Vascular Abnormalities Research Articles

Evaluation and Comparison of Capillary Morphology Among Combusted Tobacco, Heated Tobacco and E-Cigarette Users

The habit of smoking in its various forms represents a significant public health concern due to its wide range of pathological effects, included the oral cavity. In recent years, alternatives to traditional cigarettes, such as heated tobacco products and electronic cigarettes, have gained popularity and are often marketed as potentially less harmful options. This study seeks to evaluate and compare the morphometric characteristics of oral mucosal capillaries in individuals who consume combusted tobacco, heated tobacco, vaporized liquid, and non-smokers. Using videocapillaroscopy, we assessed both parametric and non-parametric data from 60 patients, divided into four groups according to their smoking habits. The analysis revealed significant differences in capillary morphology among the groups. Users of combusted tobacco exhibited pronounced reductions in capillary diameter, alongside increased tortuosity and the presence of microaneurysms. These alterations are indicative of chronic inflammation and vasoconstriction, likely driven by exposure to nicotine and the high temperatures associated with combustion. Conversely, users of heated tobacco and vaporized liquid exhibited comparatively fewer vascular abnormalities, although angiogenic effects attributable to nicotine were still observable. These findings suggest that alternative tobacco products may have a comparatively lesser impact on the oral microcirculation when compared to traditional smoking. However, the potential long-term effects of these products remain unclear. Further longitudinal research is required to fully understand the risks associated with prolonged use of heated tobacco and electronic cigarettes.

Comparative analysis of retinal vascular structural parameters in populations with different glucose metabolism status based on color fundus photography and artificial intelligence

ObjectiveMeasure and analyze retinal vascular parameters in individuals with varying glucose metabolism, explore preclinical retinal microstructure changes related to diabetic retinopathy (DR), and assess glucose metabolism’s impact on retinal structure.MethodsThe study employed a cross-sectional design encompassing a 4-year period from 2020 to 2024. Fundus photographs from 320 individuals (2020–2024) were categorized into non-diabetes, pre-diabetes, type 2 diabetes mellitus (T2DM) without DR, and T2DM with mild-to-moderate non-proliferative DR (NPDR) groups. An artificial intelligence (AI)-based automatic measurement system was used to quantify retinal blood vessels in the fundus color photographic images, enabling inter-group parameter comparison and analysis of significant differences.ResultsBetween January 2020 and June 2024, fundus color photographs were collected from 320 individuals and categorized into four groups: non-diabetes (n = 54), pre-diabetes (n = 71), T2DM without overt DR (n = 144), and T2DM with mild-to-moderate NPDR (n = 51). In pairwise comparisons among individuals with pre-diabetes, T2DM without DR, and T2DM with mild-to-moderate NPDR. Fasting blood glucose (FBG), glycated hemoglobin (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were significantly different (P < 0.05). Within the T2DM population, FBG, HbA1c, age, SBP, and DBP were significant predictors for mild-to-moderate NPDR (P < 0.05). Average venous branching number (branch_avg_v) was significantly different among pre-diabetes, T2DM without DR, and T2DM with mild-to-moderate NPDR groups. In patients with T2DM with mild-to-moderate NPDR, Average length of arteries (length_avg_a) and average length of veins (length_avg_v) increased, whereas branch_avg_v, average venous branching angle (angle_avg_v), average venous branching asymmetry (asymmetry_avg_v),overall length density (vessel_length_density), and vessel area density (vessel_density) decreased significantly (P < 0.05). Logistic regression analysis identified length_avg_a, branch_avg_v, angle_avg_v, asymmetry_avg_v, vessel_length_density, and vessel_density as independent predictors of mild-to-moderate NPDR in patients with T2DM. Receiver Operating Characteristic (ROC) curve analysis demonstrated that length_avg_a, length_avg_v, branch_avg_v, angle_avg_v, asymmetry_avg_v, vessel_length_density, and vessel_density had diagnostic value for mild-to-moderate NPDR (P < 0.05).ConclusionIn individuals diagnosed with T2DM, specific retinal vascular parameters, such as branch_avg_v and vessel_density, demonstrate a significant correlation with mild-to-moderate NPDR. These parameters hold promise as preclinical biomarkers for detecting vascular abnormalities associated with DR.

Non-vascular structural-related intraventricular hemorrhage: Epidemiology and literature review.

