Blood Vessel Injury Research Articles

Comparison of Secondary and Primary Minimally Invasive Pyeloplasty in the Treatment of Ureteropelvic Junction Obstruction: A Systematic Review and Meta-Analysis.

Objective: To compare the outcomes of secondary minimally invasive pyeloplasty (MIP) versus primary MIP for the patients with ureteropelvic junction obstruction (UPJO). Materials and Methods: We searched all the literature of PubMed, Web of Science, EMBASE, and Cochrane Library comparing secondary MIP and primary MIP and performed a systematic review and meta-analysis. Results: We included 15 studies involving 1637 patients with 1371 in the primary MIP group and 266 in the secondary MIP group. There were no significant differences in length of hospital stays, and the risk of hematuria, urinary tract infection, intestinal obstruction, stent complications, and overall complications (P > .05). Comparing with the secondary MIP group, the primary MIP group has shorter operative time (mean difference [MD] = -36.91 minutes, 95% confidence interval [CI]: -50.21 to -23.62, P < .00001), less estimated blood loss (MD = -16.70 mL, 95% CI: -31.60 to -1.80, P = .03), lower risk of urinary leakage and injury of blood vessel (relative risk [RR] = 0.32, 95% CI: 0.11-0.93, P = .04) (RR = 0.10, 95% CI: 0.02-0.61, P = .01), and higher success rate (RR = 1.07, 95% CI: 1.02-1.11, P = .003). The robot-assisted pyeloplasty is superior to the laparoscopic pyeloplasty in controlling the amount of blood loss in the secondary operation. Conclusions: Considering the poorer outcomes of secondary surgery, we believe that special attention should be paid to not missing crossing vessels, and it would be more prudent to perform a more definitive procedure with pyeloplasty instead of endopyelotomy for primary UPJO.

Injuries of pelvic blood vessels in pelvic instable fractures and dislocations in patients with combined trauma

Retrospective study of medicolegal data and case histories of 20 victims with combined pelvic trauma and blood vessels injuries are presented. In 20 victims 28 vessels were damaged: in 3 cases presacral venous plexus and in 17 cases 25 main blood vessels (14 veins and 11 arteries) were injured. Basing on the analysis of relationship between trauma mechanism, peculiarities of X-ray data and clinical manifestation the author detects a symptom complex named diagnostic triad that allows to diagnose the main pelvic vessels damage and perform surgical intervention. Recommendations concerning victim examination, treatment tactics, time for revision intervention on vessels and inner organs are given. This operation should be performed by special surgical team.

Case Report: The Second Near-Infrared Window Indocyanine Green Angiography in Giant Mediastinal Tumor Resection

Giant mediastinal tumors are often accompanied by the abundant blood supply and have an unclear border with adjacent vessels, making surgical resection difficult. Failure to distinguish the complex vessels during the operation often results in vascular injury or hemorrhage, which severely increases the operation time and perioperative risk. At present, surgeons can only determine the vessel's location and course by preoperative imaging and intraoperative exploration in visible light. Therefore, we report a case of a giant anterosuperior mediastinal tumor resection assisted by near-infrared (NIR) indocyanine green (ICG) angiography. Furthermore, we applied the second near-infrared window (NIR-II, 1,000–1,700 nm) to detect the fluorescence signals in the clinic for the first time. The NIR-II window is able to explore deeper tissues in centimeters and obtain higher resolution in millimeters than the traditional first near-infrared window (NIR-I, 700–900 nm). Finally, NIR-II ICG angiography shows the clear location and course of the vessels, which can help surgeons reduce unnecessary blood vessel injury and increase the safety of mediastinal tumor resection.

