Pressure Monitoring Research Articles

Abstract 14830: Edge-to-edge Transcatheter Mitral Valve Repair is Associated With Lower Pulmonary Artery Pressure in Cardiomems TM -monitored Patients With Heart Failure and Mitral Regurgitation

Introduction: Transcatheter mitral valve repair (TMVr) reduces heart failure (HF) hospitalizations and improves survival in patients with HF and secondary mitral regurgitation (MR), but the hemodynamics of TMVr are not well studied. Patients with a pulmonary artery pressure (PAP) monitor (CardioMEMS TM ) provide a unique opportunity to study ambulatory hemodynamics following TMVr. Methods: TMVr implants occurring July 2014 to Sept 2019 were identified from Medicare claims data and were linked to PAP data from CardioMEMS TM . Patients with CardioMEMS TM implant ≥3 mo prior to TMVr and with ≥3 mo PAP data post TMVr were included. Diastolic PAP (DPAP) and area under the curve (AUC) at 3 and 6 mo post TMVr were compared to 4 wks prior to TMVr (baseline). Analysis was repeated for those with elevated baseline DPAP, defined as ≥15 mmHg. Results: The cohort included 32 patients (74 ± 8 yrs, 66% male) with high prevalence of hypertension, ischemic heart disease, AF, and kidney disease. LVEF was available in 17 patients (32 ± 14%). Compared to baseline, DPAP was significantly lower at 3 mo (-2.1 ± 4.7 mmHg, p=0.019) and remained lower at 6 mo post TMVr (-2.5 ± 6.7 mmHg, p=0.070). AUC showed a cumulative reduction in DPAP of -129 ± 257 mmHg-days (p=0.008) at 3 mo and -438 ± 719 mmHg-days (p=0.005) at 6 mo post TMVr. Similar trends were observed for mean PAP. Sub-group analyses suggested lower DPAP after TMVr in patients with elevated baseline DPAP (3 mo Δ: -2.6 ± 4.6 mmHg, p=0.009; 6 mo Δ: -3.8 ± 6.3 mmHg, p=0.014, 3 mo AUC: -158 ± 255 mmHg-day, p=0.004; 6 mo AUC: -575 ± 721 mmHg-day, p=0.002). Conclusions: In CardioMEMS TM -monitored patients with significant MR, TMVr is associated with a clinically relevant and sustained reduction in DPAP, including patients with an elevated baseline DPAP. Although the clinical and survival benefits of TMVr are paramount, these data add to our understanding of the hemodynamic improvements of TMVr. CardioMEMS TM is an additional tool to improve filling pressures in those with HF.

Abstract 17298: Validation of Beat-to-Beat Blood Pressure and Left Ventricular Ejection Time by the Caretaker Physiological Monitor Against Invasive Central Aortic Measurement

Objective: There is an unmet need for noninvasive continuous blood pressure (BP) monitoring technologies in various clinical settings. We examined the accuracy of noninvasive Caretaker device against invasively measured central aortic BP. Methods: Beat-to-beat BP by Caretaker was recorded simultaneously with central aortic BP measured in patients undergoing cardiac catheterization. We derived correlations and Bland-Altman comparisons, after calibrating the Caretaker with 20 seconds of the initial catheter readings, as well as trend analyses for both systolic (SBP) and diastolic BP (DBP). We also measured left ventricular ejection time (LVET) from both aortic pressure tracing and Caretaker and compared the two. Results: A total of 47 patients were included in the study. A total of 31,369 beats obtained during the diagnostic portion of coronary angiogram were used for analysis. The correlations for SBP and DBP were 0.89 and 0.78, respectively (p < 0.001 for both). The Bland-Altman comparison yielded overall mean differences of 2.11 mmHg (SD 7.40) for SBP and 1.46 mmHg (SD 6.12) for DBP respectively (p <0.001 for all comparisons). The trend analysis yielded concordances of 86% and 85% for SBP and DBP, respectively. The correlation and Bland-Altman analyses for the LVET comparison yielded 0.89 (p< 0.001) with a mean difference of 13.9 ms (SD 14.4 ms). Conclusion: Beat-to-beat BP by Caretaker showed excellent agreement and high concordance in the direction and the degree of BP change with central aortic BP. This study supports the satisfactory performance of the Caretaker device in continuous tracking of beat-to-beat BP and LVET measurements.

Roundtable Discussion: How the AAMI COVID-19 Response Team Responded to Crisis.

Roundtable Discussion: How the AAMI COVID-19 Response Team Responded to Crisis.

