Hemodynamic Indices Research Articles

Effects of Continuous Graduated Pneumatic Compression and Intermittent Pneumatic Compression on Lower Limb Hemodynamics for VTE Prophylaxis in Arthroplasty.

Intermittent pneumatic compression (IPC) is considered the standard of care for preventing venous thromboembolism (VTE) in the hospital setting. However, its widespread adoption after hospitalization has been limited due to its shortcomings in obstruction of venous valves and blood reflux. The objective of this study is to compare the effects of continuous graduated pneumatic compression (CGPC), a new device with a novel mechanism, and IPC on lower hemodynamics and the incidence of VTE in patients undergoing arthroplasty. We randomized 123 participants undergoing knee arthroplasty to receive either IPC or CGPC from June 2022 through August 2023. An experienced sonographer used a Doppler ultrasound scanner to obtain hemodynamic indicators of venous blood. The primary outcome was the blood velocity of the femoral vein measured by a Doppler scanner. Secondary outcomes included the hemodynamic of the femoral vein and popliteal vein, quality of life at discharge and 30 days after surgery, symptomatic and asymptomatic VTE up to 30 days, and adverse events related to the IPC and CGPC device. For statistical analyses, Student's t-test, analysis of covariance, and the Mann-Whitney U test were used. Statistical significance was indicated with p < 0.05. There was no significant difference in femoral vein velocity between the IPC and CGPC groups. However, CGPC demonstrated a significant increase in femoral vein flow compared to the IPC group, with a median (interquartile) increasing from 158.9 (122.9, 204.3) to 265.6 (203.3, 326.8) mL/min in the CGPC group and from 139.0 (103.3, 175.9) to 189.6 (161.4, 270.8) mL/min in the IPC group (p < 0.001). Similar trends were observed in popliteal vein measurements. The differences between the two groups were similar in terms of quality of life, incidence of VTE, and adverse events. The CGPC device provides a substantial increase in blood flow compared to the IPC device. Its safety and effectiveness have been preliminarily validated. The CGPC device presents a promising alternative for VTE prophylaxis in arthroplasty. Chinese Clinical Trial Registry (registration number: ChiCTR2300078201).

Relationship of maternal ophthalmic artery Doppler with uterine artery Doppler, hemodynamic indices and gestational age: prospective MATERA study.

To examine the relationship of ophthalmic artery (OA) Doppler indices with uterine artery (UtA) Doppler indices, selected maternal hemodynamic parameters and gestational age, and to evaluate the intraobserver reproducibility of OA Doppler indices. This was a prospective cohort study of women recruited between 11 + 0 and 23 + 6 weeks' gestation using a stratified and random sampling approach to ensure adequate distribution across the gestational-age range. OA pulsatility index (PI), first peak systolic velocity (PSV1), second peak systolic velocity (PSV2) and peak systolic velocity ratio (PSV ratio), calculated as PSV2/PSV1, were measured twice in each eye by the same observer. UtA-PI was also measured twice on each side by the same observer. Maternal hemodynamic assessment was undertaken using an ultrasonic cardiac output monitor (USCOM 1A). Pearson's and Spearman's rank correlation coefficients were used to assess the correlations between variables, and Bland-Altman plots were used to evaluate the intraobserver reproducibility of OA Doppler indices. Of 194 women invited to participate in the study, 169 were eligible for inclusion, of whom 16 were excluded following an obstetric ultrasound scan and a further three owing to inadequate or incomplete OA or UtA Doppler assessment, leaving 150 women in the final analysis. Log UtA-PI had a weak correlation with both OA-PI (r = -0.19 (95% CI, -0.34 to -0.03), P = 0.021) and OA-PSV ratio (r = 0.31 (95% CI, 0.15-0.45), P < 0.001). The correlation between gestational age and OA-PI was non-significant (r = 0.14 (95% CI, -0.03 to 0.29), P = 0.097), and that between gestational age and OA-PSV ratio was weak (r = -0.23 (95% CI, -0.38 to -0.07), P = 0.004), as opposed to the strong correlation between gestational age and UtA-PI (r = -0.68 (95% CI, -0.76 to -0.58), P < 0.001). No strong correlations were observed between OA-PI or OA-PSV ratio and maternal hemodynamic indices. The correlations were unaltered by adjustment for maternal age and body mass index. The intraobserver reproducibility of OA-PI and OA-PSV ratio in the same eye was high. The correlation between the right and left eyes was moderate for OA-PI (r = 0.63 (95% CI, 0.53-0.72), P < 0.001) and strong for OA-PSV ratio (r = 0.81 (95% CI, 0.75-0.86), P < 0.001). OA-PI and OA-PSV ratio had a weak or no correlation with UtA-PI and maternal hemodynamic parameters, meaning that they can be used as independent predictors for pre-eclampsia. Gestational age had no clinically relevant effect on OA-PI and OA-PSV ratio, suggesting that these indices could be measured without adjustment at any time between 11 and 23 weeks' gestation. OA Doppler indices had high intraobserver reproducibility and were strongly correlated between the right and left eyes. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Efficacy of neuromuscular electrical stimulation with modern rehabilitation techniques in the treatment of acute ischemic stroke patients with post-motor dysfunction.

