Restoration Of Flow Research Articles

Abstract 4122369: Beyond Closure: A Case Report on Coronary Steal Syndrome by Previously Embolized Internal Mammary Artery Side Branch

Background: Internal mammary artery (IMA) side branch flow diversion post- coronary artery bypass grafting (CABG) and its role in coronary steal syndrome remains controversial. However, evident association persists when substantial side branches stem from the IMA, possibly due to relatively lower peripheral resistance as compared to higher coronary resistance. Intervention has shown promise in ameliorating reversible ischemia in these cases. Recanalization of previously occluded side branch is rare and has only been reported within a 6 month period. We report a case of recanalization of a previously occluded side-branch after 4 years with recurrence of symptoms. Case: A 63-year-old male underwent CABG with LIMA-LAD in 2020 and coil embolization of LIMA side branch for symptomatic coronary steal syndrome (figure 1). Angina recurred 3 years later, leading to right coronary artery stent placement. He now presents with palpitations and dyspnea on exertion. Vital signs and physical exam was unremarkable. ECG showed a normal sinus rhythm with no signs of ischemia. A 24-hour Holter showed significant polymorphic ventricular ectopy and episodes of sustained ventricular tachycardia (arrhythmic burden 12.4%). Transthoracic echocardiogram showed an ejection fraction of 71% and slightly decreased left ventricular global longitudinal strain (-16.6%). Decision-making: A diagnostic cardiac catheterization was performed which showed patency of bypass and stent with no signs of occlusion or restenosis, rather revealing a permeable, previously occluded side-branch (figure 2A) and resurgent coronary steal phenomenon. Repeat coiling was performed, achieving complete cessation of flow (figure 2B) and evident increased flow to the LAD. Resolution of symptoms was observed and post-procedure Holter showed normal sinus rhythm with no arrhythmic changes. Conclusion: Recanalization of an IMA side branch after complete occlusion with multiple coils is rare, particularly beyond 6 months. This appears to be the first reported case of the phenomenon, occurring after 4 years. Administration of heparin for recent stent placement, continuation of oral antiplatelet therapy and distal coil location may have contributed to restoration of flow, despite the presence of intraluminal coils. Repeat coiling proved successful in relieving symptoms.

Mechanical vascular anastomoses

Mechanical anastomoses of blood vessels represent amajor advance in modern surgery. Highly specialized instruments ensure the precise connection of blood vessels, enabling the immediate restoration of blood flow. Ring coupler systems for venous anastomoses, in particular, have proven themselves in clinical practice due to their convenience and reliability and are now an indispensable part of surgical routines. Precise and functionally proper anastomosis of blood vessels; shortening of the anastomosis time; minimization of perfusion disorders in the affected tissue; reduction of intraoperative and postoperative complications. Replantation of extremities after amputations and injuries; defect reconstruction using free flaps; microsurgical vascular bypass procedures. Severe vascular pathologies such as vascular aneurysms, arteriosclerosis or severe inflammation in the area of the anastomosis; large differences between the vessel lumina; too small or too large vessels. Clamping of both vessel ends; selection of the appropriate ring coupler size based on the vessel diameter; mobilization of at least 1 cm at each vessel end; functional testing of the coupler device; threading the vessels, securely joining the rings and removing the holding device; removing clamps, inspection of the anastomosis. Regular blood circulation checks; avoiding pressure on the anastomosis; adequate anticoagulation. Precise anastomoses; reduction in operating time.

The role of the cyclooxygenase-2 pathway in tissue ischemia and revascularization following skeletal muscle injury induced by bothropic snake venom

Bothrops asper venom (Bav) contains metalloproteinases that disrupt the microvascular system, impairing muscle tissue regeneration after injury. This study investigated the impact of the cyclooxygenase-2 (COX-2) pathway on vascular injury and revascularization in muscle injuries induced by Bav. Mice were injected with Bav into the gastrocnemius muscle and treated with lumiracoxib, a selective COX-2 inhibitor, 30 min, 2 days, and 6 days post-Bav injection. Muscle tissue was analyzed at 24 h, 7 days, and 21 days post-injection. A decrease in COX-2 expression at 24 h post-Bav injection indicated significant necrosis and tissue loss. Both Bav injection and lumiracoxib treatment influenced the decrease of prostaglandin (PG)D2 and PGE2 production. Seven and 21 days post-Bav injections, COX-2 expression increased, along with PGDs levels unaffected by lumiracoxib, indicating that the other isoform COX-1 pathway could contribute to the release of PGs. Bav/lumiracoxib treated animals presented exacerbated limb ischemia, implying that COX-2-derived prostaglandins preserve vessel integrity. CD31, an angiogenesis marker, initially (24 h) decreased post-Bav injection but increased at 7 and 21 days in Bav/lumiracoxib mice, suggesting a down-modulatory role for COX-2-derived prostaglandins in early angiogenesis and tissue regeneration. Vascular endothelial growth factor (VEGF) production rose 7 days post-Bav injection, supporting its role in angiogenesis. Previous treatment with lumiracoxib promoted release of VEGF levels 21 days post-Bav injury showing that the inhibition of COX-2 pathway in the early stage of revascularization stimulates the neovascularization regulated by elevated release of VEGF. Similarly, metalloproteinases (MMPs), such as MMP-9, MMP-10, and MMP-13, crucial for vascular remodeling, were elevated 21 days after Bav/lumiracoxib treatment. In conclusion, the COX-2 pathway is essential to decrease the high grade of ischemia caused by acute injury induced by Bav. However, the decrease of activity in the COX-2 pathway in the first stages of revascularization contributes to the elevated production of key pro-angiogenic mediators that up-regulate the restoration of microvasculature and blood flow in muscle tissue injured by botropic venoms.

