Efficacy of a mobile hypertension prevention delivery platform with human coaching.

This pilot study evaluated the efficacy of a Hypertension Prevention Program (HPP) administered through a mobile application platform with human coaching (app) on reduction in blood pressure and weight in 50 adults with prehypertension or hypertension. Participants were recruited into a 24-week mobile application intervention to administer the HPP between January 2016 and July 2016. Dietary elements of the programme were based on the Dietary Approaches to Stop Hypertension. The programme included in-app human coaching with bi-weekly phone calls, meal logging, blood pressure tracking and educational material. Main outcome variables included change in systolic and diastolic blood pressure, hypertension category, and weight loss. Data were analysed between October 2016 and December 2016. The HPP yielded overall improvements in weight (-3.04±4.04 kg, P=<0.001), diastolic blood pressure (-5.06±11.89 mm Hg, P=0.004), and hypertension category (-0.48±0.74 mm Hg, P=<0.001). Sustained engagement of 80% resulted in significant reductions in systolic blood pressure (-7.75±12.56, P=<0.001) and weight (-3.73±4.01 kg, P<0.001) for programme completers, contributing to hypertension category change (-0.58±0.64 mm Hg, P<0.001). Mobile delivery of a lifestyle intervention for hypertension prevention showed short-term potential to reduce risk of hypertension, supporting the need for longer studies to investigate the use of mHealth lifestyle modification to reduce the risk of hypertension, a public health priority.

The past, present, and future of lung transplantation.

BACKGROUND: The history of lung transplantation from the first human transplant performed in 1963 to the present is reviewed with particular focus on the added challenges because of the contaminated bronchus, exposure of the graft to airborne organisms, the poor blood supply to the bronchus, and the problem of reperfusion pulmonary edema. METHODS: The technical aspects of single and double sequential lung transplantation are reviewed, as are the current indications for single, double sequential, and heart/lung transplantation. Criteria for lung transplant recipients, in addition to their primary disease are noted, as are absolute and relative contraindications. The standard criteria for donor selection are also reviewed. RESULTS: The results of single, double sequential, and heart-lung transplantation over the past 10 years as reported by the International Society for Heart and Lung Transplantation Database are reviewed. In addition, the statistics of the lung and heart-lung transplantation program at the University of Colorado Health Sciences Center are reviewed, including the current immunosuppressive regimens and early and late monitoring for infection and rejection. This experience includes 3 early deaths in the first 53 patients for an operative mortality of 5.6%, with a 1-year actuarial survival of 90%. CONCLUSIONS: During the past decade remarkable improvement in the result of single and double sequential lung transplantation have occurred. As 1-year, actuarial survival is now approaching 90% at some institutions. Living related lobar transplantation, new antirejection agents, chimerism, and xenograft transplantation are areas for continuing and future investigation. The shortage in donor organ supply continues to be a very significant factor in limiting human lung transplantation.

Autonomic hyperreflexia: intraoperative control with pentolinium tartrate.

Autonomic hyperreflexia (AH) is a clinical syndrome associated with the development of severe hypertension. It usually occurs in patients with high-level chronic spinal cord injury, and in response to stimuli associated with the distension of a hollow viscus. Protection against AH by the prophylactic use of pentolinium tartrate (Ansolysen) in doses of 10-15 mg was evaluated in a controlled study of unanaesthetized patients who were either quadriplegic or paraplegic and who were undergoing rectal and bladder surgical procedures. When compared with the control group, the systolic and diastolic arterial pressures during operation were significantly less (P less than 0.05) and remained near normal in the pretreated patients. The use of pentolinium to prevent or control AH during surgical procedures in patients with chronic spinal cord damage is a simple alternative to spinal or general anaesthesia.

Electrocorticographic seizure activity during enflurane anesthesia.

In electrocorticographic recordings obtained during enflurane anesthesia, abnormal electrical activity was elicited with light and moderate levels of enflurane anesthesia and suppressed at a level of deep surgical anesthesia; Paco2 was constant at 34 +/- 2 torr throughout. Enflurane may prove to be of value in determining foci of abnormal electrical activity.