Anatomical and microscopic evaluation of the liver in migratory shoveler ducks (Spatula clypeata): A multi-modal study using gross anatomy, vascular casting, morphometric analysis, and histochemistry techniques.

Conventional intraosseous (IO) access is typically reserved for emergency situations and limited to short-term use (⩽48 h). We introduce a novel, fully subcutaneous IO device designed to provide stable, longer-term vascular access in non-emergent settings. This device may benefit patients requiring intravenous therapies with challenging venous access or chronic kidney disease (CKD) who need to preserve peripheral and central veins for future arteriovenous fistula creation for hemodialysis. This prospective, single-arm, first-in-human study evaluated the feasibility and safety of the fully subcutaneous IO device over a 7-day implant with daily infusions in patients with challenging venous access or CKD. Patency was assessed radiographically after placement, clinically during infusion visits, and either radiographically or clinically before explant. Usability and tolerability were evaluated through clinician and patient surveys. Safety was assessed by monitoring device-related adverse events for 30 days after explant. Ten patients were successfully implanted with the device, and patency was maintained for a full 7-day duration without routine maintenance. Clinicians reported easy device implant, use, and explant. Three patients experienced pain during the first medullary infusion; one had additional pain during the second and third infusions. No patient discomfort was reported after day three. No adverse device effects (ADEs) occurred during the study or follow-up. This novel, fully subcutaneous IO device appears to be a feasible, usable, and safe option for short-term infusion therapy in patients with CKD or challenging venous access. These findings support further investigation into its use as a long-term intraosseous vascular access option.

With long-term renal replacement therapy with hemodialysis, all possible vascular accesses may gradually be lost, including those associated with previous catheterizations. Furthermore, peritoneal dialysis is typically no longer effective in these patients. In such clinical cases, the only viable option is to attempt a tunneled central venous catheter (CVC) for hemodialysis as a life-saving procedure, based on life-saving indications. Such situations may be uncommon, but they do occur quite regularly. The use of transhepatic access as an additional method for central vein recanalization is justified, but only in the absence of other, less risky options. In cases of complete loss of classic vascular accesses following an unsuccessful attempt at transhepatic recanalization of the central veins, a tunneled CVC can be inserted into the right atrium through the created access.

Lead is used in many different products, including as paints, pigments, solder, stained glass, lead crystal glassware, ammunition, ceramic glazes, jewellery, toys. Lead exposure can result in significant and enduring harm, particularly to the liver, which is among the most impacted organs. Coconut water is documented to be a strong antioxidants and it can help decrease blood sugar and cholesterol levels among other health benefits. In exploring the antioxidant properties of coconut, the effect of coconut water on lead poisoning on the liver and kidney of adult male rats was investigated in this study. Twenty-eight adult male rats were procured from the Pharmacological Department of Niger Delta University. The rats were weighed and categorised into five groups. The rats in the treatment groups received 2mg/kg of lead acetate via their abdominal wall. Several of these rats were administered varying quantities of coconut water. After four weeks, the animals were euthanised, and their kidney and livers were excised, processed, and stained with H&E. The findings indicated that the livers of rats exposed just to lead had enlarged central veins, regions of hepatocyte destruction, obstructed hepatic spaces, and an increased presence of immune cells known as Kupffer cells. The rats administered lead and coconut water exhibited engorged veins, compromised hepatic cells, obstructed spaces, and altered Kupffer cells. Nonetheless, the rats that exclusively consumed coconut water had normal liver morphology. The study ultimately concluded that coconut water at the dose utilised did not mitigate the detrimental effects of lead on the liver and Kidney of the rats.

