Low Perfusion Research Articles

Ankle-Brachial Index and Energy Production in People Without Peripheral Artery Disease: The BLSA.

BackgroundLower ankle‐brachial index (ABI) values within the 0.90 to 1.40 range are associated with poorer mitochondrial oxidative capacity of thigh muscles in cross‐sectional analyses. Whether ABI decline is associated with greater declines in thigh muscle oxidative capacity with aging is unknown.Method and ResultsWe analyzed data from 228 participants (100 men) of the BLSA (Baltimore Longitudinal Study of Aging), aged 39 to 97 years, with an ABI between 0.9 and 1.40 at baseline and at follow‐up (mean follow‐up period of 2.8 years). We examined mitochondrial oxidative capacity of the left thigh muscle, by measuring the postexercise phosphocreatine recovery rate constant (kPCr) from phosphorus‐31 magnetic resonance spectroscopy. Greater kPCr indicated higher mitochondrial oxidative capacity. Although kPCr was available on the left leg only, ABI was measured in both legs. Longitudinal rates of change (Change) of left and right ABI and kPCr of the left thigh muscle were estimated using linear mixed effects models, and their association was analyzed by standardized multiple linear regressions. In multivariate analysis including sex, age, baseline kPCr, both left and right baseline ABI, and ABI change in both legs, (kPCr)Change was directly associated with ipsilateral (left) (ABI)Change (standardized [STD]‐β=0.14; P=0.0168) but not with contralateral (right) (ABI)Change (P=0.22). Adjusting for traditional cardiovascular risk factors, this association remained significant (STD‐β=0.18; P=0.0051). (kPCr)Change was steeper in White race participants (STD‐β=0.16; P=0.0122) and body mass index (STD‐β=0.13; P=0.0479). There was no significant association with current smoking status (P=0.63), fasting glucose (P=0.28), heart rate (P=0.67), mean blood pressure (P=0.78), and low‐density lipoprotein (P=0.75), high‐density lipoprotein (P=0.82), or triglycerides (P=0.15).ConclusionsIn people without peripheral arterial disease, greater decline in ABI over time, but not baseline ABI, was associated with faster decline in thigh mitochondrial oxidative capacity in the ipsilateral leg. Further studies are needed to examine whether early interventions that improve lower extremity muscle perfusion can improve and prevent the decline of muscle energetics.

Brain grey matter perfusion in primary progressive multiple sclerosis: Mild decrease over years and regional associations with cognition and hand function.

Extent and dynamic of neurodegeneration in progressive multiple sclerosis (MS) might be reflected by global and regional brain perfusion, an outcome at the intercept between structure and function. Here, we provide a first insight into the evolution of brain perfusion and its association with disability in primary progressive MS (PPMS) over several years. Seventy-seven persons with PPMS were followed over up to 5years. Visits included a 3-T magnetic resonance imaging with pulsed arterial spin labelling perfusion, the Timed 25-Foot Walk, 9-Hole Peg Test (NHPT), Symbol Digit Modalities Test (SDMT), and Expanded Disability Status Scale (EDSS). We extracted regional cerebral blood flow surrogates and compared them to 11 controls. Analyses focused on cortical and deep grey matter, the change over time, and associations with disability on the regional and global levels. Baseline brain perfusion of patients and controls was comparable for the cortex (p=0.716) and deep grey matter (p=0.095). EDSS disability increased mildly (p=0.023), whereas brain perfusion decreased during follow-up (p<0.001) and with disease duration (p=0.009). Lower global perfusion correlated with higher disability as indicated by EDSS, NHPT, and Timed 25-Foot Walk (p<0.001). The motor task NHPT showed associations with 20 grey matter regions. In contrast, better SDMT performance correlated with lower perfusion (p<0.001) in seven predominantly frontal regions, indicating a functional maladaptation. Decreasing perfusion indicates a putative association with MS disease mechanisms such as neurodegeneration, reduced metabolism, and loss of resilience. A low alteration rate limits its use in clinical practice, but regional association patterns might provide a snapshot of adaptive and maladaptive functional reorganization.

