Mean Arterial Pressure Values Research Articles

High Tissue Factor Microparticle Level in Major Thalassemic Patients with Pulmonary Hypertension

Objective: To analyze the correlation between tissue factor microparticles (TF-MP) levels and pulmonary hypertension (PH) in adult thalassemic patients. Methods: This study was conducted from September to October 2018, using secondary and primary data. The secondary data consisted of the PH parameter, which was retrieved from a 2017 previous study entitled ‘Clinical Characteristic and Complication due to Iron Overload in Thalassaemic Patients‘in 2017 while the primary data were the TF-MP, which were obtained from the analysis of frozen serum of the same population using ELISA method. The mean pulmonary arterial pressure (mPAP) values were obtained from echocardiography results and PH was defined as mPAP >25 mmHg. Results: Seven (16.7%) major thalassemic patients experienced PH. The median values of TF-MP levels were higher among major thalassemic patients with PH when compared to the non-PH patients (1569 vs 11.5 pg/dL; p=0.023). No significant difference was observed in the median TF-MP levels between subjects with splenectomy and subjects without splenectomy (11.6 vs 12.3 pg/dL; p=0.44). There was also no difference in mPAP values between subjects with splenectomy and subjects without splenectomy (18.0 vs 17.0 mmHg; p=0.663). When the median TF-MP levels among major thalassemic patients were analyzed in terms of correlation with transfusion level, no statistically significant difference was seen between subjects who received sufficient transfusions (≥180 mL/kgbb/year) and those who received insufficient transfusions (<180 mL/kgbb/year) (r= 0.138; p=0.390). Conclusions: There is a positive correlation between the TF-MP levels and PH in adult major thalassemic subjects.

Early prediction of preeclampsia and small-for-gestational-age via multi-marker model in Chinese pregnancies: a prospective screening study

BackgroundRecent evidence suggests early screening of preeclampsia and small-for-gestational-age (SGA) would benefit pregnancies followed by subsequent prophylactic use of aspirin. Multi-marker models have shown capability of predicting preeclampsia and SGA in first trimester. Yet the clinical feasibility of combined screening model for Chinese pregnancies has not been fully assessed. The aim of this study is to evaluate the applicability of a multi-marker screening model to the prediction of preeclampsia and SGA in first trimester particularly among Chinese population.MethodsThree thousand two hundred seventy pregnancies meeting the inclusion criteria took first-trimester screening of preeclampsia and SGA. A prior risk based on maternal characteristics was evaluated, and a posterior risk was assessed by combining prior risk with multiple of median (MoM) values of mean arterial pressure (MAP), serum placental growth factor (PLGF) and pregnancy associated plasma protein A (PAPP-A). Both risks were calculated by Preeclampsia PREDICTOR™ software, Perkin Elmer. Screening performance of prior and posterior risks for early and late preeclampsia by using PREDICTOR software was shown by Receiver Operating Characteristics (ROC) curves. The estimation of detection rates and false positive rates of delivery with both preeclampsia and SGA was made.ResultsEight cases developed early preeclampsia (0.24%) and 35 were diagnosed as late preeclampsia (1.07%). Five with early preeclampsia and ten with late preeclampsia later delivered SGA newborns (0.46%); 84 without preeclampsia gave birth to the SGAs (2.57%). According to ROC curves, posterior risks performed better than prior risks in terms of preeclampsia, especially in early preeclampsia. At 10% false positive rate, detection rates of early and late preeclampsia were 87.50 and 48.57%, detection rates of early and late SGA were 41.67 and 28.00%, respectively. For SGA, detection rates in cases with preeclampsia were much higher than those in absence of it.ConclusionsThis study demonstrates that combined screening model could be useful for predicting early preeclampsia in Chinese pregnancies. Furthermore, the performance of SGA screening by same protocol is strongly associated with preeclampsia.

Incremental prognostic value of global left atrial peak strain in women with new-onset gestational hypertension.

