Hypertension affects nearly half of US adults, with 10-20% resistant to pharmacological treatment. Transcranial focused ultrasound (FUS) targeting the periaqueductal grey (PAG) offers non-invasive neuromodulation for blood pressure control, but optimal parameters remain undefined. To systematically investigate FUS parameters for maximizing blood pressure reduction and identify the underlying biological cascade and biophysical mechanisms. We systematically investigated 12 ultrasound exposure schemes in male and female rats, examining the biological cascade from neuronal activation (cFOS and Gad67 immunohistochemistry) through systemic biomarkers (beta-endorphin, neurotensin, angiotensin II, renin-1) to hemodynamic endpoints (systolic and diastolic blood pressure). Hydrophone measurements were used to detect cavitation emissions. Optimal FUS parameters produced sex-independent reductions in systolic and diastolic blood pressure (-25 mmHg) lasting 24 hours. Immunohistochemistry revealed activation of GABAergic neurons (increased cFOS and Gad67), while plasma analysis demonstrated suppression of angiotensin II (-28 pg/mL) and renin-1 (-8 pg/mL) without altering beta-endorphin or neurotensin. We identified a non-monotonic relationship between ultrasound intensity and physiological responses, consistent with biphasic inhibitory neuron activation. Hydrophone measurements ruled out cavitation-mediated neuromodulation, and point towards thermal and radiation force mechanisms. These findings establish optimal parameters and mechanisms for PAG-targeted FUS for blood pressure control, providing a foundation for clinical translation to populations where conventional antihypertensives are ineffective or unsafe.
To evaluate diagnostic equity, feasibility and acceptability of a remote photoplethysmography-based blood pressure screening application among adults with darker skin tones in Nigeria. Prospective observational multisite field evaluation. Three hospitals in Kebbi State, Nigeria. Adults with Fitzpatrick skin types V-VI. Feasibility, agreement, diagnostic accuracy, acceptability, and equity relevant factors including facial tribal markings and internet bandwidth, using automated cuff measurements as the reference standard and a 140 over 90 mm Hg hypertension threshold. Among 306 enrolled participants, 249 (81.4%) produced usable readings. Agreement was poor (systolic mean absolute error (MAE) 15.4 mm Hg, root mean square error (RMSE) 19.9; diastolic MAE 10.9 mm Hg, RMSE 13.6). Sensitivity for threshold-based systolic and diastolic blood pressure classification was very low (systolic 0.04; diastolic 0.10), with systolic sensitivity 0.00 in Fitzpatrick type VI. Specificity was high (systolic 0.99; diastolic 0.89). Lower internet bandwidth correlated with reading failure (r = -0.69 to -0.51). While 70% of patients and over 90% of staff rated the tool favourably, technical limitations created a clear perception-performance gap. In an exploratory interaction analysis, Fitzpatrick type VI was associated with higher odds of measurement failure (OR 5.08, 95% CI 2.41 to 10.72), but there was no clear evidence that facial tribal markings modified this association (interaction OR 0.66, 95% CI 0.16 to 2.73; p=0.564). Remote photoplethysmography (rPPG)-based blood pressure screening was feasible but showed inadequate performance in this darker-skinned field cohort, with critically low sensitivity. Without algorithmic recalibration for skin tone diversity and improved offline functionality, cloud-dependent rPPG systems deployed without spectrum-balanced validation may risk exacerbating diagnostic inequities in similar settings.
Developmental programming is a key determinant of adult hypertension. Total parenteral nutrition (TPN) can exert nutritional stress during development and cause irreversible programming of metabolism via epigenetic modifications, often caused by imbalances in dietary methyl nutrients. Betaine and creatine (B+C) can increase the availability of methyl groups, but they are not included in commercial TPN formulations. We hypothesized that receiving TPN during early life would increase blood pressure in adulthood and that supplementing TPN with B+C would prevent this programming. Intrauterine growth-restricted neonates (IUGR) have been shown to develop hypertension in adult life; thus, we hypothesized that IUGR would exacerbate the TPN effect. We used 7-d-old normal birth weight female Yucatan miniature piglets (n = 24) that were randomly assigned to the following diets: sow-fed (SowFed), TPN control (TPN-control), and TPN with B+C (TPN-B+C), with 8 IUGR piglets fed TPN as a fourth group (TPN-IUGR). After 2 wk of the experimental diets, all pigs were fed a grower diet until adulthood. At 8 mo, a telemeter was implanted to measure 24-h blood pressure (BP) before and after a 2-wk high salt diet. Although BP was not different between TPN-control and SowFed adult pigs, the addition of B+C to neonatal TPN reduced mean (by 9.5 mmHg) and systolic (by 7.1 mmHg) arterial pressure (P<0.05; ANOVA, Dunnett's comparison to TPN-control) in adulthood. However, the expression of key renin-angiotensin system genes was not altered in adult pigs. The BP parameters increased in response to a high salt challenge in all pigs (by 6.2-15.4 mmHg; P<0.05; paired t-tests), but the neonatal diet did not affect the response. These data collectively suggest that TPN feeding in early life does not alter adult blood pressure but supplementing B+C in TPN may reduce the risk of hypertension.