Ultrasonography is the primary diagnostic imaging modality for upper extremity deep vein thrombosis related to peripherally inserted central venous catheters (PICCs). Computed tomography (CT) venography may offer higher sensitivity while additionally providing information about the superior vena cava and central pulmonary arteries. We compared the diagnostic accuracy of CT venography with ultrasonography for screen-detected PICC-related venous thromboembolism (VTE). Consecutive adult patients with cancer were enrolled before PICC placement. On day 20 ± 5, screening was performed by compression ultrasonography and duplex of the neck and upper extremity and CT venography of the neck, upper extremity, and chest. The primary outcome included upper extremity deep vein thrombosis, vena cava and right atrial thrombosis, and pulmonary embolism. CT scans were adjudicated by 2 radiologists blinded to initial readings. The sensitivity of CT and ultrasonography was estimated using VTE on either test as a combined standard. Forty one patients participated (median age 61 years, 51% female), of whom 18 (44%) were diagnosed with PICC-related VTE, including 15 asymptomatic detected at screening and 3 symptomatic VTE prior to screening. Screening CT venography missed 6 events (sensitivity, 60%; 95% CI, 36-80) and ultrasonography missed 3 (sensitivity, 80%; 95% CI, 55-93). Thrombi missed by CT venography were located across cannulated upper extremity deep veins, while ultrasonography missed thrombi in the brachiocephalic and more central veins. Both CT venography and ultrasonography missed VTE at screening. Results indicate that it is unlikely that the sensitivity of CT venography alone exceeds that of ultrasonography in detection of asymptomatic PICC-related VTE.

This study aimed to compare access and target lesion patency rates between undersized and apposed/oversized lateral-edge covered stents in patients with hemodialysis access-related central venous occlusive disease (CVOD). A retrospective analysis of 76 hemodialysis patients undergoing endovascular treatment for CVOD was conducted. All of the patients received undersized covered stents at the medial edge. Based on lateral-edge sizing, the patients were divided into undersized (n = 14) and apposed/oversized (n = 62) groups. Patency outcomes were compared using the log-rank test, and multivariable analysis was used to identify risk factors associated with the primary outcome. The 12-month access primary patency rate was significantly higher in the undersized group than in the apposed/oversized group (76.4% vs. 25.9%, p = 0.047). The 12-month target lesion primary patency rate was also higher in the undersized group; however, the difference was not statistically significant (76.4% vs. 52.1%, p = 0.186). Factors associated with the primary outcome included older age (odds ratio [OR] = 1.03, p = 0.011), coronary artery disease (OR = 2.03, p = 0.041), stenting to central veins for access thrombosis (OR = 3.53, p = 0.001), more stents (OR = 3.11, p = 0.002), apposed/oversized lateral stent edge (OR = 2.73, p = 0.044), and higher stent-to-vessel ratio (OR = 1.19, p = 0.022). The 12-month primary patency rate was better in the undersized group than in the apposed/oversized group. Endovascular treatment with undersized covered stents may be a feasible approach for hemodialysis access-related CVOD. Larger randomized studies are required to confirm these findings.

