Management of Moderate-to-Severe Dyspnea in Hospitalized Patients Receiving Palliative Care

ContextBenzodiazepines (BZDs) are commonly prescribed for relief of dyspnea in palliative care, yet few data describe their efficacy.ObjectivesTo describe the management of moderate-to-severe dyspnea in palliative care patients.MethodsChart review of inpatients with moderate or severe dyspnea on initial evaluation by a palliative care service. We recorded dyspnea scores at follow-up (24 hours later) and use of BZDs and opioids.ResultsThe records of 115 patients were reviewed. The mean age of patients was 64 years and primary diagnoses included cancer (64%, n = 73), heart failure (8%, n = 9), and chronic obstructive pulmonary disease (5%, n = 6). At initial assessment, 73% (n = 84) of the patients had moderate and 27% (n = 31) had severe dyspnea. At follow-up, 74% (n = 85) of patients reported an improvement in their dyspnea, of which 42% (n = 36) had received opioids alone, 37% (n = 31) had BZDs concurrent with opioids, 2% (n = 2) had BZDs alone, and 19% (n = 16) had received neither opioids nor BZDs. Logistic regression analysis identified that patients who received BZDs and opioids had increased odds of improved dyspnea (odds ratio 5.5, 95% CI 1.4, 21.3) compared with those receiving no medications.ConclusionMost patients reported improvement in dyspnea at 24 hours after palliative care service consultation. Consistent with existing evidence, most patients with dyspnea received opioids but only the combination of opioids and BZDs was independently associated with improvement in dyspnea. Further research on the role of BZDs alone and in combination with opioids may lead to better treatments for this distressing symptom.     

Bi-cephalic transcranial direct current stimulation combined with functional electrical stimulation for upper-limb stroke rehabilitation: A double-blind randomized controlled trial

BackgroundStroke survivors often present poor upper-limb (UL) motor performance and reduced movement quality during reaching tasks. Transcranial direct current stimulation (tDCS) and functional electrical stimulation (FES) are widely used strategies for stroke rehabilitation. However, the effects of combining these two therapies to rehabilitate individuals with moderate and severe impairment after stroke are still unknown.ObjectiveOur primary aim was to evaluate the effects of concurrent bi-cephalic tDCS and FES on UL kinematic motor performance and movement quality of chronic post-stroke subjects with moderate and severe compromise. Our secondary aim was to verify the effects of combining these therapies on handgrip force and UL motor impairment.MethodsWe randomized 30 individuals with moderate and severe chronic hemiparesis after stroke into tDCS plus FES (n = 15) and sham tDCS plus FES (n = 15) groups. Participants were treated 5 times a week for 2 weeks. Kinematic motor performance (movement cycle time, velocity profile) and movement quality (smoothness, trunk contribution, joint angles) were assessed during an UL reach-to-target task.Handgrip force and motor impairment were also recorded before and after the intervention.ResultsParticipants allocated to the tDCS plus FES group improved movement cycle time (P = 0.039), mean reaching velocity (P = 0.022) and handgrip force (P = 0.034). Both groups improved the mean returning phase velocity (P = 0.018), trunk contribution (P = 0.022), movement smoothness (P = 0.001) and UL motor impairment (P = 0.002).ConclusionsConcurrent bi-cephalic tDCS and FES slightly improved reaching motor performance and handgrip force of chronic post-stroke individuals with moderate and severe UL impairment.Trial registrationClinicalTrials.gov (NCT02818608).     

A ventilation technique for oxygenation and carbon dioxide elimination in CPR: Continuous insufflation of oxygen at three levels of pressure in a pig model

