Vascular Disturbances Research Articles

Maternal Microvascular Dysfunction During and After Preeclamptic Pregnancy.

Preeclampsia, a pregnancy disorder characterized by de novo hypertension and maternal multisystem organ dysfunction, is the leading cause of maternal mortality worldwide and is associated with a fourfold greater risk of cardiovascular disease throughout the lifespan. Current understanding of the etiology of preeclampsia remains unclear, due in part to the varying phenotypical presentations of the disease, which has hindered the development of effective and mechanism-specific treatment or prevention strategies both during and after the affected pregnancy. These maternal sequelae of preeclampsia are symptoms of systemic vascular dysfunction in the maternal nonreproductive microvascular beds that drives the development and progression of adverse cardiovascular outcomes during preeclampsia. Despite normalization of vascular disturbances after delivery, subclinical dysfunction persists in the nonreproductive microvascular beds, contributing to an increased lifetime risk of cardiovascular and metabolic diseases and all-cause mortality. Given that women with a history of preeclampsia demonstrate vascular dysfunction despite an absence of traditional CVD risk factors, an understanding of the underlying mechanisms of microvascular dysfunction during and after preeclampsia is essential to identify potential therapeutic avenues to mitigate or reverse the development of overt disease. This article aims to provide a summary of the existing literature on the pathophysiology of maternal microvascular dysfunction during preeclampsia, the mechanisms underlying the residual dysfunction that remains after delivery, and current and potential treatments both during and after the affected pregnancy that may reduce microvascular dysfunction in these high-risk women. © 2024 American Physiological Society. Compr Physiol 14:5703-5727, 2024.

Cardiovascular disease detection from cardiac arrhythmia ECG signals using artificial intelligence models with hyperparameters tuning methodologies

Cardiovascular disease (CVD) is connected with irregular cardiac electrical activity, which can be seen in ECG alterations. Due to its convenience and non-invasive aspect, the ECG is routinely exploited to identify different arrhythmias and automatic ECG recognition is needed immediately. In this paper, enhancement for the detection of CVDs such as Ventricular Tachycardia (VT), Premature Ventricular Contraction (PVC) and ST Change (ST) arrhythmia using different dimensionality reduction techniques and multiple classifiers are presented. Three-dimensionality reduction methods, such as Local Linear Embedding (LLE), Diffusion Maps (DM), and Laplacian Eigen (LE), are employed. The dimensionally reduced ECG samples are further feature selected with Cuckoo Search (CS) and Harmonic Search Optimization (HSO) algorithms. A publicly available MIT-BIH (Physionet) - VT database, PVC database, ST Change database and NSR database were used in this work. The cardiac vascular disturbances are classified by using seven classifiers such as Gaussian Mixture Model (GMM), Expectation Maximization (EM), Non-linear Regression (NLR), Logistic Regression (LR), Bayesian Linear Discriminant Analysis (BDLC), Detrended Fluctuation Analysis (Detrended FA), and Firefly. For different classes, the average overall accuracy of the classification techniques is 55.65 % when without CS and HSO feature selection, 64.36 % when CS feature selection is used, and 75.39 % when HSO feature selection is used. Also, to improve the performance of classifiers, the hyperparameters of four classifiers (GMM, EM, BDLC and Firefly) are tuned with the Adam and Grid Search Optimization (GSO) approaches. The average accuracy of classification for the CS feature-based classifiers that used GSO and Adam hyperparameter tuning was 79.92 % and 85.78 %, respectively. The average accuracy of classification for the HSO feature-based classifiers that used GSO and Adam hyperparameter tuning was 86.87 % and 93.77 %, respectively. The performance of the classifier is analyzed based on the accuracy parameter for both with and without feature selection methods and with hyperparameter tuning techniques. In the case of ST vs. NSR, a higher accuracy of 98.92 % is achieved for the LLE dimensionality reduction with HSO feature selection for the GMM classifier with Adam's hyperparameter tuning approach. The GMM classifier with the Adam hyperparameter tuning approach with 98.92 % accuracy in detecting ST vs. NSR cardiac disease is outperforming all other classifiers and methodologies.

