Blood Supply System Research Articles

Double-pedicle propeller flap for reconstruction of the foot and ankle: anatomical study and clinical applications.

ObjectiveReconstruction of soft tissue defects in the foot and ankle remains challenging. This study was performed to investigate the technical points and clinical effects of a double-pedicle propeller flap for repair of foot and ankle soft tissue defects.MethodsWe used five fresh calf specimens to investigate the anatomical and operative aspects of a double-pedicle propeller flap. Eighteen patients with soft tissue defects in the foot and ankle subsequently underwent defect repair with double-pedicle propeller flaps.ResultsThe anatomical study showed that the peroneal artery perforators and the sural nerve bundle (two blood supply systems) provided the theoretical anatomical basis for the double-pedicle propeller flap. The relative positions of the peroneal artery perforators and the sural nerve bundle differ according to the peroneal artery perforating level. Flap rotation in different directions can reduce or prevent the pedicles from compressing each other. All flaps survived, and three flaps developed local epidermal necrosis at the proximal end; these flaps healed after 1 to 2 weeks of dressing changes. The other 15 patients healed well.ConclusionsThe double-pedicle propeller flap can enhance the blood supply and venous return in the “big paddle” region of the flap, reducing the distal necrosis rate.

Quantitative synchrotron X-ray tomography of the material-tissue interface in rat cortex implanted with neural probes

Neural probes provide many options for neuroscientific research and medical purposes. However, these implantable micro devices are not functionally stable over time due to host-probe interactions. Thus, reliable high-resolution characterization methods are required to understand local tissue changes upon implantation. In this work, synchrotron X-ray tomography is employed for the first time to image the interface between brain tissue and an implanted neural probe, showing that this 3D imaging method is capable of resolving probe and surrounding tissue at a resolution of about 1 micrometer. Unstained tissue provides sufficient contrast to identify electrode sites on the probe, cells, and blood vessels within tomograms. Exemplarily, we show that it is possible to quantify characteristics of the interaction region between probe and tissue, like the blood supply system. Our first-time study demonstrates a way for simultaneous 3D investigation of brain tissue with implanted probe, providing information beyond what was hitherto possible.

First Report of Prevalence of Blood-Borne Viruses (HBV, HCV, HIV, HTLV-1 and Parvovirus B19) Among Hemophilia Patients in Afghanistan

Blood-borne viruses including Hepatitis B and C, HIV, HTLV-1 and parvovirus B19 are still a factor of concern, especially for hemophilia patients. Although the safety of the blood supply continues to improve worldwide, the blood supply system in Afghanistan was damaged by many years of conflict and political instability. To date, there are few studies focused on the prevalence of blood-borne viruses in hemophilia patients. This study is first to investigate the prevalence of five blood-borne viruses in Afghanistan hemophilia patients in four cities including Kabul, Herat, Mazar-i-Sharif and Jalal Abad. A total of 80 hemophilia male patients were screening for the presence of five transfusion-transmitted viruses using ELISA and PCR. Data obtained showed 2.5% seropositivity for HBV, 8.75% seropositivity for HCV, and 91.25% seropositivity for parvovirus B19. None of the patients were positive for HIV and HTLV-1 and the prevalence of HCV was higher in older patients rather than younger patients. This finding, the first to report in Afghanistan, shows a high prevalence of parvovirus B19 in Afghanistan hemophilia patients and implementation of highly sensitive screening is necessary.

Microsurgical Angioarchitectonics of Deep Brain Structures and Deep Arterial Anastomoses

Surgeries for deep and eloquent cerebral lesions require a detailed knowledge of normal brain anatomy and accurate planning. Important parts of brain anatomy are the cerebral blood supply and collateral circulation system. In addition to well-known cortical and basal (circle of Willis) anastomoses, there is also a deep interarterial anastomotic circle that is not described in the literature. Twenty brain specimens were studied for deep arterial anastomotic connections between branches of the anterior and posterior choroidal arteries. We have marked 3 symmetric zones of deep arterial anastomoses that form an epithalamic circle. Epithalamic anastomoses provide an additional mechanism of blood distribution that may play a role during surgical interventions or stroke.

Cancer stem-like cells directly participate in vasculogenic mimicry channels in triple-negative breast cancer.

