Blood Flow Status Research Articles

284 Supranutritional Mineral Supplementation During Pregnancy Alters Placental Blood Flow and Calf Mineral Concentrations

Abstract Fetal development is dependent on maternal nutrient status, and the maternal-fetal connection is mediated by the placenta. There are well-established nutrient requirements for gestating cattle aimed at promoting the health of dam and fetus; however, there is limited information on the impact of supranutritional nutrient availability on placental function and calf development. This study evaluated the effect of supranutritional mineral administration during gestation on uterine artery blood flow and calf mineral status. Angus and SimAngus cows (n = 52) were bred via artificial insemination. At d 60 of gestation, cows were assigned to treatment groups; an injectable group (INJ, n = 26) receiving a single subcutaneous mineral injection and access to free-choice trace minerals and a control group (CON; n = 26) having access to free-choice trace minerals. Liver mineral content was analyzed in a subset of cows (CON n = 10; INJ n = 6) at d 60 and 209 ± 1 of gestation. At d 139.5 ± 0.5 and 209 ±1 of gestation, uterine artery measurements were collected using Color Doppler ultrasonography. Placental cotyledons, liver tissue, and blood samples were collected from a subset of animals at calving (n = 11; CON, n = 5; INJ, n = 6). Analysis revealed a TRT*day interaction at d 139.5 ± 0.5 for circulating Co concentrations which were greater (P = 0.05) and Se tended to be greater in INJ cows (P = 0.09) compared with CON cows. Circulating Zn concentrations tended to be decreased at d 209 ± 1 (P = 0.06) in INJ cows compared with the CON cows. Circulating Cu tended to be increased (P = 0.09) and Mn was decreased (P = 0.04) in INJ cows throughout the study. Hepatic Fe concentrations were decreased in INJ cows (P = 0.01) at d 209 ± 1. At d 139.5 ± 0.5, non-gravid uterine artery area, diameter, and circumference were increased in the INJ cows (P < 0.006 ). Additionally, pulsatility index of the gravid uterine artery tended to be increased (P = 0.09) in the INJ cows. Blood and liver samples were collected from calves (CON n = 24; INJ n = 26) at 4 to 8 d post-calving to assess mineral concentrations. INJ calves had greater liver Se (P = 0.001), decreased Fe (P = 0.04), and tended to have increased Zn (P = 0.09) and Mn (P = 0.08) concentrations compared with CON calves. Finally, INJ calves tended to have greater serum Se concentrations (P = 0.09) compared with CON calves. Trace minerals have roles in immune function and impact overall calf health. These results indicate that supranutritional trace mineral administration during early gestation alters placental blood flow and improves calf mineral availability. This supplementation protocol may provide the opportunity to improve the health of future calf crops.

A modern view on the differential diagnosis of ultrasound characteristics of lymph nodes in mesadenitis in children

Mesadenitis (mesenteric lymphadenitis, mesenteritis) is a common cause of acute abdominal pain syndrome in children. At the same time, the cause of acute mesadenitis is far from being established in all cases. Diagnosis of mesenteric lymphadenitis presents a certain problem. Differential diagnosis is always carried out with acute surgical diseases of the abdominal cavity, primarily with acute appendicitis. Special attention is paid to ultrasound examination in the diagnosis of mesadenitis. Given the absence of statistically proven diagnostic criteria for changes in abdominal lymph nodes in mesadenitis, it is relevant to determine their ultrasound characteristics. The article is presented in the form of a lecture for practicing pediatricians based on a literature review. The characteristics of mesentery lymph nodes in various pathological processes are collected from various sources. The features of ultrasound characteristics of mesenteric lymph nodes in normal and acute mesadenitis with herpes infection, coronavirus infection, tuberculosis, as well as features of lymph nodes with lymphogranuloma are presented. A table has been developed that indicates such characteristics as the shape, number of lymph nodes in the section, echogenicity, blood flow status, capsule, contour, as well as additional characteristics in some conditions (such as the tendency to form conglomerates or the presence of calcinates in the structure of lymph nodes in tuberculosis lesions). A detailed description of the lymph nodes makes it possible to conduct a preliminary differential diagnosis of mesadenitis using ultrasound, which makes it possible to determine the vector of further diagnostic search in children with acute abdominal syndrome, and then to select pathogenetically justified therapeutic tactics and preventive measures.

Potential of unilateral combined bypass surgery to accelerate contralateral radiological progression in pediatric moyamoya disease.

