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Plants are a valuable source of a wide range of secondary metabolites, which are used as pharmaceuticals preparations. The previous studied showed that many medicinal plants possessed hypotensive effects and affected vascular activity either by direct effect on vascular smooth muscles or indirectly by affecting endothelium vasoactive substances. The current review was designed to highlight the medicinal plants with hypotensive and vascular effects as promising future therapies because of efficacy and safety.

The article deals with the correction of cognitive disorders of vascular genesis. The importance of the impact on modifiable risk factors for cerebral ischemia is emphasized, as well as the need to improve hemodynamics. There are considered the effects of the preparation with combined nootropic and vasoactive action — Neuro-Norm containing piracetam and cinnarizine.

A radial-to-femoral pressure gradient (RFPG) can occur in roughly one-third of cardiac surgical patients. Such a gradient has been associated with smaller stature and potentially smaller radial artery diameter. We hypothesized that preoperative radial artery diameter could be a predictor of RFPG. We also investigated the clinical impact of using a femoral versus a radial arterial catheter in terms of vasoactive support.Using ultrasound, we measured the bilateral radial artery diameters of 160 cardiac surgical patients. All arterial pressure values were continuously recorded. Significant RFPG was defined as ≥25 mm Hg in systolic and/or ≥10 mm Hg in mean arterial pressure. One hundred and forty-nine additional patients were used to validate the impact of our observations.Using 78,013 pressure datapoints in 129 patients, 34.8% of patients had an RFPG with a mean duration of 54 ± 48 minutes. Patients with a radial artery diameter1.8 mm were more likely to have an RFPG (n = 14 [48.3%] vs 12 [22.2%];A significant RFPG occurs in one-third of cardiac surgical patients and in 48% of those with a radial artery diameter1.8 mm. The use of a single radial arterial catheter instead of dual radial and femoral catheters was associated with greater vasopressor requirements in the operating room and in the intensive care unit. We do not recommend the use of a single radial artery catheter in cardiac surgery.

Background Previous reports about risk factors for linezolid-induced thrombocytopenia have been insufficient, often due to the variability in study design and population, and some factors have not yet been studied. Aim The aims of this study are to determine potential risk factors for linezolid-induced thrombocytopenia, and to analyze the influencing factors of different thrombocytopenia definitions. Method This retrospective study involved patients who were administered intravenous linezolid for ≥ 1 day between January 1, 2015 and January 1, 2021. Their demographic and clinical data were extracted from electronic medical records. Thrombocytopenia was defined as: ①thrombocytopenia with platelet count

ntrodução: São claros os benefícios funcionais da mobilização precoce (MP) capaz de minimizar limitações e deformidades diante do imobilismo, porém são muitas as barreiras para conduzir a MP como prática de rotina na unidade de terapia intensiva (UTI), entre elas, o uso de drogas vasoativas (DVA), visto que está diretamente relacionado à fraqueza adquirida na UTI, além da presença da resistência da equipe multidisciplinar em mobilizar o paciente em uso de DVA. Objetivo: O objetivo desta revisão de literatura é levantar embasamento científico no manejo do paciente crítico em uso de DVA para MP em UTI. Métodos: É uma revisão integrativa da literatura, com pesquisa nas bases de dados: PEDro, Pubmed, Lilacs, com artigos publicados entre 2011 e 2018, em português e inglês, utilizando os termos: vasoactive drugs, early mobility, exercise in ICU, vasopressor e seus equivalentes em português. Resultados: Foram incluídos nove trabalhos que analisaram a intervenção de MP em pacientes com uso de DVA, com ou sem suporte ventilatório. Não houve um tratamento homogêneo entre os trabalhos pesquisados, variando entre exercícios no leito e fora, de ação passiva e/ou ativa. Porém, independente da conduta, houve melhora da resposta cardiovascular sem alterações relevantes quanto ao uso da DVA. Conclusão: A MP não é contraindicada para pacientes em UTI com uso de DVA e mostrou-se eficaz e segura sem promover alterações hemodinâmicas e cardiorrespiratórias relevantes, que determinassem sua contraindicação absoluta.

Sex differences in behaviour partly arise from the sexual dimorphism of brain anatomy between males and females. However, the sexual dimorphism of the tree shrew brain is unclear. In the present study, we examined the detailed distribution of vasoactive intestinal polypeptide-immunoreactive (VIP-ir) neurons and fibres in the suprachiasmatic nucleus (SCN) and VIP-ir fibres in the bed nucleus of the stria terminalis (BST) of male and female tree shrews. The overall volume of the SCN in male tree shrews was comparable with that in females. However, males showed a significantly higher density of VIP-ir cells and fibres in the SCN than females. The shape of the VIP-stained area in coronal sections was arched, elongated or oval in the lateral division (STL) and the anterior part of the medial division (STMA) of the BST and oval or round in the posterior part of the medial division of the BST (STMP). The volume of the VIP-stained BST in male tree shrews was similar to that in females. The overall distribution of VIP-ir fibres was similar between the sexes throughout the BST except within the STMA, where darkly stained fibres were observed in males, whereas lightly stained fibres were observed in females. Furthermore, male tree shrews showed a significantly higher intensity of Nissl staining in the medial preoptic area (MPA) and the ventral part of the medial division of the BST than females. These findings are the first to reveal sexual dimorphism in the SCN, BST and MPA of the tree shrew brain, providing neuroanatomical evidence of sexual dimorphism in these regions related to their roles in sex differences in physiology and behaviour.

Objective. To explore the clinical application of dynamic volume CT multiparameter imaging in the observation of penile hemodynamics in patients with abnormal vascular erections. Methods. 90 patients with suspected vascular abnormal erections treated in our hospital from January 2016 to January 2020 were included in the study, and 40 patients with psychologically abnormal erections were selected for the control. The corpus cavernosum injection vasoactive drug test (ICI) and dynamic volume CT and Doppler ultrasound were used to test the hemodynamics of the corpus cavernosum of all selected patients and to analyze the changes of penile length, circumference, systolic peak flow rate, diastolic peak flow rate, and blood flow resistance index in different types of penile erection disorder patients before and after ICI test. Results. Among the 90 patients with suspected vascular abnormal erection, 34 patients had arterial abnormal erection, 25 patients had venous abnormal erection, and 31 patients had mixed vascular abnormal erection. In patients with arterial abnormal erection and mixed vascular abnormal erection, penile cavernous body diameter, PSV, and abnormal erection V are smaller than those in patients with venous abnormal erection and psychological abnormal erection, while arterial abnormal erection and psychological abnormal erection are obviously higher in RI than venous abnormal erection and mixed vascular abnormal erection, and the difference is statistically significant ( P < 0.05 ). Before the ICI test, there was no significant difference in the penis circumference and length between the four groups of patients with arterial abnormal erection, venous abnormal erection, mixed vascular abnormal erection, and psychological abnormal erection ( P > 0.05 ); after the ICI test, patients with arterial abnormal erections had significantly shorter penis perimeter and penis length than those with venous abnormal erections, mixed vascular abnormal erections, and psychological abnormal erections ( P < 0.05 ). Conclusion. Dynamic volume CT can clearly reflect the penile hemodynamic state of patients with vascular abnormal erections, provide a powerful diagnostic basis for accurately and effectively determining the classification of vascular abnormal erections, and be worthy of popularization and clinical use.

