Search Results (875)

Chronic kidney disease (CKD) affects nearly 850 million people worldwide, and most patients with kidney failure are treated with kidney replacement therapy. Despite technological progress, venous congestion remains a major determinant of morbidity and mortality, and is often underdetected by conventional tools such as clinical evaluation, weight changes, blood pressure measurement, or bioimpedance. Point-of-care ultrasonography (PoCUS) has transformed this diagnostic landscape by providing real-time, physiology-based insights into both left- and right-sided filling pressures. In dialysis care, multiple or confluent B-lines and subtle pleural irregularities suggest elevated pulmonary capillary wedge pressure, while a dilated inferior vena cava (IVC) with reduced collapsibility and increased portal vein pulsatility indicate elevated right atrial pressures. Integrating these sonographic findings into a multiparametric assessment that also includes clinical assessment, bioimpedance, and biosensor feedback enhances diagnostic sensitivity and refines fluid management. Advanced practice nurses (APNs) trained in PoCUS can perform focused examinations of the lungs, IVC, portal venous system, arteriovenous access, and skeletal muscle, translating ultrasound findings into physiological interpretations that guide individualized ultrafiltration strategies and patient care. Nutritional ultrasound (NUS) further complements congestion assessment by quantifying muscle mass and quality, linking nutritional reserve and functional status with hemodynamic tolerance. The implementation of structured education, competency-based training, and standardized scanning protocols allows nurses to incorporate these techniques safely and reproducibly into daily dialysis workflows. By integrating PoCUS and NUS within interdisciplinary decision-making, nursing practice evolves from procedural to diagnostic, supporting early identification of congestion, protection of vascular access, and detection of malnutrition. This multiparametric, physiology-guided approach exemplifies the concept of precision nursing, where patient evaluation becomes continuous, individualized, and grounded in real-time pathophysiological insight. Full article

Background/Objectives: Acute heart failure (AHF) is a heterogeneous syndrome with phenotype-dependent prognosis. NT-proBNP is the reference biomarker, but standard echocardiographic measures (TAPSE, RV–RA gradient, LVOT VTI) offer only partial prognostic insight. The Virtue Index, defined as (RV–RA gradient)/(TAPSE × LVOT VTI), was introduced to integrate right–left ventricular interaction. This study evaluated its clinical and prognostic performance in AHF and its behavior across ejection-fraction phenotypes. Methods: We retrospectively analyzed 222 patients with AHF; complete data for Virtue calculation were available in 168 (99 HFrEF, 69 HFpEF) patients. HFmrEF patients were excluded from subgroup prognostic analyses. Correlation with NT-proBNP was assessed using Spearman testing with bootstrap intervals, and in-hospital mortality prediction was evaluated using ROC analysis with DeLong comparisons. Results: In HFpEF, the Virtue Index correlated moderately with NT-proBNP (ρ = 0.38, p = 0.002) and showed fair prognostic discrimination (AUC 0.704), similar to the RV–RA gradient (0.724) and higher than TAPSE or LVOT VTI. In HFrEF, correlation was weak (ρ = 0.19, p = 0.06) and predictive accuracy was modest (AUC 0.584), while LVOT VTI performed best (AUC 0.700). NT-proBNP outperformed all echocardiographic parameters in both groups. Conclusions: The Virtue Index reflects integrated hemodynamics and shows phenotype-dependent prognostic value in AHF, being more informative in HFpEF than in HFrEF. Although NT-proBNP remained superior, Virtue may complement biomarker-based risk assessment by offering a rapid, bedside estimate of short-term mortality risk. Full article