ObjectiveVasculogenic mimicry (VM) channels that are lined by tumor cells are a functional blood supply in malignant tumors. However, the role of VM-initiating cells remains poorly understood. Cancer stem-like cells (CSCs) are positively correlated with VM. In this study, triple-negative breast cancer (TNBC) enriched with CSCs was used to investigate the relationship between VM and CSCs.MethodsThe expression of several CSC markers was detected by immunohistochemistry in 100 human breast cancer samples. The clinical significance of CSC markers and the relationship between VM, CSCs, breast cancer subtypes, and VM-associated proteins were analyzed. CD133+ and ALDH+ human and mouse TNBC cells were isolated by FACS to examine the ability of VM formation and the spatial relationship between VM and CSCs.ResultsCSCs were associated with TNBC subtype and VM in human invasive breast cancer. CSCs in TNBC MDA-MB-231 cells formed more VM channels and expressed more molecules promoting VM than the non-TNBC MCF-7 cells in vitro. MDA-MB-231 cells that encircled VM channels on Matrigel expressed CD133. Moreover, CSCs were located near VM channels in the 3D reconstructed blood supply system in human TNBC grafts. The CD133+ and ALDH+ cells isolated from TA2 mouse breast cancer formed more VM channels in vivo. ConclusionsCSCs line VM channels directly. Additionally, CSCs provide more VM-related molecules to synergize VM formation. The signaling pathways that control CSC differentiation may also be potential treatment targets for TNBC.

Translational research for artificial red blood cells (hemoglobin vesicles)

The blood supply system for transfusions in Japan functions well. However, in cases of sudden hemorrhagic shock, the swift supply of red blood cell (RBC) product might be difficult, particularly when medical care is required in remote regions and in obstetric medicine, where there is always a risk of hemorrhage. Blood pressure maintenance by infusion of volume expanders, such as crystalloids or colloids, may be insufficient to preserve the function of vital organs because they do not contain any oxygen-carrying molecules. If artificial RBCs were at hand, they could be used as a blood substitute until blood products are received from blood banks. This would save patients without degrading their quality of life. In the 1990s, we developed an artificial RBC in the form of a hemoglobin vesicle (Hb-V). Hb-V is a liposomal microparticle that encloses oxygen-carrying human Hb molecules. Different from RBCs, it has no blood type and is stable at room temperature, ensuring a long shelf-life. Its excellent biocompatibility and oxygen-carrying capacity have been proven in a number of animal experiments, and its production technique has also been established. Therefore, translational research is being designed with the aid of the Japan Agency of Medical Research and Development.

Designing the blood supply chain: how much, how and where?

The topology of the blood supply chain network can take different forms in different settings, depending on geography, politics, costs, etc. Many developed countries are moving towards centralized networks. The goal for all blood distribution networks, regardless of topology, remains the same: to satisfy demand at minimal cost and minimal wastage. Mathematically, the blood supply system design can be viewed as a location-allocation problem, where the aim is to find the optimal location of collection and production facilities and to assign hospitals to them to minimize total system cost. However, most location-allocation models in the blood supply chain literature omit several important aspects of the problem, such as selecting amongst differing methods of collection and production. In this paper, we present a location-allocation model that takes these factors into account to support strategic decision-making at different levels of centralization. Our approach is illustrated by a case study (Colombia) to redesign the national blood supply chain under a range of realistic travel time limitations. For each scenario, an optimal supply chain configuration is obtained, together with optimal collection and production strategies. We show that the total costs for the most centralized scenario are around 40% of the costs for the least centralized scenario. Centralized systems are more efficient than decentralized systems. However, the latter may be preferred for political or geographical reasons. Our model allows decision-makers to redesign the supply network per local circumstances and determine optimal collection and production strategies that minimize total costs.

Anatomical development and clinical significance of the concept of porta hepatis

The liver has complex blood supply and outflow system, mainly is composed of portal vein, hepatic artery, hepatic vein, short hepatic vein and inferior vena cava. At the initial stage of liver anatomy, the concept of porta refers specifically to the portal vein blood flow into the anatomical region of the liver. With the further study of liver anatomy and the need to adapt to the development of clinical practice of liver surgery, the concept of porta hepatis gradually extends to the blood inflow and outflow region. This article will review and discuss the anatomical development and clinical significance of porta hepatis . Key words: Porta hepatis; Anatomy; Surgery; Perihilar surgery

Can a decentralized blood supply system reach 100% voluntary nonremunerated donation?

