Peak Systolic Blood Flow Velocity Research Articles

ERECTILE DYSFUNCTION AND OBESITY IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA AND ARTERIAL HYPERTENSION

Objective: to study the relationship between erectile dysfunction and obesity parameters and the severity of obstructive sleep apnea in patients with arterial hypertension.Material and methods: 71 patients with different severity of erectile dysfunction, overweight and obesity of grade 1, mild and severe obstructive sleep apnea and arterial hypertension were included in the study. The data of cardiorespiratory monitoring, anthropometric parameters of obesity were analyzed and the severity of erectile dysfunction was assessed by intracavernous pharmacodopplerography, the results were compared with the subjective opinion of patients on the degree of severity of erectile dysfunction according to the IIEF-5 questionnaire. All patients underwent psychosomatic status analysis according to the questionnaire scales: assessment of daytime drowsiness on the Epworth scale, severity of personal and situational anxiety on the Spielberger scale and depression level on the Beck scale.Results: comparative analysis revealed statistically significant links between anthropometric data of obesity with OSA parameters (apnea/hypopnea index, desaturation index) (p<0.05), as well as the severity of erectile dysfunction (in terms of erection and dopplerography with evaluation of the of penile blood flow) (p<0.05). A statistically significant negative relationship between the quality of penile blood flow and the degree of arterial hypertension was revealed too (p=0.02). In a comparative analysis of the subjective state of erectile function and objective examination, no statistically significant association was revealed (p=0.07). As a result of the multifactorial linear regression, we have shown that with an increase of the waist circumference to the hip circumference ratio and a higher apnea/hypopnea index, the condition of penile arterial blood flow worsens, namely, a decrease in the peak systolic blood flow velocity (β=-0.39, p=0.05; β=-0.44, p=0.03, respectively). When assessing the psychosomatic state of patients, a significant correlation has been found between the severity of depression in the Beck scale and the level of personal and situational anxiety according to the Spielberger scale (p<0.05). The relationship between depression level on the Beck scale and the degree of situational anxiety with the severity of erectile dysfunction on the Juname scale has been also shown (p<0.05). Conclusion: the combination of overweight or obesity with obstructive sleep apnea and arterial hypertension gives ground to suspect the presence of different severity of erectile dysfunction. The severity of ED is directly proportional to the level of anxiety and depression according to the questionnaire scales.

Measuring the Nitroglycerine-Induced Vasodilation in Carotid Arteries

Introduction: Nitroglycerin is a fast-acting drug that rapidly dilates coronary arteries and thus increases blood flow to these vessels, and increases the blood flow through the lateral vessels to low blood areas. It also reduces both end diastolic pressure and volume of the left ventricular. However, the effect of nitroglycerin on the circulation hemodynamic is not known. Carotid artery is an artery on each side of the head and neck that supplying blood to the brain, face, scalp, skull, neck and meninges. The purpose of this study was to evaluate the influence of the Nitroglycerin on the blood velocity of the carotid artery. Materials and Methods: Right carotid artery (common carotid artery 2 cm before the bifurcation, beginning of the internal and external carotid arteries) of 10 healthy subjects (age, 24±4 years) was scanned longitudinally with an ultrasound system (esaote Mylab 60) equipped with linear probe (4-13 MHz). Pulse wave Doppler images of blood velocity of the carotid arteries were recorded before and after taking a sublingual nitroglycerin pill. The blood velocity waveforms were extracted from sonograms over three cardiac cycles by using a custom analysis programs written in MATLAB. The effect of nitroglycerin on the carotid blood velocity was evaluated. Results: According to the results, the carotid blood velocities changed significantly after administration the nitroglycerin. The peak systolic blood flow velocity of the CCA and ICA decreased 15% ± 9 and 20%± 16 after taking the pill, respectively. The end diastolic velocity of the blood flow in the CCA and ICA decreased 19% ± 12 and 16%± 11, respectively. The dicrotic notch of the CCA and ECA descended 24% ± 12 and 24% ± 22, respectively. There was not shown significant difference in the heart rate of the subjects before and after nitroglycerin administration. Conclusion: According to presented results, nitroglycerin reduces both peak systolic and end diastolic blood velocity of the CCA and ICA. It seems that this hemodynamic change in the blood velocity caused by nitroglycerin might be a fast response of the carotid artery to the release of vasoactive substances such as nitric oxide (NO) from the endothelium.

