Artery Vein Research Articles

Propensity score-matching analysis of retrograde artery first approach pancreatosplenectomy versus radical antegrade modular pancreatosplenectomy for 'shoulder' pancreatic cancers.

'Shoulder' pancreatic cancer is a challenging situation owing to its close proximity to the branches of the celiac artery and portal vein (PV). A pioneering study demonstrated the feasibility of retrograde artery first approach pancreatosplenectomy (RAFAPS) in treating 'shoulder' pancreatic cancer. However, comparative studies on this topic are lacking. In this single-centre cohort study, we retrospectively enrolled consecutive 'shoulder' pancreatic cancer cases from September 2019 to May 2023. Based on propensity score-matching analysis, we compared the safety and short-term oncological outcomes between RAFAPS and radical antegrade modular pancreatosplenectomy (RAMPS) for 'shoulder' pancreatic cancers. The primary outcome was a negative retroperitoneal margin rate. In total, 135 (17.0%) 'shoulder' pancreatic cancers were identified among 794 pancreatic cancers during the study period. After matching based on body mass index, tumour size, distance from the right edge of the tumour to the left wall of the PV, and neoadjuvant chemotherapy, a cohort of 78 patients was selected for analysis (1:1 match, 39 per group). Invasion of splenic vein, splenic artery and PV were found in 40 (51.3%), 28 (35.9%) and 23 (29.5%) patients, respectively. RAFAPS was associated with a higher rate of negative retroperitoneal margins (100% vs 84.6%; relative risk = 1.18, 95% confidence interval [CI]: 1.034-1.351; P = 0.025) and less estimated blood loss (150 vs 300ml; estimated difference: -100ml, 95% CI: -200-0; P = 0.039) when compared to that of RAMPS. RAFAPS is a safe and effective alternative to RAMPS for managing 'shoulder' pancreatic cancers in a minimally invasive era, with decreased blood loss and favourable retroperitoneal margin.

Identification of Somatic Genetic Variants in Superficial Vascular Malformations by Liquid Biopsy in a Cohort of 88 Patients from a French Hospital.

Superficial vascular anomalies are complex disorders characterized by abnormal vascular growth. Next-generation sequencing has recently identified somatic genetic alterations associated with these malformations, offering new insights for targeted treatments. However, tissue biopsies for genetic testing can be invasive and difficult to obtain, especially in arteriovenous malformations (AVM) with hemorrhagic risks. A liquid biopsy, a non-invasive approach, offers a promising solution by detecting genetic mutations in cell-free DNA. This pilot study aimed to evaluate the feasibility of using a liquid biopsy for the genetic analysis of patients with superficial vascular anomalies through cell-free DNA sampling. Additionally, it explored whether specific sampling sites, such as the afferent artery, nidus, and efferent vein, could enhance the sensitivity of detecting pathogenic variants in patients with AVM. A total of 88 patients were enrolled, including 55 with AVM and 33 with lymphatic malformations. For patients with AVM, cell-free DNA samples were collected from peripheral blood, efferent veins, afferent arteries, and the AVM nidus. In patients with lymphatic malformations, cystic lymphatic fluid was collected by a direct puncture during diagnostic procedures. A molecular analysis was performed using a targeted gene panel relevant to somatic alterations in solid tumors. Pathogenic variants were validated by digital polymerase chain reaction for patients with lymphatic malformations. Pathogenic variants were identified in 23.6% of patients with AVM, predominantly in MAP2K1 and KRAS genes, with higher sensitivity near the AVM nidus. In addition, pathogenic variants were identified in 27.3% of patients with lymphatic malformations, all involving the PIK3CA gene. Despite the lower sensitivity of a cell-free DNA analysis compared with a tissue biopsy, especially in patients with AVM, the detection rate suggests the utility for a cell-free DNA analysis, particularly when a tissue biopsy is not feasible. This study confirms the feasibility of using a cell-free DNA liquid biopsy for genotyping patients with superficial vascular anomalies, although a tissue biopsy remains the gold standard for comprehensive genetic profiling because of its higher sensitivity. A liquid biopsy offers a non-invasive option for molecular analysis that is useful as a preliminary or alternative approach when direct tissue sampling is not possible. Importantly, the sensitivity of cell-free DNA sampling in AVM appeared highest when obtained close to the nidus, indicating an optimal sampling location for future studies. Further research is needed to improve detection sensitivity, especially for samples taken near the nidus, to validate and strengthen these findings.Although our study focused on superficial/extra-cranial AVM, further research should assess the applicability of this approach to cerebral AVM, where a tissue biopsy is particularly risky.

