Significant Pressure Reduction Research Articles

Numerical simulation of liquefaction phenomenon considering infinite boundary

The response of liquefaction behaviour can be analyzed by incorporating the effects of the transient flow of the pore-fluid through the voids, which requires a two-phase continuum formulation for saturated porous media named ‘mixture theory’. The saturated soil system is modelled as a two-phase material based on the Biot's theory for porous media. Infinite elements have been incorporated in the solution algorithms to simulate infinite boundary. A computer code is developed in FORTRAN 90 considering fully coupled dynamic analysis to determine the responses of pore fluid and soil skeleton of an unbounded saturated sandy layer. The unconditionally stable generalized Newmark-Beta method is employed in the solution algorithm for evaluation of response at each time step. A generalized non-associative plasticity-bounding surface model Pastor–Zienkiewicz Mark III is considered to describe the inelastic behaviour of soils under earthquake loading. A parametric study is conducted to consider the effect of the material nonlinearity of the soil grain on liquefaction behaviour. A significant reduction in displacement and excess pore pressure is observed while considering unbounded domain. The salient feature of the solution algorithm is simulation of build up pore pressure and consequent reduction in mean effective stress. It was also observed that key parameters like permeability, earthquake intensity and shear modulus had significant effect on liquefaction response.

The Influence of Age, Eating a Meal, and Systematic Fatigue on Swallowing and Mealtime Parameters.

Fatigue is widely accepted as a clinically relevant factor in the diagnosis, treatment, and management of dysphagia. Despite the relative importance that is placed on swallowing-related fatigue, the occurrence and effects of fatigue during swallowing is unclear. The goal of this study was to explore effects of eating a meal on measures of tongue strength, endurance, and other parameters of swallowing function under normal conditions compared to when the tongue is intentionally fatigued. Thirty healthy females, 15 "Young" (18-35years old), and 15 "Old" (70 + years old) were seen for two data collection sessions one week apart. On both days, pre-meal measures were collected, then participants consumed a standardized meal based on a previously published protocol (half a bagel with peanut butter and 8 baby carrots) followed by post-meal measures. An additional pre-meal fatigue task was included on one of the test days (counterbalanced), involving maximal tongue presses until participants could not achieve 40% of baseline maximum pressure. Pre- and post-meal measures included anterior and posterior maximum tongue pressures, saliva swallow pressure, tongue endurance, surface electromyography (sEMG), the modified Borg scale, and the Test of Mastication and Swallowing of Solids (TOMASS). Linear mixed effects regressions compared pre- and post-meal outcome measures (1) on the non-fatigue day and (2) between fatigue and non-fatigue days while controlling for participant and age. The fatigue task caused significant reductions in maximum anterior and posterior tongue pressure. After a normal meal (i.e., without fatigue), we found decreased anterior pressures in the older group only. Older participants also had decreased saliva swallow pressures after the meal compared to pre-meal, while this measure increased post-mean in the young participants. When compared to the non-fatigue meal, eating a meal after tongue fatigue resulted in significantly lower post-meal posterior pressures, regardless of age group. The same pattern was observed with posterior functional reserve. Our results demonstrate that a systematic, participant-specific tongue fatigue task induced measurable changes in maximum tongue pressure. A meal by itself was observed to reduce anterior tongue strength and saliva swallow pressures only in older participants. Overall, it appears that older adults may be more vulnerable to fatigue-induced changes in tongue strength, though the relationship between these measures and changes to functional swallowing remains unknown.

Osteopathic Manipulative Treatment and Cardiovascular Autonomic Parameters in Rugby Players: A Randomized, Sham-Controlled Trial

ObjectiveThe purpose of this study was to investigate the effects of osteopathic manipulative treatment (OMT) on cardiovascular autonomic parameters after a rugby match. MethodsResting and reactivity (ie, response to orthostasis) measures of mean arterial pressure, heart rate, and heart rate variability were assessed in 23 male players after a single session of OMT, both 18 to 20 hours after a rugby match and in a corresponding no-match condition, in a randomized, sham-controlled, crossover design. ResultsSigns of reduced heart rate variability and elevated mean arterial pressure and heart rate were found 18 to 20 hours after a rugby match compared with the no-match condition. A significant increase in heart rate variability and a significant reduction in mean arterial pressure were observed after OMT in both the after-match and no-match conditions. Heart rate and heart rate variability responses to orthostasis were not affected by previous match competition, but were significantly larger after OMT compared with sham treatment. ConclusionThis study suggests the presence of cardiovascular autonomic alterations in rugby players after a competitive match, which may be indicative of prolonged fatigue and incomplete recovery. In these players, favorable changes in cardiovascular autonomic parameters were observed following a single session of OMT.

