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  1. [Measurement of blood pressure variability and the clinical value].

    PubMed

    Kékes, Ede; Kiss, István

    2014-10-19

    Authors have collected and analyzed literature data on blood pressure variability. They present the methods of blood pressure variability measurement, clinical value and relationships with target organ damages and risk of presence of cardiovascular events. They collect data about the prognostic value of blood pressure variability and the effects of different antihypertensive drugs on blood pressure variability. They underline that in addition to reduction of blood pressure to target value, it is essential to influence blood pressure fluctuation and decrease blood pressure variability, because blood pressure fluctuation presents a major threat for the hypertensive subjects. Data from national studies are also presented. They welcome that measurement of blood pressure variability has been included in international guidelines.

  2. [Blood pressure variability: clinical interest or simple curiosity?].

    PubMed

    Ciaroni, Stefano

    2007-03-14

    Blood pressure variability is a physiological phenomenon influenced by many internal and external factors. This variability could be also influenced by pathological conditions such as arterial hypertension. Two forms must be mainly distinguished: the blood pressure variability at long and short-term. The latter could only be studied by continuous recordings. In this article will be analysed the interest of measuring blood pressure variability, its cardiovascular prognosis and the therapeutic tools when it is increased.

  3. Understanding Blood Pressure Variation and Variability: Biological Importance and Clinical Significance.

    PubMed

    James, Gary D

    2017-01-01

    Variability is a normative property of blood pressure necessary for survival which likely contributes to morbidity and mortality through allostatic load. Because of its allostatic and adaptive properties blood pressure responses to peculiar situations like the visit to the clinic can lead to the misdiagnosis of hypertension. Cuff methods of blood pressure measurement can also create blood pressure variation when there really is none. There are also physiological differences between populations related to their evolutionary history that likely further affect the extent of population differences in 24-h blood pressure variability. Quantifying the sources and extent of blood pressure variability can be done using natural experimental models and through the evaluation of ecological momentary data. It is very likely that the results of population studies of blood pressure variability and morbidity and mortality risk are inconclusive because the parameters used to assess blood pressure variability do not reflect the actual nature of blood pressure allostasis.

  4. [Clinical significance of nocturnal blood pressure and blood pressure variability: analysis of 522 cases].

    PubMed

    Palatini, P; Mormino, P; Martina, S; Businaro, R; Penzo, M; Racioppa, A; Guzzardi, G; Anaclerio, M; Pessina, A C

    1990-03-01

    Purpose of the study was to investigate whether and to what extent blood pressure variability and average night-time blood pressure are related to cardiovascular complications in hypertension. To this aim 60 normotensive and 462 hypertensive subjects were studied by means of non-invasive 24 hour blood pressure monitoring, using either the Avionics, or the ICR Spacelabs, or the Takeda system. Each subject was attributed a target organ damage score on the basis of 12-lead electrocardiogram, chest X-ray and fundoscopy, starting from 0 (no damage) up to 5 (maximum degree of damage). The 522 subjects were subsequently subdivided into 5 classes of increasing average daytime diastolic blood pressure. In each class a higher degree of cardiovascular complications was present in the subjects with the higher blood pressure variability and the higher average night-time blood pressure. From these results it may be inferred that both blood pressure variability and night-time blood pressure are related to the degree of target organ damage in hypertension. This stresses the importance of recording blood pressure throughout the 24 hours.

  5. Association of morning fasting blood glucose variability with insulin antibodies and clinical factors in type 1 diabetes.

    PubMed

    Yoneda, Chihiro; Tashima-Horie, Kanako; Fukushima, Sayaka; Saito, Satoko; Tanaka, Sayoko; Haruki, Takenori; Ogino, Jun; Suzuki, Yoshifumi; Hashimoto, Naotake

    2016-07-30

    The fasting blood glucose concentration in type 1 diabetes may vary without being much affected by diet and exercise. This study aimed to identify association of morning fasting blood glucose concentration variability with insulin antibodies and clinical factors. The subjects in this study were 54 patients with type 1 diabetes who had high variation of fasting blood glucose. The insulin antibody level was measured, and correlations of glycemic variability with antibody levels, binding rates, and other clinical factors were investigated. The standard deviation (SD) of the 30-day morning self-monitored fasting blood glucose concentration (FBG SD) was evaluated as an index of glycemic variability. The mean glucose level was 159.8±42.1 mg/dL and the FBG SD was 47.5±22.0 mg/dL. Glycemic variability (FBG SD) was positively correlated with insulin antibody level, but not with insulin antibody binding rate, and had a negative correlation with C-peptide immunoreactivity/plasma glucose (CPR/PG) and positive correlations with diabetes duration, basal insulin dose and bolus insulin dose. Glycemic variability was not correlated with BMI, HbA1c or age. In multiple regression analysis of glycemic variability, CPR/PG was the only significant related factor. The results showed that glycemic variability was mainly influenced by endogenous insulin secretion capacity and was high in patients with high insulin antibody levels. In some patients with a high insulin antibody titer, the antibody may have an effect on the variability of the fasting glucose concentration in type 1 diabetes.

  6. Assessment of clinical and laboratory variables as a guide to packed red blood cell transfusion of euvolemic anemic dogs.

    PubMed

    Kisielewicz, C; Self, I; Bell, R

    2014-01-01

    There are no standardized guidelines for determining the likelihood that euvolemic anemic dogs will benefit from transfusion of packed red blood cells (pRBC). To report clinical and laboratory variables of dogs receiving pRBC transfusion, which could guide transfusion of other anemic dogs. Twenty-four client-owned anemic dogs receiving pRBC transfusion. Prospective study; 30 transfusions assessed. Clinical findings (mucosal color, pulse quality, heart rate, respiratory rate, mentation/exercise tolerance) before and after transfusion were evaluated by the anemic dog clinical assessment score (ADCAS). Hemoglobin concentration, hematocrit, venous oxygen content (CvO2 ), and lactate concentration were measured from blood samples taken before and after transfusion. These results were not used for case management. All ADCAS variables decreased significantly with transfusion (P < .001); the total score was ≥5/12 before transfusion, and ≤3/12 in all cases that were deemed to no longer require transfusion. Hematocrit and CvO2 were <17% and <5 mL/dL, respectively, in 83% of cases before transfusion and hemoglobin concentration was <5.8 g/dL in 80%. Hemoglobin concentration, hematocrit, and CvO2 increased significantly with transfusion (P < .001); lactate concentration decreased significantly (P = .006). Clinical and laboratory variables improved significantly after transfusion of pRBC. By identifying how transfusion affected these variables, it was possible to recognize clinical (ADCAS) and laboratory (hemoglobin, CvO2 , lactate) variables, which could be useful in guiding the decision to transfuse dogs with similar presentations. Copyright © 2014 by the American College of Veterinary Internal Medicine.

  7. Glycemic variability: Clinical implications.

    PubMed

    Satya Krishna, Surabhi Venkata; Kota, Sunil K; Modi, Kirtikumar D

    2013-07-01

    Glycemic control and its benefits in preventing microvascular diabetic complications are convincingly proved by various prospective trials. Diabetes control and complications trial (DCCT) had reported variable glycated hemoglobin (HbA1C) as a cause of increased microvascular complications in conventional glycemic control group versus intensive one. However, in spite of several indirect evidences, its link with cardiovascular events or macrovascular complications is still not proved. Glycemic variability (GV) is one more tool to explain relation between hyperglycemia and increased cardiovascular risk in diabetic patients. In fact GV along with fasting blood sugar, postprandial blood sugar, HbA1C, and quality of life has been proposed to form glycemic pentad, which needs to be considered in diabetes management. Postprandial spikes in blood glucose as well as hypoglycemic events, both are blamed for increased cardiovascular events in Type 2 diabetics. GV includes both these events and hence minimizing GV can prevent future cardiovascular events. Modern diabetes management modalities including improved sulfonylureas, glucagon like peptide-1 (GLP-1)-based therapy, newer basal insulins, and modern insulin pumps address the issue of GV effectively. This article highlights mechanism, clinical implications, and measures to control GV in clinical practice.

  8. Glycemic variability: Clinical implications

    PubMed Central

    Satya Krishna, Surabhi Venkata; Kota, Sunil K.; Modi, Kirtikumar D.

    2013-01-01

    Glycemic control and its benefits in preventing microvascular diabetic complications are convincingly proved by various prospective trials. Diabetes control and complications trial (DCCT) had reported variable glycated hemoglobin (HbA1C) as a cause of increased microvascular complications in conventional glycemic control group versus intensive one. However, in spite of several indirect evidences, its link with cardiovascular events or macrovascular complications is still not proved. Glycemic variability (GV) is one more tool to explain relation between hyperglycemia and increased cardiovascular risk in diabetic patients. In fact GV along with fasting blood sugar, postprandial blood sugar, HbA1C, and quality of life has been proposed to form glycemic pentad, which needs to be considered in diabetes management. Postprandial spikes in blood glucose as well as hypoglycemic events, both are blamed for increased cardiovascular events in Type 2 diabetics. GV includes both these events and hence minimizing GV can prevent future cardiovascular events. Modern diabetes management modalities including improved sulfonylureas, glucagon like peptide-1 (GLP-1)-based therapy, newer basal insulins, and modern insulin pumps address the issue of GV effectively. This article highlights mechanism, clinical implications, and measures to control GV in clinical practice. PMID:23961476

  9. Effect of Azilsartan on Day-to-Day Variability in Home Blood Pressure: A Prospective Multicenter Clinical Trial.

    PubMed

    Miyoshi, Toru; Suetsuna, Ryoji; Tokunaga, Naoto; Kusaka, Masayasu; Tsuzaki, Ryuichiro; Koten, Kazuya; Kunihisa, Kohno; Ito, Hiroshi

    2017-07-01

    The blood pressure variability (BPV) such as visit-to-visit, day-by-day, and ambulatory BPV has been also shown to be a risk of future cardiovascular events. However, the effects of antihypertensive therapy on BPV remain unclear. The purpose of this study was to evaluate the effect of azilsartan after switching from another angiotensin II receptor blocker (ARB) on day-to-day BPV in home BP monitoring. This prospective, multicenter, open-labeled, single-arm study included 28 patients undergoing treatment with an ARB, which was switched to azilsartan after enrollment. The primary outcome was the change in the mean of the standard deviation and the coefficient of variation of morning home BP for 5 consecutive days from baseline to the 24-week follow-up. The secondary outcome was the change in arterial stiffness measured by the cardio-ankle vascular index. The mean BPs in the morning and evening for 5 days did not statistically differ between baseline and 24 weeks. For the morning BP, the means of the standard deviations and coefficient of variation of the systolic BP were significantly decreased from 7.4 ± 3.6 mm Hg to 6.1 ± 3.2 mm Hg and from 5.4±2.7% to 4.6±2.3% (mean ± standard deviation, P = 0.04 and P = 0.04, respectively). For the evening BP, no significant change was observed in the systolic or diastolic BPV. The cardio-ankle vascular index significantly decreased from 8.3 ± 0.8 to 8.1 ± 0.8 (P = 0.03). Switching from another ARB to azilsartan reduced day-to-day BPV in the morning and improved arterial stiffness.

  10. Effect of Azilsartan on Day-to-Day Variability in Home Blood Pressure: A Prospective Multicenter Clinical Trial

    PubMed Central

    Miyoshi, Toru; Suetsuna, Ryoji; Tokunaga, Naoto; Kusaka, Masayasu; Tsuzaki, Ryuichiro; Koten, Kazuya; Kunihisa, Kohno; Ito, Hiroshi

    2017-01-01

    Background The blood pressure variability (BPV) such as visit-to-visit, day-by-day, and ambulatory BPV has been also shown to be a risk of future cardiovascular events. However, the effects of antihypertensive therapy on BPV remain unclear. The purpose of this study was to evaluate the effect of azilsartan after switching from another angiotensin II receptor blocker (ARB) on day-to-day BPV in home BP monitoring. Methods This prospective, multicenter, open-labeled, single-arm study included 28 patients undergoing treatment with an ARB, which was switched to azilsartan after enrollment. The primary outcome was the change in the mean of the standard deviation and the coefficient of variation of morning home BP for 5 consecutive days from baseline to the 24-week follow-up. The secondary outcome was the change in arterial stiffness measured by the cardio-ankle vascular index. Results The mean BPs in the morning and evening for 5 days did not statistically differ between baseline and 24 weeks. For the morning BP, the means of the standard deviations and coefficient of variation of the systolic BP were significantly decreased from 7.4 ± 3.6 mm Hg to 6.1 ± 3.2 mm Hg and from 5.4±2.7% to 4.6±2.3% (mean ± standard deviation, P = 0.04 and P = 0.04, respectively). For the evening BP, no significant change was observed in the systolic or diastolic BPV. The cardio-ankle vascular index significantly decreased from 8.3 ± 0.8 to 8.1 ± 0.8 (P = 0.03). Conclusions Switching from another ARB to azilsartan reduced day-to-day BPV in the morning and improved arterial stiffness. PMID:28611863

  11. High-normal blood pressure is associated with visit-to-visit blood pressure variability in the US adults.

    PubMed

    Faramawi, Mohammed F; Delongchamp, Robert; Said, Qayyim; Balamurugan, Appathurai; Hassan, Alaa; Abouelenien, Saly; Ismaeil, Mohamed

    2017-02-01

    High-normal blood pressure and visit-to-visit blood pressure variability are common in clinical settings. They are associated with cardiovascular outcomes. No population based studies have assessed the association between these two phenomena. Our objective was to test the relationship of high-normal blood pressure with visit-to-visit blood pressure variability. A cross-sectional study. We used data from the cross-sectional Third National Health and Nutrition Examination Survey to test the relationship between high-normal blood pressure and visit-to-visit blood pressure variability; we conducted multivariable regression analyses to evaluate the relationship between these two variables. The analysis included 6,071 participants. The participants' mean age was 37.16 years. The means of visit-to-visit systolic and diastolic blood pressure variability were 5.84 mmHg and 5.26 mmHg. High-normal blood pressure was significantly associated with systolic and diastolic blood pressure variability (p values <0.05). High-normal blood pressure is associated with visit-to-visit blood pressure variability. Additional research is required to replicate the reported results in prospective studies and evaluate approaches to reduce blood pressure variability observed in clinical settings among patients with high-normal blood pressure to reduce the subsequent complications of blood pressure variability.

  12. [Clinical selection of blood donors].

    PubMed

    Danic, B

    2003-06-01

    For 20 years, the organization set up to insure the blood transfusion safety has never stopped strengthening. It is based on clinical and epidemiological selection of the blood donation candidates, biologic selection of blood donations and different physico-chemical techniques for pathogens reduction or inactivation in blood products. In France, this organization is optimized by the assertion of the voluntary and non-remunerated character of blood donation registered in the law of January 4th, 1993. The blood donors selection is structured in three successive stages. The first stage is the pre-donation information. The second stage begins with reading and filling out an info-questionnaire which prepare for an interview with a physician. This interview is specially directed to prevention of transfusion-transmitted infections and the prevention of adverse reactions after a 400 to 600 mL collection of whole blood or components. Finally, the third stage is the delivery of a post-donation information which invites the donor to contact the "établissement français du sang" (EFS) in case of a new event arisen after the donation or in case of reviewing of its own answers during the medical interview.

  13. [Hypertensive urgency or high blood pressure variability?

    PubMed

    Rodionov, A V

    2017-01-01

    Hypertensive urgency (HU) is a common reason particularly for elderly patients to seek medical advice. Severe asymptomatic hypertension and situational high blood pressure (BP) in patients with its high variability is frequently taken as HU. The use of short-acting antihypertensive drugs is not only indicated in these situations, but it may also increase the risk of cardiovascular events (CVE). Over the past decade, increased BP variability is an independent predictor for a higher risk of CVE. Among the major groups of antihypertensive drugs, there are calcium antagonists, mainly amlodipine, which has the greatest potential to reduce BP variability. Thus, calcium antagonists can be considered as first-line drugs for patients with high BP variability.

  14. Variability of Microcirculation Detected by Blood Pulsation Imaging

    PubMed Central

    Kamshilin, Alexei A.; Teplov, Victor; Nippolainen, Ervin; Miridonov, Serguei; Giniatullin, Rashid

    2013-01-01

    The non-invasive assessment of blood flow is invaluable for the diagnostic and monitoring treatment of numerous vascular and neurological diseases. We developed a non-invasive and non-contact method of blood pulsation imaging capable of visualizing and monitoring of the two-dimensional distribution of two key parameters of peripheral blood flow: the blood pulsation amplitude and blood pulsation phase. The method is based on the photoplethysmographic imaging in the reflection mode. In contrast with previous imaging systems we use new algorithm for data processing which allows two dimensional mapping of blood pulsations in large object's areas after every cardiac cycle. In our study we carried out the occlusion test of the arm and found (i) the extensive variability of 2D-distribution of blood pulsation amplitude from one cardiac cycle to another, and (ii) existence of the adjacent spots to which the blood is asynchronously supplied. These observations show that the method can be used for studying of the multicomponent regulation of peripheral blood circulation. The proposed technique is technologically simple and cost-effective, which makes it applicable for monitoring the peripheral microcirculation in clinical settings for example, in diagnostics or testing the efficiency of new medicines. PMID:23431399

  15. Blood Pressure Variability and Cognitive Function Among Older African Americans: Introducing a New Blood Pressure Variability Measure.

    PubMed

    Tsang, Siny; Sperling, Scott A; Park, Moon Ho; Helenius, Ira M; Williams, Ishan C; Manning, Carol

    2017-09-01

    Although blood pressure (BP) variability has been reported to be associated with cognitive impairment, whether this relationship affects African Americans has been unclear. We sought correlations between systolic and diastolic BP variability and cognitive function in community-dwelling older African Americans, and introduced a new BP variability measure that can be applied to BP data collected in clinical practice. We assessed cognitive function in 94 cognitively normal older African Americans using the Mini-Mental State Examination (MMSE) and the Computer Assessment of Mild Cognitive Impairment (CAMCI). We used BP measurements taken at the patients' three most recent primary care clinic visits to generate three traditional BP variability indices, range, standard deviation, and coefficient of variation, plus a new index, random slope, which accounts for unequal BP measurement intervals within and across patients. MMSE scores did not correlate with any of the BP variability indices. Patients with greater diastolic BP variability were less accurate on the CAMCI verbal memory and incidental memory tasks. Results were similar across the four BP variability indices. In a sample of cognitively intact older African American adults, BP variability did not correlate with global cognitive function, as measured by the MMSE. However, higher diastolic BP variability correlated with poorer verbal and incidental memory. By accounting for differences in BP measurement intervals, our new BP variability index may help alert primary care physicians to patients at particular risk for cognitive decline.

  16. Dysglycemia induces abnormal circadian blood pressure variability

    PubMed Central

    2011-01-01

    Background Prediabetes (PreDM) in asymptomatic adults is associated with abnormal circadian blood pressure variability (abnormal CBPV). Hypothesis Systemic inflammation and glycemia influence circadian blood pressure variability. Methods Dahl salt-sensitive (S) rats (n = 19) after weaning were fed either an American (AD) or a standard (SD) diet. The AD (high-glycemic-index, high-fat) simulated customary human diet, provided daily overabundant calories which over time lead to body weight gain. The SD (low-glycemic-index, low-fat) mirrored desirable balanced human diet for maintaining body weight. Body weight and serum concentrations for fasting glucose (FG), adipokines (leptin and adiponectin), and proinflammatory cytokines [monocyte chemoattractant protein-1 (MCP-1) and tumor necrosis factor-α (TNF-α)] were measured. Rats were surgically implanted with C40 transmitters and blood pressure (BP-both systolic; SBP and diastolic; DBP) and heart rate (HR) were recorded by telemetry every 5 minutes during both sleep (day) and active (night) periods. Pulse pressure (PP) was calculated (PP = SBP-DBP). Results [mean(SEM)]: The AD fed group displayed significant increase in body weight (after 90 days; p < 0.01). Fasting glucose, adipokine (leptin and adiponectin) concentrations significantly increased (at 90 and 172 days; all p < 0.05), along with a trend for increased concentrations of systemic pro-inflammatory cytokines (MCP-1 and TNF-α) on day 90. The AD fed group, with significantly higher FG, also exhibited significantly elevated circadian (24-hour) overall mean SBP, DBP, PP and HR (all p < 0.05). Conclusion These data validate our stated hypothesis that systemic inflammation and glycemia influence circadian blood pressure variability. This study, for the first time, demonstrates a cause and effect relationship between caloric excess, enhanced systemic inflammation, dysglycemia, loss of blood pressure control and abnormal CBPV. Our results provide the fundamental

  17. Clinical Practice Variability in Temperature Correction of Arterial Blood Gas Measurements and Outcomes in Hypothermia-Treated Patients After Cardiac Arrest.

    PubMed

    Terman, Samuel Waller; Nicholas, Katherine S; Hume, Benjamin; Silbergleit, Robert

    2015-09-01

    Mechanical ventilation in patients treated with mild therapeutic hypothermia (MTH) for the postcardiac arrest syndrome may be challenging given changes in solubility of arterial blood gases (ABGs) with cooling. Whether ABG measurements should be temperature corrected (TC) remain unknown. We sought to describe practice variability in TC at a single institution and explored the association between TC and neurological outcome. We conducted a retrospective cohort study reviewing electronic health records of all patients treated with MTH after cardiac arrest. We examined whether the percentage of TC ABGs relative to total number of ABGs drawn for each subject during hypothermia was associated with the neurological outcome at hospital discharge and 6-12-month follow-up. The cerebral performance category of 1-2 was defined as a favorable outcome in the logistic regression models. 1223 ABGs were obtained during MTH on 122 subjects over 6 years. TC was never used in 72 subjects (59%; no TC group), made available in 1-74% of ABGs in 17 subjects (14%; intermediate TC group), and made available in ≥75% of ABGs in 33 subjects (27%; mostly TC group). Groups differed in the proportion of subjects with shockable presenting rhythms (47% vs. 47% vs. 76%, p=0.02) and admitting ICU (p=0.005). Favorable 6-month outcomes were more common in the mostly TC than no TC group (48% vs. 25%; OR [95% CI]: 2.9 [1.2-7.1]), but not after adjustment (OR 1.5, 95% CI 0.33-6.9). There was substantial practice variability in the temperature correction strategy. Availability of temperature-corrected ABGs was not associated with improved neurological outcomes after adjusting for covariates.

  18. From genetic variability to phenotypic expression of blood group systems.

    PubMed

    Raud, L; Férec, C; Fichou, Y

    2017-06-29

    More than 300 red blood cell (RBC) antigens belonging to 36 blood group systems have been officially reported in humans by the International Society of Blood Transfusion (ISBT). Phenotypic variability is directly linked to the expression of the 41 blood group genes. The Rh blood group system, which is composed of 54 antigens, is the most complex and polymorphic system. Many rare genetic variants within the RH (RHD and RHCE) genes, involving various mutational mechanisms (single-nucleotide substitutions, short insertions/deletions, rearrangements, large deletions), have been reported in the literature and reference databases. Expression of the variants induces variable clinical outcomes depending on their nature and impact on antigen structure. Their respective molecular and cellular effects remain however poorly studied. Biological resources to conduct this research are also barely available. We have paid a specific attention to three different classes of single-nucleotide substitutions: 1/ splice site variants in the Rh, Kell, Kidd, Junior and Langereis systems by the minigene splicing assay developed locally; 2/ missense variants in the RhD protein and their effect on intermolecular interaction with its protein partner RhAG, intracellular trafficking and plasma membrane integration; and 3/ synonymous variants in the RHD gene. Overall not only this project has fundamental objectives by analyzing the functional effect of variants in order to make genotype-phenotype correlation, but the aim is also to develop/engineer molecular tools and cell models to carry out those studies. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  19. Nighttime blood pressure, systolic blood pressure variability, and left ventricular mass index in children with hypertension.

    PubMed

    Sharma, Ajay P; Mohammed, Javed; Thomas, Benson; Lansdell, Nathan; Norozi, Kambiz; Filler, Guido

    2013-08-01

    Nighttime blood pressure (BP) and systolic BP variability on ambulatory blood pressure monitoring (ABPM) have been strongly associated with target-organ damage in hypertensive adults. The clinical relevance of these variables in children with hypertension remains under-studied. The study group included children aged 5-18 years old referred to the outpatient nephrology clinic for an elevated casual BP who underwent an ABPM and echocardiography (ECHO) study and did not have secondary hypertension. The interpretation of ABPM parameters and left ventricular mass index (LVMI) was based on normative references. Seventy-two children fulfilled the inclusion criteria. The association of various potential predictors including age, BMI z-score, casual BP z-score and ABPM parameters (BP z-score, BP load, nocturnal dipping and BP variability- within-subject standard deviation (SD) of BP) with LVMI was analyzed. On adjusted regression analysis, nighttime systolic BP load [standardized regression coefficient (β) 0.23; p < 0.05] and daytime systolic BP variability (β 0.37; p < 0.05) had significant association with LVMI. In children with primary hypertension, nighttime systolic BP load and daytime systolic BP variability had a stronger association with LVMI than casual BP and other ABPM parameters. Future longitudinal studies are needed to establish the causality among these variables.

  20. Clinical use of blood, blood components and blood products.

    PubMed Central

    Blajchman, M A; Shepherd, F A; Perrault, R A

    1979-01-01

    The goal of modern transfusion therapy is to provide appropriate replacement therapy with blood components as opposed to whole blood for patients with specific hematologic deficiencies. A prerequisite of component therapy is, therefore, correct identification of the deficiency. Appropriate use of components avoids many of the hazards associated with the use of whole blood, and at the same time makes maximal use of this valuable resource. Blood components separated from whole blood soon after collection and appropriately stored can, in combination, provide all the factors present in fresh whole blood. Red cell concentrates prepared from multiple packs have a hematocrit of approximately 70%. They may be stored for up to 3 weeks at 4 degrees C and are recommended for most situations requiring red cell transfusions. Platelet concentrates, which can be stored for up to 72 hours at 22 degrees C, may be used for thrombocytopenic patients. Fresh frozen plasma, stored plasma, cryoprecipitated factor VIII, factor VIII concentrate and factor IX complex concentrate are available for the proper treatment of patients with hemorrhagic disorders due to coagulation factor deficiencies. Similarly, albumin and immune serum globulin are available for their oncotic and antibody properties respectively. Thus, the availability and appropriate use of the various blood products allows not only optimal transfusion therapy for each patient, but also fuller utilization of national blood resources. PMID:466591

  1. Low correlation between visit-to-visit variability and 24-hour variability of blood pressure

    PubMed Central

    Muntner, Paul; Shimbo, Daichi; Diaz, Keith M.; Newman, Jonathan; Sloan, Richard P.; Schwartz, Joseph E.

    2013-01-01

    Visit-to-visit variability (VVV) of clinic systolic blood pressure (SBP) has been associated with cardiovascular disease risk. Given the need for obtaining blood pressure (BP) at multiple visits to calculate VVV, substituting BP variability from ambulatory blood pressure monitoring (ABPM) may be a practical alternative. We assessed the correlation between VVV of BP and BP variability from ABPM using data from 146 untreated, mostly normotensive participants (mean age 47.9 years) in a substudy of the ongoing Masked Hypertension Study. VVV of SBP and diastolic blood pressure (DBP) was estimated by the standard deviation (SDvvv) and average real variability (ARVvvv) from 6 study visits over a median of 216 days. ABPM data were used to calculate the day-night SD (SDdn) and the ARV of SBP and DBP over 24 hours (ARV24). For SBP, the mean SDvvv and SDdn were 6.3 (SD=2.5) and 8.8 (SD=1.8) mmHg, respectively, and mean ARVvvv and ARV24 were 7.2 (SD=3.2) and 8.4 (SD=2.1) mmHg, respectively. The Spearman correlation coefficient between SDvvv and SDdn of SBP was rs=0.25 and between ARVvvv and ARV24 was rs=0.17. Participants in the highest quartile of SDdn of SBP were 1.66 (95% CI: 0.93 – 2.75) times more likely to be in the highest quartile of SDvvv of SBP. The observed-to-expected ratio between the highest quartiles of ARVvvv and ARV24 of SBP was 0.89 (95% CI: 0.41 – 1.69). The correlations for SDvvv and SDdn and ARVvvv and ARV24 of DBP were minimal. These data suggest VVV and 24-hour variability are weakly correlated and not interchangeable. PMID:23784506

  2. [Clinical variables of preoperative risk].

    PubMed

    Saad, I A; Zambon, L

    2001-01-01

    To identify risk variables leading to early postoperative pulmonary complication (POPC) in thoracic and upper abdominal surgery. 297 patients submitted to elective surgery were classified as low, moderate and high risk for POPC using PORT scale, following Torrington & Henderson (1988). The patients were followed up for 72 hours postoperative. POPC were defined as atelectasis, pneumonia, tracheobronchitis, wheezing, prolonged intubation and/or prolonged mechanical ventilation. Univariate analysis was applied to study these independent variables: type of surgery, age, nutritional status (BMI), respiratory disease, smoking habit, spirometry and surgical time. Multivariate logistic regression analysis were performed in order to evaluate the relationship between independent and dependent (POPC) variables. POPC incidence was 12.1%. By multivariate logistic regression analysis the variables increasing chance to POPC was cough with yellow mucus (OR= 3.8), thoracic surgery (OR=2.9) compared to abdominal surgery, BMI (OR=1.13), duration of smoking (OR=1.03) and prolonged duration of surgery (OR=1.007). In the thoracic surgery group, multivariate logistic regression analysis showed: wheezing (OR=6.2), BMI (OR=1.15), long time smoking (OR= 1.04) and prolonged duration of surgery (OR= 1.007) related to POPC. The variables occurrence that increased chance to POPC in thoracic and upper abdominal surgery were: cough with yellow mucus, thoracic surgery, BMI, duration of smoking and duration of surgery. Regarding the thoracic surgery group the significance variables were wheezing, BMI, duration of smoking and duration of surgery.

  3. Clinical relevance of central blood pressure - a critical review.

    PubMed

    Kostapanos, Michael; McEniery, Carmel M; Wilkinson, Ian B

    2016-11-01

    Vital organs are exposed to the central rather than the brachial blood pressure. To date, central blood pressure can be assessed noninvasively through the use of several devices. In this review, we critically discuss the clinical relevance of central blood pressure assessment. Considerable evidence suggests that central blood pressure is a better predictor of end-organ damage than brachial blood pressure. However, there is still uncertainty concerning the value of central pressure for predicting cardiovascular outcomes, as the existing studies are underpowered to address this issue. A full synthesis of the available data is needed in this regard. Among the different antihypertensive drug classes, beta-blockers appear to lower central blood pressure less than brachial blood pressure. This difference may, at least in part, explain the reduced efficacy of beta-blockers in the prevention of cardiovascular outcomes compared with the other antihypertensive drug classes, which may lower central and brachial blood pressure to a similar extent. Nevertheless, this differential effect might not be relevant to the newer beta-blockers with vasodilating properties, including nebivolol, celliprolol and carvedilol. However, whether a preferential reduction of central blood pressure results in better outcomes should be further assessed by appropriately powered clinical trials. Other emerging challenges include the assessment of the potential predictive value of central blood pressure variability and the development of new antihypertensive medications based on central blood pressure rather than brachial blood pressure.

  4. [Clinical classification of variable angle exotrophy].

    PubMed

    Arroyo-Yllanes, María Estela; Osorio-González, Déborah Itzel; Pérez-Pérez, José Fernando

    2007-01-01

    Variable exotropia is determined by a series of mechanisms that provide different clinical characteristics to outline individual therapy. There is no specific categorization that can identify such an entity. A clinical classification is proposed that includes different clinical features in accordance with the mechanisms involved in the variability genesis of such exotropias. Patients with a diagnosis of variable angle exotropia without previous surgery were included. A complete ophthalmic and strabismus exploration was performed. Variability characteristics were studied and grouped by entries in the classification proposed. Ninety patients were examined from the Pediatric Ophthalmology and Strabismus Unit of the General Hospital of Mexico O.D., with a diagnosis of variable angle exotropia. The following forms of presentations were found: secondary variable angle exotropia due to neurological alteration in 32 cases (35.5%), secondary variable angle exotropia due to monocular bad vision in 19 cases (21.2%), dissociated horizontal deviation in 14 cases (15.5%), mixed variable angle exotropia in 22 cases (4.5%) and primary variable angle exotropia in 3 cases (3.33%). This classification allows categorization of all patients of variable angle exotropia into proposed categories. The most common mechanism responsible for variability is neurological alteration. Primary variable angle exotropias are rare and are present in a minimum percentage.

  5. Centrifugal blood pumps for various clinical needs.

    PubMed

    Ichikawa, Seiji; Nosé, Yukihiko

    2002-11-01

    During the past 10 years, different types of blood pumps were developed to address various clinical needs. The Nikkiso centrifugal blood pump was developed for cardiopulmonary bypass application. This blood pump has been widely used in Japan in more than 20% of the cardiopulmonary bypass procedures. The Kyocera C1E3 Gryo pump was developed for short-term circulatory assistance and extracorporeal membrane oxygenation application for up to 2 weeks. This blood pump has been clinically used for up to 28 days without any blood clot formation. Through Phase I of the Japanese government New Energy and Industrial Technology Development Organization (NEDO) program, a chronically implanted centrifugal pump for left ventricular assistance was developed. This pump has already demonstrated its effectiveness, safety, and durability as a 2 year blood pump through in vitro and in vivo experiments. Currently, it is in the process of being converted from an experimental to a clinical device. Through Phase II of the NEDO program, a permanently implantable biventricular assist centrifugal blood pump system is under development. It has demonstrated that the previously mentioned left ventricular assist device blood pump is easily converted into a right ventricular assist pump by simply adding a spacer between the pump and the actuator. This communication discusses the historical development strategies for centrifugal blood pumps and their current status for different clinical needs.

  6. A clinical governance framework for blood services.

    PubMed

    Williamson, L M; Benjamin, R J; Devine, D V; Katz, L M; Pink, J

    2015-05-01

    The elements of clinical governance, which ensure excellence in clinical care, can be applied to blood services. In this survey, their application in a range of blood providers was gauged, with the aim of identifying best practice and producing a generalizable framework. The Medical Directors of members of the Alliance of Blood Operators surveyed how different elements of clinical governance operated within their organizations and developed recommendations applicable in the blood service environment. The recommendations that emerged highlighted the importance of an organization's culture, with the delivery of optimal clinical governance being a corporate responsibility. Senior management must agree and promote a set of values to ensure that the system operates with the patient and donor at its heart. All staff should understand how their role fits into the 'journey to the patient', and a culture of openness promoted. Thus, reporting of errors and risks should be actively sought and praised, with penalties applied for concealment. Systems should exist to collect, analyse and escalate clinical outcomes, safety data, clinical risk assessments, incident reports and complaints to inform organizational learning. Clinical governance principles from general health care can be applied within blood services to complement good manufacturing practice. This requires leadership, accountability, an open culture and a drive for continuous improvement and excellence in clinical care. © 2015 International Society of Blood Transfusion.

  7. Asymmetric features of short-term blood pressure variability.

    PubMed

    Guzik, Przemyslaw; Piskorski, Jaroslaw; Krauze, Tomasz; Narkiewicz, Krzysztof; Wykretowicz, Andrzej; Wysocki, Henryk

    2010-11-01

    Prolongations of cardiac cycles have a significantly larger contribution to short-term heart rate variability than shortenings--this is called heart rate asymmetry. Our aim is to establish the existence of blood pressure asymmetry phenomenon, which has not been done so far. We used 30-min resting continuous recordings of finger pressure waveforms from 227 healthy young volunteers (19-31 years old; 97 female), and performed Poincaré plot analysis of systolic blood pressure (SBP) to quantify the effect. Median contribution of SBP increases (C(i)) to short-term blood pressure variability was 52.8% (inter-quartile range: 50.9-55.1%) and median number of SBP increases (N(i)) was 48.8% (inter-quartile range: 47.2-50.1%). The C(i)>50% was found in 82% (P<0.0001; binomial test) and N(i)<50% in 75% (P<0.0001) of the subjects. Although SBP increases are significantly less abundant than reductions, their contribution to short-term blood pressure variability is significantly larger, which means that short-term blood pressure variability is asymmetric. SBP increases and reductions have unequal contribution to short-term blood pressure variability at supine rest in young healthy people. As this asymmetric behavior of blood pressure variability is present in most of the healthy studied people at rest, it can be concluded that blood pressure asymmetry is a physiological phenomenon.

  8. [Usefulness for detection of inappropriate blood pressure variability using 'wearable blood pressure sensor'].

    PubMed

    Iijima, Katsuya

    2015-11-01

    In the clinical settings, it has frequently seen that the elderly have rapid blood pressure (BP) elevation and decline, leading to such as orthostatic disorders and post-urination syncope. Excessive blood pressure variability (BPV) according to aging leads to aggravation of hypertensive target organ damage due to both disturbed baroreflex function and arterial stiffening. We developed continuous BP monitoring sensor using newly developing device 'wearable BP sensor', as our advantageous approach of without a cuff-stress. The new mobile device could reflect continuous beat-to-beat systolic BP, heart rate(HR), these very close changes and double product(sBPX HR) as a major indicator of cardiac lead, in consistent with cuff-based BP value. Our new challenge using this device might approach to the potential to achieve the quality-up of treatment strategy with consideration for very short-term BPV.

  9. Clinical Image: Visual Estimation of Blood Loss.

    PubMed

    Donham, Benjamin; Frondozo, Robby; Petro, Michael; Reynolds, Andrew; Swisher, Jonathan; Knight, Ryan M

    Military prehospital providers frequently have to make important clinical decisions with only limited objective information and vital signs. Because of this, accurate estimation of blood loss, at the point of injury, can augment any available objective information. Prior studies have shown that individuals significantly overestimate the amount of blood loss when the amount of hemorrhage is small, and they tend to underestimate the amount of blood loss with larger amounts of hemorrhage. Furthermore, the type of surface on which the blood is deposited can impact the visual estimation of the amount of hemorrhage. To aid providers with the ability to accurately estimate blood loss, we took several units of expired packed red blood cells and deposited them in different ways on varying surfaces to mimic the visual impression of combat casualties. 2017.

  10. Low correlation between visit-to-visit variability and 24-h variability of blood pressure.

    PubMed

    Muntner, Paul; Shimbo, Daichi; Diaz, Keith M; Newman, Jonathan; Sloan, Richard P; Schwartz, Joseph E

    2013-11-01

    visit-to-visit variability (VVV) of clinic systolic blood pressure (SBP) has been associated with cardiovascular disease risk. Given the need for obtaining blood pressure (BP) at multiple visits to calculate VVV, substituting BP variability from ambulatory blood pressure monitoring (ABPM) may be a practical alternative. We assessed the correlation between VVV of BP and BP variability from ABPM using data from 146 untreated, mostly normotensive participants (mean age 47.9 years), in a substudy of the ongoing Masked Hypertension Study. VVV of SBP and diastolic blood pressure (DBP) was estimated by the standard deviation (s.d.vvv) and average real variability (ARVvvv) from six study visits over a median of 216 days. ABPM data were used to calculate the day-night s.d. (s.d.dn), and the ARV of SBP and DBP over 24 h (ARV24). For SBP, the mean s.d.vvv and s.d.dn were 6.3 (s.d.=2.5) and 8.8 mm Hg (s.d.=1.8), respectively, and mean ARVvvv and ARV24 were 7.2 (s.d.=3.2) and 8.4 mm Hg (s.d.=2.1), respectively. Spearman's correlation coefficient between s.d.vvv and s.d.dn of SBP was rs=0.25, and between ARVvvv and ARV24 was rs=0.17. Participants in the highest quartile of s.d.dn of SBP were 1.66 (95% CI: 0.93-2.75) times more likely to be in the highest quartile of s.d.vvv of SBP. The observed-to-expected ratio between the highest quartiles of ARVvvv and ARV24 of SBP was 0.89 (95% CI: 0.41-1.69). The correlations for s.d.vvv and s.d.dn, and ARVvvv and ARV24 of DBP were minimal. These data suggest VVV and 24-h variability are weakly correlated and not interchangeable.

  11. Blood Pressure Variability and Its Management in Hypertensive Patients

    PubMed Central

    2012-01-01

    Optimizing treatment for hypertension has focused on reducing cardiovascular risk through reduction of mean blood pressure (BP) under the basic assumption that lower is better, as long as diastolic BP is sufficient to maintain coronary perfusion. However, antihypertensive therapy as currently practiced does not eliminate all hazards associated with BP elevation. Blood pressure variability (BPV) correlates closely with target-organ damage independent of mean BP and transient increases in BP are also triggers of vascular events. So far, there is no definitive outcome data relating specific reduction in BPV to decline cardiovascular events or death. Thus, the decision whether BPV should be considered a new therapeutic target is left to the clinical judgment of physicians and individualized for each patient. However, new evidence suggests that taking an antihypertensive medication at bedtime significantly affects BPV and lowers the risk of cardiovascular events and death. This strategy may provide a means of individualizing treatment of hypertension according to the circadian BPV of each patient and may be a new option to optimize BP control and reduce risk. PMID:23267418

  12. Blood Pressure Variability and Stress Management Training for Essential Hypertension

    ERIC Educational Resources Information Center

    Garcia-Vera, Maria Paz; Sanz, Jesus; Labrador, Francisco J.

    2004-01-01

    The purpose of this study was to determine whether stress management training reduces blood pressure (BP) variability in hypertensive patients. Previous literature suggests that cardiovascular risk is not only a function of BP levels, but also of BP variability, and this partially depends on changes induced by the stress of everyday life. The…

  13. Blood Pressure Variability and Stress Management Training for Essential Hypertension

    ERIC Educational Resources Information Center

    Garcia-Vera, Maria Paz; Sanz, Jesus; Labrador, Francisco J.

    2004-01-01

    The purpose of this study was to determine whether stress management training reduces blood pressure (BP) variability in hypertensive patients. Previous literature suggests that cardiovascular risk is not only a function of BP levels, but also of BP variability, and this partially depends on changes induced by the stress of everyday life. The…

  14. Red blood cell transfusion in clinical practice.

    PubMed

    Klein, Harvey G; Spahn, Donat R; Carson, Jeffrey L

    2007-08-04

    Every year, about 75 million units of blood are collected worldwide. Red blood cell (RBC) transfusion is one of the few treatments that adequately restore tissue oxygenation when oxygen demand exceeds supply. Although the respiratory function of blood has been studied intensively, the trigger for RBC transfusion remains controversial, and doctors rely primarily on clinical experience. Laboratory assays that indicate failing tissue oxygenation would be ideal to guide the need for transfusion, but none has proved easy, reproducible, and sensitive to regional tissue hypoxia. The clinical importance of the RBCs storage lesion (ie, the time-dependent metabolic, biochemical, and molecular changes that stored blood cells undergo) is poorly understood. RBCs can be filtered, washed, frozen, or irradiated for specific indications. Donor screening and testing have dramatically reduced infectious risks in the developed world, but infection remains a major hazard in developing countries, where 13 million units of blood are not tested for HIV or hepatitis viruses. Pathogen inactivation techniques are in clinical trials for RBCs, but none is available for use. Despite serious immunological and non-immunological complications, RBC transfusion holds a therapeutic index that exceeds that of many common medications.

  15. What variables can influence clinical reasoning?

    PubMed

    Ashoorion, Vahid; Liaghatdar, Mohammad Javad; Adibi, Peyman

    2012-12-01

    Clinical reasoning is one of the most important competencies that a physician should achieve. Many medical schools and licensing bodies try to predict it based on some general measures such as critical thinking, personality, and emotional intelligence. This study aimed at providing a model to design the relationship between the constructs. Sixty-nine medical students participated in this study. A battery test devised that consist four parts: Clinical reasoning measures, personality NEO inventory, Bar-On EQ inventory, and California critical thinking questionnaire. All participants completed the tests. Correlation and multiple regression analysis consumed for data analysis. There is low to moderate correlations between clinical reasoning and other variables. Emotional intelligence is the only variable that contributes clinical reasoning construct (r=0.17-0.34) (R(2) chnage = 0.46, P Value = 0.000). Although, clinical reasoning can be considered as a kind of thinking, no significant correlation detected between it and other constructs. Emotional intelligence (and its subscales) is the only variable that can be used for clinical reasoning prediction.

  16. What variables can influence clinical reasoning?

    PubMed Central

    Ashoorion, Vahid; Liaghatdar, Mohammad Javad; Adibi, Peyman

    2012-01-01

    Background: Clinical reasoning is one of the most important competencies that a physician should achieve. Many medical schools and licensing bodies try to predict it based on some general measures such as critical thinking, personality, and emotional intelligence. This study aimed at providing a model to design the relationship between the constructs. Materials and Methods: Sixty-nine medical students participated in this study. A battery test devised that consist four parts: Clinical reasoning measures, personality NEO inventory, Bar-On EQ inventory, and California critical thinking questionnaire. All participants completed the tests. Correlation and multiple regression analysis consumed for data analysis. Results: There is low to moderate correlations between clinical reasoning and other variables. Emotional intelligence is the only variable that contributes clinical reasoning construct (r=0.17-0.34) (R2 chnage = 0.46, P Value = 0.000). Conclusion: Although, clinical reasoning can be considered as a kind of thinking, no significant correlation detected between it and other constructs. Emotional intelligence (and its subscales) is the only variable that can be used for clinical reasoning prediction. PMID:23853636

  17. [Current clinical aspects of ambulatory blood pressure monitoring].

    PubMed

    Sauza-Sosa, Julio César; Cuéllar-Álvarez, José; Villegas-Herrera, Karla Montserrat; Sierra-Galán, Lilia Mercedes

    2016-01-01

    Systemic arterial hypertension is the prevalentest disease worldwide that significantly increases cardiovascular risk. An early diagnosis together to achieve goals decreases the risk of complications significatly. Recently have been updated the diagnostic criteria for hypertension and the introduction of ambulatory blood pressure monitoring. The introduction into clinical practice of ambulatory blood pressure monitoring was to assist the diagnosis of «white coat hypertension» and «masked hypertension». Today has also shown that ambulatory blood pressure monitoring is better than the traditional method of recording blood pressure in the office, to the diagnosis and to adequate control and adjustment of drug treatment. Also there have been introduced important new concepts such as isloted nocturnal hypertension, morning blood pressure elevation altered and altered patterns of nocturnal dip in blood pressure; which have been associated with increased cardiovascular risk. Several studies have shown significant prognostic value in some stocks. There are still other concepts on which further study is needed to properly establish their introduction to clinical practice as hypertensive load variability, pulse pressure and arterial stiffness. In addition to setting values according to further clinical studies in populations such as elderly and children.

  18. Blood Pressure and Visit-to-Visit Blood Pressure Variability Among Individuals With Primary Proteinuric Glomerulopathies.

    PubMed

    Sethna, Christine B; Meyers, Kevin E C; Mariani, Laura H; Psoter, Kevin J; Gadegbeku, Crystal A; Gibson, Keisha L; Srivastava, Tarak; Kretzler, Matthias; Brady, Tammy M

    2017-08-01

    Hypertension and blood pressure variability (BPV; SD and average real variability) in primary proteinuric glomerulopathies are not well described. Data were from 433 participants in the NEPTUNE (Nephrotic Syndrome Study Network). Hypertensive BP status was defined as previous history of hypertension or BP ≥140/90 mm Hg for adults/≥95th percentile for children at baseline. BPV was measured in participants with ≥3 visits in the first year. Two-hundred ninety-six adults (43 years [interquartile range, 32-57.8 years], 61.5% male) and 147 children (11 years [interquartile range, 5-14 years], 57.8% male) were evaluated. At baseline, 64.8% of adults and 46.9% of children were hypertensive. Histological diagnosis was associated with hypertensive status in adults (P=0.036). In adults, hypertensive status was associated with lower hazard of complete remission (hazard ratio, 0.36; 95% confidence interval, 0.19-0.68) and greater hazard of achieving the composite end point (end-stage renal disease or estimated glomerular filtration rate decline >40%; hazard ratio, 4.1; 95% confidence interval, 1.4-12). Greater systolic and diastolic SD and average real variability were also associated with greater hazard of reaching the composite end point in adults (all P<0.01). In children, greater BPV was an independent predictor of composite end point (determined by systolic SD and average real variability) and complete remission (determined by systolic and diastolic average real variability; all P<0.05). Hypertensive status was common among adults and children enrolled in NEPTUNE. Differences in hypertensive status prevalence, BPV, and treatment were found by age and histological diagnosis. In addition, hypertensive status and greater BPV were associated with poorer clinical outcomes. © 2017 American Heart Association, Inc.

  19. Clinical and acoustical variability in hypokinetic dysarthria

    SciTech Connect

    Metter, E.J.; Hanson, W.R.

    1986-10-01

    Ten male patients with parkinsonism secondary to Parkinson's disease or progressive supranuclear palsy had clinical neurological, speech, and acoustical speech evaluations. In addition, seven of the patients were evaluated by x-ray computed tomography (CT) and (F-18)-fluorodeoxyglucose (FDG) positron emission tomography (PET). Extensive variability of speech features, both clinical and acoustical, were found and seemed to be independent of the severity of any parkinsonian sign, CT, or FDG PET. In addition, little relationship existed between the variability across each measured speech feature. What appeared to be important for the appearance of abnormal acoustic measures was the degree of overall severity of the dysarthria. These observations suggest that a better understanding of hypokinetic dysarthria may result from more extensive examination of the variability between patients. Emphasizing a specific feature such as rapid speaking rate in characterizing hypokinetic dysarthria focuses on a single and inconstant finding in a complex speech pattern.

  20. Effects of repeated blood donations on iron status and hematologic variables of canine blood donors.

    PubMed

    Ferreira, Rui R F; Gopegui, Rafael R; Araujo, Maria Manuela R C; de Matos, Augusto J F

    2014-06-01

    To evaluate the bone marrow regenerative response and iron status of canine blood donors subjected to repeated blood collections for 1 year. Prospective cohort study. 57 blood donor dogs. Hematologic variables, including reticulocyte percentage, were evaluated before and 10 days after each blood collection in 16 dogs donating 13% of total blood volume (TBV) every 2 months (group 1), 16 dogs donating 13% of TBV every 3 months (group 2), and 25 dogs donating 15% of TBV every 3 months (group 3) for 1 year. Serum concentrations of iron, transferrin, and ferritin were analyzed before inclusion in the study and 10 days after the last donation. Significant increases in RBC distribution width, platelet count, WBC count, and reticulocyte percentage were detected after blood donation in all groups. Dogs of group 2 had a significantly higher serum ferritin concentration than did dogs of group 1; dogs of group 1 had a significant decrease in serum ferritin concentration. A positive correlation between the number of blood donations and both RBC distribution width and reticulocyte percentage was found for all groups. All blood donation regimens induced a bone marrow regenerative response, which was able to restore depleted blood cells within 10 days after blood donation while maintaining iron status within the calculated reference range. However, dogs donating 13% of TBV every 2 months had a significant decrease in iron stores, which suggested that iron-related variables must be monitored during prolonged blood donor programs.

  1. Clinical implications of positive blood cultures.

    PubMed Central

    Bryan, C S

    1989-01-01

    Positive blood cultures can be classified according to their veracity (true-positive or false-positive culture), clinical severity (inconsequential or life threatening), place of origin (community acquired or nosocomial), source (primary or secondary), duration (transient, intermittent, or continuous), pattern of occurrence (single episode, persistent, or recurrent), or intensity (high or low grade). In general, however, positive blood cultures identify a patient population at high risk of death. In my studies, patients with positive blood cultures were 12 times more likely to die during hospitalization than patients without positive blood cultures. Many bacteremias and fungemias occur in complicated clinical settings, and it appears that only about one-half of the deaths among affected patients are due directly to infection. Hence, it is appropriate to speak of "crude mortality" and "attributable mortality." Among hospitalized patients, recent trends include rising incidences of Staphylococcus aureus and coagulase-negative staphylococcal and enterococcal bacteremias and a dramatic increase in the incidence of fungemias. The diagnostic and therapeutic implications of blood cultures positive for specific microorganisms continue to evolve and are the subject of a large and growing medical literature. PMID:2680055

  2. MEASUREMENT-TO-MEASUREMENT BLOOD PRESSURE VARIABILITY IS RELATED TO COGNITIVE PERFORMANCE: THE MAINE-SYRACUSE STUDY

    PubMed Central

    Crichton, Georgina E.; Elias, Merrill F.; Dore, Gregory A.; Torres, Rachael V.; Robbins, Michael A.

    2014-01-01

    The objective was to investigate the association between variability in blood pressure and cognitive function for sitting, standing and reclining blood pressure values, and variability derived from all 15 measures. In previous studies only sitting blood pressure values have been examined, and only a few cognitive measures have been employed. A secondary objective was to examine associations between blood pressure variability and cognitive performance in hypertensive individuals stratified by treatment success. Cross-sectional analyses were performed on 972 participants of the Maine Syracuse Study for whom 15 serial blood pressure clinic measures (5 sitting, 5 recumbant and 5 standing) were obtained, prior to testing of cognitive performance. Using all 15 measures, higher variability in systolic and diastolic blood pressure was associated with poorer performance on multiple measures of cognitive performance, independent of demographic factors, cardiovascular risk factors, and pulse pressure. When sitting, reclining and standing systolic blood pressure values were compared, only variability in standing blood pressure was related to measures of cognitive performance. However, for diastolic blood pressure, variability in all three positions was related to cognitive performance. Mean blood pressure values were weaker predictors of cognition. Furthermore, higher overall variability in both systolic and diastolic blood pressure was associated with poorer cognitive performance in unsuccessfully treated hypertensive individuals (with blood pressure ≥140/90 mmHg), but these associations were not evident in those with controlled hypertension. PMID:25156168

  3. Ambulatory blood pressure monitoring-derived short-term blood pressure variability in primary hyperparathyroidism.

    PubMed

    Concistrè, A; Grillo, A; La Torre, G; Carretta, R; Fabris, B; Petramala, L; Marinelli, C; Rebellato, A; Fallo, F; Letizia, C

    2017-07-12

    Primary hyperparathyroidism is associated with a cluster of cardiovascular manifestations, including hypertension, leading to increased cardiovascular risk. The aim of our study was to investigate the ambulatory blood pressure monitoring-derived short-term blood pressure variability in patients with primary hyperparathyroidism, in comparison with patients with essential hypertension and normotensive controls. Twenty-five patients with primary hyperparathyroidism (7 normotensive,18 hypertensive) underwent ambulatory blood pressure monitoring at diagnosis, and fifteen out of them were re-evaluated after parathyroidectomy. Short-term-blood pressure variability was derived from ambulatory blood pressure monitoring and calculated as the following: 1) Standard Deviation of 24-h, day-time and night-time-BP; 2) the average of day-time and night-time-Standard Deviation, weighted for the duration of the day and night periods (24-h "weighted" Standard Deviation of BP); 3) average real variability, i.e., the average of the absolute differences between all consecutive BP measurements. Baseline data of normotensive and essential hypertension patients were matched for age, sex, BMI and 24-h ambulatory blood pressure monitoring values with normotensive and hypertensive-primary hyperparathyroidism patients, respectively. Normotensive-primary hyperparathyroidism patients showed a 24-h weighted Standard Deviation (P < 0.01) and average real variability (P < 0.05) of systolic blood pressure higher than that of 12 normotensive controls. 24-h average real variability of systolic BP, as well as serum calcium and parathyroid hormone levels, were reduced in operated patients (P < 0.001). A positive correlation of serum calcium and parathyroid hormone with 24-h-average real variability of systolic BP was observed in the entire primary hyperparathyroidism patients group (P = 0.04, P  = 0.02; respectively). Systolic blood pressure variability is increased in normotensive

  4. The Clinical Significance of Elevated Blood Lactate

    PubMed Central

    Phillipson, Eliot A.; Sproule, Brian J.

    1965-01-01

    Three patients with elevated blood lactate values are described. The first, despite moderate hyperlactatemia of 5.3 mEq./1. and severe acidosis with an arterial blood pH of 6.98, had no “excess lactate”. In a second patient, moderate acidosis with a pH of 7.27 and blood lactate of 7.5 mEq./1., of which 33% was excess lactate, was found to be secondary to tissue hypoxia on an ischemic basis and preceded the onset of clinical shock by four hours. A third patient, diabetic and under treatment with phenformin hydrochloride, presented with many features suggestive of pulmonary embolism, including marked pulmonary hypertension. A diagnosis of idiopathic lactic acidosis was established when the arterial blood pH was found to be 6.77 and a blood lactate value of 14.2 mEq./1., 60% as excess lactate, was discovered in the absence of a demonstrable cause of tissue hypoxia. Exploration of the pulmonary vascular bed showed no sign of mechanical blockage. The diagnostic, therapeutic and prognostic value of measuring blood lactic acid, and of quantitating the proportion circulating as “excess lactate”, is emphasized. PMID:14312443

  5. Heterogeneity of Prognostic Studies of 24-Hour Blood Pressure Variability: Systematic Review and Meta-Analysis

    PubMed Central

    Taylor, Kathryn S.; Heneghan, Carl J.; Stevens, Richard J.; Adams, Emily C.; Nunan, David; Ward, Alison

    2015-01-01

    In addition to mean blood pressure, blood pressure variability is hypothesized to have important prognostic value in evaluating cardiovascular risk. We aimed to assess the prognostic value of blood pressure variability within 24 hours. Using MEDLINE, EMBASE and Cochrane Library to April 2013, we conducted a systematic review of prospective studies of adults, with at least one year follow-up and any day, night or 24-hour blood pressure variability measure as a predictor of one or more of the following outcomes: all-cause mortality, cardiovascular mortality, all cardiovascular events, stroke and coronary heart disease. We examined how blood pressure variability is defined and how its prognostic use is reported. We analysed relative risks adjusted for covariates including the appropriate mean blood pressure and considered the potential for meta-analysis. Our analysis of methods included 24 studies and analysis of predictions included 16 studies. There were 36 different measures of blood pressure variability and 13 definitions of night- and day-time periods. Median follow-up was 5.5 years (interquartile range 4.2–7.0). Comparing measures of dispersion, coefficient of variation was less well researched than standard deviation. Night dipping based on percentage change was the most researched measure and the only measure for which data could be meaningfully pooled. Night dipping or lower night-time blood pressure was associated with lower risk of cardiovascular events. The interpretation and use in clinical practice of 24-hour blood pressure variability, as an important prognostic indicator of cardiovascular events, is hampered by insufficient evidence and divergent methodologies. We recommend greater standardisation of methods. PMID:25984791

  6. Heterogeneity of prognostic studies of 24-hour blood pressure variability: systematic review and meta-analysis.

    PubMed

    Taylor, Kathryn S; Heneghan, Carl J; Stevens, Richard J; Adams, Emily C; Nunan, David; Ward, Alison

    2015-01-01

    In addition to mean blood pressure, blood pressure variability is hypothesized to have important prognostic value in evaluating cardiovascular risk. We aimed to assess the prognostic value of blood pressure variability within 24 hours. Using MEDLINE, EMBASE and Cochrane Library to April 2013, we conducted a systematic review of prospective studies of adults, with at least one year follow-up and any day, night or 24-hour blood pressure variability measure as a predictor of one or more of the following outcomes: all-cause mortality, cardiovascular mortality, all cardiovascular events, stroke and coronary heart disease. We examined how blood pressure variability is defined and how its prognostic use is reported. We analysed relative risks adjusted for covariates including the appropriate mean blood pressure and considered the potential for meta-analysis. Our analysis of methods included 24 studies and analysis of predictions included 16 studies. There were 36 different measures of blood pressure variability and 13 definitions of night- and day-time periods. Median follow-up was 5.5 years (interquartile range 4.2-7.0). Comparing measures of dispersion, coefficient of variation was less well researched than standard deviation. Night dipping based on percentage change was the most researched measure and the only measure for which data could be meaningfully pooled. Night dipping or lower night-time blood pressure was associated with lower risk of cardiovascular events. The interpretation and use in clinical practice of 24-hour blood pressure variability, as an important prognostic indicator of cardiovascular events, is hampered by insufficient evidence and divergent methodologies. We recommend greater standardisation of methods.

  7. Blood pressure variability and outcomes in chronic kidney disease.

    PubMed

    Di Iorio, Biagio; Pota, Andrea; Sirico, Maria Luisa; Torraca, Serena; Di Micco, Lucia; Rubino, Roberto; Guastaferro, Pasquale; Bellasi, Antonio

    2012-12-01

    We investigated the effects of visit-to-visit systolic blood pressure variability (SBPV) on both mortality and dialysis inception in a cohort of chronic kidney disease (CKD) patients not requiring dialysis therapy. Furthermore, we also explored the carry-over effect of visit-to-visit SBPV on mortality after dialysis initiation. We conducted a longitudinal retrospective, observational, multi-centre study in three tertiary care nephrology outpatient clinics. All the ambulatory CKD patients admitted to the outpatient clinics from 1 January 2004 to 31 December 2005 were screened for study eligibility. We selected all consecutive patients older than 18 years of age with a mean estimated glomerular filtration rate of <60 mL/min/m(2), free from cardiovascular disease. SBPV was defined as the ratio of the SD to the mean SBP of five values recorded during a run-in phase of 4-5 months. Data on dialysis inception and mortality were recorded through 31 December 2010. Overall, we selected a cohort of 374 elderly (median age: 79 years) subjects. A total of 232 (62%) and 103 (29%) patients were male and had diabetes, respectively. A significant association between SBPV and the risk of death but not of CKD progression to dialysis was noted at univariate and after multivariable adjustments (hazard ratio for all-cause mortality per 1% increase in SBPV: 1.05; 95% confidence interval: 1.02-1.09; P = 0.001). Notably, no lethal event was recorded after dialysis initiation. Current findings suggest that SBPV may be of use for risk stratification in CKD patients.

  8. Higher Blood Pressure Variability in White Coat Hypertension; from the Korean Ambulatory Blood Pressure Monitoring Registry

    PubMed Central

    Kang, In Sook; Shin, Jinho; Ihm, Sang-Hyun; Kim, Ju Han; Park, Sungha; Kim, Kwang-Il; Kim, Woo-Shik; Kim, Soon Gil; Shin, Gil Ja

    2016-01-01

    Background and Objectives Blood pressure variability (BPV) was recently shown to be a risk factor of stroke. White coat hypertension (WCH) used to be regarded as innocuous, but one long-term follow-up study reported that WCH increased stroke rate compared to normotension (NT). In this study, we aimed to evaluate the relationship between WCH and BPV. Subjects and Methods We analyzed 1398 subjects from the Korean Ambulatory Blood Pressure Registry, who were divided into NT (n=364), masked hypertension (n=122), white coat hypertension (n=254), and sustained hypertension (n=658) groups. Results Baseline characteristics were similar among groups. The average real variability (ARV), a highly sensitive BPV parameter, was highest in the WCH group, followed by the sustained hypertension, masked hypertension, and NT groups. The results persisted after being adjusted for covariates. The WCH vs. sustained hypertension results (adjusted mean±standard error) were as follows: 24-h systolic ARV, 22.9±0.8 vs. 19.4±0.6; 24-h diastolic ARV, 16.8±0.6 vs. 14.3±0.5; daytime systolic ARV, 21.8±0.8 vs. 16.8±0.6; and daytime diastolic ARV, 16.2±0.6 vs. 13.4±0.5 (p<0.001 for all comparisons). Conclusion From the registry data, we found that subjects with WCH or masked hypertension had higher BPV than NT. However, long-term follow-up data assessing the clinical influences of WCH on stroke are needed. PMID:27275173

  9. Red blood cell components: time to revisit the sources of variability.

    PubMed

    Sparrow, Rosemary L

    2017-03-01

    Quality and safety of red blood cell (RBC) components is managed by screening of donors and strict regulatory controls of blood collection, processing and storage procedures. Despite these efforts, variations in RBC component quality exist as exemplified by the wide range in storage-induced haemolysis. This article provides a brief overview of the variables that contribute or potentially contribute to the quality of stored RBC components, including blood collection, processing, and donor-related variables. Particular focus is made on donor health and lifestyle factors that are not specifically screened and may impact on the physicobiochemical properties of RBCs and their storability. Inflammatory and oxidative stress states may be especially relevant as RBCs are susceptible to oxidative injury. Few studies have investigated the effect of specific donor-related variables on the quality of stored RBC components. Donor-related variables may be unaccounted confounders in the "age of blood" clinical studies that compared outcomes following transfusion of fresher or longer-stored RBC components. The conclusion is drawn that the blood donor is the greatest source of RBC component variability and the least "regulated" aspect of blood component production. It is proposed that more research is needed to better understand the connection between donor-related variables and quality consistency of stored RBC components. This could be very important given the impact of modern lifestyles that sees escalating rates of non-communicable health conditions that are associated with increased oxidative stress, such as hypertension, obesity and diabetes in children and adults, as well as an ageing population in many countries. The effect of these changes to global health and population demographics will impact on blood donor panels, and without significant new research, the consequences on the quality of stored blood components and transfusion outcomes are unknown.

  10. Is It Daily, Monthly, or Yearly Blood Pressure Variability that Enhances Cardiovascular Risk?

    PubMed

    Dolan, Eamon; O'Brien, Eoin

    2015-11-01

    Variability is a phenomenon common to most biological processes that we can measure and is a particular feature of blood pressure (BP). Variability causes concern for many physicians regarding its clinical meaning and potential impact on cardiovascular risk. In this review, we assess the role of different time periods of blood pressure variability (BPV) in cardiovascular risk stratification. We review the indices of BPV derived from ambulatory blood pressure measurement (ABPM), home blood pressure measurement (HBPM), or at the clinic setting with the intention of providing a clear message for clinical practice. BPV, either derived from ABPM or HBPM, does not consistently augment cardiovascular risk prediction over and beyond that of average BP, particularly in low-risk individuals. That said, it would seem that certain medications such as calcium channel blockers may have a beneficial effect on visit-to-visit BPV and perhaps reduce the associated cardiovascular risk. This highlights the benefits in using combination therapy which might couple a number of therapeutic benefits such as the reductions of mean blood pressure and BPV. Overall, we should remain aware that the average BP level remains the main modifiable risk factor derived from BP measurements and continue to improve the control of hypertension and adverse health outcomes.

  11. Association of heart rate with blood pressure variability: implications for blood pressure measurement.

    PubMed

    Cahan, Amos; Ben-Dov, Iddo Z; Bursztyn, Michael

    2012-03-01

    Antihypertensive β-blocker use is associated with greater intervisit blood pressure variability (BPV) and with less favorable outcomes compared to other antihypertensive agents. A theoretical model demonstrated that accuracy and precision of BP measurement are affected by heart rate (HR) at a constant cuff deflation rate. We aimed to examine the empirical relationship between HR and BPV in a clinical setting. Intratracing variability in ambulatory BP monitoring (ABPM) were analyzed in search of a link between BPV and HR. BPV was expressed as standard deviation (s.d.), coefficient of variation (CV), and variability independent of the mean (VIM). In a dataset of 4,693 subjects, HR was inversely associated with BPV and independently explained 1.3% of between-subject variation in s.d. of awake systolic BP (1.5% of CV and VIM). Linear regression suggested 0.5 mm Hg increase in s.d. of systolic BP per 10 beats per minute (bpm) decrease in HR. In a subset of 1,019 patients with available data on medications, HR was independently and inversely related with awake systolic BPV (P < 0.0001), more so in diuretic (P < 0.050) and renin-angiotensin system antagonists-treated (P < 0.050) patients. Associations of β-blockade with increased BPV were abolished by model-adjustment for HR. In another subset of patients who were monitored twice (n = 635), HR had a mild (0.6%) but significant (P < 0.05) inverse contribution to the change in awake systolic BPV between repeated monitoring. Ambulatory BPV is inversely related to HR and is not increased in referred patients treated with β-blockers after correction for HR. © 2012 American Journal of Hypertension, Ltd.

  12. Blood pressure variability, prehypertension, and hypertension in adolescents

    PubMed Central

    Batisky, Donald L

    2012-01-01

    Medical conditions diagnosed during adolescence may have long term impacts on the health of an individual. As a result, identifying cardiovascular risk factors earlier in life such as prehypertension (pre-HTN) and hypertension (HTN) can have significant benefits across an individual’s lifespan. Diagnosing elevated blood pressure (BP) during adolescence can be difficult, partially due to the natural variability that occurs during this period of life. Levels of BP that define adolescent prehypertension/hypertension are provided as well as an abridged review of BP variability across research groups. Strategies for BP management of adolescents are considered, with the primary focus on nonpharmacologic interventions. PMID:24600286

  13. Red blood cell components: time to revisit the sources of variability

    PubMed Central

    Sparrow, Rosemary L.

    2017-01-01

    Quality and safety of red blood cell (RBC) components is managed by screening of donors and strict regulatory controls of blood collection, processing and storage procedures. Despite these efforts, variations in RBC component quality exist as exemplified by the wide range in storage-induced haemolysis. This article provides a brief overview of the variables that contribute or potentially contribute to the quality of stored RBC components, including blood collection, processing, and donor-related variables. Particular focus is made on donor health and lifestyle factors that are not specifically screened and may impact on the physicobiochemical properties of RBCs and their storability. Inflammatory and oxidative stress states may be especially relevant as RBCs are susceptible to oxidative injury. Few studies have investigated the effect of specific donor-related variables on the quality of stored RBC components. Donor-related variables may be unaccounted confounders in the “age of blood” clinical studies that compared outcomes following transfusion of fresher or longer-stored RBC components. The conclusion is drawn that the blood donor is the greatest source of RBC component variability and the least “regulated” aspect of blood component production. It is proposed that more research is needed to better understand the connection between donor-related variables and quality consistency of stored RBC components. This could be very important given the impact of modern lifestyles that sees escalating rates of non-communicable health conditions that are associated with increased oxidative stress, such as hypertension, obesity and diabetes in children and adults, as well as an ageing population in many countries. The effect of these changes to global health and population demographics will impact on blood donor panels, and without significant new research, the consequences on the quality of stored blood components and transfusion outcomes are unknown. PMID:28263168

  14. Assessment of Normal Variability in Peripheral Blood Gene Expression

    DOE PAGES

    Campbell, Catherine; Vernon, Suzanne D.; Karem, Kevin L.; ...

    2002-01-01

    Peripheral blood is representative of many systemic processes and is an ideal sample for expression profiling of diseases that have no known or accessible lesion. Peripheral blood is a complex mixture of cell types and some differences in peripheral blood gene expression may reflect the timing of sample collection rather than an underlying disease process. For this reason, it is important to assess study design factors that may cause variability in gene expression not related to what is being analyzed. Variation in the gene expression of circulating peripheral blood mononuclear cells (PBMCs) from three healthy volunteers sampled three times onemore » day each week for one month was examined for 1,176 genes printed on filter arrays. Less than 1% of the genes showed any variation in expression that was related to the time of collection, and none of the changes were noted in more than one individual. These results suggest that observed variation was due to experimental variability.« less

  15. Methodology and technology for peripheral and central blood pressure and blood pressure variability measurement: current status and future directions - Position statement of the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability.

    PubMed

    Stergiou, George S; Parati, Gianfranco; Vlachopoulos, Charalambos; Achimastos, Apostolos; Andreadis, Emanouel; Asmar, Roland; Avolio, Alberto; Benetos, Athanase; Bilo, Grzegorz; Boubouchairopoulou, Nadia; Boutouyrie, Pierre; Castiglioni, Paolo; de la Sierra, Alejandro; Dolan, Eamon; Head, Geoffrey; Imai, Yutaka; Kario, Kazuomi; Kollias, Anastasios; Kotsis, Vasilis; Manios, Efstathios; McManus, Richard; Mengden, Thomas; Mihailidou, Anastasia; Myers, Martin; Niiranen, Teemu; Ochoa, Juan Eugenio; Ohkubo, Takayoshi; Omboni, Stefano; Padfield, Paul; Palatini, Paolo; Papaioannou, Theodore; Protogerou, Athanasios; Redon, Josep; Verdecchia, Paolo; Wang, Jiguang; Zanchetti, Alberto; Mancia, Giuseppe; O'Brien, Eoin

    2016-09-01

    Office blood pressure measurement has been the basis for hypertension evaluation for almost a century. However, the evaluation of blood pressure out of the office using ambulatory or self-home monitoring is now strongly recommended for the accurate diagnosis in many, if not all, cases with suspected hypertension. Moreover, there is evidence that the variability of blood pressure might offer prognostic information that is independent of the average blood pressure level. Recently, advancement in technology has provided noninvasive evaluation of central (aortic) blood pressure, which might have attributes that are additive to the conventional brachial blood pressure measurement. This position statement, developed by international experts, deals with key research and practical issues in regard to peripheral blood pressure measurement (office, home, and ambulatory), blood pressure variability, and central blood pressure measurement. The objective is to present current achievements, identify gaps in knowledge and issues concerning clinical application, and present relevant research questions and directions to investigators and manufacturers for future research and development (primary goal).

  16. Blood Glucose Variability and Outcomes in Critically Ill Children

    PubMed Central

    Naranje, Kirti Mahadeorao; Poddar, Banani; Bhriguvanshi, Arpita; Lal, Richa; Azim, Afzal; Singh, Ratender K.; Gurjar, Mohan; Baronia, Arvind K.

    2017-01-01

    Objectives: To find the incidence of hyperglycemia (blood glucose [BG] ≥150 mg/dl), hypoglycemia (BG ≤60 mg/dl), and variability (presence of hypoglycemia and hyperglycemia) in critically ill children in the 1st week of Intensive Care Unit (ICU) stay and their association with mortality, length of ICU stay, and organ dysfunction. Materials and Methods: The design was a retrospective observational cohort study. Consecutive children ≤18 years of age admitted from March 2003 to April 2012 in a combined adult and pediatric closed ICU. Relevant data were collected from chart review and hospital database. Results: Out of 258 patients included, isolated hyperglycemia was seen in 139 (53.9%) and was unrelated to mortality and morbidity. Isolated variability in BG was noted in 76 (29.5%) patients and hypoglycemia was seen in 9 (3.5%) patients. BG variability was independently associated with multiorgan dysfunction syndrome on multivariate analysis (adjusted odds ratio [OR]: 7.1; 95% confidence interval [CI]: 1.6–31.1). Those with BG variability had longer ICU stay (11 days vs. 4 days, on log-rank test, P = 0.001). Insulin use was associated with the occurrence of variability (adjusted OR: 3.6; 95% CI: 1.8–7.0). Conclusion: Glucose disorders were frequently observed in critically ill children. BG variability was associated with multiorgan dysfunction and increased ICU stay.

  17. Noncontact blood perfusion mapping in clinical applications

    NASA Astrophysics Data System (ADS)

    Iakovlev, Dmitry; Dwyer, Vincent; Hu, Sijung; Silberschmidt, Vadim

    2016-04-01

    Non-contact imaging photoplethysmography (iPPG) to detect pulsatile blood microcirculation in tissue has been selected as a successor to low spatial resolution and slow scanning blood perfusion techniques currently employed by clinicians. The proposed iPPG system employs a novel illumination source constructed of multiple high power LEDs with narrow spectral emission, which are temporally modulated and synchronised with a high performance sCMOS sensor. To ensure spectrum stability and prevent thermal wavelength drift due to junction temperature variations, each LED features a custom-designed thermal management system to effectively dissipate generated heat and auto-adjust current flow. The use of a multi-wavelength approach has resulted in simultaneous microvascular perfusion monitoring at various tissue depths, which is an added benefit for specific clinical applications. A synchronous detection algorithm to extract weak photoplethysmographic pulse-waveforms demonstrated robustness and high efficiency when applied to even small regions of 5 mm2. The experimental results showed evidences that the proposed system could achieve noticeable accuracy in blood perfusion monitoring by creating complex amplitude and phase maps for the tissue under examination.