The application of high frequency ultrasound in the muscles, bones and the thoracodorsal artery in subscapular region and analysis of ultrasonic characteristics.

To analyze the application value of high-frequency ultrasound in the muscles, bones and the thoracodorsal artery in the subscapular region and summarize the characteristics of ultrasound. Subscapularis muscle, bone and thoracodorsal artery of 72 healthy subjects were examined using high-frequency ultrasound, the initial segment diameter of the thoracodorsal artery and peak systolic blood flow velocity were recorded, and the ultrasonographic characteristics of subscapularis muscle, bone and thoracodorsal artery were summarized. The spinous processes of 7th thoracic vertebrae, 9th thoracic vertebrae and 11th thoracic vertebrae all showed strong echoes with posterior acoustic shadow. The vertebral plates of 8th thoracic vertebrae, 10th thoracic vertebrae and 11th thoracic vertebrae showed a strong linear echo on both sides of the spinous process, and the lateral side was connected with the transverse processes of 8th thoracic vertebrae, 10th thoracic vertebrae, and 11th thoracic vertebrae. The inferior scapular artery was launched from the axillary artery, along with the deep side of the inferior scapular muscle, the latissimus dorsi and teres major muscle, and then it went inferior and backward which was then divided into arteriae dorsalis scapulae and thoracodorsal artery, showing a tubular structure with no echo. Color Doppler Flow Imaging (CDFI) showed the endovascular blood flow signal of the inferior scapular artery and its branches. The internal diameter of the initial segment of the thoracodorsal artery of the male subjects was bigger than that of the female subjects, and the difference was statistically significant (p < 0.05). High-frequency ultrasound can provide a reliable reference for the anatomical structure and adjacent relationship of subscapular muscles, bones and thoracodorsal artery, and is worthy of being promoted as a non-invasive and reliable mean of examination.

Supine vs. Prone Position With Turn of the Head Does Not Affect Cerebral Perfusion and Oxygenation in Stable Preterm Infants ≤32 Weeks Gestational Age.

Intraventricular hemorrhage (IVH) is a frequent major damage to the brain of premature babies ≤32 weeks gestational age, and its incidence (20–25%) has not significantly changed lately. Because of the intrinsic fragility of germinal matrix blood vessels, IVH occurs following disruption of subependymal mono-layer arteries and is generally attributed to ischemia-reperfusion alterations or venous congestion, which may be caused by turn of the head. Therefore, supine position with the head in a midline position is considered a standard position for preterm infants during their first days of life. We asked whether a change in body position (supine vs. prone) linked with a turn of the head by 90° in the prone position would change blood flow velocities and resistance indices in major cerebral arteries and veins of stable premature babies at two different time points (t0, day of life 2, vs. t1, day 9). Moreover, we assessed cerebral tissue oxygenation (cStO2) by near-infrared spectroscopy and determined correlations for changes in velocities and oxygenation. Twenty one premature infants [gestational age 30 (26–32) weeks] with sufficiently stable gas exchange and circulation were screened by ultrasonography and near-infrared spectroscopy. Peak systolic and end-diastolic blood flow velocities in the anterior cerebral arteries (29 ± 6 m/s vs. 28 ± 7 peak flow at t0, 36 ± 8 vs. 35 ± 7 at t1), the basilar artery, the right and the left internal carotid artery, and the great cerebral vein Galen (4.0 ± 0.8 m/s vs. 4.1 ± 1.0 maximum flow at t0, 4.4 ± 0.8 vs. 4.4 ± 1.0 at t1) did not show significant differences following change of body and head position. Also, there were no differences in cStO2 (83 ± 7% vs. 84 ± 7 at t0, 76 ± 10 vs. 77 ± 11 at t1) and in vital signs such as heart rate and blood pressure. We conclude that change in body position with turn of the head in the prone position does not elicit significant alterations in cerebral blood flow velocities or in oxygenation of cerebral tissues. Maturational changes in arterial flow velocities and cStO2 are not correlated. For this subgroup of premature infants at low risk of IVH our data do not support the concept of exclusive preterm infant care in supine position.

Estimating hemodynamic shear stress in murine peripheral collateral arteries by two-photon line scanning.

