The Impacts of Serum Uric Acid on arterial hemodynamics and Cardiovascular Risks.

Unlabelled: Hyperuricemia, and its clinical manifestation gout, is a metabolic disease process that has been recognized since the dawn of medical inquiry. Uric acid was hypothesized to be a mediator of cardiovascular disease for period of time. Epidemiological correlations of hyperuricemia with hypertension and cardiovascular events were evident for two centuries' studies.

Measurement accuracy of a stand-alone oscillometric central blood pressure monitor: a validation report for Microlife WatchBP Office Central.

Background: The superiority of prognostic value of blood pressure (BP) measured at central aorta (CBP) over conventional brachial BP measured by cuff-based BP monitors has reignited the development of new noninvasive techniques for estimating CBP. The present study validated the accuracy of CBP measured by a newly developed stand-alone CBP monitor.

Methods: The CBP monitor provided readings of brachial systolic BP (SBP), brachial diastolic BP (DBP), central SBP, and central pulse pressure (PP).

Resistance exercise training reduces arterial reservoir pressure in older adults with prehypertension and hypertension.

We examined changes in central blood pressure (BP) following resistance exercise training (RET) in men and women with prehypertension and never-treated hypertension. Both Windkessel theory and wave theory were used to provide a comprehensive examination of hemodynamic modulation with RET. Twenty-one participants (age 61±1 years, n=6 male; average systolic blood pressure (SBP)/diastolic blood pressure (DBP)=138/84 mm Hg) were randomized to either 12 weeks of RET (n=11) or an inactive control group.

Association of clinical symptomatic hypoglycemia with cardiovascular events and total mortality in type 2 diabetes: a nationwide population-based study.

Objective: Hypoglycemia is associated with serious health outcomes for patients treated for diabetes. However, the outcome of outpatients with type 2 diabetes who have experienced hypoglycemia episodes is largely unknown.

Research Design And Methods: The study population, derived from the National Health Insurance Research Database released by the Taiwan National Health Research Institutes during 1998-2009, comprised 77,611 patients with newly diagnosed type 2 diabetes.

Measurement of central aortic pulse pressure: noninvasive brachial cuff-based estimation by a transfer function vs. a novel pulse wave analysis method.

Background: The prognostic value of central aortic pulse pressure (PP-C) may have been underestimated due to its measurement inaccuracy. We aimed to investigate the accuracy of noninvasive brachial cuff-based estimation of PP-C by a generalized transfer function (GTF) or a novel pulse wave analysis (PWA) approach to directly estimate PP-C.

Methods: Invasive high-fidelity right brachial and central aortic pressure tracings, and left brachial pulse volume plethysmography (PVP) waveforms from an oscillometric blood pressure (BP) monitor were all digitized simultaneously in 40 patients during cardiac catheterization.

Excessive wave reflections on admission predict post-discharge events in patients hospitalized due to acute heart failure.

Aims: The role of wave reflections in the pathogenesis of acute heart failure syndrome (AHFS) remains unclear. The present study investigated the long-term prognostic values of the carotid augmentation index (cAI), carotid augmented pressure (cAP), amplitude of the reflected pressure wave from a decomposed carotid pressure wave (Pb), and carotid pulse pressure (PP) on admission in patients hospitalized due to AHFS.

Methods And Results: A total of 120 patients (72 ± 14 years, 83.

Two strategies to intensify evidence-based medicine education of undergraduate students: a randomised controlled trial.

Introduction: Undergraduate evidence-based practice (EBP) is usually taught through standalone courses and workshops away from clinical practice. This study compared the effects of 2 clinically integrated educational strategies on final year medical students.

Materials And Methods: Final year medical students rotating to the general medicine service for a 2-week internship were randomly assigned to participate in a weekly EBP-structured case conference focusing on students' primary care patients (Group A, n = 47), or to receive a weekly didactic lecture about EBP (Group B, n = 47).

Measurement of central systolic blood pressure by pulse volume plethysmography with a noninvasive blood pressure monitor.

Background: Central systolic blood pressure (SBP) can be estimated by an oscillometric method developed from a pulse volume plethysmography (PVP) device. The present study applied this novel method to a noninvasive blood pressure monitor (NBPM).