Analysis of early and middle stage efficacy and complications of oblique lumbar interbody fusion in treating degenerative lumbar diseases

To investigate the early and middle stage efficacy and complications of minimally invasive extraperitoneal oblique lumbar interbody fusion (OLIF) in the treatment of degenerative lumbar diseases. The clinical data of 22 patients with degenerative lumbar diseases underwent OLIF from October 2017 to March 2019 were retrospectively analyzed, including 14 males and 8 females, aged from 51 to 72 years with an average of (63.15±7.22) years. There were 6 cases of lumbar spinal stenosis, 5 cases of lumbar spondylolisthesis, 4 cases of adjacent vertebral disease, 3 cases of degenerative lumbar scoliosis, 3 cases of discogenic low back pain, and 1 case of recurrence after posterior lumbar decompression. Posterior minimally invasive pedicle screw fixation was performed in 13 cases and Stand-alone fixation in 9 cases. Intraoperative blood loss, operation time, postoperative drainage volume, landing time were recorded. The intervertebral disc height(IDH), intervertebral foramen height(IFH), intervertebral foramen area( IFA), canal diameter(CD), canal area(CA) were measured before and after operation. The imaging changes (including location of fusion cage, interbody fusion, and cage subsidence) and complications were observed. Oswestry Disability Index (ODI), numerical rating scales (NRS) and Japanese Orthopaedic Association (JOA) scores were compared before and 3, 6, 12 months after operation. All 22 patients successfully completed the operation. The intraoperative blood loss was 25 to 280 ml with an average of (95.45±79.07) ml and that of simple anterior approach was 25 to 70 ml with an average of (45.71±15.42) ml. The operation time was 75 to 210 min with an average of (137.72±37.66) min, and the simple anterior operation time was 75 to 105 min with an average of (91.40±15.96) min. The total drainage volume was 10 to 110 ml with an average of (56.23±31.15) ml, and the time to go down to the ground was 24 to 72 hours (54.48±18.24) hours after operation. Postoperative IDH improved (6.63±2.61)mm(P<0.05), the IFH improved (5.35±2.47)mm (P<0.05), the IFA improved (97.67±33.58)mm2(P<0.05), the CD improved (3.31±1.61) mm(P<0.05), the CA improved (57.52±31.39) mm2(P<0.05). Five patients got interbody fusion at 6 months after operation and all 22 patients got interbody fusion at 12 months after operation. There was 5 cases of fusion cage subsidence, all of which occurred in the cases without posterior fixation(using Stand-alone fixation). There was no serious complication such as big blood vessel injury, ureter injury, dural sac injury and nerve root injury. Peritoneal injury occurred in 1 case, postoperative transient thigh pain, decrease of quadriceps femoris muscle strength in 4 cases and sympathetic nerve injury in 1 case. The symptoms of lumbago and radicular pain of lower extremities were alleviated obviously 3 days after operation. The ODI, NRS and JOA scores at 6, 12 months after operation were significantly improved(P<0.05). The treatment of lumbar degenerative diseases with definite indications by OLIF can achieve satisfactory clinical results, and it has advantages of less intraoperative bleeding, fast time to land, less complications, good imaging improvement and indirect decompression. But the operation time and fluoroscopy time are longer in the early stage, and complications such as peritoneal injury and lumbar plexus over traction may occur. The long-term incidence of settlement of fusion cage with Stand-alone technology is higher.

Fusion-Based Deep Learning with Nature-Inspired Algorithm for Intracerebral Haemorrhage Diagnosis.

Natural computing refers to computational processes observed in nature and human-designed computing inspired by nature. In recent times, data fusion in the healthcare sector becomes a challenging issue, and it needs to be resolved. At the same time, intracerebral haemorrhage (ICH) is the injury of blood vessels on the brain cells, which is mainly liable for stroke. X-rays and computed tomography (CT) scans are widely applied for locating the haemorrhage position and size. Since manual segmentation of the CT scans by planimetry by the use of radiologists is a time-consuming process, deep learning (DL) is used to attain effective ICH diagnosis performance. This paper presents an automated intracerebral haemorrhage diagnosis using fusion-based deep learning with swarm intelligence (AICH-FDLSI) algorithm. The AICH-FDLSI model operates on four major stages namely preprocessing, image segmentation, feature extraction, and classification. To begin with, the input image is preprocessed using the median filtering (MF) technique to remove the noise present in the image. Next, the seagull optimization algorithm (SOA) with Otsu multilevel thresholding is employed for image segmentation. In addition, the fusion-based feature extraction model using the Capsule Network (CapsNet) and EfficientNet is applied to extract a useful set of features. Moreover, deer hunting optimization (DHO) algorithm is utilized for the hyperparameter optimization of the CapsNet and DenseNet models. Finally, a fuzzy support vector machine (FSVM) is applied as a classification technique to identify the different classes of ICH. A set of simulations takes place to determine the diagnostic performance of the AICH-FDLSI model using the benchmark intracranial haemorrhage data set. The experimental outcome stated that the AICH-FDLSI model has reached a proficient performance over the compared methods in a significant way.