Left atrial strain and strain rate parameters, measured by bidimensional-speckle tracking echocardiography, have been proposed as predictors of atrial fibrillation, stroke, congestive heart failure and cardiovascular death. However, they have not yet been tested in hypertensive disorders of pregnancy. The aim of this study was to assess the prognostic role of global left atrial peak strain (GLAPS) in a population of pregnant women with new-onset hypertension in a medium-term follow-up. Twenty-seven consecutive women with new-onset hypertension after 20 weeks pregnancy and 23 age-matched, race-matched and gestational week-matched consecutive normotensive pregnant women were enrolled in this prospective study. All participants underwent a complete echocardiographic study with bidimensional-speckle tracking echocardiography and carotid examination. At 1-year follow-up, we evaluated the occurrence of persistent hypertension. In comparison with normotensive women, those hypertensive had a higher burden of cardiovascular risk factors, similar left atrial volume indexed (P = 0.14), but severely impaired left atrial strain (P < 0.0001) and strain rate values (P < 0.0001). At 1-year follow-up, persistent hypertension was documented in 59.3% of patients. At the univariate Cox analysis, the variables associated with the occurrence of the investigated outcome in all hypertensive pregnancies were SBP (hazard ratio 1.04, P = 0.04), DBP (hazard ratio 1.11, P = 0.01), mean arterial pressure (hazard ratio 1.09, P = 0.01) values and the GLAPS value (hazard ratio 0.85, P = 0.0019). The latter was significantly associated with the investigated outcome both in preeclamptic (hazard ratio 0.84, P = 0.02) and nonpreeclamptic pregnant women (hazard ratio 0.83, P = 0.04). The receiver operating characteristics curve analysis highlighted that a GLAPS value of 23.5% or less predicted persistent hypertension with sensitivity of 100% and specificity of 90.90%. In hypertensive pregnant women a GLAPS value of 23.5% or less reveals a greater severity of atrial cardiomyopathy and might predict postpregnancy persistent hypertension.

Diagnosis of irreversible loss of brain function ("brain death")-what is new?

The determination of the irreversible cessation of brain function (ICBF) is conducted in Germany according to the guideline of the German Medical Association, which is currently its fourth update issued in July 2015. This article provides an assessment of the current situation including an international comparison. International case reports with allegedly incorrect ICBF diagnosis are reviewed from the point of view of the German guideline. These case reports underpin the validity of the German guideline, especially its following provisions: (1)in patients with known or suspected adaptation to chronic hypercapnia, apnea cannot be diagnosed as usual; therefore in such acase the proof of cerebral circulatory arrest is mandatory; (2) if perfusion scintigraphy is used for proof of cerebral circulatory arrest, only validated lipophilic radiopharmaceuticals are allowed. This is compatible with new research data which indicate that cellular function can be reactivated for several hours after circulatory arrest but not the brain function. The recently updated recommendations of the German Society for Clinical Neurophysiology and Functional Imaging (DGKN) for ancillary testing include editorial adaptations (e.g., the more precise specification of the electrode positions for electroencephalography), standards of display screen with digital electroencephalography and age-related minimum values of mean arterial pressure for Doppler and duplex sonography in children. The novel requirements regarding the institutional organization of ICBF diagnostics in Germany issued in the "Second law on the amendment of transplantation law-improvement of the cooperation and the framework for organ donation" that became effective recently are presented and discussed critically in this review.

Noninvasive Intracranial Pressure Estimation With Transcranial Doppler: A Prospective Observational Study.

Transcranial Doppler (TCD) ultrasonography has been described for the noninvasive assessment of intracranial pressure (ICP). This study investigates the relationship between standard, invasive intracranial pressure monitoring (ICPi) and noninvasive ICP assessment using a simple formula based on TCD-derived flow velocity (FV) and mean arterial blood pressure values (ICPTCD). We performed a prospective observational study on 100 consecutive traumatic brain injury patients requiring invasive ICP monitoring, admitted to the Neurosciences and Trauma Critical Care Unit of Addenbrooke's Hospital, Cambridge, UK. ICPi was compared with ICPTCD using a method based on the "diastolic velocity-derived estimator" (FVd), which was initially described for the noninvasive estimation of cerebral perfusion pressure but subsequently utilized for ICP assessment. Median ICPi was 13 mm Hg (interquartile range: 10, 17.25 mm Hg). There was no correlation between ICPi and ICPTCD (R=-0.17; 95% confidence interval [CI]: -0.35, 0.03; P=0.097). Bland-Altman analysis demonstrated wide 95% limits of agreement between ICPi and ICPTCD (-27.58, 30.10; SD, 14.42). ICPTCD was not able to detect intracranial hypertension (ICPi >20 mm Hg); the area under the receiver operating characteristic curve for prediction was 34.5% (95% CI, 23.1%-45.9%) with 0% sensitivity and 74.4% specificity for ICPTCD to detect ICPi>20 mm Hg. Using a formula based on diastolic FV, TCD is an insufficiently accurate method for the noninvasive assessment of ICP. Further studies are warranted to confirm these results in a broader patient cohort.

