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Background In patients with cardiac resynchronization therapy defibrillators (CRT-Ds), intracardiac impedance measured by dedicated CRT-D software may be used to monitor hemodynamic changes. We investigated the relationship of hemodynamic parameters assessed by intracardiac impedance and by echocardiography in a controlled clinical setting. Methods The study enrolled 68 patients (mean age, 66 ± 9 years; 74% males) at 12 investigational sites. The patients had an indication for CRT-D implantation, New York Heart Association class II/III symptoms, left ventricular ejection fraction 15%–35%, and a QRS duration ≥150 ms. Two months after a CRT-D implantation, hemodynamic changes were provoked by overdrive pacing. Intracardiac impedance was recorded at rest and at four pacing rates ranging from 10 to 40 beats/min above the resting rate. In parallel, echocardiography measurements were performed. We hypothesized that a mean intra-individual correlation coefficient (rmean) between stroke impedance (difference between end-systolic and end-diastolic intracardiac impedance) measured by CRT-D and the aortic velocity time integral (i.e., stroke volume) determined by echocardiography would be significantly larger than 0.65. Results The hypothesis was evaluated in 40 patients with complete data sets. The rmean was 0.797, with a lower confidence interval bound of 0.709. The study hypothesis was met (p = 0.007). A stepwise reduction of stroke impedance and stroke volume was observed with increasing heart rate. Conclusions Intracardiac impedance measured by implanted CRT-Ds correlated well with the aortic velocity time integral (stroke volume) determined by echocardiography. The impedance measurements bear potential and are readily available technically, not requiring implantation of additional material beyond standard CRT-D system., Highlights • Intracardiac impedance measurement feature (ICI-MF) is integrated in some CRT-Ds. • We studied relationship between echo hemodynamic parameters and ICI-MF of CRT-Ds. • Stroke volume by echo correlated well with stroke impedance by ICI-MF of CRT-Ds. • Stepwise reduction in stroke impedance and stroke volume with increasing heart rate. • The ICI-MF bears potential and requires only a ‘standard’ CRT-D system implantation.

Background: COVID-19 can cause a clinical spectrum from asymptomatic disease to life-threatening respiratory failure and acute respiratory distress syndrome (ARDS). There is an ongoing discussion whether the clinical presentation and ventilatory parameters are the same as typical ARDS or not. There is no clear understanding of how the hemodynamic parameters have been affected in COVID-19 ARDS patients. We aimed to compare hemodynamic and respiratory parameters of moderate and severe COVID-19 and non-COVID-19 ARDS patients. These patients were monitored with an advanced hemodynamic measurement system by the transpulmonary thermodilution method in prone and supine positions. Patients and methods: data of 17 patients diagnosed with COVID-19 and 16 patients diagnosed with other types of diseases with moderate and severe ARDS, mechanically ventilated, placed in a prone position, had advanced hemodynamic measurements with PICCO, and stayed in the intensive care unit for more than a week were analyzed retrospectively. Patient characteristics and arterial blood gases analysis recorded at admission and respiratory and advanced hemodynamic parameters during the first week were compared in prone and supine positions. Results: no difference was observed in the respiratory parameters including respiratory system compliance between COVID-19 and non-COVD-19 patients in prone and supine positions. In comparison of advanced hemodynamic parameters in the first week of intensive care, the extravascular lung water and pulmonary vascular permeability indexes measured in supine position of COVID-19 ARDS patients were found to be significantly higher than non-COVID-19 patients. Duration of prone position was significantly longer in patients diagnosed with COVID-19 ARDS. Conclusions: the results of this study suggested that COVID-19 ARDS is a variant of typical ARDS with a different pathophysiology., NA

Sweating during exercise is regulated by objective parameters, body weight, and endothelial function, among other factors. However, the relationship between vascular arterial stiffness and sweat volume in young adults remains unclear. This study aimed to identify hemodynamic parameters before exercise that can predict sweat volume during exercise, and post-exercise parameters that can be predicted by the sweat volume. Eighty-nine young healthy subjects (aged 21.9 ± 1.7 years, 51 males) were recruited to each perform a 3-km run on a treadmill. Demographic and anthropometric data were collected and hemodynamic data were obtained, including heart rate, blood pressure and pulse wave analysis using non-invasive tonometry. Sweat volume was defined as pre-exercise body weight minus post-exercise body weight. Post-exercise hemodynamic parameters were also collected. Sweat volume was significantly associated with gender, body surface area (BSA) (b = 0.288, p = 0.010), peripheral systolic blood pressure (SBP), peripheral and central pulse pressure (PP), and was inversely associated with augmentation index at an HR of 75 beats/min (AIx@HR75) (b = -0.005, p = 0.019) and ejection duration. While BSA appeared to predict central PP (B = 19.271, p ≤ 0.001), central PP plus AIx@HR75 further predicted sweat volume (B = 0.008, p = 0.025; B = -0.009, p = 0.003 respectively). Sweat volume was associated with peripheral SBP change (B = -17.560, p = 0.031). Sweat volume during a 3-km run appears to be influenced by hemodynamic parameters, including vascular arterial stiffness and central pulse pressure. Results of the present study suggest that vascular arterial stiffness likely regulates sweat volume during exercise.

Aim of the study: to evaluate the effect of sublethal dose of clozapine on the rat cardiovascular system 24 hours after administration of the drug.Materials and methods. The experiments were carried out on 17 male Wistar rats weighing 220-270 g. Under general anesthesia with sevoflurane, the animals of Group I were enterally given 0.9% NaCl solution, Group II animals received clozapine in a dose of 150 mg/kg diluted in 2.0 ml of NaCl solution 0.9%, Group III animals were given clozapine in a dose of 150 mg/kg diluted in 2.0 ml of 40% ethanol. Blood pressure (BP), heart rate (HR), skin microcirculation using laser Doppler flowmetry (LDF), NADH and FAD+ fluorescence were estimated 24 hours after the drug administration. After euthanasia, autopsy with sampling of internal organs for morphological study was done. Then paraffin heart sections with subsequent H&E staining were made, which were studied using the Nikon Eclipse Ni-U light microscope.Results. Spectral analysis of local skin blood flow fluctuations showed that clozapine reduced Amax and amplitude in all frequency ranges of active microcirculation regulatory system in comparison with the controls. No differences in blood gases and acid-base status were seen between the groups of animals 24 hours after administration of the drugs. However, the animals from clozapine groups (II and III) had lower hemoglobin and hematocrit than in the control group.Histological examination of rat hearts in groups II and III revealed congested venules, haemorrhages by dia-pedeses, perivascular and interstitial edema. The signs of blood stasis and marginalization of granulocytes were noted in the vascular lumen. Irregular staining of myocardium due to cardiomyocytes with hypereosinophilic and occasionally homogeneous cytoplasm, fragmentation and deformations of cardiac cells were revealed. Car-diomyocytic nuclei were polymorphic and irregularly stained, and perinuclear edema was observed.Conclusions. The results of the study demonstrate the toxic effect of clozapine manifesting as progressive myocardial alteration and disordered central and peripheral circulation. However, control of bradycardia, restored skin perfusion and metabolic improvement (diagnosed by NADH fluorescence and blood acid-base status) after 24 hours may be due to the activation of compensatory mechanisms, particularly through changes in neurogenic and humoral regulation of homeostasis.

Background: Laparoscopic cholecystectomy (LC) is associated with pneumoperitoneum and hemodynamic disturbances. Pregabalin and Clonidine have been used for anesthetic effects, but a better drug for controlling hemodynamic parameters is being investigated. Aims: The study was done to assess and compare the efficacy of preoperative single oral dose of pregabalin and clonidine in maintaining the hemodynamic parameters in the LC. Settings and Design: The prospective, interventional, randomized, comparative, single-blinded study was conducted in the department of anesthesia and surgery from January 2015 to September 2016 after taking approval from the institutional ethical committee. Materials and Methods: The study included a total of 90 patients, aged between 18 and 56 years of both sexes scheduled for elective LC. Patients were randomized into three groups of 30 each who received oral pregabalin 150 mg, clonidine 200 ug, and placebo. The hemodynamic parameters were recorded at various time intervals along with any adverse events. Statistical Analysis: Quantitative variables were compared using unpaired t-test (when the data sets were not normally distributed) between the two groups. Qualitative variables were compared using Chi-square test/Fisher's exact test. P < 0.05 was considered statistically significant. Results: There was a significant increase in the heart rate (HR) and systolic, diastolic, and mean blood pressure during laryngoscopy and pneumoperitoneum in the control group as compared to both pregabalin and clonidine. HR was significantly lower in clonidine group after extubation and in postoperative period than both control group and pregabalin group. There was no major difference in the incidence of side effects. Conclusion: Both pregabalin (150 mg) and clonidine (200 ug) were effective in controlling the hemodynamic parameters during LC, with clonidine providing better hemodynamic stability than Pregabalin.

