Venous Bed Research Articles

Integrative Metabolomics Differentiate Coronary Artery Disease, Peripheral Artery Disease, and Venous Thromboembolism Risks.

Arterial and venous cardiovascular conditions, such as coronary artery disease (CAD), peripheral artery disease (PAD), and venous thromboembolism (VTE), are genetically correlated. Interrogating underlying mechanisms may shed light on disease mechanisms. In this study, we aimed to identify (1) epidemiological and (2) causal, genetic relationships between metabolites and CAD, PAD, and VTE. We used metabolomic data from 95 402 individuals in the UK Biobank, excluding individuals with prevalent cardiovascular disease. Cox proportional-hazards models estimated the associations of 249 metabolites with incident disease. Bidirectional 2-sample Mendelian randomization (MR) estimated the causal effects between metabolites and outcomes using genome-wide association summary statistics for metabolites (n=118 466 from the UK Biobank), CAD (n=184 305 from CARDIoGRAMplusC4D 2015), PAD (n=243 060 from the Million Veterans Project), and VTE (n=650 119 from the Million Veterans Project). Multivariable MR was performed in subsequent analyses. We found that 196, 115, and 74 metabolites were associated (P<0.001) with CAD, PAD, and VTE, respectively. Further interrogation of these metabolites with MR revealed 94, 34, and 9 metabolites with potentially causal effects on CAD, PAD, and VTE, respectively. There were 21 metabolites common to CAD and PAD and 4 common to PAD and VTE. Many putatively causal metabolites included lipoprotein traits with heterogeneity across different sizes and lipid subfractions. Small VLDL (very-low-density lipoprotein) particles increased the risk for CAD while large VLDL particles decreased the risk for VTE. We identified opposing directions of CAD and PAD effects for cholesterol and triglyceride concentrations within HDLs (high-density lipoproteins). Subsequent sensitivity analyses including multivariable MR revealed several metabolites with robust, potentially causal effects of VLDL particles on CAD. While common vascular conditions are associated with overlapping metabolomic profiles, MR prioritized the role of specific lipoprotein species for potential pharmacological targets to maximize benefits in both arterial and venous beds.

Subtotal Thrombosis of the Left Pulmonary Artery Trunk as a Complication of COVID-19: a Clinical Case

The article describes a clinical case of a 62-year-old patient infected with SARS-CoV-2, in whom, 15 days after the onset of symptoms of COVID-19 with lung damage, chest computed tomography with contrast revealed concurrent subtotal obstruction of the pulmonary artery trunk and defects of its branches filling due to blood clots formed in situ. Against the background of anticoagulant therapy for 13 days, blood clots resolved in both central and peripheral parts of the lung venous bed.

Prospective Visual Inspection of the Ventrum of Tongue (VIVOT) Vasculature Predicts the Presence of Esophageal Varices

Venous collateral shunting of blood from the splanchnic to systemic venous systems due to portal hypertension increases the pressure in the ventral lingual venous bed. We hypothesized that the appearance of sublingual varices evaluated by pre-endoscopy/bedside visual inspection of ventrum of tongue (VIVOT) might predict the presence of esophageal varices (EVs). Methods: To test this hypothesis, we prospectively enrolled patients with cirrhosis (CP) referred for EV screening for assessment of lingual vasculature after informed consent. Non-cirrhosis control patients were also enrolled. Methods: VIVOT was scored based on the presence of vessels &gt; 2 mm and/or serpiginous veins. VIVOT scores were then correlated with endoscopic findings. Results: A total of 59 patients with cirrhosis (Group 1) were enrolled, as were 62 patients without cirrhosis (Group 2). Group 1 consisted of 100% male patients with mean age 59.5 ± 5.4 years; 39.0% were African American (AA). Group 2 consisted of 86% male patients, 59.0 ± 13 years and 53% AA. Among Group 1 patients, varices were present in 29% (16 esophageal and 3 gastric). There were no demographic differences among Group 1 patients with or without varices. Positive VIVOT scores were associated with EVs on endoscopy in 11 of 16 patients (sensitivity 68.75%). Positive VIVOT findings were present in 8 of 40 patients without EVs (specificity 80%). False-positive VIVOT scores were present in 6 of 62 non-cirrhotic controls. Overall, the positive predictive value among patients with cirrhosis was 59% with a negative predictive value of 84%. Conclusions: VIVOT has modest values in predicting EVs and should not be used alone to stratify patients for endoscopic evaluation when elastography and laboratory tests are available; however, its use in resource-limited settings to identify high-risk patients may be considered.

