Branch Of Artery Research Articles

Retrostyloid and retromandibular courses of the external carotid artery.

The external carotid artery (ECA) branching pattern has been extensively studied in the current literature. However, its topographical variability has been barely reported. The aim of the current study was to assess the ECA in relationship with the styloid process (SP) and the mandible. 100 computed tomography angiograms were randomly selected and retrospectively investigated on the neck region for the ECA course in relation to the SP and the mandible. A retrostyloid course of the ECA was identified on 18 sides (9%). Six patients had a bilateral retrostyloid ECA, and six patients had a unilateral variant. The side and sexes did not affect the prevalence of this variant. The elongated SP or variable ossification of the stylohyoid chain did not affect the retrostyloid course. The ECA retromandibular course of type 1 (straight course deep to the ramus of the mandible) was identified in 30.5%, type 2 (lateral retromandibular loop) in 20%, and type 3 (lateral retromandibular loop behind the ramus of the mandible) in 45.5%. The side and sexes did not affect the prevalence of this variant. Our study enhances the current knowledge on the ECA topography. Both variants investigated in the current study, displace the ECA into the parapharyngeal space. Knowledge of these anatomic variations are of importance preoperatively to avoid iatrogenic injuries.

Distribution of branches of anterior choroidal artery in the uncus: an anatomical study.

The aim of our study was to examine the relationship between uncus and uncal branches of anterior choroidal artery (AChA) and to observe the morphological and morphometric features of these branches. 124 hemispheres from 62 fresh cadavers were included in the study. Measurement of the length of AChA and the distances of the uncal branches to the origin of AChA were measured by ImageJ software. Morphological variations of uncal branches originating from AChA were observed. The length of AChA was found as mean 26.24 ± 4.34mm. It was determined that the average distance of these uncal branches arising from the AChA was 13.48 ± 7.31mm. In 4 out of 124 AChAs, no branches were observed. 594 branches originating from 120 were detected. 130/594 branches appeared to be terminal branches. AChAs of 80/120 hemispheres have been reported to have uncal branches. Thirty of 130 uncal branches were observed to originate as the first branch of AChA. It was found that uncal branches may originate from AChA with a variability between 1 and 4. When evaluated according to the origin of each branch from the AChA, it was observed that the uncal branches originated from the midpoint of the AChA on average. Also, in 64 hemispheres, morophological variations were detected regarding the origin of uncal branches. We believe that the morphological and morphometric data we obtained from the uncal branches of the AChA are of clinical importance in terms of understanding this complex region and minimizing errors in surgical procedures.

Postmyocardial syndrome after myocardial infarction and percutaneous coronary intervention

Postmyocardial syndrome (Dressler syndrome) is a form of secondary pericarditis with or without pericardial effusion resulting from myocardial damage. Dressler syndrome is not a common disease, but it should be suspected in patients with pathognomonic symptoms after a myocardial infarction (MI). The article presents a clinical case of a 65-year-old man, a smoker who is overweight, with a history of hypertension, MI with ST segment elevation, stenting of the envelope branch of the left coronary artery, thrombospiration. According to coronary angiography, the patient revealed a multivessel lesion of the coronary arteries. Two weeks after stenting, the patient’s condition worsened: shortness of breath, pain in the left half of the chest, fever appeared. During the examination at the outpatient stage, bilateral hydrothorax and hydropericardium were revealed. He was hospitalized, was treated with ibuprofen 600 mg 3 times a day for 7 days, with a positive effect. Ten days after discharge, the patient noted an increase in shortness of breath, an increase in body temperature, a recurrence of dull chest pain. He was hospitalized at the Vorokhobov City Clinical Hospital No. 67, where bilateral hydrothorax, hydropericardium, pneumonitis were detected during the examination. the diagnosis "Postmyocardial syndrome, recurrent course" was established. Hospital treatment was carried out with colchicine, methylprednisolone, acetylsalicylic acid, ticagrelor, losartan, bisoprolol, amlodipine, spironolactone. Against the background of the therapy, the condition improved, the patient began to notice an increase in exercise tolerance, a gradual regression of dull chest pain on the left, body temperature decrease to subfebrile figures. Positive dynamics of laboratory parameters was noted.

