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The lymphatic system is an important part of the circulatory system, as an auxiliary system of the vein, which has the functions of immune defense, maintaining the stability of the internal environment, and regulating the pressure of the tissue. It has long been thought that there are no typical lymphatic vessels consisting of endothelial cells in the central nervous system (CNS). In recent years, studies have confirmed the presence of lymphatic vessels lined with endothelial cells in the meninges. The periventricular meninges of the CNS host different populations of immune cells that affect the immune response associated with the CNS, and the continuous drainage of interstitial and cerebrospinal fluid produced in the CNS also proceeds mainly by the lymphatic system. This fluid process mobilizes to a large extent the transfer of antigens produced by the CNS to the meningeal immune cells and subsequently to the peripheral immune system through the lymphatic network, with clinically important implications for infectious diseases, autoimmunity, and tumor immunology. In our review, we discussed recent research advances in intracranial lymphatic circulation and the pathogenesis of its associated diseases, especially the discovery of meningeal lymphatic vessels, which has led to new therapeutic targets for the treatment of diseases associated with the intracranial lymphatic system. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy of modified rotation skin flap with similar shape in the repair of skin defects caused by trauma, bedsore and tumor resection. Methods From March 2014 to May 2019, 27 patients with skin defects caused by trauma of the head and face, bedsore, pigmented nevus and tumor resection were repaired by modified rotation skin flap with similar shape. After the pathological tissue was completely excised during the operation, the modified rotation skin flap with similar shape was designed to repair the wounds at suitable layer after sufficient free tissue was formed. Results No blood circulation disorder was found in all patients after operation. The flaps survived and the incisions healed by first intention. No obvious local deformation was found and patients were satisfied with the efficacy. Conclusion The modified rotation skin flap with similar shape has the advantages of high survival rate of skin flap, complete local physiological curvature, short length of scar, low local tension, concealed scar and good efficacy of repair. [ABSTRACT FROM AUTHOR]

We studied sex-related features of the microcirculation response of symmetrical areas of the human head to hypoxic loads. In 20 healthy volunteers (10 male and 10 female), short-term hypoxia was modeled using the ReOxy Cardio device (S. A. Aimediq). Microcirculation parameters were synchronously measured by laser Doppler flowmetry in the initial state and immediately after short-term hypoxic exposure. 3D graphs were constructed and regression equations were formulated that describe the relationships between changes in microcirculation on both sides of the measurement. Using a new method of geometric zoning, it was shown that the direction of reactions to hypoxia of the left microcirculatory bed is opposite in subjects of different sexes. In 80% male subjects, hypoxia led to an increase in perfusion on the left, in 20% — to a decrease. In female subjects, the picture was opposite: perfusion decreased in 90% and increased in 10% subjects. It can be assumed that these differences in the reactions of microcirculation to hypoxia in men and women are an additional confirmation of different structural and functional organization of the male and female brain, which leads to different resistance of males and females to external disturbing influences. The results of the study can be used in medical practice to develop methods for personalized assessments of circulatory disorders and differentiated approaches to the treatment of men and women with cardiovascular diseases. [ABSTRACT FROM AUTHOR]

The article presents the discussion on Evolutionary anthropologist Herman Pontzer busting myths about humans burning calories. Topics include energy budget supporting the traits involving trade-offs trying to unravel, between energy spent on exercise, reproduction, stress, illness, and vital functions; and containing energy used for breathing, circulation, and other vital functions.

Venous system pathologies have increasingly been linked to clinically relevant disorders of CSF circulation whereas the exact coupling mechanisms still remain unknown. In this work, flow dynamics of both systems were studied using real-time phase-contrast flow MRI in 16 healthy subjects during normal and forced breathing. Flow evaluations in the aqueduct, at cervical level C3 and lumbar level L3 for both the CSF and venous fluid systems reveal temporal modulations by forced respiration. During normal breathing cardiac-related flow modulations prevailed, while forced breathing shifted the dominant frequency of both CSF and venous flow spectra towards the respiratory component and prompted a correlation between CSF and venous flow in the large vessels. The average of flow magnitude of CSF was increased during forced breathing at all spinal and intracranial positions. Venous flow in the large vessels of the upper body decreased and in the lower body increased during forced breathing. Deep respiration couples interdependent venous and brain fluid flow—most likely mediated by intrathoracic and intraabdominal pressure changes. Further insights into the driving forces of CSF and venous circulation and their correlation will facilitate our understanding how the venous system links to intracranial pressure regulation and of related forms of hydrocephalus. [ABSTRACT FROM AUTHOR]

