scholarly journals Renal arteries denervation with second generation systems: a remedy for resistant hypertension?

2020 ◽  
Vol 22 (Supplement_L) ◽  
pp. L160-L165
Author(s):  
Francesco Versaci ◽  
Sebastiano Sciarretta ◽  
Massimiliano Scappaticci ◽  
Simone Calcagno ◽  
Riccardo di Pietro ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Second Generation ◽  
Randomized Study ◽  
Renal Arteries ◽  
Control Group ◽  
Energy Delivery ◽  
Arterial Blood ◽  
Treatment Of Hypertension ◽  
Effective Therapeutic Strategy

Abstract Initial studies on renal denervation (RDN) for the treatment of non-controlled arterial hypertension (HTN) through radiofrequency ablation of renal arteries demonstrated that RDN is an effective therapeutic strategy to reduce arterial blood pressure (BP). Nonetheless, the first randomized study, SYMPLICITY-HTN-3, failed to demonstrate a clear benefit for RND over the control group. Technologic evolution, with the introduction of new second generation multi-electrode devices, allowed deep energy delivery along the full circumference of the vessel. Two recent randomized studies involving patients assuming (SPYRAL HTN-ON MED) or not (SPYRAL HTN-OFF MED) antihypertensive pharmacologic treatment, demonstrated the efficacy and safety of RDN using second generation systems for radiofrequency ablation. Another recent randomized study demonstrated that RDN with ultrasounds (RADIANCE-HTN SOLO) of the main renal arteries led to a significant BP reduction compared to the control group. These studies have once again raised the interest of the scientific community towards attempting to define the appropriate role of RDN in the treatment of hypertension. Nonetheless, larger and longer clinical trials will be necessary to draw further conclusions.

scholarly journals Accumulation of Prostacyclin in Rat Brain during Haemorrhagic Hypotension—Possible Role of PGI2 in Autoregulation

1984 ◽  
Vol 4 (1) ◽  
pp. 107-109 ◽  
Author(s):  
E. Shohami ◽  
A. Sidi
Keyword(s):  
Blood Pressure ◽  
Steady State ◽  
Control Group ◽  
Prostaglandin E ◽  
Cortical Tissue ◽  
Arterial Blood ◽  
Haemorrhagic Hypotension ◽  
Potent Vasodilator ◽  
Prostaglandin F

The effect of haemorrhagic hypotension on the levels of prostaglandin E2 (PGE2), thromboxane B2 (TXB2), and 6-keto prostaglandin F1α (6-keto-PGF1α) in cortical tissue of rats was studied. Lightly anesthetized rats were subjected to steady-state hypotension for 15 min, with a mean arterial blood pressure of 80, 60, and 40 mm Hg, and compared to a control group of normotensive rats. No significant change was found in the levels of PGE2 and TXB2. The level of 6-keto-PGF1α increased from 7.8 ± 0.9 to 14.1 ± 1.9 pg/mg protein (p < 0.02) at 80 mm Hg. Our findings suggest that prostacyclin, which is a potent vasodilator, might play a role in setting the lower limit of the autoregulation range.

scholarly journals Role of hyperoxygenation on surgical site wound infection: a randomised case control study

2019 ◽  
Vol 6 (8) ◽  
pp. 2927
Author(s):  
Samba Siva Rao G. ◽  
Kiran Kumar Suggala
Keyword(s):  
Surgical Site Infection ◽  
Case Control Study ◽  
Elective Surgery ◽  
Randomized Study ◽  
Control Group ◽  
Site Infection ◽  
Medical College ◽  
Induction Of Anaesthesia ◽  
Control Study

Background: The aim of this study was to assess the influence of hyperoxygenation on surgical site wound infections.Methods: Using prospective randomized study, conducted from January 2018 to December 2018 at Mamata Medical College and General hospital, Khammam. This study includes 100 patients who were going for elective surgery at various divisions of Department of surgery. Patients were assigned randomly to an oxygen/air mixture with a faction of inspiration (FiO2) of 30% (n=50) and 60% (n=50). Administration was started after induction of anaesthesia and maintained for 3hours after surgery.Results: Surgical site infection was recorded in 5 patients (2 of 50, 10%) in the hyperoxygenation group and 11 patients (11 of 50, 22%) in the control group (p<0.05). Time of hospitalization was 5±3 days in the hyperoxygenation group and 9±4 days in the control group (p<0.05).Conclusions: Hyperoxygenation was associated with a reduction in surgical site infection. It also decreases the duration of hospital stay and decreases economic burden.