A review of the ethmoidal foramina and their clinical application.

The ethmoidal foramina (EF), located on the medial orbital wall along the frontoethmoidal sutures, are critical anatomical landmarks for surgeries involving the medial orbital wall. This review aimed to review the surgical anatomy of the EF, including their embryology and radiology. Although the frontoethmoidal sutures mostly have two foramina passing through them, there are reports of single foramen or multiple, up to six foramina. These foramina provide a passage for the ethmoidal arteries and nerves, branches of ophthalmic arteries and nerves. The surgical guideline "24-12-6" is based on the approximate distance between the anterior lacrimal crest, the anterior and posterior ethmoidal arteries, and the optic canal, commonly used to navigate this area. However, some studies from various populations defined different ratios. Embryologically, the EF were formed by the union of intramembranous ossified frontal bones and endochondral ossified ethmoid bones. EF and neurovascular structures can be identified in computed tomography even in the 3 mm sectional intervals. A comprehensive anatomical understanding of EF will help clinicians improve surgical guidelines and ultimately reduce the risk of complications.

The gut microbial metabolite phenylacetylglutamine increases susceptibility to atrial fibrillation after myocardial infarction through ferroptosis and NLRP3 inflammasome.

Myocardial infarction (MI) is an important risk factor for the development of atrial fibrillation (AF), and the gut microbial metabolite phenylacetylglutamine (PAGln) is strongly associated with the prognosis of MI patients. However, whether PAGln is involved in the regulation of AF after MI is currently unknown. Therefore, the present study aimed to explore the effect of PAGln on the susceptibility to AF after MI.MI model was constructed by surgically ligating the left anterior descending branch of the coronary artery. PAGln was administered by intraperitoneal injection for 7 consecutive days starting after surgery and then investigated by histopathologic, molecular biological, and electrophysiologic studies.Myocardial ischemia resulted in intestinal barrier dysfunction and significantly increased circulating levels of PAGln. Compared with the myocardial ischemia group, administration of PAGln significantly exacerbated atrial fibrosis and atrial electrical remodeling in mice after myocardial ischemia, as evidenced by shortening of the ERP (at varying pacing cycle lengths of 40, 60, 80, and 100), ion channel remodeling (Nav1.5, Cav1.2, and Kv1.5), and decreased expression of CX40, which led to an increase in the susceptibility to AF (54.5% vs. 90.9%, P < 0.05). In addition, administration of PAGln further exacerbated MI-induced intestinal barrier dysfunction compared with the MI group. Mechanistically, PAGln may affect atrial remodeling and AF susceptibility after MI by modulating ferroptosis and NLRP3 inflammasome.The present study preliminarily reveals that the gut microbial metabolite PAGln exacerbates post-MI AF remodeling and AF susceptibility, possibly through ferroptosis and activation of NLRP3 inflammasome.

Study on the protective mechanism of Xuemaitong Capsule against acute myocardial ischemia rat based on network pharmacology and metabolomics

