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Understanding xylem embolism formation is challenging due to dynamic changes and multiphase interactions in conduits. Here, we hypothesise that embolism spread involves gas diffusion in xylem, and is affected by time. We measured hydraulic conductivity (Kh) in flow‐centrifuge experiments over 1 h at a given pressure and temperature for stem samples of three angiosperm species. Temporal changes in Kh at 5, 22, and 35°C, and at various pressures were compared to modelled gas concentration changes in a recently embolised vessel in the centre of a centrifuge sample. Temporal changes in Kh were logarithmic and species‐specific. Maximum relative increases of Kh between 6% and 40% happened at 22°C for low centrifugal speed (<3250 RPM), while maximum decreases between 41% and 61% occurred at higher speeds. These reductions in Kh were experimentally shown to be associated with a temporal increase of embolism at the centre of centrifuge samples, which was likely associated with gas concentration increases in recently embolized vessels. Although embolism is mostly pressure‐driven, our experimental and modelled data indicate that time, conduit characteristics, and temperature are involved due to their potential role in gas diffusion. Gas diffusion, however, does not seem to cover the entire process of embolism spread. Summary Statement: Based on flow‐centrifuge experiments and modelling, we found that embolism formation is not only driven by pressure, but also involves gas movement, which is affected by time, temperature, and vessel anatomy. These findings contribute to a better understanding of plant water transport. [ABSTRACT FROM AUTHOR]

BACKGROUND: In the ARTESiA trial (Apixaban for the Reduction of Thromboembolism in Patients With Device-Detected Subclinical Atrial Fibrillation), apixaban, compared with aspirin, reduced stroke or systemic embolism in patients with device-detected subclinical atrial fibrillation (SCAF). Clinical guidelines recommend considering SCAF episode duration when deciding whether to prescribe oral anticoagulation for this population. METHODS: We performed a retrospective cohort study in ARTESiA. Using Cox regression adjusted for CHA2DS2-VASc score and treatment allocation (apixaban or aspirin), we assessed frequency of SCAF episodes and duration of the longest SCAF episode in the 6 months before randomization as predictors of stroke risk and of apixaban treatment effect. RESULTS: Among 3986 patients with complete baseline SCAF data, 703 (17.6%) had no SCAF episode ≥6 minutes in the 6 months before enrollment. Among 3283 patients (82.4%) with ≥1 episode of SCAF ≥6 minutes in the 6 months before enrollment, 2542 (77.4%) had up to 5 episodes, and 741 (22.6%) had ≥6 episodes. The longest episode lasted <1 hour in 1030 patients (31.4%), 1 to <6 hours in 1421 patients (43.3%), and >6 hours in 832 patients (25.3%). Higher baseline SCAF frequency was not associated with increased risk of stroke or systemic embolism: 1.1% for 1 to 5 episodes versus 1.2%/patient-year for ≥6 episodes (adjusted hazard ratio, 0.89 [95% CI, 0.59–1.34]). In an exploratory analysis, patients with previous SCAF but no episode ≥6 minutes in the 6 months before enrollment had a lower risk of stroke or systemic embolism than patients with at least one episode during that period (0.5% versus 1.1%/patient-year; adjusted hazard ratio, 0.48 [95% CI, 0.27–0.85]). The frequency of SCAF did not modify the reduction in stroke or systemic embolism with apixaban (P interaction=0.1). The duration of the longest SCAF episode in the 6 months before enrollment was not associated with the risk of stroke or systemic embolism during follow-up (<1 hour: 1.0%/patient-year [reference]; 1–6 hours: 1.2%/patient-year [adjusted hazard ratio, 1.27 (95% CI, 0.85–1.90)]; >6 hours: 1.0%/patient-year [adjusted hazard ratio, 1.02 (95% CI, 0.63–1.66)]). SCAF duration did not modify the reduction in stroke or systemic embolism with apixaban (P trend=0.1). CONCLUSIONS: In ARTESiA, baseline SCAF frequency and longest episode duration were not associated with risk of stroke or systemic embolism and did not modify the effect of apixaban on reduction of stroke or systemic embolism. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01938248. [ABSTRACT FROM AUTHOR]

ABSTRACT Plant hydraulic theory states that leaf and stem vulnerability to embolism is coordinated within individual plants. The hydraulic vulnerability segmentation hypothesis (HVSH) predicts higher vulnerability in leaves to protect the stem from hydraulic failure, preserving stem xylem, which is generally more metabolically expensive and slower to regenerate than leaf tissues. However, studies designed to test HVSH have reported wide ranges in vulnerability segmentation (VS), and patterns with the environment have been elusive. In this study, we tested HVSH in phylogenetically constrained tree species from contrasting ecosystems across the Australian landscape. In 12 species, we found no support for HVSH. While leaf vulnerability was strongly governed by climate, VS was universally absent or negative. Consistently, the onset of leaf embolism occurred after the loss of leaf turgor and seasonally low leaf water potentials, illustrating the rarity of embolism in leaves. Within the leaf, embolism primarily occurring first and last in the leaf midvein, suggesting redundancy in leaf architecture to preserve function. Overall, this multi‐ecosystem study provides a more complete picture of drought resistance mechanisms: (1) leaf safety was greatest in trees from drier ecosystems and (2) hydraulic thresholds were mostly conserved across organs indicating environmentally driven drought resistance in both leaves and stems. [ABSTRACT FROM AUTHOR]

Hyaluronic acid (HA) non-surgical procedures are increasingly popular, with approximately 5.6 million performed annually by plastic surgeons worldwide. These treatments effectively address signs of aging in the forehead and nasofrontal areas but come with risks such as bruising, swelling, infections, inflammation, granulomas, skin necrosis, and vascular obstructions. The nose, forehead, and glabella are particularly high-risk areas for visual changes and embolic complications. The nasofrontal region's vascular network is supplied by branches from both the external and internal carotid arteries. The external carotid artery includes the lateral nasal, columellar, and angular arteries, while the frontal branch of the superficial temporal artery supplies the temporal and lateral frontal areas. The internal carotid system, via the ophthalmic artery, includes the supratrochlear, supraorbital, and dorsal nasal arteries, supplying the central and middle forehead and upper nasal dorsum. These networks form a robust vascular arcade. Patients with vascular complications from facial injections often present with a reticulated skin pattern, hematoma, ecchymosis, tenderness, pain, pressure, and sometimes scabs or pustules. Specific skin patterns are associated with vascular complications in defined facial areas. A structured treatment protocol using targeted ultrasound-guided hyaluronidase injections effectively manages these complications, emphasizing a detailed understanding of vascular anatomy and precise diagnostic tools. [ABSTRACT FROM AUTHOR]

Objective: Infective endocarditis (IE) is a severe condition characterized by high mortality rates. We aimed to assess reinfection and mortality rates in IE patients at a tertiary referral center during long-term follow-up. Patients and Methods: We retrospectively analyzed 204 patients meeting modified Duke criteria for definite IE between 2009 and 2019. Early reinfection was defined as occurrence within 6 months, and late reinfection was defined as occurrence 6 months after the initial diagnosis. Results: Mean follow-up duration was 40.3 ± 26.4 months. Valve surgery was performed in 125 patients (69.8%), while 54 (30.2%) received medical therapy alone. Early reinfection was seen in 9 patients (5.1%), and late reinfection in 12 patients (6.7%). Staphylococci (41.9%), Streptococci (26.3%), and Enterococci (15.6%) were common pathogens. Peripheral limb emboli predicted reinfection (HR 4.118, 95% CI 1.471-11.528, p=0.007). Survival rates at 1, 2, and 5 years were 70.2%, 65.7%, and 57.3%, respectively. Age (HR 1.030, 95% CI 1.011 -- 1.049, p=0.002), peripheral limb emboli (HR 2.994, 95% CI 1.509-5.940, p=0.002), and septic shock (HR 2.357, 95% CI 1.097-5.065, p=0.028) predicted mortality. Conclusion: Infective endocarditis mortality rates remain high regardless of reinfection. Peripheral limb emboli independently determine reinfection and mortality. Careful management of this group may reduce morbidity and mortality. [ABSTRACT FROM AUTHOR]

