Velocity Index Research Articles

Endogenous thrombin potential and time-dependent thrombin generation parameters are independent risk factors for mortality in the general population

BackgroundThrombin generation (TG) is used as a global test of coagulation and is an indicator of thrombosis and bleeding risk. Until now, data on the association of TG and mortality are inconclusive. ObjectivesWe investigated the association between TG and mortality in the prospective Moli-sani cohort (n = 21 920). MethodsTG was measured using calibrated automated thrombinography using PPP-Reagent Low. Lag time (LT), endogenous thrombin potential (ETP), peak height, time-to-peak (TTP), and velocity index were quantified. The association of TG and mortality was studied by Cox regression and adjusted for sex, age, body mass index, smoking, contraceptives, and medical history (cardiovascular diseases, hypertension, hypercholesterolemia, diabetes, and cancer). ResultsLT and TTP were 4.1 ± 1.0 minutes and 6.6 ± 1.5 minutes, on average. The peak height was 364 ± 88 nM, velocity index was 163 ± 63 nM/min, and ETP was 1721 ± 411 nM·min. ETP was negatively associated with all-cause mortality (hazard ratio [HR], 0.86; 95% CI, 0.81-0.92; P < .001). Subjects in the lowest quintile of the ETP (ETPQ1) had a 1.3-fold higher mortality rate. Additionally, a high TTP/LT ratio was negatively associated with mortality (HR, 0.71; 95% CI, 0.57-0.89; P = .003). Individuals in quintile 1 of the TTP/LT ratio had a 1.4-fold higher mortality rate compared with the remainder of the cohort. Subjects that were both in ETPQ1 and TTP/LTQ1 had a 1.8-fold higher mortality rate, regardless of whether they reported history of cardiovascular disease at baseline (HR, 1.61 [CI: 1.07-2.42]) or not (HR, 1.89 [CI: 1.51-2.36]). ConclusionLow ETP and TTP/LT ratios are independent risk factors for all-cause mortality in the general population.

Quantitative evaluation of ocular vascularity and correlation analysis in patients with diabetic retinopathy by SMI and OCTA

AimsTo find potential relation between retrobulbar vessels and fundus microvessels and to detect sensitive and effective clinical indicators in predicting the progress of diabetic retinopathy (DR), ocular hemodynamics were measured using superb microvascular imaging (SMI) and ultrawide-field optical coherence tomography angiography (UWF-OCTA).MethodsObservational, cross-sectional study evaluating ocular hemodynamics in patients with DR by SMI (Aplio i900, Canon Medical) and UWF-OCTA (BM-400 K BMizar, Tupai Medical Technology). The peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) of the central retinal artery (CRA), posterior ciliary artery (PCA), and ophthalmic artery (OA) were measured by SMI. UWF-OCTA evaluated the fundus vascular parameters. A correlation analysis was used to determine the correlation between SMI and UWF-OCTA parameters.ResultsOne hundred thirty-nine eyes of 139 diabetic patients were included: 29 without DR (NDR), 36 with mild to moderate nonproliferative DR (M-NPDR), 37 with severe NPDR (S-NPDR), and 37 with proliferative DR (PDR). PSV and EDV of retrobulbar vessels decreased from NDR to S-NPDR while increasing PDR. RI of OA showed a decreasing trend in the progression of DR, but other vessels didn’t show the same trend. ROC curve analysis showed that CRAPSV, CRAEDV, PCAEDV, OAPSV, and OAEDV had diagnostic value distinguishing M-NPDR and S-NPDR. The correlation analysis observed a significant association between the SMI parameters of CRA and PCA and UWF-OCTA parameters. CRA hemodynamics were more associated with fundus vascular parameters, especially the retina, in the NDR group than in the M-NPDR group. In contrast, PCA consistently correlated with fundus vascular parameters, especially in the choroid, from the NDR to the M-NPDR group. However, OA showed a poor correlation with OCTA parameters.ConclusionThe velocity of retrobulbar vessels, mainly the CRA, may serve as a valuable predictor for assessing the progress of DR. The use of SMI in diabetic patients may help identify patients at risk of developing retinopathy.

Correlation between Morphological and Hemodynamic Parameters of Carotid Arteries and Cerebral Vasomotor Reactivity.