When to expect cognitive disorders in hypertension

Abstract In large-scale clinical studies, age, arterial hypertension (AH), multi-focal atherosclerosis, and cognitive disorders (CD) are interrelated, affecting the level of disability, quality of life, and social adaptation of patients with cardiovascular diseases. Aim of the study To determine the prognostic criteria for cognitive disorders in patients with hypertension. Methods To achieve the aim of the study, the examinations were performed in 182 outpatients with AH II stage, 34–68 years, in 164 of them were CD according to neuropsychological tests of MMSE and MoCA, mostly of mild and moderate degree. The relationship between clinical data, cognitive function characteristics and daily monitoring data of hypertension were evaluated. The data obtained were analyzed using medical methods statistics. Results Among factors such as age (>60 years), gender (male / female), disease duration (>10 years), waist circumference, overweight or obesity, hypercholesterolemia, no influence on the development of CD was detected (p>0.05)). Risk factors for the development of CD in hypertension were an burdensome history of CD in closest relatives (2.79 (95% CI 1.15–6.77) relative to practically healthy individuals and 2.41 (1.01–5.88)), high vegetative index (rs +0,15; p<0,05). The correlation between CD and high rates of blood pressure variability according to daily monitoring of blood pressure in patients with hypertension, even under conditions of blood pressure control, is confirmed by the results of correlation and one-factor logit analysis. Thus, elevated levels of systolic blood pressure variability in the day and at night increased the chances of developing CD in patients with hypertension by 2.11 times, (rs = +0.57 and rs = +0.61; p<0.001). It was found that the likelihood of developing cognitive impairment exceeds 50% (high risk) if the level of systolic blood pressure variability is above 12 mm Hg in the day (area under ROC curve AUC = 0.891; 95% CI 0.883–0.940. (AUC = 0.891; 95% CI 0.883–0.940; ST = 82.5% and SP = 92.9%) and at night over 10 mm Hg (AUC = 0.922; 95% CI 0.861–0.963; ST = 82.5% and SP = 85.7%) according to daily blood pressure monitoring. Conclusion The prognosis for the development of cognitive impairment in arterial hypertension is influenced by: evidence of family CD history, autonomic nervous system index and variability of day and night blood pressure characteristics, according to ambulatory daily monitoring data. Funding Acknowledgement Type of funding source: None

A minimally-occlusive cuff method utilizing ultrasound vascular imaging for stress-free blood pressure measurement

Abstract Objective Occlusive cuff inflation in ambulatory blood pressure (BP) monitoring disturbs the daily life of the user, and affects efficacy of monitoring. To overcome this limitation, we have developed a novel minimally-occlusive cuff method for stress-free measurement of BP. This study aimed to experimentally evaluate the reliability of this method, and improve the precision of this method by implementing a machine learning algorithm. Methods In this method, a thin-plate-type ultrasound probe (Size: 5.6mm-thickness × 28mm × 26mm; weight: 10g) is placed between the cuff and the skin, and used to measure the ultrasonic dimension of the artery (Figure 1). The cuff pressure (Pc), arterial dimension at systole (Ds) and diastole (Dd), systolic BP (SBP) and diastolic BP (DBP) during cuff inflation are theoretically related by the following equations, SBP-Pc = P0·Exp[α·Ds] DBP-Pc = P0·Exp[α·Dd] Where P0 and α are constants, and α indicates arterial stiffness. Since multiple sets of the two equations can be defined over multiple cardiac beats while measuring Pc, Ds and Dd during mild cuff inflation (Pc is controlled less than 50 mmHg, Figure 1), it is possible to estimate SBP (SBPe) and DBP (DBPe) as solutions of the equations. In 6 anesthetized dogs, we attached the cuff and the probe to the right thigh to get SBPe and DBPe, which were one-time calibrated in each animal against reference SBP and DBP measured by using an intra-arterial catheter. We also determined the pulse arrival time (PAT), which is a commonly employed parameter in cuff-less BP monitoring. In all the dogs, BP was changed extensively by infusing noradrenaline or sodium nitroprusside. Results DBPe correlated tightly with DBP with a coefficient of determination (R2) of 0.85±0.08, and predicted DBP with error of 3.9±7.9 mmHg after one-time calibration (Figure 2). PAT correlated poorly with DBP (R2=0.49±0.17), and predicted DBP less accurately than this method. SBPe correlated well with SBP (R2=0.78±0.08) (Figure 3). However, even after one-time calibration, difference between SBPe and SBP was 2.6±18.9 mmHg, which was not acceptable. To improve the precision in SBP prediction, we used supervised machine learning approach with use of a support vector algorithm (Python, Scikit-learn), which regressed feature variables (SBPe, DBPe, Ds, Dd heart rate, and PAT) against teacher signal (reference SBP). The support vector algorithm, once trained, predicted SBP with acceptable accuracy with error of 0.7±6.9 mmHg (Figure 3). Conclusions This method reliably tracks BP changes without occlusive cuff inflation. Once calibrated, this method measures DBP accurately. With the aid of machine learning, precision in SBP prediction was greatly improved to an acceptable level. This method with machine learning approach has potential for stress-free BP measurement in ambulatory BP monitoring. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Society for the Promotion of Science

