Venous Injury Research Articles

A decade of managing pediatric major traumatic vascular injuries: insights from a referral center.

Incidence, management, and outcomes of pediatric vascular injuries secondary to non-iatrogenic trauma were reviewed over a decade in our institution. A retrospective review of medical records (2013-2022) of major traumatic vascular injuries, focusing on injury profiles, treatment modalities, and clinical outcomes. Thirty patients with 48 vessel injuries were included. Firearms were the leading mechanism, accounting for 43.3% (n = 13) of cases. We identified 29 arterial injuries and 19 venous injuries, with 30 (62.5%) of the overall injuries occurred in the lower extremities. Shock (17; 56.7%) and associated injuries (25; 83.3%) were common. Surgery was the most common management strategy. Autologous bypass graft was the most frequently performed procedure for arterial injuries (8; 42.1%), while ligation dominated in venous injuries (9; 64.3%). Blood transfusion requirements (24; 82.7%) and post-operative prescription of anticoagulantand antiplatelet agents(12; 41.4%) were similar for arterial and venous injuries (p > 0.05). Three patients demised, resulting in a 90% survival rate. Neither the mechanism of injury, anatomical location, and presence of shock on arrival nor the baseline hemoglobin level served as predictors of mortality. Intensive resuscitation with blood transfusion and prompt surgical intervention achieve favorable survival rates for pediatric traumatic vascular injuries. Optimal post-operative anticoagulant and antiplateletregimens remain unclear.

Effects of Predictive Nursing Process on Elderly Patients with Total Hip Arthroplasty.

Elderly individuals represent a significant demographic undergoing total hip arthroplasty, with distinct risks and complications. The study aimed to determine whether predictive nursing, guided by risk assessment, could reduce these risks and improve patient outcomes. A total of 191 elderly patients undergoing total hip arthroplasty were included in the study, with 142 patients randomly assigned to either the control or observation groups. The control group received routine care, while the observation group received predictive nursing based on comprehensive risk assessment. Various assessment tools were employed to evaluate risks such as venous thrombosis, pressure injuries, falls, joint dislocation, infections, and psychological factors. The primary outcomes included functional improvement measured by the Harris Hip Score, Activities of Daily Living (ADL), anxiety levels, and patient satisfaction. Our study demonstrated that predictive nursing interventions, guided by comprehensive risk assessment, yielded significant reductions in postoperative complications, particularly deep vein thrombosis, in elderly patients undergoing total hip arthroplasty. In addition, patients who received predictive nursing care experienced notable benefits, including shorter hospital stays, heightened satisfaction levels, enhanced hip function, improved ADL scores, and reduced anxiety levels compared with those receiving standard care. The study underscores the substantial benefits of predictive nursing interventions guided by risk assessment in improving outcomes for elderly patients undergoing total hip arthroplasty, highlighting the potential of individualized nursing care to optimize postoperative recovery and enhance patient well-being.

Evaluation of the outcomes of reconstructive surgeries on hepatic vessels in combined trauma

Aim. To optimize the treatment of liver trauma by analyzing surgical outcomes.Materials and Methods. A retrospective analysis was conducted on data from 98 patients who underwent reconstructive liver vascular surgeries for combined trauma between 2018 and 2023. Patients were categorized into three groups based on the type of liver vascular injury: Type A (30 patients), Type B (40 patients), and Type C (28 patients). Diagnostic methods included computed tomography (CT) scans, angiography, and blood tests. Surgeries were performed using microsurgical techniques and innovative materials.Results and Discussion. The average duration of surgery increased with the severity of liver injury: Type A surgeries averaged 1.81 hours, Type B averaged 2.84 hours, and Type C averaged 3.04 hours. Blood loss was also significantly higher in patients with Type B and Type C injuries. Complication and reoperation rates were highest among Type C patients (20.84% complication rate and 18.36% reoperation rate), while Type A patients had the lowest rates. Survival rates were highest in Type A patients (99.11%) and lowest in Type C patients (82.53%).Conclusion. The results indicate that reconstructive liver vascular surgeries for combined trauma yield outcomes that vary by the type of vascular injury. Arterial injuries (Type A) are associated with more favorable prognoses, whereas venous and mixed injuries (Types B and C) present greater challenges. Enhancements in diagnostic techniques and surgical approaches are essential for reducing complications and improving patient survival.