The function of cerebral small vessels can be assessed using cerebral vasomotor reactivity (VMR). Our aim in this retrospective cross-sectional study was to investigate a correlation between carotid artery stenosis measured through ultrasonographic morphological and hemodynamic parameters and cerebral VMR. A total of 285 patients (125 males; mean age 54) were included. The breath-holding index (BHI) was used to evaluate cerebral VMR. Ultrasonographic carotid artery parameters were collected: the presence and characteristics of carotid plaques, the degree of carotid diameter stenosis, intima-media thickness (IMT), peak systolic velocity (PSV), and end diastolic velocity (EDV). Additionally, hemodynamic parameters of the middle cerebral artery (MCA) were evaluated, including the mean flow velocity (MFV) and pulsatility index (PI). The following was collected from patients' medical histories: age, gender, and vascular risk factors. A negative correlation between the BHI and age (r = -0.242, p < 0.01), BHI and the presence of carotid plaques, BHI and IMT (r = -0.203, p < 0.01), and BHI and the PI of MCA on both sides (r = -0.268, p < 0.01) was found. We found a positive correlation between the BHI in the left MCA and EDV in the left internal carotid artery (r = 0.121, p < 0.05). This study shows the correlation between cerebral VMR and carotid stenosis but indicates a higher influence of morphological parameters on VMR values.

(234) How Age and Obesity Influence Erectile Dysfunction: Evaluation Based Upon Penile Color Duplex Doppler Ultrasound

Abstract Introduction Color duplex Doppler ultrasound (CDDU) is an objective and reliable diagnostic tool for documenting penile hemodynamics. Objective vascular testing provides a physiologic diagnosis of erectile dysfunction (ED) and helps direct appropriate therapy even in this age of ED management including oral drugs. Although age and diabetes are known to be the major etiological factors in development of ED, it is not clear whether obesity as such also plays any role or not. Objective The main objective of this study is to retrospectively assess the penile CDDU hemodynamic parameters of obese men with ED in comparison to non-obese ED men in relation to age. Methods A total of 271 men including obese and non-obese who were diagnosed with ED visiting our Andrology clinic were included in this study. Initial ED was determined by using the International Index of Erectile Function (IIEF) score. Penile CDDU data was retrospectively collected from these ED patients, and parameters mainly peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI) were used for analysis. RI (=PSV-EDV/PSV) was calculated, and different types of penile vascular status were established based on our previously published SOP guidelines for standardization of penile CDDU parameters. Statistical analysis was performed using MedCalc statistical software version 22.009 (MedCalc Software bv, Ostend, Belgium). Results Our study results revealed that with advancement of age the occurrence of vascular changes in obese men were higher in comparison to non-obese men with ED. Table 1 summarizes the influence of obesity on the prevalence of penile vascular status in different age groups of obese and non-obese men with ED. Surprisingly, higher number of obese men showed non-vascular, venous and mixed vascular components compared to non-obese ED patients. Among these obese groups of all ages, the venous leakage was prevalent than arterial or mixed components. Conclusions Our current analysis indicates that besides age, obesity is also one of the major risk factors in altering the penile hemodynamics with increased incidence of veno-occlusive dysfunction (VOD) in ED patients. In addition, this demonstrates the utility of performing CDDU and diagnosing the presence of VOD in further understanding the pathophysiology of obesity associated ED, and an important determining factor in such patient care. Disclosure No.

Dependence of local carotid arterial stiffness on the presence of atherosclerotic plaque in the carotid basin in hypertensive patients

Aim. To evaluate the viscoelastic properties of the common carotid arteries (CCA) in patients with stage II hypertension (HTN) and to compare these indicators between groups with and without carotid artery (CA) stenosis &lt;50 %. Materials and methods. The study included 48 patients with stage II HTN, mean age – 55.9 years, 45.8 % men. Basic anthropometric data, laboratory parameters of lipid and carbohydrate metabolism, creatinine, quality intima-media thickness (QIMT), local stiffness indicators: artery diameter, distensibility, distensibility coefficient (DC), compliance coefficient (CC), stiffness indices α, β, local pulse wave velocity (PWV), pressure and augmentation index (using RF-QIMT, RF-QAS technologies) were studied. Statistical analysis was performed, p values of &lt; 0.05 were considered statistically significant. Results. CA atheromas with stenosis up to 50 % were found in 48 % of the examined, they were older with higher parameters of vessel diameter by 4.6 %, QIMT – by 12.5 %, α index – by 28.0 %, β index – by 27.7 %, and PWV – by 14.7 %. A medium-strength positive correlation has been revealed for age, QIMT, HDL, creatinine level and local stiffness parameters (distensibility, CC, PWV, indices α, β). The atherosclerotic plaque (ASP) presence in the CA was associated with the limit levels of the left CCA QIMT over 698 μm (sensitivity 65.2 %, specificity 86.6 %, p &lt; 0.01), of the right – over 598 μm (sensitivity 73.9 %, specificity 66.6 %, p &lt; 0.01). However, a greater dependence on age than on the presence of atheroma has been proven. At the same time, the odds ratio of the ASP presence was 2.99-fold higher (p = 0.0065) with an increase in the CCA diameter of more than 7.94 mm, and in the multivariate model incorporating age – 2.6-fold higher (p = 0.036), while age has not impacted significantly (p = 0.301) the prognosis. Conclusions. In individuals with stage II HTN, the presence of CA atherosclerosis with stenosis up to 50 % is associated with a significant increase in vessel diameter regardless of age. CCA intima media thickness depends more on the age of hypertensive patients.

