Artery Stenosis Research Articles

Curative Effect of Interventional Therapy and Neurological Changes in Ischemic Stroke of Posterior Circulation Evaluated by Magnetic Resonance Imaging under Genetic Algorithm

Objective. This study aimed to evaluate the improvement and neurological function changes of patients with ischemic stroke in the posterior circulation before and after interventional therapy using magnetic resonance imaging (MRI) under genetic algorithm and compressed sensing algorithm. Methods. Thirty-six patients with posterior circulation ischemia who visited the interventional cerebrovascular disease area were included in this study. The treatment effect was observed through abnormal signal changes in the lesion area on each sequence of MRI images before and after treatment. The National Institutes of Health Stroke Scale (NIHSS) was used for the evaluation of the changes in neurological function. Results. The real data experiment results suggested that the peak signal-to-noise ratio (PSNR) = 39.33 and structure similarity (SSIM) = 0.96 in the algorithm reconstructed image, which showed no significant difference with the simulation experiment results of PSNR = 35.19 and SSIM = 0.96 ( P < 0.05 ). In addition, the stenosis rate after interventional treatment (13.89%) was substantially lower than that before treatment (91.67%) ( P < 0.05 ). Cerebral blood flow (CBF) of the bilateral occipital lobes and cerebellum after six months of treatment was higher than that before treatment ( P < 0.05 ), and the incidence of postoperative restenosis was 11.11% (4/36). Conclusion. The combination of genetic algorithm and compressed sensing algorithm had a good effect on MRI image processing. The posterior circulation ischemia interventional stent implantation can effectively improve the stenosis of the vertebral artery and vertebral basilar artery as well as the cerebral tissue perfusion in the ischemic area, which improved the clinical symptoms substantially and reduced the probability of restenosis.

Mesenteric occlusive disease of the inferior mesenteric artery is associated with anastomotic leak after left-sided colon and rectal cancer surgery: a retrospective cohort study

PurposeAnastomotic leak (AL) is a serious complication following colorectal surgery. Atherosclerosis causes inadequate anastomotic perfusion and is suggested to be a risk factor for AL. The aim of this study was to investigate the association of mesenteric occlusive disease on preoperative computed tomography (CT) scan with AL after left-sided colon or rectal cancer surgery.MethodsThis was a retrospective, multicenter cohort study including 1273 patients that underwent left-sided or rectal cancer resection between 2009 and 2018 from three hospitals in the Netherlands. AL patients were 1:1 matched with non-leak patients and preoperative contrast-enhanced CT-scans were retrospectively analyzed for mesenteric atherosclerotic lesions. The main outcome measure was the presence of mesenteric occlusive disease on the preoperative CT-scan.ResultsAnastomotic leak developed in 6% of 1273 patients (N = 76). Low anterior resection and stage I–III disease were statistically significant associated with AL (p = 0.01, p = 0.04). No other statistically significant differences in patient characteristics between AL and non-leak patients were found. A clinically significant stenosis (≥ 70–100%) of the inferior mesenteric artery was statistically significant more frequent present in AL patients, compared to non-leak patients (p < 0.01). No statistically significant differences in the presence of mesenteric occlusive disease of the celiac artery and superior mesenteric artery between AL patients and non-leak patients were found.ConclusionMesenteric occlusive disease of the IMA on preoperative CT-scan is associated with AL after left-sided colon or rectal resection for cancer. Preoperative identification of high-risk patients with a preoperative CT-scan of the mesenteric vasculature might be useful to reduce the risk of AL.

