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1.
Medicine (Baltimore) ; 100(3): e24359, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546071

RESUMO

ABSTRACT: High polyunsaturated fatty acids (PUFAs) intake is recommended for primary and secondary prevention of cardiovascular disease (CVD). However, the association of PUFAs with blood pressure (BP) is still controversial. In the present study, two-sample Mendelian randomization (MR) analysis was performed to investigate the causal relationship of PUFAs with BP, including systolic blood pressure (SBP), diastolic blood pressure (DBP), and pulse pressure (PP).Genetic instruments and summary statistics for two-sample MR analysis were obtained from 3 large-scale genome-wide association studies (GWASs). Eight single nucleotide polymorphisms (SNPs) significantly (P < 5 × 10-8) related to 6 PUFAs were used as instrumental variables. Conventional inverse-variance weighted method was adopted to evaluate the causality of PUFAs with BP; the Weighted Median, MR-egger, and Leave-one-out method were used for sensitivity analyses.As a result, there was no evidence of a causal association between all PUFAs and SBP. In addition, arachidonic acid (AA, ß = -0.04, P < .001) and eicosapentaenoic acid (EPA, ß = -0.47, P = .02) were negatively associated with DBP, while linoleic acid (LA, ß = 0.03, P = .005) and α-linolenic acid (ALA, ß = 3.83, P < .001) were positively associated with DBP. There was no evidence of a causal relationship between either docosapentaenoic acid (DPA) or docosahexaenoic acid (DHA) with DBP.In conclusion, a genetic predisposition to plasma polyunsaturated fatty acid (PUFA) had a divergent effect on DBP, independent of SBP. It suggested that it is helpful for lower DBP level to supplemental intake of AA and EPA or promote the conversion of LA and ALA to AA and EPA respectively, which need to be further validated with randomized controlled studies.


Assuntos
Pressão Arterial/fisiologia , Ácidos Graxos Insaturados/análise , Ácido Araquidônico/análise , Ácido Araquidônico/sangue , Ácido Eicosapentaenoico/análise , Ácido Eicosapentaenoico/sangue , Ácidos Graxos Insaturados/sangue , Feminino , Humanos , Masculino , Análise da Randomização Mendeliana , Fatores de Risco
2.
Anesthesiology ; 133(5): 997-1006, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-33048167

RESUMO

BACKGROUND: In most patients having noncardiac surgery, blood pressure is measured with the oscillometric upper arm cuff method. Although the method is noninvasive and practical, it is known to overestimate intraarterial pressure in hypotension and to underestimate it in hypertension. A high-fidelity upper arm cuff incorporating a hydraulic sensor pad was recently developed. The aim of the present study was to investigate whether noninvasive blood pressure measurements with the new high-fidelity cuff correspond to invasive measurements with a femoral artery catheter, especially at low blood pressure. METHODS: Simultaneous measurements of blood pressure recorded from a femoral arterial catheter and from the high-fidelity upper arm cuff were compared in 110 patients having major abdominal surgery or neurosurgery. RESULTS: 550 pairs of blood pressure measurements (5 pairs per patient) were considered for analysis. For mean arterial pressure measurements, the average bias was 0 mmHg, and the precision was 3 mmHg. The Pearson correlation coefficient was 0.96 (P < 0.0001; 95% CI, 0.96 to 0.97), and the percentage error was 9%. Error grid analysis showed that the proportions of mean arterial pressure measurements done with the high-fidelity cuff method were 98.4% in zone A (no risk), 1.6% in zone B (low risk) and 0% in zones C, D, and E (moderate, significant, and dangerous risk, respectively). The high-fidelity cuff method detected mean arterial pressure values less than 65 mmHg with a sensitivity of 84% (95% CI, 74 to 92%) and a specificity of 97% (95% CI, 95% to 98%). To detect changes in mean arterial pressure of more than 5 mmHg, the concordance rate between the two methods was 99.7%. Comparable accuracy and precision were observed for systolic and diastolic blood pressure measurements. CONCLUSIONS: The new high-fidelity upper arm cuff method met the current international standards in terms of accuracy and precision. It was also very accurate to track changes in blood pressure and reliably detect severe hypotension during noncardiac surgery.


Assuntos
Pressão Arterial/fisiologia , Determinação da Pressão Arterial/métodos , Determinação da Pressão Arterial/normas , Monitorização Intraoperatória/métodos , Monitorização Intraoperatória/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Determinação da Pressão Arterial/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/instrumentação , Oscilometria/instrumentação , Oscilometria/métodos , Oscilometria/normas , Estudos Prospectivos , Adulto Jovem
3.
Endocrinol. diabetes nutr. (Ed. impr.) ; 67(8): 530-539, oct. 2020. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196886