Objective: To evaluate hemodynamic parameters after implantation of Perceval prostheses of quick deployment, as well as various complications that arose in patients in the early and long-term postoperative period (6 months). Material and methods: We performed 20 implantations of Perceval prostheses of quick deployment in a narrow fibrous ring. The function of the prosthesis was evaluated in the postoperative period on the 7-10th day and after 6 months. The patients underwent echocardiographic examination before the intervention, in the early and long-term postoperative period. Results: The analysis of the results of echocardiography showed rather low values of pressure gradients on the aortic valve and rather large values of the effective and indexed area of the valve opening in patients after implantation of Perceval prostheses. Conclusions: According to the results of echocardiographic study, implantation of Perceval prostheses is associated with low average and peak pressure gradients on the aortic valve and the effective area and indexed effective area of the valve opening.

Objective: To evaluate hemodynamic parameters after bioprosthetics of the aortic valve cusps, as well as complications arising in patients in the early and long-term period (6 months). Material and methods: 9 patients underwent bioprosthetics of the valves of the aortic valve with a narrow fibrous ring. The function of the cusps and left ventricle remodeling were evaluated on the 7-10th day and after 6 months. Results: Patients underwent echocardiographic examination before the intervention, in the early and long-term postoperative period. The analysis showed rather low values of pressure gradients on the aortic valve and rather large values of the effective and index area of the valve opening in patients after bioprosthetics of the aortic valve cusps. Conclusions: In the early postoperative period, prosthetics of the aortic valve leaflets with xenopericardium, according to an echocardiographic study, are associated with low average and peak pressure gradients on the aortic valve and a larger effective area and index effective area of the valve opening. The risk of the “patient-prosthesis mismatch” phenomenon with narrow fibrous rings is significantly lower with xenopericardial bioprosthetics than with standard prosthetics.

Kigelia Africanahas a rich history of ethnobotanical usage in the treatment of a wide range of illnesses andcomplications like hypertension, cancer and microbial infections in south western Nigeria. The present work sought to investigate the effects of methanolic leaf extract ofKigelia Africanaon the blood pressure and biochemical indices of normotensive albino rats. Twenty five male albino Wistar rats, weighing between 180-200g, and divided into five groups (I-V) of five animals each were used for the experiment. GroupsII – V were administered 1mg/kg b.w ramipril, 25-, 50- and 100mg/kg b.wKigelia Africanarespectively by oral gavage for 14 consecutive days. Group I received vehicle (1 mg/kg distilled water) only throughout the duration of the experiment and served as control. Twenty-four hours after the last administration, the blood pressure was determined before sacrificing the animals following anesthesia. The activities of serum biomarkers (aspartate aminotransferase AST, total protein TP, alanine aminotransferase ALT, alkaline phosphatase ALP), serum lipid profile; (cholesterol TC, low/very low density lipoprotein LDL-c/VLDL-c, high density lipoprotein HDL and triglyceride TG) and cardiac antioxidant indices (catalase CAT, superoxide dismutase SOD and glutathione GSH) were determined. Administration of ramipril (1mg/kg b.w) and all dosages ofKigelia africana(25, 50 and 100mg/kg b.w) caused significant (P All dosages ofKigelia africanaextract resulted in significant (PKigelia africana(25, 50 and 100mg/kg b.w.) were comparable with those administered the reference drug, ramipril (1 mg/kg). Cardiac SOD activity was however decreased in rats administered extract (25, 50 or 100 mg/kg b.wt) and ramipril (1mg/kg bw). The results suggest the hypolipidemic, hypotensive and antioxidant properties and of methanolic extract ofKigelia africanaleaf and lend support to the ethnobotanical usage of the leaf in the treatment of hypertension.

Dietary nitrate has been associated with nitric oxide bioconversion and beneficial vascular effects. A randomized, controlled, crossover and placebo 3-week supplementation trial with a beetroot-cereal bar enriched in nitrate (9.5 ± 0.05 mmol) and polyphenols was performed on patients displaying three risk factors for the development of cardiovascular diseases. The beetroot-cereal bar formulation was elected because it showed the highest nitrate, phenolic compounds, antioxidant capacity than beetroot chips and juice. Plasmatic nitrate and nitrite were increased ≈15 and ≈7 fold, respectively, endothelial function was improved, arterial stiffness was reduced and arterial blood pressures, both systolic and diastolic, were reduced by ≈−14.0 mm Hg and ≈−6.5 mm Hg, respectively. The nitrate and phenolic compound bioacessibility from the beetroot-cereal bar were 85% and 68% after intestinal uptake of simulated gastrointestinal digestion, respectively. Beetroot-cereal bar may be an effective strategy to improve cardiovascular parameters in patients presenting risk factors for the development of cardiovascular diseases.

Hemodynamic indices of healthy people obtained by catheterization in such vascular areas as the chambers of the heart (both ventricles, both atria, coronary sinus), IVC, SVC, RHV, right renal vein, sigmoid sinus, and aorta were analyzed. Using the mean values of hemodynamic parameters, we constructed graphs of the curves of the central, arterial, and venous pressure, synchronized with each other, with an ECG, and with the peripheral pulse wave. In the present work, to generalize the results obtained, we constructed integral curves of the dynamics of the blood substrate (“bolus,” BB) vector from the entrance (the fusion of venous flows: SVC, IVC, RHV, and coronary sinus) to the exit from the heart-lung-heart system in the form of LVEF. It was revealed that the complete CC consists of two BBs, simultaneously passing the hemodynamic pathway: heart-lung-heart. One BB completes the transformation, leaving PC after contact with the external gaseous medium in the lung and the formation of the pulse wave spheroid in LV, going into SC in the form of LVEF; another BB, after the formation of the pulse wave spheroid in RV, goes into PC, followed by hemodynamic, metabolic and gas transformation. CMIP is a universal indicator of the quality and stability of the relationship of all hemodynamic structures (flows in vessels and heart chambers) included in integral hemodynamic flows (IC-1, IC-2) throughout the complete CC. Changes in the configuration or level of CMIP is an indicator of imbalance and restructuring of the integral indicators of blood flow (therefore, components of hemodynamic flows), indicating a deviation in the parameters of stability of homeostasis as a whole.

Piras, A, Cortesi, M, Campa, F, Perazzolo, M, and Gatta, G. Recovery time profiling after short-, middle- and long-distance swimming performance. J Strength Cond Res 33(5): 1408-1415, 2019-We investigated cardiac autonomic responses and hemodynamic parameters on recovery time after short-, middle- and long-swimming performance. Ten male regional-level swimmers were tested to estimate time and frequency domains of arterial baroreflex sensitivity (BRS) and heart rate variability after 100, 200, and 400 m of front crawl. We found a BRS reduction for 90 minutes after a maximal 100- and 200-m front crawl event, meanwhile the reflex was restored back to the baseline value approximately 70 minutes after 400 m. The vagally mediated high-frequency power of R-R intervals was significantly reduced for 30 minutes after 400 m, and more than 90 minutes after 100 and 200 m, with a concomitant increase of sympathetic modulation. After 400 m, athletes have reduced their stroke volume for 50 minutes, which remained at the baseline level after 100 and 200 m. Heart rate was restored back after 90 minutes in all conditions, whereas total peripheral vascular resistance was significantly reduced for 50 minutes after 200 and 400 m, with a persistent reduction after 100 m. Time course of autonomic recovery after 3 different swimming performances is influenced by exercise intensity and duration, showing a rapid recovery after 400 m, an intermediate recovery after 200 m, and a significantly delayed recovery after a more strictly anaerobic performance like 100 m of front crawl. These results could encourage coaches to consider that athlete might be affected by the specific recovery time of the previous exercise performed, suggesting that the management of the exercise intensity, and appropriate monitoring of cardiac autonomic parameters might be helpful to know the physical condition of each athlete.

Objective: To evaluate hemodynamic parameters on an implantable allograft, as well as to study left ventricular (LV) remodeling, various complications arising in patients after allograft implantation in aortic valve stenosis in the early and late periods. Material and Methods: From February 2009 to July 2017, aortic valve replacement using allografts was performed in 33 patients. The function of allograft and LV was evaluated in patients in the postoperative period on the 7–10th day and after 3, 6 months, 1, 2, 3 years in the late postoperative period. Results: Implanted allografts in the aortic position with aortic stenosis show satisfactory hemodynamic parameters in all implantable sizes in both the early and late postoperative periods. At the same time, the area of the effective hole did not change in any size of the allografts during the study period. At the same time, there was a significant decrease in the maximum speed of blood flow on the aortic allografts, which led to suboptimal indicators of systolic and average gradients in the early postoperative period, which decreased to normal values for the native aortic valve in the period from 3 months to 2 years. The LV remodeling that occurred led to a significant improvement in the quality of life of patients, assessed using the MLHFQ questionnaire, as well as up to 3 months after the implantation of allografts into the aortic position. Conclusions: The use of allografts of 21-27 standard size in the aortic position in case of aortic stenosis makes it possible to substantially approach the parameters of the functioning of the native valve in both the early and long-term (3 years) periods. The phenomenon of “patient prosthesis-mismatch” was not observed even with the implantation of 21 size of allograft. It was also noted that even with the implantation of an allograft of 19 standard size (1 case), it was possible to obtain satisfactory results: the effective hole area was 1.3 cm2, which for this patient corresponded to the normal value of the patient-prosthesis conformity index (0.87 cm2 / m2).