Background/Objectives: Heart failure with preserved ejection fraction (HFpEF) accounts for nearly half of all heart failure cases and remains challenging to diagnose and manage due to its complex, multifactorial nature. Increasing evidence highlights the significance of arterial stiffness, assessed by pulse wave velocity (PWV), and autonomic dysfunction, reflected by impaired heart rate recovery (HRR) after exercise, as relevant markers in HFpEF. This review aims to synthesize current knowledge on the diagnostic and prognostic value of PWV and HRR in HFpEF. Methods: A narrative literature review was conducted using PubMed to identify studies published between 2009 and 2025 that investigated PWV and HRR in patients with HFpEF or populations at risk. Included studies ranged from invasive hemodynamic measurements and cardiopulmonary exercise tests to large cohort analyses such as IDENTIFY-HF and MESA. Key findings were summarized in comparative tables. Results: Patients with HFpEF consistently show higher PWV than age-matched controls, supporting the concept of HFpEF as a systemic vascular disorder. Elevated PWV has been linked to increased risk of HFpEF onset and poorer outcomes. Likewise, blunted HRR indicates autonomic imbalance and is strongly associated with higher morbidity and mortality. Interventions including structured exercise training and optimized risk factor management may help improve PWV and HRR. Conclusions: PWV and HRR offer valuable, complementary insights for risk stratification and individualized care in HFpEF. Further research should focus on integrating these parameters into diagnostic algorithms and evaluating targeted therapies that address vascular stiffness and autonomic dysfunction. Full article

During fetal life, the hepatic artery (HA) is responsible for a small contribution to the total hepatic blood inflow; however, it plays a key role in maintaining liver perfusion and reflects fetal hemodynamic adaptation. With advances in ultrasonography, HA Doppler assessment has emerged as a potential tool for evaluating fetal well-being. This review aims to synthesize current knowledge on the embryology, anatomy, physiology, and Doppler assessment of the fetal hepatic artery, highlighting its diagnostic and clinical significance. A prenatal hepatic arterial buffer response (HABR), analogous to that in postnatal life, allows for compensatory vasodilatation when umbilical or portal venous inflow decreases. Doppler studies demonstrate that a reduced pulsatility index (PI) and resistance index (RI) and an increased peak systolic velocity (PSV) correspond to enhanced arterial flow and decreased vascular resistance. These patterns have been observed in fetal growth restriction (FGR) and certain chromosomal abnormalities. Fetal hepatic artery Doppler assessment contributes to the understanding of fetal adaptation to hypoxia and has a promising role in fetal well-being evaluation. As of now, there are no established reference curves, and it has not yet been incorporated into routine obstetric screening; future research should focus on standardizing measurement techniques and validating its prognostic value. Full article

Myocardial infarction (MI) triggers complex heart–brain interactions that increase the risk of stroke, cognitive decline, and mortality. Neuroinflammation and oxidative stress serve as critical mediators of these complications. We evaluated the neuroprotective effects of nebivolol, a β-blocker with nitric oxide-releasing properties, during acute MI. Male Sprague-Dawley rats were divided into sham-operated controls, MI-induced controls, and MI groups treated with oral nebivolol or intravenous loading followed by oral nebivolol. MI was induced by left anterior descending coronary artery ligation. Cardiac function was assessed by echocardiography and hemodynamic measurements. Brain tissues were analyzed for proinflammatory cytokines, oxidative stress markers, and histopathological changes. Nitric oxide synthase (NOS) isoform expression was evaluated by immunohistochemistry. MI induced significant neuroinflammation in the cerebral cortex and hippocampus, characterized by elevated cytokines, increased oxidative stress, upregulated iNOS expression, and altered histological patterns (necrosis, astrocytosis, gliosis, demyelination). Intravenous nebivolol significantly reduced these neuroinflammatory markers, normalized cytokine levels, prevented structural brain changes, and attenuated iNOS expression, while oral administration showed minimal effects. Both routes preserved cardiac function without affecting infarct size. These findings demonstrate that nebivolol, particularly via intravenous administration, provides significant NO-dependent neuroprotection during acute MI, supporting its potential as a dual-action therapeutic strategy targeting both cardiac and neurological complications. Full article

