Vein Wall Thickness Research Articles

HSYA ameliorates venous thromboembolism by depleting the formation of TLR4/NF-κB pathway-dependent neutrophil extracellular traps

Neutrophil extracellular traps (NETs), released by activated neutrophils, are implicated in various medical conditions, including venous thromboembolism (VTE). To develop effective therapeutic strategies for VTE, it is crucial to elucidate the mechanisms involved. In this study, we explored the role of NETs in VTE pathogenesis and assessed the impact of hydroxyl safflower yellow pigment A (HSYA) treatment on VTE pathogenesis. Various biochemical, pharmacological, and functional assessments were performed in human samples and VTE mouse models. Our findings revealed that NETs formation was enhanced in VTE patients and mouse model. NETs were shown to reduce the viability and integrity of endothelial cells and facilitated ferroptosis in human umbilical vein endothelial cells (HUVECs) in a concentration-dependent manner. Depletion of NETs using the NE inhibitor Alvelestat significantly alleviated ferroptosis in VTE mice. Similarly, NETs depletion markedly attenuated thrombus formation and vein wall thickness in VTE mice. Notably, NETs treatment induced a significant elevation in total N6-Methyladenosine (m6A) RNA methylation level in HUVECs, with the most significant increase observed in methyltransferase-like 3 (METTL3). Mechanistically, the TLR4/NF-κB pathway was activated, and silencing METTL3 reversed the NETs-induced activation of this pathway in HUVECs. Rescue assays illustrated that METTL3 regulated the viability and ferroptosis of NETs-stimulated HUVECs by mediating TLR4 mRNA stability. Additionally, we found that HSYA exerted protective effects against ferroptosis in NETs-induced HUVECs and VTE mice. In summary, HSYA ameliorates VTE by depleting neutrophil extracellular traps through the inhibition of the TLR4/NF-κB pathway, thus providing a novel therapeutic strategy for treating VTE.

Behçet's syndrome: one year in review 2024.

The aim of this review is to provide a critical summary of studies published during 2023 that contribute to our understanding of Behçet's syndrome. An increase in the incidence of BS was reported in Northern Spain after 2014.Studies on patient perspectives showed the impact of Behçet's syndrome on quality of life, daily activities, education, work, and relationships. Differences in genetics among Behçet's syndrome patients with different types of organ involvement were reported and an association between HLA-B/MICA and SLCO4A1 polymorphisms and eye involvement and between DDX60L polymorphisms and nervous system involvement were observed. It was suggested that Integrin α9β1 plays a crucial role in the neutrophil-mediated inflammatory pathways underlying this syndrome and the dysfunction of the PDL1/PD-1 pathway may be associated with the hyperactivity of the Th-1/Th-17 axis. Vein wall thickness seems to be increased in patients with Behçet's syndrome, but its pathogenetic and clinical implications are not clear. There is growing evidence regarding the efficacy of TNF inhibitors in different types of organ involvement. A number of small case series point out to the potential role of TCZ and JAK inhibitors.

Screening for familial disease presence in first-degree relatives of Behçet's disease patients: Is measurement of common femoral vein wall thickness valuable for the diagnosis?

We aimed to assess first degree relatives (FDRs) of BD patients for the presence of clinical symptoms and signs of BD and evaluate common femoral vein (CFV) wall thickness measurement for the diagnosis. Patients with BD(n=129) and FDRs(n=230) of these patients were included. FDRs were questioned in terms of BD symptoms by phone. Pathergy test and CFV wall thickness measurement were performed among 111 FDRs who accepted the clinical assessment. Clinical assessment group were classified according to the criteria sets for BD. FDRs who did not meet the criteria sets and had at least one clinical finding in addition to oral aphthae(OA) were categorized as the "suspected BD". :We observed increased frequency of isolated BD manifestations in FDRs. Ten FDRs were diagnosed with BD during clinical evaluation. Significantly increased CFV wall thickness was observed in FDRs of BD patients fulfilling diagnostic BD criteria (p<0.001 for both sides) and also in those with suspected BD group (p<0.05 for both sides). Presence of OA, genital ulcer, folliculitis or erythema nodosum were associated with increased CFV wall thickness (p<0.05). . Our results suggest that CFV wall thickness measurement can be used in diagnosis of familial BD.