Hemodynamic indices studied in healthy people were obtained by catheterization in various vascular areas: the chambers of the heart (ventricles, atria, coronary sinus), pulmonary trunk, sigmoid sinus, aorta, inferior vena cava, superior vena cava (SVC), and right hepatic vein (RHV). Using the mean values of the hemodynamic parameters, we constructed graphics of the curves of the central, arterial, and venous pressure, synchronized with each other, with an ECG, and with pulse wave. The complex of hemodynamic curves, supplemented by curves of RHV and SVC, revealed a coincidence in one zone of temporal equalization of pressure (ZTEP) for values of the left atrium, coronary sinus, right ventricle, sigmoid sinus, SVC, and RHV(wedged). We identified this ZTEP as a hemodynamic trigger (T-point), assuming that this point is the trigger point for the launch of the high-energy processes of the right heart, forming the following cardiac cycle: the beginning of the systole of right ventricle, the opening of pulmonary valve.

Background Lidocaine and magnesium sulfate have become increasingly utilized in general anesthesia. The present study evaluated the effects of these drugs, isolated or combined, on hemodynamic parameters as well as on the cisatracurium-induced neuromuscular blockade (NMB). Methods At a university hospital, 64 patients, ASA physical status I and II, undergoing elective surgery with similar pain stimuli were randomly assigned to four groups. Patients received a bolus of lidocaine and magnesium sulfate before the tracheal intubation and a continuous infusion during the operation as follows: 3 mg.kg− 1 and 3 mg.kg− 1.h− 1 (lidocaine - L group), 40 mg.kg− 1 and 20 mg.kg− 1.h− 1 (magnesium - M group), equal doses of both drugs (magnesium plus lidocaine - ML group), and an equivalent volume of isotonic solution (control - C group). Hemodynamic parameters and neuromuscular blockade features were continuously monitored until spontaneous recovery of the train of four (TOF) ratio (TOFR > 0.9). Results The magnesium sulfate significantly prolonged all NMB recovery features, without changing the speed of onset of cisatracurium. The addition of lidocaine to Magnesium Sulfate did not influence the cisatracurium neuromuscular blockade. A similar finding was observed when this drug was used alone, with a significantly smaller fluctuation of mean arterial pressure (MAP) and heart rate (HR) measures during anesthesia induction and maintenance. Interestingly, the percentage of patients who achieved a TOFR of 90% without reaching T1–95% was higher in the M and ML groups. Than in the C and L groups. There were no adverse events reported in this study. Conclusion Intravenous lidocaine plays a significant role in the hemodynamic stability of patients under general anesthesia without exerting any additional impact on the NMB, even combined with magnesium sulfate. Aside from prolonging all NMB recovery characteristics without altering the onset speed, magnesium sulfate enhances the TOF recovery rate without T1 recovery. Our findings may aid clinical decisions involving the use of these drugs by encouraging their association in multimodal anesthesia or other therapeutic purposes. Trial registration NCT02483611 (registration date: 06-29-2015).

OBJECTIVES: To investigate predictors and propose reference equations for the augmentation index normalized to 75 bpm heart rate (AIx@75) in healthy children and adolescents. METHODS: This was a cross-sectional, observational study involving 134 healthy children and adolescents aged 9 to 19 years old. Participants were categorized into child (n=53) and adolescent (n=81) groups, as well as into male (n=69) and female (n=65) groups. We evaluated AIx@75, vascular and hemodynamic parameters, anthropometric data, physical activity profile, and quality of life (Peds-QL4.0; physical, emotional, social and school domains). RESULTS: The predictors of AIx@75 in the whole sample were age, peripheral diastolic blood pressure (pDBP), mean arterial pressure, pulse pressure amplification (PPA), systolic volume (SV), cardiac index (CI), and pulse wave velocity (PWV; R2=80.47%). In the male group, the predictors of AIx@75 were SV, CI, total vascular resistence (TVR), and PWV (R2=78.56%), while in the female group, they were pDBP, PPA, SV, and PWV (R2=82.45%). In the children, they were pDBP, PPA, SV, and PWV (R2=79.17%), while in the adolescents, they were body mass index, pDBP, PPA, SV, TVR, and PWV (R2=81.57%). CONCLUSION: In the present study, we used a representative sample from Belo Horizonte to establish normality values of AIx@75. We also identified, for the first time, independent predictors of AIx@75 in healthy children and adolescents categorized by sex and age. Determining AIx@75 reference equations may facilitate the early diagnosis of preclinical atherosclerosis and allow an objective measure of the vascular effects of therapeutic interventions aimed at modifying cardiovascular risk factors.

Introduction: Few data exist on the effects of increasing norepinephrine doses or increasing arterial CO2 (PaCO2) on hemodynamics and cerebral oxygenation in comatose out-of-hospital cardiac arrest (OHCA) patients. Methods: We prospectively studied 10 resuscitated OHCA-patients undergoing targeted temperature management (36C°). The trial consisted of 5 phases with 20 minutes steady state in-between: Phase 1–4 were increasing doses of norepinephrine to reach targets of mean arterial pressure (MAP). First 65, second 75, third 85, fourth 65 mmHg again. In the fifth phase, MAP was constant while PaCO2 was increased to 6.5–7.3 kPa to increase cardiac output. Primary outcome was cerebral near-infrared spectroscopy (NIRS). Secondary outcomes were hemodynamic variables from Swan-Ganz catheters and blood samples from the radial artery and jugular bulb. Results: To reach a MAP at 85 mmHg, norepinephrine was increased from 0.11 ± 0.02 to 0.18 ± 0.02 µg/kg/min (P < 0.001). Norepinephrine uptitration significantly increased systemic vascular resistance (SVR) and pulmonary vascular resistance, without affecting cardiac output, heart rate or cerebral oxygenation. Increasing PaCO2, resulted in a significant increase in cardiac output and cerebral NIRS, but arterial-venous cerebral oxygen-uptake decreased. Norepinephrine demand to keep MAP at 65 mmHg was unaffected by increasing PaCO2. Conclusions: A short-term increase in MAP with norepinephrine in resuscitated comatose cardiac arrest-patients is associated with increased SVR and pulmonary vascular resistance without affecting cardiac output or cerebral NIRS. Increased cardiac output caused by an increase in PaCO2 increased cerebral NIRS, but not cerebral oxygen uptake.

Cardiovascular diabetology 20(1), 6 (2021). doi:10.1186/s12933-020-01175-5, Published by BioMed Central, London

This study aimed to investigate whether a single bout of Self-myofascial Release (SMR) has a beneficial effect on peripheral and central Blood Pressure (BP) and different parameters of arterial stiffness. Twenty nine healthy male recreational athletes (26.1 ± 2.9 years, BMI 23.4 ± 1.5 k/m2) completed an instructed SMR using a foam roller. Peripheral and central BP and different parameters of arterial stiffness were measured noninvasively before SMR and at different time points (t1, t15, t30) during a subsequent 30-min recovery phase. There was a significant decrease in both systolic (t15, −2.36 ± 4.45 mmHg, p = 0.05; t30, −4.01 ± 4.47 mmHg, p = 0.003) and diastolic (t30, −2.45 ± 5.45 mmHg, p = 0.025) peripheral pressure during the recovery phase after SMR. Regarding central BP, only systolic pressure showed a significant decrease (t30, −3.64 ± 5.83 mmHg, p = 0.003). Mean arterial pressure (t15, −1.91 ± 3.36, p = 0.03; t30, −3.05 ± 2.88 mmHg, p < 0.001), augmentation pressure (t30, −1.60 ± 2.40 mmHg, p = 0.009), peripheral resistance (t30, −0.09 ± 0.10 s* mmHg/ml, p < 0.001), and stiffness index β0 (t30, −0.33 ± 0.55, p = 0.021) were significantly reduced after SMR. No significant changes were determined for reflection coefficient, augmentation index, cardiac output, and heart rate, respectively. SMR showed effects on peripheral and central BP and different parameters of arterial stiffness in healthy young adults. •A single bout of self-myofascial release confers favourable cardiovascular benefits. •Self-myofascial release induces mechanical stress to the vascular system. •Effects on vascular function is comparable to the effects after a bout of exercise.

