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Sharman JE, Otahal P, Stowasser M, Stanton T, Reid CM, Nolan M, Roberts-Thomson P, Negishi K, Greenough R, Stewart S, Marwick TH, Abhayaratna WP. Blood Pressure Lowering in Patients With Central Hypertension: A randomized Clinical Trial. Hypertension 2024. [PMID: 38563148 DOI: 10.1161/hypertensionaha.123.21653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 03/10/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Cuff blood pressure (BP) is recommended for guiding hypertension management. However, central BP has been proposed as a superior clinical measurement. This study aimed to determine whether controlling hypertension as measured by central BP was beneficial in reducing left ventricular mass index beyond control of standard cuff hypertension. METHODS This multicenter, open-label, blinded-end point trial was conducted in individuals treated for uncomplicated hypertension with controlled cuff BP (<140/90 mm Hg) but elevated central BP (≥0.5 SD above age- and sex-specific normal values). Participants were randomized to 24-months intervention with spironolactone 25 mg/day (n=148) or usual care control (n=153). The primary outcome was change in left ventricular mass index measured by cardiac MRI. Cuff and central BPs were measured by clinic, 7-day home and 24-hour ambulatory BPs. RESULTS At 24-months, there was a greater reduction in left ventricular mass index (-3.2 [95% CI, -5.0 to -1.3] g/m2; P=0.001) with intervention compared with control. Cuff and central BPs were lowered by a similar magnitude across all BP measurement modes (eg, clinic cuff systolic BP, -6.16 [-9.60 to -2.72] mm Hg and clinic central systolic BP, -4.96 [-8.06 to -1.86] mm Hg; P≥0.48 all). Secondary analyses found that changes in left ventricular mass index correlated to changes in BP, with the magnitude of effect nearly identical for BP measured by cuff (eg, 24-hour systolic BP, β, 0.17 [0.02-0.31] g/m2) or centrally (24-hour systolic BP, β, 0.16 [0.01-0.32] g/m2). CONCLUSIONS Among individuals with central hypertension, spironolactone had beneficial effects in reducing LV mass. Secondary analyses showed that changes in LV mass were equally well associated with lower measured standard cuff BP and central BP. REGISTRATION URL: https://www.anzctr.org.au/; Unique identifier: ACTRN12613000053729.
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Affiliation(s)
- James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (J.E.S., P.O., P.R.-T.)
| | - Petr Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (J.E.S., P.O., P.R.-T.)
| | - Michael Stowasser
- Endocrine Hypertension Research Centre, University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, Australia (M.S.)
| | - Tony Stanton
- School of Medicine, University of Queensland, Brisbane, Australia (T.S.)
| | - Christopher M Reid
- Department of Epidemiology and Preventative Medicine, Centre of Cardiovascular Research and Education in Therapeutics, Monash University, Melbourne, Australia (C.M.R.)
- School of Public Health, Curtin University, Perth, Australia (C.M.R.)
| | | | - Philip Roberts-Thomson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia (J.E.S., P.O., P.R.-T.)
- Department of Cardiology, Royal Hobart Hospital, Australia (P.R.-T.)
| | - Kazuaki Negishi
- Sydney Medical School Nepean, Charles Perkins Centre Nepean, The University of Sydney, Australia (K.N.)
| | | | - Simon Stewart
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Australia (S.S.)
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia (T.H.M.)
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Ripollés-Melchor J, Monge-García MI, Vincent JL. Dangers of misinterpreting intraoperative hypotension. Comments on Br J Anaesth 2023; 131: 823-31 and Br J Anaesth 2023; 131: 810-2. Br J Anaesth 2024; 132:802-803. [PMID: 38238197 DOI: 10.1016/j.bja.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/04/2023] [Accepted: 12/23/2023] [Indexed: 03/05/2024] Open
Affiliation(s)
- Javier Ripollés-Melchor
- Department of Anesthesiology, Infanta Leonor University Hospital, Madrid, Spain; Fluid Therapy and Hemodynamic Monitoring Working Group of the Spanish Society of Anesthesiology and Critical Care, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain.
| | - Manuel I Monge-García
- Fluid Therapy and Hemodynamic Monitoring Working Group of the Spanish Society of Anesthesiology and Critical Care, Madrid, Spain; Jerez de La Frontera University Hospital, Jerez de la Frontera, Spain
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Kern MJ, Seto AH. Virtual FFR From Optical Coherence Tomography: A 1-Stop Shop for PCI Guidance? Circ Cardiovasc Interv 2024; 17:e014077. [PMID: 38525652 DOI: 10.1161/circinterventions.124.014077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Morton J Kern
- Interventional Cardiology, Division of Cardiology, Long Beach Veteran's Administration Medical Center, CA
| | - Arnold H Seto
- Interventional Cardiology, Division of Cardiology, Long Beach Veteran's Administration Medical Center, CA
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Razavi SR, Szun T, Zaremba AC, Shah AH, Moussavi Z. 1-Year Mortality Prediction through Artificial Intelligence Using Hemodynamic Trace Analysis among Patients with ST Elevation Myocardial Infarction. Medicina (Kaunas) 2024; 60:558. [PMID: 38674204 PMCID: PMC11052412 DOI: 10.3390/medicina60040558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Patients presenting with ST Elevation Myocardial Infarction (STEMI) due to occlusive coronary arteries remain at a higher risk of excess morbidity and mortality despite being treated with primary percutaneous coronary intervention (PPCI). Identifying high-risk patients is prudent so that close monitoring and timely interventions can improve outcomes. Materials and Methods: A cohort of 605 STEMI patients [64.2 ± 13.2 years, 432 (71.41%) males] treated with PPCI were recruited. Their arterial pressure (AP) wave recorded throughout the PPCI procedure was analyzed to extract features to predict 1-year mortality. After denoising and extracting features, we developed two distinct feature selection strategies. The first strategy uses linear discriminant analysis (LDA), and the second employs principal component analysis (PCA), with each method selecting the top five features. Then, three machine learning algorithms were employed: LDA, K-nearest neighbor (KNN), and support vector machine (SVM). Results: The performance of these algorithms, measured by the area under the curve (AUC), ranged from 0.73 to 0.77, with accuracy, specificity, and sensitivity ranging between 68% and 73%. Moreover, we extended the analysis by incorporating demographics, risk factors, and catheterization information. This significantly improved the overall accuracy and specificity to more than 76% while maintaining the same level of sensitivity. This resulted in an AUC greater than 0.80 for most models. Conclusions: Machine learning algorithms analyzing hemodynamic traces in STEMI patients identify high-risk patients at risk of mortality.
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Affiliation(s)
- Seyed Reza Razavi
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB R3T 5V6, Canada;
| | - Tyler Szun
- Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P5, Canada; (T.S.); (A.C.Z.); (A.H.S.)
| | - Alexander C. Zaremba
- Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P5, Canada; (T.S.); (A.C.Z.); (A.H.S.)
| | - Ashish H. Shah
- Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P5, Canada; (T.S.); (A.C.Z.); (A.H.S.)
| | - Zahra Moussavi
- Biomedical Engineering Program, University of Manitoba, Winnipeg, MB R3T 5V6, Canada;
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Arghavani H, O'Connor S, Fortier C, Rudkowska I. Lack of change in blood pressure and arterial stiffness after high dairy intake in hyperinsulinemic subjects: a cross-over randomized controlled trial. Appl Physiol Nutr Metab 2024; 49:350-359. [PMID: 37939366 DOI: 10.1139/apnm-2023-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
To evaluate the effects of high dairy (HD) (≥4 servings/day), compared to adequate dairy (AD) (2-3 servings/day as per Canada's Food Guide for Healthy Eating (2007)), on blood pressure (BP) and measures of arterial stiffness in hyperinsulinemic subjects. In this cross-over clinical trial, hyperinsulinemic adults were randomized to AD and HD for 6 weeks. Anthropometric, glycemic, and lipid parameters were analyzed and dietary intake was evaluated; BP, carotid-femoral pulse wave velocity, augmentation index, and measures of arterial stiffness were assessed. Twenty-seven participants completed the study. Dairy intake was 2.2 ± 1.2 servings/day during AD. In addition, lower total and low-density lipoprotein (LDL) cholesterol were observed without significant change in BP or arterial stiffness between before and after AD. During HD, the subjects consumed 5.8 ± 1.9 servings/day of dairy products, providing a higher intake of protein, saturated fat, calcium, phosphorus, sodium, and potassium compared to the baseline diet. After the HD, subjects had higher body fat, fasting insulin, homeostatic model assessment for insulin resistance (HOMA-IR) index, and triglycerides without altering BP or arterial stiffness compared to before HD. Overall, adequate or high intake of total dairy did not modify BP or arterial stiffness in hyperinsulinemic adults after 6 weeks.
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Affiliation(s)
- Hana Arghavani
- Endocrinology and Nephrology Axis, CHU de Québec Research Center-Université Laval, Québec, QC, Canada
| | - Sarah O'Connor
- Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ) Research Centre, Québec, QC, Canada
- Faculty of Pharmacy, Université Laval, Québec, QC, Canada
| | - Catherine Fortier
- Endocrinology and Nephrology Axis, CHU de Québec Research Center-Université Laval, Québec, QC, Canada
- Department of Kinesiology, Université Laval, Québec, QC, Canada
| | - Iwona Rudkowska
- Endocrinology and Nephrology Axis, CHU de Québec Research Center-Université Laval, Québec, QC, Canada
- Department of Kinesiology, Université Laval, Québec, QC, Canada
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de Oliveira GT, Souza HLR, Prazeres EO, Bernardes BP, Patterson SD, Arriel RA, Camilo GB, Hohl R, Meireles A, Marocolo M. A Practical Approach for Ischemic Preconditioning Intervention in Sports: A Pilot Study for Cuff Thigh Occlusion Pressure Estimation Based on Systolic Blood Pressure. J Hum Kinet 2024; 91:157-164. [PMID: 38689581 PMCID: PMC11057619 DOI: 10.5114/jhk/186064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/14/2024] [Indexed: 05/02/2024] Open
Abstract
For the ischemic preconditioning (IPC) intervention, the accuracy of the protocol is paramount for mediating its possible ergogenic effects. However, the lack of standardization and widespread use of arbitrary cuff pressures (ranging from 130 to >300 mmHg) have been predominantly observed, potentially affecting the results and compromising the reproducibility of findings. Thus, the purpose of this study was to determine an appropriate cuff pressure during IPC. Seventeen healthy male participants were enrolled in the study. Anthropometric measurements were initially conducted, followed by systolic and diastolic blood pressure measurements. Subsequently, we determined the individual thigh occlusion pressure (TOP) for the right leg using a hand-held Doppler device. Based on these findings, we developed an estimation equation for TOP, considering the current brachial systolic blood pressure (SBP) values. We then conducted a retrospective analysis of its capacity to mediate occlusion. We observed the ability to estimate TOP using the equation (p = 0.01; ES: 0.86), presenting ~6% superiority in absolute values for occlusion compared to direct measurement (TOP equation: 169.9 ± 9.1; TOP direct measured: 161.2 ± 11.1). However, TOP estimation was insufficient to produce complete occlusion in two out of 17 subjects (11.8%). In conclusion, the estimation of TOP incorporating SBP values may offer a valid and practical means for cuff administration during IPC protocols with potential to minimize adverse effects and maximize its positive effects.
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Affiliation(s)
- Géssyca T. de Oliveira
- Department of Biophysics and Physiology, Exercise Physiology Performance—EXPPER, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Hiago L. R. Souza
- Department of Biophysics and Physiology, Exercise Physiology Performance—EXPPER, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Eduardo O. Prazeres
- Department of Biophysics and Physiology, Exercise Physiology Performance—EXPPER, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Bernardo P. Bernardes
- Department of Biophysics and Physiology, Exercise Physiology Performance—EXPPER, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Stephen D. Patterson
- Centre for Applied Performance Science, St. Mary’s University, London, United Kingdom
| | - Rhaí André Arriel
- Department of Biophysics and Physiology, Exercise Physiology Performance—EXPPER, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | | | - Rodrigo Hohl
- Department of Biophysics and Physiology, Exercise Physiology Performance—EXPPER, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Anderson Meireles
- Department of Biophysics and Physiology, Exercise Physiology Performance—EXPPER, Federal University of Juiz de Fora, Juiz de Fora, Brazil
| | - Moacir Marocolo
- Department of Biophysics and Physiology, Exercise Physiology Performance—EXPPER, Federal University of Juiz de Fora, Juiz de Fora, Brazil
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Silva GP, Mendes RCMG, Lopes CT, Lopes MV, Perrelli JG, Mangueira SO, Linhares FM. Evidence of content validity of the nursing diagnosis risk for unstable blood pressure. Int J Nurs Knowl 2024. [PMID: 38403971 DOI: 10.1111/2047-3095.12464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
PURPOSE To analyze evidence of content validity of the nursing diagnosis (ND) Risk for Unstable Blood Pressure in incarcerated women. METHOD: A methodological study assessing the content validity of an ND, was performed in Brazil, between June and September 2022, with 49 nurses as experts. The label, definition, and relevance of the 19 risk factors of the ND Risk for Unstable Blood Pressure were appraised. Based on the predictive diversity model, the content validity index (CVI) and respective 95% confidence intervals were calculated for each risk factor. A CVI ≥ 0.8 was considered adequate evidence of content validity. FINDINGS The label and the definition of the diagnosis was reformulated. The relevance of 19 etiological factors showed a CVI ≥ 0.8. According to the recommendation of the panel of experts, one of the etiological factors was split in two and two label of etiological factors were changed. CONCLUSIONS A new label (Risk for Imbalanced Blood Pressure), new definition, and 20 etiological factors (11 risk factors, five associated conditions, and four at-risk populations) of the ND Risk for Unstable Blood Pressure in incarcerated women were considered valid. IMPLICATIONS FOR NURSING PRACTICE NANDA-I accepted the proposal for this nursing diagnosis; hence this study contributed to updating the classification based on scientific evidence. This evidence will favor diagnostic reasoning and recognition of the diagnosis during clinical assessment, and support studies assessing the clinical validity of these elements in incarcerated women.