scholarly journals Effect of the use of dexmedetomidine as a local anesthetic adjuvant to bupivacaine 0.125% in epidural labor analgesia: randomized controlled study

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Mohamed Elsayed Afandy ◽  
Motaz M. A. Abusabaa ◽  
Hashem Adel Lotfy ◽  
Radwa Fathy Mansour
Keyword(s):  
Epidural Analgesia ◽  
Local Anesthetics ◽  
Randomized Study ◽  
Neonatal Outcomes ◽  
Controlled Study ◽  
Control Group ◽  
Normal Delivery ◽  
Pregnant Females ◽  
Arterial Blood ◽  
Significant Prolongation

Abstract Background Multiple methods exist for the management of pain during normal labor. Epidural analgesia has been reported to be an effective method in that perspective. The current study was conducted to evaluate the efficacy of dexmedetomidine as an adjuvant to local anesthetics in epidural analgesia for pregnant females presented for normal delivery. Sixty pregnant females were included in this prospective randomized study, and they were divided into two equal groups: control group which received bupivacaine alone and dexmedetomidine group that received bupivacaine with dexmedetomidine. The primary outcome was the onset of analgesia, while the secondary outcomes included the duration of analgesia, hemodynamic changes, labor progress, neonatal outcomes, and maternal complications. Results Dexmedetomidine group was associated with earlier onset of analgesia (P ˂ 0.001), prolonged duration (P ˂ 0.001), and lower need for top-up doses (P ˂ 0.001) compared to control group. Also, sedation and maternal satisfaction were significantly better in the same group (P = 0.001, 0.025; respectively). Labor progress parameters and neonatal outcomes were comparable between the two groups. Dexmedetomidine group has lower heart rate and mean arterial blood pressure compared to the control group. Despite of dexmedetomidine group had higher incidence of hypotension and bradycardia, it was statistically insignificant when compared to control group. Conclusions Dexmedetomidine is a reliable and an effective adjuvant to the local anesthetics in epidural analgesia during normal delivery as it resulted in earlier onset and significant prolongation of the analgesic time with decrease in the top-up doses intake. Trial registration Pan African Clinical Trial Registry (PACTR201710002664704). Register on 3 October 2017.

Respiratory Muscle Strength and its use in COVID-19 pandemic: Role of Lung Function tests (Preprint)

2020 ◽  
Author(s):  
Dr. Anita Agrawal ◽  
Vivek Nalgilkar
Keyword(s):  
Respiratory Muscle ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Muscle Performance ◽  
Control Group ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis ◽  
Significant Difference