Purpose of Review Management of vestibular schwannomas (VSs) is multimodal and include watchful observation, radiation treatment, and surgery. Over the past decades, a shift in treatment strategy toward radiation treatment has gradually displaced surgery from the main treatment option for VS. In recent years, however, surgery has been further refined by developments of microsurgical and endoscopic techniques and advances in intraoperative application of neuroprotective drugs. This article presents outcomes of modern surgical treatment of VS in the era of radiosurgery and reviews recent published advancements relevant to VS management. Recent Findings Following VS surgery, excellent tumor resection rates and cranial nerve outcomes were achieved in a consecutive series of 572 adult patients with mean postoperative follow up of 4 years. Innovations in surgical technique include endoscopic technique as additional tool to microsurgery, exploration of semi-sitting position for large tumors, and intraoperative use of vasoactive agents as neuroprotective strategy. Summary Despite great developments in radiation treatment of VS, surgery remains the key solution for the majority of the cases in order to achieve cure of the disease, long-term tumor control, and preservation of cranial nerve function at long-term.

Summary Crosstalk between endothelial cells (ECs) and pericytes or vascular smooth muscle cells (VSMCs) is essential for the proper functioning of blood vessels. This balance is disrupted in several vascular diseases but there are few experimental models which recapitulate this vascular cell dialogue in humans. Here, we developed a robust multi-cell type 3D vessel-on-chip (VoC) model based entirely on human induced pluripotent stem cells (hiPSCs). Within a fibrin hydrogel microenvironment, the hiPSC-derived vascular cells self-organized to form stable microvascular networks reproducibly, in which the vessels were lumenized and functional, responding as expected to vasoactive stimulation. Vascular organization and intracellular Ca2+ release kinetics in VSMCs could be quantified using automated image analysis based on open-source software CellProfiler and ImageJ on widefield or confocal images, setting the stage for use of the platform to study vascular (patho)physiology and therapy., Graphical abstract, Highlights • 3D VoC formed by hiPSC-ECs and hiPSC-VSMCs • Vascular organization in 3D VoC formed by hiPSC-VSMC and primary mural cells • Functional responses of hiPSC-VSMCs in 3D VoC • Automated analysis of microvascular network morphology and Ca2+ release in VSMCs, In this article, Orlova and colleagues describe the generation of an entirely human induced pluripotent stem cells (hiPSC)-derived vessel-on-chip composed with endothelial cells (ECs) and vascular smooth muscle cells (VSMCs). Changes in microvascular network architecture and intracellular Ca2+ release kinetics could be quantified during vascular organization or upon drug treatment providing a useful platform to study vascular development and disease.

This paper is a retrospective analysis of the long-term work of a large group of Russian scientists representing various Medical Institutions of St. Petersburg (in the past years of Leningrad) in the period from the 70s of the XX century to the present in the field of theoretical clinical lymphology. We aimed to discuss critical studies of a group of anatomists, in the sphere of the structure of lymphangions and lymph nodes in health and lymphedema of the lower extremities in humans. Experimental data of physiologists are presented, which made it possible for the first time to substantiate the functional mechanisms of active lymph transport in health and in lymphedema of the lower extremities. In addition, there are some results of testing biopsy specimens with various pharmacological agents and vasoactive substances. At last, there is an example of the clinical use of theoretical knowledge in the tactics of choice and expediency of surgical treatment of lymph drainage disorders in patients is given.

This systematic review and meta-analysis investigates the objective evidence regarding outcomes in head and neck free flap surgeries using vasoactive agents in the perioperative period. A search was performed in PubMed, Cochrane, Web of Science, and Scopus databases. Inclusion criteria were clinical studies in which vasopressors were used in head and neck free flap surgery during the intraoperative and perioperative period. Eighteen studies (n=5397) were included in the qualitative analysis and nine (n=4381) in the meta-analysis. There was no difference in flap failure outcomes with perioperative vasopressor use in head and neck free flap surgery (n=4015, OR=0.93, 95% CI [0.60, 1.44]). When patients received vasopressors perioperatively, there was an associated decrease in flap-specific complications (n=3881, OR=0.69, 95% CI [0.55, 0.87]). Intraoperative vasopressor use does not negatively impact free tissue transfer outcomes in head and neck surgery and may reduce overall free flap complications.

Background An increasing number of patients undergo surgical procedures worldwide each year, and despite advances in quality and care, morbidity and mortality rates remain high. Perioperative hypotension is a well-described condition, and is associated with adverse outcomes. Both fluids and vasoactive agents are commonly used to treat hypotension, however, whether one vasoactive agent is preferable over another has yet to be explored. Methods In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement, we plan to conduct a scoping review of studies assessing the use of vasoactive agents in patients undergoing non-cardiac surgery. We will provide an overview of indications, agents used and outcomes assessed. We will assess and report the certainty of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results We will provide descriptive analyses of the included studies accompanied by tabulated results. Conclusion The outlined scoping review will provide a summary of the body of evidence on the use of vasoactive agents in the non-cardiac surgical population.