Comparison of the accuracy and safety of robot-and navigation-assisted screw placement in atlantoaxial dislocation surgery

Objective: To compare the accuracy and safety of robot-assisted and navigation-assisted screw placement in atlantoaxial dislocation surgery. Methods: A retrospective analysis was conducted on the clinical data of 49 patients with atlantoaxial dislocation treated consecutively at the Honghui Hospital of Xi'an Jiaotong University from April 2022 to December 2023. Among them, 27 were male and 22 were female, aged (44.2±11.7) years. Based on the date of surgery, 29 patients (from April 2022 to April 2023) received the S8 navigation-assisted screw placement (navigation group), 20 patients (from May to December 2023) received Mazor robot-assisted screw placement (robot group). The accuracy of screw placement, screw placement time, operation time, intraoperative blood loss, and intraoperative complications were recorded and compared between the two groups. The Japanese Orthopedic Association (JOA) score and visual analog scale (VAS) score of pain were adopted to evaluate the recovery of cervical spinal cord function and cervical and shoulder pain at preoperative period and 3-month follow-up, and the occurrence of complications was observed. Results: A total of 196 screws were inserted in 49 patients. In the navigation-assisted group, a total of 116 screws were inserted with an accuracy rate of 93.1% (108/116); in contrast, in the robot-assisted group, a total of 80 screws were inserted with an accuracy rate of 97.5% (78/80) (P=0.040). The mean screw placement time, operation time, and blood loss in the navigation-assisted group were all significantly lower than those in the robot-assisted group [(37.8±3.4)min vs (48.4±4.6)min, (127.7±15.3)min vs (165.7±12.1)min and (205.8±13.6)ml vs (290.6±11.2) ml, respectively all P<0.01]. One case experienced intraoperative venous plexus injury in the robot-assisted group. Postoperatively, all patients experienced significant relief in neck pain symptoms, and neurological symptoms recovered to varying degrees. The VAS and JOA scores at 3 months post-surgery for both groups showed statistically significant improvements compared to pre-surgery (all P<0.01), but there was no statistically significant difference between the two groups (all P>0.05). Conclusions: Both robot-assisted and navigation-assisted screw placement show high accuracy and safety in atlantoaxial dislocation surgery. Compared to navigation, robot assistance increases the surgical time and blood loss, but significantly improves the accuracy of screw placement.

Utility of pelvic CT angiography in blunt pelvic trauma

PurposeTo assess the clinical utility of pelvic computed tomography angiography (CTA) in predicting the need for intervention following blunt traumatic pelvic vascular injury, independent of other trauma severity assessment metrics. Materials and methodsThis retrospective study was IRB approved and HIPAA compliant; informed consent was waived. Eligible patients presented with blunt abdominopelvic trauma and underwent triple-phase pelvic CTA on admission from 1/1/2006 - 8/31/2019. Of the 21,162 eligible patients, 350 met criteria (males 225, females 125, mean age 42 years, range 11-96 years). Vessels were evaluated for contrast extravasation, occlusion, narrowing/spasm, dissection, and pseudoaneurysm. Fisher's exact test was used to compare differences in outcome based on vascular injury on CTA. Results74 of 350 (21%) patients demonstrated vascular injury on CTA. 65 had arterial extravasation, 12 had venous injury, 3 had thrombosis, 3 had pseudoaneurysm, 1 had dissection, and 16 had arterial narrowing/spasm.42 of 65 (65%) patients with active arterial extravasation on pelvic CTA underwent conventional angiography, and 31 demonstrated active bleeding requiring intervention; 5 patients without extravasation underwent negative conventional angiographies. None of the 276 patients without active arterial extravasation received intervention, and all survived. Contrast extravasation on admission pelvic CTA significantly predicted the need for direct intervention and overall mortality (p<0.0001). ConclusionPelvic CTA can be safely implemented in trauma imaging protocols to diagnose vascular injury and determine the need for subsequent intervention. Absence of contrast extravasation on CTA precludes the need for further intervention, independent of newer trauma severity assessment metrics.