Culprit vessel revascularization prior to complete angiography as a strategy to minimize delays in primary percutaneous coronary intervention for patients with ST-elevation myocardial infarction: a systematic review and meta-analysis.

The rapid restoration of blood flow in patients with acute myocardial infarction with ST elevation through percutaneous coronary intervention (PCI) is crucial for the survival of this population. Attempts to decrease the time from diagnosis of ST-segment elevation myocardial infarction (STEMI) to arrival at the catheterization laboratory have been extensively investigated. However, strategies during the procedure aiming to reduce the time to reperfusion are lacking. We conducted a meta-analysis to evaluate culprit vessel revascularization prior to complete angiography as a strategy to minimize delays in primary PCI for patients with STEMI. We searched PubMed, Embase, and Cochrane Central. Outcomes: vascular access-to-balloon, door-to-balloon, and first medical contact-to-balloon times; death, reinfarction in 30 days, Bleeding Academic Research Consortium ≥3 type, coronary artery bypass grafting referral, and left ventricular ejection fraction %. Statistical analysis was performed using the R program (version 4.3.2). Heterogeneity was assessed with I2 statistics. We included 2050 patients from six studies, of which two were randomized controlled trials and four were observational studies. Culprit vessel revascularization prior to complete angiography was associated with a statistically significant decrease of times: vascular access-to-balloon time (mean difference -6.79 min; 95% CI: -8.00 to -5.58; P < 0.01; I2 = 82%) and door-to-balloon time (mean difference -9.02 min; 95% CI: -12.83 to -5.22; P < 0.01; I2 = 93%). In this meta-analysis, performing PCI on the culprit lesion prior to complete coronary angiography led to significantly shorter reperfusion times, with no discernible differences in complication rates.

Endometriosis development in relation to hypoxia: a murine model study.

Endometriosis, due to its ambiguous symptoms, still remains one of the most difficult female diseases to treat, with an average diagnosis time of 7-9years. The changing level of hypoxia plays an important role in a healthy endometrium during menstruation and an elevated expression of the hypoxia-inducible factor 1-alpha (HIF-1α) has been demonstrated in ectopic endometria. HIF-1α mediates the induction of proangiogenic factors and the development of angiogenesis is a critical step in the establishment and pathogenesis of endometriosis. Although the inhibition of angiogenesis has been proposed as one of the actionable therapeutic modalities, vascular normalization and re-oxygenation may become a possible new approach for therapeutic intervention. Our goal was to investigate whether a selected murine model of endometriosis would be suitable for future studies on new methods for treating endometriosis. Non-invasive, high-resolution ultrasound-monitored observation was selected as the preclinical approach to obtain imaging of the presence and volume of the endometriotic-like lesions. The EF5 (2-(2-Nitro-1H-imidazol-1-yl)-N-(2,2,3,3,3-pentafluoropropyl)acetamide) compound that selectively binds to reduced proteins in hypoxic cells was used for hypoxia detection. The expression of Pten and other crucial genes linking endometriosis and hypoxia were also assessed. Using EF5, a pentafluorinated derivative of the 2-nitroimidazole that is metabolically reduced by oxygen-inhibitable nitroreductase, we confirmed that hypoxia did develop in the selected model and was detected in uterine and ectopic endometriotic lesions. Moreover, the changes in oxygen tension also influenced the expression level of significant genes related to endometriosis, like Pten, Trp53, Hif1a, Epas1, and Vegfa. Their strong modulation evidenced here is indicative of model reliability. Using high-resolution ultrasound-based imaging, we present a non-invasive method of visualization that enables the detection and observation of lesion evolution throughout the duration of the experiment, which is fundamental for further preclinical studies and treatment evaluation. The selected model and method of visualization appear to be suitable for the study of new treatment strategies based on hypoxia alleviation and blood flow restoration.