The Choice of Treatment Tactics in Patients with Severe Acute Pancreatitis Taking Into Account the Factor of Intra-Abdominal Hypertension

Relevance. Increased intra-abdominal pressure (IAP) in patients with severe acute pancreatitis (AP) is one of the triggers for the development of a functional organ failure, which leads to death. In this case, the favorable outcome of treatment of patients with severe AP is largely determined by early diagnosis and timely elimination of intra-abdominal hypertension (IAH). At the same time, there is no unified and agreed opinion on the principles and specific methods of eliminating the IAH syndrome in patients with severe AP today, which greatly complicates the choice of treatment strategy and tactics.Aim of study. To assess the role and clinical significance of IAP monitoring in patients with severe AP with various manifestations of organ dysfunction and, offer a set of therapeutic measures aimed at resolving intra-abdominal hypertension.Material and methods. The current study included 199 patients with severe AP, divided into two groups depending on the chosen treatment strategy. Group I included 107 patients where the diagnosis and treatment of the disease corresponded to generally accepted standards. Group II included 92 patients, where, in order to objectify the severity and prognosis of the course of AP, along with standard studies, IAP and APACHE II scale indicators were additionally monitored during treatment, and the severity of organ dysfunctions was assessed. In these patients the choice of medical tactics, including the use of conservative and surgical interventions, was made on a differentiated basis, based on the severity of the disease and the dynamics of the IAH.Results. The role and significance of IAP monitoring and APACHE II scale indicators in the treatment of patients with severe AP were determined. The use of a differentiated approach to the choice of treatment strategies for patients with AP considering the severity of the disease and severity of IAH syndrome results in reduced hospital mortality by 10.3% and reduced postoperative mortality by 11.4%.Conclusion. Monitoring of intra-abdominal pressure and APACHE II scale indices in conjunction with standard clinical and laboratory parameters allows patients to be clearly stratified according to the severity of acute pancreatitis, which helps optimize the choice of treatment tactics, including methods and timing of surgery, as well as the use of a set of effective therapeutic measures aimed at eliminating intra-abdominal hypertension.

Validation of blood pressure measurement with Medicom-Combi blood pressure monitor using oscillometric and auscultatory methods for use among adults (according to International Protocol of European Society of Hypertension for validation of blood pressure measuring devices in adults)

Purpose. To evaluate the accuracy of measuring blood pressure (BP) by the ECG and Medicom-Combi daily blood pressure monitoring system, designed to monitor blood pressure with oscillometric and auscultatory methods, among adults in accordance with the European Hypertension Society’s International Protocol for validation of adult blood pressure measuring instruments (ESH‑2001). Materials and methods. Patients were recruited based on criteria recommended by the ESH‑2001 protocol. A total of 99 pairs of test and control measurements of blood pressure were obtained (three pairs of measurements for each of 33 subjects). The measurements were carried out sequentially on the same arm. For the arm circumference of 24–32 cm and 32–42 cm, two cuffs of the test complex were used (adult small and adult large, respectively). Results. When testing the complex, 66, 93, and 99 measurements were obtained within 5, 10, and 15 mmHg for systolic blood pressure (SBP) and 66, 89 and 95 measurements for diastolic blood pressure (DBP), respectively, using the oscillometric method, as well as 71, 93 and 97 measurements for SBP and 71, 84 and 93 measurements for DBP, respectively, when using the auscultatory method. The mean ± SD of the differences between the test and control measurements were 1.8 ± 5.4 / 1.6 ± 6.9 mmHg for SBP / DBP using the oscillometric method and 0.8 ± 5.9 / –1.2 ± 7.9 mmHg for SBP / DBP using the auscultatory method. Conclusion. The complex of daily monitoring of ECG and blood pressure Medicom-Combi, designed for daily monitoring of blood pressure, meets the requirements stated in the international protocol ESH‑2001 (class ‘Passed’) for adults and is recommended for use in clinical practice.

The Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study of Endobronchial Intubation: An Analysis of 2,000 Incident Reports

Background: The Royal College of Anesthesiologists of Thailand hosted a multicentered project, namely the Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study. Objective: The aims of the present study were to investigate incidences, contributing factors and suggested preventive strategies of anesthesia-related complications particularly the endobronchial intubation (EBI). Materials and Methods: The PAAd Thai study was a collaborative incident report among 22 hospitals across Thailand. After approval by the Institutional Ethical Committee, the structured incident report together with open ended data record form of anesthesia-related complications such as cardiac arrest, death within 24 hours, and respiratory complications including EBI were requested to be sent to the data management center together with monthly statistics of anesthesia service in each hospital for 12 months (between January 2015 and December 2015) on an anonymous and voluntary basis. The EBI reports were reviewed by three anesthesiologists. Any discretion was discussed to achieve a consensus. Descriptive statistics were used. Results: Among the first 2,000 incident reports, there were 23 EBIs, at the rate of 1.06:10,000 (95% CI 0.62 to 1.49) or 1.15% of all reports. Two-thirds of the incidents occurred in patients with age less than 5 years old and more than 60 years old, and in elective cases. The common sites of surgery were trunk, head and neck, and laparoscopic procedures. EBIs were diagnosed by pulse oximeter (13 cases, 54.0%), increased airway pressure (four cases, 17.2%) and clinical monitoring (four cases 17.2%). Common phases of detection were pre-induction (one case, 4.3%), induction (nine cases, 39.2%), maintenance (12 cases, 52.2%), and emergence (one case, 4.3%). Contributing factors were lack of knowledge, inexperience, and haste, while factors minimizing the incidents were having experience and vigilance. Suggested preventive strategies were additional training, including simulation, practice guidelines, improvement of supervision, and communication. Conclusion: The authors have found that EBI was uncommon, but it is one of the serious anesthesia-related adverse events. It can happen anytime during the entire course of anesthesia. Under these circumstances, careful monitoring and vigilance of the anesthesiologists is essential. Keywords: Anesthesia, Complication, Endobronchial intubation, Intubation, Hypoxia

Feasibility of remote digital monitoring using wireless Bluetooth monitors, the Smart Angel\u2122 app and an original web platform for patients following outpatient surgery: a prospective observational pilot study

BackgroundRemote monitoring of mean arterial blood pressure (MAP), heart rate (HR) or oxygen saturation (SpO2) remains a challenge in outpatient surgery. This study evaluates a new digital technology (Smart Angel™) for remotely monitoring hemodynamic data in real time: data transmitted from the patient’s home to a central server, using a dedicated web-based software package.MethodsAdults scheduled for elective outpatient surgery were prospectively enrolled. In the first 5 postoperative days, patients completed a self-report questionnaire (pain, comfort, nausea, vomiting) and recorded SpO2, HR and MAP via two wireless Bluetooth monitors connected to a 4G tablet to transmit the data to a website, in real time, using Smart Angel™ software. Before transmission to the website, these data were also self-reported by the patient on a paper form. The primary outcome was the proportion of variables (self-monitored physiological data + questionnaire scores) correctly transmitted to the hospital via the system compared with the paper version.On Day 5, a system usability scale survey (SUS score 1–100) was also attributed.ResultsFrom May 2018 to September 2018, data were available for 29 out of 30 patients enrolled (1 patient was not discharged from hospital after surgery). The remote monitoring technology recorded 2038 data items (62%) compared with 2656 (82%) items recorded on the paper form (p = 0.001). The most common errors with the remote technology were software malfunctioning when starting the MAP monitor and malfunctioning between the tablet and the Bluetooth monitor. No serious adverse events were noted. The SUS score for the system was 85 (68–93) for 26 patients.ConclusionThis work evaluates the ability of a pilot system for monitoring remote physiological data using digital technology after ambulatory surgery and highlights the digital limitations of this technology. Technological improvements are required to reduce malfunctioning (4G access, transmission between apps).Trial registrationClinicalTrials.gov (NCT03464721) (March 8, 2018).

ECMO-assisted resection of left main bronchial malignant tumor and left pneumonectomy with comprehensive nursing support: a case report

BackgroundPatients with Extracorporeal Membrane Oxygenation (ECMO) undergoing primary bronchial malignancy resection and left pneumonectomy via bilateral thoracic approach are rare for there exist few reports available to date. And the nursing experience about this disease is rare reported.Case presentationThis study reported a 50-year-old man with adenoid cystic carcinoma in left main bronchus by computed tomography (CT), fiberoptic bronchoscopy, and puncture biopsy. The case is the first report about operation method and the comprehensive nursing care, including conventional nursing, airway management, fluid management, nutritional support, and psychosocial support for patients undergoing primary bronchial malignancy resection and left pneumonectomy. After multidisciplinary treatment and comprehensive care, the patient was cured and discharged on the 17th day after surgery.ConclusionThis study reported a rare case with bronchial malignancy resection and left pneumonectomy and discussed its nursing care. A skilled management of ECMO, intraoperative position transformation, and prevention, as well as control of pulmonary complications are fundamental in caring patients with bronchial tumors. Monitoring of pulmonary function and blood pressure, adequate nutrition, and psychological support could be contributing factors for successful treatment during the postoperative stage.