BackgroundXuemaitong Capsule (XMT) is a widely recognized traditional Miao medicine extensively utilized in Chinese clinical settings. Previous studies have demonstrated XMT protective effects against acute myocardial ischemia (AMI). However, the mechanism by which XMT provides protection to AMI rats is yet to be fully understood. Aim of the studyThe purpose of this study was to investigate the protective mechanism of XMT on AMI rats through network pharmacology, traditional pharmacodynamics and metabolomics. Material and methodsThe components and potential targets of XMT were identified through the application of traditional Chinese medicine system pharmacology and traditional Chinese medicine molecular mechanism bioinformatics analysis tools. We constructed herb-composition-target networks and analyzed protein–protein interaction (PPI) networks. The potential mechanism was explored by pathway enrichment analysis. Subsequently, the AMI model was constructed by ligation of the anterior descending branch of the left coronary artery, and XMT protective effects on AMI rats were evaluated by analyzing the myocardial enzyme profiles, electrocardiograms(ECG), Triphenyltetrazolium chloride(TTC) staining, and Hematoxylin-Eosin (HE) staining in AMI rats. Metabolomics based on UHPLC-Q-Exactive Orbitrap MS was used to observe the protective effect of XMT on the serum metabolic profile of AMI, and multivariate statistical analysis further revealed the differential patterns of metabolites after XMT treatment. Finally, integrated pathway analysis was carried out to reveal the biological metabolic mechanism. ResultsA total of 392 active components of XMT acted with 624 targets for treating AMI. Pathway enrichment analysis revealed that XMT could treat AMI through TNF, MAPK and PI3K-Akt signaling pathways. Further, XMT could effectively prevent ST-segment elevation in the ECG, reduce the size of myocardial infarction, decrease cardiac weight index and cardiac enzyme levels, and mitigate histological damage in the hearts of AMI rats. In addition, XMT callback 117 metabolites and four metabolic pathways, including taurine and hypotaurine metabolism, phenylalanine metabolism, pyrimidine metabolism and retinol metabolism. Through integrating network pharmacology and metabolomics, we explored the biological mechanism by which XMT treats AMI. It was speculated that the mechanism of XMT is to regulate TNF signaling, PI3K-Akt pathway and MAPK signaling pathway, and participate in cell apoptosis, oxidative stress, immune and inflammatory reaction and other biological processes. ConclusionXMT plays a protective role in AMI rats by regulating multiple metabolic biomarkers, multiple targets and pathways. Therefore, XMT may provide a potential strategy for the treatment of AMI.

Facial Artery Branch Thrombolysis for Nasal Vascular Embolism Induced by Hyaluronic Acid Injection.

Vascular embolism is a severe complication following hyaluronic acid (HA) filler injections, with hyaluronidase injection being the most effective treatment. The nasal region, including the nose and nasolabial fold, is the most common site of vascular embolism after facial HA injections. Currently, there is insufficient clinical evidence regarding the benefits of facial artery thrombolysis. This article aimed to evaluate the efficacy of hyaluronidase injection via the facial artery as an emergency treatment for vascular embolism induced by facial aesthetic HA fillers. We reviewed 14 patients who experienced nasal vascular embolism following facial HA filler injections. All 14 patients underwent percutaneous facial artery thrombolysis with a combination of hyaluronidase and urokinase administered intravascularly. For patients with longer occlusion duration and severe necrosis, femoral artery interventional thrombolysis was performed, with local injection of platelet-rich plasma to promote recovery. Follow-up ranged from 1 month to 1 year. Following facial artery hyaluronidase injection, all cases showed improvement in nasal skin lesions. Twelve patients fully recovered, while 2 patients were left with minor superficial scars and defects in the nasal wings. Early thrombolysis postnasal embolism is crucial, and percutaneous facial artery puncture is an effective emergency treatment. Arterial intervention targeting the facial artery in the nasolabial fold may offer more precise thrombolysis. The combined use of hyaluronidase and urokinase is both safe and effective.

