There are two competing accounts for a theory for human action proposed by Catholic theologians working within the received moral tradition today: a hylomorphic account and an intentional account. In this article, the author compares each of the rival theories for its ability to explain both the structure and morality of the human acts surrounding the elective termina­tion of the pregnancy of a woman with pulmonary arterial hypertension. This scenario of PAH is a superb test case to compare (...) the explanatory power of the two rival action theories. The author’s analysis reveals that the hylomorphic account is the superior account, which can explain better not only the norma­tive conclusions of the Catholic moral tradition but also our lived experience as acting persons in a world governed by cause-and-effect relationships. National Catholic Bioethics Quarterly 11.3 (Autumn 2011): 503–518. (shrink)

There are two competing accounts for a theory for human action proposed by Catholic theologians working within the received moral tradition today: a hylomorphic account and an intentional account. In this article, the author compares each of the rival theories for its ability to explain both the structure and morality of the human acts surrounding the elective termina­tion of the pregnancy of a woman with pulmonary arterial hypertension. This scenario of PAH is a superb test case to compare (...) the explanatory power of the two rival action theories. The author’s analysis reveals that the hylomorphic account is the superior account, which can explain better not only the norma­tive conclusions of the Catholic moral tradition but also our lived experience as acting persons in a world governed by cause-and-effect relationships. National Catholic Bioethics Quarterly 11.3 : 503–518. (shrink)

Introducción: El dormir mal podría ser la causa de hipertensión arterial y de otras enfermedades crónicas no transmisibles.Objetivo: Conocer la calidad de sueño de las personas con hipertensión arterial.Metodología: Se realizo un estudio descriptivo, se aplico el cuestionario de Índice de Calidad de Sueño de Pittsburgh.Resultados: Se evaluó la calidad de sueño en 85 personas con hipertensión arterial, de abril a diciembre del 2021. El 84% tiene un índice de mala y muy mala calidad de sueño.Conclusión: Las (...) personas con hipertensión con mala y muy mala calidad de sueño puede afectar sus cifras de tensión arterial. (shrink)

We hypothesize that threat of dehydration provided selection pressure for the evolutionary emergence and persistence of the anterior communicating artery (ACoA – the inter‐arterial connection that completes the Circle of Willis) in early amniotes.The ACoA is a hemodynamically insignificant artery, but, as we argue in this paper, its privileged position outside the blood‐brain barrier gives it a crucial sensing function for the osmolarity of the blood against the background of the rest of the brain, which efficiently protects itself from (...) dehydration. Till now, the questions of why the ACoA evolved, and what its physiological function is, have remained unsatisfactorily answered. The traditional view—that the ACoA serves as a collateral source of vascularization in case of arterial stenosis—is anthropocentric, and not in accordance with principles of natural selection that apply more generally. Diseases underlying arterial stenosis are associated with aging and the human lifestyle, so this cannot explain why the ACoA formed hundreds of millions of years ago and persisted in amniotes to this day.The peculiar hemodynamic properties of the ACoA could be selected traits that allowed for more efficient forebrain detection of dehydration and complex behavioral responses to water loss, a major advantage in the survival of early amniotes. This hypothesis also explains insufficient hydration often seen in elderly humans. (shrink)

We hypothesize that threat of dehydration provided selection pressure for the evolutionary emergence and persistence of the anterior communicating artery (ACoA – the inter‐arterial connection that completes the Circle of Willis) in early amniotes.The ACoA is a hemodynamically insignificant artery, but, as we argue in this paper, its privileged position outside the blood‐brain barrier gives it a crucial sensing function for the osmolarity of the blood against the background of the rest of the brain, which efficiently protects itself from (...) dehydration. Till now, the questions of why the ACoA evolved, and what its physiological function is, have remained unsatisfactorily answered. The traditional view—that the ACoA serves as a collateral source of vascularization in case of arterial stenosis—is anthropocentric, and not in accordance with principles of natural selection that apply more generally. Diseases underlying arterial stenosis are associated with aging and the human lifestyle, so this cannot explain why the ACoA formed hundreds of millions of years ago and persisted in amniotes to this day.The peculiar hemodynamic properties of the ACoA could be selected traits that allowed for more efficient forebrain detection of dehydration and complex behavioral responses to water loss, a major advantage in the survival of early amniotes. This hypothesis also explains insufficient hydration often seen in elderly humans. (shrink)