AimPulmonary ventilation remains an important part of cardiopulmonary resuscitation, affecting gas exchange and haemodynamics. We designed and studied an improved method of ventilation for CPR, constructed specifically to support both gas exchange and haemodynamics. This method uses continuous insufflation of oxygen at three levels of pressure, resulting in tri-level pressure ventilation (TLPV). We hypothesized that TLPV improves gas exchange and haemodynamics compared to manual gold standard ventilation (GSV).MethodsIn 14 pigs, ventricular fibrillation was induced and automated CPR performed for 10 min with either TLPV or GSV. After defibrillation, CPR was repeated with the other ventilation method. Gas exchange and haemodynamics were monitored. Data are presented as mean ± standard error of the mean.ResultsTLPV was superior to GSV for PaO₂ (163 ± 36 mmHg difference; P = 0.001), and peak AWP (−20 ± 2 cmH₂O difference; P = 0.000) and higher for mean AWP (8 ± 0.2 cmH₂O difference; P = 0.000). TLPV was comparable to GSV for CPP (5 ± 3 mmHg difference; P = 0.012), VCO₂ (0.07 ± 0.3 mL/min/kg difference; P = 0.001), SvO₂ (4 ± 3%-point; P = 0.001), mean carotid flow (−0.5 ± 4 mL/min difference; P = 0.016), and pH_a (0.00 ± 0.03 difference; P = 0.002). The PaCO₂ data do not provide a conclusive result (4 ± 4 mmHg difference).ConclusionWe conclude that the ventilation strategy with a tri-level pressure cycle performs comparable to an expert, manual ventilator in an automated-CPR swine model.     

Differential displacement of soft tissue layers from manual therapy loading

BackgroundUnderstanding the biomechanics of spinal manipulative therapy requires knowing how loads are transmitted to deeper structures. This investigation monitored displacement at sequential depths in thoracic paraspinal tissues parallel with surface load directions.MethodsParticipants were prone and a typical preload maneuver was applied to thoracic tissues. Ultrasound speckle tracking synchronously monitored displacement and shear deformation of tissue layers in a region of interest adjacent to load application to a depth of 4 cm. Cumulative and shearing displacements along with myoelectric activity were quantitatively estimated adjacent to loading site.FindingsThe cephalocaudal cumulative displacement in layers parallel to the surface were, in order of depth, 1.27 (SD = 0.03), 1.18 (SD = 0.02), and 1.06 (SD = 0.01) mm (P < 0.000), respectively. The superficial/intermediate shear was 2.1 ± 2.3% whereas the intermediate/deep shear was 4.4% (SE = 3.7, P = 0.014). Correlation of tissue layers was stronger with application site displacement at the surface (0.87 < r < 0.89) than with muscle activation (0.65 < r < 0.67).InterpretationSurface loading of the torso in combined posteroanterior and caudocephalic directions result in both displacement of tissues anteriorly and in shearing between tissue layers in the plane of the tissues strata to depths that could plausibly affect spinal tissues. Displacements of tissues more likely arise passively, consistent with load transmitted by the retinacula cutis and epimuscular force pathways. Displacements are similar in magnitude to those known to evoke biologically relevant responses in both animal and human studies.     

The Role of a Low-Dose Ketamine-Midazolam Regimen in the Management of Severe Painful Crisis in Patients With Sickle Cell Disease

ContextAcute pain is one of the main causes of hospital admission in sickle cell disease, with variable intensity and unpredictable onset and duration.ObjectivesWe studied the role of a low-dose intravenous (IV) ketamine-midazolam combination in the management of severe painful sickle cell crisis.MethodsA retrospective analysis was performed with data from nine adult patients who were admitted to the intensive care unit with severe painful sickle cell crises not responding to high doses of IV morphine and other adjuvant analgesics. A ketamine-midazolam regimen was added to the ongoing opioids as an initial bolus of ketamine 0.25 mg/kg, followed by infusion of 0.2–0.25 mg/kg/h. A midazolam bolus of 1 mg followed by infusion of 0.5–1 mg/h was added to reduce ketamine emergence reactions. Reduction in morphine daily requirements and improvement in pain scores were the determinants of ketamine-midazolam effect. The t-tests were used for statistical analysis.ResultsNine patients were assessed, with mean age of 27 ± 11 years. Morphine requirement was significantly lower after adding the IV ketamine-midazolam regimen. The mean ± SD IV morphine requirement (milligram/day) in the pre-ketamine day (D0) was 145.6 ± 16.5, and it was 112 ± 12.2 on Day 1 (D1) of ketamine treatment (P = 0.007). The Numeric Rating Scale scores on D0 ranged from eight to ten (mean 9.1), but improved to range from five to seven (mean 5.7) on D1. There was a significant improvement in pain scores after adding ketamine-midazolam regimen (P = 0.01).ConclusionLow-dose ketamine-midazolam IV infusion might be effective in reducing pain and opioid requirements in patients with sickle cell disease with severe painful crisis. Further controlled studies are required to prove this effect.     

