Spontaneous breathing during airway pressure release ventilation in experimental lung injury: effects on hepatic blood flow

Abstract Objective  Positive pressure ventilation can affect systemic haemodynamics and regional blood flow distribution with negative effects on hepatic blood flow. We hypothesized that spontaneous breathing (SB) with airway pressure release ventilation (APRV) provides better systemic and hepatic blood flow than APRV without SB.

Relationship between increased blood pressure and hematocrit during modified ultrafiltration for pediatric open heart surgery

Abstract Objective  Modified ultrafiltration increases blood pressure after cardiopulmonary bypass in children. To investigate the cause of this hemodynamic improvement, we assessed the relationship between increased blood pressure and hematocrit.

Variation in Blood Pressure as a Guide to Volume Loading in Children Following Cardiopulmonary Bypass

Abstract Objective  Intravascular volume loading is used to optimize cardiac output in children following weaning from cardiopulmonary bypass. Central venous pressure (CVP) is frequently used to titrate fluid administration but it is often misleading in predicting fluid responsiveness. Variation in the arterial pressure waveform is exaggerated in patients with deficient intravascular volume and has been shown to be a good predictor of fluid responsiveness in adults following cardiac surgery. The aim of this study was to compare the measures of variation in blood pressure as a guide to volume loading in children following cardiopulmonary bypass.

Total antioxidant status and 8-hydroxy-2’-deoxyguanosine levels in gingival and peripheral blood of periodontitis patients

Abstract Introduction:  The aim of this study was to determine 8-OHdG concentration as a biomarker of oxidant-induced DNA damage and to assess total antioxidant status (TAS) in gingival and peripheral blood during periodontal lesion.

Regional cerebral blood flow abnormalities in patients with primary hyperparathyroidism

Abstract Introduction  We assessed the alterations in regional cerebral blood flow (rCBF) in patients with primary hyperparathyroidism (PHP) before parathyroidectomy by semiquantitative analysis of brain single photon emission computed tomography (SPECT) images.

A new tourniquet system that determines pressures in synchrony with systolic blood pressure

Abstract Introduction  This study reports the results of the clinical use of a new tourniquet system for surgery of the lower extremity that can determine tourniquet pressure in synchrony with systolic blood pressure.

Pharmacologic Elevation of Blood Pressure for Acute Brain Ischemia

Abstract Introduction  Several studies demonstrated that patients with low blood pressure upon presentation with acute ischemic stroke have worse outcomes. Elevated mean arterial pressure (MAP) directly improves cerebral perfusion. Phenylephrine is a selective alpha-1 agonist with peripheral vasoconstrictive effect, raising the blood pressure without constricting brain vessels.

The effect of acute normovolaemic haemodilution on blood gas parameters: a case report

Abstract Introduction  Increased awareness of the risks related to homologous blood transfusions such as immunological reactions, transmission of infections, and immunosuppression, has necessitated exploration of alternative techniques to deal with the needs of intra-operative blood transfusion. Strategies that reduce or remove the risks associated with allogeneic transfusion include pre-operative autologous donation, peri-operative cell-salvage techniques, deliberate hypotension, and pharmacological interventions. Acute normovolaemic haemodilution is another such technique.

Impact of Computerized Decision Support on Blood Pressure Management and Control: A Randomized Controlled Trial

Abstract BACKGROUND  We conducted a cluster randomized controlled trial to examine the effectiveness of computerized decision support (CDS) designed to improve hypertension care and outcomes in a racially diverse sample of primary care patients.

Abstract Background  Using a conventional Doppler probe, it is difficult to identify blood vessels precisely in lymph node dissection during laparoscopic surgery.

The Accuracy of Clinician Perceptions of “Usual” Blood Pressure Control

Abstract BACKGROUND  The term “clinical inertia” is used to describe the failure to manage a chronic condition aggressively enough to bring it under control. The underlying mechanisms for clinical inertia remain poorly understood.