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Affiliation(s)
- Gabrielle P Silva
- Nursing Department, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Ryanne C M G Mendes
- Nursing Department, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Camila T Lopes
- Nursing Department and Surgical Clinic, Federal University of São Paulo, São Paulo, São Paulo, Brazil
| | - Marcos Vo Lopes
- Nursing Department, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Suzana O Mangueira
- Nursing Department, Federal University of Pernambuco, Recife, Pernambuco, Brazil
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Kawada T, Miyamoto T, Fukumitsu M, Saku K. Input-size dependence of the baroreflex neural arc transfer characteristics during Gaussian white noise inputs. Am J Physiol Regul Integr Comp Physiol 2024; 326:R121-R133. [PMID: 38047314 DOI: 10.1152/ajpregu.00199.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/23/2023] [Accepted: 11/26/2023] [Indexed: 12/05/2023]
Abstract
Although Gaussian white noise (GWN) inputs offer a theoretical framework for identifying higher-order nonlinearity, an actual application to the data of the neural arc of the carotid sinus baroreflex did not succeed in fully predicting the well-known sigmoidal nonlinearity. In the present study, we assumed that the neural arc can be approximated by a cascade of a linear dynamic (LD) component and a nonlinear static (NS) component. We analyzed the data obtained using GWN inputs with a mean of 120 mmHg and standard deviations (SDs) of 10, 20, and 30 mmHg for 15 min each in anesthetized rats (n = 7). We first estimated the linear transfer function from carotid sinus pressure to sympathetic nerve activity (SNA) and then plotted the measured SNA against the linearly predicted SNA. The predicted and measured data pairs exhibited an inverse sigmoidal distribution when grouped into 10 bins based on the size of the linearly predicted SNA. The sigmoidal nonlinearity estimated via the LD-NS model showed a midpoint pressure (104.1 ± 4.4 mmHg for SD of 30 mmHg) lower than that estimated by a conventional stepwise input (135.8 ± 3.9 mmHg, P < 0.001). This suggests that the NS component is more likely to reflect the nonlinearity observed during pulsatile inputs that are physiological to baroreceptors. Furthermore, the LD-NS model yielded higher R2 values compared with the linear model and the previously suggested second-order Uryson model in the testing dataset.NEW & NOTEWORTHY We examined the input-size dependence of the baroreflex neural arc transfer characteristics during Gaussian white noise inputs. A linear dynamic-static nonlinear model yielded higher R2 values compared with a linear model and captured the well-known sigmoidal nonlinearity of the neural arc, indicating that the nonlinear dynamics contributed to determining sympathetic nerve activity. Ignoring such nonlinear dynamics might reduce our ability to explain underlying physiology and significantly limit the interpretation of experimental data.
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Affiliation(s)
- Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tadayoshi Miyamoto
- Department of Sport and Health Sciences, Faculty of Sport and Health Sciences, Osaka Sangyo University, Osaka, Japan
| | - Masafumi Fukumitsu
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Keita Saku
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
- Bio Digital Twin Center, National Cerebral and Cardiovascular Center, Osaka, Japan
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Di Padua C, Osawa T, Waschulzik B, Balling G, Schaeffer T, Staehler H, Piber N, Hager A, Ewert P, Hörer J, Ono M. Impact of early postoperative haemodynamic and laboratory parameters on outcome after the Fontan procedure. Cardiol Young 2024:1-8. [PMID: 38282512 DOI: 10.1017/s1047951124000040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To identify early postoperative haemodynamic and laboratory parameters predicting outcomes following total cavopulmonary connection. METHODS Patients who underwent total cavopulmonary connection between 2012 and 2021 were evaluated. Serial values of mean pulmonary artery pressure, mean arterial pressure, peripheral oxygen saturation, and lactate levels were collected. The influence of these variables on morbidities was analyzed. Cut-off values were calculated using the receiver operating characteristic analysis. RESULTS A total of 249 patients were included. All patients had previous bidirectional cavopulmonary shunt. Median age and weight at total cavopulmonary connection were 2.2 (1.8-2.7) years and 11.7 (10.7-13.4) kg, respectively. All patients were extubated in the ICU at a median of 3 (2-5) hours after ICU admission. Postoperative pulmonary artery pressure, around 12 hours after extubation, was significantly associated with chest tube drainage (p = 0.048), chylothorax (p = 0.021), ascites (p = 0.016), and adverse events (p = 0.028). Receiver operating characteristic analysis revealed a cut-off value of 13-15 mmHg for chest tube drainage and chylothorax and 17 mmHg for ascites and adverse events. Mean arterial pressure 1 hour after extubation was associated with prolonged chest tube drainage (p = 0.015) and adverse events (p = 0.008). Peripheral oxygen saturation 6 hours after extubation (p = 0.003) was associated with chest tube duration and peripheral oxygen saturation 1 hour after extubation (p < 0.001) was associated with ascites. Lactate levels on 2nd postoperative day (p = 0.022) were associated with ascites and lactate levels on 1st postoperative day (p = 0.009) were associated with adverse events. CONCLUSIONS Higher pulmonary artery pressure, lower mean arterial pressure, lower peripheral oxygen saturation, and higher lactate in early postoperative period, around 12 hours after extubation, predicted in-hospital and post-discharge adverse events following total cavopulmonary connection.
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Affiliation(s)
- Chiara Di Padua
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
- Europäisches Kinderherzzentrum München, Munich, Germany
| | - Takuya Osawa
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
- Europäisches Kinderherzzentrum München, Munich, Germany
| | - Birgit Waschulzik
- School of Medicine, Institute of AI and Informatics in Medicine, Technische Universität München, Munich, Germany
| | - Gunter Balling
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Thibault Schaeffer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
- Europäisches Kinderherzzentrum München, Munich, Germany
| | - Helena Staehler
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
- Europäisches Kinderherzzentrum München, Munich, Germany
| | - Nicole Piber
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Alfred Hager
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Jürgen Hörer
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
- Europäisches Kinderherzzentrum München, Munich, Germany
| | - Masamichi Ono
- Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
- Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
- Europäisches Kinderherzzentrum München, Munich, Germany
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Sobianin I, Psoma SD, Tourlidakis A. A 3D-Printed Piezoelectric Microdevice for Human Energy Harvesting for Wearable Biosensors. Micromachines (Basel) 2024; 15:118. [PMID: 38258237 PMCID: PMC10820656 DOI: 10.3390/mi15010118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 01/24/2024]
Abstract
The human body is a source of multiple types of energy, such as mechanical, thermal and biochemical, which can be scavenged through appropriate technological means. Mechanical vibrations originating from contraction and expansion of the radial artery represent a reliable source of displacement to be picked up and exploited by a harvester. The continuous monitoring of physiological biomarkers is an essential part of the timely and accurate diagnosis of a disease with subsequent medical treatment, and wearable biosensors are increasingly utilized for biomedical data acquisition of important biomarkers. However, they rely on batteries and their replacement introduces a discontinuity in measured signals, which could be critical for the patients and also causes discomfort. In the present work, the research into a novel 3D-printed wearable energy harvesting platform for scavenging energy from arterial pulsations via a piezoelectric material is described. An elastic thermoplastic polyurethane (TPU) film, which forms an air chamber between the skin and the piezoelectric disc electrode, was introduced to provide better adsorption to the skin, prevent damage to the piezoelectric disc and electrically isolate components in the platform from the human body. Computational fluid dynamics in the framework of COMSOL Multiphysics 6.1 software was employed to perform a series of coupled time-varying simulations of the interaction among a number of associated physical phenomena. The mathematical model of the harvester was investigated computationally, and quantification of the output energy and power parameters was used for comparisons. A prototype wearable platform enclosure was designed and manufactured using fused filament fabrication (FFF). The influence of the piezoelectric disc material and its diameter on the electrical output were studied and various geometrical parameters of the enclosure and the TPU film were optimized based on theoretical and empirical data. Physiological data, such as interdependency between the harvester skin fit and voltage output, were obtained.
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Affiliation(s)
- Ihor Sobianin
- School of Engineering & Innovation, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK; (I.S.); (S.D.P.)
| | - Sotiria D. Psoma
- School of Engineering & Innovation, The Open University, Walton Hall, Milton Keynes MK7 6AA, UK; (I.S.); (S.D.P.)
| | - Antonios Tourlidakis
- Department of Mechanical Engineering, University of Western Macedonia, 50100 Kozani, Greece
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Singla D, Mangla M, Agarwal A, Kumari R. Comparative Evaluation of Three Different Techniques of Radial Artery Cannulation: A Prospective Randomised Study. Cureus 2024; 16:e52326. [PMID: 38357073 PMCID: PMC10866683 DOI: 10.7759/cureus.52326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE We planned this study to compare three approaches to arterial cannulation, i.e., catheter over the needle, catheter over the guidewire, and ultrasound-guided cannulation, in terms of overall success rate, first pass success rate, time for cannulation and incidence of complications. METHODS After obtaining informed written consent from the patient, they were randomized into three groups, based on chits in the box technique, to undergo radial artery cannulation as follows: group N (using catheter over needle technique), group W (using catheter over guidewire technique), group U (radial artery cannulations under ultrasound guidance). We calculated a sample size of 50 patients in each group based on the primary endpoint of the overall success rate. The data was analyzed using one-way ANOVA and post hoc Tukey's test. RESULTS There was a non-statistically significant trend towards a higher overall success rate in groups W and U compared to group N (47 and 46, respectively, compared to 43, p-value 0.35). Similarly, no significant differences were observed concerning any of the characteristics of radial artery cannulation, except the first pass success rate, where the success rate was highest in group W (33, 70.21%), followed by group U (34, 68%) with a p-value of 0.04. CONCLUSION Though catheter over guidewire and ultrasound-based techniques offer advantages in terms of higher first-pass success rate, they do not significantly increase the overall success rate or reduce the total incidence of complications.
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Affiliation(s)
- Deepak Singla
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Mishu Mangla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Hyderabad, IND
| | - Ankit Agarwal
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Ranjeeta Kumari
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Rishikesh, IND
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12
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Wang F, Zhu Y. Intraoperative hypotension and postoperative outcomes. Comment on Br J Anaesth 2023; 131: 823-831. Br J Anaesth 2024; 132:178-180. [PMID: 37923583 DOI: 10.1016/j.bja.2023.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023] Open
Affiliation(s)
- Fei Wang
- Department of Anesthesiology, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yihao Zhu
- Department of Anesthesiology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China, Chengdu, China.
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13
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Delmotte L, Desebbe O, Alexander B, Kouz K, Coeckelenbergh S, Schoettker P, Turgay T, Joosten A. Smartphone-Based versus Non-Invasive Automatic Oscillometric Brachial Cuff Blood Pressure Measurements: A Prospective Method Comparison Volunteer Study. J Pers Med 2023; 14:15. [PMID: 38276230 PMCID: PMC10817276 DOI: 10.3390/jpm14010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction: Mobile health diagnostics have demonstrated effectiveness in detecting and managing chronic diseases. This method comparison study aims to assess the accuracy and precision of the previously evaluated OptiBP™ technology over a four-week study period. This device uses optical signals recorded by placing a patient's fingertip on a smartphone's camera to estimate blood pressure (BP). Methods: In adult participants without cardiac arrhythmias and minimal interarm blood pressure difference (systolic arterial pressure (SAP) < 15 mmHg or diastolic arterial pressure (DAP) < 10 mmHg), three pairs of 30 s BP measurements with the OptiBP™ (test method) were simultaneously compared using three pairs of measurements with the non-invasive oscillometric brachial cuff (reference method) on the opposite arm over a period of four consecutive weeks at a rate of two measurements per week (one in the morning and one in the afternoon). The agreement of BP values between the two technologies was analyzed using Bland-Altman and error grid analyses. The performance of the smartphone application was investigated using the International Organization for Standardization (ISO) definitions, which require the bias ± standard deviation (SD) between two technologies to be lower than 5 ± 8 mmHg. Results: Among the 65 eligible volunteers, 53 participants had adequate OptiBP™ BP values. In 12 patients, no OptiBP™ BP could be measured due to inadequate signals. Only nine participants had known chronic arterial hypertension and 76% of those patients were treated. The mean bias ± SD between both technologies was -1.4 mmHg ± 10.1 mmHg for systolic arterial pressure (SAP), 0.2 mmHg ± 6.5 mmHg for diastolic arterial pressure (DAP) and -0.5 mmHg ± 6.9 mmHg for mean arterial pressure (MAP). Error grid analyses indicated that 100% of the pairs of BP measurements were located in zones A (no risk) and B (low risk). Conclusions: In a cohort of volunteers, we observed an acceptable agreement between BP values obtained with the OptiBPTM and those obtained with the reference method over a four-week period. The OptiBPTM fulfills the ISO standards for MAP and DAP (but not SAP). The error grid analyses showed that 100% measurements were located in risk zones A and B. Despite the need for some technological improvements, this application may become an important tool to measure BP in the future.
