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Purpose Evidence has suggested that clevidipine may provide faster blood pressure (BP) reduction with less volume than nicardipine in stroke and cardiothoracic surgery patients, but its use in hypertensive crises has not been well established. The primary objective of this study was to compare the treatment success of clevidipine and nicardipine in hypertensive crisis. Methods This was a multicenter, retrospective cohort study including patients who received either clevidipine or nicardipine for treatment of hypertensive crisis. The primary outcome was the time from infusion start to attainment of goal BP, defined as the higher value of the guideline-directed 25% reduction in BP or the physician-ordered goal. Secondary outcomes were the time from infusion start to guideline-directed 25% reduction in BP, drug and total volume intake, the time from order entry to BP goal attainment, the number of BP and heart rate excursions, intensive care unit (ICU) length of stay, and study medication cost. Results In total, 182 patients were included in the study (103 receiving nicardipine and 79 receiving clevidipine). Time to goal BP was similar between the groups (35 vs 33 minutes for clevidipine vs nicardipine, respectively; P = 0.37). Time to guideline-directed 25% reduction was also similar (P = 0.42). Volume from study drug was significantly less with clevidipine (222 vs 518 mL; P = 0.01); however, the total volume received in the ICU was similar (3,370 vs 3,383 mL; P = 0.43). Percent time in the goal BP range was similar (43.1% vs 42.3%). The cost of clevidipine was $199.37 per vial (based on the average wholesale price as of June 2023). This cost was 682% higher than that for a bag of nicardipine. Conclusion Time to goal BP was similar for clevidipine and nicardipine in this population. Any decreases in medication-associated volume with clevidipine were no longer evident when all volume sources were considered. These results show that clevidipine may not provide meaningful benefit in this heterogenous population. The difference in cost does not seem justified given the lack of improvement in clinically relevant outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Propofol is an intravenous anesthetic administered as a bolus or continuous infusion during anesthetic induction and maintenance. Its pharmacokinetic characteristics include hepatic and extrahepatic metabolism with a rapid onset of action and short duration, which provides a smooth anesthetic induction without excitatory effects. Objective: To evaluate whether the isolated use of propofol in anesthetic induction in dogs changes the hemodynamic variables assessed via echocardiography. Study Design: Prospective clinical study. Animals: Twelve healthy dogs. Methods: The dogs were induced with propofol (dose/effect) at 3 mg/kg/minute, and echocardiographic evaluations were performed immediately before anesthetic induction (MB) and immediately after its interruption (MI), at the end of the supply of the anesthetic agent. Results: A significant reduction was observed between the values of the following hemodynamic variables: Ejection Fraction (EF%), which varied from 70% to 65% (p = 0.011) between moments, and the Doppler Ejection Index (DEI), which ranged from 27.1 mL/beat/m2 to 22.4 mL/beat/m2 (p = 0.044). The heart rate (HR) and the other studied hemodynamic variables showed no significant differences between the evaluated moments. Conclusion and Clinical Relevance: Propofol was a safe anesthetic‐inducing agent, maintaining stable hemodynamic indices during anesthetic induction at the used rate. [ABSTRACT FROM AUTHOR]

Background: In addition to their classic genomic effects, glucocorticoids also manifest rapid non genomic effects. We speculate that dexamethasone has the potential prompt onset of analgesic effects. The objective of this study is to investigate the influence of a single preoperative dose of dexamethasone on the half maximal effective concentration (EC50) of remifentanil when combined with dexmedetomidine for pain relief during pancreatic extracorporeal shockwave lithotripsy (P-ESWL). Methods: A total of 60 patients undergoing P-ESWL were enrolled and randomized at 1:1 ratio into the dexamethasone (DXM) group and the placebo group. Before anesthesia induction, patients in DXM group received an intravenous injection of 8 mg dexamethasone, while subjects in placebo group received an equal dose of physiological saline. Monitored anesthesia care (MAC) was performed based on remifentanil in combination with dexmedetomidine. Remifentanil was administered by TCI with an initial target concentration of 2.5 µg/mL for both groups. A positive response was defined as that VAS score > 3 by the patient at any time during the procedure. Subsequent target concentrations were adjusted by Dixon up-down sequential method, where dose modifications were performed by 0.3 ng/mL intervals, based on the response of the previous patient. The EC50 of remifentanil for pain relief during P-ESWL treatment was calculated using Dixon's up-and-down method. Hemodynamic variables, oxygen saturation and adverse events were also recorded. Results: Dixon up-and-down method revealed that the EC50 of remifentanil was significantly higher in placebo group (2.65 ± 0.28 ng/mL) than in DXM group (2.02 ± 0.23 ng/ml) (P < 0.001). Hemodynamic parameter exhibited a significant decrease in mean arterial pressure (MAP) and heart rate (HR) before and after induction in placebo group; however, data of the two groups were comparable (P>0.05). Less adverse events occurred in DXM group, including the incidence of postoperative nausea and vomiting (PONV) and analgesia requirement with in the first 24 h following the procedure at ward. Conclusion: Dexamethasone exerted analgesic effects with a rapid onset, and patients received dexamethasone 8 mg preoperative had a lower required EC50 of remifentanil during P-ESWL. It is also associated with reduced PONV in addition to reduced postoperative analgesic consumption in the first postoperative 24 h. Trial registration: Registered in the Chinese Clinical Trial Registry (ChiCTR2300078171) on 30/11/2023. [ABSTRACT FROM AUTHOR]

Competitive swimmers complete 50‐m front crawl swimming without breathing or with a limited number of breaths. Breath holding during exercise can trigger diving reflex including bradycardia and diminished active muscle blood flow, whereas oxygen supply to vital organ such as brain is maintained. We hypothesized that swimmers achieving faster time in 50‐m front crawl with limited number of breaths demonstrate a blunted diving reflex of cardiac and active muscle blood flow responses with elevated cerebral perfusion to counteract peripheral and central fatigues. Twenty‐eight competitive swimmers (12 females) underwent a 50‐m front crawl swimming time trial with minimum respiratory interruptions, following which they were categorized into two groups: Fast (n = 13) and Slow (n = 15). Additionally, they performed knee extension exercises with maximal voluntary breath‐ holding, wherein leg blood flow (Doppler ultrasound), cardiac output (Modelflow), heart rate (electrocardiogram), and middle cerebral artery mean blood velocity (transcranial Doppler ultrasound) were evaluated. The pattern of leg blood flow response differed between the two groups (p = 0.031) with the Fast group experiencing a delayed onset of reductions in leg blood flow (p = 0.035). The onset of bradycardia was also delayed in the Fast group (p = 0.014), with this group demonstrating a higher value of the lowest heart rate (between‐trial difference in average: 15.9 [3.73, 28.2] beats/min) and cardiac output (between‐trial difference in median: 2.84 L/min) (both, p ≤ 0.013). Middle cerebral artery mean blood velocity was similar between the groups (all p ≥ 0.112). We show that swimmers with superior performance in 50‐m front crawl swim with limited breaths display a diminished diving reflex. [ABSTRACT FROM AUTHOR]

Purpose: Excessive tachycardia in resuscitated septic shock patients can impair hemodynamics and worsen patient outcome. We investigated whether heart rate (HR) control can be achieved without increased vasopressor requirements using the titratable highly selective, ultra-short-acting β1-blocker landiolol. Methods: This randomized, open-label, controlled trial was conducted at 20 sites in 7 European countries from 2018 to 2022 and investigated the efficacy and safety of landiolol in adult patients with septic shock and persistent tachycardia. Patients were randomly assigned to receive either landiolol along with standard treatment (n = 99) or standard treatment alone (n = 101). The combined primary endpoint was HR response (i.e., HR within the range of 80−94 beats per minute) and its maintenance without increasing vasopressor requirements during the first 24 h after treatment start. Key secondary endpoints were 28-day mortality and adverse events. Results: Out of 196 included septic shock patients, 98 received standard treatment combined with landiolol and 98 standard treatment alone. A significantly larger proportion of patients met the combined primary endpoint in the landiolol group than in the control group (39.8% [39/98] vs. 23.5% [23/98]), with a between-group difference of 16.5% (95% confidence interval [CI]: 3.4–28.8%; p = 0.013). There were no statistically significant differences between study groups in tested secondary outcomes and adverse events. Conclusion: The ultra-short-acting beta-blocker landiolol was effective in reducing and maintaining HR without increasing vasopressor requirements after 24 h in patients with septic shock and persistent tachycardia. There were no differences in adverse events and clinical outcomes such as 28-day mortality vs. standard of care. The results of this study, in the context of previous trials, do not support a treatment strategy of stringent HR reduction (< 95 bpm) in an unselected septic shock population with persistent tachycardia. Further investigations are needed to identify septic shock patient phenotypes that benefit clinically from HR control. [ABSTRACT FROM AUTHOR]

