Occlusion Test Research Articles

Automatic Detection of Cracks in Cracked Tooth Based on Binary Classification Convolutional Neural Networks.

Cracked tooth syndrome is a commonly encountered disease in dentistry, which is often accompanied by dramatic painful responses from occlusion and temperature stimulation. Current clinical diagnostic trials include traditional methods (such as occlusion test, probing, cold stimulation, etc.) and X-rays based medical imaging (periapical radiography (PR), cone-beam computed tomography (CBCT), etc.). However, these methods are strongly dependent on the experience of the clinicians, and some inconspicuous cracks are also extremely easy to be overlooked by visual observation, which will definitely affect the subsequent treatments. Inspired by the achievements of applying deep convolutional neural networks (CNNs) in crack detection in engineering, this article proposes an image-based crack detection method using a deep CNN classifier in combination with a sliding window algorithm. A CNN model is designed by modifying the size of the input layer and adding a fully connected layer with 2 units based on the ResNet50, and then, the proposed CNN is trained and validated with a self-prepared cracked tooth dataset including 20,000 images. By comparing validation accuracy under seven different learning rates, 10−5 is chosen as the best learning rate for the following testing process. The trained CNN is tested on 100 images with 1920 × 1080-pixel resolutions, which achieves an average accuracy of 90.39%. The results show that the proposed method can effectively detect cracks in images under various conditions (stained, overexplosion, images affected by other diseases). The proposed method in this article provides doctors with a more intelligent diagnostic solution, and it is not only suitable for optical photographs but also for automated diagnosis of other medical imaging images.

Evaluation of an innovative low flow oxygen blender system for global access.

BackgroundSafe and effective oxygen delivery methods are not available for the majority of infants and young children globally. A novel oxygen blender system was designed to accurately deliver concentration-controlled, oxygen-enriched air to hypoxemic children up to age five. The system does not require compressed medical air, is compatible with both oxygen tanks and oxygen concentrators, and is low cost. This is the first study that tested the performance of the innovative oxygen blender system.MethodsThe performance of the oxygen blender system was assessed in vitro based on delivered oxygen levels and flow rates with an oxygen tank, an oxygen tank using a nasal occlusion model, and an oxygen concentrator.ResultsThe measured %O2 of the performance test was within ± 5% of full scale (FS) of the target value across all flows and all nasal cannulas. Occlusion testing demonstrated that 50% occlusion did not significantly affect the system outputs. The oxygen blender system was shown to be compatible with both oxygen tanks and oxygen concentrators.ConclusionsThe novel oxygen blender system accurately controls oxygen concentrations and blended air flow rates, and is compatible with both oxygen tanks and oxygen concentrators. This innovation may be an opportunity for improved infant and child oxygen treatment worldwide.

Case report: Rare abernethy malformation with hepatopulmonary syndrome in a pediatric patient

Abernethy malformation is a rare abnormality of the hepatic portal vein system with non-specific and diverse clinical manifestations. Here, we described a case of abernethy malformation with hepatopulmonary syndrome in a 10-year-old girl. On physical examination, cyanosed lips and acropachy could be found. Her oxygen saturation fluctuated at 89–94%, and the fasting blood ammonia was 98 umol/L. Furthermore, there were abnormalities in the imaging. The microbubble test with contrast echocardiography was positive. Computer tomography angiography (CTA) showed the splenic vein, and the superior mesenteric drained directly into the inferior vena cave after confluence. The same result was also observed in delayed splenic arteriography. Then, we discovered a tiny branch of the intrahepatic portal vein by the inferior vena cava balloon occlusion test, which could also show the confluence of the splenic vein and superior mesenteric vein with the inferior venacave. According to the evidence above, we concluded that the girl was a patient of type II abernethy malformation. For the severe dysplasia of the portal vein, the girl accepted partial ligation of portosystemic shunt and Rex shunt, which improved her oxygen saturation and exercise tolerance.