Blood pressure (BP) monitoring is essential in managing critically ill patients in the intensive care unit (ICU), particularly for ensuring adequate end-organ perfusion in hypotensive states. Invasive arterial catheters and noninvasive oscillometric cuffs are often used together, but discrepancies between the two methods are common. These differences can arise from technical factors (e.g., transducer leveling, cuff size and placement, arterial waveform damping) as well as patient-related factors (e.g., vasoconstriction, arrhythmias, altered arterial compliance). This creates a clinical dilemma: which measurement best reflects the patient’s true perfusion pressure, and how should management be guided? This review offers a practical approach for addressing discrepancies between invasive and noninvasive BP measurements in adult hypotensive ICU patients, including those with shock requiring vasopressor support. Based on contemporary data, we propose that a difference greater than 10 mmHg in mean arterial pressure (MAP) between the two methods can serve as a pragmatic threshold to trigger structured evaluation, rather than a universal definition of clinical significance. MAP is prioritized as the key variable for assessing perfusion pressure. When a discrepancy is detected, clinicians are encouraged to integrate both measurements with clinical signs of hypoperfusion and to perform a systematic assessment of technical and physiologic contributors before deciding which value should guide treatment. We present a stepwise clinical decision-making algorithm that helps practitioners (1) recognize when a discrepancy is large enough to matter, (2) evaluate perfusion using bedside and laboratory markers, (3) identify technical or anatomic reasons for discordant readings, and (4) determine when more central arterial monitoring may be appropriate. By structuring the evaluation of discordant BP measurements, this approach aims to reduce the risk of unrecognized hypotension or overtreatment, support more consistent hemodynamic decision-making, and ultimately improve the management of critically ill, hypotensive patients. Full article

Background/Objectives: Headache after a traumatic brain injury (TBI) is one of the most common post-concussive symptoms and is associated with altered pain processing and elevated disability levels. Understanding physiologic correlates of nociception in individuals with persistent post-traumatic headache (pPTH) may help identify novel treatment targets for pain-related disability. The objective of this case–control study was to compare extra- and intracranial hemodynamic responses to a noxious cold pressor task (CPT) between individuals with pPTH and healthy controls (HC) using functional near-infrared spectroscopy (fNIRS). Methods: Ten individuals with pPTH were compared to ten HC with no history of TBI, persistent headache, or chronic pain. fNIRS optodes over the medial prefrontal cortex (PFC) measured extra- and intracranial peak-to-peak hemodynamic responses during tepid- (control) and cold-water (CPT) hand immersion. Evoked pain responses during the CPT were assessed with numeric pain ratings. Linear mixed effects modeling assessed the role of group and evoked pain on hemodynamic responses. Results: pPTH group membership (p = 0.031) predicted greater extracranial hemodynamic responses to the CPT, whereas intracranial PFC responses did not differ between groups. Regardless of group membership, greater increases in pain intensity during the CPT were associated with increased hemodynamic responses for the dorsomedial PFC (p = 0.031). Conclusions: Compared to controls, individuals with pPTH responded to a noxious cold stimulus with elevated systemic hemodynamic responses regulated by the autonomic nervous system. Irrespective of group, hemodynamic responses within the dmPFC were associated with evoked pain responses to the CPT and may provide a useful biomarker for individual variations in cortical pain processing for healthy and clinical populations. Full article

Background: Exhaled NO concentrations at different flow rates can be used to calculate pulmonary NO dynamics in the conductive and peripheral airways and can be described by the total bronchial flux of NO (JawNO) and alveolar NO concentration (CANO), respectively. Changes in these parameters have been shown in pre-capillary pulmonary hypertension (PH); however, data from studies with low sample sizes are controversial and did not prospectively assess JawNO and CANO after adequate therapy. Methods: Patients with untreated pre-capillary PH (group 1: N = 23, group 3: N = 11, group 4: N = 18) and control subjects (N = 27) were recruited in a single-center observational study. Patients with group 1 (N = 15) and group 4 PH (N = 13) also attended a single follow-up visit when on pulmonary vasodilators or following interventions. Exhaled NO concentrations were measured at 50 mL/s and 100–250 mL/s expiratory flows and the two-compartment linear model was used for the calculation of JawNO and CANO. Results: CANO was higher in patients (median (interquartile range) 3.84 (2.64–7.29) ppb) than in control subjects (2.70 (1.85–4.29) ppb, p < 0.01; Mann–Whitney test) without a difference among PH groups or an association with survival. CANO showed moderate negative associations with the diffusion capacity of the lung for carbon monoxide (Spearman r = −0.41, p < 0.01) and a trend for mortality risk categories in groups 1 and 4 (r = −0.30, p = 0.06). Only JawNO changed at follow-up (0.69 (0.14–1.10) vs. 0.91 (0.40–1.68) nL/s, p = 0.02; Wilcoxon test), and there was a positive correlation between its increase and the improvement in 6 min walk distance (r = 0.40, p = 0.04). Conclusions: Alveolar NO concentration is increased in patients with pre-capillary PH, and the change in JawNO is related to the improvement in exercise capacity in PH groups 1 and 4. This is the first study implying that JawNO might be a non-invasive marker responsive to improved pulmonary hemodynamics in PH. Full article