Prognostic Factors of Survival in Patients With Advanced Cancer Admitted to Home Care

ContextData regarding prognostication of life expectancy in patients with advanced cancer are of paramount importance to patients, families, and clinicians. However, data regarding patients followed at home are lacking.ObjectivesThe aim of this study was to evaluate the correlation between various factors recorded at the beginning of home care assistance and survival.MethodsA sample of consecutive patients admitted to two home care programs was surveyed. A preliminary consensus was achieved as to the possible variables easy to be recorded at home. These included age at the time of home care admission, gender, residence, marital status, primary cancer diagnosis, Karnofsky Performance Status (KPS) score, measures of systolic blood pressure and heart rate, cyanosis, use of oxygen, and body temperature. The Edmonton Symptom Assessment System was used to record the intensity of each symptom. Patients were divided into two groups: patients with a survival of less than 10 days (short survival) and patients with a survival of 10 days or more (medium-long survival).ResultsThree hundred seventy-four consecutive patients admitted to home care programs were surveyed, of which 187 were male. The mean ± SD age was 72.1 ± 12.7 years. The mean survival was 56.2 ± 65 days. Mean survival was 71.5 ± 67 days (287 patients) and 5.6 ± 2.7 days (87 patients) in the short and medium-long survival groups, respectively. No association between type of tumor and survival was observed (P = 0.162). Univariate logistic regression analysis revealed that male gender (P = 0.020), older age (P = 0.012), lower KPS scores (P < 0.0005), systolic blood pressure less than 100 mm Hg (P = 0.003), heart rate greater than 100 beats per minute (P = 0.0006), delirium (P = 0.004), the use of oxygen (P = 0.002), intensity of fatigue (P = 0.006), drowsiness (P < 0.0005), anorexia (P < 0.0005), dyspnea (P < 0.0005), poor sense of well-being (P < 0.0005), and distress score (P < 0.0005) were associated with a survival of less than 10 days. Marital status, residence, cognitive function, fever, pain, depression, and anxiety were not found to be significantly correlated with survival. In a multiple logistic regression model, low systolic blood pressure and high heart rate, gender, delirium, use of oxygen, KPS score, drowsiness, anorexia, and dyspnea were significantly correlated with a shorter survival.ConclusionLow systolic blood pressure and high heart rate, male gender, poor KPS score, anorexia, and dyspnea were correlated with a shorter survival. Moreover, patients with low systolic blood pressure and high heart rate, male gender, poor KPS score, and greater intensity of anorexia and dyspnea are more likely to die within one week. The combination of physical symptoms from the Edmonton Symptom Assessment System and other parameters included in this study, which are simple to assess and are repeatable at home, should be further explored in future studies to provide a simple tool for use with patients with advanced cancer admitted to a home care program.     

Evaluation of apolipoprotein M as a biomarker of coronary artery disease

ObjectiveTo investigate the possible role of apolipoprotein M (ApoM) in the development of coronary artery disease (CAD).Design and methodsCase-controlled study, which consisted of 118 CAD patients and 255 unrelated subjects used as control group. Plasma concentration of ApoM was determined by dot blot, severity of CAD was expressed with Gensini score or the numbers of lesioned coronary arteries, and serum lipid levels were also measured.Results and discussionOur study shows the mean level of plasma ApoM is 1.3757 ± 0.1493 ODu mm^? 2 in CAD patients, while it is 1.3502 ± 0.1288 ODu mm^? 2 in control group, and there are significant differences in plasma level of ApoM between two groups (t = 0.032, P < 0.05). Concentration of plasma ApoM is positively associated with plasma total cholesterol (r = 0.38, P = 0.025), high density lipoprotein cholesterol (r = 0.29, P = 0.03), low density lipoprotein cholesterol (r = 0.16, P = 0.03) and apolipoproein A–I (r = 0.24, P = 0.03). Multiple logistic and linear regression analysis showed that plasma concentration of ApoM did not correlate either with the number of lesioned coronaries or the Gensini score after adjusted for conventional cardiovascular risk factors (P > 0.05, respectively).ConclusionThe findings suggest that ApoM could not be an independent risk factor but a biomarker of CAD.     