A Needle's Misdirection: Unravelling Vascular Injuries in Malpositioned Central Venous Catheters and Safe Removal Approaches

Central venous catheters (CVC) are commonly inserted to obtain vascular access. Complications such as vascular injuries arising from malpositioned CVC may occur, and safe surgical removal is required to prevent further complications. We retrospectively reviewed all patients treated in the cardiothoracic surgery department at our institution in the past 10 years for intrathoracic vascular injuries in malpositioned CVC without the need for concurrent cardiac or thoracic surgical procedures. Among the 21 patients in our series, 2 patients (10%) had a single arterial injury, 16 patients (76%) had venous injuries only, and 3 patients (14%) had both arterial and venous injuries. 16 patients (76%) underwent surgery to remove the malpositioned CVC; majority of them underwent sternotomy (n=12, 57%) and 7 of them had repair of blood vessels, and 4 patients (19%) underwent video assisted thoracoscopic surgery (VATS). 2 out of the 5 patients who had their CVC directly removed followed by external compression required emergency sternotomy due to pericardial effusion. In patients with artery or mediastinal vessel injuries, a sternotomy approach was preferred, whereas VATS was chosen when subclavian vessels or brachiocephalic vein injuries were noted. Endovascular procedures are alternatives for high surgical risk patients, but these advanced procedures are currency limited due to high expertise and facilities requirements.

Deep Vein Thrombosis

Deep vein thrombosis (DVT) is a major preventable cause of morbidity and mortality worldwide. Venous thromboembolism (VTE), which includes DVT and pulmonary embolism (PE), affects an estimated 1 per 1,000 people and contributes to 60,000–100,000 deaths annually. Normal blood physiology hinges on a delicate balance between pro- and anti-coagulant factors. Virchow’s Triad distills the multitude of risk factors for DVT into three basic elements favoring thrombus formation: venous stasis, vascular injury, and hypercoagulability. Clinical, biochemical, and radiological tests are used to increase the sensitivity and specificity for diagnosing DVT.

Impact of ligation versus repair of isolated popliteal vein injuries on Deep Vein Thrombosis and Pulmonary Embolism incidence in trauma patients: a meta-analysis.

Traumatic injuries affecting the veins in the lower extremities have been correlated with both mortality and severe complications. Venous injuries are recognized as a contributing factor to the development of venous thromboembolism, commonly treated through procedures involving either vein ligation or repair. Despite previous efforts, substantial uncertainty remains when it comes to choosing between the execution of ligation versus various reparative techniques. The aim of this study was to evaluate the short-term results of surgically treating traumatic venous injuries through repair compared to ligation, specifically examining the resulting impacts on trauma patients in relation to DVT and PE occurrences. A comprehensive search strategy was employed until August 10, 2023, to systematically explore Scopus and PubMed databases. Following the removal of duplicates, two researchers independently assessed the titles and abstracts of the identified studies. Only studies meeting the project's requirements and inclusion criteria, as evaluated through their full texts, were included in our investigation. Our study exclusively focused on original articles, specifically those involving human trauma patients with isolated popliteal vein injuries. Excluded from consideration were review articles, meta-analyses, cellular and molecular research, animal studies, case reports, case series, letters to the editor, posters, duplicates, and publications in languages other than English. The implementation of this systematic review and meta-analysis conformed to the standards delineated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Conducting a thorough search, the inquiry identified 248 records. The assessment of titles and abstracts led to 51 studies that had the potential for eligibility. After reviewing the full texts of the chosen studies, 4 studies involving 1521 patients constituted the ultimate findings. We concluded that the ligation procedure had a higher incidence of pulmonary embolism compared to the repair of vein injuries, while the repair procedure had a higher incidence of deep vein thrombosis than ligation. Additional large-scale randomized controlled trials are still necessary to further support the findings of this meta-analysis.

