native high landers face two main environmental challenges i.e. hypobaric hypoxia and low ambient temperatures. Both factors contribute to increased sympathetic stimulation and increased blood pressure. Despite these challenges, subjects living at high altitude have lower systolic and diastolic pressures as compared to subjects living in plains. Present study investigated cold pressor test (CPT) which is a potential predictor of future hypertension in high landers and low landers Materials and Methods: Vascular reactivity in terms of changes in systolic and diastolic blood pressure and heart rate in response to cold pressor test has been compared in high lander (n=45) and low lander (n=46) population. Systolic and diastolic blood pressure changes and heart rate changes with cold pressor test are lower in high landers as compared to low landers. Females in both the groups in general exhibited greater cold pressor response than males. Hypo-reactive cold pressor test is due to higher parasympathetic tone and lower sympathetic tone. Decreased cold pressor response in high landers reflects another adaptive modulation of sympatho-vagal activity that enables them to stay in hypobaric atmosphere and lower temperatures without undue autonomic stress.

Effects of praeruptorin C on blood pressure and expression of phospholamban in spontaneously hypertensive rats

BackgroundThe traditional Chinese medicine Praeruptorin c (Pra-c) has many physiological and pharmacological effects, including antagonistic effects on blood pressure and calcium levels, maintenance of cellular calcium homeostasis, and improved cardiac systolic and diastolic function. It is potentially a novel and versatile drug for the treatment and prevention of cardiovascular diseases. ObjectiveTo explore the possible impact of Pra-c on blood pressure in SHR and its mechanism of action. Materials and methodsTwenty SHR were randomly divided into a Pra-c group [Pra-c was administered intragastrically, 20mgkg−1d−1, n=10] or an untreated control group (n=10), containing 10 age-matched SD rats. Each group of rats was followed for 8 weeks. Before and during the treatment, tail artery systolic blood pressure was measured using a tail-cuff every 2 weeks. After 8 weeks, the rats were sacrificed and RNA was extracted from homogenates of cardiac tissue. Tissue from the left ventricle was fixed, sectioned and H&E stained to assess possible changes in myocardial cell structure and morphology. Semi-quantitative RT-PCR was used to assess changes in phospholamban gene expression in treated and untreated rats. ResultsSHR treated with Pra-c for 8 weeks had a lower systolic pressure than untreated SHR (p<0.05), two measures of cardiac damage, the heart mass index and left ventricle mass index (HMI and LVMI, respectively) were improved, and the level of PLB mRNA expression was lower in the untreated SHR group (p<0.05). Discussion and conclusionWith continuous hypertension, SHR gradually formed or developed cardiac hypertrophy and fibrosis. Pra-c had a clear effect on blood pressure in SHR, and reversed SHR ventricular remodeling by upregulating the gene expression of sarcoplasmic reticulum PLB.

Positive effect of mushrooms substituted for meat on body weight, body composition, and health parameters. A 1-year randomized clinical trial

Reducing energy density (ED) of the diet is an important strategy for controlling obesity. This 1-year, randomized clinical trial examined the effect of substituting mushrooms for red meat (‘mushroom diet’), compared to a standard diet (‘meat diet’), on weight loss and maintenance among 73 obese adults (64 women, 9 men). The subjects completed anthropometric measurements and 7-day food records four times during a standardized weight loss and maintenance regimen. At the end of the 1-year trial, compared to participants on the standard diet, participants on the mushroom diet (n=36) reported lower intakes of energy (mean±[SE]=−123±113kcals) and fat (−4.25±6.88g), lost more pounds and percentage body weight (−7.03±3.34lbs, 3.6%), achieved lower body mass index (−1.53±0.36), waist circumference (−2.6±3.5in.) and percent total body fat (−0.85±0.53), and had lower systolic and diastolic pressure (−7.9 and −2.5mmHg); their lipid profile and inflammatory markers also improved. After initial weight loss, subjects following the mushroom diet maintained that loss well. Those who completed the full 12-month trial still weighed a mean of 7lbs less than baseline. Thus, encouraging adults to substitute mushrooms for red meat was a useful strategy for enhancing weight loss, weight maintenance, and health parameters.