Voluntary nonremunerated donation stands for the framework of a solid, safe, and sustainable blood supply; for this reason, the World Health Organization has set a goal toward achieving 100% voluntary nonremunerated blood donation in 2020. However, in Lebanon like in most developing countries, the majority of blood donations still come from family/replacement donors (around 75%) followed by voluntary donors for only 15%; compensated donors yet account for 10% of blood donations. Lebanon has a decentralized and fragmented blood supply system where private health care facilities predominate over the public system; thus, numerous challenges and roadblocks-that are discussed in this article-are likely to delay the fulfillment of the WHO resolution. By properly addressing (and resolving) those caveats, it should be expected that Lebanon can forecast achieving (or at least getting close to) 100% voluntary nonremunerated blood donation within the next decade.

Classification system of the tibiofibular syndesmosis blood supply and its clinical relevance

Due to the lack of anatomical studies concerning complexity of the tibiofibular syndesmosis blood supply, density of blood vessels with further organization of syndesmotic vascular variations is presented in clinically relevant classification system. The material for the study was obtained from cadaveric dissections. We dissected 50 human ankles observing different types of arterial blood supply. Our classification system is based on the vascular variations of the anterior aspect of tibiofibular syndesmosis and corresponds with vascular density. According to our study the mean vascular density of tibiofibular syndesmosis is relatively low (4.4%) and depends on the type of blood supply. The highest density was observed among ankles with complete vasculature and the lowest when lateral anterior malleolar artery was absent (5.8% vs. 3.5%, respectively). Awareness of various types of tibiofibular syndesmosis arterial blood supply is essential for orthopedic surgeons who operate in the ankle region and radiologists for the anatomic evaluation of this area. Knowledge about possible variations along with relatively low density of vessels may contribute to modification of treatment approach by the increase of the recommended time of syndesmotic screw stabilization in order to prevent healing complications.

Organizational models for health actions in the field of blood and blood products in Brazilian and Spanish regional contexts.

This article aims to characterize some elements that define the organizational models of healthcare actions in the field of blood and blood products. This exploratory and qualitative study was carried out based on a documentary survey complemented by interviews with key informants of hemotherapy services from three regional territories in Spain and Brazil. It was evidenced demographic, territorial and organizational characteristics, as well as on instruments, resources and individuals involved in the planning, organization and implementation of services and actions in the area. The demographic characteristics and the territorial distribution showed a direct relation with the variation in the blood supply system, in the service structure and in the involvement of different individuals. The predominance of hospital services was a common feature in the territories studied, especially for transfusion services. Regionalization, centralization and concentration strategies were aimed at implementing the organization models of such services and actions in the territories. The use of planning and information technologies presents variation in the territories studied. The limits of organizational models are determined by the context and restriction of its constituent elements - structure, resources, financing, individuals involved - which compromise to some degree the objectives/purposes of the policy.

The Politics of Blood Safety Regulation in China: The Blood Plasma Economy and the Making of China's Blood Safety Regulatory Regime

In the 1980s, Chinese regulators were quick to impose tough restrictions on the import of blood products into China when HIV/AIDS first came to light in industrialized countries. In spite of such precautions, China still ended up with a massive blood-related HIV/AIDS crisis, particularly among blood sellers in Henan Province. This study examines the evolution of China’s blood safety regulatory regime in the age of market-oriented reforms and HIV/AIDS. I first describe how the push by local authorities in Henan to develop a blood plasma economy turned into a blood plasma fever that spread HIV/AIDS with deadly efficiency in spite of central government efforts to prevent the spread of HIV/AIDS through the use of imported blood products. I next examine the responses or nonresponses to the ensuing tragedy. Warning signals were ignored and suppressed, whistleblowers were pushed out, and for years the HIV/AIDS carriers were left on their own. It was not until the 2003 SARS crisis that China’s new leaders took public health issues seriously and adopted decisive measures to tackle the HIV/AIDS crisis in Henan. Meanwhile the (then) Ministry of Health responded with greater alacrity to adopt vigorous reforms of the blood collection and supply system. By dissecting the politics of China’s efforts to remake its blood safety regulatory regime, this study offers a unique lens for better understanding China’s struggles to reform the economy and build a regulatory state.

