Peak Flow Velocity Research Articles

Effects of conditioning on the left ventricular function of young purebred Arabian horses.

The effects of conditioning on cardiac function in young horses is still unknown. For this reason, this study evaluated the left ventricular (LV) function of young horses by echocardiography after six weeks of conditioning. Fourteen untrained young purebred Arabian horses were evaluated at rest and after a stress test (ST) before and after a six-week conditioning program. There was an increase in V4 (p < 0.001) after conditioning, as well as a reduction in both heart rate (HR) at rest and peak HR during the ST (p < 0.001). There was also a reduction in internal diameter, along with an increase in interventricular septal, free wall and mean thicknesses and LV mass (p < 0.05). After the ST, the conditioned animals showed higher values of velocity time integral, stroke volume, systolic and cardiac indices, ejection (ET) and deceleration times (DT), end-diastolic volume, time to onset of radial myocardial velocity during early diastole and time to peak of transmitral flow velocity, in addition to reduced pre-ejection period (PEP), PEP/ET ratio and mean velocity of circumferential fiber shortening (p < 0.05). The conditioning protocol promoted physiological adaptations that indicate an improvement in the animals' aerobic capacity associated with an enhanced left ventricular function.

Correlation between left atrial appendage morphology based on fractal dimension quantification and its hemodynamic parameters in patients with atrial fibrillation

To investigate the relationship between left atrial appendage (LAA) morphology, quantified based on fractal dimension (FD), and LAA hemodynamic parameters in patients with atrial fibrillation (AF), in an effort to reveal the effect of LAA shape on blood flow. 225 patients with AF who underwent cardiac computed tomography angiography (CTA) and transesophageal echocardiography (TEE) were enrolled. LAA morphology was quantified based on FD on cardiac CTA images, and LAA hemodynamic parameters, including injection fraction (EF), filling peak flow velocity (FV), maximum speed of emptying (PEV), and wall motion velocity (WMV), were assessed using TEE. We divided the patients with AF into two groups based on a mean LAA FD of 1.32: the low FD group (n=124) and the high FD group (n=101). Compared to the low FD group, there were more patients with LAA circulatory stasis/thrombus (P=0.008) in the high FD group, as well as lower LAA FV (P=0.004), LAA PEV (P=0.007), and LAA WMV (P=0.007). LAA FD was an independent and significant determinant of LAA EF (β=-11.755, P=0.001), LAA FV (β=-17.364, P=0.004), LAA PEV (β=-18.743, P<0.001), and LAA WMV (β=-7.740, P=0.001) in multiple linear regression analysis. LAA FD is an essential determinant of LAA hemodynamic parameters, suggesting that the relatively complex morphology of the LAA may influence its hemodynamics, which can correlate with embolic events.

Echocardiographic Detection of Subclinical Left Ventricular Dysfunction in Asymptomatic Type Two Diabetes Mellitus

Background: Before systolic dysfunction and symptomatic heart, diabetic cardiomyopathy begins with left ventricular diastolic dysfunction (LVDD). Echocardiographic modalities were used to detect subclinical LV impairment in asymptomatic type 2 diabetics. This study aimed to identify subclinical left ventricular impairment in asymptomatic patients with type two diabetes using several echocardiographic techniques. Methods: In the present prospective cohort study, 30 adults over 18 having type II diabetes mellitus (DM) (Group I) and 20 normal controls (Group II) were studied. Transthoracic echocardiography and 12-lead ECG were performed on all individuals. Results: Pulsed wave Doppler techniques revealed significant variation in transmitral flow velocities between groups, including septal e', lateral mitral annulus early velocity (e'), septal early diastolic peak flow velocity (E)\e', Lateral E\e', and average E\e'. EF was significantly decreased in group I (P &lt; 0.001). With a p-value of 0.001, LVESD was significantly higher in group I. The septal, lateral, and average systolic mitral annulus (S') motions in group II were significantly larger than those in group I. When comparing groups, I and II, the first showed much longer myocardial performance index (MPI) and isovolumetric contraction time (IVCT). The ET for Group I was significantly lower than that of Group II. The study group exhibited significantly greater levels of fasting blood sugar, post-prandial blood sugar, and haemoglobin A1C (HBA1C) compared to the control group (P &lt;0.001). Conclusions: Patients having diabetes mellitus exhibited considerably greater levels of DM history fasting glucose levels, postprandial glucose levels, haemoglobin A1C (HBA1C), E/e´ ratio, LVESD, IVCT, and MPI, while having significantly lower EF and ET relative to the healthy group.