EFFECTS OF THE CHRONIC INHIBITION OF TYPE 5 PHOSPHODIESTERASE ON PENILE MICROVASCULAR ENDOTHELIAL REACTIVITY AND BLOOD PRESSURE IN HYPERTENSIVE PATIENTS WITH ERECTILE DYSFUNCTION

Objective: The primary aim of this study was to test penile endothelial microvascular function and blood pressure in patients with treated primary arterial hypertension, before and after a chronic oral treatment with sildenafil citrate (SIL). Design and method: This was a prospective, randomized, double blinded and crossover study, controlled against placebo (PLA), with 30 day washout between treatments. Penile endothelial-dependent microvascular reactivity of hypertensive patients (aged 57.4 ± 5.6 years, n = 50) was evaluated using cutaneous laser speckle contrast imaging (LSCI) before and after chronic administration of placebo or sildenafil (50 mg twice daily during 30 days). LSCI was coupled with the cutaneous iontophoresis of acetylcholine (ACh) using increasing anodal microcurrents (30–180 μA). The measurements of skin blood flow (arbitrary perfusion units, APU) were divided by values of mean arterial pressure to give the cutaneous vascular conductance (CVC) in APU/mmHg. Erectile function was evaluated using the Simplified International Index of Erectile Function (IIEF-5) score. 24 hour ambulatory blood pressure monitoring (ABPM) was performed using oscillometric devices (Spacelabs). Results: IIEF-5 scores significantly increased after SIL [18(16–20) and 21.5(19.75–23); P < 0.0001] but not after PLA [18(14.75–19.25) and 17.84 ± 3.88; P = 0.16]. The basal values of CVC in the penis increased significantly after SIL (P = 0.004), but not after PLA (P = 0.86). Maximum CVC values after cutaneous ACh administration increased only with SIL treatment (P = 0.001); after PLA (P = 0.63). The area under the curve of penile microvascular vasodilation induced by ACh also significantly increased after SIL (P = 0.003) but not after PLA (P = 0.98). Finally, 24 hours diastolic arterial pressure significantly decreased after SIL (83.5 ± 8.9 and 79.9 ± 8.2; P = 0.0003) but not after PLA (P = 0.27). The decrease in 24-hour systolic blood pressure was not statistically significant after SIL or PLA, but it was significant in the office measurements after treatment with sildenafil [136(130–144.3) and 131.5 (119–139.3); P = 0.02] but not with placebo [136(130.8–145) and 134.7 ± 13;P = 0.23]. Conclusions: Penile endothelium-dependent microvascular reactivity and erectile function improved after chronic treatment with sildenafil. The treatment also reduced blood pressure suggesting that, in addition to the effects on erectile function, chronic treatment with sildenafil could improve blood pressure control.

Effect of Bone Marrow-Derived Mesenchymal Stem Cells on Ischaemic-Reperfused Hearts in Adult Rats with Established Chronic Kidney Disease.

Background and ObjectivesBone marrow-derived mesenchymal stem cells (BM-MSCs) are adult multipotent non-haematopoietic stem cells that have regeneration potential. The current study aimed to detect the ability of BM-MSCs to improve kidney and cardiac functions in adult rats with established chronic kidney disease.MethodsRats were divided into sham-operated control, untreated sub totally nephrectomised and treated sub totally nephrectomised groups. Body weight, kidney and cardiac tissue weights, plasma creatinine and urea levels and arterial blood pressure were measured. ECG was recorded, and an in vitro isolated heart study was performed. Results: Stem cell treatment decreased the elevated plasma creatinine and urea levels and decreased systolic, diastolic and mean arterial blood pressure values. These changes were accompanied by a decrease in glomerular hypertrophy with apparent normal renal parenchyma. Additionally, BM-MSCs shortened Q-To and Q-Tc intervals, all time to peak tension values, the half relaxation value at 30 min of reperfusion and the contraction time at 15 and 30 min of reperfusion. Moreover, stem cell treatment significantly increased the heart rate, QRS voltage, the peak tension at the 15- and 30-min reperfusion time points and the peak tension per left ventricle at the 30-min reperfusion time point compared to the pre-ischaemia baseline. BM-MSCs resolve inter muscular oedema and lead to the re-appearance of normal cardiomyocytes. This improvement occurs with the observations of BM-MSCs in renal and heart tissues.ConclusionsBM-MSCs can attenuate chronic kidney disease progression and the associated cardiac electrophysiological and inotropic dysfunction.

Examining Arm Vascular Function and Blood Flow Regulation in Row-trained Males.

This study sought to determine whether vascular function and blood flow regulation during handgrip exercise are altered in row-trained males. Nine young row-trained males (ROW, 20 ± 1 yr; V˙O2peak = 51 ± 2 mL·kg·min) and 14 recreationally active male controls (C: 22 ± 1 yr; V˙O2peak = 37 ± 2 mL·kg·min) were recruited for this study. Subjects performed multiple bouts of progressive rhythmic handgrip exercise. Brachial artery (BA) diameter, blood flow, shear rate, and mean arterial pressure were measured at rest and during the last minute of each exercise workload. Resting values for BA diameter, blood flow, shear rate, and mean arterial pressure were not different between groups. During handgrip exercise, the ROW group reported significantly lower BA blood flow (ROW vs C: 4 kg [146 ± 21 vs 243 ± 13 mL·min], 8 kg [248 ± 29 vs 375 ± 17 mL·min], 12 kg [352 ± 43 vs 490 ± 22 mL·min]) across all workloads when compared with controls. The examination of BA dilation, when controlled for the shear rate stimulus and evaluated across all workloads, was revealed to be significantly greater in ROW group versus controls. This study revealed that vascular function and blood flow regulation were significantly different in row-trained males when compared with untrained controls evidenced by greater shear-induced BA dilation and lower arm blood flow during progressive handgrip exercise.