Rapid Blood Pressure Reduction in Acute Intracerebral Hemorrhage: Feasibility and Safety

Abstract Background  The optimal blood pressure (BP) for treating acute intracerebral hemorrhage remains (ICH) uncertain. High BP may contribute to hematoma growth while excessive BP reduction might precipitate peri-hemorrhage ischemia. We examine here the feasibility and safety of reducing BP to lower than presently recommended levels in patients with acute ICH.

Ocular blood flow in patients with obstructive sleep apnea syndrome (OSAS)

Abstract Background  Sleep-related disorders are among the important risk factors for neurovascular diseases. Obstructive sleep apnea syndrome (OSAS) is characterized by snoring, excessive daytime sleepiness, and insomnia. Our aim was to investigate the presence of glaucoma in patients with OSAS and to reveal vascular pathology related to the pathogenesis of glaucoma in those patients.

Laparoscopy-assisted Pylorus-preserving Gastrectomy: Preservation of Vagus Nerve and Infrapyloric Blood Flow Induces Less Stasis

Abstract Background  Pylorus-preserving gastrectomy (PPG) prevents postprandial symptoms; however, delayed gastric retention due to aberrant pylorus function can occur during the early postoperative period. This study aimed to establish a stasis-less PPG procedure with preservation of the vagal nerve and blood flow to the pyloric cuff, and to apply the technique for laparoscopy-assisted PPG.

Comparison of markers of circulating blood volume in hemodialysis patients

Abstract Background  Pulse dye-densitometry (PDD) is a newly developed technique for monitoring the arterial concentration of indocyanine green (ICG). By using this method, the circulating blood volume (CBV) can be measured as accurately as by established dilution methods using 131I-labeled human serum albumin in healthy subjects. In the present study, we estimated the CBV in hemodialysis (HD) patients, using PDD, and compared the utility of this method with that of other markers of the CBV.

Fluid Balance and Blood Volume Measurement after Aneurysmal Subarachnoid Hemorrhage

Abstract Background  Patients with aneurysmal subarachnoid hemorrhage (SAH) are at risk for circulatory volume depletion, which is a risk factor for delayed cerebral ischemia (DCI). In a prospective observational study we assessed the effectiveness of fluid administration based on regular evaluation of the fluid balance in maintaining normovolemia.

Near-Infrared Spectroscopy to Monitor Peripheral Blood Flow Perfusion

Abstract Background  Non-invasive evaluation of peripheral perfusion may be useful in many contexts including peri-operative monitoring. We validated a novel non-invasive spectroscopy technique to assess peripheral perfusion. This method, which is based on the measurement of tissue saturation variations after an ischemic period, was compared to strain gauge plethysmography and radionuclide plethysmography. The technique uses near-infrared spectroscopy (NIRS) to determine the rate of change of forearm tissue saturation during reactive hyperemia.

Neuromonitoring in the intensive care unit. I. Intracranial pressure and cerebral blood flow monitoring

Abstract Background  Monitoring the injured brain is an integral part of the management of severely brain injured patients in intensive care. Brain-specific monitoring techniques enable focused assessment of secondary insults to the brain and may help the intensivist in making appropriate interventions guided by the various monitoring techniques, thereby reducing secondary brain damage following acute brain injury.

Influence of Intermittent Pneumatic Compression Devices on Non-Invasive Blood Pressure Measurement of the Ankle

Abstract Background  It is rapidly becoming the standard of care to employ the perioperative use of intermittent pneumatic compression (IPC) devices on the lower leg to prevent the development of deep venous thrombosis. There are instances when the anesthesiologist must apply a blood pressure cuff to the ankle in order to obtain a blood pressure reading. The purpose of this study is to determine the influence of IPC devices on non-invasive blood pressure measurements of the ankle.

Hemodynamic and tissue blood flow responses to long-term pneumoperitoneum and hypercapnia in the pig

Abstract Background  Increased peritoneal blood flow may influence the ability of cancer cells to adhere to and survive on the peritoneal surface during and after laparoscopic cancer surgery. Carbon dioxide (CO2) pneumoperitoneum is associated with a marked blood flow increase in the peritoneum. However, it is not clear whether the vasodilatory effect in the peritoneum is related to a local or systemic effect of CO2.