Introduction: Percutaneous renal biopsy (PRB) is the gold standard for diagnosing nephropathies, but it carries a risk of bleeding complications, mainly perinephric hematomas (PHs). While PH incidence is often reported, the significance of PH size remains insufficiently explored. This scoping review systematically mapped the evidence on PH size after ultrasound-guided PRB in adults, focusing on imaging modalities, measurement methods, the definition of ‘large’ PH, factors influencing PH size, and its clinical implications. Materials and Methods: Following the Joanna Briggs Institute methodology, we searched PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Scopus through 27 August 2025. Eligible studies included at least 50 adult subjects undergoing ultrasound-guided PRB with quantitative, imaging-based assessment of PH size. Results: Fifty-one studies met the inclusion criteria. Almost all relied on ultrasound, with only one using computed tomography. PH size was measured using heterogeneous methods, most often one-dimensional diameters, less frequently surface area or volumetry, with no standardization. Reported PH frequencies varied substantially across studies (1.1–85%), likely reflecting differences in imaging protocols, timing, and reporting thresholds. Several studies proposed PH size thresholds (e.g., diameter ≥ 2–3 cm, volume ≥ 40–85 mL) linked to adverse outcomes such as transfusion or hemodynamic instability. Factors associated with larger PHs included needle gauge, number of passes, impaired kidney function, coagulopathy, and certain histopathologies. Conclusions: PH size has prognostic value beyond incidence alone. Standardized measurement and reporting are needed to clarify its clinical relevance after PRB. Full article

Background: Sugammadex is a selective γ-cyclodextrin compound that encapsulates steroidal neuromuscular blocking agents such as rocuronium, allowing rapid and predictable recovery from neuromuscular block (NMB). However, dose–response information in feline patients remains limited. Methods: In this prospective, randomized, and blinded experimental study, three intravenous doses of sugammadex (2, 4, and 8 mg kg⁻¹) were compared for the reversal of profound rocuronium-induced NMB (0.6 mg kg⁻¹) in thirty adult ASA I cats anesthetized with sevoflurane. Neuromuscular function was continuously assessed using acceleromyography (train-of-four stimulation). The onset and recovery times for T₁/T₀ ratios of 25–90%, T₄/T₁ ratios, and recovery index were measured, along with cardiovascular and respiratory parameters. Results: Sugammadex shortened the recovery time in a dose-dependent manner. The mean time to achieve T₁/T₀ = 90% was 519 s (2 mg kg⁻¹), 300 s (4 mg kg⁻¹), or 256.8 s (8 mg kg⁻¹). The 43-s difference between the two higher doses was not statistically significant (p = 0.317) and, therefore, not clinically relevant. Greater interindividual variability in the reversal time was observed at a dose of 4 mg kg⁻¹. One cat in this group experienced transient recurarization, and no adverse cardiovascular effects were detected. Conclusions: Both 4 and 8 mg kg⁻¹ of sugammadex produced rapid and complete reversal of profound rocuronium-induced NMB in sevoflurane-anesthetized cats without hemodynamic compromise. These results apply to healthy ASA I cats, and further studies are warranted in animals with systemic disease. Full article