IntroductionIndividuals with high scores of perceived stress are more likely to develop arterial hypertension than those with low levels of stress. In addition to this, AH and stress are both independent risk factors for executive function impairment and worse quality of life. Therefore, strategies to control and cope with emotional stress are of paramount importance. However, less is known about the association of PS with EF, QoL, and coping in individuals with hypertension. This study aimed to evaluate (...) the association of PS with EF performance, coping strategies use, and QoL in a sample of hypertensive patients.MethodsWe assessed a group of 45 hypertensive individuals. The EF evaluation was: Frontal Assessment Battery; Controlled Oral Word Association Test—FAS; Letter-Number Sequencing subtest from the Wechsler Adult Intelligence Scale—Third Edition ; Digit Span subtest from the Wechsler Memory Scale-Revised and Wisconsin Card Sorting Test. The type and frequency of coping strategies used were measured by the Brief Coping with Experienced Problems Scale. The World Health Organization Quality of Life Questionnaire Bref was applied to measure QoL. The associations of the PS with EF performance, coping strategies, and QoL were investigated using univariate and multiple linear regression models adjusted for age, sex, education, systolic pressure, and depression symptoms.ResultsIn the multivariate analyses, higher PS was an independent predictor for a lower frequency of emotion-focused strategy use. However, PS was not significantly related to EF and Qol in this sample. The lower the PS, the greater the use of emotion-focused coping.ConclusionHypertensive individuals with high PS use less frequently positive emotion-focused coping strategies. (shrink)

This renin‐angiotensin system (RAS) interpretation is focused on differences in tissue dependence on RAS and on the topological hierarchy that allows mediators to act only on downstream tissues.Dependence of tissues on RAS: Tested by expectation maximization clustering of the RNA human tissue expression (https://biogps.org/). ACE and vasoconstrictive AT1R clustered with the prorenin receptor. ACE2 and dilatory MAS1 clustered with nine RAS‐related genes, highly expressed in: Liver; Cardiac_Myocytes; Skeletal_Muscle; Uterus; Kidney; Lung; Small_Intestine; Smooth_Muscle.RAS and stress accumulation: While prorenin is active after (...) binding to its receptor, binding of soluble renin increases its enzymatic activity several times. Increased renin secretion multiplies the overall capacity for producing Ang I, leading to hypertension and increased vascular resistance.Coronavirus infection and comorbidities: Cardiorespiratory failure during infection is linked to the previously altered RAS role in lungs and myocardium. Reduced vasodilation by ACE2 lead to vasoconstriction and suboptimal tissue perfusion patterns. Also see the video abstract here https://www.youtube.com/watch?v=Jf0Iped-Mws. (shrink)

Two hard cases have generated controversy regarding the application of the principle of double effect in recent years. As regards the first, the case of the conjoined twins of Malta, there has been considerable convergence: most natural law ethicists seem to agree that separation of the twins was morally permissible. By contrast, the so-called “Phoenix case,” involving an abortion at a Catholic hospital for a woman with pulmonary arterial hypertension, has become a touchstone of disagreement between defenders of (...) the so-called “new” natural law theory, and more “traditional” Thomists. I argue in this essay that, contrary to widespread opinion, the two cases were alike in the following respect: in neither need the principal agents have intended the death of anyone. (shrink)