Continuous cardiovascular hemodynamics monitoring with pressure recording analytical method in patients under spinal anesthesia for elective cesarean section: a pilot study.

Pressure recording analytical method (PRAM) of MOSTCARE is a minimally invasive system based on mathematical analysis of arterial pressure profile changes and allows continuous recording of hemodynamic measurements. Herein, we aimed to use the MostCare system to investigate the hemodynamics of patients receiving spinal anesthesia during elective cesarean section. In this observational study, we recruited 17 patients scheduled for elective cesarean section. For each patient, we acquired continuous recordings of hemodynamic parameters at 14 key timepoints: surgical admission (two baseline parameters), immediately after the administration of spinal anesthesia, six subsequent time points (2, 4, 6, 8, 10, and 12 min after anesthesia), during peritoneum and uterine incision, during delivery, following the administration of oxytocin, and after surgery had been completed. Statistical analysis was carried out by repeated measures analysis of variance (ANOVA). During a twelve min period after spinal anesthesia, we observed significant reductions in mean arterial pressure (MAP), dicrotic pressure (Pdic), cardiac index (CI), stroke volume index (SVI), dP/dtmax, and cardiac cycle efficiency (CCE) (P<0.05 for all). However, systemic vascular resistance index (SVRI) was reversely correlated to CI and increased significantly after spinal anesthesia (P<0.05). These hemodynamic parameters return to near basal values after peritoneum incision. Furthermore, there were significant fluctuations in MAP, Pdic and CI after oxytocin administration (P<0.05). PRAM of MostCare system revealed significant changes in key hemodynamic parameters undergoing cesarean section with spinal anesthesia. It enables clinicians gain a much better understanding of hemodynamics of parturients and optimize clinical management strategies. This study was registered at http://www.chictr.org.cn on 16, July, 2019. No. ChiCTR1900024566.

Geomechanical Integrity and Non-Isothermal Effect in CO2 Storage

Carbon capture and storage (CCS) is an important component among several initiatives to reduce greenhouse gases emitted to the atmosphere. In Norway, a joint venture is underway between Equinor, Shell and Total to implement the world's first complete value chain (capture, shipping, transport and storage) offshore CCS demonstration project, in which the CO2 can come from many different sources. Here we investigate the thermal effect on a future candidate site for CO2 storage, Smeaheia, using numerical modelling. To do this, we compare results from hydro-mechanical (HM-model) and thermo-hydro-mechanical (THM model) CO2 injection simulations, including the equation of state for the fluids. The injected CO2 is colder than the storage reservoir, and as the CO2 migrates, it cools down the surrounding formations, mainly the reservoir and the overlying caprock. Increased pore pressure due to injection dissipates fast in the high-permeable reservoir in Smeaheia. However, in the caprock, the cooling causes the fluid to contract and the low-permeable caprock creates undrained conditions for the formation water which results in significant reduction in pore pressure. We observe that the thermal effect contributes to destabilizing the reservoir and stabilizing the caprock, which is seemingly fortuitous, but also potentially an unpredictable situation because of the large stress transients and gradients in a small area where the stability can be sensitive to small weaknesses and heterogeneities.

