Arterial Caliber Research Articles

Vasospasm in Pediatric Subarachnoid Hemorrhage.

Cerebral vasospasm (CV) is a common severe complication of subarachnoid hemorrhage (SAH), a severe type of intracranial bleeding that is uncommon in children. The purpose of this article is to review the current literature regarding this potentially devastating complication. CV may be asymptomatic and is less common in children compared to adults. Several molecular phenomena, including inflammatory ones, contribute to its pathophysiology. Better collateral circulation and higher cerebral blood flow are protective factors in children. When clinically apparent, CV may manifest as a change in the child's neurologic status or vital signs. CV can be diagnosed using brain vessel imaging, such as computed tomography angiography, magnetic resonance angiography, digital subtraction angiography, transcranial Doppler ultrasonography, and computed tomography perfusion. A reduction of < 50% in the artery's caliber confirms the diagnosis. Besides general supportive measures and causative treatment of SAH, CV management options include the administration of calcium channel blockers and neurointerventional approaches, such as intra-arterial vasodilators and balloon angioplasty. Long-term outcomes in children are usually favorable.

Whys and Wherefores of Coronary Arterial Positive Remodeling.

Positive remodeling (PR) is an atherosclerotic plaque feature defined as an increase in arterial caliber at the level of an atheroma, in response to increasing plaque burden. The mechanisms that lead to its formation are incompletely understood, but its role in coronary atherosclerosis has major clinical implications. Indeed, plaques with PR have elevated risk of provoking acute cardiac events. Hence, PR figures among the high-risk plaque features that cardiac imaging studies should report. This review aims to provide an overview of the current literature on coronary PR. It outlines the pathophysiology of PR, the different techniques used to assess its presence, and the imaging findings associated to PR, on both noninvasive and invasive studies. This review also summarizes clinical observations, trials, and studies, focused on the impact of PR on clinical outcome.

A 3D Statistical Shape Model of the Right Ventricular Outflow Tract in Pulmonary Valve Replacement Patients Post-Surgical Repair.

Assessment of the right ventricular outflow tract and pulmonary arteries (RVOT) for percutaneous pulmonary valve implantation (PPVI) uses discrete measurements (diameters and lengths) from medical images. This multi-centre study identified the 3D RVOT shape features prevalent in patients late after surgical repair of congenital heart disease (CHD). A 3D RVOT statistical shape model (SSM) was computed from 81 retrospectively selected CHD patients (14.7 ± 6.8 years) who required pulmonary valve replacement late after surgical repair. A principal component analysis identified prevalent shape features (modes) within the population which were compared with standard geometric measurements (diameter, length and surface area) and between sub-groups of diagnosis, RVOT type and dysfunction. Shape mode 1 and 2 represented RVOT size and curvature and tapering and length, respectively. Shape modes 3-5 related to branch pulmonary artery calibre, conical vs. bulbous RVOTs and RVOT curvature, respectively. Tetralogy of Fallot, transannular patch type and regurgitant RVOTs were larger and straighter while conduit and stenotic types were longer and more cylindrical than other subgroups. This SSM analysed the main 3D shape features present in a population of RVOTs, exploiting the wide 3D anatomical information provided by routine imaging. This morphological information may have implications for PPVI patient selection and device design.

Uterine layers hypervascularization in atypical placentation: the comparison of magnetic resonance imaging with vascular pathomorphology