Abstract 2092: Ultrasound And Histology Protocol For Characterization Of Venous Stents Effect In Deep Veins In Vivo

Background: Deep venous stenting is a common strategy to treat deep vein thrombosis (DVT) decreasing future symptoms and complications. We propose a histopathological characterization of stents deployed in the inferior vena cava of rats and demonstrate how it correlates with ultrasound evaluation. Methods: Sprague Dawley rats (643±62g) were anesthetized (isoflurane). IVC diameter was measured by ultrasound on B mode. Through a midline laparotomy, infrarenal IVC side branches were ligated, posterior venous branches cauterized, micro-clips temporarily placed, and a U-stich is placed in the IVC. Using retrograde canulation of the IVC a sharpened guidewire with a stent sheath backloaded is inserted through the U-stich. The stent sheath is advanced with enough running room to deploy the venous self-expanding stent. After removal, U-stitch was tightened for hemostasis. No anticoagulation was used. Venous flow and patency were measured using a color/pulsed-wave Doppler 10-mHz probe post-procedure (PO) and 24 hours after (POD1). Vein wall thickness (VWT), in-stent-restenosis (ISR), and residual thrombosis percentage were quantified using trichrome staining at 7-, 14-, and 21-days. Results: Complete stent patency was observed in 50% of animals, partial patency in 15%, and obstruction in 35% after insertion. Table I. Recanalization at 1-day improved flow was observed in 41% of obstructed or partially patent stents. ISR was 6.2±3.8% of the luminal stent area (LSA), residual thrombosis in 29.9±23%, VWT mean 80±13.5 μm, no statistical differences found between timepoints. Figure 1. Conclusion: Characterization and follow-up of deep vein stents can be achieved by ultrasound and histology. This viable animal model can identify human pathological stent processes as early thrombosis, resolution, recanalization, and ISR. This model can reduce costs for feasibility studies to test novel stents and simulate real-life patency outcomes at multiple time points.

Caffeine-Containing Local Products and Their Effects on Liver and Kidney Histopathology: A Comparative Study

Caffeine has several modified natural and synthetic forms and it is the most abundantly consumed drug around the globe. It is present in fruits, seeds and leaves of many plants but coffee contains highest content of caffeine and is considered its richest source. It is also found in much high ratio in non-alcoholic beverages, i.e., tea and carbonated drinks like coke. The aim of current mammalian model based investigation was to evaluate the possible histopathological variations influencing the function of kidney and liver due to the intake of selective caffeinated products: Arabica and Robusta beans’ blend based coffee and coke. The 30 albino mice of male gender and 1.5 month age were acclimatized for ten days and later on, categorized as group I (control group which was treated with standard mice feed), experimental group II (treated with coffee blend) and experimental group III (treated with coke). The renal and hepatic histological sections were cut and stained for weekly observations. Hematoxyline and eosin staining was used and microscopic observations were recorded at 40X. The ANOVA based statistical analyses showed that significant variations occurred in body weight, diameter of renal blood vessels, glomeruli and of necrotic areas of both experimental groups (p ≤ 5%). Moreover in hepatic tissues, vein wall thickness, diameter of bile ducts and liver lobules also indicated significant variations. The conclusion is excessive and regular intake of above mentioned composition having coffee and coke may result in diverse physiological disturbances and a programmed general public awareness is required regarding their limited intake.

Editorial to: Where is the gap after a 90 W/4 s very high‐power short‐duration ablation of atrial fibrillation?: Association with the left atrial‐pulmonary vein voltage and wall thickness

Editorial to: Where is the gap after a 90 W/4 s very high‐power short‐duration ablation of atrial fibrillation?: Association with the left atrial‐pulmonary vein voltage and wall thickness

Where is the gap after a 90 W/4 s very-high-power short-duration ablation of atrial fibrillation?: Association with the left atrial-pulmonary vein voltage and wall thickness.