Changes in wall shear stress of blood vessels are assumed to be an important component of many physiological and pathophysiological processes. However, due to technical limitations experimental in vivo data are rarely available. Here, we investigated two-photon excitation fluorescence microscopy as an option to measure vessel diameter as well as blood flow velocities in a murine hindlimb model of arteriogenesis (collateral artery growth). Using line scanning at high frequencies, we measured the movement of blood cells along the vessel axis. We found that peak systolic blood flow velocity averaged 9mm/s and vessel diameter 42µm in resting collaterals. Induction of arteriogenesis by femoral artery ligation resulted in a significant increase in centerline peak systolic velocity after 1day with an average of 51mm/s, whereas the averaged luminal diameter of collaterals (52µm) changed much less. Thereof calculations revealed a significant fourfold increase in hemodynamic wall shear rate. Our results indicate that two-photon line scanning is a suitable tool to estimate wall shear stress e.g., in experimental animal models, such as of arteriogenesis, which may not only help to understand the relevance of mechanical forces in vivo, but also to adjust wall shear stress in ex vivo investigations on isolated vessels as well as cell culture experiments.

Effects on cervical spondylosis of vertebral artery type and the concentrations of plasma NPY and UII in the patients treated with the modified acupuncture at unilateral/bilateral Renying (ST 9)

To observe the differences in the clinical therapeutic effects on cervical spondylosis of vertebral artery type (CSA) between the modified acupuncture and the routine acupuncture at unilateral/bilateral Renying (ST 9) as well as the impacts on the concentrations of plasma neuropeptide Y (NPY) and urotensinⅡ(UⅡ) in the patients. A total of 160 patients were divided into a modified bilateral acupuncture group, a modified unilateral acupuncture group, a routine bilateral acupuncture group and a routine unilateral acupuncture group, 40 cases in each one according to the random number table. In the modified bilateral acupuncture group, the modified acupuncture was applied bilaterally to Renying (ST 9). In the modified unilateral acupuncture group, the modified acupuncture was applied unilaterally to Renying (ST 9). In the routine bilateral acupuncture group, the routine acupuncture was applied bilaterally to Renying (ST 9). In the routine unilateral acupuncture group, the routine acupuncture was applied unilaterally to Renying (ST 9). The treatment was given once every day, continuously for 6 days as one course. Two courses of treatment were required at the interval of 1 day. In each group, before and after treatment, we observed the peak systolic blood flow velocity (Vs) of the vertebral artery (VA) and the basilar artery (BA), cervical vertigo symptoms and functional assessment scales (ESCV) and the concentration of plasma NPY and UⅡ. The clinical therapeutic effects were compared among the groups. After treatment, the clinical therapeutic effect in the modified bilateral acupuncture group was 90.0% (36/40), which was better than 80.0% (32/40) in the modified unilateral acupuncture group, 77.5% (35/40) in the routine bilateral acupuncture group and 65.0% (26/40) in the routine unilateral acupuncture group (all P<0.05). After treatment, Vs of VA and BA was improved remarkably in every group (all P<0.01), and the result in the modified bilateral acupuncture group was higher than those in the other groups (all P<0.01). After treatment, ESCV scores were all increased remarkably in every group (all P<0.01). ESCV score and improvement index in the modified bilateral acupuncture group were all higher than those in the other groups (P<0.05, P<0.01). After treatment, the concentrations of plasma NPY and UⅡ were all reduced remarkably in every group (all P<0.01) and the differences were significant among the groups (all P<0.01). The modified bilateral acupuncture at Renying (ST 9) effectively regulates the blood supply of the vertebral basilar artery and improves the cerebral circulation. The effects are superior to those of the unilateral acupuncture at Renying (ST 9).

Application of Transcranial Color Doppler Ultrasonography for Assessing Middle Cerebral Arteries in Rheumatoid Arthritis.

To assess the role of ultrasonography for assessing middle cerebral arteries (MCAs) in rheumatoid arthritis (RA). Middle cerebral arteries of 32 RA patients and 32 healthy volunteers were examined by ultrasonography. Peak systolic blood flow velocity (PSV), end-diastolic velocity, and resistance index (RI) of MCA were measured using Doppler ultrasound. Results were expressed as mean ± SD. No significant difference in peak systolic velocity was obtained between RA patients (52.44 ± 19.56 cm/s) and healthy volunteers (51.59 ± 16.83 cm/s, P > 0.05). End-diastolic velocity in RA patients was significantly lower (15.41 ± 5.44 cm/s vs 24.54 ± 8.45 cm/s, P < 0.01) and RI markedly higher (0.66 ± 0.10 vs 0.60 ± 0.06, P < 0.05) compared with control values. Resistance index in 32 RA patients increased with disease duration (2 months to 31 years), from a median value of 0.350 to 0.830; there was a strong correlation between RI and disease duration (r = 0.965, P < 0.05). A point of 0.64 in receiver operating characteristic curve was chosen as the cutoff point, and the area under the curve was 0.918. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 90.6%, 87.5%,87.9%, 90.3%, and 89.1%, respectively. Color Doppler ultrasound in RA patients with hemodynamic changes of MCAs could be a relatively sensitive tool for the detection of cerebral atherosclerotic lesions. This could enable timely intervention for early clinical reference.

