Utility of estimated pulse wave velocity for assessing vascular stiffness: comparison of methods

Aim. Pulse wave velocity independently predicts cardiovascular risk. Easy to use single cuff oscillometric methods are utilized in clinical practice to estimate pulse wave velocity. We applied the approach in master athletes to assess possible beneficial effects of lifelong exercise on vascular health. Furthermore, we compared single cuff measurements with a two-cuff method in another cohort. Methods. We obtained single cuff upper arm oscillometric measurements thrice in 129 master athletes aged 35 to 86 years and estimated pulse wave velocity using the ArcSolver algorithm. We applied the same method in 24 healthy persons aged 24 to 55 years participating in a head down tilt bedrest study. In the latter group, we also obtained direct pulse wave velocity measurements using a thigh cuff.Results. Estimated pulse velocity very highly correlated with age (R2 = 0.90) in master athletes. Estimated pulse wave velocity values were located on the same regression line like values obtained in participants of the head down tilt bed rest study. The modest correlation between estimated and measured PWV (r² 0.40; p<0.05) was attenuated after adjusting for age; the mean difference between pulse wave velocity measurements was 1 m/s.Conclusion. Estimated pulse wave velocity mainly reflects the entered age rather than true vascular properties and, therefore, failed detecting beneficial effects of life long exercise.Funding. The AGBRESA-Study was funded by the German Aerospace Center (DLR), the European Space Agency (ESA, contract number 4000113871/15/NL/PG) and the National Aeronautics and Space Administration (NASA, contract number 80JSC018P0078). Fabian Hoffmann received funding by the DLR and the German Federal Ministry of Economy and Technology, BMWi (50WB1816). SM, JT and JJ were supported by the Austrian Federal Ministry for Climate Action, Environment, Energy, Mobility, Innovation and Technology, BMK (SPACE4ALL Project, FFG No. 866761).

Endovenous Iliocaval Revascularization for Transplant Kidney Salvage

Purpose: We report the case of a venous iliocaval recanalization to preserve a transplant kidney. Case Report: A young patient with a nephrotic syndrome caused by focal segmental glomerulosclerosis (FSGS) underwent a robot-assisted living-donor kidney transplant. The postoperative course was uneventful; serum creatinine at discharge was 1.51 mg/dL (normal range = 0.72–1.17 mg/dL). In the course of the following months, the patient was readmitted repeatedly due to acute kidney failure not related to rejection, recurrent FSGS, or anastomotic stenosis. All episodes started after prolonged standing and renal function improved after bed rest. Several hospital admissions and investigations later, phlebography revealed an occlusion of the inferior vena cava (IVC) and both common iliac veins with large collateral vessels through the azygos system. An endovenous recanalization of the iliocaval tract was performed, with subsequent normalization of transplant kidney function. Conclusion: Vascular complications after renal transplantation are an important cause of graft loss. We present an endovenous treatment option for a chronic occlusion of the IVC and common iliac vein with intermittent venous congestion as a cause of transplant failure.

The Potential of Walnut Oil with Massage Effleurage to Prevent Grade 1 Decubitus Wounds of Bed Rest Patients

The main problem in decubitus patients is the risk of damage to skin integrity related to factors: immobility, decreased sensory perception, decreased tissue perfusion, decreased nutritional status, friction and pulling force, advanced age, and increased humidity. The decubitus is a problem faced by patients with chronic diseases, weak conditions, and patients who experience paralysis. This study aimed to analyze the potential of walnut oil in preventing grade 1 decubitus Wounds of bed Rest Patients. This study used a Quasi-Experimental design (pretest-posttest control group). The sample was 20 people, divided into 2 groups; treatment and control. The treatment group received effleurage massage with walnut oil given twice a day for 7 days, while the control group received pressure ulcers prevention treatment according to the SOP applied in the hospital. A total of 10 patients who received massage using walnut oil showed a p-value of 0.04 (<0.05), which meant that walnut oil massage was affected significantly in preventing pressure ulcers. In conclusion, decubitus wounds can be prevented by effleurage massage with walnut oil which is given regularly twice a day.

