Distal Pressure Research Articles

Renal pressure-flow relationship and renin activation in a porcine model comparing unilateral and bilateral renal artery stenosis.

Because renal artery stenosis (RAS) often presents bilateral, we sought to investigate the renal pressure-flow relationship and its relation to renin release, in the presence of a contralateral significant stenosis. A porcine model of graded unilateral RAS in the presence of a significant contralateral stenosis was created. The severity of the stenosis was expressed as the ratio between distal renal pressure (Pd) and aortic pressure (Pa). Pd and renal flow velocity were continuously measured using a combined pressure-flow wire (Combowire®). Hemodynamic measurements and blood sampling for renin, angiotensin, and aldosterone were performed in baseline conditions and during progressive balloon inflation in the renal artery leading to stepwise 5% Pd decrements. Resistive index (RI) was computed as (1-(End Diastolic V/Maximum Peak Systolic V))*100. A decrease of average peak flow velocity (APV) was observed when distal renal perfusion pressure decreased by 25% and was associated with activation of renin secretion. The RI decreased already for minimal changes in Pd/Pa ratio. In an animal model of unilateral graded RAS in the presence of a significant contralateral stenosis, a 25% decrease in perfusion pressure results in a significant decrease in distal renal flow, causing a more pronounced upregulation of renin secretion when compared to a model of graded unilateral RAS without contralateral significant RAS.

Abstract 4120749: GPR39 Orchestrates the Myogenic Response in Coronary Autoregulation

Background: Coronary autoregulation is the ability of a normal heart to maintain constant coronary blood flow (CBF) over a wide range of coronary driving pressures (CDPs) provided cardiac work remains constant. It is based on the myogenic response, the molecular mechanism of which is unknown. We recently described the presence of a G-protein coupled receptor (GPR39) in the vascular smooth muscle cells (VSMCs) of coronary arterioles in the mouse heart. We showed that endogenous eicosanoids, the vasoconstrictor 15-hydroxyeicosatetraenoic acid (15-HETE) and the vasodilator 14,15-epoxyeicosatrienoic acid (14,15 EET). act through this receptor to maintain coronary vascular tone. Hypothesis: We, therefore, hypothesized that GPR39 is the molecular switch responsible for the coronary myogenic response and autoregulation. Methods: We studied 6 anesthetized dogs at baseline and after administration of VC-108, a specific, potent GPR39 antagonist. Both during baseline and drug administration multiple coronary stenoses were created on the left anterior descending coronary artery (LAD). At each stage, heart rate, mean aortic pressure, distal LAD pressure, and right atrial pressure (RAP) were measured, as was CBF. Stenosis severity was defined by the CDP (LAD pressure minus RAP). Results: Mean basal coronary hyperemic response was 3.0 in all anesthetized animals indicating normal vasomotor function. Systemic hemodynamics did not differ between baseline and drug stages. Figure 1 is an example from a single dog where, at baseline, CBF remained constant over a CDP of 40-90 mm Hg indicating intact autoregulation. As expected, CBF declined when CDP fell below the autoregulatory range. After VC-108 administration CBF correlated linearly with CDP, indicating abolishment of the myogenic response. Baseline CDP vs. CBF data from all 6 animals within the autoregulatory range is depicted in Figure 2. No relation is noted between the two indicating intact autoregulation. In contrast, CDP vs. CBF relation is linear in all animals after VC108 is administered over the entire range of CDP’s measured, indicating abolishment of autoregulation (Figure 3). Conclusions: Our results indicate that GPR39 is a potential molecular switch for the regulation of the myogenic response underlying coronary autoregulation. Pharmacological blockage of GPR39 abolishes the myogenic tone. These novel findings set the stage for development of novel pharmacological agents for treatment of coronary artery disease.

Comparison of Nitroglycerin-Induced Pressure Ratio Drop and Resting Full-Cycle Ratio in a Pressure Wire Study.

Background/Objectives: The acute drop in distal coronary pressure (Pd)-to-aortic pressure (Pa) ratio after intracoronary nitroglycerin (NTG-Pd/Pa) administration is an acceptable estimate of fractional flow reserve (FFR). We aimed to compare the diagnostic performance of NTG-Pd/Pa with that of the resting full-cycle ratio (RFR) in predicting the binary results of FFR. Methods: This study included two prospective studies registered under the numbers NCT04700397 and NCT03693157. Altogether, 202 vessels were included. The optimal cutoff of NTG-Pd/Pa for predicting FFR ≤ 0.8 was identified and validated in another prospective registry. We used the McNemar's test and the DeLong method to compare the diagnostic efficiency of NTG-Pd/Pa vs. RFR in predicting FFR ≤ 0.8 in a pooled cohort. Results: NTG-Pd/Pa was strongly correlated with FFR (r = 0.945, p < 0.001). The NTG-Pd/Pa cutoff for predicting FFR ≤ 0.8 was 0.85 in both the derivation and validation cohorts. The area under the receiver-operating characteristic curve (AUC) and accuracy in predicting FFR ≤ 0.8 were higher for NTG-Pd/Pa than for RFR in the pooled cohort (AUC 0.97 vs. 0.91, p < 0.001; accuracy 91% vs. 84%, p < 0.001). The sensitivity and negative predictive values were also higher for NTG-Pd/Pa than for RFR (all p < 0.05). The specificity and positive predictive value were numerically higher for NTG-Pd/Pa than for RFR (all p > 0.05). Conclusions: The diagnostic performance of NTG-Pd/Pa may surpass that of the RFR in predicting the binary results of the FFR.