RESUMO

INTRODUCCIÓN: El paciente con diabetes mellitus tipo 2 requiere recibir educación acerca de la enfermedad dirigida a mejorar los conocimientos y habilidades para su control. El objetivo de este estudio fue evaluar la eficacia de la terapia nutricia y de la educación a través de un sitio multimedia, sobre el nivel de conocimientos y control metabólico en pacientes con diabetes tipo 2. MATERIAL Y MÉTODOS: Ensayo clínico abierto de 12 meses de seguimiento en 161 pacientes con diabetes tipo 2. Se asignaron 101 pacientes al grupo de intervención con terapia nutricional (TN) + Nutriluv (sitio multimedia), 80 pacientes al grupo control con TN. Se midió al inicio y al final la hemoglobina glucosilada (HbA1c), glucosa, colesterol, triglicéridos, colesterol LDL y HDL. Se registró el peso, la circunferencia de cintura, el porcentaje de grasa, la presión arterial sistólica y la diastólica. El nivel de conocimientos se midió con el cuestionario de conocimientos en diabetes DKQ24 (por sus siglas en inglés). RESULTADOS: Los conocimientos en diabetes mejoraron en el grupo con TN+Nutriluv comparado con el grupo TN (p < 0,05). La HbA1c, HDL, presión arterial diastólica y circunferencia de cintura mejoraron en el grupo con TN+Nutriluv (p < 0,05). En el grupo con TN mejoró el colesterol HDL, la presión arterial diastólica, la circunferencia de cintura y se incrementó el porcentaje de grasa (p < 0,05). Presentaron mayor riesgo de una HbA1c > 7% quienes tuvieron más años de diagnóstico de la diabetes. CONCLUSIÓN: El uso de un sitio multimedia para proveer educación en diabetes mejora los conocimientos, el HbA1c y otros indicadores de riesgo cardiovascular en pacientes con diabetes tipo 2


INTRODUCTION: The patient with diabetes mellitus type requires to receive education about the disease aimed at improving knowledge and skills for their control. The objective of this study is to evaluate the efficacy of nutritional therapy and education through a multimedia site on the level of knowledge and metabolic control in patients with type 2 diabetes. PATIENTS AND METHODS: Open-label clinical trial of 12 months of follow-up in 161 patients with type 2 diabetes. A total of 101 patients were assigned to the intervention group with nutrition therapy (TN) + Nutriluv (multimedia site in diabetes), 80 patients to the TN control group. The glycosylated hemoglobin (HbA1c), glucose, cholesterol, triglycerides, LDL and HDL cholesterol were measured at the beginning and end. Weight, waist circumference, percentage of fat, systolic blood pressure and diastolic blood pressure were recorded. The level of knowledge was measured with the Diabetes Knowledge Questionnaire (DKQ24). RESULTS: The knowledge in diabetes improved in the group with TN+Nutriluv compared with the TN group (P<0.05). HbA1c, HDL, diastolic blood pressure and waist circumference, improved in the group with TN+Nutriluv (P<0.05). In the group with TN, cholesterol HDL, diastolic blood pressure, waist circumference and the fat percentage was increased (P<0.05). They had a higher risk of having an HbA1c>7% who had more years of diagnosis of diabetes. CONCLUSIONS: The use of a multimedia site with education in diabetes, improves knowledge, HbA1c, and other indicators of cardiovascular risk in diabetes type 2 patients


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Diabetes Mellitus Tipo 2/terapia , Multimídia , Educação de Pacientes como Assunto/métodos , Avaliação Educacional , Resultado do Tratamento , Testes de Química Clínica/métodos , Terapia Nutricional , Diabetes Mellitus Tipo 2/complicações , México , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e Questionários , Pressão Arterial/fisiologia , Antropometria , Composição Corporal
4.
PLoS One ; 15(8): e0237736, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817703

RESUMO

AIMS: To assess the impact of two different respiratory rates in hemodynamic, perfusion and ventilation parameters in a pediatric animal model of cardiac arrest (CA). METHODS: An experimental randomized controlled trial was carried out in 50 piglets under asphyxial CA. After ROSC, they were randomized into two groups: 20 and 30 respirations per minute (rpm). Hemodynamic, perfusion and ventilation parameters were measured 10 minutes after asphyxia, just before ROSC and at 5, 15, 30 and 60 minutes after ROSC. Independent medians test, Kruskal-Wallis test and χ2 test, were used to compare continuous and categorical variables, respectively. Spearman's Rho was used to assess correlation between continuous variables. A p-value <0.05 was considered significant. RESULTS: Arterial partial pressure of carbon dioxide (PaCO2) was significantly lower in the 30 rpm group after 15 minutes (41 vs. 54.5 mmHg, p <0.01), 30 minutes (39.5 vs. 51 mmHg, p < 0.01) and 60 minutes (36.5 vs. 48 mmHg, p = 0.02) of ROSC. The percentage of normoventilated subjects (PaCO2 30-50 mmHg) was significantly higher in the 30 rpm group throughout the experiment. pH normalization occurred faster in the 30 rpm group with significant differences at 60 minutes (7.40 vs. 7.34, p = 0.02). Lactic acid levels were high immediately after ROSC in both groups, but were significantly lower in the 20 rpm group at 30 (3.7 vs. 4.7 p = 0.04) and 60 minutes (2.6 vs. 3.6 p = 0.03). CONCLUSIONS: This animal model of asphyxial CA shows that a respiratory rate of 30 rpm is more effective to reach normoventilation than 20 rpm in piglets after ROSC. This ventilation strategy seems to be safe, as it does not cause hyperventilation and does not affect hemodynamics or cerebral tissue perfusion.


