Controversies in Hypertension V: Resistant and Refractory Hypertension.

Apparent resistant hypertension, defined as uncontrolled office blood pressure despite ≥ 3 antihypertensive medications including a diuretic or use of ≥ 4 medications regardless of blood pressure, occurs in ≤ 15% of treated hypertensives. Apparent refractory hypertension, defined as uncontrolled office pressure despite use of 5 or more medications including a diuretic, occurs in ≤ 10% of resistant cases. Both are associated with increased comorbidity and enhanced cardiovascular risk.

Controversies in Hypertension IV: Renal Denervation.

Renal denervation is not a cure for hypertension. Although more recent sham-controlled trials were positive, a significant minority of patients in each trial were unresponsive. The optimal patient or patients need to be defined.

Controversies in Hypertension III: Dipping, Nocturnal Hypertension, and the Morning Surge.

A comprehensive approach to hypertension requires out-of-office determinations by home or ambulatory monitoring. The 4 phenotypes comparing office and out-of-office pressures in treated and untreated patients include normotension, hypertension, white-coat phenomena, and masked phenomena. Components of out-of-office pressure may be equally as important as mean values.

Controversies in Hypertension I: The Optimal Assessment of Blood Pressure Load and Implications for Treatment.

The most important factor in treating hypertension is assessing an individual patient's true blood pressure load, the cornerstone being research-grade office determination. Office blood pressure should be supplemented with out-of-office measurement, including home and ambulatory monitoring (if available), which we consider complementary and not interchangeable. Controversy remains for initiation of treatment of white coat hypertension, where cardiovascular risk lies between normotension and sustained hypertension; antihypertensive therapy should be considered unless low cardiovascular risk, wherein pressures should be followed for progression to sustained hypertension.

The diastolic blood pressure J-curve revisited: An update.

Hypertension remains a leading cause of morbidity and mortality. Recent treatment guidelines stress more strict systolic blood pressure (SBP) targets without regard for abnormally low achieved diastolic blood pressures (DBP). However, as DBP falls below a critical level, adverse events increase, the so-called J-shaped curve.

Patterns of prophylactic anticonvulsant use in spontaneous intracerebral and subarachnoid hemorrhage: results of a practitioner survey.

Background: The use of prophylactic anti-seizure medications (ASMs) in the management of patients with spontaneous intracerebral hemorrhage (sICH) and aneurysmal subarachnoid hemorrhage (aSAH) is controversial.

Objective: The purpose of this survey was to better characterize the current state of prophylactic ASM use in sICH and aSAH in North America.

Methods: US and Canadian neurosurgeons, neurologists, and interventional neuroradiologists with an interest in or expertise in the management of neurovascular disease were surveyed using an electronic survey tool.

Transradial Access for High-Risk Percutaneous Coronary Intervention: Implications of the Risk-Treatment Paradox.

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Evaluation of the Onclarity HPV assay on the high-throughput COR system.

: Here we compare the performance of the high-throughput BD COR System (COR) to the Viper LT System (Viper) using the BD Onclarity HPV assay.: Remnant clinical specimens, contrived specimens in SurePath (BD) and PreservCyt (Hologic) media, and prospective clinical specimens in BD Cervical Brush Diluent (CBD) were tested. Outcomes included intra-laboratory agreement of Onclarity results on COR and inter-system agreement between COR and Viper.

The Nrf2-mediated defense mechanism associated with HFE genotype limits vulnerability to oxidative stress-induced toxicity.

There is considerable interest in gene and environment interactions in neurodegenerative diseases. The HFE (homeostatic iron regulator) gene variant (H63D) is highly prevalent in the population and has been investigated as a disease modifier in multiple neurodegenerative diseases. We have developed a mouse model to interrogate the impact of this gene variant in a model of paraquat toxicity.

Optimizing telemedicine to facilitate amyotrophic lateral sclerosis clinical trials.

Amyotrophic lateral sclerosis (ALS) has the largest drug pipeline among neuromuscular diseases, with over 160 companies actively involved in ALS research. There is a growing need to recruit trial participants, but ALS patients often have limited mobility and most ALS trials are conducted in a small number of major centers. These factors effectively limit patient participation, particularly for those in rural areas.

High-affinity mutant Interleukin-13 targeted CAR T cells enhance delivery of clickable biodegradable fluorescent nanoparticles to glioblastoma.

Glioblastoma (GBM), the deadliest form of brain cancer, presents long-standing problems due to its localization. Chimeric antigen receptor (CAR) T cell immunotherapy has emerged as a powerful strategy to treat cancer. IL-13-receptor-α2 (IL13Rα2), present in over 75% of GBMs, has been recognized as an attractive candidate for anti-glioblastoma therapy.

Distal Radial and Ulnar Arteries: the Alternative Forearm Access.

