Assessment Of Blood Flow Research Articles

Перспективы микроволновой радиотермометрии в ранней диагностике эндометрита и несостоятельности шва на матке после абдоминального родоразрешения

Aim: To assess the capabilities of microwave radiothermometry (MRTM) in early diagnosis of Postpartum endometritis and uterine suture failure after caesarean section. Design: Prospective non-randomized clinical trial. Materials and methods. A comparative analysis of the sensitivity of ultrasound (ultrasound) with dopplerometry and MRTM in the diagnosis of endometritis and suture failure on the uterus after cesarean section was carried out. The study included puerperal women after abdominal delivery (n = 90): 24 patients with a puerperia complication in the form of endometritis (group I), 16 — with suture failure on the uterus (group II), 50 — with a physiologically occurring postoperative period (control group). Assessment of the condition of the uterus and the postoperative suture on it was carried out on the 3–4th day after the operation. Results. Despite the fact that ultrasound with dopplerometry assessment of blood flow in the branches of the uterine arteries makes it possible to assess the structure of the myometrium and with a fairly high degree of probability to identify its inflammatory changes and defects in the suture, the sensitivity of this method in the early (3–4th day of the postoperative period) diagnosis of endometritis after abdominal delivery reaches an average of 54.2 ± 23.5%, and in the insolvency of the suture on the uterus — 31.25 ± 14.65%. At the same time, the MRTM study revealed indirect signs of endometritis in 66.7 ± 7.9% (if the conclusion is based on only one parameter — the thermoassymetry index, ITA) and 87.5 ± 8.3% (taking into account the combination of three signs), and for the insolvency of the suture on the uterus, the sensitivity of the method is 81.25 ± 4.75% for both ITA and three thermogram parameters, which is 2.6 times higher, than with ultrasound. Conclusion. Despite the rather high diagnostic effectiveness of the ultrasound method for assessing the condition of the scar on the uterus after cesarean section, the MRTM method has advantages in the form of higher sensitivity, ease of implementation, no need for expensive equipment and specialized medical qualifications. The greatest effectiveness of the diagnosis of postpartum purulent-septic complications can be achieved only with an integrated approach with clinical and laboratory tests and functional diagnostics, and timely prevention and an integrated approach to the treatment of purulent-inflammatory diseases of postoperative puerperia contribute to a significant reduction in the frequency of severe forms of postpartum infection. Keywords: caesarean section, endometritis, uterine suture failure, ultrasound, microwave radiothermometry, hysteroscopy.

ПРОГНОСТИЧЕСКИЕ ФАКТОРЫ РИСКА РАЗВИТИЯ ПРЕЭКЛАМПСИИ: СОВРЕМЕННЫЙ ВЗГЛЯД НА ПРОБЛЕМУ. СИСТЕМАТИЧЕСКИЙ ОБЗОР

Significance Preeclampsia is one of the common complications that significantly affects both pregnancy progress and delivery and the newborn health and can be also frequently followed by the death of mother and baby. This substantiates the need to identify risk factors for predicting preeclampsia The purpose of the study was to identify prognostic risk factors of preeclampsia. Material and methods. This systematic review analyzed modern studies on risk factors of preeclampsia and clinical, laboratory and instrumental methods of analysis to identify risk factors of preeclampsia as well as approaches to their assessment. The systematic review was conducted according to the PRISMA guidelines using certain PICO(S) criteria. Results The risk of preeclampsia should be assessed by risk factors to predict preeclampsia early in gestation. To identify such factors in various studies of Russian and foreign authors, the authors analyzed anamnestic factors and results of laboratory and instrumental diagnostic methods. Thus, a history of elevated blood pressure indicates an increased risk of preeclampsia. The highest risk of preeclampsia is registered in pregnant women with antiphospholipid syndrome. Most risk factors of preeclampsia are not potentially avoidable, except for excessive weight gain during pregnancy and multiple pregnancies, such as IVF. According to some researchers, the determination of laboratory parameters (platelet count, creatinine level, liver enzymes and urine protein) can help to predict preeclampsia. Changes in the absolute levels of angiogenic proteins of ischemic trophoblast VEGF, PlGF, sFlt-1, and sEng in mother’s blood and urine not only precede the onset of preeclampsia by several weeks or months, but also correlate with the disease severity and normalize after the delivery, suggesting a high prognostic value of this risk factor. Meta-analyses show that Doppler assessment of blood flow in uterine arteries can predict the risk of preeclampsia. Conclusion. As prognostic risk factors for preventive measures, with a high degree of probability the following set of data should be evaluated: arterial hypertension, antiphospholipid syndrome, obesity, multiple pregnancy, the history of assisted reproductive technologies, assessment results of blood flow in the uterine arteries, some laboratory blood parameters. The search for new predictive risk factors of preeclampsia requires further research.