Primary intraventricular hemorrhage (PIVH) is a rare type of hemorrhagic stroke typically associated with vascular structural abnormalities. However, little is known about the epidemiology and etiology of PIVH caused by non-vascular structural abnormalities. In this study, we aimed to clarify the etiology, clinical characteristics, and prognosis of non-vascular structural-related intraventricular hemorrhage (NVSRIVH). We retrospectively collected and analyzed data from 29 consecutive patients with NVSRIVH admitted to our hospital between January 2017 and May 2024. Outcomes were assessed using the modified Rankin Scale (mRS) at 90 days. A systematic review of the pertinent literature was performed and a pooled analysis of data from selected studies was performed. Among 2035 patients with spontaneous intracerebral hemorrhage, 40 (2 %) had PIVH. After excluding patients with vascular abnormalities and those without cerebrovascular examination results, data for 29 patients (13 males and 16 females, average age: 66.38 ± 2.76 years) were analyzed. The most common initial symptom was headache (65.5 %), with a median Glasgow Coma Scale (GCS) of 12 (7, 15) and modified Graeb score (mGS) of 15 (6, 18). Chronic hypertension was the most common clinical risk factor (79.3 %). Surgical intervention was performed in 24 patients, most commonly external ventricular drainage (62.1 %). At the 90-day follow-up, 22 patients (74.49 %) had good outcomes (mRS ≤ 3), and 7 patients (21.43 %) had poor outcomes (mRS > 3). Logistic regression analyses showed that GCS scores at admission, mGS, and hydrocephalus are associated with poor outcomes. NVSRIVH is a rare stroke subtype with a relatively good prognosis. NVSRIVH may be associated with long-term chronic disease, and chronic hypertension and age are the most relevant clinical risk factors.

Comparison of retinal vascular abnormalities in the fellow eyes of children with Coats' disease and normal subjects using ultra-widefield fundus fluorescein angiography.

To investigate retinal vascular abnormalities in the affected and fellow eyes of children with Coats' disease using Optos® ultra-widefield fundus fluorescein angiography (UWFFA) and compare the peripheral vascular abnormalities between fellow eyes and normal control eyes. Children diagnosed with Coats' disease who underwent UWFFA were retrospectively reviewed. Healthy eyes with complete UWFFA data were selected as controls. Retinal vascular abnormalities of the primary affected, fellow eyes and normal control eyes were recorded by investigating the UWFFA images. Among the 190 eyes of 95 patients with unilateral Coats' disease, 83 (87.4%) were male, and the median age was 9.00 (7.00, 12.25) years (4-18 years). 93 (97.9%) fellow eyes had peripheral capillary telangiectasia that most commonly located in the temporal periphery. 59 (62.1%) fellow eyes had microaneurysms and 19 (20.0%) had vascular leakage; 29 (30.5%) fellow eyes had peripheral vascular tortuosity and 86 (90.5%) eyes had peripheral right-angle vessels. Peripheral capillary non-perfusion (CNP) were found in 31.6% (30/95) fellow eyes. We also found that the terminal vascular patterns in the fellow eyes were mainly loop pattern, accounting for 90.5%. The incidence of capillary bed abnormalities, vascular leakage, right-angle vessels and CNP were significantly higher in fellow eyes of Coats' disease than control eyes (p<0.001, p=0.044, p<0.001, p=0.001, respectively). Regarding the terminal vascular patterns, the proportion of loop pattern in fellow eye group was significantly higher than that in control eye group (p<0.001). A total of 21 Coats' patients had follow-up UWFFA data. The average follow-up time was 13.19±10.09 (3-35) months. There was no significant change in peripheral retinal vascular abnormalities in the fellow eye of all patients between the first and last visit. Because Optos® UWFFA device is able to quickly take panoramic fundus images using mild excitation light without contacting the cornea, it allows the detection of peripheral vascular changes in the fellow eyes of children with Coats' disease. Contrary to the previous belief that Coats' disease is a "unilateral condition", our finding shows that Coats' disease appears to be a highly asymmetric bilateral disease, and the peripheral vascular abnormalities in the fellow eye remains stable in short term.

Improving methodology of radiosurgery for posterior fossa cavernomas: higher volume, lower dose.

