Significant Difference In Pressure Research Articles

Toward Acid and Heparin-Free Dialysis: The Regional Anticoagulation Approach

Abstract Background and hypothesis In chronic intermittent hemodialysis, heparin is the standard anticoagulant as is the use of acid-containing dialysate. Regional anticoagulation (RA) with a calcium-free, citrate-containing dialysate has been developed. We compared RA using a calcium-free, citrate-free dialysate, routinely used in our centre, to systemic heparinization. Methods In a retrospective, observational, single-centre, cross-over study, we examined 15 patients undergoing chronic hemodialysis who were at high risk of bleeding and temporarily unable to use heparin. These patients received temporary treatment with RA involving calcium-free and citrate-free dialysate. We compared the dialysis session success rates during two distinct periods: standard heparinization and RA procedure with a calcium-free and citrate-free dialysate. Results In our study of 15 patients on chronic hemodialysis which compared 30 RA sessions to 28 heparin-based anticoagulation session, we observed a 100% success rate with a median session duration of 240 minutes in both RA and heparin groups. No early extracorporeal circulation (ECC) loss was reported. However, we noted significant differences in the post-dialysis ECC thrombosis scores, with higher Global Thrombosis Index (GTI) and higher membrane coagulation scores in the RA group (p < 0.007 and p < 0.02, respectively). No hypocalcaemia or hypercalcemia symptoms occurred. Median post-filter ionized calcium levels were 0.32 [0.29–0.39] mmol/L at 30 minutes and median patient ionized calcium levels was 1.19 [1.135–1.28] mmol/L at 60 minutes. No significant difference in per-dialysis arterial blood pressure was observed between groups. Conclusion Our study evaluated the RA approach using a calcium-free, citrate-free acetate dialysate in a chronic hemodialysis centre and found it effective. Although an acid-free dialysate was not used in this study, our findings suggest it could be the next frontier in the evolution of advanced dialysis techniques.

#2213 APOL1 high-risk genotype in in a Dutch multi-ethnic population

Abstract Background and Aims The presence of 2 APOL1 high-risk alleles (high-risk APOL1 genotype) is associated with an increased risk of ESKD. In the USA, the prevalence of these high-risk alleles is high in people of West African descent and almost absent in patients from European descent. In Amsterdam, there is a significant number of people from Surinam, and (West-) Africa. A big group of Surinamese individuals have a West African heritage. The prevalence, however, of high-risk APOL1 genotype in the Netherlands and thereby the significance is unknown. The aim of this research was to investigate the prevalence of the APOL1 risk alleles in a multi-ethnic cohort of the Amsterdam general population consisting of individuals of African Surinamese, Ghanaian, Moroccan and Dutch origin. Second we correlate the presence of these risk alleles to blood pressure, kidney function and proteinuria. Method HELIUS is a multi-ethnic prospective cohort study including people aged 18-70 who were randomly selected, stratified by ethnic origin, from the Amsterdam general population. Baseline examination took place tween 2011 and 2015. We analysed a population of 5971 individuals with available genotype data, of whom 1287 were of Dutch, 3048 of Moroccan, 1156 of African Suriname and 480 of Ghanaian descent. APOL1 risk was determined by genotyping two APOL1 missense variants, rs73885319A>G, S342G; rs60910145T>G, I384M, together constitute the G1 high-risk allele and the 6-base pair deletion allele, rs71785313 RRRATAA/−, N388Y399/−−, is the G2 high risk allele. Logistic regression analyses were performed to determine correlation between creatinine, eGFR, and systolic blood pressure and apol1 high risk genotype, with additional adjustments for age, sex, and BMI. Results The prevalence of high-risk APOL1 genotype was 4.17% in the total sample, in African Surinamese 9.5%, and in the Ghanaian 29.0%. There were no individuals with high risk genotype in the Moroccan or Dutch descent population. The presence of high risk APOL1 genotype was associated with an elevated creatinine level of 10.68 µmol/L (SD 0.91) in the whole cohort. Also, in the Surinamese and Ghanaian populations population the presence of the high-risk APOL1 genotype was associated with an increased creatinine of 2.6 µmol/L (SD 1.00) as compared to the black population with low-risk APOL1 genotype. People with high-risk APOL1 genotype had significantly higher systolic blood pressure 10.69 mmHg (SD 0.091) than those without. Nevertheless, there was no significant difference in systolic blood pressure in the black population with high-risk APOL1 genotype in comparison with the black population with low-risk APOL1 genotype 1.38 mmHg (SD 1.17). Also, there was no significant difference in eGFR (CKD CKD-EPI 2009) in any analysis and no differences in proteinuria was seen, between those with and without the high-risk APOL1 genotype. Conclusion In this population, the overall prevalence of the APOL1 risk alleles seems to conform to the African American population in the USA. There is however a much higher prevalence of high-risk APOL1 genotype in the Ghanaian in comparison to the African Surinamese. The group with high-risk APOL1 genotype had significantly higher creatinine levels and higher systolic blood pressure. However there was no significant difference in blood pressure within the black population between APOL1 high-risk genotype and low-risk genotype. There was no significant difference in eGFR, possibly because the CKD-EPI 2009 formula was used which overestimates the eGFR in the black population. Better calculation with cysteine C possibly gives different outcomes. In conclusion, this is the first study in Europe investigating the prevalence of APOL1 high-risk genotype in a large population-based cohort. APOL1 risk alleles, and high-risk genotype, are prevalent in our population of African descent. More analysis in this cohort are pending and also longitudinal data will follow.

