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Background and purpose: Major adverse cardiac events(MACE) are prevalent in patients with locally advanced-non-small cell lung cancer(LA-NSCLC) following radiotherapy(RT). The CHyLL model, incorporating coronary heart disease(CHD),Hypertension(HTN),Logarithmic LADV15 was developed and internally-validated to predict MACE among LA-NSCLC patients. We sought to externally validate CHyLL to predict MACE in an independent LA-NSCLC cohort. Patients and methods: Patients with LA-NSCLC treated with RT were included. CHyLL score was calculated:5.51CHD + 1.28HTN + 1.48ln(LADV15 + 1)-1.36CHD*ln(LADV15 + 1). CHyLL performance in predicting MACE was assessed and compared to mean heart dose(MHD) using Cox-proportional hazard(PH) analyses and Harrel's concordance(C)-indices. MACE and overall survival(OS) among low-vs high-risk groups(CHyLL < 5 vs ≥ 5) were compared. Results: In the external validation cohort(N = 102), the median age was 71 years and 55% were females. Most(n = 74,73%), had clinical Stage III disease and 35(34%) underwent surgery. CHyLL demonstrated good MACE prediction with C-index of 0.73(95% Confidence Interval(CI):0.58-0.89), while MHD did not (C-index = 0.46 (95% CI:0.30-0.62)). Per CHyLL, 32(31%) and 70(69%) patients were considered low-and high-risk for MACE, respectively. CHyLL consistently identified lower MACE rates in the low-vs high-risk group(log-rank p = 0.108):0 vs 8%(12 months),5 vs 16%(24 months),5 vs 16%(36 months),and 5 vs 19%(48 months) post-RT. In the pooled internal and external validation cohort(N = 303), MACE rates in low-vs high-risk groups were statistically significantly different(log-rank p = 0.01):1 vs 6%(12 months),3 vs 12%(24 months),6 vs 19%(36 months),and 6 vs 21%(48 months). Conclusions: CHyLL was externally validated and superior to MHD in predicting MACE. CHyLL has the potential to identify high-risk patients who may benefit from cardio-oncology optimization and to estimate personalized LADV15 constraints based on cardiac risk factors and acceptable MACE thresholds.
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Owing to the unfamiliar environment, recreational and professional diving is confronted with several challenges. Usage of self-contained under-water breathing apparatuses during the dive provides the indispensable breathing gas supply for the diver. Instead of air, oxygen-enriched breathing gases (EANx or nitrox) are used with increasing frequency. Unfortunately, their usage implies negative effects because the elevated oxygen partial pressure (pO2) increases oxidative stress. As a result, the increased formation of reactive oxygen species exerts negative effects on the central nervous system, lungs, vasculature and eyes. However, these disadvantages can be avoided if appropriate rules are followed, e.g. a pO2<1.4 bar. EANx breathing gases have, on the other hand, major advantages as they help reducing narcotic nitrogen effects and bubble formation. Several land-based studies had proven a reduced ventilation of exercising subjects if EANx was used instead of air. As breathing gas is the most valuable under-water good, we wanted to translate the on-land results into under-water results. Appropriate studies now demonstrate a novel EANx property as under-water ventilation is also reduced with EANx. In this short communication, we present this additional advantage of EANx-breathing. This benefit seems to be of particular importance as it delays unforeseen running-out-of-gas and thus, contributes to further improving diving safety.
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Between 1958 and 1961 approximately 10,000 children with severe deformities of extremities were born, whose mothers had taken the sedative thalidomide. Since then, drugs in pregnancy are applied with legitimate caution by the pharmaceutical industry, physicians and patients, although often accompanied by irrational panic. The pharmaceutical industry takes a legally safe position noting "contraindication" or at least "strict indication" in the consumer information. This transfers responsibility to the prescribing doctor. Even without drug therapy, the spontaneous malformation rate is approx. 3 to 4%. Concerning expectant mothers, a therapeutic nihilism may lead to a dramatic deterioration of the maternal disease, thereby causing high risks in fetal development. The aim of the present work is to present a structured "Guideline for Practice" of medication that can be used during pregnancy for treating medical conditions of the ear, nose and throat.