In addition to inducing xylem embolism, freeze–thaw events can cause frost fatigue phenomena. Freezing temperature, freezing times, number of freeze–thaw cycles and frost drought can affect the level of freeze–thaw-induced embolism, but it is unknown whether there is an effect on frost fatigue. We assessed whether these frost-related factors changed frost fatigue in the three diffuse-porous species by simulating freeze–thaw treatments under different conditions. We also proposed a new metric, embolism area, in place of embolism resistance, to more accurately quantify the shift of the vulnerability curve after experiencing freeze–thaw-induced embolism and refilling. Frost fatigue caused vulnerability curves of all species to change from S-shaped to double S-shaped or even R-shaped curves. When exposed to a freeze–thaw event, Acer truncatum showed strong resistance to frost fatigue; in contrast, Populus (I-101 × 84 K) and Liriodendron chinense were more vulnerable. Changing freezing temperature and times did not impact the response to frost fatigue in the three species, but a greater number of freeze–thaw cycles and more severe frost drought significantly exacerbated their fatigue degree. Considering that frost fatigue may be a widespread phenomenon among temperate diffuse-porous species, more work is needed in the future to reveal the mechanisms of frost fatigue. [ABSTRACT FROM AUTHOR]

Background Distal embolization after endovascular thrombectomy (EVT) is common. We aimed to determine factors associated with tissue infarction in the territories of distal emboli. Methods This is a retrospective cohort study of consecutive patients with anterior circulation large vessel occlusions who underwent EVT from 2015 to 2021. Patients with Thrombolysis In Cerebral Infarction (TICI) 2b reperfusion and follow-up imaging were identified. Baseline characteristics, procedural details, and imaging findings were reviewed. Primary outcome was categorized according to the occurrence of infarction at the territory of distal embolus on follow-up diffusion- weighted imaging MRI. Results Of 156 subjects, 97 (62%) had at least one infarction in the territories at risk. Hypertension was significantly more prevalent in the infarct group (83% vs 53%, P=0.001). General anesthesia was more commonly used in the infarct group (60% vs 43%, P=0.037). The median number of distal emboli and diameter of the occluded vessel were similar. After adjusting for confounders, hypertension (aOR 4.73, 95% CI 1.81 to 13.25, P=0.002), higher blood glucose (aOR 1.01, 95% CI 1.00 to 1.03, P=0.023), and general anesthesia (aOR 2.75, 95% CI 1.15 to 6.84, P=0.025) were independently associated with infarction. The presence of angiographic leptomeningeal collaterals predicted tissue survival (aOR 0.13, 95% CI 0.05 to 0.33, P<0.001). 90- day modified Rankin scale (mRS) scores were worse for the infarction patients (mRS 0-2: infarct, 39% vs 55%, P=0.046). Conclusions Nearly 40% of patients with TICI 2b had no tissue infarction in the territory of a distal embolus. The association of infarction with hypertension and general anesthesia suggests late or post-procedural blood pressure management could be a modifiable factor. Patients with poor leptomeningeal collaterals or hyperglycemia may benefit from further attempts at revascularization. [ABSTRACT FROM AUTHOR]

Cardiac myxomas are the most common primary benign tumors of the heart. The occlusion of peripheral arteries and complete obstruction of the abdominal aorta by a tumor embolus presents with distinct clinical manifestations. Herein, we present the case of a 38-year-old male with acute paresthesia, muscle weakness, erythematous, and violaceous changes in skin color localized to the dorsum of the left forefoot initially treated as cutaneous vasculitis. Further studies revealed the total occlusion of the terminal abdominal aorta by a saddle embolus from a cardiac myxoma. A multidisciplinary team consisting of cardiothoracic and vascular surgeons were involved in treating the patient, which resulted in full resolution of the case. This paper details the progression of acute bilateral limb ischemia to chronic limb threatening ischemia resulting from the total occlusion of the terminal abdominal aorta by a saddle embolus. [ABSTRACT FROM AUTHOR]

Subtropical evergreen broadleaved forests distributed in montane zones of southern China experience seasonal droughts and winter frost. Previously, studies have recognized that xylem anatomy is a determinant of its vulnerability to embolism caused by drought and freezing events. We hypothesized that there is a coordination of xylem resistance to freeze–thaw and drought‐induced embolism for the subtropical montane evergreen broadleaved tree species because they are influenced by common xylem structural traits (e.g., vessel diameter). We examined the branch xylem anatomy, resistance to drought‐induced embolism (P50), and the percent loss of branch hydraulic conductivity after a severe winter frost (PLCwinter) for 15 evergreen broadleaved tree species in a montane forest in South China. Our results showed that P50 of the studied species ranged from −2.81 to −5.13 MPa, which was not associated with most xylem anatomical properties except for the axial parenchyma‐to‐vessel connectivity. These tree species differed substantially in PLCwinter, ranging from 0% to 76.41%. PLCwinter was positively related to vessel diameter and negatively related to vessel density, vessel group index, and vessel‐to‐vessel connectivity, but no coordination with P50. This study suggests that hydraulic adaptation to frost is important to determine the distributional limit of subtropical montane evergreen woody angiosperms. [ABSTRACT FROM AUTHOR]

Aims Echocardiographic assessment of cancer-associated non-bacterial thrombotic endocarditis (Ca-NBTE) is limited to case reports and small clinical series. The study aimed to identify heart valve abnormalities and its relation to embolic complications and cancer types. Methods and results Manual review of echocardiographic images and medical records of Mayo Clinic patients (31 March 2002–30 June 2022) was performed. Ca-NBTE in 111 patients (mean age 63.2 ± 9.7 years, 66.7% female) predominantly affected mitral valves (MV) (69), 56 aortic (AV), 8 tricuspid (TV), and rarely pulmonic (PV) (1). In 18 patients, 2 valves were involved, 3 and 4 valve involvement in only a single patient each. Embolic complications were prevalent (n = 102, 91.9%). Ca-NBTE affected MV more frequently on the upstream (atrial) (90% vs. 49.3%) and TV downstream (ventricular) side (75% vs. 37.5%). NBTE size (cm) varied significantly among valves, with TV hosting the largest masses (0.63–2.40 × 0.39–1.77), compared with MV [(0.11–1.81 × 0.11–1.62), (length P = 0.001; width P = 0.03)] and AV [(0.20–2.70 × 0.11–1.51), (length P = 0.001; width P = 0.056)]; MV masses were borderline longer in systemic compared with cerebral emboli (P = 0.057). Majority of MV (79.6%) and AV (69.6%) had thickened leaflets. NBTE lesions commonly affected closing margins (73.9% MV, 85.7% AV, and 62.5% of TV) but rarely commissures of MV (8.7%), yet fairly frequently of AV (41.1%). Five patients had severe regurgitation of MV and 5 AV. Conclusion Ca-NBTE manifests mainly as thrombotic mobile masses attached to thickened MV and AV, with distinct variations in size based on valve type. Embolic destination but not cancer type is associated with NBTE mass size and location. [ABSTRACT FROM AUTHOR]

