Dyslipidemia is a major metabolic disorder and a key risk factor for atherosclerotic cardiovascular disease (ASCVD), particularly in the geriatric population. Elderly patients frequently present with multiple comorbidities, such as hypertension and hyperuricemia, which complicate clinical management and substantially increase cardiovascular risk. Moreover, acute conditions, including trauma-related injuries, may further disrupt metabolic control, functional capacity, and adherence to long-term therapy. This case report describes a 70-year-old male patient (RE) who presented to a primary healthcare center with swelling and intermittent pain in the right lower extremity following a fall. The patient had a known history of dyslipidemia, hypertension, and hyperuricemia. Laboratory investigations revealed elevated total cholesterol (242 mg/dL), borderline fasting plasma glucose (102 mg/dL), and uric acid level of 6.6 mg/dL. Physical examination was unremarkable except for edema and localized tenderness in the affected limb, consistent with a soft tissue injury. A holistic management approach was implemented, integrating pharmacological and non-pharmacological interventions. Statin therapy was initiated to address dyslipidemia, antihypertensive treatment was optimized, and analgesic therapy combined with limb elevation was provided to manage acute pain and edema. Non-pharmacological strategies included comprehensive lifestyle modification, encompassing dietary counseling (low saturated fat, low salt, and low purine diet), gradual resumption of physical activity following injury recovery, and structured patient–family education to improve adherence and prevent recurrent falls. Follow-up evaluation demonstrated clinical improvement, including resolution of edema, improved functional mobility, and better metabolic control. The novelty of this case lies in demonstrating how acute trauma in geriatric patients can act as a critical entry point for integrated chronic disease management within primary care settings. This case emphasizes that holistic, biopsychosocial–spiritual management not only improves lipid and blood pressure control but also enhances functional outcomes and quality of life in elderly patients with complex comorbidities.

Invasive mechanical ventilation (IMV) is widely used in pediatric intensive care units. Acute lower respiratory infection is its primary indication; it is characterized by increased inspiratory and expiratory resistance, as well as decreased lung compliance. It can progress to acute respiratory distress syndrome, which poses a challenge in optimizing IMV. Although different ventilatory modes are not presumed to generate significant clinical differences, there is a marked preference for the pressure control mode in pediatrics. In predominantly obstructive conditions, volume control mode ensures ventilation regardless of the degree of inspiratory resistance, allowing for extended expiratory time and preventing hyperinflation. In restrictive conditions, pressure control enables ventilation to be adjusted to protective parameters, albeit with the potential risk of inducing damage due to higher flow rates. The physiological basis of the different ventilation modes and their clinical application are reviewed.

Caribbean and South American team-based strategy to control hypertension (CATCH): Rationale and study design of a cluster randomized trial.

Hypertensive disorders during the postpartum period are a major contributor to maternal morbidity and mortality. The most recent statistics suggest that 16% of pregnancies are complicated by hypertension, and that number is increasing. The majority of complications occur in the postpartum period, and new publications have revolutionized the way we manage postpartum hypertension. Recent studies have shown that tight blood pressure (BP) control in the postpartum period may decrease adverse maternal outcomes. Several studies have demonstrated that nifedipine lowers BP more effectively than labetalol, resulting in fewer readmissions. The use of diuretics is a topic of controversy, with mixed evidence regarding their effectiveness. A remote patient monitoring system may improve postpartum BP follow-up in low-resource settings. Patients with hypertension during pregnancy have an increased lifetime risk of cardiovascular diseases, and establishing care for long-term follow-up is an essential part of postpartum care. Contrary to historical teaching, not all hypertensive disorders are cured by delivery. Hypertension requires close follow-up during the fourth trimester, and these patients may benefit from tighter BP control. Further research should be done to establish guideline-based treatment and monitoring throughout the lifetime.