Liver Stiffness Evaluation in Chronic Hepatitis C Patients with Cirrhosis before and after Direct-Acting Antivirals.

After the introduction of direct-acting antivirals, parallel significant clinical progress has been achieved in the assessment of liver fibrosis progression/regression before treatment and during the follow-up of the cirrhotic patients with chronic hepatitis C virus (HCV) infection. The evolution of chronic hepatitis C into liver cirrhosis is correlated with an extensive accumulation of the extracellular matrix, leading to the formation of large amounts of fibrotic tissues that, initially, are concentrated in periportal areas and, in the later stages, surround the nodules of regenerating hepatocytes. The progressive increase in the fibrotic matrix contributes to vascular disturbances (favoring the development of portal hypertension) and to microenvironmental changes. The four clinical stages of liver cirrhosis are predictors for different clinical scenarios. The wide-ranging functions of the liver require different methods for their assessment. The non-invasive evaluation using transient elastography is useful in determining the longitudinal modifications of fibrosis during and after treatment with direct-acting antivirals. The liver stiffness evaluation, known to have a wide range of values in cirrhotic patients, can offer different prognostic implications after sustained virological response. This review discusses the different time points of liver stiffness evaluation that appear to show a more well-defined propensity to identify adequate monitoring schedules for these patients.

Microvascular Changes during Viral Infections: A Systematic Review of Studies Using Retinal Vessel Diameter Assessments.

Viral infection frequently affects the cardiovascular system, and vascular disturbances in patients can lead to health complications. One essential component of the cardiovascular system that is vulnerable to the inflammatory effects of viral infections is the microcirculatory system. As a suitable and practical non-invasive method to assess the structure and function of the retinal microcirculation, a proxy for the microcirculatory system, retinal fundus imaging can be used. We examined the impact of viral infections on retinal vessel diameters and performed a systematic analysis of the literature. Our search was carried out on PubMed using predefined search queries. After a methodological filtering process, we were able to reduce the corpus of 363 publications to 16 studies that met the search parameters. We used a narrative review style to summarise the observations. Six studies covered COVID-19, seven described HIV, and three were included in the subgroup called others, covering viruses, such as Dengue Fever and Crimean-Congo Haemorrhagic Fever. Analysis of the literature showed that viral infections are associated with alterations in the retinal vessels' vasoactivity. COVID-19 and other infections cause inflammation-associated the vasodilatation of microvasculature as a short-term effect of the infection. Long COVID-19 as well as HIV are the cause of chronic inflammation impacting microvascular morphology via retinal vessel diameter narrowing. The review emphasises the importance of the understudied area of viral infections' effects on retinal microcirculation. Continuous research in this area is needed to further verify retinal fundus imaging as an innovative tool for the optimal diagnosis of microvascular changes. As changes in the microvasculature precede changes in bigger arteries, the early detection of microvascular changes can go a long way in reducing the morbidity and mortality associated with cardiovascular diseases.

Impact of Deep Breathing, Murottal, and Hypertension Exercises on Headache Management in Hypertensive Individuals

Hypertension, characterized by an abnormal increase in blood pressure, often triggers headaches at the back of the head and neck due to vascular disturbances. This study explores the effectiveness of a holistic non-pharmacological intervention—comprising Deep Breathing Relaxation Technique, Qur'anic recitation (murottal), and Hypertension Exercise—to alleviate these headaches in hypertensive patients at Mekarjaya Community Health Center, Indonesia. Employing a quantitative approach, the research utilized a Quasi-Experimental Design with a Pretest and Posttest Control Group. The intervention group underwent IMAS therapy, an integrated approach combining the three techniques, while the control group continued only with routine medication. Conducted in December 2022 with 16 participants in each group, results from both Dependent and Independent T-tests (p < 0.05) confirmed the significant effect of the interventions. This study not only underscores the potential of such integrative therapies in managing hypertension-related headaches but also contributes to broader health care practices by offering a viable alternative to conventional medication. The findings align with and extend existing research on relaxation therapies for hypertension, suggesting substantial benefits in patient well-being and symptom management.