Plant products as an alternative phytotherapeutics to regulate thrombosis – A review

Thrombosis, a life-threatening disease causes thrombus formation within blood vessels to obstruct the flow of blood through vascular system. The disease causes morbidity and mortality of arterial and venous thrombosis which can result in acute infraction and deep vein thrombosis. Majority of clotting factors are serine proteases and are present as precursors of proteolytic enzymes known as zymogens that circulate in inactivated forms but get activated in response to injury in blood vessels. The serine proteases are involved in coagulation, anticoagulation, and fibrinolysis. Thrombin and fibrin are the main key therapeutic target for the treatment of thrombosis. Commercially available antithrombotic and thrombolytic drugs are known to be associated with serious side effects like bleeding, hypertension, and haemorrhage therefore natural products have been suggested as best replacement of synthetic antithrombotic and thrombolytic drugs with less side effects for human health. Plants have been suggested as potential source of anticoagulants against thrombosis with fewer or no side effects.

Prekid arterijske kolateralne mreže kao uzrok amputacije potkolenice nakon konkvazacije uzrokovane motokultivatorom - studija slučaja

Introduction. Leg conquassation caused by petrol tiller is one of the most severe injuries in bone and joint traumatology. Firm strokes by sharp tiller blades produce strong force that easily damages both soft tissues and bones. Since tillers are used in soil processing, the wounds are highly contaminated with dirt and fertilizers, hence the anaerobic spore-forming bacilli, such as tetanus and gas gangrene pathogens. Case report. This paper presents the treatment of a 69 years old man with chronic arterial insufficiency of the lower extremities who suffered severe injury of the lower leg (IIIB open tibial fracture according to Gustillo) by petrol tiller while performing agricultural work. Due to the absence of pulsations, Multislice CT angiography and arteriography were performed. Arteriography of the injured leg confirmed chronic occlusion of the anterior tibial artery and numerous stenotic lesions of the peroneal and posterior tibial arteries. Posterior tibial artery was chronically occluded in its distal part and connected to the foot with moderately developed collateral arteries which provided the viability of the injured leg. Despite undertaken basic principles of treatment of this serious injury (primary surgical treatment of wounds, external fixation, reconstruction of soft tissue, antibiotic and anti-tetanus prophylaxis) due to infection and gangrene the treatment ended with lower leg amputation. Conclusion. Leg amputation can be expected in this type of injuries in cases of extensive destruction of tissue in the field of existing chronic arterial insufficiency in elderly patients, even in the absence of injury of main blood vessels due to traumatic disconnection of collateral in such patients.

Large Locking Fusion Plate and Cable Fixation in the Treatment of Periprosthetic Femoral Fracture (PFF) After Total Hip Arthroplasty

<i>Objective</i> To investigate the clinical effect of large locking fusion plate and cable fixation in the treatment of Periprosthetic femoral fracture (PFF) after total hip arthroplasty (THA). <i>Methods </i>Clinical data of 15 cases of PFF after THA treated with large locking fusion plate and cable fixation from June 2012 to June 2019 in our hospital were retrospectively analyzed. These cases included 4 males and 11 females, whose age were 61-82 years old, with an average age of 71.3 years, 6 cases on the left side and 9 cases on the right side. We performed total hip arthroplasty in 10 patients and hemiarthroplasty in 5 patients. There were 5 cases of Type B1 fracture, 8 cases of type B2 fracture, and 2 cases of type B3 fracture. Preoperative and postoperative hip function, HSS score, Harris score and surgical complications were observed and evaluated. <i>Results </i>15 patients were followed up 15-77 months after the operation (mean 36.9 months), and the hip function was significantly improved. The preoperative HSS score of knee function was 4.13±1.69, and the postoperative HSS score of knee function was 90.93±3.06, with11 excellent cases, 4 good cases and 0 general cases, with an excellent rate of 100%. Preoperative Harris score of knee function was 3.73±1.16. Harris score of hip function was 89.33±3.73 at the last follow-up. Among of all Harris scores, 10 cases were excellent, 3 cases were good, and 2 cases were general, with an excellent rate of 86.7%. Postoperative HHS and Harris scores were higher than those before surgery (P=0.031, P<0.001). No blood vessel or nerve injury occurred during the operation. During the postoperative follow-up, no complications such as periprosthetic infection, loosening, dislocation, nonunion of fracture and refracture occurred in 14 cases, and one case suffered refracture after the operation, which was healed after the nail and stick system fixation. <i>Conclusion</i> The application of large locking fusion plate and cable in the treatment of femoral periprosthetic fractures after total hip arthroplasty is simple, easy to operate, less complications, satisfactory clinical results, and worthy of promotion.