In this study, the protective effects of artichoke (Cynara scolymus L.) leaf extracts against hepatotoxicity induced by cyclophosphamide (CP), a cytotoxic agent, were investigated. Thirty female Wistar rats were randomly divided into five equal groups. The control and CP groups received 10% dimethyl sulfoxide (DMSO) via gavage for 10 days. On the 7th day, a single intraperitoneal dose of CP (200 mg/kg body weight) was administered to the rats in both the CP and the experimental groups. The rats in the experimental groups were also treated with n-hexane, ethyl acetate (EtOAc), and methanolic (MeOH) extracts (1g/kg body weight, via gavage) each dissolved in DMSO, for 10 days. In the LC-QTOF-MS analyses of the extracts, apigenin-7-O-rutinoside was present exclusively in the EtOAc extract, while this extract also had the highest concentrations of luteolin-7-O- glucoside, apigenin 7-glucoside, apigenin, oxo-octadecatrienoic acid, hydroxy-octadecatrienoic acid, and hydroxy-octadecadienoic acid. In the plasma and liver tissue samples of the CP group, levels of MDA, TNF-α, and IL-1β increased, while antioxidant markers levels and IL-10 levels decreased. Compared to the CP group, the MeOH extract group showed reduced levels of MDA, TNF-α, and IL-1β, along with increased levels of GSH (except in liver tissue), GPx, SOD, and IL-10 in both plasma and liver samples. In the EtOAc group, liver MDA levels were significantly reduced and plasma GSH levels were elevated. However, changes in plasma IL-1β, IL-10, and TNF-α levels were not statistically significant. In the n-hexane group, none of the examined parameters showed significant changes. Histopathological examinations of liver tissues in the CP group revealed sinusoidal dilation, hyperemia in the central veins, vacuolar degeneration, and increased Kupffer cell activation. In contrast, the EtOAc group exhibited a marked reduction in these anomalies, indicating notable histological improvement. The MeOH group showed a reduction in hyperemia and vacuolar degeneration, while the n-hexane group demonstrated only limited tissue recovery. Consequently, the results of this study demonstrated that the EtOAc extract, rich in diverse phenolic compounds, was the most effective in mitigating CP-induced hepatic degeneration. Meanwhile, the MeOH extract, which had the highest total phenolic content, exhibited the strongest antioxidant and anti-inflammatory effects and contributed to partial histological improvement.

Feasibility of the Protrieve Sheath for Embolic Protection During Venous Thrombectomy in Twenty-two Patients.

Introduction: Venous Stent migration to the cardiopulmonary system is a rare complication of endovascular stenting. Most reported stent embolizations originate from central thoracic veins, upper extremity, dialysis fistulas, or renal veins. Migration from iliac veins is rarely reported. Complications include valvopathy, acute heart failure ( AHF), arrhythmias, endocarditis, or tamponade. Endovascular extraction is the first-line intervention, though surgical extraction may be required. We present a patient with stent migration resulting in severe tricuspid regurgitation (TR) and AHF. Case presentation: A 69-year-old male with extensive cardiac and peripheral vascular disease. Presented to our clinic with episodes of dizziness, dyspnea, and chest pain. Episodes occur during the day, relieved with rest. Examination was significant for systolic murmur, healed foot ulcer, moderate lower extremity swelling, and varicose veins. Patient has received a (16 x 100 Zilver venous stent) for severe stenosis in the left iliac vein in 3/2022. Transthoracic echocardiography showed an echodense tubular structure measuring 10 x 2 centimeters, resembling a stent, in the right atrium crossing the tricuspid valve into the right ventricle and holding the tricuspid valve open, causing severe TR. Cardiac catheterization was performed, confirming the stent position. The patient underwent surgical extraction of the stent and tricuspid valve repair. Discussion: Stent migration, though rare, can cause AHF and valvopathy. It should be suspected in patients with a prior venous stenting. Studies suggest that stent migration may result from respiratory-induced changes in vein diameter. As veins dilate, the stent expands and shortens, which can contribute to migration. Our patient with a history of stenting in the left iliac vein experienced symptoms of AHF and leaflet damage requiring valve repair. Percutaneous extraction with a snare can be attempted, but it often fails, especially when the stent is poorly positioned or causes valvular damage, leading to the need for open-heart surgery. The use of self-expanding bare metal stents may reduce migration by providing better vessel wall opposition. Serial imaging is also recommended to ensure long-term stent position and prevent dangerous complications. Conclusion: Stent migration into the cardiopulmonary system is rare but serious. Percutaneous retrieval is possible, but valvular involvement may require open-heart surgery with valve repair.

