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

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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

Intraocular pressure, blood pressure, and retinal blood flow autoregulation: a mathematical model to clarify their relationship and clinical relevance.

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

2014-05-29

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. 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. 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. 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. Copyright 2014 The Association for Research in Vision and Ophthalmology, Inc.

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

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Annamária Magdás

2016-01-01

Full Text Available 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 m2 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.

High beat-to-beat blood pressure variability in atrial fibrillation compared to sinus rhythm.

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Olbers, Joakim; Gille, Adam; Ljungman, Petter; Rosenqvist, Mårten; Östergren, Jan; Witt, Nils

2018-02-07

Atrial fibrillation (AF) is associated with an increased risk for cardiovascular morbidity and mortality, not entirely explained by thromboembolism. The underlying mechanisms for this association are largely unknown. Similarly, high blood pressure (BP) increases the risk for cardiovascular events. Despite this the interplay between AF and BP is insufficiently studied. The purpose of this study was to examine and quantify the beat-to-beat blood pressure variability in patients with AF in comparison to a control group of patients with sinus rhythm. We studied 33 patients - 21 in atrial fibrillation and 12 in sinus rhythm - undergoing routine coronary angiography. Invasive blood pressure was recorded at three locations: radial artery, brachial artery and ascending aorta. Blood pressure variability, defined as average beat-to-beat blood pressure difference, was calculated for systolic and diastolic blood pressure at each site. We observed a significant difference (p blood pressure variability between the atrial fibrillation and sinus rhythm groups at all locations. Systolic blood pressure variability roughly doubled in the atrial fibrillation group compared to the sinus rhythm group (4.9 and 2.4 mmHg respectively). Diastolic beat-to-beat blood pressure variability was approximately 6 times as high in the atrial fibrillation group compared to the sinus rhythm group (7.5 and 1.2 mmHg respectively). No significant difference in blood pressure variability was seen between measurement locations. Beat-to-beat blood pressure variability in patients with atrial fibrillation was substantially higher than in patients with sinus rhythm. Hemodynamic effects of this beat-to-beat variation in blood pressure may negatively affect vascular structure and function, which may contribute to the increased cardiovascular morbidity and mortality seen in patients with atrial fibrillation.

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

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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.

Multidisciplinary Treatment of the Metabolic Syndrome Lowers Blood Pressure Variability Independent of Blood Pressure Control.

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Marcus, Yonit; Segev, Elad; Shefer, Gabi; Sack, Jessica; Tal, Brurya; Yaron, Marianna; Carmeli, Eli; Shefer, Lili; Margaliot, Miri; Limor, Rona; Gilad, Suzan; Sofer, Yael; Stern, Naftali

2016-01-01

Blood pressure (BP) variability (BPV) contributes to target organ damage independent of BP. The authors examined the effect of a 1-year multidisciplinary intervention on BPV in patients with the metabolic syndrome (MetS) as defined by criteria from the Third Report of the Adult Treatment Panel. Forty-four nondiabetic patients underwent clinical and biochemical profiling, 24-hour ambulatory BP monitoring (ABPM), body composition, carotid intima-media thickness, and carotid-femoral pulse wave velocity (PWV). The intervention targeted all MetS components. BPV was assessed by the standard deviation of daytime systolic BP derived from ABPM. Patients with low and high BPV (lower or higher than the median daytime standard deviation of 11.6 mm Hg) did not differ in regards to systolic and diastolic BP, age, fasting glucose, glycated hemoglobin, and body mass index, but the high-variability group had higher values of low-density lipoprotein and leg fat. The 1-year intervention resulted in weight reduction but not BP-lowering. BPV declined in the high-variability group in association with lowering of PWV, C-reactive protein, glycated hemoglobin, alanine aminotransferase, asymmetric dimethylarginine, and increased high-density lipoprotein cholesterol. A multidisciplinary intervention independent of BP-lowering normalized BPV, lowered PWV, and enhanced metabolic control. © 2015 Wiley Periodicals, Inc.

Variability of blood pressure and blood glucose during perioperative period for patients with secondary neovascular glaucoma after silicone oil removed in PDR

Directory of Open Access Journals (Sweden)

Fu-Lin Gao

2015-06-01

Full Text Available AIM:To research blood pressure and blood glucose variability during peroperative period for patients with secondary neovasular glaucoma(NVGafter silicone oil removed in proliferative diabetic retinaopathy(PDR.METHODS: Totally, 271 patients(271 eyesundergone surgery of vitrectomy and silicon-oil tamponade combined with cataract were respective analyzed. Fourteen patients(14 eyeswith secondary NVG after silicon oil removed and randomly controlled group of no NVG according with ages, operation method in the same time were studied. The blood pressure and blood glucose variability during peroperative period was analyzed, and did comparison after excluded contralateral eye. The complications of 271 patients were surveyed in following-up period 1～12mo. The incidence of NVG, the time, blood pressure, blood glucose and glycated hemoglobin(Hbc%variability during peroperative period was statisticed and compared by software of SPSS 11.0.RESULTS: Fourteen eyes(5.2%of 271 cases was with secondary NVG(female: 4 eyes, 28.6%; male: 10 eyes, 71.4%, average ages was 57.07 years(49～68 years. NVG presented in the 107～ 135d after vitrectomy and 7～45d(average 31.78dafter silicon-oil removed. Diabetes mellitus was 10～15(average 13.2a. In NVG group, the variability of blood glucose was 4.0～10.2mmol/L(mean 8.52±3.24mmol/L, variable coefficient was 0.48. In NNVG group, the variability of blood glucose was 5.0～8.2mmol/L(mean 7.22±0.24mmol/L, variable coefficient was 0.43. It was significantly difference in comparison in variable coefficient(PPPPCONCLUSION: There are significant variability on fasting blood glucose, daytime SBP and night DBP during perioperative in PDR patients with secondary NVG. It might be occurred 1wk after silicone oil removal surgery.

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

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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.

LB01.06: VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND CARDIOVASCULAR OUTCOMES IN FELODIPINE EVENT REDUCTION STUDY.

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Zhang, Y; Zhang, X; Liu, L; Zanchetti, A

2015-06-01

Many antihypertensive outcome trials have shown that visit-to-visit blood pressure variability is correlated closely with clinical outcomes in hypertensive patients. The objective of the study was to investigate the relationship between visit-to-visit blood pressure variability (BPV) and the major cardiovascular outcomes in the Chinese hypertensive patients. Felodipine Event Reduction (FEVER) study was a double-blind, randomized trial on 9711 Chinese hypertensive patients, in whom cardiovascular outcomes were significantly reduced by more intense therapy achieving a mean of 138 mmHg SBP compared with less-intense therapy achieving a mean of 142 mmHg. Visit-to-visit BPV during the follow-up period [defined as standard deviation (SD), coefficient of variation (CV), and average real variability(ARV)] was derived from casual cuff BP measures after six months follow-up until the end of the study. Hazard ratios (HRs), for the incidence of CVD associated with SD, CV, and ARV of SBP and DBP were calculated using Cox proportional hazard models. Overall predictive power [area under receiver operating characteristic (AUC ROC) curve] of the level of blood pressure, blood pressure variability and other baseline characteristics was calculated. In FEVER study, visit-to-visit variability in SBP were significant predictors of subsequent stroke [eg, hazard ratios [HR] for ARV, SD and CV was 1.071 (95% CI: 1.025-1.118), 1.373 (95% CI: 1.159-1.626) and 0.572 (95% CI: 0.451-0,726)]. Visit-to-visit variability in DBP were also showed similar trend [eg, HR for ARV, SD and CV was 1.066 (95% CI: 0.992-1.145), 1.931 (95% CI: 1.435-2.598) and 0.558 (95% CI: 0.438-0,710)]. However, using the analysis of AUC ROC analysis, the risk importance sequence of the stroke events in this cohort was level of SBP, age, level of DBP ARV, SD, sex, CV and treatment. Visit-to-visit blood pressure variability has some effects on the cardiovascular outcomes in the Chinese hypertensive patents in the cohort in

Clinical blood pool MR Imaging

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Leiner, Tim [Maastrich University Medical Center (Netherlands). Dept. of Radiology; Goyen, Martin [University Medical Center Hamburg-Eppendorf (Germany); Rohrer, Mathias [Bayer Schering Pharma AG, Berlin (Germany). European Business Unit Diagnostic Imaging; Schoenberg, Stefan O. (eds.) [University Hospital Mannheim Medical Faculty Mannheim - Heidelberg Univ. (Germany). Dept. of Clinical Radiology and Nuclear Medicine

2008-07-01

Clinical Blood Pool MR Imaging - This excellent treatise on Vasovist {sup registered} created by a team of exceptional faculty who are pioneers in MR Angiography covers the basic techniques, safety, efficacy, image processing and pharmaco-economic details to successfully implement a new level of MRA image quality with this new contrast agent. Martin Prince, Cornell University, New York The editors and authors have made groundbreaking contributions towards establishing MR angiography in various investigative settings, rendering it more precise and applying it for diverse indications. The work presented here is founded upon the extensive experience of the editors, as well as the broad range of experience from other scientific working groups. Maximilian Reiser, Ludwig Maximilian University, Munich Vasovist {sup registered} (Gadofosveset), worldwide the first blood pool agent, has only recently become available for clinical use, but has already gained wide acceptance as a tool to improve magnetic resonance angiography. This book presents the first in-depth introduction to the basic physicochemical aspects of the agent, the application of Vasovist {sup registered} in clinical MRA, as well as potential clinical applications beyond MRA and patient management-related aspects. The first part of the book explains basic and technical properties of the agent and the differences of Vasovist {sup registered} compared to currently available extracellular agents. The second part contains detailed chapters on safety and efficacy. In the third part the focus is on MR angiographic applications, and in the fourth part of the book potential clinical fields beyond MRA are explored. All clinical chapters feature ready-to-use clinical protocols and a series of take home messages that concisely summarize the current role of blood pool imaging for each specific indication. (orig.)

Sources of variability of resting cerebral blood flow in healthy subjects

DEFF Research Database (Denmark)

Henriksen, Otto Mølby; Kruuse, Christina Rostrup; Olesen, Jes

2013-01-01

Measurements of cerebral blood flow (CBF) show large variability among healthy subjects. The aim of the present study was to investigate the relative effect of established factors influencing CBF on the variability of resting CBF. We retrospectively analyzed spontaneous variability in 430 CBF...... measurements acquired in 152 healthy, young subjects using (133)Xe single-photon emission computed tomography. Cerebral blood flow was correlated positively with both end-tidal expiratory PCO2 (PETCO2) and female gender and inversely with hematocrit (Hct). Between- and within-subject CO2 reactivity...... when Hct was also accounted for. The present study confirms large between-subject variability in CBF measurements and that gender, Hct, and PETCO2 explain only a small part of this variability. This implies that a large fraction of CBF variability may be due to unknown factors such as differences...

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

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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.

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

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Matteucci, Elena; Consani, Cristina; Masoni, Maria Chiara; Giampietro, Ottavio

2010-10-05

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. 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). 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. 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.

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

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Masoni Maria

2010-10-01

Full Text Available Abstract 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.

Effects of aging on blood pressure variability in resting conditions

NARCIS (Netherlands)

Veerman, D. P.; Imholz, B. P.; Wieling, W.; Karemaker, J. M.; van Montfrans, G. A.

1994-01-01

The objective of this study was to determine the effect of aging on beat-to-beat blood pressure and pulse interval variability in resting conditions and to determine the effect of aging on the sympathetic and vagal influence on the cardiovascular system by power spectral analysis of blood pressure

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

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

2017-12-01

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 advertisement was associated with a significant decrease in the age of participants enquiring into the study (from 60.9 to 58.7 years; P 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.

Clinical and Laboratory Potential Predictors of Blood Culture Positivity in Under Five Children with Clinically Severe Pneumonia - Khartoum -Sudan.

Science.gov (United States)

Salih, Karimeldin Mohamed Ali; El-Samani, El-Fatih; Bilal, Jalal Ali; Eldouch, Widad; Ibrahim, Salah Ahmed

2015-08-01

Blood culture is necessary for appropriate management of clinically severe pneumonia in children under five years of age. However, in limited resource countries it might be unduly costly and waste of valuable time because of the high negative culture rate. This study aims to identify clinical and laboratory parameters that potentially predict a positive blood culture in cases of severe pneumonia. A hospital based study, enrolled 189 cases satisfying the WHO definition of severe pneumonia. Age, gender, clinical history, physical examination, temperature, complete blood count, C-reactive protein, blood culture and Chest X Ray for all the patients were recorded. Forty one patients had positive blood culture giving a prevalence of 21.7%. All variables were used in a dichotomous manner. White Blood Count (WBC) more than 20 000, very high C-reactive protein (C-RP ≥8mg/L) and Temperature more than 40(o)C, had a positive predictive value of 46.1%, 44.3% and 40.0% respectively for a positive culture as well as a Negative Predictive Value of 91.1%, 91.6% and 91.7% respectively. The WBC more than 20 000 and temperature above 40(o)C had a significant association with a positive blood culture. Their adjusted Odds Ratios were 3.9 (95% CI: 1.4-10.90) and 3.1 (95% CI: 1.2-8.4) respectively. This was not the case for C-RP (Odds Ratio=2.2, 95% CI: 0.7-2.2) or positive Chest X Ray (Odds Ratio=1.5, 95% CI: 0.6-3.6). Temperature of more than 40(o)C, Very high C-RP and WBC of more than 20 000 are good indicators of a potential positive blood culture. It is therefore recommended that further research be undertaken to refine these predictors as screening tools before resorting to blood culture. It is also recommended that antibiotic treatment may be initiated on the basis of the high temperature and WBC, while waiting for the culture results.

ABO blood groups and malaria related clinical outcome.

Science.gov (United States)

Deepa; Alwar, Vanamala A; Rameshkumar, Karuna; Ross, Cecil

2011-03-01

The study was undertaken to correlate the blood groups and clinical presentations in malaria patients and to understand the differential host susceptibility in malaria. From October 2007 to September 2008, malaria positive patients' samples were evaluated in this study. Hemoglobin, total leukocyte count, and platelet count of each patient were done on an automated cell counter. After determining the blood groups, malarial species and the severity of clinical course were correlated. A total of 100 patients were included in the study, of which 63 cases were positive for Plasmodium falciparum and 37 cases were positive for P. vivax infection and 11 patients had mixed infection. The results of the blood groups showed 22 - 'A' group, 42 - 'B' group, 35 - 'O' group and 1 was 'AB' group. When the clinical courses between different groups were compared using the following parameters for severe infection--a parasitic load of >10/1000 RBCs, severe anemia with hemoglobin 101°F and other organ involvement, it was observed that 'O' group had an advantage over other the groups. The difference in rosetting ability between red blood cells of different 'ABO' blood groups with a diminished rosetting potential in blood group 'O' red blood cells was due to the differential host susceptibility. 'O' group had an advantage over the other three blood groups. Based on literature and the results of this study, the diminished rosetting potential in blood group 'O' red blood cells is suggested as the basis for the differential host susceptibility.

[The association between blood pressure variability and sleep stability in essential hypertensive patients with sleep disorder].

Science.gov (United States)

Zhu, Y Q; Long, Q; Xiao, Q F; Zhang, M; Wei, Y L; Jiang, H; Tang, B

2018-03-13

Objective: To investigate the association of blood pressure variability and sleep stability in essential hypertensive patients with sleep disorder by cardiopulmonary coupling. Methods: Performed according to strict inclusion and exclusion criteria, 88 new cases of essential hypertension who came from the international department and the cardiology department of china-japan friendship hospital were enrolled. Sleep stability and 24 h ambulatory blood pressure data were collected by the portable sleep monitor based on cardiopulmonary coupling technique and 24 h ambulatory blood pressure monitor. Analysis the correlation of blood pressure variability and sleep stability. Results: In the nighttime, systolic blood pressure standard deviation, systolic blood pressure variation coefficient, the ratio of the systolic blood pressure minimum to the maximum, diastolic blood pressure standard deviation, diastolic blood pressure variation coefficient were positively correlated with unstable sleep duration ( r =0.185, 0.24, 0.237, 0.43, 0.276, P Blood pressure variability is associated with sleep stability, especially at night, the longer the unstable sleep duration, the greater the variability in night blood pressure.

What variables can influence clinical reasoning?

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Vahid Ashoorion

2012-01-01

Full Text Available 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 (R 2 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.

What variables can influence clinical reasoning?

Science.gov (United States)

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.

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

DEFF Research Database (Denmark)

Stangerup, Ida; Kramp, Nana L.; Ziegler, Andreas K.

2017-01-01

BACKGROUNDNo 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. STUDY DESIGN AND METHODSVO2peak, 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...

Associations of blood pressure variability and retinal arteriolar diameter in participants with type 2 diabetes.

Science.gov (United States)

Veloudi, Panagiota; Blizzard, Leigh; Srikanth, Velandai K; McCartney, Paul; Lukoshkova, Elena V; Hughes, Alun D; Head, Geoffrey A; Sharman, James E

2016-07-01

Blood pressure variability is associated with macrovascular complications and stroke, but its association with the microcirculation in type II diabetes has not been assessed. This study aimed to determine the relationship between blood pressure variability indices and retinal arteriolar diameter in non-diabetic and type II diabetes participants. Digitized retinal images were analysed to quantify arteriolar diameters in 35 non-diabetic (aged 52 ± 11 years; 49% male) and 28 type II diabetes (aged 61 ± 9 years; 50% male) participants. Blood pressure variability was derived from 24-h ambulatory blood pressure. Arteriolar diameter was positively associated with daytime rate of systolic blood pressure variation (p = 0.04) among type II diabetes participants and negatively among non-diabetics (p = 0.008; interaction p = 0.001). This finding was maintained after adjusting for age, sex, body mass index and mean daytime systolic blood pressure. These findings suggest that the blood pressure variability-related mechanisms underlying retinal vascular disease may differ between people with and without type II diabetes. © The Author(s) 2016.

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

Science.gov (United States)

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 variability. Screening adults with fluctuating blood pressure for lead exposure could be warranted.

From pioneering to implementing automated blood pressure measurement in clinical practice: Thomas Pickering's legacy

DEFF Research Database (Denmark)

Stolarz-Skrzypek, Katarzyna; Thijs, Lutgarde; Wizner, Barbara

2010-01-01

Thomas G. Pickering spent most of his scientific career in carrying out research on clinical hypertension and blood pressure (BP) measurement. In our review of Pickering's seminal work, we first focused on white-coat hypertension and masked hypertension, two terms that he had introduced. Next, we...... highlighted the early publications of Pickering on diurnal BP variability and on the clinical application of self-measured BP. Pickering's work inspired many investigators worldwide and constituted a solid basis for further research. Pickering's original ideas led to algorithms for risk stratification...

Ambulatory Blood Pressure Monitoring in Clinical Practice: A Review

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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

24-Hour Blood Pressure Variability Assessed by Average Real Variability: A Systematic Review and Meta-Analysis.

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Mena, Luis J; Felix, Vanessa G; Melgarejo, Jesus D; Maestre, Gladys E

2017-10-19

Although 24-hour blood pressure (BP) variability (BPV) is predictive of cardiovascular outcomes independent of absolute BP levels, it is not regularly assessed in clinical practice. One possible limitation to routine BPV assessment is the lack of standardized methods for accurately estimating 24-hour BPV. We conducted a systematic review to assess the predictive power of reported BPV indexes to address appropriate quantification of 24-hour BPV, including the average real variability (ARV) index. Studies chosen for review were those that presented data for 24-hour BPV in adults from meta-analysis, longitudinal or cross-sectional design, and examined BPV in terms of the following issues: (1) methods used to calculate and evaluate ARV; (2) assessment of 24-hour BPV determined using noninvasive ambulatory BP monitoring; (3) multivariate analysis adjusted for covariates, including some measure of BP; (4) association of 24-hour BPV with subclinical organ damage; and (5) the predictive value of 24-hour BPV on target organ damage and rate of cardiovascular events. Of the 19 assessed studies, 17 reported significant associations between high ARV and the presence and progression of subclinical organ damage, as well as the incidence of hard end points, such as cardiovascular events. In all these cases, ARV remained a significant independent predictor ( P <0.05) after adjustment for BP and other clinical factors. In addition, increased ARV in systolic BP was associated with risk of all cardiovascular events (hazard ratio, 1.18; 95% confidence interval, 1.09-1.27). Only 2 cross-sectional studies did not find that high ARV was a significant risk factor. Current evidence suggests that ARV index adds significant prognostic information to 24-hour ambulatory BP monitoring and is a useful approach for studying the clinical value of BPV. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Reproducibility of heart rate variability, blood pressure variability and baroreceptor sensitivity during rest and head-up tilt

DEFF Research Database (Denmark)

Højgaard, Michael V; Agner, Erik; Kanters, Jørgen K

2005-01-01

OBJECTIVE: Previous studies have indicated moderate-to-poor reproducibility of heart rate variability (HRV) but the reproducibility of blood pressure variability (BPV) and spectral measures of baroreceptor sensitivity (BRS) are not well established. METHODS: We measured normal-to-normal heart beat...... pressures were extracted for the assessment of day-to-day and short-term reproducibility. Power spectrum analysis (Fourier) and transfer function analysis was performed. Reproducibility was assessed using the coefficient of variation (CV). The reproducibility of the mean RR interval, mean systolic......, diastolic and mean blood pressure was good (CVspectral parameters of HRV (CV range 18-36%) and BPV (16-44%) and moderate reproducibility of BRS (14-20%). CONCLUSION: Spectral estimates of BRS had only moderate reproducibility although...

Self-monitored blood pressure: a role in clinical practice?

Science.gov (United States)

Padfield, Paul L

2002-02-01

Electronic self-monitoring of blood pressure is increasing in popularity and most international guidelines on the management of hypertension approve cautious use of the technique in the assessment of potentially hypertensive individuals. A recent editorial in the Archives of Internal Medicine suggested that it was "appropriate to encourage the widespread use of self recorded BP as an important adjunct to the clinical care of the patient with hypertension". Such a statement is based on increasing evidence that self-monitoring of blood pressure gives similar information to daytime ambulatory blood pressure -- a now well-established technology in the management of hypertension. Suggested strategies for the use of self-monitoring of blood pressure include monitoring in individuals whose clinical risk status is low enough that they need not necessarily be given medical therapy simply on the basis of a clinic pressure (i.e. at a 10 year risk of cardiovascular disease below 20%). The threshold for defining 'normotension/hypertension' is now regarded as being broadly similar for ABPM and SBPM and is set at 135/85 mmHg. In a recent meta-analysis of all available studies the average difference between these techniques, using the same patients, is -1.7/1.2 mmHg. There is some evidence that careful use of self-monitoring may improve blood pressure control in patients who are otherwise resistant to care. Self-monitoring of blood pressure has now been shown in at least one major prospective study to predict outcome better than clinic pressures and in that setting it now has equivalence to the use of ABPM. There remain issues regarding the availability of validated devices, the quality of training of patients in their use and the possibility that inaccurate recording might occur, either deliberately or by accident. Self-monitoring of blood pressure may well not give the same readings as carefully measured blood pressure by research nurses but its use is clearly superior to

Alternative Blood Products and Clinical Needs in Transfusion Medicine

OpenAIRE

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...

Clinical Use and Patentability of Cord Blood

Science.gov (United States)

Cavusoglu, Turker; Kilic, Kubilay Dogan; Yigitturk, Gurkan; Tomruk, Canberk; Turgut, Mehmet; Uyanikgil, Yigit

2018-03-14

The blood in the umbilical cord that provides the connection between mother and fetus during pregnancy is called cord blood. The blood of umbilical cord which is usually got rid of following birth, is a very rich stem cell source. Cord blood collection gives no harm to the mother and baby. Besides, its allogeneic and au-tologous usage, the most important disadvantage is that the number of cells is insufficient in adults. Today, it is predominantly used for therapeutic purposes for many diseases. The aim of this review is giving a detailed information about groups of stem cells in cord blood and determining the point of clinical use. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

Blood Glucose Monitoring Before and After Type 1 Diabetes Clinic Visits.

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Driscoll, Kimberly A; Johnson, Suzanne Bennett; Wang, Yuxia; Wright, Nancy; Deeb, Larry C

2017-12-23

To determine patterns of blood glucose monitoring in children and adolescents with type 1 diabetes (T1D) before and after routine T1D clinic visits. Blood glucose monitoring data were downloaded at four consecutive routine clinic visits from children and adolescents aged 5-18 years. Linear mixed models were used to analyze patterns of blood glucose monitoring in patients who had at least 28 days of data stored in their blood glucose monitors. In general, the frequency of blood glucose monitoring decreased across visits, and younger children engaged in more frequent blood glucose monitoring. Blood glucose monitoring increased before the T1D clinic visits in younger children, but not in adolescents. It declined after the visit regardless of age. Members of the T1D care team need to consider that a T1D clinic visit may prompt an increase in blood glucose monitoring when making treatment changes and recommendations. Tailored interventions are needed to maintain that higher level of adherence across time. © The Author(s) 2017. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com

Time-Dependent Drug Administration in Hypertension and its Effect on Blood Pressure Variability

OpenAIRE

Magdás Annamária; Podoleanu Cristian; Tusa Anna-Boróka; Găburoi Adina; Incze Alexandru

2017-01-01

Background: Optimizing blood pressure variability seems to represent a new therapeutic target in the management of hypertension. It is emphasized that scheduling at least one antihypertensive agent at bedtime, has the ability to reduce blood pressure.

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

International Nuclear Information System (INIS)

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

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

Science.gov (United States)

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

Time-Dependent Drug Administration in Hypertension and its Effect on Blood Pressure Variability

Directory of Open Access Journals (Sweden)

Magdás Annamária

2017-06-01

Full Text Available Background: Optimizing blood pressure variability seems to represent a new therapeutic target in the management of hypertension. It is emphasized that scheduling at least one antihypertensive agent at bedtime, has the ability to reduce blood pressure.

LB02.03: EVALUATION OF DAY-BY-DAY BLOOD PRESSURE VARIABILITY IN CLINIC (DO WE STILL NEED STANDARD DEVIATION?).

Science.gov (United States)

Ryuzaki, M; Nakamoto, H; Hosoya, K; Komatsu, M; Hibino, Y

2015-06-01

Blood pressure (BP) variability correlates with cardio-vascular disease as BP level itself. There is not known easy way to evaluate the BP variability in clinic.To evaluate the usefulness of maximum-minimum difference (MMD) of BP in a month compared to standard deviation (SD), as an index of BP variability. Study-1: Twelve patients (age 65.9 ± 12.1 y/o) were enrolled. Measurements of home systolic (S) BP were required in the morning. The 12 months consecutive data and at least 3 times measurements a month were required for including. (Mean 29.0 ± 4.5 times/month in the morning). We checked the correlation between MMD and SD. Study-2: Six hemodialized patients monitored with i-TECHO system (J of Hypertens 2007: 25: 2353-2358) for longer than one year were analyzed. As in study-1, we analyzed the correlation between SD and MMD of SBP. 17.4 ± 11.9 times per month. Study-3: The data from our previous study (FUJIYAM study Clin. Exp Hypertens 2014: 36:508-16) were extracted. 1524 patient-month morning BP data were calculated as in study-1. Picking up data measuring more than 24 times a month, 517 patient-month BP data were analyzed. We compared the ratio to 25 times measured data of SD and MMD, in the setting 5, 10, 15, 20 times measured data. Study-1: SBP, MMD was correlated very well to SD (p  2 times. If data were extracted (measurements>24 times), correlation was 0.927 (P < 0.0001). The equation of SBPSD = 1.520+ 0.201xMMD. The ratios of SD to 25 times were as follows; 0.956 in 5 times, 0.956 in 10, 0.979 in 15, 0.991 in 20 times. The ratios of MMD to 25 times were as follows; 0.558 in 5, 0.761 in 10, 0.874 in 15, 0.944 in 20. We can assume SD easily by measuring MMD as an index of day-by-day BP variability of a month. The equation formulas were very similar though the patients' groups were different. But we have to be careful how many times patients measure in a month.

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

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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

Clinical significance of stress-related increase in blood pressure: current evidence in office and out-of-office settings.

Science.gov (United States)

Munakata, Masanori

2018-05-29

High blood pressure is the most significant risk factor of cardiovascular and cerebrovascular diseases worldwide. Blood pressure and its variability are recognized as risk factors. Thus, hypertension control should focus not only on maintaining optimal levels but also on achieving less variability in blood pressure. Psychosocial stress is known to contribute to the development and worsening of hypertension. Stress is perceived by the brain and induces neuroendocrine responses in either a rapid or long-term manner. Moreover, endothelial dysfunction and inflammation might be further involved in the modulation of blood pressure elevation associated with stress. White-coat hypertension, defined as high clinic blood pressure but normal out-of-office blood pressure, is the most popular stress-related blood pressure response. Careful follow-up is necessary for this type of hypertensive patients because some show organ damage or a worse prognosis. On the other hand, masked hypertension, defined as high out-of-office blood pressure but normal office blood pressure, has received considerable interest as a poor prognostic condition. The cause of masked hypertension is complex, but evidence suggests that chronic stress at the workplace or home could be involved. Chronic psychological stress could be associated with distorted lifestyle and mental distress as well as long-lasting allostatic load, contributing to the maintenance of blood pressure elevation. Stress issues are common in patients in modern society. Considering psychosocial stress as the pathogenesis of blood pressure elevation is useful for achieving an individual-focused approach and 24-h blood pressure control.

Definition of ambulatory blood pressure targets for diagnosis and treatment of hypertension in relation to clinic blood pressure: prospective cohort study.

Science.gov (United States)

Head, Geoffrey A; Mihailidou, Anastasia S; Duggan, Karen A; Beilin, Lawrence J; Berry, Narelle; Brown, Mark A; Bune, Alex J; Cowley, Diane; Chalmers, John P; Howe, Peter R C; Hodgson, Jonathan; Ludbrook, John; Mangoni, Arduino A; McGrath, Barry P; Nelson, Mark R; Sharman, James E; Stowasser, Michael

2010-04-14

Twenty-four hour ambulatory blood pressure thresholds have been defined for the diagnosis of mild hypertension but not for its treatment or for other blood pressure thresholds used in the diagnosis of moderate to severe hypertension. We aimed to derive age and sex related ambulatory blood pressure equivalents to clinic blood pressure thresholds for diagnosis and treatment of hypertension. We collated 24 hour ambulatory blood pressure data, recorded with validated devices, from 11 centres across six Australian states (n=8575). We used least product regression to assess the relation between these measurements and clinic blood pressure measured by trained staff and in a smaller cohort by doctors (n=1693). Mean age of participants was 56 years (SD 15) with mean body mass index 28.9 (5.5) and mean clinic systolic/diastolic blood pressure 142/82 mm Hg (19/12); 4626 (54%) were women. Average clinic measurements by trained staff were 6/3 mm Hg higher than daytime ambulatory blood pressure and 10/5 mm Hg higher than 24 hour blood pressure, but 9/7 mm Hg lower than clinic values measured by doctors. Daytime ambulatory equivalents derived from trained staff clinic measurements were 4/3 mm Hg less than the 140/90 mm Hg clinic threshold (lower limit of grade 1 hypertension), 2/2 mm Hg less than the 130/80 mm Hg threshold (target upper limit for patients with associated conditions), and 1/1 mm Hg less than the 125/75 mm Hg threshold. Equivalents were 1/2 mm Hg lower for women and 3/1 mm Hg lower in older people compared with the combined group. Our study provides daytime ambulatory blood pressure thresholds that are slightly lower than equivalent clinic values. Clinic blood pressure measurements taken by doctors were considerably higher than those taken by trained staff and therefore gave inappropriate estimates of ambulatory thresholds. These results provide a framework for the diagnosis and management of hypertension using ambulatory blood pressure values.

Influences of obstructive sleep apnea on blood pressure variability might not be limited only nocturnally in middle-aged hypertensive males.

Science.gov (United States)

Shao, Liang; Heizhati, Mulalibieke; Yao, Xiaoguang; Wang, Yingchun; Abulikemu, Suofeiya; Zhang, Delian; Zhou, Ling; Hong, Jing; Li, Nanfang

2018-05-01

In this cross-sectional study, we analyzed the potential association between sleep measures and blood pressure variability. Ninety-three middle-aged hypertensive males, who underwent polysomnography and 24-h ambulatory blood pressure monitoring, were enrolled. Blood pressure variability was assessed by blood pressure standard deviation. Obstructive sleep apnea (apnea hypopnea index ≥ 15) was diagnosed in 52 (55.91%) patients. Mean body mass index and age were 27.77 ± 3.11 kg/m 2 and 44.05 ± 8.07 years, respectively. Hypertensive males with obstructive sleep apnea showed significantly higher 24-h, diurnal, and nocturnal diastolic blood pressure variability, compared to those without obstructive sleep apnea. While total cohort was further divided into two groups using the median of oxygen desaturation index, another indicator for severity of OSA, significant differences were also observed in 24-h, diurnal, and nocturnal diastolic blood pressure variability between two groups with higher and lower oxygen desaturation index. While subjects were also divided into two groups via the mean of sleep stage 1, hypertensive males with sleep stage 1 ≥ 8.1% showed significantly higher diurnal diastolic blood pressure variability than those with sleep stage 1 blood pressure variability; oxygen desaturation index of 3% with 24-h diastolic, diurnal, and nocturnal diastolic blood pressure; and sleep stage 1 was with 24-h and with diurnal diastolic blood pressure variability in all study subjects. Effects of obstructive sleep apnea on blood pressure variability may not be limited nocturnally.

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

Science.gov (United States)

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

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

Directory of Open Access Journals (Sweden)

Setia S

2017-07-01

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 important gaps in knowledge and clinical practice. Keywords: hypertension, blood pressure monitoring, blood pressure variability, guidelines

Effects of renal sympathetic denervation on 24-hour blood pressure variability

Directory of Open Access Journals (Sweden)

Christine Stefanie Zuern

2012-05-01

Full Text Available Background: In patients with arterial hypertension, increased blood pressure (BP variability contributes to end organ damage independently from mean levels of arterial BP. Increased BP variability has been linked to alterations in autonomic function including sympathetic overdrive. We hypothesized that catheter-based renal sympathetic denervation (RDN confers beneficial effects on BPV. Methods and Results: Eleven consecutive patients with therapy-refractory arterial hypertension (age 68.9±7.0 years; baseline systolic BP 189±23mmHg despite medication with 5.6±2.1 antihypertensive drugs underwent bilateral RDN. Twenty-four hour ambulatory blood pressure monitoring (ABPM was performed before RDN and six months thereafter. BPV was primarily assessed by means of standard deviation of 24-hour systolic arterial blood pressures (SDsys. Secondary measures of BPV were maximum systolic blood pressure (MAXsys and maximum difference between two consecutive readings of systolic BP (deltamaxsys over 24 hours. Six months after RDN, SDsys, MAXsys and deltamaxsys were significantly reduced from 16.9±4.6mmHg to 13.5±2.5mmHg (p=0.003, from 190±22mmHg to 172±20mmHg (p<0.001 and from 40±15mmHg to 28±7mmHg (p=0.006, respectively, without changes in concomitant antihypertensive therapy. Reductions of SDsys, MAXsys and deltamaxsys were observed in 10/11 (90.9%, 11/11 (100% and 9/11 (81.8% patients, respectively. Although we noted a significant reduction of systolic office blood pressure by 30.4±27.7mmHg (p=0.007, there was only a trend in reduction of average systolic BP assessed from ABPM (149±19mmHg to 142±18mmHg; p=0.086.Conclusions: In patients with therapy-refractory arterial hypertension, RDN leads to significant reductions of BP variability. Effects of RDN on BPV over 24 hours were more pronounced than on average levels of BP.

Variability of clinical features in attacks of migraine with aura

DEFF Research Database (Denmark)

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

2016-01-01

. CONCLUSION: 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 features of migraine, may be an important consideration in designing clinical studies......BACKGROUND: 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...... 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. RESULTS: Retrospectively reported visual aura symptoms were variable and often overlapping...

[Positive Distribution Rate of Coombs Test in Patients with Clinical Anemia and Blood Transfusion and Its Effect on Clinical Blood Transfusion].

Science.gov (United States)

Wu, Gang; Duan, Yu-Han

2018-02-01

To study the positive distribution rate of Coombs test in patients with clinical anemia and blood transfusion, and its effect on clinical blood transfusion. Seventy patients with hemoglobin level in the normal range were enrolled into control group, while 130 patients with anemia or blood transfusion who' s hemoglobin level was lower comfirmed by micro-column gel antihuman globin detection card and 70 surgical patients with anemia or blood transfusion who' s hemoglobin level was lower comfirmed by micro-column gel anti-human globin card were enrolled into anemia or blood transfusion (A or BT) group. And coomb' s test performed for all the patients, in which the positive patients in Department of Internal Medicine need to be re-typed. Among 70 surgical patients with anemia or blood transfusion, 14 cases were directly detected to be anti-human globine positive with detection rate 20%; among 130 internal medicine patients with anemia or blood transfusion, 54 cases were directly detected to be anti-human globine positive with detection rate 41.4%. Among 270 cases, the highest positive rate (66.7%) was observed in patients with 50-59 g/L of hemoglobin. According to type test, the samples of 54 patients with anemia in Department of Internal Medicine, who were directly selected to be anti-human globin positive, could be divided into anti-C3d(7 cases, accounting for 13.0%), anti-IgG(12 cases accounting for, 22.2%) and anti-C3d+anti-IgG(35 cases, accounting for 64.8%), while according to diseases, the anti-human globin positive ratio was high in tumor cancer, hephropathy and gastroenteropathy patients, and patients in intensive care unit, moreover the blood transfusion frequency of these patients was higher than that of patients with anti-human globin negative(Pblood transfusion, so as to ensure the effectiveness of blood transfusion.

Impact of antihypertensive combination and monotreatments on blood pressure variability: assessment by old and new indices. Data from a large ambulatory blood pressure monitoring database.

LENUS (Irish Health Repository)

Parati, Gianfranco

2014-06-01

High 24-h ambulatory blood pressure (ABP) variability is associated with poor cardiovascular outcomes. We analysed a large ABP monitoring database containing data from hypertensive patients treated with telmisartan\\/amlodipine combination or various monotherapies with the aim of quantifying the 24-h distribution of blood pressure (BP) reduction by treatment through the smoothness index and of developing and testing a new treatment-on-variability index (TOVI) to quantify the effects of treatment on both mean BP and BP variability.

Prospect for application of umbilical cord blood to clinical treatment of radiation sickness

International Nuclear Information System (INIS)

Jia Tingzhen; Ke Xiaoyan

1998-01-01

Objective: To look forward to the prospect for application of umbilical cord blood to clinical treatment of radiation sickness by analyzing the results using umbilical cord blood in laboratory experiments and clinical research. Method: The data on umbilical cord blood published in literature are reviewed. Results: The umbilical blood is rich in hematopoietic stem/progenitor cells, low in immunological activity of lymphocytes, expanded significantly ex vivo under selected culture condition readily available and collected easily. Conclusion: With the above advantages, the prospect for application of umbilical cord blood is encouraging, particularly in the clinical treatment of radiation sickness

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

Directory of Open Access Journals (Sweden)

Sousa Rejane

2012-05-01

Full Text Available Abstract 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 p p p  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.

Significance of blood pressure variability in patients with sepsis.

Science.gov (United States)

Pandey, Nishant Raj; Bian, Yu-Yao; Shou, Song-Tao

2014-01-01

This study was undertaken to observe the characteristics of blood pressure variability (BPV) and sepsis and to investigate changes in blood pressure and its value on the severity of illness in patients with sepsis. Blood parameters, APACHE II score, and 24-hour ambulatory BP were analyzed in 89 patients with sepsis. In patients with APACHE II score>19, the values of systolic blood pressure (SBPV), diasystolic blood pressure (DBPV), non-dipper percentage, cortisol (COR), lactate (LAC), platelet count (PLT) and glucose (GLU) were significantly higher than in those with APACHE II score ≤19 (Pblood cell (WBC), creatinine (Cr), PaO2, C-reactive protein (CRP), adrenocorticotropic hormone (ACTH) and tumor necrosis factor α (TNF-α) were not statistically significant (P>0.05). Correlation analysis showed that APACHE II scores correlated significantly with SBPV and DBPV (P0.05). Logistic regression analysis of SBPV, DBPV, APACHE II score, and LAC was used to predict prognosis in terms of survival and non-survival rates. Receiver operating characteristics curve (ROC) showed that DBPV was a better predictor of survival rate with an AUC value of 0.890. However, AUC of SBPV, APACHE II score, and LAC was 0.746, 0.831 and 0.915, respectively. The values of SBPV, DBPV and non-dipper percentage are higher in patients with sepsis. DBPV and SBPV can be used to predict the survival rate of patients with sepsis.

Clinical variables, lifestyle and coping in hemodialysis.

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Comelis Bertolin, Daniela

2016-10-01

To verify the relationship between coping strategies of people with chronic kidney disease undergoing hemodialysis and their clinical variables and lifestyle habits. It was developed a cross-sectional study that used the Coping Strategies Inventory of Folkman and Lazarus and a semi-structured questionnaire for collecting clinical variables and lifestyles of patients undergoing hemodialysis in the Urology and Nephrology Institute of São Jose do Rio Preto-SP (Brazil). Participants were 107 adults undergoing hemodialysis, with an average age of 51 years; 62.4% were men. The main causes of chronic kidney disease were chronic glomerulonephritis, diabetes mellitus, undetermined cause and hypertension. The most reported coping strategies were focused on emotion. There were greater coping scores among people who had diabetes, those who had leisure and those who referred religion. People who exercised and those who had undergone renal transplantation had more positive coping. Clinical variables of people undergoing hemodialysis can be sources of stress, and lifestyle habits are associated with coping strategies to mitigate the effects of stress. Copyright© by the Universidad de Antioquia.

Renal blood flow in sepsis: a complex issue

OpenAIRE

Molitoris, Bruce A

2005-01-01

The clinical complexity of sepsis and the regional variability in renal blood flow present a difficult challenge for the clinician or investigator in understanding the role and clinical importance of reduced blood flow in the pathophysiology of sepsis-induced acute renal failure. Understanding the role of regional microvasculature flow and interactions between endothelium and white blood cells in the local delivery of oxygen and substrates is of critical importance. Therefore, measuring total...

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

Science.gov (United States)

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.

Influence of clinical and lipid variables on the magnitude of postprandial lipemia in subjects with and without hipertriglyceridemia

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Clara Eugenia Pérez G.

2007-01-01

Full Text Available Introduction. The postprandial lipemia is characterized by some prolonged increase in circulation of triglycerides rich lipoproteins that can produce atherosclerosis, which is an important cause of death in our population. Objective. To evaluate the effect of lipidic and clinical variables on the values of postprandial lipemia in subjects with and without hipertriglyceridemia. Materials and methods. Forty-eight subjects of both sexes were studied, half of them, with basal triglycerides above 200mg/dl, who ingested a standardized lipidic load (breakfast with 30g of fat and then they were followed during seven hours gathering total blood every hour to determine the level of postprandial triglycerides and the postprandial lipemia values. The later data was correlated with clinical variables as age, body mass index, waist circumference, among other; and with lipidic variable as total cholesterol, HDL, LDL and basal triglycerides. Results. There was alteration in the clearence of postprandial triglycerides in those subjects with a basal concentration of triglycerides above 186 mg/dl. The clinical variables most related tothe magnitude of postprandial lipemia were age (p=0.009 and waist perimeter, while the lipidic variables that were strongly related with the postprandial lipemia were the basal triglycerides concentration (p=<0.001, the VLDL cholesterol (p=<0.001 and the HDL cholesterol(p=0.041. Conclusion. The variables that could predict the behavior of postprandial triglycerides in the individuals of this study are age, waist perimeter, VLDL cholesterol, HDL cholesterol and the basal triglycerides concentration.

Clinical variables in radiotracer biodistributions

International Nuclear Information System (INIS)

Lentle, B.C.; Scott, J.R.; Schmidt, R.P.; Noujaim, A.A.

1981-01-01

Radionuclide dosimetry must, by its nature, define tissue irradiation in terms of mean exposure in a population of a statistically acceptable size. In the daily practice of clinical nuclear medicine there are, however, quite large variations in the biodistribution of tracers and thus in resulting radiation doses. Age is a variable, particularly in respect of bone-seeking tracers. Sex imposes variations in radiation dose on account of the differing anatomical configurations of the gonads. Breast uptake and excretion of certain tracers in women are additional variables. Activity and occupation are occasional variables. Numerous iatrogenic causes of altered radiotracer biodistributions have been described. Cancer chemotherapy is a particularly potent cause of changed biodistributions while even a trivial matter such as preparing the skin with an iodine containing antiseptic may cause displacement of technetium from its compounds. In the blocking of thyroid uptake of radioiodines, there is good precedent for the manipulation of regional tissue dosimetry. It is possible to go beyond the mere cataloguing of these effects to look creatively at the subject of comparative tissue biodistributions and hence comparative dosimetry. Effects such as the clinical observation of the interference by cis-platinum with the usual biodistribution of radio-gallium suggest that such compounds can be used as probes each to lead to a better understanding of the mechanism of action of the other

EDUCORE project: a clinical trial, randomised by clusters, to assess the effect of a visual learning method on blood pressure control in the primary healthcare setting

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Garrido-Elustondo Sofia

2010-07-01

Full Text Available Abstract Background High blood pressure (HBP is a major risk factor for cardiovascular disease (CVD. European hypertension and cardiology societies as well as expert committees on CVD prevention recommend stratifying cardiovascular risk using the SCORE method, the modification of lifestyles to prevent CVD, and achieving good control over risk factors. The EDUCORE (Education and Coronary Risk Evaluation project aims to determine whether the use of a cardiovascular risk visual learning method - the EDUCORE method - is more effective than normal clinical practice in improving the control of blood pressure within one year in patients with poorly controlled hypertension but no background of CVD; Methods/Design This work describes a protocol for a clinical trial, randomised by clusters and involving 22 primary healthcare clinics, to test the effectiveness of the EDUCORE method. The number of patients required was 736, all between 40 and 65 years of age (n = 368 in the EDUCORE and control groups, all of whom had been diagnosed with HBP at least one year ago, and all of whom had poorly controlled hypertension (systolic blood pressure ≥ 140 mmHg and/or diastolic ≥ 90 mmHg. All personnel taking part were explained the trial and trained in its methodology. The EDUCORE method contemplates the visualisation of low risk SCORE scores using images embodying different stages of a high risk action, plus the receipt of a pamphlet explaining how to better maintain cardiac health. The main outcome variable was the control of blood pressure; secondary outcome variables included the SCORE score, therapeutic compliance, quality of life, and total cholesterol level. All outcome variables were measured at the beginning of the experimental period and again at 6 and 12 months. Information on sex, age, educational level, physical activity, body mass index, consumption of medications, change of treatment and blood analysis results was also recorded; Discussion The

Survival and cardiovascular events after coarctation-repair in long-term follow-up (COAFU): Predictive value of clinical variables.

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Bambul Heck, P; Pabst von Ohain, J; Kaemmerer, H; Ewert, P; Hager, A

2017-02-01

Long-term sequelae and events after coarctation repair are well described. However, the predictive value of variables from clinical follow-up investigation for late events and survival has rarely been investigated. All patients who participated in the prospective cross-sectional COALA Study in 2000 with a structural clinical investigation including blood pressure measurement and symptom-limited exercise test were contacted for reevaluation of survival, current clinical status and major cardiovascular events. Of 273 eligible patients, 209 were available for follow-up. Nine patients had died at a median age of 46years (range 30-64years), five of them due to cardiovascular complications. Late mortality after surgical intervention was 5.7% with a median age of 41years (range 16-64years). Twenty-five patients had a major cardiovascular event: 12 had procedures at the aortic valve or aortic arch, 8 had procedures for restenosis, 2 had endocarditis, 2 had a cerebrovascular insult and 1 an aortic dissection. The presence of bicuspid aortic valve (p=0.009), brachial-ankle blood pressure gradient >20mmHg (p<0.001) and reduced left ventricular function (p=0.002) correlated with major cardiovascular events. Surgical correction of coarctation of the aorta shows fairly low mortality in the long-term follow-up. Late morbidities include recoarctation, but also the consequences of the hemodynamics produced by a congenital bicuspid aortic valve, presence of which is predictive for aortic valve procedures: however the predictive value of clinical variables is limited. Copyright © 2016. Published by Elsevier Ireland Ltd.

Clinical and acoustical variability in hypokinetic dysarthria

International Nuclear Information System (INIS)

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

1986-01-01

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

Quantification of surgical blood loss.

Science.gov (United States)

Lee, Marcel H; Ingvertsen, Britt T; Kirpensteijn, Jolle; Jensen, Asger L; Kristensen, Annemarie T

2006-06-01

To compare gravimetric and colorimetric methods of quantifying surgical blood loss, and to determine if there is a correlation between preoperative hemostatic tests (buccal mucosa bleeding time [BMBT] and intraoperative blood loss). Prospective clinical study. Dogs (n=15) admitted for cutaneous tumor excision, orthopedic procedure, or exploratory laparotomy. Intraoperative blood loss was quantified by measuring irrigation fluid and weighing surgical sponges used for blood and fluid collection during surgery. Results of gravimetric measurements were then correlated to blood loss quantified using spectrophotometric analysis of hemoglobin (Hb) content. Hemostatic variables including BMBT were measured before surgery and compared with the calculated amount of blood loss. Blood loss quantified by gravimetric measurement showed a significant correlation with colorimetric determination of Hb content in surgical sponges and collected irrigation fluid (r=0.93, P<.0001). BMBT correlated weakly but significantly with intraoperative blood loss (r=0.56, P<.05). Quantifying intraoperative blood loss using spectrophotometric Hb analysis accurately assessed the amount of blood loss; however, it is a time-consuming procedure, primarily applicable as a research tool. Gravimetric evaluation of intraoperative blood loss was found to be an accurate method, which can be recommended for use in a clinical setting. Estimation of blood loss using a gravimetric method is accurate and applicable in the clinical setting and provides surgeons with a simple and objective tool to evaluate intraoperative blood loss.

Renal Blood Flow, Glomerular Filtration Rate, and Renal Oxygenation in Early Clinical Septic Shock.