Assessment of temporal changes in glomerular filtration rate following clamp ischemia in male and female rats using transcutaneous FITC-sinistrin clearance

Warm arterial clamping with reperfusion in rats is a commonly utilized model of ischemic kidney injury (IRI). Traditionally, changes in plasma creatinine or creatinine clearance have been utilized to assess kidney function in this model. A limitation of these approaches, however, is that changes in plasma creatinine are relatively slow to occur, resulting in low temporal fidelity. This limits our ability to relate changes in kidney function to histo-pathological changes observed during reperfusion of the kidneys. Transcutaneous assessment of FITC-sinistrin clearance enables accurate, repeated measurement of glomerular filtration rate in conscious animals over short segments of time (hours) without drawing blood. The goal of the current study was to characterize temporal changes in renal function in male and female rats after reperfusion from bi-lateral warm arterial clamp ischemia using transcutaneous FITC-sinistrin clearance. Our study was performed in age matched male (n=8) and female (n=5) Sprague Dawley rats (12-20wks of age). FITC sinistrin clearance was measured by affxing a miniaturized transcutaneous measurement device between the shoulder blades (MediBeacon) of rats. 50mg/kg of FITC-sinistrin was then injected i.v via the tail vein and the device allowed to record for ~3 hours. Measurements were taken either at pre-surgery (baseline), 1-3 hours, 24 hours or 7 days following reperfusion of the kidneys from warm bilateral arterial clamp ischemia. For the ischemic surgery, animals were anesthetized with isoflurane (2-5%, 95% O2) and the right and left kidneys were accessed by flank incisions. After being exposed, the renal arteries were separated from the renal veins via dissection. Both renal arteries were then clamped with microserrefines for 45 minutes. After the ischemic period, the clamps were removed, allowing blood flow to be restored to the kidneys. Body temperature was measured via a rectal probe and maintained at 37°C throughout the procedure by a servo-controlled heating table and UV heating lamp. The wounds were then closed, and the animals allowed to recover. Buprenorphine was administered as an analgesic. For each measurement, the ½ life of FITC sinistrin was determined using a 1-compartment model (MB Lab software) and glomerular filtration rate (GFR) per 100g of body weight rate calculated. Baseline GFR was 0.94±0.03ml/min/100g in males and 1.09±0.02/min/100g in females (PTTEST=0.04). Following 45 minutes of warm bilateral arterial ischemia and reperfusion, GFR fell to 0.24±0.08ml/min/100g in male and 0.36±0.15ml/min/100g in females within 1-3 hours of reperfusion. At 24 hours of reperfusion, GFR averaged 0.06±0.03ml/min/100g in males and 0.28±0.16ml/min/100g in females. GFR recovered in males and females by 7 days of reperfusion averaging 0.86±0.10ml/min/100g in males and 0.83±0.00ml/min/100g in females. There was no significant difference between FITC-sinistrin clearance between males and females at any time point after IRI. Our data indicate that most of the reduction in GFR is present immediately after releasing the clamp. This is consistent with continued vascular disturbances mediating the initial decline in glomerular filtration rate in this model (i.e. vasospasm). The absence of sex differences in GFR decline using this method suggests that sex-differences detected using plasma creatinine may be, at least in part, secondary to the more rapid production of creatinine in males than in females or greater baseline filtration/body weight ratio in females compared to males rather than differences in renal function decline to ischemia. American Heart Association Transformational Project Award 970585 to Paul O'Connor. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Case Report on a Supracondylar Process of the Humerus: Morphological and Morphometric analysis

The supracondylar process is a rare anatomical variation characterized by an irregular bone prominence with a variable size. Found in the anteromedial part of the distal region of the humerus, can compress the median nerve and other structures. The aim of this paper was to perform a morphological and morphometric evaluation of this variation in a right dry humerus. Faces, margins, and shape of the process were observed. Measurements was taken from the process and the entire bone. The apex of the process points toward the transition between the trochlea and the humeral capitulum. The bony spicule was 6.24 mm long. The base of the spicule measured 6.80 mm in length and 4.18 mm in width. Longitudinal crests associated with the base of the process and a deep longitudinal depression were observed. The combined longitudinal length of the caudal and cranial crests together was 32.37 mm. The distance from the bone spicule to the medial epicondyle was 65.29 mm. In pathological cases, vascular disturbances, sensory deficits, and decreased muscle strength can be observed. A comprehensive description of this variation is crucial for enhancing current knowledge and awareness in clinical practice, as it aids in accurate diagnosis and treatment.

