Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound   Target Concepts: Gene/Protein Disease Symptom Drug Enzyme Compound

---

Query: UMLS:C0020538 (hypertension)
170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Vascular medial thickening, a hallmark of hypertension, is associated with vascular smooth muscle cell (VSMC) hypertrophy and hyperplasia. Although the precise mechanisms responsible are elusive, we have shown that strain induced regulation of autocrine insulin-like growth factor-1 (IGF-1) and nitric oxide (NO) reciprocally modulate VSMC proliferation. Therefore, we investigated potential IGF-1 and NO abnormalities in young (10-week-old) spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY) and their respective VSMC ex vivo. The SHR had increased mean arterial pressure (173 +/- 2 v 128 +/- 3 mm Hg, n = 24, P <.05) but similar pulse pressures (31 +/- 2 v 30 +/- 3 mm Hg; P >.05) v WKY. The SHR exhibited increased aortic wall thickness in comparison with WKY (523 +/- 16 v 355 +/- 17 micro m; P <.05). No differences were seen in plasma combined NO(2) and NO(3) (NO(x)) (0.48 +/- 0.11 mmol/L for WKY v 0.58 +/- 0.18 mmol/L for SHR) or plasma IGF-1 (1007 +/- 28 ng/mL for WKY v 953 +/- 26 ng/mL for SHR). Aortic VSMC from SHR displayed enhanced proliferation in comparison with WKY (P <.05). Underlying this enhanced proliferation was altered SHR VSMC sensitivity to the antiproliferative NO donor 2,2"[Hydroxynitrosohydrazono] bis-ethanimine (DETA-NO) (ID(50): 270 +/- 20 mmol/L for SHR; 150 +/- 11 mmol/L for WKY; P <.05). Basal cyclic guanosine monophosphate (cGMP) secretion from SHR VSMC was 65-fold greater than that seen from WKY (P <.001). In response to DETA-NO, cGMP secretion from SHR VSMC increased modestly (1.5-fold; P <.01), whereas treatment of WKY VSMC resulted in a 26-fold (P <.001) increase in cGMP. The SHR VSMC did not respond to exogenous IGF-1, whereas WKY VSMC exhibited a dose dependent increase in proliferation with IGF-1 (10(-10) to 10(-7) mol/L). These data suggest that VSMC hyperplasia in early hypertension is not reflected by imbalances in plasma IGF-1 or NO. Rather, altered SHR VSMC sensitivity to NO is likely responsible in part for the observed hyperproliferation seen in early stages of hypertension.
...
PMID:Altered insulin-like growth factor-1 and nitric oxide sensitivities in hypertension contribute to vascular hyperplasia. 1274 2

Off-pump coronary artery bypass technique or bypass graft surgery without the use of a heart-lung machine has been introduced in the last six years, and now comprises approximately 25 per cent of all coronary artery bypass surgery being done in the world. One of the goals of beating heart surgery is to eliminate the complications associated with the use of cardiopulmonary bypass. The use of all arterial conduits for coronary artery bypass graft has become more acceptable after experiences gained and reports of better long-term results. From January 2001 to December 21 2002 the authors performed 251 off-pump procedures. One hundred and nine of these cases were done utilizing all arterial conduits. The data was stratified using the US National Society of Thoracic Surgeons Cardiac Surgery Database pre-operative risk module and divided into 3 groups as suggested: Low risk group with a predicted mortality of 0-1 per cent (2 patients); Medium risk group with a predicted mortality of 2-9 per cent (87 patients), and High risk group with a predicted mortality of 10+ per cent (10 patients). The predicted mortality of the entire group was 4.5 per cent. There were 90 males and 19 females with a mean age of 60.2 +/- 10.7 years, with 15.6 per cent of them older than 70 years. Pre-operative co-morbidities included 1/4 of the patients who had ejection fraction (EF) of equal to or less than 0.4, 4.5 per cent had unstable angina, 1.6 per cent had urgent/emergent status, 26.6 per cent underwent re-operative procedure, 1 per cent had pre-operative serum creatinine more than 2 mg per cent, 4.8 per cent had a history of stroke, 20.2 per cent had a history of congestive heart failure, 45.2 per cent had a history of previous myocardial infarction, 10.7 per cent had a history of chronic obstructive pulmonary disease, 46.9 per cent had a history of diabetes, 62 per cent had hypertension, and 20 patients (18.3%) required intra aortic balloon pump. Intra-operative parameters revealed 3.7 +/- 1.3 grafts/patient. The left internal mammary artery (LIMA) was used to the left anterior descending (LAD) in 6.4 per cent, or sequential with the diagonals 93.6 per cent. The 30 days mortality was 3.6 per cent (4 cases). Further analysis revealed that pre-operatively, none of these 4 cases was in the low predicted (predicted mortality of 0-1%) risk group, 2 of them were in the medium (predicted mortality of 2-9%) and the other 2 were in the high predicted risk (predicted mortality of 10+%) group. The skin-to-skin time was 4.1 hours and there were two conversions to on-pump in this group. Post-operatively, the intubation time was 4.7 hours. There was no peri-operative myocardial infarction, one patient required dialysis, and no patient experienced stroke. There was no sternal wound or arm wound infection, 9.5 per cent experienced temporal sensation impairment at the site of the radial artery harvesting at one month. Re-operation for bleeding occurred in 3 cases, and thirteen patients (14.3%) developed new atrial fibrillation. The authors are no longer making a one-foot long incision and spread ten inches wide like in the old days'. With the less invasive approach lessened in the recent past, the authors have found the less invasive the incision the less the pain after surgery. Totally eliminating the leg incision has allowed the patient to get up and mobilize on the same afternoon, if the procedure was done in the morning. All of these approaches combined with the off-pump technique, as far as the authors are concerned, will provide those who need coronary arterial bypass graft the best operative procedure.
...
PMID:Off-pump coronary bypass surgery and all arterial conduits: learning experience at Bangkok Heart Institute. 1286 64