Acute ischemic stroke (AIS) refers to a sudden loss of blood flow in a region of the brain, which leads to a loss of neurological function. To unveil the efficacy of neuromuscular electrical stimulation (NMES) with modern rehabilitation techniques in AIS patients with post-motor dysfunction. A total of 200 AIS patients with post-motor dysfunction were divided into groups A, B, C, and D (n = 50). Patients in the four groups were routinely treated with medicine, on this basis: group B received NMES treatment; group C received modern rehabilitation technology treatment; and group D was treated with NMES and modern rehabilitation technology. Rehabilitation effect, cerebral hemodynamic indices, neurological function recovery, Fugl-Meyer Assessment (FMA) and Motor Assessment Scale (MAS) scores, self-care, and quality of life were compared. After treatment, the total effective rate of group D was 96% higher than that of group A (64%), group B (82%), and group C (84%). Bilateral middle cerebral artery Vm and Vs and scores of FMA, MAS, functional independence measure, and modified Barthel index increased; RI and NHISS scores decreased; and all group D improved significantly versus groups A, B, and C, and both groups B and C improved significantly versus group A. NMES with modern rehabilitation technologies synergistically treat motor dysfunction after AIS with ideal rehabilitation effect, improving cerebral hemodynamics, neurological and limb motor function recovery, and self-care ability and quality of life.

Association of maternal body mass index with hemodynamic and vascular alterations at 35-37 weeks' gestation.

Globally, one in four pregnant women is classified as overweight or obese, based on their prepregnancy body mass index (BMI). Obese pregnant women are at increased risk of adverse pregnancy outcomes and long-term cardiovascular disease that occurs earlier in life. This study aimed to assess maternal hemodynamic and vascular parameters at 35-37 weeks' gestation, to understand the alterations that may occur in association with increased maternal BMI and gestational weight gain, and to evaluate obesity-related pregnancy outcomes. This was a prospective observational study of 11 731 women with a singleton pregnancy attending for a routine hospital visit at 35 + 0 to 36 + 6 weeks' gestation at King's College Hospital, London, UK, between December 2021 and June 2024. Women were categorized based on their BMI at 11-13 weeks' gestation, as normal weight (BMI, 18.5-24.9 kg/m2), overweight (BMI, 25.0-29.9 kg/m2) or obese (BMI, ≥ 30 kg/m2). We recorded details regarding maternal demographic characteristics and medical history, used Doppler ultrasound to assess the uterine artery pulsatility index (UtA-PI) (as a marker for uteroplacental perfusion) and ophthalmic artery peak systolic velocity (PSV) ratio (as a marker for small vessel peripheral circulation), and measured carotid-to-femoral pulse-wave velocity, augmentation index (as direct and indirect markers of aortic stiffness, respectively), cardiac output, total peripheral resistance (TPR), and central systolic and diastolic blood pressure. Multivariable analysis was performed to examine the relationship of BMI and gestational weight gain with hemodynamic and vascular measures, adjusting for maternal demographics, medical history, pregnancy characteristics and pregnancy outcomes (including pre-eclampsia and gestational diabetes mellitus). Overweight and obese women were more often of black ethnicity, and had higher central systolic and diastolic blood pressure, cardiac output, aortic stiffness and UtA-PI, compared with normal-weight women. There was no significant difference between overweight or obese women and normal-weight women with regard to TPR and ophthalmic artery PSV ratio. On multivariable analysis, increasing BMI at 11-13 weeks and gestational weight gain between 11-13 weeks and 35-37 weeks were independently associated with increases in all cardiovascular indices (including ophthalmic artery PSV ratio), apart from TPR. Women with a high BMI in early pregnancy vs normal-weight women, and those with higher gestational weight gain, had worse maternal hemodynamic and vascular indices at 35-37 weeks' gestation, independent of baseline and pregnancy characteristics. Our findings support the notion that optimization of prepregnancy weight and gestational weight gain may improve maternal hemodynamics and vascular function during pregnancy, and therefore may improve pregnancy outcomes. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Improving prognostic evaluations in patients with stage IIIb light chain cardiac amyloidosis: role of haemodynamic parameters

BackgroundThere is no unified prognostic scoring system for light chain cardiac amyloidosis (AL-CA), particularly stage IIIb AL-CA. This study aimed to use invasive haemodynamic information to investigate markers that can more accurately evaluate the prognosis of patients with stage IIIb AL-CA.MethodsIn this retrospective cohort study, we conducted invasive haemodynamic measurements concurrently with myocardial biopsies to diagnose AL-CA. We used Cox regression analysis and time-dependent receiver operating characteristic curve analysis to study the associations between these measurements and overall mortality. Echocardiographic parameters were also recorded and analysed via logistic regression to explore their relationships with haemodynamic changes.ResultsAlthough traditional haemodynamic parameters, such as the cardiac index (CI), pulmonary artery wedge pressure (PAWP), pulmonary artery pressure, and vascular resistance, did not correlate with mortality, the PAWP/CI ratio emerged as a vital prognostic marker. Patients with a PAWP/CI ratio above 11 mmHg/L/min/m2 had markedly poorer survival. Kaplan‒Meier analysis highlighted the prognostic significance of the ratio, revealing distinct survival differences. Furthermore, logistic regression confirmed that echocardiographically measured pulmonary artery systolic pressure independently correlated with increases in the PAWP/CI ratio.ConclusionsIn stage IIIb AL-CA patients, the PAWP/CI ratio, which surpasses traditional haemodynamic indicators, significantly predicts all-cause mortality, emphasizing its prognostic value. Our findings suggest that echocardiography-derived PASP could alternatively reflect the PAWP/CI ratio.

