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Background: Previous investigations have suggested beneficial effects of fresh versus stored red blood cell transfusion in critically ill patients. The present study investigates the effects of red blood cell storage time on the clinical course and hemodynamic and laboratory parameters in patients with septic shock. Patients and Methods: 18 patients with septic shock received 2 erythrocyte units stored for ≤ 7 days (n = 8) or > 7 days (n = 10). The sequential organ failure assessment (SOFA) score was calculated for 7 days. Hemodynamic parameters (cardiac index, extravascular lung water) were determined using transpulmonary thermodilution. Laboratory parameters (lactate, base excess, C-reactive protein, procalcitonin, IL-1β, IL-6, TNF-α, sVCAM-1, sICAM-1) were monitored before and 1, 3, 6, 12, 24, and 48 h after transfusion. The Mann-Whitney-U test and Neumann test were used for group comparison and trend assessment, respectively. Results: We failed to observe significant differences with respect to SOFA scores between patients receiving fresh or stored erythrocytes. However, a significant trend towards an improvement in the SOFA score was found in the group receiving fresh erythrocytes (p < 0.01). No significant differences in hemodynamic or laboratory parameters were found between both groups. Conclusion: While the present findings do not provide clear-cut evidence supporting beneficial effects of fresh red blood cells in septic shock, they warrant larger randomized studies to confirm or refute such effects. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

A fused hierarchical neural networks (FHNNs) is proposed for applications mainly related to diagnosis and fault detection. The benefit of such a model is well demonstrated by applying FHNNs for cardiovascular disease (CVD) diagnosis hierarchically using hemodynamic parameters (HDPs) derived from non-invasive sphygmogram (SPG). Patients' medical records with diagnostic results confirmed by doctors obtained from two hospitals in China are used to test and verify FHNNs. Variance analysis is used to categorize HDPs according to the importance/relevance based on their influence on discriminating diseases. Different neural networks structures are tested in diagnosing CVD so as to choose the optimal sub neural networks (sub-NNs) for the proposed FHNNs. Finally FHNNs with fused sub-NNs for CVD diagnosis is presented. The validity and effectiveness in the improvement of accuracy is witnessed clearly from the testing results. [ABSTRACT FROM PUBLISHER]

Objective: In this study, patients admitted with the diagnosis of Eisenmenger syndrome (ES) in a tertiary referral center were analyzed. Methods: The data of 20 consecutive patients (mean age: 27.6+1.8 years, 7 male and mean follow-up time: 35.6±9.1 months) with ES were retrospectively analyzed. Demographic characteristics, symptoms, physical examination, laboratory and hemodynamic parameters were analyzed at the time of first admission. Results: The most frequent underlying heart diseases were ventricular septal defect (VSD) with complex congenital disease (n:8, 40%) and isolated VSD (n:7, 35%). 6-minute walking test distance was 347.9±33.7 meters and 15 patients (75%) had a functional capacity of NYHA Class III, at the time of admission. ES was diagnosed with catheterization in all patients and mean systolic pulmonary arterial pressure measured by catheterization was 112±6.8 mmHg. Pulmonary function tests, FVC (forced vital capacity), FEV1 (forced expiratory volume), FEV1/FVC values were respectively, 3.1±0.4, 2.5±0.4 L and 76.7±3.3%. Metabolic tests were performed in all patients at the first visit. Mean VO2 max was 16.7 ±1.0 ml / kg/min and VE/VCO2 rate was 53.9±3.2%. Although PH and partial pressure of carbon dioxide levels were within normal range in blood gas analysis, oxygen saturation and partial pressure of oxygen levels were low. Conclusion: The most common underlying heart disease of ES patients is VSD. In this cases exercise capacity is restricted and this restriction is reflected in laboratory parameters. [ABSTRACT FROM AUTHOR]

Geometrical changes of blood vessels, called aneurysm, occur often in humans with possible catastrophic outcome. Then, the blood flow is enormously affected, as well as the blood hemodynamic interaction forces acting on the arterial wall. These forces are the cause of the wall rupture. A mechanical quantity characteristic for the blood–wall interaction is the wall shear stress, which also has direct physiological effects on the endothelial cell behavior. Therefore, it is very important to have an insight into the blood flow and shear stress distribution when an aneurysm is developed in order to help correlating the mechanical conditions with the pathogenesis of pathological changes on the blood vessels. This insight can further help in improving the prevention of cardiovascular diseases evolution. Computational fluid dynamics (CFD) has been used in general as a tool to generate results for the mechanical conditions within blood vessels with and without aneurysms. However, aneurysms are very patient specific and reliable results from CFD analyses can be obtained by a cumbersome and time-consuming process of the computational model generation followed by huge computations. In order to make the CFD analyses efficient and suitable for future everyday clinical practice, we have here employed data mining (DM) techniques. The focus was to combine the CFD and DM methods for the estimation of the wall shear stresses in an abdominal aorta aneurysm (AAA) underprescribed geometrical changes. Additionally, computing on the grid infrastructure was performed to improve efficiency, since thousands of CFD runs were needed for creating machine learning data. We used several DM techniques and found that our DM models provide good prediction of the shear stress at the AAA in comparison with full CFD model results on real patient data. [ABSTRACT FROM AUTHOR]

In this paper, the hemodynamics in a three-dimensional out-of-plane sequential bypass graft model is first investigated. Based on the advantageous flow characteristics observed within the side-to-side (STS) anastomosis in the sequential bypass graft simulation, a new CABG coupled-sequential anastomosis configuration is designed, entailing coupled STS and end-to-side (ETS) anastomotic components. In this new CABG design, the flow fields and distributions of various wall shear stress parameters within the STS and ETS anastomotic regions are studied, and compared to those of the conventional distal anastomosis, by means of computational fluid dynamics simulation of pulsatile Newtonian blood flow. Simulation results demonstrate that the new sequential anastomoses model provides: (i) a more uniform and smooth flow at the ETS anastomosis, without any stagnation point on the artery bed and vortex formation in the heel region of the ETS anastomosis within the coronary artery; (ii) a spare route for the blood flow to the coronary artery, to avoid re-operation in case of re-stenosis in either of the anastomoses; and (iii) improved distribution of hemodynamic parameters at the coronary artery bed and in the heel region of the ETS anastomosis, with more moderate shear stress indices. These advantages of the new design over the conventional ETS anastomosis are influenced by the occlusion ratio of the native coronary artery, and are most prominent when the proximal segment of the coronary artery is fully occluded. By varying the design parameters of the anastomotic angle and distance between the two anastomoses, the superior coupled STS-ETS anastomoses design is found to have the anastomotic angle of 30° and 30 mm distance between the two (STS and ETS) components. [ABSTRACT FROM AUTHOR]

