Dilatation Of Artery Research Articles

Clinical Significance of Serum Omega-3 Fatty Acids on Endothelial Function in Patients with Coronary Artery Disease Under Statin Therapy

Vascular endothelial function plays an important role in the pathogenesis of atherosclerosis. The reduction in low-density lipoprotein cholesterol (LDL-C) is a key therapy for preventing coronary artery disease (CAD), but the role of omega-3 fatty acids as residual risk factors of CAD remains controversial. We studied the correlation between serum omega-3 fatty acid levels and endothelial function in patients with CAD receiving statin therapy and examined the effect of eicosapentaenoic acid (EPA) therapy on endothelial function. Methods: A total of 150 consecutive patients with CAD receiving statin therapy (LDL-C levels < 100 mg/dL) were enrolled. Serum omega-3 fatty acid levels were measured, and endothelial function was assessed by flow-mediated dilation (FMD) of the brachial artery. Subsequently, 65 patients with impaired FMD (< 6%) and low EPA/arachidonic acid (AA) (< 0.3) were administered EPA, and FMD was reassessed after 3 months. Results: A multivariate linear regression analysis demonstrated that serum docosahexaenoic acid (DHA) and EPA plus DHA levels were independent determinants of %FMD (β = 0.214 and 0.163, p < 0.05, respectively). The EPA therapy significantly improved %FMD (from 3.7 ± 1.0% to 4.1 ± 1.0%, p < 0.05) in patients with low EPA/AA, and especially in patients with low EPA/AA and high triglyceride levels (from 3.4 ± 1.0% to 4.0 ± 1.1%, p < 0.01). Conclusions: Serum omega-3 fatty acid levels were associated with endothelial dysfunction in patients with CAD receiving statin therapy. EPA therapy improves endothelial function in patients with low EPA/AA, especially those with low EPA/AA and high triglycerides.

Prolonged sitting is not associated with altered shear-mediated dilation of the internal carotid artery, despite impairing lower limb endothelial function.

The present study aims to examine the effect of 4 h of continuous sitting on cerebral endothelial function, which is a crucial component of cerebral blood flow regulation. We hypothesized that 4 h of sitting may impair cerebral endothelial function similarly to how it affects lower limb vasculature. Thirteen young, healthy participants were instructed to remain seated for 4 h without moving their lower limbs. The blood flow and shear rate (SR) in the popliteal and internal carotid artery (ICA) were measured using duplex Doppler ultrasound. During the 4-h sitting, peripheral (popliteal artery) and cerebral (ICA) endothelial function were assessed every hour. We induced peripheral and cerebral flow-mediated dilation (pFMD and ICA FMD) using hyperemia (5 min of cuff inflation on lower limb, then deflation) or hypercapnia (30s of hypercapnia, end-tidal partial pressure of CO2 + 9 mmHg), respectively. We then calculated each relative peak dilation from the baseline diameter to identify both pFMD and ICA FMD. We observed a significant decrease in pFMD starting at 2 h from the onset of sitting, and this reduction persisted throughout the 4-h sitting [Base (6.8 ± 4.2%) vs. 2-h (3.9 ± 2.0%), p = 0.044; vs. 3-h (3.2 ± 1.8%), p = 0.016; vs. 4-h (3.2 ± 1.9%), p = 0.005]. In contrast, during the 4-h sitting, ICA blood flow, SR, and ICA FMD remained unchanged (p = 0.062, p = 0.068, and p = 0.203, respectively). Unlike peripheral endothelial function, cerebral endothelial function remained stable during 4-h sitting. This suggests that the acute effect of prolonged sitting on cerebral vasculature differs from that of lower limb vasculature.