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Otorrinolaringopatias , Preparações Farmacêuticas , Criança , Feminino , Humanos , Otorrinolaringopatias/tratamento farmacológico , Gravidez , TalidomidaRESUMO
BACKGROUND: Stable chest pain is a common indication for cardiac catheterization. We assessed the prognostic value of the Prospective Multicenter Imaging Study for Evaluation (PROMISE) Minimal-Risk Tool in identifying patients who are at very low risk of obstructive coronary artery disease (CAD) or downstream cardiovascular adverse outcomes. METHODS: We applied the PROMISE Minimal-Risk Tool to consecutive patients without known CAD who underwent elective cardiac catheterization for stable angina from January 1, 2000 to December 31, 2014 in the Duke Databank for Cardiovascular Disease (DDCD). Patients with scores >0.46 (top decile of lowest-risk from the PROMISE cohort) were classified as low-risk. Logistic regression modeling compared likelihood of freedom from obstructive coronary artery disease on index angiography, 2-year survival, and 2-year survival free of myocardial infarction (MI) and MI/revascularization between low- and non low-risk patients. Alternative cut points to define low- risk patients were also explored. RESULTS: Among 6251 patients undergoing cardiac catheterization for stable chest pain, 1082 (17.3%) were low-risk per the PROMISE minimal-risk tool. Among low risk patients, obstructive coronary artery disease was observed in 14.9% and left main disease (≥ 50% Stenosis) was rare (0.9%). Compared with other patients, low risk patients had a higher likelihood of freedom from obstructive coronary disease on index catheterization (85.1% vs. 44.2%, OR 4.84, 95% CI 4.06-5.77). Low risk patients had significantly higher survival (98.2% vs. 94.4%, OR 3.18, 95% CI 1.99-5.08), MI-free survival (97.2% vs. 91.9%, OR 3.03, 95% CI 2.07-4.45), and MI/revascularization-free survival (86.2 vs. 59.9%, OR 4.19, 95% CI 3.48-5.05) at 2 years than non-low risk patients. Operating characteristics for predicting the outcomes of interest varied modestly depending on the low-risk cut-point used but the positive predictive value for 2 year freedom from death was >98% regardless. CONCLUSION: The PROMISE minimal-risk tool identifies 17% of stable chest pain patients referred to cardiac catheterization as low risk. These patients have a low prevalence of obstructive CAD and better survival than non-low risk patients. While this suggests that these patients are unlikely to benefit from catheterization, further research is needed to confirm a favorable downstream prognosis with medical management alone.
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Angina Estável , Estenose Coronária , Vasos Coronários/diagnóstico por imagem , Fatores de Risco de Doenças Cardíacas , Uso Excessivo dos Serviços de Saúde , Infarto do Miocárdio , Medição de Risco/métodos , Angina Estável/complicações , Angina Estável/diagnóstico , Angina Estável/etiologia , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico , Estenose Coronária/epidemiologia , Estenose Coronária/fisiopatologia , Estenose Coronária/cirurgia , Feminino , Humanos , Masculino , Uso Excessivo dos Serviços de Saúde/prevenção & controle , Uso Excessivo dos Serviços de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Revascularização Miocárdica/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Prognóstico , Estados Unidos/epidemiologiaRESUMO
Patients with type 2 diabetes who present with confusion and/or abdominal pains should be screened for sodium-glucose cotransporter 2 (SGLT-2)-induced diabetic ketoacidosis. Severe acidosis was diagnosed despite only moderately increased blood sugar levels. If so, immediate ICU treatment is essential.