Оценка кровоснабжения миокарда методом допплерографии коронарных артерий после пантовой бальнеотерапии

The purpose of this study was to objectively assess the effectiveness of rehabilitation using balneotherapy with velvet antler products. Materials and methods. Doppler assessment of coronary artery blood flow was performed. As a reference vessel, we chose the anterior descending artery, which is the largest branch of the left coronary artery and has its own numerous branches providing blood supply to the main part of the functionally active left ventricle myocardium. We studied the following groups of patients, whose rehabilitation included balneotherapy with velvet antler products: 1) 48 subjects with stage 2 arterial hypertension and 2) 49 subjects with coronary artery disease after balloon angioplasty and coronary artery stenting. In addition to balneotherapy, group 1 received standard hypotensive therapy with angiotensin-converting-enzyme inhibitors, beta blockers and thiazide diuretics, while group 2 was given indirect anticoagulants, beta blockers and new generation statins. Before and upon completing the treatment course, each patient’s peak blood flow velocity was measured, as well as blood flow integral in the proximal segment of the anterior descending artery. Results. After the balneotherapy course, most patients in both groups showed quiet and increased activation of high reactivity level. According to our observations, patients tolerated the treatment well. Initially, peak blood flow velocity and blood flow integral were recorded within the range of 28–45 cm/s (mean: 36.9 ± 4.4 cm/s) and 9–14 cm (mean: 11.00 ± 1.25 cm), respectively, without between-group differences. After the multimodality treatment that included balneotherapy with velvet antler products, these parameters were recorded within the range of 39–52 cm/s (mean: 45.7 ± 3.5 cm/s) and 11–16 cm (mean: 14.0 ± 1.3 cm), respectively, with no between-group differences either. The increase in peak blood flow velocity was statistically significant (p ˂ 0.001). Thus, balneotherapy using innovative velvet antler products combined with medication treatment and physical therapy, presumably, contributed to improving coronary blood circulation in patients with stable ischemic heart disease and arterial hypertension.

Determination of beam oscillating pattern for tailoring melt flow and microstructural characteristics of laser welded Ti–6Al–4V alloy

The trajectory of beam is highly correlated to the heat distribution and fluid flow within the melting pool in laser welding, which has a great impact on improving the joint microstructure. This study employs fluid simulation techniques to investigate the temperature distribution and flow behavior of Ti–6Al–4V alloy under three laser oscillation welding patterns including none oscillation, sinusoidal oscillation, and circular oscillation, and the optimal oscillating pattern was determined through an analysis of microstructure characteristics. Temperature field simulation results indicate that the oscillation of the beam is efficaciously utilized to diminish the concentrated heat distribution on the base material. Moreover, a manifest difference in energy density and the area of laser action is produced, which leads to variations in the location and depth of the distribution of keyholes. Under circular oscillation, the flow behavior is more pronounced, with peak flow velocity increasing by approximately 80 % compared to none oscillation and new vortices were created in the horizontal section at the end of an oscillation period. Furthermore, compared to none oscillation and sinusoidal oscillation, the lower cooling rate under circular oscillating pattern contributes to the formation of equiaxed grains. The fine equiaxed grains are easy to move and form an ordered lattice structure, which favors the transformation of low-angle grain boundaries and the increase in the strength of the crystal texture. Therefore, with oscillation frequency and amplitude set at 80 Hz and 0.8 mm, respectively, the use of circular oscillating pattern in laser welding results in an improvement in weld seam microstructure.

Decreasing the blood flow of non-compressible intra-abdominal organs with non-invasive transcutaneous electrical stimulation

Non-invasive neuromodulation of non-compressible internal organs has significant potential for internal organ bleeding and blood-shift in aero/space medicine. The present study aims to investigate the potential influences of the non-invasive transcutaneous electrical nerve stimulation (TENS) on multiple non-compressible internal organs’ blood flow. Porcine animal model (n = 8) was randomized for a total of 48 neuromodulation sessions with two different TENS stimulation frequencies (80 Hz, 10 Hz) and a placebo stimulation. A combination of two different electrode configurations (Abdominal-only or Abdominal and hind limb) were also performed. Intraarterial blood flow measurements were taken during pre and post-stimulation periods at the left renal artery, common hepatic artery, and left coronary artery. Intracranial, and extracranial arterial blood flows were also assessed with digital subtraction angiography. TENS with abdominal-only electrode configurations at 10 Hz demonstrated significant reductions in average peak blood flow velocity (APV) of the common hepatic artery (p = 0.0233) and renal arteries (p = 0.0493). Arterial pressures (p = 0.0221) were also significantly lower when renal APV was reduced. The outcome of the present study emphasises the potential use of TENS in decreasing the blood flow of non-compressible internal organs when the correct combination of electrodes configuration and frequency is used.