Cerebrovascular pulsatile tinnitus: causes, treatments, and outcomes in 164 patients with neuroangiographic correlation

BackgroundPulsatile tinnitus (PT) can cause significant detriment to quality of life and may herald a life-threatening condition. Endovascular evaluation is the gold standard for the definitive diagnosis of PT and...

Alterations in tissue oxygen saturation measured by near-infrared spectroscopy in trauma patients after initial resuscitation are associated with occult shock

PurposePersistent occult hypoperfusion after initial resuscitation is strongly associated with increased morbidity and mortality after severe trauma. The objective of this study was to analyze regional tissue oxygenation, along with other global markers, as potential detectors of occult shock in otherwise hemodynamically stable trauma patients.MethodsTrauma patients undergoing active resuscitation were evaluated 8 h after hospital admission with the measurement of several global and local hemodynamic/metabolic parameters. Apparently hemodynamically stable (AHD) patients, defined as having SBP ≥ 90 mmHg, HR < 100 bpm and no vasopressor support, were followed for 48 h, and finally classified according to the need for further treatment for persistent bleeding (defined as requiring additional red blood cell transfusion), initiation of vasopressors and/or bleeding control with surgery and/or angioembolization. Patients were labeled as “Occult shock” (OS) if they required any intervention or “Truly hemodynamically stable” (THD) if they did not. Regional tissue oxygenation (rSO2) was measured non-invasively by near-infrared spectroscopy (NIRS) on the forearm. A vascular occlusion test was performed, allowing a 3-min deoxygenation period and a reoxygenation period following occlusion release. Minimal rSO2 (rSO2min), Delta-down (rSO2–rSO2min), maximal rSO2 following cuff-release (rSO2max), and Delta-up (rSO2max–rSO2min) were computed. The NIRS response to the occlusion test was also measured in a control group of healthy volunteers.ResultsSixty-six consecutive trauma patients were included. After 8 h, 17 patients were classified as AHD, of whom five were finally considered to have OS and 12 THD. No hemodynamic, metabolic or coagulopathic differences were observed between the two groups, while NIRS-derived parameters showed statistically significant differences in Delta-down, rSO2min, and Delta-up.ConclusionsAfter 8 h of care, NIRS evaluation with an occlusion test is helpful for identifying occult shock in apparently hemodynamically stable patients.Level of evidenceIV, descriptive observational study.Trial registrationClinicalTrials.gov Registration Number: NCT02772653.

Work Of Breathing At Moderate Ventilation Is Not Affected By Balloon-tipped Catheter Positioning Methods

Measuring respiratory mechanics (work of breathing; Wb) requires one to measure pleural pressure, which is done by measuring esophageal pressure (PES) using a balloon-tipped catheter placed approximately at the lower third of the esophagus. The accuracy of PES to reflect pleural pressure requires the catheter be positioned at the correct depth. Our recent systematic review has identified several methods for determining the correct catheter depth: the occlusion method - depth is identified through various occlusion tests; the withdrawal method - catheter is withdrawn from the stomach until a negative pressure deflection during an inhalation is observed then is withdrawn an additional 10 cm; and inserting the catheter 45 cm distal from naris. It is unknown if different positioning methods significantly influences the resultant mechanics data. PURPOSE: Compare catheter depth and the Wb, via modified Campbell diagrams, between positioning methods. METHODS: Five healthy participants (2 female; 22 ± 2 years, 177.7 ± 7.4 cm, 73.2 ± 7.5 kg) visited the lab on 3 occasions. Participants provided written informed consent and had spirometry assessed. In visit 2, participants were instrumented with a balloon-tipped catheter and then depths determined for each of the aforementioned three methods. In visit 3, chest wall compliance is measured using the two-point method, then participants completed a trial of voluntary hyperpnea for 5 min at a moderate ventilation (50 L/min) at each depth. The testing order was randomized and balanced. One-way repeated measures ANOVAs were used to compare the depths and Wb across methods (significance = P < .05). RESULTS: We found no difference in depth (45.0 ± 0.0 vs. 45.8 ± 3.2 vs. 44.5 ± 3.7 cm; P = .62) or the Wb across position methods (3.8 ± 1.8 vs. 3.2 ± 1.2 vs. 3.1 ± 1.3 Joules; P = .38). CONCLUSION: Our current data suggest that the three most commonly used catheter positioning methods do not yield significantly different depths. Likewise, a difference in catheter depth of ~1.5 cm does not appear to be sufficient to alter the Wb obtained at moderate ventilation. Future work, with more varied catheter depths, is needed to identify the magnitude of depth difference that would yield a physiologically meaningful difference in respiratory mechanics data. Support: Hooper Undergraduate Research Award (NAU)

