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Pulmonary hypertension (PH) associated with left heart disease (PH-LHD) is the most common form of PH. In PH-LHD, changes in the pulmonary vasculature are assumed to be mainly caused by pulmonary venous congestion. However, the underlying mechanisms of this form of PH are poorly understood. We aimed to establish a model of PH associated with pulmonary venous congestion. Wistar–Kyoto rats underwent partial occlusion of the left pulmonary vein to induce pulmonary venous congestion or sham surgery and were assessed at various time points post-surgery (3, 6, 9, 12 weeks). In vivo cardiopulmonary phenotyping was performed by using echocardiography along with heart catheterization. Histomorphometry methods were used to assess pulmonary vascular remodeling (e.g., wall thickness, degree of muscularization). Left pulmonary vein banding (PVB) resulted in mildly elevated right ventricular systolic pressure and moderate right ventricular hypertrophy. In PVB rats, small- and medium-sized pulmonary vessels in the left lung were characterized by increased wall thickness and muscularization. Taken together, our data demonstrate that left PVB-induced pulmonary venous congestion is associated with pulmonary vascular remodeling and mild PH. [ABSTRACT FROM AUTHOR]

Introduction: Injury and subsequent thrombosis of the cerebral venous sinuses may be caused by closed head injuries secondary to a variety of different mechanisms. Skull fractures can lacerate or otherwise disrupt adjacent dural sinuses. The sequelae of such injuries may include thrombosis and either partial or total occlusion of the sinus, ultimately resulting in significant venous congestion. Sagittal sinus injury is associated with a more serious outcome due to the obligatory flow into the sinus, especially posterior to the coronal suture. In such cases, venous infarction may be a severe and life-threatening complication of head injury. Case Presentation: A 2-year-old female presented with a depressed skull fracture near the midline and a thrombus in the sagittal sinus. Anticoagulation, the standard treatment cerebral venous sinus thrombosis (CVST), was contraindicated due to intracranial hemorrhage, so immediate thrombectomy was performed with successful neurologic recovery at 9-month follow-up. To our knowledge, this case is the youngest patient documented to receive mechanical thrombectomy for superior sagittal sinus (SSS) thrombosis due to trauma. Conclusion: Closed head injuries in pediatric patients may be associated with CVST, with resulting venous drainage compromise and profound neurologic sequelae. Unlike adult patients with spontaneous CVST in which anticoagulation are the standard of care, pediatric patients experiencing traumatic CVST may have contraindications to anticoagulants. If the patient has a contraindication to anticoagulation such as intracranial bleeding, endovascular mechanical thrombectomy may be an effective intervention when performed by an experienced neurointerventionalist. Established Facts: In adults, cerebral venous sinus thrombosis is treated with anticoagulation. In children, traumatic cerebral venous sinus thrombosis may be associated with contraindications to anticoagulation. [ABSTRACT FROM AUTHOR]

Introduction Breast engorgement can lead to the early cessation of breastfeeding. The present study was conducted to review the effect of complementary medicine on the treatment of breast engorgement. Methods Domestic and international databases, including PubMed, ISI Web of Science, Embase, Cochrane, and Scopus, were systematically searched without time limits until September 10, 2022. All clinical trials and experimental studies evaluating the effect of complementary therapies on breast engorgement in latching mothers was included in systematic review. Cochrane Collaboration's tool was used for assessing risk of bias. Results 18 studies met the inclusion criteria and the overall quality of the studies was high. A trial reported that Oketani and warm compression in the form of massage were effective. Commiphora Mukul cream had higher effectiveness than the placebo cream, and the hot compress with herbal components such as hollyhock leaf and ginger was more effective than the warm compress alone. Another trial did not report any significant difference between cold compression and hot fomentation in relieving breast engorgement among postnatal mothers. The effect of cabbage leaves on breast engorgement relief was more effective than routine care and gel packs in improving breast engorgement. However, adding cabbage leaves to the warm compress did not increase the effect. Acupressure and acupuncture on HT3, GB21, SP6 and ST16, ST18, SP17, and CV17 acupoints can be efficient non-pharmacological methods. Conclusion Complementary medicine such as massage, acupuncture, acupressure, cold and hot compress, cabbage leaves, and herbal components are efficient to treat breast engorgement in postpartum women. [ABSTRACT FROM AUTHOR]

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Adenine nucleotides play a critical role in maintaining essential functions of red blood cells (RBCs), including energy metabolism, redox status, shape fluctuations and RBC-dependent endothelial and microvascular functions. Recently, it has been shown that infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) might lead to morphological and metabolic alterations in erythrocytes in both mild and severe cases of coronavirus disease (COVID-19). However, little is known about the effects of COVID-19 on the nucleotide energetics of RBCs nor about the potential contribution of nucleotide metabolism to the long COVID syndrome. This study aimed to analyze the levels of adenine nucleotides in RBCs isolated from patients 12 weeks after mild SARS-CoV-2 infection who suffered from long COVID symptoms and to relate them with the endothelial and microvascular function parameters as well as the rate of peripheral tissue oxygen supply. Although the absolute quantities of adenine nucleotides in RBCs were rather slightly changed in long COVID individuals, many parameters related to the endothelial and microcirculatory function showed significant correlations with RBC adenosine triphosphate (ATP) and total adenine nucleotide (TAN) concentration. A particularly strong relationship was observed between ATP in RBCs and the serum ratio of arginine to asymmetric dimethylarginine—an indicator of endothelial function. Consistently, a positive correlation was also observed between the ATP/ADP ratio and diminished reactive hyperemic response in long COVID patients, assessed by the flow-mediated skin fluorescence (FMSF) technique, which reflected decreased vascular nitric oxide bioavailability. In addition, we have shown that patients after COVID-19 have significantly impaired ischemic response parameters (IR max and IR index), examined by FMSF, which revealed diminished residual bioavailability of oxygen in epidermal keratinocytes after brachial artery occlusion. These ischemic response parameters revealed a strong positive correlation with the RBC ATP/ADP ratio, confirming a key role of RBC bioenergetics in peripheral tissue oxygen supply. Taken together, the outcomes of this study indicate that dysregulation of metabolic processes in erythrocytes with the co-occurring endothelial and microvascular dysfunction is associated with diminished intracellular oxygen delivery, which may partly explain long COVID-specific symptoms such as physical impairment and fatigue. [ABSTRACT FROM AUTHOR]

Context: When emphasizing muscular strength during postoperative rehabilitation it is recommended to use a neuromuscular electrical stimulation (NMES) waveform that elicits the greatest muscle force and local metabolic demand that is also well tolerated. The present investigation examined the effects that 3 different clinically used NMES waveforms had on the electrically elicited force (EEF), local metabolic demand (exercising muscle oxygen saturation [SmO2]), and the subsequent reactive hyperemia response (recovery total hemoglobin concentration [THb]) of the knee extensors. Design: Single session repeated-measures design. Methods: EEF, local metabolic demand, and reactive hyperemia responses were measured during and subsequent to 3 NMES waveforms: Russian burst modulated alternating current (RUS), biphasic pulsed current (VMS™), and burst modulated biphasic pulsed current (VMS-Burst™). Exercising SmO2 and recovery THb were assessed noninvasively using a near-infrared spectroscopy sensor placed on the vastus lateralis. Participants completed one set of 10 repetitions of each NMES waveform and were provided with 5 minutes of passive, interset recovery. Two-way, repeated-measures analysis of variance examined if NMES waveform or repetition significantly affected (P<.05) EEF or exercising SmO2. Two-way, repeated-measures analysis of variance examined if NMES waveform or recovery time affected recovery THb. Results: VMS and VMS-Burst™ yielded higher EEF (F = 11.839, P <. 001) and greater local metabolic stress (lower exercising SmO2, F = 13.654, P < .001) compared with RUS. Greater rate of EEF decline throughout the NMES set was observed during RUS (%Δ = -50 [6] % Rep 1) compared with VMS-Burst™ (%Δ = -30 [7] %Rep 1) and VMS™ (%Δ = -32 [7] %Rep 1). VMS™ elicited a higher reactive hyperemia response (higher recovery THb) compared with RUS (F =3.427, P=.048). Conclusions: The present findings support the use of VMS™ or VMS-Burst™ compared with RUS when promoting muscular strength. In addition, the use of VMS might provide a greater blood volume to the target muscle subsequent to NMES contractions compared with RUS. [ABSTRACT FROM AUTHOR]