Effects of 15-Day Head-Down Bed Rest on Emotional Time Perception

Accurate time perception is clearly essential for the successful implementation of space missions. To elucidate the effect of microgravity on time perception, we used three emotional picture stimuli: neutral, fear, and disgust, in combination with a temporal bisection task to measure 16 male participants’ time perception in 15 days of –6° head-down bed rest, which is a reliable simulation model for most physiological effects of spaceflight. We found that: (1) participants showed temporal overestimation of the fear stimuli in the middle phase (day 8), suggesting that when participants’ behavioral simulations were consistent with the action implications of the emotional stimuli, they could still elicit an overestimation of time even if the subjective arousal of the emotional stimuli was not high. (2) Participants’ temporal sensitivity tends to get worse in the bed rest phase (days 8 and 15) and better in the post-bed rest phase, especially for neutral and fear stimuli, suggesting that multiple presentations of short-term emotional stimuli may also lead to a lack of affective effects. This reduced the pacemaker rate and affected temporal perceptual sensitivity. Also, this may be related to changes in physiological factors in participants in the bed rest state, such as reduced vagal excitability. These results provide new evidence to support the theory of embodied cognition in the context of time perception in head-down bed rest and suggest important perspectives for future perception science research in special environments such as microgravity.

Prevalence of Traditional Asian Postpartum Practices at a Federally Qualified Health Center

To evaluate the knowledge of, participation in, attitudes towards, and experiences with “doing the month” (DTM), a traditional Chinese and Vietnamese postpartum practice, at a federally qualified health center that serves predominantly Asian immigrants. DTM practices revolve around the balance between yin and yang and include practices such as the mother remaining on bed rest for as long as possible, restricting diet to certain foods, and avoiding visitors and social activities. A cross-sectional survey in Chinese, Vietnamese, and English was developed to determine the prevalence of women who have heard of and participated in DTM. 154 respondents participated. The mean age of respondents was 40.1 years. Without prompting of what DTM was, 58 (37.7%) responded that they had heard of DTM. After an explanatory paragraph, this increased to 117 (76.6%) participants. Out of 107 patients who have children, 65 (60.7%) “did the month” after giving birth. Participation rates were highest for women who identified as Chinese or Vietnamese. Likert-type scale questions showed that respondents believed DTM was stressful but enjoyable and helpful for recovery from childbirth. In conclusion, DTM is a common practice that health providers should be aware of.

Heterogeneity of Hematological Response to Hypoxia and Short-Term or Medium-Term Bed Rest

Hematological changes are commonly observed following prolonged exposure to hypoxia and bed rest. Typically, such responses have been reported as means and standard deviations, however, investigation into the responses of individuals is insufficient. Therefore, the present study retrospectively assessed individual variation in the hematological responses to severe inactivity (bed rest) and hypoxia. The data were derived from three-bed rest projects: two 10-d (LunHab project: 8 males; FemHab project: 12 females), and one 21-d (PlanHab project: 11 males). Each project comprised a normoxic bed rest (NBR; PIO2=133mmHg) and hypoxic bed rest (HBR; PIO2=91mmHg) intervention, where the subjects were confined in the Planica facility (Rateče, Slovenia). During the HBR intervention, subjects were exposed to normobaric hypoxia equivalent to an altitude of 4,000m. NBR and HBR interventions were conducted in a random order and separated by a washout period. Blood was drawn prior to (Pre), during, and post bed rest (R1, R2, R4) to analyze the individual variation in the responses of red blood cells (RBC), erythropoietin (EPO), and reticulocytes (Rct) to bed rest and hypoxia. No significant differences were found in the mean ∆(Pre-Post) values of EPO across projects (LunHab, FemHab, and PlanHab; p&gt;0.05), however, female EPO responses to NBR (Range - 17.39, IQR – 12.97 mIU.ml−1) and HBR (Range – 49.00, IQR – 10.91 mIU.ml−1) were larger than males (LunHab NBR Range – 4.60, IQR – 2.03; HBR Range – 7.10, IQR – 2.78; PlanHab NBR Range – 7.23, IQR – 1.37; HBR Range – 9.72, IQR – 4.91 mIU.ml−1). Bed rest duration had no impact on the heterogeneity of EPO, Rct, and RBC responses (10-d v 21-d). The resultant hematological changes that occur during NBR and HBR are not proportional to the acute EPO response. The following cascade of hematological responses to NBR and HBR suggests that the source of variability in the present data is due to mechanisms related to hypoxia as opposed to inactivity alone. Studies investigating hematological changes should structure their study design to explore these mechanistic responses and elucidate the discord between the EPO response and hematological cascade to fully assess heterogeneity.