Assuntos
Asfixia/terapia , Parada Cardíaca/terapia , Taxa Respiratória/fisiologia , Ventilação/normas , Animais , Pressão Arterial/fisiologia , Asfixia/fisiopatologia , Dióxido de Carbono/metabolismo , Modelos Animais de Doenças , Parada Cardíaca/fisiopatologia , Humanos , Ácido Láctico/metabolismo , Pediatria , Estatísticas não Paramétricas , Suínos/fisiologia
5.
Eur J Vasc Endovasc Surg ; 60(5): 647-654, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32819817

RESUMO

OBJECTIVE: The aim was to evaluate the potential of near infrared spectrometry (NIRS) monitoring enhanced by autoregulation parameters to detect clamp ischaemia during awake carotid endarterectomy (CEA). METHODS: This was a prospective, hypothesis generating, single centre observational study. Fifty-nine consecutive patients with carotid artery stenosis, of whom 15 (25%) were symptomatic, were enrolled. The patients underwent awake CEA with NIRS monitoring. Regional oxygen saturation (rSO2), relative tissue haemoglobin concentration (rTHb), and mean arterial blood pressure were captured by ICM + software (University of Cambridge Enterprise, Cambridge, UK). The cerebral oxygenation index (COx) and haemoglobin volume index (HVx) were calculated continuously. Two groups were formed depending on neurological symptoms: a symptomatic group with shunt insertion (shunt) and an asymptomatic group (no shunt). RESULTS: Eight patients (14%) became symptomatic and needed intra-operative shunting. The decrease in ipsilateral rSO2 was higher in the shunt group (13.5% vs. 5.3%) and rTHB increased on the non-operated side (+0.05 ± 0.01; p = .016). In symptomatic patients no significant change in rTHB was found during clamping, whereas in asymptomatic patients there was a bilateral increase (ipsilateral: + 0.06 [p = .022]; contralateral: + 0.06 [p = .010]). In asymptomatic patients, ipsilateral COx decreased after clamping (-0.06 ± 0.02; p = .024), indicating functional autoregulation. In symptomatic patients, ipsilateral COx increased to 0.32 (+0.19 ± 0.05; p = .048), indicating loss of autoregulation. Accordingly, pooled ipsilateral and contralateral data showed increasing HVx and COx in symptomatic patients (HVx, p < .001; COx, p = .039). CONCLUSION: In addition to a drop in rSO2, the loss of autoregulatory capacity may be useful in identifying clinically significant clamping ischaemia during CEA under general anaesthesia and may allow optimisation of blood pressure management during awake CEA.


Assuntos
Isquemia Encefálica/diagnóstico , Estenose das Carótidas/cirurgia , Circulação Cerebrovascular/fisiologia , Endarterectomia das Carótidas/efeitos adversos , Complicações Intraoperatórias/diagnóstico , Monitorização Intraoperatória/métodos , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral/efeitos adversos , Pressão Arterial/fisiologia , Isquemia Encefálica/etiologia , Isquemia Encefálica/fisiopatologia , Isquemia Encefálica/prevenção & controle , Circulação Colateral/fisiologia , Estudos de Viabilidade , Feminino , Homeostase/fisiologia , Humanos , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/fisiopatologia , Complicações Intraoperatórias/prevenção & controle , Masculino , Oximetria/métodos , Oxigênio/sangue , Estudos Prospectivos , Espectroscopia de Luz Próxima ao Infravermelho , Vigília/fisiologia
6.
PLoS One ; 15(7): e0235933, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32640004

RESUMO

BACKGROUND: Non-Invasive Venous waveform Analysis (NIVA) is novel technology that captures and analyzes changes in venous waveforms from a piezoelectric sensor on the wrist for hemodynamic volume assessment. Complex cranial vault reconstruction is performed in children with craniosynostosis and is associated with extensive blood loss, potential life-threatening risks, and significant morbidity. In this preliminary study, we hypothesized that NIVA will provide a reliable, non-invasive, quantitative assessment of intravascular volume changes in children undergoing complex cranial vault reconstruction. OBJECTIVE: To present proof-of-concept results of a novel technology in the pediatric population. METHODS: The NIVA prototype was placed on each subject's wrist, and venous waveforms were collected intraoperatively. Estimated blood loss and fluid/blood product administration were recorded in real time. Venous waveforms were analyzed into a NIVA value and then correlated, along with mean arterial pressure (MAP), to volume changes. Concordance was quantified to determine if the direction of change in volume was similar to the direction of change in MAP or change in NIVA. RESULTS: Of 18 patients enrolled, 14 had usable venous waveforms, and there was a significant correlation between change in NIVA value and change in volume. Change in MAP did not correlate with change in volume. The concordance between change in MAP and change in volume was less than the concordance between change in NIVA and change in volume. CONCLUSION: NIVA values correlate more closely to intravascular volume changes in pediatric craniofacial patients than MAP. This initial study suggests that NIVA is a potential safe, reliable, non-invasive quantitative method of measuring intravascular volume changes for children undergoing surgery.


Assuntos
Craniossinostoses/cirurgia , Veias/fisiologia , Pressão Arterial/fisiologia , Perda Sanguínea Cirúrgica , Criança , Pré-Escolar , Craniossinostoses/terapia , Feminino , Hidratação , Hemodinâmica , Humanos , Lactente , Masculino , Procedimentos Cirúrgicos Reconstrutivos
7.
Rev. clín. esp. (Ed. impr.) ; 220(5): 275-281, jun.-jul. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-194965