Background: Chronic refractory edema in the lower extremities is a disabling condition characterized by persistent swelling and venous stasis skin changes, despite standard conservative therapies. Research Question: What are the underlying etiologies of chronic refractory lower extremity edema, and how effective is a structured, integrated diagnostic protocol in improving etiologic classification and guiding targeted management? Study Design and Methods: This was a single-center, retrospective analysis of 58 prospectively enrolled patients with chronic, refractory lower extremity edema persisting for ≥1 year, all of whom underwent a standardized diagnostic protocol. Superficial and deep venous insufficiency were assessed using duplex ultrasonography with reflux testing. Central venous anatomy was evaluated with iliocaval ultrasonography to detect potential obstructions in the inferior vena cava or iliac veins. Right heart catheterization was performed to assess for pulmonary hypertension, a possible contributor to chronic venous hypertension in the lower extremities. Iliocaval venography and intravascular ultrasound were employed to confirm or exclude obstructive pathology of the central veins. Right heart catheterization and invasive venous assessments were conducted concurrently. Etiologies were categorized as cardiopulmonary (pulmonary hypertension [PH]), central (non-thrombotic iliac vein lesion [NIVL]), peripheral (superficial venous insufficiency [SVI]), or multifactorial. Results: Of the 58 patients, 51.7% had a single identifiable etiology, while 41.4% had multifactorial causes. Non-thrombotic iliac vein lesion (NIVL) was the most common etiology, identified in 55.2% of cases, followed by pulmonary hypertension (PH) in 48.3%, and superficial venous insufficiency (SVI) in 43.1%. Among patients with multifactorial etiologies, NIVL frequently coexisted with either PH or SVI. Unknown etiology, not attributable to any of the specified categories (NIVL, PH, or SVI), was identified in 6.7% of patients. Endovascular intervention for iliocaval obstruction (n = 23) and venous ablation for isolated SVI (n = 10) led to sustained clinical improvement, with no recurrence or procedural complications observed during follow-up. Interpretation: This pathophysiology-based diagnostic algorithm enabled accurate etiologic classification and informed individualized treatment strategies for patients with chronic refractory edema and chronic venous skin changes of the lower extremities.

INTRODUCTION: When performing catheterization of central and peripheral veins, specialists use methods of external orientation and ultrasound navigation. Approaches and techniques for central vein catheterization using ultrasound navigation are changing, which requires periodic evaluation of the benefits of ultrasound catheterization techniques. OBJECTIVE: Comparison of the success rate and incidence of complications catheterization central and peripheral veins based on external landmarks and using ultrasound navigation. MATERIALS AND METHODS: Design is a systematic review and meta-analysis of randomized clinical trials (RCTs). The literature was searched in the PubMed and Google Scholar databases. The overall success of catheterization, success on the first attempt, and the incidence of complications (hematoma, arterial puncture, and pneumothorax) were investigated. Quality assessment and statistical data processing were performed in the Review Manager program, version 5.4.1. The reliability of evidence was assessed using the GRADE approach. results. The systematic review and meta-analysis included 16 RCTs with a total of 3,341 patients. Ultrasound navigation increased the overall success rate of catheterization (relative risk (RR) 1.1 (1.03–1.2)) (p = 0.007) and the success rate of catheterization on the first attempt (RR = 1.52 (1.18–1.95)) (p = 0.001). The heterogeneity of the data was high. Ultrasound monitoring reduced the overall incidence of complications during central vein catheterization (internal jugular, subclavian/axillary, femoral) by 3.3 times (RR = 0.3 (0.23–0.41)) (p < 0.001); including a pneumothorax by 8.4 times (RR = 0.19 (0.04–0.84)) (p = 0.03); arterial penetration by 3.8 times (RR = 0.26 (0.18–0,40)) (p < 0.001); hematoma by 3.3 times (RR 0.3 (0.17–0.52)) (p < 0.001). During peripheral vein catheterization, ultrasound monitoring increased the catheterization success rate (RR = 1.22 (1.09–1.35)). CONCLUSIONS: Ultrasound central vein catheterization increases the overall success and success on the first attempt. Ultrasound can reduce the complications by 3.3 times (pneumothorax, arterial puncture, hematoma formation). During peripheral vein catheterization, ultrasound increased the overall success and success of catheterization on the first attempt, however, this applied to patients with difficult vascular access.

