Patients will be randomly allocated into two groups of 40 patients each:
Group L:will receive 18-20 ml/kg/h of Ringer's lactate starting from conduction of spinal anesthesia.

Patients will be randomly allocated into two groups of 40 patients each:
Group R: will receive 4-6 ml/kg/h of Ringer's lactate starting from conduction of spinal anesthesia.

Intraoperative Complications

Randomization will be done using computer generated table of random numbers in a 1:1 ratio and will be conducted using sequentially numbered, opaque and sealed envelope. The trial will be planned that neither the doctors (investigators) nor the patients will be aware of the group allocation and amount of fluid received. Intraoperative and postoperative data collections will be achieved by the same blinded anesthiologist.
Patients will be randomly allocated into two groups:
Group L: 40 patients who will be subjected to ''liberal" approach of intraoperative 18-20 ml/kg/h of Ringer's lactate starting from conduction of spinal anesthesia.
Group R: 40 patients who will be subjected to ''restrictive" approach of intraoperative 4-6 ml/kg/h of Ringer's lactate starting from conduction of spinal anesthesia.
Blood loss will be replaced if more than 500 ml in a ratio of 3 ml crystalloid: 1 ml blood.

Ringer lactate

Assiut University Hospital

Liberal Versus Restrictive Fluid Protocols in Adults

Liberal Versus Restrictive Fluid Protocols in Adults Patients Undergoing Unilateral Orthopedic Lower Limb Surgery Under Spinal Anesthesia

systolic blood pressure (mmHg) diastolic blood pressure (mmHg) mean arterial blood pressure (mmHg)

RAGAA AHMED HERDAN

lecturer of anesthesia and intensive care

Assiut University

comparing the effect of two different protocols of fluid therapy (liberal versus restrictive) in adult patients undergoing unilateral orthopedic lower limb surgery under spinal anesthesia

Randomization will be done using computer generated table of random numbers in a 1:1 ratio and will be conducted using sequentially numbered, opaque and sealed envelope. The trial will be planned that neither the doctors (investigators) nor the patients will be aware of the group allocation and amount of fluid received. Intraoperative and postoperative data collections will be achieved by the same blinded anesthiologist.

patients with postural orthostatic tachycardia syndrome diagnosis.

Patients with Postural orthostatic tachycardia syndrome who has peripheral neuropathy

Whole blood will be retain for DNA extraction.

Postural Tachycardia Syndrome

Oral glucose tolerance test

Vanderbilt University Medical Center

Gastrointestinal Symptoms in Postural Orthostatic Tachycardia Syndrome

POSTURAL ORTHOSTATIC TACHYCARDIA SYNDROME AND GASTROINTESTINAL SYMPTOMS: Contribution of Gastrointestinal Peptides

The plasma levels of GI peptides (GLP-1, GLP-2, PPY, glucagon, C-peptide, insulin) and their pattern of secretion after ingestion of 75 g glucose.

Gastric emptying time will be measured by acetaminophen absorption test after ingestion of 75 grams glucose.

The gastrointestinal symptoms will be evaluated by questionnaire after ingestion of 75 grams glucose.

Symptoms related to postural orthostatic tachycardia symptoms will be evaluated by specific questionnaire after ingestion of 75 grams glucose.

Cyndya Shibao

Assistant Professor

Subjects undergo Symplicity Renal Denervation within 2 weeks of baseline visit will follow usual care after week 13 visit

Subjects following usual care until week 13 visit will then undergo Symplicity Renal Denervation within 2 weeks of Week 13 visit

Subjects undergo renal denervation within 2 weeks of baseline visit
Symplicity Renal Denervation System

Early Renal Denervation

Subjects undergo renal denervation within 2 weeks of Week 13 visit
Symplicity Renal Denervation System

Late Renal Denervation

Total

Gender

Region of Enrollment

Within-subject comparison of increase in urine sodium excretion following saline loading before RSD and 13 weeks following RSD.

Urine Sodium Excretion

Urine volume following furosemide therapy after sodium loading.

Subjects undergo Symplicity Renal Denervation within 2 weeks of baseline visit will follow usual care after week 13 visit
Symplicity Renal Denervation: Renal denervation

Early Symplisity Renal Denervation

Subjects following usual care until week 13 visit will then undergo Symplicity Renal Denervation within 2 weeks of Week 13 visit
Symplicity Renal Denervation: Renal denervation

Late Symplisity Renal Denervation

Urine Volume

Difference in 24-hour urine sodium excretion, compared between pre-RSD and 13 weeks after RSD.