Background: Cerebrospinal fluid (CSF) circulation in the brain has garnered considerable attention in recent times. In contrast, there have been fewer studies focused on the spine, despite the expected importance of CSF circulation in disorders specific to the spine, including syringomyelia. The driving forces that regulate spinal CSF flow are not well defined and are likely to be different to the brain given the anatomical differences and proximity to the heart and lungs. The aims of this study were to determine the effects of heart rate, blood pressure and respiration on the distribution of CSF tracers in the spinal subarachnoid space, as well as into the spinal cord interstitium. Methods: In Sprague Dawley rats, physiological parameters were manipulated such that the effects of spontaneous breathing (generating alternating positive and negative intrathoracic pressures), mechanical ventilation (positive intrathoracic pressure only), tachy/bradycardia, as well as hyper/hypotension were separately studied. To investigate spinal CSF hydrodynamics, in vivo near-infrared imaging of intracisternally infused indocyanine green was performed. CSF tracer transport was further characterised with in vivo two-photon intravital imaging. Tracer influx at a microscopic level was quantitatively characterised by ex vivo epifluorescence imaging of fluorescent ovalbumin. Results: Compared to mechanically ventilated controls, spontaneous breathing animals had significantly greater movement of tracer in the subarachnoid space. There was also greater influx into the spinal cord interstitium. Hypertension and tachycardia had no significant effect on spinal subarachnoid spinal CSF tracer flux and exerted less effect than respiration on tracer influx into the spinal cord. Conclusions: Intrathoracic pressure changes that occur over the respiratory cycle, particularly decreased intrathoracic pressures generated during inspiration, have a profound effect on tracer movement after injection into spinal CSF and increase cord parenchymal tracer influx. Arterial pulsations likely drive fluid transport from perivascular spaces into the surrounding interstitium, but their overall impact is less than that of the respiratory cycle on net tracer influx. [ABSTRACT FROM AUTHOR]

Hemispherotomies represent a major part of surgical interventions for epilepsy in childhood (16–21%). The anatomical resection has been replaced by minimally invasive disconnection techniques with lower perioperative mortality and fewer postoperative complications. Today the procedure is not only carried out from the lateral aspect via the Sylvian fissure/insula but also via a vertical parasagittal approach. Depending on the publication, hemispherotomy leads to freedom from postoperative seizures in 60–90% of patients. Despite changes in the surgical technique, disturbances of the cerebrospinal fluid circulation continue to be the main complication in 5–15% of cases. Hemispheric epileptogenic lesions usually lead to early onset and difficult to treat epilepsy in childhood. These epilepsies are characterized by a high frequency of seizures and propagation of epileptic discharges to the healthy hemisphere. The aim of a hemispherotomy is, in addition to postoperative freedom from seizures, the complete disconnection of the affected hemisphere. When deciding on a hemispherotomy, the expected functional consequences play a major role in addition to epileptological aspects. In the case of deficits already present preoperatively (hemianopia, hemiparesis) or reorganization of functions in the contralesional hemisphere (language), no new deficits are to be expected from the operation. In terms of cognition, a hemispherotomy can improve function by releasing the neuroplastic potential of the healthy hemisphere. In order to keep the negative and often irreversible effects of epilepsy as low as possible and to be able to use as much potential for neuroplasticity of the healthy hemisphere as possible, surgery should be considered as early as possible. [ABSTRACT FROM AUTHOR]