Single Center Outcomes of Percutaneous Deep Vein Arterialization in Patients with End-Stage Peripheral Artery Disease.

Background: Peripheral artery disease (PAD) can present as chronic limb threatening ischemia (CLTI) with ischemic pain and tissue loss. Progression of distal disease can lead to a "no option" or end-stage disease without traditional open or endovascular revascularization due to lack of pedal targets. Innovations in endovascular technology allow for the use of percutaneous deep vein arterialization (pDVA) to treat patients with CLTI. Purpose: We describe our experience and technique for treating four patients with end-stage PAD with pDVA. Research Design: Four patients with end-stage PAD were followed during and after pDVA creation. Technical success, complications, wound healing, and freedom from major amputation were analyzed. Data Collection and Analysis: Patient data and outcomes were collected via chart review and at time of follow up appointments in vascular surgery clinic. Results: Technical success was 100%, without post-procedural complications, and patients were continued on antiplatelet and anticoagulation. Three patients (75%) had successful wound healing, with 2 patients healing after transmetatarsal amputation (TMA), and 1 healing a distal foot ulceration that did not require surgery. One patient had worsening ischemic breakdown of a TMA, despite re-intervention on the pDVA, which required a below knee amputation (BKA). Freedom from major amputation was 75% overall, with an average follow-up time of 410 days post-procedure (Range: 113-563 days). Conclusions: Percutaneous deep vein arterialization attempts to provide blood flow to the preserved venous bed in patients with end-stage PAD. Exploration and utilization of this technique continues to expand in the modern vascular era. This case series highlights 4 patients with end-stage PVD who underwent pDVA, with 100% procedural success, and 75% limb salvage rate.

Endovascular and Surgical Venous Arterialization for No-Option Patients With Chronic Limb-Threatening Ischemia: A Systematic Review and Meta-Analysis.

Chronic limb-threatening ischemia (CLTI) is known for its high rates of major amputation and mortality. Conventional revascularization techniques often fail in CLTI patients due to the heavily diseased arteries. Foot vein arterialization (FVA) has been proposed as an alternative technique to provide arterial blood to the foot by using the disease-free venous bed. This systematic review and meta-analysis aimed to determine outcomes of surgical FVA (sFVA) and percutaneous FVA (pFVA) at 6 and 12 months post-procedure. PubMed, Scopus, Web of Science, and the Cochrane Library databases were searched to identify papers reporting clinical outcomes of sFVA and pFVA published between January 1966 and March 2023. Databases were searched for eligible studies. A meta-analysis was performed to evaluate the limb salvage rate, overall survival rate, and wound healing rate at 6 and 12 months. A total of 27 studies were included, with 753 patients and 793 limbs. Of the included studies, 16 analyzed the sFVA technique and 11 the pFVA technique. Of the included patients, 86.3% were Rutherford 5/6 in the sFVA group versus 98.4% in the pFVA group. The pooled limb salvage rate at 6 and 12 months was 78.1% and 74.1% in the sFVA group and 81.7% and 78.6% in the pFVA group, respectively. Wound healing rates were not reported in the sFVA group. In the pFVA group, the pooled wound healing rates were 48.1% and 64.5% at 6 and 12 months, respectively. This study showed promising results after FVA among a large population of CLTI patients. In high-risk patients, pFVA is a feasible option with favorable limb salvage and wound healing rates.