Combining antibiotic-loaded bone cement-based free vastus lateralis muscle-sparing flap with split-thickness skin grafts: A reliable strategy for reconstructing diabetic foot ulcers at non-weight-bearing areas.

Diabetic foot ulcers (DFUs) present significant challenges due to their associated amputation rates, mortality, treatment complexity and excessive costs. Our earlier work introduced a wound surgical integrated treatment (WSIT) for DFUs, yielding promising outcomes. This study focuses on a specific WSIT protocol employing antibiotic-loaded bone cement (ALBC) in the first Stage, and free vastus lateralis muscle-sparing (VLMS) flaps and split-thickness skin grafts (STSGs) in the second stage to repair non-weight-bearing DFUs. From July 2021 to July 2023, seven DFU patients (aged 47-71 years) underwent this treatment. Demographic data, hospital stay and repair surgery times were collected. Histological and immunohistochemical analyses assessed angiogenesis, collagen deposition and inflammation. SF-36 questionnaire measured pre- and postoperative quality of life. Preoperative ultrasound Doppler showed that the peak blood flow velocity of the recipient area artery was significantly >30 cm/s (38.6 ± 6.8 cm/s) in all patients. Muscle flap sizes varied from 8 × 3.5 × 1 to 18 × 6 × 2 cm. The operation time of the repair surgery was 156.9 ± 15.08 minutes, and the hospital stay was 18.9 ± 3.3 days. Histological analysis proved that covering DFUs with ALBC induced membrane formation and increased collagen, neovascularization and M2 macrophages fraction while reducing M1 macrophages one. All grafts survived without amputation during a 7- to 24-month follow-up, during which SF-36 scores significantly improved. A combination of ALBC with free VLMS flaps and STSGs proved to be safe and effective for reconstructing non-weight-bearing DFUs. It rapidly controlled infection, enhanced life quality and foot function, and reduced hospitalization time. We advocate integrating this strategy into DFU treatment plans.

Impact of left atrial appendage flow velocity on thrombus resolution and clinical outcomes in patients with atrial fibrillation and silent left atrial thrombi: insights from the LAT study.

Blood stasis is crucial in developing left atrial (LA) thrombi. LA appendage peak flow velocity (LAAFV) is a quantitative parameter for estimating thromboembolic risk. However, its impact on LA thrombus resolution and clinical outcomes remains unclear. The LAT study was a multicentre observational study investigating patients with atrial fibrillation (AF) and silent LA thrombi detected by transoesophageal echocardiography (TEE). Among 17 436 TEE procedures for patients with AF, 297 patients (1.7%) had silent LA thrombi. Excluding patients without follow-up examinations, we enrolled 169 whose baseline LAAFV was available. Oral anticoagulation use increased from 85.7% at baseline to 97.0% at the final follow-up (P < 0.001). During 1 year, LA thrombus resolution was confirmed in 130 (76.9%) patients within 76 (34-138) days. Conversely, 26 had residual LA thrombi, 8 had thromboembolisms, and 5 required surgical removal. These patients with failed thrombus resolution had lower baseline LAAFV than those with successful resolution (18.0 [15.8-22.0] vs. 22.2 [17.0-35.0], P = 0.003). Despite limited predictive power (area under the curve, 0.659; P = 0.001), LAAFV ≤ 20.0 cm/s (best cut-off) significantly predicted failed LA thrombus resolution, even after adjusting for potential confounders (odds ratio, 2.72; 95% confidence interval, 1.22-6.09; P = 0.015). The incidence of adverse outcomes including ischaemic stroke/systemic embolism, major bleeding, or all-cause death was significantly higher in patients with reduced LAAFV than in those with preserved LAAFV (28.4% vs. 11.6%, log-rank P = 0.005). Failed LA thrombus resolution was not rare in patients with AF and silent LA thrombi. Reduced LAAFV was associated with failed LA thrombus resolution and adverse clinical outcomes.

Echocardiographic characterization of age- and sex-associated differences in cardiac function and morphometry in nonhuman primates.