Surgical cerebral revascularization is recommended for treating pediatric moyamoya disease (MMD). However, whether unilateral combined bypass surgery can cause disease progression on the contralateral side is uncertain. The study aimed to investigate the vascular architecture and regional cerebral blood flow (rCBF) status of patients with pediatric MMD after successful unilateral combined bypass surgery and to identify the possible risk factors. Pediatric patients diagnosed with MMD and admitted to Xuanwu Hospital who underwent combined bypass surgery between 2019 and 2021 were enrolled. Digital subtraction angiography (DSA) and magnetic resonance imaging (MRI) with arterial spin labeling (ASL) were performed to investigate the vascular architecture and rCBF during surgery and at short-term follow-up. Suzuki's angiographic staging and moyamoya vessel grading system were both used. Progression was defined as an increase in either Suzuki stage or moyamoya vessel grade detected after unilateral surgery. All analyses were performed with conventional statistic methods. A total of 27 successive patients with a median age of 8 [interquartile range (IQR), 5-14] years old were identified. On the non-operated (non-OP) side, 11 (40.7%) patients demonstrated progression, all of whom showed an increase in the moyamoya vessel grade, and 5 also displayed Suzuki stage progression during the median 4.7 (IQR, 3.7-5.7) months follow-up. However, rCBF barely changed on the non-OP side compared to preoperation [preoperation: median, 49.6, (IQR, 42.9-61.1) mL/100 g/min; postoperation: median, 50.2, (IQR, 43.5-59.3) mL/100 g/min; P=0.445]. Combined bypass surgery might accelerate the radiological progression on the contralateral side, which occurs before the decline of rCBF. Those with earlier Suzuki stage MMD of the non-OP side are prone to rapid progression after unilateral combined revascularization.

Angiography-based hemodynamic features predict recurrent ischemic events after angioplasty and stenting of intracranial vertebrobasilar atherosclerotic stenosis

ObjectivesTo assess the predictive value of hemodynamic features for stroke relapse in patients with intracranial vertebrobasilar atherosclerotic stenosis treated with percutaneous transluminal angioplasty and stenting (PTAS) using quantitative digital subtraction angiography (q-DSA).MethodsIn this retrospective longitudinal study, patients with intracranial vertebrobasilar atherosclerotic stenosis and who underwent PTAS treatment between January 2012 and May 2020 were enrolled. The q-DSA assessment was performed before and after PTAS. ROIs 1–4 were placed along the vertebral artery, proximal and distal basilar artery, and posterior cerebral artery; ROIs 5–8 were in 5 mm and 10 mm proximal and distal to the lesion, respectively. Relative time to peak (rTTP) was defined as the difference in TTP between ROIs. Cox regression analyses were performed to determine risk factors for recurrent stroke.ResultsA total of 137 patients (mean age, 62 years ± 10 [standard deviation], 83.2% males) were included, and 26 (19.0%) patients had stroke relapse during follow-up (median time of 42.6 months [interquartile range, 19.7–60.7]). Preprocedural rTTP4-1 (adjusted hazard ratio (HR) = 2.270; 95% CI 1.371–3.758; p = 0.001) and preprocedural rTTP8-5 (adjusted HR = 0.240; 95% CI 0.088–0.658; p = 0.006) were independently associated with the recurrent stroke. These hemodynamic parameters provided an incremental prognostic value for stroke relapse (AUC, 0.817 [0.704–0.931]; the net reclassification index, 0.431 [0.057–0.625]; and the integrated discrimination index, 0.140 [0.035–0.292]).ConclusionsIn patients with intracranial vertebrobasilar atherosclerosis treated with PTAS, preprocedural prolonged TTP of the target vessel and shortened trans-stenotic TTP difference were associated with stroke relapse. Q-DSA-defined hemodynamic parameters provided incremental predictive value over conventional parameters for stroke recurrence.Clinical relevance statementQuantitative DSA analysis enables intuitive observation and semi-quantitative evaluation of peri-therapeutic cerebral blood flow. More importantly, quantitative DSA–defined hemodynamic parameters have the potential for risk stratification of patients with intracranial atherosclerotic stenosis.Key PointsSemi-quantitative angiography-based parameters can reflect pre- and postprocedural subtle changes in blood flow in patients with intracranial atherosclerotic stenosis.Although angioplasty procedures can significantly improve blood flow status, patients with more restricted baseline blood flow still show a higher risk of stroke recurrence.Angiography-based hemodynamic features possess prognostic value and can serve as clinical markers to assess stroke risk of patients with intracranial atherosclerotic stenosis.