Ventricular remodeling is an independent risk factor for many cardiovascular events. Inhibiting ventricular remodeling early may be an effective way to postpone heart failure for patients with cardiovascular illness. The study was designed to examine the effect of sodium houttuyfonate on ventricular remodeling induced by pressure overload in rats, as well as to explore the mechanisms involved. The model rats in which ventricular remodeling was induced abdominal aortic banding (AAB) were randomly divided into 4 groups: AAB control, AAB plus captopril (40 mg/kg), AAB plus low dose of sodium houttuyfonate (50 mg/kg), and AAB plus high dose of sodium houttuyfonate (100 mg/kg). One month after operation, hemodynamic parameters, heart mass indexes, size of cardiomyocytes, myocardial collagen volume, angiotensin II content in ventricular tissue, and serum concentrations of aldosterone and tumor necrosis factor (TNF)-α were evaluated. Sodium houttuyfonate significantly reduced heart mass indexes, the size of cardiomyocytes, and the myocardial collagen volume and decreased the levels of angiotensin II, aldosterone, and TNF-α. At the high dose, it decreased blood pressure and heart rate. In conclusion, sodium houttuyfonate attenuates ventricular remodeling induced by pressure overload in rats. The beneficial effects are in part associated with its alleviating the activation of renin-angiotensin-aldosterone system and decreasing the TNF-α level. Furthermore, its function seems to correlate with reduced blood pressure and heart rate. Le remodelage ventriculaire est un facteur de risque indépendant pour un grand nombre d’événements cardiovasculaires. L’inhibition précoce du remodelage ventriculaire pourrait être un moyen efficace de retarder l’insuffisance cardiaque chez les patients souffrant de maladies cardiovasculaires. La présente étude a eu pour but d’examiner les mécanismes de l’houttuyfonate sodique ainsi que son effet sur le remodelage ventriculaire induit par une surcharge de pression chez les rats. Après l’induction du remodelage ventriculaire par un cerclage aortique abdominal, on a réparti les rats modèles aléatoirement dans 4 groupes: groupe témoin, groupe captopril (40 mg/kg), groupe ayant reçu une faible dose (50 mg/kg) de houttuyfonate sodique et groupe ayant reçu une forte dose (100 mg/kg). Un mois après l’opération, on a évalué les paramètres hémodynamiques, les indices de masse cardiaque, la taille des cardiomyocytes, le volume de collagène myocardique, la concentration d’angiotensine II dans le tissu ventriculaire, et les concentrations sériques d’aldostérone et de facteur de nécrose tumorale (TNF)-α. Le houttuyfonate sodique a diminué de manière significative les indices de masse cardiaque, la taille des cardiomyocytes, le volume de collagène myocardique, ainsi que les taux d’angiotensine II, d’aldostérone et de TNF-α. À la dose la plus élevée, il a diminué la pression artérielle et la fréquence cardiaque. En conclusion, le houttuyfonate sodique atténue le remodelage ventriculaire induit par une surcharge de pression chez le rats. Les effets bénéfiques sont en partie associés à sa capacité d’atténuer l’activation du système rénine-angiotensine-aldostérone et de diminuer le taux de TNF-α. De plus, il semble y avoir une corrélation entre sa fonction et la réduction de la pression artérielle et de la fréquence cardiaque. [ABSTRACT FROM AUTHOR]

Abstract: The present study was designed to evaluate the cardioprotective potential of salvianolic acid A on isoproterenol-induced myocardial infarction in rats. Hemodynamic parameters and lead II electrocardiograph were monitored and recorded continuously. Cardiac marker enzymes and antioxidative parameters in serum and heart tissues were measured. Assay for mitochondrial respiratory function and histopathological examination of heart tissues were performed. Isoproterenol-treated rats showed significant increases in the levels of lactate dehydrogenase, aspartate transaminase, creatine kinase and malondialdehyde and significant decreases in the activities of superoxide dismutase, catalase and glutathione peroxidase in serum and heart. These rats also showed declines in left ventricular systolic pressure, maximum and minimum rate of developed left ventricular pressure, and elevation of left ventricular end-diastolic pressure and ST-segment. In addition, mitochondrial respiratory dysfunction characterized by decreased respiratory control ratio and ADP/O was observed in isoproterenol-treated rats. Administration of salvianolic acid A for a period of 8 days significantly attenuated isoproterenol-induced cardiac dysfunction and myocardial injury and improved mitochondrial respiratory function. The protective role of salvianolic acid A against isoproterenol-induced myocardial damage was further confirmed by histopathological examination. The results of our study suggest that salvianolic acid A possessing antioxidant activity has a significant protective effect against isoproterenol-induced myocardial infarction. [Copyright &y& Elsevier]

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Background and Purpose: If clip application or coil placement for treatment of intracranial (IC) aneurysms is not feasible, the parent vessel can be occluded to induce thrombosis of the aneurysm. In the case that such an occlusion cannot be tolerated without subsequent sequel, the additional construction of an extracranial (EC)-IC bypass is needed for sufficient ipsilateral revascularization. Hitherto, the effectiveness of this combined treatment option was not investigated in a controlled randomized trial or in a review. The aim of the current report was to analyze clinical effectiveness of EC-IC bypass for cerebral revascularization in patients with Hunterian ligation in case of otherwise untreatable aneurysm of the anterior cerebral circulation. Special reference was given to different hemodynamic subgroups. Methods: A computerized database search was conducted from November 1985 to November 2002 using MEDLINE, relevant Internet sources, and full-text journal articles using appropriate indexed terms. Journal of Neurosurgery, Neurosurgery, Acta Neurochirurgica, and Stroke were manually searched for the period November 1985 to November 2002 and checked reference lists of all relevant articles for additional eligible studies. Language restriction was done for English, French, and German. Reports dealing with EC-IC bypass surgery for cerebral revascularization in case of aneurysm of the anterior cerebral circulation were reviewed when appropriate. Studies were included that contained evaluable data on clinical state, preoperative and postoperative hemodynamic state, surgical outcome, and follow-up. A statistical analysis was performed for different outcome parameters and clinical effectiveness in the included studies. Results: Overall, 20 studies were included, each with a study quality of 0-1. The postoperative outcome related to death or stroke depended mainly on preoperative hemodynamic subgroups (cerebral blood flow [CBF]/cerebral blood volume [CBV]; oxygen extraction fraction [OEF]). The final functional status was worse the more CBF/CBV ratio and OEF increased. Perioperative risk for death (0.8%) or stroke (1.5%) during the first month after operation was similar to the death or stroke rate during the following 2 to 12 months after operation. Neurologic function was improved over the preoperative state in 74% of the patients and was unchanged in 9%. The modified Rankin scale score was postoperatively 0 to 1 in 81% and 2 in 6% of the patients. Long-term patency was excellent, with 2.3% failure rate per year after the first year after surgery. There was no de novo aneurysm formation in the follow-up. Conclusion: Neurologic function and subsequent stroke attributable to hemodynamic insufficiency in patients with otherwise untreatable IC aneurysm improves significantly by EC-IC bypass surgery if the brain area corresponding to the impaired neurologic function remains viable. The hemodynamic parameters observed for patients who experience improved neurologic function or diminished stroke risk profile after EC-IC bypass surgery contain both significantly elevated OEF and CBF/CBV. Therefore, hemodynamic state represents an important indicator for EC-IC bypass surgery. The large amount of data leads to narrow stroke with no significant heterogeneity, and the overall results are, therefore, likely to be statistically robust. [Copyright &y& Elsevier]