Tracheal agenesis versus tracheal atresia: anatomical conditions, pathomechanisms and causes with a possible link to a novel MAPK11 variant in one case

BackgroundIn this study we aimed to describe the morphological and pathogenetic differences between tracheal agenesis and tracheal atresia, which are not clearly distinguished from each other in the literature, and to contribute thereby to the understanding and management of these conditions. Both tracheal agenesis and tracheal atresia represent rare disorders of still unknown aetiology that cannot be detected by prenatal ultrasound. If the affected foetuses survive until birth these conditions result in respiratory failure and in futile attempts to rescue the infant’s life.ResultsAutopsies and genetic analyses, including singleton or trio exome sequencing, were performed on five neonates/foetuses with tracheal agenesis and three foetuses with tracheal atresia. Tracheal agenesis was characterized by absence of the sublaryngeal trachea and presence of a bronchooesophageal fistula and by pulmonary isomerism and occurred as an isolated malformation complex or as part of a VACTERL association. Special findings were an additional so-called ‘pig bronchus’ and a first case of tracheal agenesis with sirenomelia. Tracheal atresia presenting with partial obliteration of its lumen and persistence of a fibromuscular streak resulted in CHAOS. This condition was associated with normal lung lobulation and single, non-VACTERL type malformations. Trio ES revealed a novel variant of MAPK11 in one tracheal agenesis case. Its involvement in tracheooesophageal malformation is herein discussed, but remains hypothetical.ConclusionTracheal agenesis and tracheal atresia represent different disease entities in terms of morphology, pathogenesis and accompanying anomalies due to a primary developmental and secondary disruptive possibly vascular disturbance, respectively.

Forensic Hypoglycaemia & Neuroglycopenia — A Clinical Legal Social Endocrinology Challenge for 2024, Forensic Law in Hypoglycaemia 4

Forensic Hypoglycaemia & Neuroglycopenia — A Clinical Legal Social Endocrinology Challenge for 2024, Forensic Law in Hypoglycaemia 4

Strengthening the basics: acids and bases influence vascular structure and function, tissue perfusion, blood pressure, and human cardiovascular disease.

Acids and their conjugate bases accumulate in or dissipate from the interstitial space when tissue perfusion does not match the metabolic demand. Extracellular acidosis dilates most arterial beds, but associated acid-base disturbances-e.g., intracellular acidification and decreases in HCO3- concentration-can also elicit pro-contractile influences that diminish vasodilation and even dominate in some vascular beds to cause vasoconstriction. The ensemble activities of the acid-base-sensitive reactions in vascular smooth muscle and endothelial cells optimize vascular resistance for blood pressure control and direct the perfusion towards active tissue. In this review, we describe the mechanisms of intracellular pH regulation in the vascular wall and discuss how vascular smooth muscle and endothelial cells sense acid-base disturbances. We further deliberate on the functional effects of local acid-base disturbances and their integrated cardiovascular consequences under physiological and pathophysiological conditions. Finally, we address how mutations and polymorphisms in the molecular machinery that regulates pH locally and senses acid-base disturbances in the vascular wall can result in cardiovascular disease. Based on the emerging molecular insight, we propose that targeting local pH-dependent effectors-rather than systemic acid-base disturbances-has therapeutic potential to interfere with the progression and reduce the severity of cardiovascular disease.