Background: To discuss whether decreasing the pressure of endotracheal tube cuff slowly with a constant speed can decrease the incidence of coughing during extubation. Methods: Ninety patients undergoing elective noncardiac surgery under general anesthesia with endotracheal intubation were randomly divided into two groups: group P, the pilot balloon was connected to a syringe and an aneroid manometer through a three-way stopcock, respectively, and the decrease of cuff pressure was controlled at 3 cmH2O/s during deflating before extubation; group C, the pressure in endotracheal tube cuff was decreased suddenly with a syringe extracting the air from the cuff rapidly at once exactly before extubation. The incidence of coughing during extubation period was recorded. Mean arterial pressure (MAP) and heart rate (HR) were recorded before general anesthesia induction (T0), just before cuff deflation (T1), immediately after deflation (T2), at 1 min (T3), 3 min (T4), and 5 min after extubation (T5). The occurrence of adverse reactions was also recorded. Results: The initiation of coughing during extubation period occurs at immediately the time of balloon deflation. Compared with group C, the incidence of coughing was significantly decreased (P = 0.001), MAP and HR were significantly decreased at T2-T4 and T2-T5, respectively (P < 0.05 for all), and the incidence of pharyngolaryngeal discomfort after extubation was significantly reduced (P = 0.021) in group P. Conclusions: Decreasing the pressure of endotracheal tube cuff slowly with a constant speed can significantly reduce the incidence of coughing during extubating period, stabilize hemodynamics, and reduce the incidence of adverse reactions. [ABSTRACT FROM AUTHOR]

Introduction: Angiography is associated with anxiety, stress, and changes in patients' vital signs. The role of the liaison nurse is to bridge gaps and solve problems between departments, thereby preventing the occurrence of undesired complications during patient transfers. Proper preparation of patients by the liaison nurse may lead to an improvement in the hemodynamic status of patients. The present study was conducted to investigate the effect of liaison nurse on hemodynamic status during transfer process to angiography. Method: This randomized controlled trial was conducted from December 2019 to March 2020 on 62 patients who were candidates for elective angiography at Imam Reza Hospital in Mashhad. Participants were selected using a convenience sampling method and then randomly assigned to either the control or intervention group using a lottery system. In the intervention group, patients benefited from the presence of a liaison nurse from the moment the transfer order was issued by the doctor. Tools used included a demographic information questionnaire and a hemodynamic signs checklist. Data were analyzed using SPSS 25 with independent T-tests, paired T-tests, Wilcoxon, Mann-Whitney test, chi-squared, and Fisher's exact test. Result: Following the intervention, the mean systolic blood pressure, heart rate, and respiratory rate in the intervention group were found to be significantly lower than those in the control group (p < 0.05). In contrast, the mean body temperature, diastolic blood pressure and the percentage of arterial blood oxygen saturation did not exhibit a statistically significant difference between the two groups (p > 0.05). Conclusion: The liaison nurse role emerges as a valuable strategy for enhancing patients' hemodynamic stability, and its implementation can have a positive impact on patient outcomes in hospital settings. [ABSTRACT FROM AUTHOR]

Background: Our aim was to evaluate the influence of staged goal directed therapy (GDT) on postoperative pulmonary complications (PPCs), intraoperative hemodynamics and oxygenation in patients undergoing Mckeown esophagectomy. Methods: Patients were randomly divided into three groups, staged GDT group (group A, n = 56): stroke volume variation (SVV) was set at 8–10% during the one lung ventilation (OLV) stage and 8–12% during the two lung ventilation (TLV) stage, GDT group (group B, n = 56): received GDT with a target SVV of 8–12% During the entire surgical procedure, and control group (group C, n = 56): conventional fluid therapy was administered by mean arterial pressure (MAP), central venous pressure (CVP), and urine volume. The primary outcome was the incidence of postoperative pulmonary complications within Postoperative days (POD) 7. The secondary outcomes were postoperative lung ultrasound (LUS) B-lines artefacts (BLA) scoring, incidence of other complications, the length of hospital stay, intraoperative hemodynamic and oxygenation indicators included mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), cardiac output (CO), oxygenation index (OI), respiratory indices (RI), alveolar-arterial oxygen difference (Aa-DO2). Results: Patients in group A and group B had a lower incidence of PPCs (7/56 vs. 17/56 and 9/56 vs. 17/56, p < 0.05), and a fewer B-lines score on postoperative ultrasound (4.61 ± 0.51 vs. 6.15 ± 0.74 and 4.75 ± 0.62 vs. 6.15 ± 0.74, p < 0.05) compared to group C. The CI, CO, MAP, and OI were higher in group A compared to group B and group C in the stage of thoracic operation. During the abdominal operation stage, patients in group A and group B had a better hemodynamic and oxygenation indicators than group C. Conclusions: In comparison to conventional fluid therapy, intraoperative staged GDT can significantly reduce the incidence of postoperative pulmonary complications in patients undergoing McKeown esophagectomy, facilitating patient recovery. Compared to GDT, it can improve intraoperative oxygenation and stabilize intraoperative hemodynamics in patients. Trial registration: This study was registered in the Chinese Clinical Trial Registry on 24/11/2021 (ChiCTR2100053598). [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusion Residual stenosis (RS) and hemodynamics demonstrate a significant correlation with postoperative in‐stent restenosis/thrombosis following carotid artery stenting (CAS).This study endeavors to elucidate the potential associations between RS and adverse postoperative hemodynamic factors.This study utilized 46 patient‐specific carotid artery models post‐stenting, which were categorized into two groups based on the presence of RS: the normal group (N, n = 23) and the RS group (RS, n = 23). A comparative analysis was conducted to evaluate the discrepancies in geometry and adverse hemodynamic parameters, alongside investigating the potential correlation between hemodynamic and geometric parameters.The results reveal that a higher reflux flow volume is discernible in the RS group during low‐velocity phases of the cardiac cycle, concomitant with an augmented extent of areas exposed to oscillatory shear stress and extended particle residence time. Moreover, the adverse hemodynamic parameters exhibit a positive correlation with the degree of stent expansion, stent length in the common carotid artery (CCA), and the distal slope of the RS.The distal slope and tortuosity of RS significantly influence the development of adverse hemodynamic conditions post‐stenting, exacerbating the hemodynamic environment near the stenosis. Interestingly, while an extended stent length in the internal carotid artery (ICA) region improves hemodynamics by reducing flow disturbance, a longer stent in the CCA significantly worsens these conditions. Hence, it is prudent to analyze the characteristics of the local lesion regions to optimize the strategy for stent implantation. [ABSTRACT FROM AUTHOR]

Background: To analyze the effects of different anesthesia depths on perioperative heart rate variability and hemodynamics in middle-aged and elderly patients undergoing general anesthesia, and to provide a basis for clinical application. Methods: A total of 111 patients with gastric cancer who were treated with epidural anesthesia combined with general anesthesia were selected as the study subjects, and the patients were randomly divided into group A, group B and group C. The bispectral index (BIS) was maintained by adjusting the infusion speed of anesthetics, the BIS of group A was maintained at 50 ~ 59, the BIS of group B was maintained at 40 ~ 49, and the BIS of group C was maintained at 30 ~ 39. The high-frequency power (HFP), low-frequency power (LFP), total power (TP), mean arterial pressure (MAP), heart rate (HR), diastolic blood pressure (DBP), and systolic blood pressure (SBP) were measured before anesthesia induction (T1), immediately after intubation (T2), 3 min after intubation (T3), and 6 min after extubation (T4). The cognitive function of the patients was evaluated before and 48 h after surgery. Results: The HFP, LFP/HFP, TP, HR, DBP and SBP between the three groups at T1 ~ T3 are significantly difference from each other (P < 0.05). There were significant differences in spontaneous breathing recovery time, eye opening time and extubation time among group A, B and C groups, and group B had the lowest spontaneous breathing recovery time, eye opening time and extubation time (P < 0.05). There was no significant difference in the incidence of adverse reactions during anesthesia between the three groups. The cognitive function score of group B was significantly higher than that of group A and group C (P < 0.05). Conclusions: BIS maintenance of 40 ~ 49 has little effect on perioperative heart rate variability and hemodynamics in middle-aged and elderly patients undergoing general anesthesia, which is helpful for postoperative recovery. [ABSTRACT FROM AUTHOR]

Understanding the evolving nature of coronary hemodynamics is crucial for early disease detection and monitoring progression. We require digital twins that mimic a patient's circulatory system by integrating continuous physiological data and computing hemodynamic patterns over months. Current models match clinical flow measurements but are limited to single heartbeats. To this end, we introduced the longitudinal hemodynamic mapping framework (LHMF), designed to tackle critical challenges: (1) computational intractability of explicit methods; (2) boundary conditions reflecting varying activity states; and (3) accessible computing resources for clinical translation. We show negligible error (0.0002–0.004%) between LHMF and explicit data of 750 heartbeats. We deployed LHMF across traditional and cloud-based platforms, demonstrating high-throughput simulations on heterogeneous systems. Additionally, we established LHMFC, where hemodynamically similar heartbeats are clustered to avoid redundant simulations, accurately reconstructing longitudinal hemodynamic maps (LHMs). This study captured 3D hemodynamics over 4.5 million heartbeats, paving the way for cardiovascular digital twins. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the physical and physiological demands of intercounty camogie match-play between positions and halves of play. Data were collected from 28 players during 18 competitive games using global positioning systems (10-Hz) and heart rate monitors (2.4-GHz). The study demonstrated that intercounty camogie players covered a total distance (TD) (m ± SD) of 6,040 ± 628 m, relative distance (RD) of 83 ± 13 m⋅min-1, and maximum speed of 25 ± 1 km⋅h-1. Furthermore, the players covered a mean sprint distance of 214 ± 112 m and 14 ± 6 sprints. Players' mean heart rate (HRmean) and HRmaxwas 138 ± 23 b⋅min-1 and 164 ± 20 b⋅min-1, respectively. There were decrements between halves in TD (p < 0.01, ES = -0.45), RD (p < 0.01, ES = -0.45), maximum speed (p < 0.05, ES 5 -0.18), HRmax(p < 0.05, ES = -0.23), running (p < 0.01, ES = -0.34), high-speed running (p < 0.01, ES = 0.34), sprinting (p < 0.01, ES 5 -0.10), HRmax(p < 0.05, ES = -0.23), and HRmax % (p < 0.05, ES = -0.24). Midfielders covered a greater TD compared with full-forwards (p < 0.05, ES 5 -0.38) and half-forwards (p < 0.05, ES 5 -0.38). Full-backs covered a significantly lower RD than midfielders (p < 0.05, ES 5 -1.2), half-backs compared with full-forwards (p < 0.05, ES 5 1.14), and half-forwards compared with full-forwards (p < 0.05, ES 5 1.15). Full-forwards covered significantly less RD when compared with half-backs (p < 0.05, ES 5 -1.14), midfielders (p < 0.05, ES 5 -1.47), and half-forwards (p < 0.05, ES 5 -1.15). The findings provide physical and physiological values on the match demands of intercounty camogie match-play. [ABSTRACT FROM AUTHOR]