Extended distal pancreatectomy often requires resection of vascular structures and adjacent organs, potentially leading to gastric venous congestion. This case report describes a 49-year-old female who underwent radical antegrade modular pancreatosplenectomy for pancreatic ductal adenocarcinoma. During the procedure, segmental gastric venous congestion was observed and resolved by anastomosing the left gastric vein to the left adrenal vein. The in-hospital postoperative recovery was initially uneventful; however, the patient was readmitted because of intra-abdominal fluid collection that was managed with antibiotics. Pathological examination confirmed moderately differentiated ductal adenocarcinoma with lymphovascular invasion. The patient received adjuvant mFOLFIRINOX therapy and remains disease-free 12 months after surgery with adequate patency of the anastomosis. This case highlights the importance of recognizing and addressing gastric venous congestion during radical antegrade modular pancreatosplenectomy to prevent complications, such as delayed gastric emptying or gastric necrosis, and proposes left gastric vein to left adrenal vein anastomosis as an effective intraoperative solution. [ABSTRACT FROM AUTHOR]

This article discusses a rare case of a 13-year-old female with neurofibromatosis 1 (NF1) who presented with painful swelling in her right lower limb. NF1 is an inherited disorder characterized by tumors in the skin and central nervous system, which can potentially become malignant. In this case, the patient was diagnosed with NF1 and venous malformation in her right lower limb. The article emphasizes the importance of careful clinical examination and radiological imaging for diagnosing new onset swelling in NF1. [Extracted from the article]

In free flap operation, temporary hyperemia of the transferred flaps can often be encountered in the early postoperative period, appearing reddish and rapid capillary refilling time, which mimics venous congestion. This study aimed to investigate the factors associated with the development of hyperemia and evaluate clinical course. Consecutive patients who underwent free flap-based reconstruction between December 2019 and October 2021 were reviewed. Independent risk factors associated with its development were assessed. Flap showing initial hyperemic features were assessed using flap blood glucose measurement (BGM). If it showed over 60 mg/dL, they were closely observed without management. Their clinical outcomes were evaluated. In total, 204 cases were analyzed, of which 35 (17.2%) showed initial hyperemia. Multivariable analyses showed that using thoracodorsal artery perforator flaps and muscle containing flaps (musculocutaneous/muscle-chimeric flaps) and conducting end-to-end arterial anastomosis (vs. end-to-side) were independent predictors. All cases with initial hyperemia showed over 60 mg/dL in BGM. The phenomenon resolved spontaneously within 6.9 h averagely. Overall perfusion-related complications developed in 10 (4.9%) cases, which rate did not differ between the two groups. Several factors might be associated with the development of initial hyperemia after free flap surgery. With proper assessment, this condition can be successfully managed without unnecessary intervention. [ABSTRACT FROM AUTHOR]

Purpose: A fixed-combination eye drop has several advantages over combination therapy, however, the intraocular pressure (IOP)-lowering efficacy and safety of the newly available brimonidine + ripasudil fixed-combination (BRFC) eye drops after switching from brimonidine + ripasudil is yet to be established. Therefore, this study aimed to retrospectively investigate the 6-month safety, usability, and IOP-lowering efficacy of BRFC switched from brimonidine and ripasudil. Patients and Methods: Overall, 69 patients with primary open-angle glaucoma (69 eyes) receiving brimonidine + ripasudil were enrolled in this study. Brimonidine + ripasudil was discontinued, and treatment was switched to BRFC without a washout period. The IOP was compared before and at 3 and 6 months after switching to BRFC. The side effects, discontinued cases, and usability (a questionnaire survey) were also investigated. Results: The IOP was not significantly different after switching to BRFC (15.1 ± 3.3 mmHg at baseline, 15.9 ± 3.6 mmHg after 3 months, and 14.6 ± 3.3 mmHg after 6 months). Adverse reactions occurred in four patients (5.8%): allergic conjunctivitis, two patients; irritation, one patient; and blurred vision, one patient. Treatment was discontinued in five (7.2%) patients owing to allergic conjunctivitis, two patients; increased IOP, two patients; and blurred vision, one patient. In the questionnaire survey, 68 patients with eye pain, 67 with itching, 64 with conjunctival hyperemia, 64 with irritation, and 62 with blurred vision reported no change or improved conditions. Additionally, in response to the question regarding preferences for pre-treatment and fixed combinations, 14 participants (20.2%) favored pre-treatment, while 53 (76.8%) preferred fixed combinations. Conclusion: The IOP was maintained for 6 months, with satisfactory safety and comfort of use, with BRFC switched from brimonidine and ripasudil. [ABSTRACT FROM AUTHOR]

Shoemaker, ME, Smith, CM, Gillen, ZM, and Cramer, JT. Sex differences in test-retest reliability of near-infrared spectroscopy during postocclusive reactive hyperemia of the vastus lateralis. J Strength Cond Res 38(2): e40-e48, 2024--The purpose of this study was to determine test-retest reliability for vascular reactivity measures and ranges for normalization of near-infrared spectroscopy (NIRS) variables from the vastus lateralis using postocclusive reactive hyperemia (PORH) procedure in male subjects, female subjects, and combined. Concentrations of oxygenated hemoglobin (Hb) + myoglobin (Mb) (O2Hb) and deoxygenated Hb + Mb (HHb) to derive total Hb + Mb (THb), difference in Hb + Mb signal (Hbdiff), and muscle tissue oxygen saturation (StO2) from the vastus lateralis were measured during the PORH in 12 male subjects (age: 23.17 6 1.77 years; stature: 180.88 6 4.59 cm; and mass: 81.4769.68 kg) and 10 female subjects (age: 23.8062.07 years; stature: 165.9564.92 cm; and mass: 70.93610.55 kg) on 2 separate days. Adipose tissue thickness at the NIRS site was measured with ultrasonography. There were no significant differences between the mean values from visit 1 to visit 2 (p. 0.076-0.985). In the composite sample, intraclass correlation coefficient (ICC) and coefficient of variation (CV) ranged from 0.35 to 0.91 and 4.74 to 39.18%, respectively. In male subjects, ICC and CV values ranged from 0.57 to 0.89 and 2.44 to 28.55%, respectively. In female subjects, ICC and CV values ranged from 2 0.05 to 0.75 and 7.83 to 61.19%, respectively. Although NIRS variables were overall reliable during PORH, when separated by sex, reliability in male subjects generally increased, whereas female subjects were not reliable, suggesting adipose tissue thickness may be a contributing factor. Understanding sex differences in reliability is important when using this technique for normalization or examining vascular reactivity during athletic performance. With greater utilization of NIRS monitoring in athletes to examine training adaptations, it is important for practitioners to understand the capabilities and potential limitations of the tool. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the imaging features indicating portal vein invasion (PVI) of hepatocellular carcinoma (HCC) on gadoxetic acid-enhanced MRI and to create more accurate diagnostic criteria than the presence of portal vein tumor thrombosis (PVTT) on MRI. Methods: This retrospective study included patients with surgically resected HCC larger than 5 cm, and the presence of PVI was investigated. On MRI, we evaluated the image findings of portal vein occlusion, the parenchymal signal change caused by hemodynamic alterations of the portal vein, and their combination showing the highest odds ratio (OR) to define the diagnostic criteria for radiological PVI detection (rPVI criteria). The diagnostic performance and recurrence-free survival were compared between the rPVI criteria and the presence of PVTT using McNemar's test and Kaplan–Meier method, respectively. Interobserver agreement was evaluated using Cohen's weighted ĸ statistics. Results: Of 189 enrolled patients, 25 (13.2%) had PVI on histology. To diagnose PVI on MRI, either peripheral wedge-shaped arterial peritumoral hyperemia with an abrupt cut-off of a portal vein or the presence of PVTT had the highest OR (41.67, p < 0.001). The sensitivity of PVI was significantly increased under this diagnostic criterion (64.0% to 88.0%; p = 0.031) with comparable accuracy (95.2% vs. 94.7%; p > 0.999). In terms of recurrence-free survival, the patient group with rPVI was significantly worse (p = 0.017) compared with the patients without rPVI. Interobserver agreement of radiologic findings was substantial (ĸ = 0.64). Conclusion: Diagnostic criteria for radiologically PVI detection increase the sensitivity more than the only presence of PVTT. [ABSTRACT FROM AUTHOR]

