The Role of Several Angiogenesis Peptides Markers in the Management of Hypertensive Pregnant Women

2018 ◽  
Vol 69 (6) ◽  
pp. 1509-1514
Author(s):  
Elena Mihalceanu ◽  
Daniela Cristina Dimitriu ◽  
Ioan Tudor Lazar ◽  
Brindusa Alina Petre ◽  
Gabriel Constantinescu ◽  
...  

The objectives of the research herein are to detect if the modifications of sFlt-1 and PlGF can be correlated with the clinical and biochemical status of the hypertensive pregnant woman and if the sFlt-1/PlGF ratio is a good predictor for preeclampsia in case of the investigated patients. In the study herein, 100 pregnant women were evaluated; they were distributed in the following groups: The group of pregnant women diagnosed with HTN at the time of hospital admission � including 50 pregnant women, of which 16 pregnant women presented medium and severe forms of preeclampsia and 34 pregnant women with pregnancy-induced hypertension and 50 pregnant women with normal pregnancy evolution as control group. We have performed hematological and biochemical tests, using serum samples from all analyzed patients and measured the serum concentrations of sFlt-1 and PlGF angiogenic factors. We found a significant correlation between the value of the arterial blood pressure, the proteinuria, the serum creatinine and the AST, on one hand, and the sFlt-1/PlGF ratio, on the other hand. The ROC curve has emphasized the fact that the proteinuria (AUC = 0.849), the AST (AUC = 0.664), the value of the arterial blood pressure SBP/DBP (AUC = 0.683/0.631), the serum creatinine (AUC = 0.674) and the sFlt-1/PlGF ratio, at a cut off value = 200, are effective preeclampsia predictors. Similarly, statistically significant increase (p = 0.001) of the sFlt-1 serum concentration in case of the pregnant women from the PE group (14365�6464 pg/mL) and from the PIH group (9892�8443 pg/mL), compared to the control group (3278�1444 pg/mL) and, respectively, a significant decrease (p = 0.003) of the PlGF pro-angiogenic marker for the group of pregnant women suffering from preeclampsia (119.30�56.63 pg/mL) and from PIH (129.12�21.41 pg/mL), compared to the control group (327.57�59.62 pg/mL). The results obtained within this research show that sFlt-1/PlGF ratio represents an effective preeclampsia predictor, confirming the fact that the study of the angiogenic factors may help to analyze the stratification of the risk degree in HTN pregnant women.

2018 ◽  
Vol 1 (108) ◽  
pp. 2-8
Author(s):  
Kęstutis Bunevičius ◽  
Albinas Grunovas ◽  
Jonas Poderys

Background. Occlusion pressure intensity influences the blood flow intensity. Immediately after the cuff pressure is released, reactive hyperaemia occurs. Increased blood flow and nutritive delivery are critical for an anabolic stimulus, such as insulin. The aim of study was to find which occlusion pressure was optimal to increase the highest level of post occlusion reactive hyperaemia. Methods. Participants were randomly assigned into one of the four conditions (n = 12 per group): control group without blood flow restriction, experimental groups with 120; 200 or 300 mmHg occlusion pressure. We used venous occlusion plethysmography and arterial blood pressure measurements. Results. After the onset of 120 and 200 mm Hg pressure occlusion, the blood flow intensity significantly decreased. Occlusion induced hyperaemia increased arterial blood flow intensity 134 ± 11.2% (p < .05) in the group with 120 mmHg, in the group with 200 mmHg it increased 267 ± 10.5% (p < .05), in the group with 300 mmHg it increased 233 ± 10.9% (p < .05). Applied 300 mmHg occlusion from the 12 minute diastolic and systolic arterial blood pressure decreased statistically significantly. Conclusions. Occlusion manoeuvre impacted the vascular vasodilatation, but the peak blood flow registered after occlusion did not relate to applied occlusion pressure. The pressure of 200 mmHg is optimal to impact the high level of vasodilatation. Longer than 12 min 300 mmHg could not be recommended due to the steep decrease of systolic and diastolic blood pressures.