Detailed heart rate (HR) response patterns during exercise in patients with heart failure (HF) and sinus rhythm remain uncertain. We screened consecutive patients with HF who underwent cardiopulmonary exercise tests at a large academic center from November 2013 to July 2023. HR response during exercise was statistically classified using logistic differential equation models. A total of 99 patients were included. Of them, 75 patients were assigned to "sigmoidal pattern" and the other 24 to "exponential pattern." Patients with the sigmoidal pattern were older and exhibited higher plasma B-type natriuretic peptide levels. Increases in HR and oxygen consumption (V̇ o 2)/kg up to the anaerobic threshold level were not different between both patterns. However, beyond the threshold, the sigmoidal pattern group showed no further increase in HR and significantly lower V̇ o 2/kg than their counterparts (interactions for P < 0.001). HR response during exercise in patients with heart failure and sinus rhythm was categorized into two unique groups: sigmoidal and exponential patterns. More detailed clarification of the sigmoidal pattern, potentially indicating sinus node dysfunction, should offer new clinical insights for chronotropic incompetence. NEW & NOTEWORTHY: Heart rate response patterns can be classified into two groups among patients with chronic heart failure reaching maximal exertion: sigmoidal and exponential. [ABSTRACT FROM AUTHOR]

Background: Orthognathic surgery, a common corrective procedure for jaw abnormalities, requires precise anesthesia management to ensure patient stability and optimal recovery. This study compares the effects of total intravenous anesthesia (TIVA) and inhalational anesthesia on hemodynamics and recovery outcomes in patients undergoing orthognathic surgery. Materials and Methods: A prospective study was conducted at Pravara Rural Hospital, Pravara Institute of Medical Sciences, Loni, Maharashtra, over three years from July 2021 to July 2024. A total of 40 patients scheduled for orthognathic surgery were randomly assigned to either the TIVA group(Propofol + Fentanyl) (n=20) or the inhalational anesthesia group(Sevoflurane) (n=20). Hemodynamic parameters including heart rate, blood pressure, and oxygen saturation were monitored intraoperatively. Recovery outcomes, such as time to extubation, postoperative pain scores, and incidence of nausea and vomiting, were assessed in the postoperative period. Statistical analysis was performed using Student's t-test and Chisquare test. Results: The TIVA group demonstrated more stable intraoperative hemodynamics with significantly lower variability in heart rate (mean ± SD: 75 ± 5 bpm vs. 85 ± 8 bpm, p<0.05) and blood pressure (mean arterial pressure: 80 ± 6 mmHg vs. 90 ± 10 mmHg, p<0.05) compared to the inhalational group. The recovery profile was also superior in the TIVA group, with a shorter time to extubation (mean ± SD: 10 ± 3 minutes vs. 15 ± 5 minutes, p<0.05), lower postoperative pain scores (mean ± SD: 3 ± 1 vs. 5 ± 2 on a 10-point scale, p<0.05), and reduced incidence of nausea and vomiting (10% vs. 30%, p<0.05). Conclusion: Total intravenous anesthesia provides better hemodynamic stability and improved recovery outcomes compared to inhalational anesthesia in patients undergoing orthognathic surgery. These findings suggest that TIVA may be a preferable anesthesia technique for this patient population. [ABSTRACT FROM AUTHOR]

The opening and closing dynamics of the aortic valve (AV) has a strong influence on haemodynamics in the aortic root, and both play a pivotal role in maintaining normal physiological functions of the valve. The aim of this study was to establish a subject‐specific fluid–structure interaction (FSI) workflow capable of simulating the motion of a tricuspid healthy valve and the surrounding haemodynamics under physiologically realistic conditions. A subject‐specific aortic root was reconstructed from magnetic resonance (MR) images acquired from a healthy volunteer, whilst the valve leaflets were built using a parametric model fitted to the subject‐specific aortic root geometry. The material behaviour of the leaflets was described using the isotropic hyperelastic Ogden model, and subject‐specific boundary conditions were derived from 4D‐flow MR imaging (4D‐MRI). Strongly coupled FSI simulations were performed using a finite volume‐based boundary conforming method implemented in FlowVision. Our FSI model was able to simulate the opening and closing of the AV throughout the entire cardiac cycle. Comparisons of simulation results with 4D‐MRI showed a good agreement in key haemodynamic parameters, with stroke volume differing by 7.5% and the maximum jet velocity differing by less than 1%. Detailed analysis of wall shear stress (WSS) on the leaflets revealed much higher WSS on the ventricular side than the aortic side and different spatial patterns amongst the three leaflets. [ABSTRACT FROM AUTHOR]

Smartwatches and home‐based blood pressure (BP) devices have permitted easy use of heart rate variability (HRV) and BP to identify the recovery status of users after acute exercise training. The reproducibility of HRV and BP after exercise in healthy young participants is not well known. Eighteen participants (age 27 ± 6 years, female n = 8) performed test and retest aerobic exercises (cycling, 30 min, 60% of peak workload, W) and a control session in randomized order. RMSSD, high and low‐frequency power of RR intervals, and BP were measured at rest and 30–60 min after interventions. The relative reproducibility was assessed by the intraclass correlation coefficient (ICC) and 95% confidence interval (95% CI). The absolute reproducibility was evaluated using the coefficient of variation (CV%). HRV indices revealed moderate‐to‐excellent reproducibility at rest (ICC 0.81–0.86; 95% CI 0.53–0.95) but not after exercise (ICC −0.06 to 0.60; 95% CI −1.85 to 0.85). Systolic BP had a good‐to‐excellent reproducibility before (ICC 0.93; 95% CI 0.81–0.98, CV% 4.2) and after exercise (ICC 0.93; 95% CI 0.81–0.97, CV% 4.2). The reproducibility of HRV indices is poor after exercise in young participants. However, the reproducibility of BP is excellent at rest and after aerobic exercise. [ABSTRACT FROM AUTHOR]

