BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleedi...BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleeding and hypovolemic shock which entails significant clinical attention during initial resuscitation.AIM To assess whether an initial episode of prehospital or emergency department hypotension is associated with an increased risk of morbidity and mortality in trauma patients.METHODS A retrospective analysis was performed to include all trauma patients hospitalized between 2011 and 2021.Hypotension was defined as a systolic blood pressure≤90 mmHg in the prehospital setting or upon arrival to the hospital.Patients were classified into normotensive vs hypotensive and survivors vs nonsurvivors.Data was analyzed and compared,and multivariable logistic regression analysis was performed to identify the predictors of mortality.RESULTS Over the ten years,17341 trauma admissions were analyzed,of which 1188(6.9%)patients had hypotension episodes either at the scene or upon hospital arrival.Patients with hypotension were two years younger(P=0.001)in age and were more likely to have higher pulse rate(P=0.001),elevated shock index(P=0.001),sustained more severe injuries,frequently required blood transfusion and laparotomy,and had higher complications and mortality rates.Multivariable regression analysis identified hypotension[adjusted odds ratio(aOR)=2.505;95% confidence interval(95%CI)=1.798-3.489;P=0.001]and acute respiratory distress syndrome(ARDS;aOR=5.482;95%CI=3.297-9.116;P=0.001)as independent predictors of mortality.Among hypotensive trauma patients,only ARDS(aOR=3.518;95%CI=1.385-7.204;P=0.006)was significantly associated with mortality.CONCLUSION Hypotensive episodes following trauma are associated with higher severity and mortality.The development of ARDS is an independent predictor of mortality in hypotensive trauma patients.A hypotensive episode is a warning sign and calls for aggressive,timely management following trauma.展开更多
In order to find atriopeptin （AP） analogues with more potent and longer-lasting effects,we have synthesized rat APⅢ and its three analogues A1, A2, A3 , and assayed their bioactivitiesin anesthetized rats. The resu...In order to find atriopeptin （AP） analogues with more potent and longer-lasting effects,we have synthesized rat APⅢ and its three analogues A1, A2, A3 , and assayed their bioactivitiesin anesthetized rats. The results demonstrate that the synthesized APⅢ has powerful diuretic,natriuretic effects, and can remarkably lower arterial blood pressure, while the heart rote remainsunchanged in the process. The aforementioned effects of APⅢ are dose-dependent. The hypotensionof APⅢ is independent of the diuresis caused by APⅢ. The three analogues’ of APⅢ are all 24peptides. A<sub>1</sub> and A<sub>3</sub> had no bioactivities, while A<sub>2</sub> possessed atriopeptin-like, but weaker activities.The results suggest that the 5th, 6th and 7th amino add residues and their configurations in thepeptide chain of AP Ⅲ are crucial for eliciting bioactivities.展开更多
Desmodium velutinum (D. velutinum) is a plant of the family Fabaceae used in traditional Congolese medicine for the treatment of high blood pressure (HBP) or hypertension (HT). The present work evaluated the hypotensi...Desmodium velutinum (D. velutinum) is a plant of the family Fabaceae used in traditional Congolese medicine for the treatment of high blood pressure (HBP) or hypertension (HT). The present work evaluated the hypotensive activity and determined the phytochemical profile of the aqueous extract and fractions of Desmodium velutinun (Willd) D. C. (Fabaceae) in the rat. The hypotensive effect of the aqueous extract and different fractions (F1, F2, F3 and F4) was evaluated at the dose of 2.5 mg/kg in normotensive rats anesthetized with 15% urethane at 1.5 g/kg, i.p. (intraperitoneally). Our results showed that the F3 fraction after administration caused a significant decrease in blood pressure and heart rate which remained higher than that of the aqueous extract and fractions (F1, F2 and F4). The richness in polyphenolic and flavonoid compounds as well as the separating capacity of the eluent used within the F3 fraction clearly justifies the beneficial effects of the latter on blood pressure and heart rate compared with the extract and fractions (F1, F2 and F4). In a second part we carried out the qualitative (thin-layer chromatography) and quantitative (total polyphenols and flavonoids determination) analysis. The chemical compounds remained dominated by the polyphenolic and flavonoid groups, the content of total polyphenols and total flavonoids meets the following increasing order: (extract, F1, F2, F3 and F4). The results obtained could certify the use of Desmodium velutinun in traditional Congolese medicine.展开更多