Purpose Of Review: Radial artery access for catheter-based procedures has demonstrated improved margins of safety and patient comfort without a loss of efficacy compared with femoral access. Unfortunately, radial access is not always available, so a review of the alternatives such as the ulnar artery and distal radial artery has been completed to understand alternative access sites that may preserve the benefits of distal forearm access without losing the efficacy of traditional transradial access.

Recent Findings: Several different trials have demonstrated the utility of ulnar access as a possible workhorse access point.

The pulseless radial artery in transradial catheterization: challenges and solutions.

: An absent radial pulse prior to cardiac catheterization is an ominous finding as it portends the need for higher-risk arterial access. Solutions exist that can avoid the use of more hazardous access. Given the benefits of the radial artery access, it is essential to prevent radial artery occlusion, to diagnose acute occlusion at the time of hemostasis so it can be treated, and understand alternatives for access that exists in the lower forearms if the radial occlusion is recalcitrant.

DIVERSet JAG Compounds Inhibit Topoisomerase II and Are Effective Against Adult and Pediatric High-Grade Gliomas.

High-grade gliomas (HGGs) are aggressive primary brain tumors with local invasive growth and poor clinical prognosis in both adult and pediatric patients. Clinical response is compounded by resistance to standard frontline antineoplastic agents, an absence of novel therapeutics, and poor in vitro models to evaluate these. We screened a range of recently identified anticancer compounds in conventional adult, pediatric, and new biopsy-derived HGG models.

Should Generalized Immunosuppression or Targeted Organ Treatment be the Best Principle for Overall Management of Systemic Lupus Erythematosus?

Systemic lupus erythematosus (SLE) is a systemic autoimmune disease, and standard therapy algorithms include the use of agents with generalized immunosuppressive effects. The outcomes for SLE patients have been markedly improved by this approach. However, the concept that involved organs might be targeted for treatment in an individual patient has potential to provide further benefits, offering enhanced efficacy and fewer off-target effects.

Seasonal dengue surge: Providers⬨tm) perceptions about the impact of dengue on patient volume, staffing and use of point of care testing in Indian emergency departments.

Background: Global health emergencies, such as from diseases like dengue fever, can lead to rapid surges in visits to emergency departments. The objective of our study was to evaluate the impact of dengue on factors that could impact emergency department flow, including patient volume and staffing, on Indian emergency departments.

Methods: This was a prospective cohort study of Indian emergency providers.

Voxel-based micro-finite element analysis of dental implants in a human cadaveric mandible: Tissue modulus assignment and sensitivity analyses.

The success of dental implant treatment is related to the complex 3-dimensional (3D) biomechanics of the implant-bone interaction. In this work, 3D numerical models are built based on micro X-ray computed tomography (micro-CT) images of a cadaveric mandible specimen with implants placed in it. The simulation results show that the computed strain values in bone are sensitive to the uncertainties in trabecular tissue modulus and fairly insensitive to the modulus of implants and teeth and the detailed geometry of the fixed boundary condition.

Optimizing donor scheduling before recruitment: An effective approach to increasing apheresis platelet collections.

Background/aims: Typical approach for increasing apheresis platelet collections is to recruit new donors. Here, we investigated the effectiveness of an alternative strategy: optimizing donor scheduling, prior to recruitment, at a hospital-based blood donor center.

Methods: Analysis of collections, during the 89 consecutive months since opening of donor center, was performed.

Development of a Pain Scoring System for Use in Sheep Surgically Implanted with Ventricular Assist Devices.

: In prey species, such as sheep, clinical signs of postoperative pain can manifest in subtle ways or may be concealed entirely. Previous publications describing pain assessment in ruminants focus on lameness and flock behavior, often in a farm environment. These indicators of pain may be difficult to assess in sheep housed in biomedical research settings.

Evaluation of bedside shift report: A research and evidence-based practice initiative.

This evaluation of bedside shift report describes the process of involving clinical nurses in evidence-based practice (EBP) and research at an academic medical center by using existing structures and resources. Nurse involvement and study findings are described from idea inception to asking the clinical question, searching and synthesizing literature, collecting and analyzing data, interpreting results, and deriving conclusions. Study findings and conclusions demonstrate that nurses' active participation in a clinical relevant project promotes implementation and integration of EBP and research in the practice setting.

Addition of doxycycline to ciprofloxacin for infection prophylaxis during autologous stem cell transplants for multiple myeloma.

Background: The most commonly used antibacterial prophylaxis during autologous stem cell transplants (ASCT) for multiple myeloma (MM) involves a fluoroquinolone, such as ciprofloxacin or levofloxacin. We assessed the impact of adding doxycycline to ciprofloxacin as routine antibacterial prophylaxis in these patients.

Methods: We retrospectively reviewed electronic medical records and our ASCT database to analyze rates and types of bacterial infections in MM patients who underwent ASCT in our institution.