Predictors of preoperative cognitive dysfunction in adults with Moyamoya disease: a preliminary research

ObjectiveTo explore potential risk factors of preoperative cognitive dysfunction in adult patients with moyamoya disease (MMD) and discuss significance of moyamoya vessels.MethodsThe author reviewed adult MMD patients harboring no parenchymal infarction or hemorrhage underwent a standardized neuropsychological assessment test battery from December 2018 to May 2019. The authors defined patients with cognitive dysfunction as cognitive impairment shown on 3 or more neuropsychological tests. According to the presence of cerebral angiography, arterial stenosis, moyamoya vessels, and compensatory arteries were conducted. Univariate and multivariate analyses were performed to identify predictors for cognitive dysfunction before surgery. Subgroup analyses by onset type and Suzuki stage were carried out to identify specific predictors for preoperative cognitive dysfunction.ResultsIn total, 29 of 92 (31.52%) patients had cognitive dysfunction. Multivariate analysis showed that moyamoya vessels generating from left hemisphere was recognized as independent predictor for cognitive dysfunction (P = 0.025, OR [95%CI], 0.085 [0.012–0.874]). For patients in left ICA-moyamoya subgroup, 19 of 45 (42.22%) cases with sparse moyamoya vessels had cognitive dysfunction (P = 0.031), while 22 (91.67%) of patients with dense moyamoya vessels had normal cognition (P = 0.004). Moyamoya vessels arising from ophthalmic artery had no significant association with cognitive dysfunction (P = 0.111). Multivariate analysis found that moyamoya vessels originating from left ICA was recognized as independent predictors for preoperative cognitive dysfunction (P = 0.048, OR [95%CI], 0.394 [0.132–0.926]).ConclusionsMoyamoya vessels arising from left hemisphere was a risk factor for the preoperative cognitive dysfunction in adult patients with MMD, with the denser moyamoya vessels, the less cognitive dysfunction. The current study offers a new perspective of moyamoya vessels and supporting data for choosing MMD candidates on cerebral revascularization.

The thermal behavior of blood flow in the arteries with various radii and various stenosis angles using non-Newtonian Sisko model

In this work, the FVM method is employed to simulate blood flow behavior within stenosis arteries based on the non-Newtonian Sisko model by using UDF in Fluent. Stenosis is simulated in cone geometry, and influences of different angles of stenosis with different artery radii are studied on the Nusselt number and temperature of blood flow. It is observed that with increasing angles of stenosis and reducing internal radius, the artery is narrowed, which results in enhancement of Nusselt number of blood flow. Thus, the temperature of blood flow is reduced. Also, applying heat fluxes of q“ = 400 W/m2, q” = 800 W/m2, and q“ = 1000 W/m2 prepare temperature enhancement as much as 0.44 K, 0.89 K, and 1.15 K respectively which are important from a medical viewpoint. The maximum temperature is reported as much as 38.2 °C by applying heat flux of q” = 1000 W/m2, which is noticeable for the human body healthy, especially for the function of enzymes and other proteins of the body. Also, with increasing angles of stenosis and reducing internal radius, the artery is tightened and velocity of blood fluid is enhanced which affects blood circulation between tissues and the oxygenation process, temperature variation, and heat transfer alteration of blood flow within the human body. In reality, circulation of blood transfers heat between tissues, and the dimensions of the blood vessels are various, whenever more blood is needed in some vessels of the body due to more activity, these blood vessels expand to supply the required blood while other vessels tight to compensate it. Therefore, present mechanical research is applicable for medical science especially in surgical widening of a blocked or narrowed blood vessel.

Iron Deposition in Gray Matter Nuclei of Patients With Intracranial Artery Stenosis: A Quantitative Susceptibility Mapping Study.