The effect of Buerger Allen Exercise Versus Reflexology on Lower Extremity Perfusion and Pain among Patients with Type 2 Diabetes Mellitus

The effect of Buerger Allen Exercise Versus Reflexology on Lower Extremity Perfusion and Pain among Patients with Type 2 Diabetes Mellitus

The role of perfusion index and plethysmography variability index for predicting dehydration severity in patients with acute gastroenteritis

Background:Acute gastroenteritis is a clinical syndrome that may cause severe dehydration in affected individuals and a reason of mortality and morbidity in all age groups. Measurement of perfusion index and plethysmography variability index may provide emergency physicians valuable information about hemodynamics of the patient.Objectives:Our study aimed to investigate the role of perfusion index and plethysmography variability index measurement at admission for estimating dehydration severity and determiningthe possible change in those parameters after fluid replacement among patients presenting to emergency department with acute gastroenteritis.Methods:This was a prospective cross‐sectional study. Patients diagnosed with acute gastroenteritis at the emergency department were consecutively enrolled. The two groups were defined according to the severity of dehydration: mild and moderate/severe dehydration groups. The values of perfusion index and plethysmography variability index of all patients were measured.Results:A total of 180 patients were included in the study. As compared with the mild dehydration group, moderate/severe dehydration group had a significantly lower perfusion index value and significantly higher plethysmography variability index value on admission (p &lt; 0.001 for both comparisons). Among moderate/severe dehydration patients, perfusion index value significantly increased and plethysmography variability index significantly decreased after treatment (p &lt; 0.001). There was a significant positive correlation between osmolarity and plethysmography variability index (r = 0.298; p = 0.007) and a significant negative correlation between osmolality and perfusion index (r = −0.259; p = 0.019) in the patients with moderate/severe dehydration.Conclusion:The study show that perfusion index and plethysmography variability index may be useful for determining the severity of dehydration in acute gastroenteritis and may be use for assessing the response to fluid replacement especially in patients with severe dehydration at emergency department.

Utility of indocyanine green angiography in delaying breast reconstruction postmastectomy

BackgroundPerfusion mapping with indocyanine green angiography (ICGA) in breast reconstruction can change intraoperative plans and reduce the risk of flap necrosis. We evaluated the utility of ICGA in the decision to delay reconstruction postmastectomy and its predictive power for necrosis.MethodsSingle-institution retrospective study of implant-based breast reconstructions following mastectomy using ICGA from 2015 to 2021. A decision was made to proceed with immediate reconstruction or delay reconstruction based on clinical assessment and perfusion analysis. Incidence of complications in the immediate and delayed cohorts were assessed. Intraoperative ICGA perfusion values were correlated with postoperative outcomes to calculate diagnostic accuracy.ResultsThree hundred twenty breast reconstructions were performed. Two hundred fifty-nine of these underwent immediate reconstruction, while 61 underwent delayed reconstruction due to poor perfusion. Median time between mastectomy and delayed reconstruction was 7.3 days (range, 4–21 days). All 8 cases (3.1%) of necrosis were in the immediate cohort. Cases of necrosis had significantly lower intraoperative ICGA perfusion values compared to cases without necrosis (absolute values 13.1 versus 27.1 units, p = 0.017). Increasing our ICGA cut-off score for necrosis from 14 to 22 units would have increased sensitivity from 63 to 100% but reduced specificity from 70 to 48%.ConclusionsDelayed breast reconstruction due to poor perfusion on ICGA resulted in no cases of necrosis. A higher ICGA cut-off score for predicting necrosis is more sensitive but less specific. ICGA is useful as a supplement rather than a substitute for clinical assessment in flap perfusion evaluation.Level of Evidence Level III, Risk / Diagnostic Study.