Risk of Exposure to Zika Virus and Impact on Cord Blood Banking and Adult Unrelated Donors in Hematopoietic Cell Transplantation: The Canadian Blood Services Experience

Zika virus has emerged as a potential threat to the Canadian blood supply system. Stem cell donors within Canadian Blood Services' Cord Blood Bank (CBB) and OneMatch Stem Cell and Marrow Network (OM) now undergo screening measures designed to reduce the risk of Zika virus transmission. The impact these screening measures have on cord blood and unrelated adult stem cell donations is currently unknown. Among 146 donor workups initiated by OM between July 2016 and May 2017, 102 were completed and 44 workups were canceled. There were 17 potential donors (11.6%) with a risk of Zika virus exposure identified by the donor questionnaire (13 completed, 4 canceled workups). None of the workups involved a donor diagnosed with confirmed Zika virus within the past 6 months. Only 1 of the 44 canceled workups (and only 1 of 4 cases with a risk of Zika transmission) was canceled because of the risk of Zika transmission, and a backup donor was selected. Canadian Blood Services' CBB identified 25 of 875 cord blood units (2.9%) from women who donated their infants' cord blood and underwent screening that otherwise met the initial cell number thresholds for banking and had at least 1 risk factor for exposure to Zika virus. No women were diagnosed with Zika virus at any point of their pregnancy. All 25 units were discarded. Unrelated donors at OM have a higher incidence of a risk of exposure to Zika virus compared with cord blood donors. Only rarely did transplant centers cancel donor workups due to potential Zika virus exposure. The impact of screening for Zika virus exposure risk on cord blood banking was minor. Continued vigilance and surveillance is recommended.

Hand reconstruction by transplanting the fostered residual finger and second toe which share the same blood supply system

Objective To investigate the methods and results of hand reconstruction by transplanting the fostered residual finger and the second toe, which share the same blood supply system. Methods From January, 2014 to January, 2016, 3 cases with destructive hand injuries in our hospital; and debridement was performed in one session during the early stage of trauma, with skin grafting to cover the wrist stump and foster the residual finger to a branch of the dorsalis pedis artery. The first dorsal metatarsal artery around the toe web was identified and then grad-ually isolated proximally with dissection of the branches of the dorsalis pedis artery supplying the fostered finger until the convergence of the two blood vessels. Then , reconstructed hand by residual finger and combined second toe transplantation. Results After a follow-up period of 3 months to 2 years, the reconstructed hand had a good appearance and was able to complete basic mundane actions. The function of the limb was restored to a large extent and the patient was satisfied with the reconstructed hand. Conclusion Transfer of a fostered residual finger and combined second toe which have the same blood supply system for hand reconstruction as a new method need to anasto-mose only one set of arteries, and it is feasible with the good appearance and function of the reconstructed hand. Key words: Destructive hand injuries; Foster finger; Second toe; Reconstruction; Combined transfer

An Inter-regional US Blood Supply Simulation Model to Evaluate Blood Availability to Support Planning for Emergency Preparedness and Medical Countermeasures.

Planning for a response to threats like pandemics or mass casualty events is a national priority. The US blood supply system can be particularly vulnerable to such events. It is important to understand the impacts of emergency situations on blood availability and the resiliency of the US blood supply system. On the basis of the Stock-and-Flow simulation model of the US blood supply system, we developed an inter-regional blood transfer system representing the action of multiple blood collectors and distributors to enable effective planning of strategies to minimize collection and donation disruptions to the blood supply system in the event of a national emergency. We simulated a pandemic or mass casualty event on both a national and an inter-regional blood supply system. Differences in the estimated impacts demonstrated the importance of incorporating spatial and temporal variations of blood collection and utilization across US regions. The absence of blood shortage in both emergency scenarios highlighted the resilience of the inter-regional system to meet the potential associated blood demand. Our inter-regional model considered complex factors and can be a valuable tool to assist regulatory decision-making and strategic planning for emergency preparedness to avoid and mitigate associated adverse health consequences. (Disaster Med Public Health Preparedness. 2018;12:201-210).

Progress in the blood supply of Afghanistan.

The blood supply system in Afghanistan was badly damaged by years of conflict. In 2009, the Afghanistan National Blood Safety and Transfusion Service (ANBSTS) was established. For 6 years, we collaborated to assist with policy and infrastructure development; blood bank operations; blood collection, testing, and component production; transfusion practices; and training of technicians, nurses, midwives, and physicians. Policies were established, infrastructure was strengthened, and capable staff was acquired and trained. Standard operating procedures were developed, testing was improved, and quality systems were established. Thirty trainings were held for blood center staff. Four additional formal trainings were held for 39 physicians, 36 nurses and/or midwives, and 38 laboratory technicians. During 5 years of this project, blood collection increased by 40%. The ANBSTS has made impressive progress developing infrastructure, personnel, procedures, quality systems, and training programs and increasing blood collection. Knowledge of transfusion medicine was improved through structured training.

