Dilation Pressure Research Articles

Comparison between the 0- and 30-s balloon dilation time in percutaneous transluminal angioplasty for restenosed arteriovenous fistula among hemodialysis patients: a multicenter, prospective, randomized trial (CARP study)

BackgroundThis study aims to compare patency rates of the 0- and 30-s (sec) balloon dilation time in hemodialysis (HD) patients with restenosis after percutaneous transluminal angioplasty (PTA).MethodsThe patients who underwent PTA within 6 months for failed arteriovenous fistula at the forearm were randomly assigned the 0-s or 30-s dilation time group. Effect of dilation time on the 3- and 6-month patency rates after PTA was examined.ResultsFifty patients were enrolled in this study. The 3-month patency rate in the 30-s dilation group was better than that in the 0-s dilation group (P = 0.0050), while the 6-month patency rates did not show a significant difference between the two groups (P = 0.28). Cox’s proportional hazard model revealed that 30-s of inflation time (hazard ratio 0.027; P = 0.0072), diameter of the proximal (hazard ratio 0.32; P = 0.031), and dilation pressure (hazard ratio 0.63; P = 0.014) were associated with better 3-month patency. Dilation pressure between previous and present PTA did not differ in the 0-s (P = 0.15) and 30-s dilation groups (P = 0.16). The 6-month patency rate of the present PTA in the 30-s dilation group was higher than that of the previous PTA (P = 0.015). The visual analog scale did not differ between the two groups (P = 0.51).ConclusionThe presenting data suggest that 30-s dilation potentially results in a better 3-month patency rate than 0-s dilation in HD patients with restenosis after PTA.

Urinary proteomic analysis for biomarker discovery of pulmonary arterial hypertension-induced right ventricular failure

Abstract Background Right ventricular failure (RVF) is one of the independent and strong predictors of mortality in pulmonary arterial hypertension (PAH). Urine is more suitable and sensitive for biomarker discovery with no need for homeostatic control compared to blood. Purpose The purpose of this study is to investigate candidate urinary biomarkers for RV structural and functional monitoring during PAH progression. Methods The urinary proteome of 21 monocrotaline (MCT)-induced PAH rats (8 controls, 8 of compensated RV group, 5 of decompensated RV group) were identified using liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS). And the differential proteins were verified by parallel reaction monitoring (PRM)-targeted quantitative proteomics. Candidate biomarkers were further validated using ELISA in the urine of PAH patients. Results In total, 1811 urinary proteins were identified with at least 1 unique peptide (FDR≤1%). Compared to the control group of rats, 118 and 184 proteins were altered in the compensated and decompensated groups, respectively, and 62 differential proteins were found between the two stages (2.0-fold change, p< 0.05). The canonical pathways revealed that complement system, glutathione metabolism and iron homeostasis were enriched in the compensated stage, while interferon signaling, fibrosis, Wnt signaling and epithelial-mesenchymal transition were enriched in the failing stage. Four proteins confirmed by PRM, which were also of good discrimination ability of two RV stages were selected for further validation. ELISA results of the urine of PAH patients showed that IL18BP, IFNABR, LGALS3BP and α2-AP were sequentially elevated as disease progressed. Correlation analysis with clinical indicators showed that these proteins were positively correlated with right atrial pressure and right heart dilation, and negatively correlated with cardiac index and tricuspid annular plane systolic excursion. The combination of these four proteins panel could significantly distinguish PAH patients from healthy controls (AUC=0.985, 95%CI 0.955-1) and performs well in distinguishing high-risk PAH patients from low-risk ones (AUC=0.922, 95%CI 0.807-1). Conclusions Novel RVF candidate urinary biomarkers were found through in-depth proteomic analysis of PAH rat model. The panel of these four proteins, which were significantly correlated with RV structural remodeling and systolic function, showed good performance in diagnosis and risk stratification of PAH patients.Figure 1.Study workflowFigure 1.Main results of the study

Treatment of coronary artery disease with sirolimus- versus paclitaxel-coated balloons

