Nonvascular Causes Research Articles

Should antinuclear antibodies (ANA) be used to screen for connective tissue disease in neurological patients?

Patients with connective tissue diseases (CTD) can have a wide range of neurological manifestations. Neurological complaints may be the presenting symptom of CTD. Therefore, screening for CTD using anti-nuclear antibodies (ANA) is a common practice. However, due to the abundance of positive ANA in a healthy population, interpretation of the results may be complex. we retrospectively evaluated files of patients hospitalized for evaluation of neurological symptoms in Sheba Medical Center during the years 2007-2022. Data was collected regarding epidemiology, ANA status, and rheumatological diagnosis. 4723 patients' files were reviewed. Of them, 46.6% were positive for ANA. 6.9% of them were diagnosed with CTD. This population had significantly higher rates of positive ANA status (71.2% vs 28.8%, p<0.001), was significantly older (59.4 vs 53.4years, p<0.001) and had a significantly higher ANA titer (1:484.8, 1:268 p<0.001) compared to patients without CTD. Factors which were found predictive for CTD diagnosis included female gender, older age, ANA titer above 1:160, and the diagnosis of a non-vascular etiology for the neurological disease. Females, older patients, patients with high ANA titer and with diagnosis of a non-vascular cause to their neurological complains may be more likely to harbor a CTD and should probably be further evaluated.

Long-term clinical and imaging outcomes of patients undergoing percutaneous femoral intervention following TAVI-related vascular access complications

Abstract Introdcution: Vascular access complications (VAC) are the most common in-hospital adverse event following transcatheter aortic valve implantation (TAVI). Often, ileo-femoral VAC requires bail-out percutaneous interventions with either prolonged balloon inflation and/or stent implantation. The long-term outcomes of these procedures have not been characterized. We aim to assess the clinical and imaging outcomes of patients who underwent bailout percutaneous vascular interventions due to VAC following TAVI. Methods Single-centre prospective study including all consecutive patients with a VAC following trans-femoral TAVI, between 2015-July 2023. VAC was defined as uncontrolled bleeding, acute occlusion or flow limiting stenosis of the femoral vessel leading to percutaneous treatment. Clinical and imaging follow-up was performed with bilateral arterial ultrasound (US) Doppler to assess patency and peak systolic velocity of common femoral arteries. Results A total of 1518 patients underwent TF-TAVI, of which 107 (7%) underwent concomitant ileo-femoral percutaneous angioplasty (PTA) intervention in the same day as TAVI. In patients submitted to PTA, 7 were treated to gain access for TAVI, and 100 (7%) were performed to treat vascular access complications. At a mean follow-up time of 23±3 months, 37 patients died (37%), 6 (16%) from in-hospital complications and 31 (84%) from non-vascular causes after discharge. From the surviving 63 patients (study group) – mean age 83±6 years-old, 29% male, 46% with previous peripheral arterial disease –, 24 underwent bilateral US. Unable to perform imaging on 39 patients due to geographical or mobility issues. At a mean follow-up time of 30±23 months, only 6 patients (10%) reported intermittent claudication, of which 4 (67%) had pre-TAVI symptoms. No patient had at rest symptoms or amputation history. All but one had patent vessel on US. The mean peak systolic velocity of the treated vessel and the contralateral vessel were 71.1±22.9cm/s and 73.1±23.8cm/s, respectively, with no statistically significant difference between them in each patient (mean difference 1.9±25.4, p=0.709). We found no statistically significant differences between peak systolic velocities between both vessels in each patient, accordingly with the treated vessel (Table 2). Conclusion This prospective study shows that patients submitted to percutaneous bailout iliofemoral interventions have a very low rate of lower limb adverse events with very good patency rates at mean follow up of 2.5 years.

Effectiveness of Proprioceptive Neuromuscular Facilitation and Strengthening Exercise towards Increasing Strength Stroke Patient's Hand Muscles at Tani Dan Nelayan Regional General Hospital