Background: The microgravity environment has a direct impact on the cardiovascular system due to the fluid shift and weightlessness that results in cardiac dysfunction, vascular remodeling, and altered Cardiovascular autonomic modulation (CAM), deconditioning and poor performance on space activities, ultimately endangering the health of astronauts. Objective: This study aimed to identify the acute and chronic effects of microgravity and Earth analogues on cardiovascular anatomy and function and CAM. Methods: CINAHL, Cochrane Library, Scopus, Science Direct, PubMed, and Web of Science databases were searched. Outcomes were grouped into cardiovascular anatomic, functional, and autonomic alterations, and vascular remodeling. Studies were categorized as Spaceflight (SF), Chronic Simulation (CS), or Acute Simulation (AS) based on the weightlessness conditions. Metaanalysis was performed for the most frequent outcomes. Weightlessness and control groups were compared. Results: 62 articles were included with a total of 963 participants involved. The meta-analysis showed that heart rate increased in SF [Mean difference (MD) = 3.44; p = 0.01] and in CS (MD = 4.98; p < 0.0001), whereas cardiac output and stroke volume decreased in CS (MD = -0.49; p = 0.03; and MD = -12.95; p < 0.0001, respectively), and systolic arterial pressure decreased in AS (MD = -5.20; p = 0.03). According to the qualitative synthesis, jugular vein cross-sectional area (CSA) and volume were greater in all conditions, and SF had increased carotid artery CSA. Heart rate variability and baroreflex sensitivity, in general, decreased in SF and CS, whereas both increased in AS. Conclusion: This review indicates that weightlessness impairs the health of astronauts during and after spaceflight, similarly to the effects of aging and immobility, potentially increasing the risk of cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Background and purpose: Previous studies predicting the rupture risk of intracranial aneurysms (IAs) have predominantly utilized static imaging data, overlooking the dynamic blood flow and biomechanical properties of the aneurysm wall. Irregular pulsation detected by 4D-CTA is a potential predictor of aneurysm rupture, albeit with uncertain clinical significance. This study aimed to analyze the changes in morpho-hemodynamic characteristics of IAs during the cardiac cycle to elucidate the dynamic changes and the associated hemodynamic mechanisms. Methods: A retrospective review was conducted on the 4D-CTA data of IA patients between January 2017 and September 2019. R-R intervals were segmented into 20-time phases, reconstructing 20 CT datasets to identify irregular pulsation and extract 3D aneurysm models. Computational fluid dynamics (CFD) simulations analyzed hemodynamic parameters such as oscillatory shear index (OSI) and relative residence time (RRT). Changes in morpho-hemodynamic characteristics were quantified in terms of the absolute change (parameter*) and relative change rate (parameter%). Rupture risk was assessed using the rupture resemblance model (RRS). Results: Eleven UIAs from 10 patients were finally included, with five aneurysms showing irregular pulsation (45.45%). No significant differences in morpho-hemodynamic characteristics were observed between aneurysms with or without irregular pulsation. More remarkable changes in aneurysm size (size*: 0.59  ±  0.14  mm vs. 0.32  ±  0.12  mm, p  =  0.010; size%: 10.49%  ±  1.43% vs. 3.95%  ±  1.79%, p  <  0.001), volume (volume%: 13.72% vs. 6.39%, p  =  0.009), OSI (OSI*: 0.02  ±  0.01 vs. 0.004  ±  0.005, p  =  0.004; OSI%: 200% vs. 12.50%, p  =  0.004) and RRT (RRT%: 97.14% vs. 43.95, p  =  0.052) over the cardiac cycle were significantly linked to irregular pulsation. Aneurysms with irregular pulsation demonstrated a more unfavorable hemodynamic environment during the cardiac cycle, irrespective of the predicted rupture risk. Furthermore, irregular pulsation at the aneurysm dome exhibited higher hemodynamic instability than at the sidewall. Conclusion: Irregular pulsation may indicate hemodynamic instability within the aneurysm, leading to an increased rupture risk in the area where irregular pulsation occurs. This proof-of-concept study could enhance understanding of dynamic changes in UIAs during the cardiac cycle and the underlying hemodynamic mechanisms. [ABSTRACT FROM AUTHOR]

The current S1 guidelines on the intraoperative clinical application of hemodynamic monitoring in patients scheduled for noncardiac surgery are presented based on a case report under the aspect of an optimized intraoperative anesthesiological management. The S1 guidelines were developed with the aim of identifying the questions on the intraoperative hemodynamic monitoring and management which are important for the routine daily clinical practice, to discuss them in a guideline group and to answer them based on the current state of scientific knowledge. The guidelines were written under the auspices of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and published by the AWMF in 2023 under the register number 001/049. [ABSTRACT FROM AUTHOR]

Context Energy drinks (EDs) are beverages that contain ingredients that may pose a risk to consumers' cardiovascular health. But current evidence is conflicting and warrants further investigation. Objective A systematic review and meta-analysis was conducted on studies that examined the acute effects of ED consumption on systolic blood pressure (SBP), diastolic blood pressure (DBP), resting heart rate, cardiac output (CO), endothelial function, and QT/QTc interval in healthy adults. Data Sources The databases PubMed, EMBASE, Cochrane, LILACS, Web of Science, SportDiscus, and the gray literature were searched to identify randomized controlled trials (RCTs). Data Extraction Two independent evaluators screened 2014 studies and extracted relevant data from those selected for the analysis. A risk of bias assessment was also performed with the RoB 2 tool and a strength of evidence assessment was performed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Data Analysis A total of 17 RCTs were included in the meta-analysis. With regard to risk of bias, 11 studies were rated as having "some concerns" and 6 as "high risk of bias." The consumption of EDs increased SBP, DBP, and CO in different time frames. More pronounced effects were seen on SBP at 60-80 minutes (4.71 mmHg; 95% CI: 2.97–6.45; GRADE: moderate), DBP at 120 minutes (4.51 mmHg; 95% CI: 2.60–6.42; GRADE: low), and CO at 30-40 minutes after consumption (0.43 L; 95% CI: 0.08–0.77; GRADE: very low). The effects of ED consumption on resting heart rate and QT/QTc interval were not significant (P ≤ 0.05). The assessment of endothelial function effects was not performed due to the absence of any RCTs meeting the inclusion criteria. Conclusions Acute consumption of EDs increases SBP, DBP, and CO in healthy adults. However, no alterations were observed in other cardiovascular parameters. The results should be interpreted with caution due to the limited number of studies included in the analysis. Systematic Review Registration PROSPERO registration no. CRD42022295335. [ABSTRACT FROM AUTHOR]

Background: The bed bath is an important part of nursing care. There are few studies evaluating the effects of traditional and dry bed baths on patients. Aim: This study was performed with the aim of investigating the effect of traditional and dry bed baths given to intensive care unit patients on the patients' hemodynamic parameters, the duration of the bathing procedure and the cost of consumable items. Methods: This was a randomized crossover clinical trial and a prospective study. The study was conducted in a General Surgery Intensive Care Unit with 22 intensive care patients aged 18 and over, who had a nursing diagnosis of bathing personal care deficiency. Each patient was given two types of bed baths at an interval of 24 h: a traditional bed bath and a dry bed bath performed with single‐use tissues. Immediately before each bath, in the 5th, 10th and 15th minute of bathing, immediately after bathing and 30 min after bathing, body temperature, heart rate, blood pressure, breathing rate and peripheral oxygen saturation measurement changes over time were compared within the group using the Friedman test. The Wilcoxon signed ranks test was used to compare the variables of bathing duration and bathing consumable item costs between the bathing procedures. Results: It was found that at the completion of traditional and dry bed bathing, the participants' body temperature, blood pressure, heart rate and breathing rate parameters were statistically significantly lower than before bathing, whereas peripheral oxygen saturation values showed a significant increase (p < 0.05). It was found that the dry bed bath took a statistically significantly shorter time than the traditional bed bath and that the cost of consumable bathing materials was less (p < 0.05). Conclusions: It was concluded that traditional and dry bed baths given to intensive care patients affected their hemodynamic parameters and that the dry bed bath was superior to the traditional bed bath in that it took less time and that it cost less. Summary statement: What is already known about this topic? Traditional and dry bed baths are personal care procedures that are frequently carried out by nurses with patients in intensive care units.Bed baths may affect the hemodynamic parameters of patients in intensive care units, but few studies have evaluated their effects.Determination of the hemodynamic parameters of patients during bed baths, the duration of bathing and the cost of consumable bathing materials may help nurses to achieve patients' body hygiene in a more reliable way and to decide on and adopt measures to minimize risks. What this paper adds? This paper contributes to the performance of personal hygiene. It is necessary to closely monitor the hemodynamic parameters of intensive care patients when they are being given bed baths.This study has direct effects in awakening nurses to the potential risk of bed baths causing a change in hemodynamic parameters in intensive care patients and in taking measures to reduce these risks to a minimum. Also, giving dry bed baths, which are superior in taking less time and having lower costs, provides advantages to nurses in terms of work load, physical difficulties and finance. The implications of this paper: This study emphasizes the positive impacts of dry bed baths carried out by nurses for patients in intensive care units.The dry bed bath can be accepted as enhancing patient safety by being easy to perform and by shortening the time when the patient is exposed to environmental risks. [ABSTRACT FROM AUTHOR]

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Objectives: This study aimed to assess the acute impact of distinct loading breathing types and intensities on cardiac autonomic function and hemodynamic responses in healthy young adults. Methods: A randomized, crossover trial involved 28 participants who underwent inspiratory resistive breathing, expiratory resistive breathing (ERB) and combined resistive breathing, each at 30% and 60% of maximal respiratory pressures. Data on heart rate variability (HRV) and hemodynamic parameters were collected during each trial. Results: The study revealed significant main and interaction effects for both the performed task and the intensity across all measured variables (all p < 0.001). ERB at 60% load demonstrated significantly higher HRV values in the standard deviation of normal‐to‐normal RR intervals, the square root of the mean squared difference of successive normal‐to‐normal RR intervals and high‐frequency power, as well as significantly lower values in heart rate, stroke volume, stroke volume index, cardiac output, cardiac index, end‐diastolic volume and end‐diastolic volume index, compared to other loaded protocols (all p < 0.001). Conclusion: These findings highlight the acute effect of type‐specific and load‐dependent resistive breathing on cardiac autonomic and hemodynamic functions, where ERB at 60% intensity showed the most significant cardiovagal modulation while causing the least hemodynamic alterations. [ABSTRACT FROM AUTHOR]