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Diabetes Mellitus Tipo 2 , Cetoacidose Diabética , Inibidores do Transportador 2 de Sódio-Glicose , Idoso , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico , Cetoacidose Diabética/diagnóstico , Cetoacidose Diabética/terapia , Humanos , Hipoglicemiantes , Masculino , Taquicardia , TaquipneiaRESUMO
PURPOSE: Cardiovascular regulation during exercise, described using time series analysis, is expected to be attenuated after bed rest (BR) and this effect will be dampened by a reactive jumps countermeasure. METHODS: Twenty subjects (29 ± 6 years, 23.6 ± 1.7 kg m-2) were tested on a cycle ergometer 9 days (BDC-9) before the beginning of BR as well as 2 (R + 2) and 13 days (R + 13) after the end of BR, applying moderate pseudo-random binary (PRBS) work rate changes. Heart rate (HR) and mean arterial blood pressure (mBP) were measured beat-to-beat and interpolated to 1 s intervals. HR and mBP were cross-correlated [CCF(HR-mBP)] during the PRBS. Eleven subjects participated in a reactive jump countermeasure (JUMP) during the BR period, the other part of the group served as control group (CTRL). RESULTS: In the CTRL group, significantly lower CCF(HR-mBP) values during BDC-9 were observed compared to R + 2 during the lags 20-25 s and significantly higher values during the lags - 39 s to - 35 s. In the JUMP group, significantly lower CCFs were only observed at R + 2 compared with BDC-9 during the lags 23 s and 24 s, whereas the CCFs for BDC-9 were significantly higher at several lags compared with R + 13. CONCLUSION: Attenuations in the regulation of the cardiovascular system during cycling exercise after BR were found in the CTRL group of the RSL study. Cardiovascular regulation in the JUMP group was improved compared to values before the beginning of BR, suggesting the effectiveness of the reactive jumps countermeasure to mitigate the deleterious effects of prolonged BR.
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Repouso em Cama/efeitos adversos , Pressão Sanguínea , Decúbito Inclinado com Rebaixamento da Cabeça/efeitos adversos , Frequência Cardíaca , Adulto , Repouso em Cama/métodos , Humanos , MasculinoRESUMO
An interdisciplinary collaboration is required in the medical care of chronically ill patients with complex illnesses. Especially in the field of internistic rheumatology, interdisciplinary work is essential to consider the complex somatic and psychosocial aspects of a chronic illness. Nevertheless, the aspects of interprofessional work in the study of medicine and psychology are insufficiently addressed. For this reason, a model project for interdisciplinary university teaching was conceived, which combines both subjects. The course was held for the first time in semester 2019/2020 and was rated excellent by the participants. The main goal of the course is the implementation of interprofessional work in the training of medical personnel. In addition, the discipline of internistic rheumatology could be brought closer to the students.
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Currículo , Relações Interprofissionais , Equipe de Assistência ao Paciente/organização & administração , Psicologia , Reumatologia , Doença Crônica , Humanos , Estudantes de Medicina/psicologia , UniversidadesRESUMO
It was hypothesized that faster cardiorespiratory kinetics during exercise are associated with higher orthostatic tolerance. Cardiorespiratory kinetics of 14 healthy male subjects (30 ± 4 years, 179 ± 8 cm, 79 ± 8 kg) were tested on a cycle ergometer during exercise with changing work rates of 30 and 80 W. Pulmonary oxygen uptake ( ) was measured breath-by-breath and heart rate (HR), mean arterial blood pressure (MAP), and total peripheral resistance (TPR) were measured beat-to-beat. Muscular oxygen uptake ( ) was estimated from HR and . Kinetic parameters were determined by time-series analysis, using cross-correlation functions (CCFmax(x)) between the parameter and the work rate. Cardiovascular regulations of MAP, HR, and TPR during orthostatic stress were measured beat-to-beat on a tilt seat. Changes between the minima and maxima during the 6° head-down tilt and the 90° head-up tilt positions were calculated for each parameter (Δtilt-up). correlated significantly with ΔTPRtilt-up (r = 0.790, p ≤ 0.001). CCFmax(HR) was significantly correlated with ΔHRtilt-up (r = -0.705, p = 0.002) and the amplitude in HR from 30 to 80 W (rSP = -0.574, p = 0.016). The observed correlations between cardiorespiratory regulation in response to exercise and orthostatic stress during rest might allow for a more differential analysis of the underlying mechanisms of orthostatic intolerance in, for example, patient groups.
