Significant Pressure Reduction Research Articles

Effectiveness of Mindfulness-Based Stress Reduction (MBSR) in Managing Hypertension among Adults in Indonesia

Purpose: The aim of the study was to investigate the effectiveness of mindfulness-based stress reduction (MBSR) in managing hypertension among adults Methodology: This study adopted a desk methodology. A desk study research design is commonly known as secondary data collection. This is basically collecting data from existing resources preferably because of its low cost advantage as compared to a field research. Our current study looked into already published studies and reports as the data was easily accessed through online journals and libraries. Findings: Mindfulness-based stress reduction (MBSR) effectively reduces blood pressure by managing stress and enhancing relaxation. Studies show significant reductions in systolic and diastolic pressure, particularly in individuals with resistant hypertension. MBSR programs are most beneficial when tailored to cultural contexts and when participants maintain consistent practice. It serves as a valuable, non-pharmacological complement to traditional hypertension treatments, improving overall well-being and long-term health outcomes. Unique Contribution to Theory, Practice and Policy: Biofeedback theory, cognitive behavioral theory (CBT) & transactional model of stress and coping may be used to anchor future studies on the effectiveness of mindfulness-based stress reduction (MBSR) in managing hypertension among adults. It emphasizes the importance of addressing both mental and physical health, providing a complementary treatment to traditional medical interventions such as medication. As a non-drug treatment, MBSR can reduce reliance on expensive medications, offering a more affordable alternative for long-term hypertension management.

Acute Effect of High-Intensity Interval Exercise on Blood Pressure in Females Living with Type 2 Diabetes and Hypertension.

Background: The acute effects of high-intensity interval training (HIIT) on blood pressure (BP) may depend on the exercise protocol performed. Purpose: To compare the acute effect of high and low-volume HIIT on post-exercise and ambulatory BP in untrained older females diagnosed with both type 2 diabetes (T2D) and hypertension (HTN). Methods: Fifteen females (69 [65 ─ 74] years) completed a crossover study with three experimental conditions: 1) REST (35 min in sitting position); 2) HIIT10 (10 × 1 min at 90% heart rate max [HRmax]), and 3) HIIT4 (4 × 4 min at 90% HRmax). After each experimental condition, BP was measured under controlled (4 hours) and in subsequent free-living conditions (20 hours). Results: In the controlled post-condition 4-hour period, no significant interaction (time × condition) was observed for all BP parameters (p ≥ 0.082). Similarly, during the subsequent 20-hour free-living ambulatory monitoring (diurnal and nocturnal), no differences between conditions were detected (p ≥ 0.094). A significant reduction in nighttime pulse pressure was observed in both HIIT4 and HIIT10 compared to REST (46 [44 ─ 50], 45 [42 ─ 53] vs. 50 [45 ─ 57] mmHg, respectively; p ≤ 0.018) with no differences between HIIT conditions (p = 0.316). Changes in nocturnal systolic BP approached but did not reach statistical significance (p = 0.068). Conclusions: This study suggests that in untrained older females living with T2D and HTN, the HIIT10 and HIIT4 protocols have very limited to no acute effect on post-exercise and ambulatory BP. The fact that the vast majority of participants had well-controlled office and ambulatory BP values as well as low cardiorespiratory fitness could explain these findings.

The Effect of Protective Barriers on the Dynamic Response of Underground Structures

Engineers have dedicated considerable attention over the past ten years to studying the influences of dynamic loads caused by both intentional and unintentional events on infrastructures. As a result, determining how buried structures react to explosions and enhancing their security against blast loads have become crucial subjects in defensive engineering. To achieve this goal, constructing a protective barrier, which is known as a blast wall, in front of structures can be an effective measure. This research focused on examining the impact of a protective barrier on the response of a box-shaped tunnel located in Kobe, Japan, using a comprehensive numerical approach. The results revealed that incorporating a barrier with widths of either 1 m or 2 m resulted in a significant reduction in peak pressure. Specifically, the use of a 1 m wide barrier resulted in a 77% decrease, while a 2 m wide barrier achieved an even greater reduction of 84%. Additionally, it was observed that minimizing the distance between the barrier and the explosion point, as well as increasing the width of the barrier, resulted in reduced peak pressure throughout all sections of the tunnel.