To evaluate the association of intra-arrest diastolic blood pressure and end-tidal carbon dioxide with return of spontaneous circulation in adult ICU cardiac arrest. This prospective observational study was conducted in an adult medical-surgical ICU over 9 months. Adult patients with an indwelling arterial catheter and mainstream capnography at the time of cardiac arrest were included. Diastolic blood pressure (DBP) and end-tidal carbon dioxide (EtCO2) were recorded at the end of each 2-minute CPR cycle. The primary analysis used mean DBP and mean EtCO2 across the CPR episode. Last recorded pre-outcome values were analyzed separately as secondary peri-outcome measures. The primary outcome was ROSC. Associations were assessed using logistic regression, and discrimination was evaluated using receiver operating characteristic curve analysis. A total of 68 cardiac arrest events from 63 patients were analyzed; ROSC was achieved in 29 events (42.6%). Mean DBP across the CPR episode was higher in events achieving ROSC than in those without ROSC (39 ± 18 vs 24 ± 10 mmHg; mean difference 15 mmHg, 95% CI 8-23; p < 0.001). Mean EtCO2 was also higher in events achieving ROSC (19 ± 5 vs 15 ± 6 mmHg; mean difference 4 mmHg, 95% CI 1-6; p = 0.010). For mean values, DBP showed numerically higher discrimination than EtCO2, but the difference was not statistically significant (AUC 0.78 vs 0.69; DeLong p = 0.30). In secondary peri-outcome analysis, last recorded pre-outcome values had higher AUCs, particularly for DBP (0.96 vs 0.85; DeLong p = 0.04), although this time point was identifiable only after ROSC or termination of resuscitation. In adult ICU cardiac arrest events with simultaneous arterial pressure and capnographic monitoring, both DBP and EtCO2 were associated with ROSC. DBP showed numerically higher discrimination than EtCO2, although this was not statistically significant for mean values across the CPR episode. Last recorded pre-outcome values should be interpreted only as peri-outcome associations and not as real-time predictors or treatment targets. DBP and EtCO2 should be viewed as complementary physiologic markers during CPR.
Blood pressure (BP) variability is an independent risk factor for cardiovascular disease. Gut microbiome (GM) regulates BP, but its association with BP variability remains unclear. We examined the association of GM, determined by stool shotgun metagenomic sequencing, with 24-hour BP average real variability (ARV) assessed by ambulatory BP monitoring in 235 community-dwelling adults from Hong Kong (111 men and 124 women, mean age 54 ± 6 years) using covariate-adjusted statistical models. The GM alpha diversity was negatively associated with systolic BP (SBP) ARV in the full cohort, driven by women. In men, beta diversity of both GM species and function was associated with SBP ARV, while Bacteroides nordii and the steroid hormone biosynthesis pathway had a positive association with SBP ARV. Bacteroides nordii emerged as the key species driving the significant positive association of steroid hormone biosynthesis and other pro-pathogenic pathways with SBP ARV, including lipopolysaccharide biosynthesis, phenylalanine, and sulfur metabolism in men, warranting further investigation for its causal role. We demonstrated distinct signatures of GM dysbiosis, composition, and function with minimal overlap between men and women with increased 24-hour SBP variability. Our work suggests that sex differences should be an important consideration in mechanistic and therapeutic investigations of GM-mediated BP variability.