Quantification of Portal Vein Vascularization Using an Automated Post-Processing Video Analysis Tool.

Purpose Blood flow dynamics represent a diagnostic criterion for many diseases. However, no established reference standard is available. In clinical practice, ultrasound pulsed-wave Doppler (PW-Doppler) is frequently used to assess visceral blood flow, despite its well-known limitations. A quantitative analysis of conventional color Doppler patterns can be performed using an innovative ultrasound-based algorithm (pixel flow analysis, PFA). This tool already shows promising results in obstetrics, but the technique has not yet been evaluated for portal venous blood flow assessment. Methods This prospective exploratory research study evaluated the applicability of PFA in the portal venous system. Measurements of portal venous flow using PFA and PW-Doppler were compared in healthy volunteers (n=20) and in patients with hepatic steatosis (n=10) and liver cirrhosis (n=10). Results In healthy volunteers (60% female, mean age 23 years, BMI 21.5 kg/m 2 [20.4-23.8]), PFA and PW-Doppler showed a strong positive correlation in fasting conditions (r=0.69; 95% CI 0.36-0.87), recording a median blood flow of 834 ml/min (624-1066) and 718 ml/min (620-811), respectively. PFA was also applicable in patients with chronic liver diseases (55% female, age 65 years (55-72); BMI 27.8 kg/m 2 (25.4-30.8)), but the correlation between PFA and PW-Doppler was poor (r=- 0.09) in the subgroup with steatosis. A better correlation (r=0.61) was observed in patients with liver cirrhosis. Conclusion PFA and PW-Doppler assessment of portal venous vascularization showed high agreement in healthy volunteers and patients with liver cirrhosis. Therefore, PFA represents a possible alternative to conventional PW-Doppler sonography for visceral blood flow diagnostics and merits further evaluation.

Highlighting early detection of thyroid pathology and gestational diabetes effects on oxidative stress that provokes preterm delivery in thyroidology: Does that ring a bell?

ObjectivesAd fontes, the status of the thyroid gland, and metabolic disturbance lead to the alteration of oxygenation. In pregnancy, it is particularly crucial to possess all predictive parameters. MethodsThis cross-sectional study was conducted at the Clinic of Gynecology and Obstetrics, Clinical Center of Serbia, Belgrade, Serbia, between 2017 and 2021 which study included a total of 99 women who had been admitted for preterm delivery and had undergone thyroid analysis, detected Hashimoto thyroiditis, and Oral Glucose Tolerance Test (OGTT) 40 days after delivery and had pathological Homeostatic Model Assessment for Insulin Response (HOMA IR) indices. In the group of urgent patients with preterm delivery, we looked after not only routine Doppler of the umbilical artery, but we measured specific ratios such as the Cerebroplacental ratio (CP). ResultsThe mean maternal age was 32.23 ± 5.96 years and the mean gestational age was detected as 35.40 ± 2.39 weeks. The delivery was completed vaginally in 77 women (78%) and surgically in 22 (22%). The Mean APGAR score was 8.44 ± 1.18, the mean birth weight was 2666.87 ± 622.17g and the cases undergoing cesarean section had significantly higher values of pulsatility index (1.85 ± 0.27 vs. 1.34 ± 0.31) and CP (1.22 ± 0.26 vs. 0.47 ± 0.17). ConclusionsThe introduction of Doppler sonography for blood flow assessment helps to form a complete clinical description of the patient, particularly in conditions where oxidative stress became provocative by the thyroid gland antibodies and gestational diabetes in Thyroidology.

Comparison of laser speckle contrast imaging with laser Doppler perfusion imaging for tissue perfusion measurement.

Laser-based tissue perfusion monitoring techniques have been increasingly used in animal and human research to assess blood flow. However, these techniques use arbitrary units, and knowledge about their comparability is scarce. This study aimed to model the relationship between laser speckle contrast imaging (LSCI) and laser Doppler perfusion imaging (LDPI), for measuring tissue perfusion over a wide range of blood flux values. Fifteen healthy volunteers (53% female, median age 29 [IQR 22-40] years) were enrolled in this study. We performed iontophoresis with sodium nitroprusside on the forearm to induce regional vasodilation to increase skin blood flux. Besides, a stepwise vascular occlusion was applied on the contralateral upper arm to reduce blood flux. Both techniques were compared using a linear mixed model analysis. Baseline blood flux values measured by LSCI were 33 ± 6.5 arbitrary unit (AU) (Coefficient of variation [CV]=20%) and by LDPI 60 ± 11.5AU (CV=19%). At the end of the iontophoresis protocol, the regional blood flux increased to 724 ± 412% and 259 ± 87% of baseline measured by LDPI and LSCI, respectively. On the other hand, during the stepwise vascular occlusion test, the blood flux reduced to 212 ± 40% and 412 ± 177% of its baseline at LDPI and LSCI, respectively. A strong correlation was found between the LSCI and LDPI instruments at increased blood flux with respect to baseline skin blood flux; however, the correlation was weak at reduced blood flux with respect to baseline. LSCI and LDPI instruments are highly linear for blood flux higher than baseline skin blood flux; however, the correlation decreased for blood flux lower than baseline. This study's findings could be a basis for using LSCI in specific patient populations, such as burn care.