Clinical efficacy of antibiotic-loaded bone cement and negative pressure wound therapy in multidrug-resistant organisms diabetic foot ulcers: a retrospective analysis.

The purpose of this study was to investigate the clinical efficacy of antibiotic-loaded bone cement (ALBC) combined with Negative pressure wound therapy (NPWT) aspiration technique in the treatment of multidrug-resistant diabetic foot ulcers (MDRO-DFUs). A retrospective analysis of the clinical data of 80 patients with MDROs-DFU who were used Vacuum sealing drainage (VSD) as NPWT excipient and met the inclusion criteria from January 2019 to January 2024 at our hospital. Patients were divided into an experimental group and a control group, with 40 cases in each. The control group received conventional treatment, routine debridement, and NPWT treatment, while the experimental group received ALBC treatment in addition to the treatment plan of the control group. Measurements of blood inflammatory indicators, foot hemodynamic indicators, wound bacterial clearance time, wound healing time, and hospital stay were taken before and after treatment for both groups. Inflammatory indexes, Vascular endothelial growth factor(VEGF), and internal diameter of dorsalis pedis arteriosus of both groups after treatment were significantly better than those before treatment, and the improvement of the experimental group was more obvious than that of the control group; the experimental group had a significantly shorter time of trauma bacterial turnover, healing time of trauma, and hospitalization time compared with that of the control group (P<0.05).

The effect of sciatic nerve block on sciatic nerve depth and pain level in patients with ankle fracture based on different approaches under ultrasound guidance.

To investigate the clinical efficacy of using different approach sciatic nerve blocks on the sciatic nerve depth and pain degree in patients with ankle fracture. A retrospective analysis was conducted on 151 patients with ankle fractures who were admitted to the hospital from May 2020 to May 2023. The patients were divided into a control group (n=76) using the greater trochanteric plane approach (GTA) and an observation group (n=75) using the suprapopliteal approach (PA). Perioperative related indexes, pain levels, muscle strength, hemodynamic indexes, and adverse reactions were compared between the two groups. There was no significant difference in operation time between the two groups. The nerve block operation time and onset time were lower in the observation group, while the maintenance time of nerve block was higher in the observation group(P<0.05). The visual analogue scale (VAS) scores at 2h, 12h, and 24h postoperatively were lower in the observation group. Muscle strength of the posterior femoral muscle group was significantly better in the observation group at 8h after surgery. Hemodynamic indexes were lower in the observation group at 15minutes and 30minutes after anesthesia. The total incidence of adverse reactions was lower in the observation group compared to the control group. Ultrasound-guided sciatic nerve block using the suprapopliteal approach in patients with ankle fractures can help stabilize muscle strength and hemodynamics, alleviate pain symptoms, and avoid motor block and adverse reactions. This approach is recommended for adoption.

Correlation Between the Inferior Vena Cava/Aorta (Ivc/Ao) Ratio and Serum Lactate Levels in Children With Renal Disorder.

Acute kidney injury (AKI) is common in critically ill children in the PICU, with incidence rates from 2.5% to 58%, impacting mortality and hospital duration. Early AKI detection is vital, but conventional hemodynamic monitoring often lacks specificity. This study investigates the relationship between the inferior vena cava/aortic (IVC/Ao) ratio and serum lactate levels as non-invasive indicators of renal hemodynamics and tissue perfusion in children. Understanding these parameters could improve early diagnosis, aid clinical decisions, and enhance outcomes for pediatric AKI patients, offering an accessible monitoring method for clinicians. This cross-sectional study involved 48 pediatric patients aged 5-18 years showing Pediatric Early Warning Score (PEWS) ≥3 and diagnosed with renal disorders. Patients were admitted to the emergency department, high care unit, PICU, and pediatric ward at Dr. Hasan Sadikin Hospital, Bandung, between May and August 2023. AKI was diagnosed using pRIFLE or KDIGO criteria. The IVC/Ao ratio was assessed via transabdominal USG, and serum lactate levels were measured. Spearman correlation analysis was conducted to assess their relationship. The median (IQR) IVC/Ao ratio was 0.91 (0.70-1.10), and serum lactate levels were 1.5 (1.1-2.4) mmol/L. Spearman correlation analysis revealed a negative correlation between the IVC/Ao ratio and serum lactate (rho = -0.65, p < 0.001). A decrease in the IVC/Ao ratio correlates with an increase in serum lactate levels in children with AKI.

