Vessel Damage Research Articles

Rheumatoid Vasculitis and Blepharitis Caused By Rheumatoid Arthritis In 6 Years Old Boy: A Case Report

Link of Video Abstract: https://youtu.be/4Guk_6foSxw Introduction: Rheumatoid Vasculitis (RV) is a rare complication affecting approximately 1% of patients with severe rheumatoid arthritis. This condition is an extra-articular manifestation of rheumatoid arthritis that affects the small and medium arteries in the body. Vasculitis is an inflammatory necrotizing vascular wall disease that can occur in autoimmune disease. This inflammation leads to damage in blood vessels due to stenosis or occlusion and thrombosis, resulting in pain, necrosis, and aneurysm. Inflammation can be primary or secondary. Skin, fingers, peripheral nerves, eyes and the heart are the most commonly affected areas. Case description: We report a case of a 6-year-old boy who presented RV and blepharitis. The patient subsequently experienced nail fold infarcts and gangrene of his left finger. He was found to fulfill Jones Criteria, and treatment with aspirin and corticosteroids significantly improved his symptoms. This rare case describes the early onset of rheumatoid vasculitis in a patient with rheumatoid arthritis. Rheumatoid vasculitis is a systemic disease that develops from rheumatoid arthritis with rheumatoid autoantibodies and extra-articular manifestations characterized by tissue damage or ischemia involving the skin and peripheral nerves. The incidence of rheumatoid vasculitis in children is less than 1%, with 12 to 53 cases per 100,000 children under 17 years old. Conclusion: Rheumatoid vasculitis is a rare complication of rheumatoid. This condition occurs in patients who have rheumatoid arthritis for a long period. The patient will prevent further complications with early diagnostic and proper treatment.

Correlation of idiopathic benign paroxysmal positional vertigo with cerebral small vessel disease

Benign paroxysmal positional vertigo (BPPV) is the most prevalent form of peripheral vertigo, with vascular lesions being one of its suspected causes. The older adults are particularly vulnerable to BPPV. Cerebral small vessel disease (CSVD), on the other hand, is a clinical condition that results from damage of cerebral small vessels. Vascular involvement resulting from age-related risk factors and proinflammatory state may act as the underlying factor linking both BPPV and CSVD. The objective of this study is to explore the potential correlation between BPPV and CSVD by examining whether individuals aged 50 and older with BPPV exhibit a greater burden of CSVD. This retrospective study included patients aged 50years and older who had been diagnosed with BPPV. A control group consisting of patients diagnosed with idiopathic facial neuritis (IFN) during the same time period was also included. The burden of cerebral white matter hyperintensities (WMHs) was evaluated using the Fazekas scale. An ordinal regression analysis was conducted to investigate the potential correlation between BPPV and WMHs. The study included a total of 101 patients diagnosed with BPPV and 116 patients with IFN. Patients with BPPV were found to be significantly more likely (OR=2.37, 95% CI 1.40-4.03, p=0.001) to have a higher Fazekas score compared to the control group. Brain infarctions, hypertension, and age were all identified as significant predictors of white matter hyperplasia on MRI, with OR of 9.9 (95% CI 4.21-24.84, P<0.001), 2.86 (95% CI 1.67-5.0, P<0.001), and 1.18 (95% CI 1.13-1.22, P<0.001) respectively. Our findings suggest that vascular impairment caused by age-related risk factors and proinflammatory status may be contributing factors to the development of BPPV in individuals aged 50 and above, as we observed a correlation between the suffering of BPPV and the severity of WMHs.

FRI350 Prolonged Transient Central Diabetes Insipidus Induced By Traumatic Brain Injury