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Affiliation(s)
- Lila Delmotte
- Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium; (L.D.); (T.T.)
| | - Olivier Desebbe
- Department of Anesthesiology & Perioperative Medicine, Sauvegarde Clinic, Ramsay Santé, 69009 Lyon, France;
| | - Brenton Alexander
- Department of Anesthesiology, University of California San Diego, La Jolla, CA 92103, USA;
| | - Karim Kouz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Sean Coeckelenbergh
- Department of Anesthesiology, Université Paris-Saclay, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (APHP), 94800 Villejuif, France
- Outcomes Research Consortium, Cleveland, OH 44195, USA
| | - Patrick Schoettker
- Biospectal SA, 1003 Lausanne, Switzerland;
- Department of Anesthesiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Tuna Turgay
- Department of Anesthesiology, Erasme University Hospital, Université Libre de Bruxelles, 808 Route de Lennik, 1070 Brussels, Belgium; (L.D.); (T.T.)
| | - Alexandre Joosten
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
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14
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Yu DY, Cringle SJ, Darcey D, Tien LYH, Vukmirovic AJ, Yu PK, Mehnert A, Morgan WH. Posture-Induced Changes in Intraocular, Orbital, Cranial, Jugular Vein, and Arterial Pressures in a Porcine Model. Invest Ophthalmol Vis Sci 2023; 64:22. [PMID: 38108688 PMCID: PMC10732089 DOI: 10.1167/iovs.64.15.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/17/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose The purpose of this study was to determine posture-induced changes in arterial blood pressure (ABP), intraocular pressure (IOP), orbital pressure (Porb), intracranial pressure (ICP), and jugular vein pressure (JVP) at various tilt angles in an in vivo pig. Methods Anesthetized and ventilated pigs (n = 8) were placed prone on a tiltable operating table. ABP, IOP, Porb, ICP, and JVP were monitored while the table was tilted at various angles between 15 degrees head up tilt (HUT) and 25 degrees head down tilt (HDT) either in stepwise changes (5 degrees per step) or continuously. The mean pressure was calculated from digitized pressure waveforms from each compartment. For stepwise changes in tilt angle the pressures were plotted as a function of tilt angle. For continuous tilt changes, the pressures were plotted as a function of time. Results In the case of stepwise changes, ABP remained relatively stable whilst IOP, Porb, ICP, and JVP demonstrated significant differences between most angles (typically P < 0.0001). The difference was greatest for IOP (P < 0.0001) where the average IOP increased from 13.1 ± 1.23 mm Hg at 15 degrees HUT to 46.3 ± 2.03 mm Hg at 25 degrees HDT. The relationship between pressure and tilt angle was almost linear for ICP and JVP, and sigmoidal for IOP and Porb. Interestingly, the effect of changes in tilt angle occurred very rapidly, within a few seconds. Conclusions Our results in a pig model demonstrate that changes in posture (tilt angle) induce rapid changes in IOP, Porb, ICP, and JVP, with IOP affected most severely.
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Affiliation(s)
- Dao-Yi Yu
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Stephen J. Cringle
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Dean Darcey
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Liam Y. H. Tien
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
| | - Aleksandar J. Vukmirovic
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Paula K. Yu
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - Andrew Mehnert
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
| | - William H. Morgan
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Lions Eye Institute, The University of Western Australia, Perth, Australia
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15
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Michard F, Joosten A, Futier E. Intraoperative blood pressure: could less be more? Br J Anaesth 2023; 131:810-812. [PMID: 37778938 DOI: 10.1016/j.bja.2023.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 10/03/2023] Open
Abstract
Retrospective observational studies have reported a significant association between intraoperative hypotension and postoperative morbidity. However, association does not imply causation, and whether preventing intraoperative hypotension can improve patient outcome remains to be demonstrated. In this issue of the British Journal of Anaesthesia, D'Amico and colleagues meta-analysed 10 prospective randomised trials comparing low (≤60 mm Hg) and higher mean arterial pressure targets during anaesthesia and surgery. They did not observe an increase in postoperative morbidity and mortality in the low target group. In contrast, they reported a statistically significant (but not clinically relevant) reduction in postoperative cardiac arrhythmia and hospital length of stay when targeting mean arterial pressure ≤60 mm Hg. These findings suggest that during most surgical cases, intraoperative hypotension is a marker of the severity, frailty, or both rather than a mediator of postoperative complications.
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Affiliation(s)
| | - Alexandre Joosten
- Department of Anesthesiology and Intensive Care, Paris-Saclay University, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), Villejuif, France
| | - Emmanuel Futier
- Department of Anesthesia and Critical Care, Université Clermont Auvergne, Hopital d'Estaing, Clermont-Ferrand, France
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16
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Noe KM, Don A, Cochrane AD, Zhu MZL, Ngo JP, Smith JA, Thrift AG, Vogiatjis J, Martin A, Bellomo R, McMillan J, Evans RG. Intraoperative hemodynamics and risk of cardiac surgery-associated acute kidney injury: An observation study and a feasibility clinical trial. Clin Exp Pharmacol Physiol 2023; 50:878-892. [PMID: 37549882 PMCID: PMC10947000 DOI: 10.1111/1440-1681.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 06/21/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023]
Abstract
Targeting greater pump flow and mean arterial pressure (MAP) during cardiopulmonary bypass (CPB) could potentially alleviate renal hypoxia and reduce the risk of postoperative acute kidney injury (AKI). Therefore, in an observational study of 93 patients undergoing on-pump cardiac surgery, we tested whether intraoperative hemodynamic management differed between patients who did and did not develop AKI. Then, in 20 patients, we assessed the feasibility of a larger-scale trial in which patients would be randomized to greater than normal target pump flow and MAP, or usual care, during CPB. In the observational cohort, MAP during hypothermic CPB averaged 68.8 ± 8.0 mmHg (mean ± SD) in the 36 patients who developed AKI and 68.9 ± 6.3 mmHg in the 57 patients who did not (p = 0.98). Pump flow averaged 2.4 ± 0.2 L/min/m2 in both groups. In the feasibility clinical trial, compared with usual care, those randomized to increased target pump flow and MAP had greater mean pump flow (2.70 ± 0.23 vs. 2.42 ± 0.09 L/min/m2 during the period before rewarming) and systemic oxygen delivery (363 ± 60 vs. 281 ± 45 mL/min/m2 ). Target MAP ≥80 mmHg was achieved in 66.6% of patients in the intervention group but in only 27.3% of patients in the usual care group. Nevertheless, MAP during CPB did not differ significantly between the two groups. We conclude that little insight was gained from our observational study regarding the impact of variations in pump flow and MAP on the risk of AKI. However, a clinical trial to assess the effects of greater target pump flow and MAP on the risk of AKI appears feasible.
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Affiliation(s)
- Khin M Noe
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Andrea Don
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Andrew D Cochrane
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Department of Cardiothoracic Surgery, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Michael Z L Zhu
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Department of Cardiothoracic Surgery, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Jennifer P Ngo
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
- Department of Cardiac Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan
| | - Julian A Smith
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Department of Cardiothoracic Surgery, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Johnny Vogiatjis
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
| | - Andrew Martin
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Department of Cardiothoracic Surgery, Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Rinaldo Bellomo
- Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia
- Department of Intensive Care, Austin Health, Heidelberg, Victoria, Australia
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Victoria, Australia
| | - James McMillan
- Perfusion Services Pty Ltd, Melbourne, Victoria, Australia
| | - Roger G Evans
- Cardiovascular Disease Program, Department of Physiology, Biomedicine Discovery Institute, Monash University, Melbourne, Victoria, Australia
- Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
- Pre-clinical Critical Care Unit, Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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17
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Arellano-Cabezas FJ, Carranza-Samanez KM. [Anxiety level and physiological response to invasive dental treatments. a longitudinal study]. Rev Cient Odontol (Lima) 2023; 11:e175. [PMID: 38312469 PMCID: PMC10831990 DOI: 10.21142/2523-2754-1104-2023-175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/05/2023] [Indexed: 02/06/2024] Open
Abstract
Objective To determine the relationship between the level of anxiety and the physiological response to invasive dental treatments. Materials and methods A convenience sample of 180 patients was formed (73 men and 107 women) ≥18 years (range: 18-58) undergoing treatment with local anesthetics from three private dental offices in the city of Lima. Measurements were made before, during and after treatment on anxiety according to the IDARE questionnaire of 40 questions (20 trait and 20 state) and their physiological response was evaluated according to oxygen saturation (OS), pulse and blood pressure (BP) measured. with digital pulse oximeter and blood pressure monitor. The Friedman and Spearman correlation tests were used, working with a value of P<0.05. Results Most patients had a medium level of anxiety before dental treatment (state 49.4% and trait 55.6%). OS, pulse and BP increased after application of the anesthetic and decreased at the end of treatment, with significant differences (P<0.05). Anxiety scores were significantly correlated only with pulse (state: r=0.238-0.564; trait: r=0.174-0.323) and BP (state: r=0.429-0.699; trait: r=0.312-0.465) (P<0.05). Conclusion State-trait anxiety had a positive relationship with the physiological dimensions of blood pressure and pulse before dental treatment with local anesthetics.
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Affiliation(s)
- Fernando Jesús Arellano-Cabezas
- Carrera de Estomatología, Universidad Científica del Sur. Lima, Perú. Universidad Científica del Sur Carrera de Estomatología Universidad Científica del Sur Lima Peru
| | - Kilder Maynor Carranza-Samanez
- Research Group in Dental Sciences, Carrera de Estomatología, Universidad Científica del Sur. Lima, Universidad Científica del Sur Research Group in Dental Sciences Carrera de Estomatología Universidad Científica del Sur Lima Peru
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18
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Daiuto SA, de Carvalho RP, do Vale B, Dsouki NA, Giannocco G, Cafarchio EM, Aronsson P, Sato MA. Angiotensinergic and GABAergic transmission in the medial preoptic area: role in urinary bladder and cardiovascular control in female rats. Front Physiol 2023; 14:1224505. [PMID: 37772054 PMCID: PMC10524595 DOI: 10.3389/fphys.2023.1224505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 08/24/2023] [Indexed: 09/30/2023] Open
Abstract
Introduction: The medial preoptic area (mPOA) participates in thermoregulatory control and blood pressure modulation as shown by studies with electrical stimulation of this area or cobalt chloride injection, a non-selective synapse inhibitor. This study aimed to investigate whether angiotensin II (Ang II) and GABA could act or not in the mPOA to mediate the cardiovascular and micturition control pathways. Methods: Female Wistar rats were submitted to stereotaxic surgery for implantation of a guide cannula into the mPOA 7 days prior to the experiments. Afterwards, the animals were isoflurane- anesthetized and submitted to the catheterization of the femoral artery and vein and urinary bladder cannulation for mean arterial pressure (MAP), heart rate (HR), and intravesical pressure (IP) recordings, respectively. After the baseline MAP, HR, and IP recordings for 15 min, Ang II (0.1 nM, 1 μL), losartan (AT-1 receptor antagonist, 100 nM, 1 μL), GABA (50 mM, 1 μL) or saline (1 μL) were injected into the mPOA, and the variables were measured for additional 30 min. In a different group of rats, the AT-1 receptor, angiotensin II converting enzyme (ACE), and GABAa receptor gene expression was evaluated in mPOA samples by qPCR. The data are as mean ± SEM and submitted to One-way ANOVA (Tukey posttest) or paired Student t-test (P <0.05). Results: The injection of Ang II into the mPOA evoked a significant hypotension (-37±10 mmHg, n = 6, p = 0.024) and bradycardia (-47 ± 20 bpm, p = 0.030) compared to saline (+1 ± 1 mmHg and +6 ± 2 bpm, n = 6). A significant increase in IP was observed after Ang II injection into the mPOA (+72.25 ± 17.91%, p = 0.015 vs. -1.80 ± 2.98%, n = 6, saline). No significant changes were observed in MAP, HR and IP after the losartan injection in the mPOA compared to saline injection. Injection of GABA into the mPOA evoked a significant fall in MAP and HR (-68 ± 2 mmHg, n = 6, p < 0.0001 and -115 ± 14 bpm, n = 6, p = 0.0002 vs. -1 ± 1 mmHg and +4 ± 2 bpm, n = 6, saline), but no significant changes were observed in IP. The AT-1 receptor, ACE and GABAa receptor mRNA expression was observed in all mPOA samples. Discussion: Therefore, in female rats, Ang II mediated transmission in the mPOA is involved in the cardiovascular regulation and in the control of central micturition pathways. A phasic control dependent on AT-1 receptors in the mPOA seems to be involved in the regulation of those cardiovascular and intravesical 3 parameters. In contrast, GABAergic transmission in the mPOA participates in the pathways of cardiovascular control in anesthetized female rats, nevertheless, this neurotransmission is not involved in the micturition control.