Thermal UAS survey of reactivated hot spring activity in Waiwera, New Zealand

Abstract. The utilization of geothermal reservoirs as alternative energy source is becoming increasingly important worldwide. Through close-range aerial photogrammetry realized by unmanned aircraft systems (UAS), this study investigates the surface expression of a leaking warm water reservoir in Waiwera, New Zealand, that has been known for many centuries but remained little explored. Due to overproduction during the 1960s and 1970s the reservoir has suffered significant pressure reduction, which resulted in the loss of artesian conditions and led to the desiccation of the hot springs in close succession. However, shortly after the recent shutdown of the primary user (Waiwera Thermal Resort &amp;amp; Spa) renewed artesian activity was reported by locals but no hot spring activity has been observed so far. Therefore, this study was carried out in October 2019 to assess the actual conditions of thermal activity in the area of the former hot springs. UAS with coupled thermal infrared cameras were used for thermal mapping and the obtained data show renewed activity of the hot springs on the beachfront of Waiwera. Faults and fractures were identified as important fluid pathways, as well as individual fluid conducting lithologies.

A CLINICAL STUDY TO EVALUATE THE ANTIHYPERTENSIVE EFFECT OF TRINPANCHMOOL KWATH IN MANAGEMENT OF ESSENTIAL HYPERTENSION

The present study was conducted to evaluate the antihypertensive effect of an Ayurvedic formulation Trinpanchmool Kwath in the management of essential hypertension. The study was conducted in 30 patients selected from OPD and IPD of R.G.G. P.G.A.C. and Hospital, Paprola. Patients were randomly divided into three groups. Group- I patients were managed with Trinpanchmool Kwath , Group- II patients were managed with Tab Chlorthalidone and Group– III patients were managed with both Trinpanchmool Kwath and Tab. Chlorthalidone. The results obtained were analysed on the basis of various objective and subjective parameters. However change in blood pressure was the main criteria for assessing the effect of the therapy. Statistically highly significant reduction was observed in systolic and diastolic blood pressure after 45 days of therapy. In Group-I systolic blood pressure reduced by 9.374%, in Group-II systolic blood pressure decreased by 15.46% and in Group-III systolic blood pressure decreased by 16.86%. Similarly in Group-I diastolic blood pressure decreased by 8.195% , in Group-II showed 11.250% reduction and in Group-III diastolic blood pressure decreased by 12.17% after completion of therapy. Results revealed that therapy given in Group-III i.e. the combination of Trinpanchmool Kwath and Tab. Chlorthalidone showed best results as compared to other groups. Group-II, in which patients were managed with Tab Chlorthalidone showed better results over Group-I where only Trinpanchmool Kwath was given to the patients. However statistically highly significant reduction in both systolic and diastolic pressure was observed in all three groups.

Effects of Cultured Cordycep militaris on Sexual Performance and Erectile Function in Streptozotocin-Induced Diabetic Male Rats.

Cordyceps militaris (CM), a valuable edible and medicinal fungus, has been used as traditional medicine to treat health conditions, as well as hyposexuality in Asian societies for over a century. Due to the high demand, several artificial cultivation methods have been developed for their biological activities. In this study, CM was cultured on medium that contained white rice and silkworm pupae, and the levels of cordycepin and adenosine, as well as its aphrodisiac effects in diabetes-induced erectile dysfunction (DIED), were evaluated. Diabetic rats were induced by streptozotocin (STZ) injection and administered orally with CM (0.1, 0.5, and 1.0 g/kg BW/day) for 3 weeks. Diabetic rats in negative and positive control groups received vehicle and sildenafil citrate (5 mg/kg), respectively. Results showed the changes in mating behaviour in which mount latency and intromission latency were significantly increased in diabetic rats, compared with the normal control group. Diabetic rats also showed a significant reduction in intracavernosal pressure (ICP) response to cavernous nerve stimulation, sperm count, testosterone level, penile nitric oxide synthase (NOS), and testicular superoxide dismutase (SOD) activities, when compared to the normal control group. Administration of CM (0.1, 0.5, and 1.0 g/kg BW/day) reversed the effects of diabetes on the mating behaviour, and the ICP responses to electrical stimulation. Moreover, the levels of penile NOS, testicular SOD activities, testosterone, and sperm count were significantly increased, and testicular malondialdehyde (MDA) levels were significantly decreased in these treated diabetic rats. Diabetic rats treated with sildenafil showed a significant induction in intromission frequency and NOS and SOD activities, as well as a marked increase in ICP responses. These results suggest that CCM exerts its aphrodisiac effect, possibly through activating testosterone production and suppressing oxidative stress to enhance erectile function in diabetic rats.