Cold stimulation of the oral cavity redistributes blood towards the brain in healthy volunteers.

The aim of this study was to analyze cold stimulation-induced changes in cerebral and cardiac hemodynamics. Upon ingestion of an ice cube, the changes in resistance index, mean flow velocity and flow index of the middle cerebral arteries (MCA) were assessed using transcranial Doppler sonography. Extracranial duplex sonography was used to measure the mean flow velocity and resistance index of the right internal carotid artery (ICA). The change in mean arterial pressure, heart rate, root mean square of successive differences (RMSSD) and end-tidal carbon dioxide pressure were analyzed additionally. These changes were compared to sham stimulation. Compared with sham stimulation, cooling of the oral cavity resulted in significant changes in cerebral and cardiac hemodynamics. The cold stimulation decreased the resistance index in the MCA (-4.5% ± 5.4%, p < 0.0001) and right ICA (-6.3% ± 15.6%, p = 0.001). This was accompanied by an increase in mean flow velocity (4.1% ± 8.0%, p < 0.0001) and flow index (10.1% ± 43.6%, p = 0.008) in the MCA. The cardiac effects caused an increase in mean arterial pressure (1.8% ± 11.2%, p = 0.017) and RMSSD (55% ± 112%, p = 0.048), while simultaneously decreasing the heart rate (-4.3% ± 9.6%, p = 0.0001). Cooling of the oral cavity resulted in substantial changes in cerebral and cardiac hemodynamics resulting in a blood flow diversion to the brain.

Predictive Value of Quantitative Electroencephalogram Combined with Transcranial Doppler Ultrasound in Delayed Cerebral Ischemia after Subarachnoid Hemorrhage

ObjectiveTo explore the predictive value of transcranial Doppler ultrasound (TCD) combined with quantitative electroencephalogram (QEEG) in delayed cerebral ischemia (DCI) caused by aneurysmal subarachnoid hemorrhage (aSAH). MethodsThe subjects were 105 patients with aSAH from June 2020 to December 2022. Patients were divided into DCI group (n=34) and non-DCI group (n=71) according to the presence of DCI 14d after onset. Further comparison was conducted on the baseline data as well as the parameters of QEEG and TCD within 24h after admission. Multivariate logistic analysis was performed to investigate risk factors related to DCI within 14 days of admission in aSAH patients. ResultsThere were significant differences in the comparison of the proportion of Hunt-Hess grading, relative δ power (RDP), relative α power (RAP), relative α/β power ratio (ADR), as well as peak systolic velocity (Vs), mean blood flow velocity (MBFV) and pulsatility index (PI) of middle cerebral artery between the two groups (P<0.05). Furthermore, Logistic regression analysis revealed that ADR [OR=1.668, 95%CI (1.369, 4.345)] and MBFV of middle cerebral artery [OR=3.279, 95%CI (2.332, 6.720)] were risk factors for the occurrence of DCI in aSAH patients (P<0.05). In addition, evaluation of the predictive value revealed that combined use of the two indicators showed the highest predictive value (AUC: 0.959, 95%CI: 0.896∼0.993). ConclusionPatients with aSAH complicated by DCI have relatively higher MBFV of middle cerebral artery and ADR. Combined use of the two indicators can provide reference for early prediction of DCI in aSAH patients.

Higher arterial stiffness and blunted vagal control of the heart in young women with compared to without a clinical diagnosis of PTSD.