Oral nimodipine is the only drug approved for aneurysmal subarachnoid hemorrhage (aSAH). However, bioavailability is poor and peak plasma concentrations fluctuate widely, leading to dose‐limiting hypotension. Administration is problematic in patients who cannot swallow. An enteral liquid formulation exists but causes severe diarrhea. GTX‐104 is an intravenous (IV) nimodipine formulation that has 100% bioavailability and is not affected by swallowing, gastrointestinal absorption and first pass effects. When administered in pharmacokinetically‐equivalent doses to oral nimodipine in healthy humans, GTX‐104 has more consistent plasma concentrations and causes less hypotension than oral nimodipine. To conduct a randomized, open label, blinded endpoint study to determine the safety and tolerability of GTX‐104 compared with oral nimodipine in patients with aSAH We conducted a multicenter, prospective, randomized, open‐label safety and tolerability study of GTX‐104 compared to oral nimodipine in aSAH. Inclusion/exclusion criteria matched prescribing information for oral nimodipine and included adults with aSAH of all Hunt/Hess grades. Subjects were randomized 1:1 to GTX‐104 or oral nimodipine. The primary endpoint was the proportion of subjects with clinically significant hypotension (hypotension requiring treatment, with a reasonable likelihood of being due to study drug, as determined by an independent, blinded committee). Secondary endpoints included all episodes of hypotension, adverse events, EQ‐5D‐3L and modified Rankin scale within 90 days of aSAH. 102 subjects were randomized at 24 sites in the USA. Demographics reflected those of aSAH. There was a 20% relative reduction in clinically significant hypotension with GTX‐104 compared to oral nimodipine (28% versus 35%). 54% of GTX‐104 subjects got >95% of the prescribed dose compared to 8% on oral nimodipine. Favorable outcome (90‐day mRS 0‐2) was more common in the GTX‐104 group compared with oral nimodipine (62% versus 48%). Fewer patients on GTX‐104 (36% versus 48% oral nimodipine) had serious adverse events. There were no safety issues with GTX‐104. GTX‐104, an IV formulation of nimodipine that can be administered through central or peripheral veins, is safer and potentially more efficacious than oral nimodipine.

Thoracic central vein obstruction (TCVO) refers to occlusive disease of the thoracic central veins leading to compromised venous return from the head, neck, chest, and upper extremities to the right atrium. TCVO has benign and malignant causes and involves intraluminal, intramural, or extravascular obstruction. TCVO is the preferred term to describe the anatomic and/or pathologic process; however, the clinical manifestations (and historically, the anatomic description) are commonly referred to as superior vena cava syndrome. Diagnostic evaluation of patients with suspected TCVO starts with US or venography (ie, typically MR or CT venography but possibly catheter-directed or conventional venography). Treatment of TCVO has evolved, with endovascular therapy emerging as the preferred treatment option to alleviate symptoms rapidly and safely. Endovascular recanalization techniques include thrombectomy, thrombolysis, and blunt or sharp recanalization. Endovascular reconstruction can be performed by means of placement of stents or stent-grafts. Antiplatelet and anticoagulant agents may be used after recanalization and reconstruction to improve patency rates or to treat deep vein thrombosis. Overall, technical and clinical success rates are high and major adverse events are rare, occurring in 1%-2% of patients. ©RSNA, 2025 Supplemental material is available for this article.