Oxidative stress is a key factor in the development of chronic heart failure (CHF). Molecular hydrogen (H₂) exhibits antioxidant properties, yet the mechanisms by which it alleviates hemodynamic disturbances and ischemic myocardial injury in CHF are not fully understood. This study examined the effects of a single (40-min) and multiple (40-min daily for 5 days) inhalations of H₂ in a rat model of CHF induced by catecholamine administration. Microcirculatory function was evaluated using laser Doppler flowmetry and laser fluorescence spectroscopy. Lipid peroxidation levels in plasma and myocardium were measured, and histological analysis of myocardial tissue was performed. The findings demonstrated that H₂ inhalation improved microvascular perfusion (p < 0.05) by activating local regulation and restoring central control mechanisms. This contrasts with the decreased perfusion and disrupted adaptive regulation observed in CHF. Notably, oxidative stress and metabolic abnormalities induced in the model were significantly mitigated by H₂, with the most substantial effects observed after multiple administrations (p < 0.05). Histological assessments revealed that repeated H₂ inhalation reduces myocardial edema and preserves tissue morphology during cardiac remodeling. In conclusion, hydrogen therapy shows potential for delaying CHF progression at early stages by normalizing microcirculation and tissue metabolism. Full article

Background: Polymyxin B hemoperfusion (PMX-HP) is increasingly used as an adjunctive therapy for severe sepsis and septic shock, yet the prognostic significance of continuous renal replacement therapy (CRRT) and vasoactive-inotropic score (VIS) dynamics under real-world ICU practice remains unclear. This study aimed to evaluate whether CRRT requirement and hemodynamic responses to PMX-HP influence short-term mortality among critically ill patients. Methods: We conducted a retrospective cohort study of 64 ICU patients in Taiwan with severe sepsis or septic shock who received PMX-HP. Clinical characteristics, illness severity, VIS measurements before and after PMX-HP, organ-support therapies, and outcomes—including 28-day mortality, ICU and hospital mortality, and lengths of stay—were analyzed. Patients were stratified by CRRT use, and multivariate logistic regression was performed to identify independent predictors of 28-day mortality. Results: Among 64 patients (mean age 66 years; 67% male), 67.2% received CRRT and the overall 28-day mortality was 46.9%. CRRT users exhibited higher crude mortality and higher APACHE II scores. Survivors were younger and had lower baseline severity. Hemodynamic trajectories differed substantially: VIS increased after PMX-HP more frequently in non-survivors than survivors. In multivariate analysis, post-PMX-HP VIS elevation and higher APACHE II were independent predictors of 28-day mortality, whereas CRRT requirement was not an independent determinant. Conclusions: In this real-world cohort, PMX-HP did not significantly reduce mortality. Illness severity and inadequate vasopressor improvement, rather than CRRT use, primarily determined outcomes. VIS elevation following PMX-HP may serve as an early indicator of poor hemodynamic recovery in septic shock. Full article

Background: Intraoperative high-volume diuresis is a frequent but underrecognized complication in cardiac surgery, potentially leading to hypovolemia, electrolyte imbalances, and hemodynamic instability. Its mechanisms remain poorly defined. This study investigated the hormonal and biochemical regulation of urine output during off-pump coronary artery bypass grafting (OPCABG). Methods: For this single-center observational cohort study, 70 patients undergoing OPCABG were enrolled (diuresis: urine output > 5 mL/kg/h, n = 38; normal, n = 32). Hormonal markers and osmolality parameters were measured perioperatively. Logistic regression was used to identify independent predictors, and receiver operating characteristic (ROC) curves was used to assess model performance. Results: Intraoperative high-volume diuresis occurred in 54.2% of patients. Logistic regression identified a low Body Mass Index (BMI) (OR 0.72, p = 0.002), reduced albumin (OR 0.75, p = 0.014), and lower copeptin (OR 0.43, p = 0.037) as independent predictors (AUC 0.855). Perioperatively, NT-proBNPT0 rose in both groups, aldosterone increased only in the diuresis group, and copeptin showed a slight nonsignificant rise. Plasma sodium was higher in cases of diuresis at the end of surgery (148.4 vs. 144.9 mmol/L, p < 0.001). Despite greater urine output and fluid infusion, the rates of intensive care unit (ICU) admission and hospital stays were similar. Conclusions: Intraoperative high-volume diuresis in OPCABG is strongly associated with reduced antidiuretic hormone activity, suggesting a partial central diabetes insipidus-like mechanism. Although not affecting short-term outcomes, it posed challenges for intraoperative fluid and electrolyte management. Larger multicenter studies are needed for validation. Full article