Ostial LCx: Achilles Heel of Left Main Bifurcation Angioplasty and How We Evolved in Its Management

In-stent restenosis (ISR) within bifurcation lesions of the left main (LM) coronary artery (LMCA) is challenging due to its complex anatomy and critical function. This case series highlights 3 patients with LM bifurcation ISR (Medina 1,1,1) post-index intervention using different stent strategies as follows: Case 1: A 58-year-old male developed distal LM bifurcation stenosis after ostial left anterior descending artery (LAD) stenting. Mini-culotte bifurcation angioplasty effectively managed this. Case 2: A 62-year-old male presented with neo-atherosclerosis-induced distal LM bifurcation ISR post-provisional LM-left anterior descending artery (LAD) stenting. A single-stent crossover with a drug-coated balloon in a large side branch achieved optimal flow restoration. Case 3: A chronic total occlusion in the right coronary artery and distal LM bifurcation ISR due to stent overhang into LMCA in a 72-year-old male was resolved with a string culotte technique. These cases underscore ISR management strategies tailored to patient-specific anatomy and clinical needs, advocating advanced imaging techniques like intravascular ultrasound and optical coherence tomography for procedural precision and safety.

Cardioprotection with transcoronary saline infusion during primary angioplasty for ST-elevation myocardial infarction: design and rationale of the STEMI-Cool pilot study

Abstract Background Prompt restoration of blood flow in ST-segment elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (pPCI) improves outcomes, but is associated with myocardial stunning, increased infarct size, and microvascular dysfunction. To date, there is no effective therapy to reduce this ischaemia-reperfusion injury (IRI). Mild systemic hypothermia has demonstrated potential but is difficult to achieve and poorly tolerated. Transcoronary hypothermia delivers rapid and effective myocardial cooling, is well tolerated, but not effective when commenced after flow restoration. Coronary haemodilution during reperfusion has shown cardioprotective effects in preclinical studies but has not been fully assessed. Purpose STEMI-Cool is a pragmatic, registry-based randomised clinical trial to assess recruitment rate, feasibility, and safety of a simple protocol which we have reported in a proof-of-concept study. The study has commenced recruitment and aims to overcome the limitations of previous negative studies by combining the beneficial effects of transcoronary cooling and dilution, initiating the infusion prior to wire insertion - therefore avoiding initial unprotected reperfusion (likely to be the critical time for IRI), and avoiding significant delays in reperfusion. Moreover, we will explore mechanistic endpoints and an original method to quantify the intracoronary dilution (with a thermodilution-derived "haemodilution constant ratio"). Lastly, we will investigate ways to "engineer out" the thermistor wire so that the method could be applied to routine pPCI with conventional equipment. Methods Pragmatic broad eligibility criteria allow potential recruitment of all STEMI cases clinically eligible for pPCI. Sixty patients will be randomised 1:1 to standard of care or protected reperfusion with continuous infusion of room temperature saline through the guiding catheter, to achieve intracoronary temperature reduction of 6-8°C. The infusion commences prior to crossing the occlusion with a thermistor wire, which is used as guidewire, and continues for 10 minutes after flow restoration (i.e., TIMI flow≥2). Invasive coronary physiology studies are undertaken after pPCI. Novel and established biomarkers of myocardial damage and inflammation (including dipeptidyl peptidase 3, tumor necrosis factor α, and interleukins 1β, 6, 10) are measured in the preprocedural arterial blood. Cardiac imaging and clinical outcomes are assessed at 48h and 6-12 months. Nesting STEMI-Cool in our local registry Heart-ACS facilitates blood sampling and follow-up. Conclusions STEMI-Cool will primarily investigate recruitment rate, feasibility and safety of an innovative, simple cooling and diluting strategy for cardioprotection during pPCI. Mechanistic outcomes will explore inflammatory, microvascular, structural and functional changes. Finally, we will aim to simplify further the protocol for future research and potential clinical use.STEMI-Cool method schematicSTEMI-Cool protocol timeline

Demographic, clinical characteristics, managements strategies and in-hospital outcomes of patients enrolled in prospective nationwide SCAD registry