Assessment of the effect of -blockers on the functional state in patients with ventricular arrhythmias: results of a comparative study

Aim.Compare the effects of bisoprolol, nebivolol and sotalol on the functional state of patients with ventricular arrhythmias (VA).
 Material and methods.120 patients with VA against the background of essential hypertension or its combination with coronary heart disease took part in the research, they were randomized into three groups for treatment with bisoprolol, nebivolol and sotalol. As part of combination therapy, patients were administered lisinopril, and if indicated, acetylsalicylic acid, atorvastatin. Initially and after 24 weeks of therapy the following was done: echocardiography, treadmill test, six-minute walk test, subjective assessment of quality of life, all-day monitoring of blood pressure and electrocardiogram.
 Results.With comparable hypotensive and antiarrhythmic effects, therapy with nebivolol increased exercise tolerance to a greater extent, in comparison with bisoprolol and sotalol. Nebivolol and sotalol improved the quality of life, in comparison with bisoprolol.
 Conclusion.In patients with VA against the background of essential hypertension or its combination with coronary heart disease as part of combination therapy the use of nebivolol may be preferable to bisoprolol or sotalol due to a more pronounced positive effect on the functional state.

Effects of Ramadan fasting on blood pressure in hypertensive patients

During Ramadan, repeated cycles of fasting and feeding might contribute to changes in blood pressure and heart rate among hypertensive patients. Studies on the effects of fasting on the blood pressure of hypertensive patients are scarce, and have provided inconclusive results. The aim of this study was to examine the effect of fasting on ambulatory blood pressure and heart rate in treated hypertensive subjects. The study prospectively recruited 40 hypertensive patients between April and June 2019, and followed up at the cardiology department of Habib Thameur Hospital of Tunis. A 24 hour pressure monitoring was carried out during three periods: prior to Ramadan, during Ramadan, and one month after. SPSS version 20 was used to perform the statistical analysis. The paired Student's t -test was used to compare data within the 3 periods. We studied 40 hypertensive subjects (65% women, 35% men), mean age was 57 ± 11years. Patients in the study group were using ACE inhibitors (15%), AT2 receptor blockers (17.5%), calcium channel blockers(17.5%), b-blockers(2.5%) and a combination treatment (47.5%). Average 24 h ambulatory blood pressure in the whole group was 129 ± 15/75 ± 8 mmHg before Ramadan, 127 ± 17/74 ± 8 mmHg during Ramadan and 126 ± 13/74 ± 7 in the following month ( P > 0.05). Daytime and night time mean values of systolic and diastolic blood pressure were not different between the three periods. This study showed a significant improvement in the heart rate during the second period in comparison with the first one ( P = 0.03). In this study, there were no significant changes in systolic and diastolic blood pressures during the 3 periods. There was a significant improvement in the heart rate during the ten last days of Ramadan, in comparison with the pre-Ramadan period. This suggest that fasting during the month of Ramadan, using the same medication might be non-threatening for patients with hypertension.

Dual Aptamer-Copper (II) Phosphate Nanocomposite-Based Point-of-Care Biosensor for the Determination of Escherichia coli O157:H7 through Pressure Monitoring with a Hand-Held Barometer

Here, two types of aptamer (specific to E. coli O157:H7 pathogenic bacteria) Cu3(PO4)2 nanocomposites loaded with Fe3O4 nanoparticles (aptamer@Fe3O4, magnetic separation) and platinum nanoparticles (PtNPs) (aptamer@PtNP) were prepared in house via enzymatic hydrolysis of H2O2 to O2 through a one-step method. In the proposed point-of-care biosensor, these nanocomposites were used as capture and signal probes for the determination of pathogenic E. coli O157:H7 bacteria via hand-held barometers detecting gas pressure signals in a sealed bottle. The pressure signal was linear when the concentration of E. coli O157:H7 was from 103 to 108 CFU/mL. With the easily prepared dual aptamer-Cu3(PO4)2 nanocomposites and the hand-held barometer signal readout, the proposed point-of-care biosensor was shown to be a potential tool for the determination of pathogenic bacteria in underdeveloped areas.

