Effects of Renal Sympathetic Denervation on 24-hour Blood Pressure Variability

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 BP variability. Methods and Results: Eleven consecutive patients with therapy-refractory arterial hypertension (age 68.9 ± 7.0 years; baseline systolic BP 189 ± 23 mmHg despite medication with 5.6 ± 2.1 antihypertensive drugs) underwent bilateral RDN. Twenty-four hour ambulatory BP monitoring (ABPM) was performed before RDN and 6 months thereafter. BP variability was primarily assessed by means of standard deviation of 24-h systolic arterial BP (SDsys). Secondary measures of BP variability were maximum systolic BP (MAXsys) and maximum difference between two consecutive readings of systolic BP (Δmaxsys) over 24 h. Six months after RDN, SDsys, MAXsys, and Δmaxsys were significantly reduced from 16.9 ± 4.6 to 13.5 ± 2.5 mmHg (p = 0.003), from 190 ± 22 to 172 ± 20 mmHg (p < 0.001), and from 40 ± 15 to 28 ± 7 mmHg (p = 0.006), respectively, without changes in concomitant antihypertensive therapy. Reductions of SDsys, MAXsys, and Δmaxsys 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 BP by 30.4 ± 27.7 mmHg (p = 0.007), there was only a trend in reduction of average systolic BP assessed from ABPM (149 ± 19 to 142 ± 18 mmHg; p = 0.086). Conclusion: In patients with therapy-refractory arterial hypertension, RDN leads to significant reductions of BP variability. Effects of RDN on BP variability over 24 h were more pronounced than on average levels of BP

Технологическая подготовка производства изготовления детали "Ступица" на станках с ЧПУ

В данной выпускной квалификационной работе рассмотриваются вопросы технологической подготовки производства детали "Ступица".ТПП включает в себя анализ технологичности, выбор способа получения заготовки, расчет припусков на обработку детали, проектирование технологического процесса, выбор технологического оснащения, кроме того был произведен расчет технико-экономических показателей технологического процесса и социальная ответственность на производстве.In this final qualification work, the issues of technological preparation for the production of the “Hub” part are considered. The TPP includes an analysis of manufacturability, a choice of the method for producing the workpiece, calculation of allowances for processing the part, design of the technological process, the choice of technological equipment, in addition, the calculation of technical and economic indicators technological process and social responsibility in the workplace