Science.gov (United States)

Skytte Larsson, Jenny; Krumbholz, Vitus; Enskog, Anders; Bragadottir, Gudrun; Redfors, Bengt; Ricksten, Sven-Erik

2018-06-01

Data on renal hemodynamics, function, and oxygenation in early clinical septic shock are lacking. We therefore measured renal blood flow, glomerular filtration rate, renal oxygen consumption, and oxygenation in patients with early septic shock. Prospective comparative study. General and cardiothoracic ICUs. Patients with norepinephrine-dependent early septic shock (n = 8) were studied within 24 hours after arrival in the ICU and compared with postcardiac surgery patients without acute kidney injury (comparator group, n = 58). None. Data on systemic hemodynamics and renal variables were obtained during two 30-minute periods. Renal blood flow was measured by the infusion clearance of para-aminohippuric acid, corrected for renal extraction of para-aminohippuric acid. Renal filtration fraction was measured by renal extraction of chromium-51 labeled EDTA. Renal oxygenation was estimated from renal oxygen extraction. Renal oxygen delivery (-24%; p = 0.037) and the renal blood flow-to-cardiac index ratio (-21%; p = 0.018) were lower, renal vascular resistance was higher (26%; p = 0.027), whereas renal blood flow tended to be lower (-19%; p = 0.068) in the septic group. Glomerular filtration rate (-32%; p = 0.006) and renal sodium reabsorption (-29%; p = 0.014) were both lower in the septic group. Neither renal filtration fraction nor renal oxygen consumption differed significantly between groups. Renal oxygen extraction was significantly higher in the septic group (28%; p = 0.022). In the septic group, markers of tubular injury were elevated. In early clinical septic shock, renal function was lower, which was accompanied by renal vasoconstriction, a lower renal oxygen delivery, impaired renal oxygenation, and tubular sodium reabsorption at a high oxygen cost compared with controls.

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

Science.gov (United States)

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 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.

Effect of postmortem sampling technique on the clinical significance of autopsy blood cultures.

Science.gov (United States)

Hove, M; Pencil, S D

1998-02-01

Our objective was to investigate the value of postmortem autopsy blood cultures performed with an iodine-subclavian technique relative to the classical method of atrial heat searing and antemortem blood cultures. The study consisted of a prospective autopsy series with each case serving as its own control relative to subsequent testing, and a retrospective survey of patients coming to autopsy who had both autopsy blood cultures and premortem blood cultures. A busy academic autopsy service (600 cases per year) at University of Texas Medical Branch Hospitals, Galveston, Texas, served as the setting for this work. The incidence of non-clinically relevant (false-positive) culture results were compared using different methods for collecting blood samples in a prospective series of 38 adult autopsy specimens. One hundred eleven adult autopsy specimens in which both postmortem and antemortem blood cultures were obtained were studied retrospectively. For both studies, positive culture results were scored as either clinically relevant or false positives based on analysis of the autopsy findings and the clinical summary. The rate of false-positive culture results obtained by an iodine-subclavian technique from blood drawn soon after death were statistically significantly lower (13%) than using the classical method of obtaining blood through the atrium after heat searing at the time of the autopsy (34%) in the same set of autopsy subjects. When autopsy results were compared with subjects' antemortem blood culture results, there was no significant difference in the rate of non-clinically relevant culture results in a paired retrospective series of antemortem blood cultures and postmortem blood cultures using the iodine-subclavian postmortem method (11.7% v 13.5%). The results indicate that autopsy blood cultures obtained using the iodine-subclavian technique have reliability equivalent to that of antemortem blood cultures.

Review and classification of variability analysis techniques with clinical applications

Science.gov (United States)

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

Review and classification of variability analysis techniques with clinical applications.

Science.gov (United States)

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.

Ambulatory blood pressure and urinary albumin excretion in clinically healthy subjects

DEFF Research Database (Denmark)

Clausen, Peter Vilhelm; Jensen, J S; Borch-Johnsen, K

1998-01-01

UAER. Because 24-hour ambulatory blood pressure is a superior predictor of hypertensive target organ involvement, we aimed to investigate blood pressure profile in clinically healthy subjects with elevated UAER. Ambulatory blood pressure monitoring was performed with a portable recorder in 27 subjects...... loss of albumin could not be solely related to the higher blood pressure. In conclusion, apparently healthy subjects with elevated UAER had slightly but significantly higher 24-hour systolic and diastolic blood pressure levels in addition to increased blood pressure loads but normal circadian variation...

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

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Araújo Joamira P.

2014-12-01

Full Text Available 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 x 5; group x 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.

Current concepts in blood glucose monitoring.

Science.gov (United States)

Khadilkar, Kranti Shreesh; Bandgar, Tushar; Shivane, Vyankatesh; Lila, Anurag; Shah, Nalini

2013-12-01

Blood glucose monitoring has evolved over the last century. The concept of adequate glycemic control and minimum glycemic variability requires an ideal, accurate and reliable glucose monitoring system. The search for an ideal blood glucose monitoring system still continues. This review explains the various blood glucose monitoring systems with special focus on the monitoring systems like self- monitored blood glucose (SMBG) and continuous glucose monitoring system (CGMS). It also focuses on the newer concepts of blood glucose monitoring and their incorporation in routine clinical management of diabetes mellitus.

Current concepts in blood glucose monitoring

Science.gov (United States)

Khadilkar, Kranti Shreesh; Bandgar, Tushar; Shivane, Vyankatesh; Lila, Anurag; Shah, Nalini

2013-01-01

Blood glucose monitoring has evolved over the last century. The concept of adequate glycemic control and minimum glycemic variability requires an ideal, accurate and reliable glucose monitoring system. The search for an ideal blood glucose monitoring system still continues. This review explains the various blood glucose monitoring systems with special focus on the monitoring systems like self- monitored blood glucose (SMBG) and continuous glucose monitoring system (CGMS). It also focuses on the newer concepts of blood glucose monitoring and their incorporation in routine clinical management of diabetes mellitus. PMID:24910827

Current concepts in blood glucose monitoring

Directory of Open Access Journals (Sweden)

Kranti Shreesh Khadilkar

2013-01-01

Full Text Available Blood glucose monitoring has evolved over the last century. The concept of adequate glycemic control and minimum glycemic variability requires an ideal, accurate and reliable glucose monitoring system. The search for an ideal blood glucose monitoring system still continues. This review explains the various blood glucose monitoring systems with special focus on the monitoring systems like self- monitored blood glucose (SMBG and continuous glucose monitoring system (CGMS. It also focuses on the newer concepts of blood glucose monitoring and their incorporation in routine clinical management of diabetes mellitus.

Blood pressure variability and risk of cardiovascular events and death in patients with hypertension and different baseline risks.

Science.gov (United States)

Mehlum, Maria H; Liestøl, Knut; Kjeldsen, Sverre E; Julius, Stevo; Hua, Tsushung A; Rothwell, Peter M; Mancia, Giuseppe; Parati, Gianfranco; Weber, Michael A; Berge, Eivind

2018-01-20

Blood pressure variability is associated with increased risk of cardiovascular events, particularly in high-risk patients. We assessed if variability was associated with increased risk of cardiovascular events and death in hypertensive patients at different risk levels. The Valsartan Antihypertensive Long-term Use Evaluation trial was a randomized controlled trial of valsartan vs. amlodipine in patients with hypertension and different risks of cardiovascular events, followed for a mean of 4.2 years. We calculated standard deviation (SD) of mean systolic blood pressure from visits from 6 months onward in patients with ≥3 visits and no events during the first 6 months. We compared the risk of cardiovascular events in the highest and lowest quintile of visit-to-visit blood pressure variability, using Cox regression. For analysis of death, variability was analysed as a continuous variable. Of 13 803 patients included, 1557 (11.3%) had a cardiovascular event and 1089 (7.9%) died. Patients in the highest quintile of SD had an increased risk of cardiovascular events [hazard ratio (HR) 2.1, 95% confidence interval (95% CI) 1.7-2.4; P risk of death (HR 1.10, 95% CI 1.04-1.17; P = 0.002). Associations were stronger among younger patients and patients with lower systolic blood pressure, and similar between patients with different baseline risks, except for higher risk of death among patients with established cardiovascular disease. Higher visit-to-visit systolic blood pressure variability is associated with increased risk of cardiovascular events in patients with hypertension, irrespective of baseline risk of cardiovascular events. Associations were stronger in younger patients and in those with lower mean systolic blood pressure. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.

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

International Nuclear Information System (INIS)

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

2014-01-01

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. To study the association between anthropometric variables and blood pressure levels in schoolchildren from the 5 th and 8 th grades, and to identify which parameter was more strongly correlated with blood pressure levels. Contemporary cross-sectional study with probabilistic population-based cluster sampling of schoolchildren enrolled from the 5 th to the 8 th 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. 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). 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

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

Energy Technology Data Exchange (ETDEWEB)

Schommer, Vânia Ames [Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS (Brazil); Barbiero, Sandra Mari; Cesa, Cláudia Ciceri; Oliveira, Rosemary [Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS (Brazil); Silva, Anelise Damiani [Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS (Brazil); Pellanda, Lucia Campos, E-mail: luciapell.pesquisa@cardiologia.org.br [Instituto de Cardiologia/Fundação Universitária de Cardiologia (IC/FUC), Porto Alegre, RS (Brazil); Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS (Brazil)

2014-04-15

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. To study the association between anthropometric variables and blood pressure levels in schoolchildren from the 5{sup th} and 8{sup th} grades, and to identify which parameter was more strongly correlated with blood pressure levels. Contemporary cross-sectional study with probabilistic population-based cluster sampling of schoolchildren enrolled from the 5{sup th} to the 8{sup th} 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. 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). 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.

Interhospital Variability in Perioperative Red Blood Cell Ordering Patterns in United States Pediatric Surgical Patients.

Science.gov (United States)

Thompson, Rachel M; Thurm, Cary W; Rothstein, David H

2016-10-01

To evaluate perioperative red blood cell (RBC) ordering and interhospital variability patterns in pediatric patients undergoing surgical interventions at US children's hospitals. This is a multicenter cross-sectional study of children aged blood type and crossmatch were included when done on the day before or the day of the surgical procedure. The RBC transfusions included were those given on the day of or the day after surgery. The type and crossmatch-to-transfusion ratio (TCTR) was calculated for each surgical procedure. An adjusted model for interhospital variability was created to account for variation in patient population by age, sex, race/ethnicity, payer type, and presence/number of complex chronic conditions (CCCs) per patient. A total of 357 007 surgical interventions were identified across all participating hospitals. Blood type and crossmatch was performed 55 632 times, and 13 736 transfusions were provided, for a TCTR of 4:1. There was an association between increasing age and TCTR (R(2) = 0.43). Patients with multiple CCCs had lower TCTRs, with a stronger relationship (R(2) = 0.77). There was broad variability in adjusted TCTRs among hospitals (range, 2.5-25). The average TCTR in US children's hospitals was double that of adult surgical data, and was associated with wide interhospital variability. Age and the presence of CCCs markedly influenced this ratio. Studies to evaluate optimal preoperative RBC ordering and standardization of practices could potentially decrease unnecessary costs and wasted blood. Copyright © 2016 Elsevier Inc. All rights reserved.

Childhood Depression: Relation to Adaptive, Clinical and Predictor Variables

OpenAIRE

Garaigordobil, Maite; Bernar?s, 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...

Automated blood-sample handling in the clinical laboratory.

Science.gov (United States)

Godolphin, W; Bodtker, K; Uyeno, D; Goh, L O

1990-09-01

The only significant advances in blood-taking in 25 years have been the disposable needle and evacuated blood-drawing tube. With the exception of a few isolated barcode experiments, most sample-tracking is performed through handwritten or computer-printed labels. Attempts to reduce the hazards of centrifugation have resulted in air-tight lids or chambers, the use of which is time-consuming and cumbersome. Most commonly used clinical analyzers require serum or plasma, distributed into specialized containers, unique to that analyzer. Aliquots for different tests are prepared by handpouring or pipetting. Moderate to large clinical laboratories perform so many different tests that even multi-analyzers performing multiple analyses on a single sample may account for only a portion of all tests ordered for a patient. Thus several aliquots of each specimen are usually required. We have developed a proprietary serial centrifuge and blood-collection tube suitable for incorporation into an automated or robotic sample-handling system. The system we propose is (a) safe--avoids or prevents biological danger to the many "handlers" of blood; (b) small--minimizes the amount of sample taken and space required to adapt to the needs of satellite and mobile testing, and direct interfacing with analyzers; (c) serial--permits each sample to be treated according to its own "merits," optimizes throughput, and facilitates flexible automation; and (d) smart--ensures quality results through monitoring and intelligent control of patient identification, sample characteristics, and separation process.

Cardiovascular Topics Blood pressure control at a hospital day clinic ...

African Journals Online (AJOL)

1999-02-01

Feb 1, 1999 ... control in a hospital day clinic population receiving cal- cium channel ... we had showed poor control of blood pressure in this hospital-based population .... Assessment of com- .... Program are obering: 19 almost half of newly treated hyper- tensives will di ... blood pressure control and quality of life. There is ...

Assessment of the clinical efficacy of the heart spectrum blood pressure monitor for diagnosis of atrial fibrillation: An unblinded clinical trial.

Science.gov (United States)

Kao, Wei-Fong; Hou, Sen-Kuang; Huang, Chun-Yao; Chao, Chun-Chieh; Cheng, Chung-Chih; Chen, Yi-Jung

2018-01-01

Atrial fibrillation (AF) is the most common arrhythmia. The most common diagnostic method, 12-lead electrocardiogram (ECG), can record episodes of arrhythmia from which the type and severity can be determined. The Heart Spectrum Blood Pressure Monitor (P2; OSTAR Meditech Corp., New Taipei City, Taiwan) is used to measure cardiovascular pressure change with fast Fourier transform (FFT) analysis to obtain heart rate frequency variability and accurate blood pressure data. We compared the diagnostic efficacy of the Heart Spectrum Blood Pressure Monitor to a 12-lead ECG (gold standard) for patients with AF. Three measurement methods were used in this study to analyze the heart index and compare the results with simultaneous 12-lead ECG: blood pressure; mean arterial pressure, which was calculated from individual blood pressure as a constant pressure; and a constant pressure of 60 mmHg. The physician used a 12-lead ECG and the Heart Spectrum Blood Pressure Monitor simultaneously. The Heart Spectrum Blood Pressure Monitor used FFT analysis to diagnose AF, and the findings were compared to the 12-lead ECG readings. This unblinded clinical trial was conducted in the emergency department of Taipei Medical University Hospital. Twenty-nine subjects with AF and 33 without AF aged 25 to 97 y (mean, 63.5 y) were included. Subjects who were exposed to high-frequency surgical equipment during testing, those with cardiac pacemakers or implantable defibrillators, and pregnant women were excluded. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 97%, 97%, 97%, and 97%, respectively, for method 1; 90%, 100%, 100%, and 91%, respectively, for method 2; and 100%, 94%, 94%, and 100%, respectively, for method 3. The sensitivity, specificity, PPV, and NPV for both methods ranged between 90% and 100%, indicating that the Heart Spectrum Blood Pressure Monitor can be effectively applied for AF detection.

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

Science.gov (United States)

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 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.

Knowledge, attitudes and clinical practice of blood products prescribers in Niamey.

Science.gov (United States)

Mayaki, Z; Kabo, R; Moutschen, M; Albert, A; Dardenne, N; Sondag, D; Gérard, C

2016-05-01

The lack of traceability and monitoring of blood donors and transfused patients constitute a barrier to the most basic rules of haemovigilance and overall good transfusion practices. This study draws up an inventory of knowledge, attitudes and clinical practice of blood prescribers in Niamey. A questionnaire was administered to 180 prescribers of blood products in Niamey in 2011. Questions were related to basic informations on blood transfusion and clinical use of blood. Analyses were performed using SAS 9.3 version. The sample consisted of 180 respondents from several professional categories: 51 physicians (28.33%), 10 medical students (5.56%), 84 nurses (46.67%), 15 anaesthesiologist assistant (8.33%) and 20 midwives (11.11%). Among these, 22.2% received training in blood transfusion safety. Half of the respondents (50.8%) got between 50 and 75% of correct answers, 45.8% got less than 50% correct while 3.35% scored more than 75% correct answers. The overall quality of responses was higher among physicians compared to other prescribers (Ptransfusion safety (Ptransfusion practices is necessary for prescribers of blood products. Accompanying measures to improve transfusion practice must be considered or strengthened through assessments, knowledge update/upgrade (regular, ongoing training) and establishment of active and motivated hospital transfusion committees. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

Assessment of three frequently used blood glucose monitoring devices in clinical routine.

Science.gov (United States)

Zueger, Thomas; Schuler, Vanessa; Stettler, Christoph; Diem, Peter; Christ, Emanuel R

2012-07-12

Self-monitoring of blood glucose plays an important role in the management of diabetes and has been shown to improve metabolic control. The use of blood glucose meters in clinical practice requires sufficient reliability to allow adequate treatment. Direct comparison of different blood glucose meters in clinical practice, independent of the manufactures is scarce. We, therefore, aimed to evaluate three frequently used blood glucose meters in daily clinical practice. Capillary blood glucose was measured simultaneous using the following glucose meters: Contour® (Bayer Diabetes Care, Zürich, Switzerland), Accu-Chek® aviva (Roche Diagnostics, Rotkreuz, Switzerland), Free-Style® lite (Abbott Diabetes Care, Baar, Switzerland). The reference method consisted of the HemoCue® Glucose 201+ System (HemoCue® AB, Ängelholm, Sweden) with plasma conversion. The devices were assessed by comparison of the Mean Absolute Relative Differences (MARD), the Clarke Error Grid Analysis (EGA) and the compliance with the International Organization of Standardization criteria (ISO 15197:2003). Capillary blood samples were obtained from 150 patients. MARD was 10.1 ± 0.65%, 7.0 ± 0.62% and 7.8 ± 0.48% for Contour®, Accu-Chek® and Free-Style®, respectively. EGA showed 99.3% (Contour®), 98.7% (Accu-Chek®) and 100% (Free-Style®) of all measurements in zone A and B (clinically acceptable). The ISO criteria were fulfilled by Accu-Chek® (95.3%) and Free-Style® (96%), but not by Contour® (92%). In the present study the three glucose meters provided good agreement with the reference and reliable results in daily clinical routine. Overall, the Free-Style® and Accu-Chek® device slightly outperformed the Contour® device.

Ambulatory versus home versus clinic blood pressure: the association with subclinical cerebrovascular diseases: the Ohasama Study.

Science.gov (United States)

Hara, Azusa; Tanaka, Kazushi; Ohkubo, Takayoshi; Kondo, Takeo; Kikuya, Masahiro; Metoki, Hirohito; Hashimoto, Takanao; Satoh, Michihiro; Inoue, Ryusuke; Asayama, Kei; Obara, Taku; Hirose, Takuo; Izumi, Shin-Ichi; Satoh, Hiroshi; Imai, Yutaka

2012-01-01

The usefulness of ambulatory, home, and casual/clinic blood pressure measurements to predict subclinical cerebrovascular diseases (silent cerebrovascular lesions and carotid atherosclerosis) was compared in a general population. Data on ambulatory, home, and casual/clinic blood pressures and brain MRI to detect silent cerebrovascular lesions were obtained in 1007 subjects aged ≥55 years in a general population of Ohasama, Japan. Of the 1007 subjects, 583 underwent evaluation of the extent of carotid atherosclerosis. Twenty-four-hour, daytime, and nighttime ambulatory and home blood pressure levels were closely associated with the risk of silent cerebrovascular lesions and carotid atherosclerosis (all Ppressure values were simultaneously included in the same regression model, each of the ambulatory blood pressure values remained a significant predictor of silent cerebrovascular lesions, whereas home blood pressure lost its predictive value. Of the ambulatory blood pressure values, nighttime blood pressure was the strongest predictor of silent cerebrovascular lesions. The home blood pressure value was more closely associated with the risk of carotid atherosclerosis than any of the ambulatory blood pressure values when home and one of the ambulatory blood pressure values were simultaneously included in the same regression model. The casual/clinic blood pressure value had no significant association with the risk of subclinical cerebrovascular diseases. Although the clinical indications for ambulatory blood pressure monitoring and home blood pressure measurements may overlap, the clinical significance of each method for predicting target organ damage may differ for different target organs.

General practitioner's reported use of clinical guidelines for hypertension and ambulatory blood pressure.

LENUS (Irish Health Repository)

Flynn, E

2012-03-01

ABPM is an invaluable clinical tool, as it has been shown to improve blood pressure control in primary care. Many clinical guidelines for hypertension advocate ambulatory blood pressure monitoring. This study aims to quantify the use of clinical guidelines for hypertension and to explore the role of ABPM in Primary Care. A questionnaire survey was sent to GPs working in the West of Ireland. 88% (n=139) of GPs use clinical guidelines that recommend the use of ABPM. 82% (n=130) of GPs find use of clinic blood pressure monitoring insufficient for the diagnosis and monitoring of hypertension. Despite good access to ABPM, GPs report lack of remuneration, 72% (n=116), cost 68% (n=108), and lack of time, 51% (n=83) as the main limiting factors to use of ABPM. GPs recognise the clinical value of ABPM, but this study identifies definite barriers to the use of ABPM in Primary Care.

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

Science.gov (United States)

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.

Evaluation of hematologic, blood gas, and select biochemical variables in ovine whole blood stored in CPDA-1 bags.

Science.gov (United States)

Sousa, Rejane S; Barrêto, Raimundo A; Sousa, Isadora K F; Chaves, Dowglish F; Soares, Herbert S; Barros, Isabella O; Minervino, Antonio H H; Ortolani, Enrico L

2013-03-01

The economic consequences from mortality of sheep after blood loss can be considerable. To date there are no reports addressing hematologic, blood gas, and biochemical changes in ovine blood stored in CPDA-1 bags. The aim of this study was to investigate hematologic, blood gas, and biochemical alterations resulting from storage of ovine blood in CPDA-1 bags to establish transfusion protocols in sheep. From each of 7 healthy 8-month-old sheep 450 mL of blood were collected into CPDA-1 bags and stored for 35 days in at 3-6°C. Samples were taken from the bags at days 0, 7, 14, 21, and 35. Whole blood was used to assess PCV, MCV, RBC count, pH, pO2 , pCO2 , and concentrations of bicarbonate, sodium, and lactate. Plasma was used to measure potassium, hemoglobin, and glucose concentrations. The PCV remained stable throughout the storage period, while plasma hemoglobin and MCV began to increase on days 7 and 21, respectively. The RBC count began to decrease on day 21. Blood pH decreased and pCO2 increased steadily throughout the storage period. Potassium concentration increased from 3.8 to 18.3 mmol/L on day 7 and remained high thereafter. In contrast, sodium concentration began to decrease on day 7. The results show that ovine blood undergoes hematologic, blood gas, and biochemical changes during storage. Further studies are required to establish RBC viability in CPDA-1 bags after a storage period of 35 days. © 2012 American Society for Veterinary Clinical Pathology.

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

Science.gov (United States)

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.

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

International Nuclear Information System (INIS)

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

2015-01-01

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

Ambulatory blood pressure monitoring in daily clinical practice - the Spanish ABPM Registry experience.

Science.gov (United States)

Gorostidi, Manuel; Banegas, José R; de la Sierra, Alejandro; Vinyoles, Ernest; Segura, Julián; Ruilope, Luis M

2016-01-01

Many patients are hypertensive at the medical settings but show normal blood pressure out of the doctor's office, and are classified as white-coat hypertensives. On the other hand, many patients with controlled hypertension at the clinic show ambulatory blood pressure levels above the thresholds considered for an adequate blood pressure control, known as having masked hypertension. Using data from the Spanish Ambulatory Blood Pressure Monitoring Registry (Spanish ABPM Registry), a national program developed to promote the use of the ambulatory technique for hypertension management in daily practice, we have reviewed the main strengths of this approach, that is the ability to detect discrepancies of blood pressure status with respect to office blood pressure measurement, and to better assess accurate rates of hypertension control. White-coat hypertension within patients with elevated office blood pressure, and masked hypertension within office-controlled patients affected one of three patients in each office status. On the other hand, rates of ambulatory blood pressure control (50%) doubled those of office blood pressure control (25%), still remaining half the patients uncontrolled. We think that a systematic use of ambulatory blood pressure monitoring, and strategies to improve blood pressure control constitute key priorities in hypertension management. © 2015 Stichting European Society for Clinical Investigation Journal Foundation.

Diagnostic clinical parasitology: IV. Identification of the blood parasites?

Science.gov (United States)

Garcia, L S; Voge, M

1981-01-01

This is the fourth article in a series of articles entitled "Diagnostic Clinical Parasitology" and contains information on the recovery and identification of human blood parasites. The organisms covered include those that cause the diseases malaria, babesiosis, leishmaniasis, and trypanosomiasis. Some of the filarial worms, which can be considered "blood parasites," have been discussed in the third article in the series, "Identification of the Helminths." Although some of these organisms may rarely be encountered in the laboratory in clinical specimens, they will probably have to be identified in proficiency testing specimens, some of which may not always be representative of patient clinical material. The differences between potential organism recovery from patients coming from endemic areas and from those individuals who become infected with no prior exposure to the organism will also be emphasized. Often, for a number of different reasons, organism recovery and subsequent identification may be more difficult than the textbook imply. It is very important for the technologist to recognize this fact, particularly when dealing with a possibly fatal infection, ie, Plasmodium falciparum.

Pulsatile flow of blood and heat transfer with variable viscosity under magnetic and vibration environment

International Nuclear Information System (INIS)

Shit, G.C.; Majee, Sreeparna

2015-01-01

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. - Highlights: • We have investigated the pulsatile MHD flow of blood and heat transfer in arteries. • The influence of periodic body acceleration has been taken into account. • The temperature dependent viscosity of blood is considered. • The variable viscosity has an increasing effect on blood flow and heat transfer. • The overall temperature distribution enhances in the presence of magnetic field

Pulsatile flow of blood and heat transfer with variable viscosity under magnetic and vibration environment

Energy Technology Data Exchange (ETDEWEB)

Shit, G.C., E-mail: gopal_iitkgp@yahoo.co.in; Majee, Sreeparna

2015-08-15

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. - Highlights: • We have investigated the pulsatile MHD flow of blood and heat transfer in arteries. • The influence of periodic body acceleration has been taken into account. • The temperature dependent viscosity of blood is considered. • The variable viscosity has an increasing effect on blood flow and heat transfer. • The overall temperature distribution enhances in the presence of magnetic field.

Combining clinical variables to optimize prediction of antidepressant treatment outcomes.

Science.gov (United States)

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.

All Clinically-Relevant Blood Components Transmit Prion Disease following a Single Blood Transfusion: A Sheep Model of vCJD

Science.gov (United States)

de Wolf, Christopher; Tan, Boon Chin; Smith, Antony; Groschup, Martin H.; Hunter, Nora; Hornsey, Valerie S.; MacGregor, Ian R.; Prowse, Christopher V.; Turner, Marc; Manson, Jean C.

2011-01-01

Variant CJD (vCJD) is an incurable, infectious human disease, likely arising from the consumption of BSE-contaminated meat products. Whilst the epidemic appears to be waning, there is much concern that vCJD infection may be perpetuated in humans by the transfusion of contaminated blood products. Since 2004, several cases of transfusion-associated vCJD transmission have been reported and linked to blood collected from pre-clinically affected donors. Using an animal model in which the disease manifested resembles that of humans affected with vCJD, we examined which blood components used in human medicine are likely to pose the greatest risk of transmitting vCJD via transfusion. We collected two full units of blood from BSE-infected donor animals during the pre-clinical phase of infection. Using methods employed by transfusion services we prepared red cell concentrates, plasma and platelets units (including leucoreduced equivalents). Following transfusion, we showed that all components contain sufficient levels of infectivity to cause disease following only a single transfusion and also that leucoreduction did not prevent disease transmission. These data suggest that all blood components are vectors for prion disease transmission, and highlight the importance of multiple control measures to minimise the risk of human to human transmission of vCJD by blood transfusion. PMID:21858015

[Common variable immunodeficiency: Clinical and immunological characterization of patients and homogeneous subgroup definition by means of B lymphocyte subpopulation typing].

Science.gov (United States)

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.

The Association of Posttraumatic Stress Disorder With Clinic and Ambulatory Blood Pressure in Healthy Adults.

Science.gov (United States)

Edmondson, Donald; Sumner, Jennifer A; Kronish, Ian M; Burg, Matthew M; Oyesiku, Linda; Schwartz, Joseph E

2018-01-01

Posttraumatic stress disorder (PTSD) is associated with incident cardiovascular risk. We tested the association of PTSD with clinic and ambulatory blood pressure (ABP) in a sample of healthy participants and tested ABP reactivity to anxiety as a mechanism by which PTSD may influence blood pressure (BP). Participants were originally enrolled during workplace BP screenings at three sites; approximately 6 years (standard deviation = 1.0) later, they completed nine clinic BP assessments within three visits, 1 week apart. Before the third visit, participants were screened for PTSD (≥33 on the PTSD Checklist-Civilian) and depression (Beck Depression Inventory) and then completed 24-hour ABP monitoring with electronic diary assessment of anxiety (0-100) at each awake reading. Of 440 participants, 92 (21%) screened positive for PTSD. In regression models adjusted for depression and demographic and clinical variables, PTSD was associated with greater mean systolic BP (3.8 mm Hg clinic [95% confidence interval {CI}] = 1.1-6.5, p = .006), 3.0 mm Hg awake ABP [95% CI = 0.1-5.9, p = .04], and a nonsignificant 2.1 mm Hg ABP during sleep [95% CI = -1.0 to 5.1, p = .18]). PTSD was associated with greater 24-hour median anxiety (p ABP (p ABP reactivity to anxiety was greater in participants with PTSD, which partially explained the association of PTSD with ABP. PTSD is associated with greater systolic BP, partly because of greater anxiety, and systolic BP reactivity to anxiety throughout the day. Daily anxiety and related BP reactivity may be targets for interventions to reduce the cardiovascular risk associated with PTSD.

Day-to-Day Blood Pressure Variability and Risk of Dementia in a General Japanese Elderly Population: The Hisayama Study.

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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 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 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 dementia and AD. There was no interaction between home SBP levels and CoV levels of home SBP on the risk of each subtype of dementia. Our findings suggest that increased day-to-day blood pressure variability is, independently of average home blood pressure, a significant risk factor for the development of all-cause dementia, VaD, and AD in the general elderly Japanese population. © 2017 The Authors.

A Systematic Review and Meta-Analysis of the Clinical Appropriateness of Blood Transfusion in China.

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Zhu, Changtai; Gao, Yulu; Li, Zhiqiang; Li, Qinyun; Gao, Zongshuai; Liao, Yanqiu; Deng, Zhifeng

2015-12-01

The issue of the clinical appropriateness of blood transfusion has become a focus of transfusion medicine worldwide. In China, irrational uses of blood have often been reported in recent years. However, to date there lacks a systematic review of the rational uses of blood. This study aimed to determine the clinical appropriateness of blood transfusion in China. We searched PubMed, Web of Science, the Cochrane Library, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database, WanFang Database, and Chinese BioMedical Literature Database, and the retrieval cut-off date was June 31, 2015. SPSS 17.0 and MetaAnalyst 3.13 were employed as the statistics tools in this review. A pooled rate of clinical inappropriateness of transfusion was analyzed by DerSimonian-Laird method. In this study, a total of 39 observational studies were included, which related to 75,132 cases of blood transfusion. According to the meta-analysis results, the overall incidence of clinical inappropriateness of transfusion in China was estimated to be 37.3% (95% confidence interval [CI] [32.1, 42.8]). The subgroup analyses revealed that the pooled rates of clinical inappropriateness of transfusion of plasma, red blood cells (RBCs), cryoprecipitate, and platelets were 56.3% (95% CI [45.8, 66.2]), 30.9% (95% CI [27.1, 35.0]), 25.2% (95% CI [13.2, 42.7]), and 14.1% (95% CI [8.8, 21.9]), respectively. However, the pooled incidence of inappropriateness of transfusion in operative departments was 47.5% (95% CI [36.8, 58.3]), which was significantly higher than that in nonoperative departments, 25.8% (95% CI [18.7, 34.4], P  0.05). In conclusion, China has suffered from a disadvantage in the clinical appropriateness of blood transfusion, especially in plasma and RBC use. In future, comprehensive measures should be implemented in order to improve the clinical appropriateness of blood transfusion.

Forensic Luminol Blood Test for Preventing Cross-contamination in Dentistry: An Evaluation of a Dental School Clinic

OpenAIRE

Marcelo Carlos Bortoluzzi; Peterson Cadore; Andrea Gallon; Soraia Almeida Watanabe Imanishi

2014-01-01

Background: More than 200 different diseases may be transmitted from exposure to blood in the dental setting. The aim of this study is to identify possible faults in the cross-contamination chain control in a dental school clinic searching for traces of blood in the clinical contact surfaces (CCS) through forensic luminol blood test. Methods: Traces of invisible blood where randomly searched in CCS of one dental school clinic. Results: Forty eight surfaces areas in the CCS were tes...

In the aftermath of SPRINT: further comparison of unattended automated office blood pressure measurement and 24-hour blood pressure monitoring.

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Seidlerová, Jitka; Gelžinský, Julius; Mateřánková, Markéta; Ceral, Jiří; König, Petr; Filipovský, Jan

2018-03-22

Several papers reported that unattended automated office blood pressure (uAutoOBP) is closely related to daytime ambulatory blood pressure monitoring (ABPM). In the present study, we aim to study uAutoOBP and its relation to 24-hour ABPM and ABPM variability. Stable treated hypertensive subjects were examined in two Czech academic hypertension centres. uAutoOBP was measured with the BP Tru device; attended BP three times with auscultatory method (AuscOBP) by the physician. ABPM was performed within one week from the clinical visit. Data on 98 subjects aged 67.7 ± 9.3 years with 24-hour ABPM 120.3 ± 10.6/72.7 ± 7.9 mm Hg are reported. uAutoOBP was lower than 24-hour (by -5.2 ± 11.3/-0.5 ± 6.9 mm Hg) and daytime (by -6.7 ± 12.82.4 ± 8.0 mm Hg) ABPM and the individual variability of the difference was very large (up to 30 mm Hg). The correlation coefficients between ABPM and uAutoOBP were similar compared to AuscOBP (p ≥ .17). Variability of uAutoOBP, but not AuscOBP, readings during one clinical visit was related to short-term blood pressure variability of ABPM. The difference between AuscOBP and uAutoOBP was larger in patients with white-coat effect compared to other blood pressure control groups (25.1 ± 7.0 vs. 2.2 ± 10.3 mm Hg; p = .0036). Our study shows that uAutoOBP is not good predictor of ambulatory blood pressure monitoring, not even of the daytime values. It might, however, indicate short-term blood pressure variability and, when compared with AuscOBP, also detect patients with white-coat effect.

Identifying novel phenotypes of acute heart failure using cluster analysis of clinical variables.

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Horiuchi, Yu; Tanimoto, Shuzou; Latif, A H M Mahbub; Urayama, Kevin Y; Aoki, Jiro; Yahagi, Kazuyuki; Okuno, Taishi; Sato, Yu; Tanaka, Tetsu; Koseki, Keita; Komiyama, Kota; Nakajima, Hiroyoshi; Hara, Kazuhiro; Tanabe, Kengo

2018-07-01

Acute heart failure (AHF) is a heterogeneous disease caused by various cardiovascular (CV) pathophysiology and multiple non-CV comorbidities. We aimed to identify clinically important subgroups to improve our understanding of the pathophysiology of AHF and inform clinical decision-making. We evaluated detailed clinical data of 345 consecutive AHF patients using non-hierarchical cluster analysis of 77 variables, including age, sex, HF etiology, comorbidities, physical findings, laboratory data, electrocardiogram, echocardiogram and treatment during hospitalization. Cox proportional hazards regression analysis was performed to estimate the association between the clusters and clinical outcomes. Three clusters were identified. Cluster 1 (n=108) represented "vascular failure". This cluster had the highest average systolic blood pressure at admission and lung congestion with type 2 respiratory failure. Cluster 2 (n=89) represented "cardiac and renal failure". They had the lowest ejection fraction (EF) and worst renal function. Cluster 3 (n=148) comprised mostly older patients and had the highest prevalence of atrial fibrillation and preserved EF. Death or HF hospitalization within 12-month occurred in 23% of Cluster 1, 36% of Cluster 2 and 36% of Cluster 3 (p=0.034). Compared with Cluster 1, risk of death or HF hospitalization was 1.74 (95% CI, 1.03-2.95, p=0.037) for Cluster 2 and 1.82 (95% CI, 1.13-2.93, p=0.014) for Cluster 3. Cluster analysis may be effective in producing clinically relevant categories of AHF, and may suggest underlying pathophysiology and potential utility in predicting clinical outcomes. Copyright © 2018 Elsevier B.V. All rights reserved.

Effects of supplemental humic acid on ruminal fermentation and blood variables in rams

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Nurten Galip

Full Text Available In this study, we particularly aimed to research the effect of supplemental humic acid on ruminal fermentation and blood variables in rams. A trial was conducted to evaluate the effect of humic acid (HA on protozoa count, percentages of different protozoa types and blood parameters. Three male Kivircik rams with ruminal cannula were used in a Latin square design, during 22 days periods (15 days for adaptation, 7 days for collection. They received 0 control group (CG, 5 g/day or 10 g/day of HA (HA5, HA10, assay groups. HA were added to the ration with grain diet. Ration was consisted of 5% grain diet and 95 % alfalfa hay. Rumen contents collected before, 3h and 6h after morning feeding on days 1 and 7 in each collection period were analyzed. Blood samples were also collected the same days. No significant difference in biochemical and hematological parameters (except eosinophils levels, P<0.05, variables of ruminal fluid (except sodium levels before feeding and species of rumen protozoa organism (except the percentage Epidinium spp. were evidenced with the addition of HA. In conclusion, we think that they might have been true the widely use in animal food of humates which don’t have any negative effect on biochemical and hematological parameters in particular.

Effects of supplemental humic acid on ruminal fermentation and blood variables in rams

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Umit Polat

2010-11-01

Full Text Available In this study, we particularly aimed to research the effect of supplemental humic acid on ruminal fermentation and blood variables in rams. A trial was conducted to evaluate the effect of humic acid (HA on protozoa count, percentages of different protozoa types and blood parameters. Three male Kivircik rams with ruminal cannula were used in a Latin square design, during 22 days periods (15 days for adaptation, 7 days for collection. They received 0 control group (CG, 5 g/day or 10 g/day of HA (HA5, HA10, assay groups. HA were added to the ration with grain diet. Ration was consisted of 5 % grain diet and 95 % alfalfa hay. Rumen contents collected before and, 3h and 6h after morning feeding on days 1 and 7 in each collection period were analyzed. Blood samples were also collected the same days. No significant difference in biochemical and hematological parameters (except eosinophils levels, P, variables of ruminal fluid (except sodium levels before feeding and species of rumen protozoa organism (except the percentage Epidinium spp. were evidenced with the addition of HA. In conclusion, we think that they might have been true the widely use in animal food of humates which don’t have any negative effect on biochemical and hematological parameters in particular. 

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

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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.

Blood antioxidant profile and lipid peroxides in dairy cows with clinical mastitis

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Rajesh Rathore

2013-10-01

Full Text Available Aim: To evaluate blood antioxidant profile and lipid peroxides in dairy cows with clinical mastitis. Materials and Methods: Twelve cases of clinical mastitis in cross-bred cows were selected based on physical examination of udder and milk, California Mastitis Test (CMT, Somatic Cell Count (SCC and confirmation by bacteriological examination of milk and requisite biochemical tests. Twelve lactating cows showing negative CMT reaction and SCC <2x105 cells/ml were considered as healthy control. Antioxidant parameters measured in blood were superoxide dismutase (SOD, catalase activities and reduced glutathione (GSH concentration. Erythrocytic lipid peroxidation (LPO was measured in terms of malondialdehyde (MDA production. Results: Significant (P<0.05 decrease in blood SOD and catalase activities, GSH concentration and an increase in erythrocytic lipid peroxides was observed in cows with clinical mastitis. Conclusion: It is concluded that there is a compromise in antioxidant defense of the body in dairy cows with clinical mastitis resulting in oxidative damage, therefore, necessitate the use of antioxidants and other protective compounds along with conventional therapy for mastitis control. [Vet World 2013; 6(5.000: 271-273

Clinical Implications of Glucose Variability: Chronic Complications of Diabetes

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Hye Seung Jung

2015-06-01

Full Text Available 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.

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

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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 pAUC≤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.

Childhood Depression: Relation to Adaptive, Clinical and Predictor Variables

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Maite Garaigordobil

2017-05-01

Full Text Available 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.

Morning pressor surge, blood pressure variability, and arterial stiffness in essential hypertension.

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Pucci, Giacomo; Battista, Francesca; Anastasio, Fabio; Schillaci, Giuseppe

2017-02-01

An excess morning blood pressure surge (MBPS) may portend an increased cardiovascular risk, but the mechanisms thereof have been little investigated. The link between MBPS, short-term blood pressure (BP) variability, and arterial stiffness has not been entirely defined. In 602 consecutive untreated hypertensive patients (48 ± 12 years, 61% men, office BP 149/93 ± 17/10 mmHg), we measured carotid-femoral pulse wave velocity (cf-PWV, SphygmoCor) and 24-h ambulatory BP. Using self-reported sleep and wake times, MBPS was defined as sleep-trough (ST-MBPS), prewaking, rising. Short-term BP variability was calculated as weighted 24-h SBP SD and average real variability of 24-h SBP (ARV), that is, average of absolute differences between consecutive SBP readings. ST-MBPS (r = 0.16, P < 0.001) and rising MBPS (r = 0.12, P = 0.003) showed a direct correlation with cf-PWV, whereas prewaking MBPS had no such relation (r = 0.06, P = 0.14). Only ST-MBPS was independently associated with cf-PWV (t = 1.96, P = 0.04) after adjustment for age, sex, height, office mean arterial pressure, heart rate, and renal function. This association was lost after further adjustment for weighted 24-h SBP SD (P = 0.13) or ARV (P = 0.24). ARV was a significant mediator of the relationship between ST-MBPS and cf-PWV (P = 0.003). In untreated hypertension, ST-MBPS has a direct relation with aortic stiffness, which is mediated by an increased ARV. The adverse effects of MBPS may be partly explained by its link with arterial stiffness, mediated by short-term SBP variability.

Letter to editor: Blood pressure, hypertension and lead exposure.

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Yang, Wen-Yi; Staessen, Jan A

2018-02-19

A significant association of office diastolic blood pressure with low-level blood lead exposure was reported in a Brazilian adult population. However, caution should be taken to interpret these results. The multivariable-adjusted association with blood pressure was positive for diastolic blood pressure, but inverse for systolic blood pressure. The association sizes were infinitesimal without clinical relevance. The outcome measures, i.e. blood pressure and the prevalence of hypertension were analysed across categories of the blood lead distribution - not in relation to blood lead as continuous variable. Blood pressure was the average of two oscillometric office readings, whereas ambulatory monitoring is the state-of-the-art.

Clinical polymorphism and variability in education of autistic children

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Morozov S.A.Morozova T.I.

2016-12-01

Full Text Available Children with autism spectrum disorders are considered a highly heterogeneous group by clinical signs, which makes it impossible to develop a common method of correctional and educational development for them. In this article, results of an analysis of clinical, psychological and pedagogic polymorphism in autism spectrum disorders are shown, emphasized are its main components and basic consequences necessary for organizing education. Results are viewed in the context of the principle of variability in education. A dual structure of variability in education of autistic children has been discovered. Shortly reviewed are some topical problems of correctional education process for autism spectrum disorders

Variability of carotid artery measurements on 3-Tesla MRI and its impact on sample size calculation for clinical research.

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Syed, Mushabbar A; Oshinski, John N; Kitchen, Charles; Ali, Arshad; Charnigo, Richard J; Quyyumi, Arshed A

2009-08-01

Carotid MRI measurements are increasingly being employed in research studies for atherosclerosis imaging. The majority of carotid imaging studies use 1.5 T MRI. Our objective was to investigate intra-observer and inter-observer variability in carotid measurements using high resolution 3 T MRI. We performed 3 T carotid MRI on 10 patients (age 56 +/- 8 years, 7 male) with atherosclerosis risk factors and ultrasound intima-media thickness > or =0.6 mm. A total of 20 transverse images of both right and left carotid arteries were acquired using T2 weighted black-blood sequence. The lumen and outer wall of the common carotid and internal carotid arteries were manually traced; vessel wall area, vessel wall volume, and average wall thickness measurements were then assessed for intra-observer and inter-observer variability. Pearson and intraclass correlations were used in these assessments, along with Bland-Altman plots. For inter-observer variability, Pearson correlations ranged from 0.936 to 0.996 and intraclass correlations from 0.927 to 0.991. For intra-observer variability, Pearson correlations ranged from 0.934 to 0.954 and intraclass correlations from 0.831 to 0.948. Calculations showed that inter-observer variability and other sources of error would inflate sample size requirements for a clinical trial by no more than 7.9%, indicating that 3 T MRI is nearly optimal in this respect. In patients with subclinical atherosclerosis, 3 T carotid MRI measurements are highly reproducible and have important implications for clinical trial design.

Forensic Luminol Blood Test for Preventing Cross-contamination in Dentistry: An Evaluation of a Dental School Clinic.

Science.gov (United States)

Bortoluzzi, Marcelo Carlos; Cadore, Peterson; Gallon, Andrea; Imanishi, Soraia Almeida Watanabe

2014-10-01

More than 200 different diseases may be transmitted from exposure to blood in the dental setting. The aim of this study is to identify possible faults in the crosscontamination chain control in a dental school clinic searching for traces of blood in the clinical contact surfaces (CCS) through forensic luminol blood test. Traces of invisible blood where randomly searched in CCS of one dental school clinic. Forty eight surfaces areas in the CCS were tested and the presence of invisible and remnant blood was identified in 28 (58.3%) items. We suggest that the luminol method is suitable for identifying contamination with invisible blood traces and this method may be a useful tool to prevent cross-contamination in the dental care setting.

Multicenter Clinical Evaluation of BacT/Alert Virtuo Blood Culture System.

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Jacobs, Michael R; Mazzulli, Tony; Hazen, Kevin C; Good, Caryn E; Abdelhamed, Ayman M; Lo, Pauline; Shum, Bianche; Roman, Katharine P; Robinson, Danielle C

2017-08-01

BacT/Alert Virtuo is an advanced, automated blood culture system incorporating improved automation and an enhanced detection algorithm to shorten time to detection. A multicenter study of the investigational Virtuo system (bioMérieux, Inc., Durham, NC) compared to BacT/Alert 3D (BTA3D) for detection of bacteremia/fungemia in four bottle types, SA and FA Plus (aerobic) and SN and FN Plus (anaerobic), was performed in a clinical setting with patient samples in a matched system design clinical trial. Blood was added to paired aerobic or anaerobic bottles, with the volume in each bottle in each pair required to be ≤10 ml and with the volumes required to be within 30% of each other. Of 5,709 bottle sets (52.5% aerobic pairs and 47.5% anaerobic pairs), 430 (7.5%) were positive for bacterial or fungal growth, with 342 (6.0%) clinically significant and 83 (1.5%) contaminated. A total of 3,539 sets (62.0%) were volume compliant, with 203 sets (5.7%) clinically significant. The positivity rates for volume-compliant bottle pairs determined by the two systems were comparable, with 68.7% of clinically significant isolates detected by both instruments, 15.7% by Virtuo only, and 15.7% by BTA3D only. Virtuo detected microbial growth nearly 2 h sooner overall than BTA3D (mean, 15.9 h versus 17.7 h). Shorter time to detection by Virtuo was related to organism group, with the time to detection being significantly shorter for enteric Gram-negative bacilli and enterococci (means, 3.6 h and 2.3 h shorter, respectively). This large clinical study demonstrated that the Virtuo blood culture system produced results comparable to those seen with the long-established BTA3D system, with significantly shorter time to detection. Copyright © 2017 Jacobs et al.

Ambulatory Blood Pressure Monitoring – Clinical Practice Recommendations

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Katalin Mako

2016-09-01

Full Text Available Ambulatory blood pressure monitoring (ABPM became a subject of considerable scientific interest. Due to the increasing use of the ABPM in everyday clinical practice it is important that all the users have a correct knowledge on the clinical indications, the methodology of using the device including some technical issues and the interpretation of results. In the last years several guidelines and position papers have been published with recommendations for the monitoring process, reference values, for clinical practice and research. This paper represents a summary of the most important aspects related to the use of ABPM in daily practice, being a synthesis of recommendations from the recent published guidelines and position papers. This reference article presents the practical and technical issues of ABPM, the use of this method in special situations, the clinical interpretation of measured values including the presentation of different ABPM patterns, derived parameters, the prognostic significance and the limitations of this method.

Clinical and Surgical Strategies for Avoiding or Reducing Allogeneic Blood Transfusions.

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Dos Santos, Antonio Alceu; Baumgratz, Jose Francisco; Vila, Jose Henrique Andrade; Castro, Rodrigo Moreira; Bezerra, Rodrigo Freire

2016-04-01

Blood transfusions have still been used as a standard therapy to treat severe anemia. Current evidences point to both excessive allogeneic blood consumption and decreased donations, which result in reduced stocks in blood banks. Several studies have increasingly suggested a more restrictive transfusion practice for blood products. Currently, a number of autologous blood conservation protocols in surgeries have been noted. We report a case of severe anemia with 2.9 g/dL hemoglobin, which was successfully handled without using the standard therapy to treat anemia with hemotransfusions. Such a case of severe anemia condition resulted after the patient was submitted to ascending aortic aneurism repair, valvar aortic replacement, reimplantation of right coronary ostium, followed by a coronary artery bypass grafting and several postoperative complications. The main clinical and surgical strategies used in this case to avoid blood transfusions were acute normovolemic hemodilution, intraoperative blood cell salvage, and meticulous hemostasis, beyond epsilon-aminocaproic acid, desmopressin, prothrombin complex concentrate, human fibrinogen concentrate, factor VIIa recombinant, erythropoietin and hyperoxic ventilation.

Blood pressure variability in children with primary vs secondary hypertension.

Science.gov (United States)

Leisman, Daniel; Meyers, Melissa; Schnall, Jeremy; Chorny, Nataliya; Frank, Rachel; Infante, Lulette; Sethna, Christine B

2014-06-01

Increased blood pressure variability (BPV) is correlated with adverse cardiovascular (CV) events in adults. However, there has been limited research on its effect in the pediatric population. Additionally, BPV differences between primary and secondary hypertension (HTN) are not known. Children with primary and secondary HTN underwent 24-hour ambulatory blood pressure monitoring and echocardiography studies. BPV measures of standard deviation (SD), average real variability (ARV), and range were calculated for the 24-hour, daytime, and nighttime periods. Seventy-four patients (median age, 13.5 years; 74% boys) were examined, 40 of whom had primary HTN. Body mass index z score and age were independent predictors of systolic ARV (R(2) =0.14) and SD (R(2) =0.39). There were no statistically significant differences in overall or wake period BPV measures between secondary or primary HTN groups, but sleep period diastolic SD was significantly greater in the secondary HTN group (9.26±3.8 vs 7.1±2.8, P=.039). On multiple regression analysis, secondary HTN was associated with increased sleep period diastolic SD (P=.025). No metrics of BPV in the overall, wake, and sleep periods were found to be significantly associated with left ventricular hypertrophy (LVH). The results of this study do not show a strong relationship between overall or wake BPV with primary vs secondary HTN, but the association of secondary HTN with sleep period diastolic BPV deserves further exploration. Contrary to expectation, the findings of this study failed to indicate a relationship between BPV and LVH for all patients as well for primary hypertensive and secondary hypertensive patients. ©2014 Wiley Periodicals, Inc.