  18. Agreement between ambulatory, home, and office blood pressure variability.

    PubMed

    Juhanoja, Eeva P; Niiranen, Teemu J; Johansson, Jouni K; Puukka, Pauli J; Jula, Antti M

    2016-01-01

    Ambulatory, home, and office blood pressure (BP) variability are often treated as a single entity. Our aim was to assess the agreement between these three methods for measuring BP variability. Twenty-four-hour ambulatory BP monitoring, 28 home BP measurements, and eight office BP measurements were performed on 461 population-based or hypertensive participants. Five variability indices were calculated for all measurement methods: SD, coefficient of variation, maximum-minimum difference, variability independent of the mean, and average real variability. Pearson's correlation coefficients were calculated for indices measured with different methods. The agreement between different measurement methods on the diagnoses of extreme BP variability (participants in the highest decile of variability) was assessed with kappa (κ) coefficients. SBP/DBP variability was greater in daytime (coefficient of variation: 9.8 ± 2.9/11.9 ± 3.6) and night-time ambulatory measurements (coefficient of variation: 8.6 ± 3.4/12.1 ± 4.5) than in home (coefficient of variation: 4.4 ± 1.8/4.7 ± 1.9) and office (coefficient of variation: 4.6 ± 2.4/5.2 ± 2.6) measurements (P < 0.001/0.001 for all). Pearson's correlation coefficients for systolic/diastolic daytime or night-time ambulatory-home, ambulatory-office, and home-office variability indices ranged between 0.07-0.25/0.12-0.23, 0.13-0.26/0.03-0.22 and 0.13-0.24/0.10-0.19, respectively, indicating, at most, a weak positive (r < 0.3) relationship. The agreement between measurement methods on diagnoses of extreme SBP/DBP variability was only slight (κ < 0.2), with the κ coefficients for daytime and night-time ambulatory-home, ambulatory-office, and home-office agreement varying between-0.014-0.20/0.061-0.15, 0.037-0.18/0.082-0.15, and 0.082-0.13/0.045-0.15, respectively. Shorter-term and longer-term BP variability assessed by different methods of BP measurement seem to correlate only weakly

  19. Which patients should be evaluated for blood glucose variability?

    PubMed

    Candido, R

    2013-09-01

    Diabetes is characterized by glycaemic disorders that include both sustained chronic hyperglycaemia and acute fluctuations (i.e. glycaemic variability). Increasing attention is being paid to the role of glycaemic variability as a relevant determinant for diabetes control and prevention of its vascular complications. As a consequence, it is strongly suggested that a global antidiabetic strategy should be aimed at reducing to a minimum the different components of glycaemic control (i.e. HbA1c, fasting and postprandial glucose, as well as glycaemic variability). Subjects at risk of hypoglycaemia, subjects with postprandial hyperglycaemia and patients who need to adjust or start insulin seem to be the categories that require glycaemic variability monitoring. The analysis of blood glucose variability represents an additional tool in the global assessment of glycaemic control and can serve as a guide to the clinician in the management of therapy and for the patients both in the prevention of acute complications, in particular hypoglycaemia, and chronic disease, in particular macrovascular complications.

  20. Mosaic Trisomy 17: Variable Clinical and Cytogenetic Presentation

    PubMed Central

    Daber, Robert D.; Chapman, Kimberly A.; Ruchelli, Eduardo; Kasperski, Stefanie; Mulchandani, Surabhi; Thiel, Brian D.; Hakonarson, Hakon; Zackai, Elaine H.; Conlin, Laura K.; Spinner, Nancy B.

    2011-01-01

    Mosaic trisomy 17 is rare with only 28 cases reported and the clinical presentation is highly variable. The diagnosis is most commonly made by prenatal karyotype and in most cases is followed by a normal postnatal karyotype on blood lymphocytes. We present two cases of mosaic trisomy 17 diagnosed prenatally, with follow up in multiple tissues at birth. In the first case, trisomy 17 was identified in all amniocytes, and at birth standard results of chromosome analysis in peripheral blood were normal, but mosaic trisomy 17 was identified (50–75%) in skin fibroblasts by genome-wide SNP array analysis. This patient presented with minor anomalies, congenital heart disease, asymmetry, intestinal malrotation and died on day 9 of life. In the second patient amniocentesis after ultrasound finding of tetralogy of Fallot showed mosaic trisomy 17. Postnatally, results of a SNP array were normal in blood, buccal mucosa and skin. It is possible that the cardiac defect is related to trisomy 17 in key tissues during heart development, although at birth the aneuploidy could not be identified in tissues that are routinely analyzed for diagnosis. These cases add to our understanding of mosaic trisomy 17, highlighting the failure to diagnose this aneuploidy in peripheral blood. PMID:21998853

  1. Influence of Study Design Variables on Clinical Pathology Data.

    PubMed

    Aulbach, Adam; Provencher, Anne; Tripathi, Niraj

    2017-02-01

    A number of factors related to study design have the potential to impact clinical pathology test results during the conduct of nonclinical safety studies. A thorough understanding of these factors is paramount in drawing accurate conclusions from clinical pathology data generated during such studies, particularly when attempting to make the distinction between test article and nontest article-related effects. Study design and conduct variables with potential to impact clinical pathology data discussed in this overview include those related to species and test system, animal age, animal care and husbandry practices, fasting, acclimatization periods, effects of transportation and stressors, route of administration, effects of in-life and surgical procedures, influence of study length, timing of blood collections, impact of vehicle/formulation composition, and some general concepts related to drug class. The material presented here is a summary based on information presented at the 35th Annual Symposium of the Society of Toxicologic Pathology (June 2016), during Symposium Session 2 titled "Deciphering Sources of Variability in Clinical Pathology-It's Not Just about the Numbers."

  2. Calf blood pressure: clinical implications and correlations with arm blood pressure in infants and young children.

    PubMed

    Crapanzano, M S; Strong, W B; Newman, I R; Hixon, R L; Casal, D; Linder, C W

    1996-02-01

    Indirect measurement of lower extremity blood pressure is often used in the clinical setting, although normative data after the newborn period are not readily available. Indirect blood pressure (BP) measurement was obtained in the right arms and right calves of 148 healthy infants and young children 2 weeks to 3 years of age. All measurements were made using an oscillometric device. The infants and children are quiet or asleep and in the supine position. A BP cuff of proper size was chosen. Three measurements were made in both extremities; the average of the second and third measurements was used for all analyses. Age correlated better with calf systolic blood pressure (SBPc) than with arm SBP (SBPa) (r = .52 vs .17). Calf diastolic blood pressure (DBPc) and calf mean blood pressure (MBPc) correlated moderately poorly with age (r = .37 and .39, respectively). There was no order effect. SBPc correlated best with height (r = .53), then age (r = .52), and, finally, weight (r = .51). The correlation between BPc and BPa was moderately low. The correlation of SBPc with SBPa was r = .46; that of DBPc with DBPa was r = .37; and that of MBPc with MBPa was r = .41. From birth to 6 months, SBPc was slightly lower than SBPa (1 to 3 mm Hg). SBPc increased linearly relative to SBPa and began to exceed SBPa at 6 months of age. The pattern of DBP and MBP was similar. Wide variability of blood pressure parameters was noted between the infants and children at all ages. Reference data are presented for BPc and the difference between BPc and BPa in healthy infants and children from 2 weeks to 3 years of age. BPc is not equivalent to BPa and should not be arbitrarily substituted. Because of the wide variability among healthy infants and children, SBPc measurements should be interpreted with caution when evaluating for coarctation of the aorta.

  3. Effect of induced ruminal acidosis on blood variables in heifers

    PubMed Central

    2013-01-01

    Background Ruminal acidosis is responsible for the onset of different pathologies in dairy and feedlot cattle, but there are major difficulties in the diagnosis. This study modelled the data obtained from various blood variables to identify those that could indicate the severity of ruminal acidosis. Six heifers were fed three experimental rations throughout three periods. The diets were characterised by different starch levels: high starch (HS), medium starch (MS) and low starch, as the control diet (CT). Ruminal pH values were continuously measured using wireless sensors and compared with pH measurements obtained by rumenocentesis. Blood samples were analysed for complete blood count, biochemical profile, venous blood gas, blood lipopolysaccharide (LPS) and LPS-binding proteins (LBP). Results The regression coefficient comparing the ruminal pH values, obtained using the two methods, was 0.56 (P = 0.040). Feeding the CT, MS and HS led to differences in the time spent below the 5.8, 5.5 and 5.0 pH thresholds and in several variables, including dry matter intake (7.7 vs. 6.9 vs. 5.1 kg/d; P = 0.002), ruminal nadir pH (5.69 vs. 5.47 vs. 5.44; P = 0.042), mean ruminal pH (6.50 vs. 6.34 vs. 6.31; P = 0.012), haemoglobin level (11.1 vs. 10.9 vs. 11.4 g/dL; P = 0.010), platelet count (506 vs. 481 vs. 601; P = 0.008), HCO3- (31.8 vs. 31.3 vs. 30.6 mmol/L; P = 0.071) and LBP (5.9 vs. 9.5 vs. 10.5 μg/mL; P < 0.001). A canonical discriminant analysis (CDA) was used to classify the animals into four ruminal pH classes (normal, risk of acidosis, subacute ruminal acidosis and acute ruminal acidosis) using haemoglobin, mean platelet volume, β-hydroxybutyrate, glucose and reduced haemoglobin. Conclusions Although additional studies are necessary to confirm the reliability of these discriminant functions, the use of plasma variables in a multifactorial model appeared to be useful for the evaluation of ruminal acidosis severity. PMID:23647881

  4. Effect of induced ruminal acidosis on blood variables in heifers.

    PubMed

    Marchesini, Giorgio; De Nardi, Roberta; Gianesella, Matteo; Stefani, Anna-Lisa; Morgante, Massimo; Barberio, Antonio; Andrighetto, Igino; Segato, Severino

    2013-05-06

    Ruminal acidosis is responsible for the onset of different pathologies in dairy and feedlot cattle, but there are major difficulties in the diagnosis. This study modelled the data obtained from various blood variables to identify those that could indicate the severity of ruminal acidosis. Six heifers were fed three experimental rations throughout three periods. The diets were characterised by different starch levels: high starch (HS), medium starch (MS) and low starch, as the control diet (CT). Ruminal pH values were continuously measured using wireless sensors and compared with pH measurements obtained by rumenocentesis. Blood samples were analysed for complete blood count, biochemical profile, venous blood gas, blood lipopolysaccharide (LPS) and LPS-binding proteins (LBP). The regression coefficient comparing the ruminal pH values, obtained using the two methods, was 0.56 (P = 0.040). Feeding the CT, MS and HS led to differences in the time spent below the 5.8, 5.5 and 5.0 pH thresholds and in several variables, including dry matter intake (7.7 vs. 6.9 vs. 5.1 kg/d; P = 0.002), ruminal nadir pH (5.69 vs. 5.47 vs. 5.44; P = 0.042), mean ruminal pH (6.50 vs. 6.34 vs. 6.31; P = 0.012), haemoglobin level (11.1 vs. 10.9 vs. 11.4 g/dL; P = 0.010), platelet count (506 vs. 481 vs. 601; P = 0.008), HCO3(-) (31.8 vs. 31.3 vs. 30.6 mmol/L; P = 0.071) and LBP (5.9 vs. 9.5 vs. 10.5 μg/mL; P < 0.001). A canonical discriminant analysis (CDA) was used to classify the animals into four ruminal pH classes (normal, risk of acidosis, subacute ruminal acidosis and acute ruminal acidosis) using haemoglobin, mean platelet volume, β-hydroxybutyrate, glucose and reduced haemoglobin. Although additional studies are necessary to confirm the reliability of these discriminant functions, the use of plasma variables in a multifactorial model appeared to be useful for the evaluation of ruminal acidosis severity.

  5. Blood Pressure Variability: Can Nonlinear Dynamics Enhance Risk Assessment During Cardiovascular Surgery? A Feasibility Study

    PubMed Central

    Subramaniam, Balachundhar; Khabbaz, Kamal R.; Heldt, Thomas; Lerner, Adam B.; Mittleman, Murray A.; Davis, Roger B.; Goldberger, Ary L.; Costa, Madalena D.

    2014-01-01

    Brief Summary We propose that complex (nonlinear) fluctuations of hemodynamic variables (including systemic blood pressure parameters) during cardiovascular surgery contain information relevant to risk assessment and intraoperative management. Preliminary analysis of a pilot study supports the feasibility and potential merits of performing a larger, prospective study to assess the clinical utility of such new dynamical measures and to evaluate their potential role in enhancing contemporary approaches to risk assessment of major adverse events. PMID:24508020

  6. Gender differences in the relationship between resting heart rate variability and 24-hour blood pressure variability.

    PubMed

    Thayer, Julian F; Sollers, John J; Friedman, Bruce H; Koenig, Julian

    2016-01-01

    The study explored the relationship between time- and frequency-domain indices of cardiac autonomic control and 24 h blood pressure variability (BPV) in a sample of healthy men and women. Vagally mediated cardiac control was inversely related to 24 h BPV, and measures of cardiac autonomic control were better predictors of systolic BPV in men and better predictors of diastolic BPV in women. These findings may help researchers to understand the disparity in cardiovascular disease morbidity and mortality between men and women.

  7. Imipramine blood levels and clinical outcome.

    PubMed

    Rigal, J G; Albin, H C; Duchier, A R; D'Aulnay, J M; Fenelon, J H; Vincon, G A; Demotes-Mainard, F M

    1987-08-01

    Fifty-one depressed inpatients, after 1 drug-free week, were treated for 5 weeks with imipramine 4 mg/kg day. Plasma levels of imipramine (IMI) and its active metabolite desmethylimipramine (DMI) were measured weekly, 15 hours after the last drug intake. Steady state blood levels (IMI + DMI) ranged from 60 to 585 ng/ml. The mean value for plasma concentration (IMI + DMI) at day 42 was 271 ng/ml. In the same way, therapeutic effectiveness was assessed every week using the Hamilton Rating Scale for Depression (HDRS). There was a significant correlation between plasma concentration and the decrease of Hamilton scores. The IMI/DMI ratio showed a responder-nonresponder difference; 86% patients with a ratio between 0.4 and 1 were responders. Conversely, most patients with a ratio below 0.4 or above 1 were nonresponders. The ideal ratio for clinical response would be 0.68. The ratio is a subject-specific feature, able to be an early predictor of clinical outcome.

  8. Suicide attempts in schizophrenic patients: clinical variables.

    PubMed

    Mauri, M C; Paletta, S; Maffini, M; Moliterno, D; Altamura, A C

    2013-10-01

    Schizophrenia is associated with a significant risk of suicide: 40-50% of schizophrenic patients report suicidal ideation at some point in their lives, and 4-13% eventually commit suicide. In order to be able to predict and prevent suicide in schizophrenic patients, it is necessary to investigate and characterise suicide victims who meet the criteria for psychotic disorders and risk factors. The aim of this retrospective study was to verify the associations between suicide attempts (SAs) and the demographic and clinical variables of 106 patients who met the DSM-IV-TR criteria for schizophrenia. The patients were divided into two groups on the basis of the presence/absence of lifetime suicide attempts, and their main demographic and clinical characteristics were analysed and compared. The patients with a history of SAs frequently had a duration of untreated psychosis (DUP) of ≥1 year (chi-squared test=9.984, df=1, p=0.0016). They also showed significant associations with the presence of a depressive dimension (chi-squared test=4.439, df=1, p=0.0351), hospitalisations before SAs (chi-squared test=25.515, df=1, p <0.001), and a family history of psychiatric disorders (chi-squared test=12.668, df=2, p=0.0018) or suicidal behaviours (chi-squared test=18.241, df=2, p=0.0001). Finally, they were more frequently prescribed typical antipsychotic agents. The severity of psychiatric symptoms indicates a high risk of suicide in schizophrenic patients. Further prospective studies of larger samples should investigate the role of early interventions and atypical antipsychotic treatment in reducing the risk. Copyright © 2013 Elsevier B.V. All rights reserved.

  9. [Clinical use of haematopoietic stem cells from cord blood].

    PubMed

    Lyngstadaas, Anita; Husebekk, Anne; Funderud, Steinar; Brinch, Lorentz

    2004-11-18

    A group of experts appointed by the Norwegian Centre for Health Technology Assessment (SMM) has undertaken a systematic review of available literature on the clinical effectiveness of transplanting haematopoietic stem cells from cord blood. A total of 17 studies form the documentary basis of the review. Autologous transplants of stem cells from cord blood have not been published. Retrospective studies suggest that the clinical effect of allogeneic cord blood transplants, at least in children, is comparable to transplants with allogeneic stem cells from bone marrow or peripheral blood cells. This review demonstrates the need for prospective studies comparing transplantations of cord blood with bone marrow or peripheral blood stem cells.

  10. Blood Pressure Measurement: Clinic, Home, Ambulatory, and Beyond

    PubMed Central

    Drawz, Paul E.; Abdalla, Mohamed; Rahman, Mahboob

    2014-01-01

    Blood pressure has traditionally been measured in the clinic setting using the auscultory method and a mercury sphygmomanometer. Technological advances have led to improvements in measuring clinic blood pressure and allowed for measuring blood pressures outside the clinic. This review outlines various methods for evaluating blood pressure and the clinical utility of each type of measurement. Home blood pressures and 24 hour ambulatory blood pressures have improved our ability to evaluate risk for target organ damage and hypertension related morbidity and mortality. Measuring home blood pressures may lead to more active participation in health care by patients and has the potential to improve blood pressure control. Ambulatory blood pressure monitoring enables the measuring nighttime blood pressures and diurnal changes, which may be the most accurate predictors of risk associated with elevated blood pressure. Additionally, reducing nighttime blood pressure is feasible and may be an important component of effective antihypertensive therapy. Finally, estimating central aortic pressures and pulse wave velocity are two of the newer methods for assessing blood pressure and hypertension related target organ damage. PMID:22521624

  11. The relationships between visit-to-visit blood pressure variability and renal and endothelial function in chronic kidney disease.

    PubMed

    Nakano, Chikara; Morimoto, Satoshi; Nakahigashi, Mitsutaka; Kusabe, Makiko; Ueda, Hiroko; Someya, Kazunori; Ichihara, Atsuhiro; Iwasaka, Toshiji; Shiojima, Ichiro

    2015-03-01

    Visit-to-visit blood pressure variability has been shown to be an independent risk factor for cardiovascular diseases. High visit-to-visit blood pressure variability and endothelial dysfunction are observed in patients with chronic kidney disease. It is therefore assumed that high variability in visit-to-visit blood pressure measurements may be associated with endothelial dysfunction in these patients. The present study investigated the associations between visit-to-visit blood pressure variability and renal and endothelial function in patients with chronic kidney disease. We analyzed 150 consecutive patients with predialysis chronic kidney disease who visited our outpatient clinic from January 2006 to December 2010. The study examined the relationships between variability in visit-to-visit systolic blood pressure levels or mean systolic blood pressure (M SBP) and estimated glomerular filtration rate (eGFR) and flow-mediated dilation, an index of endothelial function. Variability in visit-to-visit systolic blood pressure showed a significant negative association with eGFR, independent of age, hemoglobin A1c, low-density lipoprotein (LDL) cholesterol and uric acid, whereas M SBP did not. Similarly, variability in SBP showed a significant negative association with flow-mediated dilation, independent of age, eGFR, HbA1c, LDL cholesterol and M SBP. These data indicate that variability in visit-to-visit blood pressure measurements is associated with impaired renal and endothelial function in patients with chronic kidney disease. This finding suggests that reducing blood pressure fluctuations might have beneficial effects in patients with chronic kidney disease, although this point needs to be addressed by future studies.

  12. Ambulatory blood pressure monitoring in spinal cord injury: clinical practicability.

    PubMed

    Hubli, Michèle; Krassioukov, Andrei V

    2014-05-01

    Trauma to the spinal cord often results not only in sensorimotor but also autonomic impairments. The loss of autonomic control over the cardiovascular system can cause profound blood pressure (BP) derangements in subjects with spinal cord injury (SCI) and may therefore lead to increased cardiovascular disease (CVD) risk in this population. The use of ambulatory blood pressure monitoring (ABPM) allows insights into circadian BP profiles, which have been shown to be of good prognostic value for cardiovascular morbidity and mortality in able-bodied subjects. Past studies in SCI subjects using ABPM have shown that alterations in circadian BP patterns are dependent on the spinal lesion level. Tetraplegic subjects with sensorimotor complete lesions have a decreased daytime arterial BP, loss of the physiological nocturnal BP dip, and higher circadian BP variability, including potentially life-threatening hypertensive episodes known as autonomic dysreflexia (AD), compared with paraplegic and able-bodied subjects. The proposed underlying mechanisms of these adverse BP alterations mainly are attributed to a lost or decreased central drive to sympathetic spinal preganglionic neurons controlling the heart and blood vessels. In addition, several maladaptive anatomical changes within the spinal cord and the periphery, as well as the general decrease of physical daily activity in SCI subjects, account for adverse BP changes. ABPM enables the identification of adverse BP profiles and the associated increased risk for CVD in SCI subjects. Concurrently, it also might provide a useful clinical tool to monitor improvements of AD and lost nocturnal dip after appropriate treatments in the SCI population.

  13. Alternative Blood Products and Clinical Needs in Transfusion Medicine

    PubMed Central

    Whitsett, Carolyn; Vaglio, Stefania; Grazzini, Giuliano

    2012-01-01

    The primary focus of national blood programs is the provision of a safe and adequate blood supply. This goal is dependent on regular voluntary donations and a regulatory infrastructure that establishes and enforces standards for blood safety. Progress in ex vivo expansion of blood cells from cell sources including peripheral blood, cord blood, induced pluripotent stem cells, and human embryonic stem cell lines will likely make alternative transfusion products available for clinical use in the near future. Initially, alloimmunized patients and individuals with rare blood types are most likely to benefit from alternative products. However, in developed nations voluntary blood donations are projected to be inadequate in the future as blood usage by individuals 60 years and older increases. In developing nations economic and political challenges may impede progress in attaining self-sufficiency. Under these circumstances, ex vivo generated red cells may be needed to supplement the general blood supply. PMID:22567025

  14. High-resolution ultrasound imaging and noninvasive optoacoustic monitoring of blood variables in peripheral blood vessels

    NASA Astrophysics Data System (ADS)

    Petrov, Irene Y.; Petrov, Yuriy; Prough, Donald S.; Esenaliev, Rinat O.

    2011-03-01

    Ultrasound imaging is being widely used in clinics to obtain diagnostic information non-invasively and in real time. A high-resolution ultrasound imaging platform, Vevo (VisualSonics, Inc.) provides in vivo, real-time images with exceptional resolution (up to 30 microns) using high-frequency transducers (up to 80 MHz). Recently, we built optoacoustic systems for probing radial artery and peripheral veins that can be used for noninvasive monitoring of total hemoglobin concentration, oxyhemoglobin saturation, and concentration of important endogenous and exogenous chromophores (such as ICG). In this work we used the high-resolution ultrasound imaging system Vevo 770 for visualization of the radial artery and peripheral veins and acquired corresponding optoacoustic signals from them using the optoacoustic systems. Analysis of the optoacoustic data with a specially developed algorithm allowed for measurement of blood oxygenation in the blood vessels as well as for continuous, real-time monitoring of arterial and venous blood oxygenation. Our results indicate that: 1) the optoacoustic technique (unlike pure optical approaches and other noninvasive techniques) is capable of accurate peripheral venous oxygenation measurement; and 2) peripheral venous oxygenation is dependent on skin temperature and local hemodynamics. Moreover, we performed for the first time (to the best of our knowledge) a comparative study of optoacoustic arterial oximetry and a standard pulse oximeter in humans and demonstrated superior performance of the optoacoustic arterial oximeter, in particular at low blood flow.

  15. Measurement-to-measurement blood pressure variability is related to cognitive performance: the Maine Syracuse study.

    PubMed

    Crichton, Georgina E; Elias, Merrill F; Dore, Gregory A; Torres, Rachael V; Robbins, Michael A

    2014-11-01

    The objective was to investigate the association between variability in blood pressure (BP) and cognitive function for sitting, standing, and reclining BP values and variability derived from all 15 measures. In previous studies, only sitting BP values have been examined, and only a few cognitive measures have been used. A secondary objective was to examine associations between BP variability and cognitive performance in hypertensive individuals stratified by treatment success. Cross-sectional analyses were performed on 972 participants of the Maine Syracuse Study for whom 15 serial BP clinic measures (5 sitting, 5 recumbent, and 5 standing) were obtained before testing of cognitive performance. Using all 15 measures, higher variability in systolic and diastolic BP was associated with poorer performance on multiple measures of cognitive performance, independent of demographic factors, cardiovascular risk factors, and pulse pressure. When sitting, reclining, and standing systolic BP values were compared, only variability in standing BP was related to measures of cognitive performance. However, for diastolic BP, variability in all 3 positions was related to cognitive performance. Mean BP values were weaker predictors of cognition. Furthermore, higher overall variability in both systolic and diastolic BP was associated with poorer cognitive performance in unsuccessfully treated hypertensive individuals (with BP ≥140/90 mm Hg), but these associations were not evident in those with controlled hypertension.

  16. Study on Yang-Xu Using Body Constitution Questionnaire and Blood Variables in Healthy Volunteers

    PubMed Central

    Chen, Hong-Jhang; Lin, Yii-Jeng; Wu, Pei-Chen; Hsu, Wei-Hsiang; Hu, Wan-Chung; Wu, Trong-Neng; Chen, Fang-Pey; Lin, Yun-Lian

    2016-01-01

    Traditional Chinese medicine (TCM) formulates treatment according to body constitution (BC) differentiation. Different constitutions have specific metabolic characteristics and different susceptibility to certain diseases. This study aimed to assess the Yang-Xu constitution using a body constitution questionnaire (BCQ) and clinical blood variables. A BCQ was employed to assess the clinical manifestation of Yang-Xu. The logistic regression model was conducted to explore the relationship between BC scores and biomarkers. Leave-one-out cross-validation (LOOCV) and K-fold cross-validation were performed to evaluate the accuracy of a predictive model in practice. Decision trees (DTs) were conducted to determine the possible relationships between blood biomarkers and BC scores. According to the BCQ analysis, 49% participants without any BC were classified as healthy subjects. Among them, 130 samples were selected for further analysis and divided into two groups. One group comprised healthy subjects without any BC (68%), while subjects of the other group, named as the sub-healthy group, had three BCs (32%). Six biomarkers, CRE, TSH, HB, MONO, RBC, and LH, were found to have the greatest impact on BCQ outcomes in Yang-Xu subjects. This study indicated significant biochemical differences in Yang-Xu subjects, which may provide a connection between blood variables and the Yang-Xu BC. PMID:27340421

  17. Determination of Correlation Among Heart Rate Variability, Left Atrium Global Strain, and Nighttime Blood Pressure Among Patients with Tinnitus

    PubMed Central

    Değirmenci, Hüsnü; Bakırcı, Eftal Murat; Salcan, İsmail; Demirelli, Selami; Duman, Hakan; Ceyhun, Gökhan; Küçüksu, Zafer

    2014-01-01

    Background We aimed to examine the correlation among nighttime blood pressure, heart rate variability, and left atrium peak systolic global longitudinal strain among patients with subjective tinnitus. Material/Methods Eighty patients with tinnitus were assigned to Group 1 and 80 healthy individuals were assigned to Group 2. Clinical blood pressure measurements, ambulatory blood pressure monitoring, and Holter electrocardiography monitoring were performed. All of the cases included in the study were examined with conventional echocardiography and 2-dimensional speckle tracking echocardiography. Results Mean nighttime systolic blood pressure (130.3±5.4) and mean nighttime diastolic blood pressure (82.8±3.9) in Group 1 were higher than in Group 2 (125.1±5.4 and 80.7±4.7, respectively) (p<0.05). Mean heart rate in Group 1 was significantly lower than in Group 2 but there was no statistically significant difference between the groups in terms of heart rate variability parameters and left atrium peak systolic global longitudinal strain values (p>0.05). Conclusions Nighttime systolic blood pressure and nighttime diastolic blood pressure were higher among the patients with tinnitus. In light of these results, we can conclude that both clinical blood pressure measurement and ambulatory blood pressure monitoring are important for patients with tinnitus. PMID:25249354

  18. Determination of correlation among heart rate variability, left atrium global strain, and nighttime blood pressure among patients with tinnitus.

    PubMed

    Değirmenci, Hüsnü; Bakırcı, Eftal Murat; Salcan, İsmail; Demirelli, Selami; Duman, Hakan; Ceyhun, Gökhan; Küçüksu, Zafer

    2014-09-24

    We aimed to examine the correlation among nighttime blood pressure, heart rate variability, and left atrium peak systolic global longitudinal strain among patients with subjective tinnitus. Eighty patients with tinnitus were assigned to Group 1 and 80 healthy individuals were assigned to Group 2. Clinical blood pressure measurements, ambulatory blood pressure monitoring, and Holter electrocardiography monitoring were performed. All of the cases included in the study were examined with conventional echocardiography and 2-dimensional speckle tracking echocardiography. Mean nighttime systolic blood pressure (130.3±5.4) and mean nighttime diastolic blood pressure (82.8±3.9) in Group 1 were higher than in Group 2 (125.1±5.4 and 80.7±4.7, respectively) (p<0.05). Mean heart rate in Group 1 was significantly lower than in Group 2 but there was no statistically significant difference between the groups in terms of heart rate variability parameters and left atrium peak systolic global longitudinal strain values (p>0.05). Nighttime systolic blood pressure and nighttime diastolic blood pressure were higher among the patients with tinnitus. In light of these results, we can conclude that both clinical blood pressure measurement and ambulatory blood pressure monitoring are important for patients with tinnitus.

  19. Genetic and environmental influences on blood pressure variability: a study in twins.

    PubMed

    Xu, Xiaojing; Ding, Xiuhua; Zhang, Xinyan; Su, Shaoyong; Treiber, Frank A; Vlietinck, Robert; Fagard, Robert; Derom, Catherine; Gielen, Marij; Loos, Ruth J F; Snieder, Harold; Wang, Xiaoling

    2013-04-01

    Blood pressure variability (BPV) and its reduction in response to antihypertensive treatment are predictors of clinical outcomes; however, little is known about its heritability. In this study, we examined the relative influence of genetic and environmental sources of variance of BPV and the extent to which it may depend on race or sex in young twins. Twins were enrolled from two studies. One study included 703 white twins (308 pairs and 87 singletons) aged 18-34 years, whereas another study included 242 white twins (108 pairs and 26 singletons) and 188 black twins (79 pairs and 30 singletons) aged 12-30 years. BPV was calculated from 24-h ambulatory blood pressure recording. Twin modeling showed similar results in the separate analysis in both twin studies and in the meta-analysis. Familial aggregation was identified for SBP variability (SBPV) and DBP variability (DBPV) with genetic factors and common environmental factors together accounting for 18-40% and 23-31% of the total variance of SBPV and DBPV, respectively. Unique environmental factors were the largest contributor explaining up to 82-77% of the total variance of SBPV and DBPV. No sex or race difference in BPV variance components was observed. The results remained the same after adjustment for 24-h blood pressure levels. The variance in BPV is predominantly determined by unique environment in youth and young adults, although familial aggregation due to additive genetic and/or common environment influences was also identified explaining about 25% of the variance in BPV.

  20. Clinical value of ambulatory blood pressure: Is it time to recommend for all patients with hypertension?

    PubMed

    Solak, Yalcin; Kario, Kazuomi; Covic, Adrian; Bertelsen, Nathan; Afsar, Baris; Ozkok, Abdullah; Wiecek, Andrzej; Kanbay, Mehmet

    2016-02-01

    Hypertension is a very common disease, and office measurements of blood pressure are frequently inaccurate. Ambulatory Blood Pressure Monitoring (ABPM) offers a more accurate diagnosis, more detailed readings of average blood pressures, better blood pressure measurement during sleep, fewer false positives by detecting more white-coat hypertension, and fewer false negatives by detecting more masked hypertension. ABPM offers better management of clinical outcomes. For example, based on more accurate measurements of blood pressure variability, ABPM demonstrates that taking antihypertensive medication at night leads to better controlled nocturnal blood pressure, which translates into less end organ damage and fewer clinical complications of hypertension. For these reasons, albeit some shortcomings which were discussed, ABPM should be considered as a first-line tool for diagnosing and managing hypertension.

  1. Ambulatory Blood Pressure Monitoring in Clinical Practice: A Review

    PubMed Central

    Viera, Anthony J.; Shimbo, Daichi

    2016-01-01

    Ambulatory blood pressure monitoring offers the ability to collect blood pressure readings several times an hour across a 24-hour period. Ambulatory blood pressure monitoring facilitates the identification of white-coat hypertension, the phenomenon whereby certain individuals who are not on antihypertensive medication show elevated blood pressure in a clinical setting but show non-elevated blood pressure averages when assessed by ambulatory blood pressure monitoring. Additionally, readings can be segmented into time windows of particular interest, e.g., mean daytime and nighttime values. During sleep, blood pressure typically decreases, or dips, such that mean sleep blood pressure is lower than mean awake blood pressure. A non-dipping pattern and nocturnal hypertension are strongly associated with increased cardiovascular morbidity and mortality. Approximately 70% of individuals dip ≥10% at night, while 30% have non-dipping patterns, when blood pressure remains similar to daytime average, or occasionally rises above daytime average. The various blood pressure categorizations afforded by ambulatory blood pressure monitoring are valuable for clinical management of high blood pressure since they increase accuracy for diagnosis and the prediction of cardiovascular risk. PMID:25107387

  2. [Predictors of mean blood glucose control and its variability in diabetic hospitalized patients].

    PubMed

    Sáenz-Abad, Daniel; Gimeno-Orna, José Antonio; Sierra-Bergua, Beatriz; Pérez-Calvo, Juan Ignacio

    2015-01-01

    This study was intended to assess the effectiveness and predictors factors of inpatient blood glucose control in diabetic patients admitted to medical departments. A retrospective, analytical cohort study was conducted on patients discharged from internal medicine with a diagnosis related to diabetes. Variables collected included demographic characteristics, clinical data and laboratory parameters related to blood glucose control (HbA1c, basal plasma glucose, point-of-care capillary glucose). The cumulative probability of receiving scheduled insulin regimens was evaluated using Kaplan-Meier analysis. Multivariate regression models were used to select predictors of mean inpatient glucose (MHG) and glucose variability (standard deviation [GV]). The study sample consisted of 228 patients (mean age 78.4 (SD 10.1) years, 51% women). Of these, 96 patients (42.1%) were treated with sliding-scale regular insulin only. Median time to start of scheduled insulin therapy was 4 (95% CI, 2-6) days. Blood glucose control measures were: MIG 181.4 (SD 41.7) mg/dL, GV 56.3 (SD 22.6). The best model to predict MIG (R(2): .376; P<.0001) included HbA1c (b=4.96; P=.011), baseline plasma glucose (b=.056; P=.084), mean capillary blood glucose in the first 24hours (b=.154; P<.0001), home treatment (versus oral agents) with basal insulin only (b=13.1; P=.016) or more complex (pre-mixed insulin or basal-bolus) regimens (b=19.1; P=.004), corticoid therapy (b=14.9; P=.002), and fasting on admission (b=10.4; P=.098). Predictors of inpatient blood glucose control which should be considered in the design of DM management protocols include home treatment, HbA1c, basal plasma glucose, mean blood glucose in the first 24hours, fasting, and corticoid therapy. Copyright © 2014 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  3. Increased Blood Pressure Variability Is Associated with Worse Neurologic Outcome in Acute Anterior Circulation Ischemic Stroke

    PubMed Central

    Bennett, Alicia; Stoddard, Gregory J.; Smith, Gordon; Wang, Haimei; Wold, Jana; Chung, Lee; Tirschwell, David L.; Majersik, Jennifer J.

    2016-01-01

    Background. Although research suggests that blood pressure variability (BPV) is detrimental in the weeks to months after acute ischemic stroke, it has not been adequately studied in the acute setting. Methods. We reviewed acute ischemic stroke patients from 2007 to 2014 with anterior circulation stroke. Mean blood pressure and three BPV indices (standard deviation, coefficient of variation, and successive variation) for the intervals 0–24, 0–72, and 0–120 hours after admission were correlated with follow-up modified Rankin Scale (mRS) in ordinal logistic regression models. The correlation between BPV and mRS was further analyzed by terciles of clinically informative stratifications. Results. Two hundred and fifteen patients met inclusion criteria. At all time intervals, increased systolic BPV was associated with higher mRS, but the relationship was not significant for diastolic BPV or mean blood pressure. This association was strongest in patients with proximal stroke parent artery vessel occlusion and lower mean blood pressure. Conclusion. Increased early systolic BPV is associated with worse neurologic outcome after ischemic stroke. This association is strongest in patients with lower mean blood pressure and proximal vessel occlusion, often despite endovascular or thrombolytic therapy. This hypothesis-generating dataset suggests potential benefit for interventions aimed at reducing BPV in this patient population. PMID:27974991

  4. Measurement of peripheral B cell subpopulations in common variable immunodeficiency (CVID) using a whole blood method.

    PubMed

    Ferry, B L; Jones, J; Bateman, E A; Woodham, N; Warnatz, K; Schlesier, M; Misbah, S A; Peter, H H; Chapel, H M

    2005-06-01

    Recent reports have described reduced populations of CD27+ memory B cells and increased percentages of undifferentiated B cells in peripheral blood of patients with common variable immunodeficiency (CVID). This work has prompted two attempts to classify CVID based on rapid flow cytometric quantification of peripheral blood memory B cells and immature B cells. Evidence to support the hypothesis that such in vitro B cell classification systems correlate with clinical subtypes of CVID is being sought. For the classification to be useful in routine diagnosis, it is important that the flow cytometric method can be used without prior separation of peripheral blood mononuclear cells (PBMC). We have examined 23 CVID patients and 24 controls, using both PBMC and whole blood, and find an excellent correlation between these methods. The reproducibility of the method was excellent. We classified the CVID patients by all three of the existing classifications, including secretion of immunoglobulin by B cells in vitro as described by Bryant, as well as the more recent flow cytometric classification methods. Only one patient changed classification as a result of using whole blood.

  5. Measurement of peripheral B cell subpopulations in common variable immunodeficiency (CVID) using a whole blood method

    PubMed Central

    Ferry, B L; Jones, J; Bateman, E A; Woodham, N; Warnatz, K; Schlesier, M; Misbah, S A; Peter, H H; Chapel, H M

    2005-01-01

    Recent reports have described reduced populations of CD27+ memory B cells and increased percentages of undifferentiated B cells in peripheral blood of patients with common variable immunodeficiency (CVID). This work has prompted two attempts to classify CVID based on rapid flow cytometric quantification of peripheral blood memory B cells and immature B cells. Evidence to support the hypothesis that such in vitro B cell classification systems correlate with clinical subtypes of CVID is being sought. For the classification to be useful in routine diagnosis, it is important that the flow cytometric method can be used without prior separation of peripheral blood mononuclear cells (PBMC). We have examined 23 CVID patients and 24 controls, using both PBMC and whole blood, and find an excellent correlation between these methods. The reproducibility of the method was excellent. We classified the CVID patients by all three of the existing classifications, including secretion of immunoglobulin by B cells in vitro as described by Bryant, as well as the more recent flow cytometric classification methods. Only one patient changed classification as a result of using whole blood. PMID:15932516

  6. Evaluation of heart rate variability and night-time blood pressure measurements in patients with idiopathic sudden sensorineural hearing loss.

    PubMed

    Demirelli, S; Degirmenci, H; Fırtına, S; Salcan, I; Ermis, E; Duman, H; Ipek, E; Hamur, H; Ceyhun, G

    2016-01-01

    The aim of this study is to investigate the role of the autonomic nervous system in the etiology of idiopathic sudden sensorineural hearing loss (ISSHL) by measuring heart rate variability (HRV) and night-time blood pressure levels. A total of 58 patients, 31 ISSHL patients (group 1) and 27 healthy volunteers (control group; group 2), were included in this study. Clinical and ambulatory blood pressure measurements and Holter electrocardiography were performed in both groups. After these evaluations, HRV parameters and night-time blood pressure values were determined. Mean systolic blood pressure (SBP) and mean diastolic blood pressure (DBP) measured at night-time were higher in group 1 compared to group 2 (p < 0.05). Heart rate variability parameters were lower in group 1 than in group 2. In patients with ISSHL, elevated blood pressure at night-time and reduced heart rate variability suggest that autonomic nervous system dysfunction might play a role in the etiopathogenesis of the disease. The measurements of ambulatory blood pressure and heart rate variability can reveal more enlightening data in the determination of the etiology of ISSHL and guiding the treatment.

  7. Estimating blood loss after birth: using simulated clinical examples.

    PubMed

    Buckland, Sara S; Homer, Caroline S E

    2007-06-01

    To determine the accuracy of the estimation of blood loss using simulated clinical examples. Over 100 attendees came together at a seminar about postpartum haemorrhage in June 2006. Five blood loss assessment stations were constructed, each containing a simulated clinical example. Each station was numbered and was made up of a variety of equipment used in birthing suites. Over 5L of 'artificial' blood was made. The artificial blood was similar to the colour and consistency of real blood. A convenience sample of 88 participants was given a response sheet and asked to estimate blood loss at each station. Participants included midwives, student midwives and an obstetrician. Blood in a container (bedpan, kidney dish) was more accurately estimated than blood on sanitary pads, sheets or clothing. Lower volumes of blood were also estimated correctly by more participants than the higher volumes. Improvements are still needed in visual estimation of blood loss following childbirth. Education programs may increase the level of accuracy. We encourage other clinicians and educators to embark upon a similar exercise to assist midwives and others to improve their visual estimation of blood loss after birth. Accurate estimations can ensure that women who experience significant blood loss can receive appropriate care and the published rates of postpartum haemorrhage are correct.

  8. Private cord blood banking: current use and clinical future.

    PubMed

    Hollands, Peter; McCauley, Catherina

    2009-09-01

    International private umbilical cord blood banking has expanded rapidly in recent years since the first cord blood transplant which was 20 years ago. Private companies offer parents the opportunity to store umbilical cord blood for the possible future use by their child or other family members. The private cord blood industry has been criticised by a number of professional bodies including the EU Ethics Committee, the Royal College of Obstetrics and Gynaecology, the Royal College of Midwives and the US College of Paediatrics. This review presents the arguments from the opponents of private cord blood banking, and then makes the case for private cord banking based on the latest scientific and clinical evidence.

  9. Healthy Lifestyle and Blood Pressure Variability in Young Adults.

    PubMed

    Maseli, Anna; Aeschbacher, Stefanie; Schoen, Tobias; Fischer, Andreas; Jung, Manuel; Risch, Martin; Risch, Lorenz; Conen, David

    2017-07-01

    The aim of this study was to assess the relationships between healthy lifestyle metrics and blood pressure variability (BPV) in young and healthy adults. A population-based sample of 1,999 individuals aged 25-41 years was investigated. A lifestyle-score from 0 (most unhealthy) to 7 (most healthy) was calculated by giving one point for each of the following components: never smoking cigarettes, adhering to a healthy diet, performing moderate or intense physical activity, having a body mass index <25 kg/m2, a total cholesterol <200 mg/dl, a glycated hemoglobin <5.7%, or a conventional BP <120/80 mm Hg. Standardized ambulatory 24-hour BP measurements were obtained in all individuals. BPV was defined as the SD of all individual ambulatory BP recordings. We constructed multivariable linear regression models to assess the relationships between the lifestyle-score and BPV. None of the results were adjusted for multiple testing. Median age was 37 years and 46.8% were men. With increasing lifestyle-score, systolic and diastolic BPV is decreasing linearly (P for trend <0.0001), even after multivariable adjustment. Per 1-point increase in lifestyle-score, the β-coefficient (95% confidence interval) for systolic and diastolic 24-hour BPV was -0.03 (-0.03; -0.02) and -0.04 (-0.05; -0.03), respectively, both P for trend <0.0001. These relationships were attenuated but remained statistically significant after additional adjustment for mean individual BP. In this study of young and healthy adults, adopting a healthy lifestyle was associated with a lower BPV. These associations were independent of mean BP levels.

  10. The impact of early hypoglycemia and blood glucose variability on outcome in critical illness

    PubMed Central

    Bagshaw, Sean M; Bellomo, Rinaldo; Jacka, Michael J; Egi, Moritoki; Hart, Graeme K; George, Carol

    2009-01-01

    Introduction In critical illness, the association of hypoglycemia, blood glucose (BG) variability and outcome are not well understood. We describe the incidence, clinical factors and outcomes associated with an early hypoglycemia and BG variability in critically ill patients. Methods Retrospective interrogation of prospectively collected data from the Australia New Zealand Intensive Care Society Adult Patient Database on 66184 adult admissions to 24 intensive care units (ICUs) from 1 January 2000 to 31 December 2005. Primary exposure was hypoglycemia (BG < 4.5 mmol/L) and BG variability (BG < 4.5 and ≥ 12.0 mmol/L) within 24 hours of admission. Primary outcome was all-cause mortality. Results The cumulative incidence of hypoglycemia and BG variability were 13.8% (95% confidence interval (CI) = 13.5 to 14.0; n = 9122) and 2.9% (95%CI = 2.8 to 3.0, n = 1913), respectively. Several clinical factors were associated with both hypoglycemia and BG variability including: co-morbid disease (P < 0.001), non-elective admissions (P < 0.001), higher illness severity (P < 0.001), and primary septic diagnosis (P < 0.001). Hypoglycemia was associated with greater odds of adjusted ICU (odds ratio (OR) = 1.41, 95% CI = 1.31 to 1.54) and hospital death (OR = 1.36, 95% CI = 1.27 to 1.46). Hypoglycemia severity was associated with 'dose-response' increases in mortality. BG variability was associated with greater odds of adjusted ICU (1.5, 95% CI = 1.4 to 1.6) and hospital (1.4, 95% CI = 1.3 to 1.5) mortality, when compared with either hypoglycemia only or neither. Conclusions In critically ill patients, both early hypoglycemia and early variability in BG are relatively common, and independently portend an increased risk for mortality. PMID:19534781

  11. ICU Blood Pressure Variability May Predict Nadir of Respiratory Depression After Coronary Artery Bypass Surgery

    PubMed Central

    Costa, Anne S. M.; Costa, Paulo H. M.; de Lima, Carlos E. B.; Pádua, Luiz E. M.; Campos, Luciana A.; Baltatu, Ovidiu C.

    2016-01-01

    Objectives: Surgical stress induces alterations on sympathovagal balance that can be determined through assessment of blood pressure variability. Coronary artery bypass graft surgery (CABG) is associated with postoperative respiratory depression. In this study we aimed at investigating ICU blood pressure variability and other perioperative parameters that could predict the nadir of postoperative respiratory function impairment. Methods: This prospective observational study evaluated 44 coronary artery disease patients subjected to coronary artery bypass surgery (CABG) with cardiopulmonary bypass (CPB). At the ICU, mean arterial pressure (MAP) was monitored every 30 min for 3 days. MAP variability was evaluated through: standard deviation (SD), coefficient of variation (CV), variation independent of mean (VIM), and average successive variability (ASV). Respiratory function was assessed through maximal inspiratory (MIP) and expiratory (MEP) pressures and peak expiratory flow (PEF) determined 1 day before surgery and on the postoperative days 3rd to 7th. Intraoperative parameters (volume of cardioplegia, CPB duration, aortic cross-clamp time, number of grafts) were also monitored. Results: Since, we aimed at studying patients without confounding effects of postoperative complications on respiratory function, we had enrolled a cohort of low risk EuroSCORE (European System for Cardiac Operative Risk Evaluation) with < 2. Respiratory parameters MIP, MEP, and PEF were significantly depressed for 4–5 days postoperatively. Of all MAP variability parameters, the ASV had a significant good positive Spearman correlation (rho coefficients ranging from 0.45 to 0.65, p < 0.01) with the 3-day nadir of PEF after cardiac surgery. Also, CV and VIM of MAP were significantly associated with nadir days of MEP and PEF. None of the intraoperative parameters had any correlation with the postoperative respiratory depression. Conclusions: Variability parameters ASV, CV, and VIM of the MAP

  12. Blood pressure (BP) assessment-from BP level to BP variability.

    PubMed

    Feber, Janusz; Litwin, Mieczyslaw

    2016-07-01

    The assessment of blood pressure (BP) can be challenging in children, especially in very young individuals, due to their variable body size and lack of cooperation. In the absence of data relating BP with cardiovascular outcomes in children, there is a need to convert absolute BP values (in mmHg) into age-, gender- and height appropriate BP percentiles or Z-scores in order to compare a patient's BP with the BP of healthy children of the same age, but also of children of different ages. Traditionally, the interpretation of BP has been based mainly on the assessment of the BP level obtained by office, home or 24-h BP monitoring. Recent studies suggest that it is not only BP level (i.e. average BP) but also BP variability that is clinically important for the development of target organ damage, including the progression of chronic kidney disease. In this review we describe current methods to evaluate of BP level, outline available methods for BP variability assessment and discuss the clinical consequences of BP variability, including its potential role in the management of hypertension.

  13. [Blood sampling using "dried blood spot": a clinical biology revolution underway?].

    PubMed

    Hirtz, Christophe; Lehmann, Sylvain

    2015-01-01

    Blood testing using the dried blood spot (DBS) is used since the 1960s in clinical analysis, mainly within the framework of the neonatal screening (Guthrie test). Since then numerous analytes such as nucleic acids, small molecules or lipids, were successfully measured on the DBS. While this pre-analytical method represents an interesting alternative to classic blood sampling, its use in routine is still limited. We review here the different clinical applications of the blood sampling on DBS and estimate its future place, supported by the new methods of analysis as the LC-MS mass spectrometry.

  14. Impact of menstruation on select hematology and clinical chemistry variables in cynomolgus macaques.

    PubMed

    Perigard, Christopher J; Parrula, M Cecilia M; Larkin, Matthew H; Gleason, Carol R

    2016-06-01

    In preclinical studies with cynomolgus macaques, it is common to have one or more females presenting with menses. Published literature indicates that the blood lost during menses causes decreases in red blood cell mass variables (RBC, HGB, and HCT), which would be a confounding factor in the interpretation of drug-related effects on clinical pathology data, but no scientific data have been published to support this claim. This investigation was conducted to determine if the amount of blood lost during menses in cynomolgus macaques has an effect on routine hematology and serum chemistry variables. Ten female cynomolgus macaques (Macaca fascicularis), 5 to 6.5 years old, were observed daily during approximately 3 months (97 days) for the presence of menses. Hematology and serum chemistry variables were evaluated twice weekly. The results indicated that menstruation affects the erythrogram including RBC, HGB, HCT, MCHC, MCV, reticulocyte count, RDW, the leukogram including neutrophil, lymphocyte, and monocyte counts, and chemistry variables, including GGT activity, and the concentrations of total proteins, albumin, globulins, and calcium. The magnitude of the effect of menstruation on susceptible variables is dependent on the duration of the menstrual phase. Macaques with menstrual phases lasting ≥ 7 days are more likely to develop changes in variables related to chronic blood loss. In preclinical toxicology studies with cynomolgus macaques, interpretation of changes in several commonly evaluated hematology and serum chemistry variables requires adequate clinical observation and documentation concerning presence and duration of menses. There is a concern that macaques with long menstrual cycles can develop iron deficiency anemia due to chronic menstrual blood loss. © 2016 American Society for Veterinary Clinical Pathology.

  15. Ambulatory Blood Pressure Monitoring in Spinal Cord Injury: Clinical Practicability

    PubMed Central

    Hubli, Michèle

    2014-01-01

    Abstract Trauma to the spinal cord often results not only in sensorimotor but also autonomic impairments. The loss of autonomic control over the cardiovascular system can cause profound blood pressure (BP) derangements in subjects with spinal cord injury (SCI) and may therefore lead to increased cardiovascular disease (CVD) risk in this population. The use of ambulatory blood pressure monitoring (ABPM) allows insights into circadian BP profiles, which have been shown to be of good prognostic value for cardiovascular morbidity and mortality in able-bodied subjects. Past studies in SCI subjects using ABPM have shown that alterations in circadian BP patterns are dependent on the spinal lesion level. Tetraplegic subjects with sensorimotor complete lesions have a decreased daytime arterial BP, loss of the physiological nocturnal BP dip, and higher circadian BP variability, including potentially life-threatening hypertensive episodes known as autonomic dysreflexia (AD), compared with paraplegic and able-bodied subjects. The proposed underlying mechanisms of these adverse BP alterations mainly are attributed to a lost or decreased central drive to sympathetic spinal preganglionic neurons controlling the heart and blood vessels. In addition, several maladaptive anatomical changes within the spinal cord and the periphery, as well as the general decrease of physical daily activity in SCI subjects, account for adverse BP changes. ABPM enables the identification of adverse BP profiles and the associated increased risk for CVD in SCI subjects. Concurrently, it also might provide a useful clinical tool to monitor improvements of AD and lost nocturnal dip after appropriate treatments in the SCI population. PMID:24175653

  16. Clinical assessment of intraarterial blood gas monitor accuracy

    NASA Astrophysics Data System (ADS)

    Aziz, Salim; Spiess, R.; Roby, Paul; Kenny, Margaret

    1993-08-01

    The accuracy of intraarterial blood gas monitoring (IABGM) devices is challenging to assess under routine clinical conditions. When comparing discrete measurements by blood gas analyzer (BGA) to IABGM values, it is important that the BGA determinations (reference method) be as accurate as possible. In vitro decay of gas tensions caused by delay in BGA analysis is particularly problematic for specimens with high arterial oxygen tension (PaO2) values. Clinical instability of blood gases in the acutely ill patient may cause disagreement between BGA and IABGM values because of IABGM response time lag, particularly in the measurement of arterial blood carbon dioxide tension (PaCO2). We recommend that clinical assessments of IABGM accuracy by comparison with BGA use multiple bedside BGA instruments, and that blood sampling only occur during periods when IABGM values appear stable.

  17. Cerebral blood flow: Physiologic and clinical aspects

    SciTech Connect

    Wood, J.H.

    1987-01-01

    This book contains 46 chapters divided among nine sections. The section titles are: Historical Perspectives; Cerebrovascular Anatomy; Cerebrovascular Physiology; Methods of Clinical Measurement; Experimental Methods; Imaging of Cerebral Circulation; Cerebrovascular Pathophysiology; Cerebrovascular Pharmacology; and Surgical and Interventional Augmentation.

  18. Home Blood Pressure Variability as Cardiovascular Risk Factor in the Population of Ohasama

    PubMed Central

    Asayama, Kei; Kikuya, Masahiro; Schutte, Rudolph; Thijs, Lutgarde; Hosaka, Miki; Satoh, Michihiro; Hara, Azusa; Obara, Taku; Inoue, Ryusuke; Metoki, Hirohito; Hirose, Takuo; Ohkubo, Takayoshi; Staessen, Jan A.; Imai, Yutaka

    2013-01-01

    Blood pressure variability based on office measurement predicts outcome in selected patients. We explored whether novel indices of blood pressure variability derived from the self-measured home blood pressure predicted outcome in a general population. We monitored mortality and stroke in 2421 Ohasama residents (Iwate Prefecture, Japan). At enrollment (1988–1995), participants (mean age, 58.6 years; 60.9% women; 27.1% treated) measured their blood pressure at home, using an oscillometric device. In multivariable-adjusted Cox models, we assessed the independent predictive value of the within-subject mean systolic blood pressure (SBP) and corresponding variability as estimated by variability independent of the mean, difference between maximum and minimum blood pressure, and average real variability. Over 12.0 years (median), 412 participants died, 139 of cardiovascular causes, and 223 had a stroke. In models including morning SBP, variability independent of the mean and average real variability (median, 26 readings) predicted total and cardiovascular mortality in all of the participants (P≤0.044); variability independent of the mean predicted cardiovascular mortality in treated (P=0.014) but not in untreated (P=0.23) participants; and morning maximum and minimum blood pressure did not predict any end point (P≥0.085). In models already including evening SBP, only variability independent of the mean predicted cardiovascular mortality in all and in untreated participants (P≤0.046). The R2 statistics, a measure for the incremental risk explained by adding blood pressure variability to models already including SBP and covariables, ranged from <0.01% to 0.88%. In a general population, new indices of blood pressure variability derived from home blood pressure did not incrementally predict outcome over and beyond mean SBP. PMID:23172933

  19. Clinical aspects of blood pressure autorhythmometry

    NASA Technical Reports Server (NTRS)

    Levine, H.; Halberg, F.

    1974-01-01

    Self-measurements made by a 55-year-old physician with mild to moderate hypertension of ten years' duration are considered. The physician had been in excellent health until age 45 when sustained elevation of blood pressure up to 180/100 mmHg and a slight aortic diastolic murmur were noted. On the basis of the investigation it is suggested that physical and mental performance measures provide an objective basis for assessing the desirability of a given physiological change. Such studies will have to be complemented by a search for long-term effects.

  20. Clinical aspects of blood pressure autorhythmometry

    NASA Technical Reports Server (NTRS)

    Levine, H.; Halberg, F.

    1974-01-01

    Self-measurements made by a 55-year-old physician with mild to moderate hypertension of ten years' duration are considered. The physician had been in excellent health until age 45 when sustained elevation of blood pressure up to 180/100 mmHg and a slight aortic diastolic murmur were noted. On the basis of the investigation it is suggested that physical and mental performance measures provide an objective basis for assessing the desirability of a given physiological change. Such studies will have to be complemented by a search for long-term effects.

  1. Clinical variability in ataxia-telangiectasia.

    PubMed

    Lohmann, Ebba; Krüger, Stefanie; Hauser, Ann-Kathrin; Hanagasi, Hasmet; Guven, Gamze; Erginel-Unaltuna, Nihan; Biskup, Saskia; Gasser, Thomas

    2015-07-01

    Ataxia-telangiectasia (A-T) is an autosomal recessive inherited disease characterized by progressive childhood-onset cerebellar ataxia, oculomotor apraxia, choreoathetosis and telangiectasias of the conjunctivae. Further symptoms may be immunodeficiency and frequent infections, and an increased risk of malignancy. As well as this classic manifestation, several other non-classic forms exist, including milder or incomplete A-T phenotypes caused by homozygous or compound heterozygous mutations in the ATM gene. Recently, ATM mutations have been found in 13 Canadian Mennonites with early-onset, isolated, predominantly cervical dystonia, in a French family with generalized dystonia and in an Indian family with dopa-responsive cervical dystonia. In this article, we will describe a Turkish family with three affected sibs. Their phenotypes range from pure cervical dystonia associated with hand tremor to truncal and more generalized dystonic postures. Exome sequencing has revealed the potentially pathogenic compound heterozygous variants p.V2716A and p.G301VfsX19 in the ATM gene. The variants segregated perfectly with the phenotypes within the family. Both mutations detected in ATM have been shown to be pathogenic, and the α-fetoprotein, a marker of ataxia telangiectasia, was found to be increased. This report supports recent literature showing that ATM mutations are not exclusively associated with A-T but may also cause a more, even intra-familial variable phenotype in particular in association with dystonia.

  2. [Clinical variability of Juvenile Huntington's Disease phenotype].

    PubMed

    Błaszczyk, Magdalena; Boczarska-Jedynak, Magdalena; Rudzińska, Monika

    2015-01-01

    Huntington's disease is rare, genetically determinated, neurodegenerative disorder. It is determined by dynamic mutation of IT15 gene on short arm of 4 chromosome. Characteristic symptomatology include involuntary movements, cognitive decline and wide spectrum of mood and behaviour disorders. It typically becomes noticeable in mid-adult life, but there are reported cases of appaers of symptoms between 2 and 80 year of life. Especially interesting is juvenile Huntington's disease- the Westphal variant with the beginning in childchood (before 20 year of age) because of clinical differences causing diagnostic difficulties. It affects 5-10% of carries of the mutant gene. Symptoms became noticeable before 10 year of age only in 1% of them.

  3. Autoantibody formation in the alloimmunized red blood cell recipient: clinical and laboratory implications.

    PubMed

    Zumberg, M S; Procter, J L; Lottenberg, R; Kitchens, C S; Klein, H G

    2001-01-22

    Alloimmunization to erythrocyte antigens is a well-characterized complication in heavily transfused patients. Less well recognized, however, is the frequency of autoantibody formation in these previously alloimmunized patients. The autoantibodies are heterogeneous and of variable clinical significance. We describe the clinical history, laboratory evaluation, diagnosis, and treatment in 4 patients who developed autoantibodies in temporal association with alloantibody formation. In one case, the autoantibody found on routine screening had no clinical significance. In another case, the autoantibody made accurate blood typing and subsequent transfusion exceedingly difficult. Two patients experienced hemolysis as a consequence of the autoantibody. The management of both patients included supportive measures, while one patient required glucocorticosteroids and red blood cell transfusion. We review the published literature concerning autoimmunization in the transfused alloimmunized host. The spectrum of clinical consequences is important for the general practitioner to recognize, as these complications may occur during routine blood transfusions.

  4. Interferences from blood collection tube components on clinical chemistry assays.

    PubMed

    Bowen, Raffick A R; Remaley, Alan T

    2014-01-01

    Improper design or use of blood collection devices can adversely affect the accuracy of laboratory test results. Vascular access devices, such as catheters and needles, exert shear forces during blood flow, which creates a predisposition to cell lysis. Components from blood collection tubes, such as stoppers, lubricants, surfactants, and separator gels, can leach into specimens and/or adsorb analytes from a specimen; special tube additives may also alter analyte stability. Because of these interactions with blood specimens, blood collection devices are a potential source of pre-analytical error in laboratory testing. Accurate laboratory testing requires an understanding of the complex interactions between collection devices and blood specimens. Manufacturers, vendors, and clinical laboratorians must consider the pre-analytical challenges in laboratory testing. Although other authors have described the effects of endogenous substances on clinical assay results, the effects/impact of blood collection tube additives and components have not been well systematically described or explained. This review aims to identify and describe blood collection tube additives and their components and the strategies used to minimize their effects on clinical chemistry assays.

  5. Interferences from blood collection tube components on clinical chemistry assays

    PubMed Central

    Bowen, Raffick A.R.; Remaley, Alan T.

    2014-01-01

    Improper design or use of blood collection devices can adversely affect the accuracy of laboratory test results. Vascular access devices, such as catheters and needles, exert shear forces during blood flow, which creates a predisposition to cell lysis. Components from blood collection tubes, such as stoppers, lubricants, surfactants, and separator gels, can leach into specimens and/or adsorb analytes from a specimen; special tube additives may also alter analyte stability. Because of these interactions with blood specimens, blood collection devices are a potential source of pre-analytical error in laboratory testing. Accurate laboratory testing requires an understanding of the complex interactions between collection devices and blood specimens. Manufacturers, vendors, and clinical laboratorians must consider the pre-analytical challenges in laboratory testing. Although other authors have described the effects of endogenous substances on clinical assay results, the effects/impact of blood collection tube additives and components have not been well systematically described or explained. This review aims to identify and describe blood collection tube additives and their components and the strategies used to minimize their effects on clinical chemistry assays. PMID:24627713

  6. Heart rate variability, blood pressure variability, and baroreflex sensitivity in overtrained athletes.

    PubMed

    Baumert, Mathias; Brechtel, Lars; Lock, Jürgen; Hermsdorf, Mario; Wolff, Roland; Baier, Vico; Voss, Andreas

    2006-09-01

    To assess the effects of abruptly intensified physical training on cardiovascular control. Retrospective longitudinal study. Research laboratory. Ten healthy athletes (5 men and 5 women) from track and field as well as triathlon. A 2-week training camp, including daily stepwise increasing cycling tests, running of 40 minutes, and additional cycling of 60 minutes. Time and frequency domain parameters of resting heart rate and blood pressure variability (HRV and BPV) and baroreflex sensitivity (BRS), before, during, and after the training camp. We found significantly reduced HRV during the training camp (mean beat-to-beat interval: 1042 [937 to 1194] ms vs. 933 [832 to 1103] ms vs. 1055 [947 to 1183] ms, P < 0.01; root-mean-square of beat-to-beat interval differences: 68 [52 to 95] ms vs. 52 [38 to 71] ms vs. 61 [48 to 78] ms, P < 0.05). Further, BRS was significantly reduced: 25.2 (20.4 to 40.4) ms/mmHg vs. 17.0 (12.9 to 25.7) ms/mmHg vs. 25.7 (18.8 to 29.1) ms/mmHg, P < 0.05. These effects disappeared at a large degree after 3 to 4 days of recovery. Abruptly intensified physical training results in an altered autonomic cardiovascular activity towards parasympathetic inhibition and sympathetic activation that can be monitored by means of HRV and BRS analyses and might provide useful markers to avoid the overtraining syndrome.

  7. Cord blood banking for clinical transplantation.

    PubMed

    Rubinstein, P

    2009-11-01

    Cord blood (CB) stem and progenitor cells from related donors have been transplanted for past 20 years and from unrelated donors issued by public CB banks for 16 years. This brief look at public CB banking highlights aspects of its current status to suggest that accomplishing the currently required tasks, though no small undertaking, is not enough: much remains to be contributed. CB banking started in the 1930s, collecting blood for transfusion and showed that CB could be effectively collected, stored and administered intravenously without negative consequences. The realization that it contains hematopoietic 'stem' cells (actually, colony-forming units) followed discoveries elsewhere in hematopoiesis research, while HLA and unrelated BMT were being investigated. Progress in the exploration of ethnically stratified HLA allele frequencies, together with plausible neonatal (partial) immunological tolerance, seemed to predict initially frequent, unavoidable, but sufficiently tolerable HLA mismatching with CB grafts. Gluckman et al. and Boyse et al. proved that HLA-identical sibling CB grafts led to definitive engraftment. Technical developments in processing and freezing enabled public banks to accumulate large inventories and to supply grafts that could succeed despite major HLA incompatibility and low cell doses and provide hope for universal access to unrelated-donor transplantation. Public CB banking has thrived worldwide. Regulation and accreditation defined Good Tissue Practice in the CB banking environment and provided accepted do's, don't's and how to's. Startling advances continue to be made, not only technical, but including the description of molecular regulation in the function of natural killer and other cells involved in allogeneic recognition that will have dramatic effects and will permit further improvement in CB selection and use.

  8. Genetic and environmental influences on blood pressure variability: a study in twins

    PubMed Central

    Xu, Xiaojing; Ding, Xiuhua; Zhang, Xinyan; Su, Shaoyong; Treiber, Frank A.; Vlietinck, Robert; Fagard, Robert; Derom, Catherine; Gielen, Marij; Loos, Ruth J.F.; Snieder, Harold; Wang, Xiaoling

    2013-01-01

    Objectives Blood pressure variability (BPV) and its reduction in response to antihypertensive treatment are predictors of clinical outcomes; however, little is known about its heritability. In this study, we examined the relative influence of genetic and environmental sources of variance of BPV and the extent to which it may depend on race or sex in young twins. Methods Twins were enrolled from two studies. One study included 703 white twins (308 pairs and 87 singletons) aged 18–34 years, whereas another study included 242 white twins (108 pairs and 26 singletons) and 188 black twins (79 pairs and 30 singletons) aged 12–30 years. BPV was calculated from 24-h ambulatory blood pressure recording. Results Twin modeling showed similar results in the separate analysis in both twin studies and in the meta-analysis. Familial aggregation was identified for SBP variability (SBPV) and DBP variability (DBPV) with genetic factors and common environmental factors together accounting for 18–40% and 23–31% of the total variance of SBPV and DBPV, respectively. Unique environmental factors were the largest contributor explaining up to 82–77% of the total variance of SBPV and DBPV. No sex or race difference in BPV variance components was observed. The results remained the same after adjustment for 24-h blood pressure levels. Conclusions The variance in BPV is predominantly determined by unique environment in youth and young adults, although familial aggregation due to additive genetic and/or common environment influences was also identified explaining about 25% of the variance in BPV. PMID:23470779

  9. Day-to-day variability of blood glucose concentration curves generated at home in cats with diabetes mellitus.

    PubMed

    Alt, Nina; Kley, Saskia; Haessig, Michael; Reusch, Claudia E

    2007-04-01

    To evaluate day-to-day variability in blood glucose curves (BGCs) generated at home and at the clinic for cats with diabetes mellitus. Prospective study. 7 cats with diabetes mellitus. Procedures-BGCs generated at home on 2 consecutive days and within 1 week at the clinic were obtained twice. On each occasion, insulin dose, amount of food, and type of food were consistent for all 3 BGCs. Results of curves generated at home were compared with each other and with the corresponding clinic curve. Differences between blood glucose concentration determined after food was withheld (fasting), nadir concentration, time to nadir concentration, maximum concentration, and mean concentration during 12 hours had high coefficients of variation, as did the difference between fasting blood glucose and nadir concentrations and area under the curve of home curves. Differences between home curve variables were not smaller than those between home and clinic curves, indicating large day-to-day variability in both home and clinic curves. Evaluation of the paired home curves led to the same theoretical recommendation for adjustment of insulin dose on 6 of 14 occasions, and evaluation of home and clinic curves resulted in the same recommendation on 14 of 28 occasions. Four of the 6 paired home curves in cats with good glycemic control and 2 of the 8 paired home curves in cats with poor glycemic control led to the same recommendation. Considerable day-to-day variability was detected in BGCs generated at home. Cats with good glycemic control may have more reproducible curves generated during blood collection at home than cats with poorer control.

  10. Intraocular Pressure, Blood Pressure, and Retinal Blood Flow Autoregulation: A Mathematical Model to Clarify Their Relationship and Clinical Relevance

    PubMed Central

    Guidoboni, Giovanna; Harris, Alon; Cassani, Simone; Arciero, Julia; Siesky, Brent; Amireskandari, Annahita; Tobe, Leslie; Egan, Patrick; Januleviciene, Ingrida; Park, Joshua

    2014-01-01

    Purpose. This study investigates the relationship between intraocular pressure (IOP) and retinal hemodynamics and predicts how arterial blood pressure (BP) and blood flow autoregulation (AR) influence this relationship. Methods. A mathematical model is developed to simulate blood flow in the central retinal vessels and retinal microvasculature as current flowing through a network of resistances and capacitances. Variable resistances describe active and passive diameter changes due to AR and IOP. The model is validated by using clinically measured values of retinal blood flow and velocity. The model simulations for six theoretical patients with high, normal, and low BP (HBP-, NBP-, LBP-) and functional or absent AR (-wAR, -woAR) are compared with clinical data. Results. The model predicts that NBPwAR and HBPwAR patients can regulate retinal blood flow (RBF) as IOP varies between 15 and 23 mm Hg and between 23 and 29 mm Hg, respectively, whereas LBPwAR patients do not adequately regulate blood flow if IOP is 15 mm Hg or higher. Hemodynamic alterations would be noticeable only if IOP changes occur outside of the regulating range, which, most importantly, depend on BP. The model predictions are consistent with clinical data for IOP reduction via surgery and medications and for cases of induced IOP elevation. Conclusions. The theoretical model results suggest that the ability of IOP to induce noticeable changes in retinal hemodynamics depends on the levels of BP and AR of the individual. These predictions might help to explain the inconsistencies found in the clinical literature concerning the relationship between IOP and retinal hemodynamics. PMID:24876284

  11. Clinical Implications of Glucose Variability: Chronic Complications of Diabetes.

    PubMed

    Jung, Hye Seung

    2015-06-01

    Glucose variability has been identified as a potential risk factor for diabetic complications; oxidative stress is widely regarded as the mechanism by which glycemic variability induces diabetic complications. However, there remains no generally accepted gold standard for assessing glucose variability. Representative indices for measuring intraday variability include calculation of the standard deviation along with the mean amplitude of glycemic excursions (MAGE). MAGE is used to measure major intraday excursions and is easily measured using continuous glucose monitoring systems. Despite a lack of randomized controlled trials, recent clinical data suggest that long-term glycemic variability, as determined by variability in hemoglobin A1c, may contribute to the development of microvascular complications. Intraday glycemic variability is also suggested to accelerate coronary artery disease in high-risk patients.

  12. Comparison of hematology, plasma biochemistry, and blood gas variables between 2 venipuncture sites in Southern Stingrays (Dasyatis americana).

    PubMed

    Phillips, Brianne E; Christiansen, Emily F; Stoskopf, Michael K; Broadhurst, Heather; George, Robert; Harms, Craig A

    2016-12-01

    The Southern Stingray (Dasyatis americana) is a batoid elasmobranch frequently exhibited in zoological institutions. Blood is commonly collected from the caudal hemal arch at the tail base in stingrays for the purpose of health assessment and clinical pathology tests. An alternative site that allows a dorsal or ventral approach without necessitating puncture of a cartilaginous structure has been identified between the cartilaginous pectoral fin rays (ceratotrichia). The purpose of the study was to compare CBC, plasma biochemistry analytes, and blood gas variables between blood samples collected from the caudal and pectoral fin vasculature sites of the Southern Stingray. Fifteen captive Southern Stingrays (10 females, 5 males) from 4 zoo and aquarium facilities were sampled. Lithium heparinized blood samples were collected from the caudal and pectoral venipuncture sites of each animal. Values from estimated total and differential leukocyte counts, plasma biochemistry analytes, and blood gas variables were compared. There were no statistically significant differences between venipuncture sites for the measured analytes except for CK activity, which was statistically significantly higher in the pectoral site samples. Levels of agreement between sites were good or moderate for 22 analytes and poor for ALT, AST, CK, pO2 , lactate, monocytes, and eosinophils. The good agreement between sampling sites for the majority of the measured analytes and the lack of differences that would alter clinical interpretation support the use of the pectoral site as an alternative to the traditional caudal fin venipuncture site in Southern Stingrays. © 2016 American Society for Veterinary Clinical Pathology.

  13. Ability of clinicopathologic variables and clinical examination findings to predict race elimination in endurance horses.

    PubMed

    Fielding, C Langdon; Meier, Chloe A; Fellers, Greg K; Magdesian, K Gary

    2017-01-01

    OBJECTIVE To compare results of point-of-care laboratory testing with standard veterinary clinical examination findings at a single time point during endurance competition to identify horses at risk for elimination. ANIMALS 101 endurance horses participating in the 2013 Western States 160-km (100-mile) endurance ride. PROCEDURES At the 58-km checkpoint, blood samples were collected from all horses. Samples were analyzed for pH, Pco2, base excess, anion gap, PCV, and whole blood concentrations of sodium, potassium, chloride, total carbon dioxide, BUN, glucose, and bicarbonate. Corrected electrolyte and PCV values were calculated on the basis of plasma total protein concentration. Immediately following the blood sample collection, each horse underwent a clinical examination. In addition to standard examination variables, an adjusted heart rate was calculated on the basis of the variable interval between entry into the checkpoint and heart rate recording. A combination of stepwise logistic regression, classification and regression tree analysis, and generalized additive models was used to identify variables that were associated with overall elimination or each of 3 other elimination categories (metabolic elimination, lameness elimination, and elimination for other reasons). RESULTS Corrected whole blood potassium concentration and adjusted heart rate were predictive for overall elimination. Breed, plasma total protein concentration, and attitude were predictive for elimination due to metabolic causes. Whole blood chloride concentration and corrected PCV were predictive for elimination due to lameness. Corrected PCV was predictive for elimination due to other causes. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that for horses in endurance competition, a combination of breed and clinical examination and laboratory variables provided the best prediction of overall elimination.