Although pulmonary vein isolation (PVI) for atrial fibrillation (AF) utilizing radiofrequency (RF) applications with a very high-power and short-duration (vHPSD) has shortened the procedure time, the determinants of pulmonary vein (PV) gaps in the first-pass PVI and acute PV reconnections are unclear. An extensive encircling PVI was performed with the QDOT MICRO catheter with a vHPSD (90 W-4 s) in 30 patients with AF (19 men, 64 ± 10 years). The association of the PV gap sites (first-pass PVI failure, acute PV reconnections [spontaneous reconnections or dormant conduction provoked by adenosine triphosphate] or both) with the left atrial (LA) wall thickness and LA bipolar voltage on the PVI line and ablation-related parameters were assessed. PV gaps were observed in 29 (6%) of 480 segments (16 segments per patient) in 17 patients (56%). The PV gaps were associated with the LA wall thickness, bipolar voltage, and the number of RF points (LA wall thickness, 2.5 ± 0.5 vs. 1.9 ± 0.4 mm, p < .001; bipolar voltage, 2.59 ± 1.62 vs. 1.34 ± 1.14 mV, p < .001; RF points, 6 ± 2 vs. 4 ± 2, p = .008) but were not with the other ablation-related parameters. Receiver operating characteristic curves yielded that an LA wall thickness ≥2.3 mm and bipolar voltage ≥2.40 mV were determinants of PV gaps with an area under the curve of 0.82 and 0.73, respectively. The LA voltage and wall thickness on the PV-encircling ablation line were highly associated with PV gaps using the 90 W/4 s-vHPSD ablation.

Common femoral vein wall thickness measurement by Doppler ultrasonography is an accurate diagnostic test for Behçet's Disease both in supine and standing positions.

We recently reported the first controlled Doppler ultrasonography (US) study demonstrating increased common femoral vein (CFV) thickness in Behçet's Disease (BD). Standard lower extremity venous Doppler US is performed in erect position. In order to confirm accuracy and applicability of method, we measured CFV thickness in both supine and standing positions in this study. We included sex and age-matched 42 BD patients and 41 healthy controls (HCs). After routine visits, bilateral CFV thickness was measured with Doppler US both in supine and standing positions. Bilateral CFV thickness was significantly higher in BD than in HC. There were no statistically significant differences in measurements of CFV wall thickness between standing and supine positions in both groups. CFV measurement by Doppler US is a new and non-invasive diagnostic tool for the diagnosis of BD. Our study confirmed that patient position does not affect CFV wall thickness measurement for diagnosis of BD.

Increased inferior vena cava wall thickness as a sign of extensive venous inflammation in Behçet's Disease.

Behçet's disease (BD) affects both arterial and venous vessels. We have previously shown that common femoral vein wall thickness (WT) is increased in BD and can be used as a diagnostic test. However, there is limited data assessing large veins. Therefore, this study seeks to assess inferior vena cava wall thickness (IVC) by transthoracic echocardiography (TTE) in BD compared to healthy controls (HC). Age- and gender-matched 70 BD patients and 51 HC were included. IVC wall thickness and common femoral vein WT were measured by TTE and Doppler ultrasonography, respectively. All examinations were performed on the same day as the clinical assessment. The mean IVC wall thickness of BD patients was significantly higher than HC (2.9mm (0.3) vs 2.6mm (0.3), p < 0.001). Patients with mucocutaneous involvement (2.8mm (0.3)) and major organ involvement (2.9mm (0.3)) had significantly thicker walls compared to HC (p = 0.003, p < 0.001, respectively). IVC wall thickness was higher in patients with vascular involvement compared to those with nonvascular major organ involvement (3.1mm (0.3) vs 2.8mm (0.2), p = 0.04). There was a moderate correlation between IVC and common femoral vein WT (r = 0.49 for the right, r = 0.43 for the left, p = 0.01 for both). This study shows that venous wall inflammation is not limited to lower extremity veins and is also present in IVC walls of BD patients regardless of IVC involvement. Vascular wall inflammation is probably a widespread vascular event of all venous walls in BD. Key Points • Venous wall inflammation is not limited to lower extremity veins and is present also in IVC wall in Behçet's disease. • Extensive venous wall inflammation in Behçet's disease includes large venous structures despite not being clinically involved.