Estimation of intersubject variability of cerebral blood flow measurements using MRI and positron emission tomography

DEFF Research Database (Denmark)

Henriksen, Otto Mølby; Larsson, Henrik B W; Hansen, Adam E

2012-01-01

PURPOSE: To investigate the within and between subject variability of quantitative cerebral blood flow (CBF) measurements in normal subjects using various MRI techniques and positron emission tomography (PET). MATERIALS AND METHODS: Repeated CBF measurements were performed in 17 healthy, young...

An examination of hospital satisfaction with blood suppliers.

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Carden, Robert; DelliFraine, Jami L

2004-11-01

The purpose of this study was to identify factors that predict overall hospital satisfaction with blood suppliers. The data for this study came from a 2001 satisfaction survey of hospital blood bank managers conducted by the National Blood Data Resource Center. A total of 1325 blood-utilizing hospitals were included in the final study database. The measurement of hospital satisfaction with its blood supplier encompasses the five composites of the SERVQUAL model. The five composites are 1) tangibles, 2) reliability, 3) responsiveness, 4) assurance, and 5) empathy. Linear regression was performed with overall hospital satisfaction as the dependent variable and the five composites of the SERVQUAL model and control variables as predictors of overall hospital satisfaction with blood suppliers. Significant predictors of hospital satisfaction with blood suppliers are satisfaction with medical and clinical support provided by the blood center, satisfaction with the routine delivery schedule, and price (service fee) of red cells. Prior studies have demonstrated the importance of customer satisfaction to organizations. As organizations, blood centers can benefit from improved satisfaction from their hospital customers. Blood center strategies that focus on improving these three predictors of overall hospital satisfaction with primary blood suppliers will be the most likely to improve and/or maintain hospital customer satisfaction with primary blood suppliers.

The interrelationship between clinical and immunity variables in epilepsy

Directory of Open Access Journals (Sweden)

Kalinin Vladimir V.

2016-12-01

Full Text Available Introduction. The role of cellular immunity in the pathogenesis of epilepsy, as an interaction between immunity and clinical and neurobiological variables is not properly understood.

Diurnal blood pressure changes.

Science.gov (United States)

Asayama, Kei; Satoh, Michihiro; Kikuya, Masahiro

2018-05-23

The definition of diurnal blood pressure changes varies widely, which can be confusing. Short-term blood pressure variability during a 24-h period and the dipping status of diurnal blood pressure can be captured by ambulatory blood pressure monitoring, and these metrics are reported to have prognostic significance for cardiovascular complications. Morning blood pressure surge also indicates this risk, but its effect may be limited to populations with specific conditions. Meanwhile, the combined use of conventional office blood pressure and out-of-office blood pressure allows us to identify people with white-coat and masked hypertension. Current home devices can measure nocturnal blood pressure during sleep more conveniently than ambulatory monitoring; however, we should pay attention to blood pressure measurement conditions regardless of whether they are in a home, ambulatory, or office setting. The relatively poor reproducibility of diurnal blood pressure changes, including the nocturnal fall of blood pressure, is another underestimated issue to be addressed. Although information on diurnal blood pressure changes is expected to be used more effectively in the future, we should also keep in mind that blood pressure levels have remained central to the primary and secondary prevention of blood pressure-related cardiovascular diseases in clinical practice.

Effects of bee venom acupuncture on heart rate variability, pulse wave, and cerebral blood flow for types of Sasang Constitution

Directory of Open Access Journals (Sweden)

Lee Sang-min

2009-03-01

Full Text Available 1. Objectives: To evaluate effects of bee venom acupuncture on cardiovascular system and differences according to each constitution. 2. Methods: Heart rate variability, pulse wave and the velocity of cerebral blood flow were measured before bee venom acupuncture(BVA, right after and after 30 minuets, had been applied to 20 subjects. 3. Results: 1. BVA did not have effects on measurement variables of heart rate variability. 2. BVA had effects on pulse wave, showing total time, radial augmentation index up and height of percussion wave, time to percussion wave, sum of pulse pressure down. 3. BVA did not have effects on the cerebral blood flow velocity when considering not Sasang Constitution 4. Considering Sasang Constitution, BVA demonstrates different responses in time to preincisura wave, mean blood flow velocity, peak systolic velocity and end diastolic velocity. 4.Conclusion: From those results, the following conclusions are obtained. Cause BVA alters pulse wave and makes differences in the cerebral blood flow velocity according to Sasang Constitution. Various methods of BVA treatment are needed considering Sasang Constitution.

New aspects of blood collection and handling procedures for the assessment of t-PA and PAI-1 variables after the introduction of acid blood collection

NARCIS (Netherlands)

Meijer, P.; Kret, R.; Bloetjes, P.T.M.; Rosen, S.; Kluft, C.

1994-01-01

Blood collection and handling procedures for t-PA activity have thusfar been rather strict and have restrained the use in clinical practice. We evaluated simplifications in the procedures for specifically the use of Stabilyte® vacutainers with respect to time before centrifugation of blood, storage

Single-cell measurement of red blood cell oxygen affinity

OpenAIRE

Caprio, Di; Stokes, Chris; Higgins, John M.; Schonbrun, Ethan

2015-01-01

Oxygen is transported throughout the body by hemoglobin in red blood cells. While the oxygen affinity of blood is well understood and is routinely assessed in patients by pulse oximetry, variability at the single-cell level has not been previously measured. In contrast, single-cell measurements of red blood cell volume and hemoglobin concentration are taken millions of times per day by clinical hematology analyzers and are important factors in determining the health of the hematologic system....

Variability in blood flow and pO2 in tumors in response to carbogen breathing

International Nuclear Information System (INIS)

Lanzen, Jennifer L.; Braun, Rod D.; Ong, Aqui L.; Dewhirst, Mark W.

1998-01-01

Purpose: There is speculation that the CO 2 in carbogen (95% O 2 , 5% CO 2 ) can block the vasoconstrictive effects of oxygen. However, it has recently been shown that blood flow in human tumors is variable while patients breathe carbogen. Furthermore, we have shown a consistent decrease in tumor blood flow (TBF) with carbogen breathing in the rat window chamber model. Also, we have previously shown that there is no significant difference in tumor growth time after radiation with air vs. carbogen breathing. This study was designed to investigate the effects of carbogen breathing on blood flow and oxygen levels in a solid tumor. Methods: Measurements were made in Fischer-344 rats with 8-10 mm diameter R3230Ac tumors transplanted either within the quadriceps muscle (n = 16) or subcutis (n = 14). Nontumor-bearing quadriceps muscle was studied in six other rats. After a 20-minute air-breathing baseline, rats breathed carbogen for an additional 40 minutes. Partial pressure of oxygen (pO 2 ) was continuously monitored at one position for 60 minutes using 9-12 μm diameter oxygen microelectrodes. Blood flow was simultaneously monitored in all animals using laser Doppler flowmetry (1-2 probes/tumor). Results: Blood flow changes during carbogen breathing were variable in all tissues and intratumoral heterogeneity was observed. Despite variability in blood flow, pO 2 consistently increased in normal muscle but varied in both tumor sites. During carbogen breathing, the percent pO 2 measurements greater than the baseline average were 99.5% ± 0.4% (mean ± SEM), 42.7% ± 13.8%, and 79.8% ± 11.0% in normal muscle, subcutaneous tumor, and muscle tumor, respectively. To show the magnitude of change, average pO 2 values during air and carbogen breathing were calculated for each site. Normal muscle increased from 14.9 ± 2.3 to 39.0 ± 6.4 mm Hg (paired t-test; p = 0.009). Muscle tumors showed a rise from 14.6 ± 3.2 to 34.5 ± 8.2 mm Hg (p = 0.019). However, pO 2 in subcutaneous

Red blood cell antibodies in pregnancy and their clinical consequences

DEFF Research Database (Denmark)

Nordvall, Maria; Dziegiel, Morten Hanefeld; Hegaard, Hanne Kristine

2009-01-01

The objective was to determine clinical consequences of various specificities for the infant/fetus. The population was patients referred between 1998 and 2005 to the tertiary center because of detected red blood cell (RBC) alloimmunization. Altogether 455 infants were delivered by 390 alloimmuniz...

Clinical picture and treatment of 2212 patients with common variable immunodeficiency

NARCIS (Netherlands)

Gathmann, Benjamin; Mahlaoui, Nizar; Gérard, Laurence; Oksenhendler, Eric; Warnatz, Klaus; Schulze, Ilka; Kindle, Gerhard; Kuijpers, Taco W.; van Beem, Rachel T.; Guzman, David; Workman, Sarita; Soler-Palacín, Pere; de Gracia, Javier; Witte, Torsten; Schmidt, Reinhold E.; Litzman, Jiri; Hlavackova, Eva; Thon, Vojtech; Borte, Michael; Borte, Stephan; Kumararatne, Dinakantha; Feighery, Conleth; Longhurst, Hilary; Helbert, Matthew; Szaflarska, Anna; Sediva, Anna; Belohradsky, Bernd H.; Jones, Alison; Baumann, Ulrich; Meyts, Isabelle; Kutukculer, Necil; Wågström, Per; Galal, Nermeen Mouftah; Roesler, Joachim; Farmaki, Evangelia; Zinovieva, Natalia; Ciznar, Peter; Papadopoulou-Alataki, Efimia; Bienemann, Kirsten; Velbri, Sirje; Panahloo, Zoya; Grimbacher, Bodo; de Vergnes, Nathalie; Costes, Laurence; Andriamanga, Chantal; Courteille, Virginie; Brosselin, Pauline; Korganow, Anne-Sophie; Lutz, Patrick; ten Berge, R. J. M.

2014-01-01

Common variable immunodeficiency (CVID) is an antibody deficiency with an equal sex distribution and a high variability in clinical presentation. The main features include respiratory tract infections and their associated complications, enteropathy, autoimmunity, and lymphoproliferative disorders.

Clinical picture and treatment of 2212 patients with common variable immunodeficiency

NARCIS (Netherlands)

Gathmann, B.; Mahlaoui, N.; Gerard, L.; Oksenhendler, E.; Warnatz, K.; Schulze, I.; Kindle, G.; Kuijpers, T.W.; Dutch, W.I.D.; Beem, R.T. van; Guzman, D.; Workman, S.; Soler-Palacin, P.; Gracia, J.; Witte, T. de; Schmidt, R.E.; Litzman, J.; Hlavackova, E.; Thon, V.; Borte, M.; Borte, S.; Kumararatne, D.; Feighery, C.; Longhurst, H.; Helbert, M.; Szaflarska, A.; Sediva, A.; Belohradsky, B.H.; Jones, A.; Baumann, U.; Meyts, I.; Kutukculer, N.; Wagstrom, P.; Galal, N.M.; Roesler, J.; Farmaki, E.; Zinovieva, N.; Ciznar, P.; Papadopoulou-Alataki, E.; Bienemann, K.; Velbri, S.; Panahloo, Z.; Grimbacher, B.; Meer, L.T. van der; Deuren, M. van; Netea, M.G.; Meer, J.W.M. van der; et al.,

2014-01-01

BACKGROUND: Common variable immunodeficiency (CVID) is an antibody deficiency with an equal sex distribution and a high variability in clinical presentation. The main features include respiratory tract infections and their associated complications, enteropathy, autoimmunity, and lymphoproliferative

Impact of Endogenous and Exogenous Interferences on Clinical Chemistry Parameters Measured on Blood Gas Analyzers.

Science.gov (United States)

Grieme, Caleb V; Voss, Dena R; Davis, Scott R; Krasowski, Matthew D

2017-03-01

The prevalence of hemolysis, icterus, and lipemia (HIL) was determined for residual whole blood specimens analyzed for clinical chemistry parameters on blood gas analyzers. The frequency and potential impact of exogenous interference from iodide, salicylate, and thiocyanate (metabolite of sodium nitroprusside) on analysis of whole blood chloride was also assessed. Over an approximately two month period at an academic medical center, indices for HIL were determined on Roche cobas c502 analyzers for 1,986 residual whole blood specimens that had been previously analyzed for clinical chemistry parameters on Radiometer ABL90 FLEX blood gas analyzers. To examine exogenous interferences, retrospective analysis was performed over multiple years to ascertain whether patient samples analyzed for whole blood chloride were potentially affected by interference from iodide, salicylate, or thiocyanate. Some degree of hemolysis (defined as hemolysis index of greater than 60) was present in 9.7% of the whole blood specimens. Increasing rates of hemolysis were associated with higher whole blood potassium concentrations. Nearly 60% of specimens with potassium concentrations between 6.0 and 6.9 mEq/L had hemolysis indices of 100 or greater, and 75% of specimens with a potassium concentration of 7.0 mEq/L or greater were severely hemolyzed (hemolysis index of 300 or greater). In contrast to the hemolysis results, icterus and lipemia were determined to have minimal impact on patient results. For the exogenous interferences, we did not identify any patient samples where elevated salicylate levels or pharmaceutical iodide administration overlapped with whole blood chloride analysis (out of 75,887 and 169,229 total chloride measurements, respectively). We did, however, find that for patients receiving nitroprusside therapy in the inpatient setting, whole blood chloride concentrations were significantly higher during nitroprusside therapy [106.7 +/- 6.2 mEq/L (mean, SD)] compared to before

Association between different measurements of blood pressure variability by ABP monitoring and ankle-brachial index.

Science.gov (United States)

Wittke, Estefânia; Fuchs, Sandra C; Fuchs, Flávio D; Moreira, Leila B; Ferlin, Elton; Cichelero, Fábio T; Moreira, Carolina M; Neyeloff, Jeruza; Moreira, Marina B; Gus, Miguel

2010-11-05

Blood pressure (BP) variability has been associated with cardiovascular outcomes, but there is no consensus about the more effective method to measure it by ambulatory blood pressure monitoring (ABPM). We evaluated the association between three different methods to estimate BP variability by ABPM and the ankle brachial index (ABI). In a cross-sectional study of patients with hypertension, BP variability was estimated by the time rate index (the first derivative of SBP over time), standard deviation (SD) of 24-hour SBP; and coefficient of variability of 24-hour SBP. ABI was measured with a doppler probe. The sample included 425 patients with a mean age of 57 ± 12 years, being 69.2% women, 26.1% current smokers and 22.1% diabetics. Abnormal ABI (≤ 0.90 or ≥ 1.40) was present in 58 patients. The time rate index was 0.516 ± 0.146 mmHg/min in patients with abnormal ABI versus 0.476 ± 0.124 mmHg/min in patients with normal ABI (P = 0.007). In a logistic regression model the time rate index was associated with ABI, regardless of age (OR = 6.9, 95% CI = 1.1- 42.1; P = 0.04). In a multiple linear regression model, adjusting for age, SBP and diabetes, the time rate index was strongly associated with ABI (P < 0.01). None of the other indexes of BP variability were associated with ABI in univariate and multivariate analyses. Time rate index is a sensible method to measure BP variability by ABPM. Its performance for risk stratification of patients with hypertension should be explored in longitudinal studies.

Rational Clinical Use of Blood and Blood products – A summary

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D Ghartimagar

2017-03-01

Full Text Available Blood transfusion is an essential therapeutic intervention. The main role of the blood centre is to provide safe and timely blood and blood component(s to the patients that will improve the physiological status of the patient. Various blood components can be harvested from a single donation of whole blood. The blood centre ensures that there is an adequate inventory of all blood types and blood components to meet the needs of the patients. The blood centre does donor selection, blood collection, component preparation, screening for transfusion – transmitted infections and blood processing. Serologically compatible blood and components are provided to the patients after meticulous pre-transfusion testing as per the standard protocol. Rational use of blood and blood products means right product is used with the right dose on right time for the right reason.

Ambulatory blood pressure monitoring in clinical trials with antihypertensive agents

NARCIS (Netherlands)

A.H. van den Meiracker (Anton)

1995-01-01

textabstractAmbulatory blood pressure monitoring (ABPM) is being used increasingly for the evaluation of antihypertensive agents in clinical trials. In this brief review several aspects of ABPM are discussed. In particular, attention is paid to the extent to which ABPM is subject to a placebo

High blood pressure in acute ischemic stroke and clinical outcome.

Science.gov (United States)

Manabe, Yasuhiro; Kono, Syoichiro; Tanaka, Tomotaka; Narai, Hisashi; Omori, Nobuhiko

2009-11-16

This study aimed to evaluate the prognostic value of acute phase blood pressure in patients with acute ischemic stroke by determining whether or not it contributes to clinical outcome. We studied 515 consecutive patients admitted within the first 48 hours after the onset of ischemic strokes, employing systolic and diastolic blood pressure measurements recorded within 36 hours after admission. High blood pressure was defined when the mean of at least 2 blood pressure measurements was ≥200 mmHg systolic and/or ≥110 mmHg diastolic at 6 to 24 hours after admission or ≥180 mmHg systolic and/or ≥105 mmHg diastolic at 24 to 36 hours after admission. The high blood pressure group was found to include 16% of the patients. Age, sex, diabetes mellitus, hypercholesterolemia, atrial fibrillation, ischemic heart disease, stroke history, carotid artery stenosis, leukoaraiosis, NIH Stroke Scale (NIHSS) on admission and mortality were not significantly correlated with either the high blood pressure or non-high blood pressure group. High blood pressure on admission was significantly associated with a past history of hypertension, kidney disease, the modified Rankin Scale (mRS) on discharge and the length of stay. On logistic regression analysis, with no previous history of hypertension, diabetes mellitus, atrial fibrillation, and kidney disease were independent risk factors associated with the presence of high blood pressure [odds ratio (OR), 1.85 (95% confidence interval (CI): 1.06-3.22), 1.89 (95% CI: 1.11-3.22), and 3.31 (95% CI: 1.36-8.04), respectively]. Multi-organ injury may be presented in acute stroke patients with high blood pressure. Patients with high blood pressure had a poor functional outcome after acute ischemic stroke.

Association between different measurements of blood pressure variability by ABP monitoring and ankle-brachial index

Directory of Open Access Journals (Sweden)

Moreira Leila B

2010-11-01

Full Text Available Abstract Background Blood pressure (BP variability has been associated with cardiovascular outcomes, but there is no consensus about the more effective method to measure it by ambulatory blood pressure monitoring (ABPM. We evaluated the association between three different methods to estimate BP variability by ABPM and the ankle brachial index (ABI. Methods and Results In a cross-sectional study of patients with hypertension, BP variability was estimated by the time rate index (the first derivative of SBP over time, standard deviation (SD of 24-hour SBP; and coefficient of variability of 24-hour SBP. ABI was measured with a doppler probe. The sample included 425 patients with a mean age of 57 ± 12 years, being 69.2% women, 26.1% current smokers and 22.1% diabetics. Abnormal ABI (≤ 0.90 or ≥ 1.40 was present in 58 patients. The time rate index was 0.516 ± 0.146 mmHg/min in patients with abnormal ABI versus 0.476 ± 0.124 mmHg/min in patients with normal ABI (P = 0.007. In a logistic regression model the time rate index was associated with ABI, regardless of age (OR = 6.9, 95% CI = 1.1- 42.1; P = 0.04. In a multiple linear regression model, adjusting for age, SBP and diabetes, the time rate index was strongly associated with ABI (P Conclusion Time rate index is a sensible method to measure BP variability by ABPM. Its performance for risk stratification of patients with hypertension should be explored in longitudinal studies.

Cooperative study of clinical benefits from use of the fully portable blood irradiator

International Nuclear Information System (INIS)

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

Cooperative study of clinical benefits from use of the fully portable blood irradiator

Energy Technology Data Exchange (ETDEWEB)

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.

Very poor agreement between routine outpatient clinic office and ambulatory blood pressure: time to improve an old hospital outpatient clinic routine?

Science.gov (United States)

Reinhard, Mark; Poulsen, Per L; Christensen, Kent L

2016-12-01

We investigated the agreement between elevated outpatient clinic office blood pressure (OC-OBP) as measured in the daily routine in our University Hospital Cardiology Outpatient Clinic and subsequent awake ambulatory blood pressure (AABP). In all patients referred for ambulatory blood pressure monitoring from our Cardiology Outpatient Clinic, we identified OC-OBP and changes in medication in the period from 1 January 2014 to 15 September 2015. The AABP was used as a reference measurement for the OC-OBP. A total of 183 patients were included in the study. Their mean age was 62.1±14.0 years and 49% were women. The mean systolic OC-OBP was 166.8±17.9 mmHg and the difference between the mean systolic OC-OBP and AABP was 28.0±19.5 mmHg (Pclinic agrees poorly with AABP and may lead to unnecessary treatment and pharmacologically induced symptomatic hypotension, particularly in elderly patients. The results of this study urgently call for alternative solutions to routine OC-OBP in hospital outpatient clinics.

Heart Rate and Systolic Blood Pressure Variability on Recently Diagnosed Diabetics

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Anaclara Michel-Chávez

2015-01-01

Full Text Available 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.

Difference in blood pressure measurements between arms: methodological and clinical implications.

Science.gov (United States)

Clark, Christopher E

2015-01-01

Differences in blood pressure measurements between arms are commonly encountered in clinical practice. If such differences are not excluded they can delay the diagnosis of hypertension and can lead to poorer control of blood pressure levels. Differences in blood pressure measurements between arms are associated cross sectionally with other signs of vascular disease such as peripheral arterial disease or cerebrovascular disease. Differences are also associated prospectively with increased cardiovascular mortality and morbidity and all cause mortality. Numbers of publications on inter-arm difference are rising year on year, indicating a growing interest in the phenomenon. The prevalence of an inter-arm difference varies widely between reports, and is correlated with the underlying cardiovascular risk of the population studied. Prevalence is also sensitive to the method of measurement used. This review discusses the prevalence of an inter-arm difference in different populations and addresses current best practice for the detection and the measurement of a difference. The evidence for clinical and for vascular associations of an inter-arm difference is presented in considering the emerging role of an inter-arm blood pressure difference as a novel risk factor for increased cardiovascular morbidity and mortality. Competing aetiological explanations for an inter-arm difference are explored, and gaps in our current understanding of this sign, along with areas in need of further research, are considered.

Optoacoustic monitoring of blood hemoglobin concentration: a pilot clinical study

Science.gov (United States)

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.

Quality of life after surgical treatment of coarctation in long-term follow-up (CoAFU): Predictive value of clinical variables.

Science.gov (United States)

Bambul Heck, Pinar; Pabst von Ohain, Jelena; Kaemmerer, Harald; Ewert, Peter; Hager, Alfred

2018-01-01

We sought to analyze the quality of life and the predictive value of clinical variables from previous follow-up study in patients late after surgical treatment of aortic coarctation on the quality of life. All patients, who have participated in the prospective cross-sectional COALA Study in 2000 with a structural clinical investigation including blood pressure measurement and symptom-limited exercise test were contacted for the health-related quality of life questionnaire SF-36 from January 2013 through December 2014. From 273 eligible patients, we received data from 135 patients, 9 of them died during the follow-up time at the median age of 46years (range 30-64years). Seventy-four patients did not participate in the study, other 64 patients moved to remote or unknown areas and could not be contacted. Quality of life was good in the fields of physical role and pain. However, patients reported a significant impairment in general health and in health transition, depending on the age. Arterial hypertension and variables from echocardiography or exercise testing from the COALA study were not predictive on functional health status. Quality of life in patients late after aortic coarctation repair is fairly good compared with healthy controls. Impairments in general health and health transition depend mainly on age, can be explained due to numerous comorbidities and reinterventions in long-term. The predictive value of the commonly assessed clinical variables on quality of life is limited. Copyright © 2017. Published by Elsevier B.V.

Genetic variability of genital mycoplasmas and its clinical value

Directory of Open Access Journals (Sweden)

K. I. Plakhova

2015-01-01

Full Text Available The article presents data on genetic variability of genital mycoplasmas. The author presents the results of genetic variability studies for M. hominis, gene vaa, U. parvum, gene mba, and M. genitalium, gene mg192, sampled from women with different clinical manifestations of inflammatory diseases of the urogenital system. Based on the molecular typing results for 138 samples of genital mycoplasmas, the author revealed a relationship between clinical manifestations of inflammatory diseases of the urogenital system caused by U. parvum and different U. parvum serovars as well as different genetic variations of M. hominis.Infection with 6 U. parvum serovar results in the development of inflammatory diseases of the urogenital tract accompanied by subjective manifestations (р < 0.05. Genetic variant II of М. hominis was revealed more often in patients with clinical manifestations of inflammatory diseases while variant I was revealed more often in patients infected with М. hominis without any signs of inflammation (р < 0.05. Genetic variants of M. genitalium were determined; no significant differences in terms of their prevalence in the examined patients were revealed.

Mobile clinic in Massachusetts associated with cost savings from lowering blood pressure and emergency department use.

Science.gov (United States)

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.

The Clinical Impact of Rapid, Direct MALDI-ToF Identification of Bacteria from Positive Blood Cultures.

Science.gov (United States)

French, Kathryn; Evans, Jason; Tanner, Hannah; Gossain, Savita; Hussain, Abid

2016-01-01

Faster identification of bacterial isolates from blood cultures can enable earlier clinical intervention for patients with sepsis. We evaluated the clinical impact of direct identification of micro-organisms from positive blood cultures using MALDI-ToF. Positive blood cultures with organisms seen on Gram stain were included over a four week period. For each patient case, comparison was made between the clinical advice given on day one with only a Gram stain result, and the follow up advice given on day two with the benefit of organism identification. Culture results were then compared with direct MALDI-ToF identification. For 73 of 115 cases (63.5%), direct organism identification was obtained by MALDI-ToF. Of those 73, 70 (95.5%) had a result concordant with that of the plate culture. In 28 of the 115 cases (24.3%) direct MALDI-ToF identification on day one would have had a clear clinical benefit. In 11 cases it would have helped to identify the potential source of bacteraemia. In 11 cases it would have indicated a different antibiotic regimen on day one, with five patients receiving appropriate antibiotics 24 hours earlier. For 14 cases the blood culture isolate could have been designated as unlikely to be clinically significant. We have demonstrated that organism identification on day one of blood culture positivity can have a direct clinical impact. Faster identification using MALDI-ToF assists the clinician in assessing the significance of a blood culture isolate on day one. It can allow earlier appropriate choice of antimicrobial agent, even in the absence of susceptibility testing, and help narrow down the potential source of infection providing a focus for further investigation in a more timely way than conventional techniques alone.

The Clinical Impact of Rapid, Direct MALDI-ToF Identification of Bacteria from Positive Blood Cultures.

Directory of Open Access Journals (Sweden)

Kathryn French

Full Text Available Faster identification of bacterial isolates from blood cultures can enable earlier clinical intervention for patients with sepsis. We evaluated the clinical impact of direct identification of micro-organisms from positive blood cultures using MALDI-ToF.Positive blood cultures with organisms seen on Gram stain were included over a four week period. For each patient case, comparison was made between the clinical advice given on day one with only a Gram stain result, and the follow up advice given on day two with the benefit of organism identification. Culture results were then compared with direct MALDI-ToF identification.For 73 of 115 cases (63.5%, direct organism identification was obtained by MALDI-ToF. Of those 73, 70 (95.5% had a result concordant with that of the plate culture. In 28 of the 115 cases (24.3% direct MALDI-ToF identification on day one would have had a clear clinical benefit. In 11 cases it would have helped to identify the potential source of bacteraemia. In 11 cases it would have indicated a different antibiotic regimen on day one, with five patients receiving appropriate antibiotics 24 hours earlier. For 14 cases the blood culture isolate could have been designated as unlikely to be clinically significant.We have demonstrated that organism identification on day one of blood culture positivity can have a direct clinical impact. Faster identification using MALDI-ToF assists the clinician in assessing the significance of a blood culture isolate on day one. It can allow earlier appropriate choice of antimicrobial agent, even in the absence of susceptibility testing, and help narrow down the potential source of infection providing a focus for further investigation in a more timely way than conventional techniques alone.

ABO blood groups and oral premalignancies: A clinical study in selected Indian population.

Science.gov (United States)

Bhateja, S; Arora, G

2014-01-01

Background: The ABO blood group antigens are present on the surface of red blood cells and various epithelial cells. As the majority of human cancers are derived from epithelial cells, changes in blood group antigens constitute an important aspect of human cancers. The aim of the study was to establish clinical usefulness of ABO blood group as a predisposing factor in early diagnosis and management of patients with oral precancerous lesions/conditions. Materials and Methods: The study sample consisted of 50 control and 50 oral precancer (25 leukoplakia and 25 Oral Submucous Fibrosis) confirmed by histopathologic examination. All samples were subjected to blood group testing and their prevalence was compared by Z-test using STATA version 8. Results: The "A" blood group was prevalent among the precancerous group. Significant differences on prevalences of blood groups were found (P blood group. Conclusion: Blood group type should be considered along with other risk factors to understand the individual patient's risk and further studies in larger samples with inclusion of Rh factor is needed to elucidate the relationship with ABO blood group types.

Beat to beat variability in cardiovascular variables: noise or music?

Science.gov (United States)

Appel, M. L.; Berger, R. D.; Saul, J. P.; Smith, J. M.; Cohen, R. J.

1989-01-01

Cardiovascular variables such as heart rate, arterial blood pressure, stroke volume and the shape of electrocardiographic complexes all fluctuate on a beat to beat basis. These fluctuations have traditionally been ignored or, at best, treated as noise to be averaged out. The variability in cardiovascular signals reflects the homeodynamic interplay between perturbations to cardiovascular function and the dynamic response of the cardiovascular regulatory systems. Modern signal processing techniques provide a means of analyzing beat to beat fluctuations in cardiovascular signals, so as to permit a quantitative, noninvasive or minimally invasive method of assessing closed loop hemodynamic regulation and cardiac electrical stability. This method promises to provide a new approach to the clinical diagnosis and management of alterations in cardiovascular regulation and stability.

Recommendations for blood pressure measuring devices for office/clinic use in low resource settings

NARCIS (Netherlands)

Parati, G.; Mendis, S.; Abegunde, D.; Asmar, R.; Mieke, S.; Murray, A.; Shengelia, B.; Steenvoorden, G.; Montfrans, G. van; O'Brien, E.

2005-01-01

This paper, which summarizes the conclusions of a WHO Expert meeting, is aimed at proposing indications to develop technical specifications for an accurate and affordable blood pressure measuring device for office/ clinic use in low resource settings. Blood pressure measuring devices to be used in

Identification of clinical biomarkers for pre-analytical quality control of blood samples.

Science.gov (United States)

Kang, Hyun Ju; Jeon, Soon Young; Park, Jae-Sun; Yun, Ji Young; Kil, Han Na; Hong, Won Kyung; Lee, Mee-Hee; Kim, Jun-Woo; Jeon, Jae-Pil; Han, Bok Ghee

2013-04-01

Pre-analytical conditions are key factors in maintaining the high quality of biospecimens. They are necessary for accurate reproducibility of experiments in the field of biomarker discovery as well as achieving optimal specificity of laboratory tests for clinical diagnosis. In research at the National Biobank of Korea, we evaluated the impact of pre-analytical conditions on the stability of biobanked blood samples by measuring biochemical analytes commonly used in clinical laboratory tests. We measured 10 routine laboratory analytes in serum and plasma samples from healthy donors (n = 50) with a chemistry autoanalyzer (Hitachi 7600-110). The analyte measurements were made at different time courses based on delay of blood fractionation, freezing delay of fractionated serum and plasma samples, and at different cycles (0, 1, 3, 6, 9) of freeze-thawing. Statistically significant changes from the reference sample mean were determined using the repeated-measures ANOVA and the significant change limit (SCL). The serum levels of GGT and LDH were changed significantly depending on both the time interval between blood collection and fractionation and the time interval between fractionation and freezing of serum and plasma samples. The glucose level was most sensitive only to the elapsed time between blood collection and centrifugation for blood fractionation. Based on these findings, a simple formula (glucose decrease by 1.387 mg/dL per hour) was derived to estimate the length of time delay after blood collection. In addition, AST, BUN, GGT, and LDH showed sensitive responses to repeated freeze-thaw cycles of serum and plasma samples. These results suggest that GGT and LDH measurements can be used as quality control markers for certain pre-analytical conditions (eg, delayed processing or repeated freeze-thawing) of blood samples which are either directly used in the laboratory tests or stored for future research in the biobank.

Patient Blood Management in Europe: surveys on top indications for red blood cell use and Patient Blood Management organization and activities in seven European university hospitals.

Science.gov (United States)

Bruun, M T; Pendry, K; Georgsen, J; Manzini, P; Lorenzi, M; Wikman, A; Borg-Aquilina, D; van Pampus, E; van Kraaij, M; Fischer, D; Meybohm, P; Zacharowski, K; Geisen, C; Seifried, E; Liumbruno, G M; Folléa, G; Grant-Casey, J; Babra, P; Murphy, M F

2016-11-01

Patient Blood Management (PBM) in Europe is a working group of the European Blood Alliance with the initial objective to identify the starting position of the participating hospitals regarding PBM for benchmarking purposes, and to derive good practices in PBM from the experience and expertise in the participating teams with the further aim of implementing and strengthening these practices in the participating hospitals. We conducted two surveys in seven university hospitals in Europe: Survey on top indications for red blood cell use regarding usage of red blood cells during 1 week and Survey on PBM organization and activities. A total of 3320 units of red blood cells were transfused in 1 week at the seven hospitals. Overall, 61% of red cell units were transfused to medical patients and 36% to surgical patients, although there was much variation between hospitals. The organization and activities of PBM in the seven hospitals were variable, but there was a common focus on optimizing the treatment of bleeding patients, monitoring the use of blood components and treatment of preoperative anaemia. Although the seven hospitals provide a similar range of clinical services, there was variation in transfusion rates between them. Further, there was variable implementation of PBM activities and monitoring of transfusion practice. These findings provide a baseline to develop joint action plans to further implement and strengthen PBM across a number of hospitals in Europe. © 2016 International Society of Blood Transfusion.

Clinical variability of neuroacanthocytosis syndromes-a series of six patients with long follow-up.

Science.gov (United States)

Dulski, J; Sołtan, W; Schinwelski, M; Rudzińska, M; Wójcik-Pędziwiatr, M; Wictor, L; Schön, F; Puschmann, A; Klempíř, J; Tilley, L; Roth, J; Tacik, P; Fujioka, S; Drozdowski, W; Sitek, E J; Wszolek, Z; Sławek, J

2016-08-01

To provide clinical clues to differential diagnosis in patients with chorea and other movement disorders with blood acanthocytes. We present a long-term video accompanied follow-up of six Caucasian patients with neuroacanthocytosis from several centers, three diagnosed with chorea-acanthocytosis (ChAc): 34-y.o.(no.1), 36-y.o.(no.2), 43-y.o.(no.3), two diagnosed with McLeod Syndrome (MLS): 52-y.o.(no.4), 61-y.o.(no.5) and one 63-y.o.(no.6), a brother of no.5, with clinical suspicion of MLS. Additionally we report pathological findings of the mother of two brothers with MLS reported in our series with acanthocytes on peripheral blood smear The patients had an unremarkable family history and were asymptomatic until adulthood. Patients no. 1,2,4,5,6 developed generalized chorea and patient no. 3 had predominant bradykinesia. Patients no. 1,2,3 had phonic and motor tics, additionally patients no. 1 and 2 exhibited peculiar oromandibular dystonia with tongue thrusting. In patients no. 2 and 3 dystonic supination of feet was observed, patient no. 3 subsequently developed bilateral foot drop. Patients no. 2 and 4 had signs of muscle atrophy. Tendon reflexes were decreased or absent and electroneurography demonstrated sensorimotor neuropathy in patients no. 1,2,3,4,5, except no. 6. Generalized seizures were seen in patients no. 2,3,5,6 and myoclonic jerks in patient no. 1. Cognitive deterioration was reported in patients no. 1,2,3,5,6. Serum creatine kinase levels were elevated in all six patients. We highlight the variability of clinical presentation of neuroacanthocytosis syndromes and the long time from the onset to diagnosis with the need to screen the blood smears in uncertain cases, however, as in one of our cases acanthocytes may even be not found. Based on our observations and data from the literature we propose several red flags that should raise the suspicion of an NA syndrome in a patient with a movement disorder: severe orofacial dyskinesia with tongue and lip

Adhesion molecules levels in blood correlate with MRI activity and clinical activity in multiple sclerosis

International Nuclear Information System (INIS)

Millers, A.; Enina, G.; Platkajis, A.; Metra, M.; Kukaine, R.

2002-01-01

Research into pathogenesis of multiple sclerosis (MS) has prompted efforts to identify immunological markers associated with disease activity. Adhesion molecules ICAM-1 and VCAM-1 are associated with inflammatory mediated blood-brain barrier (BBB) dysfunction. In this study investigates the correlation between blood level of circulating ICAM-1 and VCAM-1 and magnetic resonance imaging (MRI) activity in different clinical phases of patients with MS. We show that RRMS and SPMS patients in clinically active phase with Gd-enhancing lesions in CNS had higher blood levels of cICAM-1 and cVCAM-1 compared these parameters levers of RRMS patients in remission stage. These results suggest that cICAM-1 and cVCAM-1 is a sensitive indicator of disease activity associated with BBB inflammatory dysfunction. Elevated blood level of cICAM-1 more strongly correlated with clinical activity and BBB damage, than cVCAM-1 and that could be used as biological marker of disease activity. Circulating VCAM-1 as an early indicator of BBB disturbance, may also serve as marker of beneficial activity in relapses phase of MS course. (authors)

[Clinical utility of home blood pressure monitoring in patients under treatment].

Science.gov (United States)

Bauk, L; Costa, H A; Caligiuri, S I

2015-01-01

A low number of patients who are treated with antihypertensive drugs achieve therapeutic goals. Home blood pressure monitoring is an excellent tool for studying this population. To determine the prevalence of patients with controlled and uncontrolled hypertension, as well as white-coat-effect and masked hypertension, and to evaluate the relationship with target organ damage in different groups. Blood pressure readings were performed simultaneously in the clinic and in the home using the same validated oscillometric equipment on 83 hypertensive patients on treatment with 2 or more antihypertensive drugs. They were then classified into 4 groups according to the cut-off values of the clinic and home blood pressure measurements. Left ventricular mass index, carotid intima media thickness, and microalbuminuria as markers of target organ damage, were also evaluated. Controlled blood pressure was present in 32.5%, 30.2% had sustained hypertension. The white coat effect was seen in 26.5%, while 10.8% were masked uncontrolled hypertension. Left ventricular mass index was higher in patients with no ambulatory control compared to controlled patients, and carotid IMT was also higher too in uncontrolled and white coat effect groups than controlled patients. More than one third of our patients who were treated with 2 or more drugs were not properly controlled, and they had significantly greater target organ damage than controlled patients. Copyright © 2014 SEHLELHA. Published by Elsevier Espana. All rights reserved.

When to trust our learners? Clinical teachers' perceptions of decision variables in the entrustment process.

Science.gov (United States)

Duijn, Chantal C M A; Welink, Lisanne S; Bok, Harold G J; Ten Cate, Olle T J

2018-06-01

Clinical training programs increasingly use entrustable professional activities (EPAs) as focus of assessment. However, questions remain about which information should ground decisions to trust learners. This qualitative study aimed to identify decision variables in the workplace that clinical teachers find relevant in the elaboration of the entrustment decision processes. The findings can substantiate entrustment decision-making in the clinical workplace. Focus groups were conducted with medical and veterinary clinical teachers, using the structured consensus method of the Nominal Group Technique to generate decision variables. A ranking was made based on a relevance score assigned by the clinical teachers to the different decision variables. Field notes, audio recordings and flip chart lists were analyzed and subsequently translated and, as a form of axial coding, merged into one list, combining the decision variables that were similar in their meaning. A list of 11 and 17 decision variables were acknowledged as relevant by the medical and veterinary teacher groups, respectively. The focus groups yielded 21 unique decision variables that were considered relevant to inform readiness to perform a clinical task on a designated level of supervision. The decision variables consisted of skills, generic qualities, characteristics, previous performance or other information. We were able to group the decision variables into five categories: ability, humility, integrity, reliability and adequate exposure. To entrust a learner to perform a task at a specific level of supervision, a supervisor needs information to support such a judgement. This trust cannot be credited on a single case at a single moment of assessment, but requires different variables and multiple sources of information. This study provides an overview of decision variables giving evidence to justify the multifactorial process of making an entrustment decision.

Clinical Outcomes of a Pharmacy-Led Blood Factor Stewardship Program.

Science.gov (United States)

Trueg, Anne O; Lowe, Christopher; Kiel, Patrick J

To report the results of a pharmacist-directed blood factor stewardship program targeting off-label utilization designed to limit use to established organizational guidelines in high-risk populations. Prospective evaluation of recombinant factor VIIa and prothrombin complex concentrate orders beginning June 2013 through May 2014 and a matched retrospective cohort from June 2012 to May 2013. Matched cohorts were evaluated for 28-day mortality, change in international normalized ratio (INR), adverse events, concurrent blood product use, and cost savings. Forty-two orders for blood factor were ordered between June 2013 and May 2014, 70 orders in the year before (N = 112). Twenty eight-day mortality was not different between the cohorts: 53.9% versus 50% (P = 0.77). Blood factor use with underlying liver failure and active bleeding was strongly associated with 28-day mortality: odds ratio (95% confidence interval), 2.9 (1.5-7.14) and 2.91 (0.01-2.91), respectively. Blood products dispensed increased over the year with plasma products the most significant (1 vs. 4 P = 0.004). All other clinical outcomes were nonsignificant. An annual cost savings of $375,539 was achieved, primarily through a significant reduction in recombinant factor VIIa and avoidance in high-risk patients. Use of off-label blood factors can be controlled through a pharmacist-led stewardship program. Twenty eight-day mortality was not different between the 2 cohorts; however, identification of risk factors for death associated with blood factor use allows for restriction in high-risk populations, creates a discussion of futile care, and yields cost savings.

Variability in ACL tunnel placement: observational clinical study of surgeon ACL tunnel variability.

Science.gov (United States)

Wolf, Brian R; Ramme, Austin J; Wright, Rick W; Brophy, Robert H; McCarty, Eric C; Vidal, Armando R; Parker, Richard D; Andrish, Jack T; Amendola, Annunziato

2013-06-01

Multicenter and multisurgeon cohort studies on anterior cruciate ligament (ACL) reconstruction are becoming more common. Minimal information exists on intersurgeon and intrasurgeon variability in ACL tunnel placement. Purpose/ The purpose of this study was to analyze intersurgeon and intrasurgeon variability in ACL tunnel placement in a series of The Multicenter Orthopaedic Outcomes Network (MOON) ACL reconstruction patients and in a clinical cohort of ACL reconstruction patients. The hypothesis was that there would be minimal variability between surgeons in ACL tunnel placement. Cross-sectional study; Level of evidence, 3. Seventy-eight patients who underwent ACL reconstruction by 8 surgeons had postoperative imaging with computed tomography, and ACL tunnel location and angulation were analyzed using 3-dimensional surface processing and measurement. Intersurgeon and intrasurgeon variability in ACL tunnel placement was analyzed. For intersurgeon variability, the range in mean ACL femoral tunnel depth between surgeons was 22%. For femoral tunnel height, there was a 19% range. Tibial tunnel location from anterior to posterior on the plateau had a 16% range in mean results. There was only a small range of 4% for mean tibial tunnel location from the medial to lateral dimension. For intrasurgeon variability, femoral tunnel depth demonstrated the largest ranges, and tibial tunnel location from medial to lateral on the plateau demonstrated the least variability. Overall, surgeons were relatively consistent within their own cases. Using applied measurement criteria, 85% of femoral tunnels and 90% of tibial tunnels fell within applied literature-based guidelines. Ninety-one percent of the axes of the femoral tunnels fell within the boundaries of the femoral footprint. The data demonstrate that surgeons performing ACL reconstructions are relatively consistent between each other. There is, however, variability of average tunnel placement up to 22% of mean condylar depth

Clinical implication of blood glucose monitoring in general dental offices: the Ehime Dental Diabetes Study

OpenAIRE

Harase, Tadahiro; Nishida, Wataru; Hamakawa, Tomohiro; Hino, Satoshi; Shigematsu, Kenji; Kobayashi, Satoru; Sako, Hirofumi; Ito, Shirou; Murakami, Hajime; Nishida, Kei; Inoue, Hiroshi; Fujisawa, Masahito; Yoshizu, Hiroshi; Kawamura, Ryoichi; Takata, Yasunori

2015-01-01

Objective We examined whether general dentists can contribute to the detection of patients with undiagnosed diabetes and prediabetes by monitoring blood glucose in dental clinics. Research design and methods A total of 716 patients who visited clinics for dental treatment were enrolled and classified into 3 groups (mild, moderate, and severe) according to Kornman's criteria for periodontitis. The correlations between the casual blood glucose level, presence or absence of the history of diabet...

Fetal scalp blood sampling during labor

DEFF Research Database (Denmark)

Chandraharan, Edwin; Wiberg, Nana

2014-01-01

Fetal cardiotocography is characterized by low specificity; therefore, in an attempt to ensure fetal well-being, fetal scalp blood sampling has been recommended by most obstetric societies in the case of a non-reassuring cardiotocography. The scientific agreement on the evidence for using fetal...... scalp blood sampling to decrease the rate of operative delivery for fetal distress is ambiguous. Based on the same studies, a Cochrane review states that fetal scalp blood sampling increases the rate of instrumental delivery while decreasing neonatal acidosis, whereas the National Institute of Health...... and Clinical Excellence guideline considers that fetal scalp blood sampling decreases instrumental delivery without differences in other outcome variables. The fetal scalp is supplied by vessels outside the skull below the level of the cranial vault, which is likely to be compressed during contractions...

Predictive role of the nighttime blood pressure

DEFF Research Database (Denmark)

Hansen, Tine W; Li, Yan; Boggia, José

2011-01-01

Numerous studies addressed the predictive value of the nighttime blood pressure (BP) as captured by ambulatory monitoring. However, arbitrary cutoff limits in dichotomized analyses of continuous variables, data dredging across selected subgroups, extrapolation of cross-sectional studies...... of conclusive evidence proving that nondipping is a reversible risk factor, the option whether or not to restore the diurnal blood pressure profile to a normal pattern should be left to the clinical judgment of doctors and should be individualized for each patient. Current guidelines on the interpretation...

24-hour aortic blood pressure variability showed a stronger association with carotid damage than 24-hour brachial blood pressure variability: The SAFAR study.

Science.gov (United States)

Yu, Shikai; Chi, Chen; Protogerou, Athanase D; Safar, Michel E; Blacher, Jacques; Argyris, Antonis A; Nasothimiou, Efthimia G; Sfikakis, Petros P; Papaioannou, Theodore G; Xu, Henry; Zhang, Yi; Xu, Yawei

2018-03-01

We aim to compare 24-hour aortic blood pressure variability (BPV) with brachial BPV in relation to carotid damage as estimated by carotid intima-media thickness (CIMT) and cross-sectional area (CCSA). Four hundred and forty five individuals received brachial and aortic 24-hour ambulatory BP monitoring with a validated device (Mobil-O-Graph). Systolic BPV was estimated by average real variability (ARV) and time-weighted standard deviation (wSD). In multiple logistic regression analysis, CIMT > 900 μm was significantly and independently associated with aortic ARV (OR = 1.38; 95% CI: 1.04-1.84), aortic wSD (OR = 1.65; 95% CI: 1.19-2.29) and brachial ARV (OR = 1.53; 95% CI: 1.07-2.18), but not with brachial wSD. CCSA > 90th percentile was significantly and independently associated with aortic ARV (OR = 1.50; 95% CI: 1.07-2.10) and wSD (OR = 1.70; 95% CI: 1.12-2.56), but not with brachial BPVs. In receiver operator characteristics curve analysis, aortic wSD identified CCSA > 90th percentile better than brachial wSD (AUC: 0.73 vs 0.68, P < .01). In conclusion, aortic 24-hour systolic BPV showed a slightly stronger association with carotid damage than brachial BPV. ©2018 Wiley Periodicals, Inc.

Blood DNA methylation biomarkers predict clinical reactivity in food-sensitized infants.

Science.gov (United States)

Martino, David; Dang, Thanh; Sexton-Oates, Alexandra; Prescott, Susan; Tang, Mimi L K; Dharmage, Shyamali; Gurrin, Lyle; Koplin, Jennifer; Ponsonby, Anne-Louise; Allen, Katrina J; Saffery, Richard

2015-05-01

The diagnosis of food allergy (FA) can be challenging because approximately half of food-sensitized patients are asymptomatic. Current diagnostic tests are excellent makers of sensitization but poor predictors of clinical reactivity. Thus oral food challenges (OFCs) are required to determine a patient's risk of reactivity. We sought to discover genomic biomarkers of clinical FA with utility for predicting food challenge outcomes. Genome-wide DNA methylation (DNAm) profiling was performed on blood mononuclear cells from volunteers who had undergone objective OFCs, concurrent skin prick tests, and specific IgE tests. Fifty-eight food-sensitized patients (aged 11-15 months) were assessed, half of whom were clinically reactive. Thirteen nonallergic control subjects were also assessed. Reproducibility was assessed in an additional 48 samples by using methylation data from an independent population of patients with clinical FA. Using a supervised learning approach, we discovered a DNAm signature of 96 CpG sites that predict clinical outcomes. Diagnostic scores were derived from these 96 methylation sites, and cutoffs were determined in a sensitivity analysis. Methylation biomarkers outperformed allergen-specific IgE and skin prick tests for predicting OFC outcomes. FA status was correctly predicted in the replication cohort with an accuracy of 79.2%. DNAm biomarkers with clinical utility for predicting food challenge outcomes are readily detectable in blood. The development of this technology in detailed follow-up studies will yield highly innovative diagnostic assays. Copyright © 2015 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Clinical assessment of the accuracy of blood glucose measurement devices.