Rationale: One in five women worldwide delivers through cesarean section, which is associated to a high rate of placenta previa and abnormal placenta attachment to the uterine wall. The grade of placenta accreta spectrum (PAS) correlates with blood loss volume, which could be related to vascularization characteristics. Up to now, there have been no studies on the diagnostic value of magnetic resonance criteria for hypervascularization of the uterine wall and their correlation with an assumed grade of PAS according to the International Federation of Gynecology and Obstetrics (FIGO) classification. Also, abnormal vessels location and their wall structure have not been studied with state-of-the-art pathomorphological methods. Aim: To develop a classification for various types of the uterine wall hypervascularization depending on the depth of placental invasion assessed by magnetic resonance imaging (MRI). Methods: We retrospectively analyzed medical files of 66 patients aged 18 to 45 years, who were assumed to have PAS based on their sonography results. To clarify the extent and localization of the placental invasion, all patients had MRI performed at 24 to 32 weeks of gestation. In all patients, the PAS grade was verified pathologically; in 30 of them (45,5%), a detailed pathological examination was additionally performed. The PAS grades were classified according to Morbidly Adherent Placenta Imaging Reporting and Data System (MAPI-RADS). The MRI data were correlated with the PAS (FIGO) grade estimated from intraoperative data and with intraoperative blood loss. At the final study step, the MRI data was correlated with abnormal pathomorphology, with the assessment of the degree of vascularization and the visual picture of abnormal uteroplacental vasculature. Results: We have proposed a classification of MRI signs of hypervascularization in the lower uterine segment correlating with the depth of placenta accreta. Type 1. Single small vessels in the myometrium, medium caliber arteries in the projection of the uterine serosa (normal variation for the 3rd trimester of gestation). Type 2. Numerous small confluent vessels, mainly in the uteroplacental region, and retroplacental hematomas (typical for placenta accreta, or FIGO PAS 1). Type 3. Intrauterine hypervascularization with a deficient myometrium thickness, predominantly vessels of the middle layer (typical for placenta increta, or FIGO PAS 2). Type 4. Thinning of the lower uterine segment due to significant bulging of the placenta in the presence of curved anastomosing vessels of vast caliber over 4 mm (typical for placenta increta – FIGO PAS 2, as well as placenta percreta – FIGO PAS 3a). Type 5. Hypervascularization outside the uterus, over its surface and in the parametrial tissues: at the border with the bladder, uterine isthmus, including signs of fibrosis and growing into the posterior bladder wall (typical for various grades of placenta percreta – FIGO PAS 3b, 3c). Conclusion: The proposed classification of uterine wall hypervascularization in accordance with the grades of placenta accreta spectrum (FIGO PAS) could be useful for its practical implementation by radiologists.

Inter-observer and inter-modality concordance of non-contrast MR angiography and CT angiography for preoperative assessment of potential renal donors

BackgroundMagnetic resonance angiography (MRA) is rapidly being employed as an effective substitute for CTA, particularly in situations of poor kidney function. We aimed to examine the inter-observer and inter-modality reliability of non-contrast MR angiography (NC-MRA) and CTA as a non-invasive tool for assessing the anatomical findings of potential living kidney donors.ResultsAll potential donors were referred from specialized kidney transplantation center and underwent NC-MRA of the renal arteries using a respiratory-triggered magnetization prepared 3D balanced steady-state free precession (b-SSFP) with inversion recovery pulses and fat saturation (Inhance 3D Inflow Inversion Recovery (IFIR)). Two experienced radiologists reviewed NC-MRA images and were asked to evaluate both renal arteries anatomy and their branching pattern, presence of accessory or aberrant renal arteries, and identify any anatomical variant. Lin’s correlation test was performed to test MRA readings by each of the two observers against CTA findings which considered as the gold standard for assessment of renal arteries. Additionally, observers were asked to assess the image quality. The study included 60 potential kidney donors (43 males and 17 females) with mean age ± SD of 31.3 ± 5.6 years. Excellent to very good inter-observer agreement was found between both observers in the assessment of renal arteries by NC-MRA. There was perfect concordance between MRA and CTA findings in detecting early arterial division, caliber, and length of left extra-parenchymal segmental branches. Moderate concordance was found in the assessment of the supplied segments of extra-parenchymal segmental renal arterial branches and substantial concordance between both MRA observers’ findings in the remaining variables of the study. There was excellent agreement between both observers in the assessment of image quality parameters.ConclusionsNC-MRA for the renal arteries is an effective alternative for CTA without the risks of radiation or contrast media.