Young women are typically thought to be protected from cardiovascular disease (CVD) before menopause. However, posttraumatic stress disorder (PTSD) increases CVD risk in women by up to threefold. Data in predominantly male cohorts point to physiological mechanisms such as vascular and autonomic derangements as contributing to increased CVD risk. The purpose of the study reported here was to determine whether young women diagnosed with PTSD, compared to those without, present with arterial stiffness and impaired autonomic control of the heart. A total of 73 healthy young women, ranging in age from 18 to 40years, with a history of trauma exposure were included in this study, 32 with and 41 without a clinical PTSD diagnosis. We measured resting pulse wave velocity (PWV), central hemodynamics, augmentation pressure and augmentation index (AI) via pulse wave analysis using applanation tonometry. Heart rate variability was also assessed via peripheral arterial tone. In comparison to controls, women with PTSD showed higher central arterial pressure (mean ± standard deviation: systolic blood pressure 104 ± 8 vs. 97 ± 8mmHg, p < 0.001; diastolic blood pressure 72 ± 7 vs. 67 ± 7mmHg, p = 0.003), PWV (6 ± 0.3 vs. 5 ± 0.6m/s, p < 0.001) and AI (22 ± 13 vs. 15 ± 12%, p = 0.007) but lower standard deviation of normal-to-normal intervals (SDNN; 44 ± 17 vs. 54 ± 18ms, p = 0.005) and root mean square of successive differences between normal heartbeats (RMSSD; 37 ± 17 vs. 51 ± 22ms, p = 0.002). PTSD in young women is associated with higher brachial and central pressures, increased arterial stiffness and blunted parasympathetic control of the heart. These findings illustrate potential mechanisms underlying high risk for CVD in young women with PTSD, suggesting possible treatment targets for this at-risk group.

Assessment of transcranial Doppler indices after MgSO4 administration in severe preeclamptic women with neurologic symptoms.

To investigate the effect of intravenous MgSO4 on maternal cerebral hemodynamics as well as the association between altered Doppler indices of the ophthalmic arteries and ocular lesions in patients with preeclampsia. After each of the 15 included patients was diagnosed with preeclampsia, MgSO4 was infused followed by transcranial Doppler tests of the indices of the ophthalmic, anterior, middle, posterior cerebral, vertebral, and basilar arteries, followed by a second MgSO4 infusion. The peak, mean, diastolic velocity, and pulsatile and resistance indices of each artery were automatically measured during testing. Based on the emergent data, the cerebral perfusion pressure, resistance-area product, and cerebral flow index were calculated. The cerebral perfusion pressure of the posterior cerebral arteries significantly decreased following the infusion of MgSO4 (p < 0.05). Before the infusion of MgSO4, cerebral perfusion pressure and cerebral flow index of the ophthalmic arteries were significantly increased (p < 0.05) in the preeclamptic pregnant patients with ocular lesions compared those without ocular lesions. After the infusion of MgSO4, the cerebral perfusion pressure and cerebral flow index of both ophthalmic arteries were slightly decreased, but the difference was not significant. Altered Doppler indices following the infusion of MgSO4 suggest significant changes in the hemodynamics of the posterior cerebral and ophthalmic arteries that are particularly related to the neurological signs and symptoms of women with preeclampsia. These findings may improve the understanding of the mechanism of the cerebral complications of preeclampsia. Advancing comprehension of these underlying mechanisms is postulated to play a pivotal role in the mitigation of hypertensive encephalopathy associated with preeclampsia.

Fusiform versus Saccular Intracranial Aneurysms-Hemodynamic Evaluation of the Pre-Aneurysmal, Pathological, and Post-Interventional State.

Minimally-invasive therapies are well-established treatment methods for saccular intracranial aneurysms (SIAs). Knowledge concerning fusiform IAs (FIAs) is low, due to their wide and alternating lumen and their infrequent occurrence. However, FIAs carry risks like ischemia and thus require further in-depth investigation. Six patient-specific IAs, comprising three position-identical FIAs and SIAs, with the FIAs showing a non-typical FIA shape, were compared, respectively. For each model, a healthy counterpart and a treated version with a flow diverting stent were created. Eighteen time-dependent simulations were performed to analyze morphological and hemodynamic parameters focusing on the treatment effect (TE). The stent expansion is higher for FIAs than SIAs. For FIAs, the reduction in vorticity is higher (Δ35-75% case 2/3) and the reduction in the oscillatory velocity index is lower (Δ15-68% case 2/3). Velocity is reduced equally for FIAs and SIAs with a TE of 37-60% in FIAs and of 41-72% in SIAs. Time-averaged wall shear stress (TAWSS) is less reduced within FIAs than SIAs (Δ30-105%). Within this study, the positive TE of FDS deployed in FIAs is shown and a similarity in parameters found due to the non-typical FIA shape. Despite the higher stent expansion, velocity and vorticity are equally reduced compared to identically located SIAs.