Pancreaticoduodenal Artery Aneurysm in a Patient with Celiac Artery Atresia

Visceral artery aneurysms have an array of presentations and management strategies. Pancreaticoduodenal artery aneurysms (PDAAs) are rare, potentially lethal, and necessitate treatment. We present the case of a PDAA in a patient with a congenitally hypoplastic celiac artery treated by open surgical reconstruction. A 60-year-old female presented with an incidental 2-cm proximal inferior PDAA. Significantly, her celiac trunk was hypoplastic and all flow to the hepatic, gastric, and splenic arteries stemmed from a dilated superior mesenteric artery. The PDAA was located 1cm from the origin of the pancreaticoduodenal artery at the superior mesenteric artery and was adhered to the fourth portion of the duodenum. Considering her anatomy, open repair with reconstruction of the pancreaticoduodenal artery was pursued via a midline laparotomy, resection of the PDAA, and primary end-to-side pancreaticoduodenal artery to superior mesenteric artery reconstruction. There was an excellent flow into the pancreaticoduodenal artery, gastroduodenal artery, and their emanating branches intraoperatively and on postoperative imaging. The patient progressed well and was discharged home on postoperative day 5. Liver function tests were serially checked and were within normal limits upon discharge. We demonstrate a safe and successful surgical option for patients with PDAA who required preserved gastroduodenal aneurysm flow.

Efficacy and safety of Shexiang Baoxin Pill (MUSKARDIA) in patients with stable coronary artery disease across different weight subgroups.

Shexiang Baoxin Pill (MUSKARDIA), a traditional Chinese patent medicine, plays a crucial role in both preventing and treating diverse cardiovascular diseases, including coronary heart disease, myocardial infarction (MI), and heart failure. Preclinical research has demonstrated that the cardioprotective effects of MUSKARDIA are achieved through multiple pathways, such as enhancing coronary artery dilation, fostering new blood vessel growth, reducing inflammation and oxidative stress, improving lipid metabolism, and protecting vascular endothelium. This subgroup analysis aimed to evaluate the efficacy and safety of Shexiang Baoxin Pill (MUSKARDIA) plus optimal medical therapy (OMT) across different weight categories in treating stable coronary artery disease (CAD). This investigation was a subgroup analysis of a multicenter, randomized, double-blind, placebo-controlled phase IV clinical study. Patients receiving OMT were randomly assigned to either MUSKARDIA or placebo group for a 24-month period. This analysis focused on body weight as a distinguishing factor, using 65kg as the cutoff. The primary efficacy endpoint was the composite of major adverse cardiovascular events (MACEs), including cardiovascular death, non-fatal myocardial infarction (MI), and non-fatal stroke. Secondary efficacy endpoint comprised a composite of all-cause mortality, non-fatal MI, non-fatal stroke, hospitalizations for unstable angina or heart failure, and coronary revascularization procedures. A total of 2646 patients were included in the analysis, with 916 patients weighing less than 65kg and 1730 patients weighing 65kg or more. The median ages were 68 (range: 35-90) years and 62 (range: 29-90) in these two subgroups, respectively. For patients weighing less than 65kg, the MUSKARDIA group exhibited a significantly lower incidence of the primary efficacy endpoint (0.65%) compared to the placebo group (2.64%) (P=0.018), with a reduced risk of MACEs (HR=0.241, 95%CI: 0.068-0.856; P=0.0168). Conversely, in patients weighing 65kg or more, no significant differences were observed in the incidence rates or risks of primary or secondary efficacy endpoints between the MUSKARDIA and placebo groups (All P>0.05). Adverse events were similar between two groups across both weight subgroups. MUSKARDIA plus OMT demonstrated promising efficacy and acceptable safety in CAD patients weighing less than 65kg, potentially reducing the risk of MACEs. For patients weighing 65kg or more, further investigation is needed to optimize dosing strategies.

Dieulafoy’s lesion of the colon: management of this unusual location

Dieulafoy’s lesion (DL) is a rare but potentially life-threatening vascular anomaly characterized by the presence of an abnormally dilated artery in the submucosa of the gastrointestinal tract. Although the stomach is the most common site, colonic involvement is rare, making both diagnosis and management challenging. This article reports a case of colonic Dieulafoy’s lesion in a 74-year-old patient presenting with melena and discusses current strategies for endoscopic management. Early endoscopic intervention is essential for diagnosis and treatment, with mechanical methods such as the application of hemostatic clips being preferred to prevent recurrence.