Abstract Background Percutaneous coronary interventions (PCI) with paclitaxel-coated balloons (PCB) represent an established treatment for in-stent restenosis (ISR) and small coronary arteries. Lately sirolimus-coated balloons (SCB) have been introduced. Yet, studies comparing SCBs to PCBs are lacking. Purpose We sought to assess clinical outcomes at 12 months of an all-comer population presenting with acute or chronic coronary artery disease (CAD) treated with either a novel SCB or an established PCB. Methods We analyzed consecutive patients from the ongoing prospective SIROOP registry (NCT:04988685). Outcomes of interest included, target lesion failure (TLF), target lesion revascularization (TLR), target vessel myocardial infarction (TV-MI) and cardiac-death (cv-death). All angiograms and outcomes were independently adjudicated. Results A total of 359 patients were included in this analysis, 220 (61%) and 139 (39%) patients were treated with SCBs and PCBs, respectively. Diabetes was present in 108 (30%) of patients and 145 (40%) patients presented with an acute coronary syndrome. The mean Syntax score of the overall population was 17.8±11, 95 (26%) of the lesions were ISR, 30 (8.4%) chronic total occlusions (CTOs) and 211 (59%) had moderate to severe calcifications. All lesions were treated with a DCB-only approach in both groups. Mean DCB diameter was 2.8±0.56 mm and the maximal mean dilatation pressure was 8.1±4.7 atm. We encountered no relevant coronary artery perforations or acute vessel closures. Further baseline and procedural characteristics can be found in Figure 1. At 1-year follow-up, there was no statistically significant difference in the TLF rate between patients treated with SCBs versus PCBs (14 (7.4%) versus 12 (10%), respectively, (p=0.5)), with TLR being the leading cause for TLF (13 (6.8%) in the SCB and 10 (8.8%) in the PCB group, p=0.7). Figure 2 depicts the Kaplan-Meier curve of TLF over time. The leading TLF cause appeared to be lesion recoil/ collapse in both groups. Comparing ISR lesions treated with SCBs versus PCBs, there was also no significant difference with regards to the TLF rate (3 (9.1%) versus 4 (8.2%), respectively, p=1.00). Conclusions To our best knowledge, this is one of the first studies comparing SCBs to PCBs for treatment of CAD. At 1-year follow-up, there was no significant difference in outcomes between the two groups. Moreover, there was a numerically lower number of adverse events among patients treated with SCBs. These findings warrant further investigation in a dedicated randomized trial.Baseline and procedural characteristicsKaplan-Meier curve of TLF

Effect of Resveratrol on Endothelial Function in Patients with CKD and Diabetes: A Randomized Controlled Trial.

Patients with CKD and diabetes are at higher risk of developing cardiovascular disease, in part, because of impaired endothelial function. Cardioprotective compounds such as resveratrol could improve endothelial function and attenuate the cardiovascular burden in patients with CKD and diabetes. We hypothesized that resveratrol supplementation would improve endothelial function in patients with CKD and diabetes. Twenty-eight adults aged 68±7 years (84% men) with stage 3 CKD and diabetes were enrolled in a randomized, double-blind, placebo-controlled, crossover study to investigate the effects of 6-week resveratrol supplementation (400 mg/d) on endothelial function. Endothelial function was determined through brachial artery flow-mediated dilation. The mean values for eGFR and hemoglobin A 1c were 40±9 ml/min per 1.73 m 2 and 7.36%±0.72%, respectively. Compared with placebo, resveratrol supplementation increased flow-mediated dilation (ratio of geometric mean changes and 95% confidence interval for between-group comparisons, 1.43 (1.15 to 1.77); P value = 0.001). eGFR, hemoglobin A 1c , BP, and nitroglycerin-mediated dilation were unchanged with resveratrol or placebo ( P = 0.15), suggesting the observed change in flow-mediated dilation was likely independent of changes in traditional cardiovascular risk factors. Resveratrol supplementation improved endothelial function in patients with CKD and diabetes. Resveratrol and Vascular Function in CKD, NCT03597568 . This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_11_20_CJN0000000000000337.mp3.

Effects of moxibustion of "biaoben acupoint combination" on heart rate variability, atrial natriuretic peptide in the model rats of IBS-D complicated with anxiety