Dynamics of ultrasound indicators of retrobulbar blood flow at different durations of type 1 diabetes mellitus in childhood and adolescence

The results of a study of the dynamics of ultrasound parameters of blood flow in the eye and orbit in patients with type 1 diabetes mellitus in childhood and adolescence are presented. The study included data from 70 patients aged 5 to 18 years, with disease duration up to 5 years, from 5 to 10 years, and more than 10 years. Ultrasound indicators of linear blood flow velocity and peripheral resistance index were analyzed in the ophthalmic arteries, central arteries and veins of the retina, posterior short ciliary arteries, and superior ophthalmic veins at different periods of the duration of type 1 diabetes mellitus. The study revealed a decrease in blood flow velocity in the central retinal arteries and in the posterior short ciliary arteries with increasing duration of type 1 diabetes. The greatest decrease in blood flow velocity was recorded in the group with a duration of diabetes mellitus of more than 10 years. The data obtained can be used to assess and dynamically monitor early disorders of the blood supply to the eye and orbit in patients with type 1 diabetes mellitus in childhood and adolescence.

The Heart's Function as a Pump Assessed via Impedance Cardiography and the Autonomic System Balance in Patients with Early-Stage Acromegaly.

Acromegaly is a rare, chronic disease that involves structural and functional abnormalities of the cardiovascular system. Acromegaly likely affects interactions between the cardiovascular system and the autonomic nervous system (ANS). Therefore, assessing the relationship between sympathetic-parasympathetic balance by analyzing heart rate variability (HRV) and the hemodynamic profile via impedance cardiography (ICG) may be useful in learning the exact nature of interactions between the ANS and the cardiovascular system. The purpose of this study was to assess a possible association between HRV and ICG-based parameters of cardiac function in patients newly diagnosed with acromegaly. This observational cohort study was conducted on 33 patients (18 men, mean age of 47 years) newly diagnosed with acromegaly and no significant comorbidities. A correlation analysis (Spearman's rank coefficient R) of the parameters assessed via ICG and the HRV assessed via 24 h ambulatory electrocardiography was performed. ICG assessments included the following parameters: stroke volume index (SI), cardiac index (CI), acceleration index (ACI), velocity index (VI), and Heather index (HI). The analysis of HRV included both time-domain parameters (pNN50, SDNN, SDSD, rMSSD) and frequency-domain parameters (total power (TP) and its individual frequency bands: low-frequency (LF day/night), high-frequency (HF day/night), and the LF/HF ratio (day/night)). Frequency-domain HRV analysis showed the following correlations: (1) lower nighttime LF values with higher ACI (R = -0.38; p = 0.027) and HI (R = -0.46; p = 0.007) values; (2) higher nighttime HF values with higher ACI (R = 0.39; p = 0.027) and HI (R = 0.43; p = 0.014) values; (3) lower nighttime LF/HF values with higher ACI (R = -0.36; p = 0.037) and HI (R = -0.42; p = 0.014) values; (4) higher nighttime TP values with higher SI values (R = 0.35; p = 0.049). Time-domain parameters of HRV showed a significant correlation only between the nighttime values of SDSD and SI (R = 0.35; p = 0.049) and between the daytime and nighttime values of SDNN and HR (R = -0.50; p = 0.003 and R = -0.35; p = 0.046). In multivariate regression, only ACI was revealed to be independently related to HRV. In patients newly diagnosed with acromegaly, the relationship between the sympathetic-parasympathetic balance assessed via HRV and the hemodynamic profile assessed via ICG was revealed. Better function of the left ventricle was associated with a parasympathetic shift in the autonomic balance.

Veloergometric Doppler study of brain blood circulation after balneological antler correction of vasomotor autoregulation

The aim of the study was to evaluate the change in veloergometry (VEM)-induced dynamic state of peak blood flow velocity (Vps) and resistance index (RI) in the middle cerebral artery after balneotherapy of arterial hypertension with Altai red deer antlers.Material and methods. A small cohort of patients (n = 48) with grade I–II arterial hypertension aged 56 [50–59] years (median [lower quartile-upper quartile]) was examined. In the course of the duplex research of middle cerebra artery Vps, RI in a prone position, sitting and during a bicycle exercise were registered.Results. In a prone position Vps was 100 [95–105] сm/s, RI – 0.62 [0.58–0.64]; on the cycle ergometer Vps decreased by 20 % and was 80 [77–85] сm/s. In the course of bicycle exercises of average intensity (60 W for women and 90 W for men), Vps increased by 45 %, to 115 [112–120] сm/s, RI increased to 0.73 [0.71–0.75]. On a maximum excise loading Vps reduced by 25 % up to 88 [86–92] сm/s, RI did not change. After antler balneotherapy Vps in a prone position decreased and was equal 87 [82–92] сm/s (p = 0.0001), it occurred due to the improvement of microcirculation confirmed by decrease in RI to 0.52 [0.5–0.53] (р = 0.0001). To a lesser extent there was also an orthostatic falling of Vps at these patients. In the course of bicycle exercises of average intensity, Vps was registered with higher amplitude (up to 60 %, 122 [120– 125] сm/s). On a maximum of bicycle exercise Vps decreased by 30 % of an average and was equal to 85 [82–86] сm/s.Conclusions. Veloergometric Doppler study of a blood-groove in a middle cerebra artery is a representative method for assessing the dynamic state of autoregulation and can be used for diagnostic audit of physical therapy. The antler balneotherapy of the Altai maral products makes positive impact on cerebral vasomotor function.