Background Early clinical trials validating endovascular therapy (EVT) for emergent large vessel occlusion (ELVO) ischemic stroke in the anterior circulation initially focused on patients with small or absent completed infarctions (ischemic cores) to maximize the probability of detecting a clinically meaningful and statistically significant benefit of EVT. Subsequently, real-world experience suggested that patients with large core ischemic strokes (LCS) at presentation may also benefit from EVT. Several large, retrospective, and prospective randomized clinical trials have recently been published that further validate this approach. These guidelines aim to provide an update for endovascular treatment of LCS. Methods A structured literature review of LCS studies available since 2019 and grading the strength and quality of the evidence was performed. Recommendations were made based on these new data by consensus of the authors, with additional input from the full SNIS Standards and Guidelines Committee and the SNIS Board of Directors. results The management of ELVO strokes with large ischemic cores continues to evolve. The expert panel agreed on several recommendations: Recommendation 1: In patients with anterior circulation ELVO who present within 24 hours of last known normal with large infarct core (70-149 mL or ASPECTS 3-5) and meet other criteria of RESCUE-Japan LIMIT, SELECT2, ANGELASPECT, TESLA, TENSION, or LASTE trials, thrombectomy is indicated (Class I, Level A). Recommendations 2-7 flow directly from recommendation 1. Recommendation 2: EVT in patients with LCS aged 18-85 years is beneficial (Class I, Level A). Recommendation 3: EVT in patients with LCS >85 years of age may be beneficial (Class I, Level B-R). Recommendation 4: Patients with LCS and NIHSS score 6-30 benefit from EVT in LCS (Class I, Level A). Recommendation 5: Patients with LCS and NIHSS score <6 and >30 may benefit from EVT in LCS (Class IIa, Level A). Recommendation 6: Patients with LCS and low baseline mRS (0-1) benefit from EVT (Class I, Level A). Recommendation 7: Patients with LCS and time of last known well 0-24 hours benefit from EVT (Class I, Level A). Recommendation 8: It is recommended that patients with ELVO LCS who also meet the criteria for on-label or guideline-directed use of IV thrombolysis receive IV thrombolysis, irrespective of whether endovascular treatments are being considered (Class I, Level B-NR). Conclusions The indications for endovascular treatment of ELVO strokes continue to expand and now include patients with large ischemic cores on presentation. Further prospective randomized studies, including follow-up to assess the population-based efficacy of treating patients with LCS, are warranted. [ABSTRACT FROM AUTHOR]

Summary: Drought‐induced xylem embolism is a primary cause of plant mortality. Although c. 70% of cycads are threatened by extinction and extant cycads diversified during a period of increasing aridification, the vulnerability of cycads to embolism spread has been overlooked.We quantified the vulnerability to drought‐induced embolism, pressure–volume curves, in situ water potentials, and a suite of xylem anatomical traits of leaf pinnae and rachises for 20 cycad species. We tested whether anatomical traits were linked to hydraulic safety in cycads.Compared with other major vascular plant clades, cycads exhibited similar embolism resistance to angiosperms and pteridophytes but were more vulnerable to embolism than noncycad gymnosperms. All 20 cycads had both tracheids and vessels, the proportions of which were unrelated to embolism resistance. Only vessel pit membrane fraction was positively correlated to embolism resistance, contrary to angiosperms. Water potential at turgor loss was significantly correlated to embolism resistance among cycads.Our results show that cycads exhibit low resistance to xylem embolism and that xylem anatomical traits – particularly vessels – may influence embolism resistance together with tracheids. This study highlights the importance of understanding the mechanisms of drought resistance in evolutionarily unique and threatened lineages like the cycads. [ABSTRACT FROM AUTHOR]

Embolism resistance of xylem tissue varies among species and is an important trait related to drought resistance, with anatomical attributes like pit membrane thickness playing an important role in avoiding embolism spread. Grafted Citrus trees are commonly grown in orchards, with the rootstock being able to affect the drought resistance of the whole plant. Here, we evaluated how rootstocks affect the vulnerability to embolism resistance of the scion using several rootstock/scion combinations. Scions of 'Tahiti' acid lime, 'Hamlin', 'Pera' and 'Valencia' oranges grafted on a 'Rangpur' lime rootstock exhibit similar vulnerability to embolism. In field‐grown trees, measurements of leaf water potential did not suggest significant embolism formation during the dry season, while stomata of Citrus trees presented an isohydric response to declining water availability. When 'Valencia' orange scions were grafted on 'Rangpur' lime, 'IAC 1710' citrandarin, 'Sunki Tropical' mandarin or 'Swingle' citrumelo rootstocks, variation in intervessel pit membrane thickness of the scion was found. The 'Rangpur' lime rootstock, which is known for its drought resistance, induced thicker pit membranes in the scion, resulting in higher embolism resistance than the other rootstocks. Similarly, the rootstock 'IAC 1710' citrandarin generated increased embolism resistance of the scion, which is highly relevant for citriculture. Summary statement: Different Citrus rootstocks influence scion vulnerability to embolism, with 'Rangpur' lime inducing less vulnerability and thicker pit membranes. Besides, in field‐grown trees, measurements of leaf water potential did not suggest significant embolism formation even during the dry season. [ABSTRACT FROM AUTHOR]

The stems of some herbaceous species can undergo basal secondary growth, leading to a continuum in the degree of woodiness along the stem. Whether the formation of secondary growth in the stem base results in differences in embolism resistance between the base and the upper portions of stems is unknown. We assessed the embolism resistance of leaves and the basal and upper portions of stems simultaneously within the same individuals of two divergent herbaceous species that undergo secondary growth in the mature stem bases. The species were Solanum lycopersicum (tomato) and Senecio minimus (fireweed). Basal stem in mature plants of both species displayed advanced secondary growth and greater resistance to embolism than the upper stem. This also resulted in significant vulnerability segmentation between the basal stem and the leaves in both species. Greater embolism resistance in the woodier stem base was found alongside decreases in the pith‐to‐xylem ratio, increases in the proportion of secondary xylem, and increases in lignin content. We show that there can be considerable variation in embolism resistance across the stem in herbs and that this variation is linked to the degree of secondary growth present. A gradient in embolism resistance across the stem in herbaceous plants could be an adaptation to ensure reproduction or basal resprouting during episodes of drought late in the lifecycle. Summary statement: The basal stems of some herbs undergo secondary growth as plants get older, leading to a continuum in woodiness and embolism resistance along the stem. Greater embolism resistance occurs alongside decreases in the pith‐to‐xylem ratio and increases in secondary xylem and lignin content. [ABSTRACT FROM AUTHOR]