EXPERIMENTAL AND MORPHOLOGICAL JUSTIFICATION OF THE ENTERAL INSUFFICIENCY DEVELOPMENT IN ABDOMINAL SEPSIS

Abstract. Abdominal sepsis continues to remain the most frequent and formidable complication that complicates the course of acute surgical diseases of the abdominal cavity in 15-25 % of cases, and the mortality rate in various forms of peritonitis, depending on the form and its spread, is from 4 % to 60 %, reaching 90 % in postoperative peritonitis.The aim of the study. To study the dynamics of morphological changes of internal organs in animals with simulated acute diff use peritonitis, depending on the stage of the infl ammatory process of the peritoneum.Material and methods. The object of experimental research was 54 white sexually mature non-linear rats weighing 0.18-0.20 kg, kept in the vivarium of the Bukovinian State Medical University, which were divided into two groups. The main group consisted of 28 animals that were simulated with abdominal sepsis. Control group – 26 intact rats. All animals had free access to food and water. Abdominal sepsis in rats was modeled according to our proposed method, which consisted in infecting the peritoneal cavity with the contents of the hollow organs of the abdominal cavity. Animals were removed from the experiment on 1, 3, and 7 days of simulated peritonitis by decapitation under thiopental anesthesia.The results. On the fi rst day of simulation of peritonitis in the animals of the main group, a histological examination of the peritoneum revealed focal purulent peritonitis with damage to the parietal peritoneum. Diff use hyperemia, focal edema of the connective tissue, which is most developed in the submesothelial layers, was observed. Areas of swollen connective tissue contain a slight but diff use mononuclear infl ammatory infi ltrate. We did not detect morphofunctional changes in the liver and kidneys of animals of the main group on the fi rst day of experimental peritonitis. However, already on the third day of the study, the structure of the liver lobe was only partially preserved. The central veins were well visualized, slightly dilated, and contained a small number of erythrocytes. Changes were also found in the lung tissue of animals with peritonitis: enlarged alveoli and congestion of small vessels and hemorrhages. Hemorrhagic syndrome is not excluded as an early manifestation of acute pulmonary insu ffi ciency. On the seventh day, the structure of the liver lobe was signifi cantly disturbed in the animals. The central veins were well visualized, slightly dilated and contained a large number of erythrocytes. Sinusoids were not visualized in the vast majority of fi elds of view, sometimes they were detected only centrilobularly. The beam organization of hepatocytes was disturbed throughout the size of the lobule. During the histological examination of the kidney tissue of the animals on the 7th day of Клінічна анатомія та оперативна хірургія – Т. 22, № 4 – 2023 27 the experiment, we observed that in the cortical layer of the kidney, the glomeruli were somewhat enlarged and dilated, their vessels were fi lled with blood, serous exudate was observed in the lumens, and individual glomeruli were shrunken and collapsed. The vessels of the venous bed were somewhat dilated, full of blood, and small perivascular spot hemorrhages were visualized.Conclusion. Morphological changes occur already during the reactive phase of abdominal sepsis and indicate the stages of multiple organ failure syndrome.

Патоморфологічні зміни нирок, печінки та біохімічні показники сироватки крові червоновухих прісноводних черепах (Trachemys scripta elegans) за парентерального введення гентаміцину

Principles of reptile treatment are significantly different from the drug therapy for mammals and birds, which is primarily due to anatomical and physiological peculiarities of reptiles. Gentamicin, which has a nephrotoxic effect, is used for the treatment of reptile infectious diseases. For the purpose of studying the effects of gentamicin of reptiles a serum biochemical analysis was conducted determining aspartate aminotransferase and alanine aminotransferase activity, urea and uric acid concentration. Two research groups of red-eared sliders (Trachemys scripta elegans) were formed for the study; every 48 hours they received an injection of gentamicin in a dose 10 mg/kg into thoracic limb muscles. The animals of the first research group were withdrawn from the experiment on the 7th day, and the animals of the second group were withdrawn on the 14th day of the research. As a result of parenteral administration of gentamicin in turtles, there is an increase in the concentration of uric acid and urea, as well as the activity of aspartate aminotransferases and alanine aminotransferases in blood serum. In the kidneys, structural changes of the glomeruli were found: alternative changes in podocytes, as well as degenerative and necrotic changes in the renal tubule epithelium. Degenerative changes of nephrocytes were accompanied by the dilation of smooth endoplasmic reticulum tubules, mitochondrial crista destruction, accumulation of autophagolysosomes, cytosomes and lysosomes in the cytoplasm. Furthermore, signs of nephrocyte apoptosis with the formation of apoptotic bodies were detected. A liver examination revealed dystrophic and necrotic changes in hepatocytes, expansion and overflow of the vessels of the venous beds.