Angiographic Predictors of Outcomes After Balloon Test Occlusion

Background Balloon test occlusion (BTO) with adjunctive single‐photon emission computed tomography has been used to predict tolerance after permanent internal carotid artery occlusion. Anatomic characteristics of the cerebral circulation might predict BTO outcomes and identify patients susceptible to test failure. Methods We performed a single‐center retrospective analysis of patients who underwent internal carotid artery BTO from July 2013 to June 2020. Patients who passed the clinical BTO underwent single‐photon emission computed tomography imaging; technetium‐99m‐ethyl cysteinate dimer was injected intravenously after 15 to 30 minutes of occlusion and induced hypotension. The diameter of the vessels of the circle of Willis was measured angiographically. Single‐photon emission computed tomography imaging hypoperfusion severity was classified as none, mild, low intermediate, high intermediate, and severe. A threshold vessel diameter with most predicted accuracy for BTO failure was created using the Youden index. The threshold value was tested in a logistic regression for prediction of BTO failure and accuracy as represented with a receiver operator curve. Results Fifty‐seven patients underwent BTO. Neoplasia was the most common indication (n=43, 75%). Twelve (21.1%) patients failed the clinical BTO. Contralateral dominant vertebral artery ( P =0.02), smaller anterior communicating artery (ACom; P =0.002), and ipsilateral posterior communicating artery ( P =0.03) diameters were correlated with clinical BTO failure. Smaller ACom was most predictive with an area under the curve of 0.907. The Youden index identified an ACom diameter threshold of 1.1 mm, with a sensitivity of 91.7% and specificity of 77.8% (odds ratio, 0.026 [95% CI, 0.003–0.226]; receiver operating characteristic, 0.847) for predicting BTO failure. Patients with severe single‐photon emission computed tomography asymmetry had significantly smaller‐caliber ACom arteries (ACom median diameter, 0.95 versus 1.4 mm; P =0.0073). Conclusions Angiographic findings can be used to predict BTO results. A small ipsilateral posterior communicating artery, and more significantly, a small ACom (&lt;1.1 mm) can be used to identify patients who are likely to fail BTO.

Prevalence of endothelial dysfunction and increased vascular stiffness in patients with solid malignancies

Background: Endothelial dysfunction is recognized as one of the early markers of cardiovascular disorders. It is supposed to be a potential predictor of cardiovascular complications in patients receiving adjuvant and neoadjuvant chemotherapy.&#x0D; Aim: To estimate the prevalence of endothelial dysfunction in solid cancer patients compared to that in individuals without any malignancies.&#x0D; Materials and methods: This observational study included 74 patients with solid malignancies, mostly gastrointestinal. Prior to polychemotherapy, all patients were examined for endothelial function of small and large arteries (AngioScan-01, Fiton, Russia) and peripheral artery stiffness (pulse wave contour analysis and occlusion test). The results were compared with those of the Russian population trials of endothelial dysfunction – Meridian-RO (Ryazan region) and trial in the rural population of the Krasnodar region.&#x0D; Results: Compromised vasodilation and smaller arteries tone were found in 64.9% (48/74) of the cancer patients, while impaired vasodilation of larger muscular arteries was present in 94.6% (70/74) of the patients. According to the Meridian-RO trial in the Ryazan region, endothelial dysfunction had been found in 51.2% (n = 341) of women and 52.4% (n = 300) of men, whereas the Krasnodar regional population data had shown it in 68.4% (n = 353) of women and 71.7% (n = 253) of men.&#x0D; Conclusion: The prevalence of endothelial dysfunction in the patients with solid malignancies, who have not undergone any chemo- or radiation therapy, is significantly higher than in the population of comparable age, conventional cardiovascular risk factors, and comorbidities. No significant increase of vascular stiffness was identified.