RESUMO

OBJETIVOS: Si bien se desconocen los motivos, la prevalencia de hipertensión arterial y de eventos cardiovasculares ateroscleróticos en la población adulta con síndrome de Down (SD) es anecdótica. Para entender mejor este hallazgo evaluamos las características hemodinámicas de una cohorte de adultos con SD. MÉTODOS: Estudio transversal en adultos con SD incluidos de modo consecutivo de las consultas externas del servicio de medicina interna entre junio y noviembre 2018. Se recogieron variables demográficas, clínicas y analíticas. Se utilizó un dispositivo de bioimpedancia torácica (HOTMAN® System) para las medidas hemodinámicas. Se realizó una monitorización ambulatoria de presión arterial en un subgrupo de sujetos. RESULTADOS: Veintiséis sujetos de edad media 45±11 años participaron en el estudio (50% varones). La presión arterial (PA) media en la muestra fue de 109/69±11/9mmHg, con una frecuencia cardiaca media de 60±12lpm. Ningún sujeto era hipertenso. El perfil hemodinámico predominante consistió en normodinamismo (65%), normotensión (96%), hipocronotropismo (46%), normoinotropismo (50%) e hipervolemia (54%), con valores normales de resistencias vasculares periféricas (58%). Se realizó una monitorización ambulatoria de la presión sarterial a 12 sujetos (46%). Los valores medios en 24horas de PA sistólica fueron 105±11mmHg, PA diastólica 67±11mmHg, PA media 80±11mmHg y frecuencia cardiaca media 61±6lpm. CONCLUSIONES: El perfil hemodinámico más frecuentemente observado en adultos con SD consistió en hipocronotropismo e hipervolemia, con valores normales de resistencias vasculares periféricas y valores medios óptimos de PA. No identificamos ningún sujeto hipertenso en nuestra muestra


OBJECTIVES: Although the reasons are unknown, the prevalence of arterial hypertension and atherosclerotic cardiovascular events in the adult population with Down syndrome (SD) is anecdotal. To better understand this finding, we evaluated the haemodynamic characteristics of a cohort of adults with SD. METHODS: We conducted a cross-sectional study of adults with SD recruited consecutively from the outpatient clinics of an internal medicine department between June and November 2018. We collected demographic, clinical and laboratory variables and employed a thoracic bioimpedance device (HOTMAN® System) for the haemodynamic measures. Outpatient blood pressure monitoring (OBPM) was conducted on a subgroup of participants. RESULTS: Twenty-six participants (mean age, 45±11years) participated in the study (50% men). The sample's mean blood pressure (BP) was 109/69±11/9mmHg, with a mean heart rate of 60±12bpm. None of the participants had hypertension. The predominant haemodynamic profile consisted of normal dynamism (65%), normal BP (96%), hypochronotropism (46%), normal inotropism (50%) and hypervolaemia (54%), with normal peripheral vascular resistance values (58%). Twelve participants underwent OBPM (46%). The mean 24-h systolic BP, diastolic BP, mean BP and mean heart rate were 105±11mmHg, 67±11mmHg, 80±11mmHg and 61±6bpm, respectively. CONCLUSIONS: The most common haemodynamic profile observed in adults with SD consisted of hypochronotropism and hypervolaemia, with normal values for peripheral vascular resistance and optimal mean BP values. There were no participants with hypertension in our sample


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Síndrome de Down , Hemodinâmica/fisiologia , Monitorização Hemodinâmica , Resistência Vascular , Comorbidade , Estudos Transversais , Hipertensão , Pressão Arterial/fisiologia , Espanha
9.
Br J Anaesth ; 125(1): 25-37, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32475686

RESUMO

BACKGROUND: Finger cuff technologies allow continuous noninvasive arterial blood pressure (AP) and cardiac output/index (CO/CI) monitoring. METHODS: We performed a meta-analysis of studies comparing finger cuff-derived AP and CO/CI measurements with invasive measurements in surgical or critically ill patients. We calculated overall random effects model-derived pooled estimates of the mean of the differences and of the percentage error (PE; CO/CI studies) with 95%-confidence intervals (95%-CI), pooled 95%-limits of agreement (95%-LOA), Cochran's Q and I2 (for heterogeneity). RESULTS: The pooled mean of the differences (95%-CI) was 4.2 (2.8 to 5.62) mm Hg with pooled 95%-LOA of -14.0 to 22.5 mm Hg for mean AP (Q=230.4 [P<0.001], I2=91%). For mean AP, the mean of the differences between finger cuff technologies and the reference method was ≤5±8 mm Hg in 9/27 data sets (33%). The pooled mean of the differences (95%-CI) was -0.13 (-0.43 to 0.18) L min-1 with pooled 95%-LOA of -2.56 to 2.23 L min-1 for CO (Q=66.7 [P<0.001], I2=90%) and 0.07 (0.01 to 0.13) L min-1 m-2 with pooled 95%-LOA of -1.20 to 1.15 L min-1 m-2 for CI (Q=5.8 [P=0.326], I2=0%). The overall random effects model-derived pooled estimate of the PE (95%-CI) was 43 (37 to 49)% (Q=48.6 [P<0.001], I2=63%). In 4/19 data sets (21%) the PE was ≤30%, and in 10/19 data sets (53%) it was ≤45%. CONCLUSIONS: Study heterogeneity was high. Several studies showed interchangeability between AP and CO/CI measurements using finger cuff technologies and reference methods. However, the pooled results of this meta-analysis indicate that AP and CO/CI measurements using finger cuff technologies and reference methods are not interchangeable in surgical or critically ill patients. CLINICAL TRIAL NUMBER: PROSPERO registration number: CRD42019119266.