Invasive quantitative assessment of coronary microvascular dysfunction in patients with hypertrophic cardiomyopathy

Abstract Background Patients (P) with hypertrophic cardiomyopathy (HCM) commonly suffer from coronary microvascular dysfunction (CMD) - the affection of function/structure of the coronary microvasculature. Invasive assessment of CMD through thermodilution methods allows for the calculation of coronary flow reserve (CFR) and index of microvascular resistance (IMR). These methods, while extensively studied in the context of non-obstructive coronary artery disease and myocardial infarction, have not been thoroughly validated in HCM P. Objectives To invasively assess the presence of CMD in P with HCM and to determine clinical predictors of invasively assessed CMD. Methods In a prospective single-centre study, we opportunistically recruited consecutive adult P with an established diagnosis of HCM with or without LVOTO that had an indication to pursue elective coronarography – such as pre-procedural evaluation for alcoholic septal ablation (ASA) or exclusion of epicardial coronary artery disease. P characteristics and coronary hemodynamic invasive assessment data were extracted. CFR was calculated as the ratio between resting and hyperemia mean transit times (TmnRest;TmnHyper). IMR was calculated as the ratio between distal coronary pressure (Pd) and the inverse of TmnHyper (IMR=Pd/TmnHyper-1). A cutoff of ≤22.0 in IMR, an ≥d 2 in CFR was used. We excluded P with end-stage HCM (LV EF &amp;lt;50% and/or or left ventricular wall thinning), or with epicardial coronary artery disease. Continuous variables were reported as mean ± SD or median and IQR depending on data distribution pattern and categorical data as frequencies and percentages. A linear regression model was used to test predictors of IMR and CFR involvement. Results 25 HCM P with a mean age of 63±10 years were included, 14 (56%) were female. In 20 (80%) of the P the cause for coronary angiography was ASA. All P referred for ASA had LVOTO and were on beta-blocker therapy (Table 1.). Median CFR was 2.5 [1.5-3] and median IMR was 19 [14-22], both within normal range. A total of 13 (44%) P had a reduced CFR and 5 (20%) of P had an increased IMR. 14 P (56%) had an altered CFR or IMR value, with the presence of a functional CMD phenotype in 10 P (40%) (Table 2). Angina was associated with a higher IMR (5.3, 95% CI - 0.05-10, p=0.053) and for each +1 increase in CCS a larger increase in the likelihood of a higher IMR was observed (CCS 1, +7 (95%CI 0.68 – 14); CCS 2, +9 (95%CI 4 – 14); CCS 3, 10 (95%CI 2 – 18)). A similar but non significant trend was observed for higher CCS correlating with lower CFR (Table 3). Conclusion In a prospective cohort of HCM P submited to invasive angiographic evaluation 56% had at least one invasive measure compatible with CMD. Angina, and a higher degree of anginal symptoms correlated positively with the presence of higher IMR and therefore with a higher level of CMD. In the future, we intend to correlate these findings with multimodality imaging/clinical outcomes.Patient characteristics and LR results

The impact of hydrostatic pressure on fractional flow reserve in saphenous vein grafts