Introduction: Calcified arterial cerebral embolism is a rare occurrence among large and medium vessel occlusions causing ischemic stroke and its diagnosis and treatment is a challenge. The sources of calcified embolism might be a calcific atheroma from the aortic arch and carotid artery, but also heart valve disease has been reported in the literature. Calcified embolism is frequently simultaneous on multiple vascular territories. The prognosis of patients is usually poor, including patients treated by using endovascular thrombectomy (EVT) and this diagnosis could be easily missed in the acute phase. In addition, the optimal secondary prevention has not been yet fully stated. Methods: We are presenting two cases of acute stroke due to calcified embolism in the middle cerebral artery (MCA) coming from a complicated carotid atheroma, non-stenosing in the first case (a 49 years old man) and stenosing in the second case (a 71 years old man) without clinical indications to intravenous thrombolysis and/or EVT, extensively investigated in the acute phase and followed-up for over 12 months with a favorable clinical course and the persisting steno-occlusion in the involved MCA. In both cases, antiplatelet treatment and targeting of vascular risk factors were done without recurrences in the follow-up period. Discussion: Cerebral calcified embolism has been reported in 5.9% of cases of acute ischemic stroke in a single center series and only in 1.2% of a large retrospective cohort of EVT-treated patients. In both series the prognosis was poor and only one third of EVT-treated patients had functional independence at 3-months follow-up. The natural history of these subtype of ischemic stroke is relatively poorly understood and both etiological diagnosis and treatment have not yet defined. It is possible that some cases might be underdiagnosed and underreported. Conclusions: Calcified cerebral embolism is a rare cause of stroke, but it is largely underreported and both acute phase and secondary preventive treatment have to be defined. [ABSTRACT FROM AUTHOR]

Background and Aims Lianas have higher relative abundance and biomass in drier seasonal forests than in rainforests, but whether this difference is associated with their hydraulic strategies is unclear. Here, we investigate whether lianas of seasonally dry forests are safer and more efficient in water transport than rainforest lianas, explaining patterns of liana abundance. Methods We measured hydraulic traits on five pairs of congeneric lianas of the tribe Bignonieae in two contrasting forest sites: the wet 'Dense Ombrophilous Forest' in Central Amazonia (~2 dry months) and the drier 'Semideciduous Seasonal Forest' in the inland Atlantic Forest (~6 dry months). We also gathered a broader database, including 197 trees and 58 liana species from different tropical forests, to compare hydraulic safety between habits and forest types. Key Results Bignonieae lianas from both forests had high and similar hydraulic efficiency but exhibited variability in resistance to embolism across forest types when phylogenetic relationships were taken into account. Three genera had higher hydraulic safety in the seasonal forest than in the rainforest, but species across both forests had similar positive hydraulic safety margins despite lower predawn water potential values of seasonal forest lianas. We did not find the safety–efficiency trade-off. Merging our results with previously published data revealed a high variability of resistance to embolism in both trees and lianas, independent of forest types. Conclusions The high hydraulic efficiency of lianas detected here probably favours their rapid growth across tropical forests, but differences in hydraulic safety highlight that some species are highly vulnerable and may rely on other mechanisms to cope with drought. Future research on the lethal dehydration threshold and the connection between hydraulic resistance strategies and liana abundance could offer further insights into tropical forest dynamics under climatic threats. [ABSTRACT FROM AUTHOR]

Accidental arterial embolization of hyaluronic acid (HA) fillers can lead to severe complications, including skin ischemia, blindness, and stroke. Currently, the intra-arterial dispersal and fragmentation behavior of HA gels is unknown but critical to our understanding of the pathomechanism of these injuries. This work introduces the Pulsatile Unit for the Laboratory Simulation of Arterio-embolic Restrictions (PULSAR) and evaluates the intravascular behavior of different HA gels. The fragmentation and dispersal behaviors of four HA gels with distinct rheological properties were evaluated via high-resolution videography and ImageJ particle size and morphology analysis. The gels' elastic modulus (G′), loss modulus (G″), tan(δ), and HA concentration were subsequently correlated with their intra-arterial behaviors. This study effectively confirms the extensive fragmentation of HA gels upon arterial inoculation, with particle sizes ranging from <50 µm to >1 mm. Gel particle size and morphology correlated most significantly with tan(δ). Conversely, arterial flow rates did not significantly influence gel fragmentation behavior, though the probability of proximal, macrovascular obstruction was affected. Overall, this study validates the PULSAR model for simulation of arterial dynamics and the testing of intravascular filler kinematics. The findings demonstrate the ability of gels to microfragment and disseminate distally, as well as induce partial proximal occlusion depending on gel rheology and arterial flow parameters. [ABSTRACT FROM AUTHOR]

Background ST-elevation myocardial infarction (STEMI) is a cardiac emergency that requires prompt diagnosis and treatment. We describe a challenging and complex case of managing acute STEMI in a patient with severe anaemia, deranged clotting profile, and infective prodrome. Case summary A 54-year-old Caucasian gentleman was referred by his general practitioner as an emergency after presenting with acute onset of chest pain. His electrocardiogram revealed anterior ST elevation. His past medical history includes a mechanical aortic valve, requiring anticoagulation, and a recent gastrointestinal bleed secondary to type C gastritis. His initial presentation was further complicated by severe anaemia, deranged clotting profile, and elevated infective markers. He required a prompt transfer to the catheterization laboratory to assess and stabilize the situation. We discuss the emerging challenges during treatment, particularly as the diagnosis of septic embolism from infective prosthetic valve endocarditis was unfolding, requiring urgent cardiac surgery. Discussion Acute coronary vessel closure leading to STEMI from septic embolism secondary to prosthetic aortic valve endocarditis is very rare. It is essential to consider the whole picture of the presentation for timely diagnosis and tailored treatment. [ABSTRACT FROM AUTHOR]

Introduction: Drought-induced embolism formation in conifers is associated with several tracheid and pit traits, which vary in parallel from stem apex to base. We tested whether this axial anatomical variability is associated with a progressive variation in embolism vulnerability along the stem from apex to base. Methods: We assessed the tracheid hydraulic diameter (Dh), mean pit membrane area (PMA) and the xylem pressure at 50% loss of conductivity (P50) on longitudinal stem segments extracted at different distances from the stem apex (DFA) in a Picea abies and an Abies alba tree. Results: In both trees, Dh and PMA scaled with DFA0.2. P50 varied for more than 3 MPa fromthe treetop to the stembase, according to a scaling of -P50 with DFA-0.2. The largest Dh, PMA and P50 variation occurred for DFA<1.5 m. PMA and Dh scaled more than isometrically (exponent b=1.2). Pit traits vary proportionally with tracheid lumen diameter. Discussion and conclusions: Apex-to-base trends in tracheid and pit traits, along with variations in P50, suggest a strong structure-function relationship that is influenced by DFA. Although the effect of DFA on P50 has not been extensively explored previously, we propose that analyzing the relationship between P50 and DFA could be crucial for a comprehensive assessment of embolism vulnerability at the individual level. [ABSTRACT FROM AUTHOR]

Background • Obstruction and its consequences have become a threat to human health globally. It includes thrombosis, embolism, and obstruction in the airway, bile duct, lymphatic channels, and intestines. Through extensive research, it was discovered that ancient Unani scholars discussed the concept of obstruction under the term “Suddah,” which translates to “blocking the way”. Objectives • This study aims to explore the predisposing factors and causes of obstruction and mode of action of various deobstruent (Mufattiḥ-i-Sudad) drugs. Methods • The concept of obstruction formation and deobstruent drugs was explored in various Unani classical literature, published indexed journals, dissertations, authentic websites, and journals. Results • Based on observations from the literature, obstruction (Suddah) most commonly arises due to an excess of cold temperament (shadīd burudāt) and derangement of morbid matter (māddā) in terms of quantity and quality. Specifically, excessive, viscous, and thick humor (kaseer, lesdar, and ghaleez khilt) can become occluded in various passages and cavities of the body. Further analysis revealed that deobstruent drugs exhibit a hot temperament (ha’rr), a bitter taste, and possess multiple properties such as being demulcent (latafat), resolvent (tahallul), detergent (jīla), and disintegrator (taqti’). Conclusion • This study serves as a tool for screening deobstruent (Mufattiḥ-i-Sudad) drugs which can be used in various forms of obstruction occurring in the lumen and cavities of the body. The deobstruent drugs with their reported activities validated the concept of deobstruent (Mufattih sudad) activity. [ABSTRACT FROM AUTHOR]