Leptomeningeal Collaterals and Infarct Progression in Patients With Acute Large‐Vessel Occlusion and Low NIHSS

Background Approximately 10% of patients with acute ischemic stroke with large‐vessel occlusion (LVO) have mild neurological deficits. Although leptomeningeal collaterals (LMCs) are the major determinant of clinical outcomes for patients with acute ischemic stroke with LVO, the contribution of baseline LMC status to subsequent infarct progression in patients with mild stroke with LVO is poorly defined. Methods This observational study included patients with acute anterior circulation LVO and mild stroke symptoms (National Institutes of Health Stroke Scale < 6) from a prospectively collected, multicenter, national stroke registry. The Alberta Stroke Program Early Computed Tomography Score was quantified on the initial and follow‐up images. An infarct progression, defined as any Alberta Stroke Program Early Computed Tomography Score decrease between the initial versus follow‐up scans, was categorized as either 0/1/2+. The LMCs on the baseline images were graded as good, fair, or poor. Results Of the 623 included patients (mean age, 67.6±13.4 years; 380 [61.0%] men; 186 [29.9%] with reperfusion treatment), the baseline LMC was graded as good in 331 (53.1%), fair in 219 (35.2%), and poor in 73 (11.7%). The Alberta Stroke Program Early Computed Tomography Score decrement was noted as 0 in 288 (46%) patients, 1 in 154 (24%), and 2+ in 181 (29%). A poor LMC was associated with an infarct progression (adjusted odds ratio, 2.05 [95% CI, 1.22–3.47]). Conclusions Poor collateral blood flow was associated with infarct progression in patients with acute ischemic stroke with LVO and mild symptoms. In this selective population, early assessment of collateral blood flow status can help in early detection of patients susceptible to infarct progression.

Association of intravascular enhancement sign detected on high-resolution vessel wall imaging with ischaemic events in middle cerebral artery occlusion

PurposePatients with intracranial artery occlusion have high rates of ischaemic events and recurrence. Early identification of patients with high-risk factors is therefore beneficial for prevention. Here we assessed the association between the intravascular enhancement sign (IVES) on high-resolution vessel wall imaging (HR-VWI) and acute ischaemic stroke (AIS) in a population with middle cerebral artery (MCA) occlusion. MethodWe retrospectively analysed the records of 106 patients with 111 MCA occlusions, including 60 with and 51 without AIS, who had undergone HR-VWI and computed tomography angiography (CTA) examinations from November 2016 to February 2023. Numbers of IVES vessels were counted and compared to the CTA findings. Statistical analyses of demographic and medical data were also performed. ResultsOccurrence rates and numbers of IVES vessels were significantly higher in the AIS than the non-AIS group (P < 0.05), and most vessels were detected on CTA. Numbers of vessels positively correlated with AIS occurrence (rho = 0.664; P < 0.0001). A multivariable ordinal logistic regression model adjusted for age, degree of wall enhancement, hypertension, and heart status identified the number of IVES vessels as an independent predictor for AIS (odds ratio = 1.6; 95% CI, 1.3–1.9; P < 0.0001). ConclusionNumber of IVES vessels is an independent risk factor for AIS events, and may represent poor cerebral blood flow status and collateral compensation level. It thus provides cerebral haemodynamic information for patients with MCA occlusion for clinical use.

Deciphering simultaneous heart conditions with spectrogram and explainable-AI approach

The sounds made by the heart are regularly used to determine the mechanics and status of blood flow within the heart. While machine-learning algorithms have been presented to classify different heart conditions via auscultation, these models typically output a single-label decision and offer little insight into the magnitude or severity of the classified condition. The inner workings of these networks are a ‘black box’, offering a diagnosis prediction without a metric for explaining how the conclusion was drawn. Here, we present a novel approach, combining deep convolutional neural networks and explainable AI algorithms, to extract key temporal signatures in recordings of multiple heart conditions to enable multi-label classification and severity determination. Signatures found are supported by previous research and offer more information than a simple single-label classification algorithm. The neural networks are able to reach a multi-label classification accuracy of up to 78% (alongside 98% single-label accuracy) after being trained solely on single-label data. This approach may assist physicians in making quick, accurate, and comprehensive diagnoses and provide new insights for the progress of multi-label machine learning for medical diagnosis.