This study was conducted to investigate the systemic hemodynamic and vascular changes in women during and after two commonly used clinical blood flow restriction (BFR) pressures at rest. There are minimal data regarding the independent effects of BFR on hemodynamic and systemic vascular changes due to pressor response, particularly among women. Therefore, this study investigated BFR‐induced alterations in pressor response and systemic flow redistribution at rest during two commonly used pressures (50% and 80% limb occlusion pressure [LOP]). Fifteen women (22.1 ± 4.2 years) completed two randomised sessions involving 8‐min of bilateral, lower limb restriction at 50% or 80% LOP followed by 8‐min of recovery post‐deflation. Changes in vascular (arterial diameter [DIA], time‐averaged mean velocity [TAMV], volume flow [VF], and area) and hemodynamic (heart rate [HR] and blood pressure) measures over time (pre‐, during, post‐occlusion) and by session (50% vs. 80% LOP) were tested using repeated measures analysis of variance. Repeated measures correlations (rrm) quantified common intraindividual associations between BFR‐induced hemodynamic and vascular responses. HR increased from baseline during 50% LOP and remained elevated during recovery (p < 0.05). HR increased from baseline during 80% LOP, while tibial VF and TAMV decreased (p < 0.03 for all). HR and TAMV values returned to baseline during recovery, while brachial artery VF decreased (p < 0.05). Changes in HR, brachial VF, and brachial TAMV were similar between 50% and 80% LOP (rrm = 0.32–0.70, p < 0.05 for all). At 80% LOP, changes in HR were positively correlated with brachial VF (rrm = 0.38) and TAMV (rrm = 0.43) and negatively correlated with tibial VF (rrm = −0.36) and TAMV (rrm = −0.30) (p < 0.05 for all). Results suggest that BFR at 80% LOP elicits an acute systemic pressor reflex without concomitant increases in brachial arterial flow, while 50% LOP elicits a subdued response. [ABSTRACT FROM AUTHOR]

Skull pin insertion causes hypertension and tachycardia that adversely affects cerebral hemodynamics. We compared the efficacy of sterile silicone studs (SS) and pin site infiltration with lidocaine in attenuation of the sympathetic response to skull pin insertion. Adult patients (N = 120) undergoing supratentorial craniotomy under general anesthesia were randomized to receive either medical-grade sterile SS or 2 mL of 2% plain lidocaine infiltration at each pin site. Hemodynamic (heart rate and mean arterial pressure) response to skull pin insertion at baseline and at 0, 1, 2, 3, and 5 minutes after skull pin insertion was compared. Requirement of rescue analgesia (fentanyl), complications such as pin-site bleeding, and surgeon satisfaction score were assessed. Heart rate in the lidocaine group was significantly greater at 0, 1, 2, 3, and 5 minutes after pin insertion compared with the SS group (P < 0.05). Mean arterial pressure was also significantly higher in the lidocaine group at 0, 1, 2, and 3 minutes after pin insertion (P = 0.001, P = 0.01, P = 0.034, and P = 0.042) compared with the SS group. The number of patients requiring fentanyl [17/60 (28.3%) vs. 40/60 (66%), P = 0.001] was lower in the SS group. The incidence of pin site bleeding was also lower in the SS group, and surgeon satisfaction score was greater. Sterile SS appear to be more effective than lidocaine infiltration in attenuating the hemodynamic response to skull pin insertion with minimal adverse effects. Further multicenter studies are necessary to conclusively establish the safety and efficacy of sterile SS. [ABSTRACT FROM AUTHOR]

Background: The establishment of pneumoperitoneum has impacts on patient's cardiovascular function. In this study, the respiratory variation of inferior vena cava (IVC), stroke volume (SV) index, and other parameters was monitored to determine how the pneumoperitoneum affects the patient's hemodynamic and acknowledge how to resolve it. Materials and Methods: Fifty-five patients were randomly divided into Group A (8 mmHg), Group B (10 mmHg), Group C (12 mmHg), Group D (14 mmHg), and Group E (12 mmHg, infusion with 7 mL/kg crystalloid solution). The parameters including IVC variability, SV index, mean artery pressure (MAP), heart rate (HR), cardiac output index (CI), and airway pressure were measured, to compare the changes before and after pneumoperitoneum. Results: Among Group A, Group B, Group C, and Group D, there were no significant differences in patients' prepneumoperitoneum information. Compare with prepneumoperitoneum, the difference in IVC variability, SV index, MAP, HR, CI, and airway pressure was statistically significant (P < 0.05). After the establishment of pneumoperitoneum, the difference in IVC variability, SV index, and airway pressure among Group A, Group B, Group C, and Group D was statistically significant (P < 0.05). Compare with Group C, the change rates of IVC variability, SV index, MAP, HR, and CI were smaller in Group E (P < 0.05). Conclusion: The establishment of pneumoperitoneum could increase the patient's IVC variability and reduce SV index, and with the increase of pressure, IVC variability had an increasing trend, SV index had a decreasing trend. Fluid transfusion could reduce the relative influence of the pneumoperitoneum. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of dexmedetomidine and propofol on hemodynamics, stress response and immune function in children undergoing liver mass resection. Methods: The random number table method was used, 90 children who underwent elective liver mass resection in our hospital from May 2021 to April 2023 were divided into dexmedetomidine group (dexmedetomidine anesthesia) and propofol group (propofol anesthesia), 45 cases in each group. The changes of hemodynamics [heart rate (HR), mean arterial pressure (MAP)], stress response [cortisol (Cor), adrenocorticotropic hormone (ACTH)] and T lymphocyte subsets [CD4+, CD8+, CD4+/CD8+] were compared between two groups, and the incidence of adverse reactions during anesthesia was observed. Results: MAP in dexmedetomidine group was lower than that in propofol group at 10 min after anesthesia induction (T1) to the end of operation (T4), and HR was higher than that in propofol group(P<0.05). Cor and ACTH in dexmedetomidine group were lower than those in propofol group at T4 and 1 day after operation (T5) (P<0.05). CD8+ in dexmedetomidine group was lower than that in propofol group at T4 and T5, while CD4+ and CD4+/CD8+ were higher than those in propofol group (P<0.05). There was no difference in the incidence of adverse reactions between two groups(P>0.05). Conclusion: Compare with propofol anesthesia, dexmedetomidine can better stabilize hemodynamics, reduce stress response, and reduce immunosuppression in children undergoing liver mass resection. [ABSTRACT FROM AUTHOR]

Introduction: Stress response to surgery is characterized by increase in secretion of endocrinal system and activation of immunological and sympathetic nervous system. Alpha 2-adrenoceptor agonists have several beneficial actions during the perioperative period. They decrease sympathetic tone, with attenuation of the neuroendocrine and hemodynamic responses to anaesthesia and surgery; reduce anaesthetic and opioid requirements; and cause sedation and analgesia. Aims and objectives; The objective of this study is to evaluate the intra-operative, and postoperative haemodynamic stress responses in patients, when Dexmedetomidine is used as an anaesthetic adjunct. Materials and Method: After the approval from Ethical Committee of Guntur medical college, Guntur, A.P, 100 patients scheduled for elective surgery planned to be done under general anaesthesia were included in the study.Patients were randomly divided into two equal groups, according to the study drug administered, each group include 50 patients in number (n=50), group I (the control or placebo group) and group II (Dexmedetomidine group). Patients received either Dexmedetomidine hydrochloride (available as 100 μg/ml ) in group II or saline solution in group I in equal amount. Data were collected and entered into the software STATA (version 11.0). P<0.05 was considered significant and P>0.05 was considered insignificant. Results: There was no significant difference in the base line parameters among the groups. Dexmedetomidine decreased heart rate significantly compared to control group. Dexmedetomidine reduced the intraoperative use of Propofol and Fentanyl significantly compared to control group. Conclusion: The perioperative infusion of Dexmedetomidine appears to be effective to attenuate stress induced haemodynamic fluctuation, reduced Propofol requirements, decreased the intra and post-operative narcotic analgesic administration, produced perioperative sedation in patients who underwent elective surgeries when compared with placebo. [ABSTRACT FROM AUTHOR]

Background: Laryngoscopy and intubation are almost always associated with an increased sympathetic activity. To attenuate the pressor response, various drugs have been tried. This study aimed at finding out the different doses of clonidine in attenuating the hemodynamic response to laryngoscopy and intubation in patients posted for any elective surgery under general anaesthesia. Material and methods: This was a prospective, comparative, observational study, which involved two groups of patients. Each group had 30 patients, Group A (n=30) received injection Clonidine 1µg/kg diluted to 10 ml of normal saline and group B (n=30) received injection Clonidine 2µg/kg diluted to 10 ml normal saline intravenously. Patients were observed for 10 minutes. Baseline data of heart rate, mean arterial blood pressure, rate pressure product, respiratory rate, and sedation score were noted. All the parameters were recorded at different intervals up to 10 minutes after intubation. Results were compiled and statistically analysed. Result: In group B, following laryngoscopy and intubation, there is more decrease in HR, MAP, RPP at 2 minutes and 3 minutes after intubation from baseline values compared to group A, which was statistically significant (p<0.01). So, there is more attenuation of hemodynamic response in group B as compare to group A. Conclusion: Clonidine 2 µg/kg was found to be marginally superior to Clonidine 1 µg/kg for attenuation of sympathetic response without any adverse effects. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to research the effect of different bed head angles on the hemodynamic parameters of intensive care patients lying in the supine position. Methods: This study was a non‐randomized and non‐controlled, quasi‐experimental repeated measures study. The study was conducted with 50 intensive care patients aged 18 and over in a general surgery intensive care unit in Turkey. With each patient in the supine position, the bed head was raised to an angle of 0°, 20°, 30°, and 45° without a pillow, and the hemodynamic parameters of central venous pressure, systolic and diastolic blood pressure, heart rate, breathing rate, and peripheral oxygen saturation were recorded after 0 and 10 min. Results: It was found that the mean central venous pressure value measured at min 0 and 10 was higher when the intensive care patients' bed head angle was raised to 45° than when the bed head was at an angle of 0° or 20° (p <.05). It was found that the patients' other hemodynamic parameters were not affected by different bed head angles. Conclusions: It was concluded as a result of this research that in intensive care patients in the supine position, only central venous pressure was affected by bed head angle, and that central venous pressure measurement can be reliably made at a bed head angle of 30°. [ABSTRACT FROM AUTHOR]