A clinical case of spontaneous coronary artery dissection in a young patient

Аim. To describe a clinical case of acute myocardial infarction in a young patient caused by spontaneous dissection of the coronary artery.Material and methods. The patient, a 32-year-old man, was hospitalized in the cardiology department with a clinical picture of acute coronary syndrome. When collecting anamnestic data, it was established that the patient has an aggravated cardiovascular, hereditary, pharmacological anamnesis and concomitant pathology. A special attitude of the patient to hisdisease in the form of an anosognosic reaction was revealed. The data of the coronary angiography study determined further tactics of patient management at the inpatient stage.Results. Taking into account the clinical picture, the dynamics of electrocardiograms, the results of laboratory diagnostics, acute myocardial infarction with ST segment elevation on the electrocardiogram was preliminarily diagnosed. During coronary angiography, spontaneous coronary artery dissection was detected in the patient, which was the main cause of acute left ventricular myocardial infarction. A decision was made to implant 3 stents in order to completely cover the dissection zone of the anterior interventricular branch of the left coronary artery. The choice of conservative and/or surgical tactics for managing patients with spontaneous coronary artery dissection is debatable. After percutaneous coronary intervention, drug therapy was prescribed, including dual antiplatelet therapy. The patient noted an improvement in his well-being, without relapses of pain syndrome. In the dynamics of inpatient treatment, according to echocardiographic examination, an aneurysm of the apex of the left ventricle with a mural thrombus was detected, which required correction of drug therapy, taking into account the increased risks of thromboembolic and hemorrhagic complications.Conclusion. This clinical case demonstrates that spontaneous dissection of the coronary artery is one of the pathogenetic mechanisms of the formation of the clinical picture of acute coronary syndrome and affects the development of complications and further prognosis.

An unexpected variation of occipital and ascending pharyngeal arteries: clinical implications

PurposeThe eight typical External Carotid Artery (ECA) branches are the superior thyroid artery, ascending pharyngeal artery, lingual artery, facial artery, occipital artery, posterior auricular artery, maxillary artery, and superficial temporal artery. The Internal Carotid Artery (ICA) has no branches in the cervical region before entering the carotid canal. We identified a variant of the Occipital Artery (OA) and Ascending Pharyngeal Artery (APA) originating in the cervical portion of the ICA and wish to explore the clinical implications this variation may have.MethodsBetween August and December 2023, 28 formaldehyde donors were dissected in the anatomy course for first-year medical and physician assistant students at the Creighton University School of Medicine, Phoenix campus.ResultsIn one donor, dissection of the right common carotid artery (CCA) revealed a variation of the ECA branches. Two branches were found on the proximal portion of the ICA. After tracing the branches cranially, we identified these as the OA and APA. These two arteries typically originate from the ECA. The bifurcation angle was observed to be nearly 180 degrees. This variation was only observed on the right side.ConclusionAs the prevalence of this variation has only been described in one study, reporting at 0.14%, documentation and education of this anatomy aids surgeons and interventional radiologists in head and neck procedures. Exploring the paths of these ectopic arteries promotes informed decision making and risk stratification for carotid endarterectomy, arterial embolization, bypass procedures, and arterial harvesting. Furthermore, performing thorough imaging such as CT angiograms on patients preoperatively provides better foresight to minimize complications.

Infective Endocarditis Following Selective Angioembolisation for Lower Gastrointestinal Tract Bleeding: A Case Report

Selective angioembolisation is a common treatment modality for lower gastrointestinal bleeding. Sepsis is an uncommon complication of the procedure, and infective endocarditis is even rarer yet. Presented here is a case of a male in his 50s who received selective angioembolisation to a branch of the right colic artery to control lower gastrointestinal bleeding. He subsequently developed sepsis and acute cardiac failure due to Enterococcus faecalis bacteraemia and infective endocarditis, requiring a valve replacement surgery and an extended course of antibiotics.