As hemodynamics is widely believed to correlate with anastomotic stenosis in coronary bypass surgery, this paper investigates the flow characteristics and distributions of the hemodynamic parameters (HPs) in a coronary bypass model (which includes both proximal and distal anastomoses), under physiological flow conditions. Disturbed flows (flow separation/reattachment, vortical and secondary flows) as well as regions of high oscillatory shear index (OSI) with low wall shear stress (WSS), i.e., high-OSI-and-low-WSS and low-OSI-and-high-WSS were found in the proximal and distal anastomoses, especially at the toe and heel regions of distal anastomosis, which indicate highly suspected sites for the onset of the atherosclerotic lesions. The flow patterns found in the graft and distal anastomoses of our model at deceleration phases are different from those of the isolated distal anastomosis model. In addition, a huge significant difference in segmental averages of HPs was found between the distal and proximal anastomoses. These findings further suggest that intimal hyperplasia would be more prone to form in the distal anastomosis than in the proximal anastomosis, particularly along the suture line at the toe and heel of distal anastomosis. [ABSTRACT FROM AUTHOR]

Summary: Background: We evaluated the effect of dexmedetomidine infusion on rocuronium dose requirement, haemodynamic parameters, and the recovery of neuromuscular blockade during sevoflurane anaesthesia in patients. Material: This randomized study was conducted on 40 ASA I–II patients. Neuromuscular block was measured by stimulation of the ulnar nerve and acceleromyograph of adductor pollicis muscle. After tracheal intubation; patients received either 1.0μ/kg over 10min followed by a maintenance 0.2μg/kg/h of dexmedetomidine (Group D)(n=20) or the same volume saline infusion (Group C)(n=20). After this, 0.6mg/kg rocuronium was given to all patients. The incremental doses of rocuronium (0.15mg/kg) were repeated to maintain muscle relaxation at the level of with T1 just positive or maximum up to 10% of its control. The variables recorded were times to recovery of T1 to 25%, 75%, and 90% of control and total dose of rocuronium used during surgery. Heart rate, and mean arterial pressure were recorded. The extubation criteria were adequate recovery of neuromuscular function as judged by TOF ratio >0.95. Results: There were significant decreases in heart rate, and mean arterial pressure in group D 15min after intubation. The times to T1 of 25% was also significantly longer in the dexmedetomidine group (54±13 vs 35±6.7min, respectively, p=0.001). There were no significant variables in recovery time between groups (T1 25–75%, 14.5±6.8 vs 12±5min, respectively, p=0.193). The time required to a 90%T1 recovery was significantly longer in the dexmedetomidine group (86±29.2 vs 58±15.3min, respectively, p=0.005). The total dose requirement of rocuronium was significantly lower in the dexmedetomidine group (61.5±4.65 vs 74±5.21mg respectively, p=0.001). Conclusion: We concluded that dexmedetomidine infusion reduced rocuronium dose requirement, decreased hemodynamic parameters during sevoflurane anaesthesia. [Copyright &y& Elsevier]

Background Persistent poor patency rates of arteriovenous fistulae and bridge grafts for dialysis access prompted us to investigate whether flow parameters derived from an initial postconstruction, precannulation duplex study could predict access longevity or direct remedial procedures to salvage nonmaturing conduits.Methods We analyzed 125 consecutive dialysis access conduits (34 forearm fistulae, 53 arm fistulae, 38 prosthetic bridge grafts, 108 patients, 82 male/26 female, average age 58 years) over the past 5 years having early (2 to 8 weeks) duplex scanning done prior to attempted hemodialysis cannulation. Velocity waveforms were recorded in the arterial inflow, arterial and venous anastomoses, mid-conduit, and in the venous outflow with averaging of volume flow rate (product of average velocity and cross-sectional area) measured at 3 mid-conduit sites. Conduits were deemed "adequate" for dialysis cannulation or "nonmaturing" by the presence of detected high-grade stenoses (peak systolic velocity >400cm/s, velocity ratio >3, and minimal diameter <2 to 3 mm) and subjected to remedial interventions (endovascular or open). Subsequent access function for hemodialysis use and late patency were recorded and correlated with early duplex findings.Results Average flow rates (forearm fistula 784 ± 623 mL/min, arm fistula 1400 ± 850, bridge graft 1270 ± 604) and mid-conduit peak-systolic velocities (215 ± 214 cm/s forearm fistula vs 312 ± 194 arm fistula) differed between conduit type and location. Remedial interventions were needed in 10 (26%) bridge grafts and 18 (21%) fistulae "nonmaturing" due to occlusive lesions. Conduit flow rates differentiated "nonmaturing" (606 ± 769 mL/min) and "maturing" (1140 ± 857) fistulae (P = .01). A threshold conduit flow rate of 800 mL/min better discriminated failing and functional fistulae and bridge grafts (accuracy 77%) than a flow rate greater or less than 500 mL/min (accuracy 67%). Remedial interventions doubled average flow rates of "nonmaturing" accesses (from 605 to 1159 mL/min) to values similar to "mature, functional" conduits (1374 mL/min) and facilitated a mean duration of patency (12.9 months) equivalent to conduits not needing remedial interventions (11.5 months).Conclusions Duplex-derived hemodynamic parameters characterized early dialysis access conduit function, prognosticated access patency, guided necessary remedial interventions, and facilitated favorable access longevity. [ABSTRACT FROM AUTHOR]