Aggregation of red blood cells (RBC) is one of many factors that impair vascular circulation and is closely related to the zeta potential. Pulsed magnetic field (PMF) is effective in improving RBC aggregation and mobility. Therefore, this study aims to observe indirectly the change of RBC membrane charges using negatively charged magnetic beads (MBs) and to elucidate the effect of PMF on RBC aggregation via zeta potential. Since concentrations of hematocrit (Ht) and plasma are different for each person, in order to objectify the zeta potential, RBC suspension was prepared using phosphate buffered saline (PBS) which is a protein-free buffer and prevents RBC agglomerating. Tert-butyl hydroperoxide (tBHP) was also used to oxidize agents to understand RBC aggregation in an environment of tumor cells or inflammation. Our PMF stimulator has a maximum intensity of 0.27 T at a transition time of $102 \mu \text{s}$ with pulse intervals of 1 Hz. The number of RBCs attached to MB was higher in the PMF group than in the control group. In addition, in the oxidized blood, the number of RBCs attached to MB decreased compared to that of the control group, but it was increased after PMF treatment. In the PMF-treated group, a larger number of MBs attached to RBCs was also observed. Our results could be interpreted that the instantaneous flux change of PMF increases negative charge density on RBC membrane, thereby increasing zeta potential between RBCs, inducing disaggregation of RBCs, thus eventually contributing to the improvement of blood circulation. PMF suggests the possibility of being used as a noninvasive treatment for preventing blood circulation disorder. Further study needs to verify the effect of PMF on the changes in plasma concentration in patients with cardiovascular diseases such as atherosclerosis, thrombosis, and hypertension. [ABSTRACT FROM AUTHOR]

Hydrocephalus is a neurological condition due to the aberrant circulation and/or obstruction of cerebrospinal fluid (CSF) flow with consequent enlargement of cerebral ventricular cavities. However, it is noticed that a lot of patients may still go through symptomatic progression despite standard shunting procedures, suggesting that hydrocephalus is far more complicated than a simple CSF circulative/obstructive disorder. Growing evidence indicates that genetic factors play a fundamental role in the pathogenesis of some hydrocephalus. Although the genetic research of hydrocephalus in humans is limited, many genetic loci of hydrocephalus have been defined in animal models. In general, the molecular abnormalities involved in the pathogenesis of hydrocephalus include brain development and ependymal cell dysfunction, apoptosis, inflammation, free radical generation, blood flow, and cerebral metabolism. Moreover, recent studies have indicated that the molecular abnormalities relevant to aberrant cerebral glymphatic drainage turn into an attractive subject in the CSF circulation disorder. Furthermore, the prevalent risk factors could facilitate the development of hydrocephalus. In this review, we elicited some possible fundamental molecular mechanisms and facilitating risk factors involved in the pathogenesis of hydrocephalus, and aimed to widen the diagnosis and therapeutic strategies for hydrocephalus management. Such knowledge could be used to improve patient care in different ways, such as early precise diagnosis and effective therapeutic regimens. [ABSTRACT FROM AUTHOR]