Functional results of partial nephrectomy depending on the use of various intraoperative techniques

Background. A lot of techniques are utilized in order to improve functional results of partial nephrectomy. Many questions regarding this issue remain controversial.Aim. To evaluate the influence of various techniques on the functional results of partial nephrectomy.Materials and methods. The retrospective study included 904 patients with renal cell carcinoma who underwent open partial nephrectomy between 2010 and 2019. The functional results were assessed according to the trifecta and pentafecta criteria. The effect on the functional results of the following techniques was assessed: a) enucleation of the tumor; b) coagulation of the bed without suture; c) preventive seams; d) hemostatic suture of the parenchyma;e) earlier removal of the clamp from the kidney vessels; f) use of intraoperative ultrasound; g) selective clamping of a branch of the renal artery. The effect of the studied characteristics on functional outcomes was assessed using univariate analysis by determining the odds ratio (OR) with 95 % confidence interval (CI). The difference was considered significant at the significance level of p &lt;0.05.Results. Two techniques significantly improved the likelihood of achieving the “trifecta”: enucleation (OR with 95 % CI 2.27 (1.36–3.81), p &lt;0.001) and preventive sutures (OR with 95 % CI 1.97 (1.22–2.83), p &lt;0.001). The univariate analysis showed a statistically significant increase in the probability of achieving the pentafecta for three techniques: enucleation (OR with 95 % CI 2.28 (1.33–3.82), p &lt;0.001), preventive sutures (OR with 95 % CI 2.22 (1.27–3.61), p &lt;0.001), and coagulation of the bed without sutures (OR with 95 % CI 2.24 (1.29–3.76), p &lt;0.001). When considering all techniques, a significant increase in the frequency of achieving the trifecta (OR with 95 % CI 2.31 (1.41–3.28), p &lt;0.001) and pentafecta (OR with 95 % CI 2.41 (1.45–3.77), p &lt;0.001) was observed.Conclusion. Tumor enucleation, preventive sutures and coagulation of the removed tumor bed without suturing allow, even when used as a single technique, to significantly improve the functional results of partial nephrectomy. Other technical maneuvers we evaluated also provide improved functional results when used in combination, thus creating a new concept of nephron-sparing surgery.

Association between preoperative D-dimer with morphologic features and surgical outcomes of acute type A aortic dissection.

The Association between preoperative D-dimer with morphologic features and surgical outcomes of Acute Type A Aortic Dissection (ATAAD) is still unclear. 430 ATAAD patients who underwent total arch replacement (TAR) and frozen elephant trunk (FET) in Beijing Anzhen Hospital of Capital Medical University between January 2016 to December 2020 were enrolled in the present study. Patients were divided into higher D-dimer (>2307 ng/ml) group and lower D-dimer (≤2307 ng/ml) group. We compared the extent of dissection and branch artery perfusion patterns between the two groups. The restricted cubic spline (RCS) was performed to assess the association between D-dimer with the extent of dissection and major adverse events after surgery. Among 430 patients, there was 45(10.47%) in-hospital mortality and 156(36.28%) major adverse events. Patients with higher D-dimer had bigger dissection extension length and false lumen perimeter in ascending aorta, thoracic descending aorta, diaphragmatic, coeliac trunk, and renal artery level. For the branch artery perfusion patterns, Patients with higher D-dimer had a higher proportion of malperfusion among the innominate artery, right renal artery, and both side iliac artery, a higher proportion of dissected intercostal artery/all intercostal artery>0.5(43.46% vs 29.63%, p = 0.003). The RCS linear regression model revealed a nonlinear association between lnD-dimer with extension length and false lumen perimeter (all p for overall and p for nonlinearity＜0.001 except false lumen perimeter in ascending aorta level). The RCS logistic regression model revealed a linear association between lnD-dimer with major adverse events (p for overall＜0.001, p for nonlinearity = 0.637). The association between lnD-dimer and major adverse events was still significant in the fully adjusted logistic regression model with CTA characteristics (OR (95% CI) =1.388 (1.137, 1.695), p = 0.001). Preoperative D-dimer strongly and positively correlates with the extent of dissection and major adverse events of ATAAD after total arch replacement (TAR) and frozen elephant trunk (FET). D-dimer seems to be a supplement that Indicates the severity of aortic dissection to aortic CTA.

Red Scalp Disease: An underdiagnosed entity.

