Central blood pressure assessment using 24-hour brachial pulse wave analysis

Maria Lorenza Muiesan, Massimo Salvetti, Fabio Bertacchini, Claudia Agabiti-Rosei, Giulia Maruelli, Efrem Colonetti, Anna Paini Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy Abstract: This review describes the use of central blood pressure (BP) measurements during ambulatory monitoring, using noninvasive devices. The principles of measuring central BP by applanation tonometry and by oscillometry are reported, and information on device validation studies is described. The pathophysiological basis for the differences between brachial and aortic pressure is discussed. The currently available methods for central aortic pressure measurement are relatively accurate, and their use has important clinical implications, such as improving diagnostic and prognostic stratification of hypertension and providing a more accurate assessment of the effect of treatment on BP. Keywords: aortic blood pressure measurements, ambulatory monitoring, pulse wave analysi

Are Baseline Levels of Gas6 and Soluble Mer Predictors of Mortality and Organ Damage in Patients with Sepsis? The Need-Speed Trial Database

Soluble tyrosine kinase receptor Mer (sMer) and its ligand Growth arrest-specific protein 6 (Gas6) are predictors of mortality in patients with sepsis. Our aim is to clarify whether their measurement at emergency department (ED) presentation is useful in risk stratification. We reanalyzed data from the Need-Speed trial, evaluating mortality and the presence of organ damage according to baseline levels of sMer and Gas6. 890 patients were eligible; no association with 7-and 30-day mortality was observed for both biomarkers (p > 0.05). sMer and Gas6 levels were significantly higher in acute kidney injury (AKI) patients compared to non-AKI ones (9.8 [4.1–17.8] vs. 7.9 [3.8–12.9] ng/mL and 34.8 [26.4–47.5] vs. 29.8 [22.1–41.6] ng/mL, respectively, for sMer and Gas6), and Gas6 also emerged as an independent AKI predictor (odds ratio (OR) 1.01 [1.00–1.02]). Both sMer and Gas6 independently predicted thrombocytopenia in sepsis patients not treated with anticoagulants (OR 1.01 [1.00–1.02] and 1.04 [1.02–1.06], respectively). Moreover, sMer was an independent predictor of both prothrombin time-international normalized ratio (PT-INR) > 1.4 (OR 1.03 [1.00–1.05]) and sepsis-induced coagulopathy (SIC) (OR 1.05 [1.02–1.07]). An early measurement of the sMer and Gas6 plasma concentration could not predict mortality. However, the biomarkers were associated with AKI, thrombocytopenia, PT-INR derangement and SIC, suggesting a role in predicting sepsis-related organ damage

Social Design. Design e bene comune.

Per questo primo doppio numero della rivista, Social Design. Design e "bene comune", curato da Marinella Ferrara, Francesco E. Guida, Mario Piazza, Paola Proverbio e Raimonda Riccini, quasi come una sfida, si è provato a rompere l’ortodossia di un approccio lineare alla storia. In questo orientamento, che tende a portare più vicino a noi i temi storici, il Social Design si offre in modo calzante per il suo essere questione contemporanea e complessa, ampia e ambigua financo controversa, anche solo dal punto di vista delle diverse espressioni sinonimiche con cui si presenta: design etico, design umanitario, design per la collettività, design di pubblica utilità, design per l’utenza ampliata, design per la sostenibilità, ... Il numero ha ricevuto la Menzione d'Onore alla XXVII edizione del Compasso d'Oro (giugno 2022), ed è stato segnalato nell'ADI Design Index 2021 (promosso da ADI, Associazione per il Disegno Industriale) nella sezione "Ricerca teorica, storica, critica e progetti editoriali"

Genetic Variants of Matrix Metalloproteinase and Sepsis: The Need Speed Study

Many causal mechanisms in sepsis susceptibility are largely unknown and the functional genetic polymorphisms (GP) of matrix metalloproteinases (MMPs) and their natural tissue inhibitor of MMPs (TIMP1) could play a role in its development. GPs of MMPs and TIMP (namely MMP-1 rs1799750, MMP-3 rs3025058, MMP-8 rs11225395, MMP-9 rs2234681, and TIMP-1 rs4898) have been compared in 1058 patients with suspected sepsis to assess the association with susceptibility and etiology of sepsis. Prevalence of MMP8 rs11225395 G/G genotype was higher in sepsis patients than in those with non-infective Systemic Inflammatory Reaction Syndrome (35.6 vs. 26%, hazard ratio, HR 1.56, 95% C.I. 1.04–2.42, p = 0.032). G/G patients developed less hyperthermia (p = 0.041), even after stratification for disease severity (p = 0.003). Patients carrying the 6A allele in MMP3 rs3025058 had a higher probability of microbiologically-proven sepsis (HR 1.4. 95%C.I. 1.01–1.94, p = 0.044), particularly when due to virus (H.R. 2.14, 95% C.I. 1.06–4.31, p = 0.046), while MMP-1 G/G genotype patients carried a higher risk for intracellular bacteria (Chlamydia, Mycoplasma, and Legionella, H.R. 6.46, 95% C.I. 1.58–26.41, p = 0.003). Neither severity of sepsis at presentation, nor 30-day mortality were influenced by the investigated variants or their haplotype. MMP8 rs11225395 G/G carriers have lower temperature at presentation and a more than 50% increased susceptibility to sepsis. Among patients with sepsis, carriers of MMP1 rs1799750 G/G have an increased susceptibility for intracellular pathogen infections, while virus serology is more often positive in those with the MMP3 rs3025058 A/A genotype