Science.gov (United States)

Pfützner, Andreas; Mitri, Michael; Musholt, Petra B; Sachsenheimer, Daniela; Borchert, Marcus; Yap, Andrew; Forst, Thomas

2012-04-01

Blood glucose meters for patient self-measurement need to comply with the accuracy standards of the ISO 15197 guideline. We investigated the accuracy of the two new blood glucose meters BG*Star and iBG*Star (Sanofi-Aventis) in comparison to four other competitive devices (Accu-Chek Aviva, Roche Diagnostics; FreeStyle Freedom Lite, Abbott Medisense; Contour, Bayer; OneTouch Ultra 2, Lifescan) at different blood glucose ranges in a clinical setting with healthy subjects and patients with type 1 and type 2 diabetes. BGStar and iBGStar are employ dynamic electrochemistry, which is supposed to result in highly accurate results. The study was performed on 106 participants (53 female, 53 male, age (mean ± SD): 46 ± 16 years, type 1: 32 patients, type 2: 34 patients, and 40 healthy subjects). Two devices from each type and strips from two different production lots were used for glucose assessment (∼200 readings/meter). Spontaneous glucose assessments and glucose or insulin interventions under medical supervision were applied to perform measurements in the different glucose ranges in accordance with the ISO 15197 requirements. Sample values 400 mg/dL were prepared by laboratory manipulations. The YSI glucose analyzer (glucose oxidase method) served as the standard reference method which may be considered to be a limitation in light of glucose hexokinase-based meters. For all devices, there was a very close correlation between the glucose results compared to the YSI reference method results. The correlation coefficients were r = 0.995 for BGStar and r = 0.992 for iBGStar (Aviva: 0.995, Freedom Lite: 0.990, Contour: 0.993, Ultra 2: 0.990). Error-grid analysis according to Parkes and Clarke revealed both 100% of the readings to be within the clinically acceptable areas (Clarke: A + B with BG*Star (100 + 0), Aviva (97 + 3), and Contour (97 + 3); and 99.5% with iBG*Star (97.5 + 2), Freedom Lite (98 + 1.5), and Ultra 2 (97.5 + 2

Role of blood pressure and other variables in the differential cardiovascular event rates noted in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA)

DEFF Research Database (Denmark)

Poulter, Neil R; Wedel, Hans; Dahlöf, Björn

2005-01-01

Results of the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA) show significantly lower rates of coronary and stroke events in individuals allocated an amlodipine-based combination drug regimen than in those allocated an atenolol-based combination drug regimen (HR...... 0.86 and 0.77, respectively). Our aim was to assess to what extent these differences were due to significant differences in blood pressures and in other variables noted after randomisation....

Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage.

Science.gov (United States)

Carson, Jeffrey L; Guyatt, Gordon; Heddle, Nancy M; Grossman, Brenda J; Cohn, Claudia S; Fung, Mark K; Gernsheimer, Terry; Holcomb, John B; Kaplan, Lewis J; Katz, Louis M; Peterson, Nikki; Ramsey, Glenn; Rao, Sunil V; Roback, John D; Shander, Aryeh; Tobian, Aaron A R

2016-11-15

More than 100 million units of blood are collected worldwide each year, yet the indication for red blood cell (RBC) transfusion and the optimal length of RBC storage prior to transfusion are uncertain. To provide recommendations for the target hemoglobin level for RBC transfusion among hospitalized adult patients who are hemodynamically stable and the length of time RBCs should be stored prior to transfusion. Reference librarians conducted a literature search for randomized clinical trials (RCTs) evaluating hemoglobin thresholds for RBC transfusion (1950-May 2016) and RBC storage duration (1948-May 2016) without language restrictions. The results were summarized using the Grading of Recommendations Assessment, Development and Evaluation method. For RBC transfusion thresholds, 31 RCTs included 12 587 participants and compared restrictive thresholds (transfusion not indicated until the hemoglobin level is 7-8 g/dL) with liberal thresholds (transfusion not indicated until the hemoglobin level is 9-10 g/dL). The summary estimates across trials demonstrated that restrictive RBC transfusion thresholds were not associated with higher rates of adverse clinical outcomes, including 30-day mortality, myocardial infarction, cerebrovascular accident, rebleeding, pneumonia, or thromboembolism. For RBC storage duration, 13 RCTs included 5515 participants randomly allocated to receive fresher blood or standard-issue blood. These RCTs demonstrated that fresher blood did not improve clinical outcomes. It is good practice to consider the hemoglobin level, the overall clinical context, patient preferences, and alternative therapies when making transfusion decisions regarding an individual patient. Recommendation 1: a restrictive RBC transfusion threshold in which the transfusion is not indicated until the hemoglobin level is 7 g/dL is recommended for hospitalized adult patients who are hemodynamically stable, including critically ill patients, rather than when the hemoglobin level

Basic and clinical application progression of invigorating blood and dissolving stasis Chinese medicine in ophthalmology

Directory of Open Access Journals (Sweden)

Ying Wang

2017-06-01

Full Text Available Invigorating blood and dissolving stasis method is a kind of unique therapy of Traditional Chinese Medicine(TCMtreatment, which efficacy has become increasingly prominent in the treatment of ophthalmology. With the further studies of blood stasis and invigorating blood and dissolving stasis therapy, it is widely used in clinical ophthalmology, and get good effects beyond thought, especially when western medicine has no curative effects. It improved the cure rate of fundus oculi disease from the eyelids, conjunctiva, lacrimal sac, vitreous body to the choroid and retina, optic nerve and macula lutea, from surface to fundus, or pathological changes related to inflammation, degeneration, necrosis, atrophy, hyperplasia of fibrous tissue hyperplasia. This paper is aim to explain the definition of invigorating blood and dissolving stasis and make a review of basic research and clinical application about it in several diseases.

Achieving blood pressure control among renal transplant recipients by integrating electronic health technology and clinical pharmacy services.

Science.gov (United States)

Migliozzi, Daniel R; Zullo, Andrew R; Collins, Christine; Elsaid, Khaled A

2015-11-15

The implementation and outcomes of a program combining electronic home blood pressure monitoring (HBPM) and pharmacist-provided medication therapy management (MTM) services in a renal transplantation clinic are described. Patients enrolled in the program were provided with a computer-enabled blood pressure monitor. A dedicated renal transplantation pharmacist was integrated into the renal transplantation team under a collaborative care practice agreement. The collaborative care agreement allowed the pharmacist to authorize medication additions, deletions, and dosage changes. Comprehensive disease and blood pressure education was provided by a clinical pharmacist. In the pretransplantation setting, the pharmacist interviewed the renal transplant candidate and documents allergies, verified the patient's medication profile, and identified and assessed barriers to medication adherence. A total of 50 renal transplant recipients with at least one recorded home blood pressure reading and at least one year of follow-up were included in our analysis. A significant reduction in mean systolic and diastolic blood pressure values were observed at 30, 90, 180, and 360 days after enrollment in the program (p services implemented in a renal transplant clinic was associated with sustained improvements in blood pressure control. Incorporation of a pharmacist in the renal transplant clinic resulted in the detection and resolution of medication-related problems. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Exaggerated blood pressure variability is associated with memory impairment in very elderly patients.

Science.gov (United States)

Fujiwara, Takeshi; Hoshide, Satoshi; Kanegae, Hiroshi; Eguchi, Kazuo; Kario, Kazuomi

2018-04-01

We investigated the association between working memory (WM) impairment and blood pressure variability (BPV) in very elderly patients. Japanese outpatients ≥80 years who engaged in normal activities of daily living were the study cohort. WM function was evaluated by a simple visual WM test consisting of 3 figures. We considered the number of figures recalled by the patient his/her test score. We defined the patients with a score of 0 or 1 as those with WM impairment and those with scores of 2 or 3 as those without. To investigate the relative risk of WM impairment, we evaluated each patient's 24 hour ambulatory systolic blood pressure (SBP) and its weighted standard deviation (SD SBP ), office SBP, and the visit-to-visit SD SBP during the 1 year period from the patient's enrollment. A total of 66 patients (mean 84 ± 3.6 years) showed WM impairment, and 431 patients (mean 83 ± 3.1 years) showed no WM impairment. There were no significant differences in 24 hour ambulatory SBP or office SBP between these two groups. However, the WM impairment patients showed significantly higher weighted SD SBP and visit-to-visit SD SBP values compared to the no-impairment group even after adjusting for age. Among these ≥80-year-old patients, those with the highest quartile of both weighted SD SBP (≥21.4 mm Hg) and visit-to-visit SD SBP (≥14.5 mm Hg) showed the highest relative risk (odds ratio 3.52, 95% confidence interval 1.42-8.72) for WM impairment. Exaggerated blood pressure variability parameters were significantly associated with working memory impairment in very elderly individuals. ©2018 Wiley Periodicals, Inc.

Modulation of the Interleukin-21 Pathway with Interleukin-4 Distinguishes Common Variable Immunodeficiency Patients with More Non-infectious Clinical Complications.

Science.gov (United States)

Desjardins, Marylin; Béland, Marianne; Dembele, Marieme; Lejtenyi, Duncan; Drolet, Jean-Phillipe; Lemire, Martine; Tsoukas, Christos; Ben-Shoshan, Moshe; Noya, Francisco J D; Alizadehfar, Reza; McCusker, Christine T; Mazer, Bruce D

2018-01-01

Common variable immunodeficiency (CVID) is characterized by hypogammaglobulinemia and clinical manifestations such as infections, autoimmunity, and malignancy. We sought to determine if responsiveness to interleukin-21 (IL-21), a key cytokine for B cell differentiation, correlates with distinct clinical phenotypes in CVID. CVID subjects were recruited through the Canadian Primary Immunodeficiency Evaluative Survey registry. Peripheral blood mononuclear cells were cultured with anti-CD40 ± interferon-gamma, interleukin-4 (IL-4), IL-21, and/or IL-4+IL-21. B cell subpopulations and IgG production were determined at baseline and day 7 by flow cytometry and ELISA. Clinical complications were compared using contingency tables. CVID subjects exhibited decreased CD27 + B cells and IgG production after 7 days of stimulation with anti-CD40+IL-21 (p  2% class-switched memory B cells at baseline. The IL-4 and IL-21 in vitro assays distinguish two groups of CVID subjects and can be used with baseline B cell subpopulation phenotyping to better identify patients experiencing more vs. fewer clinical non-infectious complications and potentially to modulate therapy.

How novice, skilled and advanced clinical researchers include variables in a case report form for clinical research: a qualitative study.

Science.gov (United States)

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

Clinical Trials With Large Numbers of Variables: Important Advantages of Canonical Analysis.

Science.gov (United States)

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.

Short-term variability and nocturnal decline in ambulatory blood pressure in normotension, white-coat hypertension, masked hypertension and sustained hypertension: a population-based study of older individuals in Spain.

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Gijón-Conde, Teresa; Graciani, Auxiliadora; López-García, Esther; Guallar-Castillón, Pilar; García-Esquinas, Esther; Rodríguez-Artalejo, Fernando; Banegas, José R

2017-06-01

Blood pressure (BP) variability and nocturnal decline in blood pressure are associated with cardiovascular outcomes. However, little is known about whether these indexes are associated with white-coat and masked hypertension. We performed a cross-sectional analysis of 1047 community-dwelling individuals aged ⩾60 years in Spain in 2012. Three observer-measured home BPs and 24-h ambulatory blood pressure monitoring (ABPM) were performed under standardized conditions. BP variability was defined as BP s.d. and coefficient of variation. Differences in BP variability and nocturnal BP decrease between groups were adjusted for sociodemographic and clinical covariates using generalized linear models. Of the cohort, 21.7% had white-coat hypertension, 7.0% had masked hypertension, 21.4% had sustained hypertension, and 49.9% were normotensive. Twenty-four hour, daytime and night-time systolic BP s.d. and coefficients of variation were significantly higher in subjects with white-coat hypertension than those with normotension (Pcoat hypertension than in those with normotension (Pcoat hypertension group and lowest in the masked hypertension group in all patients and untreated patients (Pcoat hypertension, 78.1% of subjects with masked hypertension, and 72.2% of subjects with sustained hypertension (Pcoat hypertension and blunted nocturnal BP decrease was observed more frequently in subjects with masked hypertension. These findings may help to explain the reports of increased cardiovascular risk in patients with white-coat hypertension and poor prognosis in those with masked hypertension, highlighting the importance of ABPM.

The Paradox of Pelvic Exenteration: The Interaction of Clinical and Psychological Variables.

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Arnaboldi, Paola; Santoro, Luigi; Mazzocco, Ketti; Oliveri, Serena; Maggioni, Angelo; Pravettoni, Gabriella

2015-10-01

To text the feasibility of a psychological intervention package administered to 49 pelvic exenteration candidates, aimed at evaluating the preoperative prevalence of psychological distress and assessing the presence of any correlation between preoperative psychological distress and clinical variables such as pain and hospitalization length. Patients were referred to the psychology unit from the very beginning of their clinical pathway and were administered the Psychological Distress Inventory (PDI) and the Mini-Mental Adjustment to Cancer (Mini-MAC) questionnaire at prehospital admission. Patients presenting with a significant level of distress received nonstandardized psychological support. Statistical analyses were performed to detect the presence of any correlation between psychological variables at prehospital admission and clinical outcomes. The 40% of patients had significant levels of distress at prehospital admission (PDI ≥ 30). As regards Mini-MAC, the mean value of fighting spirit attitude and fatalism was higher in our sample than in the normative sample of the Mini-MAC validation study in the Italian cancer population. Their anxious preoccupation attitude was lower. There were no correlations between clinical and psychological variables: level of postsurgery pain was higher (3.7) in the subgroup of patients with presurgery PDI < 30 compared with those with PDI ≥ 30 (3.5). However, this difference was not statistically significant (P = 1.00). Considering hospitalization length, the above described trend was similar. Although highly distressed, pelvic exenteration candidates show an adaptive range of coping mechanisms. This calls for a greater effort in studying the complexity of their psychoemotional status to provide them with the best multidisciplinary care. Extensive study of the real effectiveness of psychological intervention is warranted: randomized clinical trials could help in detecting the presence of any correlation between clinical and

Clinical evaluation of an automatic blood pressure controller during cardiac surgery

NARCIS (Netherlands)

Meijers, R.H.A.M.; Schmartz, D.; Cantraine, F.R.L.; Barvais, L.; d Hollander, A.A.; Blom, J.A.

1997-01-01

During surgery, computers can be of great use to support the anesthesiologist in providing task automation. In this paper we describe a closed loop blood pressure controller and show the results of its clinical evalua- tion.Methods. The controller is based on a simple and robust

Evaluation of Blood Glucose Meter Efficacy in an Antenatal Diabetes Clinic.

Science.gov (United States)

McGrath, Rachel T; Donnelly, Vanessa C; Glastras, Sarah J; Preda, Veronica A; Sheriff, Nisa; Ward, Peter; Hocking, Samantha L; Fulcher, Gregory R

2016-02-01

The optimal treatment of diabetes in pregnancy requires accurate measurement of blood glucose levels, in order to minimize adverse outcomes for both mother and neonate. Self-monitoring of blood glucose is routinely used to measure glycemic control and to assess whether treatment targets are being met; however, the accuracy of blood glucose meters in pregnancy is unclear. Pregnant women with gestational, type 1, or type 2 diabetes mellitus were eligible to participate. Nonfasting capillary blood glucose levels were measured in duplicate using the BGStar(®) (Sanofi, Sydney, Australia) and FreeStyle Lite(®) (Abbott, Sydney) blood glucose meters. Venous blood samples were collected and analyzed for plasma glucose, hematocrit, and glycated hemoglobin. Capillary blood glucose was compared with plasma glucose and further assessed according to International Organization for Standardization (ISO) 15197:2013 standards. One hundred ten women were recruited, providing 96 samples suitable for analysis. The mean ± SD laboratory plasma glucose level was 4.6 ± 1.4 mmol/L; the BGStar and FreeStyle Lite capillary blood glucose values were 5.3 ± 1.4 mmol/L and 5.0 ± 1.3 mmol/L, respectively. Both meters showed a positive bias (0.42 mmol/L for the FreeStyle Lite and 0.65 mmol/L for the BGStar). Furthermore, neither meter fulfilled the ISO 15197:2013 standards, and there was a nonsignificant improvement in meter performance at blood glucose levels of ≤4.2 mmol/L. Hematocrit did not affect the results of either blood glucose meter. Clarke Error Grid analysis demonstrated that approximately 70% of the results of both meters would lead to appropriate clinical action. The BGStar and FreeStyle Lite blood glucose meters did not meet ISO 15197:2013 recommendations for blood glucose monitoring systems when assessed in a population of women with diabetes in pregnancy. Clinicians should consider this difference in blood glucose readings when making diabetes

A new 99mTc-red blood cell labeling procedure for cardiac blood pool imaging: Clinical results

International Nuclear Information System (INIS)

Kelbaek, H.; Buelow, K.; Aldershvile, J.; Moegelyang, J.; Nielsen, S.L.; Copenhagen Univ.

1989-01-01

The first clinical results of a new 99m Tc-red blood cell labeling procedure avoiding cell centrifugation are presented. One ml heparinized blood samples were incubated with small amounts of a stannous kit. By titration studies, ideal quantities of sodium hypochlorite for oxidation of extracellular tin and of EDTA as stabilizer of the label were found. The Cl - concentration and pH of the labeled blood were acceptable, and EDTA increased labeling yield and stability determined in vitro by a few percent. The new procedure gave a slightly higher labeling yield than a current technique using centrifugation of cells. Labeling efficiency expressed as cell bound/total activity was 96.6%±1.3% in healthy subjects and 95.5%±2.2% in cardiac patients and remained high for 2 h after reinjection. The biological halflife of labeled cells following the new procedure was 11-12 h rendering it suitable for serial determinations of radionuclide cardiography. (orig.)

Variability in lateralised blood flow response to language is associated with language development in children aged 1-5 years.

Science.gov (United States)

Kohler, M; Keage, H A D; Spooner, R; Flitton, A; Hofmann, J; Churches, O F; Elliott, S; Badcock, N A

2015-01-01

The developmental trajectory of language lateralisation over the preschool years is unclear. We explored the relationship between lateralisation of cerebral blood flow velocity response to object naming and cognitive performance in children aged 1-5 years. Functional transcranial Doppler ultrasound was used to record blood flow velocity bilaterally from middle cerebral arteries during a naming task in 58 children (59% male). At group level, the Lateralisation Index (LI) revealed a greater relative increase in cerebral blood flow velocity within the left as compared to right middle cerebral artery. After controlling for maternal IQ, left-lateralised children displayed lower expressive language scores compared to right- and bi-lateralised children, and reduced variability in LI. Supporting this, greater variability in lateralised response, rather than mean response, was indicative of greater expressive language ability. Findings suggest that a delayed establishment of language specialisation is associated with better language ability in the preschool years. Copyright © 2015 Elsevier Inc. All rights reserved.

The clinical study of cerebral blood flow imaging in patients with early syphilis

International Nuclear Information System (INIS)

Liu Zengli; Shi Xin; Wu Jinchang; Tang Jun; Zhong Jijun

2003-01-01

Objective: To study the clinical value of cerebral blood flow imaging for evaluation of patients with early syphilis. Methods: Fifty-three patients with early syphilis underwent cerebral blood flow imaging using 99 Tc m -ethylenecysteinate dimer(ECD). Regional cerebral blood flow (rCBF) changes were analyzed. Results: The acquired images of 53 patients were graded as 5 types. The rCBF was significantly depressed in 48 of 53 patients mainly in the areas dominated by anterior cerebral artery and middle cerebral artery. Conclusion: Treponema pallidum (TP) could start invading central nervous system at the early stage of infection

Blood lead level in dogs from urban and rural areas of India and its relation to animal and environmental variables

International Nuclear Information System (INIS)

Balagangatharathilagar, M.; Swarup, D.; Patra, R.C.; Dwivedi, S.K.

2006-01-01

Lead is a common environmental pollutant with deleterious health effects on human and animal. Industrial and other human activities enhance the lead level in the environment leading to its higher residues in exposed population. The present study was aimed at determining blood lead concentration in dogs from two urban areas and in surrounding rural areas of India and analyzing lead level in dogs in relation to environmental (urban/ rural) and animal (age, sex, breed and housing) variables. Blood samples were collected from 305 dogs of either sex from urban (n = 277) and unpolluted rural localities (n = 28). Irrespective of breed, age and sex, the urban dogs had significantly (P < 0.01) higher mean blood lead concentration (0.25 ± 0.01 μg/ml) than rural dogs (0.10 ± 0.01 μg/ml). The mean blood lead level in stray dogs either from urban or rural locality (0.27 ± 0.01 μg/ml) was significantly (P < 0.01) higher than that of pets (0.20 ± 0.01 μg/ml), and the blood lead concentration was significantly higher in nondescript dogs (0.25 ± 0.01 μg/ml) than pedigreed dogs (0.20 ± 0.01 μg/ml). The locality (urban/rural) was the major variable affecting blood lead concentration in dogs. Breed and housing of the dogs of urban areas and only housing (pet/stray) in rural areas significantly (P < 0.01) influenced the blood lead concentration in dogs

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

Energy Technology Data Exchange (ETDEWEB)

Halbrook, R.S.; Shugart, L.R.; Watson, A.P.; Munro, N.B.; Linnabary, R.D. (Environmental Sciences Division, Oak Ridge National Laboratory, TN (United States))

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.

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

Directory of Open Access Journals (Sweden)

Mohamed Faisal Lutfi

Full Text Available 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.To assess the association between FBG levels and cardiac autonomic modulation (CAM in euglycaemic healthy subjects based on heart rate variability (HRV derived indices.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.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.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 further increase in glucose level readjusts sympathovagal balance

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

Science.gov (United States)

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 (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, non-neural factors.

[Ambulatory blood pressure monitoring is a useful tool for all patients].

Science.gov (United States)

de la Sierra, A

Clinical blood pressure measurement (BP) is an occasional and imperfect way of estimating this biological variable. Ambulatory blood pressure monitoring (ABPM) is by far the best clinical tool for measuring an individual's blood pressure. Mean values over 24h, through the daytime and at night all make it more possible to predict organic damage and the future development of the disorder. ABPM enables the detection of white-coat hypertension and masked hypertension in both the diagnosis and follow-up of treated patients. Although some of the advantages of ABPM can be reproduced by more automated measurement without the presence of an observer in the clinic or self-measurement at home, there are some other elements of great interest that are unique to ABPM, such as seeing what happens to a patient's BP at night, the night time dipping pattern and short-term variability, all of which relate equally to the patient's prognosis. There is no scientific or clinical justification for denying these advantages, and ABPM should form part of the evaluation and follow-up of practically all hypertensive patients. Rather than continuing unhelpful discussions as to its availability and acceptability, we should concentrate our efforts on ensuring its universal availability and clearly explaining its advantages to both doctors and patients. Copyright © 2016 SEH-LELHA. Publicado por Elsevier España, S.L.U. All rights reserved.

Clinical transfusion practice update: haemovigilance, complications, patient blood management and national standards.

Science.gov (United States)

Engelbrecht, Sunelle; Wood, Erica M; Cole-Sinclair, Merrole F

2013-09-16

Blood transfusion is not without risk. Although the risks of HIV and hepatitis transmission have diminished, haemovigilance programs highlight that other significant transfusion hazards remain. Sepsis from bacterial contamination is the most common residual infectious hazard in developed countries, and events due to clerical error are problematic. Unnecessary transfusions should be avoided. New national guidelines on patient blood management (PBM) emphasise holistic approaches, including strategies to reduce transfusion requirements. Perioperative PBM should incorporate preoperative haemoglobin and medication optimisation, intraoperative blood conservation, and consideration of restrictive postoperative transfusion and cell-salvage techniques. When massive transfusion is required, hospitals should implement massive transfusion protocols. These protocols reduce mortality, improve communication and facilitate adequate provision of blood products. They should include multidisciplinary team involvement and guidelines for use of blood components and adjunctive agents. Although fresh frozen plasma to red blood cell and platelet to red blood cell ratios of ≥ 1 : 2 appear to reduce mortality in trauma patients who receive massive transfusion, there is insufficient evidence to recommend specific ratios. Systematic reviews have found no significant benefit of recombinant activated factor VII in critical bleeding, and an increase in thromboembolic events; specialist haematology advice is therefore recommended when considering use of this agent. The National Safety and Quality Health Service Standards address use of blood and blood products, and provide important transfusion principles for adoption by all clinicians. Storage of red cells in additive solution results in changes, known as the "storage lesion", and studies to determine the clinical effect of the age of blood at transfusion are ongoing.

Preanalytical Variables Affecting the Integrity of Human Biospecimens in Biobanking

DEFF Research Database (Denmark)

Ellervik, Christina; Vaught, Jim

2015-01-01

BACKGROUND: Most errors in a clinical chemistry laboratory are due to preanalytical errors. Preanalytical variability of biospecimens can have significant effects on downstream analyses, and controlling such variables is therefore fundamental for the future use of biospecimens in personalized...... medicine for diagnostic or prognostic purposes. CONTENT: The focus of this review is to examine the preanalytical variables that affect human biospecimen integrity in biobanking, with a special focus on blood, saliva, and urine. Cost efficiency is discussed in relation to these issues. SUMMARY: The quality...

HIV-1 Genetic Variability in Cuba and Implications for Transmission and Clinical Progression.

Science.gov (United States)

Blanco, Madeline; Machado, Liuber Y; Díaz, Héctor; Ruiz, Nancy; Romay, Dania; Silva, Eladio

2015-10-01

INTRODUCTION Serological and molecular HIV-1 studies in Cuba have shown very low prevalence of seropositivity, but an increasing genetic diversity attributable to introduction of many HIV-1 variants from different areas, exchange of such variants among HIV-positive people with several coinciding routes of infection and other epidemiologic risk factors in the seropositive population. The high HIV-1 genetic variability observed in Cuba has possible implications for transmission and clinical progression. OBJECTIVE Study genetic variability for the HIV-1 env, gag and pol structural genes in Cuba; determine the prevalence of B and non-B subtypes according to epidemiologic and behavioral variables and determine whether a relationship exists between genetic variability and transmissibility, and between genetic variability and clinical disease progression in people living with HIV/AIDS. METHODS Using two molecular assays (heteroduplex mobility assay and nucleic acid sequencing), structural genes were characterized in 590 people with HIV-1 (480 men and 110 women), accounting for 3.4% of seropositive individuals in Cuba as of December 31, 2013. Nonrandom sampling, proportional to HIV prevalence by province, was conducted. Relationships between molecular results and viral factors, host characteristics, and patients' clinical, epidemiologic and behavioral variables were studied for molecular epidemiology, transmission, and progression analyses. RESULTS Molecular analysis of the three HIV-1 structural genes classified 297 samples as subtype B (50.3%), 269 as non-B subtypes (45.6%) and 24 were not typeable. Subtype B prevailed overall and in men, mainly in those who have sex with men. Non-B subtypes were prevalent in women and heterosexual men, showing multiple circulating variants and recombinant forms. Sexual transmission was the predominant form of infection for all. B and non-B subtypes were encountered throughout Cuba. No association was found between subtypes and

Visit-to-visit cholesterol variability correlates with coronary atheroma progression and clinical outcomes.

Science.gov (United States)

Clark, Donald; Nicholls, Stephen J; St John, Julie; Elshazly, Mohamed B; Kapadia, Samir R; Tuzcu, E Murat; Nissen, Steven E; Puri, Rishi

2018-04-21

Utilizing serial intravascular ultrasonography (IVUS), we aimed to exam the association of intra-individual lipid variability, coronary atheroma progression, and clinical outcomes. We performed a post hoc patient-level analysis of nine clinical trials involving 4976 patients with coronary artery disease who underwent serial coronary IVUS in the setting of a range of medical therapies. We assessed the associations between progression in percent atheroma volume (ΔPAV), clinical outcomes, and visit-to-visit lipid variability including low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), non-HDL-C, total cholesterol (TC)/HDL-C, and apolipoprotein B (ApoB). Variability of lipid parameters was measured using intra-individual standard deviation over 3, 6, 12, 18, and 24 months. Atherogenic lipoprotein variability significantly associated with ΔPAV [odds ratio (95% confidence interval; P-value), LDL-C: 1.09 (1.02, 1.17, P = 0.01); non-HDL-C: 1.10 (1.02, 1.18, P = 0.01); TC/HDL-C: 1.14 (1.06, 1.24, P = 0.001); ApoB: 1.13 (1.03, 1.24, P = 0.01)]. Survival curves revealed significant stepwise relationships between cumulative major adverse cardiovascular events and increasing quartiles of atherogenic lipoprotein variability at 24-months follow-up (log-rank P C). Stronger associations were noted between achieved lipoprotein levels and ΔPAV [LDL-C: 1.27 (1.17, 1.39; P C: 1.32 (1.21, 1.45; P C: 1.31 (1.19, 1.45; P < 0.001); ApoB: 1.20 (1.07, 1.35; P = 0.003)]. Greater visit-to-visit variability in atherogenic lipoprotein levels significantly associates with coronary atheroma progression and clinical outcomes, although the association between achieved atherogenic lipoproteins and atheroma progression appears stronger. These data highlight the importance of achieving low and consistent atherogenic lipoprotein levels to promote plaque regression and improve clinical outcomes.

Point-of-care blood gases, electrolytes, chemistries, hemoglobin, and hematocrit measurement in venous samples from pet rabbits.

Science.gov (United States)

Selleri, Paolo; Di Girolamo, Nicola

2014-01-01

Point-of-care testing is an attractive option in rabbit medicine, because it permits rapid analysis of a panel of electrolytes, chemistries, blood gases, hemoglobin, and hematocrit, requiring only 65 μL of blood. The purpose of this study was to evaluate the performance of a portable clinical analyzer for measurement of pH, partial pressure of CO2, Na, chloride, potassium, blood urea nitrogen, glucose, hematocrit, and hemoglobin in healthy and diseased rabbits. Blood samples obtained from 30 pet rabbits were analyzed immediately after collection by the portable clinical analyzer (PCA) and immediately thereafter (time <20 sec) by a reference analyzer. Bland-Altman plots and Passing-Bablok regression analysis were used to compare the results. Limits of agreement were wide for all the variables studied, with the exception of pH. Most variables presented significant proportional and/or constant bias. The current study provides sufficient evidence that the PCA presents reliability for pH, although its low agreement with a reference analyzer for the other variables does not support their interchangeability. Limits of agreement provided for each variable allow researchers to evaluate if the PCA is reliable enough for their scope. To the authors' knowledge, the present is the first report evaluating a PCA in the rabbit.

A Systematic Evaluation of Blood Serum and Plasma Pre-Analytics for Metabolomics Cohort Studies

Directory of Open Access Journals (Sweden)

Elodie Jobard

2016-12-01

Full Text Available The recent thriving development of biobanks and associated high-throughput phenotyping studies requires the elaboration of large-scale approaches for monitoring biological sample quality and compliance with standard protocols. We present a metabolomic investigation of human blood samples that delineates pitfalls and guidelines for the collection, storage and handling procedures for serum and plasma. A series of eight pre-processing technical parameters is systematically investigated along variable ranges commonly encountered across clinical studies. While metabolic fingerprints, as assessed by nuclear magnetic resonance, are not significantly affected by altered centrifugation parameters or delays between sample pre-processing (blood centrifugation and storage, our metabolomic investigation highlights that both the delay and storage temperature between blood draw and centrifugation are the primary parameters impacting serum and plasma metabolic profiles. Storing the blood drawn at 4 °C is shown to be a reliable routine to confine variability associated with idle time prior to sample pre-processing. Based on their fine sensitivity to pre-analytical parameters and protocol variations, metabolic fingerprints could be exploited as valuable ways to determine compliance with standard procedures and quality assessment of blood samples within large multi-omic clinical and translational cohort studies.

Order of draw practices in venous blood sampling at clinical biochemistry departments in the Danish health care system

DEFF Research Database (Denmark)

Jacobsen, Katja Kemp; Brandt, Ida; Christensen, Anne Vindahl

2018-01-01

the procedures in venous blood sampling among clinical biochemistry departments to assess the uniformity of order of blood draw and adherence to international guidelines in the Danish health care system. METHODS: We collected venous order of draw procedures from 49 clinical biochemistry departments at 22 public...... 15189:2012 accreditation (p = .57). CONCLUSIONS: Venous order of draw procedures is diverse at Danish clinical biochemistry departments and show moderate adherence to international guidelines....

DETERMINANTS OF SUBOPTIMAL BLOOD PRESSURE CONTROL IN HYPERTENSIVE PATIENTS: 24-HOUR AMBULATORY BLOOD PRES-SURE MONITORING

Directory of Open Access Journals (Sweden)

Mansoor Moazenzadeh

2010-12-01

Full Text Available Abstract    INTRODUCTION: The study was conducted to define the determinants of suboptimal blood pressure (BP control among hypertensive patients under treatment and explore a predictive model for detecting the patients at risk for increased BP.    METHODS: We enrolled 97 patients (40 males, 57 females under treatment for hypertension between June 2006 and May 2007 in Shafa hospital, Kerman, Iran. BP was measured at clinic twice within 5-minute intervals. After setting up ambulatory blood pressure monitoring (ABPM, BP was measured at 30-minute intervals during the day and 60-minute intervals during the night. The frequency of increased BP (more than 140/90 mmHg was included in a regression model as dependent variable and all the others such as age, sex, body mass index (BMI, drugs and baseline clinical measurements as the predictors.    RESULTS: Increased BP was detected in 44% (95% CI: 38.79%-49.65% of all measurements during 24-hour monitoring. The frequency of increased BP had a significant relationship with BMI (b=0.35, P=0.001. Clinic's pulse pressure was a significant predicting factor for BP increase (P=0.02.    CONCLUSION: BMI and pulse pressure are the best predictors for being hypertensive during lifetime. Ineffective treatment of hypertension is frequent among the hypertensive patients.      Keywords: Blood pressure control, Pulse pressure, Ambulatory blood pressure monitoring (ABPM, BMI.

Diastolic blood pressure variability in 24 hour-ABPM and outcomes of chronic kidney disease
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Sahutoglu, Tuncay; Sakaci, Tamer

2018-04-10

Blood pressure variability (BPV) has been associated with increased morbidity and mortality. There are a few studies that reported worse outcomes of chronic kidney disease (CKD) with greater visit-to-visit BPV (VVV), but data with ambulatory blood pressure monitoring (ABPM) is scarce. Ambulatory hypertensive CKD (stage 2 - 4) patients (> 18 years old) with complete 24 hours of ABPM study (SpaceLabs), who were followed up between January 2012 and December 2016, were retrospectively analyzed for the baseline characteristics and outcomes of CKD. Coefficient of variation (CV) in diastolic blood pressure (DBP) was used as an index of BPV. Data of 191 patients (mean age 59.7 ± 12.4 years, 54.9% males, 42.1% diabetic, mean eGFR-EPI (Chronic Kidney Disease Epidemiology Collaboration) 51.7 ± 22.0 mL/min/1.73m2, mean follow-up 26.2 ± 10.4 months) were available for the analysis. On multivariate linear regression analysis, greater DBP-CV was associated with slower decline in eGFR-EPI per year (B -0.648, p = 0.000). Likewise, the hazard ratio (HR) for dialysis inception (occurred in 9.4%) was found significantly lower with increasing DBP-CV in unadjusted and fully adjusted Cox models (HR 0.730, 95% CI 0.618 - 0.861, p = 0.000, and HR 0.678, 95% CI 0.526 - 0.874, p = 0.003, respectively). These findings suggest that DBP variability in 24-hour ABPM may be a good prognostic factor for the outcomes of CKD. Further studies are needed to determine the impact of 24-hour ABPM BPV on CKD progression and its differences from VVV.
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Biomarkers of traumatic injury are transported from brain to blood via the glymphatic system.

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Plog, Benjamin A; Dashnaw, Matthew L; Hitomi, Emi; Peng, Weiguo; Liao, Yonghong; Lou, Nanhong; Deane, Rashid; Nedergaard, Maiken

2015-01-14

The nonspecific and variable presentation of traumatic brain injury (TBI) has motivated an intense search for blood-based biomarkers that can objectively predict the severity of injury. However, it is not known how cytosolic proteins released from traumatized brain tissue reach the peripheral blood. Here we show in a murine TBI model that CSF movement through the recently characterized glymphatic pathway transports biomarkers to blood via the cervical lymphatics. Clinically relevant manipulation of glymphatic activity, including sleep deprivation and cisternotomy, suppressed or eliminated TBI-induced increases in serum S100β, GFAP, and neuron specific enolase. We conclude that routine TBI patient management may limit the clinical utility of blood-based biomarkers because their brain-to-blood transport depends on glymphatic activity. Copyright © 2015 the authors 0270-6474/15/350518-09$15.00/0.

Investigation of clinical pharmacokinetic variability of an opioid antagonist through physiologically based absorption modeling.

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Ding, Xuan; He, Minxia; Kulkarni, Rajesh; Patel, Nita; Zhang, Xiaoyu

2013-08-01

Identifying the source of inter- and/or intrasubject variability in pharmacokinetics (PK) provides fundamental information in understanding the pharmacokinetics-pharmacodynamics relationship of a drug and project its efficacy and safety in clinical populations. This identification process can be challenging given that a large number of potential causes could lead to PK variability. Here we present an integrated approach of physiologically based absorption modeling to investigate the root cause of unexpectedly high PK variability of a Phase I clinical trial drug. LY2196044 exhibited high intersubject variability in the absorption phase of plasma concentration-time profiles in humans. This could not be explained by in vitro measurements of drug properties and excellent bioavailability with low variability observed in preclinical species. GastroPlus™ modeling suggested that the compound's optimal solubility and permeability characteristics would enable rapid and complete absorption in preclinical species and in humans. However, simulations of human plasma concentration-time profiles indicated that despite sufficient solubility and rapid dissolution of LY2196044 in humans, permeability and/or transit in the gastrointestinal (GI) tract may have been negatively affected. It was concluded that clinical PK variability was potentially due to the drug's antagonism on opioid receptors that affected its transit and absorption in the GI tract. Copyright © 2013 Wiley Periodicals, Inc.

Central blood pressure variability is increased in hypertensive patients with target organ damage.

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de la Sierra, Alejandro; Pareja, Julia; Yun, Sergi; Acosta, Eva; Aiello, Francesco; Oliveras, Anna; Vázquez, Susana; Armario, Pedro; Blanch, Pedro; Sierra, Cristina; Calero, Francesca; Fernández-Llama, Patricia

2018-02-01

We aimed to evaluate the association of aortic and brachial short-term blood pressure variability (BPV) with the presence of target organ damage (TOD) in hypertensive patients. One-hundred seventy-eight patients, aged 57 ± 12 years, 33% women were studied. TOD was defined by the presence of left ventricular hypertrophy on echocardiogram, microalbuminuria, reduced glomerular filtration rate, or increased aortic pulse wave velocity. Aortic and brachial BPV was assessed by 24-hour ambulatory BP monitoring (Mobil-O-Graph). TOD was present in 92 patients (51.7%). Compared to those without evidence of TOD, they had increased night-to-day ratios of systolic and diastolic BP (both aortic and brachial) and heart rate. They also had significant increased systolic BPV, as measured by both aortic and brachial daytime and 24-hours standard deviations and coefficients of variation, as well as for average real variability. Circadian patterns and short-term variability measures were very similar for aortic and brachial BP. We conclude that BPV is increased in hypertensive-related TOD. Aortic BPV does not add relevant information in comparison to brachial BPV. ©2018 Wiley Periodicals, Inc.

Variability of CSF Alzheimer's disease biomarkers: implications for clinical practice.

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Stephanie J B Vos

Full Text Available BACKGROUND: Cerebrospinal fluid (CSF biomarkers are increasingly being used for diagnosis of Alzheimer's disease (AD. OBJECTIVE: We investigated the influence of CSF intralaboratory and interlaboratory variability on diagnostic CSF-based AD classification of subjects and identified causes of this variation. METHODS: We measured CSF amyloid-β (Aβ 1-42, total tau (t-tau, and phosphorylated tau (p-tau by INNOTEST enzyme-linked-immunosorbent assays (ELISA in a memory clinic population (n = 126. Samples were measured twice in a single or two laboratories that served as reference labs for CSF analyses in the Netherlands. Predefined cut-offs were used to classify CSF biomarkers as normal or abnormal/AD pattern. RESULTS: CSF intralaboratory variability was higher for Aβ1-42 than for t-tau and p-tau. Reanalysis led to a change in biomarker classification (normal vs. abnormal of 26% of the subjects based on Aβ1-42, 10% based on t-tau, and 29% based on p-tau. The changes in absolute biomarker concentrations were paralleled by a similar change in levels of internal control samples between different assay lots. CSF interlaboratory variability was higher for p-tau than for Aβ1-42 and t-tau, and reanalysis led to a change in biomarker classification of 12% of the subjects based on Aβ1-42, 1% based on t-tau, and 22% based on p-tau. CONCLUSIONS: Intralaboratory and interlaboratory CSF variability frequently led to change in diagnostic CSF-based AD classification for Aβ1-42 and p-tau. Lot-to-lot variation was a major cause of intralaboratory variability. This will have implications for the use of these biomarkers in clinical practice.

Phenotypic and functional characteristics of blood natural killer cells from melanoma patients at different clinical stages.

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Giulia Fregni

Full Text Available Melanomas are aggressive skin tumors characterized by high metastatic potential. Immunotherapy is a valuable alternative for metastatic melanoma patients resistant to chemotherapy. Natural Killer (NK cells are efficient anti-tumor cytotoxic effectors. We previously showed that blood NK cells from stage IV metastatic melanoma patients display decreased NK receptors and that chemotherapy modifies the functional status of blood NK cells. To investigate the role of NK cells along melanoma progression, we have here studied NK cells from patients at different stages of the disease. First, we showed that ex vivo NK cells from certain stage III-IV patients displayed low degranulation potential. Using a dynamic label-free assay, we found that immunoselected IL-2 activated blood NK cells from patients efficiently lysed melanoma cells through NKp46 and NKG2D receptors, independently to the clinical stage. Moreover, the ex vivo phenotype of circulating NK cells from 33 patients (stage I to IV was extensively analyzed. NK cells from patients displayed higher variability in the percentages of Natural Cytotoxicity Receptors (NCR and Natural Killer Group 2D (NKG2D receptor expression compared to donor NK cells. The main defect was the decreased expression of NCR1 (NKp46 by NK cells from metastatic patients. Interestingly, we found a positive correlation between the NK cell percentages of NKp46 and the duration of stage IV in melanoma patients. Finally, we showed that NK cells infiltrated primary melanomas and displayed a predominant peritumoral distribution. These results are new arguments for the development of NK-based therapies in melanoma patients.

Single-cell measurement of red blood cell oxygen affinity.

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Di Caprio, Giuseppe; Stokes, Chris; Higgins, John M; Schonbrun, Ethan

2015-08-11

Oxygen is transported throughout the body by hemoglobin (Hb) in red blood cells (RBCs). Although the oxygen affinity of blood is well-understood and routinely assessed in patients by pulse oximetry, variability at the single-cell level has not been previously measured. In contrast, single-cell measurements of RBC volume and Hb concentration are taken millions of times per day by clinical hematology analyzers, and they are important factors in determining the health of the hematologic system. To better understand the variability and determinants of oxygen affinity on a cellular level, we have developed a system that quantifies the oxygen saturation, cell volume, and Hb concentration for individual RBCs in high throughput. We find that the variability in single-cell saturation peaks at an oxygen partial pressure of 2.9%, which corresponds to the maximum slope of the oxygen-Hb dissociation curve. In addition, single-cell oxygen affinity is positively correlated with Hb concentration but independent of osmolarity, which suggests variation in the Hb to 2,3-diphosphoglycerate (2-3 DPG) ratio on a cellular level. By quantifying the functional behavior of a cellular population, our system adds a dimension to blood cell analysis and other measurements of single-cell variability.

The volume of the carotid bodies and blood pressure variability and pulse pressure in patients with essential hypertension

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Jaźwiec, P.; Gać, P.; Poręba, M.; Sobieszczańska, M.; Mazur, G.; Poręba, R.

2016-01-01

Aim: To assess the relationship between the volume of the carotid bodies (V rCB+lCB ) examined by means of computed tomography angiography (CTA) and blood pressure variability and pulse pressure (PP) in 24-hour ambulatory blood pressure monitoring (ABPM) in patients with essential hypertension. Materials and methods: A group of 52 patients with essential hypertension was examined (mean age: 68.32±12.31 years), the sizes of carotid bodies were measured by means of carotid artery CTA, and 24-hour ABPM was carried out. The 24-hour ABPM established systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), PP, SBP variability (SBPV), and DBP variability (DBPV). Results: SBP, MAP, and SBPV were significantly higher in the group of hypertension patients with V rCB+lCB equal to or above the median than in the group of hypertension patients with V rCB+lCB less than the median, as well as in the group of hypertension patients with oversized carotid bodies, than in the group of hypertension patients with normal V rCB+lCB . Moreover, the PP was statistically significantly higher in the group of hypertension patients with V rCB+lCB equal to or above the median than in the group of hypertension patients with V rCB+lCB less than the median. The existence of statistically significant positive linear relationships was revealed between V rCB+lCB and SBP, PP, and SBPV. A higher body mass index, older age, smoking, and higher V rCB+lCB are independent risk factors increasing SBPV in the research group. Conclusion: A positive relationship between the size of the carotid bodies and variability of the SBP and PP is observed in patients with essential hypertension. - Highlights: • Purpose. Determination of the relationships: V rCB+lCB vs. BPV and V rCB+lCB vs. PP. • Positive linear correlations were documented between V rCB+lCB and SBP, PP and SBPV. • Higher BMI, age, V rCB+lCB and smoking are independent risk factor of increased SBPV.

Effect of tranexamic acid irrigation on perioperative blood loss during orthognathic surgery: a double-blind, randomized controlled clinical trial.

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Eftekharian, Hamidreza; Vahedi, Ruhollah; Karagah, Tuba; Tabrizi, Reza

2015-01-01

Perioperative hemorrhage is an important concern during orthognathic surgery. The purpose of this study was to assess the effect of tranexamic acid (TXA) irrigation on perioperative hemorrhage during orthognathic surgery. In this double-blind, randomized controlled clinical trial, 56 participants who underwent orthognathic surgery were divided into 2 groups. The patients in the first group received TXA irrigation with normal saline (1 mg/mL), and the patients in the second group had normal saline for irrigation during orthognathic surgery. Age, gender, operation duration, the amount of irrigation solution used, and preoperative hemoglobin, hematocrit, and weight were the variables that were studied. The use of TXA solution for irrigation was the predictive factor of the study. Each group consisted of 28 patients. Group 1 consisted of 15 male patients (53.6%) and 13 female patients (46.4%) and group 2 consisted of 14 male patients (50%) and 14 female patients (50%). There was no difference in the distributions of the variables between the 2 groups, except for the duration of the operation. The mean duration of the operation was 3.94 ± 0.61 hours in group 1 and 4.17 ± 0.98 hours in group 2, and the difference in this respect between the 2 groups was statistically significant (P .05). TXA is effective in reducing intraoperative blood loss in patients for whom substantial blood loss is anticipated. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

Long-term Prognosis in COPD Exacerbation: Role of Biomarkers, Clinical Variables and Exacerbation Type.

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Grolimund, Eva; Kutz, Alexander; Marlowe, Robert J; Vögeli, Alaadin; Alan, Murat; Christ-Crain, Mirjam; Thomann, Robert; Falconnier, Claudine; Hoess, Claus; Henzen, Christoph; Zimmerli, Werner; Mueller, Beat; Schuetz, Philipp

2015-06-01

Long-term outcome prediction in COPD is challenging. We conducted a prospective 5-7-year follow-up study in patients with COPD to determine the association of exacerbation type, discharge levels of inflammatory biomarkers including procalctionin (PCT), C-reactive protein (CRP), white blood cell count (WBC) and plasma proadrenomedullin (ProADM), alone or combined with demographic/clinical characteristics, with long-term all-cause mortality in the COPD setting. The analyzed cohort comprised 469 patients with index hospitalization for pneumonic (n = 252) or non-pneumonic (n = 217) COPD exacerbation. Five-to-seven-year vital status was ascertained via structured phone interviews with patients or their household members/primary care physicians. We investigated predictive accuracy using univariate and multivariate Cox regression models and area under the receiver operating characteristic curve (AUC). After a median [25th-75th percentile] 6.1 [5.6-6.5] years, mortality was 55% (95%CI 50%-59%). Discharge ProADM concentration was strongly associated with 5-7-year non-survival: adjusted hazard ratio (HR)/10-fold increase (95%CI) 10.4 (6.2-17.7). Weaker associations were found for PCT and no significant associations were found for CRP or WBC. Combining ProADM with demographic/clinical variables including age, smoking status, BMI, New York Heart Association dyspnea class, exacerbation type, and comorbidities significantly improved long-term predictive accuracy over that of the demographic/clinical model alone: AUC (95%CI) 0.745 (0.701-0.789) versus 0.727 (0.681-0.772), (p) = .043. In patients hospitalized for COPD exacerbation, discharge ProADM levels appeared to accurately predict 5-7-year all-cause mortality and to improve long-term prognostic accuracy of multidimensional demographic/clinical mortality risk assessment.

Use of the Accusport semi-automated analyser to determine blood lactate as an aid in the clinical assessment of horses with colic

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M.L. Schulman

2001-07-01

Full Text Available The most useful diagnostic methods in the initial evaluation of horses with colic assess the morphological and functional status of the gastrointestinal tract and cardiovascular status. This evaluation is best achieved using a combination of clinical and laboratory data. Blood lactate concentration (BL is one of these variables. BL rises mainly due to poor tissue perfusion and anaerobic glycolysis associated with shock, providing an indicator of both the severity of disease and its prognosis. A hand-held lactate meter, Accusport, provides a rapid (60 seconds, inexpensive dry-chemical-based determination of BL. This trial evaluated the Accusport's ability to provide BL data as an adjunct to the initial clinical evaluation of horses with colic. The accuracy of the Accusport was tested by evaluation of its interchangeability with the benchmark enzymatic kit evaluation of BL in a trial using data collected firstly from 10 clinically normal control horses and subsequently from 48 horses presented with signs of colic. The BL values were recorded together with the clinical variables of heart rate (HR, capillary refill time (CRT, haematocrit (Hct, and pain character and severity on the initial assessment of the colic horses. Information regarding choice of therapeutic management (medical or surgical and eventual case outcome (full recovery or died/euthanased was recorded. The Accusport was found to be interchangeable with the enzymatic kit for recording BL values in colic horses with BL 8 mmol/ died or were euthanased.

Excess Vitamin Intake before Starvation does not Affect Body Mass, Organ Mass, or Blood Variables but Affects Urinary Excretion of Riboflavin in Starving Rats.