Juxtahepatic venous injuries are not AAST Grade V injuries if there is no contrast extravasation

Abstract Background: The organ injury scale (OIS) for liver trauma by the American Association of the Surgery of Trauma (AAST) was last updated in 2018 with new “imaging criteria” that continued to grade juxtahepatic venous (JHV) injuries, regardless of presence or absence of active bleeding, as Grade V. We hypothesized that JHV injury found on imaging, in the absence of active bleeding, should not be considered Grade V based on location alone. The aim of the study was to compare the outcomes of patients classified as AAST-OIS Grade V liver injuries based purely on JHV location, with patients who had AAST-OIS Grade I–III liver injuries. Materials and Methods: A retrospective analysis of 121 patients with liver injury from the TReCS database (June 2020–May 2023) was conducted. Patients underwent contrast-enhanced dual-phase computed tomography scans on admission were reviewed by both radiologists and surgeons. Patients diagnosed with JHV injuries (JHV – with no contrast extravasation [CE]) and patients with low-grade injuries (OIS I–III) were compared for baseline data on age, gender, injury severity score (ISS) scoring, injury mechanism, length of hospital stay, and liver-related complications. Results: Of 121 patients identified, 66 had Grade I–III injuries and 21 had Grade V injuries due to JHV location alone. Three of the latter group had CE and were excluded. Heterogeneity was compared between the two groups for age (P = 0.634), gender (P = 0.964), mechanisms (P = 0.346), and ISS (P = 0.068). The median length of stay for the JHV (with no CE) group was 4.5 days and 6.00 days for the OIS Grade I–III group (P = 0.233). One patient in the JHV group had hemobilia, and there were no other liver-related complications in the cohort. Conclusion: Our findings suggest that the “imaging” criterion of “JHV” injuries, in the absence of extravasation or significant disruption, may be safely revised to a lower grade on the AAST-OIS for liver injuries.

Evaluation of the suitability of using ArtiSential in various renal surgery: IDEAL stage 1 study

BackgroundArtiSential, a new articulating laparoscopic instruments, addresses the limited movement associated with conventional laparoscopic instruments. This study was conducted to assess the clinical effectiveness of ArtiSential in detailed steps of various renal surgery.MethodsThis study was approved by the Institutional Review Board of our institution and registered on the Clinical Research Information Service site of the Korea Disease Control and Prevention Agency. Participants meeting all inclusion and exclusion criteria were included in the clinical trial and underwent renal surgery. The clinical effectiveness of ArtiSential was assessed in terms of the feasibility and objective and subjective parameters across 9 detailed steps.ResultsOf the 15 potential candidates enrolled from October 2021 to November 2021, 1 patient dropped out due to anaphylaxis from an anesthetic agent, and 14 patients underwent laparoscopic surgery using ArtiSential. Of the 14 patients, 2 patients were converted to laparoscopic surgery using straight-shaped instruments due to the ischemia time exceeding 30 min, and 1 patient due to excessive bleeding. The feasibility for most steps was more than 90%, except the renorrhaphy step. The median total operation time and ischemia time were 161 and 23 min, respectively. The median estimated blood loss was 58.5 mL. Two cases of venous injury occurred during renal pedicle dissection step. The accuracy of the procedure judged by reviewers and usability judged by the operator were acceptable in all steps. The surgeon’s quantitatively measured stress score was the highest during renorrhaphy step.ConclusionsLaparoscopic surgery using ArtiSential is feasible for most steps except the renorrhaphy step. The difficulty of performing renorrhaphy is attributed to prolonged ischemia time, which could be addressed by overcoming the learning curve.Trial registrationClinical Research Information Service site of the Korea Disease Control and Prevention Agency, KCT0006532. Registered 03/09/2021, https://cris.nih.go.kr/cris/search/detailSearch.do?seq=24071.