Severe aortic stenosis: secular trends of incidence and outcomes.

Severe aortic stenosis (AS) is the guideline-based indication for aortic valve replacement (AVR), which has markedly increased with transcatheter approaches, suggesting possible increasing AS incidence. However, reported secular trends of AS incidence remain contradictory and lack quantitative Doppler echocardiographic ascertainment. All adults residents in Olmsted County (MN, USA) diagnosed over 20 years (1997-2016) with incident severe AS (first diagnosis) based on quantitatively defined measures (aortic valve area ≤ 1 cm2, aortic valve area index ≤ 0.6 cm2/m2, mean gradient ≥ 40 mmHg, peak velocity ≥ 4 m/s, Doppler velocity index ≤ 0.25) were counted to define trends in incidence, presentation, treatment, and outcome. Incident severe AS was diagnosed in 1069 community residents. The incidence rate was 52.5 [49.4-55.8] per 100 000 patient-year, slightly higher in males vs. females and was almost unchanged after age and sex adjustment for the US population 53.8 [50.6-57.0] per 100 000 residents/year. Over 20 years, severe AS incidence remained stable (P = .2) but absolute burden of incident cases markedly increased (P = .0004) due to population growth. Incidence trend differed by sex, stable in men (incidence rate ratio 0.99, P = .7) but declining in women (incidence rate ratio 0.93, P = .02). Over the study, AS clinical characteristics remained remarkably stable and AVR performance grew and was more prompt (from 1.3 [0.1-3.3] years in 1997-2000 to 0.5 [0.2-2.1] years in 2013-16, P = .001) but undertreatment remained prominent (>40%). Early AVR was associated with survival benefit (adjusted hazard ratio 0.55 [0.42-0.71], P < .0001). Despite these improvements, overall mortality (3-month 8% and 3-year 36%), was swift, considerable and unabated (all P ≥ .4) throughout the study. Over 20 years, the population incidence of severe AS remained stable with increased absolute case burden related to population growth. Despite stable severe AS presentation, AVR performance grew notably, but while declining, undertreatment remained substantial and disease lethality did not yet decline. These population-based findings have important implications for improving AS management pathways.

Retinal neurovascular alteration in type 2 diabetes with renal impairment in association with systemic arterial stiffness

BackgroundDiabetic retinopathy (DR) patients should be alert for subclinical macroangiopathy. We aimed to investigate the association between retinal neurovascular alteration and systemic arterial stiffness in type 2 diabetes mellitus (type 2 DM) patients with varying degrees of renal impairment.MethodsThe study included 170 patients with confirmed diagnosis of type 2 DM aged ≥18 years old. Renal function was assessed by estimated glomerular filtration rate (eGFR). Arterial stiffness was measured by brachial-ankle pulse wave velocity (baPWV) and ankle brachial index (ABI). Retinal neurovascular parameters were derived from Optical Coherence Tomography (OCT)/OCT-Angiography, represented by vessel density (VD Central, Inner, Outer, Full), foveal avascular zone (FAZ area and FAZ perimeter) of the superficial capillary plexus, the average of macular ganglion cell-inner plexiform layer thickness (ave mGC-IPLt) and the average of retinal nerve fiber layer thickness (aveRNFLt). The association between variables among the groups (according to renal function, diabetic retinopathy (DR) severity, and arterial stiffness categories) were analyzed by regression analysis with multiple hypothesis testing commands.ResultsOut of the 265 eyes, the mean DM duration and HbA1c were 6.21 ± 6.37 years and 8.44 ± 2.06% respectively. While the mean of eGFR, baPWV and ABI were 66.78 ± 32.80 ml/min/1.73m2, 15.49 ± 3.07 m/s, and 1.05 ± 0.12, respectively. Patients with more severe renal impairment demonstrated longer DM duration (p < 0.001), higher baPWV (p < 0.0001), and retinal vascular alteration. Proliverative DR group showed the lowest eGFR (p < 0.0001), highest baPWV (p < 0.0001), and retinal neurovascular changes. Significantly lower eGFR and retinal vascular alteration were found in the baPWV > 14 group. Some neurovascular parameters were significantly negatively correlated with baPWV; moreover, retinal neurovascular changes were also noted in the abnormal ABI group.ConclusionsThe strong association between changes in the retinal neurovascular system, DR severity, renal impairment, and arterial stiffness in type 2 DM was confirmed. Patients with more severe renal impairment had higher levels of arterial stiffness, more severe DR and retinal neurovascular alteration. Retinal neurovascular changes seen in OCT/OCTA might mimic renal microvascular alteration and systemic arterial stiffness. Therefore, assessment of baPWV and OCT/OCTA should be integrated in DR screening to enhance cardiovascular risk stratification and prognosis as well as to provide clinically useful early identification of subclinical micro- and macrovascular alterations.