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Moriya, Aya; Fukuwatari, Tsutomu; Shibata, Katsumi

2013-01-01

B-vitamins are important for producing energy from amino acids, fatty acids, and glucose. The aim of this study was to elucidate the effects of excess vitamin intake before starvation on body mass, organ mass, blood, and biological variables as well as on urinary excretion of riboflavin in rats. Adult rats were fed two types of diets, one with a low vitamin content (minimum vitamin diet for optimum growth) and one with a sufficient amount of vitamins (excess vitamin diet). Body mass, organ mass, and blood variables were not affected by excess vitamin intake before starvation. Interestingly, urinary riboflavin excretion showed a different pattern. Urine riboflavin in the excess vitamin intake group declined gradually during starvation, whereas it increased in the low vitamin intake group. Excess vitamin intake before starvation does not affect body mass, organ mass, or blood variables but does affect the urinary excretion of riboflavin in starving rats.

Does this adult patient with suspected bacteremia require blood cultures?

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Coburn, Bryan; Morris, Andrew M; Tomlinson, George; Detsky, Allan S

2012-08-01

Clinicians order blood cultures liberally among patients in whom bacteremia is suspected, though a small proportion of blood cultures yield true-positive results. Ordering blood cultures inappropriately may be both wasteful and harmful. To review the accuracy of easily obtained clinical and laboratory findings to inform the decision to obtain blood cultures in suspected bacteremia. A MEDLINE and EMBASE search (inception to April 2012) yielded 35 studies that met inclusion criteria for evaluating the accuracy of clinical variables for bacteremia in adult immunocompetent patients, representing 4566 bacteremia and 25,946 negative blood culture episodes. Data were extracted to determine the prevalence and likelihood ratios (LRs) of findings for bacteremia. The pretest probability of bacteremia varies depending on the clinical context, from low (eg, cellulitis: 2%) to high (eg, septic shock: 69%). Elevated temperatures alone do not accurately predict bacteremia (for ≥38°C [>100.3°F], LR, 1.9 [95% CI, 1.4-2.4]; for ≥38.5°C [>101.2°F], LR, 1.4 [95% CI, 1.1-2.0]), nor does isolated leukocytosis (LR, cultures should not be ordered for adult patients with isolated fever or leukocytosis without considering the pretest probability. SIRS and the decision rule may be helpful in identifying patients who do not need blood cultures. These conclusions do not apply to immunocompromised patients or when endocarditis is suspected.

Building prognostic models for breast cancer patients using clinical variables and hundreds of gene expression signatures

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Liu Yufeng

2011-01-01

Full Text Available Abstract Background Multiple breast cancer gene expression profiles have been developed that appear to provide similar abilities to predict outcome and may outperform clinical-pathologic criteria; however, the extent to which seemingly disparate profiles provide additive prognostic information is not known, nor do we know whether prognostic profiles perform equally across clinically defined breast cancer subtypes. We evaluated whether combining the prognostic powers of standard breast cancer clinical variables with a large set of gene expression signatures could improve on our ability to predict patient outcomes. Methods Using clinical-pathological variables and a collection of 323 gene expression "modules", including 115 previously published signatures, we build multivariate Cox proportional hazards models using a dataset of 550 node-negative systemically untreated breast cancer patients. Models predictive of pathological complete response (pCR to neoadjuvant chemotherapy were also built using this approach. Results We identified statistically significant prognostic models for relapse-free survival (RFS at 7 years for the entire population, and for the subgroups of patients with ER-positive, or Luminal tumors. Furthermore, we found that combined models that included both clinical and genomic parameters improved prognostication compared with models with either clinical or genomic variables alone. Finally, we were able to build statistically significant combined models for pathological complete response (pCR predictions for the entire population. Conclusions Integration of gene expression signatures and clinical-pathological factors is an improved method over either variable type alone. Highly prognostic models could be created when using all patients, and for the subset of patients with lymph node-negative and ER-positive breast cancers. Other variables beyond gene expression and clinical-pathological variables, like gene mutation status or DNA

Evolving Identification of Blood Cells Associated with Clinically Isolated Syndrome: Importance of Time since Clinical Presentation and Diagnostic MRI.

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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

2017-06-15

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.

Implementation of patient blood management remains extremely variable in Europe and Canada: the NATA benchmark project: An observational study.

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Van der Linden, Philippe; Hardy, Jean-François

2016-12-01

Preoperative anaemia is associated with increased postoperative morbidity and mortality. Patient blood management (PBM) is advocated to improve patient outcomes. NATA, the 'Network for the advancement of patient blood management, haemostasis and thrombosis', initiated a benchmark project with the aim of providing the basis for educational strategies to implement optimal PBM in participating centres. Prospective, observational study with online data collection in 11 secondary and tertiary care institutions interested in developing PBM. Ten European centres (Austria, Spain, England, Denmark, Belgium, Netherlands, Romania, Greece, France, and Germany) and one Canadian centre participated between January 2010 and June 2011. A total of 2470 patients undergoing total hip (THR) or knee replacement, or coronary artery bypass grafting (CABG), were registered in the study. Data from 2431 records were included in the final analysis. Primary outcome measures were the incidence and volume of red blood cells (RBC) transfused. Logistic regression analysis identified variables independently associated with RBC transfusions. The incidence of transfusion was significantly different between centres for THR (range 7 to 95%), total knee replacement (range 3 to 100%) and CABG (range 20 to 95%). The volume of RBC transfused was significantly different between centres for THR and CABG. The incidence of preoperative anaemia ranged between 3 and 40% and its treatment between 0 and 40%, the latter not being related to the former. Patient characteristics, evolution of haemoglobin concentrations and blood losses were also different between centres. Variables independently associated with RBC transfusion were preoperative haemoglobin concentration, lost volume of RBC and female sex. Implementation of PBM remains extremely variable across centres. The relative importance of factors explaining RBC transfusion differs across institutions, some being patient related whereas others are related to

Blood pressure variability predicts cardiovascular events independently of traditional cardiovascular risk factors and target organ damage

DEFF Research Database (Denmark)

Vishram, Julie K K; Dahlöf, Björn; Devereux, Richard B

2015-01-01

). METHODS: In 8505 patients randomized to losartan vs. atenolol-based treatment in the LIFE study, we tested whether BP variability assessed as SD and range for BP6-24months measured at 6, 12, 18 and 24 months of treatment was associated with target organ damage (TOD) defined by LVH on ECG and urine albumin......BACKGROUND: Assessment of antihypertensive treatment is normally based on the mean value of a number of blood pressure (BP) measurements. However, it is uncertain whether high in-treatment visit-to-visit BP variability may be harmful in hypertensive patients with left ventricular hypertrophy (LVH.......05), but MI was not. CONCLUSION: In LIFE patients, higher in-treatment BP6-24months variability was independently of mean BP6-24months associated with later CEP and stroke, but not with MI or TOD after 24 months....

Influence of euthanasia method on blood and gill variables in normoxic and hypoxic Gulf killifish Fundulus grandis.

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Larter, K F; Rees, B B

2017-06-01

In many experiments, euthanasia, or humane killing, of animals is necessary. Some methods of euthanasia cause death through cessation of respiratory or cardiovascular systems, causing oxygen levels of blood and tissues to drop. For experiments where the goal is to measure the effects of environmental low oxygen (hypoxia), the choice of euthanasia technique, therefore, may confound the results. This study examined the effects of four euthanasia methods commonly used in fish biology (overdose of MS-222, overdose of clove oil, rapid cooling and blunt trauma to the head) on variables known to be altered during hypoxia (haematocrit, plasma cortisol, blood lactate and blood glucose) or reflecting gill damage (trypan blue exclusion) and energetic status (ATP, ADP and ATP:ADP) in Gulf killifish Fundulus grandis after 24 h exposure to well-aerated conditions (normoxia, 7·93 mg O 2  l -1 , c. 150 mm Hg or c. 20 kPa) or reduced oxygen levels (0·86 mg O 2  l -1 , c. 17 mm Hg or c. 2·2 kPa). Regardless of oxygen treatment, fish euthanized by an overdose of MS-222 had higher haematocrit and lower gill ATP:ADP than fish euthanized by other methods. The effects of 24 h hypoxic exposure on these and other variables, however, were equivalent among methods of euthanasia (i.e. there were no significant interactions between euthanasia method and oxygen treatment). The choice of an appropriate euthanasia method, therefore, will depend upon the magnitude of the treatment effects (e.g. hypoxia) relative to potential artefacts caused by euthanasia on the variables of interest. © 2017 The Fisheries Society of the British Isles.

Value of black blood T2* cardiovascular magnetic resonance

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Carpenter John Paul

2011-03-01

Full Text Available Abstract Purpose To assess whether black blood T2* cardiovascular magnetic resonance is superior to conventional white blood imaging of cardiac iron in patients with thalassaemia major (TM. Materials and methods We performed both conventional white blood and black blood T2* CMR sequences in 100 TM patients to determine intra and inter-observer variability and presence of artefacts. In 23 patients, 2 separate studies of both techniques were performed to assess interstudy reproducibility. Results Cardiac T2* values ranged from 4.5 to 43.8 ms. The mean T2* values were not different between black blood and white blood acquisitions (20.5 vs 21.6 ms, p = 0.26. Compared with the conventional white blood diastolic acquisition, the coefficient of variance of the black blood CMR technique was superior for intra-observer reproducibility (1.47% vs 4.23%, p Conclusions Black blood T2* CMR has superior reproducibility and reduced imaging artefacts for the assessment of cardiac iron, in comparison with the conventional white blood technique, which make it the preferred technique for clinical practice.

Genetic variability of the pattern of night melatonin blood levels in relation to coat changes development in rabbits

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Chemineau Philippe

2004-03-01

Full Text Available Abstract To assess the genetic variability in both the nocturnal increase pattern of melatonin concentration and photoresponsiveness in coat changes, an experiment on 422 Rex rabbits (from 23 males raised under a constant light programme from birth was performed. The animals were sampled at 12 weeks of age, according to 4 periods over a year. Blood samples were taken 7 times during the dark phase and up to 1 h after the lighting began. Maturity of the fur was assessed at pelting. Heritability estimates of blood melatonin concentration (0.42, 0.17 and 0.11 at mid-night, 13 and 15 h after lights-out respectively and strong genetic correlations between fur maturity and melatonin levels at the end of the dark phase (-0.64 indicates that (i the variability of the nocturnal pattern of melatonin levels is under genetic control and (ii the duration of the nocturnal melatonin increase is a genetic component of photoresponsiveness in coat changes.

Lack of association between systolic blood pressure and blood viscosity in normotensive healthy subjects.

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Irace, Concetta; Carallo, Claudio; Scavelli, Faustina; Loprete, Antonio; Merante, Valentina; Gnasso, Agostino

2012-01-01

A direct relationship between blood pressure and viscosity has frequently been reported, although clear data are not available. To better understand the relationship between these two variables, we evaluated blood viscosity and blood pressure in a group of healthy subjects without cardiovascular risk factors. Healthy subjects were selected from participants in a campaign of prevention of cardiovascular disease (n = 103). They underwent blood sampling for measurement of plasma and blood viscosity, haematocrit, blood lipids and glucose. The quantity and distribution of body fat was assessed by body mass index and waist/hip ratio, respectively. Systolic blood pressure (SBP) correlated significantly with age (r = 0.222) and waist/hip ratio (r = 0.374). Diastolic blood pressure (DBP) correlated significantly with waist/hip ratio (r = 0.216), haematocrit (r = 0.333) and blood viscosity (r = 0.258). Multiple linear regression analyses demonstrated that the only variable significantly associated with SBP was age, while haematocrit was the only variable significantly associated with DBP. Blood viscosity was closely related to waist/hip ratio. These findings show that SBP, in healthy subjects, is not influenced by haematocrit and blood viscosity. In contrast, DBP is related to the values of haematocrit. Among classical cardiovascular risk factors, waist/hip ratio is closely related to blood viscosity.

Hepcidin as a new biomarker for detecting autologous blood transfusion.

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Leuenberger, Nicolas; Barras, Laura; Nicoli, Raul; Robinson, Neil; Baume, Norbert; Lion, Niels; Barelli, Stefano; Tissot, Jean-Daniel; Saugy, Martial

2016-05-01

Autologous blood transfusion (ABT) is an efficient way to increase sport performance. It is also the most challenging doping method to detect. At present, individual follow-up of haematological variables via the athlete biological passport (ABP) is used to detect it. Quantification of a novel hepatic peptide called hepcidin may be a new alternative to detect ABT. In this prospective clinical trial, healthy subjects received a saline injection for the control phase, after which they donated blood that was stored and then transfused 36 days later. The impact of ABT on hepcidin as well as haematological parameters, iron metabolism, and inflammation markers was investigated. Blood transfusion had a particularly marked effect on hepcidin concentrations compared to the other biomarkers, which included haematological variables. Hepcidin concentrations increased significantly: 12 hr and 1 day after blood reinfusion, these concentrations rose by seven- and fourfold, respectively. No significant change was observed in the control phase. Hepcidin quantification is a cost-effective strategy that could be used in an "ironomics" strategy to improve the detection of ABT. © 2016 Wiley Periodicals, Inc.

Excess Vitamin Intake before Starvation does not Affect Body Mass, Organ Mass, or Blood Variables but Affects Urinary Excretion of Riboflavin in Starving Rats

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Aya Moriya

2013-01-01

Full Text Available B-vitamins are important for producing energy from amino acids, fatty acids, and glucose. The aim of this study was to elucidate the effects of excess vitamin intake before starvation on body mass, organ mass, blood, and biological variables as well as on urinary excretion of riboflavin in rats. Adult rats were fed two types of diets, one with a low vitamin content (minimum vitamin diet for optimum growth and one with a sufficient amount of vitamins (excess vitamin diet. Body mass, organ mass, and blood variables were not affected by excess vitamin intake before starvation. Interestingly, urinary riboflavin excretion showed a different pattern. Urine riboflavin in the excess vitamin intake group declined gradually during starvation, whereas it increased in the low vitamin intake group. Excess vitamin intake before starvation does not affect body mass, organ mass, or blood variables but does affect the urinary excretion of riboflavin in starving rats.

Effects of carprofen or meloxicam on selected haemostatic variables in miniature pigs after orthopaedic surgery

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Petr Raušer

2011-01-01

Full Text Available The aim of the study was to detect and compare the haemostatic variables and bleeding after 7‑days administration of carprofen or meloxicam in clinically healthy miniature pigs. Twenty-one clinically healthy Göttingen miniature pigs were divided into 3 groups. Selected haemostatic variables such as platelet count, prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen, serum biochemical variables such as total protein, bilirubin, urea, creatinine, alkaline phosphatase, alanine aminotransferase and gamma-glutamyltransferase and haemoglobin, haematocrit, red blood cells, white blood cells and buccal mucosal bleeding time were assessed before and 7 days after daily intramuscular administration of saline (1.5 ml per animal, control group, carprofen (2 mg·kg-1 or meloxicam (0.1 mg·kg-1. In pigs receiving carprofen or meloxicam, the thrombin time was significantly increased (p p p p < 0.05 compared to the control group. Significant differences were not detected in other haemostatic, biochemical variables or bleeding time compared to other groups or to the pretreatment values. Intramuscular administration of carprofen or meloxicam in healthy miniature pigs for 7 days causes sporadic, but not clinically important changes of selected haemostatic variables. Therefore, we can recommend them for perioperative use, e.g. for their analgesic effects, in orthopaedic or other surgical procedures without increased bleeding.

Irradiation of blood, blood compounds and cell culture in equipment of radiotherapy of clinical usage. Study about volume and ideal dose

International Nuclear Information System (INIS)

Fernandes, Marco Antonio Rodrigues; Pereira, Adelino Jose; Novaes, Paulo Eduardo Ribeiro dos Santos

1996-01-01

The irradiation of blood bags with the objective of minimizing the graft-versus-host disease in the proceedings of blood transfusion has been consolidated as an indispensable step in the advances of hematopoietic system diseases therapeutics. This practice performed in the great oncological treatment centers requires appropriate equipment (cell irradiators), that due to the high coast, is inaccessible to the majority of the services. The main objective of this work is the show the technique developed by the Radiological Physics Service of the Hospital A. C. Camargo Radiation Department, using the teletherapy equipment of clinical usage available at the Institution. The literature shows that a total dose of 2000 to 3500 c Gy must be administered to all target volume to get an ideal dose/volume relation that proportionates better therapeutic results, neutralizing the cells which are causative of post transfusion reactions of rejection, without prejudicing the other cells that are necessary to the maintenance and preservation of the transplanted person's hematopoietic system functions. With the technic developed for optimization of the irradiation. it is possible to conclude that the utilization of radiotherapy equipment of clinical usage for blood irradiation, substituting cells irradiators, is a good option, permitting safe transfusion of products irradiated with adequate dose. (author)

SPECT myocardial blood flow quantitation toward clinical use: a comparative study with {sup 13}N-Ammonia PET myocardial blood flow quantitation

Energy Technology Data Exchange (ETDEWEB)

Hsu, Bailing [University of Missouri-Columbia, Nuclear Science and Engineering Institute, Columbia, Missouri (United States); Hu, Lien-Hsin; Yang, Bang-Hung; Ting, Chien-Hsin; Huang, Wen-Sheng [Taipei Veterans General Hospital, Department of Nuclear Medicine, Taipei (China); Chen, Lung-Ching [Shin Kong Wu-Ho Su Memorial Hospital, Division of Cardiology, Taipei (China); Chen, Yen-Kung [Shin Kong Wu-Ho Su Memorial Hospital, Department of Nuclear Medicine, Taipei (China); Hung, Guang-Uei [Chang Bing Show Chwan Memorial Hospital, Department of Nuclear Medicine, Changhua (China); Wu, Tao-Cheng [National Yang-Ming University, Cardiovascular Research Center, Taipei (China)

2017-01-15

The aim of this study was to evaluate the accuracy of myocardial blood flow (MBF) quantitation of {sup 99m}Tc-Sestamibi (MIBI) single photon emission computed tomography (SPECT) compared with {sup 13}N-Ammonia (NH3) position emission tomography (PET) on the same cohorts. Recent advances of SPECT technologies have been applied to develop MBF quantitation as a promising tool to diagnose coronary artery disease (CAD) for areas where PET MBF quantitation is not available. However, whether the SPECT approach can achieve the same level of accuracy as the PET approach for clinical use still needs further investigations. Twelve healthy volunteers (HVT) and 16 clinical patients with CAD received both MIBI SPECT and NH3 PET flow scans. Dynamic SPECT images acquired with high temporary resolution were fully corrected for physical factors and processed to quantify K1 using the standard compartmental modeling. Human MIBI tracer extraction fraction (EF) was determined by comparing MIBI K1 and NH3 flow on the HVT group and then used to convert flow values from K1 for all subjects. MIBI and NH3 flow values were systematically compared to validate the SPECT approach. The human MIBI EF was determined as [1.0-0.816*exp(-0.267/MBF)]. Global and regional MBF and myocardial flow reserve (MFR) of MIBI SPECT and NH3 PET were highly correlated for all subjects (global R{sup 2}: MBF = 0.92, MFR = 0.78; regional R{sup 2}: MBF ≥ 0.88, MFR ≥ 0.71). No significant differences for rest flow, stress flow, and MFR between these two approaches were observed (All p ≥ 0.088). Bland-Altman plots overall revealed small bias between MIBI SPECT and NH3 PET (global: ΔMBF = -0.03Lml/min/g, ΔMFR = 0.07; regional: ΔMBF = -0.07 - 0.06, ΔMFR = -0.02 - 0.22). Quantitation with SPECT technologies can be accurate to measure myocardial blood flow as PET quantitation while comprehensive imaging factors of SPECT to derive the variability between these two approaches were fully addressed and corrected

SPECT myocardial blood flow quantitation toward clinical use: a comparative study with "1"3N-Ammonia PET myocardial blood flow quantitation

International Nuclear Information System (INIS)

Hsu, Bailing; Hu, Lien-Hsin; Yang, Bang-Hung; Ting, Chien-Hsin; Huang, Wen-Sheng; Chen, Lung-Ching; Chen, Yen-Kung; Hung, Guang-Uei; Wu, Tao-Cheng

2017-01-01

The aim of this study was to evaluate the accuracy of myocardial blood flow (MBF) quantitation of "9"9"mTc-Sestamibi (MIBI) single photon emission computed tomography (SPECT) compared with "1"3N-Ammonia (NH3) position emission tomography (PET) on the same cohorts. Recent advances of SPECT technologies have been applied to develop MBF quantitation as a promising tool to diagnose coronary artery disease (CAD) for areas where PET MBF quantitation is not available. However, whether the SPECT approach can achieve the same level of accuracy as the PET approach for clinical use still needs further investigations. Twelve healthy volunteers (HVT) and 16 clinical patients with CAD received both MIBI SPECT and NH3 PET flow scans. Dynamic SPECT images acquired with high temporary resolution were fully corrected for physical factors and processed to quantify K1 using the standard compartmental modeling. Human MIBI tracer extraction fraction (EF) was determined by comparing MIBI K1 and NH3 flow on the HVT group and then used to convert flow values from K1 for all subjects. MIBI and NH3 flow values were systematically compared to validate the SPECT approach. The human MIBI EF was determined as [1.0-0.816*exp(-0.267/MBF)]. Global and regional MBF and myocardial flow reserve (MFR) of MIBI SPECT and NH3 PET were highly correlated for all subjects (global R"2: MBF = 0.92, MFR = 0.78; regional R"2: MBF ≥ 0.88, MFR ≥ 0.71). No significant differences for rest flow, stress flow, and MFR between these two approaches were observed (All p ≥ 0.088). Bland-Altman plots overall revealed small bias between MIBI SPECT and NH3 PET (global: ΔMBF = -0.03Lml/min/g, ΔMFR = 0.07; regional: ΔMBF = -0.07 - 0.06, ΔMFR = -0.02 - 0.22). Quantitation with SPECT technologies can be accurate to measure myocardial blood flow as PET quantitation while comprehensive imaging factors of SPECT to derive the variability between these two approaches were fully addressed and corrected. (orig.)

Concordance of mutation detection in circulating tumor DNA in early clinical trials using different blood collection protocols

DEFF Research Database (Denmark)

Ahlborn, Lise B.; Madsen, Mette; Jonson, Lars

2017-01-01

in a clinical setting. Here we investigate the concordance between standard blood collection for molecular analysis using immediate separation of plasma, compared to the use of collection tubes allowing for delayed processing. Methods: In this study, we measured the fractional abundance of tumor specific...... patients with advanced solid cancers enrolled in early clinical trials. Results: Concordance in the fractional abundance of mutations in ctDNA isolated from blood collected in either K3EDTA or BCT tubes from patients with different solid cancers was observed. Conclusions: This study indicates that BCT...... mutations (BRAF p.V600E and PIK3CA p.H1047R) in ctDNA isolated from blood samples collected in either cell-stabilizing Cell-Free DNA BCT tubes (delayed processing within 72 hours) or standard K3EDTA tubes (immediate processing within 15 minutes). Twenty-five blood sample pairs (EDTA/BCT) were collected from...

Comparison of valsartan and amlodipine on ambulatory blood pressure variability in hypertensive patients.

Science.gov (United States)

Eguchi, Kazuo; Imaizumi, Yuki; Kaihara, Toshiki; Hoshide, Satoshi; Kario, Kazuomi

We tested the hypothesis that calcium channel blockers (CCBs: amlodipine group, n = 38)) are superior to angiotensin receptor blockers (ARBs: valsartan group, n = 38) against ambulatory blood pressure variability (BPV) in untreated Japanese hypertensive patients. Both drugs significantly reduced ambulatory systolic and diastolic BP values. With regard to BPV, standard deviation (SD) in SBP did not change with the administration of either drug, but the ARB significantly increased SD in awake DBP (12 ± 4-14 ± 4 mmHg). The ARB also significantly increased the coefficients of variation (CVs)in awake and 24-h SBP/DBP (all P valsartan, especially in reducing maximum BP levels.

Overview of clinical efficacy and safety of pharmacologic strategies for blood conservation.

Science.gov (United States)

Levy, Jerrold H

2005-09-15

The pharmacologic management of hemostasis in patients undergoing surgery with cardiopulmonary bypass is discussed. Nearly 45 studies involving 7,000 patients have reported efficacy of aprotinin in blood conservation. Both in primary coronary artery bypass graft (CABG) surgeries and in repeat surgeries, aprotinin treatment significantly reduces the incidence of blood transfusions and the number of units of blood transfused. These effects have been observed for red blood cell, platelet, and other blood products. The safety of aprotinin treatment has been extensively evaluated in randomized clinical trials, in postmarketing databases, and in systematic reviews of the literature. Overall, data do not indicate that aprotinin treatment increases mortality, myocardial infarction, or renal failure. These findings are supported by the results of a recent meta-analysis of 35 studies in patients undergoing CABG surgery. In addition, the meta-analysis suggests that aprotinin treatment was associated with a reduced incidence of stroke and a trend toward a reduced incidence of atrial fibrillation. Although lysine analogs, desmopressin, and recombinant factor VIIa are sometimes used to reduce bleeding, only aprotinin is indicated for use during CABG surgery. The future of cardiac surgery will be marked by an increasingly complex, high-risk group of patients and a greater need for multiple pharmacologic options for reducing bleeding. Pharmacologic approaches that attenuate the activation of the hemostatic system and inflammation need to be employed to decrease coagulopathies and the need for allogeneic blood administration.

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

Science.gov (United States)

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), SICH SITS (OR, 1.14; 95% CI, 1.06-1.23), and SICH ECASS (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 P interaction accounting for pre-treatment BP and the acute BP course (ie, BPV) to achieve best possible outcome for the patient. © 2017 American Heart Association, Inc.

Clinical study of color Doppler sonography in Graves' disease blood flow changes after thyroid arteries embolization

International Nuclear Information System (INIS)

Zhuang Wenquan; Li Weiduo; Yang Jianyong; Chen Wei; Huang Yonghui; Guo Wenbo; Li Jiaping

2003-01-01

Objective: To study the color doppler image characteristics of thyroid arteries pre- and post-interventional procedure and to assess the clinical efficacy in Gnaves' disease. Methods: 11 from 31 patients diagnosed as Graves' disease undertaken thyroid arteries embolization, were analyzed. Color Doppler sonography was applied to monitor the pre-and post- procedure thyroid size and diameters of thyroid arteries. Power Doppler was used to detect the Vmax, Vmin, RI and blood flow. Results: After thyroid arteries embolization, the size and vascularity of thyroids were reduced. The thyroid arteries showed shrinkage and stoppage blood flow at the embolized site. The changes of RI, blood parameters of Vmax, Vmin and diameters of the thyroid arteries pre- and post-procedure turned out to be statistically significant for clinical restriction. Conclusion: The color Doppler sonography plays an important role for preoperative diagnosis and predicting the prognosis

The effect of intermittent fasting on blood pressure variability in patients with newly diagnosed hypertension or prehypertension.

Science.gov (United States)

Erdem, Yunus; Özkan, Gülsüm; Ulusoy, Şükrü; Arıcı, Mustafa; Derici, Ülver; Şengül, Şule; Sindel, Şükrü; Ertürk, Şehsuvar

2018-01-01

Intermittent fasting is a phenomenon which can be observed in most humans. The effect of intermittent fasting on blood pressure variability (BPV) has not previously been investigated. The purpose of this study was to assess the effect of fasting on blood pressure (BP) (with office, home, central, and ambulatory blood pressure monitoring [ABPM]) and on BPV. Sixty individuals were included in the study. Office, home, ABPM, and central BP measurements were performed before and during intermittent fasting. Standard deviation and coefficient variation were used for office and home BPV measurement, while the smoothness index was used to calculate ABPM variability. Patients' BP and BPV values before and during intermittent fasting were then compared. Intermittent fasting resulted in a significant decrease in office BP values and ABPM measurements but caused no significant change in home and central BP measurements. Twenty-four hour urinary sodium excretion decreased. Smoothness values obtained from ABPM measurements were low; in other words, BPV was greater. BPV was higher in patients who woke up to eat before sunrise, but BPV was low in patients with high body mass index. Intermittent fasting produced a significant decrease in BP values in terms of office and ABPM measurements in this study but caused no significant change in central BP and home measurements. We also identified an increase in BPV during intermittent fasting, particularly in patients who rose before sunrise. Copyright © 2017 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

Clinical Utility of Blood Cell Histogram Interpretation.

Science.gov (United States)

Thomas, E T Arun; Bhagya, S; Majeed, Abdul

2017-09-01

An automated haematology analyser provides blood cell histograms by plotting the sizes of different blood cells on X-axis and their relative number on Y-axis. Histogram interpretation needs careful analysis of Red Blood Cell (RBC), White Blood Cell (WBC) and platelet distribution curves. Histogram analysis is often a neglected part of the automated haemogram which if interpreted well, has significant potential to provide diagnostically relevant information even before higher level investigations are ordered.

Effect of Platelet-Rich Plasma (PRP versus Autologous Whole Blood on Pain and Function Improvement in Tennis Elbow: A Randomized Clinical Trial

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Seyed Ahmad Raeissadat

2014-01-01

Full Text Available Background. Autologous whole blood and platelet-rich plasma (PRP have been both suggested to treat chronic tennis elbow. The aim of the present study was to compare the effects of PRP versus autologous whole blood local injection in chronic tennis elbow. Methods. Forty patients with tennis elbow were randomly divided into 2 groups. Group 1 was treated with a single injection of 2 mL of autologous PRP and group 2 with 2 mL of autologous blood. Tennis elbow strap, stretching, and strengthening exercises were administered for both groups during a 2-month followup. Pain and functional improvements were assessed using visual analog scale (VAS, modified Mayo Clinic performance index for the elbow, and pressure pain threshold (PPT at 0, 4, and 8 weeks. Results. All pain and functional variables including VAS, PPT, and Mayo scores improved significantly in both groups 4 weeks after injection. No statistically significant difference was noted between groups regarding pain scores in 4-week follow-up examination (P>0.05. At 8-week reevaluations, VAS and Mayo scores improved only in PRP group (P<0.05. Conclusion. PRP and autologous whole blood injections are both effective to treat chronic lateral epicondylitis. PRP might be slightly superior in 8-week followup. However, further studies are suggested to get definite conclusion.

A global survey of clinicians' awareness, accessibility, utilization of e-continuous education, and quality of clinical blood use: policy considerations

Directory of Open Access Journals (Sweden)

Smit Sibinga CT

2017-07-01

Full Text Available Cees Th Smit Sibinga,1 Maruff A Oladejo,2 Olamide Hakeem Adejumo,3 Quentin Eichbaum,4 Midori Kumagawa,5 Shuichi Kino,5 Sima Zolfaghari,6 Silvano Wendel,7 Gordana Rasovic,8 Namjil Erdenebayar,9 Maya Makhmudova,10 Loyiso Mpuntsha,11 Charlotte Ingram,11 Bakyt B Kharabaev,12 Isaac Kajja,13 Zainab Mukhtar Hussain Sanji,14 Maria M M Satti15 1IQM Consulting for International Development of Quality Management in Transfusion Medicine, University of Groningen, Groningen, the Netherlands; 2Department of Educational Management, University of Lagos, Lagos, 3Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria; 4Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA; 5Japanese Red Cross Hokkaido Block Blood Center, Japan; 6IBTO, Tehran, Iran; 7Blood Bank, Hospital Sirio Libanês, Sao Paulo, Brazil; 8Montenegro National Blood Transfusion Center, Podgorica, Montenegro; 9National Center for Transfusion Medicine, Ulaanbaatar, Mongolia; 10Consultant IQM Consulting, Tashkent, Uzbekistan; 11South Africa National Blood Transfusion Service, Johannesburg, South Africa; 12National Blood Transfusion Service, Bishkek, Kyrgyzstan; 13Department of Orthopedics, Mulago Hospital, Makerere University, Uganda; 14Consultant, Dow University of Health Sciences, Karachi, Pakistan; 15National Blood Transfusion Service, Khartoum, Sudan Introduction: Clinical use of blood has shown the least developed part in the vein-to-vein transfusion chain. This global study was carried out in order to investigate the level of awareness, accessibility and utilization of continuous e-learning and education, and quality of blood use among blood prescribing clinicians and nurses.Approach: Descriptive ex post facto survey design.Methods: A total of 264 purposively selected blood prescribing clinicians and nurses from the four Human Development Index (HDI groups of countries (low, medium, high, and very high participated in this study

Red blood cell antigen genotype analysis for 9087 Asian, Asian American, and Native American blood donors.

Science.gov (United States)

Delaney, Meghan; Harris, Samantha; Haile, Askale; Johnsen, Jill; Teramura, Gayle; Nelson, Karen

2015-10-01

There has yet to be a comprehensive analysis of blood group antigen prevalence in Asian Americans and Native Americans. There may be ethnic differences in blood group frequencies that would result in clinically important mismatches through transfusion. Blood donors who self-identified as Asian or Native American were tested using a single-nucleotide polymorphism (SNP) DNA array (HEA BeadChip kit, Bioarray Solutions Ltd) that predicts expression of 38 human erythrocyte antigens (HEAs) and by serology for ABO, D, C, M, N, Jk(a) , and Jk(b) . The prevalence of blood group antigens was compared to published European prevalence. Discrepancies between SNP-predicted and serology-detected antigens were tallied. A total of 9087 blood donors were tested from nine Asian and Native American heritages. The predicted prevalence of selected antigens in the RHCE, JK, FY, MNS, LU, CO, and DO blood group systems were variable between Asian populations, but overall not significantly different than Europeans. Compared to European frequencies, Kell blood group allele frequencies were significantly different in the Chinese, Native American, Hawaiian/Pacific Islander, South Asian, and Southeast Asian heritage blood donors; Diego antigens Di(a) and Di(b) were different in donors of Native American and South Asian ancestries (p Asian and Native Americans donors. Several ethnic groups exhibited differences in HEA frequencies compared to Europeans. Genotype-serotype discrepancies were detected in all systems studied. © 2015 AABB.

European Society of Hypertension practice guidelines for ambulatory blood pressure monitoring.

Science.gov (United States)

Parati, Gianfranco; Stergiou, George; O'Brien, Eoin; Asmar, Roland; Beilin, Lawrence; Bilo, Grzegorz; Clement, Denis; de la Sierra, Alejandro; de Leeuw, Peter; Dolan, Eamon; Fagard, Robert; Graves, John; Head, Geoffrey A; Imai, Yutaka; Kario, Kazuomi; Lurbe, Empar; Mallion, Jean-Michel; Mancia, Giuseppe; Mengden, Thomas; Myers, Martin; Ogedegbe, Gbenga; Ohkubo, Takayoshi; Omboni, Stefano; Palatini, Paolo; Redon, Josep; Ruilope, Luis M; Shennan, Andrew; Staessen, Jan A; vanMontfrans, Gert; Verdecchia, Paolo; Waeber, Bernard; Wang, Jiguang; Zanchetti, Alberto; Zhang, Yuqing

2014-07-01

Given the increasing use of ambulatory blood pressure monitoring (ABPM) in both clinical practice and hypertension research, a group of scientists, participating in the European Society of Hypertension Working Group on blood pressure monitoring and cardiovascular variability, in year 2013 published a comprehensive position paper dealing with all aspects of the technique, based on the available scientific evidence for ABPM. The present work represents an updated schematic summary of the most important aspects related to the use of ABPM in daily practice, and is aimed at providing recommendations for proper use of this technique in a clinical setting by both specialists and practicing physicians. The present article details the requirements and the methodological issues to be addressed for using ABPM in clinical practice, The clinical indications for ABPM suggested by the available studies, among which white-coat phenomena, masked hypertension, and nocturnal hypertension, are outlined in detail, and the place of home measurement of blood pressure in relation to ABPM is discussed. The role of ABPM in pharmacological, epidemiological, and clinical research is also briefly mentioned. Finally, the implementation of ABPM in practice is considered in relation to the situation of different countries with regard to the reimbursement and the availability of ABPM in primary care practices, hospital clinics, and pharmacies.

Efficacy of Dragon's blood cream on wound healing: A randomized, double-blind, placebo-controlled clinical trial

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Foroogh Namjoyan

2016-01-01

Full Text Available The blood-red sap of Dragon's blood has been used in folk medicine for fractures, wounds, inflammation, gastrointestinal disorders, rheumatism, blood circulation dysfunctions, and cancer. Existing in vitro and in vivo bioactivity of this herb on different mechanisms of healing shows strong potential of this sap in wound healing. This clinical trial study was designated to evaluate the wound healing effect of Dragon's blood on human wounds. Sixty patients, between the ages of 14–65 years, who were referred to remove their skin tag, were assigned to this double-blind, placebo-controlled, randomized clinical trial and received either Dragon's blood or a placebo cream. They were visited on the 3rd, 5th, 7th, 10th, 14th, and 20th day of the trial to check the process of healing and to measure the wound's surface. At the end of trial, there was a significant difference in the mean duration of wound healing between the two groups (p = 0.0001. The phenolic compounds and the alkaloid taspine, which exist in Dragon's-blood resin, are probably the main reasons for the wound healing property of this plant. Being natural accessible, safe, and affordable makes Dragon's blood cream, a good choice for addition to the wound healing armamentarium. Further studies on wounds with different causes and among larger populations are suggested to ensure the effectiveness and safety of Dragon's blood.

Evidence-based blood pressure reducing actions of electroacupuncture: mechanisms and clinical application.

Science.gov (United States)

Longhurst, John C; Tjen-A-Looi, Stephanie C

2017-10-25

Hypertension is a serious world-wide health problem as it increases cardiovascular atherosclerotic risk, stroke and attending morbidity and mortality. Both systolic and diastolic blood pressures and particularly systolic pressure increase with aging. The downsides from pharmacological therapy have led to consideration of additional treatments, including acupuncture, which evokes endogenous neural-hormonal systems to lower blood pressure. Using basic science studies to guide clinical approaches to research, it is apparent that low frequency, low intensity electroacupuncture reduces sympathetic outflow in approximately 70% of patients with mild to moderate hypertension who are off antihypertensive drugs. Systolic and, to a lesser extent, diastolic arterial blood pressures can be lowered over two to four weeks for prolonged periods, lasting as long as one month, after cessation of an eight weeks of once weekly stimulation. Many questions about long-term therapy, treatment of resistant patients and efficacy in patients on medication remain to be studied. Current data, however, suggest that there may be a role of acupuncture in treatment of hypertension.

Evaluation of the clinical utility of a rapid blood test for human leptospirosis

NARCIS (Netherlands)

Eapen, C. K.; Sugathan, Sheela; Kuriakose, Mariamma; Abdoel, Theresia; Smits, Henk L.

2002-01-01

A rapid assay device for the detection of Leptospira-specific immunoglobulin M (IgM) antibodies was applied on whole blood samples collected from a group of consecutive patients admitted with clinical suspicion of leptospirosis to a district hospital in Kerala, India. The hospital is located in an

Clinical isolates of GB virus type C vary in their ability to persist and replicate in peripheral blood mononuclear cell cultures

International Nuclear Information System (INIS)

George, Sarah L.; Xiang Jinhua; Stapleton, Jack T.

2003-01-01

GB virus C/hepatitis G virus (GBV-C) replication in vitro is inefficient and inconsistent. In this study, clinical isolates of GBV-C were evaluated using peripheral blood mononuclear cell (PBMC) based culture methods. Isolates varied consistently in their ability to persistently replicate, and yield increased in cells grown without PHA/IL-2 stimulation. The deduced polyprotein sequence of an isolate that replicated well was determined (GenBank AY196904) and compared to 20 full-length GBV-C sequences. Fourteen of the 16 unique amino acid polymorphisms identified were in the coding regions for nonstructural proteins associated with interferon resistance and RNA replication. These data indicate that clinical GBV-C isolates vary in their ability to persist in culture, do not require PHA/IL-2 stimulation, and that sequence variability in key regulatory regions may affect growth in PBMC cultures. Since GBV-C appears to inhibit HIV replication in a coinfection model, these studies should facilitate determination of the mechanism of this interaction

Perioperative blood transfusion and blood conservation in cardiac surgery: the Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guideline.

Science.gov (United States)

Ferraris, Victor A; Ferraris, Suellen P; Saha, Sibu P; Hessel, Eugene A; Haan, Constance K; Royston, B David; Bridges, Charles R; Higgins, Robert S D; Despotis, George; Brown, Jeremiah R; Spiess, Bruce D; Shore-Lesserson, Linda; Stafford-Smith, Mark; Mazer, C David; Bennett-Guerrero, Elliott; Hill, Steven E; Body, Simon

2007-05-01

A minority of patients having cardiac procedures (15% to 20%) consume more than 80% of the blood products transfused at operation. Blood must be viewed as a scarce resource that carries risks and benefits. A careful review of available evidence can provide guidelines to allocate this valuable resource and improve patient outcomes. We reviewed all available published evidence related to blood conservation during cardiac operations, including randomized controlled trials, published observational information, and case reports. Conventional methods identified the level of evidence available for each of the blood conservation interventions. After considering the level of evidence, recommendations were made regarding each intervention using the American Heart Association/American College of Cardiology classification scheme. Review of published reports identified a high-risk profile associated with increased postoperative blood transfusion. Six variables stand out as important indicators of risk: (1) advanced age, (2) low preoperative red blood cell volume (preoperative anemia or small body size), (3) preoperative antiplatelet or antithrombotic drugs, (4) reoperative or complex procedures, (5) emergency operations, and (6) noncardiac patient comorbidities. Careful review revealed preoperative and perioperative interventions that are likely to reduce bleeding and postoperative blood transfusion. Preoperative interventions that are likely to reduce blood transfusion include identification of high-risk patients who should receive all available preoperative and perioperative blood conservation interventions and limitation of antithrombotic drugs. Perioperative blood conservation interventions include use of antifibrinolytic drugs, selective use of off-pump coronary artery bypass graft surgery, routine use of a cell-saving device, and implementation of appropriate transfusion indications. An important intervention is application of a multimodality blood conservation program

Episiotomy and its relationship to various clinical variables that influence its performance

Science.gov (United States)

Ballesteros-Meseguer, Carmen; Carrillo-García, César; Meseguer-de-Pedro, Mariano; Canteras-Jordana, Manuel; Martínez-Roche, Mª Emilia

2016-01-01

Objective: to understand the episiotomy rate and its relationship with various clinical variables. Method: a descriptive, cross-sectional, analytic study of 12,093 births in a tertiary hospital. Variables: Parity, gestational age, start of labor, use of epidural analgesia, oxytocin usage, position during fetal explusion, weight of neonate, and completion of birth. The analysis was performed with SPSS 19.0. Results: the global percentage of episiotomies was 50%. The clinical variables that presented a significant association were primiparity (RR=2.98), gestational age >41 weeks (RR=1.2), augmented or induced labor (RR=1.33), epidural analgesia use (RR=1,95), oxytocin use (RR=1.58), lithotomy position during fetal expulsion (RR=6.4), and instrumentation (RR=1.84). Furthermore, maternal age ≥35 years (RR=0.85) and neonatal weight <2500 g (RR=0.8) were associated with a lower incidence of episiotomy. Conclusions: episiotomy is dependent on obstetric interventions performed during labor. If we wish to reduce the episiotomy rate, it will be necessary to bear in mind these risk factors when establishing policies for reducing this procedure. PMID:27224064

No benefit of intraoperative whole blood sequestration and autotransfusion during coronary artery bypass grafting : results of a randomized clinical trial

NARCIS (Netherlands)

Ramnath, A N; Naber, H R; de Boer, A; Leusink, J A

OBJECTIVES: In a randomized clinical trial of patients undergoing elective coronary artery bypass grafting, we evaluated the effect of intraoperative whole blood sequestration and autotransfusion on postoperative blood loss and the use of allogeneic blood products. METHODS: Male patients were

[Multicenter clinical study on umbilical cord arterial blood gas parameters for diagnosis of neonatal asphyxia].

Science.gov (United States)

2010-09-01

To obtain the normal range of statistics of umbilical artery blood gas parameters of the newborns for diagnosis of neonatal asphyxia. From March 2008 through September 2009, 17 978 singleton term appropriate for gestational age (AGA) or larger than gestational age (LGA) newborns in six hospitals of five provinces/autonomous regions were consecutively enrolled in this prospective study. The normal ranges of umbilical artery blood gas parameters were obtained from 17 645 newborns with 1 min Apgar score ≥ 8. The correlations between umbilical artery blood pH, BE and prenatal high-risk factors, Apgar scores, and organ damage were analyzed. The diagnostic criteria for asphyxia included the following: (1) Having high-risk factors that might cause asphyxia; (2) 1 min Apgar score ≤ 7 (the respiratory depression must be present); (3) At least one organ showed evidence of hypoxic damage; (4) Other causes of low Apgar score were excluded. The study focused on the distributive characteristics of umbilical artery blood pH (clinically corrected by Eisenberg formula) and BE values of the asphyxiated and non-asphyxiated cases in low Apgar score group, as well as the sensitivity and specificity of different selected pH and BE threshold spots within their distributing ranges. Among the 17 978 singleton term AGA or LGA newborns, the statistically normal range of umbilical artery blood pH, BE for the 17 645 cases with 1 min Apgar scores ≥ 8 were 7.20 ± 0.20 (x(-) ± 1.96 s) and -7.64 ± 10.02 (x(-) ± 1.96 s), respectively. The pH well correlated positively with BE (r = 0.734, P blood pH and BE values correlated positively with the Apgar scores. The umbilical artery blood pH and BE values correlated negatively with organ damage (r = 1, the P values = 0.000 for both). Among the 333 low Apgar score cases, the umbilical artery blood pH corrected values and BE values of the asphyxiated group (163 cases) were 7.011 ± 0.09 (x(-) ± s) and -14.98 ± 2.99 (x(-) ± s), being lower than

Effect of blood collection technique in mice on clinical pathology parameters.

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Schnell, Michael A; Hardy, Christine; Hawley, Melanie; Propert, Kathleen Joy; Wilson, James M

2002-01-01

A study was conducted in normal healthy C57BL/6 mice to determine the effect of method of blood collection on clinical pathology parameters and to provide value ranges for these parameters. Males and females were used and were randomly assigned to treatment groups based upon phlebotomy method. The blood was collected using one of four methods: intracardiac (IC), a single attempt at collection from the caudal vena cava (VC), collection from the caudal vena cava with collection of any extravasated blood from the peritoneum (MC), or retroorbital phlebotomy (RO). Evaluation of blood and serum samples was conducted for a number of serum biochemistries including liver function tests and complete blood count with differentials and platelet counts. Female mice demonstrated higher values for red blood cell number, hemoglobin (p values for platelet counts, specific white blood cell numbers (total, neutrophil, lymphocyte, and eosinophil counts), globulin, amylase, and the BUN/creatinine ratio. Overall, the VC method was associated with the least variation in both sexes and appeared slightly better than the IC method for the parameters evaluated. The largest difference between groups was noted for the transaminase levels. While alanine aminotransferase (ALT) values were similar between the IC and VC groups, aspartate aminotransferase (AST) values were associated with less variation for the VC method. Transaminase levels for the MC and RO groups were associated with relatively large ranges and variation. ALT results from the RO method, the only method amenable to repetitive sample collection used in this evaluation, indicate that this is an acceptable method. The results demonstrate the substantial impact that phlebotomy method has on the assay results and that the VC or IC methods provide the most consistent results. The ranges by collection method and sex provided here can be used to select the preferred method of collection when designing a study and for comparison of data

Clinical condition and comorbidity as determinants for blood culture positivity in patients with skin and soft-tissue infections

NARCIS (Netherlands)

van Daalen, F. V.; Kallen, M. C.; van den Bosch, C. M. A.; Hulscher, M. E. J. L.; Geerlings, S. E.; Prins, J. M.

2017-01-01

The utility of performing blood cultures in patients with a suspected skin infection is debated. We investigated the association between blood culture positivity rates and patients' clinical condition, including acute disease severity and comorbidity. We performed a retrospective study, including

Transcranial Doppler ultrasonography in children with sickle cell anemia: Clinical and laboratory correlates for elevated blood flow velocities.

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Lagunju, IkeOluwa; Sodeinde, Olugbemiro; Brown, Biobele; Akinbami, Felix; Adedokun, Babatunde

2014-02-01

Transcranial Doppler (TCD) sonography of major cerebral arteries is now recommended for routine screening for stroke risk in children with sickle cell disease (SCD). We performed TCD studies on children with sickle cell anemia (SCA) seen at the pediatric hematology clinic over a period of 2 years. TCD scans were repeated yearly in children with normal flow velocities and every 3 months in children with elevated velocities. Findings were correlated with clinical variables, hematologic indices, and arterial oxygen saturation. Predictors of elevated velocities were identified by multiple linear regressions. We enrolled 237 children and performed a total of 526 TCD examinations. Highest time-averaged maximum flow velocities were ≥170 cm/s in 72 (30.3%) cases and ≥200 cm/s in 20 (8.4%). Young age, low hematocrit, low hemoglobin, and arterial oxygen desaturation <95% showed significant correlations with presence of increased cerebral flow velocities. Low hematocrit, low hemoglobin concentration, young age, and low arterial oxygen desaturation predicted elevated cerebral blood flow velocities and, invariably, increased stroke risk, in children with SCA. Children who exhibit these features should be given high priority for TCD examination in the setting of limited resources. Copyright © 2013 Wiley Periodicals, Inc.

Retrospective analysis of patients clinical manifestations before and after pheochromocytoma surgery.

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Balazovjech, I; Davidova, H; Breza, J

2004-01-01

A retrospective analysis of presurgical clinical picture and blood pressures of 34 patients with histologically verified pheochromocytoma. Assessment of clinical state, blood pressure and prognosis in the course of patients control hospitalizations from 2001 to 2002. The study was designed as a synoptic one, based on a retrospective analysis of 34 patients records with histologically verified pheochromocytoma (26 women and 8 men). Our assessments of clinical symptomatology, maximum paroxysmal hypertension values, average blood pressure values in patients with persistent arterial hypertension, arterial hypertension grade and circadian index were based on patients records. Patients epinephrectomies were followed during their control hospitalizations to assess their clinical state. Their blood pressures were evaluated by means of their circadian monitoring. From the 34 patients, 21 were diagnosed with solitary pheochromocytomas. The circadian index persistence analysis prior to the surgery was associated with circadian blood pressure monitoring in 21 patients. It was lost in 57% of patients. During their control hospitalization as many as 82% of patients preserved their circadian blood pressure variability with a more than 10% decrease in the night time, 5 patients did not preserve their circadian blood pressure variability. Seven from the original 34 patients died: Three of them died from their primary disease, one 63-year old man died from shock following tumour extirpation. The death of other 3 patients was not associated with their primary disease. Long-lasting survival of patients with pheochromocytoma after surgical treatment--except for those with malignant disease--was demonstrated. Although our assessment of the resulting treatment effects was positive, a long-term follow-up is inevitable because of a difficult pathologic-anatomical verification of the malignant nature of the disease as well as of the risk of tumour relapse assessment. (Tab. 1, Fig. 5, Ref 36.)

Comparison of the clinical information provided by the FreeStyle Navigator continuous interstitial glucose monitor versus traditional blood glucose readings.