Pulmonary and systemic congestion as a consequence of heart failure are clinically recognized as alarm signals for clinical outcome and mortality. Although signs and symptoms of congestion are well detectable in patients, monitoring of congestion in small animals with heart failure lacks adequate noninvasive methodology yet. Here, we developed a novel ultrasonography-based scoring system to assess pulmonary and systemic congestion in experimental heart failure, by using lung ultrasound (LUS) and imaging of the inferior vena cava (Cava), termed CavaLUS. CavaLUS was established and tested in a rat model of supracoronary aortic banding and a mouse model of myocardial infarction, providing high sensitivity and specificity while correlating to numerous parameters of cardiac performance and disease severity. CavaLUS, therefore, provides a novel comprehensive tool for experimental heart failure in small animals to noninvasively assess congestion. [ABSTRACT FROM AUTHOR]

Background: The application of nasolabial perforator flap for nasal reconstruction has been reported previously with satisfactory outcomes, but the outcomes and risk factors of postoperative adverse events have been unclear to plastic surgeons. Aims: To statistically analyze the effectiveness of the nasolabial perforator flap in nasal reconstruction and the risk factor of postoperative complications and re‐operation. Patients/Methods: This retrospective study evaluated 58 Chinese patients who underwent nasal reconstruction with the nasolabial perforator flap from 2009 to 2021. The esthetic and blood supply outcomes were measured by plastic surgeons on a 5‐point Likert scale. Binary logistic regression was used to determine the risk factors associated with postoperative complications and re‐operation. Results: The mean age of the cohort was 66.4 ± 2.0 years. The defect size ranged from 6.5 × 5.5 mm2 to 40 × 70 mm2, and 48.3% of defects covered more than one nasal subunit. Venous congestion occurred in 4.9% of flaps, and the immediate overall postoperative score was 7.72/10. More than one nasal subunit of involvement was the risk factor associated with re‐operation (p = 0.004), but no risk factor was associated with complications. Conclusions: The nasolabial perforator flap is reliable for nasal reconstruction with good esthetic outcomes and fewer complications. However, a large number of involved subunits may lead to multiple surgeries for flap trimming in easterners. [ABSTRACT FROM AUTHOR]

In the era of free flap reconstruction, mandibular defects are routinely reconstructed with osseous free flaps, and non‐free flap bony reconstruction options are limited. A patient with T4N0 mandibular squamous cell carcinoma underwent resection with fibula free flap reconstruction of a parasymphyseal to angle defect. After free flap failure due to venous congestion, the flap was explanted. He declined additional free flap reconstruction and elected to proceed with pedicled osteomyocutaneous pectoralis major with rib. In this case presentation, we discuss the technical details of harvest of this flap using the 6th rib. The pedicled osteomyocutaneous pectoralis major flap with osseous rib harvest, which is infrequently described in the literature, remains a viable option for bony reconstruction, particularly in the salvage setting. [ABSTRACT FROM AUTHOR]

Background: Non-invasive ventilation is an effective way for providing respiratory support for neonates with respiratory insufficiency. It has significantly decreased the need for endotracheal intubation. However, non-invasive ventilation has been associated with pressure injures. Aim: to assess nurses’ performance regarding non-invasive ventilation of neonates and its relation to associated pressure injuries. Design: descriptive correlational research design. Settings: this study was conducted at Neonatal Intensive Care Units of El-Menshawy General Hospital, Kafrelsheikh General Hospital and Kafrelsheikh University Hospital. Subjects: All pediatric nurses (110) who are working at the previously mentioned settings and all neonates (110) received non-invasive ventilation at the time of data collection were involved in the study. Tools of data collection: three tools were used, Tool (I) non-invasive ventilation and pressure injuries questionnaire, Tool (II) nurses' assessment of hyperemia and Tool (III) nurses' practice observational checklists. Results: the current study revealed that less than three- quarters of the nurses had low level of knowledge and none of them had high level of knowledge. Nurses’ practice regarding non-invasive ventilation and skin care was unsatisfactory. There was a highly statistically positive correlation between nurses' total knowledge and nurses’ total practice related to non-invasive ventilation and skin care. Conclusion: the studied nurses had poor level of knowledge and unsatisfactory practice regarding non-invasive ventilation and skin care. Recommendations: educational program and periodic work shops regarding non-invasive ventilation and neonatal skin care should be provided for nurses working at NICU. [ABSTRACT FROM AUTHOR]

Background Hypovolemic postural orthostatic tachycardia syndrome (POTS) is thought to be caused by dysregulated circulating blood volume. Management is mainly limited to symptom-targeted lifestyle changes. Radiofrequency venous ablation (RFA) represents a minimally invasive method of increasing circulating blood volume. The following case series describes a novel application of RFA to successfully target POTS symptoms in patients demonstrating venous insufficiency. The use of RFA in alleviating POTS symptoms has not previously been reported. Case summary We describe four patients with either a well-established historical POTS diagnosis or dysautonomia symptoms refractory to both medical management and lifestyle modifications. They all demonstrated venous reflux on lower extremity venous ultrasound testing. Upon vascular surgery referral, all underwent great and small saphenous vein RFA. They each subsequently reported subjective improvement in their dysautonomia symptoms and quality-of-life. Two with symptom recurrence years later were found to have new-onset pelvic venous congestion and are being evaluated for pelvic venous insufficiency interventions. Discussion Lower extremity venous pooling can exacerbate dysautonomia symptoms in POTS patients. Patients refractory to conventional treatment strategies should undergo venous insufficiency workup, and if positive, should be referred for venous pooling intervention evaluation. The success of RFA at treating refractory POTS symptoms in these four patients with lower extremity venous reflux, including no surgical intervention and no adverse effects, are compelling grounds to further explore this therapy and to quantify and standardize symptom improvement assessment in a larger patient population. Future directions include a demonstration of quality-of-life improvement in randomized clinical trials. [ABSTRACT FROM AUTHOR]

Background: There is increasing recognition of connective tissue disorders and their influence on disease in the general population. A conserved clinical phenotype involving connective tissue disorders and idiopathic intracranial hypertension (IIH) and associated cerebral venous outflow disorders (CVD) has not been previously described. Methods: A single-institution retrospective review of a prospectively maintained database of patients with connective tissue disorders and CVD was performed. Results: A total of 86 patients were identified. The majority of these patients carried a diagnosis of Ehlers-Danlos syndrome (55%) and most were non-obese (mean body mass index 29.7 kg/m2), Caucasian (90%) females (87%). Most prevalent presenting symptoms included pressure headache (98%), dizziness (90%), tinnitus (92%), and cognitive dysfunction (69%). Aside from CVD and IIH, the most common associated conditions were postural orthostatic tachycardia syndrome (POTS; 55.8%), cerebrospinal fluid (CSF) leaks (51.2%), dysautonomia (45.3%), cranio-cervical instability (37.2%), mast cell activation syndrome (25.6%), and tethered cord syndrome (23.3%). Allergies to medications (87.2%) and surgical tape (19.8%) were also frequent. Despite significantly lower opening pressures on lumbar puncture, headache severity and quality of life scores were reported with the same severity of classic IIH patients, suggesting an underlying hypersensitivity to intracranial pressures and cerebral venous congestion. Conclusion: There is a rare but conserved clinical phenotype that has not been described previously that presents with severe IIH symptoms in predominantly young, non-obese Caucasian women with a high associated incidence of dysautonomia, POTS, craniocervical instability, and CSF leaks, among others. [ABSTRACT FROM AUTHOR]

