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Kamboj N, Metcalfe K, Chu CH, Conway A. Predicting Blood Pressure After Nitroglycerin Infusion Dose Titration in Critical Care Units: A Multicenter Retrospective Study. Comput Inform Nurs 2024; 42:259-266. [PMID: 38112619 DOI: 10.1097/cin.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Critical care nurses use physiological indicators, such as blood pressure, to guide their decision-making regarding the titration of nitroglycerin infusions. A retrospective study was conducted to determine the accuracy of systolic blood pressure predictions during nitroglycerin infusions. Data were extracted from the publicly accessible eICU program database. The accuracy of a linear model, least absolute shrinkage and selection operator, ridge regression, and a stacked ensemble model trained using the AutoGluon-Tabular framework were investigated. A persistence model, where the future value in a time series is predicted as equal to its preceding value, was used as the baseline comparison for model accuracy. Internal-external validation was used to examine if heterogeneity among hospitals could contribute to model performance. The sample consisted of 827 patients and 2541 nitroglycerin dose titrations with corresponding systolic blood pressure measurements. The root-mean-square error on the test set for the stacked ensemble model developed using the AutoGluon-Tabular framework was the lowest of all models at 15.3 mm Hg, equating to a 22% improvement against the baseline. Internal-external validation revealed consistent accuracy across hospitals. Further studies are needed to determine the impact of using systolic blood pressure predictions to inform nurses' clinical decision-making regarding nitroglycerin infusion titration in critical care.
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Affiliation(s)
- Navpreet Kamboj
- Author Affiliations: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto (Ms Kamboj, and Drs Metcalfe, and Chu); KITE-Toronto Rehabilitation Institute, University Health Network (Dr Chu); Women's College Research Institute (Dr Metcalfe), Toronto, Ontario, Canada; and School of Nursing, Queensland University of Technology (Dr Conway), Brisbane, Australia
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Katsuda SI, Horikoshi Y, Shiomi M, Kitajima S, Ito T, Hazama A, Shimizu T, Shirai K. Arterial stiffness of the aorta and iliofemoral artery and their responses to nitroglycerin administration in myocardial infarction-prone Watanabe heritable hyperlipidemic rabbits. J Hypertens 2024; 42:441-449. [PMID: 37937516 PMCID: PMC10842652 DOI: 10.1097/hjh.0000000000003608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES The role of hypercholesterolemia in arterial stiffness, which usually reflects the progression of atherosclerosis has not been fully investigated. To clarify the meaning of arterial stiffness in hypercholesterolemia, we evaluated arterial stiffness in myocardial infarction-prone Watanabe heritable hyperlipidemic (WHHLMI) rabbits by using new arterial stiffness indices of the aorta and common iliac to femoral artery. The new arterial stiffness indices of both arteries were determined by the application of the theory of cardio-ankle vascular index (CAVI) to the aorta (aBeta) and ilio-femoral artery (ifBeta). Furthermore, the responses of both indices to nitroglycerin (NTG) administration were compared between WHHHMI and normal rabbits. DESIGN AND METHODS aBeta and ifBeta of WHHLMI and normal rabbits were measured under anesthesia. Pulse wave velocity in the whole aorta (aPWV) and ilio-femoral artery (ifPWV), blood pressure, and other parameters were measured before and after administration of NTG (50-120 μg/kg/min) every 1 for 5 min. RESULTS Atherosclerotic lesions were observed in the aorta, but a little in the ilio-femoral artery in WHHLMI rabbits. Compared with normal rabbits, aBeta was significantly higher, but ifBeta was lower in WHHLMI rabbits. When NTG was administered, ifBeta decreased significantly in both groups; however, aBeta increased in normal rabbits, but remained unchanged in WHHIMI rabbits. CONCLUSION These findings suggested that hereditary hypercholesterolemia in rabbits did not uniformly enhance arterial stiffness in elastic artery and muscular artery. The responses to NTG were also different between two arteries. The mechanism of these different responses needs further studies.