Aim The present study investigated whether hypertension, blood pressure, and antihypertensive therapy were associated with frailty status in community-dwelling older adults. In addition, we tested whether such associations were consistent across different frailty instruments. Material and methods Two-hundred older adults were enrolled in the study. Participant frailty status was determined according to a modified physical frailty phenotype (mFP), the FRAIL scale, and the Study of Osteoporotic Fracture (SOF) index. Blood pressure was assessed three times, in three different days, and mean values were used in the final analysis. Information pertaining to disease conditions and antihypertensive therapy were collected by two researchers through self-report and careful review of medical charts. Results No significant differences in hemodynamic parameters, hypertension diagnosis, and antihypertensive therapy were observed across frailty statuses, regardless of the frailty assessment tool used. Conclusion Findings of the present study indicate that hypertension, blood pressure levels and antihypertensive medication were not cross-sectionally associated with frailty status in cognitively preserved community-dwelling older adults with low prevalence of comorbidities, regardless of the tool used for frailty identification.

Background: Under normal physiological conditions, renal tissue oxygen is tightly regulated. At high altitude, a physiological challenge is imposed by the decrease in atmospheric oxygen. At the level of the kidney, the physiological adaptation to high altitude is poorly understood, which might relate to different integrated responses to hypoxia over different time domains of exposure. Thus, this systematic review sought to examine the renal physiological adaptation to high altitude in the context of the magnitude and duration of exposure to high altitude in the healthy kidney model. Methods: To conduct the review, three electronic databases were examined: OVID, PubMed, and Scopus. Search terms included: Altitude, renal, and kidney. The broad, but comprehensive search, retrieved 1,057 articles published between 1997 and April 2020. Fourteen studies were included in the review. Results: The inconsistent effect of high altitude on renal hemodynamic parameters (glomerular filtration rate, renal blood flow, and renal plasma flow), electrolyte balance, and renal tissue oxygen is difficult to interpret; however, the data suggest that the nature and extent of renal physiological adaptation at high altitude appears to be related to the magnitude and duration of the exposure. Conclusion: It is clear that renal physiological adaptation to high altitude is a complex process that is not yet fully understood. Further research is needed to better understand the renal physiological adaptation to hypoxia and how renal oxygen homeostasis and metabolism is defended during exposure to high altitude and affected as a long-term consequence of renal adaptation at high altitude.

Известно, что при старении человека адаптационные возможности его организма снижаются. Это обусловлено как изменениями вегетативной регуляции, так и морфологической перестройкой (ремоделированием) сердечно-сосудистой системы. Для оценки возрастных изменений вегетативной нервной и сердечно-сосудистой систем был проведен метаанализ, в котором были рассмотрены изменения при старении параметров гемодинамики (АД и ЧСС), вариабельности сердечного ритма (ВСР), концентрации катехоламинов, электрической активности мышечных симпатических нервов (МСНА), а также величины барорецепторного рефлекса (БР). Были проанализированы результаты 32 работ из базы PubMed, в которых по исследуемым показателям сравнивали здоровых людей разных возрастных групп (27±5 и 64±5 лет). В результате было установлено, что у пожилых людей по сравнению с молодыми людьми уровень АД выше, ЧСС остается без изменений, но ВСР и БР существенно уменьшаются, симпатовагусный баланс смещается в сторону увеличения симпатических влияний на работу сердца, повышаются МСНА и уровень норадреналина в плазме крови. Ослабление вегетативного контроля у пожилых людей с повышением активности симпатической нервной системы обусловливает увеличение базовых значений АД и величину его прироста в условиях стресса. Данные изменения являются причиной снижения адаптационных способностей пожилых людей и субстратом для развития сердечнососудистых патологий., It is known that with the aging, the adaptive capabilities of his body decrease. This is due to both changes in autonomic regulation and morphological remodeling of the cardiovascular system. To assess age-related changes in the autonomic nervous and cardiovascular systems, a meta-analysis was carried out, which examined changes in the aging of hemodynamic parameters [blood pressure (BP) and heart rate (HR)], heart rate variability (HRV), catecholamine concentrations, electrical activity of muscle sympathetic nerves (MSHA) , as well as the magnitude of the BR. The results of 32 works from the PubMed database were analyzed, in which healthy people of different age groups (27±5 and 64±5 years) were compared by the studied indicators. As a result of a meta-analysis, it was found that in older people compared with young people, the BP is higher, HR remains unchanged, but HRV and BR significantly decrease, the sympathetic-vagal balance shifts toward an increase in sympathetic effects on heart function, MSNA and plasma noradrenaline level increase. In the elderly people a loosening in autonomic control with an increase in sympathetic nervous activity causes an increase in the baseline of BP and its increase in conditions of stress. These changes are the cause of a decrease in the adaptive abilities of the old person and a substrate for the development of cardiovascular pathologies., Успехи геронтологии, Выпуск 4 2020

Aim: To evaluate the subacute effects of the number of Pilates exercise series (one and three) on the cardiovascular responses of medicated hypertensive women. Methods: Eight hypertensive and nine normotensive women underwent a Pilates session with low and high volume, and cardiovascular responses were measured. Aged sample of 50-65 years old underwent to anthropometrical measurements previously to the experimental procedures. The cardiovascular assessment was performed before and after every experimental session. The experimental procedures consisted of two familiarization sessions, load determination, and two experimental sessions (one or three series) for each group. Results: In the intragroup analysis, HR was found to be reduced in the normotensive group. In the hypertensive group, a reduction in the double product was observed after both Pilates sessions, and in the normotensive group only after the session with one series. The volume of exercises of the Pilates method did not interfere in the responses of systolic and diastolic BP after exercise. However, a more prominent area under the curve was seen in the systolic BP of hypertensive subjects who performed three series. Conclusion: The present study shows that performing one or three series of the Pilates exercise does not induce hypotension post-exercise and did not interfere in the cardiovascular responses of medicated hypertensive women.

Introduction/Objective. Spinal anesthesia (SA) for cesarean section may lead to significant changes in hemodynamic parameters, especially hypotension. The aim of this study was to determine and compare the efficacy and safety of preemptive infusion protocols of the two most commonly used vasopressors, ephedrine (Group E, n = 29) and phenylephrine (Group P, n = 31) not only on prevention of hypotension but also to determine their effect on hemodynamic parameters, such as stroke volume (SV) and cardiac output (CO) using a continuous non-invasive hemodynamic monitor. Methods. The infusion of ephedrine was administered at the rate of 5 mg/min. immediately after SA. Phenylephrine was administered at an infusion rate of 25 ?g/min for two minutes prior to SA. Results. In Group E, mean systolic blood pressure (SBP) and heart rate (HR) were similar to baseline. CO was higher (p < 0.001), while systemic vascular resistance (SVR) was lower than baseline (p < 0.001). In Group P, mean SBP and diastolic blood pressure (DBP) were lower than baseline, respectively (p = 0.006, p < 0.001). SBP, DBP, CO, SV, SVR, and HR were significantly different between the E and P groups (p < 0.001). Conclusion. E and P vasopressors are both effective in the prevention of hypotension during SA.

Four-dimensional (4D) flow magnetic resonance imaging (4D Flow MRI) enables acquisition of time-resolved three-directional velocity data in the entire heart and all major thoracic vessels. The segmentation of these tissues is typically performed using semi-automatic methods. Some of which primarily rely on the velocity data and result in a segmentation of the vessels only during the systolic phases. Other methods, mostly applied on the heart, rely on separately acquired balanced Steady State Free Precession (b-SSFP) MR images, after which the segmentations are superimposed on the 4D Flow MRI. While b-SSFP images typically cover the whole cardiac cycle and have good contrast, they suffer from a number of problems, such as large slice thickness, limited coverage of the cardiac anatomy, and being prone to displacement errors caused by respiratory motion. To address these limitations we propose a multi-atlas segmentation method, which relies only on 4D Flow MRI data, to automatically generate four-dimensional segmentations that include the entire thoracic cardiovascular system present in these datasets. The approach was evaluated on 4D Flow MR datasets from a cohort of 27 healthy volunteers and 83 patients with mildly impaired systolic left-ventricular function. Comparison of manual and automatic segmentations of the cardiac chambers at end-systolic and end-diastolic timeframes showed agreements comparable to those previously reported for automatic segmentation methods of b-SSFP MR images. Furthermore, automatic segmentation of the entire thoracic cardiovascular system improves visualization of 4D Flow MRI and facilitates computation of hemodynamic parameters. Funding details: 310612; Funding details: FP7, Seventh Framework Programme; Funding details: 621-2014-6191, VR, Vetenskapsrådet; Funding details: 223615; Funding details: 20140398; Funding text: This work was partially funded by the FP7-funded project DOPPLER-CIP [grant number 223615]; the European Union’s Seventh Framework Programme ( FP7/2007-2013 ) [grant number 310612 ]; the Swedish Research Council [grant number 621-2014-6191 ]; and the Swedish Heart and Lung Foundation [grant number 20140398 ].