Development of a new micellar formulation of carvedilol and curcumin to enhance blood pressure reduction in a spontaneously hypertensive rat model.

Cardiovascular diseases remain a leading cause of morbidity and mortality worldwide, requiring innovative therapeutic strategies. This project explores a nano-pharmaceutical approach to enhance the efficacy of cardiovascular drugs, focusing on carvedilol and curcumin. These agents, known for their potential cardiovascular benefits, are encapsulated within Soluplus® micelles to form a novel drug delivery system. The novelty of this formulation lies in its ability to significantly improve the solubility of both carvedilol and curcumin, which have traditionally been limited by their hydrophobic nature. By utilizing Soluplus® micelles, we have developed a unique delivery system that optimizes the therapeutic potential of both drugs. The nanomicelles were meticulously characterized for drug loading, size distribution, and morphological features. The carvedilol and curcumin release patterns were investigated, revealing sustained and controlled release profiles. Additionally, the antioxidant capacity of the micellar formulation was evaluated, demonstrating the preservation of curcumin's antioxidative properties. In vivo studies using spontaneously hypertensive male rats explored the pharmacokinetics and hemodynamic effects of the nanomicellar system. These results indicated successful encapsulation of both drugs without altering their plasma profiles. Furthermore, the administration of carvedilol and curcumin micelles exhibited a more significant reduction in mean arterial pressure compared to individual drug administration, suggesting a potential synergistic effect. In conclusion, this nano-pharmaceutical approach offers a promising avenue for cardiovascular therapy, providing a platform for combined drug delivery and potential synergistic effects. The optimized formulation could lead to improved patient outcomes and enhanced cardiovascular health.

Outcome of Targeted Driving Pressure Mechanical Ventilation in ARDS patients

Background: Lung protective strategy in acute respiratory distress syndrome (ARDS) patients is based on low tidal volume (VT), lower end-inspiratory (plateau) pressure and higher positive end-expiratory pressure (PEEP). But to predict body weight adjusted tidal volume, heterogeneous pathology of the lung in ARDS with different respiratory system compliance (CRS) is not considered. In driving pressure (ΔP=VT / CRS) tidal volume (VT) is normalized to functional lung size. It is unclear whether mechanical ventilation targeting driving pressure (ΔP) is more effective than low tidal volume ventilation (LTVV) in patients with ARDS. Materials and Methods: An open labelled randomized controlled trial was conducted at Intensive Care Unit of Dhaka Medical College Hospital, a tertiary care referral hospital over 12 months from March 2021 to February 2022. Ninety two patients with ARDS, defined by the Berlin criteria, requiring mechanical ventilation were randomized to 1:1 ratio after enrollment in the study using simple random sampling, one group receiving targeted driving pressure (ΔP) that is </=14cm of H2O ventilation another group receiving low tidal volume ventilation (LTVV) that is 4-6ml/kg PBW. Results: The study found no significant differences between the two groups in terms of clinical variables and laboratory parameters (p > 0.05), except for the duration of mechanical ventilation (MV), which was significantly shorter in the Targeted ΔP group (p<0.05). Aspiration pneumonia was the most common cause of ARDS, occurring in 34.8% of the Targeted ΔP group and 39.1% of the LTVV group. The Targeted ΔP group demonstrated a significant increase in mean respiratory system compliance compared to the LTVV group (p<0.001), and a significantly shorter length of ICU stay (p <0.001). Additionally, the PaO2/FiO2 ratio was significantly higher in the Targeted ΔP group on Days 3, 5, and 7 (p<0.05). Mean exhaled tidal volume was also significantly higher in the Targeted ΔP group on these days (p<0.05). In the Targeted ΔP group, mean driving pressure significantly decreased on Days 3, 5, and 7 (p <0.001), along with a significant reduction in mean plateau pressure (PPlt) (p <0.001). Mean positive end-expiratory pressure (PEEP) significantly decreased on Days 3, 5, and 7 (p <0.001). Respiratory rate significantly decreased on Day 7 (p <0.05). Mean set tidal volume (VT) significantly increased on Days 3, 5, and 7 (p <0.001). Moreover, the 28-day mortality incidence was significantly lower in the Targeted ΔP group compared to the LTVV group (8.7% vs. 26.1%, p <0.05). Conclusion: Targeted Driving pressure (ΔP) guided ventilation offers significant clinical benefits over LTVV in managing ARDS patients in terms of increased respiratory system compliance (CRS), shorter lengths of hospital and ICU stays, and lower in-hospital mortality. Bangladesh Crit Care J September 2024; 12 (2): 81-88