Background: Cerebrovascular autoregulation (CAR) is often impaired in preterm infants but requires invasive mean arterial blood pressure (MABP) measurements for continuous assessment. We aimed to assess whether using heart rate (HR) results in different CAR assessment compared with using MABP. Methods: We compared CAR (moving window correlation-coefficient with cerebral oxygenation saturation (rcSO2)), and percentage of time with impaired CAR (%timeCARi) calculated by either HR (TOHRx, tissue oxygenation heart rate reactivity index) or MABP (COx, cerebral oximetry index) during the first 72 h after birth, and its association with short-term cerebral injury. Results: We included 32 infants, median gestational age of 25 + 5/7 weeks (interquartile range 24 + 6/7–27 + 5/7). COx and TOHRx correlation coefficients (cc) were significantly different in the first two days after birth (individual means ranging from 0.02 to 0.07 and −0.05 to 0.01). %TimeCARi using MABP (cc cut-off 0.3), was higher on day 1 (26.1% vs. 17.7%) and day 3 (23.4% vs. 16.9%) compared with HR (cc cutoff −0.3). During 65.7–69.6% of the time, both methods indicated impaired CAR simultaneously. The aforementioned calculations were not associated with early cerebral injury. Conclusions: In conclusion, HR and MABP do not seem interchangeable when assessing CAR in preterm infants. [ABSTRACT FROM AUTHOR]

Arterial compliance (AC) plays a crucial role in vascular aging and cardiovascular disease. The ability to continuously estimate aortic AC or its surrogate, pulse pressure (PP), through wearable devices is highly desirable, given its strong association with daily activities. While the single-site photoplethysmography (PPG)-derived arterial stiffness indices show reasonable correlations with AC, they are susceptible to noise interference, limiting their practical use. To overcome this challenge, our study introduces a noise-resistant indicator of AC: Katz's fractal dimension (KFD) of PPG signals. We showed that KFD integrated the signal complexity arising from compliance changes across a cardiac cycle and vascular structural complexity, thereby decreasing its dependence on individual characteristic points. To assess its capability inmeasuring AC,we conducted a comprehensive evaluation using both in silico studies with 4374 virtual human data and real-world measurements. In the virtual human studies, KFD demonstrated a strong correlation with AC (r = 0.75), which only experienced a slight decrease to 0.66 at a signal-to-noise ratio of 15dB, surpassing the best PPG-morphology-derived AC measure (r = 0.41) under the same noise condition. In addition, we observed that KFD's sensitivity to AC varied based on the individual's hemodynamic status,whichmay further enhance the accuracy of AC estimations. These in silico findings were supported by real-world measurements encompassing diverse health conditions. In conclusion, our study suggests that PPGderived KFD has the potential to continuously and reliably monitor arterial compliance, enabling unobtrusive and wearable assessment of cardiovascular health. [ABSTRACT FROM AUTHOR]

Background/Aims: The growing prevalence of sedentary behaviour across the life course is linked to an increased risk of chronic venous disease and related mortality, warranting the need for non-invasive interventions to improve blood flow and lower extremity function. The aim of this study was to investigate the change in venous blood flow, heart rate and blood pressure after 8 minutes of using the Leeper device, Circulation Booster and light intensity walking. Methods: A quasi-experimental crossover study involving 11 participants (eight women, three men, mean age 23.91 years, standard deviation 1.04 years) was conducted using Leeper and Circulation Booster devices and light intensity walking. During each intervention, participants exercised for 8 minutes, and blood flow was recorded at 0, 4 and 8 minutes. Heart rate and blood pressure were recorded at 0 and 8 minutes. Blood flow was the primary outcome measure, and heart rate and blood pressure were secondary outcomes. Participants rested for 10 minutes between exercise. A two-way repeated measures analysis of variance was used to analyse the effect of intervention and time on blood flow, blood pressure and heart rate. Results: There was no significant interaction between intervention and time on blood flow (P=0.180) indicating that blood flow did not change over time depending on intervention. There was no significant main effect of time on blood flow (P=0.206), indicating that no intervention caused a significant increase or decrease in blood flow after 8 minutes of exercise. Conclusions: The interventions involving the Leeper and Circulation Booster devices and light intensity walking did not appear to significantly increase blood flow in young adults. Further studies involving participants from older age groups and those with pathological interventions are warranted to examine the potential effectiveness of these interventions. Implications for practice: The findings may assist with the advice that allied health professionals provide regarding the use of seated exercise trainers and EMS devices and their ability to influence changes in blood flow. [ABSTRACT FROM AUTHOR]

Pulse wave encephalopathy (PWE) is hypothesised to initiate many forms of dementia, motivating its identification and risk assessment. As candidate pulsatility based biomarkers for PWE, pulsatility index and pulsatility damping have been studied and, currently, do not adequately stratify risk due to variability in pulsatility and spatial bias. Here, we propose a locus-independent pulsatility transmission coefficient computed by spatially tracking pulsatility along vessels to characterise the brain pulse dynamics at a whole-organ level. Our preliminary analyses in a cohort of 20 subjects indicate that this measurement agrees with clinical observations relating blood pulsatility with age, heart rate, and sex, making it a suitable candidate to study the risk of PWE. We identified transmission differences between vascular regions perfused by the basilar and internal carotid arteries attributed to the identified dependence on cerebral blood flow, and some participants presented differences between the internal carotid perfused regions that were not related to flow or pulsatility burden, suggesting underlying mechanical differences. Large populational studies would benefit from retrospective pulsatility transmission analyses, providing a new comprehensive arterial description of the hemodynamic state in the brain. We provide a publicly available implementation of our tools to derive this coefficient, built into pre-existing open-source software. [ABSTRACT FROM AUTHOR]

The progress in research on the physiology of the cardiovascular system made in the last 100 years allowed for the development of the pathogenesis not only of secondary forms of hypertension but also of primary hypertension. The main determinants of blood pressure are described by the relationship between stroke volume, heart rate, peripheral resistance, and arterial stiffness. The theories developed by Guyton and Folkow describe the importance of the volume factor and total peripheral resistance. However, none of them fully presents the pathogenesis of essential hypertension. The multifactorial model of primary hypertension pathogenesis developed by Irving Page in the 1940s, called Page's mosaic, covers most of the pathophysiological phenomena observed in essential hypertension. The most important pathophysiological phenomena included in Page's mosaic form a network of interconnected "nodes". New discoveries both from experimental and clinical studies made in recent decades have allowed the original Page mosaic to be modified and the addition of new pathophysiological nodes. Most of the clinical studies confirming the validity of the multifactorial pathogenesis of primary hypertension concern adults. However, hypertension develops in childhood and is even perinatally programmed. Therefore, the next nodes in Page's mosaic should be age and perinatal factors. This article presents data from pediatric clinical trials describing the most important pathophysiological processes associated with the development of essential hypertension in children and adolescents. [ABSTRACT FROM AUTHOR]

The purpose of this study was to assess the effects of a child-specific school-based high-intensity interval training (HIIT) implemented into physical education (PE) classes on various hemodynamic parameters and heart rate variability indices. Forty-six students (age 11 ± 1 year) were randomized into an intervention (INT n = 22) and a control group (CON n = 24). During a 12-week period, the INT and CON groups participated in regular PE twice weekly (45-90 minutes). The INT group received HIIT during the first 20 minutes of the 2 PE classes. Systolic and diastolic blood pressure, total peripheral resistance, aortic pulse wave velocity (aPWV), heart rate, SD of normal to normal heartbeat intervals, the root mean square of successive differences between normal heartbeats (RMSSD), the proportion of differences between adjacent normal to normal heartbeat intervals of more than 50 ms, low-frequency power, high-frequency power, and the LF/HF ratio were assessed before and after the experimental period. A p value ≤0.05 was considered statistically significant. Forty students (20 INT; 20 CON) were included in the analysis. A significant time x group interaction was detected for aPWV(p = 0.05, η² = 0.099), RMSSD (p = 0.010, η² = 0.161), low-frequency power (p = 0.009, η² = 0.165), high-frequency power (p < 0.001, η² = 0.272), and the LF/HF ratio (p < 0.001, η² = 0.354). The INT group revealed significant improvements for the respective parameters. School-based HIIT can induce improvements in cardiovascular parameters. These results highlight the potential of embedding HIIT within the school setting, offering a time-efficient exercise intervention. [ABSTRACT FROM AUTHOR]