New evidence for baroreflex and respiratory chemoreflex-mediated cerebral sympathetic activation in humans.

The brain is highly innervated by sympathetic nerve fibers; however, their physiological purpose is poorly understood. We hypothesized that unilateral cerebral norepinephrine (NE) spillover, an index of cerebral sympathetic nerve activity (SNA), would be elevated when engaging the baroreflex [via lower-body negative pressure (LBNP; -20 and -40 Torr)] and respiratory chemoreflexes [via carbon dioxide (CO2) administration (+8 Torr)], independently and in combination. Twelve young and healthy participants (five females) underwent simultaneous blood sampling from the right radial artery and internal jugular vein. Tritiated NE was infused through the participants' right forearm vein. Right internal jugular vein and internal carotid artery blood flow were measured using duplex ultrasound. Unilateral cerebral NE spillover remained unchanged when only LBNP was applied (P = 0.29) but increased with hypercapnia (P = 0.035) and -40 Torr LBNP + CO2 (P < 0.01). There were no changes in total NE spillover during the LBNP and LBNP + CO2 trials (both P = 0.66), nor during CO2 alone (P = 0.13). No correlations were present between the increase in unilateral cerebral NE spillover during -40 Torr LBNP + CO2 and reductions in internal carotid artery blood flow (P = 0.56). These results indicate that baroreflex and respiratory chemoreflex stressors elevate cerebral SNA; however, the observed cerebral sympathetic activation has no impact on blood flow regulation in the internal carotid artery.NEW & NOTEWORTHY The results of the current study suggest that baroreflex and respiratory chemoreflex stressors elevate cerebral sympathetic nervous activity, quantified using the brain norepinephrine spillover method. However, the observed cerebral sympathetic activation has no impact on blood flow regulation in the internal carotid artery.

Computational exploration of injection strategies for improving medicine distribution in the liver.

The liver, a vital metabolic organ, is always susceptible to various diseases that ultimately lead to fibrosis, cirrhosis, acute liver failure, chronic liver failure, and even cancer. Optimal and specific medicine delivery in various diseases, hepatectomy, shunt placement, and other surgical interventions to reduce liver damage, transplantation, optimal preservation, and revival of the donated organ all rely on a complete understanding of perfusion and mass transfer in the liver. This study aims to simulate the computational fluid dynamics of perfusion and the temporal-spatial distribution of a medicine in a healthy liver to evaluate the hemodynamic characteristics of flow and medicine transport with the purpose of more effective liver treatment. Patient-specific geometries of parenchyma and hepatic artery, portal vein, and hepatic vein vessels of a healthy liver were segmented and reconstructed from the abdominal computed tomography scan images. Mesh was generated for the comprehensive combined model using unstructured tetrahedral elements. Transient pressure values were applied as boundary conditions at the portal vein and hepatic artery inlets, and pressure outlet boundary condition was assumed at the hepatic vein outlet. Medicine injection was done through the portal vein. The liver parenchyma was assumed to be a porous medium. Finally, computational fluid dynamics (CFD) simulation was performed to investigate blood perfusion, medicine distribution, and saturation time. The velocity parameter values calculated for the hepatic artery, portal vein, and hepatic vein vessels were consistent with the physiological ranges. The mass flow rate was higher in the portal vein than in the hepatic artery, which was consistent with high perfusion through the portal vein. The portal pressure gradient was 8.53mmHg. From a pharmacokinetic viewpoint, medicine distribution in porous tissue was a heterogeneous process. Medicine distribution was higher at end-diastolic pressure than at peak-systolic pressure which showed the influence of hepatic artery flow. The tissue was saturated faster at first 40s and with decreasing porosity, saturation time decreased, and distribution improved. The right lobe included a higher number of vascular terminals due to its larger volume, and the flow rate was higher in this lobe compared to the left lobe. This showed the significant effect of the right lobe on the overall function of the body. Recirculation flow zones along hepatic artery and portal vein branches emphasized the sensitivity of downstream vessels. Rotational flow and potential vortex formation at the hepatic vein outlet may indicate a risk of plaque and clot formation in this region. The heterogeneous distribution of medicine indicated the importance of injection time in treating liver diseases. The percentage of tissue porosity affected the saturation time, so adjusting the medicine dose and injection time could be challenging in treatments.