Treatment Intensification and Blood Glucose Control Among Hospitalized Diabetic Patients

Abstract Background  Hyperglycemia is common among diabetic inpatients, and has been linked to adverse outcomes. However, antihyperglycemic treatment is seldom intensified in noncritical care patients, and the relationship between intensification frequency and glucose control is poorly understood. We evaluated the relationship between treatment intensification and changes in blood glucose in hospitalized diabetic patients.

Glycodelin gene expression in human peripheral white blood cells

Abstract Background  Glycodelin plays an important role in normal and abnormal reproductive growth. The in vitro properties of glycodelin have been studied in K562 cells. The role of glycodelin in vivo in the peripheral circulation has not been determined.

Abnormal Retinal Blood Vessels in Ehlers-Danlos Syndrome Type VI

Abstract Background  Ehlers-Danlos syndrome (EDS) is a hereditary connective tissue disorder caused by defective collagen synthesis and categorized into 11 types based on genetic mutations and clinical features.1 Its principal clinical characteristics include hyperelasticity and vulnerability of the skin and joints to laxity, and fragility of blood vessels.

Liver Transplantation Across Rh Blood Group Barriers Increases the Risk of Biliary Complications

Abstract Background  Cold ischemia time and the presence of postoperative hepatic arterial thrombosis have been associated with biliary complications (BC) after liver transplantation. An ABO-incompatible blood group has also been suggested as a factor for predisposal towards BC. However, the influence of Rh nonidentity has not been studied previously.

Perimetric and retrobulbar blood flow changes following carotid endarterectomy

Abstract Background  Carotid stenosis can produce visual changes. This study examines perimetric and retrobulbar blood flow changes following carotid endarterectomy (CEA) in patients without visual symptoms.

Carbon dioxide insufflation attenuates parietal blood flow obstruction in distended colon

Abstract Background  Bowel distention after colonoscopy has been considered as a cause of blood flow disturbance. Carbon dioxide (CO2), with its higher absorbability and vasodilating effect, may reduce parietal blood flow disturbance of distended colon when used for intraluminal insufflation instead of air. The purpose of this study was to assess parietal blood flow of the colon distended with intraluminal air/CO2 insufflation.

Identification of predictive factors for perioperative blood transfusion in colorectal resection patients

Abstract Background  Blood transfusion is associated with higher postoperative complication. With the availability of autologous blood and erythropoietin, it would be advantageous to identify patients who are at higher risk for requiring blood transfusion. Our aim is to identify possible predictive factors for perioperative blood transfusion in patients undergoing colorectal resection. We examined 206 patients who underwent colorectal resections.

The effect of ABO–Rh blood group determinants on urinary tract infections

Abstract Background  Blood group antigens are a group of carbohydrate determinants found on erythrocytes, phagocytes, lymphocytes and certain epithelial tissues including urothelium. There are several publications that defines enhanced bacterial adhesions due to genetic markers such as blood group types.

Suppressive effect of resistant maltodextrin on postprandial blood triacylglycerol elevation

Abstract Background  As the physiological functions of soluble dietary fibre, the favourable efficacy, such as attenuating the absorption of saccharides or lipids, is expected. Resistant maltodextrin, a soluble dietary fibre, was investigated and found that it delays the glucose absorption and attenuates the postprandial rise in the blood glucose levels, however, the efficacy of resistant maltodextrin on lipid metabolism is not yet reported.

Detection and evaluation of epithelial cells in the blood of colon cancer patients using RT-PCR

Abstract Background  As a mode of colorectal cancer recurrence, liver metastasis plays an important role. One of the factors reported to predict liver metastasis is the detection of trace amounts of tumor cells in the blood. For this purpose, cancer cell-induced cytokeratins (CKs) are generally identified, using the reverse transcriptase-polymerase chain reaction (RT-PCR). In the present study, we aimed to detect trace amounts of tumor cells, based on CK20, in the circulating venous blood, and we examined pathological factors, liver metastasis, and prognosis.