Chronic atrophic polychondritis (PCA) is a rare, chronic and potentially serious connective tissue disease characterized by repeated episodes of inflammation of certain cartilaginous structures, mainly the nose, auricular pinna, larynx and tracheobronchial tree, associated with various manifestations articular, ocular, audiovestibular, cutaneous, cardiac and general systems. Ocular involvement, rarely revealing, is mainly represented by episcleritis and/or scleritis. We present a rare case of ocular involvement in PCA associated with rheumatoid arthritis. Observation A 59-year-old patient with a history of arterial hypertension and bilateral episcleritis of undetermined etiology was admitted to the ophthalmology department for a painful red eye with a decrease in visual acuity in both eyes evolving for 10 days. The ophthalmological examination revealed visual acuity of 0.1 LogMAR on the right and 0.4 LogMAR on the left, pseudoptosis on the right, diffuse bilateral conjunctival hyperaemia with dilation of the superficial and deep episcleral vessels. Examination of the posterior segment shows retinal folds at the macular level, more evident on the left. Ocular ultrasound shows bilateral scleral thickening. Optical coherence tomography showed a thickened hyperreflective choroid with an irregular pigment epithelium. In front of this table, the patient is referred to the internal medicine department for an etiological assessment of his scleritis. The patient also reports nasal obstruction with intermittent dysphonia, hypoacusis and progressively onset tinnitus, as well as inflammatory polyarthralgia of the large and small joints sparing the distal interphalangeal joints evolving for more than two years. The clinical examination finds a febrile patient at 38.7°C, with purplish-red, hot and painful swelling of the pavilion of both ears. Nasofibroscopy shows diffuse rhinitis; pure-tone audiometry revealed bilateral sensorineural hearing loss. The biological assessment shows an inflammatory syndrome. Rheumatoid factor is elevated at 145 IU/mL (10 N) and anti-citrullinated protein antibodies are positive, at 271 IU/mL. X-rays of the hands and feet show a geode of the inner cheek of the fifth metatarsal head bilaterally. The diagnosis retained is that of PCA, associated with rheumatoid arthritis (RA). Faced with the severity of the ocular involvement, the patient is put on a bolus of methylprednisolone three days in a row, at a dose of 15 mg/kg/d, relayed by oral corticosteroid therapy at 1 mg/kg/d, then on methotrexate as a disease-modifying treatment for RA. The evolution is marked by a clear improvement of the cartilage inflammation and a disappearance of the conjunctival hyperaemia; reassessment of RA activity shows disease in lull. The diagnosis retained is that of PCA, associated with rheumatoid arthritis (RA). Faced with the severity of the ocular involvement, the patient is put on a bolus of methylprednisolone three days in a row, at a dose of 15 mg/kg/d, relayed by oral corticosteroid therapy at 1 mg/kg/d, then on methotrexate as a disease-modifying treatment for RA. The evolution is marked by a clear improvement of the cartilage inflammation and a disappearance of the conjunctival hyperaemia; reassessment of RA activity shows disease in lull. The diagnosis retained is that of PCA, associated with rheumatoid arthritis (RA). Faced with the severity of the ocular involvement, the patient is put on a bolus of methylprednisolone three days in a row, at a dose of 15 mg/kg/d, relayed by oral corticosteroid therapy at 1 mg/kg/d, then on methotrexate as a disease-modifying treatment for RA. The evolution is marked by a clear improvement of the cartilage inflammation and a disappearance of the conjunctival hyperaemia; reassessment of RA activity shows disease in lull. The evolution is marked by a clear improvement of the cartilage inflammation and a disappearance of the conjunctival hyperaemia; reassessment of RA activity shows disease in lull. The evolution is marked by a clear improvement of the cartilage inflammation and a disappearance of the conjunctival hyperaemia; reassessment of RA activity shows disease in lull. Conclusion ocular involvement is usual during the evolution of PCA, it can be inaugural as evidenced by this observation. [ABSTRACT FROM AUTHOR]

In 2006, the induced pluripotent stem cell (iPSC) was presented to the world, paving the way for the development of a magnitude of novel therapeutic alternatives, addressing a diverse range of diseases. However, despite the immense cell therapy potential, relatively few clinical trials evaluating iPSC-technology have actually translated into interventional, clinically applied treatment regimens. Herein, our aim was to determine trends in globally conducted clinical trials involving iPSCs. Data were derived both from well-known registries recording clinical trials from across the globe, and databases from individual countries. Comparisons were firstly drawn between observational and interventional studies before the latter was further analyzed in terms of therapeutic and nontherapeutic trials. Our main observations included global distribution, purpose, target size, and types of disorder relevant to evaluated trials. In terms of nontherapeutic trials, the USA conducted the majority, a large average number of participants—187—was included in the trials, and studies on circulatory system disorders comprised a slightly higher proportion of total studies. Conversely, Japan was the frontrunner in terms of conducting therapeutic trials, and the average number of participants was much lower, at roughly 29. Disorders of the circulatory, as well as nervous and visual systems, were all studied in equal measure. This review highlights the impact that iPSC-based cell therapies can have, should development thereof gain more traction. We lastly considered a few companies that are actively utilizing iPSCs in the development of therapies for various diseases, for whom the global trends in clinical trials could become increasingly important. [ABSTRACT FROM AUTHOR]