Investigation of pulmonary artery dilation in the population of Moscow using automated analysis of radiological examination results

INTRODUCTION: In modern clinical practice, the diagnosis establishment and monitoring of pulmonary arteries are important components of care for patients with cardiovascular and respiratory diseases. However, in Russia, there remains a limited amount of epidemiological data on the prevalence of pulmonary artery dilation, especially at the population level.This study aims to fill this gap by providing population-based data on the prevalence of pulmonary artery dilation in the city of Moscow. With the help of advanced artificial intelligence technologies, this work seeks to offer a comprehensive assessment of the pathology, covering both its main characteristics and the effects of various factors such as age and gender.OBJECTIVE: To investigate the prevalence of pulmonary artery dilation in Moscow using the data from computed tomography (CT) scans of the chest analysed by means of an automatic artificial intelligence technology.MATERIALS AND METHODS: The study involved the analysis of a large volume of chest CT scans acquired from September 2022 to February 2023. The total study sample comprised 134,218 patients. Artificial intelligence technologies were applied for the automatic detection of signs of pulmonary artery dilation.RESULTS: An analysis of 125,878 CT scans, including 57,913 men and 67,965 women, revealed that 34.4% of patients (43,242 individuals) showed signs of pulmonary artery dilation. Among them, the proportion of men with this pathology was 35.6% (20,630 individuals), while for women it was 33.3% (22,612 individuals). The prevalence of the pathology increased with age, starting at 14.8% among younger patients and reaching 62.7% among the elderly. The prevalence of pulmonary artery dilation among the population of Moscow was 794.7 cases per 100,000 people.DISCUSSION: The results of this research allowed us to draw conclusions regarding the meaning of pulmonary artery dilation as a predictor of pulmonary hypertension. The results demonstrated a correlation between the frequency of pathology occurrence and gender and age groups, with a more pronounced association observed in women. Detailed analysis also revealed corellations of pulmonary artery diameter with age and gender.CONCLUSION: The study provided the first population-based data on the prevalence of pulmonary artery dilation in Moscow. The importance of early diagnosis to prevent severe complications, especially in patients with chronic lung diseases, is emphasized. The study results can provide a basis for screening strategies and treatment approaches for this pathology.

Macrovascular Function in People with HIV After Recent SARS-CoV-2 Infection

Background: People with HIV (PWH) are at increased risk of vascular dysfunction and cardiovascular disease (CVD). SARS-CoV-2 infection has been associated with acute CVD complications. The aim of the study was to as-sess macrovascular function as an early indicator of CVD risk in PWH after mild SARS-CoV-2 infection. Methods: PWH aged 20–60 years, with undetectable viral load (RNA < 20 copies/mL), on stable anti-retroviral therapy (≥6 months) and history of mild COVID-19 (≥30 days) without any CVD manifestations prior to enrollment were recruited. Participants were excluded if they had history of diabetes mellitus, end-stage renal disease, heart or respiratory disease. Participants were matched 1:1 to pre-pandemic PWH. A health survey, surrogate measures of CVD risk, and macrovascular function (brachial artery flow-mediated vasodilation and arterial stiffness assessments via applanation tonometry) were compared between group. Results: A total of 17 PWH and history of COVID-19 (PWH/COV+) were matched with 17 PWH without COVID-19 (PWH/COV−) pre-pandemic. Mean age (45.5 years), sex (76.5% male), body mass index (27.3), and duration of HIV infection (12.2 years) were not different between groups. Both groups had comparable CVD risk factors (total cholesterol, LDL, HDL, systolic and diastolic blood pressure). There were no differences in measures of flow mediated arterial dilatation or arterial stiffness after 30 days of SARS-CoV-2 infection. Conclusions: After recent SARS-CoV-2 infection, PWH did not demonstrate evidence of macrovascular dysfunction and increased CVD risk. Results suggest that CVD risk may not be increased in people with well-controlled HIV who did not manifest CVD complications SARS-CoV-2 infection.

Effects of Age and Sex on Systemic Inflammation and Cardiometabolic Function in Individuals With Type 2 Diabetes.