Organized trauma systems reduce morbidity and mortality after serious injury. Rapid transport to high-level trauma centers is ideal, but not always feasible. Thus, interhospital transfers are an important component of trauma systems. However, transferring a seriously injured patient carries the risk of worsening condition before reaching definitive care. In this study, we evaluated characteristics and outcomes of patients whose hemodynamic status worsened during the transfer process. We conducted a retrospective cohort study using data from the Pennsylvania Trauma Outcomes Study database from 2011 to 2018. Patients were included if they had a heart rate ≤ 100 and systolic blood pressure ≥ 100 at presentation to the referring hospital and were transferred within 24 h. We defined hemodynamic deterioration (HDD) as admitting heart rate > 100 or systolic blood pressure < 100 at the receiving center. We compared demographics, mechanism of injury, injury severity, management, and outcomes between patients with and without HDD using descriptive statistics and multivariable regression analysis. Of 52,919 included patients, 5331 (10.1%) had HDD. HDD patients were more often moderately-severely injured (injury severity score 9-15; 40.4% versus 39.4%, P < 0.001) and injured via motor vehicle collision (23.2% versus 16.6%, P < 0.001) or gunshot wound (2.1% versus 1.3%, P < 0.001). HDD patients more often had extremity or torso injuries and after transfer were more likely to be transferred to the intensive care unit (35% versus 28.5%, P < 0.001), go directly to surgery (8.4% versus 5.9%, P < 0.001), or interventional radiology (0.8% versus 0.3%, P < 0.001). Overall mortality in the HDD group was 4.9% versus 2.1% in the group who remained stable. These results were confirmed using multivariable analysis. Interhospital transfers are essential in trauma, but one in 10 transferred patients deteriorated hemodynamically in that process. This high-risk component of the trauma system requires close attention to the important aspects of transfer such as patient selection, pretransfer management/stabilization, and communication between facilities. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Negative pressure breathing is breathing with decreased pressure in the respiratory tract without lowering pressure acting on the torso. We lowered air pressure only during inspiration (NPBin). NPBin, used to increase venous return to the heart, is considered a countermeasure against redistribution of body fluids toward the head during spaceflight. We studied NPBin effects on circulation in healthy humans with an emphasis on NPBin-induced oscillations of hemodynamic parameters synchronous with breathing. We propose an approach to analyze the oscillations based on coherent averaging. METHODS: E ight men ages 24-42 yr participated in the NPBin and control series. During the series, to reproduce fluids shift observed under microgravity, subjects were supine and head down (-8°). Duration of NPBin was 20 min, rarefaction -20 cm H2O. Hemodynamic parameters were measured by Finometer. Electrical impedance measurements were used to estimate changes in blood filling of cerebral vessels. RESULTS: Mean values of hemodynamic parameters virtually did not change under NPBin, but NPBin induced oscillations of the parameters synchronous with respiration. Peak-to-peak amplitude under NPBin were: mean arterial pressure, 4 ± 1 (mmHg); stroke volume, 7 ± 3 (mL); and heart rate, 4 ± 1 (bpm). Electrical impedance of the head increased during inspiration. The increase under NPBin was three times greater than under normal breathing. DISCUSSION: A nalysis of oscillations gives more information than analysis of mean values. NPBin induces short-term decrease in left ventricle stroke volume and arterial blood pressure during each inspiration; the decrease is compensated by increase after inspiration. NPBin facilitates redistribution of body fluids away from the head. [ABSTRACT FROM AUTHOR]

Rotary blood pumps (RBPs) operating at a constant speed generate non-physiologic blood pressure and flow rate, which can cause endothelial dysfunction, leading to adverse clinical events in peripheral blood vessels and other organs. Notably, pulsatile working modes of the RBP can increase vascular pulsatility to improve arterial endothelial function. However, the laws and related mechanisms of differentially regulating arterial endothelial function under different pulsatile working modes are still unclear. This knowledge gap hinders the optimal selection of the RBP working modes. To address these issues, this study developed a multi-element in vitro endothelial cell culture system (ECCS), which could realize in vitro cell culture effectively and accurately reproduce blood pressure, shear stress, and circumferential strain in the arterial endothelial microenvironment. Performance of this proposed ECCS was validated with numerical simulation and flow experiments. Subsequently, this study investigated the effects of four different pulsation frequency modes that change once every 1-4-fold cardiac cycles (80, 40, 80/3, and 20 cycles per min, respectively) of the RBP on the expression of nitric oxide (NO) and reactive oxygen species (ROS) in endothelial cells. Results indicated that the 2-fold and 3-fold cardiac cycles significantly increased the production of NO and prevented the excessive generation of ROS, potentially minimizing the occurrence of endothelial dysfunction and related adverse events during the RBP support, and were consistent with animal study findings. In general, this study may provide a scientific basis for the optimal selection of the RBP working modes and potential treatment options for heart failure. [ABSTRACT FROM AUTHOR]

Purpose: Sedentary behavior may contribute to increased central wave reflection due to associated peripheral vasoconstriction, yet its impact on central hemodynamics and the mitigating effects of interventional strategies have not been thoroughly investigated. We tested whether standing or seated elliptical breaks alleviate the deleterious effects of prolonged sitting on central wave reflections. Methods: Eighteen healthy adults (9 9 females, 25 ± 3 yr) completed three 3-h protocols on separate days: uninterrupted sitting, sitting with periodic standing, and sitting with periodic seated elliptical activity. Central wave reflection, central pulse wave velocity, and lower-limb pulse wave velocity were measured before and after each intervention. Results: Central relative wave reflection magnitude (RM) increased during sitting (0.31 ± 0.05 to 0.35 ± 0.05; P <0.01) but did not change after standing (0.30 ± 0.05 to 0.32 ± 0.04; P = 0.19) or elliptical protocols (0.30 ± 0.05 to 0.30 ± 0.04; P > 0.99). The change in RM during prolonged sitting (ARM) was attenuated with elliptical activity (0.04 ± 0.05 vs 0.00 ± 0.03; P = 0.02) but not with periodic standing (0.04 ± 0.04 vs 0.02 ± 0.05; P = 0.54). In addition, augmentation index and central pulse wave velocity increased after sitting (both P < 0.01) and periodic standing (both P < 0.01) but were unchanged after elliptical activity. Lower limb pulse wave velocity did not change after sitting (P = 0.73) or standing (P = 0.21) but did decrease after elliptical activity (P = 0.03). Conclusions: Prolonged sitting without interruptions increased central wave reflection, whereas elliptical but not standing interruptions were able to ameliorate multiple sitting-induced vascular consequences. More work is required to examine the long-term effectiveness of interruption strategies, as well as the optimal type, frequency, and duration for reducing vascular risk associated with sedentary behaviors. [ABSTRACT FROM AUTHOR]

Purpose: This study tested the hypothesis that blood pressure responses would increase relative to force production in response to prolonged bouts of muscular work. Methods: Fifteen individuals performed two minutes of static handgrip (SHG; 35% MVC), followed by three minutes of post-exercise-cuff-occlusion (PECO), before and after thirty minutes of rest (control), or rhythmic handgrip exercise (RHG) of the contralateral and ipsilateral forearms. Beat-by-beat recordings of mean arterial pressure (MAP), heart rate (HR), and handgrip force (kg) were averaged across one-minute periods at baseline, and minutes 5, 10, 15, 20, 25, and 30 of RHG. MAP was also normalized to handgrip force, providing a relative measure of exercise pressor responses (mmHg/kg). Hemodynamic responses to SHG and PECO were also compared before and after contralateral RHG, ipsilateral RHG, and control, respectively. Similar to the RHG trial, areas under the curve were calculated for MAP (blood pressure index; BPI) and normalized to the time tension index (BPInorm). Results: HR and MAP significantly increased during RHG (15.3 ± 1.4% and 20.4 ± 3.2%, respectively, both p < 0.01), while force output decreased by up to 36.6 ± 8.0% (p < 0.01). This resulted in a 51.6 ± 9.4% increase in BPInorm during 30 min of RHG (p < 0.01). In contrast, blood pressure responses to SHG and PECO were unchanged following RHG (all p ≥ 0.07), and only the mean HR (4.2 ± 1.5%, p = 0.01) and ΔHR (67.2 ± 18.1%, p < 0.01) response to SHG were exaggerated following ipsilateral RHG. Conclusions: The magnitude of exercise pressor responses relative to force production progressively increases during, but not following, prolonged bouts of muscular work. [ABSTRACT FROM AUTHOR]