Aging per se is a major risk factor for cardiovascular diseases and is associated with progressive changes in cardiac structure and function. Rodent models are commonly used to study cardiac aging, but do not closely mirror differences as they occur in humans. Therefore, we performed a 2D echocardiographic study in non-human primates (NHP) to establish age- and sex-associated differences in cardiac function and morphometry in this animal model. M mode and 2D echocardiography and Doppler analyses were performed cross-sectionally in 38 healthy rhesus monkeys (20 females and 18 males), both young (age 7-12years; n = 20) and old (age 19-30years; n = 18). The diameters of the cardiac chambers did not differ significantly by age group, but males had larger left ventricular diameters (2.43 vs 2.06cm in diastole and 1.91 vs 1.49cm in systole, p = 0.0004 and p = 0.0001, respectively) and left atrial diameter (1.981 vs 1.732cm; p = 0.0101). Left ventricular mass/body surface area did not vary significantly with age and sex. Ejection fraction did not differ by age and females presented a higher ejection fraction than males (54.0 vs 50.8%, p = 0.0237). Diastolic function, defined by early to late mitral peak flow velocity ratio (E/A), was significantly lower in old rhesus monkeys (2.31 vs 1.43, p = 0.0020) and was lower in females compared to males (1.595 vs 2.230, p = 0.0406). Right ventricular function, evaluated by measuring the Tricuspid Annular Plane Systolic Excursion, did not differ by age or sex, and Right Ventricular Free Wall Longitudinal Strain, did not differ with age but was lower in males than in females (-22.21 vs -17.95%, p = 0.0059). This is the first echocardiographic study to evaluate age- and sex-associated changes of cardiac morphometry and function in young and old NHP. The findings of this work will provide a reference to examine the effect of age and sex on cardiac diseases in NHP.

Influence of body weight, age, and sex on cerebrospinal fluid peak flow velocity in dogs without neurological disorders.

Changes in the brain can affect the flow velocity of cerebrospinal fluid (CSF). In humans, the flow velocity of CSF is not only altered by disease but also by age and sex. Such influences are not known in dogs. Peak flow velocity of CSF in dogs is associated with body weight, age, and sex. Peak flow velocity of CSF was measured in 32 client-owned dogs of different breeds, age, and sex. Peak flow velocity of CSF was determined by phase-contrast magnetic resonance imaging (PC-MRI) at the mesencephalic aqueduct, foramen magnum (FM), and second cervical vertebral body (C2). Dogs were grouped according to body weight, age, and sex. Flow velocity of CSF was compared between groups using linear regression models. Dogs with body weight >20 kg had higher CSF peak velocity compared with dogs <10 kg within the ventral and dorsal subarachnoid space (SAS) at the FM (P = .02 and P = .01, respectively), as well as in the ventral and dorsal SAS at C2 (P = .005 and P = .005, respectively). Dogs ≤2 years of age had significantly higher CSF peak flow velocity at the ventral SAS of the FM (P = .05). Females had significantly lower CSF peak flow velocity within the ventral SAS of FM (P = .04). Body weight, age, and sex influence CSF peak flow velocity in dogs. These factors need to be considered in dogs when CSF flow is quantitatively assessed.

Sedimentary Characteristics, Ages, and Environmental Significance of Gravel Deposits and Loess in Shandong, Eastern China: Regional Response to Global Change Since the Last Glacial Period

AbstractInvestigation of rarely studied gravel layers found in the loess in Shandong Province, eastern China, reveals the fabric characteristics of two gravel layers (G1, G2) and the sedimentary characteristics of loess at the typical and well‐preserved Heiyu section (HY), where, to determine the paleoclimatic changes during Marine Isotope Stage 3a. Optically stimulated luminescence dates of the HY formation range from 0.26 ± 0.02 ka to 39.00 ± 2.00 ka. In addition, the ages of G1 and G2 were estimated using the Bayesian model to be 39.60–40.50 and 29.00–29.50 ka. G1 and G2 are mainly composed of fine and medium gravel, both of which were subangular to subrounded limestone, with gravel directions to NE and E. The average flow velocity, average depth, and flood peak flow of G1 are 1.10 m/s, 0.49 m, and 37.04 m3/s, respectively, calculated using the flow energy method, whereas those of G2 are 0.98 m/s, 0.38 m, and 18.38 m3/s, respectively. Analysis of climate proxy indices show that the sedimentary environment of the gravel and loess in HY might be a regional response to global change.