Abstract 607: Combined Intracerebroventricular Angiotensin-(1-7) and Candesartan Normalizes Blood Pressure and Improves Baroreflex Function in Transgenic (mRen2)27 Hypertensive Rats

Transgenic (mRen2)27 rats that over express the murine Ren2 gene are hypertensive and have impaired baroreflex sensitivity (BRS) for control of heart rate (HR). We previously showed that infusion of central angiotensin-(1-7) [Ang-(1-7)] improved the vagal components of the BRS independent of altering mean arterial pressure (MAP) but that, AT 1 receptor blockade normalized MAP and blood pressure variability (BPV) without correcting the BRS. To determine if the overall sympathovagal imbalance and the BRS function can be corrected by supplementing Ang-(1-7) in combination with AT 1 receptor blockade, we compared intracerebroventricular (ICV) infusions of the AT 1 receptor antagonist candesartan (CV: 4 ug/5uL/hr) and Ang-(1-7) [0.1 ug/5uL/hr; n = 4] or artificial cerebrospinal fluid (aCSF; 5 uL/hr; n = 8) for 4 weeks in 18 week old male (mRen2)27 rats. MAP was significantly reduced in CV/ Ang-(1-7) treated rats [71 ± 13 vs. aCSF: 132 ± 12 mm Hg; p = 0.01] with no changes in HR. Lowering of MAP was associated with a reduction in low frequency systolic arterial pressure, an index of BPV, [LF-SAP%: 32 ± 8 vs. aCSF: 73 ± 10, p = 0.02] in these animals. Both vagal [high frequency alpha: 1.1 ± 0.3 vs. aCSF: 0.6 ± 0.1, p= 0.05 and Sequence UP: 1.7 ± 0.4 vs. aCSF: 0.7 ± 0.1, p= 0.03] and sympathetic [low frequency alpha: 0.65 ± 0.14 vs. aCSF: 0.34 ± 0.03, p= 0.02 and Sequence DOWN: 1.4 ± 0.3 vs. aCSF: 0.76 ± 0.1, p= 0.01] components of the BRS were significantly increased resulting in improvements in the overall BRS [Sequence ALL: 1.6 ± 0.3 vs. aCSF: 0.75 ± 0.1, p= 0.01] as well as the sympathovagal imbalance [LF RRI /HF RRI : 0.2 ± 0.1 vs. aCSF: 2.3 ± 0.6, p= 0.004] in treated animals. Thus, combination ICV therapy normalized MAP and corrected the sympathovagal imbalance leading to improved BRS function. Since impaired BRS significantly associates with cardiovascular pathologies independently from hypertension, specifically targeting an increase in central Ang-(1-7) with reduced Ang II actions to provide improved BRS and lower MAP may achieve a more optimal therapeutic benefit.