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Affiliation(s)
- Sergio A. Daiuto
- Department Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitario FMABC, Santo Andre, Brazil
| | - Rodrigo P. de Carvalho
- Department Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitario FMABC, Santo Andre, Brazil
| | - Bárbara do Vale
- Department Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitario FMABC, Santo Andre, Brazil
| | - Nuha A. Dsouki
- Department Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitario FMABC, Santo Andre, Brazil
| | - Gisele Giannocco
- Department Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Eduardo M. Cafarchio
- Department Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitario FMABC, Santo Andre, Brazil
| | - Patrik Aronsson
- Department Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Monica A. Sato
- Department Morphology and Physiology, Faculdade de Medicina do ABC, Centro Universitario FMABC, Santo Andre, Brazil
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Karamchandani K, Dave S, Hoffmann U, Khanna AK, Saugel B. Intraoperative arterial pressure management: knowns and unknowns. Br J Anaesth 2023; 131:445-451. [PMID: 37419749 DOI: 10.1016/j.bja.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/16/2023] [Accepted: 05/29/2023] [Indexed: 07/09/2023] Open
Abstract
Preventing postoperative organ dysfunction is integral to the practice of anaesthesia. Although intraoperative hypotension is associated with postoperative end organ dysfunction, there remains ambiguity with regards to its definition, targets, thresholds for initiating treatment, and ideal treatment modalities.
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Affiliation(s)
- Kunal Karamchandani
- Department of Anesthesiology and Pain Management, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Siddharth Dave
- Department of Anesthesiology and Pain Management, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ulrike Hoffmann
- Department of Anesthesiology and Pain Management, Division of Neuroanesthesia, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ashish K Khanna
- Department of Anesthesiology, Section on Critical Care Medicine, Perioperative Outcomes and Informatics Collaborative (POIC), Wake Forest University School of Medicine, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA; Outcomes Research Consortium, Cleveland, OH, USA
| | - Bernd Saugel
- Outcomes Research Consortium, Cleveland, OH, USA; Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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20
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Bergholz A, Greiwe G, Kouz K, Saugel B. Continuous Blood Pressure Monitoring in Patients Having Surgery: A Narrative Review. Medicina (Kaunas) 2023; 59:1299. [PMID: 37512110 PMCID: PMC10385393 DOI: 10.3390/medicina59071299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/11/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023]
Abstract
Hypotension can occur before, during, and after surgery and is associated with postoperative complications. Anesthesiologists should thus avoid profound and prolonged hypotension. A crucial part of avoiding hypotension is accurate and tight blood pressure monitoring. In this narrative review, we briefly describe methods for continuous blood pressure monitoring, discuss current evidence for continuous blood pressure monitoring in patients having surgery to reduce perioperative hypotension, and expand on future directions and innovations in this field. In summary, continuous blood pressure monitoring with arterial catheters or noninvasive sensors enables clinicians to detect and treat hypotension immediately. Furthermore, advanced hemodynamic monitoring technologies and artificial intelligence-in combination with continuous blood pressure monitoring-may help clinicians identify underlying causes of hypotension or even predict hypotension before it occurs.
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Affiliation(s)
- Alina Bergholz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Gillis Greiwe
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Karim Kouz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
- Outcomes Research Consortium, Cleveland, OH 44195, USA
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21
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Porta A, Bari V, Gelpi F, Cairo B, De Maria B, Tonon D, Rossato G, Faes L. On the Different Abilities of Cross-Sample Entropy and K-Nearest-Neighbor Cross-Unpredictability in Assessing Dynamic Cardiorespiratory and Cerebrovascular Interactions. Entropy (Basel) 2023; 25:e25040599. [PMID: 37190390 PMCID: PMC10137562 DOI: 10.3390/e25040599] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 05/17/2023]
Abstract
Nonlinear markers of coupling strength are often utilized to typify cardiorespiratory and cerebrovascular regulations. The computation of these indices requires techniques describing nonlinear interactions between respiration (R) and heart period (HP) and between mean arterial pressure (MAP) and mean cerebral blood velocity (MCBv). We compared two model-free methods for the assessment of dynamic HP-R and MCBv-MAP interactions, namely the cross-sample entropy (CSampEn) and k-nearest-neighbor cross-unpredictability (KNNCUP). Comparison was carried out first over simulations generated by linear and nonlinear unidirectional causal, bidirectional linear causal, and lag-zero linear noncausal models, and then over experimental data acquired from 19 subjects at supine rest during spontaneous breathing and controlled respiration at 10, 15, and 20 breaths·minute-1 as well as from 13 subjects at supine rest and during 60° head-up tilt. Linear markers were computed for comparison. We found that: (i) over simulations, CSampEn and KNNCUP exhibit different abilities in evaluating coupling strength; (ii) KNNCUP is more reliable than CSampEn when interactions occur according to a causal structure, while performances are similar in noncausal models; (iii) in healthy subjects, KNNCUP is more powerful in characterizing cardiorespiratory and cerebrovascular variability interactions than CSampEn and linear markers. We recommend KNNCUP for quantifying cardiorespiratory and cerebrovascular coupling.
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Affiliation(s)
- Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Vlasta Bari
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
- Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Francesca Gelpi
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | | | - Davide Tonon
- Department of Neurology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy
| | - Gianluca Rossato
- Department of Neurology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy
| | - Luca Faes
- Department of Engineering, University of Palermo, 90128 Palermo, Italy
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Saugel B, Thomsen KK, Maheshwari K. Goal-directed haemodynamic therapy: an imprecise umbrella term to avoid. Br J Anaesth 2023; 130:390-393. [PMID: 36732140 DOI: 10.1016/j.bja.2022.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 02/04/2023] Open
Abstract
'Goal-directed haemodynamic therapy' describes various haemodynamic treatment strategies that have in common that interventions are titrated to achieve predefined haemodynamic targets. However, the treatment strategies differ substantially regarding the underlying haemodynamic target variables and target values, and thus presumably have different effects on outcome. It is an over-simplifying approach to lump complex and substantially differing haemodynamic treatment strategies together under the term 'goal-directed haemodynamic therapy', an imprecise umbrella term that we should thus stop using.
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Affiliation(s)
- Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Outcomes Research Consortium, Cleveland, OH, USA.
| | - Kristen K Thomsen
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kamal Maheshwari
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA
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Deussen A, Kopaliani I. Targeting inflammation in hypertension. Curr Opin Nephrol Hypertens 2023; 32:111-117. [PMID: 36476561 PMCID: PMC9872860 DOI: 10.1097/mnh.0000000000000862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Hypertension remains a global health and socioeconomic burden. Immune mechanisms are now recognized as integral part of the multifactorial etiology of hypertension and related organ damage. The present review addresses inflammatory pathways and immune targets in hypertension, which may be important for an immunomodulatory treatment of hypertension aside from lowering arterial pressure. RECENT FINDINGS Anti-inflammatory interventions targeting single interleukins or almost the entire immune system show different beneficial effects. While immunomodulation (targeting specific portion of immune system) shows beneficial outcomes in certain groups of hypertensives, this does not pertain to immunosuppression (targeting entire immune system). Immunomodulatory interventions improve outcomes of hypertension independent of arterial pressure. The studies reveal interleukins, such as interleukin (IL)-1β and IL-17 as targets of immunomodulation. Besides interleukins, targeting αvβ-3 integrin and matrix metalloproteinase-2 or using experimental cell-therapy demonstrate beneficial effects in hypertensive organ damage. The NLR family pyrin domain containing 3 (NLRP3) inflammasome/IL-1β/endothelial cell/T-cell axis seems to be an important mediator in sustained inflammation during hypertension. SUMMARY Although immunomodulation may be advantageous as a causal therapy in hypertension, targeting immune networks rather than single interleukins appears of major importance. Further research is required to better identify these networks and their links to human hypertension.
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Affiliation(s)
- Andreas Deussen
- Department of Physiology, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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24
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Jiang C, Li S, Wang Y, Lai Y, Bai Y, Zhao M, He L, Kong Y, Guo X, Li S, Liu N, Jiang C, Tang R, Sang C, Long D, Du X, Dong J, Anderson CS, Ma C. Diastolic Blood Pressure and Intensive Blood Pressure Control on Cognitive Outcomes: Insights From the SPRINT MIND Trial. Hypertension 2023; 80:580-589. [PMID: 36688305 DOI: 10.1161/hypertensionaha.122.20112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND The potential benefits or harms of intensive systolic blood pressure (BP) control on cognitive function and cerebral blood flow in individuals with low diastolic blood pressure (DBP) remain unclear. METHODS We conducted a post hoc analysis of the SPRINT MIND (Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension) that randomly assigned hypertensive participants to an intensive (<120 mm Hg; n=4278) or standard (<140 mm Hg; n=4385) systolic blood pressure target. We evaluated the effects of BP intervention on cognitive outcomes and cerebral blood flow across baseline DBP quartiles. RESULTS Participants in the intensive group had a lower incidence rate of probable dementia or mild cognitive impairment than those in the standard group, regardless of DBP quartiles. The hazard ratio of intensive versus standard target for probable dementia or mild cognitive impairment was 0.91 (95% CI, 0.73-1.12) in the lowest DBP quartile and 0.70 (95% CI, 0.48-1.02) in the highest DBP quartile, respectively, with an interaction P value of 0.24. Similar results were found for probable dementia (interaction P=0.06) and mild cognitive impairment (interaction P=0.80). The effect of intensive treatment on cerebral blood flow was not modified by baseline DBP either (interaction P=0.25). Even among participants within the lowest DBP quartile, intensive versus standard BP treatment resulted in an increasing trend of annualized change in cerebral blood flow (+0.26 [95% CI, -0.72 to 1.24] mL/[100 g·min]). CONCLUSIONS Intensive BP control did not appear to have a detrimental effect on cognitive outcomes and cerebral perfusion in patients with low baseline DBP. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT01206062.
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Affiliation(s)
- Chao Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
| | - Sitong Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
| | - Yufeng Wang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
| | - Yiwei Lai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
| | - Yu Bai
- DSchool of Clinical Medicine, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China (Y.B.)
| | - Manlin Zhao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
| | - Liu He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
| | - Yu Kong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
| | - Xueyuan Guo
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
| | - Songnan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
| | - Chenxi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
| | - Ribo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
| | - Caihua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
| | - Deyong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.).,DHeart Health Research Center, Beijing, China (X.D., C.S.A.)
| | - Jianzeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.).,DDepartment of Cardiology, The First Affiliated Hospital of Zhengzhou University, Henan Province, China (J.D.)
| | - Craig S Anderson
- DHeart Health Research Center, Beijing, China (X.D., C.S.A.).,DDepartment of Neurology, Royal Prince Alfred Hospital, University of Sydney, Australia (C.S.A.).,DFaculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, Australia (C.S.A.)
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University and National Clinical Research Center for Cardiovascular Diseases, Beijing, China (C.J., S.L., Y.W., Y.L., M.Z., L.H., Y.K., X.G., S.L., N.L., C.J., R.T., C.S., D.L., X.D., J.D., C.M.)
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van Zadelhoff AC, Poppe JA, Willemsen S, Mauff K, van Weteringen W, Goos TG, Reiss IKM, Vermeulen MJ, de Graaff JC. Age-dependent changes in arterial blood pressure in neonates during the first week of life: reference values and development of a model. Br J Anaesth 2023:S0007-0912(23)00033-8. [PMID: 36858885 DOI: 10.1016/j.bja.2023.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/19/2023] [Accepted: 01/25/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Arterial pressure measurements are important to monitor vital function in neonates, and values are known to be dependent of gestational and postnatal age. Current reference ranges for mean arterial pressure in neonates have been derived from small samples and combined data of noninvasive and invasive measurements. We aimed to define reference values for noninvasive mean, systolic, and diastolic blood pressure during the first week of life in otherwise healthy preterm and term neonates defined by gestational and postnatal age. METHODS In this retrospective cohort study in a neonatal intensive care unit (NICU) in a Dutch tertiary paediatric hospital, we included the noninvasive blood pressures of neonates admitted between 2016 and 2018, with exclusion of those with severe comorbidities (major cardiac malformations, intracerebral haemorrhage, and tracheal intubation >6 h). We defined the median (P50) with -2 standard deviations (sd) (P0.23), -1 sd (P16), +1 sd (P84), and +2 sd (P97.7) for gestational age and postnatal age using quantile regression, percentiles provided online (http://bloodpressure-neonate.com/). RESULTS A total of 607 neonates, with 5885 measurements, fulfilled the inclusion criteria. The P50 values of mean noninvasive arterial blood pressure in extreme preterm infants steeply increased during the first day after birth and gradually increased within a week from 27 to 49 mm Hg at 24 h of gestational age, and from 49 to 61 mm Hg at 41 weeks of gestational age. CONCLUSIONS These reference values for noninvasive blood pressure in neonates in the NICU for various gestational age groups provide guidance for clinical decision-making in healthy and diseased neonates during anaesthesia and sedation.