Ascending aortic blood flow velocity is increased in children with primary snoring/mild sleep-disordered breathing and associated with an increase in CD8 + T cells expressing TNFα and IFNγ.

Sleep-disordered breathing (SDB) is associated with cardiovascular disease and systemic inflammation in adults but this remains to be explored in children, especially in children with the most common form of SDB, i.e. primary snoring/mild SDB. This pilot study investigated the relationship between the cardiovascular function and inflammation in children with mild SDB. Nineteen participants aged 5-14years underwent overnight polysomnography, cardiac magnetic resonance imaging (aortic blood flow velocity and left and right ventricular systolic function) and assessment for inflammatory markers (intracellular cytokine analysis of T cells by flow cytometry). Parents also completed the Sleep Disturbances Scale for Children (SDSC). Children with mild SDB exhibited increased ascending aortic peak systolic velocity compared to controls (SDB 119.95m/s vs. control 101.49m/s, p<0.05). No significant group differences were observed for left and right ventricular ejection fraction or mean aortic blood flow velocity from either the ascending aorta or pulmonary artery. Children with mild SDB had increased inflammatory markers as demonstrated by elevated T cell interferon gamma (IFNγ) (SDB 52±4% vs. control 25±3% positive cells, p<0.005) and tumour necrosis factor alpha (TNFα) (SDB 39±4% vs. control 20±2% positive cells, p<0.005) expression from CD8+ cells. A strong positive correlation was observed between ascending aorta peak blood flow velocity and both TNFα and IFNγ (TNFα, r=0.54, p<0.03; IFNγ, r=0.63, p<0.005, respectively). Polysomnography revealed that oxygen saturation (SaO2) nadir was significantly lower in children with mild SDB compared to controls (SDB 92.3±2.7% vs. control 94.4±1.6%, p<0.05). A lower SaO2 nadir was associated with an increased ascending aorta peak systolic velocity (r=-0.48, p<0.05). As well, both a lower SaO2 nadir and an increased ascending aorta peak systolic velocity were associated with higher SDSC Sleep-Disordered Breathing and Disorder of Initiating and Maintaining Sleep subscale scores but not the polysomnographic-derived Obstructive Apnea-Hypopnea Index. The finding of elevated ascending aortic peak systolic blood flow velocity and its association with increased inflammatory markers suggests that the profile of cardiovascular changes noted in adult SDB may also occur in children with mild SDB.

Ультразвуковое исследование внутренней половой артерии трансперинеальным доступом при артериогенной эректильной дисфункции

To determine the practical and diagnostic value of transperineal ultrasound imaging of the internal pudendal artery (IPA) in patients with arteriogenic erectile dysfunction (ED). Transperineal IPA and penile Doppler ultrasonography was performed in 50 healthy young male volunteers aged 23.6+/-3.4 years without ED (IIEF-5 score of 21-22) and 60 patients with ED (IIEF-5 score of 6-18, mean age 49+/-4.6 years), including 30 men with prostate cancer (PCa) after comprehensive treatment and 30 patients with type 1 and type 2 diabetes mellitus. To determine the diagnostic value of the transperineal IPA imaging, the results were compared with the findings of magnetic resonance or contrast-enhanced dynamic CT angiography of the iliac arteries. In all healthy men no abnormalities were found in the perineal primary arterial blood flow, in 100% of cases perineal branch of IPA was rectilinear, while patients with arteriogenic ED had low IPA and penile peak systolic blood flow velocity (<0.05), pathologically altered type of blood flow and non-rectilinear course of IPA, stenosis and occlusion in the pelvic and extrapelvic branches of IPA. When comparing the findings of IPA Doppler ultrasound and angiography studies of the small pelvis in healthy men, they completely matched, showing satisfactory arterial IPA perfusion, absence of stenoses or occlusions. Sensitivity and specificity of the transperineal IPA ultrasound imaging were 95% and 90%, respectively. Transperineal IPA ultrasound imaging allows to assess the important morphometric features of the perineal branches of IPA - the arterial diameter, the response to stimulation, the course of the artery, the type of arterial blood flow, the presence or absence of arterial stenoses and occlusions, and to measure peak systolic blood flow velocity.