Right ventricular failure (RFV) is a potential complication following cardio-thoracic surgery, with an incidence ranging from 0.1% to 30%. The increase in pulmonary vascular resistance (PVR) is one of the main triggers of perioperative RVF. Inhaled pulmonary vasodilators (IPVs) can reduce PVR and improve right ventricular function with minimal systemic effects. This narrative review aims to assess the efficacy of inhaled nitric oxide and inhaled prostacyclins for the treatment of perioperative RVF. The literature, although statistically limited, supports the clinical similarity between them. However, it failed to demonstrate a clear benefit from the pre-emptive use of inhaled nitric oxide in patients undergoing left ventricular assist device implantation or early administration during heart-lung transplants. Additional concerns are related to cost safety and IPV use in pathologies associated with pulmonary venous congestion. The largest ongoing randomized controlled trial on adults (INSPIRE-FLO) is addressing whether inhaled Epoprostenol and inhaled nitric oxide are similar in preventing RVF after heart transplants and left ventricular assist device placement, and whether they are similar in preventing primary graft dysfunction after lung transplants. The preliminary analysis supports their equivalence. Several key points may be achieved by the present narrative review. When RVF occurs in the setting of elevated PVR, IPV should be the preferred initial treatment and they should be preventively used in patients at high risk of postoperative RVF. If severe refractory postoperative RVF occurs, IPVs should be combined with complementary pharmacology (inotropes and inodilators). If unsuccessful, right ventricular mechanical support should be established. [ABSTRACT FROM AUTHOR]

Background: Eagle jugular syndrome (EJS), recently identified as a cause of cerebrovascular disease (CVD) due to venous obstruction by an elongated styloid process (SP), is reported here alongside a case of concurrent de novo cerebral cavernous malformation (CCM). This study aims to explore the potential causal relationship between EJS and de novo CCM through a comprehensive literature review. Method: Systematic literature reviews, spanning from 1995 to 2023, focused on EJS cases with definitive signs and symptoms and de novo CCM cases with detailed clinical characteristics. Data on the pathophysiology and clinical manifestations of EJS, as well as potential risk factors preceding de novo CCM, were collected to assess the relationship between the two conditions. Result: Among 14 patients from 11 articles on EJS, the most common presentation was increased intracranial hypertension (IIH), observed in 10 patients (71.4%), followed by dural sinus thrombosis in four patients (28.6%). In contrast, 30 patients from 28 articles were identified with de novo CCM, involving 37 lesions. In these cases, 13 patients developed CCM subsequent to developmental venous anomalies (43%), seven following dural arteriovenous fistula (dAVF) (23%), and two after sinus thrombosis (6%). In a specific case of de novo brainstem CCM, the development of an enlarged condylar emissary vein, indicative of venous congestion due to IJV compression by the elongated SP, was noted before the emergence of CCM. Conclusion: This study underscores that venous congestion, a primary result of symptomatic EJS, might lead to the development of de novo CCM. Thus, EJS could potentially be an indicator of CCM development. Further epidemiological and pathophysiological investigations focusing on venous circulation are necessary to clarify the causal relationship between EJS and CCM. [ABSTRACT FROM AUTHOR]

Background: Homoeopathic medicines have the potential to treat patients suffering from cancers, Diabetic Retinopathy, and hemorrhagic disorders wherein anti-angiogenesis plays a vital role. Homoeopathic medicines have been used to treat hemorrhagic disorders. For example, Hamamelis is used in hemorrhages, varicose veins and venous congestion. Thalaspi bursa is used in the flabby conditions of uterus, hemorrhagic conditions of uterine fibroid. This being said, action of homoeopathic medicines remains unknown. Therefore, this study was intended to establish the angiogenic/anti-angiogenic effect of the selected homoeopathic medicines employing chick embryo model. Objective: To test toxicity and study the antiangiogenic properties of selected homoeopathic medicines employing YSM assay in the chick embryo model. Materials and Method: Yolk Sac Membrane is widely utilized as an in vivo system to study angiogenesis and anti-angiogenesis. The images for all YSMs were captured and analyzed for angiogenic/anti-angiogenic effect. Results: Significant antiangiogenic effects were observed at 10% concentrations of Hamamelis 200cH, Thalaspi bursa 200cH and Thalaspi bursa 1M. The reduction in vessel density and total vascular network length, total branching points, total networks and total segment symbolizes that these drugs have antiangiogenic potential and therefore may assist in the treatment of menstrual disorders, which are followed by cramps and discharge of clots. Conclusion: The action of selected homoeopathic medicines as anti-angiogenic agents is proven and can be used to combat various diseases like hemorrhages, varicose veins, in venous congestion, and problems related to hemorrhagic disorders. This will further help to study the action of these Homoeopathic medicines as a potential line of treatment in patient suffering from cancers, Diabetic Retinopathy, and hemorrhagic disorders wherein anti-angiogenesis plays a vital role. [ABSTRACT FROM AUTHOR]

Purpose: To explore the clinical features of COVID-19-associated conjunctivitis with the objective of preventing the spread of infection. Study design: Retrospective cohort study. Methods: From March 2020 to March 2021, we retrospectively reviewed 26 (9.8%) consecutive COVID-19 patients with conjunctivitis among 282 COVID-19 cases admitted to our hospital. Clinical symptoms, onset date of conjunctivitis, time to patient recovery, and eye drop intervention were investigated. In addition, risk factors for developing conjunctivitis were statistically examined among 206 inpatients available for within 5 days of the onset. A multivariate analysis of conjunctivitis risk factors was performed. Results: Among the 282 COVID-19 patients, 4 (1.4%) had conjunctival hyperemia as the primary symptom. The median time of onset was 4 days after the COVID-19 onset. Hyperemia was observed in all cases, but other ocular symptoms were rare. The median duration of hyperemia was 3 days. A multiple logistic regression analysis revealed that a young age (p=0.005) and current smoking habit (p=0.027) were independent risk factors for conjunctivitis after COVID-19. Conclusions: COVID-19-associated conjunctivitis is rare in the elderly and strongly associated with a history of smoking. It often occurs in the early stages of infection, and while hyperemia is recognized as a clinical symptom, other ocular symptoms are rare or non-existent. Many cases recover within a short time. [ABSTRACT FROM AUTHOR]

Background and Purpose: Choroid plexus (ChP) hyperemia has been observed in patients with intracranial vasculopathy and to reduce following successful surgical revascularization. This observation may be attributable to impaired vascular reserve of the ChP or other factors, such as the ChP responding to circulating markers of stress. We extend this work to test the hypothesis that vascular reserve of the ChP is unrelated to intracranial vasculopathy. Methods: We performed hypercapnic reactivity (blood oxygenation level‐dependent; echo time = 35 ms; spatial resolution = 3.5 × 3.5 × 3.5 mm, repetition time = 2000 ms) and catheter angiography assessments of ChP reserve capacity and vascular patency in moyamoya patients (n = 53) with and without prior surgical revascularization. Time regression analyses quantified maximum cerebrovascular reactivity and reactivity delay time in ChP and cortical flow territories of major intracranial vessels with steno‐occlusion graded as <70%, 70%‐99%, and occlusion using Warfarin‐Aspirin‐Symptomatic‐Intracranial‐Disease stenosis grading criteria. Analysis of variance (significance: two‐sided Bonferroni‐corrected p <.05) was applied to evaluate cortical and ChP reactivity, after accounting for end‐tidal carbon dioxide change, for differing vasculopathy categories. Results: In patients without prior revascularization, arterial vasculopathy was associated with reduced cortical reactivity and lengthened reactivity delay (p ≤.01), as expected. Regardless of surgical history, the ChP reactivity metrics were not significantly related to the degree of proximal stenosis, consistent with ChP reactivity being largely preserved in this population. Conclusions: Findings are consistent with ChP reactivity in moyamoya not being dependent on observed vasculopathy. Future work may investigate the extent to which ChP hyperemia in chronic ischemia reflects circulating markers of glial or ischemic stress. [ABSTRACT FROM AUTHOR]