Plant of Bambusa vulgaris is used in traditional medicine practice for the management of many pathologies including hypertension. The effect of the aqueous extract of the leaves of Bambusa vulgaris on blood pressure w...Plant of Bambusa vulgaris is used in traditional medicine practice for the management of many pathologies including hypertension. The effect of the aqueous extract of the leaves of Bambusa vulgaris on blood pressure was evaluated in normotensive male rabbits. Blood pressure was measured by the invasive method. Thus, aqueous extract of Bambusa vulgaris leaves had been injected intravenously at doses ranging from 1 mg/kg to 30 mg/kg in rabbits anesthetized with thiopental. The effects of this extract on blood pressure were also evaluated in rabbits having previously received different doses of atropine. The aqueous extract of Bambusa vulgaris leaves induced a dose-dependent hypotension which is not canceled in the presence of atropine. The results obtained show that the extract has blood pressure lowering effect which may be mediated by muscarinic-type cholinergic receptors.展开更多
Purpose: The aim of the current study was to investigate: 1) Whether there is an association between age and changes in systolic blood pressure (SBP) after stellate ganglion block (SGB), and 2) Whether gender plays a ...Purpose: The aim of the current study was to investigate: 1) Whether there is an association between age and changes in systolic blood pressure (SBP) after stellate ganglion block (SGB), and 2) Whether gender plays a role in hypotensive and hypertensive responses to SGB. Methods: We retrospectively reviewed SBP changes (ΔSBP) due to SGB, which were performed on 1641 subjects. SBP 30 min after SGB was compared to the baseline values. For the age study, average age of both sexes was calculated for six ranges of ΔSBP. For the gender study, the numbers of subjects (%) in various ranges of positive and negative values of ΔSBP were compared between men and women. Results: There was a significant association between age and both increasing (p Conclusions: There was an association between age and blood pressure changes after SGB and the association is most likely due to age-related alteration of cardiovascular functions. The different changes of SBP between men and women after SGB may well be attributable to gender differences of autonomic nervous regulation;sympathetic dominant man versus, parasympathetic dominant women.展开更多
Adrenomedullin (AdM), consisting of 52 amino acids, is a newly isolated pepotide from human pheochromocytoma. With hypotensive activity in normotensive rat, AdM was thought to be a newly discovered peptide in the regu...Adrenomedullin (AdM), consisting of 52 amino acids, is a newly isolated pepotide from human pheochromocytoma. With hypotensive activity in normotensive rat, AdM was thought to be a newly discovered peptide in the regulation of blood pressure. To investigate the biological functions and mechanisms of AdM, we synthesized AdM by the method of solid-phase in a Beckman 990B automatic peptide synthesizer. Synthesized AdM was cyclized and purified with final purity >98%. Its structure was same as AdM isolated from phechromocvtoma.展开更多
Intradialytic hypotension(IDH)is a prevalent and critical complication of haemodialysis associated with significant morbidity,mortality,and reduced quality of life in end-stage renal disease patients.IDH results from ...Intradialytic hypotension(IDH)is a prevalent and critical complication of haemodialysis associated with significant morbidity,mortality,and reduced quality of life in end-stage renal disease patients.IDH results from multifactorial interactions,including excessive ultrafiltration rates(UFR),rapid osmotic shifts,impaired vascular resistance,and comorbidities such as diabetes and cardiovascular disease.It triggers hypovolemic stress,leading to myocardial stunning,cerebral ischemia,and organ dysfunction.Non-modifiable risk factors,including age and preexisting conditions,exacerbate susceptibility,while modifiable elements such as high interdialytic weight gain and improper dialysis prescriptions worsen outcomes.In this review,we aim to conduct an in-depth analysis of IDH,exploring its clinical relevance,underlying mechanisms,risk factors,and management approaches.Additionally,we advocate for a standardised definition and propose a strategic framework to guide future research efforts.Effective management requires individualised approaches,including optimised UFR,cooled dialysate,and nutritional adjustments,alongside emerging technologies like bio-impedance spectroscopy and artificial intelligence for real-time risk prediction.A multidisciplinary team approach,incorporating nephrologists,nurses,and dietitians,is essential for holistic patient care.Future research and technological advancements hold promise for mitigating IDH’s clinical and systemic impact,ultimately improving patient outcomes and survival.展开更多