Rasa1-related arteriovenous malformation is driven by aberrant venous signalling.

Arteriovenous malformations (AVMs) develop where abnormal endothelial signalling allows direct connections between arteries and veins. Mutations in RASA1, a Ras GTPase activating protein, lead to AVMs in humans and, as we show, in zebrafish rasa1 mutants. rasa1 mutants develop cavernous AVMs that subsume part of the dorsal aorta and multiple veins in the caudal venous plexus (CVP) - a venous vascular bed. The AVMs progressively enlarge and fill with slow-flowing blood. We show that the AVM results in both higher minimum and maximum flow velocities, resulting in increased pulsatility in the aorta and decreased pulsatility in the vein. These hemodynamic changes correlate with reduced expression of the flow-responsive transcription factor klf2a. Remodelling of the CVP is impaired with an excess of intraluminal pillars, which is a sign of incomplete intussusceptive angiogenesis. Mechanistically, we show that the AVM arises from ectopic activation of MEK/ERK in the vein of rasa1 mutants, and that cell size is also increased in the vein. Blocking MEK/ERK signalling prevents AVM initiation in mutants. Alterations in venous MEK/ERK therefore drive the initiation of rasa1 AVMs.

Intralobar bronchopulmonary sequestration: an example of the late onset of this rare congenital pathology

Bronchopulmonary sequestration (BPS) refers to a rare congenital lung malformation with a nonventilated dysplastic fragment of parenchyma separated from the main bronchial tree. This segment has a systemic blood supply through aberrant arteries and venous outflow into the systemic venous bed or pulmonary veins and has a common with the rest of the lung (intralobar BPS) or an independent (extralobar BPS) visceral pleura. Purpose of the study is to describe an unusual late onset of right-sided intralobar BPS characterized by a pseudopneumonic course in a patient with concomitant anomalies of the thoracic spine and diaphragm; to discuss the issues of formation, manifestation, diagnosis, differential diagnosis, complications, and treatment of intralobar BPS, and to consider its combination with other developmental anomalies. Conclusion. BLS should be considered in patients with an unusual course of pulmonary anomalies, especially localized in the basal segments of the left (more common) or right (less common) lung and characterized by abnormal blood supply and other malformations.

Thrombosis in Multisystem Inflammatory Syndrome Associated with COVID-19 in Children: Retrospective Cohort Study Analysis and Review of the Literature.

Background: The causative agent of the new coronavirus infection SARS-CoV-2 has unique properties causing hyperinflammatory syndrome and cytokine storm, as well as widespread endotheliitis and thrombotic microangiopathy, initially detected in the lungs of adult patients who died from a severe form of the disease. Venous and arterial thrombosis in adults were identified as common causes of severe complications and deaths in new coronavirus infections. There are very few reports of thrombotic events in children with COVID-19 in the literature. Methods: We conducted a retrospective analysis of the histories of 60 patients in the Irkutsk Regional Children's Clinical Hospital from November 2020 to November 2022 with a MIS-C diagnosis established according to WHO criteria, of which 8 (13.3%) were diagnosed with venous and/or arterial thrombosis, confirmed by laboratory and ultrasound and/or X-ray methods. Results: The average age of children with thrombosis (Me) was 7.5 years (min 4 months, max 17 years), with a M:F ratio of 3.0. Venous thrombosis was detected in six of the eight patients, including in the deep veins of the lower extremities in four. Pulmonary embolism occurred in two (one of them was fatal), and cerebral venous sinus thrombosis and thrombosis of the branches of the upper and lower vena cava were found in one patient. Extensive bilateral stroke due to thrombosis of the large cerebral arteries occurred in two patients, including one in combination with distal gangrene. Secondary thrombotic renal microangiopathy took place in three of the eight patients. Among these three, atypical HUS was diagnosed in one case. Multiple thrombosis involving the venous and arterial bed was detected in four of the eight patients. High levels of D-dimer, thrombocytopenia, increased NT-proBNP, cerebral coma, and aseptic meningitis were the events most often associated with thrombosis. All patients received immunomodulatory therapy (immunoglobulin, dexamethasone/methylprednisolone), pathogenetic therapy for multiorgan failure, anticoagulant therapy with heparin/LMWH, and acetylsalicylic acid. Biologics were used in two patients. Conclusions: The main predictors of thrombosis in children with MIS-C were increased D-dimer, thrombocytopenia, hospitalization in the ICU, and noncardiogenic pulmonary edema. Thrombosis of the deep veins of the lower extremities, large cerebral arteries, and secondary thrombotic microangiopathy was common. There was a single death (12.5% of the eight patients), associated with PE.