Correlation of Ultrasound Umbilical Venous Blood Flow in Normal Pregnancy with Gestational Age and Foetal Weight

Background: Umbilical venous (UV) blood flow is a direct and physiological measurement of vascular placental function.
 Objectives: To correlate UV blood flow with gestational age (GA) and foetal weight (FW) in a cohort of normal pregnant Nigerian women.
 Materials and Methods: 2,247 women with normal singleton pregnancy between 20 – 40 weeks were included in this study, which was conducted between May 2020 – October 2022, in Bayelsa State, South-South Nigeria. The women had ultrasound assessment of UV blood flow and foetal biometric parameters and weight. Data was analysed using SPSS version 25, associations between categorical variables and between categorical and continuous variables were assessed using chi square and t-test, respectively, with p-value <0.05 considered statistically significant. Correlation analysis was done, and presented in tables and charts.
 Results: There was a strong linear correlation between UV blood flow volume and GA (correlation coefficient, ɼ= 0.95; p=0.001), FW (ɼ=0.81; p=0.001), foetal biparietal diameter (BPD) (ɼ=0.88; P=0.001) and abdominal circumference (AC) (ɼ=0.75; P=0.001). Conversely, UV blood flow volume/FW showed a strong inverse relationship with FW (ɼ=- 0.73; p = 0.001), and a weak inverse relationship with GA (ɼ=- 0.36; p = 0.001).
 Conclusion: UV blood flow increases with advancing gestation and FW. The increase in UV blood flow in later gestation is however surpassed by the increase in FW, resulting in a reduction in UV blood flow volume per unit FW in the third trimester. The linear increase in UV blood flow volume with foetal BPD and AC suggests that these three parameters could be used in combination to estimate both GA and FW.

Ultrasound evaluation of biometric and Doppler parameters of kidneys in sheep in the prenatal and postnatal periods

The aim of this study was the ultrasound evaluation of kidneys in sheep fetuses during consecutive weeks of pregnancy and of lamb kidneys in the first two weeks after delivery. To evaluate the fetal kidneys, 20 single-pregnancy Suffolk sheep were examined. In the postpartum period, the kidneys were examined in 10 ewe lambs and 9 ram lambs. B-Mode ultrasound was used to assess the length, width and thickness of the kidney, as well as the thickness of the renal parenchyma and the renal cortex. Vascular haemodynamics was assessed with color and pulsed Doppler in renal, segmental and interlobular arteries. Fetal kidneys were visualized from 53 ± 2.00 days, and corticomedullary differentiation was observed from the 10th week of pregnancy onwards. All fetal kidney biometric parameters increased significantly in the following weeks of pregnancy. The width and thickness of the kidneys were greater in male than in female fetuses (P < 0.05). The left kidney was thicker than the right kidney (P < 0.05). An interactive effect of gestational age, fetal sex and kidney location on kidney width, kidney thickness and renal parenchyma thickness (P < 0.05) has been demonstrated. All the biometric parameters of the kidneys differed significantly between the first and the second week of life of the lambs. The thickness of the renal cortex was greater in the ram lambs (P < 0.05). However, the length, width and thickness depended on the location of the kidneys (P < 0.05). An interactive effect of age, sex and kidney location on kidney width in lambs was demonstrated (P < 0.05). In the fetal renal artery, peak systolic velocity (PSV) and end-diastolic velocity (EDV) were significantly lower than in lamb kidneys in the first few days of life. In turn, the PSV/EDV and resistance index (RI) in fetal kidneys were significantly higher than that in newborn lambs. In lambs, PSV, PSV/EDV, RI and PI in the renal artery were significantly higher than that in the segmental and interlobular arteries. Regardless of the location of the arterial vessel, significant differences were noted between the Doppler indices in one-week and two-week-old lambs. The obtained results may be useful in establishing reference values for biometric and hemodynamic ultrasound parameters of sheep kidneys during the fetal and neonatal period. Assessment of the renal cortex is especially of great clinical importance. Increased echogenicity and reduced thickness may indicate certain pathological processes in the kidney. The results of Doppler indices indicate that the postnatal renal haemodynamics depends on the age of the lambs and the location of the renal vessels. Therefore, these factors should be taken into account in the assessment of renal arterial blood flow in lambs.