  14. Genome wide analysis of blood pressure variability and ischemic stroke

    PubMed Central

    Khan, Muhammad S; Nalls, Michael A; Bevan, Steve; Cheng, Yu-Ching; Chen, Wei-Min; Malik, Rainer; McCarthy, Nina S; Holliday, Elizabeth G; Speed, Douglas; Hasan, Nazeeha; Pucek, Mateusz; Rinne, Paul E.; Sever, Peter; Stanton, Alice; Shields, Denis C; Maguire, Jane M; McEvoy, Mark; Scott, Rodney J; Ferrucci, Luigi; Macleod, Mary J; Attia, John; Markus, Hugh S; Sale, Michele M; Worrall, Bradford B; Mitchell, Braxton D; Dichgans, Martin; Sudlow, Cathy; Meschia, James F; Rothwell, Peter M

    2013-01-01

    Background and Purpose Visit-to-visit variability in BP is associated with ischemic stroke. We sought to determine whether such variability has a genetic aetiology and whether genetic variants associated with BP variability are also associated with ischemic stroke. Methods A GWAS for loci influencing BP variability was undertaken in 3,802 individuals from the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT) study where long-term visit-to-visit and within visit BP measures were available. Since BP variability is strongly associated with ischemic stroke, we genotyped the sentinel SNP in an independent ischemic stroke population comprising of 8,624 cases and 12,722 controls and in 3,900 additional (Scandinavian) participants from the ASCOT study in order to replicate our findings. Results The ASCOT discovery GWAS identified a cluster of 17 correlated SNPs within the NLGN1 gene (3q26.31) associated with BP variability. The strongest association was with rs976683 (p=1.4×10−8). Conditional analysis on rs976683 provided no evidence of additional independent associations at the locus. Analysis of rs976683 in ischemic stroke patients found no association for overall stroke (OR 1.02; 95% CI 0.97-1.07; p=0.52) or its sub-types: CE (OR 1.07; 95% CI 0.97-1.16; p=0.17), LVD (OR 0.98; 95% 0.89-1.07; p=0.60) and SVD (OR 1.07; 95% CI 0.97-1.17; p=0.19). No evidence for association was found between rs976683 and BP variability in the additional (Scandinavian) ASCOT participants (p=0.18). Conclusions We identified a cluster of SNPs at the NLGN1 locus showing significant association with BP variability. Follow up analyses did not support an association with risk of ischemic stroke and its subtypes. PMID:23929743

  15. Clinical hemoglobinopathies: iron, lungs and new blood.

    PubMed

    Morris, Claudia R; Singer, Sylvia T; Walters, Mark C

    2006-11-01

    Sickle cell disease and beta-thalassemia major are clinically significant hereditary anemias that elicit worldwide attention due to the frequency and severity of these disorders. Historically, most children who inherited these disorders died in the first decade of life. Recently, however, supportive care has extended lifespan through the fifth decade of life and beyond, with survival through early adulthood now indistinguishable from those unaffected by these disorders. As a result, chronic health impairments that significantly reduce the quality of life such as pulmonary hypertension and the consequences of transfusional iron overload have become principal challenges. We focus on important recent advances that are very likely to alter the nature of supportive care of these disorders or make it possible to identify prospectively high-risk patients who might benefit from novel therapies or even curative treatment in the form of hematopoietic cell transplantation. The availability of the latter, traditionally constrained by the requirement of a human leukocyte antigen-identical sibling donor, is very likely to be broadened as results after unrelated donor hematopoietic cell transplantation improve. In this review, several areas that are very likely to have a significant impact in the management of patients who inherit these disorders are discussed.

  16. [Clinical consideration of coagulase negative Staphylococci isolated in blood culture].

    PubMed

    Oshitani, Yohei; Ishikawa, Tomoyuki; Murata, Ken; Aoyagi, Yoshiki; Yabe, Yasuyo; Aoshima, Masahiro

    2012-01-01

    Despite blood culture's usefulness in antimicrobial therapy, fewer blood cultures and the infrequency of more than 1 set in cultures appear to be problems in Japan. Since June 2007 infection control team (ICT) recommended more than 1 set in blood sampling and intervention in positive blood culture, coagulase negative Staphylococci (CNS) has frequently been isolated from blood culture and its clinical significance is often difficult to judge. To determine the effect of ICT intervention, we evaluated the number of blood culture specimens, the frequency of more than 1 set in all blood culture specimens, and decision-making on antimicrobial treatment for CNS isolated retrospectively from blood. The study was divided into term I in August 2007 to July 2008, term II in August 2008 to July 2009, and term III in August 2009 to February 2010. We also analyzed how physicians treated infection or its suspicion after CNS and its drug susceptibility. The monthly number of blood culture specimens increased from 40.3 to 51.6 between terms I and III. The frequency of more than 1 set in a single blood culture session rose significantly from 67% to 89% between these terms (p < 0.001). The number of indeterminate also dropped cases significantly during these 2 terms from 27% to 6% (p = 0.017). Infection or suspected infection cases--45 of 49--had central vein catheter implantation. Inappropriate treatment by physicians in these cases also dropped significantly from 85% (11/13) to 45% (5/11) (p = 0.043) during the same 2 terms. ICT Intervention may thus increase the number of blood culture specimens, enable more than 1 set in blood sampling, make it easier to judge the presence of infection, and increase appropriate treatment by physicians. We thus believe that the quality of antimicrobial treatment could be improved through education such as ICT action.

  17. Clinical significance of Bacillus species isolated from blood cultures.

    PubMed

    Weber, D J; Saviteer, S M; Rutala, W A; Thomann, C A

    1989-06-01

    To determine the clinical significance of blood isolates of Bacillus, we reviewed all blood cultures obtained at North Carolina Memorial Hospital between 1981 and 1985. Over the five-year study period the number of patients (incidence per 10,000 hospital admissions) from whom Bacillus was isolated increased from 4.97 in 1981 to 12.5 in 1985. The incidence per 1,000 blood cultures also increased from 1.12 in 1981 to 2.33 in 1985. Review of the medical records of 78 of the 95 patients (82%) with positive cultures allowed retrospective classification of five isolates (6.4%) as clinically significant, 33 isolates (42.3%) as possibly significant, and 40 isolates (51.3%) as nonsignificant. Underlying diseases in patients with clinically significant Bacillus bacteremia included burn trauma in two, leukemia in one, carcinoma in one, and gastrointestinal hemorrhage in one. All isolates judged to be clinically significant and the majority of possibly significant isolates were B cereus. We conclude that the isolation of Bacillus species from blood cultures is clinically significant in 5% to 10% of cases, that the incidence of Bacillus bacteremia is increasing, and that burn trauma should be added to the list of conditions known to predispose to clinically significant Bacillus bacteremia.

  18. Interpretation of Blood Microbiology Results - Function of the Clinical Microbiologist.

    PubMed

    Kristóf, Katalin; Pongrácz, Júlia

    2016-04-01

    The proper use and interpretation of blood microbiology results may be one of the most challenging and one of the most important functions of clinical microbiology laboratories. Effective implementation of this function requires careful consideration of specimen collection and processing, pathogen detection techniques, and prompt and precise reporting of identification and susceptibility results. The responsibility of the treating physician is proper formulation of the analytical request and to provide the laboratory with complete and precise patient information, which are inevitable prerequisites of a proper testing and interpretation. The clinical microbiologist can offer advice concerning the differential diagnosis, sampling techniques and detection methods to facilitate diagnosis. Rapid detection methods are essential, since the sooner a pathogen is detected, the better chance the patient has of getting cured. Besides the gold-standard blood culture technique, microbiologic methods that decrease the time in obtaining a relevant result are more and more utilized today. In the case of certain pathogens, the pathogen can be identified directly from the blood culture bottle after propagation with serological or automated/semi-automated systems or molecular methods or with MALDI-TOF MS (matrix-assisted laser desorption-ionization time of flight mass spectrometry). Molecular biology methods are also suitable for the rapid detection and identification of pathogens from aseptically collected blood samples. Another important duty of the microbiology laboratory is to notify the treating physician immediately about all relevant information if a positive sample is detected. The clinical microbiologist may provide important guidance regarding the clinical significance of blood isolates, since one-third to one-half of blood culture isolates are contaminants or isolates of unknown clinical significance. To fully exploit the benefits of blood culture and other (non- culture

  19. Symbolic dynamics marker of heart rate variability combined with clinical variables enhance obstructive sleep apnea screening

    NASA Astrophysics Data System (ADS)

    Ravelo-García, A. G.; Saavedra-Santana, P.; Juliá-Serdá, G.; Navarro-Mesa, J. L.; Navarro-Esteva, J.; Álvarez-López, X.; Gapelyuk, A.; Penzel, T.; Wessel, N.

    2014-06-01

    Many sleep centres try to perform a reduced portable test in order to decrease the number of overnight polysomnographies that are expensive, time-consuming, and disturbing. With some limitations, heart rate variability (HRV) has been useful in this task. The aim of this investigation was to evaluate if inclusion of symbolic dynamics variables to a logistic regression model integrating clinical and physical variables, can improve the detection of subjects for further polysomnographies. To our knowledge, this is the first contribution that innovates in that strategy. A group of 133 patients has been referred to the sleep center for suspected sleep apnea. Clinical assessment of the patients consisted of a sleep related questionnaire and a physical examination. The clinical variables related to apnea and selected in the statistical model were age (p < 10-3), neck circumference (p < 10-3), score on a questionnaire scale intended to quantify daytime sleepiness (p < 10-3), and intensity of snoring (p < 10-3). The validation of this model demonstrated an increase in classification performance when a variable based on non-linear dynamics of HRV (p < 0.01) was used additionally to the other variables. For diagnostic rule based only on clinical and physical variables, the corresponding area under the receiver operating characteristic (ROC) curve was 0.907 (95% confidence interval (CI) = 0.848, 0.967), (sensitivity 87.10% and specificity 80%). For the model including the average of a symbolic dynamic variable, the area under the ROC curve was increased to 0.941 (95% = 0.897, 0.985), (sensitivity 88.71% and specificity 82.86%). In conclusion, symbolic dynamics, coupled with significant clinical and physical variables can help to prioritize polysomnographies in patients with a high probability of apnea. In addition, the processing of the HRV is a well established low cost and robust technique.

  20. Review and classification of variability analysis techniques with clinical applications

    PubMed Central

    2011-01-01

    Analysis of patterns of variation of time-series, termed variability analysis, represents a rapidly evolving discipline with increasing applications in different fields of science. In medicine and in particular critical care, efforts have focussed on evaluating the clinical utility of variability. However, the growth and complexity of techniques applicable to this field have made interpretation and understanding of variability more challenging. Our objective is to provide an updated review of variability analysis techniques suitable for clinical applications. We review more than 70 variability techniques, providing for each technique a brief description of the underlying theory and assumptions, together with a summary of clinical applications. We propose a revised classification for the domains of variability techniques, which include statistical, geometric, energetic, informational, and invariant. We discuss the process of calculation, often necessitating a mathematical transform of the time-series. Our aims are to summarize a broad literature, promote a shared vocabulary that would improve the exchange of ideas, and the analyses of the results between different studies. We conclude with challenges for the evolving science of variability analysis. PMID:21985357

  1. Review and classification of variability analysis techniques with clinical applications.

    PubMed

    Bravi, Andrea; Longtin, André; Seely, Andrew J E

    2011-10-10

    Analysis of patterns of variation of time-series, termed variability analysis, represents a rapidly evolving discipline with increasing applications in different fields of science. In medicine and in particular critical care, efforts have focussed on evaluating the clinical utility of variability. However, the growth and complexity of techniques applicable to this field have made interpretation and understanding of variability more challenging. Our objective is to provide an updated review of variability analysis techniques suitable for clinical applications. We review more than 70 variability techniques, providing for each technique a brief description of the underlying theory and assumptions, together with a summary of clinical applications. We propose a revised classification for the domains of variability techniques, which include statistical, geometric, energetic, informational, and invariant. We discuss the process of calculation, often necessitating a mathematical transform of the time-series. Our aims are to summarize a broad literature, promote a shared vocabulary that would improve the exchange of ideas, and the analyses of the results between different studies. We conclude with challenges for the evolving science of variability analysis.

  2. Pretransfusion blood irradiation: Clinical rationale and dosimetric considerations

    SciTech Connect

    Masterson, M.E.; Febo, R. )

    1992-05-01

    The irradiation of blood before transfusion into immunosuppressed patients is an increasingly common technique used to prevent graft-versus-host disease. A technical procedure is described for the calibration of blood irradiators, including the determination of absolute dose rate and relative dose distribution over the blood volume. Results of dose rate measurements on commercially available irradiators indicate differences of +5% to {minus}13% with manufacturer-supplied calibrations and variations in the relative dose rate over the irradiation volume from 70% to 180%. The clinical implications of these findings and the need for accurate dosimetry are discussed.

  3. Relationship of office, home, and ambulatory blood pressure to blood glucose and lipid variables in the PAMELA population.

    PubMed

    Mancia, Giuseppe; Facchetti, Rita; Bombelli, Michele; Polo Friz, Hernan; Grassi, Guido; Giannattasio, Cristina; Sega, Roberto

    2005-06-01

    Alterations in blood glucose and cholesterol are more frequently detectable in hypertensive than in normotensive conditions. However, no information exists as to whether this phenomenon involves only office or also home and 24-hour ambulatory blood pressure (ie, when values are representative of daily life). In 2045 subjects enrolled in the Pressioni Arteriose Monitorate E Loro Associazioni (PAMELA) study, we measured home, 24-hour, and office blood pressure. Measurements also included fasting blood glucose and serum total and HDL cholesterol values. Prevalence of diabetes (> or =126 mg/dL or use of antidiabetic drugs), impaired fasting blood glucose (> or =110 to <126 mg/dL), and hypercholesterolemia (serum total cholesterol > or =240 mg/dL or 200 mg/dL) increased progressively from "optimal" to "normal," "high-normal," and "elevated" office systolic or diastolic blood pressure. Fasting blood glucose and total serum cholesterol also increased progressively from the first to the fourth group, with HDL cholesterol values showing a concomitant progressive decrease. This was also the case for quartiles of office, home, and 24-hour blood pressure. In the whole population, there was a positive correlation between serum cholesterol or blood glucose and all blood pressure values (P always <0.0001), with a much smaller and less consistent relationship with heart rate. In a multivariate analysis that included gender, body mass index, age, and antihypertensive treatment, all blood pressure values remained highly significantly related to values of either metabolic variables. Thus, in the PAMELA population, glucose and lipid values are independently related to blood pressure. This is also the case when daily life blood pressure values are considered.

  4. Clinical value of blood glucose measurement in pet rabbits.

    PubMed

    Harcourt-Brown, F M; Harcourt-Brown, S F

    2012-06-30

    Blood glucose was measured with a portable glucose meter in 907 rabbits, including 238 clinically healthy ones. Blood glucose concentrations ranged from 1.2 to 30.1 mmol/l. Diabetes mellitus was not encountered. No significant effect of sex or sedation was found. Hypoglycaemia was seen in 16 rabbits including one with an insulinoma. There was a significant relationship between blood glucose, food intake, signs of stress and severity of clinical disease. Rabbits showing signs of stress had higher blood glucose than rabbits with no signs and rabbits that were totally anorexic had higher blood glucose values than those that were eating normally or those with reduced food intake. Severe hyperglycaemia (>20 mmol/l) was associated with conditions with a poor prognosis. Rabbits with confirmed intestinal obstruction had a mean blood glucose of 24.7 mmol/l (n=18). This was significantly higher than the rabbits with confirmed gut stasis, which had a mean value of 8.5 mmol/l (n=51). The conclusion of the study was that blood glucose is a measurable parameter that can be used to assess the severity of a rabbit's condition and help to differentiate between gut stasis and intestinal obstruction in rabbits that are anorexic.

  5. Influence of hot environments on some blood variables of sheep

    NASA Astrophysics Data System (ADS)

    Gomes da Silva, Roberto; Paranhos da Costa, Mateus J. R.; Silva Sobrinho, Américo G.

    1992-12-01

    Thirty-two Polwarth sheep of ages up to 1 year were observed under temperatures varying from 10.5 to 46.5°C. The following blood cell counts were made: erythrocyte (RBC), leucocyte (WBC), eosinophil (EOS), neutrophil (NEU), lymphocyte (LYM) and monocyte (MON). Other traits measured were: haemoglobin (HB), haematocrit (HT), blood glucose (GLU) and serum protein (PROT). Multivariate analysis of variance was used and the results showed a significant ( P<0.001) effect for the interaction of shearing and temperature treatment. Under temperatures >25°C, sheep presented a decrease of RBC, WBC, HB and HT, these differences being greater in the shorn than in the unshorn animals. Unshorn animals presented higher variations in EOS, NEU, LYM, MON and GLU. Blood glucose increased under high temperatures in the shorn animals (from 56.36±0.65 mg/100 ml to 60.52±0.69 mg/100 ml) as in the unshorn animals (from 54.72±0.74 mg/100 ml to 57.56±0.77 mg/100 ml).

  6. Relationships between blood pressure and health and fitness-related variables in obese women

    PubMed Central

    Shin, Jeong Yeop; Ha, Chang Ho

    2016-01-01

    [Purpose] The present study aimed to separately compare systolic blood pressure and diastolic blood pressure with health and fitness-related variables among Asian obese and normal weight middle-aged women. [Subjects and Methods] The study included 1,201 women aged 30–59 years. The participants were classified into obese and normal weight groups. The blood pressure and health and fitness-related variables of all participants were assessed. [Results] Significant interaction effects were observed for most blood pressure and health and fitness-related variables between the groups. However, significant interaction effects were not observed for standard weight, basal metabolic rate, and heart rate. Blood pressure showed significant positive correlations with weight, body fat, fat weight, core fat, body mass index, and basal metabolic rate in both groups. Systolic blood pressure was significantly correlated with muscular endurance, power, and agility in the obese group and with VO2max and flexibility in the normal weight group. Diastolic blood pressure was significantly correlated with muscular endurance and power in the obese group and with VO2max in the normal weight group. [Conclusion] The relationships between systolic blood pressure and heart rate, muscle endurance, power, and agility are stronger than the relationships between diastolic blood pressure and these variables. PMID:27821965

  7. Photoplethysmographic variability: spontaneous fluctuations in the tissue blood volume and in the systolic blood volume increase

    NASA Astrophysics Data System (ADS)

    Nitzan, Meir; Babchenko, Anatoly; Turivnenko, Sergei; Khanokh, Boris

    1997-05-01

    Several parameters of the cardiovascular system such as heart rate, arterial blood pressure and blood flow fluctuate spontaneously due to the autonomic nervous system activity. In the current study, the low frequency fluctuations of the tissue blood volume and the blood volume pulse in the fingertips of healthy subjects were investigated using transmission photoplethysmography (PPG). The baseline of the PPG signal (BL) is inversely related to tissue blood volume so that the parameter BV, defined by: BV equals Const.-BL is directly related to the blood volume. The amplitude (AM) is directly related to the systolic blood volume increase. For most of the examinations BV and AM show positive correlation, which is expected since BV depends on the tissue blood volume and AM depends on the compliance of the blood vessels, both of which decrease during vasoconstriction, which is caused by higher activity of the sympathetic nervous system. The analysis of the PPG signal provides, therefore, a potential tool for study in the mechanism of the regulation of the microcirculation by the sympathetic nerves.

  8. Newborn Thyroid Screening: Influence of Pre-Analytic Variables on Dried Blood Spot Thyrotropin Measurement.

    PubMed

    Butler, Allison M; Charoensiriwatana, Wiyada; Krasao, Piamnukul; Pankanjanato, Rotjanapan; Thong-Ngao, Penpan; Polson, Randall C; Snow, Gregory; Ehrenkranz, Joel

    2017-09-01

    Measuring thyrotropin (TSH) eluted from a dried blood spot (DBS) is used to screen an estimated 30 million newborns annually for congenital hypothyroidism (CH). Newborn thyroid screening has eliminated cretinism from the industrialized world and decreased the adverse effects of unrecognized CH on neurocognitive development. Hematocrit, a pre-analytic variable that affects the measurement of TSH from a DBS, contributes to the imprecision of DBS TSH measurement and could account for false-negative and false-positive DBS newborn screening test results. To assess whether variations in hematocrit found in newborns have a clinical effect in DBS-based newborn thyroid screening, the effects of hematocrit variability on the measurement of DBS TSH were studied. U.S. Centers for Disease Control and Prevention procedures for manufacturing DBS performance testing standards were used to generate DBSs from blood samples, with hematocrits of 35%, 40%, 45%, 50%, 55%, 60%, and 65% and serum TSH concentrations of 6.3 ± 0.4 and 26.6 ± 8.0 mIU/L. TSH was measured in the eluates of four replicate DBS 3 mm punches at each hematocrit using the Thailand Ministry of Public Health Newborn Screening Operation Center enzyme-linked immunosorbent assay. Data were analyzed using a linear mixed-effects model. Based on the mixed-effects model, hematocrit significantly affected DBS TSH measurement (p < 0.001). A 1% increase in hematocrit resulted in a 0.06 mIU/L decrease in eluate TSH when TSH was 6.3 + 0.4 mIU/L, and a 0.21 mIU/L decrease in eluate TSH when TSH was 26.6 + 8.0 mIU/L. DBS TSH is significantly affected by the blood sample hematocrit. The pre-analytic variability due to hematocrit is independent of TSH assay sensitivity, specificity, precision, repeatability, and reference intervals. The effect of hematocrit on DBS TSH measurement is clinically relevant, could account for geographic and ethnic variation in the incidence of CH, and may result in both false

  9. Bias and variability in blood pressure measurement with ambulatory recorders.

    PubMed

    Pannarale, G; Bebb, G; Clark, S; Sullivan, A; Foster, C; Coats, A J

    1993-10-01

    This study sought to determine whether patient characteristics such as age, sex, blood pressure, and pulse pressure differently affect the accuracy of an oscillometric (SpaceLabs 90207) and a microphonic (TM2420 version 7) blood pressure monitor. Blood pressure recorded by two oscillometric and two microphonic ambulatory monitors was compared with simultaneous readings by two pairs of trained, blinded observers using random-zero sphygmomanometry. One hundred and eighteen subjects (53 men and 65 women, aged 17 to 94 years; systolic pressure, 89 to 211 mm Hg; diastolic, 44 to 116 mm Hg) were studied. There were no significant differences within each observer pair or between the two observer pairs as well as no correlation between interobserver differences and patient characteristics. The differences between the monitor and trained observers' readings were 2.8 +/- 9.9 mm Hg systolic and 3.9 +/- 6.8 mm Hg diastolic for the SpaceLabs and 5.0 +/- 5.2 mm Hg systolic and 3.4 +/- 6.1 mm Hg diastolic for the TM2420. Patient characteristics that predicted measurement error were defined by multiple regression. For oscillometry, systolic measurement error was highly correlated with systolic pressure, pulse pressure, and subject age. The diastolic error was significantly correlated with pulse pressure, diastolic pressure, and subject sex. For the oscillometric monitor, patient characteristics accounted for 36.6% of the variation of the systolic error and 34.7% of the variation of the diastolic error. For the microphonic monitor, only age correlated with diastolic error, and no significant correlations were seen with systolic error. Patient characteristics accounted for only 1.2% of the systolic and 8.9% of the diastolic error.(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Clinical feasibility of dried blood spots: Analytics, validation, and applications.

    PubMed

    Enderle, Yeliz; Foerster, Kathrin; Burhenne, Jürgen

    2016-10-25

    Dried blood spots (DBS) sampling and their specific advantages are becoming common in analytical and clinical routine. Being first established for metabolic disorder screening in neonates, its use emerged to a broad spectrum of clinical applications. Although DBS are easily generated, the conduction of specific analytical and clinical validation procedures should be obligatory when implementing DBS for clinical purposes, e.g. therapeutic drug monitoring or clinical drug trials. A respective recommendation has already been published by the European Bioanalysis Forum. Since no official guidelines are present, investigators are currently free in DBS procedure development and validation. This review summarizes and discusses published clinical validation procedures in relation to their applications to highlight the clinical feasibility of DBS.

  11. Biological correlates of blood pressure variability in elderly at high risk of cardiovascular disease.

    PubMed

    Poortvliet, Rosalinde K E; Lloyd, Suzanne M; Ford, Ian; Sattar, Naveed; de Craen, Anton J M; Wijsman, Liselotte W; Mooijaart, Simon P; Westendorp, Rudi G J; Jukema, J Wouter; de Ruijter, Wouter; Gussekloo, Jacobijn; Stott, David J

    2015-04-01

    Visit-to-visit variability in blood pressure is an independent predictor of cardiovascular disease. This study investigates biological correlates of intra-individual variability in blood pressure in older persons. Nested observational study within the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) among 3,794 male and female participants (range 70-82 years) with a history of, or risk factors for cardiovascular disease. Individual visit-to-visit variability in systolic and diastolic blood pressure and pulse pressure (expressed as 1 SD in mm Hg) was assessed using nine measurements over 2 years. Correlates of higher visit-to-visit variability were examined at baseline, including markers of inflammation, endothelial function, renal function and glucose homeostasis. Over the first 2 years, the mean intra-individual variability (1 SD) was 14.4mm Hg for systolic blood pressure, 7.7mm Hg for diastolic blood pressure, and 12.6mm Hg for pulse pressure. After multivariate adjustment a higher level of interleukin-6 at baseline was consistently associated with higher intra-individual variability of blood pressure, including systolic, diastolic, and pulse pressure. Markers of endothelial function (Von Willebrand factor, tissue plasminogen activator), renal function (glomerular filtration rate) and glucose homeostasis (blood glucose, homeostatic model assessment index) were not or to a minor extent associated with blood pressure variability. In an elderly population at risk of cardiovascular disease, inflammation (as evidenced by higher levels of interleukin-6) is associated with higher intra-individual variability in systolic, diastolic, and pulse pressure. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  12. An artificial pancreas provided a novel model of blood glucose level variability in beagles.

    PubMed

    Munekage, Masaya; Yatabe, Tomoaki; Kitagawa, Hiroyuki; Takezaki, Yuka; Tamura, Takahiko; Namikawa, Tsutomu; Hanazaki, Kazuhiro

    2015-12-01

    Although the effects on prognosis of blood glucose level variability have gained increasing attention, it is unclear whether blood glucose level variability itself or the manifestation of pathological conditions that worsen prognosis. Then, previous reports have not been published on variability models of perioperative blood glucose levels. The aim of this study is to establish a novel variability model of blood glucose concentration using an artificial pancreas. We maintained six healthy, male beagles. After anesthesia induction, a 20-G venous catheter was inserted in the right femoral vein and an artificial pancreas (STG-22, Nikkiso Co. Ltd., Tokyo, Japan) was connected for continuous blood glucose monitoring and glucose management. After achieving muscle relaxation, total pancreatectomy was performed. After 1 h of stabilization, automatic blood glucose control was initiated using the artificial pancreas. Blood glucose level varied for 8 h, alternating between the target blood glucose values of 170 and 70 mg/dL. Eight hours later, the experiment was concluded. Total pancreatectomy was performed for 62 ± 13 min. Blood glucose swings were achieved 9.8 ± 2.3 times. The average blood glucose level was 128.1 ± 5.1 mg/dL with an SD of 44.6 ± 3.9 mg/dL. The potassium levels after stabilization and at the end of the experiment were 3.5 ± 0.3 and 3.1 ± 0.5 mmol/L, respectively. In conclusion, the results of the present study demonstrated that an artificial pancreas contributed to the establishment of a novel variability model of blood glucose levels in beagles.

  13. Variability of blood pressure in dialysis patients: a new marker of cardiovascular risk.

    PubMed

    Di Iorio, Biagio; Di Micco, Lucia; Torraca, Serena; Sirico, Maria Luisa; Guastaferro, Pasquale; Chiuchiolo, Luigi; Nigro, Filippo; De Blasio, Antonietta; Romano, Paolo; Pota, Andrea; Rubino, Roberto; Morrone, Luigi; Lopez, Teodoro; Casino, Francesco Gaetano

    2013-01-01

    Hemodialysis patients have a high cardiovascular mortality, and hypertension is the most prevalent treatable risk factor. We aimed to assess the predictive significance of dialysis-to-dialysis variability in blood pressure in hemodialysis patients. We performed a historical cohort study in 1,088 prevalent hemodialysis patients, followed up for 5 years. The risk of cardiovascular death was determined in relation to dialysis-to-dialysis variability in blood pressure, maximum blood pressure and pulse pressure. Variability in blood pressure was a predictor of cardiovascular death (hazard ratio [HR] = 1.242; 95% confidence interval [95% CI], 1.004-1.537; p=0.046). Also age (HR=1.021; 95% CI, 1.011-1.048; p=0.049), diabetes (HR=1.134; 95% CI, 1.128-1.451; p=0.035), creatinine (HR=0.837; 95% CI, 0.717-0.977; p=0.024) and albumin (HR=0.901; 95% CI, 0.821-0.924; p=0.022) influenced mortality. Maximum blood pressure and pulse pressure did not show any effect on cardiovascular death. Dialysis-to-dialysis variability in blood pressure is a predictor of cardiovascular mortality in hemodialysis patients, and blood pressure variability may be used in managing hypertension and predicting outcomes in dialysis patients.

  14. Cold blood and clinical research during World War I.

    PubMed

    Hanigan, W C; King, S C

    1996-07-01

    Therapeutic transfusion was not a common procedure at the turn of the century. Although its safety was enhanced by the discovery of blood groups and preinfusion testing in the decade prior to World War I, techniques and indications remained cumbersome and clinically naive. By 1916, a stable Western Front, an efficient line of transport, and the operative requirements of a large number of wounded demonstrated the futility of pharmacotherapy or saline infusion for traumatic shock. In the same year, Rous and Turner at the Rockefeller Institute developed a preservative solution for whole blood. Rous' student, Dr. O.H. Robertson, arrived in France with Base Hospital 5 in June 1917 during a period of growing recognition by military surgeons that transfused blood was an effective therapy, although a practical delivery system was not available. Over the next 8 months, Robertson clinically tested a transfusion technique using preserved blood in glass jars carried to the front in specially designed cases. The method was accepted immediately, and by the Armistice transfusion was used frequently on the front line or during the perioperative period. The accessibility of preserved blood with an efficient transfusion system reinforced the introduction of "resuscitation teams" attached to Casualty Clearing Hospitals for the specialized management of traumatic shock. Robertson's success at technical innovation during World War I associated with a large clinical population resulted in the development of the indications and procedures for modern transfusion therapy.

  15. Variability of clinical features in attacks of migraine with aura.

    PubMed

    Hansen, Jakob M; Goadsby, Peter J; Charles, Andrew C

    2016-03-01

    There is significant variability in the clinical presentation of migraine, both among patients, and between attacks in an individual patient. We examined clinical features of migraine with aura in a large group of patients enrolled in a clinical trial, and compared retrospective migraine attack characteristics reported upon enrollment in the trial with those recorded prospectively in the trial. Patients with migraine (n = 267) with typical visual aura in more than 30% of their attacks were enrolled from 16 centers for a clinical trial. Upon enrollment, patients provided a detailed retrospective description of the clinical features of their attacks of migraine. During the trial, clinical symptoms in migraine attacks starting with aura were recorded prospectively in 861 attacks. Retrospectively reported visual aura symptoms were variable and often overlapping; the most common symptoms were dots or flashing lights, wavy or jagged lines, blind spots, and tunnel vision. Multiple patients reported more than one visual phenomenon. Approximately half of the patients reported nonvisual aura symptoms, the most common were numbness and tingling, followed by difficulty in recalling or speaking words. A significant percentage of patients also reported a change in olfaction. There were several inconsistencies between the features of prospectively recorded and retrospectively reported attacks. Headache, nausea, photophobia, and phonophobia were all less common in prospectively recorded attacks as compared with retrospective reporting. Nausea was prospectively recorded in only 51% of attacks and mostly with mild intensity. The occurrence and severity of nausea was reduced with advancing patient age. Phonophobia was not consistently recorded in conjunction with photophobia. These findings are consistent with variable involvement of different brain regions during a migraine attack. The variable occurrence of nausea, and phonophobia in conjunction with photophobia, both defining

  16. Variability and trend of multiple blood lead measures among construction and manufacturing workers.

    PubMed

    Blando, James; Lu, Shou-En; Gu, Hui; Lin, Yong; Marshall, Elizabeth G

    2013-11-01

    This study evaluated multiple blood lead measures collected over time and assessed differences arising from exposure and testing variability. Blood lead data was used to compare individuals from manufacturing and construction occupational cohorts. Trends of blood lead levels (BLLs) over time were analysed using mixed model analysis. Random selection of BLL values was used to determine the improvement in the precision of mean BLL estimates as the number of tests increased. From 2003-2007, there were 619 manufacturing and 657 construction workers with more than one blood lead test reported. Construction workers had much more variability in their blood lead trends. They also tended to have less frequent follow-up blood tests compared with manufacturing workers. Both occupational cohorts had persistent BLLs that resulted in many workers with chronically high blood lead values (>25 µg/dL). Approximately 11.2% of construction workers and 34.8% of manufacturing workers with an initial blood lead test above 25 µg/dL remained above this blood level through the study period. The precision in the mean BLL estimates increased more substantially for construction workers when compared with manufacturing workers as the number of blood lead tests per worker increased. This study confirmed differences in the pattern of blood lead tests and the resulting trends for manufacturing compared with construction workers. It also suggested that the number of blood lead tests performed on a worker is an important consideration in the assessment of a worker's mean blood lead estimate, and this is particularly true for workers with highly variable exposures.

  17. Is there a "magic" hemoglobin number? Clinical decision support promoting restrictive blood transfusion practices.

    PubMed

    Goodnough, Lawrence Tim; Shah, Neil

    2015-10-01

    Blood transfusion has been identified as one of the most frequently performed therapeutic procedures, with a significant percentage of transfusions identified to be inappropriate. Recent key clinical trials in adults have provided Level 1 evidence to support restrictive red blood cell (RBC) transfusion practices. However, some advocates have attempted to identify a "correct" Hb threshold for RBC transfusion; whereas others assert that management of anemia, including transfusion decisions, must take into account clinical patient variables, rather than simply one diagnostic laboratory test. The heterogeneity of guidelines for blood transfusion by a number of medical societies reflects this controversy. Clinical decision support (CDS) uses a Hb threshold number in a smart Best Practices Alert (BPA) upon physician order, to trigger a concurrent utilization self-review for whether blood transfusion therapy is appropriate. This review summarizes Level 1 evidence in seven key clinical trials in adults that support restrictive transfusion practices, along strategies made possible by CDS that have demonstrated value in improving blood utilization by promoting restrictive transfusion practices.

  18. Clinical, haematological and biochemical responses of sheep undergoing autologous blood transfusion

    PubMed Central

    2012-01-01

    Background This study aimed to evaluate the clinical, haematological and biochemical responses to autologous blood transfusion and the feasibility of this practice in sheep. Thus, we used eight male, 8 months old sheep, weighing on average 30 kg, from which 15 mL/kg of whole blood was collected and stored in CPDA-1 bags. Blood samples were refrigerated for 8 days and subsequently re-infused. The clinical, haematological and biochemical parameters were evaluated before blood collection and reinfusion, after 10 minutes of collection and reinfusion, after 3, 6, 12, 24, 48, 96 and 192 hours after collection and reinfusion. Results With respect to clinical parameters, we observed a decrease in heart rate after 24, 48 and 196 hours from reinfusion compared to basal values (p < 0.05). Haematological variables including globular volume and erythrocyte counts showed a significant decrease (p < 0.01) at all time points after collection and increased (p < 0.01) at all time points after reinfusion. There was a significant increase in total protein and calcium at all time points after reinfusion (p < 0.05). Conclusion Autologous transfusion in sheep slightly altered the physiological, biochemical and haematological responses of sheep, indicating that the technique proposed is safe and can be applied in the clinical practice of this species. The 8 d period was not sufficient for complete recovery of the haematological parameters after blood collection. PMID:22607611

  19. Ambulatory and home blood pressure monitoring: gaps between clinical guidelines and clinical practice in Singapore

    PubMed Central

    Setia, Sajita; Subramaniam, Kannan; Teo, Boon Wee; Tay, Jam Chin

    2017-01-01

    Purpose Out-of-office blood pressure (BP) measurements (home blood pressure monitoring [HBPM] and ambulatory blood pressure monitoring [ABPM]) provide important additional information for effective hypertension detection and management decisions. Therefore, out-of-office BP measurement is now recommended by several international guidelines. This study evaluated the practice and uptake of HBPM and ABPM among physicians from Singapore. Materials and methods A sample of physicians from Singapore was surveyed between 8 September and 5 October 2016. Those included were in public or private practice had been practicing for ≥3 years, directly cared for patients ≥70% of the time, and treated ≥30 patients for hypertension per month. The questionnaire covered six main categories: general BP management, BP variability (BPV) awareness/diagnosis, HBPM, ABPM, BPV management, and associated training needs. Results Sixty physicians (30 general practitioners, 20 cardiologists, and 10 nephrologists) were included (77% male, 85% aged 31–60 years, and mean 22-year practice). Physicians recommended HBPM and ABPM to 81% and 27% of hypertensive patients, respectively. HBPM was most often used to monitor antihypertensive therapy (88% of physicians) and 97% thought that ABPM was useful for providing information on BPV. HBPM instructions often differed from current guideline recommendations in terms of frequency, number of measurements, and timing. The proportion of consultation time devoted to discussing HBPM and BPV was one-quarter or less for 73% of physicians, and only 55% said that they had the ability to provide education on HBPM and BPV. Patient inertia, poor patient compliance, lack of medical consultation time, and poor patient access to a BP machine were the most common challenges for implementing out-of-office BP monitoring. Conclusion Although physicians from Singapore do recommend out-of-office BP measurement to patients with hypertension, this survey identified several

  20. Ambulatory and home blood pressure monitoring: gaps between clinical guidelines and clinical practice in Singapore.

    PubMed

    Setia, Sajita; Subramaniam, Kannan; Teo, Boon Wee; Tay, Jam Chin

    2017-01-01

    Out-of-office blood pressure (BP) measurements (home blood pressure monitoring [HBPM] and ambulatory blood pressure monitoring [ABPM]) provide important additional information for effective hypertension detection and management decisions. Therefore, out-of-office BP measurement is now recommended by several international guidelines. This study evaluated the practice and uptake of HBPM and ABPM among physicians from Singapore. A sample of physicians from Singapore was surveyed between 8 September and 5 October 2016. Those included were in public or private practice had been practicing for ≥3 years, directly cared for patients ≥70% of the time, and treated ≥30 patients for hypertension per month. The questionnaire covered six main categories: general BP management, BP variability (BPV) awareness/diagnosis, HBPM, ABPM, BPV management, and associated training needs. Sixty physicians (30 general practitioners, 20 cardiologists, and 10 nephrologists) were included (77% male, 85% aged 31-60 years, and mean 22-year practice). Physicians recommended HBPM and ABPM to 81% and 27% of hypertensive patients, respectively. HBPM was most often used to monitor antihypertensive therapy (88% of physicians) and 97% thought that ABPM was useful for providing information on BPV. HBPM instructions often differed from current guideline recommendations in terms of frequency, number of measurements, and timing. The proportion of consultation time devoted to discussing HBPM and BPV was one-quarter or less for 73% of physicians, and only 55% said that they had the ability to provide education on HBPM and BPV. Patient inertia, poor patient compliance, lack of medical consultation time, and poor patient access to a BP machine were the most common challenges for implementing out-of-office BP monitoring. Although physicians from Singapore do recommend out-of-office BP measurement to patients with hypertension, this survey identified several important gaps in knowledge and clinical practice.

  1. Controlled clinical comparison of three commercial blood culture systems.

    PubMed

    Frank, U; Malkotsis, D; Mlangeni, D; Daschner, F D

    1999-04-01

    In a controlled clinical comparison, three commercial blood culture systems--the standard aerobic BacT/Alert bottle (STD), the aerobic BacT/Alert FAN bottle (FAN) and the Isolator system (ISO; Wampole Laboratories, USA) were compared for their ability to detect aerobic and facultatively anaerobic microorganisms. A total of 945 BacT/Alert (STD and FAN) blood culture sets were compared. Of these, 110 blood culture sets (11.6%) yielded growth of 116 clinically significant bacterial and fungal isolates. Microorganisms were recovered from 10.7% (101/945) of the FAN bottles compared to 8.9% (84/945) of the STD bottles. Of the significant isolates, 78 (67.2%) were recovered by both bottles, 29 (25%) by the FAN bottle only and nine (7.8%) by the STD bottle only (P<0.01). Along with 56.1% (530/945) of BacT/Alert blood culture sets, a concomitant ISO tube was obtained. Of the triple (STD + FAN + ISO) blood culture sets, 54 (10.2%) yielded growth of 59 clinically relevant isolates. Microorganisms were detected in 9.1% (48/530) of the FAN bottles, 8.3% (44/530) of the STD bottles and 4% (21/530) of the ISO tubes (P<0.001). Overall, the BacT/Alert system detected more clinically significant microorganisms than the ISO tube; the STD and the FAN bottle each recovered significantly more staphylococci (P<0.01 and P<0.001, respectively) and gram-negative rods (P<0.01, both). In conclusion, the BacT/Alert FAN bottle performed better than the BacT/Alert STD bottle; both BacT/Alert bottles, however, were superior to the ISO tube in terms of recovery of clinically significant microorganisms, including gram-positive and gram-negative bacteria.

  2. REPRODUCIBILITY OF BLOOD PRESSURE DIPPING: RELATION TO DAY-TO-DAY VARIABILITY IN SLEEP QUALITY

    PubMed Central

    Hinderliter, Alan L.; Routledge, Faye S.; Blumenthal, James A.; Koch, Gary; Hussey, Michael A.; Wohlgemuth, William K.; Sherwood, Andrew

    2013-01-01

    Background Previous studies of the reproducibility of blood pressure (BP) dipping have yielded inconsistent results. Few have examined factors that may influence dayto-day differences in dipping. Methods and Results Ambulatory BP monitoring was performed on three occasions, approximately one week apart, in 115 untreated adult subjects with elevated clinic BPs. The mean±SD BP dip was 18±7/15±5 mmHg (sleep/awake BP ratio = 0.87±0.05/0.82±0.06), with a median (interquartile range) day-to-day variation of 5.2 (3.1–8.1)/4.3(2.8–5.6) mmHg. There was no decrease in variability with successive measurements. The reproducibility coefficient (5.6 [95% CI 5.1, 6.1] mmHg) was greater and the intraclass correlation coefficient (0.53 [95% CI 0.42, 0.63]) was smaller for the systolic dip than for 24-hour or awake systolic BPs, suggesting greater day-today variability in dipping. Variability in systolic dipping was greater in subjects with higher awake BP, but was not related to age, gender, race, or body mass index. Within individuals, day-to-day variations in dipping were related to variations in the fragmentation index (p < 0.001), a measure of sleep quality. Conclusions Although mean 24-hour and awake BPs were relatively stable over repeated monitoring days, our study confirms substantial variability in BP dipping. Day-to-day differences in dipping are related to sleep quality. PMID:23850195

  3. [Short-term variability of blood pressure: physiology and pharmacology].

    PubMed

    Elghozi, J-L

    2008-06-01

    Non invasive continuous measurement of blood pressure (BP) is currently performed at the finger level. The various oscillations of BP are distinguished using spectral analysis based on the fast Fourier transform. The first order oscillation of BP is synchronous with the heart beat and generates pulsaltile changes in BP. Second order oscillations are generated by respiration and depend on intrathoracic pressure changes. They do not exceed few millimeters of mercury. Heart rate also oscillates with respiration. This respiratory sinus arrhythmia depends on vagal activity. A slower third order oscillation also called 10-s period rhythm or Mayer waves depend on vascular tone changes. These waves may reach 20 mmHg. Mayer waves reflect oscillations in resistance vessels and depend on sympathetic discharges. Sympathetic nerves determine oscillations in resistance vessels and cardiac rhythm at the same 0.1 Hz frequency. A better understanding of these oscillations helps in understanding BP regulatory mechanisms and in treating BP disorders. Prognosis of arterial hypertension also depends on these BP fluctuations. Recent time and frequency domain developments in the analysis of the reflex relationship between BP and heart rate allow the calculations of indexes of spontaneous baroreflex sensitivity. Baroreflex sensitivity is a new indicator of cardiovascular risk.

  4. Blood stem cell products: toward sustainable benchmarks for clinical translation.

    PubMed

    Csaszar, Elizabeth; Cohen, Sandra; Zandstra, Peter W

    2013-03-01

    Robust ex vivo expansion of umbilical cord blood (UCB) derived hematopoietic stem and progenitor cells (HSPCs) should enable the widespread use of UCB as a source of cells to treat hematologic and immune diseases. Novel approaches for HSPC expansion have recently been developed, setting the stage for the production of blood stem cell derived products that fulfill our current best known criteria of clinical relevance. Translating these technologies into clinical use requires bioengineering strategies to overcome challenges of scale-up, reproducibility, and product quality assurance. Clinical-scale implementation should also define criteria and targets for cost-effective cell manufacturing. As production strategies become more effective, new opportunities in the therapeutic use of ex vivo expanded hematopoietic cell products will emerge. Herein we examine key technological milestones that need to be met in order to move ex vivo expanded HSPC therapies from the bench-top to the bedside in a robust and reliable manner.

  5. Intraindividual Temporal miRNA Variability in Serum, Plasma, and White Blood Cell Subpopulations.

    PubMed

    Ammerlaan, Wim; Betsou, Fay

    2016-10-01

    Blood microRNAs (miRNAs) are ideal biomarkers, and blood derivatives are often collected in the scope of miRNA research projects. However, knowledge of temporal variations of miRNAs in healthy individuals is lacking. In this study, miRNA variability was measured over a 1-year period in different blood derivatives, collected every 2-3 months from two healthy donors. There is a continuum of intraindividual temporal variability, with particularly stable (coefficient of variation [CV] <20%-30%) and particularly unstable (CV >100%-130%) miRNAs in serum, plasma, and specific white blood cell subpopulations. The temporal intraindividual variability of miRNAs should be taken into consideration in experimental design of biospecimen collections and validation of diagnostic biomarkers.

  6. [Current Clinical Variables in Schizophrenia Cases with Suicide Attempt History].

    PubMed

    Sağlam Aykut, Demet; Civil Arslan, Filiz; Özkorumak Karagüzel, Evrim; Karakullukçu, Serdar; Tiryaki, Ahmet

    2017-01-01

    High suicide risk was shown to be related with depression and low quality of life in studies investigating clinical variables related to suicidal behavior. The aim of this study was to investigate the effects of a suicide attempt on clinical presentation by comparing sociodemographic variables, clinical signs, symptoms of depression, quality of life, social functionality, and reported adverse drug reactions in schizophrenic patients with and without suicide. Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale (CDS), Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q), Social Functioning Scale (SFS), and Udvalg for Kliniske Undersøgelser Side Effect Rating Scale (UKU) were administered to 115 patients with schizophrenia. 44.3% of patients had at least one suicide attempt. Among sociodemographic variables, a family history of suicide, smoking, and total duration of disease were significantly higher in patients with suicide history than without. Scores of CDS and UKU subscores were significantly higher, and quality of life and social occupation in social functionality were significantly lower in patients with a history of suicide. In correlation analysis, CSD was negatively correlated with Q-LES-Q and independency/performance subscore of SFI, and positively correlated with UKU-Neurological subscore. In line with this data, suicidal behavior may be suggested to affect clinical presentation and course characteristic of schizophrenic patients. Additional treatments towards factors that may impact on the clinical course and social support programs might be suggested for these patients.

  7. Determining staffing requirements for blood donor clinics: the Canadian Blood Services experience.

    PubMed

    Blake, John T; Shimla, Susan

    2014-03-01

    Canadian Blood Services runs approximately 16,000 donor clinics annually. While there were more than 220 different clinic configurations used in 2011 and 2012, 67% of all clinic configurations followed one of 51 standard models. As part of operational planning for current and future configurations it was necessary for Canadian Blood Services to calculate staffing requirements for standard clinic models. In this article we present a method that incorporates both cost control and impact on donor experience. We calculate staffing requirements to minimize costs, but adjust using queuing theory to ensure donor wait time metrics are met. The method can be applied in a wide variety of situations. Although developed for a particular study, the methods described in this article can be applied in a wide variety of situations. A case study in which the model is used to review existing staffing arrangements at Canadian Blood Services is presented. The staffing model can be used to balance the requirements of minimizing staffing costs with that of ensuring that donors do not suffer unnecessary delays. Moreover, in an example application, savings of 3.4% were identified through the modeling process. © 2013 American Association of Blood Banks.

  8. Blood product costing: relationship to price and clinical efficacy.

    PubMed

    Trenchard, P M; Dixon, R

    1995-09-01

    Detailed information is provided about primary product costing and price issues as they affect transfusion manufacturing practice and clinical transfusion practice. Product price is shown to have a crucial influence upon clinical practice and associated research. By focusing particularly upon cost-benefit analysis of blood product transfusion therapy a substantive conclusion is drawn that price should equal the associated manufacturing cost. Clinical outcome studies relate clinical efficacy to the manufacturing specification of the product, which should therefore determine the product cost. Thus, the true manufacturing cost is the sum of all the process activity costs that create the final product specification, e.g. red cell number+volume reduction+leucocyte reduction+microbiological safety, for processed red cells. Sometimes different product specifications may compete for a single activity cost, e.g. one-spin processing achieves volume reduction and leucocyte reduction for processed red cells but also plasma removal for protein fractionation. A method for understanding the relative clinical importance of different products is described, which guides the cost allocation process. Furthermore, for some products there is uncertainty about the clinical benefits of some components of the specification, e.g. leucocyte load and immunomodulation, and a method is described for ranking this quality-uncertainty level objectively. The optimal costing model must ensure that the product with the highest uncertainty ranking is assured a high degree of cost stability. These concepts prepare the way for a Quality Associated Costing model for blood products that correlates with clinical efficacy.

  9. The acute effect of resistance exercise with blood flow restriction with hemodynamic variables on hypertensive subjects.

    PubMed

    Araújo, Joamira P; Silva, Eliney D; Silva, Julio C G; Souza, Thiago S P; Lima, Eloíse O; Guerra, Ialuska; Sousa, Maria S C

    2014-09-29

    The purpose of this study was to analyze systolic blood pressure (SBP), diastolic blood pressure (DBP) and the heart rate (HR) before, during and after training at moderate intensity (MI, 50%-1RM) and at low intensity with blood flow restriction (LIBFR). In a randomized controlled trial study, 14 subjects (average age 45±9,9 years) performed one of the exercise protocols during two separate visits to the laboratory. SBP, DBP and HR measurements were collected prior to the start of the set and 15, 30, 45 and 60 minutes after knee extension exercises. Repeated measures of analysis of variance (ANOVA) were used to identify significant variables (2 × 5; group × time). The results demonstrated a significant reduction in SBP in the LIBFR group. These results provide evidence that strength training performed acutely alters hemodynamic variables. However, training with blood flow restriction is more efficient in reducing blood pressure in hypertensive individuals than training with moderate intensity.

  10. The Acute Effect of Resistance Exercise with Blood Flow Restriction with Hemodynamic Variables on Hypertensive Subjects

    PubMed Central

    Araújo, Joamira P.; Silva, Eliney D.; Silva, Julio C. G.; Souza, Thiago S. P.; Lima, Eloíse O.; Guerra, Ialuska; Sousa, Maria S. C.

    2014-01-01

    The purpose of this study was to analyze systolic blood pressure (SBP), diastolic blood pressure (DBP) and the heart rate (HR) before, during and after training at moderate intensity (MI, 50%-1RM) and at low intensity with blood flow restriction (LIBFR). In a randomized controlled trial study, 14 subjects (average age 45±9,9 years) performed one of the exercise protocols during two separate visits to the laboratory. SBP, DBP and HR measurements were collected prior to the start of the set and 15, 30, 45 and 60 minutes after knee extension exercises. Repeated measures of analysis of variance (ANOVA) were used to identify significant variables (2 × 5; group × time). The results demonstrated a significant reduction in SBP in the LIBFR group. These results provide evidence that strength training performed acutely alters hemodynamic variables. However, training with blood flow restriction is more efficient in reducing blood pressure in hypertensive individuals than training with moderate intensity. PMID:25713647

  11. Clinical validation of software for a versatile variability analyzer: Assessment of autonomic function

    PubMed Central

    Ananthakrishnan, T. S.; Jindal, G. D.; Sinha, Vineet; Jain, Rajesh K.; Kataria, S. K.; Deshpande, Alaka K.

    2007-01-01

    Study of physiological variability is an upcoming area of research having manifold clinical applications. Considerable work has been done on heart rate variability and blood pressure variability during the past four decades. Electronics division, Bhabha Atomic Research Centre, has developed an instrument called medical analyzer, which can be used to study several variabilities simultaneously. This instrument has been used to collect data from control subjects and patients with established diagnosis. The data has been analyzed with the help of a software package developed for this purpose and has been found to be consistent with expected manifestations of the disease on the autonomic nervous system. The description of the software package and results of the study are briefly described in this paper. PMID:21157528

  12. [Artificial blood - coming soon or never reaching clinical maturity?].

    PubMed

    Schöler, M; Frietsch, T; Jambor, C; Knels, R

    2010-03-01

    Formerly developed resuscitation fluids solely imitated the main function of the blood -oxygen transport. A research driven by the army requested an oxygen carrier that does not need cross typing and cooled storage. Artificial oxygen carriers (AOC) use either the molecular oxygen bondage to hemoglobin: HBOC- "hemoglobin based oxygen carriers" or the physical dissolution of oxygen in the blood plasma compartment by hyperbaric pressure in perfluorocarbon emulsions (PFC). Decades of preclinical and clinical research did pass but the results were disappointing- in Russia, a not well designed PFC is available locally and the only approved HBOC in South Africa is not being used much. Other products, just prior to filing for FDA approval, did not achieve convincing study results and research and production was stopped. Some trials have been stopped by the FDA for safety reasons, half of trials with the primary endpoint reduction of allogeneic transfusion requirement were unsuccessful or offset by an increased blood requirement later. However, some ventures currently are trying to use the knowledge gained so far and are investigating third and fourth generation products of artificial blood components. These imitate the cellular structure of red cells as micells, nanocapsules, (ABC- artificial blood cells) or gas bubbles (microbubbles), admixture of volume substitutes such as starches, gelatin or albumin or use hyperbaric oxygenation [38]. Artificial platelets are in clinical phase IIa, recombinant albumin in phase III. In this article, a short overview about the current situation on artificial blood products is given. The critical point for the break through for artificial blood products did not come yet but could be ahead- Copyright Georg Thieme Verlag KG Stuttgart . New York

  13. Systemic Hemodynamic Atherothrombotic Syndrome and Resonance Hypothesis of Blood Pressure Variability: Triggering Cardiovascular Events

    PubMed Central

    2016-01-01

    Blood pressure (BP) exhibits different variabilities and surges with different time phases, from the shortest beat-by-beat to longest yearly changes. We hypothesized that the synergistic resonance of these BP variabilites generates an extraordinarily large dynamic surge in BP and triggers cardiovascular events (the resonance hypothesis). The power of pulses is transmitted to the peripheral sites without attenuation by the large arteries, in individuals with stiffened arteries. Thus, the effect of a BP surge on cardiovascular risk would be especially exaggerated in high-risk patients with vascular disease. Based on this concept, our group recently proposed a new theory of systemic hemodynamic atherothromboltic syndrome (SHATS), a vicious cycle of hemodynamic stress and vascular disease that advances organ damage and triggers cardiovascular disease. Clinical phenotypes of SHATS are large-artery atherothombotic diseases such as stroke, coronary artery disease, and aortic and pheripheral artery disease; small-artery diseases, and microcirculation-related disease such as vascular cognitive dysfunction, heart failure, and chronic kidney disease. The careful consideration of BP variability and vascular diseases such as SHATS, and the early detection and management of SHATS, will achieve more effective individualized cardiovascular protection. In the near future, information and communication technology-based 'anticipation medicine' predicted by the changes of individual BP values could be a promising approach to achieving zero cardiovascular events. PMID:27482253

  14. Systemic Hemodynamic Atherothrombotic Syndrome and Resonance Hypothesis of Blood Pressure Variability: Triggering Cardiovascular Events.

    PubMed

    Kario, Kazuomi

    2016-07-01

    Blood pressure (BP) exhibits different variabilities and surges with different time phases, from the shortest beat-by-beat to longest yearly changes. We hypothesized that the synergistic resonance of these BP variabilites generates an extraordinarily large dynamic surge in BP and triggers cardiovascular events (the resonance hypothesis). The power of pulses is transmitted to the peripheral sites without attenuation by the large arteries, in individuals with stiffened arteries. Thus, the effect of a BP surge on cardiovascular risk would be especially exaggerated in high-risk patients with vascular disease. Based on this concept, our group recently proposed a new theory of systemic hemodynamic atherothromboltic syndrome (SHATS), a vicious cycle of hemodynamic stress and vascular disease that advances organ damage and triggers cardiovascular disease. Clinical phenotypes of SHATS are large-artery atherothombotic diseases such as stroke, coronary artery disease, and aortic and pheripheral artery disease; small-artery diseases, and microcirculation-related disease such as vascular cognitive dysfunction, heart failure, and chronic kidney disease. The careful consideration of BP variability and vascular diseases such as SHATS, and the early detection and management of SHATS, will achieve more effective individualized cardiovascular protection. In the near future, information and communication technology-based 'anticipation medicine' predicted by the changes of individual BP values could be a promising approach to achieving zero cardiovascular events.

  15. Combining clinical variables to optimize prediction of antidepressant treatment outcomes.

    PubMed

    Iniesta, Raquel; Malki, Karim; Maier, Wolfgang; Rietschel, Marcella; Mors, Ole; Hauser, Joanna; Henigsberg, Neven; Dernovsek, Mojca Zvezdana; Souery, Daniel; Stahl, Daniel; Dobson, Richard; Aitchison, Katherine J; Farmer, Anne; Lewis, Cathryn M; McGuffin, Peter; Uher, Rudolf

    2016-07-01

    The outcome of treatment with antidepressants varies markedly across people with the same diagnosis. A clinically significant prediction of outcomes could spare the frustration of trial and error approach and improve the outcomes of major depressive disorder through individualized treatment selection. It is likely that a combination of multiple predictors is needed to achieve such prediction. We used elastic net regularized regression to optimize prediction of symptom improvement and remission during treatment with escitalopram or nortriptyline and to identify contributing predictors from a range of demographic and clinical variables in 793 adults with major depressive disorder. A combination of demographic and clinical variables, with strong contributions from symptoms of depressed mood, reduced interest, decreased activity, indecisiveness, pessimism and anxiety significantly predicted treatment outcomes, explaining 5-10% of variance in symptom improvement with escitalopram. Similar combinations of variables predicted remission with area under the curve 0.72, explaining approximately 15% of variance (pseudo R(2)) in who achieves remission, with strong contributions from body mass index, appetite, interest-activity symptom dimension and anxious-somatizing depression subtype. Escitalopram-specific outcome prediction was more accurate than generic outcome prediction, and reached effect sizes that were near or above a previously established benchmark for clinical significance. Outcome prediction on the nortriptyline arm did not significantly differ from chance. These results suggest that easily obtained demographic and clinical variables can predict therapeutic response to escitalopram with clinically meaningful accuracy, suggesting a potential for individualized prescription of this antidepressant drug. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

  16. In-Clinic Blood Pressure Prediction of Normal Ambulatory Blood Pressure Monitoring in Pediatric Hypertension Referrals.

    PubMed

    Johnson, Philip K; Ferguson, Michael A; Zachariah, Justin P

    2016-07-01

    Since younger patients have low pretest probability of hypertension and are susceptible to reactive and masked hypertension, ambulatory blood pressure monitoring (ABPM) can be useful. To better target use in referred patients, we sought to define in-clinic systolic blood pressure (SBP) measures that predicted normal ABPM and target end organ damage. Data were collected on consecutive patients referred for high BP undergoing an ambulatory BP monitor from 2010 to 2013 (n = 248, 33.9% female, mean age 15.5 ± 3.6 years). Candidate in-clinic predictors were systolic maximum, minimum, or average BPs obtained by auscultative, oscillometric, or both. Multivariable logistic regression models were used to determine the prediction of normal ABPM by in-clinic BP predictors. Separate models considered predicting left ventricular hypertrophy (LVH) by in-clinic SBP vs. ABPM-defined hypertension. Identified predictor utility was tested with receiver operator characteristic curves. Maximum (OR 0.97 [95% CI 0.94-0.99]; P = .047), minimum (0.96 [0.94-0.99]; P = .002), and average (0.97 [0.95-1.00]; P = .04) in-clinic auscultative SBP predicted normal ABPM. Each had a c-statistic of 0.58. LVH was associated with in-clinic auscultative minimum SBP treated continuously (1.05, [1.01-1.10], P = .01) or dichotomized at the 90th percentile (8.23, [1.48-45.80], P = .02), as well as ABPM-defined hypertension (3.31, [1.23-8.91], P = .02). Both predictors had poor sensitivity and specificity. In youth, normal auscultative in-clinic systolic blood pressure indices weakly predicted normal ambulatory blood pressure and target end organ damage. © 2016 Wiley Periodicals, Inc.

  17. Blood-brain barrier dysfunction in brain diseases: clinical experience.

    PubMed

    Schoknecht, Karl; Shalev, Hadar

    2012-11-01

    The blood-brain barrier, a unique feature of the cerebral vasculature, is gaining attention as a feature in common neurologic disorders including stroke, traumatic brain injury, epilepsy, and schizophrenia. Although acute blood-brain barrier dysfunction can induce cerebral edema, seizures, or neuropsychiatric symptoms, epileptogenesis and cognitive decline are among the chronic effects. The mechanisms underlying blood-brain barrier dysfunction are diverse and may range from physical endothelial damage in traumatic brain injury to degradation of extracellular matrix proteins via matrix metalloproteinases as part of an inflammatory response. Clinically, blood-brain barrier dysfunction is often detected using contrast-enhanced imaging. However, these techniques do not give any insights into the underlying mechanism. Elucidating the specific pathways of blood-brain barrier dysfunction at different time points and in different brain diseases using novel imaging techniques promises a more accurate blood-brain barrier terminology as well as new treatment options and personalized treatment. Wiley Periodicals, Inc. © 2012 International League Against Epilepsy.

  18. Optoacoustic monitoring of blood hemoglobin concentration: a pilot clinical study

    NASA Astrophysics Data System (ADS)

    Petrova, Irina Y.; Esenaliev, Rinat O.; Petrov, Yuriy Y.; Brecht, Hans-Peter F.; Svensen, Christer H.; Olsson, Joel; Deyo, Donald J.; Prough, Donald S.

    2005-07-01

    The optoacoustic technique is noninvasive, has high spatial resolution, and potentially can be used to measure the total hemoglobin concentration ([THb]) continuously and accurately. We performed in vitro measurements in blood and in vivo tests in healthy volunteers. Our clinical protocol included rapid infusion of intravenous saline to simulate rapid change in the [THb] during fluid therapy or surgery. Optoacoustic measurements were made from the wrist area overlying the radial artery for more than 1 h. The amplitude of the optoacoustic signal generated in the radial artery closely followed the [THb] measured directly in concurrently collected blood samples.

  19. Nutrition assessment and its effect on various clinical variables among patients undergoing liver transplant

    PubMed Central

    Singh, Kalyani

    2016-01-01

    Background Malnutrition is highly prevalent in patients undergoing liver transplantation and has been associated to various clinical variables and outcome of the surgery. Methods We recruited 54 adult patients undergoing living donor liver transplant (LT) as study sample. Nutrition assessment was performed by body mass index (BMI), BMI for ascites, albumin, subjective global assessment (SGA) and anthropometry [mid upper arm circumference (MUAC), mid arm muscle circumference (MAMC), and triceps skin-fold (TSF)], Hand Grip strength, and phase angle of the body. Prevalence and comparison of malnutrition was performed with various clinical variables: aetiology, Child Turcotte Pugh scores and model for end stage liver disease (ESLD) grades, degree of ascites, blood product usage, blood loss during the surgery, mortality, days [intensive care unit (ICU), Ventilator and Hospital], and Bio-impedance analysis [weight, fat mass, fat free mass (FFM), muscle mass and body fat%]. Results Assessment of nutrition status represents a major challenge because of complications like fluid retention, hypoalbuminemia and hypoproteinemia. Different nutrition assessment tools show great disparity in the level of malnutrition among ESLD patients. In the present study recipient nutrition status evaluation by different nutrition assessment tools used showed malnutrition ranging from 3.7% to 100%. BMI and anthropometric measurements showed lower prevalence of malnutrition than phase angle and SGA whereas hand grip strength showed 100% malnutrition. Agreement among nutrition assessment methods showed moderate agreement (κ=0.444) of SGA with phase angle of the body. Malnutrition by different assessment tools was significantly associated to various clinical variables except MELD and days (ICU, Ventilator and Hospital). SGA was significantly (P<0.05) associated to majority of the clinical variables like aetiology, child Turcotte Pugh grades, degree of ascites, blood product usage, blood loss

  20. Blood pressure variability in the elderly. Association between postprandial and sleeping periods.

    PubMed

    Garcia, Fernando Abrão; Fidale, Beatriz; Ferreira-Filho, Sebastião Rodrigues

    2017-04-27

    The variability of arterial blood pressure (BP) is considered an important cardiovascular risk factor. To verify the possible associations between the postprandial and the sleeping blood pressure variability. This study evaluated systolic, diastolic, mean, pulse pressures and heart variability in 69 elderly patients in preprandial, postprandial and sleeping periods. One 24 hours ambulatory blood pressure monitoring was used for measurements and the results were showed in the time-rate index. We observed a decrease in the systolic blood pressure values from preprandial to postprandial and to the sleeping periods (124.7 ± 14.6, 113.2 ± 15.3 and 108.5 ± 13.9mmHg, respectively; p = 0.003). Associations between BP variability of the postprandial and sleeping periods were obtained for systolic, diastolic and mean arterial pressure. The correlation between postprandial and sleeping BP variability has rarely been demonstrated in the literature. These correlations between BP changes after eating and during sleep might suggest that both events could coexist in other clinical situations. A variabilidade da Pressão Arterial Sistêmica (PAS) é considerada um importante fator de risco cardio vascular. Verificar as possíveis associações entre as variabilidades pressóricas nos períodos pós prandial e durante o sono. A variabilidade das pressões sistólica, diastólica, média, de pulso e frequência cardíaca foram avaliadas em 69 pacientes idosos nos períodos pós prandial e durante o sono. A Monitorização Ambulatorial da Pressão Arterial de 24 horas foi usada para o cálculo da variabilidade pressórica e os resultados apresentados no índice frequência tempo. Observamosuma redução nos níveis sistólicos pos prandiais em relação ao período pre prandial e durante o sono (124.7 ± 14.6, 113.2 ± 15.3 e 108.5 ± 13.9mmHg, respectivamente; p = 0.003). A associação das variabilidade das pressões sistólicas, diastólicas e média foram confirmadas (p < 0

  1. Clinical use of blood and blood components in post-abortion care in Botswana.

    PubMed

    Tsima, B M; Melese, T; Mogobe, K D; Chabaesele, K; Rankgoane, G; Nassali, M; Habte, D

    2016-08-01

    Understanding the pattern and gaps in blood product utilisation in post-abortion care is crucial for evidence-based planning and priority setting. To describe the current use of blood and blood components in post-abortion care in Botswana. We conducted a retrospective cross-sectional study across four hospitals in Botswana using routine patients' records. We included all patients admitted for an abortion between January and August 2014. Descriptive statistics are used to report the results. Whole blood and red cell concentrates were used in 59/619 (9·5%) of patients. Plasma and platelet use was 1·3 and 0·7%, respectively. The mean admission haemoglobin level was 10·07 g dL(-1) (SD 2·69) and differed significantly between referral and district hospitals. The mean number of blood units transfused per patient was 2·23 (standard deviation (SD) 1·23), with 15/55 (27·3%) receiving a single unit. A total of 43/288 (14·9%) of the patients had haemoglobin levels below 7 g dL(-1) but did not receive any transfusion. There was a moderate positive correlation between admission haemoglobin level and time to transfusion (Spearman's rho = 0·37, P = 0·01). The number of blood units given increased with decreasing admission haemoglobin level. The strength of this association was moderate (Spearman's rho = -0·48, P < 0·001). There is a relatively low utilisation of blood and blood components in post-abortion care in Botswana despite an apparent clinical need in some instances. The reason for this shortfall, as well as its impact on morbidity and mortality, needs to be explored and be a focus of health systems research in Botswana. © 2016 The Authors. Transfusion Medicine published by John Wiley & Sons Ltd on behalf of British Blood Transfusion Society.

  2. [Study on serological blood group conversion rule and clinical blood transfusion in allogeneic hematopoietic stem cell transplantation].

    PubMed

    Yu, Zhong-qing; Gao, Zhi-feng; Li, Hui-yu

    2012-08-01

    To explore the conversion rule of serological blood group and blood group substance after successful allogeneic hematopoietic stem cell transplantation, and to provide theory for clinical special blood type identification and blood transfusion. The growth cycle of recipient WBC and RBC, RBC chimera, blood group antibody production and remaining in full transition were observed. Conversion rule of blood group substance, contradiction between cells typing and sera typing were detected by saline medium tube method and microcolumn gel method after stem cells transplantation. The average time of engraftment in 21 recipients was about 18.6 days, RBC growth cycle in 8 major blood type incompatibility was 56.6 days, 25.9 days in 9 minor blood type incompatibility, 67 days in 4 bidirectional blood type incompatibility (P < 0.01). The ratio of RBC chimeric growth was 1:9, gradually converse to donor's blood group. Residue of recipient anti-A(B) was left after conditioning regimen, disappeared after full transformation, and recipient anti-A(B) was converse to donor's blood type in major blood type incompatibility. 5 A blood type recipient donated by O blood type blood generated anti-B instead of anti-A, 3 B blood type recipient generated only anti-A instead of B in minor blood type incompatibility, and 1 AB blood type recipient donated by A did not generate anti-B. Among 4 bidirectional blood type incompatibility, 2 B blood type recipient donated by A blood type blood did not generate anti-B, 2 A recipient by B could not produce anti-A. Recipient blood group substance helped original ABO blood type substance remain unchanged. Among patient with allogeneic hematopoietic stem cell transplantation, recipient's ABO and RBC blood type can be converse to donor's, but there is significant difference between patients of serological blood group and of normal people (P < 0.01). Recipient blood group substance helps original ABO blood type substance remain unchanged (P > 0.01).

  3. Beat-to-beat heart rate and blood pressure variability and hypertensive disease in pregnancy.

    PubMed

    Flood, Pamela; McKinley, Paula; Monk, Catherine; Muntner, Paul; Colantonio, Lisandro D; Goetzl, Laura; Hatch, Maureen; Sloan, Richard P

    2015-09-01

    The aim of this study is to determine the relationship between heart rate and/or blood pressure variability, measured at 28 weeks' gestation, and the incidence of pregnancy-induced hypertension or preeclampsia. Secondary analysis of data from a prospectively enrolled cohort of 385 active military women in whom spectral analysis of continuous heart rate and variability was measured at 28 weeks' gestation. The primary outcome was the predictive value of spectral analysis of heart rate and blood pressure for hypertensive diseases of pregnancy. High-frequency heart rate variability was reduced and low-frequency variability of systolic and diastolic blood pressure increased in women who would develop pregnancy-induced hypertension but not preeclampsia. Low-frequency variability of diastolic blood pressure remained a significant predictor of pregnancy-induced hypertension but not preeclampsia after adjustment for age, weight, and blood pressure in a multivariate model. Early identification of pregnancy-induced hypertension can facilitate treatment to avoid maternal morbidity. Understanding the physiological underpinnings of the two very different diseases may lead to improved treatment and prevention. If proven effective in a broader population, the ability to differentiate pregnancy-induced hypertension from preeclampsia may reduce unnecessary iatrogenic interventions or inappropriate preterm delivery. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  4. Mat Pilates training reduced clinical and ambulatory blood pressure in hypertensive women using antihypertensive medications.

    PubMed

    Martins-Meneses, Daniele Tavares; Antunes, Hanna Karen Moreira; de Oliveira, Nara Rejane Cruz; Medeiros, Alessandra

    2015-01-20

    Physical exercise has been used in the treatment of hypertension. However, there are few methods researched and shown beneficial for treatment of hypertension. The objective was to evaluate the effect of Mat Pilates training (MP) on blood pressure (BP) of hypertensive women medicated with antihypertensive drugs. 44 hypertensive women (50.5 ± 6.3 years age), treated with medication for blood pressure and, uninvolved in structured exercise program were distributed into two groups: Training Group (TG) and Control Group (CG). TG performed 60-minute sessions of MP, twice a week for 16 weeks. CG was requested to maintain daily activities without exercise training. The following variables were evaluated during the pre- and post-experimental periods: clinical and ambulatory BP, heart rate (HR) and double product (DP), besides body mass, height, body mass index, waist and hip circumferences, flexibility, and right and left hand strengths. TG showed statistically significant improvements (p<0.05) within and between-groups for the systolic, diastolic and mean BP in all moments evaluated (clinical, 24h, awake and asleep). Besides that, TG showed improvements in height, waist and hip circumferences, flexibility, right and left hand strengths and clinical DP. The other variables in TG, as well as all variables in the CG didn't show significant changes. In hypertensive women using antihypertensive medications, MP reduces clinical and ambulatory BP. These results support the recommendation of MP as a non-drug treatment for hypertension. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  5. [Clinical variability and diagnosis steps in childhood mitochondrial disease].

    PubMed

    Mercier, S; Josselin de Wasch, M; Labarthe, F; Jardel, C; Lombès, A; Munnich, A; Toutain, A; Nivet, H; Saliba, E; Chantepie, A; Castelnau, P

    2009-04-01

    Mitochondrial respiratory chain deficiencies are known for their high clinical variability. Difficult to diagnose, the prevalence of these diseases is probably underestimated. We report 18 children diagnosed with respiratory chain deficiency at the Tours University Hospital over the past 10 years. Three clinical profiles can be distinguished depending on the age at onset of the first symptoms: the neonatal period (4 cases), between 1 month and 2 years of age (10 cases), and after 10 years (4 cases). However, no clinical feature appears specific of any age group. In contrast, respiratory chain analysis on liver biopsy was very informative for all our patients at any age and with any clinical presentation, even with predominant neurological symptoms. These biochemical analyses support the diagnosis of mitochondrial disorders in view of molecular analysis, which nevertheless frequently remains inconclusive. These investigations should benefit from the new molecular screening technologies based on DNA chips that can identify the genomic mutations responsible for these severe and relatively frequent diseases.

  6. Expert Assistant For A Clinical Hematology Blood Cell Analyzer

    NASA Astrophysics Data System (ADS)

    Young, Carole; Navlakha, Jainendra K.

    1989-03-01

    The COULTER COUNTER Model S Plus Series instruments are automated clinical hematology blood cell analyzers which measure the count, volume and population distribution of red blood cells, white blood cells and platelets, and hemoglobin from patient blood samples. In the clinical laboratory environment, instrument startup consists of a number of component and system checks to assure proper operation and calibration to insure reliable results are produced on patient samples. If a startup check fails, troubleshooting procedures are provided to assist the operator in determining the cause of the error. Troubleshooting requires expertise in instrument operation, troubleshooting procedures and evaluation of the data produced. This expert system is designed and developed to assist the startup diagnostics of COULTER COUNTER Model S Plus Series instruments. The system reads data produced by the instrument and validates it against expected values. If the values are not all correct, then the troubleshooting starts. Troubleshooting is handled for the most common subsystem problems and those which the operator has the equipment and knowledge to handle, problems that are cheapest to fix and problems that are quickest to fix. The expert system restarts the startup sequence whenever troubleshooting has been successful or recommends calling Customer Service when unsuccessful.