Vascular dysfunction in behavior‐variant frontotemporal dementia

AbstractBackgroundThe vascular disturbance was recently found in a postmortem study of frontotemporal dementia (FTD), but whether vascular dysfunction exists in the early stage of FTD remains elusive. The study aimed to explore whether there was evidence of vascular dysfunction in FTD and its relationship with central neurodegeneration and the clinical outcome.MethodTwenty patients with behavior frontotemporal dementia (bvFTD) were enrolled and underwent assessment of peripheral plasma vascular markers, positron emission tomography/magnetic resonance imaging, and neuropsychological examinations. Group difference was tested using the student’s t‐test and Mann‐Whitney U test. Partial correlation analysis was implemented using age and sex as covariates to explore the association between peripheral vascular markers, neuroimaging, and clinical measures.ResultAll four factors including matrix metalloproteinases‐1(MMP‐1), matrix metalloproteinases‐3 (MMP‐3), Osteopontin, and pentraxin‐3 are increased in the FTD group. The plasma level of MMP‐1 was negatively correlated with the gray matter metabolism of the prefrontal cortex (r = ‐0.5119, p = 0.0210) and the anterior cingulate cortex (r = ‐0.4685, p = 0.0269). MMP‐3 was negatively correlated with the gray matter metabolism of the anterior temporal cortex (r = ‐0.4650, p = 0.0388). Pentraxin‐3 was negatively correlated with age at sampling (r = ‐0.5024, p = 0.0240) and age at onset (r = ‐0.5693, p = 0.0088). No other significant associations were found in other vascular cytokines and clinical measures.ConclusionThe vascular disturbance was found in patients with bvFTD and associated with the disease‐specific neurodegeneration pattern, indicating vascular dysfunction and perturbance of the BBB participation in the pathogenesis of FTD. The vascular pathway might be a promising target for future potential therapy.

The profile of villous chorion vascularization in primary placental insufficiency

Introduction. Placentation and autochthonous vascularization during the early period of intrauterine development in primary placental insufficiency are important stages in the establishment of embryo-haemochorial circulation. Vascular and angiogenesis dysfunctions in the early period of gestation are essential in the development of changes in placental vascular status with severe repercussions on pregnancy outcome in the first trimester of gestation. The purpose of the work. Evaluation of vascular density by the application of the anti-CD31 antibody in the chorio-villar germinal site in short-term dysregulated pregnancies. Material and methods. 184 cases were divided into 2 groups: stagnant pregnancies (SP (L1 = 144 cases) and early spontaneous abortion (ESA) (L2 = 40 cases). Control material: pregnancies resolved at social indications/desire (A) (n = 18) distributed according to gestational term (3-5 weeks), (6-9 weeks), and (10-12weeks). The estimation of the histomorphological features was performed by applying the classical conventional method with hematoxylin-eosin (H.E.), and the immunohistochemical evaluation of the vascular density in the chorio-villar profile with the help of the endothelial marker anti-CD31. The statistical relationships between fetal conceptus assessment forms, gestational term, and age were analyzed. Results. Distribution of pregnancies by profile: (SP) – 78.2% vs (ESA) – 21.8%, with vascular disturbances attested in 100% of cases by increasing the density of avascular chorionic villi in the case of stagnant pregnancies in 75% of cases. The application of immunoexpression with anti-CD31 at the level of the stroma of the chorionic villi determined PVI with a maximum mean in the control group (91.51±0.71) vs the ESA and SP groups (82.29±12.96 and 57.47±6.53, respectively). The index of vascularization with lumen (IV/L+) and vascularization index without lumen (IV/L-) were statistically significantly different (p = 0.011) for (SP). Applying the student t-test revealed statistically significant differences for PVI in most groups, except PSD vs SP at the age of 10-12 gestation of weeks (w.g.) At the same time, there are statistically significant differences between the means of vessels with lumen within PSD and SP (t31 = 5.500, p = 0.000005), and the means of vessels without lumen registered statistically significant differences in the PSD and SP groups (t12 = 3.862, p = 0.002). Conclusions. Pregnancy evolution depends on the degree of vascularization, as well as on the quality of the vascular network.