To compare the effects on the heart rate variability (HRV) and the expression of the atrial natriuretic peptide (ANP) in the model rats of irritable bowel syndrome with predominant diarrhea (IBS-D) rats complicated with anxiety between moxibustion of "biaoben acupoint combination" and that of "conventional acupoint combination". Of 50 healthy SPF female SD rats, aged 3 months, 8 rats were selected randomly as a blank group, and the rest rats were prepared to be the model of IBS-D complicated with anxiety. Twenty-four rats after successfully modeled were randomized into a model group, a conventional acupoint combination group (convention group) and a biaoben acupoint combination group (biaoben group), 8 rats in each one. In the convention group, moxibustion was delivered at "Tianshu" (ST 25), "Zusanli"(ST 36) and "Shangjuxu"(ST 37); and in the biaoben group, moxibustion was applied to "Neiguan" (PC 6), "Zusanli" (ST 36), and "Guanyuan" (CV 4). One session of moxibustion took 20 min, once daily, for 14 days in total. Before and after intervention, the body mass and fecal moisture content were compared in the rats of each group; using abdominal wall withdrawal reflex, the visceral hypersensitivity was evaluated; with elevated plus maze (EPM) and light-dark box (LDB), the anxiety conditions were assessed. After intervention, HRV was compared among groups, the ultrastructure of intestinal mucosa was observed under the transmission electron microscope in the rats of each group, and ANP expression in the myocardial tissue was detected using Western blot method and immunofluorescence. Before the intervention, compared with the blank group, the body mass and visceral pain threshold of rats were reduced in the model group, the convention group and the biaoben group (P<0.05), fecal moisture content and AWR scores (at the dilatation pressure of 40, 60 and 80 mm Hg, 1 mm Hg ≈ 0.133 kPa) were elevated (P<0.05); and time in the open arm, the open arm entry number and the total movement distance (EPM), the time spent in the light compartment, the number of dark to light transitions and the total transition distance (LDB) were decreased (P<0.05). After the intervention, compared with the blank group, in the model group, the body mass, visceral pain threshold, standard diviation of NN intervals (SDNN) and root mean square of successive RR interval differences (RMSSD) were dropped (P<0.05), fecal moisture content, AWR scores (the dilation pressures of 40, 60 and 80 mm Hg), LF/HF and ANP expression were increased (P<0.05), the time in open arm, the open arm entry number and the total movement distance (EPM), the time spent in the light compartment, the number of dark to light transitions and the total transition distance (LDB) were decreased (P<0.05). When compared with the model group, in the convention group and the biaoben group, the body mass, visceral pain threshold, SDNN and RMSSD were increased (P<0.05), fecal moisture content, AWR scores (the dilation pressures of 60 and 80 mm Hg), LF/HF and ANP expression were dropped (P<0.05), the time in open arm, the open arm entry number and the total movement distance (EPM), the time spent in the light compartment, the number of dark to light transitions and the total transition distance (LDB) were increased (P<0.05). In the biaoben group, compared with the convention group, the body mass, visceral pain threshold, SDNN and RMSSD were elevated (P<0.05), fecal moisture content, AWR score (the dilation pressure of 80 mm Hg), LF/HF and ANP expression were decreased (P<0.05), the time in open arm, the open arm entry number and the total movement distance (EPM), the time spent in the light compartment, the number of dark to light transitions and the total transition distance (LDB) were increased (P<0.05). The epithelial cells of the intestinal mucosa showed a normal morphology in the blank group, the tight junction of the cells was disrupted and the junction was loose in the model group; the tight junction was imperfect in the convention group, but it was intact in the biaoben group. Compared with the conventional acupoint combination, moxibustion of biaoben acupoint combination is more effective on the symptoms of IBS-D complicated with anxiety in the model rats. The effect mechanism may be related to attenuating anxiety-like negative emotions, positively regulating HRV, stabilizing IBS-D intestinal mucosal barrier and down-regulating the expression of ANP in myocardium.

An improved coupled flow-geomechanical model for cyclic steam stimulation

Considering the pore deformation and permeability changes during dilation-recompaction in cyclic steam stimulation (CSS), an existing geomechanical model is improved and thermo-mechanically coupled with the flow equations to form a coupled flow-geomechanical model. The impacts of dilation-recompaction parameters can be quantified through sensitivity analysis and uncertainty assessment utilizing the synergy between Latin hypercube designs and response surface methodology. The improved coupled flow-geomechanical model allows a more reasonable history-matching of steam injection pressure and volume and oil/water production volume. In both the linear and quadratic models, the rise in recompaction pressure has the most significant effect on the rise in the volumes of steam injection and water production, both rock compressibility and recompaction pressure are positively correlated with steam injectivity and oil/water production, and the dilation pressure is negatively correlated with steam injectivity and oil/water production. In the linear model, dilation pressure has the most significant negative impact on the cumulative oil production, and compressibility and recompaction pressure are positively correlated with oil production. In the quadratic model, the rise in recompaction pressure has the most significant effect on the rise in the cumulative volumes of oil/water production and steam injection. The interactions between the dilation/recompaction pressures and spongy-rock compressibility negatively affect the cumulative volumes of oil/water production and steam injection.