Introduction: Hypertensive emergencies represent lifethreatening conditions characterised by acute elevations in blood pressure with evidence of target organ damage. They remain a significant contributor to cardiovascular, neurological, and renal morbidity and mortality, often leading to hospitalisation. Early detection of end-organ involvement is therefore crucial to prevent irreversible damage and improve clinical outcomes. Aim: To study the association between patients presenting with hypertensive emergency in the Medical Intensive Care Unit (MICU) and target end-organ damage across different genders and age groups. Materials and Methods: The present cross-sectional study was conducted among adult patients aged 18-80 years presenting with blood pressure ≥180/120 mmHg at R. D. Gardi Medical College and Charitable Hospital, Ujjain, Madhya Pradesh, India, over a period of six months, from June 2024 to November 2024. Demographic data, medical history, and other clinical information, including Electrocardiography (ECG), Two Dimensional (2D) echocardiography, chest X-ray, funduscopic examination, ultrasonography of the abdomen, and neuroimaging studies, were collected. Data were analysed using SPSS software (Statistical Package for the Social Sciences (SPSS) Inc., Chicago, IL), version 29.0.10, with a p-value <0.05 considered statistically significant. Results: Among the 96 patients, 58 (60%) were male and 38 (40%) were female. The mean {±Standard Deviation (SD)} age was 58.66±12.62 years (range: 18-80 years). A past history of hypertension was present in 58 (60.4%) patients, with a mean duration of 6.51±4.34 years (range: 1-20 years). The most common forms of acute target organ damage were Cerebrovascular Accident (CVA) with retinopathy in 24 patients (25%), followed by Myocardial Infarction (MI) with retinopathy in 15 (15.6%), retinopathy alone in 13 (13.5%), retinopathy with pulmonary oedema and acute heart failure in 11 (11.5%), and MI alone in 10 patients (10.4%). Conclusion: Hypertensive emergencies were more frequent among middle-aged and elderly males, most of whom had a prior history of hypertension. CVAs and retinopathy were the leading complications, followed by MI either alone or in combination with retinopathy. Strengthening early detection and ensuring strict blood pressure control are essential to reduce the burden of target organ damage in these patients.

Hybrid shoe-approaching and pressure control strategy for multi-channel braking systems of mine hoists

Validates blood pressure control for seizure management: Jujuboside B exerts antiseizure effects via blood pressure reduction and activation of NTS-VGLUT2+ neurons.

BACKGROUND Preeclampsia (PE) substantially increases the risk of postpartum anxiety, yet limited research has examined how disease onset and clinical features, such as blood pressure control and body mass index (BMI) changes during pregnancy, affect this risk. AIM To develop and apply a predictive model for postpartum anxiety disorder in patients with PE based on multidimensional indicators. METHODS A cross-sectional study was conducted among 196 patients with PE admitted to the Department of Obstetrics, Ninth People’s Hospital of Suzhou (Affiliated with Soochow University), from June 2019 to June 2024. According to the self-rating anxiety scale at six weeks postpartum, participants were divided into anxiety and no-anxiety groups. Two data sets were analyzed, and multivariate logistic regression was performed to identify risk and protective factors. Regression coefficients and constants were used to construct the predictive model. Model performance was evaluated using the receiver operating characteristic curve and area under the curve, along with a goodness-of-fit test. The model was then validated with clinical data. RESULTS Of the 196 patients with PE evaluated using the self-rating anxiety scale at six weeks postpartum, 51 (26.02%) patients showed anxiety symptoms. Significant group differences (P < 0.05) were observed for blood pressure control, BMI increase, hematocrit (Hct), family relationships, and psychological resilience. Logistic regression indicated that, poor blood pressure control, greater BMI increase, elevated Hct levels, and strained family relationships during pregnancy were risk factors for postpartum anxiety in patients with PE (P < 0.05), whereas higher psychological resilience was a protective factor (P < 0.05). The prediction model was defined as: Logit (P ) = 0.684 × pregnancy blood pressure control + 0.805 × pregnancy BMI increase + 0.756 × Hct + 1.063 × family relationship - 1.105 × psychological resilience score - 5.487. The model’s area under the curve (0.908) exceeded that of individual indicators: Blood pressure control (0.794), BMI increase (0.814), Hct (0.808), family relationships (0.840), and psychological resilience (0.833). The goodness-of-fit test showed no overfitting (χ 2 = 1.904, P = 0.725). Clinical validation demonstrated sensitivity of 85.71%, specificity of 87.72%, and accuracy of 87.18%. CONCLUSION Postpartum anxiety risk in patients with PE is associated with poor blood pressure control, excessive BMI gain, elevated Hct index, and poor family relationships, while strong psychological resilience serve as a protective factor. The developed prediction model effectively supports clinical assessment and targeted management of postpartum anxiety in patients with PE.