Uncertainty Quantification and Sensitivity Analysis for Non-invasive Model-Based Instantaneous Wave-Free Ratio Prediction.

The main objectives of this work are to validate a 1D-0D unsteady solver with a distributed stenosis model for the patient-specific estimation of resting haemodynamic indices and to assess the sensitivity of instantaneous wave-free ratio (iFR) predictions to uncertainties in input parameters. We considered 52 patients with stable coronary artery disease, for which 81 invasive iFR measurements were available. We validated the performance of our solver compared to 3D steady-state and transient results and invasive measurements. Next, we used a polynomial chaos approach to characterise the uncertainty in iFR predictions based on the inputs associated with boundary conditions (coronary flow, compliance and aortic/left ventricular pressures) and vascular geometry (radius). Agreement between iFR and the ratio between cardiac cycle averaged distal and aortic pressure waveforms (resting ) obtained through 1D-0D and 3D models was satisfactory, with a bias of 0.0-0.005 (±0.016-0.026). The sensitivity analysis showed that iFR estimation is mostly affected by uncertainties in vascular geometry and coronary flow (steady-state parameters). In particular, our 1D-0D method overestimates invasive iFR measurements, with a bias of -0.036 (±0.101), indicating that better flow estimates could significantly improve our modelling pipeline. Conversely, we showed that standard pressure waveforms could be used for simulations, since the impact of uncertainties related to inlet-pressure waveforms on iFR prediction is negligible. Furthermore, while compliance is the most relevant transient parameter, its effect on iFR estimates is negligible compared to that of vascular geometry and flow. Finally, we observed a strong correlation between iFR and resting , suggesting that steady-state simulations could replace unsteady simulations for iFR prediction.

Endograft-specific hemodynamics after endovascular aneurysm repair: a CFD analysis

Intraluminal prosthetic graft thrombus (IPT) has been described in case of endovascular aortic pathology repair. This study aimed to assess hemodynamic indicators associated with various anatomical morphologies following endovascular aortic repair (EVAR), aiming to offer further references for the choice of clinical therapy. Six model models (normal, iliac compression, aortic compression, aortoiliac compression, iliac distortion, and long-leg stent) were established based on common anatomical morphologies following EVAR. Hemodynamic indicators, such as flow velocity, time-average wall shear stress (TAWSS), oscillatory shear stress index (OSI), and relative residence time (RRT), were captured using computational fluid dynamics (CFD), and the differences between the six models were examined. The peak blood flow velocity at the compressed side iliac artery and the uncompressed side iliac artery corresponding to the aortoiliac artery compression model and the aortic compression model decreased by 30.63% to 48.62%, compared with that in the normal model. Compared with that in the normal model, the peak blood flow velocity at the aorta and the distorted side iliac artery in the iliac distortion model decreased by 7.89% and 41.13%, respectively. The length of the iliac artery stent has little effect on the blood flow velocity. The TAWSS at Iliac grafts showed varying degrees of decline in the other three compression models, particularly in the aortic compression model compared to the normal model. The TAWSS increases at the corner of the artery showing distortion but exhibited a significant decrease toward the distal end of the corner. The areas with higher OSI, and longer RRT were concentrated in the aortoiliac compression model and the iliac distortion model. We found that endograft compression and distortion may be risk factors for IPT. Moreover, the influence of longer stents on the hemodynamics inside stent-grafts is negligible. However, future real-world studies should be conducted to test and verify this speculation.

A Retrospective Study to Investigate the Relationship Between Body Mass Index and Hemodynamic Characteristics in Hypertensive Patients.

The relationship between hemodynamic parameters and body mass index (BMI) in the context of blood pressure regulation in hypertension is unclear. Here, we analyzed data from 1368 uncontrolled hypertensive patients, including key hemodynamic indicators such as heart rate (HR), cardiac index (CI), arterial stiffness (AS), systemic vascular resistance index (SVRI), and thoracic blood ratio (TBR). In this cohort, the average BMI across all hypertension patients was 26.859±3.897 (kg/m2), with obese patients (BMI≥28kg/m2) averaging 31.01±2.87kg/m2 and non-obese (BMI<28kg/m2) averaging 24.70±2.28kg/m2. Younger obese patients exhibited higher diastolic pressures than non-obese peers (p<0.01). Hemodynamic analysis showed obese patients had increased HR and SVRI but lower CI and AS (p<0.01). Hypertensive males aged under 60 with obesity displayed a more prominent peripheral vascular phenotype (p<0.05) and volemic phenotype (p<0.01) than non-obese males. Obese females aged under 60 showed a higher incidence of cardiac phenotype (p<0.01). Across genders, obese hypertensive patients aged over 60 had a greater prevalence of volemic phenotype than non-obese patients (p<0.05, p<0.01, respectively). BMI inversely correlated with CI and positively with SVRI across age and gender categories (p<0.01). Taken together, we find that patients with hypertension exhibit diverse hemodynamic profiles, and BMI significantly correlates with hemodynamic parameters such as SVRI and CI. Our research identifies BMI as a valuable target for personalized hypertension treatment.