Vein wall thickness and severity of pulmonary involvement due to sars n-cov2 virus infection

BackgroundAn observational study involving patients recovered from COVID-19 was conducted in order to evaluate the presence/absence of vein wall thickness increasing, according to the severity of pulmonary involvement quantified with a CT-scoring system.MethodsThe venous wall thickness (VWT) of 31 patients (23 males and 8 females) with COVID 19 previously admitted to Federico II University Hospital of Naples was evaluated through ultrasound measurement of the common femoral Vein 1 cm proximal to the saphenous-femoral junction and the popliteal Vein 1 cm distal to the confluence of gemellary veins. Measurements were taken with an automated tool to avoid human error. All patients were evaluated in the supine position. Patients were then stratified into two groups, VWT > 1 mm and VWT < 1 mm. Lung damage was assessed through thoracic High Resolution Computer Tomography and subsequently quantified using the scoring system set out by Chung et al. CEAP-C class was calculated for all patients.ResultsThe mean value of COVID score in VWT > 1 mm group was 7.4 (S.D. 4.83), whilst the mean value of the COVID score in the VWT < 1 mm group was 3.82 (S.D 3.34). These findings were determined to be statistically significant in a two-tie Student-T test. The linear regression test between VWT and Covid score values demonstrated a direct relationship between the two variables.ConclusionThese results demonstrate a link between two different aspects of the pathological effects on the vessels during a SARS-COV 2 infection. As such a common primum movens can be hypothesized in both micro-thrombotic and inflammatory processes relating to COVID 19.

A semantic segmentation method to analyze retinal vascular parameters of diabetic nephropathy.

By using spectral domain optical coherence tomography (SD-OCT) to measure retinal blood vessels. The correlation between the changes of retinal vascular structure and the degree of diabetic nephropathy is analyzed with a full-pixel Semantic segmentation method. A total of 120 patients with diabetic nephropathy who were treated in the nephrology department of Quzhou People's Hospital from March 2023 to March 2024 were selected and divided into three groups according to the urinary albumin creatinine ratio (UACR). The groups included simple diabetes group (UACR < 30 mg/g), microalbuminuria group (30 mg/g ≤ UACR <300 mg/g) and macroalbuminuria group (UACR ≥300 mg/g). SD-OCT was used to scan the arteries and veins in the superior temporal area B of the retina. The semantic segmentation method built into the SD-eye software was used to automatically identify the morphology and structure of the vessels and calculate the parameters of arteriovenous vessels. The parameters of arteriovenous vessels are as follows: outer diameter of the retinal artery (RAOD); inner diameter of the retinal artery (RALD); arterial wall thickness (AWT); arterial wall to lumen ratio (AWLR); cross sectional area of arterial wall (AWCSA); retinal vein outer diameter (RVOD); retinal vein inner diameter (RVLD); vein wall thickness (VWT); vein wall to lumen ratio (VWLR); cross sectional area of vein wall (VWCSA). Statistical analysis software was used to compare and analyze the parameters of retinal arteriovenous vessels of the three groups. The study revealed statistically significant differences in RAOD and RALD among the three groups (p < 0.05) with the RAOD and RALD of the macroalbuminuria group and microalbuminuria group being lower than those of the simple diabetes group. Conversely, there were no significant differences in AWT, AWLR and AWCSA among the three groups (p > 0.05). Additionally, the differences in RVOD and RVLD among the three groups were found to be statistically significant (p < 0.05) with the RVOD and RVLD of the simple diabetes group being lower than those of the microalbuminuria group and macroalbuminuria group. No significant differences were observed in VWT and VWL among the groups. Additionally, RVOD and RVLD were weakly associated with UACR (R = 0.247, p = 0.007; R = 0.210, p = 0.021). Full-pixel semantic segmentation method combined with OCT images is a new retinal vascular scanning technology, which can be used as a new method for early diagnosis of diabetic nephropathy. The structural changes of retinal vessels can be used to predict the severity of diabetic nephropathy during the development of diabetic nephropathy.