A new tunnel drainage system using double-adhesive spray-applied membrane: key parameters and applicable scope

To address water leakage in tunnels with high water pressure, a new waterproof drainage system was proposed. The system uses a spray-applied material with double-adhesive properties as a waterproof layer, significantly reducing leakages, and incorporates a unique bottom drainage system to reduce water pressure. In order to check the effectiveness of the new drainage system and to analyze the effects of various structural measures on pressure reduction, a numerical seepage analysis was carried out under the conditions of a water head of 160 m and a surrounding rock permeability of 1 × 10−6 m/s. The results show that the maximum water pressure on the secondary lining is 0.6 MPa, which is about 60% reduction compared to a fully enclosed waterproof system and shows a significant pressure reduction. The spacing of the circumferential drainage pipe and the width of the drainage sheet significantly affect the drainage performance, while the arrangement of the drainage system and the size of the bottom drainage pipe have minimal impact. With full consideration of pressure reduction, cost efficiency and construction feasibility, it is recommended to use the following drainage scheme for iterative calculations during the design stage: “1” shaped arrangement, blind pipe diameter of 10 cm, width of drainage sheets of 0.8 m, and drainage spacing of 6 m. By combining the experimentally determined hydrostatic peel-off strength of 1.4 MPa for spray-applied membrane, the applicable scope of the new drainage system was acquired. The research results can provide valuable insights into the application of spray-applied waterproofing membrane in drainage tunnels with high water pressure.

Immediate and Short-Term Outcome of Percutaneous Trans-Catheter Device Closure of Atrial Septal Defects in Adults

Abstract Background Atrial septal defect (ASD) is one of the most common types of congenital heart defects, occurring in about 25% of children. ASD comprises 6–10% of all congenital heart defects. Included in this group of malformations are several types of atrial communications that allow shunting of blood between the systemic and the pulmonary circulations. ASDs are the most common form of acyanotic congenital heart disease. Objectives The aim of the study is to evaluate the immediate and short-term outcome of transcatheter ASD closure on cardiac functions and functional capacity in adults. Patients and Interventions This was a prospective study which recruited all adult patients undergoing secundum ASD closure between April 2023 and December 2023. Investigations included 12 surface ECG, 2D Echocardiography and assessment of functional capacity as being assessed by 6-minute walk test. These investigations were performed preprocedural, postprocedural and at one month follow up. Results Fifty patients, age ranging from 18 to 62, were divided into two groups: group 1 included 25 patients, age ranging from 18 to 40 years, while group 2 included 25 patients older than 40 years old, underwent successful transcatheter closure of ASD. There was a highly significant reduction in right ventricular (RV) and right atrial (RA) volume as being assessed by RV end diastolic volume index, RV basal diameter, and RA volume index. Also, there was a significant reduction in RV systolic function as being assessed by RV fractional area change (FAC). Furthermore, there was a highly significant reduction in Right ventricular systolic pressure (RVSP) and mean pulmonary artery pressure (mPAP). Also, there was a significant improvement of functional capacity as being assessed by 6-minute walk test distance (6 MWTD). Between the 2 groups, the results of our study showed that there was a significant difference in the postprocedural percentage of reduction in mPAP between group 1 and group 2, ΔmPAP 3.45(3.03-11.11) in group 1 and ΔmPAP 11.76 (7.14 – 16.67) in group 2 with p value of 0.001 which shows more reduction in mPAP in group 2 in comparison to group 1. Also, there was a significant difference in percentage of reduction in mPAP between group 1 and group 2 at 1 month follow up, ΔmPAP 6.9(6.06-13.04) in group 1 and 14.81 (8.82 – 20.59) with p value of 0.001 which shows more reduction in mPAP in group 2 in comparison to group 1. It was observed that there was significant difference in improvement of functional capacity as being assessed by 6MWTD at one month follow up between group 1 and group 2, Δ 6MWTD was 3.52 (2 – 6.38) in group 1 and 6.67 (5.54 – 9.21) in group 2 with P value of 0.008 which shows more improvement in functional capacity in group 2 in comparison to group 1 as seen in the next table. Conclusions Our study indicates that transcatheter closure of ASD results in promising cardiac remodeling and early significant improvement in right ventricular dimensions and functional class in adults

Flow restoration during mechanical thrombectomy for large vessel occlusion is associated with an immediate reduction of systemic blood pressure.