Purpose: This study aimed to use quantitative susceptibility mapping (QSM) to systematically investigate the changes of iron content in gray matter (GM) nuclei in patients with long-term anterior circulation artery stenosis (ACAS) and posterior circulation artery stenosis (PCAS).Methods: Twenty-five ACAS patients, 25 PCAS patients, and 25 age- and sex-matched healthy controls underwent QSM examination. Patients were scored using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) to assess the degree of neural function deficiency. On QSM images, iron related susceptibility of GM nuclei, including bilateral caudate nucleus, putamen (PU), globus pallidus (GP), thalamus (TH), substantia nigra (SN), red nucleus, and dentate nucleus (DN), were assessed. Susceptibility was compared between bilateral GM nuclei in healthy controls, ACAS patients, and PCAS patients. Partial correlation analysis, with age as a covariate, was separately performed to assess the relationships of susceptibility with NIHSS and mRS scores.Results: There were no significant differences between the susceptibilities for left and right hemispheres in all seven GM nucleus subregions for healthy controls, ACAS patients, and PCAS patients. Compared with healthy controls, mean susceptibility of bilateral PU, GP, and SN in ACAS patients and of bilateral PU, GP, SN, and DN in PCAS patients were significantly increased (all P < 0.05). In addition, mean susceptibility of bilateral TH and SN in PCAS patients was significantly higher than in ACAS patients (both P < 0.05). With partial correlation analysis, mean susceptibility at bilateral PU of ACAS patients was significantly correlated with mRS score (r = 0.415, P < 0.05), and at bilateral PU in PCAS patients was correlated with NIHSS score (r = 0.424, P < 0.05).Conclusion: Our findings indicated that abnormal iron metabolism may present in different subregions of GM nuclei after long-term ACAS and PCAS. In addition, iron content of PU in patients with ACAS and PCAS was correlated with neurological deficit scores. Therefore, iron quantification measured by QSM susceptibility may provide a new insight to understand the pathological mechanism of ischemic stroke caused by ACAS and PCAS.

Carotid Artery Stenting for Patients with Radiation-Induced Carotid Artery Stenosis.

In radiation-induced carotid artery stenosis (RIS), morphological characteristics, such as bilateral and long lesion distances and in-stent stenosis, have been reported as common after carotid artery stenting (CAS). Here, we present 25 cases at our hospital wherein CAS was performed for RIS and compare the morphological characteristics and the safety of the treatment with cases of atherosclerotic carotid artery stenosis (AS). Twenty-five lesions from 21 patients underwent CAS for RIS at our hospital between March 2002 and July 2020. The procedure was performed at a mean of 10.0 ± 5.2 years after radiation therapy with 60-72 Gy, with a median follow-up of 45 months. We retrospectively selected consecutive patients with AS with comparable follow-up times from the beginning of the study as controls. We compared the patients' background, stenosis findings including plaque MRI, perioperative period, and postoperative course. All patients in both groups completed the procedure, and the median follow-up time for the RIS and AS groups was 45 and 40 months, respectively (p = 0.1479). Patients in the RIS group had a lower mean age (69.9 ± 6.9 vs. 75.3 ± 7.04, p = 0.0075), a higher stenosis rate (79.1 ± 8.7% vs. 68.6 ± 11.7%, p = 0.0032), and longer stenosis greater than one vertebra (long lesions) (10 vs. 1, p = 0.0046) compared with the patients in the AS group. Although there was no significant difference in outcomes between the two groups, restenosis tended to be more common in the RIS group. Plaque MRI was characterized by a significantly higher T2WI signal (p = 0.0381) in the RIS group, which was attributable to the fact that a necrotic core has been reported commonly in the plaque tissue of RIS. RIS has a high likelihood of restenosis both morphologically and in terms of plaque characteristics. Thus, close follow-up is crucial.

Risk Factors and Distribution Characteristics of Intracranial and Intracranial Artery Stenosis in Young Sufferers with Ischemic Stroke.