Carotid stump is blind remnant of occluded proximal segment of the internal carotid artery (ICA) that can become the potential source of embolism. Carotid stump syndrome is a potentially treatable cause of recurrent ischemic events in the carotid territory in the setting of occlusion of the ipsilateral ICA. It is thought to be caused by turbulent blood flow in the patent stump of the occluded ICA causing microemboli migrating in the brain through external carotid--ophthalmic anastomotic channels and retrograde flow. Here, we report a patient with known ipsilateral chronic ICA occlusion, who was on best medical management, presented on two separate occasions with recurrent embolic infarctions in ipsilateral carotid territory. She was diagnosed with carotid stump syndrome and treated through endovascular route with clinical and angiographic follow-up. [ABSTRACT FROM AUTHOR]

Aortoiliac occlusive disease (AIOD) can occur from either chronic, progressive atherosclerotic disease, acute on chronic thrombosis or acute arterial embolism, and can all result in limb ischemia. Bypass surgery had long been the gold standard for treatment for AIOD, however, with advances in endovascular techniques, minimally invasive treatment of aortoiliac lesions has become the first line choice of management in many cases. Herein, we describe a case of utilizing the Inari ClotTriever to perform aortoiliac mechanical thrombectomy and the ARTIX thrombectomy system to perform an embolectomy the superficial femoral artery, highlighting new therapies to treat AIOD. [ABSTRACT FROM AUTHOR]

The seasonal plasticity of resistance to xylem embolism has been demonstrated in leaves of some tree species, but is controversial in stems. In this study, we investigated the seasonality of stem xylem resistance to embolism in six temperate woody species (four deciduous and two evergreen tree species) that were grown at the same site. The xylem conduit anatomy, the concentrations, and ratios of the main cation in the xylem sap, as well as the content of nonstructural carbohydrates (including soluble sugars and starch) were measured in each species under each season to reveal the potential mechanisms of seasonal change in embolism resistance. The stem of all species showed increasing resistance to embolism as seasons progressed, with more vulnerable xylem in spring, but no significant adjustment in the other three seasons. The seasonal plasticity of stem embolism resistance was greater in deciduous species than in evergreen. On a seasonal scale, conduit diameter and conduit implosion resistance, the ratios of K+/Ca2+ and K+/Na+, and starch content were generally not correlated with embolism resistance, suggesting that these are probably not the main drivers of seasonal plasticity of stem embolism resistance. The seasonality of embolism resistance provides critical information for better understanding plant hydraulics in response to seasonal environments, especially under climate change. [ABSTRACT FROM AUTHOR]

Introduction: Endovascular left atrial appendage occlusion (LAAO) is associated with a high incidence of peri-procedure silent cerebral embolism (SCE), while the recommended activated clotting time (ACT) level by the expert consensus is lower than that in atrial fibrillation (AF) ablation. The aim of our study was to investigate whether raising the targeted ACT level during LAAO to the same level as AF ablation could decrease the incidence of SCE. Methods: It was a prospective observational cohort study. Consecutive AF patients receiving LAAO between January 2021 and December 2022 were included and categorized into two groups based on the time of enrollment. Patients enrolled in 2021 (group 250) maintained a target ACT level of ≥250 s during LAAO procedure, while patients enrolled in 2022 (group 300) maintained the peri-procedure ACT ≥300 s. All patients underwent cerebral magnetic resonance imaging before and after the procedure. Results: A total of 81 patients were included (38 in the group 250 and 43 in the group 300). After inverse probability of treatment weighting (IPTW), patients in the group 250 showed a significantly lower incidence of SCE than group 300 (IPTW p = 0.038). Only a stable high ACT pattern could decrease the risk of SCE. No significant differences were found between other ACT change patterns on the SCE incidence. Conclusion: Raising the peri-procedure ACT level to a stable 300 s could decrease the risk of the SCE without increasing the major bleeding events. [ABSTRACT FROM AUTHOR]

Objective: A hypercoagulable state exists in patients with oral squamous cell carcinoma (OSCC), but the role of platelets in the tumour microenvironment has not been explored. This study revealed the status of intratumoral plateletmicrothrombi (PLT‐MT) and their clinicopathological relevance and predictive value in OSCC. Study Design: This study retrospectively evaluated 106 OSCC patients. Tumour and tumour‐adjacent tissue specimens were used to stain PLT‐MT. Clinicopathological information, patient follow‐ups and outcomes and preoperative coagulation and inflammatory hematologic indicators were collected, and their correlation with PLT‐MT was analysed. Results: Intratumoral PLT‐MT was present in 35 of 106 patients with OSCC who had higher preoperative D‐dimer, CRP, FIB and PT levels and lower TT levels. PLT‐MT was an independent correlative factor of lymph node metastasis and suggested worse OS in N0 patients. Conclusions: Intratumoral PLT‐MT was found in OSCC and was correlated with a hypercoagulable inflammatory state. PLT‐MT was an independent marker of lymph node metastasis and showed potential in prognosis prediction. [ABSTRACT FROM AUTHOR]

High-risk/massive pulmonary embolism (PE) has a high mortality rate, especially when cardiac arrest occurs. Venoarterial (V-A) extracorporeal membrane oxygenation (ECMO) can rapidly restore and maintain circulation while a decision regarding further care or performance of other interventions takes place. Catheter-based embolectomy (CBE) is a technology that allows for percutaneous access, clot removal, and potential resolution of shock while avoiding sternotomy required for traditional pulmonary embolectomy. Rapid placement of V-A ECMO in patients with high-risk/massive PE prior to CBE may confer circulatory protection before, during, and after the procedure. [ABSTRACT FROM AUTHOR]

Introduction: Although thrombolytic therapy is the standard treatment for massive pulmonary thromboembolism (PTE), it is often ineffective in patients with circulatory collapse. Surgical embolectomy is another treatment option, but whether it is absolutely necessary is controversial. We sought to evaluate the outcomes of patients with massive PTE treated with intensive critical care including extracorporeal membrane oxygenation (ECMO) without thrombolytic therapy or surgical embolectomy. Methods: We analyzed 39 patients who were treated for massive PTE from January 2011 to June 2019. Massive PTE was treated with anticoagulation and hemodynamic support at an intensive care unit. ECMO was applied in patients with circulatory collapse. The computed tomography (CT) obstruction index and the ratio of the right ventricle to left ventricle short-axis diameters (RV/LV) were measured using serial CT angiography to confirm changes in pulmonary emboli and RV strain. Results: Twenty-one patients were in cardiogenic shock, and 15 of them needed cardiopulmonary resuscitation (CPR). Fifteen patients were treated with ECMO and nine of them were weaned successfully. The overall in-hospital mortality was 23% (9/39). On the follow-up CT scan after 6 months, residual PTE was observed in 10 patients and their median CT obstruction index was 6.25 % (range 2.5–35). The initial mean RV/LV ratio was 1.8 ± 0.47 and the value measured at follow-up CT decreased to less than 1 (0.9 ± 0.1). Conclusions: Intensive critical care with heparin alone and timely ECMO support without thrombolytic therapy could be an effective treatment option in patients with acute massive PTE. [ABSTRACT FROM AUTHOR]

