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Aims: Parameters derived from reservoir‐excess pressure analysis have been demonstrated to predict cardiovascular events. Thus, altered reservoir‐excess pressure parameters could have a detrimental effect on highly‐perfused organs like the heart. We aimed to cross‐sectionally determine whether reservoir‐excess pressure parameters were associated with N‐terminal pro‐brain‐type natriuretic peptide (NT‐proBNP) in older adults. Methods: We studied 868 older adults with diverse cardiovascular risk. Reservoir‐excess pressure parameters were obtained through radial artery tonometry including reservoir pressure integral, peak reservoir pressure, excess pressure integral (INTXSP), systolic rate constant (SRC) and diastolic rate constant (DRC). Plasma levels of NT‐proBNP, as a biomarker of cardiac overload, were analysed by the Proximity Extension Assay technology. Results: Multivariable linear regression analyses revealed that all reservoir‐excess pressure parameters studied were associated with NT‐proBNP after adjusting for age and sex. After further adjustments for conventional cardiovascular risk factors, INTXSP [β = 0.191 (95% confidence interval, CI: 0.099, 0.283), P < 0.001], SRC [β = −0.080 (95% CI: −0.141, −0.019), P = 0.010] and DRC [β = 0.138 (95% CI: 0.073, 0.202), P < 0.001] remained associated with NT‐proBNP. Sensitivity analysis found that there were occasions where the association between SRC and NT‐proBNP was attenuated, but both INTXSP and DRC remained consistently associated with NT‐proBNP. Conclusions: The observed associations between reservoir‐excess pressure parameters and NT‐proBNP suggest that altered reservoir‐excess pressure parameters may reflect an increased load inflicted on the left ventricular cardiomyocytes and could have a potential to be utilized in the clinical setting for cardiovascular risk stratification. [ABSTRACT FROM AUTHOR]

Background: Complications such as forearm hematoma after coronary intervention through the radial artery are a common complication. Material and methods: By observing, describing, and analyzing the pictures taken during clinical diagnosis and consultation, we summarize the prevention, treatment, and nursing of forearm hematoma after percutaneous coronary intervention, to provide reference for the nursing of patients with forearm hematoma. Results: We have innovatively summarized the risk classification of forearm hematoma and the three key time points for preventing hematoma. Conclusion: Complications such as forearm hematoma after coronary intervention through the radial artery are a common complication. We have innovatively summarized the risk classification of forearm hematoma and the three key time points for preventing hematoma, providing reference for the prevention and management of forearm hematoma in clinical practice. For patients undergoing transradial coronary intervention, the three key time points for preventing hematoma and symptomatic management based the risk classification of forearm hematoma are crucial. Highlights: By identifying risk factors and mastering management measures, the incidence of forearm hematoma after intervention can be effectively reduced, and patient comfort can be improved.Strengthening preoperative evaluation, standardized intraoperative procedures, postoperative care, and rational drug treatment are key measures for prevention.In the future, intelligent monitoring devices can be used for real‐time monitoring and pressure adjustment of forearm hematoma to improve the timeliness and accuracy of hematoma observation. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Coronary occlusion due to large thrombus is frequently encountered during ST‐elevation myocardial infarction (STEMI). Despite guidelines discourage this practice, often thrombus aspiration is necessary to reduce thrombotic burden and to prevent embolization. We report a case of mechanical thrombectomy with a Neurovascular Catheter from radial artery during inferior STEMI. [ABSTRACT FROM AUTHOR]

Flexible pressure sensors are valuable in applications such as electronic skin, smart robots, artificial prosthetics, and wearable electronics. In this study, a fully packaged, flexible, self‐powered, long‐term stable sensor array based on piezoelectrets is developed for pressure monitoring. A pressure sensor with a microcavity structure and a thickness of 500 µm achieved an impressive piezoelectric coefficient of 23.8 pC N−1 and a fast response time of 93 ms. The sensor yielded an output voltage of 0.26 V when subjected to a force using 0.3 g soybeans, and it displayed a remarkable linear relationship (R2 = 0.992) between force and electricity with pressure ranging from 1.4 to 13.6 N and a sensitivity of 9 mV N−1. Real‐time monitoring of sound vibration, radial artery pulse, and finger movement is demonstrated along with the successful recording of dynamic pressure changes within the porcine knee joint. It holds potential for fields such as monitoring pressure changes in the movement of human bodies and robotics and can contribute significantly to pressure assessment during total knee replacement. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to evaluate the use of a new classification for safer transradial access hepatic interventional radiology, based on preoperative evaluation of the location of the left subclavian artery bifurcation in the aortic arch. Methods: A total of 38 consecutive patients with hepatocellular carcinoma and 74 sessions of radial access for visceral intervention (R.A.V.I.) were reviewed. We classified the location of the left subclavian artery bifurcation in the aortic arch in three areas using an oblique view computed tomography image matched with the curve of the aortic arches according to a new criteria Three Areas Criteria For R.A.V.I. (named "TAC‐F‐R"), and measured the required time from initial left radial artery arteriography to celiac artery or superior mesenteric artery arteriography. Results: The median time required for left radial artery arteriography to the celiac artery or superior mesenteric artery arteriography in each of the three areas were: area A, 0:11:10 (h, min, s); area B, 0:14:44; and area C, 0:31:51. There were significant differences between each area after Bonferroni correction (p < 0.01; A vs. B, p = 0.086; A vs. C, p = 0.001; and B vs. C, p = 0.045), with areas A and B requiring a significantly shorter time. Finally, no patients showed neurogenic disfunction within 1 week after the R.A.V.I. procedure. Conclusions: The new classification, "TAC‐F‐R," for safer transradial access hepatic interventional radiology is effective for avoiding difficult cases, and selects more suitable patients with hepatocellular carcinoma for the R.A.V.I. procedure. [ABSTRACT FROM AUTHOR]

Objective: This study used random forest model to explore the feasibility of radial artery calcification in prediction of coronary artery calcification in hemodialysis patients. Material and Methods: We enrolled hemodialysis patients and performed ultrasound examinations on their radial arteries to evaluate the calcification status using a calcification index. All involved patients received coronary artery computed tomography scans to generate coronary artery calcification scores (CACS). Clinical variables were collected from all patients. We constructed both a random forest model and a logistic regression model to predict CACS. Logistic regression model was used to identify the risk factors of radial artery calcification. Results: One hundred eighteen patients were included in our analysis. In random forest model, the radial artery calcification index, age, serum C-reactive protein, body mass index (BMI), diabetes, and hypertension history were related to CACS based on the average decrease of the Gini coefficient. The random forest model achieved a sensitivity of 76.9%, specificity of 75.0%, and area under receiver operating characteristic of 0.869, while the logistic regression model achieved a sensitivity of 75.2%, specificity of 68.7%, and area under receiver operating characteristic of 0.742 in prediction of CACS. Sex, BMI index, smoking history, hypertension history, diabetes history, and serum total calcium were all the risk factors related to radial artery calcification. Conclusions: A random forest model based on radial artery calcification could be used to predict CACS in hemodialysis patients, providing a potential method for rapid screening and prediction of coronary artery calcification. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This is a case of 83 years old male who had radial artery pseudoaneurysm after cardiac catheterization. The diagnosis was through Doppler ultrasound and the patient was treated with thrombin injection and reported good outcomes. The literature also included 41 cases of pseudoaneurysm after catheterization. The mean age of patients was 68.5 years with a male prevalence of 49%. Onset of pseudoaneurysm ranged from 0 days (directly after the catheterization) to 150 days with a median of 5 days. The treatment of patients was mainly surgical (19 cases) followed by compression (either manual or TR band) (12 cases), thrombin injection (four cases), compression then surgery (three cases), compression then thrombin injection (one case), percutaneous endovascular repair using a covered stent (one case) and not reported in one case. All cases recovered well. [ABSTRACT FROM AUTHOR]

