Spontaneous Blood Research Articles

The SIH-EBP Score: A grading scale to predict the response to the first epidural blood patch in spontaneous intracranial hypotension.

To develop and validate an easy-to-use scoring system to predict the response to the first epidural blood patching in patients with spontaneous intracranial hypotension. This study recruited consecutive patients with spontaneous intracranial hypotension receiving epidural blood patching in a tertiary medical center, which were chronologically divided into a derivation cohort and a validation cohort. In the derivation cohort, factors associated with the first epidural blood patching response were identified by using multivariable logistic regression modeling. A scoring system was developed, and the cutoff score was determined by using the receiver operating characteristic curve. The findings were verified in an independent validation cohort. The study involved 280 patients in the derivation cohort and 78 patients in the validation cohort. The spontaneous intracranial hypotension-epidural blood patching score (range 0-5) included two clinical variables (sex and age) and two radiological variables (midbrain-pons angle and anterior epidural cerebrospinal fluid collections). A score of ≥3 was predictive of the first epidural blood patching response, which was consistent in the validation cohort. Overall, patients who scored ≥3 were more likely to respond to the first epidural blood patching (odds ratio = 10.3). For patients with spontaneous intracranial hypotension-epidural blood patching score ≥3, it is prudent to attempt at least one targeted epidural blood patching before considering more invasive interventions.

Analiza varijabilnosti arterijskog pritiska merenjem pritiska na obe ruke i u funkciji vremena u bolesnika sa de novo otkrivenom hipertenzijom

INTRODUCTION At the initial office visit, blood pressure should be measured in both arms, ideally with electronic devices that can measure them simultaneously. SBP difference between arms >10 mmHg must be confirmed by repeated measurements. If confirmed, the arm with the higher blood pressure should be used for all subsequent measurements, as its values more accurately reflect the level of blood pressure in the major arteries. Using blood pressure readings on the arm with higher pressure improves outcome prediction. A consistent difference in SBP between the arms >15 to 20 mmHg may be due to atherosclerosis and restriction of the large intrathoracic or supraclavicular arteries, necessitating investigation of arterial disease. The blood pressure values on the right and left brachialis arteries differ in most cases, and the higher one is taken as more accurate. Prognostic significance: for each 10 mmHg difference according to Agarwal (2008), the relative risk of total mortality increases by 24%. In order to accurately assess the degree of hypertension, the spontaneous variability of pressure as a function of time and the pressure difference between the arms must be taken into account. WORK OBJECTIVES: 1. Analysis of spontaneous blood pressure variability upon arrival and repeated after 5 to 30 minutes; 2. Blood pressure differences between the left (LR) and right arm (DR). MATERIALS AND METHODS: A prospective study was conducted from the database of the "Dr. Bastać" Internal Medicine Practice on 26 patients, average age 58±12 years, with newly discovered hypertension by measuring blood pressure with the indirect manometer method at the first examination immediately after arrival and after 15 minutes. The control group consists of 28 patients who do not have hypertension. The data were statistically processed with the Student's T test. WORK RESULTS The mean value (Xsr) of systolic and diastolic blood pressure (SKP/DKP) of the examined group on arrival is 166/92 mmHg on the right hand (DR), and 161/93 mmHg on the left hand (LR). and after rest at DR 153/90 mmHg and LR 149/87. There is a statistically highly significant difference especially between the CAP on the hands - it is always higher on the right hand by an average of 5 mmHg (p=0.002) and 4 mmHg after rest. Spontaneous variability was determined in 10 (40%) subjects where there was a statistically significant drop in tension after rest. After a 15-minute rest, the significance of pressure differences between arms is maintained, but the high variability of 40% post-rest pressure variability is lost. CONCLUSION: Pressure on arrival in newly diagnosed untreated patients is always higher on the right arm by an average of 5 mmHg (p=0.002), and after rest 4 mmHg, this difference is maintained. Spontaneous variability was determined in 10 (40%) subjects where there was a statistically significant drop in tension after rest. After 15 minutes of rest, the significance of the pressure differences between the arms is maintained, but the high pressure variability is lost.

Abnormal Spontaneous Blood Oxygenation Level Dependent Fluctuations in Children with Focal Cortical Dysplasias: Initial Findings in Surgically Confirmed Cases.