Abstract Spontaneous coronary artery dissection (SCAD) is an uncommon yet increasingly recognized cause of acute coronary syndrome (ACS), particularly in young to middle-aged women. This multicentric, prospective nation-wide registry aimed to elucidate the demographic characteristics, clinical presentation, management strategies, and outcomes of patients with SCAD. A total of 95 patients with SCAD were enrolled in 10 centers, with females constituting 81% of the cohort, and with an average age of 49.7±11.9 years. Among the traditional risk factors, prior hypertension was observed in 49%, followed by hyperlipidemia in 43%, diabetes mellitus in 9% and prior or current smoking in 47% of patients. The presentation of SCAD as ST-elevation myocardial infarction (STEMI) was predominant, occurring in 61% of cases, with the left anterior descending artery (LAD) being the most involved vessel (68%). Regarding the classification of SCAD, type 2 SCAD was the most frequent (53%), followed by type 1 (24%) and type 4 (16%). Notably, involvement of the distal segment of the culprit artery was observed in 68% of cases, while baseline TIMI 3 flow was noted in 52% of patients. Percutaneous coronary intervention (PCI) was performed in 52% of cases, with pre-interventional TIMI 0-2 flow (62% Vs. 28%; p&amp;lt;0.05) and proximal artery involvement (41% Vs. 13%; p&amp;lt;0.05) being more prevalent compared to conservatively managed patients. Final stent implantation was performed in 67% of PCI cases, with TIMI 3 flow restoration in 76% of patients undergoing PCI. The average left ventricular ejection fraction prior to discharge was 51±9.9%. In-hospital mortality was reported in three female patients, undergoing attempted PCI with left main and LAD involvement. The use of antiplatelet therapy was widespread, with aspirin administered to 98% and P2Y12 inhibitors to 75% of patients at discharge. Data from this prospective nationwide multicentric SCAD registry show that SCAD occurs predominantly in relatively young female patients, with moderately prevalent traditional cardiovascular risk factors, usually presents as STEMI, with good overall survival rates despite half of the patients managed conservatively. PCI was often attempted in SCAD lesion with compromised arterial flow and located proximally, with lower rates of stent implantation and procedure success compared to traditionally observed rates in primary PCI. This underscores the importance of heightened awareness and tailored management approaches for this unique subset of ACS patients in order to refine risk stratification, optimize treatment strategies, and improve outcomes in this population.

Nap1L1 Ubiquitination Degradation-dependent Protective Effects of Wnt2 on Cardiac Ischemia/Reperfusion Injury

Abstract Background Cardiomyocyte death during ischemia/reperfusion (I/R) injury occurs following the restoration of blood flow for obstructed coronary arteries, posing a challenge to timely reperfusion strategy for ischemic heart disease. This study aimed to investigate the potential protective role of Wnt2 against cardiomyocyte death after I/R injury. Methods Serum Wnt2 levels in patients with acute myocardial infarction (AMI) before and after percutaneous coronary intervention (PCI) and in mice subjected to I/R were measured by ELISA. Cardiomyocyte death, including apoptosis and ferroptosis, which were examined by TUNEL and thiobarbituric acid reactive substances (TBARs) assay, respectively. TMT6-based proteomics analysis was used to identify critical molecules mediating the effects of Wnt2. Results Serum Wnt2 level decreased after PCI in patients with MI and was negatively correlated with cTNT and CK-MB levels within the first 48 hours post-PCI. Wnt2 also decreased in I/R mice in compared with sham group.Supplement of rbWnt2 ameliorated I/R injury as characterized by the improved cardiac function and decreased infarct area and level of asynchronicity. Proteomics analysis KEGG Enrichment top 20 of differentially expressed proteins (DEPs) included reactive oxygen species (ROS). RbWnt2 inhibited cardiomyocytes apoptosis and ferroptosis by suppressed ROS level following I/R in vivo and in vitro. Based on proteomics analysis data, most of differentially expressed proteins (DEGs) were enriched in cytoplasm or nucleus. Among them, Nucleosome assembly protein-like 1(Nap1L1) was progressively increased in hearts following I/R, and showed a negative correlation with cardiac Wnt2 level during the I/R procedure. RbWnt2 treatment significantly attenuated the upregulation of Nap1L1 induced by I/R injury in vivo and in vitro. Hypoxia/Normoxia injury elicited Nap1L1 increased both in nucleus and cytoplasm, which was attenuated by rbWnt2 treatment in AMCMs. AAV9 mediated knockdown of Nap1l1 protects heart from apoptosis and ferroptosis while overexpression of Nap1l1 partly abolished the protective effects of Wnt2 in I/R mice. Mechanistically, Wnt2 upregulated anti-oxidative enzymes (Gpx1, Gpx4, Ucp3, Sod1, Sod2) by regulation of Nap1l1 to suppress ROS level and protect cardiomycoytes following I/R injury. Further analysis revealed that binding of Wnt2 and Lrp6 enhanced the expression of Tripartite motif 11 (TRIM11, a ubiquitin E3 ligase) and subsequently promoted the degradation of Nap1l1 in cardiomyocytes, which contributes to cardiac protection following I/R injury. Conclusions Wnt2 protects the heart against I/R-induced injury by inducing Nap1L1 degradation through Lrp6/Trim11 signaling, which was mediated by suppressing ROS levels via enhancing anti-oxidation enzymes to inhibits cardiomyocytes apoptosis and ferroptosis. These findings may offer new insights for developing therapeutic strategies to prevent I/R injury.Abstract GraphConclusion