Factors Affecting Visual Acuity and Central Visual Function in Glaucoma Patients With Myopia

To investigate associated factors including structural parameters of myopia and vessel density (VD) using optical coherence tomography angiography (OCT-A) to visual acuity (VA) and central visual function in glaucoma patients with myopia. Retrospective cross-sectional study METHODS: Sixty-five eyes of 60 glaucoma patients with myopia and without media opacity and retinal lesions were include. Both Swedish interactive thresholding algorithm (SITA) 24-2 and 10-2 visual field (VF) testing were performed. Superficial and deep VD in the peripapillary and macular regions were evaluated using OCT-A; retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured. β-zone peripapillary atrophy (PPA) area, disc torsion, disc-fovea distance, and peripapillary choroidal thickness were measured. Decreased VA was defined as best-corrected VA <20/25. The worse mean deviation of SITA 24-2, thinner GCIPL thickness, and lower deep peripapillary VD were associated with the presence of central VF damage in glaucoma patients with myopia. Thinner GCIPL thickness, lower deep peripapillary VD, and longer disc-fovea distance were associated with decreased VA in logistic regression analysis. Thinner GCIPL thickness, lower deep peripapillary VD, and larger β-zone PPA area were associated with lower VA in linear regression analysis. Deep peripapillary VD showed a positive correlation with GCIPL thickness, whereas there was no relationship between deep peripapillary VD and RNFL thickness. Decreased VA in glaucoma patients with myopia was associated with lower deep peripapillary VD and papillomacular bundle damage. Lower deep peripapillary VD was independently associated with decreased VA along with thinner GCIPL thickness. Therefore, this could be stated that decreased VA in glaucoma patients is related to the damage location and the status of blood flow in the optic nerve head.

Fetal posterior cerebral artery in pediatric and adult moyamoya disease: A single-center experience of 480 patients

PurposeIn past pediatric and adult cohort studies of moyamoya disease, the fetal posterior cerebral artery has received less attention. Its relationship with the clinical manifestations and collateral circulation of moyamoya disease or ipsilateral cerebral hemispheres remains unclear. MethodWe summarize the clinical features of patients with and without fetal posterior cerebral artery moyamoya disease from consecutive cases.We explored the relationship between fetal posterior cerebral arteries and collateral circulation in the ipsilateral cerebral hemispheres, as well as differences among different subgroups of patients.According to the morphology, the fetal posterior cerebral artery is divided into complete fetal posterior cerebral artery and partial fetal posterior cerebral artery. Clinical features were classified as: infarction,hemorrhage,and non-stroke in unilateral/bilateral cerebral hemispheres. Collateral circulation is divided into extracranial vascular compensation and leptomeningeal collateral circulation. Digital subtraction angiography and CT/MR were used to evaluate the blood flow status and clinical characteristics of patients with moyamoya disease. ResultA total of 960 cerebral hemispheres from 142 pediatric patients and 338 adult patients were included in the study. A total of 273 (56.9%) patients had 399 cerebral hemispheres (41.6%) with fetal posterior cerebral arteries. Adults with fetal posterior cerebral arteries had lower rates of infarction (24.6%vs37.3%, P =0.005) and were less likely to have bilateral stroke (8.4%vs11.5%, P =0.038). Cerebral hemispheres with fetal posterior cerebral artery were more likely to have anterior cerebral artery and middle cerebral artery stenosis and less likely to have occlusion (P =0.002, 0.001), and less likely to involve the posterior circulation (P < 0.001). The cerebral hemispheres of the fetal posterior cerebral artery had higher leptomeningeal collateral circulation scores. There are significant differences in extracranial vascular compensation between cerebral hemispheres with and without fetal posterior cerebral artery. Adult patients with fetal posterior cerebral artery were more advanced in Suzuki stage (P =0.017). ConclusionsOur results suggest that fetal posterior cerebral artery is associated with infarct manifestations in pediatric and adult moyamoya disease. In the cerebral hemispheres, the fetal posterior cerebral artery is associated with ipsilateral hemispheric anterior and posterior circulation artery injury, extracranial vascular compensation, leptomeningeal collateral circulation compensation, and infarction. Adult patients with fetal posterior cerebral artery were more advanced in Suzuki stage.

Increased blood flow of spinal cord lesion after decompression improves neurological recovery of degenerative cervical myelopathy: an intraoperative ultrasonography-based prospective cohort study.