Agreement between CT-Angiography and Digital Subtraction Angiography in Predicting Angiographic Vasospasm in Patients with Subarachnoid Hemorrhage.

Background/Objectives: Digital subtraction angiography (DSA) is the gold standard in the diagnosis of cerebral vasospasm, frequently observed after subarachnoid hemorrhage (SAH). However, less-invasive methods, such as computed tomography angiography (CTA), may be equally accurate. To further clarify comparability, this study evaluated the reliability of CTA in detecting cerebral vasospasm. Methods: This retrospective study included 51 patients with SAH who underwent both CTA and DSA within 24 h. The smallest diameter of the proximal cerebral arterial segments was measured in both modalities at admission and during the vasospasm period. The mean difference in diameter, the intraclass correlation coefficient (ICC) of CTA and DSA, the difference in grade of vasospasm and sensitivity, the specificity and the positive predictive value (PPV) for CTA were calculated. Results: A total of 872 arterial segments were investigated. At time of admission, arterial diameters were significantly smaller on CTA compared to DSA in all segments (-0.26 ± 0.12 mm; p < 0.05). At time of suspected vasospasm (day 9 ± 5), these differences remained significant only for the M1 segment (-0.18 ± 0.37 mm, p = 0.02), the P1 segment (-0.13 ± 0.24 mm, p = 0.04) and the basilar artery (-0.20 ± 0.37 mm, p = 0.0.04). The ICC between CTA and DSA was good (0.5-0.8). The sensitivity of CTA for predicting angiographic vasospasm was 99%, the specificity was 50% and the PPV was 92%. Conclusions: Arterial diameters measured on CTA may underestimate the arterial caliber observed in DSA; however, these absolute differences were minor. Importantly, vessel diameter alone does not fully reflect malperfusion, requiring additional imaging techniques such as CT perfusion.

Geometry and Symmetry of Willis' Circle and Middle Cerebral Artery Aneurysms Development.

Background: A relationship between the geometry and symmetry of Willis' circle and intracranial aneurysms was reported for anterior communicating and posterior communicating (PCom) aneurysms. A similar association with the middle cerebral artery (MCA) aneurysms instead appeared weaker. Methods: We reviewed 432 patients from six Italian centers with unilateral MCA aneurysms, analyzing the relationship between the caliber and symmetry of Willis' circle and the presence of ruptured and unruptured presentation. CT-angiograms were evaluated to assess Willis' circle geometrical characteristics and the MCA aneurysm side, dimension and rupture status. Results: The hypoplasia of the first segment of the anterior cerebral artery (A1) was in approximately one-quarter of patients and PCom hypoplasia was in almost 40%. About 9% had a fetal PCom ipsilaterally to the aneurysm. By comparing the aneurysmal and healthy sides, only the PCom hypoplasia appeared significantly higher in the affected side. Finally, the caliber of the internal carotid artery (ICA) and the first segment of MCA (M1) caliber were significantly greater in patients with unruptured aneurysms, and PCom hypoplasia appeared related to the incidence of an ipsilateral MCA aneurysm and its risk of rupture. Conclusions: Although according to these findings asymmetries of Willis' circle are shown to be a risk factor for MCA aneurysm formation and rupture, the indifferent association with ipsilateral or contralateral hypoplasia remains a datum of difficult hemodynamic interpretation, thereby raising the concern that this association may be more casual than causal.

Application of micropolar fluid model to blood flow through catheterized artery with stenosis and thrombosis

This paper presents a model of nonisothermal blood flow through a diseased arterial segment due to the presence of stenosis and thrombosis. The rheological properties of the blood in the annulus are captured by utilizing micropolar fluid model. The equation describing the blood flow and heat transfer is developed under the assumption that stenosis growth into the lumen of the artery is small as compared to the average radius of the artery. Biological processes like intimal proliferation of cells or changes in artery caliber may be activated by small growths that cause moderate stenotic blockages. Closed-form solutions for temperature, velocity, resistance impedance and wall shear stress are obtained and then utilized to estimate the impact of various physical parameters on micropolar blood flow. Graphs are plotted to illustrate variations in temperature, velocity, shear stress at the wall and resistance impedance against different controlling parameters. The results are also validated via the bvp4c approach.