Accurate classification of white blood cells by coupling pre-trained ResNet and DenseNet with SCAM mechanism

BackgroundVia counting the different kinds of white blood cells (WBCs), a good quantitative description of a person’s health status is obtained, thus forming the critical aspects for the early treatment of several diseases. Thereby, correct classification of WBCs is crucial. Unfortunately, the manual microscopic evaluation is complicated, time-consuming, and subjective, so its statistical reliability becomes limited. Hence, the automatic and accurate identification of WBCs is of great benefit. However, the similarity between WBC samples and the imbalance and insufficiency of samples in the field of medical computer vision bring challenges to intelligent and accurate classification of WBCs. To tackle these challenges, this study proposes a deep learning framework by coupling the pre-trained ResNet and DenseNet with SCAM (spatial and channel attention module) for accurately classifying WBCs.ResultsIn the proposed network, ResNet and DenseNet enables information reusage and new information exploration, respectively, which are both important and compatible for learning good representations. Meanwhile, the SCAM module sequentially infers attention maps from two separate dimensions of space and channel to emphasize important information or suppress unnecessary information, further enhancing the representation power of our model for WBCs to overcome the limitation of sample similarity. Moreover, the data augmentation and transfer learning techniques are used to handle the data of imbalance and insufficiency. In addition, the mixup approach is adopted for modeling the vicinity relation across training samples of different categories to increase the generalizability of the model. By comparing with five representative networks on our developed LDWBC dataset and the publicly available LISC, BCCD, and Raabin WBC datasets, our model achieves the best overall performance. We also implement the occlusion testing by the gradient-weighted class activation mapping (Grad-CAM) algorithm to improve the interpretability of our model.ConclusionThe proposed method has great potential for application in intelligent and accurate classification of WBCs.

Effect of hypertension on microcirculatory disorders in patients with rheumatoid arthritis

Introduction. The presence of endothelial dysfunction contributes to the progression of rheumatoid arthritis (RA) and the development of cardiovascular diseases. However, microcirculatory signs in the combination of RA with hypertension have not been studied enough.Objective – to clarify the contribution of concomitant hypertension in the formation of microcirculatory disorders in patients with RA.Materials and methods. The observational study involved 123 patients of both sexes from 18 to 72 years old (103 – the study group with verified RA, 23 – the control group, representing relatively healthy volunteers). Hypertension occurred in 55.3 % of patients. Laser Doppler flowmetry was performed to assess vasomotor function. Both the initial perfusion parameters were studied with the calculation of the amplitude-frequency spectrum, as well as an occlusive test and a test with acetylcholine iontophoresis. Initial perfusion parameters were studied with time– frequency analysis, an arterial occlusion test and an acetylcholine iontophoresis test were performed.Results. Patients with concomitant hypertension against the background of RA had a more pronounced decrease in the amplitudes of the endothelial (p=0.036) and neurogenic (NC) (p=0.005) components of the spectrum, an increase in respiratory modulation (RM) (p=0.002), as well as a decrease in the reserve of capillary blood flow (p=0.010) and shortened time to perfusion half-restoration (p=0.042) in the occlusion test. However, there were no significant differences between the groups in terms of the acetylcholine iontophoresis test (p≥0.05). The relationship between the RM amplitude and cardiovascular risk (CVR) was established according to the SCORE (ρ=0.269; p=0.022), as well as with systolic (ρ=0.324; p=0.005) and diastolic (ρ=0.234; p=0.045) blood pressure was established. An assessment of the RM amplitude predicted the presence of concomitant hypertension with a sensitivity of 72.5 % and a specificity of 75 % (p=0.001).Conclusion. The presence of concomitant hypertension against the background of RA was associated with more pronounced vasomotor dysfunction, as well as with the presence of venular hypertension (VH), which is the pathogenetic link of hypertension. At the same time, an increase in the amplitude of the RM, which reflects VH, allows it to be used as an early additional prognostic marker for the presence of concomitant hypertension and increased CVR in patients with RA.