Risk factors for long-term mortality in tricuspid valve replacement

Purpose: Tricuspid valve replacement (TVR) has historically been associated with high mortality and unfavourable long-term outcomes. However the mortality risk factors are not well known. The aim of this study is to report the clinical characteristics and risk factors for mortality in patients submitted to TVR in our institution. Methods: Between January 1996 and December 2012, 68 consecutive patients undergoing isolated or combined TVR were registered. Clinical, laboratory, and echocardiographic findings were collected before and after surgery. The mean follow up was 4.1 years, and only one patient was lost during the study period. Results: The mean age was 62±10.4 years, and 79% were females. The etiology of the tricuspid valve disease was: rheumatic (63.2%), functional (17.6%), infective endocarditis (7.4%), congenital (1.5%), degenerative (1.5%), and prosthetic valve failure (8.8%). Mitral valve disease was associated in 58.2% of patients. The 60.3% of patients had previous cardiac surgery. TVR was performed with a mechanical valve in 92.6% of patients. Right heart failure and NYHA class III-IV were present in 75% and 58.4%, respectively. Preoperative echocardiographic data showed moderate-severe tricuspid regurgitation in 89.5%, right ventricular (RV) dilation and reduced RV contractility in 32.3% and 21%, respectively. Mean hospitalization was 14.5 days. Most common postoperative complications were: right heart failure (35.8%), need for inotropic drug support (54.5%), shock (25%), bleeding (22.7%) and acute renal failure (22.4%). Overall operative mortality was 17.9%. Total mortality, including operative, was 34.3%. Risk factors for increased total mortality were: diabetes mellitus (35% vs 7%, p=0.016), ischemic heart disease (22% vs 0%, p=0.022), lung disease (35% vs 12%, p=0.048), lower levels of alanine transaminase (19±9.3 vs 33±26.1, p<0.046), lower preoperative systolic pulmonary artery pressure (41±7.7 vs 47±13.5, p=0.037), and higher levels of urea (11±3.3 vs 8±2.5, p=0.02). No relationship was observed between long term mortality and advanced functional class, preoperative right heart failure, RV dilation or RV dysfunction. Conclusions: Patients requiring TVR are at high risk. Predictors for long term mortality are: preoperative diabetes mellitus, ischemic heart disease, lung disease, levels of alanine transaminase and urea, and systolic pulmonary artery pressure. In contrast, preoperative RV size and function, right heart failure or NYHA functional class were not related to long-term mortality.

Application Research of the Power Spectrum Estimation in the Ankle-Brachial Index Detection

The key of ankle-brachial index (ABI) measurement is accurately measurement of upper and lower extremities systolic pressure. When the blood flow is blocked, blood flow will resume a normal beat and the corresponding cuff pressure of the first trough starting point is the systolic pressure. First it detects the pulse signal main frequency by spectral analysis of the pulse signal which based on the power spectrum estimation. Regarding pulse signal frequency as the basic standard, it achieves power spectrum estimation of blood flow signal with a sliding window. Last it achieves locating the position of systolic pressure by detecting whether the blood flow signal frequency and the pulse signal frequency are the same. Through simulation and experiments, it can achieve accurate detection of systolic pressure and automatic measurement of ankle-brachial index by application of this method.

Assessment of mitochondrial DNA ND2 gene C5178A polymorphism for cerebral-cardiovascular complications in patients with type 2 diabetes mellitus