#2113 Membranoproliferative glomerulonephritis experience over 20 years in a tertiary centre in the United Kingdom

Abstract Background and Aims Membranoproliferative Glomerulonephritis (MPGN) is a histological pattern of injury which typically accounts for light microscopy findings on 1-3% of kidney biopsies. It is classified based on immunofluorescence into complement-mediated, immune complex-mediated (IC) and immunofluorescence negative. The underlying aetiologies such as C3 Glomerulopathy are rare diseases, and thus longitudinal real-world experience in terms of underlying causes, treatment and outcomes is valuable. Method This study presents a retrospective review of biopsy data from January 2000 through to December 2020 in a tertiary renal referral centre in the United Kingdom (UK). This review was conducted using the organisation's biopsy database, with patient demographics and clinical information obtained from the Electronic Patient Record. All patients with an MPGN pattern on biopsy were reviewed. Those with new MPGN post-transplant, with an MPGN pattern on biopsy but subsequently diagnosed as IgA Nephropathy, and with an MPGN pattern but a known lupus diagnosis, were excluded. Results A histological finding of MPGN on kidney biopsy was found in 67 patients. Of these, 41 remained in the study following application of the exclusion criteria, with an additional 3 excluded as there was insufficient information available for classification in their biopsy reports. Of the 38 remaining, 28 had IC MPGN and 10 had C3 Glomerulopathy (C3G) - 8 with C3 Glomerulonephritis (C3GN) and 2 with C3 Dense Deposit Disease (DDD). Median follow up was 72 (range 45-126) months. Median age was 64 years in the IC MPGN and 55 years in the C3G groups (p 0.125). The majority in both groups were female, 60.7% (17) and 60% (6) respectively. There was no significant difference in renal function, blood pressure, or proteinuria at presentation between the groups. MPGN was associated with infections in 8 patients (21.1%), connective tissue disease in 3 patients (7.9%), monoclonal gammopathies or haematological malignancies in 8 patients (21.1%), and 2 had identified complement deficiencies (5.3%). Over the study period 47.4% (18) of patients progressed to end stage kidney disease and 50% (19) died. There was no significant difference in these outcomes between the IC MPGN and the C3G groups. Progression to renal replacement therapy (RRT) was seen in 42.9% (12) of the IC MPGN group, and 60% (6) of the C3G group (p=0.287). This included two patients who received a kidney transplant (both in the C3G group), one of whom developed recurrence during the available follow up. Conclusion This study adds a UK perspective with long term data and outcomes in a rare condition. Almost half of patients progressed to RRT and half of patients died during the follow-up period. These outcomes were seen at similar rates in those with IC MPGN and those with C3G. A variety of associated conditions were observed, and the low number of complement deficiencies identified is likely due to the historical nature of the review with reduced screening for complement abnormalities and genetics in the earlier period. Outcomes on follow-up:

Clinical study on the efficacy and safety of glaucoma drainage implants in the treatment of different types of glaucoma

Objective: To evaluate the efficacy and safety of glaucoma drainage implants(XEN-45 Gel Stent) for glaucoma treatment. Methods: A prospective study was conducted to continuously collect the clinical data of patients who were diagnosed with glaucoma and underwent XEN-45 Gel Stent implantation in the Ophthalmology Department of Peking University People's Hospital from January 2022 to August 2023. The visual acuity, intraocular pressure, number of glaucoma medications, and success rate of the patients were analyzed before and after surgery at 1 day, 1 week, 1 month, 3 months, 6 months, 12 months, and 18 months. The differences in intraocular pressure and number of glaucoma medications among primary open-angle glaucoma, primary angle closure glaucoma, secondary glaucoma, and different implantation methods of XEN-45 Gel Stent among patients with primary open-angle glaucoma were compared. The intraoperative and postoperative complications were observed, and the risk factors for needling and surgical complete success were analyzed. Results: A total of 48 eyes from 48 patients were included in this study, comprising 27 males and 21 females, with a mean age of (54.4±18.0) years and the disease duration was 36.0(7.3, 81.0) months.There were 28 cases of primary open-angle glaucoma, 4 cases of primary angle closure glaucoma, and 16 cases of secondary glaucoma.The follow-up period was 8.0 (3.0, 12.0) months. At 12 months after surgery, the intraocular pressure decreased from 20.5 (17.0, 26.0) mmHg to (13.5±3.3) mmHg (P<0.05), and the number of glaucoma medications decreased from 3.0 (3.0, 4.0) to 0.0 (0.0, 0.0) (P<0.05). The complete success rate and qualified success rate were 73.9% (17/23) and 91.3% (21/23), respectively. The most common postoperative complications were shallow anterior chamber in 6 cases (12.5%), hypotony in 3 cases (6.3%), and blocked stent in 3 cases (6.3%). The most common postoperative treatment was needling in 27 cases (56.3%). There was no significant difference in intraocular pressure among different types of glaucoma. In the comparison of postoperative effects of different surgical implantation methods for primary open-angle glaucoma, there were no statistically significant differences in intraocular pressure and the number of glaucoma medications at other follow-up time points except 1 month after surgery (P<0.05). Univariate logistic regression analysis did not find any risk factors associated with needling and surgical complete success. Conclusions: XEN-45 Gel Stent implantation is an effective and safe surgical option for different types of glaucoma patients in China, which can significantly reduce intraocular pressure and the use of glaucoma medications and has a high success rate. However, some patients may need needling or other treatments after surgery.