Stroke is a functional brain disorder that occurs suddenly with focal or global clinical signs that last more than 24 hours without signs of non-vascular causes, including signs of subarachnoid hemorrhage, intracerebral hemorrhage, ischemia, or cerebral infarction. The aim of this research is to analyze the effectiveness of proprioceptive Neuromuscular Facilitation (PNF) and Strengthening Exercises to Increase Hand Muscle Strength in Stroke Patients at the Farmers and Fishermen's Hospital, Boalemo Regency. Quaisy experimental research designed two groups pre-test and post-test design. The sample was 30 people, sampling used the purposive sampling technique. Analysis was carried out using the paired t-test and independent t-test. The results of the research were that there was a difference in Hand Muscle Strength values between those given Proprietary Neuromuscular Facilitation (PNF) with Strengthening Exercise with (p-value 0.039). The conclusion of this research is the provision of Proprioceptive Neuromuscular Facilitation (PNF). better in increasing hand muscle strength values compared to the Strengthening Exercise. It is recommended that the Farmers and Fishermen's Hospital of Boalemo Regency, in providing healing to stroke patients, apply Proprioceptive Neuromuscular Facilitation and Strengthening Exercise therapy as a complementary therapy for healing stroke patients.

Abstract WMP77: In-Hospital Mortality Sex Differences in Young Adults With Intracerebral Hemorrhage

Introduction: Intracerebral hemorrhage (ICH) accounts for 10-20% of strokes and is associated with severe disability and high mortality. While males are reported to have worse outcomes in older patients with ICH, data are limited regarding sex differences in mortality risk after ICH for younger patients. Methods: We conducted a cross-sectional study of 134 adults aged 18-44 admitted to our academic medical center with ICH from 01/01/2012-12/31/2021, using data from an internal stroke registry and the Intracerebral Hemorrhage Outcomes Project (ICHOP). All vascular and non-vascular causes were included other than trauma. We used logistic regression models to calculate odds ratios (OR) and 95% confidence intervals (CI) for the association between sex and in-hospital mortality, adjusting for comorbidities and presence of multicompartmental hemorrhage (including intraventricular extension). Results: Characteristics of the study sample are summarized in the Table. Males had higher proportion of chronic hypertension and subcortical ICH location. Adjusting for hypertension, ICH location, multicompartmental extension, and use of antiplatelet medication, males had higher odds of death (OR 4.0, 95% CI 1.1-15.4) than females. Functional outcomes at discharge are shown in the Figure. Conclusion: In our cohort of young adults with ICH, males had 4-fold higher odds of in-hospital death than females. Future research should investigate the social and biological mechanisms that may underlie sex differences in mortality for young adults with ICH, including differences in ICH etiology, and potentially differential withdrawal of life sustaining treatment.

The Effect of Motor Relearning Program on Daily Living Activity and Dynamic Balance in Non-Hemorrhagic Post Stroke Hemiparese Patients at Grandmed Lubuk Pakam Hospital

Stroke is a functional disorder of the brain that can occur suddenly or abruptly with focal or global neurological signs that can last 24 hours or more (if no surgery or death occurs) without any signs of non-vascular causes, which include signs of subarachnoid hemorrhage, intracerebral hemorrhage, ischemia or cerebral infarction. This can cause disturbances in vital brain functions such as coordination disorders, balance disorders, posture control disorders, sensation disorders and movement reflex disorders, thereby reducing the ability to carry out daily living activities and balance disorders. The motor relearning program method is a program for retraining specific motor controls by avoiding unnecessary or wrong movements that involve cognitive processes, the application of motor and psychological science, training, understanding of nervous anatomy and physiology and is not based on the theory of normal development (neuro development). The research aims to determine the effect of the motor relearning program on daily living activities and dynamic balance disorders in post-stroke patients. The method used in this research is a quasi experiment with one group pretest and post test design. The research sample consisted of 9 people. The samples will be observed and adjusted to the specified criteria so that they do not cause problems. Each respondent was measured 2 (two) times, namely before and after the intervention. Test the hypothesis using the Wilcoxon test. The research results obtained a value of p = 0.000 (p=&lt;0.05), which means there is a significant influence of the motor relearning program intervention on daily living activities and dynamic balance disorders in post-stroke patients. The results of this research can be concluded that the motorbike relearning program can improve daily living activities and dynamic balance disorders in patients after non-hemorrhagic stroke. It is hoped that the results of this research can contribute to health services for the community in overcoming the problems of daily living activities and dynamic balance disorders in post-stroke patients.