Outcome of laparoscopic cholecystectomy in terms of intraoperative complications in a tertiary care hospital.

Objectives: The main objective was to evaluate the outcome of laparoscopic cholecystectomy in terms of intra-operative complications and the rate and reasons of conversion to open cholecystectomy. Study Design: Descriptive Study. Setting: Hayatabad Medical Complex, Peshawar. Period: June 2018 to May 2019. Material &amp; Methods: After taking consent of Hospital ethical &amp; research committee, patients admitted with clinical diagnosis of cholelithiasis and chronic cholecystitis, confirmed by abdominal ultrasound, undergoing laparoscopic cholecystectomy fulfilling inclusion criteria were selected. Results: A total of 150 were included in the study. Mean age was 39.2yrs with female to male ratio of 9.75:1. Laparoscopic cholecystectomy was successfully accomplished in 98% cases. In 2% (3 patients) converted cases the most common cause of conversion observed was dense adhesions in the calots triangle. Intra-operative complications were noted in 1.4% patients, those included bile duct injury and leakage from the gallbladder bed. However other complications such as bowel injury, blood vessel injury, and post operative hemorrhage did not occur. Overall morbidity was 1.4% with no mortality. Conclusion: Laparoscopic cholecystectomy is a safe and effective procedure in our setup to the accepted standards, as evident by the national and international studies. And it can be accomplished with minimal morbidity and low rate of conversion with the increasing surgeon’s experience.

Weibel Palade Bodies: Unique Secretory Organelles of Endothelial Cells that Control Blood Vessel Homeostasis

Vascular endothelial cells produce and release compounds regulating vascular tone, blood vessel growth and differentiation, plasma composition, coagulation and fibrinolysis, and also engage in interactions with blood cells thereby controlling hemostasis and acute inflammatory reactions. These interactions have to be tightly regulated to guarantee smooth blood flow in normal physiology, but also allow specific and often local responses to blood vessel injury and infectious or inflammatory insults. To cope with these challenges, endothelial cells have the remarkable capability of rapidly changing their surface properties from non-adhesive (supporting unrestricted blood flow) to adhesive (capturing circulating blood cells). This is brought about by the evoked secretion of major adhesion receptors for platelets (von-Willebrand factor, VWF) and leukocytes (P-selectin) which are stored in a ready-to-be-used form in specialized secretory granules, the Weibel-Palade bodies (WPB). WPB are unique, lysosome related organelles that form at the trans-Golgi network and further mature by receiving material from the endolysosomal system. Failure to produce correctly matured VWF and release it through regulated WPB exocytosis results in pathologies, most importantly von-Willebrand disease, the most common inherited blood clotting disorder. The biogenesis of WPB, their intracellular motility and their fusion with the plasma membrane are regulated by a complex interplay of proteins and lipids, involving Rab proteins and their effectors, cytoskeletal components as well as membrane tethering and fusion machineries. This review will discuss aspects of WPB biogenesis, trafficking and exocytosis focussing on recent findings describing factors contributing to WPB maturation, WPB-actin interactions and WPB-plasma membrane tethering and fusion.