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McGarraugh, Geoffrey V; Clarke, William L; Kovatchev, Boris P

2010-05-01

The purpose of the analysis was to compare the clinical utility of data from traditional self-monitoring of blood glucose (SMBG) to that of continuous glucose monitoring (CGM). A clinical study of the clinical accuracy of the FreeStyle Navigator CGM System (Abbott Diabetes Care, Alameda, CA), which includes SMBG capabilities, was conducted by comparison to the YSI blood glucose analyzer (YSI Inc., Yellow Springs, OH) using 58 subjects with type 1 diabetes. The Continuous Glucose-Error Grid Analysis (CG-EGA) was used as the analytical tool. Using CG-EGA, the "clinically accurate," "benign errors," and "clinical errors" were 86.8%, 8.7%, and 4.5% for SMBG and 92.7%, 3.7%, and 3.6% for CGM, respectively. If blood glucose is viewed as a process in time, SMBG would provide accurate information about this process 86.8% of the time, whereas CGM would provide accurate information about this process 92.7% of the time (P glucose values than CGM, control of blood glucose involves a system in flux, and CGM provides more detailed insight into the dynamics of that system. In the normal and elevated glucose ranges, the additional information about the direction and rate of glucose change provided by the FreeStyle Navigator CGM System increases the ability to make correct clinical decisions when compared to episodic SMBG tests.

Infectivity of blood products from donors with occult hepatitis B virus infection

DEFF Research Database (Denmark)

Allain, Jean-Pierre; Mihaljevic, Ivanka; Gonzalez-Fraile, Maria Isabel

2013-01-01

BACKGROUND: Occult hepatitis B virus (HBV) infection (OBI) is identified in 1:1000 to 1:50,000 European blood donations. This study intended to determine the infectivity of blood products from OBI donors. STUDY DESIGN AND METHODS: Recipients of previous donations from OBI donors were investigated...... blood cells [RBCs], p Donor and recipient strains sequence homology of at least 99% confirmed transfusion-transmitted infection in 10 cases and excluded it in one case. CONCLUSION: Blood...... through lookback (systematic retrieval of recipients) or traceback (triggered by clinical cases). Serologic and genomic studies were undertaken on consenting donors and recipients. Multiple variables potentially affecting infectivity were examined. RESULTS: A total of 45 of 105 (42.9%) donor...

Multiscale time irreversibility of heart rate and blood pressure variability during orthostasis

International Nuclear Information System (INIS)

Chladekova, L; Czippelova, B; Turianikova, Z; Tonhajzerova, I; Calkovska, A; Javorka, M; Baumert, M

2012-01-01

Time irreversibility is a characteristic feature of non-equilibrium, complex systems such as the cardiovascular control mediated by the autonomic nervous system (ANS). Time irreversibility analysis of heart rate variability (HRV) and blood pressure variability (BPV) represents a new approach to assess cardiovascular regulatory mechanisms. The aim of this paper was to assess the changes in HRV and BPV irreversibility during the active orthostatic test (a balance of ANS shifted towards sympathetic predominance) in 28 healthy young subjects. We used three different time irreversibility indices—Porta’s, Guzik's and Ehler's indices (P%, G% and E, respectively) derived from data segments containing 1000 beat-to-beat intervals on four timescales. We observed an increase in the HRV and a decrease in the BPV irreversibility during standing compared to the supine position. The postural change in irreversibility was confirmed by surrogate data analysis. The differences were more evident in G% and E than P% and for higher scale factors. Statistical analysis showed a close relationship between G% and E. Contrary to this, the association between P% and G% and P% and E was not proven. We conclude that time irreversibility of beat-to-beat HRV and BPV is significantly altered during orthostasis, implicating involvement of the autonomous nervous system in its generation. (paper)

Extracellular membrane vesicles in blood products-biology and clinical relevance

Directory of Open Access Journals (Sweden)

Emilija Krstova Krajnc

2016-01-01

Full Text Available Extracellular membrane vesicles are fragments shed from plasma membranes off all cell types that are undergoing apoptosis or are being subjected to various types of stimulation or stress.  Even in the process of programmed cell death (apoptosis, cell fall apart of varying size vesicles. They expose phosphatidylserine (PS on the outer leaflet of their membrane, and bear surface membrane antigens reflecting their cellular origin. Extracellular membrane vesicles have been isolated from many types of biological fluids, including serum, cerebrospinal fluid, urine, saliva, tears and conditioned culture medium. Flow cytometry is one of the many different methodological approaches that have been used to analyze EMVs. The method attempts to characterize the EMVs cellular origin, size, population, number, and structure. EMVs are present and accumulate in blood products (erythrocytes, platelets as well as in fresh frozen plasma during storage. The aim of this review is to highlight the importance of extracellular vesicles as a cell-to-cell communication system and the role in the pathogenesis of different diseases. Special emphasis will be given to the implication of extracellular membrane vesicles in blood products and their clinical relevance. Although our understanding of the role of  EMVs in disease is far from comprehensive, they display promise as biomarkers for different diseases in the future and also as a marker of quality and safety in the quality control of blood products.

Prolonged storage of packed red blood cells for blood transfusion.

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Martí-Carvajal, Arturo J; Simancas-Racines, Daniel; Peña-González, Barbra S

2015-07-14

A blood transfusion is an acute intervention, used to address life- and health-threatening conditions on a short-term basis. Packed red blood cells are most often used for blood transfusion. Sometimes blood is transfused after prolonged storage but there is continuing debate as to whether transfusion of 'older' blood is as beneficial as transfusion of 'fresher' blood. To assess the clinical benefits and harms of prolonged storage of packed red blood cells, in comparison with fresh, on recipients of blood transfusion. We ran the search on 1st May 2014. We searched the Cochrane Injuries Group Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (OvidSP), Embase (OvidSP), CINAHL (EBSCO Host) and two other databases. We also searched clinical trials registers and screened reference lists of the retrieved publications and reviews. We updated this search in June 2015 but these results have not yet been incorporated. Randomised clinical trials including participants assessed as requiring red blood cell transfusion were eligible for inclusion. Prolonged storage was defined as red blood cells stored for ≥ 21 days in a blood bank. We did not apply limits regarding the duration of follow-up, or country where the study took place. We excluded trials where patients received a combination of short- and long-stored blood products, and also trials without a clear definition of prolonged storage. We independently performed study selection, risk of bias assessment and data extraction by at least two review authors. The major outcomes were death from any cause, transfusion-related acute lung injury, and adverse events. We estimated relative risk for dichotomous outcomes. We measured statistical heterogeneity using I(2). We used a random-effects model to synthesise the findings. We identified three randomised clinical trials, involving a total of 120 participants, comparing packed red blood cells with ≥ 21 days storage

Sub-Clinical Cognitive Decline and Resting Cerebral Blood Flow in Middle Aged Men.

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Otto Mølby Henriksen

Full Text Available Although dementia is associated with both global and regional cerebral blood flow (CBF changes, little is known about cerebral perfusion in the early pre-clinical stages of cognitive decline preceding overt cognitive dysfunction. The aim of this study was to investigate the association of early sub-clinical cognitive decline with CBF.The study participants were recruited from a cohort of Danish men born in 1953. Based on a regression model we selected men who performed better (Group A, n = 94 and poorer (Group B, n = 95 on cognitive testing at age 57 than expected from testing at age 20. Participants underwent supplementary cognitive testing, blood sampling and MRI including measurements of regional and global CBF.Regional CBF was lower in group B than in group A in the posterior cingulate gyrus and the precuneus. The associations were attenuated when corrected for global atrophy, but remained significant in regions of interest based analysis adjusting for regional gray matter volume and vascular risk factors. No influence of group on global CBF was observed.We conclude that early sub-clinical cognitive decline is associated with reduced perfusion in the precuneus and posterior cingulate gyrus independently of regional atrophy and vascular risk factors, but cannot be statistically separated from an association with global atrophy.

Practices for Identifying and Rejecting Hemolyzed Specimens Are Highly Variable in Clinical Laboratories.

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Howanitz, Peter J; Lehman, Christopher M; Jones, Bruce A; Meier, Frederick A; Horowitz, Gary L

2015-08-01

Hemolysis is an important clinical laboratory quality attribute that influences result reliability. To determine hemolysis identification and rejection practices occurring in clinical laboratories. We used the College of American Pathologists Survey program to distribute a Q-Probes-type questionnaire about hemolysis practices to Chemistry Survey participants. Of 3495 participants sent the questionnaire, 846 (24%) responded. In 71% of 772 laboratories, the hemolysis rate was less than 3.0%, whereas in 5%, it was 6.0% or greater. A visual scale, an instrument scale, and combination of visual and instrument scales were used to identify hemolysis in 48%, 11%, and 41% of laboratories, respectively. A picture of the hemolysis level was used as an aid to technologists' visual interpretation of hemolysis levels in 40% of laboratories. In 7.0% of laboratories, all hemolyzed specimens were rejected; in 4% of laboratories, no hemolyzed specimens were rejected; and in 88% of laboratories, some specimens were rejected depending on hemolysis levels. Participants used 69 different terms to describe hemolysis scales, with 21 terms used in more than 10 laboratories. Slight and moderate were the terms used most commonly. Of 16 different cutoffs used to reject hemolyzed specimens, moderate was the most common, occurring in 30% of laboratories. For whole blood electrolyte measurements performed in 86 laboratories, 57% did not evaluate the presence of hemolysis, but for those that did, the most common practice in 21 laboratories (24%) was centrifuging and visually determining the presence of hemolysis in all specimens. Hemolysis practices vary widely. Standard assessment and consistent reporting are the first steps in reducing interlaboratory variability among results.

Protocol for a prospective collaborative systematic review and meta-analysis of individual patient data from randomized controlled trials of vasoactive drugs in acute stroke: The Blood pressure in Acute Stroke Collaboration, stage-3.

Science.gov (United States)

Sandset, Else Charlotte; Sanossian, Nerses; Woodhouse, Lisa J; Anderson, Craig; Berge, Eivind; Lees, Kennedy R; Potter, John F; Robinson, Thompson G; Sprigg, Nikola; Wardlaw, Joanna M; Bath, Philip M

2018-01-01

Rationale Despite several large clinical trials assessing blood pressure lowering in acute stroke, equipoise remains particularly for ischemic stroke. The "Blood pressure in Acute Stroke Collaboration" commenced in the mid-1990s focussing on systematic reviews and meta-analysis of blood pressure lowering in acute stroke. From the start, Blood pressure in Acute Stroke Collaboration planned to assess safety and efficacy of blood pressure lowering in acute stroke using individual patient data. Aims To determine the optimal management of blood pressure in patients with acute stroke, including both intracerebral hemorrhage and ischemic stroke. Secondary aims are to assess which clinical and therapeutic factors may alter the optimal management of high blood pressure in patients with acute stroke and to assess the effect of vasoactive treatments on hemodynamic variables. Methods and design Individual patient data from randomized controlled trials of blood pressure management in participants with ischemic stroke and/or intracerebral hemorrhage enrolled during the ultra-acute (pre-hospital), hyper-acute (<6 h), acute (<48 h), and sub-acute (<168 h) phases of stroke. Study outcomes The primary effect variable will be functional outcome defined by the ordinal distribution of the modified Rankin Scale; analyses will also be carried out in pre-specified subgroups to assess the modifying effects of stroke-related and pre-stroke patient characteristics. Key secondary variables will include clinical, hemodynamic and neuroradiological variables; safety variables will comprise death and serious adverse events. Discussion Study questions will be addressed in stages, according to the protocol, before integrating these into a final overreaching analysis. We invite eligible trials to join the collaboration.

Low heart rate variability in patients with clinical burnout.

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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. Copyright © 2016 Elsevier B.V. All rights reserved.

Clinicopathologic analysis of Passeriform venous blood reflects transitions in elevation and habitat

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Heatley JJ

2013-06-01

Full Text Available J Jill Heatley,1 Jennifer Cary,2 Karen E Russell,3 Gary Voelker2 1Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, 2Department of Wildlife and Fisheries Sciences and Texas A&M Biodiversity Research and Teaching Collections, Texas A&M University, 3Department of Pathobiology, College of Veterinary Medicine and Biomedical Sciences, College Station, TX, USA Abstract: Jugular blood samples from 110 Passeriformes collected at several Texas locations were analyzed for multiple clinicopathologic parameters between April 2010 and August 2011. Electrolyte, blood gas, and select erythrocyte parameters were analyzed on site with a point of care analyzer, and gender, age, body condition score, location, and species were recorded. Many analytes exhibited a Gaussian distribution across species and are reported as a single range. Taxon affected electrolyte and red blood cell parameters, but not most blood gas or acid base variables. Migratory status affected select electrolytes but few blood gas variables. Red blood cell parameters were affected the most by variables of age, taxonomic group, and gender, but not migratory life history. We found significant changes in glucose and numerous acid base analytes in birds sampled from habitats with evolutionarily recent ecologic degradation. We advocate the use of these analytes, particularly venous blood gas values, as determined by a point of care analyzer, as reasonable biomarkers for determination of Passeriform population health, but also recommend that red blood cell parameters and electrolyte concentrations be controlled for age, species, and gender in future studies. Further, based on our investigation, venous blood gas values and acid base balance in Passeriformes can assess the health of an ecosystem. Keywords: avian, biochemistry, blood gas, electrolyte, hematology, Passerine

Comparison of the clinical and microbiological characteristics of Campylobacter and Helicobacter bacteremia: the importance of time to blood culture positivity using the BACTEC blood culture systems.

Science.gov (United States)

Yamamoto, Kei; Hayakawa, Kayoko; Nagashima, Maki; Shimada, Kayo; Kutsuna, Satoshi; Takeshita, Nozomi; Kato, Yasuyuki; Kanagawa, Shuzo; Yamada, Koji; Mezaki, Kazuhisa; Kirikae, Teruo; Ohmagari, Norio

2017-11-28

Campylobacter spp. and Helicobacter spp. are rare but important causes of bacteremia in humans. Distinguishing these bacteria is complicated because of their similar phenotypic profiles. We conducted clinical and microbiological investigations of Campylobacter spp. or Helicobacter spp. bacteremia. Patients diagnosed with bacteremia from 2008 to 2014 were included. The clinical and microbiological characteristics of Campylobacter spp. and Helicobacter spp. bacteremia were compared. The BACTEC system was used in blood cultures. A receiver operating characteristic curve was plotted based on the time to blood culture positivity. Sixteen cases of Helicobacter spp. bacteremia (patient age: 61 ± 18 years) and 14 cases of Campylobacter spp. bacteremia (patient age: 49 ± 21 years) were identified. Median time to blood culture positivity was longer for the Helicobacter spp. cases than the Campylobacter spp. cases (91.4 h vs 55.3 h, p culture positivity > 75 h predicted Helicobacter spp. bacteremia with a sensitivity of 0.88 and a specificity of 0.93 (area under the receiver operating characteristic curve of 0.90). In conclusion, a time to blood culture positivity was useful in distinguishing Helicobacter spp. bacteremia from Campylobacter spp. bacteremia.

[Clinical research of minimal extracorporeal circulation in perioperative blood conservation of coronary artery bypass graft].

Science.gov (United States)

Liu, Yan; Cui, Hu-jun; Tao, Liang; Chen, Xu-fa

2011-04-01

To analyze the clinical effect of minimal extracorporeal circulation (MECC) in blood conservation perioperatively coronary artery bypass graft (CABG). The data of 120 cases received simple CABG since August 2006 to October 2009 was analyzed retrospectively. All the patients were divided to three groups according to the mode of circulation support in-operation: MECC, conventional extracorporeal circulation (cECC) or off-pump, 40 cases in each group. Jostra MECC system with normal temperature was used in MECC group, and common membrane oxygenator with moderate hypo-temperature was used in cECC group. Collect the data of coagulation and the blood cytological examination perioperatively, the draining volume during the first 24 h after operation, and consumption of blood products perioperatively. Standard and logistic EuroSCORE were higher in MECC group than the others (P blood products in cECC group, but no difference among the three groups. MECC could reduce the ruin to blood cell and interfere to coagulation function during the conventional ECC procedure, decrease the postoperative draining volume and requirement of blood products.

Muscle pH, rigor mortis and blood variables in Atlantic salmon transported in two types of well-boat.

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Gatica, M C; Monti, G E; Knowles, T G; Gallo, C B

2010-01-09

Two systems for transporting live salmon (Salmo salar) were compared in terms of their effects on blood variables, muscle pH and rigor index: an 'open system' well-boat with recirculated sea water at 13.5 degrees C and a stocking density of 107 kg/m3 during an eight-hour journey, and a 'closed system' well-boat with water chilled from 16.7 to 2.1 degrees C and a stocking density of 243.7 kg/m3 during a seven-hour journey. Groups of 10 fish were sampled at each of four stages: in cages at the farm, in the well-boat after loading, in the well-boat after the journey and before unloading, and in the processing plant after they were pumped from the resting cages. At each sampling, the fish were stunned and bled by gill cutting. Blood samples were taken to measure lactate, osmolality, chloride, sodium, cortisol and glucose, and their muscle pH and rigor index were measured at death and three hours later. In the open system well-boat, the initial muscle pH of the fish decreased at each successive stage, and at the final stage they had a significantly lower initial muscle pH and more rapid onset of rigor than the fish transported on the closed system well-boat. At the final stage all the blood variables except glucose were significantly affected in the fish transported on both types of well-boat.

Evaluation of the TEG® platelet mappingTM assay in blood donors

DEFF Research Database (Denmark)

Bochsen, Louise; Wiinberg, Bo; Kjelgaard-Hansen, Mads Jens

2007-01-01

for quantification of platelet function, including the contribution of the adenosine diphosphate (ADP) and thromboxane A2 (TxA2) receptors to clot formation. Methods In 43 healthy blood donors, the analytical (CVa) and inter-individual variability (CVg) of the TEG® Platelet MappingTM assay were determined together......Background Monitoring of antiplatelet therapy in patients at cardiovascular risk is difficult because existing platelet function tests are too sophisticated for clinical routine. The whole blood TEG® Platelet MappingTM assay measures clot strength as maximal amplitude (MA) and enables...

Blood Pressure Variability and Risk for Progression of Cardiovascular and Renal Diseases in Patients with Diabetes Mellitus

Directory of Open Access Journals (Sweden)

Zaharie Sorin Ioan

2015-09-01

Full Text Available Accurate measurement of blood pressure (BP and evaluation of global cardiovascular risk is crucial for diagnosis and treatment of hypertensive patients. When hypertension and diabetes mellitus are associated, the risk for cardiovascular events is bigger than the sum of the components. Beyond systolic and diastolic BP values as targets for antihypertensive treatment, recent guidelines recognize BP variability as an independent predictor for future cardiovascular events. 24 hours ambulatory BP monitoring (ABPM and home BP monitoring (HBPM are two methods used in patient day to day life conditions for BP measurements. Increased variability of systolic and/or diastolic BP within one day (“short-term BP variability” and also over longer periods (“long-term BP variability” showed by ABPM and/or HBPM is associated with target-organ damage and cardiovascular events. This review is focused on the prognostic importance of BP variability in hypertensive patients with diabetes mellitus.

[Infective endocarditis in intensive cardiac care unit - clinical and biochemical differences of blood-culture negative infective endocarditis].

Science.gov (United States)

Kaziród-Wolski, Karol; Sielski, Janusz; Ciuraszkiewicz, Katarzyna

2017-01-23

Diagnosis and treatment of infective endocarditis (IE) is still a challenge for physicians. Group of patients with the worst prognosis is treated in Intensive Cardiac Care Unit (ICCU). Etiologic agent can not be identified in a substantial number of patients. The aim of study is to find differences between patients with blood culture negative infective endocarditis (BCNIE) and blood culture positive infective endocarditis (BCPIE) treated in ICCU by comparing their clinical course and laboratory parameters. Retrospective analysis of 30 patients with IE hospitalized in ICCU Swietokrzyskie Cardiac Centre between 2010 and 2016. This group consist of 26 men (86,67%) and 4 women (13,3%). Mean age was 58 years ±13. Most of the cases were new disease, recurrence of the disease was observed in 2 cases (6,7%). 8 patients (26,7%) required artificial ventilation, 11 (36,7%) received inotropes and 6 (20%) vasopresors. In 14 (46,7%) cases blood cultures was negative (BCNIE), the rest of patients (16, 53,3%) was blood cultures - positive infective endocarditis (BCIE). Both of the groups were clinically similar. There were no statistically significant differences in incidence of cardiac implants, localization of bacterial vegetations, administered catecholamines, antibiotic therapy, artificial ventilation, surgical treatment, complication and in-hospital mortality. Incidence of cardiac complications in all of BCNIE cases and in 81,3% cases of BCPIE draws attention, but it is not statistically significant difference (p=0,08). There was statistically significant difference in mean BNP blood concentration (3005,17 ng/ml ±2045,2 vs 1013,42 ng/ml ±1087,6; p=0,01), but there were no statistically significant differences in rest of laboratory parameters. BCNIE group has got higher mean BNP blood concentration than BCPIE group. There were no statistically significant differences between these groups in others laboratory parameters, clinical course and administered antibiotic therapy

Return behavior of occasional and multigallon blood donors: the role of theory of planned behavior, self-identity, and organizational variables.

Science.gov (United States)

Wevers, Anne; Wigboldus, Daniël H J; van Baaren, Rick; Veldhuizen, Ingrid J T

2014-03-01

For blood establishments it is important that blood donors return for a donation. Past research has stressed the importance of theory of planned behavior (TPB) on return behavior, but self-identity (SI) and organizational variables (OVs) might play a role as well. This study added SI and OVs to the TPB to identify the determinants for return behavior. Whole blood donors (n = 2005) completed a questionnaire assessing TPB, SI, and OVs. OVs contained "perceived satisfaction with the blood bank" and "feeling pressure from the blood bank to donate blood." Return behavior over the past 2 years was dichotomized as low return (0%-50%) versus high return (51%-100%). Logistic regression analyses assessed the effects of TPB, SI, and OVs on high return, separately for occasional donors (two to 10 lifetime donations) and multigallon donors (>10 lifetime donations). Results showed that, for all donors, affective attitude was positively associated with return behavior, whereas pressure to donate blood was negatively associated with return behavior. The point estimates of self-efficacy, SI, and perceived satisfaction are high for multigallon donors, but do not reach significance. For all donors, positive feelings about donating blood stimulate return behavior, while experiencing a pressure to donate blood emanating from the blood bank was not beneficial. Results suggest that multigallon donors are more stimulated to return when they score higher on self-efficacy, SI, and perceived satisfaction. Interventions aiming at donor retention need to be carefully formulated to avoid negative effects of feeling pressure to donate blood. © 2013 American Association of Blood Banks.

Association of sputum and blood eosinophil concentrations with clinical measures of COPD severity: an analysis of the SPIROMICS cohort.

Science.gov (United States)

Hastie, Annette T; Martinez, Fernando J; Curtis, Jeffrey L; Doerschuk, Claire M; Hansel, Nadia N; Christenson, Stephanie; Putcha, Nirupama; Ortega, Victor E; Li, Xingnan; Barr, R Graham; Carretta, Elizabeth E; Couper, David J; Cooper, Christopher B; Hoffman, Eric A; Kanner, Richard E; Kleerup, Eric; O'Neal, Wanda K; Paine, Richard; Peters, Stephen P; Alexis, Neil E; Woodruff, Prescott G; Han, MeiLan K; Meyers, Deborah A; Bleecker, Eugene R

2017-12-01

Increased concentrations of eosinophils in blood and sputum in chronic obstructive pulmonary disease (COPD) have been associated with increased frequency of exacerbations, reduced lung function, and corticosteroid responsiveness. We aimed to assess whether high eosinophil concentrations in either sputum or blood are associated with a severe COPD phenotype, including greater exacerbation frequency, and whether blood eosinophils are predictive of sputum eosinophils. We did a multicentre observational study analysing comprehensive baseline data from SPIROMICS in patients with COPD aged 40-80 years who had a smoking history of at least 20 pack-years, recruited from six clinical sites and additional subsites in the USA between Nov 12, 2010, and April 21, 2015. Inclusion criteria for this analysis were SPIROMICS baseline visit data with complete blood cell counts and, in a subset, acceptable sputum counts. We stratified patients on the basis of blood and sputum eosinophil concentrations and compared their demographic characteristics, as well as results from questionnaires, clinical assessments, and quantitative CT (QCT). We also analysed whether blood eosinophil concentrations reliably predicted sputum eosinophil concentrations. This study is registered with ClinicalTrials.gov (NCT01969344). Of the 2737 patients recruited to SPIROMICS, 2499 patients were smokers and had available blood counts, and so were stratified by mean blood eosinophil count: 1262 patients with low (George Respiratory Questionnaire symptom scores (p=0·037), and increased wheezing (p=0·018), but no evidence of an association with COPD exacerbations (p=0·35) or the other indices of COPD severity, such as emphysema measured by CT density, COPD assessment test scores, Body-mass index, airflow Obstruction, Dyspnea, and Exercise index, or Global Initiative for Chronic Obstructive Lung Disease stage. Blood eosinophil counts showed a weak but significant association with sputum eosinophil counts

Preanalytical Blood Sampling Errors in Clinical Settings

International Nuclear Information System (INIS)

Zehra, N.; Malik, A. H.; Arshad, Q.; Sarwar, S.; Aslam, S.

2016-01-01

Background: 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. Methods: 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. Results: When asked in the questionnaire, around 61.6 percent of the paramedical staff stated that they cleaned the vein by moving the alcohol swab from inward to outwards while 20.8 percent of the staff reported that they felt the vein after disinfection. On contrary to WHO guidelines, 89.6 percent 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 percent thought that they had ample knowledge regarding the blood sampling process but they did not practice it properly. Conclusion: 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. (author)

Discrepancies in Clinic and Ambulatory Blood Pressure in Korean Chronic Kidney Disease Patients

Science.gov (United States)

2017-01-01

Blood pressure (BP) control is considered the most important treatment for preventing chronic kidney disease (CKD) progression and associated cardiovascular complications. However, clinic BP is insufficient to diagnose hypertension (HT) and to monitor overall BP control because it does not correlate well with ambulatory blood pressure monitoring (ABPM). We enrolled 387 hypertensive CKD patients (stages G1–G4, 58.4% male with median age 61 years) from 3 hospitals in Korea. HT of clinic BP and ABPM was classified as ≥ 140/90 and ≥ 130/80 mmHg, respectively. Clinic BP control rate was 60.2%. The median 24-hour systolic blood pressures (SBPs) of CKD G3b and CKD G4 were significantly higher than those of CKD G1–2 and CKD G3a. However, the median 24-hour SBPs were not different between CKD G1–2 and CKD G3a or between CKD G3b and CKD G4. Of all patients, 5.7%, 38.0%. 42.3%, and 14.0% were extreme-dippers, dippers, non-dippers, and reverse-dippers, respectively. Non-/reverse-dippers independently correlated with higher Ca × P product, higher intact parathyroid hormone (iPTH), and lower albumin. Normal BP was 33.3%, and sustained, masked, and white-coat HT were 29.7%, 26.9%, and 10.1%, respectively. White-coat HT independently correlated with age ≥ 61 years and masked HT independently correlated with CKD G3b/G4. In conclusion, ABPM revealed a high prevalence of non-/reverse-dippers and sustained/masked HT in Korean CKD patients. Clinicians should try to obtain a CKD patient's ABPM, especially among those who are older or who have advanced CKD as well as those with abnormal Ca × P product, iPTH, and albumin. PMID:28378550

White blood cell and platelet count as adjuncts to standard clinical evaluation for risk assessment in patients at low probability of acute aortic syndrome.

Science.gov (United States)

Morello, Fulvio; Cavalot, Giulia; Giachino, Francesca; Tizzani, Maria; Nazerian, Peiman; Carbone, Federica; Pivetta, Emanuele; Mengozzi, Giulio; Moiraghi, Corrado; Lupia, Enrico

2017-08-01

Pre-test probability assessment is key in the approach to suspected acute aortic syndromes (AASs). However, most patients with AAS-compatible symptoms are classified at low probability, warranting further evaluation for decision on aortic imaging. White blood cell count, platelet count and fibrinogen explore pathophysiological pathways mobilized in AASs and are routinely assayed in the workup of AASs. However, the diagnostic performance of these variables for AASs, alone and as a bundle, is unknown. We tested the hypothesis that white blood cell count, platelet count and/or fibrinogen at presentation may be applied as additional tools to standard clinical evaluation for pre-test risk assessment in patients at low probability of AAS. This was a retrospective observational study conducted on consecutive patients managed in our Emergency Department from 2009 to 2014 for suspected AAS. White blood cell count, platelet count and fibrinogen were assayed during evaluation in the Emergency Department. The final diagnosis was obtained by computed tomography angiography. The pre-test probability of AAS was defined according to guidelines. Of 1210 patients with suspected AAS, 1006 (83.1%) were classified at low probability, and 271 (22.4%) were diagnosed with AAS. Within patients at low probability, presence of at least one alteration among white blood cell count >9*10 3 /µl, platelet count probability, white blood cell count >9*10 3 /µl and platelet count probability, the estimated risk of AAS based on the number of alterations amongst white blood cell count >9*10 3 /µl and platelet count probability to fine-tune risk assessment of AAS.

A fast and highly sensitive blood culture PCR method for clinical detection of Salmonella enterica serovar Typhi

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Zhou Liqing

2010-04-01

Full Text Available Abstract Background Salmonella Typhi causes an estimated 21 million new cases of typhoid fever and 216,000 deaths every year. Blood culture is currently the gold standard for diagnosis of typhoid fever, but it is time-consuming and takes several days for isolation and identification of causative organisms. It is then too late to initiate proper antibiotic therapy. Serological tests have very low sensitivity and specificity, and no practical value in endemic areas. As early diagnosis of the disease and prompt treatment are essential for optimal management, especially in children, a rapid sensitive detection method for typhoid fever is urgently needed. Although PCR is sensitive and rapid, initial research indicated similar sensitivity to blood culture and lower specificity. We developed a fast and highly sensitive blood culture PCR method for detection of Salmonella Typhi, allowing same-day initiation of treatment after accurate diagnosis of typhoid. Methods An ox bile tryptone soy broth was optimized for blood culture, which allows the complete lysis of blood cells to release intracellular bacteria without inhibiting the growth of Salmonella Typhi. Using the optimised broth Salmonella Typhi bacteria in artificial blood samples were enriched in blood culture and then detected by a PCR targeting the fliC-d gene of Salmonella Typhi. Results Tests demonstrated that 2.4% ox bile in blood culture not only lyzes blood cells completely within 1.5 hours so that the intracellular bacteria could be released, but also has no inhibiting effect on the growth of Salmonella Typhi. Three hour enrichment of Salmonella Typhi in tryptone soya broth containing 2.4% ox bile could increase the bacterial number from 0.75 CFU per millilitre of blood which is similar to clinical typhoid samples to the level which regular PCR can detect. The whole blood culture PCR assay takes less than 8 hours to complete rather than several days for conventional blood culture

The relationships between clinical variables and renal parenchymal disease in pediatric clinically suspected urinary tract infection

Directory of Open Access Journals (Sweden)

Jung Lim Byun

2010-02-01

Full Text Available Purpose : To evaluate the significance of clinical signs and laboratory findings as predictors of renal parenchymal lesions and vesicoureteral reflux (VUR in childhood urinary tract infection (UTI. Methods : From July 2005 to July 2008, 180 patients admitted with a first febrile UTI at the Pediatric Department of Konkuk University Hospital were included in this study. The following were the clinical variables: leukocytosis, elevated C-reactive protein (CRP, positive urine nitrite, positive urine culture, and fever duration both before and after treatment. We evaluated the relationships between clinical variables and dimercaptosuccinic acid (DMSA scan and voiding cystourethrography (VCUG results. Results : VCUG was performed in 148 patients; of them, 37 (25.0% had VUR: 18 (12.2% had low-grade (I-II VUR, and 19 (10.5% had high-grade (III-V VUR. Of the 95 patients who underwent DMSA scanning, 29 (30.5% had cortical defects, of which 21 (63.6% had VUR: 10 (30.3%, low-grade (I-II VUR; and 11 (33.3%, high-grade VUR. Of the 57 patients who were normal on DMSA scan, 8 (14.0% had low-grade VUR and 6 (10.5% had high-grade VUR. The sensitivity, specificity, and positive and negative predictive values of the DMSA scan in predicting high-grade VUR were 64.7%, 69.9%, 33.3%, and 89.5%, respectively. Leukocytosis, elevated CRP, and prolonged fever (?#243;6 hours after treatment were significantly correlated with the cortical defects on DMSA scans and high-grade VUR. Conclusion : Clinical signs, including prolonged fever after treatment, elevated CRP, and leukocytosis, are positive predictors of acute pyelonephritis and high-grade VUR.

Cerebral blood flow during delirium tremens and related clinical states studied with xenon-133 inhalation tomography

International Nuclear Information System (INIS)

Hemmingsen, R.; Vorstrup, S.; Clemmesen, L.; Holm, S.; Tfelt-Hansen, P.; Sorensen, A.S.; Hansen, C.; Sommer, W.; Bolwig, T.G.

1988-01-01

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

The prognostic blood biomarker proadrenomedullin for outcome prediction in patients with chronic obstructive pulmonary disease (COPD): a qualitative clinical review.

Science.gov (United States)

Schuetz, Philipp; Marlowe, Robert J; Mueller, Beat

2015-03-01

Plasma proadrenomedullin (ProADM) is a blood biomarker that may aid in multidimensional risk assessment of patients with chronic obstructive pulmonary disease (COPD). Co-secreted 1:1 with adrenomedullin (ADM), ProADM is a less biologically active, more chemically stable surrogate for this pluripotent regulatory peptide, which due to biological and ex vivo physical characteristics is difficult to reliably directly quantify. Upregulated by hypoxia, inflammatory cytokines, bacterial products, and shear stress and expressed widely in pulmonary cells and ubiquitously throughout the body, ADM exerts or mediates vasodilatory, natriuretic, diuretic, antioxidative, anti-inflammatory, antimicrobial, and metabolic effects. Observational data from four separate studies totaling 1366 patients suggest that as a single factor, ProADM is a significant independent, and accurate, long-term all-cause mortality predictor in COPD. This body of work also suggests that combined with different groups of demographic/clinical variables, ProADM provides significant incremental long-term mortality prediction power relative to the groups of variables alone. Additionally, the literature contains indications that ProADM may be a global cardiopulmonary stress marker, potentially supplying prognostic information when cardiopulmonary exercise testing results such as 6-min walk distance are unavailable due to time or other resource constraints or to a patient's advanced disease. Prospective, randomized, controlled interventional studies are needed to demonstrate whether ProADM use in risk-based guidance of site-of-care, monitoring, and treatment decisions improves clinical, quality-of-life, or pharmacoeconomic outcomes in patients with COPD.

Genetic variability within french race and riding horse breeds from genealogical data and blood marker polymorphisms

OpenAIRE

Moureaux, Sophie; Verrier, Etienne; Ricard, Anne; Meriaux, J-Claude

1996-01-01

The genetic variability of five horse breeds raised in France was analysed: Thoroughbred, Trotteur Français, Arab, Anglo-Arab and Selle Français. Genealogical data and genotypes at seven blood group and nine protein loci were used. Paternal family sizes were found to be unbalanced, especially in Trotteur français, Selle Franqais and Thoroughbred. Average coefficients of inbreeding for offspring born from 1989 to 1992 were 1.02 (Thoroughbred), 1.86 (Trotteur Français), 3.08 (Arab), 1.17 (...

Predicting blood β-hydroxybutyrate using milk Fourier transform infrared spectrum, milk composition, and producer-reported variables with multiple linear regression, partial least squares regression, and artificial neural network.

Science.gov (United States)

Pralle, R S; Weigel, K W; White, H M

2018-05-01

Prediction of postpartum hyperketonemia (HYK) using Fourier transform infrared (FTIR) spectrometry analysis could be a practical diagnostic option for farms because these data are now available from routine milk analysis during Dairy Herd Improvement testing. The objectives of this study were to (1) develop and evaluate blood β-hydroxybutyrate (BHB) prediction models using multivariate linear regression (MLR), partial least squares regression (PLS), and artificial neural network (ANN) methods and (2) evaluate whether milk FTIR spectrum (mFTIR)-based models are improved with the inclusion of test-day variables (mTest; milk composition and producer-reported data). Paired blood and milk samples were collected from multiparous cows 5 to 18 d postpartum at 3 Wisconsin farms (3,629 observations from 1,013 cows). Blood BHB concentration was determined by a Precision Xtra meter (Abbot Diabetes Care, Alameda, CA), and milk samples were analyzed by a privately owned laboratory (AgSource, Menomonie, WI) for components and FTIR spectrum absorbance. Producer-recorded variables were extracted from farm management software. A blood BHB ≥1.2 mmol/L was considered HYK. The data set was divided into a training set (n = 3,020) and an external testing set (n = 609). Model fitting was implemented with JMP 12 (SAS Institute, Cary, NC). A 5-fold cross-validation was performed on the training data set for the MLR, PLS, and ANN prediction methods, with square root of blood BHB as the dependent variable. Each method was fitted using 3 combinations of variables: mFTIR, mTest, or mTest + mFTIR variables. Models were evaluated based on coefficient of determination, root mean squared error, and area under the receiver operating characteristic curve. Four models (PLS-mTest + mFTIR, ANN-mFTIR, ANN-mTest, and ANN-mTest + mFTIR) were chosen for further evaluation in the testing set after fitting to the full training set. In the cross-validation analysis, model fit was greatest for ANN, followed

Platelet-rich plasma differs according to preparation method and human variability.

Science.gov (United States)

Mazzocca, Augustus D; McCarthy, Mary Beth R; Chowaniec, David M; Cote, Mark P; Romeo, Anthony A; Bradley, James P; Arciero, Robert A; Beitzel, Knut

2012-02-15

Varying concentrations of blood components in platelet-rich plasma preparations may contribute to the variable results seen in recently published clinical studies. The purposes of this investigation were (1) to quantify the level of platelets, growth factors, red blood cells, and white blood cells in so-called one-step (clinically used commercial devices) and two-step separation systems and (2) to determine the influence of three separate blood draws on the resulting components of platelet-rich plasma. Three different platelet-rich plasma (PRP) separation methods (on blood samples from eight subjects with a mean age [and standard deviation] of 31.6 ± 10.9 years) were used: two single-spin processes (PRPLP and PRPHP) and a double-spin process (PRPDS) were evaluated for concentrations of platelets, red and white blood cells, and growth factors. Additionally, the effect of three repetitive blood draws on platelet-rich plasma components was evaluated. The content and concentrations of platelets, white blood cells, and growth factors for each method of separation differed significantly. All separation techniques resulted in a significant increase in platelet concentration compared with native blood. Platelet and white blood-cell concentrations of the PRPHP procedure were significantly higher than platelet and white blood-cell concentrations produced by the so-called single-step PRPLP and the so-called two-step PRPDS procedures, although significant differences between PRPLP and PRPDS were not observed. Comparing the results of the three blood draws with regard to the reliability of platelet number and cell counts, wide variations of intra-individual numbers were observed. Single-step procedures are capable of producing sufficient amounts of platelets for clinical usage. Within the evaluated procedures, platelet numbers and numbers of white blood cells differ significantly. The intra-individual results of platelet-rich plasma separations showed wide variations in

Basic and clinical study on determination of gastrin in the blood by radioimmunoassay

International Nuclear Information System (INIS)

Yonahara, Yoshio; Kato, Masayuki; Kashima, Hiroshi; Ito, Yasushi; Takahara, Yoshiko

1975-01-01

The usefulness of a radioimmunoassay kit in the determination of gastrin in the blood was examined with the following results. (1) The kit is best used within two weeks during which time its specific radioactivity remains high. Correction of the pH of the buffer solution must be conducted without fail. (2) If the temperature and time of the incubation are strictly controlled, it is possible to obtain almost the same results for each condition of time and temperature. (3) As for reproducibility, scattering was observed to some extent at high concentrations, but little at low concentrations. The recovery rate was as good as 100.6% on the average, indicating the usefulness of this method in clinical tests. (4) In 30 normal subjects, the blood levels of gastrin ranged from 52 to 123 (average 86.8 23.3) pg/ml. In gastric ulcers and duodenal ulcers, it was normal or slightly higher. Further, duodenal ulcers showed higher blood levels than did gastric ulcers, and chronic gastritis showed values slightly higher than normal. It was also interesting that blood levels of gastrin were unusually high in megaloblastic anemias. (author)

From pioneering to implementing automated blood pressure measurement in clinical practice: Thomas Pickering's legacy

DEFF Research Database (Denmark)

Stolarz-Skrzypek, Katarzyna; Thijs, Lutgarde; Wizner, Barbara

2010-01-01

Thomas G. Pickering spent most of his scientific career in carrying out research on clinical hypertension and blood pressure (BP) measurement. In our review of Pickering's seminal work, we first focused on white-coat hypertension and masked hypertension, two terms that he had introduced. Next, we...

Combined effects of resistance training and carbohydrate-restrictive or conventional diets on weight loss, blood variables and endothelium function

Directory of Open Access Journals (Sweden)

Claudia Mello MEIRELLES

Full Text Available ABSTRACT Objective: To compare the effects of either a carbohydrate-restrictive diets or a conventional hypoenergetic diet combined with resistance training. Methods: Twenty-one overweight and obese adults participated in an eight-week program consisting of progressive resistance training combined with carbohydrate-restrictive diets (initially set at <30 g carbohydrate; n=12 or conventional hypoenergetic diet (30% energetic restriction; carbohydrate/protein/lipid: 51/18/31% of total energy consumption; n=9. It was hypothesized that the carbohydrate-restrictive diets would induce greater weight loss but that both diets would elicit similar effects on selected health markers. Body mass, and body composition, blood variables and flow-mediated brachial artery dilation (flow-mediated brachial artery dilation; by ultrasound were used to assess changes due to the interventions. Results: Significant within-group reductions in body mass (-5.4±3.5%; p=0.001 versus -3.7±3.0%; p=0.015 and body fat (body fat; -10.2±7.0%; p=0.005 versus -9.6±8.8%; p=0.017 were identified for carbohydrate-restrictive diets and conventional hypoenergetic diet, respectively, but there were no significant differences between groups as the result of the interventions. Fat free mass, blood variables and flow-mediated brachial artery dilation did not significantly change, except for the total cholesterol/high-density lipoprotein ratio, which was reduced 10.4±16.9% in carbohydrate-restrictive diets (p=0.037 and 0.5±11.3% in conventional hypoenergetic diet (p=0.398. Conclusion: Carbohydrate-restrictive diets associated with resistance training was as effective as conventional hypoenergetic diet in decreasing body mass and body fat, as well as maintaining fat free mass, blood variables and flow-mediated brachial artery dilation, however it was more effective at lowering the total cholesterol/low density lipoprotein ratio.

Correlation between measured energy expenditure and clinically obtained variables in trauma and sepsis patients.

Science.gov (United States)

Frankenfield, D C; Omert, L A; Badellino, M M; Wiles, C E; Bagley, S M; Goodarzi, S; Siegel, J H

1994-01-01

Indirect calorimetry is the preferred method for determining caloric requirements of patients, but availability of the device is limited by high cost. A study was therefore conducted to determine whether clinically obtainable variables could be used to predict metabolic rate. Patients with severe trauma or sepsis who required mechanical ventilation were measured by an open-circuit indirect calorimeter. Several clinical variables were obtained simultaneously. Measurements were repeated every 12 hours for up to 10 days. Twenty-six trauma and 30 sepsis patients were measured 423 times. Mean resting energy expenditure was 36 +/- 7 kcal/kg (trauma) vs 45 +/- 8 kcal/kg (sepsis) (p types.

Quality assurance of clinical transfusion practice by implementation of the privilege of blood prescription and computerized prospective audit of blood requests.

Science.gov (United States)

Marconi, M; Almini, D; Pizzi, M N; Riccardi, D; Bergamaschi, W; Giovanetti, A M; Rebulla, P; Sirchia, G

1996-03-01

Guidelines, algorithms and recommendations have been issued in the attempt to ensure appropriateness of transfusion practice, but the results are less than satisfactory, mainly due to the difficulty to turn paper procedures into actual practice. In our hospital we have tried to overcome this difficulty through the implementation of a quality assurance programme which includes giving the privilege of nonurgent blood prescription to a limited number of physicians and a computerized prospective audit of blood requests. The latter is performed through verification of the compliance of blood requests, which are designed to include a patient's laboratory and clinical data, with hospital guidelines for the proper use of blood. In the 12 months since implementation of the computerized prospective audit the transfusion service has evaluated 7884 requests. Of these, 63.4% (n = 4998) were for red blood cells, 21.1% (n = 1664) for platelets and 15.5% (n = 1222) for fresh frozen plasma. The prospective audit showed that 96.8% and 98.1% of requests for red units and platelets were appropriate, respectively. Conversely, approximately 27% of plasma requests did not comply with guidelines, mainly because the evidence of coagulopathy was missing. However, inappropriateness of plasma requests for elective general surgery decreased from 39% at the onset of the programme to 14% in the last trimester considered. Moreover, the evaluation by retrospective audit of the proportion of patients transfused with both red blood cells and plasma in the perioperative period out of those transfused with red blood cells only, as an indicator of unwanted reconstitution of whole blood, showed that this proportion decreased from 47.6% (320/672) in the 12 months before implementation of computerized audit to 37.8% (244/646) in the following 12 months (difference = -9.8%, 95% confidence interval of the difference from -4.5% to -15.1%; P audit is a useful tool for assuring the quality of blood requesting.

Undergraduate Nurse Variables that Predict Academic Achievement and Clinical Competence in Nursing

Science.gov (United States)

Blackman, Ian; Hall, Margaret; Darmawan, I Gusti Ngurah.

2007-01-01

A hypothetical model was formulated to explore factors that influenced academic and clinical achievement for undergraduate nursing students. Sixteen latent variables were considered including the students' background, gender, type of first language, age, their previous successes with their undergraduate nursing studies and status given for…

Evaluation of the i-STAT Portable Clinical Analyzer for point-of-care blood testing in the intensive care units of a university children's hospital.

Science.gov (United States)

Papadea, Christine; Foster, Joyce; Grant, Sharon; Ballard, Sandra A; Cate, John C; Southgate, W Michael; Purohit, Dilip M

2002-01-01

We evaluated the analytical performance of the i-STAT Portable Clinical Analyzer (PCA), a point-of-care testing system consisting of a hand-held analyzer and single-use cartridges that measure different panels of electrolytes, metabolites, blood gases, and hematocrit in 65-100 microl of blood. Our objective was to determine whether PCA measurements at the bedside of patients in the neonatal and pediatric intensive care units of the MUSC Children's Hospital would be as reliable as those performed by the clinical laboratory's primary methods (Radiometer ABL 725 blood gas analyzer; Vitros 750 chemistry analyzer; and Coulter STKS hematology analyzer). Four cartridge types: (a) EC8+ (sodium; potassium; chloride; urea; glucose; pH; blood gases [PO2; pCO2]), (b) EC6+ (sodium; potassium; ionized calcium; glucose; hematocrit; pH), (c) G3+ (pH; PO2; pCO2), and (d) creatinine, were assessed for reproducibility, linearity, and method comparisons using aqueous samples, blood samples supplemented with several analytes, and -225 blood samples from patients. Reproducibility (CV) was good ( or < 3 mo) showed that agreement between the PCA and the primary methods was clinically acceptable. After the PCA was implemented for clinical testing, the observation of discrepant results of creatinine concentrations in neonatal blood samples that would have affected clinical management led to a second creatinine comparison study (59 additional samples) and to our eventual discontinuation of the PCA creatinine assay. This problem notwithstanding, the successful implementation of the PCA is attributed to careful analytical evaluations and ongoing communication with the clinical staff.

THE EFFECT OF HORMONE THERAPY ON MEAN BLOOD PRESSURE AND VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY IN POSTMENOPAUSAL WOMEN: RESULTS FROM THE WOMEN’S HEALTH INITIATIVE RANDOMIZED CONTROLLED TRIALS

Science.gov (United States)

Shimbo, Daichi; Wang, Lu; Lamonte, Michael J.; Allison, Matthew; Wellenius, Gregory A.; Bavry, Anthony A.; Martin, Lisa W.; Aragaki, Aaron; Newman, Jonathan D.; Swica, Yael; Rossouw, Jacques E.; Manson, JoAnn E.; Wassertheil-Smoller, Sylvia

2014-01-01

Objectives Mean and visit-to-visit variability (VVV) of blood pressure are associated with an increased cardiovascular disease risk. We examined the effect of hormone therapy on mean and VVV of blood pressure in postmenopausal women from the Women’s Health Initiative (WHI) randomized controlled trials. Methods Blood pressure was measured at baseline and annually in the two WHI hormone therapy trials in which 10,739 and 16,608 postmenopausal women were randomized to conjugated equine estrogens (CEE, 0.625 mg/day) or placebo, and CEE plus medroxyprogesterone acetate (MPA, 2.5 mg/day) or placebo, respectively. Results At the first annual visit (Year 1), mean systolic blood pressure was 1.04 mmHg (95% CI 0.58, 1.50) and 1.35 mmHg (95% CI 0.99, 1.72) higher in the CEE and CEE+MPA arms respectively compared to corresponding placebos. These effects remained stable after Year 1. CEE also increased VVV of systolic blood pressure (ratio of VVV in CEE vs. placebo, 1.03, Pblood pressure increased at Year 1, and the differences in the CEE and CEE+MPA arms vs. placebos also continued to increase after Year 1. Further, both CEE and CEE+MPA significantly increased VVV of systolic blood pressure (ratio of VVV in CEE vs. placebo, 1.04, Pblood pressure. PMID:24991872

Effect of ileo-rectal anastomosis and post-valve T-caecum cannulation on growing pigs : 2. Blood variables and mineral balances

NARCIS (Netherlands)

Köhler, T.; Verstegen, M.W.A.; Mosenthin, R.; Wensing, T.; Hartog, L.A. den; Huisman, J.

1992-01-01

In a long-term study nine ileo-rectally anastomosed (IRA) and seven post-valve T-caecum (PVTC)-cannulated pigs were compared with six intact pigs with regard to different blood variables, sodium and potassium retention and weights of selected organs. After surgery, apart from urea and K measured 13

Blood lead levels and chronic blood loss

Energy Technology Data Exchange (ETDEWEB)

Manci, E.A.; Cabaniss, M.L.; Boerth, R.C.; Blackburn, W.R.