The impact of microalbuminuria and insulin resistance as prognostic biomarker for nephropathy in obese persons: a systematic review

Background: The progression of weight gain over the normal level is accompanied by an increase in renovascular damage markers, such as microalbuminuria. Microalbuminuria could be an indication of vascular disturbances caused by obesity. The global pandemic of renal disease has something to do with the link between obesity and type-2 diabetes. Furthermore, microalbuminuria can also be a possible factor for developing insulin resistance syndrome and high blood pressure. The goal of this research is to analyze the impact that insulin resistance, as well as microalbuminuria, play in predicting the severity of nephropathy among obese individuals and also look into these markers in identifying patients with this condition. Methods: The selected studies (updated to November 2022) were evaluated using the Electronic PubMed database. Based on our selection criteria only those that included high-quality investigations on the relevance of insulin resistance and microalbuminuria as markers of nephropathy in obese people were included. We evaluated this link using odds ratios with a confidence interval of 95%. Results: Overall, 15 studies, including over 10,000 obese individuals, were evaluated for this study. The summative results revealed that microalbuminuria and insulin may be strong indicators for the advancement of nephropathy in individuals with diabetes mellitus and obese individuals. In support of this, more studies need to be carried out on obese individuals with nephropathy in the absence of diabetes to confirm the relevance of these biomarkers as a prevention measure. Conclusions: Understanding the importance of the impact microalbuminuria and resistance to insulin play as biomarkers in the health of obese individuals may be very important to prevent nephropathy progression and premature death in both diagnosed and undiagnosed situations. A limitation of this review is that it didn't focus on other anomalies related to obesity such as cardiovascular disease or diabetes.

Foot-core stability in non-hemorrhagic stroke: A case report

Introduction: Stroke is a neurological deficit or apoplexy that occurs suddenly due to vascular disturbances. Exercise delivery, the function of the foot-core system (foot-core stability), and the potentially beneficial effects of training have received increasing attention in the clinical and athletic fields because of the critical role of the intrinsic leg muscles as local stabilizers and direct sensors of foot deformation. 
 Case description: The research was a case study of an elderly patient aged 67 years diagnosed with hemiparesis non-hemorrhagic stroke. This case was taken at the Magetan Physiotherapy Clinic from December 7 to December 27, 2022. Physiotherapy problems in this case included pain, muscle weakness, limited joint motion, and impaired standing balance.
 Results: The results obtained after administering physiotherapy interventions and exercise therapy can improve the functional abilities of the body experiencing weakness, increase proprioception in patients and provide foot-core stability that can help with problems.
 Conclusions: Physiotherapy interventions with exercise therapy could increase proprioception and provide foot-core stability for stroke patient’s with severe disability.

Could ginger extract be a therapeutic drug for migraine?

Migraine is a common neurological disorder that may be accompanied by vascular disturbances, Migraine is one of the most causes of disability worldwide. Zingiber officinale is a medicinal herb that has an analgesic effect on many disorders such as headaches, migraine, muscle tension, stomach spasm, and dysmenorrhea. Also, ginger has many pharmacological actions used to treat and prevent various common symptoms and diseases. This review aims to evaluate the potential of ginger to treat or prevent migraine episodes. Especially nowadays, Patients prefer herbal and complementary medicine to avoid the hard side effects of chemical drugs. The author searched several databases including PubMed, Science Direct, Wiley Online, and Scopus through February 2023 for recent articles with good quality evaluating the potential of ginger to treat migraine patients. The author made investigations and Interpretations depending on the results of the authors' experiments in previous articles included in my review. It is suggested that the bioactive compounds in ginger have the potential to treat and prevent acute migraine episodes effectively and safely. The author recommends encouraging the manufacturing of different pharmaceutical dosage forms of ginger extract to be used worldwide in a safe way and to render a higher absorption rate, and pharmacological response.

Relationship Between Cardio-metabolic Parameters in Diabetic Non-smokers, Current Smokers, and Quitters: A Systematic Review and Meta-analysis