Abstract Background Intracoronary physiological measurements can be subject to the influence of hydrostatic pressure. Saphenous vein grafts (SVGs) diverge in origin and trajectory from native coronary arteries, which may increase the susceptibility of fractional flow reserve (FFR) measurements to be impacted by the hydrostatic pressures. The precise impact of SVG anatomy on physiological pressure indices remains unknown at present. Purpose We sought to study the impact of SVG anatomy on FFR. Methods Included were symptomatic patients with prior coronary artery bypass grafting and at least one non-occluded SVG, who underwent coronary computed tomography angiography (CCTA) preceding invasive coronary angiography. SVG course and height excursion were reconstructed based on the CCTA images. Similarly to native coronary arteries, the impact of hydrostatic pressure on FFR was calculated by adding 0.077 mmHg to the distal coronary pressure for every millimeter height difference in a supine position between the SVG ostium and the position of the pressure wire tip. Results In total, 74 patients (mean age 71 ± 7 years; 85% male) with 87 SVGs were included. A total of 76 SVGs underwent interrogation by FFR. The height difference between SVG ostium and pressure wire tip position was largest for single SVGs to the circumflex artery (Cx; - 55.1 ± 17.0 mm), followed by sequential SVGs to the Cx (- 53.1 ± 17.7 mm) and to the right coronary artery (RCA; - 36.7 ± 21.6 mm). Corrected FFR was significantly lower as compared to uncorrected FFR in single SVGs to the Cx (0.85 ± 0.17 vs. 0.90 ± 0.18), and sequential SVGs to the Cx (0.92 ± 0.14 vs. 0.96 ± 0.15) and the RCA (0.82 ± 0.20 vs. 0.85 ± 0.21) (P&amp;lt;0.001 for all). Conclusions Hydrostatic pressure related to the course anatomy of SVGs notably affects FFR values, resulting in an overestimation of FFR in SVGs to the Cx and sequential SVGs to the RCA. In these SVGs, FFR values near the cutoff value should be interpreted cautiously.

Comparison of fully angiography-derived versus a hybrid of angiography and pressure-wire-derived approach to assess coronary microvascular resistance: the OxAMI-Hybrid study

Abstract Background Despite growing evidence of its clinical implications, assessment of coronary microvascular dysfunction (CMD) remains limited in routine clinical practice. Hence, there is an increasing interest in angiography-derived indices to encourage assessment of CMD in the cardiac catheterisation laboratory. We investigate here a novel approach, IMRhybrid, using a combination of pressure-wire-based assessment of distal coronary pressure (Pd) and an angiography-derived surrogate of coronary flow. Methods Patients were enrolled to the OxAMI-Hybrid study. The accuracy of IMRhybrid was assessed in diagnosing CMD using fully pressure wire and bolus thermodilution Index of Microcirculatory Resistance (IMR) as a reference. The accuracy of IMRhybrid was then compared against a fully angiography-derived index of microvascular resistance (IMRangio). Based on previous work, angiography-derived IMR, IMRangio, was calculated as IMRangio = Quantitative Flow Ratio (QFR) ado x Pahyperaemia x TIMI Frame Count (TFC) hyperaemia / Frame Rate. Conversely, IMRhybrid was expressed as IMRhybrid = Pdhyperaemia x TFChyperaemia / Frame Rate, where frame rate was fixed at 15 frame per second for both indices. In both cases, TFC/frame rate represented angiography-derived mean transit time, mTt in hyperaemia. Results 60 patients were enrolled prospectively, of which 28 with acute coronary syndrome and 32 with stable coronary artery disease. A total of 66 vessel analyses were performed. Both IMRhybrid and IMRangio correlated with IMR (rho=0.51, p &amp;lt;0.001 and rho=0.51, p &amp;lt;0.001 respectively) and showed good and comparable overall diagnostic accuracy in predicting IMR ≥ 25 (83.3% and 75.4% respectively) with a receiver operator curve (ROC) analyses showing an AUC of 0.82 and 0.81 respectively (p for comparison= 0.97). Conclusion Both approaches, IMRhybrid and IMRangio provide viable and comparable methods of assessing CMD which correlate with bolus thermodilution-based IMR, retaining good diagnostic accuracy. IMRhybrid is a simple alternative to conventional bolus thermodilution-based IMR, offering the advantage of being suitable with any pressure wire system.A: IMR, B: QFR, C: TFCA+C: IMRhybrid, B+D: IMRangio

Combining fractional flow reserve and the index of microcirculatory resistance for prognosis prediction in renal artery stenosis interventions: a feasibility sub-study of FAIR-pilot trial