Background Postoperative intracranial hypotension-associated venous congestion (PIHV) is a rare event. The authors report the case of a patient presenting with PIHV after spinal surgery following the sudden loss of cerebrospinal fluid (CSF) induced by suction drainage. Methods A 69-year-old patient underwent uneventful revision surgery for wound dehiscence after lumbar surgery with placement of a subfascial suction drain. Results Postoperatively, the patient presented with fluctuating consciousness and a generalized tonic–clonic seizure. Computed tomography (CT) and serial magnetic resonance imaging (MRI) were performed showing convexity subarachnoid hemorrhages (SAHs), diffuse swelling of the brain and thalami and striatum bilaterally without diffusion restriction, and signs of intracranial hypertension resulting in pseudohypoxic brain swelling in PIHV. A dural leak at L3–L4 was treated with several CT-guided patches combining autologous blood and fibrin glue injections. The patient recovered without neurologic deficit and follow-up MRI revealed progressive complete reversal of brain swelling, and re-expansion of CSF spaces. Conclusion PIHV is a rare but potentially fatal entity. Awareness of PIHV after cranial or spinal surgery leads to early treatment of CSF hypovolemia and possibly better clinical outcome. Following acute CSF volume loss, an acute elevation of cerebral blood volume overcoming autoregulatory mechanisms seems a likely explanation for diffuse cerebral vasogenic edema and SAH in PIHV. [ABSTRACT FROM AUTHOR]

Introduction: Left renal vein compression (nutcracker physiology) with secondary spinal epidural venous congestion is a newly recognized cause of daily persistent headache. Presently, only women with underlying symptomatic hypermobility issues appear to develop headache from this anatomic issue. The hypothesized etiology is an abnormal reset of the patient's cerebrospinal fluid (CSF) pressure to an elevated state. Headaches that occur during sleep can have a varied differential diagnosis, one of which is elevated CSF pressure. We present the case of an older woman who began to develop severe wake-up headaches at midnight. She was found to have left renal vein compression and spinal epidural venous congestion on imaging. After treatment with lumbar vein coil embolization, which alleviated the spinal cord venous congestion, her headaches alleviated. Case Report: A 61-year-old woman with a history of hypermobile Ehlers-Danlos syndrome began to be awakened with severe head pain at midnight at least several times per week. The headache was a holocranial, pressure sensation, which worsened in the supine position. The headaches were mostly eliminated with acetazolamide. Because of her hypermobility issues and pressure-like headache, she was investigated for underlying nutcracker physiology and spinal epidural venous congestion. This was confirmed using magnetic resonance (MR) angiography and conventional venography, and after lumbar vein coil embolization her wake-up headaches ceased. Conclusion: The case report suggests a possible new underlying and treatable cause for early morning, wake-up headaches: nutcracker physiology with secondary spinal epidural venous congestion. The case expands on the clinical headache presentation of nutcracker physiology. [ABSTRACT FROM AUTHOR]

Introduction: An innovative eye drops formulation containing 0.2% hyaluronic acid and a low concentration of hydrocortisone (0.001%; hereafter HALH) has been recently placed on the market (Idroflog®, Alfa Intes, Italy) to manage the dysregulated parainflammation in patients with dry eye disease (DED). In the present paper, the effectiveness of HALH on the signs and symptoms of DED was retrospectively evaluated and compared with that one obtained using standard tear substitutes (STS) by means of low- and high-tech (Keratograph®) assessments. Methods: This was a multicenter retrospective study carried out between February and April 2023, involving adult patients with DED diagnosis owing to post-cataract surgery, meibomian gland dysfunction, allergy, or glaucoma medications. The primary aim was to compare the changes induced by different therapies on Keratograph® parameters (noninvasive Keratograph tear breakup time [NIKBUT], tear meniscus height [TMH], eyelid meibography, conjunctival hyperemia, and conjunctivochalasis) or collected by traditional low-tech measures (tear breakup time [TBUT], Schirmer test, Efron score, and epithelial alterations) and the Ocular Surface Disease Index score. Results: Data from 155 patients were analyzed. The effectiveness of HALH and STS was reported by both high- and low-tech measures. NIKBUT-first showed a significant improvement in the HALH group versus the STS one at 15 days (6.4 ± 3.6 vs 5.4 ± 3.7 s, p = 0.02), whereas this difference was latent with low-tech TBUT until 45 days (6.8 ± 2.6 vs 5.6 ± 2.3 s, p = 0.03). Patients with DED occurring after cataract surgery reported an enhanced activity of HALH versus STS, particularly for NIKBUT-first, TMH, Schirmer test, and hyperemia stage. Conclusion: These findings highlighted the effectiveness of HALH in all DED subtypes, especially in patients with post-cataract surgery, as well as its superiority versus STS in terms of tear film stability improvement. We recommend longer observation (i.e., 3–6 months) to fully ascertain whether the early improvement detected by high-tech measures will be confirmed in subsequent time points even using low-tech tests. [ABSTRACT FROM AUTHOR]

BACKGROUND: Coronary microvascular dysfunction (CMD) is involved in heart failure (HF) onset and progression, independently of HF phenotype and obstructive coronary artery disease. Invasive assessment of CMD might provide insights into phenotyping and prognosis of patients with HF. We aimed to assess absolute coronary flow, absolute microvascular resistance, myocardial perfusion, coronary flow reserve, and microvascular resistance reserve in patients with HF with preserved ejection fraction and HF with reduced ejection fraction (HFrEF). METHODS: Single-center, prospective study of 56 consecutive patients with de novo HF with nonobstructive coronary artery disease divided into HF with preserved ejection fraction (n=21) and HFrEF (n=35). CMD was invasively assessed by continuous intracoronary thermodilution and defined as coronary flow reserve <2.5. Left ventricular and left anterior descending artery--related myocardial mass was quantified by echocardiography and coronary computed tomography angiography. Myocardial perfusion (mL/min per g) was calculated as the ratio between absolute coronary flow and left anterior descending artery--related mass. RESULTS: Patients with HFrEF showed a higher left ventricular and left anterior descending artery--related myocardial mass compared with HF with preserved ejection fraction (P<0.010). Overall, 52% of the study population had CMD, with a similar prevalence between the 2 groups. In HFrEF, CMD was characterized by lower absolute microvascular resistance and higher absolute coronary flow at rest (functional CMD; P=0.002). CMD was an independent predictor of a lower rate of left ventricular reverse remodeling at follow-up. In patients with HF with preserved ejection fraction, CMD was mainly due to higher absolute microvascular resistance and lower absolute coronary flow during hyperemia (structural CMD; P≤0.030). CONCLUSIONS: Continuous intracoronary thermodilution allows the definition and characterization of patterns with distinct CMD in patients with HF and could identify patients with HFrEF with a higher rate of left ventricular reverse remodeling at follow-up. [ABSTRACT FROM AUTHOR]

Autogenous Bone Graft is considered the safest material due to the compatibility of the material with the patient's body. A non-vascularized bone graft can apply growth factors such as Plateletrich-plasma (PRP) to catalyze bone healing. In Indonesia, no research currently analyzes PRP's application to autogenous bone grafts in jaw bone in vivo. To analyze the clinical effect of Platelet Rich Plasma (PRP) application in non-vascularized autogenous bone graft in the mandible of Ovis aries sheep as a human model. A total of 24 Ovis aries sheep were classified as PRP and non-PRP groups. A defect on the sheep's mandible measuring 2 cm x 1.5 cm x 2cm was made, and the cut segment was then used as a scaffold. The cut segment was then refined into a mill using pestle and mortar and mixed with Platelet Rich Plasma (PRP). The analyzed variables were signs of infection before and after surgery and signs of inflammation such as wound temperature, hyperemia, and edema. Based on the results of statistical tests, there was no statistically significant difference in temperature, edema, and hyperemia between the PRP and non-PRP groups. Conclusion: PRP applied to mandibular defects does not affect the bone healing mechanism clinically. [ABSTRACT FROM AUTHOR]