Surgical decompression is a highly effective therapy for degenerative cervical myelopathy (DCM), but the mechanisms of neurological recovery following decompression remain unclear. This study aimed to evaluate the spinal cord blood flow status after sufficient decompression by intraoperative contrast-enhanced ultrasonography (CEUS) and to analyze the correlation between neurological recovery and postdecompressive spinal cord blood perfusion in DCM. Patients with multilevel DCM were treated by ultrasound-guided modified French-door laminoplasty using a self-developed rongeur. Neurological function was evaluated using the modified Japanese Orthopaedic Association (mJOA) score preoperatively and at 12 months postoperatively. Spinal cord compression and cervical canal enlargement before and after surgery were assessed by magnetic resonance imaging and computerized tomography. The decompression status was evaluated in real time by intraoperative ultrasonography, while the spinal cord blood flow after sufficient decompression was assessed by CEUS. Patients were categorized as favourable (≥50%) or unfavourable (<50%) recovery according to the recovery rate of the mJOA score at 12 months postoperatively. Twenty-nine patients were included in the study. The mJOA scores were significantly improved in all patients from 11.2±2.1 preoperatively to 15.0±1.1 at 12 months postoperatively, with an average recovery rate of 64.9±16.2%. Computerized tomography and intraoperative ultrasonography confirmed adequate enlargement of the cervical canal and sufficient decompression of the spinal cord, respectively. CEUS revealed that patients with favourable neurological recovery had a greater increased blood flow signal in the compressive spinal cord segment after decompression. In DCM, intraoperative CEUS can clearly reflect spinal cord blood flow. Patients with increased blood perfusion of the spinal cord lesion immediately after surgical decompression tended to achieve greater neurological recovery.

Clinical Study of Peripherally Inserted Central Catheter-Related Thrombosis and Its Influence on the Blood Flow Status of the Inserted Veins in Cancer Patients

To investigate the clinical features of peripherally inserted central catheter (PICC)-related thrombosis (PICCRT) within 2 weeks after PICC placement in cancer patients and its dynamic influence on the blood flow status of veins inserted with catheter, and to provide support for implementing thrombosis prevention and control measures. Between May 2019 and July 2020, patients who had solid tumors and who had PICC were prospectively enrolled at West China Hospital, Sichuan University. Scheduled color Doppler imaging was performed to examine the status of PICCRT formation at 8 points of time, with the first one conducted one day before the insertion of PICC and the other 7 completed within 2 weeks after the insertion of PICC. Then, based on whether patients had PICCRT, the patients were divided into two groups, a non-PICCRT group and a PICCRT group. The PICCRT group was further divided into two subgroups, an asymptomatic PICCRT group and a symptomatic PICCRT group, according to whether the patients had thrombosis-related symptoms and signs. Comparisons were made to study the incidence of PICCRT and the vascular diameter and the blood flow velocity in the veins inserted with catheters at different points of time in the patients of different groups. Among 173 cancer patients in the cohort, 126 (72.8%) developed PICCRT, all of which occurred within 1 week after PICC insertion. There were 95 cases of asymptomatic PICCRT and 31 cases of symptomatic PICCRT. Before and after PICC insertion, the vascular diameter of both the asymptomatic and symptomatic PICCRT groups was significantly smaller than that of the non-PICCRT group and the blood flow velocity was significantly slower than that of the non-PICCRT group, with the difference continuing to increase with the prolongation of catheter indwelling time. Inserting catheters in veins with bigger vascular diameter and faster blood flow velocity may help reduce the incidence of PICCRT. The first week post catheter insertion is the key intervention period for the prevention of PICCRT.

Enhanced external counterpulsation modulates the heartbeat evoked potential.

Introduction: Accumulating evidence suggests that enhanced external counterpulsation (EECP) influences cardiac functions, hemodynamic characteristics and cerebral blood flow. However, little is known about whether or how the EECP affects the brain-heart coupling to produce these physiological and functional changes. We aimed to determine if the brain-heart coupling is altered during or after EECP intervention by assessing the heartbeat evoked potential (HEP) in healthy adults. Methods: Based on a random sham-controlled design, simultaneous electroencephalography and electrocardiography signals as well as blood pressure and flow status data were recorded before, during and after two consecutive 30-min EECP in 40 healthy adults (female/male: 17/23; age: 23.1 ± 2.3years). HEP amplitude, frequency domain heart rate variability, electroencephalographic power and hemodynamic measurements of 21 subjects (female/male: 10/11; age: 22.7 ± 2.1years) receiving active EECP were calculated and compared with those of 19 sham control subjects (female/male: 7/12; age: 23.6 ± 2.5years). Results: EECP intervention caused immediate obvious fluctuations of HEP from 100 to 400ms after T-peak and increased HEP amplitudes in the (155-169) ms, (354-389) ms and (367-387) ms time windows after T-peak in the region of the frontal pole lobe. The modifications in HEP amplitude were not associated with changes in the analyzed significant physiological measurements and hemodynamic variables. Discussion: Our study provides evidence that the HEP is modulated by immediate EECP stimuli. We speculate that the increased HEP induced by EECP may be a marker of enhanced brain-heart coupling. HEP may serve as a candidate biomarker for the effects and responsiveness to EECP.