Introduction: Red scalp disease or scalp rosacea, an inflammatory dermatosis, is frequently misdiagnosed as scarring alopecia due to nonspecific trichoscopic findings and limited case reports. While facial rosacea is well-documented, rosacea affecting extrafacial sites, such as the scalp, remains underrecognized. Accurate diagnosis is crucial to avoid unnecessary treatments and to establish appropriate prognosis. Case Report: A 70-year-old male with an asymptomatic red scalp for one year, unresponsive to topical treatments, presented to our clinic. Examination revealed diffuse erythema with papules and pustules. Trichoscopy showed vascular polygons, “caterpillar hair” vessels, linear arterial branching, and hairpin vessels. Diagnosis of scalp rosacea was made, and significant improvement was observed after two months of oral tetracycline therapy. Discussion/Conclusion: Red scalp disease is characterized by diffuse erythema, inflammatory lesions, and vascular changes. Patients often exhibit mild facial photosensitivity but may not show prominent facial rosacea symptoms. Distinct trichoscopic patterns can assist in accurate diagnosis. Early recognition and treatment with systemic antibiotics, such as tetracyclines, are crucial to prevent progression to more severe inflammation. Increased awareness among dermatologists and trichologists is essential to enhance the diagnosis and management of this condition.

Endonasal surgery high-risk carotid injury timeout checklist: implementation, institutional protocol and experience.

Carotid artery injury is a rare, but major complication of endonasal operations. The morbidity and mortality of such a complication can be mitigated by preparedness and a clear plan set in place to address the hemorrhage expeditiously. This study examines the implementation of such a carotid injury timeout checklist and demonstrates its effectiveness in a patient with possible arterial injury. A carotid injury timeout checklist was implemented for high risk endonasal procedures. The case selection was left to the surgeon, with guidelines including prior surgery, prior radiation, invasive tumors, and certain pathologies such as meningioma or chordoma. Factors affecting implementation were analyzed including tumor characteristics and patient history. Over a 12-month period, 103 endonasal operations were performed since the carotid artery injury timeout checklist was implemented, with 21 (20.4%) having a carotid artery injury timeout performed. Tumor characteristics that were associated with performing this timeout included Knosp grade (for pituitary adenomas, p = 0.002), carotid artery encasement (p < 0.001), extended approach (p < 0.001), tumor size (p = 0.05) and diagnosis (p < 0.001). Re-operation and prior radiation were not factors for this cohort. The single carotid artery branch (hypertrophic vidian artery) injury that was sustained was easily and successfully managed, aided by preparation established via this protocol. The additional time necessary for this timeout to be performed was negligible with respect to the overall surgery length. A carotid artery injury timeout can and should be successfully implemented for extended endonasal operations for pituitary and parasellar tumors with high risk factors including, but not limited to, carotid injury encasement, large tumor size and non-adenomatous diagnoses. A comprehensive plan for both intraoperative and perioperative management of the carotid injury is necessary to minimize the risk of morbidity and to deliver care expeditiously.

Safety Optimization of Injections in Specific Areas of the Scalp: A Cadaveric and 3D-CT Analysis of Arterial Distribution.

An injection method called cranial ceiling elevation is used in Asian countries to reduce facial proportions. Scalp injections carry risks such as arterial embolism or compression, leading to adverse events including scalp necrosis and hair loss. No arterial studies or injection recommendations exist for the injection of specific scalp regions. We aimed to examine blood vessel types and distributions to identify relatively safe areas for scalp injections. Computed tomography scans were used to evaluate the blood vessels in the scalp of 50 cadaver heads and anatomical studies were performed. Each scalp was divided into two segments (L1/L2) and six areas (S1/S1'-S3/S3'). The total number of arteries and the probability of each named artery occurring in each section were recorded. The total number of arteries in L1 was higher than that in L2 (L1, 78.76 ± 31.07; L2, 75.28 ± 28.68). The most frequently distributed artery in both L1 and L2 was the parietal branch of the superficial temporal artery. No significant difference was observed between the total number of arteries and the number of each named artery in the S1/S1'-S3/S3' segments. Except for S2' and S3', the number of named arteries in L1 was higher than that in L2. Large-volume scalp injections are not recommended. For injections within 30° above the ear, it is advisable to inject at L2. For other regions, it is also recommended to inject at L2. The periosteal layer should be selected for injection.