Intraoperative analgesic effect of intravertebral lidocaine injection during percutaneous kyphoplasty in the treatment of thoracolumbar compression fractures in elderly patients.

In recent years, percutaneous kyphoplasty (PKP) has been increasingly used in clinical settings. In this study, we aimed to determine the analgesic effect of intravertebral lidocaine injections in PKP. A total of 60 patients who were treated with PKP were enrolled in this study. Lidocaine hydrochloride was chosen as the medication for the experimental group. Patients were randomly assigned into three groups using a double-blind study design: In group A (20 cases), no drugs were injected into the vertebral body during surgery; group B (20 cases) received intravertebral injection of normal saline; and in group C (20 cases), lidocaine hydrochloride was administered into the vertebral body during surgery. The age of patients, operation time, balloon dilatation pressure, balloon dilatation volume, and amount of bone cement injected were compared across the three groups. A pain visual analog scale (VAS) was used to assess pain suffered by the patients before, during, and 24 hours after the surgery. Age, operation time, balloon dilatation pressure, balloon dilatation volume, and amount of bone cement injected did not differ significantly among the three groups (P> 0.05). The differences in VAS scores 24 hours before and after surgery were not statistically significant (P> 0.05). Group C had lower intraoperative VAS scores than groups A and B, and the difference was statistically significant (P< 0.01). There was no statistically significant difference between group A and group B (P> 0.05). Intravertebral injections of lidocaine during PKP can successfully reduce intraoperative pain.

Hysteroscopic removal of a heterotopic cervical pregnancy to preserve a patient’s intrauterine sac

To introduce a case of removing the heterotopic cervical pregnancy while preserving the normal gestational sac in the uterine cavity by hysteroscopic surgery under ultrasound guidance. Video description of the case and surgical procedure. Hospital affiliated to university. A 35-year-old woman, G7P1A5L1, was admitted with a heterotopic cervical pregnancy 21 days after IVF-ET (the corrected gestational age was 5+2 weeks). The serum β-hCG level was 24,530.00 mIU/ml at the corrected gestational age of 5+3 weeks. The ultrasound examination on the day of admission showed that there was a gestational sac in the cervical canal (1.5×0.8×0.5 cm, yolk sac visible) and another sac in the intrauterine cavity (1.2×1.2×1.1 cm, yolk sac visible). The pregnant woman and her partner strongly urged the removal of the cervical gestational sac and continuing the intrauterine pregnancy to term. After the Institutional Review Board (IRB) approval was obtained, hysteroscopic surgery with bipolar resectoscope and transabdominal ultrasound guidance was used to resect the heterotopic cervical pregnancy while preserving the intrauterine gestational sac. The heterotopic cervical pregnancy was completely resected by hysteroscopy, and the normal gestational sac in the uterine cavity was successfully preserved. Ultrasound-guided hysteroscopic surgery allowed us to successfully preserve the intrauterine pregnancy while removing the cervical pregnancy completely. During the operation, the dilation pressure and the flow rate of the dilation fluid was kept as low as possible to avoid excessive intrauterine pressure and excessive dilation fluid entering the intrauterine cavity, which could have had adverse effects on the intrauterine pregnancy sac. No surgical-related or anesthesia-related complications occurred. The pathological results confirmed placental villi and decidual tissue. The One-month follow-up ultrasonography showed a live single intrauterine pregnancy with cardiac activity. Hysteroscopic removal of a heterotopic cervical pregnancy under ultrasound guidance can be safely performed while successfully preserving an ongoing intrauterine pregnancy.

Pressure induced changes in endothelial cell morphology and Ca2+ signaling in ex vivo pressurized resistance arteries revealed using 4D diSPIM myography and AI deep-learning