Hypoperfused myocardium and systolic function in patients with AMI undergoing complete revascularization

Abstract Background and Aim Coronary revascularization is the standard treatment for acute myocardial infarction (AMI), while the restoration of epicardial flow is non-parallel to myocardial reperfusion. This study sought to investigate the dynamic of myocardial perfusion and its association with left ventricular (LV) systolic function in AMI patients undergoing complete revascularization. Methods AMI patients who underwent complete revascularization were prospectively enrolled, and hybrid positron emission tomography/magnetic resonance (PET/MR) was performed at 2 months and 1 year. Hypoperfused myocardium was defined as myocardium with reduced perfusion and normal metabolism. Results Forty-five patients (59.80 ± 10.68 years, 80.0% male) were enrolled, and hypoperfused myocardium (median: 12% of LV) was detected in 21 (46.7%) patients 2 months post-AMI. Patients with hypoperfused myocardium (Group A) had significantly higher hypersensitive C-reactive protein (hs-CRP) (p = 0.016) and lower T2 value (p = 0.010) than those without (Group B). In the follow-up PET/MR at 1 year, significant LV ejection fraction improvement was observed in Group A (56.39 ± 9.76% vs. 54.58 ± 10.39%, p = 0.016) but not in Group B (51.63 ± 13.09% vs. 50.79 ± 16.95%, p = 0.615). Six (31.6%) patients in Group A showed recovery of perfusion, of which there were more females (p = 0.025), fewer diabetics (p = 0.044), or overweight (p = 0.035), with better global longitudinal strain (GLS) (p = 0.005). Conclusions Myocardial hypoperfusion is not rare and evolves over time in AMI patients undergoing complete revascularization, of which the reversal is probably associated with improved LV systolic function.Structured Graphical AbstractRepresentative PET/MR image of 2 separat

Ganga, GAP, and lockdown: potential threats to the biodiversity of the river

ABSTRACT The Ganges River holds a vital status within India as a cornerstone of the nation's ecological and socio-economic fabric. Flowing through diverse terrains like the Himalayas, Gangetic plains, and coastal regions, it fosters an incredibly rich biodiversity, supporting a myriad of life forms ranging from microorganisms to mammals. Beyond its ecological significance, the river sustains the livelihoods of millions, contributing significantly to the economy of northern India. However, rampant human development over recent decades has posed grave threats to its well-being. Pollution from sewage and industrial waste has tainted its waters with heavy metals, posing risks of bioaccumulation and magnification within aquatic life. Infrastructure projects like dams and bridges disrupt natural habitats and impede the migration of aquatic species, further jeopardising the river's ecological balance. Despite these challenges, there have been glimmers of hope, particularly noted during the COVID-19 lockdown when industrial activities ceased, offering the river a temporary reprieve. Moving forward, effective measures are imperative, including reducing industrial and domestic effluent discharge, scrutinising sources of heavy metal contamination, and prioritising the restoration of the river's natural flow. Preserving the Ganges’ ecological integrity is paramount, necessitating concerted efforts to ensure its health and vitality for future generations.

Joint guarantee rate index assessment of the contribution of agricultural water-saving measures to river ecological flow in water shortage areas

Reconciling higher ecological water demands and economic purposes with finite freshwater resources remains one of the great management dilemmas. Low water efficiency and large water consumption in agricultural irrigation hinder the protection of river ecological flow in the water shortage areas of Northwest China. By analyzing the surplus and shortage of river ecological protection targets, the intensity guarantee rate index is innovatively proposed to quantitatively evaluate the important contribution of improved water-saving measures for river flow restoration. It compensates for the shortcomings of the duration guarantee rate index in evaluation that may mask ecological problems. Considering ecological baseflow, fish species, and landscape water demand, the ecological flow interval (6.00–12.42 m3/s) was determined. Three scenarios are highlighted for different typical years and irrigation regimes in combination with planting structure adjustment and irrigation water utilization coefficient. In 75 %, 90 %, and 95 % typical years, the maximum total annual water-savings (Scenario 3) are 57.3, 57.1, and 87.2 million m3 (sufficient irrigation); 32.2, 33.9, and 35.5 million m3 (deficit irrigation) respectively. The guarantee degree of river ecological flow under both irrigation regimes increased from the previous 65.6 % to a maximum of 91.7 % and 81.2 %. The increase in the daily guarantee rate and decrease in the intensity guarantee rate under the aforementioned three scenarios indicate a reduction of damage depth and duration of ecological flow. By using a quantitative study, it is pointed out that improving agricultural water-saving is a reasonable and necessary way to protect the river flow.