Stroke Mimics: Insights from a Retrospective Neuroimaging Study

Objectives: The study’s goals are to evaluate the management of Stroke Mimics (SMs), conditions with stroke-like symptoms but non-vascular origins. It seeks to assess the effect of unnecessary intravenous thrombolysis on therapy delays and determine the best SMs diagnosis approach. Materials and methods: A review was conducted of all patients admitted to the Emergency Department under a “stroke code” from January 1, 2018, to January 31, 2019. Anamnestic and clinical data, along with information on neuroimaging protocols and findings, were collected. Advanced MRI sequences, such as Arterial Spin Labeling (ASL) MR perfusion and MR spectroscopy, were revised to confirm the diagnoses. Results: 513 stroke codes were found; a neurovascular disease was diagnosed in 414 cases: 282 ischemic strokes and 73 intracranial hemorrages and 59 TIAs. The 99 SMs included, 13 infections, 12 syncopes, 11 epileptic seizures, 11 hemodinamic conditions, 10 tumors, 9 metabolic disorders, 9 diziness, 7 migraines, 4 drug/alcohol intoxication, 3 functional disorders, 3 acute hydrocefalus, 2 multiple sclerosis, 2 arteriovenous malformations, 1 spinal cord compression and 2 unexplained conditions. Specific neuroimaging findings were evaluated for all cases. Positive and negative predictive values of clinical diagnosis of SM were respectively 0.23 and 0.35. 125 SM patients underwent MRI examination, 40 of which within 3 hours from the activation of stroke code. Advanced MRI sequences as ASL, MR perfusion, MR spectroscopy were used to reach the correct diagnosis. Conclusions: Advanced multimodal MRI can be a valuable tool in the assessment of, particularly in cases where conventional imaging techniques such as DWI-FLAIR mismatch are inconclusive. The novelty of this retrospective study is to demonstrate that the consistent use of arterial spin labeling perfusion in cases with stroke code leads to a rapid and accurate diagnosis of SMs. The implementation of an MRI-based pathway can expedite the diagnosis and treatment of underlying non-vascular causes such as SMs.

Risk factors associated with slit ventricle syndrome after ventriculoperitoneal shunt surgery

Objective: Slit ventricle syndrome (SVS) is defined as a slit-like appearance of the lateral ventricles with associated symptoms such as headache, vomiting, or drowsiness. The study investigated the risk factors associated with the incidence of SVS following ventriculoperitoneal shunt surgery.Methods: We retrospectively reviewed the medical records of patients who underwent ventriculoperitoneal shunt surgery from January 2011 to 2019 at a single institution. SVS was diagnosed by a slit-like appearance of the lateral ventricles and a low Evan’s ratio (&lt;0.25) on follow-up radiologic images. Results: SVS was diagnosed in 53 (18.2%) of 292 patients who underwent ventriculoperitoneal shunt surgery. The mean age of patients with SVS (48.3 years; range, 4–85 years) was significantly lower than the mean age of those without SVS (58.4 years; range, 0.5–85 years) (p=0.024). Male patients showed a slightly higher incidence of SVS, but the result was not statistically significant. Patients who had hydrocephalus with vascular causes (e.g. subarachnoid hemorrhage and intracranial hematoma) showed a significantly lower incidence of SVS than those with non-vascular causes (p=0.002).Conclusion: The incidence of SVS was higher in younger patients and in those with a non-vascular cause of hydrocephalus.

Плейотропные эффекты ипраглифлозина

Type 2 diabetes mellitus and its complications is a serious threat to the health and lives of the world's population. Among the causes of death in type 2 diabetes mellitus are both cardiovascular and non-vascular causes. Sodium-glucose cotransporter type 2 inhibitors are well-established drugs for the treatment of type 2 diabetes mellitus with various hemodynamic and metabolic effects. The range of pleiotropic effects is quite wide and includes an improvement in the lipid profile, a decrease in insulin resistance and body weight, a decrease in the risk of adverse cardiovascular outcomes, nephroprotection, as well as a positive effect on the course of non-alcoholic fatty liver disease. Recent data also testify to the antiproliferative effects of this group of drugs. Ipragliflozin is one of the representatives of the class of sodium-glucose cotransporter type 2 inhibitors, which is effective in terms of glycemic control in monotherapy and in combination with other hypoglycemic drugs. The BRIGHTEN and SPOTLIGHT studies have shown an association of ipragliflozin with increased HDL and lower triglycerides. Ipragliflozin contributes to the reduction of insulin resistance and body weight, as confirmed by the PRIME-V and ILLUMINATE studies. In some cases, regression of LV hypertrophy and a decrease of NT-proBNP were shown when taking ipragliflozin. The effect on the course of non-alcoholic fatty liver disease and the reduction of fibrosis, confirmed by liver biopsy, in patients with type 2 diabetes is the advantage of ipragliflozin. There is also evidence of the antiproliferative efficacy of ipragliflozin in various types of malignant neoplasms. The review highlights the effectiveness of ipragliflozin in relation to dyslipidemia, insulin resistance, cardiovascular outcomes in patients with type 2 diabetes mellitus, presents data on the positive effect of the drug on the course of NAFLD and type 2 diabetes, and also considers possible mechanisms of the antiproliferative effect of the drug.