Background: Along with advances in end-stage heart failure (HF) treatments, such as heart transplantation (HTx) and ventricular assist devices as destination therapy, there is an increasing need to define scoring systems for selecting the most suitable candidates for these interventions. Furthermore, constraints in donor number necessitate the precise evaluation of patients before candidacy for HTx. Methods: We enrolled eighty patients with severe symptomatic HF, left ventricular ejection fraction < 30%, and New York Heart Association Functional Class III–IV. All patients underwent right heart catheterization for hemodynamic assessment and were followed for 18 months. We defined cSVO2 as the ratio of right atrial pressure (RAP) to mixed venous saturation. Results: During follow-up, 13 patients died, 7 patients underwent HTx, and 36 patients were hospitalized with signs and symptoms of HF. Among hemodynamic parameters, RAP and cSVO2had strongest association with prognosis and clinical worsening. Conclusion: Defining predictors of clinical worsening has great importance in HF. The current study showed cSVO2as a strong predictor of clinical worsening in end-stage HF.

Background: Following head injury, cardiopulmonary functions are impaired and this disturbs the oxygenation transport pathway. Expanding cardiopulmonary physical therapy to encompass the oxygen transport system as a whole has implication for treatment as well as assessment and treatment outcome. Therefore, the aim of the study is to assess the oxygenation level in head injury patients with relation to body positioning in the intensive care unit (ICU). Methodology: Thirty consecutive patients with head injury with hemodynamically stable were included from the surgical ICU, ages ranging from 15 to 50 years. Noninvasive vital parameters (oxygen saturation [SpO2], pulse rate [PR], respiratory rate [RR], and blood pressure [BP]) were observed and recorded in different body positions at regular intervals of 5 min for 15 min in each position. Results: There was increment in SpO2 value in all positions from 0 min to end of 15 min in supine (98.63 ± 0.36–98.73 ± 0.30), right-side lying (98.77 ± 0.30–98.93 ± 0.20), left-side lying (98.73 ± 0.29–99.03 ± 0.24), and recline sitting (30°–70°) (99.03 ± 0.24–99.50 ± 0.22). However, there was statistically significant increment in recline sitting (30°–70°) compared to other positions (P = 0.036) while other parameters (PR, RR, and BP) were getting stabilized at lower values at end of 15 min in every positions tested. Conclusion: We conclude that upright position bring about significant increase in arterial SpO2 compared to any other positions. Other vital parameters were seen to stabilize at lower values at the end of 15 min in every position tested.

Hemodynamic stability is very much important during induction of general anesthesia. So, this study was planned to compare hemodynamic parameters during induction by thiopentone and propofol. This prospective study was conducted after approval from institutional ethics committee in non-hypertensive patients of ASA grade I and II aged between 18-60 yrs of either sex, admitted for different surgical procedure. The patients were randomized into group P (propofol) and group T (thiopentone). Heart rate, both systolic (SBP) and diastolic blood pressure (DBP) were recorded during induction and at 1 minutes, 2 minutes, 3 minutes and 4 minutes interval after intubation. Thirty patients in each group were included during study period. After induction, there was fall in both mean SBP and DBP after an increase during intubation which was more in group T (p˂0.05). The statistically significant difference was observed only at 1min between two groups for SBP (P value 0.05). There was rise in heart rate during intubation in both the groups, thereafter heart rate started decreasing. The fall was similar in both the group at any given point of observation (P value >0.05). Both propofol and thiopentone alter the blood pressure and heart rate during induction in surgical patients which are more pronounced in thiopentone but these changes return close to baseline value earlier in case of propofol. So, propofol could be the preferred inducing agent in hemodynamically unstable patients. [J Med Allied Sci 2017; 7(1.000): 9-13]

BACKGROUND This study is undertaken to compare the hemodynamic effects and reduction in the doses of volatile anaesthetics and muscle relaxants using two different doses of dexmedetomidine infusion during maintenance of anaesthesia in spine, functional endoscopic sinus surgery and middle ear surgeries. METHODS Sixty patients are randomly divided into 2 groups of 30 each. After shifting to the operation theatre baseline vitals were recorded. Anesthesia induced with thiopentone sodium and intubation done with the help of succinylcholine and maintained with oxygen, nitrous oxide and isoflurane. After 1 min of intubation, maintenance infusion of dexmedetomidine (0.4 mcg/kg/hr and 0.7 mcg/kg/hr for patients allotted in 2 separate groups) was started and stopped 15 min before end of surgery. Hemodynamic parameters and any reduction in the doses of volatile anaesthetics and muscle relaxants was noted. RESULTS Dexmedetomidine infusion (0.4 mcg/kg/hr and 0.7 mcg/kg/hr) in both groups reduced the requirements of muscle relaxants and volatile anaesthetics. Hemodynamic stability was better in the group receiving 0.4 mcg/kg/hr. Patients receiving 0.7 mcg/kg/hr had higher incidence of hypotension, bradycardia and delayed emergence from anaesthesia. CONCLUSION Dexmedetomidine infusion at 0.4 mcg/kg/hr during maintenance of anaesthesia in spine surgery, FESS and middle ear surgery would be good option to reduce the requirements of volatile anaesthetics, muscle relaxants and for better hemodynamic stability. OBJECTIVE OF STUDY: Primary Objective To compare and evaluate the hemodynamic effects and reduction in requirements of volatile anaesthetics and muscle relaxants with two different doses of dexmedetomidine infusion during maintenance of general anaesthesia in patients undergoing spine, FESS and middle ear surgeries.

We aim to investigate the correlations between hemodynamic parameters, penile rigidity grading, and the therapeutic effects of phosphodiesterase type 5 inhibitors using color Doppler flow imaging after intracavernosal injection in patients with erectile dysfunction. This study involved 164 patients. After intracavernosal injection with a mixture of papaverine (60 mg), prostaglandin E1 (10 μg), and lidocaine (2%, 0.5–1 ml), the penile vessels were assessed using color Doppler flow imaging. Penile rigidity was classified based on the Erection Hardness Score system as Grades 4, 3, 2 or 1 (corresponding to Schramek Grades V to II). Then, the patients were given oral sildenafil (50–100 mg) and scored according to the International Index of Erectile Function (IIEF-5) questionnaire. The number of patients with penile rigidities of Schramek Grades II to V was 14, 18, 21, and 111, respectively. The IIEF-5 score was positively correlated with the refilling index of the penile cavernosal artery (r = 0.79, P < 0.05), the peak systolic velocity (r = 0.45, P < 0.05), and penile rigidity (r = 0.75, P < 0.05), and was negatively correlated with the end diastolic velocity (r = −0.74, P < 0.05). For patients with erectile dysfunction, both the IIEF-5 score after sildenafil administration, which is correlated with penile rigidity, and the hemodynamic parameters detected using color Doppler flow imaging may predict the effects of phosphodiesterase type 5 inhibitor treatment and could provide a reasonable model for the targeted-treatment of erectile dysfunction.

Aims: This study aimed to assess the dose-related efficacy of intrathecal dexmedetomidine (DEX) on hemodynamic parameters and block characteristics following ropivacaine (ROP) spinal anesthesia (SA) for cesarean section (CS). Methods: This was a double-blind trial conducted on four groups namely D2.5, D5, D7.5, and placebo. One hundred and twenty patients scheduled for nonemergency CS under SA were recruited and randomized into four groups. The first to fourth groups received 2.5 μg, 5 μg, and 7.5 μg of intrathecal DEX and 1.5 mL normal saline, respectively, in addition to ROP for SA. Blood pressure (BP), heart rate (HR), arterial blood saturation, sensory motor block, and pain score were recorded. Results: The lowest BP/HR was observed in D7.5 group (P < 0.05). Moreover, the onset and duration of sensory motor block were shorter (P = 0.0001) and showed the lowest level of pain (P = 0.0001) in D7.5 group. Decrease in BP, HR, and pain score was observed with increasing dose of DEX, whereas the onset of sensory motor block and the time to achieve sensory motor block to ≥T6 declined with increasing the dose of DEX. Conclusion: The 7.5-μg intrathecal DEX is recommended to use for stabling the hemodynamic parameters and block characteristics following ROP SA for CS. However, likely complications such as fall in both HR and BP should be taken into account simultaneously.