Pre-Hospital and In-Hospital Management of an Abdominal Impalement Injury Caused by a Tree Branch

In South Korea, most patients who visit trauma centers with abdominal injuries have blunt trauma, and penetrating injuries are relatively rare. In extremely rare cases, some patients are admitted with a long object penetrating their abdomen, and these injuries are referred to as abdominal impalement injuries. Most cases of impalement injuries lead to fatal bleeding, and patients often die at the scene of the accident. However, patients who survive until reaching the hospital can have a good prognosis with optimal treatment. A 68-year-old female patient was admitted to the trauma center with a 4-cm-thick tree branch impaling her abdomen. The patient was transported by a medical helicopter and had stable vital signs at admission. The branch sticking out of the abdomen was quite long; thus, we carefully cut the branch with an electric saw to perform computed tomography (CT). CT revealed no signs of major blood vessel injury, but intestinal perforation was observed. During laparotomy, the tree branch was removed after confirming that there were no vascular injuries, and enterostomy was performed because of extensive intestinal injury. After treating other injuries, the patient was discharged without any complications except colostomy. Abdominal impalement injuries are treated using various approaches depending on the injury mechanism and injured region. However, the most important consideration is that the impaled object should not be removed during transportation and resuscitation. Instead, it should only be removed after checking for injuries to blood vessels during laparotomy in an environment where injury control is possible.

Hemophilia: The Past, the Present, and the Future.

Hemophilia: The Past, the Present, and the Future.

Cardiovascular Protective Effects of Plant Polysaccharides: A Review.

Cardiovascular disease is a kind of heart, brain, and blood vessel injury disease by the interaction of various pathological factors. The pathogenesis of cardiovascular disease is complex with various risk factors, including abnormally elevated blood pressure, glucose, and lipid metabolism disorders, atherosclerosis, thrombosis, etc. Plant polysaccharides are a special class of natural products derived from plant resources, which have the characteristics of wide sources, diverse biological activities, and low toxicity or side effects. Many studies have shown that plant polysaccharides improve cardiovascular diseases through various mechanisms such as anti-oxidative stress, restoring the metabolism of biological macromolecules, regulating the apoptosis cascade to reduce cell apoptosis, and inhibiting inflammatory signal pathways to alleviate inflammation. This article reviews the pharmacological effects and protective mechanisms of some plant polysaccharides in modulating the cardiovascular system, which is beneficial for developing more effective drugs with low side effects for management of cardiovascular diseases.

Porphyromonas gingivalis Induces Proinflammatory Cytokine Expression Leading to Apoptotic Death through the Oxidative Stress/NF-κB Pathway in Brain Endothelial Cells.

Porphyromonas gingivalis, a periodontal pathogen, has been proposed to cause blood vessel injury leading to cerebrovascular diseases such as stroke. Brain endothelial cells compose the blood-brain barrier that protects homeostasis of the central nervous system. However, whether P. gingivalis causes the death of endothelial cells and the underlying mechanisms remain unclear. This study aimed to investigate the impact and regulatory mechanisms of P. gingivalis infection in brain endothelial cells. We used bEnd.3 cells and primary mouse endothelial cells to assess the effects of P. gingivalis on endothelial cells. Our results showed that infection with live P. gingivalis, unlike heat-killed P. gingivalis, triggers brain endothelial cell death by inducing cell apoptosis. Moreover, P. gingivalis infection increased intracellular reactive oxygen species (ROS) production, activated NF-κB, and up-regulated the expression of IL-1β and TNF-α. Furthermore, N-acetyl-L-cysteine (NAC), a most frequently used antioxidant, treatment significantly reduced P. gingivalis-induced cell apoptosis and brain endothelial cell death. The enhancement of ROS production, NF-κB p65 activation, and proinflammatory cytokine expression was also attenuated by NAC treatment. The impact of P. gingivalis on brain endothelial cells was also confirmed using adult primary mouse brain endothelial cells (MBECs). In summary, our results showed that P. gingivalis up-regulates IL-1β and TNF-α protein expression, which consequently causes cell death of brain endothelial cells through the ROS/NF-κB pathway. Our results, together with the results of previous case-control studies and epidemiologic reports, strongly support the hypothesis that periodontal infection increases the risk of developing cerebrovascular disease.