Focal cortical dysplasias (FCD) are a frequent cause of drug-resistant epilepsy in children but are often undetected on structural magnetic resonance imaging (MRI). We aimed to measure and validate the variation of resting state functional MRI (rs-fMRI) blood oxygenation level dependent (BOLD) metrics in surgically proven FCDs in children, to assess the potential yield for detecting and understanding these lesions. We prospectively included pediatric patients with surgically proven FCD with inconclusive structural MRI and healthy controls, who underwent a ten-minute rs-fMRI acquired at 3T. Rs-fMRI data was pre-processed and maps of values of regional homogeneity (ReHo), degree centrality (DC), amplitude of low frequency fluctuations (ALFF) and fractional ALFF (fALFF) were calculated. The variations of BOLD metrics within the to-be-resected areas were analyzed visually, and quantitatively using lateralization indices. BOLD metrics variations were also analyzed in fluorodeoxyglucose-positron emission tomography (FDG-PET) hypometabolic areas. We included 7 patients (range: 3-15 years) and 6 aged-matched controls (range: 6-17 years). ReHo lateralization indices were positive in the to-be-resected areas in 4/7 patients, and in 6/7 patients in the additional PET hypometabolic areas. These indices were significantly higher compared to controls in 3/7 and 4/7 patients, respectively. Visual analysis revealed a good spatial correlation between high ReHo areas and MRI structural abnormalities (when present) or PET hypometabolic areas. No consistent variation was seen using DC, ALFF, or fALFF. Resting-state fMRI metrics, noticeably increase in ReHo, may have potential to help detect MRI-negative FCDs in combination with other morphological and functional techniques, used in clinical practice and epilepsy-surgery screening.

Community Cardiac Arrest as a Challenge for Emergency Medical Services in Poland

The problem of cardiac arrest, particularly out-of-hospital cardiac arrest (OHCA), is the subject of continuous research. The aim of this study was to analyze the use of an automated external defibrillator (AED) during the resuscitation of an adult in public places in Poland between 2015 and 2020. A retrospective analysis of the selected documentation obtained from AED distributors, the medical records obtained from the emergency call center, and the emergency medical teams was conducted. During the analysis period, there were 100 cases of recorded and documented use of AEDs in OHCAs in public places. In 70% of the cases, defibrillation was performed with an AED. This result could be higher, but the study's methodology and limited access to data only allowed for this result. In Poland, there are no legal acts on the registration of automatic external defibrillators and their implementation. Appropriate registries should be introduced nationwide as soon as possible. Due to the inadequacy of the medical records of the emergency medical teams to record the use of automated external defibrillators by a bystander to an incident, changes to these documents should be pursued. Based on such a small cohort, it is not possible to conclude that the return of spontaneous blood circulation is correlated with the use of AEDs and public access to defibrillation PADs.

Abnormal Regional Spontaneous Neural Activity and Functional Connectivity in Unmedicated Patients with Narcolepsy Type 1: A Resting-State fMRI Study.

Previous Resting-state functional magnetic resonance imaging (fMRI) studies have mainly focused on cerebral functional alteration in processing different emotional stimuli in patients with narcolepsy type 1 (NT1), but were short of exploration of characteristic brain activity and its remote interaction patterns. This study aimed to investigate the spontaneous blood oxygen fluctuations at rest and to elucidate the neural mechanisms underlying neuropsychiatric behavior. A total of 18 unmedicated patients with NT1 and matched healthy individuals were recruited in a resting-state fMRI study. Magnetic resonance imaging (MRI) data were first analyzed using fractional low-frequency amplitude of low-frequency fluctuation (fALFF) to detect changes in local neural activity, and regions with group differences were taken as regions of interest (ROIs). Secondly, functional connectivity (FC) analysis was used to explore altered connectivity between ROIs and other areas. Lastly, the relationship between functional brain activity and neuropsychiatric behaviors was analyzed with correlation analysis. fALFF analysis revealed enhanced neural activity in bilateral fusiform gyrus (FFG), right precentral gyrus, and left postcentral gyrus (PoCG) in the NT1 group. The patients indicated reduced activity in the bilateral temporal pole middle temporal gyrus (TPOmid), left caudate nucleus (CAU), left parahippocampus, left precuneus (PCUN), right amygdala, and right anterior cingulate and paracingulate gyri. ESS score was negatively correlated with fALFF in the right FFG. The NT1 group revealed decreased connectivity between left TPOmid and right PoCG, the bilateral middle frontal gyrus, left superior frontal gyrus, medial, and right supramarginal gyrus. Epworth Sleepiness Scale (ESS) was negatively correlated with FC of the left TPOmid with left putamen (PUT) in NT1. Compared with healthy controls (HCs), enhanced FC of the left CAU with right FFG was positively associated with MSLT-SOREMPs in patients. Furthermore, increased FC of the left PCUN with right PoCG was positively correlated with SDS score. We found that multiple functional activities related to the processing of emotional regulation and sensory information processing were abnormal, and some were related to clinical characteristics. fALFF in the left postcentral or right precentral gyrus may be used as a biomarker of narcolepsy, whereas fALFF in the right fusiform and the FC strength of the left temporal pole middle temporal gyrus with the putamen may be clinical indicators to assess the drowsiness severity of narcolepsy.