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Fellahi JL, Schweizer R, Ruste M, Jacquet-Lagreze M. Fluids, vasopressors, and acute kidney injury after major abdominal surgery. Comment on Br J Anaesth 2022; 129: 317-26. Br J Anaesth 2023; 130:e193-e194. [PMID: 36464519 DOI: 10.1016/j.bja.2022.10.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/11/2022] [Accepted: 10/18/2022] [Indexed: 12/04/2022] Open
Affiliation(s)
- Jean-Luc Fellahi
- Service d'anesthésie-réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France; Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, Lyon, France.
| | - Rémi Schweizer
- Service d'anesthésie-réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - Martin Ruste
- Service d'anesthésie-réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France; Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, Lyon, France
| | - Matthias Jacquet-Lagreze
- Service d'anesthésie-réanimation, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France; Laboratoire CarMeN, Inserm UMR 1060, Université Claude Bernard Lyon 1, Lyon, France
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Szostek AS, Saunier C, Elsensohn MH, Boucher P, Merquiol F, Gerst A, Portefaix A, Chassard D, De Queiroz Siqueira M. Effective dose of ephedrine for treatment of hypotension after induction of general anaesthesia in neonates and infants less than 6 months of age: a multicentre randomised, controlled, open label, dose escalation trial. Br J Anaesth 2023; 130:603-610. [PMID: 36639328 DOI: 10.1016/j.bja.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/18/2022] [Accepted: 12/10/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The recommended dose of ephedrine in adults (0.1 mg kg-1) frequently fails to treat hypotension after induction of general anaesthesia in neonates and infants less than 6 months of age. The aim of this study was to determine the optimal dose of ephedrine in this population for the treatment of hypotension after induction of general anaesthesia with sevoflurane. METHODS We conducted a multicentre, prospective, randomised, open-label, controlled, dose-escalation trial. Subjects were randomised if presenting a >20% change from baseline in MAP. Six cohorts of 20 subjects each were enrolled. Ten subjects in the first cohort received 0.1 mg kg-1 i. v. (reference dose). For each subsequent cohort, 10 subjects were assigned to the next higher dose (consecutively 0.6, 0.8, 1, 1.2, and 1.4 mg kg-1 i. v.), and the other subjects were assigned to one or more doses already investigated in previous cohorts. The primary outcome was the return of MAP to >80% of baseline at least once within 10 min after ephedrine administration. RESULTS A total of 119 infants (25% females), with a mean age (standard deviation) of 2.7 (1.3) months, received their allocated dose of ephedrine. The optimal dose of ephedrine was 1.2 mg kg-1, with a percentage of success of 65.5% (95% confidence interval, 35.6-86.4). The doses of ephedrine investigated did not induce adverse events. CONCLUSIONS Doses of ephedrine much higher (∼10-fold) than those used in adults are necessary in neonates and infants for the treatment of hypotension after induction of general anaesthesia with sevoflurane. CLINICAL TRIAL REGISTRATION NCT02384876.
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Affiliation(s)
- Anne-Sara Szostek
- Department of Paediatric Anaesthesia, Hospices Civils de Lyon, Bron, France
| | - Clarisse Saunier
- Department of Epidemiology, Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Bron, France
| | - Mad-Hélénie Elsensohn
- Department of Biostatistics, Hospices Civils de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Pierre Boucher
- Department of Paediatric Anaesthesia, Hospices Civils de Lyon, Bron, France
| | - Fanette Merquiol
- Department of Anaesthesia, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Adeline Gerst
- Department of Anaesthesia, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Aurélie Portefaix
- Department of Epidemiology, Hospices Civils de Lyon, EPICIME-CIC 1407 de Lyon, Inserm, Bron, France; Department of Biostatistics, Hospices Civils de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Évolutive UMR 5558, Villeurbanne, France
| | - Dominique Chassard
- Department of Anaesthesia, Hospices Civils de Lyon, Université Lyon 1, Bron, France.
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Kawada T, Yokoi A, Nishiura A, Kakuuchi M, Li M, Uemura K, Suehara S, Sawada S, Saku K. Impact of neurally mediated antidiuretic effect relative to pressure diuresis during acute changes in sympathetic nerve activity. Am J Physiol Regul Integr Comp Physiol 2023; 324:R82-R89. [PMID: 36409023 DOI: 10.1152/ajpregu.00205.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We examined urine excretion during primary acute sympathetic activation (PASA) in anesthetized Wistar-Kyoto rats. Since arterial pressure (AP) changes with sympathetic nerve activity (SNA) during PASA, urine excretion reflects a neurally mediated antidiuretic effect combined with an effect of pressure diuresis. We hypothesized that preventing AP changes under PASA would enable the direct estimation of the neurally mediated antidiuretic effect alone. We changed the isolated carotid sinus pressure stepwise from 60 to 180 mmHg and compared the relationship of normalized urine flow (nUF, urine flow normalized by body weight) versus SNA between conditions allowing and preventing baroreflex-mediated changes in the mean AP. The slope of the SNA-nUF relationship was [Formula: see text]nUFvar = 0.444 ± 0.074 μL·min-1·kg-1·%-1 when the mean AP was variable, whereas it was [Formula: see text]nUFfix = -0.143 ± 0.032 μL·min-1·kg-1·%-1 when the mean AP was fixed at 100 mmHg (n = 7 rats). The slope associated with the effect of pressure diuresis alone, calculated as [Formula: see text]nUFvar - [Formula: see text]nUFfix, was 0.586 ± 0.105 μL·min-1·kg-1·%-1. Hence, the potency of the neurally mediated antidiuretic effect |[Formula: see text]nUFfix|/([Formula: see text]nUFvar - [Formula: see text]nUFfix) was 0.235 ± 0.014 relative to the effect of pressure diuresis under PASA. Our findings would aid an integrative understanding of the effects of renal hemodynamic and sympathetic modulations on urine output function.
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Affiliation(s)
- Toru Kawada
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Aimi Yokoi
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Akitsugu Nishiura
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Midori Kakuuchi
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Meihua Li
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazunori Uemura
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita, Japan
| | | | | | - Keita Saku
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Suita, Japan
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Kremer N, Rako Z, Glocker F, Tello K. Monitoring of Right Ventricular Failure With Daily Pressure Volume Loops Obtained via an Application and 3-Dimensional Echocardiography. Circ Heart Fail 2023; 16:e010097. [PMID: 36373554 DOI: 10.1161/circheartfailure.122.010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- N Kremer
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany (N.K., Z.R., K.T.)
| | - Z Rako
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany (N.K., Z.R., K.T.)
| | - F Glocker
- emka medical GmbH, Aschaffenburg, Germany (F.G.)
| | - K Tello
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Giessen, Germany (N.K., Z.R., K.T.)
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30
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Ikeda Y, Sugiyama T, Shiko Y, Nagai A, Noguchi S, Kawasaki Y, Mazda Y. Association between maternal cardiac output and fetal acidaemia in Caesarean delivery under spinal anaesthesia with norepinephrine infusion: a retrospective cohort study. Br J Anaesth 2023; 130:e4-e7. [PMID: 36411131 DOI: 10.1016/j.bja.2022.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/10/2022] [Accepted: 10/10/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Yusuke Ikeda
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Takayasu Sugiyama
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Yuki Shiko
- Department of Anesthesiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan; Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba University, Chiba, Japan
| | - Azusa Nagai
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Shohei Noguchi
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba University, Chiba, Japan; Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Yusuke Mazda
- Department of Obstetric Anesthesiology, Center for Maternal-Fetal and Neonatal Medicine, Saitama Medical University, Kawagoe, Saitama, Japan.
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Kaloria N, Singh A, Soni SL, Ganesh V, Naik N, Rajnikant K. Arterial cannulation guided by direct waveform assessment: a novel technique. Anaesth Rep 2023; 11:e12207. [PMID: 36632351 PMCID: PMC9827103 DOI: 10.1002/anr3.12207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- N. Kaloria
- Department of Anaesthesia and Intensive CarePostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - A. Singh
- Department of Anaesthesia and Intensive CarePostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - S. L. Soni
- Department of Anaesthesia and Intensive CarePostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - V. Ganesh
- Department of Anaesthesia and Intensive CarePostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - N. Naik
- Department of Anaesthesia and Intensive CarePostgraduate Institute of Medical Education and ResearchChandigarhIndia
| | - K. Rajnikant
- Department of Anaesthesia and Intensive CarePostgraduate Institute of Medical Education and ResearchChandigarhIndia
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Shao X, Jiang J. Intraoperative central venous pressure and acute kidney injury incidence in patients with cardiac arrest. Comment on Br J Anaesth 2022; 128: 785-95. Br J Anaesth 2023; 130:e21-e22. [PMID: 36369017 DOI: 10.1016/j.bja.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 09/29/2022] [Accepted: 10/02/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Xiaolu Shao
- Department of Intensive Care, Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Jianping Jiang
- Department of Intensive Care, Pinghu First People's Hospital, Pinghu, Zhejiang, China.
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Abstract
Purpose To investigate the association of systemic blood pressure and incident primary open-angle glaucoma (POAG) using a large open-access database. Methods Prospective cohort study included 484,268 participants from the UK Biobank without glaucoma at enrollment. Incident POAG events were recorded through assessment visits, hospital inpatient admissions, and primary care data. Blood pressure measures included systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse pressure (PP), and mean arterial pressure (MAP). Repeated measurements throughout the study period were analyzed as time-varying covariables. The parameters were modeled as both categorical and continuous nonlinear variables. The primary outcome measure was the relative hazard of incident POAG. Results There were 2390 incident POAG events over 5,715,480 person-years of follow-up. Median follow-up was 12.08 years. In multivariable analyses, compared to SBP and PP in the normal range (SBP, 120-130 mmHg; PP, 40-50 mmHg), higher SBP and PP were associated with an increased risk of incident POAG (linear trend P = 0.038 for SBP, P < 0.001 for PP). Specifically, SBP of 130 to 140 mmHg or 140 to 150 mmHg was associated with a 1.16 higher hazard of incident POAG (95% CI, 1.01-1.32 and 1.01-1.33, respectively), whereas a PP of greater than 70 mmHg was associated with a 1.13 higher hazard of incident glaucoma (95% CI, 1.00-1.29). In multivariable models, no statistically significant associations were found for DBP or MAP with incident glaucoma. These findings were similar when blood pressure measures were modeled as continuous variables. Conclusions Higher SBP and PP were associated with an increased risk of incident POAG. Further studies are required to characterize these relationships better.
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Affiliation(s)
- Carmelo Macri
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Christopher X Wong
- Department of Cardiology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Samuel J Tu
- Department of Cardiology, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Robert Casson
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Kuldev Singh
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, United States
| | - Sophia Y Wang
- Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, United States
| | - Michelle T Sun
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, California, United States
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34
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Victorino CA, Faria JCP, Sawamura LS, de Souza FIS, Sarni ROS. Association between acanthosis nigricans and overweight with hypertension in children and adolescents from low-income families. Rev Assoc Med Bras (1992) 2022; 68:1721-1725. [PMID: 36449800 PMCID: PMC9779977 DOI: 10.1590/1806-9282.20220852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/03/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aimed to describe the prevalence of acanthosis nigricans and high blood pressure in children and adolescents from low-income families, and to verify the association of elevated blood pressure with nutritional status and the presence of acanthosis nigricans. METHODS This is a cross-sectional and controlled study with 232 children and adolescents from an institution for low-income families. Pubertal stage, body mass index Z-score, waist-to-height circumference ratio (increased waist-to-height circumference ratio >0.5), the presence of acanthosis nigricans, and blood pressure were assessed. RESULTS The prevalence of excess weight and the change in waist-to-height circumference ratio was 37.9%. Acanthosis nigricans and increased blood pressure occurred in 20.3 and 34.8%, respectively. The prevalence of acanthosis nigricans and hypertension was higher in individuals with excess weight (p<0.001; p<0.001) and with an increased waist-to-height circumference ratio (p=0.009; p<0.001). Logistic regression showed a significant and independent association of body mass index Z-score (OR 2.35; 95%CI 1.52-3.65; p<0.001) and the presence of acanthosis nigricans (OR 2.43; 95%CI 1.12-5.23; p=0.023) with elevated blood pressure. CONCLUSION Acanthosis nigricans and elevated blood pressure occurred in one-fifth and one-third of the individuals in an institution for children from low-income families. Overweight and the presence of acanthosis nigricans increased the risk of high blood pressure more than twofold.