Medial sural artery perforator free flap versus radial forearm free flap in oral cavity reconstruction and donor site morbidity.

Radial Forearm Free flap (RFFF) is widely used in head and neck reconstruction, yet its donor site defect remains a significant drawback. The Medial Sural Artery Perforator Free Flap (MSAPFF) is considered an alternative flap to RFFF. This study aims to comprehensively analyze their characteristics, outcomes, and their impact on patient quality of life. All patients who underwent oral cavity reconstruction using RFFF and MSAPFF between February 2017 and April 2023 were included in this study. Flap characteristics, outcomes and post-operative complications were recorded and compared. Subjective donor site morbidity, aesthetic and functional results, and quality of life were also analyzed. The study included 76 patients: 37 underwent reconstruction with RFFF, and 39 with MSAPFF. There was no significance difference between the RFFF and MSAPFF regarding the success rate (97.2% vs 97.4%), flap size (4.8 × 8.8 cm2 vs 5 × 9.8 cm2), hospital of stay (15.5 days vs 13.5 days) and recipient site complications (P > 0.05). However, MSAPFF showed larger flap thickness (P = 0.001), smaller arterial caliber (P = 0.008), shorter pedicle length (P = 0.001), and longer harvesting time (P < 0.001). No significant difference was observed between the pre-and postoperative ranges of wrist and ankle movements or in recipient site complications. MSAPFF showed a significant difference in donor site morbidity (P < 0.05). The MSAPFF is an excellent alternative to the RFFF for repairing oral cavity defects, with additional advantage of a well-hidden scar on the posterior calf, a larger flap thickness, accepted pedicle length and arterial caliber. However, one should consider the harvesting time and surgical skills required in comparison to the RFFF. The study highlights the importance of the MSAPFF as an alternative option for RFFF with less donor site morbidity and high success rate in oral cavity reconstruction and improved patient Quality of life after ablative surgery.

Hybrid procedures in the treatment of obliterative arteriopathy of the lower limbs

Lower extremity artery disease is defined as a narrowing of the caliber of arteries to the lower limbs, resulting in hemodynamic loss, with or without clinical symptoms, The detection and the diagnosis of peripheral arterial disease is obtained by calculating the ankle brachial index , An adapted treatment reduces the morbi-mortality linked to this disease, the management of LEAD involves controlling risk factors and hygienic-dietary measures, medical management, and finally surgical treatment (conventional surgery, endovascular treatment, or hybrid procedures). The progress in hybrid procedures has expanded the possibilities for revascularization in patients with severe and complex arterial lesions. These techniques provide an excellent alternative for specific indications,

Carotid Artery Stenosis as a Predictor for Stroke Following Transcatheter Aortic Valve Implantation.

Stroke remains a clinical risk in the long-term follow-up of patients after transcatheter aortic valve implantation (TAVI). We aimed to investigate the association between existing carotid artery stenosis (CS) and the risk of stroke after TAVI. The study participants were consecutive patients who underwent TAVI between 2008 and 2020 and were screened for CS at baseline and at the 30-day follow-up. Hemodynamically relevant CS was defined as a reduction of the carotid artery caliber by >50% in relation to the distal segment. The primary endpoint of this study was ischemic stroke or transient ischemic attack (TIA) within 30 days of TAVI. Stroke-related death was also assessed. Of the 1,537 patients included, 220 (14.3%) patients had CS ≥50%. Within 30days following TAVI, 41 patients (2.7%) experienced an ischemic stroke or TIA, and seven had stroke-related death. The median time from TAVI to stroke/TIA was 3.0 days. Patients with CS ≥50% had a 2.56-fold increased risk of stroke/TIA after TAVI (95%CI: 1.29-5.10, P = .006). The association was consistent in the multivariable model after adjusting for sex, atrial fibrillation, and estimated glomerular filtration rate. Investigations are needed to mitigate the risk of stroke in patients with CS ≥50%.