Abstract Disclosure: R. Marques: None. S. Sharma: None. B.S. Flores Chang: None. A. Sajan: None. Introduction: Central diabetes insipidus (CDI) is a rare complication of traumatic brain injury (TBI). Most cases of CDI due to TBI are transient and resolve within 2-5 days. We report a patient with prolonged transient CDI which lasted for 35 days after sustaining a gunshot wound to the head. Case Description: A 17-year-old male with no past medical history presented after gunshot wound in the head. He had comminuted fractures of the right temporal bone, right zygomatic arch, greater and lesser rings of sphenoid bone, right maxillary sinus, right medial orbital wall, right orbital floor and bilateral frontal sinuses. A computerized tomography of head showed subarachnoid haemorrhage of the frontal lobes as well as subdural haemorrhage of right parietal lobe, right falx cerebri and left cerebral hemisphere. On hospital day 2, he had an intracranial pressure monitor placed which was unremarkable. He underwent right hemicraniectomy with debridement and washout on hospital day 3. Shortly afterwards, his urine output increased to &amp;gt;500 cc/hr with serum sodium of 172 mEq/L [135-145], serum osmolality 307 mOsmol/kg [270-295], and urine osmolality of 117 mOsm/kg [300-900]; consistent with CDI. He was acutely treated with intravenous desmopressin with resolution of hypernatremia. During the next five weeks of his 3-month hospitalization, he continued to have polyuria with specific gravity as low as 1.003 [1.005-1.030], and occasional hypernatremia, with a peak serum sodium of 150 mEq/L. Intranasal desmopressin as well as free water supplementation were given daily to alleviate his polyuria and hypernatremia. Evaluation of anterior pituitary function was normal except for decreased gonadotrophins. His polyuria resolved after five weeks, and labs showed urine osmolality of 530 mOsm/kg with serum sodium 138 mEq/L and urine specific gravity 1.010, consistent with resolution of CDI. Intranasal desmopressin was discontinued. His serum sodium remained stable without desmopressin for the next 7 weeks with serum sodium at discharge of 141 mEq/L. Discussion: The damage of the hypothalamic vasopressin-producing neurons, their axons or the posterior pituitary results in permanent post-TBI CDI. In cases of transient CDI, the pathogenesis is likely related to small vessel damage or inflammatory edema rather than direct neuronal damage. In our case, the patient initially developed hypernatremia and polyuria from acute CDI due to hemicraniectomy with debridement and washout. He continued to have prolonged transient CDI due to the extensive intracranial hemorrhage and edema. The CDI resolved with desmopressin (both intravenous and intranasal) and fluid replacement. Transient CDI is a rare complication intracranial haemorrhage. Our case highlights that the severity of TBI may correlate with the duration of transient CDI. Presentation: Friday, June 16, 2023

X-ray diagnostics of fire damage vessels of the abdominal cavity of the retroperitoneal space

This article deals with the analysis of damage to the main vessels of the abdominal cavity. In particular, the article is devoted to the radiological diagnosis of damage to the vessels of the abdominal cavity caused by gunshot wounds. The article examines various methods and technologies of using X-ray and computer tomographic imaging for accurate localization and characterization of damage to the vascular bed. The author of the article emphasizes the importance of the clinical significance of such a diagnosis, its advantages, and possible limitations in its use for effective treatment of victims. A detailed review of foreign research was conducted to adapt and study the existing world experience in the direction of research for the opportunity to provide timely and high-quality assistance to victims.&#x0D; The aim. The aim of the work is the theoretical substantiation of gunshot injuries to the main vessels of the abdominal cavity of the retroperitoneal space.&#x0D; Scientific novelty. For the first time, a detailed analysis of damage to the main vessels of the abdominal cavity of the retroperitoneal space was carried out.&#x0D; Materials and methods. Analysis of theoretical sources, comparison, induction of isolated analytical data. The research was conducted on the basis of the repository of scientific texts of the State Institution "Amosov National Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine".&#x0D; Results. It was determined that with the help of MSCT-angiography, signs of damage to the main vessels of the abdominal cavity can be accurately diagnosed, additional information about damage to bone structures, neighbouring organs and tissues is obtained.&#x0D; Conclusions. It was determined that MSCT-angiography has become the main method of assessing gunshot injuries to the vessels of the abdominal cavity. Using this method allows you to accurately determine the location and nature of injuries, which helps doctors in choosing the optimal treatment plan for affected patients. However, it is important to consider the possible limitations of this method and to develop additional diagnostic strategies for a complete and comprehensive assessment of vascular injuries

Vascular injury during lumbar discectomy: risk factors, diagnosis, methods of surgical correction, features of anaesthetic management and intensive care