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Affiliation(s)
- Camila Augusta Victorino
- Centro Universitário Faculdade de Medicina do ABC – Santo André (SP), Brazil.,Universidade Nove de Julho – São Paulo (SP), Brazil
| | - João Carlos Pina Faria
- Centro Universitário Faculdade de Medicina do ABC – Santo André (SP), Brazil.,Universidade Nove de Julho – São Paulo (SP), Brazil.,Corresponding author:
| | - Luciana Satiko Sawamura
- Centro Universitário Faculdade de Medicina do ABC – Santo André (SP), Brazil.,Universidade Municipal de São Caetano do Sul – São Caetano do Sul (SP), Brazil
| | - Fabíola Isabel Suano de Souza
- Centro Universitário Faculdade de Medicina do ABC – Santo André (SP), Brazil.,Universidade Federal de São Paulo – São Paulo (SP), Brazil
| | - Roseli Oselka Saccardo Sarni
- Centro Universitário Faculdade de Medicina do ABC – Santo André (SP), Brazil.,Universidade Federal de São Paulo – São Paulo (SP), Brazil
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35
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Blobner BM, Kirabo A, Kashlan OB, Sheng S, Arnett DK, Becker LC, Boerwinkle E, Carlson JC, Gao Y, Gibbs RA, He J, Irvin MR, Kardia SLR, Kelly TN, Kooperberg C, McGarvey ST, Menon VK, Montasser ME, Naseri T, Redline S, Reiner AP, Reupena MS, Smith JA, Sun X, Vaidya D, Viaud-Martinez KA, Weeks DE, Yanek LR, Zhu X, Minster RL, Kleyman TR. Rare Variants in Genes Encoding Subunits of the Epithelial Na + Channel Are Associated With Blood Pressure and Kidney Function. Hypertension 2022; 79:2573-2582. [PMID: 36193739 PMCID: PMC9669116 DOI: 10.1161/hypertensionaha.121.18513] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 07/31/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The epithelial Na+ channel (ENaC) is intrinsically linked to fluid volume homeostasis and blood pressure. Specific rare mutations in SCNN1A, SCNN1B, and SCNN1G, genes encoding the α, β, and γ subunits of ENaC, respectively, are associated with extreme blood pressure phenotypes. No associations between blood pressure and SCNN1D, which encodes the δ subunit of ENaC, have been reported. A small number of sequence variants in ENaC subunits have been reported to affect functional transport in vitro or blood pressure. The effects of the vast majority of rare and low-frequency ENaC variants on blood pressure are not known. METHODS We explored the association of low frequency and rare variants in the genes encoding ENaC subunits, with systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse pressure. Using whole-genome sequencing data from 14 studies participating in the Trans-Omics in Precision Medicine Whole-Genome Sequencing Program, and sequence kernel association tests. RESULTS We found that variants in SCNN1A and SCNN1B were associated with diastolic blood pressure and mean arterial pressure (P<0.00625). Although SCNN1D is poorly expressed in human kidney tissue, SCNN1D variants were associated with systolic blood pressure, diastolic blood pressure, mean arterial pressure, and pulse pressure (P<0.00625). ENaC variants in 2 of the 4 subunits (SCNN1B and SCNN1D) were also associated with estimated glomerular filtration rate (P<0.00625), but not with stroke. CONCLUSIONS Our results suggest that variants in extrarenal ENaCs, in addition to ENaCs expressed in kidneys, influence blood pressure and kidney function.
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Affiliation(s)
- Brandon M Blobner
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Annet Kirabo
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ossama B Kashlan
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Computational and Systems Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shaohu Sheng
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Donna K Arnett
- College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Lewis C Becker
- GeneSTAR Research Program, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Eric Boerwinkle
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Jenna C Carlson
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Yan Gao
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Richard A Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Tulane University Translational Science Institute, New Orleans, LA, USA
| | - Marguerite R Irvin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sharon LR Kardia
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Tanika N Kelly
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Tulane University Translational Science Institute, New Orleans, LA, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Stephen T McGarvey
- Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, RI, USA
| | - Vipin K Menon
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - May E Montasser
- Department of Medicine, University of Maryland, Baltimore, MD, USA
| | - Take Naseri
- Department of Epidemiology and International Health Institute, Brown University School of Public Health, Providence, RI, USA
- Ministry of Health, Apia, Samoa
| | - Susan Redline
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alexander P Reiner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | - Jennifer A Smith
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Xiao Sun
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Dhananjay Vaidya
- GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Daniel E Weeks
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa R Yanek
- GeneSTAR Research Program, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xiaofeng Zhu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | | | - Ryan L Minster
- Department of Human Genetics, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Thomas R Kleyman
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Cell Biology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Pharmacology and Chemical Biology, University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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36
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Zietara A, Spires DR, Juffre A, Costello HM, Crislip GR, Douma LG, Levchenko V, Dissanayake LV, Klemens CA, Nikolaienko O, Geurts AM, Gumz ML, Staruschenko A. Knockout of the Circadian Clock Protein PER1 (Period1) Exacerbates Hypertension and Increases Kidney Injury in Dahl Salt-Sensitive Rats. Hypertension 2022; 79:2519-2529. [PMID: 36093781 PMCID: PMC9669134 DOI: 10.1161/hypertensionaha.122.19316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/14/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Circadian rhythms play an essential role in physiological function. The molecular clock that underlies circadian physiological function consists of a core group of transcription factors, including the protein PER1 (Period1). Studies in mice show that PER1 plays a role in the regulation of blood pressure and renal sodium handling; however, the results are dependent on the strain being studied. Using male Dahl salt-sensitive (SS) rats with global knockout of PER1 (SSPer1-/-), we aim to test the hypothesis that PER1 plays a key role in the regulation of salt-sensitive blood pressure. METHODS The model was generated using CRISPR/Cas9 and was characterized using radiotelemetry and measures of renal function and circadian rhythm. RESULTS SSPer1-/- rats had similar mean arterial pressure when fed a normal 0.4% NaCl diet but developed augmented hypertension after three weeks on a high-salt (4% NaCl) diet. Despite being maintained on a normal 12:12 light:dark cycle, SSPer1-/- rats exhibited desynchrony mean arterial pressure rhythms on a high-salt diet, as evidenced by increased variability in the time of peak mean arterial pressure. SSPer1-/- rats excrete less sodium after three weeks on the high-salt diet. Furthermore, SSPer1-/- rats exhibited decreased creatinine clearance, a measurement of renal function, as well as increased signs of kidney tissue damage. SSPer1-/- rats also exhibited higher plasma aldosterone levels. CONCLUSIONS Altogether, our findings demonstrate that loss of PER1 in Dahl SS rats causes an array of deleterious effects, including exacerbation of the development of salt-sensitive hypertension and renal damage.
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Affiliation(s)
- Adrian Zietara
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL 33602, USA
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226
| | - Denisha R. Spires
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226
| | - Alexandria Juffre
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, FL 32610, USA
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL 32610, USA
| | - Hannah M. Costello
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL 32610, USA
| | - G. Ryan Crislip
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL 32610, USA
| | - Lauren G. Douma
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, FL 32610, USA
| | - Vladislav Levchenko
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL 33602, USA
| | - Lashodya V. Dissanayake
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL 33602, USA
| | - Christine A. Klemens
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL 33602, USA
- Hypertension and Kidney Research Center, University of South Florida, Tampa, FL 33602, USA
| | - Oksana Nikolaienko
- Department of Cellular Membranology, Bogomoletz Institute of Physiology, Kyiv, Ukraine
| | - Aron M. Geurts
- Department of Physiology, Medical College of Wisconsin, Milwaukee, WI 53226
| | - Michelle L. Gumz
- Department of Biochemistry and Molecular Biology, University of Florida, Gainesville, FL 32610, USA
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, FL 32610, USA
- Department of Medicine, Division of Nephrology, Hypertension, and Renal Transplantation, University of Florida, Gainesville, FL 32610, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, FL 32610, USA
| | - Alexander Staruschenko
- Department of Molecular Pharmacology and Physiology, University of South Florida, Tampa, FL 33602, USA
- Hypertension and Kidney Research Center, University of South Florida, Tampa, FL 33602, USA
- James A. Haley Veterans’ Hospital, Tampa, FL 33612, USA
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Vega Colón M, López González JM, Jiménez Gómez BM, Pico Veloso J, Fernández Mendez M, Fernández Suárez FE, del Castro Madrazo JA, Álvarez Marcos F, Fajardo Pérez M, Lin JA, Galluccio F, Hou JD, Chan SM. Prospective Observational Study after Eversion Carotid Endarterectomy with Ultrasound-Guided Deep-Intermediate Cervical Plexus Blockade. Healthcare (Basel) 2022; 10:healthcare10101986. [PMID: 36292433 PMCID: PMC9601612 DOI: 10.3390/healthcare10101986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/01/2022] [Accepted: 10/03/2022] [Indexed: 11/04/2022] Open
Abstract
(1) Introduction: The aim was to describe the anesthetic and surgical technique of eversion carotid endarterectomy performed under intermediate-deep cervical block with sedation, and to analyze the intraoperative and postoperative results. (2) Material and Methods: Thirty cases of unilateral eversion carotid endarterectomy (n = 30), performed between 2019–2020 in a tertiary center under intermediate-deep ultrasound-guided cervical plexus block and sedation, were prospectively observed and analyzed. Hemodynamic (blood pressure, heart rate) and neurological (cerebral oximetry) variables were measured in four intraoperative phases: at the beginning of the operation, prior to carotid clamping, after unclamping and at the end of the operation. We assessed acute postoperative pain in a numerical rating scale at 6, 12 and 24 h, early and 30-day complications, and length of stay. (3) Results: Baseline mean arterial pressure values were 100.4 ± 18 mmHg, pre-clamping 95.8 ± 14 mmHg, post-clamping 94.9 ± 11 mmHg, and at the end of the operation 102.4 ± 16 mmHg. Cerebral oximetry values were 61.7 ± 7/62.7 ± 8, 68.5 ± 9.6/69.1 ± 11.7 and 68.1 ± 10/68.1 ± 10 for the left and right hemispheres at baseline, pre- and post-clamping, respectively. The pain assessment showed a score less than or equal to 3. The incidence of residual nerve block, early complications, and major complications in the first 30 days was 40%, 16.7% and 3.3%, respectively. (4) Conclusions: The combination of intermediate-deep cervical plexus block and low-dose sedation is an effective and safe alternative in awake eversion carotid endarterectomy.
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Affiliation(s)
- María Vega Colón
- Division of Cardiovascular and Thoracic Anesthesiology, Asturias University Central Hospital (HUCA), 33001 Oviedo, Spain
| | - José Manuel López González
- Division of Cardiovascular and Thoracic Anesthesiology, Asturias University Central Hospital (HUCA), 33001 Oviedo, Spain
| | - Bárbara María Jiménez Gómez
- Division of Cardiovascular and Thoracic Anesthesiology, Asturias University Central Hospital (HUCA), 33001 Oviedo, Spain
| | - Jandro Pico Veloso
- Division of Cardiovascular and Thoracic Anesthesiology, Asturias University Central Hospital (HUCA), 33001 Oviedo, Spain
| | - Marta Fernández Mendez
- Division of Cardiovascular and Thoracic Anesthesiology, Asturias University Central Hospital (HUCA), 33001 Oviedo, Spain
| | | | | | | | - Mario Fajardo Pérez
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain Echo Training School, 28029 Madrid, Spain
| | - Jui-An Lin
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Anesthesiology, School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Anesthesiology, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Department of Anesthesiology, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
- Correspondence:
| | - Felice Galluccio
- Morphological Madrid Research Center (MoMaRC), Ultradissection Spain Echo Training School, 28029 Madrid, Spain
- Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 11696, Taiwan
| | - Jin-De Hou
- Department of Anesthesiology, School of Medicine, National Defense Medical Center, Taipei 11490, Taiwan
- Division of Anesthesiology, Hualien Armed Forces General Hospital, Hualien 97144, Taiwan
| | - Shun-Ming Chan
- Department of Anesthesiology, Tri-Service General Hospital and National Defense Medical Center, Taipei 11490, Taiwan
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38
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Pula R, Gooty S, Thakur N, Sharathchandra B. Dural sac cross-sectional area measured using ultrasound to modify the dosage of local anaesthetic in spinal anaesthesia for transurethral resection of prostate surgery: A prospective, double blind, randomised controlled study. Indian J Anaesth 2022; 66:719-723. [PMID: 36437974 PMCID: PMC9698297 DOI: 10.4103/ija.ija_244_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND AIMS The area of lumbar spinal canal decreases with age, and hence the level of sensory blockade is higher in the elderly after spinal injection. The present study optimised the dose of local anaesthetic in elderly patients based on the lumbar dural sac cross sectional area (DSCSA) determined using ultrasound. METHODS Sixty patients of age above 60 years undergoing transurethral resection of prostrate (TURP) surgery in a tertiary care hospital were included in the study. Patients were categorised into two groups of 30 each based on a computer-generated random number table. In the control group (C), 2 ml of 0.5% hyperbaric bupivacaine was given and in the ultrasound group (U), the drug dose was modified according to DSCSA which was measured using the formula area = p (diameter/2) 2. RESULTS The DSCSA and bupivacaine dosage were significantly lower in group U compared to control group (P = 0.0001). The maximal level of cephalad spread of sensory blockade was significantly lower in ultrasound group, than in control group (P = 0.002). The two-segment block regression time and motor recovery time was less in group U. Higher mean arterial pressure (105.8 ± 9.66 mmHg; P = 0.007), and a lower decrease from baseline (14.15 ± 7.55%; P = 0.041) was noted in group U after subarachnoid block. CONCLUSION The estimation of DSCSA is an effective parameter and can be used to modify the dose of local anaesthetic for subarachnoid block in elderly patients undergoing TURP surgery.