Cardiovascular Magnetic Resonance Parametric Mapping Techniques for the Assessment of Chronic Coronary Syndromes.

The term chronic coronary syndromes encompasses a variety of clinical presentations of coronary artery disease (CAD), ranging from stable angina due to epicardial coronary artery disease to microvascular coronary dysfunction. Cardiac magnetic resonance (CMR) imaging has an established role in the diagnosis, prognostication and treatment planning of patients with CAD. Recent advances in parametric mapping CMR techniques have added value in the assessment of patients with chronic coronary syndromes, even without the need for gadolinium contrast administration. Furthermore, quantitative perfusion CMR techniques have enabled the non-invasive assessment of myocardial blood flow and myocardial perfusion reserve and can reliably identify multivessel coronary artery disease and microvascular dysfunction. This review summarizes the clinical applications and the prognostic value of the novel CMR parametric mapping techniques in the setting of chronic coronary syndromes and discusses their strengths, pitfalls and future directions.

Flow-based method demonstrates improved accuracy for calculating wall shear stress in arterial flows from 4D flow MRI data

Four-dimensional flow magnetic resonance imaging (i.e., 4D flow MRI) has become a valuable tool for the in vivo assessment of blood flow within large vessels and cardiac chambers. As wall shear stress (WSS) has been correlated with the development and progression of cardiovascular disease, focus has been directed at developing techniques to quantify WSS directly from 4D flow MRI data. The goal of this study was to compare the accuracy of two such techniques – termed the velocity and flow-based methods – in the setting of simplified and complex flow scenarios. Synthetic MR data were created from exact solutions to the Navier-Stokes equations for the steady and pulsatile flow of an incompressible, Newtonian fluid through a rigid cylinder. In addition, synthetic MR data were created from the predicted velocity fields derived from a fluid–structure interaction (FSI) model of pulsatile flow through a thick-walled, multi-layered model of the carotid bifurcation. Compared to the analytical solutions for steady and pulsatile flow, the flow-based method demonstrated greater accuracy than the velocity-based method in calculating WSS across all changes in fluid velocity/flow rate, tube radius, and image signal-to-noise (p < 0.001). Furthermore, the velocity-based method was more sensitive to boundary segmentation than the flow-based method. When compared to results from the FSI model, the flow-based method demonstrated greater accuracy than the velocity-based method with average differences in time-averaged WSS of 0.31 ± 1.03 Pa and 0.45 ± 1.03 Pa, respectively (p <0.005). These results have implications on the utility, accuracy, and clinical translational of methods to determine WSS from 4D flow MRI.

MRI Assessment of Cerebral Blood Flow in Nonhospitalized Adults Who Self-Isolated Due to COVID-19.

Neurological symptoms associated with coronavirus disease 2019 (COVID-19), such as fatigue and smell/taste changes, persist beyond infection. However, little is known of brain physiology in the post-COVID-19 timeframe. To determine whether adults who experienced flu-like symptoms due to COVID-19 would exhibit cerebral blood flow (CBF) alterations in the weeks/months beyond infection, relative to controls who experienced flu-like symptoms but tested negative for COVID-19. Prospective observational. A total of 39 adults who previously self-isolated at home due to COVID-19 (41.9 ± 12.6 years of age, 59% female, 116.5 ± 62.2 days since positive diagnosis) and 11 controls who experienced flu-like symptoms but had a negative COVID-19 diagnosis (41.5 ± 13.4 years of age, 55% female, 112.1 ± 59.5 since negative diagnosis). A 3.0 T; T1-weighted magnetization-prepared rapid gradient and echo-planar turbo gradient-spin echo arterial spin labeling sequences. Arterial spin labeling was used to estimate CBF. A self-reported questionnaire assessed symptoms, including ongoing fatigue. CBF was compared between COVID-19 and control groups and between those with (n=11) and without self-reported ongoing fatigue (n=28) within the COVID-19 group. Between-group and within-group comparisons of CBF were performed in a voxel-wise manner, controlling for age and sex, at a family-wise error rate of 0.05. Relative to controls, the COVID-19 group exhibited significantly decreased CBF in subcortical regions including the thalamus, orbitofrontal cortex, and basal ganglia (maximum cluster size=6012 voxels and maximum t-statistic=5.21). Within the COVID-19 group, significant CBF differences in occipital and parietal regions were observed between those with and without self-reported on-going fatigue. These cross-sectional data revealed regional CBF decreases in the COVID-19 group, suggesting the relevance of brain physiology in the post-COVID-19 timeframe. This research may help elucidate the heterogeneous symptoms of the post-COVID-19 condition. 2. Stage 3.