Advanced transducer materials have become increasingly important with the rapid development of the internet of things and flexible electronics. Herein, fully transparent flexible polyvinylidene fluoride/polydimethylsiloxane (PVDF/PDMS) composite piezoelectric films are fabricated using scrape coating techniques based on electrospun PVDF nanofiber films. Compared to the electrospun PVDF, the PVDF/PDMS not only owns high transparency and a more uniform and stable structure but also has superior piezoelectric properties. Based on the electrospun PVDF and the PVDF/PDMS films, flexible piezoelectric sensors are developed, which can effectively detect weak mechanical signals including finger tapping and bending signals, radial artery pulses, and environmental sound signals. The PVDF/PDMS sensor performs better than the electrospun PVDF sensor and presents great potential for applications in flexible sensors and transducers. Especially, thanks to their high transparency, the PVDF/PDMS composite piezoelectric films lend themselves easily to application fields requiring transparent sensors such as imperceptible sensors and human‐machine interfaces, display devices, electronic skins, intelligent windows, etc. [ABSTRACT FROM AUTHOR]

Few studies have shown that radial artery (RA), which is used as a secondary arterial graft, offers superior results compared with right internal thoracic artery (RIMA) in coronary artery bypass grafting (CABG). In a meta‐analysis of observational studies starting in 2023, we looked at the effect of re‐operation on postoperative infection and haemorrhage in CABG with RA vs. RIMA. The electronic database up to October 2023 was examined in the course of the research. Analysis was carried out on the clinical trials of postoperative wound infections and haemorrhage re‐surgery. Among 912 trials associated with CABG, we selected 8 trials to be included in the final data analysis. The main results were secondary wound infection and re‐operation after surgery. The odds ratios (OR) and confidence intervals (CIs) were computed on the basis of a randomized or fixed‐effect model of wound infection and re‐operation. Seven trials showed a significant reduction in the risk of wound infection in RA treated as a secondary artery transplant compared with RIMA (OR, 1.60; 95% CI, 1.03, 2.47 p = 0.04); Four trials showed that RIMA was not significantly different from RA in the rate of re‐operation for postoperative bleeding (OR, 1.31; 95% CI, 0.60, 2.88 p = 0.50). In CABG, RA is used as a secondary arterial conduit graft to lower the risk of wound infection in CABG patients. [ABSTRACT FROM AUTHOR]

Background: The vasculature function is mainly regulated by the autonomic nervous system. Importantly, the sensory‐motor nervous system also innervates peripheral vessels and has the capacity to modulate vascular tone. Here we investigated the effects of electrical stimulation of a mixed nerve trunk on blood flow in deep arteries and muscle perfusion. Our hypothesis is that stimulation of a mixed nerve can modify blood flow. Methods: Twenty‐nine healthy participants were included into a randomized‐crossover and blinded clinical trial. Each subject received a placebo and two percutaneous peripheral nerve stimulation (pPNS) protocols on the median nerve: Pain Threshold continuous Low Frequency (PT‐cLF) and Sensory Threshold burst High Frequency (ST‐bHF). Blood flow was then assessed bilaterally using Power Doppler Ultrasonography at the main arteries of the arm, and blood perfusion at the forearm muscles. Afterwards, blood flow was quantified using a semi‐automatized software, freely shared here. Results: Placebo, consisting in needle insertion, produced an immediate and generalized reduction on peak systolic velocity in all arteries. Although nerve stimulation produced mainly no effects, some significant differences were found: both protocols increased the relative perfusion area of the forearm muscles, the ST‐bHF protocol prevented the reduction in peak systolic velocity and TAMEAN of the radial artery produced by the control protocol and PT‐cLF produced a TAMEAN reduction of the ulnar artery. Conclusions: Therefore, the arterial blood flow in the arm is mainly impervious to the electrical stimulation of the median nerve, composed by autonomic and sensory‐motor axons, although it produces mild modifications in the forearm muscles perfusion. [ABSTRACT FROM AUTHOR]

The acute reduction in peripheral arterial stiffness during reactive hyperemia is assumed to be flow‐mediated; however, the mechanism remains unproven. We hypothesized that restricting the blood flow increase during reactive hyperemia would abolish the reduction in peripheral arterial stiffness. Fourteen healthy young adults (5 females, 25 ± 5 years, mean ± SD) underwent reactive hyperemia with a rapid‐release cuff on the upper arm inflated to 220 mmHg for 5 min: once with unrestricted blood flow and once with restricted blood flow by manually applying pressure to the brachial artery. Brachial–radial pulse wave velocity (PWV) was measured with tonometers over brachial and radial arteries before cuff inflation and at 5, 15, and 30 min after release. Brachial blood flow was monitored with Doppler ultrasound. Baseline brachial–radial PWV was similar between conditions (10.3 ± 1.8 vs. 10.7 ± 1.7 m/s). With unrestricted flow, PWV decreased 5 min post‐reactive hyperemia (8.6 ± 1.1 m/s; p < 0.05) and returned near baseline at 15 and 30 min post (p < 0.05). With restricted flow, PWV did not change (p > 0.05) post‐reactive hyperemia. Reactive hyperemia acutely reduced peripheral arterial stiffness, but not when brachial artery blood flow increase was restricted. This suggests that the reduction in peripheral arterial stiffness during reactive hyperemia depends on increased blood flow. [ABSTRACT FROM AUTHOR]

The properly applied pressure between the skin and hemostasis devices is an essential parameter for preventing bleeding and postoperative complications after a transradial procedure. However, this parameter is usually controlled based on the subjective judgment of doctors, which might cause insufficient hemostatic effect or thrombosis. Here this study develops a compact and wireless sensing system for continuously monitoring the pressure applied on the radial artery and wrist skin in clinical practice. A liquid metal (LM)‐based all‐soft pressure sensor is fabricated to enable conformal attachment between the device and skin even under large deformation conditions. The linear sensitivity of 0.007 kPa−1 among the wide pressure range of 0–100 kPa is achieved and the real‐time detection data can be wirelessly transmitted to mobile clients as a reference pressure value. With these devices, detailed pressure data can be collected, analyzed, and stored for medical assistance as well as to improve surgery quality. [ABSTRACT FROM AUTHOR]

Background: The radial forearm free flap (RFFF) is considered a workhorse for head and neck cancer reconstructive surgery due to its generally consistent anatomy, pliability, long pedicle, and accessible harvest location. Methods: A 63‐year‐old male with trisomy 21 and recurrent midface basal cell carcinoma presented for surgical management. The patient underwent tumor resection including left infrastructure maxillectomy with ipsilateral rhinectomy. Preoperative Allen's test was normal; however, the planned osteocutaneous radial forearm free flap reconstruction was aborted intraoperatively due to aberrant vascular anatomy in the form of a diminutive radial artery branch. Reconstruction was instead performed with an anterolateral thigh free flap. Results: The patient recovered well in the hospital and was subsequently discharged to his care facility. Conclusions: Radial artery anomalies may be present among trisomy 21 patients making reconstruction with a RFFF not feasible, and thus preoperative Doppler ultrasound to assess arterial anatomy is essential in this population. [ABSTRACT FROM AUTHOR]

Background: Accurate blood pressure (BP) measurement remains challenging in patients with HeartMate 3™ left ventricular assist devices (HM3 LVADs). The Finapres® NOVA is a promising non‐invasive continuous BP monitor that uses the volume clamp method via a finger cuff, so here we aimed to validate the instrument in HM3 patients. Methods: In a single‐center cohort, BP was monitored in 15 patients within 72 h following HM3 implantation. A radial artery catheter quantified arterial blood pressure (ABP), while the NOVA measured finger arterial pressure (fiAP) and reconstructed brachial artery pressure (reBAP). Waveforms were recorded for 10 min, and mean values were calculated in 15‐s intervals. Resuts: fiAP and ABP were moderately correlated during both the first (ICC 0.61, p = 0.04) and final measurements (ICC 0.66, p = 0.03). reBAP and ABP were strongly correlated during both the first (ICC 0.81, p = 0.002) and final measurements (ICC 0.83, p = 0.001). Both NOVA‐derived values may underestimate low BP values while overestimating relatively high BP values. The reBAP was within 5 mm Hg of the ABP in 40% of patients (and within 10 mm Hg in 67%). Conclusions: This pilot represents the first evidence in support of the Finapres® NOVA for non‐invasive BP measurement in select patients with HM3 LVADs. The instrument may provide useful data during BP medication adjustments or pump titration, but despite the correlation between the non‐invasive reBAP and invasive ABP, individual‐level inaccuracy may be clinically meaningful. Further investigation is needed to clarify these limitations and optimize accuracy before widespread adoption in this unique patient population. [ABSTRACT FROM AUTHOR]