Systemic inflammation, aging, and type 2 diabetes (T2D) lead to varying degrees of cardiovascular dysfunction and impaired aerobic exercise capacity. This study evaluates the impact of inflammation and sex differences on coronary and peripheral vascular function and exercise capacity in older individuals with and without T2D. Older individuals (aged≥65 years) underwent biochemical and tissue inflammatory phenotyping, cardiopulmonary exercise testing, cardiovascular magnetic resonance imaging, and vascular reactivity testing. Correlation and regression analyses determined the effects of systemic inflammation, older age, and sex on cardiovascular health, stratified by T2D status. For the 133 recruited individuals (44% women; median age, 71±7 years, 41% with T2D), the presence of T2D most significantly increased the white blood cell count (P=0.004; P.adj.=0.140) among markers of systemic inflammation. White blood cell count was comparable in men and women. Hyperemic myocardial blood flow and flow-mediated and flow-independent nitroglycerin-induced brachial artery dilation were significantly impaired in men but not women with T2D. Peak oxygen consumption during exercise was lower with T2D (P=0.021), and overall reduced in women compared with men (P=0.002). Across all participants, both peak oxygen consumption during exercise and hyperemic myocardial blood flow were significantly impaired with increased white blood cell count. Women showed more adverse myocardial remodeling assessed by extracellular volume than men (P=0.008), independently of T2D status. The pathophysiological manifestations of T2D on vascular function and aerobic exercise capacity are distinct in older men and women, and this may reflect underlying differences in vascular and myocardial aging in the presence of T2D.

Oxidative stress suppresses internal carotid artery dilation to hypercapnia in healthy older adults.

Background: Cerebrovascular disease and dementia risk increases with age and lifetime risk is greater in women. Cerebrovascular dysfunction likely precedes cerebrovascular disease and dementia but the mechanisms are incompletely understood. We hypothesized that oxidative stress mediates cerebrovascular dysfunction with human aging. Methods: Internal carotid artery dilation (ICACO2 dilation) and middle cerebral artery cerebrovascular reactivity (MCA CVRCO2) in response to hypercapnia (5% CO2) was measured in 20 young (10F/10M; age 23±3 years [mean±SD]) and 21 older (11F/10M; age 69±9 years) adults during intravenous infusions of saline (control) and vitamin C (acutely reduced oxidative stress condition). Results: ICACO2 dilation increased in response to vitamin C infusion in older adults (saline=4.3±2.4%; vitamin C=6.7±3.3%) but was unchanged in young adults (saline=6.1±2.7%; vitamin C=5.5±1.9%) (group*condition: p=0.004). MCA CVRCO2 was not different in response to vitamin C in either group (group*condition: p=0.341). However, when separated by sex, older female participants exhibited increased MCA CVRCO2 with vitamin C (saline=0.85±0.79cm/s/mmHg; vitamin C=1.33±1.01cm/s/mmHg) compared to older male participants (saline=1.21±0.57cm/s/mmHg; vitamin C=0.99±0.47cm/s/mmHg) (sex*condition: p=0.011). Conclusions: Oxidative stress selectively impairs cerebrovascular function in older adults in an artery- and sex-specific manner.

Diagnosis and treatment of pediatric arterial stenosis associated with neurofibromatosis type 1

BackgroundNeurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder affecting multiple systems. However, arterial stenosis is a rare manifestation in patients with NF1. Since the symptoms of arterial stenosis caused by NF1 are often atypical and have a high under-diagnosis rate, this can lead to serious complications such as hypertension, ischemic stroke, or even death. The aim of our research is to analyse the clinical characteristics of arterial stenosis in pediatric patients with NF1 and to summarise its diagnosis, treatment and prognosis.MethodsWe conducted a retrospective review of data from patients with NF1 treated at Beijing Children’s Hospital from 2016 to 2020. Patients diagnosed with arterial stenosis, identified through clinical symptoms, physical examination, arterial ultrasonography, or imaging studies, were included in this study. These patients received symptomatic drug and/or surgical treatments and were followed up regularly. We summarized demographic characteristics, sites of arterial stenosis, clinical manifestations, and treatment outcomes.ResultAmong the 258 patients with NF1 treated at our hospital, 12 (4.7%) had arterial stenosis, comprising 9 males and 3 females with a median age of 7 years (range: 1–14 years). Renal artery stenosis was diagnosed in 7 patients (58.3%), while internal carotid artery (ICA) stenosis was diagnosed in 5 patients (41.7%). The predominant symptoms of renal artery and ICA stenosis were renal hypertension and convulsions, respectively. Antihypertensive drugs were effective in 5 patients with renal hypertension; 2 patients required balloon dilatation of the renal artery due to inadequate response to medication. Oral antiepileptic treatment was effective in 3 patients with ICA stenosis, and encephaloduroarteriosynangiosis was effective in the remaining 2 cases. The follow-up period ranged from 2 to 6 years, with a median duration of 3 years. No deterioration or mortality was observed during the follow-up period.ConclusionsArterial stenosis was present in approximately 4.7% of patients with NF1, predominantly affecting the renal artery and ICA. Renal hypertension and convulsions were the primary symptoms of renal artery and ICA stenosis, respectively. Early diagnosis and intervention can substantially improve the prognosis of these patients.