Bedside Cerebral Blood Flow Quantification in Neonates.

Measurement of blood flow to the brain in neonates would be a very valuable addition to the medical diagnostic armamentarium. Such conditions such as assessment of closure of a patent ductus arteriosus (PDA) would greatly benefit from such an evaluation. However, measurement of cerebral blood flow in a clinical setting has proven very difficult and, as such, is rarely employed. Present techniques are often cumbersome, difficult to perform and potentially dangerous for very low birth weight (VLBW) infants. We have been developing an ultrasound blood volume flow technique that could be routinely used to assess blood flow to the brain in neonates. By scanning through the anterior fontanelles of 10 normal, full-term newborn infants, we were able to estimate total brain blood flows that closely match those published in the literature using much more invasive and technically demanding methods. Our method is safe, easy to do, does not require contrast agents and can be performed in the baby's incubator. The method has the potential for monitoring and assessing blood flows to the brain and could be used to routinely assess cerebral blood flow in many different clinical conditions.

ОЦЕНКА ОВАРИАЛЬНОГО РЕЗЕРВА ПАЦИЕНТОК С ХРОНИЧЕСКИМ САЛЬПИНГООФОРИТОМ

An important problem in reproductology is inflammatory diseases of the pelvic organs. About 60% of patients with chronic salpingoophoritis are of reproductive age, and 65-77% of cases of acute processes turn into chronic. The analysis of the scientific literature on the effect of chronic salpingoophoritis on the reproductive function of women is carried out. The diagnostic significance of the ultrasound method in assessing the state of the ovarian reserve has been studied. The analysis of the dependence of the concentration of anti-Muller hormone and the indicators of the ovarian reserve was carried out. Evaluation of the ovarian reserve should be carried out using high-frequency transvaginal sensors. These methods allow us to study the architectonics of the intra-organ bloodstream of the ovaries. Modern ultrasound machines allow you to study in detail all the indicators of the ovarian reserve and remove Doppler parameters. Dopplerography can be considered effective for assessing blood flow in the ovaries. The PD energy doppler makes it possible to evaluate intra- and perifollicular blood flow in small diameter vessels. Extensive visualization capabilities are important, capable of creating a planar and 3D image of the ovary under study. An integrated approach is needed to assess the ovarian reserve. In comparison with ultrasound examination, the level of anti-muller hormone more fully shows the activity of immature follicles ranging in size from 0.2 to 4 mm, which are visible during ultrasound examination are poorly visible.

Assessment of dynamic cerebral autoregulation in near-infrared spectroscopy using short channels: A feasibility study in acute ischemic stroke patients.

In acute ischemic stroke, progressive impairment of cerebral autoregulation (CA) is frequent and associated with unfavorable outcomes. Easy assessment of cerebral blood flow and CA in stroke units bedside tools like near-infrared spectroscopy (NIRS) might improve early detection of CA deterioration. This study aimed to assess dynamic CA with multichannel CW-NIRS in acute ischemic stroke (AIS) patients compared to agematched healthy controls. CA reaction was amplified by changes in head of bed position. Long- and short channels were used to monitor systemic artery pressure- and intracranial oscillations simultaneously. Gain and phase shift in spontaneous low- and very low-frequency oscillations (LFO, VLFO) of blood pressure were assessed. A total of 54 participants, 27 with AIS and 27 age-matched controls were included. Gain was significantly lower in the AIS group in the LFO range (i) when the upper body was steadily elevated to 30. and (ii) after its abrupt elevation to 30°. No other differences were found between groups. This study demonstrates the feasibility of NIRS short channels to measure CA in AIS patients in one single instrument. A lower gain in AIS might indicate decreased CA activity in this pilot study, but further studies investigating the role of NIRS short channels in AIS are needed.