Abstract 4134306: Menopausal Status Protects Against Vascular Dysfunction Induced by Breast Cancer Chemotherapy

Introduction: Breast cancer chemotherapy is associated with an increased risk of cardiovascular events, particularly pronounced in postmenopausal women. Vascular damage and docetaxel-caused endothelial dysfunction may underlie these effects, although the role of estrogens and menopausal status remains undefined. Hypothesis: Estrogens protect premenopausal women from neoadjuvant chemotherapy-induced endothelial dysfunction (NACT regimen: docetaxel, doxorubicin, cyclophosphamide) and its component docetaxel. Methods: We studied vascular function and its molecular determinants in mammary artery branches from pre- and postmenopausal women undergoing breast cancer surgery, with or without prior NACT. Mechanisms were investigated in bilaterally ovariectomized female C57BL/6J mice treated with docetaxel or placebo. Results: While NACT evoked endothelial dysfunction characterized by the loss of nitric oxide bioavailability in blood vessels from postmenopausal women, premenopausal women were protected from this phenomenon (Fig. 1) . Furthermore, premenopausal women’s blood vessels exhibited resilience against NACT-induced vascular oxidative stress. In particular, NOX4 expression was markedly lower in NACT-treated arteries from premenopausal women compared to their postmenopausal counterparts. No differences were seen in the non-NACT groups. At the molecular level, NACT incited lower inhibitory phosphorylation of Thr495 eNOS in premenopausal women's arteries compared to those of postmenopausal women post-NACT. In mice following bilateral ovariectomy, docetaxel caused endothelial dysfunction, but did not perturb acetylcholine-induced vasodilation in non-ovariectomized mice. Docetaxel induced blood pressure only in the group of ovariectomized mice. Conclusions: NACT-induced vascular dysfunction, often observed in breast cancer survivors, is absent in premenopausal women. This can be partially attributed to the protective role of estrogens, which prevent excessive production of reactive oxygen species and inhibitory eNOS phosphorylation.

A Man with Rapidly Progressive Limb Gangrene

Antiphospholipid syndrome (APS) and polyarteritis nodosa (PAN) are two distinct, but potentially overlapping, autoimmune disorders that are characterized by vascular morbidities. We present a case of probable APS that manifested as rapidly progressive peripheral gangrene with a positive test for lupus anticoagulant (LAC), alongside with angiographic evidence of suspected renal and hepatic artery aneurysms commonly associated with PAN, but also the presence of diffuse thrombosis over the distal arterial branches in the four limbs. Through this case, we aim to review the overlapping features and potential interplay between APS and PAN, highlighting the necessary considerations for optimizing management to salvage the ongoing limb ischemia.

Dan-shen Yin attenuates myocardial fibrosis after myocardial infarction in rats: Molecular mechanism insights by integrated transcriptomics and network pharmacology analysis and experimental validation