Objective To determine the threshold of the inotropic score (IS) and vasoactive–inotropic score (VIS) for predicting mortality in pediatric septic shock. Method This retrospective cohort study included children aged 1 mo to 13 y with septic shock, requiring vasoactive medication. The area under curve receiver operating characteristic (AUROC) was calculated using mean IS and mean VIS to predict PICU mortality, and Youden index cut points were generated. Sensitivity, specificity, and binary regression analysis were performed. Results A total of 176 patients were enrolled (survivor, n = 72, 41% and nonsurvivor, n = 104, 59%). For predicting the PICU mortality, AUROC (95% CI) of IS was 0.80 (0.74–0.86) [sensitivity of 88.5 (80.7–94) and specificity of 58.3 (46.1–69.8)] and AUROC of VIS was 0.88 (0.82–0.92) [sensitivity of 83.7 (75.1–90.2) and specificity of 80.6 (69.5–89)]. The respective cutoff scores of IS and VIS were 28 and 42.5. On regression analysis (adjusted odds ratio, 95% CI), illness severity (PRISM-III) (1.12, 1.05–1.12), worst lactate value (1.31, 1.08–1.58), IS (> 28) (3.98, 1.24–12.80), and VIS (> 42.5) (4.66, 1.57–13.87) independently predicted the PICU mortality (r2 = 0.625). Conclusion Threshold of inotropic score (> 28) and vasoactive–inotropic score (> 42.5) were independently associated with PICU mortality. In addition to IS and VIS, severity and worst lactate value independently predicted septic shock mortality in PICU.

espanolLa sepsis y sus complicaciones representan uno de los mayores desafios contemporaneos. Desde hace anos constituyen la primera causa de muerte en terapia intensiva medica y postquirurgica y su incidencia aumenta con relacion al desarrollo de procedimientos mas invasivos, tratamientos inmunodepresores, quimioterapia, mayor edad de los enfermos, sindrome de inmunodeficiencia y floras hospitalarias multirresistentes. La metodologia de la investigacion, es una revision bibliografica que se apoyo en medios electronicos como Google academico, PubMed, entre otros. Donde se encontro informacion relevante que ayudo a la consecucion del presente trabajo. El objetivo fundamental es crear un instrumento de trabajo bastante explicito y completo que permita ser una referencia para otros investigadores, acerca del tema de estudio. La correcta clasificacion del shock de acuerdo a los consensos ya existentes sobre esta patologia es vital para el enfoque, tanto de diagnostico como del tratamiento, para reducir la morbilidad en los pacientes. Este es un problema de salud publica, ya que esta patologia se puede presentar en areas quirurgicas de centros de salud por intervenciones quirurgicas, es por ello que cualquier sitio que sea identificado como potencial para contraer sepsis debe ser identificado y tratado de forma oportuna. La deteccion rapida de la hipoperfusion tisular y una reanimacion agresiva, tiene como objetivo normalizar los parametros de perfusion. El uso de fluidos, administracion de antibioticos de amplio espectro, empleo de agentes inotropos y/o vasopresores y la eliminacion del foco infeccioso, como tratamiento posee evidencia de que mejora el pronostico de los pacientes con esta patologia. En el caso del shock septico refractario el uso de vasopresores, hidrocortisona y nuevos farmacos vasoactivos deben considerarse. Al igual que el soporte nutricional es importante, ya que el shock septico puede producir una complicacion grave como la desnutricion que debe ser prevenida y tratada adecuadamente. EnglishSepsis and its complications represent one of the greatest contemporary challenges. For years they have been the leading cause of death in intensive medical and postsurgical therapy and their incidence increases in relation to the development of more invasive procedures, immunosuppressive treatments, chemotherapy, older patients, immunodeficiency syndrome and multiresistant hospital floras. The research methodology is a bibliographic review that was supported by electronic media such as academic Google, PubMed, among others. Where relevant information was found that helped to achieve this work. The main objective is to create a fairly explicit and complete working instrument that allows it to be a reference for other researchers on the subject of study. The correct classification of shock according to the existing consensus on this pathology is vital for the approach, both diagnosis and treatment, to reduce morbidity in patients. This is a public health problem, since this pathology can occur in surgical areas of health centers due to surgical interventions, that is why any site that is identified as potential to contract sepsis must be identified and treated in a timely manner. Rapid detection of tissue hypoperfusion and aggressive resuscitation aims to normalize perfusion parameters. The use of fluids, administration of broad spectrum antibiotics, use of inotropic and / or vasopressor agents and the elimination of the infectious focus, as treatment, has evidence that it improves the prognosis of patients with this pathology. In the case of refractory septic shock, the use of vasopressors, hydrocortisone, and new vasoactive drugs should be considered. Like nutritional support, it is important, since septic shock can produce a serious complication such as malnutrition that must be prevented and treated appropriately.

Background: Acute poisoning is a major cause of suicide and public health problem all over the world. Evaluation of the morbidity and outcome of admitted patients can assess the efficacy of treatment, making it possible to take better decisions and to further improve quality of care. Objectives: The present study was aimed to study multiple factors associated with fatal poisoning of the patients admitted to ICU and to assess APACHE II Scoring System in prediction of poisoning outcome. Material and Methods: in this prospective study, from January 2019 to December 2019, critical patients with acute poisoning admitted to ICU, Menoufia University hospitals-Egypt were enrolled into this study. Data including demographic features, clinical and lab findings, Acute Physiology and Chronic Health Evaluation (APACHE II) at admission, mode and route of poisoning, the need for mechanical ventilation or vasoactive agents, duration of mechanical ventilation and ICU stay were documented, collected and analyzed by the relevant statistical methods. All patients were studied till death or discharge from the ICU. Results: During the study period, 152 out of 1745 patients admitted to the Menoufia poisoning control center (MPCC) were admitted to the ICU. Out of them, 54 died and 98 survived. The majority were in age group (20-40) years. Females were (62.5%) of the total cases. Intentional poisoning was predominant. Pesticides were the most commonly employed poison including aluminium phosphide and organophosphorus compounds. Aluminium phosphide was highly toxic. High APACHE II score, mechanical ventilation and inotropic support were associated with high mortality. Conclusion: Some findings were correlated with outcome in acute poisoning and can be used as guidance for risk assessment and treatment planning of the patients. The higher the APACHE II score, the more serious the condition becomes. Proper counseling to counteract the stressful situations to reduce fatalities. In addition, some policy should be applied to control the easy availability of poisons in the society.

Migraine headache treatment is quickly evolving. There have been three new acute migraine treatment options (i.e., lasmiditan, rimegepant, ubrogepant) and four new preventive migraine treatment options (i.e., erenumab, fremanezumab, galcanezumab, eptinezumab) released in the past 3 years. The new migraine treatments are focusing on pathways within the newly, better understood neurovascular hypothesis that further describes the pathophysiology of migraine headaches in more detail than before. The discovery of vasoactive peptides, such as calcitonin gene-related peptide, has led to the development of many of these migraine agents. Rimegepant is one of these newly approved agents for acute migraine treatment in adults with or without aura. Rimegepant has been found to decrease pain and symptoms associated with migraine attacks and is generally well-tolerated.