The 30-year history of coronary artery surgery in China has shown rapid development, particularly in the past 10 years. By 1994, approximately 100 coronary bypass grafting procedures were performed nationally, with mortality rates halving between 1992 and 1993. By 1998, more than 1000 operations had been performed, with mortality rates falling to less than 1% at Fu Wai Hospital, Beijing, but with varying results across the country. Figures for 1995 from Fu Wai Hospital show that the use of the left internal mammary artery was favoured in 65% of patients, with the radial artery used in less than 10%. Changes to the presenting patient profiles have been noted across time, with the incidence of hypertension and diabetes increasing and with severe ventricular dysfunction decreasing. Off-pump and minimally invasive coronary artery bypass grafting were introduced to China in 1996 with encouraging early results.
...
PMID:Review of coronary artery surgery in China. 1635 34

Adverse neurologic outcomes after cardiac surgery can have devastating consequences, among them increased mortality risk and, among survivors, loss of independence and a diminished quality of life. They also represent a burden on the health-care system, requiring prolonged hospitalizations and additional aftercare and, therefore, greater costs. Adverse outcomes are classified by their severity. Frank stroke is the most serious. This complication is associated with patient age; however, the presence of significant ascending aortic disease represents the greatest hazard. Multivariable analysis also indicates that prior neurologic events, diabetes, chronic obstructive pulmonary disease, preoperative status, and diffuse vascular disease are predictive. The second type of adverse cerebral outcome includes neurocognitive abnormalities such as memory loss and diminished emotional health. The strongest predictors of these abnormalities are hypertension and a history of alcohol use, as well as age. These predictive factors have been incorporated into the Multicenter Study of Perioperative Ischemia stroke-risk index, which clinicians can use to better assess the risk of adverse neurologic events. Clinical research examining the relationship between the predictive variables for neurologic adverse events and cerebral blood flow has suggested some surgical strategies for minimizing risk, such as limiting manipulation of the ascending aorta. The benefits of strategies such as using low or high mean arterial pressures and manipulating pump flow remain unclear. Off-pump coronary bypass surgery has been proposed as a means of reducing neurologic risk, but its effectiveness is unproved in this area. One pharmacologic strategy, the administration of aprotinin, has been shown to reduce the incidence of stroke in high-risk patients.
...
PMID:Predicting and preventing adverse neurologic outcomes with cardiac surgery. 1649 92