Genetic Deletion of Carboxypeptidase N Attenuates Angiotensin II-Induced Hypertension and Target Organ Damage

Objectives: Kininase I transforms bradykinin and kallidin, into kinin B1 receptor (B1R) agonists des-Arg9-BK and des-Arg10-kallidin, respectively. Carboxypeptidase M (CPM) is the membrane bound isoform of kininase I and carboxypeptidase N (CPN) is the isoform located in the plasma. Activation of the B1R has been implicated in the development of hypertension, diabetes and atherosclerosis. Pharmacologic inhibition of kininase I is associated with reductions in B1R expression, inflammation, oxidative stress, and improvements in insulin resistance. B1R can interact with aminopeptidase N (CD13) or high-mobility group box 1 (HMGB1) to mediate an inflammatory response. However, the exact role of kininase I in the development of hypertension and the regulation of these B1R-mediated signaling mechanisms remains unknown. In this study, we hypothesize that gene deletion of CPN will prevent B1R activation, reduce inflammation via interfering with CD13 and HMGB1 signaling, and ultimately attenuate the progression of hypertension and target organ damage. Methods and Results: To test our hypothesis we utilized 12-week-old male and female C57BL/6NJ wild-type (WT) and CPN gene knockout (CPNKO) mice. These mice were infused angiotensin II (Ang II, 600 ng/kg/min) or saline (vehicle) via osmotic minipumps for 2 weeks. Vehicle treated CPNKO and WT mice showed no significant difference in mean arterial blood pressure (MAP) (104 ±7 vs 102 ±5 mmHg, n=5, p≤0.05). Ang II-induced elevations in MAP were significantly reduced in CPNKO mice compared to WT mice infused with Ang II (129 ±8 vs 150 ±6 mmHg, n=5, p≤0.05). Interestingly, we did not find any significant sex differences in MAP in CPNKO groups. Additionally, Ang II treatment significantly increased cardiomyocyte hypertrophy in male and female WT mice, but this effect was blunted in CPNKO mice (n=5, p≤0.05; wheat germ agglutinin staining). Ang II infusion promoted collagen deposition in the aorta of WT male and female mice, but not in CPNKO mice (n=5, p≤0.05; picrosirius red/Masson’s trichrome). In male WT mice, Ang II significantly increased the immunoreactivity of CPM in the heart, but this was abrogated in CPNKO mice infused with Ang II (n=4, p≤0.05). Similarly, B1R was also upregulated in male WT mice hearts when compared to CPNKO mice after Ang II infusions (n=3, p≤0.05). We also found that Ang II significantly increased HMGB1 and CD13 in male WT hearts and brains, but not in CPNKO mice (n=4, p≤0.05). In addition, oxidative stress levels in the brain were significantly increased by Ang II in WT mice and was attenuated in CPNKO mice (n=4, p≤0.05; dihydroethidium staining). Conclusions: Genetic deletion of CPN attenuates Ang II-induced hypertension by reducing B1R mediated reductions in CD13 and HMGB1-mediated inflammatory responses and oxidative stress. Our data suggests that targeting kininase I may be a novel therapeutic target for hypertension and target organ damage. Funding: This study was supported by NHLBI/NIH 5R01HL153115 (S. Sriramula). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Immune Activation Promotes Cardiac Remodeling in a Mouse Model of Takotsubo Cardiomyopathy