Background Chronic obstructive pulmonary disease (COPD) has been emerging as a great health problem in world. Cigarette smoke is known to cause oxidative stress and deplete glutathione (GSH) levels. Nuclear erythroid-related factor 2 (Nrf2) is involved in transcriptional regulation of glutamate-cysteine ligase catalytic subunit (GCLc). Antioxidant compounds may be of therapeutic value in monitoring disease progression. Crocin demonstrates antioxidant and anti-inflammatory functions. The aim of this study was to investigate the protective role of crocin against CSE-mediated oxidative stress, inflammatory process, Nrf2 modifications and impairment of cardiac function in rats with COPD. Methods Eighty rats were divided into four groups: Control, Cigarette smoke exposure (CSE), Crocin, Crocin+CS. Each group was divided into the two parts: 1) to evaluate lung inflammatory and oxidative process, 2) to evaluate the effect of Cigarette smoke induced-lung injuries on cardiac electrocardiogram (such as heart rate and QRS complex) and hemodynamic parameters (such as perfusion pressure and left ventricular developed pressure). Results CSE rats showed a significant increase in cotinine concentration (17.24 ng/ml), and inflammatory parameters and a decrease in PO2 (75.87 mmHg) and expression of PKC (0.86 fold), PI3K (0.79 fold), MAPK (0.87 fold), Nrf2 (0.8 fold) and GCLc (0.75 fold) genes, antioxidant activity, and finally cardiac abnormalities in electrocardiogram and hemodynamic parameters. Co-treatment whit crocin could restore all these values to normal levels. Conclusions CS induced-COPD in rat model provides evidence that chronic CS exposure leads to lung injury and mediated cardiac dysfunction. Crocin co-treatment by modulating of Nrf2 pathway protected lung injury caused by COPD and its related cardiac dysfunction. In this study, we showed the importance of Nrf2 activators as a therapeutic target for the development of novel therapy for lung oxidative injuries.

Supplemental Digital Content is available in the text, Background: Oral bosentan has been widely applied in pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD). A systemic review and meta-analysis was conducted for a therapeutic evaluation of oral bosentan in both adult and pediatric patients with PAH-CHD. The acute responses and a long-term effect were respectively assessed in a comparison with baseline characteristics, and the improvement of exercise tolerance was analyzed. Methods: PubMed, Medline, Embase, and Cochrane Central Register of clinical controlled trails or observational studies have been searched for a recording of bosentan effects on the PAH-CHD participants. For mortality and rate of adverse events (AEs), it was described in detail. Randomized-effects model or fixed-effects model was used to calculate different effective values with a sensitivity analysis. Results: Seventeen studies were pooled in this review, and 3 studies enrolled the pediatric patients. Among all studies, 456 patients were diagnosed with PAH-CHD, and 91.7% were treated with oral bosentan. With a term less than 6 months of bosentan therapy, there existed a significant improvement in 6-minute walk distance (6MWD) and the World Health Organization functional class (WHO-FC), but no such differences in Borg dyspnea index scores (BDIs) and the resting oxygen saturation (SpO2). Although with a prolonged treatment, not only 6MWD and FC, but also the resting SpO2 and heart rate were changed for a better exercise capability. Additionally, compared with the basic cardiopulmonary hemodynamics, it showed a statistically significant difference in mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance index (PVRi). Although a limitation of pooled studies with comparative outcomes of different terms, outcomes presented a lower WHO-FC which contributes to a success in a prolonged treatment. Conclusions: Bosentan in PAH-CHD is well established and still requires clinical trials for an identification of its efficiency on CHD patients for an optimized period lessening a serious complication and the common AEs.

This study aimed to investigate the effect of glutamate-evoked masseter muscle pain on intramuscular oxygenation during rest and sustained elevated muscle activity (SEMA). Seventeen healthy individuals participated in two sessions in which they were injected with glutamate and saline in random order. Each session was divided into three, 10-min periods. During the first (period 1) and the last (period 3) 10-min periods, participants performed five intercalated 1-min bouts of masseter SEMA with 1-min periods of 'rest'. At onset of the second 10-min period, glutamate (0.5 ml, 1 M; Ajinomoto, Tokyo, Japan) or isotonic saline (0.5 ml; 0.9%) was injected into the masseter muscle and the participants kept the muscle relaxed in a resting position for 10 min (period 2). The hemodynamic characteristics of the masseter muscle were recorded simultaneously during the experiment by a laser blood-oxygenation monitor. The results demonstrated that glutamate injections caused significant levels of self-reported pain in the masseter muscle; however, this nociceptive input did not have robust effects on intramuscular oxygenation during rest or SEMA tasks. Interestingly, these findings suggest an uncoupling between acute nociceptive activity and hemodynamic parameters in both resting and low-level active jaw muscles. Further studies are needed to explore the pathophysiological significance of blood-flow changes for persistent jaw-muscle pain conditions.

Background: Lumbar spine surgery is associated with hemodynamic variations at intubation, change of position, and skin incision. A balanced anesthesia with multimodal analgesia (MMA) is necessary to attenuate these changes. Aim: To assess the relative effectiveness of preemptive MMA compared with the conventional analgesic regime in suppressing the hemodynamic response to endotracheal intubation, prone positioning, and skin incision. Settings and Design: A randomized, prospective study involving 42 patients belonging to the American Society of Anesthesiologists Physical Status 1 and II scheduled to undergo elective lumbar spine surgery were allocated into two groups of 21 each. Materials and Methods: Forty-two patients were randomly allocated into Groups A and B. Group A (study group) received diclofenac, paracetamol, clonidine, and bupivacaine with adrenaline skin infiltration and Group B (control group) injection paracetamol and saline with adrenaline skin infiltration. Statistical Analysis Used: Hemodynamic parameters (heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], and mean arterial pressure [MAP]) between the groups following intubation, prone position, and skin incision were noted and compared using repeated measure analysis of variance. One sample t-test was used to compare the standard mean concentration with the means of the study and control groups. P < 5% being considered statistically significant. Results: In the study group, HR, SBP, DBP, and MAP were lower at intubation and change of position as compared to the control group and were statistically significant. Conclusion: Preemptive MMA with balanced anesthesia is effective in attenuating the hemodynamic responses to multiple noxious stimuli during lumbar spine surgery.

Background: Lumbar spine surgery demands intense analgesia. Preemptive multimodal analgesia (MMA) is a novel approach to attenuate the stress response to surgical stimulus. Aims: The aim of the study was to assess the intraoperative morphine consumption in patients undergoing lumbar spine surgery. Patients and Methods: A randomized, prospective, double-blind study involving 42 patients belonging to the American Society of Anesthesiologists Class I and II scheduled to undergo elective lumbar spine surgery were allocated into two groups of 21 each. Group A (study group) received injection diclofenac sodium, paracetamol, clonidine, and skin infiltration with bupivacaine adrenaline and Group B (control group) received paracetamol and skin infiltration with saline adrenaline. Preemptive analgesia was practiced in both the groups. Intraoperative morphine consumption was documented. Statistical Methods: Intraoperative morphine consumption between the two groups was compared using Mann–Whitney U-test. Postextubation sedation score between the two groups was compared using Chi-square test and presented as number and percentage. P < 5% was considered statistically significant. Results: Intraoperative morphine consumption was significantly low in the study group (P < 0.001). Postextubation sedation score was comparable between the two groups. Conclusion: Preemptive MMA has demonstrated significant morphine sparing effect intraoperatively in patients undergoing lumbar spine surgeries.

Date of Conference: 16-19 February 2017 Conference Name: IEEE EMBS International Conference on Biomedical & Health Informatics, BHI 2017 We present a mixed-signal system for extracting hemodynamic parameters in real-time from noisy electrical bioimpedance (EBI) measurements in an energy-efficient manner. The proof-of-concept system consists of floating-gate-based analog signal processing (ASP) electronics implemented on a field programmable analog array (FPAA) chip interfaced with an on-chip low-power microcontroller. Physiological features important for calculating hemodynamic parameters (e.g., heart rate, blood volume, and blood flow) are extracted using the custom signal processing circuitry, which consumes a total power of 209 nW. Testing of the signal processing circuitry has been performed using ∼580 sec of an impedance plethysmography dataset collected from the knee of a subject using a custom analog EBI front-end. Results show the similarities of variations in heart rate, blood volume, and blood flow calculated using features extracted by the ASP circuitry implemented on an FPAA and a MATLAB digital signal processing algorithm.