Objective: Direct revascularization remains an important tool in the treatment of patients with Moyamoya disease (MMD). The superficial temporal artery (STA) is the most commonly used donor vessel for direct bypass, and an STA graft has traditionally been considered a low‐flow graft for flow augmentation. This study aimed to quantitatively evaluate the blood flow of the STA after direct revascularization. Methods: All direct revascularization procedures performed between 2018 and 2021 by one experienced neurosurgeon were screened. Quantitative ultrasound was used to measure the flow data of the patient's bilateral parietal branch of the STA(STA‐PB), the bilateral frontal branch of the STA(STA‐FB), and the left radial artery. Data on the patients' basic information, Suzuki grade, Matsushima type, anastomosis type, and blood biochemical parameters were collected and analyzed using univariate and multivariate models. An MBC Scale scoring system was proposed to evaluate the recipient artery network of the middle cerebral artery (MCA) tree. The relationship between MBC Scale score and STA graft flow was statistically analyzed. Results: In total, 81 patients (43 males and 38 females) successfully underwent STA‐MCA bypass and were included in this study. The mean flow rates in the STA‐PB graft on 1 day preoperatively, 1 day postoperatively, 7 days postoperatively, and >6 months postoperatively (long‐term) were 10.81, 116.74, 118.44, and 56.20 mL/min respectively. Intraoperative graft patency was confirmed in all patients. Comparing the preoperative and all postoperative time points, the STA‐PB flow rates were statistically significant (p < 0.001). The MCA‐C score was significantly associated with postoperative flow rate on day 1 (p = 0.007). Conclusion: The STA is a useful donor artery for direct revascularization inpatients with MMD and can provide sufficient blood supply to the ischemic cerebral territory. [ABSTRACT FROM AUTHOR]

Recent progress in flexible sensors and piezoelectric materials has enabled the development of continuous monitoring systems for human physiological signals as wearable and implantable medical devices. However, their non‐degradable characteristics also lead to the generation of a significant amount of non‐decomposable electronic waste (e‐waste) and necessitate a secondary surgery for implant removal. Herein, a flexible and biodegradable piezoelectric material for wearable and implantable devices that addresses the problem of secondary surgery and e‐waste while providing a high‐performance platform for continuous and seamless monitoring of human physiological signals and tactile stimuli is provided. The novel composition of bioresorbable poly(l‐lactide) and glycine leads to flexible piezoelectric devices for non‐invasive measurement of artery pulse signals in near‐surface arteries and slight movement of the muscle, including the trachea, esophagus, and movements of joints. The complete degradability of piezoelectric film in phosphate‐buffered saline at 37 °C is also shown. The developed pressure sensor exhibits high sensitivity of 13.2 mV kPa−1 with a response time of 10 ms and shows good mechanical stability. This piezoelectric material has comparable performance to commonly used non‐degradable piezoelectric materials for measuring physiological signals. It can also be used in temporary implantable medical devices for monitoring due to its degradable nature. [ABSTRACT FROM AUTHOR]

This article discusses the case of a 39-year-old patient with systemic lupus erythematosus and end-stage kidney disease who experienced recurrent episodes of arteriovenous graft thrombosis and heavy calcification of the radial and ulnar arteries. The patient had been on hemodialysis for 15 years and had undergone a total parathyroidectomy. Efforts were made to slow the progression of vascular calcification, including dietary phosphate restriction and a change in phosphate-lowering medication. A follow-up assessment showed attenuation of digital vascular calcification, although the frequency of graft thrombosis was uncertain. The optimal treatment for vascular calcification in patients with chronic kidney disease remains controversial. [Extracted from the article]

The development of triboelectric nanogenerator technology has many benefits across various fields, particularly in healthcare applications; herein, a concise single‐electrode pulse sensor with a high output performance at a reasonable cost is suggested. The device is made up of a polydimethylsiloxane film with a spacer‐created trench structure stacked on top of a graphene‐coated polyethylene terephthalate film. A comprehensive examination of sensor fabrication together with material and electrical characterization is explained. The entire study is carried out using a graphene–silver composite electrode device, giving an output performance of ≈1.66 and ≈2.9 V for tapping movement in plain and microstructured triboelectric surfaces, respectively; however, for the graphene electrode device, the output obtained is ≈5.5 V. This wearable sensor can successfully extract the typical human wrist pulse, which displays the pressure wave from the radial artery in the range of ≈5 V with the help of an exemplary amplifier circuit and will be suitable to integrate with IoT. [ABSTRACT FROM AUTHOR]

The cuffless blood pressure (BP) monitoring device has attracted much attention because of its comfortable and real‐time monitoring. Inspired by the physical structure of the human epidermis, an ultra‐sensitive flexible resistive sensor with a double strain layer and crack structure is prepared by screen printing in this study. The strain material of the sensor is mainly prepared by blending Poly(3,4‐ethylenedioxythiophene) :poly(styrenesulfonate) (PEDOT:PSS) with waterborne polyurethane and reduced graphene oxide. The sensor exhibits a high gauge factor (GF, ≈1682), fast response (≈48 ms), and long‐term stability (> 2000 cycles) at low strain (≈0–5%). The sensor is placed on the human radial artery and can accurately measure the pulse wave. The features of the pulse wave are automatically extracted using a convolutional neural network. Then the features are corrected using a long short‐term memory neural network, and the current BP value is predicted using a fully connected network layer. The BP result meets the A‐level standards of the Association for the Advancement of Medical Instrumentation and the British Hypertension Society. This study provides an efficient device and method for continuous and non‐invasive BP monitoring. [ABSTRACT FROM AUTHOR]

Arteriovenous fistula (AVF) and/or arteriovenous graft (AVG) burdens cardiac load. It is a challenge to create a vascular access (VA) on a patient who suffers severe heart failure and also combines with contraindications of central vein catheter implantation. Superficialized radial artery (RA) could be an available VA as an outflow for continuous hemodialysis. A 57‐year‐old male had a left arm distal radiocephalic fistula for hemodialysis for 10 months. The patient showed gradual aggravation of heart failure. RA superficialization was performed under anesthesia protocols and surgery steps. Fourteen days after the surgery, the superficialized artery supplied the hemodialysis as an outflow without any uncomfortable and complications. The echocardiographies present the changes of the heart structures and functions during the whole period from the beginning of AVF formation to the 18‐month follow‐up RA superficialization. RA superficialization technique should be an alternative VA for continuous hemodialysis under suitable conditions. [ABSTRACT FROM AUTHOR]

Despite coronavirus disease 2019, cardiovascular disease, the leading cause of global death, requires timely detection and treatment for a high survival rate, underscoring the 24 h monitoring of vital signs. Therefore, telehealth using wearable devices with vital sign sensors is not only a fundamental response against the pandemic but a solution to provide prompt healthcare for the patients in remote sites. Former technologies which measured a couple of vital signs had features that disturbed practical applications to wearable devices, such as heavy power consumption. Here, we suggest an ultralow power (100 μW) sensor that collects all cardiopulmonary vital signs, including blood pressure, heart rate, and the respiration signal. The small and lightweight (2 g) sensor designed to be easily embedded in the flexible wristband generates an electromagnetically reactive near field to monitor the contraction and relaxation of the radial artery. The proposed ultralow power sensor measuring noninvasively continuous and accurate cardiopulmonary vital signs at once will be one of the most promising sensors for wearable devices to bring telehealth to our lives. [ABSTRACT FROM AUTHOR]