Methods: We enrolled 50 patients (37 men, age range 30-84 years) referred for cardiac catheterization.

Estimation of central aortic systolic pressure from the second systolic peak of the peripheral upper limb pulse depends on central aortic pressure waveform morphology.

Background: Direct identification of second systolic peaks of peripheral upper limb pulses (pSBP2) has been used to represent central systolic blood pressure (cSBP), but its accuracy at low SBP was questioned.

Objectives: We investigated the relationship of pSBP2 with characteristics of central pressure waveforms.

Methods: High-fidelity central aortic and right brachial pressure waveforms were simultaneously recorded using a custom-made dual pressure sensor catheter in 78 patients (65.

Quantification of the calibration error in the transfer function-derived central aortic blood pressures.

Background: The accuracy of the central aortic systolic (SBP-C) and pulse (PP-C) blood pressures estimated noninvasively by a generalized transfer function technique has been questioned. The purpose of the present study was to quantify precisely the impact of the input errors (differences between the oscillometric (SBP-O, DBP-O, PP-O) and invasive (SBP-B, DBP-B, PP-B) brachial systolic, diastolic, and pulse blood pressures) on the output errors (differences between the estimated and invasively measured SBP-C and PP-C).

Methods: Invasive high-fidelity right brachial and central aortic pressure waveforms, and SBP-O, DBP-O, and PP-O (=SBP-O - DBP-O) were obtained simultaneously in 40 patients during cardiac catheterization.

Pulsatile hemodynamics and clinical outcomes in acute heart failure.

Background: The role of pulsatile hemodynamics in the management of patients with acute heart failure syndrome (AHFS) remains to be elucidated. We investigated the changes of the pulsatile hemodynamics along the hospital course of AHFS in relation to short-term outcomes.

Methods: A total of 80 AHFS patients (73.

Central versus ambulatory blood pressure in the prediction of all-cause and cardiovascular mortalities.

Objectives: Central systolic (SBP-C) and/or pulse pressure (PP-C) better predicts cardiovascular events than does peripheral blood pressure. The present study compared the prognostic significance of office central blood pressure with multiple measurements of out-of-office ambulatory peripheral blood pressure, with reference to office peripheral systolic (SBP-B) or pulse pressure (PP-B).

Methods: In a community-based population of 1014 healthy participants, SBP-C and PP-C were estimated using carotid tonometry, and 24-h systolic (SBP-24 h) and pulse pressure (PP-24 h) were obtained from 24-h ambulatory blood pressure monitoring.

Assessment of clinical competence of medical students using the objective structured clinical examination: first 2 years' experience in Taipei Veterans General Hospital.

Background: Competence-oriented education is currently the mainstream method of teaching clinical medical education. The objective structured clinical examination (OSCE) is a widely employed and accepted tool to measure the clinical competence of medical students. We describe the first 2 years' experience of OSCE in Taipei Veterans General Hospital.

Electromechanical activation time in the prediction of discharge outcomes in patients hospitalized with acute heart failure syndrome.

Objective: Left ventricular systolic time intervals, including pre-ejection period (PEP), ejection time (ET), and their ratio (PEP/ET), is determined by systolic and diastolic function and ventriculo-arterial coupling. We investigated the usefulness of the electromechanical activation time [(EMAT) PEP minus isovolumic contraction time] in the prediction of cardiac mortality or re-hospitalization for heart failure in patients with the acute heart failure syndrome (AHFS).

Patients And Methods: A total of 45 patients (71.

Diabetes and 15-year cardiovascular mortality in a Chinese population: Differential impact of hypertension and metabolic syndrome.

Background: It remains unclear if the risk for cardiovascular (CV) mortality in patients with diabetes mellitus (DM) is equivalent to that in patients with a history of cardiac disease in Asian populations. The aims of the present study were to investigate whether or not non-heart disease (HD) DM subjects have a similar risk of CV mortality as HD patients without DM (non-DM HD), and whether or not hypertension (HT) or metabolic syndrome (MS) is a CV mortality marker for diabetic subjects identified from a community-based population.

Methods: We followed 11,058 Chinese people aged > or = 30 years on Kinmen island for a median of 15.