Finite element analysis of braided dense-mesh stents for carotid artery stenosis

When braided dense-mesh stents are used to treat carotid stenosis, the structural mechanics of vascular stents, the contact mechanics with blood vessels, and the fluid mechanics in the blood environment need to be studied in depth to reduce the damage of stents to blood vessels and the incidence of in-stent restenosis. Three types of braided stents with 8, 16, and 24 strands and laser-cut stents with the corresponding size parameters were designed, and the bending behavior of each of these types of stent, deployment, and fluid dynamic analysis of the 24-strand braided stent were simulated. The results show that the bending stress of the 8-, 16-, and 24-strand braided stents is 46.33%, 50.24%, and 31.86% of that of their laser-cut counterparts. In addition, higher strand density of the braided stents was associated with greater bending stress; after the 24-strand braided stent was expanded within the stented carotid artery, the carotid stenosis rate was reduced from 81.52% to 46.33%. After stent implantation, the maximum stress on the vessel wall in a zero-pressure diastolic environment decreased from 0.34 to 0.20 MPa, the maximum pressure on the intravascular wall surface decreased from 4.89 to 3.98 kPa, the area of high-pressure region decreased, the wall shear force of the stenotic segment throat decreased, and blood flow increased in the stenosis segments. The braided stent had less bending stress and better flexibility than the laser-cut stent under the same stent size parameters; after the 24-strand braided stent was implanted into the stented vessel, it could effectively dilate the vessel, and the blood flow status was improved.

Иммунный статус в развитии рестеноза у пациентов с окклюзионно-стенотическим поражением бедренно-подколенного артериального сегмента после бедренно-подколенного шунтирования

Objective: to assess the immune status of systemic and local blood flow after femoral-popliteal bypass surgery in patients with and without restenosis. Materials and methods. The analysis of the treatment of 82 patients who underwent femoral-popliteal bypass surgery was carried out. Depending on the condition of the reconstruction zone after 12 months, the patients were divided into two groups: group I - 21 patients without restenosis, group II - 61 patients with the development of restenosis. The analysis of IgA, IgM, IgG, circulating immune complexes (CIC), interleukin (IL)-6, IL-1 in the systemic and local blood flow before and after surgery was performed. Results. In patients with the development of restenosis of the reconstruction zone, the level of IgA in the systemic and IgA, IgM in the local bloodstream was initially lower, the level of CIC, IL-1, IL-6 in the systemic and IgG, IL-1, IL-6 in the local bloodstream was higher, after surgery, the level of IgA in the local bloodstream was lower, higher - IgM in systemic and IL-6 in local blood flow in comparison with patients without restenosis. The correlation between the immune status and the development of restenosis was established: before surgery in the systemic circulation - IgA (r=-0.31, p&lt;0.01), CIC (r=0.39, p&lt;0.001), IL-6 (r=0.25, p&lt;0.05), IL-1 (r=0.26, p&lt;0.05), in the local bloodstream - IgA (r=-0.26, p&lt;0.05), IgM (r=-0.30, p&lt;0.01), IgG (r=0.26, p&lt;0.05), IL-6 (r=0.30, p&lt;0.01), IL-1 (r=0.29, p&lt;0.01); after surgery in the systemic circulation - IgM (r=0.33, p&lt;0.01), in the local - IgA (r=-0.24, p&lt;0.05), IL-6 (r=0.40, p&lt;0.001). The relationship between the degree of chronic arterial insufficiency (r=0.22, p&lt;0.05), the ankle- brachial index after surgery (r=-0.27, p&lt;0.05) with the development of restenosis was revealed. Conclusion. The interrelation of the immune status of the systemic and local blood flow before and after surgery and restenosis in the anastomosis zone after femur-popliteal bypass surgery has been shown. The study of the immune status will make it possible to develop an algorithm for restenosis prevention.

Retracted: Predictive Value of CT Perfusion Imaging on the Basis of Automatic Segmentation Algorithm to Evaluate the Collateral Blood Flow Status on the Outcome of Reperfusion Therapy for Ischemic Stroke

Retracted: Predictive Value of CT Perfusion Imaging on the Basis of Automatic Segmentation Algorithm to Evaluate the Collateral Blood Flow Status on the Outcome of Reperfusion Therapy for Ischemic Stroke

Exaggerated blood pressure response to static exercise in hindlimb ischemia-reperfusion.