Interactive Teaching Aid Kit for Cardiopulmonary Resuscitation

Cardiopulmonary resuscitation (CPR) is an emergency procedure performed on a person experiencing cardiac arrest to manually preserve brain function until spontaneous breathing and blood circulation can be restored. If performed timely and properly, it can improve the survival rate of a person experiencing cardiac arrest. The promotion of CPR has always been an important task for countries around the world. Countries around the world often hold relevant study camps and seminars to improve the public’s awareness of CPR. On the basis of this rationale, this paper proposes an interactive teaching aid kit for CPR that uses a CPR manikin and tutoring software to facilitate CPR learning among trainees. The CPR manikin is equipped with sensors that determine whether the CPR steps are performed correctly. Data from the sensors are sent to the tutoring software through wireless transmission. The software provides video demonstrations and textual instructions concerning the standard CPR procedure. In this software, the interactive interface displays real-time information about the trainee’s CPR process, such as information on the CPR step being performed and the number of chest compression and breaths given. Thus, this teaching aid kit allows trainees to learn CPR without an instructor. This system may enable CPR to become a readily learnable skill for the general population.

Intracerebral Hemorrhage-Induced Cognitive Impairment in Rats Is Associated With Brain Atrophy, Hypometabolism, and Network Dysconnectivity.

The mechanisms underlying intracerebral hemorrhage (ICH)-related cognitive impairment (CI) remain unclear. Long-term structural and functional changes were investigated in the brains of healthy male and female Wistar rats after experimental ICH. Following double injection of autologous blood, rats underwent short-term (onset, 3 and 7 days) and long-term (3 and 6 months) radiological assessment and behavioral tests exploring spontaneous locomotion, anxiety-like behavior and working memory, spatial recognition memory and visual recognition memory. Volumetric and metabolic changes in brain areas were examined by 7Tesla-MRI and [18F] FDG-PET, respectively. Brain connectomic disorders and maladaptive processes were seeked through brain metabolic connectivity analysis and atrophy-related network analysis. From an initial hematoma mean volume of 23.35 ± 9.50 mm3, we found early spontaneous locomotor recovery and significant spontaneous blood resorption (≈ 40% of the initial lesion) from days 0 to 7. After 3 and 6 months, ICH rats exhibited CI in several domains as compared to the sham group (working memory: 58.1 ± 1.2 vs. 70.7 ± 1.2%, p < 0.001; spatial recognition memory: 48.7 ± 1.9 vs. 64 ± 1.8%, p < 0.001 and visual recognition memory: 0.14 ± 0.05 vs. 0.33 ± 0.04, p = 0.013, in female only). Rats that experienced ICH had remote and concomitant cerebral atrophy and hypometabolism of ipsilateral striatum, thalamus, limbic system and cortical areas (temporal and parietal lobes). Interestingly, both structural and metabolic deterioration was found in the limbic system connected to the affected site, but remotely from the initial insult. On the other hand, increased activity and functional connectivity occurred in the contralateral hemisphere. These connectomics results showed that both maladaptative and compensation processes coexist in the rat brain following ICH, even at young age and in a disease-free setting. These radiological findings deepen our understanding of ICH-related CI and may serve as biomarkers in the view of future therapeutic intervention.

Physiological Mechanisms and Significance of Intracranial B Waves.