Uncontrolled blood pressure (BP) poses a significant threat to public health, contributing to increased all-cause and cardiovascular disease (CVD) mortality.The study objectives were to assess BP control among hypertensive patients attending primary care centers in Qatar and to explore the association between patient-specific factors and BP control. A retrospective chart review from 2017 to 2020 was conducted across Qatar primary care centers. A sample size of 400 patients per year was chosen to be able to estimate the yearly proportion of patients achieving BP control (the primary outcome) to within a margin of error of at most 5% using 95% confidence interval. Univariable and multivariable logistic regression models were used to assess the relationship between patient variables and BP control. Among the 2,185 selected patients, over 60% of general hypertensive patients achieved BP control, (n=1226/1859, 66% in 2018), (n=1398/2038, 69% in 2019), and (n=1229/1897, 65% in 2020). More than 60% of diabetics or patients with chronic kidney disease (CKD) reached target BP levels (n=882/1309, 67.4% in 2018), (n=1002/1402, 71.5% in 2019), and (n=878/1314, 66.8% in 2020). Gender, nationality (Qatari vs. non-Qatari), and presence of comorbidities like dyslipidemia, congestive heart failure, peripheral vascular disease, atrial fibrillation and CKD were found to significantly impact BP levels. This study suggests that over half of hypertensive patients in Qatar's primary care setting achieved controlled BP. Key predictors of BP control included Qatari nationality, dyslipidemia, and CHF. However, due to the inherent limitations of retrospective chart review methodology, these results should be interpreted judiciously. Future prospective studies are crucial to corroborate these predictors and inform the development of tailored strategies to overcome barriers for achieving optimal BP control.
The skill of measurement of blood pressure (BP) is limited to a brief demonstration during Phase I MBBS without retraining/reinforcement in any other phases of training. Disparity of skill retention among the students along with limitation of resource leads to lack of mastery. The study aims to determine the effectiveness of Demonstration Observation Assistance Performance (DOAP) and Video Assisted Learning (VAL) as a teaching-learning method for measurement of BP in Physiology and analyse the perception of students and faculty of DOAP and VAL as a teaching-learning tool. The cross-sectional study was conducted for a duration of 5 months from September 2024 to January 2025 on Phase 1 MBBS students of 2024 - 2025 batch enrolled in the Institute. Using non-randomized convenience sampling method, 148 students were divided into two groups A and B of 74 students each. Each group were divided into 11 subgroups for which a teacher is assigned and Group A were trained by DOAP while group B trained by using VAL in separate session. Assessment was done by Objective Structured Clinical Examination (OSCE) for each group and the groups swap to prevent disparity. Perception using 5-point Likert scale-based feedback questionnaires were taken from both the students and the teachers to evaluate skill acquisition and learner satisfaction. Statistical analysis was done using independent t test and Chi-Square/Fisher exact test. There was statistically significant increase (P value = 0.001) in the mean OSCE score of DOAP (8.52 ± 0.64) as compared to that of VAL (7.73 ± 1.06). Perception of both students and teachers shows DOAP as a more effective teaching learning method but has limitation of resources while VAL is more convenient and flexible. A combination of DOAP and VAL can create an integrated blended learning that uses the strength of both to enhance the learning of practical skills.
It is recommended to use a tourniquet cuff pressure between 40-80% of the individuals' arterial occlusion pressure (AOP) during blood flow restriction (BFR) exercise. The AOP is usually determined in one limb for unilateral BFR exercise or in both limbs individually for bilateral BFR exercise. However, given that the tourniquet cuffs are inflated at both limbs simultaneously during bilateral BFR exercises (e.g., cycling, walking, and squat exercise), it is currently not known if the respective AOP also needs to be determined during bilateral tourniquet cuff inflation. Consequently, the present study aimed to compare the AOP during unilateral versus bilateral tourniquet cuff inflation in the lower extremities. In a randomized cross-over trial, the AOP of 25 young healthy participants was determined during unilateral and bilateral tourniquet cuff inflation in supine, seated, and standing position. All measurements were completed in one experimental session with a rest period of 5 min in between. At the beginning and end of each condition, heart rate and blood pressure were recorded. Regardless of body position, AOP was higher during bilateral compared to unilateral tourniquet cuff inflation (mean difference = 3.2 mmHg [95% confidence interval: 1.0, 5.4], p = 0.006, d = 0.12). Furthermore, AOP and heart rate increased with change in body position from supine to seated to standing position (p < 0.001, d ≥ 0.76). Even though there was a statistically significant difference in AOP between unilateral and bilateral tourniquet cuff inflation irrespective of body position, bilateral cuff inflation during AOP determination appears to have only minor impact on AOP in the lower extremities given the small mean difference and trivial effect size. However, since differences in AOP between unilateral and bilateral tourniquet cuff inflation of ≥ 30 mmHg have been recorded, practitioners must be aware of potentially pronounced differences between unilateral and bilateral cuff inflation during AOP determination in some individuals using the specific BFR device and AOP measurement protocol employed in this study. These results need to be verified for different inflation protocols, devices (i.e., manual versus automatic AOP determination), and populations (e.g., older adults, patients).