BACKGROUND To explore the effect mechanism of "treat the spleen" therapy on immune thrombocytopenia (ITP) based on the characteristics of vasoactive factors. METHODS The ITP mice model was established by passive immunomodeling. 120 successfully modeled BALB/c mice were randomly divided into 6 groups: normal group, model group, prednisone group, Guipi Decoction group, Jianpi Yiqi group, and Jianpi Shexue group. These mice were treated with medicine for 16 days. After treatment, the platelet (PLT) counts and the degree of bleeding were evaluated, and the serum ET-1, NO, NOS3, TXA2, PGI2, vWF, VCAM-1, and TM contents of the model mice were detected by enzyme-linked immunosorbent assay (ELISA). RESULTS The PLT counts in peripheral blood of mice in each experimental group significantly decreased compared with that in the normal group (P

OBJECTIVE: The management of early hypotension in extremely low gestational age neonates (ELGANs) varies greatly between centers. The objective of this study was to provide updated data on the use of vasoactive medications in ELGANs during the first postnatal week. STUDY DESIGN: We identified ELGANs (22-27 weeks gestational age) cared for at Pediatrix neonatal intensive care units from 2009-2018. We evaluated the frequency of exposure to vasoactive medications by gestational age, and compared use of vasoactive medications between 2 epochs (2009-2013 and 2014-2018). RESULTS: A total of 10 070/34 234 (29%) ELGANs received ≥1 vasoactive medication. Dopamine was the most frequently used vasoactive medication. The majority (83%) of treated ELGANs initiated therapy on postnatal day 0-1. Overall use of vasoactive medications was slightly lower in 2014-2018 than 2009-2013 (28% vs 31%, p

We sought to review the pharmacology of vasoactive therapy and fluid administration in sepsis and septic shock, with specific insight into the physiologic interplay of these agents. A PubMed/MEDLINE search was conducted using the following terms (vasopressor OR vasoactive OR inotrope) AND (crystalloid OR colloid OR fluid) AND (sepsis) AND (shock OR septic shock) from 1965 to October 2020. A total of 1,022 citations were reviewed with only relevant clinical data extracted. While physiologic rationale provides a hypothetical foundation for interaction between fluid and vasopressor administration, few studies have sought to evaluate the clinical impact of this synergy. Current guidelines are not in alignment with the data available, which suggests a potential benefit from low-dose fluid administration and early vasopressor exposure. Future data must account for the impact of both of these pharmacotherapies when assessing clinical outcomes and should assess personalization of therapy based on the possible interaction.

Церебральний атеросклероз (ЦА) — дисфункція мозку, що виникає внаслідок дифузного і/або дрібно-вогнищевого пошкодження мозкової тканини в умовах недостатності церебрального кровопостачання і повільно прогресує протягом тривалого часу. Метою нашого дослідження є комплексний аналіз ефективності та оцінка безпеки курсового приймання амінофенілмасляної кислоти (АФМК) у пацієнтів із ЦА і цукровим діабетом 2-го типу (ЦД2) як ад’ювантного до базової терапії, який використовується в Україні відповідно до стандартів ведення пацієнтів із цією патологією за схемою: по 1 табл. (250 мг) 2 рази на день протягом місяця. Це клінічне дослідження проводилося як наглядове (неінтервенційне), відкрите, контрольоване, рандомізоване, проспективне дослідження, в якому АФМК призначалася відповідно до зареєстрованих показань. У дослідженні взяли участь 26 пацієнтів (середній вік становив 43±6 років) — 5 чоловіків та 21 жінка, які отримували лікування в Державній установі «Інститут ендокринології та обміну речовин ім. В.П. Комісаренка НАМН України» з приводу ЦД2 в стадії субкомпенсації, який супроводжувався ЦА. Встановлено, що в пацієнтів із ЦА і ЦД2 під впливом курсового лікування АФМК активізуються когнітивні функції (підвищується рівень уваги та покращується пам’ять), поліпшується емоційна сфера (знижується рівень тривоги) і спостерігається відносна вазоактивна дія на церебральну гемодинаміку (знижується периферичний опір в окремих судинах каротидного і вертебро-базилярного басейнів). За даними спектрального та часового аналізу варіабельності ритму серця (ВРС) АФМК гармонізує симпато-парасимпатичний баланс у пацієнтів із ЦА і ЦД2. Позитивний вплив АФМК на нейропсихологічні функції, церебральний кровотік і ВРС дає підґрунтя рекомендувати цей препарат у схему комплексного лікування пацієнтів із ЦА і ЦД2.

Aim of the study.To investigate the vasoactive drugs for urinary bladder wall ischemia correction, based on its role in OAB pathogenesis. Patients and methods.OAB treatment in 150 women was performed. In addition to the standard anticholinergic therapy microcirculation corrector was prescribed to some patients with insufficient treatment efficacy. Results.The combination of simultaneous prescription of anticholinergic and vasoactive drugs was effective for OAB treatment. The treatment resulted in significant decrease of the OAB symptoms. Conclusion.Low efficacy of M-cholinolytic therapy of the OAB patients is determined by the blood flow disturbances in the urinary bladder wall. It is reasonable to include the vasoactive drugs in complex OAB therapy.

Smooth muscle cells (SMCs) usually express a contractile phenotype in the healthy aorta. However, aortic SMCs have the ability to undergo profound changes in phenotype in response to changes in their extracellular environment, as occurs in ascending thoracic aortic aneurysms (ATAA). Accordingly, there is a pressing need to quantify the mechanobiological effects of these changes at single cell level. To address this need, we applied Traction Force Microscopy (TFM) on 759 cells coming from three primary healthy (AoPrim) human SMC lineages and three primary aneurysmal (AnevPrim) human SMC lineages, from age and gender matched donors. We measured the basal traction forces applied by each of these cells onto compliant hydrogels of different stiffness (4, 8, 12, 25 kPa). Although the range of force generation by SMCs suggested some heterogeneity, we observed that: 1. the traction forces were significantly larger on substrates of larger stiffness; 2. traction forces in AnevPrim were significantly higher than in AoPrim cells. We modelled computationally the dynamic force generation process in SMCs using the motor-clutch model and found that it accounts well for the stiffness-dependent traction forces. The existence of larger traction forces in the AnevPrim SMCs were related to the larger size of cells in these lineages. We conclude that phenotype changes occurring in ATAA, which were previously known to reduce the expression of elongated and contractile SMCs (rendering SMCs less responsive to vasoactive agents), tend also to induce stronger SMCs. Future work aims at understanding the causes of this alteration process in aortic aneurysms. Supplementary information The online version of this article (10.1007/s10237-020-01412-6) contains supplementary material, which is available to authorized users.