Effect of perioperative autologous versus allogeneic blood transfusion on the immune system in gastric cancer patients

Abstract Background  Allogeneic blood transfusion-induced immunomodulation (TRIM) and its adverse effect on the prognosis of patients treated surgically for cancer remain complex and controversial. However, the potential risk associated with allogeneic blood transfusion has heightened interest in the use of autologous blood transfusion. In the present study, the serum concentrations of neopterin, interferon-gamma (IFN-γ), T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and a possible association between these variables were investigated. The purpose was to further evaluate the effect of autologous versus allogeneic blood transfusion on immunological status in patients undergoing surgery for gastric cancer.

The relationship between admission blood glucose levels and hospital mortality

Abstract Aims/hypothesis  The purpose of this study was to examine the relationship between blood glucose level (BGL) on admission with mortality rates among patients admitted to hospital through the Emergency Department.

Cerebral blood flow abnormality in patients with idiopathic generalized epilepsy

Abstract Purpose   To investigate the regional cerebral blood flow (rCBF) changes in patients with idiopathic generalized epilepsy (IGE), we compared brain single photon emission computed tomography (SPECT) images of drug na?ve IGE patients with those of age/sex matched healthy volunteers.

The Cultural Gradient: Culture Moderates the Relationship between Socioeconomic Status (SES) and Ambulatory Blood Pressure

A social gradient has been consistently demonstrated in Western countries with higher socioeconomic status (SES) related to lower blood pressure (BP). In non-Western countries, however, the social gradient is not always evident, with some countries appearing to show a reversed social gradient. It was hypothesized that culture moderates the social gradient, with the relationship between SES and BP differing as a function of culture. To investigate the idea of a “cultural gradient” a sample of Hispanic immigrants and Whites was studied. A total of 79 participants (30 Hispanic immigrant, 49 White) wore ambulatory blood pressure monitors for 24 h. The Hispanic immigrants also completed the Acculturation Rating Scale for Mexican Americans- II. Hispanic immigrants had lower SES and lower BP compared to Whites. A cultural gradient moderating the social gradient was evident with Hispanic immigrants displaying a positive relationship between SES and BP and Whites displaying a negative relationship. Among Hispanic immigrants, increased acculturation to Western culture decreased the positive relationship between SES and BP. Just as there is a social gradient with increasing socioeconomic status related to better cardiovascular health, there appears to be a cultural gradient with increasing acculturation to Western society related to worse cardiovascular health.

Intraovarian arterial blood flow resistance in oligomenorrheal infertile women

   Purpose : Intraovarian arterial blood flows before and after follicular rupture in ovulation induced cycles were examined by transvaginal color flow Doppler imaging. The changes observed in the intraovarian arterial resistance before and after ovulation in relation to the regularity of menstruation and several other parameters were analyzed. Methods : In a prospective study, 22 patients undergoing infertility treatment in our center were recruited. Patients were divided into two subgroups, according to their menstrual regularity (regular menstrual group and oligomenorrheal group) and 42 cycles were studied. All patients received the same FSH low-dose stimulation treatment. The relationship between the post and preovulatory arterial pulsatility indexes (PI) was analyzed. Cycles that showed a decrease in their PI after ovulation of 10% or more were considered “profoundly decreased cycles.” Cycles from the same patients without ovulatory stimulation (natural cycles) were used as control.

Impact of Blood Transfusions on Recurrence and Survival After Rectal Cancer Surgery

Purpose  This study was designed to determine whether type or number of blood units transfused affected short-term and long-term outcome in patients undergoing surgery for rectal cancer. The number of perioperative blood units is associated with postoperative mortality and overall survival by some authors. In addition, allogenic perioperative blood transfusion has been postulated to produce host immunosuppression and has been reported to result in adverse outcome in patients with colorectal cancer. Autologous blood transfusion might improve results compared with allogenic transfusion.