Assuntos
Pressão Arterial/fisiologia , Determinação da Pressão Arterial/métodos , Débito Cardíaco/fisiologia , Cuidados Críticos/métodos , Assistência Perioperatória/métodos , Análise de Onda de Pulso/métodos , Determinação da Pressão Arterial/instrumentação , Dedos , Humanos
10.
J Vis Exp ; (159)2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32478716

RESUMO

Although vein grafts have been commonly used as autologous grafts in revascularization surgeries for ischemic diseases, the long-term patency remains poor because of the acceleration of intimal hyperplasia due to the exposure to arterial blood pressure. The present protocol is designed for the establishment of experimental venous intimal hyperplasia by interposing rabbit jugular veins to the ipsilateral carotid arteries. The protocol does not require surgical procedures deep in the body trunk and the extent of the incision is limited, which is less invasive for the animals, allowing long-term observation after implantation. This simple procedure enables researchers to investigate strategies to attenuate the progression of intimal hyperplasia of the implanted vein grafts. Using this protocol, we reported the effects transduction of microRNA-145 (miR-145), which is known to control the phenotype of vascular smooth muscle cells (VSMCs) from the proliferative to the contractile state, into harvested vein grafts. We confirmed the attenuation of intimal hyperplasia of vein grafts by transducing miR-145 before implantation surgery through the phenotype change of the VSMCs. Here we report a less invasive experimental platform to investigate the strategies that can be used to attenuate intimal hyperplasia of vein grafts in revascularization surgeries.


Assuntos
Pressão Arterial/fisiologia , Hiperplasia/patologia , Túnica Íntima/patologia , Túnica Íntima/fisiopatologia , Procedimentos Cirúrgicos Vasculares/métodos , Veias/transplante , Animais , Modelos Animais de Doenças , Coelhos
11.
Clín. investig. arterioscler. (Ed. impr.) ; 32(3): 94-100, mayo-jun. 2020. tab, graf, ilus
Artigo em Inglês | IBECS | ID: ibc-193353

RESUMO

OBJECTIVES: To estimate the prevalence of an inter-arm blood pressure difference greater than 10mmHg in patients with type 2 diabetes, and the association of this measurement with the presence of a low ankle-brachial index and mortality at 5-year follow-up. METHOD: A validated blood pressure measurement protocol was used. The blood pressure was calculated for each arm to obtain mean systolic differences. Peripheral arterial disease was confirmed by an ankle-arm index less than 0.9. The medical history of the patient was reviewed in the computerized clinical notes after 5 years of follow-up. RESULTS: The study included 139 patients with a mean age of 70.1 years (49% male), and a mean duration of diabetes mellitus of 10.8 years. A total of 50 (36%) patients had an inter-arm systolic blood pressure difference greater than 10mmHg. Patients with an inter-arm systolic blood pressure greater than 10 mmHg had lower ankle-arm index (0.91 ± 0.30 vs. 1.04 ± 0.28, P = 0.005), and higher mortality rates from all causes (48.0% vs. 28.9%; hazard ratio 1.64; 95% confidence interval: 1.06-2.53; P = 0.03), compared with those with lower inter-arm systolic blood pressure difference. CONCLUSION: A high proportion of patients with type 2 diabetes have an elevated systolic blood pressure difference between arms. A significant relationship was found between elevated inter-arm systolic blood pressure difference, lower ankle-brachial index and greater all-cause mortality


OBJETIVOS: Estimar la prevalencia de una diferencia de presión arterial entre brazos superior a 10mmHg en pacientes con diabetes tipo 2, y su asociación con el índice tobillo-brazo y la mortalidad a los 5 años de seguimiento. MÉTODO: Se utilizó un protocolo validado de medición de presión arterial. La presión sanguínea se calculó para cada brazo para obtener diferencias sistólicas medias. La enfermedad arterial periférica fue confirmada por un índice tobillo-brazo inferior a 0,9. El estado vital del paciente se revisó en la historia clínica electrónica a los 5 años de seguimiento. RESULTADOS: Estudiamos a 139 pacientes con una edad media de 70,1 años (49% hombres) y una duración media de diabetes mellitus de 10,8 años. Un total de 50 (36%) pacientes tenía una diferencia de presión arterial sistólica entre brazos mayor de 10 mmHg. Los pacientes con diferencia elevada de presión arterial sistólica entre los brazos mostraron un menor índice tobillo-brazo (0,91 ± 0,30 vs. 1,04 ± 0,28; P = 0,005), y una mayor tasa de mortalidad por todas las causas (48,0% vs. 28,9%; cociente de riesgo 1,64; intervalo de confianza al 95%: 1,06-2,53; P = 0,03), respecto a los pacientes con menores diferencias de presión sistólica entre brazos. CONCLUSIÓN: Encontramos una alta proporción de pacientes con diabetes tipo 2 que tenían una diferencia elevada de presión arterial sistólica entre los brazos. Existe una asociación significativa entre la diferencia elevada de la presión arterial sistólica entre brazos, el índice tobillo-brazo y mortalidad


Assuntos
Humanos , Masculino , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Braço/irrigação sanguínea , Índice Tornozelo-Braço/métodos , Diabetes Mellitus/mortalidade , Protocolos Clínicos , Pressão Arterial/fisiologia , Intervalos de Confiança , Análise de Variância
12.
Nutr. hosp ; 37(3): 483-489, mayo-jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193855