ObjectiveRecently published studies have described slow spontaneous cerebral blood flow (CBF) and cerebrospinal fluid (CSF) oscillations measured by magnetic resonance imaging (MRI) as potential drivers of brain glymphatic flow, with a similar frequency as intracranial B-waves. Aiming to establish the relationship between these waveforms, we performed additional analysis of frequency and waveform parameters, of our previously published transcranial Doppler (TCD) and intracranial pressure (ICP) recordings of intracranial B waves, to compare to published MRI frequency measurements of CBF and CSF slow oscillations.Patients and MethodsWe analyzed digital recordings of B waves in 29 patients with head injury, including middle cerebral artery (MCA) flow velocity (FV), ICP, end tidal CO2, and arterial blood pressure (ABP). A subset of these recordings demonstrated high B wave activity and was further analyzed for parameters including frequency, interaction, and waveform distribution curve features. These measures were compared to published similar measurements of spontaneous CBF and CSF fluctuations evaluated using MRI.ResultsIn patients with at least 10% amplitude B wave activity, the MCA blood flow velocity oscillations comprising the B waves, had a maximum amplitude at 0.0245 Hz, and time derivative a maximum amplitude at 0.035 Hz. The frequency range of the B waves was between 0.6–2.3 cycles per min (0.011-0.038 Hz), which is in the same range as MRI measured CBF slow oscillations, reported in human volunteers. Waveform asymmetry in MCA velocity and ICP cycles during B waves, was also similar to published MRI measured CBF slow oscillations. Cross-correlation analysis showed equivalent time derivatives of FV vs. ICP in B waves, compared to MRI measured CBF slow oscillations vs. CSF flow fluctuations.ConclusionsThe TCD and ICP recordings of intracranial B waves show a similar frequency range as CBF and CSF flow oscillations measured using MRI, and share other unique morphological wave features. These findings strongly suggest a common physiological mechanism underlying the two classes of phenomena. The slow blood flow and volume oscillations causing intracranial B waves appear to be part of a cascade that may provide a significant driving force for compartmentalized CSF movement and facilitate glymphatic flow.

Cerebral Augmentation Effect Induced by External Counterpulsation Is Not Related to Impaired Dynamic Cerebral Autoregulation in Ischemic Stroke.

Background and PurposeDynamic cerebral autoregulation is impaired after ischemic stroke. External counterpulsation (ECP) augments the cerebral blood flow of patients with ischemic stroke by elevation of blood pressure (BP). We aimed to investigate if cerebral augmentation effects during ECP were associated with impaired dynamic cerebral autoregulation in patients after acute ischemic stroke.MethodsForty patients with unilateral ischemic stroke and large artery atherosclerosis in the anterior circulation territory within 7 days from symptom onset and eighteen healthy controls were recruited. We monitored changes in mean flow velocity over both middle cerebral arteries (MCA) by transcranial Doppler (TCD) before, during, and immediately after ECP. Cerebral augmentation index was MCA mean flow velocity increase in percentage during ECP compared with baseline to evaluate the augmentation effects of ECP. Spontaneous arterial BP and cerebral blood flow velocity in both bilateral MCAs were recorded using a servo-controlled plethysmograph and TCD, respectively. Transfer function analysis was used to derive the autoregulatory parameters, including phase difference (PD), and gain.ResultsThe cerebral augmentation index in patients with stroke was significantly higher on both the ipsilateral and contralateral sides than that in controls, while the PD in patients with stroke was significantly lower on both sides than those in controls (all P < 0.05). The cerebral augmentation index did not correlate with PD and gain on either the ipsilateral or contralateral side of patients with stroke or in controls (all P > 0.05). The cerebral augmentation index of patients with stroke was significantly related to mean BP change on the ipsilateral side (R2 = 0.108, P = 0.038).ConclusionThe degree of ECP-induced cerebral augmentation effects as measured by the cerebral augmentation index did not correlate with the magnitude of impaired dynamic cerebral autoregulation.

Cerebral autoregulation across the menstrual cycle in eumenorrheic women.