Active withdrawal of corticosteroids using tocilizumab and its association with autoantibody profiles in relapsed Takayasu arteritis: a multicentre, single-arm, prospective study (the Ab-TAK study).

The feasibility of corticosteroid withdrawal (CW) for Takayasu arteritis (TAK) remains uncertain. Two autoantibodies (Abs) are identified against endothelial protein C receptor (EPCR) and scavenger receptor class B type 1 (SR-BI) in TAK, determining its three subgroups. This study aimed to evaluate CW using tocilizumab (TCZ) and its association with the Ab profile. This prospective study, lasted for 24 weeks, included patients with relapsed but stable TAK. Scheduled tapering of prednisolone (PSL) was performed with subcutaneous TCZ (CW at week 20). The primary endpoint was the difference in type A remission, defined by CW and the absence of inflammatory signs, according to the Ab profile at week 24. Twenty patients were included and 18 patients with a mean PSL dose of 4.9 ± 2.8 mg/day were analysed. Anti-EPCR Ab-positive (E+), anti-SR-BI Ab-positive (S+), and double-negative (DN) groups included four (22.2%), eight (44.4%), and six (33.3%) patients, respectively. At week 24, the mean PSL dose was 2.0 ± 2.7 mg/day. Type A remission was observed in eight patients (44.4%), with significant differences based on the Ab profile: E+ (three patients, 75%), S+ (five patients, 62.5%), and DN (zero patients, 0%) (P=0.018). Besides, age, disease duration, PSL dose, type V arterial lesion, arterial dilation, and C-reactive protein >0.01 mg/dL were identified as risks for CW failure. CW using TCZ was achieved in 44.4% of patients with TAK relapse and was significantly higher in E+ and S+ patients. CW can be a feasible target, and the precise selection of patients is critical.

Outcomes of coronary artery aneurysms: insights from the Coronary Artery Ectasia and Aneurysm Registry (CAESAR).

Coronary artery ectasias and aneurysms (CAE/CAAs) are among the less common forms of coronary artery disease, with undefined long-term outcomes and treatment strategies. To assess the clinical characteristics, angiographic patterns, and long-term outcomes in patients with CAE, CAA, or both. This 15-year (2006-2021) retrospective single-centre registry included 281 patients diagnosed with CAE/CAA via invasive coronary angiography. Major adverse cardiovascular events included all-cause death, non-fatal myocardial infarction, unplanned ischaemia-driven revascularisation, hospitalisation for heart failure, cerebrovascular events, and clinically overt bleeding. Time-dependent event risks for the CAE and CAA groups were assessed using Cox regression models and Kaplan-Meier curves. CAEs (n = 161, 57.3%) often had a multi-district distribution (45.8%), while CAAs (78, 27.8%) exhibited a single-vessel pattern (80%). The co-existence of CAAs and CAE was observed in 42 cases (14.9%), and multi-vessel obstructive coronary artery disease was prevalent (55.9% overall). Rates of major adverse cardiovascular events were 14.3% in-hospital and 38.1% at a median follow-up of 18.9 (interquartile range [IQR] 6.0-39.9) months. The presence of CAAs was associated with increased major adverse cardiovascular events risk in comparison to CAE (hazard ratio [HR] = 2.26, 95% confidence interval [CI] 1.38-3.69, p = 0.001), driven by a higher hazard ratio of non-fatal myocardial infarctions (HR = 5.00, 95% CI 1.66-15.0, p = 0.004) and unplanned ischaemia-driven revascularisation in both dilated (HR = 3.23, 95% CI 1.40-7.45, p = 0.006) and non-dilated coronary artery segments (HR 3.83, 95% CI 2.08-7.07, p = 0.001). Overlap between obstructive and dilated coronary artery disease is frequent. Among the spectrum of dilated coronary artery disease, the presence of a CAA was associated with worse long-term outcomes.