HSV-2 Retinitis and Encephalitis Masquerading as Giant Cell Arteritis and Acute Ischemic Stroke of the Midbrain (P12-10.002)

<h3>Objective:</h3> To describe a unique case of stroke mimicry. <h3>Background:</h3> Non-vascular causes of acute neurological symptoms may clinically and radiographically mimic ischemic strokes. In the brainstem, such considerations are generally restricted to neoplastic, demyelinating, or infectious etiologies. HSV-2 may very rarely cause isolated mesencephalitis. <h3>Design/Methods:</h3> We describe a patient who presented with headache, arthralgias, and visual dysfunction who was initially diagnosed with giant cell arteritis (GCA) but was eventually found to have HSV-2 infection. <h3>Results:</h3> A 75-year-old man with past medical history notable for atrial fibrillation (on apixaban), hypertension, hyperlipidemia, and rheumatoid arthritis (on adalimumab) presented for evaluation of gait instability. Four weeks prior to presentation, he developed bitemporal headaches without visual symptoms and arthralgias. His rheumatologist checked an ESR (40) and ordered a temporal artery biopsy. He presented the day his apixaban was held prior to biopsy (1 week prior to this presentation) with right eye inferior visual field loss. Fundoscopy revealed disc edema felt consistent with anterior ischemic optic neuropathy. He was treated with pulse-dose steroids out of concern for GCA and underwent bilateral temporal artery biopsy before being discharged home on an oral steroid taper and resumed anticoagulation. CT, CTA, and MRI were reportedly normal and the biopsies were ultimately negative. He then presented this admission with gait instability and MRI exhibited a diffusion restricting lesion with T2-FLAIR hyperintensity without hemorrhage in the left cerebral peduncle. His visual symptoms progressed and he underwent right eye anterior chamber paracentesis with fluid resulting PCR positive for HSV-2. Subsequent CSF sampling also revealed lymphocytic pleocytosis and HSV-2 positivity. Despite maximal medical therapy, he lost vision in both eyes over a matter of weeks before developing Charles-Bonnet syndrome. <h3>Conclusions:</h3> HSV-2 encephalitis may cause mesencephalic, non-hemorrhagic, restricting lesions mimicking acute ischemic stroke. HSV may also cause a necrotizing retinitis, initially mimicking ischemic, even arteritic, optic neuropathy. <b>Disclosure:</b> Dr. Sutherland has received personal compensation in the range of $0-$499 for serving as a Consultant for McGraw-Hill. Dr. Gummerson has nothing to disclose. Dr. De Havenon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Integra. Dr. De Havenon has stock in Certus. The institution of Dr. De Havenon has received research support from NIH/NINDS. The institution of Dr. De Havenon has received research support from Regeneron Pharmaceuticals. The institution of Dr. De Havenon has received research support from AMAG Pharmaceuticals. The institution of Dr. De Havenon has received research support from AMGEN. Dr. De Havenon has received publishing royalties from a publication relating to health care.

Widened mediastinum at elderly: a challenge in the emergency room (ER)

A widened mediastinum is a feature often seen on a plain chest x-ray. When the mediastinum is greater than 6 to 8 cm, depending on which source, it is noted to be wide. A wide mediastinum has many causes which include thoracic aortic aneurysm of the ascending and proximal descending aorta, aortic dissection of ascending and proximal descending aorta, unfolding of the aorta, passing through traumatic aortic ruptura and non-vascular structural causes, such as hilar lymphadenopathy either infectious or malignant (lymphoma, seminoma, thymoma). At elderly, this finding constitutes a real challenge in the emergency room, which must be interpreted in the light of the hemodynamic condition of the patient, taking into account that in the scenario of chronic aortic syndrome it includes aneurysmal dilatations of the aortic root that can be dissected incompletely, presenting with latent intramural hematoma in ascending aorta until aortic tamponade with secondary obstructive shock.