The objective of our study was to evaluate hemodynamic effects and the cardiac function after very early extubation within the first 6 hours after open-heart surgery in children. During a 12-month period, we performed a retrospective study of 50 children (ages 3 months to 7 years) admitted to the pediatric intensive care unit immediately after minor cardiac surgery. All children were extubated within the first 6 hours after their arrival. Arterial blood and central venous pressure were monitored, and arterial blood gas analysis was performed. Cardiac index, stroke volume index, systemic vascular resistance index, and extravascular lung water index were measured by thermodilution. Early extubation of children after minor open-heart surgery with cardiopulmonary bypass is safe and does not affect cardiac functions. A slight decrease of arterial oxygen tension not resulting in respiratory or metabolic acidosis or reintubation was noted. Very early extubation in children after open-heart surgery does not promote cardiodepressive effects. It is a safe procedure that helps to reduce the unnecessary and prolonged mechanical ventilation of children after cardiopulmonary bypass surgery. [ABSTRACT FROM AUTHOR]

Abstract: We have studied some hemodynamic parameters as heart rate (HR) developed pressure (DP) and maximal positive values of the first derivative of pressure (+dP/dt max) in isolated heart from control or resveratrol treated rats. In acute ex vivo experiments, resveratrol (1–100μM) infusion in Langendorff perfused hearts did not affect contractile function in either normoxic conditions or after ischemia/reperfusion. However when semi-chronically administered by IP injection during 7 days, resveratrol which had no effect on pre-ischemic heart greatly improved post-ischemic indexes of myocardial function. Resveratrol effect is dose-dependent and seemed optimal at a plasma level of 18.5μM. This concentration is very close to that previously shown to be optimal and non-toxic by others. These beneficial effects of resveratrol are only partly explained by its antioxidant properties as suggested by the lack of any dose–response effect on tissue malondialdehyde (MDA) levels. They are also clearly not mediated by nitric oxide (NO) elevation. When acutely infused resveratrol had no beneficial effect and therefore could not be proposed in acute scenarios of ischemia/reperfusion or stroke. However resveratrol appeared as an efficient and promising molecule in the prevention of heart dysfunction. [Copyright &y& Elsevier]

Abstract: The aim of this study was to test the effects of age and chronic exercise training on antioxidant and heat shock protein (Hsp) expression by comparing the hearts of young (Y), sedentary old (SO) and trained old (TO) rats. In SO rats, there were: (a) changes in myocardial structure and function; (b) increased malondialdehyde levels; (c) no changes in superoxide-dismutase (SOD) enzymes; (d) reduced Hsp70 expression; and (e) increased Hsp27 expression. In TO rats, SOD enzymes and Hsp70 expression were increased and Hsp27 was further increased. Malondialdehyde level did not differ between TO and SO rats, which shows that chronic exercise did not affect the peroxidation index. In summary, by increasing Hsp27 and Hs70 levels, prolonged exercise partially counterbalanced the heart age-related effects in the antioxidant system without altering peroxidation levels. These findings suggest that the beneficial effects on aged-related cardiovascular changes could be connected to the “anti-oxidant” effects of prolonged exercise training. [Copyright &y& Elsevier]

Abstract: The neuropeptide FF (NPFF) antagonist desaminotyrosyl-Phe-Leu-Phe-Gln-Pro-Gln-Arg-NH2 dose-dependently reversed NPFF-induced elevation of blood pressure in anesthetized rats after intravenous injection without causing a significant change of blood pressure and heart rate by itself. However, another antagonist dansyl-Pro-Gln-Arg-NH2 produced a significant drop of the mean arterial pressure only at a large dose (10μmol/kg body weight), but reversal of the NPFF-induced hypertension was modest. Consequently and contrary to the conclusions of a previous study, NPFF antagonists cannot be identified simply by measuring the changes in the hemodynamic parameters upon the injection of the compounds alone and without a subsequent NPFF challenge. [Copyright &y& Elsevier]

Hemodynamic parameters using Swan Ganz catheter were studied in 17 patients with end stage renal disease. The acute effects of radiocephalic AV fistula on the hemodynamic parameters were studied at 24 hours of surgery. The chronic effects were studied in 8 of these patients at 6 weeks of arteriovenous(AV) fistula. The AV fistula matured in 3 to 4 weeks time and blood flow was sufficient for hemodialysis(400 mL/min). Patients with chronic renal failure had normal or high normal hemodynamic parameters. Six weeks after the AV fistula, the cardiac index and the stroke volume index slightly increased along with a significant increase in systolic and mean systemic arterial pressure. None of the patients had significant increase in cardiac filling pressures. Although there was some fall in systemic vascular resistance index and rise in cardiac index and stroke volume index, these changes were physically small and unlikely to put any extra hemodynamic load. Thus, AV fistula in dialysis patients is not an appreciable cause of circulatory or pulmonary congestion. [ABSTRACT FROM AUTHOR]

Abstract Background: The aim of this study was to investigate the effects of extraperitoneal laparoscopy and carbon dioxide insufflation on hemodynamic parameters, arterial blood gases and complications in urethrocystopexy operations. Methods: Twenty-five female patients who underwent extraperitoneal laparoscopic mesh urethrocystopexy operation for the correction of urinary incontinence were allocated to the study. Hemodynamic parameters were noted and blood gas analyzes were performed before the induction of anesthesia, 10 min after induction, 5 and 10 min after the beginning of carbon dioxide insufflation, at the end of carbon dioxide insufflation and 30 min after exsufflation. Results: There was no significant change in mean arterial pressure, peripheral oxygen saturation, arterial carbon dioxide pressure, and arterial oxygen saturation compared to preinsufflation and preinduction values. End-tidal carbon dioxide pressure did not increase above 45 mm/Hg during carbon dioxide insufflation. Arterial oxygen saturation and partial oxygen pressure did not decrease. Subcutaneous emphysema, pneumothorax, pneumomediastinum and pleural effusion were not noted in any patient. Conclusion: We conclude that, extraperitoneal laparoscopic urethrocystopexy is not associated with hemodynamic and respiratory impairment. [ABSTRACT FROM AUTHOR]