Increase in thalamic cerebral blood flow is associated with antidepressant effects of ketamine in major depressive disorder

Ketamine is a promising treatment option for patients with Major Depressive Disorder (MDD) and has become an important research tool to investigate antidepressant mechanisms of action. However, imaging studies attempting to characterise ketamine’s mechanism of action using blood oxygen level-dependent signal (BOLD) imaging have yielded inconsistent results- at least partly due to intrinsic properties of the BOLD contrast, which measures a complex signal related to neural activity. To circumvent the limitations associated with the BOLD signal, we used arterial spin labelling (ASL) as an unambiguous marker of neuronal activity-related changes in cerebral blood flow (CBF). We measured CBF in 21 MDD patients at baseline and 24 h after receiving a single intravenous infusion of subanesthetic ketamine and examined relationships with clinical outcomes. Our findings demonstrate that increase in thalamus perfusion 24 h after ketamine administration is associated with greater improvement of depressive symptoms. Furthermore, lower thalamus perfusion at baseline is associated both with larger increases in perfusion 24 h after ketamine administration and with stronger reduction of depressive symptoms. These findings indicate that ASL is not only a useful tool to broaden our understanding of ketamine’s mechanism of action but might also have the potential to inform treatment decisions based on CBF-defined regional disruptions.

Is There a Role for the Vascular Laboratory in Supporting Home-Based Vascular Rehabilitation Programs?

A pilot study assessing the efficacy of a nonsupervised exercise program for intermittent claudication is described, and case descriptions of 4 patients are presented. The ankle/brachial index (ABI) has long been the standard for evaluating lower limb perfusion; however, the ABI is not reliable with noncompressible arteries. Pedal acceleration time (PAT), a novel technique that quantifies perfusion using duplex ultrasound by measuring the acceleration time of the arterial waveform, has been found to be more reliable. When considering only ABI, nonsupervised exercise is not sufficient management of claudication in peripheral arterial disease (PAD), but PAT may be more sensitive to changes in collateral blood flow developed by exercise. We initiated a pre-post study from a single institution over 6 weeks that included a walking program for patients with claudication with modified resistance band exercises for amputees. Changes in symptoms, smoking, and the perfusion markers of resting ABI and anterior pedal and posterior pedal PAT were monitored. Of the 4 patients described, 3 noted symptomatic improvement with categorical improvement in PAT. Compliant patients do report success with at-home exercise regimens. Patients who are unsuccessful may benefit from supervised vascular rehabilitation. PAT, in comparison with ABI, may offer a better approach to monitor this progression and offer a stepwise approach to the management of PAD.

The Role of the Artery of Ligamentum Teres in Revascularization in Legg-Calve-Perthes Disease.

A recent cadaveric study supported that most immature hips are supplied by the artery of ligamentum teres and suggested this medial vascular source may influence the pattern of revascularization in Legg-Calve-Perthes disease (LCPD). The purposes of this study were to characterize the perfusion pattern of the capital femoral epiphysis and determine the role of the artery of ligamentum teres in early revascularization of LCPD. Retrospective review of perfusion magnetic resonance imaging (pMRI) from 64 hips in early stage LCPD (Waldenström stage I to IIa) was performed. Two independent graders categorized perfusion pattern based on the presence of perfusion medially (from artery of ligamentum teres) and/or laterally (from the medial femoral circumflex artery) on coronal and sagittal MRI series: type 1-lateral perfusion only, type 2-separate medial and lateral perfusion, or type 3-coalescent medial and lateral perfusion. Lateral pillar classification was obtained for hips that reached mid-fragmentation. We identified 64 patients (75% male) with mean age at diagnosis of 8.5±2.1 years. 36% (23/64) hips underwent pMRI during stage I and 64% (41/64) during stage IIa. pMRI revealed separate and distinct medial and lateral sources of perfusion (type 2) in 50% (32/64) hips. In stage I, the distribution of type 1/2/3 hips was found to be 26%/52%/22%. However, in stage IIa there was a nonsignificant trend toward greater coalescence of the medial and lateral perfusion with a distribution of type 1/2/3 of 7%/49%/44% (P=0.07). There was a nonsignificant trend toward weak negative linear correlation between lower initial perfusion grade and worsened lateral pillar classification at mid-fragmentation (r=-0.25, P=0.05). The presence of separate and distinct areas of perfusion of medial and lateral capital femoral epiphysis provides further evidence of the role of the ligamentum teres vessels in revascularization during the early stages of LCPD. The changes in perfusion pattern with disease progression likely reflect that medial femoral circumflex artery and ligamentum teres vessel revascularization occur separately, but ultimately coalesce posteriorly over time. Level II-prognostic study.