RESUMO

INTRODUCCIÓN: el efecto del entrenamiento intervalado de alta intensidad (HIIT) sobre la utilización de grasas durante el ejercicio necesita ser estudiado en mayor profundidad. OBJETIVO: determinar el efecto de un programa de entrenamiento HIIT en sujetos con sobrepeso u obesidad sobre la utilización de grasas, la composición corporal y variables cardiovasculares. El segundo objetivo fue comparar las variables de estudio según el tiempo de duración del programa (es decir, 12,16 y 20 semanas). MATERIAL Y MÉTODOS: se estudiaron 30 sujetos (edad, 44,8 ± 11,6 años). Se formaron 3 grupos de forma aleatoria: el G1 realizó 12 semanas (G1, n = 12, 48,08 ± 8,20 años); el G2 realizó 16 semanas (G2, n = 10, 42,10 ± 11,60 años) y el G3 realizó 20 semanas (G3, n = 8, 43,38 ± 15,76 años). Todos los grupos realizaron el mismo protocolo de HIIT 3 veces por semana. RESULTADOS: los tres grupos presentaron una disminución de la grasa corporal de forma significativa (p < 0,05), sin diferencias entre grupos. Las variables cardiovasculares no reportaron diferencias entre grupos (p interacción > 0,05). Sin embargo, los grupos disminuyeron la presión arterial sistólica (p < 0,05). En el análisis pre vs. post, los tres grupos presentaron mejoras en el VO2max, sin diferencias entre grupos (p interacción, > 0,05). Por último, los tres grupos aumentaron la utilización de grasas durante el ejercicio (p < 0,05). CONCLUSIÓN: el programa incrementó la utilización de grasas durante el ejercicio, disminuyó el tanto por ciento de grasa corporal y se mejoraron parámetros cardiovasculares; sin embargo, después de las 12 semanas es recomendable aplicar variaciones al entrenamiento para maximizar los resultados


INTRODUCTION: the effect of high intensity interval training (HIIT) on fat utilization during exercise needs to be studied in depth. OBJECTIVE: to determine the effect of HIIT training program in subjects with overweight or obesity on the use of fat during exercise, body composition and cardiovascular variables. The second objective was to compare the variables according to the duration of the program (i.e., 12, 16 and 20 weeks). MATERIAL AND METHODS: 30 subjects were studied (age 44.8 ± 11.6 years). Three groups were formed at random, the G1 (12 weeks, n = 12, 48.08 ± 8.20 years), G2 (16 weeks, n = 10, 42.10 ± 11.60 years) and G3 (20 weeks, n = 8, 43.38 ± 15.76 years). All groups performed HIIT 3 times per week. RESULTS: the three groups showed a significant decrease in body fat percentage (p < 0.05), without differences between groups. Similarly, cardiovascular variables did not report differences between groups (p-interaction > 0.05) after the intervention; however, the groups reported a significant decrease systolic blood pressure (p < 0, 05). In the pre vs. post analysis by groups, the three groups showed improvements in VO2max without differences between groups (p-interaction > 0.05). Finally, the three groups increased the fats utilization during exercise (p < 0.05). CONCLUSION: the program increased fat utilization during exercise, decreased body fat % and improved cardiovascular parameters, however after 12 training weeks it is advisable to apply variations to training to maximize results


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Ácidos Graxos/administração & dosagem , Sobrepeso/tratamento farmacológico , Obesidade/tratamento farmacológico , Exercício Físico , Pressão Arterial/fisiologia , Composição Corporal , Ingestão de Alimentos , Gorduras na Dieta , Análise de Variância , Antropometria
13.
Yonsei Med J ; 61(6): 482-491, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32469172

RESUMO

PURPOSE: Cardiac power (CP) index is a product of mean arterial pressure (MAP) and cardiac output (CO). In aortic stenosis, however, MAP is not reflective of true left ventricular (LV) afterload. We evaluated the utility of a gradient-adjusted CP (GCP) index in predicting survival after transcatheter aortic valve replacement (TAVR), compared to CP alone. MATERIALS AND METHODS: We included 975 patients who underwent TAVR with 1 year of follow-up. CP was calculated as (CO×MAP)/[451×body surface area (BSA)] (W/m²). GCP was calculated using augmented MAP by adding aortic valve mean gradient (AVMG) to systolic blood pressure (CP1), adding aortic valve maximal instantaneous gradient to systolic blood pressure (CP2), and adding AVMG to MAP (CP3). A multivariate Cox regression analysis was performed adjusting for baseline covariates. Receiver operator curves (ROC) for CP and GCP were calculated to predict survival after TAVR. RESULTS: The mortality rate at 1 year was 16%. The mean age and AVMG of the survivors were 81±9 years and 43±4 mm Hg versus 80±9 years and 42±13 mm Hg in the deceased group. The proportions of female patients were similar in both groups (p=0.7). Both CP and GCP were independently associated with survival at 1 year. The area under ROCs for CP, CP1, CP2, and CP3 were 0.67 [95% confidence interval (CI), 0.62-0.72], 0.65 (95% CI, 0.60-0.70), 0.66 (95% CI, 0.61-0.71), and 0.63 (95% CI 0.58-0.68), respectively. CONCLUSION: GCP did not improve the accuracy of predicting survival post TAVR at 1 year, compared to CP alone.


Assuntos
Pressão Arterial/fisiologia , Débito Cardíaco/fisiologia , Substituição da Valva Aórtica Transcateter , Idoso de 80 Anos ou mais , Área Sob a Curva , Feminino , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Análise Multivariada , Modelos de Riscos Proporcionais , Curva ROC , Fatores de Risco , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do Tratamento
14.
Clin Exp Hypertens ; 42(7): 622-639, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-32420765

RESUMO

PURPOSE: To review the recent developments on the effect of chronic high mean arterial blood pressure (MAP) on cerebral blood flow (CBF) autoregulation and supporting the notion that CBF autoregulation impairment has connection with chronic cerebral diseases. Method: A narrative review of all the relevant papers known to the authors was conducted. Results: Our understanding of the connection between cerebral perfusion impairment and chronic high MAP and cerebral disease is rapidly evolving, from cerebral perfusion impairment being the result of cerebral diseases to being the cause of cerebral diseases. We now better understand the intertwined impact of hypertension and Alzheimer's disease (AD) on cerebrovascular sensory elements and recognize cerebrovascular elements that are more vulnerable to these diseases. Conclusion: We conclude with the suggestion that the sensory elements pathology plays important roles in intertwined mechanisms of chronic high MAP and AD that impact cerebral perfusion.