Cardiovascular health is currently assessed through a variety of hemodynamic parameters, many of which can only be determined by invasive measurement often requiring hospitalization. A noninvasive method of evaluating several of these parameters such as systemic vascular resistance (SVR), maximum left ventricular elasticity E_LV end diastolic volume VED and cardiac output, is presented. The method has three elements: (1) a distributed model of the human cardiovascular system (Ozawa [et_al.], Ann. Biomed. Eng. 29:284–297, 2001) to generate a solution library that spans the anticipated range of parameter values, (2) a method for establishing the multidimensional relationship between features computed from the arterial blood pressure and/or flow traces (e.g., mean arterial pressure, pulse amplitude, mean flow velocity) and the critical hemodynamic parameters, and (3) a parameter estimation method that yields the best fit between measured and computed data. Sensitivity analyses were used to determine the critical parameters, and the influence of fixed model parameters. Using computer-generated brachial pressure and velocity profiles (which can be measured noninvasively), the error associated with this method was found to be less than 3% for SVR, and less than 10% for ELV and VED Simulations were also performed to test the ability of the approach to predict changes in SVR and ELV from an initial base line state. © 2002 Biomedical Engineering Society. PAC2002: 8719Hh, 8719Uv [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to examine which hemodynamic parameters change under the natural volume overload of pregnancy. Study Design: 46 healthy pregnant women were echocardiographically examined during the course of pregnancy. To evaluate left ventricular diastolic function, mitral inflow and pulmonary venous flow profiles were used. Fractional shortening and left ventricular muscle mass were calculated. Results: In the course of pregnancy the left ventricular muscle mass index increased (from 66 ± 6 to 96 ± 9 g/m[sup 2] ), fractional shortening decreased (from 38 ± 4 to 32 ± 6%) and a disturbed diastolic relaxation pattern was documented. Eight weeks after delivery, all left ventricular systolic and diastolic functional parameters returned to normal values. Conclusion: The natural volume overload in pregnancy leads to a reversible ‘physiological’ left ventricular hypertrophy, a short-term decrease in systolic function and a significant change in left ventricular diastolic function.Copyright © 2002 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Tumor necrosis factor-α (TNF-α) release has been implicated in a sepsis-like syndrome following cardiopulmonary bypass (CPB). This also may be important in patients who have had a left ventricular assist device (LVAD) implanted. This report investigates the effect of reducing systemic blood flow on hemodynamic response, mixed venous oxygen saturation (Svo2), and the release of TNF-α. LVADs were implanted in 9 pigs. The aorta was clamped, and thus the LVAD flow represented the entire systemic blood flow. Plasma TNF-α in the femoral artery (FA) and superior mesenteric vein (SMV) was measured at baseline and following systemic blood flow changes. Simultaneously, hemodynamic parameters and oxygen saturation in the pulmonary artery (Svo2) were measured. Following reductions in systemic blood flow, plasma TNF-α increased gradually to a maximum level at a systemic blood flow of 20%. There was no significant difference between TNF-α levels in the SMV and the FA. There was a significant (p < 0.05) correlation between cardiac index, stroke volume index, and TNF-α. The Svo2 decreased significantly (p < 0.05) at a systemic blood flow of 30 and 20%. A rise in TNF-α occurred when the Svo2 was less than 75%. The data demonstrate that a reduction in systemic blood flow causes an increase in plasma TNF-α. This can lead to the development of a sepsis-like syndrome in a group of patients who already are hemodynamically compromised. While weaning short-term LVAD support, rapid diminution of the cardiac output and the pump flow must be avoided. [ABSTRACT FROM AUTHOR]

Objective: Excess production of nitric oxide (NO) by inducible NO synthase (iNOS) has been implicated in the pathophysiology of septic shock. This study was designed to see whether S-methylisothiourea sulfate (SMT), a selective inhibitor for iNOS, prevents cardiovascular changes and multiple organ damage in the canine endotoxic shock model.Design: Prospective, comparable, experimental study.Setting: Laboratory at a university hospital.Subjects: Twenty male mongrel dogs were studied under pentobarbital anesthesia.Interventions: Dogs were divided into three groups: bacterial lipopolysaccharide (LPS) group (n = 7) receiving continuous infusion of LPS (2 mg/kg/h for 1 h); LPS plus SMT group (n = 7) receiving LPS and SMT (1 mg/kg, bolus i. v., followed by continuous infusion of 1 mg/kg/h for 1 h); and vehicle plus SMT group (n = 6).Measurements and Results: Hemodynamics, blood gas parameters, and urine output were measured during 6 h observation periods. Serum levels of lactate, transaminases, and bilirubin were measured at baseline, 1 and 6 h. Creatinine and free water clearance, urine sodium excretion and fractional excretion of sodium were calculated. LPS caused a profound hypotension associated with decreases in cardiac output and oxygen delivery, lactic acidosis, renal and liver dysfunction, and thrombocytopenia. SMT prevented the LPS-induced hypotension and renal dysfunction, whereas it did not affect the LPS-induced decreases in cardiac output or oxygen delivery, hyperlactatemia, liver dysfunction, or thrombocytopenia. SMT alone had no appreciable effects on hemodynamics, blood gases, liver or renal functions.Conclusions: These findings show that SMT improves renal, but not hepatic dysfunction, in dogs with endotoxic shock, suggesting that iNOS-derived NO plays differential roles in sepsis-associated multiple organ dysfunction. [ABSTRACT FROM AUTHOR]

Open chest surgery in rodents requires assisted breathing and the most common approach for ventilation is via an endotracheal tube. Even with well-trained operators the endotracheal intubation is technically challenging and may lead to prolonged procedures and endotracheal intubation complications. Nose cone ventilation is a simpler procedure compared to endotracheal intubation and has the potential to improve animal welfare by reducing procedure time and endotracheal intubation associated complications. Rats are obligate nose breathers, and therefore replacing intubation with air supply from a nose cone would be an advantage and a more natural way of breathing. Here, we compared the values for several blood gases, blood pressure and heart rate from rats that were nose cone ventilated with rats that underwent endotracheal intubation at 12 timepoints equally distributed across three surgical stages: baseline, open chest and closed chest. Throughout the monitoring period the hemodynamic and blood gas values for both methods of ventilation were within published, normal ranges for the rat and were biologically equivalent (equivalence test p value ≤ 0.05). Our data showed that nose cone ventilation-maintained blood gases and hemodynamic homeostasis equivalent to endotracheal intubation. Nose cone ventilation can be recommended as an alternative to endotracheal intubation in rat experiments where investigators require airway control.