In order to explore the risk factors of intracranial and intracranial arterial stenosis, the distribution of young ischemic stroke sufferers with intracranial and intracranial arterial stenosis and the related are analyzed. In this study, a total of 213 young sufferers with ischemic stroke (IS) admitted to our hospital from February 2019 to September 2021 are selected. According to the CT diagnosis of intracranial artery stenosis (AS), 213 patients are divided into two groups, with 86 in the AS Group and 127 in the non-AS Group. To analyze the distribution of intracranial and intracranial AS in young patients with ischemic stroke, 86 patients with AS are examined by carotid B-mode ultrasound. Furthermore, a univariate analysis is performed on the relevant indicators of the sufferers in the cancer (CA) set and the two sets without CA, and then, the indicators with statistically extensive disparity were selected for multivariate logistic regression analysis of the risk factors for CA symptoms. The results show 50% of the sufferers with moderate or severe ischemic CA in young adults and 63.95% of the sufferers with intracranial artery stenosis. It is clearly evident that the main risk factors affecting the occurrence of intracranial and intracranial arteries in young IS are hypertension and long-term smoking, long-term drinking, and hyperlipidemia.

Endovascular evaluation of intracranial atherosclerotic stenosis in a sample of Egyptian patients presented with ischemic stroke

Background and aim Intracranial atherosclerosis is an important etiology of ischemic stroke and is associated with multiple vascular risk factors. Endovascular evaluation is used for assessing patterns and distributions of intracranial atherosclerotic stenosis in a sample of Egyptian patients presented with ischemic stroke. Patients and methods A total of 50 patients with ischemic stroke or transient ischemic attack were included. Assessment of the state of cerebral vessels before the procedure was done by duplex ultrasound, magnetic resonance angiography, and/or computed tomography angiography to confirm any stenosis in intracranial vessels. Neurological assessment was done before and after the procedure using the National Institutes of Health Stroke Scale score. Digital subtraction angiography was done to evaluate the degrees and patterns of stenosis. Results A total of 50 participants (29 males and 21 females) were included. Their ages ranged from 30 to 78 years. The major risk factors were dyslipidemia (62.0%), hypertension (60.0%), diabetes mellitus (54.0%), smoking (48.0%), and atrial fibrillation (22.0%). The procedure was performed on 50 patients. A total of 39 (78.0%) patients had angiographic findings of vessel stenosis in either extracranial or intracranial vessels or both. In those 39 patients, 32 (64.0%) patients had arterial stenosis, and seven (14.0%) patients were found to have total occlusion. A total of 18 (36.0%) patients had angiographic findings of intracranial atherosclerotic stenosis. Of these 18 patients, 14 (28.0%) patients had arterial stenosis, and four (8.0%) patients were found to have total occlusion. The most common site of intracranial stenosis was middle cerebral artery (33.3%). Conclusion Endovascular evaluation of patients with ischemic stroke is yielding, informative, safe, and easy to be done.

Bibliometric analysis of effect of applied magnetic field on blood flow in stenosed artery

Around 50% of the deaths in the world are because of heart diseases. One of the heart diseases is Atherosclerosis which occurs due to stenosis in arteries. Researchers and medical practioners are working on how to reduce the reduction/fluctuations in blood flow in stenosed arteries. One of the methods under consideration is the application of magnetic field on blood flow in stenosed arteries. With limited healthcare resources, Bibliometric studies help scholars and funding agencies to focus on the research area in which more attention is needed. The main purpose of this bibliometric analysis is to find the development in blood flow in stenosed arteries and to identify potential areas for further research. This paper provides an overall picture of research carried in blood flow in stenosed arteries in the presence of applied magnetic field and, in the current century. This analysis is done using mainly Scopus database along with Google scholar, data taken from Mendeley and using some graphical tools. This survey revealed that the maximum publications are from journals and conferences and India lead the publications in this area. Blood flow and stenosis are frequently used key words and major contributions in this area are from computer science journals followed by mechanical journals. Medical and Engineering are two main fields in which the publications in this topic are more. The high number of citations of the journals in which the related articles are published shows the importance and thrust in this area. This paper puts a light on contribution of researchers in the area which will help medical practioners to take up the idea to next level.

Inflammatory endothelium-targeted and cathepsin responsive nanoparticles are effective against atherosclerosis.