COVID 19 pandemic has affected the world for more than one year now. It has had impact on children as well, but the numbers have been fewer than adults, with lesser morbidity. Children have been commonly asymptomatic and are suspected to be the spreaders to the more susceptible part of the community. Nasopharyngeal swab testing is difficult and challenging in smaller children, and therefore their results should be interpreted with caution. Multisystem involvement has been seen in some children who required ICU admission. Most centers treated these cases as a multisystem inflammatory syndrome and used vasoactive agents for support. Overall, children showed lower morbidity and mortality all over the world.

Background: The role of vasoactive medications in septic shock is well-defined, but the appropriate time of initiation of these medications in reference to fluid boluses is not clear. We planned to study prospectively the practices and outcome of initiation of vasoactive infusions with respect to resuscitation fluids boluses in pediatric septic shock. Patients and methods: Children aged 1 month to 18 years diagnosed with septic shock were enrolled to receive fluid resuscitation boluses along with vasoactive drugs. The primary outcome was to look at various practices of the initiation of vasoactive infusions; accordingly, patients were categorized into three groups: N1 received vasoactive infusions after completion of the first bolus (20 mL/kg), N2 after the second (40 mL/kg), and N3 after the third fluid (60 mL/kg) bolus. Secondary outcomes were to compare the time taken, amount of fluid required to achieve hemodynamic stability, total fluid required, and complications in the first 24 hours of treatment and mortality. Results: Hundred children were enrolled and grouped into N1, N2, and N3 with 46, 10, and 44 patients, respectively. The volume of fluid required to achieve the resolution of shock in N1 (40 ± 10 mL/kg) was significantly less than in N2 (70 ± 10 mL/kg) and N3 (70 ± 20 mL/kg); p = 0.02. The time taken to achieve hemodynamic stability was significantly less in N1 (115 ± 45 minutes) than in N2 (196 ± 32 minutes) and N3 (212 ± 44 minutes); p = 0.02. The volume of intravenous fluid required in the first 24 hours (p = 0.02) and complications were lower in the N1 group (p = 0.04). No statistical difference in mortality was seen. Conclusion: Early initiation of vasoactive infusions (after the first bolus) resulted in less total fluid volume, lesser time to achieve hemodynamic stability, less fluid boluses, less length of stay in the pediatric intensive care unit, and lesser complications in the first 24 hours. Highlight: Early initiation of vasoactive infusions—after completion of the first fluid bolus resulted in less need for further fluid boluses, lesser time for shock resolution, lesser fluid overload, and less PICU stay—in pediatric septic shock. How to cite this article: Karanvir, Gupta S, Kumar V. Practices of Initiation of Vasoactive Drugs in Relation to Resuscitation Fluids in Children with Septic Shock: A Prospective Observational Study. Indian J Crit Care Med 2021;25(8):928–933.

Эндотелиальные клетки, выстилающие стенки сосудов, преобразовывают деформацию собственных структур, вызванную током крови, в химические сигналы, одним из которых является важный регулятор просвета сосуда - оксид азота (NO). К настоящему моменту накоплен большой объём данных о клеточных механизмах активации продукции NO, однако сведений о динамике генерации оксида азота эндотелиальными клетками в зависимости от гидродинамических условий недостаточно. В этой связи разработка микрофлюидных систем in vitro, имитирующих кровеносное русло, и изучение в них эндотелия в сложных гидродинамических условиях является актуальной задачей. В данной работе для создания контролируемых гидродинамических условий для монослоя эндотелиоцитоподобных клеток EA.hy926 была спроектирована и разработана микрофлюидная система, имитирующая линейные участки микрососудистого русла. Методом непрямого определения содержания оксида азота (II) NO с использованием флуоресцентного зонда 4,5-диаминофлуоресцеина DAF-2 впервые получены данные об увеличении продукции NO клетками EA.hy926 при механическом стрессе, создаваемом потоком ростовой среды. Представлены расчетные гидродинамические характеристики микрофлюидной системы, а также методика измерения продукции NO. Возможность исследования функциональной активности эндотелия позволяет использовать разработанную микрофлюидную модельную систему как для изучения клеточно-автономных регуляторных свойств эндотелия при действии ряда вазоактивных фармакологических препаратов и других методов воздействия на эндотелий, так и при моделируемой дисфункции эндотелия. Endothelial cells lining vascular walls transform the flow-induced deformation of their own structures into chemical signals, one of which, nitric oxide (NO), is an important regulator of the vascular lumen diameter. By present, a large amount of data on cellular mechanisms for activation of NO production has been accumulated. However, there is insufficient information on changes in endothelial NO generation under different hydrodynamic conditions. Therefore, development of microfluidic systems that model blood vessels in vitro and using them to study the endothelium under complex hydrodynamic conditions are relevant tasks. In this study, a microfluidic system was developed to create controlled hydrodynamic conditions for a monolayer of endotheliocyte-like cells EAhy.926. This system simulates linear sections of the microvasculature. By indirect measurement of NO (II) content with a fluorescent 4,5-diaminofluorescein (DAF-2) probe, we showed an increase in the NO production by EAhy.926 cells under mechanical stress generated by the medium flow. The article presents the method for measuring NO production and the calculated hydrodynamic characteristics of the microfluidic system. The results showed that the developed microfluidic model system is promising for studying cell-autonomous regulatory properties of the endothelium both under the action of vasoactive agents and in simulated endothelial dysfunction.

Adrenoceptor and calcium channel modulating medications are widely used in clinical practice for acute neurological and systemic conditions. It is generally assumed that the cerebrovascular effects of these drugs mirror that of their systemic effects – and this is reflected in how these medications are currently used in clinical practice. However, recent research suggests that there are distinct cerebrovascular-specific effects of these medications that are related to the unique characteristics of the cerebrovascular anatomy including the regional heterogeneity in density and distribution of adrenoceptor subtypes and calcium channels along the cerebrovasculature. In this review, we critically evaluate existing basic science and clinical research to discuss known and putative interactions between adrenoceptor and calcium channel modulating pharmacotherapies, the neurovascular unit, and cerebrovascular anatomy. In doing so, we provide a rationale for selecting vasoactive medications based on lesion location and lay a foundation for future investigations that will define neuroprotective paradigms of adrenoceptor and calcium channel modulating therapies to improve neurological outcomes in acute neurological and systemic disorders.