The aim of this investigation was to evaluate the recovery pattern of a whole-body compression garment on hemodynamic parameters and on autonomic nervous system (ANS) activity after a swimming performance. Ten young male athletes were recruited and tested in 2 different days, with and without wearing the garment during the recovery phase. After a warm-up of 15 minutes, athletes were instructed to perform a maximal 400-m freestyle swimming event, and then time series of beat-to-beat intervals for heart rate variability (HRV), baroreflex sensitivity (BRS), and hemodynamic parameters were recorded for 90 minutes of recovery. The vagally mediated high frequency (HF) power of R-R intervals, NN50, and pNN50 showed a faster recovery due to the costume; meanwhile, the low frequency (LF) spectral component of HRV (LFRR) index of sympathetic modulation of the heart and the LF:HF ratio and BRS alpha index (αLF) were augmented in control than in garment condition. When athletes wore the swimsuit, cardiac output was increased and the returning of the blood to the heart, investigated as stroke volume, was kept constant because of the reduction of the total peripheral resistances. During control condition, heart rate (HR) was restored back to baseline value 20 minutes later with respect to garment condition, confirming that the swimsuit recover faster. The effectiveness of the swimsuit on ANS activity after a maximal aerobic performance has been shown with a greater recovery in terms of HRV and hemodynamic parameters. Baroreflex sensitivity was reduced in both conditions, maybe due to prolonged vasodilatation that may have also influenced the postexercise hypotension.

There is considerable interest in the pleiotropic effects of statins and their potential role in the treatment of pulmonary hypertension. Previous experimental findings indicate that a combination of lipophilic statins with phosphodiesterase type-5 inhibitor, sildenafil, can offer preventive effects on rat monocrotaline-induced pulmonary hypertension. The present study is aimed to assess whether therapeutic regimen provides any benefits. Seven days after pulmonary hypertension induction, hydrophilic rosuvastatin and sildenafil were given for 14 days to male Wistar outbred rats. Right ventricular pressure, right ventricle mass and three biomarkers were evaluated after 21 days: brain natriuretic peptide, high-density lipoprotein cholesterol and vascular endothelial growth factor. The present study demonstrates that administration of hydrophilic statin with sildenafil results in reduction of pulmonary vascular remodeling and right ventricular pressure. The results of biochemical measurements may suggest that statins play a positive role in right ventricle function or the process of angiogenesis in pulmonary hypertension development.

Objectives: Anxiety regarding dental procedures is a universal challenge for every patient and the treating dental surgeon. Measurement of heart rate, blood pressure, and oxygen saturation is now commonly accepted by the scientific community as an accurate and objective measurement of the patient's anxiety compared to other subjective assessments. The aim of this study was to assess the influence of educational videos demonstrating transalveolar extraction of mandibular third molars on hemodynamic parameters. Materials and Methods: The study was designed as a prospective clinical trial. The modified dental anxiety scale was used to assess the preoperative anxiety of the patient. Participating patients were divided randomly into two groups (verbal and video group). Each patient's hemodynamic parameters such as heart rate, blood pressure, and oxygen saturation were measured in the waiting area, sitting on the dental chair, incision, bone drilling, tooth elevation, suturing, and in the postoperative area. All the analysis was done using the SPSS version 18 software. Results: Overall, there were no significant differences between the two groups with respect to hemodynamic parameters. The mean heart rate and blood pressure of patients between both groups were comparatively consistent and did not very much from the onset of procedure to the end. On the other hand, oxygen saturation levels were statistically significantly higher in the video group at the onset of incision and drilling. Conclusions: Videos can be interpreted in different ways by patients. Overall, hemodynamic parameters are overall not influenced with videos.

El desarrollo tecnológico alcanzado permite realizar cirugía de acceso mínimo que con anterioridad requerían grandes incisiones, con elevada morbilidad y traumatismo para el paciente. Junto con la evolución de los medios técnicos e instrumental para este tipo de cirugía, también la anestesiología ha tenido que enfrentar nuevos retos. La monitorización, drogas y el manejo anestésico del paciente han sufrido modificaciones, pues las nuevas variaciones fisiológicas y de complicaciones quirúrgicas han traído consigo cambios importantes en los parámetros hemodinámicos y respiratorios, debidos a la insuflación de la cavidad peritoneal con CO2, el aumento de la presión intraabdominal y los cambios de posición durante el procedimiento. Current technological development allows minimum access surgeries previously requiring big incisions resulting in high patient’s morbidity and trauma. Along with the development of technology and instruments for this type of surgery, anesthesiology also faced new challenges. Patient’s monitoring, drug and anesthetic management changed because new physiological variations and surgery complications have produced changes in hemodynamic and respiratory parameters, due to CO2 peritoneal cavity insuflation, increased intra-abdominal pressure and changes of position during the procedure.

Background/Aims: Cirrhosis causes a decrease in cerebral blood flow because of a hyperdynamic circulatory state. We aimed to study the cerebral hemodynamic parameters in patients with decompensated cirrhosis and their relationship to the Child-Pugh and Model for End-Stage Liver Disease (MELD) scores. Materials and Methods: We used transcranial Doppler to investigate the cerebral hemodynamic parameters, namely the mean flow velocity of the middle cerebral artery, pulsatility index (PI), and resistive index (RI), in 50 patients who had decompensated cirrhosis and in a control group of 50 healthy people. We also investigated their relationship to the Child-Pugh and MELD scores. Results: Patients with cirrhosis had a lower mean flow velocity than those in the control group. Further, patients with cirrhosis had higher PI and RI values. There was a positive correlation between PI and the Child-Pugh score. In addition, there was a positive correlation among PI, RI, and the MELD score. The RI values of patients with ascites were higher than those of patients without ascites. Conclusion: Cerebral autoregulation might be impaired in patients with cirrhosis. Cerebral resistance proportionally increases to disease severity. There was a positive correlation among PI, RI, and MELD scores, which means that transcranial Doppler might be useful not only in the follow-up of the severity of the disease but also in determining the survival of these patients. © Copyright 2016 by The Turkish Society of Gastroenterology.

An important paper describing the Standards of the Polish Ultrasound Society regarding the assessment of portal and hepatic vasculature was published in the Journal of Ultrasonography. Due to the multiplicity of morphological and hemodynamic data required, the time needed to obtain these data and the legal responsibility of doctors for the results, there seems to be a need to determine a clear range of the assessed parameters depending on the reference level of a given healthcare facility. Therefore, the aim of this paper was to transfer the recommendations of the European Federation of Societies for Ultrasound in Medicine and Biology, which determine the range of the evaluated ultrasonographic parameters in portal hypertension depending on the diagnostic reference level, into Polish reality. European healthcare institutions are characterized by a clear three-level reference network. Due to the lack of a similar division in Poland, we propose our own classification of the competence of medical entities. The first reference level: ultrasound assessments in a primary health care setting (performed by GPs, emergency physicians, non-specialist private practice physicians, non-specialist practice physicians); at least one mid-class ultrasound scanner with pulsed and color Doppler options, equipped with convex 3–5 MHz and linear 7–12 MHz transducers should be available at physician's disposal. The second reference level: ultrasound assessments in the hospital setting and specialist outpatient clinics, performed by specialist private practice physicians, radiologists, gastroenterologists and hepatologists; top class (premium) digital ultrasound scanner should be available at physician's disposal. Third reference level: ultrasound assessments performed in gastroenterology, hepatology and liver surgery departments as well as their specialist outpatient clinics; physicians should use top class digital ultrasound equipment. At every reference level, physicians performing abdominal ultrasound should have the appropriate certification to perform such an assessment or specialize in gastrointestinal diagnosis.

WOS: 000389785600048 PubMed: 27871540 Study Objective: To compare the effects of Truview PCD (TM) video laryngoscopy (TVL) and Macintosh blade direct laryngoscopy (MDL) on hemodynamic responses observed during laryngoscopy and orotracheal intubation conditions in geriatric patients. Design: Randomized prospective study. Setting: Operating room. Patients: One hundred patients in the risk group American Society of Anesthesiologists I to III aged 65 years and older underwent elective surgery under general anesthesia. Interventions: This prospective study was performed between January 2014 and February 2015 after institutional ethics committee approval. Patients were randomly allocated to 2 groups, namely, TVL and MDL. Measurements: Hemodynamic parameters, modified Cormack-Lehane grade, intubation period, and preoperative examination (age, sex, American Society of Anesthesiologists, modified Mallampati test score, and thyromental and stemomental distances) of patients were evaluated. Main Results: There were no statistically significant differences in hemodynamic responses (heart rates and mean arterial pressure) between the 2 groups (P > .05). The median intubation period in the TVL group was significantly higher than observed in the MDL group (t = 4.594; P < .05). The laryngoscopy views in TVL group were better than the views in MDL group. The Cormack-Lehane grade in the TVL group was lower when compared to the MDL group. Conclusion: The TVL system does not provide significant hemodynamic response sparing or shorten orotracheal intubation times when compared to MDL in geriatric patients. (C) 2016 Elsevier Inc. All rights reserved.