Abstract Background Interventional therapies for renal artery stenosis (RAS) was debatable in previous randomized trials. Fractional flow reserve (FFR), while useful in coronary interventions, does not assess microcirculatory status, which may be critical in RAS. The index of microcirculatory resistance (IMR) provides additional microvascular information, which has not been used in RAS patients. Purpose To investigate the feasibility of IMR measurement in RAS patients and the association with the outcome. Methods FAIR-pilot study is a multicenter pilot randomized controlled trial exploring the application of FFR to guide the renal artery stenting in patients with renovascular hypertension (NCT05732077). A pressure-temperature sensor guidewire was used to measure the IMR. To derive mean transit time at rest, thermodilution curves were obtained by 3 injections of 4 mL of room temperature saline down the renal artery. Hyperemia was induced using dopamine 50μg/kg bolus to the renal artery. The IMR was calculated as distal arterial pressure (Pd) x mean transit time during hyperemia (TmnH) (Figure 1). Prognostic evaluation was based on improvements in postoperative blood pressure, which was assessed using both ambulatory blood pressure monitor (ABPM) and anti-hypertensive medication number, along with renal function, as determined by the estimated glomerular filtration rate (eGFR). Results The IMR was measured among five patients enrolled in FAIR-pilot study. As shown in Table 1 and 2, stent implantation was conducted on five lesions across patients 1 to 4 based on renal FFR &amp;lt; 0.8, with each experiencing varying degrees of improved blood pressure control subsequently. Patient 5 did not receive a stent and was lost to follow-up. At three-month, the recorded decrease in systolic blood pressure ranged from a maximum of 34 mmHg to a minimum decrease of -6 mmHg among the four patients. The antihypertensive medication number showed a maximum reduction of 2 and no change as the minimum. We observed a correlation between baseline IMR and baseline renal function. No significant change in IMR was noted after interventional procedures. Preliminary findings suggest that IMR measurement is feasible in patients with RAS, while the ∆T (temperature change time) was very small, which potentially increasing the measurement bias. Conclusion The study suggests measuring IMR in patients with RAS is feasible and can offer information into the renal microvasculature. However, the small ∆T encountered during measurement may introduce increased bias, which should be considered when interpreting results.

The interplay between coronary microvascular resistance, arterial reservoir function and coronary flow reserve: unravelling the significance of high microvascular resistance

Abstract Background Beyond the observation that patients with low CFR indicating presence of coronary microvascular dysfunction (CMD) have an unfavourable prognosis compared to patients with preserved CFR, recent large multicentre trials [1-2] have shown that increased minimal hyperaemic microvascular resistance (HMR or IMR) ,neither on top of the low CFR nor alone, does not play a role as a prognostic factor for ischemia in nonobstructive coronary artery disease (INOCA) patients. Purpose This study investigates the pathophysiological interactive processes in CMD and no-CMD groups with high and low HMR taking into account potential adaptive mechanisms that alter arterial reservoir function [3] associated with microvascular resistance and systemic vasomotor response in INOCA patients. Methods Analysis was conducted on 312 unique unobstructed vessels (FFR&amp;gt;0.80) from 258 patients (73% male) enrolled in the DEFINE-FLOW [4] study. CFR and HMR were quantified using intracoronary Doppler and pressure measurements. Vessels were categorized into four groups based on high and low CFR and HMR using the best available cut-off values (2.5 for both). Arterial reservoir capacity (ARC) and related parameters [3] were quantified using reservoir-excess pressure (Preservoir and Pexcess) analysis of averaged aortic and distal coronary pressure waveforms in CMD (CFR&amp;lt;2.5) and no-CMD (CFR≥2.5) subgroups. (Figure 1-2) Results Compared to vessels without CMD, functional and structural CMD have increased Pexcess (p:0.007) and a rapid decline in diastolic pressure (DRCcoronary p&amp;lt;0.001, DRCaortic, p&amp;lt;0.05), indicating the ongoing systemic hemodynamic superfluous state despite locally suppressed resting blood flow in the structural CMD. Higher baseline microvascular resistance (BMR) was associated with increased reservoir pressure (r:0.302, p&amp;lt;0.001). The vessels with preserved CFR despite high HMR are characterised by uniquely increased ARC (p:0.014), effectively diminished Pexcess (p:0.010), which parallels the local (highest BMR p&amp;lt;0.001) and global (lowest DRCaortic, p&amp;lt;0.05) vasomotor response, that normalizes the systemic and local hyperperfusion, and ultimately regains an adequate flow reserve (CFR) (p&amp;lt;0.001). The high HMR in this group was mainly due to increased resting tonus unlike structural CMD, evident by the highest RRR (BMR/HMR).(p&amp;lt;0.001) (Figure 1-2) Conclusion(s) The high HMR despite preserved CFR vessels form a unique-adaptive group, characterised by substantially increased arterial reservoir capacity and effectively diminished Pexcess, by means of an adaptive vasomotor response which manifests locally in the coronary bed as pronouncedly augmented BMR &amp; RRR, and globally as reduced DRC in the aortic pressure waveform. This adaptive myogenic response normalising resting flow and ongoing systemic and local hyperperfusion ultimately regains an adequate flow reserve (CFR).Figure 1.Methods and Main FindingsFigure 2.Visual Abstract

Anti-nociceptive effect of STW 5-II in rodent models of stress and post-inflammatory visceral hypersensitivity