BACKGROUND There is a concern that pulmonary function testing could represent a potential way for COVID 19 transmission due to the congregation of patients with lung disease and because of the potential for coughing and droplet formation surrounding pulmonary function testing procedures There remain many unknowns facts about the possibility of transmission and the data are in evolution; however, the risks of transmission may be significant, and likely to vary based on the prevalence of the virus in the community and the age and severity of lung disease. Pulmonary functions routinely used for screening the COVID 19 patients are pulse oximeter and arterial blood gas analysis techniques. In addition to these two, the impaired respiratory muscle performance can also be tested. It is an underappreciated factor contributing to poor outcomes unfolding during the coronavirus pandemic. While impaired respiratory muscle performance is considered to be rare, it is more frequently encountered in patients with poorer health. The primary aim of this study is to discuss the potential role of respiratory muscle performance from the perspective of the coronavirus pandemic. We have done studies on COPD patients where the impaired respiratory muscle performance is reduced and when we compare that with control group, we realize that this is a good test to identify for COVID 19 patients. OBJECTIVE The purpose of this paper is to discuss the potential role of testing respiratory muscle performance. It can be utilised for screening large population during COVID-19 pandemic. METHODS This work was done at a Premier Medical Institute of Mumbai, which is a tertiary care centre catering to a large number of patients from all over Mumbai and also other parts of the state of Maharashtra. After proper diagnosis from the Chest Physician and labelled as COPD patient, the MIP measurements was conducted. Spirometry was done during the routine procedure. RESULTS In total, 90 subjects with a mean age of 60.3 ± 14.76 years and percentage of forced expiratory volume in 1 second (FEV1) of 89.67+9.92 L were recruited. MIP was significantly higher in control group than COPD. (z=-12.5). The analysis of variance (ANOVA) showed significant difference for maximal inspiratory pressure (p=0.003) between different stages of COPD. The MIP results showed that there was a statistically significant difference between mild and very severe (p=0.0019) as well as between moderate and very severe (p=0.002). The MIP results showed that there was a statistically significant difference between mild and very severe (p=0.0019) as well as between moderate and very severe (p=0.002). A significant positive correlation among maximal static pressure and FEV1 % (r= 0.5) was also observed. MIP thus is an effective technique to measure reduced performance of respiratory muscle strength. CONCLUSIONS In addition to pulse oximeter and arterial blood gas analysis, MIP can be the test of choice to test the impaired respiratory muscle performance in COVID 19 patients. Screening for respiratory muscle impairment in patients with dyspnea or characteristics associated increased risk of severe respiratory complication due to viral infection may be advantageous.

The role of the prostacyclin-thromboxane system in cerebral vasospasm following induced subarachnoid hemorrhage in the rabbit

1984 ◽  
Vol 61 (6) ◽  
pp. 1120-1128 ◽  
Author(s):  
Richard C. Chan ◽  
Felix A. Durity ◽  
Gordon B. Thompson ◽  
Robert A. Nugent ◽  
Marie Kendall
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Platelet Aggregation ◽  
Clinical Status ◽  
Control Group ◽  
Content Type ◽  
Arterial Blood ◽  
Or Groups ◽  
Significant Difference ◽  
Potent Vasoconstrictor

✓ Subarachnoid hemorrhage (SAH) was induced in 50 rabbits by injecting 1.25 cc/kg of autologous, well heparinized, fresh arterial blood into the cisterna magna, followed by suspending the animals in a head-down position at 30° for 15 minutes. The animals were evenly divided into five groups: a control group, or groups receiving post-SAH prostacyclin (PGI2), carbacyclin, thromboxane A2 (TXA2) synthetase inhibitor (OKY-1581), or nutralipid. Radiographic vertebrobasilar arterial spasm was demonstrated on the 3rd day post-SAH in the control animals. This was decreased in the prostacyclin and the carbacyclin groups and was absent in the OKY-1581 and the nutralipid groups. Cerebral blood flow (CBF) measurements on the 4th day post-SAH using the xenon-133 technique failed to reveal any significant difference between the prostacyclin, the carbacyclin, and the control groups, but flows in the nutralipid and the OKY-1581 groups were significantly higher. There was a good correlation between the clinical status and the CBF. Intracytoplasmic vacuolation and detachment of the vascular endothelium, seen ultrastructurally, may account for the impaired synthesis of prostacyclin. Exogenous prostacyclin and carbacyclin decreased vasospasm but failed to improve cerebral perfusion. OKY-1581 blocked the synthesis of the potent vasoconstrictor, TXA2, which is not only formed during platelet aggregation but also induces platelet aggregation. Nutralipid contains linolenic acid, a precursor of eicosapentaenoic acid (EPA), which is more potent in inhibiting platelet aggregation and in blocking TXA2 production. The various fatty acid constituents of nutralipid bind to albumin and thereby shorten the half-life of TXA2.

scholarly journals Efficacy of Oral Nicorandil to Prevent Contrast-Induced Nephropathy in Patients with Chronic Renal Dysfunction Undergoing an Elective Coronary Procedure