Lymph node Yield in Apical Tissue During Triangle Operation While Doing Whipples Operation: An Observational Study

Introduction: The "TRIANGLE operation" involves the en-bloc removal of the tumor and the entire "mesopancreas" from the triangle-shaped space bounded by the superior mesenteric artery, coeliac trunk, and portal vein. This study assessed lymph node yield in apical tissue during the triangle operation.Methods: An observational cross-section study was conducted for two years at the Department of Gastrointestinal and General Surgery at a tertiary care center of Nepal. from 15th March 2022 to 15th March 2024. The operative procedure included pancreaticoduodenectomy or Whipple’s operation. Total sampling was done. Postoperative outcome and lymph node yeild of the surgeries were studied. Ethical approval was taken from the Institutional Review Committee (Reference No-1102202204).Results: A total of 56 patients underwent pancreaticoduodenectomy along with a triangle operation. The mean age of the patients was 56.38±14.79 years. Male: Female ratio was 1.2:1. Mean preoperative BMI was 24.41±4.72. The mean total lymph node yield was 20.95±8.57. Nineteen patients had a positive lymph node yield in the triangle tissue. The mean triangle lymph node yield was 10.59±4.92, and the mean positive lymph node was 2.58 ±1.64. Among 56 patients, nine patients had both apical margin and the rest of the triangle tissue margin positive. Ten patients had negative apical tissue margins, but the rest of the triangle tissue was positive, whereas, in thirty-seven patients, both the apical tissue and the rest of the triangle circumferential resection margin tissue were negative.Conclusions: This study emphasizes the importance of the inclusion of apical tissue dissection at the confluence of SMA and coeliac trunk to achieve R0 resection. However, a long-term follow is awaited.

Impact of Altered Graft Position During Living Donor Liver Retransplantation and its Outcomes.

Liver retransplantation (reLT), which is the only treatment for liver graft failure, remains challenging not only because of its technical nature but also because it is performed in high-risk patients. Nineteen patients who underwent reLT (second LT, n = 18; third LT, n = 1) between 1999 and 2021 were divided into two groups according to the graft laterality between prior transplantation and reLT (ipsilateral group, n = 9; contralateral group, n = 10). The aim of this study was to evaluate the short- and the long-term outcomes of patients who underwent living donor reLT and compared graft survival between ipsilateral and contralateral grafts. For hepatic vein reconstruction, the previous anastomotic orifice of the recipient was used in 8 (88.9%) patients in the ipsilateral group, while a new orifice on inferior vena cava of the recipient was created in 8 (80%) patients in the contralateral group. The conduit for the portal vein and hepatic artery were employed in 2 and 2 patients in the ipsilateral group and in 5 and 0 patients in the contralateral group, respectively. The overall incidence of hepatic artery and portal vein complications was 11.1% and 11.1% in the ipsilateral group, and 30% and 11.1% in the contralateral group, respectively. The 1-, 5-year graft survival rates were 70.8%, 66.7% in the ipsilateral group, and 70%, 70% in the contralateral group, respectively. There was no difference between ipsilateral and contralateral grafts in reLT in terms of surgical complications and graft survival.