Objective:To summarize evidence on the prevention and management of intradialytic hypotension in maintenance hemodialysis patients,providing reference for clinical practice.Method:Chinese and English databases,guideli...Objective:To summarize evidence on the prevention and management of intradialytic hypotension in maintenance hemodialysis patients,providing reference for clinical practice.Method:Chinese and English databases,guideline websites,and professional society websites were systematically searched for literature on intradialytic hypotension guidance,including clinical decisions,guidelines,evidence summaries,systematic reviews,and expert consensuses,from database inception to October 1,2024.Evidence was extracted after literature quality evaluation.Results:A total of 11 publications were included:2 clinical decisions,7 guidelines,1 systematic review,and 1 expert consensus.38 pieces of evidence were summarized across 4 themes:pre-dialysis assessment and prevention,monitoring and management during dialysis,medication use,and patient self-management.Conclusion:The best evidence for prevention and management of intradialytic hypotension in maintenance hemodialysis patients is scientific and comprehensive.Healthcare professionals are advised to apply this evidence judiciously in conjunction with clinical realities to ensure patient safety.展开更多
Objective: To investigate the pharmacological basis of its uses of Phyla nodiflora(P. nodiflora) for the treatment of anomalies predominantly by smooth muscle containing tissues such as gastrointestinal/vascular/bronc...Objective: To investigate the pharmacological basis of its uses of Phyla nodiflora(P. nodiflora) for the treatment of anomalies predominantly by smooth muscle containing tissues such as gastrointestinal/vascular/broncho spasm and cardiovascular modulation.Methods: The crude hydroalcoholic extract of P. nodiflora(Pn.Cr) and its fractions were evaluated on isolated rabbit jejunum, rat trachea, aorta and atrium. To access the contractile or relaxant effects of testing materials, the tissues were mounted in isolated organ bath and responses were recorded with transducers coupled with data acquisition system.BALB/c mice were challenged with castor oil for the assessment of in-vivo antidiarrheal activity. Normotensive rats were used for in-vivo hypotensive study.Results: Hydroalcoholic extract of Pn.Cr at variable concentrations inhibited the natural spontaneous rhythm and 80 mmol/L K^+ mediated contractions in isolated segment of jejunum with EC_(50) values of 3.18 and 1.91 mg/mL respectively. Verapamil, a Ca^(2+) channel blocker, demonstrated akin pattern in jejunum and therefore possibly suggesting calcium blocking activity. On isolated rat tracheal tissue, Pn.Cr showed relaxation of high-K^+and carbachol mediated contractions(EC_(50) values: 1.24 and 2.42 mg/mL). Pn.Cr treatment relaxed the rat aortic ring in a cumulative doses with high-K^+ and phenylephrine-induced contractions(EC_(50) values 0.25 and 0.92 mg/mL). Activity based fractionation of Pn.Cr showed that dichloromethane fraction was more potent for relaxing the tissues spasm compared to aqueous fraction. In-vivo experiments, significant protection by Pn.Cr(P < 0.05) was observed in castor oil-induced diarrhea(50–500 mg/kg)whereas hypotensive effect in anesthetized rats was seen at the dose range of 1–10 mg/kg of Pn.Cr(P < 0.05).Conclusion: This study suggests the blockage of calcium channel in the smooth muscles as a pharmacological application to make usage of P. nodiflora in the management of diarrhea, asthma and hypotensive effect.展开更多
The use of cooled dialysate temperatures first came about in the early 1980s as a way to curb the incidence of intradialytic hypotension （IDH）. IDH was then, and it remains today, the most common complication affect...The use of cooled dialysate temperatures first came about in the early 1980s as a way to curb the incidence of intradialytic hypotension （IDH）. IDH was then, and it remains today, the most common complication affecting chronic hemodialysis patients. It decreases quality of life on dialysis and is an independent risk factor for mortality. Cooling dialysate was first employed as a technique to incite peripheral vasoconstriction on dialysis and in turn reduce the incidence of intradialytic hypotension. Although it has become a common practice amongst in-center hemodialysis units, cooled dialysate results in up to 70% of patients feeling cold while on dialysis and