Managing blood pressure in patients with large vessel occlusion affects infarct size and clinical outcomes. We examined how restoring blood flow impacts systemic blood pressure during mechanical thrombectomy. Patients with large vessel occlusion in the anterior circulation undergoing mechanical thrombectomy between June 2016 and January 2018 were screened. We included those treated under local anesthesia or conscious sedation and analyzed standardized anesthesia protocols to assess systolic and diastolic blood pressure levels throughout the procedure. The primary outcome was the change of blood pressure, compared 5 min before versus 5 min after the last recanalization attempt. Successful reperfusion was defined as Thrombolysis in Cerebral Infarction score ⩾ 2b. Of 134 patients, 117 (87%) achieved successful angiographic reperfusion, showing a notable systolic blood pressure drop 5 min after flow restoration (10.2 ± 14.6 vs 3.24 ± 8.65 mm Hg, p = 0.009). Successful angiographic reperfusion was a significant predictor for this decrease in multivariable logistic regression: OR = 1.34 (95% CI: 1.03-1.73, p = 0.0299). Among 66 patients not given circulation-affecting meds, a significant systolic pressure reduction was also observed (155 ± 17 mm Hg to 148 ± 17 mm Hg ; p < 0.001). No diastolic pressure changes were significant. Flow restoration was associated with an immediate reduction of systolic blood pressure values in patients undergoing mechanical recanalization under local anesthesia or conscious sedation. This suggests a complex interplay between endovascular stroke therapy and cardiovascular hemodynamics.

NO-cGMP-K+ Channels Pathways Participate in the Antihypertensive Effects of Attalea phalerata Martius ex Spreng Oil-Loaded Nanocapsules.

Attalea phalerata Martius ex Spreng is a palm tree that is widely distributed in the Central-West region of Brazil. In this study, we investigated whether the oil-loaded nanocapsules of A. phalerata (APON) have acute and long-lasting antihypertensive effects in male spontaneously hypertensive rats (SHR), as well as explored the underlying molecular mechanisms. APON was prepared using the interfacial polymer deposition method. The particle size, polydispersity index, and zeta potential were investigated using dynamic and electrophoretic light scattering. The antihypertensive effects of APON (administered at doses of 1, 3, and 10 mg/kg) were evaluated after acute intraduodenal administration and after 7 days of oral treatment. To investigate the molecular pathways involved, we used pharmacological antagonists and inhibitors that target prostaglandin/cyclic adenosine monophosphate, nitric oxide/cyclic guanosine monophosphate, and potassium channels. Both acute and prolonged administration of APON (at doses of 3 and 10 mg/kg) resulted in a significant reduction in systolic, diastolic, and mean arterial pressure. Prior treatment with a non-selective nitric oxide synthase inhibitor (Nω-nitro-L-arginine methyl ester), guanylyl cyclase inhibitor (methylene blue), or non-selective calcium-sensitive K+ channel blocker (tetraethylammonium) abolished the antihypertensive effects of APON. Our study showed that A. phalerata oil-loaded nanocapsules have a significant antihypertensive effect in SHR after both short-term and long-term (7-day) use. This effect seems to rely on the vascular endothelium function and involves the NO-cGMP-K+ channel pathway. This research suggests a new direction for future studies to definitively prove the therapeutic benefits of APON in treating cardiovascular disease.

Does plantar pressure in short-term standing differ between modular insoles selected based upon preference or matched to self-reported foot shape?