1986-03-01

Over 90% of lead in blood is bound to the erythrocytes. This high affinity of lead for red cells may mean that chronic blood loss is a significant means for excretion of lead. This study sought correlations between blood lead levels and clinical conditions involving chronic blood loss. During May, June and July, 146 patients with normal hematocrits and red cell indices were identified from the hospital and clinic populations. For each patient, age, race, sex and medical history were noted, and a whole blood sample was analyzed by flameless atomic absorption spectrophotometry. Age-and race-matched pairs showed a significant correlation of chronic blood loss with lead levels. Patients with the longest history of blood loss (menstruating women) had the lowest level (mean 6.13 ..mu..g/dl, range 3.6-10.3 ..mu..g/dl). Post-menopausal women had levels (7.29 ..mu..g/dl, 1.2-14 ..mu..g/dl) comparable to men with peptic ulcer disease, or colon carcinoma (7.31 ..mu..g/dl, 5.3-8.6 ..mu..g/dl). The highest levels were among men who had no history of bleeding problems (12.39 ..mu..g/dl, 2.08-39.35 ..mu..g/dl). Chronic blood loss may be a major factor responsible for sexual differences in blood lead levels. Since tissue deposition of environmental pollutants is implicated in diseases, menstruation may represent a survival advantage for women.

Role of blood flow and blood flow modifiers in clinical hyperthermia therapy

International Nuclear Information System (INIS)

Olch, A.J.

1986-01-01

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 0 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

Clinical and immunological aspects of pretransplant blood transfusions

NARCIS (Netherlands)

Waanders, Marloes Maria

2009-01-01

Blood transfusions can lead to immunization or tolerance in the recipient. The latter is characterized by an improved transplant outcome after pretransplant blood transfusions. First observations of improved kidney graft outcome after blood transfusion date 35 years back, however no exclusive

Large-scale clinical comparison of the lysis-centrifugation and radiometric systems for blood culture

International Nuclear Information System (INIS)

Brannon, P.; Kiehn, T.E.

1985-01-01

The Isolator 10 lysis-centrifugation blood culture system (E. I. du Pont de Nemours and Co., Inc., Wilmington, Del.) was compared with the BACTEC radiometric method (Johnston Laboratories, Inc., Towson, Md.) with 6B and 7D broth media for the recovery of bacteria and yeasts. From 11,000 blood cultures, 1,174 clinically significant organisms were isolated. The Isolator system recovered significantly more total organisms, members of the family Enterobacteriaceae, Staphylococcus spp., and yeasts. The BACTEC system recovered significantly more Pseudomonas spp., Streptococcus spp., and anaerobes. Of the Isolator colony counts, 87% measured less than 11 CFU/ml of blood. Organisms, on an average, were detected the same day from each of the two culture systems. Only 13 of the 975 BACTEC isolates (0.01%) were recovered by subculture of growth-index-negative bottles, and 12 of the 13 were detected in another broth blood culture taken within 24 h. Contaminants were recovered from 4.8% of the Isolator 10 and 2.3% of the BACTEC cultures

Sensitivity, specificity and predictive value of blood cultures from cattle clinically suspected of bacterial endocarditis

DEFF Research Database (Denmark)

Houe, Hans; Eriksen, L.; Jungersen, Gregers

1993-01-01

This study investigated the number of blood culture-positive cattle among 215 animals clinically suspected of having bacterial endocarditis. For animals that were necropsied, the sensitivity, specificity and predictive value of the diagnosis of endocarditis were calculated on the basis...... of the isolation of the causative bacteria from blood. Furthermore, it was investigated whether the glutaraldehyde coagulation time, total leucocyte count, per cent neutrophil granulocytes, pulse rate and duration of disease could help to discriminate endocarditis from other diseases. Among 138 animals necropsied...... the sensitivity, specificity and predictive value of blood cultivation were 70.7 per cent, 93.8 per cent and 89.1 per cent, respectively. None of the other measurements could be used to discriminate between endocarditis and non-endocarditis cases....

[Prospects in blood transfusion].

Science.gov (United States)

Rouger, P

2003-04-01

What will be the evolution of blood transfusion in the next 10 years? What are the scientific and medical arguments to help the decision makers to propose the developments? Many scientific and clinical studies show that blood substitutes are not ready for use in man. So, for a long time, blood collection in man will still be a necessity to prepare cell concentrates (red blood cells and platelets) and fresh frozen plasma. During this period, blood safety will be based on development of testing technics and preparation processes of blood products. Another major point will be a better clinical use of blood derivates. Cellular therapy will be probably only a way of diversification in blood transfusion centers in partnership with hospitals.

Clinical and Pathogenetic Significance of Osteoassociated Microelements in the Joint Diseases. Report I. Microelementosis in the Blood

Directory of Open Access Journals (Sweden)

O.V. Syniachenko

2016-04-01

Full Text Available Relevance. Microelementosis (imbalance in the body of certain microelements — ME is considered as one of the most important clinical and pathogenetic components of degenerative and inflammatory joint diseases, and ME can play the role of co-factors involved in the processes of articular inflammation. The objective: to study the levels in the blood serum and to assess the clinical and pathogenetic significance of osteoassociated ME (cobalt — Co, copper — Cu, iron — Fe, litium — Li, manganese — Mn, lead — Pb, strontium — Sr, zinc — Zn in a variety of arthritis — rheumatoid (RA, Chlamydia-induced urogenital reactive arthritis (ReA, psoriatic (PsA, gouty (GA and osteoarthritis (OA. Material and methods. There were 262 patients under observation, among them 89 persons suffering from RA, 31 — ReA, 35 — PsA, 49 — GA and 58 — OA. The distribution of males and females in these groups were 1 : 2, 2 : 1, 1 : 1, 11 : 1, 1 : 3, respectively, the average age of the patients was 47, 34, 42, 48 and 58 years, and the duration of clinical manifestations of the disease — 10, 4, 11, 7 and 12 years. ME in the blood serum were studied using atomic absorption spectrometer with electrographite atomizer SolAAr-Mk2-MOZe. Results. Microelementosis in arthritis is manifested by increased blood concentrations of toxic Li, Pb and Sr, moreover, the feature of ReA is a normal ferremia level, PsA — hyperkupremia, and OA — hypozincemia. Microelement blood composition depends on the activity, clinical and laboratory signs of disease, the prevalence of articular process, aggravation of bone destructive changes in the joints (subchondral sclerosis, osteocystosis, bone erosions, epiphyseal osteoporosis, etc, the presence of systemic osteoporosis, spondylopathies (osteochondrosis, spondyloarthrosis and extra-articular manifestations of arthritis (lesions of the skin, muscles, peripheral nervous system, lymph nodes, internal organs. Blood indexes

Correlation between Very Short and Short-Term Blood Pressure Variability in Diabetic-Hypertensive and Healthy Subjects.

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Casali, Karina R; Schaan, Beatriz D; Montano, Nicola; Massierer, Daniela; M F Neto, Flávio; Teló, Gabriela H; Ledur, Priscila S; Reinheimer, Marilia; Sbruzzi, Graciele; Gus, Miguel

2018-02-01

Blood pressure (BP) variability can be evaluated by 24-hour ambulatory BP monitoring (24h-ABPM), but its concordance with results from finger BP measurement (FBPM) has not been established yet. The aim of this study was to compare parameters of short-term (24h-ABPM) with very short-term BP variability (FBPM) in healthy (C) and diabetic-hypertensive (DH) subjects. Cross-sectional study with 51 DH subjects and 12 C subjects who underwent 24h-ABPM [extracting time-rate, standard deviation (SD), coefficient of variation (CV)] and short-term beat-to-beat recording at rest and after standing-up maneuvers [FBPM, extracting BP and heart rate (HR) variability parameters in the frequency domain, autoregressive spectral analysis]. Spearman correlation coefficient was used to correlate BP and HR variability parameters obtained from both FBPM and 24h-ABPM (divided into daytime, nighttime, and total). Statistical significance was set at p ABPM) and LF component of short-term variability (FBPM, total, R = 0.591, p = 0.043); standard deviation (24h-ABPM) with LF component BPV (FBPM, total, R = 0.608, p = 0.036), coefficient of variation (24h-ABPM) with total BPV (FBPM, daytime, -0.585, p = 0.046) and alpha index (FBPM, daytime, -0.592, p = 0.043), time rate (24h-ABPM) and delta LF/HF (FBPM, total, R = 0.636, p = 0.026; daytime R = 0,857, p ABPM (total, daytime) reflect BP and HR variability evaluated by FBPM in healthy individuals. This does not apply for DH subjects.

Diagnostic accuracy of routine blood examinations and CSF lactate level for post-neurosurgical bacterial meningitis.

Science.gov (United States)

Zhang, Yang; Xiao, Xiong; Zhang, Junting; Gao, Zhixian; Ji, Nan; Zhang, Liwei

2017-06-01

To evaluate the diagnostic accuracy of routine blood examinations and Cerebrospinal Fluid (CSF) lactate level for Post-neurosurgical Bacterial Meningitis (PBM) at a large sample-size of post-neurosurgical patients. The diagnostic accuracies of routine blood examinations and CSF lactate level to distinguish between PAM and PBM were evaluated with the values of the Area Under the Curve of the Receiver Operating Characteristic (AUC -ROC ) by retrospectively analyzing the datasets of post-neurosurgical patients in the clinical information databases. The diagnostic accuracy of routine blood examinations was relatively low (AUC -ROC CSF lactate level achieved rather high diagnostic accuracy (AUC -ROC =0.891; CI 95%, 0.852-0.922). The variables of patient age, operation duration, surgical diagnosis and postoperative days (the interval days between the neurosurgery and examinations) were shown to affect the diagnostic accuracy of these examinations. The variables were integrated with routine blood examinations and CSF lactate level by Fisher discriminant analysis to improve their diagnostic accuracy. As a result, the diagnostic accuracy of blood examinations and CSF lactate level was significantly improved with an AUC -ROC value=0.760 (CI 95%, 0.737-0.782) and 0.921 (CI 95%, 0.887-0.948) respectively. The PBM diagnostic accuracy of routine blood examinations was relatively low, whereas the accuracy of CSF lactate level was high. Some variables that are involved in the incidence of PBM can also affect the diagnostic accuracy for PBM. Taking into account the effects of these variables significantly improves the diagnostic accuracies of routine blood examinations and CSF lactate level. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Blood pressure and heart rate variability analysis of orthostatic challenge in normal human pregnancies.

Science.gov (United States)

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 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.

A Comparison and Calibration of a Wrist-Worn Blood Pressure Monitor for Patient Management: Assessing the Reliability of Innovative Blood Pressure Devices

Science.gov (United States)

Melville, Sarah; Teskey, Robert; Philip, Shona; Simpson, Jeremy A; Lutchmedial, Sohrab

2018-01-01

Background Clinical guidelines recommend monitoring of blood pressure at home using an automatic blood pressure device for the management of hypertension. Devices are not often calibrated against direct blood pressure measures, leaving health care providers and patients with less reliable information than is possible with current technology. Rigorous assessments of medical devices are necessary for establishing clinical utility. Objective The purpose of our study was 2-fold: (1) to assess the validity and perform iterative calibration of indirect blood pressure measurements by a noninvasive wrist cuff blood pressure device in direct comparison with simultaneously recorded peripheral and central intra-arterial blood pressure measurements and (2) to assess the validity of the measurements thereafter of the noninvasive wrist cuff blood pressure device in comparison with measurements by a noninvasive upper arm blood pressure device to the Canadian hypertension guidelines. Methods The cloud-based blood pressure algorithms for an oscillometric wrist cuff device were iteratively calibrated to direct pressure measures in 20 consented patient participants. We then assessed measurement validity of the device, using Bland-Altman analysis during routine cardiovascular catheterization. Results The precalibrated absolute mean difference between direct intra-arterial to wrist cuff pressure measurements were 10.8 (SD 9.7) for systolic and 16.1 (SD 6.3) for diastolic. The postcalibrated absolute mean difference was 7.2 (SD 5.1) for systolic and 4.3 (SD 3.3) for diastolic pressures. This is an improvement in accuracy of 33% systolic and 73% diastolic with a 48% reduction in the variability for both measures. Furthermore, the wrist cuff device demonstrated similar sensitivity in measuring high blood pressure compared with the direct intra-arterial method. The device, when calibrated to direct aortic pressures, demonstrated the potential to reduce a treatment gap in high blood

Quantifying temporal glucose variability in diabetes via continuous glucose monitoring: mathematical methods and clinical application.

Science.gov (United States)

Kovatchev, Boris P; Clarke, William L; Breton, Marc; Brayman, Kenneth; McCall, Anthony

2005-12-01

Continuous glucose monitors (CGMs) collect detailed blood glucose (BG) time series, which carry significant information about the dynamics of BG fluctuations. In contrast, the methods for analysis of CGM data remain those developed for infrequent BG self-monitoring. As a result, important information about the temporal structure of the data is lost during the translation of raw sensor readings into clinically interpretable statistics and images. The following mathematical methods are introduced into the field of CGM data interpretation: (1) analysis of BG rate of change; (2) risk analysis using previously reported Low/High BG Indices and Poincare (lag) plot of risk associated with temporal BG variability; and (3) spatial aggregation of the process of BG fluctuations and its Markov chain visualization. The clinical application of these methods is illustrated by analysis of data of a patient with Type 1 diabetes mellitus who underwent islet transplantation and with data from clinical trials. Normative data [12,025 reference (YSI device, Yellow Springs Instruments, Yellow Springs, OH) BG determinations] in patients with Type 1 diabetes mellitus who underwent insulin and glucose challenges suggest that the 90%, 95%, and 99% confidence intervals of BG rate of change that could be maximally sustained over 15-30 min are [-2,2], [-3,3], and [-4,4] mg/dL/min, respectively. BG dynamics and risk parameters clearly differentiated the stages of transplantation and the effects of medication. Aspects of treatment were clearly visualized by graphs of BG rate of change and Low/High BG Indices, by a Poincare plot of risk for rapid BG fluctuations, and by a plot of the aggregated Markov process. Advanced analysis and visualization of CGM data allow for evaluation of dynamical characteristics of diabetes and reveal clinical information that is inaccessible via standard statistics, which do not take into account the temporal structure of the data. The use of such methods improves the

Determination of Several Clinical Parameters of the Blood for the HealthyEvaluation of the Radiation Worker

International Nuclear Information System (INIS)

Yazid, M; Triyono; Aris-Bastianudin

2000-01-01

Determination of the several clinical parameters of the blood for healthyevaluation of the radiation worker has been done. This research was done forarrangement of the medical general check up of the radiation worker toobserve pathological indicator of several body organs. The blood sample wastaken from vena mediana cubiti and analyzed by reagent using standardprocedure from Boehringer Mainheim. That procedure is specific for eachclinical parameters. That clinical parameters concentration was measured byClinicon Photometer 4010. The clinical data of the radiation worker wascompared to the non radiation worker. The measurement results of 501patients, shown that total protein concentrations for all worker are > 8.00g%, the cholesterol concentration of 25 patient are > 260 mg%. The glucoseconcentration for fasting condition of 7 patients are > 200 mg/dl, the ureumconcentration of all patients are 7mg% and the creatinine of 112 patients are > 1.4 mg%. From those results canbe concluded that the most pathological indicator can be identified fromliver, heart and kidney function respectively. From the clinical aspects canbe seen that there is no significant difference between the health ofradiation worker and non radiation worker. (author)

Ex vivo changes in blood glucose levels seldom change blood glucose control algorithm recommendations

NARCIS (Netherlands)

de Groene, L.; Harmsen, R. E.; Binnekade, J. M.; Spronk, P. E.; Schultz, M. J.

2010-01-01

Background. Hyperglycemia and glycemic variabilities are associated with adverse outcomes in critically ill patients. Blood glucose control with insulin mandates an adequate and precise assessment of blood glucose levels. Blood glucose levels, however, can change ex vivo after sampling. The aim of

Regional cerebral blood flow in psychiatry: Application to clinical research

International Nuclear Information System (INIS)

Berman, K.F.; Weinberger, D.R.; Morihisa, J.M.; Zec, R.F.

1984-01-01

In the following sections, the authors describe aspects of the xenon-133 inhalation technique as it has been modified in their lab, as well as a number of considerations and prerequisites for setting up such a facility. The authors also discuss the processes by which they technically and clinically validated the methods used. Several case studies follow along with descriptions of the approaches they are taking in investigating psychiatric illnesses with rCBF. Since the concept of a relation between brain functional activity, metabolism, and blood flow has a long history, both in theory and in practice, they first briefly review some of this history and some of the principles involved

Integration of DPC and clinical microbiological data in Japan reveals importance of confirming a negative follow-up blood culture in patients with MRSA bacteremia.

Science.gov (United States)

Miyamoto, Naoki; Yahara, Koji; Horita, Rie; Yano, Tomomi; Tashiro, Naotaka; Morii, Daiichi; Tsutsui, Atsuko; Yaita, Kenichiro; Shibayama, Keigo; Watanabe, Hiroshi

2017-10-01

Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is one of the commonest and most life-threatening of all infectious diseases. The morbidity and mortality rates associated with MRSA bacteremia are higher than those associated with bacteremia caused by other pathogens. A common guideline in MRSA bacteremia treatment is to confirm bacteremia clearance through additional blood cultures 2-4 days after initial positive cultures and as needed thereafter. However, no study has presented statistical evidence of how and to what extent confirming a negative follow-up blood culture impacts clinical outcome. We present this evidence for the first time, by combining clinical microbiological data of blood cultures and the DPC administrative claims database; both had been systematically accumulated through routine medical care in hospitals. We used electronic medical records to investigate the clinical background and infection source in detail. By analyzing data from a university hospital, we revealed how survival curves change when a negative follow-up blood culture is confirmed. We also demonstrated confirmation of a negative culture is significantly associated with clinical outcomes: there was a more than three-fold increase in mortality risk (after adjusting for clinical background) if a negative blood culture was not confirmed within 14 days of the initial positive blood culture. Although we used data from only one university hospital, our novel approach and results will be a basis for future studies in several hospitals in Japan to provide statistical evidence of the clinical importance of confirming a negative follow-up blood culture in bacteremia patients, including those with MRSA infections. Copyright © 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

A comparison of total amount of blood needed in patients taking autologous or homologous blood transfusion in coronary artery bypass grafting a clinical randomized case control trial

International Nuclear Information System (INIS)

Akhlagh, S.H.; Chohedri, A.H.; Bazojoo, A.; Nemati, M.H.

2007-01-01

The aim of this clinical case-control trial was to compare the total amount of blood needed in patients taking autologous or homologous blood transfusion in coronary artery bypass grafting (CABG) surgery. Sixty patients scheduled for CABG were randomly allocated to ANH (Acute Normovulemic Hemodynamic) group (A group) or control group (B group). Hematocrit before operation and 24 hours after the operation were checked. The amount of the total blood needed in each group was measured at the end of the operation. There was no significant difference between the two groups as regards post operational hematocrit. The mean total blood infused to the control and ANH group was 2010 ml and 1815 ml respectively. However there was significant difference between the two groups as regards the total amount of the blood needed during operation. Our randomized, double blinded case control study demonstrated that autologous blood, beside carrying lower risks for hemolytic and nonhemolytic transfusion reactions decrease the total amount of blood needed for CABG. However larger studies with more patients are needed to confirm the results. (author)

Blood in Semen

Science.gov (United States)

Symptoms Blood in semen By Mayo Clinic Staff Blood in semen (hematospermia) can be frightening, but the cause of this uncommon condition is usually benign. Typically, blood in semen goes away on its own. If you're ...

Quantitative Assessment of Blood Pressure Measurement Accuracy and Variability from Visual Auscultation Method by Observers without Receiving Medical Training

Science.gov (United States)

Feng, Yong; Chen, Aiqing

2017-01-01

This study aimed to quantify blood pressure (BP) measurement accuracy and variability with different techniques. Thirty video clips of BP recordings from the BHS training database were converted to Korotkoff sound waveforms. Ten observers without receiving medical training were asked to determine BPs using (a) traditional manual auscultatory method and (b) visual auscultation method by visualizing the Korotkoff sound waveform, which was repeated three times on different days. The measurement error was calculated against the reference answers, and the measurement variability was calculated from the SD of the three repeats. Statistical analysis showed that, in comparison with the auscultatory method, visual method significantly reduced overall variability from 2.2 to 1.1 mmHg for SBP and from 1.9 to 0.9 mmHg for DBP (both p auscultation methods). In conclusion, the visual auscultation method had the ability to achieve an acceptable degree of BP measurement accuracy, with smaller variability in comparison with the traditional auscultatory method. PMID:29423405

Clinical Audit of the Radiotherapy Process in Rectal Cancer: Clinical Practice Guidelines and Quality Certification Do Not Avert Variability in Clinical Practice.

Science.gov (United States)

Torras, M G; Canals, E; Jurado-Bruggeman, D; Marín-Borras, S; Macià, M; Jové, J; Boladeras, A M; Muñoz-Montplet, C; Molero, J; Picón, C; Puigdemont, M; Aliste, L; Torrents, A; Guedea, F; Borras, J M

2018-06-01

The therapeutic approach to cancer is complex and multidisciplinary. Radiotherapy is among the essential treatments, whether used alone or in conjunction with other therapies. This study reports a clinical audit of the radiotherapy process to assess the process of care, evaluate adherence to agreed protocols and measure the variability to improve therapeutic quality for rectal cancer. Multicentre retrospective cohort study in a representative sample of patients diagnosed with rectal cancer in the Institut Català d'Oncologia, a comprehensive cancer centre with three different settings. We developed a set of indicators to assess the key areas of the radiotherapy process. The clinical audit consisted of a review of a random sample of 40 clinical histories for each centre. The demographic profile, histology and staging of patients were similar between centres. The MRI reports did not include the distance from tumour to mesorectal fascia (rCRM) in 38.3% of the cases. 96.7% of patients received the planned dose, and 57.4% received it at the planned time. Surgery followed neoadjuvant treatment in 96.7% of the patients. Among this group, postoperative CRM was recorded in 65.5% of the cases and was negative in 93.4% of these. With regard to the 34.5% (n = 40) of cases where no CRM value was stated, there were differences between the centres. Mean follow-up was 3.4 (SD 0.6) years, and overall survival at four years was 81.7%. The audit revealed a suboptimal degree of adherence to clinical practice guidelines. Significant variability between centres exists from a clinical perspective but especially with regard to organization and process. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

A comparative study on the blood and milk cell counts of healthy, subclinical and clinical mastitis Karan Fries cows

Directory of Open Access Journals (Sweden)

Mohanned Alhussien

2015-05-01

Full Text Available Aim: The present study was aimed to study the use of cell counts as an early indicator of mammary health. Materials and Methods: Milk and blood cell counts were estimated from 8 healthy, 8 subclinical (SCM, and 8 clinically mastitis (CM groups of Karan Fries (KF cows. Results: Total leucocyte counts and neutrophil percent in blood and milk somatic cells and milk neutrophil percent of healthy cows increased significantly (p<0.05 in SCM cows and CM cows. Viability of blood and milk neutrophils was more in healthy cows, but decreased significantly (p<0.05 in SCM and CM cows. Significant (p<0.05 decrease were also observed in both the blood and milk lymphocytes and monocytes of SCM and CM cows. Phagocytic activity (PA of blood neutrophils also decreased significantly (p<0.05 in SCM cows. There was no difference between the PA of SCM and CM cows. Milk neutrophil percent was more in the SCM and clinically infected milk than in the blood of these cows. About 96-97% of the neutrophils had segmented nucleus in both healthy and subclinical milk, whereas, 2-3% were having band shaped or immature nuclei. There was a significant decrease in the segmented neutrophils, whereas, band neutrophils increase significantly to about 5% in the infected milk of mastitic cows. Viability of the milk neutrophils decreased more in case of subclinical and clinical milk as compared to that of blood. PA was found to be highest in the milk of healthy group of cows, but decreased significantly (p<0.05 in subclinically infected cows. However, there was no difference between the PA of milk neutrophils of SCM and CM cows. PA of milk was also found to be significantly lower in the milk of healthy cows when compared to that of blood neutrophils. Conclusion: This study indicated that percent neutrophils and their type in conjunction with milk somatic cell counts can be used as a more reliable indicator of mammary health in cows.

Blood transfusion indications in neurosurgical patients: A systematic review.

Science.gov (United States)

Bagwe, Shefali; Chung, Lawrance K; Lagman, Carlito; Voth, Brittany L; Barnette, Natalie E; Elhajjmoussa, Lekaa; Yang, Isaac

2017-04-01

Neurosurgical procedures can be complicated by significant blood losses that have the potential to decrease tissue perfusion to critical brain tissue. Red blood cell transfusion is used in a variety of capacities both inside, and outside, of the operating room to prevent untoward neurologic damage. However, evidence-based guidelines concerning thresholds and indications for transfusion in neurosurgery remain limited. Consequently, transfusion practices in neurosurgical patients are highly variable and based on institutional experiences. Recently, a paradigm shift has occurred in neurocritical intensive care units, whereby restrictive transfusion is increasingly favored over liberal transfusion but the ideal strategy remains in clinical equipoise. The authors of this study perform a systematic review of the literature with the objective of capturing the changing landscape of blood transfusion indications in neurosurgical patients. Copyright © 2017 Elsevier B.V. All rights reserved.

Quantile Regression Analysis of the Distributional Effects of Air Pollution on Blood Pressure, Heart Rate Variability, Blood Lipids, and Biomarkers of Inflammation in Elderly American Men: The Normative Aging Study.

Science.gov (United States)

Bind, Marie-Abele; Peters, Annette; Koutrakis, Petros; Coull, Brent; Vokonas, Pantel; Schwartz, Joel

2016-08-01

Previous studies have observed associations between air pollution and heart disease. Susceptibility to air pollution effects has been examined mostly with a test of effect modification, but little evidence is available whether air pollution distorts cardiovascular risk factor distribution. This paper aims to examine distributional and heterogeneous effects of air pollution on known cardiovascular biomarkers. A total of 1,112 men from the Normative Aging Study and residents of the greater Boston, Massachusetts, area with mean age of 69 years at baseline were included in this study during the period 1995-2013. We used quantile regression and random slope models to investigate distributional effects and heterogeneity in the traffic-related responses on blood pressure, heart rate variability, repolarization, lipids, and inflammation. We considered 28-day averaged exposure to particle number, PM2.5 black carbon, and PM2.5 mass concentrations (measured at a single monitor near the site of the study visits). We observed some evidence suggesting distributional effects of traffic-related pollutants on systolic blood pressure, heart rate variability, corrected QT interval, low density lipoprotein (LDL) cholesterol, triglyceride, and intercellular adhesion molecule-1 (ICAM-1). For example, among participants with LDL cholesterol below 80 mg/dL, an interquartile range increase in PM2.5 black carbon exposure was associated with a 7-mg/dL (95% CI: 5, 10) increase in LDL cholesterol, while among subjects with LDL cholesterol levels close to 160 mg/dL, the same exposure was related to a 16-mg/dL (95% CI: 13, 20) increase in LDL cholesterol. We observed similar heterogeneous associations across low versus high percentiles of the LDL distribution for PM2.5 mass and particle number. These results suggest that air pollution distorts the distribution of cardiovascular risk factors, and that, for several outcomes, effects may be greatest among individuals who are already at high risk

FUNCTIONAL STUDIES ON BLOOD MICROCIRCULATION SYSTEM WITH LASER DOPPLER FLOWMETRY IN CLINICAL MEDICINE: PROBLEMS AND PROSPECTS

Directory of Open Access Journals (Sweden)

D. G. Lapitan

2016-01-01

Full Text Available The paper presents a  review of the research update on the blood microcirculation system assessed with laser Doppler flowmetry (LDF. Specific procedures for measurement of the microcirculation index by LDF and individual variability of microcirculation parameters during their real time assessment in vivo are discussed. In physiological conditions, a relative deviation of the results of measurements by LDF is within the range±35% and above from the mean value of the microcirculation index. This imposes certain limitations on the interpretation of the diagnostic results in terms of the “normal or pathologic”. Specifics of performance of functional stress tests on the microcirculation system are reviewed. Diagnostic criteria based on functional stress testing of the microcirculation system, which can be implemented with methodologically strict normatives and regulations, for examples, those for the occlusion test, are more reliable from metrologic perspective and significant compared to the results obtained without stress testing. Problems of implementation of the functional tests into clinical practice are discussed. It was shown that they may have a potentially wide spectrum of clinical indications, from functional diagnostics and early detection of microcirculatory abnormalities in diabetes mellitus, arterial hypertension and other diseases associated with microcirculatory disorders, to the physical rationale of exposure parameters, as well as objectification of efficiency of medical procedures aimed to stimulation of the microcirculatory functions in a patient's tissues and organs.

Hypertension and blood pressure variability management practices among physicians in Singapore.

Science.gov (United States)

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

Blood gas and serum biochemical RIs for healthy newborn Murrah buffaloes (Bubalus bubalis).

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Santana, André M; Silva, Daniela G; Clemente, Virna; Pizauro, Lucas J L; Bernardes, Priscila A; Santana, Clarissa H; Eckersall, Peter D; Fagliari, José J

2018-03-01

There is a lack of published work on RIs for newborn buffaloes. Establishing blood gas and serum biochemical RIs for newborn buffaloes is important for monitoring health. This study establishes blood gas and serum biochemical RIs of newborn buffaloes. Twenty-eight newborn buffaloes, 10-30 days old, were selected. Thirty blood biochemical variables were analyzed. The Anderson-Darling test was used to assess the normality of the distribution. The Dixon test and the Tukey test were used to identify outliers. The RI and 90% CI were determined using standard and robust methods and the Box-Cox transformation. A total of 30 RIs for healthy buffalo calves have been reported in this study. RIs for blood gas variables were reported for pH, partial pressure of oxygen (pO 2 ), partial pressure of carbon dioxide (pCO 2 ), saturation of O 2 (SO 2 ), bicarbonate (cHCO 3 - ), base excess (BE), total carbon dioxide (ctCO 2 ), and anion gap (AG). RIs for serum biochemical variables were reported for glucose (GLU), direct bilirubin (DB), total bilirubin (TB), AST, ALP, GGT, CK, LDH, creatinine (CREA), urea, cholesterol (CHOL), triglycerides (TG), Ca, P, Mg, Na, K, iCa, Cl, iron, total protein (TP), and albumin (ALB). This is the first reported study covering complete serum chemistry and blood gas RIs for healthy 1-month-old Murrah buffaloes. © 2018 American Society for Veterinary Clinical Pathology.

Blood Clotting and Pregnancy

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Remifentanil Reduces Blood Loss During Orthognathic Surgery.

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Matsuura, Nobuyuki; Okamura, Taiki; Ide, Satoko; Ichinohe, Tatsuya

2017-01-01

Remifentanil is reported to reduce oral tissue blood flow. We performed a retrospective investigation using logistic regression analysis of anesthesia records to investigate whether the use of remifentanil infusion in a balanced anesthesia technique was useful as a primary technique to reduce blood loss during orthognathic surgery. Subjects were 80 patients who underwent Le Fort I osteotomy and sagittal split ramus osteotomy of the mandible. The variables included gender, age, weight, type of maintenance anesthetic, type and dose or infusion rate of opioid, mean systolic blood pressure (SBP-mean), coefficient of variation of systolic blood pressure (CVSBP) during surgery, mean heart rate (HR-mean), duration of surgery, total blood loss, volume of infusion used, amount of local anesthetic used, body temperature, and urine output. Gender, type of maintenance anesthetic, type of opioid, SBP-mean, CVSBP, HR-mean, and duration of surgery were used as candidates for independent variables. Logistic regression analysis was performed for the selected independent variables with the total blood loss as the dependent variable. The factors associated with the reduction of blood loss were the use of remifentanil (odds ratio, 3.112; 95% CI, 1.166-8.307; P = .023) and smaller CVSBP (odds ratio, 2.747; 95% CI, 1.07-7.053; P = .036). Use of remifentanil and smaller CVSBP were associated with a reduction of blood loss during orthognathic surgery.

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

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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.

Comprehensive Experiment--Clinical Biochemistry: Determination of Blood Glucose and Triglycerides in Normal and Diabetic Rats

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Jiao, Li; Xiujuan, Shi; Juan, Wang; Song, Jia; Lei, Xu; Guotong, Xu; Lixia, Lu

2015-01-01

For second year medical students, we redesigned an original laboratory experiment and developed a combined research-teaching clinical biochemistry experiment. Using an established diabetic rat model to detect blood glucose and triglycerides, the students participate in the entire experimental process, which is not normally experienced during a…

Effects of Aerobic Exercise Training and Irbesartan on Blood Pressure and Heart Rate Variability in Patients with Chronic Obstructive Pulmonary Disease

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Karine Marquis

2008-01-01

Full Text Available BACKGROUND AND OBJECTIVES: The present pilot study was undertaken to evaluate the efficacy of an aerobic exercise training (AET program alone or combined with an antihypertensive agent (irbesartan to reduce blood pressure (BP and enhance heart rate variability (HRV in chronic obstructive pulmonary disease patients.

Manual versus automated streaking system in clinical microbiology laboratory: Performance evaluation of Previ Isola for blood culture and body fluid samples.

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Choi, Qute; Kim, Hyun Jin; Kim, Jong Wan; Kwon, Gye Cheol; Koo, Sun Hoe

2018-01-04

The process of plate streaking has been automated to improve routine workflow of clinical microbiology laboratories. Although there were many evaluation reports about the inoculation of various body fluid samples, few evaluations have been reported for blood. In this study, we evaluated the performance of automated inoculating system, Previ Isola for various routine clinical samples including blood. Blood culture, body fluid, and urine samples were collected. All samples were inoculated on both sheep blood agar plate (BAP) and MacConkey agar plate (MCK) using Previ Isola and manual method. We compared two methods in aspect of quality and quantity of cultures, and sample processing time. To ensure objective colony counting, an enumeration reading reference was made through a preliminary experiment. A total of 377 nonduplicate samples (102 blood culture, 203 urine, 72 body fluid) were collected and inoculated. The concordance rate of quality was 100%, 97.0%, and 98.6% in blood, urine, and other body fluids, respectively. In quantitative aspect, it was 98.0%, 97.0%, and 95.8%, respectively. The Previ Isola took a little longer to inoculate the specimen than manual method, but the hands-on time decreased dramatically. The shortened hands-on time using Previ Isola was about 6 minutes per 10 samples. We demonstrated that the Previ Isola showed high concordance with the manual method in the inoculation of various body fluids, especially in blood culture sample. The use of Previ Isola in clinical microbiology laboratories is expected to save considerable time and human resources. © 2018 Wiley Periodicals, Inc.

Ambulatory blood pressure profiles in familial dysautonomia.

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Goldberg, Lior; Bar-Aluma, Bat-El; Krauthammer, Alex; Efrati, Ori; Sharabi, Yehonatan

2018-02-12

Familial dysautonomia (FD) is a rare genetic disease that involves extreme blood pressure fluctuations secondary to afferent baroreflex failure. The diurnal blood pressure profile, including the average, variability, and day-night difference, may have implications for long-term end organ damage. The purpose of this study was to describe the circadian pattern of blood pressure in the FD population and relationships with renal and pulmonary function, use of medications, and overall disability. We analyzed 24-h ambulatory blood pressure monitoring recordings in 22 patients with FD. Information about medications, disease severity, renal function (estimated glomerular filtration, eGFR), pulmonary function (forced expiratory volume in 1 s, FEV1) and an index of blood pressure variability (standard deviation of systolic pressure) were analyzed. The mean (± SEM) 24-h blood pressure was 115 ± 5.6/72 ± 2.0 mmHg. The diurnal blood pressure variability was high (daytime systolic pressure standard deviation 22.4 ± 1.5 mmHg, nighttime 17.2 ± 1.6), with a high frequency of a non-dipping pattern (16 patients, 73%). eGFR, use of medications, FEV1, and disability scores were unrelated to the degree of blood pressure variability or to dipping status. This FD cohort had normal average 24-h blood pressure, fluctuating blood pressure, and a high frequency of non-dippers. Although there was evidence of renal dysfunction based on eGFR and proteinuria, the ABPM profile was unrelated to the measures of end organ dysfunction or to reported disability.

Integration of Quantitative Positron Emission Tomography Absolute Myocardial Blood Flow Measurements in the Clinical Management of Coronary Artery Disease.

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Gewirtz, Henry; Dilsizian, Vasken

2016-05-31

In the >40 years since planar myocardial imaging with(43)K-potassium was introduced into clinical research and management of patients with coronary artery disease (CAD), diagnosis and treatment have undergone profound scientific and technological changes. One such innovation is the current state-of-the-art hardware and software for positron emission tomography myocardial perfusion imaging, which has advanced it from a strictly research-oriented modality to a clinically valuable tool. This review traces the evolving role of quantitative positron emission tomography measurements of myocardial blood flow in the evaluation and management of patients with CAD. It presents methodology, currently or soon to be available, that offers a paradigm shift in CAD management. Heretofore, radionuclide myocardial perfusion imaging has been primarily qualitative or at best semiquantitative in nature, assessing regional perfusion in relative terms. Thus, unlike so many facets of modern cardiovascular practice and CAD management, which depend, for example, on absolute values of key parameters such as arterial and left ventricular pressures, serum lipoprotein, and other biomarker levels, the absolute levels of rest and maximal myocardial blood flow have yet to be incorporated into routine clinical practice even in most positron emission tomography centers where the potential to do so exists. Accordingly, this review focuses on potential value added for improving clinical CAD practice by measuring the absolute level of rest and maximal myocardial blood flow. Physiological principles and imaging fundamentals necessary to understand how positron emission tomography makes robust, quantitative measurements of myocardial blood flow possible are highlighted. © 2016 American Heart Association, Inc.

Peculiarities of Changes in Daily Blood Pressure and Its Variability in Patients with Essential Hypertension and Diabetes Mellitus Type 2

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E.Yu. Gura

2014-09-01

In patients with essential hypertension combined with diabetes type 2 dipper and non-dipper circadian rhythms prevailed. They had higher values of SBP variability in the daytime, load with high blood pressure in the daytime and at night; the degree of the insufficient night reduction and morning increase of BP. Those parameters were significantly in non-dipper circadian rhythm.

Clinical significance of coryneform Gram-positive rods from blood identified by MALDI-TOF mass spectrometry and their susceptibility profiles - a retrospective chart review.

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Mushtaq, Ammara; Chen, Derrick J; Strand, Gregory J; Dylla, Brenda L; Cole, Nicolynn C; Mandrekar, Jayawant; Patel, Robin

2016-07-01

With the advent of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), most Gram-positive rods (GPRs) are readily identified; however, their clinical relevance in blood cultures remains unclear. Herein, we assessed the clinical significance of GPRs isolated from blood and identified in the era of MALDI-TOF MS. A retrospective chart review of patients presenting to the Mayo Clinic, Rochester, MN, from January 1, 2013, to October 13, 2015, was performed. Any episode of a positive blood culture for a GPR was included. We assessed the number of bottles positive for a given isolate, time to positivity of blood cultures, patient age, medical history, interpretation of culture results by the healthcare team and whether infectious diseases consultation was obtained. We also evaluated the susceptibility profiles of a larger collection of GPRs tested in the clinical microbiology laboratory of the Mayo Clinic, Rochester, MN from January 1, 2013, to October 31, 2015. There were a total of 246 GPRs isolated from the blood of 181 patients during the study period. 56% (n = 101) were deemed contaminants by the healthcare team and were not treated; 33% (n = 59) were clinically determined to represent true bacteremia and were treated; and 8% (n = 14) were considered of uncertain significance, with patients prescribed treatment regardless. Patient characteristics associated with an isolate being treated on univariate analysis included younger age (P = 0.02), identification to the species level (P = 0.02), higher number of positive blood culture sets (P < 0.0001), lower time to positivity (P < 0.0001), immunosuppression (P = 0.03), and recommendation made by an infectious disease consultant (P = 0.0005). On multivariable analysis, infectious diseases consultation (P = 0.03), higher number of positive blood culture sets (P = 0.0005) and lower time to positivity (P = 0.03) were associated with an isolate being treated. 100, 83, 48 and 34% of GPRs

Multicentre standardisation of a clinical grade procedure for the preparation of allogeneic platelet concentrates from umbilical cord blood

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Rebulla, Paolo; Pupella, Simonetta; Santodirocco, Michele; Greppi, Noemi; Villanova, Ida; Buzzi, Marina; De Fazio, Nicola; Grazzini, Giuliano

2016-01-01

Background In addition to a largely prevalent use for bleeding prophylaxis, platelet concentrates from adult blood have also been used for many years to prepare platelet gels for the repair of topical skin ulcers. Platelet gel can be obtained by activation of fresh, cryopreserved, autologous or allogeneic platelet concentrates with calcium gluconate, thrombin and/or batroxobin. The high content of tissue regenerative factors in cord blood platelets and the widespread availability of allogeneic cord blood units generously donated for haematopoietic transplant but unsuitable for this use solely because of low haematopoietic stem cell content prompted us to develop a national programme to standardise the production of allogeneic cryopreserved cord blood platelet concentrates (CBPC) suitable for later preparation of clinical-grade cord blood platelet gel. Materials and methods Cord blood units collected at public banks with total nucleated cell counts 150×109/L and volume >50 mL, underwent soft centrifugation within 48 hours of collection. Platelet-rich plasma was centrifuged at high speed to obtain a CBPC with target platelet concentration of 800–1,200×109/L, which was cryopreserved, without cryoprotectant, below −40 °C. Results During 14 months, 13 banks produced 1,080 CBPC with mean (± standard deviation) volume of 11.4±4.4 mL and platelet concentration of 1,003±229×109/L. Total platelet count per CBPC was 11.3±4.9×109. Platelet recovery from cord blood was 47.7±17.8%. About one-third of cord blood units donated for haematopoietic transplant could meet the requirements for preparation of CBPC. The cost of preparation was € 160.92/CBPC. About 2 hours were needed for one technician to prepare four CBPC. Discussion This study yielded valuable scientific and operational information regarding the development of clinical trials using allogeneic CBPC. PMID:26509822

The clinical significance of determination of peripheral blood TXA2, PGI2, TNF-α levels in patients with acute pancreatitis

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Hong Guangqiu; Ye Fei; Lin Hao

2010-01-01

Objective: To investigate the clinical significance of changes of peripheral blood TXA 2 , PGI 2 , TNF-α levels on assessment of the severity and prognosis of patients with acute pancreatitis (AP). Methods: Peripheral blood levels of TXA 2 , PGI 2 (plasma with RIA) and TNF-α (serum with ELISA) were detected in 30 patients with severe AP (SAP group), 56 patients with mild AP(MAP group) and 40 controls. Results: The peripheral blood levels of TXA 2 , TNF-α in the SAP group were significantly higher than those in the MAP group (P 2 levels were significantly lower (P 2 , PGI 2 and TNF-α levels were closely related to the severity and prognosis of AP and were important clinical indicators. (authors)

Design and development of microcontroller-based clinical chemistry analyser for measurement of various blood biochemistry parameters.

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Taneja, S R; Gupta, R C; Kumar, Jagdish; Thariyan, K K; Verma, Sanjeev

2005-01-01

Clinical chemistry analyser is a high-performance microcontroller-based photometric biochemical analyser to measure various blood biochemical parameters such as blood glucose, urea, protein, bilirubin, and so forth, and also to measure and observe enzyme growth occurred while performing the other biochemical tests such as ALT (alkaline amino transferase), amylase, AST (aspartate amino transferase), and so forth. These tests are of great significance in biochemistry and used for diagnostic purposes and classifying various disorders and diseases such as diabetes, liver malfunctioning, renal diseases, and so forth. An inexpensive clinical chemistry analyser developed by the authors is described in this paper. This is an open system in which any reagent kit available in the market can be used. The system is based on the principle of absorbance transmittance photometry. System design is based around 80C31 microcontroller with RAM, EPROM, and peripheral interface devices. The developed system incorporates light source, an optical module, interference filters of various wave lengths, peltier device for maintaining required temperature of the mixture in flow cell, peristaltic pump for sample aspiration, graphic LCD display for displaying blood parameters, patients test results and kinetic test graph, 40 columns mini thermal printer, and also 32-key keyboard for executing various functions. The lab tests conducted on the instrument include versatility of the analyzer, flexibility of the software, and treatment of sample. The prototype was tested and evaluated over 1000 blood samples successfully for seventeen blood parameters. Evaluation was carried out at Government Medical College and Hospital, the Department of Biochemistry. The test results were found to be comparable with other standard instruments.

Impact of donor- and collection-related variables on product quality in ex utero cord blood banking.

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Askari, Sabeen; Miller, John; Chrysler, Gayl; McCullough, Jeffrey

2005-02-01

Optimizing product quality is a current focus in cord blood banking. This study evaluates the role of selected donor- and collection-related variables. Retrospective review was performed of cord blood units (CBUs) collected ex utero between February 1, 2000, and February 28, 2002. Preprocessing volume and total nucleated cell (TNC) counts and postprocessing CD34 cell counts were used as product quality indicators. Of 2084 CBUs, volume determinations and TNC counts were performed on 1628 and CD34+ counts on 1124 CBUs. Mean volume and TNC and CD34+ counts were 85.2 mL, 118.9 x 10(7), and 5.2 x 10(6), respectively. In univariate analysis, placental weight of greater than 500 g and meconium in amniotic fluid correlated with better volume and TNC and CD34+ counts. Greater than 40 weeks' gestation predicted enhanced volume and TNC count. Cesarean section, two- versus one-person collection, and not greater than 5 minutes between placental delivery and collection produced superior volume. Increased TNC count was also seen in Caucasian women, primigravidae, female newborns, and collection duration of more than 5 minutes. A time between delivery of newborn and placenta of not greater than 10 minutes predicted better volume and CD34+ count. By regression analysis, collection within not greater than 5 minutes of placental delivery produced superior volume and TNC count. Donor selection and collection technique modifications may improve product quality. TNC count appears to be more affected by different variables than CD34+ count.

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

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Patrick R. Steffen

2017-08-01

Full Text Available 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.

Diagnostic accuracy of clinical and blood examination for sepsis in potentially infected neonates

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Ari Mulyani

2006-10-01

Full Text Available Background Neonatal sepsis remains a diagnostic challenge due to its nonspesific symptoms and signs. Blood culture as the gold standard is still a problem because it takes time, is expensive, and not every health facility is able to perionn. Objective To evaluate the diagnostic accuracy of clinical symptoms, hematologic findings, and C-reactive protein (CRP in neonatal sepsis. Methods Samples were taken from potentially infected neonates admitted to the Matemal-Perinatal Unit of Sardjito Hospital, between December 1st, 2000 and March 31st, 2001 using at least one of the criteria: prematurity, very low birth weight infants, matemal pyrexia during delivery, premature membrane rupture, or thick, cloudy amniotic fluid. Clinical symptoms, total leukocyte, neutrophil, platelet count, CRP, and blood culture as the gold standard were examined. Results Among 99 neonates enrolled, the sensitivity, specificity, positive and negative predictive value of clinical symptoms were 79.3%, 75.7%, 57.5%, and 89.9%, respectively; leukopenia/leukocytosis were 27.6%, 85.7%, 44.4%, and 74.1%; neutropenia! neutrophilia were 41.4%, 71.4%, 37.5%, and 74.6%; thrombocytopenia were 79.3%, 51.8%, 40.4%, and 85.7%; positive CRP were 58.6%,78.6%,53.1%, and 82.1%. Parallel tests increased the sensitivity up to 89.7%. Specificity, positive and negative predictive value, and likelihood ratio were 44.3%, 40%, 91.2%, and 1.6, respectively. Serial tests increased the specificity up to 88.6%. Sensitivity, positive and negative predictive value, and likelihood ratio were 58.6%, 68%, 83.8%, and 5.1, respectively. Conclusion Clinical sepsis, thrombocytopenia, and CRP are sufficiently accurate as diagnostic tests for sepsis in potentially infected neonates. Parallel tests will increase the sensitivity, while serial tests increase the specificity.

The relationship between dietary salt intake and ambulatory blood pressure variability in non-diabetic hypertensive patients

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Nihal Ozkayar

2016-11-01

Full Text Available High dietary salt intake was reported to increase blood pressure by numerous studies, but no study has investigated the effect of dietary salt intake on blood pressure variability (BPV. This study aimed to determine if daily salt intake is related to ambulatory BPV. The study included 136 primary hypertensive patients (92 male, 44 female with a mean age of 50.7 ± 11.1 years. All the patients underwent 24-h ambulatory blood pressure monitoring to determine both the 24-h systolic and 24-h diastolic BPV. 24-h urine sodium was measured. The correlation between BPV and 24-h urinary sodium was investigated. Logarithmic transformation of 24-h urinary sodium [log(24-h urinary sodium] was positively correlated with the mean 24-h systolic ARV, and nighttime systolic ARV (r = 0.371 and p = 0.001, r = 0.329 and p = 0.028, respectively. Similarly, log(24-h urinary sodium was positively correlated with mean 24-h diastolic ARV and nighttime diastolic ARV (r = 0.381 and p = 0.001, r = 0.320 and p = 0.020 respectively. Log(24-h urinary sodium was an independent predictor of BPV based on multivariate regression analysis. Dietary salt intake might play a role in the pathogenesis of ambulatory BPV.

Blood pressure patterns in women with gestational hypertension or mild preeclampsia at term.

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van der Tuuk, K; Tajik, P; Koopmans, C M; van den Berg, P P; Mol, B W J; van Pampus, M G; Groen, H

2017-03-01

Gestational hypertension (GH) and mild preeclampsia (PE) represent the most common medical complications of pregnancy, with the majority of cases developing at or near term. There is little knowledge of the course of blood pressure over time in these women. We explored the pattern of systolic and diastolic blood pressure over time in women with GH or mild PE at term participating in the HYPITAT trial, and we attempted to identify clinical factors influencing these blood pressure patterns and the impact of severe hypertension on clinical management. We used data from the HYPITAT trial, that included women with a singleton pregnancy with a fetus in cephalic position between 36 and 41 weeks of gestation with the diagnosis of GH or mild PE. Blood pressure measurements were performed from randomization or admission until delivery or discharge from the hospital. We included the highest blood pressure of each day. We evaluated systolic and diastolic blood pressure change over time, as well as the influence of clinical characteristics and laboratory findings on the course of blood pressure. We used univariate and multivariate regression analysis with a backward stepwise algorithm for the selection of variables. The model with the best fit (lowest AIC) was selected as the final model. We also compared mode of delivery for women with and without severe hypertension. We studied 1076 women who had 4188 blood pressure measurements done. The systolic blood pressure showed a significant non-linear increase over time and for the diastolic blood pressure the pattern was also non-linear. In the multivariable model of systolic blood pressure change over time, nulliparity, ethnicity, systolic blood pressure (at baseline), BMI and LDH at randomization influenced the course of blood pressure. In the diastolic blood pressure model ALT and the baseline diastolic blood pressure had a significant influence. When we explored the association between blood pressure and mode of delivery, it

Association Between Short-Term Systolic Blood Pressure Variability and Carotid Intima-Media Thickness in ELSA-Brasil Baseline.