Hypertensive emergencies and urgencies: A single-centre experience in Northern Italy 2008-2015

Background: An increasing attention is given to emergency departments (EDs) admissions for an acute and severe rise in blood pressure (BP). Data on epidemiology and treatment of hypertensive emergencies and urgencies admitted to ED are still limited. The aim of our study was to evaluate the prevalence, clinical presentation and treatment of patients admitted for hypertensive emergencies or hypertensive urgencies. Methods: Medical records of consecutive patients aged at least 18 years, admitted to the ED of the Spedali Civili in Brescia in 2008 and in 2015 and presenting with SBP at least 180mmHg and/or DBP at least 120mmHg were prospectively collected and analysed. Results: The prevalence of patients admitted with acute BP rise was 2.0% (n¼1551, age 7014 years) in 2008 and 1.75% (n¼1214, age 69.715 years) in 2015. According to the clinical presentation and the presence of acute organ damage, patients were defined hypertensive emergencies (20.4 and 15.4%, respectively, in 2008 and 2015) or as hypertensive urgencies (79.6 and 84.5%, respectively, in 2008 and 2015). SBP and DBP values were higher in patients with emergencies than in those with urgencies (BP 19315/10215 vs. 18913/ 9613mmHg in 2008 and 19217/9815 vs. 18912/ 9415mmHg in 2015, P<0.001 for both). Among hypertensive emergencies, the different forms of organ damage were 25% acute coronary syndromes and 1% aortic dissection in both periods, 34 and 38% acute heart failure, 40 and 37% stroke. Conclusion: Admission to the ED for hypertensive emergencies and hypertensive urgencies is still high. Diagnosis and treatment are still not appropriate and require the rapid application of recently published guideline

[OP.8D.06] OCULAR FUNDUS PHOTOGRAPHY WITH A SMARTPHONE DEVICE IN ACUTE HYPERTENSION

.OBJECTIVE: The ocular fundus (FO) examination is infrequently and poorly performed in the emergency department (ED) clinical settings, placing patients at risk for missed diagnosis of hypertensive emergencies. AIM: to investigate the feasibility of the FO photography with a smartphone small optical device (D-Eye; J Ophtalmol. 2015) in a ED setting and to compare it to a traditional FO examination. DESIGN AND METHOD: The study included 41 consecutive patients (mean age 69 ± 16 years, 50% women) presenting to an hospital ED with an acute increase in blood pressure (SBP >180 and/or DBP >100 mmHg). When admitted to the ED all patients had mydriatic FO examination obtained by an Emergency physician (EP) using both a traditional ophtalmoscope and a commercially available FO smartphone device (D-Eye, Si14 S.p.A., Padova). All FO images and videos recorded with the D-Eye system were analysed by 2 independent expert (ophthalmologist) and inexpert (EP) observers. A quantitative score of hemorrages, exudates and/or papillary edema was used (0 absent, 1 early, 2 moderate, 3 severe, 4 very severe). The Cohen K coefficient (Ki) was used to assess the inter-observer concordance index. RESULTS: Six patients had headache, 6 had focal neurologic symptoms, and 4 had acute visual changes. The mean duration of FO examination was 130 ± 39 and 74 ± 31 seconds for traditional ophtalmoscopy and for smartphone D-Eye, respectively. No relevant abnormalities of their FO were detected by traditional ophthalmoscopy, performed by the EP, while a signifcant number of abnormal FO findings were detected by the use of the D-eye device in 17 and 19 patients by the EP and ophthalmologist, respectively. The Ki value ranged from 0,66 to 0,77 (good concordance) for the assessment of hemorrages and exudates, and from 0,89 to 0,90 (optimal concordance) for the evaluation of presence and severity of papilledema. CONCLUSIONS: Our results show that a new small smartphone device (D-Eye) may be feasible in an ED setting for the fundoscopic examination, detecting a signifcant number of abnormal FO. The reliability of relevant FO abnormalities seems to be superior in respect to traditional fundoscopy

Effect of exercise on epicardial adipose tissue in adults: a systematic review and meta-analyses

According to previous epidemiological studies, we can reduce the thickness of epicardial fat and improve cardiovascular risk factors through exercise, and the changes may depend on the form of exercise. We systemically reviewed published studies that evaluated exercise intervention on epicardial adipose tissue (EAT) levels. We included randomized controlled trials (RCTs) comparing one exercise with another exercise or diet for the treatment to reduce EAT. We used fixed effects models for meta-analyses; effects of exercise on outcomes were described as mean differences (MD) or standardized difference of means (SMD) was used, their 95% confidence intervals (CI). Five RCTs were included (n = 299), 156 in exercise group and 143 in the control. In comparison to the control group, exercise significantly reduced EAT (SMD − 0.57, 95%CI − 0.97 to − 0.18) and waist circumference (MD − 2.95&nbsp;cm, 95%CI − 4.93 to − 0.97). Exercise did not have an effect on BMI (MD − 0.23&nbsp;kg/m2, 95%CI − 0.73 to 0.27), weight (MD − 0.06&nbsp;kg, 95%CI − 1.46 to 1.34), or HDL (SMD 0.26, 95%CI − 0.06 to 0.57).VO2 was significantly increased by exercise (SMD 1.58, 95%CI 1.17 to 1.99). Risk of bias was high for 3 studies, and GRADE quality of evidence was very low to moderate. Exercise reduced epicardial adipose tissue and waist circumference, and did not have effect on weight, BMI, or HDL. Newer trials with better design and methods are necessary to improve the quality of the evidence. PROSPERO registration number (CRD42018096581