AimsVisceral hypersensitivity is a therapy-resistant hallmark of irritable bowel syndrome (IBS). Many IBS patients’ symptoms develop following an acute colitis, and most report that stress worsens symptoms. STW 5-II, a combination of six herbal extracts, is a clinically proven treatment for IBS, but the mechanism is uncertain. Here, we employ two well-characterized rodent models to test the hypothesis that STW 5-II attenuates chronic colonic hypersensitivity. Main methodsSeparate cohorts of male rats were used for each model of colonic hypersensitivity. The first model used repeated water avoidance stress (1hr/day for 10 days), while the second model used intracolonic trinitrobenzene sulfonic acid to induce a short-lived colitis followed by post-inflammatory visceral hypersensitivity. Both models used sham treatment controls. Colonic sensitivity was quantified as the number of abdominal contractions to graded pressures (20–60 mmHg) of isobaric colorectal distension (CRD). Phosphorylation of extracellular signal-regulated kinase (pERK) was assessed via immunohistochemistry in the brain, spinal cord, and dorsal root ganglion (DRG). STW 5-II (10 ml/kg, p.o.) or vehicle (p.o.) was administered for 7 days, prior to CRD and pERK expression. Key findingsRats exposed to either model developed significant colonic hypersensitivity. Both models enhanced CRD-evoked pERK in DRGs, spinal cord, and brain. STW 5-II decreased colonic hypersensitivity and reduced CRD-evoked brain, spinal, and DRG pERK. SignificanceBoth models induced colonic hypersensitivity and enhanced pERK expression. STW 5-II inhibited colonic hypersensitivity and decreased noxious neuronal activation in both models, which could explain its clinically proven efficacy in relieving visceral hypersensitivity-related symptoms in IBS.

Research on The Status Quo And Problems of Mental Health of Sexual Minorities in China

In recent years, with the development of the Internet, the originally marginalized sexual minorities have appeared more and more frequently in the public field of vision, but due to the existence of proximal pressure and distal pressure, the psychological problems of sexual minorities still cannot be ignored. In order to better understand the living situation and mental health level of sexual minorities, reduce public opinion and disputes caused by gender knowledge errors, through literature collection, case interview, questionnaire survey, spss statistical analysis and other research methods, we integrated the definition, status and type of sexual minorities, stressors, social support status, mental health status and influence. The results show that the stressors faced by sexual minorities can reduce their perception of social support and thus reduce their mental health level. Therefore, increasing social support for sexual minorities can improve their mental health level. Finally, through the form of innovative programs to let more people pay attention to and understand this marginalized group, and strive to eliminate the public's cognitive bias towards sexual minorities.

Aortic versus distal pressure for derivation of hyperaemic microvascular resistance: From the ILIAS registry

BackgroundIn patients with angina and non-obstructive coronary arteries (ANOCA), intracoronary function testing typically involves assessing the minimal microvascular resistance. This can be derived from the coronary flow and the distal pressure (Pd) during maximal hyperaemia. Theoretically, in ANOCA patients, resistance and pressure have minimal impact along the epicardial vessel, suggesting the possibility of deriving hyperaemic microvascular resistance (HMR) using aortic pressure (Pa) instead of Pd, but this has not been studied previously. Methods and resultsData from the ILIAS registry, a global multicentre registry pooling lesion-level coronary pressure and flow data, were used to compare HMR calculated with Pa versus Pd. A total of N = 1321 evaluated vessels were included. The study population consisted predominantly of men (68 %) with a mean age of 62 ± 10 years, and stable anginal symptoms (93 %). The overall correlation between HMR calculated with Pa and with Pd was good (Pearson's correlation coefficient: 0.84, p ≤0.005). The Bland-Altman plot showed a mean difference between HMR based on Pa and Pd of 0.53 (limits of agreements ±1.35). An adjusted Bland-Altman showed that the difference between HMR based on Pa and Pd was significantly related to the functional severity of the epicardial lesion (R2 = 0.71, coef.: −4.5, p < 0.005). In patients with a FFR >0.80 there were no considerable outliers, and with a FFR <0.80 outliers increased significantly. ConclusionsIn ANOCA patients, defined by a FFR above 0.80, HMR can be accurately measured with aortic pressure instead of distal pressure. However, in patients with a FFR below 0.80, there is a significant difference between HMR measured with Pa and Pd.

Hemodynamic surgery of varicose veins of the lower extremities with the introduction of modern technologies