Characteristics of Substance P Transport Across the Blood–Brain Barrier

Purpose  Substance P (SP; NH3+-Arg+-Pro-Lys+-Pro-Gln-Gln-Phe-Phe-Gly-Leu-Met-NH2) belongs to a group of neurokinins that are widely distributed in the central nervous system and peripheral nervous system. The biological effects mediated by SP in the central nervous system include regulation of affective behavior, emesis, and nociception. Many of these actions are believed to be the result of the binding of SP to the neurokinin-1 (NK-1) receptor and subsequent transport across the blood–brain barrier (BBB). The objective of the study was to investigate the involvement of the NK-1 receptor in the permeation of SP across the BBB.

Blood Compatibility of Cetyl Alcohol/Polysorbate-Based Nanoparticles

Purpose  Pegylated and nonpegylated cetyl alcohol/polysorbate nanoparticles (E78 NPs) are being tested as drug carriers for specific tumor and brain targeting. Because these nanoparticle formulations are designed for systemic administration, it is important to test the compatibility of these lipid-based NPs with blood and blood cells.

A Novel Method of Endoscopic Mucosal Resection Assisted by Submucosal Injection of Autologous Blood (Blood Patch EMR)

Purpose  Endoscopic mucosal resection assisted by submucosal injection of saline is a widely used procedure; however, it has three limitations: 1) it often is difficult to maintain a desirable level of tissue elevation after the injection; 2) the saline has no efficacy in preventing hemorrhage; 3) nothing can protect the site of mucosal defect after endoscopic mucosal resection to prevent perforation. Blood, as a new medium for use in submucosal injection, may remedy these drawbacks. This is the first report of this technique.

Spatio–temporal VEGF and PDGF Delivery Patterns Blood Vessel Formation and Maturation

Purpose  Biological mechanisms of tissue regeneration are often complex, involving the tightly coordinated spatial and temporal presentation of multiple factors. We investigated whether spatially compartmentalized and sequential delivery of factors can be used to pattern new blood vessel formation.

Changes in Blood Lipid Levels following Silastic Ring Vertical Gastroplasty

Background  The purpose of this study was to evaluate the effect of the Silastic Ring Vertical Gastroplasty (SRVG) operation on blood lipid levels in obese men and women during the first year following surgery.

Hemispheric asymmetries in blood flowduring color stimulation

Abstract    Visual stimulation influences mean blood flow velocities (MBFV) in posterior cerebral arteries (PCA). In 51 healthy, right-handed volunteers MBFV were measured in PCA with opened and closed eyes and while watching colored light (red, yellow, green, blue) for 1 minute. Volunteers had eyes closed 2 minutes between different colors. MBFV in left PCA was 41.2 ± 8.6 cm/s (mean ± 2SD) and 27.8 ± 8.5 cm/s with eyes opened and closed, respectively. For red light MBFV in left PCA was 31.4 ± 7.1 cm/s, for yellow 31.4 ± 7.2 cm/s, for green 32.0 ± 8.3 cm/s, and for blue 33.0 ± 7.6 cm/s. MBFV in right PCA 41.7 ± 8.9 cm/s and 28.2 ± 9.1 cm/s with eyes opened and closed, respectively. For red light MBFV in right PCA was 39.4 ± 8.4 cm/s, for yellow 38.9 ± 9.2 cm/s, for green 37.8 ± 9.4 cm/s and for blue 38.0 ± 8.8 cm/s. There was no significant difference in MBFV between left and right PCA with eyes opened and closed, but MBFV were significantly higher in right PCA for each color than corresponding MBFV in left PCA. These findings could indicate the greater metabolism of visual cortex in right occipital lobe while watching colors. Visual cortex of right occipital lobe could have greater importance in color perception than visual cortex of left occipital lobe.

Vitamin C supplementation decreases oxidative DNA damage in mononuclear blood cells of smokers

Summary. Background:   Antioxidants, in particular vitamin C, have been suggested to decrease oxidative DNA damage. Such effects have been shown in mononuclear blood cells in the first few hours after ingestion, whereas studies of longer-term effects in well-nourished humans have been mainly negative.