Introducción: Los cambios biológicos, sicológicos, económicos y sociales que se observan durante el envejecimiento conllevan a pensar que en los ancianos existe una serie de factores que favorecen la aparición de una depresión. Objetivo: evaluar la efectividad de una intervención sicológica para disminuir la depresión en adultos mayores de la Casa de abuelos "Dr. Diego Tamayo Figueredo", de Puerto Padre, en el período de noviembre de 2013 - mayo de 2014. Material y métodos: se realizó un estudio de intervención sicológica (...) en una muestra de 12 adultos mayores de la casa de abuelos. Se aplicó un programa de intervención sicológica, así como la Escala de Depresión Geriátrica para realizar la valoración antes y después de la intervención. Se empleó el modelo Cognitivo- Conductual de Beck. Los datos fueron tratados según la estadística descriptiva. Resultados: el porciento más elevado de pacientes correspondió al grupo de ancianos con edades entre los 60 y 90 años de edad. Respecto al sexo, el más frecuente es el masculino. El asma bronquial, la hipertensión arterial y la diabetes Mellitus representaron el mayor porciento de antecedentes patológicos personales. Conclusión: la intervención sicológica resultó efectiva pues se logró disminuir a leve los niveles iniciales de depresión establecida y los considerados con leve a no depresión, por lo tanto se afirma que con su aplicación fue modificado el estado emocional de los adultos mayores que se implicaron en la muestra. Introduction: Biological, psychological, financial and social changes observed during aging lead to think that there is a series of factors that favor the appearance of depression in senior citizens. Objective: Assessing the effectiveness of a psychological intervention in order to reduce depression in senior citizens from "Dr. Diego Tamayo Figueredo" Senior Citizens' House, Puerto Padre, from November 2013 to May 2014. Material and methods: A psychological intervention study was conducted on a sample of 12 senior citizens from the house. A psychological intervention program as well as the Geriatrics Depression Scale were applied before and after the intervention in order to make the assessment. The Beck's cognitive-behavior model was used. Data was processed according to descriptive statistics. Results: The highest percentage of patients corresponded to a group of seniors between 60 and 90 years of age. Regarding sex, males are more common. Bronchial asthma, arterial hypertension and diabetes mellitus represented the highest percentage of personal pathological history. Conclusion: The psychological intervention proved to be effective since initial established depression levels were reduced to minor and those considered as minor were reduced to no depression ; therefore, it is stated that its application modified the state of mind of the senior citizens involved in the sample. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:“Just Because You Can—Doesn’t Mean You Should”Mindy B. StatterAs Albert R. Jonsen stated, “The technological imperative begins to rule clinical decisions: if a technology exists, it must be applied. Patients... are moved to higher and higher levels of care, finally becoming enmeshed in a tangle of tubes that extinguish their identity and needs as persons.” In this case the conflict created by the parental demand for the utilization of (...) technology, extracorporeal support in a neonate will be explored.I was consulted in the care of a newborn with a right–sided congenital diaphragmatic hernia (CDH). In this anomaly the diaphragm, the muscular partition that separates the abdomen and the thorax, forms incompletely, and the viscera migrate up into the chest compressing the developing lung, shifting the medistinum and heart and compressing the contralateral lung. The resulting lung maldevelopment is termed pulmonary hypoplasia. The maldevelopment of the lungs in CDH is variable with the most severe forms resulting in neonatal death. This congenital anomaly is associated with 55% survivability; the poor prognosis is due to the pulmonary hypoplasia. In addition to pulmonary hypoplasia, there is the association of pulmonary hypertension with CDH. Pulmonary hypertension is a condition where the vascular resistance in the lung is high with reduced blood flow within the lung. The physiologic consequence of pulmonary hypertension is hypoxemia, oxygen deficiency in the blood, and reduced oxygen delivery to all organs. Unlike severe pulmonary hypoplasia, pulmonary hypertension is reversible. When an infant with CDH is born and deteriorates due to respiratory failure it can be difficult to determine whether the respiratory failiure is due to pulmonary hypoplasia or pulmonary hypertension. Extracorporeal membrane oxygenation (ECMO) is indicated in the management of reversible respiratory and, or cardiac failure. In the case of neonates with CDH, ECMO addressess the reversible component of the respiratory failure, the pulmonary hypertension. The respiratory failure due to severe pulmonary hypoplasia is not reversible; ECMO is not indicated. There are established criteria to guide the determination of which infant is a candidate for ECMO. Depending upon the ECMO center, the stringency can vary.In this case, the baby had significant respiratory failure with impairment in both oxygenation, hypoxia, and ventilation–the elimination of carbon dioxide, hypercapnea. The neonatologist spoke with the mother who stated that she wanted “everything done” including ECMO in the management [End Page 22] of her baby. When the neonatologist consulted me to put the baby on ECMO I expressed my concern that this infant had irreversible respiratory failure due to pulmonary hypoplasia. And simply from a technical aspect, I could not guarantee that ECMO would “work”. When an infant is “cannulated” for extracorporeal support, cannulas are inserted to allow for the drainage of blood into the ECMO circuit, the blood oxygenated and the carbon dioxide is cleared, and the blood is then returned to the infant. The majority of diaphragmatic hernias are on the left and when the CDH is on the right side, the right heart may be compressed by the viscera in the chest, and venous drainage into the ECMO circuit may be impaired. When this is encountered, the next step in the management algorithm is to fix the hernia–reduce and return the viscera within the chest to the abdomen and eliminate the visceral compression of the right heart. The neonatologist shared my concern and also reiterated that this baby’s mother wanted “everything done”. I had little uncertainty as to the etiology of the respiratory failure in this baby. In meeting the mother’s demands I then suggested that the hernia be repaired first, and if there was improvement in the hypoxia and hypercapnea, then give the baby the benefit of the doubt that there is a component of reversibility to the respiratory failure and then proceed with ECMO cannulation. The neonatologist agreed with this suggested plan.I then went to talk with the baby’s mother. I explained my concerns that based on the profound hypercapnea on the arterial blood gases that the baby’s respiratory failure was due to pulmonary hypoplasia and not reversible with extracorporeal support. She insisted that her baby be put on ECMO. I then explained the operative algorithm and... (shrink)