Fast disintegrating tablet of Doxazosin Mesylate nanosuspension: Preparation and characterization

Doxazosin Mesylate (DOX) is an antihypertensive drug which possesses poor water solubility and hence low bioavailability. The study objective is to prepare DOX fast disintegrating tablets as a new dosage form for geriatric patients. First, 23 full factorial design using Polyvinyl pyrrolidone k 30, Poloxamer-407 and Sodium Lauryl Sulphate at low and high ratios were used for preparation of DOX nanosuspension as a trial to improve its dissolution properties. Nanosuspension formulations were characterized using Transmission electron microscopy, Differential scanning calorimetry and Fourier transform infrared spectroscopy. Then, the optimized formula was incorporated in fast disintegrating tablets using different superdisintegrants. The tablets were evaluated for hardness, thickness, friability percentage, diameter, weight variation, Wetting time, disintegration time and percentage dissolution after 10 min. A significant reduction (rapidly and efficiently) in mean arterial pressure of hypertensive rats was observed for DOX nanosuspension fast disintegrating tablet using Ac-Di-Sol as a superdisintegrant with 100% dissolution after 10 min.

Concomitant Use of Laparoscopic Radiofrequency Ablation with Hysteroscopic Myomectomy for Large, Multi-Fibroid Uterus

Study Objective To discuss the combination of minimally invasive myomectomy techniques for large multi-fibroid uteri to ensure resolution of all associated symptoms. Design Case Study. Setting Suburban hospital, Michigan. Patients or Participants 37-year-old Caucasian G2P1011. Interventions 1. Hysteroscopic resectoscope of submucosal fibroid (TruClear) 2. Ultrasound guided laparoscopic radiofrequency ablation (Acessa system) of intramural, subserosal, and broad ligament fibroids Measurements and Main Results Patient presented with a longstanding history of a bulky, multi-fibroid uterus. Her symptoms included menorrhagia (resulting in anemia), lower abdominal pressure, cramping and back pain. Two prior gynecologists had recommended open hysterectomy given that she had completed childbearing, however she desired uterine conserving surgery. Physical exam revealed a BMI of 24 and a 20-week multi-fibroid uterus. Previous ultrasound noted a multi-fibroid uterus measuring 19 × 14.1 × 8.3 cm and pre-operative MRI demonstrated the largest intramural fibroid to measure 10.9 × 9.1 × 9.2 cm in the posterior lower uterine segment. A pedunculated submucosal (type 0) fibroid was also identified with significant distortion of the endometrial cavity. She elected to proceed with laparoscopic radiofrequency ablation with ultrasound guidance for the type 4-8 fibroids with concurrent mechanical resection of her submucous fibroid. The procedure was performed without complication and the total operative time was less than 2.5 hours. She was discharged from recovery in good condition. At 6-month follow-up, she noted significant reduction in pain, pressure and cramping, with almost complete resolution of menorrhagia. Conclusion Uterine sparing concomitant multi-modality surgery can be considered for patients presenting with large fibroids, including those with submucosal fibroids as a cause for their symptoms. Laparoscopic radiofrequency ablation combined with hysteroscopic resection, even for fibroids larger than 8 cm, can provide dramatic relief of menorrhagia, bulk and pain symptoms.

Identification of suitable substitute for Sarpagandha (Rauvolfia serpentina (L.) Benth. ex Kurz) by phytochemical and pharmacological evaluation