Rationale: Atherosclerosis is characterized by lipid accumulation, plaque formation, and artery stenosis. The pharmacological treatment is a promising therapy for atherosclerosis, but this approach faces major challenges such as targeted drug delivery, controlled release, and non-specific clearance.Methods: Based on the finding that the cathepsin k (CTSK) enzyme is enriched in atherosclerotic lesions, we constructed an integrin αvβ3 targeted and CTSK-responsive nanoparticle to control the release of rapamycin (RAP) locally. The targeted and responsive nanoparticles (T/R NPs) were engineered by the self-assembly of a targeting polymer PLGA-PEG-c(RGDfC) and a CTSK-sensitive polymer PLGA-Pep-PEG. PLGA-Pep-PEG was also modified with a pair of FRET probe to monitor the hydrolysis events.Results: Our results indicated that RAP@T/R NPs accelerated the release of RAP in response to CTSK stimulation in vitro, which significantly inhibited the phagocytosis of OxLDL and the release of cytokines by inflammatory macrophages. Additionally, T/R NPs had prolonged blood retention time and increased accumulation in the early and late stage of atherosclerosis lesions. RAP@T/R NPs significantly blocked the development of atherosclerosis and suppressed the systemic and local inflammation in ApoE-/- mice.Conclusions: RAP@T/R NPs hold a great promise as a drug delivery system for safer and more efficient therapy of atherosclerosis.

Nanomaterials: A Promising Therapeutic Approach for Cardiovascular Diseases

Cardiovascular diseases (CVDs) are a primary cause of death globally. A few classic and hybrid treatments exist to treat CVDs. However, they lack in both safety and effectiveness. Thus, innovative nanomaterials for disease diagnosis and treatment are urgently required. The tiny size of nanomaterials allows them to reach more areas of the heart and arteries, making them ideal for CVDs. Atherosclerosis causes arterial stenosis and reduced blood flow. The most common treatment is medication and surgery to stabilize the disease. Nanotechnologies are crucial in treating vascular disease. Nanomaterials may be able to deliver medications to lesion sites after being infused into the circulation. Newer point‐of‐care devices have also been considered together with nanomaterials. For example, this study will look at the use of nanomaterials in imaging, diagnosing, and treating CVDs.

Соотношение коронарного кровотока по данным коронарной ангиографии с 19-сегментной схемой деления миокарда левого желудочка в зависимости от типа кровообращения

The purpose — to compare the data on localization of stenosis in coronary arteries with segmental division of left ventricular myocardium. Materials and methods. Analysis of medical literature devoted to interpretation of results of coronary angiography taking into account the schemes of myocardium segmental division and the method of comparing the stenosis localization with myocardium segmental division. Results. The proposed method of comparing the coronary angiography results with the scheme of segmental division of left ventricular myocardium makes it possible to standardize the description of the structure and functions of the left ventricular in terms of the main diagnostic methods which use the myocardium segmental division. Conclusions. The practical application of this method enables to directly correlate the localization of coronary stenosis with those segments of myocardium whose functional state may be impaired.

Successful Endovascular Management of Anastomotic Stenosis of the Left Pulmonary Artery After Double Lung Transplantation

Successful Endovascular Management of Anastomotic Stenosis of the Left Pulmonary Artery After Double Lung Transplantation

Management of concomitant coronary artery disease and aortic valve stenosis in the era of transcatheter aortic valve treatment

Severe calcific aortic stenosis (AS) and coronary artery disease (CAD) have common risk factors and are frequently encountered in the same patient in clinical practice. CAD has been reported in ≥ 50% of AS patients undergoing both surgical treatment and transcatheter aortic valve implantation (TAVI). In the last two decades, TAVI has been established as a less invasive alternative to surgery. Recently, more and more young and low surgical risk patients undergo TAVI. Despite the high prevalence of CAD in patients treated with TAVI, the management strategy of concomitant CAD in these patients remains an area of considerable uncertainty. This review provides an updated overview of the current knowledge about this topic and offers points for reflection about the best approach to use.