Frequency of Musculoskeletal Disorders and their Counter Measures Adopted by Final Year Students and Young Dentists: A Questionnaire Based Multicenter Study

Aim: Musculoskeletal disorders have significantly been related to poor ergonomics practice during clinics. There is limited data regarding the prevalence and reasons for work-related musculoskeletal disorders in young dentists. This study was conducted to find out the prevalence of musculoskeletal disorders in young dentists, identification of the perceived reasons for musculoskeletal disorders, and measures taken to manage them. Study Design: Cross-sectional observational study. Methods: A cross-sectional study was conducted on 408 house officers from ten dental institutes of twin cities and Karachi, Pakistan. The subjects were inquired through a validated questionnaire about the presence of muscular pain, affected body regions, frequency, intensity, nature of onset, aggravating factors, and average duration of the pain episodes. They were also asked about measures taken to counter musculoskeletal pain and their effectiveness. Results: The overall prevalence of musculoskeletal disorders was n=231(56.6%) with n=172(39.2%) of participants reporting it to be work-related with a higher percentage of females n=138/172 (80.2%) The most affected body regions were the back n=101/172 (58.7%), shoulders n=91/172 (52.9%) and neck n=80/172(46.5%). Improper posture n=108(62.8%) followed by prolonged sitting n=88(51.2%) were the most common reasons perceived by the young dentists for their pain. Bed rest was adopted 93(54.1%) to alleviate pain followed by posture rectification 76(44.2%). Most n=134(77.9%) of them thought that these measures are helpful for the alleviation of pain. Conclusion: The prevalence of work-related musculoskeletal disorders among young dentists is high. The back, shoulder, and neck areas were more frequently affected. A higher percentage of females suffered from MSD as compared to males. Bed rest was the most common measure adopted to alleviate the pain. Very few of them sought professional help for their musculoskeletal disorders.

The algorithm of decision-making in administration of anticoagulant therapy due to COVID‑19. Review

There is a hypothesis that on its late complicated stages, coronavirus disease of 2019 (COVID‑19) represents an endothelial disease. According to Peter’s Libbi data (2020), the endothelial monolayer measures up to 7000 m2 in surface area. The endothelial functions include anticoagulant, antiplatelet, anti‑inflammatory, vasomotion, and structure. The aim of the review was to figure out COVID‑19 logistics from the standpoint of its pathogenesis, in particular its thrombotic complications, to summarize data on the choice of an anticoagulant, its dose and duration of use. COVID‑19 is a new disease with the lack of evidence‑based data, however, its per‑syndrome analysis results in conclusion that the most part of acute and post‑COVID complications refer to thromboembolic ones. According to the recommendations of the European Society of Cardiology on diagnostic and treatment of thromboembolism, the need for thromboembolism prevention is defined in case of respiratory failure, installed intravenous catheters, infection (specifically pneumonia), bed rest, elderly age, etc. The adherence to evidence‑based recommendations will allow one to administer rational anticoagulation therapy without harm to a patient. It concerns both patients, who are on anticoagulant therapy at hospital admission, and those who requires its new administration. The following questions are mostly frequent arising in doctors: How one should manage a patient with active bleeding, or platelet levels < 25 · 109/ L, or with congenital abnormality of coagulation? What types of blood chemistry should be considered when administering anticoagulant? What therapy should be administered at discharge? Compliance with clear anticoagulation algorithms will prevent thromboembolic complications, further damage to organs and systems, and significant bleeding.

Head-Down Tilt Bed Rest Improves Executive Function Amongst Younger Adults: A Pilot Project

Purpose Microgravity has been shown to be a significant stressor on the cardiovascular system and the brain due to the redistribution of fluids that occurs in the absence of gravitational force, but there is scarce literature surrounding the effects of microgravity on cerebral hemodynamics and cognition. Understanding the early effects that simulated gravity has on cognitive function is essential for developing proper physical and cognitive countermeasures to assure safe and effective cognitive/decisions making while astronauts prepare for the initial launch or when they arrive in a microgravity environment. Therefore, this study aims to determine how an acute simulation of microgravity would alter cerebral oxygenation and executive functions. Methods Sixty-five young healthy participants (22±6 years, 21 females) completed a thirty (30) minute horizontal (00 tilt) followed by a 90-min -6° head-down-tilt (HDT) protocol. Cerebral oxygenation in the prefrontal cortex was monitored throughout the testing session using near-infrared spectroscopy. Cognition was also measured using a computerized Stroop Task. Results Our results demonstrate that cerebral oxygenation was higher during HDT compared to the horizontal supine position (9.11±1.3 vs 7.51±1.8, p=0.02). For the cognitive results, the non-executive performance of the Stroop task remained stable during HDT (652.46± 19.3 vs. 632.49±14.5, p=0.09). However, reaction time during the executive task performance was improved after the HDT (1058±195 msec to 950±158 msec, p<0.01). Conclusion Our results suggest that an acute bout of simulated microgravity can enhance executive functioning.