ANALISIS KALIBRASI SYRINGE PUMP

Sustainable health services need to be supported by equipment that is always in a ready-to-use condition and can be functioned properly. One of them is the pumpa syringe tool, through the provision of suitable equipment, preventive maintenance is needed including periodic maintenance and implementation of testing and calibration. The method used in this research is quantitative research with analytical descriptive method which aims to analyze the results of the syringe pump calibration using an infusion pump analyzer and also aims to determine the results of the data obtained after observing the workflow of the tool.From the results of examinations that have been carried out on the syringe pump calibration using the infusion pump analyzer at the Medan Health Facility Security Center (BPFK), the results obtained from the flow rate test of the syringe pump tool at the 10 mL/h point are 9.7 +- 0.4 mLh, so the final result is 9.7 + 0.4 = 10.1 mL/h or 9.7 - 0.4 = 9.3 mL h, it can be concluded that the measurement results that have been made are still within the 10% tolerance limit of the 10 mL/h. Measurement point value Occlusion test the syringe pump tool at the point of 100 mL/h yields 9.97+- 0.4 psi, so the final result is 9.97 + 0,4 = 10.37 psi or 9.97 - 0.4 = 9.57 psi, so it can be concluded that the measurement results that has been doneis still within the tolerance limit of &lt;- 20 psi In performing then calibration.

The Association between Level of Control and Exodeviation after the Monocular Occlusion Test in Pediatric Patients with Intermittent Exotropia

PurposeWe investigated the association between the level of control and exodeviation after the monocular occlusion test (MO) in pediatric patients with intermittent exotropia.MethodsWe retrospectively reviewed the records of pediatric patients with intermittent exotropia who visited Yeungnam University Hospital between September 2015 and December 2020. The largest exodeviation obtained before and after 1 hour of MO were compared. The LACTOSE (Look And Cover, then Ten seconds of Observation Scale for Exotropia) control scoring system was used to measure the level of control. Controllability was defined when the patient had the subjective awareness of exotropia and the instinctive ability to correct ocular deviation.ResultsFive hundred and three consecutive patients (260 male and 243 female patients; mean age, 7.8 years) were included. In all control scores, exodeviation significantly increased after the MO (p < 0.001). However, the patients with an increase in exodeviation ≥5 prism diopters (PD) after the test did not show any significant association with the control scores. The presence of controllability was significantly associated with an increase of ≥5 PD at near (p = 0.034).ConclusionsExodeviation showed significant increase after the MO, regardless of the level of control, in pediatric patients with intermittent exotropia. There was no significant association between the control scores and an increase of ≥5 PD after the MO. Patients with controllability were more likely to show increase in exodeviation after the MO.