Prolonged workplace standing is commonplace and associated with a range of lower limb issues. Evaluating footwear interventions aiming to modify plantar pressure during standing is essential as the body is static, creating a different requirement for footwear. Previous research associates medial midfoot pressure with greater perceived comfort and identifies arch height as the most variable element of foot shape. Targeting footwear mass customization within this area may better address differences within the target wearers. This study aims to evaluate a modular insole system for its ability to modify plantar pressure during standing. Twenty-five participants completed a static and dynamic standing protocol for 60 seconds whilst measuring in-shoe peak and mean plantar pressure (KPa) and contact area (%). Individuals wore three insole options targeted towards different medial arch shapes (A– low arch, B– medium arch, C– high arch) and rated them for comfort. Participants received guidance to self-identify foot shape (low, medium, or high arch). Comparisons were drawn across the three insole profiles and between the insole rated as most comfortable (preferred), and the insole that matched the self-identified foot shape (matched). As insole arch height increased, medial midfoot pressure and contact area significantly increased, alongside significant reductions in first metatarsal pressure and contact. Preference was spread across insoles A, B, and C (56%, 32%, 12% of participants, respectively). Sixteen participants had different matched and preferred insoles, with significantly greater medial midfoot pressure and contact in the matched insole. The modular insole enabled different wear experiences, however, results suggest that individuals selected insoles lower than their foot shape. Providing adequate medial arch support enables redistribution of pressure which may enable greater comfort during the workday.

Plantar pressure reduction in the heel region through self-adjusting insoles with a heel cup in standard and individualized rocker shoes

BackgroundEffectiveness of therapeutic footwear in reducing peak pressure in persons with diabetes and loss of protective sensation to prevent diabetic foot ulcers varies due to manual production and possible changing foot structure. A previous two-way approach to address this issue, featuring individualized 3D-printed rocker midsoles and self-adjusting insoles, proved effective in the forefoot but less in the heel. To address this, new insoles incorporating a heel cup are developed. MethodsIn-shoe pressure was measured, while persons with diabetes and loss of protective sensation with high peak pressure (≥ 200 kPa) in the heel walked on a treadmill with control and individualized rocker shoe paired with control and new insole. FindingsGeneralized estimating equations revealed significant decrease in peak pressure in the proximal heel with the new insole alone and combined with rocker shoe compared to rocker shoe alone. For the distal heel, significant decrease in peak pressure is shown with the combination of new insole and rocker shoe compared to control shoe. For the forefoot and toes (excluding hallux) significant decrease in peak pressure is shown using the rocker shoe alone or combined with the heel cup compared to control shoe. InterpretationThe new insole paired with rocker shoe is effective in reducing peak pressure in the distal heel. To have similar (or more) success in proximal heel, one could replace the rocker midsole with more compliant materials. The rocker shoe used separately or combined with a heel cup effectively reduces the peak pressure in the forefoot and other toes.

EVALUATION OF CAST SPLITTING ON LOWER LEG COMPARTMENT PRESSURES: A PILOT STUDY IDENTIFYING THE MOST EFFECTIVE SPLITTING TECHNIQUE

IntroductionLower limb immobilisation with full casts is commonly used to manage fractures. There may be the need to split casts in an emergency, such as compartment syndrome, with no current consensus as to which technique is most effective in reducing pressure quickly. Our study aims to compare the reduction in pressure across lower leg compartments using three different cast splitting techniques.MethodsThis study was done on a volunteer doctor. Pressure sensors were positioned at the anterior, posterior and lateral compartments. A single plaster technician applied below knee full casts with sequential layering and were allowed to dry as per manufacture instructions. Cast were split utilising three splitting methods; bivalve, tramline and single split and measurements taken when each layer was split. We compared results of ten repetitions for each splitting technique.ResultsWhen the cast was initially cut there were significant reduction in pressure with the bivalve split (20.6 ± 0.76 N) when compared to both the single split (26.8 ± 1.13 N, P &lt; 0.001) and tramline split (26.4 ± 0.90 N, P &lt; 0.001). When the cast was spread there were significant reduction in pressure with the bivalve split (10.7 ± 0.83 units) when compared to both the single split (14.6 ± 0.85 N, P &lt; 0.001) and tramline split (16.6 ± 0.77 N, P &lt; 0.001). When the final layer of wool was released the pressure remained lower (statistically significant) in the bivalve split compared to both single split and tramline split.ConclusionOur study demonstrates that bivalve cast splitting provided a more rapid reduction in pressure compared to other techniques across all three compartments. Our data shows that once down to skin, bivalve splitting continues to provide the lowest pressure compared to the other techniques. We recommend utilising bivalve when splitting a cast in an emergency.