Vascular complications based on mode of extracorporeal membrane oxygenation

BackgroundVascular complications remain a prevalent and devastating complication of extracorporeal membrane oxygenation (ECMO). Risks for vascular complications have risen as the volume and medical complexity of ECMO cases has rapidly increased in recent years. This study assesses occurrence and clinical impact of vascular complications across all ECMO modes and cannulation methods in a high-volume academic center. MethodsA retrospective single-institution review was performed of all ECMO cannulations for central or peripheral venovenous (VV) or venoarterial (VA) ECMO in 2019-2020. Patients who expired during cannulation were excluded. Primary outcomes of vascular consultation rates at or after ECMO placement, limb loss, and mortality were assessed during index hospitalization. ResultsA total of 229 patients were identified during the 2-year study period. VA ECMO was used in the majority of patients (n = 137, 60%), with 83% (N = 114) undergoing peripheral cannulation. Vascular surgery was consulted in 54 (23.6%) patients. Complication rates ranged from 33.9% in peripheral VA cannulation to 7% in jugular VV cannulation. Overall, 65% of vascular consults required operative intervention; interventions were highest in peripheral VA ECMO (n = 30 of 114, 26.3%). Across all ECMO types, acute limb ischemia (ALI) was the most common complication (n = 38, 16.5%), with rates ranging from 26.1% in central VA ECMO to 4.8% in jugular VV ECMO. Distal antegrade perfusion catheters (DPCs) were employed in n = 68 of 114 (59.6%) of all peripheral VA ECMO cases. Prophylactic DPCs were found to be incorrectly placed in 10.2% (n = 7 of 68) of cases, which obscured the ability to fully evaluate the effect of prophylactic DPCs on reducing rates of ALI. Major amputation (Below Knee Amputation/Above Knee Amputation) occurred in six peripheral VA patients (5.3%), two central VA patients (8.65), and two femoral-femoral VV patients (4%). Patients with ALI experienced significantly lower rates of in-hospital survival in Kaplan-Meier analysis (32.5% vs 54%, log-rank = 0.023). ConclusionsThis study highlights the prevalence of vascular complications, and their associated mortality impact, across all modes of ECMO and additionally identifies several areas for institutional performance improvement. ALI was the most common complication across all cohorts and was associated with decreased in-hospital survival. The impact of DPC on ALI was difficult to elucidate due to nonstandardized placement patterns and selective use. In the care of these medically complex patients on multidisciplinary teams, review of outcomes and group discussions targeting areas for improvement are critical to success; in this study, findings resulted in the development of a lower extremity perfusion management protocol.

Effectiveness of the choice of the optimal method for surgical treatment of genital prolapse

AIM: This study aimed to evaluate the effectiveness of the choice of surgical method for treating genital prolapse, depending on the intensity of pelvic floor tissue perfusion.&#x0D; MATERIALS AND METHODS: The study assessed the relationship of extragenital pathology, medical history of women operated for genital prolapse and medical history of women without genital prolapse during peri- and post-menopause (control group, n=67) with indicators of vaginal perfusion intensity. Overall, 328 patients with pelvic organ prolapse (IIIV degree) underwent surgery according to the Pelvic Organ Prolapse Quantification system. Of these, 287 patients were examined after 2 years to diagnose disease recurrence; these patients were included in the main study group (n=287). For statistical processing of the obtained results, the STATISTICA 10.0 and EViews 12.0 software packages were used.&#x0D; RESULTS: Correlation analysis revealed an inverse relationship between vaginal microcirculation intensity with age (rs=0.187; р=0.025), menopause duration (rs=0.390; р=0.001), genital prolapse duration (rs=0.245; р=0.046), and surgical menopause (rs=0.442; р 0.001). The study of microcirculation intensity in the anterior and posterior vaginal walls, depending on the presence of somatic diseases, revealed an inverse correlation with diseases such as hypertension (rs=0.291; р 0.001), coronary heart disease (rs=0.169; р=0.044), and diabetes mellitus (rs=0.223; р=0.008). When choosing a method of surgical treatment that minimizes the contact of mesh prosthesis with native tissues in women with comorbid pathology, a relapse of the disease after 2 years was detected in only 2.4% women.&#x0D; CONCLUSION: The choice of the optimal method for treatment in patients with somatic burden and low perfusion capacity of pelvic organs and tissues can reduce the number of complications after surgical treatment of pelvic prolapse.