Abstract P042: Role Of Angiotensin In Determining Blood Flow Remaining Kidney Following Nephrectomy

We have previously presented data obtained in anesthetized Sprague Dawley (SD) rats showing acute increases of the renal blood flow (RBF) in the remaining kidney after unilateral nephrectomy (UNx) which were prevented with the AT1 receptor blocker losartan (ARB). We now chronically monitored RBF for 7 days following UNx in unanesthetized SD rats (6 weeks of age) with daily ARB treatment (oral; 10 mg/Kg; n=6) or vehicle (Vhe; Nutella; n=7) administered every 12 hr, from 5 days before UNx and throughout the entire experimental period. Rats were first instrumented with a Transonic flow probe on the left renal artery and a femoral arterial catheter for 24 hr continuous monitoring of RBF and mean arterial pressure (MAP). A week later, rats were anesthetized with isoflurane, and the right kidney was removed (UNx). After rapid recovery (15 min), RBF and MAP were monitored continuously for the next 7 days. In ARB treated rats, MAP fell an average of 115 to 106 mmHg (p<0.05) and RBF increased from 6.2 to 7.4 ml/min (p=0.06). Following Unx, RBF of both the ARB and Vhe group gradually rose (P<0.05) to an average of 10.6 and 9.9 ml/min (p=0.48) in ARB and Vhe treated groups respectively at day 7 while MAP remained unchanged. A similar increase of kidney weight was observed in both groups. Other SD rats (n=7) were instrumented with a femoral arterial and venous catheter for measurements of GFR following UNx. Rats were trained to wear a jacket carrying a miniaturized light emitting diode for real-time transcutanous excitation and detection of the emitted light to determine disappearance curves following i.v. injection of FITC-Sinistrin. Total GFR decreased from 1.8 to 1.2 ml/min/100gbw 2 days after UNx (p<0.05) and remained at that level for 21 days following UNx. We conclude that following UNx the RBF of the remaining kidney increases independent of changes of the renin-angiotensin system and corresponds to kidney hypertrophy. GFR returned to nearly 70% of the 2 kidney filtration rate 2 days following UNx and remained unchanged for the next 21 days.

Abstract P001: Diurnal Dysfunction Of The Renal Endothelin System Is Associated With Obesity-induced Hypertension In Rats

Loss of endothelin (ET) control of Na + reabsorption results in salt-sensitive hypertension. Diet-induced obesity such as via high fat (HF) diet can produce salt-sensitive hypertension. The goal of this study was to determine if obesity produced by HF diet impairs the renal ET system. Male SD rats were fed either HF (45 Kcal% fat) or normal fat (10 Kcal% fat, NF) diet at 6 weeks of age and for 8 weeks duration. Telemetry transmitters were implanted for systolic blood pressure (SBP) and activity monitoring. During the last 2 weeks of the diet, HF and NF rats were sub-divided into 2 groups to receive an additional high salt (4% NaCl, HS) diet or continue on normal salt (0.3% NaCl, NS) diet. Urine was collected and food and water intakes monitored in 12-hr increments the final 2 days. All groups maintained a diurnal BP pattern. However, rats on HF had significantly higher SBP compared to NF (146 ± 1 vs 138 ± 2 mmHg during the active period, p=0.003, n= 12/group). 12-hr urine volume or Na + excretion values were similar between groups. However, urinary ET-1, a measure of intrarenal ET-1 production, was significantly lower in the HF compared to NF controls (0.92 ± 0.15 vs 1.52 ± 0.09 pg/12hrs, p= 0.0007, n= 12/group). Relative mRNA expression of ET-1 in the renal cortex collected at ZT12 was significantly lower in the HF vs. NF (0.8 ± 0.1 vs 1.3 ± 0.2, p= 0.008, n= 6/group). A similar reduction of ET-1 mRNA was observed in the OM of HF rats. However, there was no change in ET-1 mRNA in the IM of HF rats compared to NF (0.8 ± 0.1 vs 1.0 ± 0.2, p= 0.28, n= 8/group). HS diet led to a further increase in SBP in HF vs the HF/NS group (152 ± 2 vs 147 ± 1 mmHg, p=0.04, n= 8/group) while addition of HS to the NF group showed no significant increase in SBP (145 ± 2 vs 140 ± 3 mmHg, p=0.37 n= 6/group). The NF/HS group had a significant increase in active-time ET-1 excretion compared to NF/NS (4.0 ± 0.4 vs 1.5 ± 0.2 pg/12hrs, p<0.0001, n= 6/group). ET-1 excretion was elevated in the HF/HS vs HF/NS rats (2.6 ± 0.3 vs 1.1 ± 0.1 pg/12hrs, p= 0.02, n= 8/group), but was significantly lower than NF/HS rats (4.0 ± 0.4 pg/12hrs p=0.009). These findings demonstrate that HF diets impair the renal ET-1 system and are consistent with our hypothesis that loss of renal ET-1 contributes to salt-sensitive hypertension in diet-induced obesity.