Induced fatigue impact on plantar pressure in females with mild hallux valgus

Fatigue has been established to change plantar pressure distribution, yet its impact on hallux valgus (HV) patients, who exhibit morphological and biomechanical changes in the foot, remains insufficiently studied. Twenty-eight female participants, comprising 16 with mild HV and 12 healthy controls, were recruited. Plantar pressures were recorded pre- and post-fatigue using the Footscan platform during self-selected-speed walking trials, fatigue protocol was performed on a treadmill. Foot was segmented into 10 anatomical regions for calculating parameters including maximal force, peak pressure, impulse, contact duration, contact area, and force time-series, alongside assessing the distribution of medial and lateral contact forces (Foot balance) across the groups. During post-fatigue, patients with mild HV demonstrated adaptive changes in plantar pressure distinct from healthy controls, with significant reductions in maximal force, peak pressure, and impulse in the M1 and M2 regions and increases in the M3–M5 regions. In contrast, the control group exhibited an opposite pattern, concentrating pressure in the M1 and M2 regions post-fatigue. The force time-series analysis revealed significant disparities between HV patients and controls, particularly in the M4 and M5 regions, where HV patients showed a less pronounced and lower passive peak in forces. Results show that women with mild HV demonstrate adaptive changes in plantar pressure post-fatigue, distinctly different from healthy individuals, aiding in preventive strategies for fatigue-induced foot injuries for HV patients.

Airway pressure release ventilation (APRV) versus pressure support ventilation (PSV)-A prospective intervention trial comparing haemodynamic parameters in intensive care patients.

Assisted mechanical ventilation may alter the pressure profile in the thorax compared to normal breathing, which can affect the blood flow to and from the heart. Studies suggest that in patients with severe lung disease, airway pressure release ventilation (APRV) may be haemodynamically beneficial compared to other ventilator settings. The primary aim of this study was to investigate if APRV affects cardiac index in intubated intensive care patients without severe lung disease when compared to pressure support ventilation (PSV). The secondary aim comprised potential changes in other haemodynamic and ventilatory parameters. Twenty patients were enrolled in the intensive care unit (ICU) at Sahlgrenska University Hospital. Eligible patients met the inclusion criteria; 18 years of age or above, intubated and mechanically ventilated, triggering and stable on PSV mode, with indwelling haemodynamic monitoring via a pulse-induced continuous cardiac output (PiCCO) catheter. The study protocol started with a 30-min interval on PSV mode, followed by a 30-min interval on APRV mode, and finally a 30-min interval back on PSV mode. At the end of each interval, PiCCO outputs, ventilator outputs, arterial and venous blood gas analyses, heart rate and central venous pressure were recorded and compared between modes. There was no significant difference in cardiac index (3.42 vs. 3.39 L/min/m2) between PSV and APRV, but a significant increase in central venous pressure (+1.0 mmHg, p = .027). Furthermore, we found a significant reduction in peak airway pressure (-3.16 cmH2O, p < .01) and an increase in mean airway pressure (+2.1 cmH2O, p < .01). No statistically significant change was found in oxygenation index (partial pressure of O2 [pO2]/fraction of inspired oxygen) nor in other secondary outcomes when comparing PSV and APRV. There was no significant association between global end-diastolic volume index and cardiac index (R2 = 0.0089) or central venous pressure (R2 = 0.278). All parameters returned to baseline after switching the ventilator mode back to PSV. We could not detect any changes in cardiac index in ICU patients without severe lung disease during APRV compared to PSV mode, despite lower peak airwaypressure and increasedmean airway pressure.

Clinical, Functional, and Quality-of-Life Outcomes after Computer Assisted Vacuum Thrombectomy for Pulmonary Embolism: Interim Analysis of the STRIKE-PE Study