Prevention and Management of Restenosis After Coronary Interventional Therapy

Percutaneous coronary intervention (PCI) is one of the key methods for treating coronary heart disease, yet post-procedural restenosis remains a significant clinical challenge. Restenosis refers to the re-narrowing of the coronary artery after PCI due to factors such as neointimal hyperplasia and smooth muscle cell proliferation, which adversely affects blood flow restoration and patient prognosis. To address this issue, this study systematically explores strategies for the prevention and management of restenosis. Effective preventive measures are discussed in terms of pharmacological prevention, stent selection, optimization of procedural techniques, and lifestyle interventions. Additionally, the article analyzes pharmacological treatment options and re-intervention strategies for patients experiencing restenosis. The findings indicate that personalized treatment plans, optimized stent selection, rigorous postoperative management, and long-term monitoring are key to reducing the incidence of restenosis. Future research should further investigate the application of genetic testing and smart healthcare technologies in the management of restenosis.

Establishment and analysis of an animal model for nutcracker syndrome.

This study investigated the effects of renal vein congestion of varying durations on kidney damage by establishing an animal model of Nutcracker Syndrome (NCS). In addition, we assessed whether renal damage improved after relieving the congestion. We established a rat model of NCS and relieved renal congestion through secondary surgery, with renal vein reperfusion confirmed by animal ultrasound. Histopathological changes in congested kidneys were evaluated at 3, 6, and 9days using HE and Masson staining, and the expression of renal injury factors was determined using q-PCR. Renal tissue pathology changes were evident with prolonged obstruction time. Compared to the sham-operated group, no apparent fibrosis was observed in the kidneys at 3days post-congestion, whereas fibrosis was most severe at 9days post-congestion, with no significant improvement observed even after blood flow restoration. Six days post-congestion relief, some alleviation of renal fibrosis occurred. q-PCR results indicated a significant reduction in the expression of fibrosis markers after 3 or 6days of renal vein ligation release. Following blood flow restoration on the 9th day post-congestion, no significant changes in fibrosis markers were noted. Prolonged renal vein congestion in a rat model of NCS resulted in severe kidney damage and significant fibrosis after 9days. While relieving congestion within 6days led to some improvement, no reduction in fibrosis occurred after 9days, underscoring the importance of congestion duration in renal pathology.

Improved Door-to-Needle Time After Implementation of Tenecteplase as the Preferred Thrombolytic for Acute Ischemic Stroke at a Large Community Teaching Hospital Emergency Department.

Background: Acute ischemic stroke is a leading cause of death and long-term disability. To improve patient outcomes, timely restoration of blood flow to the ischemic brain tissue is vital. One reperfusion strategy includes the administration of thrombolytics. Historically, alteplase has been the thrombolytic of choice for acute ischemic stroke; however, given recent safety and efficacy data, tenecteplase has gained popularity due to its optimal pharmacokinetic profile. Objectives: This study compares outcomes between adult patients with acute ischemic stroke who received tenecteplase as the preferred thrombolytic versus alteplase. Methods: This was a single center, retrospective cohort study that included adult patients who received intravenous thrombolytic therapy, either tenecteplase 0.25 mg/kg or alteplase 0.9 mg/kg, for acute ischemic stroke from May 2021 to December 2023. The primary outcome was door-to-needle time. Secondary safety outcomes included the incidence of symptomatic intracerebral hemorrhage (ICH), any ICH on 24-hour follow-up imaging, major extracranial bleeding, and angioedema. Secondary efficacy outcomes included discharge with a favorable neurological outcome, discharge disposition, ICU length of stay, and overall length of stay. Secondary stroke metric times evaluated include door-to-computed tomography (CT) time, CT-to-needle time, neurologist notification-to-needle time, and thrombolytic decision-to-needle time. Results: Fifty patients were included in the alteplase group and 50 patients were included in the tenecteplase group. The primary outcome, door-to-needle time, was significantly shorter in the tenecteplase group (36 vs 30 minutes, P = .006). There were no statistically significant differences found in the secondary safety and efficacy outcomes. Patients who received tenecteplase experienced significantly faster CT-to-needle times (17 vs 11 minutes, P = .006), neurologist notification-to-needle times (32 vs 25 minutes, P = .001), and thrombolytic decision-to-needle times (9 vs 5 minutes, P < .001). Conclusions: In this retrospective, observational study, there was a statistically significant decrease in door-to-needle time with tenecteplase compared to alteplase. No significant differences in secondary safety and efficacy outcomes were observed.