Exploring the anatomical configurations of the cerebral arteries in a cohort of South African patients

The cerebral arteries, specifically the anterior cerebral artery (ACA) and posterior cerebral artery (PCA), work together with the smaller calibre arteries to provide effective communication between the anterior and posterior circuits of the brain via the circle of Willis (CoW). Morphologic variations of the cerebral arteries and the CoW may alter blood flow to the brain, resulting in intracranial vascular disorders associated with stroke, and aneurysms. This study aimed to document the morphology of the cerebral arteries and the CoW in the South African population. Two hundred and thirty-nine computed tomography angiography scans were assessed. Cerebral arteries and CoW normal morphology and variations were classified as complete, absent, or hypoplastic. The ACA A1 was absent in 4.91%, hypoplastic in 30.40%, fenestrated in 1.06%, and typical in 63.6%. The ACA A2 was absent in 0.42%, hypoplastic in 26.28%, and typical in 69.44%. We found triple ACA A2 in 2.98%, azygos in 1.28% and fenestrated in 1.28%. The middle cerebral artery (MCA) was hypoplastic in 7.35% and typical in 92.64%. The PCA was hypoplastic in 28.74% and typical in 71.25%. Knowledge of the configuration of the CoW plays a significant role in guiding therapeutic decision-making in treating various neurovascular pathologies.

Follow-up evaluation of snuffbox arteriovenous fistula as an alternative site for hemodialysis - a case series in a lower-middle country

Link of Video Abstract: https://youtu.be/MSeO8kuKhGc Introduction: The preferred vascular access for hemodialysis in chronic kidney disease patients is the arteriovenous fistula (AVF). It is recommended to create AVFs as distally as possible. The snuffbox, situated at the far end of the wrist, is infrequently utilized for AVF insertion due to the prevalent smaller vessel calibers. Case: This case series involves seven patients with chronic kidney disease scheduled for first AVF placement in the snuffbox region, with an average age of 56.71 years. All patients showed an average radial artery caliber of 20.3mm, a mean peak systolic velocity of 67.14 cm/s, and a cephalic vein caliber of 22.7mm, according to preoperative vascular ultrasound. The AVF placement involved an end-to-side anastomosis. All patient demonstrated anastomosis clinical maturation, the primary patency rate was 86%. Follow-up Doppler examinations revealed that patients achieving functional patency had an average caliber of 5.22mm and an average flow rate of 810.65 ml/s. Conclusion: SAVF are created less frequently due to predominantly smaller vessel caliber. However, it can be a viable alternative site for fistula implantation. Vascular mapping is required to ensure that both vessels have minimum 2 mm caliber. Maturation in SAVF have comparable results with the other sites.

Suprasternal approach for insertion of Impella 5.5 into the proximal right subclavian artery

The Impella 5.5 (Abiomed) is a percutaneous, temporary left ventricular assist device (LVAD) that serves as an important method of treatment of acute cardiogenic shock refractory to medical management. The Impella 5.5 and 5.0 are commonly inserted through the right axillary artery; however, this may be limited by inadequate vessel diameter to accommodate the Impella and inadequate vessel quality. A central approach to Impella 5.5 incision has been described in the pediatric population, particularly via the innominate artery through a suprasternal and/or neck incision, with success. As an alternative to axillary Impella placement, we propose the usage of a limited suprasternal incision for Impella 5.5 insertion in the adult population, either through the proximal right subclavian artery or the distal innominate artery. This may offer multiple advantages, such as increased vessel diameter and quality of more proximal vessels, avoidance of partial sternotomy, avoidance of a second infraclavicular wound site if the patient progresses to require LVAD or transplant, avoidance of lymphatic and nerve injury through the axillary exposure, ease of manipulation for repositioning, and patient rehabilitation. Potential limitations include difficulty due to body habitus, potential risk of stroke with the innominate approach, and wound complications. A central approach is a reasonable alternative to axillary Impella placement in patients with inadequate axillary artery caliber, defined as less than 6–7 mm diameter, poor artery quality to accommodate anastomosis, and small body habitus, allowing for ease of exposure.

