Blood Supply Disorders Research Articles

THE INFLUENCE OF MECHANICAL ASPHYXIA ON THANATOGENESIS DURING HANGING

Hanging as a type of mechanical asphyxia causes not only asphyxia but also affects the blood supply to the brain and locally on the tissues of the neck. Aim of work: to substantiate the genesis of death due to hanging. Material and methods: review of scientific publications, analytical. Results. In thanatogenesis by hanging, a number of components are considered, the contribution of each is unclear. Cerebral circulation disorders when the neck is compressed by a loop occur much earlier than the consequences of the development of asphyxia, and therefor brain functions are disrupted quite quickly. Lack of oxygen in the blood also affects the function of the heart, since it requires significant energy sources. The presence of ischemia in the body causes necrotic lesions of cardiomyocytes, which manifests itself as a secondary myocardial infarction with the release of biochemical markers of cardiac ischemia into the blood. Conclusions. Compression of the neck with a loop during hanging involves in thanatogenesis a disorder of blood supply, metabolic disorder and lack of oxygen in the brain, leading to a disorder of its functions and death, including from hemorrhages into the brain substance and membranes. The development of asphyxia causes the activation of the sympatho-adrenal system, which in total leads to asphyxiation-induced (secondary) myocardial infarction, adding a cardiac component to thanatogenesis.

Clinical case of median arcuate ligament syndrome in the practice of a pediatric surgeon

Recurrent abdominal pain in childhood and adolescence may be indicative of chronic mesenteric ischemia with median arcuate ligament syndrome as a result of compression of the celiac artery by the median arcuate ligament of the diaphragm and its internal crura, neurofibrous tissue of the celiac plexus. The presence of symptoms characteristic of various diseases of gastrointestinal tract organs, absence of pathognomonic signs and complex approach in diagnostics of abdominal cavity vascular system, insufficient awareness of specialists of children’s outpatient clinics determine the urgency of timely diagnostics and treatment of patients with this pathology. Median arcuate ligament syndrome, or Dunbar syndrome, is more often a congenital malformation. This syndrome can be considered as an acquired pathology in the case of compression of the celiac artery by enlarged lymph nodes and neurofibrous tissue of the celiac plexus. In addition to hemodynamically significant disorders of blood supply to the gastrointestinal tract, Dunbar syndrome in children and adolescents is also accompanied by psycho-emotional disorders due to the presence of unstable stools, recurrent abdominal pain, and often repeated ineffective requests for medical care. Clinical observation, methods of diagnosis and surgical treatment of median arcuate ligament syndrome in a 14-year-old patient are presented in the study.

Efficacy of Superselective Intra-arterial Recanalization of Embolized Arteries Resulting from Facial Hyaluronic Acid Injection.

Arterial embolism is a rare complication caused by hyaluronic acid (HA) injection. However, it is one of the most serious complications. Once it happens, the complication would have a great and long-term impact on patients. Intra-arterial recanalization has been reported for recovering the visual acuity in patients with visual loss caused by hyaluronic acid. There is little report about the benefits of superselective intra-arterial recanalization therapy for skin wounds caused by hyaluronic acid vascular embolization. Eight patients who had received the superselective intra-arterial recanalization therapy were retrospectively reviewed. Hyaluronidasewasinjected into the facialartery by superselective intra-arterial recanalization therapy, followed by symptomatic treatment. The facial artery recanalization was successfully performed and no interventional procedure-related adverse events happened. Arterial embolization accompanies by the interruption or reduction of blood supply, followed by ochrodermia, pain, numbness, swelling, yellowish white secreta and even necrosis on skin wound area. Early detection of skin blood supply disorders and early recovery of blood supply areverycritical to treatfacial artery embolization caused byHA. After superselective intra-arterial recanalization therapy, the blood supply to facial skin was restored and skin wounds recovered in all patients. Only 1 patient was left with small and superficial scars. Superselective intra-arterial recanalization therapy is an effective and safe methodthat can alleviateskin wounds caused by HA vascular embolization. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Aortic Dissection: Classification, Etiology, Pathogenesis and Clinical Picture