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Fenômenos Fisiológicos Cardiovasculares , Exercício Físico/fisiologia , Decúbito Inclinado com Rebaixamento da Cabeça/fisiologia , Adulto , Pressão Sanguínea , Frequência Cardíaca , Humanos , Masculino , Resistência VascularRESUMO
BACKGROUND: The relation between endogenous testosterone concentrations and myocardial mass and function remains incompletely understood. OBJECTIVES: To determine the cross-sectional association between endogenous hormone levels with cardiac magnetic resonance measures of myocardial mass, structure, and function in community-dwelling men across a wide age range. METHODS: A total of 720 men from the Framingham Heart Study Offspring Cohort (age range 37-82, mean = 59.6 years) who underwent cardiac magnetic resonance imaging and had hormone levels measured. Total testosterone (measured using liquid chromatography-tandem mass spectrometry), sex hormone-binding globulin (measured using an immunofluorometric assay), and calculated free testosterone levels were assessed in male participants of the Framingham Heart Study Offspring Cohort at examination 7. Cardiac magnetic resonance imaging was performed between examinations 7 and 8 (2002-2006). RESULTS: Age-adjusted linear regression models showed statistically significant association between total testosterone levels and left ventricular mass (p = 0.009), left ventricular mass index (p = 0.006), cardiac output (p = 0.001), and main pulmonary artery diameter (p = 0.008); the association between total testosterone and these cardiac magnetic resonance measures was weak and was not significant after adjustment for established risk factors-age, body mass index, diabetes, and hypertension. Furthermore, calculated free testosterone level was not significantly associated with any measure of myocardial mass or function. Sex hormone-binding globulin level was significantly associated with left ventricular mass (p = 0.002), left ventricular mass index (p = 0.004), cardiac output (p = 0.003), left ventricular ejection fraction (p = 0.039), and main pulmonary artery diameter (p = 0.042) in age-adjusted models; these associations were also rendered non-significant after adjusting for cardiovascular risk factors. CONCLUSIONS: Neither testosterone nor sex hormone-binding globulin levels in men are associated significantly with myocardial mass and function independent of established cardiovascular risk factors.
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Coração/fisiologia , Globulina de Ligação a Hormônio Sexual/metabolismo , Testosterona/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/sangue , Estudos de Coortes , Coração/anatomia & histologia , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Fatores de RiscoAssuntos
Fragilidade , Idoso , Idoso de 80 Anos ou mais , Idoso Fragilizado , Avaliação Geriátrica , Registros Hospitalares , Hospitais , HumanosRESUMO
Pregnancy rhinitis (PR), a common condition in pregnant women, is defined as long-lasting nasal congestion due to mucosal swelling and increased secretion without any signs of infection, allergy or tumor, starting at any time during pregnancy and disappearing within 2 weeks of delivery. Smoking and a sensitization to house dust mites are known risk factors. While a definitive pathophysiological concept for PR does not exist, hormonal influences are discussed. We present a stepwise therapeutic strategy for PR and an overview to the latest literature.
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Complicações na Gravidez , Rinite , Feminino , Humanos , GravidezRESUMO
PURPOSE: The aim of the study was to test whether or not the arteriovenous oxygen concentration difference (avDO2) kinetics at the pulmonary (avDO2pulm) and muscle (avDO2musc) levels is significantly different during dynamic exercise. METHODS: A re-analysis involving six publications dealing with kinetic analysis was utilized with an overall sample size of 69 participants. All studies comprised an identical pseudorandom binary sequence work rate (WR) protocol-WR changes between 30 and 80 W-to analyze the kinetic responses of pulmonary ([Formula: see text]) and muscle ([Formula: see text]) oxygen uptake kinetics as well as those of avDO2pulm and avDO2musc. RESULTS: A significant difference between [Formula: see text] (0.395 ± 0.079) and [Formula: see text] kinetics (0.330 ± 0.078) was observed (p < 0.001), where the variables showed a significant relationship (rSP = 0.744, p < 0.001). There were no significant differences between avDO2musc (0.446 ± 0.077) and avDO2pulm kinetics (0.451 ± 0.075), which are highly correlated (r = 0.929, p < 0.001). CONCLUSION: It is suggested that neither avDO2pulm nor avDO2musc kinetic responses seem to be responsible for the differences between estimated [Formula: see text] and measured [Formula: see text] kinetics. Obviously, the conflation of avDO2 and perfusion ([Formula: see text] ) at different points in time and at different physiological levels drive potential differences in [Formula: see text] and [Formula: see text] kinetics. Therefore, [Formula: see text] should, in general, be considered whenever oxygen uptake kinetics are analyzed or discussed.