Takotsubo Cardiomyopathy (TCM) is an acute, life-threatening condition characterized by a drop in ejection fraction (EF) and apical ballooning of the left ventricle (LV). TCM is most frequently observed in women and is associated with an emotional or physical stressor. Importantly, with medical intervention, cardiac dysfunction is transient, and EF is often restored over weeks to months. Despite this, patients who experience TCM are at an increased risk of additional cardiovascular events and premature mortality. The precise etiology of TCM is unknown but a wave of excess circulating catecholamines is thought to be a trigger. Furthermore, the cause for increased cardiovascular risk post-TCM is unknown. The goal of this study is to understand how the immune system may contribute to TCM and the associated cardiovascular event risk. To induce TCM, mice were given a single dose of 200mg/kg isoproterenol (ISO), i.p. and cardiac function was assessed by conscious echocardiography (ECG). An initial study compared the effect of ISO between sexes (n=4-6). Though ISO induced a drop in EF in both sexes after 24 hours (p&lt;0.001 compared to vehicle (Veh)), females exhibited lower EF (46.64±3.11%) than males (68.36±2.62%, p&lt;0.0001). This mirrors the increased prevalence of clinically defined TCM in females in human populations. For this reason, female mice were used for the following experiments. A time course study demonstrated that EF begins to normalize by Day 3 (78.78±2.70 v 90.80±1.00%, p&lt;0.001) and is restored to baseline levels by Day 7 (90.65±1.17%). Flow cytometry was used to identify changes in immune cell populations in the heart on Days 0, 1, 3 and 7 (n=4-5). Neutrophils and inflammatory monocytes increased on Day 1, returning to baseline by Day 3. Dendritic cells and macrophages were elevated on Day 3 post-ISO, with a specific increase in CCR2+ TIM4- recruited inflammatory macrophages (p&lt;0.0001). Across all subsets, the number of immune cells returned to baseline levels by Day 7. Due to the robust immune response observed, we tested the specific hypothesis that transfer of immune cells from mice who have experienced TCM would induce cardiac dysfunction in naïve recipient mice. Donor mice were treated with either Veh or ISO and 1 day later splenocyte isolation and transfer was performed. Importantly, transfer of splenocytes from mice who had TCM induced a significant drop in EF the following day in the recipient mice (86.30±1.08%, p=0.001, n=10) concurrent with an increase in LV inner diameter and volume during systole. A final study tested the hypothesis that a history of TCM would increase risk for future cardiovascular disease. Veh or ISO-treated mice were allowed to recover for 10 days. Tail-cuff plethysmography showed no significant difference in baseline blood pressure and minipumps were implanted to deliver a constant infusion of Angiotensin II (Ang II, 140ng/kg/min). Mice with a history of TCM exhibited higher blood pressures compared to controls (135.11±3.32 v 116.9±6.41mmhg, n=6/9, p&lt;0.05) by week 2 of Ang II infusion. These results together demonstrated that TCM is associated with a robust immune response and points to a possible causal contribution of immune activation to the cardiac dysfunction observed in TCM. Furthermore, a history of TCM promotes a hypertensive phenotype, but additional studies are needed to test whether this is through immunological mechanisms. AHAPOST837441 DJF, 19EIA34480023-MSM, and 1R01 HL161212-MSM. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Analysis of the Effect of Family-Centered Empowerment Model (FCEM) Health Education Through WeChat on Medication Compliance and Blood Pressure of Elderly Hypertensive Patients in Rural Areas

Objective: To validate the effectiveness of a Family-Centered Empowerment Model (FCEM) health education through WeChat on medication compliance and blood pressure among elderly hypertensive patients in rural areas. Methods: One hundred and two rural elderly hypertensive patients aged 65–80 years were selected and randomly divided into an experimental and control group of 51 each. The control group implemented conventional health education, and the experimental group implemented FCEM health education through WeChat platform for 4 consecutive weeks. The Therapeutic Adherence Scale for Hypertensive Patients (TASHP) scores and blood pressure measurements were compared between and within the two groups. Results: After the intervention, there were significant differences in medication compliance and blood pressure between the two groups (P &lt; 0.001). In the control group, before and after the intervention, there was a significant difference in medication compliance (P &lt; 0.001), but no significant difference in blood pressure (P &gt; 0.05). In the experimental group, there were significant differences in medication compliance and blood pressure before and after the intervention (P &lt; 0.001). Conclusion: The FCEM health education through an online social platform significantly improved medication compliance and led to effective blood pressure control in rural elderly hypertensive patients. Therefore, as an effective, safe, and economical model, it is also necessary to explore its effectiveness in improving health problems in other chronic diseases and other age groups.

Clinical features and comprehensive treatment of persistent corneal epithelial dysfunction after cataract surgery

ObjectiveEvaluation of clinical efficacy and safety of tobramycin/dexamethasone eye ointment in treating persistent corneal epithelial dysfunction (PED) after cataract surgery.Methods26 cases diagnosed as PED after cataract surgery accept the tobramycin/dexamethasone ophthalmic ointment and intense pulse light treatment in the Xiamen University of Xiamen eye center between September 2016 and April 2022 were retrospectively analyzed, mainly including clinical manifestations, characteristics of morphological changes imaged by in vivo confocal microscopy, meibomian glands infrared photography, lipid layer thickness (LLT), management and therapeutic effects.ResultsThere were 26 eyes, include 8(35%) males and 15(65%) females with an average age of 69.6 ± 5.2 years(50 to 78 years). The mean hospitalization time was (18.4 ± 7.5) days after cataract surgery. Twenty patients had meibomian gland dysfunction. Infrared photography revealed varying loss in the meibomian glands, with a mean score of 3.8 ± 1.2 for gland loss. The mean LLT was 61.6 ± 8.4 nm. After treatment, 20 patients were cured, and 3 received amniotic membrane transplantation. After treatment, the uncorrected visual acuity (UCVA) and best-corrected vision activity (BCVA) improved (P < 0.001), and there was no significant difference in intraocular pressure (IOP) before and after treatment (P > 0.05).ConclusionsThe early manifestation of PED after surgery is punctate staining of the corneal epithelium. Tobramycin and dexamethasone eye ointment bandages have a good repair effect. The meibomian gland massage combined with intense pulse light treatment can effectively shorten the course of the disease.