One of the priority tasks in neurosurgery is to reduce the frequency of postoperative complications and mortality. Lumbar discectomy is the most frequently performed intervention in spinal neurosurgery and it is a fairly safe procedure. One of the possible intraoperative surgical complications, that threatens the patient’s life is vascular injury. The first clinical case of damage to the large vessels during discectomy was described in 1945. It is believed that the frequency of this complication is 1‒5 cases per 10,000 surgical interventions, but the literature notes that these figures may be significantly underestimated. Some authors indicate that the frequency of this complication, despite the development of surgical techniques over the past 50 years, has not significantly decreased, so it is important for surgeons to be informed and alert about the possibility of such a problem. Among the factors that significantly increase the risk of vascular damage congenital, acquired and technical are determined. Variability of clinical symptoms of damage to lagre vessels is due to different localization of injury, type (arterial, venous or combined) and scale of vascular disaster. For each level of surgical intervention, the "most typical" vessel damage is identified. Vascular injury during discectomy can occur according to three clinical and pathomorphological scenarios: manifestation of vessel rupture symptoms, arteriovenous fistula or a pseudoaneurysm formation. According to different authors, the frequency of these findings varies significantly. This review examines the symptoms of possible variants of vascular damage development during discectomy and describes the characteristics of surgical correction methods. Along with clarifying the location and variant of vascular damage, the critical thing is assessing the amount of blood loss and the rate of ongoing bleeding. In the case of suspected massive bleeding, the paramount importance is the involvement of additional medical personnel for the surgical haemostasis and providing sufficient blood for haemotransfusions. In case of a vascular accident, the key requirement for adequate anaesthetic management is the maintenance of permissive arterial hypotension until the moment of surgical haemostasis. Targeted treatment of haemorrhagic shock in case of damage to large vessels consists of rapid haemostatic resuscitation including blood components and products in a balanced 1:1:1 ratio, such as plasma, red blood cells, fresh frozen plasma, platelets, and coagulation factors. In Ukraine, obtaining a sufficient amount of blood components and products (according to the protocol of massive haemotransfusion) in case of unpredicted blood loss is a difficult task, therefore, in the absence of certain components or blood products, whole blood can be used as an alternative. The number and severity of complications and outcomes primarily depend on the efficiency and timeliness of blood transfusions, along with the speed of surgical arrest of bleeding. This publication describes in detail the main points of management of patients with massive bleeding according to modern international standards and Ukraine regulatory documents.

A Case of Floating Aortic Arch Thrombosis in a Patient without Thrombophilia.

Floating aortic arch thrombi-blood clots forming in an aorta without aneurysms or atherosclerosis-in a normal aorta are exceedingly rare. The etiology is unknown, and there are no guidelines for appropriate treatment strategies. We report a case of floating aortic arch thrombosis in a patient without coagulopathy that was treated surgically. As the mass could not be identified preoperatively as a tumor or thrombus, synthetic graft replacement was performed, allowing resection of the lesion site. Histopathological examination revealed erosion and fissures in the tunica intima of the aorta, which suggested vessel damage to the tunica intima as the cause.

Critical Analysis of Container Accidents in International Logistics

Purpose: Container accidents are a significant issue in international logistics, causing property damage, financial loss, environmental hazards, and even loss of life. These accidents can occur in various settings, such as ports, container yards, roads, rails, or seas. Efforts are being made to enhance container safety, but they remain a persistent challenge that requires ongoing attention to ensure the safe and efficient movement of goods across the globe. By understanding the specific aspects of container accidents that are human-controllable and addressing these issues, a more sustainable and efficient global logistics industry can be achieved. Methodology: An exploratory research design is used in the research study. A comprehensive review of existing literature, including research papers, academic journals, books, reports, and reputable online sources was done. Literature that focuses on container accidents, maritime safety, human factors, and accident investigation reports was extensively studied to gain an understanding of the current state of knowledge on the topic. Data from relevant secondary sources that provide information on container accidents that are human-controllable were identified and collected. Results &amp; Outcome: Container accidents that are happening owing to natural calamities such as floods, cyclones, sea perils, etc are uncontrollable. There are other forms of container accidents viz cargo damage, container equipment damage, container vessel damage, loss of life owing to container fall, etc occurring due to container sliding while handling, tipping of container vessels while loading, skewing of container vessels in the transit voyage, etc. that are controllable by human interference. Unevenly loaded containers seem to be the prime reason for many container accidents that are apparently controllable by humans by following the International Convention for Safe Containers (CSC) guidelines of the International Maritime Organization. In an LCL (Less than Container Load) scenario, adhering to such guidelines may be challenging. There are many research articles discussing the load balancing of containers in an LCL scenario using various optimization techniques, and it appears that the literature is still evolving. Originality: A exploratory study to understand the human controllable factors in container accidents, further study the regulatory guidelines, and analyse the research papers published. Type of the Paper: Exploratory research.