The article presents a case of complicated cardiac hydatidosis with cerebral embolism in a 50-year-old woman from Peru. The patient was admitted to the emergency room with altered mental status and right motor deficit, and the diagnosis of hydatidosis was confirmed through complementary tests. Surgery was performed to remove the brain cysts and the patient had a good postoperative recovery. Treatment included the use of albendazole. The importance of considering cardiac hydatidosis in the diagnosis of intracardiac and cerebral masses is highlighted. [Extracted from the article]

Background: Previous research has hinted at a crucial link between gut microbiota and arterial embolism and thrombosis, yet the causal relationship remains enigmatic. To gain a deeper understanding, we aimed to comprehensively explore the causal relationship and elucidate the impact of the gut microbiota on the risk through a two-sample Mendelian randomization (MR) study. Methods: Genetic instrumental variables for gut microbiota were identified from a genome-wide association study (GWAS) of 18,340 participants. Summary statistics for IBS were drawn from a GWAS including 1,076 cases and 381,997 controls. We used the inverse-variance weighted (IVW) method as the primary analysis. To test the robustness of our results, we further performed the weighted median method, MR-Egger regression, and MR pleiotropy residual sum and outlier test. Results: We identified three bacterial traits that were associated with the risk of arterial embolism and thrombosis: odds ratio (OR): 1.58, 95% confidence interval (CI): 1.08-2.31, p = 0.017 for genus Catenibacterium; OR: 0.64, 95% CI: 0.42-0.96, p = 0.031 for genus Dialister; and OR: 2.08, 95% CI: 1.25-3.47, p = 0.005 for genus Odoribacter. The results of sensitivity analyses for these bacterial traits were consistent (P<0.05). Conclusion: Our systematic analyses provided evidence to support a potential causal relationship between several gut microbiota taxa and the risk of arterial embolism and thrombosis. More studies are required to show how the gut microbiota affects the development of arterial embolism and thrombosis. [ABSTRACT FROM AUTHOR]

Globally, diabetes mellitus (DM) and stroke are two common chronic illnesses that have a substantial impact on rates of morbidity and mortality. There is significant evidence linking diabetes to an increased risk of stroke in terms of incidence, severity, and mortality. This extensive review looks at shared risk factors, underlying pathophysiological mechanisms, epidemiological trends, and evidencebased therapy approaches to give a thorough analysis of the causal relationship between diabetes mellitus and stroke. Studies using epidemiological data regularly show that people with diabetes have a higher incidence of stroke than people without the disease. Furthermore, diabetes is linked to a less favorable outcome following a stroke, as well as an elevated chance of stroke recurrence. Determining the pathophysiological pathways that connect diabetes and stroke is essential to understanding their relationship. Key pathophysiological processes associated with these disorders include endothelial dysfunction, inflammation, oxidative stress, hyperglycemia, and dyslipidemia. Due to microvascular complications, these mechanisms raise the risk of hemorrhagic stroke and predispose diabetics to an increased risk of ischemic stroke by creating a prothrombotic and atherosclerotic milieu. Diabetes and stroke are linked due to shared risk factors like smoking, obesity, dyslipidemia, hypertension, and poor glycemic control. Lifestyle changes, blood pressure control, lipid-lowering therapy, antiplatelet medicines, and a nutritious diet are essential for stroke risk reduction. Reducing the risk of stroke in people with diabetes requires the implementation of management techniques that focus on both diabetes control and stroke prevention. Optimizing results and lowering the frequency of stroke-related complications in diabetics requires multidisciplinary care. The intricate interactions between diabetes mellitus and stroke are highlighted in this review's conclusion, which also highlights the value of patient education, risk factor treatment, the effect of antidiabetic therapy on stroke, and integrated care in lowering the incidence of stroke in people with diabetes. [ABSTRACT FROM AUTHOR]

The African Restionaceae (Poales), the dominant graminoid layer in the megadiverse Cape Floristic Region of South Africa, are distributed across a wide range of moisture availability, yet currently there is very little known about the underlying hydraulics of this group.We tested two methods for measuring culm vulnerability to embolism, the optical and pneumatic methods, in three species of Cannomois ranging in habitat from semi‐riparian (Cannomois virgata) to dryland (Cannomois parviflora and C. congesta). Estimates of culm xylem vulnerability were coupled with measures of turgor loss point (ΨTLP) and minimum field water potential (ΨMD) to assess hydraulic safety margins.The optical and pneumatic methods produced similar estimates of P50, but differed for P12 and P88. All three species were quite vulnerable to embolism, with P50 of –1.9 MPa (C. virgata), −2.3 MPa (C. congesta), and −2.4 MPa (C. parviflora). Estimates of P50, ΨTLP and ΨMD aligned with habitat moisture stress, with highest values found in the semi‐riparian C. virgata. Consistent differences in P50, ΨMD and ΨTLP between species resulted in consistent hydraulic safety margins across species of 0.96 ± 0.1 MPa between ΨMD and P50, with onset of embolism occurring 0.43 ± 0.04 MPa after ΨTLP for all three species.Our study demonstrates that restio occupancy of dry environments involves more than the evolution of highly resistant xylem, suggesting that other aspects of water relations are key to understanding trait–environment relationships in this group. [ABSTRACT FROM AUTHOR]

Acute occlusion of the anterior spinal artery and subsequent spinal ischemic infarction leads to anterior spinal artery syndrome characterized by back pain and bilateral flaccid paresis with loss of protopathic sensibility. As a rare cause fibrocartilaginous embolism has been described and is associated with sports or unusual strain. Following gymnastic exercise the day before symptom-onset, a 11 years old girl presented with neck pain, paresis of arms and legs, and impaired deep tendon reflexes. She was unable to lift her arms, grasp, stand, walk and had urinary incontinence. Magnetic resonance imaging revealed a longitudinal T2 hyperintense signal in the anterior spinal cord from C3 to C6 with accompanying bilateral diffusion restriction involving gray matter bilaterally at the level of C4 and C5 and unilaterally at the level of C3/4. The adjacent annulus fibrosus of the intervertebral disc showed a fissure without disc protrusion. Treatment with prednisolone and enoxaparin was started within 12 hours of symptom-onset and continued over 6 days and 8 weeks, respectively. After 2 months, her motor function gradually improved, spinal imaging showed persistent T2 signal hyperintense defects at the level of C4/5. After 5 months, there was only slight impairment affecting elevation and abduction of the right arm. Following physical exercise, the patient suffered from acute anterior spinal cord ischemia with imaging findings in line with a presumed fibrocartilaginous embolism. Unlike most cases, our patient showed almost complete recovery following treatment with prednisolone and enoxaparin. We speculate that the positive outcome is related to rapid treatment initiation. [ABSTRACT FROM AUTHOR]

Immunotherapy improves the prognosis of patients with advanced lung cancer. The expression level of PD-L1 in lung cancer tissue is the most reliable marker for predicting the efficacy of immunotherapy. However, the relationship between PD-L1 expression level and clinicopathological characteristics in patients with lung adenocarcinoma is unclear. The paper aims to analyze the correlation between PD-L1 expression and clinicopathological features in surgically resected lung adenocarcinoma. Clinicopathological data of 100 patients with surgically resected lung adenocarcinoma admitted to the Department of Thoracic Surgery of our hospital from January 2021 to August 2021 were retrospectively analyzed. Immunohistochemistry showed that 36 patients had positive PD-L1 results in postoperative tumor tissues (incidence rate, 36.0%). The tumor-node-metastasis stage, tumor stage, node stage, degree of differentiation, smoking history, and intravascular cancer embolus were statistically different between the two groups (P < 0.05). Multivariate logistic regression analysis showed that postoperative pathological stages above stage II, T3-4, N1-2, poorly differentiated tumors, and positive intravascular cancer embolus were independent factors for PD-L1 positive in lung adenocarcinoma tissue. Therefore, these patients require more attention in the clinic to increase the efficiency of immunotherapy. [ABSTRACT FROM AUTHOR]