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Affiliation(s)
- Ravikanth Pula
- ESIC Medical College and Super Speciality Hospital, Hyderabad, Telangana, India,Address for correspondence: Dr. Ravikanth Pula, ESIC Medical College and Super Speciality Hospital, Hyderabad, Telangana, India. E-mail:
| | - Sunanda Gooty
- ESIC Medical College and Super Speciality Hospital, Hyderabad, Telangana, India
| | - Nagarjuna Thakur
- ESIC Medical College and Super Speciality Hospital, Hyderabad, Telangana, India
| | - B Sharathchandra
- ESIC Medical College and Super Speciality Hospital, Hyderabad, Telangana, India
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Ribeiro AB, Ribeiro AB, de Araújo CB, Fortes CV, Clemente LM, Paranhos HDFO, Watanabe E, Salgado HC, Silva-Lovato CH. Effect of a Hygiene Protocol on Denture-Related Stomatitis Remission, Local Inflammatory Factors, and Hemodynamic Responses by Arterial Pressure. Antibiotics (Basel) 2022; 11:antibiotics11101320. [PMID: 36289978 PMCID: PMC9598829 DOI: 10.3390/antibiotics11101320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/16/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022] Open
Abstract
Denture-related stomatitis (DRS) is frequent oral inflammation in complete denture wearers. This study evaluated the effect of a hygiene protocol on DRS remission, local inflammatory factors, and hemodynamic responses. Thirty-three individuals were enrolled in the study. The outcomes were measured before and after 10 days of a hygiene protocol treatment consisting of brushing the palate with a soft brush and water and denture brushing with a denture-specific brush and mild soap, as well as immersion of the denture for 20 min in a 0.25% sodium hypochlorite solution. Data were analyzed by paired Wilcoxon for biofilm removal and CFU count of microorganisms. The paired T test was used to assess salivary MUC 1, cytokines, and arterial pressure (p < 0.05). A significant difference was found in the DRS degree (p < 0.001), biofilm (p < 0.001), microbial load of Candida spp. (p < 0.001), Gram-negative (p < 0.004), Staphylococcus spp. (p < 0.001), and S. mutans (p < 0.001) of the denture, and S. mutans (p < 0.001) of the palate after use of the protocol. The salivary flow (p = 0.2) and pH (p = 0.97) did not change; there was an increase of MUC 1 (p = 0.049) and a decrease in IL-6 (p = 0.038), IL-2 (p = 0.04), IL-10 (p = 0.041), and IFNγ (p = 0.04). There was also a decrease in systolic (p = 0.012) and mean arterial pressure (p = 0.02). The current hygiene protocol reduced the inflammation degree of DRS and promoted an improvement of local inflammatory factors and a reduction in the systolic arterial pressure of the patients.
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Affiliation(s)
- Adriana Barbosa Ribeiro
- Department of Dental Materials and Prosthesis, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Aline Barbosa Ribeiro
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Camila Borba de Araújo
- Department of Dental Materials and Prosthesis, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Caroline Vieira Fortes
- Department of Dental Materials and Prosthesis, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Lorena Mosconi Clemente
- Department of Dental Materials and Prosthesis, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Helena de Freitas Oliveira Paranhos
- Department of Dental Materials and Prosthesis, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Evandro Watanabe
- Department of Restorative Dentistry, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Helio Cesar Salgado
- Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14040-904, Brazil
| | - Cláudia Helena Silva-Lovato
- Department of Dental Materials and Prosthesis, School of Dentistry of Ribeirão Preto, University of São Paulo, Ribeirão Preto 14040-904, Brazil
- Correspondence: ; Tel.: +55-16-3315-4006
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Hussain SM, Ernst ME, Barker AL, Margolis KL, Reid CM, Neumann JT, Tonkin AM, Phuong TLT, Beilin LJ, Pham T, Chowdhury EK, Cicuttini FM, Gilmartin-Thomas JFM, Carr PR, McNeil JJ. Variation in Mean Arterial Pressure Increases Falls Risk in Elderly Physically Frail and Prefrail Individuals Treated With Antihypertensive Medication. Hypertension 2022; 79:2051-2061. [PMID: 35722878 PMCID: PMC9378722 DOI: 10.1161/hypertensionaha.122.19356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Impaired cerebral blood flow has been associated with an increased risk of falls. Mean arterial pressure (MAP) and variability in MAP have been reported to affect cerebral blood flow but their relationships to the risk of falls have not previously been reported. METHODS Utilising data from the Aspirin in Reducing Events in the Elderly trial participants, we estimated MAP and variability in MAP, defined as within-individual SD of MAP from baseline and first 2 annual visits. The relationship with MAP was studied in 16 703 participants amongst whom 1539 falls were recorded over 7.3 years. Variability in MAP was studied in 14 818 of these participants who experienced 974 falls over 4.1 years. Falls were confined to those involving hospital presentation. Cox regression was used to calculate hazard ratio and 95% CI for associations with falls. RESULTS Long-term variability in MAP was not associated with falls except amongst frail or prefrail participants using antihypertensive medications. Within this group each 5 mm Hg increase in long-term variability in MAP increased the risk of falls by 16% (hazard ratio, 1.16 [95% CI, 1.02-1.33]). Amongst the antihypertensive drugs studied, beta-blocker monotherapy (hazard ratio, 1.93 [95% CI, 1.17-3.18]) was associated with an increased risk of falls compared with calcium channel blockers. CONCLUSIONS Higher levels of long-term variability in MAP increase the risk of serious falls in older frail and prefrail individuals taking antihypertensive medications. The observation that the relationship was limited to frail and prefrail individuals might explain some of the variability of previous studies linking blood pressure indices and falls.
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Affiliation(s)
- Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
- Department of Medical Education, Melbourne Medical School, The University of Melbourne, Victoria 3010 Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy; and, Department of Family Medicine, Carver College of Medicine. The University of Iowa, Iowa City, Iowa. USA
| | - Anna L Barker
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | | | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Johannes T Neumann
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
- Department of Cardiology, University Heart & Vascular Center Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Thao Le Thi Phuong
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Lawrence J Beilin
- Medical School, Royal Perth Hospital, University of Western Australia, Perth, Australia
| | - Thao Pham
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Enayet K Chowdhury
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - Julia FM Gilmartin-Thomas
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
- College of Health and Biomedicine, and Institute for Health & Sport, Victoria University, Victoria, Australia
- Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Prudence R Carr
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Victoria 3004 Australia
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Kouz K, Wegge M, Flick M, Bergholz A, Moll-Khosrawi P, Nitzschke R, Trepte CJC, Krause L, Sessler DI, Zöllner C, Saugel B. Continuous intra-arterial versus intermittent oscillometric arterial pressure monitoring and hypotension during induction of anaesthesia: the AWAKE randomised trial. Br J Anaesth 2022; 129:478-486. [PMID: 36008202 DOI: 10.1016/j.bja.2022.06.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Hypotension during induction of anaesthesia is associated with organ injury. Continuous arterial pressure monitoring might help reduce hypotension. We tested the hypothesis that continuous intra-arterial compared with intermittent oscillometric arterial pressure monitoring reduces hypotension during induction of anaesthesia in noncardiac surgery patients. METHODS In this single-centre randomised trial, 242 noncardiac surgery patients in whom intra-arterial arterial pressure monitoring was planned were randomised to unblinded continuous intra-arterial or to intermittent oscillometric arterial pressure monitoring (with blinded intra-arterial arterial pressure monitoring) during induction of anaesthesia. The primary endpoint was the area under a mean arterial pressure (MAP) of 65 mm Hg within the first 15 min of induction of anaesthesia. Secondary endpoints included areas under MAP values of 60, 50, and 40 mm Hg and durations of MAP values <65, <60, <50, and <40 mm Hg. RESULTS There were 224 subjects available for analysis. The median (25th-75th percentile) area under a MAP of 65 mm Hg was 15 (2-36) mm Hg • min in subjects assigned to continuous intra-arterial monitoring and 46 (7-111) mm Hg • min in subjects assigned to intermittent oscillometric monitoring (P<0.001). Subjects assigned to continuous intra-arterial monitoring had smaller areas under MAP values of 60, 50, and 40 mm Hg and shorter durations of MAP values <65, <60, <50, and <40 mm Hg than subjects assigned to intermittent oscillometric monitoring. CONCLUSION Continuous intra-arterial arterial pressure monitoring reduces hypotension during induction of anaesthesia compared with intermittent oscillometric arterial pressure monitoring in noncardiac surgery patients. In patients for whom an arterial catheter is planned, clinicians might therefore consider inserting the arterial catheter before rather than after induction of anaesthesia. CLINICAL TRIALS REGISTRATION NCT04894019.
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Affiliation(s)
- Karim Kouz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mirja Wegge
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Moritz Flick
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alina Bergholz
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Parisa Moll-Khosrawi
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rainer Nitzschke
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Constantin J C Trepte
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linda Krause
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniel I Sessler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA; Outcomes Research Consortium, Cleveland, OH, USA
| | - Christian Zöllner
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Saugel
- Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Outcomes Research Consortium, Cleveland, OH, USA.
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Kim HK, Ishizawa R, Fukazawa A, Wang Z, Bezan Petric U, Hu MC, Smith SA, Mizuno M, Vongpatanasin W. Dapagliflozin Attenuates Sympathetic and Pressor Responses to Stress in Young Prehypertensive Spontaneously Hypertensive Rats. Hypertension 2022; 79:1824-1834. [PMID: 35652337 PMCID: PMC9308730 DOI: 10.1161/hypertensionaha.122.19177] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND SGLT2i (sodium-glucose cotransporter 2 inhibitor), a class of anti-diabetic medications, is shown to reduce blood pressure (BP) in hypertensive patients with type 2 diabetes. Mechanisms underlying this action are unknown but SGLT2i-induced sympathoinhibition is thought to play a role. Whether SGLT2i reduces BP and sympathetic nerve activity (SNA) in a nondiabetic prehypertension model is unknown. METHODS Accordingly, we assessed changes in conscious BP using radiotelemetry and alterations in mean arterial pressure and renal SNA during simulated exercise in nondiabetic spontaneously hypertensive rats during chronic administration of a diet containing dapagliflozin (0.5 mg/kg per day) versus a control diet. RESULTS We found that dapagliflozin had no effect on fasting blood glucose, insulin, or hemoglobin A1C levels. However, dapagliflozin reduced BP in young (8-week old) spontaneously hypertensive rats as well as attenuated the age-related rise in BP in adult spontaneously hypertensive rat up to 17-weeks of age. The rises in mean arterial pressure and renal SNA during simulated exercise (exercise pressor reflex activation by hindlimb muscle contraction) were significantly reduced after 4 weeks of dapagliflozin (Δmean arterial pressure: 10±7 versus 25±14 mm Hg, Δrenal SNA: 31±17% versus 68±39%, P<0.05). Similarly, rises in mean arterial pressure and renal SNA during mechanoreflex stimulation by passive hindlimb stretching were also attenuated by dapagliflozin. Heart weight was significantly decreased in dapagliflozin compared with the control group. CONCLUSIONS These data demonstrate a novel role for SGLT2i in reducing resting BP as well as the activity of skeletal muscle reflexes, independent of glycemic control. Our study may have important clinical implications for preventing hypertension and hypertensive heart disease in young prehypertensive individuals.