Background/Objectives: Ischemic heart disease remains a leading cause of morbidity and mortality worldwide, accompanied by a major decline in local myocardial pH. However, the mechanisms of pH regulation and the homeostasis of H⁺ neutralizing buffers, such as HCO₃⁻, in cardiomyocytes remain incompletely understood. We identified a solute carrier, Slc26a6, in mouse and human hearts playing key roles in the regulation of cardiac pH, excitability, and contractility. Slc26a6 is an acid loader, so we hypothesized that ablation of Slc26a6 may protect the heart from ischemia/reperfusion (I/R) injury. Methods: The I/R model was generated using wild type (WT) and Slc26a6 knockout (Slc26a6^−/−) mice. Multidisciplinary in vivo, in vitro, and ex vivo approaches were used, including echocardiography, electrophysiology, hemodynamic monitoring, fluorescence microscopy, histochemistry, and cellular Ca²⁺ transients, sarcoplasmic reticulum Ca²⁺ load, and sarcomere shortening were recorded. Results: Troponin I level was lower in Slc26a6^−/− I/R mice. Slc26a6^−/− mice showed better systolic and diastolic function, reduced collagen deposition, and reduced infarct size compared to that of WT mice. Cellular experiments in measurement of sarcomere shortening, Ca²⁺ transients, and sarcoplasmic reticulum Ca²⁺ load in cardiomyocytes from the infarct zone supported the in vivo findings, demonstrating better single cell function in Slc26a6^−/− compared to WT mice. Ex vivo pH_i measurement showed elevated pH_i in Slc26a6^−/− mouse heart. Conclusions: Ablation of Slc26a6 protects the heart from I/R injury, suggesting the importance of Cl⁻/HCO₃⁻ exchange in cardiac pH regulation and I/R injury. The elevated pH_i in Slc26a6^−/− mouse heart may counterbalance the effects of the myocardium acidosis resulting from ischemia. Full article

The high incidence of cardiovascular disease and the early failure of bioprosthetic valves due to calcification have driven the development of anti-calcification technologies. As a new storage technology, drying treatment is expected to delay the calcification process by reducing glutaraldehyde residues. However, the effects of drying treatment on the mechanical properties and valve functions of bovine pericardial materials are still unclear. The objective of this study is to evaluate the influence of drying and rehydration treatments on the mechanical integrity and geometric properties of bovine pericardium and the hemodynamic performance of bioprosthetic valves made with these tissues. Cross-linked bovine pericardial samples (n = 15) were divided into three groups—wet (control group progressed with normal glutaraldehyde), dehydrated (ethanol–glycerol dehydration), and rehydration (saline immersion) groups—and the geometric stability and nonlinear mechanical behaviors of the materials were analyzed via thickness measurements and uniaxial and biaxial tensile tests. Quantitative results showed that thickness remained stable across groups (wet: 0.356 ± 0.052 mm; dry: 0.361 ± 0.053 mm; rehydrated: 0.361 ± 0.053 mm, p > 0.05). Elastic modulus values were preserved (wet: 12.5 ± 1.8 MPa; dry: 13.1 ± 2.0 MPa; rehydrated: 12.7 ± 1.9 MPa, p > 0.05), and anisotropy ratio showed no significant changes (1.53 ± 0.06 vs. 1.57 ± 0.07, p > 0.05). The hemodynamic performance of bioprosthetic valves made with these materials was evaluated in vitro using a pulsating flow simulation. Hemodynamic parameters demonstrated excellent preservation: effective orifice area (wet: 2.625 ± 0.11 cm²; rehydrated: 2.585 ± 0.12 cm², Δ = 1.5%, p = 0.32) and regurgitation fraction (wet: 39.35 ± 2.9%; rehydrated: 42.78 ± 3.2%, p = 0.15) showed no statistically significant differences. The geometric properties of the material were not significantly changed by the drying treatment, and the material maintained its nonlinear viscoelastic characteristics and anisotropy. The rehydrated bioprosthetic valves did not differ significantly from those in the wet group in terms of the effective orifice area, regurgitation fraction, and transvalvular pressure difference, and the hemodynamic performance remained stable. Full article