BackgroundSarpagandha is an important Ayurveda drug used for treating many diseases including high blood pressure. Rauvolfia serpentina is the genuine source plant for Sarpagandha and it is a critically endangered species belonging to the family Apocynaceae. The present study is aimed at finding out an appropriate substitute for the endangered species R. serpentina by evaluating the phytochemistry and biological activities of allied species such as Rauvolfia tetraphylla L, Rauvolfia hookeri S.R.Sriniv. & Chithra, Rauvolfia micrantha Hook.f., and Rauvolfia verticillata (Lour.) Baill.ResultsThe result indicated that the root of R. serpentina is phytochemically similar with that of R. tetraphylla. Chemical profiling using HPTLC showed similar chemical profiles for R. serpentina and R. tetraphylla. LC/MS characterization of various species showed that most of the active alkaloids are common for both R. serpentina and R. tetraphylla. Anti-hypertensive activity and analgesic activity were evaluated in experimental animal model. Rauvolfia serpentina and R. tetraphylla showed comparatively significant reduction in systolic and diastolic pressure. Comparable analgesic activity was also shown by R. serpentina and R. tetraphylla.ConclusionOn the basis of phytochemical and pharmacological evaluation, it was concluded that the root of R. tetraphylla can be used as a validated substitute for Sarpagandha.Graphical abstract

External Stability Analysis of Narrow Backfilled Gravity Retaining Walls

A three wedge failure mechanism is proposed to determine active earth pressure exerted by narrow backfills on gravity retaining walls and its point of application. Gravity retaining wall proportions are optimized against external failure modes using proposed active earth pressure and its line of action of resultant thrust. Overturning failure, eccentricity failure of the resultant force, sliding failure on its base, and bearing capacity failure are given due consideration for the determination of optimum proportions of gravity wall. Optimum dimensions of the gravity wall are evaluated such that factors of safety against overturning, eccentricity, sliding, and bearing capacity should be greater than 2.0, 1.0, 1.5, and 2.5 respectively. Significant reduction in active earth pressure in narrow backfill width gravity retaining walls is noticed due to the inadequate development of shear bands because of the constraint of rock face boundary. The study recommends employing an appropriate failure mechanism for the development of shear bands behind retaining wall based on depth and width of narrow backfill. The proposed study indicates that significant savings in the cross sectional area may be accomplished as compared to a classical design by Coulomb’s theory.

Hemodynamic response to transseptal transcatheter mitral valve replacement in patients with severe mitral stenosis due to severe mitral annular calcification.

We aimed to investigate the invasive hemodynamic changes with transcatheter mitral valve replacement (TMVR) in patients with severe mitral stenosis due to severe mitral annular calcification. The hemodynamic response to TMVR in patients with mitral stenosis related to degenerative mitral annular calcification has not been fully elucidated. We conducted retrospective review of patients who underwent successful transseptal TMVR with balloon-expandable valves for symptomatic severe mitral stenosis due to mitral annular calcification at our institution between January 2014 and February 2020. Invasive hemodynamic measurements were obtained both before valve implantation (predeployment) and after (postdeployment). Eighteen patients (age 72 ± 10 years, 44% female) were included for the analysis. There was a significant reduction in mean left atrial pressure (23.7 ± 5.6 mmHg versus 20.6 ± 4.8 mmHg; p=.01), left atrial v-wave (mean 39.3 ± 10.2 mmHg versus 32.9 ± 9.9 mmHg; p=.01), and an increase in systemic mean blood pressure (72.6 mmHg ±11.2 versus 79.5 ± 9.9 mmHg; p=.02) postdeployment compared to predeployment. Patients who had symptom improvement at 30-day follow-up tended to have greater reduction in mean left atrial pressure (4.4 ± 4.4 mmHg versus 0.5 ± 5.2 mmHg; p=.16) and v-wave (8.6 ± 9.0 mmHg versus 0.7 ± 8.4 mmHg; p=.10) compared to those who did not experience improvement of symptoms. Transseptal TMVR for severe mitral stenosis due to mitral annular calcification is associated with reductions in mean left atrial pressure and left atrial v-wave, and an increase in systemic arterial pressure.