The Effect of Clothes on Blood Pressure Measurement in Normotensive and Hypertensive Subjects in a Real-Life Setting

Introduction: The effect of clothing on the recording of blood pressure in a normotensive and hypertensive population remains essential to diagnosing and managing. Methods: This is a cross-sectional study to measure blood pressure using a validated oscillometric sphygmomanometer in two populations. The records were made over the thicker sleeve arm and non-sleeved arm (either on bare arm or indicating the removal of the outermost garment). Clothing was categorized according to how patients attended the outpatient clinic based on the real world. Results: A total of 75 patients were included with a diagnosis of hypertension whose mean age was 67.1 years (SD ± 16.3). The group of normotension included 63 patients whose mean age was 21.1 years (SD ± 2.2). There was not variability related to technique or inherent to the condition of the subject on the first and second measurements of blood pressure. In the comparative analysis, the group with normotension did not report a significant difference in systolic or diastolic blood pressure due to the effect of clothing during the first or second measurement (p > 0.05). In the group with hypertension, a significant difference was observed in the first measurement, between the group over-the-sleeve and non-sleeved arm (systolic blood pressure, p: 0.021 and diastolic, p: 0.001). However, when the variable order of measurement was analyzed by randomizing the initial registry with or without clothing was not found a statistical difference. Conclusion: Clothing does not a significant difference in the measure of blood pressure in a normotensive or hypertensive population.

The Effect of Tera Gymnastics on Reducing Hypertension in the Elderly in Dukugawing-Kepunduan Cirebon

Elevations in blood pressure and pulse might result from changes in the cardiovascular system that occur with aging, including the loss of artery flexibility. Motion-based exercise for the elderly increases the release of hormones that relax the patient by stimulating the sympathetic and parasympathetic nervous systems. Senior gymnastics is an excellent physical activity for removing fat and cholesterol from blood vessels. This study aimed to determine the impact of senior exercise on hypertension in the older population in the Dukugawing Block, Kepunduan Village, Dukuntang District, and Cirebon Regency. The pre-experimental research design employed in this study included 34 senior hypertensive participants in a one-group pre-posttest design using simple total sampling. As the data were normally distributed, a paired t-test was used for data analysis after blood pressure was taken using a sphygmomanometer and elderly gymnastics was measured using a standard operating procedure (SOP). As a result of the intervention, the average blood pressure dropped from 150/94 mmHg to 140/90 mmHg, according to the data. After administering an aged exercise intervention for the elderly in the Dukugawing Block, Kepunduan Village, Dukuntang District, Cirebon Regency, a paired sample t-test analysis yielded a p-value = 0.00 &lt;0.05, indicating a significant difference in blood pressure before and after participation.

Neutrophil-lymphocyte and Platelet-lymphocyte Ratios of Pregnant Women Living with HIV/AIDS

Background: Chronic inflammation, a factor for high mortality, persists throughout the pregnancy period of women living with human immunodeficiency Virus (HIV).&#x0D; Aim: To determine whether pregnancy alone or the combined effects of HIV and pregnancy are the sources of the inflammation, this study evaluated the predictive variables for inflammation, lymphocyte ratio (NLR), and Platelet-Lymphocyte Ratio (PLR).&#x0D; Materials and Methods: A population of 128 women, aged 15-49 years were grouped into 4; Group A- 32 HIV positive and pregnant, Group B- 32 HIV negative and pregnant, Group C- 32 HIV positive not pregnant, Group D- 32 HIV negative not pregnant (control group). Differential white blood cell and platelet count methods were used to determine the neutrophil (N), Lymphocyte (L) and platelet (P) counts. The ratio calculation method was used to derive the NLR and PLR.&#x0D; Results: NLR was significantly higher for group A (2.62±0.41) compared to groups B (2.25 ± 0.18); C (0.95 ± 0.07); D (1.68 ± 0.19) at p ≤ 0.00. However, the NLR of groups A and B (p ≤ 0.05) were not significantly different, PLR was significantly higher for group A (9.86±1.12) compared to groups B (6.65 ± 1.12); C (5.35 ± 0.47); D (6.34 ± 0.43). There was no significant difference in blood pressure across the groups, significant difference was however observed in their Body Mass Index.&#x0D; Conclusion: Hence, Inflammation may have been caused by pregnancy alone.