Objective To assess the relationship between mitochondrial DNA (mtDNA) ND2 gene C5178A polymorphism and complications of cardio-cerebral-vascular in patients with type 2 diabetes mellitus (T2DM). Methods This is a case-control study.448 unrelated patients with T2DM were collected from Zhejiang Provincial People′s Hospital from 2010 to 2011,including 274 males and 174 females.Direct nucleotide sequencing analysis was used to screen mt DNA ND2 gene C5178A genotyping in patients.Meanwhile,detailed clinical and laboratory information for all of study subjects were collected.Body mass index (BMI),blood pressure,blood lipid,blood glucose and incidence rate of cerebral infarction were compared between 5178C patients and 5178A patients.Furthermore,according to the genotyping results,we analyzed whether these differences exist in patients with different gender by using t test or χ2test. Results 348 out of 448 patients with T2DM were C carriers and the remaining patients were A carriers.There′re significant differences between T2DM patients with 5178A and T2DM patients with 5178C on systolic pressure (124.6 mm Hg±9.0 mm Hg vs 127.8 mm Hg±10.7 mm Hg,t=2.700,P=0.007) and HDL (1.3 mmol/L±0.2 mmol/L vs 1.2 mmol/L±0.3 mmol/L,t=2.968,P=0.003).Moreover,the incidence of cerebral infarction in T2DM patients with 5178A (8.0%,8/100) was much lower than that with 5178C (21.0%,73/348; χ2=8.832,P=0.003).No statistical gender difference was found in the distribution of C5178A (P>0.05).Our results also revealed that the female T2DM patients with 5178A had a lower serum triglyceride (1.5 mmol/L±0.8 mmol/L; t=2.601,P=0.011) and lower systolic pressure (123.6 mm Hg±6.6 mm Hg;t=2.887,P=0.004) than that with 5178C (1.8 mmol/L±1.0 mmol/L and 128.0 mm Hg±9.0 mm Hg, respectively).Furthermore,cerebral infarction was more common in female T2DM patients with 5178C (21.3%,29/136;χ2=5.232,P=0.022) than that with 5178A (5.3%,2/38).Similarly,male T2DM patients with 5178A had a much lower incidence rate of cerebral infarction (9.7%,6/62;χ2=3.946,P=0.047) than that with 5178C (20.7%,44/212).In contrary, the serum concentration of HDL was higher in male T2DM patients with 5178A (1.4 mmol/L±0.2 mmol/L; t=3.511,P=0.001) than that with 5178C (1.2 mmol/L±0.3 mmol/L). Conclusions The polymorphism site mtDNA C5178A correlates with cerebral-cardiovascular complications in patients with type 2 diabetes mellitus.mt DNA 5178A allele may protect T2DM patients from developing cerebral-cardiovascular diseases through regulation of blood pressure and lipid metabolism.(Chin J Lab Med,2013,36:519-522) Key words: Diabetic angiopathies; Diabetes mellitus; type2; Brain infarction; NADH dehydrogenase; DNA; Mitochondrial; Polymorphism; genetic

Effects of cognitive behavioral therapy on psychological and physiological status of hypertension patients in community

Objective To investigate the influence of psychological intervention in emotional disorder on blood pressure, lipids and glucose in hypertensive patients in community. Methods 599 hypertensive in community were divided to intervention group (n=302) and control group (n=297) by randomization. The control group received routine medication.Additionally the intervention group got another psychological intervention which lasted 6 months. An SCL-90 scale was adopted to evaluate patients' psychological change of mental health, blood sugar, low density lipoprotein cholesterol, total cholesterol, systolic pressure and diastolic blood pressure before and after treatment. Results Somatization, compulsion, interpersonal relationship, depression, anxiety, hostility and terror in intervention group((1.44±0.29), (1.78±0.39), (1.66±0.38), (1.63±0.48), (1.43±0.35), (1.37±0.52)and(1.28±0.41) respectively)had a lower score than control group((2.01±0.59), (2.04±0.68), (1.88±0.38), (1.84±0.59), (1.92±0.54), (1.61±0.53)and(1.60±0.50)). The differences were significant(P<0.01). After intervention, blood glucose, low density lipoprotein, total cholesterol, systolic pressure, and diastolic pressure were((4.65±0.811)mmol/L, (2.97±0.702)mmol/L, (4.86±0.884)mmol/L, (134.11±13.39)mm Hg(1 mm Hg=0.133 kPa) and (93.73±7.61)mm Hg respectively) and before intervention((5.09±0.710)mmol/L, (3.23±0.584)mmol/L, (5.36±1.138)mmol/L, (150.13±12.23)mm Hg and (89.64±8.35)mm Hg respectively). The differences were significant(P<0.05). Conclusion Cognitive behavioral therapy can improve community hypertension patients’ physiology and psychology, which is good for blood pressure, lipids, glucose control. Key words: Cognitive behavioral therapy; Hypertension; Physiology; Psychology