Ultrasound‑mediated microbubble cavitation can induce transient tumor perfusion loss (TTPL), yet the pressure‑dependent magnitude and short‑timescale recovery of this effect remains poorly defined. This study investigated how acoustic pressure governs both the extent and duration of TTPL following a single cavitation exposure. Subcutaneous hepatocellular carcinoma tumors (HEPG2 human cell line) in athymic nude mice (n = 15) received a 1‑second cavitation treatment at peak‑negative pressures of 1.4, 2.8, or 4.1 MPa. Due to the small f-number of the transducer employed, the estimated average peak negative pressures of these conditions within the tumor were 0.6, 1.1, and 1.7 MPa respectively. Tumor perfusion was evaluated using contrast‑enhanced ultrasound (CEUS) immediately (within 1 min), 5, 15, 30, and 60 min after treatment. Perfused area loss was quantified with a maximum intensity projection time‑area curve (MIP‑TAC) metric. Cavitation activity was assessed using passive cavitation detection (PCD), and histology evaluated acute tissue effects. Low acoustic pressure produced only partial perfusion loss with full recovery within 5 min. Moderate acoustic pressure induced substantial TTPL followed by near complete recovery by 15 min. High‑pressure treatment caused complete perfusion loss in all tumors, with initial recovery at 15 min but also with a subsequent decline over the hour. Elevated broadband energy recorded with PCD confirmed inertial cavitation in the moderate and high conditions. Histology revealed damage‑associated staining in 1/5 moderate‑pressure tumors and 3/5 high‑pressure tumors, consistent with pressure‑dependent mechanical injury, possibly contributing to the gradual decline in tumor perfusion observed after initial rebound in the high-pressure condition.
The impact of different mechanical ventilation modes on pulmonary outcomes following laparoscopic surgery in the Trendelenburg position remains unclear. This study aimed to compare the effects of two common ventilation modes on postoperative pulmonary complications (PPCs) in elderly patients undergoing such procedures. Elderly patients scheduled for laparoscopic surgery in the Trendelenburg position were randomly allocated to receive either pressure-controlled ventilation (PCV) or volume-controlled ventilation (VCV). Both groups were managed with a lung-protective ventilation strategy. The primary outcome was the incidence of PPCs within the first three postoperative days. Airway pressures, details enabling the calculation of respiratory system dynamic compliance (Cdyn) and arterial blood gas levels were also recorded at predetermined intraoperative time points: before anesthesia induction (T0); 10 min after tracheal intubation in the supine position without pneumoperitoneum (T1); 30 min (T2) and 60 min (T3) after establishing pneumoperitoneum and the Trendelenburg position; and at the end of surgery after returning to the supine position (T4). Compared with the VCV group (32.1%), the PCV group exhibited a significantly lower incidence of PPCs (13.0%; χ2 = 5.758, P = 0.016) (RR = 0.403, 95% CI: 0.183-0.888). Furthermore, patients managed with PCV exhibited significantly lower intraoperative airway pressures-including peak airway pressure (Ppeak), plateau pressure (Pplat), and driving pressure (ΔP)-as well as reduced dead space fraction (VD/VT) and arterial partial pressure of carbon dioxide (PaCO₂). Cdyn was higher in the PCV group. In elderly patients undergoing laparoscopic surgery in the Trendelenburg position, pressure-controlled ventilation was shown to improve Cdyn and was associated with a lower composite rate of postoperative pulmonary complications than volume-controlled ventilation. Whether these physiological advantages translate into clinically meaningful benefit requires confirmation in larger studies.