Acute heat exposure increases skeletal muscle blood flow in humans. However, the mechanisms mediating this hyperemic response remain unknown. The cyclooxygenase pathway is active in skeletal muscle, is heat sensitive, and contributes to cutaneous thermal hyperemia in young healthy humans. Therefore, the purpose of this study was to test the hypothesis that cyclooxygenase inhibition would attenuate blood flow in the vastus lateralis muscle during localized heating. Twelve participants (6 women) were studied on two separate occasions: 1) time control (i.e., no ibuprofen); and 2) ingestion of 800 mg ibuprofen, a nonselective cyclooxygenase inhibitor. Experiments were randomized, counter-balanced, and separated by at least 10 days. Pulsed short-wave diathermy was used to induce unilateral deep heating of the vastus lateralis for 90 min, whereas the contralateral leg served as a thermoneutral control. Microdialysis was utilized to bypass the cutaneous circulation and directly measure local blood flow in the vastus lateralis muscle of each leg via the ethanol washout technique. Heat exposure increased muscle temperature and local blood flow (both P < 0.01 vs. baseline). However, the thermal hyperemic response did not differ between control and ibuprofen conditions (P > 0.2). Muscle temperature slightly decreased for the thermoneutral leg (P < 0.01 vs. baseline), yet local blood flow remained relatively unchanged across time for control and ibuprofen conditions (both P > 0.7). Taken together, our data suggest that inhibition of cyclooxygenase-derived vasodilator prostanoids does not blunt thermal hyperemia in skeletal muscle of young healthy humans. [ABSTRACT FROM AUTHOR]

The appearance of sclerotic bone lesions in contrast-enhanced computed tomography (CT) scans is often a significant concern for the possible presence of metastatic disease, especially in individuals with a known history of cancer. Prior research has demonstrated that in cases where patients suffer from thrombosis in major veins like the superior vena cava or the brachiocephalic vein, vertebral venous congestion can create imaging patterns on CT scans that resemble sclerotic bone metastases. However, instances of such imaging findings in patients without any form of venous obstruction are not commonly reported. In this study, we present cases of pseudopathologic vertebral enhancement observed consistently following left-side contrast injections in cancer patients devoid of venous obstruction. We aim to discuss and propose a potential mechanism for this phenomenon, drawing attention to a less commonly recognized diagnostic consideration in oncological imaging. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension (PH) is a common disease affecting up to 1% of the population and at least 50% of patients diagnosed with heart failure (HF) (Hoeper et al. in Lancet Respir Med 4(4):306–322, 2016). It is estimated that PH is present in 15% to 60% of patients with valvular heart disease (VHD) which can result from an increase in pulmonary blood flow and subsequently in pulmonary venous congestion and pulmonary vascular resistance (PVR). It is important to identify the severity of PH in patients with VHD to appropriately risk stratify and manage these patients (Magne et al. in JACC Cardiovasc Imaging 8(1):83–99, 2015). In this review, we examine the diagnostic criteria for PH and its pathophysiology. We also focus on the growing evidence supporting the presence of PH secondary to VHD and describe the contemporary surgical and medical therapeutic interventions in this patient population (Fig. 1). [ABSTRACT FROM AUTHOR]

Objective: Pine resin is a product obtained from plants belonging to the Pinaceae family and traditionally used in the treatment of wounds. The aim of this study is to determine the effectiveness of pine resin in corneal wounds. Material-Methods: In this study, three groups of 7 male Wistar Albino rats (n=7), each 2 months old, were established. To create the corneal wound model, the rats were anesthetized and the borders of the wound to be created on the corneal surface were determined using a 3 mm punch biopsy, then the first two layers of the cornea were removed with a corneal knife. Then, the first group was considered as the control group and no treatment was performed. The second group was determined as the pine resin group and applied once a day. The third group was considered as the drug group and was administered once a day. Fluorescein staining was performed every day for three days and the results were recorded. Results: Pine resin group showed the fastest recovery. On the third day, the rats were euthanized, and their eyes were enucleated. The collected eyes were sent for histopathologic examination and stained with hematoxylin-eosin. The lesions in the examined specimens were evaluated under microscope for hyperemia, vascularization, cellular infiltration and corneal edema. Conclusion: As a result of the study, ulceration was observed in the pine resin group. The study concluded that pine resin reduces clinical symptoms and promotes healing in corneal wounds. [ABSTRACT FROM AUTHOR]

Background: Tracheoesophageal fistula (TEF) repair in Paediatric Surgery is a critical intervention, often requiring careful consideration of anatomical structures. The azygous vein, situated near the oesophagus and trachea, is a structure of interest in this context. This abstract explores the importance of preserving or not preserving the azygous vein during TEF repair and its potential impact on surgical outcomes. Methodology: A comprehensive review of paediatric surgical cases involving TEF repair was conducted, focusing on the role of the azygous vein. Data from a diverse sample size of paediatric patients, ranging from infants to adolescents, were analysed. Surgical techniques, patient demographics, and postoperative outcomes were assessed to determine the effects of azygous vein preservation or nonpreservation on TEF repair success. Results: Our analysis revealed that azygous vein preservation during TEF repair was associated with a significantly higher rate of surgical success (40%) compared to cases where the azygous vein was not preserved (32%). Furthermore, the preservation group had a lower rate of surgical failure (10%) in contrast to the non-preservation group (18%). These findings are in line with previous studies and were highly statistically significant, as indicated by the odds ratio (OR) of 2.00 with a 95% confidence interval (CI) of 1.32 to 3.02 and a P-value of < 0.001. While the decision to preserve the azygous vein led to slightly longer operative times and potential risk decreases the venous congestion not causing congestion. These factors did not outweigh the advantages of preservation, as evidenced by the superior surgical outcomes. The sample size comprised fifty (50) paediatric patients, with 50% undergoing azygous vein preservation and 50% without preservation. Conclusion: The decision to preserve or not preserve the azygous vein during TEF repair in paediatric surgery should be made on a case-by-case basis, considering the patient's unique anatomy and the surgeon's expertise. Our findings suggest that both approaches can yield successful outcomes, but careful patient selection and surgical planning are essential to optimize results. Future research should focus on developing clear guidelines to aid surgeons in making this critical decision. [ABSTRACT FROM AUTHOR]

OBJECTIVE Soft tissue defects of the distal lower extremity and foot present major challenges in reconstruction. In elderly patients with co morbidities, the reverse sural artery flap is a versatile tool in reconstruction of lower extremity and foot defect as they are poor candidates of free microsurgical flap. This study was conducted to assess the versatility of the flap to cover defects in varying sites of the distal leg and foot and also its efficacy to serve as an alternative option for free microsurgical flap in the elderly patients (>60yrs). MATERIALS AND METHODS All patients above 50 years of age who presented with lower extremity and foot defects underwent Reversal Sural Artery flap from January 2021 to January 2022 were included in this study. 19 patients were included in this study. The etiology of the defects were trauma, electrical burns injury and infection. The flaps were raised as pedicled, islanded and adipofascial flaps. Donor site was covered using split skin grafting in all cases. The patients were followed up for a minimum of 6 months. RESULTS The mean age of the patients were 62.5 years. 15 male and 4 female patients were included. Size of the defects were minimum of 4x3 cm and maximum of 10x5 cm. 10 patients had diabetes mellitus and 5 patients had hypertension and 3 patients had both diabetes and hypertension and 1 patient had associated head injury. 4 patients had pre-operative flap delay followed by flap inset 7 days later. Pedicled RSA flap was done in 15 patients, adipofascial flap cover was done in 2 patients and islanded flap cover was done in 2 patients. Venous congestion present in most of the cases in early postoperative period. Flap settled uneventfully in 17 patients. 2 patients had distal flap necrosis for about 2 cm which was managed by debridement and advancement after which flaps settled well. All donor sites graft settled well. CONCLUSION The reverse sural artery flap is a reliable alternative for free microsurgical flap cover for reconstruction of lower extremity and foot defects in elderly patients who are poor candidates for free microsurgical flap cover, with less operative time, easy learning curve, fewer complications and high success rates. [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]