Retinal vessel segmentation to diagnose diabetic retinopathy using fundus images: A survey

AbstractDiabetes can cause damage to the retina's blood vessels in the eye leading to diabetic retinopathy (DR). The images captured using a fundus camera are used to segment and study the blood vessel damage. Once the retina is damaged, it cannot be repaired. Therefore, early detection of blood vessel damage is the only way to control the progression of the disease. It allows physicians to provide timely and appropriate treatment to patients. The ophthalmologist can manually recognize and mark these vessels based on some clinical and geometrical features; however, it is time‐consuming. Extraction and segmentation play a significant role in showing the difference between healthy and newly developed abnormal vessels. Due to the increased diabetes population, automated systems have been designed to detect retinal blood vessels and assist ophthalmologists. Identifying, extracting, and examining blood vessels are intricate processes, specifically identifying new vessels in the retina. In medical image analysis, artificial intelligence and deep learning techniques have become widely used practices for automatic retinal blood vessel segmentation. We reviewed articles from 1989 to 2023, including handcrafted segmentation to recent deep‐learning techniques with available public datasets. We have concluded this article with an overview of observed parameters, calculations, and future directions for the analysis of retinal images. We believe this review article will help researchers identify research gaps in the field of DR.

Embryonic blood vessel damage and embryotoxicity induced by electronic cigarettes vape juice

Embryonic blood vessel damage and embryotoxicity induced by electronic cigarettes vape juice

Analysis of the Creep Failure of P92/HR3C Dissimilar Steel Welded Joint

Harsh service environments, such as high temperature and pressure, cause many unforeseen premature failures, especially for welded joint structures, whose heat-affected zones have been in service. Cases of pressure vessel damage caused by premature cracking in the process often occur. In this paper, the finite element model of dissimilar welded joints of P92/HR3C steel was established to simulate the actual service process, and the variation law of maximum principal stress, equivalent stress, and stress triaxiality on the inner and outer surfaces of the joint and both sides of the welding were analyzed. The results show that in the long-term use of welded joints, the stress concentration occurs in the weld fusion zone; with the increase in service time, the creep strength of the HR3C weld interface is much higher than the P92 weld interface, the structural shape changes and the stress concentration is transferred from the HR3C-weld to the P92-weld.

Sinonasal and Orbital Imaging Findings in COVID-Associated Rhino-Orbito-Cerebral Mucormycosis During the Second Wave of COVID-19: A Retrospective Cohort Study in a Tertiary Hospital in Central India.

Background Mucormycosis is a consequence of the angioinvasive disease caused by filamentous fungi that belong to the order Mucorales, particularly Mucor, Rhizopus, and Rhizomucor. Rhizopus oryzae is the most prevalent form. The invading hyphae lead to damage of blood vessels leading to thrombosis and consequent tissue necrosis. The incidence of this disease entity witnessed a significant rise during the second wave of the coronavirus disease 2019 (COVID-19) pandemic. Timely diagnosis and prompt treatment are crucial to diminish both the mortality and morbidity associated with this disease. Imaging plays a pivotal role in diagnosing the ailment, evaluating its extent, identifying complications such as thrombosis, and facilitating surgical planning. It demonstrates exceptional sensitivity in detecting the disease at its early stages, often before symptoms manifest. Due to the angioinvasive nature of Mucor, early detection assumes utmost importance as it necessitates intensive antifungal therapy and the removal of devitalized tissue through debridement. Methodology We conducted a retrospective cohort study to analyze computed tomography (CT) imaging findings in patients with COVID-associated rhino-orbito-cerebral mucormycosis (ROCM) confirmed by histopathological examination. We compared these findings with CT findings of the nose and paranasal sinuses in patients without mucor following COVID-19 sinusitis (non-ROCM). Results All 16 cases in the non-ROCM group were in stage 1 disease. In contrast, in the ROCM group, three patients had stage 1 disease, five patients had stage 2 disease, and 10 patients had stage 3 disease (p = 0.0001). The pterygopalatine fossa was significantly affected in 10 of 18 ROCM patients and in none of the non-ROCM patients. Conclusions Imaging plays a crucial role in the early detection of mucormycosis. It assists treating physicians in initiating prompt and aggressive treatment, thereby improving the prognosis of this frequently fatal disease.