Quantification of near-infrared fluorescence imaging with indocyanine green in free flap breast reconstruction

One of the complications of free flap breast reconstruction is the occurrence of skin and fat necrosis. Intra-operative use of near-infrared (NIR) fluorescence imaging with Indocyanine Green (ICG) has the potential to predict these complications. In this study, the quantification of the fluorescence intensity measured in free flap breast reconstruction was performed to gain insight into the perfusion patterns observed with ICG NIR fluorescence imaging. ICG NIR fluorescence imaging was performed in patients undergoing free flap breast reconstruction following mastectomy. After completion of the arterial and venous anastomosis, 7.5mg ICG was administered intravenously. The fluorescence intensity over time was recorded using the Quest Spectrum Platform®. Four regions of interest (ROI) were selected based on location and interpretation of the NIR fluorescence signal: (1) The perforator, (2) normal perfusion, (3) questionable perfusion, and (4) low perfusion. Time-intensity curves were analyzed, and two parameters were extracted: Tmax and Tmax slopes. Successful ICG NIR fluorescence imaging was performed in 13 patients undergoing 17 free flap procedures. Region selection included 16 perforators, 17 normal perfusions, 8 questionable perfusions, and 5 low perfusion ROIs. Time-intensity curves of the perforator ROIs were comparable to the ROIs of normal perfusion and demonstrated a fast inflow. No outflow was observed for the ROIs with questionable and low perfusion. This study provides insight into the perfusion patterns observed with ICG NIR fluorescence imaging in free flap breast reconstruction. Future studies should correlate quantitative parameters with clinical perfusion assessment and outcome.

Arterial Collapse during Thrombectomy for Stroke: Clinical Evidence and Experimental Findings in Human Brains and In Vivo Models.

Aspiration thrombectomy has become a preferred approach to recanalize large-vessel occlusion in stroke with a growing trend toward using larger-bore catheters and stronger vacuum pumps. However, the mechanical response of the delicate cerebral arteries to aspiration force has not been evaluated. Here, we provide preclinical and clinical evidence of intracranial arterial collapse in aspiration thrombectomy. We presented a clinical case of arterial collapse with previously implanted flow diverters. We then evaluated the effect of vacuum with conventional aspiration catheters (with and without stent retrievers) in a rabbit model (n = 3) using fluoroscopy and intravascular optical coherence tomography. Then, in a validated human cadaveric brain model, we conducted 168 tests of direct aspiration thrombectomy following an experimental design modifying the catheter inner diameter (0.064 inch, 0.068 inch, and 0.070 inch), cerebral perfusion pressures (mean around 60 and 90 mm Hg), and anterior-versus-posterior circulation. Arterial wall response was recorded and graded via direct transluminal observation. Arterial collapse was observed in both the patient and preclinical experimental models. In the human brain model, arterial collapse was observed in 98% of cases in the M2 and in all the cases with complete proximal flow arrest. A larger bore size of the aspiration catheter, a lower cerebral perfusion pressure, and the posterior circulation in comparison with the anterior circulation were associated with a higher probability of arterial collapse. Arterial collapse does occur during aspiration thrombectomy and is more likely to happen with larger catheters, lower perfusion pressure, and smaller arteries.

Muscle-Skeletal Abnormalities and Muscle Oxygenation during Isokinetic Strength Exercise in Heart Failure with Preserved Ejection Fraction Phenotype: A Cross-Sectional Study.