The influence of intermittent venovenous hemodiafiltration on the course of acute kidney injury in multiple trauma victims

Background. Acute kidney injury (AKI) is a common complication of polytrauma that requires renal replacement therapy (RRT) in 10 to 28 % of cases. RRT methods can be divided into discrete, or intermittent, and continuous. There are currently no clear recommendations regarding the choice of the RRT method. The purpose was to study the effect of intermittent venovenous hemodiafiltration (HDF) on indicators of renal function, hemodynamics, homeostasis and inflammation in multiple trauma victims with rhabdomyolysis and AKI. Materials and methods. Fifty victims with multiple trauma complicated by rhabdomyolysis and AKI were examined. We investigated the levels of total creatine kinase and myoglobin, indicators of kidney function, frequency of vasopressor support, indicators of general blood analysis, liver complex, coagulogram, acid-base and gas composition of blood. The study was conducted upon admission, before the start and after the end of each HDF session and on the last day of treatment. Results. Multiple trauma with massive rhabdomyolysis led to AKI, manifested by oliguria and hyperazotemia (and from the 3rd day, by hyperkalemia), as well as cardiovascular failure, anemia, liver dysfunction, and inflammatory response. AKI progression to renal failure despite conservative therapy led to the beginning of HDF on 3.6 ± 0.8 days of hospital stay. HDF allowed to effectively reduce indicators of the renal complex and normalize the potassium level, and at the same time did not have a negative effect on hemostasis or other indicators of homeostasis. 72.9 % of victims needed two HDF sessions, 47.9 % — three, 31.3 % — four or more. The most pronounced reduction of hyperazotemia was observed after the second session. Among the survivors, restoration of adequate diuresis by the day 14 was observed in 39.3 % of cases. The mortality rate was 34.0 %. Laboratory markers of renal function were not significantly different between survivors and deceased; the difference was in markers of liver function, coagulogram and acid-base balance, as well as the need for vasopressor support. That is, the mortality was due to the progression not so much of kidney failure, but of the failure of other organs and systems. It should also be noted that the injury severity score among survivors was 23.5 ± 4.0 points, and among non-survivors — 40.5 ± 6.8 points (p &lt; 0.001). Conclusions. Multiple trauma with massive rhabdomyolysis leads to the development of multiple organ failure. Intermittent HDF allows to quickly and effectively reduce azotemia and normalize potassium levels without adversely affecting coagulation or other indicators of homeostasis. Most multiple trauma victims need 2 or more sessions of HDF. Mortality remains high and primarily depends on the severity of anatomical injuries and the addition of other organs and systems failure.

Состояние гемодинамики спортсменов с поражением опорно-двигательного аппарата при физических нагрузках разной направленности

Adequate haemodynamic indices for the body’s optimal functioning during physical activity is the main condition for an athlete’s effective performance. In healthy athletes, certain changes in the circulatory system due to the type of exercise occur, which are not always of a positive adaptive nature. For athletes with musculoskeletal disorders, such changes are poorly described in literature. The purpose of this study was to assess haemodynamic changes in athletes with musculoskeletal disorders depending on the type of physical activity. Materials and methods. The research involved 93 people, including 52 athletes with various forms of musculoskeletal disorders and 41 healthy athletes. The mean age of athletes with musculoskeletal disorders was 27.4 ± 4.1 years, and that of healthy athletes was 25.3 ± 1.5 years. The length of training was 5.4 ± 1.2 and 7.3 ± 2.6 years, respectively. During the 1st stage of the research, we used baseline haemodynamic values to analyse the state of the circulatory system in athletes with musculoskeletal disorders and healthy subjects doing various types of exercises in their training process. The 2nd stage involved studying changes in the functional haemodynamic resources of athletes with musculoskeletal disorders in response to a graded exercise test. Results. At rest, peripheral haemodynamic indices (systolic blood pressure, mean arterial pressure, and peripheral vascular resistance) in athletes with musculoskeletal disorders were found to be higher, while central haemodynamic indices (stroke volume and cardiac output) lower than in healthy athletes. Physical load activates resources allowing the cardiovascular system to work more intensely in athletes with musculoskeletal disorders. We found that haemodynamic changes in groups of athletes with musculoskeletal disorders correspond to those in groups of healthy athletes with a similar focus of the training process. In athletes with musculoskeletal disorders, the most negative changes in haemodynamics and strain of the adaptive mechanisms are caused by the predominance of static exercises and strength training.

Method for evaluating volume responsiveness during the passive leg raising test

Accurate fluid assessment is essential in critically ill patients, as both fluid insufficiency and fluid excess can result in adverse outcomes. The passive leg raising test (PLR) is a dependable and simple method of evaluating fluid responsiveness. Its accuracy and specificity have been validated over the past decade. Consequently, we have compiled a list of indicators that can be used to predict fluid responsiveness. By selecting more suitable hemodynamic indicators, fluid therapy can be more effectively guided.

Assessment of the development of the central nervous system in fetuses with fetal growth restriction.