Morphologic characteristics of painful varicose veins in women: possible role of disordered collagen and endothelial cells

ObjectiveThis study examines to what extent vein wall thickness, collagen arrangements, muscular layers distribution, immunohistochemical presentation of endothelial cell arrangement, and adventitia layer placement differed in patients with small painful veins vs large painful symptomatic varicose veins (VVs). MethodsThis study was conducted from June 2022 to September 2022 at Valley Vein Health Center, a rural phlebology outpatient clinic. Ten samples from each of the three subjects were collected (n = 3): five were small symptomatic veins, and five were large symptomatic veins. All tissue blocks were cut transversely, perpendicular to the vessel axis, into 5-μm-thick sections. Three stains were chosen: Masson trichrome, hematoxylin and eosin, and a cluster of differentiation 31 (CD31). Statistical analysis was performed with the GraphPad statistical program. Comparisons between vein wall thicknesses were made using Student’s t test. ResultsThe average thickness of small veins was less than that of large veins (426 μm ± 26.1 μm vs 480 μm ± 19.2 μm, respectively; P < .001). Histologic and immunohistochemical (CD31) analysis of small symptomatic VVs by hematoxylin and eosin and trichrome stain showed an endothelial layer overlying the media, mostly of elastic tissue fibers, and smooth muscle bundles. CD31 expression analysis demonstrated more endothelial channels in the tunica media of the enlarged veins compared with smaller vessels. The larger vein’s microscopic structure was variable with irregular collagen arrangement, clumped elastin layer appearance, feathered muscular layer distribution, and thickened adventitia layer placement. ConclusionsThe morphological distinctions in VVs highlighted in this study need to be considered to develop potential drug therapies tailored to women.

Size adjustment suture technique for lymphaticovenular anastomosis.

In this report, we describe a super microsurgical technique that enables rapid and accurate anastomosis while adjusting for caliber differences when anastomosing a small-caliber lymphatic vessel and a vein with a larger caliber, which is frequently encountered in surgeries such as lymphaticovenous anastomosis (LVA). The suture size adjustment technique was performed in 30 anastomoses of lymphatic vessels and veins, whose diameter of lymph duct was at least two times smaller than that of the vein. The type of lymphedema, caliber of lymphatic vessels and veins anastomosed, caliber ratio, vein wall thickness, modified caliber ratio after vein wall thickness subtracted, presence of additional anastomosis, and anastomosis time were examined. On average, the lymphatic vessels had a diameter of 0.61 mm, while the veins were 1.43mm in diameter. The mean caliber ratio of vein to lymphatic vessel was 2.3, while the modified caliber ratio of vein-to-lymphatic vessel was 1.5 on average. The average venous wall thickness was 0.51. The average anastomosis time was 9.1min and no additional anastomosis due to leakage was necessary in any case. We successfully performed an anastomosis of lymphatic vessels and veins with different calibers, which can maintain long-term patency while adjusting the caliber difference and suppressing leakage at the anastomosis site. Finally, the caliber of the vein is commonly larger than that of the lymphatic vessel to be anastomosed in many cases of LVA surgery, indicating that the proposed anastomosis method could be of therapeutic use in many cases.

Common femoral vein wall thickness measurement as a diagnostic test in suspected Behçet's disease.

Common femoral vein wall thickness measurement as a diagnostic test in suspected Behçet's disease.

Intima-media thickness of common femoral vein is increased in Behçet's disease

The histopathological data about vascular inflammation in Behçet's disease(BD) mainly comprises patients with arterial involvement. Inflammatory cell infiltration was mainly observed around the vasa vasorum and adventitial layer of the aneurysmatic vessels, and only a few cells were seen in the intimal layer during active arteritis. There is limited data for the histopathology of venous inflammation. We recently showed that increased common femoral vein(CFV) wall thickness is a specific sign of vein wall inflammation in BD. We aimed to investigate the different vein subsections measuring the whole wall and the intima-media thickness(IMT) of CFV with ultrasonography in BD. We found increased IMT of CFV compared to controls as well as CFV wall thickness. This study shows that there is a full layer venous wall inflammation in BD independent of vascular involvement. Our results suggest that venous endothelial inflammation may trigger the thickening of the vein wall and cause thrombotic tendency in BD.