Transcriptional profile of the rat cardiovascular system at single cell resolution

We sought to characterize cellular composition across the cardiovascular system of the healthy Wistar rat, an important model in preclinical cardiovascular research. We performed single-nucleus RNA sequencing (snRNA-seq) in 78 samples in 10 distinct regions, including the four chambers of the heart, ventricular septum, sinoatrial node, atrioventricular node, aorta, pulmonary artery, and pulmonary veins, which produced 505,835 nuclei. We identified 26 distinct cell types and additional subtypes, with different cellular composition across cardiac regions and tissue-specific transcription for each cell type. Several cell subtypes were region specific, including a subtype of vascular smooth muscle cells enriched in the large vasculature. We observed tissue-enriched cellular communication networks, including heightened Nppa-Npr1/2/3 signaling in the sinoatrial node. The existence of tissue-restricted cell types suggests regional regulation of cardiovascular physiology. Our detailed transcriptional characterization of each cell type offers the potential to identify novel therapeutic targets and improve preclinical models of cardiovascular disease.

Comparison of clinical results between transpulmonary thermodilution monitoring and conventional methods in cardiac surgery: An observational study.

The Pulse Index Contour Continuous Cardiac Output (PICCO) module provides advanced and continuous monitoring of cardiac output through the use of arterial pulse contour analysis and transpulmonary thermodilution. The objective of this study was to compare the early postoperative outcomes of patients who were monitored using the conventional method and the pulse contour analysis method. A prospective observational study was conducted involving 45 patients who underwent cardiac surgery between 2020 and 2022. Patients were randomly assigned to either Group P (PICCO) or Group C (conventional). In the PICCO cohort, a femoral artery cannula was inserted for the continuous recording and management of hemodynamic data, in accordance with the decision-making algorithm of the module. In the conventional group, cannulation of the radial artery and jugular vein was performed. The postoperative hemodynamic and clinical data are subjected to analysis. The utilization of dopamine was markedly diminished in Group P at both the 0- and 6-hour postoperative intervals, whereas the administration of dobutamine was observed to be elevated (P = .008). The frequency of red packed cell transfusions was higher in Group C at postoperative hour 0. Hemodynamic data indicated a 42% increase in cardiac index and a 33% decrease in systemic vascular resistance, along with a 33% increase in global ejection fraction in patients monitored with PICCO. The mortality rates observed in the 2 groups were not statistically different. The implementation of advanced monitoring techniques, specifically the PICCO module, led to notable enhancements in hemodynamic parameters. The utilization of this technique may prove advantageous in guiding inotrope selection and transfusion decisions during the initial postoperative period. However, it is important to note that morbidity and mortality rates remain comparable.

MODERN VIEWS AND APPROACHES TO THE CHOICE OF GRAFTS DURING CORONARY ARTERY BYPASS GRAFTING. PART 2: COMPARATIVE ANALYSIS OF DIFFERENT TYPES OF GRAFTS

It is known that coronary artery bypass grafting is still one of the main method of treatments from the point of increasing survival rates and avoidinig resergions and the risk of repeated interventions for most patients, in particular, in patients with multivessel coronary disease and diabetics. More than 45 years have passed since the first operation of coronary artery bypass grafting, and currently coronary artery bypass grafting is not only the most common operation in cardiovascular surgery, but also the “gold standard” for the treatment of the coronary heart disease. Currently, the internal thoracic artery, radial artery, and saphenous vein graft are used as grafts in coronary bypass grafting. And the question of which grafts are more efficient and durable is becoming more and more urgent. The long-term benefit of the internal thoracic artery has long been proven and the anastomosis between the left internal thoracic artery and the anterior interventricular branch of the left coronary artery is well established and remains the gold standard for revascularization of severe coronary artery disease. The radial artery and saphenous vein are grafts of the second order. It is not always possible to achieve complete revascularization with arterial grafts, which requires the use of venous grafts. Unfortunately, the saphenous vein graft does not have the same duration of functioning, which leads to the occurrence of dysfunctions and the development of repeated ischemic events. On the other hand, the radial and internal arteries are exposed to spasm and vulnerable to competitive blood flow In this paper, a detailed analysis of the main types of grafts in coronary surgery is carried out.