Background. Hypertensive disorders of pregnancy (HDP), including gestational hypertension and preeclampsia, are among the most common and serious obstetric complications worldwide. They result from impaired cardiovascular adaptation to pregnancy and significantly increase maternal and perinatal morbidity and mortality. Physical activity is considered a safe, non-pharmacological intervention with potential preventive benefits. Aim. To summarize current evidence on the impact of physical activity during pregnancy on blood pressure regulation and the risk of HDP. Material and Methods. This narrative review included publications indexed in PubMed and Google Scholar from 2020–2026. Observational and interventional studies, systematic reviews, meta-analyses, and international guidelines assessing associations between physical activity, blood pressure, and HDP were analyzed. Articles published before 2020 (except key recommendations) and those not in English or Polish were excluded. Results. Pregnancy involves increased cardiac output, blood volume, and heart rate, with decreased systemic vascular resistance and blood pressure. Disruption of these adaptations predisposes women to HDP. Regular moderate-intensity physical activity improves endothelial function, reduces oxidative stress and inflammation, enhances autonomic balance and supports weight control. Evidence shows lower systolic and diastolic blood pressure and a reduced risk of gestational hypertension among physically active pregnant women. However, findings on preeclampsia prevention remain inconclusive, likely due to its multifactorial etiology. Conclusions. Moderate physical activity during pregnancy is a safe strategy that promotes cardiovascular adaptation, improves blood pressure control, and lowers the risk of HDP, particularly gestational hypertension. Although its role in preventing preeclampsia remains unclear, current evidence supports including physical activity in routine prenatal care.

Metabolic dysfunction‑associated steatotic liver disease (MASLD) is the most common chronic liver disease worldwide, as demonstrated by a 50% increase in the prevalence over the past three decades. More than one quarter of the global population and nearly 40% of adults in the United States are affected by this burdensome disease. Once thought to be an "innocent bystander," MASLD is now understood as a multisystem disease associated with obesity, type 2 diabetes mellitus, dyslipidemia, and cardiovascular disease. Its rising prevalence emphasizes the critical role of primary care providers, including nurse practitioners (NP), in early identification and management. Existing on a spectrum, MASLD ranges from simple hepatic steatosis to nonalcoholic steatohepatitis with inflammation, fibrosis, and cirrhosis. Early stages are often asymptomatic, but progression can lead to portal hypertension, end-stage liver disease, hepatocellular carcinoma, and death. Disease management focuses on lifestyle modification and optimal control of metabolic comorbidities, including glycemic management, statin therapy for dyslipidemia, blood pressure control, and treatment for obstructive sleep apnea. Pharmacologic options remain limited, although vitamin E and pioglitazone may benefit select patients. Furthermore, emerging therapies are under investigation. This article presents a case of MASLD in a patient with metabolic comorbidities and persistently elevated aminotransferases, illustrating the significance of focused assessments and highlighting the role of nurse practitioners in screening, lifestyle counseling, early intervention, and longitudinal follow-up to prevent disease progression and improve outcomes.

Results from blood pressure (BP) control interventional trials can inform clinicians and health systems pursuing better BP control, but they must be interpreted cautiously. Deconstruct the observed drop in systolic BP (SBP) into components attributable to increased adherence to previously prescribed medications, regression to the mean, and initiation of new medications. Secondary analysis of BP Home, a pragmatic randomized controlled trial. Patients owning a smartphone who reported uncontrolled BP at their last clinic visit (> 145mmHg) and a desire to lower their BP by > 10mmHg. In BP Home, participants were randomly assigned to receive one of two devices for self-measurement of BP and followed for up to 24months via electronic health records (EHR). The primary outcome was EHR-recorded office SBP. We fit SBP trajectories for each participant using linear mixed models, and estimated the contributions of medication adjustments, and increased adherence to pre-existing BP medications due to their enrollment in a research study (i.e., a Hawthorne effect). Regression to the mean was calculated for each participant as the difference between their last measured pre-enrollment SBP and their modeled SBP trajectory at enrollment. Among participants taking BP medications at enrollment, we estimated an average immediate drop in SBP of -4.2mmHg (95% CI, -5.1 to -3.3; p < 0.001) at enrollment, explainable by increased medication adherence following study enrollment. Starting a new medication class post-enrollment resulted in an SBP drop of -4.1mmHg (95% CI, -5.3 to -2.8; p < 0.001). The average expected regression to the mean was -3.9 (95% CI, -4.4 to -3.3; p < 0.001). A significant portion of BP reductions in trials may stem from increased adherence to pre-existing medications arising from enrollment in a research study and enhanced awareness of their elevated BP. NCT03796689 (registered on 2019-01-04).