2019 ◽  
Vol 44 (6) ◽  
pp. 1372-1382 ◽  
Author(s):  
Zeyuan Fan ◽  
Yang Li ◽  
Hanhua Ji ◽  
Xinwen Jian
Keyword(s):  
Adverse Events ◽  
Renal Dysfunction ◽  
Protective Factor ◽  
Randomized Study ◽  
Multivariate Logistic Regression Model ◽  
Control Group ◽  
Contrast Induced Nephropathy ◽  
Cox Proportional Hazard ◽  
Coronary Procedure

Objectives: This prospective, randomized study was to investigate the role of nicorandil in the prevention of contrast-induced nephropathy (CIN) in patients with chronic renal dysfunction undergoing an elective coronary procedure. Methods: A total of 252 eligible patients were enrolled in this study and allocated into the control group (n = 125) or nicorandil group (n = 127). Both groups received the standard hydration treatment, and patients in the nicorandil group were orally administrated 10 mg of nicorandil (t.i.d.) beginning 2 days before and continuing for 2 days after an elective coronary procedure. Serum creatinine (SCr) and cystatin C (CysC) were measured at 24 h before and 24, 48, and 72 h after the procedure. The occurrences of CIN and adverse events within 1 year were recorded. Results: The nicorandil group had relatively lower SCr and CysC levels and a higher eGFR at 24 and 48 h after the procedure than the control group (p < 0.05). The incidence of CIN was significantly decreased in the nicorandil group compared to the control group. The multivariate logistic regression model revealed that nicorandil treatment was an independent protective factor for CIN (OR 0.669, 95% CI 0.522–0.857, p = 0.001). The multivariate COX proportional hazard model showed that nicorandil treatment was an independent protective predictor for adverse events (HR 0.881, 95% CI 0.781–0.993, p = 0.037). Conclusions: Nicorandil could exhibit a protective effect against CIN in patients with chronic renal dysfunction undergoing an elective coronary procedure and reduce the adverse events within 1 year after the procedure, which is superior to hydration treatment only.

The Potential protective role of astaxanthin on doxorubicin-induced cardiac toxicity in rats

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Marina Sorial Mina Derias ◽  
Abd El Rahman Fahmy Ahmed Sabaa ◽  
Abd El Moneim Mahmoud Ali Osman ◽  
Abd El-Hamid A Mohamed ◽  
Doaa Ahmed Abou-bakr Darwish
Keyword(s):  
Blood Pressure ◽  
Cardiac Troponin ◽  
Cardiac Tissue ◽  
Cardiac Toxicity ◽  
Treated Group ◽  
Control Group ◽  
Isolated Hearts ◽  
Arterial Blood ◽  
Tissue Iron