Abstract MP37: Adverse Childhood Experiences Impact Blood Pressure And Pulse Wave Velocity In Adolescence

Adverse childhood experiences (ACEs), such as abuse, neglect, and household dysfunction, have been associated with increased risk of cardiovascular disease (CVD) in adulthood. Understanding how ACEs affects blood pressure during early life is key for the development of early interventions that may reduce the risk of future CVD. We hypothesized that exposure to ACEs is associated with detrimental hemodynamic parameters during adolescence. This study included 78 male and female adolescents (median age=16, range=13-18) recruited from Children’s of Alabama hospital. Exclusion criteria included cardiovascular or renal disease and antihypertensive medication. An oscillometric blood pressure (BP) monitor was used to measure 24-h ambulatory BP. ACE exposure was measured with the Adolescent Life Change Event (ALCES) questionnaire and was prevalent, with 65% (51 of 78) of participants experiencing 1 ACEs. The mean cumulative ACE score was 1.4±0.2. ACE exposure was not correlated with gender, race, age, or body mass index (BMI). Linear regression models were utilized to link ACE exposure (0 versus 1 ACEs) with 24-h mean arterial pressure (MAP), systolic BP (SBP), diastolic BP (DBP), and pulse wave velocity (PWV). Race and gender were included as covariates. Mean 24-h DBP was significantly (p=0.04) higher in participants with ACE exposure (65.9±0.7 mmHg, n=51) compared to those with no ACE exposure (64.1±0.9 mmHg, n=27); this association was independent of covariates. Since BMI was significantly correlated with SBP, PWV, and MAP, additional models included BMI as a covariate. Both ACE exposure (p= 0.02) and BMI (p<0.001) were associated with increased PWV, while the interaction between ACE exposure and BMI was negatively associated with PWV (p=0.02). Mean 24-h SBP and MAP were not significantly associated with ACE exposure. The finding that ACE exposure is associated with elevated DBP and PWV and not with SBP is in accordance with previously reported results in young adults and suggests that ACEs may alter autonomic pathways leading to CVD and hypertension. Interventions targeted at individuals with ACE exposure early in life could lower the risk of arterial stiffness and in turn the cascade of events leading to CVD.

Efficiency of double fixed combined therapy in patients with arterial hypertension and associated thyrotoxicosis after one year of treatment

The aim: to evaluate the effectiveness of different fixed double antihypertensive combinations based on the results of outpatient monitoring of arterial pressure and to analyze their effect on central arterial pressure and cardiac remodeling in patients with arterial hypertension and thyrotoxicosis. Materials and methods: patients with hypertension and TT who were included in the study were divided into groups using the blind envelope method with compensated TT: patients of group 1 were prescribed a fixed combination of perindopril with indapamide, group 2 - a combination of perindopril with amlodipine. Patients with uncompensated TT were prescribed a combination of bisoprolol with perindopril. The groups were statistically comparable in terms of age, duration of AH and TT, SBP and DBP levels. The observation of the patients lasted 12 months. After a year of follow-up, AMAD and EchoCG were performed in order to study AHT in patients with hypertension and TT. The patients were consulted by a cardiologist and endocrinologist. Results: After 6 months of treatment, 8 (16 %) patients were excluded from the study, of which 6 (75 %) due to the need for surgical treatment and did not achieve euthyroidism, 2 (25 %) due to the need for antiarrhythmic therapy. Studied double fixed combinations effectively reduce blood pressure (BP) according to the results of ambulatory blood pressure monitoring (ABPM). Conclusions: The fixed combination of perindopril with indapamide, perindopril with amlodipine, bisoprolol with perindopril provided a decrease in both blood pressure according to ABPM results and central pressure, however, this was not accompanied by a significant improvement in the structural and functional state of the heart

Effectiveness of arterial hypertension control using ambulatory blood pressure monitoring in patients in the remote period after myocardial infarction and ischemic stroke