24-hour Urine Sodium Excretion

Estimated Glomerular Filtration Rate (GFR) by creatinine and cystatin C

Glomerular Filtration Rate

Study terminated early, endpoints not measured

Serum Cystatin C

Blood Urea Nitrogen (BUN) Level

Creatinine Clearance From 24-hour Urine Creatinine

Urine Albumin

Intra-renal hemodynamics as measured by Renal Resistive Index (RRI) by renal Doppler ultrasonography Study terminated early, endpoints not measured

Renal Resistive Index

Echo: Left ventricular end systolic volume Study terminated early, endpoints not measured

Left Ventricular End Systolic Volume

Echo: Left Ventricular Ejection Fraction Study terminated early, endpoints not measured

Left Ventricular Ejection Fraction

Echo: Global longitudinal strain Study terminated early, endpoints not measured

Global Longitudinal Strain

LV End Systolic Dimension (LVESd)

LV End Diastolic Dimension (LVEDd)

Left Atrial Size

Plasma N-terminal Pro-brain Natriuretic Peptide

Resting Plasma Norepinephrine

Resting Urine Norepinephrine

Plasma Renin Activity

Plasma Aldosterone

6 Minute Walk Test

Kansas City Cardiomyopathy Questionnaire Score

Patient Global Assessment

New York Heart Association (NYHA) Functional Classification

Heart Rate Variability

Tissue Doppler Indices

Echo: Left Ventricular End Diastolic Volume

Left Ventricular End Diastolic Volume

Overall Study

Kathy Moore

Heart Failure

Symplicity Renal Denervation

Emory University

Massachusetts General Hospital

Brigham and Women's Hospital

Tufts Medical Center

Mayo Clinic

Washington University

Duke University Medical Center

Metro Health System

Cleveland Clinic

University of Pennsylvania Health System

Thomas Jefferson University Hospital

The University of Vermont - Fletcher Allen Health Care

Study of Renal Denervation in Patients With Heart Failure

Promotion of Renal Sodium Excretion by Renal Sympathetic Denervation in Congestive Heart Failure

Adrian Hernandez

Associate Professor

National Heart, Lung, and Blood Institute (NHLBI)

Medtronic

To evaluate if the various indices of sympathetic activity (Autonomic Function Testing) differ between patients with chronic fatigue syndrome and postural tachycardia syndrome (CFS-P), and CFS without POTS.

To test the null hypothesis that there is no difference between two saline therapies (pulse saline vs. sham saline) in improving both the fatigue score and postural tachycardia syndrome.Saline infusions

Response to nitric oxide inhibition in the presence and absence of an intact autonomic nervous system will be evaluated. L-NMMA trimethaphan will be used for NO inhibition and autonomic blockade, respectively.

The effects of chronic autonomic withdrawal on improving symptoms of chronic fatigue and postural tachycardia syndrome will be evaluated

Chronic Fatigue Syndrome

Orthostatic Intolerance

The autonomic function tests include asking the subject to breathe deeply for two minutes and breathing as fast and as hard as they can for 30 seconds, maintaining a handgrip for 3 minutes, breathing against pressure for 15 seconds, placing one hand in ice water for 1 minute and an orthostatic test. All these tests are meant to stimulate the autonomic nervous system to produce changes in blood pressure and heart rate of short duration that reflect how well the involuntary nervous system is working. In addition, a 24-hour blood pressure monitoring and exercise test may be also performed in some subjects.

Autonomic Function Testing

The effects of continuous IV infusion or pulse IV administration of saline in increasing total blood volume and fatigue score will be evaluated

Saline infusions

Trimethaphan IV infusion for approximately 60 minutes at a dose of 4-6 mg/min L-NMMA IV infusion for approximately 45 minutes at 125, 250, and 500 mg/kg/min for 15 minutes each

hypovolemia/fatiga muscular

Liberal Versus Restrictive Fluid Protocols in Adults

Gastrointestinal Symptoms in Postural Orthostatic Tachycardia Syndrome

Study of Renal Denervation in Patients With Heart Failure

Autonomic Nervous System and Chronic Fatigue Syndrome

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