In the peri-operative and post-operative course of coronary bypass operations, the diabetic patient is susceptible to complications that cause morbidity and mortality. Morbidity might best be conceptualized as the cumulative effect of the diabetic patient chronically at risk and a variety of surgically related insults, including surgical stress, anaesthesia, hypo- and hypertension, anaemia, dysrhythmias, de- or hyperhydration and cardiopulmonary bypass (CPB) that exceed the compensatory capacities of the patient. Because all these factors for adverse outcome coexist, it becomes difficult to determine which ones are most important. However, it is reasonable that, in the presence of generalized atherosclerosis affecting the aorta ascendens, carotids and the cerebral arteries, the interaction of CPB-associated embolization, hypoperfusion and inflammation may cause neurologic morbidity. Many physiologic alterations (such as non-pulsatile perfusion and hemodilution) occur during CPB and may worsen renal dysfunction in patients with diabetic nephropathy. Pulmonary dysfunctions, associated with diabetic microangiopathy, could be unmasked by atelectasis, capillary leak and other pathophysiological conditions developing after the use of extracorporeal circulation. Actually, there is evidence that with the avoidance of CBP and the use of adequate OPCAB (Off Pump Coronary Artery Bypass) techniques, by experienced teams, the incidences of neurological, renal and pulmonary complications decrease, in high-risk patients, e. g. diabetics, as well as in unselected cohorts. Because it is not possible to identify confidently those patients who are at risk for CPB-associated complications, we use a strategy where all CABG (Coronary Artery Bypass Grafting) are performed in OPCAB technique. The total OPCAB approach will in addition ascertain the development of organizational OPCAB routines and expertise. The process of re-engineering the unit towards total OPCAB needs systematic training and re-training of cardiac surgeons by surgeons, experienced in both, OPCAB surgery and knowledge transfer, according to the principles of continuing medical education (CME). Thus, the chances of the OPCAB technique improving the outcome of diabetic patients can be fully realized.
...
PMID:[Should we avoid cardiopulmonary bypass with diabetic patients?]. 1659 47

Cardiovascular diseases are the leading cause of morbidity and mortality for women in developed countries. Numerous studies have shown that women have higher morbidity and mortality rates than men following coronary artery bypass graft surgery (CABG). Having this evidence as our starting point, we compared the outcomes of CABG procedures in women and men. The analysis included patient preoperative risk factors (age, left ventricular ejection fraction, diabetes mellitus, arterial hypertension, hypercholesterolemia, myocardial infarction and cerebrovascular insult), number of grafts and perioperative complications (reopening for bleeding, perioperative myocardial infarction, sternal wound infections--both superficial and deep, atrial and ventricular fibrillation, cardiac decompensation), and mortality. Women had more risk factors and comorbidities than man, including arterial hypertension and hypercholesterolemia, but less severe atherosclerosis and higher left ventricular ejection fraction. Off-pump myocardial revascularization was done in 48% of women and in 42% of men. There was no statistically significant difference in perioperative complications between women and men. Comparison of the mean values showed the perioperative mortality to be higher in women than in men (3.4% vs. 2.9%), but the difference was not statistically significant (p = 0.724).
...
PMID:[Coronary artery surgery in women]. 1680 76

NO is known to induce expression of heme oxygenase-1, an antioxidant enzyme in blood vessels. We tested whether NO might modulate the endothelial NADPH oxidase function via heme oxygenase-1. In human microvascular endothelial cells, the NO donor DETA-NONOate (0.1 to 1 mmol/L) strongly induced expression of heme oxygenase-1 but not Cu/Zn superoxide dismutase. This was associated with a reduction of the superoxide-generating capacity of NADPH oxidase, an effect that depended on de novo gene transcription and heme oxygenase-1 activity. Activation of NADPH oxidase by tumor necrosis factor (TNF) alpha increased generation of reactive oxygen species. DETA-NONOate alone had little effect on TNF-stimulated reactive oxygen species, but it enhanced the TNF response when: (1) heme oxygenase-1 expression was blocked with specific small-interfering RNA; (2) heme oxygenase-1 activity was blocked by zinc-protoporphyrin; or (3) NADPH oxidase activity was blocked by diphenyleneiodonium. Moreover, the heme oxygenase-1 end product bilirubin directly inhibited fully functional NADPH oxidase and seemed to interrupt the assembly and activation of the oxidase. In conclusion, NO may modulate superoxide production by NADPH oxidase in human vascular endothelial cells, at least partly by inducing heme oxygenase-1. Our results indicate that suppression of NADPH oxidase-dependent reactive oxygen species formation may represent a novel mechanism underlying the cardiovascular protective actions of heme oxygenase-1 and bilirubin.
Hypertension 2006 Nov
PMID:NO modulates NADPH oxidase function via heme oxygenase-1 in human endothelial cells. 1698 56