P.155 Giant aneurysm, tiny patient: flow diversion stenting of a giant MCA aneurysm in a young child

Background: A 3-year-old girl presented with a 6-day history of severe headaches. On examination, upper motor neuron signs were noted in the left upper and lower extremities with increased tone, reflexes, and a positive Babinski sign. MRI of the brain revealed a giant right middle cerebral artery (MCA) aneurysm with significant mass effect, associated with cerebral edema and ventricular effacement. CT and CT angiogram showed evidence of aneurysmal wall calcification and lamellar thrombosis within the aneurysmal sac. In addition, there was a smaller right MCA aneurysm in close proximity to the giant aneurysm. Methods: After a balloon occlusion test to assess collateral blood flow to the MCA territory, it was decided to treat both aneurysms with a flow diverting stent. Dual antiplatelet loading was done with aspirin and clopidogrel. The smallest available diameter of Pipeline Shield stent was deployed. Results: The patient remained neurologically unchanged. Early follow-up imaging demonstrated stent patency, reduced size and mass effect of the large aneurysm, reduced cerebral edema, and no flow into the smaller aneurysm. Conclusions: Flow diversion stenting may be employed successfully in pediatric patients, though has unique technical considerations including small size vessels and limited evidence for antiplatelet agent choice and dosing.

Microvascular reactivity as a predictor of major adverse events in patients with on-pump cardiac surgery.

BackgroundMicrocirculatory disturbances are typically most severe during cardiopulmonary bypass (CPB), which occurs during cardiac surgeries. If microvascular reactivity compensates for microcirculatory disturbances during CPB, tissue hypoxemia can be minimized. The primary aim of this study was to assess whether microvascular reactivity during CPB could predict major adverse events (MAE) after cardiac surgery.MethodsThis prospective observational study included 115 patients who underwent elective on-pump cardiac surgeries. A vascular occlusion test (VOT) with near-infrared spectroscopy was performed five times for each patient: before the induction of general anesthesia, 30 min after the induction of general anesthesia, 30 min after applying CPB, 10 min after protamine injection, and post-sternal closure. The postoperative MAE was recorded. The area under the receiver operating characteristic (AUROC) curve analysis was performed for the prediction of MAE using the recovery slope.ResultsOf the 109 patients, MAE occurred in 32 (29.4%). The AUROC curve for the recovery slope during CPB was 0.701 (P < 0.001; 95% CI [0.606, 0.785]). If the recovery slope during CPB was < 1.08%/s, MAE were predicted with a sensitivity of 62.5% and specificity of 72.7%.ConclusionsOur study demonstrated that the recovery slope of the VOT during CPB could predict MAE after cardiac surgery. These results support the idea that disturbances in microcirculation induced by CPB can predict the development of poor clinical outcomes, thereby demonstrating the potential role of microvascular reactivity as an early predictor of MAE after cardiac surgery.

P156 TRANSCATHETER CLOSURE OF ATRIAL SEPTAL DEFECT IN OVER 60 YEARS OLD PATIENTS

Abstract Background Ostium secundum ASD (ASDII) is the most common type of congenital heart disease in adults. Percutaneous closure has emerged as the first–line treatment for the majority of ASDII. However, the occurrence of Pulmonary Hypertension (PH) with combined pre– and post–capillary component may render ASD management challenging in elderly patients. Methods We report the hemodynamic data and clinical findings of elderly patients (&amp;gt; 60 years old) undergoing transcatheter closure of an ASDII at our department. Results From 2000 to 2021, 82 elderly patients were scheduled (mean age 65,4+ 4,4) of which 60 (73%) were female. Systemic arterial hypertension and supraventricular arrhythmias were the most common comorbidities accounting respectively 51% and 38% of cases. The right ventricular overload supported the ASD closure in 76 cases (93%) and paradoxical embolism in the remaining 6 (7%). 17 patients (21%) were in NYHA class III– IV. At right heart catheterization, 33 patients had normal pulmonary arterial pressure and 49 patients showed a mean pulmonary artery pressure &amp;gt; 20 mmhg. In the latter cohort, 33 showed a pulmonary artery wedge pressure (PAWP) &amp;lt; 15 mmHg (Group I) and 16 &amp;gt; 15 mmHg (Group II). The device implantation was completed in all patients except one with elevated pulmonary vascular resistance (PVR) of the Group I. For 14 patients of Group II, balloon occlusion test was required during the catheterization. ASD closure was achieved promptly in 10 patients. However, to reduce the risk of acute pulmonary oedema, in one case we created a small fenestration in the occluder device and in other case we retained the patency of additional defect (both patients exhibiting slightly PAWP increase during balloon occlusion test). In one patient showing significantly PAWP increase during balloon test, delayed ASD closure was performed ensuring the improvement of hemodynamic parameters at 3 months initiation of medical therapy with angiotensin–converting enzyme inhibitor and loop diuretic diuretics. For the remaining 4 patients, the percutaneous closure was not been done because of prohibitive hemodynamic parameters. Overall, ASD closure was performed successfully in 94% of cases. Conclusions Age and comorbidities are not absolute contraindications to ASDII percutaneous closure. In the complex cases, both medical therapies and balloon occlusion test may be use to support the decision–making process.