Percutaneous transluminal angioplasty alone versus stent placement for the treatment of transplant renal artery stenosis

PurposeThe purposes of this retrospective study were to assess the efficacy of endovascular techniques for the treatment of transplant renal artery stenosis (TRAS) by analyzing technical and clinical success and to compare the results of percutaneous transluminal angioplasty (PTA) alone to those of stenting. Materials and methodsA retrospective analysis was conducted on 31 patients who underwent endovascular treatment for TRAS between January 2012 and December 2017. There were 23 men and 8 women with a mean age of 60.5±14 (SD) years (range: 24–81 years). Ten patients (10/31; 32%; 8 men, 2 women; median age, 63 years) were treated with PTA alone and 21/31 (68%; 15 men, 6 women; median age, 65 years) with metallic stent placement. Several variables including serum creatinine level, glomerular filtration rate, arterial blood pressure value, antihypertensive medication obtained before and after treatment were compared. Technical success was assessed for each procedure. Clinical success was defined as a 15% drop in serum creatinine level, a decrease greater than 15% in mean blood pressure values or a decrease greater than 10% in mean blood pressure values with a reduction in the number of antihypertensive drugs needed for hypertension control. ResultsTechnical success was obtained in all patients [31/31; 100%; 95% confidence interval (CI): 89–100%] and clinical success in 27/31 patients (87%; 95%CI: 71–95%). Four patients (4/31; 13%; 95%CI: 5–29%) underwent repeat endovascular intervention. Mean serum creatinine level and mean arterial blood pressure values were significantly lower after treatment (177.4 and 93.8μmol/l, respectively) compared to before treatment (319.4 and 106.7μmol/l, respectively) in the stent group but not in the group treated with PTA alone (P=0.0012 and P=0.002, respectively). ConclusionThe endovascular approach is safe and effective in the management of TRAS and stenting, depending on the morphology of the stenosis, should be the treatment of choice when possible.

Whole body exercise training improves blood pressure and postural balance responses during orthostatic stress onset in older women

The purpose of the current study was to investigate the effects of whole body exercise training on spontaneous baroreflex sensitivity at rest, blood pressure and postural balance responses during orthostatic onset in older women. The sample composed by eight healthy older women (65±3 yrs.). R‐R intervals and blood pressure were continuously measured from a standard electrocardiogram (ECG) and infrared finger plethysmography, respectively, at rest (10min) and during orthostatic position (7min). Spontaneous baroreflex sensitivity at rest was obtained by spectral method in the low‐frequency component of R‐R and systolic blood pressure time series (αLF). The nadir point was considered the lower value of mean arterial pressure (MAP) during transition from supine to orthostatic position. The percentage changes (%ΔMAP) from supine to orthostatic nadir were calculated. The time of MAP oscillations during orthostatic onset (MAPtime) was calculated by the sum of time to nadir and time to recovery (nearest value of MAP at rest). In addition, during the ORT onset (15s) the center of pressure displacements (COP) were acquired by a force plate, and COP distance and speed were calculated. The whole body exercise training protocol (rowing ergometer) consisted of three weekly sessions (30 minutes) at 60–80% of maximal heart rate (defined by a previous maximal exercise test) for 10 weeks. The volunteers were evaluated pre and post‐trainning. Student‐t tests for paired samples was employed (p≤0.05) to compare all variables. At rest, αLF (pre= 3.9 ±1.7 vs. post= 5.3 ±1.1 ms2 p&lt;0.001) increased post‐training and MAP (pre= 85.1 ±10.3 vs. post= 77.4 ±7.8 mmHg p&lt; 0.02) decreased. No differences in CO (pre= 4.526 ±0.7697 vs. post= 5.058 ±2.104 L/min p=0.02) and SV (pre= 66.33 ±19.94 vs. post= 72.18 ±29.67 mL p=0.01) were found at rest. Although %ΔMAP (pre= −0.3 ±0.2 vs. post= −0.3 ±0.16 mmHg p&lt; 0.19) was not different pre and post training, MAPtime (pre= 14.16 ±3.996 vs. post= 10.94 ±5.637 seconds p&lt;0.04) decreased post‐training protocol. Moreover. COP distance (pre= 673.7 ±74.9 vs. post= 560.3 ±95.1 mm p&lt; 0.03) and speed (pre= 44.9 ±4.9 vs. post= 37.3 ±6.3 mm/s p&lt;0.03) were lower post‐training. Whole body exercise training improves spontaneous baroreflex sensitivity at rest mean arterial pressure and postural balance adjustments during orthostatic stress onset in older women. Research ethics committee (CEP‐851.371/14).Support or Funding InformationFoundation for Research Support of the State of Rio de Janeiro ‐ FAPERJ (E‐6/110.079/2013), Coordination for the Improvement of Higher Education Personnel ‐ CAPES.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Ultrasound-guided continuous serratus anterior plane block: dexmedetomidine as an adjunctive analgesic with levobupivacaine for post-thoracotomy pain. A prospective randomized controlled study.