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Affiliation(s)
- Shin-ichiro Katsuda
- Department of Cellular and Integrative Physiology, Fukushima Medical University School of Medicine, 1 Hikari-ga-oka
| | - Yuko Horikoshi
- Division of Laboratory Medicine, Fukushima Medical University School of Health Sciences, Fukushima
| | - Masashi Shiomi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe
- Division of Biological Resources and Development, Analytical Research Center for Experimental Sciences, Saga University, Saga
| | - Shuji Kitajima
- Division of Biological Resources and Development, Analytical Research Center for Experimental Sciences, Saga University, Saga
| | - Toshiro Ito
- Department of Cellular and Integrative Physiology, Fukushima Medical University School of Medicine, 1 Hikari-ga-oka
| | - Akihiro Hazama
- Department of Cellular and Integrative Physiology, Fukushima Medical University School of Medicine, 1 Hikari-ga-oka
| | - Tsuyoshi Shimizu
- Shimizu Institute of Space Physiology, Suwa Maternity Clinic, Nagano
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Al Qurashi M, Al-Khotani A, Mohtisham F, AlRaddadi E, AlShaikh H, Hakami AY, Aga SS. Digital Ischemia in an Extreme Preterm Infant Treated with Nitroglycerin Patch. Case Rep Pediatr 2024; 2024:2255756. [PMID: 38449574 PMCID: PMC10917479 DOI: 10.1155/2024/2255756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/04/2024] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
Ischemic limb lesions occasionally occur in neonates admitted to neonatal intensive care units. Known risk factors include the placement of arterial catheters, arterial punctures to obtain blood samples, and the use of vasoactive/vasopressor medications for hypotension. Prolonged peripheral tissue ischemia may result in serious complications, and successful management depends on early detection, proper assessment, and the institution of appropriate intervention. Currently, there is no standard approach for the management of peripheral tissue ischemia in extreme preterm infants. Topical nitroglycerine use is one of the promising options used to manage ischemic limb injuries in neonates, as demonstrated in several case reports. We report a case of digital ischemia in an extreme preterm infant with no clear risk factors except extreme prematurity, which recovered after topical nitroglycerine therapy.
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Affiliation(s)
- Mansour Al Qurashi
- Department of Pediatrics, Ministry of National Guard Health Affairs (MNGHA), King Saud Bin Abdul Aziz University for Health Sciences (KSAU-HS), WR King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre (KAIMRC), Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Abdulaziz Al-Khotani
- Department of Pediatrics, Umm AlQura University, Makkah, Saudi Arabia
- Department of Pediatrics, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Farzeen Mohtisham
- Department of Pediatrics, Ministry of National Guard Health Affairs (MNGHA), King Saud Bin Abdul Aziz University for Health Sciences (KSAU-HS), WR King Abdulaziz Medical City, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Centre (KAIMRC), Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Eman AlRaddadi
- King Abdullah International Medical Research Centre (KAIMRC), Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City, Jeddah, Saudi Arabia
- Department of Basic Sciences, College of Science and Health Professions, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Heba AlShaikh
- Department of Pediatrics, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia
| | - Alqassem Y. Hakami
- King Abdullah International Medical Research Centre (KAIMRC), Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City, Jeddah, Saudi Arabia
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences (KSAU-HS), King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Syed Sameer Aga
- King Abdullah International Medical Research Centre (KAIMRC), Ministry of National Guard Health Affairs (MNGHA), King Abdulaziz Medical City, Jeddah, Saudi Arabia
- Department of Basic Medical Sciences, College of Medicine, King Saud Bin Abdul Aziz University for Health Sciences (KSAU-HS), King Abdulaziz Medical City, Jeddah, Saudi Arabia
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Papakyriakopoulou P, Valsami G, Kadoglou NPE. Nose-to-Heart Approach: Unveiling an Alternative Route of Acute Treatment. Biomedicines 2024; 12:198. [PMID: 38255302 PMCID: PMC10813812 DOI: 10.3390/biomedicines12010198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Intranasal (IN) administration has emerged as a novel approach for rapid systemic absorption, with potential applicability in the management of acute cardiovascular events. This review explores the evolution of IN cardiovascular pharmacotherapy, emphasizing its potential in achieving systemic effects and bypassing the first-pass metabolism associated with oral administration. The extensive vascularization of nasal mucosa and a porous endothelial basement membrane facilitate efficient drug absorption into the bloodstream. The IN route ensures a critical swift onset of action, which allows self-administration in at-home settings. For instance, etripamil nasal spray, a first-in-class formulation, exemplifies the therapeutic potential of this approach in the treatment of spontaneous supraventricular tachycardia. The review critically assesses studies on IN formulations for angina, acute myocardial infarction, hypertensive episodes, and cardiac arrhythmias. Preclinical evaluations of beta-blockers, calcium-channel blockers, and antianginal drugs demonstrate the feasibility of IN administration for acute cardiovascular events. A small number of clinical trials have revealed promising results, emphasizing the superiority of IN drug delivery over oral administration in terms of bioavailability and onset of action. Unambiguously, the limited clinical trials and patient enrollment pose challenges in generalizing experimental outcomes. However, the nose-to-heart approach has clinical potential.
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Affiliation(s)
- Paraskevi Papakyriakopoulou
- Laboratory of Biopharmaceutics and Pharmacokinetics, Section of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15771 Athens, Greece; (P.P.); (G.V.)
| | - Georgia Valsami
- Laboratory of Biopharmaceutics and Pharmacokinetics, Section of Pharmaceutical Technology, Department of Pharmacy, School of Health Sciences, National and Kapodistrian University of Athens, 15771 Athens, Greece; (P.P.); (G.V.)