Peripheral artery disease (PAD) reduces the blood flow supply in the affected limbs as one of the significant cardiovascular concerns. Revascularization surgery in the femoral artery plays a central role in treating PAD. Exercise is also a rehabilitation strategy suggested for PAD patients to improve vascular functions. However, the effects of limb ischemia-reperfusion (IR), one of the most predominant complications in revascularization surgery, on exercise-induced arterial blood pressure (BP) response are poorly understood. In the present study, we determined 1) the blood flow status in the hindlimb muscles of rats (plantar muscle, red and white portions of gastrocnemius) with different time points of the hindlimb IR; and 2) the BP response to static muscle contraction in rats at different time points after the blood flow reperfusion procedure. Results of this study indicated that, compared with the Sham group, the blood flow in the hindlimb muscles evaluated by Evans blue concentration was significantly reduced at 6h of femoral artery occlusion (FAO 6h) (vs. sham control, p < 0.05). The decreased blood flow was gradually recovered after the blood flow reperfusion for 18 (IR 18h), 66 (IR 66h), and 114 (IR 114h) hours (p < 0.05 vs. FAO 6h for all IR groups). The response of mean arterial pressure was 20 ± 4mmHg in Sham rats (n = 7); 32 ± 10mmHg in IR 18h rats (n = 10); 27 ± 7mmHg in IR 66h rats (n = 13); 26 ± 4mmHg in IR 114h rats (n = 9) (p < 0.05 vs. Sham for all groups). No significant difference was observed in the peak-developed tension during muscle contraction among all the groups (p > 0.05). In conclusion, static exercise-induced BP response is exaggerated following IR. Whereas the BP response is not statistically significant but tends to decrease with a prolonged IR time, the exaggerated BP response remains through time points from post-IR 18h-114h.

The preoperative focal cerebral blood flow status may be associated with slow flow in the bypass graft after combined surgery for moyamoya disease.

The aim of this study was to investigate the association between early postoperative slow flow in bypass grafts and preoperative focal cerebral blood flow (CBF) in patients who underwent combined surgery for moyamoya disease (MMD). The subjects were 18 patients (22 surgeries) who underwent single photon emission computed tomography (SPECT) before surgery. The CBF value of the middle cerebral artery territory was extracted from the SPECT data, and the value relative to the ipsilateral cerebellar CBF (relative CBF, or RCBF) was calculated. The association between RCBF and early postoperative slow flow in the bypass graft was investigated. In addition, the correlation between the revascularization effect and preoperative RCBF was analyzed. In four of 22 surgeries (18.2%), slow flow in the bypass graft was identified in the early postoperative period. Preoperative RCBF in the slow flow and patent groups was 0.86 ± 0.15 and 0.87 ± 0.15, respectively, with no significant difference (P = 0.72). The signal intensity of four slow-flowed bypasses was improved in all cases on magnetic resonance angiography images captured during the chronic phase (mean of 3.3 months postoperatively). The revascularization scores were 2 ± 0.82 and 2.1 ± 0.68 in the slow flow and patent groups, respectively, and did not differ significantly (P = 0.78). A significant correlation was not observed between preoperative RCBF and the revascularization effect. No significant association was observed between preoperative RCBF and early postoperative slow flow in bypass grafts in patients with MMD undergoing combined surgery. Given the high rate of improved depiction of slow-flowed bypass in the chronic postoperative phase, the conceptual significance of an opportune surgical intervention is to maintain CBF by supporting the patient's own intracranial-extracranial conversion function.

Clinical Effects of Bushen Culuan Prescription on Infertility Due to Decreased Ovarian Reserve of Kidney Deficiency and Liver Depression Pattern

Abstract Objective The objective of this study was to explore the clinical effects of Bushen Culuan prescription on infertility due to decreased ovarian reserve of kidney deficiency and liver depression pattern. Methods Totally 100 infertile patients with ovarian hypofunction treated from October 2019 to January 2022 were selected and divided into the observation group and the control group by a random number table. The control group was treated with estrogen sequential therapy, and the observation group was treated with Bushen Culuan prescription. The clinical efficacy, sex hormone levels including (follicle-stimulating hormone [FSH], luteinizing hormone [LH], and estradiol [E2]), ovarian function, ovarian blood flow status (peak systolic velocity [PSV], antral follicle count [AFC], arterial pulse index [PI], and resistance index [RI]), and pregnancy outcome in the two groups were compared and analyzed. Results The total effective rate of the observation group (96.00%) was significantly higher than that of the control group (80.00%). The difference was statistically significant (p &lt; 0.05). Before treatment, there was no significant difference in sex hormone levels (FSH, LH, E2, and FSH/LH), ovarian function (number of primary follicles, number of dominant follicles, ovulation number, and endometrial thickness), and ovarian blood flow (PSV, RI, PI, and AFC) between the two groups (p &gt; 0.05). After treatment, the levels of serum hormones FSH, LH, E2, and FSH/LH decreased significantly in both groups. The number of primary follicles, dominant follicles, and ovulation increased significantly, and the thickness of endometrium decreased significantly; the indexes of PSV, RI, and AFC of ovarian blood flow increased significantly, and the PI index decreased significantly. The levels of each index in the observation group were better than those in the control group (p &lt; 0.05). In the control group, 32 cases were pregnant within 1 year after treatment, and the pregnancy rate was 64.00%; 21 cases in the observation group were pregnant within 1 year after treatment, and the pregnancy rate was 42.00%; the pregnancy rate in the observation group was higher than that in the control group, and the difference was statistically significant (χ2 = 4.014, p = 0.045 &lt; 0.05). Conclusion Bushen Culuan prescription has a definite effect on infertility due to ovarian hypofunction. The action mechanism may involve multicomponent and multitarget stimulation to improve patients' ovarian function, regulate the level of sex hormones, and improve the pregnancy outcome.