The hyperaccumulation phenomenon holds significant potential for Ni agromining in ultramafic areas; however, data on tropical hyperaccumulator species, particularly regarding metal distribution and tolerance mechanisms, remain scarce. This study characterized the foliar elemental distribution of Blepharidium guatemalense, analyzed its metal localization at both tissue and cellular levels, and quantified its Ni accumulation when grown in Brazilian ultramafic soil. Plants were grown in pots for 90 days, and Ni concentrations in the aerial biomass and bio-ore were determined. Synchrotron-based micro-X-ray fluorescence (S-µXRF) was used to assess metal distribution in tissues, supplemented by microscopic examination with dimethylglyoxime (DMG) to visualize Ni accumulation in specific cell types. B. guatemalense reached 19,000 mg kg−1 Ni in leaves. Processing leaf biomass produced ash containing 24 wt% Ni, indicating promising metal-recovery potential for the species. S-µXRF revealed that Ni was predominantly localized in the central and secondary veins of the leaves, suggesting efficient vascular transport. Microscopic analysis using the colorimetric reagent DMG further showed that Ni accumulation occurs near the epidermis and phloem, suggesting that B. guatemalense employs specific physiological mechanisms for Ni translocation, potentially supporting both defense and growth functions. These results establish B. guatemalense as a promising candidate for large-scale Ni agromining in tropical regions.

Cannabidiol (CBD) is a well-known cannabinoid with therapeutic potential among numerous non-psychoactive compounds. CBD is characterized by a wide range of pharmacological actions on conditions such as pain, inflammation, epilepsy, anxiety, and others.The aim of the study was to investigate the histological characteristics and compare the morphometric parameters of the microcirculatory bed of rat liver after 2 and 6 weeks of experimental exposure to 10% cannabidiol oil.Materials and methods. The experiment was conducted in the conditions of the vivarium of the Danylo Halytsky Lviv National Medical University and at the Department of Pathological Anatomy and Forensic Medicine. 40 sexually mature white non-linear male rats weighing 180-230 g were used as the object of the study. Depending on the duration of CBD oil application, the animals of the experimental group were divided into 2 series of 14 individuals in each. Rats of the first series were receiving 10% CBD oil (dose 10 mg/kg/day) once a day orally dripped for 2 weeks, rats of the second series were also receiving 10% CBD oil (dose 10 mg/kg/day) once a day orally dripped for 6 weeks. The control group included 12 sexually mature white male rats, 6 individuals in each series of the experimental study. All experiments, as well as housing, care, feeding, marking and euthanasia were carried out in compliance with the requirements of the European Convention for the Protection of Vertebrate Animals used for Experimental and other Scientific Purposes (Strasbourg, 1986), Council of Europe Directive 2010/63/EU, Law of Ukraine No. 3447-IV “On the Protection of Animals from Cruelty to Animals”. Histological and morphometric studies of the vessels of the liver microcirculatory bed of two series and the control group were performed using statistical methods. The reliability criteria of Pearson (χ2), Mann-Whitney (U), Wilcoxon T-test, McNemar p (McN) were used. The difference was considered statistically significant at a minimum significance level of p<0.05.Results. Based on the morphological study of the vessels of the liver microcirculatory bed under the experimental influence of CBD for 2 and 6 weeks, it was found that the histological structure of the vascular compartment did not change. Comparative morphometric analysis of the vessels of the liver microcirculatory bed indicates the absence of a significant difference in the average external diameters of the interlobular artery after 6 weeks of CBD exposure with the control group (p>0.05). No significant difference in the average diameters of the sublobular and collecting veins after CBD exposure for 2 and 6 weeks (p>0.05), as well as hemodynamic disorders, which is important for the liver blood outflow system. Similarly, no significant difference in the average diameter of the portal vein with the control group in the two terms of the experiment was found (p>0.05), and no hemodynamic changes were recorded. It was found that minor hyperemia was diagnosed in single central veins after both 2 and 6 weeks of experimental exposure to CBD, but the relative values did not significantly differ from the control group in both series of the experiment (p>0.05).Conclusions. Comparative morphometric analysis of the vessels of the liver microcirculatory bed at the end of 2 and 6 weeks of the experiment indicates the safety of using 10% CBD oil (dose 10 mg/kg/day).