A Comparison of the Human Umbilical Cord's Histomorphometric and Histological Structure in Pregnant Diabetic and Non-Diabetic Women

This study aimed to explore the histomorphometrical and histopathological alterations of umbilical cord (UC) vessels caused by gestational diabetes mellitus (GDM) and pre-gestational diabetes mellitus (PGDM). A total of thirty UC samples were obtained from full term pregnant women without any complications. Ten out of thirty UCs were obtained from non-diabetic pregnant women (normal group), 10 from GDM and 10 from PGDM pregnant women. Segments from the placental attachment, center and fetal side of UCs were taken for each group. These segments were processed for paraffin blocks, sectioned, and stained with H&amp;E, Masson trichrome (MT) and Periodic Acid Shift (PAS). The results of the histomorphometric study showed no significant differences in the UC mean weight among these three groups. In three different segments, GDM resulted in a significant decrease in artery and vein wall thickness compared to the control group. GDM and PGDM resulted in a non-significant difference in the diameter of artery and vein in fetal segment, the vein in placental segment, and artery in the central segment compared with normal. All the UCs in the three groups contained two arteries and one vein but only one cord recorded in the GDM group contained one artery and one vein. Histological study of diabetic UC segments showed extravasation of blood, artery discordance, degeneration of Warton’s jelly (WJ) fibers with formation of honeycomb like empty spaces, formation of multiple spaces between smooth muscle cells of tunica media and detachment of the umbilical arteries from surrounding WJ. In both diabetic groups, there was a marked decrease in collagen fibers in tunica intima and media with their irregular arrangement in both arteries and vein especially in placental segment. The results also showed there was a rich carbohydrate content in the intima and media in all three groups. In conclusion, the current results proved that GDM and PGDM have an adverse effect on the structure of UC and its vessels. Keywords: Umbilical cord; Diabetes mellitus; Histological study; Special stains; Blood vessels DOI: 10.7176/JBAH/13-6-04 Publication date: April 30 th 2023

Ultrasound assessment is linked to histological vein wall thickness in chronic venous disease.

Few studies compared both ultrasound and histological approaches for the same series of patients with chronic venous disease (CVD). We aimed to assess the diagnostic performances of duplex ultrasound assessment (US) of Vein Wall Thickness (VWT) among patients with CVD. 38 adults with primary varicose veins having undergone Great Saphenous Vein thermal ablation with phlebectomy, and agreeing to biopsy of the Posterior Accessory Great Saphenous Vein (PASV) were consecutively included in a two-center prospective study. VWT assessment of the PASV was performed using both US, and microscope examination. High values for microscope-assessed VWT were defined at > 0.5mm. The mean age was 53.0 ± 13.1years, 71% were women. Maximization of US performances was obtained with a threshold of 0.6mm: Sensitivity (Se) = 92.9%, Specificity (Sp) = 91.7%, positive (86.7%) and negative predictive value (NPV) (95.7%), positive (11.1) and negative likelihood ratio (NLR) (0.07). US assessment of VWT could be a non-invasive tool for diagnosis and follow-up in CVD, and an interesting in vivo parameter complementing diameter and reflux measures, with a view to optimizing treatment. It could help to determine i) the energy level necessary in case of endovenous laser ablation, and ii) the sclerosing agent concentration in case of chemical ablation.

AB0639 Common Femoral Vein Thickness Measurement as a diagnostic test in Incomplete Behçet’s Disease

BackgroundBehçet's disease (BD) is characterized by recurrent oral and/or genital aphthous ulcers accompanied by cutaneous, ocular, articular, gastrointestinal and central nervous system lesions. Diagnosing BD can be a clinical challenge in patients presenting with a limited number of organ manifestations, especially with single major organ involvement. We reported the first controlled doppler ultrasound study showing increased common femoral vein (CFV) thickness in BD (1). We recently also showed that increased CFV thickness is a distinctive feature of BD, rarely present in other inflammatory or vascular diseases such as ankylosing spondylitis, systemic vasculitides, venous insufficiency, and non-inflammatory DVT with a specificity higher than 80% for the cut-off value of ≥ 0.5 mm. We suggest that CFV thickness measurement is an easy, non-invasive diagnostic test for BD (2).ObjectivesIn this study, we aimed to assess the diagnostic performance of CFV thickness measurement in patients with ‘Incomplete’ Behçet’s Disease diagnosed by expert opinion.MethodsWe included 28 patients with incomplete BD (15 male, 12 female) diagnosed with expert opinion and followed in the Marmara University Behcet’s Clinic. Demographic, clinical characteristics and treatment data were recorded during routine visits. Common femoral vein wall thickness was measured by an experienced radiologist at the same day.ResultsMedian age was 34.3 years and median disease duration 2 years (0-16). Four patients were newly diagnosed. At follow-up onset, oral ulcers were present in 22 (78.6%), genital ulcers in 6 (21.6%), papulopustular lesions in 4 (14.3%) and pathergy positivity in 5 (17.9%) patients. Ten (35.7%) patients had familial BD. While 24 (85.7%) patients had major organ involvement, 4 (14.3%) patients had mucocutaneous disease. Distrubution of major organ involvements were given in Figure 1.Figure 1.Distribution of major organ involvements (n) in study groupAll patients except 1, had CFV thickness value above the cut-off value of ≥0.5 mm. Right CFV thickness was 0.71 (0.3-1.3) mm and left CFV thickness 0.72 (0.4-1.2) mm. Bilateral femoral vein thicknesses were similar in patients with and without an history of familial BD.ConclusionDiagnosing BD can be challenging in patients presenting with one major organ involvement such as oral ulcers and posterior uveitis, brain-stem disease or arterial aneurysms, especially in countries with a low prevalence. These patients are generally diagnosed as ‘incomplete’ BD by ‘expert opinion’. Early diagnosis is of utmost importance in some of these cases, especially with venous thrombosis as their management differs from non-inflammatory venous thrombosis, necessitating immunosuppressive use rather than anticoagulant therapy. Our results show that CFV thickness measurement with Doppler US, a non-invasive, fast and cost-effective radiological modality, is a valuable diagnostic test in incomplete BD, especially with major organ involvement.