Aortic dissection is a pathological process in which the aortic wall is divided into inner and outer layers under the action of hemodynamic forces. The process can be localized in various parts of the aorta, and also can be cause of blood supply disorders not only of organs which are located along the vessel (orthograde), but also organs which are located retrogradely. Risk factors for aortic dissection may include age, gender, atherosclerosis, inflammatory diseases, chest injuries, heart surgery, hereditary predisposition, congenital defects of the cardiovascular system and hereditary connective tissue disorders. The most often complication of aortic dissection is malperfusion syndrome, which can manifest itself as symptoms of upper and lower limb ischemia, syncope, ischemic stroke, prerenal azotemia (with decreased renal perfusion), abdominal ischemia syndrome (with occlusion of mesenteric arteries), spinal ischemic stroke. Knowledge of the totality of etiological factors, risk factors, pathogenesis, various manifestations and complications of aortic dissection allows you not to miss the beginning of the pathological process and provide timely assistance.

DYNAMICS OF CHANGES IN THE VASCULAR BED AND ORGANOMETRICAL INDICATORS OF WHITE RATS TESTICLES DURING EXPERIMENTAL SKIN THERMAL INJURY AND UNDER THE CORRECTION WITH A XENODERMAL SUBSTRATE

DYNAMICS OF CHANGES IN THE VASCULAR BED AND ORGANOMETRICAL INDICATORS OF WHITE RATS TESTICLES DURING EXPERIMENTAL SKIN THERMAL INJURY AND UNDER THE CORRECTION WITH A XENODERMAL SUBSTRATE

Using Laser-Assisted Indocyanine Green Angiography to Assess Nipple-Areolar Complex Survival During Reduction Mammoplasty.

In reduction mammoplasty, preserving an appropriate skin flap is crucial to achieve a favorable postoperative appearance and prevent blood supply disorders in the nipple-areolar complex (NAC). Previous studies have indicated that a thinner or narrower flap is more favorable for breast shaping, but also increases the risk of blood supply disorders. Accessing the blood perfusion of the NAC and determining the critical threshold for NAC viability are essential aspects of reduction mammoplasty. The aim of this study was to utilize indocyanine green (ICG) angiography to assess NAC perfusion during reduction mammoplasty. It also sought to identify critical thresholds of various indicators affecting NAC survival and provide guidance for skin flap trimming. Thirty-eight patients who underwent reduction mammoplasty were included. Each patient received ICG angiography before and after skin flap trimming. Data on NAC perfusion, skin flap length, width, thickness, and other relevant indicators were collected. Among the patients, 5 experienced NAC blood supply disorders. Multiple linear regression analysis demonstrated that the NAC blood supply had a significant correlation with the tissue thickness at the pedicle base (P < .001) and with the length-to-width ratio across the nipple (P < .05). To optimize NAC survival and achieve favorable breast shaping, cutoff points for the thickness at the pedicle base and the length-to-width ratio across the nipple of 1.15 cm and 1.71, respectively, were established. ICG angiography provides an effective means to assess NAC blood supply and postoperative survival. The cutoff points established in this study help to predict the survival of the NAC and guide flap trimming.

Effect of Tissue Pedicle Position on Postoperative Recovery From Severe Auricular Laceration.