Objectives This study sought to characterize in-hospital treatment patterns and associated patient outcomes among patients hospitalized for heart failure (HF) in U.S. clinical practice. Background Hospitalizations for HF are common and associated with poor patient outcomes. Real-world patterns of in-hospital treatment, including diuretic therapy, in contemporary U.S. practice are unknown. Methods Using Optum de-identified Electronic Health Record data from 2007 through 2018, patients hospitalized for a primary diagnosis of HF (ejection fraction ≤40%) and who were hemodynamically stable at admission, without concurrent acute coronary syndrome or end-stage renal disease, and treated with intravenous (IV) diuretic agents within 48 h of admission were identified. Patients were categorized into 1 of 4 mutually exclusive hierarchical treatment groups defined by complexity of treatment during hospitalization (intensified treatment with mechanical support or IV vasoactive therapy, IV diuretic therapy reinitiated after discontinuation for ≥1 day without intensified treatment, IV diuretic dose increase/combination diuretic treatment without intensified treatment or IV diuretic reinitiation, or uncomplicated). Results Of 22,677 patients hospitalized for HF with reduced ejection fraction (HFrEF), 66% had uncomplicated hospitalizations without escalation of treatment beyond initial IV diuretic therapy. Among 7,809 remaining patients, the highest level of therapy received was IV diuretic dose increase/combination diuretic treatment in 25%, IV diuretic reinitiation in 36%, and intensified therapy in 39%. Overall, 19% of all patients had reinitiation of IV diuretic agents (26% of such patients had multiple instances), 12% were simultaneously treated with multiple diuretics, and 61% were transitioned to oral diuretic agents before discharge. Compared with uncomplicated treatment, IV diuretic reinitiation and intensified treatment were associated with significantly longer median length of stay (uncomplicated: 4 days; IV diuretic reinitiation: 8 days; intensified: 10 days) and higher rates of in-hospital (uncomplicated: 1.6%; IV diuretic reinitiation: 4.2%; intensified: 13.2%) and 30-day post-discharge mortality (uncomplicated: 5.2%; IV diuretic reinitiation: 9.7%; intensified: 12.7%). Conclusions In this contemporary real-world population of U.S. patients hospitalized for HFrEF, one-third of patients had in-hospital treatment escalated beyond initial IV diuretic therapy. These more complex treatment patterns were associated with highly variable patterns of diuretic use, longer hospital lengths of stay, and higher mortality. Standardized and evidence-based approaches are needed to improve the efficiency and effectiveness of in-hospital HFrEF care.

The aim of the study was to identify associations between allelic variants of AGT, AGT2R1 and NOS3 genes with production of endo-thelin-1 (ET-1) and nitric oxide (NO) in young residents of the Russian North without a history of cardiovascular diseases. Methods. The sample consisted of 286 young adults (116 females and 170 males) born in the Arkhangelsk region. Single nucleotide polymorphisms in the AGT, AGT2R1 and NOS3 genes were determined by polymerase chain reaction (PCR). Plasma NO oxide and ET-1 levels were measured. Results. T704C polymorphism in AGT gene was not associated with the studied vasoactive endothelial factors. However, vasoactive factors production in homozygotes with mutant T/T alleles of C521T polymorphism in the same gene is shifted towards vasoconstrictive factors. The level of ET-1 in the group with T/T genotype was higher than in the groups with C/T and C/C genotypes (p = 0.006 and p = 0.04, respectively). Homozygotes with mutant C alleles of AGT2R1 gene had higher concentration of ET-1 as compared to homozygotes with wild-type A alleles (p = 0.012). Young men with 786 C/C of NOS3 gene had higher plasma concentration of ET-1 than individuals with C/T (p = 0.01) and T/T (p = 0.07). ET-1 was higher in the group of girls homozygotes with mutant C alleles, however no statistically significant differences were found. Conclusions. Our results suggest that the risk of imbalance in vasoactive factors in young healthy residents of the Russian North is associated with the increase in ET-1 production level, but not with NO level. The presence of 521 T/T genotype in AGT gene, 1666C/C in AGT2R1 gene and -786C/C in NOS3 gene increases the risk of vasoactive factors imbalance development towards vasoconstriction.

Author(s): Kunas, Grace; Smereck, Janet A.; Ladkany, Diana; Davis, Jonathan E. | Abstract: Introduction: Priapism, a time-sensitive urologic emergency, is associated with hematologic disorders, malignancies, trauma, pharmaceuticals, and recreational drugs.Case Report: A 51-year-old male presented with 36 hours of priapism after recreational use of nonprescribed pharmaceuticals including an oral phosphodiesterase inhibitor and intracorporally injected erectile medications, together with unspecified quantities of cocaine and alcohol. Venous blood gas confirmed ischemic priapism. Detumescence was achieved with intracavernosal phenylephrine injection, aspiration, and irrigation.Conclusion: This case highlights the risk that recreational use of vasoactive medications by patients who seek to prolong sexual activity may lead to delayed presentation for ischemic priapism

Aim: To determine the clinical features and management of ulcers of the lower limb. Methods: The Department of General Surgery conducted a prospective cross-sectional analysis. With the aid of computer-generated random numbers, 100 patients with chronic leg ulcers were chosen at random from those who visited the OPD or were admitted to the surgical ward. After determining the primary cause of leg ulcers, proper antibiotic coverage for gram positive, gram negative, and anaerobic organisms, proper glycaemic control, leg elevation, compression bandaging, total cessation of smoking and causative drugs, nutritional support, vasoactive agents to restore blood flow, nerve stimulation, and proper wound care with debridement slough excision are also recommended. Results: The leg ulcers were more prevalent in the age group 40-70 years. Test of proportion showed that proportion of males 85% was significantly higher than that of females 15% (Z=9.74; p

Background Increasing evidence suggests that vasoactive neuropeptides such as pituitary adenylate cyclase-activating polypeptide-38 (PACAP-38), substance P, calcitonin gene-related peptide, and vasoactive intestinal peptide are involved in the pathophysiology of migraine in adults, but their role in pediatric migraineurs remains unclear. We prospectively investigated plasma levels of these vasoactive neuropeptides in pediatric migraine patients without aura and compared the results with those of age-matched healthy controls. Methods Thirty-eight children aged 6–18 years with migraine without aura and 20 age-matched control subjects were included in the study. Neuropeptides in plasma samples from the controls, and in either the ictal or interictal periods in pediatric migraine without aura, were measured using ELISA. Results PACAP-38 and vasoactive intestinal peptide levels in both ictal and interictal plasma were higher in the patients with pediatric migraine without aura than in the controls ( p Conclusions This study demonstrates increased plasma PACAP-38 and vasoactive intestinal peptide levels, but not calcitonin gene-related peptide and substance P levels, in pediatric patients with migraine during both attack and attack-free periods. The study findings suggest that PACAP-38 and vasoactive intestinal peptide may be implicated in the pathophysiology of migraine, particularly in pediatric migraineurs.