Abstract 15054: Genome Wide Association Study of Coronary Microvascular Disease Assessed by Cardiac Perfusion Positron Emission Tomography

Introduction: Coronary Microvascular Disease (CMVD), defined as disease of the coronary pre-arterioles, arterioles, and capillaries, accounts for 30-50% of the burden of ischemic heart disease. However, little is known about the pathogenesis, and there are no directed therapies for CMVD. Perfusion cardiac PET allows for the quantitative assessment of myocardial blood flow (MBF) at rest and stress and MBF reserve (MBFR) and represents the most clinical advanced non-invasive imaging modality for CMVD. Hypothesis: Here we perform the first genome-wide association study (GWAS) for CMVD using cardiac PET MBF parameters. Methods: Rest and stress MBF and MBFR were measured using Rubidium-82 cardiac perfusion PET stress tests which were obtained as part of routine clinical care. We performed a GWAS in 383 samples of European (EUR) and 539 samples of African ancestry (AFR) in the Penn Medicine Biobank using MBF values and REGENIE software. Models were adjusted for age, sex, age 2 , age x sex, 5 principal components, and batch corresponding to phenotype extraction. Additionally fine mapping was performed for loci with P-value &lt; 1e-05 using implementation of SuSiE in the polyfun package by integrating gene expression and functional annotations from heart ventricular, atrium, aorta, and coronary artery tissues in the EpiMap database. Results: We identified 10 variants in AFR ancestry for MBFR at p-value &lt; 5e-7. Among the top hits, our results identified novel signals in variants mapping to LOC105374051, UNC13A, RPL21P130, ATP6V0A2, CCSER1, and MDFI , among others. We also identified 4 variants in AFR and 1 in EUR for rest MBF and 3 variants in AFR and 1 in EUR for stress MBF phenotypes, including loci near ARHGAP18 and ARHGAP22 . Fine mapping identified 4 loci in AFR for MBFR including NRP1, ERC1, RN7SKP148, and SCL15A4 . In sex-stratified analyses, we found that variants were more strongly associated with PET-derived MBF phenotypes in AFR women than in AFR men and in EUR men relative to EUR women. Conclusions: Our study identified several variants associated with perfusion PET MBF parameters in populations of EUR and AFR ancestry, some of which represent putative CMVD loci. This work yields novel insights into mechanisms of CMVD.

Abstract 15837: Decreased Placental Blood Flow in Fetuses With Congenital Heart Disease is Associated With Placental Vascular Abnormalities and Impaired Fetal Growth

Introduction: Studies suggest the placenta is abnormal in fetuses with congenital heart disease (CHD), possibly due to shared abnormal vascular developmental pathways. Umbilical venous volume flow (UVVF) is a validated Doppler-derived noninvasive imaging method to assess blood flow from placenta to fetus. We previously demonstrated that mid-gestational UVVF is decreased in fetuses with CHD compared to controls. We hypothesize that decreased UVVF in fetuses with CHD is associated with placental vascular abnormalities as well as impaired fetal growth. Methods: Pregnant women carrying fetuses with CHD (n=38; n=29 single ventricle (SV); n=8 TOF, n=1 d-TGA) or without (n=38) were enrolled in a prospective case-control study. UVVF and combined cardiac output (CCO) were measured during second trimester fetal echocardiograms (echo). Postnatal placentas were analyzed and assigned a placental abnormality severity score (PASS) based on the degree of lesions associated with fetal vascular malperfusion (FVM) and chronic inflammation (CI). Biometrics were collected for all newborns. T-tests or Fisher’s Exact tests were performed to assess statistical significance. Results: Gestational age (GA) at time of fetal echo was slightly greater for the CHD group (Table). All CHD fetuses as well as subgroup analysis of SV only had decreased UVVF indexed to fetal weight (UVVF/Wt) and to CCO (UVVF/CCO). Placental PASS analysis demonstrated higher grade FVM and CI lesions in fetuses with CHD. Fetuses with CHD were born earlier and had decreased birth weight z-scores compared to controls. Conclusions: Fetuses with CHD demonstrate decreased placental blood flow in utero, higher grade placental lesions associated with FVM and CI, and decreased birth weight. UVVF reflects characteristics of abnormal placental pathology and may be a useful marker of placental malperfusion in fetuses with CHD. Future study looking at association of UVVF and clinical outcomes is warranted.