Postoperative recovery from severe auricular lacerations varies significantly. However, few studies have sought to clarify the risk factors associated with the prognosis of severe auricular lacerations, and little attention has been paid to the intraoperative management of severe auricular lacerations and early postoperative intervention. The purpose of this study was to analyze the risk factors that may affect the prognosis of severe auricular lacerations. Case data and imaging data of patients with severe auricular lacerations treated in our department between January 2018 and September 2022 were collected. A total of 90 patients (90 severe auricular lacerations) were included in the analysis and were divided into good group (68 cases) and poor group (22 cases) according to postoperative recovery, which was defined as poor postoperative recovery when postoperative auricular blood supply disorders required interventional treatment or second stage plastic surgery. The percentage of ventral tissue pedicles in the poor recovery group was 77.3% ( P <0.001). The proportion of ventral tissue pedicle was significantly higher in the poor postoperative group than in the good postoperative group, and ventral tissue pedicle [odds ratio (OR)=12.22, P =0.002] was an independent risk factor for poor postoperative recovery from severe auricular laceration. The prognosis of patients with severe auricular lacerations differs between the different tissue pedicle locations, and prophylactic treatment of patients with ventral tissue pedicles is beneficial. In addition, patients with ventral tissue pedicles should be informed in advance of their increased risk of surgical failure.

Regarding the Use of Direct-Acting Anticoagulants of Animal Origin in Diabetic Retinopathy

Relevance. Diabetic retinopathy occupies one of the leading places in the frame of blindness and low vision. The very first changes in the retina in diabetic retinopathy are disorders of microcirculation and blood supply in the small vessels of the macula. There are few effective drugs that can restore perfusion in the small retina’s vessels. In this connection, it is relevant to search for anticoagulants that allow restoring blood supply in the macular area in diabetic retinopathy in the early stages.The purpose. To analyze the research of a domestic direct-action anticoagulant from animals, a drug of the heparin group Pyavit, both in ophthalmology for diabetic retinopathy and in other fields of medicine. The analysis of publications on eLibrary and PubMed resources for the last 30 years was done, by the keywords: direct-acting anticoagulants, diabetic retinopathy, hirudins, hemodynamics, optical coherence tomography (OCT), hemostasis. The data on the study and application of the drug from its development to its use in diabetic retinopathy, retinal vascular pathology, and pregnancy was analyzed. Researchers have studied the importance of the salivary gland secretion of a medical leech, which is a regulator of the hemostasis system. In 1992 I.P. Baskova patented a new drug Pyavit, which is officially approved for use in medical practice (registration number No. 000363/02). Dosage regimen: 300 mg three times a day for 20 days, and repeat the course through 1–2 months. In ophthalmology, researchers have proven the positive effect of the drug on the retina in diabetic retinopathy with an improvement in visual acuity, retinal thickness according to objective indicators of optical coherence tomography, fluorescence angiography, and hemostasis system.Conclusion. The analysis of scientists’ research allows us to expand knowledge about the positive effect of the drug Piavit on the path of diabetic retinopathy. Based on this review, the authors plan to further study the drug, which will assess the importance and significance of improving microcirculation in the macular area of the retina using the anticoagulant Pyavit to preserve visual functions.

Functionalization of biomimetic mineralized collagen for bone tissue engineering.

Mineralized collagen (MC) is the basic unit of bone structure and function and is the main component of the extracellular matrix (ECM) in bone tissue. In the biomimetic method, MC with different nanostructures of neo-bone have been constructed. Among these, extra-fibrous MC has been approved by regulatory agencies and applied in clinical practice to play an active role in bone defect repair. However, in the complex microenvironment of bone defects, such as in blood supply disorders and infections, MC is unable to effectively perform its pro-osteogenic activities and needs to be functionalized to include osteogenesis and the enhancement of angiogenesis, anti-infection, and immunomodulation. This article aimed to discuss the preparation and biological performance of MC with different nanostructures in detail, and summarize its functionalization strategy. Then we describe the recent advances in the osteo-inductive properties and multifunctional coordination of MC. Finally, the latest research progress of functionalized biomimetic MC, along with the development challenges and future trends, are discussed. This paper provides a theoretical basis and advanced design philosophy for bone tissue engineering in different bone microenvironments.