Arterial hypertension is one of the most important modified risk factors and its adequate control is a cornerstone of primary and secondary prevention. On the other hand, excessive lowering of blood pressure can be harmful, especially in patients with a history of ischemic events. The aim: To evaluate daily blood pressure fluctuations with ambulatory blood pressure monitoring in patients with controlled hypertension according to office measurements in the remote period after myocardial infarction and ischemic stroke Materials and methods: The study involved 64 patients with hypertension in remote period (at least 6 months) after myocardial infarction (38 patients) and ischemic stroke (26 patients) with systolic blood pressure during the last three months and at least two visits. in the range of 120-139 mm Hg and diastolic blood pressure 70–89 mm Hg. Patients with valvular heart disease, severe arrhythmias, significant heart failure (NYHA III-IV) were not included in the study.All patients underwent daily blood pressure monitoring. According to the recommendations of ESC / ESH in 2018, the optimal blood pressure control was considered to be the average daily blood pressure after myocardial infarction 130–140 / 70–79 mm Hg. at the age of >65 years, 120–130 / 70–79 mm Hg at the age of ≤65 years; after ischemic stroke 120–130 / <80 mm Hg. All values below the optimal levels were considered to be low blood pressure, higher than optimal – high blood pressure. Particular attention was paid to excessive reduction of blood pressure with the calculation of the number of excessive reductions and their duration during the day. Results: The average daily blood pressure values corresponded to the definition of optimal in only 23.4 % of patients with ischemic events. In 63.2 % of patients after myocardial infarction, the mean daily values of systolic blood pressure and diastolic blood pressure were lower than recommended, and in patients after ischemic stroke, this number was significantly lower – 23.1 %. Conversely, in more than half of the patients after ischemic stroke (53.6 %) the average daily blood pressure levels exceeded the recommended ones. In patients after myocardial infarction, this number was only 13.2 %. Excessive reductions in blood pressure were recorded in 58 of 64 patients (90.6 %), in 54 persons such episodes were observed during the day (84.3 %). Persistent (over 1 hour) excessive decrease in blood pressure was registered in 16 people (25.0 %), 8 of whom had persistent excessive blood pressure reductions ≥2/day (12.5 %). Predictors of excessive blood pressure lowering were males, myocardial infarction, beta-blockers. Conclusions: Patients with hypertension after myocardial infarction or ischemic stroke require regular monitoring of blood pressure, even in cases where blood pressure is within the recommended range for some time. It is necessary to take into account the risk not only of increasing but also of excessive lowering of blood pressure

Diagnostics of seal and rod degradation in hydraulic cylinders using acoustic emissions

External leakage from hydraulic cylinders is of a major concern for the offshore oil and gas industry. This occurs mainly as a result of physical damage to the piston rod or due to degradation of the piston rod seals. Numerous studies have been conducted to diagnose leakage from hydraulic cylinders due to seal failure using fluid, pressure, accelerometer or acoustic emission-based condition monitoring techniques. However, very few attempts have been made to diagnose multiple faults in hydraulic cylinders at the same time. Therefore, in this study, acoustic emission-based condition monitoring technique is used to detect and separate acoustic emission features due to different faults that are observed in hydraulic cylinders. An experimental study was performed on a test rig using water glycol as hydraulic fluid. Experiments were performed with different combinations of seals (unworn, semi worn and worn seals), and piston rods (unworn and worn). Acoustic emission features such as root mean square, peak, mean, kurtosis, skewness, mean frequency, median frequency and bandpower were used to identify seal and rod conditions. By using acoustic emission median frequency and mean frequency features it was possible to detect and separate leakage, and seal and rod degradation in the test rig over a large range of hydraulic working pressures. This study indicates that acoustic emission monitoring can be a strong basis for future research to identify and segregate other types of faults that are observed in hydraulic cylinders.

Study on New Type of Roadway Side Support Technology in Coal Mines

In order to solve the problems of coal pillar loss and relieve the tension of mining replacement in the coalface of a coal mine, this study proposes an adaptive method of retaining roadway along gob with supporting body (pier column) near loading roadway. The supporting technology of pier column retaining roadway along gob is studied through theoretical analysis and numerical simulation. The results show that the roof activity of roadway along gob can be divided into three distinct stages, namely, the stage influenced by primary mining, the stability stage of roadway retention, and the stage influenced by secondary mining. By establishing a roof mechanics model, equations are derived for calculating roof cutting resistance in three stages of gob retaining roadway, and the parameters of the supporting pier are determined. Combined with FLAC3D numerical simulation, this study develops a numerical model to investigate the surrounding rock stress distribution characteristics and deformation rules, as well as the stress and deformation rules of piers and pillars during the two mining periods of gob retaining roadway. The numerical results demonstrate that the compressible pier column supporting body adopted in this study can not only achieve better retaining effect in the roadway along the goaf, but also reduce the cost and labor. Keywords: Gob-side entry retaining, compressible pier column, surrounding rock movement, numerical simulation, pressure monitoring.