Background: Smoking is associated with an increase in macrovascular and microvascular complications in people with diabetes. In addition to other concomitant vascular disturbances, it also appears to affect cardio-metric parameters. This may partly explain the acceleration of vascular complications in people with diabetes. This study aimed to investigate the relationship between smoking and its cessation in cardio-metric parameters in diabetes. Materials and Methods: Searches were conducted in Medline, Embase, and CINAHL. After screening 6866 studies, 14 observational studies with a total of 98978 participants with type 1 or type 2 diabetes were selected for the investigation. Results: Meta-analysis demonstrated that the mean difference of hemoglobin A1c (HBA1C) between non-smokers and smokers was 0.61% (95% confidence interval [CI] -0.88 to -0.33, P<0.001). The difference in low-density lipoprotein cholesterol between non-smokers and smokers was 0.11 mmol/L (95% CI -20.21 to 0.01, P=0.04). The difference in high-density lipoprotein cholesterol between non-smokers and smokers was 0.12 mmol/L (95% CI 0.08-0.15, P<0.001). However, there was no statistically significant difference in blood pressure (BP) between the two groups. The difference in HBA1C between quitters and continuing smokers was not statistically significant at 10.0.10% (95 CI -0.42 to 0.21, P=0.53). Conversely, the results revealed that over 10 years, HBA1C was comparable between non-smokers and quitters. Conclusion: Smoking in patients with diabetes was widespread and should be the target of smoking cessation campaigns. Smoking cessation does not lead to an increase in HBA1C in the long term and may reduce vascular complications in diabetes by its desirable effect on the lipid profile.

Moebius Syndrome: What We Know So Far.

Moebius syndrome (MBS) is a rare congenital cranial nerve disorder characterized by unilateral, bilateral symmetrical, or asymmetrical facial (VII) and abducens (VI) nerve palsies. Genetics and rhombencephalon vascular disturbances from intrauterine environmental exposures have been attributed to its development. It can present with various orofacial abnormalities. Although the diagnosis is purely clinical, certain characteristic features are present in the brain's images. With no cure, it is essential to devise management on a personalized basis. We discuss etiology, presentation, diagnostic approaches, and effective management in the existing literature. This comprehensive review examines the clinic-pathological aspects of Moebius syndrome. The authors employed the PUBMED base index to identify pertinent literature and reference it accordingto research keywords. Findings suggest the most popular etiology is the theory of intrauterine vascular disruption to the brainstem during embryogenesis, followed by the genetic hypothesis. Intrauterine environmental exposures have been implicated as potential risk factors. Facial and abducens nerve palsies are the most common presenting features. However, clinical manifestations of lower cranial nerves (IX, X, XI, XII) may be present with orthopedic anomalies and intellectual deficiencies. The diagnosis is clinical with minimal defined diagnostic criteria. Characteristic radiological manifestations involving the brainstem and cerebellum can be observed in imaging studies. With no definitive treatment options, a multidisciplinary approach is employed to provide supportive care. Despite radiological manifestations, Moebius syndrome is diagnosed clinically. Although incurable, a multidisciplinary approach, with personalized rehabilitative measures, can manage physical and psychological deficits; however, standard guidelines need to be established.

HEART RATE VARIABILITY IS AFFECTED IN YOUNG ADULT CELIAC PATIENTS, INDICATING AUTONOMIC DYSFUNCTION AND INCREASED CARDIOVASCULAR RISK

Aim: Celiac Disease (CD) is a common autoimmune disease that can present at any age with varied symptoms. Cardiac involvement including vascular and arrhythmic disturbances has an important prognostic value in patients with autoimmune disorders. The aim of this study was to evaluate the effects of CD on cardiovascular autonomic functions by measuring the indices of heart rate variability (HRV).
 Materials and Methods: Ninety-one CD patients and the ninety-three healthy volunteers were included in the study. We examined both time domain and frequency domain indices of HRV measured by 24-hour ambulatory electrocardiography.
 Results: All of the time domain and frequency domain HRV parameters, with the exceptions of low frequency power and low frequency to high frequency ratio, were significantly lower in patients with CD compared to the control (p < 0.01). This difference retained for most of the HRV parameters when daytime and nighttime HRV parameters were compared separately. Correlation analysis revealed significant associations of HRV parameters with hemoglobin and ferritin levels and with duration of CD (p < 0.01). No correlation was found between HRV parameters and anti-tissue transglutaminase IgA and IgG levels which indicate the activity of the disease.
 Conclusion: The study confirmed that patients with CD have reduced HRV, indicating the presence of objective autonomic dysfunction and increased cardiovascular risk.