Artificial Intelligence-based quantitative evaluation of retinal vascular parameters in thyroid-associated ophthalmopathy.

Thyroid-associated ophthalmopathy (TAO) may result in increased metabolism and abnormalities in microcirculation. The fractal dimension (Df) of retinal vessels has been shown to be related to the pathology of a number of ophthalmic disorders, but it hasn't been investigated in TAO. We analyzed 1078 participants aged 18 to 72 (548 healthy volunteers and 530 TAO). Images were captured using a non-mydriatic 45-degree fundus camera. Baseline retinal characteristics, such as vessel width, tortuosity, and Df were measured using semiautomated software from fundus images. The average retinal parameters were compared between the two groups. The receiver operation curve (ROC) was used to assess the diagnostic efficacy of various retinal vascular parameters for TAO. Despite controlling for potential confounding variables, Df, vessel width, and tortuosity significantly increased in TAO compared to healthy volunteers. Compared to active TAO, patients in the inactive phase had a larger retinal venous caliber (p < 0.05), but there was no difference in Df or arterial caliber. Moderate and severe cases had a higher Df compared with mild cases (EUGOGO guidelines). The area under the ROC for Df, tortuosity, and vascular caliber in the diagnosis of TAO was 0.904 (95% CI: 0.884-0.924), 0.638 (95% CI: 0.598-0.679), and 0.617 (95% CI: 0.576-0.658), respectively. Due to its accessibility, affordability, and non-invasive nature, retinal vascular Df may serve as a surrogate marker for TAO and might be used to identify severe cases. With relatively high diagnostic performance, the Df is of some utility for the detection of TAO.

Abstract TP220: Intracranial Dotter Angioplasty Using Tenzing for Symptomatic Atherosclerotic Stenosis: Initial Experience

Introduction: Traditional endovascular treatment for acutely symptomatic intracranial atherosclerotic disease (ICAD) includes balloon angioplasty and stenting. Catheter mediated angioplasty (or “Dotter” angioplasty) has been previously described for extracranial carotid and peripheral arteries. The Tenzing 7 (Route 92 Medical, San Mateo, CA), a novel shelf-reducing delivery catheter, has an atraumatic tapered distal tip that progressively enlarges to a 0.062 inch (1.6 mm) outer diameter, which may enable catheter-mediated Dotter angioplasty of ICAD, or Tenzing-plasty. We report our initial experience in treating symptomatic ICAD using Tenzing-plasty. Methods: After IRB approval, we performed a retrospective review of patients undergoing endovascular treatment for symptomatic ICAD with Tenzing-plasty as a first approach at our stroke centers from 2021-2023. All patients were treated using the Tenzing 7 delivery catheter in an off-label fashion. The Tenzing was slowly inserted across the ICAD stenosis in each case under roadmap fluoroscopic guidance. Subsequent balloon angioplasty and/or stenting were at operator discretion. We examined clinical, imaging, and procedural data. Results: We identified 14 consecutive patients with symptomatic ICAD stenosis who underwent Tenzing-plasty, either as part of an emergent thrombectomy procedure, or if medical management of ICAD had failed. The median age was 62±11 years and 6 were female (43%). Stenosis location was: 1 ICA, 7 M1, 4 M2, 2 vertebral. The average pre-treatment ICAD stenosis was 95±7%, including 6 patients (43%) with complete occlusion. In 100% of cases, Tenzing-plasty resulted in improvement in arterial caliber after median 1 pass (IQR1-1), with average stenosis improving to 64±15%. Subsequent balloon angioplasty was performed in 3/14 cases (21%). Stenting was performed in 10 cases (using Atlas, Wingspan, Onyx Resolute, Onyx Frontier). There were no instances of arterial perforation or symptomatic intracranial hemorrhage. Conclusions: Intracranial Dotter angioplasty as a first approach using the novel tapered tip Tenzing 7 catheter may be a feasible and safe alternative for improving luminal caliber and flow restoration of symptomatic ICAD lesions. Further study is warranted.