Captive cheetah (Acinonyx jubatus) scheduled for either general health examination or dental surgery were immobilised with combinations of medetomidine-ketamine (K/DET, n = 19), midazolam-ketamine (K/MID, n = 4) or medetomidine-tiletamine-zolazepam (Z/DET, n = 5). Induction time and arterial blood pressure was not statistically significantly (P > 0.05) different between treatment groups. Transient seizures were observed in the K/DET treated animals during induction. Hypertension was present in all groups during anaesthesia with mean (+/- SD) systolic pressure of 30.7 +/- 5.0 kPa for the K/DET group, 27.7 +/- 2.7 kPa for the K/MID group, and 33.1 +/- 4.6 kPa for the Z/DET group. Heart rate was statistically significantly (P < 0.05) lower in the K/DET group (69 +/- 13.2 beats/min) compared to the K/MID group (97 +/- 22.6 beats/min), and ventilation rate was statistically significantly (P < 0.05) lower in the K/MID group (15 +/- 0.0 breaths/min) compared with the K/DET group (21 +/- 4.6). A metabolic acidosis and hypoxia were observed during anaesthesia when breathing air. Oxygen (O2) administration resulted in a statistically significant (P < 0.05) increase in the arterial partial pressure of carbon dioxide (hypercapnoea), arterial partial pressure of O2, and % oxyhaemoglobin saturation.
...
PMID:Cardiopulmonary effects of medetomidine or midazolam in combination with ketamine or tiletamine/zolazepam for the immobilisation of captive cheetahs (Acinonyx jubatus). 1745 46

Studies were conducted to determine whether the diffusion of NO from the renal medullary thick ascending limb (mTAL) to the contractile pericytes of surrounding vasa recta was reduced and, conversely, whether diffusion of oxygen free radicals was enhanced in the salt-sensitive Dahl S rat (SS/Mcwi). Angiotensin II ([Ang II] 1 micromol/L)-stimulated NO and superoxide (O(2)(*-)) production were imaged by fluorescence microscopy in thin tissue strips from the inner stripe of the outer medulla. In prehypertensive SS/Mcwi rats and a genetically designed salt-resistant control strain (consomic SS-13(BN)), Ang II failed to increase either NO or O(2)(*-) in pericytes of isolated vasa recta. Ang II stimulation resulted in production of NO in epithelial cells of the mTAL that diffused to vasa recta pericytes of SS-13(BN) rats but not in SS/Mcwi rats except when tissues were preincubated with the superoxide scavenger TIRON (1 mmol/L). Ang II resulted in a greater increase of O(2)(*-) in the mTAL of SS/Mcwi compared with SS.13(BN) mTAL. The O(2)(*-) diffused to adjoining pericytes in tissue strips only in SS/Mcwi rats but not in control SS-13(BN) rats. Diffusion of Ang II-stimulated O(2)(*-) from mTAL to vasa recta pericytes was absent when tissue strips from SS/Mcwi rats were treated with the NO donor DETA-NONOate (20 micromol/L). We conclude that the SS/Mcwi rat exhibits increased production of O(2)(*-) in mTAL that diffuses to surrounding vasa recta and attenuates NO cross-talk. Diffusion of O(2)(*-) from mTAL to surrounding tissue could contribute to reduced bioavailability of NO, reductions of medullary blood flow, and interstitial fibrosis in the outer medulla of SS/Mcwi rats.
Hypertension 2007 Jun
PMID:Enhanced superoxide production in renal outer medulla of Dahl salt-sensitive rats reduces nitric oxide tubular-vascular cross-talk. 1747 Jul 22

We aimed to quantify the effect of avoiding cardiopulmonary bypass on outcomes in high-risk patients. Of the 2079 consecutive CABG's performed by three surgeons between April 1997 and September 2002, 389 were classified as high-risk according to the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification, with a score of >5. The off-pump group had 196 patients and the on-pump group had 193 patients. Multivariate logistic regression was used to assess the effect of off-pump on in-hospital outcomes, while adjusting for treatment selection bias with a propensity score. The incidence of hypertension, hypercholesterolaemia, and renal dysfunction were higher in the off-pump group. The median EuroSCORE for off-pump patients was 7 (6-8), while for the on-pump patients was 7 (6-8; P=0.31). After adjusting for the propensity score, off-pump patients were less likely to have stroke (OR 0.17; P=0.041), renal failure (OR 0.35; P=0.029), blood transfusion (OR 0.12; P<0.001), prolonged mechanical ventilation (OR 0.36; P=0.021), and inotrope support (OR 0.35; P<0.001). Off-pump patients also had significantly shorter post-operative hospital stays. There was no significant difference between off-pump and on-pump patients in terms of in-hospital and mid-term mortality. Off-pump CABG is justified in EuroSCORE high-risk cases.
...
PMID:Is off-pump coronary surgery justified in EuroSCORE high-risk cases? A propensity score analysis. 1767 Jan 51


<< Previous 1 2 3 4 5 Next >>

---