We conducted a prospective series involving 35 posterior fossa cavernomas in 33 patients treated with low-dose radiosurgery protocols (12 Gy in a single fraction or 18 Gy in 3 fractions). Compared to previously published series, our approach targeted a larger treatment volume, encompassing the entire hemosiderin ring surrounding the cavernoma. Radiosurgery was indicated for cases of hemorrhage or progressive neurological deficits in anatomically challenging, nonsurgical areas. The statistical analysis was designed to address the unknown onset time of cavernoma prior to radiosurgery, enabling a more accurate calculation of the hemorrhage incidence rate before treatment. Follow-up evaluations, including clinical assessments and MRI, were conducted at 3-6-9-12-18-24 months and subsequently on an annual basis. With a mean follow-up duration of 26 months, exceeding the previously described latency period, and a median [IQR] follow-up of 13 months [8.7-30.4] which represents approximately half the latency period, only one patient experienced a recurrence of hemorrhage, occurring 20 months post-treatment and remaining asymptomatic. No patients exhibited radio-induced parenchymal changes or clinical deterioration following radiosurgery. These preliminary results support the strategy of increasing the target volume while reducing the radiation dose for cavernous malformations. We further recommend incorporating sensitivity analyses to evaluate the robustness of results, particularly in the context of uncertainties surrounding the time of onset of cavernomas.

Electroacupuncture normalized tumor vasculature by downregulating glyoxalase-1 to polarize tumor-associated macrophage to M1 phenotype in triple-negative breast cancer.

Triple-negative breast cancer is a particularly aggressive type of breast cancer that is closely associated with abnormal vascularization within the tumor. However, traditional anti-VEGF therapies and other treatments have limited efficacy. Tumor-associated macrophages (TAMs) induce and regulate tumor angiogenesis. In recent years, regulating TAMs polarization has become a hot topic for research with objectives to normalize tumor vasculature and improve drug delivery and the tumor microenvironment. Our previous studies have found that peritumoral electroacupuncture (EA) can regulate tumor angiogenesis, but the underlying mechanism remains unclear. In this study, we examined the phenotype of TAMs and inflammatory factors to observe the effect of peritumoral electroacupuncture on the phenotypic polarization of TAMs. Based on this, we evaluated the structure and function of tumor vasculature. Finally, we conducted a preliminary exploration of the mechanism underlying the regulation of TAMs phenotypic polarization by peritumoral electroacupuncture. In this study, we found that peritumoral electroacupuncture could promote the phenotypic polarization of TAMs toward the M1 type, thereby reducing microvascular density in tumor tissue, increasing pericyte coverage, improving the stability of the basement membrane, promoting vascular maturation, and enhancing perfusion while reducing tissue hypoxia. Peritumoral electroacupuncture can promote the phenotypic polarization of TAMs toward the M1 type, leading to normalization of tumor vascular structure and function. The mechanism may be related to the downregulation of glyoxalase-1 and subsequent activation of the MGO-AGEs/RAGE axis.

Mechanism of Traditional Chinese Medicine extract in the treatment of diabetic erectile dysfunction.

Diabetic erectile dysfunction (DED) is a prevalent but often overlooked microvascular complication of type 2 diabetes mellitus (T2DM), with strong associations to cardiovascular disease. The pathophysiology of erectile dysfunction (ED) in T2DM patients is more intricate than in non-diabetic individuals, likely involving multiple pathogenic mechanisms such as endothelial dysfunction, vascular alterations, neuropathy, and oxidative stress. Traditional Chinese Medicine (TCM) has long been utilized in the management of DED, drawing on an extensive body of clinical experience. In TCM, DED is typically attributed to imbalances such as renal yang deficiency or insufficiencies in qi and blood. Herbal therapies within the TCM framework offer a multifaceted approach to treatment, targeting not only the replenishment of kidney yang and the regulation of qi and blood but also incorporating strategies for glycemic control and renal protection. This holistic approach has demonstrated effectiveness in alleviating erectile dysfunction in diabetic patients, thereby improving quality of life. However, the complexity of Chinese herbal formulations, with their diverse bioactive constituents, complicates the identification of specific active compounds and the mechanistic understanding of their therapeutic actions. This complexity has contributed to ongoing skepticism regarding the clinical utility of TCM and herbal remedies in the treatment of DED. This study aimed to investigate the pathological mechanisms underlying the therapeutic effects of TCM in the treatment of DED, with a specific focus on the associated signaling pathways. By elucidating these mechanisms, the study seeks to provide a scientific basis for novel therapeutic strategies and enhance the viability of TCM-based approaches for DED management. Future research should prioritize the development of efficacious Chinese patent medicines tailored for the treatment of DED. This study utilizes keywords such as "diabetic erectile dysfunction", "signaling pathways", "traditional Chinese Medicine", "bioactive compounds", "herbal", "herbal monomers", and "herbal extracts" to conduct a comprehensive literature search in databases including Embase, PubMed, Web of Science, CNKI, Wanfang, and VIP, spanning all relevant publications up to February 2024. It has been demonstrated that TCM extract can treat the DED by influencing the signaling pathways involved. A comprehensive literature review was conducted across multiple databases, followed by rigorous screening, exclusion, summarization, synthesis, and analysis of relevant studies. The results indicate that TCM for DED primarily targets key pathological features, including endothelial dysfunction, vascular and neural abnormalities, and oxidative stress. The underlying mechanisms involve the NO/cGMP, eNOS, and PI3K/Akt/mTOR signaling pathways, contributing to significant improvements in erectile function. These findings provide a scientific basis for the use of TCM in DED, offering viable therapeutic options and innovative strategies to advance TCM-based treatment approaches. Furthermore, TCM exhibits notable potential in mitigating the pathological progression of DED. The pharmacological mechanisms and molecular signaling pathways of TCM extracts have been extensively investigated, underscoring their high value for clinical research and therapeutic development.