The diagnosis of normal-pressure hydrocephalus (NPH) is often complicated due to deficiencies of the objective measures currently used after test drainage of CSF. We used Arterial Spin Labeled Magnetic Resonance Imaging (ASL-MRI)-a novel, simplified, completely non-invasive, radiation-free method-to measure global cerebral blood flow (CBF) before and after performing a large-volume lumbar puncture (LVLP) in patients suspected of NPH. We compared baseline ASL-CBF in 20 patients (65-91 years old, mean: 75 years; 11 men) with history of recurrent falls from unsteady gait, urinary incontinence, cognitive decline, and ventriculomegaly (Evans index >0.30). After LVLP under fluoroscopy draining 20-53 mL of CSF we measured ASL-CBF and compared the cerebral perfusion with baseline values for whole brain, predefined cortical regions, deep grey nuclei, and periventricular white matter. Correlation was assessed with changes in gait speed and balance, neuropsychology testing and urinary incontinence. Post-LVLP all patients had significant increase in global ASL-CBF with mean values rising from 39 to 45 mL/100g/min (p <0.01). CBF enhancement was notable in gray matter regions, thalamus and periventricular frontal white matter. Draining ≤40 mL of CSF resulted on average CBF increase of 0.9 mL/100g/min compared with 5.2 mL/100g/min after draining 50 mL of CSF (p <0.01) indicating a dose-response relationship whereby draining <40 mL of CSF may not be adequate to diagnose NPH. We confirmed the occurrence of CBF hypoperfusion in NPH. Linear mixed-effects model for regional blood flow analysis confirmed consistent enhancement of cerebral perfusion in all evaluated regions post-lumbar puncture. Exploratory analysis to correlate baseline CBF with the magnitude of change post-lumbar puncture revealed a negative correlation (Pearson r = -0.819 p = 0.000) indicating that patients with lower baseline CBF exhibited larger increases in perfusion after CSF drainage. There was a positive correlation between enhancement of CBF and improvement of gait speed and balance. Using ASL-MRI we have demonstrated that global cerebral hypoperfusion is a constant feature of NPH that improves with CSF drainage. As a result, the clinical diagnosis of NPH can be greatly simplified using ASL-MRI.
Multimodality treatment with catheter-based intervention is still commonly used for pulmonary atresia with ventricular septal defect (PA/VSD) or hemi-truncus with major aortopulmonary artery collateral arteries (MAPCAs) requiring unifocalization. A total of 12 patients with PA/VSD with MAPCAs (n = 10) or hemi-truncus (n = 2) who had undergone unifocalization since 1994 were enrolled. The development of the central pulmonary artery (cPA) was absent in 2 patients, diminutive (< 2 mm) in 3, sizable (> 2 mm) in 5, and unilateral (hemi-truncus) in 2. Treatment strategy was determined according to the morphology of the central PA. VSD closure was not performed at the same time of unifocalization. The source of pulmonary blood flow from completion of unifocalization to VSD closure was either systemic to pulmonary artery shunt (SPS) or right ventricle-to-pulmonary artery (RV-PA) conduit. A total of 39 catheterizations were performed. Median follow-up was 13.2 years [interquartile range: 2.3-16.5 years]. All patients achieved VSD closure. Cumulative survival rate was 83.3% at 10 years. Median RV to aortic pressure (AoP) ratio during VSD closure was 0.57 [0.51-0.75]. After a patient with partial anomalous pulmonary venous connection and pulmonary hypertension was eliminated RV/AoP was lower in RV-PA conduit (n = 5) than in SPS cases (n = 6) (0.49 vs. 0.76, p = 0.014). RV-PA conduit as a source of pulmonary blood flow facilitates blood flow control and effective catheter-based intervention to reconstructed PA after unifocalization then contributed maintaining low RV pressure at VSD closure.
Background Hypertension is a leading modifiable risk factor for cardiovascular morbidity and mortality worldwide, yet substantial gaps persist in its detection and management in low- and middle-income countries. Understanding where attrition occurs along the hypertension care cascade is critical for identifying high-impact intervention points, particularly in settings undergoing rapid demographic and epidemiological transition. Methods The original parent study informing this secondary analysis was a community-based cross-sectional analysis of adults aged 18 years and older in rural and urban districts of Northwestern Tanzania using data from a baseline non-communicable disease survey in 2019. Twelve districts across six regions were selected through a multistage cluster sampling approach. Hypertension care was assessed using a cascade-of-care framework comprising four sequential stages: prior blood pressure screening, prior diagnosis, access to antihypertensive medication, and blood pressure control at the time of screening. Analyses were stratified by rural-urban residence, with statistical comparisons accounting for clustering at the district level. Results Among 6,957 participants, 26% reported ever having their blood pressure measured by a health professional, with no significant difference between rural and urban settings (28% vs. 24%, p = 0.09). Among those previously screened, 42% reported a prior diagnosis of hypertension, with a higher proportion among rural residents (45% vs. 39%, p = 0.001). Approximately half of diagnosed individuals reported access to antihypertensive medication, with no rural-urban differences. Among participants with medication access, 64% achieved blood pressure control, with comparable control rates across settings. Conclusion The primary bottleneck in hypertension care in Northwestern Tanzania occurs at early detection, with uniformly low screening across rural and urban populations. Once identified and treated, effective blood pressure control is achievable. Strengthening early screening and care activation represents the greatest opportunity to improve hypertension outcomes and provides a critical pre-pandemic baseline to inform policy and programmatic interventions.