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Pulmão/metabolismo , Pulmão/fisiologia , Músculo Esquelético/metabolismo , Músculo Esquelético/fisiologia , Consumo de Oxigênio/fisiologia , Oxigênio/metabolismo , Adulto , Exercício Físico/fisiologia , Teste de Esforço , Feminino , Frequência Cardíaca/fisiologia , Humanos , Cinética , Masculino , Troca Gasosa Pulmonar/fisiologiaRESUMO
PURPOSE: The effects of 60 days of head down tilt bed rest (HDBR) with and without the application of a reactive jump countermeasure were investigated, using a method which enables to discriminate between pulmonary ([Formula: see text]O2pulm) and muscular ([Formula: see text]O2musc) oxygen uptake kinetics to control for hemodynamic influences. METHODS: 22 subjects were randomly allocated to either a group performing a reactive jumps countermeasure (JUMP; n = 11, male, 29 ± 7 years, 23.9 ± 1.3 kg m- 2) or a control group (CTRL; n = 11, male, 29 ± 6 years, 23.3 ± 2.0 kg m- 2). Heart rate (HR) and [Formula: see text]O2pulm were measured in response to repeated changes in work rate between 30 and 80 W before (BDC-9) and two times after HDBR (R+ 2, R+ 13). Kinetic responses of HR, [Formula: see text]O2pulm, and [Formula: see text]O2musc were assessed applying time series analysis. Higher maxima in cross-correlation functions (CCFmax(x)) between work rate and the respective parameter indicate faster kinetics responses. Statistical analysis was performed applying multifactorial analysis of variance. RESULTS: CCFmax([Formula: see text]O2musc) and CCFmax([Formula: see text]O2pulm) were not significantly different before and after HDBR (P > 0.05). CCFmax(HR) decreased following bed rest (JUMP: BDC-9: 0.30 ± 0.09 vs. R+ 2: 0.28 ± 0.06 vs. R+13: 0.28 ± 0.07; CTRL: 0.35 ± 0.09 vs. 0.27 ± 0.06 vs. 0.33 ± 0.07 P = 0.025). No significant differences between the groups were observed (P > 0.05). Significant alterations were found for CCFmax of mean arterial blood pressure (mBP) after HDBR (JUMP: BDC-9: 0.21 ± 0.07 vs. R+ 2: 0.30 ± 0.13 vs. R+ 13: 0.28 ± 0.08; CTRL: 0.25 ± 0.07 vs. 0.38 ± 0.13 vs. 0.28 ± 0.08; P = 0.008). CONCLUSIONS: Despite hemodynamic changes, [Formula: see text]O2 kinetics seem to be preserved for a longer period of HDBR, even without the application of a countermeasure.
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Exercício Físico/fisiologia , Decúbito Inclinado com Rebaixamento da Cabeça/fisiologia , Frequência Cardíaca/fisiologia , Músculos/fisiologia , Oxigênio , Adulto , Pressão Arterial/fisiologia , Repouso em Cama , Humanos , Cinética , MasculinoRESUMO
BACKGROUND: Interventional closure of left atrial appendage (LAAC) represents an alternative for stroke prevention in patients with non-valvular atrial fibrillation. Whether LAAC may affect metabolomic pathways has not been investigated yet. This study evaluates the impact of LAAC on the metabolism of essential amino acids, kynurenine and creatinine. METHODS: Peripheral blood samples of prospectively enrolled patients undergoing successful LAAC were taken before (T0) and 6â¯months after (T1, mid-term follow-up). Targeted metabolomic profiling was performed using electrospray ionization liquid chromatography-mass spectrometry (ESI-LC-MS/MS) and MS/MS measurements focusing on metabolism of essential amino acids. RESULTS: 44 patients with non-valvular AF (mean CHA2DS2-VASc score 4, mean HAS-BLED score 4) were enrolled. Changes in metabolites of essential amino acids, myocardial contraction and bioenergetic efficacy, such as phenylalanine (percentage change 8.2%, pâ¯=â¯0.006), tryptophan (percentage change 20.3%, pâ¯=â¯0.0006), tyrosine (percentage change 20.2%, pâ¯=â¯0.0001), creatinine (percentage change 7.2%, pâ¯>â¯0.05) and kynurenine (percentage change 8.3%, pâ¯=â¯0.0239) were found at mid-term follow-up. CONCLUSIONS: LAAC may affect the metabolism of essential amino acids and bioenergetic efficacy. ClinicalTrials.gov Identifier: NCT02985463.