Pre-trained convolutional neural network with transfer learning by artificial illustrated images classify power Doppler ultrasound images of rheumatoid arthritis joints.

To study the classification performance of a pre-trained convolutional neural network (CNN) with transfer learning by artificial joint ultrasonography images in rheumatoid arthritis (RA). This retrospective study focused on abnormal synovial vascularity and created 870 artificial joint ultrasound images based on the European League Against Rheumatism/Outcome Measure in Rheumatology scoring system. One CNN, the Visual Geometry Group (VGG)-16, was trained with transfer learning using the 870 artificial images for initial training and the original plus five additional images for second training. The models were then tested for the ability to classify joints using real joint ultrasound images obtained from patients with RA. The study was registered in UMIN Clinical Trials Registry (UMIN000054321). A total of 156 clinical joint ultrasound images from 74 patients with RA were included. The initial model showed moderate classification performance, but the area under curve (AUC) for grade 1 synovitis was particularly low (0.59). The second model showed improvement in classifying grade 1 synovitis (AUC 0.73). Artificial images may be useful for training VGG-16. The present novel approach of using artificial images as an alternative to actual images for training a CNN has the potential to be applied in medical imaging fields that face difficulties in collecting real clinical images.

Sex-specific anatomical variation of circle of Willis arteries.

Anatomical variations in the circle of Willis (CoW) arteries are common and can affect hemodynamic stress, thereby influencing the risk of cerebrovascular pathology. Previous studies have suggested sex differences in CoW anatomy, but findings vary due to limited study population size and different measurement methods. This study aims to investigate sex differences in artery diameters, anatomical variants and bifurcation angles of the CoW using a large population cohort and semi-automatic measurements. Sex-specific CoW anatomical variations were assessed using Magnetic Resonance Angiography (MRA) scans of 1,052 individuals without intracranial vascular abnormalities. Diameters and bifurcation angles of large CoW arteries (>1.2 mm) were measured with a semi-automatic tool. Diameters of smaller anterior communicating artery (Acom) and posterior communicating arteries (Pcoms) and the anatomical variants of the CoW were determined manually. Generalized Linear Models (GLMs) and logistic regression models with adjustments for covariates were used to compare anatomical variations between sexes. Men exhibited larger diameters in all semi-automatically measured CoW arteries. A complete anterior CoW was more prevalent in men than women, while there was no difference for the posterior CoW. Aplasia/hypoplasia of the Acom was more prevalent in women. Aplasia/hypoplasia of one Pcom was more common in women, while aplasia/hypoplasia of both Pcoms was more common in men. No sex differences were found in CoW bifurcation angles and in the occurrence of fetal-type posterior cerebral arteries. This study identified significant CoW differences in artery diameters and anatomical variants between sexes, while bifurcation angles between arteries were comparable. Future research should investigate the association between these sex-specific CoW variations and cerebrovascular pathology.

Prenatal human brain development is not spared by IUGR: A systematic review.