Minimaly invasive and pathogenetically based methods are currently prevalent in phlebology, as they are in other fields of surgery. CHIVA (Сure conservatrice et hemodynamiу que de l’insuffisance veineuse en ambulatoire) hemodynamic surgery is one of these popular minimally invasive surgical procedures. The execution technique relies on the findings of a duplex ultrasound scan that is used to analyse the hemodynamics of the superficial venous network. The CHIVA strategy aims to preserve the venous material while also restoring normal distal venous pressure and venous function. However, this technique has a number of disadvantages, including the possibility of vein recanalisation and relapses, as well as the fact that the immediate cosmetic outcome is not always satisfactory. Objective — to compare the outcomes of lower extremity varicose vein treatment based on the employed method: the CHIVA method executed via open surgery versus the CHIVA method combined with other minimally invasive methods (sclerotherapy, endovenous laser coagulation (EVLC)). Materials and methods. A randomised prospective study was conducted on 52 patients with varicose veins of the lower extremities categorised as C1‑C3 according to the CEAR classification. The patients were divided into 2 groups of 26 patients each, with one group undergoing the CHIVA procedure using the classic open technique, and the other group receiving a combination of CHIVA with EVLC and sclerotherapy. To evaluate the results, we used Hobb’s criteria, measured the diameter of the great saphenous vein via ultrasound, analysed alterations in the Venous Clinical Severity Scoring (VCSS) , studied data from the Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ 20), and determined the incidence of relapses. Results. After CHIVA and CHIVA + EVLC + sclerotherapy, the normalisation of hemodynamics and interruption of the venous shunt led to a substantial reduction in the diameter of the great saphenous vein within 6 months after the operation (p&lt;0.01). Both groups had an improvement in VCSS 6 months after surgery. No statistical difference was observed between the treatment groups. All methods had a positive impact on the quality of life of patients, as shown by the CIVIQ 20 questionnaire. Of the 52 operated patients, there were 4 relapses (7.7%). No relapses were noted in the group receiving CHIVA with EVLC and sclerotherapy (p=0.039). As evaluated by Hobb’s criteria, patients exhibited greater satisfaction with the outcomes of hemodynamic surgery combined with EVLC and sclerotherapy due to its better and faster aesthetic outcomes (р=0.012 and 0.05). Conclusions. All 52 patients exhibited favourable treatment outcomes, demonstrating a reduction in CVI symptoms during a comprehensive clinical assessment using ultrasound within 6 months and 1 year. The combination of CHIVA with EVLC and sclerotherapy showed distinct advantages in the treatment of varicose veins, yielding the most favourable cosmetic outcomes according to Hobb’s criteria and achieving a reccurence rate of 0%.

Clinical Symptoms of Patients with Early-Stage and Advanced-Stage Ovarian Cancer

Background: Ovarian cancer is a malignant neoplasm originating from ovarian cells with different histological types depending on the subtype. It can affect women of all ages. Ovarian cancer ranks third in terms of incidence among diagnosed female cancer patients, following breast and cervical cancer. Ovarian cancer often doesn’t present specific/clear symptoms. As a result, only a small number of patients are diagnosed at an early stage (20%). The study aimed to analyze the clinical complaints experienced by ovarian cancer patients, both in early and advanced stages before diagnosis. Methods: This descriptive cross-sectional study analyzes clinical complaints before the diagnosis of early and advanced-stage ovarian cancer patients. The study was conducted in the Gynecology-Oncology inpatient ward at Dr. Soetomo Regional General Hospital in 2021, utilizing medical record data. Results: A total of 98 patients (21 patients with early-stage, and 77 patients with advanced-stage) were analyzed. The majority of the patients are aged 45-58 years (49%), work as homemakers (32.7%), and are married (63.3%). The three most common complaints experienced by subjects with early-stage ovarian cancer were abdominal/pelvic pain (23.8%), abdominal/pelvic pressure (28.6%), and abdominal distension (42.9%), while in patients with advanced-stage ovarian cancer were abdominal/ pelvic pain (32.7%), abdominal distension (42.9%), and abdominal discomfort (bloating, early satiety, feeling of fullness, frequent belching, heartburn, nausea and vomiting) (44.2%). Conclusions: The three most common clinical complaints among patients before being diagnosed with early and advanced-stage ovarian cancer in the inpatient ward of Dr. Soetomo Regional General Hospital Surabaya in 2021 were similar. The recognition of these complaints and several risk factors are expected to assist in the earlier diagnosis of ovarian cancer.

Optimizing distal and proximal splenic artery embolization with patient-specific computational fluid dynamics

Splenic artery embolization (SAE) has become a favored alternative to splenectomy, offering a less invasive intervention for injured spleens while preserving spleen function. However, our understanding of the role that hemodynamics plays during embolization remains limited. In this study, we utilized patient-specific computational fluid dynamics (CFD) simulations to study distal and proximal embolization strategies commonly used in SAE. Detailed 3D computer models were constructed considering the descending aorta, various major visceral arteries, and the iliac arteries. Subsequently, the blood flow and pressure associated with different coil placement locations in proximal embolization were studied considering the collateral vessels. Coil induced variations in pressure fields were quantified and compared to baseline. The coil induced flow stagnation was also quantified with particle residence time. Distal embolization was modeled with Lagrangian particle tracking and the effect of particle size, release location, and timing on embolization outcome was studied. Our findings highlight the crucial role of collateral vessels in maintaining blood supply to the spleen following proximal embolization. It was demonstrated that coil location can affect distal pressure and that strategic coil placement guided by patient-specific CFD simulations can further reduce this pressure as desired. Additionally, the results point to the critical roles that particle size, release timing, and location play in distal embolization. Our study provides an early attempt to use patient-specific computer modeling for optimizing embolization strategies and ultimately improving patient outcomes during SAE procedures.