Teeth and gums in diabetes

Teeth and gums in diabetes

Symmetry Function: The Differences between Active and Non-Active Above-the-Knee Amputees.

The number of patients with unilateral above-knee amputation (AKA) due to non-vascular causes has remained stable over the years, at 0.92 per 1000 people per year. Post-AKA individuals are at risk of experiencing a higher incidence of chronic pain. Post rehabilitation, it is estimated that between 16–62% of patients with musculoskeletal disabilities fail to meet the minimum criteria for physical activity in comparison to a healthy population. The current study included 14 participants (11 men and 3 women) with a mean age of 46.1 ± 14.2 years, body height of 1.76 ± 0.09 m, and weight of 79.6 ± 18.3 kg, who were all post-unilateral above-the-knee amputees. Patients in the study were divided into two groups: active (AC) and non-active (NAC). This study was conducted in a certified Laboratory of Biomechanical Analysis using the BTS Smart-E system (BTS Bioengineering). In order to investigate the symmetry function (SF) of gait, the only measurements included were the time series assessment of gait variables defining pelvic and lower limb joint motion and ground reaction forces (GRF). Both groups had an asymmetrical gait pattern with a different magnitude and relative position in the gait cycle, which was revealed by SF. The differences in terms of median, minimum, and maximum were statistically significant (p < 0.05), with SF ranging from –25 to 24% for the AC group and from 43 to 77% (59% on average) for the NAC group. The AC’s pattern was more symmetrical compared to the NAC’s pattern, especially in the case of pelvic and hip joint motion.

Effects of Handrail and Cane Support on Energy Cost of Walking in People With Different Levels and Causes of Lower Limb Amputation

ObjectiveThe energy cost of walking with a lower limb prosthesis is higher than able-bodied walking and depends on both cause and level of amputation. This increase might partly be related to problems with balance control. In this study we investigated to what extent energy cost can be reduced by providing support through a handrail or cane and how this depends on level and cause of amputation. DesignQuasi-experimental study. SettingRehabilitation gait laboratory. ParticipantsTwenty-six people with a lower limb amputation were included: 9 with vascular and 17 with nonvascular causes, 16 at transtibial, and 10 at transfemoral or knee disarticulation level (N=26). InterventionsParticipants walked on a treadmill with and without handrail support and overground with and without a cane. Main Outcome MeasuresEnergy cost was assessed using respirometry. ResultsOn the treadmill, handrail support resulted in a 6% reduction in energy cost on average. This effect was attributed to an 11% reduction in those with an amputation attributable to vascular causes, whereas the nonvascular group did not show a significant difference. No interaction with level of amputation was found. Overground, no main effect of cane support was found, although an interaction effect with cause of amputation demonstrated a small nonsignificant decrease in energy cost (3%) in the vascular group and a significant increase (6%) in the nonvascular group when walking with a cane. The effect of support was positively correlated with self-selected walking speed. ConclusionsThis study demonstrates that providing external support can contribute to a reduction in energy cost in people with an amputation due to vascular causes with reduced walking ability while walking in the more challenging condition of the treadmill. Although it is speculated that this effect might be related to problems with balance control, this will need further investigation.

Diabetic foot and peripheral arterial disease. Single centre experience.

Objectives:To determine the prevalence of vasculopathic diabetic foot and the associated factors in a Saudi tertiary center.Methods:This retrospective chart review included adult patients (≥18 years) diagnosed with diabetic foot between May 2015 and July 2019 in King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia. Based on clinical presentation and laboratory results, the patients were categorized into 2 groups namely, “vascular induced diabetic foot group” and “non-vascular induced diabetic foot group”.Results:A total of 404 diabetic patients were enrolled in the study. The mean age of the patients was 62.03±12.30 years; 61.9% were males. Most of the diabetic foot cases had a non-vascular etiology (n=327, 80.9%), while 77 cases (19.1%) were due to vasculopathy. Patient in the vascular group had a significantly higher incidence of coronary artery disease (32.5% versus 14.4%; p<0.001), and a higher incidence of peripheral artery disease (PAD) in the unaffected limb (22.1% versus 2.1%; p<0.001).Conclusion:Most cases of diabetic foot were due to non-vascular causes. Old age, history of coronary artery disease, or PAD in the unaffected limb were factors that were significantly associated with diabetic foot due to arterial disease.