There is emerging evidence that ovarian hormones play a significant role in the lower stroke incidence observed in pre‐menopausal women compared with men. However, the role of ovarian hormones in cerebrovascular regulation remains to be elucidated. We examined the blood pressure‐cerebral blood flow relationship (cerebral autoregulation) across the menstrual cycle in eumenorrheic women (n = 12; mean ± SD: age, 31 ± 7 years). Participants completed sit‐to‐stand and Valsalva maneuvers (VM, mouth pressure of 40 mmHg for 15 s) during the early follicular (EF), late follicular (LF), and mid‐luteal (ML) menstrual cycle phases, confirmed by serum measurement of progesterone and 17β‐estradiol. Middle cerebral artery blood velocity (MCAv), arterial blood pressure and partial pressure of end‐tidal carbon dioxide were measured. Cerebral autoregulation was assessed by transfer function analysis during spontaneous blood pressure oscillations, rate of regulation (RoR) during sit‐to‐stand maneuvers, and Tieck’s autoregulatory index during VM phases II and IV (AI‐II and AI‐IV, respectively). Resting mean MCAv (MCAvmean), blood pressure, and cerebral autoregulation were unchanged across the menstrual cycle (all p > 0.12). RoR tended to be different (EF, 0.25 ± 0.06; LF; 0.19 ± 0.04; ML, 0.18 ± 0.12 sec−1; p = 0.07) and demonstrated a negative relationship with 17β‐estradiol (R2 = 0.26, p = 0.02). No changes in AI‐II (EF, 1.95 ± 1.20; LF, 1.67 ± 0.77 and ML, 1.20 ± 0.55) or AI‐IV (EF, 1.35 ± 0.21; LF, 1.27 ± 0.26 and ML, 1.20 ± 0.2) were observed (p = 0.25 and 0.37, respectively). Although, a significant interaction effect (p = 0.02) was observed for the VM MCAvmean response. These data indicate that the menstrual cycle has limited impact on cerebrovascular autoregulation, but individual differences should be considered.

Application of graph theory across multiple frequency bands in drug-naïve obsessive-compulsive disorder with no comorbidity

Recently, graph theoretical analysis based on resting-state functional magnetic resonance imaging has provided a means of investigating the complex brain connectome in obsessive-compulsive disorder (OCD) patients. However, these studies have been restricted to spontaneous blood oxygen level-dependent (BOLD) signals with frequency bands between 0.01 and 0.08 Hz, and the parameters from graph theory across multiple frequency bands have seldom been studied. Here, we calculated global metrics (small-worldness, global efficiency and modularity) and nodal metrics (degree centrality, betweenness centrality, nodal clustering coefficient and shortest path) at four different frequency bands (slow-2 (0.199–0.25 Hz), slow-3 (0.074–0.198 Hz), slow-4 (0.027–0.073 Hz) and slow-5 (0.01–0.027 Hz), from 0.01 to 0.25 Hz) in seventy-three OCD patients and ninety healthy controls. The analyses were also calculated in traditional low-frequency bands (0.01–0.08 Hz) for reference. For the global metrics, the OCD patients showed increased small-worldness and modularity only in the slow-3 band. For the local metrics, we observed a frequency-dependent characteristic, with the main significant differences in regions including the right precentral gyrus, occipital region, right anterior cingulum cortex and fusiform cortex. Our results suggested frequency-specific abnormalities of the brain connectome in OCD and the future studies may need to consider different frequency bands when measuring spontaneous activity in the brain.

A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING CARDIO PULMONARY RESUSCITATION AMONG B.SC.NURSING 1ST YEAR STUDENTS IN SELECTED COLLEGES OF NURSING , BHILAI, C.G.

Background:Cardio pulmonary resuscitation is an important medical procedure which is performed in an effort to manually preserved intact brain function until further measure are taken to restore normal spontaneous blood circulation and breathing in a person in cardiac arrest.It is a combination of rescue breathing and chest compression .which is delivered to the victim who is to be in cardiac arrest being important members of the health care team medical student are deemed to passes the basic skills and expertise whichare needed to perform CPR. To assess the knowledge score regarding cardio pulmonary resuscitation among B Objectives:1. .Sc. nursing 1st year student before intervention and after intervention. 2.To compare knowledge score regarding cardio pulmonary resuscitation among B.Sc. nursing 1st year student before and after intervention.3. To nd out the association in knowledge score regarding cardio pulmonary resuscitation among B.Sc. nursing 1st year student with their selected socio demographic variables before intervention. Method: In this study the research approach was pre experimental pre-test &amp; pos-test design without control group design was applied. Total 40 samples selected by purposive sampling technique. The intervention Structured Teaching Programme was introduced to the group after the pre test. Knowledge was assessed by self structured questionnaire assessed by questionnaire before and after the intervention. Results:The result revealed that meanpre-test 82.5 % students had inadequate knowledge and 17.5 % students had moderate knowledge. And during post test 85% students had moderate knowledge and 15% students had adequate knowledge. The study concluded that, structured teaching program Conclusion: me about Cardio Pulmonary Resuscitationshould be implemented to improve the knowledge amongthe B.Sc. nursingstudents.