Daidzein Inhibits Human Platelet Activation by Downregulating Thromboxane A2 Production and Granule Release, Regardless of COX-1 Activity.

Platelets play crucial roles in cardiovascular diseases (CVDs) by regulating hemostasis and blood coagulation at sites of blood vessel damage. Accumulating evidence indicates daidzein inhibits platelet activation, but the mechanism involved has not been elucidated. Thus, in this study, we investigated the mechanism responsible for the inhibition of collagen-induced platelet aggregation by daidzein. We found that in collagen-induced platelets, daidzein suppressed the production of thromboxane A2 (TXA2), a molecule involved in platelet activation and aggregation, by inhibiting the cytosolic phospholipase A2 (cPLA2) signaling pathway. However, daidzein did not affect cyclooxygenase-1 (COX-1). Furthermore, daidzein attenuated the PI3K/PDK1/Akt/GSK3αβ and MAPK (p38, ERK) signaling pathways, increased the phosphorylation of inositol trisphosphate receptor1 (IP3R1) and vasodilator-stimulated phosphoprotein (VASP), and increased the level of cyclic adenosine monophosphate (cAMP). These results suggest that daidzein inhibits granule release (ATP, serotonin, P-selectin), integrin αIIbβ3 activation, and clot retraction. Taken together, our study demonstrates that daidzein inhibits collagen-induced platelet aggregation and suggests that daidzein has therapeutic potential for the treatment of platelet aggregation-related diseases such as atherosclerosis and thrombosis.

Force generation in human blood platelets by filamentous actomyosin structures

Blood platelets are central elements of the blood clotting response after wounding. Upon vessel damage, they bind to the surrounding matrix and contract the forming thrombus, thus helping to restore normal blood circulation. The hemostatic function of platelets is directly connected to their mechanics and cytoskeletal organization. The reorganization of the platelet cytoskeleton during spreading occurs within minutes and leads to the formation of contractile actomyosin bundles, but it is not known if there is a direct correlation between the emerging actin structures and the force field that is exerted to the environment. In this study, we combine fluorescence imaging of the actin structures with simultaneous traction force measurements in a time-resolved manner. In addition, we image the final states with superresolution microscopy. We find that both the force fields and the cell shapes have clear geometrical patterns defined by stress fibers. Force generation is localized in a few hotspots, which appear early during spreading, and, in the mature state, anchor stress fibers in focal adhesions. Moreover, we show that, for a gel stiffness in the physiological range, force generation is a very robust mechanism and we observe no systematic dependence on the amount of added thrombin in solution or fibrinogen coverage on the substrate, suggesting that force generation after platelet activation is a threshold phenomenon that ensures reliable thrombus contraction in diverse environments.

Contemporary Interpretations of Ophthalmological Manifestations of Chronic Myeloproliferative Neoplasms

The course of chronic myeloproliferative neoplasms (CMPN), a group of systemic hematological diseases, can be accompanied by various complications and changes in tissues and organs of the whole organism. The eye is the only organ where damage of nerve fibers and blood vessels can be directly observed and examined, and ocular symptoms can be the initial, manifest of systemic pathology, the toxic effects of modern targeted therapy, or the first manifestation of a relapse of the disease after treatment. The most frequently described manifestations are caused by hematological anomalies that cause microvascular disorders. Such changes today remain insufficiently studied in terms of the using new research methods and contemporary targeted therapy. In addition, ocular symptoms may precede more serious extraocular complications. Combined ophthalmological and hematological examination of patients with CMPN can become a preventive approach for early diagnosis and timely treatment.

Early Medieval Memorial Enclosures in Semirechye: new data

This article for the first time reproduces and comprehensively interprets the data of excavated memorial enclosures of the early Middle Ages on the territory of Semirechye – southeastern part of Kazakhstan. Two memorial complexes of Karakystak 18 and Ulken Kakpak essentially complement the corpus of similar excavated monuments of Semirechye. The analysis of both constructive features of the memorial monuments and accompanying inventory is undertaken. Finds of ceramic fragments from three different vessels near the enclosure No. 2 of Ulken Kakpak may indicate intentional damage of vessels after the memorial ritual in honor of the deceased. Using the comparative study with similar archaeological objects from the territory of Sayan-Altai and Mongolia we assume the dating of these memorial enclosures in Semirechye in 8th–10th centuries. The authors concluded that the memorial enclosures on the territory of Semirechye have a much smaller variety of constructive features than similar objects in South Siberia and Central Asia. The memorial complexes in Karakystak and Ulken Kakpak could have been created both by the Turks of the "ten arrow’s" Western Turkic Qaghanate and more probably by the Turgesh or Karluks.