Background and purpose: Accurate epidemiological information is essential for the improved understanding of dystonia syndromes, as well as better provisioning of clinical services and providing context for diagnostic decision‐making. Here, we determine epidemiological, social deprivation, and mortality characteristics of adult‐onset idiopathic dystonia in the Welsh population. Methods: A retrospective population‐based cohort study using anonymized electronic health care data in Wales was conducted to identify individuals with dystonia between 1 January 1994 and 31 December 2017. We developed a case‐ascertainment algorithm to determine dystonia incidence and prevalence, as well as characterization of the dystonia cohort, based on social deprivation and mortality. Results: The case‐ascertainment algorithm (79% sensitivity) identified 54,966 cases; of these cases, 41,660 had adult‐onset idiopathic dystonia (≥20 years). Amongst the adult‐onset form, the median age at diagnosis was 41 years, with males significantly older at time of diagnosis compared to females. Prevalence rates ranged from 0.02% in 1994 to 1.2% in 2017. The average annual incidence was 87.7/100,000/year, increasing from 49.9/100,000/year (1994) to 96.21/100,000/year (2017). In 2017, people with dystonia had a similar life expectancy to the Welsh population. Conclusions: We have developed a case‐ascertainment algorithm, supported by the introduction of a neurologist‐reviewed validation cohort, providing a platform for future population‐based dystonia studies. We have established robust population‐level prevalence and incidence values for adult‐onset idiopathic forms of dystonia, with this reflecting increasing clinical recognition and identification of causal genes. Underlying causes of death mirrored those of the general population, including circulatory disorders, respiratory disorders, cancers, and dementia. [ABSTRACT FROM AUTHOR]

Acute mesenteric circulatory disorder belongs to the most serious diseases of the abdominal cavity. Being an emergency condition, it is associated with high mortality. Coronavirus infection is an anthroponotic disease in the group of acute respiratory infections, is characterized by damage to the upper respiratory tract, severe intoxication, coagulopathy and in severe cases - multiple organ failure. The aim of the work was to analyze the results of the surgical treatment of mesenteric vascular thrombosis in patients with COVID-19. We have studied the results of diagnostics and treatment of 13 patients (9 males and 4 females) with acute mesenteric thrombosis and COVID-19. We have analyzed patients’ complaints and the clinical picture of the disease, as well as performed general medical examination (routine blood and urine tests, biochemical parameters, coagulogram), X-ray examination of abdominal and thoracic cavities, computed tomography / angiography of abdominal organs, diagnostic laparoscopy, diagnostic mini-laparotomy and laparotomy. The symptoms of the disease include nausea, vomiting, abdominal pain, diarrhea, fever, cough, shortness of breath and belching. The disease was diagnosed by contrast computed tomography. Four patients developed simultaneous thrombosis – stroke, thrombosis of the portal and mesenteric veins, splenic and renal infarction, thrombosis of the superior mesenteric and portal veins. Six patients have been suffering from underlying health conditions, 7 patients – had none. Ten patients underwent surgery (laparotomy with resection of the nonviable intestine), 3 – received conservative treatment (heparin therapy). Six patients died (4 out of 10 – during surgery and 2 out of 3 – during conservative treatment). Postoperative mortality was 40%. [ABSTRACT FROM AUTHOR]

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Possible changes in the morphology of the gills and liver of P. corruscans after exposure to TCF were evaluated. The fish were distributed into five groups in triplicate (n = 10 in each group: 0.0; 0.125; 0.25; 0.5; 1.0 mg/L of the commercial product NEGUVON®, for 96 h. TCF induced a high histopathological index associated with circulatory disorders (congestion and aneurysm), as well as progressive changes (lamellar hyperplasia, capillary dilation, epithelial detachment and edema) at the highest concentrations (0.25; 0.5 and 1.0 mg/L). In addition to the histopathological disturbances, there was an increase in the levels of neutral glycoproteins and alterations in the histomorphometry of the secondary lamellae (total height, apical region, median, basal and interlamellar) at the highest concentrations. In the liver, the alterations were more intensified, in addition to circulatory (congestion) and regressive disturbances (loss of hepatocyte architecture and accumulation of intracellular substances), progressive alterations (focal necrosis) were observed, indicating a high degree of hepatic tissue involvement. The results indicate that the use of TCF concentrations above 0.25 mg/L promotes histopathological, histomorphometric and histochemical changes in the gills and liver of P. corruscans, imposing a biological risk that affects the aquatic environment and the health of fish. [ABSTRACT FROM AUTHOR]