A novel theory for rapid localization of the transverse-sigmoid sinus junction and “keyhole” in the retrosigmoid keyhole approach: micro-anatomical study, technique nuances, and clinical application

To determine a rapid and accurate method for locating the keypoint and “keyhole” in the suboccipital retrosigmoid keyhole approach. (1) Twelve adult skull specimens were selected to locate the anatomical landmarks on the external surface of the skull.The line between the infraorbital margin and superior margin of the external acoustic meatus was named the baseline. A coordinate system was established using the baseline and its perpendicular line through the top point of diagastric groove.The perpendicular distance (x), and the horizontal distance (y) between the central point of the “keyhole” and the top point of the digastric groove in that coordinate system were measured. The method was applied to fresh cadaveric specimens and 53 clinical cases to evaluate its application value. (1) x and y were 14.20 ± 2.63 mm and 6.54 ± 1.83 mm, respectively (left) and 14.95 ± 2.53 mm and 6.65 ± 1.61 mm, respectively (right). There was no significant difference between the left and right sides of the skull (P > 0.05). (2) The operative area was satisfactorily exposed in the fresh cadaveric specimens, and no venous sinus injury was observed. (3) In clinical practice, drilling did not cause injury to venous sinuses, the mean diameter of the bone windows was 2.0–2.5 cm, the mean craniotomy time was 26.01 ± 3.46 min, and the transverse and sigmoid sinuses of 47 patients were well-exposed. We propose a “one point, two lines, and two distances” for “keyhole” localization theory, that is we use the baseline between the infraorbital margin and superior margin of the external acoustic meatus and the perpendicular line to the baseline through the top point of the digastric groove to establish a coordinate system. And the drilling point was 14.0 mm above and 6.5 mm behind the top point of the digastric groove in the coordinate system.

Cubital vein access provides a practical alternative to internal jugular vein access for coronary sinus catheter placement.

Insertion of electrode catheters into the coronary sinus (CS) through the right internal jugular vein (RIJV) carries risks of pneumothorax and severe hematoma formation. This study was performed to compare the safety and feasibility of catheterization through the left cubital superficial vein versus the RIJV. This prospective nonrandomized study involved consecutive patients who underwent catheter ablation from September 2021 to February 2023. Blind puncture techniques were used in the left cubital vein group; ultrasound-guided insertion was performed in the RIJV group. The success rates of sheath insertion and CS catheterization, the procedure and fluoroscopy times of CS cannulation, and complications were compared between groups. The left cubital vein group comprised 152 patients, and the RIJV group comprised 58 patients. The sheath insertion success rate was significantly lower in the cubital vein group than in the RIJV group (84.9% vs 100%, respectively; p = .0008). In the cubital vein group, blind puncture attempts failed in 20 patients; three patients developed guidewire-induced venous injury. One arterial puncture occurred in the RIJV group. After successful sheath insertion, no significant differences were observed in the CS cannulation success rate (97% vs 100%, p = .55), procedure time (median [range], 93 [51-174] vs 74 [44-129] s; p = .19), or fluoroscopy time (median [range], 66 [36-134] vs 48 [30-92] s; p = .17). No serious complications requiring procedural discontinuation occurred. The left cubital vein approach is practical, offering a viable alternative to the RIJV approach.

Ginger protects against vein graft remodeling by precisely modulating ferroptotic stress in vascular smooth muscle cell dedifferentiation

Vein graft failure (VGF) is associated with vein graft (VG) intimal hyperplasia, which is characterized by abnormal accumulation of vascular smooth muscle cells (VSMCs). Most neointimal VSMCs are derived from pre-existing VSMCs via a process of VSMC phenotypic transition, also known as dedifferentiation. There is increasing evidence to suggest that ginger or its bioactive ingredients may block VSMC dedifferentiation, exerting vasoprotective functions; however, the precise mechanisms have not been fully characterized. Therefore, we investigated the effect of ginger on VSMC phenotypic transition in VG remodeling after transplantation. Ginger significantly inhibited neointimal hyperplasia and promoted lumen opening in a 3-month VG, which was primarily achieved by reducing ferroptotic stress. Ferroptotic stress is a pro-ferroptotic state. Contractile VSMCs did not die but instead gained a proliferative capacity and switched to the secretory type, forming neointima after vein transplantation. Ginger and its two main vasoprotective ingredients (6-gingerol and 6-shogaol) inhibit VSMC dedifferentiation by reducing ferroptotic stress. Network pharmacology analysis revealed that 6-gingerol inhibits ferroptotic stress by targeting P53 while 6-shogaol inhibits ferroptotic stress by targeting 5-lipoxygenase (Alox5), both promoting ferroptosis. Furthermore, both ingredients co-target peroxisome proliferator-activated receptor gamma (PPARγ), decreasing PPARγ mediated nicotinamide adenine dinucleotide phosphate (NADPH) oxidase 1 (Nox1) expression. Nox1 promotes intracellular reactive oxygen species (ROS) production and directly induces VSMC dedifferentiation. In addition, Nox1 is a ferroptosis-promoting gene that encourages ferroptotic stress production, indirectly leading to VSMC dedifferentiation. Ginger, a natural multi-targeted ferroptotic stress inhibitor, finely and effectively prevents VSMC phenotypic transition and protects against venous injury remodeling.