The SGLT2 inhibitor remogliflozin induces vasodilation in the femoral artery of rabbits via activation of a Kv channel, the SERCA pump, and the cGMP signaling pathway.

This study explored the vasodilatory mechanisms of the sodium-glucose cotransporter-2 inhibitor remogliflozin using femoral arteries of rabbits. Remogliflozin dilated femoral arterial rings pre-contracted with phenylephrine in a concentration-dependent manner. Pretreatment with the Ca2+-sensitive K+ channel inhibitor (paxilline), the ATP-sensitive K+ channel inhibitor (glibenclamide), or the inwardly rectifying K+ channel inhibitor (Ba2+) did not alter the vasodilatory effect. However, vasodilation was significantly reduced by pretreatment with the voltage-dependent K+ (Kv) channel inhibitor (4-AP) and with the Kv1.5 subtype inhibitor (DPO-1) but not with Kv2.1 or Kv7 subtype inhibitor. Neither endothelium removal nor the inhibition of nitric oxide production altered the vasodilatory effect of remogliflozin. However, pretreatment with the sarcoplasmic/endoplasmic reticulum Ca2+-ATPase (SERCA) pump inhibitors thapsigargin and cyclopiazonic acid effectively reduced the remogliflozin effect, as did pretreatment with cGMP/PKG-related but not cAMP/PKA-related signaling pathway inhibitors. These results indicate that remogliflozin-mediated dilation of the femoral artery occurs via the activation of Kv channels, mainly the Kv1.5 subtype, SERCA pump, and cGMP/PKG-related signaling pathways.

Coronary Ectasia: Prevalence, Angiographic Characteristics and Clinical Outcome

Background/Aim: Coronary artery ectasia (CAE) is defined as diffuse dilation of the coronary arteries and differs from coronary aneurysms by being non-localized. The condition is rare, often associated with atherosclerosis, and poses significant management challenges due to its unclear pathophysiology and varied clinical presentations. The study aims to provide insights into the hospital's experience with CAE and evaluate its prognostic factors. Materiels and methods: This retrospective study evaluated 28 patients with CAE from 1692 individuals who underwent coronary angiography between January 2021 and January 2024. Patients with other heart conditions were excluded. CAE diagnosis was based on coronary artery dilation ≥1.5 times the adjacent normal segment. Data on clinical characteristics, myocardial perfusion, and stenosis were collected, and coronary lesions were classified using the Markis classification system. Results: CAE was observed in 1.65% of the study population, with most patients being male smokers, averaging 55 years of age. Of the CAE patients, 74% had significant lesions, 59% had multi-vessel involvement, and 25% presented with spontaneous thrombosis. Left ventricular dysfunction was noted in 60% of patients. Pharmacologic treatments included aspirin for all, while 9 patients also received anticoagulation therapy. Percutaneous coronary intervention (PCI) was conducted in select cases with thrombus formation or significant stenosis. Conclusion: CAE remains a poorly understood condition with a significant thrombotic risk. Atherosclerosis was the predominant cause, and management strategies, especially for thrombosis, remain individualized. Optimal treatment is still unclear, and large multicenter studies are needed to develop better treatment guidelines for CAE patients.

Dilatory responsiveness of the internal carotid artery to shear stimulus is constant under different levels of transient hypercapnia.