This study aimed to investigate the effect of ambient temperature on intradialytic hypotension (IDH) in hemodialysis (HD) patients. A single-center retrospective cohort study. Patients receiving HD at the HD center at Shanghai Sixth People's Hospital between January 1, 2022, and May 31, 2025. Ambient temperature and demographics (age, sex, dry weight, predialysis systolic blood pressure (SBP), interdialytic weight gain, HD shifts, modalities, dialysate calcium concentration, and ultrafiltration rate) were primary and secondary predictors. The primary outcome of this study was IDH. Pearson χ2 tests for categorical variables and t test for continuous variables. Logistic regression was used to analyze IDH risk per temperature bin relative to the highest. We collected 946,703 blood pressure records from 149,273 HD sessions. IDH occurred in 5,073 sessions, accounting for a prevalence of 3.4%. Compared with sessions at an ambient temperature of 33.5-35.5 °C, HD patients had a 2-fold higher risk of IDH when the ambient temperature was less than or equal to -0.5 °C. Furthermore, each 2 °C decrease in ambient temperature was associated with a 4.4% increase in IDH risk. Sensitivity analyses indicated that 21.5 °C as the temperature threshold shows the risk difference under the Nadir90/100 definition. The 3-way interaction indicated that patients with predialysis SBP ≥ 140 mm Hg and UFR ≤ 500 mL in spring and summer have the lowest intradialytic IDH risk. In addition, the analysis identified age, sex, HD shifts, predialysis SBP, interdialytic weight gain, dialysate calcium concentration, ultrafiltration rate, and season as independent risk factors for IDH. A single-center, retrospective, and observational study design, not considering indoor temperature, inconsistent threshold analysis results, and ambiguity risk factors. Lower ambient temperatures significantly increase the risk of IDH occurrence. Clinical staff should integrate ambient temperature, patient characteristics, and HD parameters into risk assessments to enhance early prevention, monitoring, and intervention of IDH. This large-sample retrospective observational study collected intradialytic blood pressure data from adult patients at a single hemodialysis center in Shanghai over 3.5 years, aiming to characterize the association between ambient temperature and intradialytic hypotension (IDH) risk. IDH is a prevalent intradialytic complication, significantly affecting dialysis adequacy and patient safety. Its pathogenesis is multifactorial, with established individual factors including predialysis systolic blood pressure, ultrafiltration rate, and interdialytic weight gain, whereas the role of climatic factors remains unclear. This study provides preliminary insights into the effect of ambient temperature on IDH, offering references for optimized clinical management.
Long-distance medical evacuation by ground, maritime, and fixed-wing air transport (EVASAN) from Mayotte to La Réunion is frequent for pediatric neurocritical patients. The impact of EVASAN on intracranial pressure (ICP) control is poorly documented, especially in this geographic and socioeconomic context. We aimed to analyze ICP variations during EVASAN and to describe associated physiological parameters and short-term outcomes. Retrospective cohort study of pediatric patients (< 18 lt; 18 years) evacuated from Mayotte to La Réunion between January 2019 and December 2024 with invasive ICP monitoring at departure (n = 22). ICP values and clinical variables (mean arterial pressure [MAP], heart rate [HR], oxygen saturation [SpO2], end-tidal carbon dioxide [EtCO2], fraction of inspired oxygen [FiO2], temperature, sedation, and vasopressor use) were extracted at predefined time points: initial (baseline), departure (intensive care unit), ferry transfer, takeoff, during flight, landing, and arrival at La Réunion pediatric intensive care unit. Primary outcome was ICP variation during EVASAN. Wilcoxon signed-rank tests compared paired time points; Spearman correlations explored associations. The study was approved under MR-004; consent was obtained as described. A total of 22 patients (mean age 9.4 years, 73% pediatric traumatic brain injury) were included. The ferry phase was associated with a modest but statistically significant median increase in ICP (+ 5 mm Hg, P = .038). No sustained increase between departure and arrival was observed (median + 3 mm Hg, P = .251). FiO2 increased from a median of 0.3 to 0.4 (P = .008), whereas SpO2, MAP, HR, and EtCO2 remained stable. There was no correlation between ICP variation and 6-month Pediatric Glasgow Outcome Scale scores. Missing data and heterogeneity of care restricted inference. In this single-center retrospective series, EVASAN was associated with transient ICP increases during the maritime ferry phase but not with sustained intracranial hypertension at arrival nor worse mid-term neurological outcome.