Double left brachiocephalic vein in a paediatric patient with CHD: a case report

AbstractAnomalous brachiocephalic vein (ABCV) is a rare entity of head and neck venous channel variations and malformations. Amongst the five subtypes of ABVC, double left brachiocephalic vein (DLBCV) is the rarest. We present the case of a 1-year-11-month-old syndromic child, who had global developmental delay (GDD) with Sprengel deformity and failure to thrive (suspected Klippel Feil phenotype), who presented to us for the cardiac evaluation. Her 2D echocardiography revealed unobstructed total anomalous supra-cardiac pulmonary venous connection. However, for the delineation of individual pulmonary venous course, CT-pulmonary angiography was advised. CTPA revealed supra-cardiac total anomalous pulmonary venous connection (TAPVC) with incidentally noted DLBCV. Importance of recognition of DLBCV enables us to prevent accidental venous injury during cardiac surgery and to avoid intraoperative technical issues during transvenous pacemaker insertion.

An Institutional Analysis of Early Postoperative Free Tissue Transfer Takeback Procedures.

Postoperative free tissue transfer reexploration procedures are relatively infrequent but associated with increased overall failure rates. This study examines the differences between flaps requiring takeback versus no takeback, as well as trends in reexploration techniques that may increase the odds of successful salvage. A retrospective review was conducted on all free tissue transfers performed at our institution from 2011 to 2022. Patients who underwent flap reexploration within 30 days of the original procedure were compared with a randomly selected control group who underwent free flap procedures without reexploration (1:2 cases to controls). Univariate and multivariate logistic regression analyses were performed. From 1,213 free tissue transfers performed in the study period, 187 patients were included in the analysis. Of the total flaps performed, 62 (0.05%) required takeback, and 125 were randomly selected as a control group. Free flap indication, flap type, reconstruction location, and number of venous anastomoses differed significantly between the two groups. Among the reexplored flaps, 8 (4.3% of the total) had a subsequent failure while 54 (87.10%) were salvaged, with significant differences in cause of initial flap failure, affected vessel type, and salvage technique. Free tissue transfers least prone to reexploration involved breast reconstruction in patients without predisposition to hypercoagulability or reconstruction history. When takeback operations were required, salvage was more likely in those without microvascular compromise or with an isolated venous injury who required a single exploratory operation.

Characterization of zebrafish coagulation cofactors Fviii and Fv mutants and modeling hemophilia A and factor V deficiency.

