Basal Arteries Research Articles

Global intracranial arterial tortuosity is associated with intracranial atherosclerotic burden

The effect of arterial tortuosity on intracranial atherosclerosis (ICAS) is not well understood. This study aimed to evaluate the effect of global intracranial arterial tortuosity on intracranial atherosclerotic burden in patients with ischemic stroke. We included patients with acute ischemic stroke who underwent magnetic resonance angiography (MRA) and classified them into three groups according to the ICAS burden. Global tortuosity index (GTI) was defined as the standardized mean curvature of the entire intracranial arteries, measured by in-house vessel analysis software. Of the 516 patients included, 274 patients had no ICAS, 140 patients had a low ICAS burden, and 102 patients had a high ICAS burden. GTI increased with higher ICAS burden. After adjustment for age, sex, vascular risk factors, and standardized mean arterial area, GTI was independently associated with ICAS burden (adjusted odds ratio [adjusted OR] 1.33; 95% confidence interval [CI] 1.09–1.62). The degree of association increased when the arterial tortuosity was analyzed limited to the basal arteries (adjusted OR 1.48; 95% CI 1.22–1.81). We demonstrated that GTI is associated with ICAS burden in patients with ischemic stroke, suggesting a role for global arterial tortuosity in ICAS.

Prognosis of abnormal uterine bleeding in women of reproductive age with extragenital disorders

The purpose of the study was to elaborate on a prognostic model for predicting the development of abnormal uterine bleeding in women of reproductive age with accompanying extragenital disorders based on mathematical methods.
 Materials and methods. The study, which was in 2019-2022, involved 100 women of reproductive age with AUB and accompanying extragenital disorders under observation, who made up the main group. The control group comprised 50 women of reproductive age undergoing medical checkups. On the basis of 23 diagnostic indicators, the most informative ones were mathematically selected for the prognosis of AUB in women with extragenital abnormalities.
 Results and their discussion. The prognosis of the risk of developing AUB in women of reproductive age with extragenital disorders was carried out on a double scale (0 – low probability, 1 – high probability). The search for diagnostically informative factors involved a set of 23 working indicators that were investigated in the examined patients using four levels of the risk scale. In order to solve this issue, the factors that have the greatest importance in the formation of the prognosis were selected using discriminant analysis methods, and a corresponding mathematical model was created. The classification functions made it possible to enter the practical plane and form rules for assessing the presence/absence of the risk of developing AUB in patients of reproductive age with extragenital disorders. The corresponding expressions are the following equations:
 NP = BAS ART*75.57+FSH*2.96+prolac*0.02+estrad*0.02-40.78
 PP = BAS ART*105.35+FSH*0.79+prolac*0.1+estrad*0.08-114.49,
 where NP is a negative prognosis, PP is a positive prognosis.
 If NP > PP, then the most likely prognosis is the absence of AUB in the patient; otherwise, if PP > NP – there is an increased risk of AUB.
 Conclusion. Pulsation index in the basal arteries of the uterus, FSH, prolactin and estrogens are prognostically significant indicators for predicting the risk of abnormal uterine bleeding in patients of reproductive age with extragenital disorders. The above formula, obtained from the conducted discriminant analysis, makes it possible to predict bleeding in a specific patient

Localization of the neuropeptides pituitary adenylate cyclase-activating polypeptide, vasoactive intestinal peptide, and their receptors in the basal brain blood vessels and trigeminal ganglion of the mouse CNS; an immunohistochemical study.

Pituitary adenylate cyclase-activating polypeptide (PACAP) and vasoactive intestinal peptide (VIP) are structurally related neuropeptides that are widely expressed in vertebrate tissues. The two neuropeptides are pleiotropic and have been associated with migraine pathology. Three PACAP and VIP receptors have been described: PAC1, VPAC1, and VPAC2. The localization of these receptors in relation to VIP and PACAP in migraine-relevant structures has not previously been shown in mice. In the present study, we used fluorescence immunohistochemistry, well-characterized antibodies, confocal microscopy, and three-dimensional reconstruction to visualize the distribution of PACAP, VIP, and their receptors in the basal blood vessels (circle of Willis), trigeminal ganglion, and brain stem spinal trigeminal nucleus (SP5) of the mouse CNS. We demonstrated a dense network of circularly oriented VIP fibers on the basal blood vessels. PACAP nerve fibers were fewer in numbers compared to VIP fibers and ran along the long axis of the blood vessels, colocalized with calcitonin gene-related peptide (CGRP). The nerve fibers expressing CGRP are believed to be sensorial, with neuronal somas localized in the trigeminal ganglion and PACAP was found in a subpopulation of these CGRP-neurons. Immunostaining of the receptors revealed that only the VPAC1 receptor was present in the basal blood vessels, localized on the surface cell membrane of vascular smooth muscle cells and innervated by VIP fibers. No staining was seen for the PAC1, VPAC1, or VPAC2 receptor in the trigeminal ganglion. However, distinct PAC1 immunoreactivity was found in neurons innervated by PACAP nerve terminals located in the spinal trigeminal nucleus. These findings indicate that the effect of VIP is mediated via the VPAC1 receptor in the basal arteries. The role of PACAP in cerebral arteries is less clear. The localization of PACAP in a subpopulation of CGRP-expressing neurons in the trigeminal ganglion points toward a primary sensory function although a dendritic release cannot be excluded which could stimulate the VPAC1 receptor or the PAC1 and VPAC2 receptors on immune cells in the meninges, initiating neurogenic inflammation relevant for migraine pathology.

Features of uterine cavity in women with extragenital disorders and abnormal uterine bleedings

Objectives: to determine the features of the uterine cavity in women with extragenital disorders and abnormal uterine bleedings (AUB) using modern diagnostic methods.Materials and methods. The study involved 100 women with AUB and concomitant extragenital disorders, who constituted the main group. The control group consisted of 50 somatically healthy women. Women underwent ultrasound with Doppler mapping, and MRI if indicated to assess the condition of the pelvic organs. Due to the presence of AUB the patients of the main group underwent hysteroscopy and/or separate diagnostic curettage with further morphological assessment of the material obtained.Results. Ultrasound showed that the uterine size in women of the control group corresponded to physiological norms, and the thickness and structure corresponded to the M-echo phase of the menstrual cycle. The main group was additionally divided into subgroups depending on the detected pathological changes in the uterine cavity: endometrial polyp (glandular polyp, adenofibromatous polyp), submucous leiomatous node, endometrial polyp and submucous leiomatous node, endometrial hyperplasia, endometrial hyperplasia in combination with submucous leiomatous node. During the Doppler study the blood flow in the uterine, basal and spiral arteries was analyzed depending on the echographic assessment of the state of the uterine cavity in the main group in comparison with the data of the control group. The patients of the main group were found to have a significant increase in the level of the pulsation index in all the studied vessels in comparison with the corresponding values in the control group (Kruskal–Wallis test, Mann–Whitney test, p < 0.001).Conclusions. The most common disorder of the uterine cavity in women with extragenital diseases and AUB, detected by ultrasound scanning, were polyps of the uterine cavity and endometrial hyperplasia. A feature of blood flow in pathological processes in the uterine cavity was an increase in the pulsation index in the uterine, basal and spiral arteries in women of the main group compared to the control group.

Pulsatility Index in the Basal Ganglia Arteries Increases with Age in Elderly with and without Cerebral Small Vessel Disease.

Cerebral small vessel disease contributes to stroke and cognitive impairment and interacts with Alzheimer disease pathology. Because of the small dimensions of the affected vessels, in vivo characterization of blood flow properties is challenging but important to unravel the underlying mechanisms of the disease. A 2D phase-contrast sequence at 7T MR imaging was used to assess blood flow velocity and the pulsatility index of the perforating basal ganglia arteries. We included patients with cerebral amyloid angiopathy (n = 8; identified through the modified Boston criteria), hypertensive arteriopathy (n = 12; identified through the presence of strictly deep or mixed cerebral microbleeds), and age- and sex-matched controls (n = 28; no cerebral microbleeds). Older age was related to a greater pulsatility index, irrespective of cerebral small vessel disease. In hypertensive arteriopathy, there was an association between lower blood flow velocity of the basal ganglia and the presence of peri-basal ganglia WM hyperintensities. Our results suggest that age might be the driving factor for altered cerebral small vessel hemodynamics. Furthermore, this study puts cerebral small vessel disease downstream pathologies in the basal ganglia region in relation to blood flow characteristics of the basal ganglia microvasculature.

Mediastinal basal pulmonary artery identification and classification by three-dimensional reconstruction

The primary objective of the present study was to use CT angiography and 3D reconstruction to assess and to classify the mediastinal pulmonary basal segmental arteries. We report a particular type of bifurcated left lower pulmonary artery, namely, the "mediastinal basal pulmonary artery" type, which is the first branch from the proximal the left pulmonary artery (LPA) between the left main bronchus (LMB) and the left superior pulmonary vein (LSPV) and proceeding directly into the lower lobe. There are many types of mediastinal basal pulmonary arteries, and these can be classified worldwide in a unified way and format, which will be beneficial for clinical records, annotation and academic exchange. The mediastinal basal pulmonary arteries are described either as "supernumerary" when duplicating or "displaced" when replacing the normal arterial branching pattern of the lower lobe. The displaced type is more frequent than the supernumerary type. There are 12 types of left mediastinal basilar arteries. This is the first report to categorize the mediastinal basal pulmonary artery, is the first to suggest a system for mediastinal basal pulmonary artery nomenclature, and creates simplified models for use when planning anatomical segmentectomy. Knowledge and recognition of this rare and special condition may facilitate better diagnosis and treatment of these patients.

Динамика показателей маточного кровотока при малоинвазивном хирургическом лечении внутриматочной патологии с использованием различных видов энергии

Study Objective: To analyze the nature of changes in the parameters of uterine blood flow in minimally invasive surgical treatment of intrauterine pathology with the use of the diode laser energy operated in pulsed mode or bipolar energy. Study Design: Retrospective comparative study. Materials and Methods. A retrospective analysis of the reports of the Doppler ultrasound examination of the uterine blood flow in 102 patients who underwent surgery in the period from 2016 till 2020 was conducted to study the dynamics of uterine blood flow parameters in minimally invasive surgeries of intrauterine pathology utilizing various types of energy. Treatment of intrauterine pathology with the use of surgical diode laser in pulsed mode was performed in 60 women (1st group), 42 women were treated with bipolar energy (2nd group). Resistance index (RI) and pulsatility index (PI) in the right and left uterine arteries, arterial perfusion index (API), possibility to register the blood flow in sub-endometrial and endometrial blood vessels were evaluated while studying the uterine blood flow. Study Results. After the surgeries performed with the use of diode laser, the IR and PI remained unchanged statistically significantly more frequently than after the surgical treatment with the use of bipolar energy: 75 and 53.34% vs 30.95 and 33.33%. API statistically significantly more frequently increased in the 1st group (53.33%) and decreased in the 2nd group (66.67%). The blood flow in basal and coiled arteries of the uterus in post-surgery period is registered statistically significantly more often if diode laser was used as compared to the surgeries performed with bipolar energy (43.33 and 41.67% vs 21.43 and 19.05%, respectively). Conclusion. The use of bipolar energy in the treatment of intrauterine pathology leads to more severe uterine blood flow disturbances than surgeries with the use of diode laser. That is why it is reasonable to use the energy of a diode laser in pulsed mode in case of minimally invasive surgical treatment of intrauterine pathology. Keywords: intrauterine pathology, office hysteroscopy, diode laser, bipolar electrode, uterine blood flow.

Влияние COVID-19 на менструальную функцию женщин в репродуктивном периоде

Aim: to assess the effect of the COVID-19 infection on the menstrual function in women of reproductive age. Patients and Methods: the study group included 20 women who experienced COVID-19 and presented with menstrual disorders after infection. The study group was divided into two subgroups, i.e., women with mild (n=10) or severe (n=10) COVID-19 infection (subgroups 1 and 2, respectively). The control group included ten women without a history of COVID-19 infection and menstrual disorders. Hormone levels and hemostasis were evaluated, Doppler ultrasound (US) of basal and spiral arteries and ovarian arteries was performed in all women. Results: the mean age was 28.5±1.28 years in both groups. The period duration was 28.3±1.21 days in the control group and 53.1±0.84 days in the study group (i.e., 1.9-times greater, p<0.05). The rate of ovulatory cycles was 100% in the study group. The rate of anovulatory cycles was 25.8% in subgroup 1 and 77.8% in subgroup 2. Endometrial thickness (by US) was 10.64 [10.4; 11.1] mm in the control group, 6.31 [6.12; 6.87] mm in subgroup 1 and 3.20 [3.12; 3.45] mm in subgroup 2 (p<0.05). Significant abnormalities in hormone levels, endometrial hemodynamics, and hemogram parameters were detected in the study group compared to the control group. Moreover, in women with severe COVID-19 infection, these abnormalities were much more significant. Conclusion: in women of reproductive age who experienced COVID-19 infection, menstrual disorders were revealed based on hormone levels, hemostasis, and pelvic hemodynamics. KEYWORDS: coronavirus infection, COVID-19, menstrual function, reproductive period, Doppler ultrasound, hemodynamics, thrombosis, hemostasis. FOR CITATION: Mal’tseva A.N. Effect of the COVID-19 infection on the menstrual function in women of reproductive age. Russian Journal of Woman and Child Health. 2022;5(2):112–117 (in Russ.). DOI: 10.32364/2618-8430-2022-5-2-112-117.

Морфофункциональное состояние эндометрия у пациенток до и после органосохраняющих операций по поводу доброкачественных опухолей яичников

Benign ovarian tumors (BOT) have a significant impact on fertility and are associated with infertility, which, in turn, relates to endometrial receptivity and depends on the ovarian status, forming the so-called endometriopathy. Objective. To study the morphological and functional features of the endometrium in patients of reproductive age before and after ovary-sparing surgery for BOT according to 2D and 3D ultrasounds. Patients and methods. The study included 145 patients who underwent surgery for BOT. Patients were divided into two groups. Group 1 included 75 patients with diminished ovarian reserve (OR), group 2 included 70 patients with normal OR. Diminished OR was defined as serum Anti-Müllerian hormone (AMH) level <1.1 ng/mL. Pelvic ultrasound (US) was performed in the mid-secretory phase before and 6–12 months after surgery. We measured endometrial thickness, endometrial pattern, visualization of basal and spiral arteries by 2D ultrasound, volume and volumetric blood flow in the endometrial and subendometrial regions by 3D ultrasound. Results. The analysis revealed endometrial dysfunction in patients with diminished OR before and after surgery, however there was a trend towards improvement in all the examined parameters after 12 months. In patients with normal OR before surgery, endometrial parameters did not differ from the population, but more persistent abnormalities were noted in the postoperative period. Conclusion. The 3D ultrasound technique provides an objective assessment of morphological and functional features of the endometrium and allows to identify markers of endometrial dysfunction. Key words: benign ovarian tumors, volumetric blood flow, ovarian reserve, 3D ultrasound, endometrium

Features of instrumental research methods in combination of endometrial hyperplasia with chronic endometritis

Annotation. Hyperplastic processes of the endometrium can be triggered by a chronic inflammatory process. In addition, the importance of the presence of a long hyperproliferative process in the endometrium to accelerate genome modification with significant negative consequences of the development of oncogynecological pathology has been proved. The above risks require the development of clear diagnostic criteria for endometrial hyperplastic processes at the stage of non-invasive instrumental diagnosis. The aim of the study was to establish the features of the impact of chronic endometritis on the risk of neoplastic endometrial processes. A study of 161 women aged 18 to 53 years. Of these, 58 women had a verified diagnosis of endometrial hyperplastic process, and 71 women had endometrial hyperplasia due to chronic endometritis. The control group consisted of 32 women without signs of hyperplastic processes and chronic endometritis. Statistical data processing was performed on a personal computer using Microsoft Excel spreadsheets and the application package Statistica for Windows v.7.0, StatSoft Inc. (USA). All obtained quantitative data were processed by the method of variation statistics. A significant increase in uterine size was found in patients with endometrial hyperplastic processes, an increase in M-echo in patients with a combination of chronic endometritis and endometrial hyperplasia. The control group consisted of 32 somatically healthy women. Statistical data processing was performed on a personal computer using Microsoft Excel spreadsheets and the application package Statistica for Windows v.7.0, StatSoft Inc. (USA). All obtained quantitative data were processed by the method of variation statistics. A significant increase in uterine size was found in patients with endometrial hyperplastic processes, an increase in M-echo in patients with a combination of chronic endometritis and endometrial hyperplasia. The basal artery resistance index was found to be lower in the group of women with chronic endometritis. Similar indicators are established for the values of the pulsation index of the basal arteries of the uterus and the state of the spiral arteries. Thus, the method of ultrasound diagnosis of internal female genitals is a highly sensitive and specific method for the diagnosis of hyperproliferative processes of the endometrium, but has limited informativeness for the diagnosis of chronic endometritis. The combination of ultrasound diagnostics with dopplerometry of uterine vessels and endometrium (with the development of appropriate diagnostic criteria) allows to suspect chronic endometritis at the stage of pre-diagnostic hysteroscopy and subsequent pathomorphological and immunohistochemical examination.

Radiation Exposure of the Base of the Heart Accelerates Coronary Atherosclerosis

To determine the mechanisms associated with the development of atherosclerotic lesions in the heart after exposure to radiation therapy (RT). We hypothesize that accelerated development of cardiovascular disease (CVD) post-RT depends upon the region of the heart exposed to radiation.C57Bl/6 mice are naturally resistant to atherosclerosis. Apolipoprotein E is a multifunctional protein and its deficiency results in atherosclerosis in mice. Therefore, Apolipoprotein E knockout (ApoE-/-) mice are more suitable to investigate the development of atherosclerosis after radiation. Thus, 9 or 16 weeks old male ApoE-/- mice on a high fat diet (HFD) received 16Gy cardiac RT targeted to the whole or partial (apical or basal) region of the heart. Atherosclerotic lesions and inflammatory changes in the hearts and aortas were assessed using immunohistochemistry eight weeks following radiation and compared to control unirradiated mice.Our studies demonstrate that atherosclerotic lesion formation is accelerated by cardiac RT. We found that (1) Subendocardial atherosclerotic lesions at the base of heart of 9 weeks old mice after basal irradiation (7.8 ± 2.49) are comparable to those formed post-whole heart irradiation (12.2 ± 3.29). (2) Basal cardiac irradiation led to a greater number of atherosclerotic lesions in the basal coronary arteries (29.33 ± 5.48) and basal subendocardial vasculature (6.66 ± 2.07) as compared to unirradiated controls in 16 weeks old mice at 8 weeks post-RT. (3) Apical or whole heart irradiation had no impact on the development or acceleration of lesions in the basal region of the hearts in 16-week-old mice, thus demonstrating the adverse impact of basal irradiation. (4) Infiltration of inflammatory cells (CD45+ and CD3+) and enhanced expression of endothelial adhesion molecules (CD31+) after RT were differentially and locally regulated based upon the irradiation site. These results are indicative of a long-term inflammatory response to RT which may be crucial in the development of CVD. (5) Basal irradiation led to a significant increase in aortic atherosclerotic lesions in 16 weeks old mice as compared to the 9 weeks old mice. Thus, development of aortic atherosclerotic lesions could be a result of a combination of factors including age, diet and area of the heart irradiated.Our results indicate that the base of the heart in the 16 weeks old ApoE-/- mice on HFD was more prone to development of RT-induced atherosclerotic lesions and thus omitting this area from RT direct exposure may improve the quality of life for cancer patients receiving thoracic RT.

CT diagnostics of pulmonary embolism: Does iodine delivery rate still affect image quality in iterative reconstruction?

Computed tomographic (CT) imaging in suspected pulmonary artery embolism represents the standard procedure. Studies without iterative reconstruction proved beneficial using increased iodine delivery rate (IDR). This study compares image quality in pulmonary arteries on iteratively reconstructed CT images of patients with suspected pulmonary embolism using different IDR. 1065 patients were included in the study. Patients in group A (n = 493) received an iodine concentration of 40 g/100 ml (IDR 1.6 g/s) and patients in group B (n = 572) an iodine concentration of 35 g/100 ml (IDR 1.4 g/s) at a flow rate of 4 ml/s. A 80-detector spiral CT scanner with iterative reconstruction was used. We measured mean density values in truncus pulmonalis, both pulmonary arteries and segmental pulmonary arteries. Subjectively, the contrast of apical and basal pulmonary arteries was determined on a 4-point Likert scale. Radiodensity was significantly higher in all measured pulmonary arteries using the increased IDR (p < 0.001). TP: 483.0 HU vs. 393.4 HU; APD: 452.1 HU vs. 372.1 HU; APS: 448.2 HU vs. 374.4 HU; ASP: 443.9 vs. 374.4 HU. Subjectively assessed contrast enhancement in apical (p = 0.077) and basal (p = 0.429) lung sections showed no significant differences. Higher IDR improves objective image quality in all patients with significantly higher radiodensities by iterative reconstruction. Subjective contrast of apical and basal lung sections did not differ. The number of non-sufficient scans decreased with high IDR.

Transcranial doppler ultrasonography study in migraine patients treated with erenumab

Pathogenesis of migraine is believed to be neurogenic, with vascular changes having a role in the attack pathophysiology. Migraine patients have reported abnormalities in cerebral hemodynamics. Human monoclonal antibodies represent the new therapy of migraine, acting against the vasodilator effect of Calcitonin gene-related peptide. In this frame, the aim of the present study was to evaluate blood flow velocities in basal brain arteries and vasomotor reactivity of migraine patients using TCCD, before and after monoclonal antibody treatment with erenumab.

Medicolegal evaluation of pontine hemorrhage at autopsy- Highlights from a case and an overview

One in ten non-traumatic intracerebral hemorrhages (ICH) is located in the pons with chronic arterial hypertension as the leading etiology. In the forensic context, deaths related to a pontine hemorrhage (PH) are usually encountered in situations of drug abuse, excited delirium, trauma, as well as in sudden natural deaths where some hypertensive catastrophe is the usual underlying mechanism. The clinical presentation of PH may be variable, causing a failure in timely diagnosis that, if presents with unexplainable circumstances, may become the subject of medicolegal concern. The present case relates to a middle-aged man with a long history of hypertension and presents during an afternoon with an abrupt onset of deleterious symptoms. The patient was managed conservatively but succumbed to his illness and expires during treatment. A questionable diagnosis and the case circumstances, however, directed the doctors to inform the police. A medicolegal autopsy was therefore carried out that leads to the discovery of a lethal pontine hemorrhage rupturing into the fourth ventricle and involving the adjacent cerebellar tissues as well. Severe atherosclerosis of the basal arteries constituting Circle of Willis and Vertebrobasilar system was seen along with their hallmark effects that became evident during brain sectioning. Pathological stigmata of well established hypertension were found in the heart and kidneys. A clinic pathological correlation of the physical characteristics and topography of the hematoma to its severity was also carried out, based upon the known CT and autopsy findings. The possibility of a drug related or traumatic and secondary brainstem/Duret hemorrhage was ruled out.

Abstract 38: Radiation Exposure And Coronary Atherosclerosis: Differential Effect Of The Radiation Site

Background: Thoracic radiation is commonly used in breast cancer, Hodgkin’s lymphoma, head and neck and lung cancer patients. Accelerated coronary artery atherosclerosis is a common complication of thoracic radiation as a result of unintended cardiac radiation. It is unclear however whether specific areas of the heart are more susceptible to the effects of radiation (RT). In this study we hypothesize that accelerated development of lesions post RT is dependent upon differential sensitivity of specific areas of the heart to the effects of RT. Methods: Male Apolipoprotein E knockout mice on a high fat diet received 16Gy cardiac RT targeted to the whole or partial (apical or basal) region of the heart at 9 or 16 weeks of age (n=5 per group). Atherosclerotic lesions in H&amp;E stained slides and inflammatory infiltrates in the hearts by IHC were assessed 8 weeks following RT and compared to control unirradiated mice. Results: Our studies show that: (1) Subendocardial atherosclerotic lesions at the base of heart in mice irradiated at 9 weeks of age after basal irradiation (7.8±2.49) were comparable to whole heart irradiation (12.2±3.29). (2) A greater number of atherosclerotic lesions were present in the basal coronary arteries (29.33±5.48 vs 9±2.70) and basal subendocardial vasculature (6.66±2.07 vs 0.2±0.2) after irradiation of the cardiac base as compared to unirradiated controls in mice irradiated at 16 weeks of age. (3) Apical or whole heart irradiation had no impact on the development of lesions in the basal region of the hearts of older mice. (4) IL-6 was significantly increased in the serum of mice 6 hours post basal cardiac irradiation (105.10±17.56 pg/ml) when compared to unirradiated controls (29.85±11.63 pg/ml), demonstrating an acute inflammatory response. (5) Infiltration of inflammatory cells (CD45 and CD3) and enhanced expression of endothelial adhesion molecules (CD31) were differentially and locally regulated based upon the site of irradiation. Conclusion: Our results indicate that the base of the heart is more prone to development of RT induced atherosclerotic lesions likely due to acute and delayed inflammatory responses. Avoiding this area from direct radiation exposure may improve the quality of life for cancer patients receiving thoracic RT.

Abstract 3069: Radiation exposure of the base of the heart accelerates coronary atherosclerosis

Abstract Purpose: To determine the mechanisms associated with the development of atherosclerotic lesions in different areas of the heart exposed to radiation therapy (RT). We hypothesize that accelerated development of cardiovascular disease (CVD) post-RT is dependent upon the differential sensitivity of regions of the heart to radiation. Experimental procedures: Male Apolipoprotein E knockout (ApoE-/-) mice on a high fat diet received 16Gy cardiac irradiation targeted to the whole or partial (apical or basal) region of the heart at 9 weeks or 16 weeks of age. Atherosclerotic lesions and inflammatory changes in the hearts as compared to control unirradiated mice were assessed eight weeks following radiation. Results: Our studies demonstrate that atherosclerotic lesion formation is accelerated by cardiac RT. Our results show that (1) Subendocardial atherosclerotic lesions at the base of heart of 9 weeks old mice after basal irradiation are comparable to those formed post whole heart irradiation. (2) A greater number of atherosclerotic lesions were present in the basal coronary arteries and basal subendocardial vasculature after irradiating the cardiac base as compared to unirradiated controls in older mice at 8 weeks post-RT. (3) Apical or whole heart irradiation had no impact on the development or acceleration of lesions in the basal region of the hearts of 16 week old mice, thus demonstrating the adverse impact of basal irradiation. (4) Infiltration of inflammatory cells (CD45 and CD3) and enhanced expression of endothelial adhesion molecules (CD31) were differentially and locally regulated based upon the site of irradiation. This also demonstrates a long-term inflammatory response to RT which may be crucial in the development of RT-related CVD. Conclusion: Our results indicate that the base of the heart is more prone to development of RT-induced atherosclerotic lesions that could lead to CVD and thus omitting this area from RT direct exposure may improve the quality of life for cancer patients receiving thoracic RT. Citation Format: Prerna R. Nepali, Mickael Mathieu, Sarah Kitz, Chiharuko Nakauchi, James Russell, Sebastien Monette, Andreas Rimner, Fiona A. Stewart, Edgar A. Jaimes, Adriana Haimovitz-Friedman. Radiation exposure of the base of the heart accelerates coronary atherosclerosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 3069.

Anatomo-functional characteristics of the pelvic organs in women with habitual miscarriage and chronic endometritis

Chronic endometritis is a clinical and morphological syndrome, which under the influence of an infectious agent contributes to the violation of cyclic biotransformation and reciprocity of the endometrium. In the diagnosis of gynecological pathology, in particular chronic endometritis, or habitual miscarriage on the background of chronic endometritis, ultrasonography is a mandatory, non-invasive and highly specific method of research. The aim of the study was to assess the anatomical and functional condition of the pelvic organs in women with habitual miscarriage and chronic endometritis using ultrasound (ultrasound and Doppler) criteria. We examined 98 women of childbearing age who applied to the Inomed clinic in the city of Vinnytsia during 2019-2020. Patients were divided into two groups: the main group – 68 women with habitual miscarriage and chronic endometritis; control group – 30 re-pregnant women without previous pregnancy loss. Initially, ultrasound examination (ultrasound) of the pelvic organs was performed on day 5-7 of the menstrual cycle, and to monitor folliculogenesis, the study was repeated on day 13-17 of the cycle. One of the main signs of chronic endometritis is the heterogeneity of the structure of the endometrium, which was found in the vast majority of examined patients of the main group (80.88% at n=68). When determining the thickness of the endometrium, two diametrically opposite processes were established, namely: atrophy (39.71% at n=68) and atypical glandular hyperplasia (22.05% at n=68). In the second half of the menstrual cycle there was a significant thinning of the endometrial layer &lt;0.6 cm. In the control group during the ultrasound examination revealed the following disorders: increased uterine peristalsis, dilation of the arcuate plexus, the heterogeneity of the subendometrial layer, and when re-ultrasound took into account the data of folliculogenesis. Follicular cysts were detected in 10.3% of cases in the main group and 3.3% in the control group of women. At the time of re-ultrasound in each ovary was observed 5-8 antral follicles (the size of which ranged from 6.8 mm to 11.5 mm) with the presence of one dominant, the size of which ranged from 18.2 to 23.4 mm. In order to increase the informativeness of ultrasound, Doppler was additionally performed. Thus, ultrasonography is a highly specific method for determining the anatomical and functional characteristics of the pelvic organs, in particular the pathology of the endometrium in women with habitual miscarriage. The main ultrasound characteristics of chronic endometritis, as one of the causes of reproductive losses, are changes in endometrium structure, thickness, the presence of additional structures (polyps) and fluid component. Informativeness of ultrasound examination of structural changes in the endometrium in chronic endometritis is complemented by Doppler characteristics of blood flow in the basal and spiral arteries of the uterus.

ULTRASOUND PARAMETERS AND THE STATE OF UTERINE HEMODYNAMICS IN WOMEN WITH MENSTRUAL DYSFUNCTION IN PUBERTY

The study of hemodynamic features of the pelvic organs in women is of great clinical importance, since it allows assessing the degree of recovery of endometrial regeneration after menstruation, the possibility of implantating a fertilized egg and placental development. Women who have had menstrual dysfunction in puberty, the determination of qualitative and quantitative parameters of uterine hemodynamics can be useful while choosing treatment tactics, evaluating its effectiveness, and will also provide significant assistance in predicting the prospects for their reproductive health. The purpose of the study. To examine the hemodynamics of uterus and assess the ability of endometrium to implant in women with menstrual dysfunction in puberty with the help of ultrasound and dopplerometry.Materials and methods. To achieve the set goals, 120 women of reproductive age from 19 to 32 years old were examined. By the nature of the disorders, the main group of women (n = 90) with menstrual dysfunction in puberty were divided into 3 subgroups (n = 30): the first group - women with primary oligomenorrhea, the second one - with late menarche, the third one - with pubertal bleeding. The control group consisted of women (n = 30) with the correct rhythm of menstruation in puberty. Results. On the basis of a comparative analysis of the echographic parameters of the size of the uterus in women with menstrual dysfunctions in puberty (main group) and women with the correct rhythm of menstruation (control group), it was found that, on the average stage of endometrial secretion, the volume of the uterus is 1, 2 times smaller in women of the main group (p˂0.05) due to the width of the body of the uterus (p˂0.001). The ratio between the length of the body and cervix in the examined groups did not differ significantly. The thickness of the anterior wall of the uterus is less than the control values in women with late menarche (p˂0.05) and pubertal bleeding (p˂0.01), which was a predictor of the absence of combined uterine pathology. Echographic examination of the thickness of the endometrium at a late stage of the proliferation phase in the examined women did not reveal significant differences with the control group. In the middle stage of the secretion phase, the thickness of the endometrium was less in women, who had menstrual dysfunction in puberty - 9.50 ± 0.27 mm versus 11.38 ± 0.48 mm in the group with the correct menstruation rhythm (p &lt;0.001), but remained within the reference values. Dopplerometry of uterine arteries was performed to assess the functional activity and the possibility of sectorial transformation of the endometrium, which did not reveal significant differences in women of the main and control groups. Conclusions. An analysis of the ratio between the body length and the cervix of the uterus proves the absence of signs of genital infantilism in patients with menstrual dysfunctions in puberty. Doppler studies of hemodynamics in the arteries of uterus in this group of women in different phases of the menstrual cycle indicate an adequate blood supply to the uterus. Although the inferior phase of proliferation of endometrial thickness in its middle stages remained insufficient secretion (9,52 ± 0,42 mm; p &lt;0.01), however, the normal blood flow in the radial and basal uterine arteries contributed to the successful implantation of the blastocyst.

Diagnosis particularities of lung cancer in a young patient without external risk factors – A case report

Abstract Lung cancer is the most common type of cancer worldwide, smoking being the strongest risk factor. We present the case of a non-smoker, a 23-year-old patient, without environmental exposure or personal pathological history, who was hospitalised for dry cough, a unique episode of haemoptysis and low-graded fever. He was admitted with a left basal diminished vesicular murmur, without detectable rales, and normal oxygen saturation. The chest X-ray highlighted left pleural effusion in a medium amount. A chest ultrasound revealed also an adjacent pulmonary consolidation. The cytological examination of the pleural fluid detected the presence of lymphocytes 36%, eosinophils 25%, polymorphonuclear 39% and frequent red blood cells. Angio-computer tomography confirmed the existence of a left hilar tumour formation with a mass effect on the hilar structures, possibly a few tumoral emboli in the lateral and posterior basal segmentary arteries, a lower left lobe consolidation, a left pleural effusion with hydroaeric level, and a left pneumothorax. The patient required a fibre bronchoscopy that showed us a proliferative infiltrative process, stenosis of the left lower bronchia, and extrinsic compression of the left lower lobe and the 6th segment. Infiltration of mucosa at the left basal pyramid was also detected. The histological examination argued for pulmonary adenocarcinoma. The particularities of the case consist of the lack of exposure to known risk factors for bronchopulmonary neoplasm and the early appearance of lung cancer and its complications in a young patient.

Ультразвукові параметри і стан гемодинаміки матки у жінок, які мали порушення менструальної функції у пубертатний період

Studying the hemodynamic features of the pelvic organs in women is of great clinical importance, since it makes it possible to assess the degree of restoration of endometrial regeneration after menstruation, the possibility of implanting a fertilized egg and developing the placenta. In women with menstrual dysfunction in the puberty, determining the qualitative and quantitative parameters of uterine hemodynamics may be useful in choosing treatment tactics, evaluating its effectiveness, and will also help significantly in predicting the prospects for the restoration of their reproductive health. The objective: using ultrasound and dopplerometry to study the uterine hemodynamics and assess the ability of the endometrium to implant in women with menstrual dysfunction in the pubertal period. Materials and methods. To achieve this goal, 120 women of reproductive age from 19 to 32 years old were studied. According to the nature of the violations, the main group of women (n=90) with pathology of menstrual function in the puberty was divided into 3 subgroups (n=30): the first – women with primary oligomenorrhea in the anamnesis, the second – with late age menarche, the third – with puberty bleeding. The control group included women (n=30) with the correct rhythm of menstruation in puberty. Results. Based on a comparative analysis of the echographic parameters of the size of the uterus in women with menstrual irregularities in the puberty (main group) and women with the correct rhythm of menstruation (control group), it was found that in the middle stage of endometrial secretion, the uterus is 1,2 times smaller in women the main group (p&lt;0.05) due to the width of the uterus (p&lt;0.001). The ratio between the length of the body and cervix in the examined groups did not significantly differ. The thickness of the front wall of the uterus is less than the control values in women with late menarche (p&lt;0.05) and puberty bleeding (p&lt;0.01), which served as a predictor of the absence of combined uterine pathology. An echographic study of the thickness of the endometrium in the late stage of the proliferation phase in the group of women examined did not establish any significant differences with the control group. In the middle stage of the secretion phase, the endometrial thickness was less in women with menstrual dysfunction in puberty – 9.50±0.27 mm compared to 11.38±0.48 mm in the group with the correct rhythm of menstruation (p&lt;0.001), but remained within the limits of reference values. To assess the functional activity and the possibility of secretory transformation of the endometrium, dopplerometry of the uterine arteries was performed, which did not reveal significant differences in women of the main and control groups. Conclusion. An analysis of the relationship between body and cervical lengths proves the absence of signs of genital infantilism in patients with menstrual dysfunction in the pubertal period. Dopplerometric studies of hemodynamics in the arteries of the uterus in this group of women in different phases of the menstrual cycle indicate an adequate blood supply to the uterus. And although as a result of the inferior phase of endometrial proliferation, its thickness in the middle stage of secretion remained insufficient (9.52±0.42 mm; p&lt;0.01), normal blood flow in the radial and basal arteries of the uterus contributed to the successful implantation of a blastocyst. Keywords: menarche, oligomenorrhea, pubertal bleeding, uterine hemodynamics, endometrial proliferation, dopplerometry.