Exosomes from chondrocytes overexpressing miR-214-3p facilitate M2 macrophage polarization and angiogenesis to relieve Legg Calvé-Perthes disease

ObjectiveLegg-Calvé-Perthes disease (LCPD) is a partial or total necrosis of femoral head bone caused by blood supply disorder and its etiology is not clear. Studies have revealed that microRNA-214-3p (miR-214-3p) plays a vital role in LCPD, however, its exact mechanism is still unclear. In this study, we investigated the potential role of chondrocytes-derived exosomes carrying miR-214-3p (exos-miR-214-3p) in the pathogenesis of LCPD. MethodsRT-qPCR was performed to evaluate miR-214-3p expression level in femoral head cartilage, serum and chondrocytes of patients with LCPD, as well as dexamethasone (DEX)-exposed TC28 cells. Effects of exos-miR-214-3p on the proliferation and apoptosis were verified via MTT assay, TUNEL staining and caspase3 activity assay. The M2 macrophage markers were assessed by flow cytometry, RT-qPCR and Western blot. Moreover, angiogenic effects of human umbilical vein endothelial cells (HUVECs) were tested using CCK-8 and tube formation assays. Bioinformatics prediction, luciferase assay and ChIP were applied to verify the association between ATF7, RUNX1 and miR-214-3p. ResultsmiR-214-3p was found to be decreased in patients with LCPD and DEX-treated TC28 cells, of which overexpression promoted cell proliferation and suppressed apoptosis. Mechanistically, exos-miR-214-3p facilitated M2 polarization by ATF7/TLR4 axis and HUVECs angiogenesis via RUNX1/VEGFA axis. ConclusionmiR-214-3p alleviates LCPD by promoting M2 polarization of macrophages and angiogenesis.

The relevance of studying the state of blood circulation of the neurogenic bladder in children

Neurogenic disorders of the bladder are diverse in their mechanisms and difficult to treat. Researchers around the world have step by step discovered new aspects of the pathogenetic mechanisms responsible for detrusor dysfunction. Naturally, with the understanding of these mechanisms, new lines of therapy appeared, making the treatment of such children more effective and justified. Only complex therapy, considering all pathogenetic mechanisms, can give the best result. To date, the degree of influence and ways to solve the problem of impaired blood supply to the bladder have not been fully studied. For a long time, this issue has not been given due attention, due to the complexity of an objective assessment of the sufficiency of blood supply to the bladder. However, those few studies suggest that it is impossible to count on success in the treatment of such children without including in therapy components aimed at normalizing the angiological factor and, as a consequence, correcting detrusor hypoxia and energy metabolism disorders. Angiological disorders have a multidirectional character from vasospasm and circulatory hypoxia to vasodilation and congestive hyperemia. Therefore, the diagnosis and treatment of blood supply disorders of the bladder is a very important and difficult task. Since neurogenic disorders of the bladder are very common, a universal method of assessing the condition of its vessels is needed, which will be convenient and accessible to doctors in routine practice. Such a method is rheopelviography. The introduction of this method into routine practice will lead to the accumulation of experience and improve the diagnosis and treatment of bladder dysfunctions.

Scoring Systems to Evaluate the Mortality Risk of Patients with Emphysematous Cystitis: A Retrospective Observational Study