Temporal alteration in ovarian follicle fate with hormonal and hemodynamic perspectives during receptive phase of estrous cycle in endometritic cattle.

The present research was carried out to assess the serum progesterone (P4) concentration and uterine hemodynamics at estrus till ovulation in cyclic cows (N = 130) with healthy or diseased uterus. At estrus, 85 cows were diagnosed with clinical endometritis (CE; n = 44) and sub-clinical endometritis (SCE; n = 41); whereas, 45 cows being served as control namely no endometritis (NE; n = 45) were included in the study. Serum progesterone estimation at 12 - 14 and 40 hr after the onset of estrus and Doppler sonography of both middle uterine arteries were done to envisage the uterine hemodynamics and ovulation. The serum progesterone concentration was significantly higher at 12 - 14 hr after onset of estrus in CE and SCE cows. At 12 - 14 hr after onset of estrus, a cut-off value of ≥ 0.48 ng mL-1 P4 was obtained, above which 22.72% CE, 26.82% SCE and only 8.88% NE cows failed to ovulate within 36 - 40 hr of estrus onset. Among the Doppler indices, pulsatility and resistance indices were significantly higher; whereas, volume and velocity indices were significantly lower in NE cows. In cows diagnosed with CE and SCE, a higher supra-basal P4 concentration, and velocity and volume of blood flow to uterus at estrus negatively affected the duration to ovulation.

Mathematical expansion and clinical application of chronic kidney disease stage as vector field.

There are cases in which CKD progression is difficult to evaluate, because the changes in estimated glomerular filtration rate (eGFR) and proteinuria sometimes show opposite directions as CKD progresses. Indices and models that enable the easy and accurate risk prediction of end-stage-kidney disease (ESKD) are indispensable to CKD therapy. In this study, we investigated whether a CKD stage coordinate transformed into a vector field (CKD potential model) accurately predicts ESKD risk. Meta-analysis of large-scale cohort studies of CKD patients in PubMed was conducted to develop the model. The distance from CKD stage G2 A1 to a patient's data on eGFR and proteinuria was defined as r. We developed the CKD potential model on the basis of the data from the meta-analysis of three previous cohort studies: ESKD risk = exp(r). Then, the model was validated using data from a cohort study of CKD patients in Japan followed up for three years (n = 1,564). Moreover, the directional derivative of the model was developed as an index of CKD progression velocity. For ESKD prediction in three years, areas under the receiver operating characteristic curves (AUCs) were adjusted for baseline characteristics. Cox proportional hazards models with spline terms showed the exponential association between r and ESKD risk (p<0.0001). The CKD potential model more accurately predicted ESKD with an adjusted AUC of 0.81 (95% CI 0.76, 0.87) than eGFR (p<0.0001). Moreover, the directional derivative of the model showed a larger adjusted AUC for the prediction of ESKD than the percent eGFR change and eGFR slope (p<0.0001). Then, a chart of the transformed CKD stage was developed for implementation in clinical settings. This study indicated that the transformed CKD stage as a vector field enables the easy and accurate estimation of ESKD risk and CKD progression and suggested that vector analysis is a useful tool for clinical studies of CKD and its related diseases.