Assuntos
Doença de Alzheimer/fisiopatologia , Pressão Arterial/fisiologia , Circulação Cerebrovascular , Hipertensão/fisiopatologia , Homeostase , Humanos
16.
PLoS One ; 15(5): e0232830, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32407353

RESUMO

During general anesthesia (GA), direct analysis of arterial pressure or aortic flow waveforms may be inconclusive in complex situations. Patient-specific biomechanical models, based on data obtained during GA and capable to perform fast simulations of cardiac cycles, have the potential to augment hemodynamic monitoring. Such models allow to simulate Pressure-Volume (PV) loops and estimate functional indicators of cardiovascular (CV) system, e.g. ventricular-arterial coupling (Vva), cardiac efficiency (CE) or myocardial contractility, evolving throughout GA. In this prospective observational study, we created patient-specific biomechanical models of heart and vasculature of a reduced geometric complexity for n = 45 patients undergoing GA, while using transthoracic echocardiography and aortic pressure and flow signals acquired in the beginning of GA (baseline condition). If intraoperative hypotension (IOH) appeared, diluted norepinephrine (NOR) was administered and the model readjusted according to the measured aortic pressure and flow signals. Such patients were a posteriori assigned into a so-called hypotensive group. The accuracy of simulated mean aortic pressure (MAP) and stroke volume (SV) at baseline were in accordance with the guidelines for the validation of new devices or reference measurement methods in all patients. After NOR administration in the hypotensive group, the percentage of concordance with 10% exclusion zone between measurement and simulation was >95% for both MAP and SV. The modeling results showed a decreased Vva (0.64±0.37 vs 0.88±0.43; p = 0.039) and an increased CE (0.8±0.1 vs 0.73±0.11; p = 0.042) in hypotensive vs normotensive patients. Furthermore, Vva increased by 92±101%, CE decreased by 13±11% (p < 0.001 for both) and contractility increased by 14±11% (p = 0.002) in the hypotensive group post-NOR administration. In this work we demonstrated the application of fast-running patient-specific biophysical models to estimate PV loops and functional indicators of CV system using clinical data available during GA. The work paves the way for model-augmented hemodynamic monitoring at operating theatres or intensive care units to enhance the information on patient-specific physiology.


Assuntos
Anestesia Geral/métodos , Pressão Arterial/fisiologia , Débito Cardíaco/fisiologia , Monitorização Hemodinâmica/métodos , Hipotensão/fisiopatologia , Modelos Cardiovasculares , Volume Sistólico/fisiologia , Algoritmos , Fenômenos Biomecânicos , Pressão Sanguínea , Feminino , Humanos , Hipotensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Norepinefrina/administração & dosagem , Estudo de Prova de Conceito , Estudos Prospectivos , Vasoconstritores/administração & dosagem
18.
J Interv Cardiol ; 2020: 5787439, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32327943

RESUMO

Background: The saline-induced distal coronary pressure/aortic pressure ratio predicted fractional flow reserve (FFR). The resting full-cycle ratio (RFR) represents the maximal relative pressure difference in a cardiac cycle. Therefore, the present study aimed to compare the results of saline-induced RFR (sRFR) with FFR. Methods: Seventy consecutive lesions with only moderate stenosis were included. The FFR, RFR, and sRFR values were compared. The sRFR was assessed using an intracoronary bolus infusion of saline (2 mL/s) for five heartbeats. The FFR was obtained after an intravenous injection of papaverine. Results: Overall, the FFR, sRFR, and RFR values were 0.78 ± 0.12, 0.79 ± 0.13, and 0.83 ± 0.14, respectively. With regard to anatomical morphology were 40, 18, and 12 cases of focal, diffuse, and tandem lesion. There was a significant correlation between the sRFR and FFR (R = 0.96, p < 0.01). There were also significant correlations between the sRFR and FFR in the left coronary and right coronary artery (R = 0.95, p < 0.01 and R = 0.98, p < 0.01). Furthermore, significant correlations between sRFR and FFR were observed in not only focal but also in nonfocal lesion including tandem and diffuse lesions (R = 0.93, p < 0.01 and R = 0.97, p < 0.01). A close agreement on FFR and sRFR was shown using the Bland-Altman analysis (95% CI of agreement: -0.08-0.07). In the receiver operating characteristic curve analysis, the cutoff value of sRFR to predict an FFR of 0.80 was 0.81 (area under curve, 0.97; sensitivity 90.6%; and specificity 98.2%). Conclusion: The sRFR can accurately and safely predict the FFR and might be effective for diagnosing ischemia.