Background: Dynamic positron emission tomography (dPET) is a nuclear medicine imaging technique providing functional images for organs of interest with applications in oncology, cardiology, and drug discovery. This technique requires the acquisition of the time-course arterial plasma activity concentration, called the arterial input function (AIF), which is conventionally acquired via arterial blood sampling. Purpose: The aim of this study was to (A) optimize the geometry for a novel and cost efficient non-invasive detector called NID designed to measure the AIF for dPET scans through Monte Carlo simulations and (B) develop a clinical data analysis chain to successfully separate the arterial component of a simulated AIF signal from the venous component. Methods: The NID was optimized by using an in-house Geant4-based software package. The sensitive volume of the NID consists of a band of 10 cm long and 1 mm in diameter scintillating fibers placed over a wrist phantom. The phantom was simulated as a cylinder, 10 cm long and 6.413 cm in diameter comprised of polyethylene with two holes placed through it to simulate the patient's radial artery and vein. This phantom design was chosen to match the wrist phantom used in our previous proof of concept work. Two geometries were simulated with different arrangements of scintillating fibers. The first design used a single layer of 64 fibers. The second used two layers, an inner layer with 29 fibers and an outer layer with 30 fibers. Four positron emitting radioisotopes were simulated: 18F, 11C, 15O, and 68Ga with 100 million simulated decay events per run. The total and intrinsic efficiencies of both designs were calculated as well as the full width half maximum (FWHM) of the signal. In addition, contribution by the annihilation photons versus positrons to the signal was investigated. The results obtained from the two simulated detector models were compared. A clinical data analysis chain using an expectation maximization maximum likelihood algorithm was tested. This analysis chain will be used to separate arterial counts from the total signal. Results: The second NID design with two layers of scintillating fibers had a higher efficiency for all simulations with a maximum increase of 17% total efficiency for 11C simulation. All simulations had a significant annihilation photon contribution. The signal for 18F and 11C was almost entirely due to photons. The clinical data analysis chain was within 1% of the true value for 434 out of 440 trials. Further experimental studies to validate these simulations will be required. Conclusions: The design of the NID was optimized and its efficiency increased through Monte Carlo simulations. A clinical data analysis chain was successfully developed to separate the arterial component of an AIF signal from the venous component. The simulations show that the NID can be used to accurately measure the AIF non-invasively for dPET scans. [ABSTRACT FROM AUTHOR]

The article reviews the controversies and evidence surrounding the common emergency department (ED) procedure of arterial line insertion. It discusses the indications for the procedure, such as continuous blood pressure monitoring, and the lack of evidence of its benefit on mortality and morbidity. It also highlights the contraindications and complications of arterial line insertion, including serious complications that are rare but possible.

Percutaneous intervention of patients who suffer from generalized vascular disease is often a great challenge due to the limited accessibility of the access gates. We discuss the case of a 66‐year‐old man who presented with critical right internal carotid artery (ICA) stenosis after previous hospitalization due to stroke. In addition to arteria lusoria, the patient had known bilateral femoral amputation, occlusion of the left ICA and significant three‐vessel coronary artery disease. After unsuccessful common carotid artery (CCA) cannulation from the right distal radial artery access, we successfully performed the diagnostic angiography and the planned right ICA‐CCA intervention using superficial temporal artery (STA) puncture. We showed that STA access can be used as an alternative and additional access site for diagnostic carotid artery angiography and intervention when standard access sites alone are insufficient. [ABSTRACT FROM AUTHOR]

Objective: To define a semiquantitative classification of finger pulp blood flow (FPBF) and to evaluate whether this classification could be used to assess FPBF in healthy controls and in systemic sclerosis (SSc) patients. Methods: Thirty controls and 86 SSc patients were consecutively included. A classification of FPBF including 5 grades (from grade 0 [no signal] to 4 [signal detected on the entire finger pulp, including the subepidermal vascular network]) was evaluated. This classification was explored in basal conditions and after hand baths in hot and cold water in controls. Its relevance was also assessed at room temperature in SSc patients. Results: In controls, power Doppler ultrasonography (PDUS) of FPBF was improved after hot challenge (P = 0.024), whereas cold challenge decreased FPBF (P = 0.001). FPBF correlated with the vasodilation status assessed by the resistivity index of radial arteries (Spearman's correlation coefficient = –0.50, P = 0.0049). Grade 0 was more frequent in SSc patients than in controls (22.1% versus 3.3%; P < 0.05). In SSc patients, grade 0 was associated with severity markers of the digital vasculopathy such as digital ulcers (DUs) (current or past) (P < 0.05) or ulnar artery occlusion (P < 0.05). On the other hand, DUs were less frequent in patients with grade 4 (P < 0.05). A pathologic threshold of <2 (grade 0 or 1) was significantly associated with DUs (odds ratio 6.67 [95% confidence interval 2.31–19.21], P < 0.0001). Conclusion: PDUS allowed a semiquantitative evaluation of FBPF in SSc patients and controls. Further studies are warranted to validate these results in independent SSc populations and to compare PDUS to existing tools assessing digital blood flow. [ABSTRACT FROM AUTHOR]

The article titled "A new imaging classification for safer radial access visceral intervention of the liver and optimal case selection: A preliminary report" published in Hepatology Research discusses the use of the radial artery approach in abdominal arterial interventional procedures. The authors propose a simple and reproducible preoperative evaluation method, called TAC-F-R, to determine the indication for radial access visceral intervention (R.A.V.I.) and predict the difficulty of the procedure based on anatomical features of the aortic arch. The method uses oblique sagittal multiplanar reconstructed CT images and simple anatomical structures, making it practical for daily clinical practice. However, further validation and examination of other factors that influence the procedure are needed. [Extracted from the article]

Radial artery spasm (RAS) is the most common cause of transradial access site crossover and is a common intra‐procedural complication. RAS incidence can lead to radial artery occlusion (RAO) postprocedure, preventing the radial artery as a future access site. We evaluated the efficacy of nitroglycerin preventing RAS and RAO during transradial catheterization discussing the different routes of administration, including topical, subcutaneous, and intra‐arterial. A systematic review and meta‐analysis included all relevant articles until April 23, 2022. We searched six databases Google Scholar, Web of Science, SCOPUS, EMBASE, PubMed (MEDLINE), and CENTRAL. We registered our review protocol in PROSPERO with ID: CRD42022330356. We included 11 trials with 5814 patients. Compared to placebo, the pooled analysis favored subcutaneous nitroglycerin in preventing RAS (risk ratio [RR]: 0.57 with 95% confidence interval [CI] [0.43–0.77], p =.0003) and RAO (RR: 0.39 with 95% CI [0.16–0.98], p =.05). In contrast to the intra‐arterial nitroglycerin that showed nonstatistically significant results in preventing RAS and RAO (RR: 0.8 with 95% CI [0.63–1.02], p =.07)‐ (RR: 0.78 with 95% CI [0.6–1.01], p =.06)), respectively. Also, topical nitroglycerin did not prevent RAS (RR: 0.73 with 95% CI [0.42–1.24], p =.24). Compared with placebo, subcutaneous nitroglycerin during transradial catheterization reduced the incidence of RAS and RAO. Meanwhile, Intra‐arterial and topical nitroglycerin did not show statistically significant outcomes. Subcutaneous nitroglycerin may be a practical and cost‐effective technique to facilitate transradial catheterization; however, more RCTs are needed to evaluate the subcutaneous versus intra‐arterial nitroglycerin administration. [ABSTRACT FROM AUTHOR]

This article discusses a preliminary study on the use of placental volume (PV) as a diagnostic tool for identifying placentation failure in early pregnancy in women with a history of recurrent pregnancy loss due to antiphospholipid syndrome or thrombophilia. The study included thirty patients and measured PV using a specific technique at 13-14 weeks of gestation. The results showed that PV had an inverse correlation with uterine blood flow but not with fetal blood flow. The study is ongoing and aims to further investigate the use of PV measurement in predicting pregnancy outcomes for these patients. [Extracted from the article]