Brain Perfusion Analysis Method using Computed Tomography Images

Abstract. In this paper, a multi-stage perfusion calculation pipeline is suggested. It contains preprocessing algorithms for brain tissue segmentation, input artery and output vein detection, a self-supervised neural network for CT image denoising, and regularization deconvolution methods. SVD and TTV-based regularization methods were used at the last stage. The results of the comparison of these methods to classical SVD and TTV ones show that the self-supervised method outperforms others both for simulation and real data. For simulation, RMSE and SSIM metrics were used for comparison, and as for the real data, CNR metrics were compared for lesion and normal white matter areas, and for the latter ones bias and standard deviation were calculated.

ATP citrate lyase drives vascular remodeling in systemic and pulmonary vascular diseases through metabolic and epigenetic changes.

ATP citrate lyase (ACLY), a crucial enzyme in de novo lipid synthesis and histone acetylation, plays a key role in regulating vascular smooth muscle cell (VSMC) proliferation and survival. We found that human coronary and pulmonary artery tissues had up-regulated ACLY expression during vascular remodeling in coronary artery disease and pulmonary arterial hypertension. Pharmacological and genetic inhibition of ACLY in human primary cultured VSMCs isolated from the coronary arteries of patients with coronary artery diseases and from the distal pulmonary arteries of patients with pulmonary arterial hypertension resulted in reduced cellular proliferation and migration and increased susceptibility to apoptosis. These cellular changes were linked to diminished glycolysis, reduced lipid synthesis, impairment in general control nonrepressed protein 5 (GCN5)-dependent histone acetylation and suppression of the transcription factor FOXM1. In vivo studies using a pharmacological inhibitor and VSMC-specific Acly knockout mice showed that ACLY inhibition alleviated vascular remodeling. ACLY inhibition alleviated remodeling in carotid injury and ligation models in rodents and attenuated pulmonary arterial hypertension in Sugen/hypoxia rat and mouse models. Moreover, ACLY inhibition showed improvements in vascular remodeling in human ex vivo models, which included cultured human coronary artery and saphenous vein rings as well as precision-cut lung slices. Our results propose ACLY as a novel therapeutic target for treating complex vascular diseases, offering promising avenues for future clinical intervention.

Cerebral, Splanchnic, and Renal Transit Time Measurement and Blood Volume Estimation Using Contrast-Enhanced Ultrasonography.

We aimed to measure cerebral, splanchnic, and renal transit times and the associated blood volumes using contrast ultrasound. In healthy individuals, regional transit times were calculated from time-intensity curves generated as ultrasound contrast passed through the associated inflow and outflow vessels. These included the internal carotid artery and internal jugular vein (brain), the superior mesenteric artery and portal vein (intestines), and the renal artery and renal vein (kidney). An organ's blood volume relative to the stroke volume delivered to that organ with each cardiac cycle was calculated from the product of heart rate and transit time of contrast passage through the associated vascular bed. The fraction of systemic stroke volume received by each organ was calculated from the respective velocity-time integral and inflow vessel cross-sectional area and used to estimate absolute organ blood volume. The cohort consisted of 16 participants (age: 42 ± 13 years; 5 female) without known cerebrovascular, gastrointestinal, or renal disease. Cerebral, splanchnic, and renal transit times were obtained for 15, 14, and 8 individuals, respectively. Anatomic variability of the renal vessels confounded the acquisition of renal transit times. For all organs, transit times were reproducible and the associated blood volumes were generally comparable to reference values. Cerebral, gastrointestinal, and renal transit times/blood volumes can be reasonably acquired from contrast ultrasound, although the latter is less reliably available. Assessment of the impact on regional blood volumes of pharmacologic or other interventions is a next step toward clinical application of this technique.

The impact of intraoperative Fogarty balloon dilation on arteriovenous fistula success: clinical and functional outcomes.