Eight Weeks of Supervised Indoor Climbing Significantly Reduces Arterial Pressure and Total Cholesterol in Recreational Climbers

The present study sought to investigate physiological adaptations associated with an 8-week supervised climbing intervention in recreational climbers. Nine participants (5 males and 4 females; age: 37 ± 8 years; stature: 169.7 ± 10.6 cm; body mass 83.3 ± 20.3 kg) volunteered to complete the intervention concomitant with their recreational climbing activities. Blood pressure, body composition, peak aerobic capacity, total cholesterol, and handgrip strength were assessed before and after the intervention. Post-intervention, diastolic blood pressure was significantly reduced (pre: 87 ± 6 mmHg, post: 72 ± 10 mmHg, p<0.01), without significant changes in systolic blood pressure (pre: 136 ± 15 mmHg, post: 128 ± 20 mmHg, p=0.19). This resulted in a significant reduction in mean arterial pressure (pre: 103 ± 9 mmHg, post: 90 ± 13 mmHg, p<0.01). A significant reduction in total cholesterol was also observed following the 8-week climbing intervention (pre: 5.09 ± 0.49 mmol/L, post: 4.39 ± 0.63 mmol/L, p<0.01). However, there were no significant changes in body fat percentage (p=0.67), skeletal muscle mass (p=0.76), isometric hand-grip strength (dominant hand: p=0.93, non-dominant hand: p=0.12) or peak aerobic capacity (p=0.37). Supervised indoor climbing exercise may therefore serve as an important non-pharmacological intervention to improve cardiovascular health by reducing mean arterial pressure and total cholesterol levels in recreational climbers, independent of changes in body composition or peak aerobic capacity.

Identification of physiologic treatment targets with favourable haemodynamic consequences in heart failure with preserved ejection fraction.

AimsHeart failure with preserved ejection fraction (HFpEF) is characterized by complex pathophysiology including an impaired diastolic reserve. We recently showed that milrinone favourably modifies filling pressures at rest and during exertion in HFpEF patients; however, the responsible mechanism is uncertain. The objective of this study was to develop a clearer understanding of the acutely modifiable physiologic parameters that may be targeted in HFpEF.Methods and resultsWe conducted computer modelling simulations based on invasive haemodynamic assessments, by right heart catheterization, in HFpEF patients at baseline and in response to milrinone. Our aim was to develop a detailed understanding of the physiologic mechanisms, which accounted for the observed actions. The resultant circulatory model of HFpEF encompassed the left ventricular (LV) end‐systolic and end‐diastolic pressure–volume relations, together with stressed blood volume, heart rate, and arterial mechanics. To support the modelled action of milrinone, we conducted complementary LV conductance catheter and echocardiography studies in sheep to evaluate LV end‐systolic and end‐diastolic pressure–volume relations. In HFpEF patients, the acute haemodynamic effects of intravenous milrinone (n = 10) administration compared with placebo (n = 10) included significant reductions in right atrial pressure (7 ± 1 to 3 ± 1 mmHg, P < 0.001) and pulmonary capillary wedge pressure (13 ± 1 to 8 ± 1 mmHg, P < 0.001), while cardiac index increased (2.77 ± 0.19 to 3.15 ± 0.14 L/min/m2, P < 0.05), and mean arterial pressure remained unchanged (95 ± 2 to 93 ± 3 mmHg, P = not significant). Computer simulations showed that these haemodynamic effects were explained by a concomitant 31% reduction in stressed blood volume together with 44% increase in LV end‐systolic elastance (LV E es). Individually, changes in these parameters were not sufficient to explain the haemodynamic effects of milrinone. In vivo studies conducted in sheep (n = 5) showed that milrinone reduced LV filling pressure (8.0 ± 0.8 to 2.7 ± 0.6 mmHg, P < 0.01) and increased LV E es (0.96 ± 0.07 to 2.07 ± 0.49, P < 0.05), while no significant effect on LV stiffness was observed (0.038 ± 0.003 to 0.034 ± 0.008, P = not significant).ConclusionsThese data demonstrate that stressed blood volume in HFpEF represents a relevant physiologic target in HFpEF; however, concomitant modulation of other cardiovascular parameters including LV contractility may be required to achieve desirable haemodynamic effects.