Abstract Background and Aim of Work Doxorubicin (DOX) is one of the most commonly used effective anticancer drugs, through its inhibition of topoisomerase II, DNA replication and repair. In addition, DOX leads to generation of semiquinone free radicals and oxygen free radicals which attack DNA and oxidize DNA bases. However, the clinical use of doxorubicin is limited by its adverse effects such as cardiotoxicity, which is acute and occurs within 2-3 days of its administration. Recently, the potential health benefits of Astaxanthin were investigated, however, the protective effect of astaxanthin supplementation on cardiac dysfunction induced by Doxorubicin is not clearly investigated. The aim of the present study is directed to investigate the possible role of astaxanthin (xanthophyll carotenoid) in protection against DOX- induced cardiac toxicity, and to elucidate the underlying mechanism(s). Materials and Methods Animals used were 47 adult male albino rats, which were randomly allocated into four groups. Control group(C): received 0.1ml/100gm BW i.p. saline injections for 7 successive days. DOX-treated group: received 0.1ml/100gm BW i.p. saline injections for 7 successive days, followed by a single i.p. injection of DOX, 20 mg/kg i.p. on the 7th day. ATX-treated group: received 40mg/kg/day BW i.p. ATX injections for 7 successive days. ATX+DOX treated group: received 40mg/kg/day BW i.p. ATX injections for 7 successive days, followed by a single i.p. injection of DOX, 20 mg/kg i.p. on the 7th day. At the end of the study, the overnight fasted rats were subjected to final arterial blood pressure measurement. Rats were then weighed and anaesthetized with 40 mg/kg B.W i.p. thiopental sodium. Then, ECG was recorded, blood samples were collected from abdominal aorta and centrifuged. The resulting plasma was used for measurement of plasma cardiac Troponin I (cTnI) and plasma Cytochrome C. The heart was subjected to In vitro study of isolated hearts perfused in langendorff preparation. Hearts and ventricles were weighed. The left ventricle was then stored at -80οC for later determination of cardiac tissue iron. Statistical Analysis was made using 1-way ANOVA for difference between means of different groups. Ethics Committee The study protocol was approved by the Research Ethical Committee of Faculty o fMedicine Ain Shams University (Reference No. FWA00017585). Results The systolic blood pressure was increased significantly in the DOX treated group compared to the control group. All of the systolic, diastolic and mean arterial blood pressures were significantly decreased in the ATX +DOX treated group compared to the DOX treated group. Heart rate was significantly increased in the ATX +DOX treated group compared to the control group, and compared to the DOX treated group. PT and PT/LVW were significantly increased in the ATX +DOX group compared to both of the DOX group and the control group. In addition, PT and PT/LVW were significantly increased in the ATX-treated group compared to the DOX group. The TPT was prolonged in the DOX group compared to the control group and this prolongation was statistically significant in pre-ischemia and 5 minutes after reperfusion of the isolated hearts, and was significantly shortened in the ATX-treated group and ATX +DOX group compared to the DOX. Also, TPT was significantly shortened in the ATX-treated and in the in the ATX +DOX groups compared to the control group. HRT was significantly prolonged in the DOX group compared to the control group. However, HRT was significantly shortened in the ATX-treated and ATX +DOX groups compared to the DOX group, and in the ATX +DOX group compared to the control group. The MFR and MFR/LVW were significantly decreased in the DOX group compared to the control group. However, the MFR was significantly increased in each of the ATX-treated group and ATX +DOX group when each was compared to the DOX group. Moreover, MFR was significantly increased in the ATX +DOX group compared to the control group. Each of plasma cardiac Troponin, plasma Cytochrome C and Cardiac Tissue Iron were significantly increased in the DOX group compared to the control group, and all were significantly decreased in the ATX-treated group when compared to DOX group, and in the ATX +DOX group when compared to the DOX group. No significant changes were detected in body weight, heart weights and ECG parameters between the different studied groups. Conclusion Doxorubicin produces acute cardiotoxic effects and impairs systolic and diastolic cardiac functions, which is due to increased oxidative stress, mitochondrial instability and iron accumulation in the cardiac tissue. Astaxanthin exerts a major cardioprotective activities against DOXinduced cardiotoxicity, probably due to its major antioxidant and iron chelation properties.

Effect of Vasoconstrictive Agents Added to Lidocaine on Intravenous Lidocaine-induced Convulsions in Rats 

1995 ◽  
Vol 82 (2) ◽  
pp. 574-580 ◽  
Author(s):  
Masataka Yokoyama ◽  
Masahisa Hirakawa ◽  
Hiroshi Goto
Keyword(s):  
Control Group ◽  
Intravenous Lidocaine ◽  
Acute Hypertension ◽  
Equal Degree ◽  
Arterial Blood ◽  
Plasma Lidocaine ◽  
Induced Hypertension ◽  
The Brain ◽  
Control Group Group