The vascular endothelium is critical in promoting vasodilation of resistance-size arteries through Ca 2+ dependent pathways. Vascular endothelial cells (ECs) are exposed to mechanical stimulation through changing intravascular pressure and flow, yet it is unclear how these forces impact EC morphology and Ca 2+ signaling in pressurized arteries. Visualizing how the endothelium of an intact resistance-size vessel responds to changing physical forces requires isometric, sub-micron, resolution. Conventional confocal fluorescent microscope systems are limited by poor axial resolution. 4D dual inverted selective plane of illumination microscopy (diSPIM; 3i) uniquely provides isometric resolution at ~330 nm with high temporal resolution and minimal photobleaching or phototoxicity. We designed custom pressure myography chambers to allow simultaneous 4D diSPIM fluorescent imaging and vessel diameter tracking measurements via transmitted IR light (diSPIM Myography). We captured fluorescent images of ex vivo pressurized resistance-size mouse mesenteric arteries at 80, 60, 40, and 20 mm Hg before and after the generation of myogenic tone and in the absence of extracellular Ca 2+ . Representative images were annotated for ECs, nuclei, myoendothelial projections (MEPS), and Ca 2+ signals. Annotations were used as ground truth for CNN AI model generation and validation using Apeer (Zeiss). Arivis Vision4D (Zeiss) was used to run the AI model and quantify data. As static intravascular pressure is increased in arteries without tone (with or without Ca 2+ ), ECs increase in width as the vessel dilates. Myogenic tone minimizes pressure dilation and changes in EC width, however, ECs compress by up to 1 micron as pressure increases from 20 to 80 mm Hg. Additionally, increasing intravascular pressure in arteries with tone decreases local EC Ca 2+ signaling. The data demonstrate a relationship between intravascular pressure and EC shape and Ca 2+ signaling in intact resistance arteries under conditions of physiologic temperature, pressure, pH, and tone. diSPIM myography provides a method of studying the effects of physiologically relevant mechanical stimuli and the roles of various mechanosensitive mechanisms on vascular function. AI image annotation reduces analysis bias and increases the breadth of quantifiable microscopy data. DMC is supported by NIH R00HL133451 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Single inhalation exposure to polyamide micro and nanoplastic particles impairs vascular dilation without generating pulmonary inflammation in virgin female Sprague Dawley rats

BackgroundExposure to micro- and nanoplastic particles (MNPs) in humans is being identified in both the indoor and outdoor environment. Detection of these materials in the air has made inhalation exposure to MNPs a major cause for concern. One type of plastic polymer found in indoor and outdoor settings is polyamide, often referred to as nylon. Inhalation of combustion-derived, metallic, and carbonaceous aerosols generate pulmonary inflammation, cardiovascular dysfunction, and systemic inflammation. Additionally, due to the additives present in plastics, MNPs may act as endocrine disruptors. Currently there is limited knowledge on potential health effects caused by polyamide or general MNP inhalation.ObjectiveThe purpose of this study is to assess the toxicological consequences of a single inhalation exposure of female rats to polyamide MNP during estrus by means of aerosolization of MNP.MethodsBulk polyamide powder (i.e., nylon) served as a representative MNP. Polyamide aerosolization was characterized using particle sizers, cascade impactors, and aerosol samplers. Multiple-Path Particle Dosimetry (MPPD) modeling was used to evaluate pulmonary deposition of MNPs. Pulmonary inflammation was assessed by bronchoalveolar lavage (BAL) cell content and H&E-stained tissue sections. Mean arterial pressure (MAP), wire myography of the aorta and uterine artery, and pressure myography of the radial artery was used to assess cardiovascular function. Systemic inflammation and endocrine disruption were quantified by measurement of proinflammatory cytokines and reproductive hormones.ResultsOur aerosolization exposure platform was found to generate particles within the micro- and nano-size ranges (thereby constituting MNPs). Inhaled particles were predicted to deposit in all regions of the lung; no overt pulmonary inflammation was observed. Conversely, increased blood pressure and impaired dilation in the uterine vasculature was noted while aortic vascular reactivity was unaffected. Inhalation of MNPs resulted in systemic inflammation as measured by increased plasma levels of IL-6. Decreased levels of 17β-estradiol were also observed suggesting that MNPs have endocrine disrupting activity.ConclusionsThese data demonstrate aerosolization of MNPs in our inhalation exposure platform. Inhaled MNP aerosols were found to alter inflammatory, cardiovascular, and endocrine activity. These novel findings will contribute to a better understanding of inhaled plastic particle toxicity.

A novel Nanocellulose-Gelatin-AS-IV external stent resists EndMT by activating autophagy to prevent restenosis of grafts.

Vein grafts are widely used for coronary artery bypass grafting and hemodialysis access, but restenosis remains the "Achilles' heel" of these treatments. An extravascular stent is one wrapped around the vein graft and provides mechanical strength; it can buffer high arterial pressure and secondary vascular dilation of the vein to prevent restenosis. In this study, we developed a novel Nanocellulose-gelatin hydrogel, loaded with the drug Astragaloside IV (AS-IV) as an extravascular scaffold to investigate its ability to reduce restenosis. We found that the excellent physical and chemical properties of the drug AS-IV loaded Nanocellulose-gelatin hydrogel external stent limit graft vein expansion and make the stent biocompatible. We also found it can prevent restenosis by resisting endothelial-to-mesenchymal transition (EndMT) in vitro. It does so by activating autophagy, and AS-IV can enhance this effect both in vivo and in vitro. This study has added to existing research on the mechanism of extravascular stents in preventing restenosis of grafted veins. Furthermore, we have developed a novel extravascular stent for the prevention and treatment of restenosis. This will help optimize the clinical treatment plan of external stents and improve the prognosis in patients with vein grafts.