Finite Difference Computation of Au‐Cu/Magneto‐Bio‐Hybrid Nanofluid Flow in an Inclined Uneven Stenosis Artery

The present study addresses the fluid transport behaviour of the flow of gold (Au)‐copper (Cu)/biomagnetic blood hybrid nanofluid in an inclined irregular stenosis artery as a consequence of varying viscosity and Lorentz force. The nonlinear flow equations are transformed into dimensionless form by using nonsimilar variables. The finite‐difference technique (FTCS) is involved in computing the nonlinear transport dimensionless equations. The significant parameters like angle parameter, the Hartmann number, changing viscosity, constant heat source, the Reynolds number, and nanoparticle volume fraction on the flow field are exhibited through figures. Present results disclose that the Lorentz force strongly lessens the hybrid nanofluid velocity. Elevating the Grashof number values enhances the rate of blood flow. Growing values of the angle parameter cause to reduce the resistance impedance on the wall. Hybrid nanoparticles have a superior wall shear stress than copper nanoparticles. The heat transfer rate is amplifying at the axial direction with the growing values of nanoparticles concentration. The applied Lorentz force significantly reduces the hybrid and unitary nanofluid flow rate in the axial direction. The hybrid nanoparticles expose a supreme rate of heat transfer than the copper nanoparticles in a blood base fluid. Compared to hybrid and copper nanofluid, the blood base fluid has a lower temperature.

VISCOSE AND THROMBOCYTIC-AGGREGATION DISORDERS ON PATIENTS WITH MYOCARDIAL INFARCTION WITH STABLE ELEMENTATION OF ST SEGMENT

Relevance. Clinical studies indicate a significant role in the pathogenesis of acute myocardial infarction, the functional state of platelet aggregation and blood viscosity, which determine the nature of blood flow in the vessels at the level of macro– and microcirculation.&#x0D; Objective: the aim of the study was to analyze changes in viscosity and platelet-aggregation disorders under the influence of different tactical, diagnostic and interventional approaches in patients with myocardial infarction and stable elevation of the ST segment in the presence of multivascular coronary artery disease.&#x0D; Materials and methods. Patient inclusion criteria for the study: MI with persistent ST-segment elevation; multi-vascular atherosclerotic coronary artery disease; angiographically significant stenosis of the coronary vessels more than 50-70%, at least in 2 projections; functionally significant stenosis of the coronary arteries, according to the fractional blood flow reserve (FBFR) (&lt;0.80). 102 patients were divided into 4 groups of the same type. The groups used 4 different tactical and treatment-diagnostic approaches. Group 1 (n = 25) - occlusion of an infarct-dependent vessel was detected using coronary angiography and its immediate stenting was performed; FBFR was established on days 2-3, and stenosis of infarction-independent arteries was proved; using optical coherence tomography (OCT), the stability, size, length of atheroma was assessed and delayed stenting of these vessels was performed. Group 2 (n = 26) - stenting of the infarct-dependent artery was performed; FBFR was established on days 2-3, but without OCT, followed by stenting of infarct-independent arteries. Group 3 (n = 25) - carried out simultaneous stenting of infarct-dependent and infarct-independent vessels after coronary angiography. Group 4 (n = 26) - only stenting of the infarct-dependent vessel was performed. All patients received standard two-component antiplatelet therapy (acetylsalicylic acid 75-150 mg/day and clopidogrel 75 mg/day) and received 20 mg of atorvastatin and 10 mg of ezetimibe. The results obtained in patients were compared with those results obtained in 30 practically healthy people of the same age and gender. The number of platelets and the concentration of fibrinogen were determined in each subject. Using a viscometer and a laser aggregometer the degree of platelet adhesion, the time of platelet adhesion, the degree of platelet aggregation, and blood viscosity were assessed. All indicators were studied three times - on the first day of myocardial infarction, after 3-4 weeks, and after a year. &#x0D; Results. Hyperviscous and hypercoagulable syndromes were established in patients with MI with persistent ST-segment elevation. They manifested themselves in the first weeks by a compensatory increase in the number of platelets, blood viscosity, fibrinogen levels, and an increase in platelet aggregation. Delayed stenting of infarct-independent arteries used in group 1 contributed to a lower amplitude of fluctuations of all laboratory parameters in comparison with other tactical and therapeutic approaches.&#x0D; Conclusions. It is possible to optimize the state of viscosity and the processes of adhesion/aggregation of platelets due to the systemic stepwise improvement of arterial blood supply. Traditional tactical and therapeutic-diagnostic principles of management of such category of patients do not fundamentally improve the state of viscous and coagulation-aggregation parameters even when using double antiplatelet therapy.