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Colicchio TK, Osborne JD, Do Rosario CV, Anand A, Timkovich NA, Wyatt MC, Cimino JJ. Semantically oriented EHR navigation with a patient specific knowledge base and a clinical context ontology. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2024; 2023:309-318. [PMID: 38222434 PMCID: PMC10785934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Widespread adoption of electronic health records (EHR) in the U.S. has been followed by unintended consequences, overexposing clinicians to widely reported EHR limitations. As an attempt to fixing the EHR, we propose the use of a clinical context ontology (CCO), applied to turn implicit contextual statements into formally represented data in the form of concept-relationship-concept tuples. These tuples form what we call a patient specific knowledge base (PSKB), a collection of formally defined tuples containing facts about the patient's care context. We report the process to create a CCO, which guides annotation of structured and narrative patient data to produce a PSKB. We also present an application of our PSKB using real patient data displayed on a semantically oriented patient summary to improve EHR navigation. Our approach can potentially save precious time spent by clinicians using today's EHRs, by showing a chronological view of the patient's record along with contextual statements needed for care decisions with minimum effort. We propose several other applications of a PSKB to improve multiple EHR functions to guide future research.
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Affiliation(s)
| | - John D Osborne
- Informatics Institute, University of Alabama at Birmingham
| | | | - Ankit Anand
- Informatics Institute, University of Alabama at Birmingham
| | | | | | - James J Cimino
- Informatics Institute, University of Alabama at Birmingham
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Huang M, Du H, Lai J, Huang X, Xie W, Wu Y, Chen B, Li Y, Gao F, Huang W, Li G, Chen D, Liang G, Li Z, Liu Q, Ding B. Clinical efficacy of Kuanxiong aerosol for patients with prehospital chest pain: A randomized controlled trial. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2024; 123:155206. [PMID: 38091825 DOI: 10.1016/j.phymed.2023.155206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 11/02/2023] [Accepted: 11/08/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Kuanxiong Aerosol (KXA)(CardioVent®), consisting of Asarum sieboldii Miq. oil, Santalum album L. oil, Alpinia officinarum Hance oil, Piper longum L. oil and borneol, seems to relieve the symptoms of chest pain and serve as a supplementary treatment for prehospital chest pain in emergency department. STYLE OF THE STUDY This randomized controlled trial aimed to determine the clinical effect and safety of KXA for patients with prehospital chest pain. METHODS A total of 200 patients were recruited from Guangdong Provincial Hospital of Chinese Medicine and randomly divided into KXA group (n = 100) and Nitroglycerin Aerosol (NA) group (n = 100) by SAS 9.2 software. All patients were treated with standardized Western medicine according to the pre-hospital procedure. The experimental group and NA group was additionally treated with KXA and NA respectively. The primary outcome was the relieving time of prehospital chest pain (presented as relief rate) after first-time treatment. The secondary outcomes included the evaluation of chest pain (NRS scores, degree of chest pain, frequency of chest pain after first-time treatment), efficacy in follow-up time (the frequency of average aerosol use, emergency department visits, 120 calls, medical observations and hospitalization at 4 weeks, 8 weeks, 12 weeks), alleviation of chest pain (Seattle angina questionnaire, chest pain occurrence, and degree of chest pain at 12-weeks treatment) and the change of TCM symptoms before and after 12-weeks treatment. In addition, the safety of KXA was also assessed by the occurrence of adverse events. The database was created using Epidata software, and statistical analysis was conducted by SPSS 23.0 software. RESULTS A total of 194 participants finally completed the trial, the results showed that after first-time treatment, KXA had a higher relief rate (72.2%) of chest pain within 30 min than that of NA group (59.4%, p = 0.038), KXA group had a lower degree of chest pain (p = 0.005), lower NRS score (p = 0.011) and higher reduction of NRS score (p = 0.005) than the NA. In the follow-up period, KXA group decreased the frequency of 120 call better than that of NA group at 4 weeks (p = 0.040), but KXA had a similar efficacy as NA in the improvement on the of frequency of chest pain, aerosol use, emergency department visits, 120 call, medical observation and hospitalization at 4 weeks, 8 weeks and 12 weeks (p>0.05). There also had no difference between the two groups on the occurrence of chest pain, degree of chest pain, physical limitation, angina stability, treatment satisfaction, and disease perception between the two groups at 12 weeks (p>0.05). In addition, KXA and NA both improved the patient's chest pain, but not the TCM symptoms. In terms of safety, KXA showed similar safety as NA in this study. CONCLUSIONS KXA relieved prehospital chest pain faster than NA and had a better remission effect on the prehospital chest pain than that of the NA group in short-period. In long-period, KXA showed similar efficacy on the improvement of prehospital chest pain as NA. KXA may be a safe and reliable therapy for prehospital chest pain.
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Affiliation(s)
- Manhua Huang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China; Second Clinical Medical College of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Hongjin Du
- Zhuhai Hospital of Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Jiahua Lai
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Xiaoyan Huang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Wenyuan Xie
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Yanhua Wu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Baijian Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Yonglin Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Feng Gao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Wei Huang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Guowei Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Dunfan Chen
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Guorong Liang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Zunjiang Li
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China; Second Clinical Medical College of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Quanle Liu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China; Second Clinical Medical College of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China.
| | - Banghan Ding
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China; Second Clinical Medical College of Guangzhou University of Chinese Medicine, 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, China.
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