Sepsis is a critical illness characterized by pronounced temporal dynamics and marked heterogeneity of organ perfusion. Current hemodynamic management relies largely on global macro-circulatory variables such as MAP and CO, but these measures provide limited insight into inter-organ blood-flow redistribution and often fail to detect occult hypoperfusion in vulnerable tissues. Consequently, organ dysfunction may continue to progress even when systemic targets appear to be achieved. The arterial resistance index (RI) can be repeatedly assessed in specific organs with relatively high temporal resolution, it provides a practical signal for tracking perfusion heterogeneity in sepsis. On this basis, this review reframes sepsis as a process dominated by dynamic blood-flow redistribution rather than a single, homogeneous state of circulatory failure and proposes the Arterial Resistance Index Series in Echography (ARISE) framework. ARISE focuses on four representative vascular beds that capture key dimensions of circulatory regulation-including central control, vulnerable organs, and peripheral perfusion: the cerebral, renal, and superior mesenteric arteries, as well as the anatomical snuffbox artery. The framework emphasizes RI trajectories over time, inter-organ flow distribution, and the structured integration of these patterns. Available evidence indicates that arterial RI in different organs exhibits pronounced temporal variation and inter-organ heterogeneity during sepsis. Distinct trajectories are observed across central, vulnerable, and peripheral vascular beds, reflecting ongoing redistribution of blood flow as the disease evolves. Multi-organ RI assessment can reveal pathophysiological phenomena not captured by conventional macro-circulatory indices, including occult hypoperfusion, macro-microcirculatory uncoupling, and "sacrificial" redistribution. Advances in critical care ultrasonography now enable bedside, real-time, quantitative monitoring of multi-organ RI, providing the technical foundation for dynamic perfusion assessment. Overall, ARISE shifts sepsis assessment from a static pressure-flow paradigm to a dynamic framework centered on organ blood-flow distribution and evolving perfusion patterns.
Along with advancing age comes declines in physical, cognitive, and cardiovascular function. This diminished capacity may lead to decreased ability to perform activities of daily living, disability onset, and loss of independence. Exercise is a regenerative medicine therapy that can mitigate this loss of function. High intensity interval training (HIIT) is an aerobic exercise paradigm consisting of intense activity periods interspersed with bouts of active recovery. Previously we demonstrated that HIIT preserved physical function in adult, middle-aged, and older male mice. However, whether HIIT preserves physical, cognitive, and cardiovascular function, mitigates frailty, and improves brain and heart health in older adult female mice remains unknown. Cognitive, physical, and cardiovascular function in older adult female C57BL/6 will be preserved in exercised mice (HIIT) versus sedentary control (SED). Mice (HIIT and SED, both n=9, 24m at end) were tested pre/post-intervention for physical (rotarod, treadmill, grip meter, inverted cling, voluntary wheel running, activity monitor), cognitive (open field, novel object recognition, puzzle box, y-maze), and cardiovascular (blood pressure, echocardiogram) function, body composition, and whole body calorimetry. The mice underwent 14-weeks of HIIT training with progressive volume and intensity. HIIT significantly (p<0.05) increased or preserved function in many tests including: aerobic capacity (+71% HIIT versus, vs, no change, NC, in SED), four limb strength/endurance (-67% SED vs -28% HIIT), forelimb strength (-16% SED vs NC HIIT), overall motor function (NC SED vs +39% HIIT), executive function (NC SED vs +73% HIIT), and exploratory behavior, which improved across multiple tests with HIIT while remaining unchanged in SED. HIIT also reduced both systolic blood pressure by 12% (-17 mmHg) and mean arterial pressure by -16 mmHg. In addition, HIIT significantly reduced cardiac fibrosis, increased muscle fiber type 2a percentage, reduced IL-1β expression in the hypothalamus, and mitigated frailty onset. HIIT significantly reduced age-related functional loss in all three domains assessed while preventing frailty onset in older adult females and improving markers of brain and heart health.