Cerebral venous revascularization in meningioma surgery

Introduction. Brain tumors are a complex problem of modern neurosurgery. Meningiomas, mostly benign tumors, can become a problem when they are difficult to locate. The complexity is also caused by tumors affecting the sinuses of the brain. In this case, the surgeon faces a number of issues related to the diagnosis, preoperative planning and the choice of treatment tactics for these patients. The choice in favor of revascularization of the venous bed is also not always unambiguous due to the lack of clear indications and contraindications to this type of intervention. The purpose of the work was to analyze articles on the topic of surgical treatment of meningiomas of the brain venous system.Conclusion. Based on the results of the work, a critical analysis of the cited literature is presented, showing the insufficient development of the problem of treating patients with such tumors at the moment. In further clinical studies, it is necessary to clarify both the technical aspects when removing these tumors, and to work more deeply on the indications and contraindications for surgery in the group of these patients.

The venous bed of the shoulder and forearm area of the fruits of blackand-white cows

Embryonic development and formation of the bloodstream, namely the venous outflow highways of the shoulder and forearm area in the fetuses of black-and-white cows, in our opinion, are an urgent topic for study. Unfortunately, despite active measures to prevent limb injuries in animals, modern veterinary agricultural complexes continue to face periodic non-contagious diseases associated with limb injury. The cascade of reactions occurring in the body after an injury is inextricably linked with the venous system of fluid outflow from the limbs of animals. The corpses of fetuses of black-and-white cows aborted at the fifth month of pregnancy with no signs of infectious diseases were used as the studied material. In total, five fruits were examined, delivered from private farms of the Leningrad region. The following research methods were used: fine anatomical dissection, vasorentgenography, morphometry using an electronic caliper, measuring ruler and the RadiAnt DICOM Viewer program. As a result of the study, we found that in the fetuses of black-and–white cows at the fifth month of pregnancy, the outflow of venous blood from the shoulder and forearm area is carried out through the following vessels: the superficial venous trunk in the forearm area is formed by the additional subcutaneous vein and the subcutaneous vein of the forearm; the deep venous trunk is formed by the median radial vein, as well as the initial sections of the shoulder veins and median vein of the elbow. The largest diameter in the forearm area are the veins of the superficial trunk. This is due to the fact that it takes the bulk of the blood from the brush area. Venous valves are located more often in the vessels of the deep trunk than in the superficial trunk. This is due to their location and hemodynamic functions, as they contract more strongly than the surface ones. An extensive venous bed is necessary for the passage of a large amount of blood, so the diameter of the vessels of the deep trunk of the shoulder area is larger than the surface.