1992 ◽  
Vol 82 (2) ◽  
pp. 157-162 ◽  
Author(s):  
Margaret Ramsay ◽  
Fiona Broughton Pipkin ◽  
Peter Rubin

1. Twenty-eight healthy non-pregnant women and 28 women in the first or second trimester of pregnancy were studied. They were given an incremental intravenous infusion of either noradrenaline or angiotensin II. Pressor and heart rate responses were documented. 2. Dose-pressor response curves were constructed for the two agents in pregnant and non-pregnant women (n=14 in each group). The regression parameters of slope and intercept were calculated, and were used to derive the variables of dose required to elicit a 10 mmHg rise in systolic or diastolic blood pressure. 3. The pressor response to angiotensin II was diminished in pregnancy, with approximately twice the dose being required to raise the systolic or diastolic arterial blood pressure as in non-pregnant subjects. 4. The systolic pressor response to noradrenaline was slightly diminished in pregnancy, but the diastolic pressor response was unchanged. There were no significant differences between the doses of noradrenaline required to elicit a 10 mmHg rise in systolic or diastolic arterial blood pressure in pregnant or non-pregnant subjects. 5. There was a diminution in the bradycardia evoked in response to both hormones in pregnancy. 6. We conclude that the well-documented pressor insensitivity to angiotensin II during pregnancy is a specific phenomenon, not a manifestation of a generalized reduction in vascular reactivity.


2021 ◽  
Vol 71 (3) ◽  
pp. 1033-36
Author(s):  
Fatima Iqbal ◽  
Manzoor Ahmed Faridi ◽  
Aisha Saeed ◽  
Inamullah Shah

Objective: To compare the result of the combination of hyperbaric bupivacaine plus fentanyl with hyperbaric bupivacaine alone in patients undergoing caesarean section in spinal anaesthesia. Study Design: Comparative, cross-sectional study. Place and Duration of Study: Department of Anesthesia, Fauji Foundation Hospital, Rawalpindi Pakistan, from Dec 2017 to Jun 2018. Methodology: After consulting the institutional ethical review committees a total of 60 females between ages 18-40 years were enrolled for caesarean section delivery. They were divided into two groups. The study group (n=30) received a subarachnoid injection of 0.5% hyperbaric bupivacaine (10mg) 2ml with 25ug of fentanyl 0.5ml and control group (n=30) was injected 0.5% hyperbaric bupivacaine 12.5mg (2.5 ml) only. Pain experienced during the procedure was assessed by using 10-point visual analogue scoring method. The mean duration of analgesia, mean arterial blood pressure and heart rate after surgery were compared between two groups. Results: The mean duration of analgesia was 206.5/min ± 6.4 in the study group and it was 163.6min ± 7.2 in the control group (p=0.001). Mean arterial BP after surgery was 92.3mmHg ± 3.8 in the study group and 88.7mmHg ± 4.1 in the control group (p=0.001). The mean heart rate recorded after surgery was 75.2/min ± 5.2 in the study group and it was 70.4/min ± 6.1 in the control group (p=0.001). Conclusions: The mean duration of analgesia was significantly longer in the study group when compared with the control group with better mean arterial blood pressure and heart rate response after Caesarean section.


2008 ◽  
Vol 65 (2) ◽  
pp. 135-139
Author(s):  
Branislava Ivanovic ◽  
Ivan Paunovic ◽  
Djordje Nikcevic ◽  
Dane Cvijanovic ◽  
Nevena Kalezic ◽  
...  

Bacground/Aim. Increased values of thyroid hormones in the clinical syndrome of hyperthyreosis affect blood pressure values and its circadial variation. The aim of this study was to define the influence of hyperthyreosis on the values and circadial variations of arterial blood pressure, as well as to investigate the effect of thyroid surgery on blood pressure values. Methods. We compared the 24-hour averages of systolic and diastolic blood pressure, their variations and their reduction during the night between 20 female patients with hyperthyroidism and hypertension de novo and 20 healthy females. We compared the values of 24-hour ambulatory monitoring performed before the surgery with the values gathered two weeks after the surgery. Results. The 24-hour average systolic and diastolic blood pressure values were higher in the patients with hyperthyroidism than in the control group (p < 0.001). In the group of patients, the variations in blood pressure were significantly higher than they were in the group of healthy people (p < 0.001). The amplitude of the nocturnal reduction of blood pressure was also significantly lower in the patients with hyperthyroid status and hypertension, in comparison to the healthy persons (p < 0.001). Two weeks after the surgery, a significant reduction of blood pressure values (both for systolic and diastolic) appeared. Conclusion. The patients with hyperthyroidism- caused hypertension had higher systolic and diastolic blood pressure, higher variations in blood pressure and lower nocturnal reduction of blood pressure than healthy subjects. Thyroid surgery, as a control of thyroid function, optimised blood pressure very rapidly.