Coronary blood flow regulation in the prediabetic metabolic syndrome

Abstract.   This study tested whether the pre-diabetic metabolicsyndrome impairs coronary blood ow control sufciently to alterthe balance between coronary blood ow and myocardialmetabolism. Experiments were conducted in dogs instrumented withcatheters in the aorta, coronary sinus, and left ventricle andwith ow transducers around the circumex coronary artery andaorta. Coronary blood ow, myocardial oxygen consumption(MVO2), cardiac output, aortic pressure,left ventricular pressure and heart rate were measured at restand during treadmill exercise in normal, control and high fatfed dogs. High fat feeding for ~ six weeks increased body weight15%, increased aortic blood pressure 10%, and induced insulinresistance. Fasting plasma insulin levels were increased2.4-fold while plasma glucose concentration was unchangedrelative to controls (5.0 ± 0.3 mM). The cardiac index increasedwith exercise but was not altered by high fat feeding. Themetabolic syndrome reduced the slope of the relationship betweencoronary blood ow and MVO2 (P < 0.0001) and decreased coronaryvenous PO2 at a given level ofMVO2 (P < 0.05). These ndings indicatethat the metabolic syndrome impairs the balance betweenmyocardial oxygen delivery and metabolism by tonicallyvasoconstricting the coronary circulation.

Blood flow is an important determinant of forearm glucose uptake following a mixed meal

Abstract.   Insulin-mediated vasodilation has been suggested to be ofimportance for glucose uptake during normoglycemichyperinsulinemia. If this also is valid after an ordinary mixedmeal remains to be evaluated. Forearm blood flow (FBF) andforearm glucose uptake change (evaluated by venous occlusionplethysmography) and glucose arteriovenous differences wereevaluated over 120 minutes in 10 healthy volunteers following anordinary mixed meal (700–900 kcal, 34% of energy from fat).Fasting arterial glucose level was 4.9±0.9 mmol/l, and themaximum glucose level was reached 30 minutes after the start ofingestion (6.6±0.8 mmol/l, p<0.0001). Plasma insulin levelswere increased four-fold. FBF increased rapidly within 20minutes after the start of ingestion and reached its maximumafter 50 minutes (94% higher than baseline level,p<0.01). After 2 hours FBFwas still substantially elevated (75% above baseline level,p<0.01). Forearm glucoseuptake increased fivefold already after 20 minutes (p<0.01). During the 2 hours, theincrease in FBF contributed to 41% of the forearm glucose uptake(p<0.05). The presentstudy showed that the increase in FBF seen after an ordinarymixed meal is important for the change in forearm glucoseuptake. These results support the view that modulation of limbblood flow is a determinant of glucose uptake.

Changes in blood-brain barrier permeability during hot water-induced seizures in rats

Abstract.   Hot water epilepsy (HWE) was induced in freely movingWistar rats by applying hot water jets over the head region. Thestatus of the blood-brain barrier (BBB) during the seizures andduring hot water-induced hyperthermia without seizures wasexamined using Evans blue dye. In order to investigate thecontribution of concomitant factors to this process,synchronized body temperature and blood pressure recordings werealso made. Tonic-clonic seizure activity was observed within anaverage of 3.9 min (SE=0.6 min) in the rats exposed to the hotwater jets; this treatment induced BBB opening in the corticaland deep brain areas. Body temperature and blood pressureincreased from 36.5°±0.3°C to 40.0°±0.2°C, and from 91±3 mmHg to153±4 mmHg, respectively. In the group of animals exposed to hotwater application without inducing seizures, there weresignificant increases both in blood pressure and bodytemperature; however, the extravasation of Evans blue was notpronounced in the brains. Hot water-induced seizures, increasedcerebrovascular permeability. Although high blood pressure andhyperthermia contribute to this permeability, the seizureactivity is the major factor in this change.