Introduction: Hyperbaric oxygen (HBO) exposure for 10-15 min has been shown to reduce peripheral blood flow due to vasoconstriction. However, the relationship between decreased peripheral blood flow and the therapeutic effects of HBO treatment on peripheral circulatory disorders remain unknown. Longer exposures have been reported to have vasodilatory effects and increase peripheral blood flow. This study investigated the effect of HBO treatment on blood flow and transcutaneous oxygen pressure (TcPO2). Methods: Twenty healthy volunteers aged 20--65 years (nine males) participated in this study. All participants breathed oxygen for 60 min at 253.3 kPa. Peripheral blood flow using laser Doppler flowmetry and TcPO2 on the ear, hand, and foot were continuously measured from pre-HBO exposure to 10 min post-exposure. Results: Peripheral blood flow in each body part decreased by 7--23% at the beginning of the HBO exposure, followed by a slow increase. Post-exposure, peripheral blood flow increased 4--76% in each body part. TcPO2 increased by 840-1,513% during the exposure period, and remained elevated for at least 10 min after the exposure. Conclusions: The findings of the current study suggest vasoconstriction during HBO treatment is transient, and even when present does not inhibit the development of increased tissue oxygen partial pressure. These findings are relevant to studies investigating changes in peripheral blood flow during HBO treatment in patients with circulatory disorders. [ABSTRACT FROM AUTHOR]

Objective: To investigate the etiology, clinical manifestations, diagnosis, treatment and prognosis of neonatal cerebral infarction (NCI) to further improve the understanding of the disease. Methods: Clinical data and follow-up results of 33 cases of NCI in neonatal intensive care unit of a firstclass hospital from September 2009 to September 2019 were retrospectively analyzed. Results: All 33 patients were diagnosed with NCI by MRI. Among them, 31 cases (93.94%) were fullterm infants, 25 cases (75.76%) were mother's first birth, and 18 (54.55%) cases were males. Pregnancy complications were reported in 18 cases (54.55%), and 19 cases (57.58%) had perinatal hypoxia history. Seizures were the most common first symptom and clinical manifestation in the course of disease (81.8%). There were 27 cases (81.82%) of patent foramen ovale (PFO) among NCI cohort. Ischemic cerebral infarction occurred in 32 cases (96.97%). The middle cerebral artery and its branches were more frequently involved, mainly on the left side. The acute stage of NCI was managed by symptomatic support treatment, and the recovery stage involved mainly rehabilitation treatment. Among the 33 cases, five cases were lost to follow-up, two patients died, 26 patients survived without complications, one case had cerebral palsy, one case had language retardation, and six cases had dyskinesia. Poor prognosis was associated with the involvement of deep gray matter nuclei or multiple lobes, and intrapartum complications. Vaginal mode of delivery and longer hospital stay were associated with better prognosis. Conclusions: Complications leading to placental circulation disorder during pregnancy and perinatal hypoxia are common high-risk factors of NCI. The seizure is the most common clinical manifestation. There is a possible correlation between PFO and NCI. Involvement of deep gray matter or multiple lobes and intrapartum complications may indicate poor prognosis, while vaginal delivery and prolonged hospitalizations are associated with better prognosis of NCI. [ABSTRACT FROM AUTHOR]

An increase in the level of endotoxin (bacterial lipopolysaccharide, LPS) leads to hypercytokinemia and the development of a systemic inflammatory response, which is accompanied by circulatory disorders. According to modern concepts, the circulation is controlled by the brain–heart axis, the highest level of which is represented by the infralimbic cortex (IL). The major reflex mechanism that regulates the level of arterial pressure (AP) is baroreflex. The aim of this study was to test the hypothesis that impaired nervous control is one of the factors contributing to circulatory disorders in endotoxemia. In acute experiments on Wistar rats, AP was recorded in the femoral artery, baroreflex sensitivity (BRS) was tested by intravenous administration of phenylephrine, and IL was exposed to microelectrostimulation. LPS administration to experimental animals (n = 10) caused an initial increase and subsequent decline in the mean AP, as well as a gradual increase in heart rate (HR), compared to the respective values before LPS administration and in the control group (n = 11). It was found that LPS administration entailed the attenuation of BRS and suppression of depressor responses to IL stimulation. These results indicate a possible weakening of cortical and reflex control of circulation in endotoxemia. They also confirm the above hypothesis, suggesting that changes in the level of proinflammatory cytokines have a modulatory effect on the state of the brain–heart axis and reflex mechanisms of cardiovascular control. [ABSTRACT FROM AUTHOR]