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Ribeiro, Adèle H; Lotufo, Paulo A; Fujita, André; Goulart, Alessandra C; Chor, Dora; Mill, José G; Bensenor, Isabela M; Santos, Itamar S

2017-10-01

Blood pressure (BP) is associated with carotid intima-media thickness (CIMT), but few studies have explored the association between BP variability and CIMT. We aimed to investigate this association in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) baseline. We analyzed data from 7,215 participants (56.0% women) without overt cardiovascular disease (CVD) or antihypertensive use. We included 10 BP readings in varying positions during a 6-hour visit. We defined BP variability as the SD of these readings. We performed a 2-step analysis. We first linearly regressed the CIMT values on main and all-order interaction effects of the variables age, sex, body mass index, race, diabetes diagnosis, dyslipidemia diagnosis, family history of premature CVD, smoking status, and ELSA-Brasil site, and calculated the residuals (residual CIMT). We used partial least square path analysis to investigate whether residual CIMT was associated with BP central tendency and BP variability. Systolic BP (SBP) variability was significantly associated with residual CIMT in models including the entire sample (path coefficient [PC]: 0.046; P < 0.001), and in women (PC: 0.046; P = 0.007) but not in men (PC: 0.037; P = 0.09). This loss of significance was probably due to the smaller subsample size, as PCs were not significantly different according to sex. We found a small but significant association between SBP variability and CIMT values. This was additive to the association between SBP central tendency and CIMT values, supporting a role for high short-term SBP variability in atherosclerosis. © American Journal of Hypertension, Ltd 2017. All rights reserved. For Permissions, please email: journals.permissions@oup.com

Evaluating measurement models in clinical research: covariance structure analysis of latent variable models of self-conception.

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Hoyle, R H

1991-02-01

Indirect measures of psychological constructs are vital to clinical research. On occasion, however, the meaning of indirect measures of psychological constructs is obfuscated by statistical procedures that do not account for the complex relations between items and latent variables and among latent variables. Covariance structure analysis (CSA) is a statistical procedure for testing hypotheses about the relations among items that indirectly measure a psychological construct and relations among psychological constructs. This article introduces clinical researchers to the strengths and limitations of CSA as a statistical procedure for conceiving and testing structural hypotheses that are not tested adequately with other statistical procedures. The article is organized around two empirical examples that illustrate the use of CSA for evaluating measurement models with correlated error terms, higher-order factors, and measured and latent variables.

Biochemical and Clinical Variables of Normal Parathyroid and Hyperparathyroid Diabetic Chronic Kidney Disease Patients

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Syed Abdul Kader

2016-09-01

Full Text Available Background: In chronic kidney disease (CKD intact parathyroid hormone (iPTH level is often increased before clinical hyperphosphatemia occurs. Despite its importance very few studies evaluated parathyroid status in CKD. Objective: The study was undertaken to estimate level of parathormone in diabetic CKD patients at a tertiary level hospital and assessing its relationship with different parameters like hemoglobin, calcium etc. and comparing biochemical and clinical variables between normal parathyroid and hyperparathyroid groups. Materials and Methods: It was a hospital based cross-sectional study involving purposively selected chronic kidney disease patients attending nephrology and endocrinology outdoor and indoor services of BIRDEM hospital, Dhaka, Bangladesh. Study was conducted during the period of April to October 2010. All the subjects were divided into two groups based on serum parathormone level and different parameters were compared between groups. Results: The mean duration of chronic kidney disease was significantly higher in hyperparathyroid group than that in the normal group (<0.001. Retinopathy and hypertension were more common in hyperparathyroid group than that in patients with normal serum parathormone (p<0.001 and p=0.012. Neuropathy was solely present in hyperparathyroid group (p<0.001. Mean fasting blood glucose, serum creatinine and serum phosphate were significantly higher in the hyperparathyroid group compared to normal group (p<0.001 in all cases while the mean serum calcium and haemoglobin were lower in hyperparathyroid group than those in the normal group (p<0.001 in both cases. Serum creatinine and serum parathormone bears a significantly linear relationship (r=0.986, p<0.001, while serum parathormone and serum calcium bears a significantly negative relationship (r=−0.892 and p<0.001. Conclusion: Earlier intervention on the basis of iPTH in addition to other biochemical parameters of chronic kidney disease is

An Interdisciplinary Education Initiative to Promote Blood Conservation in Cardiac Surgery.

Science.gov (United States)

Goda, Tamara S; Sherrod, Brad; Kindell, Linda

Transfusion practices vary extensively for patients undergoing cardiac surgical procedures, leading to high utilization of blood products despite evidence that transfusions negatively impact outcomes. An important factor affecting transfusion practice is recognition of the importance of teams in cardiac surgery care delivery. This article reports an evidenced-based practice (EBP) initiative constructed using the Society of Thoracic Surgery (STS) 2011 Blood Conservation Clinical Practice Guidelines (CPGs) to standardize transfusion practice across the cardiac surgery team at a large academic medical center. Project outcomes included: a) Improvement in clinician knowledge related to the STS Blood Conservation CPGs; and b) Decreased blood product utilization for patients undergoing cardiac surgical procedures. Participants' scores reflected an improvement in the overall knowledge of the STS CPGs noting a 31.1% (p = 0.012) increase in the number of participants whose practice reflected the Blood Conservation CPGs post intervention. Additionally, there was a reduction in overall blood product utilization for all patients undergoing cardiac surgery procedures post intervention (p = 0.005). Interdisciplinary education based on the STS Blood Conservation CPGs is an effective way to reduce transfusion practice variability and decrease utilization of blood products during cardiac surgery.

A multi-dataset time-reversal approach to clinical trial placebo response and the relationship to natural variability in epilepsy.

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Goldenholz, Daniel M; Strashny, Alex; Cook, Mark; Moss, Robert; Theodore, William H

2017-12-01

Clinical epilepsy drug trials have been measuring increasingly high placebo response rates, up to 40%. This study was designed to examine the relationship between the natural variability in epilepsy, and the placebo response seen in trials. We tested the hypothesis that 'reversing' trial direction, with the baseline period as the treatment observation phase, would reveal effects of natural variability. Clinical trial simulations were run with time running forward and in reverse. Data sources were: SeizureTracker.com (patient reported diaries), a randomized sham-controlled TMS trial, and chronically implanted intracranial EEG electrodes. Outcomes were 50%-responder rates (RR50) and median percentage change (MPC). The RR50 results showed evidence that temporal reversal does not prevent large responder rates across datasets. The MPC results negative in the TMS dataset, and positive in the other two. Typical RR50s of clinical trials can be reproduced using the natural variability of epilepsy as a substrate across multiple datasets. Therefore, the placebo response in epilepsy clinical trials may be attributable almost entirely to this variability, rather than the "placebo effect". Published by Elsevier Ltd.

An overview of the role of microparticles/microvesicles in blood components: Are they clinically beneficial or harmful?

Science.gov (United States)

Burnouf, Thierry; Chou, Ming-Li; Goubran, Hadi; Cognasse, Fabrice; Garraud, Olivier; Seghatchian, Jerard

2015-10-01

blood collection on MP generation, while clinical research should clarify links of MPs with transfusion reactions and certain clinical disorders. Harmonization and consensus in sampling protocols, sample handling and processing, and assessment methods are needed to achieve consensual interpretations. This review focuses on the role of MPs as an essential laboratory tool and as a most effective player in transfusion science and medicine and in health and disease. Copyright © 2015 Elsevier Ltd. All rights reserved.

Effect of concentrate level on feeding behavior and rumen and blood parameters in dairy goats: relationships between behavioral and physiological parameters and effect of between-animal variability.

Science.gov (United States)

Giger-Reverdin, S; Rigalma, K; Desnoyers, M; Sauvant, D; Duvaux-Ponter, C

2014-07-01

This work aimed first to compare 2 diets differing in their percentage of concentrate [low (LO): 30% concentrate vs. High (HI): 60% concentrate] by measuring simultaneously feeding behavior, rumen parameters, blood and plasma parameters, and milk yield and composition in 8 mid-lactation goats. The second aim was to study the interrelationships between these variables and to analyze the between-animal variability to better understand the between-animal differences in acidosis susceptibility. All of the animals received the 2 diets ad libitum as total mixed ration according to a crossover design of two 4-wk periods. Mean daily DMI was similar between the 2 diets but the variability was higher for the HI than for the LO diet. Goats produced more milk when fed the HI diet compared with the LO diet but with a lower fat:protein ratio (0.81 vs. 0.99). They ate more rapidly the HI than the LO diet but stopped eating sooner after the afternoon feed allowance, and spent less time chewing. The increase in concentrate percentage modified rumen parameters: the pH and acetate:propionate ratio decreased and total VFA, ammonia, and soluble carbohydrate concentrations increased. Hematocrit, plasma NEFA, and blood K and Ca concentrations decreased but glycemia and uremia increased. Other parameters were not modified: milk fat content, blood pH, and bicarbonate and Na concentrations. A large between-animal variability was detected for all the measured parameters, especially for feeding behavior, with important consequences on rumen and blood parameters. This work confirmed the effects of a high percentage of concentrate on feeding behavior, rumen and blood parameters, and milk production, and some known relationships such as the positive link between rumen pH and chewing index. It also pointed out other relationships between parameters seldom measured at the same time, such as rumen redox potential or blood pH and chewing index, or the negative link between blood and rumen pH. When

Clinical studies on cerebral blood flow in chronic subdural hematoma

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Fukuda, Atsuhiro; Akagi, Katsuhito; Horibe, Kunio; Yamasaki, Mami; Yuguchi, Takamichi

1988-11-01

Cerebral blood flow (CBF) and clinical symptoms were examined between pre- and post-operations in twenty-four patients with unilateral chronic subdural hematoma. The following results were obtained by intravenous /sup 133/Xe method : 1. There was a reducing tendency of the CBF (hemisphere) on hematoma side, in most cases. While, the groups of headache and disturbances of consciousness did not give a laterality between hematoma and opposite side without the group of hemiparesis. 2. The absolute values of the CBF in the groups of headache and disturbances of consciousness were correlated with the clinical symptoms. In the group of hemiparesis, the laterality between hematoma and opposite side was correlated with the clinical symptoms. 3. In the group of hemiparesis, the F-flow (fast-flow) had sensitive reaction more than the ISI (initial slope index) with symptomatic improvement. 4. It was found that there was not an increase in the absolute value of the CBF, which was under the normal limit between pre- and post-operations in the case without improvement. By SPECT (Method of IMP), the following results were obtained : 1. There was the area of defect at the location of hematoma and the CBF tended to reduce at the subcortical white matter and at the basal ganglia of hematoma side. 2. The CBF of the contralateral hematoma side in the hemisphere of cerebellum was also tended to reduce.

Clinical predictors and impact of ambulatory blood pressure monitoring in pediatric hypertension referrals.

Science.gov (United States)

Davis, Marguerite L; Ferguson, Michael A; Zachariah, Justin P

2014-09-01

Elevated blood pressure (BP) is rising in children. Significant proportions of children have reactive hypertension or masked hypertension, making ambulatory BP monitoring (ABPM) a valuable tool, although with potential economic implications. In youth referred for elevated BP, we sought clinic BP combinations that obviated the need for ABPM and to specify the economic role of ABPM. In a retrospective pediatric referral cohort (N = 170), we examine clinic systolic BP (SBP) predictors of components of ABPM hypertension and their combination. In economic analyses, we compared effectiveness and charges of three diagnostic pathways: (1) clinic BP alone; (2) abnormal clinic BP prompting ABPM; or (3) universal ABPM. ABPM hypertension occurred in 55 (32.4%) and reactive hypertension in 37 (21.8%), average automated (β = 0.208; 95% confidence interval, 0.027, 0.389; P = .03) and maximum auscultatory clinic SBP (β = 0.160; 95% confidence interval 0.022, 0.299; P = .02) were associated with ABPM SBP mean, but none predicted SBP load. No clinic SBP combination was associated with ABPM hypertension. Universal ABPM accrued the lowest average charge per hypertensive youth identified ($10,948). We did not identify a clinic SBP combination that predicted ABPM hypertension in youth referred for elevated BP. Universal ABPM, in this context, may be the most economically and clinically efficient diagnostic strategy. Copyright © 2014 American Society of Hypertension. Published by Elsevier Inc. All rights reserved.

Heart rate variability and baroreflex sensitivity in bilateral lung transplant recipients.

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Fontolliet, Timothée; Gianella, Pietro; Pichot, Vincent; Barthélémy, Jean-Claude; Gasche-Soccal, Paola; Ferretti, Guido; Lador, Frédéric

2018-01-09

The effects of lung afferents denervation on cardiovascular regulation can be assessed on bilateral lung transplantation patients. The high-frequency component of heart rate variability is known to be synchronous with breathing frequency. Then, if heart beat is neurally modulated by breathing frequency, we may expect disappearance of high frequency of heart rate variability in bilateral lung transplantation patients. On 11 patients and 11 matching healthy controls, we measured R-R interval (electrocardiography), blood pressure (Portapres ® ) and breathing frequency (ultrasonic device) in supine rest, during 10-min free breathing, 10-min cadenced breathing (0·25 Hz) and 5-min handgrip. We analysed heart rate variability and spontaneous variability of arterial blood pressure, by power spectral analysis, and baroreflex sensitivity, by the sequence method. Concerning heart rate variability, with respect to controls, transplant recipients had lower total power and lower low- and high-frequency power. The low-frequency/high-frequency ratio was higher. Concerning systolic, diastolic and mean arterial pressure variability, transplant recipients had lower total power (only for cadenced breathing), low frequency and low-frequency/high-frequency ratio during free and cadenced breathing. Baroreflex sensitivity was decreased. Denervated lungs induced strong heart rate variability reduction. The higher low-frequency/high-frequency ratio suggested that the total power drop was mostly due to high frequency. These results support the hypothesis that neural modulation from lung afferents contributes to the high frequency of heart rate variability. © 2018 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.

Monitoring variables affecting positron emission tomography measurements of cerebral blood flow in anaesthetized pigs

DEFF Research Database (Denmark)

Alstrup, Aage Kristian Olsen; Zois, Nora Elisabeth; Simonsen, Mette

2018-01-01

Background Positron emission tomography (PET) imaging of anaesthetized pig brains is a useful tool in neuroscience. Stable cerebral blood flow (CBF) is essential for PET, since variations can affect the distribution of several radiotracers. However, the effect of physiological factors regulating...... and the monitoring parameters. Results No significant statistical correlations were found between CBF and the nine monitoring variables. However, we found that arterial carbon dioxide tension (PaCO2) and body temperature were important predictors of CBF that should be observed and kept constant. In addition, we...... found that long-duration anaesthesia was significantly correlated with high heart rate, low arterial oxygen tension, and high body temperature, but not with CBF. Conclusions The findings indicate that PaCO2 and body temperature are crucial for maintaining stable levels of CBF and thus optimizing PET...

Spectral analyses of systolic blood pressure and heart rate variability and their association with cognitive performance in elderly hypertensive subjects.

Science.gov (United States)

Santos, W B; Matoso, J M D; Maltez, M; Gonçalves, T; Casanova, M; Moreira, I F H; Lourenço, R A; Monteiro, W D; Farinatti, P T V; Soares, P P; Oigman, W; Neves, M F T; Correia, M L G

2015-08-01

Systolic hypertension is associated with cognitive decline in the elderly. Altered blood pressure (BP) variability is a possible mechanism of reduced cognitive performance in elderly hypertensives. We hypothesized that altered beat-to-beat systolic BP variability is associated with reduced global cognitive performance in elderly hypertensive subjects. In exploratory analyses, we also studied the correlation between diverse discrete cognitive domains and indices of systolic BP and heart rate variability. Disproving our initial hypothesis, we have shown that hypertension and low education, but not indices of systolic BP and heart rate variability, were independent predictors of lower global cognitive performance. However, exploratory analyses showed that the systolic BP variability in semi-upright position was an independent predictor of matrix reasoning (B = 0.08 ± .03, P-value = 0.005), whereas heart rate variability in semi-upright position was an independent predictor of the executive function score (B = -6.36 ± 2.55, P-value = 0.02). We conclude that myogenic vascular and sympathetic modulation of systolic BP do not contribute to reduced global cognitive performance in treated hypertensive subjects. Nevertheless, our results suggest that both systolic BP and heart rate variability might be associated with modulation of frontal lobe cognitive domains, such as executive function and matrix reasoning.

[Phenotypic variability in 47, XXX patients: Clinical report of four new cases].

Science.gov (United States)

Goldschmidt, Ernesto; Márquez, Marisa; Solari, Andrea; Ziembar, María I; Laudicina, Alejandro

2010-08-01

The 47, XXX karyotype has a frequency of 1 in 1000 female newborns. However, this karyotype is not usually suspected at birth or childhood. These patients are usually diagnosed during adulthood when they develop premature ovarian failure or infertility, because the early phenotype doesn t have any specific features. The study describes four cases and the clinical variability of the 47, XXX karyotype.

Initial blood lactate correlates with carboxyhemoglobin and clinical severity in carbon monoxide poisoned patients.

Science.gov (United States)

Cervellin, Gianfranco; Comelli, Ivan; Rastelli, Gianni; Picanza, Alessandra; Lippi, Giuseppe

2014-12-01

The aim of this study was to assess the role of blood lactate levels at admission in carbon monoxide (CO)-poisoned patients for establishing severity of poisoning and short term prognosis. All cases of CO poisoning visited in the emergency department during the years 2012 and 2013 were retrieved from the hospital database. The concentration of COHb and lactate was assessed in arterial blood in all patients with suspected CO poisoning, along with the plasma concentration of troponin I (TnI). The control population for TnI results consisted in 125 blood donors. Twenty three (61%) out of 38 CO-poisoned patients underwent hyperbaric oxygen (HBO) treatment, and 10 (26%) were admitted to a hospital ward. A significant correlation was found between lactate and COHb (r=0.54; p99th percentile compared to 2% controls (p=0.003). The odds ratio for detectable TnI and TnI >99th percentile in CO-poisoned patients were 13.1 (p<0.001) and 7.6 (p=0.006), respectively. Initial blood lactate level may be useful for risk stratification of CO-poisoned patients, especially for predicting hospitalization. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Radiolabelled blood elements techniques and clinical applications

International Nuclear Information System (INIS)

Thakur, M.L.

1992-01-01

Over the past few years, in nuclear medicine, the diagnostic applications of radiolabelled blood elements in general, and of radiolabelled white blood cells in particular, have become increasingly popular. This is primarily due to the introduction of lipid soluble 111 In-oxine as an agent, which not only is an excellent and a reliable tracer for blood cells but also enables the investigators to study the in vivo cell kinetics and map the localization of labelled cells by external gamma scintigraphy. The tracer has the modest half life of 67 hours and decays with the emission of two gamma photons (173 and 247 keV) in high abundance. This technique has provided a powerful tool to study the in vivo cell kinetics in health and localize abnormal lesions in diseases which invoke intense focal cellular concentration

Radiolabelled blood elements techniques and clinical applications

Energy Technology Data Exchange (ETDEWEB)

Thakur, M L

1993-12-31

Over the past few years, in nuclear medicine, the diagnostic applications of radiolabelled blood elements in general, and of radiolabelled white blood cells in particular, have become increasingly popular. This is primarily due to the introduction of lipid soluble {sup 111}In-oxine as an agent, which not only is an excellent and a reliable tracer for blood cells but also enables the investigators to study the in vivo cell kinetics and map the localization of labelled cells by external gamma scintigraphy. The tracer has the modest half life of 67 hours and decays with the emission of two gamma photons (173 and 247 keV) in high abundance. This technique has provided a powerful tool to study the in vivo cell kinetics in health and localize abnormal lesions in diseases which invoke intense focal cellular concentration 5 figs, 2 tabs

On the improvement of blood sample collection at clinical laboratories.

Science.gov (United States)

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.

Blood Clotting and Pregnancy

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Full Text Available ... to Action on DVT and PE to raise public awareness of these blood conditions and increase research ... may be of some help: Results of Clinical Studies Published in Blood Search Blood , the official journal ...

Recovery of Unrelated Donors of Peripheral Blood Stem Cells versus Recovery of Unrelated Donors of Bone Marrow: A Prespecified Analysis from the Phase III Blood and Marrow Transplant Clinical Trials Network Protocol 0201.

Science.gov (United States)

Burns, Linda J; Logan, Brent R; Chitphakdithai, Pintip; Miller, John P; Drexler, Rebecca; Spellman, Stephen; Switzer, Galen E; Wingard, John R; Anasetti, Claudio; Confer, Dennis L

2016-06-01

We report a comparison of time to recovery, side effects, and change in blood counts from baseline to after donation from unrelated donors who participated in the Blood and Marrow Transplant Clinical Trials Network phase III randomized, multicenter trial (0201) in which donor-recipient pairs were randomized to either peripheral blood stem cell (PBSC) or bone marrow (BM) donation. Of the entire cohort, 262 donated PBSC and 264 donated BM; 372 (71%) donors were from domestic and 154 (29%) were from international centers (145 German and 9 Canadian). PBSC donors recovered in less time, with a median time to recovery of 1 week compared with 2.3 weeks for BM donors. The number of donors reporting full recovery was significantly greater for donors of PBSC than of BM at 1, 2, and 3 weeks and 3 months after donation. Multivariate analysis showed that PBSC donors were more likely to recover at any time after donation compared with BM donors (hazard ratio, 2.08; 95% confidence interval [CI], 1.73 to 2.50; P donor and donation in more recent years. Donors of BM were more likely to report grades 2 to 4 skeletal pain, body symptoms, and fatigue at 1 week after donation. In logistic regression analysis of domestic donors only in which toxicities at peri-collection time points (day 5 filgrastim for PBSC donors and day 2 after collection of BM donors) could be analyzed, no variable was significantly associated with grades 2 to 4 skeletal pain, including product donated (BM versus PBSC; odds ratio, 1.13; 95% CI, .74 to 1.74; P = .556). Blood counts were affected by product donated, with greater mean change from baseline to after donation for white blood cells, neutrophils, mononuclear cells, and platelets in PBSC donors whereas BM donors experienced a greater mean change in hemoglobin. This analysis provided an enhanced understanding of donor events as product donated was independent of physician bias or donor preference. Copyright © 2016 The American Society for Blood and

Blood thiamin status and determinants in the population of Seychelles (Indian Ocean).

Science.gov (United States)

Bovet, P; Larue, D; Fayol, V; Paccaud, F

1998-04-01

Micronutrient deficiencies have become rare in industrialised countries as availability of fresh food, supplementation, and fortification have improved but a less favourable situation may still prevail in many developing countries. Blood thiamin status and determinants were therefore investigated in the Seychelles in view of the high incidence of dilated cardiomyopathy and as the staple diet is polished rice that is deficient in thiamin. This was a cross sectional population study using an age and sex stratified random sample. Seychelles Islands (Indian Ocean). A subsample of 206 subjects aged 25-64 years from the population of Seychelles. Measurement of total thiamin concentration in whole blood using high performance liquid chromatography. Dietary variables measured using a face to face semi-quantitative food questionnaire. Mean (SD) whole blood thiamin concentration was 77.9 (22.4) nmol/l and low concentration (< 70 nmol/l) was found in 37% of the subjects (95% CI: 31%, 44%). Blood thiamin was significantly related to education and diet but not to age, sex, smoking, and body mass index. Blood thiamin was associated positively with meat, vegetable, salad, and tea intake and negatively with alcohol and fish intake. However, no combination of the examined variables could explain more than 15% of the observed variance in blood thiamin values. These data suggest that the distribution of blood thiamin in the sampled population is shifted to lower values compared with that generally accepted as normal in European populations. Further research should establish the significance of such lower values in this specific population to facilitate clinical and public health action as necessary.

White thrombus formation in blood tubing lines in a chronic hemodialysis unit.

Science.gov (United States)

Watnick, Suzanne; Stooksbury, Michael; Winter, Rolf; Riscoe, Michael; Cohen, David M

2008-03-01

Previous reports have described white particulate matter in banked blood components, but no prior public reports describe such matter in blood tubing during the course of routine in-center hemodialysis. This report describes the events, investigations, and preliminary conclusions associated with the spontaneous formation of adherent white thrombus in the venous and arterial blood lines during routine in-center hemodialysis treatments. Design setting, participants, & measurements: This investigation occurred at the Portland Veterans Administration Medical Center (PVAMC) Hemodialysis Unit from October 2006 through April 2007. Sixty-eight variables regarding demographics, medical history and dialysis treatments were collected on our 34 chronic hemodialysis outpatients. Over a 5-wk interval, 62% (21 of 34) of the chronic hemodialysis patients unexpectedly developed a white precipitate adhering to the lumenal surface of their dialysis blood tubing, with 73 of 580 chronic dialysis treatments exhibiting the phenomenon. Microscopic and biochemical analyses were consistent with white thrombus, formed by an aggregation of platelets and fibrin. An alert was issued and other in-center hemodialysis units noted similar findings. This was remedied by the removal of specific tubing. Both patient-specific and tubing-specific factors may have been operative. Although patient safety was not adversely affected, assessment of clinical and manufacturing variables potentially affecting platelet activation is warranted.

Clinical application of OCTA in observation of macular blood flow density in patients with diabetic retinopathy

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Xiang Xiang

2017-07-01

Full Text Available AIM: Using optical coherence tomography angiography(OCTAto observe the changes and clinical significance of macular blood flow density in patients with diabetic retinopathy(DR.METHODS: Totally 47 eyes(28 patientswith diabetic retinopathy(DRwere enrolled in the DR group. According to the international clinical grading criteria of diabetic retinopathy, 30 eyes(19 patientswith non-proliferative diabetic retinopathy were classified as the NPDR group, and 17 eyes(11 patientswith proliferative diabetic retinopathy were classified as PDR group. A total of 46(27 subjectshealthy eyes with matched age were enrolled in the control group. All the subjects underwent the 3mm×3mm scanning of macular retina by optical coherence tomography angiography(OCTA, obtaining 4 levels of macular blood flow density map. The macular blood flow density at 3 levels, including superficial retinal layer, deep retinal layer and choroidal capillaries layer, were measured. RESULTS: The macular blood flow density of superfical retinal layer, deep retinal layer and choroidal capillaries layer in DR group were 0.4963±0.0840, 0.4798±0.0801 and 0.5290±0.0528, respectively. Among them, the blood flow density of each layer were 0.5064±0.0843,0.4983±0.0766,0.5345±0.0529, respectively, for the NPDR group, and were 0.4786±0.0830, 0.4473±0.0778,0.5192±0.0526, respectively, for the PDR group. For the control group, the density of each layers were 0.5919±0.0704, 0.6301±0.0527, 0.5691±0.0169, respectively. The macular blood flow density was significantly different in the superficial retinal layer, deep retinal layer and choroidal capillary layer between the control group and the NPDR group, as well as the PDR group and the DR group(total PP=0.029, but not in the superficial retina layer and choroid capillary layer(P=0.236, 0.268. CONCLUSION: Compared with the control group, the macular blood flow density of superficial retinal layer, deep retinal layer and choroidal capillary

Comparative biochemical analyses of venous blood and peritoneal fluid from horses with colic using a portable analyser and an in-house analyser.

Science.gov (United States)

Saulez, M N; Cebra, C K; Dailey, M

2005-08-20

Fifty-six horses with colic were examined over a period of three months. The concentrations of glucose, lactate, sodium, potassium and chloride, and the pH of samples of blood and peritoneal fluid, were determined with a portable clinical analyser and with an in-house analyser and the results were compared. Compared with the in-house analyser, the portable analyser gave higher pH values for blood and peritoneal fluid with greater variability in the alkaline range, and lower pH values in the acidic range, lower concentrations of glucose in the range below 8.3 mmol/l, and lower concentrations of lactate in venous blood in the range below 5 mmol/l and in peritoneal fluid in the range below 2 mmol/l, with less variability. On average, the portable analyser underestimated the concentrations of lactate and glucose in peritoneal fluid in comparison with the in-house analyser. Its measurements of the concentrations of sodium and chloride in peritoneal fluid had a higher bias and were more variable than the measurements in venous blood, and its measurements of potassium in venous blood and peritoneal fluid had a smaller bias and less variability than the measurements made with the in-house analyser.

In vitro evaluation of di(2-ethylhexyl)terephthalate-plasticized polyvinyl chloride blood bags for red blood cell storage in AS-1 and PAGGSM additive solutions.

Science.gov (United States)

Graminske, Sharon; Puca, Kathleen; Schmidt, Anna; Brooks, Scott; Boerner, Amanda; Heldke, Sybil; de Arruda Indig, Monika; Brucks, Mark; Kossor, David

2018-05-01

Di(2-ethylhexyl)phthalate (DEHP) makes polyvinyl chloride flexible for use in blood bags and stabilizes the red blood cell (RBC) membrane preventing excessive hemolysis. DEHP migrates into the blood product and rodent studies have suggested that DEHP exposure may be associated with adverse health effects albeit at high dosages. Although structurally and functionally similar to DEHP, di(2-ethylhexyl)terephthalate (DEHT; or Eastman 168 SG [Eastman Chemical Company]) is metabolically distinct with a comprehensive and benign toxicology profile. This study evaluated RBC stability in DEHT-plasticized bags with AS-1 and PAGGSM compared to conventional DEHP-plasticized bags with AS-1. Thirty-six whole blood units were collected into CPD solution, leukoreduced, centrifuged, and divided into RBCs and plasma. To limit donor-related variability, three ABO-identical RBCs were mixed together and then divided equally and stored among the three different plasticizer and additive solution combinations. RBCs from 12 trios were analyzed for a standard panel of in vitro variables on Day 0 and after storage. No individual bag on Day 42 exceeded the US 1.0% hemolysis criteria. While hemolysis during storage was higher in the DEHT bags, the PAGGSM RBCs were close to the control RBCs (0.38% vs. 0.32%, respectively). ATP retention was higher than 70% and potassium levels were similar regardless of plasticizer. Additional RBC variables exhibited some significant differences but were not viewed as clinically important. DEHT/PAGGSM provides similar hemolysis protection to that of DEHP/AS-1. Although hemolysis values with DEHT and AS-1 are higher than that of DEHP, DEHT is a potential DEHP alternative. © 2018 AABB.

Clinic and Ambulatory Blood Pressure in a Population-Based Sample of African Americans: the Jackson Heart Study

Science.gov (United States)

Thomas, S. Justin; Booth, John N.; Bromfield, Samantha G.; Seals, Samantha R.; Spruill, Tanya M.; Ogedegbe, Gbenga; Kidambi, Srividya; Shimbo, Daichi; Calhoun, David; Muntner, Paul

2017-01-01

Blood pressure (BP) can differ substantially when measured in the clinic versus outside of the clinic setting. Few population-based studies with ambulatory blood pressure monitoring (ABPM) include African Americans. We calculated the prevalence of clinic hypertension and ABPM phenotypes among 1,016 participants in the population-based Jackson Heart Study, an exclusively African-American cohort. Mean daytime systolic BP was higher than mean clinic systolic BP among participants not taking antihypertensive medication (127.1[standard deviation 12.8] versus 124.5[15.7] mmHg, respectively) and taking antihypertensive medication (131.2[13.6] versus 130.0[15.6] mmHg, respectively). Mean daytime diastolic BP was higher than clinic diastolic BP among participants not taking antihypertensive medication (78.2[standard deviation 8.9] versus 74.6[8.4] mmHg, respectively) and taking antihypertensive medication (77.6[9.4] versus 74.3[8.5] mmHg, respectively). The prevalence of daytime hypertension was higher than clinic hypertension for participants not taking antihypertensive medication (31.8% versus 14.3%) and taking antihypertensive medication (43.0% versus 23.1%). A high percentage of participants not taking and taking antihypertensive medication had nocturnal hypertension (49.4% and 61.7%, respectively), white coat hypertension (30.2% and 29.3%, respectively), masked hypertension (25.4% and 34.6%, respectively), and a non-dipping BP pattern (62.4% and 69.6%, respectively). In conclusion, these data suggest hypertension may be misdiagnosed among African Americans without using ABPM. PMID:28285829

Blood Clotting and Pregnancy

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Full Text Available ... may be of some help: Results of Clinical Studies Published in Blood Search Blood , the official journal of ASH, for the results of the latest blood research. While recent articles generally require a subscriber login, ...

Predictive value of clinical and laboratory variables for vesicoureteral reflux in children.

Science.gov (United States)

Soylu, Alper; Kasap, Belde; Demir, Korcan; Türkmen, Mehmet; Kavukçu, Salih

2007-06-01

We aimed to determine the predictability of clinical and laboratory variables for vesicoureteral reflux (VUR) in children with urinary tract infection (UTI). Data of children with febrile UTI who underwent voiding cystoureterography between 2002 and 2005 were evaluated retrospectively for clinical (age, gender, fever > or = 38.5 degrees C, recurrent UTI), laboratory [leukocytosis, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), pyuria, serum creatinine (S(Cr))] and imaging (renal ultrasonography) variables. Children with VUR (group 1) vs. no VUR (group 2) and children with high-grade (III-V) VUR (group 3) vs. no or low-grade (I-II) VUR (group 4) were compared. Among 88 patients (24 male), 38 had VUR and 21 high-grade VUR. Fever > or = 38.5 degrees C was associated with VUR [odds ratio (OR): 7.5]. CRP level of 50 mg/l was the best cut-off level for predicting high-grade VUR (OR 15.5; discriminative ability 0.89 +/- 0.05). Performing voiding cystourethrography based on this CRP level would result in failure to notice 9% of patients with high-grade VUR, whereas 69% of children with no/low-grade VUR would be spared from this invasive test. In conclusion, fever > or = 38 degrees C and CRP > 50 mg/l seem to be potentially useful clinical predictors of VUR and high-grade VUR, respectively, in pediatric patients with UTI. Further validation of these findings could limit unnecessary voiding cystourethrography.

The relationship between dietary salt intake and ambulatory blood pressure variability in non-diabetic hypertensive patients.

Science.gov (United States)

Ozkayar, Nihal; Dede, Fatih; Ates, Ihsan; Akyel, Fatma; Yildirim, Tolga; Altun, Bulent

High dietary salt intake was reported to increase blood pressure by numerous studies, but no study has investigated the effect of dietary salt intake on blood pressure variability (BPV). This study aimed to determine if daily salt intake is related to ambulatory BPV. The study included 136 primary hypertensive patients (92 male, 44 female) with a mean age of 50.7±11.1 years. All the patients underwent 24-h ambulatory blood pressure monitoring to determine both the 24-h systolic and 24-h diastolic BPV. 24-h urine sodium was measured. The correlation between BPV and 24-h urinary sodium was investigated. Logarithmic transformation of 24-h urinary sodium [log(24-h urinary sodium)] was positively correlated with the mean 24-h systolic ARV, and nighttime systolic ARV (r=0.371 and p=0.001, r=0.329 and p=0.028, respectively). Similarly, log(24-h urinary sodium) was positively correlated with mean 24-h diastolic ARV and nighttime diastolic ARV (r=0.381 and p=0.001, r=0.320 and p=0.020 respectively). Log(24-h urinary sodium) was an independent predictor of BPV based on multivariate regression analysis. Dietary salt intake might play a role in the pathogenesis of ambulatory BPV. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

Blood Clotting and Pregnancy

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Full Text Available ... that may be of some help: Results of Clinical Studies Published in Blood Search Blood , the official journal of ASH, for the results of the latest blood research. While recent articles generally require a subscriber login, ...

Low White Blood Cell Count

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Symptoms Low white blood cell count By Mayo Clinic Staff A low white blood cell count (leukopenia) is a decrease ... of white blood cell (neutrophil). The definition of low white blood cell count varies from one medical ...

Micrometastatic cancer cells in lymph nodes, bone marrow, and blood: Clinical significance and biologic implications.

Science.gov (United States)

Leong, Stanley P L; Tseng, William W

2014-01-01

Cancer metastasis may be regarded as a progressive process from its inception in the primary tumor microenvironment to distant sites by way of the lymphovascular system. Although this type of tumor dissemination often occurs in an orderly fashion via the sentinel lymph node (SLN), acting as a possible gateway to the regional lymph nodes, bone marrow, and peripheral blood and ultimately to distant metastatic sites, this is not a general rule as tumor cells may enter the blood and spread to distant sites, bypassing the SLN. Methods of detecting micrometastatic cancer cells in the SLN, bone marrow, and peripheral blood of patients have been established. Patients with cancer cells in their SLN, bone marrow, or peripheral blood have worse clinical outcomes than patients with no evidence of spread to these compartments. The presence of these cells also has important biologic implications for disease progression and the clinician's understanding of the process of cancer metastasis. Further characterization of these micrometastatic cancer cells at each stage and site of metastasis is needed to design novel selective therapies for a more "personalized" treatment. © 2014 American Cancer Society, Inc.

Normalization of Phenotypic Data from a Clinical Data Warehouse: Case Study of Heterogeneous Blood Type Data with Surprising Results.

Science.gov (United States)

Cimino, James J

2015-01-01

Clinical data warehouses often contain analogous data from disparate sources, resulting in heterogeneous formats and semantics. We have developed an approach that attempts to represent such phenotypic data in its most atomic form to facilitate aggregation. We illustrate this approach with human blood antigen typing (ABO-Rh) data drawn from the National Institutes of Health's Biomedical Translational Research Information System (BTRIS). In applying the method to actual patient data, we discovered a 2% incidence of changed blood types. We believe our approach can be applied to any institution's data to obtain comparable patient phenotypes. The actual discrepant blood type data will form the basis for a future study of the reasons for blood typing variation.

Transcriptomic profiling of peripheral blood nucleated cells in dogs with and without clinical signs of chronic mitral valve disease

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Garncarz Magdalena

2014-03-01

Full Text Available The aim of the study was to demonstrate differences in the gene expression of signalling pathways between healthy dogs and dogs with chronic mitral valve disease in different heart failure groups. Blood samples were collected from 49 dogs of various breeds between 1.4 and 15.2 years of age. Isolated RNA samples were analysed for quality and integrity and the gene expression profile was determined. The study demonstrated that nucleated cells from peripheral blood can be used to assess the status of heart failure in dogs. Furthermore, significant differences in the expression of the genes were noticed between healthy dogs and dogs with clinical signs of chronic mitral valve disease. This is a preliminary non-invasive study showing the feasibility of genetic testing from peripheral blood nucleated cells, which at the same time has made it possible to set the future directions of genetic studies in clinical cases of canine chronic mitral valve disease.

Clinical effect observation of pranoprofen combined with deproteinized calf blood extract eye drops for moderate to severe dry eye

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Jing-Hua Qiu

2018-04-01

Full Text Available AIM: To explore clinical effect of pranoprofen combined with deproteinized calf blood extract eye drops for moderate to severe dry eye. METHODS: A total of 84 patients(132 eyeswho received treatment at the Zhengzhou Second Hospital were selected from January 2016 to January 2017. According to random number table method they were divided into control group 42 cases(68 eyesand observation group 42 cases(64 eyes, the control group using polyvinyl alcohol eye drops with pranoprofen, observation group with pranoprofen with deproteinized extract of calf blood eye drops. Subjective and objective scores before and after treatment were recorded. RESULTS: There was no statistically significant difference on the four objective indicators of pretreatment FL, BUT, SⅠt, and vision between the two groups(P>0.05. Dry eye symptom scores of the two groups decreased after treatment, both with significantly different(PPPPCONCLUSION: The clinical effect of praprofen on the treatment of moderate to severe dry eye with the deproteinized calf blood extract is better.

UL146 variability among clinical isolates of Human Cytomegalovirus from Japan

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Francisco Aguayo

2010-01-01

Full Text Available Human Cytomegalovirus (HCMV is a herpesvirus associated with serious diseases in immunocompromised subjects. The region between ORF UL133 and UL151 from HCMV, named ULb' is frequently deleted in attenuated AD169 and in highly passaged laboratory strains. However, this region is conserved in low-passaged and more virulent HCMV, like the Toledo strain. The UL146 gene, which is located in the ULb' region, encodes a CXC-chemokine analogue. The diversity of UL146 gene was evaluated among fifty-six clinical isolates of HCMV from Japan. Results show that UL146 gene was successfully amplified by the polymerase chain reaction (PCR in only 17/56 strains (30%, while the success rate for UL145/UL147 gene was 18/56 strains (32%. After DNA sequencing, the 35 amplified strains were classified into 8 groups. When compared, variability of UL146 ranged from 25.1% to 52.9% at the DNA level and from 34.5% to 67% at the amino acid level. Seven groups had the interleukin-8 (IL-8 motif ERL (Glu-Leu-Arg CXC and one group had only the CXC motif, suggesting the absence of the IL-8 function of UL146. In conclusion, we found that UL146 gene of HCMV is hyper-variable in clinical strains from Japan suggesting the possibility of a different function in each sequence group.

Comparison of blood services and clinical transfusion practices in ...

African Journals Online (AJOL)

Introduction Tracking blood safety status of member states by World Health Organisation is now a routine activity through Global Database for Blood Safety. To understand further the differences between high income and low-income countries a detailed review may be warranted. In this review, the blood services of ...

Evaluation of a point-of-care blood analyzer and determination of reference ranges for blood parameters in rockfish.

Science.gov (United States)

Harrenstien, Lisa A; Tornquist, Susan J; Miller-Morgan, Timothy J; Fodness, Brian G; Clifford, Kevin E

2005-01-15

To compare values of blood parameters in rockfish obtained by use of a point-of-care portable blood analyzer with values determined by a veterinary diagnostic laboratory, calculate reference ranges for various blood parameters in black rockfish, and compare values of blood parameters in clinically normal fish with those of fish with clinical abnormalities. Prospective study. 41 captive adult black rockfish (Sebastes melanops) and 4 captive adult blue rockfish (Sebastes mystinus). Rockfish were anesthetized with tricaine methanesulfonate for collection of blood samples. Heparinized blood samples were immediately analyzed with a point-of-care analyzer. Blood sodium, potassium, chloride, urea nitrogen, and glucose concentrations; Hct; pH; partial pressure of carbon dioxide; total carbon dioxide concentration; bicarbonate concentration; base excess; and hemoglobin concentration were determined. A microhematocrit technique was used to determine PCV, and a refractometer was used to estimate total plasma protein concentration. Paired heparinized blood samples were transported to a veterinary diagnostic laboratory for analyses. Data obtained with the point-of-care analyzer were reproducible; however, values for most blood parameters were significantly different from those obtained by the veterinary diagnostic laboratory. Fish with poor body condition had several blood parameter values that were lower than corresponding values in clinically normal fish. Point-of-care blood analyses may prove useful in rockfish. Point-of-care data for a large number of clinically normal fish must be obtained for reference ranges to be calculated, and further assessments of clinically abnormal fish are necessary to determine the relevance of the data.

Temporal changes in clinic and ambulatory blood pressure during cyclic post-menopausal hormone replacement therapy

DEFF Research Database (Denmark)

Sørensen, M B; Rasmussen, Verner; Jensen, Gorm Boje

2000-01-01

OBJECTIVE: Post-menopausal hormone replacement (HRT) might protect against cardiovascular disease, possibly by arterial vasodilation and reduced blood pressure. Progestogens are needed to avoid endometrial disease but vascular effects are controversial. The objective was to assess temporal changes...... in blood pressure (BP) by two measurement techniques during a cyclic hormone replacement regimen. DESIGN AND METHODS: Sixteen healthy and normotensive post-menopausal women (age 55 +/- 3 years) were studied in a placebo-controlled, randomized crossover study, and were randomized to 17beta-oestradiol plus...... and in the ninth weeks of treatment in both periods. RESULTS: Clinic systolic and diastolic BP were reduced after 10 days of oestradiol (-5.1 and -3.2 mmHg respectively, P

Children with language problems in a speech and hearing clinic : Background variables and extent of language problems

NARCIS (Netherlands)

Keegstra, A.L.; Knijff, W.A.; Post, W.J.; Goorhuis-Brouwer, S.M.

Objective: Analysis of a clinical population referred for language analysis in terms of background variables and extent of language problems. Design: Descriptive study. Materials and methods: Children referred to a speech and hearing clinic because of assumed language problems were analyzed with

SPECIFICITIES OF THE SUBSET PROFILE OF PERIPHERAL BLOOD IN PATIENTS WITH GLIOBLASTOMA: PATHOGENETIC AND CLINICAL ASSESSMENTS

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V. A. Chumakov

2006-01-01

Full Text Available Abstract. In glioblastoma (GB, it is necessary to take into consideration GB-associated secondary immunodeficiency (SID, so-called syndrome of tumor-associated SID (STASID. Cell subsets having effector and regulatory functions, play an important role in developing STASID, and their proportions in patients with different forms of GB can be of pathogenetic importance and have clinical value for treatment and rehabilitation scheduling as well. The most pathogenically and clinically important features of cell subsets profile of peripheral blood were analyzed in patients with different clinical and morphological types of GB. The patients were divided into three groups, i.e., groups I and II were formed by patients with STASID (marked and slightly marked SID, accordingly; group III – patients with SIDTAS (tumor-associated autoimmune syndrome, associated with SID. Marked suppression of cell immunity is typical of group I - imbalance in T-lymphocytes, in a number of specific subsets, and in subsets clusters, as well as disproportions in the immunoregulatory indexes. In group II, the subset profiles of blood were slightly different from the norm. In patients with SIDTAS, activation of cell immunity was evident, forming SID with signs of autoimmune syndrome, affecting effector and regulatory chains of immunity, and influencing the severity and forecast of the disease. Specific features of the immune status in patients with GB identified can be resulted from different clinicalmorphological types of the tumor; the latter are to be considered in differential diagnostics of clinical course of GB and in scheduling of clinical-immunological efficient anti-tumor pharmacotherapy in pre- and postoperative periods.

Blood Clotting and Pregnancy

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Full Text Available ... copy by e-mailing a request to the Blood Publishing Office . Patient Groups A list of Web links to patient groups and other organizations that provide information. back to top ASH ... Blood Blood Advances The Hematologist ASH Clinical News ASH ...

NONINVASIVE METHODS ASSESSMENT BLOOD FLOW IN ANTERIOR SEGMENT AND CLINICAL APPLICATION PERSPECTIVE

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T. N. Kiseleva

2017-01-01

Full Text Available The literature review contains information on the anatomical and physiological features of the vessels of the conjunctiva, iris, ciliary body. There are data on the development and application of new non-invasive methods for the study of hemodynamics in the microvessels of anterior eye segment. To study the blood flow of the anterior segment of the eye, biomycroscopy, photography and videobiomicroscopy, television biomicroscopy of vessels, darkfield visualization, application fluorescence angiography, photoacoustic angiography, orthogonal polarization spectroscopy, laser Doppler flowmetry and OCT-angiography were used in recent years. These methods allow to determine the qualitative and quantitative characteristics of conjunctiva, iris, ciliary body microcirculation. They are highly informative for assess of various drugs effect on the vascular eye system. Investigation of hemodynamics in the eye microvessels is necessary for a fundamental approach to the study of the pathophysiology of systemic circulatory pathologies (with arterial hypertension, diabetes, etc. and changes in regional blood flow in organ of vision disease. Monitoring of anterior segment microcirculation in clinical practice makes possible to monitor the effectiveness of drug and surgical treatment.

Comprehensive Experiment—Clinical Biochemistry: Determination of Blood Glucose and Triglycerides in Normal and Diabetic Rats

Science.gov (United States)

Jiao, Li; Xiujuan, Shi; Juan, Wang; Song, Jia; Lei, Xu; Guotong, Xu; Lixia, Lu

2015-01-01

For second year medical students, we redesigned an original laboratory experiment and developed a combined research-teaching clinical biochemistry experiment. Using an established diabetic rat model to detect blood glucose and triglycerides, the students participate in the entire experimental process, which is not normally experienced during a standard clinical biochemistry exercise. The students are not only exposed to techniques and equipment but are also inspired to think more about the biochemical mechanisms of diseases. When linked with lecture topics about the metabolism of carbohydrates and lipids, the students obtain a better understanding of the relevance of abnormal metabolism in relation to diseases. Such understanding provides a solid foundation for the medical students' future research and for other clinical applications. PMID:25521692

Comprehensive experiment-clinical biochemistry: determination of blood glucose and triglycerides in normal and diabetic rats.

Science.gov (United States)

Jiao, Li; Xiujuan, Shi; Juan, Wang; Song, Jia; Lei, Xu; Guotong, Xu; Lixia, Lu

2015-01-01

For second year medical students, we redesigned an original laboratory experiment and developed a combined research-teaching clinical biochemistry experiment. Using an established diabetic rat model to detect blood glucose and triglycerides, the students participate in the entire experimental process, which is not normally experienced during a standard clinical biochemistry exercise. The students are not only exposed to techniques and equipment but are also inspired to think more about the biochemical mechanisms of diseases. When linked with lecture topics about the metabolism of carbohydrates and lipids, the students obtain a better understanding of the relevance of abnormal metabolism in relation to diseases. Such understanding provides a solid foundation for the medical students' future research and for other clinical applications. © 2014 Biochemistry and Molecular Biology Education.

Nutraceuticals with a clinically detectable blood pressure‐lowering effect: a review of available randomized clinical trials and their meta‐analyses

Science.gov (United States)

Cicero, Arrigo F G

2016-01-01

AIMS The aim of the present study was to review and comment on the available evidence on nutraceuticals with a clinically demonstrable blood pressure (BP)‐lowering effect. METHODS We reviewed studies published in the English language from 1990 to 2015 on dietary supplements or nutraceuticals claiming to show an effect on human BP. An initial list of possibly effective agents and studies was obtained from the online reference, the Natural Medicine Comprehensive Database. Using PubMed, we searched agents identified from this list using the MeSH terms ‘hypertension’, ‘blood pressure’, ‘dietary supplement’ and ‘nutraceuticals’, alone and in combination. We then focused our attention on meta‐analyses and randomized clinical trials. RESULTS Beyond the well‐known effects on BP of the Dietary Approaches to Stop Hypertension (DASH) and the Mediterranean diet, a large number of studies have investigated the possible BP‐lowering effect of different dietary supplements and nutraceuticals, most of which are antioxidant agents with a high tolerability and safety profile. In particular, a relatively large body of evidence supports the use of potassium, magnesium, L‐arginine, vitamin C, cocoa flavonoids, beetroot juice, coenzyme Q10, controlled‐release melatonin and aged garlic extract. The antihypertensive effect of all these nutraceuticals seems to be dose related and the overall tolerability is good. CONCLUSION Some nutraceuticals might have a positive impact on BP in humans. Further clinical research is needed, to identify from the available active nutraceuticals those with the best cost‐effectiveness and risk–benefit ratio for widespread and long‐term use in the general population with a low‐added cardiovascular risk related to uncomplicated hypertension. PMID:26852373

Nutraceuticals with a clinically detectable blood pressure-lowering effect: a review of available randomized clinical trials and their meta-analyses.