Relationship between cumulative dose of thiazolidinediones and clinical outcomes in type 2 diabetic patients with history of heart failure: a population-based cohort study in Taiwan.

Background: Thiazolidinediones (TZDs) are widely used antidiabetic agents, but there is great concern and conflicting reports over their possible effect on cardiovascular morbidity, especially in patients with heart failure (HF).

Methods: Using 2000-2005 Taiwan's National Health Insurance (NHI) claims data, this population-based, retrospective cohort study investigated if there was an association between the cumulative TZD dose and clinical outcomes in type 2 diabetic patients recently hospitalized for HF. Study outcomes were death, first all-cause readmission, and first readmission for HF.

Comparative proteomic analysis of rat aorta in a subtotal nephrectomy model.

Although accelerated atherosclerosis and arteriosclerosis are the main causes of cardiovascular morbidity and mortality in chronic kidney disease (CKD) patients, the molecular pathogenesis remains largely obscure. Our study of the aortic function in a typical CKD model of subtotal nephrectomy (SNX) rats demonstrated phenotypes that resemble CKD patients with aortic stiffness. The 2-DE analysis of rat aortas followed by MS identified 29 up-regulated and 53 down-regulated proteins in SNX rats.

Estimation of central systolic blood pressure using an oscillometric blood pressure monitor.

Current noninvasive techniques for assessing central aortic pressure require the recording of an arterial pressure wave using a high-fidelity applanation tonometer. We therefore developed and validated a novel method to estimate the central aortic systolic pressure using an oscillometric blood pressure monitor alone. Invasive high-fidelity right brachial and central aortic pressure waves, and left-brachial pulse volume plethysmography from an oscillometric blood pressure monitor, were obtained at baseline and 3 min after administration of sublingual nitroglycerin in 100 patients during cardiac catheterization.

Wave reflection and arterial stiffness in the prediction of 15-year all-cause and cardiovascular mortalities: a community-based study.

The value of increased arterial wave reflection, usually assessed by the transit time-dependent augmentation index and augmented pressure (Pa), in the prediction of cardiovascular events may have been underestimated. We investigated whether the transit time-independent measures of reflected wave magnitude predict cardiovascular outcomes independent of arterial stiffness indexed by carotid-femoral pulse wave velocity. A total of 1272 participants (47% women; mean age: 52+/-13 years; range: 30 to 79 years) from a community-based survey were studied.

High incidence of the cardiac variant of Fabry disease revealed by newborn screening in the Taiwan Chinese population.

Background: Fabry disease is a treatable lysosomal storage disorder, which is often misdiagnosed or belatedly diagnosed.

Methods And Results: To determine the disease incidence in the Taiwan Chinese population, a Fabry disease newborn screening study was initiated. A total of 110 027 newborns were screened by assaying the alpha-galactosidase A (alpha-Gal A) activity using dry blood spots.

Relation of adiponectin and high-sensitivity C-reactive protein to pulse-wave velocity and N-terminal pro-B-type natriuretic peptide in the general population.

The roles of metabolic syndrome and chronic subclinical inflammation in arterial stiffening and the development of heart failure remain to be elucidated. Whether adiponectin and high-sensitivity C-reactive protein (hs-CRP) were independently related to brachial-ankle pulse-wave velocity (ba-PWV) and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) in the general population were investigated. Eligible study subjects were 445 Chinese residents aged > or =40 years who participated in a community-based survey, underwent examination of ba-PWV, and had complete data of serum adiponectin, hs-CRP (<10 mg/L), and NT-pro-BNP.

Central or peripheral systolic or pulse pressure: which best relates to target organs and future mortality?

Objective: To examine the relationship between brachial and central carotid pressures and target organ indices at baseline and their association with future mortality.

Methods: We examined, cross-sectionally and longitudinally, the relations of baseline systolic and pulse pressures in central (calibrated tonometric carotid pulse) and peripheral (brachial, mercury sphygmomanometer) arteries to baseline left ventricular mass, carotid intima-media thickness, estimated glomerular filtration rate, and 10-year all-cause and cardiovascular mortality in 1272 participants (47% women aged 30-79 years) from a community of homogeneous Chinese.

Results: Left ventricular mass was more strongly related to central and peripheral systolic pressures than pulse pressures.