The importance of balance and postural control in the recovery of stroke patients

Introduction.According to the criteria of WHO, stroke is a health condition that causes focal or global brain disorders (1), but without an apparent nonvascular cause. Stroke is considered the third leading cause of death in industrialized countries and accounts for 9% of all deaths, being considered one of the largest cases of disability in the world. Due to the medical, social and economic consequences that it causes, stroke is considered a public health issue. Purpose of research. The study starts from the idea that in the recovery of stroke patients it is important to have an individualized physiotherapy program adapted to the functional parts of each patient, having the role of improving the static and dynamic balance, of achieving postural control and finally functional independence. Material and method. The study included a number of 22 patients with sequelae stroke. They made physiotherapy, occupational therapy and occupational therapy sessions in the ambulatory, with the length of 1 hour, 3 times a week, in total 15 sessions. The evaluation of the patient was performed in the beginning of the treatment and at the end of it. Scales were used to assess mobility, static and dynamic balance, gait and functional independence. Results. The application of individualized treatment adapted to the functional body of each patient allowed a rapid recovery for the vast majority of the studied patients. The values obtained in the tests and evaluation scales are in accordance with the clinical evolution of the patients. Conclusions.The application of the treatment by kinetic therapy, work therapy and occupational therapy to the 22 patients, for a period of 3 weeks pointed out the reduction of pain, the improvement of movements, the recovery of transfers and gait, the postural improvement.

Combined effect of diabetic retinopathy and diabetic kidney disease on all-cause, cancer, vascular and non-cancer non-vascular mortality in patients with type2 diabetes: A real-world longitudinal study.

Aims/IntroductionWe assessed the relationship between diabetic retinopathy (DR) and/or diabetic kidney disease (DKD) according to their severity and all‐cause, cancer, vascular and non‐cancer non‐vascular mortality in real‐world patients with type 2 diabetes.Materials and MethodsA total of 1,902 patients with type 2 diabetes were enrolled from 1995 to 1999 and followed to 2017. At baseline, DR was diagnosed in 374 patients, DKD in 529, vision‐threatening DR in 123 and advanced DKD in 287. Patients were classified by the status of DR and DKD. Multivariate Cox regression analysis was carried out.ResultsThere were 266 deaths during a median follow‐up period of 18.6 years. Among these, 92 were from cancer, 78 were from vascular causes and 82 were from non‐cancer non‐vascular causes. DR and/or DKD predicted all‐cause, vascular and non‐cancer non‐vascular mortality, but not cancer mortality. Similarly, vision‐threatening DR and/or advanced DKD predicted all‐cause, vascular and non‐cancer non‐vascular mortality, but not cancer mortality. Hazard ratios for all‐cause, vascular and non‐cancer non‐vascular mortality were highest in the DR(+)DKD(+) group, and higher in the DR(−)DKD(+) and the DR(+)DKD(−) groups than in the DR(−)DKD(−) group. The results for vision‐threatening DR and advanced DKD were similar. The interaction for non‐cancer non‐vascular mortality, but not all‐cause and vascular mortality, between DR and DKD and between vision‐threatening DR and advanced DKD might be significant.ConclusionsDR and DKD may be jointly and independently associated with all‐cause, vascular and non‐cancer non‐vascular mortality, but not cancer mortality, according to their severity in real‐world patients with type 2 diabetes.

Penile Doppler Ultrasound for Erectile Dysfunction: Technique and Interpretation

OBJECTIVE. Erectile dysfunction (ED) is a common medical condition that has a high prevalence and incidence worldwide and may have a significant impact on both physical and psychosocial health. The purpose of this article is to review the role of penile Doppler sonography in the assessment of ED. CONCLUSION. Penile Doppler sonography is an essential tool for differentiating between vascular and nonvascular causes of ED; therefore, radiologists must be familiar with the imaging protocol, the limitations of the technique, and interpretation of its findings, to warrant an accurate diagnosis and appropriate patient management.