1997 ◽  
Vol 272 (6) ◽  
pp. R2034-R2039 ◽  
Author(s):  
C. D. Wagner ◽  
A. Just ◽  
B. Nafz ◽  
P. B. Persson

The aim of this study was to investigate spontaneous variability of arterial blood pressure in conscious foxhounds in the absence of direct sympathetic and parasympathetic influences. Autonomic blockade was achieved by administration of the ganglionic blocking agent hexamethonium (n = 7). In contrast to the control group (n = 7), marked oscillations with a cycle length of 100 s (0.01 Hz) were observed. The relationship of the power densities of the oscillation band (0.01 +/- 0.005 Hz) to the total power increased threefold (0.213 +/- 0.007 vs. 0.057 +/- 0.005; P < 0.01). The 0.01-Hz oscillations typically commenced after some delay. To test whether the absence of the mechanoreceptor afferents was responsible for these fluctuations, we investigated an additional group of foxhounds that were subjected to total baroreceptor and cardiopulmonary receptor denervation (n = 7). Neither in this protocol, nor in a group subjected to denervation and ganglionic blockade (n = 6), did we observe sustained oscillations in this frequency range. Since the oscillations were not seen after combined afferent (mechanoreceptor denervation) and efferent (ganglionic) blockade, central oscillators as a source of the oscillations can be ruled out. A simple model of a circulating pressoric factor may explain the fluctuations, provided that there is a time delay between the stimulus and the release or action of the factor. The findings suggest that a circulating factor accounts for the 0.01-Hz oscillations, which is dependent on intact pathways from the cardiac receptors or baroreceptors to the central nervous system. This hypothesis is put forward since cardiopulmonary and baroreceptor denervation blocked the oscillations seen after ganglionic blockade.


BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Katharina Riedel ◽  
Marcus Thudium ◽  
Azize Boström ◽  
Johannes Schramm ◽  
Martin Soehle

Abstract Background Resection of cerebral arteriovenous malformations (AVM) is technically demanding because of size, eloquent location or diffuse nidus. Controlled arterial hypotension (CAH) could facilitate haemostasis. We performed a study to characterize the duration and degree of CAH and to investigate its association with blood loss and outcome. Methods We retrospectively analysed intraoperative arterial blood pressure of 56 patients that underwent AVM-resection performed by the same neurosurgeon between 2003 and 2012. Degree of CAH, AVM size, grading and neurological outcome were studied. Patients were divided into two groups, depending on whether CAH was performed (hypotension group) or not (control group). Results The hypotension group consisted of 28 patients, which presented with riskier to treat AVMs and a higher Spetzler-Martin grading. CAH was achieved by application of urapidil, increasing anaesthetic depth or a combination thereof. Systolic and mean arterial blood pressure were lowered to 82 ± 7 and 57 ± 7 mmHg, respectively, for a median duration of 58 min [25% percentile: 26 min.; 75% percentile: 107 min]. In the hypotension group, duration of surgery (4.4 ± 1.3 h) was significantly (p <  0.001) longer, and median blood loss (500 ml) was significantly (p = 0.002) higher than in the control group (3.3 ± 0.9 h and 200 ml, respectively). No case fatalities occurred. CAH was associated with a higher amount of postoperative neurological deficits. Conclusions Whether CAH caused neurological deficits or prevented worse outcomes could be clarified by a prospective randomised study, which is regarded as ethically problematic in the context of bleeding. CAH should only be used after strict indication and should be applied as mild and short as possible.


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