In this study, we have developed a new pen‐type pulse wave measurement system to evaluate heart failure treatment based on cardiovascular information. In order to acquire minute pathological changes in diseases such as heart failure, the pen‐type pulse wave measurement system is equipped with a high‐resolution MEMS tactile sensor that achieves a displacement resolution of 0.4 μm and an input resolution of 50μN. This measurement system consists of a small sensor package, a pen‐type measurement system, and a glass sensor package to enable physicians to measure the radial artery of men and women of all ages in a minimally invasive, rapid, and precise manner. Realizing this measurement system, simple and precise pulse wave measurement by direct measurement and measurement of pulse wave characteristics for individual differences has been possible. [ABSTRACT FROM AUTHOR]

Introduction: Arterial blood gas analysis is a minimally invasive technique used in our daily practice but is not a complication free technique. The aim of this study was to validate results from blood gas analysis obtained from the arteriovenous fistula (AVF)/graft as a surrogate marker of the arterial blood gas analysis. Methods: A prospective observational study was made in 45 patients. We performed arterial and AVF/graft blood gas analysis and results were compared by a paired sample t Student test. Results: Most of our subjects was male (68.9%) and the mean age was 67 years (±14). Hemodialysis vintage was 63 months (±66), and vascular access age was 62 months (±56). The more prevalent vascular access was left radiocephalic AVF (n = 16; 35.6%) and the main puncture artery was right radial artery (n = 27; 60.0%). There were no statistically significant differences between the samples collected. Conclusions: Our results suggest a possible alternative of arterial blood gas analysis in AVF/graft for hemodialysis patients. This could result in making an uncomfortable procedure almost painless and reducing complications. Future research should take place to include anatomical characteristics of the AVF or the circulation of recirculation. [ABSTRACT FROM AUTHOR]

Background: Radial artery is the preferred site for cannulation. Recently, the ulnar artery was chosen as an alternative in adults. Aims: We aimed to measure the diameter and depth of the ulnar and radial arteries using ultrasound, and our secondary purpose was to evaluate their anatomical position using a near‐infrared transcutaneous illumination device. Methods: Forty‐eight children (age range: 0–144 months) were assigned to the following groups: group Infant (aged <12 months), group Preschool (aged ≤12 to <72 months), and group School (aged ≥72 months). The diameter, depth, and position of the ulnar and radial arteries were compared between groups. Results: There was no significant difference between the diameters of the ulnar and radial arteries. In group Infant, group Preschool, and group School, mean diameters of the ulnar artery were 1.27 ± 0.15 mm, 1.62 ± 0.27 mm, and 2.03 ± 0.28 mm, respectively, and the radial artery were 1.29 ± 0.15 mm, 1.69 ± 0.27 mm, and 2.06 ± 0.29 mm, respectively. The corresponding differences between the diameters of ulnar and radial arteries were −0.02 mm, −0.07 mm, and −0.02 mm [95% CI −0.16 mm to 0.12 mm, −0.25 mm to 0.11 mm, and −0.25 mm to 0.21 mm; p =.776, p =.411, and p =.852]. In groups Preschool and School, the ulnar artery was at the recommended depth of 2–4 mm for arterial cannulation compared with the radial artery. In the Infant, Preschool, and School age groups, the ulnar and radial arteries were at the recommended depth of 2–4 mm for arterial cannulation in 70.0%, 100.0%, 93.8%, and 80.0%, 65.0%, and 50.0% of the cases, respectively. (difference: −10.0%, 35.0%, and 43.8%, 95%; CI −43.4% to 23.4%, 14.1% to 55.9%, and 19.4% to 68.1%, respectively). Conclusions: The ulnar artery can be considered a promising alternative to the radial artery for facilitating arterial cannulation in children. [ABSTRACT FROM AUTHOR]

Considerable calcification and stenosis frequently occur in the radial artery (RA) in diabetic nephropathy. PTA was performed successfully using a balloon to expand and restrictively tear the longitudinal axis of the RA. This approach seems to be a useful measure of promoting the maturation of AVF in diabetic nephropathy. [ABSTRACT FROM AUTHOR]

Background: The antecubital fossa is a main perforator cluster region located beside the anterior elbow defect, rendering it crucial to harvest the perforator pedicled flaps for the anterior elbow defects. Patients and methods: A total of 30 preserved cadaveric forearms were dissected in order to describe the perforator anatomy in the antecubital fossa. For each perforator, the number, the site of origin, the diameter at its origin, and the trajectory were recorded. In addition, all the patients treated for anterior elbow defects using inferior cubital artery (ICA) perforator pedicled flaps between June 2013 and June 2018 were reviewed in this retrospective study. Results: A total of 85 perforators were dissected in the antecubital fossa area from the 30 specimens. Among these, 65 perforators originated from the radial artery, 6 from the recurrent radial artery, 13 from the brachial artery, and 1 from the ulnar artery. Each forearm specimen had a constant and large ICA perforator. All perforators originated from source vessels 2–5 cm distal from the interepicondylar line and could be harvested as perforator pedicled flap for anterior elbow reconstruction. In the clinical study, 11 patients with anterior elbow defects were treated with ICA perforator pedicled flaps with satisfactory functional and aesthetic outcomes. Conclusion: The antecubital fossa has a constant and dominant ICA perforator and many other perforators. The pedicled antecubital fossa perforator flaps could be harvested flexibly with a reliable blood supply for anterior elbow reconstruction. [ABSTRACT FROM AUTHOR]

Dynamic cerebral autoregulation to spontaneous fluctuations in cerebral perfusion pressure (CPP) is often assessed by transcranial Doppler (TCD) in the time domain, yielding primarily the mean flow index (Mx), or in the frequency domain using transfer function analysis (TFA), yielding gain and phase. For both domains, the measurement of blood pressure is critical. This study assessed the inter‐method reliability of dynamic cerebral autoregulation using three different methods of pressure measurement. In 39 patients with aneurysmal subarachnoid hemorrhage, non‐invasive arterial blood pressure (ABP), invasive ABP (measured in the radial artery) and CPP were recorded simultaneously with TCD. Intraclass correlation coefficient (ICC) was used to quantify reliability. Mx was higher when calculated using invasive ABP (0.39; 95% confidence interval [95% CI]: 0.33; 0.44) compared to non‐invasive ABP, and CPP. The overall ICC showed poor to good reliability (0.65; 95% CI: 0.11; 0.84; n = 69). In the low frequency domain, the comparison between invasively measured ABP and CPP showed good to excellent (normalized gain, ICC: 0.87, 95CI: 0.81; 0.91; n = 96; non‐normalized gain: 0.89, 95% CI: 0.84; 0.92; n = 96) and moderate to good reliability (phase, ICC: 0.69, 95% CI: 0.55; 0.79; n = 96), respectively. Different methods for pressure measurement in the assessment of dynamic cerebral autoregulation yield different results and cannot be used interchangeably. [ABSTRACT FROM AUTHOR]

A 50‐year‐old man with a medical history of diabetes mellitus and hypertension was admitted to a university hospital for severe respiratory insufficiency caused by SARS‐CoV‐2 infection. His arterial blood pressure and blood oxygen levels were monitored through a plastic cannula inserted in the radial artery in the intensive care unit. After recovery from respiratory insufficiency, the patient was moved to a local hospital where hematoma formation and skin necrosis at the puncture site were noted. On the 25th day from the initial admission, the patient developed massive bleeding from the wound on the hematoma and was transferred to our hospital on emergency. A 6‐Fr sheath introducer was inserted through the right distal radial artery in the anatomical snuff box, and instant hemostasis was accomplished without external compression. Thereafter, percutaneous thrombin injection for the pseudoaneurysm was conducted under ultrasound guidance. However, bleeding from the pseudoaneurysm was still observed after radial sheath withdrawal. We then performed coil embolization of the radial artery, which involved a coil proximal to the aneurysm, four coils in the neck of the aneurysm, and two coils distal to the aneurysm. Permanent hemostasis was achieved with no further vascular complications. [ABSTRACT FROM AUTHOR]