Intrauterine growth restriction (IUGR) is a severe condition in which the fetus fails to reach its genetically predetermined growth potential, impairing prenatal development and predisposing individuals to postnatal consequences that may persist into adulthood. Although fetal mechanisms such as the brain-sparing effect have been proposed to protect the brain against IUGR-related deficits, the extent of this protection remains unclear. To conduct a systematic review that demonstrates prenatal morphofunctional abnormalities in the brain of individuals with IUGR. A comprehensive literature search was performed in the MEDLINE/PubMed database using keywords and Boolean operators: IUGR AND newborn AND nervous system NOT review. Inclusion criteria used: free and full-text availability, publication date from January 1, 2013, to July 31, 2024, newborns (birth to 1month), and both sexes. Exclusion criteria included studies of older infants, lack of focus on the central nervous system, multiple pregnancies, concurrent pathologies with IUGR, use of animal models, and review articles. The review protocol is registered with PROSPERO (ID: CRD42024542500). Seventeen studies were identified, totaling 2085 individuals. Of these, 1203 had some form of IUGR (early- or late-onset, symmetrical or asymmetrical, with or without circulatory centralization), whereas 882 were appropriate for gestational age (AGA) and served as controls. Across all studies, individuals with IUGR showed biometric, morphological, and/or cerebral vascular abnormalities, even when biparietal diameter or head circumference measurements were similar to those of AGA individuals. Prenatal human brain development is not spared by IUGR.

Endovascular management of carotid blowout syndrome

ABSTRACT Objectives To evaluate success, complications and efficacy for endovascular management for carotid blowout syndrome. Methods Images were evaluated for contrast extravasation, vessel wall irregularity, pseudoaneurysm/aneurysm formation. Hemostatic results in the immediate postprocedural period and procedure related infarcts were assessed. Results Total of 20 lesions in 21 patients were detected on digital subtraction angiography (DSA). In a case of esthesioneuroblastoma with active bleeding, DSA failed to show vascular abnormality. There was active contrast extravasation in 7 cases. Treatment modalities included covered stent placement (n = 3), pseudoaneurysm/aneurysm embolization (n = 4), parent artery occlusion (n = 13) and PVA injection (n = 1) in the immediate postoperative period was achieved in all except one case. During the post-procedural period, 6 patients (28.6%) suffered from cerebral ischemia. Rebleeding episodes were encountered in 10 cases (47.6%) after a mean duration of 35 days which responded to tamponade in 4 cases. Diagnostic DSA was performed in 5 of the cases, which failed to identify bleeding source in 2 and remaining 3 cases were treated by endovascular means. A case with massive hemorrhage 1-hour after endovascular treatment died before any intervention could be performed. Conclusion Endovascular treatment can achieve immediate hemostasis to prevent otherwise a highly morbid and mortal complication. However, rebleeding rates are high and cerebral ischemia with or without neurologic deficit occur in a non-negligible percentage of patients.

Exploration of treatment strategies for cerebral cavernous malformations: two case reports on non-resection treatment and literature review

BackgroundCavernous malformations are common vascular abnormalities of the central nervous system, but cavernous malformations of the cerebral aqueduct are rare. The choice of treatment is influenced by various factors.Case DescriptionWe report two cases of midbrain cavernous malformations. Both cases involved midbrain lesions obstructing the cerebral aqueduct, leading to obstructive hydrocephalus. The primary symptoms and complaints of the patients were related to hydrocephalus. Prior to surgery, patients underwent comprehensive imaging evaluations and received endoscopic third ventriculostomy rather than tumor resection. Both patients had favorable recoveries. We also reviewed the literature and discussed the choice of treatment strategies.ConclusionCavernous malformations are slow-progressing central nervous system lesions with a relatively benign natural course. When selecting a treatment strategy, clinicians should carefully consider the underlying cause of the patient’s primary symptoms and the specific objectives of the surgery. Avoiding overly aggressive resection that fails to address the main symptoms and potentially causes irreversible damage is crucial.

Lack of ST2 aggravates glioma invasiveness, vascular abnormality and immune suppression