Cardiac structure and function in resistant hypertension: The beneficial role of blood pressure control.

Cardiac structure and function in resistant hypertension: The beneficial role of blood pressure control.

Factors associated with the efficacy and safety of endoscopic dilatation of symptomatic strictures in Crohn’s disease: a retrospective cohort study

Objective Endoscopic balloon dilatation (EBD) is a standard treatment for intestinal strictures in Crohn’s disease (CD). No evidence-based guidelines exist regarding the balloon diameter or the balloon pressure to be used, with recent studies suggesting the use of a smaller diameter than classically used. We sought to analyze the factors associated with safety and efficacy of EBD in CD strictures, particularly looking at balloon diameter and dilatation pressure. Methods We conducted a monocentric retrospective study of patients who underwent EBD between 2005 and 2020. Results Our endoscopy department performed EBD in 94 CD patients during the considered period. The mean size of balloon dilatation was 16 mm (±2.5; including 21 patients with balloon <14 mm) and the mean dilatation pressure was 5.3 atm (±1.5). No perforation was observed. Over a median follow-up of 5.6 years, the probability of being operated was 5.4% at 1 year and 10.4% at 3 years. Smaller height (HR = 0.90, p = 0.022) and a higher BMI (HR = 1.23, p = 0.014) were associated with the risk of operation. The probability of being operated or redilated was 30.1% at 1 year and 52.5% at 3 years. No factor was significantly associated with this risk. The size of the balloon had no impact on outcomes. Conclusion In this retrospective cohort, including a significant proportion of CD patients dilated with balloon <14 mm, no perforation was observed and the size of the balloon or the dilatation pressure had no impact on the risk of surgery or redilatation.

Abstract 14468: Which Measure of Right Ventricle Assessment Should Be Used in COVID19 to Predict In-Hospital Mortality?

Introduction: Right ventricle failure is one of the features of severe COVID19 which is associated with poor outcomes. Measurement of failing right ventricle (RV) is difficult, and the few measures that have been used to study RV include tricuspid annular plane systolic excursion (TAPSE), right ventricle systolic pressure (RVSP) and RV dilation. There is limited data with regards to which of these parameters should be used to predict mortality in COVID19. Hypothesis: low TAPSE, high RVSP, and higher dilation are associated with higher in-hospital mortality. Methods: We performed a retrospective chart review of patient hospitalized with COVID-19 infection and underwent echocardiography (ECHO) within the Northeast Georgia Health System from March 2020 to December 2021. The primary outcome was in hospital mortality. RV dilation was classified as none, mild, moderate, and severe. TAPSE and RVSP were used as continuous variable in univariate analysis. We used multivariable cox regression model and adjusted for demographical characteristics and underlying co-morbidities, along with the three RV failure parameters. We used interaction terms between the parameters to identify which parameter correlated with mortality. For interaction, we classified TAPSE into 4 group - &lt;1.2; 1.2 to 1.5; 1.5-1.8 and &gt;1.8. Results: In total 7939 patients were identified with COVID-19 infection and of these, 3,109 underwent ECHO. Of these 56% were males and mean age was 65.6 years (SD 15.1 years). In hospital mortality was 25.9%. On univariate analysis, TAPSE (HR 0.71, 95%CI 0.61-0.84), RV dilation (HR 1.11, 95%CI 1.04-1.19) were strongly associated while RVSP (HR 1.01, 95%CI 1.00-1.01) was poorly associated with in-hospital mortality. On multivariable cox regression model with interaction, TAPSE &lt; 1.2 along with moderate to severe RV dilation was associated with in hospital mortality (HR 1.88, 95%CI 1.25-2.8, p=0.002). Dilated RV was still associated with in-hospital mortality even when TAPSE was higher than 1.2 (HR 1.56, 95%CI 1.01-2.4, p=0.04). Conclusions: Moderate to severe Dilation of RV and TAPSE &lt; 1.2 were strongly associated with an increase in mortality. Moderate to severe dilation of RV was also associated with increased mortality with TAPSE between 1.2 to 1.8.