  7. Circadian blood pressure variability in type 1 diabetes subjects and their nondiabetic siblings - influence of erythrocyte electron transfer

    PubMed Central

    2010-01-01

    Background Normotensive non-diabetic relatives of type 1 diabetes (T1D) patients have an abnormal blood pressure response to exercise testing that is associated with indices of metabolic syndrome and increased oxidative stress. The primary aim of this study was to investigate the circadian variability of blood pressure and the ambulatory arterial stiffness index (AASI) in healthy siblings of T1D patients vs healthy control subjects who had no first-degree relative with T1D. Secondary aims of the study were to explore the influence of both cardiovascular autonomic function and erythrocyte electron transfer activity as oxidative marker on the ambulatory blood pressure profile. Methods Twenty-four hour ambulatory blood pressure monitoring (ABPM) was undertaken in 25 controls, 20 T1D patients and 20 siblings. In addition to laboratory examination (including homeostasis model assessment of insulin sensitivity) and clinical testing of autonomic function, we measured the rate of oxidant-induced erythrocyte electron transfer to extracellular ferricyanide (RBC vfcy). Results Systolic blood pressure (SBP) midline-estimating statistic of rhythm and pulse pressure were higher in T1D patients and correlated positively with diabetes duration and RBC vfcy; autonomic dysfunction was associated with diastolic BP ecphasia and increased AASI. Siblings had higher BMI, lower insulin sensitivity, larger SBP amplitude, and higher AASI than controls. Daytime SBP was positively, independently associated with BMI and RBC vfcy. Among non-diabetic people, there was a significant correlation between AASI and fasting plasma glucose. Conclusions Siblings of T1D patients exhibited a cluster of sub-clinical metabolic abnormalities associated with consensual perturbations in BP variability. Moreover, our findings support, in a clinical setting, the proposed role of transplasma membrane electron transport systems in vascular pathobiology. PMID:20920366

  8. Can Ambulatory Blood Pressure Variability Contribute to Individual Cardiovascular Risk Stratification?

    PubMed

    Magdás, Annamária; Szilágyi, László; Incze, Alexandru

    2016-01-01

    Objective. The aim of this study is to define the normal range for average real variability (ARV) and to establish whether it can be considered as an additional cardiovascular risk factor. Methods. In this observational study, 110 treated hypertensive patients were included and admitted for antihypertensive treatment adjustment. Circadian blood pressure was recorded with validated devices. Blood pressure variability (BPV) was assessed according to the ARV definition. Based on their variability, patients were classified into low, medium, and high variability groups using the fuzzy c-means algorithm. To assess cardiovascular risk, blood samples were collected. Characteristics of the groups were compared by ANOVA tests. Results. Low variability was defined as ARV below 9.8 mmHg (32 patients), medium as 9.8-12.8 mmHg (48 patients), and high variability above 12.8 mmHg (30 patients). Mean systolic blood pressure was 131.2 ± 16.7, 135.0 ± 12.1, and 141.5 ± 11.4 mmHg in the low, medium, and high variability groups, respectively (p = 0.0113). Glomerular filtration rate was 78.6 ± 29.3, 74.8 ± 26.4, and 62.7 ± 23.2 mL/min/1.73 m(2) in the low, medium, and high variability groups, respectively (p = 0.0261). Conclusion. Increased values of average real variability represent an additional cardiovascular risk factor. Therefore, reducing BP variability might be as important as achieving optimal BP levels, but there is need for further studies to define a widely acceptable threshold value.

  9. Variability in blood and blood component utilization as assessed by an anesthesia information management system.

    PubMed

    Frank, Steven M; Savage, Will J; Rothschild, Jim A; Rivers, Richard J; Ness, Paul M; Paul, Sharon L; Ulatowski, John A

    2012-07-01

    Data can be collected for various purposes with anesthesia information management systems. The authors describe methods for using data acquired from an anesthesia information management system to assess intraoperative utilization of blood and blood components. Over an 18-month period, data were collected on 48,086 surgical patients at a tertiary care academic medical center. All data were acquired with an automated anesthesia recordkeeping system. Detailed reports were generated for blood and blood component utilization according to surgical service and surgical procedure, and for individual surgeons and anesthesiologists. Transfusion hemoglobin trigger and target concentrations were compared among surgical services and procedures, and between individual medical providers. For all patients given erythrocytes, the mean transfusion hemoglobin trigger was 8.4 ± 1.5, and the target was 10.2 ± 1.5 g/dl. Variation was significant among surgical services (trigger range: 7.5 ± 1.2-9.5 ± 1.1, P = 0.0001; target range: 9.1 ± 1.2-11.3 ± 1.4 g/dl, P = 0.002), surgeons (trigger range: 7.2 ± 0.7-9.8 ± 1.0, P = 0.001; target range: 8.8 ± 0.9-11.8 ± 1.3 g/dl, P = 0.001), and anesthesiologists (trigger range: 7.2 ± 0.8-9.6 ± 1.2, P = 0.001; target range: 9.0 ± 0.9-11.7 ± 1.3 g/dl, P = 0.0004). The use of erythrocyte salvage, fresh frozen plasma, and platelets varied threefold to fourfold among individual surgeons compared with their peers performing the same surgical procedure. The use of data acquired from an anesthesia information management system allowed a detailed analysis of blood component utilization, which revealed significant variation among surgical services and surgical procedures, and among individual anesthesiologists and surgeons compared with their peers. Incorporating these methods of data acquisition and analysis into a blood management program could reduce unnecessary transfusions, an outcome that may increase patient safety and reduce costs.

  10. Identification of low and high frequency ranges for heart rate variability and blood pressure variability analyses using pharmacological autonomic blockade with atropine and propranolol in swine.

    USDA-ARS?s Scientific Manuscript database

    Understanding autonomic nervous system functioning, which mediates behavioral and physiological responses to stress, offers great potential for evaluation of farm animal stress and welfare. Evaluation of heart rate variability (HRV) and blood pressure variability (BPV), using time and frequency doma...

  11. On the origin of low-frequency blood pressure variability in the conscious dog.

    PubMed Central

    Just, A; Wagner, C D; Ehmke, H; Kirchheim, H R; Persson, P B

    1995-01-01

    1. Baroreceptor denervation increases blood pressure variability below 0.1 Hz. This study was undertaken to determine to what extent these fluctuations originate from the central nervous system or from cardiovascular sources. 2. Blood pressure was recorded at a rate of 10 Hz for approximately 3.5 h in conscious, resting dogs. Power density spectra were calculated from all 2(17) points of each recording session and integrated between 0.0002 and 0.1 Hz. 3. Blockade of the afferent limb of the baroreceptor reflex by surgical denervation of sinoaortic and cardiopulmonary afferents (Den; n = 6) significantly increased integrated power more than sixfold compared with a control group (n = 11). 4. Impairment of the efferent limb in non-deafferented dogs by either alpha 1-adrenergic blockade with prazosin (Praz; n = 7) or ganglionic blockade with hexamethonium (Hex; n = 6) failed to raise variability. 5. Both prazosin (n = 6) and hexamethonium (n = 3) reduced the increased variability in denervated dogs. 6. In non-deafferented dogs receiving hexamethonium, elevation of mean blood pressure to the hypertensive level of the Den group, by a continuous infusion of noradrenaline (n = 4), did not change the variability. 7. It is concluded that in the absence of changes in posture, most of the increased blood pressure variability after baroreceptor denervation is derived from the central nervous system. 8. Direct comparison of power spectra of the Den (total variability) and Hex groups (variability derived from the cardiovascular system only) suggests that the central nervous system is also the prevalent source of low-frequency blood pressure variability in intact animals. PMID:8583405

  12. Variability of clinical functional MR imaging results: a multicenter study.

    PubMed

    Wurnig, Moritz C; Rath, Jakob; Klinger, Nicolaus; Höllinger, Ilse; Geissler, Alexander; Fischmeister, Florian P; Aichhorn, Markus; Foki, Thomas; Kronbichler, Martin; Nickel, Janpeter; Siedentopf, Christian; Staffen, Wolfgang; Verius, Michael; Golaszewski, Stefan; Koppelstätter, Florian; Knosp, Engelbert; Auff, Eduard; Felber, Stephan; Seitz, Rüdiger J; Beisteiner, Roland

    2013-08-01

    To investigate intersite variability of clinical functional magnetic resonance (MR) imaging, including influence of task standardization on variability and use of various parameters to inform the clinician whether the reliability of a given functional localization is high or low. Local ethics committees approved the study; all participants gave written informed consent. Eight women and seven men (mean age, 40 years) were prospectively investigated at three experienced functional MR sites with 1.5- (two sites) or 3-T (one site) MR. Nonstandardized motor and highly standardized somatosensory versions of a frequently requested clinical task (localization of the primary sensorimotor cortex) were used. Perirolandic functional MR variability was assessed (peak activation variability, center of mass [COM] variability, intraclass correlation values, overlap ratio [OR], activation size ratio). Data quality measures for functional MR images included percentage signal change (PSC), contrast-to-noise ratio (CNR), and head motion parameters. Data were analyzed with analysis of variance and a correlation analysis. Localization of perirolandic functional MR activity differed by 8 mm (peak activity) and 6 mm (COM activity) among sites. Peak activation varied up to 16.5 mm (COM range, 0.4-16.5 mm) and 45.5 mm (peak activity range, 1.8-45.5 mm). Signal strength (PSC, CNR) was significantly lower for the somatosensory task (mean PSC, 1.0% ± 0.5 [standard deviation]; mean CNR, 1.2 ± 0.4) than for the motor task (mean PSC, 2.4% ± 0.8; mean CNR, 2.9 ± 0.9) (P < .001, both). Intersite variability was larger with low signal strength (negative correlations between signal strength and peak activation variability) even if the task was highly standardized (mean OR, 22.0% ± 18.9 [somatosensory task] and 50.1% ± 18.8 [motor task]). Clinical practice and clinical functional MR biomarker studies should consider that the center of task-specific brain activation may vary up to 16.5 mm, with

  13. Childhood Depression: Relation to Adaptive, Clinical and Predictor Variables

    PubMed Central

    Garaigordobil, Maite; Bernarás, Elena; Jaureguizar, Joana; Machimbarrena, Juan M.

    2017-01-01

    The study had two goals: (1) to explore the relations between self-assessed childhood depression and other adaptive and clinical variables (2) to identify predictor variables of childhood depression. Participants were 420 students aged 7–10 years old (53.3% boys, 46.7% girls). Results revealed: (1) positive correlations between depression and clinical maladjustment, school maladjustment, emotional symptoms, internalizing and externalizing problems, problem behaviors, emotional reactivity, and childhood stress; and (2) negative correlations between depression and personal adaptation, global self-concept, social skills, and resilience (sense of competence and affiliation). Linear regression analysis including the global dimensions revealed 4 predictors of childhood depression that explained 50.6% of the variance: high clinical maladjustment, low global self-concept, high level of stress, and poor social skills. However, upon introducing the sub-dimensions, 9 predictor variables emerged that explained 56.4% of the variance: many internalizing problems, low family self-concept, high anxiety, low responsibility, low personal self-assessment, high social stress, few aggressive behaviors toward peers, many health/psychosomatic problems, and external locus of control. The discussion addresses the importance of implementing prevention programs for childhood depression at early ages. PMID:28572787

  14. Clinical and haematological responses of feline blood donors anaesthetised with a tiletamine and zolazepam combination.

    PubMed

    Spada, Eva; Proverbio, Daniela; Bagnagatti De Giorgi, Giada; Perego, Roberta; Valena, Emanuela; Della Pepa, Alessandra; Baggiani, Luciana

    2015-04-01

    This prospective study investigated the effect on clinical and haematological variables of the anaesthetic combination of tiletamine and zolazepam in feline blood donors. Blood (10 ml/kg bodyweight to a maximum volume of 60 ml) was collected from the jugular vein of 31 owned healthy cats anaesthetised with 2.5 mg/kg of tiletamine and 2.5 mg/kg of zolazepam intramuscularly. Rectal temperature (RT), systolic arterial pressure (SAP), mean arterial pressure (MAP), diastolic arterial pressure (DAP), heart rate (HR) and complete blood count (including red blood cells [RBC], haemoglobin [HB], haematocrit [HT], platelet [PLT] count, white blood cells [WBC], lymphocytes, neutrophils, eosinophils, monocytes and basophils) were evaluated pre- and postdonation. RT decreased significantly (P <0.01) after blood donation (mean change in RT -0.7°C). Significant increases in SAP (P = 0.03), MAP (P <0.01) and DAP (P <0.01) occurred after blood donation (mean increase 13 mmHg, 12 mmHg and 11 mmHg, respectively). Although RBC, HT, HB, WBC, PLT, neutrophil and monocyte counts decreased, and HR, and lymphocyte, eosinophil and basophil counts increased after blood donation this change was not statistically significant. Mean time from pre- to postdonation evaluation was 39 ± 11 mins (range 24-76 mins). None of the cats had evidence of pallor or collapse after recovery from anaesthesia. The collection of blood at 10 ml/kg bodyweight to a maximum volume of 60 ml in healthy cats using a low dose tiletamine and zolazepam anaesthetic appears to be well tolerated by feline blood donors.

  15. Low heart rate variability in patients with clinical burnout.

    PubMed

    Lennartsson, Anna-Karin; Jonsdottir, Ingibjörg; Sjörs, Anna

    2016-12-01

    Several studies have shown that acute psychosocial stress and chronic psychosocial stress reduce heart rate variability (HRV). It is likely that individuals suffering from burnout have reduced HRV, as a consequence of the long-term stress exposure. This study investigated HRV in 54 patients with clinical burnout (40 women and 14 men) and in 55 individuals reporting low burnout scores (healthy; 24 women and 31 men) and 52 individuals reporting high burnout scores (non-clinical burnout; 33 women and 19 men). The participants underwent a 300s ECG recording in the supine position. Standard deviation of normal R-R intervals (SDNN) and the root mean square of successive normal interval differences (RMSSD) were derived from time domain HRV analysis. Frequency domain HRV measures; total power (TP), low frequency power (LF), high frequency power (HF), and LF/HF ratio were calculated. All HRV measures, except LF/HF ratio, were lower in the clinical burnout patients compared to both the non-clinical burnout group and the healthy group. The difference was larger between the patients and the healthy group than between the patients and the non-clinical burnout group. HRV did not differ significantly between the non-clinical burnout group and the healthy group. Low HRV in burnout patients may constitute one of the links to associated adverse health, since low HRV reflects low parasympathetic activity - and accordingly low anabolic/regenerative activity.

  16. AARC clinical practice guideline: blood gas analysis and hemoximetry: 2013.

    PubMed

    Davis, Michael D; Walsh, Brian K; Sittig, Steve E; Restrepo, Ruben D

    2013-10-01

    We searched MEDLINE, CINAHL, and Cochrane Library database for articles published between January 1990 and December 2012. The update of this clinical practice guideline is based on 237 clinical trials, 54 reviews, and 23 meta-analyses on blood gas analysis (BGA) and hemoximetry. The following recommendations are made following the Grading of Recommendations Assessment, Development, and Evaluation scoring system. BGA and hemoximetry are recommended for evaluating a patient's ventilatory, acid-base, and/or oxygenation status. BGA and hemoximetry are suggested for evaluating a patient's response to therapeutic interventions. BGA and hemoximetry are recommended for monitoring severity and progression of documented cardiopulmonary disease processes. Hemoximetry is recommended to determine the impact of dyshemoglobins on oxygenation. Capillary BGA is not recommended to determine oxygenation status. Central venous BGA and hemoximetry are suggested to determine oxygen consumption in the setting of early goal-directed therapies. For the assessment of oxygenation, a peripheral venous P(O2) is not recommended as a substitute for an arterial blood measurement (P(aO2)). It is not recommended to use venous P(CO2) and pH as a substitute for arterial blood measurement of P(aCO2) and pH. It is suggested that hemoximetry is used in the detection and evaluation of shunts during diagnostic cardiac catheterization.

  17. Clinical applications of the continuous flow blood separator machine.

    PubMed Central

    Oon, C J; Hobbs, J R

    1975-01-01

    The NCl/IBM or Aminco Continuous Flow Blood Separator Machine is a safe apparatus for the selective removal or exchange of either packed red blood cells, leucocyte-rich or platelet-rich layers or plasma. Abnormal fractions from any of these layers may be collected and discarded. Normal constituents may be collected for therapeutic uses. The wide scope of its applications includes important uses in clinical immunology: temporary provision of good leucocytes or platelets; harvesting of immune leucocytes (preparation of transfer factor at up to 10 units per harvest); removal of cryo- or macro-globulins, immune complexes or blocking factors; replacement therapy for antibody or complement deficiencies. Examples are given of such uses together with some of the medical problems so far encountered. Images FIG. 6 PMID:1106917

  18. Visualizing blood vessel trees in three dimensions: clinical applications

    NASA Astrophysics Data System (ADS)

    Bullitt, Elizabeth; Aylward, Stephen

    2005-04-01

    A connected network of blood vessels surrounds and permeates almost every organ of the human body. The ability to define detailed blood vessel trees enables a variety of clinical applications. This paper discusses four such applications and some of the visualization challenges inherent to each. Guidance of endovascular surgery: 3D vessel trees offer important information unavailable by traditional x-ray projection views. How best to combine the 2- and 3D image information is unknown. Planning/guidance of tumor surgery: During tumor resection it is critical to know which blood vessels can be interrupted safely and which cannot. Providing efficient, clear information to the surgeon together with measures of uncertainty in both segmentation and registration can be a complex problem. Vessel-based registration: Vessel-based registration allows pre-and intraoperative images to be registered rapidly. The approach both provides a potential solution to a difficult clinical dilemma and offers a variety of visualization opportunities. Diagnosis/staging of disease: Almost every disease affects blood vessel morphology. The statistical analysis of vessel shape may thus prove to be an important tool in the noninvasive analysis of disease. A plethora of information is available that must be presented meaningfully to the clinician. As medical image analysis methods increase in sophistication, an increasing amount of useful information of varying types will become available to the clinician. New methods must be developed to present a potentially bewildering amount of complex data to individuals who are often accustomed to viewing only tissue slices or flat projection views.

  19. [Variability in the recommendations for the clinical management of osteoporosis].

    PubMed

    Sanfélix-Genovés, José; Catalá-López, Ferrán; Sanfélix-Gimeno, Gabriel; Hurtado, Isabel; Baixauli, Cristóbal; Peiró, Salvador

    2014-01-07

    Analysis of the variability in the recommendations of the main guidelines and clinical documents for the management of osteoporosis. Searches were carried out in PubMed, Google, web pages of national and international scientific societies related to the management of osteoporosis, and agencies that develop guidelines. We analyzed guidelines and clinical documents that included recommendations for the indication of bone densitometry and/or pharmacological treatment, which could influence the management of osteoporosis in the Spanish National Health System, which have been published between 2006 and 2012. We included 12 documents. Eleven recommend performing bone densitometry upon assessing women risk factors, but the number and type of risk factors vary between documents: 6 recommend its implementation to all women over 65 years, 4 in men aged 65-70 years, and 3 when there is radiological suspicion of osteoporosis. There is agreement on the recommendations on the indication for densitometry to monitor drug response. In primary prevention, all national documents combined risk factors and densitometric osteoporosis and 3 of them recommend individual assessment according to risk factors. Most of the international guidelines require the calculation of risk with the FRAX(®) tool. In secondary prevention, all documents recommend treatment in cases of hip or clinical vertebral fracture; in men, and for the rest of fractures, the recommendations are heterogeneous. Overall there is a high variability in the recommendations of guidelines and other documents for the management of osteoporosis. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  20. Biological variables in the hair uptake of methylmercury from blood in the Macaque monkey

    SciTech Connect

    Mottet, N.K.; Body, R.L.; Wilkens, V.; Burbacher, T.M.

    1987-04-01

    The total mercury (Hg) in hair and blood of 45 young healthy adult female Macaque fascicularis given 0, 50, 70, or 90 ..mu..g MeHg/kg body wt orally in apple juice daily revealed a close and constant ratio between blood Hg and hair. The amount of hair Hg does not increase with time (maximum period of observation 490 days) at a given dose level. Also the ratio was unchanged between background and subtoxic dose levels. Individuals at a given dose level with a higher-than-average blood level had a proportionately higher hair level. The Macaque blood/hair ratio is markedly lower than that reported for humans. Pregnancy did not have an appreciable effect on the hair mercury level. Review of the known variables in human and Macaque hair growth and structures does not provide an explanation for the difference. They suggest that an as yet unidentified biological variable(s), possibly circumfollicular blood flow, could account for the difference. This ratio difference notwithstanding, controlled studies on Macaque hair such as this add support for the validity of terminal hair as a trace metal exposure indicator.

  1. Inhibitory effects of losartan and azelnidipine on augmentation of blood pressure variability induced by angiotensin II in rats.

    PubMed

    Jiang, Danfeng; Kawagoe, Yukiko; Kuwasako, Kenji; Kitamura, Kazuo; Kato, Johji

    2017-07-05

    Increased blood pressure variability has been shown to be associated with cardiovascular morbidity and mortality. Recently we reported that continuous infusion of angiotensin II not only elevated blood pressure level, but also increased blood pressure variability in a manner assumed to be independent of blood pressure elevation in rats. In the present study, the effects of the angiotensin type I receptor blocker losartan and the calcium channel blocker azelnidipine on angiotensin II-induced blood pressure variability were examined and compared with that of the vasodilator hydralazine in rats. Nine-week-old male Wistar rats were subcutaneously infused with 240 pmol/kg/min angiotensin II for two weeks without or with oral administration of losartan, azelnidipine, or hydralazine. Blood pressure variability was evaluated using a coefficient of variation of blood pressure recorded every 15min under an unrestrained condition via an abdominal aortic catheter by a radiotelemetry system. Treatment with losartan suppressed both blood pressure elevation and augmentation of systolic blood pressure variability in rats infused with angiotensin II at 7 and 14 days. Azelnidipine also inhibited angiotensin II-induced blood pressure elevation and augmentation of blood pressure variability; meanwhile, hydralazine attenuated the pressor effect of angiotensin II, but had no effect on blood pressure variability. In conclusion, angiotensin II augmented blood pressure variability in an angiotensin type 1 receptor-dependent manner, and azelnidipine suppressed angiotensin II-induced augmentation of blood pressure variability, an effect mediated by the mechanism independent of the blood pressure-lowering action. Copyright © 2017 Elsevier B.V. All rights reserved.

  2. Blood Pressure and Heart Rate Variability to Detect Vascular Dysregulation in Glaucoma

    PubMed Central

    Koch, Eva Charlotte; Staab, Johanna; Fuest, Matthias; Witt, Katharina; Voss, Andreas; Plange, Niklas

    2015-01-01

    Purpose. To investigate blood pressure and heart rate variability in patients with primary open-angle glaucoma (POAG) to detect disturbed blood pressure regulation. Methods. Thirty-one patients with POAG (mean age 68 ± 10 years) and 48 control subjects (mean age 66 ± 10 years) were included in a prospective study. Continuous blood pressure and heart rate were simultaneously and noninvasively recorded over 30 min (Glaucoscreen, aviant GmbH, Jena, Germany). Data were analyzed calculating univariate linear (time domain and frequency domain), nonlinear (Symbolic Dynamics, SD) and bivariate (Joint Symbolic Dynamics, JSD) indices. Results. Using nonlinear methods, glaucoma patients were separated with more parameters compared to linear methods. In POAG, nonlinear univariate indices (pW113 and pW120_Sys) were increased while the indices pTH10_Sys and pTH11_Sys reflect a reduction of dominant patterns. Bivariate indices (JSDdia29, JSDdia50, and JSDdia52; coupling between heart rate and diastolic blood pressure) were increased in POAG. The optimum set consisting of six parameters (JSDdia29, JSDdia58, pTH9_Sys, pW231, pW110_Sys and pW120_Sys) revealed a sensitivity of 83.3% and specificity of 80.6%. Conclusions. Nonlinear uni- and bivariate indices of continuous recordings of blood pressure and heart rate are altered in glaucoma. Abnormal blood pressure variability suggests disturbed autonomic regulation in patients with glaucoma. PMID:26495136

  3. Blood Pressure and Heart Rate Variability to Detect Vascular Dysregulation in Glaucoma.

    PubMed

    Koch, Eva Charlotte; Staab, Johanna; Fuest, Matthias; Witt, Katharina; Voss, Andreas; Plange, Niklas

    2015-01-01

    Purpose. To investigate blood pressure and heart rate variability in patients with primary open-angle glaucoma (POAG) to detect disturbed blood pressure regulation. Methods. Thirty-one patients with POAG (mean age 68 ± 10 years) and 48 control subjects (mean age 66 ± 10 years) were included in a prospective study. Continuous blood pressure and heart rate were simultaneously and noninvasively recorded over 30 min (Glaucoscreen, aviant GmbH, Jena, Germany). Data were analyzed calculating univariate linear (time domain and frequency domain), nonlinear (Symbolic Dynamics, SD) and bivariate (Joint Symbolic Dynamics, JSD) indices. Results. Using nonlinear methods, glaucoma patients were separated with more parameters compared to linear methods. In POAG, nonlinear univariate indices (pW113 and pW120_Sys) were increased while the indices pTH10_Sys and pTH11_Sys reflect a reduction of dominant patterns. Bivariate indices (JSDdia29, JSDdia50, and JSDdia52; coupling between heart rate and diastolic blood pressure) were increased in POAG. The optimum set consisting of six parameters (JSDdia29, JSDdia58, pTH9_Sys, pW231, pW110_Sys and pW120_Sys) revealed a sensitivity of 83.3% and specificity of 80.6%. Conclusions. Nonlinear uni- and bivariate indices of continuous recordings of blood pressure and heart rate are altered in glaucoma. Abnormal blood pressure variability suggests disturbed autonomic regulation in patients with glaucoma.

  4. Effect of Fasting Blood Glucose Level on Heart Rate Variability of Healthy Young Adults

    PubMed Central

    Lutfi, Mohamed Faisal; Elhakeem, Ramaze Farouke

    2016-01-01

    Background Previous studies reported increased risk of cardiac events in subjects with fasting blood glucose (FBG) levels lower than the diagnostic threshold of diabetes mellitus. However, whether increased cardiac events in those with upper normal FBG is secondary to the shift of their cardiac sympathovagal balance towards sympathetic predominance is unknown. Aims To assess the association between FBG levels and cardiac autonomic modulation (CAM) in euglycaemic healthy subjects based on heart rate variability (HRV) derived indices. Subjects and Methods The study enrolled 42 healthy young adults. Following sociodemographic and clinical assessment, blood samples were collected to measure FBG levels. Five minutes ECG recordings were performed to all participants to obtain frequency domain HRV measurements, namely the natural logarithm (Ln) of total power (LnTP), very low frequency (LnVLF), low frequency (LnLF) and high frequency (LnHF), low frequency/ high frequency ratio (LnLF/HF), normalized low frequency (LF Norm) and high frequency (HF Norm). Results FBG levels correlated positively with LnHF (r = 0.33, P = 0.031) and HF Norm (r = 0.35, P = 0.025) and negatively with LF Norm (r = -0.35, P = 0.025) and LnLF/HF (r = -0.33, P = 0.035). LnHF and HF Norm were significantly decreased in subjects with the lower (4.00 (1.34) ms2/Hz and 33.12 (11.94) n.u) compared to those with the upper FBG quartile (5.64 (1.63) ms2/Hz and 49.43 (17.73) n.u, P = 0.013 and 0.032 respectively). LF Norm and LnLF/HF were significantly increased in subjects with the lower (66.88 (11.94) n.u and 0.73 (0.53)) compared to those with the higher FBG quartile (50.58 (17.83) n.u and 0.03 (0.79), P = 0.032 and 0.038 respectively). Conclusion The present study is the first to demonstrate that rise of blood glucose concentration, within physiological range, is associated with higher parasympathetic, but lower sympathetic CAM. Further researches are needed to set out the glycemic threshold beyond which

  5. Clinical Decision Support Reduces Overuse of Red Blood Cell Transfusions: Interrupted Time Series Analysis.

    PubMed

    Kassakian, Steven Z; Yackel, Thomas R; Deloughery, Thomas; Dorr, David A

    2016-06-01

    Red blood cell transfusion is the most common procedure in hospitalized patients in the US. Growing evidence suggests that a sizeable percentage of these transfusions are inappropriate, putting patients at significant risk and increasing costs to the health care system. We performed a retrospective quasi-experimental study from November 2008 until November 2014 in a 576-bed tertiary care hospital. The intervention consisted of an interruptive clinical decision support alert shown to a provider when a red blood cell transfusion was ordered in a patient whose most recent hematocrit was ≥21%. We used interrupted time series analysis to determine whether our primary outcome of interest, rate of red blood cell transfusion in patients with hematocrit ≥21% per 100 patient (pt) days, was reduced by the implementation of the clinical decision support tool. The rate of platelet transfusions was used as a nonequivalent dependent control variable. A total of 143,000 hospital admissions were included in our analysis. Red blood cell transfusions decreased from 9.4 to 7.8 per 100 pt days after the clinical decision support intervention was implemented. Interrupted time series analysis showed that significant decline of 0.05 (95% confidence interval [CI], 0.03-0.07; P < .001) units of red blood cells transfused per 100 pt days per month was already underway in the preintervention period. This trend accelerated to 0.1 (95% CI, 0.09-0.12; P < .001) units of red blood cells transfused per 100 pt days per month following the implementation of the clinical decision support tool. There was no statistical change in the rate of platelet transfusion resulting from the intervention. The implementation of an evidence-based clinical decision support tool was associated with a significant decline in the overuse of red blood cell transfusion. We believe this intervention could be easily replicated in other hospitals using commercial electronic health records and a similar reduction in

  6. Short term Heart Rate Variability to predict blood pressure drops due to standing: a pilot study.

    PubMed

    Sannino, G; Melillo, P; Stranges, S; De Pietro, G; Pecchia, L

    2015-01-01

    Standing from a bed or chair may cause a significant lowering of blood pressure (ΔBP), which may have severe consequences such as, for example, falls in older subjects. The goal of this study was to develop a mathematical model to predict the ΔBP due to standing in healthy subjects, based on their Heart Rate Variability, recorded in the 5 minutes before standing. Heart Rate Variability was extracted from an electrocardiogram, recorded from 10 healthy subjects during the 5 minutes before standing. The blood pressure value was measured before and after rising. A mathematical model aiming to predict ΔBP based on Heart Rate Variability measurements was developed using a robust multi-linear regression and was validated with the leave-one-subject-out cross-validation technique. The model predicted correctly the ΔBP in 80% of experiments, with an error below the measurement error of sphygmomanometer digital devices (± 4.5 mmHg), a false negative rate of 7.5% and a false positive rate of 10%. The magnitude of the ΔBP was associated with a depressed and less chaotic Heart Rate Variability pattern. The present study showes that blood pressure lowering due to standing can be predicted by monitoring the Heart Rate Variability in the 5 minutes before standing.

  7. Short term Heart Rate Variability to predict blood pressure drops due to standing: a pilot study

    PubMed Central

    2015-01-01

    Background Standing from a bed or chair may cause a significant lowering of blood pressure (ΔBP), which may have severe consequences such as, for example, falls in older subjects. The goal of this study was to develop a mathematical model to predict the ΔBP due to standing in healthy subjects, based on their Heart Rate Variability, recorded in the 5 minutes before standing. Methods Heart Rate Variability was extracted from an electrocardiogram, recorded from 10 healthy subjects during the 5 minutes before standing. The blood pressure value was measured before and after rising. A mathematical model aiming to predict ΔBP based on Heart Rate Variability measurements was developed using a robust multi-linear regression and was validated with the leave-one-subject-out cross-validation technique. Results The model predicted correctly the ΔBP in 80% of experiments, with an error below the measurement error of sphygmomanometer digital devices (±4.5 mmHg), a false negative rate of 7.5% and a false positive rate of 10%. The magnitude of the ΔBP was associated with a depressed and less chaotic Heart Rate Variability pattern. Conclusions The present study showes that blood pressure lowering due to standing can be predicted by monitoring the Heart Rate Variability in the 5 minutes before standing. PMID:26391336

  8. Clinical variability in KBG syndrome: report of three unrelated families.

    PubMed

    Maegawa, Gustavo Henrique Boff; Leite, Júlio Cesar Loguercio; Félix, Têmis Maria; da Silveira, Heraldo Luís Dias; da Silveira, Heloísa Emília

    2004-12-01

    The KBG syndrome is characterized by short stature, macrodontia, a specific combination of minor anomalies, developmental delay, and/or mental retardation. We reported on four patients from three unrelated families. The most frequent clinical findings were: atypical face, long/flat philtrum, thin upper lip, macrodontia, dental malposition, enamel hypoplasia, and cleft teeth. Skeletal anomalies such as cervical ribs and vertebral abnormalities were also noted. Hand anomalies were observed in three patients. Mental retardation and developmental delay were present in three of the four patients. There is wide clinical variability in the expression of this syndrome. The males are usually more severely affected then the females, suggesting possible X-linked inheritance in some cases.

  9. Variability in the clinical expression of Parkinson's disease.

    PubMed

    Wolters, Erik Ch

    2008-03-15

    Parkinsonism is a clinical syndrome characterized by bradykinesia, hypo-/akinesia, muscular rigidity, and resting tremor, mainly caused by Parkinson's disease (PD). Symptoms of PD are due to a progressive loss of nigral neurons causing striatal dopaminergic denervation. However, nigral degeneration is only a part of the underlying synucleinopathy, and clinical symptoms go far beyond motor parkinsonism. Olfactory disturbances, fatigue, pain, autonomic dysfunction, sleep fragmentation, depression, and dementia with or without psychosis are frequently seen. The variability in the expression of these signs and symptoms, as discussed in this paper, might be explained by the specific topographical sequence of the pathology, depending on the extent and progression of the degenerative process at defined sites. Better insight in the clinicopathological correlations of this disease may help to further develop early diagnosis and adequate therapeutic strategies.

  10. Validity and Usefulness of `Wearable Blood Pressure Sensing' for Detection of Inappropriate Short-Term Blood Pressure Variability in the Elderly

    NASA Astrophysics Data System (ADS)

    Iijima, Katsuya; Kameyama, Yumi; Akishita, Masahiro; Ouchi, Yasuyoshi; Yanagimoto, Shintaro; Imai, Yasushi; Yahagi, Naoki; Lopez, Guillaume; Shuzo, Masaki; Yamada, Ichiro

    An increase in short-term blood pressure (BP) variability is a characteristic feature in the elderly. It makes the management of hemodynamics more difficult, because it is frequently seen disturbed baro-reflex function and increased arterial stiffness, leading to isolated systolic hypertension. Large BP variability aggravates hypertensive target organ damage and is an independent risk factor for the cardiovascular (CV) events in elderly hypertensive patients. Therefore, appropriate control in BP is indispensable to manage lifestyle-related diseases and to prevent subsequent CV events. In addition, accumulating recent reports show that excessive BP variability is also associated with a decline in cognitive function and fall in the elderly. In the clinical settings, we usually evaluate their health condition, mainly with single point BP measurement using cuff inflation. However, unfortunately we are not able to find the close changes in BP by the traditional way. Here, we can show our advantageous approach of continuous BP monitoring using newly developing device `wearable BP sensing' without a cuff stress in the elderly. The new device could reflect systolic BP and its detailed changes, in consistent with cuff-based BP measurement. Our new challenge suggests new possibility of its clinical application with high accuracy.

  11. Improving the clinical management of traumatic brain injury through the pharmacokinetic modeling of peripheral blood biomarkers.

    PubMed

    Dadas, Aaron; Washington, Jolewis; Marchi, Nicola; Janigro, Damir

    2016-11-30

    Blood biomarkers of neurovascular damage are used clinically to diagnose the presence severity or absence of neurological diseases, but data interpretation is confounded by a limited understanding of their dependence on variables other than the disease condition itself. These include half-life in blood, molecular weight, and marker-specific biophysical properties, as well as the effects of glomerular filtration, age, gender, and ethnicity. To study these factors, and to provide a method for markers' analyses, we developed a kinetic model that allows the integrated interpretation of these properties. The pharmacokinetic behaviors of S100B (monomer and homodimer), Glial Fibrillary Acidic Protein and Ubiquitin C-Terminal Hydrolase L1 were modeled using relevant chemical and physical properties; modeling results were validated by comparison with data obtained from healthy subjects or individuals affected by neurological diseases. Brain imaging data were used to model passage of biomarkers across the blood-brain barrier. Our results show the following: (1) changes in biomarker serum levels due to age or disease progression are accounted for by differences in kidney filtration; (2) a significant change in the brain-to-blood volumetric ratio, which is characteristic of infant and adult development, contributes to variation in blood concentration of biomarkers; (3) the effects of extracranial contribution at steady-state are predicted in our model to be less important than suspected, while the contribution of blood-brain barrier disruption is confirmed as a significant factor in controlling markers' appearance in blood, where the biomarkers are typically detected; (4) the contribution of skin to the marker S100B blood levels depends on a direct correlation with pigmentation and not ethnicity; the contribution of extracranial sources for other markers requires further investigation. We developed a multi-compartment, pharmacokinetic model that integrates the biophysical

  12. Clinical significance of home blood pressure measurements for the prevention and management of high blood pressure.

    PubMed

    Imai, Yutaka; Hosaka, Miki; Elnagar, Noha; Satoh, Michihiro

    2014-01-01

    1. Ambulatory blood pressure (ABP) monitoring (M) provides BP information at many points on any particular day during unrestricted routine daily activities, whereas home blood pressure (HBP) monitoring provides a lot of BP information obtained under fixed times and conditions over a long period of time, thus mean values of HBP provide high reproducibility, and thus an overall superiority compared with ABP.  2. HBP is at least equally or better able than ABP to predict hypertensive target organ damage and prognosis of cardiovascular disease.  3. HBPM allows for ongoing disease monitoring by patients, improves adherence to antihypertensive treatment, and can provide health-care providers with timely clinical data and direct and immediate feedback regarding diagnosis and treatment of hypertension.  4. HBPM provides BP information in relation to time; that is, BP in the morning, in the evening and at night during sleep, and it is an essential tool for the diagnosis of white-coat and masked hypertension.  5. HBPM yields minimal alerting affects and no or minimal placebo effect, and can therefore distinguish small, but significant, serial changes in BP. It is thus the most practical method for monitoring BP in the day-to-day management of hypertension. 6. The superiority of HBPM over ABPM and clinic BPM is apparent from almost all practical and clinical research perspectives. © 2013 Wiley Publishing Asia Pty Ltd.

  13. Ambulatory blood pressure monitoring-derived short-term blood pressure variability is increased in Cushing's syndrome.

    PubMed

    Rebellato, Andrea; Grillo, Andrea; Dassie, Francesca; Sonino, Nicoletta; Maffei, Pietro; Martini, Chiara; Paoletta, Agostino; Fabris, Bruno; Carretta, Renzo; Fallo, Francesco

    2014-11-01

    Cushing's syndrome is associated with high cardiovascular morbility and mortality. Blood pressure (BP) variability within a 24-h period is increasingly recognized as an independent predictor of cardiovascular risk. The aim of our study was to investigate the short-term BP variability indices in Cushing's syndrome. Twenty-five patients with Cushing's syndrome (mean age 49 ± 13 years, 4 males; 21 Cushing's disease and 4 adrenal adenoma patients) underwent 24-h ambulatory BP monitoring (ABPM) and evaluation of cardiovascular risk factors. Cushing patients were divided into 8 normotensive (NOR-CUSH) and 17 hypertensive (HYP-CUSH) patients and were compared with 20 normotensive (NOR-CTR) and 20 hypertensive (HYP-CTR) age-, sex-, and BMI-matched control subjects. Short-term BP variability was derived from ABPM and calculated as the following: (1) standard deviation (SD) of 24-h, daytime, and nighttime BP; (2) 24-h weighted SD of BP; and (3) average real variability (ARV), i.e., the average of the absolute differences between consecutive BP measurements over 24 h. In comparison with controls, patients with Cushing's syndrome, either normotensive or hypertensive, had higher 24-h and daytime SD of BP, as well as higher 24-h weighted SD and ARV of BP (P = 0.03 to P < 0.0001). No difference in metabolic parameters was observed between NOR-CTR and NOR-CUSH or between HYP-CTR and HYP-CUSH subgroups. ABPM-derived short-term BP variability is increased in Cushing's syndrome, independent of BP elevation. It may represent an additional cardiovascular risk factor in this disease. The role of excess cortisol in BP variability has to be further clarified.

  14. Quantification of peripheral and central blood pressure variability using a time-frequency method.

    PubMed

    Kouchaki, Z; Butlin, M; Qasem, A; Avolio, A P; Kouchaki, Z; Butlin, M; Qasem, A; Avolio, A P; Kouchaki, Z; Avolio, A P; Butlin, M; Qasem, A

    2016-08-01

    Systolic blood pressure variability (BPV) is associated with cardiovascular events. As the beat-to-beat variation of blood pressure is due to interaction of several cardiovascular control systems operating with different response times, assessment of BPV by spectral analysis using the continuous measurement of arterial pressure in the finger is used to differentiate the contribution of these systems in regulating blood pressure. However, as baroreceptors are centrally located, this study considered applying a continuous aortic pressure signal estimated noninvasively from finger pressure for assessment of systolic BPV by a time-frequency method using Short Time Fourier Transform (STFT). The average ratio of low frequency and high frequency power band (LFPB/HFPB) was computed by time-frequency decomposition of peripheral systolic pressure (pSBP) and derived central aortic systolic blood pressure (cSBP) in 30 healthy subjects (25-62 years) as a marker of balance between cardiovascular control systems contributing in low and high frequency blood pressure variability. The results showed that the BPV assessed from finger pressure (pBPV) overestimated the BPV values compared to that assessed from central aortic pressure (cBPV) for identical cardiac cycles (P<;0.001), with the overestimation being greater at higher power.

  15. Blood pressure variability in relation to autonomic nervous system dysregulation: the X-CELLENT study.

    PubMed

    Zhang, Yi; Agnoletti, Davide; Blacher, Jacques; Safar, Michel E

    2012-04-01

    The purpose of this study was to investigate the association of autonomic nervous system dysregulation with blood pressure variability. Among the 2370 participants in the X-CELLENT study, 577 patients (59.0±10.2 years) were randomly selected to participate in an ancillary ambulatory blood-pressure monitoring study. We proposed a novel autonomic nervous system regulation index termed dSBP/dHR, which was defined as the steepness of the slope of the relationship between the 24-h systolic blood pressure (SBP) and the heart rate (HR) for each participant. Within-subjects s.d. of SBP, weighted for the time interval between consecutive validated readings from 24-h ambulatory blood pressure monitoring, was used to evaluate blood pressure variability. When dSBP/dHR was divided into tertiles, we observed a progressive increase from tertile 1 to tertile 3 in the daytime SBP, a progressive decrease in nighttime SBP, and consequently a progressive increase in the day-night SBP gradient (P<0.001). The s.d. of both daytime and nighttime SBPs were consistently and significantly increased from tertile 1 to tertile 3 (P<0.01). Both before and after adjustment for age, gender and 24-h mean blood pressure, all of these increasing and decreasing trends reached statistical significance (P<0.01). Furthermore, in our sensitivity analysis, when men and women were considered separately, the findings remained unaltered. In summary, autonomic nervous system dysfunction was associated with a heightened day-night SBP gradient and more variable SBP over 24 h in patients with essential hypertension.

  16. Mechanism of blood pressure and R-R variability: insights from ganglion blockade in humans

    NASA Technical Reports Server (NTRS)

    Zhang, Rong; Iwasaki, Kenichi; Zuckerman, Julie H.; Behbehani, Khosrow; Crandall, Craig G.; Levine, Benjamin D.; Blomqvist, C. G. (Principal Investigator)

    2002-01-01

    Spontaneous blood pressure (BP) and R-R variability are used frequently as 'windows' into cardiovascular control mechanisms. However, the origin of these rhythmic fluctuations is not completely understood. In this study, with ganglion blockade, we evaluated the role of autonomic neural activity versus other 'non-neural' factors in the origin of BP and R-R variability in humans. Beat-to-beat BP, R-R interval and respiratory excursions were recorded in ten healthy subjects (aged 30 +/- 6 years) before and after ganglion blockade with trimethaphan. The spectral power of these variables was calculated in the very low (0.0078-0.05 Hz), low (0.05-0.15 Hz) and high (0.15-0.35 Hz) frequency ranges. The relationship between systolic BP and R-R variability was examined by cross-spectral analysis. After blockade, R-R variability was virtually abolished at all frequencies; however, respiration and high frequency BP variability remained unchanged. Very low and low frequency BP variability was reduced substantially by 84 and 69 %, respectively, but still persisted. Transfer function gain between systolic BP and R-R interval variability decreased by 92 and 88 % at low and high frequencies, respectively, while the phase changed from negative to positive values at the high frequencies. These data suggest that under supine resting conditions with spontaneous breathing: (1) R-R variability at all measured frequencies is predominantly controlled by autonomic neural activity; (2) BP variability at high frequencies (> 0.15 Hz) is mediated largely, if not exclusively, by mechanical effects of respiration on intrathoracic pressure and/or cardiac filling; (3) BP variability at very low and low frequencies (< 0.15 Hz) is probably mediated by both sympathetic nerve activity and intrinsic vasomotor rhythmicity; and (4) the dynamic relationship between BP and R-R variability as quantified by transfer function analysis is determined predominantly by autonomic neural activity rather than other

  17. Mechanism of blood pressure and R-R variability: insights from ganglion blockade in humans

    NASA Technical Reports Server (NTRS)

    Zhang, Rong; Iwasaki, Kenichi; Zuckerman, Julie H.; Behbehani, Khosrow; Crandall, Craig G.; Levine, Benjamin D.; Blomqvist, C. G. (Principal Investigator)

    2002-01-01

    Spontaneous blood pressure (BP) and R-R variability are used frequently as 'windows' into cardiovascular control mechanisms. However, the origin of these rhythmic fluctuations is not completely understood. In this study, with ganglion blockade, we evaluated the role of autonomic neural activity versus other 'non-neural' factors in the origin of BP and R-R variability in humans. Beat-to-beat BP, R-R interval and respiratory excursions were recorded in ten healthy subjects (aged 30 +/- 6 years) before and after ganglion blockade with trimethaphan. The spectral power of these variables was calculated in the very low (0.0078-0.05 Hz), low (0.05-0.15 Hz) and high (0.15-0.35 Hz) frequency ranges. The relationship between systolic BP and R-R variability was examined by cross-spectral analysis. After blockade, R-R variability was virtually abolished at all frequencies; however, respiration and high frequency BP variability remained unchanged. Very low and low frequency BP variability was reduced substantially by 84 and 69 %, respectively, but still persisted. Transfer function gain between systolic BP and R-R interval variability decreased by 92 and 88 % at low and high frequencies, respectively, while the phase changed from negative to positive values at the high frequencies. These data suggest that under supine resting conditions with spontaneous breathing: (1) R-R variability at all measured frequencies is predominantly controlled by autonomic neural activity; (2) BP variability at high frequencies (> 0.15 Hz) is mediated largely, if not exclusively, by mechanical effects of respiration on intrathoracic pressure and/or cardiac filling; (3) BP variability at very low and low frequencies (< 0.15 Hz) is probably mediated by both sympathetic nerve activity and intrinsic vasomotor rhythmicity; and (4) the dynamic relationship between BP and R-R variability as quantified by transfer function analysis is determined predominantly by autonomic neural activity rather than other

  18. Effects of food or sleep deprivation during civilian survival training on clinical chemistry variables.

    PubMed

    Ståhle, Lars; Granström, Elisabeth; Ljungdahl Ståhle, Ewa; Isaksson, Sven; Samuelsson, Anders; Rudling, Mats; Sepp, Harry

    2013-06-01

    To describe clinical chemistry and weight changes after short-term food or sleep deprivation or multiple deprivations during civilian survival training. Data from one baseline-controlled two-period crossover study designed to compare sleep deprivation for up to 50 hours with food deprivation for up to 66 hours (n = 12) and data from regular multiple-deprivations survival training comparing participants (n = 33) with nondeprived instructors (n = 10). Food deprivation was associated with decreased body weight, blood glucose, serum triglycerides, sodium, chloride, and urine pH, and there were increases in blood and urine ketones and serum free fatty acids. Sleep deprivation was associated with a minor decrease in hemoglobin and erythrocyte particle count and volume fraction and an increase in leukocytes. The clinical chemistry and body weight changes associated with food deprivation were qualitatively similar to those observed in fasting obese patients but developed quicker in the survival training setting. Sleep deprivation had few effects on the clinical chemistry profile except for hematological variables. Physicians evaluating clinical chemistry data from patients subjected to short-term food or sleep deprivation should take the physiological state into account in their assessment. Copyright © 2013 Wilderness Medical Society. Published by Elsevier Inc. All rights reserved.

  19. Recommendations on whole blood sampling, transport, and storage for simultaneous determination of pH, blood gases, and electrolytes. International Federation of Clinical Chemistry Scientific Division.

    PubMed

    Burnett, R W; Covington, A K; Fogh-Andersen, N; Külpman, W R; Maas, A H; Müller-Plathe, O; Siggaard-Andersen, O; Van Kessel, A L; Wimberley, P D; Zijlstra, W G

    1994-09-01

    Pre-analytical variables, e.g., specimen collection, transport, and storage, can contribute significantly to inaccurate pH, blood gas, and electrolyte values. The International Federation of Clinical Chemistry (IFCC), through its Committee on pH, Blood Gases and Electrolytes, has developed specific recommendations to minimize the undesirable effects of pre-analytical variables. The Committee has drawn upon the experiences of its own members as well as published data by others. Specifically, the Committee has included pertinent guidelines and suggestions by the IFCC Working Group on Selective Electrodes (WGSE), the National Committee on Clinical Laboratory Standards (NCCLS), and the Electrolyte/Blood Gas Division of the American Association for Clinical Chemistry (AACC). This paper will familiarize the reader with the effect of different types of specimen containers and anticoagulants. It discusses important aspects of specimen collection procedures including patient status and special precautions during specimen collection from indwelling catheters or cannulae. The paper also identifies different requirements in storage and transport of specimens for blood gas and electrolyte analysis.

  20. CXCL5 polymorphisms are associated with variable blood pressure in cardiovascular disease-free adults

    PubMed Central

    2012-01-01

    Objective Leukocyte count has been associated with blood pressure, hypertension, and hypertensive complications. We hypothesized that polymorphisms in the CXCL5 gene, which encodes the neutrophilic chemokine ENA-78, are associated with blood pressure in cardiovascular disease (CVD)-free adults and that these polymorphisms are functional. Methods and results A total of 192 community-dwelling participants without CVD or risk equivalents were enrolled. Two CXCL5 polymorphisms (−156 G > C (rs352046) and 398 G > A (rs425535)) were tested for associations with blood pressure. Allele-specific mRNA expression in leukocytes was also measured to determine whether heterozygosity was associated with allelic expression imbalance. In −156 C variant carriers, systolic blood pressure (SBP) was 7 mmHg higher than in −156 G/G wild-type homozygotes (131 ± 17 vs. 124 ± 14 mmHg; P = 0.008). Similarly, diastolic blood pressure (DBP) was 4 mmHg higher in −156 C variant carriers (78 ± 11 vs. 74 ± 11 mmHg; P = 0.013). In multivariate analysis of SBP, age, sex, body mass index, and the −156 G > C polymorphism were identified as significant variables. Age, sex, and the −156 G > C SNP were further associated with DBP, along with white blood cells. Allelic expression imbalance and significantly higher circulating ENA-78 concentrations were noted for variant carriers. Conclusion CXCL5 gene polymorphisms are functional and associated with variable blood pressure in CVD-free individuals. The role of CXCL5 as a hypertension- and CVD-susceptibility gene should be further explored. PMID:23245743

  1. CXCL5 polymorphisms are associated with variable blood pressure in cardiovascular disease-free adults.

    PubMed

    Beitelshees, Amber L; Aquilante, Christina L; Allayee, Hooman; Langaee, Taimour Y; Welder, Gregory J; Schofield, Richard S; Zineh, Issam

    2012-08-02

    Leukocyte count has been associated with blood pressure, hypertension, and hypertensive complications. We hypothesized that polymorphisms in the CXCL5 gene, which encodes the neutrophilic chemokine ENA-78, are associated with blood pressure in cardiovascular disease (CVD)-free adults and that these polymorphisms are functional. A total of 192 community-dwelling participants without CVD or risk equivalents were enrolled. Two CXCL5 polymorphisms (-156 G > C (rs352046) and 398 G > A (rs425535)) were tested for associations with blood pressure. Allele-specific mRNA expression in leukocytes was also measured to determine whether heterozygosity was associated with allelic expression imbalance. In -156 C variant carriers, systolic blood pressure (SBP) was 7 mmHg higher than in -156 G/G wild-type homozygotes (131 ± 17 vs. 124 ± 14 mmHg; P = 0.008). Similarly, diastolic blood pressure (DBP) was 4 mmHg higher in -156 C variant carriers (78 ± 11 vs. 74 ± 11 mmHg; P = 0.013). In multivariate analysis of SBP, age, sex, body mass index, and the -156 G > C polymorphism were identified as significant variables. Age, sex, and the -156 G > C SNP were further associated with DBP, along with white blood cells. Allelic expression imbalance and significantly higher circulating ENA-78 concentrations were noted for variant carriers. CXCL5 gene polymorphisms are functional and associated with variable blood pressure in CVD-free individuals. The role of CXCL5 as a hypertension- and CVD-susceptibility gene should be further explored.

  2. Excess Weight, Anthropometric Variables and Blood Pressure in Schoolchildren aged 10 to 18 years

    PubMed Central

    Schommer, Vânia Ames; Barbiero, Sandra Mari; Cesa, Cláudia Ciceri; Oliveira, Rosemary; Silva, Anelise Damiani; Pellanda, Lucia Campos

    2014-01-01

    Background The prevalence of hypertension among children and adolescents is estimated to range between 1% and 13%. Excess weight and central obesity are related to blood pressure levels in adults, and may be important in the early pathogenesis of SH when present in childhood. Objectives To study the association between anthropometric variables and blood pressure levels in schoolchildren from the 5th and 8th grades, and to identify which parameter was more strongly correlated with blood pressure levels. Methods Contemporary cross-sectional study with probabilistic population-based cluster sampling of schoolchildren enrolled from the 5th to the 8th grades in public elementary schools of Porto Alegre. Data on familial risk factors and anthropometry were collected. Statistical analysis included correlations and cluster-adjusted confidence intervals. Results The mean age of participants was 12.57 (± 1.64) years, and 55.2% of them were females. Abnormal blood pressure levels were found in 11.3% of the sample and borderline values, in 16.2%. Among the anthropometric variables analyzed, hip circumference was the one with the strongest correlation with increased blood pressure (r = 0.462, p < 0.001), followed by waist circumference (r = 0.404, p < 0.001) and abdominal skinfold (r = 0.291, p < 0.001). Conclusion We observed an association of waist circumference and skinfolds with increased blood pressure levels in the schoolchildren of the sample. Therefore, it is of the utmost importance that early measurements of blood pressure, and waist and hip circumferences become a routine in health services in order to prevent this condition. PMID:24676224

  3. Altered blood oxygen level-dependent signal variability in chronic post-traumatic stress disorder during symptom provocation

    PubMed Central

    Ke, Jun; Zhang, Li; Qi, Rongfeng; Xu, Qiang; Li, Weihui; Hou, Cailan; Zhong, Yuan; Zhang, Zhiqiang; He, Zhong; Li, Lingjiang; Lu, Guangming

    2015-01-01

    Background Recent research suggests that variability in brain signal provides important information about brain function in health and disease. However, it is unknown whether blood oxygen level-dependent (BOLD) signal variability is altered in post-traumatic stress disorder (PTSD). We aimed to identify the BOLD signal variability changes of PTSD patients during symptom provocation and compare the brain patterns of BOLD signal variability with those of brain activation. Methods Twelve PTSD patients and 14 age-matched controls, who all experienced a mining accident, underwent clinical assessment as well as fMRI scanning while viewing trauma-related and neutral pictures. BOLD signal variability and brain activation were respectively examined with standard deviation (SD) and general linear model analysis, and compared between the PTSD and control groups. Multiple regression analyses were conducted to explore the association between PTSD symptom severity and these two brain measures across all subjects as well as in the PTSD group. Results PTSD patients showed increased activation in the middle occipital gyrus compared with controls, and an inverse correlation was found between PTSD symptom severity and brain activation in the hippocampus and anterior cingulate cortex/medial prefrontal cortex. Brain variability analysis revealed increased SD in the insula, anterior cingulate cortex/medial prefrontal cortex, and vermis, and decreased SD in the parahippocapal gyrus, dorsolateral prefrontal cortex, somatosensory cortex, and striatum. Importantly, SD alterations in several regions were found in both traumatic and neutral conditions and were stratified by PTSD symptom severity. Conclusion BOLD signal variability may be a reliable and sensitive biomarker of PTSD, and combining brain activation and brain variability analysis may provide complementary insight into the neural basis of this disorder. PMID:26229476

  4. Oral iron supplementation after blood donation: a randomized clinical trial.

    PubMed

    Kiss, Joseph E; Brambilla, Donald; Glynn, Simone A; Mast, Alan E; Spencer, Bryan R; Stone, Mars; Kleinman, Steven H; Cable, Ritchard G

    2015-02-10

    Although blood donation is allowed every 8 weeks in the United States, recovery of hemoglobin to the currently accepted standard (12.5 g/dL) is frequently delayed, and some donors become anemic. To determine the effect of oral iron supplementation on hemoglobin recovery time (days to recovery of 80% of hemoglobin removed) and recovery of iron stores in iron-depleted ("low ferritin," ≤26 ng/mL) and iron-replete ("higher ferritin," >26 ng/mL) blood donors. Randomized, nonblinded clinical trial of blood donors stratified by ferritin level, sex, and age conducted in 4 regional blood centers in the United States in 2012. Included were 215 eligible participants aged 18 to 79 years who had not donated whole blood or red blood cells within 4 months. One tablet of ferrous gluconate (37.5 mg of elemental iron) daily or no iron for 24 weeks (168 days) after donating a unit of whole blood (500 mL). Time to recovery of 80% of the postdonation decrease in hemoglobin and recovery of ferritin level to baseline as a measure of iron stores. The mean baseline hemoglobin levels were comparable in the iron and no-iron groups and declined from a mean (SD) of 13.4 (1.1) g/dL to 12.0 (1.2) g/dL after donation in the low-ferritin group and from 14.2 (1.1) g/dL to 12.9 (1.2) g/dL in the higher-ferritin group. Compared with participants who did not receive iron supplementation, those who received iron supplementation had shortened time to 80% hemoglobin recovery in both the low-ferritin (mean, 32 days, interquartile range [IQR], 30-34, vs 158 days, IQR, 126->168) and higher-ferritin groups (31 days, IQR, 29-33, vs 78 days, IQR, 66-95). Median time to recovery to baseline ferritin levels in the low-ferritin group taking iron was 21 days (IQR, 12-84). For participants not taking iron, recovery to baseline was longer than 168 days (IQR, 128->168). Median time to recovery to baseline in the higher-ferritin group taking iron was 107 days (IQR, 75-141), and for participants not taking iron

  5. Diurnal blood pressure variability and physical activity measured electronically and by diary.

    PubMed

    Gretler, D D; Carlson, G F; Montano, A V; Murphy, M B

    1993-02-01

    In order for 24 h ambulatory blood pressure monitoring (ABPM) to be useful in clinical decision making, it is necessary to quantify ambient physical activity and to develop appropriate norms of ambulatory pressure for different levels of activity. The present study has compared the predictive value of physical activity determined by an electronic activity monitor or a written diary, for concomitantly recorded blood pressure during ABPM in healthy normotensive subjects. Each subject wore four activity monitors, on the right and left wrists, on the left ankle and at the waist, respectively. Linear regression analysis was performed for each subject to determine the correlation between ABPM data (systolic and diastolic blood pressure and heart rate) and activity data (obtained from diaries and the four monitors). Significant differences in the degree of correlation were found for both the location of the activity monitor and the time (1/2, 2, 5, 10, 15, and 30 min preceding blood pressure measurement) over which activity was averaged (P < .05 by two-way analysis of variance). The best correlation was obtained with the activity monitor worn on the dominant wrist, and when activity was averaged over 2 to 10 min preceding blood pressure determination, accounting for 18 to 69% (mean 36 +/- 5%) of systolic blood pressure variation. Diaries performed similarly in these well-motivated subjects. It is concluded that because of the significant interaction between activity and blood pressure, ABPM data should be interpreted only in the light of concomitant activity data.(ABSTRACT TRUNCATED AT 250 WORDS)

  6. Environmental lead exposure is associated with visit-to-visit systolic blood pressure variability in the US adults.

    PubMed

    Faramawi, Mohammed F; Delongchamp, Robert; Lin, Yu-Sheng; Liu, Youcheng; Abouelenien, Saly; Fischbach, Lori; Jadhav, Supriya

    2015-04-01

    The association between environmental lead exposure and blood pressure variability, an important risk factor for cardiovascular disease, is unexplored and unknown. The objective of the study was to test the hypothesis that lead exposure is associated with blood pressure variability. American participants 17 years of age or older from National Health and Nutrition Examination Survey III were included in the analysis. Participants' blood lead concentrations expressed as micrograms per deciliter were determined. The standard deviations of visit-to-visit systolic and diastolic blood pressure were calculated to determine blood pressure variability. Multivariable regression analyses adjusted for age, gender, race, smoking and socioeconomic status were employed. The participants' mean age and mean blood lead concentration were 42.72 years and 3.44 mcg/dl, respectively. Systolic blood pressure variability was significantly associated with environmental lead exposure after adjusting for the effect of the confounders. The unadjusted and adjusted means of visit-to-visit systolic blood pressure variability and the β coefficient of lead exposure were 3.44, 3.33 mcg/dl, β coefficient = 0.07, P < 0.01. This study documents a positive linear relationship between environmental lead exposure and systolic blood pressure variability. Screening adults with fluctuating blood pressure for lead exposure could be warranted.

  7. Short-Term Blood Pressure Variability Relates to the Presence of Subclinical Brain Small Vessel Disease in Primary Hypertension.

    PubMed

    Filomena, Josefina; Riba-Llena, Iolanda; Vinyoles, Ernest; Tovar, José L; Mundet, Xavier; Castañé, Xavier; Vilar, Andrea; López-Rueda, Antonio; Jiménez-Baladó, Joan; Cartanyà, Anna; Montaner, Joan; Delgado, Pilar

    2015-09-01

    Blood pressure (BP) variability is associated with stroke risk, but less is known about subclinical cerebral small vessel disease (CSVD). We aimed to determine whether CSVD relates to short-term BP variability independently of BP levels and also, whether they improve CSVD discrimination beyond clinical variables and office BP levels. This was a cohort study on asymptomatic hypertensives who underwent brain magnetic resonance imaging and 24-hour ambulatory BP monitoring. Office and average 24-hour, daytime and nighttime BP levels, and several metrics of BP variability (SD, weighted SD, coefficient of variation, and average real variability [ARV]) were calculated. Definition of CSVD was based on the presence of lacunar infarcts and white matter hyperintensity grades. Multivariate analysis and integrated discrimination improvement were performed to assess whether BP variability and levels were independently associated with CSVD and improved its discrimination. Four hundred eighty-seven individuals participated (median age, 64; 47% women). CSVD was identified in 18.9%, related to age, male sex, diabetes mellitus, use of treatment, ambulatory BP monitoring-defined BP levels, and ARV of systolic BP at any period. The highest prevalence (33.7%) was found in subjects with both 24-hour BP levels and ARV elevated. BP levels at any period and ARV (24 hours and nocturnal) emerged as independent predictors of CSVD, and discrimination was incrementally improved although not to a clinically significant extent (integrated discrimination improvement, 5.31%, 5.17% to 5.4%). Ambulatory BP monitoring-defined BP levels and ARV of systolic BP relate to subclinical CSVD in hypertensive individuals. © 2015 American Heart Association, Inc.

  8. INTRACRANIAL AND BLOOD PRESSURE VARIABILITY AND LONG-TERM OUTCOME AFTER ANEURYSMAL SUBARACHNOID HEMORRHAGE

    PubMed Central

    Kirkness, Catherine J.; Burr, Robert L.; Mitchell, Pamela H.

    2009-01-01

    Background Care of individuals in the intensive care unit (ICU) with brain injury traditionally focuses on maintaining ABP and ICP within prescribed ranges. However research suggests that the dynamic variability of these pressure signals provides additional information about physiologic functioning and may reflect adaptive capacity. Objectives The purpose of this study was to examine the ability to predict long-term outcome from arterial blood pressure (ABP) and intracranial pressure (ICP) variability in patients with aneurysmal subarachnoid hemorrhage (SAH). Methods ABP and ICP were monitored continuously for four days in 90 patients (74% female; mean age 53 years) in an ICU following SAH. Variability of ABP and ICP signals was calculated at four time scales (24-hour, hourly, 5-minute, and difference of sequential 5second averages). Long-term functional outcome was assessed 6 months post-SAH using the Extended Glasgow Outcome Scale. Results Pressure (ABP, ICP) variability indices were better predictors of 6-month functional outcome than mean pressure levels. Indices reflecting faster variability (particularly 5-second) were positively associated with better long-term outcome (typical p<0.001), while greater 24-hour variability was related to poorer outcomes (typical p <0.001), controlling for initial neurologic condition. Conclusions Beyond the measurement of ABP and ICP levels in acutely ill patients with SAH, simple measures of variability of these signals provide prognostic information regarding long-term functional outcome. The relationship between outcome and ICP and ABP variability in SAH 2 variability was dependent on the time scale at which the variability was measured. Given its positive association with better outcome, greater faster variability may reflect better physiologic adaptive capacity. PMID:19411584

  9. [Explore objective clinical variables for detecting delirium in ICU patients: a prospective case-control study].

    PubMed

    Liu, Xiaojiang; Lyu, Jie; An, Youzhong

    2017-04-01

    The aim of this case-control study is to explore clinical objective variables for diagnosing delirium of intensive care unit (ICU) patients. According to the method of prospective case-control study, critical adult postoperative patients who were transferred to ICU of Peking University People's Hospital from October 2015 to May 2016 and needed mechanical ventilation were included. After evaluating the Richmond agitation sedation scale score (RASS), the patients whose score were -2 or greater were sorted into two groups, delirium and non-delirium, according to the confusion assessment method for the ICU (CAM-ICU). Then these patients were observed by domestic multifunctional detector for electroencephalographic (EEG) variables such as brain lateralization, brain introvert, brain activity, brain energy consumption, focus inward, focus outward, cerebral inhibition, fatigue, sleep severity, sedation index, pain index, anxiety index, fidgety index, stress index and the cerebral blood flow (CBF) index which was named of perfusion index. Other variables including indexes of ICU blood gas analysis, which was consisted of variables of blood gas analysis, routine blood test and biochemistry, previous history and prognostic outcome was recorded. Binary logistic regression was used for multivariate analysis. Forty-three postoperative patients, who needed intensive care, were included. Eighteen were in delirium group and twenty-five in control group. Excluding the trauma, variables like gender, age, temperature, heart rate, respiratory rate, mean arterial pressure, acute physiology and chronic health evaluationII(APACHEII) score, organ failure, dementia and emergency surgery didn't show any statistical significance between two groups. The trauma in delirious patients increased obviously compared with the control group (33.3% vs. 4.0%, P = 0.031). Except for the brain activity [122.47 (88.62, 154.21) vs. 89.40 (86.27, 115.97), P = 0.034], there were no statistical differences in

  10. Temporary impact of blood donation on physical performance and hematologic variables in women.

    PubMed

    Stangerup, Ida; Kramp, Nana L; Ziegler, Andreas K; Dela, Flemming; Magnussen, Karin; Helge, Jørn Wulff

    2017-08-01

    No former studies have examined how blood donation influences physical performance in women, who due to menstruation may have a slower recovery of performance. Therefore, the aim of this study was to clarify how VO2peak , time trial (TT) performance, and hematologic variables are affected in 18 iron-sufficient (plasma ferritin [P-ferritin] > 30 µg/L) women after a standard 450-mL blood donation. VO2peak , TT performance, and blood variables were measured at baseline and 3, 7, 14, 21, and 28 days after blood donation in 18 iron-sufficient women. Anthropometrics were measured at baseline and Day 28. VO2peak was reduced by 7.5 ± 1.1% from 2973 ± 87 mL/min at baseline to 2765 ± 73 mL/min 3 days after blood donation and remained below baseline until 28 days. The TT performance was reduced by 5.2 ± 1.0% from baseline (868 ± 31 sec) to Day 3 (915 ± 29 sec), but was not different from baseline 14 days after blood donation. Blood hemoglobin (B-Hb) concentration declined by 7.6 ± 2.1% from 8.4 ± 0.1 to 7.8 ± 0.1 mmol/L at baseline and on Day 3, respectively. P-ferritin at baseline was 58 ± 7 µg/L and it decreased (55 ± 3%) to a nadir of 24 ± 3 µg/L 28 days after blood donation and remained lower at 36 ± 4 µg/L after 90 days. VO2peak and B-Hb were only recovered 28 days after a blood donation whereas TT performance was back to baseline 14 days after blood donation. © 2017 AABB.

  11. [Organization of an anaesthesia preoperative evaluation clinic - The Anaesthesia/Patient Blood Management Clinic: one Model].

    PubMed

    Schöpper, Christa; Venherm, Stefan; Van Aken, Hugo; Ellermann, Ines; Steinbicker, Andrea

    2016-04-01

    The anesthesia preoperative evaluation has been developed in recent years in a centralized clinic, that can be visited by the majority of patients, in order to evaluate and obtain patient's consent for anesthesia. In the current article, the organization and structure of such a central anesthesia preoperative evaluation clinic in the Department of Anesthesia, Intensive Care and Pain Medicine at the University Hospital of Muenster, is described. Besides the central preoperative evaluation clinic, 3 clinics are localized in separate buildings and preoperative visits have to be completed in special scenarios on the wards, too. A pharmaceutical evaluation for patient's medication and the patient blood management have been integrated into the anesthesia preoperative evaluation clinic. Processes are explained and current numbers of patients are mentioned. © Georg Thieme Verlag Stuttgart · New York.

  12. Heart Rate and Blood Pressure Variability under Moon, Mars and Zero Gravity Conditions During Parabolic Flights

    NASA Astrophysics Data System (ADS)

    Aerts, Wouter; Joosen, Pieter; Widjaja, Devy; Varon, Carolina; Vandeput, Steven; Van Huffel, Sabine; Aubert, Andre E.

    2013-02-01

    Gravity changes during partial-G parabolic flights (0g -0.16g - 0.38g) lead to changes in modulation of the autonomic nervous system (ANS), studied via the heart rate variability (HRV) and blood pressure variability (BPV). HRV and BPV were assessed via classical time and frequency domain measures. Mean systolic and diastolic blood pressure show both increasing trends towards higher gravity levels. The parasympathetic and sympathetic modulation show both an increasing trend with decreasing gravity, although the modulation is sympathetic predominant during reduced gravity. For the mean heart rate, a non-monotonic relation was found, which can be explained by the increased influence of stress on the heart rate. This study shows that there is a relation between changes in gravity and modulations in the ANS. With this in mind, countermeasures can be developed to reduce postflight orthostatic intolerance.

  13. Genetic variability in the sable (Martes zibellina L.) with respect to genes encoding blood proteins

    SciTech Connect

    Kashtanov, S.N.; Kazakova, T.I.

    1995-02-01

    Electrophoresis of blood proteins was used to determine, for the first time, the level of genetic variability of certain loci in the sable (Martes zibellina L., Mustelidae). Variation of 23 blood proteins encoded by 25 genes was analyzed. Polymorphism was revealed in six genes. The level of heterozygosity was estimated at 0.069; the proportion of polymorphic loci was 24%. Data on the history of the sable population maintained at the farm, on geographical distribution of natural sable populations, and on the number of animals selected for reproduction in captivity is presented. The great number of animals studies and the extensive range of natural sable populations, on the basis of which the population maintained in captivity was obtained, suggest that the results of this work can be used for estimating the variability of the gene pool of sable as a species. 9 refs., 2 figs., 1 tab.

  14. On the improvement of blood sample collection at clinical laboratories.

    PubMed

    Grasas, Alex; Ramalhinho, Helena; Pessoa, Luciana S; Resende, Mauricio G C; Caballé, Imma; Barba, Nuria

    2014-01-09

    Blood samples are usually collected daily from different collection points, such hospitals and health centers, and transported to a core laboratory for testing. This paper presents a project to improve the collection routes of two of the largest clinical laboratories in Spain. These routes must be designed in a cost-efficient manner while satisfying two important constraints: (i) two-hour time windows between collection and delivery, and (ii) vehicle capacity. A heuristic method based on a genetic algorithm has been designed to solve the problem of blood sample collection. The user enters the following information for each collection point: postal address, average collecting time, and average demand (in thermal containers). After implementing the algorithm using C programming, this is run and, in few seconds, it obtains optimal (or near-optimal) collection routes that specify the collection sequence for each vehicle. Different scenarios using various types of vehicles have been considered. Unless new collection points are added or problem parameters are changed substantially, routes need to be designed only once. The two laboratories in this study previously planned routes manually for 43 and 74 collection points, respectively. These routes were covered by an external carrier company. With the implementation of this algorithm, the number of routes could be reduced from ten to seven in one laboratory and from twelve to nine in the other, which represents significant annual savings in transportation costs. The algorithm presented can be easily implemented in other laboratories that face this type of problem, and it is particularly interesting and useful as the number of collection points increases. The method designs blood collection routes with reduced costs that meet the time and capacity constraints of the problem.

  15. On the improvement of blood sample collection at clinical laboratories

    PubMed Central

    2014-01-01

    Background Blood samples are usually collected daily from different collection points, such hospitals and health centers, and transported to a core laboratory for testing. This paper presents a project to improve the collection routes of two of the largest clinical laboratories in Spain. These routes must be designed in a cost-efficient manner while satisfying two important constraints: (i) two-hour time windows between collection and delivery, and (ii) vehicle capacity. Methods A heuristic method based on a genetic algorithm has been designed to solve the problem of blood sample collection. The user enters the following information for each collection point: postal address, average collecting time, and average demand (in thermal containers). After implementing the algorithm using C programming, this is run and, in few seconds, it obtains optimal (or near-optimal) collection routes that specify the collection sequence for each vehicle. Different scenarios using various types of vehicles have been considered. Unless new collection points are added or problem parameters are changed substantially, routes need to be designed only once. Results The two laboratories in this study previously planned routes manually for 43 and 74 collection points, respectively. These routes were covered by an external carrier company. With the implementation of this algorithm, the number of routes could be reduced from ten to seven in one laboratory and from twelve to nine in the other, which represents significant annual savings in transportation costs. Conclusions The algorithm presented can be easily implemented in other laboratories that face this type of problem, and it is particularly interesting and useful as the number of collection points increases. The method designs blood collection routes with reduced costs that meet the time and capacity constraints of the problem. PMID:24406140

  16. Blood pressure and heart rate variability and baroreflex sensitivity before and after brain death

    PubMed Central

    Conci, F; Di, R; Castiglioni, P

    2001-01-01

    OBJECTIVES—To evaluate spontaneous blood pressure and heart rate variability and spontaneous baroreflex sensitivity before and after brain death.
METHODS—Spontaneous variability of arterial blood pressure and heart rate—estimated by power spectra of systolic (SBP) and diastolic blood pressure (DBP) and pulse interval (PI)—and spontaneous baroreflex sensitivity (BRS)—estimated by the alpha index and the sequence technique—were evaluated in 11 patients twice: shortly before and 1 hour after the onset of brain death.
RESULTS—Significant spectral changes occurred after brain death: a general power reduction in PI spectra; a shift of SBP, DBP and PI powers toward the lower frequencies, resulting in a greater slope of the "1/f" spectral trends; and a marked reduction of SBP and DBP powers (-93%) and of SBP-PI coherence (−63%) at 0.1Hz. The estimated average BRS was relatively high before brain death (around 11 ms/mm Hg), and fell close to 0 or even was not detectable at all after brain death.
CONCLUSIONS—Parameters describing spontaneous blood pressure and heart rate variability and indexes reflecting the baroreflex function, which were relatively normal up to a few hours before brain death, underwent marked changes with the onset of brain death. All the changes found are likely to reflect the cessation of activity of the cardiovascular brain stem centres. These findings indicate that techniques of blood pressure and heart rate spectral analysis and of dynamic assessment of baroreflex sensitivity may be useful to complement the diagnosis of brain stem death.