Prognostic value of near-infrared spectroscopy in mortality and organ dysfunction in patients recovery from septic shock: The research protocol

Background: Sepsis or septic shock results in the alteration of blood flow at the microcirculatory level, affecting tissue oxygenation and organ function and associated with death. This study aimed to use near-infrared spectroscopy (NIRS) in conjunction with vascular occlusion test (VOT) to assess the association of microcirculatory dysfunction after recovered from septic shock and in-hospital mortality. Methods: We conducted a prospective observational study in patients who recovered from septic shock. We performed NIRS with VOT within 24 hours of hospitalization in medical and anesthetic ICU (T0), then at the time of recovery from septic shock (D0), at day 3 (D3), day 5 (D5), and day 7 (D7) after recovery from septic shock. We recorded the de-oxygenation (DeO2) slope, the re-oxygenation (ReO2) slope, and the area under the hyperemic response curve (the reperfusion area). We focused on parameters of microcirculation dysfunction, in-hospital mortality, and in-hospital complications. Hypothesis: We hypothesize that NIRS with vascular occlusion test parameters are associated with in-hospital mortality and hospital complications Ethic: The study protocol has been approved by the Institution Review Board of Ramathibodi Hospital, Mahidol University, Thailand (No. MURA2020/147). Trial registration: TCTR20220413001

Dynamics of Local Temperature in the Fingertips After the Cuff Occlusion Test: Infrared Diagnosis of Adaptation Reserves to Hypoxia and Assessment of Survivability of Victims at Massive Blood Loss.

Since changes in the tone and size of the lumen of peripheral blood vessels with massive blood loss are part of the mechanism of adaptation to hypoxia, which automatically changes the flow of warm blood to the fingertips, it was assumed that infrared thermography of the fingertips can reveal the dynamics of heat release in them, reflecting the reactivity of peripheral blood vessels and adaptation to hypoxia. It was assumed that the cuff occlusion test (COT) would assess the available reserves of adaptation to hypoxia and improve the accuracy of resistance to hypoxia and the prognosis of survival in massive blood loss. The temperature change in the fingertips before and after the application of COT in the corresponding hand was studied in healthy adult volunteers, donors after donating 400 mL of blood and in victims with blood loss of less than or more than 35%. During COT, the temperature in the fingers of the ischemic hand decreased in all the subjects. After COT the temperature in the fingers rose above the baseline level in healthy volunteers and in donors who donated 400 mL of blood, but did not increase in most patients with massive blood loss, of which some patients died despite the treatment. We report the dynamics of local temperature in the finger pads after the COT in healthy adult volunteers, in donors after they donated 400 mL of venous blood each, and in victims with massive blood loss less than or greater than 35%. It is shown that the detection of local hyperthermia in the finger pads after occlusion is a sign of good adaptation to hypoxia and the probability of survivability of the victim with massive blood loss.