Hysteroscopic management of a "hernia-like" uterine myoma within the uterine cavity

To introduce a case of a uterus "hernia-like" myoma within the uterine cavity that was successfully treated with hysteroscopy. Step-by-step explanation of the case and surgical procedure using a video and slides. The Medical Ethics Committee of Women and Children's Hospital of Chongqing Medical University approved the study and decided for this video to be exempt from formal approval, and informed consent was obtained from the patient. Hospital. A 37-year-old woman, gravida 1, para 1, with a history of secondary infertility for 2 years and heavy menstrual bleeding for 7 months, which eventually resulted in anemia, was diagnosed with a type 1 (International Federation of Gynecology and Obstetrics leiomyoma subclassification system) myoma approximately 4 cm in diameter using ultrasonography. Her hemoglobin level was 8.6 g/dL (11.5-15.0 g/dL), red blood cell count was 3.6 ×10-12/L (3.8-5.1 ×10-12/L), and hematocrit was 26.7% (35%-45%). Hysteroscopic myomectomy with bipolar resectoscope and transabdominal ultrasound guidance was used to resect the hernia-like myoma. Blunt dissection combined with oxytocin (20 U I.V.) and uterine dilation pressure reduction was used to induce the hernial content (myoma) protrusion into the uterine cavity. The hernia-like myoma was completely resected by hysteroscopy, and all symptoms disappeared. The hernia-like myoma was successfully and completely resected by hysteroscopy. The operative time was 37 minutes. No surgical-related or anesthesia-related complications occurred. During the follow-up period, the patient had regular menstrual cycles without hypermenorrhea, and her anemia had improved. The 5-month follow-up ultrasound examination and hysteroscopy revealed that the uterine cavity had recovered well. The patient conceived 7 months after the procedure and delivered at term (39 weeks 1 day) via cesarean section. A hernia-like myoma covered with endometrium is a degenerative myoma that herniates into the myometrium and forms a hernia sac-like defect. Hysteroscopy is an effective and feasible method for treating hernia-like myoma.

Adhesive Capsulitis of the Hip: A Case Presentation and Review.

There remains a paucity of literature addressing adhesive capsulitis of the hip (ACH), making the diagnosis and treatment a continued challenge for healthcare providers. ACH encompasses restricted hip range-of-motion and pain that progresses through analogous Stages (1-4) to adhesive capsulitis of the shoulder. We report a case presentation of a middle-aged man that illustrates the significance of certain patient factors and provide a review of current literature to aid in the diagnostic evaluation and treatment for addressing ACH. Initial conservative treatment of ACH includes the appropriate management of associated comorbidities, oral and/or injectable pharmacologics, and physical therapy. While frequently resolving with time, refractory cases of ACH may require more aggressive approaches including pressure dilation, manipulation under anesthesia, synovectomy, capsular release and, for select patients, total hip arthroplasty. Given the limited available literature addressing ACH, healthcare providers may be forced to rely on a small number of published case reports and outdated review articles to guide their diagnostic evaluation and treatment approaches. Thus, this case presentation and review provides an updated approach to better diagnose and manage patients with ACH.

Apelin is expressed throughout the human kidney, is elevated in chronic kidney disease & associates independently with decline in kidney function.

Chronic kidney disease (CKD) is common and cardiovascular disease (CVD) is its commonest complication. The apelin system is a potential therapeutic target for CVD but data relating to apelin in CKD are limited. We examined expression of the apelin system in human kidney, and investigated apelin and Elabela/Toddler (ELA), the endogenous ligands for the apelin receptor, in patients with CKD. Using autoradiography, immunohistochemistry and enzyme-linked immunosorbent assay, we assessed expression of apelin, ELA and the apelin receptor in healthy human kidney, and measured plasma apelin and ELA in 155 subjects (128 patients with CKD, 27 matched controls) followed up for 5years. Cardiovascular assessments included blood pressure, arterial stiffness (pulse wave velocity) and brachial artery flow-mediated dilation. Surrogate markers of endothelial function (plasma asymmetric dimethylarginine and endothelin-1) and inflammation (C-reactive protein and interleukin-6) were measured. The apelin system was expressed in healthy human kidney, throughout the nephron. Plasma apelin concentrations were 60% higher in women than men (6.48 [3.62-9.89] vs. 3.95 [2.02-5.85] pg/mL; P< .0001), and increased as glomerular filtration rate declined (R= -0.41, P< .0001), and albuminuria rose (R= 0.52, P< .0001). Plasma apelin and ELA were associated with vascular dysfunction. Plasma apelin associated independently with a 50% decline in glomerular filtration rate at 5years. We show for the first time that the apelin system is expressed in healthy human kidney. Plasma apelin is elevated in CKD and may be a potential biomarker of risk of decline in kidney function. Clinical studies exploring the therapeutic potential of apelin agonism in CKD are warranted.