Exercise intolerance, a hallmark of patients with heart failure (HF), is associated with muscle weakness. However, its causative microcirculatory and muscle characteristics among those with preserved or reduced ejection fraction (HFpEF or HFrEF) phenotype is unclear. The musculoskeletal abnormalities that could result in impaired peripheral microcirculation are sarcopenia and muscle strength reduction in HF, implying lowered oxidative capacity and perfusion affect transport and oxygen utilization during exercise, an essential task from the microvascular muscle function. Besides that, skeletal muscle microcirculatory abnormalities have also been associated with exercise intolerance in HF patients who also present skeletal muscle myopathy. This cross-sectional study aimed to compare the muscle microcirculation dynamics via near-infrared spectroscopy (NIRS) response during an isokinetic muscle strength test and ultrasound-derived parameters (echo intensity was rectus femoris muscle, while the muscle thickness parameter was measured on rectus femoris and quadriceps femoris) in heart failure patients with HFpEF and HFrEF phenotypes and different functional severities (Weber Class A, B, and C). Twenty-eight aged-matched patients with HFpEF (n = 16) and HFrEF (n = 12) were assessed. We found phenotype differences among those with Weber C severity, with HFrEF patients reaching lower oxyhemoglobin (O2Hb, μM) (−10.9 ± 3.8 vs. −23.7 ± 5.7, p = 0.029) during exercise, while HFpEF reached lower O2Hb during the recovery period (−3.0 ± 3.4 vs. 5.9 ± 2.8, p = 0.007). HFpEF with Weber Class C also presented a higher echo intensity than HFrEF patients (29.7 ± 8.4 vs. 15.1 ± 6.8, p = 0.017) among the ultrasound-derived variables. Our preliminary study revealed more pronounced impairments in local microcirculatory dynamics in HFpEF vs. HFrEF patients during a muscle strength exercise, combined with muscle-skeletal abnormalities detected via ultrasound imaging, which may help explain the commonly observed exercise intolerance in HFpEF patients.

Low Flow and Microvascular Shunts: A Final Common Pathway to Cerebrovascular Disease: A Working Hypothesis.

Low flow and microvascular shunts (MVS) is the final common pathway in cerebrovascular disease. Low flow in brain capillaries (diam. 3-8μm) decreases endothelial wall shear rate sensed by the glycocalyx regulating endothelial function: water permeability; nitric oxide synthesis via nitric oxide synthase; leucocyte adhesion to the endothelial wall and penetration into the tissue; activation of cytokines and chemokines initiating inflammation in tissue. Tissue edema combined with pericyte and astrocyte capillary constriction increases capillary resistance. Increased capillary resistance diverts flow through MVS (diam. 10-25μm) that are non-nutritive, without gas exchange, waste or metabolite clearance and cerebral blood flow (CBF) regulation. MVS predominate in subcortical and periventricular white matter. The shift in flow from capillaries to MVS is a pathological, maladaptive process. Low perfusion in the injured tissue exacerbates brain edema. Low blood flow and MVS alone can lead to all of the processes involved in tissue injury including inflammation and microglial activation.

Precision radiotherapy by SPECT lung functional imaging in NSCLC

Background: Single Photon Emission Computed Tomography (SPECT) could be used to avoid the non-affected perfusion areas in patients with non-small-cell lung cancer (NSCLC) and to potentially reduce lung toxicity. The aim of this study is to compare dosimetric differences between two different 3D-conformal treatment plans, with and without CT/SPECT contribution. Methods: Simulation Computed tomography (CT) scans were accurately co-registered with SPECT scans and three different areas, based on SPECT intensity perfusion, were contoured: low perfusion (LP), medium perfusion (MP) and high perfusion (HP). Two different 3D-conformal plans, with co-planar and nonco-planar fields, were generated; one without SPECT information (anatomic plan), and one using the perfusion area identified with functional imaging (functional plan). Results: 9 patients were planned and a total of 18 plans were available for analysis. Anatomical and functional plans resulted in comparable planning target volume (PTV) coverage. In the functional plans, a significant reduction of dose in high perfusion areas was reported. The reduction of HP-V20 Gy values ranged from 15% to 8% (p = 0.046), the ipsiHP-V20 Gy from 38% to 22% (p = 0.028) and ipsiHP-Dmean reduction from 16 Gy to 12 Gy (p = 0.039). No significant differences in other organs at risk (OARs) metrics were reported between anatomical and functional plans. Conclusions: Despite the few cases reported, the strength of our study lies in the reported benefit of functional lung information in 3D conformal radiation planning, without compromising target coverage or worsening dose distribution to the OARs. There is an urgent need for prospective clinical and randomized trials in order to define the role of lung functional imaging in reducing toxicity in clinical practice.