Effect of multidisciplinary refined time management combined with organized stroke management on the efficacy of intravenous thrombolysis in patients with acute ischemic stroke

This study aims to investigate the effects of multidisciplinary refined time management combined with organized stroke management in intravenous thrombolysis on patients with acute ischemic stroke. 226 acute ischemic stroke patients treated with intravenous thrombolysiswere selected for retrospective analysis. A Control group participants underwent organized stroke management, whereas study group participants underwent multidisciplinary refined time management based on the control group. The study group responded to intravenous thrombolysis for 24 hours at an overall rate of 92.92%, significantly higher than 79.65% in the control group (p &lt; 0.05). The time from onset to emergency, time for National Institute of Health Stroke Scale (NIHSS) scoring by emergency doctors, consultation time for neurologists, judgement time for head computed tomography (CT), interpretation time for examination results, communication time with family members to sign the consent form, and time from admission to medication in the study group were significantly shorter than that in control group (p &lt; 0.05). The incidence of hemorrhagic transformation, six-month mortality and six-month rehospitalization rate in the study group were significantly lower than those in the control group (p &lt; 0.05). Before thrombolysis, cerebrovascular reserve function and neurological function indexes in both groups were improved, and there was significant difference before and after thrombolysis in this group (p &gt; 0.05); After thrombolysis, mean blood flow velocity (MFV) and breath-holding index (BHI) in the study group were significantly higher than those in the control group (p &lt; 0.05); pulsatility index (PI) was lower than that in the control group, showing a significant difference (p &lt; 0.05); Serum nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF) and neurotrophin-3 (NT-3) were significantly higher than those in the control group (p &lt; 0.05). Multidisciplinary refined time management combined with organized stroke management can improve the effect of intravenous thrombolysis in acute ischemic stroke.

Lung Cancer Biomarkers Associated with Increased Peripheral Arterial Stiffness in Middle-aged Chinese Adults.

Previous evidence suggests that serum lung cancer biomarkers are associated with inflammatory conditions; however, their relationship with peripheral arterial stiffness remains unclear. Therefore, the present study investigated the relationship between serum lung cancer biomarkers and peripheral arterial stiffness in middle-aged Chinese adults. In total, 3878 middle-aged Chinese adults were enrolled in this study. Increased peripheral arterial stiffness was assessed using the brachial-ankle pulse wave velocity and ankle-brachial index. Univariate and multivariate logistic regression analyses were used to determine the independent effects of serum lung cancer biomarkers on the risk of increased peripheral arterial stiffness. A receiver operating characteristic curve analysis was used to assess the diagnostic ability of serum lung cancer biomarkers in distinguishing increased peripheral arterial stiffness. Serum levels of carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), cytokeratin-19 fragment 21-1, and pro-gastrin-releasing peptide were higher in subjects with increased peripheral arterial stiffness than in those without (P＜0.05). After adjusting for other risk factors, serum CEA and NSE levels were found to be independently associated with increased peripheral arterial stiffness. The corresponding adjusted odds ratios (ORs) for increased peripheral arterial stiffness in CEA level quartiles were 1.00, 1.57, 2.15, and 6.13. The ORs for increased peripheral arterial stiffness in the quartiles of NSE levels were 1.00, 4.92, 6.65, and 8.01. Increased serum CEA and NSE levels are closely linked to increased peripheral arterial stiffness, and high serum CEA and NSE levels are potential risk markers for peripheral arterial stiffness in middle-aged Chinese adults.

Understanding the Kinematic Profile of 2 Underwater Pullout Breaststroke Techniques.

To compare the kinematic profile of 2 underwater pullout breaststroke techniques. Sixteen swimmers (9 men, 20.67 [2.71]y old; 7 women, 18.86 [0.83]y old) performed 3 × 25-m breaststroke using 2 pullout breaststroke techniques: Fly-Kick first and Combined. A speedometer was used to assess the peak and the mean velocity during the glide, propulsion, and recovery phases of both techniques, as well as for the total underwater sequence. The underwater distance was retrieved from video footage and was considered for each pullout technique. The range of motion of the knee during the fly-kick was also retrieved, and the time to complete the 25m was considered the performance outcome, accompanied by the mean velocity, stroke rate, stroke length, and stroke index. Velocity-time series showed different profiles between pullout techniques (P ≤ .05) mostly in the glide and propulsion phases for males and females, respectively. The mean velocity of 25m was shown to be greater in females when using the Fly-Kick first technique (P = .05, d = 0.36). Greater values in total underwater distance and knee range of motion were also observed for this technique in both cohorts.Conclusions: Female swimmers presented a higher performance when using the Fly-Kick first technique. Different kinematic profiles arise when swimmers use different underwater pullout techniques where the Fly-Kick first may allow them to reach higher kinematical standard.