Peripheral endothelial function, which accounts for the variability in shear stimulus, can be assessed using shear-mediated dilation normalized to the increased shear stimulus. Similarly, shear-mediated dilation of the internal carotid artery (ICA), an index of cerebrovascular endothelial function, should be normalized to increased shear stimulus. However, this approach has not yet been validated. Thus, the shear-mediated dilation of the ICA was assessed in 14 young adults during three levels of transient hypercapnia, induced by elevating the partial pressure of end-tidal carbon dioxide (PETCO2) for 30 seconds by 6, 9, and 12 mmHg. The ICA shear rate (SR) was calculated using the ICA diameter and velocity, both measured by Doppler ultrasound. The total vasodilator stimulus was quantified as the SR area under the curve from the onset of hypercapnia to peak dilation, including and excluding baseline values ([SRAUC] and delta SRAUC [DSRAUC], respectively). Shear-mediated dilation was calculated as the percent increase in diameter from baseline. ICA dilation was positively associated with DSRAUC (r(rm) = 0.47, P < 0.01) but not with SRAUC (r(rm) = 0.32, P = 0.09). Consequently, ICA dilation normalized to DSRAUC did not differ among trials (main effect of rial, P = 0.77). Contrarily, the difference in ICA dilation among trials remained significant when normalized to SRAUC (main effect of trial, P = 0.02). Therefore, normalized shear-mediated dilation using DSRAUC can reduce variability associated with increased shear stimulus during ICA dilation assessment, thereby enhancing the validity of evaluating cerebrovascular endothelial function.

Influence of hyperbaric air exposure on the function of brachial artery

Decompression after diving may inevitably cause the production of bubbles in the body, even without protocol violation. Bubbles produced in the circulation may damage the vascular cells, leading to vascular dysfunction. In this study, five subjects were recruited and subjected to hyperbaric exposure (15 meters; 100 minutes). The function of the brachial artery was assessed by measuring diameter, systolic peak velocity (SPV), resistance index (RI), and flow-mediated dilation (FMD) of the brachial artery before and after hyperbaric exposure. Our results showed that hyperbaric air exposure slightly increased the diameter of the brachial artery and significantly increased its RI but reduced the FMD and markedly decreased the SPV. This study indicates that hyperbaric air exposure at low pressure may also alter the function of the brachial artery. Keywords: brachial artery, diving, flow-mediated dilation, ultrasound, vascular endothelium

Novel multiple Z-score models for detection of coronary artery dilation: application in Kawasaki disease

BackgroundThis study aims to develop Z-Score models to normalize measurements of three coronary arteries and enhance the diagnosis of Kawasaki disease (KD) in children from newborns to 10 years old. Developing a reliable Z-Score model is challenging, as some existing models fail the normality test. Overcoming these challenges is crucial for improving KD diagnosis.MethodDetailed measurements of the left main coronary artery (LCA), left anterior descending coronary artery (LAD), and right coronary artery (RCA) were collected, along with patient demographics such as age, height, weight, and body surface area (BSA). Several Z-Score models, named the Kuo Z-Score models, were proposed, with separate designs for different coronary arteries and different age groups, resulting in multiple Z-Score models. The Z-Score model for the RCA employs the Box-Cox method for data transformation. Finally, we tested various age group combinations, selecting models that passed the Anderson–Darling normality test and had higher R-square values for robustness and best data fit.ResultsThe study included 1180 participants free from coronary or heart diseases. The Kuo Z-Score models were optimized for LCA, LAD, and RCA across the five age groups 0–6 years, 6–7 years, 7–8 years, 8–9 years, and 9–10 years. Only the normality test for the RCA in the 7–8 year age group failed. The proposed model fitted to the normality assumption outperforming the other models.ConclusionThe Kuo Z-Score models, applicable across a broad age range, provides robust identification of coronary artery dilatation and aneurysm in KD. The models’ capability to normalize diverse data sets marks a significant advancement in KD diagnostic sensitivity, aiding in better clinical decision-making and potentially improving patient outcomes.