some even experience shivering. Over the years, various studies have been performed to evaluate the safety and effcacy of cooled dialysate in comparison to a standard, more thermoneutral dialysate temperature of 37℃. Although these studies are limited by small sample size, they are promising in many aspects. They demonstrated that cooled dialysis is safe and equally efficacious as thermoneutral dialysis. Although patients report feeling cold on dialysis, they also report increased energy and an improvement in their overall health following cooled dialysis. They established that cooling dialysate temperatures improves hemodynamic tolerability during and after hemodialysis, even in patients prone to IDH, and does so without adversely affecting dialysis adequacy. Cooled dialysis also reduces the incidence of IDH and has a protective effect over major organs including the heart and brain. Finally, it is an inexpensive measure that decreases economic burden by reducing necessary nursing intervention for issues that arise on hemodialysis such as IDH. Before cooled dialysate becomes standard of care for patients on chronic hemodialysis, larger studies with longer follow-up periods will need to take place to confrm the encouraging outcomes mentioned here.展开更多
Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and invol...Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death.In addition,autoimmune and genetic factors are involved in the development of CAN.CAN might be subclinical for several years until the patient develops resting tachycardia,exercise intolerance,postural hypotension,cardiac dysfunction and diabetic cardiomyopathy.During its sub-clinical phase,heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic.Newer imaging techniques(such as scintigraphy)have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system.One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN;however,the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN,and also proposed screening for CAN in patients with diabetes mellitus.A major challenge,however,is the lack of specific treatment to slow the progression or prevent the development of CAN.Lifestyle changes,improved metabolic control might prevent or slow the progression of CAN.Reversal will require combination of these treatments with new targeted therapeutic approaches.The aim of this article is to review the latest evidence regarding the epidemiology,pathogenesis,manifestations,diagnosis and treatment for CAN.展开更多
Objective To assess the prevalence of and risk factors for postprandial hypotension （PPH） among old and very old Chinese men. Methods The study included 349 Chinese men aged 65 and older, grouped into two age catego...Objective To assess the prevalence of and risk factors for postprandial hypotension （PPH） among old and very old Chinese men. Methods The study included 349 Chinese men aged 65 and older, grouped into two age categories： group 1 （old） included 163 men aged 65 to 80 years; group 2 （very old） included 186 men aged over 80 years. Blood pressure changes after meals were assessed every 15 min by ambulatory blood pressure monitoring. Symptoms after meal ingestion and after standing up and changes in the baseline condition relative to blood pressure changes were observed continuously. Additional baseline data included body mass index, medical history, and medication use Results The prevalence of PPH was 59.3% overall and was significantly higher in group 2 than group 1 （63.4% vs. 54.6%, P 〈 0.05）. In group 2, the prevalence of PPH after breakfast （33.8%） and lunch （32.1%） were higher than that after supper （20.9%）, P 〈 0.05. Hypertension and age were significant risk factors for PPH （OR = 2.188, 95% CI： 1.134-4.223, P = 0.02; OR = 1.86, 95% CI： 1.112-3.11, P = 0.018, respectively）. In contrast, acarbose use was protective against PPH （OR = 0.4, 95% CI： 0.189-0.847, P = 0.017）. The decrease in blood pres- sure during PPH was 20-40 mmHg and the maximum was 90 mmHg. PPH usually occurred at 30-60 min after a meal and lasted 30-120 rnin. Conclusions These findings demonstrate that the prevalence of PPH in men aged over 80 years is significantly higher than those in men aged 65 to 80 years, and the blood pressure decline is also higher for men aged over 80 years. In addition, hypertension and age were main risk factors for PPH in the older men, which suggest that preventing and treating PPH is worthwhile.展开更多
Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point...Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point where phenylephrine has become the preferred vasopressor. Due to the absence of definitive evidence showing absolute clinical benefit of one over the other, especially in emergency and high-risk Cesarean sections, our choice of phenylephrine over the other vasopressors like mephentermine, metaraminol, and ephedrine is guided by indirect evidence on fetalacid-base status. This review article evaluates the present day evidence on the various vasopressors used in obstetric anesthesia today.展开更多