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Aminoácidos Essenciais/sangue , Apêndice Atrial/metabolismo , Apêndice Atrial/cirurgia , Metabolismo Energético/fisiologia , Metabolômica/métodos , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , Espectrometria de Massas por Ionização por Electrospray/métodos , Resultado do Tratamento , Dispositivos de Oclusão VascularRESUMO
Patients with non-valvular atrial fibrillation (AF) and a high risk for oral anticoagulation can be treated by percutaneous implantation of left atrial appendage occlusion devices (LAAC) to reduce the risk of cardio-embolic stroke. This study evaluates whether LAAC may influence lipid metabolism, which has never been investigated before. Patients with successful LAAC were included consecutively. Venous peripheral blood samples of patients were collected immediately before (T0, baseline) and 6 months after (T1, mid-term) LAAC. A targeted metabolomics approach based on electrospray ionization liquid chromatography-mass spectrometry (ESI-LC-MS/MS) and MS/MS measurements was performed. A total of 34 lipids revealed a significant change from baseline to mid-term follow-up after successful LAAC. Subgroup analysis revealed confounding influence by gender, age, diabetes mellitus type II, body mass index, left ventricular ejection fraction, creatinine and NT-proBNP. After multivariable adjustment within logistic regression models, these 34 lipids were still significantly altered after LAAC. Successful percutaneous LAAC may affect lipid metabolism and thereby may potentially affect pro-atherogenic and cardio-toxic effects.
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Apêndice Atrial/metabolismo , Fibrilação Atrial/sangue , Diabetes Mellitus Tipo 2/sangue , Lipídeos/sangue , Metaboloma , Intervenção Coronária Percutânea/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Fibrilação Atrial/complicações , Fibrilação Atrial/diagnóstico por imagem , Fibrilação Atrial/cirurgia , Índice de Massa Corporal , Creatinina/sangue , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Diabetes Mellitus Tipo 2/cirurgia , Ecocardiografia Transesofagiana , Feminino , Humanos , Metabolismo dos Lipídeos , Lipídeos/classificação , Modelos Logísticos , Masculino , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Espectrometria de Massas por Ionização por Electrospray , Volume Sistólico/fisiologia , Espectrometria de Massas em TandemRESUMO
BACKGROUND: The systolic blood pressure intervention trial (SPRINT) published in 2015 has opened up new discussions on whether a lower blood pressure target as recommended by the current guidelines would be better for some patient groups. OBJECTIVES: To review patient groups in which lower blood pressure targets would not be better. MATERIALS AND METHODS: The results of SPRINT, its post-hoc and subgroup analyses, other studies and newer studies, as well as metaanalyses on the topic of blood pressure targets are reviewed and discussed. Studies with patients excluded from the SPRINT study were also analysed. The current international guidelines and recommendations of the Deutsche Hochdruckliga e.â¯V. DHL® are included. RESULTS: Blood pressure monitoring methods differed considerably in the previously published studies. The low blood pressure value in SPRINT was mainly achieved due to the unusual method of blood pressure monitoring used and, as such, cannot be compared with blood pressure values in other studies. Based on current evidence, "the lower the better" should not be recommended in the following patient groups: older patients, in particular infirm older patients, patients with diabetes, patients without coronary heart disease or with low cardiovascular risk. CONCLUSIONS: When determining a blood pressure target, the method of blood pressure monitoring should be defined. A lower blood pressure target has been shown to be better in some well defined patient groups. However, adverse events due to antihypertensive medications should always be taken into account. Given the multiple exclusion criteria in trials and the results of many studies, "new" lower blood pressure targets could not be recommended in a large population of patients.