Emphysematous cystitis (EC) is a complicated urinary tract infection (UTI) characterized by gas formation within the bladder wall and lumen. Immunocompetent people are less likely to suffer from complicated UTIs, but EC usually occurs in women with poorly controlled diabetes mellitus (DM). Other risk factors of EC include recurrent UTI, neurogenic bladder disorder, blood supply disorders, and prolonged catheterization, but DM is still the most important of all aspects. Our study investigated clinical scores in predicting clinical outcomes of patients with EC. Our analysis is unique in predicting EC clinical outcomes by using scoring system performance. We retrospectively collected EC patient data from the electronic clinical database of Taichung Veterans General Hospital between January 2007 and December 2020. Urinary cultures and computerized tomography confirmed EC. In addition, we investigated the demographics, clinical characteristics, and laboratory data for analysis. Finally, we used a variety of clinical scoring systems as a predictor of clinical outcomes. A total of 35 patients had confirmed EC, including 11 males (31.4%) and 24 females (68.6%), with a mean age of 69.1 ± 11.4 years. Their hospital stay averaged 19.9 ± 15.5 days. The in-hospital mortality rate was 22.9%. The Mortality in Emergency Department Sepsis (MEDS) score was 5.4 ± 4.7 for survivors and 11.8 ± 5.3 for non-survivors (p = 0.005). For mortality risk prediction, the AUC of ROC was 0.819 for MEDS and 0.685 for Rapid Emergency Medicine Score (REMS). The hazard ratio of univariate and multivariate logistic regression analyses of REMS for EC patients was1.457 (p = 0.011) and 1.374 (p = 0.025), respectively. Physicians must pay attention to high-risk patients according to clinical clues and arrange imaging studies as soon as possible to confirm the diagnosis of EC. MEDS and REMS are helpful for clinical staff in predicting the clinical outcome of EC patients. If EC patients feature higher scores of MEDS (≥12) and REMS (≥10), they will have higher mortality.

Cerebrovascular Changes and Cerebral Atrophy in the Development of Dementia during Alzheimer's Disease

Background: Alzheimer's disease (AD) is the world's number one cerebral neurodegenerative disease. Up to 80% of all dementia cases are due to this disease. AD occurs not only because of impaired metabolism of amyloid beta (Aβ) and tau protein in cerebral tissue, but also in connection with specific disorders of cerebral blood supply, manifested in dyscirculatory angiopathy of Alzheimer's type (DAAT). Aims: The present research focuses on the clinical discovery of the sequence of development of dyscirculatory angiopathy of Alzheimer's type, cerebral atrophy, and dementia in patients with AD and their immediate family members. Methods: 99 patients were selected for the research, of whom: Test Group 1 93 (93.94%) suffered from various stages of AD and severity of dementia (age 34-79 (mean age 67): 32 (34.40%) men, 61 (65.59%) women). Test Group 2 6 (6.06%) children aged 8-12 with a high probability of inheriting AD. Each of them had a parent diagnosed with AD with mild dementia (TDR-1), and a grandparent diagnosed with AD with moderate (TDR-2) or severe dementia (TDR-3). Each child complained of fatigue, memory loss, difficulty in remembering, difficulty in concentrating, and frequent headaches. Results: Test Group 1. According to the severity of dementia and atrophic changes in the temporal lobes, the patients were subdivided: preclinical stage TDR-0 - 10 (10.75%) people, mild stage AD TDR-1 - 26 (27.96%) people, moderately severe stage AD TDR-2-40 (43.01%) people, severe AD TDR-3 - 17 (18.28%) people. We identified dyscirculatory angiopathy of Alzheimer's type in all patients, regardless of their AD stage. Test Group 2. There were no signs of dementia of cognitive disorders in any case. Initial involutive cerebral changes were detected in all 6 (100%) patients. Phenomena similar to DAAT were detected in all 6 (100%) patients. Conclusion: Cerebrovascular changes manifested by dyscirculatory angiopathy of Alzheimer's type, regardless of the stage of the disease, are observed in all patients with AD, as well as in all their young offspring. These changes affect amyloid beta metabolism in the brain and contribute to its deposition and accumulation in cerebral tissue, which leads to neurodegeneration and AD development. The data obtained indicate that dyscirculatory angiopathy of Alzheimer's type is primary and, moreover, possibly congenital in AD development.