Sex-Related Differences in Oxidative, Platelet, and Vascular Function in Chronic Users of Heat-not-Burn vs. Traditional Combustion Cigarettes.

Smoking is still a major cardiovascular risk factor, despite many public awareness campaigns and dedicated interventions. Recently, modified risk products (MRP), e.g., heat-not-burn cigarettes (HNBCs), have been introduced as surrogates of traditional combustion cigarettes (TCCs). Although these products are promoted as healthier than TCCs, few studies have been conducted to assess it. This work is a sex-focused sub-study of a prospective observational study in which apparently healthy chronic TCC smokers were age-matched with regular HNBC users. Blood samples were collected for biochemical assays and blood pressure and flow-mediated dilation (FMD) were measured. Out of 60 subjects, 33 (55%) were women, and 27 (45%) men, with 11 (33%) vs. 9 (33%) non-smokers, respectively, 10 (30%) vs. 10 (37%) TCC smokers, and 12 (36%) vs. 8 (30%) HNBC smokers (p = 0.946). Bivariate and multivariable analyses showed no statistically significant between-sex differences in NO, H2O2, sCD40L, sNox2-dp, sP-selectin, platelet aggregation, cotinine or FMD, overall, in non-smokers, in TCC smokers, or in HNBC smokers (all p > 0.05). HNBCs appeared safer than TCCs when focusing on Nox2-dp (p = 0.026) and sP-selectin (p = 0.050) but had similar levels of the other measured markers. In conclusion, HNBCs have similar detrimental effects on women and men’s oxidative stress (H2O2: p = 0.49; sNox2-dp: p = 0.31) and platelet activation (sP-selectin: p = 0.33; platelet aggregation p = 0.87).

Atypical presentation of pulmonary embolism and deep vein thrombosis due to protein S deficiency in a young female with chest pain

Venous thromboembolism has many risk factors including protein S deficiency, which poses a significant diagnostic challenge as it presents with atypical complaints. A treatable yet potentially fatal condition, acute pulmonary embolism, is currently third most common cause of cardiovascular death. Clinicians should include pulmonary embolism as differential diagnosis in young adults with atypical symptoms with 2 D ECHO findings of the dilated right atrium, right ventricle, and elevated pulmonary artery pressure, and diagnosis is confirmed by computed tomography pulmonary angiography (CTPA). Anticoagulants including NOACs should be initiated promptly to improve the outcome for patients.

Association of Circulating Cathepsin B Levels With Blood Pressure and Aortic Dilation.

Hypertension is a key risk factor for spontaneous coronary artery dissection (SCAD) and aortic dilation. Circulating proteins play key roles in a range of biological processes and represent a major source of druggable targets. The aim of this study was to identify circulating proteins that were associated with blood pressure (BP), SCAD and aortic dilation. We identified shared genetic variants of BP and SCAD in genome-wide association studies, searched for circulating protein affected by these variants and examined the association of circulating protein levels with BP, aortic aneurysm and dissection (AAD) and aortic diameters by integrating data from circulating protein quantitative trait loci (pQTL) studies and genome wide association study (GWAS) in individuals from the UK Biobank using two-sample Mendelian randomization analysis methods. Single nucleotide polymorphisms (SNPs) in JAG1, ERI1, ULK4, THSD4, CMIP, COL4A2, FBN1, FAM76B, FGGY, NUS1, and HNF4G, which were related to extracellular matrix components, were associated with both BP and SCAD. We found 49 significant pQTL signals among these SNPs. The regulated proteins were encoded by MMP10, IL6R, FIGF, MMP1, CTSB, IGHG1, DSG2, TTC17, RETN, POMC, SCARF2, RELT, and GALNT16, which were enriched in biological processes such as collagen metabolic process and multicellular organism metabolic process. Causal associations between BP and AAD and aortic diameters were detected. Significant associations between circulating levels of cathepsin B, a well-known prorenin processing enzyme, and BP and aortic diameters were identified by using several Mendelian randomization analysis methods and were validated by independent data.ConclusionThe present study identified the association between circulating cathepsin B and BP and aortic diameters. The findings indicated that BP-associated genetic variants may influence aortic dilation risk by circulating proteins that regulate BP.