Background Epinephrine is reported to decrease the threshold of intravenous lidocaine-induced convulsions. However, the mechanism underlying this effect is not clear. Therefore, we carried out a study to examine the role of vasopressor-induced hypertension. Methods Fifty-six awake Wistar rats were assigned to seven groups of eight. All groups received a continuous intravenous infusion of lidocaine at a rate of 4 mg.kg-1.min-1 until generalized convulsions occurred. The control group (group C) received plain lidocaine. The acute hypertensive groups received lidocaine with epinephrine (group E), norepinephrine (group N), or phenylephrine (group P) to increase mean arterial blood pressure (MAP) to 150 +/- 5 mmHg. Sodium nitroprusside (SNP) was added to prevent an increase in mean arterial pressure in the remaining three groups (vasopressor-SNP groups). Results The acute hypertensive groups required significantly smaller cumulative doses of lidocaine to produce convulsions compared with control (C = 41.5 +/- 2.9 &gt; E = 24.1 +/- 2.7, N = 27.1 +/- 2.8, P = 26.7 +/- 2.5 mg.kg-1; values are mean +/- SD, P &lt; 0.01). In addition, plasma lidocaine concentrations (C = 11.0 +/- 0.7 &gt; E = 7.4 +/- 0.5, N = 7.9 +/- 0.6, P = 8.1 +/- 0.8 micrograms.ml-1, P &lt; 0.01) and brain lidocaine concentrations (C = 50.9 +/- 4.5 &gt; E = 32.6 +/- 4.2, N = 34.5 +/- 4.8, P = 37.1 +/- 4.5 micrograms.g-1, P &lt; 0.01) were less in the acute hypertensive groups at the onset of convulsions. In the vasopressor-SNP groups, the plasma and brain lidocaine concentrations at the onset of convulsions returned to the control values, although epinephrine and norepinephrine, but not phenylephrine, still decreased cumulative convulsant doses of lidocaine significantly (P &lt; 0.01) compared with control (E + SNP = 30.8 +/- 2.9 &lt; N + SNP = 34.8 +/- 2.8, P &lt; 0.01) &lt; P + SNP = 40.2 +/- 3.0 mg.kg-1, P &lt; 0.01). The brain/plasma concentration ratios were similar for the seven groups. Conclusions An equal degree of acute hypertension induced by these three different vasopressors may play a role in reducing the threshold (plasma and brain lidocaine concentrations) as well as the cumulative convulsant doses associated with lidocaine-induced convulsions.

scholarly journals Role of P 2 receptors in Cerebral Vasospasm

Stroke ◽  
2001 ◽  
Vol 32 (suppl_1) ◽  
pp. 354-355
Author(s):  
John H Zhang ◽  
Hitoshi Kimura ◽  
Robin Carpenter ◽  
Andrew D Parent
Keyword(s):  
Receptor Antagonist ◽  
Mrna Expression ◽  
Cerebral Vasospasm ◽  
Cerebral Arteries ◽  
Control Group ◽  
Arterial Blood ◽  
Transmission Electron ◽  
Intracellular Ca ◽  
Basilar Arteries

P87 Introduction: Extracellular ATP activates P 2 receptors to increase intracellular Ca 2+ , to contract cerebral arteries, and to induce vasospasm in animals. This study examined the mRNA expression of P 2 receptors in a rat double hemorrhage model and explored the therapeutic role of P 2 receptor antagonists in a dog double hemorrhage model. Methods: One hundred SD rats were divided into five groups to undergo double hemorrhage by injecting autologous arterial blood into cisterna magna on day 0 and 2. Rats were sacrificed on day 3, 5 or 7. In sham group, rats were injected with saline. In control group, no surgery was conducted. Basilar arteries were harvested for mRNA isolation and RT-PCR or were fixed for transmission electron microscopy (TEM). Eighteen dogs were divided into three groups to have double hemorrhage and sacrificed on day 7. Two groups were treated, intracisternally, with P 2 receptor antagonist suramin (selective for P 2Y and P 2X ) or PPADS (selective for P 2X1 ) (30 μM) from day 3–6. Angiograph was performed before blood injection and before sacrifice. The basilar arteries were collected for TEM. Results: Mild to moderate vasospasm (30–40% reduction) was observed on day 3–7 in rats. The mRNA expression of P 2X1 receptor was down-regulated (P<0.05) on day 3 and recovered on day 5 and 7. P 2Y1 and P 2Y2 receptors were up-regulated (P<0.05) on day 5 and remain elevated on day 7. No changes were observed in the shame group. Severe vasospasm was observed on day 7 in dogs. P 2 receptor antagonist Suramin but not PPADS significantly reversed (P<0.01, ANOVA) vasospasm in dogs. Discussion: P 2Y1 and P 2Y2 , but not P 2X1 , may be involved in cerebral vasospasm. Up-regulation of P 2Y receptor may enable ATP to produce contraction at low concentrations. Suramin reduced vasospasm probably by blocking P 2Y receptors.

Sign in / Sign up

Export Citation Format

Share Document