文摘BACKGROUND Early hemodynamic assessment remains crucial for proper management in trauma settings.Hypotension is a vital indication in trauma patients to be considered upon initial triaging to assess the risk of bleeding and hypovolemic shock which entails significant clinical attention during initial resuscitation.AIM To assess whether an initial episode of prehospital or emergency department hypotension is associated with an increased risk of morbidity and mortality in trauma patients.METHODS A retrospective analysis was performed to include all trauma patients hospitalized between 2011 and 2021.Hypotension was defined as a systolic blood pressure≤90 mmHg in the prehospital setting or upon arrival to the hospital.Patients were classified into normotensive vs hypotensive and survivors vs nonsurvivors.Data was analyzed and compared,and multivariable logistic regression analysis was performed to identify the predictors of mortality.RESULTS Over the ten years,17341 trauma admissions were analyzed,of which 1188(6.9%)patients had hypotension episodes either at the scene or upon hospital arrival.Patients with hypotension were two years younger(P=0.001)in age and were more likely to have higher pulse rate(P=0.001),elevated shock index(P=0.001),sustained more severe injuries,frequently required blood transfusion and laparotomy,and had higher complications and mortality rates.Multivariable regression analysis identified hypotension[adjusted odds ratio(aOR)=2.505;95% confidence interval(95%CI)=1.798-3.489;P=0.001]and acute respiratory distress syndrome(ARDS;aOR=5.482;95%CI=3.297-9.116;P=0.001)as independent predictors of mortality.Among hypotensive trauma patients,only ARDS(aOR=3.518;95%CI=1.385-7.204;P=0.006)was significantly associated with mortality.CONCLUSION Hypotensive episodes following trauma are associated with higher severity and mortality.The development of ARDS is an independent predictor of mortality in hypotensive trauma patients.A hypotensive episode is a warning sign and calls for aggressive,timely management following trauma.
文摘In order to find atriopeptin （AP） analogues with more potent and longer-lasting effects,we have synthesized rat APⅢ and its three analogues A1, A2, A3 , and assayed their bioactivitiesin anesthetized rats. The results demonstrate that the synthesized APⅢ has powerful diuretic,natriuretic effects, and can remarkably lower arterial blood pressure, while the heart rote remainsunchanged in the process. The aforementioned effects of APⅢ are dose-dependent. The hypotensionof APⅢ is independent of the diuresis caused by APⅢ. The three analogues’ of APⅢ are all 24peptides. A<sub>1</sub> and A<sub>3</sub> had no bioactivities, while A<sub>2</sub> possessed atriopeptin-like, but weaker activities.The results suggest that the 5th, 6th and 7th amino add residues and their configurations in thepeptide chain of AP Ⅲ are crucial for eliciting bioactivities.
文摘Desmodium velutinum (D. velutinum) is a plant of the family Fabaceae used in traditional Congolese medicine for the treatment of high blood pressure (HBP) or hypertension (HT). The present work evaluated the hypotensive activity and determined the phytochemical profile of the aqueous extract and fractions of Desmodium velutinun (Willd) D. C. (Fabaceae) in the rat. The hypotensive effect of the aqueous extract and different fractions (F1, F2, F3 and F4) was evaluated at the dose of 2.5 mg/kg in normotensive rats anesthetized with 15% urethane at 1.5 g/kg, i.p. (intraperitoneally). Our results showed that the F3 fraction after administration caused a significant decrease in blood pressure and heart rate which remained higher than that of the aqueous extract and fractions (F1, F2 and F4). The richness in polyphenolic and flavonoid compounds as well as the separating capacity of the eluent used within the F3 fraction clearly justifies the beneficial effects of the latter on blood pressure and heart rate compared with the extract and fractions (F1, F2 and F4). In a second part we carried out the qualitative (thin-layer chromatography) and quantitative (total polyphenols and flavonoids determination) analysis. The chemical compounds remained dominated by the polyphenolic and flavonoid groups, the content of total polyphenols and total flavonoids meets the following increasing order: (extract, F1, F2, F3 and F4). The results obtained could certify the use of Desmodium velutinun in traditional Congolese medicine.