Plantar pressure distribution and wearing characteristics of three forefoot offloading shoes in healthy adult subjects

Forefoot offloading shoes are used to reduce pressure on specific regions of the foot. Aim of the pressure reduction is to aid healing of the soft and bony tissues and prevent complications by treating foot disorders. A great variety of forefoot offloading shoes are available. In a first step to investigate the appropriate use of these footwear in orthopedic settings, we studied plantar pressure distribution and wearing characteristics of three forefoot offloading shoes namely the Mailand, OrthoWedge and Podalux in a healthy population.Twenty subjects walked in a randomized order wearing three forefoot offloading shoes and a reference shoe for six minutes. The Pedar system was used to measure the pressure in 7 regions. Peak pressure and pressure time integral were analyzed as measures of pressure distribution. Furthermore, wearing characteristics were addressed using a Numeric Rating Scale. Pressure distribution and wearing characteristics of the forefoot offloading shoes were compared to a reference shoe.The Mailand and OrthoWedge shoes significantly reduced peak pressure with more than 80% under the hallux and more than 45% under MTH1 (p<.001). The Podalux did not show significant peak pressure reduction under the forefoot compared to the reference shoe. Under the lesser toes, the MTH4-5 region and heel region the Podalux shoe showed even a significant increase in peak pressure (p=.001). Looking at wearing characteristics, the Podalux and reference shoe scored significantly better than the other two forefoot offloading shoes (p<.01).In this study the differences between different forefoot offloading shoes was assessed. The Mailand and OrthoWedge shoes gave the best pressure reduction in the forefoot but are less comfortable in use. The Podalux rocker shoe showed opposite results. Next step is a patient study to compare our results in a patient population.

ROLE OF PREOPERATIVE OESOPHGEALMANOMETRY IN OPERATIVE DECISION MAKING IN PATIENTS WITH CARDIAC ACHALASIA

Background: Surgery is considered the treatment of choice for esophageal achalasia, since it provides symptomatic relief that is stronger and longer lasting. Laparoscopic Heller cardiomyotomy is the preferred treatment for an anti reflux surgery with found oplication. Preoperative HRM is essential to the detection of sufficient fundoplication.Aim of the work: To assess the role of preoperative manometry in selection the type of antireflux surgery with Heller cardiomyotomy (Dor or Nissen fundoplication).Patients and methods: This prospective cohort study was conducted on twenty (20) patients presented to Ain-Shams University hospitals outpatient clinics suffering from chronic dysphagia from January 2018 through January 2020 to assess the role of preoperative manometry in selection of operative type and decision making in treatment of achalasia.Results: Using HRM ,14 patients (70%) with type 1 achalasia underwent Dor fundoplication and in these Dysphagia and regurgitation improved substantially in patients (p value = 0.001 and 0.001 respectively), also there were 4 patients (28.5%) with post-operative reflux. 6 Patients (30%) with type 2 achalasia underwent Nissen fundoplication and in these patients there was a significant improvement in dysphagia and regurgitation (p value = 0.034 and 0.023 respectively), 3 patients (50%) developed post-operative dysphagia, two of them improved on follow up. There was a significant reduction in LES pressure in both Dor and Nissen operation (p value = 0.001 and 0.026 respectively).Conclusion: Preoperative HRM is crucial in choosing type of fundoplication in achalasia as symptomatic responses vary depending on achalasia subtype.

The Effects of Dexmedetomidine Prescription in Paediatric Patients With Pulmonary Hypertension Under Congenital Heart Surgery

Anesthetized patient management for pediatric patients with pulmonary arterial hypertension (PAH) is a major challenge. The aim of this study was to evaluate the ability of dexmedetomidine to reduce pulmonary arterial hypertension in patients with pulmonary arterial hypertension undergoing cardiac surgery. Sixty-six patients with pulmonary arterial hypertension underwent the study. Patients were randomly divided into two groups: group D received a dexmedetomidine injection in a dose of 1 μg/kg in the first hour and then decreased to 0.5 μg/kg/hr, injection continued after surgery until extubation in the post-anesthetic care unit (PACU). Group C received normal saline 0.9% in a similar volume. Pulmonary artery systolic pressure (PASP) and systemic systolic blood pressure (SSBP) were recorded during and after the surgery in the postanesthetic care unit. Needing vasodilators, sedatives, extubation time, and the length of ICU stay were recorded for all patients. Patients in the dexmedetomidine group showed a significant reduction in Pulmonary artery systolic pressure and Pulmonary artery systolic pressure/systemic systolic blood pressure rates during surgery and during the first 24 hours in the post-anesthetic care unit (P&lt;0.001). The dexmedetomidine group, in comparison with the control group, needed a significantly lower dose of a vasodilator (P&lt;0.001) and a lower dose of sedation (P&lt;0.001). It is concluded that the use of dexmedetomidine during the surgery in children with pulmonary hypertension reduces pulmonary artery systolic pressure during and after the surgery.