The structural rearrangement of testicular arteries in case of chronic ethanol intoxication

Prolonged poisoning of the body with ethanol damages almost all its organs and systems. Structural changes in testicular arteries under the influence of chronic ethanol intoxication have not been fully studied. Purpose - to analyze the morphometric parameters of the small caliber arteries of the right and left testicles of rats in case of chronic ethanol intoxication. Materials and methods. 62 laboratory sexually mature male rats was performed. The animals were divided into two groups. The Group 1 (control) included 30 rats, the Group 2 (experimental) - 32 animals. The experimental rats, which were conducted to the experiment, were injected intragastrically with a 30% ethanol solution at the rate of 2 ml per 100 g of body weight for 28 days once a day. Animals were euthanized by heart bleeding under thiopental anesthesia. Histological micro-sections were made from the left and right testicles. Morphometrically, the outer and inner diameters of the arteries, media thickness, adventitia, Vogenvoort and Kernogan indices, the height of endotheliocytes, the diameter of their nuclei, the nuclear-cytoplasmic ratio in these cells, and the relative volume of damaged endotheliocytes were determined morphometrically in small-caliber arteries. Statistical processing of digital data was carried out using Excel (Microsoft, USA) and STATISTICA 6.0 (Statsoft, USA) software. Results. It was established that in case of simulated experimental conditions of chronic ethanol intoxication, the investigated morphometric parameters of the arteries of the left and right testicles changed significantly. In case of chronic intoxication with ethanol in rats, pronounced structural rearrangement of testicular vessels, mainly small arteries, characterized by thickening of the blood vessel’s wall, narrowing of vessels’ lumen, rearrangement of endothelial cells, and an increase in the relative volume of the damaged cells of intima, is established, and is dominant in the left testis. Conclusions. In case of chronic intoxication with ethanol the structural changes in testicular tissues are dominant in the left testis. Pronounced remodeling of small caliber testicular arteries causes endothelial dysfunction, deterioration of blood supply to the testicles, hypoxia, dystrophic and necrobiotic tissue changes, infiltrative and sclerotic processes, which are the pathomorphological basis of male infertility. When carrying out experiments with laboratory animals, all bioethical norms and recommendations were observed. No conflict of interests was declared by the authors.

Examining the Influence of Gender, Age, and Dominance on the Caliber of Normal Coronary Arteries in the South Indian Population.