文摘Plant of Bambusa vulgaris is used in traditional medicine practice for the management of many pathologies including hypertension. The effect of the aqueous extract of the leaves of Bambusa vulgaris on blood pressure was evaluated in normotensive male rabbits. Blood pressure was measured by the invasive method. Thus, aqueous extract of Bambusa vulgaris leaves had been injected intravenously at doses ranging from 1 mg/kg to 30 mg/kg in rabbits anesthetized with thiopental. The effects of this extract on blood pressure were also evaluated in rabbits having previously received different doses of atropine. The aqueous extract of Bambusa vulgaris leaves induced a dose-dependent hypotension which is not canceled in the presence of atropine. The results obtained show that the extract has blood pressure lowering effect which may be mediated by muscarinic-type cholinergic receptors.
文摘Purpose: The aim of the current study was to investigate: 1) Whether there is an association between age and changes in systolic blood pressure (SBP) after stellate ganglion block (SGB), and 2) Whether gender plays a role in hypotensive and hypertensive responses to SGB. Methods: We retrospectively reviewed SBP changes (ΔSBP) due to SGB, which were performed on 1641 subjects. SBP 30 min after SGB was compared to the baseline values. For the age study, average age of both sexes was calculated for six ranges of ΔSBP. For the gender study, the numbers of subjects (%) in various ranges of positive and negative values of ΔSBP were compared between men and women. Results: There was a significant association between age and both increasing (p Conclusions: There was an association between age and blood pressure changes after SGB and the association is most likely due to age-related alteration of cardiovascular functions. The different changes of SBP between men and women after SGB may well be attributable to gender differences of autonomic nervous regulation;sympathetic dominant man versus, parasympathetic dominant women.
文摘Adrenomedullin (AdM), consisting of 52 amino acids, is a newly isolated pepotide from human pheochromocytoma. With hypotensive activity in normotensive rat, AdM was thought to be a newly discovered peptide in the regulation of blood pressure. To investigate the biological functions and mechanisms of AdM, we synthesized AdM by the method of solid-phase in a Beckman 990B automatic peptide synthesizer. Synthesized AdM was cyclized and purified with final purity >98%. Its structure was same as AdM isolated from phechromocvtoma.
文摘Intradialytic hypotension(IDH)is a prevalent and critical complication of haemodialysis associated with significant morbidity,mortality,and reduced quality of life in end-stage renal disease patients.IDH results from multifactorial interactions,including excessive ultrafiltration rates(UFR),rapid osmotic shifts,impaired vascular resistance,and comorbidities such as diabetes and cardiovascular disease.It triggers hypovolemic stress,leading to myocardial stunning,cerebral ischemia,and organ dysfunction.Non-modifiable risk factors,including age and preexisting conditions,exacerbate susceptibility,while modifiable elements such as high interdialytic weight gain and improper dialysis prescriptions worsen outcomes.In this review,we aim to conduct an in-depth analysis of IDH,exploring its clinical relevance,underlying mechanisms,risk factors,and management approaches.Additionally,we advocate for a standardised definition and propose a strategic framework to guide future research efforts.Effective management requires individualised approaches,including optimised UFR,cooled dialysate,and nutritional adjustments,alongside emerging technologies like bio-impedance spectroscopy and artificial intelligence for real-time risk prediction.A multidisciplinary team approach,incorporating nephrologists,nurses,and dietitians,is essential for holistic patient care.Future research and technological advancements hold promise for mitigating IDH’s clinical and systemic impact,ultimately improving patient outcomes and survival.