Adeno-Associated Virus Mediated Gene Transfer with Hyperfunctional FIX-E410H Variant Improves Mean Factor IX Activity Levels in Hemophilia B Mice

Gene therapy using recombinant adeno-associated virus (AAV) has shown promising results in recent clinical trials. Previous studies have demonstrated long-term expression of human factor IX (hFIX) (with FIX:C levels ranging from 1-6% after 7.5 years of follow-up) following AAV8-mediated gene transfer in patients with hemophilia B (HB) (1).Recently, we engineered a new recombinant FIX molecule with gain-of-function substitutive mutation E410H (hFIX-E410H) exhibiting approximately 5-fold increased specific activity compared to wild-type hFIX (hFIX-WT) (2). The enhanced specific activity of hFIX-E410H variant was explained by the increased binding affinity to its cofactor, the coagulation factor VIII. Additional experiments showed that hFIX-E410H could more efficiently bond to platelets compared to hFIX-WT.We hypothesized that with improved specific activity and binding capacity to platelets, hFIX-E410H could be a good candidate for gene therapy-based therapeutic approach of HB. After gene-transferred liver expression, hFIX-E410H would bind to patient platelets and be ready-to-act on the site of blood vessel injury in the early phase of the coagulation process. To test this hypothesis, we compared hFIX-E410H to hFIX-WT and to the well-known gain-of-function mutation R338L exhibiting a 8-fold increased specific activity (3) and being used in recent clinical trials (Spk-9001, Spark Therapeutics). We have built expression cassettes, AAV2-based single-stranded transgenes encoding i) wild-type human FIX (hFIX-WT), ii) hFIX with gain-of-function mutation E410H (hFIX-E410H), and iii) hFIX with gain-of-function mutation R338L (hFIX-R338L). Human FIX expression vectors were optimized by inserting a 300-bp truncated intron 1 (I1) between exon 1 and exon 2 of hFIX cDNA sequence. Transgenes expression, under the control of liver-specific promoter LP1, was firstly characterized on Huh7 cells. In vitro results showed lower expression levels of hFIX-E410H and hFIX-R338L variants compared to hFIX-WT, despite no defect in the intracellular trafficking process. In vitro specific activity was increased by 3.3-fold and 5.8-fold with expressed hFIX-E410H and hFIX-R338L protein variants compared to hFIX-WT, resulting in similar in vitro FIX coagulant activity levels. Transgenes were then packaged into AAV8 capsids and purified by iodixanol gradient. Two different doses (2 x 1010 and 5 x 1010 vg) of corresponding vectors ssAAV2/8-LP1-hFIX.I1-WT, ssAAV2/8-LP1-hFIX.I1-E410H, and of ssAAV2/8-LP1-hFIX.I1-R338L were tail-vein injected in 7- to 10-week-old female HB mice. Blood samples were collected between 5 to 8 weeks after injection, after intra-cardiac punction, into 1/9 volume 3.2% citrate. Platelet-poor-plasma (PPP) was immediately prepared for ELISA, thrombin generation assays and chromogenic FIX assays. A dose relationship between vector titer and transgene expression was observed in HB mice. At dose 5 x 1010 vg, plasma FIX activity level was multiplied by 1.5-fold with hFIX-E410H and by 2.3-fold with hFIX-R338L compared to hFIX-WT, due to their higher in vivo specific activity (2.5-fold and 3.2-fold increase for hFIX-E410H and hFIX-R338L, respectively). Thrombin generation capacity induced in HB mice after injection of 2 x 1010 vg of ssAAV2/8-LP1-hFIX.I1-E410H vectors was similar to the one observed after injection of 5 x 1010 vg of ssAAV2/8-LP1-hFIX.I1-WT. No inhibitors to either hFIX variant were observed.Considering the proven benefit of the enhanced activity of hFIX-R338L in recent clinical trials, the novel hyperfunctional hFIX-E410H variant with improved binding to platelets could provide another safe and efficient gene-based therapeutic option in patients with hemophilia B.1. Nathwani AC, Reiss UM, Tuddenham EG, Rosales C, Chowdary P, McIntosh J, et al. Long-term safety and efficacy of factor IX gene therapy in hemophilia B. N Engl J Med. 2014;371(21):1994-2004.2. Perot E, Enjolras N, Le Quellec S, Indalecio A, Girard J, Negrier C, et al. Expression and characterization of a novel human recombinant factor IX molecule with enhanced in vitro and in vivo clotting activity. Thromb Res. 2015;135(5):1017-24.3. Simioni P, Tormene D, Tognin G, Gavasso S, Bulato C, Iacobelli NP, et al. X-linked thrombophilia with a mutant factor IX (factor IX Padua). N Engl J Med. 2009;361(17):1671-5. DisclosuresLe Quellec:LFB: Honoraria; Novo Nordisk: Honoraria; Shire: Honoraria. Negrier:Alnylam: Research Funding; Shire: Honoraria, Research Funding, Speakers Bureau; Bayer: Honoraria, Research Funding, Speakers Bureau; Biogen: Honoraria, Research Funding, Speakers Bureau; CSL Behring: Honoraria, Research Funding, Speakers Bureau; Octapharma: Honoraria, Research Funding, Speakers Bureau; Novo Nordisk: Honoraria, Research Funding, Speakers Bureau; LFB: Honoraria, Speakers Bureau; Pfizer: Honoraria, Research Funding, Speakers Bureau; Roche: Honoraria, Speakers Bureau. Dargaud:Octapharma: Honoraria, Research Funding; Stago: Honoraria; Bayer: Honoraria, Research Funding; LFB: Honoraria, Research Funding; Alnylam: Research Funding; Baxalta/Shire: Honoraria, Research Funding; Pfizer: Honoraria, Research Funding; BMS: Honoraria, Research Funding; CSL Behring: Honoraria, Research Funding. Nathwani:Freeline Therapeutics: Employment, Other: CSO.