PurposeTo report the first interim analysis of the STRIKE-PE study, evaluating the safety and effectiveness of computer assisted vaccum thrombectomy (CAVT) for the treatment of acute pulmonary embolism (PE). Materials and MethodsThis prospective, international, multicenter study will enroll 600 adult patients with acute PE of ≤14 days and a right ventricle (RV)–to–left ventricle (LV) ratio of ≥0.9 who receive first-line endovascular treatment with CAVT using the Indigo Aspiration System (Penumbra, Alameda, California). Primary endpoints are change in RV/LV ratio and incidence of composite major adverse events (MAEs) within 48 hours. Secondary endpoints include functional and quality-of-life (QoL) assessments. ResultsThe first 150 consecutive patients were treated with 12F catheter CAVT. Mean age was 61.3 years, 54.7% were men, 94.7% presented with intermediate-risk PE, and 5.3% presented with high-risk PE. Median thrombectomy and procedure times were 33.5 minutes and 70.0 minutes, respectively, resulting in a mean reduction in systolic pulmonary artery pressure of 16.3% (P < .001). Mean RV/LV ratio decreased from 1.39 to 1.01 at 48 hours, a 25.7% reduction (P < .001). Four (2.7%) patients experienced a composite MAE within 48 hours. At 90-day follow-up, patients exhibited statistically significant improvements in the Borg dyspnea scale score and QoL measures, and the New York Heart Association class distribution returned to that reported before the index PE. ConclusionsInterim results from the STRIKE-PE study demonstrate a significant reduction in pulmonary artery pressure and RV/LV ratio, a median thrombectomy time of 33.5 minutes, a composite MAE rate of 2.7%, and significant improvements in 90-day functional and QoL outcomes.

Sacubitril/valsartan has an underestimated impact on the right ventricle in patients with sleep-disordered breathing, especially central sleep apnoea syndrome

BackgroundSacubitril/valsartan has been demonstrated to significantly improve left ventricular performance and remodelling in patients with heart failure. However, its effects on the right ventricle in patients with chronic heart failure and sleep-disordered breathing (SDB) have not been studied. AimTo investigate the impact of sacubitril/valsartan treatment on right ventricular function in patients with SDB. MethodsThis was a subanalysis of an observational prospective multicentre study involving 101 patients. At inclusion, patients were evaluated by echocardiography and nocturnal ventilatory polygraphy, which allowed patients to be divided into three groups: “central-SDB”; “obstructive-SDB”; and “no-SDB”. ResultsAfter 3 months of sacubitril/valsartan therapy, a positive impact on right ventricular function was observed. In the general population, tricuspid annular plane systolic excursion increased by +1.32±4.74mm (P=0.024) and systolic pulmonary artery pressure decreased by −3.1±10.91mmHg (P=0.048). The central-SDB group experienced the greatest echocardiographic improvement, with a significant increase in tricuspid annular plane systolic excursion of +2.1±4.9mm (P=0.045) and a significant reduction in systolic pulmonary artery pressure of −8.4±9.7mmHg (P=0.001). ConclusionsSacubitril/valsartan improved right ventricular function in patients with heart failure and SDB after only 3 months of treatment. The greatest improvement in right ventricular function was observed in the central-SDB group.

Cyclical hydraulic pressure pulses reduce breakdown pressure and initiate staged fracture growth in PMMA

Using unique experimental equipment on large bench-scale samples of Polymethylmethacrylate, used in the literature as an analogue for shale, we investigate the potential benefits of applying cyclical hydraulic pressure pulses to enhance the near-well connectivity through hydraulic fracturing treatment. Under unconfined and confined stresses, equivalent to a depth of up to 530 m, we use dynamic high-resolution strain measurements from fibre optic cables, complemented by optical recordings of fracture development, and investigate the impact of cyclical hydraulic pressure pulses on the number of cycles to failure in Polymethylmethacrylate at different temperatures. Our results indicate that a significant reduction in breakdown pressure can be achieved. This suggests that cyclic pressure pulses could require lower power consumption, as well as reduced fluid injection volumes and injection rates during stimulation, which could minimise the occurrence of the largest induced seismic events. Our results show that fractures develop in stages under repeated pressure cycles. This suggests that Cyclic Fluid Pressurization Systems could be effective in managing damage build-up and increasing permeability. This is achieved by forming numerous small fractures and reducing the size and occurrence of large fracturing events that produce large seismic events. Our results offer new insight into cyclical hydraulic fracturing treatments and provide a unique data set for benchmarking numerical models of fracture initiation and propagation.