Abstract Background Glioblastoma (GBM) is the most common primary malignant brain tumor in adults, characterized by aggressive growth and a dismal prognosis. Interleukin-33 (IL-33) and its receptor ST2 have emerged as regulators of glioma growth, but their exact function in tumorigenesis have not been deciphered. Indeed, previous studies on IL-33 in cancer have yielded somewhat opposing results as to whether it is pro- or anti-tumorigenic. Methods IL-33 expression was assessed in a GBM tissue microarray and public databases. As in vivo models we used orthotopic xenografts of patient-derived GBM cells, and syngenic models with grafted mouse glioma cells. Results We analyzed the role for IL-33 and its receptor ST2 in non-malignant cells of the glioma microenvironment and find that IL-33 levels are increased in cells surrounding the tumor. Protein complexes of IL-33 and ST2 are mainly found outside of the tumor core. The IL-33-producing cells consist primarily of oligodendrocytes. To determine the function for IL-33 in the tumor microenvironment, we used mice lacking the ST2 receptor. When glioma cells were grafted to ST2-deficient mouse brains, the resulting tumors exhibit a more invasive growth pattern, and are associated with poorer survival, compared to wild-type mice. Tumors in ST2-deficient hosts are more invasive, with increased expression of extracellular matrix remodeling enzymes and enhanced tumor angiogenesis. Furthermore, the absence of ST2 leads to a more immunosuppressive environment. Conclusions Our findings reveal that glia-derived IL-33 and its receptor ST2 participates in modulating tumor invasiveness, tumor vasculature and immunosuppression in glioma.

Abdominal hemorrhage and vascular fragility associated with neurofibromatosis type 1.

We report a case of recurrent abdominal bleeding associated with vascular fragility in a 67-year-old woman with neurofibromatosis type 1 (NF-1). Computed tomography (CT) scan revealed hemorrhagic ascites and a pseudoaneurysm of the sigmoid colon artery, which was suspected to be the source of bleeding. Emergency laparotomy confirmed extremely fragile vessels, requiring repeated surgeries for recurrent bleeding. The patient was diagnosed with NF-1 vasculopathy, a rare vascular complication of this autosomal dominant disorder. NF-1, which affects 1 in 3000-5000 individuals, is associated with reduced life expectancy due to malignancies and vascular diseases, including NF-1 vasculopathy. This condition involves structural vascular abnormalities and increased fragility affecting vessels of all sizes. Recognition of this fragility is critical during invasive procedures, such as interventional radiology or surgery, to reduce the risk of bleeding and ensure optimal management. This case highlights the importance of considering NF-1 vasculopathy in patients with abdominal bleeding and adopting tailored strategies to address its challenges.

Activating transcription factor-3 orchestrates the modulation of vascular anti-contractile activity and relaxation by governing the secretion of HDL-bound sphingosine-1-phosphate in perivascular adipose tissue.

Perivascular adipose tissues (PVATs) play a critical role in modulating vascular homeostasis and protecting against cardiovascular dysfunction-mediated blood pressure dysregulation. We demonstrated that the activating transcription factor-3 (Atf3) gene in the PVAT is crucial for improving vascular wall tension abnormalities; however, its protective mechanism remains unclear. Herein, we aim to determine whether ATF3 regulates PVAT-derived relaxing factor (PVDRF) biosynthesis and if its secretion contributes to vasorelaxation. This study employed an in vivo animal model using global Atf3-deficient mice, in vitro blood vessel myography, and biochemical analyses to evaluate ATF3-mediated PVDRF release and reactivity in the vasculature. Wild-type (WT) mouse thoracic aortic PVAT extracts significantly induced resting tone dilation and attenuated vasoconstrictor-induced contractile responses compared to Atf3-/- mice. Heat-stable PVAT extracts from WT mice caused sustained and reproducible vasodilation without tachyphylaxis in control aortic rings. Biochemical evaluation of PVDRF release revealed that Atf3-/- mice had lower sphingosine-1-phosphate (S1P) and HDL cholesterol (HDL-C) levels than WT mice. Furthermore, PVAT extracts from WT mice induced long-lasting vasorelaxation, which was significantly inhibited by the S1P3 receptor antagonist TY52156 and scavenger receptor class B type 1 receptor antagonist glyburide. ATF3 within the PVAT can modulate vascular function by strengthening sphingosine kinase 1 (sphk1)-S1P-S1P3 receptor lipid signalling and stimulating S1P binding to HDL to form the vasodilator HDL-S1P. ATF3 is an essential modulator for maintaining the physiological function of PVAT, providing a novel target for treatment of obesity-related cardiovascular diseases.