Background The sympathetic nervous system has an important role in generating pain. Various pathomechanisms are involved that respond well to the application of local anesthetics (LA), for example to the stellate ganglion block (SGB). Objectives We wanted to know more about the effects of SGB on cardiovascular parameters. Methods We included 15 healthy volunteers; another 15 healthy volunteers as a control group (sham injection of LA). In order to produce a more precise SGB, we employed only a small volume of LA (3 mL), a LA with a lower permeability (procaine 1%), and a modified injection technique. Systolic and diastolic blood pressure (SBP, DBP), heart rate (HR), and echocardiographic parameters were recorded before and after SGB. We also investigated whether there are side differences (left and right SBG). Results At baseline all parameters were within the normal range. After performing right and left SGB DBP significantly increased (on the right side from 68.73 ± 8.61 to 73.53 ± 11.10, p = 0.015; on the left side from 70.66 ± 13.01 to 77.93 ± 10.40, p = 0.003). In the control group no increase in DBP was observed. No side-specific differences were found, except a significant reduction in the maximum velocity of myocardial contraction during the systole with left-sided SGB. Conclusions Even with our methods we could not prevent the simultaneous occurrence of a partial parasympatholytic effect. For this reason, the SGB has only minor hemodynamic effects, which is desirable as it enhances the safety of the SGB.

The physiological effects of natural and urban environments on the cardiovascular system of coronary artery disease (CAD) patients are not fully understood. This controlled field study examines the effects of restorative walking in a park vs. in an urban street environment on CAD patients’ stress parameters and cardiac function. Methods: Twenty stable CAD patients were randomly allocated to 7 days controlled walking in a city park or in an urban street environment group. The relationship between different environmental exposures and health effects was analyzed using Wilcoxon signed-rank test and exact Mann-Whitney U test. Results: The mean reduction in cortisol levels and negative effects after the walk on the first day was greater in the city park than in the urban street exposed group, while a reduction in negative effects in the urban group were greater after seven days. The reduction in diastolic blood pressure (DBP) in the park group was evident on the seventh day before the walk (−4 mm Hg, p = 0.031) and 60 min after the walk (−6.00 mm Hg, p = 0.002). The cortisol slope was negatively associated with the DBP changes (r = −0.514, p < 0.05). Conclusions: Physical activity in a green environment with noise and air pollution levels lower than in an urban environment has a greater positive effect on CAD patients’ stress level and hemodynamic parameters. Mitigating green environmental influences may allow urban residents to maintain health and reduce disability.

Background: The tracheal tube is always considered to be the gold standard for laparoscopic surgeries. As conventional laryngoscopy guided endotracheal intubation evokes significant hypertension and tachycardia, we have used I-gel, second generation extraglottic airway device, in an attempt to overcome these drawbacks. We conducted this study to compare haemodynamic changes during insertion, efficacy of ventilation, and complications with the use of I-gel when compared with endotracheal tube (ETT) in laparoscopic surgeries. Materials and Methods: A total of 60 American Society of Anaesthesiologists physical status I and II adult patients undergoing elective laparoscopic surgeries were randomly allocated to one of the two groups of 30 patients each: Group-A (I-gel) in which patients airway was secured with appropriate sized I-gel, and Group-B (ETT) in which patients airway was secured with laryngoscopy - guided endotracheal intubation. Ease, attempts and time for insertion of airway device, haemodynamic and ventilatory parameters at different time intervals, and attempts for gastric tube insertion, and perioperative complications were recorded. Results: There was significant rise in pulse rate and mean blood pressure during insertion with use of ETT when compared to I-gel. Furthermore, time required for I-gel insertion was significantly less when compared with ETT. However ease and attempts for airway device insertion, attempts for gastric tube insertion and efficacy of ventilation were comparable between two groups. Conclusion: We concluded that I-gel requires less time for insertion with minimal haemodynamic changes when compared to ETT. I-gel also provides adequate positive-pressure ventilation, comparable with ETT. Hence I-gel can be a safe and suitable alternative to ETT for laparoscopic surgeries.

Ex vivo recorded action potentials (APs) in human right atrial tissue from patients in sinus rhythm (SR) or atrial fibrillation (AF) display a characteristic spike-and-dome or triangular shape, respectively, but variability is huge within each rhythm group. The aim of our study was to apply the machine-learning algorithm ranking instances by maximizing the area under the ROC curve (RIMARC) to a large data set of 480 APs combined with retrospectively collected general clinical parameters and to test whether the rules learned by the RIMARC algorithm can be used for accurately classifying the preoperative rhythm status. APs were included from 221 SR and 158 AF patients. During a learning phase, the RIMARC algorithm established a ranking order of 62 features by predictive value for SR or AF. The model was then challenged with an additional test set of features from 28 patients in whom rhythm status was blinded. The accuracy of the risk prediction for AF by the model was very good (0.93) when all features were used. Without the seven AP features, accuracy still reached 0.71. In conclusion, we have shown that training the machine-learning algorithm RIMARC with an experimental and clinical data set allows predicting a classification in a test data set with high accuracy. In a clinical setting, this approach may prove useful for finding hypothesis-generating associations between different parameters.

The aim of this study was to compare the effects of 3 different sedative-analgesic regimens in patients with intracranial mass lesions undergoing stereotactic brain biopsy. A 135 outpatients with American Society of Anesthesiologists I to II were divided into 3 groups: group A (n = 45) received a loading dose of IV alfentanil 7.5 microg/kg followed by infusion rate of 0.25 microg/kg/min; group F (n = 45) received a bolus dose of 1 microg/kg IV fentanyl and repeated as needed; and group R (n = 45) received infusion of 0.05 microg/kg/min remifentanil. Target level of sedation was 3 to 4 of the Ramsay Sedation Scale. Systolic and diastolic blood pressure, heart rate, respiratory rate, peripheric oxygen saturation (SpO2), and end-tidal carbon dioxide were recorded at different stages of the procedures. The patients in group F had significantly lower mean heart rate than those in groups A and R, but this was not in the limits of the bradycardia. The patients in group A had significantly lower mean SpO2 than those in the other groups, but mean SpO2 values did not drop below 94%. There were no significant differences in end-tidal carbon dioxide and respiratory rate values among the groups. Our results suggest that all 3 regimens have relatively similar hemodynamic and respiratory responses. The use of bolus fentanyl technique caused less hemodynamic stability. The continuous infusion technique of remifentanil or alfentanil provided better control on hemodynamic parameters.

BACKGROUND: Acute hemorheological responses to different types of aerobic exercises have never been compared in a single study in healthy people., OBJECTIVE: We aimed to compare acute effects of high intensity intermittent exercise (HIIE) and moderate intensity continuous exercise (MICE) on hemorheological parameters, in healthy young subjects., METHODS: A total of 34 sedentary young adults (12 males, 22 females) with a mean age of 20.0±2.1 years were randomly assigned to HIIE, MICE or non-exercise groups. MICE exercised at the power corresponding to 50% of heart rate reserve (HRR) continuously for 25 min. HIIE exercised at the power corresponding to 100% of HRR for 30 s followed by 30 s rest for 25 min. The non-exercise group rested. Blood samples were collected before and after exercise and studied for blood count, whole blood viscosity (WBV), plasma viscosity (PV) and red blood cell (RBC) elongation at nine different shear stresses., RESULTS: WBV, PV, RBC elongation of MICE and HIIE groups were not found to be statistically different from each other or from the non-exercise group. Compared to the non-exercise group, there was a significant increase in white blood cell (WBC) and RBC counts in the MICE group., CONCLUSIONS: Different types of aerobic exercises, namely MICE, HIIE are not different from each other in terms of hemorheological parameters immediately after exercise. © 2014-IOS Press and the authors.

Surgical specimens of vein were obtained from the tertiary venous network and/or saphenous vein from patients ( n = 20) affected by chronic venous disease (CVD). Into the venous segments, which subsequently were surgically ablated, the following hemodynamic parameters were assessed by echo-color-doppler (ECD): peak systolic velocity, end diastolic velocity, whose combination allowed the calculation of the resistance index (RI) and the reflux time (RT). Highly purified venous endothelial cell (VEC) cultures derived from venous segments of these CVD patients were then characterized for the profile of cytokines and chemokines released in the culture supernatants. Among the 27 cytokines and chemokines examined, we found a positive and significant correlation ( R = 0.5; p = 0.03) only between the spontaneous release of PDGF-BB by VEC cultures and the RT values of the patients from which the VEC were isolates. In addition, the release of PDGF-BB in the VEC culture supernatants was significantly ( p in vitro treatment with recombinant TNF-α. By using pharmacological inhibitors, specific for the main pathways, NF-kB, ERK1/2 and p38 MAPK, activated by exposure of endothelial cells to TNF-α, we found that only NF-kB appeared to be significantly involved in mediating the PDGF-BB induction by TNF-α. Of interest, the release of PDGF-BB in response to the in vitro inflammatory stimulation, maintained a positive and significant correlation with RT ( R = 0.6; p = 0.01), while showing a negative correlation with RI ( R = −0.5; p = 0.03). The potential implications of our findings for the pathophysiology of CVD are discussed.