With the development of micro‐nano manufacturing technology, various hierarchical microstructures (HMs) are used to improve the sensitivity and measurement range of flexible pressure sensors. However, the fabrication of highly ordered HMs in simple, fast, and low‐cost ways remains a great challenge. In this work, laser direct writing technology is used to fabricate highly ordered HMs to enhance the sensitivity of flexible piezoresistive sensors. The HMs show a lateral expansion with the increasing pressure due to good flexibility and small force bearing areas, resulting in more significant change in contact area than the single‐level microstructures, which leads to an enhanced sensitivity. Two case studies are conducted to verify the performance of the sensor with laser processed HMs. Experimental results show that the pulsating blood pressure signal of radial artery can be detected by attaching the sensor on the wrist. When the sensor is attached on the neck, it can also detect the vibration signal of vocal cord when speaking. These results successfully demonstrate the potential of laser processing in fabricating highly ordered HMs to achieve highly sensitive flexible piezoresistive sensors for various applications, such as wearable health monitoring and human–computer interactions. [ABSTRACT FROM AUTHOR]

Background: Historically, the ulnar artery has rarely been considered for arterial cannulation as it is less easily palpated than the radial artery. With the current routine use of ultrasound in pediatric patients, the ulnar is as accessible as the radial and could be viewed as an equivalent site for cannulation. Aims: The purpose of this study was to compare ulnar and radial artery suitability for arterial cannulation in pediatric patients using 2‐dimensional ultrasound. Methods: We examined the ulnar and radial arteries of pediatric patients aged birth to 6 years who were scheduled to undergo general anesthesia. Following anesthesia induction, the investigators positioned the patient's wrist to 30–45 degrees of extension and obtained images of the ulnar and radial arteries in the transverse and longitudinal planes. Assessments of the arteries' anterior‐posterior diameter, cross‐sectional area and depth were made by visual inspection at the time of image acquisition and by electronic caliper measurement of recorded images. Results: In 108 patients, mean anterior‐posterior diameter of the ulnar artery was larger than the radial artery in the transverse view, longitudinal view, and cross‐sectional area in 63.6%, 59.4%, and 60.4% of patients (p =.002,.004, and.006, respectively). Mean ulnar artery size was, on average, larger than the radial artery by 7.7%, 8.1%, and 12.9% in the transverse AP diameter, longitudinal AP diameter, and cross‐sectional area (95% CI 3.1–12.4%; 3.2–13.0%; 4.4–21.5%). The investigator's visual evaluation of vessel size at the bedside showed substantial agreement with the measured cross‐sectional area (linear‐weighted kappa of 0.73). In a subset of 13 patients age <24 months, the mean depth of the ulnar artery was 2.13 mm compared to 1.65 mm for the radial artery (difference −0.48 mm 95% CI 1.08–0.12). Conclusions: The ulnar artery was larger than the radial artery in 60% of pediatric patients thus may offer an arterial cannulation site advantage due to its larger size. The use of 2‐dimensional ultrasound examination allows accurate assessment of upper extremity distal arteries in order to optimize site selection for arterial cannulation in pediatric patients. [ABSTRACT FROM AUTHOR]

Background: Radial artery catheterization in neonates, infants, and young children is a common and useful invasive procedure that brings technical placement challenges and potential complications due to the small diameter size of the radial artery in these patients. The aim of this study is to determine appropriate catheter sizes in infants up to 6 months of age. Materials and Methods: A total of fifty infants undergoing general anesthesia or hospitalized in the neonatal intensive care unit were included. Images of the radial artery diameter were obtained from the infant's wrist using Philips EPIQ Diagnostic Ultrasound System CVX Release 4.0. All images obtained were distal in the forearm, medial to the border of the styloid process of the radius, at the point of maximal impulse of the radial artery, and with the wrist at a 45‐degree angle position. We recorded postmenstrual age, chronological age, gender, weight, location, comorbidities, medications, weight, and vital signs of each individual. Results: In this single cohort study of 50 children whose ages ranged from 0 to 6 months chronological age, their radial artery diameters were averaged proportionally to their weight and age. Use of a 22G catheter would result in 100% occlusion of the diameter of the artery in most study subjects. Use of a 24G catheter would result in a range of 75%–99% occlusion depending on weight, postmenstrual age, and chronological age of the infants. Conclusions: In view of these findings, we recommend using US to measure the diameter of the radial artery and choose the most appropriate catheter size before proceeding with US‐guidance for radial artery cannulation in infants. This will prevent inappropriate sizing of the catheter and the thrombotic complications this can incur. [ABSTRACT FROM AUTHOR]

Objective: To compare systolic blood pressure measured by Doppler (SBP) taken from the coccygeal artery versus common digital branch of the radial artery in cats with normal and poor perfusion parameters. Design: Prospective, observational study. Setting: University Teaching Hospital. Animals: Eighty‐five cats presenting to the emergency service for which prior emergency treatment was not received and a blood pressure was indicated on triage. Interventions: Systolic blood pressure was measured by Doppler using the radial and coccygeal arteries. Cats were categorized as having normal or poor tissue perfusion based on physical examination. Measurements and Main Results: Agreement was poor between coccygeal and radial SBP overall with absolute and relative bias (95% limits of agreement) of 23 (–51 to 96) mm Hg and 16% (–38% to 69%), respectively. In cats with poor perfusion, the agreement was absolute bias = 28 mm Hg and relative bias = 22% and with normal perfusion absolute bias = 22 mm Hg, and relative bias = 12%. The median (interquartile range) coccygeal SBP was significantly different from the radial SBP 141 (50) mm Hg versus 120 (45) mm Hg, P < 0.001. In multivariate linear regression, heart rate was negatively associated with coccygeal SBP (r2 = 0.088, P = 0.049), and pale mucous membrane color (P = 0.034) and poor pulse quality (P = 0.007) were independently associated with lower radial SBP (r2 = 0.18). Conclusions: Median coccygeal SBP is significantly greater than radial SBP in sick cats with both normal perfusion and hypoperfusion. Agreement between coccygeal and radial SBP is poor in cats and cannot be used interchangeably. As clinically significant differences exist between sites, the authors recommend obtaining SBP from both sites initially and choosing to monitor and trend changes with the one site that correlates most with physical examination findings. [ABSTRACT FROM AUTHOR]

Minimalist approaches have evolved for TAVR over the last years with impact on in‐hospital stay and patient safety. As part of this concept, transradial secondary arterial access is capable of reducing vascular and bleeding complications. Yet, steering of the marker pigtail catheter in the descending aorta might by fluoroscopic imaging sometimes be challenging. In our manuscript, we present a very simple "piggyback" technique, simplifying management of transradial secondary access in transfemoral TAVR. [ABSTRACT FROM AUTHOR]

Background: Crystalloid fluid infused during the induction of spinal anesthesia is involved in a complex set of physiological responses, including vasodilatation, reactive vasoconstriction, and changes in mean arterial pressure (MAP). The present evaluation compares the modeled capillary leakage in anesthetized versus nonanesthetized body regions. Methods: Ten female volunteers (mean age, 29 years) received 25 ml/kg of Ringer's acetate over 60 min during experimental spinal anesthesia. Blood hemoglobin was measured repeatedly in the radial artery (reference), arm (cubital) vein, and leg (femoral) vein for 240 min. Each pattern of data served as a dependent variable in volume kinetic analyses that used mixed models software and MAP as covariate. Results: The capillary leakage of fluid from the plasma to the extravascular space peaked at 17 ml/min when MAP was 100 mmHg, and the two venous curves were virtually identical. At MAP 60 mmHg, the rate was reduced to 10‐12 ml/min when assessed in arterial blood and leg vein blood, but only 5 mmHg in blood collected from the arm vein. The distribution half‐life of infused fluid was then 40 min in the leg and 80 min in the arm. These results suggest that vasoconstriction in nonanesthetized body regions halves the capillary leakage that is observed in vasodilated, anesthetized body regions. Conclusion: Graded hypotension during spinal anesthesia reduced the capillary filtration of fluid as determined by volume kinetic analysis. The effect was twice as great when venous blood was sampled from a nonanesthetized body region than from an anesthetized body region. [ABSTRACT FROM AUTHOR]