Higher contact pressure of the lateral tibiofemoral joint in lateral extra-articular tenodesis with tensioned graft in external rotation than in neutral rotation: A biomechanical study

ObjectiveTo determine the mean contact pressure, peak contact pressure, and mean contact area of the lateral tibiofemoral joint in lateral extra-articular tenodesis (LET) with tension on the graft in tibial neutral and external rotation. MethodsA total of eight Thiel-embalmed cadaveric knees were prepared and divided into two groups (4 knees in each group): the LET-NR group (lateral extra-articular tenodesis tension in neutral rotation) and (2) the LET-ER group (lateral extra-articular tenodesis tension in external rotation). Each knee was prepared according to the corresponding technique. A hydraulic testing system (E10000, Instron) simulates an axial load of 735 ​N for 10 ​s in each group. ResultsThe LET-ER group exhibited a statistically significant higher peak contact pressure compared to the LET-NR group. The peak contact pressure values in the LET-NR and LET-ER groups were 702.3 ​± ​233.9 ​kPa and 1235.5 ​± ​171.4 ​kPa, respectively (p ​= ​0.010, 95% CI, −888.0 to −178.5). The mean contact pressure values in the LET-NR and LET-ER groups were 344.9 ​± ​69.0 ​kPa and 355.3 ​± ​34.9 ​kPa, respectively (p ​= ​0.796, 95% CI, −105.1–84.2). The mean contact area values in the LET-NR and LET-ER groups were 36.8 ​± ​3.1 mm2 and 33.3 ​± ​6.4 mm2, respectively (p ​= ​0.360, 95% CI, −5.2–12.2). ConclusionsThe peak contact pressure of the lateral tibiofemoral joint is greater in LET when the graft is tensioned in external rotation than in neutral rotation. However, no statistically significant difference in the mean contact pressure or the mean contact area was observed between the two groups. Level of evidenceIII.

Effect of combination pioglitazone with sodium-glucose cotransporter-2 inhibitors or glucagon-like peptide-1 receptor agonists on outcomes in type 2 diabetes: A systematic review, meta-analysis, and real-world study from an international federated database.

To evaluate the efficacy and cardiovascular outcomes of combination pioglitazone with either a glucagon-like peptide-1 receptor agonist (GLP-1RA) or a sodium-glucose cotransporter-2 (SGLT2) inhibitor in individuals with type 2 diabetes (T2D) by conducting a systematic review, meta-analysis, and analysis of a large international real-world database. We searched MEDLINE, SCOPUS and Web of Science to identify relevant articles for inclusion (PROSPERO [CRD: 42023483126]). Nineteen studies assessing pioglitazone + SGLT2 inhibitors or GLP-1RAs versus controls were identified, 16 of which were randomized controlled trials. Risk of bias was assessed using Cochrane-endorsed tools and quality of evidence was assessed using GRADE. We additionally performed a retrospective cohort study of all individuals aged 18 years or over with T2D, using the TriNetX platform. We included propensity-score-matched individuals who were treated for at least 1 year with pioglitazone and a GLP-1RA or pioglitazone and an SGLT2 inhibitor, compared against GLP-1RA and SGLT2 inhibitor monotherapy. Outcomes were all-cause mortality, heart failure, chronic kidney disease and composite stroke and transient ischaemic attack. The average follow-up in the included studies ranged from 24 to 52 weeks. Combination of pioglitazone with a GLP-1RA reduced glycated haemoglobin (HbA1c) and weight greater than in controls: mean differences -1% (95% confidence interval [CI] -1.27, -0.74) and -1.19 kg (95% CI -1.80, -0.58), respectively. There was no statistically significant difference in systolic blood pressure (SBP) or mortality between groups: mean difference - 1.56 mmHg (95% CI -4.48, 1.35; p = 0.30) and relative risk (RR) 0.29 (95% CI 0.07-1.15; p = 0.08), respectively. Combination of pioglitazone with SGLT2 inhibitors reduced HbA1c, weight and SBP to a greater extent than control treatment: mean differences -0.48% (95% CI -0.67, -0.28), -2.3 kg (95% CI -2.72, -1.88) and -2.4 mmHg (95% CI -4.1, -0.7; p = 0.01), respectively. There was no statistically significant difference in mortality between groups (RR 1.81, 95% CI 0.30-10.97; p = 0.52). The included trials demonstrated a reduction in risk of heart failure with combination treatment. Similarly, from the real-world database (n = 25 230 identified), pioglitazone and SGLT2 inhibitor combination therapy was associated with reduced risk of heart failure compared to monotherapy alone (hazard ratio 0.50, 95% CI 0.38-0.65; p < 0.001). Both our systematic review/meta-analysis and the real-world dataset show that combination of pioglitazone with either GLP-1RAs or SGLT2 inhibitors is associated with increased weight loss and reduced risk of heart failure compared with monotherapy.