The effect of hydrostatic pressure on invasive coronary pressure measurements: Comparison with [15O]H2O-positron emission tomography flow data.

Fractional flow reserve (FFR) has emerged as the invasive gold standard for assessing vessel-specific ischemia. However, FFR measurements are influenced by the hydrostatic effect, which might adversely impact the assessment of ischemia. This study aimed to investigate the impact of hydrostatic pressure on FFR measurements by correcting for the height and comparing FFR with [15O]H2O positron emission tomography (PET)-derived relative flow reserve (RFR). The 206 patients were included in this analysis. Patients underwent coronary computed tomography angiography (CCTA), [15O]H2O PET, and invasive coronary angiography with routine FFR in every epicardial artery. Height differences between the aortic guiding catheter and distal pressure sensor were quantified on CCTA images. An FFR ≤ 0.80 was considered significant. The study found a reclassification in 7% of the coronary arteries. Notably, 11% of left anterior descending (LAD) arteries were reclassified from hemodynamically significant to nonsignificant. Conversely, 6% of left circumflex (Cx) arteries were reclassified from nonsignificant to significant. After correcting for the hydrostatic pressure effect, the correlation between FFR and PET-derived RFR increased significantly from r = 0.720 to r = 0.786 (p = 0.009). The average magnitude of correction was +0.05 FFR units in the LAD, -0.03 in the Cx, and -0.02 in the right coronary artery. Hydrostatic pressure has a small but clinically relevant influence on FFR measurements obtained with a pressure wire. Correcting for this hydrostatic error significantly enhances the correlation between FFR and PET-derived RFR.

A histology and immunochemistry study comparing open versus close and open-method endoscopic saphenous vein harvesting.

The introduction of endoscopic saphenous vein harvesting (ESVH) has been reported to reduce wound pain and infection, compared with open saphenous vein harvesting (OSVH) techniques. There are still controversies regarding this technique. The aim of our study is to investigate the endothelial preservation of saphenous vein (SV) grafts harvested by different techniques. Further observations were made for harvesting and closure time, incision length and effect of pressure distension of the veins to the vein endothelium. Prospective observational study of sixty human saphenous vein grafts was performed to evaluate endothelial preservation by haematoxylin-eosin and Cluster of Differentiation 31 (CD 31) staining. Saphenous vein was harvested endoscopically either by closed CO2 (carbon dioxide) ESVH, open CO2 ESVH or OSVH harvesting technique. Demographic data and intra-operative data were collected. Two saphenous vein samples were collected from each patient to compare differences before and after distension of the veins. Both haematoxylin-eosin and immunohistochemistry slides were imaged by a high-resolution slide scanning system. Open CO2 ESVH group showed the highest number of endothelial detachments. Mean scoring of the immunohistochemistry method using the CD31 antibody was much lower in the open CO2 ESVH group (33.25% ± 28.71, P < 0.0003). This represents a more poorly preserved endothelial cells in the Open CO2 ESVH than the closed CO2 ESVH. Closure time and incision lengths were significantly shorter in both ESVH groups compared to the OSVH group. Significant low scores of immunohistochemistry for samples were seen in distended veins (39.0% ± 30.08, p = 0.004). The OSVH in random sample B, which represents the conduit that will be used, had a far better endothelium preservation and less endothelial detachment when compared to ESVH. We observed more endothelial detachment in the open CO2 ESVH group, due to lack of subcutaneous tissue separation, poor visualization and traction stress across the wall of the saphenous vein. The closed CO2 ESVH group had more endothelial cells preserved, but the OSVH group fared the best with the least number of endothelial cell detachment and a higher score of CD31 antibody. The online version contains supplementary material available at 10.1007/s12055-024-01752-3.

Correlation and consistency between resting full-cycle ratio and fractional flow reserve in assessing coronary artery function in a Chinese real-world cohort with non-ST-segment elevation acute coronary syndrome: a retrospective observational study

ObjectiveThe study aimed to investigate the correlation and consistency between resting full-cycle ratio (RFR) and fractional flow reserve (FFR) in functional assessment of coronary arteries in a Chinese real-world cohort...

Mapping the strain-stiffening behavior of the lung and lung cancer at microscale resolution using the crystal ribcage.