Impact of high-fidelity simulation on the development of clinical judgment and motivation among Lebanese nursing students

BackgroundHigh-fidelity simulation (HFS) offers a strategy to facilitate cognitive, affective, and psychomotor outcomes and motivate the new generation of students.ObjectivesThe purpose of this study was to examine the impact of using high-fidelity simulation on the development of clinical judgment and motivation among Lebanese nursing students.DesignA post-test, quasi-experimental design was used.SettingsTwo private universities in Lebanon were targeted to implement the intervention.ParticipantsA convenience sample of 56 nursing students from two private universities in Lebanon were recruited.MethodsData were collected using the Lasater Clinical Judgment Rubric and the Motivated Strategies for Learning questionnaires.ResultsNursing students exhibited significant improvement in clinical judgment and motivation due to exposure to HFS. There was a significant difference post HFS between the intervention group and the control group in clinical judgment intervention (t = 5.23, p < 0.001) and motivation for academic achievement (t = − 6.71, p < 0.001). The intervention group had a higher mean score of clinical judgment (29.5, SD = 5.4) than the control group (22.1, SD = 5.7) and, similarly, students had higher mean scores of motivation (198.6, SD = 10.5) in the intervention group than in the control group (161.6, SD = 20). The analysis related to differences between the intervention and control groups in motivation and clinical judgment; controlling for previous experience in health care services, the analysis showed no significant difference (Wilk's lambda = 0.77, F = 1.09, p = 0.374).ConclusionThere is a need for nursing educators to implement HFS in nursing curricula, where its integration can bridge the gap between theoretical knowledge and nursing practice and enhance critical thinking and motivation among nursing students.     

Protein oxidation biomarkers in plasma of type 2 diabetic patients

ObjectivesTo evaluate oxidative stress and the extent of oxidation of plasma proteins in type 2 diabetic patients.Design and methodsStudy was carried out on blood from 31 diabetic patients of both sexes (mean age = 58 ± 7; duration of diabetes 12 ± 5 years) and healthy age and sex matched normal subjects. Biomarkers of protein oxidation; plasma protein carbonyls (PCO), advanced oxidation protein products (AOPPs) and –SH group and free radical scavenging capacity of plasma was measured.ResultsPCO and AOPPS levels were significantly (P < 0.005) higher in diabetic patients in comparison to healthy volunteers. Reduced free radical scavenging capacity (P < 0.001) and –SH group (P < 0.05) was observed in plasma of type 2 diabetic patients.ConclusionsOur data suggest that diabetics are susceptible to protein oxidation. Oxidative modulation of proteins due to reduced radical scavenging activity of plasma patients may be one of the reasons of altered physiological processes in type 2 diabetic patients.     

A clinical analysis of erythrocytapheresis for the treatment of polycythemia

PurposeTo evaluate the efficacy and safety of erythrocytapheresis (ECP) in the treatment of polycythemia.MethodsPatients diagnosed with polycythemia were included in this retrospective analysis and treated with ECP (n = 20) or conventional treatments (exsanguination; n = 20). Blood laboratory values and adverse effects were recorded.ResultsIn ECP-treated patients mean red blood cell (RBC) collection time was 25.7 ± 4.5 min (range: 19–37 min), with a mean collection volume of 773.5 ± 129.3 mL (range: 600–1002 mL). From baseline, ECP reduced the mean number of RBCs (0.6 × 10¹²/L [7.6%]), mean hemoglobin (31.1 g/L [14.8%]), and mean hematocrit (13.1% [20.2%]) (P < 0.001 for each). After ECP, a marked reduction in symptoms associated with polycythemia was also observed.ConclusionsTreatment of patients with polycythemia using ECP reduces RBC count, hemoglobin, and hematocrit. The advantages associated with ECP over conventional therapy should be considered when choosing a treatment plan for patients with polycythemia.     

Clinical screening of oropharyngeal dysphagia in patients with ALS

ObjectiveIt is a major issue to diagnose and detect oropharyngeal dysphagia in the early stage of ALS in order to avoid pulmonary and nutritional complications. The aim of this study was to validate a simple clinical test, the Volume-Viscosity Swallow Test (V-VST), to detect oropharyngeal dysphagia in this population.Patients and methodsTwenty patients were included in this study (mean age: 66.1 ± 8.13, six women). All patients had their swallowing function assessed by videofluoroscopy and V-VST.ResultsAmong these 20 patients, 15 presented oropharyngeal dysphagia, diagnosed by videofluoroscopy, and five had normal swallowing. Norris score was lower in patients with oropharyngeal dysphagia compared to the patients with normal swallowing (27 ± 6 versus 36 ± 2; P = 0.003). Among the 15 patients with oropharyngeal dysphagia, 14 had abnormal V-VST, and only one had normal V-VST. The sensibility of V-VST to detect oropharyngeal dysphagia in these patients with ALS was of 93%, and the specificity was of 80% (P = 0.007). There was no significant difference between the two populations for ALSFRS score (22 ± 6 versus 20 ± 6) and body mass index (BMI) (26 ± 6 versus 26 ± 6 kg/m²).ConclusionThe V-VST presented good sensibility and specificity. It may be interesting to use it systematically for the detection of oropharyngeal dysphagia in ALS, after confirming these results on a wider patient sample.     