A rare case of supernumerary fused and malrotated kidney

The supernumerary kidney is an accessory organ with its own blood supply and collecting system. It is a very rare type of congenital renal anomaly with fewer than 100 cases reported since firstly described at 1656 (1). Embryological basis of supernumerary kidney is connected to the ab-normal division of the nephrogenic cord into two metanephric blastemas which will form two kid-neys (2). It may be either completely separate or only loosely attached to the major kidney on the ipsilateral side. This anomaly is usually asymp-tomatic but may rarely become symptomatic in early adulthood (3). The mean age at diagnosis is 36 years. The most common presenting symptoms are pain, fever and a palpable abdominal mass. Ultrasonography, CT and MR urography may be needed to identify the anomaly.We aimed to present a rare case of super-numerary fused and malrotated kidney. Thirty--seven year-old woman was admitted to our clinic with left flank pain. CT scan demonstrated multi-ple calculi in the left kidney and supernumerary fused kidney (Figures 1 and 2). The third kidney was below the right kidney, malrotated and had its own blood supply (Figure-3).Grieshammer and colleagues showed that mutant mice lacking either SLIT2 or its receptor ROBO2 develop supernumerary ureteric buds that are correlated with abnormal maintenance of Gdnf expression in anterior metanephric mesenchyme (4). The SLIT2/ROBO2 intercellular signaling sys-tem restricts, directly or indirectly, in extent of the Gdnf expression and plays a critical role in

THE FEATURES OF BLOOD SUPPLY OF CORPUS CALLOSUM AND THE STRUCTURE OF ITS HEMOMICROCIRCULATORY CHANNEL

Today we know the location of the sources of arterial blood delivery to the corpus callosum and we can approximately say, where are situated the venous vessels that the blood outflows from it to, but it is absolutely unknown, what is the intermediate link – the blood microcirculatory channel. Aim of research. The aim of our research is in identification of the ways of venous outflow from corpus callosum and in clarification of the principle of structural organization of its hemomicrocirculatory channel. Materials and methods. In the work are used the median total preparations of the corpus callosum (together with septum pellucidum and cerebral fornix formations) of 10 men 36–60 years old. Histological paraffin sections, colored by hematoxylin and eosin and according to Van-gieson were made of these preparations, and the methods of plastination of the corpus callosum tissues in epoxy resin with further creation of polished sections of different width and serial fine sections of blocs, for which coloration served the 1 % solution of blue methene for 1% borax solution, were also used. Results. It was established, that the arterial microvessels, starting from vascular plexus that covers the upper surface of corpus callosum, penetrate it as arterioles along interfunicular connective tissue septs that divide its commissural funicles between them. The arterioles are prolonged directly in venous microvessels that can be related to gathering venules. These direct microvascular communications, coming through the thickness of corpus callosum, can be named perforating arteriolovenular anastomoses. The aforesaid collector venules, localized in the lowest sections of interfunicular interlayers, are the direct inflows of venous channel of septum pellucidum. In general system of blood supply of corpus callosum the main arteries on the one side and the veins of septum pellucidum – on the other, are not accompanied by the vessels of opposite type. Conclusions. The blood microcirculatory channel of corpus callosum is the complexly branched in its thickness net of resistive, metabolic and capacitive microvessels, placed on the running way between arterial channel of soft cerebral tunic that covers the upper surface of corpus callosum and collector veins of septum pellucidum, situated below it. The direct shunting tracts between them are perforating arteriolovenular anastomoses.

Tie2 Expression on Macrophages Is Required for Blood Vessel Reconstruction and Tumor Relapse after Chemotherapy.

Tumor relapse after chemotherapy is a major hurdle for successful cancer therapy. Chemotherapeutic drugs select for resistant tumor cells and reshape tumor microenvironment, including the blood supply system. Using animal models, we observed on macrophages in tumor tissue a close correlation between upregulated Tie2 expression and tumor relapse upon chemotherapy. Conditional deletion of Tie2 expression in macrophages significantly prohibited blood supply and regrowth of tumors. Tie2+ macrophages were derived from tumor-infiltrating Tie2-CD11b+ cells and hypoxia-induced Tie2 expression on these cells. Mechanistically, expression of Tie2 prevented macrophages from apoptosis in stress conditions via the AKT-dependent signaling pathway. Together, these results demonstrate that Tie2 expression by macrophages is necessary and sufficient to promote the reconstruction of blood vessels after chemotherapy, shedding new light on developing novel strategies to inhibit tumor relapse. Cancer Res; 76(23); 6828-38. ©2016 AACR.

献血におけるサンクションとインセンティブ : 血液政策・供血システム転換の可能性と必要性

献血におけるサンクションとインセンティブ : 血液政策・供血システム転換の可能性と必要性