Purpose: Self-myofascial release (SMR) is a form of self-massage aiming to release tension, improve blood flow, and alleviate muscle soreness. This study aimed to determine whether a single session of SMR could impact cardiovascular parameters at rest and during a cold pressor test (CPT). Methods: Twenty male participants (aged 26 ± 2 years) underwent a 20-min SMR and a 20-min seated control condition (CON) on two separate test days in a randomized order. Peripheral and central blood pressure (BP), total peripheral resistance (TPR), pulse wave velocity (PWV), heart rate (HR), root mean square of successive RR interval differences (RMSSD), and the quotient of low-frequency power and high-frequency power (LF/HF) were measured both at rest and during a CPT before (t0), 2 min (t1), and 20 min (t2) after the SMR and CON. Results: Time × condition interactions could be detected for peripheral and central diastolic BP, TPR, HR, and RMSSD. Following the SMR, peripheral diastolic BP, central diastolic BP, TPR, and RMSSD were reduced, while HR was increased compared to the CON. Regarding the CPT time × condition interactions could be detected for peripheral, and central diastolic BP, with lower values after SMR. Conclusion: The results of the present study suggest that a single bout of SMR confers favorable cardiovascular benefits in healthy normotensive individuals. Furthermore, SMR can attenuate the hemodynamic reactivity to a stress test. Future research should address whether regular SMR leads to chronic adaptations similar to regular, moderate aerobic exercise, massage therapy, and static stretching. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac autonomic system functioning may be altered by obesity leading to cardiovascular diseases and associated complications. Military police officers are exposed to traditional and occupational risk factors for the development of CVD, however data on the cardiovascular health in this population is still scarce. Aim: In this cross-sectional study, we investigated the impact of obesity on cardiac autonomic modulation and the hemodynamic profile in male active-duty military police officers. Methods: The body composition of the volunteers was assessed by octapolar electrical bioimpedance. Participants were classified as non-obese or obese in accordance with their body fat, with further subgroups as physically active obese or insufficiently active obese using International Physical Activity Questionnaire (IPAQ). Cardiac autonomic modulation was assessed by heart rate variability and the automatic oscillometric method allowed us to assess hemodynamic features. Results: 102 military police officers from the state of São Paulo participated in the study. Cardiac autonomic modulation revealed significant impairment in time and frequency domains and non-linear methods in the obese group compared to the non-obese (p < 0.05). A higher physical activity level did not alter these results in the obese group. However, no significant differences in the hemodynamic profile were observed between groups (p > 0.05). Conclusion: These findings suggest a negative association between obesity and cardiac autonomic modulation in military police officers, unaffected by increased physical activity. [ABSTRACT FROM AUTHOR]

Introduction: Smoke from traditional cigarettes and e-cigarette aerosols have distinct chemical compositions that may impact blood pressure (BP) and heart rate (HR) differently. Aims: This study compared the impact of nicotine-containing e-cigarettes (EC+) versus nicotine-free (EC−) on BP, HR and endothelial markers, and assessed if EC+ posed fewer risks than tobacco cigarettes (TC). Methods: Electronic databases were searched from inception until November 2023 for studies reporting changes in systolic and diastolic BP (SBP, DBP) and HR and endothelial parameters before and after the use of EC+, EC− and TC. Data were analyzed using weighted mean differences (WMDs) and 95% confidence intervals (CIs). Results: Fifteen studies (n = 752) were included in our meta-analysis. We demonstrate that EC+ significantly increased systolic BP (WMD = 3.41, 95% CI [0.1,6.73], p = 0.04], diastolic BP (WMD = 3.42, 95% CI [1.75, 5.09]; p < 0.01], and HR (WMD = 5.36 BPM, 95% CI [1.87, 8.85]; p < 0.01) compared to EC−. However, EC+ was observed to cause less detrimental effect on SBP (WMD = − 4.72 mmHg, 95% CI [− 6.58, − 2.86], p < 0.01), and HR (WMD = − 3.11 BPM, 95% CI [− 4.54, − 1.68]; p < 0.01) as compared to TC with no difference on DBP (WMD = − 1.14 mmHg, 95% CI [− 2.38, 0.1]; p = 0.07). EC+ also led to greater deterioration of endothelial parameters as compared to EC− but to a lesser degree as compared to TC. Conclusion: EC+ shows greater impairment in hemodynamic and endothelial parameters than EC− but less than TC. Additional studies are needed to evaluate prolonged effects of EC use. [ABSTRACT FROM AUTHOR]

We investigated the angiogenesis‐modulating ability of noscapine in vitro using osteosarcoma cell line (MG‐63) and in vivo using a zebrafish model. MTT assay and the scratch wound healing assay were performed on the osteosarcoma cell line (MG‐63) to analyze the cytotoxic effect and antimigrative ability of noscapine, respectively. We also observed the antiangiogenic ability of noscapine on zebrafish embryos by analyzing the blood vessels namely the dorsal aorta, and intersegmental vessels development at 24, 48, and 72 h postfertilization. Real‐time polymerase chain reaction was used to analyze the hypoxia signaling molecules' gene expression in MG‐63 cells and zebrafish embryos. The findings from the scratch wound healing demonstrated that noscapine stopped MG‐63 cancer cells from migrating under both hypoxia and normoxia. Blood vessel development and the heart rate in zebrafish embryos were significantly reduced by noscapine under both hypoxia and normoxia which showed the hemodynamics impact of noscapine. Noscapine also downregulated the cobalt chloride (CoCl2) induced hypoxic signaling molecules' gene expression in MG‐63 cells and zebrafish embryos. Therefore, noscapine may prevent MG‐63 cancer cells from proliferating and migrating, as well as decrease the formation of new vessels and the production of growth factors linked to angiogenesis in vivo under both normoxic and hypoxic conditions. [ABSTRACT FROM AUTHOR]

Internal carotid artery (CA) stenosis is a primary etiological factor for stroke and transient ischemic attack. The severity of arterial stenosis significantly impacts patient health and treatment decisions. Therefore, we conducted computational fluid dynamics analyses on five carotid arteries (CAs) of severe stenosis and compared them with five CAs in the control group. We improved the three-element Windkessel model method by pre-calculating the constant-pressure outlet simulation of the first cardiac cycle, which accelerated the stability of the model. The research results show that vortices were observed at the bifurcation of the CAs in the control group, whereas in the severe stenosis group, vortices predominantly occurred within the carotid sinus downstream of the stenotic segment. Notably, the vortex flow in the carotid aneurysm downstream of the stenotic segment arises due to the cross-sectional constriction induced by stenosis, which always flows in a clockwise direction and may contribute to the formation of aneurysms distal to the stenotic region. A high time-averaged wall shear stress value can effectively identify the stenosis site of CAs, while a high relative residence time value marks the protrusion near the stenosis segment. This study delved into the hemodynamic parameters between the CAs of the severe stenosis group and the control group and provided robust clinical evidence for carotid atherosclerotic disease. [ABSTRACT FROM AUTHOR]

Aim: To evaluate how preoperative anxiety affects hemodynamic parameters in patients who were undergoing surgery and to evaluate for the rise in blood pressure and heart rate in patients with higher preoperative anxiety. Methodology: 60 patients were observed for the hemodynamic changes due to anxiety in preoperative period, before induction and after induction. The anxiety scores were analysed and tabulated. Result: Preoperative anxiety has a significant impact on heart rate, systolic blood pressure, diastolic blood pressure and SpO2 of the study participants. Conclusion: During pre-operative period there is no impact of anxiety on hemodynamic parameters. But before induction there was significant impact of anxiety on heart rate, systolic blood pressure, diastolic blood pressure and SpO2. [ABSTRACT FROM AUTHOR]

Background: In laparoscopic surgeries, pneumoperitoneum results in tachycardia, hypertension, and increased myocardial oxygen demand. These changes are more pronounced in hypertensive patients. The intravenous administration of dexmedetomidine attenuates sympathoadrenal response and provides better hemodynamic stability intraoperatively. Aims:To evaluate the hemodynamic stabilizing properties of two different doses of dexmedetomidine including 0.6 µg.kg-1.h-1 and 0.2 µg.kg-1.h-1 in patients undergoing laparoscopic surgeries. Methods:A total of 60 patients posted for laparoscopic surgeries under general anesthesia were randomly assigned into two groups of 30 each. Group A and B received loading dose of dexmedetomidine 1 µg.kg-1 over 10 min and maintenance dose at 0.2 and 0.6 µg.kg-1.h-1, respectively. Hemodynamic parameters (heart rate and mean arterial pressure) and intra operative propofol requirement were monitored. Results:Fluctuations in the hemodynamics of patients were effectively attenuated by dexmedetomidine and there is no difference in the attenuation of these hemodynamic changes by maintenance dose of 0.2 or 0.6 µg.kg-1.h-1. Conclusions: Dexmedetomidine administered as infusion in a maintenance dose of 0.6 µg.kg-1.h-1 serves as an ideal anesthetic adjuvant in patients undergoing laparoscopic surgeries. [ABSTRACT FROM AUTHOR]

Introduction: Virtual reality (VR) exercises are reportedly beneficial as a physical activity tool for health promotion and rehabilitation, and can also help individuals exercise under professional supervision. We developed and investigated the potential feasibility of a VR-based aerobic exercise program using the XBOX ONE console and Kinect sensor with real-time pulse rate monitoring. The VR setting consisted of two-dimensional (2D) environments via computer, laptop, or television screens. In addition, the study investigated the potential feasibility of the VR-based exercise program on hemodynamic response and arterial stiffness in healthy participants of various ages. Methods: Healthy participants (n = 30) aged > 18 years were enrolled in the VR exercise-based program. All participants were required to wear a polar heart rate (HR) monitor set for moderate-intensity exercise, targeting 40%-59% of their HR reserve. Hemodynamic and arterial stiffness (pulse wave velocity) were noninvasively measured. The Borg scale rate of perceived exertion (RPE) was also assessed. Results: Following a VR-guided exercise routine, all participants performed moderate-intensity exercise with no adverse health outcomes during or after the exercise. The effects of VR-based aerobic exercise extended beyond enhanced central hemodynamic and arterial stiffness. However, neither hemodynamic nor arterial stiffness showed significant differences before and after the VR exercise, except for a higher RPE response following the exercise program. Conclusion: VR-based aerobic exercise with pulse rate monitoring is a promising physical activity tool to induce physiological changes and impact dyspnea scales and is also feasible for administration to healthy populations. [ABSTRACT FROM AUTHOR]