Analysis of etiology and short-term prognosis of childhood arterial ischemic stroke based on the COIST classification

Objective: This study aims to analyze the etiology and short-term prognosis of childhood arterial ischemic stroke (AIS) in Chinese children, based on the COIST classification system. Methods: A total of 380 pediatric patients with a first-ever diagnosis of AIS treated at Beijing Children's Hospital between September 2015 and April 2024 were retrospectively included. Etiology was analyzed according to COIST classification. The patients were categorized into infant and toddler group with 117 cases (>28 days to≤3 years), preschool group with 90 cases (>3 years to≤7 years), school-age group with 90 cases (>7 years to≤11 years), and adolescent group with 83 cases (>11 years to≤18 years). The etiological distribution across age groups and the short-term prognosis of patients with different etiologies were further analyzed. Results: Among the 380 patients, 235 were male (61.8%) and 145 were female (38.2%), with a mean age at presentation of(6.6±4.6)years. Approximately 2/3 of the patients were admitted in the Department of Neurology, with a mean hospital stay of (13.2±6.7)days. (1) Etiological analysis: "Vascular structural abnormalities" were the most common cause, accounting for 38.2% (145/380), followed by "Inflammatory" causes at 31.1% (118/380), "Undetermined" at 11.1% (42/380), "Other identifiable causes" at 9.2% (35/380), "Cardiac diseases" at 6.3% (24/380), and "thrombophilia" at 4.2% (16/380). (2) Etiological distribution by age group: in the infant and toddler group, "vascular structural abnormalities" were 47.9% (56/117), with basal ganglia infarction following minor trauma(combined with basal ganglia calcification) being the most common (40/117). In the preschool group, there were 34 cases (34/90) of "inflammatory" and 33 cases (33/90) of "vascular structural abnormalities", with Moyamoya disease being the most frequent cause (15/90). In the school-age group, there were 37(37/90) cases of "vascular structural abnormalities", with arterial dissection (12/90)being the most common, followed by FCA-i (11/90), and Moyamoya disease (11/90). In the adolescent group, there were 34 cases of "inflammatory"(34/83), with the highest proportion of FCA-i (13/83) in the subgroup, followed by thrombophilia (9/83) and systemic lupus erythematosus (8/83). (3) Short-term prognosis: based on the PSOM scale, 188 cases had good prognosis, accounting for 49.5% (188/380), while 192 cases had poor prognosis, accounting for 50.5% (192/380). According to the mRS score, 207 cases had good prognosis (54.5%) and 173 cases had poor prognosis (45.5%). Subtypes such as "Inflammatory-noninfectious, " FCA-i, Moyamoya disease, and arterial dissection were associated with relatively better outcomes. Less than 1/3 of patients in the "other identifiable causes" group had favorable prognosis. The in-hospital mortality rate was 3.7% (14/380). Conclusions: Vascular structural abnormalities and inflammatory (including infectious and non-infectious) factors are the predominant causes of pediatric AIS; Approximately half of children with AIS had a favorable short-term outcome.

Hereditary Vitreoretinopathies: Molecular Diagnosis, Clinical Presentation and Management.

Hereditary vitreoretinopathies (HVRs), also known as hereditary vitreoretinal degenerations comprise a heterogeneous group of inherited disorders of the retina and vitreous, collectively and variably characterised by vitreal abnormalities, such as fibrillary condensations, liquefaction or membranes, as well as peripheral retinal abnormalities, vascular changes in some, an increased risk of retinal detachment and early-onset cataract formation. The pathology often involves the vitreoretinal interface in some, while the major underlying abnormality is vascular in others. Recent advances in molecular diagnosis and identification of the responsible genes and have improved our understanding of the pathogenesis, risks and management of the HVRs. Clinically, HVRs can be classified according to the presence or absence of skeletal or other systemic abnormalities, retinal dysfunction or retinal vascular abnormalities [2]. There are some discrepancies in the literature regarding which diseases are included under the overarching term 'hereditary vitreoretinopathies'. Conditions such as Stickler syndrome, Wagner syndrome and familial exudative vitreoretinopathy are generally included, while others such as autosomal dominant neovascular inflammatory vitreoretinopathy (ADNIV) and autosomal dominant vitreoretinochoroidapathy (ADVIRC) may not. In this review, we will discuss some historical aspects, the molecular pathogenesis, clinical features and management of diseases and syndromes commonly considered as HVRs.