Diagnosing Diabetic Retinopathy in OCTA Images Based on Multilevel Information Fusion Using a Deep Learning Framework.

Objective As an extension of optical coherence tomography (OCT), optical coherence tomographic angiography (OCTA) provides information on the blood flow status at the microlevel and is sensitive to changes in the fundus vessels. However, due to the distinct imaging mechanism of OCTA, existing models, which are primarily used for analyzing fundus images, do not work well on OCTA images. Effectively extracting and analyzing the information in OCTA images remains challenging. To this end, a deep learning framework that fuses multilevel information in OCTA images is proposed in this study. The effectiveness of the proposed model was demonstrated in the task of diabetic retinopathy (DR) classification. Method First, a U-Net-based segmentation model was proposed to label the boundaries of large retinal vessels and the foveal avascular zone (FAZ) in OCTA images. Then, we designed an isolated concatenated block (ICB) structure to extract and fuse information from the original OCTA images and segmentation results at different fusion levels. Results The experiments were conducted on 301 OCTA images. Of these images, 244 were labeled by ophthalmologists as normal images, and 57 were labeled as DR images. An accuracy of 93.1% and a mean intersection over union (mIOU) of 77.1% were achieved using the proposed large vessel and FAZ segmentation model. In the ablation experiment with 6-fold validation, the proposed deep learning framework that combines the proposed isolated and concatenated convolution process significantly improved the DR diagnosis accuracy. Moreover, inputting the merged images of the original OCTA images and segmentation results further improved the model performance. Finally, a DR diagnosis accuracy of 88.1% (95%CI ± 3.6%) and an area under the curve (AUC) of 0.92 were achieved using our proposed classification model, which significantly outperforms the state-of-the-art classification models. As a comparison, an accuracy of 83.7 (95%CI ± 1.5%) and AUC of 0.76 were obtained using EfficientNet. Significance. The visualization results show that the FAZ and the vascular region close to the FAZ provide more information for the model than the farther surrounding area. Furthermore, this study demonstrates that a clinically sophisticated designed deep learning model is not only able to effectively assist in the diagnosis but also help to locate new indicators for certain illnesses.

Quantifying cerebral blood arrival times using hypoxia-mediated arterial BOLD contrast

Cerebral blood arrival and tissue transit times are sensitive measures of the efficiency of tissue perfusion and can provide clinically meaningful information on collateral blood flow status. We exploit the arterial blood oxygen level dependent (BOLD) signal contrast established by precisely decreasing, and then increasing, arterial hemoglobin saturation using respiratory re-oxygenation challenges to quantify arterial blood arrival times throughout the brain. We term this approach the Step Hemoglobin re-Oxygenation Contrast Stimulus (SHOCS). Carpet plot analysis yielded measures of signal onset (blood arrival), global transit time (gTT) and calculations of relative total blood volume. Onset times averaged across 12 healthy subjects were 1.1 ± 0.4 and 1.9 ± 0.6 for cortical gray and deep white matter, respectively. The average whole brain gTT was 4.5 ± 0.9 s. The SHOCS response was 1.7 fold higher in grey versus white matter; in line with known differences in tissue-specific blood volume fraction. SHOCS was also applied in a patient with unilateral carotid artery occlusion revealing ipsilateral prolonged signal onset with normal perfusion in the unaffected hemisphere. We anticipate that SHOCS will further inform on the extent of collateral blood flow in patients with upstream steno-occlusive vascular disease, including those already known to manifest reductions in vasodilatory reserve capacity or vascular steal.