Objective: To identify the risk factors for the development of acute kidney injury and for short and long-term mortality of patients with acute kidney injury after admission to the Pediatric Intensive Care Unit. Materials and methods: Retrospective analysis of patients admitted to the Pediatric Intensive Care Unit from January 2004 to December 2008. Acute kidney injury was defined by the KDIGO criterion. Risk factors for acute kidney injury, in-hospital, and long-term mortality were obtained through multivariate logistic regression analysis. Long-term mortality (up to 2011) was obtained by searching the institution's database and by telephone contact with patients' family members. Results: A total of 434 patients were evaluated and the incidence of acute kidney injury was 64%. Most acute kidney injury episodes (78%) occurred within the first 24hours after admission to the Pediatric Intensive Care Unit. The risk factors for the development of acute kidney injury were: low volume of diuresis, younger age, mechanical ventilation, vasoactive drugs, diuretics, and amphotericin. Lower weight, positive fluid balance, acute kidney injury, dopamine use and mechanical ventilation were independent risk factors for in-hospital mortality. Long-term mortality was 17.8%. Systolic blood pressure, PRISM score, low volume of diuresis, and mechanical ventilation were independent risk factors associated with long-term mortality after admission to the Pediatric Intensive Care Unit. Conclusion: Acute kidney injury was a frequent, early event, and was associated with in-hospital mortality and long-term mortality after admission to the Pediatric Intensive Care Unit. Resumo Objetivo: Identificar os fatores de risco para o desenvolvimento de lesão renal aguda, mortalidade a curto e em longo prazo de pacientes com lesão renal aguda após internação em Unidade de Terapia Intensiva Pediátrica. Materiais e métodos: Análise retrospectiva de pacientes internados em unidade de terapia intensiva pediátrica de janeiro de 2004 a dezembro de 2008. Lesão renal aguda foi definida pelo critério KDIGO. Fatores de risco para lesão renal aguda, mortalidade hospitalar e em longo prazo foram obtidos através de análise multivariada por regressão logística. Mortalidade em longo prazo (até 2011) foi obtida através de busca no banco de dados da instituição e contato telefônico com parentes dos pacientes. Resultados: Foram avaliados 434 pacientes e a incidência de lesão renal aguda foi de 64%. A maioria dos episódios de lesão renal aguda (78%) ocorreu nas primeiras 24 horas após internação na Unidade de Terapia Intensiva Pediátrica. Os fatores de risco para o desenvolvimento de lesão renal aguda encontrados foram: baixo volume de diurese, menoridade, uso de ventilação mecânica, droga vasoativa, diurético e anfotericina. Menor peso, balanço hídrico positivo, lesão renal aguda, uso de dopamina e ventilação mecânica foram fatores de risco independentes para mortalidade hospitalar. A mortalidade em longo prazo foi de 17,8%. Pressão arterial sistólica, escore PRISM, baixo volume de diurese e ventilação mecânica foram fatores de risco independentes associados à mortalidade em longo prazo após internação na Unidade de Terapia Intensiva Pediátrica. Conclusão: Lesão renal aguda foi um evento frequente, precoce e esteve associada à mortalidade hospitalar e em longo prazo após internação na Unidade de Terapia Intensiva Pediátrica.

Resumo Este artigo analisa as condutas de fim de vida em unidades de terapia intensiva pediátrica brasileiras. Trata-se de estudo observacional, retrospectivo, multicêntrico, incluindo crianças que faleceram entre janeiro e dezembro de 2017. Durante o período ocorreram 149 óbitos, dos quais 54 foram selecionados. Constatou-se que 83,3% dos pacientes apresentavam alguma doença de base, com choque séptico como principal causa de óbito (38,9%). Limitações de suporte de vida foram descritas em 46,3% dos prontuários, e ordem de não reanimar em 37%; porém, 74,1% dos pacientes deixaram de ser reanimados. A prática de não reanimar pacientes com prognóstico reservado tem se disseminado, e aponta-se para melhores cuidados nas últimas 48 horas de vida. No entanto, ainda se verifica uso excessivo de procedimentos invasivos, ventilação mecânica e drogas vasoativas nas horas derradeiras. Abstract This article analyzes end-of-life procedures in Brazilian pediatric intensive care units. This is an observational, retrospective, multicenter study, including children who died between January and December 2017. During the period, 149 deaths occurred, of which 54 were selected. We found that 83.3% of patients had a base illness, being septic shock the main cause of death (38.9%). Life support limitations were described in 46.3% of the medical records, and a do-not-resuscitate order for 37% of the patients; however, 74.1% were not resuscitated. The practice of not resuscitating patients with a reserved prognosis and better care in the last 48 hours of life have become more common in recent years. However, there are still excessive use of invasive procedures, mechanical ventilation, and vasoactive drugs in the last hours of life. Resumen El objetivo de este artículo es analizar las conductas al final de la vida en unidades de cuidados intensivos pediátricos brasileños. Este es un estudio observacional, retrospectivo, multicéntrico, que incluye a niños que murieron entre enero y diciembre de 2017. Durante el período, ocurrieron 149 muertes, de las cuales 54 fueron seleccionadas. Se encontró que el 83,3% de los pacientes tenían alguna enfermedad de base, con shock séptico como la principal causa de muerte (38,9%). Las limitaciones de soporte vital se describieron en el 46,3% de los registros médicos, y el orden de no resucitar en el 37%; sin embargo, no se resucitaron el 74,1% de los pacientes. La práctica de no resucitar a pacientes con mal pronóstico es cada vez más frecuente, y ya se pueden observar mejoras en la atención en las últimas 48 horas de vida. Sin embargo, todavía hay un uso excesivo de procedimientos invasivos, ventilación mecánica y drogas vasoactivas en las últimas horas.