Purpose: The study aimed to evaluate the analgesic efficiency of dexmedetomidine (DEX) when added to levobupivacaine in continuous ultrasound-guided serratus anterior plane block (SAPB) performed at the end of major thoracic surgery.Methods: This randomized, double-blind trial included 50 adults undergoing thoracic surgery. Continuous SAPB was performed at the end of surgery. Patients were randomized into two groups. Group L (n=25) received levobupivacaine only while Group DL (n=25) received a mixture of levobupivacaine and DEX. All patients received intravenous (IV) paracetamol every 8 hrs. Morphine IV was given according to VAS score of pain as a 5 mg loading dose. The primary outcome measure was postoperative pain intensity. Secondary outcome measures were postoperative morphine consumption and adverse effects.Results: Analgesia was satisfactory in the two groups up to 24 hrs. VAS score was significantly lower in group DL compared to group L between 6 and 24 hrs postoperatively. Total morphine consumption was significantly lower in group DL compared to group L (p<0.001). Up to 12 hrs postoperatively, sedation score was significantly lower in group DL compared to group L. Afterwards, all patients were fully alert. All values of mean arterial pressure and heart rate were within the clinically accepted ranges. There were no recorded cases of hypotension or bradycardia in the whole studied group.Conclusions: Continuous SAPB with levobupivacaine plus DEX seems to be a promising analgesic alternative following thoracotomy. Combined with IV paracetamol, this approach provided adequate analgesia and proper sedation.Trial registration: ISRCTN registry; study ID: ISRCTN35517318

Does Tracheal Lidocaine Instillation Reduce Intracranial Pressure Changes After Tracheal Suctioning in Severe Head Trauma? A Prospective, Randomized Crossover Study.

Tracheal suctioning is a routine procedure in mechanically ventilated children, however, in severe head-injured patients it can result in potential deleterious increase in intracranial pressure. We aimed to assess the effect of tracheal lidocaine administration on intracranial pressure during tracheal suctioning. Prospective randomized controlled crossover study. PICU of a tertiary hospital. Eleven patients with severe head trauma (Glasgow Coma Scale score 4-8) INTERVENTIONS:: Lidocaine (1.5 mg/kg) or saline solution was endotracheally instilled before a standardized tracheal suctioning maneuver. Each patient received both treatments in a crossover design. Cerebral hemodynamic and systemic and ventilatory effects were assessed at four time points: in baseline (T0), within 2 minutes (T1), 5 minutes (T2), and 15 minutes after tracheal instillation (T3). The 2-minute time interval around tracheal suctioning was used to assess each treatment efficacy MEASUREMENTS AND MAIN RESULTS:: The time course of intracranial pressure was different throughout the study in both treatment groups, with a significant increase of intracranial pressure from 14.82 ± 3.48 to 23.27 ± 9.06 with lidocaine (p = 0.003) and from 14.73 ± 2.41 to 30.45 ± 13.14 with saline (p = 0.02). The mean variation in intracranial pressure immediately after tracheal suctioning was smaller with lidocaine instillation than saline (8.45 vs 15.72 mm Hg; p = 0.006). Patients treated with lidocaine returned to baseline intracranial pressure value at 5 minutes after tracheal suctioning whereas those receiving saline solution returned to baseline intracranial pressure value at 15 minutes. Although patients treated with lidocaine had no significant hemodynamic changes, patients receiving saline solution experienced a higher mean value of mean arterial pressure (99.36 vs 81.73 mm Hg; p = 0.004) at T1. This preliminary study showed that tracheal lidocaine instillation can attenuate increase in intracranial pressure induced by tracheal suctioning and favor a faster return to the intracranial pressure baseline levels without significant hemodynamic and ventilatory changes.