Comparison of the clinical effectiveness of thermal cure and rehabilitation in knee osteoarthritis. A randomized therapeutic trial

ObjectiveTo compare the benefits of a thermal cure and non-thermal rehabilitation in treatment of knee osteoarthritis (KOA).MethodsRandomized therapeutic trial including patients with knee osteoarthritis (American College of Rheumatology criteria). Patients were randomly divided into two groups. Spa treatment consisted of underwater shower, massage-jet showers, hydromassage, pool rehabilitation and peloid therapy. Non-thermal rehabilitation consisted of analgesic physiotherapy, muscle strengthening and group physical rehabilitation. A blinded evaluation was carried out at day 21 and 12 months following treatment. It was based on the visual analogic scale of pain (VAS), which represented the primary endpoint.ResultsTwo hundred and forty patients were included (February–June 2005). The spa treatment and non-thermal rehabilitation groups included 119 and 121 patients respectively. Two hundred and thirty-three patients completed their treatments. Significant improvement of the visual analogic scale of pain was noted in the thermal cure group (61.6 ± 15 at day 0 versus 46.5 ± 22.4 at 12 months, P < 0.001), but not in the non-thermal group (64.1 ± 15 at day 0 versus 62 ± 29 at 12 months, P = 0.68). At day 21, comparison of the two groups revealed no significant difference on the VAS (P = 0.08). However, at 12 months, the thermal cure group was significantly more improved (P = 0.000).ConclusionIn our study, crenobalneotherapy had resulted, at 12 months, in more pronounced long-term improvement of the painful symptoms of KOA than had non-thermal rehabilitation.     

Feasibility of the Cognitive Assessment scale for Stroke Patients (CASP) vs. MMSE and MoCA in aphasic left hemispheric stroke patients

IntroductionPost-stroke aphasia makes it difficult to assess cognitive deficiencies. We thus developed the CASP, which can be administered without using language. Our objective was to compare the feasibility of the CASP, the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) in aphasic stroke patients.Material and methodsAll aphasic patients consecutively admitted to seven French rehabilitation units during a 4-month period after a recent first left hemispheric stroke were assessed with CASP, MMSE and MoCA. We determined the proportion of patients in whom it was impossible to administer at least one item from these 3 scales, and compared their administration times.ResultsForty-four patients were included (age 64 ± 15, 26 males). The CASP was impossible to administer in eight of them (18%), compared with 16 for the MMSE (36%, P = 0.05) and 13 for the MoCA (30%, P = 0.21, NS). It was possible to administer the CASP in all of the patients with expressive aphasia, whereas the MMSE and the MoCA could not be administered. Administration times were longer for the CASP (13 ± 4 min) than for the MMSE (8 ± 3 min, P < 10⁻⁶) and the MoCA (11 ± 5 min, P = 0.23, NS).ConclusionThe CASP is more feasible than the MMSE and the MoCA in aphasic stroke patients.     

Acute kidney injury: Effect of hemodialysis membrane on Hgf and recovery of renal function