Background The efficiency of transdermal drug delivery may be increased by pretreating the skin with microneedles, but distinct effects of microneedles and the microneedle-enhanced delivery of vasoactive drugs on the skin microvasculature are still not well investigated. Materials and methods In eight healthy human subjects, we measured the microvascular response to microneedle-induced microtraumas in the skin microvasculature using polarized light spectroscopy imaging (Tissue Viability imaging, TiVi). The microvascular response was assessed for up to 48 hours for three microneedle sizes (300 µm, 500 µm, and 750 µm) and for different pressures and application times. Results In our results, microneedle application increased the local red blood cell (RBC) concentration for up to 24 hours dependent on the needle lengths, applied time, and force. Conclusion Optimization of microneedles size, pressure, and application time should be taken into account for future protocols for drug delivery and experimental provocations.

Penanganan secara cepat dan tepat untuk menghentikan pendarahan merupakan salah satu pilar penting dalam tata laksana kasus acute variceal haemorhage (AVH). Terdapat beberapa pilihan obat yang dapat digunakan untuk menghentikan pendarahan yang terjadi, salah satunya dengan menggunakan Terlipressin, sebuah obat yang baru masuk Indonesia pada tahun 2019. Pengetahuan terkait efektivitas dan keamanan penggunaan Terlipressin sangat diperlukan untuk menunjang penggunaan obat yang optimal dan mencegah penggunaan obat secara berlebihan khususnya pada periode awal keberadaan obat tersebut di Indonesia. Kajian pustaka ini bersifat naratif dan memaparkan beberapa data terkait: profil dasar Terlipressin, efektivitas dan keamanan penggunaan pada kasus AVH yang berbasis bukti (evidence-based), posisi terapi menggunakan Terlipressin pada beberapa pedoman terapi, serta komparasi biaya terapi Terlipressin bila dibandingkan obat vasoaktif lainnya. Hanya pustaka terpublikasi dalam bentuk kajian sistematis dan meta-analisis yang digunakan dalam tinjauan efektivitas dan keamanan. Terlipressin memiliki beberapa karakteristik farmakokinetik dan farmakodinamik yang dapat memberikan keuntungan terkait teknis pemberian dibandingkan dengan beberapa obat vasoaktif yang lain. Namun demikian, hal tersebut tidak berarti bahwa Terlipressin lebih unggul dibandingkan dengan jenis vasoaktif yang lain. Hasil kajian terhadap tiga (3) artikel kajian sistematis dan meta-analisis menunjukkan bahwa efektivitas dan keamanan Terlipressin tidak lebih baik secara signifikan dibandingkan dengan obat vasoaktif lain. Oleh karena itu, Terlipressin bukan merupakan satu-satunya obat yang direkomendasikan sebagai pilihan pertama vasoaktif pada tata-laksana AVH. Sebagai obat yang relatif baru, biaya penggunaan Terlipressin lebih tinggi dibandingkan vasoaktif pilihan pertama yang lain. Dengan mempertimbangkan beberapa hal tersebut, Terlipressin sebaiknya digunakan pada pasien yang dapat memperoleh keuntungan klinis optimal, misalnya pasien dengan kontraindikasi atau riwayat efek samping dengan vasoaktif yang lain.

Background Hoof disease is one of the three major diseases that often occur in dairy cows. The impact of this disease on dairy farming is second only to mastitis. Laminitis is a diffuse, aseptic, serous, non-purulent inflammation of the dermal papillae and vascular layers of the cow’s hoof wall. In the pasture, laminitis occurs mostly in the laminae, that is, inside the hoof shell. No lesions can be seen on the surface. Therefore, laminitis cannot attract the attention of veterinarians. However, laminitis has become a major factor that seriously affects the health and welfare of dairy cows, making it an important cause of hindering the performance of dairy cows. Methods The study was conducted at a dairy farm in Harbin, Heilongjiang province, China. We selected a sample of the laminitis cows based on the veterinary diagnosis, took blood from the jugular vein and then separated the plasma, and measured the index with the Elisa kit. In this study, the markers of inflammatory and vasoactive substances status in dairy cows consisted of subclinical laminitis (SCL, n = 20), chronic laminitis (CL, n = 20) and healthy dairy cows (CON, n = 20) under the local management conditions were investigated. Results Compared with healthy cattle, HIS, IL-6, LPS, and TNF-α in subclinical laminitis group significantly increased (P P P P P P Conclusion This study reported for the first time that pasture laminitis was divided into subclinical laminitis and clinical chronic laminitis. Through research on the inflammatory factors and vasoactive substances of dairy cows, it is found that there is a close relationship between them, which affects the metabolic cycle of dairy cows. These indicators are abnormally expressed and cause hoof microcirculation disorders.

Objective: The hepatic arterial buffer response is a well-known phenomenon in hepatic circulation, describing the response of hepatic arterial resistance to changes in portal vein flow. Several vasoactive metabolites underlying its mechanism have been proposed, however, there is currently no clear consensus. The aim of this study is to investigate the hepatic arterial buffer response of porcine livers preserved in a controlled ex vivo perfusion machine. Methods: Porcine livers are perfused on an ex vivo perfusion machine and hemodynamic experiments investigating the hepatic arterial resistance response to portal vein flow and vena cava pressure variations are conducted. A simple hemodynamic model is developed to support the interpretation of the received measurements. Further, a mechanism is proposed that explains hepatic arterial resistance changes in response to vena cava pressure as myogenic and in response to portal vein flow as a combined washout and myogenic effect. Results: A clear correlation between hepatic sinusoidal pressure levels and hepatic arterial resistance is observed where an increase of approximately 4 mmHg of hepatic sinusoidal pressure level results in doubling of the hepatic arterial resistance. This relation is considered during the analysis of the portal vein flow variations resulting in a reduced isolated effect of adenosine washout on hepatic arterial resistance. With an average buffer capacity of 27% during our experiments, the hepatic arterial buffer response shows to be unimpaired in the ex vivo scenario. Conclusion: First, washout and myogenic effects both influence the hepatic arterial buffer response; and second, hepatic sinusoidal pressure levels strongly influence the hepatic arterial resistance. Significance: These results present new findings in hemodynamics of the liver, which are fundamental for successful ex vivo liver perfusion.