Hypotensive episodes on program hemodialysis during dialysis procedure: modern approach for diagnostics, prophylaxis and correction

The study objective is to evaluate the effectiveness of different approaches to correction and prevention of arterial hypotension episodes in patients undergoing long-term hemodialysis (HD). Materials and methods. The study included 35patients undergoing long-term hemodialysis in the dialysis center. In all patients, automatic non-invasive measurement of arterial pressure (AP) was performed using a built-in option of the “artificial kidney” device. Prior to the study, all patients underwent clinical test with evaluation of “dry weight” and bioelectrical impedance analysis. Crossover design was used in the study: at the beginning, hypotensive episodes were corrected in all patients using the standard method (the first 4 hemodialysis procedures); then during the following 4 procedures in addition to standard methods a computer algorithm automatically controlling ultrafiltration rate using an automatic system of pressure control (ASPC) with constant AP monitoring (AP was measured prior to hemodialysis and after it and at least 1 time in the first 5 min of the procedure; from the 4h procedure onwards, intervals were determined by the algorithm automatically) was used. Values of mean AP during hemodialysis procedures for the whole monitoring period were analyzed. The duration of the study was 3 weeks for all patients. Results . Mean pre-dialysis systolic and diastolic AP in the patients for the standard approach was 124.6 ± 27.7 and 74.5 ± 21.1 mm Hg, post-dialysis AP was 114.4 ± 24.4 and 71.3 ± 16.3 mm Hg, respectively. For ASPC, pre-dialysis and post-dialysis AP was statistically significantly higher than for the standard approach: 133.2 ± 21.3 and 79.3 ± 15.8 mm Hg (p &lt;0.001; p = 0.009), 125.7 ± 23.9 and 75.9 ± 18.3 mm Hg (p &lt;0.001; p &lt;0.001). Detailed analysis of intra-dialysis AP measured during the standard approach showed that it was 110.2 ± 17.3 and 68.3 ± 13.9 mm Hg. Using ASPC, intra-dialysis AP was significantly higher: 124 ± 20.5 and 75.9 ± 14.2 mm Hg (p = 0.03; p = 0.02). Mean AP was also higher: 82.5 ± 13.9 mm Hgfor the standard approach versus 91.5 ± 15.6 mm Hg (p = 0.01) for ASPC. The ultrafiltration rates were slightly higher without ASPC (8.2 ml/kg/hour vs. 7.9 ml/kg/hour). Therefore, it was shown that the use of ASPC in addition to standard methods of hypotension correction is effective and safe. There weren»t any significant differences in «hemodialysis-dose effectiveness» (Kt/V) in both groups; however, in the ASPC group target values of inorganic phosphorus in serum (for a dialysis patient) were reached which is one of the most important parameters of hemodialysis adequacy. Concentration of inorganic phosphorus for the ultrafiltration control algorithm was 1.5 mmol/l, for the standard dialysis program — 1.8 mmol/l which shows benefits of ASPC. This data didn»t reach statistical significance (p = 0.07) which likely can be attributed to a low number of observations. Conclusion . Intra-dialysis hypotension with high ultrafiltration rates is a frequent and potentially dangerous complication of hemodialysis which negatively affects patients» long-term prognosis mainly due to an increase in cardiovascular morbidity and mortality. A new method for prevention and correction of hypotension using ASPC allows to decrease ultrafiltration rate on time preventing a hypotensive episode, decreasing its rates and improving attainment of AP target values (both pre- and post-dialysis) as well as intra-dialysis variation during dialysis procedure.

Effect of Diminazene aceturate treatment on some cardiovascular parameters and antioxidant status of apparently healthy horses

IntroductionApart from being a widely used antiprotozoal drug in many parts of Africa, Diminazene aceturate (DIZE), has been shown to have beneficial effects in experimental murine models of hypertension, pulmonary hypertension, myocardial infarction, stroke, atherosclerosis, type 1 diabetes, and eye disease. In this study, we investigated the effect of diminazene aceturate treatment after a single intramuscular administration on some cardiovascular parameters and antioxidant status in apparently healthy Nigerian horses.Materials and methodsTen male horses were divided into two groups comprising 5 horses each. Group A was the control group with no drug administered. Group B was treated with DIZE at 3.5 mg/kg, single dose. Baseline data were collected before the commencement of the experiment and thereafter, post‐administration at 0hrs, 24hrs, 48hrs and 96hrs. Base apex electrocardiogram was recorded using a computer ECG machine while oscillometric blood pressure measurement was recorded using a veterinary blood pressure monitor. Markers of oxidative stress were determined in the serumResultSingle intramuscular treatment caused a significant (p&lt;0.05) increase in the systolic, diastolic and mean arterial blood pressure values when compared with the controls. From the electrocardiogram, sinus rhythm was recorded in both groups however, significant (p&lt;0.05) increase in heart rate, p‐wave duration, QRS complex duration and QTc were observed in the treated group when compared with the control. Oxidative stress markers (malondialdehyde and hydrogen peroxide) significantly (p&lt;0.05) increased while antioxidant enzymes (catalase, glutathione peroxidase and glutathione) were decreased when compared to the control.ConclusionThis study indicates that the use of DIZE in horses should be with great caution because of the associated cardiovascular physiological alterations, reduction in activities of antioxidant enzymes and increase in markers of oxidative stress.Support or Funding InformationNoneThis abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Presión arterial media: ¿importa el uso de escaleras?