The vulnerability of plant xylem to embolism can be described as the water potential at which xylem conductivity is lost by 50% (P50). According to the traditional hypothesis of hydraulic vulnerability segmentation, the difference in vulnerability to embolism between branches and roots is positive (P50 root−branch > 0). It is not clear whether this occurs broadly across species or how segmentation might vary across aridity gradients. We compiled hydraulic and anatomical datasets from branches and roots across 104 woody species (including new measurements from 10 species) in four biomes to investigate the relationships between P50 root–branch and environmental factors associated with aridity. We found a positive P50 root–branch relationship across species, and evidence that P50 root–branch increases with aridity. Branch xylem hydraulic conductivity transitioned from more efficient (e.g., wider conduit, higher hydraulic conductivity) to safer (e.g., narrower conduit, more negative P50) in response to the increase of aridity, while root xylem hydraulic conductivity remained unchanged across aridity gradients. Our results demonstrate that the hydraulic vulnerability difference between branches and roots is more positive in species from arid regions, largely driven by modifications to branch traits. [ABSTRACT FROM AUTHOR]

Auxins are master regulators of plant development and auxin perception mutants display smaller leaves, lower transpiration, and narrower xylem vessels than their corresponding wild types. Here, we evaluated whether the leaf embolism resistance and overall plant resistance to drought are altered in the auxin perception mutant diageotropica (dgt). Our assessments demonstrate that the dgt mutants in tomato exhibit considerably smaller xylem vessels in stems (‐24%), leaf petioles (‐43%), and leaf midribs (‐34%) than the wild type. Alongside narrower vessels, dgt mutants exhibited greater xylem cell wall thickness‐to‐conduit diameter and greater leaf embolism resistance than the wild type. The water potential at 50% cumulative leaf embolism (P50) of dgt and wild type was ‐1.39 and ‐1.14 MPa, respectively. Plants of dgt also exhibited higher stomatal safety margin (water potential difference between stomatal closure and P50), needed a longer time to reach their P50 in a dry‐down experiment, and showed a faster recovery in leaf gas exchange upon rehydration than the wild type. The impaired auxin signaling resulted in lower canopy area and stomatal conductance, which likely contributed to delaying the time for plants to reach hydraulic damage during drought. These findings demonstrate a clear association between structural and physiological changes and improved resistance against drought‐induced hydraulic dysfunction in the dgt tomato mutant. [ABSTRACT FROM AUTHOR]

This review article considers the physiology, differential diagnosis and immediate management of vasovagal response, vascular injury and carbon dioxide embolism caused during the creation of the laparoscopic pneumoperitoneum. These pathologies account for over half of all laparoscopic complications and therefore, by taking a systematic approach to these possibly life-threatening events, laparoscopy can become even safer. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) is associated with high morbidity and a mortality rate of 9-30% due to its life-threatening complications including systemic embolization of various organs. The complications are more common in culture-positive cases. In culture-negative IE, systemic embolism especially with multiorgan involvement occurring in a single patient is very rare. Such condition may significantly increase the hospital mortality and poses unique challenges in diagnosis and management. We present a case of a 14-year-old female who presented with a one-week history of vague left upper quadrant pain and fever. On presentation, she was fully conscious but with signs of septic shock requiring vasoconstrictor support and administration of a broad-spectrum antibiotics. There was generalised abdominal tenderness. Abdominal ultrasound showed geographic hypoechogenicity of the spleen with small bowel wall thickening. Contrast-enhanced computed tomography (CECT) abdomen confirmed splenic and renal infarction with ischaemic small bowel. Transthoracic echocardiography showed vegetation at the mitral valve. She developed a severe headache during admission. CT head and conventional cerebral angiography demonstrated a ruptured mycotic aneurysm. All her blood culture results were persistently negative throughout admission possibly due to the initiation of antibiotics prior to sample collection. Despite a negative culture, she developed disseminated embolism to various organs as described. The planned mitral valve surgery was delayed due to the intracranial bleed, and she underwent craniectomy for clot removal. Mitral valve replacement was performed one month later. During follow-up, she had good recovery with no signs of heart failure or significant impairment of quality of life. [ABSTRACT FROM AUTHOR]

The article examines the use of endovascular thrombectomy (EVT) for acute ischemic stroke after cardiac interventions, revealing a significantly lower rate of EVT utilization in stroke cases associated with cardiac surgery compared to those without cardiac interventions.

Introduction: Massive pulmonary embolism (MPE) is a rare but highly fatal condition. Our study's objective was to evaluate the association between advanced interventions and survival among patients with MPE treated with venoarterial extracorporeal membrane oxygenation (VA-ECMO). Methods: This is a retrospective review of the Extracorporeal Life Support Organization (ELSO) registry data. We included adult patients with MPE who were treated with VA-ECMO during 2010–2020. Our Primary outcome was survival to hospital discharge; secondary outcomes were ECMO duration among survivors and rates of ECMO-related complications. Clinical variables were compared using the Pearson chi-square and Kruskal-Wallis H tests. Results: We included 802 patients; 80 (10%) received SPE and 18 (2%) received CDT. Overall, 426 (53%) survived to discharge; survival was not significantly different among those treated with SPE or CDT on VA-ECMO (70%) versus VA-ECMO alone (52%) or SPE or CDT before VA-ECMO (52%). Multivariable regression found a trend towards increased survival among those treated with SPE or CDT while on ECMO (AOR 1.8, 95% CI 0.9–3.6), but no significant correlation. There was no association between advanced interventions and ECMO duration among survivors, or rates of ECMO-related complications. Conclusion: Our study found no difference in survival in patients with MPE who received advanced interventions prior to ECMO, and a slight non-significant benefit in those who received advanced interventions while on ECMO. [ABSTRACT FROM AUTHOR]

Objective: Mechanical thrombectomy (MT) is the gold standard treatment for acute ischemic stroke. During these interventions, a thrombus frequently obstructs a guiding catheter. The obstructed guiding catheter should be withdrawn before distal embolism occurs; however, albeit infrequently, the thrombus occludes even a sheath introducer (SI). While conventionally new SI placement is required for continuation of treatment, we propose a viable alternative for recanalization of the occluded SI, termed vacuum-assisted delivery of thrombus (VADT), with a clinical report of our cases. The usefulness of this technique was also evaluated in simulation experiments. Case Presentations: The VADT procedure is as follows: 1) insert a peel-away sheath, originally attached to a balloon-guiding catheter (BGC), into the SI to continuously open the hemostatic valve; 2) advance the BGC into the peel-away sheath while applying mechanical aspiration; and 3) remove the peel-away sheath/BGC assembly slowly. In a simulation environment using an artificial thrombus, we repeated the VADT procedure five times and reproducibly achieved SI reopening within only 10–20 seconds. From March 2013 to September 2022, 204 patients were treated with MT at our stroke center and SI occlusion occurred in three patients (1.5%). These events occurred exclusively in patients with extracranial internal carotid artery occlusion. All three patients with SI occlusion underwent successfully thrombus extraction in the SI using the VADT on the first try. Conclusion: The results of clinical experience and simulation experiments strongly support VADT as a reliable option for recanalization of an occluded SI. [ABSTRACT FROM AUTHOR]