PHYSICAL THERAPY OF PREGNANT WOMEN WITH PRIMARY MANIFESTATIONS OF VARICOSE DISEASE OF THE LOWER EXTREMITIES

As a result of the generalization of clinical experience, it has been proved that varicose disease of the lower extremities of pregnant women is defined as a polyetiological disease of the venous system.&#x0D; The high pathological incidence of varicose veins among pregnant women is caused by a number of factors. The consequence of such changes may be stagnation in the venous bed of the lower extremities. Therefore, women who have a history of primary manifestations of varicose veins of the lower extremities often have got problems during pregnancy and the postpartum period in the form of complications of symptoms leading to thrombophlebitis (inflammation of superficial veins).&#x0D; Timely started and implemented physical therapy allows relieving or completely eliminating the above symptoms of the disease of pregnant women, significantly improves the properties of blood circulation and the condition of the inner walls of vessels.&#x0D; The aim of the study is to assess the functional state of the body of women in the second and third trimester of pregnancy with primary manifestations of varicose veins of the lower extremities and the effectiveness of the physical therapy program.&#x0D; Methods and materials. 19 pregnant women with varicose veins, aged 22 to 29 years, from the second to third trimester of pregnancy participated in the study. Two groups were formed: the main number of 10 women (implemented measures of the developed physical therapy program, which included kinesiotherapy, therapeutic and electrophoresis) and a comparison group – 9 women (implemented standard physical therapy technique).&#x0D; The following methods were used during the research: 1) anthropometric examination; 2) physiological monitoring of functional indicators of the state of the cardiovascular system of women (pulsometry and tonometry with systematic registration of the indicators of systolic and diastolic blood pressure, heart rate; 3) functional diagnostics (active orthostatic test, spirometry); 4) clinical somatoscopy with participation; 5) assessment of the quality of life.&#x0D; Conclusions. In the process of different periods of pregnancy, the examined patients were diagnosed with primary varicose veins of the lower extremities. Pregnant women with varicose veins had an intensive increase of body weight in the last trimester of pregnancy.&#x0D; The inconsistency of the actual blood pressure indicators towards hypertension compared to the physiological norms was revealed. After the implementation of the developed physical therapy program, the following dynamics of changes were exposed: the average value of systolic and diastolic pressure and heart rate indicators of the main group decreased in contrast to the comparison group (p&gt;0.05). Among the women of the main group, the vital capacity of the lungs increased by 7.56%. The normalization of the regulation and type of reaction of the orthostatic test with a change of body position from horizontal to vertical was observed among pregnant women of the main group (-20.56%) in contrast to the examined comparison group (p&gt;0.05).&#x0D; The assessment based on the data of the CIVIQ questionnaire showed a probable improvement of all components of the quality of life of the respondents of the main group (indicator of the category of pain and complaints regarding the physical condition) of pregnant women. Thus, the obtained results make it possible to ascertain the effectiveness of the developed physical therapy program.

Use of medical imaging techniques as part of the evidence for the presence of meningeal lymphatics

The lymphatic system is an integral part of the microcirculatory bed, which structurally and functionally complements the venous bed. It ensures constancy in the internal environment of the human body and performs transport, barrier, lymphopoietic, and immune functions, playing an exceptional role in the metabolism and cleansing of the body’s cells and tissues from metabolic products. The researchers assume that the meningeal lymphatic vessels (MLVs) may be involved in the process of cleansing the brain from metabolic products. Today, the problem of proving the existence of MLVs is a key one in understanding the anatomy and physiology of processes in the brain as a whole. Medical imaging techniques make it possible to prove the presence of MLVs. The paper analyzes the methods that are currently more frequently used to determine MLVs. Experimental medical imaging techniques allow us to conduct researches, by confirming or ruling out the scientific theories put forward. These methods are further evidence-based medicine.

Intraorgan architectonics of hepatic veins in piglets

The liver of animals and humans is characterized by polyfunctionality. All the variety of liver functions and the intensity of their course is determined by the peculiarities of its hemodynamics. According to the morphological anatomy of the pig liver, I distinguish six lobes: the right lateral and medial, the left lateral and medial, square and caudate. The functional anatomy of the liver is based on the division of the liver into segments. In this case, the division is based on the fact that each segment has its own double blood supply, bile and lymph outflow routes. The aim of the study is to study the architectonics of the hepatic veins of newborn piglets, to give a morphometric characteristic of the branches of the intraorgan venous bed, as well as the segmental structure of the liver of piglets. The corpses of newborn piglets of the Landrace breed served as the material for the study. Vasorentgenography, fine anatomical dissection, and morphometry were chosen as research methods. The study included 15 piglets of the newborn period. During the study, it was found that four hepatic veins (right accessory, right, left and middle) flow into the caudal genital vein. Hepatic veins have complex intra-organ architectonics and take branches of the first and second order along their course. The maximum diameter is the left hepatic vein, which carries out the outflow of blood from the left lateral and medial lobes of the liver. The right hepatic vein drains blood from the right lateral and medial lobes, the middle hepatic vein drains from the square lobe, gallbladder and part of the left medial lobe. The smallest diameter is characteristic of the right accessory hepatic vein, which drains the caudate lobe.Having studied the intra–organ architectonics of the branches of the hepatic veins, it can be concluded that the liver of piglets has eight segments - one segment each in the caudate, left medial, right medial and square lobes, two segments each in the left and right lateral lobes.