Lung diseases such as cancer substantially alter the mechanical properties of the organ with direct impact on the development, progression, diagnosis, and treatment response of diseases. Despite significant interest in the lung's material properties, measuring the stiffness of intact lungs at sub-alveolar resolution has not been possible. Recently, we developed the crystal ribcage to image functioning lungs at optical resolution while controlling physiological parameters such as air pressure. Here, we introduce a data-driven, multiscale network model that takes images of the lung at different distending pressures, acquired via the crystal ribcage, and produces corresponding absolute stiffness maps. Following validation, we report absolute stiffness maps of the functioning lung at microscale resolution in health and disease. For representative images of a healthy lung and a lung with primary cancer, we find that while the lung exhibits significant stiffness heterogeneity at the microscale, primary tumors introduce even greater heterogeneity into the lung's microenvironment. Additionally, we observe that while the healthy alveoli exhibit strain-stiffening of ∼1.75 times, the tumor's stiffness increases by a factor of six across the range of measured transpulmonary pressures. While the tumor stiffness is 1.4 times the lung stiffness at a transpulmonary pressure of three cmH2O, the tumor's mean stiffness is nearly five times greater than that of the surrounding tissue at a transpulmonary pressure of 18 cmH2O. Finally, we report that the variance in both strain and stiffness increases with transpulmonary pressure in both the healthy and cancerous lungs. Our new method allows quantitative assessment of disease-induced stiffness changes in the alveoli with implications for mechanotransduction.

Pd/Pa fluctuation with continuous ATP administration indicates inaccurate FFR measurement caused by insufficient hyperemia.

Continuous intravenous adenosine triphosphate (ATP) administration is the standard method for inducing maximal hyperemia in fractional flow reserve (FFR) measurements. Several cases have demonstrated fluctuations in the ratio of mean distal coronary pressure to mean arterial pressure (Pd/Pa) value during ATP infusion, which raised our suspicions of FFR value inaccuracy. This study aimed to investigate our hypothesis that Pd/Pa fluctuations may indicate inaccurate FFR measurements caused by insufficient hyperemia. We examined 57 consecutive patients with angiographically intermediate coronary lesions who underwent fractional flow reverse (FFR) measurements in our hospital between November 2016 and September 2018. Pd/Pa was measured after continuous ATP administration (150μg/kg/min) via a peripheral forearm vein for 5min (FFRA); and we analyzed the FFR value variation in the final 20s of the 5min, defining 'Fluctuation' as variation range > 0.03. Then, 2mg of nicorandil was administered into the coronary artery during continued ATP infusion, and the Pd/Pa was remeasured (FFRA+N). Fluctuations were observed in 23 of 57 patients. The cases demonstrating discrepancies of > 0.05 between FFRA and FFRA+N were observed more frequently in the fluctuation group than in the non-fluctuation group (12/23 vs. 1/34; p < 0.0001). The discrepancy between FFRA and FFRA+N values was smaller in the non-fluctuation group (mean difference ± SD; -0.00026 ± 0.04636 vs. 0.02608 ± 0.1316). Pd/Pa fluctuation with continuous ATP administration could indicate inaccurate FFR measurements caused by incomplete hyperemia. Additional vasodilator administration may achieve further hyperemia when Pd/Pa fluctuations are observed.

Causes of Chronic Kidney Disease and Their Associations with Cardiovascular Risk and Disease in a Sub-Saharan Low-Income Population.

The causes of chronic kidney disease (CKD) in people living in Sub-Saharan Africa await identification. Also, whether cardiovascular risk and disease extent differ among patients with different CKD etiologies is uncertain. In this prospective cross-sectional study, we examined the presumed causes of chronic kidney disease (CKD) and their relationships with cardiovascular risk and disease in 743 consecutive patients from a sub-Saharan low-income population. Hypertensive nephropathy (HNP) (60.2%), diabetic nephropathy (DNP) (24.4%), HIV associated CKD (20.0%) and glomerular disease (13.6%) comprised the major CKD etiologies upon enrolment at the hospital nephrology clinic. Pulse pressure was larger in patients with concurrent HNP and DNP than in those with HNP only (p<0.001). Pulse pressure and systolic blood pressure were larger in HNP or/and DNP patients than those with HIV associated CKD and glomerular disease (p=0.04 to <0.001). Cardiovascular disease was more prevalent in patients with HNP and concurrent HNP and DNP than those from other etiologic categories (p<0.05). HNP and DNP were associated with pulsatile pressures (pulse pressure and systolic blood pressure) independent of one another (p<0.01). In adjusted product of coefficient mediation analysis, mean arterial or distending pressure accounted fully for the potential impact of HNP on pulsatile pressures (103.9-115.7%) but not for that of DNP on the respective pressures (-2.0%-(-)7.5%). HNP is by far the most prevalent presumed cause of CKD in this African population. Cardiovascular risk and disease differ markedly across CKD etiological categories.