Renal nerves are critical modulators of kidney function and blood pressure (BP) control. Their influence on sodium and fluid retention, renin release and vasoconstriction rendered them a therapeutic target more than a century ago when surgical splanchnicectomy emerged as one of the first effective antihypertensive therapies. Revisiting the concept using catheter-based approaches to ablate renal afferent and efferent nerves more selectively with various energy sources demonstrated the efficacy of renal denervation in reducing sympathetic nerve activity. A series of sham-controlled randomised clinical trials in patients with uncontrolled or resistant hypertension either on or off concomitant antihypertensive drugs demonstrated procedural safety and clinically meaningful BP reduction. Durability of the BP lowering efficacy has been demonstrated out to 10 years in observational studies. Major international guidelines now recommend renal denervation as an adjunct therapy in patients with uncontrolled or resistant hypertension where other means have failed or resulted in insufficient BP control. Patient selection and patient preference are relevant aspects to be considered in a shared decision-making process leading up to the denervation procedure, which should be performed in experienced centres. While approved in the USA, most countries in Europe, Asia-Pacific and many other regions lack adequate reimbursement currently, which remains a barrier for more widespread implementation into clinical practice despite favourable cost-effectiveness analyses. While now established in the context of hypertension management, ongoing research explores its potential utility in other conditions characterised by increased sympathetic drive, with most promising results in patients with chronic kidney disease, atrial fibrillation, heart failure and others. Further refinement of procedural aspects may reduce procedure time and augment the BP lowering efficacy. Clinicians should embrace the additional options that device-based therapies offer to improve BP management, mostly in combination with pharmacologic therapies. After all, it is just another means of bringing the pressure down.

Accurate control, monitoring of acoustic power, and flexible waveform generation are essential for safe and reproducible transcranial focused ultrasound (tFUS) neuromodulation, which is not comprehensively supported by existing benchtop platforms. This work presents a low-complexity and programmable tFUS stimulation system. The system integrates a direct digital synthesis module, a DAC-controlled programmable DC-DC supply, a full-bridge driver, and an impedance matching network to achieve flexible waveform generation and efficient transducer excitation. Acoustic power is monitored using a nonuniform discrete Fourier transform method at the driving frequency. Direct amplitude regulation enables highly linear pressure control up to 4.85 MPa. Impedance matching raised the maximum peak-to-peak excitation voltage from 86 V to 206 V (×2.4) and reduced total harmonic distortion (THD) by 19.19 dB. The power monitor achieves <5% error for outputs above 3 W. In vivo safety was evaluated in mice using both acute (single 20-min exposure) and chronic (21-day, 20-min/day) protocols. Four stimulation groups at $\mathrm{I_{SPPA}}$ = 40 W/cm2 with duty cycles from 1.8% to 14.4% ($\mathrm{I_{SPTA}}$ = 0.72-5.76 W/cm2) were compared with sham and controls. Behavioral outcomes and histological analysis revealed no abnormalities under these conditions. The $\mathrm{I_{SPTA}}$ range corresponds to one to eight times the FDA guideline limit, thereby encompassing and extending typical safety margins in neuromodulation studies. These results demonstrate the feasibility of the proposed platform, with validation at both the circuit level and through preclinical safety studies.