Renal embolisms due to cardiac myxomas are extremely rare; the clinical course, treatment, and prognosis of this disease are not established. A 69-year-old Japanese woman who underwent a nephrectomy for renal cell carcinoma 3 years earlier was hospitalized with a right occipital lobe cerebral infarction. Her renal function suddenly worsened 3 days post-admission: her serum creatinine rose from 1.46 mg/dL to 6.57 mg/dL and then to 8.03 mg/dL the next day, and hemodialysis therapy was started. Abdominal computed tomography (CT) scans showed patchy non-contrasted low-density areas in the right kidney, and chest CT scans and transesophageal ultrasonography revealed a left atrial tumor. We diagnosed renal infarction due to a left atrial myxoma. Hemodialysis and anticoagulant therapy (heparin) were continued, followed by the cardiac myxoma's resection. The patient's renal function gradually improved post-surgery, and the hemodialysis was discontinued. Considering our patient and 19 other case reports of renal infarction associated with cardiac myxoma, the treatment for such a renal infarction and the outcomes differ depending on the embolus site. The poor outcome of abdominal aortic embolism requires a prompt embolectomy, whereas a branch renal artery embolism requires anticoagulation therapy to prevent thrombosis formation around the myxoma. [ABSTRACT FROM AUTHOR]

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Introduction: Fat embolism (FE) following intramedullary (IM) reaming can cause severe pulmonary complications and sudden death. Recently, a new harvesting concept was introduced in which a novel aspirator is used first for bone marrow (BM) aspiration and then for subsequent aspiration of morselized endosteal bone during sequential reaming (A + R + A). In contrast to the established Reamer-Irrigator-Aspirator (RIA) 2 system, the new A + R + A concept allows for the evacuation of fatty BM prior to reaming. In this study, we hypothesized that the risk of FE, associated coagulopathic reactions and pulmonary FE would be comparable between the RIA 2 system and the A + R + A concept. Materials and methods: Intramedullary bone graft was harvested from intact femora of 16 Merino sheep (age: 1–2 years) with either the RIA 2 system (n = 8) or the A + R + A concept (n = 8). Fat intravasation was monitored with the Gurd test, coagulopathic response with D-dimer blood level concentration and pulmonary FE with histological evaluation of the lungs. Results: The total number and average size of intravasated fat particles was similar between groups (p = 0.13 and p = 0.98, respectively). D-dimer concentration did not significantly increase within 4 h after completion of surgery (RIA 2: p = 0.82; A + R + A: p = 0.23), with an interaction effect similar between groups (p = 0.65). The average lung area covered with fat globules was similar between groups (p = 0.17). Conclusions: The use of the RIA 2 system and the novel A + R + A harvesting concept which consists of BM evacuation followed by sequential IM reaming and aspiration of endosteal bone, resulted in only minor fat intravasation, coagulopathic reactions and pulmonary FE, with no significant differences between the groups. Our results, therefore, suggest that both the RIA 2 system and the new A + R + A concept are comparable technologies in terms of FE-related complications. [ABSTRACT FROM AUTHOR]

Purpose: In the majority of cases, large vessel occlusion (LVO) in ischemic stroke patients has an embolic origin. Systemic embolism can occur simultaneously with brain thrombosis. This retrospective study evaluated the frequency and locations of systemic embolism in LVO stroke patients receiving revascularization therapy. Materials and Methods: In our facility, we use contrast-enhanced computed tomography (CE-CT) to assess suspected stroke patients and routinely perform CE-CT from the chest to the abdomen after brain CT angiography to rule out contraindications like aortic dissection and trauma for thrombolysis. Systemic embolism is also assessed using these images, while myocardial infarction is evaluated based on electrocardiograms and laboratory findings. Other relevant clinical features of each patient are also analyzed. Results: In total, 612 consecutively admitted stroke patients and 32 LVO patients who underwent revascularization therapy were included in the present study. Systemic embolism was identified in four patients (13%). The spleen was the most commonly affected organ, followed by the heart, kidneys, limbs, and lungs. All four patients with systemic embolism exhibited LVO resulting from embolism as the underlying mechanism. Conclusion: Systemic embolism was observed in 13% of our LVO patients, all of whom had LVO of embolic origin. [ABSTRACT FROM AUTHOR]

The prognostic impact of skin oedema in the setting of locally advanced breast cancer, the extent to which this responds to neoadjuvant chemotherapy [NACT], and whether the persistence of oedema represents residual cancer are not known. A prospective study was conducted in the Department of General Surgery, PGIMER, Chandigarh, between 1 August 2017 and 31 July 2018. Locally advanced breast cancer patients who had skin oedema on clinical examination and who completed NACT were included. A punch biopsy was taken from the site of maximum oedema pre-NACT. The resolution of skin changes—oedema/ulceration post-NACT—and skin involvement by histopathology of the mastectomy specimen were analysed. All 29 patients had skin oedema to start with, and 4/29 (13.8%) had skin ulceration. Ten out of 29 (34.5%) patients had skin involvement demonstrable on histopathology pre-NACT. The skin oedema persisted in 26/29 (89.7%) post-NACT, and ulceration persisted in 3/4 (75%). On histopathology of the mastectomy specimen, skin involvement was demonstrable only in 4 patients (13.8%)—3 direct skin infiltration by tumour, 1 dermal lymphatic embolus. Skin oedema clinically persisted even in 4 patients who had a pathological complete response. While most patients have persistence of skin oedema post-NACT, this does not necessarily translate into an actual pathological skin involvement. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Diagnosing FES is difficult and time‐consuming, and identify FES as an etiology of right ventricular volume overload for early diagnosis. Because FES is a reversible condition, even severe cases can be treated if the patient survives the acute phase. [ABSTRACT FROM AUTHOR]

This article discusses a case of pulmonary embolectomy following embolism during caval tumour thrombus nephrectomy for renal cell carcinoma. The patient, a 77-year-old man, underwent surgery to remove a locally advanced renal cancer with Level IV inferior vena cava (IVC) thrombus. During the surgery, the tumour thrombus was noted to be present in the right atrium, and it was later discovered that the thrombus had dislodged and migrated into the pulmonary circulation. The patient underwent pulmonary embolectomy and had a slow recovery with some complications. The article emphasizes the importance of early recognition and continuous monitoring in managing intraoperative tumour thrombus embolism. [Extracted from the article]

We describe the case of a male heavy machinery operator who presented from work with a rapidly evolving spinal cord syndrome. Spinal MRI revealed thoracic vertebral body and cord infarction and evolving mild disc prolapse attributed to fibrocartilaginous disc embolism (FCDE). FCDE should be considered as one of the aetiological mechanisms of acute spinal cord infarction in pile-driver/heavy machinery operators, especially in association with adjacent vertebral body infarction and intervertebral disc prolapse. Magnetic resonance imaging (MRI) changes may evolve, warranting early follow-up MRI in appropriate cases. [ABSTRACT FROM AUTHOR]

Prosthetic valve thrombosis (PVT) in aortic valve and its complication coronary embolism is a very rare condition. Diagnosis and treatment process is challenging. We present a young patient with acute myocardial infarction who underwent mechanical aortic valve replacement (AVR) operation one month earlier. Percutaneous coronary intervention was performed and it was succesful. Transeasophageal ecocardiography (TEE) was performed. Thrombus was seen on the mechanical aortic valve and thrombolytic therapy was initiated. Control TEE was performed and there was no signs of thrombi. The patient was discharged healthfully with anticoagulant and antiaggregan. [ABSTRACT FROM AUTHOR]