Although considerable research has been devoted to cognitive functions deteriorating due to diseases of cardiovascular system, rather less attention has been paid to their theoretical background. Progressive vascular disorders as hypertension, atherosclerosis and carotid artery stenosis generate most of all pathological changes in the white matter, that cause specific cognitive disorder: disconnection syndromes, and disturbances in the dynamic aspect of information processing. These features made neuropsychological disorders secondary to cardiovascular diseases different than the effects of cerebral cortex damage, which (...) may be interpreted modularly. (shrink)

A tree‐like hierarchical branching structure is present in many biological systems, such as the kidney, lung, mammary gland, and blood vessels. Most of these organs form through branching morphogenesis, where outward growth results in smaller and smaller branches. However, the blood vasculature is unique in that it exists as two trees (arterial and venous) connected at their tips. Obtaining this organization might therefore require unique developmental mechanisms. As reviewed here, recent data indicate that arterial trees often form in (...) reverse order. Accordingly, initial arterial endothelial cell differentiation occurs outside of arterial vessels. These pre‐artery cells then build trees by following a migratory path from smaller into larger arteries, a process guided by the forces imparted by blood flow. Thus, in comparison to other branched organs, arteries can obtain their structure through inward growth and coalescence. Here, new information on the underlying mechanisms is discussed, and how defects can lead to pathologies, such as hypoplastic arteries and arteriovenous malformations. -/- . (shrink)