IntroductionMicroplastics (MPs), particularly polystyrene microplastics (PS-MPs), are emerging environmental contaminants that have been shown to accumulate in various organs, including the liver, leading to oxidative stress, inflammation, and metabolic dysregulation. However, the precise molecular mechanisms underlying PS-MP-induced hepatotoxicity and disruptions in lipid metabolism remain poorly understood. Taurine (Tau), a naturally occurring amino acid with known antioxidant and cytoprotective properties, may suggest a potential protective strategy against such toxicity. This study aimed to investigate the hepatotoxic effects of PS-MPs in a mouse model and to evaluate the potential ameliorative role of Tau.MethodsMice were exposed to PS-MPs with or without Tau supplementation over a 60-day experimental period. The groups were: control group, which received distilled water orally (0.5 mL/mouse). The Tau group was administered Tau at a dose of 200 mg/kg body weight. The PS-MPs group received PS-MPs at 10 mg/kg body weight, suspended in distilled water. The combination group (PS-MPs + Tau) received both Tau and PS-MPs at the same doses concurrently. Multiple endpoints were assessed, including oxidative stress biomarkers, liver function indicators, lipid and bilirubin profiles, histopathological alterations, and the expression of key genes involved in lipid metabolism and oxidative stress regulation.ResultsExposure to PS-MPs resulted in notable hepatic injury, characterized by elevated oxidative stress, dysregulated lipid profiles, impaired antioxidant enzyme activity, and altered expression of genes related to lipogenesis and fatty acid oxidation compared to the control. Histological examination revealed congested central and portal veins, massive aggregations of lymphocytes, the hepatocytes appeared markedly swollen, disorganized arrangement, and exhibited large nuclei with strong basophilic staining consistent with these biochemical findings. Co-administration of Tau mitigated these adverse effects, improving antioxidant status, normalizing metabolic markers, and partially restoring gene expression patterns and tissue integrity.ConclusionOverall, the findings indicated that PS-MPs caused liver damage via oxidative stress and lipid metabolic disturbance, and that Tau supplementation had a protective effect, possibly via modulating oxidative and metabolic pathways. This experiment emphasized the necessity for additional research into Tau as a therapeutic agent in microplastic-related liver damage.

Background Central venous stenosis is a common problem encountered in hemodialysis (HD) patients, especially those with a history of repeated central venous catheter insertions. Central venous stenosis decreases the efficiency of dialysis by the arteriovenous fistula owing to the high recirculation rates. Moreover, it reduces the potential of the creation of new vascular access. The study aimed to determine the role of noncontrast magnetic resonance venography (MRV) in the detection of stenosed or occluded intrathoracic central veins in HD patients with failed vascular access. Patients and methods The study was conducted on 16 end-stage kidney disease patients on maintenance HD. All candidates were subjected to detailed history taking, focusing on vascular access and full physical examination. Noncontrast MRV for central veins in the neck and chest was done using 1.5 T closed MRI. Results Findings detected by the noncontrast MRV included occlusion of the right internal jugular vein in 37.5% of patients, as well as occlusion of the left internal jugular vein in 37.5% of patients. An occluded left brachiocephalic vein was detected in 25% of the patients. Partial thrombosis of the superior vena cava was detected in 12.5% of patients. Four (25%) of the studied patients had occlusion or stenosis in five different veins simultaneously. Conclusions Implementation of noncontrast MRV as a screening method to guide the choice of sites of catheterization or arteriovenous fistula limb, can improve longevity and function of vascular access in HD patients.