Optimization Design and Experiment of a Cotton Straw-Crushing Device Based on Computational Fluid Dynamics

In order to design the structure and optimize the working parameters of a straw-crushing device, and to improve the qualified rate of straw-crushing length and the rate of straw fluidity, the influence of the airflow characteristics and pressure distribution in the working state of the crushing chamber and the different structure and working parameters of the straw-crushing device on the airflow field were studied based on the computational fluid dynamics (CFD) software Fluent 19.2. The simulation results show that by changing the rotation speed of the cutter shaft, the negative pressure and mass flow rate of the inlet surface of the flow field reach the maximum values of 63.6 Pa and 1.64 kg/s, respectively, when the rotation speed of the cutter shaft is 2000 rpm, which proves that the rotation speed of the cutter shaft increases, and the feeding performance also increases. In the case of 0, 8 and 16 air knives, the peak flow velocity in the crushing chamber is 43.1 m/s, 50.1 m/s and 54.48 m/s, respectively, and the airflow in the crushing chamber is improved to a certain extent, which proves the feasibility of the air knives’ structure. In order to verify the simulation results, a field experiment was carried out. The results showed that the qualified rate of straw crushing was 94.13% and the drop rate was 4.26% under the conditions of a cutter shaft speed of 1800 rpm, a machine forward speed of 6 km/h and a height of 80 mm of the cutter off the ground. The field experiment and simulation show that the qualified rate of crushing increases with the increase in the rotation speed of the cutter shaft, but the increase rate slows down, and the random speed decreases. The drop rate decreases with the increase in tool height and tool speed. The air knife structure improves the crushing qualification rate and significantly reduces the drop rate, which verifies the simulation accuracy. This study provides a theoretical basis for the optimization of straw-crushing devices.

Impact of left ventricular diastolic function and direct oral anticoagulant use for predicting embolic events in patients with heart failure and atrial fibrillation

AbstractBackgroundPatients with atrial fibrillation (AF) and heart failure (HF) have high stroke risk owing to left atrial dysfunction. However, anticoagulation is a concern in patients with high bleeding risk. We aimed to identify independent predictors of stroke in HF patients with AF.MethodsWe retrospectively examined 320 patients (mean age 79 ± 12 years, 163 women) hospitalized with acute HF complicated by AF between January 2014 and December 2018. Patients were followed from admission until ischemic stroke or systemic embolism (SSE) onset or death or were censored at the last contact date or September 2023.ResultsSSE occurred in 40 patients (median follow‐up of 528 days). Multivariate Cox regression analysis identified age (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.00–1.07, p = .034), direct oral anticoagulant (DOAC) use (HR 0.26, 95% CI 0.11–0.60, p = .002), and early diastolic peak flow velocity to early diastolic peak annular velocity (E/e'; HR 1.05, 95% CI 1.02–1.08, p &lt; .001) to be independent predictors of SSE, whereas left atrial reservoir strain was not. After determining an appropriate E/e' cutoff by receiver‐operating characteristic curve analysis and adjusting the multivariate Cox model, E/e' ≥17.5 (HR 3.30, 95% CI 1.56–6.83, p = .001) independently predicted SSE. The results were consistent with no interaction in the subanalysis except for gender.ConclusionElderly patients not on DOACs with elevated E/e' may be at higher risk of stroke, suggesting that DOACs should be the first choice for patients with elevated E/e' and aggressive additional prophylaxis and careful follow‐up are needed.

Four-dimensional flow magnetic resonance imaging for noninvasive diagnosis of clinically significant portal hypertension and high-risk gastroesophageal varices in patients with cirrhosis