Artificial intelligence with big data analytics-based brain intracranial hemorrhage e-diagnosis using CT images

Due to the fast development of medical imaging technologies, medical image analysis has entered the period of big data for proper disease diagnosis. At the same time, intracerebral hemorrhage (ICH) becomes a serious disease which affects the injury of blood vessels in the brain regions. This paper presents an artificial intelligence and big data analytics-based ICH e-diagnosis (AIBDA-ICH) model using CT images. The presented model utilizes IoMT devices for data acquisition process. The presented AIBDA-ICH model involves graph cut-based segmentation model for identifying the affected regions in the CT images. To manage big data, Hadoop Ecosystem and its elements are mainly used. In addition, capsule network (CapsNet) model is applied as a feature extractor to derive a useful set of feature vectors. Finally, the presented AIBDA-ICH model makes use of the fuzzy deep neural network (FDNN) model to carry out classification process. For validating the superior performance of the AIBDA-ICH method, an extensive set of simulations were performed and the outcomes are examined under diverse aspects. The experimental values pointed out the improved e-diagnostic performance of the AIBDA-ICH model over the other compared methods with the precision and accuracy of 94.96% and 98.59%, respectively.

Correlation between graft maturity and knee function after anterior cruciate ligament reconstruction

To investigate the correlation between graft maturity and knee function after anterior cruciate ligament (ACL) reconstruction. A total of 50 patients who underwent ACL reconstruction with autologous tendons between August 2016 and August 2018 were included in the study. There were 28 males and 22 females, with an average age of 31.0 years (range, 18-50 years). At 6 months and 2 years after operation, the signal to noise quotient (SNQ) values of tibial and femoral ends of graft were measured by MRI, and the mean value was taken as the SNQ value of graft. The function of knee joint was evaluated by Tegner, Lysholm, and International Knee Documentation Committee (IKDC) scores. The differences in SNQ values between tibial and femoral ends were analyzed at 6 months and 2 years after operation. The correlation between SNQ value at 6 months after operation and knee function score at 2 years after operation was analyzed. According to SNQ value at 6 months after operation, the patients were divided into group A (SNQ value≥12) and group B (SNQ value<12) and the correlation between SNQ value and knee function score was further analyzed. All incisions healed primarily without infection or injury of blood vessels and nerves. All patients were followed up 24-28 months (mean, 26.6 months). The IKDC, Lysholm, and Tegner scores at 6 months and 2 years after operation were significantly higher than those before operation ( P<0.05), and all scores at 2 years after operation were also significantly higher than those at 6 months ( P<0.05). The SNQ values at 6 months and 2 years after operation were 12.517±6.272 and 10.900±6.012, respectively, and the difference was significant ( t=1.838, P=0.007). The SNQ values of graft at 6 months after operation were significantly different from those at 2 years after operation ( P<0.05), and the SNQ values of tibial and femoral ends of graft at the same time point were significantly different ( P<0.05). The SNQ value of 50 patients at 6 months after operation was negatively correlated with Lysholm, IKDC, and Tegner scores at 2 years after operation ( r=-0.965, P=0.000; r=-0.896, P=0.000; r=-0.475, P=0.003). The patients were divided into groups A and B according to the SNQ value, each with 25 cases; the SNQ values of the two groups at 6 months after operation were negatively correlated with Lysholm, IKDC, and Tegner scores at 2 years after operation ( P<0.05). After ACL reconstruction, the knee function scores and graft maturity of patients gradually improved. The lower the SNQ value in the early stage, the higher the knee function score in the later stage. The SNQ value of MRI in the early stage after ACL reconstruction can predict the knee function in the later stage.