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Affiliation(s)
- Han-Kyul Kim
- Departments of Internal Medicine-Hypertension Section (H.-K.K., Z.W., U.B.P., W.V.), University of Texas Southwestern Medical Center, Dallas, TX.,Applied Clinical Research (H.-K.K., R.I., A.F., S.A.S., M.M.), University of Texas Southwestern Medical Center, Dallas, TX
| | - Rie Ishizawa
- Applied Clinical Research (H.-K.K., R.I., A.F., S.A.S., M.M.), University of Texas Southwestern Medical Center, Dallas, TX
| | - Ayumi Fukazawa
- Applied Clinical Research (H.-K.K., R.I., A.F., S.A.S., M.M.), University of Texas Southwestern Medical Center, Dallas, TX
| | - Zhongyun Wang
- Departments of Internal Medicine-Hypertension Section (H.-K.K., Z.W., U.B.P., W.V.), University of Texas Southwestern Medical Center, Dallas, TX
| | - Ursa Bezan Petric
- Departments of Internal Medicine-Hypertension Section (H.-K.K., Z.W., U.B.P., W.V.), University of Texas Southwestern Medical Center, Dallas, TX
| | - Ming Chang Hu
- Internal Medicine-Renal Division (M.C.H.), University of Texas Southwestern Medical Center, Dallas, TX.,Pak Center of Mineral Metabolism and Clinical Research (M.C.H., W.V.), University of Texas Southwestern Medical Center, Dallas, TX
| | - Scott A Smith
- Applied Clinical Research (H.-K.K., R.I., A.F., S.A.S., M.M.), University of Texas Southwestern Medical Center, Dallas, TX
| | - Masaki Mizuno
- Applied Clinical Research (H.-K.K., R.I., A.F., S.A.S., M.M.), University of Texas Southwestern Medical Center, Dallas, TX
| | - Wanpen Vongpatanasin
- Departments of Internal Medicine-Hypertension Section (H.-K.K., Z.W., U.B.P., W.V.), University of Texas Southwestern Medical Center, Dallas, TX.,Pak Center of Mineral Metabolism and Clinical Research (M.C.H., W.V.), University of Texas Southwestern Medical Center, Dallas, TX
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Valente HB, Gervazoni NDL, Laurino MJL, Vanzella LM, Stoco-Oliveira MC, Rodrigues MV, André LB, Ribeiro F, de Carvalho AC, Vanderlei LCM. Autonomic and cardiorespiratory responses to the active tilt test in individuals with Parkinson disease: cross-sectional study. Arq Neuropsiquiatr 2022; 80:689-698. [PMID: 36254441 PMCID: PMC9685817 DOI: 10.1055/s-0042-1755225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
BACKGROUND The Parkinson disease (PD) is frequently associated with autonomic dysfunctions. However, data regarding the influence of PD on the autonomic responses to postural changes is limited. OBJECTIVE To analyze and compare the autonomic responses, evaluated through linear and non-linear methods of heart rate variability, and cardiorespiratory parameters in two groups: Parkinson disease (PDG) and control (CG), at rest and during the active tilt test. METHODS A total of 48 participants were analyzed (PDG: n = 25;73.40 ± 7.01 years / CG: n = 23;70.17 ± 8.20 years). The autonomic modulation and cardiorespiratory parameters were evaluated at rest and during the active tilt test. To assess the autonomic modulation the linear indices, at the time (rMSSD, SDNN) and frequency (LF, HF, LF/HF) domains, and the non-linear indices, obtained through the Poincaré plot (SD1, SD2, SD1/SD2), were calculated. The cardiorespiratory parameters evaluated were heart rate (HR), systolic (SBP), and diastolic blood pressure (DBP), peripheral oxygen saturation (SpO2), and respiratory rate. RESULTS At rest, the PDG presented significantly lower values of rMSSD, SDNN, LF, HF, SD1, SD2, and DBP, and higher values of SpO2. During test, in the PD group, modifications were observed in HR, and SBP, besides a reduced parasympathetic response, and an increased global modulation. The qualitative analysis of the Poincaré plot showed that the PDG has a lower dispersion of the RR intervals during rest and the active tilt test. CONCLUSION Individuals with PD present reduced global variability and parasympathetic modulation at rest, and reduced parasympathetic response and damage in HR regulation when performing the active tilt test, compared with controls.
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Affiliation(s)
- Heloisa Balotari Valente
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Natacha de Lima Gervazoni
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Maria Júlia Lopez Laurino
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Laís Manata Vanzella
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Mileide Cristina Stoco-Oliveira
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Mariana Viana Rodrigues
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Larissa Borba André
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Felipe Ribeiro
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Augusto Cesinando de Carvalho
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
| | - Luiz Carlos Marques Vanderlei
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Ciências e Tecnologia, Departamento de Fisioterapia, Presidente Prudente SP, Brazil
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Sneyd JR, Absalom AR, Barends CRM, Jones JB. The appropriate way to measure blood pressure for sedated colonoscopy. Response to Br J Anaesth 2022. Br J Anaesth 2022; 129:e25-e27. [PMID: 35618536 DOI: 10.1016/j.bja.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- J Robert Sneyd
- Faculty of Medicine and Dentistry, University of Plymouth, John Bull Building, Plymouth Science Park, Plymouth, UK.
| | - Anthony R Absalom
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clemens R M Barends
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jordan B Jones
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT, USA
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Han S, Chu H, Liang Y. The appropriate way to measure blood pressure for sedated colonoscopy. Comment on Br J Anaesth 2022; 128: 610-22. Br J Anaesth 2022; 129:e25. [PMID: 35568506 DOI: 10.1016/j.bja.2022.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/07/2022] [Accepted: 04/12/2022] [Indexed: 02/05/2023] Open
Affiliation(s)
- Shuai Han
- Department of Anesthesiology, Qingdao Women's and Children's Hospital Affiliated to Qingdao University, Qingdao, China
| | - Haichen Chu
- Department of Anesthesiology, Affiliated Hospital of Qingdao University Medical College, Qingdao, China
| | - Yongxin Liang
- Department of Anesthesiology, Qingdao Women's and Children's Hospital Affiliated to Qingdao University, Qingdao, China.
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Foti L, Michard F, Villa G, Ricci Z, Romagnoli S. The impact of arterial pressure waveform underdamping and resonance filters on cardiac output measurements with pulse wave analysis. Br J Anaesth 2022; 129:e6-e8. [PMID: 35459533 DOI: 10.1016/j.bja.2022.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 03/13/2022] [Accepted: 03/22/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Lorenzo Foti
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Gianluca Villa
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Zaccaria Ricci
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Azienda Ospedaliero-Universitaria Meyer, Florence, Italy
| | - Stefano Romagnoli
- Department of Health Science, Section of Anaesthesia and Intensive Care, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Abstract
Background Arterial hypotension is common in patients during surgery and those admitted to the intensive care unit (ICU) postoperatively. Perioperative arterial hypotension reportedly significantly affects surgical patients’ outcomes. Blood pressure level is the most crucial factor that influences organ perfusion. Hypoperfusion and organ dysfunction are correlated based on their severity associated with hypotension. As several factors can cause intraoperative hypotension, anesthetists must promptly identify the etiology for appropriate treatment and revert the patient’s hemodynamic profile. Objectives This review discusses the concept of perioperative hypotension, identifies its effects in clinical situations, and provides remedies and techniques to predict and avoid its significant consequences. Conclusions The primary determinant of organ perfusion is blood pressure. On the other hand, profound hypotension is common in surgical patients and is connected to hypoperfusion and organ failure. Currently, hypotension is addressed once low blood pressure levels are recorded. Early detection of oncoming hypotension or its clinical prediction is of paramount importance in allowing the clinician to treat hypotension and reduce the incidence and length of hypotensive episodes promptly and aggressively.
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Affiliation(s)
- Fabio Guarracino
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56123 Pisa, Italy
| | - Pietro Bertini
- Department of Anaesthesia and Critical Care Medicine, Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56123 Pisa, Italy
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48
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Pen D, Shanks J, Barrett C, Abukar Y, Paton JFR, Ramchandra R. Aortic Body Chemoreceptors Regulate Coronary Blood Flow in Conscious Control and Hypertensive Sheep. Hypertension 2022; 79:1275-1285. [PMID: 35382553 DOI: 10.1161/hypertensionaha.121.18767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Peripheral arterial chemoreceptors monitor the chemical composition of arterial blood and include both the carotid and aortic bodies (ABs). While the role of the carotid bodies has been extensively studied, the physiological role of the ABs remains relatively under-studied, and its role in hypertension is unexplored. We hypothesized that activation of the ABs would increase coronary blood flow in the normotensive state and that this would be mediated by the parasympathetic nerves to the heart. In addition, we determined whether the coronary blood flow response to stimulation of the ABs was altered in an ovine model of renovascular hypertension. METHODS Experiments were conducted in conscious and anesthetized ewes instrumented to record arterial pressure, coronary blood flow, and cardiac output. Two groups of animals were studied, one made hypertensive using a 2 kidney one clip model (n=6) and a sham-clipped normotensive group (n=6). RESULTS Activation of the ABs in the normotensive animals resulted in a significant increase in coronary blood flow, mediated, in part by a cholinergic mechanism since it was attenuated by atropine infusion. Activation of the ABs in the hypertensive animals also increased coronary blood flow (P<0.05), which was not different from the normotensive group. Interestingly, the coronary vasodilation in the hypertensive animals was not altered by blockade of muscarinic receptors but was attenuated after propranolol infusion. CONCLUSIONS Taken together, these data suggest that the ABs play an important role in modulating coronary blood flow and that their effector mechanism is altered in hypertension.
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Affiliation(s)
- Dylan Pen
- Manaaki Manawa - The Centre for Heart Research and the Department of Physiology, University of Auckland, New Zealand
| | - Julia Shanks
- Manaaki Manawa - The Centre for Heart Research and the Department of Physiology, University of Auckland, New Zealand
| | - Carolyn Barrett
- Manaaki Manawa - The Centre for Heart Research and the Department of Physiology, University of Auckland, New Zealand
| | - Yonis Abukar
- Manaaki Manawa - The Centre for Heart Research and the Department of Physiology, University of Auckland, New Zealand
| | - Julian F R Paton
- Manaaki Manawa - The Centre for Heart Research and the Department of Physiology, University of Auckland, New Zealand
| | - Rohit Ramchandra
- Manaaki Manawa - The Centre for Heart Research and the Department of Physiology, University of Auckland, New Zealand
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Li W, Lin X, Chen Y, Liu K, Yang W, Zeng S, Zhang J. Predictive value of the second-trimester fibronectin concentration for severe preeclampsia: A prospective nested case-control study in China. J Obstet Gynaecol Res 2022; 48:1721-1731. [PMID: 35385197 DOI: 10.1111/jog.15259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/21/2022] [Accepted: 03/27/2022] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the value of the second-trimester fibronectin concentration, alone and in combination with other markers (e.g., mean arterial pressure, inhibin A), in the identification of women who subsequently develop severe preeclampsia. METHODS For this prospective nested case-control study, serum from pregnant women (gestational age 15-22 weeks) who underwent routine Down syndrome screening was analyzed. The women were tracked to delivery and assigned to the severe preeclampsia or control group, according to whether they developed severe preeclampsia. Each woman who later developed severe preeclampsia was paired with five healthy women with pregnancies of similar gestational age (± 1 week). Fibronectin, inhibin A, human chorionic gonadotropin, placental growth factor, cysteine, and homocysteine concentrations were measured in 44 cases in the severe preeclampsia group and 220 cases in the control group. The body mass index and mean arterial pressure were calculated. All results were compared between the two groups. Logistic regression analysis and receiver operating characteristic curve construction were conducted for markers differing significantly between two groups. RESULTS The second-trimester fibronectin value was positively correlated with severe preeclampsia and predicted 67.7% of severe preeclampsia cases. The combination of fibronectin, inhibin A, and mean arterial pressure predicted 76.7% of severe preeclampsia cases; predictive values for combinations of fibronectin with mean arterial pressure or inhibin A were 75.4% and 74.6%, respectively. Combination with these other markers increased the predictive value of fibronectin. In addition, fibronectin was more powerful for the late severe preeclampsia and severe preeclampsia without fetal growth restriction subgroups. CONCLUSIONS The second-trimester fibronectin concentration can be used to predict severe preeclampsia.
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Affiliation(s)
- Wei Li
- Department of Laboratory Medicine, Maternity and Child Healthcare Hospital of Nanshan District, Shenzhen, China
| | - Xiaowen Lin
- Department of Laboratory Medicine, Maternity and Child Healthcare Hospital of Nanshan District, Shenzhen, China
| | - Yuchen Chen
- Department of Laboratory Medicine, Maternity and Child Healthcare Hospital of Nanshan District, Shenzhen, China
| | - Kun Liu
- Department of Laboratory Medicine, Maternity and Child Healthcare Hospital of Nanshan District, Shenzhen, China
| | - Weibin Yang
- Department of Laboratory Medicine, Maternity and Child Healthcare Hospital of Nanshan District, Shenzhen, China
| | - Sifan Zeng
- Department of Laboratory Medicine, Maternity and Child Healthcare Hospital of Nanshan District, Shenzhen, China
| | - Jing Zhang
- Department of Laboratory Medicine, Maternity and Child Healthcare Hospital of Nanshan District, Shenzhen, China
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Affiliation(s)
- Hoong Sern Lim
- University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, United Kingdom
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