Synergistic effect of Hypoxic Conditioning and Cell-Tethering Colloidal Gels enhanced Productivity of MSC Paracrine Factors and Accelerated Vessel Regeneration.

Microporous hydrogels have been widely used for delivering therapeutic cells. However, several critical issues, such as the lack of control over the harsh environment they are subjected to under pathological conditions and rapid egression of cells from the hydrogels, have produced limited therapeutic outcomes. To address these critical challenges, cell-tethering and hypoxic conditioning colloidal hydrogels containing mesenchymal stem cells (MSCs) are introduced to increase the productivity of paracrine factors locally and in a long-term manner. Cell-tethering colloidal hydrogels that are composed of tyramine-conjugated gelatin prevent cells from egressing through on-cell oxidative phenolic crosslinks while providing mechanical stimulation and interconnected microporous networks to allow for host-implant interactions. Oxygenating microparticlesencapsulated in tyramine-conjugated colloidal microgels continuously generated oxygen for 2 weeks with rapid diffusion, resulting in maintaining a mild hypoxic condition while MSCs consumed oxygen under severe hypoxia. Synergistically, local retention of MSCs within the mild hypoxic-conditioned and mechanically robust colloidal hydrogels significantly increased the secretion of various angiogenic cytokines and chemokines. The oxygenating colloidal hydrogels induced anti-inflammatory responses, reduced cellular apoptosis, and promoted numerous large blood vessels in vivo. Finally, mice injected with the MSC-tethered oxygenating colloidal hydrogels significantly improved blood flow restoration and muscle regeneration in a hindlimb ischemia (HLI) model.

An Efficient Approach for Detection of Compromised SDN Switches and Restoration of Network Flow

In Software Defined Networking (SDN) the data plane is separated from the controller plane to achieve better functionality than the traditional networking. Although this approach poses a lot of security vulnerabilities due to its centralized approach. One significant issue is compromised SDN switches because the switches are dumb in SDN architecture and in absence of any intelligence it can be a easy target to the attackers. If one or more switches are attacked and compromised by the attackers, then the whole network might be down or defunct. Therefore, in this work we have devised a strategy to successfully detect the compromised SDN switches, isolate them and then reconstruct the whole network flow again by bypassing the compromised switches. In our proposed approach of detection, we have used two controllers, one as primary and another as secondary which is used to run and validate our algorithm in the detection process. Flow reconstruction is the next job of the secondary controller which after execution is conveyed to the primary controller. A two-controller strategy has been used to balance the additional load of detection and reconstruction activity from the master controller and thus achieved a balanced outcome in terms of running time and CPU utilization. All the propositions are validated by experimental analysis of the results and compared with existing state of the art to satisfy our claim.

Outcomes of Proximal Hybrid Arterial Reconstruction in Combination with Simultaneous Amputation in Dry Atherosclerotic Gangrene of Toes

INTRODUCTION: When treating atherosclerotic gangrene of the lower limb (LL), the surgeon faces the questions about the reasonability of vascular reconstruction and the optimal timing of amputation after surgery on the LL arteries. The answer to these questions is given by assessing the state of the microvasculature of the operated limb. With sufficient development of the microvasculature and good collateral circulation, it is possible to perform a simultaneous amputation after proximal reconstruction. In this situation, a clear demarcation of the zone of necrosis and reversible ischemia is required, which can be realized by the method of ultraviolet luminescence spectroscopy. AIM: To analyze the results of hybrid reconstructions on the LL arteries with multilevel diffuse atherosclerotic lesions and dry gangrene of toes (DGT). MATERIALS AND METHODS: A prospective, controlled, non-randomized study included 29 patients suffering from critical ischemia of the lower limbs and having DGT, who were operated on in the amount of hybrid arterial reconstruction. The patients were divided into two groups: patients of group 1 (n = 14) underwent restoration of the main blood flow at the level of the iliofemoral arterial segment using a hybrid method, with simultaneous minor amputation of LL at various levels; patients of group 2 (control group, n = 15) underwent a simultaneous proximal and distal hybrid operation, providing main blood flow through at least one of the lower leg arteries, followed by a minor amputation of the lower leg at various levels over the next 4–5 days. RESULTS: There were no statistically significant differences in the groups in the degree of decrease in luminescence intensity after vascular surgery. A histological examination of intraoperative preparations of DGT revealed necrosis of the cellular microenvironment at luminescence amplitude (1.0 ± 0.05) × 105 photons at 410 nm frequency. At luminescence amplitude not exceeding this level, signs of necrobiosis were noted. Luminescence level of ≥ 1.0 × 105 photons was used as the amputation boundary. In the case of an uncomplicated vascular stage of the operation, a comparable decrease in the conventional amputation boundary was noted in the study groups. In the early postoperative period, in patients of group 1, the level of inflammation markers, average number of bed-days, and the number of thrombotic complications were lower than in the control group (p 0.05). A strong correlation was recorded between the morphological signs of the acute phase of inflammation and the intensity of chemiluminescence (r = 0.7, p 0.005). CONCLUSION: In patients with DGT, at a luminescence amplitude on the lower leg and foot not exceeding 1.0 × 105 photons at 410 nm frequency and 0.7 × 105 photons at 450 nm frequency, an effective treatment method is restoration of the main blood flow in the iliofemoral segment using a hybrid method with simultaneous minor amputation at various levels of the foot. This luminescence level is the conventional boundary between necrotic changes and reversible ischemia (necrobiosis) of the soft tissues of the LL.