Differences in bovine placentome blood vessel density and transcriptomics in a mid to late-gestating maternal nutrient restriction model.

Prenatal development is reliant on a functioning placenta, which can be influenced by maternal nutrition. Moreover, the variation in cotyledonary capacity within an animal has not been fully examined to date. Therefore, the purpose of this study was to determine the effect of (1) placentome size and (2) maternal nutrient restriction on molecular, microscopic, and macroscopic features of bovine placentomes during late gestation. Pregnant cows (n=6) were placed into one of 2 treatments: CON (100% NRC) vs RES (60% of NRC) from day 140 until slaughter at day 240 of gestation. Placentomes of various sizes were perfused to assess macroscopic blood vessel density of the cotyledon. Microscopic imaging and RNA extraction for sequencing was performed. Macroscopic blood vessel density relative to placentome weight was not different (P=0.42) among small, medium, or large placentomes. Cotyledonary microscopic blood vessel number, area, and perimeter was increased (P<0.005) in high versus low blood perfusion areas. Differential expressed gene (DEG) analysis showed 209 upregulations and 168 downregulations in the RES group (P≤0.0001). Gene Ontology (GO) analysis showed that downregulated enriched terms were involved in blood vessel and mesenchymal stem cells development, whereas upregulated enriched terms were involved with translation and ribosomal function. This study demonstrates that placentome function is uniform across various placentome sizes within an animal. However, microscopic heterogeneity exists within each placentome. Maternal nutrient constraints alter placental transcriptomics which may yield compensatory mechanisms involved in nutrient transport including increased perimeter.

“A Study to Assess the Effectiveness” of Planned Teaching Programme on Knowledge and Practice Regarding Buerger Allen Exercise Among Traffic Police with Diabetes Mellitus of Selected Urban Areas”

Background: Occupational health workers spending most of the day on their feet, every working day are at greater risk of health problems including varicose vein, poor circulation and swelling in the feet’s and legs, foot problems, and joint damage. Early detection of the condition could lead to treatment that offers the potential to reduce the incidence of fatal as well as to also improve the quality of life. Aim: The aim of the study was to assess knowledge and practice regarding Buerger Allen exercise on the lower extremity perfusion among traffic police before and after planned teaching. Methodology: Quantitative (descriptive evaluatory) research approach and one group pre-test- post-test research design (pre-experimental) is used. The study was conducted in selected urban areas of Mumbai with sample consisted of 60 traffic police personnel. Structured questionnaire was prepared to assess knowledge and self-reported questionnaire was used to assess practice. Planned teaching program with demonstration on Buerger Allen exercise was the intervention of the study provided to the samples. Results: The overall pre-test mean knowledge score and the overall pre-test mean practice score was found to be 8.42. The overall post-test mean knowledge score and practice score was found 15.05 and 6.48, respectively. The “t” value (P = 0.05) for knowledge score was 18.21 and for practice score 24.87 which indicates the effectiveness of planned teaching program regarding Buerger Allen exercise.

The relationship of carotid artery disease with mental and neurocognitive disorders