A CT-based predictive model for stent-induced vessel damage: application to type B aortic dissection.

The distal stent-induced new entry (distal SINE) is a life-threatening device-related complication after thoracic endovascular aortic repair (TEVAR). However, risk factors for distal SINE are not fully determined, and prediction models are lacking. This study aimed to establish a predictive model for distal SINE based on the preoperative dataset. Two hundred and six patients with Stanford type B aortic dissection (TBAD) that experienced TEVAR were involved in this study. Among them, thirty patients developed distal SINE. Pre-TEVAR morphological parameters were measured based on the CT-reconstructed configurations. Virtual post-TEVAR morphological and mechanical parameters were computed via the virtual stenting algorithm (VSA). Two predictive models (PM-1 and PM-2) were developed and presented as nomograms to help risk evaluation of distal SINE. The performance of the proposed predictive models was evaluated and internal validation was conducted. Machine-selected variables for PM-1 included key pre-TEVAR parameters, and those for PM-2 included key virtual post-TEVAR parameters. Both models showed good calibration in both development and validation subsamples, while PM-2 outperformed PM-1. The discrimination of PM-2 was better than PM-1 in the development subsample, with an optimism-corrected area under the curve (AUC) of 0.95 and 0.77, respectively. Application of PM-2 in the validation subsample presented good discrimination with an AUC of 0.9727. The decision curve demonstrated that PM-2 was clinically useful. This study proposed a predictive model for distal SINE incorporating the CT-based VSA. This predictive model could efficiently predict the risk of distal SINE and thus might contribute to personalized intervention planning. This study established a predictive model to evaluate the risk of distal SINE based on the pre-stenting CT dataset and planned device information. With an accurate VSA tool, the predictive model could help to improve the safety of the endovascular repair procedure. • Clinically useful prediction models for distal stent-induced new entry are still lacking, and the safety of the stent implantation is hard to guarantee. • Our proposed predictive tool based on a virtual stenting algorithm supports different stenting planning rehearsals and real-time risk evaluation, guiding clinicians to optimize the presurgical plan when necessary. • The established prediction model provides accurate risk evaluation for vessel damage, improving the safety of the intervention procedure.

Preoperative computed tomography in the planning of median resternotomy in children

The capabilities of computed tomography (CT) in the diagnosis of mediastinal adhesions and measuring the density of adhesions when planning midline resternotomy in children were assessed, and the effect of preoperative CT on the incidence of surgical complications was studied. According to several authors, the frequency of resternotomies in cardiac surgery is up to 20% of the total number of surgeries per year and is accompanied by significant difficulties in the isolation of the heart and vessels. In pediatric cardiac surgery, complex congenital heart disease (CHD) mostly requires a staged approach. The staging of complex CHD correction and the need for repeated surgeries in most cardiac defects make the problem of safe repeated surgical access urgent. Postoperative adhesions are one of the most acute problems in modern cardiac surgery. The formation of adhesions is an inevitable reaction of the body after primary cardiac surgery. Massive adhesions that develop after surgery most commonly lead to adhesion of the heart and major great vessels to the posterior surface of the sternum. These changes are especially pronounced in children due to the high reactivity of the body and the lack of technical possibility and expediency of pericardial suturing after surgery. Rough adhesions during resternotomy complicate the cardiac surgeons task and increase the risk of complications. The main dangers are damage to various structures in the thorax such as the right and left heart, aorta, coronary arteries, pulmonary artery, and brachiocephalic vein. The diagnosis of postoperative adhesions in the mediastinum before resternotomy is difficult. CT has the widest diagnostic capabilities for assessing mediastinal adhesions. When performing CT as a part of preoperative resternotomy planning, it is important to examine the mediastinal topography, assess the degree of adjacency of the pericardium and mediastinal structures, determine the presence and density of adhesions, and assess patency and diameter of great vessels to select cannulas and cannulation methods necessary for emergency start of cardiopulmonary bypass (CPB) in cardiac trauma. These criteria are important when planning midline resternotomy to reduce the risks of traumatization of cardiac structures and great vessels and allow correction of surgical tactics and timely preventive surgical measures. Depending on the density, extent, and localization of adhesions, the cardiolysis technique and cannulation of great vessels required for initiation of emergency CPB may be changed. The use of preoperative CT when planning midline resternotomy in children allows to predict the risks of damage of cardiac structures and great vessels and visualize adhesive bands and measure their density, which helps the surgeon to adjust surgical tactics regarding the method and volume of cardiolysis and assess patency and diameter of great arteries and veins, thus determining the cannulation method and cannula diameter in advance if urgent CPB is needed. Therefore, standardization of CT description protocols for midline resternotomy planning with assessment of key criteria is an urgent task and requires further development.