An effectively functioning arteriovenous fistula (AVF) is vital for end-stage renal disease patients. This study aims to evaluate the effects of Fogarty® balloon catheter dilation on creating an effectively functioning AVF. This retrospective cohort study was conducted at our clinic between 2020 and 2022. A total of 120 patients underwent arteriovenous fistula (AVF) creation with intraoperative Fogarty® balloon catheter dilation. Inclusion criteria required the presence of a palpable radial artery and superficial vein in the non-dominant arm, which was confirmed via Doppler ultrasound when necessary. The surgical approach involved side-to-side anastomosis between the radial artery and cephalic vein, followed by intraoperative dilation of the artery, vein, and anastomotic area using a Fogarty® balloon catheter after completion of the anastomosis. The study included 120 patients aged between 26 and 89 years, with a nearly equal gender distribution (57 females, 47.5%; and 63 males, 52.5%). The success rate of arteriovenous fistulas (AVFs) was evaluated according to the number of patients who were able to start adequate hemodialysis 6 weeks after surgery. At 6-week follow-up, 114 patients successfully started hemodialysis through these AVFs. In contrast, six patients could not obtain an adequate AVF for effective hemodialysis. As a result, the overall success rate was calculated as 95%. This study suggests that intraoperative Fogarty balloon dilatation may contribute positively to the success rate of AVF creation. The findings indicate that this technique could be considered as a potential intraoperative strategy to optimize AVF outcomes, especially in patients with challenging vascular anatomy or a history of AVF failure.

Difficult Course of a Teenager’s Cardiogenic Shock

Abstract Fulminant myocarditis is a peculiar condition characterized by sudden-onset diffuse myocardial inflammation leading to hemodynamic compromise. We report the case of a 15-year-old male adolescent, without any cardiovascular history, who presented sudden-onset severe biventricular systolo-diastolic dysfunction leading to cardiogenic shock, 2 weeks after an episode of respiratory tract infection. A comprehensive treatment regimen was initiated including heart failure treatment, inotropic and vasoactive support, antibiotics, antiviral treatment, intravenous immunoglobulin, and glucocorticoids, but with poor evolution. Bridge-to-transplantation therapy was taken into consideration for hemodynamic stabilization. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support was initiated, first peripherally, via femoral artery and femoral vein access, but secondary to left ventricle (LV) distension, the patient developed pulmonary edema. To decompress the LV, an echocardiography-guided atrial septostomy was performed, and after 2 days, central cannulation (right atrium – ascending aorta) with another cannula for left atrial venting was done, and the patient remained with open sternum. Five days from the initiation of VA-ECMO the patient underwent an orthotopic heart transplantation by bicaval technique with favorable evolution in the follow-up period. Early initiation of VA-ECMO is a salvage intervention in pediatric patients with fulminant myocarditis, but with multiple possible complications. This paper highlights strategies for the optimization of VA-ECMO.

TEG-Guided Anticoagulation Assessment in Deep Vein Arterialization: A Prospective Analysis.

Deep Vein Arterialization (DVA) is an innovative surgical technique aimed at enhancing blood flow in compromised limbs facing amputation. Maintenance of flow post-revascularization is crucial to limb salvage. As this is a new technique, no standardized thromboprophylaxis regime is currently established, and post-procedure thromboprophylaxis is at the discretion of the proceduralist. This study aims to evaluate coagulation profiles using viscoelastic studies in peripheral artery disease (PAD) patients who underwent DVA, assessing the impact of various post-procedure thromboprophylaxis regimens. Patients (age >60years) undergoing DVA were prospectively evaluated using thromboelastography at baseline, 1, 3, and 6 months (2020-2024). Post-procedure thromboprophylaxis included monotherapy antiplatelet (MAPT), MAPT + direct oral anticoagulant (DOAC), dual antiplatelet therapy (DAPT), or DAPT + DOAC. Coagulation profiles were analyzed using descriptive statistics. Among sixteen patients (mean age 66.6 years, 75% male/Caucasian), hypertension and hyperlipidemia were present in 91%, and diabetes in 88%. The DAPT + DOAC group showed consistently superior platelet inhibition with the lowest ADP MA values throughout: baseline (35.65 mm vs. 42.2-65.03 mm in other groups), 1 month (26.7 mm vs. 32.14-69.4 mm), 3 months (27.36 mm vs. 32.2-39.97 mm), and 6 months (43.7 mm vs. 50.2-50.5 mm). MAPT demonstrated the slowest clot strengthening (CK angle 65.25° vs. 68.7-71.55°). TEG-PM demonstrated enhanced platelet inhibition and reduced clot formation in the DAPT + DOAC group, suggesting the importance of coagulation monitoring.