A review of VEXAS syndrome in 116 French patients

British Journal of DermatologyVolume 186, Issue 3 p. e115-e115 Plain Language SummaryFree Access A review of VEXAS syndrome in 116 French patients First published: 07 March 2022 https://doi.org/10.1111/bjd.20989AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Abstract Linked Article: Georgin-Lavialle et al. Br J Dermatol 2022; 186:564–574. Autoinflammatory syndromes are conditions in which fever and signs of inflammation occur without an infectious cause. Some of these, mostly rare, syndromes are linked to mutations (faults in genetic code) in a specific gene. VEXAS syndrome (Vacuoles, E1 Enzyme, X chromosome, Autoinflammatory, Somatic) has recently been described and linked to a mutation in the UBA1 gene, located on the X chromosome; it is therefore much commoner in men. A major feature of the condition is relapsing polychondritis (an inflammation of the cartilage particularly affecting the respiratory tract). Other features include a tendency to spontaneous blood clotting, lung inflammation, joint pains and skin lesions including vasculitis and neutrophilic dermatosis. VEXAS is often associated with myelodysplasia (premalignant changes in blood cells), and often has a poor prognosis. Treatment includes glucocorticoids and anti-inflammatory disease modifying drugs (DMARDs). In this paper from France, the authors from multiple centres of expertise in autoinflammatory diseases worked with laboratories performing UBA1 gene analysis to collect data on their patients with VEXAS syndrome over a 6-month period. The authors added lymph node enlargement and erosive arthritis to the clinical features. They identified three clusters of disease in their patients. The first had mild to moderate disease with less fever; this group was strongly linked to a mutation in UBA1, and had a relatively good outcome. The second cluster had more severe disease, including relapsing polychondritis, and myelodysplasia was common; this group had a higher mortality rate. The third group comprised older patients who presented with inflammatory features such as skin vasculitis and weight loss. The authors found that increased mortality in VEXAS syndrome was linked to involvement of lung tissue and the gastrointestinal tract (e.g. perforation of the gut). Volume186, Issue3March 2022Pages e115-e115 RelatedInformation

Moving beyond the ‘CAP’ of the Iceberg: Intrinsic connectivity networks in fMRI are continuously engaging and overlapping

Resting-state functional magnetic resonance imaging is currently the mainstay of functional neuroimaging and has allowed researchers to identify intrinsic connectivity networks (aka functional networks) at different spatial scales. However, little is known about the temporal profiles of these networks and whether it is best to model them as continuous phenomena in both space and time or, rather, as a set of temporally discrete events. Both categories have been supported by series of studies with promising findings. However, a critical question is whether focusing only on time points presumed to contain isolated neural events and disregarding the rest of the data is missing important information, potentially leading to misleading conclusions. In this work, we argue that brain networks identified within the spontaneous blood oxygenation level-dependent (BOLD) signal are not limited to temporally sparse burst moments and that these event present time points (EPTs) contain valuable but incomplete information about the underlying functional patterns.We focus on the default mode and show evidence that is consistent with its continuous presence in the BOLD signal, including during the event absent time points (EATs), i.e., time points that exhibit minimum activity and are the least likely to contain an event. Moreover, our findings suggest that EPTs may not contain all the available information about their corresponding networks. We observe distinct default mode connectivity patterns obtained from all time points (AllTPs), EPTs, and EATs. We show evidence of robust relationships with schizophrenia symptoms that are both common and unique to each of the sets of time points (AllTPs, EPTs, EATs), likely related to transient patterns of connectivity. Together, these findings indicate the importance of leveraging the full temporal data in functional studies, including those using event-detection approaches.

Bio-inspired, bio-degradable adenosine 5'-diphosphate-modified hyaluronic acid coordinated hydrophobic undecanal-modified chitosan for hemostasis and wound healing.