Variables that Influence Basic Prosthetic Mobility in People With Non‐Vascular Lower Limb Amputation

There exists a dearth of evidence on rehabilitation factors that influence prosthetic mobility in people with lower limb amputation (LLA). Examining variables that contribute to prosthetic mobility can inform rehabilitation interventions, providing guidance in developing more comprehensive care for these individuals. To determine the influence of modifiable and non-modifiable variables related to LLA and their impact on prosthetic mobility, using the International Classification of Functioning, Disability and Health (ICF) model. Secondarily, to determine if personal factors and self-reported balance and mobility are predictive of Component timed-up-and-go (cTUG) performance. Cross-sectional study of a convenience sample. National conference. People (N=68) with non-vascular causes of unilateral LLA. Assessment of anthropometrics, mobility, bilateral hip extensor strength, hip range of motion, single limb balance, and self report measures. Lasso linear regression and extreme gradient boosting analyses were used to determine influence of variables on prosthetic mobility. Timed performance of the cTUG. The following five variables were found to influence basic prosthetic mobility (P ≤ .05) in people with transtibial amputation: hip extensor strength, hip range of motion, single limb balance, waist circumference, and age. In the transfemoral cohort, number of comorbidities and waist circumference primarily influenced prosthetic mobility. Additionally, 66% of the variance in cTUG total time for the entire sample could be explained by simply regressing on level of amputation, number of comorbidities, age and Activities-specific Balance Confidence scale score, all variables easily collected in a waiting room. Variables that are modifiable with physical therapy intervention including hip extensor strength, hip range of motion, single limb balance, and waist circumference significantly influenced basic prosthetic mobility. These variables can be affected by targeted rehabilitation interventions and lifestyle changes. II.

In situ Reconstruction of Infected Groin Pseudoaneurysms in Drug Abusers With Biological Grafts

The aim of this study was to evaluate outcomes after in situ reconstruction using biological grafts in infected groin pseudoaneurysms in drug abusers. This was a single centre retrospective analysis of all patients undergoing in situ reconstruction with biological vascular grafts for infected groin pseudoaneurysms in drug abusers from 2000 to 2017. Outcome measures included wound healing problems, re-infection, graft patency, lower limb amputation, and mortality. Twenty-two patients (14 male) with a median age of 39 years (range 27-49) were identified. Fifteen patients (68%) underwent urgent in situ reconstruction with a xenograft, five patients (23%) with a homograft, and two patients (9%) with an autologous vein. There were no in hospital deaths, in hospital re-infections, or early major limb amputations. Four (18%) patients developed wound healing complications requiring re-operation. During a median follow up of 56 months (range 13-180 months), six patients (27%) developed re-infection requiring complete graft replacement with a new biological graft. Thereafter, three (14%) had re-re-infection. Seven patients (32%) had graft occlusions: two were treated endovascularly, two underwent re-operation, and three were treated conservatively. Two patients (9%) had patent grafts but significant stenosis: one had successful angioplasty and another one was left untreated. One patient required above knee amputation, resulting in an overall major amputation rate of 4%. Estimated primary patency was 87% after one year and 40% after five years. Six patients (27%) died during follow up from non-vascular causes. In situ reconstruction using biological grafts of infected groin pseudoaneurysms in drug abusers can be achieved with no peri-operative graft related complications, although rates of wound complications may be high. In the longer term, a significant number of patients develop re-infection, graft occlusion, or stenosis, although the amputation rate remains low. The management of this demanding group of patients remains a major challenge.

034 Penile blood flow assessment using Doppler ultrasonography (PDUS) in Erectile dysfunction patients: A 10-Year Experiences at an International Hospital in Southeast Asia

To demonstrate A 10-year experiences of the penile blood flow assessment using Doppler ultrasonography (PDUS) in Erectile dysfunction patients at an International Hospital in Southeast Asia. A total of 226 patients with ED underwent a penile Doppler examination to exclude nonvascular causes of ED during year 2007-2016. Forty-nine percentage of patients received 10 μg of intracavernosal prostaglandin E-1 and measurements were performed at 5 and 15 min after injection to determine the Peak Systolic Velocity (PSV, cm/s), End Diastolic Velocity (EDV, cm per second), and Resistance index (RI). Erectile dysfunction from vascular cause was determined to be vascular in origin if PSV was < 35 cm/s or RI was < 0.9. A mean age and median body mass index of patients underwent a penile Doppler examination was 46.67±13.53 and 26.93 kg/m2 (30.25-24.16), respectively. Most of the patients are diabetic (42.2%). Out of 226 patients,54%, satisfied the criteria of normal finding, 35.4%, arterial insufficiency, 8.4% venous leak, and 0.9% border line, respectively. Bilateral of arterial insufficiency was found in 24.34% and one single side insufficiency in 11%. There was no association between ethnicity and PDUS Results. However, vasculogenic risk factors were age, BMI and Fasting blood sugar. No serious complication after the test was reported. there are 2 cases of prolonged erection after 4 hours of the test.