Acute left hemichorea secondary to severe carotid stenosis in an elderly patients / Hemicorreia esquerda aguda secundária a estenose carotídea grave num doente idoso

Hemicorhoea is known for involuntary and abnormal movements, it presents itself as an excessive muscle motility that contains several causes, including ischemic ones. However, the pathophysiology of this sign is unknown, there are several biases, one of which is the sensitivity to lack of oxygen and low perfusion in brain sites. There are case reports in which radiological examinations did not find cerebral ischemic alterations, which demonstrates that blood alterations generated by the low flow caused by arterial stenosis are also related to this clinical finding. Hemicorea is an uncommon finding in patients with severe carotid stenosis. Most cases have ischemic changes in the basal ganglia assessed on Cranial Magnetic Resonance; however, not every clinical picture clearly shows an ischemic process. But, in this case it is essential to disocclude the right internal carotid artery through an endarterectomy, in addition to drug treatment, both for complete remission of the hemichorea.

Osteoporosis in patients with coronary artery disease after coronary bypas surgery

Aim. To determine the most significant predictors of an unfavorable progress of osteoporosis (OP) in men with coronary artery disease after coronary artery bypass grafting (CABG) according to long-term (5 years) follow-up data.Methods. The prospective study included 393 patients (men) hospitalized for CABG. All patients underwent multispiral computed tomography of the coronary and carotid arteries to assess the calcium score (CS) and determine the equivalent density of calcium deposits (EDCD), coronary angiography, and dual-energy X-ray absorptiometry. After 5 years (average 59 months) of follow-up, the prognosis (status alive/dead) was assessed in 335 patients. Mortality during follow-up in patients after CABG was 10.7% (36 patients died). 257 patients underwent repeated osteodensitometry, quantitative assessment of coronary and carotid calcification, assessment of the “end points” of bone status (osteoporotic fractures, osteoporosis).Results. During the five-year follow-up an increase in the prevalence of OP was noted from 76.1% to 90.7%, while in 43.6% of cases, the progression of OP was recorded. Fractures occurred in 39 patients (15.2%), and in 34 (13.2%) osteoporosis developed for the first time. OP progression is associated with smoking (OR 5.3, 95% CI 3.1–9.4), 30% or more carotid artery stenosis (OR 5.6, 95% CI 2.9–10.7), baseline severe (more than 400) calcification of the coronary arteries (OR 2.7 at 95% CI 1.3–9.8), low density of (EDCD less than 0.19 g/mm3 ) coronary (OR 1.7 at 95% CI 1.1–8.2) and carotid (OR 2.4, 95% CI 1.4–10.3) calcium deposits. Linear regression analysis made it possible to establish that the reliable predictors of an unfavorable course of OP are coronary CS, EDCD of the carotid arteries, and the absence of statin therapy.Conclusion. OP progression in patients in the long-term period (5 years) after CABG was noted in 43.6%. The predictors of OP progression and the complications are a high level of coronary artery calcification, a low EDCD in the carotid arteries, and 30% or more stenosis of the carotid arteries. Patients receiving statins were associated with a lower risk of osteoporosis.