Ethnopharmacological relevanceDan-shen Yin (DSY) originated from the “Shi Fang Ge Kuo” is a Chinese formula composed of three medicines: Salvia miltiorrhiza (Dan-shen), Santalum album L. (Tan-xiang) and Amomum villosum Lour. (Sha-ren). It has many years of clinical experience in the prevention of myocardial fibrosis (MF). However, the specific mechanism of DSY in prevent MF is not clear. Aim of the studyThis study aimed to assess the efficacy of DSY in the prevention of MF and reveal its underlying mechanism in a rat model of MF after myocardial infarction (MI) induced by ligation of the left anterior descending branch (LAD) of the coronary artery. Materials and methodsThe blood-entry components of DSY were analyzed by UHPLC-Q-TOF-MS/MS. LAD-ligated rats were used to assess the efficacy of DSY in the prevention of MF. Network pharmacology and transcriptomics analysis were used to predict possible target signaling pathways of DSY in MF. Echocardiography, immunohistochemistry and ELISA methods were used to evaluate the cardiac functions and biochemical changes of the rats. The mRNA expressions of target genes were measured by RT-qPCR. The proteins expressions, including Collagen I, Collagen III, α-smooth muscle actin (α-SMA), matrix metallopeptidase 2 (MMP 2), matrix metallopeptidase 9 (MMP 9), transforming growth factor-β (TGF-β), protein kinase B (AKT), phospho-AKT, extracellular regulated protein kinases (ERK), phospho-ERK, c-Jun N-terminal kinase (JNK), phospho-JNK, mothers against decapentaplegic protein (Smad3), and phospho-Smad3 were detected and quantified by Western Blot. ResultsUHPLC-Q-TOF-MS/MS analysis disclosed that 20 components within DSY could be absorbed into blood of rats. DSY improved myocardial injury in the myocardial tissue of LAD-ligated rats, as evidenced by the elevation of left ventricular ejection fraction and left ventricular fractional shortening, and the decrease of the serum CK-MB and LDH levels. Network pharmacology and transcriptomics predicted that DSY could interfere biological processes, such as extracellular matrix organization, focal adhesion and ECM-receptor interaction, and modulate TGF-β mediated signaling pathways, including PI3K/AKT, MAPK, and Smad3. Further study confirmed that DSY reduced MF, accompanied by reduced TGF-β, Collagen I, Collagen III, α-SMA, MMP 2 and MMP 9. Moreover, DSY repressed the phosphorylation of AKT, MAPKs and Smad3. In addition, DSY reduced inflammation and suppressed the mRNA expressions of IL-1β, IL-6, TNF-α, COX2 and iNOS in MF rats. ConclusionsOur study demonstrated that DSY prevented MF in vivo, the action of which was probably via reducing extracellular matrix organization, focal adhesion ECM-receptor interaction and inflammation by regulating TGF-β mediated PI3K/AKT, MAPK and Smad signaling pathways.

Organ-preserving embolization of a giant splenic hemangioma in an adult

Splenic hemangioma is a rare benign tumor, often found incidentally. Large hemangiomas bear a high risk of spontaneous rupture, an acute condition often life-threatening that requires immediate intervention. The spleen’s vital role in immunity and blood filtration mandates organ-preserving management of conditions such as hypersplenism or large lesions such as hemangiomas. A 51-year-old patient was referred to our department for abdominal pain due to a giant spleen hemangioma (6,6 × 6,3 × 5,6) cm in size. The patient was treated with hemangioma embolization through the splenic artery branches that fed the lesion, without any complications. Two years post-embolization the patient mentioned no symptoms and the hemangioma was measured (3 × 2) cm.Background The patient was referred to our department due to the large size of the lesion and the patient’s preference to avoid surgery and maintain the spleen. Our case report aims to underline (a) the safety and feasibility of the protocol among interventional radiologists, surgeons, and patients, (b) the benefit of relieving symptoms without losing a vital organ, and (c) the lower complication rate and hospital days compared with surgery. There are few reported cases of embolization of large spleen hemangioma. While Choi et al. (BMC Pediatr. 2018 12;18(1):354) report a similar case in a child. This case report describes the procedure in a stable adult and provides a 2-year follow-up.Graphical

A Rare Cause of Abdominal Pain: Superior Mesenteric Artery Branch Pseudoaneurysm Rupture.

A Rare Cause of Abdominal Pain: Superior Mesenteric Artery Branch Pseudoaneurysm Rupture.