Effects of knee flexion following knee arthroplasty on postoperative blood loss: a study on 50 patients

Abstract   Increased public and medical concerns regarding transfusion-associated infections and the cost involved in blood transfusion necessitate the imperative to justify transfusions. Since knee arthroplasties are often performed under tourniquet control, most blood loss occurs in the postoperative period. This makes this surgery ideally suited for evaluating techniques that decrease postoperative blood loss. A prospective study was carried out on 50 primary knee replacements (25 knees flexed, 25 knees extended) to evaluate the effect of maintaining the knee in 90 degrees of flexion in the immediate (24 h) postoperative period on postoperative need for transfusion. The volume of blood collected in the drains was used to estimate postoperative blood loss. Drop in haemoglobin was estimated by calculating the difference in preoperative and postoperative concentrations. Patients in the group with flexion of the knee lost a mean of 313 ml blood (2.0 g/dl drop in Hb); this was significantly less than that in the control (extension) group which lost 590 ml (3.2 g/dl drop in Hb). This decreased blood loss in the flexion group was reflected in the transfusion rates: 1 patient in the flexion group requiring transfusion compared to 6 patients in the extension group. Knee flexion following knee replacement is a simple yet effective method for decreasing postoperative blood loss and therefore transfusion rates.

The association of hypertension and diabetes: prevalence, cardiovascular risk and protection by blood pressure reduction

Abstract   Diabetes and hypertension frequently coexist, and their combination provides additive increases in the risk of life-threatening cardiovascular events. Recent guidelines agree on the need for early, aggressive reduction of blood pressure, with a goal of <130/80 mmHg, in patients with diabetes. The mechanism that underpins the increased sensitivity of diabetic subjects to hypertension is not known, but may involve impaired autoregulation or attenuated nocturnal decrease of blood pressure. All classes of antihypertensive agents are effective in reducing blood pressure in diabetic subjects, and all show evidence of a concomitant reduction in cardiovascular risk. Although there is some evidence that agents that interrupt the renin–angiotensin system (RAS) provide greater protective effects, the data are not conclusive. However, most diabetic subjects will require combination therapy to reach goal blood pressure. Antihypertensive drugs can also significantly influence the probability that otherwise healthy individuals will develop metabolic syndrome or type 2 diabetes. While diuretics and betablockers have a prodiabetic effect, angiotensin–converting enzyme inhibitors and angiotensin II receptor blockers may prevent diabetes more effectively than the metabolically neutral calcium channel blockers. Given that diabetes is an important cardiovascular risk factor, there is the potential for reductions in risk due to reduced blood pressure to be offset by an increased risk due to the development of diabetes. Such concerns should be considered in the selection of antihypertensive therapy.

Abnormal heart rate and blood pressure responses to baroreflex stimulation in multiple sclerosis patients

Abstract   Cardiovascular autonomic neuropathy has been previously reported in patients with multiple sclerosis (MS) using standard reflex tests. However, no study has separately evaluated both parasympathetic and sympathetic cardiovascular autonomic regulation. We therefore assessed the baroreflex-mediated vagal and sympathetic control of the heart rate and sympathetic control of the blood vessels in MS patients using sinusoidal neck stimulation.We studied 13 multiple sclerosis patients aged 28–58 years and 18 healthy controls aged 26–58 years. The carotid baroreflex was stimulated by sinusoidal neck suction (0 to –30 mmHg) at 0.1 Hz to assess the autonomic control of the heart and blood vessels, and at 0.2 Hz to assess the vagal control of the heart. Continuous recordings were made of blood pressure, electrocardiographic RR-interval and respiration, with breathing paced at 0.25 Hz. Spectral analysis was used to evaluate the magnitude of the low frequency (LF, 0.03–0.14 Hz) and high frequency (HF, 0.15–0.50 Hz) oscillations in RR-interval and blood pressure in response to the sinusoidal baroreceptor stimulation. Responses to the applied stimulus were assessed as the change in the spectral power of the RR-interval and blood pressure fluctuations at the stimulating frequency from the baseline values.

The Influence of Blood Transfusion on Mortality in Multiply Injured Patients

Abstract Background and Purpose:   Severely injured patients often need large amounts of blood transfusion. Besides the life-saving effect, it is known to have negative side effects as well, affecting multiple organ systems. These side effects may add significantly to the already high mortality rate of these patients. This study was undertaken to determine the independent influence of the speed (= relative) as well as the total (= absolute) amount of blood transfusion given to multiply injured patients on mortality.

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