Uncontrolled hemorrhage and wound infection are crucial causes of trauma-associated death in both the military and the clinic. Therefore, developing an efficient and rapid hemostatic method with biocompatibility, easy degradation, and wound healing is of great importance and desirability. Inspired by spontaneous blood cell plug formation in the hemostasis process, an adenosine 5′-diphosphate modified pro-coagulation hyaluronic acid (HA-ADP) coordinated with enhanced antibacterial activity of undecanal-modified chitosan (UCS) was fabricated through physical electrostatic cross-linking and freeze-drying. The as-prepared hydrogel sponges showed a porous structure suitable for blood cell adhesion. In particular, the hydrogel exhibited excellent antibacterial ability and promoted the adhesion of platelets and red blood cells, thus inducing a prominent pro-coagulation ability via platelet activation, which exhibits a shorter hemostasis time (58.94% of control) in vitro. Compared with commercially available CELOX and gelatin sponge (GS), HA-ADP/UCS accelerates hemostasis and reduces blood loss in both rat tail amputation and rat artery injury models. Furthermore, all the samples exhibited superior cytocompatibility and biodegradability. Due to these performances, HA-ADP/UCS promoted full-thickness skin defect healing significantly in vivo. All the properties of HA-ADP/UCS suggest that it has great potential for translation as a clinical application material for hemostatic and wound healing.

Exhaustive Exercise Increases Spontaneous but Not fMLP-Induced Production of Reactive Oxygen Species by Circulating Phagocytes in Amateur Sportsmen.

Simple SummaryStrenuous exercise can alter various functions of circulating phagocytes. We tested whether exhaustive exercise could influence spontaneous and fMLP-induced oxidant production (measured with luminol enhanced whole blood chemiluminescence (LBCL) normalized per phagocyte count) by blood phagocytes in amateur sportsmen. Exhaustive exercise transiently enhanced (no more than one hour from the end of bout) spontaneous oxidants generation by circulating phagocytes, while response to fMLP was decreased up to 24 h post exercise. It is suggested that a short lived increase in spontaneous oxidants production can switch on various mechanisms leading to an increase in antioxidant activity in regularly training subjects.Strenuous exercise alters the oxidative response of blood phagocytes to various agonists. However, little is known about spontaneous post exercise oxidant production by these cells. In this cross-over trial, we tested whether an exhaustive treadmill run at a speed corresponding to 70% of VO2max affects spontaneous and fMLP-provoked oxidant production by phagocytes in 18 amateur sportsmen. Blood was collected before, just after, and 1, 3, 5 and 24 h post exercise for determination of absolute and normalized per phagocyte count spontaneous (a-rLBCL, rLBCL) and fMLP-induced luminol-enhanced whole blood chemiluminescence (a-fMLP-LBCL, fMLP-LBCL). a-rLBCL and rLBCL increased by 2.5- and 1.5-times just after exercise (p < 0.05) and then returned to baseline or decreased by about 2-times at the remaining time-points, respectively. a-fMLP-LBCL increased 1.7- and 1.6-times just after and at 3 h post-exercise (p < 0.05), respectively, while fMLP-LBCL was suppressed by 1.5- to 2.3-times at 1, 3, 5 and 24 h post-exercise. No correlations were found between elevated post-exercise a-rLBCL, a-fMLP-LBCL and run distance to exhaustion. No changes of oxidants production were observed in the control arm (1 h resting instead of exercise). Exhaustive exercise decreased the blood phagocyte-specific oxidative response to fMLP while increasing transiently spontaneous oxidant generation, which could be a factor inducing secondary rise in antioxidant enzymes activity.

Guidelines for the management of acquired hemophilia A in elderly patients

Acquired hemophilia A is an autoimmune disease caused by antibodies against coagulation factor VIII (FVIII). These antibodies, called circulating FVIII anticoagulant or FVIII inhibitor, reduce plasma FVIII activity, which results in excessive bleeding. Acquired hemophilia A is classified as severe hemorrhagic disorder. Typical for this disease are extensive subcutaneous spontaneous blood extravasations, intramuscular and retroperitoneal hematomas, and post- -traumatic bleeds, including post-surgery bleeding. In approximately 30% of cases, acquired hemophilia A is initially manifested merely by minor bleeding, which may be often overlooked by physician, but as long as FVIII inhibitor is detected, patient is at risk of severe, sometimes fatal, hemorrhage. Acquired hemophilia A is most common in people aged 60–90 years. Patients in this age group often take anticoagulants, antiplatelet and non-steroidal anti-inflammatory drugs, and bruising and purpura are relatively common among them, so acquired hemophilia A can easily be overlooked. On the other hand, the delay in the diagnosis of the disorder may result in delayed initiation of hemostatic treatment and elimination of the FVIII inhibitor, which puts the patient at risk of premature death. The aim of this publication is to present the principles of diagnosis of acquired hemophilia A, the use of hemostatic drugs to inhibit and prevent bleeding, and immunosuppressive drugs to eliminate the FVIII inhibitor in elderly patients.