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Pressão Sanguínea , Hipertensão/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Determinação da Pressão Arterial , Feminino , Idoso Fragilizado , Fidelidade a Diretrizes , Humanos , Hipertensão/diagnóstico , Masculino , Pessoa de Meia-Idade , Valores de ReferênciaRESUMO
PURPOSE: Hypotension due to spinal anesthesia is a well-known side effect in pregnant women receiving caesarean section. Little is known about its impact on fetal blood circulation. METHODS: 40 women with uncomplicated singleton term pregnancies prepared for caesarean section were prospectively evaluated by Doppler sonography before and immediately after spinal anesthesia. RESULTS: In 90% of the women, blood pressure significantly decreased after spinal anesthesia and 42.5% of the patients suffered from severe hypotension. We found a significant negative correlation between maternal blood pressure change and the resistant index (RI) of the umbilical artery (rs = - 0.376, p = 0.017) and a significant positive correlation between maternal blood pressure and fetal middle cerebral artery. CONCLUSION: Healthy fetuses seem to compensate well in situations with decreased uteroplacental blood flow due to maternal hypotension measured by means of RI changes in the fetal umbilical and middle cerebral artery. This raises the question if growth-restricted and/or preterm fetuses are able to compensate similarly or if general anesthesia would be a method of choice.
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Raquianestesia/efeitos adversos , Cesárea , Feto/irrigação sanguínea , Hipotensão/etiologia , Placenta/irrigação sanguínea , Ultrassonografia Doppler/métodos , Artérias Umbilicais/fisiologia , Cordão Umbilical/efeitos dos fármacos , Útero/irrigação sanguínea , Adulto , Anestesia Geral , Anestesia Obstétrica/efeitos adversos , Pressão Sanguínea , Feminino , Humanos , Hipotensão/epidemiologia , Recém-Nascido , Artéria Cerebral Média/fisiologia , Gravidez , Resultado da GravidezRESUMO
The article Occlusion of left atrial appendage aff ects metabolomic profile:focus on glycolysis, tricarboxylic acid and urea metabolism, written by K. Sattler, M. Behnes, C. Barth, A. Wenke, B. Sartorius, I. El-Battrawy, K. Mashayekhi, J. Kuschyk, U. Hoffmann, T. Papavasiliu, C. Fastner, S. Baumann, S. Lang, X. Zhou, G. Yücel, M. BorggrefeI, Akin, was originally published Online First without open access.
RESUMO
PURPOSE: The aim of the study was to test for significant differences in non-invasively estimated muscle oxygen uptake ([Formula: see text]) kinetics, assessed by a square-wave exercise protocol (STEP) as well as by a time series approach with pseudorandom binary sequence (PRBS) work rate (WR) changes. METHODS: Seventeen healthy and active individuals (10 women, 7 men; 23 ± 2 years old; height 175 ± 11 cm; body mass 73 ± 14 kg [mean ± SD]) completed five repetitions of WR transitions from 30 to 80 W for the STEP approach and two sequences of pseudorandom binary WR changes between 30 and 80 W for the PRBS approach. Pulmonary oxygen uptake ([Formula: see text]) was measured breath by breath. [Formula: see text] kinetics were estimated during phase II [Formula: see text] in the STEP approach and during the pseudorandom binary sequence WR changes in the PRBS approach. RESULTS: No significant differences were observed between different models of the STEP and the PRBS approach for estimation of [Formula: see text] kinetics (p > 0.05). In addition, a very high variability between the models was determined for [Formula: see text] kinetics [mean time constants (τ) difference: - 2.5 ± 11.4 s]. A significant correlation for τ of [Formula: see text] between the STEP approach with experimentally determined phase I [Formula: see text] lengths and the PRBS approach was noticed (r = 0.536; p < 0.05). CONCLUSIONS: Both approaches (STEP and PRBS) are not significantly different for estimating the [Formula: see text] kinetics, but the very high variability impairs the predictability between the models. However, the determination of the length of phase I [Formula: see text] should be as appropriate as possible because predefined duration lengths can result in overestimations in [Formula: see text] kinetics.