Effect of Dorzolamide-Timolol fixed dose combination on central Corneal Thickness in patients of Primary Open Angle Glaucoma Versus Normal Tension Glaucoma

PURPOSE: To evaluate the effect of dorzolamide/timolol fixed dose combination on central corneal thickness in primary open-angle and normal tension glaucoma. METHOD: This retrospective cohort study was approved by the Ethical Review Board of College of Ophthalmology and Allied vision Sciences (1469/23) and was conducted at Diagnostic clinic Mayo Hospital, Lahore from March, 2023 to September, 2023. Sample size was calculated by a formula whose level of significance (????) was 5%, standard deviation (????) 30.9 and test values of population mean (µ̥) was 540. Using non-probability convenient sampling method total sample size was 80 patients of age group 30 to 60 which divided into normal tension and primary open angle glaucoma of 40 each. Patients with corneal edema, diabetes, and allergic to dorzolamide-timolol fixed dose combination were excluded. Data was analyzed using SPSS version 25.00. Wilcoxon signed ranks test and chi-square test were used for the significance of the study. Data p-value &lt;0.005 considered significant. All the tests were performed after patient’s informed consent. Intraocular pressure (IOP) and central corneal thickness (CCT) were measured by Goldmann applanation tonometer and ultrasound Pachymeter respectively. RESULTS: IOP and CCT in right eye 16.17± 7.05 (p=0.000) and 545.50± 22.2 (p=0.098) respectively and of left eye 16.56± 7.00 (p=0.003) and 549.16± 20.0 (p=0.133) respectively. This illustrates significant difference in intraocular pressure after treatment in both eyes but insignificance difference in central corneal thickness. CONCLUSION: Dorzolamide-Timolol combination successfully reduces IOP as intended and leads to no statistically significant change in central corneal thickness.

Effect of a single small volume fluid bolus with balanced or un-balanced fluids on chloride and acid-base status: a prospective randomized pilot study (the FLURES-trial).

To compare the short-term effects on acid base, electrolyte status and urine output of a single fluid bolus of saline to that of the balanced solution Plasmalyte® in critically ill patients. Prospective, randomized, controlled trial. Adult patients (≥ 18years) admitted to the ICU receiving a fluid bolus were randomized to receive 1 L of saline (NaCl 0.9%, Baxter) or a balanced fluid [Plasmalyte® (Baxter)]. Blood samples and urine output were collected just before (T0), just after (T1), 2 h after (T2) (only for urinary output) and three hours after termination of the fluid bolus (T4). The effect of fluid boluses on serum chloride, apparent strong ion difference, base excess, urinary output and blood pressure or vasopressor need were analyzed. Patients who received a 1 L saline fluid bolus had a significant increase in serum chloride (1.60; 95% CI 1.10 to 2.10; P < 0.001) and short-term decrease in apparent strong ion difference (-1.85; 95% CI -2.71 to -0.99; P < 0.001) and base excess (-0.90; 95% CI -1.31 to -0.50; P < 0.001). We observed a 17% increase in patients developing hyperchloremia in the saline group (0.17; 95% CI 0.05 to 0.29; P = 0.005). No significant difference in urinary output, blood pressure or vasopressor need was observed in either group. Even a single, small bolus of saline, administered to critically ill patients, causes a significant increase in chloride concentration and a decrease in apparent strong ion difference and base excess, and an increase in the number of patients developing hyperchloremia. No difference in effect on urinary output, blood pressure or vasopressor need was observed between the two groups. 2014-001005-41; date of registration: 28/10/2014. EC project number 2014/038.

ANALYSIS OF DIFFERENCES IN THE EFFECTIVENESS OF GIVING RED BEET JUICE (BETA VULGARIS L) AND CUCUMBER JUICE (CUCUMIS SATIVUS) ON REDUCING BLOOD PRESSURE IN HYPERTENSIVE PATIENTS

Hypertension is a serious health issue worldwide, leading to cardiovascular diseases like heart attack, heart failure, stroke, and kidney disease. To prevent hypertension, a combination of pharmacological and non-pharmacological methods is necessary, including adopting a healthy lifestyle and consuming herbal plants. For instance, cucumber juice therapy and a mix of beetroot and pineapple juice are commonly used. This study aims to compare the effects of red beet juice and cucumber juice on the blood pressure of hypertensive patients in Drien Tujoh Village, Tripa Makmur District, Nagan Raya Regency in 2023. The research involved 30 hypertensive patients over 35 years old, divided into two groups. The results showed a significant difference in blood pressure before and after the intervention with beetroot juice and cucumber juice. This indicates that both interventions can help lower blood pressure in hypertensive patients.

Endovascular aortic occlusion improves return of spontaneous circulation after longer periods of cardiopulmonary resuscitation: A translational study in pigs

IntroductionResuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as an adjunct to CPR for nontraumatic cardiac arrest (NTCA). This translational study investigated the impact of varying low-flow duration (15- vs 30-mins) on REBOA's hemodynamic performance and ability to achieve return of spontaneous circulation (ROSC) in a porcine model. MethodsThirty-two pigs were anesthetized and placed into ventricular fibrillation. All animals received a 4-min no-flow period before CPR was initiated. Animals were randomized into four groups: 15- vs 30-minutes of CPR; REBOA vs. no-REBOA. After completion of 15- or 30-minute low-flow, ACLS was initiated and REBOA was inflated in experimental animals. ResultsIn the 15-mins groups, there were no differences in the rates of ROSC between REBOA (4/8, 50%) and control (4/8, 50%; p = 0.99). However, in the 30-min groups, the REBOA animals had a significantly higher rate of ROSC (6/8, 75%) compared to control (1/8, 12.5%; p = 0.04). In the 7-mins after REBOA deployment in the 30-min animals there was a statistically significant difference in coronary perfusion pressure (REBOA 42.1 mmHg, control 3.6 mmHg, p = 0.038). Importantly, 5/6 animals that obtained ROSC in the 30-min group with REBOA re-arrested at least once, with 3/6 maintaining ROSC until study completion. ConclusionIn our porcine model of NTCA, REBOA preferentially improved hemodynamics and ROSC after a 30-mins period of low-flow CPR. REBOA may be a viable strategy to improve ROSC after prolonged downtime, however, more hemodynamic support will be required to maintain ROSC.