Supratentorial hydrocephalus secondary to vertebrobasilar dolichoectasia: A rare complication – Case report and literature review

Background. Intracranial arterial dolichoectasia (IADE) is a rare cerebrovascular condition characterized by cerebral artery elongation, dilation, and tortuosity, predominantly involving the basilar and vertebral arteries. Vertebrobasilar dolichoectasia (VBDE), the most common subtype, can lead to severe complications, including ischemic strokes, cranial nerve compression, and, rarely, obstructive hydrocephalus. Symptomatic cases presenting with hydrocephalus are sporadic and pose significant diagnostic and therapeutic challenges. Case report. We present a unique case of a 53-year-old South Indian female with altered sensorium and vomiting, subsequently diagnosed with VBDE. Radiological investigations revealed a severely dilated basilar artery compressing the third ventricle and aqueduct of Sylvius, with a Smoker’s criteria score of 5, indicative of severe VBDE. Advanced imaging, including cerebrospinal fluid flow studies, confirmed supra-aqueductal stenosis. The patient underwent monoventriculoperitoneal shunt surgery, resulting in complete symptom resolution. Conclusion. This case underscores the rarity of VBDE presenting with obstructive hydrocephalus and highlights the critical role of Smoker’s criteria and CSF flow studies in diagnosis and management. It emphasizes the importance of early intervention to prevent irreversible neurological damage and calls for further research to enhance diagnostic protocols and refine treatment strategies for this uncommon condition.

Endovascular therapy for aneurysmal dilatation and arteriovenous fistula of the superior mesenteric artery.

We present a clinical case illustrating the feasibility of endovascular treatment of superior mesenteric aneurysm associated with an arteriovenous fistula. The patient presented with abdominal pain and diarrhea on admission. Computed tomography angiography revealed an aneurysmal dilatation of the superior mesenteric artery and vein with an arteriovenous fistula. Endovascular therapy successfully managed the condition by reconstructing the artery, closing the fistula, and occluding the aneurysm. No aneurysm rupture or endoleak occurred, and the patient's symptoms on admission resolved. Endovascular treatment is a viable alternative for patients with superior mesenteric aneurysms and arteriovenous fistulas, but larger studies and further follow-up are needed to evaluate the safety and long-term efficacy of endovascular treatment.

Effects of Hydrogen Sulfide at Normal Body Temperature and in the Cold on Isolated Tail and Carotid Arteries from Rats and TRPA1 Knockout and Wild-Type Mice.

Background: Hydrogen sulfide (H2S) is a gasotransmitter that modulates vascular tone, causing either vasodilation or vasoconstriction depending on the vascular bed, species, and experimental conditions. The cold-sensitive transient receptor potential ankyrin-1 (TRPA1) channel mediates H2S-induced effects; however, its contribution to the vasomotor responses of different arteries at different temperatures has remained unclear. Here, we aimed to fill this gap by comparing the effects of sodium sulfide (Na2S), which is a fast-releasing H2S donor, on the isolated carotid and tail skin arteries of rats and mice at cold and normal body temperature with wire myography. Under the same circumstances, we also aimed to compare the effects of the canonical endothelium-dependent and -independent vasodilators, acetylcholine and sodium nitroprusside, respectively. Methods: We isolated the carotid and tail arteries from 32 adult Wistar rats and 64 TRPA1 knockout and wild-type mice, and then we studied their vasomotor responses to increasing doses (10-6-10-3 M) of Na2S as well as to acetylcholine and sodium nitroprusside (10-5 M for both) at 37 °C and in cold (17 or 20 °C). Results: In rat vessels, Na2S caused constriction of the carotids and relaxation of the tail arteries, which were not influenced by temperature. In mouse carotids, Na2S caused vasorelaxation, which was more pronounced in the cold at a lower dose (10-4 M). At a higher dose (10-3 M), the dilation was markedly attenuated in the absence of the TRPA1 channel. In the mouse tail arteries, Na2S caused vasorelaxation at 37 °C and vasocontraction in the cold. The genetic blockade of TRPA1 channels did not influence the vasomotor responses of the mouse tail arteries. Sodium nitroprusside-induced vasorelaxation was not influenced by any of the investigated factors, while acetylcholine-induced dilation decreased in the cold in all vessel types. Conclusions: Our results reveal the function of TRPA1 in the H2S-induced dilation of carotid arteries in mice. We also highlight interspecies differences in the vasomotor responses between rats and mice, as well as the importance of the effect of temperature on vascular responses. The implementation of the identified variables in future research can advance our understanding of cardiovascular physiology, especially in conditions with hypothermia (either accidental or therapeutic).