Nanotechnology, specifically nanocarriers, has demonstrated remarkable results in the treatment of diabetes in animal models, as this approach is distinguished by many unique physical, chemical, and biological properties of nanomaterials that enhance drug delivery and therapeutic effectiveness of insulin delivery for diabetes treatment. The study aimed to assess the therapeutic impact of selenium-insulin nano-envelopes. This envelope was examined using UV-vis measurements in the wavelength spectrum of (208.50-407.50) nm, as well as XRD. The specimens were next examined using FESEM as spherical particles with nano-diameters ranging from 110 to 40 nm. The rats were placed into three sets: a control, a diabetic, and a diabetic treated with selenium-insulin nanocapsules. The infected control group showed AST values of 155.1±678.5, ALT values of 67.20±179.3, and ALP values of 202.7±444.0. The findings revealed that the untreated diabetic group had significantly higher liver enzyme levels, indicating liver damage. The nano-encapsulated group experienced a significant drop in enzyme levels, including AST (6.18 ± 161.0), ALT (6.14 ± 60.50), and ALP (72.71 ± 627.8), indicating liver protection. These findings show that selenium-insulin nanoencapsulation could play an essential role in protecting the liver from diabetes-induced damage and allowing for greater insulin absorption and protection from degradation. Histological examination of the liver in the healthy control group showed intact hepatic cords and central veins, while congestion of the central veins and venous sinuses was observed in the alloxan-induced diabetic group. In diabetic group treated with the selenium nanocapsule, significant improvements were observed in hepatocyte levels and hepatic central vein.

We report a case of bilateral retinal vasculitis in a patient with type M2 antimitochondrial antibodies (AMA-M2). Observational case report. A 35-year-old female presented with photopsia without reduction in visual acuity in either eye. Ocular examination revealed bilateral retinal vasculitis, mainly affected the retinal veins, which was more extensive in the left eye. Both the large, central veins as the small, peripheral veins showed inflammatory involvement, without occlusive disease. Broad systemic investigation including blood analysis, chest and brain imaging showed no abnormalities, except for AMA-M2 positivity. Hepatologic and rheumatologic assessment showed no signs of cholestasis or associated connective tissue disease. The patient responded favorably to systemic steroid treatment with adjunctive mycophenolate mofetil (1g twice daily). Ongoing follow-up was arranged to monitor the hepatic function given the substantial risk of developing primary biliary cholangitis (PBC). Retinal vasculitis may be associated with AMA-M2 positivity. This case expands on the diverse spectrum of autoimmune diseases associated with type M2 antimitochondrial antibodies. Whether these antibodies play a direct role within the etiopathogenesis of retinal vasculitis or represent an epiphenomenon, remains elusive.

BACKGROUNDMigraine has been proposed as a potential contributing factor to ischemic complications involving the retina and optic nerve. Ophthalmic disorders connected with migraine encompass occlusions of the branch and central retinal arteries and veins, alongside anterior and posterior ischemic optic neuropathy. With the advent of optical coherence tomography angiography (OCTA), it is easy to identify these macular subclinical microvascular and structural changes.AIMTo evaluate macular and peripapillary structural and microvasculature changes in patients with migraine with aura (MA), migraine without aura (MW), and healthy control (HC) participants using OCTA.METHODSIn this observational cross-sectional study, we studied a total of 100 eyes: (1) 32 eyes of 16 patients with MA; (2) 36 eyes of 18 patients with MW, recruited based on the International Classification of Headache Disorders; and (3) 32 eyes of 16 age and sex-matched healthy participants. Foveal flux, foveal avascular zone (FAZ), peripapillary flux obtained from OCTA, and foveal and peripapillary ganglion cell layer (GCL) thickness calculated via optical coherence tomography were compared among the groups.RESULTSThe mean FAZ area measured in patients with MA and MW was significantly larger than that in the control participants (P = 0.002). However, there was no significant difference between the FAZ of the MA and MW groups. Macular perfusion in the superficial capillary plexus in patients with MA was significantly lower compared to MW (P = 0.0018) and HCs (P = 0.002). There was also significant thinning of the GCL in patients with MA and MW (P = 0.001) compared to HCs. However, there was no significant difference in temporal GCL thickness between the MA and MW groups.CONCLUSIONSignificant changes have been found in structural and microvascular parameters in patients with migraines compared with HCs. OCTA can serve as a valuable non-invasive imaging technique for identifying microcirculatory disturbances, aiding in better understanding the pathogenesis of different types of migraine and establishing their link with other ischemic retinal and systemic pathologies.