Features of surgical tactics for injuries of abdominal and retroperitoneal major arteries (review of literature)

Injuries of abdominal and retroperitoneal major blood vessels are the most severe injuries. Delayed diagnosis, irrational accesses and methods of temporary hemostasis aggravate the severity of the condition and lead to life-threatening complications. The objective was to summarize the data from Russian and foreign literature for improving the results of treatment of patients with injury of abdominal and retroperitoneal major vessels. The article discusses the etiology, clinic, diagnostic algorithm for abdominal vascular injury and treatment of patients with injury of abdominal arteries, describes the methods of temporary and final hemostasis. It is necessary for a general surgeon to know the therapeutic and diagnostic algorithm for vascular injury, rational accesses to them and methods of temporary and final hemostasis, as well as the principles of «damage control» tactics to save the life of the patient.

Smoking is associated with impaired verbal learning and memory performance in women more than men

Vascular contributions to cognitive impairment and dementia (VCID) include structural and functional blood vessel injuries linked to poor neurocognitive outcomes. Smoking might indirectly increase the likelihood of cognitive impairment by exacerbating vascular disease risks. Sex disparities in VCID have been reported, however, few studies have assessed the sex-specific relationships between smoking and memory performance and with contradictory results. We investigated the associations between sex, smoking, and cardiovascular disease with verbal learning and memory function. Using MindCrowd, an observational web-based cohort of ~ 70,000 people aged 18–85, we investigated whether sex modifies the relationship between smoking and cardiovascular disease with verbal memory performance. We found significant interactions in that smoking is associated with verbal learning performance more in women and cardiovascular disease more in men across a wide age range. These results suggest that smoking and cardiovascular disease may impact verbal learning and memory throughout adulthood differently for men and women.

Discovery of Small Molecule Adhesion GPCR Modulators

GPR56 (ADGRG1) is a member of a subset of G protein coupled receptors called adhesion GPCRs (AGPCRs). These GPCRs are unique in their possession of an autoproteolytic extracellular domain that cleaves the receptors as a prerequisite to activation. GPR56 couples to G12/13 family G proteins and we recently discovered that it functions as a platelet collagen receptor that is important for hemostasis. We hypothesize that GPR56 is an early-acting collagen sensor for platelets – enabling them to first recognize blood vessel injury and to initiate the platelet program that leads to repair. Despite being biologically relevant in a number of cellular processes and diseases, there is a distinct lack of available small molecule tool compounds for AGPCRs, including GPR56. We conducted a large-scale high-throughput screen to find agonists and antagonists of GPR56. Over 150,000 small molecules and extracts were screened at UM's Center for Chemical Genomics (CCG) using a cell-based serum response element (SRE) luciferase gene reporter assay in HEK293T cells. Primary screening yielded 47 initial candidate agonists that activated GPR56 in secondary cell-based reporter and biochemical GPCR reconstitution assays. GPR56 reconstitution assays with pure G proteins further revealed that 19 of these compounds caused at least a 5-fold increase over control in G protein GTPγS binding. A notable structural cluster was identified among these molecules with some members exhibiting a 10-fold increase in potency (~30 μM to ~3 μM EC50) and equivalent efficacy compared to the full agonist positive control, a synthetic peptide mimetic of the GPR56 tethered-peptide-agonist. Follow-up GPR56 activation assays investigating the structure-activity relationship (SAR) of these pharmacophores are being pursued in conjunction with orthogonal platelet activity assays. Knowledge of AGPCR mechanisms and pathologies is rapidly emerging. As such, the discovery of high affinity agonists and antagonists will be useful probes to explore their activities in endogenous contexts. These compounds may also serve as leads for the development of GPR56-targeted pro- or anticoagulants.