Several cohort analyses and 2 meta-analyses show a lower risk of cerebral cavernous malformation (CCM) hemorrhage in patients taking anti-thrombotics than those without. Most of the reported patients were taking antiplatelet agents rather than anticoagulants, and little is reported on the use of anticoagulation in the setting of an acute CCM hemorrhage. We present 3 patients from our practice requiring anticoagulation in the setting of CCM hemorrhage. Patient 1 (age: 61 years) was hospitalized with headache and right arm and leg numbness after a COVID-like illness. Imaging demonstrated a right frontal CCM with subacute blood products in addition to sagittal and transverse sinus thrombosis. The patient was initiated on IV heparin and transitioned to Eliquis. While the CCM continued to have bright T1 signal, it did not result in symptoms over the 12 months of anticoagulation. Patient 2 (age: 62 years) had a history of recurrent pulmonary embolism (PE) on apixaban and underwent brain MRI as part of a metastatic work up for cancer. MRI demonstrated a medullary CCM with subacute blood products. Due to high risk of PE recurrence, anticoagulation maintained and subsequent follow-up MRIs over 1 year were stable and the patient remained asymptomatic. Patient 3 (age: 16 years) was admitted for headache and vomiting, found to have hydrocephalus, an unusual diffuse CCM with subacute blood products and initial concern for occlusion of the straight sinus. He was placed on IV heparin for possible sinus thrombosis with clinical and radiographic stability of his hemorrhages. After a ventricular drain was placed, the straight sinus resumed normal size and the original presentation thought to be pseudo-occlusion due to high pressure. The lack of symptoms and radiographic worsening in these 3 CCM patients acutely anticoagulated with presence of subacute CCM blood products supports the theory that CCM hemorrhage may relate to intra-cavernous thrombosis.
Restrictions during the COVID-19 pandemic significantly affected the global population, particularly those with chronic conditions such as hypertension and diabetes, where lifestyle changes could have disrupted disease management. This study analyzes the association between reduced physical activity (PA) and variations in physical parameters, treatment adherence, and health-related quality of life (HRQoL). A pre-post study design was conducted from March 2019 to June 2021 in a Basic Health Area of central Spain. Clinical parameters (blood pressure, BMI, and HbA1c), PA levels, treatment adherence, and HRQoL (SF-12) were measured in 152 patients before and after the lockdown. Analysis of covariance (ANCOVA) was used to compare mean differences across PA categories (quartiles), controlling for age and sex. One year after the start of the lockdown, participants showed an increase in systolic blood pressure (p = 0.030) and significant decreases in PA (p = 0.004), treatment adherence (p < 0.001), and the mental component of HRQoL (p < 0.001). ANCOVA results indicated that the effect size (partial eta squared, ηp 2) for differences in treatment adherence was 0.260, while for mental HRQoL, it was 0.040, suggesting a more moderate clinical relevance for the latter.Subjects in the lowest physical activity category exhibited the poorest outcomes after adjusting for age and sex: Mental HRQoL difference: mean = -8.13 (95% CI: -11.11 to -5.15).Adherence difference: mean = -4.80 (95% CI: -5.94 to -3.65). In contrast, participants with high PA demonstrated an improvement in treatment adherence (mean = 1.69; 95% CI: 0.31-3.06). Negative consequences of the pandemic remain observable 1 year after the lockdown in this population. Higher levels of physical activity are associated with mitigating some of these effects. However, due to the study design, caution is required when making direct causal interpretations.
Type 2 diabetes (T2D) and obesity increase individuals' risk of microvascular and macrovascular complications, which may increase healthcare costs. The RESET program combined low-calorie diet using diabetes-specific nutritional formula and a digital lifestyle behavior change program to target sustainable weight loss and improved diabetes management. To quantify projected changes in diabetes-related complication risks following the 12-week weight-loss phase of the RESET program and to relate these modeled risk reductions to program costs. Data from 157 adults with type 2 diabetes (mean age, 56 years; diabetes duration, 2.2 years; baseline body mass index (BMI), 35 kg/m²; HbA1c, 7.5%) completing the RESET weight-loss phase were analyzed. Observed mean changes in HbA1c, BMI, and systolic blood pressure were applied to the UK Prospective Diabetes Study Outcomes Model 2 (UKPDS-OM2) to estimate projected relative risk reductions in microvascular and macrovascular complications over a 3-month horizon. Program costs were derived using a microcosting approach from the healthcare payer perspective, and parameter uncertainty was evaluated through 20 000 Monte Carlo simulations. Participants achieved mean reductions of 1.0% in HbA1c, 11.0 kg in body weight, and 4.5 mmHg in systolic blood pressure. The model projected an overall relative reduction in total complication risk of 15.4% (95% confidence interval [CI], 9.1-21.4), corresponding to an absolute reduction of 1.9 projected events per 1000 participants over 3 months, comprising a -13.2% mean reduction in macrovascular and -23.8% in microvascular complication risks. Mean program cost was £1236 per participant (95% CI, £1001-£1492), corresponding to an incremental cost of £84 per 1% relative risk reduction. Short-term, intensive weight loss achieved clinically meaningful improvements in HbA1c and body weight that were associated with favorable reductions in projected microvascular and macrovascular complications at modest cost. Absolute event reductions over 3 months were modest, and sustaining these improvements is essential to realize long-term clinical and economic benefit.