Assuntos
Pressão Arterial/fisiologia , Estenose Coronária/diagnóstico , Estenose Coronária/fisiopatologia , Reserva Fracionada de Fluxo Miocárdico/fisiologia , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco , Angiografia Coronária , Vasos Coronários/fisiopatologia , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Sensibilidade e Especificidade , Índice de Gravidade de Doença
19.
J Anim Sci ; 98(5)2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32315038

RESUMO

Pulmonary arterial pressure (PAP) is a diagnostic measure used to determine an individual's susceptibility to developing high-altitude disease. The importance of PAP measures collected at elevations lower than the intended breeding elevation of the bulls (i.e., ≥1,520 m) is unknown. Therefore, the objective of this study was to determine the genetic relationship between PAP measures collected in a range of elevations using reaction norm models. A total of 9,177 PAP and elevation observations on purebred Angus cattle, which averaged 43.49 ± 11.32 mmHg and 1,878.6 ± 296.8 m, respectively, were used in the evaluation. The average age of the individuals in the evaluation was 434.04 ± 115.9 d. A random regression model containing the effects of sex, a linear covariate of age, a quadratic fixed covariate of elevation, and random effects consisting of a contemporary group and a linear regression of PAP on elevation was used for the evaluation of PAP. Two forms of PAP were evaluated with this model. First, to address the non-normality of the data, PAP was raised to the power of -2.6 (ptPAP) based on the results of a Box-Cox analysis. Second, raw PAP (rPAP) phenotypes were evaluated to compare the results to those obtained from the transformed data. For ptPAP, heritability ranged from 0.25 to 0.37 corresponding to elevations of 1,900 and 1,215 m, respectively. For rPAP, heritability ranged from 0.22 to 0.41 corresponding to elevations of 1,700 and 2,495 m, respectively. Generally, lower elevations corresponded to decreased heritabilities while higher elevations corresponded to increased heritability estimates. For ptPAP, genetic correlations ranged from 0.18 (elevation: 1,215 and 2,495 m) to 1.00. For rPAP, genetic correlations ranged from 0.08 (elevation: 1,215 and 2,495 m) to 1.00. In general, the closer the elevations in which PAP was measured, the greater the genetic relationship. The greater the difference in elevation between PAP measures resulted in lower genetic correlations. The rank correlation between expected progeny differences (EPD) for 1,215 and 2,495 m was 0.65 and 0.49 for the ptPAP and rPAP, respectively. These results suggested that PAP measures collected in lower elevations may be used as an indicator of high-altitude adaptability. In the estimation of EPD to rank sires for their suitability for use in high-elevation production systems, it is important to account for the relationships among varied altitudes.


Assuntos
Pressão Arterial/fisiologia , Bovinos/fisiologia , Modelos Estatísticos , Altitude , Animais , Cruzamento , Bovinos/genética , Feminino , Modelos Lineares , Masculino , Fenótipo , Artéria Pulmonar/fisiologia
20.
Anesth Analg ; 130(5): 1176-1187, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32287125

RESUMO

BACKGROUND: Individualized hemodynamic monitoring approaches are not well validated. Thus, we evaluated the discriminative performance improvement that might occur when moving from noninvasive monitoring (NIM) to invasive monitoring and with increasing levels of featurization associated with increasing sampling frequency and referencing to a stable baseline to identify bleeding during surgery in a porcine model. METHODS: We collected physiologic waveform (WF) data (250 Hz) from NIM, central venous (CVC), arterial (ART), and pulmonary arterial (PAC) catheters, plus mixed venous O2 saturation and cardiac output from 38 anesthetized Yorkshire pigs bled at 20 mL/min until a mean arterial pressure of 30 mm Hg following a 30-minute baseline period. Prebleed physiologic data defined a personal stable baseline for each subject independently. Nested models were evaluated using simple hemodynamic metrics (SM) averaged over 20-second windows and sampled every minute, beat to beat (B2B), and WF using Random Forest Classification models to identify bleeding with or without normalization to personal stable baseline, using a leave-one-pig-out cross-validation to minimize model overfitting. Model hyperparameters were tuned to detect stable or bleeding states. Bleeding models were compared use both each subject's personal baseline and a grouped-average (universal) baseline. Timeliness of bleed onset detection was evaluated by comparing the tradeoff between a low false-positive rate (FPR) and shortest time to bleed detection. Predictive performance was evaluated using a variant of the receiver operating characteristic focusing on minimizing FPR and false-negative rates (FNR) for true-positive and true-negative rates, respectively. RESULTS: In general, referencing models to a personal baseline resulted in better bleed detection performance for all catheters than using universal baselined data. Increasing granularity from SM to B2B and WF progressively improved bleeding detection. All invasive monitoring outperformed NIM for both time to bleeding detection and low FPR and FNR. In that regard, when referenced to personal baseline with SM analysis, PAC and ART + PAC performed best; for B2B CVC, PAC and ART + PAC performed best; and for WF PAC, CVC, ART + CVC, and ART + PAC performed equally well and better than other monitoring approaches. Without personal baseline, NIM performed poorly at all levels, while all catheters performed similarly for SM, with B2B PAC and ART + PAC performing the best, and for WF PAC, ART, ART + CVC, and ART + PAC performed equally well and better than the other monitoring approaches. CONCLUSIONS: Increasing hemodynamic monitoring featurization by increasing sampling frequency and referencing to personal baseline markedly improves the ability of invasive monitoring to detect bleed.


Assuntos
Análise de Dados , Monitorização Hemodinâmica/métodos , Hemodinâmica/fisiologia , Hemorragia/diagnóstico , Hemorragia/fisiopatologia , Animais , Pressão Arterial/fisiologia , Débito Cardíaco , Feminino , Monitorização Fisiológica/métodos , Suínos
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