The aim of this study is to characterize zebrafish coagulation cofactors fviii and fv mutant fish and assess if they phenocopy classical hemophilia A and factor V deficiency in humans. The embryos from fviii and fv zebrafish heterozygote mutants generated by ENU mutagenesis were purchased from the ZIRC repository. They were reared to adulthood and genotyped. The heterozygote male and female were crossed to get homozygote, heterozygote, and wild-type fish. Functional kinetic coagulation assays and bleeding assays were performed on normal and mutant adult fish, and venous laser injury assays were performed on the larvae. The DNA from fviii and fv mutants were sequenced to confirm if they have a premature stop codon in exon 19, and in exon 2, respectively, and in both mutants, the amino acid glutamine is replaced with a stop codon. Homozygous and heterozygous 5 days post fertilization (dpf) larvae for fviii and fv deficient mutants exhibited prolonged time to occlusion after venous laser injury compared to wild-type controls. The homozygous and heterozygous fviii adult mutants showed modest bleeding and delayed fibrin formation in the kinetic partial thromboplastin time (kPTT) assay with their plasma. fv homozygous larvae had poor survival beyond 12 dpf. However, heterozygous fv mutants exhibited heavy bleeding and prolonged fibrin formation in the kPTT and kPT assay compared with wild-type siblings. Our characterization showed fviii and fv mutants from ZIRC phenocopied to a considerable extent classical hemophilia A and factor V deficiency in humans, respectively. These models should be useful in studying and developing novel drugs that reverse the phenotype and in generating suppressor mutations to identify novel factors that compensate for these deficiencies.

Abstract 154: Hierarchical Redundancy And Contextual Roles Of Vesicle-associated Membrane Proteins (VAMPs) In Platelet Function

Background: Platelet granule secretion, driven by the SNARE complex involving Vesicle-Associated Membrane Proteins (VAMPs) and t-SNAREs, is essential for vascular integrity. We dissected individual and combinatorial contributions of all four platelet VAMPs to granule secretion, hemostasis, and intracellular cargo trafficking. Research Questions: 1. Are specific VAMPs critical for granule fusion, or does total VAMP quantity (mass action) dictate secretion? 2. How do differential VAMP deficiencies impact hemostasis in arterial and venous microenvironments? 3. Do VAMPs influence platelet cargo loading and gene expression? Goals: Investigate individual and combinatorial roles of VAMPs in platelet biology and their context dependent contributions to hemostasis. Approach: We generated V7 -/- 8 -/- and V2 Δ 3 Δ 7 -/- 8 -/- mice, assessing granule secretion (dense, alpha, lysosomal) via ATP, PF4/P-selectin, and β-hexosaminidase/LAMP1 release assays, respectively. Hemostasis in arterial and venous models was evaluated with tail bleeding, FeCl3, and venous puncture injury assays. Cargo levels were analyzed using proteomic arrays, and platelet RNA sequencing identified transcriptional changes. Results: Global V7/V8 deletion modestly reduced secretion compared to isolated V8 deficiency. Surprisingly, while platelet-specific V2 Δ 3 Δ 7 -/- 8 -/- exhibited the most dramatic decrease, complete abolition was absent (p&lt;0.01). Alpha and lysosomal secretion were more affected than densegranule release. Both knockout models bled profusely and failed to form stable arterial thrombi (p&lt;0.01). Notably, only V2 Δ 3 Δ 7 -/- 8 -/- mice displayed significantly prolonged venous bleeding (p&lt;0.01). RNA sequencing revealed &gt;800 upregulated and &gt;500 downregulated transcripts in V7 - /- 8 -/- and V2 Δ 3 Δ 8 -/- platelets, suggesting shared transcriptional control by V7 and secondary VAMPs (V2 and V3). Conclusions: VAMP functions exhibit hierarchical redundancy, with V8 presence minimally impacting dense granule secretion and arterial hemostasis. Alpha granule release is more sensitive to VAMP loss. The requirements for platelet granule secretion for hemostasis are context dependent. The deletion of VAMPs disrupts platelet cargo trafficking and transcription.

Preperitoneal pelvic balloon tamponade-an effective intervention to control pelvic injury hemorrhage in a swine model.