Эффективность тенорафии в лечении горизонтального косоглазия у детей

Aim. Evaluation of the effectiveness of the modified tenorrhaphy method in comparison with standard resection in children in the surgical treatment of horizontal strabismus. Methods. In the period from 2017 to 2019, we operated 560 patients with horizontal strabismus aged 2 to 14 years. Of these, 288 patients underwent tenorrhaphy modified by us (main group), 272 patients underwent classical resection (the control group). In small and medium angles of strabismus, a strengthening operation was performed simultaneously on one eye in combination with a recession of the antagonist muscle. In large angles of strabismus, the reinforcing operation was performed with tenomyoplasty. Results. In main group, the state of orthotropy was achieved in 85.4 % of cases (246/288 patients), in control group – in 83.5 % of cases (227/272 patients), p = 0.523 (statistical difference is not significant). A residual angle of strabismus up to 5 ° was observed in 40 patients (14 %) in main group and in 44 patients (16.5 %) in control group, p = 0.449 (statistical difference is not significant). Conclusions. Tenorrhaphy according to our modified technique is not inferior to classical resection in efficiency and, in combination with recession (tenomyoplasty) of the antagonist muscle, gives stable predictable results. The tenorrhaphy method is safer, technically simpler, has no risk of «losing» the muscle, more physiological since there is no cutting of the muscle from the attachment site and blood supply disorders in the anterior segment of the eye; it is easy to correct in the immediate postoperative period. Key words: tenorrhaphy; fold; strabismus; children.

Monomethyl lithospermate alleviates ischemic stroke injury in middle cerebral artery occlusion mice in vivo and protects oxygen glucose deprivation/reoxygenation induced SHSY-5Y cells in vitro via activation of PI3K/Akt signaling.

Stroke is a fatal neurological disease, which seriously threatens human health and life. Ischemic stroke (IS) is the most common type of stroke in clinic. Its pathogenesis is very complex, mainly caused by nerve damage caused by brain blood supply disorder. Previous studies have confirmed that natural products play important roles in improving neurological disorders. Furthermore, our previous results also suggested that Shenxiong Tongmai granule, a clinically used herbal medicines’ prescription, has a good ameliorating effect on IS. In the present study, we found that Monomethyl lithospermate (MOL), a constituent of Shenxiong Tongmai granule, significantly improved the neurological damage in middle cerebral artery occlusion (MCAO) rats. MOL can significantly improve the neurological deficit score of MCAO rats, and improve the damage of hippocampal neurons caused by ischemia-reperfusion (IR). At the same time, we also found that MOL could reduce the level of oxidative stress in the brain tissues of MCAO rats. Furthermore, the oxygen and glucose deprivation/Reoxygenation (OGD/R)-induced SHSY-5Y cell model was established in vitro to investigate the pharmacological activity and molecular mechanisms of MOL in improving the nerve injury of IS rats. The results showed that MOL could increase the cell viability of SHSY-5Y cells, inhibit the mitochondrial membrane potential (MMOP) collapse and suppress apoptosis. In addition, MOL also ameliorated the elevated oxidative stress level caused by OGR/R treatment in SHSY-5Y cells. Further mechanistic studies showed that MOL could activate the PI3K/AKT pathway via promoting the phosphorylation of PI3K and AKT in MCAO rats and OGR/R-induced SHSY-5Y cells, which could be partially blocked by addition of PI3K/AKT pathway inhibitor of LY294002. Taken together, our current study suggested that MOL exerts a protective effect against neural damage caused by IS in vivo and in vitro by activating the PI3K/AKT pathway.

A predictive model of bowel resection for incarcerated inguinal hernia based on the systemic immune-inflammation index.