Impaired dynamic cerebral autoregulation is associated with the severity of neuroimaging features of cerebral small vessel disease.

AimsCerebral small vessel disease (CSVD) is characterized by functional and structural changes in small vessels. We aimed to elucidate the relationship between dynamic cerebral autoregulation (dCA) and neuroimaging characteristics of CSVD.MethodsA case‐control study was performed. Cerebral blood flow velocity (CBFV) of bilateral middle cerebral arteries and spontaneous arterial blood pressure were simultaneously recorded. Transfer function analysis was used to calculate dCA parameters (phase, gain, and the rate of recovery of CBFV [RoRc]). Neuroimaging characteristics of CSVD patients were evaluated, including lacunes, white matter hyperintensities (WMH), cerebral microbleeds (CMBs), perivascular spaces (PVS), and the total CSVD burden.ResultsOverall, 113 patients and 83 controls were enrolled. Compared with the control group, the phase at low frequency and the RoRc in CSVD patients were lower, and the gain at very low and low frequencies were higher, indicating bilaterally impaired dCA. Total CSVD burden, WMH (total, periventricular and deep), severe PVS, and lobar CMBs were independently correlated with the phase at low frequency.ConclusionsOur findings suggested that dCA was compromised in CSVD patients, and some specific neuroimaging characteristics (the total CSVD burden, WMH, severe PVS and lobar CMBs) might indicate more severe dCA impairment in CSVD patients.

Optimization of oxidative stress-induced premature senescence model using VH10 fibroblasts for assessment of natural compounds

The diverse physiological functions of histamine are mediated through distinct histamine receptors. In this study we investigated the role of H2R and H4R in the effects of histamine on the production of reactive oxygen species by phagocytes in whole blood.Changes in reactive oxygen species (ROS) production by whole blood phagocytes after treatment with histamine, H4R agonists (4-methylhistamine, VUF8430), H2R agonist (dimaprit) and their combinations with H4R antagonist (JNJ10191584) and H2R antagonist (ranitidine) were determined using the chemiluminescence (CL) assay. To exclude the direct scavenging effects of the studied compounds on the CL response, the antioxidant properties of all compounds were measured using several methods (TRAP, ORAC, and luminol–HRP–H2O2 based CL).Histamine, 4-methylhistamine, VUF8430 and dimaprit inhibited the spontaneous and OZP-activated whole blood CL in a dose-dependent manner. On the other hand, only VUF8430 was able to inhibit PMA-activated whole blood CL. Ranitidine, but not JNJ10191584, completely reduced the effects of histamine, 4-methylhistamine and dimaprit. The direct scavenging ability of tested compounds was negligible.Our results demonstrate that the inhibitory effects of histamine on ROS production in whole blood phagocytes were caused by H2R. Our results also suggest that H4R agonists in concentrations higher than 10− 6 M may also influence ROS production via binding to H2R.

Blood Clotting Decreases Pulmonary Circulation during the Coronavirus Disease

Spontaneous blood clotting in pulmonary circulation caused by thrombo-inflammation is one of the main mortality causes during the COVID-19 disease. Blood clotting leads to reduced pulmonary circulation and blood oxygenation. Lung inflammation can be evaluated with noninvasive diagnostic techniques. However, the correlation of the severity of the inflammation with the pulmonary blood flow has not been established. To address this question, in this work, we develop a multiscale model taking into account the interaction of a local model of thrombus growth with 1D hemodynamics in a vessel network. Flux reduction depending on the level of lung obstruction is evaluated. In particular, the model obtains that an obstruction level of 5% leads to a 12% reduction of blood flux. The suggested approach can be used to investigate the interaction of blood clotting and flow not only in the pulmonary network but also in other complex vessel networks.