 PMID:11606674

  17. Latent class instrumental variables: a clinical and biostatistical perspective.

    PubMed

    Baker, Stuart G; Kramer, Barnett S; Lindeman, Karen S

    2016-01-15

    In some two-arm randomized trials, some participants receive the treatment assigned to the other arm as a result of technical problems, refusal of a treatment invitation, or a choice of treatment in an encouragement design. In some before-and-after studies, the availability of a new treatment changes from one time period to this next. Under assumptions that are often reasonable, the latent class instrumental variable (IV) method estimates the effect of treatment received in the aforementioned scenarios involving all-or-none compliance and all-or-none availability. Key aspects are four initial latent classes (sometimes called principal strata) based on treatment received if in each randomization group or time period, the exclusion restriction assumption (in which randomization group or time period is an instrumental variable), the monotonicity assumption (which drops an implausible latent class from the analysis), and the estimated effect of receiving treatment in one latent class (sometimes called efficacy, the local average treatment effect, or the complier average causal effect). Since its independent formulations in the biostatistics and econometrics literatures, the latent class IV method (which has no well-established name) has gained increasing popularity. We review the latent class IV method from a clinical and biostatistical perspective, focusing on underlying assumptions, methodological extensions, and applications in our fields of obstetrics and cancer research.

  18. Relationship between blood calcium level and ST peak interval of electrocardiographic variables in peripartum Holstein cows

    PubMed Central

    ITOH, Megumi; SAKURAI, Yoshie; NAKAJIMA, Yasuhiro; KAWAMOTO, Satoshi

    2015-01-01

    The association between blood calcium levels and electrocardiographic variables was compared in 137 normal parturient and 36 peripartum recumbent Holstein cows to determine whether hypocalcemia in peripartum dairy cows can be rapidly diagnosed using electrocardiograph. Inverse of STc (ST peak interval/SS interval0.5) and blood ionized calcium or serum calcium concentrations were strongly correlated, and both correlation coefficients were 0.81 (P<0.001). The 95% prediction interval indicated that cows with STc >0.385 ± 0.001 sec are very likely to be hypocalcemic (blood ionized or serum calcium concentrations of <0.9 mmol/l or <7.5 mg/dl, respectively). These findings indicate that hypocalcemia in parturient cows can be non-invasively estimated using the STc. PMID:26118411

  19. Mathematical models of blood coagulation and platelet adhesion: clinical applications.

    PubMed

    Panteleev, M A; Ananyeva, N M; Ataullakhanov, F I; Saenko, E L

    2007-01-01

    At present, computer-assisted molecular modeling and virtual screening have become effective and widely-used tools for drug design. However, a prerequisite for design and synthesis of a therapeutic agent is determination of a correct target in the metabolic system, which should be either inhibited or stimulated. Solution of this extremely complicated problem can also be assisted by computational methods. This review discusses the use of mathematical models of blood coagulation and platelet-mediated primary hemostasis and thrombosis as cost-effective and time-saving tools in research, clinical practice, and development of new therapeutic agents and biomaterials. We focus on four aspects of their application: 1) efficient diagnostics, i.e. theoretical interpretation of diagnostic data, including sensitivity of various clotting assays to the changes in the coagulation system; 2) elucidation of mechanisms of coagulation disorders (e.g. hemophilias and thrombophilias); 3) exploration of mechanisms of action of therapeutic agents (e.g. recombinant activated factor VII) and planning rational therapeutic strategy; 4) development of biomaterials with non-thrombogenic properties in the design of artificial organs and implantable devices. Accumulation of experimental knowledge about the blood coagulation system and about platelets, combined with impressive increase of computational power, promises rapid development of this field.

  20. Why use automated office blood pressure measurements in clinical practice?

    PubMed

    Andreadis, Emmanuel A; Angelopoulos, Epameinondas T; Agaliotis, Gerasimos D; Tsakanikas, Athanasios P; Mousoulis, George P

    2011-09-01

    Automated office blood pressure (AOBP) measurement with the patient resting alone in a quiet examining room can eliminate the white-coat effect associated with conventional readings taken by manual sphygmomanometer. The key to reducing the white-coat response appears to be multiple blood pressure (BP) readings taken in a non-observer office setting, thus eliminating any interaction that could provoke an office-induced increase in BP. Furthermore, AOBP readings have shown a higher correlation with the mean awake ambulatory BP compared with BP readings recorded in routine clinical practice. Although there is a paucity of studies connecting AOBP with organ damage, AOBP values were recently found to be equally associated with left ventricular mass index as those of ambulatory BP. This concludes that in contrast to routine manual office BP, AOBP readings compare favourably with 24-hour ambulatory BP measurements in the appraisal of cardiac remodelling and, as such, could be complementary to ambulatory readings in a way similar to home BP measurements.

  1. Assessment of a portable clinical blood analyzer during space flight.

    PubMed

    Smith, S M; Davis-Street, J E; Fontenot, T B; Lane, H W

    1997-06-01

    This study was designed to validate the utility of a commercial portable clinical blood analyzer (PCBA) in ground-based studies and on the space shuttle. Ionized calcium, pH, electrolytes, glucose, and hematocrit were determined. Results agreed well with those from traditional laboratory methods, and the PCBA demonstrated good between-day precision for all analytes. In-flight analysis of control samples revealed differences in one analyte (sodium). There were few changes in crew members' results during flight, and these were expected. Potassium increased in flight compared with before flight, and potassium, pH, and hematocrit decreased after flight. Ionized calcium was decreased in flight and on landing day. Changes during flight were likely related to sample collection technique. Postflight changes likely reflected the fluid redistribution that occurs after exposure to weightlessness. These data confirm that the PCBA is a reliable instrument for most analytes, and can provide important medical data in remote locations, such as orbiting spacecraft.

  2. Clinical inquiries. Does blood pressure screening benefit children?

    PubMed

    Gauer, Robert; Qiu, Kefeng Maylene

    2012-07-01

    Screening may not show benefits in childhood but could pay off for adults. Although major professional organizations recommend measuring blood pressure (BP) at every clinic visit for all children older than 3 years (strength of recommendation [SOR]: C, expert opinion), scant evidence links earlier detection and treatment of childhood hypertension with improved patient-oriented outcomes. However, detecting childhood hypertension may help identify adults who would benefit from earlier treatment. Children with elevated BP have a more than 60% chance of being hypertensive as young adults (SOR: B, prospective cohort study). Children with systolic BP above the 95th percentile had a more than 4-fold increase in coronary artery disease as adults compared with children below the 95th percentile (SOR: B, retrospective study). Identifying hypertension in children is associated with a 15-fold greater likelihood of hypertension in their parents (SOR: B, case series).

  3. Liver support by extracorporeal blood purification: a clinical observation.

    PubMed

    Stange, J; Mitzner, S R; Klammt, S; Freytag, J; Peszynski, P; Loock, J; Hickstein, H; Korten, G; Schmidt, R; Hentschel, J; Schulz, M; Löhr, M; Liebe, S; Schareck, W; Hopt, U T

    2000-09-01

    Liver failure associated with excretory insufficiency and jaundice results in an endogenous accumulation of toxins involved in the impairment of cardiovascular, kidney, and cerebral function. Moreover, these toxins have been shown to damage the liver itself by inducing hepatocellular apoptosis and necrosis, thus creating a vicious cycle of the disease. We report a retrospective cohort study of 26 patients with acute or chronic liver failure with intrahepatic cholestasis (bilirubin level > 20 mg/dL) who underwent a new extracorporeal blood purification treatment. A synthetic hydrophilic/hydrophobic domain-presenting semipermeable membrane (pore size < albumin size, 100-nm thick) was used for extracorporeal blood detoxification using dialysis equipment. The opposite side was rinsed with ligandin-like proteins as molecular adsorbents that were regenerated online using a chromatography-like recycling system (molecular adsorbent recirculating system [MARS]). Bile acid and bilirubin levels, representing the previously described toxins, were reduced by 16% to 53% and 10% to 90% of the initial concentration by a single treatment of 6 to 8 hours, respectively. Toxicity testing of patient plasma onto primary rat hepatocytes by live/dead fluorescence microscopy showed cell-damaging effects of jaundiced plasma that were not observed after treatment. Patients with a worsening of Child-Turcotte-Pugh (CTP) index before the treatments showed a significant improvement of this index during a period of 2 to 14 single treatments with an average of 14 days. After withdrawal of MARS treatment, this improvement was sustained in all long-term survivors. Ten patients represented a clinical status equivalent to the United Network for Organ Sharing (UNOS) status 2b (group A1), and all survived. Sixteen patients represented a clinical status equivalent to UNOS status 2a, and 7 of these patients survived (group A2), whereas 9 patients (group B) died. We conclude that in acute excretory failure

  4. Estimation of blood pressure variability using independent component analysis of photoplethysmographic signal.

    PubMed

    Abe, Makoto; Yoshizawa, Makoto; Sugita, Norihiro; Tanaka, Akira; Chiba, Shigeru; Yambe, Tomoyuki; Nitta, Shin-ichi

    2009-01-01

    The maximum cross-correlation coefficient rho(max) between blood pressure variability and heart rate variability, whose frequency components are limited to the Mayer wave-related band, is a useful index to evaluate the state of the autonomic nervous function related to baroreflex. However, measurement of continuous blood pressure with an expensive and bulky measuring device is required to calculate rho(max). The present study has proposed an easier method for obtaining rho(max) with measurement of finger photoplethysmography (PPG). In the proposed method, independent components are extracted from feature variables specified by the PPG signal by using the independent component analysis (ICA), and then the most appropriate component is chosen out of them so that the rho(max) based on the component can fit its true value. The results from the experiment with a postural change performed in 17 healthy subjects suggested that the proposed method is available for estimating rho(max) by using the ICA to extract blood pressure information from the PPG signal.

  5. Influence of transport and time on blood variables commonly measured for the athlete biological passport.

    PubMed

    Robinson, Neil; Giraud, Sylvain; Schumacher, Yorck Olaf; Saugy, Martial

    2016-02-01

    Some recent studies have characterized the stability of blood variables commonly measured for the Athlete Biological Passport. The aim of this study was to characterize the impact of different shipments conditions and the quality of the results returned by the haematological analyzer. Twenty-two healthy male subjects provided five EDTA tubes each. Four shipment conditions (24, 36, 48, 72 h) under refrigerated conditions were tested and compared to a set of samples left in the laboratory also under refrigerated conditions (group control). All measurements were conducted using two Sysmex XT-2000i analyzers. Haemoglobin concentration, reticulocytes percentage, and OFF-score numerical data were the same for samples analyzed just after collection and after a shipment under refrigerated conditions up to 72 h. Detailed information reported especially by the differential (DIFF) channel scatterplot of the Sysmex XT-2000i indicated that there were signs of blood deterioration, but were not of relevance for the variables used in the Athlete Biological Passport. As long as the cold chain is guaranteed, the time delay between the collection and the analyses of blood variables can be extended. Copyright © 2015 John Wiley & Sons, Ltd.

  6. ANALYSIS IN BLOOD OF GOLDEN HAMSTER BY NAA FOR CLINICAL PRACTICE

    SciTech Connect

    Aguiar, R.; Zamboni, C. B.; Genezini, F. A.

    2009-06-03

    In the present study Neutron Activation Analysis (NAA) technique has been used to determine, simultaneously, some element concentrations of clinical relevance in whole blood samples of Golden Hamster. The normal range for Br, Cl, K and Na concentrations were determined. The knowledge of these values permits clinical investigation of animal model using whole blood as well as to check the similarities with human blood.

  7. Telmisartan exerts sustained blood pressure control and reduces blood pressure variability in metabolic syndrome by inhibiting sympathetic activity.

    PubMed

    Sueta, Daisuke; Koibuchi, Nobutaka; Hasegawa, Yu; Toyama, Kensuke; Uekawa, Ken; Katayama, Tetsuji; Ma, MingJie; Nakagawa, Takashi; Ogawa, Hisao; Kim-Mitsuyama, Shokei

    2014-12-01

    Accumulating evidence on blood pressure (BP) reduction with various angiotensin II receptor blockers (ARBs) show that the magnitudes and durations of BP control differ across ARBs. However, the mechanism of ARBs is unknown. This work was undertaken to compare telmisartan and valsartan in duration of BP control, BP variability, and effects on the autonomic nervous system. Using radiotelemetry combined with spectral analysis with a fast Fourier transformation algorithm, we compared the effects of various doses of telmisartan and valsartan on BP and its variability during dark (active phase) and light (inactive phase) periods over 5 weeks in SHR/NDmcr-cp(+/+)(SHRcp) rats, a model of metabolic syndrome. We also compared the effects of these ARBs on autonomic nervous system, central oxidative stress, and inflammation in SHRcp rats. Telmisartan exerted a longer-lasting BP-lowering effect and greater attenuation of BP variability in SHRcp than valsartan. Telmisartan decreased low frequency power of systolic BP and increased spontaneous baroreflex gain in SHRcp during both the dark and light periods more than valsartan. Telmisartan reduced 24-hour urinary norepinephrine excretion more than valsartan. Furthermore, telmisartan attenuated oxidative stress and the numbers of gp91(phox)-positive cells and activated microglia and astrocytes in the rostral ventrolateral medulla of SHRcp rats more than valsartan. The superiority of telmisartan over valsartan in sustained BP control and reduction of BP variability was attributed to more suppression of sympathetic activity and more improvement of baroreceptor reflex. The greater suppression of sympathetic activity by telmisartan appeared to be partially mediated by a stronger amelioration of central oxidative stress. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  8. Pulmonary function in ankylosing spondylitis: association with clinical variables.

    PubMed

    Brambila-Tapia, A J L; Rocha-Muñoz, A D; Gonzalez-Lopez, L; Vázquez-Del-Mercado, M; Salazar-Páramo, M; Dávalos-Rodríguez, I P; De la Cerda-Trujillo, L; Diaz-Toscano, M L; Hernandez-Cuervo, P; Diaz-Rizo, V; Sanchez-Mosco, D; Vazquez-Jimenez, J C; Cardona-Muñoz, E G; Gamez-Nava, J I

    2013-09-01

    To evaluate the association between pulmonary function and clinical variables in ankylosing spondylitis (AS) and to compare the pulmonary function of patients with AS with that of healthy controls, 61 AS patients and 74 healthy controls were included. In AS, we assessed clinical disease indices (BASDAI, BASFI, BASG), morning stiffness, number of hypersensitive entheses, metrology measures, 6-min walking test, acute phase reactants, radiological presence of "bamboo spine," and severity of radiological involvement in sacroiliac and vertebral joints. AS and healthy controls had similar age and gender. All the parameters of pulmonary function were significantly diminished in AS than in healthy controls (p < 0.001), with a higher proportion of restrictive pattern (57.4 vs. 5.4 %). In AS, pulmonary function correlated negatively with BASDAI, BASFI, BASG, morning stiffness, number of hypersensitive entheses, occiput-wall distance, and ESR, and positively with 6-min walking test. There was no association between pulmonary function with radiological stage of vertebral joints and sacroiliac joints, "bamboo spine," disease duration, or chest expansion. A higher frequency of AS patients had a decreased pulmonary function and results of the 6-min walking test. These abnormalities in AS were more related with disease activity than with mobility limitation.

  9. Assessment of baroreflex sensitivity from spontaneous oscillations of blood pressure and heart rate: proven clinical value?

    PubMed

    Pinna, Gian Domenico; Maestri, Roberto; La Rovere, Maria Teresa

    2015-04-01

    The baroreceptor-heart rate reflex (baroreflex sensitivity, BRS) is a key mechanism contributing to the neural regulation of the cardiovascular system. Several methods have been proposed so far to assess BRS by analyzing the spontaneous beat-to-beat fluctuations of arterial blood pressure and heart rate. These methods are inherently simple, non-invasive and low-cost. This study is an attempt to address the question of whether spontaneous baroreflex methods have proven to be of value in the clinical setting. In the first part of this article, we critically review most representative clinical studies using spontaneous BRS techniques either for risk stratification or treatment evaluation, these being major issues in the clinical management of the patients. In the second part, we address two important aspects of spontaneous BRS measurements: measurability and reliability. Estimation of BRS in the studies selected for the review was performed according to the sequence, transfer function, alpha-index and phase-rectified signal averaging method. Arterial blood pressure was recorded non-invasively during supine, short-term (<30 min) laboratory recordings. The conclusion from this review is that spontaneous BRS techniques have been shown to be of great value in clinical practice but further work is needed to confirm the validity of previous findings and to widen the field of clinical applications. Measurability and reliability can be a major issue in the measurement of spontaneous BRS, particularly in some patient populations like post-myocardial infarction and heart failure patents. Main causes of poor measurability are: non-sinus rhythm, a high rate of ectopic beats and the need for recorded time series of RR interval and arterial blood pressure to satisfy the constraints of the different BRS estimation algorithms. As for reliability, within-subject variability is rather high in the measurements of spontaneous BRS and, therefore, should be carefully taken into account

  10. Technical Stability and Biological Variability in MicroRNAs from Dried Blood Spots: A Lung Cancer Therapy-Monitoring Showcase.

    PubMed

    Kahraman, Mustafa; Laufer, Thomas; Backes, Christina; Schrörs, Hannah; Fehlmann, Tobias; Ludwig, Nicole; Kohlhaas, Jochen; Meese, Eckart; Wehler, Thomas; Bals, Robert; Keller, Andreas

    2017-09-01

    Different work flows have been proposed to use miRNAs as blood-borne biomarkers. In particular, the method used for collecting blood from patients can considerably influence the diagnostic results. We explored whether dried blood spots (DBSs) facilitate stable miRNA measurements and compared its technical stability with biological variability. First, we tested the stability of DBS samples by generating from 1 person 18 whole-genome-wide miRNA profiles of DBS samples that were exposed to different temperature and humidity conditions. Second, we investigated technical reproducibility by performing 7 replicates of DBS again from 1 person. Third, we investigated DBS samples from 53 patients with lung cancer undergoing different therapies. Across these 3 stages, 108 genome-wide miRNA profiles from DBS were generated and evaluated biostatistically. In the stability analysis, we observed that temperature and humidity had an overall limited influence on the miRNomes (average correlation between the different conditions of 0.993). Usage of a silica gel slightly diminished DBS' technical reproducibility. The 7 technical replicates had an average correlation of 0.996. The correlation with whole-blood PAXGene miRNomes of the same individual was remarkable (correlation of 0.88). Finally, evaluation of the samples from the 53 patients with lung cancer exposed to different therapies showed that the biological variations exceeded the technical variability significantly (P < 0.0001), yielding 51 dysregulated miRNAs. We present a stable work flow for profiling of whole miRNomes on the basis of samples collected from DBS. Biological variations exceeded technical variations significantly. DBS-based miRNA profiles will potentially further the translational character of miRNA biomarker studies. © 2017 American Association for Clinical Chemistry.

  11. Learning temporal weights of clinical events using variable importance.

    PubMed

    Zhao, Jing; Henriksson, Aron

    2016-07-21

    Longitudinal data sources, such as electronic health records (EHRs), are very valuable for monitoring adverse drug events (ADEs). However, ADEs are heavily under-reported in EHRs. Using machine learning algorithms to automatically detect patients that should have had ADEs reported in their health records is an efficient and effective solution. One of the challenges to that end is how to take into account the temporality of clinical events, which are time stamped in EHRs, and providing these as features for machine learning algorithms to exploit. Previous research on this topic suggests that representing EHR data as a bag of temporally weighted clinical events is promising; however, the weights were in that case pre-assigned according to their time stamps, which is limited and potentially less accurate. This study therefore focuses on how to learn weights that effectively take into account the temporality and importance of clinical events for ADE detection. Variable importance obtained from the random forest learning algorithm is used for extracting temporal weights. Two strategies are proposed for applying the learned weights: weighted aggregation and weighted sampling. The first strategy aggregates the weighted clinical events from different time windows to form new features; the second strategy retains the original features but samples them by using their weights as probabilities when building each tree in the forest. The predictive performance of random forest models using the learned weights with the two strategies is compared to using pre-assigned weights. In addition, to assess the sensitivity of the weight-learning procedure, weights from different granularity levels are evaluated and compared. In the weighted sampling strategy, using learned weights significantly improves the predictive performance, in comparison to using pre-assigned weights; however, there is no significant difference between them in the weighted aggregation strategy. Moreover, the

  12. Predictive variables for the occurrence of early clinical mastitis in primiparous Holstein cows under field conditions in France.

    PubMed Central

    Barnouin, J; Chassagne, M

    2001-01-01

    Holstein heifers from 47 dairy herds in France were enrolled in a field study to determine predictors for clinical mastitis within the first month of lactation. Precalving and calving variables (biochemical, hematological, hygienic, and disease indicators) were collected. Early clinical mastitis (ECM) predictive variables were analyzed by using a multiple logistic regression model (99 cows with ECM vs. 571 without clinical mastitis throughout the first lactation). Two variables were associated with a higher risk of ECM: a) difficult calving and b) medium and high white blood cell (WBC) counts in late gestation. Two prepartum indicators were associated with a lower ECM risk: a) medium and high serum concentrations of immunoglobulin G1 (IgG1) and b) high percentage of eosinophils among white blood cells. Calving difficulty and certain biological blood parameters (IgG1, eosinophils) could represent predictors that would merit further experimental studies, with the aim of designing programs for reducing the risk of clinical mastitis in the first lactation. PMID:11195522

  13. Diuretics vs. placebo for postpartum blood pressure control in preeclampsia (DIUPRE): a randomized clinical trial.

    PubMed

    Cursino, Telma; Katz, Leila; Coutinho, Isabela; Amorim, Melania

    2015-08-05

    Hypertension affects about 10% of pregnancies and is responsible for both maternal and neonatal devastating complications such as eclampsia, HELLP syndrome, prematurity and maternal and neonatal death. The resolution of the disease occurs in the first twelve weeks postpartum. The behavior of blood pressure and occurrence of very high blood pressure episodes among women with severe preeclampsia is related to remodeling of the dynamics of body fluids with consequent increase in intravascular volume. The persistence of hypertension in critical levels results in increased puerperal morbidity. To evaluate the effectiveness of furosemide in accelerating blood pressure recovery among women with severe preeclampsia. A triple-masked placebo controlled clinical trial, will be conducted including 120 postpartum women with severe preeclampsia, after eclampsia prophylaxis with magnesium sulfate and with adequate diuresis. Women with chronic hypertension and users of diuretics will be deleted. Informed consent will be obtained from all participants. Patients will be randomized to receive furosemide (40 mg orally every twenty four hours) or placebo. The variables are systolic and diastolic blood pressure, frequency of hypertensive crises, need for maintenance of antihypertensive therapy, number of antihypertensive agents used to control blood pressure, urine output, length of hospital stay, adverse effects and maternal complications. This study was approved by the Research Ethics Committee in humans of our institution. All participants will be duly informed about the aims of the project and will be included only if they agree to participate voluntarily, signing the informed consent. This study was registered on Clinical Trials.gov under the number NCT02163655. ( http://clinicaltrials.gov/show/NCT02163655).

  14. Engineering analysis of biological variables: an example of blood pressure over 1 day.

    PubMed

    Huang, W; Shen, Z; Huang, N E; Fung, Y C

    1998-04-28

    Almost all variables in biology are nonstationarily stochastic. For these variables, the conventional tools leave us a feeling that some valuable information is thrown away and that a complex phenomenon is presented imprecisely. Here, we apply recent advances initially made in the study of ocean waves to study the blood pressure waves in the lung. We note first that, in a long wave train, the handling of the local mean is of predominant importance. It is shown that a signal can be described by a sum of a series of intrinsic mode functions, each of which has zero local mean at all times. The process of deriving this series is called the "empirical mode decomposition method." Conventionally, Fourier analysis represents the data by sine and cosine functions, but no instantaneous frequency can be defined. In the new way, the data are represented by intrinsic mode functions, to which Hilbert transform can be used. Titchmarsh [Titchmarsh, E. C. (1948) Introduction to the Theory of Fourier Integrals (Oxford Univ. Press, Oxford)] has shown that a signal and i times its Hilbert transform together define a complex variable. From that complex variable, the instantaneous frequency, instantaneous amplitude, Hilbert spectrum, and marginal Hilbert spectrum have been defined. In addition, the Gumbel extreme-value statistics are applied. We present all of these features of the blood pressure records here for the reader to see how they look. In the future, we have to learn how these features change with disease or interventions.

  15. Clinical evaluation of a /sup 51/Cr-labeled red blood cell survival test for in vivo blood compatibility testing

    SciTech Connect

    Pineda, A.A.; Dharkar, D.D.; Wahner, H.W.

    1984-01-01

    Modified red blood cell survival studies with use of 51Cr were performed in three groups of subjects. Group 1 consisted of normal subjects who were given labeled autologous blood, group 2 were subjects in need of blood transfusions and given labeled ABO and Rh crossmatch-compatible blood, and group 3 were patients in need of blood transfusion but in whom problems arose in finding compatible blood. The results of the studies suggest that for patients with blood compatibility problems, normal red blood cell survival values at 1 hour do not exclude the possibility of severe hemolysis 24 hours later. Thus, if a 1-hour test result is normal, the procedure should be extended routinely to 24 hours. Moreover, the test can be used to evaluate the clinical importance of antibodies. We showed that anti-Yka and anti-Lan were clinically significant, but high-titer, low-avidity antibodies, anti-Kna, anti-I, and anti-HI were clinically insignificant in the cases studied. This finding emphasizes the importance of an in vivo test for the final compatibility evaluation in complicated blood replacement problems.

  16. Laser speckle contrast imaging of cerebral blood flow in humans during neurosurgery: a pilot clinical study

    NASA Astrophysics Data System (ADS)

    Parthasarathy, Ashwin B.; Weber, Erica L.; Richards, Lisa M.; Fox, Douglas J.; Dunn, Andrew K.

    2010-11-01

    Monitoring cerebral blood flow (CBF) during neurosurgery can provide important physiological information for a variety of surgical procedures. CBF measurements are important for assessing whether blood flow has returned to presurgical baseline levels and for assessing postsurgical tissue viability. Existing techniques for intraoperative monitoring of CBF based on magnetic resonance imaging are expensive and often impractical, while techniques such as indocyanine green angiography cannot produce quantitative measures of blood flow. Laser speckle contrast imaging (LSCI) is an optical technique that has been widely used to quantitatively image relative CBF in animal models in vivo. In a pilot clinical study, we adapted an existing neurosurgical operating microscope to obtain LSCI images in humans in real time during neurosurgery under baseline conditions and after bipolar cautery. Simultaneously recorded ECG waveforms from the patient were used to develop a filter that helped reduce measurement variabilities due to motion artifacts. Results from this study demonstrate the feasibility of using LSCI to obtain blood flow images during neurosurgeries and its capability to produce full field CBF image maps with excellent spatial resolution in real-time with minimal disruption to the surgical procedure.

  17. Exercise blood pressure: clinical relevance and correct measurement.

    PubMed

    Sharman, J E; LaGerche, A

    2015-06-01

    Blood pressure (BP) is a mandatory safety measure during graded intensity clinical exercise stress testing. While it is generally accepted that exercise hypotension is a poor prognostic sign linked to severe cardiac dysfunction, recent meta-analysis data also implicate excessive rises in submaximal exercise BP with adverse cardiovascular events and mortality, irrespective of resting BP. Although more data is needed to derive submaximal normative BP thresholds, the association of a hypertensive response to exercise with increased cardiovascular risk may be due to underlying hypertension that has gone unnoticed by conventional resting BP screening methods. Delayed BP decline during recovery is also associated with adverse clinical outcomes. Thus, above and beyond being used as a routine safety measure during stress testing, exercise (and recovery) BP may be useful for identifying high-risk individuals and also as an aid to optimise care through appropriate follow-up after exercise stress testing. Accordingly, careful attention should be paid to correct measurement of exercise stress test BP (before, during and after exercise) using a standardised approach with trained operators and validated BP monitoring equipment (manual or automated). Recommendations for exercise BP measurement based on consolidated international guidelines and expert consensus are presented in this review.

  18. Characterizing biological variability in livestock blood cholinesterase activity for biomonitoring organophosphate nerve agent exposure

    SciTech Connect

    Halbrook, R.S.; Shugart, L.R.; Watson, A.P.; Munro, N.B.; Linnabary, R.D. )

    1992-09-01

    A biomonitoring protocol, using blood cholinesterase (ChE) activity in livestock as a monitor of potential organophosphate nerve agent exposure during the planned destruction of US unitary chemical warfare agent stockpiles, is described. The experimental design included analysis of blood ChE activity in individual healthy sheep, horses, and dairy and beef cattle during a 10- to 12-month period. Castrated and sexually intact males, pregnant and lactating females, and adult and immature animals were examined through at least one reproductive cycle. The same animals were used throughout the period of observation and were not exposed to ChE-inhibiting organophosphate or carbamate compounds. A framework for an effective biomonitoring protocol within a monitoring area includes establishing individual baseline blood ChE activity for a sentinel group of 6 animals on the bases of blood samples collected over a 6-month period, monthly collection of blood samples for ChE-activity determination during monitoring, and selection of adult animals as sentinels. Exposure to ChE-inhibiting compounds would be suspected when all blood ChE activity of all animals within the sentinel group are decreased greater than 20% from their own baseline value. Sentinel species selection is primarily a logistical and operational concern; however, sheep appear to be the species of choice because within-individual baseline ChE activity and among age and gender group ChE activity in sheep had the least variability, compared with data from other species. This protocol provides an effective and efficient means for detecting abnormal depressions in blood ChE activity in livestock and can serve as a valuable indicator of the extent of actual plume movement and/or deposition in the event of organophosphate nerve agent release.

  19. Blood lipids, homocysteine, stress factors, and vitamins in clinically stable multiple sclerosis patients

    PubMed Central

    2010-01-01

    Multiple Sclerosis (MS) patients present a decrease of antioxidants and neuroprotective and immunoregulatory vitamins and an increase of total homocysteine (tHcy), cholesterol (CHL), HDL-cholesterol, and of cellular stress markers, variably associated with the different phases of the disease. We compared the blood levels of uric acid, folic acid, vitamins B12, A, and E, tHcy, CHL, HDL-cholesterol, and triglycerides in forty MS patients during a phase of clinical inactivity with those of eighty healthy controls, matched for age and sex. We found higher levels of tHcy (p = 0.032) and of HDL-cholesterol (p = 0.001) and lower levels of vitamin E (p = 0.001) and the ratio vitamin E/CHL (p = 0.001) in MS patients. In conclusion, modifications of some biochemical markers of cell damage were detected in MS patients during a phase of clinical inactivity. PMID:20163740

  20. Temporal sequence of recovery-related events following maximal exercise assessed by heart rate variability and blood lactate concentration.

    PubMed

    Hoshi, Rosangela Akemi; Vanderlei, Luiz Carlos Marques; de Godoy, Moacir Fernandes; Bastos, Fábio do Nascimento; Netto, Jayme; Pastre, Carlos Marcelo

    2017-09-01

    To analyse the temporal sequence of recovery events related to autonomic nervous system and metabolic processes following maximal exercise, applying linear and nonlinear indices of heart rate variability (HRV) and blood lactate concentration. On the following day of the maximum oxygen consumption test, 20 participants firstly lay down for 20 min for resting data collection and then underwent the constant velocity exhaustive test, which consisted in running at 100% of maximal velocity reached on the previous day until exhaustion. Immediately after the end of exercise, the participants kept a supine position for 120 min recovering passively. Prior to exercise and at every 10 min during the recovery time, blood samples were collected to determine lactate concentration, and heart rate variability analysis (time and frequency domain indices and recurrence plot variables) was performed. Friedman's test, complemented with Dunn's multiple comparison test, was used to compare recovery moments and baseline values. From 70 min, no significant differences were detected between lactate concentration and baseline. HRV indices were considered recovered at different timings: at 60 min for SD2; at 70 min for SDNN and LF; at 80 min for RMSSD, HF and SD1 and at 90 min for recurrence plot variables. During passive recovery after maximal exercise, restoration processes seem to comply an order, considering analysed HRV indices and lactate removal: at first, lactate concentration reaches normal values, allowing sympathovagal reorganization, and then, parasympathetic function is able to complete its reestablishment followed by system complexity recovering. © 2016 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

  1. Role of Ambulatory and Home Blood Pressure Monitoring in Clinical Practice: A Narrative Review

    PubMed Central

    Shimbo, Daichi; Abdalla, Marwah; Falzon, Louise; Townsend, Raymond R.; Muntner, Paul

    2015-01-01

    Hypertension, a common cardiovascular disease (CVD) risk factor, is usually diagnosed and treated based on blood pressure readings obtained in the clinic setting. Blood pressure may differ considerably when measured in the clinic versus outside of the clinic setting. Over the past several decades, evidence has accumulated on two approaches for measuring out-of-clinic blood pressure: ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM). Blood pressure measures on ABPM and HBPM each have a stronger association with CVD outcomes than clinic blood pressure. Controversy exists whether ABPM or HBPM is superior for estimating CVD risk, and under what circumstances these methods should be used in clinical practice for assessing out-of-clinic blood pressure. This review describes ABPM and HBPM procedures, the blood pressure phenotypic measures that can be ascertained, and the evidence that supports the use of each approach to measure out-of-clinic blood pressure. This review also describes barriers to the successful implementation of ABPM and HBPM in clinical practice, proposes core competencies for the conduct of these procedures, and highlights important areas for future research. PMID:26457954

  2. Visit-to-visit variability of blood pressure and renal function decline in patients with diabetic chronic kidney disease.

    PubMed

    Yokota, Kei; Fukuda, Masamichi; Matsui, Yoshio; Kario, Kazuomi; Kimura, Kenjiro

    2014-05-01

    The authors previously reported that the visit-to-visit variability of blood pressure is correlated with renal function decline in nondiabetic chronic kidney disease. Little is known about the association between visit-to-visit variability and renal function decline in patients with diabetic chronic kidney disease. The authors retrospectively studied 69 patients with diabetic chronic kidney disease stage 3a, 3b, or 4. The standard deviation and coefficient of variation of blood pressure in 12 consecutive visits were defined as visit-to-visit variability of blood pressure. The median observation period was 32 months. In univariate correlation, the standard deviation and coefficient of variation of blood pressure were not significantly associated with the slope of estimated glomerular filtration rate. There was no significant association between the visit-to-visit variability of blood pressure and renal function decline in patients with diabetic chronic kidney disease, in contrast with our previous study of nondiabetic patients with chronic kidney disease.

  3. Correlation between the Lactate Dehydrogenase Levels with Laboratory Variables in the Clinical Severity of Sickle Cell Anemia in Congolese Patients

    PubMed Central

    Mikobi, Tite Minga; Lukusa Tshilobo, Prosper; Aloni, Michel Ntetani; Mvumbi Lelo, Georges; Akilimali, Pierre Zalagile; Muyembe-Tamfum, Jean Jacques; Race, Valérie; Matthijs, Gert; Mbuyi Mwamba, Jean Marie

    2015-01-01

    Background Sickle cell anemia is an inflammatory disease and is characterized by chronic hemolysis. We sought to evaluate the association of lactate dehydrogenase levels with specific clinical phenotypes and laboratory variables in patients with sickle cell anemia. Methods The present cross-sectional study was conducted in Sickle Cell Centre of Yolo in Kinshasa, the Democratic Republic of Congo. Two hundred and eleven patients with Sickle Cell Anemia in steady state were recruited. Seventy-four participants with normal Hb (Hb-AA) were selected as a control group. Results The average rates of hemoglobin, hematocrit, and red blood cells tended to be significantly lower in subjects with Hb-SS (p<0.001). The average rates of white blood cells, platelets, reticulocytes and serum LDH were significantly higher in subjects with Hb-SS (p<0.001). The average rates of Hb, HbF, hematocrit and red blood cells of Hb-SS patients with asymptomatic clinical phenotype were significantly higher than those of the two other phenotypes. However, the average rates of white blood cells, platelets, reticulocytes, and LDH of Hb-SS patients with the severe clinical phenotype are higher than those of two other clinical phenotypes. Significant correlations were observed between Hb and white blood cell in severe clinical phenotype (r3 = -0.37 *) between Hb and red blood cells in the three phenotypes (r1 = 0.69 * r2 * = 0.69, r3 = 0.83 *), and finally between Hb and reticulocytes in the asymptomatic clinical phenotype and severe clinical phenotype (r1 = -0.50 * r3 = 0.45 *). A significant increase in LDH was observed in patients with leg ulcer, cholelithiasis and aseptic necrosis of the femoral head. Conclusion The increase in serum LDH is accompanied by changes in hematological parameters. In our midst, serum LDH may be considered as an indicator of the severity of the disease. PMID:25946088

  4. Variable clinical presentations of secondary delusional infestation: an experience of six cases from a psychodermatology clinic.

    PubMed

    Altunay, Ilknur K; Ates, Bilge; Mercan, Sibel; Demirci, Gulsen Tukenmez; Kayaoglu, Semra

    2012-01-01

    Delusional Infestation (DI) is a relatively rare condition with a fixed belief of being infested with living organisms, despite a lack of medical evidence of such infestation. Although it seems to be a psychiatric disease, patients commonly are admitted to dermatology clinics because of skin findings. Psychiatrists can underestimate its prevalance, whereas dermatologists can miss the diagnosis. It should be managed as a psychodermatological disease. Our aim in the study was to evaluate six patients with different clinical presentations of DI and to emphasize some clinical features. All patients were internalized in the psychodermatology clinic for this study. Medical history and clinical data from dermatologic and psychiatric examinations were noted; Mini International Neuropsychiatric Interview (MINI-Plus) and laboratory investigations including blood and urine analyses, microscopic analysis of so-called pathogens, and skin biopsy if needed, were performed. The diagnosis was made based on detailed history, dermatologic and psychiatric examinations, and laboratory investigations. All patients had symptoms of itching, burning, or crawling sensations dermatologically and thus were admitted to dermatology clinic. They were all considered secondary DI to another medical condition or to psychiatric illness. Vitamin B12 deficiency, diabetes, and hypothyroidism were the underlying medical conditions. Related psychiatric illnesses were trichotillomania and schizoaffective disorder, schizophrenia, shared pychotic disorder, and brief psychotic disorder. Two patients had delusions of inanimate materials; four patients had partial and complete remissions; and two patients have dropped out. Each patient had different clinical characteristics creating diagnostic challenges. All complaints were related to the infestation of the skin. The presence of different psychiatric comorbidities is remarkable. It seems that both psychiatrists and dermatologists can face diagnostic and

  5. Respiration-related cerebral blood flow variability increases during control-mode non-invasive ventilation in normovolemia and hypovolemia.

    PubMed

    Skytioti, Maria; Søvik, Signe; Elstad, Maja

    2017-09-12

    Increased variability in cerebral blood flow (CBF) predisposes to adverse cerebrovascular events. Oscillations in arterial blood pressure and PaCO2 induce CBF variability. Less is known about how heart rate (HR) variability affects CBF. We experimentally reduced respiration-induced HR variability in healthy subjects, hypothesizing that CBF variability would increase. Internal carotid artery (ICA) blood velocity was recorded by Doppler ultrasound in ten healthy subjects during baseline, control-mode, non-invasive mechanical ventilation (NIV), i.e., with fixed respiratory rate, hypovolemia induced by lower body negative pressure, and combinations of these. ICA beat volume (ICABV) and ICA blood flow (ICABF) were calculated. HR, mean arterial blood pressure (MAP), respiratory frequency (RF), and end-tidal CO2 were recorded. Integrals of power spectra at each subject's RF ± 0.03 Hz were used to measure variability. Phase angle/coherence measured coupling between cardiovascular variables. Control-mode NIV reduced HR variability (-56%, p = 0.002) and ICABV variability (-64%, p = 0.006) and increased ICABF variability (+140%, p = 0.002) around RF. NIV + hypovolemia reduced variability in HR and ICABV by 70-80% (p = 0.002) and doubled ICABF variability (p = 0.03). MAP variability was unchanged in either condition. Respiration-induced HR and ICABV oscillations were in inverse phase and highly coherent (coherence >0.9) during baseline, but this coherence decreased during NIV, in normovolemia and hypovolemia (p = 0.01). Controlling respiration in awake healthy humans reduced HR variability and increased CBF variability in hypovolemia and normovolemia. We suggest respiration-induced HR variability to be a mechanism in CBF regulation. Maintaining spontaneous respiration in patients receiving ventilatory support may be beneficial also for cerebral circulatory purposes.

  6. Genome-wide analysis of blood pressure variability and ischemic stroke.

    PubMed

    Yadav, Sunaina; Cotlarciuc, Ioana; Munroe, Patricia B; Khan, Muhammad S; Nalls, Michael A; Bevan, Steve; Cheng, Yu-Ching; Chen, Wei-Min; Malik, Rainer; McCarthy, Nina S; Holliday, Elizabeth G; Speed, Douglas; Hasan, Nazeeha; Pucek, Mateusz; Rinne, Paul E; Sever, Peter; Stanton, Alice; Shields, Denis C; Maguire, Jane M; McEvoy, Mark; Scott, Rodney J; Ferrucci, Luigi; Macleod, Mary J; Attia, John; Markus, Hugh S; Sale, Michele M; Worrall, Bradford B; Mitchell, Braxton D; Dichgans, Martin; Sudlow, Cathy; Meschia, James F; Rothwell, Peter M; Caulfield, Mark; Sharma, Pankaj

    2013-10-01

    Visit-to-visit variability in blood pressure (vBP) is associated with ischemic stroke. We sought to determine whether such variability has genetic causes and whether genetic variants associated with BP variability are also associated with ischemic stroke. A Genome Wide Association Study (GWAS) for loci influencing BP variability was undertaken in 3802 individuals from the Anglo-Scandinavian Cardiac Outcome Trial (ASCOT) study, in which long-term visit-to-visit and within-visit BP measures were available. Because BP variability is strongly associated with ischemic stroke, we genotyped the sentinel single nucleotide polymorphism in an independent ischemic stroke population comprising 8624 cases and 12 722 controls and in 3900 additional (Scandinavian) participants from the ASCOT study to replicate our findings. The ASCOT discovery GWAS identified a cluster of 17 correlated single nucleotide polymorphisms within the NLGN1 gene (3q26.31) associated with BP variability. The strongest association was with rs976683 (P=1.4×10(-8)). Conditional analysis of rs976683 provided no evidence of additional independent associations at the locus. Analysis of rs976683 in patients with ischemic stroke found no association for overall stroke (odds ratio, 1.02; 95% CI, 0.97-1.07; P=0.52) or its subtypes: cardioembolic (odds ratio, 1.07; 95% CI, 0.97-1.16; P=0.17), large vessel disease (odds ratio, 0.98; 95% CI, 0.89-1.07; P=0.60), and small vessel disease (odds ratio, 1.07; 95% CI, 0.97-1.17; P=0.19). No evidence for association was found between rs976683 and BP variability in the additional (Scandinavian) ASCOT participants (P=0.18). We identified a cluster of single nucleotide polymorphisms at the NLGN1 locus showing significant association with BP variability. Follow-up analyses did not support an association with risk of ischemic stroke and its subtypes.

  7. The influence of subclinical hyperthyroidism on blood pressure, heart rate variability, and prevalence of arrhythmias.

    PubMed

    Kaminski, Grzegorz; Makowski, Karol; Michałkiewicz, Dariusz; Kowal, Jarosław; Ruchala, Marek; Szczepanek, Ewelina; Gielerak, Grzegorz

    2012-05-01

    The impact of subclinical hyperthyroidism (sHT) on the cardiovascular system still needs to be elucidated. The aim of the study was to prospectively assess blood pressure (BP), variability in heart rate, and the prevalence of arrhythmias in patients with sHT, both before and after they are restored to the euthyroid state. The study group consisted of 44 normotensive patients (37 women, 7 men), aged 22-65 years (mean±SD: 45.9±11.0) with sHT. Enrolled patients were drawn from 1080 patients referred to our department for treatment of hyperthyroidism. Study patients were treated with radioiodine treatment to restore the euthyroid state. Ambulatory BP monitoring and Holter electrocardiography were performed (i) when sHT was diagnosed and (ii) at least 6 months after they became euthyroid. sHT in comparison to the euthyroid state was associated with higher (109.3±7.1 vs. 107.1±7.7 mmHg) nocturnal systolic mean BP (p=0.035) and BP load (14.8 vs. 10.2%, p=0.033), mean diastolic BP (66.4±6.6 vs. 64.8±6.6 mmHg, p=0.047), and mean arterial pressure (80.8±43.1 vs. 79.3±43.6 mmHg, p=0.049). Moreover, significant changes in both the time and frequency domain measures of heart rate variability (HRV) were observed: decrease of the square root of the mean squared differences of successive NN intervals (rMSSD) (45.68±34.1 vs. 65.09±50.6 ms, p=0.03) and the low frequency power (LF) (5.71±0.99 vs. 6.0±1.01 ms(2), p=0.049) as well as increase of QT interval dispersion (58.25±28.5 vs. 46.90±12.1 ms, p=0.020). This was accompanied by a clinically insignificant increase in the frequency of ventricular extrasystoles (VES) (3.1±7.4 vs. 0.6±1.2 per hour, p=0.048) and increased mean heart rate (78.4±6.8 vs. 76.0±8.0 beats/min, p=0.004). Some of the parameters correlated positively with thyroid hormones: nocturnal diastolic BP with free triiodothyronine (FT(3)) (r=0.397, p=0.008), rMSSD with free thyroxine (FT(4)) (r=0.389, p=0.013), and QT interval dispersion with FT(4

  8. The use of hirudin as universal anticoagulant in haematology, clinical chemistry and blood grouping.

    PubMed

    Menssen, H D; Melber, K; Brandt, N; Thiel, E

    2001-12-01

    Undesirable interactions between anticoagulants and diagnostic test kit procedures so far have prevented the development of a single uniform blood sampling tube. Contrary to K2-EDTA, heparin and other anticoagulants, hirudin only minimally alters blood cells and dissolved blood constituents, thus qualifying as a universal anticoagulant for diagnostic purposes. Automated complete blood counts, automated analyses of clinical chemistry analytes and immunohaematology were performed from hirudinised and routinely processed blood obtained from healthy volunteers (n=35) and hospitalised patients (n=45). Hirudin (400 ATU/ml blood) sufficiently anticoagulated blood for diagnostic purposes. The measurements of automated complete blood counts obtained from K2-EDTA-anticoagulated and hirudinised blood correlated significantly as did the measurements of 24 clinical chemistry analytes from hirudinised plasma and serum. Regression analysis revealed that the results of complete blood counts and clinical chemistry tests were predictable from the respective measurements from hirudinised blood (p=0.001). Immunohaematological tests and cross-matching from hirudinised and native blood of the same donors gave identical results. Single clotting factors, but not global coagulation analytes, could be measured from hirudinised blood. Therefore, a universal hirudin-containing blood sampling tube could be designed for automated analysis of haematological, serological and clinical chemistry analytes.

  9. Clinical and Immunological Features of Common Variable Immunodeficiency in China

    PubMed Central

    Lin, Lian-Jun; Wang, Yu-Chuan; Liu, Xin-Min

    2015-01-01

    Background: Common variable immunodeficiency (CVID) is one of the most common symptomatic primary immunodeficiency syndromes. The purpose of this article was to broaden our knowledge about CVID for better diagnosis and treatment. Methods: Clinical and immunological features of 40 Chinese patients with CVID were analyzed retrospectively. Results: The median age at onset was 11-year-old (range 4–51 years). The median age at diagnosis was 14.5-year-old (range 5–66 years). The average time of delay in diagnosis was 5.3 years (range 1–41 years). The most common main complaint was fever due to infections (35 cases, 87.5%). Pneumonia (28 cases, 70%) was the most common type of infections. Bronchiectasis was present in 6 patients (15%). Autoimmune disease was detected in 6 cases of CVID, and malignancy in 2 cases. The median total serum levels of IgG, IgA, and IgM at diagnosis were 1.07 g/L, 0.07 g/L, and 0.28 g/L, respectively. The percentages of CD3−/CD10+ B-cells were 1%–3.14%. Conclusions: Infection is the most frequent presentation of CVID. Patients with unexplainable infections should receive further examination including serum immunoglobulin (Ig) and lymphocyte subset analysis. Regular and sufficient substitution with Ig is recommended. PMID:25635425

  10. Systolic Blood Pressure Variability and Lower Extremity Amputation In a Non-Elderly Population with Diabetes

    PubMed Central

    Budiman-Mak, Elly; Epstein, Noam; Brennan, Meghan; Stuck, Rodney; Guihan, Marylou; Huo, Zhiping; Emanuele, Nicholas; Sohn, Min-Woong

    2016-01-01

    Objective Systolic blood pressure (SBP) variability is emerging as a new risk factor for cardiovascular diseases, diabetic nephropathy, and other atherosclerotic conditions. Our objective is to examine whether it has any prognostic value for lower-extremity amputations. Research Design and Methods This is a nested case-control study of a cohort of patients with diabetes aged < 60 years and treated in the US Department of Veterans Healthcare system in 2003. They were followed over five years for any above-ankle (major) amputations. For each case with a major amputation (event), we randomly selected up to five matched controls based on age, sex, race/ethnicity, and calendar time. SBP variability was computed using three or more blood pressure measures taken during the one-year period before the event. Patients were classified into quartiles according to their SBP variability. Results The study sample included 1038 cases and 2932 controls. Compared to Quartile 1 (lowest variability), Quartile 2 had 1.4 times (OR = 1.44, 95% CI = 1.00 – 2.07) and Quartiles 3 and 4 (highest) had 2.5 times (OR for Quartile 3 = 2.62, 95% CI = 1.85 – 3.72; OR for Quartile 4 = 2.50, 95% CI = 1.74 – 3.59) higher risk of major amputation (P for trend < 0.001). This gradient relationship held in both normotensive and hypertensive groups as well as for individuals without prior peripheral vascular disease. Conclusions This is the first study to show a significant graded relationship between SBP variability and risk of major amputation among non-elderly persons with diabetes. PMID:26809904

  11. Application of cardiovascular models in comparative physiology and blood pressure variability.

    PubMed

    Avolio, Alberto P; Xu, Ke; Butlin, Mark

    2013-01-01

    The usefulness of cardiovascular models is determined by their intended function with respect to elucidating underlying hemodynamic concepts and to enable simulations that will assist in understanding the effects of specific parameters. Models can take different forms, including mock circulatory constructs with physical components, mathematical representations of parameter space relations employing constitutive equations, or closed form representations of electrical circuit analogs described in the time or frequency domain. This investigation describes the use of cardiovascular models based on electrical analogs of mechanical hydrodynamic systems to elucidate two different physiologic concepts: (i) the use of distributed vascular impedance to investigate comparative physiology of optimal design and features related to body size across a broad range of animal species; (ii) use of lumped parameter models to assess the role of arterial stiffness in blood pressure variability. The impedance model shows that an allometric relationship between body weight and aortic effective length can be determined by using the frequency of minimum input impedance and aortic pulse wave velocity. This concept provides a background for optimal matching of body size and hemodynamic load on the heart. The lumped parameter model indicates that arterial stiffness, simulated by the total arterial compliance term, has a significant impact on variability of arterial pressure when changes are due to dynamic alterations of peripheral resistance. In addition, the known pressure dependency of arterial stiffness results in a curvilinear relationship between blood pressure variability and mean pressure. This has implications in hypertensive treatment where there are marked changes in arterial stiffness, as occurs with aging.

  12. Can We Reduce Negative Blood Cultures With Clinical Scores and Blood Markers? Results From an Observational Cohort Study.

    PubMed

    Laukemann, Svenja; Kasper, Nina; Kulkarni, Prasad; Steiner, Deborah; Rast, Anna Christina; Kutz, Alexander; Felder, Susan; Haubitz, Sebastian; Faessler, Lukas; Huber, Andreas; Fux, Christoph A; Mueller, Beat; Schuetz, Philipp

    2015-12-01

    Only a small proportion of blood cultures routinely performed in emergency department (ED) patients is positive. Multiple clinical scores and biomarkers have previously been examined for their ability to predict bacteremia. Conclusive clinical validation of these scores and biomarkers is essential.This observational cohort study included patients with suspected infection who had blood culture sampling at ED admission. We assessed 5 clinical scores and admission concentrations of procalcitonin (PCT), C-reactive protein (CRP), lymphocyte and white blood cell counts, the neutrophil-lymphocyte count ratio (NLCR), and the red blood cell distribution width (RDW). Two independent physicians assessed true blood culture positivity. We used logistic regression models with area under the curve (AUC) analysis.Of 1083 patients, 104 (9.6%) had positive blood cultures. Of the clinical scores, the Shapiro score performed best (AUC 0.729). The best biomarkers were PCT (AUC 0.803) and NLCR (AUC 0.700). Combining the Shapiro score with PCT levels significantly increased the AUC to 0.827. Limiting blood cultures only to patients with either a Shapiro score of ≥4 or PCT > 0.1 μg/L would reduce negative sampling by 20.2% while still identifying 100% of positive cultures. Similarly, a Shapiro score ≥3 or PCT >0.25 μg/L would reduce cultures by 41.7% and still identify 96.1% of positive blood cultures.Combination of the Shapiro score with admission levels of PCT can help reduce unnecessary blood cultures with minimal false negative rates.The study was registered on January 9, 2013 at the 'ClinicalTrials.gov' registration web site (NCT01768494).

  13. Can We Reduce Negative Blood Cultures With Clinical Scores and Blood Markers? Results From an Observational Cohort Study

    PubMed Central

    Laukemann, Svenja; Kasper, Nina; Kulkarni, Prasad; Steiner, Deborah; Rast, Anna Christina; Kutz, Alexander; Felder, Susan; Haubitz, Sebastian; Faessler, Lukas; Huber, Andreas; Fux, Christoph A.; Mueller, Beat; Schuetz, Philipp

    2015-01-01

    Abstract Only a small proportion of blood cultures routinely performed in emergency department (ED) patients is positive. Multiple clinical scores and biomarkers have previously been examined for their ability to predict bacteremia. Conclusive clinical validation of these scores and biomarkers is essential. This observational cohort study included patients with suspected infection who had blood culture sampling at ED admission. We assessed 5 clinical scores and admission concentrations of procalcitonin (PCT), C-reactive protein (CRP), lymphocyte and white blood cell counts, the neutrophil-lymphocyte count ratio (NLCR), and the red blood cell distribution width (RDW). Two independent physicians assessed true blood culture positivity. We used logistic regression models with area under the curve (AUC) analysis. Of 1083 patients, 104 (9.6%) had positive blood cultures. Of the clinical scores, the Shapiro score performed best (AUC 0.729). The best biomarkers were PCT (AUC 0.803) and NLCR (AUC 0.700). Combining the Shapiro score with PCT levels significantly increased the AUC to 0.827. Limiting blood cultures only to patients with either a Shapiro score of ≥4 or PCT > 0.1 μg/L would reduce negative sampling by 20.2% while still identifying 100% of positive cultures. Similarly, a Shapiro score ≥3 or PCT >0.25 μg/L would reduce cultures by 41.7% and still identify 96.1% of positive blood cultures. Combination of the Shapiro score with admission levels of PCT can help reduce unnecessary blood cultures with minimal false negative rates. The study was registered on January 9, 2013 at the ‘ClinicalTrials.gov’ registration web site (NCT01768494). PMID:26656373

  14. International Federation of Clinical Chemistry (IFCC). Scientific Division. Committee on pH, Blood Gases and Electrolytes. Approved IFCC recommendations on whole blood sampling, transport and storage for simultaneous determination of pH, blood gases and electrolytes.

    PubMed

    Burnett, R W; Covington, A K; Fogh-Andersen, N; Külpmann, W R; Maas, A H; Müller-Plathe, O; Siggaard-Andersen, O; Van Kessel, A L; Wimberley, P D; Zijlstra, W G

    1995-04-01

    Pre-analytical variables, e.g., specimen collection, transport, and storage, can contribute significantly to inaccurate pH, blood gas, and electrolyte values. The International Federation of Clinical Chemistry (IFCC), through its Committee on pH, Blood Gases and Electrolytes, has developed specific recommendations to minimize the undesirable effects of pre-analytical variables. The Committee has drawn upon the experiences of its own members as well as published data by others. Specifically, the Committee has included pertinent guidelines and suggestions by the IFCC Working Group on Selective Electrodes (WGSE), the National Committee on Clinical Laboratory Standards (NCCLS), and the Electrolyte/Blood Gas Division of the American Association for Clinical Chemistry (AACC). This paper will familiarize the reader with the effect of different types of specimen containers and anticoagulants. It discusses important aspects of specimen collection procedures including patients status and special precautions during specimen collection from indwelling catheters or cannulae. The paper also identifies different requirements in storage and transport of specimens for blood gas and electrolyte analysis.

  15. Blood pressure and heart rate variability complexity analysis in pregnant women with hypertension.

    PubMed

    Tejera, Eduardo; Areias, Maria Jose; Rodrigues, Ana Isabel; Nieto-Villar, Jose Manuel; Rebelo, Irene

    2012-01-01

    In this work, we perform a comparative analysis of blood pressure and heart rate variability complexity during pregnancy between normal, hypertensive, and preeclamptic women. A total of 563 short electrocardiographic (10 min) records were obtained from 217 pregnant women (135 normal, 55 hypertensive, and 27 preeclamptic) during several gestational ages in sitting position. We used a mixed unbalanced model for the longitudinal statistical analysis and besides the conventional spectral analysis, we applied Lempel-Ziv complexity, sample entropy, approximated entropy, and detrended fluctuation analysis in the complexity measurement. The obtained results revealed significant differences between pathological and normal states with important considerations related to pregnancy adaptability and evolution as well as the relationship of complexity and blood pressure with factors such as maternal age, familial history of diabetes or hypertension, and parity.

  16. Clinical Impact of Blood Culture Results in Acutely Ill Hospitalized Adult Patients With Cystic Fibrosis

    PubMed Central

    Vender, Robert J.; Vender, Robert L.

    2016-01-01

    Background Blood cultures are obtained clinically to confirm site and source of acute infection as well as to guide effective antibiotic therapies. Patients with cystic fibrosis (CF) are at risk for blood stream infection (BSI) as identified from positive blood culture results. Methods A retrospective chart review was performed of 190 adult CF patients from January 1, 2001 through December 1, 2015. All positive blood culture results were identified as to clinical relevance and source of BSI. Results There were a total of 3,053 blood cultures. One hundred fifty-one positive blood cultures were considered pathogenic and clinically significant. Venous access device-related BSI was identified in 31 evaluable patients and 106 blood cultures. Nineteen patients and 45 positive blood cultures were attributable to organ-specific sources. Conclusion Two patterns of BSI were identified: 1) venous access device infections without causal mortality and 2) organ-specific site infections with associated 26% mortality. PMID:27829951

  17. VISIT-TO-VISIT VARIABILITY IN BLOOD PRESSURE IS RELATED TO LATE-LIFE COGNITIVE DECLINE

    PubMed Central

    Qin, Bo; Viera, Anthony J.; Muntner, Paul; Plassman, Brenda L.; Edwards, Lloyd J.; Adair, Linda S.; Popkin, Barry M.; Mendez, Michelle A.

    2016-01-01

    The association between visit-to-visit variability of blood pressure (BP) and cognitive decline over time remains incompletely understood in a general population of older adults. We assessed the hypothesis that higher visit-to-visit variability in BP, but not mean BP, would be associated with faster decline in cognitive function among community-dwelling older adults. This prospective cohort study comprised 976 adults who had 3 or 4 visits with BP measurements as part of the China Health and Nutrition Survey from 1991, up to their first cognitive tests, and completed cognitive screening tests at 2 or more visits in 1997, 2000 or 2004. Visit-to visit BP variability was expressed as the standard deviation (SD), coefficient of variation or as the variation independent of mean BP across visits conducted at a mean interval of 3.2y. Mean (SD) age at the first cognitive test was 64 (6)y. Using multivariable-adjusted linear mixed-effects models, we found higher visit-to-visit variability in systolic BP, but not mean systolic BP, was associated with a faster decline of cognitive function (adjusted mean difference [95% CI] for high vs. low tertile of SD variability: standardized composite scores −0.038 standardized units (SU)/y [−0.066, −0.009] and verbal memory −0.041 SU/y [−0.075 to −0.008]). Higher visit-to-visit variability in diastolic BP was associated with a faster decline of cognitive function, independent of mean diastolic BP, among adults 55–64y but not those ≥ 65y. Our results suggest that higher long-term BP visit-to-visit variability is associated with a faster rate of cognitive decline among older adults. PMID:27217401

  18. The relationship between blood pressure variability, obesity and left atrial phasic function in hypertensive population.

    PubMed

    Tadic, Marijana; Cuspidi, Cesare; Ilic, Irena; Suzic-Lazić, Jelena; Zivanovic, Vladimir; Jozika, Ljilja; Celic, Vera

    2016-04-01

    We sought to investigate the relationship between blood pressure (BP) variability and left atrial (LA) phasic function assessed by volumetric and speckle tracking method in normal-weight, overweight and obese hypertensive patients. This cross-sectional study included 164 untreated hypertensive subjects who underwent a 24-h ambulatory BP monitoring and complete two-dimensional echocardiographic examination (2DE). All the patients were separated into three groups according to their body mass index (BMI): normal-weight patients (BMI < 25 kg/m(2)), overweight patients (25 ≤ BMI < 30 kg/m(2)), and obese patients (BMI ≥ 30 kg/m(2)). Daytime, nighttime and 24 h BP variability indices were higher in obese hypertensive subjects than in lean patients. Maximum and minimum LA volumes and volume indexes gradually and significantly increased, whereas pre-A LAV decreased, from normal-weight to obese subjects. Total and passive LA emptying fractions, representing LA reservoir and conduit function, gradually reduced from lean to obese individuals. Active LA EF, the parameter of LA booster pump function, increased in the same direction. Similar results were obtained by 2DE strain analysis. BP variability parameters were associated with structural, functional and mechanical parameters of LA remodeling in the whole study population. The parameters of LA reservoir function were negatively related with BP variability indices, whereas the parameters of LA pump function were positively related with BP variability indices. Obesity significantly impacts BP variability and LA phasic function in untreated hypertensive subjects. BP variability is associated with LA remodeling independent of BP, left ventricular systolic and diastolic function.

  19. Variability on red blood cell transfusion practices among Brazilian neonatal intensive care units.

    PubMed

    dos Santos, Amélia M N; Guinsburg, Ruth; Procianoy, Renato S; Sadeck, Lílian dos S R; Netto, Abimael Aranha; Rugolo, Ligia M; Luz, Jorge H; Bomfim, Olga; Martinez, Francisco E; de Almeida, Maria Fernanda B

    2010-01-01

    Guidelines for red blood cell (RBC) transfusions exist; however, transfusion practices vary among centers. This study aimed to analyze transfusion practices and the impact of patients and institutional characteristics on the indications of RBC transfusions in preterm infants. RBC transfusion practices were investigated in a multicenter prospective cohort of preterm infants with a birth weight of less than 1500 g born at eight public university neonatal intensive care units of the Brazilian Network on Neonatal Research. Variables associated with any RBC transfusions were analyzed by logistic regression analysis. Of 952 very-low-birth-weight infants, 532 (55.9%) received at least one RBC transfusion. The percentages of transfused neonates were 48.9, 54.5, 56.0, 61.2, 56.3, 47.8, 75.4, and 44.7%, respectively, for Centers 1 through 8. The number of transfusions during the first 28 days of life was higher in Center 4 and 7 than in other centers. After 28 days, the number of transfusions decreased, except for Center 7. Multivariate logistic regression analysis showed higher likelihood of transfusion in infants with late onset sepsis (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.8-4.4), intraventricular hemorrhage (OR, 9.4; 95% CI, 3.3-26.8), intubation at birth (OR, 1.7; 95% CI, 1.0-2.8), need for umbilical catheter (OR, 2.4; 95% CI, 1.3-4.4), days on mechanical ventilation (OR, 1.1; 95% CI, 1.0-1.2), oxygen therapy (OR, 1.1; 95% CI, 1.0-1.1), parenteral nutrition (OR, 1.1; 95% CI, 1.0-1.1), and birth center (p < 0.001). The need of RBC transfusions in very-low-birth-weight preterm infants was associated with clinical conditions and birth center. The distribution of the number of transfusions during hospital stay may be used as a measure of neonatal care quality.

  20. Clinical results from a noninvasive blood glucose monitor

    NASA Astrophysics Data System (ADS)

    Blank, Thomas B.; Ruchti, Timothy L.; Lorenz, Alex D.; Monfre, Stephen L.; Makarewicz, M. R.; Mattu, Mutua; Hazen, Kevin

    2002-05-01

    Non-invasive blood glucose monitoring has long been proposed as a means for advancing the management of diabetes through increased measurement and control. The use of a near-infrared, NIR, spectroscopy based methodology for noninvasive monitoring has been pursued by a number of groups. The accuracy of the NIR measurement technology is limited by challenges related to the instrumentation, the heterogeneity and time-variant nature of skin tissue, and the complexity of the calibration methodology. In this work, we discuss results from a clinical study that targeted the evaluation of individual calibrations for each subject based on a series of controlled calibration visits. While the customization of the calibrations to individuals was intended to reduce model complexity, the extensive requirements for each individual set of calibration data were difficult to achieve and required several days of measurement. Through the careful selection of a small subset of data from all samples collected on the 138 study participants in a previous study, we have developed a methodology for applying a single standard calibration to multiple persons. The standard calibrations have been applied to a plurality of individuals and shown to be persistent over periods greater than 24 weeks.

  1. Pre-dialysis systolic blood pressure-variability is independently associated with all-cause mortality in incident haemodialysis patients.

    PubMed

    Selvarajah, Viknesh; Pasea, Laura; Ojha, Sanjay; Wilkinson, Ian B; Tomlinson, Laurie A

    2014-01-01

    Systolic blood pressure variability is an independent risk factor for mortality and cardiovascular events. Standard measures of blood pressure predict outcome poorly in haemodialysis patients. We investigated whether systolic blood pressure variability was associated with mortality in incident haemodialysis patients. We performed a longitudinal observational study of patients commencing haemodialysis between 2005 and 2011 in East Anglia, UK, excluding patients with cardiovascular events within 6 months of starting haemodialysis. The main exposure was variability independent of the mean (VIM) of systolic blood pressure from short-gap, pre-dialysis blood pressure readings between 3 and 6 months after commencing haemodialysis, and the outcome was all-cause mortality. Of 203 patients, 37 (18.2%) patients died during a mean follow-up of 2.0 (SD 1.3) years. The age and sex-adjusted hazard ratio (HR) for mortality was 1.09 (95% confidence interval (CI) 1.02-1.17) for a one-unit increase of VIM. This was not altered by adjustment for diabetes, prior cardiovascular disease and mean systolic blood pressure (HR 1.09, 95% CI 1.02-1.16). Patients with VIM of systolic blood pressure above the median were 2.4 (95% CI 1.17-4.74) times more likely to die during follow-up than those below the median. Results were similar for all measures of blood pressure variability and further adjustment for type of dialysis access, use of antihypertensives and absolute or variability of fluid intake did not alter these findings. Diastolic blood pressure variability showed no association with all cause mortality. Our study shows that variability of systolic blood pressure is a strong and independent predictor of all-cause mortality in incident haemodialysis patients. Further research is needed to understand the mechanism as this may form a therapeutic target or focus for management.

  2. Antihypertensive drug classes have different effects on short-term blood pressure variability in essential hypertension.

    PubMed

    Levi-Marpillat, Natacha; Macquin-Mavier, Isabelle; Tropeano, Anne-Isabelle; Parati, Gianfranco; Maison, Patrick

    2014-06-01

    Increased blood pressure variability (BPV) contributes to end-organ damage, cardiovascular events and mortality associated with hypertension. In a cohort of 2780 hypertensive patients treated by either calcium channel blockers (CCBs), diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) or β-blockers alone or in combination, we compared indices of short-term BPV according to the different treatments. Short-term BPV was calculated as the standard deviation (s.d.) of 24 h, daytime or nighttime systolic blood pressure and diastolic blood pressure (SBP and DBP). Short-term BPV was compared between patients treated with a given antihypertensive class of interest (alone or in combination) and those not treated with this class, after controlling for ambulatory average blood pressure, heart rate, age, gender, propensity scores and carotid-femoral pulse wave velocity. Patients treated with CCBs (n=1247) or diuretics (n=1486) alone, or in addition to other drugs had significant lower s.d. of 24-h SBP compared with those not treated with these classes (mean differences in s.d. -0.50±0.50 mm Hg, P=0.001 and -0.17±0.15 mm Hg, P=0.05, respectively). There was no significant difference regarding treatment with or without ARBs, ACEIs and β-blockers. The combinations of CCBs with diuretics or ARBs on top of other treatments resulted in a lower 24-h SBP variability (mean differences in s.d. -0.43±0.17 mm Hg, P=0.02 and -0.44±0.19 mm Hg, P=0.005 vs. other combination uses, respectively). Antihypertensive drug classes have differential effects on short-term BPV with a greater reduction in patients treated with CCBs and diuretics. The combinations of CCBs with diuretics may be the most efficient treatments in lowering BPV.

  3. Impact of perioperative blood pressure variability on health resource utilization after cardiac surgery: an analysis of the ECLIPSE trials.

    PubMed

    Aronson, Solomon; Levy, Jerrold H; Lumb, Philip D; Fontes, Manuel; Wang, Yamei; Crothers, Tracy A; Sulham, Katherine A; Navetta, Marco S

    2014-06-01

    To examine the impact of blood pressure control on hospital health resource utilization using data from the ECLIPSE trials. Post-hoc analysis of data from 3 prospective, open-label, randomized clinical trials (ECLIPSE trials). Sixty-one medical centers in the United States. Patients 18 years or older undergoing cardiac surgery. Clevidipine was compared with nitroglycerin, sodium nitroprusside, and nicardipine. The ECLIPSE trials included 3 individual randomized open-label studies comparing clevidipine to nitroglycerin, sodium nitroprusside, and nicardipine. Blood pressure control was assessed as the integral of the cumulative area under the curve (AUC) outside specified systolic blood pressure ranges, such that lower AUC represents less variability. This analysis examined surgery duration, time to extubation, as well as intensive care unit (ICU) and hospital length of stay (LOS) in patients with AUC≤10 mmHg×min/h compared to patients with AUC>10 mmHg×min/h. One thousand four hundred ten patients were included for analysis; 736 patients (52%) had an AUC≤10 mmHg×min/h, and 674 (48%) had an AUC>10 mmHg×min/h. The duration of surgery and ICU LOS were similar between groups. Time to extubation and postoperative LOS were both significantly shorter (p = 0.05 and p<0.0001, respectively) in patients with AUC≤10. Multivariate analysis demonstrates AUC≤10 was significantly and independently associated with decreased time to extubation (hazard ratio 1.132, p = 0.0261) and postoperative LOS (hazard ratio 1.221, p = 0.0006). Based on data derived from the ECLIPSE studies, increased perioperative BP variability is associated with delayed time to extubation and increased postoperative LOS. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Predictive and Prognostic Clinical Variables in Cancer Patients Treated With Adenoviral Oncolytic Immunotherapy.

    PubMed

    Taipale, Kristian; Liikanen, Ilkka; Koski, Anniina; Heiskanen, Raita; Kanerva, Anna; Hemminki, Otto; Oksanen, Minna; Grönberg-Vähä-Koskela, Susanna; Hemminki, Kari; Joensuu, Timo; Hemminki, Akseli

    2016-08-01

    The development of oncolytic viruses has recently made great progress towards being available to cancer patients. With the breakthrough into clinics, it is crucial to analyze the existing clinical experience and use it as a basis for treatment improvements. Here, we report clinical data from 290 patients treated with oncolytic adenovirus. Using clinical variables and treatment characteristics, we constructed statistical models with regard to treatment response and overall survival (OS). Additionally, we investigated effects of neutralizing antibodies, tumor burden, and peripheral blood leucocyte counts on these outcomes. We found the absence of liver metastases to correlate with an improved rate of disease control (P = 0.021). In multivariate evaluation, patients treated with viruses coding for immunostimulatory granulocyte macrophage colony-stimulating factor were linked to better prognosis (hazard ratio (HR) 0.378, P < 0.001), as well as women with any cancer type (HR 0.694, P = 0.017). In multivariate analysis for imaging response, patients treated via intraperitoneal injection were more likely to achieve disease control (odds ratio (OR) 3.246, P = 0.027). Patients with low neutrophil-to-lymphocyte ratio before treatment had significantly longer OS (P < 0.001). These findings could explain some of the variation seen in treatment outcomes after virotherapy. Furthermore, the results offer hypotheses for treatment optimization and patient selection in oncolytic adenovirus immunotherapy.

  5. Facebook advertising for participant recruitment into a blood pressure clinical trial.

    PubMed

    Nash, Erin L; Gilroy, Deborah; Srikusalanukul, Wichat; Abhayaratna, Walter P; Stanton, Tony; Mitchell, Geoffrey; Stowasser, Michael; Sharman, James E

    2017-07-12

    Recruitment of sufficient sample size into clinical trials is challenging. Conventional advertising methods are expensive and are often ineffective. The effectiveness of Facebook for recruitment into blood pressure clinical trials of middle-to-older-aged people is unknown. This study aimed to assess this by comparing Facebook advertising with conventional recruitment methods from a retrospective analysis within a clinical trial. Conventional advertisements (newspaper, radio and posters) were employed for the first 20 months of a randomized controlled clinical trial conducted in three Australian capital cities from Tasmania, Queensland and the Australian Capital Territory. With dwindling participant recruitment, at 20 months a Facebook advertising campaign was employed intermittently over a 4-month period. Recruitment results were retrospectively compared with those using conventional methods in the previous 4 months. Compared with conventional recruitment methods, Facebook advertisement was associated with a significant increase in the number of participants recruited in the Australian Capital Territory (from an average 1.8-7.3/month; P < 0.05). There was also an increase in Tasmania that was of borderline significance (from 4.0 participants recruited/month to 9.3/month; P = 0.052). However, there was no effect in Queensland (from 6.0 participants recruited/month to 3.0/month; P = 0.15). Facebook advertisement was associated with a significant decrease in the age of participants enquiring into the study (from 60.9 to 58.7 years; P < 0.001). Facebook advertising was successful in helping to increase recruitment of middle-to-older aged participants into a blood pressure clinical trial, although there may be some variability in effect that is dependent on location.