Carotid stenosis constitutes a common vascular disease that significantly affects cerebral blood flow and thus is associated with patients' cognitive functions. Carotid revascularization techniques [carotid endarterectomy (CEA) and carotid artery stenting (CAS)] may benefit cognition, though there are opposing findings, reporting an apparent decrement in cognitive function, no effect, or an apparent improvement after revascularization. A great number of studies are trying to evaluate the effect of carotid revascularization (CEA, CAS) on patients' cognitive functions, as well as on their psychological condition and quality of life through a baseline and follow-up neuropsychological examination. Recent reviews refer only to the narrow limits of cognitive deficits that may be attributed to carotid stenosis, rather than elucidating the outfit of all aspects of mental and cognitive correlations. Most of those findings depict controversy in current literature as far as the neuropsychological effects of carotid revascularization techniques are concerned, while clinical entities of "vascular dementia" and "vascular depression", as well as intercurrent vascular risk factors are also addressed. This might be taken into consideration, when determining the optimal therapeutic strategy for tackling carotid artery occlusive disease, while best practice clinical decisions should be still focused on stroke prevention and symptoms alleviation, until further research on the field of neuroangiology presents undisputable conclusions regarding the underlying effects of revascularization on mood and cognition. Τhe neurovascular interface, as far as mental and neurocognitive impact of carotid stenosis is concerned, also, comprises, the conceptual pathophysiological entity of "atheroinflammation", underscoring the association of vascular lesions with cognitive impairment, major depressive disorder and bipolar disorder. Chronic recurrent ischemia and chronic low perfusion are also addressed from neurocognitive aspect, regarding therapeutic strategies that might be preferred so as to reduce the burden of chronic cerebrovascular disease in both symptomatic and asymptomatic patients, given the fact that inflammatory processes of vascular complexion underlie both neuroinflammation and atherosclerosis, affecting cerebral perfusion as well as cortical blood flow.

Dynamic susceptibility contrast MRI may contribute in prediction of stereotactic radiosurgery outcome in brain metastases.

BackgroundFollowing stereotactic radiosurgery (SRS), predicting treatment response is not possible at an early stage using structural imaging alone. Hence, the current study aims at investigating whether dynamic susceptibility contrast (DSC)-MRI estimated prior to SRS can provide predictive biomarkers in response to SRS treatment and characterize vascular characteristics of pseudo-progression.MethodsIn this retrospective study, perfusion-weighted DSC-MRI image data acquired with a temporal resolution of 1.45 seconds were collected from 41 patients suffering from brain metastases. Outcome was defined based on lesion volume changes in time (determined on structural images) or death. Motion correction and manual lesion delineation were performed prior to semi-automated, voxel-wise perfusion analysis. Statistical testing was performed using linear regression and a significance threshold at P = .05. Age, sex, primary cancers (pulmonary cancer and melanoma), lesion volume, and dichotomized survival time were added as covariates in the linear regression models (ANOVA).ResultsRelative cerebral blood volume (rCBV) and relative cerebral blood flow (rCBF) were found to be significantly lower prior to SRS treatment in patients with increasing lesion volume or early death post-SRS (P ≤ .01).ConclusionUnfavorable treatment outcome may be linked to low perfusion prior to SRS. Pseudo-progression may be preceded by a transient rCBF increase post-SRS. However, results should be verified in different or larger patient material.

Effects of wearing removable dentures and aging on palatal mucosa blood flow by laser doppler.

The purpose of this work is to analyze the effects of removable dental prostheses and aging on blood microcirculation in the palatal mucosa. Blood flow was measured in two groups using the Laser Doppler Flowmeter at three specific anatomical sites: Retro incisive papilla, medial raphe, and Schroeder area. Group 1 included young, healthy dentulous individuals (mean age: 23 ± 3 years), and Group 2 contained elderly edentulous individuals (mean age: 62 ± 11.69 years). For Group 1, measurements were taken in a single session; for Group 2, the measurements were taken in two sessions: The first just before the prosthetic load (E1) and again 1 week after new dentures were provider (E2). Statistical analyses were performed using SAS software, Version 9.4 of the SAS System for Windows, Copyright © 2017 SAS Institute Inc. (Cary, NC, USA). A P < 0.05 was classified as statistically significant. Measurements of blood flow of the palatal mucosa showed that the healthy young dentulous participants had significantly lower perfusion unit values than the elderly edentulous participants at all three anatomical sites (P < 0.05). For Group 2, the comparisons between the measurements taken before (E1) and after (E2) new dentures were provided showed no significant differences. Our results indicate that the process of aging significantly modifies the blood flow of the palatal mucosa while wearing removable dental prostheses does not modify the blood flow of the palatal mucosa in a 1week period. These results are not influenced by systemic pathology (e.g., diabetes, cardiovascular diseases) or smoking.