To evaluate the development of the central nervous system in fetuses with fetal Growth Restriction. A total of 146 pregnant women who underwent prenatal ultrasonography in Cangzhou People's Hospital from January 2022 to May 2024 were selected, all with singleton pregnancies. Among them, 73 fetuses were in the fetal growth restriction group, with ages ranging from 20 to 33 + 6weeks. The indicators for evaluating the cerebral sulci included the depth and angle of the parietooccipital sulci, the width and depth of the sylvian fissure, the width of the uncovered insula, uncover insular ratio, the depth of the calcarine sulci, and the head circumference. The hemodynamic indicators comprised the ratio of the umbilical artery resistance index, the umbilical artery pulse index, the middle cerebral artery resistance index, the middle cerebral artery pulse index, and the cerebral placental blood flow pulse index. The above parameters were analyzed statistically. In this study, the depth of the parietooccipital sulci, the depth of the calcarine sulci, and the width of the sylvian fissure were smaller in the fetal growth restriction group than those in the control group, and the angle of the parietooccipital sulci and the width of the uncovered insula were larger than those in the control group (all P < 0.05). The fetal middle cerebral artery resistance index, middle cerebral artery pulsation index and cerebroplacental pulsation ratio in the FGR group were lower than those in the control group (all P < 0.05). The development of the cerebral cortex in FGR fetuses is slower than that in normal fetuses, and the alteration of fetal hemodynamics might be one of the reasons for the delayed development of the cerebral cortex in FGR fetuses.

Computational hemodynamic indices to identify Transcatheter Aortic Valve Implantation degeneration

Background and Objectives:Structural Valve Deterioration (SVD) is the main limiting factor to the long-term durability of the bioprosthetic valves used for Transcatheter Aortic Valve Implantation (TAVI), a minimally invasive technique for the treatment of severe aortic stenosis. The aim of this retrospective study is to perform patient-specific computational analyses of blood dynamics shortly after TAVI to identify hemodynamic indices that correlate with a premature onset of SVD which is detected at 5-10 years long-term follow-up exam after TAVI. Methods:The study population comprises fourteen patients: seven cases with SVD at long-term follow-up were identified and seven cases without SVD were randomly extracted from the same cohort. Starting from pre-operative CT images, we created trustworthy post-TAVI scenarios by virtually inserting the bioprosthetic valve (stent and leaflets) and we qualitatively validated such virtual scenarios against post-TAVI CT scans, when available. We then performed numerical simulations imposing personalized inlet conditions based on patient-specific Echo Doppler cardiac output measurements and the numerical results were post-processed to identify suitable hemodynamics indices with the aim of discriminating between the SVD and non-SVD groups of patients. In particular, differences in terms of each individual index were evaluated using a Wilcoxon rank-sum test. Moreover, we defined three synthetic scores, based on suitably scaled hemodynamic indices of stress and vorticity, evaluated in different contexts: on the leaflets, in the ascending aorta, and in the whole domain. Results:We found that the hemodynamic index related to leaflets’ OSI individually shows statistically significant differences (p=0.007) between the SVD and non-SVD groups. Moreover, our proposed synthetic scores are able to clearly isolate the SVD group both in a two-dimensional space given by the aorta and leaflets scores and by only considering the global synthetic score. Conclusion:The results of this computational study suggest that blood dynamics may play an important role in creating the conditions that lead to SVD. Moreover, the proposed synthetic scores could provide further indications for clinicians in assessing and predicting TAVI valves’ long-term performance.

Efficacy of Information-Motivation-Behavioral Skills ModelBased nursing care intervention in management of patients with Heart Failure: A retrospective cohort study.

Self-care practices are integral part of heart failure (HF) management. Information-Motivation-Behavioral skills (IMB) model has shown promise in fostering better self-care behaviors, but its efficacy in management of HF patients remains underexplored. This retrospective study investigated the value of IMB model-based nursing intervention for improving self-care, hemodynamic indicators, and quality of life (QOL) of HF patients. This retrospective study involved 308 HF patients treated at a tertiary care hospital from January 2021 to January 2023. Patients were grouped based on the received nursing care. The intervention group contained patients who received IMB model-based nursing intervention (n=151), and a control group included patients who got routine nursing care (n=157). IMB intervention comprised information delivery, motivation enhancement, and behavioral skills training. Key outcomes included self-care behavior measured by the Self-Care of HF Index (SCHFI), quality of life, assessed by the Minnesota Living with HF Questionnaire (MLHFQ), and hemodynamic parameters including Left Ventricular End-Systolic Diameter (LVESD), Left Ventricular End-Diastolic Diameter (LVEDD), and Left Ventricular Ejection Fraction (LVEF). IMB model-based nursing intervention was significantly more effective in improving the condition of HF patients than the routine nursing care, including better SCHFI and MLHFQ scores and improved hemodynamic parameters (LVESD, LVEDD, and LVEF) (P<0.05). Variation in different analysis further confirmed the efficacy of the IMB model-based nursing intervention. IMB model-based nursing intervention significantly improved self-care behavior, QOL, and hemodynamic parameters in HF patients. This mode of nursing care has a potential as a valuable strategy for enhancing HF management.