Objetivo: Determinar si el uso diario de escaleras se relaciona con valores de presión arterial media, en un grupo de habitantes de un conjunto residencial con edificios de 4 pisos. Materiales y métodos: Estudio descriptivo, transversal. Se tomó la presión arterial a 125 sujetos sanos (50,4% mujeres) residentes en los 4 pisos de cada uno de los 4 edificios de un conjunto residencial. Se compararon los valores de presión arterial media según el piso de residencia mediante ANOVA de un factor y prueba de Bonferroni, y se estratificó el análisis según edad, sexo, obesidad, fumar, beber alcohol con frecuencia y actividad física. Resultados: Se encontró relación significativa (p&lt;0,05) entre el promedio de presión arterial media y el piso de residencia, siendo marcadas las diferencias especialmente entre el piso uno y el cuatro (p&lt;0,05). Se encontró significancia estadística (p&lt;0,05) al estratificar los valores de presión arterial media según sexo masculino, obesidad abdominal y fumar. Conclusión: En los adultos sanos, participantes en el estudio, hubo un efecto benéfico en el uso diario de escaleras con respecto a los valores de presión arterial media.

Preserve encephalus in surgery of trauma: online survey. (P.E.S.T.O)

BackgroundTraumatic brain injury (TBI) is a global health problem. Extracranial hemorrhagic lesions needing emergency surgery adversely affect the outcome of TBI. We conducted an international survey regarding the acute phase management practices in TBI polytrauma patients.MethodsA questionnaire was available on the World Society of Emergency Surgery website between December 2017 and February 2018. The main endpoints were the evaluation of (1) intracranial pressure (ICP) monitoring during extracranial emergency surgery (EES), (2) hemodynamic management without ICP monitoring during EES, (3) coagulation management, and (4) utilization of simultaneous multisystem surgery (SMS).ResultsThe respondents were 122 representing 105 trauma centers worldwide. ICP monitoring was utilized in 10–30% of patients at risk of intracranial hypertension (IH) undergoing EES from about a third of the respondents [n = 35 (29%)]. The respondents reported that the safest values of systolic blood pressure during EES in patients at risk of IH were 90–100 mmHg [n = 35 (29%)] and 100–110 mmHg [n = 35 (29%)]. The safest values of mean arterial pressure during EES in patients at risk of IH were > 70 mmHg [n = 44 (36%)] and > 80 mmHg [n = 32 (26%)]. Regarding ICP placement, a large percentage of respondents considered a platelet (PLT) count > 50,000/mm3 [n = 57 (47%)] and a prothrombin time (PT)/activated partial thromboplastin time (aPTT) < 1.5 times the normal control [n = 73 (60%)] to be the safest parameters. For craniotomy, the majority of respondents considered PLT count > 100,000/mm3 [n = 67 (55%)] and a PT/aPTT < 1.5 times the normal control [n = 76 (62%)] to be the safest parameters. Almost half of the respondents [n = 53 (43%)], reported that they transfused red blood cells (RBCs)/plasma (P)/PLTs at a ratio of 1/1/1 in TBI polytrauma patients. SMS was performed in 5–19% of patients, requiring both an emergency neurosurgical operation and EES, by almost half of the respondents [n = 49 (40%)].ConclusionsA great variability in practices during the acute phase management of polytrauma patients with severe TBI was identified. These findings may be helpful for future investigations and educational purposes.

Comparison of spinal and cerebral oxygen saturation with near-infrared spectroscopy method during spinal surgery in prone position

Objectives: To assess spinal and cerebral oxygenation with near-infrared spectroscopy method during spinal surgery in prone position. Methods: This prospective study included 64 patients, who were prepared for posterior spinal instrumentation and laminectomy surgeries. Group 1: 31 patients who had posterior spinal instrumentation; Group 2: 33 patients who had at least two levels of disk operation (Laminectomy). The following were recorded for all patients before and after anesthesia induction in supine position, after induction in prone position, during operation (beginning, middle and end of surgery) in prone position and before waking up in supine position: cerebral oxygen saturation (NIRSs) measurements, spinal oxygen saturation (NIRSp) measurements, peripheral oxygen saturation (SpO2), heart rate (HR), invasively monitored systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP) values. Results: There was no significant difference between two groups in terms of the variables of age, weight, anesthesia and surgery duration (p &amp;gt; 0.05). MAP values were significantly different in both groups before induction, during operation and postoperative periods (p &amp;lt; 0.05). NIRSs were significantly lower at mid-operation and at the end of operation (p &amp;lt; 0.05). NIRSp values had no significant difference in any period (p &amp;gt; 0.05). We found no significant difference between groups in HR, SAP, DAP, MAP, NIRSs and NIRSp parameters (p &amp;gt; 0.05) compared at different times. Conclusions: MAP dropped depending on induction and prone position. Cerebral oxygenation significantly decreased at the time of mid-operation and at the end of operation but spinal oxygenation had no significant decresase. Compared to laminectomy, posterior stabilization surgery did not pose an additional risk to the patients in terms of spinal and oxygen saturation.