Background: A distally based sural flap is a workhorse flap used to reconstruct the distal lower leg and foot. It developed a bad reputation due to venous congestion, leading to flap failure. Herein, we present a new modification in the form of proximal catheterization and distal ligation of the short saphenous vein to relieve flap congestion. Methods: Twenty patients underwent reconstruction with distally based sural artery flaps for defects around the ankle, distal leg, and foot from June 2019 to March 2021. Distal ligation with proximal catheterization of the short saphenous vein was performed to reduce the risk of venous congestion. Results: Early flap congestion was observed in five flaps (25%). The venous congestion was relieved by draining congested blood through the catheter. The total amount of blood removed was around 80–100 mL in the first 2 days postoperatively. The flaps healed uneventfully as two flaps with distal 2-cm necrosis healed with dressing. Conclusions: Distal ligation of the short saphenous vein may prevent venous overloading from the foot and reduce sural flap venous congestion. Proximal catheterization of the vein to relieve flap congestion is an effective flap safety tool. Level of evidence: Level V, Risk/Prognostic. [ABSTRACT FROM AUTHOR]

Background: Restoration of form and function of the oral cavity post resection for oral cavity malignancies is an enormous challenge in head and neck reconstructive surgery. The facial artery musculo-mucosal (FAMM) flap is an unexplored, underutilized yet an extremely versatile option for such defects. In this analysis we review the performance of the FAMM flap used to reconstruct tongue/floor of mouth (FOM) defects following tumor resection. Materials and Methods: In this retrospective analysis, demographic and disease profiles of 15 patients with Tongue and Floor of Mouth carcinomas reconstructed with a FAMM flap between January 2019 to January 2021 were studied. Complications and functional outcomes were analyzed. Results: Fifteen patients (10 men, 5 women) were reconstructed using a FAMM flap. Mean age of the study sample was 46.46 years (28–60 years). One flap was lost due to complete flap necrosis following venous congestion, two other flaps suffered distal tip necrosis. Three patients developed an Oro-cutaneous fistula, with one going on to develop a surgical site infection of the neck wound. Patients reconstructed for FOM defects had an excellent functional outcome. For patients reconstructed for a tongue defect, 33.33% of patients complained of restricted tongue mobility and 44.44% were dissatisfied with the quality of speech post operatively. Conclusion: The versatile FAMM flap is a reliable, easy to harvest and scarless flap. It provides excellent cosmetic and functional results FAMM flap allowing early resumption of normal daily activities making it an ideal option to reconstruct small to medium sized oral cavity defects. [ABSTRACT FROM AUTHOR]

Right heart failure is a major challenge in clinical practice. Soluble Suppression of Tumorigenicity-2 (sST2), a member of the interleukin-1-receptor family, may have clinical prognostic value. The aim of this study was to analyze whether sST2 correlates with signs of acute right heart decompensation. This prospective single-center study included 50 patients admitted for clinical signs of predominant right heart decompensation. Signs of reduced blood supply to other organs (e.g., renal function parameter, troponin T, NT-proBNP), diuretics, and signs of venous congestion (inferior vena cava (IVC) diameter) with fluid retention (weight gain, peripheral edema) resulting from reduced RV function were analyzed. The degree of peripheral edema was defined as none, mild (5–6 mm depressible, regression in 15–60 s) or severe (>7 mm depressible, regression in 2–3 min). sST2 levels were measured at the day of hospitalization. A total of 78.7% showed severe peripheral edema. The median concentration of sST2 was 35.2 ng/mL (25.–75. percentiles 17.2–46.7). sST2 is correlated with the peripheral edema degree (rSpearman = 0.427, p = 0.004) and the diameter of IVC (r = 0.786, p = 0.036), while NT-proBNP (r = 0.114, p = 0.456), troponin T (r = 0.123, p = 0.430), creatinine-based eGFR (r = −0.207, p = 0.195), or cystatin C-based eGFR (r = −0.032, p = 0.839) did not. sST2, but no other established marker, is correlated with peripheral and central fluid status in patients with decompensated right heart failure. [ABSTRACT FROM AUTHOR]

Allogeneic hematopoietic stem cell transplant (HSCT) and gene therapy (GT) are two potentially curative approaches for sickle cell disease (SCD), but they have never been compared in clinical trials. To compare the safety and efficacy of HSCT and GT to assist clinicians and patients in making informed treatment decisions. Phase I-III clinical trials and case reports/series were included. Regimens included HSCT from all stem cell sources, lentiviral gene therapy, and gene editing, with any conditioning regimen. We searched Medline and EMBASE databases as of 1st June 2020 for studies reporting HSCT and GT outcomes in SCD. The Newcastle-Ottawa scale was used to assess the risk of bias. Descriptive statistics and post-hoc imputation for standard deviations of mean change in FEV1 and FVC were performed. In total, 56 studies (HSCT, n = 53; GT, n = 3) representing 1,198 patients met inclusion criteria (HSCT, n = 1,158; GT, n = 40). Length of follow-up was 3,881.5 and 58.7 patient-years for HSCT and GT, respectively. Overall quality of evidence was low, with no randomized controlled trials identified. Two-year overall survival for HSCT was 91%; mortality was 2.5% for GT. Acute chest syndrome and vaso-occlusive episodes were reduced post-HSCT and GT. Meta-analysis was not possible due to lack of comparator and heterogeneity in outcome measures reporting. Very few studies reported post-transplant end-organ function. Six secondary malignancies (5 post-HSCT, 1 post-GT) were reported. Reporting of SCD-related complications and patient-important outcomes is lacking for both strategies. We advocate for standardized reporting to better compare outcomes within and between treatment groups. [ABSTRACT FROM AUTHOR]

BACKGROUND. Patients with rhinosinusitis account for about 30% of the total amount of otolaryngologic patients and their number is constantly growing. Currently, there is no ideal treatment for acute and especially chronic rhinosinusitis and various therapeutic approaches are still under debate. OBJECTIVES. To evaluate the effectiveness and the safety of Cinnabsin® in acute and exacerbated chronic rhinosinusitis treatment. MATERIAL AND METHODS. We included in our non-interventional, multicenter, prospective study 200 patients with acute and exacerbated chronic rhinosinusitis in order to evaluate the effectiveness and the safety of treatment with Cinnabsin® (while 20 out of 200 patients received additional therapy, only patients who did not receive additional therapy were taken into account in the statistical analysis; 180 patients have been treated with Cinnabsin® only and this is the basis of the statistical assessments performed). Changes in the total score of the typical symptoms of rhinosinusitis were assessed, and changes in edema, hyperemia and secretion were assessed by rhinoscopy. RESULTS. The total score of the typical symptoms of rhinosinusitis showed a statistically significant difference between the first and final visits – v4 vs. v1 according to Pearson Chi-square (p = 0.0000) as well as in accordance with Risk Difference (RD), Relative Risk (RR), Odds Ratio (OR) ratios at the beginning and end of the treatment. The healthy status of the patients (major improvement, improvement, no complaints) was rated as 93.9% at the final visit. The efficacy of treatment (major improvement, improvement, no complaints) was rated as 93.9% at the final visit. Treatment tolerance was rated as very good in almost all patients (99.4%). CONCLUSION. Cinnabsin® could be considered efficient in reducing the symptoms of acute rhinosinusitis, shows a very good safety profile, and could be recommended for outpatient treatment of patients with acute or exacerbated chronic rhinosinusitis, no matter the additional therapy. [ABSTRACT FROM AUTHOR]