Anesthesia for pregnant patients with symptomatic neurological disease: 13 years’ experience from a tertiary care center

BackgroundImprovements in diagnostics and clinical care have allowed more women of childbearing age, suffering from neurological diseases, to safely have pregnancy, reducing peripartum complications. However, these patients remain at risk and are a constant challenge for anesthesiologists in the delivery room.MethodsTo assess the type of anesthesiologic management performed for delivery in obstetric patients with preexisting neurological disease and who reported significant neurological symptoms during pregnancy, a retrospective observational study was carried out between 1 October 2008 and 30 September 2021.ResultsData from 49,202 pregnant women were assessed over 13 years; 239 pregnant women with a diagnosis of preexisting neurological disease and who reported significant neurological symptoms during pregnancy were identified (prevalence 0.49%). The main neurological disorders that affected pregnant women included vascular abnormalities and intracranial bleeding (N = 42, 17.6%), central nervous system tumors (N = 35, 14.6%), epilepsy and episodic and paroxysmal disorders of the central nervous system (N = 34, 14.2%), diseases of the neuromuscular junction and muscles (N = 26, 10.9%), demyelinating central nervous system diseases (N = 24, 10%). A total of 234 (97.9%) pregnant women with neurological disorders and significant neurological symptoms underwent cesarean section: 192 (80.3% of the total cesarean sections) were elective, 39 (16.3%) were urgent type 2 and 3; 3 (1.2%) were emergency cesarean sections. General anesthesia was administered to 73 patients (30.5%), while 166 patients (69.5%) were managed with neuraxial techniques. 2 patients who had had neuraxial block reported worsening neurological symptoms that required a change in medical therapy. Postoperative multiparameter monitoring was performed for less than 24 h in the recovery room for 226 patients (94.6%). 3 patients (1.2%) were observed with multiparameter monitoring in the post-anesthesia care unit (PACU) for more than 24 hours; 10 patients (4.2%) were moved to the postoperative intensive care unit (ICU). The median hospitalization duration was 4 days (with an interquartile difference of 3–6 days).ConclusionsIn our experience, when neuraxial anesthesia was feasible, it proved to be a safe option for pregnant patients with symptomatic neurological disease, resulting in uncommon maternal complications.

Unraveling the transcriptomic landscape of brain vascular cells in dementia: A systematic review.

Cerebrovascular dysfunction plays a critical role in the pathogenesis of dementia and related neurodegenerative disorders. Recent omics-driven research has revealed associations between vascular abnormalities and transcriptomic alterations in brain vascular cells, particularly endothelial cells (ECs) and pericytes (PCs). However, the impact of these molecular changes on dementia remains unclear. We conducted a comparative analysis of gene expression in ECs and PCs across neurodegenerative conditions, including Alzheimer's disease (AD), Huntington's disease, and arteriovenous malformation, utilizing transcriptomic data from published postmortem human tissue studies. We identified differentially expressed genes (DEGs) consistently dysregulated in ECs and PCs across these pathologies. Notably, several DEGs are linked to vascular cell zonation and genetic risks for AD and cerebral small vessel disease. Our findings provide insights into the cellular and molecular mechanisms underlying vascular dysfunction in dementia, highlight the knowledge gaps, and suggest potential novel vascular therapeutic targets, including genes not previously investigated in this context. Systematic review of differentially expressed genes (DEGs) in vascular cells from neurodegenerative single-nuclear RNA-sequencing (snRNA-seq) studies. Identify overlapping DEGs in multiple vascular cell types across studies. Examine functional relevance and associations with genetic risk for common DEGs. Outline future directions for the vascular omics field.

Advances in moyamoya disease: pathogenesis, diagnosis, and therapeutic interventions.

Moyamoya disease (MMD) is a type of cerebrovascular disease characterized by occlusion of the distal end of the internal carotid artery and the formation of collateral blood vessels. Over the past 20 years, the landscape of research on MMD has significantly transformed. In this review, we provide insights into the pathogenesis, diagnosis, and therapeutic interventions in MMD. The development of high-throughput sequencing technology has expanded our understanding of genetic susceptibility, identifying MMD-related genes beyond RNF213, such as ACTA2, DIAPH1, HLA, and others. The genetic susceptibility of MMD to its pathological mechanism was summarized and discussed. Based on the second-hit theory, the influences of inflammation, immunity, and environmental factors on MMD were also appropriately summarized. Despite these advancements, revascularization surgery remains the primary treatment for MMD largely because of the lack of effective in vivo and in vitro models. In this study, 16 imaging diagnostic methods for MMD were summarized. Regarding therapeutic intervention, the influences of drugs, endovascular procedures, and revascularization surgeries on patients with MMD were discussed. Future research on the central MMD vascular abnormalities and peripheral circulating factors will provide a more comprehensive understanding of the pathogenic mechanisms of MMD.