文摘Objective:To summarize evidence on the prevention and management of intradialytic hypotension in maintenance hemodialysis patients,providing reference for clinical practice.Method:Chinese and English databases,guideline websites,and professional society websites were systematically searched for literature on intradialytic hypotension guidance,including clinical decisions,guidelines,evidence summaries,systematic reviews,and expert consensuses,from database inception to October 1,2024.Evidence was extracted after literature quality evaluation.Results:A total of 11 publications were included:2 clinical decisions,7 guidelines,1 systematic review,and 1 expert consensus.38 pieces of evidence were summarized across 4 themes:pre-dialysis assessment and prevention,monitoring and management during dialysis,medication use,and patient self-management.Conclusion:The best evidence for prevention and management of intradialytic hypotension in maintenance hemodialysis patients is scientific and comprehensive.Healthcare professionals are advised to apply this evidence judiciously in conjunction with clinical realities to ensure patient safety.
基金funded by Bahauddin Zakariya University,Multan,Pakistan(No.DR&EL/D-443)
文摘Objective: To investigate the pharmacological basis of its uses of Phyla nodiflora(P. nodiflora) for the treatment of anomalies predominantly by smooth muscle containing tissues such as gastrointestinal/vascular/broncho spasm and cardiovascular modulation.Methods: The crude hydroalcoholic extract of P. nodiflora(Pn.Cr) and its fractions were evaluated on isolated rabbit jejunum, rat trachea, aorta and atrium. To access the contractile or relaxant effects of testing materials, the tissues were mounted in isolated organ bath and responses were recorded with transducers coupled with data acquisition system.BALB/c mice were challenged with castor oil for the assessment of in-vivo antidiarrheal activity. Normotensive rats were used for in-vivo hypotensive study.Results: Hydroalcoholic extract of Pn.Cr at variable concentrations inhibited the natural spontaneous rhythm and 80 mmol/L K^+ mediated contractions in isolated segment of jejunum with EC_(50) values of 3.18 and 1.91 mg/mL respectively. Verapamil, a Ca^(2+) channel blocker, demonstrated akin pattern in jejunum and therefore possibly suggesting calcium blocking activity. On isolated rat tracheal tissue, Pn.Cr showed relaxation of high-K^+and carbachol mediated contractions(EC_(50) values: 1.24 and 2.42 mg/mL). Pn.Cr treatment relaxed the rat aortic ring in a cumulative doses with high-K^+ and phenylephrine-induced contractions(EC_(50) values 0.25 and 0.92 mg/mL). Activity based fractionation of Pn.Cr showed that dichloromethane fraction was more potent for relaxing the tissues spasm compared to aqueous fraction. In-vivo experiments, significant protection by Pn.Cr(P < 0.05) was observed in castor oil-induced diarrhea(50–500 mg/kg)whereas hypotensive effect in anesthetized rats was seen at the dose range of 1–10 mg/kg of Pn.Cr(P < 0.05).Conclusion: This study suggests the blockage of calcium channel in the smooth muscles as a pharmacological application to make usage of P. nodiflora in the management of diarrhea, asthma and hypotensive effect.
文摘The use of cooled dialysate temperatures first came about in the early 1980s as a way to curb the incidence of intradialytic hypotension （IDH）. IDH was then, and it remains today, the most common complication affecting chronic hemodialysis patients. It decreases quality of life on dialysis and is an independent risk factor for mortality. Cooling dialysate was first employed as a technique to incite peripheral vasoconstriction on dialysis and in turn reduce the incidence of intradialytic hypotension. Although it has become a common practice amongst in-center hemodialysis units, cooled dialysate results in up to 70% of patients feeling cold while on dialysis and some even experience shivering. Over the years, various studies have been performed to evaluate the safety and effcacy of cooled dialysate in comparison to a standard, more thermoneutral dialysate temperature of 37℃. Although these studies are limited by small sample size, they are promising in many aspects. They demonstrated that cooled dialysis is safe and equally efficacious as thermoneutral dialysis. Although patients report feeling cold on dialysis, they also report increased energy and an improvement in their overall health following cooled dialysis. They established that cooling dialysate temperatures improves hemodynamic tolerability during and after hemodialysis, even in patients prone to IDH, and does so without adversely affecting dialysis adequacy. Cooled dialysis also reduces the incidence of IDH and has a protective effect over major organs including the heart and brain. Finally, it is an inexpensive measure that decreases economic burden by reducing necessary nursing intervention for issues that arise on hemodialysis such as IDH. Before cooled dialysate becomes standard of care for patients on chronic hemodialysis, larger studies with longer follow-up periods will need to take place to confrm the encouraging outcomes mentioned here.