The transition through menopause is accompanied by a series of adverse metabolic changes which are associated with an increased risk of cardiometabolic disease, a major cause of mortality in women after midlife. Whilst the indication for menopausal hormone replacement therapy (HRT) is the control of menopausal symptoms, understanding and discussing the cardiometabolic impacts of HRT are necessary to facilitate informed decision-making at treatment initiation and continuation, and to select appropriate regimens. A narrative review. Existing evidence suggests that HRT is likely to impact the development of metabolic risk factors including visceral fat accumulation, adverse changes in lipid profile, blood pressure and glycaemic control. Findings from randomised controlled trials have refined our understanding of the impact of HRT on cardiometabolic outcomes including coronary heart disease and stroke. Furthermore, recent research has highlighted the impact of the menopause on the development and severity of metabolic dysfunction-associated steatotic liver disease (MASLD) that has been poorly studied in the context of HRT. The route of oestrogen administration, timing of initiation and type of progestogen are all likely to affect the impact of HRT on many of these outcomes. There has recently been extensive media interest in HRT in some countries resulting in increased prescription rates. Understanding the impact of HRT on cardiometabolic risk is therefore particularly important. In this narrative review, we discuss the existing evidence and clinical guidelines on the effect of HRT on cardiometabolic risk factors and the risk of coronary heart disease, stroke and MASLD, highlighting areas of uncertainty and priorities for further research.

Guidelines suggest that home blood pressure (BP) readings are more reliable than in-clinic measurements; however, quality metrics for patients with hypertension (HTN) primarily rely on in-clinic readings. To improve BP documentation and management, we implemented an advanced practice provider (APP)-managed remote patient monitoring (RPM) program. The electronic health records (EHR) of internal medicine patients with HTN and uncontrolled BP (≥140/90 mm Hg, per our institution's quality metric) were reviewed for more recent controlled (<140/90 mm Hg) home readings. If found, these values were imported into the chart's patient-reported vitals section. If not, patients were offered RPM. Participants (n = 472) received a BP monitor that automatically transmitted home readings to the EHR and had APP-led follow-up to guide lifestyle and medication adjustments until target BP was achieved. Lower targets (<130/80 mm Hg) were pursued for higher risk patients. For 12 months, average systolic and diastolic BP of patients with initially uncontrolled HTN improved from 149.8 to 131.3 mm Hg and from 84.0 to 79.3 mm Hg, respectively (p < .001). The percentage of patients with HTN and last documented BP < 140/90 mm Hg increased 7.94% compared with 1.75% at a comparison clinic providing standard care (p = .022). This APP-managed RPM program significantly improved BP outcomes and institutional quality metrics.

Primary aldosteronism (PA) is a common cause of hypertension, characterized by renin-independent aldosterone production that drives inappropriate mineralocorticoid receptor activation, sodium retention, volume expansion, and potassium wasting, ultimately resulting in hypertension and adverse cardiorenal outcomes. Management of PA involves therapies that target these pathophysiologic mechanisms to restore homeostasis and reduce risk, which is usually tailored based on patient preference and whether PA is lateralizing or nonlateralizing. For patients with lateralizing PA, surgical adrenalectomy, and to a lesser extent, minimally invasive adrenal or adrenal artery ablation, is highly effective at improving blood pressure control and risk for incident cardiovascular outcomes. However, the vast majority of patients with PA will be treated with medical therapy using steroidal mineralocorticoid receptor antagonists as the cornerstone of therapy, and epithelial sodium channel inhibitors serving as infrequent alternatives. Dietary sodium restriction in PA should be strongly encouraged because it reduces the substrate that fuels PA pathophysiology; dietary sodium restriction can facilitate substantial reductions in blood pressure, especially when combined with mineralocorticoid receptor antagonist therapy. Once initiated, medical therapy should be intensified to achieve 3 objectives in the following order of importance: normalization of blood pressure with the fewest number of antihypertensive agents, normalization of serum potassium when applicable, and increases in renin from baseline as a biomarker of adequate aldosterone blockade.