Профілактика артеріальної гіпертензії як складової метаболічного синдрому

Purpose. To evaluate the features of the development of arterial hypertension in people with metabolic syndrome and to justify preventive measures. Object and research methods. 92 adult patients aged 40 to 49 years were examined, among them 73 women and 19 men. The survey was conducted among respondents using a questionnaire. General clinical indicators were recorded: determination of height, weight with subsequent calculation of body mass index (kg\m2), waist circumference, systolic and diastolic blood pressure. Among the laboratory indicators, the following results attracted attention: glucose, insulin, Homa index, leptin, creatinine, cystatin-c, glomerular filtration rate (GFR). Statistical processing of the results was carried out with the help of correlation analysis, definition of criteria of differences, graphic methods. Statistical processing of the results was carried out with the help of correlation analysis, definition of criteria of differences, graphic methods. During the research, the author adhered to the principles of bioethics and the Order of the Ministry of Health of Ukraine "On the approval of the Procedure for conducting clinical trials and the Standard Regulations on the Commission on Ethics No. 66 dated February 13, 2006, with amendments of 2006-2008. All patients signed an informed consent to participate in the study. Research results and their discussion. A register of respondents was created - adult men and women who were under the influence of a modified factor - overweight or obesity, which is a trigger for the prevalence of such conditions as insulin resistance, leptin resistance, arterial hypertension. The research found that 73% of the examined were overweight or obese. A reliable relationship between quantitative indicators was also confirmed using Pearson's correlation analysis (r) between waist circumference and age (r=0.55, p&lt;0.002), height (r=0.547, p&lt;0.002), weight (r=0.547, p&lt;0.002), BMI (r=0.753, p&lt;0.001), creatinine (r=0.548, p&lt;0.002). This once again confirms that waist circumference increases with age, height, weight, body mass index, and the increase in creatinine depends on waist circumference and height (r=0.364, p&lt;0.048). Thanks to the analysis of variance, reliable relationships were found between quantitative and rank indicators: Homa's index and sport (F=1.809, P=0.049), as well as leptin and sport (F=1.809, P=0.049), leptin and weight (F=0.644, P=0.035). Conclusions. An in- depth comprehensive examination with the simultaneous determination of anthropometric, hemodynamic, and hormonal indicators of the state of health made it possible to justify preventive measures against metabolic syndrome. It was shown that 73.0% of respondents were overweight and obese, which can be considered a risk factor for the development of arterial hypertension. A reliable relationship between quantitative indicators was established using Pearson's correlation analysis (r) between waist circumference and age, height, weight, BMI, creatinine. It was determined that cystatin – c is negatively correlated with the rate of glomerular filtration in the absence of an increase in creatinine. People with metabolic syndrome (both men and women) are recommended to take preventive measures to prevent the development of complications of arterial hypertension. Keywords. Body mass index, arterial hypertension, metabolic syndrome.

ORGAN-SPARING AND ORGAN- REMOVING SURGICAL PROCEDURES FOR PATHOLOGICAL CONDITIONS OF THE SPLEEN IN CHILDREN. QUESTIONS AND ANSWERS.