Monica Colvin-Adams,1 Nonyelum Harcourt,1 Robert LeDuc,2 Ganesh Raveendran,1 Yassir Sonbol,3 Robert Wilson,1 Daniel Duprez11Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA; 2Division of Biostatistics University of Minnesota, Minneapolis, MN, USA; 3Cardiovascular Division, St Luke's Hospital System, Sugar Land, TX, USAObjective: Arterial elasticity is a functional biomarker that has predictive value for cardiovascular morbidity and mortality in nontransplant populations. There is little information regarding arterial elasticity in heart transplant recipients. This study aimed to characterize small and large artery elasticity (...) in heart transplant recipients in comparison with an asymptomatic population free of overt cardiovascular disease. A second goal was to identify demographic and clinical factors associated with arterial elasticity in this unique population.Methods: Arterial pulse waveform was registered noninvasively at the radial artery in 71 heart transplant recipients between 2008 and 2010. SAEs and LAEs were derived from diastolic pulse contour analysis. Comparisons were made to a healthy cohort of 1,808 participants selected from our prevention clinic database. Multiple regression analyses were performed to evaluate associations between risk factors and SAE and LAE within the heart transplant recipients.Results: LAE and SAE were significantly lower in heart transplant recipients than in the normal cohort. Female sex and history of ischemic cardiomyopathy were significantly associated with reduced LAE and SAE. Older age and the presence of moderate cardiac allograft vasculopathy were also significantly associated with reduced SAE. Transplant duration was associated with increased SAE.Conclusion: Heart transplants are associated with peripheral endothelial dysfunction and arterial stiffness, as demonstrated by a significant reduction in SAE and LAE when compared with a healthy population. Furthermore, cardiac allograft vasculopathy is associated with a significant reduction in SAE, suggesting a potential use in screening heart transplant recipients at risk for developing this complication.Keywords: heart transplant, endothelial function, arterial elasticity, cardiac allograft vasculopathy. (shrink)

Coronary by-pass surgery has been performed in hundreds of thousands of patients in the last 15 years with a high standard of technical and surgical perfection. The indications for this kind of surgery, however, are still controversial because in spite of many retrospective and several prospective studies it cannot be proven convincingly that in a given patient this surgical procedure will prolong life or prevent myocardial infarction. The present attempt to analyze the causes for this controversy shows that the main (...) reasons for this uncertainty lie: (a) in the enigma of the underlying (ischemic heart) disease itself, which is supposed to lend itself to surgical therapy; (b) in the inadequate methods available up until now for characterizing the state of the disease, its probable course, and its pathogenesis; and (c) in the professional group interests which have a momentum of their own. (shrink)

Journal Name: Apeiron Issue: Ahead of print.

Much of postmodern philosophy questions the assumptions of Modernity, that period in the history of the Western world since the Enlightment. These assumptions are that truth is discoverable through human reason; that certain knowledge is possible; and furthermore, that such knowledge will provide a basis for the ineluctable progress of Mankind. The Enlightenment project is underwritten by the conviction that knowledge gained through the scientific method is secure. In so far as biomedicine inherits these assumptions it becomes fair game for (...) postmodern deconstruction. Today, perhaps more than ever, plural values compete, and contradictory approaches to health, for instance, garner support and acquire supremacy through consumer choice and media manipulation rather than evidence-based science. Many doctors feel a tension between meeting the needs of the patient face to face, and working towards the broader health needs of the public at large. But if the very foundations of medical science are questioned, by patients, or by doctors themselves, wherein lies the value of their work? This paper examines the issues that the anti-foundationalist thrust of postmodernism raises, in the light of a case of mild hypertension. The strict application of medical protocol, derived from a nomothetic, statistical perspective, seems unlikely to furnish value in the treatment of an individual. The anything goes, consumerist approach, however, fares no better. The author argues that whilst value cannot depend on any rationally predetermined parameters, it can be rescued, and emerges from the process of the meeting with the patient. (shrink)

The present study examined deep gray matter perfusion in neonates with congenital heart disease (CHD) with arterial spin labeling magnetic resonance imaging preoperatively. We found that neonates with cyanotic CHD showed lower right thalamus compared with controls and lower right basal ganglia perfusion compared with acyanotic CHD. When the CHD group was assessed as a whole, it showed slightly decreased left thalamus perfusion compared with controls. The results suggest that cardiac physiology plays a crucial part in changes in regional (...) cerebral perfusion. Perfusion with arterial spin labeling may be a useful marker of high risk for impaired cerebral blood flow auto-regulation and cerebral hypoperfusion in neonates with CHD. (shrink)