The effects of antioxidants on ocular blood flow in patients with glaucoma.

To investigate the effects of an antioxidant dietary supplement that includes Ginkgo biloba, on retinal and retrobulbar blood flow in patients with open-angle glaucoma (OAG). Forty-five patients with confirmed OAG were enroled in a randomized, double blinded, placebo-controlled cross-over study. Baseline and postadministration measurements of intraocular pressure (IOP), ocular perfusion pressure (OPP), retrobulbar blood flow, and retinal capillary blood flow were non-invasively measured (ultrasound and laser Doppler modalities, respectively) before and one month after antioxidant nutraceuticals and placebo administration. Changes in measurements between the active supplement and placebo arms were evaluated using paired t-tests, with p<0.05 considered statistically significant. Antioxidant supplementation produced a statistically significant increase in peak systolic and/or end diastolic blood flow velocities in all retrobulbar blood vessels compared to placebo. Vascular resistance was also reduced in central retinal and nasal short posterior ciliary arteries following antioxidant administration. Additionally, antioxidant supplementation increased superior and inferior temporal retinal capillary mean blood flow and the ratio of active to non-active retina capillaries compared to placebo. One-month oral administration of antioxidants produced increases in biomarkers of ocular blood flow within retinal and retrobulbar vascular beds in patients with OAG.

The effects of chronic smoking on total cerebral blood volume measured by carotid and vertebral artery doppler ultrasonography.

To evaluate the effects of chronic cigarette smoking on total cerebral blood flow in healthy adults by Doppler ultrasonography (US). We evaluated 50 smoker (median age 29) and 50 nonsmoker (median age 28) healthy, 20- to 40-year-old subjects without any cardiovascular and cerebrovascular disease. Peak systolic maximal blood flow velocity (PSV), end-diastolic maximal blood flow velocity (EDV), time-averaged mean blood flow velocity (TAMV), resistance index (RI), and pulsatility index (PI) were measured in the left and right carotid and vertebral arteries, and total cerebral blood flow volume was calculated. There was no significant difference of smoking rate between genders. Blood pressure and PSV values were similar in both groups. EDV values of internal carotid artery (ICA) and vertebral artery (VA) were lower and RI and PI values were higher in smokers. TAMV, total ICA (-10.8%) and VA (-6%) flow volume, and tCBF (-9.2%) were lower in smokers. Doppler US is an effective tool to detect tCBF volume decrease in chronic cigarette smokers. Although minimal, this decrease, as demonstrated here in asymptomatic, healthy people, might be critical in patients with subclinical cerebral arterial insufficiency. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 45:561-565, 2017.

Application of ultrasound in evaluating degree of xerostomia in patients with nasopharyngeal carcinoma receiving radiotherapy

Objective To investigate the effectiveness of ultrasound in evaluating the degree of xerostomia in the patients with nasopharyngeal carcinoma (NPC) receiving intensity-modulated radiotherapy (IMRT). Methods A total of 30 NPC patients who were admitted to our hospital from May 2013 to December 2014 were enrolled in this study. The degree of xerostomia in these NPC patients was scored according to the Radiation Therapy Oncology Group scoring criteria. Color Doppler ultrasound was used to measure the peak systolic blood flow velocity of the parotid gland and submandibular gland and the changes in vascular diameter of the parotid gland in the NPC patients before, during, and after IMRT. The correlation between each parameter and the degree of xerostomia was determined by analysis of variance. Results In the 28 NPC patients included in the statistical analysis, the degree of xerostomia during IMRT was significantly higher than that before IMRT (P=0.024), and the degree of xerostomia at 3 months after IMRT was significantly lower than that during IMRT (P=0.035). The peak systolic blood flow velocity of the parotid gland and submandibular gland and the proportion of patients with decreases in vascular diameter of the parotid gland during IMRT were significantly higher than those before IMRT (P=0.001 and 0.003; P=0.001); the above parameters at 3 months after IMRT were significantly lower than those during IMRT (P=0.008 and 0.012; P=0.001). During IMRT and after IMRT, the degree of xerostomia was significantly correlated with the peak systolic blood flow velocity of the parotid gland (r=0.563, P=0.026; r=0.409, P=0.031). Conclusions Ultrasound can be used as a noninvasive detection for the hemodynamic changes in the parotid gland, and it has a certain clinical reference value for evaluating the degree of xerostomia in NPC patients during and after IMRT. Key words: Blood flow of parotid gland; Xerostomia; B ultrasound detection; Nasopharyngeal neoplasms/radiotherapy