Context: Various techniques have been proposed for suturing following prosthetic aortic valve implantation, but each has its potential side effects such as patient-prosthesis mismatch (PPM) and paravalvular leak (PVL)., Aims: In the present study, we aimed to compare the postoperative sequels of aortic valve replacement (AVR) following the use of two suturing techniques including from the inside of the aorta as the common and classic suturing techniques as compared to new approach including from the outside of the aorta., Settings and Design: This cross-sectional study was performed on patients suffering from symptomatic severe aortic valve disease and candidates for AVR in one of three referral hospitals for cardiovascular disease patients in Shiraz from 2019-2021., Subjects and Methods: The patients underwent one of the two considered surgical techniques for AVR including traditional approach ( n = 60) or the tested approach (suturing from the outside of the aorta) ( n = 30)., Statistical Analysis Used: For statistical analysis, results were presented as mean ± standard deviation for quantitative variables and were summarized by frequency (percentage) for categorical variables., Results: PVL and PPM were revealed in none of the participants undergoing the tested approach, while the pointed complications were found in 41.7% and 25.0% of patients underwent traditional approach, respectively, indicating a significant difference. There was no evidence of abnormal dimensionless valve index (DVI) in the patients undergoing sutures from outside the aorta, whereas the rate of DVI abnormality in the patients undergoing traditional procedures was shown to be 18.3%. The mean aortic valve gradient was significantly higher in the group scheduling for the traditional surgical method., Conclusions: Applying new suturing method as suturing from the outside of the aorta, due to the selection of appropriate valve size, the risk for adverse consequences including PPM, PVL, or DVI can be significantly reduced., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Cardiovascular Echography.)

Objectives: Exposures to particulate matter (PM) have been related to increased risk for cardiovascular health effects and can promote cardiac ischemia and oxidative stress. Crocin has strong antioxidant properties and stress-reducing effects. Therefore, this study considered the effect of crocin on cardiovascular parameters in rats exposed to PM 10 ., Materials and Methods: Forty Wistar rats (male, 250-300 g) were grouped as control, receiving normal saline and crocin, receiving PM 10 , receiving PM 10 +Crocin. Instillation of PM 10 into the trachea was done. Forty-eight hours after exposure to the normal saline or PM, the heart was separated. Hemodynamic and electrophysiological factors were measured. The levels of superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase activity (CAT), malondialdehyde (MDA), xanthine oxidase, were evaluated by kits., Results: The voltage of the QRS complex was significantly reduced and PR and QTc intervals increased in PM 10 groups. Hemodynamic parameters before ischemia and in the ischemic-reperfusion stage, in the PM 10 group, showed a significant decrease. In the ischemic hearts of the PM 10 group, a significant decline in the activity of CAT, SOD, and GPx, and a significant increase in MDA and XOX enzymes activity were observed, and crocin improved all of these factors., Conclusion: Cardiac ischemia causes abnormal hemodynamic factors of the heart, which are exacerbated by PM 10 and further reduce the heart's contractile strength. Increased oxidative stress due to PM 10 is probably one of the important reasons for these changes. This study suggests that the use of antioxidants such as crocin improves the cardiovascular adverse effects of myocardial ischemia and PM 10 exposure., Competing Interests: The authors declare no conflicts of interest.

Purpose: To evaluate arterial stiffness using the pulse wave velocity (PWV) and augmentation index (AI) in central retinal vein occlusion (CRVO) patients., Methods: Forty-two CRVO patients (i.e., CRVO group) and 54 healthy controls (i.e., control group) were included in this comparative and cross-sectional study. The PWV, AI and augmentation pressure were measured with a noninvasive, oscillometric method., Results: The mean PWV, AI and augmentation pressure values were significantly higher in CRVO patients than in controls (p = 0.024, p < 0.001 and p = 0.001, respectively). The mean augmentation pressure, AI and PWV measurements were not statistically significant between CRVO patients with and without hypertension (p = 0.856 and p < 0.526, p = 0.432, respectively). Age, presence of hypertension, AI and PWV were found to be as independent risk factors of CRVO development (OR = 2.21, 95% CI [1.44, 3.38] and OR = 2.40, 95% CI [1.50, 3.86], OR = 3.2, 95% CI [1.70, 5.60] and OR = 5.70, 95% CI [2.00, 18.50], respectively)., Conclusion: The AI and PWV values were significantly higher in CRVO patients than in controls. These results indicate that similar abnormalities in the arterial wall structure may play an important role in the pathogenesis of the CRVO and cardiovascular diseases. In addition, our findings show that each patient with RVO should be examined in terms of systemic vascular pathologies., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Scientific evidence has shown that physical exercise is an effective way of improving several cardiovascular disease markers. However, few studies have tested its effectiveness when performed in aquatic environments. The purpose of this study was to test the impact of different aquatic exercise programs on the intima-media thickness of carotid arteries (IMT) and hemodynamic and biochemical markers of cardiovascular diseases in community-dwelling older persons. A total of 102 participants were randomly allocated into four groups: an aerobic exercise group (AerG) ( n = 25, 71.44 ± 4.84 years); an aerobic interval group (IntG) ( n = 28, 72.64 ± 5.22 years); a combined group (ComG) ( n = 29, 71.90 ± 5.67 years); and a control group (CG) ( n = 20, 73.60 ± 5.25 years). The AerG, IntG, and ComG participants took part in three different aquatic exercise programs for 28 weeks. The CG participants maintained their usual routines. All participants were evaluated for IMT, blood pressure, lipid profile, and MCP-1 and MIP-1α chemokines, pre- and post-intervention. Significant differences were found in the AerG for diastolic diameter (DD), in the IntG for peak systolic velocity (PSV), and in the ComG for DD and end-diastolic velocity (EDV). Regarding blood pressure, significant differences were found in AerG for systolic blood pressure (SBP) and diastolic blood pressure (DBP); in IntG for DBP; and in ComG for SBP, DBP, and heart rate (HR). Significant differences were found in the AerG and IntG for glucose (GLU). Lower plasma levels of monocyte chemoattractant protein-1 (MCP-1) and macrophage inflammatory protein (MIP-1α) were found in the AerG and in the ComG for MCP-1 after the intervention. Aquatic physical exercise appears to improve cardiovascular health, regardless of the type of the program adopted. Aerobic programs (combined and continuous aerobic exercises) seemed to have a more beneficial effect in reducing important cardiovascular risk markers.