Objective: This study aimed to estimate the effects of the volume of preperitoneal balloon (PPB) on arterial and venous hemorrhage in a swine pelvic fracture model. Methods: Twenty-four swine were randomized into 0-mL, 500-mL, 800-mL, and 1000-mL intra-hematoma PPB groups. They were subjected to open-book pelvic fracture and reproducible injuries in the external iliac artery and vein. The pelvic binder and IH-PPBs with different volumes of fluid were applied to control the active hemorrhage after arterial and venous injuries. The survival time and rate during 60-min observation and digital subtraction angiography (DSA) images were the primary endpoints in this study. Secondary endpoints included survival rate within 70min, peritoneal pressure, hemodynamics, blood loss, infusion fluid, blood pH, and lactate concentration. Results: Our results indicated that the 800-mL and 1000-mL groups had a higher survival rate (0%, 50%, 100% and 100% for 0, 500, 800, and 1000-mL groups respectively; p < 0.0001) and longer survival time (13.83 ± 2.64, 24.50 ± 6.29, 55.00 ± 6.33, and 60.00 ± 0.00min for 0, 500, 800, and 1,000 groups respectively; p < 0.0005) than the 0-mL or 500-mL groups during the 60min observation. Contrastingly, survival rate and time were comparable between 800-mL and 1000-mL groups during the 60-min observation. The IH-PPB volume was associated with an increase in the pressure of the balloon and the preperitoneal pressure but had no effect on the bladder pressure. Lastly, the 1000-mL group had a higher mean arterial pressure and systemic vascular resistance than the 800-mL group. Conclusion: IH-PPB volume-dependently controls vascular bleeding after pelvic fracture in the swine model. IH-PPB with a volume of 800mL and 1000mL efficiently managed pelvic fracture-associated arterial and venous hemorrhage and enhanced survival time and rate in the swine model without evidences of visceral injury.

Parasagittal Meningiomas: The Impact of Sinus Opening and Grade of Resection on Clinical Outcome and Recurrence in a Consecutive Series of Patients

Surgical management of parasagittal meningiomas (PMs) remains controversial in the literature. The need to pursue a resection as radical as possible and the high risk of venous injuries contribute to making the sinus opening a widely argued choice. This study aimed to analyze factors affecting the risk of recurrence and to assess clinical outcomes of patients who underwent surgical resection of PMs with conservative or aggressive management of the intrasinusal portion. A single-institution retrospective review of all patients with PM surgically treated between January 2013 and March 2021 was conducted. Among 56 patients, the sinus was opened in 32 patients (57%), and a conservative approach was used in 24 patients (43%). The sinus opening was found to be a predictive factor of radical resection (Simpson grade [SG] I-II) (P= 0.007). SG was the only predictive factor of recurrence (P < 0.001). The radical resection group (SG I-II) showed recurrence-free survival at 72 months of about 90% versus 30% in the non-radical resection group (SG III-IV) (log-rank test= 14.21, P < 0.001). Aggressive management of the sinus and radical resection were not found to be related to permanent deficit (P= 0.214 and P= 0.254) or worsening of Karnofsky performance scale score (P= 0.822 and P= 0.933). Removal of the intrasinusal portion of the tumor using standard procedures is not associated with a higher risk of permanent deficit or worsening of Karnofsky performance scale and reduces the risk of recurrence.

Hemorrhagic cerebral venous infarction after vein injury during intraoperative lesion resection: incidence, hemorrhagic stages, risk factors and prognosis.

Cerebral venous infarction (CVI) after vein injury during intraoperative lesion resection is associated with intracranial hemorrhage. We conducted this study to identify the incidence, clinical and imaging features, and prognosis of hemorrhage CVI. We performed a retrospective analysis of patients with confirmed CVI after vein injury who underwent craniotomy in our hospital. Postoperative clinical symptoms were observed, and imaging features were compared between patients with and without intracranial hemorrhages through CT examination. Variables were analyzed using univariate and multivariate regression analyses. Among 2,767 patients who underwent craniotomy, 93 cases of injured veins were identified intraoperatively. Hemorrhagic CVI was found in 38% (35/93). Multivariate analysis revealed that midline approach, meningioma, postoperative seizures, disorders of consciousness and interval in hours < 72 h were identified as predictors of hemorrhagic CVI. After 3 months of follow-up, the prognosis was poor in 15 cases (16%, 15/93), including death (two cases), vegetative survival (four cases), and severe disability (nine cases). Hemorrhagic CVI, as a critical complication after venous injury, can have disastrous consequences. Do not injure known veins intraoperatively. In case of injury, requisite remedial measures should be adopted during and after surgery.