No study has examined the differential value of arterial intima thickness in the subtypes of acute ischaemic stroke. This study aimed to assess whether intima thickness of carotid artery (CIT), radial artery (RIT) and dorsalis pedis artery (PIT) have an independent and additive value in differentiating ischaemic stroke subtypes due to large‐artery atherosclerosis (LAA) or small‐vessel occlusion (SVO). One hundred and sixty‐one patients with LAA and 79 patients with SVO were recruited. CIT, RIT and PIT were measured with a 24‐MHz ultrasound transducer. Binary logistic regression analysis was used to evaluate the differential values of the different parameters in the two subtypes. ROC curve analyses were plotted to compare the differential performance of different parameters and the combination model. Both RIT and PIT were substantially thicker in LAA than in SVO stroke patients. RIT and carotid intima‐media thickness had similar performances in differentiating stroke subtypes. Introduction of RIT to traditional atherosclerotic associated risk factors had a marginal satisfactory differential performance for LAA and SVO stroke patients (AUC 0.775). RIT is a promising parameter for LAA and SVO subgroup classification. The combination of RIT and traditional risk factors might be a promising tool for differentiating ischaemic stroke subgroups. [ABSTRACT FROM AUTHOR]

New Findings: What is the central question of this study?There is a paradoxical reduction in augmentation index during lower‐body dynamic (LBD) exercise in the face of an increase in central pressure. To determine causality, the amplitudes of forward and backward pressure waves were assessed separately using wave separation analysis.What is the main finding and its importance?Reflection magnitude decreased during LBD exercise in healthy young adults and was attributable to an increased forward pressure wave amplitude and decreased backward pressure wave amplitude. This vasoactive response might limit the adverse effects of wave reflection during LBD exercise, optimizing ventricular–arterial interactions. Acute lower‐body dynamic (LBD) exercise decreases surrogate measures of wave reflection, such as the augmentation index. However, the augmentation index is influenced by the combined effects of wave reflection timing, magnitude and other confounding factors external to wave reflection, which make it difficult to discern the origin of changes in surrogate measures. The relative contributions of forward (Pf) and backward (Pb) pressure wave amplitudes to central pressure can be determined by wave separation analysis. Reflection magnitude (RM = Pb/Pf) and the timing of apparent wave reflection return can also be determined. We tested the hypothesis that acute LBD exercise decreases RM and reflected wave transit time (RWTT). Applanation tonometry was used to record radial artery pressure waveforms in 25 adults (24 ± 4 years of age) at baseline and during light‐, moderate‐ and vigorous‐intensity exercise. Wave separation analysis was conducted offline using a personalized physiological flow wave to determine Pf, Pb, RM and RWTT. The RM decreased during all intensities of exercise compared with baseline (all P < 0.001; baseline, 43 ± 5%; light, 33 ± 6%; moderate, 23 ± 7%; vigorous, 17 ± 5%). The reduction in RM was attributable to the combined effect of increased Pf and decreased Pb during exercise. The RWTT decreased during all intensities of exercise compared with baseline (all P < 0.04; baseline, 156 ± 17 ms; light, 144 ± 15 ms; moderate, 129 ± 16 ms; vigorous, 121 ± 17 ms). Lastly, in a stepwise multilinear regression, Pf, but not Pb and RWTT, contributed to increased central pulse pressure during LBD exercise. These data show that wave reflection decreased and that central pulse pressure is most influenced by Pf during LBD exercise. [ABSTRACT FROM AUTHOR]

Microscopic anatomical study of the hand requires difficult or destructive dissection techniques for each anatomical structure. Synchrotron phase‐contrast imaging (sPCI) allows us to study precisely, at a microscopic resolution and in a nondestructive approach, the soft tissues and bone structures within a single 3D image. Therefore, we aimed to assess the capacity of sPCI to study the arterial anatomy of the hand and digits in human cadavers for anatomical purposes. A non‐injected hand from an embalmed body was imaged using sPCI at 21‐µm pixel size. The vascularization and innervation of the hands were virtually reconstructed at 84‐µm resolution, and the medial neurovascular bundle of the third digit at 21 µm. The thinner‐most distal structures were observed and reported. The diameter and thickness of the vascular and neural structures were defined on 2D computed tomographic axial projections, and using a granulometry method coupled to the 3D reconstructions. The vascularization of the hand was visible from the radial and ulnar arteries to the distal digital transverse anastomoses. The thinnest structure observed was the anastomotic arterial network around the proper palmar digital nerve. The latter emerged from the proper palmar digital artery and vascularized the nerve around its whole length and circumference. The perineural arterioles individualizable at this resolution had a diameter of 66–309 µm. In conclusion, sPCI allows both the arterial and neural anatomy of the hand to be studied at the same time, as well as the anatomical interactions between both networks. It facilitates the study of structures that have different sizes, diameters, thickness, and histological origin with great precision, in a noninvasive way, and using a single technique. [ABSTRACT FROM AUTHOR]

Objective: Vasculopathy is considered central to the pathogenesis of juvenile dermatomyositis (DM) and is associated with severe extramuscular manifestations. We undertook this study to investigate the hypothesis that the vasculopathy of juvenile DM can be noninvasively tracked by examining biomarkers of endothelial injury, subclinical inflammation, hypercoagulability, and vascular arterial stiffness. Methods: The study population was a UK cohort of children with juvenile DM. Circulating endothelial cells (CECs) and microparticles (MPs) were identified using immunomagnetic bead extraction and flow cytometry, respectively. Plasma thrombin generation was determined using a fluorogenic assay. Cytokine and chemokine levels were measured by electrochemiluminescence. Arterial stiffness was assessed using pulse wave velocity (PWV). Results were expressed as the median and interquartile range (IQR), and statistical significance was assessed using nonparametric analyses. Results: Ninety patients with juvenile DM and 79 healthy control subjects were included. The median age of the patients was 10.21 years (IQR 6.68–13.40), and the median disease duration was 1.63 years (IQR 0.28–4.66). CEC counts were higher in all patients with juvenile DM compared to controls (median 96 cells/ml [IQR (40–192] and 12 cells/ml [IQR 8–24], respectively; P < 0.0001). Circulating MP numbers were also significantly higher in patients with active juvenile DM compared to controls (median 204.7 × 103/ml [IQR 87.9–412.6] and 44.3 × 103/ml [IQR 15.0–249.1], respectively; P < 0.0001). MPs were predominantly of platelet and endothelial origin. Enhanced plasma thrombin generation was demonstrated in patients with active juvenile DM compared to those with inactive disease (P = 0.0003) and controls (P < 0.0001). Carotid‐radial PWV adjusted for age was increased in patients with juvenile DM compared to controls (P = 0.003). Conclusion: We observed increased endothelial injury and increased levels of proinflammatory cytokines in patients with active juvenile DM. MP profiles reflected distinct disease activity status in juvenile DM and are markers of vascular pathology, platelet activation, and thrombotic propensity. Ongoing long‐term vascular injury may result in increased arterial stiffness in patients with juvenile DM. [ABSTRACT FROM AUTHOR]

In patients with COVID-19, even small radial aneurysm may suddenly rupture. [ABSTRACT FROM AUTHOR]