Transcatheter aortic valve implantation improves carotid and vertebral arterial blood flow in patients with severe aortic stenosis: practical role of orthostatic stress test.

There are no data on the impact of transcatheter aortic valve implantation (TAVI) on carotid and vertebral arterial blood flow. Our aim was to assess the effects of the orthostatic stress test on carotid and vertebral artery blood flow in patients with severe aortic stenosis (AS) undergoing TAVI. TAVI may have beneficial effect on carotid and vertebral artery flow in patients with severe aortic stenosis. Thirty carefully selected patients with severe AS undergoing TAVI were enrolled. Peak systolic blood-flow velocity and end-diastolic velocity in the common carotid artery, internal carotid artery, and vertebral artery, as well as spectral analysis of flow pattern with time-averaged maximum velocity (centimeters per second), time-averaged mean velocity (centimeters per second), and flow volume (milliliters per minute) on both sides were measured by duplex ultrasound. Measurements were performed in the supine position and at 1 to 2 minutes after the assumption of the standing position at baseline and 3 months after TAVI. All duplex ultrasound parameters assessed in the supine position have significantly improved in patients after TAVI as compared to baseline (P < 0.001 for all). The orthostatic stress test induced decrease of carotid and vertebral arterial flow velocities in AS patients before and after TAVI. However, the drop in velocities and flow volume was numerically lower after TAVI. TAVI may have some beneficial effect on extracranial artery blood flow by minimalization of its decrease as a response to orthostatic stress.

Doppler Ultrasonography of the Central Retinal Vessels in Children With Brain Death.

The purpose of this observational study is to explore if bedside Doppler ultrasonography of the central retinal vessels has the potential to become an ancillary study to support the timely diagnosis of brain death in children. Seventeen-month prospective observational cohort. Forty-four bed pediatric medical and surgical ICU in an academic teaching hospital. All children 0-18 years old who were clinically evaluated for brain death at Children's National Health Systems were enrolled and followed until discharge or death. None. All patients had at least one ophthalmic ultrasound within 30 minutes of each brain death examination. The central retinal artery peak systolic blood flow velocity, resistive index, pulsatility index, and Doppler waveforms were evaluated in each patient. Thirty-five ophthalmic ultrasounds were obtained on 13 patients, 3 months to 15 years old, who each had two clinical examinations consistent with brain death. The average systolic blood pressure during the ultrasound examinations was 102 mm Hg (± 28), diastolic blood pressure 65 mm Hg (± 24), mean arterial pressure 79 mm Hg (± 23), heart rate 133 beats/min (± 27), temperature 36°C (± 0.96), arterial CO2 35 mm Hg (± 9), and end-tidal CO2 23 mm Hg (± 6). For all examinations, the average peak systolic velocity of the central retinal artery was significantly decreased at 4.66 cm/s (± 3.2). Twelve of 13 patients had both resistive indexes greater than or equal to 1, average pulsatility indexes of 3.6 (± 3.5) with transcranial Doppler waveforms consistent with brain death. Waveform analysis of the 35 ultrasound examinations revealed 11% with tall systolic peaks without diastolic flow, 17% with oscillatory flow, 29% showed short systolic spikes, and 23% had no Doppler movement detected. A rippling "tardus-parvus" waveform was present in 20% of examinations. This study supports that the combination of qualitative waveform analysis and quantitative blood flow variables of the central retinal vessels may have the potential to be developed as an ancillary study for supporting the diagnosis of brain death in children.