Fetal status and perinatal outcomes in placenta previa

Introduction . Obstetric hemorrhage associated with placental abnormalities holds a leading place in the pattern of massive hemorrhage and maternal mortality, have been increasingly relevant due to the elevating rate of abdominal delivery. Aim : to assess fetal condition, parameters of uteroplacental and fetal hemodynamics as well as perinatal outcomes in pregnancy complicated with placenta previa. Materials and Methods . The retrospective study included 112 women aged 18–38 years who performed delivery between January 2016 and September 2020. Two groups were formed: the main group – 42 patients with placenta previa, and the control group – 70 pregnant women with normal placentation. Examination of women was carried out at admission for delivery within the gestational age between 26 to 40 weeks. We studied the parameters of fetometry and dopplerometry, hemogram parameters, biochemical blood analysis and some hemostasis parameters. Results . The groups examined were comparable in age and anthropometric data. In the main vs. control group, the course of pregnancy was more often complicated by the threatened termination (45 % vs. 21 %; p = 0.03), anemia (hemoglobin level 107 g/L vs. 110 g/L; p = 0.044), fetal growth retardation. Assessment of uteroplacental state and fetal-placental blood flow revealed differences indicating the presence of pathophysiological basis for developing hypotrophy and fetal hypoxia in the group of women with placenta previa. In the main group, the average gestational age at the time of delivery was 35.0 ± 2.8 weeks, in the control group – 39.0 ± 1.3 weeks (p = 0.003). Delivery showed significantly increased risk of preterm birth and rate of neonatal respiratory disorders in the main group. Conclusion . The results obtained evidence about a need to provide a careful approach to manage pregnant women with placenta previa to timely prevent anemia, placental disorders and hypotrophy. At the stage of the level III obstetric hospital, it is necessary to be ready for decompensation of placental disorders, birth of children with respiratory disorders, and fetal growth retardation.

Characteristics and Limitations of Video-capillaroscopy in Reconstructive Microsurgery for Different Histologic Components of Flaps.

Indocyanine green, ultrasonography, and handheld Doppler can be used to evaluate blood flow at the donor and recipient site during microvascular reconstruction. However, these methods do not provide direct visualization and assessment of real-time blood flow. Video-capillaroscopy has been shown to be useful in clinical practice to assess microcirculation in rheumatologic disorders. In this report we used video-capillaroscopy to assess different tissue components involved in microvascular surgery. Seven patients who underwent head and neck oncologic microvascular reconstruction between November 2021 and February 2022 were included in this study. Video-capillaroscopy (GOKO-BscanZD, GOKO Imaging Devices Co., Ltd., Japan) was used to evaluate the donor-site and recipient-site tissue components. Optimal red blood cell movement was graded with a score of four, while no flow was graded with a score of 0. Seven myocutaneous flaps and seven recipient sites were evaluated. For the donor-site, our analysis demonstrated a significantly higher video-capillaroscopy quality for skin (3.43), adipose tissue (3.7) and perforators (3.7) when compared with muscle (0.429), muscle fascia (0.857), and de-epithelialized skin (1) (P < 0.001). For the recipient-site, a significantly higher video-capillaroscopy quality for skin (2.7), adipose tissue (3.5), and the periosteum (2.1) was noted when compared with muscle (0) (P < 0.001). Video-capillaroscopy efficiency is limited in the muscular component and injured (de-epithelialized) skin surface areas of flaps. Herein, we provide evidence that assessment of flap perfusion with video-capillaroscopy can be reliably achieved in the skin, periosteum, perforators, and adipose tissue. Video-capillaroscopy is expected to be applied for intraoperative real-time blood flow evaluation.

Inter-day repeatability assessment of human retinal blood flow using clinical laser speckle contrast imaging.

Laser speckle contrast imaging (LSCI) can generate retinal blood flow maps inexpensively and non-invasively. These flow maps can be used to identify various eye disorders associated with reduced blood flow. Despite early success, one of the major obstacles to clinical adoption of LSCI is poor repeatability of the modality. Here, we propose an LSCI registration pipeline that registers contrast maps to correct for rigid movements. Post-registration, intra(same)-day and inter(next)-day repeatability are studied using various quantitative metrics. We have studied LSCI repeatability intra-day by using the coefficient of variation. Using the processing pipelines and custom hardware developed, similar repeatability was observed when compared to previously reported values in the literature. Inter-day repeatability analysis indicates no statistical evidence (p = 0.09) of a difference between flow measurements performed on two independent days. Further improvements to hardware, environmental controls, and participant control must be made to provide higher confidence in the repeatability of blood flow. However, this is the first time that repeatability across two different days (inter-day) using multiple exposure speckle imaging (MESI) has been analyzed and reported.

Effect of eplerenone on serum levels of gene 2 expressed growth promoting factor in patients with arterial hypertension

The aim of the work is to study the dynamics of diastolic function parameters, the content of the soluble growth factor receptor expressed by gene 2 (sST2) and the N-terminal fragment of brain natriuretic propeptide (NT-proBNP) in the blood of patients with hypertension when eplerenone is added to antihypertensive therapy.&#x0D; Material and methods. 64 patients (average age 51.3±1.5 years) with stage II hypertension, grade 2, who did not take regular antihypertensive therapy, were examined. After registration of the initial data, 34 patients (group 1) were prescribed basic antihypertensive therapy for hypertension with the addition of the drug eplerenone (Epletor, Borshchagivskyi Zavod, Ukraine) at a dose of 25–50 mg per day for 3 months. Group 2 included 30 people who were prescribed basic hypertension therapy. The control group included 20 practically healthy people.&#x0D; All subjects underwent a clinical and laboratory examination, including measurement of blood pressure (BP) in the office, during home self-monitoring and daily monitoring, echocardiography with assessment of transmitral Doppler blood flow, determination of sST2 and NT-proBNP levels in blood serum. Mathematical computer processing of the research results was carried out using the software package «Statistica 9.0» (Statsoft Inc, USA).&#x0D; The results. After 3 months of treatment, a significantly greater decrease in SBP and DBP was established according to the data of «office» measurement, home self-monitoring and DMAT. A more pronounced positive dynamics of indicators of structural and geometric remodeling of the LV was noted in patients who received antihypertensive therapy with the addition of eplerenone. After a course of treatment, a significant increase in the E/A ratio by 33.3% (p&lt;0.01) and a significant decrease in the E/e indicator by 31.3% (p&lt;0.05) were noted in patients of group 1. At the same time, in patients of group 2, the change of E/A and E/e did not change reliably. It was found that in group 1, the serum concentration of sST2 significantly decreased by 29.5% (р&lt;0.05) and was 28.4% (р&lt;0.05) lower, compared to group 2, in which this indicator was practically not was changing A decrease in NT-proBNP was noted in patients of group 1 by 28.6% (p&lt;0.01), which was 25.3% (p&lt;0.01) less, compared to the data of group 2, where only a downward trend was noted of this indicator.&#x0D; Conclusions. In patients with arterial hypertension of the 2nd degree, the addition of eplerenone to antihypertensive therapy contributes to a more pronounced decrease in blood pressure, measured by patients during self-control, during daily monitoring, compared to antihypertensive therapy. The inclusion of the selective mineralocorticoid receptor antagonist eplerenone in the complex therapy of patients with arterial hypertension of the 2nd degree has a pronounced positive effect on the structural and geometric indicators of the myocardium, the parameters of the diastolic function of the left ventricle, as well as the content of sST2 and NT-proBNP in the blood serum, along with good tolerability.

Fetal 4D flow MRI of the great thoracic vessels at 3 Tesla using Doppler-ultrasound gating: a feasibility study

ObjectivesTo evaluate the feasibility of Doppler-ultrasound (DUS)-gated 4D flow MRI of the fetal great thoracic vessels at 3T in a clinical setting.MethodsSixteen consecutive fetuses (range 30+4–38+5 weeks) with (n = 11) and without (n = 5) cardiovascular anomalies underwent 4D flow MRI of the great thoracic vessels at 3T. Direct fetal cardiac gating was obtained using a MR-compatible DUS device. 4D flow MRI–based visualisation and quantification of four target regions (ascending aorta (AAo), descending aorta (DAo), main pulmonary artery (MPA), and ductus arteriosus (DA)) were performed using dedicated software.ResultsFetal 4D flow MRI of the great thoracic vessels was successful in 12/16 fetuses (75%) by adopting clinical 4D flow MR protocols in combination with direct fetal cardiac DUS-gating. Four datasets were excluded due to artefacts by fetal movement or maternal breathing. 4D flow MRI–derived time-velocity curves revealed typical arterial blood flow patterns in the aorta. 4D flow quantification was achieved for the pre-defined target regions. Average velocity and flow volume were 21.1 ± 5.2 cm/s and 6.0 ± 3.1 mL/s in the AAo, 24.3 ± 6.7 cm/s and 8.4 ± 3.7 mL/s in the DAo, 21.9 ± 6.4 cm/s and 7.8 ± 4.2 mL/s in the MPA, and 23.4 ± 4.7 cm/s and 5.9 ± 3.6 mL/s in the DA, respectively.ConclusionsCombination of DUS-gating of the fetal heart and 4D flow MRI allows comprehensive visualisation and quantification of haemodynamics in the fetal great thoracic vessels. DUS-gated fetal 4D flow MRI may provide a new diagnostic approach for prenatal assessment of blood flow haemodynamics.Key Points• Fetal cardiac Doppler-ultrasound (DUS) gating and 4D flow MRI can be successfully combined.• DUS-gated fetal 4D flow MRI allowed visualisation and evaluation of streamline directionality, illustration of blood flow variations, and pulsatile arterial waveforms in the target vessels.• 4D flow MRI–based visualisation and quantification of the fetal great thoracic vessels were successful and flow metrics agreed with echocardiographic reference values.