Health care systems increasingly incorporate social risk data into electronic health records (EHRs) to address needs like food, housing, and transportation insecurity. This study evaluated whether EHR-integrated social clinical decision support (SCDS) tools improved control of blood pressure (BP) and hemoglobin A1c (HbA1c) and increased social risk-informed care and documentation in community-based clinics. We conducted a cluster randomized trial in a large primary care network. This pragmatic trial was designed to assess tool impact in real-world clinic conditions. Six clinics received SCDS tools embedded in the EHR; 44 clinics served as controls. The tools supported clinic-wide workflows and targeted decision support. A screening alert was triggered for adult patients lacking up-to-date social risk screening. Additional components were activated for patients with uncontrolled hypertension or diabetes, or with a diagnosis of either condition combined with a visit no-show rate of at least 50%. Primary outcomes were BP and HbA1c control. Secondary outcomes included social risk screening and documentation. Generalized linear mixed models accounted for patient clustering. We also examined use patterns of individual tool components. Blood pressure control improved over 12 months in both arms, with significantly greater improvement in intervention clinics. Control of HbA1c showed no significant differences. Intervention clinics had significantly greater odds of social risk screening and documentation. Use of individual SCDS tool components varied widely across clinics. Access to EHR-integrated SCDS tools was associated with increased documentation of social risks and greater improvements in BP control. These findings support embedding social risk data into clinical workflows to enhance chronic disease management in primary care.

Lost circulation is one of the most common and costly drilling problems, especially in formations with weak rock strength, natural fractures, or high permeability. If drilling fluid losses are not controlled quickly, they can lead to serious operational complications such as wellbore instability, stuck pipe, reduced drilling efficiency, and in extreme cases, well control risks. For this reason, predicting and managing potential lost circulation zones is a key part of safe and efficient drilling planning. One effective method used by drilling engineers is evaluating the mud weight window, which helps identify intervals where the formation is more likely to absorb drilling fluid. The mud weight window represents the safe range of drilling fluid density between pore pressure and fracture pressure. Maintaining mud weight within this window allows the well to be drilled with sufficient pressure control while avoiding formation breakdown. When mud weight or equivalent circulating density exceeds the fracture pressure, the formation may crack and begin to take fluid. This is especially critical in narrow mud weight windows, where even small changes in density or circulating pressure can trigger losses. By analyzing the mud weight window before drilling, engineers can estimate which depths have a higher risk of losses and prepare mitigation plans in advance. In zones where losses are expected, a common preventive practice is to prepare a Lost Circulation Material (LCM) pill and keep it ready in the active mud system. This approach reduces response time, allowing the drilling crew to treat losses immediately once they are detected. LCM pills are specially designed mixtures containing materials that bridge and seal fractures, pores, and weak intervals in the formation. Depending on the formation type and the severity of the losses, LCM blends may include fibrous, granular, and flaky components. These materials work together to create an effective sealing barrier, restoring circulation and reducing further mud losses. Selecting the correct LCM blend requires careful consideration of both formation characteristics and drilling equipment limitations. The type of loss zone, estimated fracture size, mud system compatibility, and past offset well experience all influence material selection. Additionally, particle size is a critical factor when downhole tools such as mud motors, MWD (Measurement While Drilling), and LWD (Logging While Drilling) systems are present in the bottom hole assembly. Oversized LCM particles can plug internal flow passages, damage tool components, and cause motor or sensor failures. Therefore, many LCM pills are designed as “tool-safe” blends, ensuring particles can pass through the smallest tool restrictions while still providing effective sealing performance. Overall, combining mud weight window analysis with proactive LCM preparation offers a practical and efficient strategy for lost circulation management. This integrated approach improves operational readiness, minimizes non-productive time, protects expensive downhole equipment, and enhances drilling safety. By identifying risky intervals early and applying appropriate preventive and corrective measures, drilling teams can significantly reduce the impact of lost circulation and improve the overall success of drilling operations. Keywords: Mud weight window, LCM, ECD, mud motor, MWD, LWD.

Decompressive craniectomy and subsequent cranioplasty are associated with significant morbidity (Kurland et al. Neurocrit Care 23:292-304, 2015). Bone flap-preserving techniques, including floating and hinged craniotomies, offer effective intracranial pressure (ICP) control (Mohan et al. Acta Neurochir (Wien) 163(5):1415-1422, 2021), although the optimal technique remains controversial, particularly in the context of traumatic brain injury where recent landmark trials have evaluated decompressive craniectomy outcomes (Patel et al. Trauma Surg Acute Care Open 10: e001784, 2025). The bone flap is loosely secured to the cranium using surgeon's knots and adjustable slip knots, with slip knot suture ends exteriorized through the scalp. Once elevated ICP resolves, the bone flap is definitively secured by tightening the externalized sutures. This straightforward floating craniotomy technique provides controlled decompression, effective ICP management, and preserved cosmesis.

New drug therapies for hypertension.