A noninvasive method for the prediction of fetal hemolytic disease

Objective: to improve the diagnosis of fetal hemolytic disease. Subjects and methods. A study group consisted of 42 pregnant women whose newborn infants had varying degrees of hemolytic disease. The women were divided into 3 subgroups according to the severity of neonatal hemolytic disease: 1) pregnant women whose neonates were born with severe hemolytic disease (n = 14); 2) those who gave birth to babies with moderate hemolytic disease (n = 11); 3) those who delivered infants with mild hemolytic disease (n = 17). A comparison group included 42 pregnant women whose babies were born without signs of hemolytic disease. Curvesfor blood flow velocity in the middle cerebral artery were analyzed in a fetus of 25 to 39 weeks’ gestation. Results. The peak systolic blood flow velocity was observed in Subgroup 1; however, the indicator did not exceed 1.5 MoM even in severe fetal anemic syndrome. The fetal middle artery blood flow velocity rating scale was divided into 2 zones: 1) the boundary values of peak systolic blood flow velocity from the median to the obtained midscore; 2) the boundary values of peak systolic blood flow velocity of the obtained values of as high as 1.5 MoM. Conclusion. The value of peak systolic blood flow velocity being in Zone 2, or its dynamic changes by transiting to this zone can serve as a prognostic factor in the development of severe fetal hemolytic disease.

Changes in lower extremity blood flow during advancing phases of pregnancy and the effects of special footwear.

Background During pregnancy, a number of changes affecting venous blood flow occur in the circulatory system, such as reduced vein wall tension or increased exposure to collagen fibers. These factors may cause blood stagnation, swelling of the legs, or endothelial damage and consequently lead to development of venous disease. Objectives The aim of this study is to evaluate the effect of special footwear designed to improve blood circulation in the feet on venous blood flow changes observed during advancing phases of pregnancy. Methods Thirty healthy pregnant women participated in this study at 25, 30, and 35 weeks of gestation. Participants were allocated at random to an experimental group (n = 15) which was provided with the special footwear, or a control group (n = 15). At each data collection session, Doppler measurements of peak systolic blood flow velocity and cross-sectional area of the right popliteal vein were performed using a MySonoU6 ultrasound machine with a linear transducer (Samsung Medison). The differences were compared using Cohen’s d test to calculate effect size. Results With advancing phases of pregnancy, peak systolic velocity in the popliteal vein decreased significantly in the control group, whereas it increased significantly in the experimental group. No significant change in cross-sectional area was observed in any of the groups. Conclusions Findings in the experimental group demonstrated that wearing the footwear tested may prevent venous blood velocity from reducing during advanced phases of pregnancy. Nevertheless, there is a need for further investigation of the beneficial effect on venous flow of the footwear tested and its application.

Role of fibroblast growth factor 23 in the development of cardiovascular diseases in patients with end-stage renal failure on programmed hemodialysis

To determine the nature of changes in fibroblast growth factor 23 (FGF-23) and other bone mineral metabolism parameters detectable in the blood of patients with end-stage chronic renal failure (CRF) and to analyze their links to the development of cardiovascular events in uremic intoxication. A total of 75 patients (45 men and 30 women) aged 23 to 66 years (mean age, 53±2.1 years) with Stage VD CKF were examined. The levels of parathyroid hormone (PTH), calcium, phosphorus, the morphogenetic protein FGF-23, and the cardiospecific protein troponin I were investigated. Doppler echocardiography was performed on an Aloka 4000 machine. Left ventricular (LV) mass index (LVMI), LV systolic and diastolic function, and peak systolic blood flow velocity in the aortic arch (Vps) were estimated. As LVMI became higher, there were increases in the level of PTH and that of FGF-23 that plays a significant role in the processes of bone remodeling and vascular calcification. Analysis of correlations between a change in FGF-23 concentrations depending on the morphological and functional parameters of the cardiovascular system (CVS) revealed a strong direct correlation between FGF-23 levels and LVMI (r=0.746; p<0.01), a significant inverse correlation between FGF-23 and ejection fraction (r=-0.901; p<0.05), and a direct correlation of FGF-23 and troponin I (r=0.544; p<0.05). FGF-2 increasing from moderate to very high levels indicates that there is a high risk for remodeling processes in the CVS even in the absence of baseline echocardiographic signs of myocardial hypertrophy, normal aortic pulse wave velocity, and compensation of other risk factors, such as hypertension, uremia, hyperparathyroidism, even without increasing the markers of cardiovascular events, such as hyperphosphatemia. The elevated level of FGF-23 suggests that there is a need for cardioprotective therapy, the goal of which is to correct of the level of this factor.