Safety and efficacy of simultaneous bilateral carotid angioplasty and stenting

In this study, we aimed to evaluate the safety and feasibility of simultaneous bilateral carotid artery stenting (BCAS) compared with staged BCAS in patients with bilateral atherosclerotic carotid stenosis (BCS). From January 2004 to March 2012, 68 patients who underwent BCAS were identified from the Nanjing Stroke Registry Program. Of these patients, 42 (61.8%) underwent simultaneous BCAS (simultaneous group), and 26 (38.2%) underwent staged BCAS (staged group). We compared demographic data, major vascular risk factors, procedural parameters, and 30day outcomes between the simultaneous and staged groups. No significant differences were detected in baseline data between the groups. Patients in the simultaneous group had a lower post-operative systolic pressure compared with the staged group (119.1±16.1 vs. 130.2±17.5mmHg, P=0.009). Technical success was 100% of patients in the simultaneous group and 98.1% in the staged group. Hemodynamic depression was observed in 57.4% of procedures, with no significant difference between groups in the rate of HD. Four (5.9%) patients had neurological complications within 30days, including two cases of hyperperfusion syndrome in the simultaneous group, and two ischemic events in the staged group. There was no significant difference in the 30day complication rate between the simultaneous and staged groups (4.8 vs. 7.7%, P=0.633). Simultaneous BCAS may be safe and feasible for most patients with BCS, with a similar 30day complication rate to staged BCAS. Multicenter randomized control studies with larger sample sizes are warranted to further explore the safety and efficacy of simultaneous BCAS.

Effect of Vitamin D Supplementation on Blood Pressure in Blacks

Blacks have significantly higher rates of hypertension than whites, and lower circulating levels of 25-hydroxyvitamin D. There are few data about the effect of vitamin D3 (cholecalciferol) supplementation on blood pressure in blacks. During 2 winters from 2008 to 2010, 283 blacks (median age, 51 years) were randomized into a 4-arm, double-blind trial for 3 months of placebo, 1000, 2000, or 4000 international units of cholecalciferol per day. At baseline, 3 months, and 6 months, systolic and diastolic pressure and 25-hydroxyvitamin D were measured. The 3-month follow-up was completed in 250 (88%) participants. The difference in systolic pressure between baseline and 3 months was +1.7 mm Hg for those receiving placebo, -0.66 mm Hg for 1000 U/d, -3.4 mm Hg for 2000 U/d, and -4.0 mm Hg for 4000 U/d of cholecalciferol (-1.4 mm Hg for each additional 1000 U/d of cholecalciferol; P=0.04). For each 1-ng/mL increase in plasma 25-hydroxyvitamin D, there was a significant 0.2-mm Hg reduction in systolic pressure (P=0.02). There was no effect of cholecalciferol supplementation on diastolic pressure (P=0.37). Within an unselected population of blacks, 3 months of oral vitamin D3 supplementation significantly, yet modestly, lowered systolic pressure. Future trials of vitamin D supplementation on blood pressure are needed to confirm these promising results, particularly among blacks, a population for whom vitamin D deficiency may play a more specific mechanistic role in the pathogenesis of hypertension.

Commentary on: Six Things Every Plastic Surgeon Needs to Know About Teamwork Training and Checklists

Recently, I performed a seemingly uneventful inframammary breast augmentation, something that could be considered a “routine case.” Two hours later, I was called to the recovery room and discovered a major, painful swelling of the left breast. I took the patient back to the operating room for revision, drained 350 mL of hematoma, and found a small pulsating artery, which was easily cauterized. The patient recovered well, with no further complications, and is now happy with the result. In a meeting with the team after the operation, we discussed several factors that could have contributed to this complication. Among them were pressure to finish the case before the staff change at 4 pm and a moment of low systolic pressure just before closing the wound. However, what struck me the most during this meeting was when the nurse told me that the bleeding was exactly where she had expected it, because she had seen some minor bleeding there before we finished the first operation. When I asked her why she hadn't told me about it then, she said she had been afraid because she was new to our center and it was the first time she had worked with me. Also, she was sure that I had seen the bleeding and thought I had not been concerned about it. This clinical example can teach us several important lessons: