Blood Flow Occlusion Research Articles

X-ray Endovascular Embolization for Splenic Artery Aneurysm Complicated by Intestinal Bleeding

Introduction. Splenic artery aneurysms refer to the most common visceral artery aneurysms. However, they are diagnosed quite rarely, since about 80% of them appear asymptomatic. Clinically, splenic artery aneurysms manifest themselves through their complications, including hemorrhage into pancreatic cysts or intra­abdominal bleeding due to their rupture, leading to lethality up to 8.5%. Other complications of splenic artery aneurysms appear extremely rare. The gold standard for the diagnosis of splenic artery aneurysms refers to digital subtraction angiography that enables their exact localization to be determined and aneurysm embolization to be performed. Materials and methods. In the period from 2015 to 2023, we observed 51 patients who underwent endovascular interventions on the splenic artery for hypersplenism (n = 32) and aneurysms (n = 19). In most cases, the aneurysms were asymptomatic. The paper presents a rare clinical case of splenic artery aneurysm complicated by recurrent intestinal bleeding. Results and discussion. Examination (EGD, CS) did not detect the source of recurrent intestinal bleeding. Contrast CT revealed a splenic artery aneurysm. Celiac angiography detected a large aneurysm (52×41 mm) of the splenic artery, closely adjacent to the lower horizontal branch of the duodenum. Endovascular embolization of the splenic artery was performed proximal to the aneurysm, resulting in complete occlusion of blood flow through the splenic artery and aneurysm. No repeated episodes of intestinal bleeding were observed after the intervention, thereby indicating the effectiveness of hemostasis. No signs of splenic ischemization were detected by clinical and examination data due to the preservation of blood flow through short splenic vessels. Conclusion. Endovascular embolization of the splenic artery is found to be an effective treatment for its complicated aneurysms.

Acute Ischemic Stroke during Extracorporeal Membrane Oxygenation (ECMO): A Narrative Review of the Literature

Ischemic stroke (IS) is a severe complication and leading cause of mortality in patients under extracorporeal membrane oxygenation (ECMO). The aim of our narrative review is to summarize the existing evidence and provide a deep examination of the diagnosis and treatment of acute ischemic stroke patients undergoing ECMO support. The incidence rate of ISs is estimated to be between 1 and 8%, while the mortality rate ranges from 44 to 76%, depending on several factors, including ECMO type, duration of support and patient characteristics. Several mechanisms leading to ISs during ECMO have been identified, with thromboembolic events and cerebral hypoperfusion being the most common causes. However, considering that most of the ECMO patients are severely ill or under sedation, stroke symptoms are often underdiagnosed. Multimodal monitoring and daily clinical assessment could be useful preventive techniques. Early recognition of neurological deficits is of paramount importance for prompt therapeutic interventions. All ECMO patients with suspected strokes should immediately receive brain computed tomography (CT) and CT angiography (CTA) for the identification of large vessel occlusion (LVO) and assessment of collateral blood flow. CT perfusion (CTP) can further assist in the detection of viable tissue (penumbra), especially in cases of strokes of unknown onset. Catheter angiography is required to confirm LVO detected on CTA. Intravenous thrombolytic therapy is usually contraindicated in ECMO as most patients are on active anticoagulation treatment. Therefore, mechanical thrombectomy is the preferred treatment option in cases where there is evidence of LVO. The choice of the arterial vascular access used to perform mechanical thrombectomy should be discussed between interventional radiologists and an ECMO team. Anticoagulation management during the acute phase of IS should be individualized after the thromboembolic risk has been carefully balanced against hemorrhagic risk. A multidisciplinary approach is essential for the optimal management of ISs in patients treated with ECMO.

Thrombosis of the superior vena cava in a patient with an implanted cardioverter–defibrillator: A case report

BACKGROUND: Superior vena cava syndrome results from the occlusion of blood flow in the superior vena cava due to external compression, internal obstruction, or infiltration of the vessel wall by a tumor. Although thrombotic complications caused by electrodes of cardiac implantable devices are uncommon in clinical practice, their incidence has been increasing due to the increasing need for such devices, which effectively correct the compromised electrical or mechanical functions of the heart chambers. CLINICAL CASE DESCRIPTION: Herein, we have presented a case of superior vena cava thrombosis syndrome in a patient who had undergone cardioverter–defibrillator implantation for dilated cardiomyopathy. We have discussed the classification of superior vena cava syndromes, its pathogenesis, and the types of collateral circulation. CONCLUSION: As observed in our patient, the concurrent presence of chronic heart failure syndrome can make it challenging to recognize superior vena cava syndrome in the early stages of diagnosis.

Peripheral venous dilation using flow-mediated dilation response: A randomized crossover study.

Venodilation is crucial in enhancing the success rate of peripheral intravenous cannulation. Flow-mediated dilation (FMD) is a vasodilatory response initiated by temporary ischemia followed by reperfusion. This crossover study aimed to test the hypothesis that FMD induces dilation of the peripheral veins of the forearm. Fifteen healthy volunteers underwent the FMD and control conditions in a randomized order. FMD involved a 5-min occlusion of blood flow in the brachial artery, followed by reperfusion, achieved by inflating and deflating a cuff placed on the upper arm. The control condition involved participants remaining at rest. The primary outcome measure was a change in the cross-sectional area of the cephalic vein post-intervention. The secondary outcomes included changes in venous diameter and perfusion index (PI). FMD significantly increased the cross-sectional area of the cephalic vein compared with the control condition (relative change to baseline: 37.7% (31.4) vs 2.2% (11.7)), with a mean difference of 35.4% (95% confidence interval (CI): 16.4-54.5, p = 0.001). Both longitudinal and transverse diameters were significantly expanded with FMD compared to the control (relative change to baseline: 15.7% (15.4) vs 2.6% (3.6), p = 0.004; 18.9% (15.6) vs -0.0 (10.2), p = 0.003, respectively). Additionally, PI significantly increased with FMD compared with the control (relative change to baseline: 77.8% (56.9) vs 14.6% (36.0)), with a mean difference of 63.2% (95% CI: 31.2-95.2, p = 0.001). FMD application induced dilation of the cephalic vein of the forearm. The findings suggest that FMD is an effective technique for dilating the venous area and potentially improving the success rate of peripheral intravenous cannulation.

Particle behaviors of Imipenem/Cilastatin in various liquids investigated by chemical structures and temporal microscope observations

Imipenem/Cilastatin (IPM/CS) is currently used as an embolic agent in transarterial embolization for chronic musculoskeletal pain due to its efficacy of short-term blood flow occlusion. However, due to its off-label use, the development of new materials to substitute IPM/CS is needed. Therefore, investigating the behavior of IPM/CS particles becomes crucial. In this paper, we observed the changes in particle size of IPM/CS when dissolved in phosphate-buffered saline, normal saline, iodinated contrast agent and water. The results indicated that the particle size of IPM/CS ranged from 16 to 57 µm and has fastest hydrolysis rate in iodinated contrast agent. And we analyzed the possible structure of hydrolyzed product of IPM/CS in water at room temperature and 37 ℃ using 1HNMR, HPLC. The results suggested Cilastatin is stable at both temperatures, while Imipenem hydrolyzed to produce slightly different products at different temperatures.

Tissue desaturation is not a major determinant of aging-related impairment in skeletal muscle reactive hyperemia: A retrospective analysis.

Near-infrared spectroscopy (NIRS) combined with vascular occlusion test (NIRS-VOT) is a reactive hyperemia technique for in vivo evaluation of skeletal muscle microvascular reactivity. Previous studies using NIRS-VOT have been shown to be able to detect impairments in microvascular function in high-risk cardiovascular disease (CVD) populations such as older individuals. It has been demonstrated that older individuals have slower reactive hyperemia compared to young individuals. Importantly, older individuals also show less desaturation during ischemia compared to young. Based on these findings, it has been suggested that the slower reactive hyperemia observed in older individuals is explained by the lower desaturation during blood flow occlusion (reduced ischemic stimulus). This retrospective analysis compared reactive hyperemia in 36 young and 47 older tissue desaturation-matched individuals that underwent 5-min blood flow occlusion. Overall, we showed that older individuals have impaired reactive hyperemia compared to young when matching for the degree of desaturation and blood flow occlusion time. These findings provide evidence that lower tissue desaturation during ischemia is not a major determinant of impaired reactive hyperemia in older individuals.

Assessment of Electrical Impedance of the Liver and Spleen under Occlusion of Hepatic Blood Flow

Introduction. Liver resection remains the main trend in the treatment for primary and metastatic liver tumors and provides better overall and disease-free 5-year survival compared with conservative treatment options. Extensive liver resection is accompanied by the risk of post-resection liver failure. There is currently no absolute algorithm for determining the prognosis of post-resection liver failure. One of the ways to find new approaches to assessing the prognosis and diagnosing post-resection liver failure is bioimpedance analysis of the liver.The aim of the study was to assess the effect of hepatic blood flow occlusion on changes in the electrical impedance of the liver and spleen.Materials and methods. The study involved 20 male Wistar rats weighed 180-270 g. In the first series, experimental animals underwent occlusion of the hepatic blood flow for 15 minutes, and then underwent reperfusion (n=10). In the second series, occlusion of the hepatic blood flow was carried out for 90 minutes (n=10). Under general anesthesia, a median laparotomy was performed, followed by the application of a vascular clip to an analogue of the hepatoduodenal ligament, followed by clamping of the bile duct, hepatic artery and portal vein for 15 minutes in the first series and 90 minutes in the second series of the experiment. Invasive bioimpedansometry of the liver was performed using an original device for measuring the impedance of biological tissues BIM-II (RF patent No. 2366360). The data obtained were analysed at a frequency of 2 kHz, the hepatosplenic index (HSI) was calculated as the ratio of the average electrical impedance of the liver to the average electrical impedance of the spleen.Results. The 1st series of experiments. After applying the clips to the hepatoduodenal ligament analogue, the value of the electrical impedance of the liver parenchyma at a frequency of 2 kHz did not change and amounted to 2.3 (2.11; 3.1) kΩ versus 2.34 (2.05; 2.81) kΩ registered before manipulation. The median spleen impedance decreased statistically significantly from 2.7 (2.07; 3.5) kΩ to 1.63 (1.47; 2.04) kΩ (p 0.05). After 15-minute occlusion of the hepatic blood flow, the electrical impedance of the liver parenchyma statistically significantly increased by 1.47 times and amounted to 3.98 (2.64; 4.59) kΩ. The median value of spleen impedance was 1.86 (1.52; 2.23) kΩ, and was statistically significantly lower (p0.05) than before the clip application. After reperfusion, the liver impedance decreased to 3.11 (2.06; 5.11) kΩ, and the spleen impedance was 2.08 (1.53; 2.55) kΩ, while both parameters were statistically significantly different from the initial values. The dispersion coefficient D2kHz/20kHz of the liver statistically significantly increased to 2.10 (1.67; 2.58) 15 minutes after the clip application relative to the parameters before vascular exclusion – 1.71 (1.44; 2.08) and immediately after clamping analogue of the hepatoduodenal ligament – 1.60 (1.46; 2.11). After reperfusion, the dispersion coefficient D2kHz/20kHz of the liver parenchyma did not differ from the initial values and amounted to 1.79 (1.52; 2.29). The dispersion coefficient D2kHz/20kHz of the spleen decreased significantly immediately after occlusion of the hepatic blood flow from 1.54 (1.28; 1.71) to 1.36 (1.20; 1.62) and was at the corresponding level, including that after reperfusion. Fifteen minutes after the clip application, the dispersion coefficient D2kHz/20kHz of the spleen was statistically significantly lower than the values of D2kHz/20kHz of the liver (p0.05) – 1.42 (1.19; 1.6) versus 2.1 (1.67; 2.58). Before vascular exclusion of the liver, the median HSI was 0.89 (0.72, 1.11). After the clip application, the HSI parameter statistically significantly increased to 1.43 (1.28; 1.95) due to a decreased electrical impedance in the spleen parenchyma. After 15-minute ischemia, HSI statistically significantly increased to 2.01 (1.26; 2.68), and after reperfusion it remained at a level higher than the initial level.The 2nd series of experiments. Before vascular exclusion, the electrical impedance of the liver parenchyma of experimental rats was 2.39 (1.8, 2.57) kΩ. After 15 minutes, the electrical impedance increased significantly to 3.2 (3.08; 3.32) kΩ, which was consistent with the results of the previous experiment. After 30, 45, 60 and 90 minutes, the impedance values of the liver parenchyma did not change and were increased if compared with the initial level. The coefficient of the electrical impedance dispersion of the liver increased statistically significantly after 15-minute ischemia and remained at a high level until the end of the experiment. After the clip application, the HSI parameter statistically significantly increased after 15 minutes and remained at a level higher than the initial level in 30 minutes, 45 minutes, 60 minutes, 90 minutes of ischemia.Conclusions. After vascular exclusion of the liver, interrelated changes in the electrical impedance of the liver and spleen occurred within 15 minutes. These processes are mainly associated with changes in blood supply to the studied organs and ischemia effects.

Modelling midline shift and ventricle collapse in cerebral oedema following acute ischaemic stroke.

In ischaemic stroke, a large reduction in blood supply can lead to the breakdown of the blood-brain barrier and to cerebral oedema after reperfusion therapy. The resulting fluid accumulation in the brain may contribute to a significant rise in intracranial pressure (ICP) and tissue deformation. Changes in the level of ICP are essential for clinical decision-making and therapeutic strategies. However, the measurement of ICP is constrained by clinical techniques and obtaining the exact values of the ICP has proven challenging. In this study, we propose the first computational model for the simulation of cerebral oedema following acute ischaemic stroke for the investigation of ICP and midline shift (MLS) relationship. The model consists of three components for the simulation of healthy blood flow, occluded blood flow and oedema, respectively. The healthy and occluded blood flow components are utilized to obtain oedema core geometry and then imported into the oedema model for the simulation of oedema growth. The simulation results of the model are compared with clinical data from 97 traumatic brain injury patients for the validation of major model parameters. Midline shift has been widely used for the diagnosis, clinical decision-making, and prognosis of oedema patients. Therefore, we focus on quantifying the relationship between ICP and midline shift (MLS) and identify the factors that can affect the ICP-MLS relationship. Three major factors are investigated, including the brain geometry, blood-brain barrier damage severity and the types of oedema (including rare types of oedema). Meanwhile, the two major types (stress and tension/compression) of mechanical brain damage are also presented and the differences in the stress, tension, and compression between the intraparenchymal and periventricular regions are discussed. This work helps to predict ICP precisely and therefore provides improved clinical guidance for the treatment of brain oedema.

Ischemic Conditioning Reduces Neuromuscular Fatigability During Dynamic Exercise Post Stroke

INTRODUCTION: In addition to baseline muscle weakness, stroke survivors often demonstrate increased neuromuscular fatigability (an acute exercise-induced reduction in power, hereafter referred to as fatigability), which limits endurance during functional tasks. Ischemic conditioning (IC) is a non-invasive and easy-to-administer intervention that can reduce fatigability in stroke survivors during a sustained isometric contraction of their paretic knee extensors. However, IC’s effects on fatigability during dynamic contractions are unknown, despite the greater relevance to everyday activities. Additionally, fatigability is known to be task specific. Thus, the purpose of this study was to quantify the effects of IC on fatigability (percent reduction in power) during dynamic contractions of the paretic knee extensors in stroke survivors. We hypothesized that fatigability would be less after a single session of IC versus IC-sham treatment in stroke survivors. Methods: Eight stroke survivors (66 ± 6 years of age, 6 male) performed 60 maximal voluntary concentric contractions (1 every 4 seconds) with their paretic knee extensors against a resistance of 30% of their maximal voluntary isometric contraction torque through a 60-degree range of motion after receiving a single session of IC and IC-sham treatment on two separate days. IC consisted of 5 sets of 5-minute upper thigh blood flow occlusion at 225 mmHg (25 mmHg for IC-sham) with 5 minutes of no occlusion between each set. The order of the 2 sessions was randomized. All participants visited the laboratory on a different day for functional measurements (Fugl-Meyer Assessment, 10-meter walk test, and 6-minute walk test). Reduction in power was calculated as the difference between the highest average power output from 5 consecutive contractions within the first 15 contractions and the average power output from the last 5 contractions. A paired t-test was used to compare if fatigability during dynamic exercise would differ between the 2 sessions after IC and IC-sham treatment. Pearson correlation was performed to determine the relationship between the difference in fatigability (after IC versus IC-sham treatment) and functional measurements. Results: After a single session of IC treatment, stroke survivors were less fatigable compared to IC-sham treatment (21.9 ± 19.2% power reduction vs. 29.4 ± 19.0%, p = 0.016). Improvement in fatigability after IC versus IC-sham treatment was positively correlated with Fugl-Meyer Assessment lower extremity motor score ( r = 0.82, p = 0.013). CONCLUSION: These preliminary results indicate that IC could serve as a potential intervention to reduce fatigability during dynamic exercise in stroke survivors, especially those who are mildly affected by stroke. Funding Source: American Heart Association Predoctoral Fellowship (903373, ZZ) and Eunice Kennedy Shriver National Institute of Child Health and Human Development R01 Grant (HD099340, AH & MD). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Therapeutic effect and study of human umbilical cord blood mononuclear cells in patients with ischaemic bowel disease

Ischaemic bowel disease (ICBD) is a group of intestinal ischaemia syndromes caused by various aetiologies of reduced intestinal blood flow or vascular occlusion. ICBD can present as abdominal pain, bloody stool, and diarrhoea. This disease often occurs in middle-aged and elderly individuals with cardiovascular and cerebrovascular diseases. The incidence of ischaemic bowel disease has been increasing for decades, and it is difficult to diagnose, resulting in rapid disease progression and a high mortality rate. Therefore, fully understanding this disease, improving the diagnosis rate of this disease, and finding appropriate treatment methods are urgently needed to improve the condition and prognosis of patients. Umbilical cord blood stem cells are accessible, have weak immunogenicity, and have various biological functions, such as angiogenesis, inflammation and immune regulation. Many studies have confirmed that cord blood stem cells can relieve ischaemia, and these cells have attracted tremendous amounts of attention in regenerative medicine in recent years. In this paper, we discuss the clinical characteristics of ICBD, analyse the characteristics of human umbilical cord blood mononuclear cells (HUCB-MNCs), and use its to treat ischaemic bowel disease. Additionally, we compare the clinical manifestations and related indicators before and after treatment to evaluate the efficacy and safety of these methods.

Lower limb blood flow occlusion increases systemic pressor response without increasing brachial arterial blood flow redistribution in women.

This study was conducted to investigate the systemic hemodynamic and vascular changes in women during and after two commonly used clinical blood flow restriction (BFR) pressures at rest. There are minimal data regarding the independent effects of BFR on hemodynamic and systemic vascular changes due to pressor response, particularly among women. Therefore, this study investigated BFR-induced alterations in pressor response and systemic flow redistribution at rest during two commonly used pressures (50% and 80% limb occlusion pressure [LOP]). Fifteen women (22.1 ± 4.2 years) completed two randomised sessions involving 8-min of bilateral, lower limb restriction at 50% or 80% LOP followed by 8-min of recovery post-deflation. Changes in vascular (arterial diameter [DIA], time-averaged mean velocity [TAMV], volume flow [VF], and area) and hemodynamic (heart rate [HR] and blood pressure) measures over time (pre-, during, post-occlusion) and by session (50% vs. 80% LOP) were tested using repeated measures analysis of variance. Repeated measures correlations (rrm) quantified common intraindividual associations between BFR-induced hemodynamic and vascular responses. HR increased from baseline during 50% LOP and remained elevated during recovery (p < 0.05). HR increased from baseline during 80% LOP, while tibial VF and TAMV decreased (p < 0.03 for all). HR and TAMV values returned to baseline during recovery, while brachial artery VF decreased (p < 0.05). Changes in HR, brachial VF, and brachial TAMV were similar between 50% and 80% LOP (rrm = 0.32-0.70, p < 0.05 for all). At 80% LOP, changes in HR were positively correlated with brachial VF (rrm = 0.38) and TAMV (rrm = 0.43) and negatively correlated with tibial VF (rrm = -0.36) and TAMV (rrm = -0.30) (p < 0.05 for all). Results suggest that BFR at 80% LOP elicits an acute systemic pressor reflex without concomitant increases in brachial arterial flow, while 50% LOP elicits a subdued response.

Case Report: Glans penile necrosis in a patient with SARS-CoV-2 and leprosy infection

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was firstly identified in China and has been declared a global pandemic. Several serious extrapulmonary manifestations due to SARS-CoV-2 infection have also been reported and associated with hypercoagulability thrombotic vasculopathy. In addition, cases of Mycobacterium-leprae infection have also been known associated with blood coagulation abnormality. Methods Here, we report a 56-year-old male with coronavirus disease-19 (COVID-19) with concomitant leprosy infection with manifestation of glans penile necrosis, presented to the emergency department with acute penile pain. This case is unique because no occlusion blood flow to the penile was observed in the radiographic imaging. We described the potential pathophysiology in this case through a literature review. Results The patient received treatment according to the COVID-19 protocol and was given low molecular weight heparin (LMWH) therapy for 4 days. During the follow up, the clinical and functional condition of the penis showed significant improvement. Conclusions Microthrombus involvement, platelet abnormalities and impaired hemostasis due to SARS-CoV-2 and leprosy co-infection are the hypothesis in this case report.

Blood flow restriction pressure for narrow cuffs (5 cm) cannot be estimated with precision.

Blood flow restriction pressures are set relative to the lowest pressure needed to occlude blood flow with that specific cuff. Due to pressure limitations of some devices, it is often not possible to occlude blood flow in all subjects and apply a known relative pressure in the lower body with a 5 cm wide cuff.Objective. To use a device capable of generating high pressures (up to 907 mmHg) to create and validate an estimation equation for the 5 cm cuff in the lower body using a 12 cm cuff.Approach. 170 participants had their arterial occlusion pressure (AOP) with a 5 cm and 12 cm cuff and their thigh circumference measured in their right leg. The sample was randomly allocated to a prediction group (66%) and validation group (33%). Thigh circumference and 12 cm AOP were used as predictors. A Bland-Altman plot was constructed to assess agreement between measured and predicted values.Main results. The mean difference (95% confidence interval) between the observed (336.8 mmHg) and the predicted (343.9 mmHg) 5 cm AOP was 7.1 (-11.9, 26.1) mmHg. The 95% limits of agreement were -133.6 to 147.8 mmHg. There was a negative relationship between the difference and the average of predicted and measured 5 cm AOP (B= -0.317,p= 0.000043).Significance. Although this was the first study to quantify AOP over 600 mmHg with a 5 cm cuff, our equation is not valid across all levels of pressure. If possible, larger cuff widths should be employed in the lower body.

Effect of Partial Blood Flow Restriction Training in Improving Physical Functioning among Middle-Aged Subjects with Knee Osteoarthritis: A Pilot Study

Background: Blood Flow Restriction (BFR) training combines low-intensity exercise with blood flow occlusion toproduce outcomes comparable to those of high-intensity training. BFR is as effective as high-intensity protocolsknown to enhance knee extensor muscle strength in subjects with knee osteoarthritis (OA). Therefore, the aimof this study is to find out the effect of Partial Blood Flow Restriction Training on pain and physical functioningamong knee OA subjects.Purpose: To assess the effectiveness of Partial Blood Flow Restriction Training in Improving Physical FunctioningAmong Middle-Aged Subjects with Knee Osteoarthritis.Materials and Methods: This is the pilot study where twenty subjects with knee OA were divided randomly intotwo equal groups. Group “A” received BFR training combined with conventional exercise two times/week andGroup “B” received conventional exercise two times/week. Numeric Pain Rating Scale (NPRS), Western Ontarioand McMaster Universities Arthritis Index (WOMAC) were used to evaluate subjects at two intervals (Pre-Testand Post-Test).Results: The difference between the Group A and Groups B was statistically significant (p&lt;=0.001). Henceconventional exercise combined with blood flow restriction training shows significant improvement thanconventional exercise among OA knee subjects.Conclusion: This pilot study concluded that the conventional exercise combined with blood flow restrictiontraining was effective in subjects with OA knee.

Reaping Metabolic Benefits of Blood Flow Restriction Training (BFRT): A Boon for Diabetes and HypertensionA Narrative Review

Introduction: Blood Flow Restriction Training (BFRT) is an emerging tool that not only works on musculoskeletal conditions but also improve vascular and metabolic health by using controlled exercise with blood flow occlusion. Research findings suggest that lowering blood pressure and maintaining glycaemic control can decrease the likelihood of complications related to diabetes. BFR combined with exercise is studied for its positive effects on managing diabetes and hypertension due to its impact on metabolism and hemodynamic. BFRT can thus be viewed as an upcoming novel technique for treating metabolic conditions like diabetes and hypertension for reaping better results. Aim: The current narrative review aims on exploring the effects of Blood flow restriction training BFRT for managing diabetes and hypertension. Materials and Methods: The databases probed were Google scholar, PubMed, Physiotherapy Evidence Database (PEDro) and Ovid from 2015-2024. The studies with both male and female individuals, age ranging from 18 to 75 and diagnosed with type 1/ type 2 diabetes mellitus and hypertension, using BFRT as a treatment technique were included. The selected studies were segregated and analysed further. Results: From 9997 initial studies, seven relevant ones were selected after duplicate removal. Among them, six studies focused on hypertension and one on diabetes mellitus and hypertension both collectively indicating a significant positive impact of BFRT on these conditions. Conclusion: BFRT has an effect on both systemic and metabolic parameters and hence can be looked up to as an advanced tool for treating both the conditions and managing diabetes and hypertension in a better way.

Standardization of the Simple Methodology for Experimentally Induced Ischemic Stroke in Rat Models

Stroke is a globally significant and devastating disease that requires prompt treatment. Animal models are commonly used to investigate stroke therapy, often through experimentally induced ischemic stroke (EIIS). However, challenges arise in implementing EIIS in animal models. The current study aimed to present a simple EIIS methodology for animal models. A total of 60 male Sprague-Dawley rats were randomly divided into five groups, namely Group 1 (sham-operated), Groups 2 to 5 (EIIS groups) with different duration of common carotid artery (CCA) ligation, including 1, 2, 4, and 8 hours, respectively. The ligation was performed on the CCA and its branches. Before the experiment, the rats were anesthetized, and the incision area was shaved and disinfected. The sagittal ventral midline was incised, with neck muscles retracted to expose the right CCA. The occlusion was performed on three sides of a carotid artery (common, external, and internal) using a simple interrupted suture. The occlusion of blood flow using ligation was performed at different times depending on the groups. After that, the CCA ligations were re-perfused by cutting the suture knot. The brain and blood were collected on days 1 and 7 after reperfusion. The results indicated that 4 and 8 hours of CCA ligation significantly impacted the general condition and neuro-deficit score. Moreover, 4 and 8 hours of CCA ligation could induce ischemic stroke by its capacity to cause infarction within the brain parenchyma and increase the platelet-to-white blood cell ratio, C-reactive protein, and De Ritis ratio. In contrast, 1 and 2 hours of CCA ligation did not significantly affect the observed parameters. It can be concluded that the EIIS using 4 and 8 hours of CCA ligation can be applied to induce ischemic stroke in rat models with consistent impacts on general conditions, neuro-deficit, hematology, and serology.

The corticomuscular response to experimental pain via blood flow occlusion when applied to the ipsilateral and contralateral leg during an isometric force task.

Blood flow occlusion (BFO) has been previously used to investigate physiological responses to muscle ischemia, showing increased perceptual effort (RPE) and pain along with impaired neuromuscular performance. However, at present, it is unclear how BFO alters corticomuscular activities when either applied to the exercising or nonexercising musculature. The present study therefore set out to assess the corticomuscular response to these distinct BFO paradigms during an isometric contraction precision task. In a repeated measures design, fifteen participants (age = 27.00 ± 5.77) completed 15 isometric contractions across three experimental conditions; no occlusion (CNTRL), occlusion of the contralateral (i.e., nonexercising) limb (CON-OCC), and occlusion of the ipsilateral (i.e., exercising) limb (IPS-OCC). Measures of force, electroencephalographic (EEG), and electromyographic (EMG) were recorded during contractions. We observed that IPS-OCC broadly impaired force steadiness, elevated EMG of the vastus lateralis, and heightened RPE and pain. IPSI-OCC also significantly decreased corticomuscular coherence during the early phase of contraction and decreased EEG alpha activity across the sensorimotor and temporoparietal regions during the middle and late phases of contraction compared with CNTRL. By contrast, CON-OCC increased perceived levels of pain (but not RPE) and decreased EEG alpha activity across the prefrontal cortex during the middle and late phases of contraction, with no changes observed for EMG and force steadiness. Together, these findings highlight distinctive psychophysiological responses to experimental pain via BFO showing altered cortical activities (CON-OCC) and altered cortical, corticomuscular, and neuromuscular activities (IPS-OCC) when applied to the lower limbs during an isometric force precision task.

Percutaneous shunt vessel embolisation with Amplatzer vascular plugs II and IV in the treatment of dogs with splenophrenic shunts: four cases (2019-2022).

To describe the treatment of four dogs with splenophrenic shunts using percutaneous shunting vessel embolisation with Amplatzer vascular plugs II and IV and provide information on their clinical outcomes. Dogs with splenophrenic shunts treated at a veterinary hospital from January 2019 to December 2022 were identified through a medical record search. Six dogs with splenophrenic shunts were identified. Two dogs were excluded because they were treated with laparoscopic surgery. Four underwent percutaneous shunting vessel embolization with Amplatzer vascular plugs and were included in the case series. A sheath was placed in the left external jugular vein and a balloon catheter was advanced to the shunting vessel under fluoroscopy. Portal vein pressure was confirmed to be within an acceptable range during temporary balloon occlusion. Based on preoperative CT angiography and intraoperative contrast examination, Amplatzer vascular plugs II were selected for two dogs and IV were selected for two dogs. Under fluoroscopy, the plug was deployed into the shunting vessel, and angiography confirmed occlusion. In all cases, the increase in portal pressure after temporary occlusion was within the acceptable range, and complete occlusion of blood flow was possible with a single plug. There were no major procedure-related complications. No dogs developed post-ligation seizures or signs of portal hypertension. In addition, improvements in ammonia values were observed in all cases. Percutaneous splenophrenic shunt embolisation using Amplatzer vascular plugs II and IV is technically feasible in dogs, and assessed by intra-procedure angiography, a single plug completely obstructed blood flow in all dogs. Based on the literature search, this is the first report describing Amplatzer vascular plugs for the treatment of splenophrenic shunts.

Resuscitative Endovascular Balloon Occlusion of the Aorta: Implementation and Nursing Care

Uncontrolled hemorrhagic shock is the main cause of death in patients with traumatic injuries. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a rapidly performed and less-invasive treatment to stop bleeding. The REBOA balloon may be placed at the location of bleeding to achieve hemostasis. Prior to balloon placement, the indications for placement must be evaluated, including non-thoracic aortic trauma and non-traumatic patients with postpartum hemorrhage, and the appropriate sheath size (from 5 to 8 French) must be selected based on the bleeding site. As vascular injury of aortic dissection, rupture, or perforation may occur during the procedure, changes in hemodynamic parameters should be monitored. After balloon placement, ischemic complications due to blood flow occlusion such as lower extremity ischemia and acute renal failure should be tracked. After balloon removal, reperfusion injuries may occur, which can result in multiple organ failure, and should be observed closely. When caring for patients receiving REBOA, physicians should explain the procedure to their families to obtain informed consent. Also, nurses should prepare supplies and closely monitor changes in critical life signs to minimize the risks of hypotension, arrhythmia, and changes in consciousness during the procedure. After placement, the neurovascular and peripheral limbs "5P" (pain, pallor, paresthesia, pulselessness and paralysis) condition should be evaluated and recorded in detail. This treatment approach requires further study and research to assess the long-term impacts of placement and improve quality of care in these patients.

Analysis of the effects of stent-induced deformation on the hemodynamics of MCA aneurysms

The use of a stent to coil an aneurysm can alter the position of the main blood vessel and affect blood flow within the sac. This study thoroughly examines the impact of stent-induced changes on the risk of MCA aneurysm rupture. The research aims to assess the effects of coiling and vessel deformation on blood flow dynamics by comparing the OSI, WSS, and blood structure of two distinct MCA aneurysms to identify high-risk areas for hemorrhage. Computational fluid dynamics is used to model blood flow. The results indicate that aneurysm deformation does not always decrease the risk of rupture, and coiling is more effective in occluding blood flow than aneurysm deformation.