IntroductionNoninvasive diagnoses of clinically significant portal hypertension (CSPH) and high-risk gastroesophageal varices are clinically relevant but challenging. Four-dimensional (4D) flow magnetic resonance imaging (MRI) provides comprehensive flow information and is a promising alternative. This study evaluated the efficacy of 4D flow MRI as a noninvasive method for diagnosing CSPH and high-risk varices in patients with liver cirrhosis. MethodsThis prospective study enrolled consecutive patients diagnosed with liver cirrhosis at a tertiary referral center between October 2020 and March 2021. Each participant underwent abdominal 4D flow MRI. Hemodynamic parameters within the portal vein, including the average and peak flow velocities, normalized flow volume (Qnormal), and regurgitant fraction (R%), were extracted and compared between healthy individuals and patients with CSPH and between participants with high- and low-risk varices. Subsequently, these parameters were incorporated into a logistic regression (LR) model refined using L1 regularization and validated using five-fold cross-validation. The diagnostic efficacy was evaluated using receiver operating characteristic (ROC) curves. ResultsEighty-two participants were enrolled (71 patients diagnosed with liver cirrhosis and 11 healthy individuals serving as controls). Among hemodynamic parameters, patients with CSPH exhibited a notable increase in Qnormal of 0.66 ​± ​0.19 ​ml∗m2/[cycle∗kg] (P ​= ​0.001) and an R% of 1.98 (2.05) (P ​= ​0.002). Similarly, patients with high-risk varices showed a higher Qnormal of 0.61 ​± ​0.15 ​ml∗m2/[cycle∗kg] (P ​< ​0.001) and R% of 1.88 (2.81) (P ​= ​0.006). ROC analysis revealed an area under the curve (AUC) for Qnormal of 0.93 and 0.91 for R% for diagnosing CSPH, while the LR model showcased a superior AUC of 0.95. For high-risk varices, Qnormal and R% showed AUC values of 0.75 and 0.70, respectively, whereas the LR model showed a higher AUC of 0.84. ConclusionAs a noninvasive imaging modality, 4D flow MRI exhibits considerable potential for the diagnosis of CSPH and high-risk gastroesophageal varices; thus, it may minimize the reliance on invasive procedures in patients with cirrhosis.

The Diagnostic Accuracy of Transcranial Color-Coded Doppler Ultrasound Technique in Stratifying Intracranial Cerebral Artery Stenoses in Cerebrovascular Disease Patients: A Systematic Review and Meta-Analysis.

The early and accurate stratification of intracranial cerebral artery stenosis (ICAS) is critical to inform treatment management and enhance the prognostic outcomes in patients with cerebrovascular disease (CVD). Digital subtraction angiography (DSA) is an invasive and expensive procedure but is the gold standard for the diagnosis of ICAS. Over recent years, transcranial color-coded Doppler ultrasound (TCCD) has been suggested to be a useful imaging method for accurately diagnosing ICAS. However, the diagnostic accuracy of TCCD in stratifying ICASs among patients with CVD remains unclear. Therefore, this systematic review and meta-analysis aimed at evaluating the diagnostic accuracy of TCCD in the stratification of intracranial steno-occlusions among CVD patients. A total of six databases-Embase, CINAHL, Medline, PubMed, Google Scholar, and Web of Science (core collection)-were searched for studies that assessed the diagnostic accuracy of TCCD in stratifying ICASs. The meta-analysis was performed using Meta-DiSc 1.4. The Quality Assessment of Diagnostic Accuracy Studies tool version 2 (QUADAS-2) assessed the risk of bias. Eighteen studies met all of the eligibility criteria. TCCD exhibited a high pooled diagnostic accuracy in stratifying intracranial steno-occlusions in patients presenting with CVD when compared to DSA as a reference standard (sensitivity = 90%; specificity = 87%; AUC = 97%). Additionally, the ultrasound parameters peak systolic velocity (PSV) and mean flow velocity (MFV) yielded a comparable diagnostic accuracy of "AUC = 0.96". In conclusion, TCCD could be a noble, safe, and accurate alternative imaging technique to DSA that can provide useful diagnostic information in stratifying intracranial steno-occlusions in patients presenting with CVD. TCCD should be considered in clinical cases where access to DSA is limited.

Potensi Citicoline sebagai Terapi Neuroproteksi dan Neuroregenerasi pada Stroke Iskemik Akut

Ischemic stroke, caused by a blockage in the brain’s blood vessels, is a critical emergency that requires immediate treatment. This study examined the efficacy of citicoline as an adjunct therapy to improve outcomes in acute ischemic stroke. A comprehensive search of four databases (Cochrane Library, ScienceDirect, PubMed, and Google Scholar) was conducted, identifying a total of 5265 articles. Three clinical trials were selected for critical appraisal. Agarwal demonstrated a larger reduction in stroke infarct volume in the citicoline group (4.22 cm3) compared to the placebo group (2.63 cm3) (p=0.483). On day 90, the citicoline group exhibited superior results in mRS scores of 0-2 (p=0.732), NIHSS scores of 0-2 (p=0.934), Barthel index ≥95 (p=0.564), and patient mortality (p=0.468). Seifaddini’s study revealed improved peak systolic velocity and mean arterial flow velocity in the cerebrovascular system. Enrico’s study showed improved mean short afferent latency inhibition in the cholinergic circuits of the citicoline group (p=0.004). Citicoline proves effective as an adjuvant neuroprotective and neuroregenerative therapy for acute ischemic stroke.