A cadaveric analysis of the efficacy of blind injections into the lateral pterygoid muscle.

Temporomandibular disorders (TMD) are amongst the most common causes of orofacial pain. Hyperactivity of the lateral pterygoid muscle (LPM) is associated with the pathological mechanisms associated with TMD. Botulinum Toxin-A (BTX) injections into the LPM can be used as a treatment for TMD; however, a lack of clinical standardisation for this procedure can lead to adverse outcomes, especially when using anatomical landmark-based approaches. To better understand the precision of extraoral landmark-based LPM BTX injections, a maxillofacial surgeon injected 1.5 mL of 0.25% methylene blue dye into the LPM of five cadavers. Needle location, dye spread, and disrupted structures were then examined through cadaveric dissection. Landmark-based LPM BTX approaches resulted in poor outcomes in accuracy (0%) and a 40% incidence of neurovascular disruption, including the facial plexus, superficial temporal artery and superficial temporal vein. Randomised controlled trials have highlighted the risks associated with extraoral botulinum toxin injections for TMD symptomatic relief. This report demonstrates the low accuracy rate and high neurovascular risk accompanying blind LPM injections and highlights the necessity of safe treatment protocols in TMD, in particular guided image-based diagnostics and procedures.

Complexity of arachnoid adhesions dictating the outcome of microvascular decompression for trigeminal neuralgia.

Multiple techniques have been used to treat trigeminal neuralgia (TGN), including pharmacotherapy, radiosurgery, rhizotomy and microvascular decompression (MVD). Blood vessels are considered to be the most common cause of offense and compression to trigeminal nerve. We aimed to determine the causes of classic TGN and efficacy of MVD. This retrospective, cross-sectional study assessed the data of 53 patients, who underwent MVD at the Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan, from May, 2022 to December, 2023. Information regarding patient demographics, clinical presentation, Barrow Neurological Institute Facial Pain Score (BNI-FPS), intra-operative findings, and postoperative complications were analyzed. The mean age at presentation was 44.33 ± 11.71 years. Unilateral facial pain was the consistent clinical presentation among all patients, with right-sided involvement in 67.92% patients. All patients had involvement of at least two divisions of trigeminal nerve; maxillary and mandibular nerve in 84.91% and 71.70% cases, respectively. BNI-FPS Grade-IVb was found among 49.09% patients on presentation. Arachnoid adhesions, superior cerebellar artery and superior petrosal vein were the most common causes of compression in 71.70%, 50.94% and 43.40% cases, respectively. About 94% patients were discharged home on first post-operative day without complications and with BNI-FPS Grade-I. Microvascular decompression is highly advocated in classic cases of TGN. In the absence of grossly visible offending vascular structure, arachnoid adhesions should be the thorough focus of address.

Endoscopic-Assisted Multivessel Off-Pump Coronary Artery Bypass Grafting: Experience of the First 100 Procedures.

This study presents an overview of our technique and the perioperative outcomes for the first 100 patients who underwent minimally invasive endoscopic-assisted off-pump multivessel bypass grafting (endoscopic coronary artery bypass [endo-CAB]) at the Catharina Hospital in Eindhoven. The first 100 patients undergoing multivessel endo-CAB from May 2022 to March 2024 were included in this retrospective, single-center, observational study (N=100). The study encompassed both elective and urgent surgical revascularization. In all cases, endoscopic-assisted harvesting of the internal mammary artery, radial artery, or saphenous vein was performed, followed by beating-heart anastomoses through a mini-thoracotomy. A total of 226 distal anastomoses were performed, utilizing 102 left internal mammary arteries, 80 radial arteries, 30 right internal mammary arteries, and 14 saphenous veins. On average, each patient had 2.3 anastomoses. A Y graft configuration was employed in 78 patients, in-situ bilateral internal mammary artery inflow in 19 patients, and a proximal aortic graft in 3 patients. Four patients underwent concurrent arrhythmia surgery. Eleven patients received hybrid revascularization. There was 1 conversion to sternotomy (1%) and 3 instances where cardiopulmonary bypass was required (3%). The median operation time was 3.3 hours (interquartile range, 3.0-3.7 hours), and the median hospital stay was 4.0 days (interquartile range, 3-4 days). The in-hospital mortality rate was 1%. Multivessel off-pump endo-CAB surgery can be safely performed with endoscopic-assisted conduit harvesting. Combining the benefits of a minimally invasive and anaortic approach may improve perioperative outcomes for patients requiring surgical revascularization. Further studies are necessary to establish the role of this technique in routine coronary surgery.