Elevated serum homocysteine level as an independent risk factor for erectile dysfunction: a prospective pilot case-control study.

Homocysteine is an amino acid that is produced from the metabolic demethylation of dietary methionine. It has gained arising attention for its association with increased risk of myocardial infarction, stroke and venous thromboembolism. Erectile dysfunction (ED), especially for vasculogenic ED, is a vascular disorder of cavernosal vascular bed. In this prospective pilot case-control study, we investigated plasma homocysteine levels in 32 ED patients and 20 healthy control men. Related patients characteristics including age, weight, height, marital status, smoking and drinking status, level of education were collected and analysed as well as penile colour Doppler ultrasound parameters. ED patients were further categorised into mild, moderate and severe ED based on 5-item of the International Index of Erectile Function. Higher homocysteine levels were observed in ED patients as compared with controls (p<.05). A multivariate logistic regression with likelihood ratio test revealed that homocysteine and penile peak systolic blood flow velocity (PSV) levels posed significant indicators for ED (chi-square of likelihood ratio=20.42, df=2, p<.005) as well as moderate and severe ED occurrence (chi-square of likelihood ratio=28.50, df=2, p<.005). The threshold value of homocysteine concentration to discriminate ED and control subjects was 12.65μmol/L by performing receiver operating characteristic curve analyses. These data suggested that elevation of homocysteine levels was associated with an increased risk of ED.

Decreased carotid and vertebral arterial blood-flow velocity in response to orthostatic unload in patients with severe aortic stenosis.

Responses of cerebral blood flow to the postural unloading maneuver in aortic stenosis (AS) have not been described so far. Our aim was to assess effects of orthostatic stress test on changes of carotid and vertebral artery blood flow and transaortic gradients. From consecutive 101 AS patients we selected 50 patients with severe isolated AS. Maximal and mean transaortic pressure gradients, as well as peak systolic blood-flow velocity (PSV) and end-diastolic velocity (EDV) in the common carotid artery, internal carotid artery and vertebral artery on both sides were measured by duplex ultrasound in the supine position and at 1-2 min after the assumption of the sitting position in patients with AS, and in stand-ing position in healthy controls. The orthostatic stress test induced significant decrease of carotid and vertebral arterial flow velocities in AS patients. Transaortic pressure gradients also dropped while the patients were sitting (p < 0.001). A history of syncope/presyncope was not associated with a significantly lower PSV and EDV in carotid and vertebral arteries in the upright position. In healthy controls, the velocities in carotid and vertebral arterial flow have been unchanged after maneuver reducing preload. In AS patients, decrease of carotid and vertebral arterial flow velocities and transaortic gradients in the sitting position were observed. Orthostatic test position does not ap-pear to be associated with a history of syncope/presyncope in patients with severe isolated AS, de-spite a simultaneous drop of transvalvular pressure gradient.

Splanchnic blood flow and vasoactive mediators in acute pancreatitis

Introduction: Changes of microcirculation and endothelial dysfunction are an important step from mild to severe disease. Changes in splanchnic arteries in acute necrotizing pancreatitis are the consequence of the release of vasoactive mediators. Materials and methods: The study involved 53 acute pancreatitis patients (28 – severe, 25 – mild). We measured interleukin-6, C3a and endothelin-1 in the blood plasma. Flow in the visceral arteries was assessed with the help of the Doppler sonography. Results: Mild acute pancreatitis often not accompanied by hemodynamic disorders according to Doppler ultrasound during the first week of illness. Pancreatic necrosis is noted a steady increase in peak systolic blood flow velocity and resistance index in the common hepatic, splenic and superior mesenteric arteries during the first week. In patients with acute pancreatitis on admission identified increase the levels endothelin-1 and C3a. A significant increase of both substances determined only in severe acute pancreatitis. The IL-6 levels were increased in all patients. There was a significant direct correlation concentration of IL-6 with peak systolic velocity in the superior mesenteric artery, with an index of resistance in common hepatic and superior mesenteric arteries. There was a significant direct correlation concentrations of C3a with peak systolic in the common hepatic and splenic arteries, with an index of resistance in superior mesenteric artery. Conclusion: Changes in the quantitative and qualitative detection of Doppler spectrum are ahead echographic signs of necrotizing forms of pancreatitis in B-mode ultrasound. IL-6, endothelin-1, and C3a levels of correlates with disturbances in splanchnic blood flow.