Objective: To determine the incidence and risk factors for developing proliferative diabetic retinopathy (PDR), tractional retinal detachment (TRD), and neovascular glaucoma (NVG) at 5 years after the initial diagnosis of type 2 diabetes.Research Design and Methods: Insured patients aged ≥18 years with newly diagnosed type 2 diabetes and 5 years of continuous enrollment were identified from a nationwide commercial claims database containing data from 2007 to 2015. The incidences of PDR, TRD, and NVG were computed at 5 years following the index diagnosis of type 2 diabetes. Associations between these outcomes and demographic, socioeconomic, and medical factors were tested with multivariable logistic regression.Results: At 5 years following the initial diagnosis of type 2 diabetes, 1.74% (1,249 of 71,817) of patients had developed PDR, 0.25% of patients had developed TRD, and 0.14% of patients had developed NVG. Insulin use (odds ratio [OR] 3.59, 95% CI 3.16-4.08), maximum HbA1c >9% or >75 mmol/mol (OR 2.10, 95% CI 1.54-2.69), renal disease (OR 2.68, 95% CI 2.09-3.42), peripheral circulatory disorders (OR 1.88, 95% CI 1.25-2.83), neurological disease (OR 1.62, 95% CI 1.24-2.11), and older age (age 65-74 years) at diagnosis (OR 1.62, 95% CI 1.28-2.03) were identified as risk factors for development of PDR at 5 years. Young age (age 18-23 years) at diagnosis (OR 0.46, 95% CI 0.29-0.74), Medicare insurance (OR 0.60, 95% CI 0.70-0.76), morbid obesity (OR 0.72, 95% CI 0.59-0.87), and smoking (OR 0.84, 95% CI 0.70-1.00) were identified as protective factors.Conclusions: A subset of patients with type 2 diabetes develop PDR and other neovascular sequelae within the first 5 years following the diagnosis with type 2 diabetes. These patients may benefit from increased efforts for screening and early intervention. [ABSTRACT FROM AUTHOR]

The cause of idiopathic sudden sensorineural hearing loss (idiopathic SSNHL)—diagnosed after excluding other causes of hearing loss, such as SSNHL associated with vestibular schwannoma (VS)—is unknown. The presumed pathogenesis of idiopathic SSNHL includes circulatory disorders (e.g., cochlear infarction). We tested the hypothesis that patients with SSNHL who are at high stroke risk will have a lower rate of VS compared to those with low stroke risk. The rationale is that the primary cause of SSNHL in patients with high stroke risk might be a circulatory disturbance. We conducted a retrospective study in six hospitals. Our sampling of SSNHL patients included those diagnosed with idiopathic SSNHL and VS-associated SSNHL. SSNHL patients who had a head MRI were stratified by severity of hearing loss and evaluated for differences in the detection rate of VS between the high-scoring CHADS2 (CHADS2-H-), an index of stroke risk, and low-scoring CHADS2 (CHADS2-L-) groups. We identified 916 patients who met the inclusion criteria. For severe hearing loss, the CHADS2-H group had a significantly lower rate of VS than the CHADS2-L group (OR 0 [95% CI 0.00–0.612]; P = 0.007). These results indirectly support the hypothesis that a primary cause of severe idiopathic SSNHL in those at high risk of stroke might be a circulatory disorder. [ABSTRACT FROM AUTHOR]