Novel echocardiographic parameters in pulmonary hypertension assessment and the relationship between echocardiography and 6-minute walking test.

Pulmonary artery stiffness (PAS) has been shown to be related to pulmonary artery pressure in patients with pulmonary artery hypertension (PAH). The aim of this study was to determine the correlation between functional capacity and echocardiographic indices of PAS in patients with PAH. This cross-sectional study was performed on patients with PAH who were confirmed by right heart catheterization and referred to Imam Reza PAH clinic for routine follow-up between November 2019 and January 2020. All patients underwent echocardiography and the maximum Doppler frequency shift, pulmonary acceleration time, peak velocity of the pulmonary flow, and velocity time integral, as well as PAS, were measured. All patients performed a 6-minute walk test. Fifty patients with a mean age of 41.90 ± 14.73 years old participated in this study. The majority of the patients were female (74%). The most common cause of PAH was idiopathic (74%). There was a significant correlation between PAS and pulmonary artery systolic pressure (r = 0.302, P = .041), second pulmonary valve pulse Doppler velocity (V2) (r = -0.461, P = .003), time from onset of pulmonary flow ejection to V2/first pulmonary valve pulse Doppler velocity (r = -0.311, P = .037) and Z3 ratio (r = -0.346, P = .023). There was no significant correlation between PAS and 6-minute walk test, pulmonary vascular resistance, and tricuspid annular plane systolic excursion (P > .05). There was a significant correlation between V2 and pulmonary vascular resistance (r = 0.359, P = .049). PAS and first pulmonary valve pulse Doppler velocity are simple, noninvasive, available tools for the evaluation of pulmonary vascular beds and diagnosis of presymptomatic clinical status in patients with PAH.

Ultrasonic AccV: a potential indicator of peripheral arteriosclerosis in patients with chronic obstructive pulmonary disease

ObjectiveThis study aimed to investigate the risk factors for peripheral arteriosclerosis (PAS) and peripheral artery disease (PAD) in chronic obstructive pulmonary disease (COPD) patients and potential ultrasound indicators that could be used to improve detection.MethodOutpatients seeking care between January 1, 2017, and December 31, 2020, in The First Affiliated Hospital of China Medical University were prospectively recruited. Subjects were divided into COPD and non-COPD (control) groups, and the COPD group was further divided into PAD and non-PAD subgroup, at the same time, PAS and non-PAS subgroup. Indicators of PAD -ankle-brachial index (ABI), indicators of PAS- pulse wave velocity (PWV), and ultrasound indices -peak systolic blood flow velocity (PSV) and blood flow acceleration velocity (AccV) were compared.ResultSixty-nine (61.6%) of 112 enrolled subjects had COPD. COPD patients had higher age, and blood pressure (BP)lower than controls. Seventeen (24.6%) COPD patients had PAD, the prevalence of PAD increases with the decrease of lung function, and seven (16.3%) non-COPD patients had PAD, however, there was no significant statistical difference between COPD and non-COPD groups. Fifty (72.5%) COPD patients had PAS, and thirty-four (79.1%) non-COPD patients had PAS, however, there was also no significant difference. The PAS subgroup had higher age, body mass index(BMI), body fat percentage(BFP), lower FEV1 and FEV1/FVC, as well as higher levels of right brachial artery and left dorsalis pedis artery AccV. Factors that correlated with ABI were 6MWD, post-bronchodilator FEV1, FEV1/ FVC, and maximal middle expiratory flow between 75% and 25% of FVC. Age, BP, and 6MWD, but not pulmonary function, were associated with brachial-ankle PWV (baPWV). There was a positive correlation between baPWV and radial artery AccV bilaterally.ConclusionRadial artery AccV correlated well with baPWV, which suggests that ultrasound could be used to assess both morphological and functional changes in vessels, may serving as a better method to identify PAS in high-risk COPD patients.