Background and PurposeAn inguinal hernia is a common surgical disease. Once incarcerated or strangulated, it may endanger the life of the patient. Therefore, it is essential to study the risk factors of incarcerated inguinal hernia (IIH) and strangulated inguinal hernia (SIH). One of the serious complications of IIH and SIH is intestinal necrosis, which occurs owing to blood supply disorder. The study explores the risk factors of intestinal resection and establishes a simple model to assess the incidence of intestinal resection to provide significant assistance and limited guidance for clinical work.Patients and MethodsOur research team collected and retrospectively analysed the clinical data of 338 patients with IIH who were hospitalized in the First Affiliated Hospital of Wenzhou Medical University between September 2008 and December 2016. According to the surgical plan, we divided the included cases into two groups, non-intestinal and intestinal resection groups, and the clinical case characteristics of these groups were statistically analysed.ResultsBased on multivariable logistic regression analysis, we found that increased risk of bowel resection was highly correlated among the elderly (≥70 years), and for people with high temperature (≥37.3°C), high systemic immune-inflammation index(SII) values (≥1230.13), presence of bowel obstruction, and signs of peritonitis. Further, we processed the five independent risk factors using special software to obtain a simple model called a nomogram. To verify the nomogram’s accuracy and predictive ability, we calculate the C-index: 0.806 and use the calibration curve to evaluate its stability and predictive performance. We constructed the ROC curve nomogram and other sub-variables, and calculated the area under the curve (AUC) corresponding to the nomogram (AUC = 0.808, 95% CI = 0.762 to 0.848), SII (AUC = 0.752, 95% CI = 0.703 to 0.797), age (AUC = 0.641, 95% CI = 0.587 to 0.692), temperature (AUC = 0.579, 95% CI = 0.524 to 0.632), bowel obstruction (AUC = 0.685, 95% CI = 0.633 to 0.734), and signs of peritonitis (AUC = 0.580, 95% CI = 0.525 to 0.633).ConclusionIt can be said that we found for the first time that clinical variables such as SII are independent risk factors for enterectomy for IIH. The nomogram based on SII and other variables can accurately and easily predict the probability of IIH requiring bowel resection.

Proximal vertebral artery surgery. Results of treatment of ischemia of the rhombencephalon (hindbrain). Simultaneous carotid and vertebral artery decompression procedures.

Surgical treatment of hindbrain ischemia is becoming the accepted surgical procedure in cases of stenosis of extracranial segments of vertebral arteries in the course of advanced atherosclerotic lesions in their initial segments (V1) or caused by external compression of these arteries in the canal formed by the transverse processes of cervical vertebrae. The latter is referred to as vertebrobasilar insufficiency (VBI). The transposition of the left vertebral artery to the common carotid artery in cases where stent graft implantation is necessary with coverage of the subclavian artery and possible blood supply disorders of both the hindbrain and the spinal cord has become important. In the Department of Vascular Surgery at the Medical University in Wrocław , in 58 out of 76 patients treated for ischemia of the hindbrain, the procedures were performed in the distal vertebral artery. The authors present the diagnosis of 18 patients treated surgically for stenosis or kinking of vertebral arteries in their first segment. In 12 cases, the procedure was performed with simultaneous unblocking of significantly narrowed left internal carotid artery. The material includes patients operated on between 1994 and 2018, most of whom had a good or very good outcome with zero mortality.

Emerging Limb Rehabilitation Therapy After Post-stroke Motor Recovery.

Stroke, including hemorrhagic and ischemic stroke, refers to the blood supply disorder in the local brain tissue for various reasons (aneurysm, occlusion, etc.). It leads to regional brain circulation imbalance, neurological complications, limb motor dysfunction, aphasia, and depression. As the second-leading cause of death worldwide, stroke poses a significant threat to human life characterized by high mortality, disability, and recurrence. Therefore, the clinician has to care about the symptoms of stroke patients in the acute stage and formulate an effective postoperative rehabilitation plan to facilitate the recovery in patients. We summarize a novel application and update of the rehabilitation therapy in limb motor rehabilitation of stroke patients to provide a potential future stroke rehabilitation strategy.

EXPRESSION OF SYNAPTOFYSIN AND VEGF IN THE SENSOMOTOR CORTEX DURING THE CAROTID ARTERY LIGATION, THE BRAIN ANTIGEN SENSITIZATION AND THEIR COMBINATIONS.