文摘Cardiac autonomic neuropathy(CAN)is an often overlooked and common complication of diabetes mellitus.CAN is associated with increased cardiovascular morbidity and mortality.The pathogenesis of CAN is complex and involves a cascade of pathways activated by hyperglycaemia resulting in neuronal ischaemia and cellular death.In addition,autoimmune and genetic factors are involved in the development of CAN.CAN might be subclinical for several years until the patient develops resting tachycardia,exercise intolerance,postural hypotension,cardiac dysfunction and diabetic cardiomyopathy.During its sub-clinical phase,heart rate variability that is influenced by the balance between parasympathetic and sympathetic tones can help in detecting CAN before the disease is symptomatic.Newer imaging techniques(such as scintigraphy)have allowed earlier detection of CAN in the pre-clinical phase and allowed better assessment of the sympathetic nervous system.One of the main difficulties in CAN research is the lack of a universally accepted definition of CAN;however,the Toronto Consensus Panel on Diabetic Neuropathy has recently issued guidance for the diagnosis and staging of CAN,and also proposed screening for CAN in patients with diabetes mellitus.A major challenge,however,is the lack of specific treatment to slow the progression or prevent the development of CAN.Lifestyle changes,improved metabolic control might prevent or slow the progression of CAN.Reversal will require combination of these treatments with new targeted therapeutic approaches.The aim of this article is to review the latest evidence regarding the epidemiology,pathogenesis,manifestations,diagnosis and treatment for CAN.
文摘Objective To assess the prevalence of and risk factors for postprandial hypotension （PPH） among old and very old Chinese men. Methods The study included 349 Chinese men aged 65 and older, grouped into two age categories： group 1 （old） included 163 men aged 65 to 80 years; group 2 （very old） included 186 men aged over 80 years. Blood pressure changes after meals were assessed every 15 min by ambulatory blood pressure monitoring. Symptoms after meal ingestion and after standing up and changes in the baseline condition relative to blood pressure changes were observed continuously. Additional baseline data included body mass index, medical history, and medication use Results The prevalence of PPH was 59.3% overall and was significantly higher in group 2 than group 1 （63.4% vs. 54.6%, P 〈 0.05）. In group 2, the prevalence of PPH after breakfast （33.8%） and lunch （32.1%） were higher than that after supper （20.9%）, P 〈 0.05. Hypertension and age were significant risk factors for PPH （OR = 2.188, 95% CI： 1.134-4.223, P = 0.02; OR = 1.86, 95% CI： 1.112-3.11, P = 0.018, respectively）. In contrast, acarbose use was protective against PPH （OR = 0.4, 95% CI： 0.189-0.847, P = 0.017）. The decrease in blood pres- sure during PPH was 20-40 mmHg and the maximum was 90 mmHg. PPH usually occurred at 30-60 min after a meal and lasted 30-120 rnin. Conclusions These findings demonstrate that the prevalence of PPH in men aged over 80 years is significantly higher than those in men aged 65 to 80 years, and the blood pressure decline is also higher for men aged over 80 years. In addition, hypertension and age were main risk factors for PPH in the older men, which suggest that preventing and treating PPH is worthwhile.
文摘Vasopressors are routinely used to counteract hypotension after neuraxial anesthesia in Obstetrics. The understanding of the mechanism of hypotension and the choice of vasopressor has evolved over the years to a point where phenylephrine has become the preferred vasopressor. Due to the absence of definitive evidence showing absolute clinical benefit of one over the other, especially in emergency and high-risk Cesarean sections, our choice of phenylephrine over the other vasopressors like mephentermine, metaraminol, and ephedrine is guided by indirect evidence on fetalacid-base status. This review article evaluates the present day evidence on the various vasopressors used in obstetric anesthesia today.