Analysis of echocardiographic features and postnatal management of fetal pulmonary valve stenosis

Objective: To investigate the echocardiographic features, consistency of diagnosis between fetal and postnatal periods and postnatal clinical outcomes of fetal pulmonary valve stenosis (PS) with different degrees. Methods: This study was a retrospective cohort study comprising 108 cases of fetal PS diagnosed during the fetal period and followed up postnatally at Xinhua Hospital, Shanghai Jiaotong University School of Medicine from November 2012 to February 2023. Echocardiographic characteristics, including morphological and hemodynamic features were collected for all fetuses who were then were followed up to at least 6 months after birth. One-way analysis of variance and Kruskal-Wallis test were used to compare the differences in the echocardiographic features among fetuses with different degrees of PS. Subsequently, McNemar test was used to assess the consistency of diagnosis between the fetal and postnatal periods. Furthermore, Logistic regression analysis was applied to explore the risk factors for neonatal intervention in fetuses with moderate PS and the receiver operating characteristic (ROC) curve was utilized to ascertain the optimal cut-off value for continuous variables. Results: The age of the mothers of the 108 fetuses at the initial assessment was (30.8±4.0) years, and the gestational age was 26.5 (24.6, 30.0) weeks. The fetuses were categorized into mild (17 cases), moderate (49 cases), and severe groups (42 cases) based on the initial echocardiographic features. Mild PS was characterized by valve thickening and hyperechogenicity combined with systolic flow acceleration or dilation of main pulmonary artery. Moderate PS exhibited both restricted valve motion and a colorful blood flow pattern at the valve orifice. The peak flow velocities of fetuses with moderate and critical PS were notably higher than those in the mild group ((2.66±0.86) and (2.77±1.30) vs. (1.43±0.59)m/s, F=14.52, P<0.001). In critical PS, all cases showed retrograde ductal flow, with a significantly higher proportion of a small right ventricle compared to the mild and moderate PS (42.9% (18/42) vs. 0 and 2.0% (1/49), χ2=31.73, P<0.001). The proportion of severe tricuspid regurgitation was also higher (35.7% (15/42) vs. 0 and 10.2% (5/49), χ2=36.94, P<0.001). Compared to mild and severe PS, the consistency of diagnosis between fetal and postnatal periods in moderate PS was lower (40.8% (20/49) vs.13/17 and 80.3% (35/42), χ2=12.45, P=0.006). The systolic flow velocity was identified as an independent risk factor for neonatal intervention in fetuses with moderate PS (OR=7.21, 95%CI2.11-24.62). A flow velocity of ≥2.18 m/s in second trimester and ≥3.15 m/s in third trimester indicated the necessity of neonatal intervention for fetal moderate PS. Among the 108 fetuses, 68 underwent surgical intervention and all survived. Additionally, 39 fetuses were regularly followed up. A sole non-surgical fatality occurred, leading to a 6-month survival rate of 99.1% (107/108). Conclusions: Various degrees of fetal PS demonstrate distinctive morphological and hemodynamic alterations in echocardiography. The disparity in severity between the postnatal and fetal stages requires ongoing monitoring for fetal PS. The prognosis for fetal PS is generally favorable.

Effect of Maternal Preeclampsia on Cardiac Structure and Function in Very Low Birth Weight Infants.

We aimed to determine whether exposure to severe maternal preeclampsia (PE) in very low birth weight (VLBW) infants is associated with hypertrophic cardiac changes and altered hemodynamics. Case-control study of VLBW infants born at Los Angeles General Medical Center from May 2015 to August 2023, who had an echocardiogram within the first 7 days of life. Cases were infants exposed to maternal PE and controls were infants not exposed to maternal PE matched by birth weight (BW) 1:1. Laboratory, placental pathology results, hemodynamic data and clinical outcomes were collected and compared between cases and control infants. A total of 43 cases matched by BW with control infants were studied. There were no significant anatomical cardiac changes by echocardiography between cases and control infants. Cases had significantly higher blood pressure within the first 72 hours of life and lower ejection fraction (EF), fractional shortening, and peak systolic flow velocity through their patent ductus arteriosus (PDA) within the first week of life. Cases were more likely to be smaller despite being born at a later gestational age (GA), as well as small for GA with placental weight less than 10th percentile compared to control infants. Our findings indicate that infants born to mothers with PE have higher systemic vascular resistance as evidenced by elevated blood pressure, and lower EF and shortening fraction and higher pulmonary vascular resistance as evidenced by lower peak flow velocity through the PDA. We did not observe hypertrophic cardiac changes in exposed infants. These findings should be considered in clinical decision-making during management of these infants. · VLBW infants exposed to severe PE have higher rate of Small for gestational age and smaller placentas.. · VLBW infants exposed to severe PE have higher systemic vascular resistance during transitional period and lower EF and fractional shortening.. · VLBW infants exposed to severe PE have higher pulmonary vascular resistance..