An arteriovenous fistula (AVF) remains the best choice of vascular access (VA) for hemodialysis (HD). The aim of the study was to determine the factors associated with the achievement of adequate blood flow (BF) of AVFs at the 4th week after creation. Created AVFs in 63 patients with chronic kidney disease (CKD) stage 4/5 and CKD stage 5 on hemodialysis (CKD5D) were analyzed in a prospective study. Doppler ultrasound (DUS) was used for measuring the diameter of the radial artery, the brachial artery and the cephalic vein before AVF creation. The BF of AVF was calculated by DUS at the 4th week after creation and adequate BF was defined as ≥ 600 mL/min. The average age of patients was 61.31 ± 12.9 years. An adequate BF of AVF at the 4th week after creation was achieved in 43.54% of patients. The BF of AVF measured in male patients was significantly higher compared to the BF of AVF obtained in females (576.03 mL/min vs 375.12 mL/min, P = 0.004). The diameter of the blood vessels with achieved adequate BF was significantly larger compared to the diameter of the blood vessels without adequate BF (radial artery: 2.45 mm vs 2.03 mm, P = 0.000; brachial artery: 4.78 mm vs 4.06 mm, P = 0.001 and cephalic vein: 3.12 mm vs 2.83 mm P = 0.018). The gender and the diameter of the blood vessels before AVF creation were significantly associated with achievement of adequate BF of AVF at the 4th week of creation. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to examine the relationship between the temporal changes in endometrial blood flow impedance during natural and hormone replacement therapy (HRT) cycles and clinical outcomes of vitrified‐warmed embryo transfer (ET). Methods: This retrospective observational cohort study included 60 women, 28 with natural, and 32 with HRT cycles, who underwent vitrified‐warmed ET. Uterine radial artery resistance index (RA‐RI) was measured during the natural and HRT cycles at the following time points: early follicular phase, day of the human chorionic gonadotropin injection during a natural cycle or day of progesterone administration during an HRT cycle, and day of ET. Results: The clinical pregnancy rates of the natural and HRT cycles were 32.1% and 34.4%, respectively. The RA‐RI at the early follicular phase was significantly lower in the pregnant group than in the nonpregnant group with natural but not HRT cycles (p = 0.04). The odds ratio for pregnancy was 0.70 (95% confidence interval [CI], 0.52–0.95) when the RA‐RI value at the early follicular phase was increased by 0.01 in the natural cycle. With the natural cycle, the area under the receiver‐operating characteristic curves for the RA‐RI at the early follicular phase with a threshold of 0.68 was 0.75 (95% CI, 0.57–0.93), and the positive and negative predictive values were 0.53 (95% CI, 0.37–0.59) and 0.92 (0.74–0.99), respectively. Conclusion: RA‐RI at the early follicular phase might be an effective and useful tool for deciding between natural or HRT cycles for vitrified‐warmed ET. [ABSTRACT FROM AUTHOR]

Key points: We investigated the influence of arterial PCO2 (PaCO2) with and without acutely elevated arterial pH and bicarbonate ([HCO3–]) on cerebral blood flow (CBF) regulation in the internal carotid artery and vertebral artery.We assessed stepwise iso‐oxic alterations in PaCO2 (i.e. cerebrovascular CO2 reactivity) prior to and following i.v. sodium bicarbonate infusion (NaHCO3–) to acutely elevate arterial pH and [HCO3–].Total CBF was unchanged irrespective of a higher arterial pH at each matched stage of PaCO2, indicating that CBF is acutely regulated by PaCO2 rather than arterial pH.The cerebrovascular responses to changes in arterial H+/pH were altered in keeping with the altered relationship between PaCO2 and H+/pH following NaHCO3– infusion (i.e. changes in buffering capacity).Total CBF was ∼7% higher following NaHCO3– infusion during isocapnic breathing providing initial evidence for a direct vasodilatory influence of HCO3– independent of PaCO2 levels. Cerebral blood flow (CBF) regulation is dependent on the integrative relationship between arterial PCO2 (PaCO2), pH and cerebrovascular tone; however, pre‐clinical studies indicate that intrinsic sensitivity to pH, independent of changes in PaCO2 or intravascular bicarbonate ([HCO3–]), principally influences cerebrovascular tone. Eleven healthy males completed a standardized cerebrovascular CO2 reactivity (CVR) test utilizing radial artery catheterization and Duplex ultrasound (CBF); consisting of matched stepwise iso‐oxic alterations in PaCO2 (hypocapnia: –5, –10 mmHg; hypercapnia: +5, +10 mmHg) prior to and following i.v. sodium bicarbonate (NaHCO3–; 8.4%, 50 mEq 50 mL–1) to elevate pH (7.408 ± 0.020 vs. 7.461 ± 0.030; P < 0.001) and [HCO3–] (26.1 ± 1.4 vs. 29.3 ± 0.9 mEq L–1; P < 0.001). Absolute CBF was not different at each stage of CO2 reactivity (P = 0.629) following NaHCO3–, irrespective of a higher pH (P < 0.001) at each matched stage of PaCO2 (P = 0.927). Neither hypocapnic (3.44 ± 0.92 vs. 3.44 ± 1.05% per mmHg PaCO2; P = 0.499), nor hypercapnic (7.45 ± 1.85 vs. 6.37 ± 2.23% per mmHg PaCO2; P = 0.151) reactivity to PaCO2 were altered pre‐ to post‐NaHCO3–. When indexed against arterial [H+], the relative hypocapnic CVR was higher (P = 0.019) and hypercapnic CVR was lower (P = 0.025) following NaHCO3–, respectively. These changes in reactivity to [H+] were, however, explained by alterations in buffering between PaCO2 and arterial H+/pH consequent to NaHCO3–. Lastly, CBF was higher (688 ± 105 vs. 732 ± 89 mL min–1, 7% ± 12%; P = 0.047) following NaHCO3– during isocapnic breathing providing support for a direct influence of HCO3– on cerebrovascular tone independent of PaCO2. These data indicate that in the setting of acute metabolic alkalosis, CBF is regulated by PaCO2 rather than arterial pH. Key points: We investigated the influence of arterial PCO2 (PaCO2) with and without acutely elevated arterial pH and bicarbonate ([HCO3–]) on cerebral blood flow (CBF) regulation in the internal carotid artery and vertebral artery.We assessed stepwise iso‐oxic alterations in PaCO2 (i.e. cerebrovascular CO2 reactivity) prior to and following i.v. sodium bicarbonate infusion (NaHCO3–) to acutely elevate arterial pH and [HCO3–].Total CBF was unchanged irrespective of a higher arterial pH at each matched stage of PaCO2, indicating that CBF is acutely regulated by PaCO2 rather than arterial pH.The cerebrovascular responses to changes in arterial H+/pH were altered in keeping with the altered relationship between PaCO2 and H+/pH following NaHCO3– infusion (i.e. changes in buffering capacity).Total CBF was ∼7% higher following NaHCO3– infusion during isocapnic breathing providing initial evidence for a direct vasodilatory influence of HCO3– independent of PaCO2 levels. [ABSTRACT FROM AUTHOR]

Introduction: Ultrasound-guidance of radial artery catheter insertion improves the first attempt success and reduces the occurrence of hematomas. Needle-tracking devices optimize needle-ultrasound beam alignment by displaying in real-time the needle tip position. We compared the median time need by experienced physicians to achieve radial artery puncture using either a conventional ultrasonography device (CUD) or a magnetic needle-tracking ultrasound device (MUD) in a simulation training arm model.Methods: Fifty experienced residents and physicians performed two punctures in randomized order with the CUD and the MUD. The primary outcome was puncture duration; the secondary outcomes were puncture success, rate of accidental vein puncture, and practitioner's comfort (subjective scale 0-10).Results: The median [lower-upper quartile] puncture time was 10 [6-14] seconds when using CUD and 4 [3-7] seconds when using MUD (P < .01). In the multivariate analysis, MUD use was associated with decreased puncture duration whatever the puncture order (OR 1.13 [1.07-1.20], P < .01). The participants performed 99 (99%) successful punctures: 50 with the MUD (100%) and 49 with the CUD (98%). There was no accidental venous puncture. The practitioner's comfort level was 6.5 [6, 7] with the CUD and 8 [7-9] with the MUD (P < .01).Conclusion: MUD reduced radial artery puncture time and improved physician comfort in a simulation training arm model. [ABSTRACT FROM AUTHOR]