Objective: Dynamic BOLD MRI with cuff compression, inducing ischemia and post-occlusive hyperemia in skeletal muscle, has been pointed out as a potential diagnostic tool to assess peripheral limb perfusion. The objective was to explore the robustness of this technique and its sensitivity to the occlusion duration. Materials and methods: BOLD images were acquired at 3 T in 14 healthy volunteers. T 2 ∗ -imaging with 5- and 1.5-min occlusions were acquired and several semi-quantitative BOLD parameters were derived from ROI-based T 2 ∗ -time curves. Differences in parameters from the two different occlusion durations were evaluated in the gastrocnemius and soleus muscles using non-parametrical tests. Intra- and inter-scan repeatability were evaluated with coefficient of variation. Results: Longer occlusion duration resulted in an increased hyperemic signal effect yielding significantly different values (p < 0.05) in gastrocnemius for all parameters describing the hyperemic response, and in soleus for two of these parameters. Specifically, 5-min occlusion yielded steeper hyperemic upslope in gastrocnemius (41.0%; p < 0.05) and soleus (59.7%; p = 0.03), shorter time to half peak in gastrocnemius (46.9%; p = 0.00008) and soleus (33.5%; p = 0.0003), and shorter time to peak in gastrocnemius (13.5%; p = 0.02). Coefficients of variation were lower than percentage differences that were found significant. Discussion: Findings show that the occlusion duration indeed influences the hyperemic response and thus should play a part in future methodological developments. [ABSTRACT FROM AUTHOR]

Erythromelalgia (EM) is a rare disease, which is still poorly characterized. In the present paper, we compared the hand perfusion of one female EM patient, under challenges, with a healthy control group. Using a laser Doppler flowmeter (LDF) with an integrated thermal probe, measurements were taken in both hands at rest (Phase I) and after two separate challenges—post-occlusive hyperemia (PORH) in one arm (A) and reduction of skin temperature (cooling) with ice in one hand (B) (Phase II). The final measurement periods corresponded to recovery (Phases III and IV). The control group involved ten healthy women (27.3 ± 7.9 years old). A second set of measurements was taken in the EM patient one month after beginning a new therapeutic approach with beta-blockers (6.25 mg carvedilol twice daily). Z-scores of the patient's LDF and temperature fluctuations compared to the control group were assessed using the Wavelet transform (WT) analysis. Here, fluctuations with |Z| > 1.96 were considered significantly different from healthy values, whereas positive or negative Z values indicated higher or lower deviations from the control mean values. Cooling elicited more measurable changes in LDF and temperature fluctuations, especially in higher frequency components (cardiac, respiratory, and myogenic), whereas PORH notably evoked changes in lower frequency components (myogenic, autonomic, and endothelial). No significant Z-score deviations were observed in the second measurement, which might signify a stabilization of the patient's distal perfusion following the new therapeutic approach. This analysis involving one EM patient, while clearly exploratory, has shown significant deviations in WT-derived physiological components' values in comparison with the healthy group, confirming the interest in using cold temperature as a challenger. The apparent agreement achieved with the clinical evaluation opens the possibility of expanding this approach to other patients and pathologies in vascular medicine. [ABSTRACT FROM AUTHOR]

Background. Resistance exercise is a method designed to increase muscle strength and endurance, leading to beneficial physiological changes in various tissues. The aim of this study is to investigate the pathological and structural effects of short-term and long-term resistance training on various tissues of male rats, including cardiac striatum, quadriceps, liver, kidney, and lung tissue. Methods. Forty male Wistar rats were randomly divided into four groups: one-month control, four-month control, one-month exercise, and four-month exercise. After the exercise period, the animals were anesthetized and dissected to separate various tissues, which were then treated with formalin and prepared for analysis. Results. The study findings showed that liver tissue did not show significant histopathological changes in response to exercise. However, in the heart tissue, mild hyperemia and hypertrophy of muscle cells were observed in the exercise groups compared to the control groups. In the quadriceps muscle, hypertrophy was observed to a lesser extent in the one-month exercise group and to a greater extent in the four-month exercise group. There was a significant difference in the diameter of the muscle cells of the quadriceps muscle between the one-month and four-month exercise groups, indicating the beneficial effects of long-term exercise. Additionally, an increase in the size of the epithelial tissue of the urinary tubes was observed in both exercise groups, which indicates an increase in kidney function due to exercise. Conclusion. Overall, the results of this study show that resistance exercise can lead to beneficial physiological changes in various tissues, especially with long-term exercise. Understanding these changes can increase our knowledge about the benefits of exercise. Practical Implications. Resistance exercises, through actions such as hyperemia, hypertrophy of muscle cells, and hypertrophy of the epithelial tissue of urinary tubes, improve the efficiency of the heart, kidneys and muscles during sports exercises, especially with long-term exercise. [ABSTRACT FROM AUTHOR]

The new strategy for vaccine development such as the fused protein multi-epitope capable of preventing the reactivation of latent tuberculosis infection (LTBi) can be an effective strategy for controlling tuberculosis (TB) worldwide. This study was conducted to evaluate the immunity of experimentally infected BALB/c mice with Mycobacterium tuberculosis after injection of DNA construct. Nineteen female BALB/c mice were divided into three groups and injected with 0.50 mL of M. tuberculosis. After 3 weeks, lung and spleen samples from the infected mice were examined. The protective effects of light chain 3-fused protein multi-epitope against TB were evaluated for post-exposure and therapeutic exposure. The lungs and spleens of the mice were aseptically removed after death for histopathology analysis. The bacterial colonies were counted, and the cells were stained after 3 weeks of incubation. No significant differences were observed between the post-exposure and therapeutic exposure groups. The pathological changes in the lung tissue of mice in these groups included an increase in the thickness of interalveolar septa, hyperemia, and intraparenchymal pulmonary hemorrhage centers (positive control), scattered hyperemic areas (negative control), and hyperemia in the interstitial tissue, scattered hyperemic areas in the lung parenchyma and lymphocytic infiltration centers (experimental group). Flow cytometry of the post-exposure and therapeutic exposure models showed insignificant changes in all three groups. It seems necessary to develop a post-exposure and therapeutic exposure vaccine strategy that focuses on LTBi to prevent the progression of the active disease. In this regard, multi-epitope vaccines should be designed to induce both cellular and humoral immunity. [ABSTRACT FROM AUTHOR]

The presence of global synchronization of vasomotion induced by oscillating visual stimuli was identified in the mouse brain. Endogenous autofluorescence was used and the vessel ‘shadow’ was quantified to evaluate the magnitude of the frequency-locked vasomotion. This method allows vasomotion to be easily quantified in non-transgenic wild-type mice using either the wide-field macro-zoom microscopy or the deep-brain fiber photometry methods. Vertical stripes horizontally oscillating at a low temporal frequency (0.25 Hz) were presented to the awake mouse, and oscillatory vasomotion locked to the temporal frequency of the visual stimulation was induced not only in the primary visual cortex but across a wide surface area of the cortex and the cerebellum. The visually induced vasomotion adapted to a wide range of stimulation parameters. Repeated trials of the visual stimulus presentations resulted in the plastic entrainment of vasomotion. Horizontally oscillating visual stimulus is known to induce horizontal optokinetic response (HOKR). The amplitude of the eye movement is known to increase with repeated training sessions, and the flocculus region of the cerebellum is known to be essential for this learning to occur. Here, we show a strong correlation between the average HOKR performance gain and the vasomotion entrainment magnitude in the cerebellar flocculus. Therefore, the plasticity of vasomotion and neuronal circuits appeared to occur in parallel. Efficient energy delivery by the entrained vasomotion may contribute to meeting the energy demand for increased coordinated neuronal activity and the subsequent neuronal circuit reorganization.

Fractional flow reserve (FFR) determines the functional significance of epicardial stenoses assuming negligible venous pressure (Pv) and microvascular resistance. However, these assumptions may be invalid in end-stage liver disease (ESLD) because of fluctuating Pv and vasodilation. Accordingly, all patients with ESLD who underwent right-sided cardiac catheterization and coronary angiography with FFR as part of their orthotopic liver transplantation evaluation between 2013 and 2018 were included in the present study. Resting mean distal coronary pressure (Pd)/mean aortic pressure (Pa), FFR, and Pv were measured. FFR accounting for Pv (FFR - Pv) was defined as (Pd - Pv)/(Pa - Pv). The hyperemic effect of adenosine was defined as resting Pd/Pa - FFR. The primary outcome was all-cause mortality at 1 year. In 42 patients with ESLD, 49 stenoses were interrogated by FFR (90% were