Internal Carotid Artery Constriction with or without Superficial Temporal Artery–Middle Cerebral Artery Bypass for Patients with Giant Internal Carotid Aneurysms

The optimal management of giant internal carotid aneurysms (GICAs) is disputed owing to their low incidence. The aim of this study was to describe the use of internal carotid artery (ICA) constriction as therapeutic management of GICAs. This retrospective cohort study analyzed data from medical histories and follow-up of 14 patients with GICAs. Before surgery, the patients underwent balloon test occlusion and magnetic resonance perfusion evaluation. ICA constriction was considered only for patients with negative balloon test occlusion. A transverse incision of about 50% of the initial part of the ICA was done, and the free margins on both sides were sutured, causing 70%-90% stenosis. ICA constriction alone was selected (11 cases) if both anterior communicating artery and posterior communicating artery compensatory blood flow existed and magnetic resonance perfusion was ≤II1 on the affected side. If there was only 1 compensatory vessel from the anterior communicating artery and posterior communicating artery, and/or magnetic resonance perfusion was >II1, ICA constriction was combined with low-flow bypass (3 cases). The mean follow-up time of the 14 patients was 43.5 months (interquartile range: 38.8-51.3 months). Of these 14 patients, 5 achieved O'Kelly-Marotta grades C and D. Clinical improvement occurred in 12 of 14 patients. No patients experienced new-onset stroke. ICA constriction exhibits a perforator protective effect. This procedure could be a promising alternative to ICA ligation in patients with GICAs and negative balloon test occlusion.

Analysis of peripheral arterial disease (PAD) patients by laser speckle measurement techniques.

Diabetic foot is a well-known problem among patients suffering from peripheral arterial diseases (PAD). This article presents an optical sensor for contactless measurement of the anatomical site based on laser speckle techniques. The sensor illuminates the inspected tissue and analyzes the captured back-reflected light from the time-changing speckle patterns. An occlusion test was implemented to provide a statistical parameter to differentiate between a low perfused and a healthy foot. A clinical study of 15 subjects was conducted. The video was analyzed by two methods: dynamic laser speckle (DLS) and laser speckle contrast analysis (LASCA). Data analysis included several classification models, where the KNN model exhibited maximum performance. These findings suggest that a simple and inexpensive system for PAD monitoring can be designed for home use and/or in community clinics.

Improved microvascular reactivity after aged garlic extract intake is not mediated by hydrogen sulfide in older adults at risk for cardiovascular disease: a randomized clinical trial.

This study aimed to investigate the effects of AGE on microvascular reactivity, systolic blood pressure (SBP), and diastolic blood pressure (DBP) in older individuals at high risk for cardiovascular disease (CVD). Urinary thiosulfate was also investigated as an indirect marker of endogenous hydrogen sulfide (H2S) synthesis. The study was conducted in a randomized, double-blind, crossover, and placebo-controlled way. Twenty-eight participants (14 male), 67 ± 6years old with CVD risk factors, ingested 2.4g of AGE or placebo (PLA). Near-infrared spectroscopy evaluated tissue oxygen saturation (StO2) during a vascular occlusion test (30s baseline, 5min occlusion, and 2min reperfusion). The upslope of StO2 signal after cuff release was calculated to measure microvascular reactivity. Urinary thiosulfate levels were measured using a high-performance liquid chromatography system. The upslope of StO2 was significantly faster after AGE (1.01 ± 0.37%s-1) intake compared to PLA (0.83 ± 0.35%s-1; P < 0.001; d = 0.50). Relative changes in Δ% SBP from pre- to post-AGE intake (-5.17 ± 5.77%) was significantly different compared to Δ% PLA (0.32 ± 5.99%; P = 0.001; d = 0.93). No significant changes in urinary thiosulfate concentrations were observed between interventions. Moreover, no significant gender effect in any parameter assessed was found. This study demonstrated that a single dose of AGE improved microvascular reactivity in older adults at risk of CVD despite such an effect was not linked with urinary thiosulfate levels. This trial was registered at clinicaltrials.gov as NCT04008693 (May 19, 2020).