Introduction. Nowadays splenic surgery is a rather urgent problem in pediatric surgery. There are diseases where only splenectomy allows a child to live a full life. These are: sickle cell anemia (SCA), idiopathic thrombocytopenic purpura, hereditary spherocytosis (Minkowski- Chauff ard disease), thalassemia, and autoimmune hemolytic anemia. The spleen is involved in 25-30 % of cases of blunt abdominal trauma in children. The loss of more than 45 % of the circulating blood volume leads to an unstable hemodynamic state in the child. The question of surgical treatment and preservation of the spleen in hemoperitoneum due to its injury is of vital importance. Aim: To study the possibilities of surgical treatment of diseases and injuries of the spleen in children. Materials and methods. An analysis of surgical interventions for diseases and injuries of the spleen in children aged 2 to 17 years from 2019 to 2024 was performed. The study was conducted in the surgical departments of the «Clinical Center of Pediatric Medicine» of the «Okhmatdyt Hospital» of the «Western Ukrainian Specialized Center» (Lviv) and the «Chernivtsi City Children’s Clinical Hospital» (Chernivtsi). 27 children (17 girls, 10 boys) had spleen diseases and 43 children (23 girls, 20 boys) had spleen injuries. Splenectomy was performed for the following splenic diseases: sickle cell anemia (9 children), idiopathic thrombocytopenic purpura (4 children), hereditary spherocytosis (Minkowski- Chauff ard disease) (6 children), thalassemia (1 child), and autoimmune hemolytic anemia (1 child). Six children had splenic cysts: 3 children had posttraumatic cysts and 3 children had parasitic cysts. Twenty children underwent surgery for splenic injuries. The following surgical procedures were performed: laparoscopic abdominal cavity repair with spleen preservation followed by conservative therapy (13 children); laparoscopic splenectomy (2 children); laparotomy, splenic suture (2 children); and open splenectomy (3 children).Results. Conservative management of splenic injuries of varying degrees according to the American Association for the Surgery of Trauma (AAST) was performed in 23 (53.49 %) children. Resorption of hemoperitoneum in cases of conservative treatment of splenic injuries occurred 11-14 days after the start of treatment. Safe, full physical activity was resumed after 6 weeks of conservative treatment of splenic injury. Surgical procedures were performed in 20 (46.51 %) children using various techniques. 17 patients underwent laparoscopy. 2 children underwent laparoscopic splenectomy for grade IV AAST injury and hemodynamic instability. In 15 cases, treatment was started with conservative therapy, but during monitoring an increase in hemoperitoneum was observed, indicating the need for laparoscopy. Laparoscopy was performed in 13 children. A minimum of 100 ml and a maximum of 400 ml of blood was collected laparoscopically in the children. The abdominal cavity was examined and hemostasis was confi rmed. In cases where the spleen was «wrapped» with the omentum, the omentum was not separated from the spleen. The operation was completed by placing a drainage tube in the perisplenic space. In 2 children, grade IV AAST injuries were converted to an open procedure in which the spleen was sutured to stop bleeding and a drain was left near the splenic bed. Grade V AAST splenic injury in 3 children was an indication for left subcostal laparotomy and splenectomy. For splenic disease, laparoscopic splenectomy was performed in 12 (44.44 %) children, with high effi cacy in Minkowski- Chauff ard disease combined with gallstones (3 children) where simultaneous cholecystectomy was possible. Laparoscopic removal of splenic cysts was also justifi ed in 3 (11.11 %) children. However, removal of parasitic cysts required open splenectomy in 3 patients. Open splenectomy was performed in 9 children with splenic disease. In 5 children the inappropriateness of laparoscopy was due to severe perisplenitis, large spleen weight and young age of the children.Conclusions1. The morpho- functional structure of the spleen promotes spontaneous hemostasis, which is the basis for conservative treatment of spleen injuries in 53.49 % of children.2. The AAST classifi cation of splenic injuries from grade I to V, hemodynamic indicators and ultrasound monitoring of blood in the abdominal cavity can be used as a basis for choosing the method of treatment of closed blunt splenic injuries in children.3. Ineff ectiveness of conservative treatment, hemodynamic instability and increase of blood in the abdominal cavity in a child with splenic injury within 4 hours is an indication for laparoscopy.4. Splenic suturing and laparoscopic monitoring should be the preferred methods for treating closed splenic injuries in children to preserve the organ.5. The choice of surgical intervention for splenic diseases in children should be individualized and depend on the disease, the child’s age, the size of the spleen, and the presence of complications of the disease.

Abstract 4132909: Hemodynamic Indices of Right Ventricular Function Differentially Predict Adverse Clinical Outcomes in Heart Failure with Preserved vs Reduced Ejection Fraction

Background: While the critical role of right ventricular dysfunction (RVD) in heart failure (HF) is increasingly recognized, the prevalence and prognostic impact of RVD across HF subtypes is poorly understood. Research Questions/Aims: We aimed to characterize differences in hemodynamic indices of RV function among patients with HF with preserved vs reduced ejection fraction (HFpEF, EF≥50% vs HFrEF, EF&lt;50%) and to examine associations of RVD with longitudinal clinical outcomes by HF subtype. Methods: We identified patients with prevalent HF undergoing clinically indicated right heart catheterization at Massachusetts General Hospital (2005-2016). We examined three RV hemodynamic indices: right atrial to wedge pressure ratio (RA/PCWP), RV stroke work index (RVSWI), and pulmonary artery pulsatility index (PAPi). We used multivariable linear regression to assess differences in RV indices in HFpEF vs HFrEF. We then used Cox models to examine the association of each index with HF hospitalizations (HFH), major adverse cardiac events (MACE), and death, stratified by HF subtype. Models were adjusted for age, sex, BMI, hypertension, diabetes, lung disease, sleep apnea, and prior MI. Results: Of 2,062 patients (age 66 years, 33% women), 1,242 (60%) had HFrEF and 820 (40%) had HFpEF. RVD (RVSWI &lt;450 mm Hg*ml/m 2 ) was present in 27% of HFrEF vs 21% of HFpEF patients. Those with HFpEF had higher RA/PCWP (β 0.12, SE 0.05, p=0.012) and RVSWI (β 0.22, SE 0.05, p&lt;0.001) relative to HFrEF. Over 4.1 median years follow-up, 915 HFH, 1,066 MACE, and 1,116 death events occurred. Among those with HFrEF, lower PAPi was associated with greater risk of HFH (HR 0.84 (0.77, 0.92); p&lt;0.001) and MACE (HR 0.88 (0.81, 0.96); p=0.003), and higher RVSWI was associated with greater risk of death (HR 1.17, (1.07, 1.27); p&lt;0.001, Figure ). In contrast, in those with HFpEF, only higher RA/PCWP was associated with greater risk of death (HR 1.11 (1.00, 1.23); p=0.042). Conclusion: RVD occurs frequently in both HFrEF and HFpEF, and hemodynamic measures of RV function are associated with greater risk of MACE, death, and HFH. Importantly, the prognostic value of RV indices varied by HF subtype, highlighting key differences in the role of RVD in HFrEF vs HFpEF.