The aim: To study changes of the expression of synaptophysin (Syn) and vascular endothelial growth factor (VEGF) in neurons of the sensorimotor cortex (SMC) to reveal after unilateral ligation of the carotid artery, sensitization with brain antigen and their combination. Materials and methods: Experimental animals - Wistar rats (260-290 g). Experimental models: mobilization of the left common carotid artery, ligation of the indicated artery, sensitization with cerebral antigen, combination of sensitization with cerebral antigen and ligation of the carotid artery. Methods: immunohistochemistry, quantitative densitometric assessment. Results: Dyscirculatory disorders of cerebral blood supply during unilateral mobilization or ligation of the common carotid artery, sensitization with cerebral antigen lead in rats to a transient decrease in synaptophysin expression and phase changes in VEGF expression in the SMC from the lesion side. These changes occur in the absence of morphological changes in the cerebral cortex. Conclusions: The absence of morphological changes in the SMC in the short term (10-30 days) after minor trauma to the common carotid artery (separation from the bed and n.vagus) or its ligation is accompanied by a transient decrease in Syn expression and some increase in VEGF, which may reflect a violation of synaptic function and the general metabolic activity of neurons. Sensitization with a brain antigen, leading to an increase in the level of anti-brain antibodies and immune complexes in the blood of rats, can act as an independent damaging factor for the brain, and also potentiates and prolongs changes caused by impaired blood circulation.

The role of peripheral circulation disorders in the development of diabetic myopathy in children with diabetes mellitus

Abstract. The significance and role of peripheral blood circulation sufficiency in the formation of disorders of the muscular system in children with diabetes mellitus remain insufficiently studied. At the same time, the formation of some chronic complications of diabetes is associated with a deficient muscular system function. Aim of study. To discover the state of blood supply to the lower extremities in children with type 1 diabetes mellitus, according to the ankle-brachial index and to determine the value of deviations in the development of diabetic myopathy. Materials and methods. We examined 137 children with type 1 diabetes mellitus. The control group included 41 apparently healthy children. Assessment of the functional state of skeletal muscles, determination of the skeletal muscle index, hand force index and ankle-brachial index before and after exercise were studied in all patients. The ROC analysis was used to calculate cut-off points for the hand force index and the skeletal muscle index in order to determine the diagnostic criteria for dynapenia and diabetic myopathy. Results. We observed functional disorders of skeletal muscles and a decrease in the skeletal muscle index already in the first year of diabetes mellitus. In dynamics, the progression of violations was noted. Found a negative correlation between the level of glycated hemoglobin and the skeletal muscle index (r = -0.49, p &lt;0.05), and muscle strength (r = -0.31, p &lt;0.05), and a positive correlation with the index percentage of body fat (r = + 0.49, p &lt;0.05). Dinapenia was diagnosed in 68 (49.6%) children with type 1 diabetes mellitus. Diabetic myopathy was established in 37 (27.0%) patients. Changes in skeletal muscles in children with diabetes mellitus were accompanied by a deterioration in peripheral blood supply. This was supported by a decrease in the ankle-brachial index at rest and more significantly after exercise. The worst results were obtained in the group of children with diabetic myopathy. Conclusions.1. We discovered impairment in the functional state of skeletal muscles and a decrease in muscle mass in the form of dynapenia (49.6% of cases) and diabetic myopathy (27.0% of cases) in children with diabetes mellitus, taking into account the increase in the duration of the course of the disease and the insufficient state of glycemic control. 2. Impairment of peripheral circulation is one of the factors in the development of diabetic myopathy in children with type 1 diabetes mellitus. 3. The study of the ankle-brachial index after dosed physical activity can be used to diagnose latent disorders of peripheral blood supply. We can use the definition of the ankle-brachial index as a screening for children with type 1 diabetes mellitus.