Salt, Hypertension, and the Lens.

Salt is important in the pathogenesis of hypertension (HT). Salt-sensitive hypertension (SSH) accounts for about half of all HT cases. In SSH, sodium/potassium adenosine triphosphatase (Na+/K+-ATPase) activity is impaired. Impaired Na+/K+-ATPase activity in the lens epithelium results in cortical opacities in the peripheral equator of the lens. We investigated the sensitivity of cortical lens opacities in detecting SSH. The study included 191 SSH and 159 non-SSH, salt-resistant HT (SRH) patients (350 HT patients total), aged 40-80 years. One hundred twenty-four sex- and age-matched patients without a HT diagnosis made up the control group. Daily salt intake of all groups was calculated from 24-hr urinary Na excretion. SSH was diagnosed when the difference in mean arterial blood pressure values obtained during high- and low-Na diets was ≥10%. Non-SSH, SRH was diagnosed when the difference was <10%.Two researchers examined the presence of cortical lens opacities biomicroscopically using the diffuse, direct, Scheimpflug, and retroillumination from fundus methods. Total lens opacity was predictive of SSH among all cases (P < 0.001), with a sensitivity and specificity of 75.4% [95% confidence interval (CI): 68.6-81.3] and 83.6% (95% CI: 77.0-89.0), respectively. Its positive and negative predictive values were 84.7% (95% CI: 79.4-88.8) and 73.9% (95% CI: 68.6-78.5), respectively. Lens opacities can be used as a finding that can be easily observed in the detection of SSH and excess salt intake.

EFFECT OF COPAIBA OIL IN INTESTINAL MUCOSA OF RATS SUBMITTED TO HYPOVOLEMIC SHOCK.

ABSTRACT Background: Hypovolemic shock is a common disease in polytrauma patients and may develop ischemia in various organs, increasing morbidity and mortality. The bowel is usually most affected by this condition. Aim: To evaluate the effects of copaiba oil on the intestinal mucosa’s injury of rats submitted to hypovolemic shock. Method: Fifteen rats were divided into three groups: sham - simulated surgery; ischemia - animals submitted to hypovolemic shock; and copaiba - animals submitted to hypovolemic shock previously treated with copaiba oil. Mean blood pressure, arterial blood gas after shock induction, degree of intestinal lesion and villus length were evaluated. Results: The sham presented the lowest values of lactate and PaCO2 and the highest values of mean arterial pressure, pH and bicarbonate in relation to the other groups. The degree of mesenteric lesion was zero in the sham group; 3.00±1.00 in the ischemia group; and 3.00±0.71 in the copaiba group. The villus length was 173.60±8.42 in the sham, 142.77±8.33 in the ischemia and 143.01±9.57 in the copaiba group. There was a significant difference between the sham and the other groups (p<0.05); however, there not significant difference between groups Ischemia and copaiba. Conclusion: Administration of copaiba oil did not reduce the intestinal mucosa lesion of rats after hypovolemic shock.

Determinants of Outcome in Convulsive Status Epilepticus in Adults: An Ambispective Study from Central India.

Background:The determinants of the outcome in adult convulsive status epilepticus(CSE), also the implication of the value of mean arterial blood pressure (MAP), and random blood sugar at admission on the outcome are not clear.Objectives:The objective of this study is to look for the determinants of unfavorable outcome in CSE.Materials and Methods:Ambispectively gathered data from 55 patients, treated consecutively with identical protocol during January 2010–December 2016, were analyzed. The demographic and clinical variables were identified and correlated with outcome in each individual.Results:There were 65.45% males and 34.55% females. Favorable outcome (conscious and discharged) was seen in 63.6%, unfavorable (death 14.5%, absent cortical functions 10.9%, and inability to wean-off anesthetic agents 10.9%). The parameters associated with unfavorable outcome were female gender (odds ratio [OR]: 1.45), MAP ≤80 mmHg (OR: 2.57), time to first medical attention >5 h (OR: 127.8), and time to control clinical seizures >3.5 h (OR: 7.87). Almost 44.2% of patients with SE severity score >2 had unfavorable outcome (sensitivity 75% and specificity 45.7%). New scoring system, the CSE outcome score (CSEOS, developed by combining the predictors associated with higher odds of poor outcome), predicted the poor outcome with the sensitivity and specificity of 90% and 54.29%, respectively.Discussion and Conclusion:Low MAP and delay of >3.5 h in treatment initiation or seizure control are the key determinants of poor outcome in CSE. With the incorporation of CSEOS, we believe that our findings can be helpful in the process of clinical decision-making and prognostication of patients with CSE.