Renal Artery Blood Flow and Surface Parenchymal Perfusion During Renal Artery Endoshunting in a Porcine Model

ObjectiveIschaemia and reperfusion can result in permanent tissue damage. During complex open abdominal aortic surgery, transient clamping of renovisceral arteries may be required to successfully complete the vascular repair. Endovascular shunting (endoshunting) presents an alternative technique for managing such temporary renovisceral ischaemia. This study aimed to investigate the performance of endoshunting to the renal circulation in a porcine model. MethodsThis study of five domestic pigs investigated arterial volume flow rates during endoshunting of a single renal artery and the associated impact on renal perfusion parameters (laser Doppler renal parenchymal perfusion, renal oxygen extraction, and selective urinary output). The study was performed in three steps: baseline registrations (30 minutes), endoshunting (120 minutes), and restitution (60 minutes). The right kidney was used as the experimental side and the left kidney as control. ResultsThe median arterial flow rate in the left control kidney remained constant throughout the experiment. On the right (endoshunted) side, the baseline median arterial flow rate was 267 (range, 160 – 404) mL/min. Following activation of the endoshunt, the median arterial volume flow dropped by 59% to 110 (range, 45 – 150) mL/min (p = .018). During endoshunting, the median kidney surface perfusion decreased to 42% of the baseline value. On the control side, a rise in the median parenchymal perfusion was observed after endoshunt activation, which was again normalised following restitution of native right renal artery flow. During endoshunting, the median regional urine production was 0.32 (range, 0.12 – 0.50) mL/hour but resumed after renal artery flow restitution. ConclusionOn average, the endoshunted kidneys showed a rapid restoration of blood flow, parenchymal perfusion, and urine production after 120 minutes of endoshunting. This suggests that endoshunting to the kidney using an endoshunt system might be a promising strategy to preserve renal function when a temporary interruption of native renal artery blood flow is needed during complex vascular surgical repairs involving the renal arteries.

LITERATURE REVIEW THE ROLE OF ACUPUNCTURE IN THE MANAGEMENT OF PERIPHERAL NEUROPATHY

Peripheral neuropathy (PN) is a condition characterized by damage to the peripheral nervous system, resulting in symptoms such as pain, numbness, and weakness in the hands and feet. The most common causes include diabetes, thyroid disorders, vitamin B12 deficiency, alcohol abuse, chemotherapy, and human immunodeficiency virus (HIV) infection. Despite the availability of various treatments, neurological disorders remain a significant therapeutic challenge. The therapeutic effects of acupuncture are attributed to several mechanisms, including stimulation of nerve fibers, restoration of blood flow, release of neurotransmitters and hormones, modulation of the autonomic nervous system, anti-inflammatory effects, and increased neuroplasticity. These mechanisms collectively contribute to the relief of symptoms associated with peripheral neuropathy. Evidence suggests that acupuncture is beneficial in treating peripheral neuropathy. Studies have shown that acupuncture can improve nerve conduction study parameters in sensory and motor nerves, reduce neuropathic pain, and improve overall nerve function. Certain acupuncture points such as ST-36, GB-34, SP-3, SP-8, and BI-56 have been identified as particularly effective in managing symptoms of peripheral neuropathy. Although more rigorous studies are needed to fully characterize the effects of acupuncture on peripheral neuropathy, the available evidence supports its use as a complementary therapy. Standardized acupuncture protocols that combine anatomical correlation with peripheral nerves and traditional approaches to neuropathic pain management appear to be effective. Further studies with larger sample sizes and randomized comparisons to sham acupuncture will help establish acupuncture as a guideline for treating peripheral neuropathy. This review outlines the potential of acupuncture as a complementary therapy in the management of peripheral neuropathy.