Accuracy versus reliability-based modelling approaches for medical decision making

Forecasting in the medical domain is critical to the quality of decisions made by physicians, patients, and health planners. Modeling is one of the most important components of decision support systems, which are frequently used to simulate and analyze under-studied systems in order to make more appropriate decisions in medical science. In the medical modeling literature, various approaches with varying structures and characteristics have been proposed to cover a wide range of application categories and domains. Regardless of the differences between modeling approaches, all of them aim to maximize the accuracy or reliability of the results in order to achieve the most generalizable model and, as a result, a higher level of profitability decisions. Despite the theoretical significance and practical impact of reliability on generalizability, particularly in high-risk decisions and applications, a significant number of models in the fields of medical forecasting, classification, and time series prediction have been developed to maximize accuracy in mind. In other words, given the volatility of medical variables, it is also necessary to have stable and reliable forecasts in order to make sound decisions. The quality of medical decisions resulting from accuracy and reliability-based intelligent and statistical modeling approaches is compared and evaluated in this paper in order to determine the relative importance of accuracy and reliability on the quality of made decisions in decision support systems. For this purpose, 33 different case studies from the UCI in three categories of supervised modeling, namely causal forecasting, time series prediction, and classification, were considered. These cases were chosen from various domains, such as disease diagnosis (obesity, Parkinson's disease, diabetes, hepatitis, stenosis of arteries, orthopedic disease, autism) and cancer (lung, breast, cervical), experiments, therapy (immunotherapy, cryotherapy), fertility prediction, and predicting the number of patients in the emergency room and ICU. According to empirical findings, the reliability-based strategy outperformed the accuracy-based strategy in causal forecasting cases by 2.26%, classification cases by 13.49%, and time series prediction cases by 3.08%. Furthermore, compared to similar accuracy-based models, the reliability-based models can generate a 6.28% improvement. As a result, they can be considered an appropriate alternative to traditional accuracy-based models for medical decision support systems modeling purposes.

The vertebral Artery Anomalous, Stenosis vs Hypoplasia as the leading cause of Stroke. An anatomical cross-Sectional Study of VA anomalies in Neck three-Dimensional computed Tomography Angiography

Introduction: A thorough understanding of the vertebral artery (VA) variations and course of the artery and its related branches could significantly enhance the efficacy and safety of interventions involving the neck and spine. Here, we aimed to investigate the incidence of various VA variations in individuals presenting with signs and symptoms of stroke with our neurology team. Material and Method: In this retrospective study we investigate CTA images of patients with signs and symptom of stroke who referred to specialized medical imaging centre. An experienced board-certified radiologist evaluated the CTA images, recording the characteristics of VA, regarding dominance and any possible anomalies. These included anomalous origin, anomalous route, anomalous branching, stenosis, hypoplasia, atresia, thrombosis, and dissection. All data were analyzed using SPSS version24 and Pearson Chi-Square and Fishers test used for anomaly and gender correlation. Results: A total of 125 patients (53.6% females; mean age, 60.7 (11-87)) were included. In the case of VA dominance, 66.4% of cases were co-dominant while 16.0% were right, and 12.8% were left dominant. Overall, males had more VA anomalies than females, 24.8% and 17.6%, respectively (in general, 42.4% of all participants) (p = 0.020). Among patients, 4.0% (n = 5) had an anomalous origin and anomalous branching was reported in 5 patients (4.0%). Among the variations, significant stenosis (18.4%) and hypoplasia (17.6%) were the most prevalent anomalies with the earliest one having the higher rate. While anomalous branching was reported in 5 patients (4.0%). Conclusions: VA variations are relatively common and should be addressed during procedures involving the neck region and would allow surgeons to avoid life threatening injury.