Temporary right ventricular circulatory support following right ventricular infarction: results of a groin-free approach.

AimsAcute right heart failure (RHF) is a severe complication of right ventricular infarction. The management of acute RHF poses a number of challenges, such as providing haemodynamic support. Temporary circulatory support (TCS) may be required upon failing medical therapy. The ProtekDuo® dual lumen cannula provides a minimally invasive option for (TCS) through a groin‐free internal jugular vein approach. We present the largest patient series to date using the ProtekDuo® cannula as temporary right ventricular assist device (t‐RVAD) in RHF after acute myocardial infarction (MI).Methods and resultsFrom July 2016 to November 2019, 10 patients underwent t‐RVAD implantation for RHF following acute MI. Transthoracic and transoesophageal echocardiography were performed in all patients to assess cardiac function, with a particular focus on RV function. Cumulative 30‐day survival was 60%. Mean TAPSE was 6.4 ± 3.1 mm, mean fractional area change was 12.1 ± 4.2%, and mean right ventricular end diastolic area was 19.8 ± 2.7 cm2. Mean implantation time was 32.8 ± 8.3 min. Mean interval after first cardiac intervention was 4.6 ± 5.8 days. Mean t‐RVAD time was 10.0 ± 7.4 days with a significant reduction in central venous pressure 19.3 ± 2.7 vs. 8.2 ± 2.6 mmHg, P < 0.001 and a significant increase in central venous saturation 52.8 ± 15.6 vs. 80.0 ± 6.0%, P < 0.001. Mean intensive care unit stay was 18.6 ± 12.2 days. Four patients were weaned from TCS. Two patients were bridged to a long‐term paracorporeal RVAD. There were no t‐RVAD associated complications. Causes of death (n = 4) were multiorgan failure, electromechanical dissociation, and haemorrhagic stroke. Mean follow‐up time was 96.0 ± 107.6 days. No independent predictors of mortality were identified in univariate analysis.ConclusionsWe show that groin‐free, percutaneous implantation of the ProtekDuo® cannula is a feasible and safe tool for TCS in acute RHF post‐MI. This approach provides the advantages of percutaneous implantation including complete mobilization and non‐surgical bedside explantation, as well as the option for adding an oxygenator to the t‐RVAD circuit.

In-office endoscopic nasal polypectomy: prospective analysis of patient tolerability and efficacy

PurposeIn-office rhinologic procedures have become popularised in the last decade, especially in North America. Endoscopic nasal polypectomy under local anaesthesia offers instant relief in selected patients with obstructive chronic rhinosinusitis with nasal polyps. We aimed to analyse patient tolerability during the procedure while measuring its effectiveness.MethodsA prospective study of patients who underwent in-office microdebrider-assisted polypectomy under local anaesthetic from September 2018 to November 2019 in a Spanish tertiary hospital was performed. The tolerability was measured by monitoring vital signs during the procedure and using a visual analogue scale posteriorly. The effectiveness was calculated through patient-reported outcomes (SNOT-22) and endoscopic evaluation 1 and 6 months follow-up.ResultsForty-four patients were included, with a mean age of 60.7 years. The mean visual analogue scale score was 2.76 out of 10 points. Vital signs were steady overall, with a statistically significant reduction (p < 0.001) in systolic pressure during the procedure. Presyncope and epistaxis were among the few mild complications. However, we registered one major complication that required intensive care admission. There was a 64% reduction in the SNOT-22 score in the first month, with a maintained effect after 6 months. Patients with asthma and a higher polyp load were the subgroups that required more time to achieve significant improvement.ConclusionsIn-office polypectomy is a very effective technique that alleviates obstructive symptoms in patients with nasal polyposis, and it is generally safe and well tolerated when performed by an expert. However, rhinologists must be aware of potentially severe complications.