ObjectiveNoisy galvanic vestibular stimulation (nGVS) is often used to improve postural stability in disorders, such as neurorehabilitation montage. For the safe use of nGVS, we investigated whether arterial pressure (AP) and heart rate vary during static supine and slow whole-body tilt with random nGVS (0.4 mA, 0.1–640 Hz, gaussian distribution) in a healthy elderly population.MethodsThis study was conducted with a double-blind, sham-controlled, cross-over design. Seventeen healthy older adults were recruited. They were asked to maintain a static supine position on (...) a bed for 10 min, and the bed was tilted up (TU) to 70 degrees within 30 s. After maintaining this position for 3 min, the bed was passively tilted down (TD) within 30 s. Real-nGVS or sham-nGVS was applied from 4 to 15 min. The time course of mean arterial pressure (MAP) and RR interval variability (RRIV) were analyzed to estimate the autonomic nervous activity.ResultnGVS and/or time, including pre-/post-event (nGVS-start, TU, and TD), had no impact on MAP and RRIV-related parameters. Further, there was no evidence supporting the argument that nGVS induces pain, vertigo/dizziness, and uncomfortable feeling.ConclusionnGVS may not affect the AP and RRIV during static position and whole-body tilting or cause pain, vertigo/dizziness, and discomfort in the elderly. (shrink)

Coronary by-pass surgery has been performed in hundreds of thousands of patients in the last 15 years with a high standard of technical and surgical perfection. The indications for this kind of surgery, however, are still controversial because in spite of many retrospective and several prospective studies it cannot be proven convincingly that in a given patient this surgical procedure will prolong life or prevent myocardial infarction. The present attempt to analyze the causes for this controversy shows that the main (...) reasons for this uncertainty lie: (a) in the enigma of the underlying (ischemic heart) disease itself, which is supposed to lend itself to surgical therapy; (b) in the inadequate methods available up until now for characterizing the state of the disease, its probable course, and its pathogenesis; and (c) in the professional group interests which have a momentum of their own. (shrink)

The purpose of this study was to examine the effectiveness of a neuro-meditation program to support nurses during the COVID-19 pandemic. Forty-five nurses were classified into three groups based on their systolic blood pressure: normotensive, hypertensive and control. Using a parallel, randomly controlled design across a 4-week period, 10 × 30-min sessions using the Rebalance© Impulse were completed. Sleep was assessed by wrist actigraphy and subjective sleep questionnaires; perceived sleep quality, Ford Insomnia Response to Stress Test questionnaire and the Spiegel (...) Sleep Quality questionnaire. Blood pressure, resting heart rate, mean heart rate, heart rate variability index, cortisol, and alpha-amylase were also measured. Statistical analysis was completed using factorial ANOVA. Sleep improved in the G-hyp group; SSQ ; perceived sleep quality ; sleep efficiency and fragmentation index. In the G-nor group, sleep was improved to a lesser extent; perceived sleep quality. A significant time–group interaction was reported in resting heart rate, systolic blood pressure, and diastolic blood pressure with these measures being significantly reduced in the G-hyp group. RMSSD increased in the G-nor group. This initial evidence suggests that neuro-meditation reduces excessive sympathetic activity, promoting enhanced sleep quality and autonomic control during periods of increased work-related stress.Clinical Trial RegistrationThe study was conducted at Bioesterel, Sophia-Antipolis, France as a clinical trial: Neuro-meditation improves sleep quality, https://www.drks.de/ui_data_web/DrksUI.html?locale=en, DRKS00025731. (shrink)

The purpose of this study was to explore the lived experiences of three couples in each of which one of the partners has undergone coronary artery bypass graft surgery . Previous research has been largely quantitative and focused on discrete dimensions of marital quality, spousal support, or patient and spouse distress. However, few studies explored the experiences of couples as a marital dyad. This study expanded upon previous research to explore couples' experiences of bypass surgery and to examine the possibility (...) of shared meanings about that event. Shared meaning refers to the congruent beliefs that a couple has about their CABG experience . Three couples from the Cardiac Wellness Institute of Calgary were interviewed and the transcribed interviews analyzed. The descriptive phenomenological psychological method was used to identify the underlying meaning structures of the couples' experiences. The analysis revealed a single structure consisting of seven interrelated constituents describing the psychological essence of the couples' experiences of bypass surgery. The study extended the understanding of what CABG is like for a marital dyad, particularly for medical and psychological practitioners who work with CABG patients and their spouses. (shrink)