Comparison of volume-controlled ventilation and pressure-limited ventilation in laparoscopic appendicectomy - a randomized controlled clinical trial

Background: Laparoscopic appendicectomy is a widely performed surgery globally, offering notable benefits such as reduced postoperative pain, quicker mobility, and shorter hospital stays. Aims and Objectives: The study aimed to assess the changes in respiratory mechanics and compare the outcomes of volume-controlled and pressure-limited ventilation (PLV) in patients undergoing laparoscopic appendectomy. Materials and Methods: This randomized, prospective, single-blinded control study was conducted at K.A.P.V. Government Medical College, Tiruchirapalli, on 60 ASA I and II patients scheduled to undergo laparoscopic appendicectomy under general anesthesia. The patients were randomly divided into two groups (volume-controlled ventilation [VCV] group and the PLV group) of 30 patients. A patient’s history includes age, sex, history of diabetes, hypertension, or any cardiovascular disease, respiratory tract infection, wheezing or chronic chest infections, seizures, neuromuscular disease or weakness, etc. Results: There was no significant difference in gender, age, or body mass index between groups. There is no significant difference in the mean arterial pressure or ETCO2 between groups at various intervals. There was a significant difference in the mean heart rate between the VCV and the PLV groups at 5 and 20 min after induction. There was a significant difference in the peak airway pressure, dynamic compliance, and airway resistance between the VCV group and the PLV group at 10 min after induction (T1), 5 min after pneumoperitoneum (T2), 10 min after pneumoperitoneum (T3), and immediately after Trendelenburg position (T4). Conclusion: The airway resistance and peak airway pressure do not increase, and the dynamic compliance was improved in the PLV during laparoscopic appendicectomy.

Perbedaan Pemberian Jus Apel Hijau dan Air Rebusan Daun Seledri terhadap Tekanan Darah Wanita Menopause Hipertensi di Kabupaten Bojonegoro

Hypertension or high blood pressure is a chronic condition characterized by increased blood pressure on the walls of the arteries. Hypertension is caused by high sodium intake while vegetable and fruit intake is low. This study aims to determine the difference in blood pressure reduction in groups given green apple juice and boiled water from celery leaves in menopausal women who experience hypertension in Bojonegoro Regency. This type of research is quantitative research with a "True experimental" design, with a "Two Group Pre-test and Post-test Design". This sample consisted of 36 respondents who were divided into 18 respondents of green apple juice and 18 respondents of boiled celery leaf water using a purposive sampling technique. Data collection using a Stethoscope Tensimeter measuring instrument and observation sheets will be analyzed using the Paired T-Test and Independent Sample T-Test. The research results were analyzed using the Paired T-Test, it was found that there was a significant difference in systolic blood pressure (p-value = 0.003) and diastolic blood pressure (p-value 0.032) before and after administration of green apple juice. In the celery leaf boiled water group, significant results were also found to reduce systolic blood pressure (p-value = 0.000) and diastolic blood pressure (p-value = 0.017) before and after administering celery leaf boiled water. From the description above, it can be concluded that giving green apple juice and boiled water from celery leaves can significantly reduce systole and diastole. Keywords: green apple, celery, hypertension, menopausal women

Perbedaan Pemberian Jus Apel Hijau dan Air Rebusan Daun Seledri terhadap Tekanan Darah Wanita Menopause Hipertensi di Kabupaten Bojonegoro

Hypertension or high blood pressure is a chronic condition characterized by increased blood pressure on the walls of the arteries. Hypertension is caused by high sodium intake while vegetable and fruit intake is low. This study aims to determine the difference in blood pressure reduction in groups given green apple juice and boiled water from celery leaves in menopausal women who experience hypertension in Bojonegoro Regency. This type of research is quantitative research with a "True experimental" design, with a "Two Group Pre-test and Post-test Design". This sample consisted of 36 respondents who were divided into 18 respondents of green apple juice and 18 respondents of boiled celery leaf water using a purposive sampling technique. Data collection using a Stethoscope Tensimeter measuring instrument and observation sheets will be analyzed using the Paired T-Test and Independent Sample T-Test. The research results were analyzed using the Paired T-Test, it was found that there was a significant difference in systolic blood pressure (p-value = 0.003) and diastolic blood pressure (p-value 0.032) before and after administration of green apple juice. In the celery leaf boiled water group, significant results were also found to reduce systolic blood pressure (p-value = 0.000) and diastolic blood pressure (p-value = 0.017) before and after administering celery leaf boiled water. From the description above, it can be concluded that giving green apple juice and boiled water from celery leaves can significantly reduce systole and diastole.