Background The diameter of coronary arteries serves as a potential predictor of coronary artery diseases (CADs) that can lead to sudden death. Factors such as gender, age, and coronary artery dominance play a role in influencing the size of normal coronary arteries. The outcome of coronary interventions, to a certain extent, depends on luminal size. Given the considerable variability in luminal size within the normal population, establishing the baseline size of normal coronary arteries in a specific population can aid in estimating the severity of coronary disease and predicting the outcome of interventional procedures. The current study focuses on estimating the luminal diameter of normal coronary arteries within the context of age, gender, and cardiac dominance in the South Indian population. Methods A retrospective study was conducted utilizing coronary angiograms with normal findings from 453 patients, comprising 257 males and 196 females, with a mean age of 54.66±10.66 years. These patients attended the outpatient service of the Cardiology Department at Amrita Institute of Medical Sciences, Kochi, a quaternary care center, between 2015 and 2017. The luminal diameterof coronary arteries is representedas mean±SD in millimeters. Results In the present study, we noted that the largest coronary artery was the left main coronary artery (LMCA, 3.59±0.58 mm), followed by the left anterior descending artery (LAD, 3.50±0.52 mm), the left circumflex artery (LCX, 3.31±0.57 mm), and the right coronary artery (RCA, 3.18±0.57 mm). We further broke down the statistics to evolve a gender pattern. In the raw comparison of data, the luminal size of coronary arteries in males was greater than in females, and statistical significance was noted in all except LAD. In males, the largest coronary artery was LMCA (3.70±0.60 mm), followed by LAD (3.54±0.48 mm), LCX (3.36±0.58 mm), and RCA (3.25±0.62 mm). In females, no significant size difference was observed between LMCA (3.45±0.53 mm) and LAD (3.46±0.55 mm). Females exhibited an increase in the size of LMCA with advancing age. Regardless of right or left cardiac dominance, LMCA was consistently larger than RCA in both genders. However, in cases of co-dominance, only males demonstrated significantly larger LMCA. Conclusion Precise knowledge of the size of normal coronary arteries and their influence by gender, age, and dominance can be crucial for the comprehensive evaluation of CADs and the success of interventional procedures.

Comparison of Two Surgical Techniques Based on the Semitendinosus Myocutaneous Flap in Cats.

The objective of this experimental study was to compare the semitendinosus (ST) to the split-semitendinosus (SST) myocutaneous flap in covering distal limb skin defects in cats. Twenty-eight purpose-bred laboratory DSH cats were used and allocated into two groups (ST-group (A); n = 14, SST-group (B); n = 14). ST flaps, based on the distal muscle pedicle, and SST flaps, after longitudinal division of the muscle based on both muscle pedicles, were tested over skin defects created on the medial distal tibia. Clinical assessment, planimetry, CT-angiography (CTA) and histological examination were compared between groups. Days to complete flap healing between ST and SST-flaps (30.36 ± 9.1, 32.29 ± 5.44, respectively) and final total flap areas (68.36% ± 27.18, 51.83% ± 22.48, respectively) revealed no significant differences. On CTAs, the caliber of the distal caudal femoral vein on day 10 was statistically significant higher (p < 0.001) for group A and a significantly higher caliber of the distal caudal femoral artery on day 30 for group B (p = 0.021). Histology revealed statistically higher degeneration at 6 months (p = 0.047) for group A, and statistically higher fibrosis at 12 months (p = 0.019) for group B. Both ST and SST flaps had similar healing times and provided coverage of skin tibial defects in cats.

Right-angled vessel characteristics in different stages of type 2 macular telangiectasia (MacTel).

To study right-angled vessels (RAV) in disease progression and macular neovascularization in type 2 macular telangiectasia (MacTel) eyes. This retrospective image analysis study examined type 2 MacTel patients' multicolour® and OCT imaging records from January 2015 to March 2023. Age, gender, laterality, visual acuity, systemic disease, and follow-up duration were recorded. RAV characteristics were assessed using OCT and multicolour® images. This study examined RAV characteristics and type 2 MacTel disease stage. In total, 270 eyes of 146 patients (97 females, 66%) with a mean age of 60.77 ± 9.34 years were studied. 153 (57%) eyes showed RAV. The non-proliferative stage of type 2 MacTel had either no RAV or a normal-calibre right-angled vein, while the proliferative stage had a right-angled artery and a dilated or normal-calibre RAV [p < 0.001]. RAV characteristics differed at the final follow-up (p < 0.001). 11 eyes transitioned from non-proliferative to proliferative after a median period of 26 months (range: 5-96 months). RAV characteristics changed from a normal calibre right-angled vein at presentation to a normal calibre vein and artery in 6 (55%) eyes and to a dilated vein and artery in 5 (45%) eyes respectively. RAV characteristics may indicate type 2 MacTel stages. A right-angled artery in type 2 MacTel may indicate proliferative disease.