Sonographic Detection of Iatrogenic Carotid Artery Guidewires During Internal Jugular Vein Catheterization.

Background: Visualization of the guidewire during internal jugular (IJ) vein catheterization by point of care ultrasound (POCUS) has been recommended for avoiding inadvertent carotid artery dilation. The purpose of this study was to determine the accuracy of POCUS for identifying guidewires inappropriately placed in the carotid artery. Methods: This prospective, observational study involved emergency medicine (EM) residents with varying experience in guidewire visualization. Using an inanimate model, investigators placed guidewires randomly into the carotid artery or IJ vein. Residents, blinded to guidewire location, scanned the model and recorded their findings. The test performance of POCUS for arterially placed guidewires was evaluated through calculation of sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and overall accuracy, using investigator placement as the non-reference standard. Results: Twenty-five residents performed 51 observations. The test performance of POCUS for identifying arterially placed guidewires was sensitivity 95.0% (95%CI = 73.1-99.7%), specificity 96.8% (95%CI = 81.5-99.8%), NPV 96.8% (95%CI = 81.5-99.8%), and PPV 95.0% (95%CI = 73.1-99.7%). The overall accuracy was 96.1% (95%CI = 86.8-98.9%). Residents reported being very confident in their findings in 88.2% of all observations (95%CI = 76.6-94.5%), somewhat confident in 9.8% (95%CI = 4.3-21.0%), and not very confident in 2.0% (95%CI = 0.4-10.3%). No errors occurred among upper-level residents (post-graduate years 2-3) or those reporting >5 prior wire visualizations in live patients. Conclusions: This study is the first to demonstrate that physicians can easily identify misplaced guidewires located in the carotid artery with a high degree of accuracy using POCUS. We recommend routine scanning of the IJ vein and carotid artery prior to vessel dilation to reduce the likelihood of carotid artery injury.

A generalized health index: automated thoracic CT-derived biomarkers predict life expectancy.

To identify image biomarkers associated with overall life expectancy from low-dose computed tomography and integrate them as an index for assessing an individual's health. Two categories of CT image features, body composition tissues and cardiopulmonary vasculature characteristics, were quantified from LDCT scans in the Pittsburgh Lung Screening Study cohort(n = 3,635). Cox proportional-hazards models identified significant image features which were integrated with subject demographics to predict the subject's overall hazard. Subjects were stratified using composite model predictions and feature-specific risk stratification thresholds. The model's performance was validated extensively, including 5-fold cross-validation on PLuSS baseline, PLuSS follow-up examinations, and the National Lung Screening Trial (NLST). The composite model had significantly improved prognostic ability compared to the baseline model (p < 0.01) with AUCs of 0.774 (95% CI: 0.757-0.792) on PLuSS, 0.723 (95% CI: 0.703-0.744) on PLuSS follow-up, and 0.681 (95% CI: 0.651-0.710) on the NLST cohort. The identified high-risk stratum were several times more likely to die, with mortality rates of 79.34% on PLuSS, 76.47% on PLuSS follow-up, and 46.74% on NLST. Two cardiopulmonary structures (intrapulmonary artery vein ratio, intrapulmonary vein density) and two body composition tissues (SM density, bone density) identified high-risk patients. Body composition and pulmonary vasculatures are predictive of an individual's health risk; their integrations with subject demographics facilitate the assessment of an individual's overall health status or susceptibility to disease. CT-computed body composition and vasculature biomarkers provide improved prognostic value. The integration of CT biomarkers and patient demographic information improves subject risk stratification.