Background: Refractory septic shock can cause severe morbidities and mortalities in children. Resuscitation based on hemodynamics is important in children with critical illness. Thus, this study aimed to identify the hemodynamics of refractory septic shock associated with poor prognosis at an early stage to allow for timely interventions. Methods: We evaluated children with refractory septic shock admitted to a pediatric intensive care unit (PICU) and monitored their hemodynamics using a pulse index continuous cardiac output (PiCCO) system. The serial cardiac index (CI), systemic vascular resistance index (SVRI), and vasoactive−inotropic score (VIS) were recorded during the first 72 h after PICU admission. Results: Thirty-three children with refractory septic shock were enrolled. The SVRI and VIS were both associated with fatality from septic shock. The non-survivors had lower serial SVRI and higher VIS (both p < 0.05). Based on the area under the ROC curve, the SVRI was the predictor during the early resuscitative stage (first 36 h) in pediatric refractory septic shock. Conclusions: Both SVRI and VIS are predictors of mortality in children with refractory septic shock, and the SVRI is the powerful predictor of mortality in the early resuscitative stage. A low serial SVRI may allow for the early awareness of disease severity and strategies for adjusting vasoactive−inotropic agents to increase the SVRI.

Cardiac Output (CO) is a significant hemodynamic index for the diagnosis and treatment of cardiovascular diseases. Impedance cardiography (ICG) is one of the non-invasive methods widely investigated for its simplicity, cost-effectiveness and ability to measure cardiac output continuously. However, measured ICG signals are contaminated by the respiratory artefact leading to difficulties in determining characteristic points in the signal waveform, thereby lowering the accuracy of measurement results. Thus, suppressing this artefact plays an important role in ICG signal processing. This paper aims to propose a method of noise filtering to improve the quality of the signal as well as a model to evaluate the noise filtering efficiency of the method. The proposed algorithm showed promising results with the output SNR values of 21.99 ± 3.20 dB, 20.40 ± 2.88 dB, 15.57 ± 4.79 dB for normal breathing, forced breathing, and rapid breathing respectively. The root mean square percentage error (RMSPE) values of the output signals processed by the proposed algorithm compared to the standard ICG signal source for normal breathing, forced breathing, and rapid breathing are 24.13 ± 22.66%, 18.09 ± 12.98%, 32.13 ± 20.40% respectively. The quality-enhanced ICG signal could be effective tool for assisting doctors to detect cardiac abnormalities via evaluating the morphology of ICG signal waveforms as well as improving accuracy in calculating beat-to-beat and averaged hemodynamic parameters.

Purpose: Three-dimensional (3D) quantification of circulation using a Finite Elements methodology., Methods: We validate our 3D method using an in-silico arch model, for different mesh resolutions, image resolution and noise levels, and we compared this with a currently used 2D method. Finally, we evaluated the application of our methodology in 4D Flow MRI data of ascending aorta of six healthy volunteers, and six bicuspid aortic valve (BAV) patients, three with right and three with left handed flow, at peak systole. The in-vivo data was compared using a Mann-Whitney U-test between volunteers and patients (right and left handed flow)., Results: The robustness of our method throughout different image resolutions and noise levels showed subestimation of circulation less than 45 cm 2 /s in comparison with the 55cm 2 /s generated by the current 2D method. The circulation (mean ± SD) of the healthy volunteer group was 13.83 ± 28.78 cm 2 /s, in BAV patients with right-handed flow 724.37 ± 317.53 cm 2 /s, and BAV patients with left-handed flow -480.99 ± 387.29 cm 2 /s. There were significant differences between healthy volunteers and BAV patients groups (P-value < .01), and also between BAV patients with a right-handed or left-handed helical flow and healthy volunteers (P-value < .01)., Conclusion: We propose a novel 3D formulation to estimate the circulation in the thoracic aorta, which can be used to assess the differences between normal and diseased hemodynamic from 4D-Flow MRI data. This method also can correctly differentiate between the visually seen right- and left-handed helical flow, which suggests that this approach may have high clinical sensitivity, but requires confirmation in longitudinal studies with a large cohort., (© 2021 International Society for Magnetic Resonance in Medicine.)

• numerical simulation of stent implantation within patient-specific coronary artery. • arterial wall is modelled as a nonlinear, hyperelastic material. • analysis of change of hemodynamic parameters before and after stent implantation. • accuracy demonstrated through validation against follow up clinical data. Stent implantation procedure should be carefully planned and adapted to the particular patient in order to minimize possible complications. Numerical simulations can provide useful quantitative data about the state of the artery after the implantation, as well as information about the benefits of the intervention from the hemodynamical point of view. In this paper, a numerical model for stent implantation is presented. This numerical model simulates the stent expansion, the interaction of the stent with arterial wall and the deformation of the arterial wall under the influence of the stent. FE method was used to perform CFD simulations and the effects of stenting were analyzed by comparing the hemodynamic parameters before and after stent implantation. Clinical data for overall 34 patients was used for the simulations, and for 9 of them data from follow up examinations was used to validate the results of simulations of stent implantation. The good agreement of results (less than 4.1% of SD error for all the 9 validation cases) demonstrated the accuracy of the presented numerical model. The developed approach can be a valuable tool for the improvement of pre-operative planning and patient-specific treatment optimization. [ABSTRACT FROM AUTHOR]

Stress and hemodynamic changes are among the most significant symptoms and signs that could be observed in patients with acute coronary syndrome (ACS) upon admission to the emergency department. The present study was conducted to determine the effect of the fragrance of lemon balm (Melissa Officinalis) essential oil on stress level and hemodynamic parameters in patients with ACS in the emergency department. In this double-blind clinical trial, 72 patients were allocated to two groups of Melissa and placebo based on stratified block random sampling. The Melissa group inhaled two drops of Melissa essential oil, whereas the placebo group inhaled two drops of sunflower oil in two aromatherapy phases for 10 min with 90-min intervals. Stress level was measured using the depression, anxiety and stress scale (DASS-21), and hemodynamic parameters were measured and recorded in six time points by a cardiac monitoring system. Data analysis was carried out using descriptive statistics and ANOVA statistical tests, Chi-square test, independent t -test, and post-hoc Tukey's test. Interaction between the time and group indicated the significant decrease in the mean score of stress and heart rate in the time points 2 and 5 (5 min after every occasion of aromatherapy) (p < 0.001) and also the remarkable decrease in the mean arterial pressure (MAP) in the time point 2 in the Melissa group in comparison with the placebo group (p < 0.001). There were no significant differences between the mean changes in stress, heart rate and MAP in the two group (P > 0.05). Aromatherapy via the inhalation of Melissa essential oil with temporary impacts on certain time points could relieve stress and regulate hemodynamic changes in patients with ACS in emergent and acute conditions. • IInhalation of Melissa oil has a significant effect on decreased acute stress in patients with ACS in the emergency department. • Aromatherapy with Melissa oil has a significant effect on decreased threat perception and pain intensity in patients with ACS. • Aromatherapy with Melissa essential oil might temporarily contribute to stress relief and the regulation of MAP and heart rate. [ABSTRACT FROM AUTHOR]