Background and objectives: Blood vessel thrombosis causes blood circulation disorders, leading to various diseases. Currently, various antiplatelet and anticoagulant drugs, such as aspirin, warfarin, heparin, and non-vitamin K antagonist oral anticoagulants (NOACs), are used as the major drugs for the treatment of a wide range of thrombosis. However, these drugs have a side effect of possibly causing internal bleeding due to poor hemostasis when taken for a long period of time. Materials and Methods: Gastrodia elata Blume (GE) and Zanthoxylum schinifolium Siebold & Zucc (ZS) are known to exhibit hemostatic and antiplatelet effects as traditional medicines that have been used for a long time. In this study, we investigated the effect of a mixed extract of GE and ZS (MJGE09) on platelet aggregation and plasma coagulation. Results: We found that MJGE09 inhibited collagen-and ADP-induced platelet aggregation in vitro. In addition, collagen- and ADP-induced platelet aggregation were also inhibited in a dose-dependent manner on the platelets of mice that were orally administered MJGE09 ex vivo. However, compared with aspirin, MJGE09 did not prolong the rat tail vein bleeding time in vivo and did not show a significant effect on the increase in the prothrombin time (PT) and activated partial thromboplastin time (aPTT). Conclusions: These results suggest that MJGE09 can be used as a potential anticoagulant with improved antithrombotic efficacy. [ABSTRACT FROM AUTHOR]

Extremities are prone to trauma because they are projections of the body. In closed injuries, there is usually no need for an immediate final surgery. The exception is the presence of a circulatory disorder that will cause the loss of a limb. If there is bleeding, the priority in treatment should be to stop it. Compression should be applied to stop bleeding, and the affected extremity should be elevated above the level of the heart. While copious irrigation, primary closure, and splint can be applied, if primary closure is not possible, it would be appropriate to apply a splint after sterile dressing with moist absorbent gauze. In case of amputations, it is appropriate to wrap the amputate in a gauze moistened with saline, which is important in the transfer of the amputate, and then put it in a waterproof bag and place it in another bag in ice water in the ice bag. [ABSTRACT FROM AUTHOR]

Relevance. Circulatory disorders in the vertebrobasilar pool (VBP) are widespread and account for 25-30% in the structure of all cerebrovascular disorders. One of the promising methods for the treatment of vertebrobasilar insufficiency (VBI), in particular in hemodynamically significant stenoses, is stenting of the vertebral arteries. Purpose: to study the results of various methods of treating patients with clinical manifestations of vertebrobasilar insufficiency. Material and methods. The results of treatment of 78 (100%) patients with VBI syndrome who were hospitalized at the Republican Specialized Center for Surgical Angioneurology from 2021 to 2023 were analyzed. All patients depending on the tactics of treatment were divided into 3 groups. group 1 - 30 (38.5%) patients who underwent stenting of the 1st segment of the vertebral artery, group 2 - 28 (35.9%) patients who underwent carotid endarterectomy as a treatment method, group 3 - 20 (25.6%) of patients who received conservative treatment. Patients of the 3 groups were comparable in terms of sex and age. All these patients had hemodynamically significant stenoses (more than 65%) in segment I of the vertebral and carotid arteries. Of these, signs of chronic dyscirculation in the VBP were identified in 24 patients (31%), transient ischemic attacks in the VBP were observed in 19 patients (24%), and in 35 patients (45%) a history of ischemic stroke in the VBP was verified. If a hemodynamically significant lesion of the carotid arteries (more than 70% stenosis) and preserved blood flow in the ipsilateral posterior communicating artery were detected, the patients underwent carotid reconstructions of the carotid arteries. Results: The follow-up period averaged 24.6±8.8 months (from 6 months to 2 years). After conservative therapy, 15 (76%) patients showed clinical improvement - regression of VBI symptoms, disappearance of dizziness and unsteadiness when walking, but after 4-6 months these symptoms reappeared. In 5 (24%) patients, no clinical improvement was found after conservative therapy. Among 28 patients who underwent carotid reconstruction of the carotid artery, a clinical improvement in symptoms and velocity parameters of blood flow through the posterior communicating artery was observed in 24 (86%) patients. The rest 4 (14%) patients of this group showed no changes in the VBI clinic. Among patients who underwent stenting of segment I of the vertebral arteries, in 27 (91%) cases, a persistent clinical improvement was observed, manifested in a decrease or disappearance of the VBI clinic during the follow-up. In 3 (9%) patients after X-ray endovascular intervention, no significant clinical improvement was found, although with TCDS they had an increase in the blood flow velocity in the basilar artery. Conclusions: 1. When determining the indications for carotid reconstruction in patients with VBI, the conditions of the circle of Willis should be taken into account. [ABSTRACT FROM AUTHOR]