Venous sinus stenting for idiopathic intracranial hypertension: An updated Meta-analysis

BackgroundIdiopathic intracranial hypertension (IIH) is characterized by elevated intracranial pressure and primarily affects obese women of reproductive age. Venous sinus stenting (VSS) is a surgical procedure used to treat IIH, but its safety and efficacy are still controversial. MethodsA systematic review and meta-analysis were conducted following PRISMA guidelines. Multiple databases were searched for studies evaluating the safety and efficacy of VSS in IIH patients and meta-analysis was performed to pool the data. ResultsA total of 36 studies involving 1066 patients who underwent VSS were included. After VSS, a significant reduction in trans-stenotic gradient pressure was observed. Patients also showed significantly lower cerebrospinal fluid (CSF) opening pressure. Clinical outcomes demonstrated improvement in tinnitus (95%), papilledema (89%), visual disturbances (88%), and headache (79%). However, 13.7% of patients experienced treatment failure or complications. The treatment failure rate was 8.35%, characterized by worsening symptoms and recurrence of IIH. The complications rate was 5.35%, including subdural hemorrhage, urinary tract infection, stent thrombus formation, and others. ConclusionVSS appears to be a safe and effective treatment option for IIH patients who are unresponsive to medical therapy or have significant visual symptoms. However, long-term outcomes and safety of the procedure require further investigation.

Efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy.

To evaluate the efficacy and safety of Usights UC100 illuminated microcatheter in microcatheter-assisted trabeculotomy (MAT). Totally 10 eyes of 10 patients with primary open angle glaucoma (POAG) who underwent MAT facilitated by Usights UC100 (5 eyes) or iTrack (5 eyes) were reviewed. The success of this surgery was defined as intraocular pressure (IOP) <22 mm Hg with >30% reduction, without oral glaucoma medications, or additional glaucoma surgery. The mean pre-operative IOP was 25.38±10.22 mm Hg in the Usights UC100 group and 19.98±3.87 mm Hg in the iTrack group. MAT was achieved in all eyes in both groups. The success rates for the Usights UC100 group and iTrack groups were in all and 4 eyes, respectively. Both microcatheters produced a statistically significant reduction in IOP, and eyes using Usights UC100 achieved a lower IOP than the iTrack group at 3mo follow-up (12.58±1.52 and 14.84±1.89 mm Hg, respectively), but no statistical significance was there. No severe side effects were observed in either group. MAT using Usights UC100 or iTrack both achieve significant pressure reduction in cases of POAG, and Usights UC100 is as safe as iTrack.

Rotation-traction manipulation induced intradiskal pressure changes in cervical spine-an in vitro study.

Objective: Evaluate the effect of rotation-traction manipulation on intradiskal pressure in human cervical spine specimen with different force and duration parameters, and compare the intradiskal pressure changes between rotation-traction manipulation and traction. Methods: Seven human cervical spine specimens were included in this study. The intradiskal pressure was measured by miniature pressure sensor implanting in the nucleus pulposus. rotation-traction manipulation and cervical spine traction were simulated using the MTS biomechanical machine. Varied thrust forces (50N, 150N, and 250N) and durations (0.05s, 0.1s, and 0.15s) were applied during rotation-traction manipulation with Intradiscal pressure recorded in the neutral position, rotation-anteflexion position, preloading, and thrusting phases. Futuremore, we documented changes in intradiscal pressure during cervical spine traction with different loading forces (50N, 150N, and 250N). And a comparative analysis was performed to discern the impact on intradiscal pressure between manipulation and traction. Results: Manipulation application induced a significant reduction in intradiscal pressure during preloading and thrusting phases for each cervical intervertebral disc (p < 0.05). When adjusting thrust parameters, a discernible decrease in intradiscal pressure was observed with increasing thrust force, and the variations between different thrust forces were statistically significant (p < 0.05). Conversely, changes in duration did not yield a significant impact on intradiscal pressure (p > 0.05). Additionally, after traction with varying loading forces (50N, 150N, 250N), a noteworthy decrease in intradiscal pressure was observed (p < 0.05). And a comparative analysis revealed that rotation-traction manipulation more markedly reduced intradiscal pressure compared to traction alone (p < 0.05). Conclusion: Both rotation-traction manipulation and cervical spine traction can reduce intradiscal pressure, exhibiting a positive correlation with force. Notably, manipulation elicits more pronounced and immediate decompression effect, contributing a potential biomechanical rationale for its therapeutic efficacy.