Background and Purpose: The objective of this study was to identify the morphological and hemodynamic factors associated with the rupture of multiple intracranial aneurysms regardless of patient-related factors and establish a statistical model for aneurysm rupture risk assessment., Methods: The digital subtraction angiography (DSA) data of 104 mirror intracranial aneurysms in 52 consecutive patients were retrospectively analyzed in this study. 21 morphological parameters and hemodynamic parameters were calculated by 3-dimensional reconstruction and computational fluid dynamics (CFD) simulation. Significant differences ( p < 0.05) between the two groups were subsequently tested with the multivariate logistic regression to identify the independent risk factors. A prediction model was established based on the independent risk factors. The receiver operating characteristics (ROCs) were generated to estimate the prediction performance. A cohort of patients with multiple intracranial aneurysms admitted in our institute from January 2021 to October 2021 was introduced to verify the value of the model., Results: Significant differences between the ruptured and unruptured aneurysms were found in 15 out of 19 parameters. Bleb formation, neck width, and size ratio were independent factors in the multivariate logistic regression. A prediction model based on the three independent risk factors was established: Odds = -1.495 - 0.707 × (Neckwidth) + 3.061 × (Blebformation) + 2.1 × (SR) (bleb formation: Yes = 1, No = 0). The area under the curve (AUC) value of the model was 0.901. In the validation cohort, the prediction model showed satisfying performance in assessing multiple aneurysm rupture risk with a sensitivity of 100% and specificity of 88.46%., Conclusion: Bleb formation, neck width, and size ratio were independently associated with aneurysm rupture status. The prediction model may help in identifying the aneurysm with high rupture risk., Competing Interests: XL and JX are employed by company ArteryFlow Technology Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Tang, Zhou, Wen, Wu, Leng, Xiang and Zhang.)

The management of sepsis requires the rapid administration of fluid to support blood pressure and tissue perfusion. Guidelines suggest that patients should receive 30 ml per kg of fluid over the first one to three hours of management. The next concern is to determine which patients need additional fluid. This introduces the concept of fluid responsiveness, defined by an increase in cardiac output following the administration of a fluid bolus. Dynamic tests, measuring cardiac output, identify fluid responders better than static tests. Passive leg raising tests provide an alternative approach to determine fluid responsiveness without administering fluid. However, one small randomized trial demonstrated that patients managed with frequent passive leg raising tests had a smaller net fluid balance at 72 hours and reduced requirements for renal replacement therapy and mechanical ventilation, but no change in mortality. A meta-analysis including 4 randomized control trials reported that resuscitation guided by fluid responsiveness does not improve mortality outcomes in patients with sepsis. Recent studies have demonstrated that the early administration of norepinephrine may improve outcomes in patients with sepsis. The concept of fluid responsiveness helps clinicians analyze the clinical status of patients, but this information must be integrated into the overall management of the patient. This review considers the use and benefit of fluid responsiveness tests to direct fluid administration in patients with sepsis., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Background and Aims: General anesthesia induces endocrine, immunologic, and metabolic responses. Anesthetic drugs affect endocrine system by changing the level of stress hormones and hemodynamic of the patient . The purpose of this study was to compare the effects of propofol and isoflurane on hemodynamic parameters and stress-induced hormones in laparoscopic cholecystectomy (LC) surgery., Material and Methods: Seventy patients of elective LC were included in this study. Patients were randomly divided into two equal groups of 35 patients; group P received propofol (70-120 μg/kg/min) and group I received isoflurane (mac: 1.28%) as anesthesia maintenance. The following parameters were monitored, checked, and recorded from preanesthesia period to 10 min after PACU entry according to a planned method: hemodynamic parameters (heart rate and mean atrial pressure), level of blood sugar, and serum epinephrine level., Results: Heart rate and mean atrial pressure changes did not show significant differences between the two groups in all stage ( P > 0.05), but isoflurane group tolerated lower fluctuating changes. Blood glucose and serum epinephrine level rise in the isoflurane group were significantly higher than the propofol group ( P < 0.05)., Conclusion: Maintenance anesthesia by inhalation gas base on isoflurane has not shown a significant difference with total intravenous anesthesia base on propofol on hemodynamic parameter. However, propofol has a consistent effect on decreasing stress hormone and suggested for LC surgery., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Anaesthesiology Clinical Pharmacology.)

Background: General anesthesia induces endocrine, immunologic, and metabolic responses. Anesthetic drugs affect the endocrine system by changing the level of stress hormones and hemodynamic variables of the patient., Objectives: The purpose of this study was to compare the effects of propofol and dexmedetomidine on hemodynamic parameters and stress-induced hormones in laparoscopic cholecystectomy (LC) surgery., Methods: Seventy patients of elective LC were included in this study. The patients were randomly assigned into two equal groups of propofol (75 µg/kg/min) and dexmedetomidine (0.5 µg/kg/hour) as anesthesia maintenance. Hemodynamic parameters (heart rate and mean atrial pressure), blood sugar, and serum epinephrine level were monitored and recorded from pre-anesthesia period to 10 min after entry to post-anesthesia care unit (PACU) according to a planned method., Results: Heart rate and mean atrial pressure changes were significantly lower in dexmedetomidine group in all stages compared to propofol group (P < 0.001). Also, the rises in blood glucose and serum epinephrine levels in the dexmedetomidine group were significantly higher than in the propofol group (P < 0.001)., Conclusions: Anesthesia maintenance by dexmedetomidine showed a significant difference in hemodynamic parameters in comparison with propofol. While dexmedetomidine had better effects on controlling hemodynamic parameters, propofol showed better effects on decreasing stress hormones, and it can be suggested for LC surgery., Competing Interests: Conflict of Interests: The authors declared that there is no conflict of interest regarding the publication of this article., (Copyright © 2021, Author(s).)

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., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

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