An Improved Surgical Approach for Complete Interhemispheric Corpus Callosotomy Combined with Extended Frontoparietal Craniotomy in Mice.

Callosotomy is an invasive method that is used to study the role of interhemispheric functional connectivity in the brain. This surgical approach is technically demanding to perform in small laboratory animals, such as rodents, due to several methodological challenges. To date, there exist two main approaches for transecting the corpus callosum (CC) in rodents: trephine hole(s) or unilateral craniotomy, which cause damage to the cerebral cortex or the injury of large vessels, and may lead to intracranial hemorrhage and animal death. This study presents an improved surgical approach for complete corpus callosotomy in mice using an interhemispheric approach combined with bilateral and extended craniotomy across the midline. This study demonstrated that bilateral and extended craniotomy provided the visual space required for hemisphere and sinus retraction, thus keeping large blood vessels and surrounding brain structures intact under the surgical microscope using standardized surgical instruments. We also emphasized the importance of good post-operative care leading to an increase in overall animal survival following experimentation. This optimized surgical approach avoids extracallosal tissue and medium- to large-sized cerebral blood vessel damage in mice, which can provide higher study reproducibility/validity among animals when revealing the role of the CC in various neurological pathologies.

The Histological Background of Recurrence in Laryngeal Squamous Cell Carcinoma: An Insight into the Modifications of Tumor Microenvironment.

Recurrent laryngeal carcinoma presents differences from the primary tumor that largely depend on the treatment. In this article, we review the histologic and molecular treatment-induced changes that may affect the diagnosis of recurrent laryngeal carcinoma, the assessment of predictive markers, and the response to treatment with immune checkpoint inhibitors. Radiotherapy induces profound modifications that are strictly related to necrosis of different tissue components, fibrosis, and damage of the tumor vessels. Postradiotherapy recurrent/persistent laryngeal squamous cell carcinoma typically presents a discohesive growth pattern within a fibrotic background associated with significant changes of the tumor immune microenvironment, with both important immunosuppressive and immunostimulatory effects. Overall, the increase of immunoregulatory cells and immune checkpoints such as CTLA-4, TIM-3, PD-1, and PD-L1 induced by radiotherapy and chemotherapy strongly supports the use of immune checkpoint inhibitors in recurrent/persistent laryngeal carcinoma. Future studies aiming to identify predictive factors of the response to immune checkpoint inhibitors should consider such treatment-induced modifications.

Insights into the Role of Plasmatic and Exosomal microRNAs in Oxidative Stress-Related Metabolic Diseases.

A common denominator of metabolic diseases, including type 2 diabetes Mellitus, dyslipidemia, and atherosclerosis, are elevated oxidative stress and chronic inflammation. These complex, multi-factorial diseases are caused by the detrimental interaction between the individual genetic background and multiple environmental stimuli. The cells, including the endothelial ones, acquire a preactivated phenotype and metabolic memory, exhibiting increased oxidative stress, inflammatory gene expression, endothelial vascular activation, and prothrombotic events, leading to vascular complications. There are different pathways involved in the pathogenesis of metabolic diseases, and increased knowledge suggests a role of the activation of the NF-kB pathway and NLRP3 inflammasome as key mediators of metabolic inflammation. Epigenetic-wide associated studies provide new insight into the role of microRNAs in the phenomenon of metabolic memory and the development consequences of vessel damage. In this review, we will focus on the microRNAs related to the control of anti-oxidative enzymes, as well as microRNAs related to the control of mitochondrial functions and inflammation. The objective is the search for new therapeutic targets to improve the functioning of mitochondria and reduce oxidative stress and inflammation, despite the acquired metabolic memory.