Rare Cause of Leg Edema after Femoropopliteal Bypass Procedure in Patient with Previously Unrecognized Arteriovenous Fistulas: A Case Report

BACKGROUND: Arteriovenous fistulas (AVFs) are pathological, congenital, or acquired communications between the arterial and venous vascular bed. Asymptomatic AVFs do not require surgical or endovascular treatment; however, if they are symptomatic, they must be treated to relieve the patient of symptoms and cardiovascular disorders. CASE PRESENTATION: Our patient had an undiagnosed AVF that became symptomatic after femoropopliteal bypass surgery. We successfully treated these complications with four cover stents. CONCLUSION: The presence of AVFs should be kept in mind in the case of rapidly developing leg edema after revascularization. Endovascular treatment of symptomatic AVF is a safe and effective treatment modality. Treatment of symptomatic AVFs is not only recommended for improving impaired arterial or venous blood flow, but also for preventing recurrent PE.

Various Methods of Laser Photobiomodulation Therapy for Alzheimer's Disease

Alzheimer's disease is the most common neurodegenerative disease. It is believed that the number of people suffering from Alzheimer's disease worldwide is about 32 million, and the number of people with the preclinical stage of the disease can be up to 300 million. For a long time, it was believed that Alzheimer's disease arises as a result of disorders in the metabolism of amyloid beta and tau-protein in cerebral tissue. According to numerous recent studies, it has been established that the disease is accompanied by dyscirculatory angiopathy of Alzheimer's type. This is an Alzheimer's disease-specific complex lesion of the cerebral vascular system with arterial, microcirculatory, and venous bed disorders. One of the most promising directions in the field of brain revascularization, as well as the regeneration of cerebral tissue in Alzheimer's disease, is the use of laser with low output power. This direction was named laser “photobiomodulation therapy”. Currently, laser photobiomodulation therapy is divided into transcranial, intranasal, intravascular (intravenous) and transcatheter intracerebral methods of treatment. Laser energy has a complex effect on cerebral tissues. Photobiomodulation therapy stimulates angiogenesis, causes collateral and capillary revascularization, restores the exchange of adenosine triphosphate in neuronal mitochondria, improves cellular and tissue metabolism, stimulates neurogenesis, and causes regeneration of tissue structures. Various types of Photobiomodulation therapy are non-traumatic, physiological, pathogenetically substantiated, effective methods for the treatment of cerebral microcirculatory disorders in Alzheimer's disease. The choice of one or another method of laser photobiomodulation therapy is purely individual and depends on the specific clinical case.

Peripheral and regional blood bloodstreams lipid peroxidation comparative analysis in women with pelvic venous disorder.