  6. Adverse effects of alcohol ingestion post exercise on blood rheological variables during recovery.

    PubMed

    El-Sayed, M S

    2001-01-01

    The present study examined the influence of ingesting a moderate dose of alcohol on the main determinants of blood rheology namely: plasma viscosity, plasma fibrinogen concentration, plasma total protein concentration, and haematocrit. Eleven moderately active young men were studied immediately after a standardised cycle ergometer test and during the 24 h period of recovery. Alcohol (0.7 g/kg body mass) was given 1 h after exercise on one test occasion, while an equal volume of alcohol-free solution was administered on the other. Venous blood samples were obtained at baseline, post exercise, and at 1, 5, and 22 h post alcohol ingestion. A significant reduction in plasma volume was observed immediately after exercise, but this decrease was restored 1-h post drink ingestion. Blood alcohol level increased significantly 1 h after the ingestion of alcohol, but decreased and returned to the resting baseline level at 5 h during recovery. Exercise induced significant changes (P<0.05) in blood rheology as manifested by a significant increase (P<0.05) in plasma viscosity and plasma fibrinogen. Parallel increase (P<0.05) in haematocrit and total protein was also observed after exercise. The increase in these rheological variables immediately after exercise was mainly due to exercise-induced plasma volume loss. During recovery, while the increase in haematocrit post-exercise returned to the baseline level in both control and alcohol trials, plasma viscosity and plasma fibrinogen remained significantly high during recovery in the alcohol trial compared with control condition. It is concluded that exercise induces significant changes in the main determinants of blood rheology and the consumption of alcohol after physical exercise delays the normal return of plasma viscosity, plasma fibrinogen to the resting baseline levels during recovery. Although the mechanism responsible for these findings is not, as yet known, it might be linked with alcohol induce dehydration.

  7. The relationship between ambulatory blood pressure variability and enlarged perivascular spaces: a cross-sectional study.

    PubMed

    Yang, Shuna; Qin, Wei; Yang, Lei; Fan, Huimin; Li, Yue; Yin, Jiangmei; Hu, Wenli

    2017-08-21

    Recent studies reported that 24-hour ambulatory blood pressure variability (ABPV) was associated with lacunar infarction and white matter hyperintensities (WMH). However, the relationship between ABPV and enlarged perivascular spaces (EPVS) has not been investigated. Thus, our study aimed to investigate whether ABPV is associated with EPVS by 24-hour ambulatory blood pressure monitoring (ABPM). We conducted this study as a cross-sectional study. The study was based on patients who presented for physical examinations in our hospital from May 2013 to June 2016. Patients with both brain MRI scans and 24-hour ABPM were included and patients with acute stroke, a history of severe stroke and some other severe diseases were excluded. A total of 573 Chinese patients were prospectively enrolled in this study. EPVS in basal ganglia (BG) and white matter (WM) were identified on MRI and classified into three categories by the severity. WMH were scored by the Fazekas scale. Coefficient of variation (CV) and SD were considered as metrics of ABPV. Spearman correlation analysis and ordinal logistic regression analysis were used to assess the relationship between ABPV and EPVS. There were statistical differences among the subgroups stratified by the severity of EPVS in BG in the following ABPV metrics: SD and CV of systolic blood pressure (SBP), CV of diastolic blood pressure (DBP) in 24 hours, daytime and nighttime and SD of DBP in nighttime. The above ABPV metrics were positively associated with the degree of EPVS. The association was unchanged after adjusting for confounders. Spearman correlation analysis showed ABPV was not related to the degree of EPVS in the WM. ABPV was independently associated with EPVS in BG after controlling for blood pressure, but not in the WM. Pathogenesis of EPVS in BG and WM might be different. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted

  8. Reciprocal Interaction of 24-Hour Blood Pressure Variability and Systolic Blood Pressure on Outcome in Stroke Thrombolysis.

    PubMed

    Kellert, Lars; Hametner, Christian; Ahmed, Niaz; Rauch, Geraldine; MacLeod, Mary J; Perini, Francesco; Lees, Kennedy R; Ringleb, Peter A

    2017-07-01

    Significance and management of blood pressure (BP) changes in acute stroke care are unclear. Here, we aimed to investigate the impact of 24-hour BP variability (BPV) on outcome in patients with acute ischemic stroke treated with intravenous thrombolysis. From the Safe Implementation of Treatment in Stroke International Stroke Thrombolysis registry, 28 976 patients with documented pre-treatment systolic BP at 2 and 24 hours were analyzed. The primary measure of BP variability was successive variability. Data were preprocessed using coarsened exact matching. We assessed early neurological improvement, symptomatic intracerebral hemorrhage (SICH), and long-term functional outcome (modified Rankin Scale [mRS] at 90 days) by binary and ordinal regression analyses. Attempts to explain successive variation for analysis of BPV with patients characteristics at admission found systolic BP (5.5% variance) to be most influential, yet 92% of BPV variance remained unexplained. Independently from systolic BP, successive variation for analysis of BPV was associated with poor functional outcome mRS score of 0 to 2 (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.90-0.98), disadvantage across the shift of mRS (OR, 1.04; 95% CI, 1.01-1.08), mortality (OR, 1.10; 95% CI, 1.01-1.08), SICHSITS (OR, 1.14; 95% CI, 1.06-1.23), and SICHECASS (OR, 1.24; 95% CI, 1.10-1.40; ECASS [European Cooperative Acute Stroke Study 2]). Analyzing successive variation for analysis of BPV as a function of pre-treatment, systolic BP significantly improved the prediction of functional outcome (mRS score of 0-1, mRS score of 0-2, neurological improvement, mRS-shift: all Pinteraction<0.01). Excluding patients with atrial fibrillation in a sensitivity analysis gave consistent results overall. This study suggests the need for a more individual BP management accounting for pre-treatment BP and the acute BP course (ie, BPV) to achieve best possible outcome for the patient. © 2017 American Heart Association

  9. Drug-induced blood pressure increase - recommendations for assessment in clinical and non-clinical studies.

    PubMed

    Gottfridsson, Christer; Panfilov, Seva; Ebrahimi, Ahmad; Gigger, Emery; Pollard, Chris; Henderson, Simon; Ambery, Philip; Raichlen, Joel S

    2017-02-01

    Changes in blood pressure (BP) are now proactively examined throughout the drug development process as an integral aspect of safety monitoring. This is because hypertension is a very strong risk factor for cardiovascular events and drug-induced increases in BP have attracted increased regulatory attention. However, there is currently no guidance from regulatory agencies on the minimum BP data required for submissions, and there are no specific criteria for what constitutes a safety signal for increased BP in non clinical studies. Areas covered: Evaluation of BP increases through the drug discovery and development process. Expert opinion: Research into the effects of drugs should begin before clinical development is initiated and continue throughout the clinical trial program. Non clinical studies should inform a benefit-risk analysis that will aid decision-making of whether to enter the drug into Phase I development. The degree of acceptable risk will vary according to the therapy area, treatment indication and intended population for the new drug, and the approach to BP assessment and risk mitigation should be tailored accordingly. However, BP monitoring should always be included in clinical trials, and data collected from multiple studies, to convincingly prove or refute a suspicion of BP effects.

  10. VISIT-TO-VISIT VARIABILITY OF BLOOD PRESSURE AND DEATH, ESRD AND CARDIOVASCULAR EVENTS IN PATIENTS WITH CHRONIC KIDNEY DISEASE

    PubMed Central

    CHANG, Tara I.; TABADA, Grace H.; YANG, Jingrong; TAN, Thida X.; GO, Alan S.

    2016-01-01

    OBJECTIVES Visit-to-visit variability of blood pressure is an important independent risk factor for premature death and cardiovascular events, but relatively little is known about this phenomenon in patients with chronic kidney disease not yet on dialysis. METHODS We conducted a retrospective study in a community-based cohort of 114,900 adults with chronic kidney disease stages 3–4 (estimated glomerular filtration rate 15–59 mL/min per 1.73 m2). We hypothesized that visit-to-visit variability of blood pressure would be independently associated with higher risks of death, incident treated end-stage renal disease, and cardiovascular events. We defined systolic visit-to-visit variability of blood pressure using three metrics: (1) coefficient of variation (2) standard deviation of the mean systolic blood pressure, and (3) average real variability. RESULTS The highest versus the lowest quintile of the coefficient of variation was associated with higher adjusted rates of death (hazard ratio 1.22; 95% confidence interval 1.11–1.34) and hemorrhagic stroke (hazard ratio 1.91, confidence interval 1.36–2.68). Visit-to-visit variability of blood pressure was inconsistently associated with heart failure, and was not significantly associated with acute coronary syndrome and ischemic stroke. Results were similar when using the other two visit-to-visit variability of blood pressure. Visit-to-visit variability of blood pressure had inconsistent associations with end-stage renal disease, perhaps due to the relatively low incidences of this outcome. CONCLUSIONS Higher visit-to-visit variability of blood pressure is independently associated with higher rates of death and hemorrhagic stroke in patients with moderate to advanced chronic kidney disease not yet on dialysis. PMID:26599220

  11. Measurement of hematological, clinical chemistry, and infection parameters from hirudinized blood collected in universal blood sampling tubes.

    PubMed

    Menssen, H D; Brandt, N; Leben, R; Müller, F; Thiel, E; Melber, K

    2001-08-01

    Hirudin, the anticoagulatory polypeptide of the leech Hirudo medicinalis, strongly inhibits thrombus formation by specifically interacting with thrombin. For diagnostic purposes, hirudin should be superior to other anticlotting compounds because it only minimally alters the mineral, protein, and cellular blood constituents. To test this hypothesis, hirudinized and routinely processed venous blood from 80 healthy volunteers and patients was subjected to a variety of automated blood tests. A strong correlation was found between the results of automated complete blood counts obtained from K(2)-ethylenediaminetetraacetic acid (EDTA) anticoagulated and hirudinized blood (1000 antithrombin units [ATU] hirudin/ml). In addition, clinical chemistry and serological infection parameters (asparlat amintransferase [ASAT], lactate dehydrogenase [LDH], sodium, and so on, and antibodies against hepatitis B and C and human immunodeficiency virus [HIV]1/2, respectively) correlated well when measured in serum as compared with hirudinized plasma. Contrary to single clotting factors, global coagulation parameters (activated partial thromboplastin time [aPTT], prothrombin time [PT]) could not be measured in hirudinized blood. Recombinant hirudin neither interfered with immunophenotyping of mononuclear cells using FACScan analysis, nor did it alter the detection of Wilms' tumor gene expression by RT-PCR technology even at high doses (5000 ATU hirudin). Thus, a hirudin-containing blood sampling tube can be designed as a universal blood sampling tube (UBT) for testing the majority of diagnostic blood parameters.

  12. Heart Rate and Systolic Blood Pressure Variability on Recently Diagnosed Diabetics

    PubMed Central

    Michel-Chávez, Anaclara; Estañol, Bruno; Gien-López, José Antonio; Robles-Cabrera, Adriana; Huitrado-Duarte, María Elena; Moreno-Morales, René; Becerra-Luna, Brayans

    2015-01-01

    Background Diabetes affects approximately 250 million people in the world. Cardiovascular autonomic neuropathy is a common complication of diabetes that leads to severe postural hypotension, exercise intolerance, and increased incidence of silent myocardial infarction. Objective To determine the variability of heart rate (HR) and systolic blood pressure (SBP) in recently diagnosed diabetic patients. Methods The study included 30 patients with a diagnosis of type 2 diabetes of less than 2 years and 30 healthy controls. We used a Finapres® device to measure during five minutes beat-to-beat HR and blood pressure in three experimental conditions: supine position, standing position, and rhythmic breathing at 0.1 Hz. The results were analyzed in the time and frequency domains. Results In the HR analysis, statistically significant differences were found in the time domain, specifically on short-term values such as standard deviation of NN intervals (SDNN), root mean square of successive differences (RMSSD), and number of pairs of successive NNs that differ by more than 50 ms (pNN50). In the BP analysis, there were no significant differences, but there was a sympathetic dominance in all three conditions. The baroreflex sensitivity (BRS) decreased in patients with early diabetes compared with healthy subjects during the standing maneuver. Conclusions There is a decrease in HR variability in patients with early type 2 diabetes. No changes were observed in the BP analysis in the supine position, but there were changes in BRS with the standing maneuver, probably due to sympathetic hyperactivity. PMID:26176187

  13. Effects of Air Pollution and Blood Mitochondrial DNA Methylation on Markers of Heart Rate Variability.

    PubMed

    Byun, Hyang-Min; Colicino, Elena; Trevisi, Letizia; Fan, Tianteng; Christiani, David C; Baccarelli, Andrea A

    2016-04-22

    The mitochondrion is the primary target of oxidative stress in response to exogenous environments. Mitochondrial DNA (mtDNA) is independent from nuclear DNA and uses separate epigenetic machinery to regulate mtDNA methylation. The mtDNA damage induced by oxidative stress can cause mitochondrial dysfunction and is implicated in human diseases; however, mtDNA methylation has been largely overlooked in environmental studies relating to human disease. The purpose of this study was to examine the association between exposure to fine metal-rich particulates (particulate matter <2.5 µm in diameter [PM2.5]) from welding in a boilermaker union and blood mtDNA methylation in relation to heart rate variability. Forty-eight healthy men were recruited on multiple sampling cycles at the Boilermaker Union Local 29, located in Quincy, Massachusetts. We measured personal PM2.5 in the background ambient environment. We measured blood mtDNA methylation in the mtDNA promoter (D-loop) and genes essential for ATP synthesis (MT-TF and MT-RNR1) by bisulfite pyrosequencing. All analyses were adjusted for demographics, type of job, season, welding-work day, and mtDNA methylation experimental batch effect. The participants' PM2.5 exposure was significantly higher after a welding-work day (mean 0.38 mg/m(3)) than the background personal level (mean 0.15 mg/m(3), P<0.001). Blood mtDNA methylation in the D-loop promoter was associated with PM2.5 levels (β=-0.99%, SE=0.41, P=0.02). MT-TF and MT-RNR1 methylation was not associated with PM2.5 exposure (β=0.10%, SE=0.45, P=0.82). Interaction of PM2.5 exposure levels and D-loop promoter methylation was significantly associated with markers of heart rate variability. Blood mtDNA methylation levels were negatively associated with PM2.5 exposure and modified the adverse relationships between PM2.5 exposure and heart rate variability outcomes. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  14. Suppressor effects in the relations of psychological variables to resting blood pressure.

    PubMed

    Goldstein, H S; Edelberg, R; Meier, C F; Davis, L

    1991-08-01

    The role of suppressor effects in obscuring the relation of psychological variables and blood pressure was studied. Forty-five nonmedicated patients in a family practice rated themselves relative to their peers on a series of characteristics. Two of these, trapped and lonely, exhibited marked suppressor effects in their relationship with each other and resting blood pressure. Self-ratings of lonely exhibited a moderately strong positive association with ratings of trapped (r = .63) while only ratings of lonely showed a significant correlation with resting systolic blood pressure (r = .31). Yet when the suppressor effects of the ratings on feeling lonely were removed in the regression analyses, the ratings on feeling trapped showed a significant positive association with resting systolic pressure (r = .42). Similarly, while neither ratings on feeling lonely or on feeling trapped showed separately a significant association with resting diastolic pressure, when suppressor effects were removed in the regression analyses, the ratings of trapped were significantly associated with diastolic pressure in a positive direction (r = .34) and ratings of lonely were significantly associated in a negative direction (r = .33). The significance of this specific suppressor effect and the implications of suppression for psychosomatic research are discussed.

  15. Does the control of negative emotions influence blood pressure control and its variability?

    PubMed

    Symonides, Bartosz; Holas, Paweł; Schram, Małgorzata; Śleszycka, Justyna; Bogaczewicz, Anna; Gaciong, Zbigniew

    2014-12-01

    The aim was to assess the control of negative emotions in treated patients with hypertension in comparison with normotensive individuals and to evaluate the association between suppression of negative emotions, control of blood pressure (BP) on ambulatory blood pressure monitoring (ABPM) and blood pressure variability (BPV). We studied 195 patients (women/men: 89/106); mean age 45.4 ± 15.9 years. All patients had ABPM and completed the Courtauld Emotional Control Scale (CECS). The total CECS score and scores for subscales for anger, depression and anxiety were analyzed together with mean BP values from ABPM, and their SD and coefficient of variation as BPV measures. The mean CECS score was 54 ± 12 in all subjects; highest in uncontrolled hypertension 56 ± 11, intermediate 53 ± 12 in controlled hypertension and lowest 48 ± 12 in normotensive subjects. The reference value for the Polish population is 50 ± 11. Significant differences of mean CECS scores among groups were observed (p = 0.0165) also in multivariate analysis. The difference between uncontrolled hypertension and normotension was significant (p = 0.0262). Few significant, weak correlations were observed between CECS score or its subscales and ABPM derivates in all subjects. Conclusion. Suppression of negative emotions may adversely affect BP control in treated hypertensive patients and it should be considered a cause of uncontrolled hypertension.

  16. Association between mortality and blood pressure variability in hypertensive and normotensive elders: A cohort study.

    PubMed

    Weiss, Avraham; Beloosesky, Yichayaou; Koren-Morag, Nira; Grossman, Alon

    2017-08-01

    To evaluate the association between blood pressure variability (BPV) and mortality in the elderly, all blood pressure measurements recorded in a cohort of individuals 65 years and older were collected and the association between BPV coefficient of variation (BPV divided by mean arterial pressure) was calculated. Mortality during a 10-year period was compared between BPV coefficient of variation quartiles. Overall, 39 502 individuals 65 years and older were included in the analysis, of which 31 737 (80.3%) were hypertensive; 12 817 (32.4%) individuals died during the study period. Mortality was lower in the second and third blood pressure quartiles compared with the first quartile in both the normotensive and hypertensive groups. In both normotensive and hypertensive individuals, mortality was higher in the fourth quartile, but it was more pronounced in normotensive individuals (odds ratio, 1.18; 95% confidence interval, 1.06-1.31 in hypertensive individuals vs odds ratio, 1.27; 95% confidence interval, 1.17-1.37 in normotensive individuals). High and low BPV are associated with mortality in both hypertensive and normotensive elders. ©2017 Wiley Periodicals, Inc.

  17. Clinical evaluation of a self blood pressure monitor according to the First International Consensus Conference on Self Blood Pressure Measurement.

    PubMed

    Ploin, Dominique; Baguet, Jean-Philippe; Pierre, Hélène; De Gaudemaris, Régis; Mallion, Jean-Michel

    2002-12-01

    The Calor TensioSense Bras automatic blood pressure monitor has obtained European Union certification, but the clinical validity of this new oscillometric device when handled by lay subjects has yet to be evaluated. The design employed prospective and blinded blood pressure measurements and a validation procedure according to the criteria set out by the First International Consensus Conference on Self Blood Pressure Measurement (1999). Thirty-three subjects were recruited, 11 in each of three strata of systolic blood pressure (<130, 130-160 and >160 mmHg). Blood pressure was measured sequentially seven times, alternating observer and lay measurements. Two certified observers used two mercury columns and a double stethoscope; the subjects used the automatic device. All blood pressure readings and recordings were blinded. Adequate cuff sizes were used, and the subjects' position was standardized. Discrepancy analysis between manual and automatic measurements was carried out using VAPA software. Dispersion of the discrepancies between manual and automatic measurements showed no specific trend. Out of the 99 systolic blood pressure measurements, 53, 76 and 89 discrepancies were less than 5, 10 and 15 mmHg, respectively. Of the 99 diastolic blood pressure measurements, 62, 86 and 97 discrepancies were less than 5, 10 and 15 mmHg, respectively. The mean inter-observer discrepancy was 1 mmHg for both systolic and diastolic blood pressure comparisons. This evaluation showed that this device complies with the international validation protocol requirements. Thus, the device can, providing adequate instruction is given in the clinic, be recommended for self-measurement by patients at home, as well as for clinical or epidemiological research. Copyright 2002 Lippincott Williams & Wilkins

  18. Heart rate variability and blood pressure during dynamic and static exercise at similar heart rate levels.

    PubMed

    Weippert, Matthias; Behrens, Kristin; Rieger, Annika; Stoll, Regina; Kreuzfeld, Steffi

    2013-01-01

    Aim was to elucidate autonomic responses to dynamic and static (isometric) exercise of the lower limbs eliciting the same moderate heart rate (HR) response. 23 males performed two kinds of voluntary exercise in a supine position at similar heart rates: static exercise (SE) of the lower limbs (static leg press) and dynamic exercise (DE) of the lower limbs (cycling). Subjective effort, systolic (SBP) and diastolic blood pressure (DBP), mean arterial pressure (MAP), rate pressure product (RPP) and the time between consecutive heart beats (RR-intervals) were measured. Time-domain (SDNN, RMSSD), frequency-domain (power in the low and high frequency band (LFP, HFP)) and geometric measures (SD1, SD2) as well as non-linear measures of regularity (approximate entropy (ApEn), sample entropy (SampEn) and correlation dimension D2) were calculated. Although HR was similar during both exercise conditions (88±10 bpm), subjective effort, SBP, DBP, MAP and RPP were significantly enhanced during SE. HRV indicators representing overall variability (SDNN, SD 2) and vagal modulated variability (RMSSD, HFP, SD 1) were increased. LFP, thought to be modulated by both autonomic branches, tended to be higher during SE. ApEn and SampEn were decreased whereas D2 was enhanced during SE. It can be concluded that autonomic control processes during SE and DE were qualitatively different despite similar heart rate levels. The differences were reflected by blood pressure and HRV indices. HRV-measures indicated a stronger vagal cardiac activity during SE, while blood pressure response indicated a stronger sympathetic efferent activity to the vessels. The elevated vagal cardiac activity during SE might be a response mechanism, compensating a possible co-activation of sympathetic cardiac efferents, as HR and LF/HF was similar and LFP tended to be higher. However, this conclusion must be drawn cautiously as there is no HRV-marker reflecting "pure" sympathetic cardiac activity.

  19. Blood pressure variability and pedigree analysis of nocturnal SBP dipping in Kumbas from rural Chhattisgarh, India.

    PubMed

    Sultana, Razia; Pati, Atanu Kumar

    2014-05-01

    Family is the smallest unit of people to share most of the lifestyle, environmental and genetic factors. They are likely to have similarity in many physiological and behavioural aspects. Therefore, we designed a protocol to test the effect of large rural Indian families living together (Kumbas), on blood pressure variability. We also investigated the hypothesis that 'nocturnal dipping' in systolic blood pressure (SBP) is not heritable. Members of two families (1 and 2) consisting of 3-4 generations willingly participated in the study. Both families (natives of Chhattisgarh) belong to reasonably peaceful rural area and are financially stable. Farming is the main occupation of the members of both families. Few members of the families had jobs or small business. The null hypothesis regarding heritability of nocturnal dipping trait was accepted based on data emanating from either of the studied families. Hourly-averaged values depicted less variation in males and females of family 1 from midnight to early morning at around 06:00, as compared to that in males and females of family 2. The 24 h averages of BP in family 2 were significantly higher as compared to that in family 1. Further, in family 2 the peaks of SBP, diastolic blood pressure (DBP) and mean arterial pressure (MAP) occurred significantly earlier as compared to that in family 1. The peak spread of SBP, DBP, heart rate (HR), MAP and pulse pressure (PP) among the members of family 1 was narrower than that for the members of family 2. Arbitrary cut-off values for classification of dipping, small sample size, and age dependency of nocturnal dipping might have marred outcome of the pedigree analysis of nocturnal dipping trait in this study. We have a hunch that the family shares typical temporal ups and downs in 24 h BP and HR. The above hypothesis needs confirmation based on studies with large data set involving subjective and objective assessment of the effects of psychosocial factors on BP and HR variability.

  20. Treatment success in neck pain: The added predictive value of psychosocial variables in addition to clinical variables.

    PubMed

    Groeneweg, Ruud; Haanstra, Tsjitske; Bolman, Catherine A W; Oostendorp, Rob A B; van Tulder, Maurits W; Ostelo, Raymond W J G

    2017-01-01

    Identification of psychosocial variables may influence treatment outcome. The objective of this study was to prospectively examine whether psychosocial variables, in addition to clinical variables (pain, functioning, general health, previous neck pain, comorbidity), are predictive factors for treatment outcome (i.e. global perceived effect, functioning and pain) in patients with sub-acute and chronic non-specific neck pain undergoing physical therapy or manual therapy. Psychosocial factors included treatment outcome expectancy and treatment credibility, health locus of control, and fear avoidance beliefs. This study reports a secondary analysis of a primary care-based pragmatic randomized controlled trial. Potential predictors were measured at baseline and outcomes, in 181 patients, at 7 weeks and 26 weeks. Hierarchical logistic regression models showed that treatment outcome expectancy predicted outcome success, in addition to clinical and demographic variables. Expectancy explained additional variance, ranging from 6% (pain) to 17% (functioning) at 7 weeks, and 8% (pain) to 16% (functioning) at 26 weeks. Locus of control and fear avoidance beliefs did not add significantly to predicting outcome. Based on the results of this study we conclude that outcome expectancy, in patients with non-specific sub-acute and chronic neck pain, has additional predictive value for treatment success above and beyond clinical and demographic variables. Psychological processes, health perceptions and how these factors relate to clinical variables may be important for treatment decision making regarding therapeutic options for individual patients. Copyright © 2016 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  1. 75 FR 2549 - Clinical Accuracy Requirements for Point of Care Blood Glucose Meters; Public Meeting; Request...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-15

    ... Glucose Meters; Public Meeting; Request for Comments AGENCY: Food and Drug Administration, HHS. ACTION... public meeting entitled: Clinical Accuracy Requirements for Point of Care Blood Glucose Meters. The purpose of the public meeting is to discuss the clinical accuracy requirements of blood glucose meters and...

  2. Comparisons of Measured and Self-Reported Anthropometric Variables and Blood Pressure in a Sample of Hong Kong Female Nurses

    PubMed Central

    Xie, Yao Jie; Ho, Suzanne C.; Liu, Zhao Min; Hui, Stanley Sai-Chuen

    2014-01-01

    Objectives To assess the validity of self-reported weight, height, body mass index (BMI), waist circumference and blood pressure compared with standardized clinical measurements and to determine the classification accuracy in overweight/obesity and central adiposity. Methods This pilot study was integrated into a life-course study entitled “Hong Kong Women's Health Study” among 1,253 female nurses in Hong Kong who were aged 35 years to 65 years. Data were collected from self-administered questionnaires that were mailed to the respondents. Of these participants, we obtained the standard body measurements of 144 (11.5%) at our research center. We then compared the self-reported anthropometric variables and blood pressure with the measured data to assess validity based on the level of misreporting, percentage of agreement, consistency, sensitivity and specificity. Results The self-reported and measured values were highly correlated in terms of anthropometry and blood pressure (correlation coefficients ranged from 0.72 to 0.96). Height was overestimated at an average of 0.42 cm, and waist circumference was underestimated at 2.33 cm (both P<0.05), while no significant differences were observed from weight, blood pressure and BMI (all P>0.05). The proportions of overweight, obesity, and central adiposity by self-reported data did not vary greatly from the measured data (all P>0.05). The self-reporting resulted in correct classifications of BMI, waist circumference, and systolic blood pressure in 85%, 78%, and 87% of women, with corresponding Kappa index values of 0.79, 0.55, and 0.82, respectively. Sensitivity and specificity were 84.6% and 95.7%, respectively, with respect to overweight/obesity detection, whereas those for central adiposity detection were 70.6% and 83.8%, respectively. Conclusion In a sample of female Hong Kong nurses, the self-reported measures of height, weight, BMI, waist circumference and blood pressure were generally valid. Furthermore, the

  3. Orthostatic stress causes immediately increased blood pressure variability in women with vasovagal syncope.

    PubMed

    Reulecke, S; Charleston-Villalobos, S; Voss, A; González-Camarena, R; González-Hermosillo, J; Gaitán-González, M J; Hernández-Pacheco, G; Schroeder, R; Aljama-Corrales, T

    2016-04-01

    The cardiovascular and respiratory autonomic nervous regulation has been studied mainly by hemodynamic responses during different physical stressors. In this study, dynamics of autonomic response to an orthostatic challenge was investigated by hemodynamic variables and by diverse linear and nonlinear indices calculated from time series of beat-to-beat intervals (BBI), respiratory cycle duration (RESP), systolic (SYS) and diastolic (DIA) blood pressure. This study included 16 young female patients (SYN) with vasovagal syncope and 12 age-matched female controls (CON). The subjects were enrolled in a head-up tilt (HUT) test, breathing normally, including 5min of baseline (BL, supine position) and 18min of 70° orthostatic phase (OP). To increase the time resolution of the analysis the time series were segmented in five-minute overlapping windows with a shift of 1min. Hemodynamic parameters did not show any statistical differences between SYN and CON. Time domain linear analysis revealed increased respiratory frequency and increased blood pressure variability (BPV) in patients during OP meaning increased sympathetic activity and vagal withdrawal. Frequency domain analysis confirmed a predominance of sympathetic tone by steadily increased values of low over high frequency power in BBI and of low frequency power in SYS and DIA in patients during OP. The nonlinear analysis by symbolic dynamics seemed to be highly suitable for differentiation of SYN and CON in the early beginning of OP, i.e., 5min after tilt-up. In particular the index SYS_plvar3 showed less patterns of low variability in patients reflecting a steadily increase in both BPV and sympathetic activity. The proposed dynamical analysis could lead to a better understanding of the temporal underlying mechanisms in healthy subjects and patients under orthostatic stress. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  4. Association between Heart Rate Variability, Blood Pressure and Autonomic Activity in Cyclic Alternating Pattern during Sleep

    PubMed Central

    Kondo, Hideaki; Ozone, Motohiro; Ohki, Noboru; Sagawa, Yohei; Yamamichi, Keiichirou; Fukuju, Mitsuki; Yoshida, Takeshi; Nishi, Chikako; Kawasaki, Akiko; Mori, Kaori; Kanbayashi, Takashi; Izumi, Motomori; Hishikawa, Yasuo; Nishino, Seiji; Shimizu, Tetsuo

    2014-01-01

    Study Objectives: Cyclic alternating pattern (CAP) is frequently followed by changes in heart rate (HR) and blood pressure (BP), but the sequential associations between CAP and autonomic nerve activity have not been studied. The study aimed to reveal the precise changes in heart rate variability (HRV) during phase A of the CAP cycle. Design: Polysomnography was recorded according to the CAP Atlas (Terzano, 2002), and BP and electrocardiogram were simultaneously recorded. The complex demodulation method was used for analysis of HRV and evaluation of autonomic nerve activity. Setting: Academic sleep laboratory. Participants: Ten healthy males. Measurements and Results: The increase in HR (median [first quartile – third quartile]) for each subtype was as follows: A1, 0.64 (-0.30 to 1.69), A2, 1.44 (0.02 to 3.79), and A3, 6.24 (2.53 to 10.76) bpm (A1 vs. A2 P < 0.001, A1 vs. A3 P < 0.001, A2 vs. A3 P < 0.001). The increase in BP for each subtype was as follows: A1, 1.23 (-2.04 to 5.75), A2, 1.76 (-1.46 to 9.32), and A3, 12.51 (4.75 to 19.94) mm Hg (A1 vs. A2 P = 0.249, A1 vs. A3 P < 0.001, A2 vs. A3 P < 0.001). In all of phase A, the peak values for HR and BP appeared at 4.2 (3.5 to 5.4) and 8.4 (7.0 to 10.3) seconds, respectively, after the onset of phase A. The area under the curve for low-frequency and high-frequency amplitude significantly increased after the onset of CAP phase A (P < 0.001) and was higher in the order of subtype A3, A2, and A1 (P < 0.001). Conclusions: All phase A subtypes were accompanied with increased heart rate variability, and the largest heart rate variability was seen in subtype A3, while a tendency for less heart rate variability was seen in subtype A1. Citation: Kondo H; Ozone M; Ohki N; Sagawa Y; Yamamichi K; Fukuju M; Yoshida T; Nishi C; Kawasaki; Mori; Kanbayashi T; Izumi M; Hishikawa Y; Nishino S; Shimizu T. Association between heart rate variability, blood pressure and autonomic activity in cyclic alternating pattern during sleep

  5. Use of generalised additive models to categorise continuous variables in clinical prediction

    PubMed Central

    2013-01-01

    Background In medical practice many, essentially continuous, clinical parameters tend to be categorised by physicians for ease of decision-making. Indeed, categorisation is a common practice both in medical research and in the development of clinical prediction rules, particularly where the ensuing models are to be applied in daily clinical practice to support clinicians in the decision-making process. Since the number of categories into which a continuous predictor must be categorised depends partly on the relationship between the predictor and the outcome, the need for more than two categories must be borne in mind. Methods We propose a categorisation methodology for clinical-prediction models, using Generalised Additive Models (GAMs) with P-spline smoothers to determine the relationship between the continuous predictor and the outcome. The proposed method consists of creating at least one average-risk category along with high- and low-risk categories based on the GAM smooth function. We applied this methodology to a prospective cohort of patients with exacerbated chronic obstructive pulmonary disease. The predictors selected were respiratory rate and partial pressure of carbon dioxide in the blood (PCO2), and the response variable was poor evolution. An additive logistic regression model was used to show the relationship between the covariates and the dichotomous response variable. The proposed categorisation was compared to the continuous predictor as the best option, using the AIC and AUC evaluation parameters. The sample was divided into a derivation (60%) and validation (40%) samples. The first was used to obtain the cut points while the second was used to validate the proposed methodology. Results The three-category proposal for the respiratory rate was ≤ 20;(20,24];> 24, for which the following values were obtained: AIC=314.5 and AUC=0.638. The respective values for the continuous predictor were AIC=317.1 and AUC=0.634, with no statistically

  6. Use of generalised additive models to categorise continuous variables in clinical prediction.

    PubMed

    Barrio, Irantzu; Arostegui, Inmaculada; Quintana, José M; Group, Iryss-Copd

    2013-06-26

    In medical practice many, essentially continuous, clinical parameters tend to be categorised by physicians for ease of decision-making. Indeed, categorisation is a common practice both in medical research and in the development of clinical prediction rules, particularly where the ensuing models are to be applied in daily clinical practice to support clinicians in the decision-making process. Since the number of categories into which a continuous predictor must be categorised depends partly on the relationship between the predictor and the outcome, the need for more than two categories must be borne in mind. We propose a categorisation methodology for clinical-prediction models, using Generalised Additive Models (GAMs) with P-spline smoothers to determine the relationship between the continuous predictor and the outcome. The proposed method consists of creating at least one average-risk category along with high- and low-risk categories based on the GAM smooth function. We applied this methodology to a prospective cohort of patients with exacerbated chronic obstructive pulmonary disease. The predictors selected were respiratory rate and partial pressure of carbon dioxide in the blood (PCO2), and the response variable was poor evolution. An additive logistic regression model was used to show the relationship between the covariates and the dichotomous response variable. The proposed categorisation was compared to the continuous predictor as the best option, using the AIC and AUC evaluation parameters. The sample was divided into a derivation (60%) and validation (40%) samples. The first was used to obtain the cut points while the second was used to validate the proposed methodology. The three-category proposal for the respiratory rate was ≤ 20;(20,24];> 24, for which the following values were obtained: AIC=314.5 and AUC=0.638. The respective values for the continuous predictor were AIC=317.1 and AUC=0.634, with no statistically significant differences being found

  7. Regional Fat Distribution and Blood Pressure Level and Variability: The Dallas Heart Study.

    PubMed

    Yano, Yuichiro; Vongpatanasin, Wanpen; Ayers, Colby; Turer, Aslan; Chandra, Alvin; Carnethon, Mercedes R; Greenland, Philip; de Lemos, James A; Neeland, Ian J

    2016-09-01

    Our aim was to investigate the associations of regional fat distribution with home and office blood pressure (BP) levels and variability. Participants in the Dallas Heart Study, a multiethnic cohort, underwent 5 BP measurements on 3 occasions during 5 months (2 in home and 1 in office) and quantification of visceral adipose tissue, abdominal subcutaneous adipose tissue, and liver fat by magnetic resonance imaging, and lower body subcutaneous fat by dual x-ray absorptiometry. The relation of regional adiposity with short-term (within-visit) and long-term (overall visits) mean BP and average real variability was assessed with multivariable linear regression. We have included 2595 participants with a mean age of 44 years (54% women; 48% black), and mean body mass index was 29 kg/m(2) Mean systolic BP/diastolic BP was 127/79 mm Hg and average real variability systolic BP was 9.8 mm Hg during 3 visits. In multivariable-adjusted models, higher amount of visceral adipose tissue was associated with higher short-term (both home and office) and long-term mean systolic BP (β[SE]: 1.9[0.5], 2.7[0.5], and 2.1[0.5], respectively; all P<0.001) and with lower long-term average real variability systolic BP (β[SE]: -0.5[0.2]; P<0.05). In contrast, lower body fat was associated with lower short-term home and long-term mean BP (β[SE]: -0.30[0.13] and -0.24[0.1], respectively; both P<0.05). Neither subcutaneous adipose tissue or liver fat was associated with BP levels or variability. In conclusion, excess visceral fat was associated with persistently higher short- and long-term mean BP levels and with lower long-term BP variability, whereas lower body fat was associated with lower short- and long-term mean BP. Persistently elevated BP, coupled with lower variability, may partially explain increased risk for cardiac hypertrophy and failure related to visceral adiposity. © 2016 American Heart Association, Inc.

  8. Beneficial Effects of Paeoniflorin Enriched Extract on Blood Pressure Variability and Target Organ Damage in Spontaneously Hypertensive Rats

    PubMed Central

    Yang, Zheng-Biao; Lei, Shan-Shan; Chen, Bo

    2017-01-01

    Blood pressure variability (BPV) is associated with the development and progression of severe target organ damage (TOD). This study aims to evaluate the protective effect of paeoniflorin enriched extract from Radix Paeoniae Alba (PG) on BPV and TOD in spontaneously hypertensive rats (SHR). All SHR were orally treated with distilled water, metoprolol (MP, 20 mg/kg), and PG (PG-H, 90 mg/kg or PG-L, 30 mg/kg) for a single time or daily for 7 weeks. The 24-hour dynamic blood pressure was monitored and then calculated BPV including long- and short-term systolic blood pressure variability (SBPV), diastolic blood pressure variability (DBPV), mean blood pressure variability (MBPV), and heart rate variability (HRV) as well as the 24-hour-SBP, 24-hour-DBP, and 24-hour-MBP. The protective effects of PG on TOD were observed by histopathologic and biochemical detection. The results indicated that long- and short-term SBPV, DBPV, MBPV, and HRV as well as 24-hour-SBP, 24-hour-DBP, and 24-hour-MBP showed no significant changes after single-dose administration of PG and significantly decreased after administration with PG for 7 weeks. PG could also markedly improve the damage of aorta, heart, kidney, and brain. This study suggested that PG could notably reduce BPV, stabilize blood pressure, and mitigate TOD in SHR. PMID:28243310

  9. Identifying variables associated with inaccurate self-monitoring of blood glucose: proposed guidelines to improve accuracy.

    PubMed

    Bergenstal, R; Pearson, J; Cembrowski, G S; Bina, D; Davidson, J; List, S

    2000-01-01

    This study was conducted to evaluate patients' proficiency in self-monitoring of blood glucose (SMBG). Diabetes nurse educators in 4 suburban Minneapolis clinic sites surveyed the SMBG training/cure practices of 280 patients with type 1 and type 2 diabetes. Participant SMBG technique was measured by direct observation. Participants performed a finger puncture and used their own meters to measure the first blood sample. A second sample was measured on the HemoCue B Glucose analyzer, and a third sample was used to measure hemoglobin. The series of tests were then repeated. If either of the 2 glucose tests was more than 15% from the HemoCue value, participants were reeducated about the manufacturer's suggested procedure. Of the 280 participants, 19% had blood glucose test results greater than the 15% limit for meter accuracy. After reeducation, 69% of those who had initially failed achieved acceptable results. The most significant problems were lack of periodic meter technique evaluation, difficulty using wipe meters, incorrect use of control solutions, lack of hand washing even when observed, and unclean meters. As a result of the study, guidelines were subsequently developed to evaluate meter accuracy in an outpatient setting. Further effort is needed to establish standards for evaluating SMBG.

  10. Familial aggregation of blood pressure with respect to anthropometric variables in a business community of Punjab, a north Indian state.

    PubMed

    Badaruddoza; Sawhney, Rashveen

    2009-12-01

    This study aimed to examine the familial aggregation of blood pressure with respect to anthropometric variables in an upper-middle class business community in Punjab, a northern state of India. The results were evaluated in a sample of 75 families, constituting 305 individual from three generations such as offspring, parental and grandparental. The data were analyzed through familial correlations, multiple regressions, percent of variance and univariate analysis. The data indicate a strong familial aggregation of blood pressure in this population especially in offspring generations and show that such a familial influence on blood pressure can be detected from the different anthropometric variables, genetic factors, shared household environment and age. These effects were strong in SBP and moderate in DBP. SBP and DBP have showed higher genetic correlation with many anthropometric characters in offspring generation as compared to other generations. These correlations are negligible in male grandparental generation. The results suggest that almost all measured variables are significant multivariate correlates with blood pressure.

  11. Simple clinical variables predict liver histology in hepatitis C: prospective validation of a clinical prediction model.

    PubMed

    Romagnuolo, Joseph; Andrews, Christopher N; Bain, Vincent G; Bonacini, Maurizio; Cotler, Scott J; Ma, Mang; Sherman, Morris

    2005-11-01

    A recent single-center multivariate analysis of hepatitis C (HCV) patients showed that having any two criteria: 1) ferritin > or =200 microg/l and 2) spider nevi and/or albumin < or = 35 g/l predicted grade 2 or greater histological inflammation; the presence of any two of the following criteria: spider nevi, platelets < or =150 x 109/l, palpable splenomegaly and/or albumin < or =35 g/l predicted stage 2 or greater histological fibrosis. Absence of predictors also predicted a lack of inflammation and fibrosis. Our aim was prospectively to validate this clinical prediction model using an independent multicenter sample. Eighty-one patients with previously untreated active chronic HCV underwent physical examination, laboratory investigation, and liver biopsy. Biopsies were read, in blinded fashion, by a single pathologist, using a modified Hytiroglou (1995) scale. The clinical scoring system was correlated with histology; likelihood ratios (LRs), Fisher's exact p-values, and receiver operating characteristics (ROCs) were calculated. Data recording was complete in 77 and 38 patients regarding fibrotic stage and inflammatory grade, respectively. For fibrosis, 3/3 patients with any three criteria (LR 17, positive predictive value (PPV) 100%), 4/5 patients with any two criteria (LR 5.1), and 15/47 with no criteria (LR 0.6, negative predictive value (NPV) 68%) had stage 2 or greater fibrosis on biopsy (p=0.01). For inflammation, 5/5 patients with both criteria (LR 15, PPV 100%), and 8/19 patients with no criteria (LR 0.5, NPV 58%) had moderate-severe inflammation on liver biopsy (p=0.036). When missing variables were assumed to be normal, recalculated LRs were almost identical. An alanine aminotransferase (ALAT) level <60 U/l may increase the NPVs. This independent multicenter data set has validated our published model which uses simple clinical variables accurately and significantly to predict hepatic fibrosis and inflammation in HCV patients.

  12. Assessment Of Preanalytical Blood Sampling Errors In Clinical Settings.

    PubMed

    Zehra, Nayyab; Malik, Ahmed Hassaan; Arshad, Qurat; Sarwar, Sumaira; Aslam, Sehar

    2016-01-01

    Blood sampling is one of the common procedures done in every ward for disease diagnosis and prognosis. Daily hundreds of samples are collected from different wards but lack of appropriate knowledge of blood sampling by paramedical staff and accidental errors make the samples inappropriate for testing. Thus the need to avoid these errors for better results still remains. We carried out this research with an aim to determine the common errors during blood sampling; find factors responsible and propose ways to reduce these errors. A cross sectional descriptive study was carried out at the Military and Combined Military Hospital Rawalpindi during February and March 2014. A Venous Blood Sampling questionnaire (VBSQ) was filled by the staff on voluntary basis in front of the researchers. The staff was briefed on the purpose of the survey before filling the questionnaire. Sample size was 228. Results were analysed using SPSS-21. When asked in the questionnaire, around 61.6% of the paramedical staff stated that they cleaned the vein by moving the alcohol swab from inward to outwards while 20.8% of the staff reported that they felt the vein after disinfection. On contrary to WHO guidelines, 89.6% identified that they had a habit of placing blood in the test tube by holding it in the other hand, which should actually be done after inserting it into the stand. Although 86% thought that they had ample knowledge regarding the blood sampling process but they didn't practice it properly. Pre analytical blood sampling errors are common in our setup. Eighty six percent participants though thought that they had adequate knowledge regarding blood sampling, but most of them were not adhering to standard protocols. There is a need of continued education and refresher courses.

  13. Development of a portable blood irradiator for potential clinical uses

    SciTech Connect

    Hungate, F.P.

    1988-12-01

    This document provides an account of the development of a fully portable blood irradiator and the evaluation of its safety and efficacy when implanted in goats, sheep, a baboon and dogs. The program was initiated because the control of lymphocyte populations by irradiation is a potential method for improving success in organ or tissue transplantation and for treating a variety of blood diseases. 15 refs., 27 figs., 2 tabs.

  14. Identification of variables that optimize isolation and culture of multipotent mesenchymal stem cells from equine umbilical-cord blood.

    PubMed

    Schuh, Elizabeth M; Friedman, Michael S; Carrade, Danielle D; Li, Junzhi; Heeke, Darren; Oyserman, Sivan M; Galuppo, Larry D; Lara, Dorian J; Walker, Naomi J; Ferraro, Gregory L; Owens, Sean D; Borjesson, Dori L

    2009-12-01

    OBJECTIVE-To optimize the isolation and culture of mesenchymal stem cells (MSCs) from umbilical-cord blood (UCB), identify variables that predicted successful MSC isolation, and determine whether shipping, processing, and cryopreservation altered MSC viability, recovery rates, and expansion kinetics. SAMPLE POPULATION-UCB samples from 79 Thoroughbred and Quarter Horse mares. PROCEDURES-UCB samples were processed to reduce volume and remove RBCs. Nucleated cells (NCs) were cryopreserved or grown in various culture conditions to optimize MSC monolayer expansion and proliferation. Donor and UCB-sample factors were analyzed to determine their influence on the success of MSC isolation and monolayer expansion. RESULTS-MSCs capable of multilineage in vitro differentiation were expanded from > 80% of UCB samples. Automated UCB processing and temperature-controlled shipping facilitated sterile and standardized RBC reduction and NC enrichment from UCB samples. The number of NCs after UCB samples were processed was the sole variable that predicted successful MSC expansion. The UCB-derived MSCs and NCs were successfully cryopreserved and thawed with no decrease in cell recovery, viability, or MSC proliferation. The use of fibronectin-coated culture plates and reduction of incubator oxygen tension from 20% to 5% improved the MSC isolation rate. Some UCB-derived MSC clones proliferated for > 20 passages before senescence. Onset of senescence was associated with specific immunocytochemical changes. CONCLUSIONS AND CLINICAL RELEVANCE-Equine UCB samples appeared to be a rich source of readily obtainable, highly proliferative MSCs that could be banked for therapeutic use.

  15. Clinical implications of non-invasive measurement of central aortic blood pressure.

    PubMed

    Stepień, Mariusz; Banach, Maciej; Jankowski, Piotr; Rysz, Jacek

    2010-11-01

    Central arterial systolic blood pressure is a very important factor in the pathophysiology of cardiovascular diseases. Central arterial pressure is a better predictor of cardiovascular risk than peripheral brachial blood pressure. Measurement of central blood pressure is useful for a diagnosis of spurious systolic hypertension in young people. Antihypertensive drugs have a different impact on central blood pressure, for example angiotensin converting enzyme inhibitors, antagonists of angiotensin II receptors, calcium channel blockers more effectively lower central blood pressure than betablockers, despite all of those drugs (including beta-blockers) having a similar impact on peripheral pressure. This mechanism may be responsible for the beneficial effect of some antihypertensive drugs on cardiovascular end points observed in clinical trials, despite a low peripheral hypotensive effect. However, further clinical trials are required to provide more evidence for the prognostic and therapeutic implications of the measurement of central blood pressure before adopting its routine application in clinical practice.

  16. [Acupuncture theory of promoting blood circulation and removing stasis and its clinical application].

    PubMed

    Yao, Jun

    2015-04-01

    The effects and methods of acupuncture on promoting blood circulation and removing stasis and its importance for modern clinical acupuncture are explored and explained. The acupuncture theory of promoting blood circulation and removing stasis in Internal Canon of Yellow Emperor and the ancient medical scholars' knowledge of acupuncture for promoting blood circulation and removing stasis are traced, and then the principles and characteristics of acupuncture for promoting blood circulation and removing stasis are explored and summarized. The methods and common tools of prompting blood circulation and removing stasis of modern clinical acupuncture are summed up as well. It is considered that the treatment principles and methods of acupuncture for prompting blood and removing stasis deserve to be paid attention to and applied by all departments of clinical acupuncture.

  17. Blood

    MedlinePlus

    ... The liquid part, called plasma, is made of water, salts, and protein. Over half of your blood is plasma. The solid part of your blood contains red blood cells, white blood cells, and platelets. Red ...

  18. Blood pressure lowering in acute phase of stroke: latest evidence and clinical implications

    PubMed Central

    Patarroyo, Sully Xiomara Fuentes

    2012-01-01

    Persistent controversy exists as to whether there are worthwhile beneficial effects of early, rapid lowering of elevated blood pressure (BP) in acute stroke. Elevated BP or ‘hypertension’ (i.e. systolic >140 mmHg) is common in stroke, especially in patients with pre-existing hypertension and large strokes, due to variable ‘autonomic stress’ and raised intracranial pressure. While positive associations between BP levels and poor outcomes are evident across a range of studies, very low BP levels and large reductions in BP have also been shown to predict death and dependence, more so for ischaemic stroke (IS) than intracerebral haemorrhage (ICH). Accumulating evidence indicates that early BP lowering can reduce haematoma expansion in ICH, but there is uncertainty over whether this translates into improved clinical outcomes, particularly since such an effect was not evident from haemostatic therapy in clinical trials. Guidelines generally recommend control of high systolic BP (>180 mmHg), but recent evidence indicates that even more modest elevation (>140 mmHg) increases risks of cerebral oedema and haemorrhagic transformation following thrombolysis in IS. Thus, any potential benefits of rapid BP lowering in acute stroke, particularly in IS, must be balanced against the potential risks of worsening cerebral ischaemia from altered autoregulation/perfusion. This paper explores current knowledge regarding the management of hypertension in acute stroke and introduces ongoing clinical trials aimed at resolving such a critical issue in the care of patients with acute stroke. PMID:23342232

  19. Whole blood flow cytometry measurements of in vivo platelet activation in critically-Ill patients are influenced by variability in blood sampling techniques.

    PubMed

    Rondina, Matthew T; Grissom, Colin K; Men, Shaohua; Harris, Estelle S; Schwertz, Hansjorg; Zimmerman, Guy A; Weyrich, Andrew S

    2012-06-01

    Flow cytometry is often used to measure in vivo platelet activation in critically-ill patients. Variability in blood sampling techniques, which may confound these measurements, remains poorly characterized. Platelet activation was measured by flow cytometry performed on arterial and venous blood from 116 critically-ill patients. We determined how variability in vascular sampling site, processing times, and platelet counts influenced levels of platelet-monocyte aggregates (PMA), PAC-1 binding (for glycoprotein (GP) IIbIIIa), and P-selectin (P-SEL) expression. Levels of PMA, but not PAC-1 binding or P-SEL expression, were significantly affected by variability in vascular sampling site. Average PMA levels were approximately 60% higher in whole blood drawn from an arterial vessel compared to venous blood (16.2±1.8% vs. 10.7±1.2%, p<0.05). Levels of PMA in both arterial and venous blood increased significantly during ex vivo processing delays (1.7% increase for every 10 minute delay, p<0.05). In contrast, PAC-1 binding and P-SEL expression were unaffected by processing delays. Levels of PMA, but not PAC-1 binding or P-SEL expression, were correlated with platelet count quartiles (9.4±1.6% for the lowest quartile versus 15.4±1.6% for the highest quartile, p<0.05). In critically-ill patients, variability in vascular sampling site, processing times, and platelet counts influence levels of PMA, but not PAC-1 binding or P-SEL expression. These data demonstrate the need for rigorous adherence to blood sampling protocols, particularly when levels of PMA, which are most sensitive to variations in blood collection, are measured for detection of in vivo platelet activation. Copyright © 2011 Elsevier Ltd. All rights reserved.

  20. Canine visceral leishmaniasis: relationships between oxidative stress, liver and kidney variables, trace elements, and clinical status.

    PubMed

    Heidarpour, M; Soltani, S; Mohri, M; Khoshnegah, J

    2012-10-01

    The aim of this study was to investigate the role of oxidative stress in the pathology of canine visceral leishmaniasis (CVL). We therefore studied the relationships between oxidative stress markers, liver and kidney variables, trace elements, and clinical status in dogs naturally infected with Leishmania infantum. Two groups of Leishmania-infected dogs [asymptomatic (AD, n = 14) and symptomatic (SD, n = 16)] were assessed and compared with a group of non-infected control dogs (CD, n = 30). A significant decrease (p < 0.001) in serum total antioxidant status (TAS) and albumin concentration (p < 0.05) and a significant increase in serum malondialdehyde (MDA) and blood urea nitrogen (BUN) concentrations (p < 0.001), in the SD group, were observed when compared to CD and AD groups. Dogs of the AD group presented a significant decrease in copper (p < 0.01) and zinc (p < 0.001) concentrations, when compared to CD group, while the SD group presented a significant decrease (p < 0.001) in copper and zinc concentrations, when compared to CD and AD groups. Oxidative stress markers (MDA and TAS) showed significant correlations (p < 0.001) with trace elements (copper and zinc) and liver (alanine aminotransferase) and kidney (BUN and creatinine) variables. The results of the present study revealed that symptomatic dogs showed more severe oxidative stress than asymptomatic and non-infected dogs and enhanced lipid peroxidation may be linked to liver and kidney damage in canine visceral leishmaniasis.

  1. Increasing blood glucose variability is a precursor of sepsis and mortality in burned patients.

    PubMed

    Pisarchik, Alexander N; Pochepen, Olga N; Pisarchyk, Liudmila A

    2012-01-01

    High glycemic variability, rather than a mean glucose level, is an important factor associated with sepsis and hospital mortality in critically ill patients. In this retrospective study we analyze the blood glucose data of 172 nondiabetic patients 18-60 yrs old with second and third-degree burns of total body surface area greater than 30% and 5%, respectively, admitted to ICU in 2004-2008. The analysis identified significant association of increasing daily glucose excursion (DELTA) accompanied by evident episodes of hyperglycemia (>11 mmol/l) and hypoglycemia (<2.8 mmol/l), with sepsis and forthcoming death, even when the mean daily glucose was within a range of acceptable glycemia. No association was found in sepsis complication and hospital mortality with doses of intravenous insulin and glucose infusion. A strong increase in DELTA before sepsis and death is treated as fluctuation amplification near the onset of dynamical instability.

  2. Cyclosporine-inhibitable Blood-Brain Barrier Drug Transport Influences Clinical Morphine Pharmacodynamics

    PubMed Central

    Meissner, Konrad; Avram, Michael J.; Yermolenka, Viktar; Francis, Amber M.; Blood, Jane; Kharasch, Evan D.

    2013-01-01

    Background The blood-brain barrier is richly populated by active influx and efflux transporters influencing brain drug concentrations. Morphine, a drug with delayed clinical onset, is a substrate for the efflux transporter P-glycoprotein in vitro and in animals. This investigation tested whether morphine is a transporter substrate in humans. Methods Fourteen healthy volunteers received morphine (0.1 mg/kg, 1 h intravenous infusion) in a crossover study after nothing (control) or the validated P-glycoprotein inhibitor cyclosporine (5 mg/kg, 2 h infusion). Plasma and urine morphine and morphine glucuronide metabolite concentrations were measured by mass spectrometry. Morphine effects were measured by miosis and analgesia. Results Cyclosporine minimally altered morphine disposition, increasing the area under the plasma morphine concentration versus time curve to 100 ± 21 versus 85 ± 24 ng/ml•hr (p < 0.05) without changing maximum plasma concentration. Cyclosporine enhanced (3.2 ± 0.9 vs. 2.5 ± 1.0 mm peak) and prolonged miosis, and increased the area under the miosis-time curve (18 ± 9 vs. 11 ± 5 mm-hr), plasma-effect site transfer rate constant (ke0, median 0.27 vs. 0.17 hr−1), and maximum calculated effect site morphine concentration (11.5 ± 3.7 vs. 7.6 ± 2.9 ng/ml) (all p < 0.05). Analgesia testing was confounded by cyclosporine-related pain. Conclusions Morphine is a transporter substrate at the human blood-brain barrier. Results suggest a role for P-glycoprotein or other efflux transporters in brain morphine access, although the magnitude of the effect is small, and unlikely to be a major determinant of morphine clinical effects. Efflux may explain some variability in clinical morphine effects. PMID:23851346

  3. The Impact of Resonance Frequency Breathing on Measures of Heart Rate Variability, Blood Pressure, and Mood.

    PubMed

    Steffen, Patrick R; Austin, Tara; DeBarros, Andrea; Brown, Tracy

    2017-01-01

    Heart rate variability biofeedback (HRVB) significantly improves heart rate variability (HRV). Breathing at resonance frequency (RF, approximately 6 breaths/min) constitutes a key part of HRVB training and is hypothesized to be a pathway through which biofeedback improves HRV. No studies to date, however, have experimentally examined whether RF breathing impacts measures of HRV. The present study addressed this question by comparing three groups: the RF group breathed at their determined RF for 15 min; the RF + 1 group breathed at 1 breath/min higher than their determined RF for 15 min; and the third group sat quietly for 15 min. After this 15-min period, all groups participated in the Paced Auditory Serial Addition Task (PASAT) for 8 min, and then sat quietly during a 10-min recovery period. HRV, blood pressure, and mood were measured throughout the experiment. Groups were not significantly different on any of the measures at baseline. After the breathing exercise, the RF group reported higher positive mood than the other two groups and a significantly higher LF/HF HRV ratio relative to the control group, a key goal in HRVB training (p < 0.05). Additionally, the RF group showed lower systolic blood pressure during the PASAT and during the recovery period relative to the control group, with the RF + 1 group not being significantly different from either group (p < 0.05). Overall, RF breathing appears to play an important role in the positive effect HRVB has on measures of HRV.

  4. The Impact of Resonance Frequency Breathing on Measures of Heart Rate Variability, Blood Pressure, and Mood

    PubMed Central

    Steffen, Patrick R.; Austin, Tara; DeBarros, Andrea; Brown, Tracy

    2017-01-01

    Heart rate variability biofeedback (HRVB) significantly improves heart rate variability (HRV). Breathing at resonance frequency (RF, approximately 6 breaths/min) constitutes a key part of HRVB training and is hypothesized to be a pathway through which biofeedback improves HRV. No studies to date, however, have experimentally examined whether RF breathing impacts measures of HRV. The present study addressed this question by comparing three groups: the RF group breathed at their determined RF for 15 min; the RF + 1 group breathed at 1 breath/min higher than their determined RF for 15 min; and the third group sat quietly for 15 min. After this 15-min period, all groups participated in the Paced Auditory Serial Addition Task (PASAT) for 8 min, and then sat quietly during a 10-min recovery period. HRV, blood pressure, and mood were measured throughout the experiment. Groups were not significantly different on any of the measures at baseline. After the breathing exercise, the RF group reported higher positive mood than the other two groups and a significantly higher LF/HF HRV ratio relative to the control group, a key goal in HRVB training (p < 0.05). Additionally, the RF group showed lower systolic blood pressure during the PASAT and during the recovery period relative to the control group, with the RF + 1 group not being significantly different from either group (p < 0.05). Overall, RF breathing appears to play an important role in the positive effect HRVB has on measures of HRV. PMID:28890890

  5. Determinants of the impact of blood pressure variability on neurological outcome after acute ischaemic stroke

    PubMed Central

    Bennett, Alicia; Stoddard, Gregory J; Smith, Gordon; Chung, Lee; O'Donnell, Steve; McNally, J Scott; Tirschwell, David; Majersik, Jennifer J

    2017-01-01

    Introduction Increased blood pressure variability (BPV) is detrimental after acute ischaemic stroke, but the interaction between BPV and neuroimaging factors that directly influence stroke outcome has not been explored. Methods We retrospectively reviewed inpatients from 2007 to 2014 with acute anterior circulation ischaemic stroke, CT perfusion and angiography at hospital admission, and a modified Rankin Scale (mRS) 30–365 days after stroke onset. BPV indices included SD, coefficient of variation and successive variation of the systolic blood pressure between 0 and 120 hours after admission. Ordinal logistic regression models were fitted to mRS with predictor variables of BPV indices. Models were further stratified by CT perfusion volumetric measurements, proximal vessel occlusion and collateral score. Results 110 patients met the inclusion criteria. The likelihood of a 1-point rise in the mRS increased with every 10 mm Hg increase in BPV (OR for the 3 BPV indices ranged from 2.27 to 5.54), which was more pronounced in patients with larger ischaemic core volumes (OR 8.37 to 18.0) and larger hypoperfused volumes (OR 6.02 to 15.4). This association also held true for patients with larger mismatch volume, proximal vessel occlusion and good collateral vessels. Conclusions These results indicate that increased BPV is associated with worse neurological outcome after stroke, particularly in patients with a large lesion core volume, concurrent viable ischaemic penumbra, proximal vessel occlusion and good collaterals. This subset of patients, who are often not candidates for or fail acute stroke therapies such as intravenous tissue plasminogen activator or endovascular thrombectomy, may benefit from interventions aimed at reducing BPV. PMID:28959484

  6. Pulsatile flow of blood and heat transfer with variable viscosity under magnetic and vibration environment

    NASA Astrophysics Data System (ADS)

    Shit, G. C.; Majee, Sreeparna

    2015-08-01

    Unsteady flow of blood and heat transfer characteristics in the neighborhood of an overlapping constricted artery have been investigated in the presence of magnetic field and whole body vibration. The laminar flow of blood is taken to be incompressible and Newtonian fluid with variable viscosity depending upon temperature with an aim to provide resemblance to the real situation in the physiological system. The unsteady flow mechanism in the constricted artery is subjected to a pulsatile pressure gradient arising from systematic functioning of the heart and from the periodic body acceleration. The numerical computation has been performed using finite difference method by developing Crank-Nicolson scheme. The results show that the volumetric flow rate, skin-friction and the rate of heat transfer at the wall are significantly altered in the downstream of the constricted region. The axial velocity profile, temperature and flow rate increases with increase in temperature dependent viscosity, while the opposite trend is observed in the case of skin-friction and flow impedance.

  7. Association between day-by-day and ambulatory blood pressure variability in type 2 diabetes patients.

    PubMed

    Iuchi, Hiroyuki; Sakamoto, Masaya; Matsutani, Daisuke; Suzuki, Hirofumi; Kayama, Yosuke; Takeda, Norihiko; Utsunomiya, Kazunori

    2017-09-18

    It remains unclear whether ambulatory blood pressure variability (BPV) contributes toward day-by-day BPV, despite the fact that not only day-by-day but also ambulatory BPV is reported to be a risk factor for type 2 diabetes patients. This study aimed to determine the association between day-by-day BPV and ambulatory BPV, which is especially distinguished between diurnal and nocturnal BPV, in type 2 diabetes patients. Day-by-day and ambulatory BPV were assessed in 30 type 2 diabetes patients (aged 54±15 years; 87% men; glycated hemoglobin: 9.1±1.9%) in inpatient settings. Day-by-day systolic BPV was correlated significantly with diurnal systolic BPV (r=0.426, P=0.019), but not nocturnal systolic BPV (r=0.175, P=0.354). Multiple regression analysis showed that diurnal systolic BPV and diurnal mean systolic blood pressure were associated independently with day-by-day systolic BPV. With respect to type 2 diabetes, these findings suggest that day-by-day BPV is reflected in diurnal BPV rather than nocturnal BPV.

  8. Criminal Behavior as a Function of Clinical and Actuarial Variables in a Sexual Offender Population.

    ERIC Educational Resources Information Center

    Hall, Gordon C. Nagayama

    1988-01-01

    Investigated ability of clinical and actuarial variables to predict criminal behavior of 342 sexual offenders previously studied in 1987. Results suggested linear combination of actuarial variables was significantly predictive of sexual reoffenses against adults and of nonsexual reoffending. Clinical judgment was not significantly predictive of…

  9. Interferon Signature in the Blood in Inflammatory Common Variable Immune Deficiency

    PubMed Central

    Park, Joon; Munagala, Indira; Xu, Hui; Blankenship, Derek; Maffucci, Patrick; Chaussabel, Damien; Banchereau, Jacques; Pascual, Virginia; Cunningham-Rundles, Charlotte

    2013-01-01

    About half of all subjects with common variable immune deficiency (CVID) are afflicted with inflammatory complications including hematologic autoimmunity, granulomatous infiltrations, interstitial lung disease, lymphoid hyperplasia and/or gastrointestinal inflammatory disease. The pathogenesis of these conditions is poorly understood but singly and in aggregate, these lead to significantly increased (11 fold) morbidity and mortality, not experienced by CVID subjects without these complications. To explore the dysregulated networks in these subjects, we applied whole blood transcriptional profiling to 91 CVID subjects, 47 with inflammatory conditions and 44 without, in comparison to subjects with XLA and healthy controls. As compared to other CVID subjects, males with XLA or healthy controls, the signature of CVID subjects with inflammatory complications was distinguished by a marked up-regulation of IFN responsive genes. Chronic up-regulation of IFN pathways is known to occur in autoimmune disease due to activation of TLRs and other still unclarified cytoplasmic sensors. As subjects with inflammatory complications were also more likely to be lymphopenic, have reduced B cell numbers, and a greater reduction of B, T and plasma cell networks, we suggest that more impaired adaptive immunity in these subjects may lead to chronic activation of innate IFN pathways in response to environmental antigens. The unbiased use of whole blood transcriptome analysis may provides a tool for distinguishing CVID subjects who are at risk for increased morbidity and earlier mortality. As more effective therapeutic options are developed, whole blood transcriptome analyses could also provide an efficient means of monitoring the effects of treatment of the inflammatory phenotype. PMID:24069364

  10. Blood pressure and heart rate variability analysis of orthostatic challenge in normal human pregnancies.

    PubMed

    Heiskanen, Nonna; Saarelainen, Heli; Valtonen, Pirjo; Lyyra-Laitinen, Tiina; Laitinen, Tomi; Vanninen, Esko; Heinonen, Seppo

    2008-11-01

    The aim of the present study was to evaluate pregnancy-related changes in autonomic regulatory functions in healthy subjects. We studied cardiovascular autonomic responses to head-up tilt (HUT) in 28 pregnant women during the third trimester of pregnancy and 3 months after parturition. The maternal ECG and non-invasive beat-to-beat blood pressure were recorded in the horizontal position (left-lateral position) and during HUT in the upright position. Stroke volume was assessed from blood pressure signal by using the arterial pulse contour method. Heart rate variability (HRV) was analysed in frequency domain, and baroreflex sensitivity by the cross-spectral and the sequence methods. In the horizontal position, all frequency components of HRV were lower during pregnancy than 3 months after parturition (P < 0.01 to <0.001), while pregnancy had no influence on normalized low frequency and high frequency powers. During pregnancy haemodynamics was well balanced with only minor changes in response to postural change while haemodynamic responses to HUT were more remarkable after parturition. In pregnant women HRV and especially its very low frequency component increased in response to HUT, whereas at 3 months after parturition the direction of these changes was opposite. Parasympathetic deactivation towards term is likely to contribute to increased heart rate and cardiac output at rest, whereas restored sympathetic modulation with modest responses may contribute stable peripheral resistance and sufficient placental blood supply under stimulated conditions. It is important to understand cardiovascular autonomic nervous system and haemodynamic control in normal pregnancy before being able to judge whether they are dysregulated in complicated pregnancies.

  11. Clinical variables of preoperative risk in thoracic surgery.

    PubMed

    Saad, Ivete Alonso Bredda; De Capitani, Eduardo Mello; Toro, Ivan Felizardo Contrera; Zambon, Lair

    2003-05-05

    Pulmonary complications are the most common forms of postoperative morbidity in thoracic surgery, especially atelectasis and pneumonia. The first step in avoiding these complications during the postoperative period is to detect the patients that may develop them. To identify risk variables leading to early postoperative pulmonary complications in thoracic surgery. Prospective study. Hospital das Clínicas, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. 145 patients submitted to elective surgery were classified as low, moderate and high risk for postoperative pulmonary complications using a risk assessment scale. The patients were followed up for 72 hours after the operation. Postoperative pulmonary complications were defined as atelectasis, pneumonia, tracheobronchitis, wheezing, prolonged intubation and/or prolonged mechanical ventilation. Univariate analysis was applied in order to study these independent variables: age, nutritional status, body mass index, respiratory disease, smoking habit, spirometry and surgery duration. Multivariate logistic regression analysis was performed in order to evaluate the relationship between independent and dependent variables. The incidence of postoperative complications was 18.6%. Multivariate logistic regression analysis showed that the variables increasing the chances of postoperative pulmonary complications were wheezing (odds ratio, OR = 6.2), body mass index (OR = 1.15), smoking (OR = 1.04) and surgery duration (OR = 1.007). Wheezing, body mass index, smoking and surgery duration increase the chances of postoperative pulmonary complications in thoracic surgery

  12. Clinical and ultrastructural analysis of variable speed corneal trephination.

    PubMed

    Schanzlin, D J; Robin, J B; Spence, D J

    1983-09-01

    An automated, variable speed trephine was utilized to study the effects of rotation velocity on corneal trephination. Scanning electron microscopy revealed that the higher velocity (800 RPM) specimens had less stromal lamellar disruption, producing a smoother interface than either the lower velocity (100 RPM) automated trephinations or manual trephinations.

  13. Automatic blood pressure monitors. A clinical evaluation of five models in adults.

    PubMed

    Johnson, C J; Kerr, J H

    1985-05-01

    Five automatic blood pressure monitors were evaluated by comparing their values with almost simultaneous blood pressure readings from radial artery catheters. A total of 583 comparisons were made on 48 patients. Statistical analysis was performed on the pooled comparisons of systolic and diastolic pressure for each monitor. Agreement between the pressure measurements was variable between both patients and machines. For systolic pressure, two machines (Copal and Sentron) had correlation coefficients of over 0.9 while for the other machines (Dinamap 845XT, Narco and Vitastat 9001S) the values lay between 0.7 and 0.8. The steepest regression lines were also found with the Copal (0.93) and Sentron (0.86) data, but the other machines had considerably flatter slopes (0.55 to 0.67). The intercepts on the Y axes ranged from +14.1 (Copa) to +50.1 (Dinamap). In clinical use, popularity of the different machines reflected the degree to which the machine reproduced the behaviour of the direct pressure measurement.

  14. [Orofacial clinical manifestations in adult patients with variable common immunodeficiency].

    PubMed

    Chávez-García, Aurora Alejandra; Moreno-Alba, Miguel Ángel; Elizalde-Monroy, Martín; Segura-Méndez, Nora Hilda; Romero-Flores, Jovita; Cambray-Gutiérrez, Julio César; López-Pérez, Patricia; Del Rivero-Hernández, Leonel Gerardo

    2015-01-01

    Antecedentes: la inmunodeficiencia común variable es la inmunodeficienci primaria más común en adultos. Su prevalencia se estima en 1 por cada 25,000 a 75,000 recién nacidos vivos; existen variaciones por grupos étnicos, se estima en 50 a 70% en pacientes de raza caucásica. Las lesiones de la cavidad oral raramente se describen en pacientes adultos con inmunodeficiencia común variable, en niños con esta enfermedad existen informes de lesiones principalmente de origen infeccioso. Objetivo: describir las lesiones orofaciales (cavidad oral, macizo facial y cuello) en pacientes adultos con inmunodeficiencia común variable. Material y método: estudio transversal, prospectivo, efectuado en todos los adultos con inmunodeficiencia común variable adscritos a la Clínica de inmunodeficiencias primarias, del Hospital de Especialidades, Centro Médico Nacional Siglo XXI, que fueron examinados por un cirujano maxilofacial; se realizó el reporte de hallazgos en lista de cotejo y, posteriormente, el análisis descriptivo de las lesiones. Resultados: se incluyeron 26 pacientes, 16 mujeres y 10 hombres, con edad promedio de 38.6 años. En 18 de 26 pacientes estudiados se observaron lesiones orales, con siete lesiones diferentes y predominio en el sexo femenino 2:1. Las lesiones más frecuentes fueron: hiperplasia de glándulas salivales menores (19/26), petequias (12/26) y úlceras herpetiformes (7/26). En la cara y el cuello se observaron cuatro lesiones distintas, las adenopatías < 2 cm (4/26) fueron las más comunes. Conclusiones: las alteraciones inmunológicas asociadas con la inmunodeficiencia común variable favorecen la aparición de lesiones de origen infeccioso y probablemente autoinmunitario que afectan la cavidad oral, la cara y el cuello.

  15. Predicting Out-of-Office Blood Pressure in the Clinic (PROOF-BP)

    PubMed Central

    Stevens, Richard; Gill, Paramjit; Martin, Una; Godwin, Marshall; Hanley, Janet; Heneghan, Carl; Hobbs, F.D. Richard; Mant, Jonathan; McKinstry, Brian; Myers, Martin; Nunan, David; Ward, Alison; Williams, Bryan; McManus, Richard J.

    2016-01-01

    Patients often have lower (white coat effect) or higher (masked effect) ambulatory/home blood pressure readings compared with clinic measurements, resulting in misdiagnosis of hypertension. The present study assessed whether blood pressure and patient characteristics from a single clinic visit can accurately predict the difference between ambulatory/home and clinic blood pressure readings (the home–clinic difference). A linear regression model predicting the home–clinic blood pressure difference was derived in 2 data sets measuring automated clinic and ambulatory/home blood pressure (n=991) using candidate predictors identified from a literature review. The model was validated in 4 further data sets (n=1172) using area under the receiver operator characteristic curve analysis. A masked effect was associated with male sex, a positive clinic blood pressure change (difference between consecutive measurements during a single visit), and a diagnosis of hypertension. Increasing age, clinic blood pressure level, and pulse pressure were associated with a white coat effect. The model showed good calibration across data sets (Pearson correlation, 0.48–0.80) and performed well-predicting ambulatory hypertension (area under the receiver operator characteristic curve, 0.75; 95% confidence interval, 0.72–0.79 [systolic]; 0.87; 0.85–0.89 [diastolic]). Used as a triaging tool for ambulatory monitoring, the model improved classification of a patient’s blood pressure status compared with other guideline recommended approaches (93% [92% to 95%] classified correctly; United States, 73% [70% to 75%]; Canada, 74% [71% to 77%]; United Kingdom, 78% [76% to 81%]). This study demonstrates that patient characteristics from a single clinic visit can accurately predict a patient’s ambulatory blood pressure. Usage of this prediction tool for triaging of ambulatory monitoring could result in more accurate diagnosis of hypertension and hence more appropriate treatment. PMID:27001299

  16. Effect of physical variables on capture of magnetic nanoparticles in simulated blood vessels

    NASA Astrophysics Data System (ADS)

    Zhang, Minghui; Brazel, Christopher

    2011-11-01

    This study investigated how the percent capture of magnetic nanoparticles in a simulated vessel varies with physical variables. Magnetic nanoparticles (MNPs) can used as part of therapeutic or diagnostic materials for cancer patients. By capturing these devices with a magnetic field, the particles can be concentrated in an area of diseased tissue. In this study, flow of nanoparticles in simulated blood vessels was used to determine the affect of applying an external magnetic field. This study used maghemite nanoparticles as the MNPs and either water or Fetal Bovine Serum as the carrier fluid. A UV-Vis collected capture data. The percent capture of MNPs was positively influenced by five physical variables: larger vessel diameters, lower linear flow velocity, higher magnetic field strength, better dispersion, lower MNP concentration, and lower protein content in fluid. Free MNPs were also compared to micelles, with the free particles having more successful magnetic capture. Four factors contributed to these trends: the strength of the magnetic field's influence on the MNPs, the MNPs' interactions with other particles and the fluid, the momentum of the nanoparticles, and magnetic mass to total mass ratio of the flowing particles. Funded by NSF REU Site #1062611.