Features of clinical and sonographic symptoms in chronic pancreatitis with ischemic heart disease

Aim of the study. To investigate the features of the clinical course of chronic pancreatitis in comorbidity with ischemic heart disease.Research methods. We used a survey, anamnesis, objective examination, biochemical, radioimmune (indicators of insulin in the blood), instrumental (sonographic, ECG), statistical (computer analysis of data). The criteria for inclusion in chronic pancreatitis were exacerbations, abdominal pain and dyspeptic syndrome, sonographic changes in the pancreas, risk factors, patient consent for the study. The criteria for inclusion in ischemic heart disease were stable exertional angina FC I-II, CHF IIA-B, FC II-III (NYHA) in the absence of angina attacks within 3 months; regular treatment for 3 months, patient's consent. The exclusion criteria included oncological diseases, acute exacerbations of CP, myocardial infarction in the last 3 months, chronic kidney disease, and diabetes mellitus. The study was carried out in accordance with the Order of the Ministry of Health of Ukraine No.281 dated 1.11.2000. The study guidance and informed consent form were approved by the Commission on Biomedical Ethics of Bukovina State Medical University.Results. The aggravating nature of the course of the disease, the polymorphism of clinical symptoms, especially the pain syndrome, which did not always have a clear localization, irradiation, intensity and was absent in about 15%, was established. The atypical course in 83.3% of cases was associated with diseases of the digestive system. In 70.0% of patients, atherosclerotic changes in the vessels of the abdominal cavity were revealed, in 47.5% of them, lesions of the carotid artery at the stage of atheromatous plaque or its atherothrombosis, stenosis of the vascular lumen and hemodynamic disturbances were diagnosed. There was a tendency to a decrease in the ejection fraction, cardiac and stroke volumes against the background of an increase in the end systolic volume (ESV), end diastolic volume (EDV) with an EF of 50.4 ± 2.3%.Conclusion. The clinical course of chronic pancreatitis in comorbidity with ischemic heart disease is characterized by prolonged formation (more than 10 years), accompanied by structural and morphological changes in the pancreas of a fibrosing nature, the presence of atherosclerotic changes in the carotid arteries, atherosclerotic lesions of the aorta, mesenteric dysfunction, diastolic course, the possibility of premature fatal cardiovascular problems and the association with concomitant gastroenterological diseases.

Prognostic importance of biomarkers associated with haemostatic, vascular and endothelial disturbances in acute coronary syndrome patients in relation to kidney function

BackgroundPatients with kidney failure have a high risk for cardiovascular events. We aimed to evaluate the prognostic importance of selected biomarkers related to haemostasis, endothelial function, and vascular regulation in patients with acute coronary syndrome (ACS), and to study whether this association differed in patients with renal dysfunction. MethodsPlasma was collected in 1370 ACS patients included between 2008 and 2015. Biomarkers were analysed using a Proximity Extension Assay and a Multiple Reaction Monitoring mass spectrometry assay. To reduce multiplicity, biomarkers correlating with eGFR were selected a priori among 36 plasma biomarkers reflecting endothelial and vascular function, and haemostasis. Adjusted Cox regression were used to study their association with the composite outcome of myocardial infarction, ischemic stroke, heart failure or death. Interaction with eGFR strata above or below 60 ml/min/1.73 m2 was tested. ResultsTissue factor, proteinase-activated receptor, soluble urokinase plasminogen activator surface receptor (suPAR), thrombomodulin, adrenomedullin, renin, and angiotensinogen correlated inversely with eGFR and were selected for the Cox regression. Mean follow-up was 5.2 years during which 428 events occurred. Adrenomedullin, suPAR, and renin were independently associated with the composite outcome. Adrenomedullin showed interaction with eGFR strata (p = 0.010) and was associated with increased risk (HR 1.88; CI 1.44–2.45) only in patients with eGFR ≥60 ml/min/ 1.73 m2. ConclusionsAdrenomedullin, suPAR, and renin were associated with the composite outcome in all. Adrenomedullin, involved in endothelial protection, showed a significant interaction with renal function and outcome, and was associated with the composite outcome only in patients with preserved kidney function.