Pelvic venous disorder (PVD) in women is a polyetiological multifactorial disease characterized by a high prevalence (up to 80%), a high risk of infertility, and a progressive recurrent course. Morphological changes of the venous bed occur in PVD, contributing to retrograde blood flow and pelvic phlebohypertension. It is occur due to dynamic hypervolemia and hypertension long-term exposure on the venous wall. However, PVD pathogenesis analysis only from venous hemodynamic disorders position does not explain all mechanisms of the disease development and does not contribute to the treatment measures effectiveness. Currently oxidative stress reactions are considered as the most important markers of the pathological process. The aim of our work was a comparative analysis of lipid peroxidation-antioxidant defense component changes in the peripheral and regional blood flow in women with primary pelvic venous disorder depending on the disease stage. The study involved 137 women of reproductive age (mean age 37.4±9.1 years old) with diagnosed primary PVD divided into 3 groups according to the pathological process stages (stages I, II, III). Data from 30 practically healthy women (mean age 33.5±6.3 years old) were used as controls. Spectrophotometric, fluorometric, immunoassay and statistical methods were used. In patients with PVD stage I in peripheral bloodstream were higher values of SOD and GPO activity; in the regional bloodstream were higher levels of TBARs, SOD, catalase, GPO and lower GSH. In PVD stage II the peripheral bloodstream showed elevated levels of DC, GSH and SOD reduced levels; the regional bloodstream showed higher levels of DC, TBARs, GPO and GSH reduced levels relative to controls. PVD stage III was characterized by: higher levels of DC and TBARs and lower levels of SOD and GSH in the peripheral bloodstream; higher levels of DC, TBARs and lower levels of GSH and catalase in the regional bloodstream compared with control. Thus, the results of our study showed no significant differences in the LPO-AOD system between peripheral and regional bloodstreams in patients with PVD depending on the disease stage. However, negative changes in the redox balance in the regional bloodstream were earlier and were already registered at the first stage of the disease. It is likely that control of antioxidant insufficiency in patients with PVD should be an important component of preventive measures in the early stages and pathogenetic treatment in the pathological process progression, particularly in stage III of the disease.

QUANTITATIVE MORPHOLOGICAL FEATURES OF THE STRUCTURAL REARRANGEMENT OF THE VENOUS BLOOD VESSELS OF THE PROSTATE GLAND IN POST-RESECTION PORTAL HYPERTENSION.

Aim: Using quantitative morphological methods to study the peculiarities of the structural reconstruction of the venous bad of the prostate at the conditions of post-resection portal hypertension. Materials and Methods: Morphologically, the venous bed of the prostate of 15 intact white rats, 30 animals with post-resection portal hypertension, 17 rats with a combination of post-resection portal hypertension with hepatargia, enteral, cardiac, and renal insufficiency was studied. Rats were slaughtered one month after the start of the experiment by bloodletting under general thiopental anesthesia. Morphometry of the venous blood vessels of the prostate gland was performed on histological specimens, during which the diameter of the postcapillary venules, the diameter of the venules, the external diameter of the venous vessels, the internal diameter of the venous vessels, the thickness of the wall of the venous vessels was determined. Also it was studied the height of endothelial cells, diameter of their nuclei, nuclear-cytoplasmic ratio in these cells, relative volume of damaged endothelial cells, density of vessels of microcirculatory bed per 1 mm² of prostate tissue. Results: It was found that resection of the left and right lobes of the liver leads to the development of postresection portal hypertension and pronounced remodeling of the vessels of the venous bed of the prostate gland, which was characterized by the expansion of the capillary venules of the prostate by 36.5%, with the occurrence of multiple organ failure by 38.5% (р<0.001 ), an increase in the lumen of veins, thinning of their wall, atrophy, dystrophy, and necrobiosis of endothelial cells, disruption of structural cellular homeostasis, endothelial dysfunction, hypoxia, dystrophic-necrotic changes in cells, stromal structures, infiltration, and sclerosis. Morphological changes in the structures of the prostate dominated when post-resection portal hypertension was combined with multiple organ failure. Conclusions: Post-resection portal hypertension in laboratory sexually mature white male rats leads to pronounced remodeling of the venous bed of the prostate gland, which is characterized by the expansion of the lumen of the vessels, thinning of their walls, atrophic, dystrophic and necrobiotic changes in endothelial cells, a violation of structural cellular homeostasis in them, endothelial dysfunction, hypoxia, dystrophic-necrotic changes in cells, stromal structures, infiltration and sclerosis. Morphological changes in the structures of the prostate dominated when post-resection portal hypertension was combined with multiple organ failure.

Letter: Nationwide Readmission Rates and Hospital Charges for Patients With Surgical Evacuation of Nontraumatic Subdural Hematomas: Part 1-Craniotomy.

Letter: Nationwide Readmission Rates and Hospital Charges for Patients With Surgical Evacuation of Nontraumatic Subdural Hematomas: Part 1-Craniotomy.