ObjectivesAcute kidney injury (AKI) is associated with a high mortality and morbidity rate. In this study we investigated whether dialysis membranes influence the recovery of renal function, through the regulation of hepatocyte growth factor (HGF).Design and methods21 patients were enrolled and assigned to hemodialysis (HD) with cellulose (CE, N = 11) versus polymethylacrylate (PMMA, N = 10) membranes in alternating order.HGF and IL-1 were measured in serum and in peripheral blood mononuclear cells (PBMC) supernatants collected immediately before the first HD session (T0), at 15 minutes (T15), at 240 minutes (T240) and after the last HD, when renal recovery occurred. Eight healthy volunteers were the controls (CON).ResultsTime to renal function recovery was lower in CE than in PMMA patients. Serum HGF in HD patients was significantly higher than in CON. HGF levels were higher in CE than in PMMA patients at T15 (13.4 ± 2.7 vs 8.9 ± 3.0 ng/mL, P = 0.004) and T240.At recovery, HGF levels decreased. IL-1 serum levels showed a similar trend (at T15 CE: 20.5 ± 2.9 vs PMMA: 16.9 ± 3.2 pg/mL, P = 0.005). HGF release significantly increased in the course of HD, resulting in higher levels in CE than that in PMMA patients.Considering all the patients, basal HGF release negatively correlated with time to renal recovery (r2 = 0.42, P < 0.01).ConclusionsHere we demonstrated that dialysis membranes influence the cytokine profile in AKI patients, HGF release being higher in patients treated with the CE membrane, in comparison to PMMA. Our results suggest that treatment with CE might improve clinical outcomes, possibly through increased release of HGF.     

Evaluating the effect of Matricaria recutita and Mentha piperita herbal mouthwash on management of oral mucositis in patients undergoing hematopoietic stem cell transplantation: A randomized,double blind,placebo controlled clinical trial

ObjectivesTo investigate the effects of Matricaria recutita and Mentha piperita on oral mucositis (OM) in patients undergoing hematopoietic stem cell transplantation (HSCT).DesignRandomized double blind placebo controlled clinical trial.SettingFaculty of Pharmacy, Shahid Beheshti University of Medical Sciences, and Bone Marrow Transplantation Center at Taleghani Teaching Hospital, Tehran, Iran.ParticipantsSixty patients undergoing HSCT were randomly assigned to two groups: placebo (n = 33), and herbal mouthwash group (n = 27).InterventionsAll patients received the mouthwash one week before HSCT and were instructed to use it three times daily for at least 30 s.Main outcome measuresOM was graded using National Cancer Institute Common Toxicity Criteria (NCI-CTC) scale (grade 0–5). The Numerical Rating Scale (NRS: 0–10 scale) measured the severity of OM symptoms.ResultsThe duration, maximum and average daily grade of OM were significantly reduced in the treatment group (P < 0.05). The use of herbal mouthwash led to significant improvements in pain intensity (P = 0.009), dryness (P = 0.04) and dysphagia (P = 0.009). Other significant results included: reduced need for complementary medications (P = 0.03), narcotic analgesics (P = 0.047), total parenteral nutrition (TPN) (P = 0.02) and the duration of TPN (P = 0.03).ConclusionThis study shows that patients receiving the herbal mouthwash experienced less complications and symptoms associated with OM. In summary, it seems that the use of our prepared herbal mouthwash is beneficial for patients undergoing HSCT.     

The association between transforming growth factor β3 polymorphisms and left ventricular structure in hypertensive subjects

BackgroundTransforming growth factor β (TGF-β) may be a crucial regulator of cardiac remodeling. We investigated the association between the TGF-β gene polymorphisms and left ventricular structure.MethodsA total of 658 hypertensive subjects were genotyped for the TGF-β1 T869C and TGF-β3 (rs3917187 and rs4252338) polymorphisms.ResultsTGF-β3 rs3917187 AA homozygotes had, while accounting for covariates, greater left ventricular end-systolic (LVESD, P = 0.004) and end-diastolic dimension (LVEDD, P = 0.007) than G allele carriers. Moreover, left ventricular mass index (LVMI) in AA genotype was 123.0 ± 3.1 g/m² significantly higher than that in AG (114.6 ± 1.6 g/m²) and GG (115.4 ± 2.1 g/m², P = 0.03) genotypes. In multivariate regression analysis, TGF-β3 rs3917187 genotype as an independent predictor had statistically significant effects on LVESD (β = 0.164, P = 0.002), LVEDD (β = 0.172, P = 0.003) and LVMI (β = 0.136, P = 0.016), respectively. In further analyses, we observed a significant interaction between the rs3917187 and alcohol intake in relation to LVESD (P_int = 0.04) and left ventricular fractional shortening (LVFSH, P_int = 0.012). However, no relationship could be found between left ventricular parameters and the T869C or the rs4252338.ConclusionThe present results demonstrated that the TGF-β3 rs3917187 polymorphism was associated with left ventricular structure, and had an interactive influence with alcohol on LVESD and LVFSH in hypertensive subjects.