  17. Long-term prognostic implications of visit-to-visit blood pressure variability in patients with ischemic stroke.

    PubMed

    Lau, Kui-Kai; Wong, Yuen-Kwun; Teo, Kay-Cheong; Chang, Richard S K; Chan, Koon-Ho; Hon, Sonny F K; Wat, Ka-Lung; Cheung, Raymond T F; Li, Leonard S W; Siu, Chung-Wah; Tse, Hung-Fat

    2014-12-01

    Blood pressure (BP) variability (BPV) is a novel risk factor for the development of atherosclerotic diseases. High BPV has recently been shown to predict all-cause and cardiovascular mortality in patients with lacunar infarct. Whether BPV has prognostic implications in patients with ischemic stroke subtypes, other than those due to small-vessel occlusion, remains uncertain. We prospectively followed up the clinical outcome of 632 consecutive ischemic stroke patients without atrial fibrillation. The average BP and BPV, as determined by the coefficient of variation of the systolic and diastolic BP, were recorded during a mean 12 ± 6 outpatient clinic visits. The average age of the population was 71 ± 11 years. After a mean of 76 ± 18 months of follow-up, 161 patients died (26%); 35% (n = 56 of 161) of these deaths were due to cardiovascular causes. Sixteen percent and 5% developed recurrent stroke and acute coronary syndrome (ACS), respectively. After adjusting for mean systolic BP and confounding variables, patients with high systolic BPV were at significantly greater risk of cardiovascular mortality (hazards ratio (HR) = 2.36; 95% confidence interval (CI) = 1.02-5.49; P < 0.05). High systolic BPV also predicted all-cause mortality after adjusting for mean systolic BP (HR = 1.79; 95% CI = 1.16-2.75; P < 0.05). There was no association between systolic BPV and nonfatal recurrent stroke or nonfatal ACS. Raised diastolic BPV did not predict recurrent nonfatal stroke, nonfatal ACS, or mortality. Visit-to-visit systolic BPV predicts long-term all-cause and cardiovascular mortality in patients with ischemic stroke without atrial fibrillation, independent of other conventional risk factors, including average BP control. © American Journal of Hypertension, Ltd 2014. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. Prediction of hypertensive crisis based on average, variability and approximate entropy of 24-h ambulatory blood pressure monitoring.

    PubMed

    Schoenenberger, A W; Erne, P; Ammann, S; Perrig, M; Bürgi, U; Stuck, A E

    2008-01-01

    Approximate entropy (ApEn) of blood pressure (BP) can be easily measured based on software analysing 24-h ambulatory BP monitoring (ABPM), but the clinical value of this measure is unknown. In a prospective study we investigated whether ApEn of BP predicts, in addition to average and variability of BP, the risk of hypertensive crisis. In 57 patients with known hypertension we measured ApEn, average and variability of systolic and diastolic BP based on 24-h ABPM. Eight of these fifty-seven patients developed hypertensive crisis during follow-up (mean follow-up duration 726 days). In bivariate regression analysis, ApEn of systolic BP (P<0.01), average of systolic BP (P=0.02) and average of diastolic BP (P=0.03) were significant predictors of hypertensive crisis. The incidence rate ratio of hypertensive crisis was 14.0 (95% confidence interval (CI) 1.8, 631.5; P<0.01) for high ApEn of systolic BP as compared to low values. In multivariable regression analysis, ApEn of systolic (P=0.01) and average of diastolic BP (P<0.01) were independent predictors of hypertensive crisis. A combination of these two measures had a positive predictive value of 75%, and a negative predictive value of 91%, respectively. ApEn, combined with other measures of 24-h ABPM, is a potentially powerful predictor of hypertensive crisis. If confirmed in independent samples, these findings have major clinical implications since measures predicting the risk of hypertensive crisis define patients requiring intensive follow-up and intensified therapy.

  19. Enumeration of major peripheral blood leukocyte populations for multicenter clinical trials using a whole blood phenotyping assay.

    PubMed

    Hensley, Tiffany R; Easter, Austin B; Gerdts, Sarah E; De Rosa, Stephen C; Heit, Antje; McElrath, M Juliana; Andersen-Nissen, Erica

    2012-09-16

    Cryopreservation of peripheral blood leukocytes is widely used to preserve cells for immune response evaluations in clinical trials and offers many advantages for ease and standardization of immunological assessments, but detrimental effects of this process have been observed on some cell subsets, such as granulocytes, B cells, and dendritic cells. Assaying fresh leukocytes gives a more accurate picture of the in vivo state of the cells, but is often difficult to perform in the context of large clinical trials. Fresh cell assays are dependent upon volunteer commitments and timeframes and, if time-consuming, their application can be impractical due to the working hours required of laboratory personnel. In addition, when trials are conducted at multiple centers, laboratories with the resources and training necessary to perform the assays may not be located in sufficient proximity to clinical sites. To address these issues, we have developed an 11-color antibody staining panel that can be used with Trucount tubes (Becton Dickinson; San Jose, CA) to phenotype and enumerate the major leukocyte populations within the peripheral blood, yielding more robust cell-type specific information than assays such as a complete blood count (CBC) or assays with commercially-available panels designed for Trucount tubes that stain for only a few cell types. The staining procedure is simple, requires only 100 μl of fresh whole blood, and takes approximately 45 minutes, making it feasible for standard blood-processing labs to perform. It is adapted from the BD Trucount tube technical data sheet (version 8/2010). The staining antibody cocktail can be prepared in advance in bulk at a central assay laboratory and shipped to the site processing labs. Stained tubes can be fixed and frozen for shipment to the central assay laboratory for multicolor flow cytometry analysis. The data generated from this staining panel can be used to track changes in leukocyte concentrations over time in

  20. Enumeration of Major Peripheral Blood Leukocyte Populations for Multicenter Clinical Trials Using a Whole Blood Phenotyping Assay

    PubMed Central

    Hensley, Tiffany R.; Easter, Austin B.; Gerdts, Sarah E.; De Rosa, Stephen C.; Heit, Antje; McElrath, M. Juliana; Andersen-Nissen, Erica

    2012-01-01

    Cryopreservation of peripheral blood leukocytes is widely used to preserve cells for immune response evaluations in clinical trials and offers many advantages for ease and standardization of immunological assessments, but detrimental effects of this process have been observed on some cell subsets, such as granulocytes, B cells, and dendritic cells 1-3. Assaying fresh leukocytes gives a more accurate picture of the in vivo state of the cells, but is often difficult to perform in the context of large clinical trials. Fresh cell assays are dependent upon volunteer commitments and timeframes and, if time-consuming, their application can be impractical due to the working hours required of laboratory personnel. In addition, when trials are conducted at multiple centers, laboratories with the resources and training necessary to perform the assays may not be located in sufficient proximity to clinical sites. To address these issues, we have developed an 11-color antibody staining panel that can be used with Trucount tubes (Becton Dickinson; San Jose, CA) to phenotype and enumerate the major leukocyte populations within the peripheral blood, yielding more robust cell-type specific information than assays such as a complete blood count (CBC) or assays with commercially-available panels designed for Trucount tubes that stain for only a few cell types. The staining procedure is simple, requires only 100 μl of fresh whole blood, and takes approximately 45 minutes, making it feasible for standard blood-processing labs to perform. It is adapted from the BD Trucount tube technical data sheet (version 8/2010). The staining antibody cocktail can be prepared in advance in bulk at a central assay laboratory and shipped to the site processing labs. Stained tubes can be fixed and frozen for shipment to the central assay laboratory for multicolor flow cytometry analysis. The data generated from this staining panel can be used to track changes in leukocyte concentrations over time in

  1. The controversy over the age of blood: what do the clinical trials really teach us?

    PubMed Central

    Belpulsi, Danamarie; Spitalnik, Steven L.; Hod, Eldad A.

    2017-01-01

    Red blood cell transfusions have been used in clinical practice for decades and represent the most common therapeutic procedure performed in hospitalised patients. Depending on the storage solution and national regulatory requirements, red blood cells can be stored in the refrigerator up to 42 days before transfusion. We reviewed five of the most recent randomised clinical trials that examined clinical outcomes in specific patient populations. Although these studies provide some comfort regarding our current standard of care, they do not address whether the oldest blood is associated with harm in certain patient populations. PMID:28263167

  2. The controversy over the age of blood: what do the clinical trials really teach us?

    PubMed

    Belpulsi, Danamarie; Spitalnik, Steven L; Hod, Eldad A

    2017-03-01

    Red blood cell transfusions have been used in clinical practice for decades and represent the most common therapeutic procedure performed in hospitalised patients. Depending on the storage solution and national regulatory requirements, red blood cells can be stored in the refrigerator up to 42 days before transfusion. We reviewed five of the most recent randomised clinical trials that examined clinical outcomes in specific patient populations. Although these studies provide some comfort regarding our current standard of care, they do not address whether the oldest blood is associated with harm in certain patient populations.

  3. Psychosocial Variables Contribute to Length of Stay and Discharge Destination after Lumbar Surgery Independent of Demographic and Clinical Variables.

    PubMed

    Mancuso, Carol A; Duculan, Roland; Craig, Chad M; Girardi, Federico P

    2017-07-03

    Prospective analysis of resource utilization (RU) after lumbar surgery. To determine contributions of patient psychosocial variables to RU, specifically length of stay (LOS) and discharge destination. Associations between demographic/clinical variables and RU are well-established; less is known about associations between psychosocial variables, such as social support and depressive/anxiety symptoms, and RU. Preoperatively 532 patients provided standard ratings of depressive and anxiety symptoms and amount of social support. Clinical variables included calculation of a composite score reflecting invasiveness of surgery. Two outcomes were considered: LOS ≤ 3 or > 3 days; and discharged home without external services or discharged with external services. Independent variables in multivariable logistic models were demographic/clinical and psychosocial variables. Mean age was 56 years, 55% were men, 87% had degenerative conditions, 40% had a positive depression screen, 62% had anxiety greater than population norms, and 77% reported as much social support as wanted. Variables that remained associated with a LOS > 3 days (53%) in multivariable analysis were: older age (OR 1.8, CI 1.2-2.8); female gender (OR 1.9, CI 1.2-2.9), less social support (OR1.4, CI 1.1-1.7); obesity (OR1.8, CI 1.1-2.8), worse functional status (OR 1.0, CI 1.0-1.0) and more invasive surgery (OR 3.0, CI 2.4-3.7). Variables that remained associated with discharged with external services (17%) in multivariable analysis were: older age (OR 3.3, CI 1.9-5.9); less social support (OR 1.3, CI 1.0-1.7); positive depression screen (OR 1.9, CI 1.1-3.4); more anxiety (OR 2.4, CI 1.3-4.2); major comorbidity (OR 1.7, CI 1.0-2.8); and more invasive surgery (OR 1.9, CI 1.5-2.5). This study confirms the importance of demographic/clinical variables as predictors of greater RU after lumbar surgery and provides preliminary evidence for the importance of concurrent psychosocial variables, particularly less social

  4. How Many Measurements Are Needed to Estimate Blood Pressure Variability Without Loss of Prognostic Information?

    PubMed Central

    2014-01-01

    BACKGROUND Average real variability (ARV) is a recently proposed index for short-term blood pressure (BP) variability. We aimed to determine the minimum number of BP readings required to compute ARV without loss of prognostic information. METHODS ARV was calculated from a discovery dataset that included 24-hour ambulatory BP measurements for 1,254 residents (mean age = 56.6 years; 43.5% women) of Copenhagen, Denmark. Concordance between ARV from full (≥80 BP readings) and randomly reduced 24-hour BP recordings was examined, as was prognostic accuracy. A test dataset that included 5,353 subjects (mean age = 54.0 years; 45.6% women) with at least 48 BP measurements from 11 randomly recruited population cohorts was used to validate the results. RESULTS In the discovery dataset, a minimum of 48 BP readings allowed an accurate assessment of the association between cardiovascular risk and ARV. In the test dataset, over 10.2 years (median), 806 participants died (335 cardiovascular deaths, 206 cardiac deaths) and 696 experienced a major fatal or nonfatal cardiovascular event. Standardized multivariable-adjusted hazard ratios (HRs) were computed for associations between outcome and BP variability. Higher diastolic ARV in 24-hour ambulatory BP recordings predicted (P < 0.01) total (HR = 1.12), cardiovascular (HR = 1.19), and cardiac (HR = 1.19) mortality and fatal combined with nonfatal cerebrovascular events (HR = 1.16). Higher systolic ARV in 24-hour ambulatory BP recordings predicted (P < 0.01) total (HR = 1.12), cardiovascular (HR = 1.17), and cardiac (HR = 1.24) mortality. CONCLUSIONS Forty-eight BP readings over 24 hours were observed to be adequate to compute ARV without meaningful loss of prognostic information. PMID:23955605

  5. [Population characteristics and impact on heart rate variability, heart rate and blood pressure of passive smoking].

    PubMed

    Zhao, Jing; He, Fei; Hu, Da-yi; Ding, Rong-jing; Yu, Xiao-jun; Wang, Long; Zhang, Ping; Li, Xue-bin; Guo, Ji-hong; Liu, Wen-ling; Li, Cui-lan; Li, Lei; Gao, Chuan-yu; Zhao, Luo-sha; Chu, Ying-jie; Huang, Zhen-wen; Wei, Jing-han; Hua, Shao-hua; Liu, Rui-yun; Zhuang, Xiao-feng

    2013-05-01

    To investigate the basic characteristics of passive smoking population, and the impact of passive smoking on heart rate variability, heart rate and blood pressure. Eighty-six passive smokers [mean age: (52.4 ± 7.6) years] were recruited from patients and their relatives who visited cardiovascular outpatient department and excluded structural heart disease between June 2010 and June 2012, 80 normal subjects who were not exposed to smoking served as controls. Questionnaire survey, 24 hours ambulatory electrocardiogram examination and blood pressure measurement were performed in all recruited subjects. (1) Non-marriage rate [18.60% (16/86) vs. 3.75% (3/80), P < 0.01] was significantly higher while education level were significantly lower in passive smoking group than in control group. Passive smokers were more likely service industry workers [29.07% (25/86) vs. 15.00% (12/80), P < 0.05] and had longer daily working time [(7.56 ± 1.24) h vs. (6.02 ± 0.96) h, P < 0.01], and were less likely to be professional technology industry employers [20.93% (18/86) vs. 36.25% (29/80), P < 0.05] and managers [13.95% (12/86) vs. 38.75% (31/80), P < 0.01] compared to controls. The main place of passive smoking was workplace (67.44%, 58/86), entertainment venues (63.95%,55/86), restaurants (48.84%, 42/86). (2) Standard of the normal sinus RR intervals (SDNN), the normal consecutive sinus RR interval difference between the root-mean-square (rMSSD) and adjacent the difference between the RR interval>50 ms the number of share the percentage (PNN50) were significantly lower in passive smoking group than in the control group (all P < 0.05). Every 5 min average of the standard deviation of sinus RR cycle (SDNN index) and 24 h every 5 min sinus RR interval mean standard deviation (SDANN) were similar between the 2 groups (all P > 0.05). Ultra-low-frequency power (VLF), low frequency power (LF), high frequency power (HF) and LF/HF were significantly lower in passive smoking group than in

  6. NEW CLINICALLY SIGNIFICANT METHOD OF DETERMINING GLYCOPROTEINS IN BLOOD SERUM

    DTIC Science & Technology

    The reaction with ammonium molybdate is a simple and at the same time a very sensitive method for determining the level of glycoproteins in the blood ... serum , which has a number of advantages over the diphehylamine reaction. The reaction with ammonium molybdate is a valuable supplementary test for

  7. Control and monitoring system for clinically employed pneumatic blood pumps.

    PubMed

    Normann, N A; Henrichsen, D W; Cooper, T G; King, R E; Noon, G P; DeBakey, M E

    1977-01-01

    Instantaneous position of the flexing member in pneumatic blood pumps is monitored on-line by measuring the electrical capacitance across the gas space within the pump. Monitor output is utilized in closed-loop pump control and for automatic pump shutdown in response to operational abnormalities. Thus, safety and efficacy are enhanced through operational optimization, automatic safety features, and facilitated evaluation.

  8. Effects of moderate physical training on blood pressure variability and hemodynamic pattern in mildly hypertensive subjects.

    PubMed

    Izdebska, E; Cybulska, I; Izdebskir, J; Makowiecka-Ciesla, M; Trzebski, A

    2004-12-01

    The objective of our study was to compare the cardiovascular effects of moderate exercise training in healthy young (NTS, n=18, 22.9+/-0.44 years) and in hypertensive human subjects (HTS, n=30, 23+/-1.1). The VO(2max) did not significantly differ between groups. HTS of systolic blood pressure (SBP) 148+/-3.6 mmHg and diastolic blood pressure(DBP) 88+/-2.2 mmHg, and NTS of SBP: 128.8 +/- 4 mmHg and DBP: 72 +/- 2.9 mmHg were submitted to moderate dynamic exercise training, at about 50% VO(2max) 3 times per week for one hour, over 3 months. VO(2max) was measured by Astrand's test. Arterial blood pressure was measured with Finapres technique, the stroke volume, cardiac output and arm blood flow were assessed by impedance reography. Variability of SBP and pulse interval values (PI) were estimated by computing the variance and power spectra according to FFT algorithm. After training period significant improvements in VO(2max) were observed in NTS- by 1.92 +/-0.76 and in HTS by 3+/-0.68 ml/kg/min). In HTS significantly decreased: SBP by 19 +/-2.9 mmHg, in DBP by 10.7+/-2 mmHg total peripheral resistance (TPR) by 0.28 +/-0.05 TPR units. The pretraining value of low frequency component power spectra SBP (LF(SPB)) was significantly greater in HTS, compared to NTS. PI variance was lower in HTS, compared to NTS. After physical training, in HTS PI variance increased suggesting a decrease in frequency modulated sympathetic activity and increase in vagal modulation of heart rate in mild hypertension. A major finding of the study is the significant decrease of resting low frequency component SBP power spectrum after training in HTS. The value of LF(SPB) in trained hypertensive subjects normalized to the resting level of LF(SPB) in NTS. Our findings suggest that antihypertensive hemodynamic effects of moderate dynamic physical training are associated with readjustment of the autonomic cardiovascular control system.

  9. Measurement of heart rate variability: a clinical tool or a research toy?

    PubMed

    Huikuri, H V; Mäkikallio, T; Airaksinen, K E; Mitrani, R; Castellanos, A; Myerburg, R J

    1999-12-01

    The objectives of this review are to discuss the diversity of mechanisms that may explain the association between heart rate (HR) variability and mortality, to appraise the clinical applicability of traditional and new measures of HR variability and to propose future directions in this field of research. There is a large body of data demonstrating that abnormal HR variability measured over a 24-h period provides information on the risk of subsequent death in subjects with and without structural heart disease. However, the mechanisms responsible for this association are not completely established. Therefore, no specific therapy is currently available to improve the prognosis for patients with abnormal HR variability. Reduced HR variability has been most commonly associated with a risk of arrhythmic death, but recent data suggest that abnormal variability also predicts vascular causes of death, progression of coronary atherosclerosis and death due to heart failure. A consensus is also lacking on the best HR variability measure for clinical purposes. Time and frequency domain measures of HR variability have been most commonly used, but recent studies show that new analysis methods based on nonlinear dynamics may be more powerful in terms of risk stratification. Before the measurement of HR variability can be applied to clinical practice and used to direct therapy, more precise insight into the pathophysiological link between HR variability and mortality are needed. Further studies should also address the issue of which of the HR variability indexes, including the new nonlinear measures, is best for clinical purposes in various patient populations.

  10. A brief history of the early years of blood transfusion at the Mayo Clinic: the first blood bank in the United States (1935).

    PubMed

    Moore, S Breanndan

    2005-07-01

    At the Mayo Clinic in 1914, Francis McGrath modified an existing aspiration-injection apparatus and adapted it for arm-to-arm blood transfusions. Separately, in 1919, both Pemberton and Sanford described in detail the Mayo Clinic experience with more than 1000 transfusions between January 1915 and January 1918. Most transfusions were by the indirect citrate method from freshly drawn blood. In 1935, John Lundy established a bank of refrigerated blood for transfusions at Mayo Clinic and reported on the activity in that and subsequent years. The functioning clinical blood bank established by Lundy at Mayo Clinic predated that of Bernard Fantus in Chicago by almost 2 years.

  11. In-Depth Profiling of the Peripheral Blood Mononuclear Cells Proteome for Clinical Blood Proteomics

    PubMed Central

    Končarević, Saša; Lößner, Christopher; Pike, Ian; Zucht, Hans-Dieter

    2014-01-01

    Peripheral blood mononuclear cells (PBMCs) are an easy accessible cellular part of the blood organ and, along with platelets, represent the only site of active gene expression in blood. These cells undergo immunophenotypic changes in various diseases and represent a peripheral source of monitoring gene expression and posttranslational modifications relevant to many diseases. Little is known about the source of many blood proteins and we hypothesise that release from PBMCs through active and passive mechanisms may account for a substantial part of the plasma proteome. The use of state-of-the-art proteomic profiling methods in PBMCs will enable minimally invasive monitoring of disease progression or response to treatment and discovery of biomarkers. To achieve this goal, detailed mapping of the PBMC proteome using a sensitive, robust, and quantitative methodological setup is required. We have applied an indepth gel-free proteomics approach using tandem mass tags (TMT), unfractionated and SCX fractionated PBMC samples, and LC-MS/MS with various modulations. This study represents a benchmark in deciphering the PBMC proteome as we provide a deep insight by identifying 4129 proteins and 25503 peptides. The identified proteome defines the scope that enables PBMCs to be characterised as cellular major biomarker pool within the blood organ. PMID:24724028

  12. In-depth profiling of the peripheral blood mononuclear cells proteome for clinical blood proteomics.

    PubMed

    Končarević, Saša; Lößner, Christopher; Kuhn, Karsten; Prinz, Thorsten; Pike, Ian; Zucht, Hans-Dieter

    2014-01-01

    Peripheral blood mononuclear cells (PBMCs) are an easy accessible cellular part of the blood organ and, along with platelets, represent the only site of active gene expression in blood. These cells undergo immunophenotypic changes in various diseases and represent a peripheral source of monitoring gene expression and posttranslational modifications relevant to many diseases. Little is known about the source of many blood proteins and we hypothesise that release from PBMCs through active and passive mechanisms may account for a substantial part of the plasma proteome. The use of state-of-the-art proteomic profiling methods in PBMCs will enable minimally invasive monitoring of disease progression or response to treatment and discovery of biomarkers. To achieve this goal, detailed mapping of the PBMC proteome using a sensitive, robust, and quantitative methodological setup is required. We have applied an indepth gel-free proteomics approach using tandem mass tags (TMT), unfractionated and SCX fractionated PBMC samples, and LC-MS/MS with various modulations. This study represents a benchmark in deciphering the PBMC proteome as we provide a deep insight by identifying 4129 proteins and 25503 peptides. The identified proteome defines the scope that enables PBMCs to be characterised as cellular major biomarker pool within the blood organ.

  13. Raman spectroscopy of stored red blood cells: evaluating clinically-relevant biochemical markers in donated blood

    NASA Astrophysics Data System (ADS)

    Atkins, Chad G.; Buckley, Kevin; Chen, Deborah; Schulze, H. G.; Devine, Dana V.; Blades, Michael W.; Turner, Robin F. B.

    2015-07-01

    Modern transfusion medicine relies on the safe, secure, and cost-effective delivery of donated red blood cells (RBCs). Once isolated, RBCs are suspended in a defined additive solution and stored in plastic blood bags in which, over time, they undergo chemical, physiological, and morphological changes that may have a deleterious impact on some patients. Regulations limit the storage period to 42 days and the cells do not routinely undergo analytical testing before use. In this study, we use Raman spectroscopy to interrogate stored RBCs and we identify metabolic and cell-breakdown products, such as haemoglobin and membrane fragments, that build-up in the blood bags as the cells age. Our work points the way to the development of an instrument which could quickly and easily assess the biochemical nature of stored RBC units before they are transfused.

  14. The Role of Blood Flow and Blood Flow Modifiers in Clinical Hyperthermia Therapy

    NASA Astrophysics Data System (ADS)

    Olch, Arthur Jacob

    A quantitative assessment of the effect of localized magnetic-loop hyperthermia on blood flow was performed on 12 patients (19 tumor studies) using the Xenon-133 clearance method. After it was discovered that blood flow in most of the tumors increased in response to needle injection, a physiologically based, one compartment model was developed that included both a hyperemic (transient) and a steady state component. In the tumors of six patients, increases in blood flow induced by heat were also observed. The same model was used to describe the measured clearance data for both types of hyperemic response. The ability of tumor vessels to respond dynamically to stress and the degree of response may be predictive of tumor heating efficiency and subsequent therapeutic response. Many tumors treated by hyperthermia, therefore, do not reach therapeutic temperatures (42(DEGREES)C). One explanation for this may be that some tumors react to thermal stress in a manner similar to normal tissues; i.e., they increase blood flow during hyperthermia in order to dissipate heat. Higher temperatures might be achieved in these heat-resistant tumors by administering vasoconstrictive agents in an effort to reduce blood flow. In the second part of this research study, the extent to which pharmacologic inhibition of local blood flow might allow higher temperatures to develop in normal muscles exposed to localized radiofrequency hyperthermia was determined. It was found that the local muscle temperature rise could be increased by at least 90% in dogs and rabbits with the use of a local vasoconstrictive drug.

  15. Social Class and Diagnostic Suggestion as Variables in Clinical Judgment

    ERIC Educational Resources Information Center

    Di Nardo, Peter A.

    1975-01-01

    Sixty graduate students in clinical psychology made diagnostic assessments of one of two staged interviews identical in content but enacted to convey either a middle- or lower-class impression. The results indicate the existence of a class bias and suggest a status differential between psychologists and psychiatrists. (Author)

  16. Cooperative study of clinical benefits from use of the fully portable blood irradiator

    SciTech Connect

    Hungate, F.P.

    1994-10-01

    This report looks at the clinical benefits from use of a fully portable blood irradiator, techniques developed by Pacific Northwest Laboratory. Significant accomplishments included the following: blood irradiators were successfully fabricated by PNL; irradiators were activated at the University of Missouri and quality tested at PNL; A-V shunts for irradiators were successfully fabricated in the PNL plastics shop; all activities necessary for experimental work on animals using the blood irradiators were completed.

  17. Heart rate and blood pressure variability during heavy training and overtraining in the female athlete.

    PubMed

    Uusitalo, A L; Uusitalo, A J; Rusko, H K

    2000-01-01

    We investigated heavy training- and overtraining-induced changes in heart rate and blood pressure variability during supine rest and in response to head-up tilt in female endurance athletes. Nine young female experimental athletes (ETG) increased their training volume at the intensity of 70-90% of maximal oxygen uptake (VO2max) by 125% and training volume at the intensity of < 70% of VO2max by 100% during 6-9 weeks. The corresponding increases in 6 female control athletes were 5% and 10%. The VO2max of the ETG and the control athletes did not change, but it decreased from 53.0 +/- 2.2 ml x kg(-1) x min(-1) to 50.2 +/- 2.3 ml x kg(-1) x min(-1) (mean+/-SEM, p < 0.01) in five overtrained experimental athletes. In the ETG, low-frequency power of R-R interval (RRI) variability during supine rest increased from 6 +/- 1 ms2 x 10(2) to 9 +/- 2 ms2 x 10(2) (p < 0.05). The 30/15 index (= RRI(max 30)/RRI(min 15), where RRI(max 30) denotes the longest RRI close to the 30th RRI and RRI(min 15) denotes the shortest RRI close to the 15th RRI after assuming upright position in the head-up tilt test), decreased as a result of training (analysis of variance, p = 0.05). In the ETG, changes in VO2max were related to the changes in total power of RRI variability during standing (r = 0.74, p < 0.05). Heart rate response to prolonged standing after head-up tilt was either accentuated or attenuated in the overtrained athletes as compared to the normal training state. We conclude that heavy training could increase cardiac sympathetic modulation during supine rest and attenuated biphasic baroreflex-mediated response appearing just after shifting to an upright position. Heavy-training-/overtraining-induced decrease in maximal aerobic power was related to decreased heart rate variability during standing. Physiological responses to overtraining were individual.

  18. Association between heart rate variability, blood pressure and autonomic activity in cyclic alternating pattern during sleep.

    PubMed

    Kondo, Hideaki; Ozone, Motohiro; Ohki, Noboru; Sagawa, Yohei; Yamamichi, Keiichirou; Fukuju, Mitsuki; Yoshida, Takeshi; Nishi, Chikako; Kawasaki, Akiko; Mori, Kaori; Kanbayashi, Takashi; Izumi, Motomori; Hishikawa, Yasuo; Nishino, Seiji; Shimizu, Tetsuo

    2014-01-01

    Cyclic alternating pattern (CAP) is frequently followed by changes in heart rate (HR) and blood pressure (BP), but the sequential associations between CAP and autonomic nerve activity have not been studied. The study aimed to reveal the precise changes in heart rate variability (HRV) during phase A of the CAP cycle. Polysomnography was recorded according to the CAP Atlas (Terzano, 2002), and BP and electrocardiogram were simultaneously recorded. The complex demodulation method was used for analysis of HRV and evaluation of autonomic nerve activity. Academic sleep laboratory. Ten healthy males. The increase in HR (median [first quartile - third quartile]) for each subtype was as follows: A1, 0.64 (-0.30 to 1.69), A2, 1.44 (0.02 to 3.79), and A3, 6.24 (2.53 to 10.76) bpm (A1 vs. A2 P < 0.001, A1 vs. A3 P < 0.001, A2 vs. A3 P < 0.001). The increase in BP for each subtype was as follows: A1, 1.23 (-2.04 to 5.75), A2, 1.76 (-1.46 to 9.32), and A3, 12.51 (4.75 to 19.94) mm Hg (A1 vs. A2 P = 0.249, A1 vs. A3 P < 0.001, A2 vs. A3 P < 0.001). In all of phase A, the peak values for HR and BP appeared at 4.2 (3.5 to 5.4) and 8.4 (7.0 to 10.3) seconds, respectively, after the onset of phase A. The area under the curve for low-frequency and high-frequency amplitude significantly increased after the onset of CAP phase A (P < 0.001) and was higher in the order of subtype A3, A2, and A1 (P < 0.001). All phase A subtypes were accompanied with increased heart rate variability, and the largest heart rate variability was seen in subtype A3, while a tendency for less heart rate variability was seen in subtype A1.

  19. Hypertension and blood pressure variability management practices among physicians in Singapore.

    PubMed

    Setia, Sajita; Subramaniam, Kannan; Tay, Jam Chin; Teo, Boon Wee

    2017-01-01

    There are limited data on blood pressure variability (BPV) in Singapore. The absence of updated local guidelines might contribute to variations in diagnosis, treatment and control of hypertension and BPV between physicians. This study evaluated BPV awareness, hypertension management and associated training needs in physicians from Singapore. Physicians from Singapore were surveyed between September 8, 2016, and October 5, 2016. Those included were in public or private practice for ≥3 years, cared directly for patients ≥70% of the time and treated ≥30 patients for hypertension each month. The questionnaire covered 6 main categories: general blood pressure (BP) management, BPV awareness/diagnosis, home BP monitoring (HBPM), ambulatory BP monitoring (ABPM), BPV management and associated training needs. Responses from 60 physicians (30 general practitioners [GPs], 20 cardiologists, 10 nephrologists) were analyzed (77% male, 85% aged 31-60 years, mean 22 years of practice). Approximately 63% of physicians considered white-coat hypertension as part of BPV. The most common diagnostic tool was HBPM (overall 77%, GPs 63%, cardiologists 65%, nephrologists 70%), but ABPM was rated as the tool most valued by physicians (80% overall), especially specialists (97%). Withdrawn Singapore guidelines were still being used by 73% of GPs. Approximately 48% of physicians surveyed did not adhere to the BP cutoff recommended by most guidelines for diagnosing hypertension using HBPM (>135/85 mmHg). Hypertension treatment practices also varied from available guideline recommendations, although physicians did tend to use a lower BP target for patients with diabetes or kidney disease. There were a number of challenges to estimating BPV, the most common of which was patient refusal of ABPM/HBPM. The majority of physicians (82%) had no training on BPV, but stated that this would be useful. There appear to be gaps in knowledge and guideline adherence relating to the assessment and

  20. Increased Blood Pressure Variability Prior to Chronic Kidney Disease Exacerbates Renal Dysfunction in Rats

    PubMed Central

    Freitas, Frederico F. C. T.; Araujo, Gilberto; Porto, Marcella L.; Freitas, Flavia P. S.; Graceli, Jones B.; Balarini, Camille M.; Vasquez, Elisardo C.; Meyrelles, Silvana S.; Gava, Agata L.

    2016-01-01

    Increased blood pressure variability (BPV), which can be experimentally induced by sinoaortic denervation (SAD), has emerged as a new marker of the prognosis of cardiovascular and renal outcomes. Considering that increased BPV can lead to organ-damage, the goal of the present study was to evaluate the effects of SAD on renal function in an experimental model of chronic kidney disease (CKD). SAD was performed in male Wistar rats 2 weeks before 5/6 nephrectomy and the animals were evaluated 4 weeks after the induction of CKD. Our data demonstrated that BPV was increased in SAD and CKD animals and that the combination of both conditions (SAD+CKD) exacerbated BPV. The baroreflex sensitivity index was diminished in the SAD and CKD groups; this reduction was more pronounced when SAD and CKD were performed together. 5/6 nephrectomy led to hypertension, which was higher in SAD+CKD animals. Regarding renal function, the combination of SAD and CKD resulted in reduced renal plasma and blood flow, increased renal vascular resistance and augmented uraemia when compared to CKD animals. Glomerular filtration rate and BPV were negatively correlated in SAD, CKD, and SAD+CKD animals. Moreover, SAD+CKD animals presented a higher level of glomerulosclerosis when compared to all other groups. Cardiac and renal hypertrophy, as well as oxidative stress, was also further increased when SAD and CKD were combined. These results show that SAD prior to 5/6 nephrectomy exacerbates renal dysfunction, suggesting that previous augmented BPV should be considered as an important factor to the progression of renal diseases. PMID:27721797

  1. Blood metabolites and their relationship with production variables in dual-purpose cows in Venezuela.

    PubMed

    Parra, O; Ojeda, A; Combellas, J; Gabaldon, L; Escobar, A; Martinez, N; Benezra, M

    1999-01-27

    A survey was carried out on 79 lactating Bos taurus/indicus cross-bred cows on three dual-purpose cattle farms to measure the blood concentration of metabolites and to evaluate possible relationships with nutritional status and productive variables. A rotational grazing system on Star grass and other tropical pastures (10-12% CP in leaves) was used and 2-3 kg/cow/day of concentrate were fed on two farms. Restricted calf suckling was used in two herds. Average milk yield sold per farm was 6 kg/day/cow and body condition scores (BCS) were between 3.0 and 3.8 on a scale of one-to-five. On two farms, the average interval from calving to conception (ICC) was more than 145 days. Mean blood concentrations of albumin, globulin, urea, beta-hydroxybutyrate and phosphorus were generally within reference values, but a significant group of cows had low levels of albumin and urea and high levels of globulin. Packed cell volume (PCV) was below normal values, with anemia in 63% of cows during the second trimester of lactation, which was negatively correlated to milk yield. The high incidence of anemia could be related to factors such as hematophagic parasites, not evaluated in this study. ICC values were negatively related to albumin level and could be associated with protein deficiency in the diet or with disease, as globulin values were high in many cows. Based on these diagnoses, an experiment was carried out on one of the farms to evaluate the influence of supplementation with 0.5 kg/cow/day of fish meal. Total milk yield was not influenced by the fish meal and reproductive efficiency was high in the two supplemental treatments. It was shown that supplementation with undergraded protein is not required in these cows.

  2. Systolic Blood Pressure Variability is a Novel Risk Factor for Rebleeding in Acute Subarachnoid Hemorrhage

    PubMed Central

    Lin, Qing-Song; Ping-Chen; Lin, Yuan-Xiang; Lin, Zhang-Ya; Yu, Liang-Hong; Dai, Lin-Sun; Kang, De-Zhi

    2016-01-01

    Abstract Rebleeding of an aneurysm is a major cause of morbidity and mortality after subarachnoid hemorrhage (SAH). Whereas numerous studies have demonstrated predictors of rebleeding and effect of systolic blood pressure variability (SBPV) on stroke, few data on the association between SBPV and rebleeding. Here, we sought to identify the effect of SBPV on rebleeding in acute aneurysmal SAH. Case–control study. From January 2010 to June 2015, 612 patients with aneurysmal SAH were enrolled in our tertiary care medical center. Main outcome measures: Consecutive patients with acute (<3 days from ictus) aneurismal rebleeding or repair or death were retrospectively included. Antihypertensive therapy based on a predefined standardized protocol was prescribed to lower and maintain SBP between 120 and 160 mm Hg. SBP was measured hourly until a censoring event occurred. SBPV was determined as standard deviation (SD) and successive variation (SV). Binary logistic regression was used to assess the association between SBPV and rebleeding. Rebleeding occurred in 61 (10.0%) of the 612 patients. We identified 47 acute rebleeding as cases and 382 early repair or early death as controls. On binary logistic regression analysis, rebleeding was associated with the SD of SBP (odds ratio [OR], 1.254; 95% confidence interval [CI], 1.131–1.391; P < 0.001) and the SV of SBP (OR, 1.131; 95% CI, 1.039–1.231; P = 0.004). No significant difference was seen between rebleeding and mean systolic blood pressure (MSBP). SBPV is associated with increased rates of acute aneurysmal rebleeding. Further prospective research is warranted to confirm that SBP stability prevents acute aneurysm rebleeding. PMID:26986118

  3. Blood

    MedlinePlus

    ... that die or are lost from the body. White Blood Cells White blood cells (WBCs, and also ... of severe pain. previous continue Diseases of the White Blood Cells Neutropenia (pronounced: new-truh-PEE-nee- ...

  4. Stereotypies in autism: a video demonstration of their clinical variability

    PubMed Central

    Goldman, Sylvie; Greene, Paul E.

    2012-01-01

    In autism, stereotypies are frequent and disabling, and whether they correspond to a hyperkinetic movement disorder, a homeostatic response aiming at sensory modulation, or a regulator of arousal remains to be established. So far, it has been challenging to distinguish among these different possibilities, not only because of lack of objective and quantitative means to assess stereotypies, but in our opinion also because of the underappreciated diversity of their clinical presentations. Herein, we illustrate the broad spectrum of stereotypies and demonstrate the usefulness of video-assisted clinical observations of children with autism. The clips presented were extracted from play sessions of 129 children with autism disorder. We conclude that compared to widely used questionnaires and interviews, systematic video observations provide a unique means to classify and score precisely the clinical features of stereotypies. We believe this approach will prove useful to both clinicians and researchers as it offers the level of detail from retrievable images necessary to begin to assess effects of age and treatments on stereotypies, and to embark on the type of investigations required to unravel the physiological basis of motor behaviors in autism. PMID:23316144

  5. Influence of blood pressure variability on early carotid atherosclerosis in hypertension with and without diabetes

    PubMed Central

    Wu, Dan; Li, Chunyue; Chen, Yujie; Xiong, Huahua; Tian, Xiaohong; Wu, Wanqing; Huang, Wenhua; Zhang, Yuan-Ting; Zhang, Heye

    2016-01-01

    Abstract Carotid intima-media thickness (IMT) has been one widely used index of early carotid atherosclerosis. We speculated that the influence of blood pressure variability (BPV) on early carotid atherosclerosis may be varied by the location of the carotid artery and diabetes history. Thus, the goal of this study was to evaluate the effects of BPV on early arteriosclerosis progression in different segments of the carotid artery for hypertension with and without diabetes. A total of 148 hypertension patients who underwent 24 hours ambulatory blood pressure (BP) monitoring and carotid ultrasonography were enrolled in this study. Of them, 84 subjects were without diabetes, and 64 subjects were with diabetes. Short-term BPV during daytime, nighttime, and over 24 hours were evaluated through standard deviation (SD) and average real variability (ARV). We measured carotid IMT at left and right common carotid artery (CCA), carotid bulb, and the origin of the internal carotid artery (ICA). The associations between segment-specific measurements of carotid IMT and 24 hours ambulatory BPV were analyzed. We found that IMT at the common carotid artery (CCA-IMT) and IMT at the internal carotid artery (ICA-IMT) were more closely associated with BPV than was carotid bulb IMT. In addition, for all subjects, BPV was clearly associated with left CCA-IMT but not with right CCA-IMT. Furthermore, in diabetes patients, nighttime systolic BPV was independently related to mean CCA-IMT (P < 0.01) and mean bulb IMT (P < 0.01). In contrast, in nondiabetes patients, daytime and 24 hours systolic BPV was positively associated with mean CCA-IMT (P < 0.05), but not independent after adjusting for baseline characteristics such as age and sex. The findings of our study indicate a segment-specific association between carotid IMT and 24 hours ambulatory BPV, and the associations also vary according to the diabetes history. We conclude that BPV plays a distinct role in early

  6. Influence of blood pressure variability on early carotid atherosclerosis in hypertension with and without diabetes.

    PubMed

    Wu, Dan; Li, Chunyue; Chen, Yujie; Xiong, Huahua; Tian, Xiaohong; Wu, Wanqing; Huang, Wenhua; Zhang, Yuan-Ting; Zhang, Heye

    2016-06-01

    Carotid intima-media thickness (IMT) has been one widely used index of early carotid atherosclerosis. We speculated that the influence of blood pressure variability (BPV) on early carotid atherosclerosis may be varied by the location of the carotid artery and diabetes history. Thus, the goal of this study was to evaluate the effects of BPV on early arteriosclerosis progression in different segments of the carotid artery for hypertension with and without diabetes.A total of 148 hypertension patients who underwent 24 hours ambulatory blood pressure (BP) monitoring and carotid ultrasonography were enrolled in this study. Of them, 84 subjects were without diabetes, and 64 subjects were with diabetes. Short-term BPV during daytime, nighttime, and over 24 hours were evaluated through standard deviation (SD) and average real variability (ARV). We measured carotid IMT at left and right common carotid artery (CCA), carotid bulb, and the origin of the internal carotid artery (ICA). The associations between segment-specific measurements of carotid IMT and 24 hours ambulatory BPV were analyzed.We found that IMT at the common carotid artery (CCA-IMT) and IMT at the internal carotid artery (ICA-IMT) were more closely associated with BPV than was carotid bulb IMT. In addition, for all subjects, BPV was clearly associated with left CCA-IMT but not with right CCA-IMT. Furthermore, in diabetes patients, nighttime systolic BPV was independently related to mean CCA-IMT (P < 0.01) and mean bulb IMT (P < 0.01). In contrast, in nondiabetes patients, daytime and 24 hours systolic BPV was positively associated with mean CCA-IMT (P < 0.05), but not independent after adjusting for baseline characteristics such as age and sex.The findings of our study indicate a segment-specific association between carotid IMT and 24 hours ambulatory BPV, and the associations also vary according to the diabetes history. We conclude that BPV plays a distinct role in early carotid

  7. Familial aggregation of blood pressure with respect to anthropometric variables among the Lobana (nomadic origin) population in Punjab, India.

    PubMed

    Badaruddoza; Kaur, Punarjot

    2012-01-01

    Familial aggregation of blood pressure with respect to anthropometric characteristics was investigated among the Lobana (a tribal origin) population in Punjab, a North Indian state. A total of 505 individuals comprised the study sample, constituting 116 families of 3 generations. The study represents a multivariate model analysis, which includes family data with respect to blood pressure phenotypes and other metric measurements such as height, weight, body mass index, waist and hip circumferences, waist-to-hip ratio (WHR), and 4 skinfold measurements. A higher correlation for almost all sets of anthropometric variables with blood pressure was found among the offspring generation as compared with the parental and grandparental generations. The study confirmed that the familial aggregation of blood pressure with respect to anthropometric measurements is strong in the offspring generation. The findings suggest that sharing a household environment has a significant effect on familial aggregation especially for systolic blood pressure.

  8. Enantioselective pharmacokinetic and pharmacodynamic properties of carvedilol in spontaneously hypertensive rats: focus on blood pressure variability.

    PubMed

    Bertera, Facundo Martín; Del Mauro, Julieta Sofía; Chiappetta, Diego; Polizio, Ariel Héctor; Buontempo, Fabián; Taira, Carlos Alberto; Höcht, Christian

    2012-03-01

    The cardiovascular effects and pharmacokinetics of carvedilol were assessed in spontaneously hypertensive (SH) and Wistar Kyoto (WKY) animals with special focus on short-term blood pressure variability (BPV). Male SH and WKY rats were acutely treated with vehicle or carvedilol 1 or 5 mg kg(-1) (i.v.), and effects on blood pressure (BP), heart rate (HR) and BPV were recorded. Plasma pharmacokinetics of R- and S-carvedilol was studied by traditional blood sampling. Relationship between carvedilol concentrations and their hypotensive and bradycardic effects was established by pharmacokinetic-pharmacodynamic (PK-PD) modelling. Short-term BPV was assessed by standard deviation of BP recording. Vascular sympatholytic activity of carvedilol was studied by estimation of drug effects on ratio between low frequency (LF) and high frequency (HF) BPV (LF/HF ratio). Although pharmacokinetic properties of carvedilol remained mainly unaffected in SH rats with regard to WKY rats, hypertensive animals showed a reduction in drug clearance of R- and S-carvedilol after administration of 1 mg kg(-1) compared with WKY rats. PK-PD analysis of HR changes induced by S-carvedilol showed a greater maximal bradycardic response to carvedilol in SH rats (E (max), -27.6 ± 3.9%; p < 0.05) compared with WKY group (E (max), -13.4 ± 2.5%). SH rats showed a greater hypotensive effect of racemic carvedilol (E (max), -45.5 ± 5.0%; p < 0.05) with regard to WKY group (E (max), -17.9 ± 4.5%). Carvedilol induced a greater reduction of LF/HF ratio in SH rats compared with WKY rats. Short-term BPV was markedly reduced by carvedilol in WKY and SH rats. In conclusion, as a consequence of an enhanced bradycardic response and a greater vascular sympatholytic activity, carvedilol exerts a greater hypotensive response in SH rats compared with WKY animals and dramatically reduces short-term BPV.

  9. How novice, skilled and advanced clinical researchers include variables in a case report form for clinical research: a qualitative study.

    PubMed

    Chu, Hongling; Zeng, Lin; Fetters, Micheal D; Li, Nan; Tao, Liyuan; Shi, Yanyan; Zhang, Hua; Wang, Xiaoxiao; Li, Fengwei; Zhao, Yiming

    2017-09-18

    Despite varying degrees in research training, most academic clinicians are expected to conduct clinical research. The objective of this research was to understand how clinical researchers of different skill levels include variables in a case report form for their clinical research. The setting for this research was a major academic institution in Beijing, China. The target population was clinical researchers with three levels of experience, namely, limited clinical research experience, clinicians with rich clinical research experience and clinical research experts. Using a qualitative approach, we conducted 13 individual interviews (face to face) and one group interview (n=4) with clinical researchers from June to September 2016. Based on maximum variation sampling to identify researchers with three levels of research experience: eight clinicians with limited clinical research experience, five clinicians with rich clinical research experience and four clinical research experts. These 17 researchers had diverse hospital-based medical specialties and or specialisation in clinical research. Our analysis yields a typology of three processes developing a case report form that varies according to research experience level. Novice clinician researchers often have an incomplete protocol or none at all, and conduct data collection and publication based on a general framework. Experienced clinician researchers include variables in the case report form based on previous experience with attention to including domains or items at risk for omission and by eliminating unnecessary variables. Expert researchers consider comprehensively in advance data collection and implementation needs and plan accordingly. These results illustrate increasing levels of sophistication in research planning that increase sophistication in selection for variables in the case report form. These findings suggest that novice and intermediate-level researchers could benefit by emulating the comprehensive

  10. Instrumental variable methods to assess quality of care the marginal effects of process-of-care on blood pressure change and treatment costs.

    PubMed

    Kulchaitanaroaj, Puttarin; Carter, Barry L; Goedken, Amber M; Chrischilles, Elizabeth A; Brooks, John M

    2015-01-01

    Hypertension is poorly controlled. Team-based care and changes in the process of care have been proposed to address these quality problems. However, assessing care processes is difficult because they are often confounded even in randomized behavioral studies by unmeasured confounders based on discretion of health care providers. To evaluate the effects of process measures including number of counseling sessions about lifestyle modification and number of antihypertensive medications on blood pressure change and payer-perspective treatment costs. Data were obtained from two prospective, cluster randomized controlled clinical trials (Trial A and B) implementing physician-pharmacist collaborative interventions compared with usual care over six months in community-based medical offices in the Midwest. Multivariate linear regression models with both instrumental variable methods and as-treated methods were utilized. Instruments were indicators for trial and study arms. Models of blood pressure change and costs included both process measures, demographic variables, and clinical variables. The analysis included 496 subjects. As-treated methods showed no significant associations between process and outcomes. The instruments used in the study were insufficient to simultaneously identify distinct process effects. However, the post-hoc instrumental variable models including one process measure at a time while controlling for the other process demonstrated significant associations between the processes and outcomes with estimates considerably larger than as-treated estimates. Instrumental variable methods with combined randomized behavioral studies may be useful to evaluate the effects of different care processes. However, substantial distinct process variation across studies is needed to fully capitalize on this approach. Instrumental variable methods focusing on individual processes provided larger and stronger outcome relationships than those found using as-treated methods

  11. Visit-to-visit systolic blood pressure variability predicts treatment-related adverse event of hyponatremia in SPRINT.

    PubMed

    Goyal, Abhinav; Mezue, Kenechukwu; Rangaswami, Janani

    2017-08-01

    Hypertension is a common condition and an important cardiovascular risk factor. SPRINT trial showed that the beneficial effects of targeting systolic blood pressure <120 mm Hg were accompanied by more adverse events. De-identified SPRINT database was used for this analysis. All subjects in each group that achieved their respective target blood pressure (<120, intensive; <140, standard) were included. Only readings after reaching target blood pressure for the first time were included. Subjects that never reached target or had <2 readings upon reaching target were excluded. Coefficient of Variation (CV) of systolic blood pressure was calculated for each subject to characterize variability. Cox proportional hazards regression was used in the overall cohort as well as the intensive and standard treatment subgroups separately, to identify the effect of CV of systolic blood pressure on occurrence of hyponatremia. P<.05 was considered statistically significant. A total of 8884 subjects met the inclusion criteria; 4323 in intensive and 4561 in standard group. Two hundred and sixty five hyponatremic events occurred in the overall cohort; 168 in intensive, and 127 in standard treatment group. CV of systolic blood pressure consistently and independently predicted a greater hazard of hyponatremia on overall (HR 1.08, P<.001), as well as separate regressions by treatment arms (each HR=1.08 and P<.05). In conclusion, visit-to-visit systolic blood pressure variability is independently associated with a small but significant risk of hyponatremia in the SPRINT trial. © 2017 John Wiley & Sons Ltd.

  12. Impact of cord blood banking technologies on clinical outcome: a Eurocord/Cord Blood Committee (CTIWP), European Society for Blood and Marrow Transplantation and NetCord retrospective analysis.

    PubMed

    Saccardi, Riccardo; Tucunduva, Luciana; Ruggeri, Annalisa; Ionescu, Irina; Koegler, Gesine; Querol, Sergio; Grazzini, Giuliano; Lecchi, Lucilla; Nanni Costa, Alessandro; Navarrete, Cristina; Pouthiers, Fabienne; Larghero, Jerome; Regan, Donna; Freeman, Taryn; Bittencourt, Henrique; Kenzey, Chantal; Labopin, Myriam; Baudoux, Etienne; Rocha, Vanderson; Gluckman, Eliane

    2016-08-01

    Techniques for banking cord blood units (CBUs) as source for hematopoietic stem cell transplantation have been developed over the past 20 years, aimed to improve laboratory efficiency without altering the biologic properties of the graft. A large-scale, registry-based assessment of the impact of the banking variables on the clinical outcome is currently missing. A total of 677 single cord blood transplants (CBTs) carried out for acute leukemia in complete remission in centers affiliated with the European Society for Blood and Marrow Transplantation were selected. An extensive set of data concerning CBU banking were collected and correlations with clinical outcome were assessed. Clinical endpoints were transplant-related mortality, engraftment, and graft-versus-host disease (GVHD). The median time between collection and CBT was 4.1 years (range, 0.2-16.3 years). Volume reduction (VR) of CBUs before freezing was performed in 59.2% of available reports; in half of these the frozen volume was less than 30 mL. Cumulative incidences of neutrophil engraftment on Day 60, 100-day acute GVHD (II-IV), and 4-year chronic GVHD were 87, 29, and 21 ± 2%. The cumulative incidence of nonrelapse mortality (NRM) at 100 days and 4-year NRM were, respectively, 16 ± 2 and 30 ± 2%. Neither the variables related to banking procedures nor the interval between collection and CBT influenced the clinical outcome. These findings indicate a satisfactory validation of the techniques associated with CBU VR across the banks. Cell viability assessment varied among the banks, suggesting that efforts to improve the standardization of CBU quality controls are needed. © 2016 The Authors Transfusion published by Wiley Periodicals, Inc. on behalf of AABB.

  13. A simple and feasible method to determine absolute blood volume in hemodialysis patients in clinical practice.

    PubMed

    Kron, Joachim; Schneditz, Daniel; Leimbach, Til; Aign, Sabine; Kron, Susanne

    2014-01-01

    We developed a simple method to determine the absolute blood volume (V) during hemodialysis in everyday clinical practice and examined its relationship with volume overload, clinical relevance, and accuracy. The increase in relative blood volume (RBVpost - RBVpre) measured before and after infusion of 240 ml of ultra-pure dialysate using the bolus function of a commercial online hemodiafiltration machine incorporating a relative blood volume monitor was applied to determine absolute blood volume. The specific blood volume (Vs, blood volume per kg body mass at dry weight, in ml/kg) was compared to volume status as assessed by bioimpedance analysis and clinical criteria. The blood volume measured in 30 stable hemodialysis patients was 6.51 ± 1.70 l at the beginning, corresponding to a specific blood volume of 80.1 ± 12.8 ml/kg, and dropped to 5.84 ± 1.61 l or 72.0 ± 12.1 ml/kg at the end of the dialysis session, respectively. Specific blood volume correlated with volume status assessed both clinically and by bioimpedance analysis. Intradialytic morbid events occurred only in treatments where specific blood volume fell below 65 ml/kg. The reproducibility of the technique was better than 4% and the in vitro accuracy corresponds to a resolution in Vs of better than 1 ml/kg. Absolute blood volume can be easily measured at the beginning of the dialysis session using the current dialysis technology. Information about V and Vs could be a promising tool to avoid intradialytic morbid events. This technique could be completely automated without altering the hardware of currently available online dialysis devices. Therefore, it is recommended that this technique be integrated into all hemodiafiltration machines. © 2014 S. Karger AG, Basel.

  14. SOME CLINICALLY IMPORTANT ERYTHROCYTE BLOOD GROUP ANTIGENS IN DONORS.

    PubMed

    Tsintsadze, I; Gorgoshadze, T; Donskov, S; Akhvlediani, L; Nagervadze, M

    2016-09-01

    The distribution of erythrocyte blood group antigens was evaluated among 656 donors; samples were provided by the diagnostic laboratory "Medina" Ltd Health Centre of Batumi. Lab analysis of the sample was conducted by the immunogenetics laboratory at Batumi Shota Rustaveli State University. The frequency of the ABO allele system in donors was as follows: r (0.70), q (0.23), p (0.07). The distribution of Rhesus (Rh) factor in the donor population was as follows: Rh(-) was found among 16.3±1.43% of investigated donors; the Rh(+) phenotype was found in 83.7±1.43% of donors. Additionally, the CcDee phenotype frequency was 29.9±1.78%; CCD-ee was 17.2±1.47%; ccddee was 14.9±1.38%; and CcD-Ee was 13.9±1.34%; ccD-Ee phenotype was 11.1±1.22%; ccD-ee was 5.5±0.88%; same phenotype indicators -2.1±0.55 were observed for CcD-EE and ccD-EE; CCD-Ee was 1.4±0.45%, CCD-EE was 0.4±0.26%; and finally, the frequency of Ccddee phenotype amounts was 1.1±0.40%, ccddEe and CCddee phenotypes were both 0.2±0.17%. The analysis of the Kell system allele revealed a low frequency for the p allele at 0.05, whereas the frequency of the q allele was 0.95. This large epidemiologic analysis of donor blood provides valuable information for hematological and transfusion centers to inform the preparation of blood components for transfusion.

  15. Impulsive Behavior and Associated Clinical Variables in Parkinson's Disease

    PubMed Central

    Abosch, Aviva; Gupte, Akshay; Eberly, Lynn E.; Tuite, Paul J.; Nance, Martha; Grant, Jon E.

    2011-01-01

    Parkinson's disease (PD) is a degenerative brain disorder accompanied by the loss of dopaminergic neurons and the presence of motor and non-motor symptoms. We performed a cross-sectional, questionnaire-based analysis of impulsive behavior in our PD clinic population to assess prevalence and associated characteristics. We found a higher prevalence of impulsive behavior (29.7%) than previously reported, and found multiple, concurrent impulsive behaviors in 26% of subjects reporting impulsive behavior. Our findings contribute to the growing awareness of impulsive behavior in PD, and support the need for longitudinal studies to assess changes in impulsive behaviors in Parkinson's patients. PMID:21300194

  16. Clinical application and evaluation of Sysmex XE-5000 analyser for detecting nucleated red blood cells in peripheral blood.

    PubMed

    Zheng, Shan-Luan; Zheng, Tian; Cheng, Xiang; Hao, Xiao-Ke

    2014-01-01

    To evaluate the performance of Sysmex XE-5000 analyser for detecting nucleated red blood cells (NRBCs) in peripheral blood and investigate the clinical application of this analyser. The absolute NRBC counts (NRBC#) and percentage (NRBC%) of 137 blood specimens (NRBC-positive according to the DIFF channel of the analyser) were determined in the NRBC channel of the analyser. The intra-assay imprecision, carryover rate, and linear range of the analyser were evaluated. The NRBC% of the blood sample was detected with a microscope, and the difference between two methods was analysed. The intra-assay imprecision of the analyser for detecting NRBC# in specimens with high, moderate, and low Q-flag values were 2.10%, 3.26%, and 11.62%, respectively, and the imprecision for detecting NRBC% were 3.79%, 5.80%, and 13.33%, respectively. The carryover rates of the analyser for detecting NRBC# and NRBC% were 0.51% and 0.26%, respectively. Sysmex XE-5000 analyser had good linearity in NRBC# (i.e., 0/L to 18 x 10(9)/L). The NRBC%s of the two methods did not significantly differ (p = 0.716). The analyser can completely replace the traditional microscope for clinically classifying and counting NRBCs.

  17. Definition of variables required for comprehensive description of drug dosage and clinical pharmacokinetics.

    PubMed

    Medem, Anna V; Seidling, Hanna M; Eichler, Hans-Georg; Kaltschmidt, Jens; Metzner, Michael; Hubert, Carina M; Czock, David; Haefeli, Walter E

    2017-05-01

    Electronic clinical decision support systems (CDSS) require drug information that can be processed by computers. The goal of this project was to determine and evaluate a compilation of variables that comprehensively capture the information contained in the summary of product characteristic (SmPC) and unequivocally describe the drug, its dosage options, and clinical pharmacokinetics. An expert panel defined and structured a set of variables and drafted a guideline to extract and enter information on dosage and clinical pharmacokinetics from textual SmPCs as published by the European Medicines Agency (EMA). The set of variables was iteratively revised and evaluated by data extraction and variable allocation of roughly 7% of all centrally approved drugs. The information contained in the SmPC was allocated to three information clusters consisting of 260 variables. The cluster "drug characterization" specifies the nature of the drug. The cluster "dosage" provides information on approved drug dosages and defines corresponding specific conditions. The cluster "clinical pharmacokinetics" includes pharmacokinetic parameters of relevance for dosing in clinical practice. A first evaluation demonstrated that, despite the complexity of the current free text SmPCs, dosage and pharmacokinetic information can be reliably extracted from the SmPCs and comprehensively described by a limited set of variables. By proposing a compilation of variables well describing drug dosage and clinical pharmacokinetics, the project represents a step forward towards the development of a comprehensive database system serving as information source for sophisticated CDSS.

  18. NET Blood Transcript Analysis Defines the Crossing of the Clinical Rubicon: When Stable Disease Becomes Progressive.

    PubMed

    Pavel, Marianne; Jann, Henning; Prasad, Vikas; Drozdov, Ignat; Modlin, Irvin M; Kidd, Mark

    2017-01-01

    A key issue in gastroenteropancreatic neuroendocrine tumors (GEP-NETs) is early identification and prediction of disease progression. Clinical evaluation and imaging are limited due to the lack of sensitivity and disease indolence. We assessed the NETest as a predictive and prognostic marker of progression in a long-term follow-up study. GEP-NETs (n = 34) followed for a median 4 years (2.2-5.4) were evaluated. WHO tumor grade/stage grade 1: n = 17, grade 2: n = 14, grade 3: n = 1 (for 2, no grade was available); 31 (91%) were stage IV. Baseline and longitudinal imaging and blood biomarkers were available in all, and progression was defined per standard clinical protocols (RECIST 1.0). The NETest was measured by quantitative PCR of blood and multianalyte algorithmic analysis (disease activity scaled 0-100% with low <40% and high activity risk cutoffs >80%); chromogranin A (CgA) was measured by radioimmunoassay (normal <150 µg/l); progression-free survival (PFS) was analyzed by Cox proportional-hazard regression and Kaplan-Meier analysis. At baseline, 100% were NETest positive, and CgA was elevated in 50%. The only baseline variable (Cox modeling) associated with PFS was NETest (hazard ratio = 1.022, 95% confidence interval = 1.005-1.04; p < 0.012). Using Kaplan-Meier analyses, the baseline NETest (>80%) was significantly associated (p = 0.01) with disease progression (median PFS 0.68 vs. 2.78 years with <40% levels). The NETest was more informative (96%) than CgA changes (25%) in consistently predicting disease alterations (40%, p < 2 × 10-5, χ2 = 18). The NETest had an earlier time point change than imaging (1.02 ± 0.15 years). Baseline NETest levels >40% in stable disease were 100% prognostic of disease progression versus CgA (χ2 = 5, p < 0.03). Baseline NETest values <40% accurately (100%) predicted stability over 5 years (p = 0.05, χ2 = 3.8 vs. CgA). The NETest correlated with a well-differentiated GEP-NET clinical status. The NETest has

  19. The blood pressure variability, arterial elasticity and humoral factors in subjects with family history of hypertension.

    PubMed

    Rafidah, H M; Azizi, A; Suhaimi, H; Noriah, M N

    2008-03-01

    Normotensive subjects with family history of hypertension (FHT) have been reported to have increased left ventricular mass index and reduced ventricular compliance. Of interest is whether blood pressure variability (BPV), which has been associated with target organ damage, is then part of this complex inherited syndrome? The objectives of this study are to determine whether there are any significant differences in BPV, arterial compliance and humoral factors in subjects with FHT as compared to controls. Thirty-five subjects with self reported FHT and 35 matched controls underwent 24 hour BP monitoring (BR-102, Schiller Inc. Germany). Arterial compliance was measured using systolic pulse wave tonometry (HDI/Pulsewave Cardiovascular Profiling Instrument, Hypertension Diagnostic Inc. USA). None of the subjects were hypertensive or diabetic. Out of these numbers, 25 subjects with FHT and 26 controls had measurements of plasma catecholamines, plasma renin and serum aldosterone. Catecholamines were assayed with high performance liquid chromatography, while both renin and aldosterone measurements were by radioimmunoassay. Subjects with FHT have higher night time BPV. There was no significant difference in arterial compliances between both groups. There were increased level of norepinephrine (NE) in subjects with FHT but epinephrine (E), renin and aldosterone levels were similar in both groups. There were no correlations between NE and BPV but E was negatively associated with daytime and mean arterial systolic BPV. In conclusion subjects with FHT demonstrated a higher night time BPV and NE level as compared to controls.

  20. Analysis of heart rate variability and skin blood flow oscillations under deep controlled breathing.

    PubMed

    Krasnikov, Gennady V; Tyurina, Miglena Y; Tankanag, Arina V; Piskunova, Galina M; Chemeris, Nikolai K

    2013-02-01

    The effect of deep breathing controlled in both rate (0.25, 0.16, 0.1, 0.07, 0.05 and 0.03 Hz) and amplitude on the heart rate variability (HRV) and respiration-dependent oscillations of forearm/finger skin blood flow (SBF) has been studied in 29 young healthy volunteers. The influence of sympathovagal balance on the respiratory sinus arrhythmia (RSA) amplitude and respiratory SBF oscillations has been studied. The subjects with predominant parasympathetic tonus had statistically significant higher RSA amplitudes in the breathing rate region of 0.03-0.07 Hz than the subjects with predominant sympathetic tonus. In the finger-cushion zone, having a well-developed sympathetic vascular innervations, the amplitudes of respiratory SBF oscillations at breathing rates 0.05 and 0.07 Hz were higher in the group of subjects with predominant parasympathetic tonus. In the forearm skin, where the density of sympathetic innervations is low comparatively to that in the finger skin, no statistically significant differences in the amplitude of respiratory SBF oscillations were found concerning the two groups of subjects.

  1. Frequency components of systolic blood pressure variability reflect vasomotor and cardiac sympathetic functions in conscious rats.

    PubMed

    Yoshimoto, Takahiko; Eguchi, Kunihiro; Sakurai, Hiroki; Ohmichi, Yusuke; Hashimoto, Tatsuyuki; Ohmichi, Mika; Morimoto, Atsuko; Yamaguchi, Yoshiko; Ushida, Takahiro; Iwase, Satoshi; Sugenoya, Junichi; Kumazawa, Takao

    2011-09-01

    In this study, after confirming the suppression of autonomic nervous function by isoflurane anesthesia using autonomic antagonists, we pharmacologically investigated the involvement of vasomotor and cardiac sympathetic functions in systolic blood pressure variability (SBPV) frequency components in conscious rats at rest and during exposure to low-ambient temperature (LT-exposure, 9°C for 90 min). Under unanesthesia, phentolamine administration (α-adrenoceptor antagonist, 10 mg/kg) decreased the mid-frequency component (MF 0.33-0.73 Hz) and inversely increased the high-frequency component (HF 1.3-2.5 Hz). The increased HF was suppressed by subsequent treatment with atenolol (β-adrenoceptor antagonist, 10 mg/kg), but not with atropine (muscarinic receptor antagonist, 10 mg/kg). Moreover, phentolamine administration after atenolol decreased MF, but did not increase HF. LT-exposure increased MF and HF; however, phentolamine pretreatment suppressed the increased MF during LT-exposure, and atenolol pretreatment dose-dependently decreased the increased HF. These results suggest that MF and HF of SBPV may reflect α-adrenoceptor-mediated vasomotor function and β-adrenoceptor-mediated cardiac sympathetic function, respectively, in the conscious state.

  2. Some blood minerals and hormones in cows fed variable mineral levels and ionic balance.

    PubMed

    Romo, G A; Kellems, R O; Powell, K; Wallentine, M V

    1991-09-01

    Eighty multiparous Holstein cows were assigned to eight treatments in a 2 x 2 x 2 factorial design to examine changes in serum parathyroid hormone, calcitonin, Ca, P, Mg, K, and Cl under two levels of dietary Ca and P with two anion-cation balances. Factor levels were low and high Ca (51 vs. 115 g/d), P (38 vs. 52 g/d), and cationic:anionic balance (23 vs. -8 meq). Cows were offered a TMR and an experimental mineral supplement to adjust mineral and anion-cation levels. Caudal vein blood samples were collected every 2 d from d -10 to +10 from calving. Serum K was lower for low Ca and high P compared with high Ca and low P treatments. Neither hormones nor the minerals examined in serum showed treatment effects. Cows of higher parity consumed less supplement and had lower serum Ca and P. All serum variables except calcitonin showed day to day variations. Both Ca and P decreased around parturition, whereas parathyroid hormone and Mg increased. Anionic diets did not differ from cationic diets regarding serum parathyroid hormone, calcitonin, Ca, P, Mg, K, Cl, or Na.

  3. Daily environmental differences in blood pressure and heart rate variability in healthy premenopausal women.

    PubMed

    James, Gary D; Bovbjerg, Dana H; Hill, Leah A

    2015-01-01

    As daily environments change, behavior and activity also change and as blood pressure (BP) and heart rate (HR) are allostatically tied to these factors, one might expect that environments that elicit the greatest behavioral/activity variation should also evince the highest BP and HR variability [standard deviation (SD) or coefficient of variation (CV)]. The purpose of this study was to evaluate this premise. Two hundred and six women (age = 37.6 ± 9.1 years) wore an ambulatory BP monitor on a midweek workday. All worked in clerical, technical, or professional positions. Ambulatory BP and HR Means, SDs and CVs at work (11 AM-3 PM), home (∼6-10 PM) and during sleep (∼10 PM-6 AM) were compared using repeated measures ANCOVA. Mean BP and HR decreased from work and home to sleep [121 ± 11, 120 ± 11 vs. 107 ± 12 systolic; 82 ± 10, 80 ± 11 vs. 66 ± 11 diastolic; 79 ± 12, 80 ± 12 vs. 68 ± 11 HR (all P < 0.001)], while the CV of systolic and diastolic BP increased [0.06 ± 0.02, 0.07 ± 0.02 vs. 0.08 ± 0.03 systolic; 0.09 ± 0.03, 0.10 ± 0.04 vs. 0.12 ± 0.05 diastolic (P < 0.001)]. The HR SD decreased during sleep [8.1 ± 3.8, 8.2 ± 3.8 vs. 6.9 ± 3.2 (P < 0.001)]. HR variability follows the expected variability pattern with behavior and activity, whereas BP does not. © 2014 Wiley Periodicals, Inc.

  4. Variability in Clinical Integration Achieved by Athletic Training Students across Different Clinical Sport Assignments

    ERIC Educational Resources Information Center

    Dodge, Thomas M.; Mazerolle, Stephanie M.; Bowman, Thomas G.

    2015-01-01

    Context: Clinical integration impacts athletic training students' (ATSs) motivation and persistence. Research has yet to elucidate the manner in which different clinical placements can influence clinical integration. Objective: To examine differences in the levels of clinical integration achieved by ATSs across various clinical sport assignments.…

  5. Variability in Clinical Integration Achieved by Athletic Training Students across Different Clinical Sport Assignments

    ERIC Educational Resources Information Center

    Dodge, Thomas M.; Mazerolle, Stephanie M.; Bowman, Thomas G.

    2015-01-01

    Context: Clinical integration impacts athletic training students' (ATSs) motivation and persistence. Research has yet to elucidate the manner in which different clinical placements can influence clinical integration. Objective: To examine differences in the levels of clinical integration achieved by ATSs across various clinical sport assignments.…

  6. Clinical Response and Transfusion Reactions of Sheep Subjected to Single Homologous Blood Transfusion

    PubMed Central

    Sousa, Rejane Santos; Minervino, Antonio Humberto Hamad; Araújo, Carolina Akiko Sato Cabral; Rodrigues, Frederico Augusto Mazzocca Lopes; Oliveira, Francisco Leonardo Costa; Zaminhan, Janaina Larissa Rodrigues; Moreira, Thiago Rocha; Sousa, Isadora Karolina Freitas; Ortolani, Enrico Lippi; Barrêto Júnior, Raimundo Alves

    2014-01-01

    Studies in relation to blood conservation and responses to transfusion are scarce for ruminants. We evaluated the clinical manifestations of sheep that received a single homologous transfusion of whole blood, focusing on transfusion reactions. Eighteen adult sheep were subjected to a single phlebotomy to withdraw 40% of the total blood volume, which was placed into CPDA-1 bags and then divided into G0, animals that received fresh blood, and G15 and G35, animals that received blood stored for 15 or 35 days, respectively. Clinical observations were recorded throughout the transfusion, whereas heart rate, respiratory rate, and rectal temperature were assessed at the following times: 24 hours after phlebotomy and before transfusion; 30 minutes, six, twelve, 24, 48, 72, and 96 hours and eight and 16 days after transfusion. All groups presented transfusion reactions, among which hyperthermia was the most frequent (50% of animals). Tachycardia occurred most frequently in the G35 animals (50% of them). During transfusion G35 animals presented more clinical manifestation (P < 0.05). Transfusion of fresh or stored total blood improved the blood volume, but transfusion reactions occurred, demonstrating that a single transfusion of fresh or stored blood can cause inflammatory and febrile nonhemolytic transfusion reactions in sheep. PMID:25544959

  7. Sleep quality in Parkinson disease: an examination of clinical variables.

    PubMed

    Stavitsky, Karina; Cronin-Golomb, Alice

    2011-06-01

    The etiology of sleep problems in Parkinson disease (PD) is not well understood, as they may arise from the pathology of the disease or from other disease-related factors such as motor dysfunction, dopaminergic medication, and mood disturbances. The aim of this study was to investigate factors associated with sleep, including disease-related variables such as motor symptom severity, dose of medication, and mood and disease subtypes. Thirty-five nondemented patients with PD were included. Sleep was measured using 24-hour wrist actigraphy over a 7-day period, during which time participants kept a sleep diary. Subjective sleep and arousal questionnaires included the PD Sleep Scale and Epworth Sleepiness Scale. Motor symptom severity and dopaminergic medication were significantly related to measures of sleep quality. Sex differences in sleep quality were found, with men having worse sleep quality and more excessive daytime sleepiness than women. We also found that actigraphy may serve as a useful tool for identifying individuals with possible rapid eye movement behavior disorder, a sleep disorder that has important implications in early detection of PD.

  8. Sporadic phaeochromocytoma in childhood: clinical and molecular variability.

    PubMed

    Pozo, Jesús; Muñoz, Maria Teresa; Martos, Gabriel; Argente, Jesús

    2005-06-01

    Sporadic phaeochromocytoma is an infrequent tumour during paediatric age and may or may not be associated with specific autosomal dominant inherited cancer syndromes such as multiple endocrine neoplasia type 2 (MEN2), von Hippel-Lindau syndrome (VHL) type 2 or neurofibromatosis (NF) type 1. We report two cases of benign, adrenal, and unilateral phaeochromocytoma that clearly demonstrate the clinical and molecular heterogeneity of this disease during the paediatric period. The first patient presented a characteristic symptomatic form of sporadic phaeochromocytoma. The second patient, an incidental finding, was practically asymptomatic and had a de novo germline point mutation in the VHL gene (Arg167Trp). The frequency of de novo mutations in susceptible genes (especially the VHL gene) in paediatric patients with sporadic phaeochromocytoma and the elevated mortality of these cancer syndromes suggest that screening for mutations should be performed even in cases of non-familial sporadic phaeochromocytoma.