Microcirculation in fractures of long bones of the lower extremity

The study objective was to investigate soft tissue microcirculation in the area of a lower limb long bone fracture. We studied fractures of the lower limb long bones from 0 to 7 days of age in 17 males and 37 females. The mean age of patients was 57.33±2.53 years. Histological examination of soft tissues from the area of the lower limb long bone fracture and at the distance from the fracture was performed. Standard hematoxylin and eosin staining was used. The thickness and diameter of arterioles, venules, and capillaries were evaluated by morphometry of the sections made. The observed pattern reflects the response of the microcirculation of the soft tissues to the mechanical impact. The relative ratio of the artery diameter to the small-caliber vein diameter was 1.01±0.13, and the artery wall thickness to the vein wall thickness was 2.03±0.28, which can be considered a natural reaction of the microcirculation blood vessels to the mechanical impact in 1-1.5 weeks after the formed fracture of the lower limb long bone.

Phenotypic Characterization of CD4+ T Lymphocytes in Periportal Fibrosis Secondary to Schistosomiasis.

Schistosomiasis is a parasitic disease that affects about 166 million people around the world. It is estimated that 5%–10% of individuals with schistosomiasis develop severe forms of the disease, which are characterized by pulmonary hypertension, ascites, periportal fibrosis, and other significant complications. The chronic phase of the disease is associated with a Th2 type immune response, but evidence also suggests there are roles for Th1 and Th17 in the development of severe disease. The aim of this study was to evaluate the CD4+ T lymphocyte profile of patients with different degrees of periportal fibrosis secondary to schistosomiasis. These individuals had been treated for schistosomiasis, but since they live in a S. mansoni endemic area, they are at risk of reinfection. They were evaluated in relation to the degree of periportal fibrosis and classified into three groups: without fibrosis or with incipient fibrosis (WF/IFNE), n=12, possible periportal fibrosis/periportal fibrosis, n=13, and advanced periportal fibrosis/advanced periportal fibrosis with portal hypertension, n=4. We observed in the group without fibrosis a balance between the low expression of Th2 cytokines and high expression of T reg cells. As has already been described in the literature, we found an increase of the Th2 cytokines IL-4, IL-5, and IL-13 in the group with periportal fibrosis. In addition, this group showed higher expression of IL-17 and IL-10 but lower IL-10/IL-13 ratio than patients in the WF/IFNE group. Cells from individuals who present any level of fibrosis expressed more TGF-β compared to the WF/IFNE group and a positive correlation with left lobe enlargement and portal vein wall thickness. There was a negative correlation between IL-17 and the thickness of the portal vein wall, but more studies are necessary in order to explore the possible protective role of this cytokine. Despite the fibrosis group having presented a higher expression of pro-fibrotic molecules compared to WF/IFNE patients, it seems there is a regulation through IL-10 and T reg cells that is able to maintain the low morbidity of this group.