  9. Clinical and Immunological Spectrum of Common Variable Immunodeficiency (CVID).

    PubMed

    Webster, Anthony David B

    2004-09-01

    We have analysed data from 150 patients initially classified as having CVID. About 10% had laboratory abnormalities suggesting known single gene disorders (eg: hyper-IgM syndrome), and in a few a genetic defect has been confirmed. We have attempted to sub-classify the remaining patients by analysis of their circulating lymphocytes. B lymphocyte markers have been used to estimate the numbers of circulating immature and class switched B cells; there is an association between the presence of high relative numbers of immature circulating B cells, splenomegaly and autoimmune disease. About 25% of CVID patients have a moderate CD4+ T lymphopenia, sometimes with a relative expansion of CD8+ T cells. About 30% of CVID patients have persistent relatively high levels of circulating CD8+ T cells binding immunogenic peptides from EBV or CMV. Many of these patients also have high relative numbers of circulating CD8+ perforin positive T cells, and there is evidence that these cells may be responsible for neutropenia or inflammatory bowel disease in some patients. The clinical spectrum of CVID is diverse, with some patients suffering from few infections, and over 50% have evidence of structural lung damage. About 25% of UK patients have chronic inflammation in various organs, particularly the lungs, liver and spleen, often with granulomatous changes. Steroids are used to treat many of the patients with chronic inflammatory complications, although trials are in progress with anti-TNF agents. The incidence of these inflammatory complications is different between countries, being rare in Sweden. Attempts to correlate clinical phenotypes with the laboratory abnormalities described above have been disappointing, suggesting that unknown genetic factors unrelated to the cause of the immunodeficiency determine the complications; attempts to identify some of these factors will be discussed. Finally a provisional scheme to sub classify CVID patients according to lymphocyte abnormalities

  10. Effects of genetic strain and light intensity on blood physiological variables of broilers grown to heavy weights

    USDA-ARS?s Scientific Manuscript database

    The effects of genetic strain, light intensity and their interaction were examined on blood physiological variables of broilers maintained in environmentally-controlled rooms in each of 5 trials. The study consisted of a 2 × 5 factorial arranged in a randomized complete block design with 10 treatmen...

  11. Effects of color temperatures (kelvin) of led bulbs on blood physiological variables of broilers grown to heavy weights

    USDA-ARS?s Scientific Manuscript database

    Light-emitting diode (LED) lighting is being used in the poultry industry to reduce energy usage in broiler production facilities. However, limited data are available comparing efficacy of different spectral distribution of LED bulbs on blood physiological variables of broilers grown to heavy weight...

  12. Acute Effects of Caffeine on Heart Rate Variability, Blood Pressure and Tidal Volume in Paraplegic and Tetraplegic Compared to Able-Bodied Individuals: A Randomized, Blinded Trial

    PubMed Central

    Flueck, Joelle Leonie; Schaufelberger, Fabienne; Lienert, Martina; Schäfer Olstad, Daniela; Wilhelm, Matthias; Perret, Claudio

    2016-01-01

    Caffeine increases sympathetic nerve activity in healthy individuals. Such modulation of nervous system activity can be tracked by assessing the heart rate variability. This study aimed to investigate the influence of caffeine on time- and frequency-domain heart rate variability parameters, blood pressure and tidal volume in paraplegic and tetraplegic compared to able-bodied participants. Heart rate variability was measured in supine and sitting position pre and post ingestion of either placebo or 6 mg caffeine in 12 able-bodied, 9 paraplegic and 7 tetraplegic participants in a placebo-controlled, randomized and double-blind study design. Metronomic breathing was applied (0.25 Hz) and tidal volume was recorded during heart rate variability assessment. Blood pressure, plasma caffeine and epinephrine concentrations were analyzed pre and post ingestion. Most parameters of heart rate variability did not significantly change post caffeine ingestion compared to placebo. Tidal volume significantly increased post caffeine ingestion in able-bodied (p = 0.021) and paraplegic (p = 0.036) but not in tetraplegic participants (p = 0.34). Systolic and diastolic blood pressure increased significantly post caffeine in able-bodied (systolic: p = 0.003; diastolic: p = 0.021) and tetraplegic (systolic: p = 0.043; diastolic: p = 0.042) but not in paraplegic participants (systolic: p = 0.09; diastolic: p = 0.33). Plasma caffeine concentrations were significantly increased post caffeine ingestion in all three groups of participants (p<0.05). Plasma epinephrine concentrations increased significantly in able-bodied (p = 0.002) and paraplegic (p = 0.032) but not in tetraplegic participants (p = 0.63). The influence of caffeine on the autonomic nervous system seems to depend on the level of lesion and the extent of the impairment. Therefore, tetraplegic participants may be less influenced by caffeine ingestion. Trial Registration ClinicalTrials.gov NCT02083328 PMID:27776149

  13. [Clinical diagnosis of thrombosis and blood coagulation tests].

    PubMed

    Watanabe, K

    1998-03-01

    Blood coagulation tests are useful to diagnose some thrombotic diseases. Particularly, these tests are valuable for the diagnosis of familiar thrombophilia, antiphospholipid antibody syndrome (APS) and disseminated intravascular coagulation (DIC). For the diagnosis of thrombophilia, determinations of both biological activity and antigen level of antithrombin III, protein C and protein S are important for initial screening. Since activated protein C (APC) resistance is extremely rare in Japanese, APC resistant test that based on APTT, is unnecessary to include as one of the screening tests. Detection of activity and antigen level of either plasminogen or fibrinogen is recommended to screen the plasminogen deficiency or dysfibrinogenemia. Determination of lupus anticoagulant is needed for the diagnosis of APS. At this time, the dilute phospholipid APTT (dAPTT) or the dilute Russell viper venom time (dRVVT) may be useful as a screening test for LA because procedure of these tests are basically simple to perform in Japanese laboratory. In the next step, cross mixing test of dAPTT (or APTT) should be perform to make a diagnose of LA more solid. Final confirm tests can be conveniently carried out with kit of either STACLOT or LA-CONFIRM. Platelet count and FDP (or FDP D dimer) assay are two essential tests for the diagnosis of DIC. Criteria of diagnosis for DIC recommended by Blood Coagulation Research Group of Japanese Ministry of Health and Welfare is not unnecessarily appropriate for practical use. TAT and PIC can be a good laboratory tests for early detection of hypercoagulable state in patients with DIC.

  14. Dried Blood Spot Sampling for Tacrolimus and Mycophenolic Acid in Children: Analytical and Clinical Validation.

    PubMed

    Martial, Lisa C; Hoogtanders, Karin E J; Schreuder, Michiel F; Cornelissen, Elisabeth A; van der Heijden, Jac; Joore, Manuela A; Van Maarseveen, Erik M; Burger, David M; Croes, Sander; Brüggemann, Roger J M; Aarnoutse, Rob E

    2017-08-01

    Tacrolimus and mycophenolic acid (MPA) are the backbone of immunosuppressive therapy after pediatric kidney transplantation. Dosing of these drugs is individualized by therapeutic drug monitoring. Dried blood spot (DBS) sampling may prove beneficial over conventional venous sampling. We aimed to develop and clinically validate a DBS method for tacrolimus and MPA in children. A joint DBS liquid chromatography-mass spectrometry assay for tacrolimus and MPA was developed. DBS-specific items included the hematocrit effect and influence of spot volume. Subsequently, a clinical validation study among children aged 2-18 years was performed to assess the agreement between observed and DBS-predicted venous concentrations. Agreement of the methods was assessed with Passing-Bablok regression, Bland-Altman plots, and quantification of the DBS predictive performance in terms of bias (median percentage prediction error) and precision (median absolute percentage prediction error), both should be <15%. A total of 40 tacrolimus and 32 MPA samples were available from 28 children. Conversion factors were used to predict venous concentrations from DBS. For tacrolimus, 95% of the individual ratios of predicted and observed concentrations were within a range of 0.74-1.28, with 85% of these ratios between 0.80 and 1.20 (Bland-Altman plots). For MPA, the 95% limits of agreement represented a broader range of 0.49-1.49%, and 72% of individual ratios were between the 0.80 and 1.20 limits. Median percentage prediction error and median absolute percentage prediction error were less than 15% for both drugs. A DBS assay was developed for tacrolimus and MPA. Tacrolimus venous concentrations could be adequately predicted from DBS. DBS analysis of MPA seemed to be a semiquantitative measurement at the most when compared with conventional plasma analysis, considering the high variability between observed and predicted concentrations. Next, home-based DBS sampling of tacrolimus for the purpose of

  15. Blood Pressure Variability and Cardiovascular Risk in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER)

    PubMed Central

    Poortvliet, Rosalinde K. E.; Ford, Ian; Lloyd, Suzanne M.; Sattar, Naveed; Mooijaart, Simon P.; de Craen, Anton J. M.; Westendorp, Rudi G. J.; Jukema, J. Wouter; Packard, Christopher J.; Gussekloo, Jacobijn; de Ruijter, Wouter; Stott, David J.

    2012-01-01

    Variability in blood pressure predicts cardiovascular disease in young- and middle-aged subjects, but relevant data for older individuals are sparse. We analysed data from the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER) study of 5804 participants aged 70–82 years with a history of, or risk factors for cardiovascular disease. Visit-to-visit variability in blood pressure (standard deviation) was determined using a minimum of five measurements over 1 year; an inception cohort of 4819 subjects had subsequent in-trial 3 years follow-up; longer-term follow-up (mean 7.1 years) was available for 1808 subjects. Higher systolic blood pressure variability independently predicted long-term follow-up vascular and total mortality (hazard ratio per 5 mmHg increase in standard deviation of systolic blood pressure = 1.2, 95% confidence interval 1.1–1.4; hazard ratio 1.1, 95% confidence interval 1.1–1.2, respectively). Variability in diastolic blood pressure associated with increased risk for coronary events (hazard ratio 1.5, 95% confidence interval 1.2–1.8 for each 5 mmHg increase), heart failure hospitalisation (hazard ratio 1.4, 95% confidence interval 1.1–1.8) and vascular (hazard ratio 1.4, 95% confidence interval 1.1–1.7) and total mortality (hazard ratio 1.3, 95% confidence interval 1.1–1.5), all in long-term follow-up. Pulse pressure variability was associated with increased stroke risk (hazard ratio 1.2, 95% confidence interval 1.0–1.4 for each 5 mmHg increase), vascular mortality (hazard ratio 1.2, 95% confidence interval 1.0–1.3) and total mortality (hazard ratio 1.1, 95% confidence interval 1.0–1.2), all in long-term follow-up. All associations were independent of respective mean blood pressure levels, age, gender, in-trial treatment group (pravastatin or placebo) and prior vascular disease and cardiovascular disease risk factors. Our observations suggest variability in diastolic blood pressure is more strongly associated

  16. Relationship between cardiovascular health score and year-to-year blood pressure variability in China: a prospective cohort study

    PubMed Central

    An, Shasha; Bao, Minghui; Wang, Yang; Li, Zhifang; Zhang, Wenyan; Chen, Shuohua; Li, Junjuan; Yang, Xinchun; Wu, Shouling; Cai, Jun

    2015-01-01

    Objectives On the basis of cardiovascular health factors and behaviours, the American Heart Association proposed the Cardiovascular Health Score (CHS). It has been widely used to estimate the cardiovascular health status of individuals. The aim of this study was to investigate the relationship between CHS and year-to-year blood pressure variability (BPV). Design Prospective cohort study. Settings We stratified participants into two groups by gender: first group, female group; second group, male group. The relationship between CHS and year-to-year blood pressure variability were analysed. Participants A total of 41 613 individuals met the inclusion criteria (no history of stroke, transient ischaemic attack, myocardial infarction, malignant tumour or atrial fibrillation) and had complete blood pressure data. Results The coefficient of the variation of systolic blood pressure (SCV) was 8.33% in the total population and 8.68% and 8.22% in female and male groups, respectively (p<0.05). Multivariable linear regression analysis revealed that higher CHS was inversely associated with increasing year-to-year BPV, which persisted after adjusting for baseline systolic blood pressure and other risk factors. Each SD increase in CHS could lead to a 0.016SD decrease in SCV (p<0.05). Conclusions In summary, CHS was inversely related to year-to-year BPV, which suggested that a healthy lifestyle may contribute to better blood pressure management. PMID:26503389

  17. Whole Body Magnetic Resonance Imaging Features in Diffuse Idiopathic Skeletal Hyperostosis in Conjunction with Clinical Variables to Whole Body MRI and Clinical Variables in Ankylosing Spondylitis.

    PubMed

    Weiss, Bettina G; Bachmann, Lucas M; Pfirrmann, Christian W A; Kissling, Rudolf O; Zubler, Veronika

    2016-02-01

    Discrimination of diffuse idiopathic skeletal hyperostosis (DISH) and ankylosing spondylitis (AS) can be challenging. Usefulness of whole-body magnetic resonance imaging (WB-MRI) in diagnosing spondyloarthritis has been recently proved. We assessed the value of clinical variables alone and in combination with WB-MRI to distinguish between DISH and AS. Diagnostic case-control study: 33 patients with AS and 15 patients with DISH were included. All patients underwent 1.5 Tesla WB-MRI scanning. MR scans were read by a blinded radiologist using the Canadian-Danish Working Group's recommendation. Imaging and clinical variables were identified using the bootstrap. The most important variables from MR and clinical history were assessed in a multivariate fashion resulting in 3 diagnostic models (MRI, clinical, and combined). The discriminative capacity was quantified using the area under the receiver-operating characteristic (ROC) curve. The strength of diagnostic variables was quantified with OR. Forty-eight patients provided 1545 positive findings (193 DISH/1352 AS). The final MR model contained upper anterior corner fat infiltration (32 DISH/181 AS), ankylosis on the vertebral endplate (4 DISH/60 AS), facet joint ankylosis (4 DISH/49 AS), sacroiliac joint edema (11 DISH/91 AS), sacroiliac joint fat infiltration (2 DISH/114 AS), sacroiliac joint ankylosis (2 DISH/119 AS); area under the ROC curve was 0.71, 95% CI 0.64-0.78. The final clinical model contained patient's age and body mass index (area under the ROC curve 0.90, 95% CI 0.89-0.91). The full diagnostic model containing clinical and MR information had an area under the ROC curve of 0.93 (95% CI 0.92-0.95). WB-MRI features can contribute to the correct diagnosis after a thorough conventional workup of patients with DISH and AS.

  18. Variability in pathogenicity prediction programs: impact on clinical diagnostics

    PubMed Central

    Walters-Sen, Lauren C; Hashimoto, Sayaka; Thrush, Devon Lamb; Reshmi, Shalini; Gastier-Foster, Julie M; Astbury, Caroline; Pyatt, Robert E

    2015-01-01

    Current practice by clinical diagnostic laboratories is to utilize online prediction programs to help determine the significance of novel variants in a given gene sequence. However, these programs vary widely in their methods and ability to correctly predict the pathogenicity of a given sequence change. The performance of 17 publicly available pathogenicity prediction programs was assayed using a dataset consisting of 122 credibly pathogenic and benign variants in genes associated with the RASopathy family of disorders and limb-girdle muscular dystrophy. Performance metrics were compared between the programs to determine the most accurate program for loss-of-function and gain-of-function mechanisms. No one program correctly predicted the pathogenicity of all variants analyzed. A major hindrance to the analysis was the lack of output from a significant portion of the programs. The best performer was MutPred, which had a weighted accuracy of 82.6% in the full dataset. Surprisingly, combining the results of the top three programs did not increase the ability to predict pathogenicity over the top performer alone. As the increasing number of sequence changes in larger datasets will require interpretation, the current study demonstrates that extreme caution must be taken when reporting pathogenicity based on statistical online protein prediction programs in the absence of functional studies. PMID:25802880

  19. Day-to-Day Blood Pressure Variability and Risk of Dementia in a General Japanese Elderly Population: The Hisayama Study.

    PubMed

    Oishi, Emi; Ohara, Tomoyuki; Sakata, Satoko; Fukuhara, Masayo; Hata, Jun; Yoshida, Daigo; Shibata, Mao; Ohtsubo, Toshio; Kitazono, Takanari; Kiyohara, Yutaka; Ninomiya, Toshiharu

    2017-08-08

    Several observational studies have reported that higher visit-to-visit blood pressure variability is a risk factor for cognitive impairment and dementia. However, no studies have investigated the association of day-to-day blood pressure variability assessed by home blood pressure measurement with the development of dementia. A total of 1674 community-dwelling Japanese elderly without dementia, ≥60 years of age, were followed up for 5 years (2007-2012). Home blood pressure was measured 3 times every morning for a median of 28 days. Day-to-day systolic (SBP) and diastolic blood pressure variabilities, calculated as coefficients of variation (CoV) of home SBP and diastolic blood pressure, were categorized into quartiles. The hazard ratios and their 95% confidence intervals of the CoV levels of home blood pressure on the development of all-cause dementia, vascular dementia (VaD), and Alzheimer disease (AD) were computed with a Cox proportional hazards model. During the follow-up, 194 subjects developed all-cause dementia; of these, 47 had VaD and 134 had AD. The age- and sex-adjusted incidences of all-cause dementia, VaD, and AD increased significantly with increasing CoV levels of home SBP (all P for trend <0.05). These associations remained unchanged after adjustment for potential confounding factors, including home SBP. Compared with subjects in the first quartile of CoV levels of home SBP, the risks of the development of all-cause dementia, VaD, and AD were significantly higher in those in the fourth quartile (hazard ratio=2.27, 95% confidence interval=1.45-3.55, P<0.001 for all-cause dementia; hazard ratio=2.79, 95% confidence interval=1.04-7.51, P=0.03 for VaD; hazard ratio=2.22, 95% confidence interval=1.31-3.75, P<0.001 for AD). Similar associations were observed for CoV levels of home diastolic blood pressure. Meanwhile, home SBP levels were significantly associated with the risk of VaD but not with the risks of all-cause dementia and AD. There was no

  20. Clinical applications of high-speed blood flow measurements with diffuse correlation spectroscopy

    NASA Astrophysics Data System (ADS)

    Parthasarathy, Ashwin B.; Baker, Wesley B.; Gannon, Kimberly; Mullen, Michael T.; Detre, John A.; Yodh, Arjun G.

    2017-02-01

    Diffuse Correlation Spectroscopy (DCS) is an increasingly popular non-invasive optical technique to clinically measure deep tissue blood flow, albeit at slow measurement rates of 0.5-1 Hz. We recently reported the development of a new `fast' DCS instrument that continuously measures blood flow at 50-100 Hz (simultaneously from 8 channels), using conventional DCS sources/detectors, and optimized software computations. A particularly interesting result was our ability to optically record pulsatile micro-vascular blood flow waveforms, and therein readily identify high frequency features such as the dicrotic notch. Here, we showcase the utility and potential of high-speed measurements of blood flow (and arterial blood pressure) in a few clinical applications. First, we employ the fast-DCS instrumentation to measure cerebral autoregulation (CVAR) dynamics. Cerebral autoregulation refers to the mechanism by which cerebral blood flow (CBF) is maintained during fluctuations in blood pressure; CVAR is impaired in the injured brain. We derive an index of autoregulation by measuring the rates of decrease (and recovery) of blood flow and blood pressure following a sudden, induced change in systemic blood pressure (e.g., bilateral thigh cuff deflation). Our pilot experiments in healthy volunteers show that DCS measured rates of micro-vascular regulation are comparable to conventional large vessel regulatory metrics (e.g., measured with transcranial Doppler ultrasound). Second, we utilized pulsatile blood flow oscillations in cerebral arteries to estimate the critical closing pressure (CrCP), i.e., the arterial blood pressure at which CBF approaches zero. Pilot experiments in healthy subjects show good agreement between CrCP measured with DCS and transcranial Doppler ultrasound.

  1. Normalized spectral power of fetal heart rate variability is associated with fetal scalp blood pH.

    PubMed

    van Laar, J O E H; Peters, C H L; Houterman, S; Wijn, P F F; Kwee, A; Oei, S G

    2011-04-01

    Spectral power of fetal heart rate variability is related to fetal condition. Previous studies found an increased normalized low frequency power in case of severe fetal acidosis. To analyze whether absolute or normalized low or high frequency power of fetal heart rate variability is associated with fetal scalp blood pH. Prospective cohort study, performed in an obstetric unit of a tertiary care teaching hospital. Consecutive singleton term fetuses in cephalic presentation that underwent one or more scalp blood samples, monitored during labour using ST-analysis of the fetal electrocardiogram. Ten-minute continuous beat-to-beat fetal heart rate segments, preceding the scalp blood measurement were used. Absolute and normalized spectral power in the low frequency band (0.04-0.15 Hz) and in the high frequency band (0.4-1.5 Hz). In total 39 fetal blood samples from 30 patients were studied. We found that normalized low frequency and normalized high frequency power of fetal heart rate variability is associated with fetal scalp blood pH. The estimated ß of normalized low frequency power was -0.37 (95% confidence interval -0.68 to -0.06) and the relative risk was 0.69 (95% confidence interval 0.51-0.94). The estimated ß of normalized high frequency power was 0.33 (95% confidence interval 0.01-0.65) and the relative risk was 1.39 (95% confidence interval 1.01-1.92). Normalized low and normalized high frequency power of fetal heart rate variability is associated with fetal scalp blood pH. Copyright © 2011 Elsevier Ltd. All rights reserved.

  2. Variability in clinical assessment of neuroimaging in temporal lobe epilepsy.

    PubMed

    Struck, Aaron F; Westover, Michael B

    2015-08-01

    Neuroimaging is critical in deciding candidacy for epilepsy surgery. Currently imaging is primarily assessed qualitatively, which may affect patient selection and outcomes. The epilepsy surgery database at MGH was reviewed for temporal lobectomy patients from the last 10 years. Radiology reports for MRI and FDG-PET were compared to the epilepsy conference consensus. First, specific findings of ipsi/contra hippocampal atrophy and T2 signal changes were directly compared. Next the overall impression of presence of hippocampal sclerosis (HS) for MRI and temporal hypometabolism for PET was used for sensitivity/specificity analysis. To assess predictive power of imaging findings logistic regression was used. 104 subjects were identified. 70% of subjects were ILAE class I at 1-year. Radiology reports and the conference consensus differed in 31% of FDG-PET studies and 41% of MRIs. For PET most disagreement (50%) stemmed for discrepancy regarding contralateral temporal hypometabolism. For MRI discrepancy in ipsilateral hippocampal atrophy/T2 signal accounted for 59% of disagreements. When overall impression of the image was used the overall reliability between groups was high with only MRI sensitivity to detect HS (0.75 radiology, 0.91 conference, p=0.02) was significantly different between groups. On logistic regression MRI was a significant predictor of HS, but still 36% of patients with normal MRI as read by both groups had HS on pathology. Despite some difference in specific radiologic findings, overall accuracy for MRI and PET is similar in clinical practice between radiology and conference; nonetheless there are still cases of hippocampal pathology not detected by standard imaging methods. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  3. The Accreditation Experience of Clinical Laboratories and Blood Banks in Mexico.

    PubMed

    Quintana, Sandra

    2015-11-01

    The accreditation of clinical laboratories and blood banks based on ISO 15189 is now being consolidated in Mexico, and is coordinated by the Mexican accreditation entity innovative strategies, A.C. (ema) and supported by the activities of the committee of clinical laboratories and blood banks. The active participation in working groups formed by the technical committee of clinical laboratories and blood banks in specific areas, has contributed to the formulation of technical documents and criteria of evaluation that strengthen the current accreditation scheme. The national registry of evaluation (PNE) consists of technical experts and evaluators from different disciplines of clinical laboratory; the evaluators actively participate in accreditation assessment, with an ultimate goal to receive training and feedback for continuous improvement of its own performance.

  4. The Accreditation Experience of Clinical Laboratories and Blood Banks in Mexico

    PubMed Central

    2015-01-01

    The accreditation of clinical laboratories and blood banks based on ISO 15189 is now being consolidated in Mexico, and is coordinated by the Mexican accreditation entity innovative strategies, A.C. (ema) and supported by the activities of the committee of clinical laboratories and blood banks. The active participation in working groups formed by the technical committee of clinical laboratories and blood banks in specific areas, has contributed to the formulation of technical documents and criteria of evaluation that strengthen the current accreditation scheme. The national registry of evaluation (PNE) consists of technical experts and evaluators from different disciplines of clinical laboratory; the evaluators actively participate in accreditation assessment, with an ultimate goal to receive training and feedback for continuous improvement of its own performance. PMID:27683498

  5. Central blood pressure: current evidence and clinical importance

    PubMed Central

    McEniery, Carmel M.; Cockcroft, John R.; Roman, Mary J.; Franklin, Stanley S.; Wilkinson, Ian B.

    2014-01-01

    Pressure measured with a cuff and sphygmomanometer in the brachial artery is accepted as an important predictor of future cardiovascular risk. However, systolic pressure varies throughout the arterial tree, such that aortic (central) systolic pressure is actually lower than corresponding brachial values, although this difference is highly variable between individuals. Emerging evidence now suggests that central pressure is better related to future cardiovascular events than is brachial pressure. Moreover, anti-hypertensive drugs can exert differential effects on brachial and central pressure. Therefore, basing treatment decisions on central, rather than brachial pressure, is likely to have important implications for the future diagnosis and management of hypertension. Such a paradigm shift will, however, require further, direct evidence that selectively targeting central pressure, brings added benefit, over and above that already provided by brachial artery pressure. PMID:24459197

  6. Improving power to detect changes in blood miRNA expression by accounting for sources of variability in experimental designs.

    PubMed

    Daniels, Sarah I; Sillé, Fenna C M; Goldbaum, Audrey; Yee, Brenda; Key, Ellen F; Zhang, Luoping; Smith, Martyn T; Thomas, Reuben

    2014-12-01

    Blood miRNAs are a new promising area of disease research, but variability in miRNA measurements may limit detection of true-positive findings. Here, we measured sources of miRNA variability and determine whether repeated measures can improve power to detect fold-change differences between comparison groups. Blood from healthy volunteers (N = 12) was collected at three time points. The miRNAs were extracted by a method predetermined to give the highest miRNA yield. Nine different miRNAs were quantified using different qPCR assays and analyzed using mixed models to identify sources of variability. A larger number of miRNAs from a publicly available blood miRNA microarray dataset with repeated measures were used for a bootstrapping procedure to investigate effects of repeated measures on power to detect fold changes in miRNA expression for a theoretical case-control study. Technical variability in qPCR replicates was identified as a significant source of variability (P < 0.05) for all nine miRNAs tested. Variability was larger in the TaqMan qPCR assays (SD = 0.15-0.61) versus the qScript qPCR assays (SD = 0.08-0.14). Inter- and intraindividual and extraction variability also contributed significantly for two miRNAs. The bootstrapping procedure demonstrated that repeated measures (20%-50% of N) increased detection of a 2-fold change for approximately 10% to 45% more miRNAs. Statistical power to detect small fold changes in blood miRNAs can be improved by accounting for sources of variability using repeated measures and choosing appropriate methods to minimize variability in miRNA quantification. This study demonstrates the importance of including repeated measures in experimental designs for blood miRNA research. See all the articles in this CEBP Focus section, "Biomarkers, Biospecimens, and New Technologies in Molecular Epidemiology." ©2014 American Association for Cancer Research.

  7. High blood pressure in children: clinical and health policy implications.

    PubMed

    Falkner, Bonita; Lurbe, Empar; Schaefer, Franz

    2010-04-01

    Hypertension is a global problem, affecting both developed and developing nations. In addition to being a major cause of morbidity and mortality, hypertension places a heavy burden on health care systems, families, and society as a whole. Despite evidence of an increasing prevalence of hypertension among youth, the consequences of early onset are poorly established and often overlooked. Childhood hypertension is often asymptomatic and easily missed, even by health professionals. Target organ damage is detectable in children and adolescents, however, and hypertension continues into adulthood. Additional strategies to improve cardiovascular health among children and adolescents are needed, including methods to achieve healthy lifestyles at home and in school, improved systems for diagnosis, and research on mechanisms and timing of interventions. The burden of hypertension in the young will continue to grow unless it is given the attention it deserves by policy makers, health care providers, schools, parents, and society. This report aims to increase awareness of the problem of hypertension in childhood. Recent reports on prevalence and target organ injury are discussed and health policy initiatives to improve blood pressure control are proposed.

  8. Self-Organization of Blood Pressure Regulation: Clinical Evidence

    PubMed Central

    Fortrat, Jacques-Olivier; Gharib, Claude

    2016-01-01

    The pathogenesis of vasovagal syncope has remained elusive despite many efforts to identify an underlying dysfunction. Catastrophe theory explains the spontaneous occurrence of sudden events in some mathematically complex systems known as self-organized systems poised at criticality. These systems universally exhibit a power law initially described in earthquake occurrence: the Gutenberg Richter law. The magnitude plotted against the total number of earthquakes of at least this magnitude draw a straight line on log-log graph. We hypothesized that vasovagal syncope is a catastrophe occurring spontaneously in the cardiovascular system. We counted the number and magnitude (number of beats) of vasovagal reactions (simultaneous decreases in both blood pressure and heart rate on consecutive beats) in 24 patients with vasovagal symptoms during a head-up tilt test and 24 paired patients with no symptoms during the test. For each patient, we checked whether vasovagal reaction occurrence followed the Gutenberg Richter law. The occurrence followed the Gutenberg Richter law in 43 patients (correlation coefficient |r| = 0.986 ± 0.001, mean ± SEM) out of 48, with no difference between patients with and without symptoms. We demonstrated that vasovagal syncope matches a catastrophe model occurring in a self-organized cardiovascular complex system poised at criticality. This is a new vision of cardiovascular regulation and its related disorders. PMID:27065881

  9. Characteristics of Blood Pressure Profiles After Endovascular Coiling as Predictors of Clinical Outcome in Poor-Grade Aneurysmal Subarachnoid Hemorrhage.

    PubMed

    Cai, Kefu; Zhang, Yunfeng; Shen, Lihua; Ji, Qiuhong; Xu, Tian; Cao, Maohong

    2017-08-01

    Accurate identification of patients who will achieve a favorable outcome is almost impossible preoperatively or postoperatively in poor-grade (Hunt and Hess Grade IV and V) aneurysmal subarachnoid hemorrhage (SAH). Whether characteristics of blood pressure profiles during the first 24 hours after endovascular coiling could predict prognosis in poor grade patients was explored. Data were obtained retrospectively on all patients undergoing endovascular treatment with poor-grade SAH from November 2011 to June 2016. Blood pressure during the initial 24 hours was measured at 2-hour intervals after coil embolization. Studied features of mean systolic blood pressure (MSBP) and systolic blood pressure variability (SBPV) as well as demographics, medical history, clinical characteristics, and neurologic outcomes were documented. SBPV was determined as standard deviation and successive variation of systolic blood pressure. Logistic regression analysis was used to identify predictors of favorable outcome assessed on modified Rankin Scale score of 0 to 2. The patients with favorable and unfavorable outcome were comparable with respect to systolic blood pressure on admission and MSBP after coiling. However, MSBP between 120 and 140 mm Hg was one of independent predictors of good outcomes at discharge (odds ratio 7.1; P = 0.002). SBPV-successive variation after embolization was associated with functional recovery (odds ratio 0.87; P = 0.011) in multivariate logistic analysis and mortality by Cox proportional hazard regression (hazard ratio, 1.10; P = 0.001) at 6-month follow-up. Characteristics of blood pressure profiles after coiling appeared to be simple and convenient indexes for the prognosis of patients with poor-grade SAH. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Time course of changes in heart rate and blood pressure variability in rats with myocardial infarction

    PubMed Central

    Aires, R.; Pimentel, E.B.; Forechi, L.; Dantas, E.M.; Mill, J.G.

    2017-01-01

    Our aim was to determine the time course of changes in autonomic balance in the acute (1 and 3 days), sub-acute (7 days) and chronic (28 days) phases of myocardial infarction (MI) in rats. Autonomic balance was assessed by temporal and spectral analyses of blood pressure variability (BPV) and heart rate variability (HRV). Pulsatile blood pressure (BP) recordings (30 min) were obtained in awake and unrestrained male Wistar rats (N = 77; 8-10 weeks old) with MI (coronary ligature) or sham operation (SO). Data are reported as means±SE. The high frequency (HF) component (n.u.) of HRV was significantly lower in MI-1- (P<0.01) and MI-3-day rats (P<0.05) than in their time-control groups (SO-1=68±4 vs MI-1=35.3±4.3; SO-3=71±5.8 vs MI-3=45.2±3.8), without differences thereafter (SO-7=69.2±4.8 vs MI-7=56±5.8; SO-28=73±4 vs MI-28=66±6.6). A sharp reduction (P<0.05) of BPV (mmHg2) was observed in the first week after MI (SO-1=8.55±0.80; SO-3=9.11±1.08; SO-7=7.92±1.10 vs MI-1=5.63±0.73; MI-3=5.93±0.30; MI-7=5.30±0.25). Normal BPV, however, was observed 4 weeks after MI (SO-28=8.60±0.66 vs MI-28=8.43±0.56 mmHg2; P>0.05). This reduction was mainly due to attenuation of the low frequency (LF) band of BPV in absolute and normalized units (SO-1=39.3±7%; SO-3=55±4.5%; SO-7=46.8±4.5%; SO-28=45.7±5%; MI-1=13±3.5%; MI-3=35±4.7%; MI-7=25±2.8%; MI-28=21.4±2.8%). The results suggest that the reduction in HRV was associated with decrease of the HF component of HRV suggesting recovery of the vagal control of heartbeats along the post-infarction healing period. The depression of BPV was more dependent on the attenuation of the LF component, which is linked to the baroreflex modulation of the autonomic balance. PMID:28076450

  11. Clinical value of ambulatory blood pressure in pediatric patients after renal transplantation.

    PubMed

    Krmar, Rafael T; Ferraris, Jorge R

    2017-08-25

    Hypertension is a highly prevalent co-morbidity in pediatric kidney transplant recipients. Undertreated hypertension is associated with cardiovascular complications and negatively impacts renal graft survival. Thus, the accurate measurement of blood pressure is of the utmost importance for the correct diagnosis and subsequent management of post-renal transplant hypertension. Data derived from the general population, and to a lesser extent from the pediatric population, indicates that ambulatory blood pressure monitoring (ABPM) is superior to blood pressure measurements taken in the clinical setting for the evaluation of true mean blood pressure, identification of patients requiring antihypertensive treatment, and in the prediction of cardiovascular outcome. This Educational Review will discuss the clinical value of ABPM in the identification of individual blood pressure phenotypes, i.e., normotension, new-onset hypertension, white-coat hypertension, masked hypertension, controlled blood pressure, and undertreated/uncontrolled hypertension in pediatric kidney transplant recipients. Finally, we examine the utility of performing repeated ABPM for treatment monitoring of post-renal transplant hypertension and on surrogate markers related to relevant clinical cardiovascular outcomes. Taken together, our review highlights the clinical value of the routine use of ABPM as a tool for identifying and monitoring hypertension in pediatric kidney transplant recipients.

  12. Clinically Meaningful Use of Blood Tumor Markers in Oncology

    PubMed Central

    Pagliaro, Lance

    2016-01-01

    Before the introduction of modern imaging techniques and the recent developments in molecular diagnosis, tumor markers (TMs) were among the few available diagnostic tools for the management of cancer patients. Easily obtained from serum or plasma samples, TMs are minimally invasive and convenient, and the associated costs are low. Single TMs were traditionally used but these have come under scrutiny due to their low sensitivity and specificity when used, for example, in a screening setting. However, recent research has shown superior performance using a combination of multiple TMs as a panel for assessment, or as part of validated algorithms that also incorporate other clinical factors. In addition, newer TMs have been discovered that have an increased sensitivity and specificity profile for defined malignancies. The aim of this review is to provide a concise overview of the appropriate uses of both traditional and newer TMs and their roles in diagnosis, prognosis, and the monitoring of patients in current clinical practice. We also look at the future direction of TMs and their integration with other diagnostic modalities and other emerging serum based biomarkers, such as circulating nucleic acids, to ultimately advance diagnostic performance and improve patient management. PMID:28042579

  13. Mobile clinic in Massachusetts associated with cost savings from lowering blood pressure and emergency department use.

    PubMed

    Song, Zirui; Hill, Caterina; Bennet, Jennifer; Vavasis, Anthony; Oriol, Nancy E

    2013-01-01

    Mobile health clinics are in increasingly wide use, but evidence of their clinical impact or cost-effectiveness is limited. Using a unique data set of 5,900 patients who made a total of 10,509 visits in 2010-12 to the Family Van, an urban mobile health clinic in Massachusetts, we examined the effect of screenings and counseling provided by the clinic on blood pressure. Patients who presented with high blood pressure during their initial visit experienced average reductions of 10.7 mmHg and 6.2 mmHg in systolic and diastolic blood pressure, respectively, during their follow-up visits. These changes were associated with 32.2 percent and 44.6 percent reductions in the relative risk of myocardial infarction and stroke, respectively, which we converted into savings using estimates of the incidence and costs of these conditions over thirty months. The savings from this reduction in blood pressure and patient-reported avoided emergency department visits produced a positive lower bound for the clinic's return on investment of 1.3. All other services of the clinic-those aimed at diabetes, obesity, and maternal health, for example-were excluded from this lower-bound estimate. Policy makers should consider mobile clinics as a delivery model for underserved communities with poor health status and high use of emergency departments.

  14. Clinical Trials With Large Numbers of Variables: Important Advantages of Canonical Analysis.

    PubMed

    Cleophas, Ton J

    2016-01-01

    Canonical analysis assesses the combined effects of a set of predictor variables on a set of outcome variables, but it is little used in clinical trials despite the omnipresence of multiple variables. The aim of this study was to assess the performance of canonical analysis as compared with traditional multivariate methods using multivariate analysis of covariance (MANCOVA). As an example, a simulated data file with 12 gene expression levels and 4 drug efficacy scores was used. The correlation coefficient between the 12 predictor and 4 outcome variables was 0.87 (P = 0.0001) meaning that 76% of the variability in the outcome variables was explained by the 12 covariates. Repeated testing after the removal of 5 unimportant predictor and 1 outcome variable produced virtually the same overall result. The MANCOVA identified identical unimportant variables, but it was unable to provide overall statistics. (1) Canonical analysis is remarkable, because it can handle many more variables than traditional multivariate methods such as MANCOVA can. (2) At the same time, it accounts for the relative importance of the separate variables, their interactions and differences in units. (3) Canonical analysis provides overall statistics of the effects of sets of variables, whereas traditional multivariate methods only provide the statistics of the separate variables. (4) Unlike other methods for combining the effects of multiple variables such as factor analysis/partial least squares, canonical analysis is scientifically entirely rigorous. (5) Limitations include that it is less flexible than factor analysis/partial least squares, because only 2 sets of variables are used and because multiple solutions instead of one is offered. We do hope that this article will stimulate clinical investigators to start using this remarkable method.

  15. Inter-observer Variability of Clinical Criteria in Nursing Home Residents with Suspected UTI

    PubMed Central

    Juthani-Mehta, Manisha; Tinetti, Mary; Perrelli, Eleanor; Towle, Virginia; Van Ness, Peter H.; Quagliarello, Vincent

    2009-01-01

    We determined the inter-observer variability of clinical criteria for urinary tract infection (UTI) in nursing home residents. Pairs of nursing home staff caring for thirty residents were interviewed at times of suspected UTI. At least one measure from each clinical criteria category was reliably observed by nursing home staff members. PMID:18419369

  16. Predicting out-of-office blood pressure level using repeated measurements in the clinic: an observational cohort study.

    PubMed

    Sheppard, James P; Holder, Roger; Nichols, Linda; Bray, Emma; Hobbs, F D Richard; Mant, Jonathan; Little, Paul; Williams, Bryan; Greenfield, Sheila; McManus, Richard J

    2014-11-01

    Identification of people with lower (white-coat effect) or higher (masked effect) blood pressure at home compared to the clinic usually requires ambulatory or home monitoring. This study assessed whether changes in SBP with repeated measurement at a single clinic predict subsequent differences between clinic and home measurements. This study used an observational cohort design and included 220 individuals aged 35-84 years, receiving treatment for hypertension, but whose SBP was not controlled. The characteristics of change in SBP over six clinic readings were defined as the SBP drop, the slope and the quadratic coefficient using polynomial regression modelling. The predictive abilities of these characteristics for lower or higher home SBP readings were investigated with logistic regression and repeated operating characteristic analysis. The single clinic SBP drop was predictive of the white-coat effect with a sensitivity of 90%, specificity of 50%, positive predictive value of 56% and negative predictive value of 88%. Predictive values for the masked effect and those of the slope and quadratic coefficient were slightly lower, but when the slope and quadratic variables were combined, the sensitivity, specificity, positive and negative predictive values for the masked effect were improved to 91, 48, 24 and 97%, respectively. Characteristics obtainable from multiple SBP measurements in a single clinic in patients with treated hypertension appear to reasonably predict those unlikely to have a large white-coat or masked effect, potentially allowing better targeting of out-of-office monitoring in routine clinical practice.

  17. Predicting out-of-office blood pressure level using repeated measurements in the clinic: an observational cohort study

    PubMed Central

    Sheppard, James P.; Holder, Roger; Nichols, Linda; Bray, Emma; Hobbs, F.D. Richard; Mant, Jonathan; Little, Paul; Williams, Bryan; Greenfield, Sheila; McManus, Richard J.

    2014-01-01

    Objectives: Identification of people with lower (white-coat effect) or higher (masked effect) blood pressure at home compared to the clinic usually requires ambulatory or home monitoring. This study assessed whether changes in SBP with repeated measurement at a single clinic predict subsequent differences between clinic and home measurements. Methods: This study used an observational cohort design and included 220 individuals aged 35–84 years, receiving treatment for hypertension, but whose SBP was not controlled. The characteristics of change in SBP over six clinic readings were defined as the SBP drop, the slope and the quadratic coefficient using polynomial regression modelling. The predictive abilities of these characteristics for lower or higher home SBP readings were investigated with logistic regression and repeated operating characteristic analysis. Results: The single clinic SBP drop was predictive of the white-coat effect with a sensitivity of 90%, specificity of 50%, positive predictive value of 56% and negative predictive value of 88%. Predictive values for the masked effect and those of the slope and quadratic coefficient were slightly lower, but when the slope and quadratic variables were combined, the sensitivity, specificity, positive and negative predictive values for the masked effect were improved to 91, 48, 24 and 97%, respectively. Conclusion: Characteristics obtainable from multiple SBP measurements in a single clinic in patients with treated hypertension appear to reasonably predict those unlikely to have a large white-coat or masked effect, potentially allowing better targeting of out-of-office monitoring in routine clinical practice. PMID:25144295

  18. Reducing blood volume requirements for clinical pathology testing in toxicologic studies-points to consider.

    PubMed

    Poitout-Belissent, Florence; Aulbach, Adam; Tripathi, Niraj; Ramaiah, Lila

    2016-12-01

    In preclinical safety assessment, blood volume requirements for various endpoints pose a major challenge. The goal of this working group was to review current practices for clinical pathology (CP) testing in preclinical toxicologic studies, and to discuss advantages and disadvantages of methods for reducing blood volume requirements. An industry-wide survey was conducted to gather information on CP instrumentation and blood collection practices for hematology, clinical biochemistry, and coagulation evaluation in laboratory animals involved in preclinical studies. Based on the survey results and collective experience of the authors, the working group proposes the following "points to consider" for CP testing: (1) For most commercial analyzers, 0.5 mL and 0.8 mL of whole blood are sufficient for hematology and biochemistry evaluation, respectively. (2) Small analyzers with low volume requirements and low throughput have limited utility in preclinical studies. (3) Sample pooling or dilution is inappropriate for many CP methods. (4) Appropriate collection sites should be determined based on blood volume requirements and technical expertise. (5) Microsampling does not provide sufficient volume given current analyzer and quality assurance requirements. (6) Study design considerations include: the use of older/larger animals (rodents), collection of CP samples before toxicokinetic samples, use of separate subsets of mice for hematology and clinical biochemistry testing, use of a priority list for clinical biochemistry, and when possible, eliminating coagulation testing. © 2016 American Society for Veterinary Clinical Pathology.

  19. Blood pressure control and primary prevention of stroke: summary of the recent clinical trial data and meta-analyses.

    PubMed

    Gaciong, Zbigniew; Siński, Maciej; Lewandowski, Jacek

    2013-12-01

    Stroke is the second most common cause of death worldwide and of adult disability, but in the near future the global burden of cerebrovascular diseases will rise due to ageing and adverse lifestyle changes in populations worldwide. The risk of stroke increases at blood pressure levels above 115/75 mm Hg and high blood pressure (BP) is the most important modifiable risk factor for stroke, associated with 54 % episodes of stroke worldwide. There is strong evidence from clinical trials that antihypertensive therapy reduces substantially the risk of any type of stroke, as well as stroke-related death and disability. The risk attributed to BP is associated not only with absolute values but also with certain parameters describing BP diurnal pattern as well as short-term and long-term variability. Many studies reported that certain features of BP like nocturnal hypertension, morning surge or increased variability predict an increased stroke risk. However, there is no accepted effective modality for correction of these disturbances (chronotherapy, certain classes of antihypertensive drugs). In the elderly, who are mostly affected by stroke, the primary prevention guidelines recommend treatment with diuretics and calcium channel blockers to lower blood pressure to the standard level.

  20. Formant Frequencies and Bandwidths in Relation to Clinical Variables in an Obstructive Sleep Apnea Population.

    PubMed

    Montero Benavides, Ana; Blanco Murillo, José Luis; Fernández Pozo, Rubén; Espinoza Cuadros, Fernando; Torre Toledano, Doroteo; Alcázar-Ramírez, José D; Hernández Gómez, Luis A

    2016-01-01

    We investigated whether differences in formants and their bandwidths, previously reported comparing small sample population of healthy individuals and patients with obstructive sleep apnea (OSA), are detected on a larger population representative of a clinical practice scenario. We examine possible indirect or mediated effects of clinical variables, which may shed some light on the connection between speech and OSA. In a retrospective study, 241 male subjects suspected to suffer from OSA were examined. The apnea-hypopnea index (AHI) was obtained for every subject using overnight polysomnography. Furthermore, the clinical variables usually reported as predictors of OSA, body mass index (BMI), cervical perimeter, height, weight, and age, were collected. Voice samples of sustained phonations of the vowels /a/, /e/, /i/, /o/, and /u/ were recorded. Formant frequencies F1, F2, and F3 and bandwidths BW1, BW2, and BW3 of the sustained vowels were determined using spectrographic analysis. Correlations among AHI, clinical parameters, and formants and bandwidths were determined. Correlations between AHI and clinical variables were stronger than those between AHI and voice features. AHI only correlates poorly with BW2 of /a/ and BW3 of /e/. A number of further weak but significant correlations have been detected between voice and clinical variables. Most of them were for height and age, with two higher values for age and F2 of /o/ and F2 of /u/. Only few very weak correlations were detected between voice and BMI, weight and cervical perimeter, wich are the clinical variables more correlated with AHI. No significant correlations were detected between AHI and formant frequencies and bandwidths. Correlations between voice and other clinical factors characterizing OSA are weak but highlight the importance of considering indirect or mediated effects of such clinical variables in any research on speech and OSA. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All

  1. Randomised Double-Blind Comparison of Placebo and Active Drugs for Effects on Risks Associated with Blood Pressure Variability in the Systolic Hypertension in Europe Trial

    PubMed Central

    Hara, Azusa; Thijs, Lutgarde; Asayama, Kei; Jacobs, Lotte; Wang, Ji-Guang; Staessen, Jan A.

    2014-01-01

    by decreasing level but not variability of SBP. Higher blood pressure level, but not higher variability, predicted risk. Trial Registration ClinicalTrials.gov NCT02088450 PMID:25090617

  2. Influence of chromium-enriched yeast on blood glucose and insulin variables, blood lipids, and markers of oxidative stress in subjects with type 2 diabetes mellitus.

    PubMed

    Racek, Jaroslav; Trefil, Ladislav; Rajdl, Daniel; Mudrová, Vlasta; Hunter, Douglas; Senft, VáClav

    2006-03-01

    The aim of this study was to determine the effect of chromium (Cr)- enriched yeast on blood glucose and insulin variables, blood lipids, and blood markers of oxidative stress in persons with type 2 diabetes mellitus (median duration: 3.0 yr). Thirty-six subjects (9 men, 27 women; mean age: 61.3 yr; mean body mass index: 34.33 kg/m2) were supplemented with 400 microg Cr/d as Cr-enriched yeast (n = 19) or placebo (n = 17) for 12 wk in a randomized, double-blind study. The most interesting results were obtained by comparison of the change in the placebo group to the change in the Cr group. The Cr group showed a significantly greater increase in serum Cr compared to the placebo group (p < 0.05). Supplementation with Cr-enriched yeast was associated with a significant decrease in fasting serum glucose compared to placebo (p < 0.01). Blood markers of oxidative stress glutathione peroxidase activity and levels of reduced glutathione were essentially unchanged in the Cr group after 12 wk, but decreased significantly in the placebo group (p < 0.05, p < 0.01, respectively). Serum HbA1c and glycated protein (fructosamine) were essentially unchanged in the Cr group, whereas HbA1c tended to increase in the placebo group (from 6.94% to 7.11%). Fasting serum insulin decreased in both groups, with a greater tendency in the Cr group (-16.5% vs -9.5%). These data suggest that supplementation of well-controlled type 2 diabetics with Cr-enriched yeast is safe and can result in improvements in blood glucose variables and oxidative stress.

  3. Clinical characteristics of resistant hypertension evaluated by ambulatory blood pressure monitoring.

    PubMed

    Kansui, Yasuo; Matsumura, Kiyoshi; Kida, Haruko; Sakata, Satoko; Ohtsubo, Toshio; Ibaraki, Ai; Kitazono, Takanari

    2014-01-01

    Strict control of blood pressure is important to prevent cardiovascular disease, although it is sometimes difficult to decrease blood pressure to target levels. The aim of this study was to investigate the clinical characteristics of resistant hypertension evaluated by ambulatory blood pressure monitoring. One hundred in-hospital patients, whose 24-hour average blood pressure was higher than 130/80 mmHg even after treatment with more than three antihypertensive drugs, were included in the present analysis. Circadian variation of blood pressure was evaluated by nocturnal fall in systolic blood pressure. Average blood pressures of all patients were high in both daytime and nighttime, 150.0/82.9 and 143.8/78.2 mmHg, respectively. Twenty patients had been treated with hemodialysis or peritoneal dialysis. In 63 patients out of the other 80 patients (79%), estimated glomerular filtration rate (eGFR) was also decreased (<60 mL/min/1.73 m²). The patients classified into dipper, non-dipper, riser and extreme-dipper were 20%, 43%, 34% and 3%, respectively. In addition, in 17 patients whose eGFR was preserved, 12 patients showed a non-dipper or riser pattern, suggesting that it was difficult to account for this altered circadian blood pressure variation only by renal dysfunction. These results show that a large number of the patients with resistant hypertension suffered from renal dysfunction, although it was difficult to explain altered circadian blood pressure variation based on renal dysfunction alone.

  4. Distal arthrogryposis with variable clinical expression caused by TNNI2 mutation

    PubMed Central

    Čulić, Vida; Miyake, Noriko; Janković, Sunčana; Petrović, Davor; Šimunović, Marko; Đapić, Tomislav; Shiina, Masaaki; Ogata, Kazuhiro; Matsumoto, Naomichi

    2016-01-01

    Distal arthrogryposis (DA) is a clinically and genetically heterogeneous disorder with multiple joint contractures. We describe a female DA patient with hand and foot deformities, and right-sided torticollis. Using exome sequencing, we identified a novel TNNI2 mutation (c.485>A, p.Arg162Lys) in the patient and her father. The father has no typical DA but hip dysplasia. This may explain the clinical features of DA2B in this family, but with variable clinical expression. PMID:27790376

  5. Cerebral blood flow during delirium tremens and related clinical states studied with xenon-133 inhalation tomography

    SciTech Connect

    Hemmingsen, R.; Vorstrup, S.; Clemmesen, L.; Holm, S.; Tfelt-Hansen, P.; Sorensen, A.S.; Hansen, C.; Sommer, W.; Bolwig, T.G.

    1988-11-01

    The regional cerebral blood flow of 12 patients with severe alcohol withdrawal reactions (delirium tremens or impending delirium tremens) was measured during the acute state before treatment and after recovery. Greater cerebral blood flow was significantly correlated with visual hallucinations and agitation during the acute withdrawal reaction. The results suggest that delirium tremens and related clinical states represent a type of acute brain syndrome mainly characterized by CNS hyperexcitability.

  6. Altered blood pressure progression in the community and its relation to clinical events.

    PubMed

    Ingelsson, Erik; Gona, Philimon; Larson, Martin G; Lloyd-Jones, Donald M; Kannel, William B; Vasan, Ramachandran S; Levy, Daniel

    2008-07-14

    Long-term blood pressure (BP) progression and its importance as a predictor of clinical outcome have not been well characterized across different periods. We evaluated period trends for 3 BP variables (long-term slope and mean BP during a baseline period of 16 years, and last baseline value) in an earlier period (1953-1971; n = 1644, mean participant age, 61 years) and in a later period (1971-1990; n = 1040, mean participant age, 58 years) in participants in the Framingham Heart Study who initially did not have hypertension. In addition, we explored the relation of BP to cardiovascular disease incidence and all-cause mortality in the 2 periods, each with up to 16 years of follow-up. Long-term slope, mean, and last baseline BP measurements were significantly lower in the later period (P < .001). Rates of hypertension control (BP <140/90 mm Hg) were higher in the later vs the earlier period (32% vs 23%; P < .001). Multivariate hazard ratios for the relation of BP to outcomes were generally lower in the later period; this was statistically significant for the relation of last baseline BP to all-cause mortality (hazard ratio for 1-SD increase in systolic BP, 1.02 vs 1.25, P = .03; hazard ratio for diastolic BP, 1.00 vs 1.23, P = .04). We found evidence that BP levels in the community have changed over time, coinciding with improved rates of hypertension control and attenuation of BP-mortality relations. These findings are consistent with the hypothesis that hypertension treatment in the community has altered the natural history of BP progression and its relation to clinical outcome.

  7. Interpretation of Blood Microbiology Results – Function of the Clinical Microbiologist

    PubMed Central

    Pongrácz, Júlia

    2016-01-01

    The proper use and interpretation of blood microbiology results may be one of the most challenging and one of the most important functions of clinical microbiology laboratories. Effective implementation of this function requires careful consideration of specimen collection and processing, pathogen detection techniques, and prompt and precise reporting of identification and susceptibility results. The responsibility of the treating physician is proper formulation of the analytical request and to provide the laboratory with complete and precise patient information, which are inevitable prerequisites of a proper testing and interpretation. The clinical microbiologist can offer advice concerning the differential diagnosis, sampling techniques and detection methods to facilitate diagnosis. Rapid detection methods are essential, since the sooner a pathogen is detected, the better chance the patient has of getting cured. Besides the gold-standard blood culture technique, microbiologic methods that decrease the time in obtaining a relevant result are more and more utilized today. In the case of certain pathogens, the pathogen can be identified directly from the blood culture bottle after propagation with serological or automated/semi-automated systems or molecular methods or with MALDI-TOF MS (matrix-assisted laser desorption-ionization time of flight mass spectrometry). Molecular biology methods are also suitable for the rapid detection and identification of pathogens from aseptically collected blood samples. Another important duty of the microbiology laboratory is to notify the treating physician immediately about all relevant information if a positive sample is detected. The clinical microbiologist may provide important guidance regarding the clinical significance of blood isolates, since one-third to one-half of blood culture isolates are contaminants or isolates of unknown clinical significance. To fully exploit the benefits of blood culture and other (non- culture

  8. Laboratory research of laser-radiated blood therapy and its clinical application

    NASA Astrophysics Data System (ADS)

    Yang, Fu-Shou; Yang, Xi-Cheng; Zhang, Hong-Lin

    1995-05-01

    This paper deals with the therapy by the He-Ne laser of low power, modulated pulse and low dosage of 365 nm optic source. To radiate the blood in vitro of patient's, at the time, the blood was treated with addition of oxygen. The treated blood was then retransfusion into the same patient. From 1993 to 1994, we have cured 202 cases with prominent therapeutic effect. The results of clinic and laboratory research showed: It greatly increased the immunologic function of the body, the total effective ratio achived 95% (cerebral vascular diseases), and greatly decreased the drug reaction of patients after the tumors were treated by chemotherapy and radiotherapy.

  9. Elevated blood pressure in the developing world: a role for clinical pharmacists.

    PubMed

    Smith, Michael T; Monahan, Megan P; Nelson, Paige; Moruzzi, Matthew; DeLucenay, Alexander J; Birnie, Christine R

    2017-09-19

    The objective of this study was to evaluate the prevalence and patient knowledge of elevated blood pressure amongst a cross-section of patients in underserved communities in three selected low-income countries worldwide: El Salvador, India and Kenya. Mobile medical clinics were established as part of medical mission trips in El Salvador, India and Kenya. Willing male and female patients, at least 25 years of age, who presented at each clinic were screened for elevated blood pressure, including 332 patients in El Salvador, 847 patients in India and 160 patients in Kenya. Patients were classified into Stage I or II elevated blood pressure based on modified JNCVII guidelines. A questionnaire was completed regarding their knowledge about the existence and management of their disease state. Of the 1339 patients screened, 368 presented with elevated blood pressure (27%). Of these patients, 147 had been previously informed of hypertension or an elevated blood pressure (39.9%), 28 reported receiving antihypertensive medication (7.6%) and 24 reported awareness of non-pharmaceutical treatment options (6.5%). In Kenya, 81 patients were screened in a rural setting and 79 in an urban setting. Patients demonstrating controlled blood pressure were 63 (78%) and 38 (48%), respectively, demonstrating a significant difference between the rural versus urban settings (P = 0.00359). All regions demonstrated similar trends in the prevalence of elevated blood pressure, highlighting the need for increased disease state education in these regions. © 2017 Royal Pharmaceutical Society.

  10. A Prospective Clinical Study on Blood Mercury Levels Following Endodontic Root-end Surgery with Amalgam.

    PubMed

    Saatchi, Masoud; Shadmehr, Elham; Talebi, Seyed Morteza; Nazeri, Mohsen

    2013-01-01

    The purpose of this clinical study was to compare the blood mercury levels before and after endodontic surgery using amalgam as a root-end filling material. Fourteen patients requiring periradicular surgery participated in this prospective clinical study. A zinc-free amalgam was employed as root-end filling material. Blood samples were collected at three intervals: immediately before, immediately after and one week postoperatively. Mercury content of the blood was determined using gold amalgamation cold-vapor atomic absorption spectrometry. Obtained data were analyzed using analysis of variance for repeated measures and paired t-test. The mean (SD) of blood mercury levels was 2.20 (0.24) ng/mL immediately before surgery, 2.24 (0.28) ng/mL immediately after surgery and 2.44 (0.17) ng/mL one week after the periradicular surgery. The blood mercury level one week post-operative was significantly higher than both blood mercury levels immediately before (P<0.001) and immediately after (P=0.005) the surgery. Placement of an amalgam retroseal during endodontic surgery can increase blood mercury levels after one week. The mercury levels however, are still lower than the toxic mercury levels. We suggest using more suitable and biocompatible root-end filling materials.

  11. A Prospective Clinical Study on Blood Mercury Levels Following Endodontic Root-end Surgery with Amalgam

    PubMed Central

    Saatchi, Masoud; Shadmehr, Elham; Talebi, Seyed Morteza; Nazeri, Mohsen

    2013-01-01

    Introduction The purpose of this clinical study was to compare the blood mercury levels before and after endodontic surgery using amalgam as a root-end filling material. Materials and Methods Fourteen patients requiring periradicular surgery participated in this prospective clinical study. A zinc-free amalgam was employed as root-end filling material. Blood samples were collected at three intervals: immediately before, immediately after and one week postoperatively. Mercury content of the blood was determined using gold amalgamation cold-vapor atomic absorption spectrometry. Obtained data were analyzed using analysis of variance for repeated measures and paired t-test. Results The mean (SD) of blood mercury levels was 2.20 (0.24) ng/mL immediately before surgery, 2.24 (0.28) ng/mL immediately after surgery and 2.44 (0.17) ng/mL one week after the periradicular surgery. The blood mercury level one week post-operative was significantly higher than both blood mercury levels immediately before (P<0.001) and immediately after (P=0.005) the surgery. Conclusion Placement of an amalgam retroseal during endodontic surgery can increase blood mercury levels after one week. The mercury levels however, are still lower than the toxic mercury levels. We suggest using more suitable and biocompatible root-end filling materials. PMID:23922566

  12. Long-term and ultra long-term blood pressure variability during follow-up and mortality in 14,522 patients with hypertension.

    PubMed

    Hastie, Claire E; Jeemon, Panniyammakal; Coleman, Holli; McCallum, Linsay; Patel, Rajan; Dawson, Jesse; Sloan, William; Meredith, Peter; Jones, Gregory C; Muir, Scott; Walters, Matthew; Dominiczak, Anna F; Morrison, David; McInnes, Gordon T; Padmanabhan, Sandosh

    2013-10-01

    Recent evidence indicates that long-term visit-to-visit blood pressure variability (BPV) may be an independent cardiovascular risk predictor. The implication of this variability in hypertension clinical practice is unclear. BPV as average real variability (ARV) was calculated in 14,522 treated patients with hypertension in 4 time frames: year 1 (Y1), years 2 to 5 (Y2-5), years 5 to 10 (Y5-10), and years >10 (Y10+) from first clinic visit. Cox proportional hazards models for cause-specific mortality were used in each time frame separately for long-term BPV, across time frames based on ultra long-term BPV, and within each time frame stratified by mean BP. ARV in systolic blood pressure (SBP), termed ARV(SBP), was higher in Y1 (21.3±11.9 mm Hg) in contrast to Y2-5 (17.7±9.9 mm Hg), Y5-10 (17.4±9.6 mm Hg), and Y10+ (16.8±8.5 mm Hg). In all time frames, ARV(SBP) was higher in women (P<0.01) and in older age (P<0.001), chronic kidney disease (P<0.01), and prevalent cardiovascular disease (P<0.01). Higher long-term and ultra long-term BPV values were associated with increased mortality (all-cause, cardiovascular, and noncardiovascular mortality; P for trend, <0.001). This relationship was also evident in subgroups with mean SBP<140 mm Hg in all time frames. Monitoring BPV in clinical practice may facilitate risk reduction strategies by identifying treated hypertensive individuals at high risk, especially those with BP within the normal range.

  13. Extensive Genomic Variability of Knops Blood Group Polymorphisms Is Associated with Sickle Cell Disease in Africa

    PubMed Central

    Duru, Kimberley C; Noble, Jenelle A; Guindo, Aldiouma; Yi, Li; Imumorin, Ikhide G; Diallo, Dapa A; Thomas, Bolaji N

    2015-01-01

    Sickle cell disease (SCD) is a multisystem disorder characterized by chronic hemolytic anemia, vaso-occlusive crises, and marked variability in disease severity. Patients require transfusions to manage disease complications, with complements, directed by complement regulatory genes (CR1) and its polymorphisms, implicated in the development of alloantibodies. We hypothesize that CR1 polymorphisms affect complement regulation and function, leading to adverse outcome in SCD. To this end, we determined the genomic diversity of complement regulatory genes by examining single nucleotide polymorphisms associated with Knops blood group antigens. Genomic DNA samples from 130 SCD cases and 356 control Africans, 331 SCD cases and 497 control African Americans, and 254 Caucasians were obtained and analyzed, utilizing a PCR—RFLP (polymerase chain reaction–restriction fragment length polymorphism) assay. Analyzing for ethnic diversity, we found significant differences in the genotypic and allelic frequencies of Sl1/Sl2 (rs17047661) and McCa/b (rs17047660) polymorphisms between Africans, African Americans, and Caucasians (P < 0.05). The homozygote mutant variants had significantly higher frequencies in Africans and African Americans but were insignificant in Caucasians (80.2% and 59.6% vs 5.9% for Sl1/2; and 36% and 24% vs 1.8% for McCa/b). With SCD, we did not detect any difference among cases and controls either in Africa or in the United States. However, we found significant difference in genotypic (P < 0.0001) and allelic frequencies (P < 0.0001) of Sl1/Sl2 (rs17047661) and McCa/b (rs17047660) polymorphisms between SCD groups from Africa and the United States. There was no difference in haplotype frequencies of these polymorphisms among or between groups. The higher frequency of CR1 homozygote mutant variants in Africa but not United States indicates a potential pathogenic role, possibly associated with complicated disease pathophysiology in the former and potentially

  14. Urine as a biological specimen for forensic analysis of alcohol and variability in the urine-to-blood relationship.

    PubMed

    Jones, Alan W

    2006-01-01

    This article concerns the use of urine as a biological specimen for determination of alcohol in clinical and forensic toxicology and discusses factors that might influence variability in the urine/blood concentration ratio of alcohol. A large number of human drinking experiments were conducted to determine the time course of urine-alcohol concentrations (UAC) in relation to blood-alcohol concentrations (BAC). The UAC and BAC curves were shifted in time and the BAC curve always began to decrease before the UAC started to decline. During the early absorption phase the UAC/BAC ratio was less than unity, whereas in the late absorption/distribution period the ratio was between 1.0-1.2. On reaching the post-absorptive phase, the UAC always exceeded BAC and UAC/BAC ratios averaged 1.3-1.4, increasing appreciably as BAC decreased towards zero. Alcohol-induced diuresis was most pronounced during the rising portion of the BAC curve and near to the peak value. After about 2 hours post-drinking, the production rate of urine diminished to the pre-drinking rate of about 0.5-1 mL/min. Drinking water during the post-absorptive phase of the alcohol curve produced dilute urine, as reflected in lower creatinine content and osmolality, although the concentration of ethanol remained unchanged. After subjects drank a moderate dose of ethanol (0.54-0.85 g/kg) about 2% of the dose was recoverable in the urine after 7 hours. Ethyl glucuronide, a minor metabolite of ethanol, was measured in urine samples from drunk drivers. The UAC/BAC ratio of ethanol in drunk drivers did not depend on the creatinine content of the urine and therefore the relative dilution of the specimens. When alcohol-free urine was spiked with glucose and infected with the yeast species Candida albicans, ethanol was produced by fermentation after approximately 24 hours storage at room temperature. This post-sampling synthesis of ethanol was prevented by sodium fluoride (1% weight by volume) in the urine tubes or by

  15. ME 04-1 ASSESSMENT OF CENTRAL BLOOD PRESSURE FOR CLINICAL APPLICATION.

    PubMed

    Morgan, Trefor

    2016-09-01

    Central Systolic Blood Pressure is lower than brachial artery blood Pressure due to reflected waves and greater augmentation at the periphery. The relationship is not consistent during life and alters with aging of the blood vessels. Increasing stiffness means that a greater component of the reflected waves returns to the central aorta during systolic contraction causing more amplification and a higher systolic blood pressure. Diastolic blood pressure on the other hand is always higher in the aorta than at the periphery allowing blood flow. The heart contracts against the central aortic pressure and it is likely that cardiac hypertrophy iis dependent on this value. Likewise damage to the larger blood vessels are more likely to be related to central rather than brachial pressure and this may reflect a greater association with stroke.Central aortic pressure may be measured directly but not practicable in large groups of patients or indirect using tonometry and transformation equations. While the correlation is not ideal there is significant correlation. Central aortic systolic blood pressure is associated with mortality, stokes, heart attacks and cardiac hypertrophy with a higher p value than brachial artery blood pressure. The question is whether it is an independent predictor of these events and whether measurement is justifiable in clinical practice. There is a strong correlation between aortic and brachial systolic blood pressure reducing the ability of the central BP to be independent. In addition the question arises does the measurement of central systolic BP provide extra information above pulse wave velocity?Measuring central systolic blood pressure has allowed an exploration of the effects of different drug classes on central systolic blood pressure. Thus beta blockers increase the amplification index meaning that the fall in central systolic blood pressure is not as great as the fall in brachial artery systolic BP. This may explain in part why beta blockers

  16. High sensitivity test for the early diagnosis of gestational hypertension and preeclampsia. II. Circadian blood pressure variability in health and hypertensive pregnant women.

    PubMed

    Hermida, R C; Ayala, D E; Mojón, A; Iglesias, M

    1997-01-01

    The aim of this study was to describe the circadian pattern of non-invasive ambulatorily monitored blood pressure during the trimesters of pregnancy in clinically healthy women as well as in pregnant women who developed gestational hypertension or preeclampsia, and to compare sensitivity and specificity of diagnosis based on the average of the blood pressure series with the values obtained on the basis of casual measurements. We analyzed a total of 745 blood pressure series sampled by ambulatory monitoring for about 48 hours in each of several occasions in 189 women with uncomplicated pregnancies, 71 with gestational hypertension, and 29 with preeclampsia. The circadian pattern of BP variation for each group (complicated vs. uncomplicated pregnancies) and trimester of gestation was established by linear least-squares methods. Highly statistically different circadian patterns are demonstrated for systolic, mean arterial and diastolic blood pressure for both groups of pregnant women in all trimesters (P < 0.001 in all cases). Blood pressure decreases from the first trimester to the second and raises again in the third for healthy pregnant women, but continuously increases during gestation in women who developed gestational hypertension or preeclampsia. The differences in circadian rhythm-adjusted mean between complicated and uncomplicated pregnancies are highly statistically significant in all trimesters (P < .001). Sensitivity and specificity of diagnosing gestational hypertension based on the circadian mean are 73% and 48%, respectively, too low for a proper individualized diagnosis of gestational hypertension or preeclampsia. This study confirms the predictable circadian variability in blood pressure during gestation. The differences between healthy and complicated pregnancies can be observed as early as in the first trimester of pregnancy, but the use of the 24-hour mean BP does not provide a good approach for early diagnosis of gestational hypertension or

  17. Home blood pressure vs. clinic blood pressure measurement-based follow up in type ii diabetics: Effect on 24-h ambulatory BP and albuminuria. Randomised trial.

    PubMed

    Martínez, María A; Garcia-Puig, Juan; Loeches, Maria P; Mateo, Maria C; Utiel, Isaías; Torres, Rosa

    2017-08-31

    To compare the efficacy of two strategies of blood pressure (BP) measurement-based follow-up in hypertension and albuminuria control. Multicentre, prospective, randomised, open trial with a parallel-group design. Nineteen primary care centres and a hospital clinic participated. Adult type 2 diabetics with systolic BP ≥140mmHg without relevant renal disease were randomised to one of two follow-up strategies: 1) standard follow up, with a clinic BP target <140/90mmHg and 2) self-monitoring home BP (SMHBP)-based follow up, with a BP target <135/85mmHg. Biochemical standard blood variables, albuminuria, and 24-h ambulatory BP monitoring were performed at entry, 12 and 24 months. The main outcome measurement was 24-h ambulatory systolic BP variation. Albuminuria change was analysed as a secondary outcome. 116 patients were analysed (mean age: 66.8 years). Mean systolic ambulatory 24- h BP change in two years was 3.9mmHg (95% CI 1.8-6.1). We did not find significant differences between both groups (p=0.706). Similarly, no differences were found when we compared other ambulatory BP values. Initial albuminuria was similar in both groups and did not significantly changed throughout the follow-up period. In type 2 diabetics without relevant nephropathy a SMHBP- based follow up was equivalent to a standard clinic-based BP follow up in BP and albuminuria control. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  18. [Common variable immunodeficiency: Clinical and immunological characterization of patients and homogeneous subgroup definition by means of B lymphocyte subpopulation typing].

    PubMed

    Vélez, Alejandra Catalina; Castaño, Diana María; Gómez, Rubén Darío; Orrego, Julio César; Moncada, Marcela; Franco, José Luis

    2015-01-01

    Common variable immunodeficiency is a heterogeneous syndrome characterized by recurrent infections, hypogammaglobulinemia and defective production of specific antibodies. Abnormalities in peripheral blood lymphocyte subpopulations, in particular of B lymphocytes, allow the classification of patients into homogeneous groups. To perform a clinical and immunological characterization and to evaluate lymphocyte subpopulations of twelve Colombian patients with common variable immunodeficiency in order to define homogeneous groups. We reviewed medical records and evaluated serum immunoglobulins (Ig), lymphoproliferation, delayed hypersensitivity and used flow cytometry to quantify peripheral blood total lymphocyte and B cell populations. All patients had recurrent respiratory and/or gastrointestinal infections, while some also had infections affecting other systems. All patients had abnormally low serum IgG levels, while IgA and IgM levels were reduced in nine and ten patients, respectively. Lymphoproliferation to mitogen was lower in patients than in healthy controls but lymphoproliferation to specific antigen was normal in all. Flow cytometry revealed high numbers of T cells in three patients, while seven had a low CD4+/CD8+ ratio and four had reduced NK cells . Eleven patients had normal B cell counts, and eight of them also showed decreased memory B lymphocytes, and four had increased transitional or CD21 low B lymphocytes. Lymphocyte typing allowed assigning all but one patient to homogeneous groups according to international classification schemes, indicating the necessity of including more criteria until an ideal classification is achieved. This study will lead to a better medical monitoring of common variable immunodeficiency patients in groups at high risk of developing clinical complications.

  19. Evolving Identification of Blood Cells Associated with Clinically Isolated Syndrome: Importance of Time since Clinical Presentation and Diagnostic MRI

    PubMed Central

    Trend, Stephanie; Jones, Anderson P.; Geldenhuys, Sian; Byrne, Scott N.; Fabis-Pedrini, Marzena J.; Nolan, David; Booth, David R.; Carroll, William M.; Lucas, Robyn M.; Kermode, Allan G.; Hart, Prue H.

    2017-01-01

    It is not clear how the profile of immune cells in peripheral blood differs between patients with clinically isolated syndrome (CIS) and healthy controls (HC). This study aimed to identify a CIS peripheral blood signature that may provide clues for potential immunomodulatory approaches early in disease. Peripheral blood mononuclear cells (PBMCs) were collected from 18 people with CIS, 19 HC and 13 individuals with other demyelinating conditions (ODC) including multiple sclerosis (MS). Individuals with CIS separated into two groups, namely those with early (≤14 days post-diagnostic magnetic resonance imaging (MRI); n = 6) and late (≥27 days; n = 12) blood sampling. Transitional B cells were increased in the blood of CIS patients independently of when blood was taken. However, there were two time-dependent effects found in the late CIS group relative to HC, including decreased CD56bright NK cells, which correlated significantly with time since MRI, and increased CD141+ myeloid dendritic cell (mDC2) frequencies. Higher CD1c+ B cells and lower non-classical monocyte frequencies were characteristic of more recent demyelinating disease activity (ODC and early CIS). Analysing cell populations by time since symptoms (subjective) and diagnostic MRI (objective) may contribute to understanding CIS. PMID:28617321

  20. [Ambulatory blood pressure monitoring (CABPM): clinical characteristics of 31,530 patients].

    PubMed

    Sierra, Cristina; De la Sierra, Alejandro; Sobrino, Javier; Segura, Julián; Banegas, José Ramón; Gorostidi, Manuel; Ruilope, Luis Miguel

    2007-06-02

    Ambulatory blood pressure monitoring (ABPM) is a useful diagnostic and therapeutic tool in hypertensive patients. This study reports the clinical characteristics of 31,530 patients included in the Spanish Registry of ABPM. A total number of 767 investigators recruited patients with suspected or co